Personality characteristics of alcohol dependent inpatients: relationship of MCMI subtypes to self-reported drinking behavior.

Recent cluster analytic research with alcoholic inpatients has demonstrated the existence of several Millon Clinical Multiaxial Inventory (MCMI) clusters that appear to be consistent across different subject samples. The validity of these data would be strengthened by a statistical demonstration of the similarity of attained clusters across studies--a demonstration of concordance of subject classification across different clustering techniques on the same data set- and the inclusion of external, independent measures against which to evaluate the predictive validity of the cluster typology. We found a high level of concordance in subject classification across different clustering methods on the same data set and a high level of agreement with cluster typologies attained in previous studies. Subsequent multivariate analyses employing independent scales measuring various aspects of alcohol use confirmed differences among cluster members on perceived benefits of alcohol use and deleterious effects of alcohol use. The prominent differences in alcohol use along with a rationale for their development are discussed.     

Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?

Antidepressants, in particular newer agents, are among the most widely prescribed medications worldwide with annual sales of billions of dollars. The introduction of these agents in the market has passed through seemingly strict regulatory control. Over a thousand randomized trials have been conducted with antidepressants. Statistically significant benefits have been repeatedly demonstrated and the medical literature is flooded with several hundreds of "positive" trials (both pre-approval and post-approval). However, two recent meta-analyses question this picture. The first meta-analysis used data that were submitted to FDA for the approval of 12 antidepressant drugs. While only half of these trials had formally significant effectiveness, published reports almost ubiquitously claimed significant results. "Negative" trials were either left unpublished or were distorted to present "positive" results. The average benefit of these drugs based on the FDA data was of small magnitude, while the published literature suggested larger benefits. A second meta-analysis using also FDA-submitted data examined the relationship between treatment effect and baseline severity of depression. Drug-placebo differences increased with increasing baseline severity and the difference became large enough to be clinically important only in the very small minority of patient populations with severe major depression. In severe major depression, antidepressants did not become more effective, simply placebo lost effectiveness. These data suggest that antidepressants may be less effective than their wide marketing suggests. Short-term benefits are small and long-term balance of benefits and harms is understudied. I discuss how the use of many small randomized trials with clinically non-relevant outcomes, improper interpretation of statistical significance, manipulated study design, biased selection of study populations, short follow-up, and selective and distorted reporting of results has built and nourished a seemingly evidence-based myth on antidepressant effectiveness and how higher evidence standards, with very large long-term trials and careful prospective meta-analyses of individual-level data may reach closer to the truth and clinically useful evidence.     

Effects of a stress-management program on injury and stress of competitive gymnasts

20 competitive gymnasts (17 girls, 3 boys; mean age, 14.4 +/- 3.4 yr.) were recruited from two clubs in Auckland, New Zealand. Gymnasts, who had competed at a national or international level, were divided into two groups to examine the effects of a longitudinal stress-management program on injury and stress. Those in the stress-management group took part in 12 1-hr. sessions over 24 weeks, while the control group took part in a placebo program of anthropometric measurements and lectures on nutrition. All participants completed the Life Experiences Survey and Athletic Experiences Survey at baseline, 3 mo., 6 mo. (end of intervention), and 9 mo. (3 mo. after completion of intervention). Injury data were collected prospectively by weekly self-report over the 9-mo. study. Repeated-measures analyses of covariance with age and, where applicable, the baseline measure of the dependent variable entered as covariates, indicated no significant group or group by time effects for the scores on the two surveys, or injury scores. However, given the small sample, the statistical power of the study to detect even large effects was low. Therefore, rather than concluding that the stress-management program had no effect on training hours lost to injury or on stress, upper limits were placed on the magnitude of any effects that might exist. Further research using larger samples is recommended.     

Status differences and in-group bias: a meta-analytic examination of the effects of status stability, status legitimacy, and group permeability.

This work examines the moderating effects of status stability, legitimacy, and group permeability on in-group bias among high- and low-status groups. These effects were examined separately for evaluative measures that were relevant as well as irrelevant to the salient status distinctions. The results support social identity theory and show that high-status groups are more biased. The meta-analysis reveals that perceived status stability, legitimacy, and permeability moderate the effects of group status. Also, these variables interacted in their influences on the effect of group status on in-group bias, but this was only true for irrelevant evaluative dimensions. When status was unstable and perceived as illegitimate, low-status groups and high-status groups were equally biased when group boundaries were impermeable, compared with when they were permeable. Implications for social identity theory as well as for intergroup attitudes are discussed.     

The 9th annual INDUS-EM 2013 Emergency Medicine Summit, “Principles,Practices, and Patients,” a level one international meeting,Kerala University of Health Sciences and Jubilee Mission Medical College and Research Institute,Thrissur, Kerala,India, October 23–27, 2013

INDUS-EM is India’s only level one conference imparting and exchanging quality knowledge in acute care. Specifically, in general and specialized emergency care and training in trauma, burns, cardiac, stroke, environmental and disaster medicine. It provides a series of exchanges regarding academic development and implementation of training tools related to developing future academic faculty and residents in Emergency Medicine in India. The INDUS-EM leadership and board of directors invited scholars from multiple institutions to participate in this advanced educational symposium that was held in Thrissur, Kerala in October 2013.     

Optimal response biases and the slope of ROC curves as a function of signal intensity,signal probability,and relative payoff

Rats performed in a two-lever analogue of the yes-no psychophysical procedure. The signal consisted of of an increment in the intensity of a random noise. Correct responses were reinforced with single bursts of brain stimulation; incorrect responses produced brief periods of time-out. Receiver-operating-characteristic curves were generated at each of several signal intensities by varying either the signal probability (0.1–0.9) or the relative number of brain stimulations for correct responses (1:3–3:1). The index d’ (or d’_e) increased with the signal intensity and was independent of response bias. When the signal probability was varied, the animals optimized the number of correct trials. and hence the number of brain stimulations obtained at each level of detection. They approximated this optimum more closely as the signal intensity was reduced. When the ratio of brain stimulations was varied, the animals compromised between optimizing the number of correct trials and optimizing the number of brain stimulations obtained. The slopes of the ROC curves plotted on normal-normal coordinates frequently departed from unity, but did not change systematically with either the signal intensity or the method by which they were generated.     

Overlapping mental operations in serial performance with preview: Typing. A reply to Pashler

Pashler (this issue) concluded that the rate of responding in serial choice reaction tasks was controlled by a limit on simultaneous response selection rather than on simultaneous response execution. Film of a skilled typist shows that each finger movement starts as a key earlier in the sequence to be typed is struck (three earlier with words, two with orthographically legal non-words). Thus, her rate of responding is controlled by a limit on the number of responses that can be executed simultaneously, not by a limit on response selection.

Preventing simultaneous response selection is one possible strategy for maintaining correct response order in serial tasks. It is suitable for tasks such as those studied by Pashler, where response selection is relatively slow and response execution is quick. Other strategies are more suitable for tasks where response selection is quick and response execution relatively slow and variable.