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The 11th revision to the WHO International Classification of Diseases (ICD-11) identified complex post-traumatic stress disorder (CPTSD) as a new condition. There is a pressing need to identify effective CPTSD interventions.
We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological interventions for post-traumatic stress disorder (PTSD), where participants were likely to have clinically significant baseline levels of one or more CPTSD symptom clusters (affect dysregulation, negative self-concept and/or disturbed relationships). We searched MEDLINE, PsycINFO, EMBASE and PILOTS databases (January 2018), and examined study and outcome quality.
Fifty-one RCTs met inclusion criteria. Cognitive behavioural therapy (CBT), exposure alone (EA) and eye movement desensitisation and reprocessing (EMDR) were superior to usual care for PTSD symptoms, with effects ranging from g = −0.90 (CBT; k = 27, 95% CI −1.11 to −0.68; moderate quality) to g = −1.26 (EMDR; k = 4, 95% CI −2.01 to −0.51; low quality). CBT and EA each had moderate–large or large effects on negative self-concept, but only one trial of EMDR provided useable data. CBT, EA and EMDR each had moderate or moderate–large effects on disturbed relationships. Few RCTs reported affect dysregulation data. The benefits of all interventions were smaller when compared with non-specific interventions (e.g. befriending). Multivariate meta-regression suggested childhood-onset trauma was associated with a poorer outcome.
The development of effective interventions for CPTSD can build upon the success of PTSD interventions. Further research should assess the benefits of flexibility in intervention selection, sequencing and delivery, based on clinical need and patient preferences.
In this paper we review the design and development of a 100 J, 10 Hz nanosecond pulsed laser, codenamed DiPOLE100X, being built at the Central Laser Facility (CLF). This 1 kW average power diode-pumped solid-state laser (DPSSL) is based on a master oscillator power amplifier (MOPA) design, which includes two cryogenic gas cooled amplifier stages based on DiPOLE multi-slab ceramic Yb:YAG amplifier technology developed at the CLF. The laser will produce pulses between 2 and 15 ns in duration with precise, arbitrarily selectable shapes, at pulse repetition rates up to 10 Hz, allowing real-time shape optimization for compression experiments. Once completed, the laser will be delivered to the European X-ray Free Electron Laser (XFEL) facility in Germany as a UK-funded contribution in kind, where it will be used to study extreme states of matter at the High Energy Density (HED) instrument.
Objectives: Glioblastoma is a lethal disease in the elderly population. We aimed to evaluate disease and treatment outcomes in the oldest-old patients. Methods: Patients >80 years old with histologically confirmed glioblastoma treated between 2004 and 2009 were identified. We included patients managed with best supportive care (BSC), temozolomide (TMZ) alone, radiotherapy (RT) alone, or concomitantly with TMZ (CRT). Survival outcomes were analyzed using the Kaplan–Meier method. Results: Ultimately, 48 patients were analyzed. Median age and Eastern Cooperative Oncology Group (ECOG) Performance Status were 82 years and 2, respectively. The median Age-Adjusted Charlson Index (AAC) was 6. Gross total and subtotal resections were performed in 16.7% and 18.8% of patients, respectively. Biopsy followed by RT alone was the treatment modality for 23/48 (47.9%), while 17/48 (35.4%) received surgery followed by RT alone or CRT. A total of 8 (16.7%) were managed with BSC after biopsy. Median overall survival (OS) and progression-free survival (PFS) were 4.1 (95% confidence interval [95% CI] 3.3-4.9) and 2.7 (95% CI 1.5-3.9) months, respectively. Improved median OS was observed in those treated with surgical resection followed by RT alone or CRT (7.1 months), compared to biopsy followed by RT alone (4.2 months) or BSC (2.0 months; p=0.002). Surgical resection, age≤85, and AAC<6 were associated with better OS (p=0.032, p=0.031, and p=0.02, respectively). Cause of death was neurological progression in 56% of cases. RT was well-tolerated. Conclusions: PFS and OS outcomes remain poor in the oldest-old patients (>80 years old). Younger age, lower AAC, surgical resection, and adjuvant treatment were associated with improved OS.
The Deep Ice Sheet Coring (DISC) drill developed by Ice Coring and Drilling Services under contract with the US National Science Foundation is an electromechanical ice-drill system designed to take 122mm ice cores to depths of 4000 m. The new drill system was field-tested near Summit camp in central Greenland during the spring/summer of 2006. Testing was conducted to verify the performance of the DISC drill system and its individual components and to determine the modifications required prior to the system’s planned deployment for coring at the WAIS Divide site in Antarctica in the following year. The experiments, results and the drill crew’s experiences with the DISC drill during testing are described and discussed.
The origin of radio emission in magnetic CVs is a long standing problem without a satisfactory solution. We review the radio observations of both non-magnetic and magnetic CVs and discuss possible emission mechanisms. We pose the following questions: Is the presence of a magnetic white dwarf a necessary condition for radio emission? Is there a single cause for the radio emission or are there several radio emission mechanisms? We revisit the suggestion that asynchronism or at least the lack of strict magnetic locking might be a necessary condition for radio emission.
There is growing evidence of complex white dwarf magnetic fields in CVs (e.g. Meggitt & Wickramasinghe 1989; Robinson & Cordova 1994). The properties of systems with non-dipolar white dwarf magnetic fields have been investigated, and it was found that a non-negligible quadrupole component is essential for the magnetic locking of AM Her binaries (AM Hers) (Wu & Wickramasinghe 1993). In a recent study the ratio of the quadrupole to dipole component of the surface field of white dwarfs was shown to grow by a factor of 10 during the white dwarf cooling lifetime (Muslimov, van Horn & Wood 1995), thus the quadrupole field component is long lived and significant.
We present preliminary results of an analysis of X-ray and optical data of the asynchronous AM Her star BY Cam . We use X-ray data from EXOSAT (0.1… 50 keV), Ginga (1.5… 50 keV) and ROSAT (0.1…2.0 keV) and optical data obtained during a 45-day campaign in 1994.
There are 4 known periods: the orbital period (201.30 m), the spin period of the white dwarf (199.3303 m), a spin-orbit beat period (14.15 d) and a side-band period (197.4 m). The detection of this side-band period lends credence to the theory of , who suggest that for a stream accreting, diskless, magnetic CV a frequency, f = 2ωspin − Ωorb (=197.399 m), will appear as a strong spike in the power spectrum for certain systems. Wu & Mason (this volume) discuss a competing model where Pspin = 197.4 m.
Tuberculosis (TB) researchers and clinicians, by virtue of the social disease they study, are drawn into an engagement with ways of understanding illness that extend beyond the strictly biomedical model. Primers on social science concepts directly relevant to TB, however, are lacking. The particularities of TB disease mean that certain social science concepts are more relevant than others. Concepts such as structural violence can seem complicated and off-putting. Other concepts, such as gender, can seem so familiar that they are left relatively unexplored. An intimate familiarity with the social dimensions of disease is valuable, particularly for infectious diseases, because the social model is an important complement to the biomedical model. This review article offers an important introduction to a selection of concepts directly relevant to TB from health sociology, medical anthropology and social cognitive theory. The article has pedagogical utility and also serves as a useful refresher for those researchers already engaged in this genre of work. The conceptual tools of health sociology, medical anthropology and social cognitive theory offer insightful ways to examine the social, historical and cultural dimensions of public health. By recognizing cultural experience as a central force shaping human interactions with the world, TB researchers and clinicians develop a more nuanced consideration of how health, illness and medical treatment are understood, interpreted and confronted.
Binaries could provide the best niches for life in the Galaxy. Although counterintuitive, this assertion follows directly from stellar tidal interaction theory and the evolution of lower mass stars. There is strong evidence that chromospheric activity of rapidly rotating young stars may be high enough to cause mass loss from atmospheres of potentially habitable planets. The removal of atmospheric water is most critical. Tidal breaking in binaries could help reduce magnetic dynamo action and thereby chromospheric activity in favour of life. We call this the Binary Habitability Mechanism (BHM) that we suggest allows for water retention at levels comparable to or better than the Earth. We discuss novel advantages that life may exploit, in these cases, and suggest that life may even thrive on some circumbinary planets. We find that while many binaries do not benefit from BHM, high-quality niches do exist for various combinations of stars between 0.55 and 1.0 solar masses. For a given pair of stellar masses, BHM operates only for certain combinations of period and eccentricity. Binaries having a solar-type primary seem to be quite well-suited niches having wide and distant habitable zones with plentiful water and sufficient light for photosynthetic life. We speculate that, as a direct result of BHM, conditions may be suitable for life on several planets and possibly even moons of giant planets orbiting some binaries. Lower mass combinations, while more restrictive in parameter space, provide niches lasting many billions of years and are rich suppliers of photosynthetic photons. We provide a publicly available web-site (http://bit.ly/BHM-calculator or http://bit.ly/BHM-calculator-mirror), which calculates the BHM effects presented in this paper.
High speed photometry of several accreting binaries was obtained using the McDonald Observatory 2.1m telescope and ARGOS CCD photometer. A broad-band filter (BVR) was used in order to maximize flux and maintain a short (1-10s) integration time on faint targets. Such observations obtained over several years allow for variability study over time scales covering many orders of magnitude. Observations and analysis for several binaries are summarized.
Case studies contribute more focused analyses which, in the context of human loss and damage, demonstrate the effectiveness of response strategies and prevention measures and identify lessons about success in disaster risk reduction and climate change adaptation. The case studies were chosen to complement and be consistent with the information in the preceding chapters, and to demonstrate aspects of the key messages in the Summary for Policymakers and the Hyogo Framework for Action Priorities.
The case studies were grouped to examine types of extreme events, vulnerable regions, and methodological approaches. For the extreme event examples, the first two case studies pertain to events of extreme temperature with moisture deficiencies in Europe and Australia and their impacts including on health. These are followed by case studies on drought in Syria and dzud, cold-dry conditions in Mongolia. Tropical cyclones in Bangladesh, Myanmar, and Mesoamerica, and then floods in Mozambique are discussed in the context of community actions. The last of the extreme events case studies is about disastrous epidemic disease, using the case of cholera in Zimbabwe, as the example.
The case studies chosen to reflect vulnerable regions demonstrate how a changing climate provides significant concerns for people, societies, and their infrastructure. These are: Mumbai as an example of a coastal megacity; the Republic of the Marshall Islands, as an example of small island developing states with special challenges for adaptation; and Canada's northern regions as an example of cold climate vulnerabilities focusing on infrastructures.