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PubMed2001

Long-run convergence of ethnic skill differentials, revisited.

In my original study, "Long-Run Convergence of Ethnic Skill Differentials," I concluded that the ethnic differentials introduced by the Great Migration seemed to persist into the second and third generations. Alba, Lutz, and Vesselinov argue that my study contained a number of conceptual and data problems, and conclude that the correlation between the skills of the first and the third generations disappears when these problems are taken into account. My reanalysis of the Alba et al. data, however, documents a stronger link between the skills of the first and the third generations than suggested by those authors.

Educational Status↗
PubMed2005

Contribution of hip strength indices to hip fracture risk in elderly men and women.

UNLABELLED: In this prospective, case-control study, femoral neck diameter, cross-sectional moment of inertia, or section modulus was an independent predictor of hip fracture risk after adjustment for BMD. However, the contribution of each of these indices to hip fracture prediction was modest in the presence of BMD. INTRODUCTION: The relative contribution of measures of hip strength to hip fracture prediction is unclear. This study was designed to characterize the association between hip strength indices and hip fracture risk in relation to BMD in elderly men and women. MATERIALS AND METHODS: Seventy-one women and 25 men>or=60 years of age, who sustained a hip fracture during the study period of 1989-2003, were selected from the prospective, population-based Dubbo Osteoporosis Epidemiology Study. These fracture cases were randomly matched for age and sex in a 1:2 ratio with nonfracture individuals. BMD at the femoral neck was measured before the fracture event by DXA (Lunar DPX-L). Hip strength indices, including femoral neck diameter (FND), cross-sectional moment of inertia (CSMI), and section modulus (Z), were estimated by reanalysis of the image files using hip strength analysis software. RESULTS: In women, after adjustment for BMD, increased risk of hip fracture was associated with smaller FND (OR, 1.6; 95% CI, 1.0, 2.7), lower CSMI (OR, 1.8; 95% CI, 1.0, 3.2), or Z (OR, 1.6; 95% CI, 1.1, 5.1). In men, none of these hip strength indices were significant predictors of fracture risk. However, using the results in women as a prior distribution, it was estimated that the BMD-adjusted OR for FND (OR, 1.5; 95% CI, 1.0, 2.3), CSMI (OR, 1.6; 95% CI, 1.0, 2.5), or Z (OR, 2.3; 95% CI, 1.4, 3.9) was each significantly associated with hip fracture risk in men. In the logistic regression model, BMD alone accounted for 32% and 16% of the variance of fracture liability in women and men, respectively. The addition of FND, CSMI, or Z to the model increased the respective variance proportion to 34% and 19%. CONCLUSIONS: These data suggest that smaller FND and lower CSMI or Z is an independent risk factor for hip fracture in both women and men. However, the contribution of these measures to hip fracture prediction over and above BMD is likely modest.

Aged↗
PubMed2006

Prediction of hip fracture risk by quantitative ultrasound in more than 7000 Swiss women > or =70 years of age: comparison of three technologically different bone ultrasound devices in the SEMOF study.

UNLABELLED: To compare the prediction of hip fracture risk of several bone ultrasounds (QUS), 7062 Swiss women > or =70 years of age were measured with three QUSs (two of the heel, one of the phalanges). Heel QUSs were both predictive of hip fracture risk, whereas the phalanges QUS was not. INTRODUCTION: As the number of hip fracture is expected to increase during these next decades, it is important to develop strategies to detect subjects at risk. Quantitative bone ultrasound (QUS), an ionizing radiation-free method, which is transportable, could be interesting for this purpose. MATERIALS AND METHODS: The Swiss Evaluation of the Methods of Measurement of Osteoporotic Fracture Risk (SEMOF) study is a multicenter cohort study, which compared three QUSs for the assessment of hip fracture risk in a sample of 7609 elderly ambulatory women > or =70 years of age. Two QUSs measured the heel (Achilles+; GE-Lunar and Sahara; Hologic), and one measured the heel (DBM Sonic 1200; IGEA). The Cox proportional hazards regression was used to estimate the hazard of the first hip fracture, adjusted for age, BMI, and center, and the area under the ROC curves were calculated to compare the devices and their parameters. RESULTS: From the 7609 women who were included in the study, 7062 women 75.2 +/- 3.1 (SD) years of age were prospectively followed for 2.9 +/- 0.8 years. Eighty women reported a hip fracture. A decrease by 1 SD of the QUS variables corresponded to an increase of the hip fracture risk from 2.3 (95% CI, 1.7, 3.1) to 2.6 (95% CI, 1.9, 3.4) for the three variables of Achilles+ and from 2.2 (95% CI, 1.7, 3.0) to 2.4 (95% CI, 1.8, 3.2) for the three variables of Sahara. Risk gradients did not differ significantly among the variables of the two heel QUS devices. On the other hand, the phalanges QUS (DBM Sonic 1200) was not predictive of hip fracture risk, with an adjusted hazard risk of 1.2 (95% CI, 0.9, 1.5), even after reanalysis of the digitalized data and using different cut-off levels (1700 or 1570 m/s). CONCLUSIONS: In this elderly women population, heel QUS devices were both predictive of hip fracture risk, whereas the phalanges QUS device was not.

Aged↗
PubMed1997

Anomalies in the measurement of changes in total-body bone mineral by dual-energy X-ray absorptiometry during weight change.

For an eating disorder study over a period of 1 year, we measured total-body bone mineral using a Hologic QDR 1000 W in a total of 157 subjects and observed anomalies that questioned the accuracy of such measurements. Using the recommended Enhanced software, a change in total bone mineral content (delta BMC) correlated positively with a change in weight (delta W; r = 0.66), but a loss of weight was associated with an increase in bone mineral areal density (BMD; r = 0.58), arising from a reduction in bone area (AREA). Both regressions were highly significant. The dominant factor in this relationship was a strong correlation between delta AREA and delta BMC, for all parts of the skeleton, r > 0.9, with a slope close to 1. This is implausible because bone area would not be expected to change. When Standard software was used, the slope of the delta BMC/delta W correlation was steeper, but the delta BMD/delta W regression became positive. An artefact of dual-energy X-ray absorptiometry processing was suspected, and phantom measurements were made. The phantom consisted of tissue-equivalent hardboard cut and stacked to form cylinders corresponding to the head, trunk, arms, and legs of a standard man. The skeleton was constructed from layers of aluminium sheet as an approximation of the average shape, BMD, BMC, and AREA in each region. When aluminium thickness was varied, BMD thresholds were found, approximately 0.4 g/cm2 for the legs and 0.2 g/cm2 for the arms. Above these, bone area rose fairly rapidly toward a plateau. At higher skeletal densities, the relationships between measured and true BMDs were close to linear, but slopes were less than unity, so that changes would be underestimated by 10-30%. Increases of thickness of the soft tissue of the phantom lowered AREA slightly. Uniform fat proportion increases led to decreases in BMC and AREA, but lard wrapped in an annulus around the limbs led to spurious increases in BMC and AREA of a similar magnitude to those observed in vivo, while BMD fell slightly, although there had been no true change of bone variables. Similar results were obtained with lard around the limbs of a volunteer. Reanalysis of phantom scans using Standard software confirmed the software differences noted in vivo. The phantom measurements offer an explanation of the anomaly in vivo and demonstrate that, under different circumstances, change in both BMC and BMD can be wrongly recorded. We believe that no valid conclusions can be drawn from measurements by the Holgic QDR 1000 W of bone changes during weight change.

Absorptiometry, Photon↗
PubMed1997

Universal standardization of bone density measurements: a method with optimal properties for calibration among several instruments.

The International Dual-Photon X-Ray Absorptiometry (DXA) Standardization Committee (IDSC) conducted a cross-calibration study among three models of DXA machines from three different manufacturers. In that study, 100 subjects were scanned on all three machines. A set of equations were derived to convert bone mineral density (BMD) on each machine to a "standardized BMD" (sBMD) such that sBMD from the same subject derived from different machines would be approximately the same. In a reanalysis of the cross-calibration data, we showed that the conversion method used in the IDSC study did not achieve several optimal properties desirable in such conversions. We derived new conversion equations to sBMD based on minimizing differences among sBMD from the three machines. More important is that the new conversions have no residual bias that was present in the IDSC conversions. The performance of the methods were compared on the cross-calibration data as well as an external data set. We conclude that the IDSC conversions are adequate for clinical use on other machines worldwide, but that researchers should standardize their own machines in a laboratory using the new method.

Absorptiometry, Photon↗
PubMed1998

Evaluation of low density spine software for the assessment of bone mineral density in children.

Pediatric dual-energy X-ray absorptiometry spine scans often cannot be analyzed with standard software due to a failure to identify the bone edges of low density vertebrae. Low density spine (LDS) software improves bone detection compared with standard software. The objective of this study was to compare bone mineral density (BMD) measurements obtained with the standard and LDS software in 27 healthy nonobese, 32 obese, and 41 chronically ill children, ages 2-18 years. Lumbar spine (L1-L4) BMD, measured by standard analysis, ranged from 0.531-1.244 gm/cm2. Reanalysis with the LDS software resulted in a systematic increase (mean +/- SD) in estimated bone area of 17.0+/-5.0%, an increase in bone mineral content of 6.1+/-6.3%, and a mean decrease in BMD of 8.7+/-1.7% (all p < 0.001). This resulted in a mean decrease in BMD Z score of 0.7+/-0.2. Linear regression models, predicting standard BMD from LDS BMD, were fit for the three subject groups (R2 = 0.993-0.995). Small differences in slopes were detected across groups (p = 0.07); LDS BMD predicted higher standard BMD in obese subjects. In conclusion, LDS analysis resulted in a clinically significant decrease in measured BMD. The association between analysis methods was exceptionally high (R2 > 0.99), indicating that LDS BMD accurately predicts standard BMD. Although LDS BMD in obese subjects predicts higher standard BMD results than in nonobese subjects, the small difference is of questionable clinical significance. LDS software is a useful tool for the assessment of BMD in children.

Absorptiometry, Photon↗
PubMed2003

A single nucleotide polymorphism under the reverse primer binding site may lead to BsmI mis-genotyping in the vitamin D receptor gene.

UNLABELLED: The BsmI polymorphism in the VDR gene has been extensively investigated by PCR and restriction digestion in bone genetics. A SNP within the corresponding region for the previously published reverse primer was observed and confirmed by DNA sequencing. BsmI mis-genotyping caused by this SNP could confound genetic findings. INTRODUCTION: By analyzing the FokI, BsmI, ApaI, and TaqI polymorphisms in the vitamin D receptor (VDR) gene, we observed a significantly different genotype distribution in the BsmI polymorphic locus with a deviation from Hardy-Weinberg equilibrium. One of the reasons for polymerase chain reaction (PCR) non-amplification may be a mismatched base at the primer binding region. Therefore, the aim of this study was to analyse whether a single nucleotide polymorphism (SNP), which has been recently described as TruI, is responsible for the discrepancy between expected and observed genotype frequencies. MATERIALS AND METHODS: The VDR genotypes were identified in a cohort of 165 peri- and postmenopausal women of white origin. PCR amplification was carried out using the originally published primers and followed by restriction cleavage. The BsmI genotypes were further verified with a reverse primer external to the original binding site. The presence of the TruI polymorphism under the previously published reverse primer was confirmed by a restriction digestion and DNA sequencing. In Bb subjects, the colocalization of b allele with the TruI restriction site on the same chromosome was confirmed by a simultaneous digestion of the PCR product with both BsmI and TruI restriction enzymes. RESULTS: The BsmI reanalysis with an external primer provided a higher number of heterozygous subjects with a proportionally smaller number of BB subjects, and the changed genotype distribution was under Hardy-Weinberg equilibrium (BB, 31; Bb, 80; bb, 54; r = 0.0203; p = 0.90). In our primary analysis, the presence of the TruI polymorphism led to a drop out of b allele during PCR amplification and thus to the false prevalence of BB genotypes (BB, 50; Bb, 61; bb, 54; r = 11.17; p = 0.01). CONCLUSION: The SNP in the region corresponding to the reverse primer may lead to BsmI mis-genotyping, which may have confounded some previous genetic studies.

Alleles↗
PubMed2004

Evaluation of seeing-induced cross talk in tip-tilt-corrected solar polarimetry.

We reanalyze the effects of atmosphere-induced image motions on the measurement of solar polarized light using a formalism developed by Lites. Our reanalysis is prompted by the advent of adaptive optics (AO) systems that reduce image motion and higher-order aberrations, by the availability of liquid crystals as modulation devices, and by the need to understand how best to design polarimeters for future telescopes such as the Advanced Technology Solar Telescope. In this first attempt to understand the major issues, we analyze the influence of residual image motion (tip-tilt) corrections of operational AO systems on the cross talk between Stokes parameters and present results for several polarization analysis schemes. Higher-order wave-front corrections are left for future research. We also restrict our discussion to the solar photosphere, which limits several important parameters of interest, using some recent magnetoconvection simulations.

Journal Article↗
PubMed2001

Three-systems theory of human visual motion perception: review and update.

Lu and Sperling [Vision Res. 35, 2697 (1995)] proposed that human visual motion perception is served by three separate motion systems: a first-order system that responds to moving luminance patterns, a second-order system that responds to moving modulations of feature types-stimuli in which the expected luminance is the same everywhere but an area of higher contrast or of flicker moves, and a third-order system that computes the motion of marked locations in a "salience map," that is, a neural representation of visual space in which the locations of important visual features ("figure") are marked and "ground" is unmarked. Subsequently, there have been some strongly confirmatory reports: different gain-control mechanisms for first- and second-order motion, selective impairment of first- versus second- and/or third-order motion by different brain injuries, and the classification of new third-order motions, e.g., isoluminant chromatic motion. Various procedures have successfully discriminated between second- and third-order motion (when first-order motion is excluded): dual tasks, second-order reversed phi, motion competition, and selective adaptation. Meanwhile, eight apparent contradictions to the three-systems theory have been proposed. A review and reanalysis here of the new evidence, pro and con, resolves the challenges and yields a more clearly defined and significantly strengthened theory.

Contrast Sensitivity↗
PubMed1986

Evaluation of linear models of surface spectral reflectance with small numbers of parameters.

Recent computational models of color vision demonstrate that it is possible to achieve exact color constancy over a limited range of lights and surfaces described by linear models. The success of these computational models hinges on whether any sizable range of surface spectral reflectances can be described by a linear model with about three parameters. In the first part of this paper, I analyze two large sets of empirical surface spectral reflectances and examine three conjectures concerning constraints on surface reflectance: that empirical surface reflectances fall within a linear model with a small number of parameters, that empirical surface reflectances fall within a linear model composed of band-limited functions with a small number of parameters, and that the shape of the spectral-sensitivity curves of human vision enhance the fit between empirical surface reflectances and a linear model. I conclude that the first and second conjectures hold for the two sets of spectral reflectances analyzed but that the number of parameters required to model the spectral reflectances is five to seven, not three. A reanalysis of the empirical data that takes human visual sensitivity into account gives more promising results. The linear models derived provide excellent fits to the data with as few as three or four parameters, confirming the third conjecture. The results suggest that constraints on possible surface-reflectance functions and the "filtering" properties of the shapes of the spectral-sensitivity curves of photoreceptors can both contribute to color constancy. In the last part of the paper I derive the relation between the number of photoreceptor classes present in vision and the "filtering" properties of each class. The results of this analysis reverse a conclusion reached by Barlow: the "filtering" properties of human photoreceptors are consistent with a trichromatic visual system that is color constant.

Analysis of Variance↗
PubMed1988

Analysis of the development of spatial contrast sensitivity in monkey and human infants.

The development of spatial contrast sensitivity in human and monkey infants reveals changes in the properties of underlying contrast-detection mechanisms in the visual system. A reanalysis of published data shows that the development of the spatial contrast sensitivity function can be described satisfactorily by the simultaneous vertical and horizontal scaling of a template function whose shape on a log-log axis does not change during development. Because individuals differ in the point to which contrast sensitivity has developed at any particular time, the use of group-averaged data as a basis for estimating the course of the developmental process has two undesirable results. First, it provides estimates of spatial contrast sensitivity during development that do not reflect any individual's sensitivity. Second, it incorrectly suggests that the shape of the spatial contrast sensitivity function changes during development.

Aging↗
PubMed2005

The genomic pattern of tDNA operon expression in E. coli.

In fast-growing microorganisms, a tRNA concentration profile enriched in major isoacceptors selects for the biased usage of cognate codons. This optimizes translational rate for the least mass invested in the translational apparatus. Such translational streamlining is thought to be growth-regulated, but its genetic basis is poorly understood. First, we found in reanalysis of the E. coli tRNA profile that the degree to which it is translationally streamlined is nearly invariant with growth rate. Then, using least squares multiple regression, we partitioned tRNA isoacceptor pools to predicted tDNA operons from the E. coli K12 genome. Co-expression of tDNAs in operons explains the tRNA profile significantly better than tDNA gene dosage alone. Also, operon expression increases significantly with proximity to the origin of replication, oriC, at all growth rates. Genome location explains about 15% of expression variation in a form, at a given growth rate, that is consistent with replication-dependent gene concentration effects. Yet the change in the tRNA profile with growth rate is less than would be expected from such effects. We estimated per-copy expression rates for all tDNA operons that were consistent with independent estimates for rDNA operons. We also found that tDNA operon location, and the location dependence of expression, were significantly different in the leading and lagging strands. The operonic organization and genomic location of tDNA operons are significant factors influencing their expression. Nonrandom patterns of location and strandedness shown by tDNA operons in E. coli suggest that their genomic architecture may be under selection to satisfy physiological demand for tRNA expression at high growth rates.

Journal Article↗
PubMed2003

Outcome validation of the Beckman Coulter access analyzer in a second-trimester Down syndrome serum screening application.

BACKGROUND: Mid-trimester maternal serum alpha-fetoprotein (AFP) and unconjugated estriol (uE3) are 30% lower and human chorionic gonadotropin (hCG) is twofold higher in Down syndrome pregnancies compared with unaffected pregnancies. In maternal serum screening, patient-specific risks are calculated using published gaussian frequency distribution parameters for these three markers obtained with previously available immunoassays. New immunoassays must generate similar distribution parameters if the accuracy of assigned risks and overall performance of prenatal screening are to be maintained. METHODS: Agreement between the Beckman Coulter Access and the Bayer Immuno 1 assays for AFP and hCG and the Amersham Amerlex-M RIA for uE3 was assessed in 558 fresh sera. Precision was measured over 6 weeks. Median concentrations were calculated by regression of 568 Caucasian singleton pregnancy samples against gestational age in days. Frozen mid-trimester sera from 44 confirmed Down syndrome singleton pregnancies (cases) were selected without conscious bias for reanalysis, and each case was matched with five control specimens from unaffected pregnancies. Serum markers were expressed as the multiple of the median (MoM) concentration derived from the control samples, corrected for maternal weight and converted to their log-equivalent values. Normality was assessed using probability plots and the Shapiro-Wilk W-test. Gaussian distribution parameters were compared with established values, and Down syndrome risk calculations were assessed with a commonly used risk algorithm. RESULTS: The Access AFP and hCG assays had consistent proportional agreement with the established assays, whereas agreement between the uE3 methods was less consistent. Analytical imprecision was 3-6% at mid-trimester concentrations. Normal distributions were obtained for the log MoM values of all three markers in both the Down syndrome and unaffected populations, and their gaussian distribution parameters compared well with established values. The performance of the Access assays in an established trivariate risk algorithm for Down syndrome was equal to the performance exhibited by traditional methods. CONCLUSION: The Beckman Coulter Access analyzer provides valid mid-trimester serum AFP, uE3, and hCG results and risk assessments when applied in a prenatal Down syndrome screening service.

Biomarkers↗
PubMed2003

Analysis of cost outliers after gastric bypass surgery: what can we learn?

BACKGROUND: A clinical pathway for gastric bypass surgery (GBS) implemented at our institution in 1999 resulted in reduced costs and decreased variability in patient care. However, a reanalysis of GBS hospital costs identified a 16% incidence of "cost outliers". We hypothesized that analysis of clinical variables would identify factors associated with increased hospital costs following GBS. METHODS: Medical records and financial data for 91 GBS patients from November 2000 to July 2001 were reviewed. Patients with costs >1 SD above the total hospital cost mean comprised the cost outlier (CO) group, while the remaining patients were considered the normal cost (NC) group. Potential etiologies for COs included patient demographics, the number and severity of medical co-morbidities, surgical factors, and major postoperative complications. RESULTS: There were 15 patients in the CO group, and 76 patients in the NC group. Patient demographics were similar in both groups. Diabetes mellitus and severe medical co-morbidities, especially sleep apnea and degenerative joint disease were more common in the CO group (60% vs 9.2%, P < 0.05 vs NC). The incidence of major complications (33% vs 8%) was significantly increased in the CO group (P < 0.05 vs NC). CONCLUSIONS: Despite utilization of a clinical pathway for GBS, 16% of patients were "cost outliers". Factors associated with increased hospital costs after GBS included severe medical co-morbidities (especially diabetes mellitus and sleep apnea) and the occurrence of major postoperative complications. Prospective identification of "high risk" GBS patients may allow hospitals with bariatric surgery programs to modify perioperative care and eliminate potential cost outliers.

Adult↗
PubMed2002

Comparative evaluation of the DPX and DPX-IQ lunar densitometer systems following software upgrade.

Bone densitometry research departments perform system and software upgrades infrequently in order to maintain high precision. This study compares the results obtained on a Lunar densitometer with DPX, and DPX-IQ installed to achieve year 2000 compliance. The DPX-IQ provides an improved femur edge detection algorithm with an expanded reference database. Two hundred data files for each measurement site acquired on DPX were reanalyzed on DPX-IQ. There was no change to the bone mineral density (BMD), bone mineral content (BMC), T-scores or Z-scores for the L2-L4 spine, radius (ultradistal and 33%), and total body. There was a significant high correlation for the femoral neck BMD (r = 0.98; p < 0.05). The mean differences in BMD, BMC, T-scores, and Z-scores at the femoral neck and Ward's and trochanteric regions were not significant (p > 0.05). The limits of agreement within the 95% confidence interval for the femoral neck BMD using the Bland and Altman method was between -0.057 and 0.063 g/cm(2). This order of magnitude magnifies the long-term precision error and alters the usual confidence limits for interpretation of true change in densitometry practice. Therefore, it is important for reanalysis of DPX data files with the DPX-IQ to be performed so that longitudinal changes in BMD can be accurately assessed.

Absorptiometry, Photon↗
PubMed2004

The dromotropic pacemaker: system analysis and design considerations.

Patients suffering from chronotropic incompetence are generally treated with a rate-responsive pacemaker that stimulates the heart at a rate derived from a strain related sensor signal. The pacemaker concept described here uses a well-defined time interval in the electrogram as sensor parameter (AVCT: atrio-ventricular conduction time). AVCT is directly controlled by the autonomic nervous system. The design of the new algorithm was based on a thorough experimental analysis of AVCT subject to variations of the exercise rate and the pacing frequency. There it was demonstrated that AVCT is disturbed by the respiratory activity. The new rate-responsive algorithm which uses the internal model control principle explicitly takes into account the closed-loop nature of the underlying system. The major design objectives were: a) extended range of the individual heart rate, b) effective attenuation of the respiratory related disturbance and c) dynamic stability. Seven patients undergoing an incremental exercise test were paced with the new AVCT-based algorithm. When paced with this algorithm the paced heart rate was 126 +/- 12 min(-1) whereas the peak intrinsic heart rate was only 100 +/- 20 min(-1). The increase which was significant (26 +/- 13 min(-1); 15.53 min(-1)) clearly demonstrated the potential of this concept to restore chronotropic competence. A reanalysis of the experiments was undertaken in order to facilitate the individual parameterization in clinical practice. It could be demonstrated that a rather simple screening test is sufficient to gain the knowledge necessary for the individual parameterisation.

Algorithms↗
PubMed2005

Homocysteine and B vitamins in mild cognitive impairment and dementia.

Elderly subjects with mild cognitive impairment have a high risk for conversion to Alzheimer's disease or are already in a preclinical dementia stage. By cross-sectionally comparing subjects in prodromal and early phases of dementia with non-demented controls, we tested the hypothesis whether low serum vitamin B12 and folate and high plasma total homocysteine concentrations precede or are a consequence of dementia onset. From a large population of 623 consecutive subjects seen at the Memory Clinic (Ospedale Beata Vergine, Mendrisio, Switzerland), 433 subjects could be included in the analyses: 79 elderly controls, 218 Clinical Dementia Rating 0.5 subjects, and 136 demented patients (111 with Alzheimer's disease and 25 with vascular dementia). As in an earlier report on a smaller sample of the same population (n=228), the lowest folate tertile was strongly associated with mild cognitive impairment (adjusted OR=3.1) and Alzheimer's disease (adjusted OR=4.0). Hyperhomocysteinemia showed a significant association not only with Alzheimer's disease (adjusted OR=3.1) but, at variance with the previous report, also with mild cognitive impairment (adjusted OR=2.6). Present reanalysis results suggest that subclinical folate deficiency and hyperhomocysteinemia might predate dementia onset, findings to be confirmed by longitudinal studies.

Aged↗
PubMed1997

Malignant eroticized countertransference.

Gabbard (1994) divided the pathology of therapists, both male and female, who commit sexual boundary violations into those who are psychotic, those who are predatory psychopaths, those engaging in masochistic surrender, and those called "the lovesick therapist." Lovesick therapists are the most common type and manifest crucial narcissistic themes of "a desperate need for validation by their patients, a hunger to be loved and idealized, and a tendency to use patients to regulate their own self-esteem" (p. 127). Among the psychodynamic aspects of this curiously circumscribed area of loss of reality testing that makes it difficult for the therapist to see how self-destructive and harmful such enactment is, are an unconscious reenactment of incestuous longings, a misperception of the patient's wish for maternal nurturance as a sexual overture, enactments of rescue fantasies, a projected idealization of the self of the therapist, a confusion of the therapist's needs with the patient's needs, a fantasy that love is curative, acting out disavowed rage at the patient, or rage at an organization, an institute, or one's training analyst, a manic defense against mourning, a narcissistic fantasy that their sexual affair is an exception, insecurity regarding masculine identity, and assorted primitive preoedipal themes. Gabbard's (1991) erotized countertransference is one variety of what I have termed malignant eroticized countertransference. His variety is a development that occurs under the pressure of the patient's preemptive and compelling expressions of lust and love, the patient's erotic transference. But malignant eroticized countertransference can also occur without the patient having offered any such expressions; it can even occur on first meeting the patient when he or she walks into the office! This is akin to the romantic "love-at-first-sight" theme so favored in the movies and by novelists, but it is always pathological when it occurs in the therapeutic situation. Countertransference enactments are a creation between the patient and the therapist on a continuum from one pole, where the patient has just walked into the office and contributes almost nothing directly, to the other pole, where the therapist loses control of himself or herself as a response to the unbearable pressure of the patient's lust. In the treatment of malignant eroticized countertransference it seems clear from this discussion that every case should be evaluated psychodynamically and the treatment should be made to fit the patient, not the patient to the treatment. Each situation should be studied in psychodynamic depth without preconceptions based on generalizations or formulas. Therapists who are psychotic should of course be treated with antipsychotic drugs and usually should not be allowed to practice any further. Therapists who are psychopathic or sociopathic predators should certainly never be allowed to practice. Some of the individuals who are "lovesick," or, as I put it "love/lust obsessed," or those who have made a masochistic surrender to a sadistic destructive patient, are in need of reanalysis and have the potential to continue as effective therapists under careful supervision. Therapists like this do not deserve to be summarily dismissed from the profession but, like therapists who develop other serious neurotic problems, should receive appropriate help from us.

Countertransference↗