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Schizophrenia is a disorder characterized by pervasive deficits in cognitive functioning. However, few well-powered studies have examined the degree to which cognitive performance is impaired even among individuals with schizophrenia not currently on antipsychotic medications using a wide range of cognitive and reinforcement learning measures derived from cognitive neuroscience. Such research is particularly needed in the domain of reinforcement learning, given the central role of dopamine in reinforcement learning, and the potential impact of antipsychotic medications on dopamine function.
The present study sought to fill this gap by examining healthy controls (N = 75), unmedicated (N = 48) and medicated (N = 148) individuals with schizophrenia. Participants were recruited across five sites as part of the CNTRaCS Consortium to complete tasks assessing processing speed, cognitive control, working memory, verbal learning, relational encoding and retrieval, visual integration and reinforcement learning.
Individuals with schizophrenia who were not taking antipsychotic medications, as well as those taking antipsychotic medications, showed pervasive deficits across cognitive domains including reinforcement learning, processing speed, cognitive control, working memory, verbal learning and relational encoding and retrieval. Further, we found that chlorpromazine equivalency rates were significantly related to processing speed and working memory, while there were no significant relationships between anticholinergic load and performance on other tasks.
These findings add to a body of literature suggesting that cognitive deficits are an enduring aspect of schizophrenia, present in those off antipsychotic medications as well as those taking antipsychotic medications.
Indexing left ventricular mass to body surface area or height2.7 leads to inaccuracies in diagnosing left ventricular hypertrophy in obese children. Lean body mass predictive equations provide the opportunity to determine the utility of lean body mass in indexing left ventricular mass. Our objectives were to compare the diagnostic accuracy of predicted lean body mass, body surface area, and height in detecting abnormal left ventricle mass in obese children.
Obese non-hypertensive patients aged 4–21 years were recruited prospectively. Dual-energy X-ray absorptiometry was used to measure lean body mass. Height, weight, sex, race, and body mass index z-score were used to calculate predicted lean body mass.
We enrolled 328 patients. Average age was 12.6 ± 3.8 years. Measured lean body mass had the strongest relationship with left ventricular mass (R2 = 0.84, p < 0.01) compared to predicted lean body mass (R2 = 0.82, p < 0.01), body surface area (R2 = 0.80, p < 0.01), and height2.7 (R2 = 0.65, p < 0.01). Of the clinically derived variables, predicted lean body mass was the only measure to have an independent association with left ventricular mass (β = 0.90, p < 0.01). Predicted lean body mass was the most accurate scaling variable in detecting left ventricular hypertrophy (positive predictive value = 88%, negative predictive value = 99%).
Lean body mass is the strongest predictor of left ventricular mass in obese children. Predicted lean body mass is the most accurate anthropometric scaling variable for left ventricular mass in left ventricular hypertrophy detection. Predicted lean body mass should be considered for clinical use as the body size correcting variable for left ventricular mass in obese children.
In Canada, recreational use of cannabis was legalized in October 2018. This policy change along with recent publications evaluating the efficacy of cannabis for the medical treatment of epilepsy and media awareness about its use have increased the public interest about this agent. The Canadian League Against Epilepsy Medical Therapeutics Committee, along with a multidisciplinary group of experts and Canadian Epilepsy Alliance representatives, has developed a position statement about the use of medical cannabis for epilepsy. This article addresses the current Canadian legal framework, recent publications about its efficacy and safety profile, and our understanding of the clinical issues that should be considered when contemplating cannabis use for medical purposes.
The years between the early fourteenth and the mid sixteenth century are of considerable interest in the history of the prelate. In some respects, this era might be regarded as a golden age of prelacy, culminating in the appearance of great ecclesiastical dignitaries across much of Europe, such as Wolsey, d'Amboise, Cisneros, Lang and Jagiellon. In terms of their political weight, their grandeur and their wide-ranging cultural patronage, these early sixteenth-century ‘cardinal-ministers’ arguably represented a high point in prelatical influence. Nor should they be regarded as wholly distinct from their clerical contemporaries: recent studies of Renaissance cardinals and the early Tudor episcopate indicate that the next rank of senior churchmen were no less concerned to express the importance and dignity of their office. However, the period c. 1300–c. 1560 also witnessed a developing critique of prelacy – not unconnected with these eye-catching assertions of ecclesiastical status and power – with complaints about senior members of the Church hierarchy a commonplace in the literature and preaching of the day. To these criticisms were added attacks on the very concept of the prelate, which was rejected as unscriptural by John Wyclif and his followers: a critique which would be taken up enthusiastically by sixteenth-century reformers in England and Europe.
This volume has grown out of a conference on ‘The Prelate in Late Medieval and Reformation England’, held at the University of Liverpool in September 2011. All the papers delivered at that conference are published below, apart from those given by Natalia Nowakowska and Brigitte Resl. The volume also includes a chapter by Cédric Michon, offered subsequent to the Liverpool conference. I would like to thank the contributors to both the conference and to the volume, all of whom have been stimulating and good-humoured collaborators throughout this project.
I would also like to acknowledge gratefully the work and expert guidance of all those at Boydell & Brewer and York Medieval Press who have been involved with this volume and especially Caroline Palmer, Rohais Haughton and Professor Peter Biller. The Liverpool conference was funded partly by a British Academy Research Development Award, and partly by financial contributions from the department of History of the University of Liverpool and the Liverpool Centre for Medieval and Renaissance Studies, without all of whose generous support the event could not have taken place. This publication has also been made possible by a grant from the Scouloudi Foundation in association with the Institute of Historical Research, acknowledged here with gratitude.
High ecclesiastical office in the Middle Ages inevitably brought power, wealth and patronage. The essays in this volume examine how late medieval and Renaissance prelates deployed the income and influence of their offices, how they understood their role, and how they were viewed by others. Focusing primarily on but not exclusively confined to England, this collection explores the considerable common ground between cardinals, bishops and monastic superiors. Leading authorities on the late medieval and sixteenth-century Church analyse the political, cultural and pastoral activities of high-ranking churchmen, and consider how episcopal and abbatial expenditure was directed, justified and perceived. Overall, the collection enhances our understanding of ecclesiastical wealth and power in an era when the concept and role of the prelate were increasingly contested. Dr Martin Heale is Senior Lecturer in Late Medieval History, University of Liverpool. Contributors: Martin Heale, Michael Carter, James G. Clark, Gwilym Dodd, Felicity Heal, Anne Hudson, Emilia Jamroziak, Cédric Michon, Elizabeth A. New, Wendy Scase, Benjamin Thompson, C.M. Woolgar.