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Annually dated tree-rings of 509 live and deadwood limber pine (Pinus flexilis) samples from the semi-arid Wassuk Range, Nevada, yielded a 3996-yr record extending from 1983 BC to AD 2013. Correlations of radial growth with climate were positive for water relations and negative for summer temperatures. Long-term trends of ring-width corresponded to climate variability documented from other proxies, including low growth during the Late Holocene Dry Period and Medieval Climate Anomaly (MCA) and elevated growth during cool, wet periods of the Neoglacial and Little Ice Age. Spline fit of the data indicated that growth decrease in the last 20 years was second lowest on record, surpassed by lowest growth at 20 BC—AD 150. Demographics of limber pine by aspect and elevation were not strongly related to long-term climate dynamics, except in the case of extirpations on all but north aspects at the end of the MCA. Pines occurred persistently on north aspects, where a continuous record existed to present. Elevation shifts were not obvious on any aspect, and no evidence existed for migration above current treeline. Non-climatic factors appear to interact with climate to make north slopes refugial for upland pines in semi-arid regions across four millennia.
Intermittent energy restriction (IER) involves short periods of severe energy restriction interspersed with periods of adequate energy intake, and can induce weight loss. Insulin sensitivity is impaired by short-term, complete energy restriction, but the effects of IER are not well known. In randomised order, fourteen lean men (age: 25 (sd 4) years; BMI: 24 (sd 2) kg/m2; body fat: 17 (4) %) consumed 24-h diets providing 100 % (10 441 (sd 812) kJ; energy balance (EB)) or 25 % (2622 (sd 204) kJ; energy restriction (ER)) of estimated energy requirements, followed by an oral glucose tolerance test (OGTT; 75 g of glucose drink) after fasting overnight. Plasma/serum glucose, insulin, NEFA, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP) and fibroblast growth factor 21 (FGF21) were assessed before and after (0 h) each 24-h dietary intervention, and throughout the 2-h OGTT. Homoeostatic model assessment of insulin resistance (HOMA2-IR) assessed the fasted response and incremental AUC (iAUC) or total AUC (tAUC) were calculated during the OGTT. At 0 h, HOMA2-IR was 23 % lower after ER compared with EB (P<0·05). During the OGTT, serum glucose iAUC (P<0·001), serum insulin iAUC (P<0·05) and plasma NEFA tAUC (P<0·01) were greater during ER, but GLP-1 (P=0·161), GIP (P=0·473) and FGF21 (P=0·497) tAUC were similar between trials. These results demonstrate that severe energy restriction acutely impairs postprandial glycaemic control in lean men, despite reducing HOMA2-IR. Chronic intervention studies are required to elucidate the long-term effects of IER on indices of insulin sensitivity, particularly in the absence of weight loss.
The 5-HTTLPR polymorphism of the serotonin transporter has been shown to play a role in autism spectrum disorders (ASD). Moreover, disaster-related prenatal maternal stress (PNMS) has also been shown to be associated with ASD. However, no study to date has examined whether these two factors, either individually or in combination, are predictive of ASD traits in the same sample. We hypothesized that children, particularly boys, with the LL genotype exposed to high levels of disaster-related PNMS would exhibit higher levels of ASD traits compared to boys with the LS or SS genotypes and girls regardless of genotype. Genotype and ASD levels obtained using the Australian normed Autism Spectrum Rating Scales – Short Form were available for 105 30-month-old children exposed to varying levels of PNMS following the 2011 Queensland Flood. For boys, higher ASD traits were associated with the 5-HTTLPR LL genotype in combination with either a negative maternal appraisal of the flood, or high levels of maternal composite subjective stress, PSTD-like or peritraumatic dissociation symptoms. For girls, maternal peritraumatic dissociation levels in combination with the 5-HTTLPR LS or SS genotype were associated with higher ASD traits. The present findings are the first to demonstrate that children’s genotype moderates effects of disaster-related PNMS on ASD traits, with different pattern according to child sex.
Prenatal maternal stress (PNMS) has been associated with postnatal behavioral alterations that may be partly explained by interactions between the hypothalamic–pituitary–adrenal (HPA) and hypothalamic–pituitary–gonadal (HPG) axes. Yet it remains unclear whether PNMS leads to enduring HPA–HPG alterations in the offspring, and whether HPA–HPG interactions can impact behavior during development, in particular levels of aggression in childhood. Here we investigated the relationship between a marker for HPG axis function (baseline testosterone) and a marker for HPA axis response (cortisol area under the curve) in 11½-year-olds whose mothers were exposed to the 1998 Quebec ice storm during pregnancy (n = 59 children; 31 boys, 28 girls). We examined (a) whether the degree of objective or subjective PNMS regulates the testosterone–cortisol relationship at age 11½, and (b) whether this testosterone–cortisol relationship is associated with differences in aggressive behavior. We found that, at lower levels of subjective PNMS, baseline testosterone and cortisol reactivity were positively correlated; in contrast, there was no relationship between these hormones at higher levels of subjective PNMS. Cortisol response moderated the relationship between testosterone and aggression. These results support the notion PNMS may explain variance in fetal HPA–HPG interactions, and that these interactions may be associated with aggressive behavior in late childhood.
To develop and validate a child and adolescent version of the Three-Factor Eating Questionnaire (CTFEQr17) and to assess its psychometric properties and factor structure. We also examined associations between the CTFEQr17 and BMI and food preferences.
A two-phase approach was utilized, employing both qualitative and quantitative methodologies.
Primary and secondary schools, UK.
In phase 1, seventy-six children (thirty-nine boys; mean age 12·3 (sd 1·4) years) were interviewed to ascertain their understanding of the original TFEQr21 and to develop accessible and understandable items to create the CTFEQr17. In phase 2, 433 children (230 boys; mean age 12·0 (sd 1·7) years) completed the CTFEQr17 and a food preference questionnaire, a sub-sample (n 253; 131 boys) had their height and weight measured, and forty-five children (twenty-three boys) were interviewed to determine their understanding of the CTFEQr17.
The CTFEQr17 showed good internal consistency (Cronbach’s α=0·85) and the three-factor structure was retained: cognitive restraint (CR), uncontrolled eating (UE) and emotional eating (EE). Qualitative data demonstrated a high level of understanding of the questionnaire (95 %). High CR was found to be significantly associated with a higher body weight, BMI and BMI percentile. High UE and EE scores were related to a preference for high-fat savoury and high-fat sweet foods. The relationships between CTFEQr17, anthropometry and food preferences were stronger for girls than boys.
The CTFEQr17 is a psychometrically sound questionnaire for use in children and adolescents, and associated with anthropometric and food preference measures.
Collaborative programs have helped reduce catheter-associated urinary tract infection (CAUTI) rates in community-based nursing homes. We assessed whether collaborative participation produced similar benefits among Veterans Health Administration (VHA) nursing homes, which are part of an integrated system.
This study included 63 VHA nursing homes enrolled in the “AHRQ Safety Program for Long-Term Care,” which focused on practices to reduce CAUTI.
Changes in CAUTI rates, catheter utilization, and urine culture orders were assessed from June 2015 through May 2016. Multilevel mixed-effects negative binomial regression was used to derive incidence rate ratios (IRRs) representing changes over the 12-month program period.
There was no significant change in CAUTI among VHA sites, with a CAUTI rate of 2.26 per 1,000 catheter days at month 1 and a rate of 3.19 at month 12 (incidence rate ratio [IRR], 0.99; 95% confidence interval [CI], 0.67–1.44). Results were similar for catheter utilization rates, which were 11.02% at month 1 and 11.30% at month 12 (IRR, 1.02; 95% CI, 0.95–1.09). The numbers of urine cultures per 1,000 residents were 5.27 in month 1 and 5.31 in month 12 (IRR, 0.93; 95% CI, 0.82–1.05).
No changes in CAUTI rates, catheter use, or urine culture orders were found during the program period. One potential reason was the relatively low baseline CAUTI rate, as compared with a cohort of community-based nursing homes. This low baseline rate is likely related to the VHA’s prior CAUTI prevention efforts. While broad-scale collaborative approaches may be effective in some settings, targeting higher-prevalence safety issues may be warranted at sites already engaged in extensive infection prevention efforts.
Improving compliance with hand hygiene is a cornerstone of infection prevention. However, data regarding practical methods for monitoring compliance are limited. We found that product use metrics have a moderate correlation with direct observation in ward settings and limited correlation in intensive care units.
Testifying before a war crimes tribunal can have long-term physical and psychological consequences (Hamber 2009; Stover 2005). The testimonies witnesses give are not just statements about whether there have been violations of international law; typically their evidence pertains to the traumas of war they have experienced, which requires them to recall painful events. One cannot overstate the impact of this trauma in terms of the physiological and psychological health of those persons who are responsible for “bearing witness.” It means that not only did they endure significant levels of trauma during the Balkan wars, with which they still need to cope on a daily basis, but the very process of having to testify in one or more trials forces them to recall these memories, to cope with waiting periods (which can last years) before being called to testify, and to deal with the residual impact of having testified. This chapter describes the witnesses’ psychological and physical health and how witnesses believe testifying has affected their well-being. There are three key lines of inquiry regarding the factors affecting witness physical and psychological health we explore in this chapter.
First, we examine the central concept of witness well-being through multiple measures evaluating the short- and long-term impact of the wars of the former Yugoslavia on those who have testified, including a battery of questions about their post-traumatic symptoms and perceptions about their health after testifying and today. We will begin by unpacking how well the witnesses are today, which types of post-conflict reactions and psychological concerns they tend to experience, and how the testimonial process has influenced their health.
Second, we examine witnesses’ trauma, its impact, and their health to ascertain which characteristics tend to be most associated with psychological and physical health, especially their emotional states before and after testimony. The short- and long-term impact of testifying on ICTY witnesses has been a subject of interest since the beginning of the Tribunal (Wald 2002). VWS personnel can recount years of experience spent working with a diverse witness population, with some witnesses being more fragile during the testimonial process, while others are incredibly self-sufficient and composed despite having to recount horrific events.
In 1994, the United Nations began articulating the contours of “human security” in the context of international relations. Broadly defined as having two components – “freedom from fear” (absence of violent conflict) – and a much broader dimension – “freedom from want” (socioeconomic security), both are vital in post-conflict societies (Kaldor 2007; Lautensach and Lautensach 2013; UNDP 1994). Human security exists when individuals can live without threats of violence to their personal and bodily integrity, and when they can live in conditions where basic human needs are met, including work, health, security, and employment. These issues of human security are especially critical in the context of witnesses testifying before international courts, for not only are nearly all of these individuals victims of war who have needs resulting from these conflicts, they are also courageous individuals who have stepped forward to contribute to national and international justice. The act of testifying brings with it human security consequences that are critical to witness well-being, as well as the ability of international tribunals to conduct trials. One only has to look at the problems the ICC has faced regarding witness safety and its subsequent decision to suspend the Kenyatta trial involving election violence in Kenya to understand that witnesses are a sine qua non of international criminal justice.
In this chapter, we examine the impact of witnesses testifying in the context of human security issues and consequences to better understand the degree to which they face social, economic, and physical consequences and which factors are most associated with the occurrence of threats to human security. In the first section of this chapter we review the findings of the survey to document the problems faced by witnesses, the sources of these problems, and the steps taken by witnesses to address them. In the second section of the chapter we analyze the role of the three theoretical lenses on human security – wartime trauma, ethnicity, and gender – to better understand how these three factors shape the witness experience. We find that while ethnicity can help us gain a better understanding of which witnesses are most likely to experience threats to human security, the level of wartime trauma and whether the individual is an ethnic minority in their community are among the more powerful factors associated with such threats.
As discussed in Chapter 1, the principal axes through which we seek to understand the opinions and experiences of the witnesses are gender, ethnicity, and the type as well as range of trauma experienced during the Balkan wars. These three characteristics are key issues in the ICTY jurisprudence; they have helped define the nature of the conflicts and the crimes committed in the former Yugoslavia; and they are an integral part of the witnesses’ identities and the basis for their appearances on the witness stand. In this chapter, we take the reader through an exploration of how these characteristics help describe who the witnesses are, and we also analyze the extent to which there is overlap and other relationships among the three dimensions. For example, we find that wartime trauma is not evenly distributed across our witness sample, but varies in part based on witness ethnic identity and gender.
To better acquaint the reader with the witness sample we begin by providing a brief overview of witness characteristics along these three dimensions. Second, we explore in-depth how the nature and scope of trauma experienced by witnesses vary by gender and ethnicity. We conclude by assessing the utility of the three witness dimensions and how they can help us understand witness recollections, perceptions, and opinions.
GENDER, ETHNICITY, AND WARTIME EXPERIENCE: AN OVERVIEW
We begin by reviewing the key sample parameters of our witness database. Of the 300 ICTY fact witnesses in the sample, 253 are male witnesses (84.33%), while 47 are female witnesses (15.67%). Women were distinctly less likely to be called to testify by the ICTY, and our sample reflects this. Women comprise approximately 13% of all ICTY witnesses – a strikingly small sample of the witnesses who testify – and we note our sample size of 15.6% closely approximates their actual proportion. We sought to oversample women, given their low numbers and also because ICTY personnel indicated that women might be more reluctant and thus less likely to agree to be surveyed.
The justice cascade (Sikkink 2011) and the increasing resort to international tribunals to confront the atrocities perpetrated during wars and government repression have led to increasing interest in studying the impact of these international institutions and what it means for international justice (Akhavan 2009; Barria and Roper 2005; Clark 2014; Gilligan 2006; Greig and Meernik 2014; Jo and Simmons 2016; Kim and Sikkink 2010; McAllister 2014; Meernik 2005; Simmons and Danner 2010; Stover and Weinstein 2004). In addition to their fundamental mission to provide justice and redress through legalized dispute resolution, these international courts have also been charged with advancing deterrence, promoting peace, and fostering reconciliation. Whether these are appropriate goals for judicial institutions far removed from the scenes of war and atrocity, with no tools beyond the power of their words of condemnation, and in the face of frequent international indifference to their mission, is debatable. Tribunals and their supporters have often embraced these ideals and used them to rally support for international justice. As former ICC President Philippe Kirsch declared, “By putting potential perpetrators on notice that they may be tried before the Court, the ICC is intended to contribute to the deterrence of these crimes.” Former Chief Prosecutor of the ICC Luis Moreno-Ocampo asserted that, “Experience has taught us that… law is the only efficient way to prevent recurrent violence and atrocities.” Indeed, as critics of international justice as a mechanism for conflict resolution have pointed out (Mendeloff 2004; Snyder and Vinjamuri 2003), there is no shortage of such expressive idealism from those inside and outside these courts. Is such optimism warranted? Can international justice be an effective means by which to deliver justice, punish the guilty, and deter future violations of international laws?
We examine the subject of the impact of international justice by analyzing the witnesses’ perceptions of the work of the ICTY. The perspectives of individuals about international justice are increasingly important in evaluating their prospects of success.
There is a tendency to think of witnesses who testify before an international criminal tribunal in terms of how the individual is affected by the experience. The witnesses, however, are not passive vessels whom the Tribunal shapes. Witnesses appear before the ICTY with their own unique set of experiences, reasons for testifying, and interpretations of what this testimonial process has meant to them. Their personal encounters with the international justice system are the subject of this chapter as we seek to understand the reasons that motivate individuals to testify, what they know about this foreign court that has called on them to bear witness, and how they perceive their own personal treatment by the ICTY. We examine the micro- or individual-level impact of the ICTY to ultimately understand what this process means to the individual. We take up separately in Chapter 6 the witnesses’ assessments of the ICTY as an international institution that is charged with administering justice, advancing deterrence, and promoting peace.
This chapter proceeds as follows. First, we look at witness knowledge and preparation regarding the testimonial process before describing the reasons why individuals testify, their own assessments of the fairness with which they were treated by various actors involved in the judicial process, and finally, their own sense of personal satisfaction with their performance on the witness stand. The second part of the chapter focuses on an in-depth and multivariate analysis of two of the most critical issues pertaining to the witness experience. We examine how ethnicity, gender, and wartime trauma are related to the reasons why some individuals feel more compelled to testify than others. We find that while individuals who identify as Croatian or Serbian are less likely to report being motivated to testify because of a desire to “tell their story,” almost all witnesses regardless of ethnicity report being motivated to testify because of larger, external concerns such as “speaking for the dead” and “as a moral duty to all victims of wars.” Those individuals who suffered the most trauma, however, are more likely to report testifying for both external reasons and internal reasons.
This was never going to be an ordinary survey project. Surveying individuals who have experienced the horrors of war and lived to tell their story to an international tribunal is no easy undertaking. Yet such compelling research is necessary if we are to understand fully the “justice cascade” and how transitional justice mechanisms can be used to hold accountable those who have violated human rights (Sikkink 2011). While great strides have been made in developing the rule of law and international legal institutions to discourage governments and rebels from violating humanitarian laws and human rights, there is an intensely personal component to the judicial proceedings that can often be overlooked. The witnesses – whose experiences are the foundation of a tribunal's search for truth – are vital for exonerating or convicting the accused, and their testimony helps establish the historical record. They are the indispensable stakeholders for whom the core mission of the International Criminal Tribunal for the Former Yugoslavia (ICTY) is to ensure that equity and fairness are applied throughout the testimonial process. And as critical and as difficult as the testimonial process is, the witness experience does not end with the court's final judgment. The witnesses go back to their lives and face the consequences of returning home to shattered communities after testifying. What paths and pain take the witnesses from war and its aftermath to the rarified courtrooms of an international tribunal? How do the witnesses’ experiences and perceptions in the post-testimonial phase help us better understand and develop justice systems that ensure justice is done? How can we better gauge the short-term and long-term impacts on witnesses who testify? And most especially, how can legal institutions ensure that these individuals are not re-traumatized by the process and protect those who have come forward from backlash within their communities? Our most fundamental purpose of this unique survey was to examine more fully the witness experience by exploring these and other questions through an in-depth survey and short interview with a cross-section of witnesses who have testified before the ICTY.