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The burden of common perinatal mental disorders (CPMD) in low-and-middle-income countries is substantially higher than high-income countries, with low levels of detection, service provision and treatment in resource-constrained settings. We describe the development of an ultra-short screening tool to detect antenatal depression, anxiety disorders and maternal suicidal ideation.
A sample of 376 women was recruited at a primary-level obstetric clinic. Five depression and anxiety symptom-screening questionnaires, demographics and psychosocial risk questionnaires were administered. All participants were assessed with the Mini-International Neuropsychiatric Interview (MINI), a structured, diagnostic interview. Screening tool items were analysed against diagnostic data using multiple logistic regression and receiver operating curve (ROC) analysis.
The prevalence of MINI-defined major depressive episode (MDE) and/or anxiety disorders was 33%. Overall, 18% of participants expressed suicidal ideation and behaviour, 54% of these had no depression or anxiety diagnosis. Multiple logistic regression identified four screening items that were independently predictive of MDE and anxiety disorders, investigating depressed mood, anhedonia, anxiety symptoms and suicidal ideation. ROC analysis of these combined items yielded an area under the curve of 0.83 (95% CI 0.78–0.88). A cut-off score of 2 or more offered a sensitivity of 78% and specificity of 82%.
This novel screening tool is the first measure of CPMD developed in South Africa to include depressed mood, anxiety symptoms and suicidal ideation. While the tool requires further investigation, it may be useful for the early identification of mental health symptoms and morbidity in the perinatal period.
Hendra virus (HeV) continues to cause fatal infection in horses and threaten infection in close-contact humans in eastern Australia. Species of Pteropus bats (flying-foxes) are the natural reservoir of the virus. We caught and sampled flying-foxes from a multispecies roost in southeast Queensland, Australia on eight occasions between June 2013 and June 2014. The effects of sample date, species, sex, age class, body condition score (BCS), pregnancy and lactation on HeV antibody prevalence, log-transformed median fluorescent intensity (lnMFI) values and HeV RNA status were assessed using unbalanced generalised linear models. A total of 1968 flying-foxes were sampled, comprising 1012 Pteropus alecto, 742 P. poliocephalus and 214 P. scapulatus. Sample date, species and age class were each statistically associated with HeV RNA status, antibody status and lnMFI values; BCS was statistically associated with HeV RNA status and antibody status. The findings support immunologically naïve sub-adult P. alecto playing an important role in maintaining HeV infection at a population level. The biological significance of the association between BCS and HeV RNA status, and BCS and HeV antibody status, is less clear and warrants further investigation. Contrary to previous studies, we found no direct association between HeV infection and pregnancy or lactation. The findings in P. poliocephalus suggest that HeV exposure in this species may not result in systemic infection and virus excretion, or alternatively, may reflect assay cross-reactivity with another (unidentified) henipavirus.
Overweight and obesity may increase risk of disease progression in men with prostate cancer, but there have been few studies of weight loss interventions in this patient group. In this study overweight or obese men treated for prostate cancer were randomised to a self-help diet and activity intervention with telephone-based dietitian support or a wait-list mini-intervention group. The intervention group had an initial group meeting, a supporting letter from their urological consultant, three telephone dietitian consultations at 4-week intervals, a pedometer and access to web-based diet and physical activity resources. At 12 weeks, men in both groups were given digital scales for providing follow-up weight measurements, and the wait-list group received a mini-intervention of the supporting letter, a pedometer and access to the web-based resources. Sixty-two men were randomised; fifty-four completed baseline and 12-week measurements, and fifty-one and twenty-seven provided measurements at 6 and 12 months, respectively. In a repeated-measures model, mean difference in weight change between groups (wait-list mini-intervention minus intervention) at 12 weeks was −2·13 (95 % CI −3·44, −0·82) kg (P = 0·002). At 12 months the corresponding value was −2·43 (95 % CI −4·50, −0·37) kg (P = 0·022). Mean difference in global quality of life score change between groups at 12 weeks was 12·3 (95 % CI 4·93, 19·7) (P = 0·002); at 12 months there were no significant differences between groups. Results suggest the potential of self-help diet and physical activity intervention with trained support for modest but sustained weight loss in this patient group.
Gastrointestinal and mental disorders are highly comorbid, and animal models have shown that both can be caused by early adversity (e.g., parental deprivation). Interactions between the brain and bacteria that live within the gastrointestinal system (the microbiome) underlie adversity–gastrointestinal–anxiety interactions, but these links have not been investigated during human development. In this study, we utilized data from a population of 344 youth (3–18 years old) who were raised with their biological parents or were exposed to early adverse caregiving experiences (i.e., institutional or foster care followed by international adoption) to explore adversity–gastrointestinal–anxiety associations. In Study 1, we demonstrated that previous adverse care experiences were associated with increased incidence of gastrointestinal symptoms in youth. Gastrointestinal symptoms were also associated with concurrent and future anxiety (measured across 5 years), and those gastrointestinal symptoms mediated the adversity–anxiety association at Time 1. In a subsample of children who provided both stool samples and functional magnetic resonance imaging of the brain (Study 2, which was a “proof-of-principle”), adversity was associated with changes in diversity (both alpha and beta) of microbial communities, and bacteria levels (adversity-associated and adversity-independent) were correlated with prefrontal cortex activation to emotional faces. Implications of these data for supporting youth mental health are discussed.
When Philip IV ordered the arrest of all Templars in France, he and his advisors set in motion a heresy inquisition of unprecedented ambition. Secret arrest orders accompanied by a set of vernacular instructions were sent to the king's secular agents across the kingdom on 14 September 1307. The inquisitor William of Paris followed with his own letter on 22 September, addressed to the Dominican inquisitors of Toulouse and Carcassonne, and to Dominican priors, subpriors, and lectors throughout the kingdom, asking them to stand ready to receive confessions. Arrests duly took place on 13 October. The plan was evidently to secure an overwhelming number of confessions as rapidly as possible and force Pope Clement V to condemn the Order of the Temple. The pope, however, first expressed his displeasure in a letter of 27 October, and on 22 November ordered that Templars across the rest of Europe be taken into custody for ecclesiastical trial. Clement then brought Philip IV and William of Paris up short in late January or early February 1308 by suspending the power of French inquisitors to act in this affair. When the pope finally agreed to restart the inquiries in July 1308, it was on his own terms, with such inquiries being entrusted to bishops working in concert with wider groups of churchmen.
Because the ‘Trial of the Templars’ in France has most often been studied as a conflict between Church and state rather than as an episode in the history of heresy and inquisition, it has gone largely unremarked that the events of fall 1307 amounted to an audacious effort to create a proto-national heresy inquisition in France. As Julien Théry has argued, the attack on the Templars must be understood within the decade-long drive to build a ‘royal theocracy’ with Philip IV as ‘pope in his kingdom’. But within this process of ‘pontificalizing’ the French monarchy, only in 1307 did the king and his men attempt to seize control of a crucial aspect of papal authority – the power to deploy heresy inquisition. Beginning in 1301, the attacks on Bishop Bernard Saisset, Pope Boniface VIII, the Templars, and Bishop Guichard of Troyes often used the language of heretical danger to represent the king as the defender of Christ against His enemies. But only the proceedings against the Templars invoked the authority of an inquisitor of heretical depravity.
For a millennium heresy has been central to ‘the making of European culture’. Indeed, claims for its centrality could be pushed back to well before the year 1000, to the Nicene Council and even earlier debates around the nature of Christian orthodoxy. But the formative battles of the Roman period were long past by the eleventh century when western Europe began its economic, demographic, and intellectual ‘leap’ forward toward the modern world. From the Gregorian reforms to the Protestant Reformation and beyond, heresies and heretics helped to shape the religious, political, and institutional structures that medieval Europe would bequeath to the modern West. Within this sweeping history, the late medieval period, traditionally understood as the fourteenth and fifteenth centuries, presents a particularly diverse array of heterodox movements and modes of thought. Yet despite this richness, or perhaps because of it, some of the most intriguing heresies and heretics from this era of ‘paradox, tension, and unpredictability’ have been undervalued in wider studies, treated either as epilogues to the better-studied twelfth and thirteenth centuries or as preludes to the epoch-making religious revolutions of the sixteenth.
This introduction first addresses the historiographic landscape of medieval heresy, focusing in particular on periodization and its consequences. Then, as befitting a collection honoring the pioneering work of Robert E. Lerner, it outlines the elements of a ‘Lernerian’ approach to late medieval heresy and suggests ways in which this approach informs the new perspectives presented here.
The Historiographic Landscape
The work of the German historian Herbert Grundmann (1902–70) has profoundly influenced scholars of medieval religious history, including – as Richard Kieckhefer's preface notes – Robert Lerner. For the field as a whole, Grundmann's most influential work was undoubtedly his brilliant 1935 study of Religiöse Bewegungen im Mittelalter, which analyzed ways in which groups that cohered around spiritual, intellectual, and cultural ideals shared by broad swathes of European society could still end up forced into dissent or at least labeled as dissidents. In this analysis, a figure such as Valdes of Lyon partook in the apostolic impulses that animated many twelfth-century figures, but when his refusal to abandon lay preaching led to condemnation, he and his followers were labeled as heretics, and many ultimately came to understand themselves as opponents of the organized Church.
Unusual speleothems, associated with hyperalkaline (pH > 12) groundwaters
have formed within a shallow, abandoned railway tunnel at Peak Dale,
Derbyshire, UK. The hyperalkaline groundwaters are produced by the leaching
of a thin layer (<2 m) of old lime-kiln waste on the soil-bedrock surface
above the tunnel by rainwater. This results in a different reaction and
chemical process to that more commonly associated with the formation of
calcium carbonate speleothems from Ca-HCO3-type groundwaters and
degassing of CO2. Stalagmites within the Peak Daletunnel have
grown rapidly (averaging 33 mm y–1), following the closure of the
tunnel 70 years ago. They have an unusual morphology comprising a central
sub-horizontally-laminated column of micro- to nano-crystalline calcium
carbonate encompassed by an outer sub-vertical assymetricripple-laminated
layer. The stalagmites are composed largely of secondary calcite forming
pseudomorphs (<1 mm) that we believe to be predominantly after the 'cold
climate' calcium carbonate polymorph, ikaite (calcium carbonate hexahydrate:
CaCO3·6H2O), withminor volumes of small (<5 μm)
pseudomorphs after vaterite. The tunnel has a near constant temperature of
8–9°C, which is slightly above the previously published crystallization
temperatures for ikaite (<6°C). Analysis of a stalagmite actively growing
at the time ofsampling, and preserved immediately within a dry nitrogen
cryogenic vessel, indicates that following crystallization of ikaite,
decomposition to calcite occurs rapidly, if not instantaneously. We believe
this is the first occurrence of this calcium carbonate polymorph observed
To develop consensus recommendations for training future clinician educators (CEs) in emergency medicine (EM).
A panel of EM education leaders was assembled from across Canada and met regularly by teleconference over the course of 1 year. Recommendations for CE training were drafted based on the panel’s experience, a literature review, and a survey of current and past EM education leaders in Canada. Feedback was sought from attendees at the Canadian Association of Emergency Physicians (CAEP) annual academic symposium. Recommendations were distributed to the society’s Academic Section for further feedback and updated by a consensus of the expert panel.
Recommendations were categorized for one of three audiences: 1) Future CEs; 2) Academic departments and divisions (AD&D) that support training to fulfill their education leadership goals; and 3) The CAEP Academic Section. Advanced medical education training is recommended for any emergency physician or resident who pursues an education leadership role. Individuals should seek out mentorship in making decisions about career opportunities and training options. AD&D should regularly perform a needs assessment of their future CE needs and identify and encourage potential individuals who fulfill education leadership roles. AD&D should develop training opportunities at their institution, provide support to complete this training, and advocate for the recognition of education scholarship in their institutional promotions process. The CAEP Academic Section should support mentorship of future CEs on a national scale.
These recommendations serve as a framework for training and supporting the next generation of Canadian EM medical educators.