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After a generation of academic critique and legal and political transformation, the field of law-and-religion stands in the midst of a crisis. Theorists in disciplines ranging from religious studies and anthropology to international relations and law have problematized the category of “religion” from a variety of perspectives. To be sure, these theorists have rarely, if ever, sought to do away with the category, either as an empirical descriptor or as a tool of analysis. Rather, they have shown its historically contingent, politically constructed, and perennially contested nature.
Post-colonial theorists, for example, have argued for the Eurocentric genealogy of “religion” and its global diffusion through colonialism and its aftermath. Legal critics have undermined the perennial protestations of theological agnosticism by courts in the West; in the United States, such criticism has revealed an implicit strand of “low-church” Protestant presuppositions.
Three-dimensional printing is increasingly utilised for congenital heart defect procedural planning. CT or MR datasets are typically used for printing, but similar datasets can be obtained from three-dimensional rotational angiography. We sought to assess the feasibility and accuracy of printing three-dimensional models of CHD from rotational angiography datasets.
Retrospective review of CHD catheterisations using rotational angiography was performed, and patient and procedural details were collected. Imaging data from rotational angiography were segmented, cleaned, and printed with polylactic acid on a Dremel® 3D Idea Builder (Dremel, Mount Prospect, IL, USA). Printing time and materials’ costs were captured. CT scans of printed models were compared objectively to the original virtual models. Two independent, non-interventional paediatric cardiologists provided subjective ratings of the quality and accuracy of the printed models.
Rotational angiography data from 15 catheterisations on vascular structures were printed. Median print time was 3.83 hours, and material costs were $2.84. The CT scans of the printed models highly matched with the original digital models (root mean square for Hausdorff distance 0.013 ± 0.003 mesh units). Independent reviewers correctly described 80 and 87% of the models (p = 0.334) and reported high quality and accuracy (5 versus 5, p = NS; κ = 0.615).
Imaging data from rotational angiography can be converted into accurate three-dimensional-printed models of CHD. The cost of printing the models was negligible, but the print time was prohibitive for real-time use. As the speed of three-dimensional printing technology increases, novel future applications may allow for printing patient-specific devices based on rotational angiography datasets.
Dynamic movement primitives (DMP) are motion building blocks suitable for real-world tasks. We suggest a methodology for learning the manifold of task and DMP parameters, which facilitates runtime adaptation to changes in task requirements while ensuring predictable and robust performance. For efficient learning, the parameter space is analyzed using principal component analysis and locally linear embedding. Two manifold learning methods: kernel estimation and deep neural networks, are investigated for a ball throwing task in simulation and in a physical environment. Low runtime estimation errors are obtained for both learning methods, with an advantage to kernel estimation when data sets are small.
Migration is a human capital investment in which parents bear costs and children share returns. Therefore, migrants from a population with heterogeneous intergenerational discount rates will self-select on intergenerational altruism. Intergenerational altruism and fertility are arguably linked, therefore immigrants might self-select on eventual fertility. Soviet Jews who migrated to Israel despite high migration costs averaged almost one child more than members of the same birth cohorts who migrated later, at lower cost. Distinguishing selection from treatment effects using mothers' age at migration, selection accounts for most of that difference (the proportion varies with specification), even with controls for religion and religiosity. Selection on fertility may have other explanations, including cultural preservation. To probe, we conduct an alternative empirical test of immigrant selection on altruism, finding that U.S. immigrants spend more time with grandchildren than do natives. Additionally, immigrant self-selection on fertility provides an alternative explanation for Chiswick's (1978, Journal of Political Economy86(5), 897–921) earnings-overtaking result.
It is recognised that the attitudes of parents and teachers are important in supporting inclusive education in developing countries. This study involved the application of quantitative research through the administration of a survey to determine the attitudes of parents and teachers in the Republic of Nauru. The results have provided preliminary data regarding attitudes related to the emergence of inclusive education in Nauru. Parents were more positive concerning issues that relate directly to the educational benefits of their children over more general benefits of inclusion in education. At this stage, teachers report higher levels of positive attitude than parents. A more fine-grained level of analysis revealed that there is a wide range of attitudes to aspects of education for students with disabilities, and areas of expertise needed to support inclusive education. This research has provided an understanding of current parental and teacher attitudes and levels of existing teacher expertise towards inclusion that is able to inform future policy development in Nauru.
The mitigation of CMAS (calcium–magnesium–aluminum–silicon oxide) infiltration is a major requirement for the stability of thermal barrier coatings. In this study, yttria-stabilized zirconia (YSZ)–Al2O3–SiC, YSZ–Al2O3–Ta2O5, and YSZ–Al2O3–Nb2O5 self-healing composites produced by uniaxially pressing powders were investigated as an alternative to YSZ. CMAS infiltration in these materials was tested at 1250 °C for 10 h. Comparing the depth of CMAS infiltration using scanning electron microscope (SEM) in tandem with electron-dispersive X-ray spectroscopy (EDS), all self-healing materials were found to perform better than the reference materials. While standard YSZ shows massive CMAS infiltration, SEM micrographs and EDS maps revealed a 33-fold improvement in CMAS resistance for the YSZ–Al2O3–Nb2O5 system, which exhibited the best performance among the selected self-repairing materials. X-ray diffraction and high-resolution SEM micrographs taken 10 μm below the surface revealed that CMAS only infiltrated pores in the topmost region of the samples. Both YSZ–Al2O3–Ta2O5 and YSZ–Al2O3–Nb2O5 systems showed no signs of chemical reaction with CMAS.
Magnetic field-assisted freeze-casting of porous alumina structures is reported. Different freeze-casting parameters were investigated and include the composition of the original slurry (Fe3O4 and PVA content) and the control of temperature during the free casting process. The optimum content of the additives in the slurry were 3 and 6 wt% for PVA and Fe3O4, respectively. These conditions provided the most unidirectional porous structures throughout the length of the sample. The sintering temperature was maintained at 1500 °C for 3 h. The application of a vertical magnetic field (parallel to ice growth direction) with using a cooling rate mode technique was found to enhance the homogeneity of the porous structure across the sample. The current study suggests that magnetic field-assisted freeze-casting is a viable method to create highly anisotropic porous ceramic structures.
Motivational interviewing (MI) is a method of eliciting individuals’ inner motivation to change their behavior. MI is typically delivered within health care settings as well as in occupational and educational settings and in multiple populations. MI builds on practice skills that are relational and technical, aiming to evoke and reinforce client utterances in the direction of behavior change, termed change talk, and to reduce client utterances in the direction of maintaining current behaviors, termed sustain talk. Meta-analyses show that MI training leads to increased practice of relational and technical skills, and practice of relational and technical skills are related to change talk. Technical skills increase the proportion of change talk in relation to sustain talk. Sustain talk has a negative effect on behavioral outcomes, but change talk has a positive effect on behavioral outcomes. Meta-analyses also show positive effects of MI over six months in reducing or eliminating binge drinking, alcohol consumption, problematic substance use, and smoking, and increasing physical activity in chronic illness patients. Studies have shown positive effects of MI on behavior change in a range of behaviors and populations. A step-by-step guide to MI outlines typical intervention content, target populations and behaviors, practitioner training and skills required, and evaluation of fidelity and effectiveness.
Constitutional law is a sprawling subject, encompassing many topics of legal–philosophical interest. This chapter addresses several of the most fundamental and widely discussed issues, organised into three clusters. First, what is constitutional law and what are its necessary or central features or functions? Second, what is the proper role for the judiciary in enforcing constitutional law? Third, how should constitutions be interpreted? Under these headings, the chapter examines, among other things: the puzzle of ‘unwritten’ constitutions, differences between constitutional ‘conventions’ and constitutional law, and the relationship between theories of constitutional interpretation and general jurisprudential accounts of the nature or contents of law. Most issues that especially concern constitutional rights lie beyond the scope of this chapter.
Impairments in social cognition contribute significantly to disability in schizophrenia patients (SzP). Perception of facial expressions is critical for social cognition. Intact perception requires an individual to visually scan a complex dynamic social scene for transiently moving facial expressions that may be relevant for understanding the scene. The relationship of visual scanning for these facial expressions and social cognition remains unknown.
In 39 SzP and 27 healthy controls (HC), we used eye-tracking to examine the relationship between performance on The Awareness of Social Inference Test (TASIT), which tests social cognition using naturalistic video clips of social situations, and visual scanning, measuring each individual's relative to the mean of HC. We then examined the relationship of visual scanning to the specific visual features (motion, contrast, luminance, faces) within the video clips.
TASIT performance was significantly impaired in SzP for trials involving sarcasm (p < 10−5). Visual scanning was significantly more variable in SzP than HC (p < 10−6), and predicted TASIT performance in HC (p = 0.02) but not SzP (p = 0.91), differing significantly between groups (p = 0.04). During the visual scanning, SzP were less likely to be viewing faces (p = 0.0001) and less likely to saccade to facial motion in peripheral vision (p = 0.008).
SzP show highly significant deficits in the use of visual scanning of naturalistic social scenes to inform social cognition. Alterations in visual scanning patterns may originate from impaired processing of facial motion within peripheral vision. Overall, these results highlight the utility of naturalistic stimuli in the study of social cognition deficits in schizophrenia.
Substance abuse frequently occurs in schizophrenia and has a poor prognosis. In 85 patients with schizophrenia from a long-term psychiatric hospital we previously examined the clinical impact of substance abuse and found that 48% of patients had comorbid substance use disorders and that they responded less to treatment. Naltrexone has been used in patients without schizophrenia for the treatment of substance use disorder. Consequently, we conducted a double-blind controlled study of adjunctive treatment with naltrexone or placebo in patients with schizophrenia with co-morbid substance use disorders to determine whether naltrexone would improve outcome.
Thirty-seven patients entered the study and were randomized to placebo vs. naltrexone 50mg/day. The monthly assessments included the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Global Assessment Scale (GAF), and the Quality of Life Scale (QLS). We used an analysis of variance of the change scores between final visit and baseline with the last visit carried over.
All patients improved in PANSS and QLS but those on naltrexone improved less with a statistically significant group difference between the PANSS total (F=6.5, p≤0.03) and general symptom change scores (F=4.2, p≤0.04) when weighted for the Michigan Alcohol Screening (MAS).
Both groups of patients improved in this controlled setting where patients refrained from substance abuse; those on naltrexone improved less, however. As patients with schizophrenia have pervasive neuroreceptor deficits, it is possible that they have deficits in the opioid system suggesting that the addition of the opioid-blocker naltrexone may be counterproductive.
Substance abuse is clearly associated with criminal recidivism among offenders with and without mental disorder. Treatment for substance abuse correlates with lower rates of re-offending among participants in outpatient-based as well as institution-based substance abuse treatment programs. However, for offenders with mental disorder, research on the possible preventive effect of substance abuse treatment on criminal recidivism is sparse. This paper reports from on an ongoing naturalistic and prospective interview study on the relationship between post-release outpatient substance abuse treatment and re-offending.
The Stockholm county sample comprises 246 offenders of both genders subjected to a forensic psychiatric assessment, who screened positive for substance abuse problems. Eighty-five percent (n=210) agreed to participate in the study. Baseline data and follow-up interview data, collected immediately on release from incarceration (prison/forensic hospital) and 6 and 12 months later, include self-reported substance abuse, treatment involvement and criminality. By February 2010, data will be available from the first follow-up for 150 participants, from the second follow-up for 80 individuals and from the third follow-up for 10 subjects.
Results and conclusions
The focus of the presentation will be recidivism comparisons between substance abuse treatment utilizers and those who decline treatment. Data on ongoing levels of substance abuse, mental health problems and offending will serve as dependent variables. Additional analyses will present perceived benefit from and reasons for accepting or rejecting treatment.
Substance abuse is associated with criminal recidivism. Substance abuse treatment has been found to correlate negatively with re-offending among treatment utilizers. However, for offenders with mental health problems and substance abuse, research on how substance abuse treatment affects re-offending is sparse.
The study aimed to examine the relationship between self-reported outpatient-based substance abuse treatment and self-reported a) re-offending, b) substance use and c) psychiatric problems among offenders with mental health and substance use problems.
Data were gathered from a naturalistic follow-up study with 208 participants, subjected to a court-ordered psychiatric assessment. This analysis covers 91 individuals who were followed-up after an average study period of 17 months. Among these, 68% had been sentenced to institutional imprisonment or forensic psychiatric care.
Offences, substance use and psychiatric problems declined between baseline and follow-up. However, the reduction was not associated with self-reported treatment utilization. Among participants who were sentenced to non-institutional corrections, more individuals had utilized outpatient-based treatment compared to individuals who were sentenced to imprisonment or forensic psychiatric care.
A definitive conclusion about the effect of treatment is difficult to draw. For instance, self-reported data may not reflect actual treatment consumption. However, one interpretation is that participants naturally recovered over time. Institutional correction might also have resulted in positive outcomes equivalent to outpatient-based treatment.
Assessing impact of treatment from the patient perspective provides additional information about treatment efficacy in major depressive disorder (MDD) trials.
Pooled data from three identically designed clinical trials showed aripiprazole adjunctive to antidepressant therapy (ADT) was effective in treating MDD.1
Patients who completed an 8-week prospective ADT phase with inadequate response were randomized double-blind to 6-weeks adjunctive treatment with aripiprazole or placebo. The Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF) is a 16-item, self-report measure to evaluate daily functioning, with higher scores indicating better satisfaction. Comparisons of mean change from baseline (Week 8) to Week 14 in Q-LES-Q-SF items and general subscores were performed using ANCOVA (LOCF).
There was significant improvement in the Q-LES-Q-SF Overall-General subscore (total of items 1-14 expressed as a percentage of the maximum possible score) in the aripiprazole-treatment group (9.49% [n=507]) vs placebo (5.71% [n=492] p< 0.001). Placebo was significantly higher than aripiprazole in Physical Ability (placebo 0.13 vs aripiprazole 0.02, p=0.020). Aripiprazole was significantly higher than placebo in all other items except Physical Health and Vision. Aripiprazole also produced significant increases in both the Satisfaction with Medication (Item 15) (aripiprazole 0.36 vs placebo 0.20, p< 0.01) and Overall Satisfaction (Item 16) (aripiprazole 0.61 vs placebo 0.35, p< 0.001) scores.
Results emphasize that assessment of patient functioning and quality of life may have utility both in clinical trials and clinical practice.2
The safety and tolerability of aripiprazole as adjunctive treatment was examined in patients with major depressive disorder (MDD) without psychotic features who had a major depressive episode and who did not respond adequately to standard antidepressant therapy (ADT).
Data from three identical short-term, double-blind, placebo-controlled studies (CN138139, CN138163, CN138165) were pooled. After a prospective phase with placebo plus ADT, patients without adequate response entered a 6-week, double-blind phase with placebo or aripiprazole plus ADT. Safety endpoints included death, serious adverse events (SAEs), treatment-emergent adverse events (AEs), Simpson-Angus Scale (SAS), Barnes Akathisia Global Clinical Assessment, Abnormal Involuntary Movement Scale (AIMS), clinical laboratory tests, vital signs and electrocardiograms.
In total, 538 patients were randomized to adjunctive placebo and 547 to adjunctive aripiprazole. AEs with an incidence ≥5% and at least twice the rate of placebo were akathisia (adjunctive aripiprazole, 22.7%; adjunctive placebo, 4.1%), restlessness (12.4% vs 2.2%), fatigue (8.6% vs 4.3%), insomnia (8.2% vs 3.2%), vision blurred (6.2% vs 1.5%), somnolence (5.9% vs 2.6%), and constipation (4.9% vs 2.4%). AEs that had a treatment difference of ≥2% included akathisia, somnolence, sedation, dizziness, disturbance in attention, extrapyramidal disorder, restlessness, insomnia, constipation, dyspepsia, fatigue, feeling jittery, vision blurred, weight increased, and dyspnea. SAEs occurred in 0.7% of patients in each treatment group. There were no deaths during the studies.
In this pooled analysis of patients with MDD and an inadequate response to ADT, adjunctive aripiprazole showed consistently high study completion rates and low discontinuation rates resulting from adverse events.
To conduct a subgroup analysis of the efficacy of adjunctive aripiprazole as treatment in patients with major depressive disorder (MDD) who demonstrated an inadequate response to standard antidepressant therapy (ADT).
Data were pooled from three identical, short-term, double-blind, placebo-controlled studies (CN138-139, CN138-163, CN138-165) with an 8-week phase of placebo plus ADT and a 6-week double-blind phase with ADT plus adjunctive placebo or aripiprazole. Only MDD patients without psychotic features were eligible for entry. The primary efficacy endpoint was the mean change in the Montgomery Asberg Depression Rating Scale (MADRS) total score in the double-blind phase. Subgroup analyses of the primary efficacy endpoint were performed for age, race, ethnicity, MADRS response, number and choice of previous ADTs, episode duration, and use of selective serotonin re-uptake inhibitors (SSRI).
Compared with the adjunctive placebo group, adjunctive aripiprazole was associated with greater reductions in MADRS total score in all subgroups. Mean change in MADRS total score ranged from -10.71 to -5.89 with adjunctive aripiprazole and -7.57 to -4.10 with adjunctive placebo. No statistically significant treatment-by-subgroup interaction effects were observed for any subgroup except gender (p=0.039). This difference is, however, primarily because of results from study CN138-139 results; consistent results between men and women were reported in CN138-163 and CN138-165.
Pooled data indicate that in patient populations with similar baseline characteristics, treatment with adjunctive aripiprazole and ADT is efficacious in improving the symptoms of MDD in subgroups of patients having an inadequate response to ADT.
To evaluate the safety of aripiprazole as adjunctive treatment in major depressive disorder (MDD) without psychotic features within different patient subgroups.
Data were pooled from three multicentre, randomized, double-blind, placebo-controlled studies (CN138-139, CN138-163 and CN138-165). Patients who did not respond adequately to an 8-week course of standard ADT were randomized to receive adjunctive aripiprazole or placebo for a further 6 weeks. To assess differences in the adverse events (AE) profile of aripiprazole for demographic subgroups, the incidence of AEs was presented for the pooled placebo-controlled MDD studies by gender, age, and race. An odds ratio (OR) estimate was calculated and the ORs compared across all categories using the Breslow-Day test for AEs with incidence ≥5% in the pooled aripiprazole group.
In total, 14.3% of aripiprazole-treated patients and 12.5% of placebo-treated patients discontinued treatment. Treatment-emergent AEs were reported by 65.4% and 82.3% in the adjunctive placebo and adjunctive aripiprazole groups, respectively. Most aripiprazole-related AEs were, however, mild to moderate in severity. With the exception of blurred vision, which occurred in white patients only (p=0.002), there were no significant differences in the incidence of treatment-emergent AEs across different age groups, racial groups or between the genders in the aripiprazole- and placebo-treated groups.
Adjunctive aripiprazole was generally well tolerated and most treatment-emergent AEs were of mild to moderate severity. The AEs profile of adjunctive aripiprazole did not show significant variation in relation to age, gender or race, compared with that of placebo.
To evaluate the efficacy of aripiprazole adjunctive antidepressant therapy (ADT) with regard to functioning in patients with major depressive disorder (MDD) who did not achieve an adequate response with standard ADT.
Pooled data were analyzed from three nearly identically designed randomized, double-blind, placebo-controlled trials: CN138-139, CN138-163 and CN138-165. These included patients with MDD, without psychotic features, who had failed at least one ADT treatment in the present episode. Patients completing an 8-week prospective ADT phase with inadequate response were randomized to 6-weeks’ treatment with adjunctive aripiprazole (n=508) or placebo (n=494). Functioning was assessed using the Sheehan Disability Scale (SDS). Comparisons of mean change from baseline in total SDS score, and domains of family life, social life and work/school were performed using ANCOVA.
Adjunctive aripiprazole produced significant improvements in total SDS (-1.2 on an adjusted scale of 1-10, with 10=worst level of functioning/1=best) vs adjunctive placebo (-0.7, p< 0.001). Adjunctive aripiprazole produced significant changes in the family life domain (-1.4 for adjunctive aripiprazole vs -0.7 for adjunctive placebo, p< 0.001) and the social life domain (-1.4 for adjunctive aripiprazole vs -0.7 for adjunctive placebo, p< 0.001). No difference between groups was observed on the work/school domain (-0.8 for adjunctive aripiprazole and -0.6 for adjunctive placebo, p=0.34).
Adjunctive aripiprazole showed significant improvements in overall SDS scores, and family and social life domains. Less change was observed in the work/school domain. The results emphasize that assessment of patient functioning may have utility both in clinical trials and clinical practice.