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In 2013, I was waiting to turn right at the traffic lights when I suddenly became aware of a young man standing at the pedestrian crossing on the opposite side of the road. I looked again at the handsome face. The blonde hair cut in a style I remember so well. He was wearing blue jeans and a denim jacket. My heart skipped a beat. Once again, the universe had found a way to bring him back to me for a few moments. My son, Nicholas. My son who, in November 2000, had died in the psychiatric ward of a public hospital in Adelaide. He was 26 years old.
I'd visited Nicholas in hospital shortly before he died. We went for a walk in the grounds of the hospital that day, and I noticed one of the other patients, an elderly woman, was following us. We sat down on a bench and the woman came and stood close by. After a while Nicholas got up and walked over to the woman. He put his hand on her arm very gently and in a quiet voice I heard him say, ‘My mother and I are having some time together, would you mind very much moving further away?’ The woman nodded and without speaking moved away a little. We started to talk but we were interrupted again; this time the woman had started to sing. Looking over at Nicholas she sang to him. The words of the song were: ‘A certain smile, a certain place can lead an unsuspecting heart on a merry chase.’ It was an unlikely serenade but he listened attentively to her until she finished singing, then he turned back to me, and we continued our conversation.
At that moment I knew that despite the illness, his essential kindness hadn't left him. That despite the illness, the essence of Nicholas had not changed. I knew, too, that he'd let her know that she mattered. Was valued. He did it by listening to her story. A story that she had sung to him with the words of an old love story.
One of Tom Dishion's most significant contributions to prevention science was the development of affordable, ecologically valid interventions, such as the Family Check-Up, that screen for child and family risk factors broadly, but concentrate family-specific interventions on those with greatest potential for population impact. In the spirit of this approach, investigators examined effects of a brief, universal postnatal home visiting program on child emergency medical care and billing costs from birth to age 24 months. Family Connects is a community-wide public health intervention that combines identification and alignment of community services and resources with brief, postpartum nurse home visits designed to assess risk, provide supportive guidance, and connect families with identified risk to community resources. Over 18 months, families of all 4,777 resident Durham County, North Carolina, births were randomly assigned based on even or odd birth date to receive a postnatal nurse home visiting intervention or services as usual (control). Independently, 549 of these families were randomly selected and participated in an impact evaluation study. Families, blind to study goals, provided written consent to access hospital administrative records. Results indicate that children randomly assigned to Family Connects had significantly less total emergency medical care (by 37%) through age 24 months, with results observed across almost all subgroups. Examination of billing records indicate a $3.17 decrease in total billing costs for each $1 in program costs. Overall, results suggest that community-wide postpartum support program can significantly reduce population rates of child emergency medical care through age 24 months while being cost-beneficial to communities.
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.
This article ponders the possibilities existing for legal re-understandings of vulnerability and adopts the International Law Commission's Draft Articles on the Protection of Persons in the Event of Disasters (2016) as its principal discursive context. Despite some promise and potential, the draft Articles retreated to conservative understandings of disaster-vulnerability and missed an opportunity for a sophisticated formulation. This article argues for disaster law's engagement with contemporary social science research. The work of critical geographers, historians and anthropologists in political ecology is particularly apposite. By rejecting geophysical outlooks in favour of structuralist understandings of disaster-vulnerability, such research facilitates consideration of interrelated histories and the role of economics in producing disaster-vulnerability. This article argues that such perspectives allow for reconsideration of current legal understandings regarding disaster-vulnerability (particularly in relation to international cooperation and risk and reduction) and thereby offer some promise for enriching disaster law's comprehensiveness and relevance.
Glossy privet (Ligustrum lucidum W. T. Aiton) is a highly aggressive tree that has become globally invasive in a wide range of habitats and can quickly form dense thickets, shading and outcompeting native vegetation. Slowly decomposing slash following removal of dense infestations can create additional management challenges, including fire risk concerns, which curtailed planned invasive plant removal projects on certain tracts within the Balcones Canyonlands Preserve near Austin, TX. This prompted a pilot study to explore whether wood-decaying fungi could be used to hasten the recycling of L. lucidum logs back into the forest ecosystem. We inoculated 25 freshly cut L. lucidum logs with Trametes versicolor (Fr.) Pilat at two study sites and monitored the inoculated logs and 5 untreated control logs over a 3-yr period (February 2015 to March 2018). We found that inoculation significantly accelerated wood decay. By the end of our study, 100% of logs with >3 inoculation points were in advanced stages of decay, while only one of the control logs showed noticeable signs of decay. Inoculating logs in the field was easy and suitable for novices, requiring little or no previous experience to achieve successful results. An added benefit of using T. versicolor is its medicinal properties and potential for bioremediation. We have continued to inoculate logs with comparable success and are integrating them into forest restoration projects. Applied on a larger scale, these wood-decaying fungi have the potential to transform nonnative deadwood from a threat to an asset.
Test anxiety is experienced by 10–40% of students. The physical symptoms associated with test anxiety may be more likely to be exhibited by elementary students. Progressive muscle relaxation (PMR) has been demonstrated to reduce physical symptoms of anxiety and could be used in the classroom, but teacher acceptability of PMR for test anxiety has not been assessed. This study used a vignette format to survey 404 first through fifth grade teachers on their acceptability of classroom-based PMR as an intervention for test anxiety. Good levels of acceptability were found for implementation with a school psychologist or counsellor, CD player, or digital music player. Special education teachers reported slightly lower levels of acceptability for using PMR in the digital music player scenario. With good levels of teacher acceptability of PMR to address test anxiety, school psychologists and counsellors may be more likely to recommend the use of PMR in classrooms. Implications for implementation of PMR to reduce test anxiety, study limitations, and suggestions for future research are discussed.
This article examines the role of particular ideas of the countryside in unemployment relief schemes. While interwar thinking on the countryside has received attention, it has not been examined in the specific context of unemployment relief. This article uses four case studies from North East England, namely the Team Valley Trading Estate (Gateshead), Hamsterley Forest Instructional Centre (Durham), Swarland model village (Northumberland) and Heartbreak Hill (Cleveland). All four projects took different approaches to the unemployment problem, but all used some form of rural rhetoric. The ways in which the projects deployed images of the countryside creatively recombined a wide range of ideas to suit their needs rather than being rigidly confined by particular schools of thought.
This paper replies to Hodgson (2019), which responds to my analysis and critique in O'Donnell (2018). My present aim is clarification of our respective positions, our agreements and disagreements, and their underlying causes. To this end, I elaborate further on the logic underpinning my initial paper, comment on several (not all) key points in Hodgson's response, and conclude with the matter of our different agendas. Space limitations preclude fuller discussion and encourage concise expression.
In relation to Keynes's thought on general theorising, consumption theory and institutions, this paper closely examines Geoff Hodgson's views as set out in his magisterial work, How Economics Forgot History. While in full agreement with its advocacy of the institutionalist programme, it finds that Keynes's position has been misunderstood in all three areas, and that deep compatibilities exist between the General Theory and institutionalist analysis. Using all his available writings, it is argued that Keynes's conception of a general theory is very different from that underpinning neoclassical economics so that criticisms of the latter are irrelevant to the former, that Keynes's ‘fundamental psychological law’ was never advanced as a universal law applicable to all economies, and that Keynes expressly analysed a historically specific economic institution and its assemblage of sub-institutions. Keynes is an ally, not an enemy, of institutionalism in pursuing better economic theory.
This article analyses the formal and conceptual range of many different types of monastic history-writing during the central Middle Ages (c.900– c.1300) via a nuanced account of the monastic practices of memory in central medieval Ireland and Britain. The modern disciplines of History and Literature have focused on somewhat different aspects of memorial culture during the Middle Ages – broadly speaking, these have been ‘social memory’ in History and ‘the art of memory’ in Literature. This article looks to both social memory and the art of memory (and thus, to both historical and literary scholarship) in order to identify the means by which nuns and monks integrated history-writing with other educational, political, and artistic pursuits associated with memory. Memory Studies helps us address potential deficiencies in ideological readings of monastic writing as well as in conventional descriptions of monastic history in terms of genre and style. This article belongs to a broader trend in medieval literary criticism that considers forms of practice and affective response as alternatives to content and form as the basis for generic comparison. I am thus interested in the memorial practices that unite text-types that are usually contrasted or kept separate such as romance and annalistic chronicle. My arguments will be of most use to literary critics, but it is hoped that historians, too, might find something of value in arguments about the problems raised by the imposition of generic categories and by standard political and economic readings of monastic historiography.
My specific suggestions are these. First, the term ‘monastic’ that we assign to certain text-types and deny to others is very often misleading as an indicator of literary meaning, because ‘monastic’ meant many different things in theory and in practice during the Middle Ages and monastic libraries were never limited to typical ‘monastic’ texts. Neither generic typology nor accounts of mentality will suffice for articulating the relationship between monastic status, on the one hand, and the origins, aesthetics, or use of particular historical texts on the other. My second suggestion therefore is that a paradigm of memorial practices, fleshed out by the work of both History and Literature scholars working in Memory Studies, provides a better analytic framework.
Recent infection testing algorithms (RITA) for HIV combine serological assays with epidemiological data to determine likely recent infections, indicators of ongoing transmission. In 2016, we integrated RITA into national HIV surveillance in Ireland to better inform HIV prevention interventions. We determined the avidity index (AI) of new HIV diagnoses and linked the results with data captured in the national infectious disease reporting system. RITA classified a diagnosis as recent based on an AI < 1.5, unless epidemiological criteria (CD4 count <200 cells/mm3; viral load <400 copies/ml; the presence of AIDS-defining illness; prior antiretroviral therapy use) indicated a potential false-recent result. Of 508 diagnoses in 2016, we linked 448 (88.1%) to an avidity test result. RITA classified 12.5% of diagnoses as recent, with the highest proportion (26.3%) amongst people who inject drugs. On multivariable logistic regression recent infection was more likely with a concurrent sexually transmitted infection (aOR 2.59; 95% CI 1.04–6.45). Data were incomplete for at least one RITA criterion in 48% of cases. The study demonstrated the feasibility of integrating RITA into routine surveillance and showed some ongoing HIV transmission. To improve the interpretation of RITA, further efforts are required to improve completeness of the required epidemiological data.
OBJECTIVES/SPECIFIC AIMS: Early life stress is known to greatly impact neurodevelopment during critical periods, conferring risk for various psychopathologies, including the onset and exacerbation of schizophrenia and anxiety disorders. The endocannabinoid system is highly integrated into the stress response and may be one means by which early life stress produces such deleterious effects. Using a naturalistic, ecologically valid animal model, this study explored interactions between the stress response and endocannabinoid systems within the cerebellum, a region dense with the CB1 endocannabinoid receptors and shown to be susceptible to stress. METHODS/STUDY POPULATION: This study explored behavioral and neural impacts of early life stress in Long-Evans rats reared with or without limited access to bedding material during postnatal day (PND) 2-9. Corticosterone (CORT) levels were measured at PND8 and 70. During PND50-70, rats were assessed on Novel Object Recognition to test memory, Rotarod to evaluate cerebellar integrity, Elevated Plus Maze to assay anxiety, Social Preference, and Eyeblink Conditioning, a cerebellar-dependent and endocannabinoid-mediated task. Lipid analysis was performed on PND70 tissue samples of cerebellar interpositus (IP) nucleus via high-performance liquid chromatography and tandem mass spectrometry. RESULTS/ANTICIPATED RESULTS: Both male and female rats experiencing early life stress exhibited significantly impaired recognition memory (N = 16-20/group). Female rats having undergone stress exhibited decreased social preference compared to normally reared females (N = 11/group). Stressed males showed facilitated eyblink conditioning compared to normally reared males (N = 7-9/group). There were no group differences in rotarod or elevated plus maze performance or CORT levels at PND8 or 70 across rearing groups. At PND70, male rats experiencing early life stress exhibited a significant decrease in 2-arachidonoyl glycerol (2-AG) and arachidonic acid levels in the IP nucleus compared to normally reared males (N = 8-9/group). Compared to normally reared females, those experiencing early life stress exhibited a significant increase in prostaglandin E2 levels in the IP nucleus (N = 6-7/group). DISCUSSION/SIGNIFICANCE OF IMPACT: Early life stress, induced by limited bedding, resulted in sex-specific behavioral and lipid impairments. Results suggest that stress causes long-term alterations in endocannabinoid dynamics in males in the cerebellar IP nucleus and sex-related lipids in female cerebellum. These changes may contribute to observed long-term behavioral aberrations. Moreover, findings suggest these behavioral changes may be the result of negative-feedback dysfunction (as evidenced by decreased endocannabinoids in males) or increased neural inflammation or proliferation (as evidenced by increased prostaglandins in females). Future analysis will quantify mRNA and protein for cannabinoid receptors to better characterize aberrations to this system. Moreover, other neural regions dense with cannabinoid receptors (i.e., PFC, hippocampus) will be investigated. This work provides a basis for understanding stress impacts on the development of cognitive deficits observed in psychotic and anxiety disorders. Specifically, facilitation of eyblink conditioning complements research in humans with anxiety disorders. Broadly, understanding stress-related endocannabinoid dysregulation may provide insights into risks for, and the development of, psychopathology and uncover novel therapeutic targets with high translational power.
Chloris spp. are warm-season grasses that outcompete crops for scarce resources throughout Australia. In Queensland, mild winters and increased adoption of conservation tillage practices have led to an increase of this warm-season grass family in winter crops. The objective of this study is to understand whether droplet size (nozzle type) effects herbicide efficacy of summer perennial grasses, as previous research found no effect of droplet size (nozzle type) on herbicide efficacy of winter annual grasses. A study to compare droplet-size (nozzle type) effects on control of windmillgrass and its domesticated relative, rhodesgrass, was conducted at the University of Queensland in Gatton, QLD, Australia. Results showed little difference in dry weight reductions for windmillgrass or rhodesgrass across droplet size (nozzle type). Paraquat applications with the TTI nozzle resulted in significantly lower dry weight reductions compared with other droplet-size sprays (nozzle types) for rhodesgrass. Glyphosate, imazamox plus imazapyr, and clodinafop resulted in commercially acceptable control for both species, regardless of the droplet size (nozzle type) selected, indicating droplet size (nozzle type) has relatively little impact on the efficacy of these herbicides. Proper nozzle selection can result in control of Chloris spp., a hard to control weed species, while reducing the occurrence of spray drift to nearby sensitive areas.
This study employed the Delphi method, an exploratory method used for group consensus building, to determine the benefits and challenges associated with community engagement in patient-centered outcomes research.
A series of email surveys were sent to the Patient-Centered Outcomes Research Institute (PCORI)-funded researchers (n = 103) in New England. Consensus was achieved through gathering themes and engaging participants in ranking their level of agreement over three rounds. In round one, participant responses were coded thematically and then tallied. In round two participants were asked to state their level of agreement with each of the themes using a Likert scale. Finally, in round three, the group was asked to rank the round two themes based on potential impact.
Results suggested the greatest benefit of community engagement is that it brings multiple perspectives to the table, with 92% ranking it as the first or second most important contribution. Time was ranked as the most significant barrier to engaging community. Strategies to overcome barriers to community engagement include engaging key stakeholders early in the research, being kind and respectful and spending time with stakeholders. The most significant finding was that no researchers reported having specific measures to evaluate community engagement.
Community engagement can enhance both research relevance and methodology when researchers are engaged in meaningful collaborations. Advancing the science of community engagement will require the development of evaluation metrics to examine the multiple domains of partnership.
The incidence of HIV infections in Canada has increased yearly since 2014. New cases of HIV have resulted almost exclusively from non-occupational exposures, including sexual contact and needle sharing. Appropriate HIV post-exposure prophylaxis is under-prescribed to patients who present to the emergency department after a high-risk exposure. In November of 2017, a Canadian guideline on HIV pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP) was published. The guideline presents a standardized, evidence-based approach to assessing risk for HIV transmission and prescribing HIV prophylaxis. This summary highlights the key points from the guideline that are relevant to the practice of emergency medicine in Canada.