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Iraq and Afghanistan Veterans with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) history have high rates of performance validity test (PVT) failure. The study aimed to determine whether those with scores in the invalid versus valid range on PVTs show similar benefit from psychotherapy and if psychotherapy improves PVT performance.
Veterans (N = 100) with PTSD, mild-to-moderate TBI history, and cognitive complaints underwent neuropsychological testing at baseline, post-treatment, and 3-month post-treatment. Veterans were randomly assigned to cognitive processing therapy (CPT) or a novel hybrid intervention integrating CPT with TBI psychoeducation and cognitive rehabilitation strategies from Cognitive Symptom Management and Rehabilitation Therapy (CogSMART). Performance below standard cutoffs on any PVT trial across three different PVT measures was considered invalid (PVT-Fail), whereas performance above cutoffs on all measures was considered valid (PVT-Pass).
Although both PVT groups exhibited clinically significant improvement in PTSD symptoms, the PVT-Pass group demonstrated greater symptom reduction than the PVT-Fail group. Measures of post-concussive and depressive symptoms improved to a similar degree across groups. Treatment condition did not moderate these results. Rate of valid test performance increased from baseline to follow-up across conditions, with a stronger effect in the SMART-CPT compared to CPT condition.
Both PVT groups experienced improved psychological symptoms following treatment. Veterans who failed PVTs at baseline demonstrated better test engagement following treatment, resulting in higher rates of valid PVTs at follow-up. Veterans with invalid PVTs should be enrolled in trauma-focused treatment and may benefit from neuropsychological assessment after, rather than before, treatment.
The intensities of x-rays scattered by amorphous Fe80P13C7 and Fe40Ni40P14B6 samples have been measured as a function of photon energies E at fixed scattering angles 2θi using a Li-drifted Si detector and polychromatic x-rays generated by a 50KV full-wave rectified generator. The coherently scattered intensity per atom was calculated for free-standing samples as well as samples contained in a Be or pyrolytic graphite cell, after the evaluation of the energy dependence of the primary beam spectrum by an iterative process. The interference functions were then calculated from the data obtained in transmission and reflection, and compared with those measured with the conventional variable 2θ technique. Good agreement between energy-dispersive diffraction (also called variable wavelength technique) and variable 2θ diffraction was observed in all cases.
Objectives: Suicidal ideation (SI) is highly prevalent in Iraq/Afghanistan-era veterans with a history of mild traumatic brain injury (mTBI), and multiple mTBIs impart even greater risk for poorer neuropsychological functioning and suicidality. However, little is known about the cognitive mechanisms that may confer increased risk of suicidality in this population. Thus, we examined relationships between neuropsychological functioning and suicidality and specifically whether lifetime mTBI burden would moderate relationships between cognitive functioning and suicidal ideation. Methods: Iraq/Afghanistan-era Veterans with a history of mTBI seeking outpatient services (N = 282) completed a clinical neuropsychological assessment and psychiatric and postconcussive symptom questionnaires. Results: Individuals who endorsed SI reported more severe post-traumatic stress disorder (PTSD), depression, and postconcussive symptoms and exhibited significantly worse memory performance compared to those who denied SI. Furthermore, mTBI burden interacted with both attention/processing speed and memory, such that poorer performance in these domains was associated with greater likelihood of SI in individuals with a history of three or more mTBIs. The pattern of results remained consistent when controlling for PTSD, depression, and postconcussive symptoms. Conclusions: Slowed processing speed and/or memory difficulties may make it challenging to access and use past experiences to solve current problems and imagine future outcomes, leading to increases in hopelessness and SI in veterans with three or more mTBIs. Results have the potential to better inform treatment decisions for veterans with history of multiple mTBIs. (JINS, 2019, 25, 79–89)
Hill (Twin Research and Human Genetics, Vol. 21, 2018, 84–88) presented a critique of our recently published paper in Cell Reports entitled ‘Large-Scale Cognitive GWAS Meta-Analysis Reveals Tissue-Specific Neural Expression and Potential Nootropic Drug Targets’ (Lam et al., Cell Reports, Vol. 21, 2017, 2597–2613). Specifically, Hill offered several interrelated comments suggesting potential problems with our use of a new analytic method called Multi-Trait Analysis of GWAS (MTAG) (Turley et al., Nature Genetics, Vol. 50, 2018, 229–237). In this brief article, we respond to each of these concerns. Using empirical data, we conclude that our MTAG results do not suffer from ‘inflation in the FDR [false discovery rate]’, as suggested by Hill (Twin Research and Human Genetics, Vol. 21, 2018, 84–88), and are not ‘more relevant to the genetic contributions to education than they are to the genetic contributions to intelligence’.
Brittle ice, which occurs in all intermediate-depth and deep ice cores retrieved from high-latitude regions, presents a challenge for high-resolution measurements of water isotopes, gases, ions and other quantities conducted with continuous flow analysis (CFA). We present a novel method of preserving brittle ice for CFA stable water isotope measurements using data from a new ice core recovered by the Roosevelt Island Climate Evolution (RICE) project. Modest modification of the drilling technique and the accommodation of non-horizontal fractures (‘slanted breaks’) in processing led to a substantial improvement in the percentage of brittle ice analyzed with CFA (87.8%). Whereas traditional processing methods remove entire fragmented pieces of ice, our method allowed the incorporation of a total of 3 m of ice (1% of the 261 m of brittle ice and ~1300 years of climate history) that otherwise would not have been available for CFA. Using the RICE stable water isotope CFA dataset, we demonstrate the effect of slanted breaks and analyze the resulting smoothing of the data with real and simulated examples. Our results suggest that retaining slanted breaks are a promising technique for preserving brittle ice material for CFA stable water isotope measurements.
Hysterectomy is one of the most common surgical procedures performed in the United States. The literature supports vaginal hysterectomy as the safest and most cost-effective route of hysterectomy for benign disease whenever technically feasible. However, vaginal hysterectomy remains an underutilized route of hysterectomy. Proposed reasons why vaginal hysterectomy is not performed more frequently include: (1) the development of technology to perform laparoscopic and robotic hysterectomies; (2) decreased surgeon experience with vaginal hysterectomy; and (3) lower reimbursement for vaginal procedures.
This chapter will review indications and contraindications to vaginal hysterectomy. It will also discuss the benefits of performing a hysterectomy via the vaginal route whenever possible. Relevant anatomy and the steps of the procedure will be reviewed. Finally, the chapter will review the prevention of complications such as cuff cellulitis, dehiscence, and bleeding pedicle. Management of these complications will also be discussed.
Scope of the Problem
Approximately 30 percent of women in the United States will undergo a hysterectomy prior to the age of 60. Ninety percent of hysterectomies are performed for benign indications including abnormal uterine bleeding, fibroids, and uterine prolapse. When technically feasible, vaginal hysterectomy appears to be superior to both laparoscopic and abdominal hysterectomy. A recent Cochrane review concluded that vaginal hysterectomy is associated with a faster return to normal activities and less febrile morbidity than abdominal hysterectomy. Laparoscopic hysterectomy is associated with a greater number of urinary tract injuries and a significantly longer operating time than vaginal hysterectomy. The cost of vaginal hysterectomy is significantly less than robotic, laparoscopic, or abdominal hysterectomy, making this the preferred route of surgery.
The approach to hysterectomy varies widely across countries, regionally within countries, and even among surgeons working at the same hospital. The physician determines the plan for surgery, and ultimately the choice depends on the surgeon's experience, preferences, and individual patient characteristics. Despite the benefits of vaginal hysterectomy that have been repeatedly demonstrated by numerous trials, vaginal hysterectomy remains an underutilized procedure in the United States. The proportion of hysterectomies performed vaginally in the United States decreased from 24.8 percent in 1998 to 16.7 percent in 2010. As of 2013 the proportion of inpatient vaginal hysterectomies was stable at 16.9% despite a decrease in abdominal and an increase in laparoscopic procedures since 2010.
Social media presents an important means for social interaction, especially among adolescents, with Instagram being the most popular platform in this age-group. Pictures and communication about non-suicidal self-injury (NSSI) can frequently be found on the internet.
During 4 weeks in April 2016, n = 2826 (from n = 1154 accounts) pictures which directly depicted wounds on Instagram were investigated. Those pictures, associated comments, and user accounts were independently rated for content. Associations between characteristics of pictures and comments as well as weekly and daily trends of posting behavior were analyzed.
Most commonly, pictures depicted wounds caused by cutting on arms or legs and were rated as mild or moderate injuries. Pictures with increasing wound grades and those depicting multiple methods of NSSI generated elevated amounts of comments. While most comments were neutral or empathic with some offering help, few comments were hostile. Pictures were mainly posted in the evening hours, with a small peak in the early morning. While there was a slight peak of pictures being posted on Sundays, postings were rather evenly spread across the week.
Pictures of NSSI are frequently posted on Instagram. Social reinforcement might play a role in the posting of more severe NSSI pictures. Social media platforms need to take appropriate measures for preventing online social contagion.
A new deep ice-core drilling site has been identified in north Greenland at 75.12° N, 42.30° W, 316 km north-northwest (NNW) of the GRIР drill site on the summit of the ice sheet. The ice thickness here is 3085 m; the surface elevation is 2919 m.The North GRIP (NGRIP) site is identified so that ice of Eemian age (115–130 ka BP,calendar years before present) is located as far above bedrock as possible and so the thickness of the Eemian layer is as great as possible. An ice-flow model, similar to the one used to date the GRIP ice core, is used to simulate the flow along the NNW-trending ice ridge. Surface and bedrock elevations, surface accumulation-rate distribution and radio-echo sounding along the ridge have been used as model input.The surface accumulation rate drops from 0.23 m fee equivalent year−1 at GRIP to 0.19 m ice equivalent year−1 50 km from GRIP. Over the following 300km the accumulation is relatively constant, before it starts decreasing again further north. Ice thicknesses up to 3250 m bring the temperature of the basal ice up to the pressure-melting point 100–250 km from GRIP. The NGRIP site islocated 316 km from GRIP in a region where the bedrock is smooth and the accumulation rate is 0.19 m ice equivalent year−1. The modeled basal ice here has always been a few degrees below the pressure-melting point. Internal radio-echo sounding horizons can be traced between the GRIP and NGRIP sites, allowing us to date the ice down to 2300 m depth (52 ka BP). An ice-flow model predicts that the Eemian-age ice will be located in the depth range 2710–2800 m, which is 285 m above the bedrock. This is 120 m further above the bedrock, and the thickness of the Eemian layer of ice is 20 m thicker, than at the GRIP ice-core site.
One in 5 PN are ejected from common envelope binary interactions but Kepler results are already showing this proportion to be larger. Their properties, such as abundances can be starkly different from those of the general population, so they should be considered separately when using PN as chemical or population probes. Unfortunately post-common envelope PN cannot be discerned using only their morphologies, but this will change once we couple our new common envelope simulations with PN formation models.
The present report of Commission 15 has been, as usual, prepared primarily by the chairpersons of the two working groups. E. Tedesco wrote the section about Asteroids and Meteorites, with the assistance of A. Cellino, G. Consolmagno and C.-I. Lagerkvist. W. F. Huebner prepared the section about Comets, with the assistance of J. Benkhoff, H. Boehnhardt, J. Brandt, M. T. Capria, A. Cochran, G. Cremonese, M. Duncan, W. Huntress, H. Levison, and G. P. Tozzi. Moreover, the whole document has been assembled by K. Muinonen, who did the final editing, to merge the two reports and fit the document into the allotted space. Material taken from both major areas regarding the relationship between comets and asteroids has been combined into a single section.
The DJEHUTY project is an intensive effort at the Lawrence Livermore National Laboratory (LLNL) to produce a general purpose 3-D stellar structure and evolution code to study dynamic processes in whole stars.
In situ observations of comet Halley provided the first photographs of a cometary nucleus and yielded information about its environment, including the emitted gas and dust. The relation between these measurements and properties of and processes on the nucleus is established by theoretical modelling, while laboratory experiments may provide some of the physical parameters needed. In addition, laboratory tests can stimulate new ideas for processes that may be relevant to cometary physics. Processes to be studied in detail by large-scale laboratory experiments may include: (1) heat transport phenomena during sublimation of porous ice-dust mixtures, (2) material modification and chemical fractionation caused by the sublimation processes, (3) buildup and destruction of dust mantles, (4) detailed studies of gas release from mixtures of volatile ices, and (S) the investigation of ice and dust particle release mechanisms. The KOSI-team (Kometensimulation) carried out sublimation experiments with ice-mineral mixtures in a large Space Simulator. During initial experiments, cylindrical samples of 30-cm diameter and 15-cm thickness were irradiated with up to 2700–W/m2 light energy. The samples consisted of water-ice or water- and CO2-ice mineral mixtures. The experiments showed the importance of advection for heat transport into the interior. It was found that the sublimation of CO2 advances into the sample at a higher speed than that of water vapor release. Therefore, emission of volatile gases responded to insolation changes with a time lag of several hours. The ratio of the emitted gas species, as well as the dust-to-gas mass ratio, differs significantly from the values within the sample. A partly permeable refractory mantle of minerals and carbonaceous material developed with time. Dust and ice particle emission has been observed to occur from irradiated dirty ices as well as from dust mantles.
Accurate interpretation of origination and extinction of fossil species is crucial to answering a variety of questions in paleontology. Fossil datums, the observed age of first or last occurrences, are subject to sampling error as a result of preservation and low abundances near range endpoints. This sampling error can cause local range offset, an age difference between the observed first or last occurrence of a species and its true origination or extinction. Here, we develop and test a new technique, the Probable Datum Method (PDM), that can be used to assess the extent of local range offset for nannofossil species. The PDM estimates the original abundance of a taxon and its probable true age of first or last occurrence. The PDM uses a model in which original abundance is related to count abundance through preservation and the counting process. This model is empirically parameterized, including an experimental determination of false positive and error rates of a nannofossil count. The model is simulated then inverted to estimate likely original abundance and true datum age from count abundance data. We first test the PDM in a positive control experiment with known parameter values. This experiment shows that the PDM is robust and returns known values accurately. Next we apply the method to the origination of nannoplankton after the Cretaceous/Paleogene boundary to test whether first occurrences were synchronous between widely spaced locations. The PDM results suggest that observed diachrony of K/Pg originations cannot be explained by the effects of local range offset; rather, in some cases they indicate truly diachronous first occurrences between localities. Although the technique was developed to analyze nannoplankton ranges, the statistical nature of the PDM, its experimentally derived parameters, and its parsimonious nature should make it applicable to many micropaleontological studies that interpret patterns of origination and extinction.