Thornton D.,Research Unit
Psychology, Crime and Law | Year: 2016
The Propensities Model is now the dominant applied conceptualization of dynamic risk factors for sexual offending. In this paper five important limitations of this model are identified: it asserts causality but does not explain it; it does not represent human agency; it offers no account of what is involved in the development of propensities; it does not explain stable change in risk; and its account of the operation of static factors is a theoretical leap not supported by the evidence. A more elaborate theoretical framework is developed by integrating ideas from Ward's Good Lives model, Beck's account of schema modes, and Fishbein and Ajzen's Theory of Reasoned Action. This more elaborate framework incorporates the Propensities Model in a way that mitigates its limitations. Implications for research, assessment, and rehabilitation are explored. © 2015 Taylor & Francis.
Lucendo A.J.,Hospital General de Tomelloso |
Arias A.,Research Unit |
Molina-Infante J.,Hospital San Pedro de Alcantara
Clinical Gastroenterology and Hepatology | Year: 2016
Background & Aims: Proton pump inhibitor (PPI) therapy might lead to clinical and histologic remission in a significant proportion of patients with symptomatic esophageal eosinophilia (>15 eos/high-power field). We aimed to evaluate systematically the efficacy of PPI therapy for these patients. Methods: A search in MEDLINE, EMBASE, and SCOPUS databases, and the American Gastroenterological Association Institute, American College of Gastroenterology, and United European Gastroenterology meetings abstract books, was performed. Primary outcomes were clinical response and histologic remission (<15 eos/high-power field) after PPI therapy. Secondary outcomes were the influence on the response to PPIs of age group, study design/quality, PPI type, doses and interval dosing, and pH monitoring results. Data were pooled using a random-effects model. Results: Thirty-three studies (11 prospective studies) comprising 619 patients with symptomatic esophageal eosinophilia (188 children and 431 adults) were included. PPI therapy led to a clinical response in 60.8% (95% confidence interval, 48.38%-72.2%; I2 = 80.2) and histologic remission in 50.5% (95% confidence interval, 42.2%-58.7%; I2 = 67.5) of patients. No differences were observed regarding the study population (children vs adults), the type of publication, or its quality. PPIs were nonsignificantly more effective in prospective studies (52.6% vs 39.1%) administered twice daily compared with once daily (55.9% vs 49.7%), and with pathologic pH monitoring (65.4% vs 49.3%). A significant publication bias in favor of studies reporting histologic responses to PPIs was observed. Conclusions: PPI therapy induces clinicohistologic remission in half of patients with symptomatic esophageal eosinophilia. This finding should be interpreted with caution because of poor-quality evidence, heterogeneity, and publication bias. © 2016 AGA Institute.
Weinstein A.,Sourasky Medical Center |
Weizman A.,Research Unit
Current Psychiatry Reports | Year: 2012
Children's and adolescent's use of computer games and videogames is becoming highly popular and has increased dramatically over the last decade. There is growing evidence of high prevalence of addiction to computer games and videogames among children, which is causing concern because of its harmful consequences. There is also emerging evidence of an association between computer game and videogame addiction and attention deficit/hyperactivity disorder (ADHD). This is indicated by the occurrence of gaming addiction as a co-morbid disorder of ADHD, common physiological and pharmacological mechanisms, and potential genetic association between the two disorders. A proper understanding of the psychological and neurotransmitter mechanisms underlying both disorders is important for appropriate diagnostic classification of both disorders. Furthermore, it is important for development of potential pharmacological treatment of both disorders. Relatively few studies have investigated the common mechanisms for both disorders. This paper reviews new findings, trends, and developments in the field. The paper is based on a literature search, in Medline and PUBMED, using the keywords addictive gaming and ADHD, of articles published between 2000 and 2012. © Springer Science+Business Media, LLC 2012.
Shelbourne K.D.,Research Unit
The journal of knee surgery | Year: 2012
Many surgical methods are used for treating malaligned patella after patellar dislocation, but one surgical method may not be appropriate for all patients. The purpose of this study was to determine the radiographic and subjective outcomes of patients who underwent imbrication of redundant medial structures. A total of 42 patients met the inclusion criteria of suffering a traumatic, unilateral patellar dislocation and had no J-sign, no patella alta, asymmetry on Merchant view radiograph with normal patella alignment on the noninvolved side, and MRI showing injury to the medial retinaculum. Patients were prospectively evaluated. A total of 38 patients (mean age 19.2 years) completed follow-up evaluations at a mean of 31.7 months postoperatively. Mean congruence angle improved from 19.7° preoperatively to 5.4° postoperatively (p < 0.001) and was not statistically significantly different than the noninvolved knee of 4.1 (p = 0.5194). The mean linear displacement measurement improved from 6.0 mm preoperatively to 1.6 mm postoperatively (p < 0.001) and was not statistically significantly different than the noninvolved knee of 1.4 mm (p = 0.6294). Total 33 of 38 patients (87%) returned to their preinjury activity level including sports. Three patients had recurrence of patellar dislocation after surgery while playing sports. For patients who have the specific indications for imbrication of the medial retinaculum, surgery can be successful for re-establishing normal patellofemoral alignment and restoring function. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Hahn R.G.,Linkoping University |
Hahn R.G.,Research Unit
Acta Anaesthesiologica Scandinavica | Year: 2013
Intravenous fluid is life-saving in hypovolemic shock, but fluid sometimes aggravates the bleeding. During the past 25 years, animal models have helped our understanding of the mechanisms involved in this unexpected effect. A key issue is that vasoconstriction is insufficient to arrest the bleeding when damage is made to a major blood vessel. "Uncontrolled hemorrhage" is rather stopped by a blood clot formed at the outside surface of the vessel, and the immature clot is sensitive to mechanical and chemical interactions. The mortality increases if rebleeding occurs. In the aortic tear model in swine, hemorrhage volume and the mortality increase from effective restoration of the arterial pressure. The mortality vs. amount of fluid curve is U-shaped with higher mortality at either end. Without any fluid at all, irreversible shock causes death provided the hemorrhage is sufficiently large. Crystalloid fluid administered in a 3:1 proportion to the amount of lost blood initiates serious rebleeding. Hypertonic saline 7.5% in 6% dextran 70 (HSD) also provokes rebleeding resulting in higher mortality in the recommended dosage of 4ml/kg. Uncontrolled hemorrhage models in rats, except for the "cut-tail" model, confirm the results from swine. To avoid rebleeding, fluid programs should not aim to fully restore the arterial pressure, blood flow rates, or blood volume. For a hemorrhage of 1000ml, computer simulations show that deliberate hypovolemia (-300ml) would be achieved by infusing 600-750ml crystalloid fluid over 20-30min or 100ml of HSD over 10-20min in an adult male. © 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.