To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
While research on men's mental health is increasing, it has not typically focused on the intersections between ageing, masculinity and mental health in a rural context. Given the significant increase not only in our global ageing population, but also our growing awareness of mental health problems in the general population, understanding men as they grow older in relation to mental health is a notable gap in research. In this paper, the authors explore the ageing experiences of male participants over 50 with self-identified mental health problems in rural Manitoba. We draw on semi-structured qualitative interviews from a larger project which focused on the diversity of rural men's perceptions, experiences and expressions of mental health and wellness. Specifically, we explore how these men reflect on their mental health and wellness. Participants in the study described their experiences as a cumulative process of making meaning, developing strategies, resources and a more positive sense of self – but sometimes also simply for survival. Men's sense of time over time – looking back and reflecting on the present and the future – appears to be a critical resource and a positive coping strategy for these men associated with ageing. The main themes include sustaining relationships; work, retirement and volunteering; and reflections on physical and emotional health. Our paper concludes with a discussion of the implications for new research on ageing men's mental health in a rural context.
Recognition of faces of family members, friends, and colleagues is an important skill essential for everyday life. Individuals affected by prosopagnosia (face blindness) have difficulty recognizing familiar individuals. The prevalence of prosopagnosia has been estimated to be as high as 3%. Prosopagnosia can severely impact the quality of life of those affected, and it has been suggested to co-occur with conditions such as depression and anxiety.
To determine real-world diagnostic frequency of prosopagnosia and the spectrum of its comorbidities, we utilized a large database of more than 7.5 million de-identified electronic health records (EHRs) from patients who received care at major academic health centers and Federally Qualified Health Centers in New York City. We designed a computable phenotype to search the database for diagnosed cases of prosopagnosia, revealing a total of n = 902 cases. In addition, data from a randomly sampled matched control population (n = 100,973) were drawn from the database for comparative analyses to study the condition’s comorbidity landscape. Diagnostic frequency of prosopagnosia, epidemiological characteristics, and comorbidity landscape were assessed.
We observed prosopagnosia diagnoses at a rate of 0.012% (12 per 100,000 individuals). We discovered elevated frequency of prosopagnosia diagnosis for individuals who carried certain comorbid conditions, such as personality disorder, depression, epilepsy, and anxiety. Moreover, prosopagnosia diagnoses increased with the number of comorbid conditions.
Results from this study show a wide range of comorbidities and suggest that prosopagnosia is vastly underdiagnosed. Findings imply important clinical consequences for the diagnosis and management of prosopagnosia as well as its comorbid conditions.
Catatonia is a frequent, complex and severe identifiable syndrome of motor dysregulation. However, its pathophysiology is poorly understood.
We aimed to provide a systematic review of all brain imaging studies (both structural and functional) in catatonia.
We identified 137 case reports and 18 group studies representing 186 individual patients with catatonia. Catatonia is often associated with brain imaging abnormalities (in more than 75% of cases). The majority of the case reports show diffuse lesions of white matter, in a wide range of brain regions. Most of the case reports of functional imaging usually show frontal, temporal, or basal ganglia hypoperfusion. These abnormalities appear to be alleviated after successful treatment of clinical symptoms. Structural brain magnetic resonance imaging studies are very scarce in the catatonia literature, mostly showing diffuse cerebral atrophy. Group studies assessing functional brain imaging after catatonic episodes show that emotional dysregulation is related to the GABAergic system, with hypoactivation of orbitofrontal cortex, hyperactivation of median prefrontal cortex, and dysconnectivity between frontal and motor areas.
In catatonia, brain imaging is abnormal in the majority of cases, and abnormalities more frequently diffuse than localised. Brain imaging studies published so far suffer from serious limitations and for now the different models presented in the literature do not explain most of the cases. There is an important need for further studies including a better clinical characterisation of patients with catatonia, functional imaging with concurrent catatonic symptoms and the use of novel brain imaging techniques.
The Rockefeller Clinical Scholars (KL2) program began in 1976 and transitioned into a 3-year Master’s degree program in 2006 when Rockefeller joined the National Institute of Health Clinical and Translational Science Award program. The program consists of ∼15 trainees supported by the Clinical and Translational Science Award KL2 award and University funds. It is designed to provide an optimal environment for junior translational investigators to develop team science and leadership skills by designing and performing a human subjects protocol under the supervision of a distinguished senior investigator mentor and a team of content expert educators. This is complemented by a tutorial focused on important translational skills.
Since 2006, 40 Clinical Scholars have graduated from the programs and gone on to careers in academia (72%), government service (5%), industry (15%), and private medical practice (3%); 2 (5%) remain in training programs; 39/40 remain in translational research careers with 23 National Institute of Health awards totaling $23 million, foundation and philanthropic support of $20.3 million, and foreign government and foundation support of $6 million. They have made wide ranging scientific discoveries and have endeavored to translate those discoveries into improved human health.
The Rockefeller Clinical Scholars (KL2) program provides one model for translational science training.
During left-sided breast radiotherapy, the heart is often exposed to radiation dose. Shielding can be utilised to reduce heart exposure, but compromises the dose delivered to the breast tissue and, in a proportion of patients, to the tumour bed. Deep inspiration breath hold (DIBH) can be used as a technique to move the heart away from the treatment area and thus reduce heart dose. This study examines the efficacy of the Elekta Active Breathing Coordinator (ABC), a DIBH method, in reducing heart dose.
Materials and methods
In total, 12 patients receiving radiotherapy to the left breast were planned for treatment with both a free-breathing (FB) and an ABC scan. The dose volume histogram data for the plans was analysed with respect to heart V13, V5 Gy, mean heart dose and ipsilateral lung V18 Gy. Tumour bed D98%, threshold lung volume in breath hold (BH) and the maximum BH time for each patient was also measured. Patients then received their radiotherapy treatment using the ABC plan and the systematic error in the craniocaudal, lateral and vertical axes was assessed using orthogonal imaging.
The median heart V13 Gy for FB and DIBH patients was 3% (range, 0·85–11·28) and 0% (range, 0–1·56), respectively, with a mean heart dose of 2·62 Gy (range, 1·21–4·93) in FB and 1·51 Gy (range, 1·17–2·22) in ABC. The median lung V18 Gy was 8·7% (3·08–14·87) in FB plans and 9% (4·88–12·82) in ABC plans. The mean systematic set-up errors in all three planes were within the departmental set-up tolerance of 5 mm for both techniques. Median FB tumour bed D98% was 97·4% (92·8–99·5) and 97·5% (97·3–98·5) for ABC.
ABC represents a good method of reducing radiation dose to the heart while not compromising on dose to the tumour bed, and it has a clear advantage over FB radiotherapy in reducing the risk of cardiac toxicity. It is tolerated well by patients and does not produce any difficulties in patient positioning.
Research has documented that religious minorities often face the brunt of religious discrimination. Yet formal tests, using global collections, have been lacking. Building on the religious economy theory and recent work in law and politics, we propose that minority religions face discrimination from the state because they represent unwanted competition for the state supported religion, are viewed as a threat to the state and larger culture, and lack support from an independent judiciary. Drawing on the recently collected Religion and State-Minorities collection on more than 500 minority religions, we find support for each of the propositions, though the level of support varies based on the targets of state discrimination. In general, the support is strongest when explaining discrimination against minority religion's institutions and clergy, but weakens when explaining more general discrimination against the membership.
Researchers are interested in running experiments in the Middle East and North Africa (MENA), which often include financially incentivized measures of risk preferences. However, it can be that gambling is forbidden and these measures may either be illegal or result in non-random refusal of subjects to participate. If individuals derive utility from warm glow or otherwise enjoy giving, then risk preferences apply to that utility too. Even in the absence of personal stakes, if risk will be borne by others, warm glow will lead subjects to behave in a manner consistent with their preferences over risk for private consumption. I examine how paid risk elicitation mechanisms correlate with measures incentivized by charitable contributions. Results suggest that subjects behave almost identically under paid and charitable stakes. Charitable measures may provide behavioral means by which to measure risk preferences, in populations where gambling is forbidden.
It is unclear whether body mass index (BMI) is a useful measurement for examining prostate motion. Patient’s subcutaneous adipose tissue thickness (SAT) and weight has been shown to correlate with prostate shifts in the left/right direction. We sought to analyse the relationship between BMI and interfraction prostate movement in order to determine planning target volume (PTV) margins based on patient BMI.
Materials and methods
In all, 38 prostate cancer patients with three implanted gold fiducial markers in their prostate were recruited. Height, mass and SAT were measured, and the extent of interfraction prostate movement in the left/right, superior/inferior and anterior/posterior directions was recorded during each daily fiducial marker-based image-guided radiotherapy treatment. Mean corrective shift in each direction for each patient, along with BMI values, were calculated.
The median BMI value was 28·4 kg/m2 (range 21·4–44·7). Pearson’s product-moment correlation analysis showed no significant relationship between BMI, mass or SAT and the extent of prostate movement in any direction. Linear regression analysis also showed no relationship between any of the patient variables and the extent of prostate movement in any direction (BMI: R2=0·006 (ρ=0·65), 0·002 (ρ=0·80) and 0·001 (ρ=0·86); mass: R2=0·001 (ρ=0·87), 0·010 (ρ=0·54) and 0·000 (ρ=0·99); SAT: R2=0·012 (ρ=0·51), 0·013 (ρ=0·50) and 0·047 (ρ=0·19) for shifts in the X, Y and Z axis, respectively). Patients were grouped according to BMI, as BMI<30 (n=25, 65·8%) and BMI≥30 (n=13, 34·2%). A two-tailed t-test showed no significant difference between the mean prostate shifts for the two groups in any direction (ρ=0·320, 0·839 and 0·325 for shifts in the X, Y and Z axis, respectively).
BMI is not a useful parameter for determining individualised PTV margins. Gold fiducial marker insertion should be used as standard to improve treatment accuracy.
The connection between the economy and vote choice continues to garner interest both in the academic and popular press. To isolate the effects of economic considerations, we develop a laboratory experiment that allows us to vary these considerations at three levels: the individual, community, and national economy. Choices by policymakers directly affect outcomes at each of these levels, allowing us to test for egotropic, “communotropic,” and sociotropic voting, as well as examine information search. We observe significant demand for information and that demand decreases with the complexity of the environment. Moreover, information demand is positively associated with other-regarding behavior.
IN R. v Golds  EWCA Crim 748, the Court of Appeal was asked to clarify the meaning of “substantially impaired” in the partial defence of diminished responsibility in murder cases. By virtue of s. 2(1) of the Homicide Act 1957, as amended by the Coroners and Justice Act 2009, s. 52, diminished responsibility is made out where:
(1) … D was suffering from an abnormality of mental functioning which –
(a) arose from a recognised medical condition,
(b) substantially impaired D's ability to do one or more of the things mentioned in subsection (1A), and
(c) provides an explanation for D's acts and omissions in doing or being a party to the killing.
(1A) Those things are –
to understand the nature of D's conduct;
to form a rational judgment;
to exercise self-control. …
The facts in Golds were tragically redolent of many such cases. Golds suffered from schizophrenia, and was said to live in fear of “everything” and to hear voices criticising and tormenting him. His partner (Claire) had registered to become his carer. He stopped taking his medication and his condition got steadily worse. On the fateful day, according to other witnesses, there was a difficult meeting with Claire and her family, and Golds later assaulted Claire at their home. Claire told Golds to leave, and they argued further over a bank card. Golds himself did not remember what happened next, but he fetched a knife and said that he would kill Claire, which he did (22 separate knife wounds were found on her body). When the police arrived, he said that Claire “had Satan in her eyes”.
There are several novels that pique our common interest, but Zola's ambition to put a ‘scientific aim above all others' in his 19th-century novel Thérèse Raquin provides a particularly interesting topic for collective reflection. After being criticised for vulgarity, in the preface to the second edition of his work Zola justified his portrayal of a gruesome ménage àtrois as being analogous to the ‘analytical work that surgeons conduct on cadavers'. Criticism of Zola's work often focuses on whether he achieves the degree of reductionism and determinism that he allegedly strove for or whether, in fact, his predilections for the gothic and fantastic overshadow the novel's scientific, ‘surgical’ veneer. Similarly, psychiatric case notes often begin with a highly formulaic scientific account, yet on closer inspection digress to read more like a tragic novel.
A superior cavopulmonary connection is commonly performed before the Fontan procedure in patients with a functionally univentricular heart. Data are limited regarding associations between a prior superior cavopulmonary connection and functional and ventricular performance late after the Fontan procedure.
We compared characteristics of those with and without prior superior cavopulmonary connection among 546 subjects enrolled in the Pediatric Heart Network Fontan Cross-Sectional Study. We further compared different superior cavopulmonary connection techniques: bidirectional cavopulmonary anastomosis (n equals 229), bilateral bidirectional cavopulmonary anastomosis (n equals 39), and hemi-Fontan (n equals 114).
A prior superior cavopulmonary connection was performed in 408 subjects (75%); the proportion differed by year of Fontan surgery and centre (p-value less than 0.0001 for each). The average age at Fontan was similar, 3.5 years in those with superior cavopulmonary connection versus 3.2 years in those without (p-value equals 0.4). The type of superior cavopulmonary connection varied by site (p-value less than 0.001) and was related to the type of Fontan procedure. Exercise performance, echocardiographic variables, and predominant rhythm did not differ by superior cavopulmonary connection status or among superior cavopulmonary connection types. Using a test of interaction, findings did not vary according to an underlying diagnosis of hypoplastic left heart syndrome.
After controlling for subject and era factors, most long-term outcomes in subjects with a prior superior cavopulmonary connection did not differ substantially from those without this procedure. The type of superior cavopulmonary connection varied significantly by centre, but late outcomes were similar.