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We retrospectively evaluated the effectiveness of trauma-focused psychotherapy (TF-P) versus stabilization and waiting in a civilian cohort of patients with an 11th version of the international classification of disease (ICD-11) diagnosis of complex post-traumatic stress disorder (CPTSD).
We identified patients with CPTSD treated at a specialist trauma service over a 3-year period by triangulating evidence from self-report questionnaires, file review, and expert-clinician opinion. Patients completed a phase-based treatment: stabilization consisting of symptom management and establishing safety, followed by waiting for treatment (phase 1); individual TF-P in the form of trauma-focused cognitive behavioral therapy (TF-CBT), or eye movement desensitization and reprocessing (EMDR) or TF-CBT plus EMDR (phase 2). Our primary outcome was PTSD symptoms during phase 2 versus phase 1. Secondary outcomes included depressive symptoms, functional impairment, and a proxy CPTSD measure. Exploratory analysis compared outcomes between treatments. Adverse outcomes were recorded.
Fifty-nine patients were included. Compared to receiving only phase 1, patients completing TF-P showed statistically significant reductions in PTSD [t(58) = −3.99, p < 0.001], depressive symptoms [t(58) = −4.41, p < 0.001], functional impairment [t(58) = −2.26, p = 0.028], and proxy scores for CPTSD [t(58) = 4.69, p < 0.001]. There were no significant differences in outcomes between different treatments offered during phase 2. Baseline depressive symptoms were associated with higher PTSD symptoms and functional impairment.
This study suggests that TF-P effectively improves symptoms of CPTSD. However, prospective research with validated measurements is necessary to evaluate current and new treatments and identify personal markers of treatment effectiveness for CPTSD.
Intravenous fluids are solutions containing various quantities of water, electrolytes, salts, and sugar. They are used to maintain haemostasis when the enteral route is insufficient to meet physiological demand. Fluid therapy maintains hydration, oxygen delivery, and thus organ function. Poor perioperative fluid control is associated with impaired physiological function, resulting in patient harm and increasing healthcare costs. Perioperative fluid management is based upon three distinct but related factors: patient (age and comorbidities), surgical (urgency, indication and duration) and anaesthetic. This chapter is an introduction to intravenous fluids, highlighting the physiological control mechanisms, the composition of intravenous fluids, and important clinical assessment principles.
China’s rise is ushering in a new era of geostrategic contestation involving foreign aid. In many traditional OECD donors, aid policy is changing as a result. We report on a survey experiment studying the impacts of rising Chinese aid on public opinion in traditional donors. We randomly treated people with vignettes emphasising China’s rise as an aid donor in the Pacific, a region of substantial geostrategic competition. We used a large, nationally-representative sample of Australians (Australia is the largest donor to the Pacific). As expected, treating participants reduced hostility to aid and increased support for more aid focused on the Pacific. Counter to expectations, however, treatment reduced support for using aid to advance Australian interests. These findings were largely replicated in a separate experiment in New Zealand. Knowledge of Chinese competition changes support for aid, but it does not increase support for using aid as a tool of geostrategy.
In this study, we have examined ceramic matrix composites with silicon carbide fibers in a melt-infiltrated silicon carbide matrix (SiC/SiC). We subjected samples to tensile loads while collecting micro X-ray computed tomography images. The results showed the expected crack slowing mechanisms and lower resistance to crack propagation where the fibers ran parallel and perpendicular to the applied load respectively. Cracking was shown to initiate not only from the surface but also from silicon inclusions. Post heat-treated samples showed longer fiber pull-out than the pristine samples, which was incompatible with previously proposed mechanisms. Evidence for oxidation was identified and new mechanisms based on oxidation or an oxidation assisted boron nitride phase transformation was therefore proposed to explain the long pull-out. The role of oxidation emphasizes the necessity of applying oxidation resistant coatings on SiC/SiC.
To develop consensus recommendations for training future clinician educators (CEs) in emergency medicine (EM).
A panel of EM education leaders was assembled from across Canada and met regularly by teleconference over the course of 1 year. Recommendations for CE training were drafted based on the panel’s experience, a literature review, and a survey of current and past EM education leaders in Canada. Feedback was sought from attendees at the Canadian Association of Emergency Physicians (CAEP) annual academic symposium. Recommendations were distributed to the society’s Academic Section for further feedback and updated by a consensus of the expert panel.
Recommendations were categorized for one of three audiences: 1) Future CEs; 2) Academic departments and divisions (AD&D) that support training to fulfill their education leadership goals; and 3) The CAEP Academic Section. Advanced medical education training is recommended for any emergency physician or resident who pursues an education leadership role. Individuals should seek out mentorship in making decisions about career opportunities and training options. AD&D should regularly perform a needs assessment of their future CE needs and identify and encourage potential individuals who fulfill education leadership roles. AD&D should develop training opportunities at their institution, provide support to complete this training, and advocate for the recognition of education scholarship in their institutional promotions process. The CAEP Academic Section should support mentorship of future CEs on a national scale.
These recommendations serve as a framework for training and supporting the next generation of Canadian EM medical educators.
Leading-edge vortices (LEVs) can form and remain attached to a rotating wing indefinitely, but the mechanisms of stable attachment are not well understood. Taking for granted that such stable structures do form, a practical question arises: what is the trajectory of the LEV core? Noting that span-wise flow exists within the LEV core, it is apparent that a mean streamline aligned with the axis of the stable LEV must exist. The present work uses the Navier–Stokes equations along such a steady, axial streamline in order to consider the accelerations that act in the streamline-normal direction to affect its local curvature. With some simplifying assumptions, a coupled system of ordinary differential equations is derived that describes the trajectory of an axial streamline through the vortex core. The model is compared to previous work, and is found to predict the trajectory of the LEV core well at span-wise locations inboard of the midspan. This result suggests that Coriolis acceleration is responsible for limiting the span-wise extent of a stable LEV by tilting it into the wake within several chord lengths from the centre of rotation. The downwash due to the tip vortex also appears to play a role, as the only significant differences between model-predicted LEV trajectories and previous results are in the plate-normal direction.
Little is currently known about the presence and impact of personality
disorder in adolescents who self-harm.
To evaluate personality disorder in repeated self-harm in adolescence and
its impact on self-harm psychopathology and adaptation outcomes over 1
A clinical referral sample (n = 366) of adolescents
presenting with repeated self-harm aged 12–17 years, as part of a
randomised controlled trial (Assessment of Treatment in Suicidal
Teenagers study, ASSIST). Personality disorder was assessed using the
Structured Clinical Interview for DSM-IV Axis II (SCID-II). One-year
outcomes included frequency and severity of repeat self-harm,
self-reported suicidality, mood and functional impairment.
About 60% of the referred adolescents showed one or more forms of
personality disorder. Personality disorder was associated with
significantly greater severity of self-harm, overall psychopathology and
impairment. There was a complex association with treatment adherence.
Personality disorder predicted worse 1-year outcomes in relation to
self-harm frequency and severity, as well as impairment, suicidality and
Personality disorder can be reliably measured in adolescence and showed
high prevalence in this clinical self-harm sample. Controlling for other
variables, it showed a strong independent association with self-harm
severity at referral and predicted adherence to treatment and clinical
outcomes (independent of treatment) over 1 year. Consideration of
personality disorder diagnosis is indicated in the assessment and
management of adolescents who repeatedly self-harm.
Background: Low social rank and external shame have been found to be significantly associated with anxiety and depression. However, their relevance to experiences of psychosis has rarely been explored. Aims: This study aims to examine the relationship of social rank and external shame to personal recovery, depression and positive symptoms in psychosis. Method: A cross sectional correlational design was adopted to examine the relationship between all variables. Fifty-two service users, aged between 18 to 65 years, with experiences of psychosis were recruited for the study. Participants were administered outcome measures examining social rank, external shame, positive symptoms of psychosis, depression and personal recovery. Multiple regression analyses were conducted on the data. Results: Significant correlations were found between all variables. Low social rank was significantly associated with lower reported personal recovery, and higher levels of external shame and depression symptomology. The relationship between external shame and positive symptoms of psychosis and personal recovery was found to be mediated by participants’ level of depression. Conclusion: Findings suggest that social rank and external shame are relevant to those who experience psychosis. Therapeutic approaches may need to focus on perceptions of social rank and external shame in working with experiences of psychosis.
Modern experimental techniques, including LIF lifetime and FTS branching fraction measurements, have increased the reliability of atomic transition probabilities in the UV and visible. However, this combination is problematic in the increasingly important IR region, resulting in a significant gap between the capabilities to record new astronomical spectra and the data needed to sufficiently analyze them. To aid in closing this gap, we are incorporating alternative techniques to measure sets of Fe-group oscillator strengths in the near-IR.
The prevention, care, and rehabilitation of mental disorders are a growing public health problem globally. Addressing the increasing public health burden of mental disorders worldwide requires an understanding of the prevalence, associated disability, and treatment gap associated with these disorders. Community-based psychiatric epidemiological studies provide insights into the magnitude of the burden. Estimates of the prevalence of specific mental disorders in numerous countries globally have been established using either structured or semi-structured interview schedules linked to current diagnostic criteria that have improved the reliability and validity of psychiatric diagnoses. The World Mental Health (WMH) surveys and the International Consortium of Psychiatric Epidemiology are cross-national initiatives that have demonstrated that mental disorders are highly prevalent throughout the world. Neuropsychiatric conditions account for a disproportionate amount of burden of disease, although they result in few direct deaths.