Prospective Trial of Water Vapor Thermal Therapy for Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia in Subjects with a Large Prostate: 6- and 12-month Outcomes.

Background: Current guidelines recommend Rezum water vapor thermal therapy for the treatment of benign prostatic hyperplasia (BPH) for prostate glands ranging in volume from 30 to 80 cm3. Few prospective studies have specifically evaluated the use of Rezum for larger prostates. Objective: To evaluate the safety and efficacy of water vapor thermal therapy in patients with a prostate gland >80 cm3 and ≤150 cm3. Design setting and participants: In this prospective, single-arm study at seven centers in the USA, subjects were males aged >50 yr with symptomatic BPH and prostate volume of >80 cm3 and ≤150 cm3. Intervention: Rezum was used to deliver sterile water vapor via a transurethral approach to ablate targeted areas of prostate tissue. Outcome measurements and statistical analysis: The primary efficacy outcome was response to therapy, defined on a per-patient basis as a ≥30% improvement in International Prostate Symptom Score (IPSS) from baseline to 6 mo. The primary safety outcome was a composite of serious device-related safety events. Secondary outcomes included catheterization for device-related retention. IPSS outcomes over time were analyzed via generalized estimating equations. Results and limitations: Among 47 eligible patients, prostate volume ranged from 80.8 to 148.1 cm3. All patients completed 6-mo follow-up, and 40/47completed 12-mo follow-up. At 6 mo, 83% were treatment responders according to the primary efficacy endpoint. The mean IPSS improvement at 6 mo was 11.9 ± 7.5 points, reflecting significant improvement. The primary safety outcome was met, with no occurrence of device-related composite safety events. The study is limited by the nonrandomized design and early termination, unrelated to safety or effectiveness. Conclusions: Our results are consistent with previous findings for prostate glands of up to 80 cm3, and indicate the safety and efficacy of Rezum for BPH in patients with a larger prostate. Patient summary: Rezum therapy, in which water vapor is used to treat targeted areas of the prostate, is currently recommended for patients with benign enlargement of the prostate and a prostate size of up to 80 cm3. We found that this treatment was also effective and safe in patients with a larger prostate of 80-150 cm3.

Similar crimes, similar behaviors? Comparing lone-actor terrorists and public mass murderers.

This article adds to the growth in data-driven analyses seeking to compare samples of violent extremists with other violent populations of interest. While lone-actor terrorists and public mass murderers are frequently treated as distinct offender types, both engage (or attempt to engage) in largely public and highly publicized acts of violence and often use similar weapons. This article investigates the (dis)similarities between both offender types. We use a series of bivariate and multivariate statistical analyses to compare demographic, psychologic and behavioral variables across 71 lone-actor terrorists and 115 public mass murderers. The results show little distinction in sociodemographic profiles, but significant differences in (a) the degree to which they interact with co-ideologues (b) antecedent event behaviors and (c) the degree to which they leak information before the attack. Overall, our data inform the emerging idea that lone-actor terrorists and public mass shooters are not distinct offender types. There is more that unites them than divides them. Although the over-arching focus of our results are on the few variables that distinguish them, the vast majority (80%+), of the 180+ variables showed no significant difference. We discuss implications for threat assessment and management in the context of these results.

Psychology of terrorism: Introduction to the special issue.

Despite the extraordinary social and political consequences often associated with terrorist violence, as well as our responses to it, psychological research on terrorist behavior is conspicuously underdeveloped. This special issue of American Psychologist presents a series of articles that showcase new conceptual, theoretical, and empirical advances in our understanding of terrorism. In doing so, it seeks to not merely summarize recent accomplishments, but to highlight the immense value of explicitly psychological research on these issues, far more of which is called for to realize the potential for informing solutions. (PsycINFO Database Record

Shooting Alone: The Pre-Attack Experiences and Behaviors of U.S. Solo Mass Murderers.

This paper outlines the sociodemographic, developmental, antecedent attack, attack preparation, and commission properties of 115 mass murderers between 1990 and 2014. The results indicate that mass murderer attacks are usually the culmination of a complex mix of personal, political, and social drivers that crystalize at the same time to drive the individual down the path of violent action. We specifically focus upon areas related to prior criminal engagement, leakage, and attack location familiarity. Whether the violence comes to fruition is usually a combination of the availability and vulnerability of suitable targets that suit the heady mix of personal and political grievances and the individual's capability to engage in an attack from both a psychological and technical capability standpoint. Many individual cases share a mixture of unfortunate personal life circumstances coupled with an intensification of beliefs/grievances that later developed into the idea to engage in violence.

Women's connectivity in extreme networks.

A popular stereotype is that women will play more minor roles than men as environments become more dangerous and aggressive. Our analysis of new longitudinal data sets from offline and online operational networks [for example, ISIS (Islamic State)] shows that although men dominate numerically, women emerge with superior network connectivity that can benefit the underlying system's robustness and survival. Our observations suggest new female-centric approaches that could be used to affect such networks. They also raise questions about how individual contributions in high-pressure systems are evaluated.

Actions Speak Louder than Words: A Behavioral Analysis of 183 Individuals Convicted for Terrorist Offenses in the United States from 1995 to 2012.

Involvement in terrorism has traditionally been discussed in relatively simplistic ways with little effort spent on developing a deeper understanding of what involvement actually entails, and how it differs from person to person. In this paper, we present the results of a three-year project focused on 183 individuals associated with the global jihadist movement who were convicted in the United States, for terrorist offenses, between 1995 and 2012. These data were developed by a large-scale, open-source data collection activity that involved a coding dictionary of more than 120 variables. We identify and explore the diversity of behaviors that constitute involvement in terrorism. We also compare lone actors and those who acted as part of a group, finding that lone actors differed from group-based actors in key demographic attributes and were more likely to be involved in attack execution behaviors. Implications for counterterrorism are then discussed.

Relation of psychosocial factors to diverse behaviors and attitudes among Somali refugees.

Refugee studies have examined both resilience and adverse outcomes, but no research has examined how different outcomes co-occur or are distinct, and the social-contextual factors that give rise to these diverse outcomes. The current study begins to address this gap by using latent profile analysis to examine the ways in which delinquency, gang involvement, civic engagement, political engagement, and openness to violent extremism cluster among Somali refugees. We then use multivariable regression analyses to examine how adversity (e.g., discrimination, trauma, and marginalization) is associated with the identified latent classes. Data were collected from 374 Somali refugee young adults (Mage = 21.30 years, SD = 2.90, range 18-30, 38% female) from 4 different North American communities. Participants completed a structured survey assessing their experiences of adversity, delinquent and/or violent attitudes and behaviors (e.g., attitudes toward violent extremism, participation in delinquent behaviors, involvement in gangs), and positive outcomes (e.g., civic and political engagement). Our findings indicate that participants fall into 5 distinct groups, and that social-contextual and individual factors are uniquely related to those groups. Specifically, strong social bonds seem to be associated with positive outcomes. These findings point to the need to further examine both positive and negative outcomes, paying special attention to social-contextual factors. (PsycINFO Database Record

Killing Range: Explaining Lethality Variance within a Terrorist Organization.

This paper presents an analysis of the Provisional Irish Republican Army's (PIRA) brigade level behavior during the Northern Ireland Conflict (1970-1998) and identifies the organizational factors that impact a brigade's lethality as measured via terrorist attacks. Key independent variables include levels of technical expertise, cadre age, counter-terrorism policies experienced, brigade size, and IED components and delivery methods. We find that technical expertise within a brigade allows for careful IED usage, which significantly minimizes civilian casualties (a specific strategic goal of PIRA) while increasing the ability to kill more high value targets with IEDs. Lethal counter-terrorism events also significantly affect a brigade's likelihood of killing both civilians and high-value targets but in different ways. Killing PIRA members significantly decreases IED fatalities but also significantly decreases the possibility of zero civilian IED-related deaths in a given year. Killing innocent Catholics in a Brigade's county significantly increases total and civilian IED fatalities. Together the results suggest the necessity to analyze dynamic situational variables that impact terrorist group behavior at the sub-unit level.

Construction and updating of a public events questionnaire for repeated measures longitudinal studies.

Impairments of retrospective memory and cases of retrograde amnesia are often seen in clinical settings. A measure of the proportion of memories retained over a specified time can be useful in clinical situations and public events questionnaires may be valuable in this respect. However, consistency of retention of public events memory has rarely been studied in the same participants. In addition, when used in a research context, public events questionnaires require updating to ensure questions are of equivalent age with respect to when the test is taken. This paper describes an approach to constructing and updating a Public Events Questionnaire (PEQ) for use with a sample that is recruited and followed-up over a long time-period. Internal consistency, parallel-form reliability, test-retest reliability, and secondary validity analyses were examined for three versions of the PEQ that were updated every 6 months. Versions 2 and 3 of the questionnaire were reliable across and within versions and for recall and recognition. Change over time was comparable across each version of the PEQ. These results show that PEQs can be regularly updated in a standardized fashion to allow use throughout studies with long recruitment periods.

Bombing alone: tracing the motivations and antecedent behaviors of lone-actor terrorists,.

This article analyzes the sociodemographic network characteristics and antecedent behaviors of 119 lone-actor terrorists. This marks a departure from existing analyses by largely focusing upon behavioral aspects of each offender. This article also examines whether lone-actor terrorists differ based on their ideologies or network connectivity. The analysis leads to seven conclusions. There was no uniform profile identified. In the time leading up to most lone-actor terrorist events, other people generally knew about the offender's grievance, extremist ideology, views, and/or intent to engage in violence. A wide range of activities and experiences preceded lone actors' plots or events. Many but not all lone-actor terrorists were socially isolated. Lone-actor terrorists regularly engaged in a detectable and observable range of activities with a wider pressure group, social movement, or terrorist organization. Lone-actor terrorist events were rarely sudden and impulsive. There were distinguishable behavioral differences between subgroups. The implications for policy conclude this article.

Comparative optimism among patients with coronary heart disease (CHD) is associated with fewer adverse clinical events 12 months later.

The current study evaluates the levels of comparative optimism among patients with coronary heart disease (CHD) and examines its relationship to health outcomes 12 months later. 164 patients completed self-report questionnaires at the end of cardiac rehabilitation and the number of adverse clinical events in the following 12 months were recorded. Comparative optimism was assessed in relation to a typical other who has not had cardiac event, a typical other who has had the same cardiac event as the respondent, and a typical member of the cardiac rehabilitation class. Clinical-demographic details and distress were assessed. Participants were comparatively optimistic in all three ratings. Logistic regression (controlling for age, gender, co-morbidities, and distress) revealed that higher levels of adverse events were associated with older age, being male, and lower levels of overall comparative optimism. Comparative optimism was associated with decreased risk of adverse clinical events in the year following cardiac rehabilitation attendance.

Simple mathematical law benchmarks human confrontations.

Many high-profile societal problems involve an individual or group repeatedly attacking another - from child-parent disputes, sexual violence against women, civil unrest, violent conflicts and acts of terror, to current cyber-attacks on national infrastructure and ultrafast cyber-trades attacking stockholders. There is an urgent need to quantify the likely severity and timing of such future acts, shed light on likely perpetrators, and identify intervention strategies. Here we present a combined analysis of multiple datasets across all these domains which account for >100,000 events, and show that a simple mathematical law can benchmark them all. We derive this benchmark and interpret it, using a minimal mechanistic model grounded by state-of-the-art fieldwork. Our findings provide quantitative predictions concerning future attacks; a tool to help detect common perpetrators and abnormal behaviors; insight into the trajectory of a 'lone wolf'; identification of a critical threshold for spreading a message or idea among perpetrators; an intervention strategy to erode the most lethal clusters; and more broadly, a quantitative starting point for cross-disciplinary theorizing about human aggression at the individual and group level, in both real and online worlds.

Organisational adaptation in an activist network: social networks, leadership, and change in al-Muhajiroun.

Social networks are said to facilitate learning and adaptation by providing the connections through which network nodes (or agents) share information and experience. Yet, our understanding of how this process unfolds in real-world networks remains underdeveloped. This paper explores this gap through a case study of al-Muhajiroun, an activist network that continues to call for the establishment of an Islamic state in Britain despite being formally outlawed by British authorities. Drawing on organisation theory and social network analysis, we formulate three hypotheses regarding the learning capacity and social network properties of al-Muhajiroun (AM) and its successor groups. We then test these hypotheses using mixed methods. Our methods combine quantitative analysis of three agent-based networks in AM measured for structural properties that facilitate learning, including connectedness, betweenness centrality and eigenvector centrality, with qualitative analysis of interviews with AM activists focusing organisational adaptation and learning. The results of these analyses confirm that al-Muhajiroun activists respond to government pressure by changing their operations, including creating new platforms under different names and adjusting leadership roles among movement veterans to accommodate their spiritual leader's unwelcome exodus to Lebanon. Simple as they are effective, these adaptations have allowed al-Muhajiroun and its successor groups to continue their activism in an increasingly hostile environment.

Relationship of initial level of distress to changes in health-related quality of life during cardiac rehabilitation or usual care.

OBJECTIVES: To assess the relationship between changes in health-related quality of life (HRQOL) and initial levels of distress in cardiac patients who received multidisciplinary cardiac rehabilitation (CR) or usual care. High rates of psychological distress have been reported in cardiac patients. METHODS: Cardiac patients completed a questionnaire battery at the start and finish of a CR program (n = 131) or at equivalent times after hospital discharge in comparison hospitals where CR was not available (n = 185). The questionnaire battery comprised the Hospital Anxiety and Depression Scale, the Health Complaints Scale, and the Quality of Life Index Cardiac Version III (QLI CV-III). RESULTS: Significant correlations between initial levels and subsequent changes in distress and HRQOL measures were found for both the CR and comparison groups. The CR program was associated with significant changes in both somatic and cognitive complaints for only those in distress. Changes in functional and psychological morbidity were greater in the CR group than in the comparison group. CONCLUSIONS: Changes in HRQOL were significantly related to the initial levels of distress found in cardiac patients, regardless of CR attendance. The CR program had beneficial effects on levels of functional ability and on psychological morbidity reduction. Implications of the research for CR outcomes assessment are considered.

Screening for abdominal aortic aneurysms in cardiovascular patients.

BACKGROUND: The objective of the study was to determine the incidence of Abdominal Aortic Aneurysms (AAA) in a population of symptomatic cardiac patients. A retrospective cohort study of investigations was done at the cardiology clinic, Beaumont Hospital, Dublin. MATERIALS AND METHODS: There were 415 men and women recruited by referral to the cardiology clinic. All participants underwent routine ultrasound screening for AAA, and full assessment of all cardiac risk factors. Data were analyzed and correlated with age, sex, and diagnosis. RESULTS: Ultrasonographic diagnosis of aneurysm was based on an anteroposterior diameter of 3 cm or more. Of the 415 patients screened, 47 aneurysms were detected. Total incidence of AAA was 9.9% (male 14.1%, female 3.95%). All aneurysms were detected in patients over 60 years, detection rate 11.7% (male 16.3%, female 3.9%). The incidence of AAA was significantly higher in those who were subsequently proven to have cardiovascular disease, 13.8% (male 18%, female 5.15%). CONCLUSION: Screening the general population for those at risk of AAA is an ongoing debate. This study supports the concept of screening a higher risk population of patients over 60 years with cardiovascular disease.

Responsiveness of health-related quality of life outcome measures in cardiac rehabilitation: comparison of cardiac rehabilitation outcome measures.

Assessment instruments that are not responsive to change are unsuitable as outcome tools in cardiac rehabilitation because they underestimate the psychosocial benefits of program attendance. Nine questionnaires were assessed for responsiveness with the standardized response mean (SRM). Questionnaires were allocated into 3 batteries, and each battery was completed by cardiac rehabilitation and comparison participants at 2 time points (411 and 375 participants in total, respectively). There was a high degree of variability in the responsiveness of instrument subscales. The positive affect subscale of the Global Mood Scale (J. Denollet, 1993a) was the most responsive (SRM = 0.62). Further information on the comparative responsiveness of psychosocial scales is important to optimize instrument selection for outcome studies.