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This chapter explores the organizational culture of Iraq’s army between its founding in 1921 and its collapse by the time of the American invasion in 2003. During this eighty-two-year history, the organizational culture of the Iraqi Army moved from the face of a foreign occupation in the 1920s, to a political tool of internal social and political coercion, to “probably the most potent military ever wielded by an Arab government.” However, by the time American troops pulled down the statue of Saddam in Baghdad’s Firdos Square, the army’s organizational culture was but a faint echo of not only its Iran-Iraq War pinnacle but also its historic norm. Saddam’s role was the critical factor in this change. Saddam needed professional military officers competent in developing and employing a large modern armed force, but he preferred the counsel of “violent and ignorant personalities.” Saddam could never reconcile the fundamental difference between what he called tribal and civilized (or state) warfare and the professional elements of the Iraqi armed forces could not survive in his shadow.
Despite knowing for many decades that depressive psychopathology is common in first-episode schizophrenia spectrum disorders (FES), there is limited knowledge regarding the extent and nature of such psychopathology (degree of comorbidity, caseness, severity) and its demographic, clinical, functional and treatment correlates. This study aimed to determine the pooled prevalence of depressive disorder and caseness, and the pooled mean severity of depressive symptoms, as well as the demographic, illness, functional and treatment correlates of depressive psychopathology in FES.
This systematic review, meta-analysis and meta-regression was prospectively registered (CRD42018084856) and conducted in accordance with PRISMA and MOOSE guidelines.
Forty studies comprising 4041 participants were included. The pooled prevalence of depressive disorder and caseness was 26.0% (seven samples, N = 855, 95% CI 22.1–30.3) and 43.9% (11 samples, N = 1312, 95% CI 30.3–58.4), respectively. The pooled mean percentage of maximum depressive symptom severity was 25.1 (38 samples, N = 3180, 95% CI 21.49–28.68). Correlates of depressive psychopathology were also found.
At least one-quarter of individuals with FES will experience, and therefore require treatment for, a full-threshold depressive disorder. Nearly half will experience levels of depressive symptoms that are severe enough to warrant diagnostic investigation and therefore clinical intervention – regardless of whether they actually fulfil diagnostic criteria for a depressive disorder. Depressive psychopathology is prominent in FES, manifesting not only as superimposed comorbidity, but also as an inextricable symptom domain.
The overarching cultural context of the brain injury survivor, particularly that related to minority peoples with a history of colonisation and discrimination, has rarely been referred to in the research literature, despite profoundly influencing a person’s recovery journey in significant ways, including access to services. This study highlights issues faced by Australian Aboriginal traumatic brain injury (TBI) survivors in terms of real-life consequences of the high incidence of TBI in this population, current treatment and long-term challenges.
A case study approach utilised qualitative interview and file review data related to five male Aboriginal TBI survivors diagnosed with acquired communication disorders. The five TBI survivors were from diverse areas of rural and remote Western Australia, aged between 19 and 48 years at the time of injury, with a range of severity.
Common themes included: significant long-term life changes; short-term and long-term dislocation from family and country as medical intervention and rehabilitation were undertaken away from the person’s rural/remote home; family adjustments to the TBI including permanent re-location to a metropolitan area to be with their family member in residential care; challenges related to lack of formal rehabilitation services in rural areas; poor communication channels; poor cultural security of services; and lack of consistent follow-up.
Discussion and Conclusion:
These case reports represent some of the first documented stories of Aboriginal Australian TBI survivors. They supplement available epidemiological data and highlight different contexts for Aboriginal people after TBI, contributing to an overall profile that is relevant for rehabilitation service planning.
Objectives: Research has shown that analyzing intrusion errors generated on verbal learning and memory measures is helpful for distinguishing between the memory disorders associated with Alzheimer’s disease (AD) and other neurological disorders, including Huntington’s disease (HD). Moreover, preliminary evidence suggests that certain clinical populations may be prone to exhibit different types of intrusion errors. Methods: We examined the prevalence of two new California Verbal Learning Test-3 (CVLT-3) intrusion subtypes – across-trial novel intrusions and across/within trial repeated intrusions – in individuals with AD or HD. We hypothesized that the encoding/storage impairment associated with medial-temporal involvement in AD would result in a greater number of novel intrusions on the delayed recall trials of the CVLT-3, whereas the executive dysfunction associated with subcortical-frontal involvement in HD would result in a greater number of repeated intrusions across trials. Results: The AD group generated significantly more across-trial novel intrusions than across/within trial repeated intrusions on the delayed cued-recall trials, whereas the HD group showed the opposite pattern on the delayed free-recall trials. Conclusions: These new intrusion subtypes, combined with traditional memory analyses (e.g., recall versus recognition performance), promise to enhance our ability to distinguish between the memory disorders associated with primarily medial-temporal versus subcortical-frontal involvement.
Innovation Concept: The outcome of emergency medicine training is to produce physicians who can competently run an emergency department (ED) shift. While many workplace-based ED assessments focus on discrete tasks of the discipline, others emphasize assessment of performance across the entire shift. However, the quality of assessments is generally poor and these tools often lack validity evidence. The use of entrustment scale anchors may help to address these psychometric issues. The aim of this study was to develop and gather validity evidence for a novel tool to assess a resident's ability to independently run an ED shift. Methods: Through a nominal group technique, local and national stakeholders identified dimensions of performance reflective of a competent ED physician. These dimensions were included in a new tool that was piloted in the Department of Emergency Medicine at the University of Ottawa during a 4-month period. Psychometric characteristics of the items were calculated, and a generalizability analysis used to determine the reliability of scores. An ANOVA was conducted to determine whether scores increased as a function of training level (junior = PGY1-2, intermediate = PGY3, senior = PGY4-5), and varied by ED treatment area. Safety for independent practice was analyzed with a dichotomous score. Curriculum, Tool or Material: The developed Ottawa Emergency Department Shift Observation Tool (O-EDShOT) includes 12-items rated on a 5-point entrustment scale with a global assessment item and 2 short-answer questions. Eight hundred and thirty-three assessment were completed by 78 physicians for 45 residents. Mean scores differed significantly by training level (p < .001) with junior residents receiving lower ratings (3.48 ± 0.69) than intermediate residents who received lower ratings (3.98 ± 0.48) than senior residents (4.54 ± 0.42). Scores did not vary by ED treatment area (p > .05). Residents judged to be safe to independently run the shift had significantly higher mean scores than those judged not to be safe (4.74 ± 0.31 vs 3.75 ± 0.66; p < .001). Fourteen observations per resident, the typical number recorded during a 1-month rotation, were required to achieve a reliability of 0.80. Conclusion: The O-EDShOT successfully discriminated between junior, intermediate and senior-level residents regardless of ED treatment area. Multiple sources of evidence support the O-EDShOT producing valid scores for assessing a resident's ability to independently run an ED shift.
Unlike for many other respiratory infections, the seasonality of pertussis is not well understood. While evidence of seasonal fluctuations in pertussis incidence has been noted in some countries, there have been conflicting findings including in the context of Australia. We investigated this issue by analysing the seasonality of pertussis notifications in Australia using monthly data from January 1991 to December 2016. Data were made available for all states and territories in Australia except for the Australian Capital Territory and were stratified into age groups. Using a time-series decomposition approach, we formulated a generalised additive model where seasonality is expressed using cosinor terms to estimate the amplitude and peak timing of pertussis notifications in Australia. We also compared these characteristics across different jurisdictions and age groups. We found evidence that pertussis notifications exhibit seasonality, with peaks observed during the spring and summer months (November–January) in Australia and across different states and territories. During peak months, notifications are expected to increase by about 15% compared with the yearly average. Peak notifications for children <5 years occurred 1–2 months later than the general population, which provides support to the theory that older household members remain an important source of pertussis infection for younger children. In addition, our results provide a more comprehensive spatial picture of seasonality in Australia, a feature lacking in previous studies. Finally, our findings suggest that seasonal forcing may be useful to consider in future population transmission models of pertussis.
Childhood adversity is associated with poor mental and physical health outcomes across the life span. Alterations in the hypothalamic–pituitary–adrenal axis are considered a key mechanism underlying these associations, although findings have been mixed. These inconsistencies suggest that other aspects of stress processing may underlie variations in this these associations, and that differences in adversity type, sex, and age may be relevant. The current study investigated the relationship between childhood adversity, stress perception, and morning cortisol, and examined whether differences in adversity type (generalized vs. threat and deprivation), sex, and age had distinct effects on these associations. Salivary cortisol samples, daily hassle stress ratings, and retrospective measures of childhood adversity were collected from a large sample of youth at risk for serious mental illness including psychoses (n = 605, mean age = 19.3). Results indicated that childhood adversity was associated with increased stress perception, which subsequently predicted higher morning cortisol levels; however, these associations were specific to threat exposures in females. These findings highlight the role of stress perception in stress vulnerability following childhood adversity and highlight potential sex differences in the impact of threat exposures.
The rapid, quantitative and qualitative analysis of particulates on air filter samples is becoming increasingly important as more air pollution sampling stations are set up throughout the countiy. Although atomic absorption provides a sensitive technique for the analysis of many elements, the disadvantages of complex sample preparation, sample destruction and the necessity to analyze one element at a time make this technique unsuitable for a large volume of samples. X-ray energy spectroscopy when combined with automated sample handling and the latest dedicated data reduction systems provides a technique which enables the analyst to process large numbers of samples and obtain precise quantitative and qualitative data rapidly. This paper will describe the preparation and analysis of typical air filter type samples, and the steps taken to identify the elements in the samples and obtain computerized reduction of the data in μg/cm2, ppm or percent.
Accurately dating when people first colonized new areas is vital for understanding the pace of past cultural and environmental changes, including questions of mobility, human impacts and human responses to climate change. Establishing effective chronologies of these events requires the synthesis of multiple radiocarbon (14C) dates. Various “chronometric hygiene” protocols have been used to refine 14C dating of island colonization, but they can discard up to 95% of available 14C dates leaving very small datasets for further analysis. Despite their foundation in sound theory, without independent tests we cannot know if these protocols are apt, too strict or too lax. In Iceland, an ice core-dated tephrochronology of the archaeology of first settlement enables us to evaluate the accuracy of 14C chronologies. This approach demonstrated that the inclusion of a wider range of 14C samples in Bayesian models improves the precision, but does not affect the model outcome. Therefore, based on our assessments, we advocate a new protocol that works with a much wider range of samples and where outlying 14C dates are systematically disqualified using Bayesian Outlier Models. We show that this approach can produce robust termini ante quos for colonization events and may be usefully applied elsewhere.
New work on colonial legal regimes suggests new pathways for scholarship on legal regimes, legal consciousness, judicial personnel, and the Atlantic world. Malick Ghachem's recent book, The Old Regime and the Haitian Revolution (2012), introduces scholars to one legal regime—that of the French plantation colony of Saint‐Domingue—to show how enslaved and free people continually negotiated the terms of master sovereignty and manumission. This debate lasted from Saint‐Domingue's establishment as a slave society in the seventeenth century to its revolution in the 1790s, which overthrew the slave regime and culminated in independence in 1804 as the republic of Haiti.
Among low‐income homebuyers, a contract for deed (CFD) has been a widely used but risky and informal mechanism for purchasing a home or lot. This article examines a series of major consumer protections adopted by the Texas Legislature from 1995 to 2005 and whether this legislation shaped the behavior of sellers who historically relied on CFDs in Texas colonias. Tracking changes in the use of CFDs between 1990 and 2010, we show that developers responded to the legislative reforms by shifting away from CFDs and into other forms of seller financing. At the same time, developers have adopted a series of workarounds to the legislation (presumably legal), leaving low‐income buyers vulnerable to rapid repossession by the developer. In contrast, the impact of the legislation on low‐income residents selling their homes has been minimal. These consumer‐to‐consumer transactions remain highly informal, with ongoing reliance on the now illegal, unrecorded CFD.
We study the migration of a tracer within an injection-driven flow in a horizontal aquifer in which the permeability varies with depth. The permeability gradient produces a shear and this leads to lateral dispersion of the tracer. In the high permeability regions, the tracer moves substantially faster than the mean flow and eventually enters the nose region of the flow where the depth of the current is less than the depth of the aquifer. Depending on the influence of (i) the viscosity contrast between the injected fluid and the original fluid, and (ii) the vertical permeability gradient, the nose of the current may be of fixed shape or may gradually lengthen with time. This leads to a variety of patterns of dispersal of the tracer, which may either remain in the nose or cycle through the nose and be left behind. Our results illustrate the complexity of the migration of a tracer in a heterogeneous aquifer which has important implications for interpreting the results of tracer tests as may be proposed for monitoring
or gas injected into subsurface reservoirs.
A point-prevalence study of antimicrobial use among inpatients at 5 public hospitals in Sri Lanka revealed that 54.6% were receiving antimicrobials: 43.1% in medical wards, 68.0% in surgical wards, and 97.6% in intensive care wards. Amoxicillin-clavulanate was most commonly used for major indications. Among patients receiving antimicrobials, 31.0% received potentially inappropriate therapy.
As Dante and Beatrice begin their ascent to the Empyrean in canto 3 of the Paradiso, they alight on the moon where they encounter pale spirits, not mere reflections but “true substances … assigned [there] for inconstancy to holy vows” (Dante, 29-31).1 Encouraged by Beatrice, Dante asks an eager soul identified as Piccarda Donati, a Poor Clare abducted from a Florentine convent by her brother and coerced into a politically expedient marriage, “through what warp she had not entirely passed the shuttle of her vow” (Dante, 95-96). Like the followers of Saint Clare who “go cloaked and veiled on earth,” she replies, “as a girl, I fled the world to walk the way she walked and closed myself into her habit, pledged to her sisterhood till my last day” (Dante, 98-99, 103-05).