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Adverse childhood events (ACEs) have been linked to widespread chronic pain (CP) in various cross-sectional studies, mainly in clinical populations. However, the independent role of different ACEs on the development of different types of CP remains elusive. Accordingly, we aimed to prospectively assess the associations between specific types of ACEs with the development of multisite CP in a large population-based cohort.
Methods
Data stemmed from the three first follow-up evaluations of CoLaus|PsyCoLaus, a prospective population-based cohort study of initially 6734 participants (age range: 35–75 years). The present sample included 1537 participants with 2161 analyzable intervals (49.7% men, mean age 57.3 years). Diagnostic criteria for ACEs were elicited using semi-structured interviews and CP was assessed by self-rating questionnaires. Multinomial logistic regressions with generalized estimating equations method analyzed the relationship between the different ACEs measured in the beginning of the interval and the risk of developing multisite CP during the follow-up. Sensitivity analyses were performed to assess the predictive value of ACEs on multisite CP with neuropathic features.
Results
Participants with a history of parental divorce or separation had an increased risk of developing multisite CP at during follow-up in comparison to those without (RR1.98; 95% CI 1.13–3.47). A strong association was highlighted between parental divorce or separation and the risk of subsequent CP with neuropathic characteristics (RR 4.21, 95% CI 1.45–12.18).
Conclusion
These results highlight the importance of psychotherapeutic management of people experiencing parental separation to prevent CP in the future.
Background: Near-infrared spectroscopy regional cerebral oxygen saturation (rSO2) has gained interest as a raw parameter and as a basis for measuring cerebrovascular reactivity (CVR). This study aimed to identify threshold values of rSO2 and rSO2 based CVR at which outcomes worsened following traumatic brain injury (TBI). Methods: A retrospective multi-institutional cohort study was performed. The cerebral oxygen indices, COx (using rSO2 and cerebral perfusion pressure) as well as COx_a (using rSO2 and arterial blood pressure) were calculated for each patient. 2x2 tables were created grouping patients by alive/dead and favorable/unfavorable outcomes at various thresholds of COx and COx_a as well as rSO2 itself. Chi-square values were calculated to identify the most discriminative significant threshold. Results: In the cohort of 129 patients rSO2 did not have any statistically significant threshold value. For COx and COx_a, an optimal threshold value of 0.2 was identified for both survival and favorable outcomes with values above this associated with worse outcomes. Conclusions: In this study, raw rSO2was found to contain no significant prognostic information. However, rSO2 based indices of CVR, were found to have a uniform threshold of 0.2, above which clinical outcomes worsened. This study lays the groundwork to transition to less invasive means of continuously measuring CVR.
Smectitic clay minerals are unique indicators of paleoenvironmental conditions and exhibit a unique reactivity in the mineral world. Smectites may exhibit tetrahedral substitutions (Al3+, and sometimes Fe3+, can substitute for Si4+ in tetrahedral sites), resulting in a layer-charge increase, thereby impacting their properties (e.g. swelling and sorption capacities, catalytic properties, expandable abilities). The objective of the present study was to determine the influence of pH conditions on the hydrothermal production of smectite end-members exhibiting tetrahedral Al substitutions (saponite, beidellite, and nontronite), using X-ray diffraction (XRD) and Fourier-transform infrared (FTIR) methods. The results of a series of syntheses conducted at various pH values allowed discussion of the crystallization pathways of these smectites from a mechanistic point of view. Altogether, the present study provided easily reproducible protocols for the hydrothermal production of pure saponite, nontronite, or beidellite (i.e. with no other mineral). The successful synthesis of pure saponite was achieved by exposing the starting gels to 230°C for 4 days in solutions at pH ranging from 5.5 to 14. The successful synthesis of pure beidellite was achieved by exposing the starting gels to 230°C for 9 days in a solution at pH 12. The successful synthesis of pure nontronite was achieved by exposing the starting gels to 150°C for 2.5 days in a solution at pH 12.5. Although extrapolating experimental results to natural settings remains difficult, the results of the present study may be of great help to constrain better the geochemical conditions existing or having existed on extraterrestrial planetary bodies.
Fibre-optic laryngoscopy is still widely used in daily clinical practice; however, high-definition laryngoscopy using narrow band imaging could be more reliable in characterising pharyngeal and laryngeal lesions.
Methods
Endoscopic videos were assessed in a tertiary referral hospital by 12 observers with different levels of clinical experience. Thirty pairs of high-definition laryngoscopy with narrow band imaging and fibre-optic laryngoscopy videos were judged twice, with an interval of two to four weeks, in a random order. Inter- and intra-observer reliability, sensitivity and specificity were calculated in terms of detecting a malignant lesion and a specific histological entity, for beginners, trained observers and experts.
Results
Using high-definition laryngoscopy with narrow band imaging, inter-observer reliability for detecting malignant lesions increased from moderate to substantial in trained observers and experts (high-definition laryngoscopy with narrow band imaging κ = 0.66 and κ = 0.77 vs fibre-optic laryngoscopy κ = 0.51 and κ = 0.56, for trained observers and experts respectively) and sensitivity increased by 16 per cent.
Conclusion
Inter-observer reliability increased with the level of clinical experience, especially when using high-definition laryngoscopy with narrow band imaging.
Improving the quality and conduct of multi-center clinical trials is essential to the generation of generalizable knowledge about the safety and efficacy of healthcare treatments. Despite significant effort and expense, many clinical trials are unsuccessful. The National Center for Advancing Translational Science launched the Trial Innovation Network to address critical roadblocks in multi-center trials by leveraging existing infrastructure and developing operational innovations. We provide an overview of the roadblocks that led to opportunities for operational innovation, our work to develop, define, and map innovations across the network, and how we implemented and disseminated mature innovations.
While the theory of economic policy offers a potential framework for thinking about the joint pursuit of economic objectives (EOs) and non-economic objectives (NEOs), over time the theory of economic policy was formalized in a way that considers NEOs as constraints that are given, rather than as goals that may themselves be endogenous alongside EOs. We examine the analytical treatment of NEOs as co-determined with EOs, revisiting some of the ground broken by Alan Winters in his analysis of NEOs. We review the place of NEOs in the theory of economic policy, discuss current practice in the representation of such objectives as exogenous constraints, and develop an argument for representation of NEOs as objectives in themselves.
Three volumes of detailed description of Bedfordshire parish churches, presented with text from five important nineteenth-century sources; Appendices and Index complete the set.
This is to be a series of three volumes covering Bedfordshire churches in the nineteenth century. The volumes will contain descriptions of churches “on the eve of restoration” together with contemporary illustrations –most of which will be published for the first time.
For each church, there will be extracts from original records amplified by a commentary and explanatory footnotes. The main source material consists of:
1. Extracts from church inventories – mainly 1822
2. Antiquarian notes on churches by Archdeacon Bonney, c.1840
4. Articles on churches by W.A. – John Martin, the librarian at Woburn Abbey - 1845-1854
5. Church descriptions by Sir Stephen Glynne 1830-1870
There is considerable value in having these key sources, with illustrations and commentary, in one place. The descriptions by Bonney and Glynne are purely factual, but John Martin’s articles, highlighting abuses and neglect, make colourful and at times controversial reading. Bonney’s visitation notes - and the supporting evidence from contemporary records such as churchwardens’ accounts – give a clear indication that church buildings were far from neglected in the opening decades of the nineteenth century. Together these sources document features that can still be seen today, and provide information on others that have been lost.
The aim has been to present the text of contemporary sources in their original state, to convey a feeling for the times as well as to provide information. It is recognised that most of the sources could have been condensed by editing - for instance the lists of registers in the glebe terriers and the quotations in the articles by W.A. – but the Editorial Group felt that they should nevertheless be published in extenso.
The introductory commentary for each church includes a summary of the history of the building, focusing especially on eighteenth and nineteenth century restoration and alterations. These introductory notes are generally brief, but may be longer where differences between present and past external appearance merit detailed discussion. Detailed footnotes explain and amplify features mentioned in the text of the original sources and so lead the reader to additional research material.
Bedfordshire churches on the eve of restoration are well documented in a number of sources. First, there are a great many pictures of churches by artists such as Thomas Fisher and George Shepherd dating from the early Cl9th. Secondly, there are the manuscript sources which describe the condition of church buildings and ornaments in the years leading up to “the age of restoration”.
These sources are described and discussed in detail below. In outline, however, they include the glebe terriers for 1822 which describe the plan of each church and list the ornaments and furnishings. As Archdeacon of Bedford from 1821 to 1844, Dr. Henry Kaye Bonney compiled two notebooks on the churches in his care. In the one, he made detailed architectural notes on each church and its fittings, and in the other he kept a record of the orders made at his archidiaconal visitations between 1823 and 1839. Another commentator was John Martin, the Librarian at Woburn Abbey, who using the signature W.A. wrote a series of pithy articles on Bedfordshire churches for the Northampton Mercury and Bedfordshire Times between 1845 and 1854. Lastly, there are the notebooks of Sir Stephen Glynne who visited over a third of the churches in the County between 1830 and 1870.
Together these sources provide a colourful image of the appearance, condition and atmosphere of Bedfordshire churches at a time when on the one hand they were nearer their mediaeval state than they are today but when on the other they were arguably in their greatest need of attention.
Glebe Terriers (extracts) 1822
After the Reformation, the ecclesiastical authorities became increasingly aware of the need to keep proper records of church possessions. The documents known as glebe terriers fulfil this purpose, and include terriers (recording property and endowments) and inventories (listing goods and chattels). The existence of such records helped to prevent the loss and misappropriation of church property.
Terriers had been compiled for purely parochial purposes in mediaeval times, but in compliance with an archiepiscopal order or canon of 1571 it became a requirement for copies of these documents to be lodged in diocesan registries for safe-keeping.
Although the present church dates chiefly from the Cl4th and Cl5th, the foundations of the Cl2th church were discovered during excavations in 1975. The later church has a chancel, nave with north and south aisles, south porch and west tower. It retains its Cl5th roof with angels and shields (though the painted decoration is modem) and there is a ceilure above the former rood.
In 1696 a private pew was constructed for Lord Ashbumham of Ampthill Park in the south aisle of the church. Sir Christopher Wren and his pupil Nicholas Hawksmoor were involved in the design, and the pew was built by Alexander Fort, the King’s joiner. There was a heated legal dispute between Lord Ashburnham and Lord Ailesbury of Houghton House about this pew, which was eventually removed in 1847. The entrance through the east wall of the south aisle is shown in Buckler’s drawing dated 1835 (Plate 2). Lord Ailesbury had his own pew in the church, and there are faculties and papers regarding other Cl8th pews. In 1827 Boissier described the church as “crowded with pews & galleries”. Between 1823 and 1839 Bonney ordered several improvements to the pews, and in 1845 W.A. was highly critical of the arrangement of the church interior.
A faculty was obtained in 1728 to replace the pulpit, take down the chancel screen, and alter various windows. It was probably at this date that the pulpit was placed centrally in the chancel arch where it remained until 1847. Other repairs and alterations in the Cl8th and early Cl9th are recorded in the churchwardens’ accounts from 1718, vestry minutes from 1767, and churchwardens bills from 1823 (listed individually by Andrew Underwood) in the parish records.
Restoration came in 1847-8 under James Tacy Wing of Bedford, who provided new seats and galleries in the nave (Plate 3) and renewed the east window, repaired the roof and stonework, and added a small vestry on the north side of the chancel. In 1851-2 the church was lit by gas.
The tracery of the windows in the south aisle was renewed in 1872-3. Further work followed in 1877 when the vestry on the north side of the chancel was enlarged under James Piers St. Aubyn, although not all the work authorised by the faculty was carried out.
The parish churches of England are among the most noble and conspicuous of the nation’s architectural monuments. Their survival, however, owes more to chance than to good stewardship. Neglect, decay, and deliberate destruction are as much a part of their history as the work of dedicated benefactors and parishioners who strove to make our churches worthy for Christian worship.
As the sources selected for inclusion in this series demonstrate all too clearly, many Bedfordshire churches were in a dilapidated state in the opening decades of the nineteenth century. Others, whilst structurally sound and decently furnished for the worship of the day, needed “restoration” – a term meaning much more than just repair. This was the situation facing the Victorians who – far from vandalising our heritage – sought to restore these precious buildings from years of neglect and adapt them to suit the new liturgical arrangements of the time.
The coming of the ecclesiological movement in the 1840s brought a new concern for the ceremonial aspects of worship – the ministry of the sacraments instead of the ministry of the word. This entailed a change in the arrangement of church buildings, the old “preaching boxes” of the Cl8th giving way to churches in which all attention focused on the chancel and the holy table in the sanctuary. The reformers often exaggerated the poor state of church buildings as a means of drawing attention to the need for change, and the Victorians were invariably critical of alterations and repairs carried out in previous centuries when utility had been regarded as more important than sanctity.
Between about 1840 and 1914 virtually every parish church in England was in some measure restored, and vast sums of money were spent on what was seen to be one of the most worthy causes of the Victorian era. Many churches were rescued from the brink of collapse and given a new lease of life. Some were restored to their former glory. Others were mutilated beyond recognition or wholly rebuilt. Churches viewed by the Victorians as “tainted by classical alterations” were gothicised. Sound buildings were “improved” to suit the needs of a new religious age.
Churches remaining “unrestored” in appearance are to be seen at Chaigrave, Dean, Knotting, Odell, Shelton and Wymington (to name a few of the more rewarding examples in the County), but sadly the phrase “over restored” is all too common in the Bedfordshire volume of Dr. Nikolaus Pevsner’s Buildings of England series.
A brief general survey of post-Reformation church work in the County will be useful as an introduction to the subject. It seems sensible to frame the review round the work of architects - the designers of buildings and of furnishing schemes - who worked at different periods and in different styles. In this way, it is possible to view the changes in ecclesiastical taste in the County in their broader national context.
Post-Reformation church building to 1800
In general terms, church building activity came to an abrupt end at the time of the Reformation. There are, however, exceptions and recent studies in the neighbouring county of Huntingdonshire have demonstrated the extent of building work and improvements to churches into the seventeenth century. This may be untypical of the general picture, and Bedfordshire lacks any particularly distinguished examples of churches dating from the period between 1550 and 1800. Those mentioned below are all relatively minor when compared with the treasures in neighbouring counties, such as:
In Bedfordshire, Hulcote church was rebuilt by the Chemocke family in the late sixteenth century. It is gothic in form, but with a distinctly Renaissance feel. The tower at Blunham was rebuilt in 1583. At Odell there is a fine screen and ringing gallery of 1637 in the tower arch. At Campton, the north aisle dates from 1649. Whipsnade church was rebuilt in 1719. Melchboume has a seventeenthcentury porch brought, it is said, from Woodford in Northamptonshire. The body of the church was rebuilt in the classical style in about 1770. Shillington tower, destroyed in a storm in 1701, was rebuilt in brick in 1750. The 1783 black basalt Wedgwood font at Cardington - another formerly existed at Melchboume - is a particularly memorable example of eighteenth-century church furnishing. In every one of these cases the identity of the architect is unknown.
Having lived and worked in Bedfordshire for the past sixteen years, I have visited every church in the County in the course of my work. While on the staff of the Bedfordshire County Record Office I have been responsible for surveying and listing all the church records, and I am fortunate that this has enabled me to develop an intimate knowledge of the churches and their history.
It is my hope that in preparing these volumes I may be able to pass on some of this knowledge for the benefit of people interested either in specific churches or in the subject generally. I should like to thank the Society for publishing this book. I also wish to thank Gordon Vowles, the General Editor, and my colleagues on the Editorial Group for their constructive comments and suggestions throughout its gestation period.
Formal acknowledgment is due to the authorities and owners who have allowed the publication of their material. The 1822 glebe terriers are published here by kind permission of Lincoln Diocesan Record Office. Archdeacon Bonney’s church notes were among the manuscripts transferred to the County Record Office from the old Bedford Library, while Bonney’s visitation notes appear by kind permission of the present Archdeacon of Bedford, the Ven. Malcolm Lesiter. Sir Stephen Glynne’s Bedfordshire church notes are published by kind permission of Sir William Gladstone. Thanks are also due to Geoffrey Veysey, the Clwyd County Archivist, for providing information on the notes and for allowing me to quote from his article about Sir Stephen Glynne. The sources of illustrations are acknowledged separately.
Material for this volume has been gathered from several record repositories and institutions. My first debt of gratitude is to my colleagues in the Bedfordshire County Record Office, but I must also thank the staff at the British Library, the British Newspaper Library, the library of the Society of Antiquaries of London, the Bedfordshire County Library Service, Lambeth Palace Library, Cambridge University Library, Lincolnshire Archives, and the Hertfordshire County Record Office for their help and advice.
Thanks are also due to all those who have typed parts of the text including Deborah Blake and Ellen Collier, but especially to Pauline Newbery on whom the main body of the work has fallen.