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There is a paucity of long-term prospective disaster studies of the psychological sequelae among survivors.
At 1½ and 25 years after the Spitak earthquake, 142 early adolescents from two cities were assessed: Gumri (moderate–severe exposure) and Spitak (very severe exposure). The Gumri group included treated and not-treated subjects, while the Spitak group included not-treated subjects. Instruments included: DSM-III-R PTSD-Reaction Index (PTSD-RI); DSM-5 PTSD-Checklist (PCL); Depression Self-Rating Scale (DSRS); and Center for Epidemiological Studies-Depression Scale (CES-D).
(1) Between 1½ and 25 years, PTSD rates and mean scores decreased significantly in the three groups (over 50%). However, at 25 years 9.1–22.4% met DSM-5 PTSD criteria. (2) At 1½ years, the Spitak group had higher PTSD-RI (p < 0.001) and DSRS scores (p < 0.001) compared to the Gumri-not-treated group. At 25 years, the Spitak group that had experienced fewer post-earthquake adversities (p < 0.03), had a greater decrease in PTSD-RI scores (p < 0.02), and lower CES-D scores (p < 0.01). (3) Before treatment, PTSD-RI and DSRS scores did not differ between the Gumri-treated and not-treated groups. At 25-years, the Gumri-treated group showed a greater decrease in PTSD-RI scores (p < 0.03), and lower mean PTSD-RI (p < 0.02), PCL (p < 0.02), and CES-D (p < 0.01) scores. (4) Predictors of PTSD symptom severity at 25-years included: home destruction, treatment, social support, post-earthquake adversities, and chronic medical illnesses.
Post-disaster PTSD and depressive symptoms can persist for decades. Trauma-focused treatment, alleviation of post-disaster adversities, improving the social ecology, and monitoring for chronic medical illnesses are essential components of recovery programs.
This study used data from 12 cultural groups in 9 countries (China, Colombia, Italy, Jordan, Kenya, Philippines, Sweden, Thailand, and United States; N = 1,315) to investigate bidirectional associations between parental warmth and control, and child externalizing and internalizing behaviors. In addition, the extent to which these associations held across mothers and fathers and across cultures with differing normative levels of parent warmth and control were examined. Mothers, fathers, and children completed measures when children were ages 8 to 13. Multiple-group autoregressive cross-lagged structural equation models revealed that evocative child-driven effects of externalizing and internalizing behavior on warmth and control are ubiquitous across development, cultures, mothers, and fathers. Results also reveal that parenting effects on child externalizing and internalizing behaviors, though rarer than child effects, extend into adolescence when examined separately in mothers and fathers. Father-based parent effects were more frequent than mother effects. Most parent- and child-driven effects appear to emerge consistently across cultures. The rare culture-specific parenting effects suggested that occasionally the effects of parenting behaviors that run counter to cultural norms may be delayed in rendering their protective effect against deleterious child outcomes.
The contributions of vortex stretching, dilatation, baroclinic torque and viscous diffusion to Reynolds-averaged enstrophy transport in turbulent swirl flames were experimentally measured using tomographic particle image velocimetry and
planar laser induced fluorescence at jet Reynolds numbers of 26 000–51 000. The mean baroclinic torque was determined by subtracting the other terms in the enstrophy transport equation from the mean Lagrangian derivative. Enstrophy production from baroclinic torque was found to be significant relative to the other transport terms across all conditions studies. This result contrasts with direct numerical simulations of flames in homogeneous isotropic turbulence, which show a decreasing relative significance of baroclinic torque with increasing turbulence intensity (e.g. Bobbitt, Lapointe & Blanquart, Phys. Fluids, vol. 28 (1), 2016, 015101). Hence, the significance of baroclinic enstrophy production in flames is not determined entirely by the local turbulence and flame properties, but also depends on the configuration-specific pressure field.
Using multilevel models, we examined mother-, father-, and child-reported (N = 1,336 families) externalizing behavior problem trajectories from age 7 to 14 in nine countries (China, Colombia, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the United States). The intercept and slope of children's externalizing behavior trajectories varied both across individuals within culture and across cultures, and the variance was larger at the individual level than at the culture level. Mothers’ and children's endorsement of aggression as well as mothers’ authoritarian attitudes predicted higher age 8 intercepts of child externalizing behaviors. Furthermore, prediction from individual-level endorsement of aggression and authoritarian attitudes to more child externalizing behaviors was augmented by prediction from cultural-level endorsement of aggression and authoritarian attitudes, respectively. Cultures in which father-reported endorsement of aggression was higher and both mother- and father-reported authoritarian attitudes were higher also reported more child externalizing behavior problems at age 8. Among fathers, greater attributions regarding uncontrollable success in caregiving situations were associated with steeper declines in externalizing over time. Understanding cultural-level as well as individual-level correlates of children's externalizing behavior offers potential insights into prevention and intervention efforts that can be more effectively targeted at individual children and parents as well as targeted at changing cultural norms that increase the risk of children's and adolescents’ externalizing behavior.
Human Rights Watch (HRW), Amnesty International (Amnesty), and other like-minded organisations have become major actors in the world of international humanitarian law (IHL). Every year they issue hundreds of publications purporting to document violations and to promote IHL enforcement. These publications are ubiquitously cited in the media, and used as source material for governmental and United Nations inquiries, quasi-judicial bodies, the International Criminal Court, academic studies, and other frameworks. Yet, despite the increase in the number, role and influence of non-governmental organisations (NGOs) working on IHL enforcement, conflicts and civilian deaths show no signs of abating. Among the factors that reduce NGO impact in these areas is the demonstrated weakness of these organisations in the realm of fact-finding, and the tension between these activities and emphasis on political advocacy. This article will thus analyse both objective and subjective aspects of NGO fact-finding during armed conflict, including mandates and methodology, selectivity, the application of legal standards, military expertise and sourcing. These issues will be examined through case studies of Amnesty and HRW publications on the conflicts in Yemen, Ukraine and the 2014 Gaza War. The article will conclude with recommendations for NGOs and the actors with which they interact.
Using data from 1,177 families in eight countries (Colombia, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the United States), we tested a conceptual model of direct effects of childhood family adversity on subsequent externalizing behaviors as well as indirect effects through psychological mediators. When children were 9 years old, mothers and fathers reported on financial difficulties and their use of corporal punishment, and children reported perceptions of their parents’ rejection. When children were 10 years old, they completed a computerized battery of tasks assessing reward sensitivity and impulse control and responded to questions about hypothetical social provocations to assess their hostile attributions and proclivity for aggressive responding. When children were 12 years old, they reported on their externalizing behavior. Multigroup structural equation models revealed that across all eight countries, childhood family adversity had direct effects on externalizing behaviors 3 years later, and childhood family adversity had indirect effects on externalizing behavior through psychological mediators. The findings suggest ways in which family-level adversity poses risk for children's subsequent development of problems at psychological and behavioral levels, situated within diverse cultural contexts.
Using archaeological data of two human intestinal parasites from seventeenth- to early twentieth-century contexts, we explore the intersection of biological and cultural variables that shaped the ecology of cities in northeastern North America during the modern period. These parasites are useful because they require a developmental period in the soil, thus providing a link between human activities and changing environments. Prior to the last decades of the eighteenth century, Trichuris eggs dominate the archaeoparasitological assemblage. Around 1800, there is a shift to increasing proportions of Ascaris eggs, which appears to be largely complete by 1850—a period of increasing urbanization in the northeast United States. Both environmental and behavioral factors play a role in this shift and include the relationship between parasite biology and changing microenvironments, attempts to deal with waste, and use of urban spaces. During this period, poorer households would likely have been at greater risk of parasites because of the ways they used yard spaces, their delayed access to sanitary technology, and the changing nature of urban vegetation in densely occupied neighborhoods.
Introduction: Patients presenting to the Emergency Department (ED) may require clarification of their goals of care (GOC) to ensure they receive treatments aligned with their values. However, these discussions can be difficult to conduct for multiple reasons, including lack of time in a busy ED, competing priorities and a limited relationship with the patient. Few studies have examined the perceived challenges faced by Emergency Physicians in conducting GOC discussions. This study sought to contextualize and discern the barriers and facilitators to having these conversations as reported by Emergency physicians. Methods: An interdisciplinary team of Emergency Medicine, Palliative Care and Internal Medicine providers developed an online survey comprised of multiple choice, Likert-scale and open-ended questions to explore four domains of GOC discussions: training; communication; environment; and personal beliefs. Invitations and scheduled reminders were sent to 275 ED physicians at six academic sites in a Canadian urban centre, including 49 EM residents. Results: 105 (46%) staff physicians and 23 (47%) residents responded with similar representation from all sites. Differences were reported in the frequency of GOC discussions: 59% of staff physicians conduct several per month whereas 65% of residents conduct less than one per month. Most agreed that GOC discussions are within their scope of practice (92%), they feel comfortable (96%), and are adequately trained (73%) to have them; however, 66% reported difficulty initiating GOC discussions. 73% believed that admitting services should conduct GOC discussions, yet acuity was noted in the comments as a major determinant with initiating GOC discussions by ED physicians. Main barriers identified were lack of time, chaotic environment, lack of advanced directives and the inability to reach substitute decision makers. 54% of respondents indicated that the availability of 24-hour Palliative Care consults would facilitate GOC discussions in the ED. Conclusion: Emergency physicians are prepared to conduct goals of care discussions, but often believe they should instead be conducted by the patient’s admitting service. Multiple perceived barriers to goals of care discussion in the ED were identified, and a majority of respondents felt that the availability of Palliative Care in the ED may facilitate these discussions.
Healthcare workers (HCWs) reporting no history of varicella frequently receive varicella vaccination (vOka) if they test varicella-zoster virus (VZV) immunoglobulin G (IgG) negative. In this study, the utilities of VZV-IgG time-resolved fluorescence immunoassay (VZV-TRFIA) and a commercial VZV-IgG purified glycoprotein enzyme immunoassay (gpEIA) currently used in England for confirming VZV immunity have been compared to the fluorescent-antibody-to-membrane-antigen assay (FAMA). A total of 110 HCWs received two doses of vOka vaccine spaced 6 weeks apart and sera collected pre-vaccination (n = 100), at 6 weeks post-completion of vaccination (n = 86) and at 12–18 months follow-up (n = 73) were analysed. Pre-vaccination, by FAMA, 61·0% sera were VZV IgG negative, and compared to FAMA the sensitivities of VZV-TRFIA and gpEIA were 74·4% [95% confidence interval (CI) 57·9–87·0] and 46·2% (95% CI 30·1–62·8), respectively. Post-completion of vaccination the seroconversion rate by FAMA was 93·7% compared to rates of 95·8% and 70·8% determined by VZV-TRFIA and gpEIA, respectively. At 12–18 months follow-up seropositivity rates by FAMA, VZV-TRFIA and gpEIA were 78·1%, 74·0% and 47·9%, respectively. Compared to FAMA the sensitivities of VZV-TRFIA and gpEIA for measuring VZV IgG following vaccination were 96·4% (95% CI 91·7–98·8) and 74·6% (95% CI 66·5–81·6), respectively. Using both FAMA and VZV-TRFIA to identify healthy adult VZV susceptibles and measure seroconversion showed that vOka vaccination of HCWs is highly immunogenic.
Introduction: The time a smoker waits until the first cigarette of the morning is often used as a measure of dependence with the rationale that more dependent smokers will smoke sooner upon waking than will less dependent smokers after going several hours without a cigarette overnight.
Aims: We sought to examine the relationship between time-to-first-cigarette (TTFC) and household smoking restrictions in two independent samples.
Methods: Two samples of smokers, one treatment-seeking community sample (N = 433) and one non-treatment seeking sample of smokers with serious mental illness (i.e., Schizophrenia, Schizoaffective Disorder, or Bipolar I Disorder) (N = 94), provided information on cigarette dependence with the Fagerström Test for Nicotine Dependence (FTND) and on household smoking restrictions.
Results: Half (50%) of smokers with serious mental illness and 36.7% of smokers from the general population reported that there were no limitations to smoking in their home. Household smoking restrictions were significantly and positively related to TTFC in both samples.
Conclusions: These data indicate that greater attention to TTFC may be warranted. The TTFC item is intended to measure dependence based on the premise that greater dependence should be associated with shorter TTFC. If TTFC is related to a household smoking ban, however, this item may not be assessing dependence as intended in some cases.
This study prospectively assesses the mental health outcomes among women seeking abortions, by comparing women having later abortions with women denied abortions, up to 2 years post-abortion seeking.
We present the first 2 years of a 5-year telephone interview study that is following 956 women who sought an abortion from 30 facilities throughout the USA. We use adjusted linear mixed-effects regression analyses to assess whether symptoms of depression and anxiety, as measured by the Brief Symptom Inventory-short form and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire, differ over time among women denied an abortion due to advanced gestational age, compared with women who received abortions.
Baseline predicted mean depressive symptom scores for women denied abortion (3.07) were similar to women receiving an abortion just below the gestational limit (2.86). Depressive symptoms declined over time, with no difference between groups. Initial predicted mean anxiety symptoms were higher among women denied care (2.59) than among women who had an abortion just below the gestational limit (1.91). Anxiety levels in the two groups declined and converged after 1 year.
Women who received an abortion had similar or lower levels of depression and anxiety than women denied an abortion. Our findings do not support the notion that abortion is a cause of mental health problems.
Nesidiocoris tenuis (Reuter) (Heteroptera: Miridae) is an omnivorous insect used for biological control. Augmentative release and conservation of N. tenuis have been used for pest control in tomato crops. Intracellular bacterial symbionts of arthropods are common in nature and have diverse effects on their hosts; in some cases they can dramatically affect biological control. Fingerprinting methods showed that the symbiotic complex associated with N. tenuis includes Wolbachia and Rickettsia. Rickettsia of N. tenuis was further characterized by sequencing the 16S rRNA and gltA bacterial genes, measuring its amount in different developmental stages of the insect by real-time polymerase chain reaction, and localizing the bacteria in the insect's body by fluorescence in situ hybridization. The Rickettsia in N. tenuis exhibited 99 and 96% similarity of both sequenced genes to Rickettsia bellii and Rickettsia reported from Bemisia tabaci, respectively. The highest amount of Rickettsia was measured in the 5th instar and adult, and the symbionts could be detected in the host gut and ovaries. Although the role played by Rickettsia in the biology of N. tenuis is currently unknown, their high amount in the adults and localization in the gut suggest that they may have a nutritional role in this insect.
This article compares the Hobbesian realist and Kantian idealist analyses of
international law and organizations with respect to the UN General Assembly
resolutions and the International Court of Justice (ICJ) advisory opinion on
Israel's separation barrier. From the realist perspective, this case
highlights the exploitation of moral claims in support of a particularist
political agenda. In contrast, the idealist approach interprets the advisory
opinion and resolutions as important normative expressions in the developing
global system of governance based on universal human rights principles and
The analysis begins with a detailed comparison of the ideological and
intellectual foundations of these core approaches to international law and
organizations, the evolution of this debate in the post Cold War
international system, and the impact on protracted ethno-national conflicts.
This provides the basis for examining the impact of both schools in the
context of the Arab-Israeli conflict. The specific case of the UN and ICJ's
involvement in the question of Israel's separation barrier is then analyzed
in detail from both the realist and idealist perspectives.
The implications of this debate are of major importance, not only with
respect to the specific challenges posed by terrorism and the necessary
responses, but also in the wider context of the crisis in the international
system at the beginning of the 21st century. The analysis
concludes by noting the degree to which this case illustrates a wider
process in which international legal principles are manipulated in a manner
that contributes to conflict and justification of violence, conforming to
the realist interpretation. While still pursuing idealist objectives,
wishful thinking cannot conceal the abuse ofuniversalist claims of morality
in the pursuit of war by other means.
Fever is common in the postoperative period, and its causes are diverse (Table 26.1). Fever may result from a benign process such as the release of pyrogens from traumatized tissue and have little bearing on the clinical outcome. Alternatively, fever may be an early sign of a potentially life-threatening infection. The clinician's challenge is to identify those important fevers early, while avoiding the excessive use of diagnostic resources and therapeutic interventions such as unnecessary antibiotics.
Evaluation of a febrile surgical patient begins with a careful history and review of the medical record. The presence of symptoms or signs of infection before the operative procedure or underlying medical problems that increase the likelihood of postoperative complications are valuable clues. The type of surgical procedure performed, operative findings, and the temporal relationship between the operation and the onset of fever are also important. Although prolonged endotracheal intubation, indwelling bladder catheters, and intravascular catheters may be important components of patient care, they violate normal host defenses and increase the likelihood of postoperative infection. When a patient has a significant infection, symptoms and signs in addition to fever usually are present. Thus, a careful physical examination is essential. Laboratory and radiographic studies should be directed by the relevant clinical data and not obtained by an undirected “shotgun” approach.
Background: The mechanism of action of varenicline as a partial agonist may make it useful for cigarette reduction as smokers experience reduced craving and withdrawal at the same time their cigarettes provide reduced reinforcement value.
Case Description: The current case report describes a 51-year-old African American woman using varenicline to reduce her cigarette use. After making a substantial reduction in cigarettes per day (from 25 to 8), the patient unexpectedly began smoking considerably more (from 8 to 20) after 11 days treatment with varenicline.
Conclusions: The temporary increase in smoking while taking varenicline was likely the result of an ‘extinction burst’ where the extinction of a reward (e.g., nicotine's rewarding effects after smoking a cigarette) was temporarily associated with an increase in the behaviour usually associated with the reward (e.g., smoking a cigarette). Once explaining to her that no amount of cigarettes would overcome the feeling of reduced reward she likely felt while taking varenicline, she was able to reduce her smoking again.
Paterson showed how to construct an étale groupoid from an inverse semigroup using ideas from functional analysis. This construction was later simplified by Lenz. We show that Lenz’s construction can itself be further simplified by using filters: the topological groupoid associated with an inverse semigroup is precisely a groupoid of filters. In addition, idempotent filters are closed inverse subsemigroups and so determine transitive representations by means of partial bijections. This connection between filters and representations by partial bijections is exploited to show how linear representations of inverse semigroups can be constructed from the groups occurring in the associated topological groupoid.