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Understanding and Predicting Cadmium Yellow Pigment Failure Mechanisms in the Works of the Early Modernists Using STEM Methodologies
- Jennifer L. Mass, D.A. Levin Barnaby, Kayla X. Xguyen, Megan E. Holtz, Malcolm G. Thomas, Eva S. Tveit, Adam C. Finnefrock, Robert Opila, Thomas Beebe, Marcie Wiggins, David A. Muller
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- Journal:
- Microscopy and Microanalysis / Volume 24 / Issue S1 / August 2018
- Published online by Cambridge University Press:
- 01 August 2018, pp. 2122-2123
- Print publication:
- August 2018
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The Bangor Gambling Task: Characterising the Performance of Survivors of Traumatic Brain Injury
- Anna-Lynne Ruth Adlam, Malcolm Adams, Oliver Turnbull, Giles Yeates, Fergus Gracey
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- Journal:
- Brain Impairment / Volume 18 / Issue 1 / March 2017
- Published online by Cambridge University Press:
- 06 February 2017, pp. 62-73
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The Bangor Gambling Task (BGT, Bowman & Turnbull, 2004) is a simple test of emotion-based decision making, with contingencies varying across five blocks of 20 trials. This is the first study to characterise BGT performance in survivors of traumatic brain injury (TBI) relative to healthy controls. The study also aimed to explore sub-groups (cluster analysis), and identify predictors of task performance (multiple regression). Thirty survivors of TBI and thirty-nine controls completed the BGT and measures of processing speed, pre-morbid IQ, working memory, and executive function. Results showed that survivors of TBI made more gamble choices than controls (total BGT score), although the groups did not significantly differ when using a cut-off score for ‘impaired’ performance. Unexpectedly, the groups did not significantly differ in their performance across the blocks; however, the cluster analysis revealed three subgroups (with survivors of TBI and controls represented in each cluster). Findings also indicated that only age and group were significant predictors of overall BGT performance. In conclusion, the study findings are consistent with an individual difference account of emotion-based decision making, and a number of issues need to be addressed prior to recommending the clinical use of the BGT.
Cross-linking of sodium caseinate-structured emulsion with transglutaminase alters postprandial metabolic and appetite responses in healthy young individuals
- Kristiina R. Juvonen, Adam Macierzanka, Martina E. Lille, David E. Laaksonen, Hannu M. Mykkänen, Leo K. Niskanen, Jussi Pihlajamäki, Kari A. Mäkelä, Clare E. N. Mills, Alan R. Mackie, Paul Malcolm, Karl-Heinz Herzig, Kaisa S. Poutanen, Leila J. Karhunen
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- Journal:
- British Journal of Nutrition / Volume 114 / Issue 3 / 14 August 2015
- Published online by Cambridge University Press:
- 10 July 2015, pp. 418-429
- Print publication:
- 14 August 2015
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The physico-chemical and interfacial properties of fat emulsions influence lipid digestion and may affect postprandial responses. The aim of the present study was to determine the effects of the modification of the interfacial layer of a fat emulsion by cross-linking on postprandial metabolic and appetite responses. A total of fifteen healthy individuals (26·5 (sem 6·9) years and BMI 21·9 (sem 2·0) kg/m2) participated in a cross-over design experiment in which they consumed two isoenergetic (1924 kJ (460 kcal)) and isovolumic (250 g) emulsions stabilised with either sodium caseinate (Cas) or transglutaminase-cross-linked sodium caseinate (Cas-TG) in a randomised order. Blood samples were collected from the individuals at baseline and for 6 h postprandially for the determination of serum TAG and plasma NEFA, cholecystokinin (CCK), glucagon-like peptide 1 (GLP-1), glucose and insulin responses. Appetite was assessed using visual analogue scales. Postprandial TAG and NEFA responses and gastric emptying (GE) rates were comparable between the emulsions. CCK increased more after the ingestion of Cas-TG than after the ingestion of Cas (P< 0·05), while GLP-1 responses did not differ between the two test emulsions. Glucose and insulin profiles were lower after consuming Cas-TG than after consuming Cas (P< 0·05). The overall insulin, glucose and CCK responses, expressed as areas above/under the curve, did not differ significantly between the Cas and Cas-TG meal conditions. Satiety ratings were reduced and hunger, desire to eat and thirst ratings increased more after the ingestion of Cas-TG than after the ingestion of Cas (P< 0·05). The present results suggest that even a subtle structural modification of the interfacial layer of a fat emulsion can alter the early postprandial profiles of glucose, insulin, CCK, appetite and satiety through decreased protein digestion without affecting significantly on GE or overall lipid digestion.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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Service Use, Drop-Out Rate and Clinical Outcomes: A Comparison Between High and Low Intensity Treatments in an IAPT Service
- Stella W. Y. Chan, Malcolm Adams
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- Journal:
- Behavioural and Cognitive Psychotherapy / Volume 42 / Issue 6 / November 2014
- Published online by Cambridge University Press:
- 02 January 2014, pp. 747-759
- Print publication:
- November 2014
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Background: The IAPT services provide high and low intensity psychological treatments for adults suffering from depression and anxiety disorders using a stepped care model. The latest national evaluation study reported an average recovery rate of 42%. However, this figure varied widely between services, with better outcomes associated with higher “step-up” rates between low and high intensity treatments. Aims: This study aimed to compare the two intensity groups in an IAPT service in Suffolk. Method: This study adopted a between groups design. A sample of 100 service users was randomly selected from the data collected from an IAPT service in Suffolk between May 2008 and February 2011. The treatment outcomes, drop-out rate, and other characteristics were compared between those who received high and low intensity treatments. Results: The high intensity group received, on average, more sessions and contact time. They received more CBT sessions and less guided self-help. There were no group differences in terms of the drop-out and appointment cancellation rates. Analyses on clinical outcomes suggested no group difference but demonstrated an overall recovery rate of 52.6% and significant reduction in both depression and anxiety symptoms. Conclusions: Despite methodological limitations, this study concludes that the service as a whole achieved above-average clinical outcomes. Further research building upon the current study in unpacking the relative strengths and weaknesses for the high and low intensity treatments would be beneficial for service delivery.
Contributors
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- By Kristina Bentley, Richard Calland, Nyasha Chingore, Ben Cousins, Jackie Dugard, David Fig, Liesl Gerntholtz, Beth Goldblatt, Adam Habib, Ruth Hall, Zaheera Jinnah, Peris Jones, Malcolm Langford, Sandra Liebenberg, Jennifer MacLeod, Tshepo Madlingozi, Tara Polzer Ngwato, Solange Rosa, Stuart Wilson, Rachel Wynberg
- Edited by Malcolm Langford, Universitetet i Oslo, Ben Cousins, University of the Western Cape, South Africa, Jackie Dugard, University of the Witwatersrand, Johannesburg, Tshepo Madlingozi, University of Pretoria
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- Socio-Economic Rights in South Africa
- Published online:
- 05 December 2013
- Print publication:
- 18 November 2013, pp vii-xii
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- By Fred Adams, Kenneth Aizawa, Varol Akman, Murat Aydede, Lawrence W. Barsalou, William Bechtel, Henry Brighton, Jerome R. Busemeyer, William J. Clancey, Andy Clark, Frederica R. Conrey, Eric Dimperio, Chris Eliasmith, Shaun Gallagher, James G. Greeno, Paul Griffiths, Ryan K. Jessup, Michael P. Kaschak, David Kirsh, Malcolm A. MacIver, Ruth Millikan, Erik Myin, J. Kevin O’Regan, Jesse Prinz, Daniel Richardson, Philip Robbins, Mark Rowlands, Robert Rupert, R. Keith Sawyer, Andrea Scarantino, Eliot R. Smith, Michael Spivey, John Sutton, Peter M. Todd, Michael Tomasello, Barbara Tversky, Felix Warneken, Robert A. Wilson, Rolf A. Zwaan
- Edited by Philip Robbins, Washington University, St Louis, Murat Aydede, University of Florida
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- Book:
- The Cambridge Handbook of Situated Cognition
- Published online:
- 05 June 2012
- Print publication:
- 03 November 2008, pp ix-xii
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22 - Ovary
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- By Louise Hanna, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK, Malcolm Adams, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK
- Edited by Louise Hanna, Tom Crosby, Fergus Macbeth
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- Book:
- Practical Clinical Oncology
- Published online:
- 23 December 2009
- Print publication:
- 24 January 2008, pp 257-266
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Summary
Introduction
Ovarian cancer is the most common cause of death from gynaecological malignancy in the Western world. It has been named a ‘silent killer’ because of its lack of symptoms during early stages. Around 90% of ovarian cancers arise from the epithelium. Two-thirds of patients present late, with stage III or IV disease, with increasing abdominal symptoms including ascites. Typically, treatment depends on a combination of surgery and chemotherapy. Improvements in surgical techniques and chemotherapy agents have resulted in a modest increase in the 5-year survival over the past 30 years although, even now, two-thirds of women die from their disease.
Types of tumour affecting the ovary
The WHO classification of tumours of the ovary defines broad categories of ovarian tumours (WHO classification, 2003):
Surface epithelial-stromal tumours.
Sex cord-stromal tumours.
Germ cell tumours.
Tumours of the rete ovarii.
Miscellaneous tumours.
Lymphomas and haematopoietic tumours.
Secondary tumours.
Surface epithelial-stromal tumours are classified as benign, borderline or malignant. The subtypes are serous; mucinous; endometrioid, including malignant mixed müllerian tumour (carcinosarcoma); clear cell; transitional cell; squamous cell; mixed; and undifferentiated or unclassified.
Sex cord-stromal tumours are classified as granulosa-stromal cell tumours (including granulosa cell tumours and theca-fibroma tumours), sertoli-stromal cell tumours, sex-cord stromal tumours of mixed or unclassified cell types, and steroid cell tumours.
Germ cell tumours are classified as primitive germ cell tumours (including dysgerminoma, yolk sac tumour, and embryonal carcinoma), biphasic or triphasic teratomas (including immature teratoma and mature teratoma), and monodermal teratoma (composed of a single type of tissue and includes struma ovarii, which is composed of thyroid cells).
25 - Vagina
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- By Louise Hanna, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK, Malcolm Adams, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK
- Edited by Louise Hanna, Tom Crosby, Fergus Macbeth
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- Book:
- Practical Clinical Oncology
- Published online:
- 23 December 2009
- Print publication:
- 24 January 2008, pp 290-295
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Summary
Introduction
Primary carcinoma of the vagina is a rare condition that mainly affects older women. One of the main risk factors is persistent human papilloma virus (HPV) infection. Treatments are individualised, and treatment decisions are based on factors that include the site, size and stage of the tumour, and which adjacent structures are involved.
Tumours affecting the vagina
The most common malignant tumours affecting the vagina are tumours that have spread from adjacent structures (cervix and vulva). Table 25.1 shows the range of tumours that can affect the vagina (adapted from WHO Classification, 2003).
Anatomy
The vagina is a muscular tube about 8 cm long, and it extends upwards and backwards from the vulva to the uterus. The apex of the vagina, into which the cervix projects, is divided into four fornices: anterior, posterior, and two lateral.
The relations of the vagina from superior to inferior are as follows:
Anterior – bladder, urethra.
Posterior – pouch of Douglas, rectum, perineal body (separates lower vagina from anus).
Lateral – ureter, pelvic floor and perineal muscles.
The lymphatic drainage from the upper two-thirds is to the pelvic nodes, and from the lower third to the inguinal nodes.
Incidence and epidemiology
Vaginal cancer is rare; the annual disease incidence in the UK is 0.7 in 100,000 women. Approximately 180 new cases are diagnosed per year in England (National Statistics, 2005), and vaginal cancer accounts for approximately 1 to 2% of all gynaecological malignancy. The mortality-to-incidence ratio is 0.53 (National Statistics, 2005).
24 - Cervix
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- By Louise Hanna, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK, Malcolm Adams, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK
- Edited by Louise Hanna, Tom Crosby, Fergus Macbeth
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- Book:
- Practical Clinical Oncology
- Published online:
- 23 December 2009
- Print publication:
- 24 January 2008, pp 278-289
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Summary
Introduction
Cervical cancer is the most common cause of death from female malignancy worldwide. Overall it causes more than 273,000 deaths per year, accounting for 9% of all female cancer deaths. The incidence is highest in developing countries (Ferlay et al., 2004). The major risk factor is persistent human papilloma virus (HPV) infection, particularly types 16 and 18. In the UK the incidence of invasive disease has fallen as a result of cervical screening, and the mortality rates are 60% lower than they were 30 years ago.
For patients presenting with very early stage cancers (stages IA1 to IB1), surgery is the mainstay of treatment. For patients presenting with later-stage disease (IB2 to IVA), the recent standard treatment has become concurrent radiotherapy with cisplatin-based chemotherapy. The prognosis is strongly related to the stage of disease at presentation.
There is major interest in the prospect of cervical cancer prevention via the development of vaccines against HPV infection.
Types of cervical tumour
Cervical tumours can be benign, malignant primary or malignant secondary. The range of tumours is shown in Table 24.1.
Anatomy
The cervix is approximately 2.5 cm long and it is situated in the pelvis at the lower end of the uterus. The lower part of the cervix projects into the vagina. The bladder lies anteriorly, and the pouch of Douglas (which may contain small bowel) and the rectum, posteriorly.
23 - Body of the uterus
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- By Louise Hanna, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK, Malcolm Adams, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK
- Edited by Louise Hanna, Tom Crosby, Fergus Macbeth
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- Book:
- Practical Clinical Oncology
- Published online:
- 23 December 2009
- Print publication:
- 24 January 2008, pp 267-277
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Summary
Introduction
The most common tumour affecting the body of the uterus is endometrial adenocarcinoma. The major risk factor for disease is unopposed oestrogen stimulation of the endometrium, which is associated with obesity; because of this, endometrial cancer is more common among women in developed countries. Most patients present with stage I disease and have a good prognosis when treated with a combination of surgery and selective postoperative radiotherapy. Other tumours affecting the body of the uterus include the uterine sarcomas, a group of tumours that may arise from the endometrium or the myometrium. These are aggressive tumours but treatment may be curative for early stage disease.
Gestational trophoblastic tumours are discussed in Chapter 27.
Types of tumour affecting the uterus
Approximately 90% of endometrial cancers are carcinomas, and approximately 90% of these are adenocarcinomas. Types of uterine tumour are shown in Table 23.1.
Incidence and epidemiology
The annual incidence of uterine cancer is 14.9 in 100,000 (CRUK National Statistics; see info.cancerresearchuk.org, accessed September, 2006). In 2002 there were 5600 new cases of uterine cancer diagnosed in the UK. Uterine cancer accounts for 4% of all female malignancies. The disease is more common in the Western world than in developing countries and more common in women with high socioeconomic status and nulliparity. The high incidence has been linked with increasing levels of obesity and physical inactivity (Schouten et al., 2004). Endometrial carcinoma occurs typically in the postmenopausal age group, and the median age is 60 years.
26 - Vulva
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- By Louise Hanna, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK, Malcolm Adams, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK
- Edited by Louise Hanna, Tom Crosby, Fergus Macbeth
-
- Book:
- Practical Clinical Oncology
- Published online:
- 23 December 2009
- Print publication:
- 24 January 2008, pp 296-303
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Summary
Introduction
Carcinoma of the vulva is an uncommon disease. Approximately 75% of patients with vulval cancer are cured, but effective management requires the expertise of a multidisciplinary team to support patients through the physical and psychosexual morbidity that is associated with radical treatment.
Range of vulval tumours
Table 26.1 shows the large range of benign and malignant tumours which may affect the vulva (adapted from WHO, 2003).
Anatomy
The vulva is the name given to the female external genitalia. The anatomical subsites are as follow:
Mons pubis, the rounded hair-bearing region in front of the pubis.
Labia majora, the hair-bearing skin extending from the mons pubis.
Labia minora, the non-hair-bearing folds of skin that meet posteriorly at the fourchette.
Clitoris, situated in the midline at the anterior ends of the labia minora.
Vestibule, the triangular-shaped skin between the labia minora.
Incidence and epidemiology
The annual incidence of vulval cancer in the UK is 3.5 in 100,000 women (National Statistics, 2005). Approximately 880 cases are diagnosed in England each year. Vulval cancer makes up about 5% of all gynaecological cancers. Cancer mortality is approximately one-quarter of patients diagnosed. Disease incidence increases with age; presentation is very rare in women under the age of 30, with peak incidence occurring in women over the age of 70. The highest incidence occurs in underdeveloped countries.
Carcinoma of the vulva
Risk factors and aetiology
Squamous carcinoma is the most common malignant tumour of the vulva.
Contributors
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- By Isabella Aboderin, W. Andrew Achenbaum, Katherine R. Allen, Toni C. Antonucci, Sara Arber, Claudine Attias‐Donfut, Paul B. Baltes, Sandhi Maria Barreto, Vern L. Bengtson, Simon Biggs, Joanna Bornat, Julie B. Boron, Mike Boulton, Clive E. Bowman, Marjolein Broese van Groenou, Edna Brown, Robert N. Butler, Bill Bytheway, Neena L. Chappell, Neil Charness, Kaare Christensen, Peter G. Coleman, Ingrid Arnet Connidis, Neal E. Cutler, Sara J. Czaja, Svein Olav Daatland, Lia Susana Daichman, Adam Davey, Bleddyn Davies, Freya Dittmann‐Kohli, Glen H. Elder, Carroll L. Estes, Mike Featherstone, Amy Fiske, Alexandra Freund, Daphna Gans, Linda K. George, Roseann Giarrusso, Chris Gilleard, Jay Ginn, Edlira Gjonça, Elena L. Grigorenko, Jaber F. Gubrium, Sarah Harper, Jutta Heckhausen, Akiko Hashimoto, Jon Hendricks, Mike Hepworth, Charlotte Ikels, James S. Jackson, Yuri Jang, Bernard Jeune, Malcolm L. Johnson, Randi S. Jones, Alexandre Kalache, Robert L. Kane, Rosalie A. Kane, Ingrid Keller, Rose Anne Kenny, Thomas B. L. Kirkwood, Kees Knipscheer, Martin Kohli, Gisela Labouvie‐Vief, Kristina Larsson, Shu‐Chen Li, Charles F. Longino, Ariela Lowenstein, Erick McCarthy, Gerald E. McClearn, Brendan McCormack, Elizabeth MacKinlay, Alfons Marcoen, Michael Marmot, Tom Margrain, Victor W. Marshall, Elizabeth A. Maylor, Ruud ter Meulen, Harry R. Moody, Robert A. Neimeyer, Demi Patsios, Margaret J. Penning, Stephen A. Petrill, Chris Phillipson, Leonard W. Poon, Norella M. Putney, Jill Quadagno, Pat Rabbitt, Jennifer Reid Keene, Sandra G. Reynolds, Steven R. Sabat, Clive Seale, Merril Silverstein, Hannes B. Staehelin, Ursula M. Staudinger, Robert J. Sternberg, Debra Street, Philip Taylor, Fleur Thomése, Mats Thorslund, Jinzhou Tian, Theo van Tilburg, Fernando M. Torres‐Gil, Josy Ubachs‐Moust, Christina Victor, K. Warner Shaie, Anthony M. Warnes, James L. Werth, Sherry L. Willis, François‐Charles Wolff, Bob Woods
- Edited by Malcolm L. Johnson, University of Bristol
- Edited in association with Vern L. Bengtson, University of Southern California, Peter G. Coleman, University of Southampton, Thomas B. L. Kirkwood, University of Newcastle upon Tyne
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- Book:
- The Cambridge Handbook of Age and Ageing
- Published online:
- 05 June 2016
- Print publication:
- 01 December 2005, pp xii-xvi
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The Malaria Genome Sequencing Project
- Daniel J. Carucci, Malcolm J. Gardner, Herve Tettelin, Leda M. Cummings, Hamilton O. Smith, Mark D. Adams, Stephen L. Hoffman, J. Craig Venter
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- Journal:
- Expert Reviews in Molecular Medicine / Volume 1 / Issue 3 / 5 May 1998
- Published online by Cambridge University Press:
- 11 February 2004, pp. 1-9
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An international consortium of genome centres, advanced development teams and funding agencies has begun the task of sequencing the genome of the parasite Plasmodium falciparum, the most important cause of human malaria. Sequencing is proceeding chromosome by chromosome, and the annotated sequence of chromosome 2 is nearly finished. With the continual release of sequence data as they are generated, malaria researchers have access to a steady stream of genomic sequences and will soon have the complete annotation of all of the estimated 5000–7000 P. falciparum genes. The task will then be how to best apply these data to the development of new anti-malarial drugs, vaccines and diagnostic tests. This review provides a brief overview of the Malaria Genome Sequencing Project and suggests potential directions for future malaria research.
13 - Dendritic cell approaches to immunotherapy
- Edited by Peter L. Stern, Paterson Institute for Cancer Research, Manchester, Peter C. L. Beverley, University College London, Miles Carroll, Oxford BioMedica (UK) Ltd
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- Book:
- Cancer Vaccines and Immunotherapy
- Published online:
- 06 January 2010
- Print publication:
- 17 August 2000, pp 237-255
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Summary
Introduction
While the term ‘magic bullet’ has resulted in the association of cancer immunotherapy with the use of monoclonal antibodies to target tumours, it is clear that the most effective way to exploit the immune system to clear tumours is by generating tumour-specific cytotoxic T cells (CTLs). The major question for cancer immunotherapy must thus be, how can an effective antitumour CTL response best be elicited? The surprisingly universal answer that has emerged from a number of different studies is that this requires the stimulation of T cells by a specific antigen-presenting cell (APC), the dendritic cell (DC). DCs were first described as the morphologically distinct Langerhans cells in the skin and have since been shown to be the most efficient APC for the activation of naíve T cells. The main impetus for their study as APCs was the development of simple methods for the isolation of DC-precursors from blood and the expansion of these cells in vitro to yield potent APCs. For clinical researchers, DCs have the promise of providing a vehicle for effective anticancer immunotherapy. However, many questions remain. Is a defect in APC function a significant component of the failure of the immune system to eradicate cancer? Is the restoration of competent APC function sufficient to permit the execution of an effective CTL response (or is the augmentation of DC function sufficient to overcome other defects in a cell-mediated immune response to cancer)? What are the optimum schedules for the preparation and administration of DC?
CBT in a Group Format for Bi-Polar Affective Disorder
- Anne G. Palmer, Helga Williams, Malcolm Adams
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- Journal:
- Behavioural and Cognitive Psychotherapy / Volume 23 / Issue 2 / April 1995
- Published online by Cambridge University Press:
- 16 June 2009, pp. 153-168
- Print publication:
- April 1995
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The findings from this study indicate that group cognitive behavioural therapy combined with mood stabilizing medications was effective for some of the participants. Standard measures were used to monitor changes systematically and regularly. Self reports from participants suggested that they found the therapy useful and acceptable. The approach taken seems worth extending to a larger number of participants in a controlled trial, but meanwhile a detailed description of the treatment package is given, for wider dissemination of the methods.
The Problem of Detecting Changes in the Incidence of Schizophrenia
- R. E. Kendell, D. E. Malcolm, W. Adams
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- Journal:
- The British Journal of Psychiatry / Volume 162 / Issue 2 / February 1993
- Published online by Cambridge University Press:
- 02 January 2018, pp. 212-218
- Print publication:
- February 1993
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Despite reports of falling first-admission rates for schizophrenia in the UK and other Western countries, it would be rash to conclude that the incidence of schizophrenia is falling. An attempt was made to tackle the many methodological problems and sources of bias influencing the relationship between admission rates and incidence in an analysis of inception rates for schizophrenia and other psychoses in Edinburgh between 1971 and 1989. However it was calculated, the inception rate for schizophrenia fell significantly, but because there was evidence that diagnostic criteria for schizophrenia had narrowed between 1971 and 1989, and because a substantial and changing proportion of recorded first admissions were not true first admissions, it was impossible to conclude that the incidence of schizophrenia had fallen. Changes in the incidence of psychiatric syndromes are difficult to establish, particularly in retrospect, and future studies must pay more attention to the many possible confounding influences.
Bibliotherapy-based Dry Bed Training: A Pilot Study
- Stephen Hunt, Malcolm Adams
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- Journal:
- Behavioural and Cognitive Psychotherapy / Volume 17 / Issue 3 / July 1989
- Published online by Cambridge University Press:
- 16 June 2009, pp. 290-301
- Print publication:
- July 1989
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Dry Bed Training is an effective and rapid method for the elimination of primary nocturnal enuresis. However, like the urine alarm the approach demands very close clinical supervision. This is a Pilot Study to evaluate the effectiveness of a self-help approach (based on Dry Bed Training), administered using a minimum contact self-help manual, and a video in which a young mother and son demonstrated treatment techniques. Ten severe primary nocturnal enuretics, acting as their own controls, were treated using this approach. Results show initial remission in 80% of the cases, with 20% of the subjects dropping out. Of those who completed treatment 25% relapsed. These results were obtained with a significant reduction in staff time. The role of clinical supervision is critically examined. Elements of a cost-benefit analysis are identified in order to highlight the strengths and weaknesses of this approach.
Behaviour Modification for People with Mental Handicaps(2nd Edition)William Yule and Janet Carr (Eds), London: Croom Helm, 1987. pp 356, £13.95.
- Malcolm Adams
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- Journal:
- Behavioural and Cognitive Psychotherapy / Volume 17 / Issue 2 / April 1989
- Published online by Cambridge University Press:
- 16 June 2009, pp. 194-195
- Print publication:
- April 1989
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How Should We Measure Outcome in Psychotherapy?
- Malcolm Adams
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- Journal:
- The British Journal of Psychiatry / Volume 132 / Issue 6 / June 1978
- Published online by Cambridge University Press:
- 29 January 2018, pp. 595-597
- Print publication:
- June 1978
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The problem of assessing outcome in psychotherapy is considered by examining the experiment conducted by Bloch et al (1977). The experimental design and statistical considerations in investigating psychotherapy outcome are briefly examined. It is argued that attention should be directed towards assessing the severity of patients problems rather than improvement after treatment.