To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Several hypotheses may explain the association between substance use, posttraumatic stress disorder (PTSD), and depression. However, few studies have utilized a large multisite dataset to understand this complex relationship. Our study assessed the relationship between alcohol and cannabis use trajectories and PTSD and depression symptoms across 3 months in recently trauma-exposed civilians.
In total, 1618 (1037 female) participants provided self-report data on past 30-day alcohol and cannabis use and PTSD and depression symptoms during their emergency department (baseline) visit. We reassessed participant's substance use and clinical symptoms 2, 8, and 12 weeks posttrauma. Latent class mixture modeling determined alcohol and cannabis use trajectories in the sample. Changes in PTSD and depression symptoms were assessed across alcohol and cannabis use trajectories via a mixed-model repeated-measures analysis of variance.
Three trajectory classes (low, high, increasing use) provided the best model fit for alcohol and cannabis use. The low alcohol use class exhibited lower PTSD symptoms at baseline than the high use class; the low cannabis use class exhibited lower PTSD and depression symptoms at baseline than the high and increasing use classes; these symptoms greatly increased at week 8 and declined at week 12. Participants who already use alcohol and cannabis exhibited greater PTSD and depression symptoms at baseline that increased at week 8 with a decrease in symptoms at week 12.
Our findings suggest that alcohol and cannabis use trajectories are associated with the intensity of posttrauma psychopathology. These findings could potentially inform the timing of therapeutic strategies.
Posttraumatic stress symptoms (PTSS) are common following traumatic stress exposure (TSE). Identification of individuals with PTSS risk in the early aftermath of TSE is important to enable targeted administration of preventive interventions. In this study, we used baseline survey data from two prospective cohort studies to identify the most influential predictors of substantial PTSS.
Self-identifying black and white American women and men (n = 1546) presenting to one of 16 emergency departments (EDs) within 24 h of motor vehicle collision (MVC) TSE were enrolled. Individuals with substantial PTSS (⩾33, Impact of Events Scale – Revised) 6 months after MVC were identified via follow-up questionnaire. Sociodemographic, pain, general health, event, and psychological/cognitive characteristics were collected in the ED and used in prediction modeling. Ensemble learning methods and Monte Carlo cross-validation were used for feature selection and to determine prediction accuracy. External validation was performed on a hold-out sample (30% of total sample).
Twenty-five percent (n = 394) of individuals reported PTSS 6 months following MVC. Regularized linear regression was the top performing learning method. The top 30 factors together showed good reliability in predicting PTSS in the external sample (Area under the curve = 0.79 ± 0.002). Top predictors included acute pain severity, recovery expectations, socioeconomic status, self-reported race, and psychological symptoms.
These analyses add to a growing literature indicating that influential predictors of PTSS can be identified and risk for future PTSS estimated from characteristics easily available/assessable at the time of ED presentation following TSE.
This is the first report on the association between trauma exposure and depression from the Advancing Understanding of RecOvery afteR traumA(AURORA) multisite longitudinal study of adverse post-traumatic neuropsychiatric sequelae (APNS) among participants seeking emergency department (ED) treatment in the aftermath of a traumatic life experience.
We focus on participants presenting at EDs after a motor vehicle collision (MVC), which characterizes most AURORA participants, and examine associations of participant socio-demographics and MVC characteristics with 8-week depression as mediated through peritraumatic symptoms and 2-week depression.
Eight-week depression prevalence was relatively high (27.8%) and associated with several MVC characteristics (being passenger v. driver; injuries to other people). Peritraumatic distress was associated with 2-week but not 8-week depression. Most of these associations held when controlling for peritraumatic symptoms and, to a lesser degree, depressive symptoms at 2-weeks post-trauma.
These observations, coupled with substantial variation in the relative strength of the mediating pathways across predictors, raises the possibility of diverse and potentially complex underlying biological and psychological processes that remain to be elucidated in more in-depth analyses of the rich and evolving AURORA database to find new targets for intervention and new tools for risk-based stratification following trauma exposure.
Given the discrepancy between men and women’s equal rates of medical school matriculation and their rates of academic promotion and leadership role acquisition, the need to provide mentorship and education to women in academic medicine is becoming increasingly recognized. Numerous large-scale programs have been developed to provide support and resources for women’s enrichment and retention in academic medicine. Analyses of contributory factors to the aforementioned discrepancy commonly cite insufficient mentoring and role modeling as well as challenges with organizational navigation. Since residency training has been shown to be a critical juncture for making the decision to pursue an academic career, there is a need for innovative and tailored educational and mentorship programs targeting residents. Acknowledging residents’ competing demands, we designed a program to provide easily accessible mentorship and contact with role models for our trainees at the departmental and institutional levels. We believe that this is an important step towards encouraging women’s pursuit of academic careers. Our model may be useful to other emergency medicine residencies looking to provide such opportunities for their women residents.
Few residency curricular interventions have focused on improving well-being and promoting humanism. We describe the implementation of a novel curriculum based on small-group reflection rounds—the Emergency Medicine Reflection Rounds (EMRR)—at a 4-year US emergency medicine (EM) residency. During the inaugural year (2010–2011), nine residents volunteered to take part in 1-hour monthly sessions with faculty facilitators. Residents were provided with a confidential environment to discuss difficult ethical and interpersonal encounters from their clinical experiences. Ongoing feedback from participants was solicited, culminating with a four-question survey in which all respondents remarked that the EMRR contributed to improving their own well-being and agreed that it provided an important forum for residents to discuss difficult issues in a safe environment. In this article, we describe our innovation as an example of a wellness initiative that has promoted reflective practice and fostered cooperative learning around the communication, professional, and ethical challenges inherent in EM practice. Our EMRR model may be useful to other EM residences looking to supplement their wellness curriculum.
This is a summary of the presentations and discussion of Panel 2.15, Civil-Military Cooperation in Humanitarian Health Action of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to civil-military collaboration in humanitarian health actions as pertain to the responses to the damage created by the Tsunami. It is presented in the following sections: (1) how effective civil-military cooperation can help health responses, including; (a) needs assessment; (b) coordination; (c) filling gaps; and (d) capacity (2) what was done well, and what could have been done better better; and (3) conclusions and recommendations. Conclusions and recommendations included: (1) the best coordination mechanisms for civil-military cooperation; and (2) suggested additions and improvements.
We have continued to investigate ion-beam mixing in bilay-er targets irradiated by 2-MeV He+ microbeams at room temperature. Although we have previously reported a linear dependence of interface width on dose for Cu/Al targets 1, more extensive results have not supported this conclusion, within statistical uncertainty, it appears that the interface width in Cu/Al (1) is proportional to the square root of dose, at constant dose rate, (2) is larger in Al than in Cu, for the same dose, (3) is proportional to the 1/4 power of dose rate, and (4) is absent at liquid nitrogen temperature. Calculations of the expected interface growth rate from a radiation-enhanced diffusion model have provided order-of-magnitude agreement with observed rates. Additionally, intermixing of Cu and Al outside the damaged area may indicate significant transverse diffusion of vacancies.
A model for the kinetic growth of oxygen-related thermal donors in Czochralski silicon at about 450°C is presented. The model, which is based on the work of Suezawa and Sumino, derives forward reaction rates for the electrically active species by comparing analytic expressions for the early-time annealing kinetics with the infrared electronic absorption data. The analytic expressions, which are independent of the chemical structure of each species, result from three assumptions: (1) the donor defects beyond the first donor species (TD-1) are chemically stable at the donor formation temperature, (2) the reactions for the TD-1 and those electrically inactive clusters smaller than TD-1 are in equilibrium, and (3) the oxygen interstitial concentration remains constant for short annealing times. The parametrized values of the rate constants indicate that the forward rates of reaction vary widely between species, with a sharp peak at the reaction which takes the first electrically active species to the second. If the rate constants are taken to be of the form K = 4πRD, where R is the capture radius for the given forward reaction and D represents the effective diffusion coefficient, then the variation between reaction constants may be associated with differences in capture radii between species, with the diffusion coefficient assumed to be the value determined by Stavola et al. [Appl. Phys. Lett. 42, 73 (1983)] for “as-provided” material, which has an activation energy of 1.95 eV. The model is successfully applied to the two available sets of infrared absorption data (the Oeder-Wagner and Suezawa-Sumino data) when differences in the annealing temperatures and initial oxygen concentrations are taken into account. The best-fit parameters found by fitting the analytic expressions are then applied to a set of chemical reaction equations which characterize the formation rates of specific oxygen aggregates. The use of such a set of coupled, nonlinear differential equations, which must be solved numerically, introduces free parameters for the oxygen clusters smaller than the first thermal donor. It is shown that the assignments of a thermal donor core containing two, three, four, or five oxygen atoms are all capable of fitting the experimental data. This result indicates that a best fit to the kinetic data cannot be used to argue for a specific thermal donor core. Finally, the authors discuss possible mechanisms for the enhanced values of the capture radii.
The kinetics of thermal donor formation in Czochralski-silicon at ca. 450° C are explained by a simple model based on the work of Suezawa and Sumino which derives forward and reverse reaction rates for each electrically active species from the general features of the infrared electronic absorption spectra. The model, which is independent of the chemical nature of the thermal donor core, assumes that all thermal donors beyond the first donor species are chemically stable at the donor formation temperature, and approximates the reactions for species smaller than the first thermal donor as being in chemical equilibrium. The model is shown to be consistent with both sets of the available IR spectra of thermal donors (Oeder-Wagner and Suezawa-Sumino) when differences in the annealing temperature and initial oxygen concentration are taken into account.
Email your librarian or administrator to recommend adding this to your organisation's collection.