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Demoralization is prevalent in patients with life-limiting chronic illnesses, many of whom reside in rural areas. These patients also have an increased risk of disease-related psychosocial burden due to the unique health barriers in this population. However, the factors affecting demoralization in this cohort are currently unknown. This study aimed to examine demoralization amongst the chronically ill in Lithgow, a town in rural New South Wales, Australia, and identify any correlated demographic, physical, and psychosocial factors in this population.
A cross-sectional survey of 73 participants drawn from Lithgow Hospital, the adjoining retirement village and nursing home, assessing correlating demographic, physical, psychiatric, and psychosocial factors.
The total mean score of the DS-II was 7.8 (SD 26.4), and high demoralization scores were associated with the level of education (p = 0.01), comorbid condition (p = 0.04), severity of symptom burden (p = <0.001), depression (p = <0.001), and psychological distress (p = <0.001). Prevalence of serious demoralization in this population was 27.4% according to a cutoff of a DS-II score ≥11. Of those, 11 (15%) met the criteria for clinical depression, leaving 9 (12.3%) of the cohort demoralized but not depressed.
Significance of results
Prevalence of demoralization was high in this population. In line with the existing literature, demoralization was associated with the level of education, symptom burden, and psychological distress, demonstrating that demoralization is a relevant psychometric factor in rural populations. Further stratification of the unique biopsychosocial factors at play in this population would contribute to better understanding the burdens experienced by people with chronic illness in this population and the nature of demoralization.
Electrospun coaxial fibers are used to create core/sheath fiber structures to act as growth-promoting scaffolds for in vitro dorsal root ganglia (DRG) cell cultures. The core was a conducting polymer, poly(3,4-ethylenedioxythiophene):poly(styrene sulfonate) (PEDOT:PSS), and the sheath was poly-L-lactic acid (PLLA), which created coaxial fibers with a conductive core and an insulating sheath. SEM analysis confirmed the conductivity of the core and insulation of the sheath. Several coaxial spinneret designs were tested with the best results obtained by using various annular spinning needle combinations. Using a 22G/16G and 22G/17G combination, fibers with diameters of 6.1 ± 2.4 µm and 3.3 ± 0.9 µm were spun, respectively. The fibers showed a Young’s modulus and hardness of 0.16 ± 0.13 and 0.02 ± 0.01 GPa for the larger diameters, and 0.7 ± 0.4 and 0.03 ± 0.03 GPa for the smaller diameter fibers. In vitro test cultures showed the fibers successfully directed chick DRG axonal outgrowth with low biotoxicity.
Background: Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord impairment. In a public healthcare system, wait times to see spine specialists and eventually access surgical treatment for CSM can be substantial. The goals of this study were to determine consultation wait times (CWT) and surgical wait times (SWT), and identify predictors of wait time length. Methods: Consecutive patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) prospective and observational CSM study from March 2015 to July 2017 were included. A data-splitting technique was used to develop and internally validate multivariable models of potential predictors. Results: A CSORN query returned 264 CSM patients for CWT. The median was 46 days. There were 31% mild, 35% moderate, and 33% severe CSM. There was a statistically significant difference in median CWT between moderate and severe groups; 207 patients underwent surgical treatment. Median SWT was 42 days. There was a statistically significant difference in SWT between mild/moderate and severe groups. Short symptom duration, less pain, lower BMI, and lower physical component score of SF-12 were predictive of shorter CWT. Only baseline pain and medication duration were predictive of SWT. Both CWT and SWT were shorter compared to a concurrent cohort of lumbar stenosis patients (p <0.001). Conclusions: Patients with shorter duration (either symptoms or medication) and less neck pain waited less to see a spine specialist in Canada and to undergo surgical treatment. This study highlights some of the obstacles to overcome in expedited care for this patient population.
As professors, we seek not only to impart knowledge about issues and concepts in American politics but also to engage and inspire students to become more knowledgeable and more active in politics. This article explains how a student-run exit poll conducted on Election Day 2016 accomplished both goals. Seven faculty members from four universities pooled our students and carried out an exit poll in the District of Columbia, Maryland, Virginia, and Ohio. By the time the polls closed, our students had spoken to more than 2,300 respondents, providing a memorable experience and creating a shared dataset that served as the centerpiece for many final class projects. Through this project, students gained hands-on experience in survey design, sampling, research ethics, polling, and data analysis.
Although research methods and statistics play an increasing role in political science and beyond, students all too often find statistics classes intimidating and boring. This need not be the case, however, because statistics classes provide opportunities to pose and answer questions about which students care. This article highlights four steps to making our methods and statistics classes more engaging and meaningful.
For a millennium heresy has been central to ‘the making of European culture’. Indeed, claims for its centrality could be pushed back to well before the year 1000, to the Nicene Council and even earlier debates around the nature of Christian orthodoxy. But the formative battles of the Roman period were long past by the eleventh century when western Europe began its economic, demographic, and intellectual ‘leap’ forward toward the modern world. From the Gregorian reforms to the Protestant Reformation and beyond, heresies and heretics helped to shape the religious, political, and institutional structures that medieval Europe would bequeath to the modern West. Within this sweeping history, the late medieval period, traditionally understood as the fourteenth and fifteenth centuries, presents a particularly diverse array of heterodox movements and modes of thought. Yet despite this richness, or perhaps because of it, some of the most intriguing heresies and heretics from this era of ‘paradox, tension, and unpredictability’ have been undervalued in wider studies, treated either as epilogues to the better-studied twelfth and thirteenth centuries or as preludes to the epoch-making religious revolutions of the sixteenth.
This introduction first addresses the historiographic landscape of medieval heresy, focusing in particular on periodization and its consequences. Then, as befitting a collection honoring the pioneering work of Robert E. Lerner, it outlines the elements of a ‘Lernerian’ approach to late medieval heresy and suggests ways in which this approach informs the new perspectives presented here.
The Historiographic Landscape
The work of the German historian Herbert Grundmann (1902–70) has profoundly influenced scholars of medieval religious history, including – as Richard Kieckhefer's preface notes – Robert Lerner. For the field as a whole, Grundmann's most influential work was undoubtedly his brilliant 1935 study of Religiöse Bewegungen im Mittelalter, which analyzed ways in which groups that cohered around spiritual, intellectual, and cultural ideals shared by broad swathes of European society could still end up forced into dissent or at least labeled as dissidents. In this analysis, a figure such as Valdes of Lyon partook in the apostolic impulses that animated many twelfth-century figures, but when his refusal to abandon lay preaching led to condemnation, he and his followers were labeled as heretics, and many ultimately came to understand themselves as opponents of the organized Church.
The late medieval period began with one vast, imagined heretical conspiracy and ended with another. The Clementine decree Ad nostrum, drafted at the Council of Vienne in 1312 and finally promulgated by John XXII in 1317, was ‘the birth certificate of the heresy of the Free Spirit’. Almost two centuries later, the infamous Malleus maleficarum (1486) marked the culmination of medieval thought on diabolical witchcraft. At the level of pure stereotype, the similarity between the antinomian heretics for whom sex was not a sin and the malevolent sorcerers who would fornicate with demons at unholy sabbaths is evident. We now know, however, that the reality behind the supposed Free Spirit movement actually lay in the ‘late medieval search for God and godliness’ and was ‘closely related to the orthodox mystical movement’ of the period. The reality of witchcraft, on the other hand, lay mostly in the mundane world of practical magical rites used by ordinary people or especially adept cunning-folk. This may explain why the most recent connection drawn between the heresy of the Free Spirit and witchcraft has focused on mechanisms of prosecution rather than the essence of each heretical system.
Here I will pursue a different tack. Instead of looking at inquisitorial structures or the often standardized cache of charges lodged against heretics, I will seek to expose more fundamental similarities between magical rites and mystical reverie. In particular, I will argue that these seemingly disparate practices aroused essentially similar concerns among clerical authorities in the late Middle Ages. To do so, I will turn to the early fourteenth century and explore two specific examples, first of unorthodox mysticism and then of condemned magic. Both are idiosyncratic in many ways, but they also illustrate important trends. My mystic needs no introduction: Marguerite Porete, burned in Paris in 1310, and a formative figure, at least in the minds of clerical authorities, for the heresy of the Free Spirit. My magician is much less famous: John of Morigny, a Benedictine monk and author of a sprawling work of visionary rituals. His treatise was attacked by other clerics in 1315 and was burned in Paris in 1323.
This research aims to explore the submerged landscapes of the Pilbara of western Australia, using predictive archaeological modelling, airborne LiDAR, marine acoustics, coring and diver survey. It includes excavation and geophysical investigation of a submerged shell midden in Denmark to establish guidelines for the underwater discovery of such sites elsewhere.
Reforestation in the Inland Northwest, including northeastern Oregon, USA, is often limited by a dry climate and soil moisture availability during the summer months. Reduction of competing vegetative cover in forest plantations is a common method for retaining available soil moisture. Several spring and summer site preparation (applied prior to planting) herbicide treatments were evaluated to determine their efficacy in reducing competing cover, thus retaining soil moisture, on three sites in northeastern Oregon. Results varied by site, year, and season of application. In general, sulfometuron (0.14 kg ai ha–1 alone and in various mixtures), imazapyr (0.42 ae kg ha–1), and hexazinone (1.68 kg ai ha–1) resulted in 3 to 17% cover of forbs and grasses in the first-year when applied in spring. Sulfometuron+glyphosate (2.2 kg ha–1) consistently reduced grasses and forbs for the first year when applied in summer, but forbs recovered in the second year on two of three sites. Aminopyralid (0.12 kg ae ha–1)+sulfometuron applied in summer also led to comparable control of forb cover. In the second year after treatment, forb cover in treated plots was similar to levels in nontreated plots, and some species of forbs had increased relative to nontreated plots. Imazapyr (0.21 and 0.42 kg ha–1) at either rate, spring or summer 2007, or at lower rate (0.14 kg ha–1) with glyphosate in summer, provided the best control of shrubs, of which snowberry was the dominant species. Total vegetative cover was similar across all treatments seven and eight years after application, and differences in vegetation were related to site rather than treatment. In the first year after treatment, rates of soil moisture depletion in the 0- to 23-cm depth were correlated with vegetative cover, particularly late season soil moisture, suggesting increased water availability for tree seedling growth.