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Analysis of human remains and a copper band found in the center of a Late Archaic (ca. 5000–3000 cal BP) shell ring demonstrate an exchange network between the Great Lakes and the coastal southeast United States. Similarities in mortuary practices suggest that the movement of objects between these two regions was more direct and unmediated than archaeologists previously assumed based on “down-the-line” models of exchange. These findings challenge prevalent notions that view preagricultural Native American communities as relatively isolated from one another and suggest instead that wide social networks spanned much of North America thousands of years before the advent of domestication.
OBJECTIVES/SPECIFIC AIMS: Oculopharyngeal muscular dystrophy (OPMD) is a rare, late-onset muscular dystrophy that causes severe swallowing impairment (dysphagia). Although promising therapies are in the pipeline, validated dysphagia outcome measures for use in OPMD trials have not been established. Videofluoroscopic swallow studies (VFSS) are considered the clinical gold standard for dysphagia assessment, yet the optimal objective measure of VFSS in OPMD is not known. Our aim was to investigate the utility of the Modified Barium Swallow Impairment Profile (MBSImP) as an objective measure of VFSS in OPMD patients. METHODS/STUDY POPULATION: This was a single-center, prospective, cross-sectional study. In total, 26 individuals with OPMD underwent VFSS and other measures of dysphagia including 50-mL water swallow time (ST). Validity was assessed by examining correlations with an OPMD Global Severity Score (GSS) and with dysphagia duration. RESULTS/ANTICIPATED RESULTS: The MBSImP demonstrated moderate correlations with GSS (Pearson r=0.52, p=0.006) and ST (r=0.39, p=0.049). The relationship between MBSImP and dysphagia duration appeared nonlinear, and levelled off with long dysphagia duration. In contrast, ST did not correlate significantly with GSS (r=0.27, p=0.18), nor with disease duration (r=0.05, p=0.83). DISCUSSION/SIGNIFICANCE OF IMPACT: Objective measurement of VFSS is a promising outcome measure in OPMD. With long disease duration, the MBSImP may not be sufficiently sensitive to detect disease progression. More sensitive measures for scoring dysphagia severity on VFSS should be explored for application to future s of OPMD.
For almost four decades Carole Rawcliffe has been a towering figure among historians of the later Middle Ages. Although now best known for her pioneering contributions to medical history, including major studies of hospitals, leprosy and public health, her published works range far more broadly to encompass among other subjects the English nobility, Members of Parliament, the regional history of East Anglia and myriad aspects of political and social interaction. The essays collected in this festschrift, written by a selection of her colleagues, friends and former students, cover a wide spectrum of themes and introduce such diverse characters as an estranged queen, a bankrupt aristocrat, a female apothecary, a flute-playing Turkish doctor and a medieval "Dad's Army" conscripted to defend England's coasts.
Linda Clark is Editor of the 1422-1504 section of the History of Parliament; Elizabeth Danbury is an Honorary Senior Research Fellow at the Institute of English Studies, School of Advanced Study, University of London, and Honorary Research Fellow at the Department of Information Studies, University College London.
Contributors: Jean Agnew, John Alban, Brian Ayers, Caroline Barron, Christopher Bonfield, Carole Hill, Peregrine Horden, Hannes Kleineke, Nicholas Vincent.
Background: Psychological therapy services are often required to demonstrate their effectiveness and are implementing systematic monitoring of patient progress. A system for measuring patient progress might usefully ‘inform supervision’ and help patients who are not progressing in therapy. Aims: To examine if continuous monitoring of patient progress through the supervision process was more effective in improving patient outcomes compared with giving feedback to therapists alone in routine NHS psychological therapy. Method: Using a stepped wedge randomized controlled design, continuous feedback on patient progress during therapy was given either to the therapist and supervisor to be discussed in clinical supervison (MeMOS condition) or only given to the therapist (S-Sup condition). If a patient failed to progress in the MeMOS condition, an alert was triggered and sent to both the therapist and supervisor. Outcome measures were completed at beginning of therapy, end of therapy and at 6-month follow-up and session-by-session ratings. Results: No differences in clinical outcomes of patients were found between MeMOS and S-Sup conditions. Patients in the MeMOS condition were rated as improving less, and more ill. They received fewer therapy sessions. Conclusions: Most patients failed to improve in therapy at some point. Patients’ recovery was not affected by feeding back outcomes into the supervision process. Therapists rated patients in the S-Sup condition as improving more and being less ill than patients in MeMOS. Those patients in MeMOS had more complex problems.
People who have read War and Peace more than once, and enjoyed it immensely, can often scarcely remember a thing about it.
The concept of redundancy employed in this essay is the one used in mathematics and linguistics to designate symbols that do not add information to a sequence. One of the hazards of teaching twentieth-century war literature is the tacit inference of redundancy by readers, namely that the representational conventions as well as the facts and values represented are ‘predictable from … context’. The claim that twentieth-century war writing is made superfluous by War and Peace (1869) is polemical, but it is also intended to do serious work: to draw attention to representations of war which are not predictable from context, and to renew questions such as why representing war as irrational, murderous activity is unefficacious, and why we would imagine otherwise.
The designs of War and Peace as war writing can be recognised as early as 1853, when Tolstoy published a story drawing on his own military experience in the Caucasus:
War always interested me: not war in the sense of manoeuvres devised by great generals – my imagination refused to follow such immense movements, I did not understand them – but the reality of war, the actual killing. I was more interested to know in what way and under the influence of what feeling one soldier kills another than to know how the armies were arranged at Austerlitz and Borodino.
In october 1099, following the conquest of Jerusalem, First Crusade forces led by Duke Godfrey of Bouillon laid siege to the city of Arsuf, about fifteen miles north of modern Tel Aviv. According to the early-twelfth-century chronicler Albert of Aachen, the city's defenders attempted to distract Godfrey by crucifying one of Godfrey's men, Gerard of Avesnes. They placed him on the city walls within sight of the siege forces. Dying yet still able to talk, Gerard begged Godfrey to avenge his suffering and death. Godfrey told Gerard that, unfortunately, he could not avenge him; diverting men to do so would cost them the city. Furthermore, he added, ‘Certainly if you have to die, it is more useful that you alone should die than that our decree and be violated and this city remain always unsafe for pilgrims. For if you die to the present life, you will have life with Christ in heaven.’ With that Gerard was left to his fate, while the crusaders continued to assault the city.
The assault failed dramatically, prompting reflection on the potential causes of God's disfavour. In particular, Godfrey's response to Gerard's request for vengeance was called into question. Arnulf of Chocques, the newly appointed patriarch of Jerusalem, roundly condemned Godfrey not only for abandoning Gerard to his fate, but especially for failing to avenge his death. Arnulf described Godfrey's actions as ‘treachery and hardheartedness … impiety … base filth of all crimes’.
The officer stared at him curiously, as though doubting the evidence of his own ears.
‘A war?’ he chuckled at last, as though the word had amused him. ‘I'm afraid you're rather simplifying the issue, aren't you? The conception of war, you know, is rather an old-fashioned one, don't you agree? There's surely not much distinction nowadays between being at war and being at peace.’
Most writing about British Cold War culture has concentrated on nuclearism, pacifism, decolonisation, socialism, postmodernism, Americanisation – in short, on everything but war. One effect of the attention paid to these various narratives has been to obscure the fact that citizens of the USSR and those of Western capitalist democracies alike understood and feared the Cold War as war, even if later accounts have tended to lose sight of what Holger Nehring has called the ‘warlike character’ of their experiences. If the Cold War is to have any explanatory force as a context for literary works beyond serving as a useful periodising shorthand, then we need to know in what sense, if any, the literature of the Cold War era understood itself as a war literature. ‘What kind of war was this?’ asks the historian Anders Stephanson. ‘The two sides never went to war with each other. There is no obvious beginning, no single moment of initial aggression, no declaration of war, no crossing of a certain line, and no open military engagement.