Psychological Normality or Abnormality: A Case Study on Salafi-Jihadists in the Middle-East.

The present study investigated Salafi-Jihadists in terms of mental health. The participants included 12 Salafi-Jihadists living in border areas of Iran, Kurdistan, selected using a purposeful sampling method. This primarily phenomenological case study gathered data, using open-ended interviews, field observations and in-depth clinical interviews. Results indicated that the participants reported no long-standing or acute mental or personality disorder. While they demonstrated abnormalities in their thought process and cognition, they were not severe enough to constitute symptoms of a mental disorder. The results indicate that situational and group factors, in conjunction with identifiable cognitive distortions, may play a more decisive role in fundamentalist radicalization than personality characteristics and mental disorders. Due to discrimination, feelings of oppression, cognitive distortions, and wrong attitudes toward other religious schools, some Muslims have decided to join Salafi-Jihad groups in order to feel a sense of belonging and identity.

Predoctoral prescriptive authority curricula: a training option.

The purpose of the current article is to encourage discussion among stakeholders about the viability and benefits of predoctoral prescriptive authority (RxP) training. The existing APA model curriculum for RxP training requires that such training is postdoctoral. However, predoctoral models are potentially viable and offer several distinct advantages: reducing the time and financial costs of training, attracting more applicants with a biopsychosocial orientation, and, as more individuals complete this training, enlarging the constituency for state prescriptive authority initiatives. Several possible predoctoral model curricula including the incorporation of a postdoctoral master's degree in clinical psychopharmacology are described within existing APA PhD program requirements, with suggested accommodations for PsyD programs. These are offered as alternatives to, rather than as replacements for, postdoctoral training for RxP.

Recruitment Process in Salafi-Jihadist Groups in the Middle East (A Qualitative Study).

Studies on the psychology of terrorism and fundamentalism place great importance on the role of groups, with a central concept of "us" versus "them." The present study examines how and why Salafi-jihadist groups in the Middle East have attracted typical citizens. The participants in this qualitative study were unremarkable Kurdish people living near the western borders of Iran with an allegiance toward Salafi-jihadist groups. We selected 12 people for the purposes of this study. Findings indicate that "group adaptation" and "rejection of the other" are the two overarching themes pointed out by the participants. Group adaptation included four sub-themes: (a) Idealization of, plus identification and assimilation with the leader, (b) developing strong group bonds, (c) direct and nonhierarchical agency of the individual in the group, and (d) group hypnotic suggestion. The "rejection of the other" included two sub-themes: (a) in-group rejection (reducing legitimate Islam to Salafism) and (b) out-group rejection (rejection of non-Muslims). The results of the study highlight the importance of a sense of belonging to the group in the process of recruitment and assimilation of individuals into jihadist groups. Findings also indicate that the concepts of adaptation and rejection play a pivotal role in the formation of fundamentalist Salafi-jihadist groups and resultant violence. We discuss the implications of group analysis for possible ways to counterterrorism.

Tarlov cysts: an overlooked clinical problem.

Symptomatic Tarlov cysts typically cause chronic pelvic and lower extremity pain and sacral nerve root radiculopathy. Historically, open surgical treatment involved significant patient morbidity, particularly postoperative cerebrospinal fluid (CSF) leaks and infection. These CSF leaks often required multiple surgical procedures to seal. Over the past 20 years, there have been two or three isolated case reports of computed tomography (CT)-guided needle aspirations that offered limited evidence of treatment efficacy and safety. Some have reported high rates of postprocedure aseptic meningitis that were not well explained. These poor results dissuaded physicians from caring for these patients. As a group these patients are usually treated dismissively and told their cysts are asymptomatic and their pain must be coming from somewhere else. Many of them have had an unnecessary discectomy or a spinal fusion, and when these procedures did not relieve their pain they were told they are a "failed back patient." We have treated more than a hundred patients with symptomatic Tarlov cysts by CT fluoroscopic-guided needle aspiration and fibrin injection and have had excellent results with no meaningful complications and never a case of aseptic meningitis. We believe this is a safe, highly effective first-line treatment for symptomatic Tarlov cysts.

An eight component decision-making model for problem gambling: a systems approach to stimulate integrative research.

Problem Gambling (PG) represents a serious problem for affected individuals, their families and society in general. Previous approaches to understanding PG have been confined to only a subset of the psychobiological factors influencing PG. We present a model that attempts to integrate potential causal factors across levels of organization, providing empirical evidence from the vast literature on PG and complimentary literatures in decision-making and addiction. The model posits that components are arranged systematically to bias decisions in favor of either immediately approaching or avoiding targets affording the opportunity for immediate reward. Dopamine, Testosterone and Endogenous Opioids favor immediate approach, while Serotonin and Cortisol favor inhibition. Glutamate is involved in associative learning between stimuli and promotes the approach response through its link to the DA reward system. GABA functions to monitor performance and curb impulsive decision-making. Finally, while very high levels of Norepinephrine can induce arousal to an extent that is detrimental to sound decision-making, the reactivity of the Norepinephrine system and its effects of Cortisol levels can shift the focus towards long-term consequences, thereby inhibiting impulsive decisions. Empirical evidence is provided showing the effects of each component on PG and decision-making across behavioural, neuropsychological, functional neuroimaging and genetic levels. Last, an effect size analysis of the growing pharmacotherapy literature is presented. It is hoped that this model will stimulate multi-level research to solidify our comprehension of biased decision-making in PG and suggest pharmacological and psychological approaches to treatment.

Supply/Demand in Radiology: A Historical Perspective and Comparison to other Labor Markets.

RATIONALE AND OBJECTIVES: There has been attention on the job market recently and on radiology's supply/demand calculus. Supply is influenced by the number of trained radiologists, while demand is driven by demographics and technological innovation. We analyze the supply of radiologists historically and compare to other labor markets-medical and non-medical, domestic and foreign. MATERIALS AND METHODS: We review National Resident Matching Program data in radiology and several other specialties from 1991 to 2015. We also review surveys, physician recruitment data, and peer-reviewed commentaries on medical specialty job markets. Trends are compared across specialties. The regulation of American medical training is compared to that in the United Kingdom and to a nonmedical labor market, unionized theatrical stage employees. RESULTS: Radiology residency positions have increased since 1998 despite a downturn in the job market. This expansion coincides with a decreasing percentage of positions filled by domestic graduates. A similar trend has been seen in pathology, a notoriously oversupplied specialty. Conversely, other specialties have maintained their proportion of domestic graduates by way of limited supply or implicit demand. CONCLUSIONS: The radiology job market is currently oversupplied, primarily a result of increasing residency positions despite indicators of decreasing demand. The percentage of residency positions filled by domestic graduates has decreased during the same period, suggesting that medical student interest is responsive to the market. Other specialties, particularly pathology, demonstrate the dangers of chronic oversupply. We advocate a reduction of radiology residency positions such that supply closely approximates demand without exceeding it. Additional measures may be taken, if necessary, to restore market equilibrium in the event of a mild undersupply.

Treatment considerations for vertebroplasty in men.

BACKGROUND AND PURPOSE: Vertebroplasty is now a widely accepted image-guided intervention in patients with compression fracture. The purpose of this report is to look specifically at the male population undergoing vertebroplasty and identfy the management considerations distinct to men. METHODS: The hospital medical records and radiographic studies of 24 men treated with vertebroplasty between February 1999 and November 2000 were retrospectively reviewed. RESULTS: Five patients presented with idiopathic or secondary osteoporosis. In two of these five men, malignancies were discovered by core biopsies taken at the time of vertebroplasty. Thirteen patients (54%) had secondary osteoporosis. Of this group, 10 patients (42%) were steroid dependent and three (13%) were hypogonadal. Five patients (21%) had traumatic events leading to fracture. One presented with known metastases. CONCLUSION: Primary osteoporosis in men is unusual. In male patients without a definable cause of osteoporosis, known metastatic disease, or a significant history of trauma, the routine performance of a vertebral biopsy through the vertebroplasty needle before the injection of bone cement is indicated to identify unexpected neoplasm.

A randomized treatment study to compare the efficacy of repeated nerve blocks with cognitive therapy for control of chronic head and neck pain.

This prospective study compared the efficacy of two antinociceptive modalities: nerve blocks and cognitive therapy. A consecutive series of patients receiving nerve block therapy was invited to take part in a six-week randomized comparison of nerve blocks and cognitive therapy. Sixty-eight of 102 patients approached by telephone agreed to participate. Patients attended eight weekly treatment sessions. Baseline and seven weekly sets of values were recorded. The principal measure of outcome was the Pain on a Visual Analogue Scale (VAS). The secondary measures were the Hospital Anxiety and Depression Scale, and the Activities of Daily Living as measured on the Primary Care Cooperative Information Project/World Organization of National Colleges, Academies (COOP-WONCA) scale. Within the first week, one patient of 34 in the nerve block group withdrew and 12 of 34 in the cognitive therapy group withdrew from the study. After seven weeks, 33 patients in the nerve block group remained in the trial, but only 21 patients completed the questionnaires. Four of 22 patients in the cognitive therapy group completed the trial and their questionnaires. Mean VAS scores in the nerve block group dropped slightly during treatment. Mean VAS scores in the cognitive therapy group rose during the trial. However, the mean VAS score of the remaining four in the last week was below the initial group mean. Patients who had been receiving nerve blocks proved willing to remain in the study if allocated to the nerve block group and unwilling to remain in the cognitive therapy group while foregoing their accustomed treatment.

Neuronal function is necessary but not sufficient for consciousness: consciousness is necessary for will.

Behavioral neuroscience has presented philosophers with the task of clarifying the relationship between neural determinism and free will. If neural functions encode information and govern decision-making, are the constructs of will, agency and indeed morality illusions of pre-scientific ignorance? This article will argue that neuronal function is necessary for representing distinct sensory-perceptual, cognitive, motivational, emotional states, and motor functions. However, neural transmission and action potentials are simply chemical-physical representations of these informational states but are not the embodiment of consciousness itself. By some yet undiscovered mechanism, consciousness "reads" the neuronal events into conscious experience. Absent a particular specialized brain region or sufficient relevant transmitters and receptors, relevant information cannot be processed and the individual cannot be conscious of that informational state. In natural and many artificial communication systems, communications proceed bi-directionally. By an argument of symmetry, if neuronal activity can communicate with consciousness, there is no reason to preclude consciousness from communicating back and influencing neuronal function. In the intervening conscious moment, information from diverse perceptual, motivational, cognitive, and emotional sources is weighted and will results. This process then biases resultant neural processes to actualize the willed target. This approach is limited in terms of operationalization into an experimental study because at present, there is no method to measure consciousness-independent of neuronal function and subjective report.

Development of a novel, ecologically oriented virtual reality measure of executive function: the Multitasking in the City Test.

A novel virtual reality executive function task (Multitasking in the City Test [MCT]) was developed with the aim of investigating planning and multitasking with ecological validity in mind in a normal population. Thirty healthy participants (21 females) completed a neuropsychological test battery that included the MCT along with standardized tests of executive and other cognitive functions. The sample performed within normal limits on the standardized tests. The MCT was performed successfully, although specific types of errors occurred frequently. Spearman correlation coefficients were computed between the various test measures. Only the plan score from the MCT was significantly associated with one of the executive function tests administered (Modified Six Elements Test), suggesting that both variables may be measuring a similar construct. Statistically significant correlations were also found between the MCT and the Trail-Making Test Part A and Judgment of Line Orientation, suggesting that "basic" cognitive functions such as information-processing speed and visuospatial skills are being tapped on the MCT. Preliminary evidence from this study suggested that the MCT may be an ecologically valid method of evaluating executive functioning. The clinical implications of these findings are discussed.

Ecologically valid assessment of executive dysfunction using a novel virtual reality task in patients with acquired brain injury.

The current investigation sought to further establish the psychometric properties and ecological validity of the Multitasking in the City Test (MCT) in a clinical population. Ecological validity was addressed via correlational analyses between performance on this test and a subjective measure of everyday executive functioning (Frontal Systems Behavior Scale; FrSBe). The sample was composed of 13 individuals (11 males) who suffered a stroke or traumatic brain injury. A neuropsychological test battery consisting of the MCT and common executive and nonexecutive measures was administered. The only executive function tests that were significantly related to the FrSBe were the MCT and a semantic fluency test. Compared with a sample of normal participants, the patient group produced better plans but completed fewer tasks on the MCT. Patients made similar types of errors as normals, although some of these errors occurred more frequently in the patient sample. This study demonstrated the ecological validity of the MCT and suggested that patients can be differentiated from healthy individuals by quantitative (i.e., number of errors) rather than qualitative (i.e., type of errors) aspects of performance. Further interpretation of MCT performance and comparison with existing executive function tests is discussed.

CT fluoroscopy: novel application for the treatment of ventricular pathologies.

INTRODUCTION: Recent advances in multidetector CT imaging (MDCT) provide real-time "fluoroscopic-like" capabilities with excellent spatial resolution. MDCT fluoroscopy expands our ability to perform image-guided interventions in anatomically complex locations. Although MDCT fluoroscopy is currently used at our institution for a variety of procedures ranging from spinal nerve blocks to RFA ablation, we believe these same techniques can be used to navigate within the ventricles of the central nervous system to treat conditions requiring placement of intraventricular catheters, depth electrodes, or potentially stents for the relief of CSF outlet obstruction. METHODS: Using three fresh, unfrozen human cadavers, we studied the feasibility of using MDCT fluoroscopy for intraventricular catheter placement and to stent the aqueduct of Sylvius. RESULTS: The ventricles were entered via a single needle pass and catheters were placed over the wire. Contrast agent was then injected to visualize the distribution. To stent the aqueduct of Sylvius, a wire was passed into the 4th ventricle and a coronary stent was then inserted over the wire and deployed. CONCLUSION: Based on our success with these procedures, we believe this technique can be used to limit complications and improve efficacy of a number of neurosurgical procedures.

Age as a differential characteristic of rapists, pedophiles, and sexual sadists.

In this study, we investigated the role of age in three categories of 168 sex offenders, including 53 rapists, 62 pedophiles, and 53 sadists. On the basis of the match between requisites of completing each type of sexual offense, we hypothesized that rapists would be less represented in the older age group, whereas pedophilic and sexually sadistic offenders would show a more muted decline with age. This hypothesis was supported by the data, clearly a showing smaller number of rapists in the over 40 group relative to the number of pedophiles and sadists (p = 0.0009.) Further examination of the files eliminated the alternate explanation ascribing this pattern to lack of opportunity in older rapists because of incarceration. These results suggest that age over 40 may mitigate incidence of recidivism in rapists, but not in pedophiles or sexual sadists. Approximately one third of the sexual sadists had committed either first- or second-degree murder, whereas none of the nonsadistic rapists or pedophiles had these crimes on their records. The data further justify categorization of sex offenders into nonsadistic rapist, sadistic rapist, and pedophilic offenders in future research to enhance precision in delineating demographic characteristics and putative causal explanations for sexual offending.

The chemistry of acrylic bone cements and implications for clinical use in image-guided therapy.

Advances in image-guided therapy for vertebral fractures and other bone-related disorders have made acrylic bone cement an integral part of the interventional armamentarium. Unfortunately, information on the properties and chemistry of these compounds is mostly published in the biomaterial sciences literature, a source with which the interventional community is generally unfamiliar. This review focuses on the chemistry of bone cement polymerization and the properties of components in polymethylmethacrylate (PMMA)-based polymers, the most commonly used bone cements in interventional procedures such as percutaneous vertebroplasty. The effects of altering the concentration of components such as methylmethacrylate monomers, PMMA beads, benzoyl peroxide activator, N,N-dimethyl-p-toluidine (DMPT) initiator, and radiopacifiers on the setting time, polymerization temperature, and compressive strength of the cement are also considered. This information will allow interventional radiologists to manipulate bone cement characteristics for specific applications and maximize the clinical potential of image-guided interventions.

A review of complications associated with vertebroplasty and kyphoplasty as reported to the Food and Drug Administration medical device related web site.

In 2002, approximately 38,000 vertebroplasties and 16,000 kyphoplasties were performed in the United States. As the use of both modalities for the treatment of vertebral compression fractures has increased, so have questions regarding safety and efficacy. The authors addressed this by reviewing both the current literature and complications data reported to the Food and Drug Administration (FDA) Center for Devices and Radiological Health through the on-line database (http://www.fda.gov/cdrh/maude.html) and through the Office of the Freedom of Information Act at the FDA. Although both procedures are largely safe, the FDA data highlight two main concerns: reactions to the use of acrylic (polymethylmethacrylate) bone cement, including hypotension and, in some cases, death, especially when multiple vertebral levels are treated in one setting; and a possible increased risk with kyphoplasty of pedicle fracture and cord compression.

[Detection of Cryptosporidium oocysts in goat kid faeces: comparison of a latex agglutination test with three other conventional techniques]. / Détection des oocystes de Cryptosporidium dans les fèces de caprins: comparaison entre un test d'agglutination au latex et trois autres techniques conventionnelles.

Detection of Cryptosporidium oocysts from goat kid faeces: comparison of a latex agglutination test with three other conventional techniques. A quantitative latex agglutination test (QLAT) with monoclonal antibodies for the detection of Cryptosporidium oocysts in faeces was compared with 3 other conventional techniques: Heine staining on faecal smears (HS) giving semi-quantitative results (scores from 1 to 5), sucrose flotation on diluted faeces (SF) with results expressed in oocysts/g of faeces (opg), direct ELISA (DE) giving qualitative results. Goat kid unconcentrated faecal samples (234) from 8 farms were processed according to the 4 techniques. Data were analyzed with Win Episcope 1.0 and Testview 1.1 softwares. The oocyst outputs ranged from 100 000 (detection limit for SF) to 200 millions opg (mean: 15.2 millions opg). A very good agreement was recorded between QLAT and HS, SF, DE: Kappa values ranged between 0.82 and 0.90. When considering the samples exhibiting oocysts (or not) as positive (or negative) using both HS and SF (n = 219), the sensitivity and specificity of QLAT were respectively 95.1 and 96.0%. The lack of sensitivity was observed in faeces harboring a few oocysts (< or = 200 000 opg, scores < or = 2) whereas the lack of specificity was only observed in 3 samples originating from the same farm. A significant correlation was calculated between the percentage of agglutination in QLAT and the number of oocysts in SF or scores in HS (Spearman correlation ranging from 0.45 to 0.48, p < 0.001). QLAT is a rapid, simple and reliable tool for routine detection of Cryptosporidium oocysts in faeces.