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Background: The Endoscopic endonasal approach (EEA) has been gaining popularity in the past decade as an alternative to traditional transcranial and transorbital approaches. We have performed orbital apex decompression for a variety of pathological entities. Methods: We performed a retrospective chart review on patients who underwent EEA orbital apex decompression between January 1st 2010 and December 1st 2018 at McMaster University. Results: Eight patients underwent endoscopic endonasal orbital decompression at our center, including five male patients and three female patients. The mean age of our patients was 50.1 years. The different pathologies we treated included nasopharyngeal carcinoma, hemangioma, fibrous dysplasia, IgG4 disease, inverted papilloma, angioleiomyoma, and neuroendocrine paraganglioma. Five patients presented with visual symptoms. Postoperatively, one of these five patients improved to baseline, three had stable vision, another one had progressive visual decline despite surgical intervention. Conclusions: Endoscopic endonasal approach can be used as an alternative to decompress orbital apex pathologies in selected patients.
Background: The Endoscopic endonasal approach (EEA) has become increasingly popular in the treatment of suprasellar meningiomas, which often cause visual symptoms due to compression of the anterior optic apparatus. Methods: We performed a retrospective chart review on patients who underwent EEA optic nerve decompression and resection of suprasellar meningiomas between January 1st 2005 and December 1st 2018 at McMaster University. Results: The mean age of our patients was 59.8 years. We treated 9 male and 23 female patients, with a mean follow up of 6.29 years. 23 patients (71.9%) presented with visual symptoms, with a mean duration of 8.65 months. In our patient cohort, 95.5% had stable or improved visual acuity postoperatively. Less than six months of visual decline was more likely to be associated with postoperative improvement of visual acuity, with an odds ratio (OR) of 0.0222 (95% CI: 0.0017–0.289, p<0.05); as well as visual field (OR:0.0625; 95% CI, 0.0042–0.915, p<0.05). Additionally, the absence of RAPD was associated with improved postoperative visual acuity (OR: 0.0675; 95% CI, 0.0354–0.706, p<0.05). Conclusions: Endoscopic endonasal approach can achieve good visual outcome in patients harboring suprasellar meningiomas. Symptom duration of less than six months and absence of RAPD were positive predictor of postoperative visual outcome.
Converging lines of evidence implicate an important role for the immune system in schizophrenia. Microglia are the resident immune cells of the central nervous system and have many functions including neuroinflammation, axonal guidance and neurotrophic support. We aimed to provide a quantitative review of in vivo PET imaging studies of microglia activation in patients with schizophrenia compared with healthy controls.
Demographic, clinical and imaging measures were extracted from each study and meta-analysis was conducted using a random-effects model (Hedge's g). The difference in 18-kDa translocator protein (TSPO) binding between patients with schizophrenia and healthy controls, as quantified by either binding potential (BP) or volume of distribution (VT), was used as the main outcome. Sub-analysis and sensitivity analysis were carried out to investigate the effects of genotype, ligand and illness stage.
In total, 12 studies comprising 190 patients with schizophrenia and 200 healthy controls met inclusion criteria. There was a significant elevation in tracer binding in schizophrenia patients relative to controls when BP was used as an outcome measure, (Hedge's g = 0.31; p = 0.03) but no significant differences when VT was used (Hedge's g = −0.22; p = 0.29).
In conclusion, there is evidence for moderate elevations in TSPO tracer binding in grey matter relative to other brain tissue in schizophrenia when using BP as an outcome measure, but no difference when VT is the outcome measure. We discuss the relevance of these findings as well as the methodological issues that may underlie the contrasting difference between these outcomes.
Auditory hallucinations (AH) are often considered a sign of a psychotic disorder. This is promoted by the DSM-5 category of Other Specified Schizophrenia Spectrum And Other Psychotic Disorder (OSSSOPD), the diagnostic criteria for which are fulfilled with the sole presence of persistent AH, in the absence of any other psychotic symptoms. And yet, persistent AH are not synonymous with having a psychotic disorder, and should therefore not be uncritically treated as such. Many people who seek treatment for persistent AH have no other psychotic symptoms, have preserved reality-testing capacities, and will never develop a schizophrenia spectrum disorder. Instead, hallucinations may be the result of many different causes, including borderline personality disorder, post-traumatic stress disorder (PTSD), hearing loss, sleep disorders or brain lesions, and they may even occur outside the context of any demonstrable pathology. In such cases, the usage of the DSM-5 diagnosis of OSSSOPD would be incorrect, and it may prompt unwarranted treatment with antipsychotic medication. We therefore argue that a DSM-5 diagnosis of Schizophrenia Spectrum Disorder (or any other type of psychotic disorder) characterized by AH should require at least one more symptom listed under the A-criterion (i.e. delusions, disorganized speech, disorganized or catatonic behavior or negative symptoms). Adhering to these more stringent criteria may help to distinguish between individuals with persistent AH which are part of a psychotic disorder, for whom antipsychotic medication may be helpful, and individuals with AH in the absence of such a disorder who may benefit from other approaches (e.g. different pharmacological interventions, improving coping style, trauma-related therapy).
Our understanding of the complex relationship between schizophrenia symptomatology and etiological factors can be improved by studying brain-based correlates of schizophrenia. Research showed that impairments in value processing and executive functioning, which have been associated with prefrontal brain areas [particularly the medial orbitofrontal cortex (MOFC)], are linked to negative symptoms. Here we tested the hypothesis that MOFC thickness is associated with negative symptom severity.
This study included 1985 individuals with schizophrenia from 17 research groups around the world contributing to the ENIGMA Schizophrenia Working Group. Cortical thickness values were obtained from T1-weighted structural brain scans using FreeSurfer. A meta-analysis across sites was conducted over effect sizes from a model predicting cortical thickness by negative symptom score (harmonized Scale for the Assessment of Negative Symptoms or Positive and Negative Syndrome Scale scores).
Meta-analytical results showed that left, but not right, MOFC thickness was significantly associated with negative symptom severity (βstd = −0.075; p = 0.019) after accounting for age, gender, and site. This effect remained significant (p = 0.036) in a model including overall illness severity. Covarying for duration of illness, age of onset, antipsychotic medication or handedness weakened the association of negative symptoms with left MOFC thickness. As part of a secondary analysis including 10 other prefrontal regions further associations in the left lateral orbitofrontal gyrus and pars opercularis emerged.
Using an unusually large cohort and a meta-analytical approach, our findings point towards a link between prefrontal thinning and negative symptom severity in schizophrenia. This finding provides further insight into the relationship between structural brain abnormalities and negative symptoms in schizophrenia.
We present fully cosmological, hydrodynamical simulations of clusters of galaxies, including star formation, supernova feedback, chemical enrichment and metal-dependent cooling. We investigate the relation between feedback, metal enrichment of the intra-cluster medium (ICM) and the distribution of baryons in the various phases (cold gas+stars and hot ICM) at varying Initial Mass Function and wind efficiency.
Does biblical criticism have anything to contribute to a theologically engaged study of Scripture? The answer implicitly provided by many scholars, both within the guild of modern biblical scholarship and outside it, is clear: The biblical critic's findings are irrelevant to constructive projects. These findings may be the product of intensive philological, comparative, and historical work, but they are no more connected to the tasks of the modern thinker than artifacts dug up by an archaeologist. Indeed (some theologically and literarily minded readers assume), biblical critics often produce work that impedes an interpreter who is oriented towards larger ideas. Those ideas, after all, emerge from textual wholes that are subtle, creative, and innovative, while biblical critics (these readers believe) have a penchant for dismembering texts or reducing them to hackneyed representatives of types of thinking or textual genres found elsewhere in the ancient Near East. As a result, not a few theologians and philosophers who attend to the Bible shun the work of biblical critics.
Ongoing intensification and specialisation of livestock production lead to increasing volumes of manure to be managed, which are a source of the greenhouse gases (GHGs) methane (CH4) and nitrous oxide (N2O). Net emissions of CH4 and N2O result from a multitude of microbial activities in the manure environment. Their relative importance depends not only on manure composition and local management practices with respect to treatment, storage and field application, but also on ambient climatic conditions. The diversity of livestock production systems, and their associated manure management, is discussed on the basis of four regional cases (Sub-Saharan Africa, Southeast Asia, China and Europe) with increasing levels of intensification and priorities with respect to nutrient management and environmental regulation. GHG mitigation options for production systems based on solid and liquid manure management are then presented, and potentials for positive and negative interactions between pollutants, and between management practices, are discussed. The diversity of manure properties and environmental conditions necessitate a modelling approach for improving estimates of GHG emissions, and for predicting effects of management changes for GHG mitigation, and requirements for such a model are discussed. Finally, we briefly discuss drivers for, and barriers against, introduction of GHG mitigation measures for livestock production. There is no conflict between efforts to improve food and feed production, and efforts to reduce GHG emissions from manure management. Growth in livestock populations are projected to occur mainly in intensive production systems where, for this and other reasons, the largest potentials for GHG mitigation may be found.
Deposition of semiconductor films is a key process for production of thin-film solar cells, such as CdTe or CIGS cells. In order to optimize photovoltaic properties of the film a comprehensive model of the deposition process should be build, which can relate deposition conditions and film properties. We have developed a multiscale model of deposition of CdTe film in close space sublimation (CSS) process. The model is based on kinetic Monte Carlo method on the rigid lattice, in which each site can be occupied by either Cd or Te atom. The model tabulates the energy of the site as a function of its local environment. These energies were obtained from first-principles calculates and then approximated with analytical formulas. Based on determined energies of each site we performed exchange (diffusion) processes using Metropolis algorithm. In addition the model included adsorption and desorption processes of Cd and Te2 species. The results of the model show that a steady-state structure of the surface layer is formed during film growth. The model can reproduce transition from film deposition to film etching depending on external conditions. Moreover, the model can predict deposition rates for non-stoichiometric gas compositions.
Although auditory verbal hallucinations (AVH) are a core symptom of schizophrenia, they also occur in non-psychotic individuals, in the absence of other psychotic, affective, cognitive and negative symptoms. AVH have been hypothesized to result from deviant integration of inferior frontal, parahippocampal and superior temporal brain areas. However, a direct link between dysfunctional connectivity and AVH has not yet been established. To determine whether hallucinations are indeed related to aberrant connectivity, AVH should be studied in isolation, for example in non-psychotic individuals with AVH.
Resting-state connectivity was investigated in 25 non-psychotic subjects with AVH and 25 matched control subjects using seed regression analysis with the (1) left and (2) right inferior frontal, (3) left and (4) right superior temporal and (5) left parahippocampal areas as the seed regions. To correct for cardiorespiratory (CR) pulsatility rhythms in the functional magnetic resonance imaging (fMRI) data, heartbeat and respiration were monitored during scanning and the fMRI data were corrected for these rhythms using the image-based method for retrospective correction of physiological motion effects RETROICOR.
In comparison with the control group, non-psychotic individuals with AVH showed increased connectivity between the left and the right superior temporal regions and also between the left parahippocampal region and the left inferior frontal gyrus. Moreover, this group did not show a negative correlation between the left superior temporal region and the right inferior frontal region, as was observed in the healthy control group.
Aberrant connectivity of frontal, parahippocampal and superior temporal brain areas can be specifically related to the predisposition to hallucinate in the auditory domain.
Auditory verbal hallucinations (AVH) in patients with borderline personality disorder (BPD) are frequently claimed to be brief, less severe and qualitatively different from those in schizophrenia, hence the term ‘pseudohallucinations’. AVH in BPD may be more similar to those experienced by healthy individuals, who experience AVH in a lower frequency and with a more positive content than AVH in schizophrenia. In this study the phenomenology of AVH in BPD patients was compared to that in schizophrenia and to AVH experienced by non-patients.
In a cross-sectional setting, the phenomenological characteristics of AVH in 38 BPD patients were compared to those in 51 patients with schizophrenia/schizoaffective disorder and to AVH of 66 non-patients, using the Psychotic Symptom Rating Scales (PSYRATS).
BPD patients experienced AVH for a mean duration of 18 years, with a mean frequency of at least daily lasting several minutes or more. The ensuing distress was high. No differences in the phenomenological characteristics of AVH were revealed among patients diagnosed with BPD and those with schizophrenia/schizoaffective disorder, except for ‘disruption of life’, which was higher in the latter group. Compared to non-patients experiencing AVH, BPD patients had higher scores on almost all items.
AVH in BPD patients are phenomenologically similar to those in schizophrenia, and different from those in healthy individuals. As AVH in patients with BPD fulfil the criteria of hallucinations proper, we prefer the term AVH over ‘pseudohallucinations’, so as to prevent trivialization and to promote adequate diagnosis and treatment.
ac Susceptometry has been used to study a number of magnetic molecular solids including a new compound, Mn(II) octaethyltetraazaporphyrin, α-MnOETAP, and decamethylmanganocenium tetracyanoethenide, Mn(Cp*)2•TCNE, a previously reported molecule-based ferromagnet. Both of these compounds exhibit signatures of ferromagnetism including significant hysteresis below 2 K and rapidly increasing χT (where χ is the molar susceptibility) with decreasing temperature. However, their ac susceptibility data show relatively strong dependence of χ′ and χ″ on the frequency of the applied field, indicating a spinglass state. Other molecular ferromagnetic solids examined show much less sensitivity. These studies indicate that the standard practice of characterization by dc and ac susceptometry at a single frequency are clearly insufficient for identifying the magnetic state of a molecular solid.
To examine the impact of a 6-month participatory and empowerment-based intervention study on employees’ dietary habits and on changes in the canteen nutrition environment.
Worksites were stratified by company type and by the presence or absence of an in-house canteen, and randomly allocated to either an intervention group (five worksites) or a minimum intervention control group (three worksites). The study was carried out in partnership with a trade union and guided by an ecological framework targeting both individual and environment levels. Outcome measures included: (i) changes in employees’ dietary habits derived from 4 d pre-coded food diaries of a group of employees at the worksites (paired-data structure); and (ii) the canteen nutrition environment as identified by aggregating chemical nutritional analysis of individual canteen lunches (different participants at baseline and at endpoint).
Eight blue-collar worksites (five of these with canteens).
In the intervention group (n 102), several significant positive nutritional effects were observed among employees, including a median daily decrease in intake of fat (−2·2 %E, P = 0·002) and cake and sweets (−18 g/10 MJ, P = 0·002) and a median increase in intake of dietary fibre (3 g/10 MJ, P < 0·001) and fruit (55 g/d, P = 0·007 and 74 g/10 MJ, P = 0·009). With regard to the canteen nutrition environment, a significant reduction in the percentage of energy obtained from fat was found in the intervention group (median difference 11 %E, P < 0·001, n 144).
The present study shows that moderate positive changes in dietary patterns can be achieved among employees in blue-collar worksites.
Cannabis use is associated with psychosis and a range of subclinical psychiatric symptoms. The strength of this association depends on dosage and age at first use. The current study investigates whether level of cannabis exposure and starting age are associated with specific profiles of subclinical symptoms.
We collected cross-sectional data from a young adult population sample by administering an online version of the Community Assessment of Psychic Experiences (CAPE). Cannabis exposure was quantified as the amount of Euros spent on cannabis per week and the age of initial cannabis use. The primary outcome measure was the odds ratio (OR) to belong to the highest 10% of scores on the total CAPE and the positive-, negative- and depressive symptom dimensions.
In 17 698 adolescents (mean age 21.6, s.d.=4.2 years), cannabis use at age 12 years or younger was strongly associated with a top 10% score on psychotic experiences [OR 3.1, 95% confidence interval (CI) 2.1–4.3] and to a lesser degree with negative symptoms (OR 1.7, 95% CI 1.1–2.5). The OR of heavy users (>€25/week) for negative symptoms was 3.4 (95% CI 2.9–4.1), for psychotic experiences 3.0 (95% CI 2.4–3.6), and for depressive symptoms 2.8 (95% CI 2.3–3.3).
Early start of cannabis use is strongly associated with subclinical psychotic symptoms and to a lesser degree with negative symptoms, while smoking high amounts of cannabis is associated with increased levels of all three symptom dimensions: psychotic, negative and depressive. These results support the hypothesis that the impact of cannabis use is age specific.
To sin or transgress, according to one dictionary definition, is to go beyond a limit, to cross what is supposed to be a clear border. In this sense, one can say that Gary Anderson has succeeded in writing a very sinful book. Like Sennacherib as the rabbis describe him, Anderson is (he “erases boundaries between nations”)—only I use this phrase to describe Anderson in rather a more positive sense than the rabbis intended it when they applied it to the Assyrian emperor.2 Throughout this book we are discussing, Anderson crosses boundaries between academic disciplines: biblical criticisms that study the Hebrew Bible and the New Testament, Qumranic scholarship, rabbinics, patristics, the study of both medieval Catholic and early Protestant theology. He crosses boundaries within some of these fields, as well: for example, by attending to modern Israeli biblical scholarship in a way that is, alas, all too rare among non-Jewish scholars in North America and Europe; or by showing scholars of rabbinics what they can learn from the study of the New Testament, especially when that study is conscious of its roots in medieval and early modern theology. Most importantly, Anderson tears down artificial barriers that separate historical, philological, descriptive scholarship on the one side from constructive theology and inter-religious dialogue on the other.
I attempted to uncover in the preceding chapters two sides of a theological debate that took place in ancient Israel. Some biblical authors, embracing a theological intuition common throughout the ancient Near East, maintained that God differs radically from human beings because God's body and self are completely unbounded. For these thinkers, who include the J and E authors of the Pentateuch, God has many bodies, and God's person finds expression in more than one self, even as the underlying unity of the being called Yhwh endures. Other biblical authors, including those of the priestly and deuteronomic schools, completely rejected this conception. Putting greater emphasis on God's unity, they insisted that God has only one body and one self.
It was the latter group who shaped the Hebrew Bible as we know it. The priestly authors or their descendants were probably the final editors of the Pentateuch; the superstructure of the Books of Genesis, Exodus, Leviticus, and Numbers is identical to the basic framework of the priestly document. Thus it is no coincidence that the priestly ritual code that comprises the Book of Leviticus is located in the center of the Pentateuch or that the priestly account of the dedication of the tabernacle in Leviticus 8–10 occurs at the exact midpoint of the Five Books of Moses. The priestly shaping of the Pentateuch's final form has a profound influence on the way one reads this work as a whole.
In the theological intuition that has concerned us was found among the polytheists of the ancient Near East and also among worshippers of Yhwh in ancient Israel: A god – even the one God – could have many bodies and a fluid self. Israelites who accepted this premise included the biblical authors responsible for the Pentateuch's JE narratives and various scribes and poets with some connection to the northern kingdom. Other Israelites, however, rejected these notions. Certain streams of tradition in the Hebrew Bible display no sense that divine selfhood could fragment. These same traditions regard divine embodiment as fixed, and they strongly condemn the stelae and ʾasherahs so crucial to the notion of multiplicity of divine embodiment. I focus the discussion in this chapter on two such streams of tradition: deuteronomic texts and priestly texts. (By “deuteronomic texts,” I mean both the Book of Deuteronomy and the historical works that reflect its ideology: to wit, Joshua, Judges, Samuel, and Kings. The term “priestly texts” for the purposes of this book include all the priestly material in the Pentateuch – both the older PT scrolls and the later HS additions to them; when referring to this priestly material in its final form, I sometimes use the siglum “P.” I also use the term “priestly texts” to refer to the Book of Ezekiel, because Ezekiel was a priest and his book's ideological and stylistic affinity to priestly texts in the Pentateuch are well known.)
The god of the hebrew bible has a body. this must be stated at the outset, because so many people, including many scholars, assume otherwise. The evidence for this simple thesis is overwhelming, so much so that asserting the carnal nature of the biblical God should not occasion surprise. What I propose to show in this book is that the startling or bizarre idea in the Hebrew Bible is something else entirely: not that God has a body – that is the standard notion of ancient Israelite theology – but rather that God has many bodies located in sundry places in the world that God created.>
The bulk of this book is devoted to two tasks: first, demonstrating that in parts of the Hebrew Bible the one God has more than one body (and also, we shall see, more than one personality); and second, exploring the implications of this fact for a religion based on the Hebrew Bible. The first of these tasks is historical and descriptive in nature. The second, especially as taken up in the last chapter, is theological and much more speculative.
Before I embark on these two tasks, however, some readers may find a brief discussion of the corporeality of the biblical God beneficial. After all, Sunday school teachers and religious sages have long taught Jews and Christians that the Hebrew Bible is distinctive among the religious documents of antiquity precisely because it rejects the notion of a physical deity.