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Despite the frequency that refugees suffer bereavement, there is a dearth of research into the prevalence and predictors of problematic grief reactions in refugees. To address this gap, this study reports a nationally representative population-based study of refugees to determine the prevalence of probable prolonged grief disorder (PGD) and its associated problems.
This study recruited participants from the Building a New Life in Australia (BNLA) prospective cohort study of refugees admitted to Australia between October 2013 and February 2014. The current data were collected in 2015–2016, and comprised 1767 adults, as well as 411 children of the adult respondents. Adult refugees were assessed for trauma history, post-migration difficulties, probable PGD, post-traumatic stress disorder (PTSD) and mental illness. Children were administered the Strengths and Difficulties Questionnaire.
In this cohort, 38.1% of refugees reported bereavement, of whom 15.8% reported probable PGD; this represents 6.0% of the entire cohort. Probable PGD was associated with a greater likelihood of mental illness, probable PTSD, severe mental illness, currently unemployed and reported disability. Children of refugees with probable PGD reported more psychological difficulties than those whose parents did not have probable PGD. Probable PGD was also associated with the history of imprisonment, torture and separation from family. Only 56.3% of refugees with probable PGD had received psychological assistance.
Bereavement and probable PGD appear highly prevalent in refugees, and PGD seems to be associated with disability in the refugees and psychological problems in their children. The low rate of access to mental health assistance for these refugees highlights that there is a need to address this issue in refugee populations.
X-ray diffraction techniques provide information regarding the formation and alteration of mineral phases that is critical for assessing geomicrobial processes. Of particular interest is the use of powder X-ray diffraction (pXRD) to identify unknown solid-state materials, determine the particle size of nanoscale mineral phases, and refine structure characteristics, such as unit cell parameters and atomic positions. The goal of this chapter is to provide practical knowledge for the successful preparation of solid mineral samples, optimal data collection strategies, and analysis of diffractograms collected from pXRD experiments. Specific uses of pXRD techniques in geomicrobiology are discussed to demonstrate the importance of diffraction in advancing our understanding of microbial communities in geologic systems.
Driven by networked Electronic Health Record systems, Artificial Intelligence, real-time data from wearable devices with an overlay of invisible user interfaces and improved analytics, Health 4.0 is changing the healthcare industry. The focus on collaboration, coherence, and convergence that will make healthcare more predictive and personalised. Furthermore, Health 4.0 realises the value of data more consistently and effectively. It can pinpoint areas of improvement and enable more informed decisions. What it also does is help move the entire healthcare industry from a system that is reactive and focused on fee-for-service to a system that is value-based, which measures outcomes and ensures proactive prevention.
In this paper, the authors will first explore the realm of the emerging area of Health 4.0 and identify its opportunities and challenges. This includes understanding the relevant base technologies as well as the design principles for the realization of smart healthcare product, systems and product-service-systems of the future. Following on from there, the authors focus on the role of design in the specific context of healthcare.
Creativity is often said to play a vital role in the product design process, while functionality and aesthetics are considered key factors of actual products. Functionality refers to the performance of a product, and aesthetics represents the visual and ergonomic appeals of the product. However, there appears to be an elusive relation between creativity, functionality and aesthetics. This study explores how functionality, aesthetics and creativity are related to one another in design. Through exploring the definitions and assessments of creativity in design, this study reveals that novelty, usefulness and surprise are the three core elements of design creativity. A case study involving experts evaluating design samples in terms of novelty, usefulness, surprise, functionality, aesthetics and overall creativity is conducted. The results imply that there are no statistically significant relations between creativity, functionality, and aesthetics. Considering the three core elements of design creativity, the results indicate that creativity is only statistically significantly related to novelty. Moreover, our results suggest that creativity and novelty are measuring the same construct.
Rayleigh–Taylor instability occurs when a heavier fluid overlies a lighter fluid, and the two seek to exchange positions under the effect of gravity. We present a linearized theory for arbitrary three-dimensional (3D) initial disturbances that grow in time, and calculate the evolution of the interface for early times. A new spectral method is introduced for the fully 3D nonlinear problem in a Boussinesq fluid, where the interface between the light and heavy fluids is approximated with a smooth but rapid density change in the fluid. The results of large-scale numerical calculation are presented in fully 3D geometry, and compared and contrasted with the early-time linearized theory.
The democratisation of design permits greater stakeholder involvement in what has traditionally been a domain reserved for experts; the design process itself. This is enabled by technological advances in fields such as 3D printing, virtual reality and high-speed peer to peer communication technologies which have fuelled the development of new and innovative design methods. This paper compares and contrasts different approaches to the democratisation of design, and in particular, those that aim to involve wider stakeholders in the design process itself. Three different approaches(design by play, design by generation and crowdsourcing for design) are defined and contextualised within existing design frameworks and their respective suitabilities to democratise different design phases are considered. An exemplar use case of each approach is presented in order to assess how stakeholder engagement is affected by each democratising strategy. The discussion compares and contrasts the approaches with respect to their applicability and utility for different stages of the design process and how the power dynamics of the design process are altered when the different approaches are employed.
We consider fluid in a channel of finite height. There is a circular hole in the channel bottom, through which fluid of a lower density is injected and rises to form a plume. Viscous boundary layers close to the top and bottom of the channel are assumed to be so thin that the viscous fluid effectively slips along each of these boundaries. The problem is solved using a novel spectral method, in which Hankel transforms are first used to create a steady-state axisymmetric (inviscid) background flow that exactly satisfies the boundary conditions. A viscous correction is then added, so as to satisfy the time-dependent Boussinesq Navier–Stokes equations within the fluid, leaving the boundary conditions intact. Results are presented for the “lazy” plume, in which the fluid rises due only to its own buoyancy, and we study in detail its evolution with time to form an overturning structure. Some results for momentum-driven plumes are also presented, and the effect of the upper wall of the channel on the evolution of the axisymmetric plume is discussed.
OBJECTIVES/SPECIFIC AIMS: Given the heightened risk for suicide seen in individuals with PTSD+MDD, this report explored the effect of repeated ketamine infusions on SI in a cohort of veterans. METHODS/STUDY POPULATION: Veterans with PTSD+MDD (n = 15) received six intravenous infusions of 0.5 mg/kg ketamine on a Monday-Wednesday-Friday schedule over a 12-day period. All subjects endorsed SI at baseline. Outcome measures included the Montgomery-Asberg Depression Rating Scale (MADRS) total score, MADRS suicidal ideation item, and PTSD symptom Checklist for DSM-5 (PCL-5) subscales (intrusion, avoidance, negative alterations in cognition and mood, and marked alterations in arousal and reactivity), and visual analog scale of pain. Measures were collected immediately before and 24-hours after each infusion. RESULTS/ANTICIPATED RESULTS: Significant improvement in SI was observed 24-hours after the first infusion (Z = 3.21; p = .001) and remained significantly improved at all other post-infusion time points. Improvement in SI at the conclusion of the infusion series was significantly correlated with PTSD subscales of avoidance (r(12) = .610, p = .021), negative alterations in cognition and mood (r(12) = .786, p = .001), alterations in arousal and reactivity (r(12) = .729, p = .003), and pain (r(12) = .591, p = .013), even when controlling for improvement in symptoms of depression. DISCUSSION/SIGNIFICANCE OF IMPACT: The present analysis provides evidence of improvement in SI in a cohort of veterans with PTSD+MDD. Improvements in suicidality were correlated with PTSD symptom subscales and pain independent of improvement in depression. This report extends the interpersonal theory of suicide as it applies to posttraumatic pathology by demonstrating a significant association between improvements in all subclusters of PTSD, improvement in pain and improvement in suicidal ideation.
Acute pulmonary embolism is a life-threatening condition and rarely occurs in children. In adults, catheter-directed therapy emerges as a potentially safer and effective therapeutic option. However, there is a paucity of data on the safety and efficacy of catheter-directed therapy for pulmonary embolism in children. We report a single-centred experience of catheter-directed therapy for acute pulmonary embolism in children.
This is a retrospective study of children who had no CHD and underwent catheter-directed therapy at Detroit Medical Center during a 12-year period from 2005 to 2017. Demographic and clinical data associated with pulmonary embolism were collected along with the outcome.
A total of nine patients of median age 16 years with the range from 12 to 20 received catheter-directed therapy for sub-massive (n = 6) and massive pulmonary embolism (n = 3). Among nine patients, one patient received Angiojet thrombectomy and balloon angioplasty, whereas eight patients received catheter-directed thrombolysis using tissue plasminogen activator through infusion catheters (n = 3) or EkoSonic ultrasound-accelerated thrombolysis system (n = 5). In four out of five patients treated with EkoSonic, significant clinical improvement was noticed within 24 hours. Among seven patients who survived, two patients had minor gastrointestinal bleeding with median hospital stay of 8 days with the range from 5 to 24 days, and two patients with massive pulmonary embolism died possibly due to delayed institution of catheter-directed therapy.
Catheter-directed therapy with/without EkoSonic is an emerging alternative therapy for sub-massive and massive pulmonary embolism in children. A timely institution of catheter-directed therapy appeared important to improve the outcome.
Detailed representation of ingesta inflow to and digesta outflow from the rumen is critical for improving the modelling of rumen function and herbage intake of grazing ruminants. The objective of the current work was to extend a mechanistic model of a grazing ruminant, MINDY, to simulate the dynamic links between ingestive and digestive processes as affected by forage and sward features (e.g. sward structure, herbage chemical composition) as well as the internal state of the animal. The work integrates existing aspects of forage ingestion, oral physiology and rumen digestion that influence ingesta characteristics and digesta outflows from the rumen, respectively. The paper describes the structure and function of the new development, assessing the new model in terms of dynamic changes of oral processing of ingesta and rumen dilution rate under different grazing contexts. MINDY reproduces characteristics of ingesta inflow to and digesta outflow from the rumen of grazing ruminants, achieving temporal patterns of occurrence within and between meals, similar to those for grazing animals reported in the literature. The model realistically simulates changes in particle size distribution of the ingestive bolus, bolus weight and rumen dilution rate in response to contrasting grazing management regimes. The new concepts encoded in MINDY capture the underlying biological mechanisms that drive the dynamic link between ingestion and digestion patterns. This development advances in the understanding and modelling of grazing and digestive behaviour patterns of free-ranging ruminants.
Trauma exposure is associated with development of depression and anxiety; yet, some individuals are resilient to these trauma-associated effects. Differentiating mechanisms underlying development of negative affect and resilience following trauma is critical for developing effective interventions. One pathway through which trauma could exert its effects on negative affect is reward-learning networks. In this study, we examined relationships among lifetime trauma, reward-learning network function, and emotional states in young adults.
One hundred eleven young adults self-reported trauma and emotional states and underwent functional magnetic resonance imaging during a monetary reward task. Trauma-associated neural activation and functional connectivity were analyzed during reward prediction error (RPE). Relationships between trauma-associated neural functioning and affective and anxiety symptoms were examined.
Number of traumatic events was associated with greater ventral anterior cingulate cortex (vACC) activation, and lower vACC connectivity with the right insula, frontopolar, inferior parietal, and temporoparietal regions, during RPE. Lower trauma-associated vACC connectivity with frontoparietal regions implicated in regulatory and decision-making processes was associated with heightened affective and anxiety symptoms; lower vACC connectivity with insular regions implicated in interoception was associated with lower affective and anxiety symptoms.
In a young adult sample, two pathways linked the impact of trauma on reward-learning networks with higher v. lower negative affective and anxiety symptoms. The disconnection between vACC and regions implicated in decision-making and self-referential processes may reflect aberrant regulatory but appropriate self-focused mechanisms, respectively, conferring risk for v. resilience against negative affective and anxiety symptoms.
The mental health and social functioning of millions of forcibly displaced individuals worldwide represents a key public health priority for host governments. This is the first longitudinal study with a representative sample to examine the impact of interpersonal trust and psychological symptoms on community engagement in refugees.
Participants were 1894 resettled refugees, assessed within 6 months of receiving a permanent visa in Australia, and again 2–3 years later. Variables measured included post-traumatic stress disorder symptoms, depression/anxiety symptoms, interpersonal trust and engagement with refugees’ own and other communities.
A multilevel path analysis was conducted, with the final model evidencing good fit (Comparative Fit Index = 0.97, Tucker–Lewis Index = 0.89, Root Mean Square Error of Approximation = 0.05, Standardized Root-Mean-Square-Residual = 0.05). Findings revealed that high levels of depression symptoms were associated with lower subsequent engagement with refugees’ own communities. In contrast, low levels of interpersonal trust were associated with lower engagement with the host community over the same timeframe.
Findings point to differential pathways to social engagement in the medium-term post-resettlement. Results indicate that depression symptoms are linked to reduced engagement with one's own community, while interpersonal trust is implicated in engagement with the broader community in the host country. These findings have potentially important implications for policy and clinical practice, suggesting that clinical and support services should target psychological symptoms and interpersonal processes when fostering positive adaptation in resettled refugees.
Between 1905 and 1908 Percy Grainger made a major contribution to the corpus of British folk-song, collecting melodies and words of ballads, shanties and work songs, and devoting himself not just to the faithful capture of pitch and rhythm, but also the nuances of performance, with his pioneering use of the phonograph. These folk-songs became for Grainger a wellspring of compositional inspiration to which he returned time and time again. Yet while he was still a student in Frankfurt, Grainger had been making settings of British traditional tunes sourced from published collections. This article contends that these early arrangements hold the key to a deeper understanding of his later persistence in folk-song arranging and collecting, and that they prefigure the recurrent textual themes in the songs he later chose to arrange. It is argued that Grainger’s attraction to folk-song was textual and musical, tied to notions of purity, freedom and an unorthodox spirituality inspired by nature and shaped by the writings of Whitman, whereby Grainger perceived folk-song as a universal utterance. For Grainger, British folk-song was not simply a source of profound melody for appropriation; the window into a nation’s soul became a door into the souls of all humanity.
Alcohol use is commonly initiated during adolescence, with earlier onset known to increase the risk for alcohol use disorder (AUD). Altered function in neural reward circuitry is thought to increase the risk for AUD. To test the hypothesis that adolescent alcohol misuse primes the brain for alcohol-related psychopathology in early adulthood, we examined whether adolescent alcohol consumption rates predicted reward responsivity in the ventral striatum (VS), and in turn, AUD symptoms in adulthood.
A total of 139 low income, racially diverse urban males reported on their alcohol use at ages 11, 12, 15, and 17; completed self-reports of personality, psychiatric interviews, and a functional magnetic resonance imaging (fMRI) scan at age 20; and completed a psychiatric interview at age 22. We measured adolescent alcohol use trajectories using latent growth curve modeling and measured neural responses to monetary reward using a VS region of interest. We tested indirect effects of adolescent alcohol use on AUD symptoms at age 22 via VS reward-related reactivity at age 20.
Greater acceleration in adolescent alcohol use predicted increased VS response during reward anticipation at age 20. VS reactivity to reward anticipation at age 20 predicted AUD symptoms at age 22, over and above concurrent symptoms. Accelerated adolescent alcohol use predicted AUD symptoms in early adulthood via greater VS reactivity to reward anticipation.
Prospective findings support a pathway through which adolescent alcohol use increases the risk for AUD in early adulthood by impacting reward-related neural functioning. These results highlight increased VS reward-related reactivity as a biomarker for AUD vulnerability.
Small islands can guide visualization of the diverse information requirements of future context-relevant coastal governance. On small marine islands (<20 000 km2), negative effects of coastal challenges (e.g., related to population growth, unsustainable resource use or climate change) can develop rapidly, with high intensity and extreme impacts. The smallest and most remote islands within small-island states and small islands in larger states can be threatened by intrinsic governance factors, typically resulting in access to fewer resources than larger islands or administrative centres. For these reasons, efforts to support coastal change governance are critical and need to be targeted. We propose a conceptual framework that distinguishes key governance-related components of small-island social–ecological systems (SESs). To prioritize areas of vulnerability and opportunity, physical, ecological, social, economic and governance attributes are visualized to help show the ability of different types of small-island SESs to adapt, or be transformed, in the face of global and local change. Application of the framework to an Indonesian archipelago illustrates examples of local rule enforcement supporting local self-organized marine governance. Visualization of complex and interconnected social, environmental and economic changes in small-island SESs provides a better understanding of the vulnerabilities and opportunities related to context-specific governance.
This article presents the results of a program of radiocarbon dating and Bayesian modeling from the precontact Yup'ik site of Nunalleq (GDN-248) in subarctic southwestern Alaska. Nunalleq is deeply stratified, presenting a robust relative chronological framework of well-defined individual house floors abundant in ecofacts suitable for radiocarbon dating. Capitalizing on this potential, we present the results of one of the first applications of Bayesian statistical modeling of radiocarbon data from an archaeological site in the North American Arctic. Using these methods, we demonstrate that it is possible to generate robust, high-resolution chronological models from Arctic archaeology. Radiocarbon dates, procured prior to the program of dating and modeling presented here, suggested an approximately three-century duration of occupation at the site. The results of Bayesian modeling nuance this interpretation. While it is possible that there may have been activity for almost three centuries (beginning in the late fourteenth century), occupation of the dwelling complex, which dominates the site, was more likely to have endured for no more than a century. The results presented here suggest that the occupation of Nunalleq likely encompassed three generations beginning cal AD 1570–1630 before being curtailed by conflict around cal AD 1645–1675.
The use of roman numerals for stellar populations represents a classification approach to galaxy formation which is now well behind us. Nevertheless, the concept of a pristine generation of stars, followed by a protogalactic era, and finally the mainstream stellar population is a plausible starting point for testing our physical understanding of early star formation. This will be observationally driven as never before in the coming decade. In this paper, we search out observational tests of an idealised coeval and homogeneous distribution of population II stars. We examine the spatial distribution of quasars, globular clusters, and the integrated free electron density of the intergalactic medium, in order to test the assumption of homogeneity. Any real inhomogeneity implies a population II that is not coeval.
In principle, food intake by lactating dairy cows might be limited by rate of eating, capacity to produce saliva, rumen or intestinal capacity, rates of digestion and passage of food residues, or by factors such as chemicals and osmolality in the rumen. It is likely that a combination of these is used by the central nervous system to control intake. In practice, the positive relationship between digestibility and intake of forages means that high-quality material must be offered to cows during lactation if a reduced level of concentrate supplementation is envisaged but undue mobilization of body reserves avoided. Better supplementation is possible, both in terms of more frequent, smaller allocations, and of more appropriate concentrate composition with regard to the composition of the basal forage. Intake of maize silage dry matter is usually greater than for grass silage and a mixture of the two, perhaps offered in free or restricted choice, is likely to become more widely practised. Changes in body reserves are difficult to monitor and this has made it difficult to resolve the question of the magnitude of diet/environment interactions, i.e. is the same breeding and selection programme appropriate for those animals which are intended to be pushed to high yields in intensive systems and those intended to be given principally forages in semi-extensive systems?
The central nervous system is the integrator of most of the actions of the animal and as such plays a vital rôle in the control of voluntary food intake. Much of the work to understand how intake is controlled has been carried out with rats but that which has been done with pigs is included. The first experiments used electrolytic lesions in the designation of the ‘hunger centre’ and the ‘satiety centre’. Recent work has identified the paraventricular nucleus as a sensing site for experimental manipulations. Chemical stimulation of the brain has also been carried out to try to gain understanding of the rôle of neurotransmitters. Noradrenaline (NA) stimulates intake when given into many sites. Serotonin (5-HT) inhibits intake and has been claimed to play a rôle in the selection of macronutrients but 5-HT must now be interpreted in the light of the existence of several different subtypes of 5-HT receptors. Dopamine appears to moderate the hedonic response of eating. Numerous peptides are active in the brain where their rôle as neuromodulators may be quite different from their function in the periphery and at least three types of opioid receptors are implicated with kappa antagonists producing the most potent facilitatory effects. Neuropeptide Y and peptide YY produce massive orexigenic effects which readily overcome peripheral satiety factors. The brain cannot control intake in isolation. It receives inputs in the blood stream, such as glucose, as well as via the nervous system, both from the special senses and from visceral organs such as stomach, intestines and liver. Taste and olfaction are important in diet selection and a specific appetite for protein has been demonstrated in the pig.