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Research exploring the longitudinal course of posttraumatic stress disorder (PTSD) symptoms has documented four modal trajectories (low, remitting, high, and delayed), with proportions varying across studies. Heterogeneity could be due to differences in trauma types and patient demographic characteristics.
This analysis pooled data from six longitudinal studies of adult survivors of civilian-related injuries admitted to general hospital emergency departments (EDs) in six countries (pooled N = 3083). Each study included at least three assessments of the clinician-administered PTSD scale in the first post-trauma year. Latent class growth analysis determined the proportion of participants exhibiting various PTSD symptom trajectories within and across the datasets. Multinomial logistic regression analyses examined demographic characteristics, type of event leading to the injury, and trauma history as predictors of trajectories differentiated by their initial severity and course.
Five trajectories were found across the datasets: Low (64.5%), Remitting (16.9%), Moderate (6.7%), High (6.5%), and Delayed (5.5%). Female gender, non-white race, prior interpersonal trauma, and assaultive injuries were associated with increased risk for initial PTSD reactions. Female gender and assaultive injuries were associated with risk for membership in the Delayed (v. Low) trajectory, and lower education, prior interpersonal trauma, and assaultive injuries with risk for membership in the High (v. Remitting) trajectory.
The results suggest that over 30% of civilian-related injury survivors admitted to EDs experience moderate-to-high levels of PTSD symptoms within the first post-trauma year, with those reporting assaultive violence at increased risk of both immediate and longer-term symptoms.
Prenatal programming models have rarely been applied to research on children with prenatal substance exposure, despite evidence suggesting that prenatal drug exposure is a form of stress that impacts neurodevelopmental outcomes and risk for psychopathology. Utilizing data from two longitudinal multisite studies comprising children prenatally exposed to substances as well as a nonexposed comparison group (Maternal Lifestyle Study, n = 1,388; Infant Development, Environment, and Lifestyle study, n = 412), we tested whether early phenotypic indicators of hypothesized programming effects, indexed by growth parameters at birth and infant temperament, served as a link between prenatal substance exposure and internalizing and externalizing behavior at age 5. Latent profile analysis indicated that individual differences in reactivity and regulation for infants prenatally exposed to substances was best characterized by four temperament profiles. These profiles were virtually identical across two independent samples, and demonstrated unique associations with adjustment difficulties nearly 5 years later. Results of path analysis using structural equation modeling also showed that increased prenatal substance exposure was linked to poorer growth parameters at birth, profiles of temperamental reactivity in infancy, and internalizing and externalizing behavior at age 5. This pathway was partially replicated across samples. This study was among the first to link known individual-level correlates of prenatal substance exposure into a specific pathway to childhood problem behavior. Implications for the developmental origins of a child's susceptibility to psychopathology as a result of intrauterine substance exposure are discussed.
In September 2016, the annual meeting of the International Union for Quaternary Research’s Loess and Pedostratigraphy Focus Group, traditionally referred to as a LoessFest, met in Eau Claire, Wisconsin, USA. The 2016 LoessFest focused on “thin” loess deposits and loess transportation surfaces. This LoessFest included 75 registered participants from 10 countries. Almost half of the participants were from outside the United States, and 18 of the participants were students. This review is the introduction to the special issue for Quaternary Research that originated from presentations and discussions at the 2016 LoessFest. This introduction highlights current understanding and ongoing work on loess in various regions of the world and provides brief summaries of some of the current approaches/strategies used to study loess deposits.
To identify predictors of disagreement with antimicrobial stewardship prospective audit and feedback recommendations (PAFR) at a free-standing children’s hospital.
Retrospective cohort study of audits performed during the antimicrobial stewardship program (ASP) from March 30, 2015, to April 17, 2017.
The ASP included audits of antimicrobial use and communicated PAFR to the care team, with follow-up on adherence to recommendations. The primary outcome was disagreement with PAFR. Potential predictors for disagreement, including patient-level, antimicrobial, programmatic, and provider-level factors, were assessed using bivariate and multivariate logistic regression models.
In total, 4,727 antimicrobial audits were performed during the study period; 1,323 PAFR (28%) and 187 recommendations (15%) were not followed due to disagreement. Providers were more likely to disagree with PAFR when the patient had a gastrointestinal infection (odds ratio [OR], 5.50; 95% confidence interval [CI], 1.99–15.21), febrile neutropenia (OR, 6.14; 95% CI, 2.08–18.12), skin or soft-tissue infections (OR, 6.16; 95% CI, 1.92–19.77), or had been admitted for 31–90 days at the time of the audit (OR, 2.08; 95% CI, 1.36–3.18). The longer the duration since the attending provider had been trained (ie, the more years of experience), the more likely they were to disagree with PAFR recommendations (OR, 1.02; 95% CI, 1.01–1.04).
Evaluation of our program confirmed patient-level predictors of PAFR disagreement and identified additional programmatic and provider-level factors, including years of attending experience. Stewardship interventions focused on specific diagnoses and antimicrobials are unlikely to result in programmatic success unless these factors are also addressed.
Loess is widespread over Alaska, and its accumulation has traditionally been associated with glacial periods. Surprisingly, loess deposits securely dated to the last glacial period are rare in Alaska, and paleowind reconstructions for this time period are limited to inferences from dune orientations. We report a rare occurrence of loess deposits dating to the last glacial period, ~19 ka to ~12 ka, in the Yukon-Tanana Upland. Loess in this area is very coarse grained (abundant coarse silt), with decreases in particle size moving south of the Yukon River, implying that the drainage basin of this river was the main source. Geochemical data show, however, that the Tanana River valley to the south is also a likely distal source. The occurrence of last-glacial loess with sources to both the south and north is explained by both regional, synoptic-scale winds from the northeast and opposing katabatic winds that could have developed from expanded glaciers in both the Brooks Range to the north and the Alaska Range to the south. Based on a comparison with recent climate modeling for the last glacial period, seasonality of dust transport may also have played a role in bringing about contributions from both northern and southern sources.
Experiments reporting magnetic-field generation by the ablative nonlinear Rayleigh–Taylor (RT) instability are reviewed. The experiments show how large-scale magnetic fields can, under certain circumstances, emerge and persist in strongly driven laboratory and astrophysical flows at drive pressures exceeding one million times atmospheric pressure.
Children face innumerable challenges following exposure to disasters. To address trauma sequelae, researchers and clinicians have developed a variety of mental health interventions. While the overall effectiveness of multiple interventions has been examined, few studies have focused on the individual components of these interventions. As a preliminary step to advancing intervention development and research, this literature review identifies and describes nine common components that comprise child disaster mental health interventions. This review concluded that future research should clearly define the constituent components included in available interventions. This will require that future studies dismantle interventions to examine the effectiveness of specific components and identify common therapeutic elements. Issues related to populations studied (eg, disaster exposure, demographic and cultural influences) and to intervention delivery (eg, timing and optimal sequencing of components) also warrant attention.
Geologic archives show that the Earth was dustier during the last glacial period. One model suggests that increased gustiness (stronger, more frequent winds) enhanced dustiness. We tested this at Loveland, Iowa, one of the thickest deposits of last-glacial-age (Peoria) loess in the world. Based on K/Rb and Ba/Rb, loess was derived not only from glaciogenic sources of the Missouri River, but also distal loess from non-glacial sources in Nebraska. Optically stimulated luminescence (OSL) ages provide the first detailed chronology of Peoria Loess at Loveland. Deposition began after ~ 27 ka and continued until ~ 17 ka. OSL ages also indicate that mass accumulation rates (MARs) of loess were not constant. MARs were highest and grain size was coarsest during the time of middle Peoria Loess accretion, ~ 23 ka, when ~ 10 m of loess accumulated in no more than ~ 2000 yr and possibly much less. The timing of coarsest grain size and highest MAR, indicating strongest winds, coincides with a summer-insolation minimum at high latitudes in North America and the maximum southward extent of the Laurentide ice sheet. These observations suggest that increased dustiness during the last glacial period was driven largely by enhanced gustiness, forced by a steepened meridional temperature gradient.
The ever-present risk of mass casualties and disaster situations may result in airway management situations that overwhelm local emergency medical services (EMS) resources. Endotracheal intubation requires significant user education/training and carries the risk of malposition. Furthermore, personal protective equipment (PPE) required in hazardous environments may decrease dexterity and hinder timely airway placement. Alternative airway devices may be beneficial in these situations.
The objective of this study was to evaluate the time needed to place the King LT Supralaryngeal Airway compared to endotracheal intubation when performed by community EMS personnel with and without PPE.
Following training, 47 EMS personnel were timed placing both endotracheal tubes and the King LT supralaryngeal airway in a simulator mannikin. The study participants then repeated this exercise wearing PPE.
The EMS personnel wearing PPE took significantly longer to place an endotracheal tube than they did without protective equipment (53.4 seconds and 39.5 seconds, p <0.002). The time to place the King LT was significantly faster than the placement of the endotracheal tube without protective equipment (18.4 seconds and 39.5 seconds, respectively, p<0.00003). There also were statistically significant differences between the time required to place the King LT and endotracheal tube in EMS personnel wearing protective equipment (19.7 seconds and 53.4 seconds, p <0.000007).
The King LT Supralaryngeal Airway device may be advantageous in prehospital airway management situations involving multiple patients or hazardous environments. In this study, its insertion was faster than endotracheal intubation when performed by community EMS providers.
1. Outbreaks of mild food poisoning have been investigated in which heat-resistant Cl. welchii appeared to be the causative organism. The outbreaks were characterized by colic and diarrhoea without vomiting, commencing 8–20 hr. after ingestion of the contaminated food.
2. The strains of Cl. welchii concerned are only feebly toxigenic, and apart from the heat-resistance of their spores, and some colonial characters, fit well into Cl. welchii Type A. The toxin production and the serology of the strains is uniform within an outbreak.
3. Mild food poisoning similar to that seen in natural epidemics has been produced in volunteers by ingestion of cultures of heat-resistant Cl. welchii isolated from contaminated meat.
4. Infection is almost invariably due to meat which has been boiled, steamed, braised, stewed or insufficiently roasted, allowed to cool slowly, and eaten the next day, either cold or reheated.
5. Outbreaks of this kind should be prevented by cooking meat immediately before consumption; or, if this is impossible, by cooling the cooked meat rapidly and keeping it refrigerated until it is required for use.
We used X-ray spectroscopy as a diagnostic tool for investigating the properties of laser-cluster interactions at the stage in which non-adiabatic cluster expansion takes place and a quasi-homogeneous plasma is produced. The experiment was carried out with a 10 TW, 65 fs Ti:Sa laser focused on CO2 cluster jets. The effect of different laser-pulse contrast ratios and cluster concentrations was investigated. The X-ray emission associated to the Rydberg transitions allowed us to retrieve, through the density and temperature of the emitting plasma, the time after the beginning of the interaction at which the emission occurred. The comparison of this value with the estimated time for the “homogeneous” plasma formation shows that the degree of adiabaticity depends on both the cluster concentration and the pulse contrast. Interferometric measurements support the X-ray data concerning the plasma electron density.
The reduction of wafer scratching is a key goal driving the commercial development of CMP slurries. To better understand the underlying abrasive particle properties critical to the scratch performance of ILD CMP slurries, the scratching behavior of ceria slurries prepared with a range of particle size characteristics are characterized. Scratch results are presented and two effects are proposed to account for the findings. The Removal Rate Effect relies solely on the observed inverse proportionality between scratching and removal rate. This interpretation is consistent with a simple surface balance of scratches but suggests that removal rate differences dominate scratch performance. The Managed Tail Effect considers the effect of particle characteristics on both the creation and the removal of scratches. For a given particle population, the larger particles are assumed to dominate scratch creation. However, larger particles are also seen to drive removal rate which affects the removal of scratches during polishing. This interpretation implies that optimal scratch performance for a ceria ILD CMP slurry will be obtained when the width of the ceria particle's size distribution is optimized relative to its mean.
African disaster-affected populations are poorly represented in disaster mental health literature.
To compare systematically assessed mental health in populations directly exposed to terrorist bombing attacks on two continents, North America and Africa.
Structured diagnostic interviews compared citizens exposed to bombings of the US Embassy in Nairobi, Kenya (n=227) and the Oklahoma City Federal Building (n=182).
Prevalence rates of post-traumatic stress disorder (PTSD) and major depression were similar after the bombings. No incident (new since the bombing) alcohol use disorders were observed in either site. Symptom group C was strongly associated with PTSD in both sites. The Nairobi group relied more on religious support and the Oklahoma City group used more medical treatment, drugs and alcohol.
Post-disaster psycho-pathology had many similarities in the two cultures; however, coping responses and treatment were quite different. The findings suggest potential for international generalisability of post-disaster psychopathology, but confirmatory studies are needed.
We characterize, experimentally and theoretically, the electronic properties of the S/Cu(001) interface in two molecule-metal systems, Mercaptobenzoxazole(MBO) and Methanethiol on Cu(001), containing the S-headgroup. The S atom realizes the anchoring of the whole molecule to the substrate through the formation of an S-Cu hybrid, irrespective of the p(2×2) and c(2×2) reconstruction, but with different relative orbital contributions. This behaviour may be highlighted only by the comparison of the high resolution angular resolved photoemission spectra with the ab inito calculated electronic density of states of the interface.