The role of Melancholia in prostate cancer patients' depression

BACKGROUND: Although it is well established that prostate cancer (PCa) patients are more likely to experience clinical depression than their age-matched non-prostate cancer peers, and that such depression can have negative effects upon survival, little is known about the underlying nature of the depressive symptomatology that these men experience. In particular, the incidence of melancholic symptoms of depression, which are signs of increased risk of suicide and resistance to treatment, has not previously been reported in PCa patients. The present study aimed to measure the incidence and nature of Melancholia in PCa depression. METHOD: A sample of 507 PCa patients in Queensland, Australia, completed anonymous and confidential questionnaires about their background, treatment status, and depression. Data were analysed to select depressive symptoms that were part of the definition of Melancholia vs those which were not. Regression was used to determine the links between Melancholia and overall depressive status, and factor analysis revealed the underlying components of Melancholia, which were mapped over time since diagnosis for 3 years. RESULTS: Psychometric data were satisfactory. Melancholia significantly predicted depressive status for the most depressed subset of patients, but not for the total sample. Melancholia was factored into its components of Anhedonia and Agitation, and the first of these was more powerful in predicting Melancholia. Variability over the 3 years following diagnosis was noted for each of these two components of Melancholia. CONCLUSIONS: The strong presence of Melancholia in the depressive symptomatology of this sample of PCa patients suggests that some forms of treatment for depression may be more likely to succeed than others. The dominance of Anhedonia and Agitation over other symptoms of Melancholia also holds implications for treatment options when assisting these men to cope with their depression

Factor structure of the Gotland Scale of male depression in two samples of men with prostate cancer:Implications for treating male depression

Up to a quarter of all prostate cancer (PCa) patients suffer from clinically significant depression but treatments are inconsistent and short-lived in their efficacy. One possible reason could be that 'male depression' is not adequately diagnosed by the criteria for major depressive disorder (MDD) used in many clinical settings.In response to this limitation, the Gotland Scale of Male Depression (GSMD) was developed to identify the extra symptoms of MDD in men. Although the factor structure of the GSMD has been reported in non-PCa samples, it has not been determined for this group of men. Two samples of PCa patients were recruited, 191 from Australia and 138 from the United Kingdom and all patients received the GSMD individually, plus a background questionnaire. Two-factor solutions were identified for each of the two samples. The Australian sample was characterized by changes in emotional and somatic function, followed by depressed mood. The U.K. sample exhibited the same two-factor solution but in reverse order of weighting. Targeted treatments for depression in PCa patients may benefit from identification of the loadings that individual patients have on these two GSMD factors so that specific clinical profiles and treatment needs may be based on this information about their depression

Local community perceptions of disaster tourism: the case of L'Aquila, Italy

Despite increasing research in dark tourism, few attempts have been made to explore local community perceptions of becoming the object of the dark tourist gaze, an issue that is of particular relevance at disaster sites given the potential sensitivity of local people to the intrusion of tourists in the aftermath of a disaster. This paper addresses this significant gap in the literature. Based on research undertaken in L'Aquila, an Italian city that in April 2009 suffered a devastating earthquake, it explores the responses of members of the local community to their city becoming a dark (disaster) tourism destination. In so doing, it reveals an evolving response towards tourism that not only contradicts traditional understandings of resident perceptions of tourism, but also points towards how appropriate responses to disaster tourism might support the disaster recovery process

A Portable Rainfall Simulator for Plot–Scale Runoff Studies

Rainfall simulators have a long history of successful use in both laboratory and field investigations. Many plot–scale simulators, however, have been difficult to operate and transport in the field, especially in remote locations where water or electricity is unavailable. This article describes a new rainfall simulator that is relatively easy to operate and transport to and from the field while maintaining critical intensity, distribution, and energy characteristics of natural rainfall. The simulator frame is constructed from lightweight aluminum pipe with a single 50 WSQ nozzle centered at a height of 3 m (9.8 ft). An operating nozzle pressure of 28 kPa (4.1 psi) yields continuous flow at an intensity of 70 mm h-1 (2.8 in. h-1 ) over a 1.5– x 2–m (4.9– x 6.6–ft) plot area with a coefficient of uniformity of 93%. Kinetic energy of the rainfall is about 25 J m-2 mm-1 (142.8 ft–lb ft-2 in.-1), approximately 87% of natural rainfall. The simulator can be easily transported by two field personnel and completely assembled or disassembled in approximately 10 min. Water usage is at a minimum as the simulator utilizes only one nozzle

How Accurately Can Prostate Gland Imaging Measure the Prostate Gland Volume? Results of a Systematic Review

Aim. The measurement of the volume of the prostate gland can have an influence on many clinical decisions. Various imaging methods have been used to measure it. Our aim was to conduct the first systematic review of their accuracy. Methods. The literature describing the accuracy of imaging methods for measuring the prostate gland volume was systematically reviewed. Articles were included if they compared volume measurements obtained by medical imaging with a reference volume measurement obtained after removal of the gland by radical prostatectomy. Correlation and concordance statistics were summarised. Results.28 articles describing 7768 patients were identified. The imaging methods were ultrasound, computed tomography, and magnetic resonance imaging (US, CT, and MRI). Wide variations were noted but most articles about US and CT provided correlation coefficients that lay between 0.70 and 0.90, while those describing MRI seemed slightly more accurate at 0.80-0.96. When concordance was reported,it was similar; over- and underestimation of the prostate were variably reported. Most studies showed evidence of at least moderate bias and the quality of the studies was highly variable. Discussion. The reported correlations were moderate to high in strength indicating that imaging is sufficiently accurate when quantitative measurements of prostate gland volume are required. MRI was slightly more accurate than the other methods

Nonpoint pollution of surface waters with phosphorus and nitrogen

Agriculture and urban activities are major sources of phosphorus and nitrogen to aquatic ecosystems. Atmospheric deposition further contributes as a source of N. These nonpoint inputs of nutrients are difficult to measure and regulate because they derive from activities dispersed over wide areas of land and are variable in time due to effects of weather. In aquatic ecosystems, these nutrients cause diverse problems such as toxic algal blooms, loss of oxygen, fish kills, loss of biodiversity (including species important for commerce and recreation), loss of aquatic plant beds and coral reefs, and other problems. Nutrient enrichment seriously degrades aquatic ecosystems and impairs the use of water for drinking, industry, agriculture, recreation, and other purposes. Based on our review of the scientific literature, we are certain that (1) eutrophication is a widespread problem in rivers, lakes, estuaries, and coastal oceans, caused by overenrichment with P and N; (2) nonpoint pollution, a major source of P and N to surface waters of the United States, results primarily from agriculture and urban activity, including industry; (3) inputs of P and N to agriculture in the form of fertilizers exceed outputs in produce in the United States and many other nations; (4) nutrient flows to aquatic ecosystems are directly related to animal stocking densities, and under high livestock densities, manure production exceeds the needs of crops to which the manure is applied; (5) excess fertilization and manure production cause a P surplus to accumulate in soil, some of which is transported to aquatic ecosystems; and (6) excess fertilization and manure production on agricultural lands create surplus N, which is mobile in many soils and often leaches to downstream aquatic ecosystems, and which can also volatilize to the atmosphere, redepositing elsewhere and eventually reaching aquatic ecosystems. If current practices continue, nonpoint pollution of surface waters is virtually certain to increase in the future. Such an outcome is not inevitable, however, because a number of technologies, land use practices, and conservation measures are capable of decreasing the flow of nonpoint P and N into surface waters. From our review of the available scientific information, we are confident that: (1) nonpoint pollution of surface waters with P and N could be reduced by reducing surplus nutrient flows in agricultural systems and processes, reducing agricultural and urban runoff by diverse methods, and reducing N emissions from fossil fuel burning; and (2) eutrophication can be reversed by decreasing input rates of P and N to aquatic ecosystems, but rates of recovery are highly variable among water bodies. Often, the eutrophic state is persistent, and recovery is slow

The Mini-Addenbrooke's Cognitive Examination: a new assessment tool for dementia.

BACKGROUND/AIMS: We developed and validated the Mini-Addenbrooke's Cognitive Examination (M-ACE) in dementia patients. Comparisons were also made with the Mini Mental State Examination (MMSE). METHOD: The M-ACE was developed using Mokken scaling analysis in 117 dementia patients [behavioural variant frontotemporal dementia (bvFTD), n = 25; primary progressive aphasia (PPA), n = 49; Alzheimer's disease (AD), n = 34; corticobasal syndrome (CBS), n = 9] and validated in an independent sample of 164 dementia patients (bvFTD, n = 23; PPA, n = 82; AD, n = 38; CBS, n = 21) and 78 controls, who also completed the MMSE. RESULTS: The M-ACE consists of 5 items with a maximum score of 30. Two cut-offs were identified: (1) ≤25/30 has both high sensitivity and specificity, and (2) ≤21/30 is almost certainly a score to have come from a dementia patient regardless of the clinical setting. The M-ACE is more sensitive than the MMSE and is less likely to have ceiling effects. CONCLUSION: The M-ACE is a brief and sensitive cognitive screening tool for dementia. Two cut-offs (25 or 21) are recommended.This work was supported by funding to Forefront, a collaborative research group dedicated to the study of frontotemporal dementia and motor neurone disease, by the National Health and Medical Research council (NHMRC) of Australia program grant (1037746) and the Australian Research Council (ARC) Centre of Excellence in Cognition and Its Disorders Memory Node (CE110001021). S.H. is supported by the Graham Linford Fellowship from the Motor Neurone Disease Research Institute of Australia. S.M. is supported by Alzheimer Scotland (PhD Studentship). F.L. is supported by an Australian Postgraduate Award (PhD Scholarship). K.D. is supported by NIHR Cambridge Biomedical Research Centre. S.A. is supported by the NIHR Biomedical Research Centre, Oxford. C.R.B. is supported by a Clinician Scientist Fellowship from the Medical Research Council (MR/K010395/1). J.B.R. is supported by the Wellcome Trust (088324), Medical Research Council, McDonnell Foundation and the NIHR (Cambridge Biomedical Research Centre and Biomedical Research Unit in Dementia). E.M. is supported by the NHMRC Early Career Fellowship (1016399) and Alzheimer Association USA. J.R.H. is supported by an ARC Federation Fellowship (FF0776229).This is the final version of the article. It first appeared from Karger via http://dx.doi.org/10.1159/00036604

Drivers of success in implementing sustainable tourism policies in urban areas

The existing literature in the field of sustainable tourism highlights a number of barriers that impede the implementation of policies in this area. Yet, not many studies have so far considered the factors that would contribute to putting this concept into practice, and few address the case of urban areas. The concept of sustainability has only received limited attention in urban tourism research, even though large cities are recognised as one of the most important tourist destinations that attract vast numbers of visitors. Adopting a case study approach, this paper discusses a number of drivers of success identified by policy-makers in London to contribute to the implementation of sustainable tourisms policies at the local level, and briefly looks at the relationship between these drivers and the constraints perceived by the respondents to hinder the implementation of such policies in practice. These findings may help policy-makers in other large cities to successfully develop and implement policies towards sustainable development of tourism in their area

Cyprus' image—a sun and sea destination—as a detrimental factor to seasonal fluctuations. Exploration into motivational factors for holidaying in Cyprus

Cyprus is established as a summer destination. To aid the destination in developing its winter season as well, this research uses a qualitative inductive approach to explore the tourists’ current image of the island and their motivations of visiting it. The research indicates that the current image, which essentially portrays Cyprus as a sun-and-sea destination is thought to dissuade tourists from perceiving the island as a year-round destination. Nonetheless, increasing the pull factors of the destination through the development of unique special interest products can help in extending the tourism season as well as broaden its narrow image