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Field hospitals are deployed in a wide range of scenarios including natural disasters, epidemic outbreaks, armed conflicts and refugee crises. Operation in these conditions requires adaptation to disaster medicine principles and operation in an austere environment and unfamiliar cultural milieu, whilst maintaining acceptable standards of care. For many of those involved it may be their first encounter. This book, which is the first to address the preparation and operation of field hospitals, brings together the experience of world leaders in the field. Coming from a wide variety of organizations and backgrounds, all have extensive experience in field hospital deployment in multiple scenarios. The text - containing both background information and practical guidelines - will serve all those involved in field hospital deployment, including policy makers and planners, physicians and nurses, paramedical professionals and logisticians. It will help them deliver optimal care to people around the globe in difficult times of need.
Integrating spiritual care into multidisciplinary care teams has seen both successful thoughtful collaboration and challenges, including feelings of competition and poor cross-disciplinary understanding. In Israel, where the profession is new, we aimed to examine how spiritual care is perceived by other healthcare professionals learning to integrate spiritual caregivers into their teams.
Semi-structured qualitative interviews of 19 professionals (seven physicians, six nurses, three social workers, two psychologists, and one medical secretary) working with spiritual caregivers in three Israeli hospitals, primarily in oncology/hematology. The interviews were transcribed and subjected to thematic analysis.
Respondents’ overall experience with adding a spiritual caregiver was strongly positive. Beneficial outcomes described included calmer patients and improved patient–staff relationships. Respondents identified reasons for a referral not limited to the end of life. Respondents distinguished between the role of the spiritual caregiver and those of other professions and, in response to case studies, differentiated when and how each professional should be involved.
Despite its relative newness in Israel, spiritual care is well received by a wide variety of professionals at those sites where it has been integrated. Steps to improve collaboration should include improving multidisciplinary communication to broaden the range of situations in which spiritual caregivers and other professionals work together to provide the best possible holistic care.
The recent discovery of a Late/Final Pre-Pottery Neolithic B burial of an adult and two children associated with fox bones at the site of Motza, Israel, demonstrates the broader socio-cultural perspective, and possibly continued animistic world views, of Neolithic foragers at the onset of the agricultural revolution.
In this paper, we present an experimental investigation of the turbulent saturation of the flow driven by the parametric resonance of inertial waves in a rotating fluid. In our set-up, a half-metre wide ellipsoid filled with water is brought to solid-body rotation, and then undergoes sustained harmonic modulation of its rotation rate. This triggers the exponential growth of a pair of inertial waves via a mechanism called the libration-driven elliptical instability. Once the saturation of this instability is reached, we observe a turbulent state for which energy is injected into the resonant inertial waves only. Depending on the amplitude of the rotation rate modulation, two different saturation states are observed. At large forcing amplitudes, the saturation flow mainly consists of a steady, geostrophic anticyclone. Its amplitude vanishes as the forcing amplitude is decreased while remaining above the threshold of the elliptical instability. Below this secondary transition, the saturation flow is a superposition of inertial waves which are in weakly nonlinear resonant interaction, a state that could asymptotically lead to inertial wave turbulence. In addition to being a first experimental observation of a wave-dominated saturation in unstable rotating flows, the present study is also an experimental confirmation of the model of Le Reun et al. (Phys. Rev. Lett., vol. 119 (3), 2017, 034502) who introduced the possibility of these two turbulent regimes. The transition between these two regimes and their relevance to geophysical applications are finally discussed.
Philosophers are often interested in explaining significant contrasts between ordinary descriptive discourses, on the one hand, and discourses – such as ethics, mathematics, or mentalistic discourse – that are thought to be more problematic in various ways. But certain strategies for ‘saving the differences’ can make it too difficult to preserve notable similarities across discourses. My own preference is for strategies that ‘save the differences’ without sacrificing logico-semantic continuities or committing to deflationism about truth, but also without embracing either truth-pluralism or global expressivism.
I motivate my preference by examining, as a test case, mentalistic discourse. I begin by reconstructing three philosophical puzzles that have led philosophers to think of mentalistic discourse as problematic (Section 2). These puzzles concern the semantic, epistemological, and metaphysical status of contrasts between first-person present-tense attributions – ‘avowals’ – and all other ordinary contingent attributions. I then briefly present my own, neo-expressivist strategy for addressing the puzzles (Section 3). Unlike traditional ‘simple expressivism’ (which is the analogue in the mentalistic realm of ethical emotivism), neo-expressivism is not committed to avowals’ being non-truth-apt or having non-propositional meanings. And yet it does not require embracing either deflationism about truth or global expressivism. It preserves continuities between mentalistic and other discourses while allowing us to capture discontinuities. Moreover, it is possible to apply the neo-expressivist framework in other areas where the notion of expression is deemed explanatorily useful, as illustrated by considering ethical neo-expressivism (Section 4). In the final section (5), I make more general comments on truth and meaning and tease out some of the commitments of the approach I advocate.
This study examined whether the context immediately succeeding a heterophonic-homographic word (ht-homographic) plays a role in ambiguity resolution during voiced reading of Hebrew. A pretest was designed to find the preferred alternatives of 12 ht-homographic words: 20 adult subjects completed truncated sentences, each ending with a homographic word, preceded by a context allowing for both of its alternatives to be read. Following the pretest, each word was embedded in four research conditions determined by post-homographic context (keeping preceding context constant): two adjacent revealing contexts, one supporting the preferred alternative and the other the un-preferred alternative; and two distant revealing contexts, one supporting the preferred alternative and the other the un-preferred alternative. Four lists of 12 sentences, each including the four conditions, were then read aloud by four groups of 20 adults. Results from a generalized linear mixed-model analysis showed that the immediately succeeding context affected the deciphering of un-preferred alternatives in voiced reading. An item analysis further showed that highly preferred alternatives were less prone to the immediately succeeding context effect than slightly preferred alternatives. We conclude that the context immediately succeeding a ht-homographic word plays a role in ambiguity resolution during voiced reading, through interactions with the word’s lexical and syntactic characteristics.
Despite extensive research, symptom structure of posttraumatic stress disorder (PTSD) is highly debated. The network approach to psychopathology offers a novel method for understanding and conceptualizing PTSD. However, extant studies have mainly used small samples and self-report measures among sub-clinical populations, while also overlooking co-morbid depressive symptoms.
PTSD symptom network topology was estimated in a sample of 1489 treatment-seeking veteran patients based on a clinician-rated PTSD measure. Next, clinician-rated depressive symptoms were incorporated into the network to assess their influence on PTSD network structure. The PTSD-symptom network was then contrasted with the network of 306 trauma-exposed (TE) treatment-seeking patients not meeting full criteria for PTSD to assess corresponding network differences. Finally, a directed acyclic graph (DAG) was computed to estimate potential directionality among symptoms, including depressive symptoms and daily functioning.
The PTSD symptom network evidenced robust reliability. Flashbacks and getting emotionally upset by trauma reminders emerged as the most central nodes in the PTSD network, regardless of the inclusion of depressive symptoms. Distinct clustering emerged for PTSD and depressive symptoms within the comorbidity network. DAG analysis suggested a key triggering role for re-experiencing symptoms. Network topology in the PTSD sample was significantly distinct from that of the TE sample.
Flashbacks and psychological reactions to trauma reminders, along with their strong connections to other re-experiencing symptoms, have a pivotal role in the clinical presentation of combat-related PTSD among veterans. Depressive and posttraumatic symptoms constitute two separate diagnostic entities, but with meaningful between-disorder connections, suggesting two mutually-influential systems.
The move to smart disclosure promises to revitalize disclosure mandates and save them from a fate of ignored verbiage. But by making disclosure relevant and effective, this shift to smart disclosure also raises several concerns. Specifically, simple disclosures like genetically modified food disclosures, restaurant hygiene grades, annual percentage rate disclosures, etc., can result in market distortions and inefficiencies as: (1) consumers might draw false inferences from the disclosure; and (2) disclosing one dimension will elevate this dimension relative to other dimensions, and thus distort demand for the product and even alter the product itself. Relatedly, System 1 disclosures, like graphic cigarette labels, might influence behavior by triggering an emotional response rather than through informed deliberation, thus abandoning traditional justifications for disclosure mandates. In light of these concerns, it is more difficult to view disclosure mandates as minimally paternalistic. Government, by tweaking disclosure design, wields substantial power over markets and consumers.
A multi-item questionnaire concerning lay people's attitudes toward organ procurement without consent from executed prisoners was given to several hundred respondents. The items ranged from all-out condemnation (“It is tantamount to murder”) to enthusiasm (“It is great to have this organ supply”). Overall, we found two guiding principles upheld by most respondents: (1) Convicts have as much a right to their bodies and organs as other people, so the practice should be judged by the same standards as those that guide organ procurement from any donor. Procuring organs without consent is wrong. (2) Benefiting from those organs should be held to more lenient standards than are demanded for their procurement. So, benefitting from these ill-gotten organs should be tolerated.
Various jurisdictions have legalized cannabis for medical purposes. As with all psychoactive medications, medical cannabis carries a risk of diversion and accidental ingestion. These risks may be particularly high among long-term medical cannabis patients as safety practices may become less salient to patients once the treatment becomes part of everyday life. The current study examines whether patients who have used medical cannabis for longer periods differ from those who have used for shorter periods in terms of sociodemographic background and other key aspects of medical cannabis use. Furthermore, the study examines the relationship between length of medical cannabis treatment and risk factors related to storage and diversion. Finally, the study examines the extent to which oncologists provide information to their patients about safe storage and disposal.
One hundred twenty-one medical cannabis oncology patients were interviewed face-to-face and 55 oncologists participated in a survey about safe storage and disposal practices related to medical cannabis.
Length of medical cannabis treatment was related to administration by smoking and using higher monthly dosages. In terms of risk for unsafe storage and diversion, length of medical cannabis was positively associated with using cannabis outside the home and having been asked to give away medical cannabis. Physicians did not report providing information to patients regarding safe storage and disposal practices in a regular manner.
Significance of results
Results suggest that there is an ongoing risk of unsafe storage and diversion over the course of medical cannabis treatment. Oncologists may need to give more consistent and continued training in safe storage and disposal practices, especially among long-term medical cannabis patients.
The objectives were to evaluate the, usability, feasibility of use, satisfaction, and safety of the Syqe Inhaler Exo (Syqe Inhaler), a metered dose, Pharmacokinetics-validated, cannabis inhaler device in a cohort of hospitalized patients that were using medical cannabis under license as a part of their ongoing medical treatment.
Before and after inhaling from the Syqe Inhaler, participants were asked to fill a questionnaire regarding pain reduction on a visual analog scale from 0 to 10 and, if relevant, reduction in chemotherapy-induced nausea and vomiting and/or spasticity. A patient satisfaction questionnaire and a usability questionnaire were filled in following the last use. Prescribed treatment included 4 daily doses of 500 μg tetrahydrocannabinol each delivered from 16 mg cannabis flos per inhalation plus up to an additional four SOS (distress code for more doses of cannabis) doses.
Daily cannabis dose consumed during hospitalization with the Syqe Inhaler was 51 mg (20–96) versus 1,000 mg (660-3,300) consumed prehospitalization. Patients were easily trained and continued to use Syqe Inhaler for the duration of their hospitalization (5 [3–7] days). Pain intensity 30–60 minutes following inhalations was reported to be significantly lower than preinhalation 4 [1–5] versus 7 [2–9]). Participants ranked their satisfaction with Syqe Inhaler as 6 (5–7). Three participants reported mild cough, which resolved spontaneously.
Significance of results
Cannabis inhalation by combustion is not feasible for hospitalized patients. The use of Syqe Inhaler during hospitalization yielded high levels of patients and staff satisfaction with no complications.
Background: There is an unmet need for blood-based biomarkers that can reliably detect MS disease activity. Serum Biomarkers of interest includ Neurofilament-light-chain (NfL), Glial-fibrillary-strocyte-protein(GFAP) and Tau. Bone Marrow Transplantation (BMT) is reserved for aggressive forms of MS and has been shown to halt detectable CNS inflammatory activity for prolonged periods. Significant pre-treatment tissue damage at followed by inflammatory disease abeyance should be reflected longitudinal sera collected from these patients. Methods: Sera were collected from 23 MS patients pre-treatment, and following BMT at 3, 6, 9 and 12-months in addition from 33 non-inflammatory neurological controls. Biomarker quantification was performed with SiMoA. Results: Pre-AHSCT levels of serum NfL and GFAP but not Tau were elevated compared to controls (p=0.0001), and NfL correlated with lesion-based disease activity (6-month-relapse, MRI-T2 and Gadolinium-enhancement). 3-months post-treatment, while NfL levels remained elevated, Tau/GFAP paradoxically increased (p=0.0023/0.0017). These increases at 3m correlated with MRI ‘pseudoatrophy’ at 6-months. NfL/Tau levels dropped to that of controls by 6-months (p=0.0036/0.0159). GFAP levels dropped progressively after 6-months although even at 12-months remained higher than controls (p=0.004). Conclusions: NfL was the closest correlate of MS disease activity and treatment response. Chemotherapy-related toxicity may account for transient increases in NfL, Tau and MRI brain atrophy post-BMT.