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A short, effective therapy for posttraumatic stress disorder (PTSD) could decrease barriers to implementation and uptake, reduce dropout, and ameliorate distressing symptoms in military personnel and veterans. This non-inferiority RCT evaluated the efficacy of 2-week massed prolonged exposure (MPE) therapy compared to standard 10-week prolonged exposure (SPE), the current gold standard treatment, in reducing PTSD severity in both active serving and veterans in a real-world health service system.
This single-blinded multi-site non-inferiority RCT took place in 12 health clinics across Australia. The primary outcome was PTSD symptom severity measured by the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) at 12 weeks. 138 military personnel and veterans with PTSD were randomised. 71 participants were allocated to SPE, with 63 allocated to MPE.
The intention-to-treat sample included 138 participants, data were analysed for 134 participants (88.1% male, M = 46 years). The difference between the mean MPE and SPE group PTSD scores from baseline to 12 weeks-post therapy was 0.94 [95% confidence interval (CI) −4.19 to +6.07]. The upper endpoint of the 95% CI was below +7, indicating MPE was non-inferior to SPE. Significant rates of loss of PTSD diagnosis were found for both groups (MPE 53.8%, SPE 54.1%). Dropout rates were 4.8% (MPE) and 16.9% (SPE).
MPE was non-inferior to SPE in significantly reducing symptoms of PTSD. Significant reductions in symptom severity, low dropout rates, and loss of diagnosis indicate MPE is a feasible, accessible, and effective treatment. Findings demonstrate novel methods to deliver gold-standard treatments for PTSD should be routinely considered.
OBJECTIVES/GOALS: Over 30% of patients with rheumatoid arthritis (RA) exhibit fibromyalgianess, a symptom cluster associated with increased pain sensitivity. Up to half of RA patients use oral glucocorticoids (GCs) long-term despite their known, dose-dependent toxicity. We examined the association between fibromyalgianess and oral GC persistence in RA patients. METHODS/STUDY POPULATION: We used data from the Central Pain in Rheumatoid Arthritis (CPIRA) cohort to follow participants with active RA on oral prednisone who initiated a new disease-modifying anti-rheumatic drug. We measured fibromyalgianess using the Fibromyalgia Survey Questionnaire (FSQ), previously shown to correlate with key fibromyalgia features often superimposed upon RA. We stratified fibromyalgianess severity as follows: FSQ<8 low, 8-10 moderate, >10 high/very high. We defined GC persistence as GC use at 3 month followup visit. We assessed the association between baseline fibromyalgianess (exposure) and GC persistence at followup (outcome) using multiple logistic regression, adjusted for demographics, RA duration, serostatus, and inflammatory activity measured by swollen joint count and C reactive protein. RESULTS/ANTICIPATED RESULTS: Of 97 participants on prednisone at baseline, 65% were taking prednisone at follow-up. Fifty-seven percent of participants with low baseline fibromyalgianess had persistent GC use, compared to 84% with high or very high fibromyalgianess. After adjustment as outlined above, participants with high/very high baseline fibromyalgianess remained more likely to be on prednisone at follow-up, relative to those with low fibromyalgianess (OR 4.99 [95% CI 1.20 – 20.73]). DISCUSSION/SIGNIFICANCE: In this cohort of patients with active RA, high fibromyalgianess is associated with persistent GC use, independent of inflammatory activity. This finding suggests non-inflammatory pain related to fibromyalgianess may be misclassified as inflammatory pain related to RA disease activity.
Chapter Three studies ‘the word’ by merging two fields of association: first, the agglomeration of human labours, social practices, cultural values, and codified grammatical systems that made possible and supported the acquisition of Latin; second, the inhuman order of the ‘verbum Dei’. Each of these fields of association has, as its ultimate aim, the transformation of individual lives. It is under the rubric of this shared objective that I bring them together here. The first half of the chapter explores aspects of the medieval Latin grammatical tradition and its early modern afterlives. My goal is to make some seventh-century wranglings on the subject of the Latin case system serve as a point of entry into later fashions of prose style, and into the pedagogical disciplines of systematic imitation that were developed to teach Ciceronian Latin to schoolboys. The second half of the chapter explores a range of texts associated with St Paul, St Augustine, and Martin Luther in order to characterize the linguistic and spiritual stakes of medieval and early modern Britain’s absorption into Rome.
Chapter Two studies how Rome figures in shifting conceptions of the problem of the self. The chapter’s emphasis is on sixteenth- and seventeenth-century writers and texts, ranging from Edmund Spenser and John Donne to Sir Thomas Wilson and John Milton. English perspectives on Rome, however, were mediated to a significant extent by continental writers such as Petrarch, Joachim Du Bellay, and Michel Eyquem de Montaigne. Writers trained within (and in Petrarch’s case, actively forging) the traditions of humanist inquiry celebrated their commitment to returning ad fontes. In practice, however, their engagements with a ‘text’ as complex and ramified as Rome risked leaving them endlessly navigating tributary brooks, creeks, streams, and rivers rather than reposing comfortably at the source. The chapter brings together scenes of schooling, staring, and travel in order to study tensions between understandings of the self as being an immured condition of metaphysical finitude, on the one hand, and as being formed via the absorption of capabilities that arrive from the outside, on the other.
This chapter asks where and how Rome (and, by extension, polemics self-consciously characterized as reactions against Rome) figures in efforts to determine what the living owe to the dead, and what the dead can do for the living. Latin occupies a controlling position within this inquiry; so, too, do texts that cast the world of the living as the home of the dead; so, finally, do Reformation-era debates about the soteriological stakes of praying for the dead. These topics span a period of time in which Rome is the gravitational centre of a sequence of massive upheavals in vernacular piety and attendant debates about the relationship between the living and the dead. The chapter argues that interpreting these debates as facets of the fact of Rome alerts us to the role that the human voice plays in probing the limits of mortality and the nature of the human as such.
The book’s conclusion follows the fact of Rome east rather than west via a seventeenth-century translation of Ovid’s Tristia—a collection of poems written by Ovid near the Black Sea during the years following his exile from Rome. These translations see a former grammar-school boy reconstructing, from the temporal distance of manhood and maturity, a popular curriculum text and, by necessary extension, revisiting the scene of his own instruction. Ovid’s meditations on the subject of what it means to live apart from Rome, and his expressions of fear that Rome’s language is slipping from his grip, provide a final backdrop against which to reframe the book’s arguments.
Chapter One studies how Rome figures in the murky processes by which individuals settled their relation to the world. In the process, it establishes something of the range of conditions under which medieval and early modern writers negotiated their own absorption into the matter of Rome. The chapter pursues at length medieval and early modern habits of attending not so much to the wonders of Rome, but rather to all that is most ordinary, obvious (in the word’s etymological reference to that which is encountered ‘in the way’), and ubiquitous in what Rome left in its wake when it relinquished its formal, administrative hold on the provinces of Britannia. These preoccupations open onto a wide span of time: from the middle of the sixth to the middle of the seventeenth century. The texts and problems that dominate the chapter range from Gildas and Bede to Sir Thomas Browne in the late seventeenth century.
Scholars have established that Rome is at once a place and an idea. This double formula, however, which limits Rome to a specific distant place (distant, that is, from the perspective of Britain) and an idea (that is, an immaterial concept or notion of that distant place), needs to be supplemented by an acknowledgement that the Roman Empire had left in its wake material remains and cultural practices that ensured that Rome could always be close-to-hand, familiar, and domestic—even a thousand or more miles from the Eternal City. Ruins, roads, the Latin language and the thickets of its grammar, cultural and spiritual institutions, liturgical texts and devotional regimens: these phenomena ensured that Rome could be, even as far away as Medieval or Renaissance Britain, experienced as near rather than far, and as a network of material remains and cultural practices rather than as an abstract idea. The book gathers these disparate phenomena under the rubric of the ‘fact’ of Rome (with an eye to the word’s derivation from the Latin factum) in an effort to show that lives lived in Medieval and Renaissance Britain were continually immersed in versions of Rome that oscillated between conspicuousness and invisibility.
This book explores the cultural and intellectual stakes of medieval and renaissance Britain's sense of itself as living in the shadow of Rome: a city whose name could designate the ancient, fallen, quintessentially human power that had conquered and colonized Britain, and also the alternately sanctified and demonized Roman Church. Wallace takes medieval texts in a range of languages (including Latin, medieval Welsh, Old English and Old French) and places them in conversation with early modern English and humanistic Latin texts (including works by Gildas, Bede, Chaucer, Shakespeare, Bacon, St. Augustine, Dante, Erasmus, Luther and Montaigne). 'The Ordinary', 'The Self', 'The Word', and 'The Dead' are taken as compass points by which individuals lived out their orientations to, and against, Rome, isolating important dimensions of Rome's enduring ability to shape and complicate the effort to come to terms with the nature of self and the structure of human community.