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Neurobiological theories of psychopathy typically include abnormalities in paralimbic circuits, and a neurobiological profile of paralimbic dysfunction in increasingly invoked in applied legal settings. The current study systematically evaluated whether sMRI and fMRI findings in PCL-R defined psychopaths suggest paralimbic dysfunction. Our review indicates diffuse and variable neural correlates of psychopathy, with numerous issues complicating the interpretation of these heterogeneous data. Our review also extends previous discussions concerning how this heterogeneity may be related to sample characteristics, methodological variations, and statistical analyses. To elucidate the neural correlates of psychopathy, researchers may need to clarify the relationship between psychopathy and co-occurring conditions (such as substance use disorders) both conceptually and methodologically. Our review also indicates that caution is warranted when introducing these data in applied contexts. [ABSTRACT FROM AUTHOR]

Philosophers typically rely on empirical data when they comment on psychopaths' moral responsibility. Many argue that psychopaths, as per the data, suffer from significant impairments in the precursors of moral reasoning and behavior, and therefore they should not be held morally responsible for their actions. However, careful analysis of these studies shows that this view is mistaken. We discuss how several philosophers--perhaps following the lead of social scientists--have systematically misinterpreted or simplified psychological data to support their conclusions about psychopaths' responsibility. We discuss four data sources: Case studies, the moral/conventional distinction task, fear conditioning, and facial affect recognition experiments. We examine how errors in the interpretation of these data have influenced, for the worse, the moral responsibility discourse. We recommend that philosophers exercise more caution in drawing conclusions from the psychological data on psychopaths. [ABSTRACT FROM AUTHOR]

Though it has been argued that courts should admit biogenetic evidence on psychopathy, no research to date has evaluated whether individuals with clinical psychopathy have consistent genetic correlates. The current study: 1) systematically reviewed all quantitative and molecular genetic studies of PCL-R psychopathy, and 2) assessed the quality and reproducibility of findings. Using PRISMA guidelines, we reviewed 1 heritability and 15 molecular genetic studies of PCL-R psychopathy. Sample characteristics, research design, and the main findings of each study were qualitatively synthesized according to candidate neurotransmitter systems. We also assessed broad metrics of study quality such as sample generalizability, accounting for environmental or clinical variability in analyses, and replication of effects. Heritability estimates for the facets of clinical psychopathy were low. Molecular genetic findings were inconsistent and mostly unreplicated. Further, replicated findings were contradictory; elevated dopamine metabolite levels observed in independent samples was qualified by a lack of association between a candidate dopamine polymorphism and PCL-R scores. Inconsistent findings may be related to issues with study quality. Though most studies had clear hypotheses and generalizable samples, few accounted for clinical complexity of those samples, environmental factors, or gene-environment interplay. The current review suggests that the genetic bases of PCL-R psychopathy are not robust enough for forensic application. Genetic findings in people with antisocial characteristics (violence, addiction, CU traits) may not generalize to those with PCL-R psychopathy. Though genetic bases for psychopathy are widely accepted, we found very little evidence for consistent genetic correlates when we systematically reviewed studies of legally relevant PCL-R psychopathy. [ABSTRACT FROM AUTHOR]

Selecting the most appropriate patients to refer for surgery is crucial for high-quality and efficient clinical care. However, there are no specific referral criteria to guide the referral of appropriate patients for rotator cuff repair surgery. The aim of the present study was to design robust surgical referral criteria for patients with degenerative rotator cuff tears using consensus methodology. A two-round Delphi questionnaire was undertaken with a nationally representative sample of 41 specialist shoulder surgeons experienced in rotator cuff repair. Surgical referral criteria for degenerative rotator cuff tear were developed where consensus of at least 70% agreement was achieved. The initial questionnaire consisted of 24 items. Consensus was reached on 14 items, including: severity of pain, functional limitation, the identification of fat atrophy, agreement that a course of physiotherapy should be attempted before surgical referral, and exclusion for those with an active frozen shoulder. However, there was no consensus with regard to the dimensions of the tear. The surgical referral criteria developed were novel and promising for patients with degenerative rotator cuff tears, and further research is required to examine their efficacy. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Selecting the most appropriate patients to refer for surgery is crucial for high-quality and efficient clinical care. However, there are no specific referral criteria to guide the referral of appropriate patients for rotator cuff repair surgery. The aim of the present study was to design robust surgical referral criteria for patients with degenerative rotator cuff tears using consensus methodology. A two-round Delphi questionnaire was undertaken with a nationally representative sample of 41 specialist shoulder surgeons experienced in rotator cuff repair. Surgical referral criteria for degenerative rotator cuff tear were developed where consensus of at least 70% agreement was achieved. The initial questionnaire consisted of 24 items. Consensus was reached on 14 items, including: severity of pain, functional limitation, the identification of fat atrophy, agreement that a course of physiotherapy should be attempted before surgical referral, and exclusion for those with an active frozen shoulder. However, there was no consensus with regard to the dimensions of the tear. The surgical referral criteria developed were novel and promising for patients with degenerative rotator cuff tears, and further research is required to examine their efficacy. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract: In most chronic conditions, better health-related quality of life (HRQOL) is associated with higher socioeconomic status (SES) and ethnic majority status, with disadvantaged groups typically reporting lower HRQOL. In 163 children with intractable epilepsy, we evaluated the relationship between HRQOL and a broad spectrum of demographic variables (SES, parental education, gender, age, marital status, family size, and ethnic and linguistic status), in relation to known neurological and behavioral correlates of HRQOL. No demographic variable was found to be related to child HRQOL, except for marital status, where children from divorced/separated parents had lower HRQOL. However, marital status was not uniquely predictive of HRQOL when neurological and behavioral variables were taken into account. Exploratory analyses indicated that children of separated/divorced parents were more likely to have early epilepsy onset, lower adaptive/developmental levels, and worse seizure frequency, suggesting that severe epilepsy may be a risk factor for marital stress. In sum, contrary to research in other chronic conditions, sociodemographic variables in pediatric epilepsy were weak predictors of HRQOL in comparison to neurological and behavioral variables. The results are discussed with respect to epilepsy-specific determinants of HRQOL. [Copyright &y& Elsevier]

Health-related quality of life (HRQOL) is an important outcome measure in clinical research. Given the psychosocial and behavioral difficulties associated with pediatric epilepsy, evaluating HRQOL in this patient population is of particular importance. Though HRQOL has been examined in pediatric patients receiving focal resection or pharmacological (antiepileptic drug; AED) treatment, it has not been assessed in patients receiving hemispherectomy (HE) for intractable epilepsy. The current study evaluated HRQOL in a sample of pediatric HE cases (N = 26) using previously validated questionnaires relative to surgical (N = 30) and nonsurgical (N = 84) comparison groups. Compared with focal resection and nonsurgical patients, parents of children who received HE reported similar levels of HRQOL. In surgical cases, worse HRQOL was correlated with residual seizure frequency. In both surgical and nonsurgical cases, female gender, higher AED load, and lower functional independence predicted worse HRQOL. Interestingly, HE status (i.e., having undergone HE) predicted fewer epilepsy-related limitations. Consistent with previous findings, AED load, in addition to lower functional abilities, appear particularly detrimental to life quality in pediatric epilepsy. HE, however, is not associated with increased risk for poor HRQOL. When considered in light of the multiple, significant risk factors for poor outcome associated with HE, children who undergo the procedure fare surprisingly well. [ABSTRACT FROM AUTHOR]

The author reflects on challenges that physiotherapists in the musculoskeletal medicine profession face when attempting to demonstrate that they provide quality, cost effective services. She suggests that to demonstrate the value of the services of physiotherapists it may be necessary to consider more complex outcome measures. She argues that in an effort to prove the cost effectiveness of their services physiotherapists may need to analyze and publish their costs.

The article focuses on the impact of the introduction of supplementary prescribing on patient care. Most important feature of the supplementary prescribing framework is the clinical management plan. This plan differs from a patient group direction in that there is no requirement for other parties to be involved in implementation of the plan. It is therefore clear that the success or failure of supplementary prescribing is dependent on the clinical management plan and relationships between independent and supplementary prescribers. Supplementary prescribing will enable allied health professionals to practice safely and legally within a specific framework with significantly less bureaucracy.

This study examined the factor structure of the Beck Depression Inventory-II (BDI-II) in a sample of 127 individuals referred by their primary care physicians. Using exploratory factor analysis with oblique rotation, a 2-factor model appeared to be the most parsimonious representation of the data. The rotated factors accounted for approximately 53% of the variance. Consistent with previous research, the first factor was interpreted as a somatic-affective dimension and the second factor reflected a cognitive dimension. The correlation between these 2 factors was .79. It appears possible to divide the BDI-II into subscales to facilitate interpretation in medical patients. [ABSTRACT FROM AUTHOR]