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Background: Central neuropathic pain syndromes are a result of central nervous system injury, most commonly related to stroke, traumatic spinal cord injury, or multiple sclerosis. These syndromes are distinctly less common than peripheral neuropathic pain, and less is known regarding the underlying pathophysiology, appropriate pharmacotherapy, and long-term outcomes. The objective of this study was to determine the long-term clinical effectiveness of the management of central neuropathic pain relative to peripheral neuropathic pain at tertiary pain centers. Methods: Patients diagnosed with central (n=79) and peripheral (n=710) neuropathic pain were identified for analysis from a prospective observational cohort study of patients with chronic neuropathic pain recruited from seven Canadian tertiary pain centers. Data regarding patient characteristics, analgesic use, and patient-reported outcomes were collected at baseline and 12-month follow-up. The primary outcome measure was the composite of a reduction in average pain intensity and pain interference. Secondary outcome measures included assessments of function, mood, quality of life, catastrophizing, and patient satisfaction. Results: At 12-month follow-up, 13.5% (95% confidence interval [CI], 5.6-25.8) of patients with central neuropathic pain and complete data sets (n=52) achieved a ≥30% reduction in pain, whereas 38.5% (95% CI, 25.3-53.0) achieved a reduction of at least 1 point on the Pain Interference Scale. The proportion of patients with central neuropathic pain achieving both these measures, and thus the primary outcome, was 9.6% (95% CI, 3.2-21.0). Patients with peripheral neuropathic pain and complete data sets (n=463) were more likely to achieve this primary outcome at 12 months (25.3% of patients; 95% CI, 21.4-29.5) (p=0.012). Conclusion: Patients with central neuropathic pain syndromes managed in tertiary care centers were less likely to achieve a meaningful improvement in pain and function compared with patients with peripheral neuropathic pain at 12-month follow-up.
The impact of losing a limb in military service extends well beyond initial recovery and rehabilitation, with long-term consequences and challenges requiring health-care commitments across the lifecourse. This paper presents a systematic review of the current state of knowledge regarding the long-term impact of ageing and limb-loss in military veterans. Key databases were systematically searched including: ASSIA, CINAHL, Cochrane Library, Medline, Web of Science, PsycArticles/PsychInfo, ProQuest Psychology and ProQuest Sociology Journals, and SPORTSDiscus. Empirical studies which focused on the long-term impact of limb-loss and/or health-care requirements in veterans were included. The search process revealed 30 papers relevant for inclusion. These papers focused broadly on four themes: (a) long-term health outcomes, prosthetics use and quality of life; (b) long-term psycho-social adaptation and coping with limb-loss; (c) disability and identity; and (d) estimating the long-term costs of care and prosthetic provision. Findings present a compelling case for ensuring the long-term care needs and costs of rehabilitation for older limbless veterans are met. A dearth of information on the lived experience of limb-loss and the needs of veterans’ families calls for further research to address these important issues.
Irregularities plague elections in developing democracies. The international community spends hundreds of millions of dollars on election observation, with little robust evidence that it consistently improves electoral integrity. We conducted a randomized control trial to measure the effect of an intervention to detect and deter electoral irregularities employing a nation-wide sample of polling stations in Uganda using scalable information and communications technology (ICT). In treatment stations, researchers delivered letters to polling officials stating that tallies would be photographed using smartphones and compared against official results. Compared to stations with no letters, the letters increased the frequency of posted tallies by polling center managers in compliance with the law; decreased the number of sequential digits found on tallies – a fraud indicator; and decreased the vote share for the incumbent president in some specifications. Our results demonstrate that a cost-effective citizen and ICT intervention can improve electoral integrity in emerging democracies.
The current volume brings together contributions from two separate editors. The first is a collection of texts edited by Peter Clarke that evidence Cardinal Thomas Wolsey's legatine powers to grant dispensations and other papal graces and his exercise of these powers during the 1520s in Henry VIII's realm. The second is a text edited by Michael Questier. It takes the form of glosses on and suggested readings of the Elizabethan statute law which imposed treason penalties on Catholic clergy who exercised their office in reconciling to Rome (i.e. absolving from schism and heresy) and on those who availed themselves of this sacramental power. The rationale for linking these contributions in a single volume is threefold. First, both generally concern Catholicism in Tudor England, especially the authority of Catholic clergy there both before and after the break with Rome. Secondly and more specifically, they regard the role of these clergy as agents of papal authority in Tudor England. Wolsey was appointed as a papal legate in 1518 and obtained legatine powers from successive popes on a scale unparalleled in pre-Reformation England, notably to grant dispensations, and he exercised these dispensing powers there extensively; he was thus the papal agent par excellence in Tudor England on the eve of the Reformation. The Elizabethan ‘tolerationist’ text, by contrast, seeks to deny that Catholic clergy necessarily functioned as agents of papal authority. They were not, therefore, all without exception traitors to the queen, even though one literal reading of the statute book might give the impression that this was what the State had meant. Instead, so this manuscript claimed, the statutes themselves could be read in such a way as to imply that the legislators themselves accepted that the Catholic clergy's priestly functions did not depend exclusively on papal supremacy (unlike Wolsey's legatine status) or even a malign anti-popish understanding of the papacy as a legal and ecclesiastical entity. Therefore the exercise of their faculties could not automatically be interpreted as treasonable. Coincidentally Wolsey's activity as a papal agent led to him being attainted him with treason, and although the charge did not relate to his dispensing powers, four years after Wolsey's fall Henry VIII forbade his subjects to petition Rome or its agents for the kinds of graces Wolsey had issued. He established the Faculty Office to issue such graces instead, and its authority depended on royal, not papal, supremacy. Both contributions, therefore, concern the relationship between Catholic clergy and supreme authority in the English Church, wherever this was deemed to lie. Thirdly, both contributions illuminate the limits of the law and flexibility in interpreting and applying it. Wolsey's graces in effect limited the operation of canon law: his dispensations suspended it in specific instances, notably regarding marriage and ordination; and he also granted licences permitting activity that it normally forbade, such as clergy not residing in their benefices. The ‘tolerationist’ text implies, although with arguments which at times seem rather specious, that the Elizabethan State was, even in its more draconian utterances, to some extent drawing in its horns. Both contributions, therefore, concern apparently binding law which might be relaxed in Tudor England with regard to Catholic clergy (as well as laity in the case of Wolsey's papal graces).
Engraved and carved bone and stone artifacts capture our imaginations and are known worldwide from archaeological contexts, but they are seemingly rare and oftentimes difficult to recognize. While preservation issues play a role in the limited recovery of early art objects, research on incised stones and bone from the Gault site in Texas demonstrates that an expectation to find such artifacts plays a key role in their identification and recovery. The presence of incised stones found by collectors at Gault alerted archaeologists to the potential for finding early art in systematic excavations. To date, 11 incised stones and one engraved bone of Paleoindian age (13,000–9,000 calibrated years before present) have been recovered and of these, the Clovis artifacts are among the earliest portable art objects from secure context in North America. The presence of incised stone and bone at Gault led to the development of an examination protocol for identifying and analyzing engraved and incised artifacts that can be applied to a wide variety of archaeological contexts.
Executive functions (EF) are a complex set of neurodevelopmental, higher-ordered processes that are especially salient during adolescence. Disruptions to these processes are predictive of psychiatric problems in later adolescence and adulthood. The objectives of the current study were to characterize the latent structure of EF using bifactor analysis and to investigate the independent and interactive effects of genes and environments on EF during adolescence. Using a representative young adolescent sample, we tested the interaction of a polymorphism in the serotonin transporter gene (5-HTTLPR) and parental supervision for EF through hierarchical linear regression. To account for the possibility of a hierarchical factor structure for EF, a bifactor analysis was conducted on the eight subtests of the Delis-Kaplan Executive Functions System (D-KEFS). The bifactor analysis revealed the presence of a general EF construct and three EF subdomains (i.e., conceptual flexibility, inhibition, and fluency). A significant 5-HTTLPR by parental supervision interaction was found for conceptual flexibility, but not for general EF, fluency or inhibition. Specifically, youth with the L/L genotype had significantly lower conceptual flexibility scores compared to youth with S/S or S/L genotypes given low levels of parental supervision. Our findings indicate that adolescents with the L/L genotype were especially vulnerable to poor parental supervision on EF. This vulnerability may be amenable to preventive interventions. (JINS, 2014, 20, 62–73)
The role of the Beowulf manuscript in scholarship dating the poem's composition has changed considerably in recent years. During the nineteenth and much of the twentieth century, discussions of the poem's date rarely embraced the manuscript as a source of relevant evidence. The omission is not unreasonable, since the presence of transcription errors throughout the manuscript reveals that it is a copy of a copy, written out perhaps at a vast remove from the authorial original. The text transmitted in a copy might contain indications that it had been committed to parchment at a much earlier date, but there is no guarantee that such indications will be present. Accordingly, the previous disregard for the manuscript in dating studies was not an inexplicable oversight, though it suddenly seemed to be such in 1981, when Kevin S. Kiernan argued that his examination of the manuscript revealed it to contain an authorial draft of an eleventh-century poem. Kiernan's hypothesis is rarely credited, and a series of subsequent studies have demonstrated that it is untenable, but the notoriety of his argument has created the impression that manuscript studies might support a later dating. This impression is registered in Nicholas Howe's belief that “from the type of evidence offered, one can predict a scholar's dating of Beowulf … the more closely one works with the language and metre, the more likely one is to date the poem early … the more closely one works with the manuscript, the more likely one is to date the poem late.”
Since the date of the Beowulf manuscript is widely agreed upon, the very question which prompts this volume (and the conference it derives from, and even the 1980 conference with its 1981 proceedings volume) must assume that the date of the poem may not be the same as the date of the manuscript. It is certain that there must have been a moment of first inscription for the poem, and that the time and place of that moment remains a central point of interest for students of the poem. In this essay, I will bring new evidence to bear on this venerable question, and my argument shall be that Beowulf is metrically conservative according to a variety of independent metrical criteria. Further, I will suggest that that conservatism is so varied and consistent as to strongly indicate that the original version of Beowulf must be placed among the very earliest of the longer narrative Old English poems that survive, probably in the eighth century.
Of course, it remains true, I believe, that the moment of inscription is only one of the moments of interest which might engage modern scholars of the poem. As I argued in Authors, Audiences, and Old English Verse, our focus on authorship (and on moments of authorship) may sometimes cause us to lose sight of what can be gained by also considering audience, and I proposed there two later audiences for Beowulf, one located at Alfred's Wessex court in the late ninth century, and another, sometime around the turn of the eleventh century, perhaps in Canterbury, represented most clearly by the author of Maldon.