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The unique iconography of the Elephant mosaic panel in the Huqoq synagogue, considered by project director J. Magness as “the first non-biblical story ever found decorating an ancient synagogue”, has attracted a great deal of attention since it first began to be exposed in 2013. The synagogue is still under excavation and little has been published so far, but some of the mosaic panels of the late 4th-early 5th c. plainly depict Biblical scenes; there are also decorative motifs with inscriptions. The panel in question is set roughly in the centre of the E aisle, some 60 cm from the E wall. It faces east, to be correctly viewed by a person facing west towards the nave. Its orientation is similar to that of the nearby panel on the south, but it faces the opposite way from the Samson panel farther south.
With the increasing enthusiasm to provide cognitive remediation (CR) as an evidence-based practice, questions arise as to what is involved in implementing CR in a large system of care. This article describes the first statewide implementation of CR in the USA, with the goal of documenting the implementation issues that care providers are likely to face when bringing CR services to their patients.
In 2014, the New York State Office of Mental Health set up a Cognitive Health Service that could be implemented throughout the state-operated system of care. This service was intended to broadly address cognitive health, to assure that the cognitive deficits commonly associated with psychiatric illnesses are recognized and addressed, and that cognitive health is embedded in the vocabulary of wellness. It involved creating a mechanism to train staff to recognize how cognitive health could be prioritized in treatment planning as well as implementing CR in state-operated adult outpatient psychiatry clinics.
By 2017, CR was available at clinics serving people with serious mental illness in 13 of 16 adult Psychiatric Centers, located in rural and urban settings throughout New York state. The embedded quality assurance program evaluation tools indicated that CR was acceptable, sustainable, and effective.
Cognitive remediation can be feasibly implemented in large systems of care that provide a multilevel system of supports, a training program that educates broadly about cognitive health and specifically about the delivery of CR, and embedded, ongoing program evaluation that is linked to staff supervision.
Mollusc seashells grow through the local deposition and calcification of material at the shell opening by a soft and thin organ called the mantle. Through this process, a huge variety of shell structures are formed. Previous models have shown that these structural patterns can largely be understood by examining the mechanical interaction between the deformable mantle and the rigid shell aperture to which it adheres. In this paper we extend this modelling framework in two distinct directions. For one, we incorporate a mechanical feedback in the growth of the mollusc. Second, we develop an initial framework to couple the two primary and orthogonal modes of pattern formation in shells, which are termed antimarginal and commarginal ornamentation. In both cases we examine the change in shell morphology that occurs due to the different mechanical influences and evaluate the hypotheses in light of the fossil record.
Across African democracies, maintaining popular trust in electoral management bodies (EMBs) is vital to enhancing election integrity and, ultimately, regime legitimacy. However, scholars have largely sidestepped any systematic analysis of how citizens formulate their attitudes towards EMBs and how these attitudes vary over time. To address these gaps in the literature, we focus on Kenyan EMBs, which have experienced fluctuating popular support since the ruinous 2007 elections and subsequent institutional reforms. Using primary election reports and original survey and focus group data, we analyse the sources of Kenyans' trust in EMBs from 1992 onward and probe the 2013 election period deeply. Across time, we find that confidence in EMBs usually collapses after polarised elections, due to perceived problems with the EMB's autonomy and capacity. Following the 2013 elections, Kenyans were also more likely to lose confidence in the EMB if they were affiliated with losing presidential candidates or if they were critical of EMB performance.
Special topics in psychiatric rehabilitation
Frank Holloway, Emeritus Consultant Psychiatrist, South London and Maudsley NHS Foundation Trust,
Matthew Erlich, New York State Office of Mental Health and Division of Psychiatry, Columbia University College of Physicians and Surgeons, New York,
Lloyd I. Sederer, Medical Director, New York State Office of Mental Health and Columbia University's Mailman School of Public Health, New York
Psychiatric rehabilitation has global relevance (Rossler, 2006). Our aim in this chapter is to offer an account of key trends in policy and practice internationally. Providing a brief but accurate account of the literature is fraught with difficulty. The day-to-day working of mental health services is dependent on a host of country-specific factors relating to the funding and organisation of health and social care, mental health legislation and policy, and the social and cultural context. (The significance of culture is discussed in detail in Chapter 28, ‘Psychosocial rehabilitation across culture’, which focuses on rehabilitation in low- and middle-income countries.) The lack of reliable data makes comparison between countries very difficult, as does the enormous disparity in the resources available to mental health services, even within a generally wealthy region such as Europe (Muijen, 2008; World Health Organization Mental Health Europe, 2008).
Much of what is written about rehabilitation and recovery, particularly at the policy level, comes across as rather abstract – full of positive sentiments but short on practicalities. To counteract this we provide some comparative data on key components of rehabilitative mental healthcare and end with a description of a large-scale service change in New York State that two of us (LIS and ME) have been involved in.
Core concepts in rehabilitation and recovery
There is a general consensus that psychiatric or psychosocial rehabilitation has as its goal helping people experiencing persistent and severe mental illness to live good lives as independently as possible (Rossler, 2006). In the past, rehabilitation was often seen as a stand-alone process offering selected technical interventions to people, either living within the traditional mental hospital or in the community, who were ‘rehabilitation ready’. A more contemporary understanding sees rehabilitation as embedded within the fabric of health and social care services that work with the individual, his or her social network and the wider social context, with an overarching aim of promoting social inclusion (Barbato, 2006). Rehabilitation and recovery are, in this sense, the business of all mental healthcare, although in practice specific rehabilitation services tend to become involved when the patient's journey to social inclusion has become stuck.
Why do political actors undertake reforms that constrain their own discretion? We argue that uncertainty generated by political competition is a major driver of such reforms, and test this argument using subnational data on Mexican states’ adoption of state-level access to information (ATI) laws. Examining data from 31 Mexican states plus the Federal District, we find that more politically competitive states passed ATI laws more rapidly, even taking into account the party in power, levels of corruption, civil society, and other factors. The fine-grained nature of our data, reflecting the staggered timing of elections, inauguration dates, and dates of passage, allows us to distinguish between different theoretical mechanisms. We find the greatest evidence in favor of an insurance mechanism, by which incumbent parties who face uncertainty over future political control seek to ensure access to government information, and means of monitoring incumbents, in the future in case they lose power.
Using data from a multi-site study of parent–child symptom reporting concordance, this secondary analysis explored the role of parent self-efficacy related to pain management for seriously ill school-age children and adolescents.
In the initial study, 50 children and adolescents who were expected to survive 3 years or less were recruited along with their parent/primary caregiver. Parent self-report data were used in this secondary analysis to describe parent self-efficacy for managing their child's pain, caregiver strain, mood states, and perception of the child's pain; to explore relationships among these variables; and to determine predictors of greater self-efficacy.
Parents expressed a wide range of self-efficacy levels (Chronic Pain Self-Efficacy Scale; possible range 10–100, mean 76.2, SD 14.7) and higher levels on average than reported previously by family caregivers of adult patients. Caregiver Strain Index scores were markedly high (possible range 0–13, mean 8.1, SD 3.8) and inversely correlated with self-efficacy (r = −0.44, p = 0.001). On the Profile of Mood States parents reported more negative moods (t = 4.0, p < 0.001) and less vigor (t = −5.0, p < 0.001) than adults in a normative sample, yet vigor rather than mood disturbance predicted self-efficacy. With the exception of child age, self-efficacy was not associated with demographics (child gender, ethnicity, household income, parent age, education, family size) or with the diagnostic groups (primarily cardiac and oncologic) comprising the sample. Younger child age, less caregiver strain, more parent vigor, and parent perception that child is without pain predicted more than half of the variance in parent self-efficacy (R2 = 0.51).
Significance of results:
Findings advance knowledge of parent self-efficacy in managing the pain of a child with life-threatening illness. Results can be used to design supportive interventions enhancing parents’ caregiving roles during their child's last stages of life.
Twin studies have long provided a means to separate the contributions of genetic and environmental factors. A recent pioneering report by Baranzini et al. presented an analysis of the complete genomes and epigenomes of a monozygotic (MZ) twin pair discordant for multiple sclerosis. This failed to find any difference between the twins, raising doubts regarding the value of whole-genome twin studies for defining disease susceptibility alleles. However, the study was carried out with DNA extracted from blood. In many cases, the hematopoietic lineages of MZ twins are chimeric due to twin-to-twin exchange of hematopoietic stem cells during embryogenesis. We therefore wondered how chimerism might impact the ability to identify genetic differences. We inferred the blood chimerism rates and profiles of more than 30 discordant twin cases from a wide variety of medical conditions. We found that the genotype compositions of the twins were highly similar. We then benchmarked the performance of SNP callers to detect discordant variations using high-throughput sequencing data. Our analysis revealed that chimerism patterns, well within the range normally observed in MZ twins, greatly reduce the sensitivity of SNP calls. This raises questions regarding any conclusions of genomic homogeneity that might be drawn from studies of blood-derived twin DNA.
An emerging research topic in civil engineering is the dynamic interaction between crowds
and structures. Structures such as footbridges, which oscillate due to the crossing of a
group of pedestrians, or stands within stadia or concert halls, which vibrate due to the
rythmic movement of the audience are of particular interest. The objective of this study
is twofold: modelling the movement of pedestrians with consideration of
pedestrian-pedestrian, and pedestrian-obstacle interactions, and the incorporation of a
pedestrian-structure coupling in the previous model. Frémond’s model, which allows us to
simulate the movement of an assembly of particles and accounts for collisions among
considered rigid particles, is presented and adapted to the crowd by giving a willingness
to the circular particles, which allows each pedestrian to move according to a given
target. To handle the crowd-structure interaction in the case of lateral oscillations of
footbridges, the Kuramoto differential equation governing the time evolution of the
lateral motion of each pedestrian is implemented in the previous model. Preliminary
results obtained from numerical simulations are presented and discussed.