The philosophy of Miguel de Unamuno

Thesis (Ph.D.)--Boston University, 1933. This item was digitized by the Internet Archive

Mapping Patterns and Trends in the Spatial Availability of Alcohol Using Low-Level Geographic Data: A Case Study in England 2003–2013

Much literature examines the relationship between the spatial availability of alcohol and alcohol-related harm. This study aims to address an important gap in this evidence by using detailed outlet data to examine recent temporal trends in the sociodemographic distribution of spatial availability for different types of alcohol outlet in England. Descriptive analysis of measures of alcohol outlet density and proximity using extremely high resolution market research data stratified by outlet type and quintiles of area-level deprivation from 2003, 2007, 2010 and 2013 was undertaken and hierarchical linear growth models fitted to explore the significance of socioeconomic differences. We find that overall availability of alcohol changed very little from 2003 to 2013 (density +1.6%), but this conceals conflicting trends by outlet type and area-level deprivation. Mean on-trade density has decreased substantially (−2.2 outlets within 1 km (Inter-Quartile Range (IQR) −3–0), although access to restaurants has increased (+1.0 outlets (IQR 0–1)), while off-trade access has risen substantially (+2.4 outlets (IQR 0–3)). Availability is highest in the most deprived areas (p < 0.0001) although these areas have also seen the greatest falls in on-trade outlet availability (p < 0.0001). This study underlines the importance of using detailed, low-level geographic data to understand patterns and trends in the spatial availability of alcohol. There are significant variations in these trends by outlet type and deprivation level which may have important implications for health inequalities and public health policy

Ecological Niche and Geographic Distribution of Human Monkeypox in Africa

Monkeypox virus, a zoonotic member of the genus Orthopoxviridae, can cause a severe, smallpox-like illness in humans. Monkeypox virus is thought to be endemic to forested areas of western and Central Africa. Considerably more is known about human monkeypox disease occurrence than about natural sylvatic cycles of this virus in non-human animal hosts. We use human monkeypox case data from Africa for 1970–2003 in an ecological niche modeling framework to construct predictive models of the ecological requirements and geographic distribution of monkeypox virus across West and Central Africa. Tests of internal predictive ability using different subsets of input data show the model to be highly robust and suggest that the distinct phylogenetic lineages of monkeypox in West Africa and Central Africa occupy similar ecological niches. High mean annual precipitation and low elevations were shown to be highly correlated with human monkeypox disease occurrence. The synthetic picture of the potential geographic distribution of human monkeypox in Africa resulting from this study should support ongoing epidemiologic and ecological studies, as well as help to guide public health intervention strategies to areas at highest risk for human monkeypox

Problem gamblers share deficits in impulsive decision-making with alcohol-dependent individuals

Aims: Problem gambling has been proposed to represent a ‘behavioural addiction’ that may provide key insights into vulnerability mechanisms underlying addiction in brains that are not affected by the damaging effects of drugs. Our aim was to investigate the neurocognitive profile of problem gambling in comparison with alcohol dependence. We reasoned that shared deficits across the two conditions may reflect underlying vulnerability mechanisms, whereas impairments specific to alcohol dependence may reflect cumulative effects of alcohol consumption. Design: Cross-sectional study. Setting: Out-patient addiction treatment centres and university behavioural testing facilities. Participants: A naturalistic sample of 21 male problem and pathological gamblers, 21 male alcohol-dependent out-patients and 21 healthy male control participants. Measurements: Neurocognitive battery assessing decision-making, impulsivity and working memory. Findings: The problem gamblers and alcohol-dependent groups displayed impairments in risky decision-making and cognitive impulsivity relative to controls. Working memory deficits and slowed deliberation times were specific to the alcohol-dependent group. Conclusions: Gambling and alcohol-dependent groups shared deficits in tasks linked to ventral prefrontal cortical dysfunction. Tasks loading on dorsolateral prefrontal cortex were selectively impaired in the alcohol-dependent group, presumably as a consequence of long-term alcohol use

Alcohol Sales and Risk of Serious Assault

In a population-based case-crossover analysis, Joel Ray and colleagues find that the risk of being a victim of serious assault increases with retail alcohol sales, especially among young urban men

Automatic detection and visualisation of MEG ripple oscillations in epilepsy

High frequency oscillations (HFOs, 80–500 Hz) in invasive EEG are a biomarker for the epileptic focus. Ripples (80–250 Hz) have also been identified in non-invasive MEG, yet detection is impeded by noise, their low occurrence rates, and the workload of visual analysis. We propose a method that identifies ripples in MEG through noise reduction, beamforming and automatic detection with minimal user effort. We analysed 15 min of presurgical resting-state interictal MEG data of 25 patients with epilepsy. The MEG signal-to-noise was improved by using a cross-validation signal space separation method, and by calculating ~ 2400 beamformer-based virtual sensors in the grey matter. Ripples in these sensors were automatically detected by an algorithm optimized for MEG. A small subset of the identified ripples was visually checked. Ripple locations were compared with MEG spike dipole locations and the resection area if available. Running the automatic detection algorithm resulted in on average 905 ripples per patient, of which on average 148 ripples were visually reviewed. Reviewing took approximately 5 min per patient, and identified ripples in 16 out of 25 patients. In 14 patients the ripple locations showed good or moderate concordance with the MEG spikes. For six out of eight patients who had surgery, the ripple locations showed concordance with the resection area: 4/5 with good outcome and 2/3 with poor outcome. Automatic ripple detection in beamformer-based virtual sensors is a feasible non-invasive tool for the identification of ripples in MEG. Our method requires minimal user effort and is easily applicable in a clinical setting

An exploratory randomised controlled trial of a premises-level intervention to reduce alcohol-related harm including violence in the United Kingdom

&lt;b&gt;Background&lt;/b&gt;&lt;p&gt;&lt;/p&gt; To assess the feasibility of a randomised controlled trial of a licensed premises intervention to reduce severe intoxication and disorder; to establish effect sizes and identify appropriate approaches to the development and maintenance of a rigorous research design and intervention implementation.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods&lt;/b&gt;&lt;p&gt;&lt;/p&gt; An exploratory two-armed parallel randomised controlled trial with a nested process evaluation. An audit of risk factors and a tailored action plan for high risk premises, with three month follow up audit and feedback. Thirty-two premises that had experienced at least one assault in the year prior to the intervention were recruited, match paired and randomly allocated to control or intervention group. Police violence data and data from a street survey of study premises’ customers, including measures of breath alcohol concentration and surveyor rated customer intoxication, were used to assess effect sizes for a future definitive trial. A nested process evaluation explored implementation barriers and the fidelity of the intervention with key stakeholders and senior staff in intervention premises using semi-structured interviews.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Results&lt;/b&gt;&lt;p&gt;&lt;/p&gt; The process evaluation indicated implementation barriers and low fidelity, with a reluctance to implement the intervention and to submit to a formal risk audit. Power calculations suggest the intervention effect on violence and subjective intoxication would be raised to significance with a study size of 517 premises.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusions&lt;/b&gt;&lt;p&gt;&lt;/p&gt; It is methodologically feasible to conduct randomised controlled trials where licensed premises are the unit of allocation. However, lack of enthusiasm in senior premises staff indicates the need for intervention enforcement, rather than voluntary agreements, and on-going strategies to promote sustainability

Alcohol outlet density and alcohol related hospital admissions in England: a national small-area level ecological study

BACKGROUND AND AIMS: Excessive alcohol consumption has a substantial impact on public health services. A key element determining alcohol availability is alcohol outlet density. This study investigated the relationship between on-trade and off-trade outlets and hospital admission rates in local neighbourhoods. DESIGN: National small-area level ecological study. SETTING AND PARTICIPANTS: All 32 482 lower layer super output census areas (LSOAs) in England (42 227 108 million people aged 15+ years). Densities for six outlet categories (outlets within a 1-km radius of residential postcode centroids, averaged for all postcodes within each LSOA) were calculated. MEASUREMENTS: Main outcome measures were admissions due to acute or chronic conditions wholly or partially attributable to alcohol consumption from 2002/03 to 2013/14. FINDINGS: There were 1 007 137 admissions wholly, and 2 153 874 admissions partially, attributable to alcohol over 12 years. After adjustment for confounding, higher densities of on-trade outlets (pubs, bars and nightclubs; restaurants licensed to sell alcohol; other on-trade outlets) and convenience stores were associated with higher admission rate ratios for acute and chronic wholly attributable conditions. For acute wholly attributable conditions, admission rate ratios were 13% (95% confidence interval = 11-15%), 9% (7-10%), 12% (10-14%) and 10% (9-12%) higher, respectively, in the highest relative to the lowest density categories by quartile. For chronic wholly attributable conditions, rate ratios were 22% (21-24%), 9% (7-11%), 19% (17-21%) and 7% (6-9%) higher, respectively. Supermarket density was associated with modestly higher acute and chronic admissions but other off-trade outlet density was associated only with higher admissions for chronic wholly attributable conditions. For partially attributable conditions, there were no strong patterns of association with outlet densities. CONCLUSIONS: In England, higher densities of several categories of alcohol outlets appear to be associated with higher hospital admission rates for conditions wholly attributable to alcohol consumption