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Medicine is becoming increasingly reliant on diagnostic, prognostic and screening tests for the successful treatment of patients. With new tests being developed all the time, a more informed understanding of the benefits and drawbacks of these tests is crucial. Providing readers with the tools needed to evaluate and interpret these tests, numerous real-world examples demonstrate the practical application and relevance of the material. The mathematics involved are rigorously explained using simple and informative language. Topics covered include the diagnostic process, reliability and accuracy of tests, and quantifying treatment benefits using randomized trials, amongst others. Engaging illustrations act as visual representations of the concepts discussed in the book, complementing the textual explanation.Based on decades of experience teaching in a clinical research training program, this fully updated second edition is an essential guide for anyone looking to select, develop or market medical tests.
Increased amygdala responsiveness is the hallmark of fear and a characteristic across patients with anxiety disorders. The amygdala is embedded in a complex regulatory circuit. Multiple different mechanisms may elevate amygdala responsiveness and lead to the occurrence of an anxiety disorder. While top-down control by the prefrontal cortex (PFC) downregulates amygdala responses, the locus coeruleus (LC) drives up amygdala activation via noradrenergic projections. This indicates that the same fearful phenotype may result from different neural mechanisms. We propose a mechanistic model that defines three different neural biomarkers causing amygdala hyper-responsiveness in patients with anxiety disorders: (a) inherent amygdala hypersensitivity, (b) low prefrontal control and (c) high LC drive. First-line treatment for anxiety disorders is exposure-based cognitive behavioural therapy, which strengthens PFC recruitment during emotion regulation and thus targets low-prefrontal control. A treatment response rate around 50% (Loerinc et al., 2015, Clinical Psychological Reviews, 42, 72–82) might indicate heterogeneity of underlying neurobiological mechanisms among patients, presumably leading to high variation in treatment benefit. Transforming insights from cognitive neuroscience into applicable clinical heuristics to categorise patients based on their underlying biomarker may support individualised treatment selection in psychiatry. We review literature on the three anxiety-related mechanisms and present a mechanistic model that may serve as a rational for pathology-based diagnostic and biomarker-guided treatment selection in psychiatry.
Why should the state provide public goods? I explore this question by focusing on the example of public parks. It examines the three most influential approaches to public goods (the market failures, the normative, and the democratic) and concludes that they fail to explain why parks should be public. I propose an alternative that I call solidarism, a social justice-based approach that provides a response to liberal arguments about the neutrality of the state. Solidarism emphasizes that modernity gives rise to growing levels of interdependence that generate benefits and burdens that are not shared fairly. Public goods as such are a way of compensating for the negative externalities of urbanization and industrialization. Left libertarians argue that such compensation should exclusively take the form of individual benefits. I challenge this view and provide three reasons for building public infrastructure that is shared among people who live together in a physical space: solidarity, decommodification, and politics. Exploring the publicness of parks provides a window into the broader question about the limits of the market and the importance of public space for democracy.
Given the evidence of multi-parameter risk factors in shaping cognitive outcomes in aging, including sleep, inflammation, cardiometabolism, and mood disorders, multidimensional investigations of their impact on cognition are warranted. We sought to determine the extent to which self-reported sleep disturbances, metabolic syndrome (MetS) factors, cellular inflammation, depressive symptomatology, and diminished physical mobility were associated with cognitive impairment and poorer cognitive performance.
This is a cross-sectional study.
Participants with elevated, well-controlled blood pressure were recruited from the local community for a Tai Chi and healthy-aging intervention study.
One hundred forty-five older adults (72.7 ± 7.9 years old; 66% female), 54 (37%) with evidence of cognitive impairment (CI) based on Montreal Cognitive Assessment (MoCA) score ≤24, underwent medical, psychological, and mood assessments.
CI and cognitive domain performance were assessed using the MoCA. Univariate correlations were computed to determine relationships between risk factors and cognitive outcomes. Bootstrapped logistic regression was used to determine significant predictors of CI risk and linear regression to explore cognitive domains affected by risk factors.
The CI group were slower on the mobility task, satisfied more MetS criteria, and reported poorer sleep than normocognitive individuals (all p < 0.05). Multivariate logistic regression indicated that sleep disturbances, but no other risk factors, predicted increased risk of evidence of CI (OR = 2.00, 95% CI: 1.26–4.87, 99% CI: 1.08–7.48). Further examination of MoCA cognitive subdomains revealed that sleep disturbances predicted poorer executive function (β = –0.26, 95% CI: –0.51 to –0.06, 99% CI: –0.61 to –0.02), with lesser effects on visuospatial performance (β = –0.20, 95% CI: –0.35 to –0.02, 99% CI: –0.39 to 0.03), and memory (β = –0.29, 95% CI: –0.66 to –0.01, 99% CI: –0.76 to 0.08).
Our results indicate that the deleterious impact of self-reported sleep disturbances on cognitive performance was prominent over other risk factors and illustrate the importance of clinician evaluation of sleep in patients with or at risk of diminished cognitive performance. Future, longitudinal studies implementing a comprehensive neuropsychological battery and objective sleep measurement are warranted to further explore these associations.
The science of studying diamond inclusions for understanding Earth history has developed significantly over the past decades, with new instrumentation and techniques applied to diamond sample archives revealing the stories contained within diamond inclusions. This chapter reviews what diamonds can tell us about the deep carbon cycle over the course of Earth’s history. It reviews how the geochemistry of diamonds and their inclusions inform us about the deep carbon cycle, the origin of the diamonds in Earth’s mantle, and the evolution of diamonds through time.
I must tell you from the start, that although I have had a long-standing interest in Germany, especially its language and its literature, I did not do a study there. By a wonderful coincidence, I was invited to be a member of the International Advisory Committee of the Institut für Bildungsforschung und Humanentwicklung (Institute for Educational Research and Human Development). My interest in Germany began with my favorite junior high school teacher, Miss Lillian Limbacher, who taught us German by teaching us how German grammar differed from English grammar. It continued on to Deep Springs, where Kurt Bergel had me translate Goethe and taught me the wonders of German literature, including that of his favorite poet, Rilke. It seemed a gift from heaven when the directors of the Institut invited me to be a member of its International Advisory Committee, with my way paid to Berlin for annual meetings every spring. In time, I learned that the heavenly gift was facilitated by the recommendation of a member of that board, Urie Bronfenbrenner, my former teacher, who recommended me as an advisor for sociology.
This appointment held huge advantages for me. For one thing, I was beginning to be involved in research in Poland, and the Germans offered me a way to get as far as Berlin, from which I could readily take subsidized trains from East Berlin to Warsaw (two socialist states with subsidized railway fares, second class, of course), thus making it more feasible for me to travel to Warsaw within my means – as I did for eight years, every spring. For another thing, West Germany was a center of sociological research, and I thoroughly enjoyed the opportunity to travel in West Germany and to lecture at many of the leading German universities – and thereby to learn of the research being done at those universities. For a third thing, I was fascinated by the split between West and East Germany, and became ever more interested as I learned how disinterested the West Germans were in learning anything much about what was happening in East Germany. And, most important, I was fascinated with German culture, German sociology, German food, all things German, and here was my golden opportunity to ingest them all.
In the course of a very long career as a sociologist, I have written or coauthored, with my collaborators, nine books in English and a multitude of articles about our research. I had thought when I published the last of these books, Adventures in Sociology: My Life as a Cross-National Scholar, a few months ago, that I could now at long last retire and catch up on reading new books and rereading old ones. But that was not to happen quite yet. As I thought about my professional life, it seemed to me that it had been given largely to the development of a theory about the relationship of social structure and personality. I thought I had done a reasonable job of presenting this theory in the memoir, but I concluded that I still had more to do to reach my goal of presenting a fully developed theory.
Adventures in Sociology had been different from all its predecessors in that it was a true memoir, the autobiography of a social scientist. I had tried to present my life and my work together, showing how my personal relationships and the institutions in which I worked influenced my work. I had also discussed at length my conflicts with my two prominent enemies, Presidents Richard Nixon and Ronald Reagan. I was very proud of presenting my life and my work in the same book.
I had also made an early decision that Adventures in Sociology would be a book written not only for my colleagues in sociology but also for a lay audience. I made a small but highly significant change of tense in my writing. In the original publications, I had used the present tense, i.e. American respondents (obviously, at the time of some particular study) value this or that characteristic for their children, while Italian parents (obviously, at the time of that study) value this or some other characteristic. In my memoir, all of this was changed into parents in some country at some time valued some characteristic, at other times valued this or some other characteristic. I did not assume that people's values never change.
One could say that my life as a cross-national sociologist began with my 14 months’ sabbatical in Norway, and one would not be far off. Or one could say that it began when I was Len Pearlin's sidekick on the subsequent Torino study. But I like to think that my truly becoming a cross-national scholar began one day in 1970, in Varna, Bulgaria, the day I first met those incredible Poles.
We were at a convention, my first, of the International Sociological Association (ISA). One session of the program especially appealed to me, a session with a title like “Social Stratification in Socialist Society.” It had been organized by the Soviet Sociological Society and I was extraordinarily eager to attend. What were the Soviets doing speculating about social stratification in their own society?
That session turned out to be a sparring match between Soviets and Poles, with Hungarians joining in support of the Poles and East Germans playing supporting roles in subservience to the Soviets – almost all of it in English, as if for my benefit. This was a time of imposed orthodoxy in Eastern Europe, and the head of the Soviet delegation, a commissar named M. N. Rutkevich, was an especially severe imposer. The Soviet line – I caricature it here, but only slightly – was “Yes, we do have some occupational differentiation in socialist societies, but not social stratification – that's impossible under socialism.” The Polish response, put forward by their leading Marxist scholar, Wlodzimierz Wesolowski, in essence was, “We've read our Marx too, but we have also done surveys, and our findings come out remarkably similar to those of the West Europeans and the Americans. In socialist Poland, we certainly do have social stratification, and our system of social stratification is not much different from that of capitalist societies.” This response infuriated Rutkevich and his followers. Their reaction seemed to spur Wesolowski and his compatriots to the energetic pursuit of what I later learned was the Poles’ favorite indoor game, baiting the Soviets.
Who are these incredible people? I had to find out. Under the constrained circumstances of the Varna Congress, the best that I could do was to move to where the Poles were sitting and exchange what Americans called “business cards” and Japanese more appropriately called “name cards.” These gestures were followed in later weeks and months by exchanges of books and reprints.
The inspiration for this study came from the fourth paper in the series about Washington, with its speculations about why social class bore so striking a relationship with parental values – and with values and orientations more generally. The key, I speculated, was in the opportunities (or lack thereof) for exercising self-direction in one's work. When a recently hired colleague, Carmi Schooler, read my proposal to do this research, he came rushing into my office, shouting, “this is great stuff, we've got to test those ideas.” We joined forces. I had with a nearly complete lack of advance knowledge thus acquired a lifelong collaborator in Carmi Schooler. We planned a huge, expensive, but eminently worthwhile study.
The new study, in effect, was my collaborators’ and my reward for the success of our study in Washington, DC, and for Len's success in his study of Torino. Our small-scale, inexpensive studies had been eminently successful, and we were as a result given the resources for a national study of men employed in civilian occupations in the United States. It was to be a huge study of more than 3,000 men representative of all men in the contiguous United States employed in civilian occupations. We could with such a large sample generalize our findings to the entire country, a vast improvement over being able to speak only of the (atypical) Washington community.
I hasten to add that we would have much preferred an even larger study, one of both men and women employed in civilian occupations in the United States. But we settled for a study of men, for now, with every intention of adding women at some later stage when we had analyzed our sample of men. In retrospect, we might better have settled for a smaller sample of men and a comparable sample of women, but we did not have the foresight to see that newly invented statistics would soon make possible the efficient analysis of smaller samples. In any case, the large numbers proved invaluable for later detailed analyses.
We now experienced a gigantic change in our conditions of work. We shifted from a small-scale, local study, in which we employed “young people” as interviewers in the study of a local community, to contracting with a splendid nationwide research organization, the National Opinion Research Center of the University of Chicago, to do the fieldwork for us.
For much of the time that we were working on the US–Polish comparative study, my collaborators and I were also working on a comparative study of Japan and the United States. It came about this way. A noted Japanese sociologist, Ken'ichi Tominaga, had decided that he would develop such a comparative study of Japan and the United States. He secured the funds to do so from Japanese sources, drew up preliminary plans, and arranged to travel to the United States to meet potential US collaborators. I was one of the Americans to whom he wrote. I gladly responded that my collaborators and I would welcome him and his colleagues.
Tominaga brought along two colleagues, one of whom, Atsushi Naoi, was to be the actual investigator. Tominaga wanted only to be the advisor to the study. The survey was to be geographically limited, to the Kanto plane, a fairly large area that included Tokyo. We would have preferred a national study, but we were willing to settle for this more limited geographic area, which was all that they could afford. In any case, the idea of being able to add a democratic Asian society to our comparison of a capitalist society and a socialist one was immensely appealing. We could take into account not only the formal organization of society but also an East–West dimension to the cultural differences already under consideration.
A considerable potential problem, which we fully recognized from our early challenges in Torino, was that the Japanese had no National Opinion Research Center, like NORC in Chicago, nor any institution, such as the Polish Academy of Sciences, staffed with experienced survey researchers, to actually carry out the surveys. Naoi was to carry out the study himself. He already had experience conducting first-rate surveys, though, so with some misgivings, we decided that we would gamble on his competence. The study was to be owned by the Japanese, but so were the US and Polish studies formally owned by their own people; the crucial factor was that we would cooperate in the analyses.
Here I had to admit, that although I was certainly prepared to participate in the analyses, the amount of time that I could devote to the study was limited by my commitment to the Polish study, my administrative duties as a lab chief, and my growing involvement in political activities.
I do not for a moment think that my collaborators and I have studied every type of country, under all conditions of life, and over time. But we have studied several very different countries, under radically different conditions: Capitalist and socialist; under conditions of social stability and of extreme change; representing American, European, and Asian cultures. We have interviewed rigorously selected samples of employed men in all these countries, some of them in longitudinal studies, and the wives of these men or representative samples of women in some of the countries. (It would take 10 or 20 times the number of countries to be able to claim that we have studied every possible combination of factors, but I propose that in a long career, I have studied a diverse set of countries, with conclusions on which I base the following hypotheses for further examination.) I would be the first to acknowledge that further studies of more countries or at later times would lead to some modification of my hypotheses. But here is as good a start as I can offer at this time.
Now I want to review the many studies I have conducted of social structure and personality, not from the perspective of how I had seen the studies as we had conducted them at the time, but from the perspective of how they now appear – what these studies have contributed to our full understanding of the relationships between social structure and personality.
In particular, I want to review each cross-national inconsistency that we have found, to see how that discovery added to the total picture of how crossnational inconsistencies make us rethink the relationship of social structure to personality. I also want to consider whether each discovery matters for only one aspect of personality, particularly distress, or for several or even all aspects of personality that we have been able to study. And I will always be concerned with whether the culture of the country is American or European or Asian.
Before we ran into even the first instance of a cross-national inconsistency, we had focused on the United States.
My wife and I were now in Washington. We had a warm welcome from my new associates, mainly young sociologists – Manny Rosenberg, Len Pearlin, Erving Goffman, and others soon to arrive.
I knew what I wanted to do: A study of social stratification and family relationships. I was not thrilled at the idea of doing such a study in Washington, DC, because Washington was so atypical a city. But I had little choice in the matter, and Washington was not a bad place to begin such research. Our budget was limited. Basically, I could hire a few young people as my staff, and that was it. It was enough. The young people were wonderful – enthusiastic, quick to learn, and cooperative.
Numerous studies of social stratification and parent–child relationships appeared before ours, mainly by psychologists, all of them focused on particular parental practices – bottle-feeding or breastfeeding, and the frequency of using particular disciplinary practices when their children misbehaved. I had tried my damnedest to make sense of this literature and had given up in despair. My former teacher and close friend, Urie Bronfenbrenner, outdid me, though, and made eminently sensible descriptive sense of the entire body of literature. He arrayed the studies, not in sequence of their dates of publication, but of their dates of fieldwork, and discovered that there had been great changes over time in the practices that parents followed, from restrictive to permissive. Middle-class parents had led the way, always about several years ahead of working-class parents. I questioned Urie regarding his further interpretation, that the reason middle-class parents led the way was because of their greater education. I suggested, instead, that while their greater education led middleclass parents to be more likely to read the experts’ books, as we knew they did, they need not have followed the experts. That they did follow the experts was not, to my thinking, because they blindly followed expert advice, but because the experts gave them useful advice, consistent with their values.
What I did instead was to approach the entire issue from a vastly different perspective, the perspective of sociological theory.
To return to my story of the Polish research, there was now really exciting news. We had been able to enlist the cooperation of our Ukrainian colleagues, Valeriy Khmelko and Vladimir Paniotto, to be our collaborators in a comparative study of the transition of Poland and Ukraine to capitalism and democracy.
I had long been interested in doing a study of the Soviet Union. I had even secured for myself the position of the US representative on the governing board of the International Research and Exchanges Board (IREX), to negotiate on behalf of the United States with the representatives of the Soviet Union on matters sociological. All dealings with the Soviets then required a top-down bureaucratic arrangement. It had been great fun. I got to meet many Soviet officials, some of them splendid people, others anything but, and not to be trusted. In the course of my dealings with my Soviet counterparts, I tried to enlist the research collaboration of a noted Soviet sociologist, Vladimir Yadov, who previously had done excellent research, but he demurred. Yes, he was a member of the Communist Party. Yes, he was interested in joining me in a research project. But no, he would not be entrusted by the Soviet government with doing research on such delicate matters as the relationship of social structure and personality. He was entrusted, though, to be the Soviet codirector, with me as the American codirector, of a series of conferences of Soviet and US sociologists.
There was an old adage in Soviet life, that the further away you were located from Moscow, the more freedom you had to do research. Yadov knew two Ukrainian sociologists whom he thought top notch, and whom he thought would be interested in my project – Valeriy Khmelko and Vladimir Paniotto. He invited them to attend the next conference that we then were planning, and they of course readily agreed. (It was purely coincidental that my mother was born in Ukraine, and that I was personally interested in visiting that country.) My Polish collaborators were also intrigued with the possibility of our collaborating with Ukrainians. They knew a lot about research in nextdoor Ukraine, but the ties between the two countries were not strong, and my collaborators were immensely curious.
During all the time since I returned from Poland, I was concerned about the damned war in Vietnam, but there was very little I could do about it. Janet, however, soon found that she could devote herself intensively to antiwar efforts. She returned to her former employers, Vi and John Gunther, for whom she had once been secretary, but now as a full-fledged and experienced lawyer. They had just the job for her: She became the staff – the total staff – of a committee they set up to fight Mr. Nixon and his war. It was a Herculean task. She, of course, had no subpoena or any other powers to make any sort of inquiry other than to report what was already in the newspapers but not widely known, or known only to people associated with Capitol Hill or otherwise knowledgeable. She spent lots of time at the Congress, and became well acquainted with any number of knowledgeable people. And she used that knowledge advantageously. It was a very exciting life. But it was her life, not mine, except insofar as it imperiled my position as a government employee. But that was a risk that I was willing to take. I knew I could easily get another job.
Then one day, an extraordinary thing happened. I went to the immense National Institutes of Health (NIH) cafeteria, where, at a well-situated spot in the middle of the room, a well-known and much admired woman, one of the scientific stars of that institution, had set up a bridge table, and was busily soliciting signatures for a petition against the war. But she was not alone. She was being manhandled by a cigar-smoking NIH cop, who was trying to muscle her into closing shop. She resisted. I rushed in and intervened. He turned on me, and we were immediately in a scuffle, my one concern being that damned cigar, which he kept pushing closer to my eyes. But I was a pretty good boxer. My father, who had as a young man been a semiprofessional prize fighter, had bought me child-sized boxing gloves when I was a young kid. I had been beaten up by a gang of Irish kids on my way home from a Cub Scouts meeting at a local synagogue.
I had for many years wanted to study China. It was in obvious contrast to Russia and the Russian empire. It was a fascinating culture. My wife, Janet, was even more eager to see China. She had always wanted to visit China, and she encouraged me enthusiastically whenever I mentioned the possibility of my going there. She also made it extremely evident that she desperately wanted to go with me. But she had an advanced case of Alzheimer's disease, and every expert we talked with warned us that the worst thing for Alzheimer's patients to experience was change. And how much change could there be but a different language, a different culture, a different everything? A trip to China was the worst thing that Janet could undertake.
Then came my golden opportunity to go to China. A very interesting international organization was planning an international convention in Shanghai. Great. I knew the organization and thought very well of it. I had gone to one of its earlier conventions, this one in France, where the organization paid my way to the most fascinating convention I had ever attended. This time, the organization didn't offer to pay my way, but it did encourage me to attend. Janet was ready to pack. We met with her psychiatrist, Dr. Goldberg, and explained my interests and Janet's. He smiled and said to me, “I needn't tell you all the many reasons why it is not advisable for you to take Janet to China. Change is not good for Alzheimer's patients. All I can assure you, is that if you decide to take her, despite my advice, I will do all I can to help you, but that is likely to be no more than to meet the medical evacuation plane on your return.” Janet smiled her most loving smile, and said to me with joy in her eyes, “Then we are going, aren't we?” I said, hesitantly, “Yes, we are.”
My first trip to China was the most extraordinary trip of my life. It was, to begin, of immense importance for my research, because a study of China was a gigantic departure from my previous research, even in Japan, Poland, and Ukraine, because the culture was so entirely different. I also had no inkling of how to find colleagues who could potentially become my collaborators.
I received, to my surprise, an invitation to come to Norway for 14 months as a visiting scholar at a private research foundation, the Institut für Bildungsforschung (Institute for Educational Research). The invitation was the handiwork of a visiting scholar at the NIMH, not then my particular friend, but a man destined to become my good friend, Yngvar Löchen. By great good chance, the timing was optimum. Carmi and I were in the midst of planning a further study, another huge study that we could not carry out ourselves, but once we had laid the plans we could turn over the actual survey to the National Opinion Research Center of the University of Chicago (who in fact did a superb job). I could go to Poland, and after my very limited but very exciting experiences in Torino, I was eager to see Europe and the world. Fortunately, my administrative superiors were all in favor of introducing sabbaticals into the government's way of handling its scientists.
My wife's and my splendid year in Norway had several components, but I shall separate them in telling you about them.
The first was my research and my unintended effect on Norwegian research. Norwegian research was a derivative of the German tradition of extraordinarily independent research, a tradition that made no sense to me. Practitioners worked alone and could not consult with anyone, not even with statisticians. For example, in doing doctoral research, the candidate would apply for a stipend from a foundation (whose funds came from betting on soccer games). If he got the stipend, he did the research; if he didn't get the stipend, too bad. Along the way, he never could discuss his research with anyone. It was forbidden to consult even to that extent. When he finished, the oral exam was always held in a huge auditorium, attended by reporters from all seven Norwegian newspapers, for this was an important national event. The quality of the exam was connoted by the titles of the first two examiners: the first opponent and the second opponent. The outcome of the exam was dichotomous: Either there was a wild, drunken dinner, a great celebration, or the victim committed suicide.