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Generalization of conditioned-fear, a core feature of post-traumatic stress disorder (PTSD), has been the focus of several recent neuroimaging studies. A striking outcome of these studies is the frequency with which neural correlates of generalization fall within hubs of well-established functional networks including salience (SN), central executive (CEN), and default networks (DN). Neural substrates of generalization found to date may thus reflect traces of large-scale brain networks that form more expansive neural representations of generalization. The present study includes the first network-based analysis of generalization and PTSD-related abnormalities therein.
fMRI responses in established intrinsic connectivity networks (ICNs) representing SN, CEN, and DN were assessed during a generalized conditioned-fear task in male combat veterans (N = 58) with wide-ranging PTSD symptom severity. The task included five rings of graded size. Extreme sizes served as conditioned danger-cues (CS+: paired with shock) and safety-cues (CS−), and the three intermediate sizes served as generalization stimuli (GSs) forming a continuum-of-size between CS+ and CS–. Generalization-gradients were assessed as behavioral and ICN response slopes from CS+, through GSs, to CS–. Increasing PTSD symptomatology was predicted to relate to less-steep slopes indicative of stronger generalization.
SN, CEN, and DN responses fell along generalization-gradients with levels of generalization within and between SN and CEN scaling with PTSD symptom severity.
Neural substrates of generalized conditioned-fear include large-scale networks that adhere to the functional organization of the brain. Current findings implicate levels of generalization in SN and CEN as promising neural markers of PTSD.
Objectives: To summarize the clinical characteristics and outcomes of pediatric sports-related concussion (SRC) patients who were evaluated and managed at a multidisciplinary pediatric concussion program and examine the healthcare resources and personnel required to meet the needs of this patient population. Methods: We conducted a retrospective review of all pediatric SRC patients referred to the Pan Am Concussion Program from September 1st, 2013 to May 25th, 2015. Initial assessments and diagnoses were carried out by a single neurosurgeon. Return-to-Play decision-making was carried out by the multidisciplinary team. Results: 604 patients, including 423 pediatric SRC patients were evaluated at the Pan Am Concussion Program during the study period. The mean age of study patients was 14.30 years (SD: 2.32, range 7-19 years); 252 (59.57%) were males. Hockey (182; 43.03%) and soccer (60; 14.18%) were the most commonly played sports at the time of injury. Overall, 294 (69.50%) of SRC patients met the clinical criteria for concussion recovery, while 75 (17.73%) were lost to follow-up, and 53 (12.53%) remained in active treatment at the end of the study period. The median duration of symptoms among the 261 acute SRC patients with complete follow-up was 23 days (IQR: 15, 36). Overall, 25.30% of pediatric SRC patients underwent at least one diagnostic imaging test and 32.62% received referral to another member of our multidisciplinary clinical team. Conclusion: Comprehensive care of pediatric SRC patients requires access to appropriate diagnostic resources and the multidisciplinary collaboration of experts with national and provincially-recognized training in TBI.
A sediment core representing the past two millennia was recovered from Stella Lake in the Snake Range of the central Great Basin in Nevada. The core was analyzed for sub-fossil chironomids and sediment organic content. A quantitative reconstruction of mean July air temperature (MJAT) was developed using a regional training set and a chironomid-based WA-PLS inference model (r2jack = 0.55, RMSEP = 0.9°C). The chironomid-based MJAT reconstruction suggests that the interval between AD 900 and AD 1300, corresponding to the Medieval Climate Anomaly (MCA), was characterized by MJAT elevated 1.0°C above the subsequent Little Ice Age (LIA), but likely not as warm as recent conditions. Comparison of the Stella Lake temperature reconstruction to previously published paleoclimate records from this region indicates that the temperature fluctuations inferred to have occurred at Stella Lake between AD 900 and AD 1300 correspond to regional records documenting hydroclimate variability during the MCA interval. The Stella Lake record provides evidence that elevated summer temperature contributed to the increased aridity that characterized the western United States during the MCA.
Eradication of introduced species is often necessary to conserve native biota on islands. Seven wild turkeys Meleagris gallopavo were introduced to Santa Cruz Island, California, in 1975 and the population began to irrupt in the early 2000s. Turkeys posed a variety of threats to native species, including that they could replace the previously eradicated population of feral pigs Sus scrofa as a prey subsidy for golden eagles Aquila chrysaetos, which through incidental predation had driven three subspecies of island fox Urocyon littoralis to near extinction. We implemented a four-phase programme to eradicate the turkey population, based on general principles for eradication efforts. For example, we focused on preventing individual turkeys from becoming aware of our methods, which increased the likelihood we would be able to detect and dispatch all of the birds. Leveraging the tendency of turkeys to aggregate during winter, we used baited drop nets, precision shooting, and monitoring of surgically sterilized, radio-telemetered ‘Judas turkeys’ to eliminate the population. We estimate the population comprised 310 individuals when the project began in 2006 and that the last bird died in December 2012. Methods used in this project could be applied to other alien bird eradication programmes, of which there are few examples in the scientific literature.
We present the case of a 20-year-old man who was stabbed in the left chest and was diagnosed with a large pericardial effusion by focused emergency department (ED) ultrasonography. After placement of a left chest tube for presumed tension pneumothorax, the pericardial effusion had resolved. The patient's postinjury course was complicated by pericarditis and recurrent tamponade, which required repeated pericardiocentesis for management. This case illustrates the role of focused ED ultrasonography for diagnosis of pericardial effusion in penetrating trauma and the potential for delayed pericardial effusion and tamponade in such patients. Although the pathophysiology of delayed pericardial effusion is unclear, autoimmune postpericardiotomy syndrome has been proposed as the cause of this rare condition. Our case underscores the importance of close monitoring of patients with known or suspected pericardial injuries due to their potential for the development of lifethreatening complications.
Substantial research demonstrates that the stressors accompanying the profession of paramedicine can lead to mental health concerns. In contrast, little is known about the effects of stress on paramedics’ ability to care for patients during stressful events. In this study, we examined paramedics’ acute stress responses and performance during simulated high-stress scenarios.
Twenty-two advanced care paramedics participated in simulated low-stress and high-stress clinical scenarios. The paramedics provided salivary cortisol samples and completed an anxiety questionnaire at baseline and following each scenario. Clinical performance was videotaped and scored on a checklist of specific actions and a global rating of performance. The paramedics also completed patient care documentation following each scenario.
The paramedics demonstrated greater increases in anxiety (P < .05) and salivary cortisol levels (P < .05) in response to the high-stress scenario compared to the low-stress scenario. Global rating scores were significantly lower in the high-stress scenario than in the low-stress scenario (P < .05). Checklist scores were not significantly different between the two scenarios (P = .12). There were more errors of commission (reporting information not present in the scenario) in the patient care documentation following the high-stress scenario than following the low-stress scenario (P < .05). In contrast, there were no differences in omission errors (failing to recall information present in the scenario) between the two scenarios (P = .34).
Clinical performance and documentation appear vulnerable to the impact of acute stress. This highlights the importance of developing systems and training interventions aimed at supporting and preparing emergency workers who face acute stressors as part of their every day work responsibilities.
LeBlanc VR, Regehr C, Tavares W, Scott AK, MacDonald R, King K. The impact of stress on paramedic performance during simulated critical events. Prehosp Disaster Med. 2012;27(4):1-6.
Aquinas argues that practical reasoning requires foundations: first practical principles (ultimate ends) grasped by us per se from which deliberation proceeds. Contrary to the thesis of an important paper of Terence Irwin's, I deny that Aquinas advances two inconsistent conceptions of the scope of deliberation and, correspondingly, two inconsistent accounts of the content of the first practical principles presupposed by deliberation. On my account, Aquinas consistently takes first practical principles to be highly abstract, general, or formal ends, ends subject to specification and determination by a process of reasoning. Aquinas therefore gives deliberation wide scope, allowing (indeed, requiring) it not only to settle for us the things that are for the sake of our ends but also to engage in determining in important respects what our ends are. Accordingly, I conclude that Aquinas's foundations in ethics are “thin.” Our natural grasp of first practical principles gives us very little in the way substantive ethical principles.
In 386, at the age of 32, Augustine converted to Christianity. As he tells the story in the Confessions, the complex and dramatic events that constituted his conversion brought to successful conclusion a search he had begun as a teenager at Carthage with his reading of Cicero's Hortensius. Cicero had inspired in him a passionate yearning for the sort of immortality that comes with wisdom. After more than a decade of fruitless searching, Augustine finally discovered that the wisdom he had longed for was to be found with the God of Christianity. The discovery came in a moment of intellectual vision in which Augustine glimpsed and thereby came at last to understand the divine nature. “At that moment,” he tells us, “I saw [God's] 'invisible nature understood through the things that are made' [Romans 1.20]” (Conf. 7.17.23).
This issue of Medieval Philosophy and Theology is atypical in that it contains a single work by a single philosopher and scholar. Norman Kretzmann, the author of the work here presented, was one of the founders of this journal and served as the chair of its editorial board from the journal’s inception until his untimely death in 1998. His intimate association with Medieval Philosophy and Theology and his dedication to its mission makes the journal an entirely appropriate vehicle for the publication of the work that filled the last year of his life.
Mos enim amicorum est ut cum amicus ad suam exaltationem vadit, de eius recessu minus desolentur.
Thomas AquinasThis quotation from Aquinas’s Lectura super evangelium Johannis c. 14, l. 8 appeared as the dedication in Aquinas’s Moral Theory: Essays in Honor of Norman Kretzmann, edited by Scott MacDonald and Eleonore Stump (Ithaca and London: Cornell University Press, 1999).
Norman Kretzmann, one of the founders of Medieval Philosophy and Theology and chair of the journal's editorial board since its inception, died on August 1, 1998 in Ithaca, New York. Although he had been under treatment since 1991 for an incurable cancer, he remained actively engaged in his own research and directly involved in the work of the journal until a few weeks before his death.
We propose electroless metallization as a method for conformal metal deposition microelectromechanical systems (MEMS). The intrinsically conformal nature of electroless deposition makes it ideal for coating high aspect ratio (greater than 50:1) structures frequently fabricated with micromachining techniques We take advantage of the selective nature of the deposition to obtain self-aligned electrical isolation. We minimize the metal film roughness for potential applications in RF and optics. Given the specific MEMS metallization requirements, we determined the ideal concentrations of additives and surfactants in order to provide good electrical isolation, low roughness and high film reliability. Our depositions were done using seed layers as well as through direct chemical activation of the silicon surface. Characteristics such as resistivity [ 1 ], morphology [ 1 ], microstructure [ 2 ], and electrochemical behavior [ 3 ] have already been reported in the literature; our paper is focused on the specific requirements for MEMS applications.
On a map or from the air, nothing defines New York City
more clearly than the rectilinearity of Central Park at the heart of the
of Manhattan. And nothing encodes the paradox of the thinking that
created Frederick Law Olmsted's first great park
– and simultaneously
distinguishes it from many of the parks inspired by Central Park
– than the
virtually perfect geometry of its outline. The Park simultaneously
confirms the grid structure of the streets of Manhattan and dramatically
interrupts this structure: streets that run vertically uptown and downtown
or horizontally across town must, when they reach the horizontal and
vertical boundaries of the park, leave their verticality and horizontality
behind to traverse the Park before rejoining the grid of streets and
avenues at the far boundaries of the Park's expanse.
If the Cartesian clarity
of midtown Manhattan has come to represent the efficiency of American
capitalism that was making the United States a major industrial power
during the years when the Greensward Plan was designed and Central
Park constructed, the Park represented (and continues to represent) a
counter-sensibility: as Olmstead and Vaux predicted.
One of the primary reasons I became interested in film studies was the seeming open-endedness of the field. Cinema was new, I reasoned, and would continue to be new, unlike other academic fields, and particularly those devoted to historical periods: as a scholar and a teacher, I would face the future, endlessly enthralled and energized by the transformation of the potential into the actual. That my development as a film scholar/teacher increasingly involved me in avant-garde film seemed quite natural — a logical extension of the attraction of film studies in general: Avant-garde film was the newest of the new, the sharpest edge of the present as it sliced into the promise of the future. Scholars in some fields may empathize with the attitude I describe, but scholars in all fields will smile at its self-defeating implications: of course, I can see now how typically American my assumptions were — as if one could maintain the excitement of youth merely by refusing to acknowledge the past! Obviously, film studies, like any other discipline, is only a field once its history takes, or is given, a recognizable shape.
Aquinas does not build his philosophical system around a theory of knowledge. In fact the reverse is true: he builds his epistemology on the basis provided by other parts of his system, in particular, his metaphysics and psychology. To examine what we can recognize as a distinct and systematic theory of knowledge, then, we need to extract his strictly epistemological claims from the metaphysical and psychological discussions in which they are embedded.
Cognition is Aquinas’s fundamental epistemic category. He endorses the Aristotelian view that the soul is potentially all things, and he holds that cognition involves its actually becoming a given thing or, as he sometimes puts it, its being assimilated to that thing in a certain way. As Aquinas sees it, the development of this notion of cognition as the soul’s assimilation to the objects cognized requires him to deal with two sorts of issues. First, he needs a metaphysical account of the two relata: the human soul and the object of human cognition. Here he draws primarily on his Artistotelian hylomorphism.