Major Depressive Disorder, Suicidal Ideation, and Suicide Attempt in Twins Discordant for Cannabis Dependence and Early-Onset Cannabis Use

Background: Previous research has reported both a moderate degree of comorbidity between cannabis dependence and major depressive disorder (MDD) and that early-onset cannabis use is associated with increased risks for MDD. Objective: To examine whether associations between both lifetime cannabis dependence and early cannabis use and measures of MDD, suicidal ideation, and suicide attempt persist after controlling for genetic and/or shared environmental influences. Design: Cross-sectional survey of twin pairs discordant for lifetime cannabis dependence and those discordant for early cannabis use. Setting: General population sample of twins (median age, 30 years). Participants: Two hundred seventy-seven same-sex twin pairs discordant for cannabis dependence and 311 pairs discordant for early-onset cannabis use (before age 17 years). Main Outcome Measures: Self-report measures of DSM-IV-defined lifetime MDD, suicidal ideation, and suicide attempt. Results: Individuals who were cannabis dependent had odds of suicidal ideation and suicide attempt that were 2.5 to 2.9 times higher than those of their non-cannabis-dependent co-twin. Additionally, cannabis dependence was associated with elevated risks of MDD in dizygotic but not in monozygotic twins. Those who initiated cannabis use before age 17 years had elevated rates of subsequent suicide attempt (odds ratio, 3.5 [95% confidence interval, 1.4-8.6]) but not of MDD or suicidal ideation. Early MDD and suicidal ideation were significantly associated with subsequent risks of cannabis dependence in discordant dizygotic pairs but not in discordant monozygotic pairs. Conclusions: Comorbidity between cannabis dependence and MDD likely arises through shared genetic and environmental vulnerabilities predisposing to both outcomes. In contrast, associations between cannabis dependence and suicidal behaviors cannot be entirely explained by common predisposing genetic and/or shared environmental predispositions. Previously reported associations between early-onset cannabis use and subsequent MDD likely reflect shared genetic and environmental vulnerabilities, although it remains possible that early-onset cannabis use may predispose to suicide attempt.

Adam, pro-Adamites, and extra-terrestrial beings in early-modern Europe

This article examines the question of the existence of non-Adamic persons-both terrestrial and extra-terrestrial-in early modern Europe. More particularly it looks at how the existence of non-Adamites seriously called into question the credibility of the central themes of the Christian story of the creation, fall and redemption in Jesus Christ in early modern Europe. It analyses the impact on the Christian view of history caused by the discovery of the inhabitants of the New World, speculations about the polygenetic origins of the human race, and discussions about the plurality of worlds. It concludes with some reflections on the monogenetic and polygenetic accounts of the origin of humans in a post-Darwinian context.

Leadership through intellect:the meaning of leadership in the intellectual history of nineteenth and early twentieth century Germany

This study examines the understanding of leadership in Germany, as it developed throughout the nineteenth and early twentieth century. The investigation is based on the work of contemporary writers and thinkers, as well as on the leadership styles of key political figures. Given the ideological connotations of the term "Führung" in post-war Germany, the aim is to reconsider the meaning of leadership, with particular reference to the alternative notion of spiritual guidance. The rise to power of Napoleon I fundamentally influenced the understanding of leadership in Germany, as is demonstrated through an analysis of the Napoleonic reception in contemporary literature. Despite polarised responses, the formation of the heroic ideal may be identified, the quest for spiritual guidance having become subordinate to the charismatic legitimisation of political authority. As advocated by Thomas Carlyle, the mid to late nineteenth century witnessed the realisation of this ideal through Bismarck. The intellectual response to this development is characterised by the work of Wagner, Burckhardt and Nietzsche. In different ways each figure emphasised the need to redefine greatness and to seek spiritual guidance from alternative sources. The reflection on leadership in the early twentieth century is traced through the work of Harry Graf Kessler and the circles around Stefan George. Hitherto unpublished material is examined, revealing both the influences of nineteenth century thought and reactions to the "persönliches Regiment" of Wilhelm II. The intellectual debate culminates in Max Kommerell's 1928 study Der Dichter als Führer. Read in conjunction with unpublished notes and correspondence, this provides new insights into Kommerell's thought. The concept of poetic leadership constitutes a potential spiritual and intellectual alternative to the ideal of the political "Führer" which dominated the forthcoming era. It therefore remains of contemporary significance and may contribute to a broader discussion of the leadership dilemma in modern Germany.

Evaluation of hemifield sector analysis protocol in multifocal visual evoked potential (MFVEP) objective perimetry for the diagnosis and early detection of glaucomatous field defects

Visual field assessment is a core component of glaucoma diagnosis and monitoring, and the Standard Automated Perimetry (SAP) test is considered up until this moment, the gold standard of visual field assessment. Although SAP is a subjective assessment and has many pitfalls, it is being constantly used in the diagnosis of visual field loss in glaucoma. Multifocal visual evoked potential (mfVEP) is a newly introduced method used for visual field assessment objectively. Several analysis protocols have been tested to identify early visual field losses in glaucoma patients using the mfVEP technique, some were successful in detection of field defects, which were comparable to the standard SAP visual field assessment, and others were not very informative and needed more adjustment and research work. In this study, we implemented a novel analysis approach and evaluated its validity and whether it could be used effectively for early detection of visual field defects in glaucoma. OBJECTIVES: The purpose of this study is to examine the effectiveness of a new analysis method in the Multi-Focal Visual Evoked Potential (mfVEP) when it is used for the objective assessment of the visual field in glaucoma patients, compared to the gold standard technique. METHODS: 3 groups were tested in this study; normal controls (38 eyes), glaucoma patients (36 eyes) and glaucoma suspect patients (38 eyes). All subjects had a two standard Humphrey visual field HFA test 24-2 and a single mfVEP test undertaken in one session. Analysis of the mfVEP results was done using the new analysis protocol; the Hemifield Sector Analysis HSA protocol. Analysis of the HFA was done using the standard grading system. RESULTS: Analysis of mfVEP results showed that there was a statistically significant difference between the 3 groups in the mean signal to noise ratio SNR (ANOVA p<0.001 with a 95% CI). The difference between superior and inferior hemispheres in all subjects were all statistically significant in the glaucoma patient group 11/11 sectors (t-test p<0.001), partially significant 5/11 (t-test p<0.01) and no statistical difference between most sectors in normal group (only 1/11 was significant) (t-test p<0.9). sensitivity and specificity of the HAS protocol in detecting glaucoma was 97% and 86% respectively, while for glaucoma suspect were 89% and 79%. DISCUSSION: The results showed that the new analysis protocol was able to confirm already existing field defects detected by standard HFA, was able to differentiate between the 3 study groups with a clear distinction between normal and patients with suspected glaucoma; however the distinction between normal and glaucoma patients was especially clear and significant. CONCLUSION: The new HSA protocol used in the mfVEP testing can be used to detect glaucomatous visual field defects in both glaucoma and glaucoma suspect patient. Using this protocol can provide information about focal visual field differences across the horizontal midline, which can be utilized to differentiate between glaucoma and normal subjects. Sensitivity and specificity of the mfVEP test showed very promising results and correlated with other anatomical changes in glaucoma field loss.

Evaluation of hemifield sector analysis protocol in multifocal visual evoked potential objective perimetry for the diagnosis and early detection of glaucomatous field defects

CONCLUSIONS: The new HSA protocol used in the mfVEP testing can be applied to detect glaucomatous visual field defects in both glaucoma and glaucoma suspect patients. Using this protocol can provide information about focal visual field differences across the horizontal midline, which can be utilized to differentiate between glaucoma and normal subjects. Sensitivity and specificity of the mfVEP test showed very promising results and correlated with other anatomical changes in glaucoma field loss. PURPOSE: Multifocal visual evoked potential (mfVEP) is a newly introduced method used for objective visual field assessment. Several analysis protocols have been tested to identify early visual field losses in glaucoma patients using the mfVEP technique, some were successful in detection of field defects, which were comparable to the standard automated perimetry (SAP) visual field assessment, and others were not very informative and needed more adjustment and research work. In this study we implemented a novel analysis approach and evaluated its validity and whether it could be used effectively for early detection of visual field defects in glaucoma. METHODS: Three groups were tested in this study; normal controls (38 eyes), glaucoma patients (36 eyes) and glaucoma suspect patients (38 eyes). All subjects had a two standard Humphrey field analyzer (HFA) test 24-2 and a single mfVEP test undertaken in one session. Analysis of the mfVEP results was done using the new analysis protocol; the hemifield sector analysis (HSA) protocol. Analysis of the HFA was done using the standard grading system. RESULTS: Analysis of mfVEP results showed that there was a statistically significant difference between the three groups in the mean signal to noise ratio (ANOVA test, p < 0.001 with a 95% confidence interval). The difference between superior and inferior hemispheres in all subjects were statistically significant in the glaucoma patient group in all 11 sectors (t-test, p < 0.001), partially significant in 5 / 11 (t-test, p < 0.01), and no statistical difference in most sectors of the normal group (1 / 11 sectors was significant, t-test, p < 0.9). Sensitivity and specificity of the HSA protocol in detecting glaucoma was 97% and 86%, respectively, and for glaucoma suspect patients the values were 89% and 79%, respectively.

Global variations and time trends in the prevalence of childhood myopia, a systematic review and quantitative meta-analysis:implications for aetiology and early prevention

The aim of this review was to quantify the global variation in childhood myopia prevalence over time taking account of demographic and study design factors. A systematic review identified population-based surveys with estimates of childhood myopia prevalence published by February 2015. Multilevel binomial logistic regression of log odds of myopia was used to examine the association with age, gender, urban versus rural setting and survey year, among populations of different ethnic origins, adjusting for study design factors. 143 published articles (42 countries, 374 349 subjects aged 1- 18 years, 74 847 myopia cases) were included. Increase in myopia prevalence with age varied by ethnicity. East Asians showed the highest prevalence, reaching 69% (95% credible intervals (CrI) 61% to 77%) at 15 years of age (86% among Singaporean-Chinese). Blacks in Africa had the lowest prevalence; 5.5% at 15 years (95% CrI 3% to 9%). Time trends in myopia prevalence over the last decade were small in whites, increased by 23% in East Asians, with a weaker increase among South Asians. Children from urban environments have 2.6 times the odds of myopia compared with those from rural environments. In whites and East Asians sex differences emerge at about 9 years of age; by late adolescence girls are twice as likely as boys to be myopic. Marked ethnic differences in age-specific prevalence of myopia exist. Rapid increases in myopia prevalence over time, particularly in East Asians, combined with a universally higher risk of myopia in urban settings, suggest that environmental factors play an important role in myopia development, which may offer scope for prevention.

Where did we come from? The emergence and early development of voluntary sector studies in the UK

This article considers how the field of voluntary sector studies (VSS) in the UK emerged. Drawing on published and unpublished documents as well as on semi-structured interviews with people involved in the early development of VSS, a timeline of key events is suggested. The analysis reveals both social and cognitive elements in the field's development and considers the broader policy and institutional context within which key events of the VSS field occurred.

Town and Countryside in early modern Hungary The Case of Sopron, c. 1500-1800

The town of Sopron (Ödenburg) is situated near the western border of Hungary at the junction of major routes of commerce, no further than 70 km from Vienna. As early as in 1291 the town had become a chartered town or free royal town, which meant the most fully-fledged municipial autonomy in this period. The town was subordinated only to the king and could represent itself in parliament from 1445. The surrounding seigniorial towns and villages often lodged an appeal with the Town Court due to its wide legal autonomy. The inhabitants of seigniorial towns and the villagers could have been under the necessity of going to the town, and the legal proceedings they experienced in Sopron may have meant a model pattern for them. The seigniorial town (oppidum) is a settlement under the landlord's authority, with limited legal privileges, concentrated mostly on agricultural production and on the exchange of products of its immediate hinterland. Sopron as a county town was gradually becoming significant during the early modern period. The county (megye) was not only the unit of administration in Hungary, but that of the autonomy of nobility, too. The importance of Sopron as a county town attracted many noblemen dwelling in Sopron county to the town. The county was one of the most densely populated in the 15-18th c., at the beginning of the 18th c., for example, the density was 32 person/km2 and it rose more than 40 p/km2 by the end of the century. The population of Sopron was approximately 3500-3700 in the middle of the 15th c., and due to the decline during the later decades some 3000 persons lived in the town in the early 16th c. According to the first national census the population of Sopron was 12600 in 1784-87. These data place Sopron at the high level of Hungarian urban hierarchy in this period. This paper will explore two significant aspects of the relation between the town and its countryside: the problems of mutual economic dependence and the role of Sopron as a centre of culture.