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Individual differences in cognitive responses to trauma may represent modifiable risk factors that could allow early identification, targeted early treatment and possibly prevention of chronic posttraumatic stress disorder (PTSD). Ehlers and Clark's cognitive model of PTSD suggests that negative appraisals, disjointed trauma memories, and unhelpful coping strategies maintain PTSD. These are thought to be influenced by cognitive processing during trauma. The aim of this study was to test this model prospectively with path analyses.
Participants (N = 828) were recruited from an emergency department following injury in a violent assault or road traffic collision and 700 participated in the 6-month assessments. Cognitive processing was assessed shortly after the event, negative appraisals, disjointed memories, and unhelpful coping strategies at 1 month, persistent PTSD symptom severity at 6 months, and early PTSD symptom severity at 2 weeks.
Cognitive variables, with trauma type and gender, explained 52% of the variance in PTSD symptom severity at 6 months. Including early symptom severity in the model did not explain more variance (53%). Early PTSD symptom severity, with trauma type and gender, only predicted 40%. Negative appraisals and disjointed memories predicted persistent symptom severity both directly and indirectly via unhelpful strategies. Peritraumatic processing predicted persistent symptom severity mainly indirectly. The effects of trauma type and gender were fully mediated by the cognitive factors.
The results are consistent with theoretically derived predictions and support cognitive factors as indicators of risk for chronic PTSD and as a target for the treatment and prevention of PTSD.
Seated in the white plaster-worked gallery of Carrick Castle in Tipperary, his favourite house, surrounded by some of the paintings he had collected over a lifetime but could no longer see, the blind old earl of Ormond listened attentively to his Gaelic poet, Dermot O'Meara. A physician by training, O'Meara was reciting in perfect Latin the lines of a major new composition. It was summer 1614. The room was hushed as O'Meara spoke. Partly this was because Ormond, grown increasingly cantankerous in his old age, disliked noise and disruption, and ordinarily demanded quiet from his household servants. But it was also because the poem was important for the earl. He was its central subject. What it said about him, and how it said it, would affect his honour and reputation. It was his strong hope that O'Meara's Latin verses would help to secure his and his family's fame and renown in perpetuity. Called Ormonius, the poem would place the Butlers’ military identity within an ancient classical tradition of martial celebration. It contained a history of the recently completed Tudor conquest of Ireland, but one that was written from the earl's ‘Old English’ (or Anglo-Irish) point of view. Line after flowing line it recounted scenes from the battlefield, recalling the younger, vigorous Ormond who for almost fifty years prior to 1603 had repeatedly summoned his Butler troops to serve under the royal banners. As much a political testament as a literary entertainment, it asserted the rights of the Old English Butler family to continued crown favour by placing the earl and his followers at the heart of the conquest storyline.
Like other poems of its type, Ormonius was immodest in its praise – hagiographical, sycophantic. It implied Ireland had been subdued for the crown not only by English-born officers and soldiers, but by a hero-earl of unequalled military prowess and his brave and steadfast kindred, who, like him, were Irish-born subjects of English descent. Successively military commissioner of Munster and Thomond (1570–1), Lord General of Munster (1579–81, 1582–4), General of the queen's army in Leinster (1594, 1596–7), and Lord Lieutenant- General of all the royal forces in the country (1597–1601), Earl Thomas had embodied all that was most distinguished about his kind.
Advanced 2-D and 3-D computer visualizations are increasingly being used for recording and documentation, analysis, dissemination, and public engagement purposes. Recent technological advances not only considerably improve data acquisition, processing, and analysis but also enable easy and efficient online presentation. This article evaluates the contributions of advanced 2-D and 3-D computer visualization and discusses the potential of 3-D modeling for recording basketry technology and documenting the state of preservation of baskets. It explores the available analysis, integration, and online dissemination tools, using as case studies recently excavated baskets from Cache Cave in southern California. Results indicate that the proposed methodology, which incorporates reflectance transformation imaging visualizations and photogrammetric 3-D models, which are further processed using 3-D modeling software and integrated analysis tools and then transformed to a Web-based format, is a useful addition to the basketry analysis toolkit.
Previous studies using resting-state functional neuroimaging have revealed alterations in whole-brain images, connectome-wide functional connectivity and graph-based metrics in groups of patients with schizophrenia relative to groups of healthy controls. However, it is unclear which of these measures best captures the neural correlates of this disorder at the level of the individual patient.
Here we investigated the relative diagnostic value of these measures. A total of 295 patients with schizophrenia and 452 healthy controls were investigated using resting-state functional Magnetic Resonance Imaging at five research centres. Connectome-wide functional networks were constructed by thresholding correlation matrices of 90 brain regions, and their topological properties were analyzed using graph theory-based methods. Single-subject classification was performed using three machine learning (ML) approaches associated with varying degrees of complexity and abstraction, namely logistic regression, support vector machine and deep learning technology.
Connectome-wide functional connectivity allowed single-subject classification of patients and controls with higher accuracy (average: 81%) than both whole-brain images (average: 53%) and graph-based metrics (average: 69%). Classification based on connectome-wide functional connectivity was driven by a distributed bilateral network including the thalamus and temporal regions.
These results were replicated across the three employed ML approaches. Connectome-wide functional connectivity permits differentiation of patients with schizophrenia from healthy controls at single-subject level with greater accuracy; this pattern of results is consistent with the ‘dysconnectivity hypothesis’ of schizophrenia, which states that the neural basis of the disorder is best understood in terms of system-level functional connectivity alterations.
One major challenge facing policy-makers is to design education and workplace training programs that are appropriately challenging. We review previous research that suggests that difficult training is better than easy training. However, surveys we conducted of students and of expert sport coaches showed that many prescribed easy rather than difficult training for those they coached. We analyzed the performance of National Collegiate Athletic Association (NCAA) basketball teams in postseason tournaments to see whether the existing research, largely on individuals in short-term situations, would generalize to teams in the long run. Indeed, playing difficult nonconference (training) games modestly improved performance for NCAA teams in the postseason. Difficult training particularly benefitted teams that lost many nonconference games, and the effect of difficulty was positive within the range of difficulty NCAA teams actually encounter, making it clear that difficult training is superior. We suggest that our results can be generalized beyond sports, although with careful consideration of differences between NCAA basketball teams and other teams that may limit generalizability. These results suggest that policy-makers might consider amplifying the difficulty of team training exercises under certain conditions.
In March 2017, the New Jersey Department of Health received reports of 3 patients who developed septic arthritis after receiving intra-articular injections for osteoarthritis knee pain at the same private outpatient facility in New Jersey. The risk of septic arthritis resulting from intra-articular injection is low. However, outbreaks of septic arthritis associated with unsafe injection practices in outpatient settings have been reported.
An infection prevention assessment of the implicated facility’s practices was conducted because of the ongoing risk to public health. The assessment included an environmental inspection of the facility, staff interviews, infection prevention practice observations, and a medical record and office document review. A call for cases was disseminated to healthcare providers in New Jersey to identify patients treated at the facility who developed septic arthritis after receiving intra-articular injections.
We identified 41 patients with septic arthritis associated with intra-articular injections. Cultures of synovial fluid or tissue from 15 of these 41 case patients (37%) recovered bacteria consistent with oral flora. The infection prevention assessment of facility practices identified multiple breaches of recommended infection prevention practices, including inadequate hand hygiene, unsafe injection practices, and poor cleaning and disinfection practices. No additional cases were identified after infection prevention recommendations were implemented by the facility.
Aseptic technique is imperative when handling, preparing, and administering injectable medications to prevent microbial contamination.
This investigation highlights the importance of adhering to infection prevention recommendations. All healthcare personnel who prepare, handle, and administer injectable medications should be trained in infection prevention and safe injection practices.
While extensive modelling - both physical and virtual - is imperative to develop right-first-time products, the parallel use of virtual and physical models gives rise to two interrelated issues: the lack of revision control for physical prototypes; and the need for designers to manually inspect, measure, and interpret modifications to either virtual or physical models, for subsequent update of the other. The Digital Twin paradigm addresses similar problems later in the product life-cycle, and while these digital twins, or the “twinning” process, have shown significant value, there is little work to date on their implementation in the earlier design stages. With large prospective benefits in increased product understanding, performance, and reduced design cycle time and cost, this paper explores the concept of using the Digital Twin in early design, including an introduction to digital twinning, examination of opportunities for and challenges of their implementation, a presentation of the structure of Early Stage Twins, and evaluation via two implementation cases.
A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
This article will consider Adverse Childhood Experiences (ACEs) as a chaotic concept that prioritises risk and obscures the material and social conditions of the lives of its objects. It will show how the various definitions of ACEs offer no cohesive body of definitive evidence and measurement, and lead to a great deal of over-claiming. It discusses how ACEs have found their time and place, locating a variety of social ills within the child’s home, family and parenting behaviours. It argues that because ACEs are confined to intra-familial circumstances, and largely to narrow parent-child relations, issues outside of parental control are not addressed. It concludes that ACEs form a poor body of evidence for family policy and decision-making about child protection and that different and less stigmatising solutions are hiding in plain sight.
There are more than 30 distinct types of mammalian retinal ganglion cells, each sensitive to different features of the visual environment. In rabbit retina, they can be grouped into four classes according to their morphology and stratification of their dendrites in the inner plexiform layer (IPL). The goal of this study was to describe the synaptic inputs to one type of Class IV ganglion cell, the third member of the sparsely branched Class IV cells (SB3). One cell of this type was partially reconstructed in a retinal connectome developed using automated transmission electron microscopy (ATEM). It had slender, relatively straight dendrites that ramify in the sublamina a of the IPL. The dendrites of the SB3 cell were always postsynaptic in the IPL, supporting its identity as a ganglion cell. It received 29% of its input from bipolar cells, a value in the middle of the range for rabbit retinal ganglion cells studied previously. The SB3 cell typically received only one synapse per bipolar cell from multiple types of presumed OFF bipolar cells; reciprocal synapses from amacrine cells at the dyad synapses were infrequent. In a few instances, the bipolar cells presynaptic to the SB3 ganglion cell also provided input to an amacrine cell presynaptic to the ganglion cell. There was apparently no crossover inhibition from narrow-field ON amacrine cells. Most of the amacrine cell inputs were from axons and dendrites of GABAergic amacrine cells, likely providing inhibitory input from outside the classical receptive field.
There are increasing efforts aiming to utilise endophytes as biological control agents (BCAs) to improve crop production. However, reliability remains a major practical constraint for the development of novel BCAs. Many organisms are adapted to their specific habitat; it is optimistic to expect that a new organism added can find a niche or even out-compete those adapted and already present. Our approach for isolating novel BCAs for specific plant diseases is therefore to look in healthy plants in a habitat where disease is a problem, since we predict that it is more likely to find competitive strains among those present and adapted. In vitro inhibitory activities often do not correlate with in planta efficacy, especially since endophytes rely on intimate plant contact. They can, however, be useful to indicate modes of action. We therefore screen for in planta biological activity as early as possible in the process in order to minimise the risk of discarding valuable strains. Finally, some fungi are endophytic in one situation and pathogenic in another (the mutualism–parasitism continuum). This depends on their biology, environmental conditions, the formulation of inoculum, the health, developmental stage and cultivar of the host plant, and the structure of the plant microbiome.
Several grass and broadleaf weed species around the world have evolved multiple-herbicide resistance at alarmingly increasing rates. Research on the biochemical and molecular resistance mechanisms of multiple-resistant weed populations indicate a prevalence of herbicide metabolism catalyzed by enzyme systems such as cytochrome P450 monooxygenases and glutathione S-transferases and, to a lesser extent, by glucosyl transferases. A symposium was conducted to gain an understanding of the current state of research on metabolic resistance mechanisms in weed species that pose major management problems around the world. These topics, as well as future directions of investigations that were identified in the symposium, are summarized herein. In addition, the latest information on selected topics such as the role of safeners in inducing crop tolerance to herbicides, selectivity to clomazone, glyphosate metabolism in crops and weeds, and bioactivation of natural molecules is reviewed.
The Middle Nile (from Aswan in Egypt to Khartoum in Sudan, Fig. 6.1) is quite exceptional in Sub-Saharan Africa. It is a region where, from the beginning, archaeological frameworks have been constructed largely on the basis of cemetery excavations. This has, of course, much to do with regionally specific research histories and emergent archaeological practices associated with them. The traditions of materially rich mortuary cultures encountered in the Middle Nile, dating back to the early Neolithic period (here the sixth millennium BC), has continued to attract significant archaeological attention. Numerous, often large, cemeteries are still routinely being explored within the context of both research and rescue archaeology. Their material abundance continues to fascinate. The first extensive archaeological survey of Nubia, completed in 1911, excavated more than 8,200 graves in 151 cemeteries within a ‘survey’ area limited to the riverine oasis and covering an area of less than 250 km2.
Crisis resolution teams (CRTs) offer brief, intensive home treatment for people experiencing mental health crisis. CRT implementation is highly variable; positive trial outcomes have not been reproduced in scaled-up CRT care.
To evaluate a 1-year programme to improve CRTs’ model fidelity in a non-masked, cluster-randomised trial (part of the Crisis team Optimisation and RElapse prevention (CORE) research programme, trial registration number: ISRCTN47185233).
Fifteen CRTs in England received an intervention, informed by the US Implementing Evidence-Based Practice project, involving support from a CRT facilitator, online implementation resources and regular team fidelity reviews. Ten control CRTs received no additional support. The primary outcome was patient satisfaction, measured by the Client Satisfaction Questionnaire (CSQ-8), completed by 15 patients per team at CRT discharge (n = 375). Secondary outcomes: CRT model fidelity, continuity of care, staff well-being, in-patient admissions and bed use and CRT readmissions were also evaluated.
All CRTs were retained in the trial. Median follow-up CSQ-8 score was 28 in each group: the adjusted average in the intervention group was higher than in the control group by 0.97 (95% CI −1.02 to 2.97) but this was not significant (P = 0.34). There were fewer in-patient admissions, lower in-patient bed use and better staff psychological health in intervention teams. Model fidelity rose in most intervention teams and was significantly higher than in control teams at follow-up. There were no significant effects for other outcomes.
The CRT service improvement programme did not achieve its primary aim of improving patient satisfaction. It showed some promise in improving CRT model fidelity and reducing acute in-patient admissions.
This essay argues that Christine Desan's Making Money: Coin, Currency and the Coming of Capitalism intervenes decisively in debates over the origin of money, while making a fundamental contribution to the legal history of money, the philosophy of money, and the history of capitalism. Desan shows money to be a mode of governance, created by rulers to extend their power, and maintained and managed by their successors. She argues that British politicians reinvented money at the end of the seventeenth century, creating the essential institutional basis for contemporary capitalism. The essay builds on Desan's analysis, showing how the tools she develops to understand the origins and development of British money can help us explain the expansion of capitalism, and the transition to capitalism associated with the American Revolution.
Breakthrough Listen is a 10-yr initiative to search for signatures of technologies created by extraterrestrial civilisations at radio and optical wavelengths. Here, we detail the digital data recording system deployed for Breakthrough Listen observations at the 64-m aperture CSIRO Parkes Telescope in New South Wales, Australia. The recording system currently implements two modes: a dual-polarisation, 1.125-GHz bandwidth mode for single-beam observations, and a 26-input, 308-MHz bandwidth mode for the 21-cm multibeam receiver. The system is also designed to support a 3-GHz single-beam mode for the forthcoming Parkes ultra-wideband feed. In this paper, we present details of the system architecture, provide an overview of hardware and software, and present initial performance results.