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Oral histories from 9/11 responders to the World Trade Center (WTC) attacks provide rich narratives about distress and resilience. Artificial Intelligence (AI) models promise to detect psychopathology in natural language, but they have been evaluated primarily in non-clinical settings using social media. This study sought to test the ability of AI-based language assessments to predict PTSD symptom trajectories among responders.
Participants were 124 responders whose health was monitored at the Stony Brook WTC Health and Wellness Program who completed oral history interviews about their initial WTC experiences. PTSD symptom severity was measured longitudinally using the PTSD Checklist (PCL) for up to 7 years post-interview. AI-based indicators were computed for depression, anxiety, neuroticism, and extraversion along with dictionary-based measures of linguistic and interpersonal style. Linear regression and multilevel models estimated associations of AI indicators with concurrent and subsequent PTSD symptom severity (significance adjusted by false discovery rate).
Cross-sectionally, greater depressive language (β = 0.32; p = 0.049) and first-person singular usage (β = 0.31; p = 0.049) were associated with increased symptom severity. Longitudinally, anxious language predicted future worsening in PCL scores (β = 0.30; p = 0.049), whereas first-person plural usage (β = −0.36; p = 0.014) and longer words usage (β = −0.35; p = 0.014) predicted improvement.
This is the first study to demonstrate the value of AI in understanding PTSD in a vulnerable population. Future studies should extend this application to other trauma exposures and to other demographic groups, especially under-represented minorities.
We use three-dimensional (3-D) fully kinetic particle-in-cell simulations to study the occurrence of magnetic reconnection in a simulation of decaying turbulence created by anisotropic counter-propagating low-frequency Alfvén waves consistent with critical-balance theory. We observe the formation of small-scale current-density structures such as current filaments and current sheets as well as the formation of magnetic flux ropes as part of the turbulent cascade. The large magnetic structures present in the simulation domain retain the initial anisotropy while the small-scale structures produced by the turbulent cascade are less anisotropic. To quantify the occurrence of reconnection in our simulation domain, we develop a new set of indicators based on intensity thresholds to identify reconnection events in which both ions and electrons are heated and accelerated in 3-D particle-in-cell simulations. According to the application of these indicators, we identify the occurrence of reconnection events in the simulation domain and analyse one of these events in detail. The event is related to the reconnection of two flux ropes, and the associated ion and electron exhausts exhibit a complex 3-D structure. We study the profiles of plasma and magnetic-field fluctuations recorded along artificial-spacecraft trajectories passing near and through the reconnection region. Our results suggest the presence of particle heating and acceleration related to small-scale reconnection events within magnetic flux ropes produced by the anisotropic Alfvénic turbulent cascade in the solar wind. These events are related to current structures of the order of a few ion inertial lengths in size.
Linoleic acid (LA), an essential n-6 fatty acid (FA), is critical for fetal development. We investigated the effects of maternal high LA (HLA) diet on offspring cardiac development and its relationship to circulating FA and cardiovascular function in adolescent offspring, and the ability of the postnatal diet to reverse any adverse effects. Female Wistar Kyoto rats were fed low LA (LLA; 1·44 % energy from LA) or high LA (HLA; 6·21 % energy from LA) diets for 10 weeks before pregnancy and during gestation/lactation. Offspring, weaned at postnatal day 25, were fed LLA or HLA diets and euthanised at postnatal day 40 (n 6–8). Maternal HLA diet decreased circulating total cholesterol and HDL-cholesterol in females and decreased total plasma n-3 FA in males, while maternal and postnatal HLA diets decreased total plasma n-3 FA in females. α-Linolenic acid (ALA) and EPA were decreased by postnatal but not maternal HLA diets in both sexes. Maternal and postnatal HLA diets increased total plasma n-6 and LA, and a maternal HLA diet increased circulating leptin, in both male and female offspring. Maternal HLA decreased slopes of systolic and diastolic pressure–volume relationship (PVR), and increased cardiac Col1a1, Col3a1, Atp2a1 and Notch1 in males. Maternal and postnatal HLA diets left-shifted the diastolic PVR in female offspring. Coronary reactivity was altered in females, with differential effects on flow repayment after occlusion. Thus, maternal HLA diets impact lipids, FA and cardiac function in offspring, with postnatal diet modifying FA and cardiac function in the female offspring.
Despite enormous strides in our field with respect to patient care, there has been surprisingly limited dialogue on how to train and educate the next generation of congenital cardiologists. This paper reviews the current status of training and evolving developments in medical education pertinent to congenital cardiology. The adoption of competency-based medical education has been lauded as a robust framework for contemporary medical education over the last two decades. However, inconsistencies in frameworks across different jurisdictions remain, and bridging gaps between competency frameworks and clinical practice has proved challenging. Entrustable professional activities have been proposed as a solution, but integration of such activities into busy clinical cardiology practices will present its own challenges. Consequently, this pivot towards a more structured approach to medical education necessitates the widespread availability of appropriately trained medical educationalists, a development that will better inform curriculum development, instructional design, and assessment. Differentiation between superficial and deep learning, the vital role of rich formative feedback and coaching, should guide our trainees to become self-regulated learners, capable of critical reasoning yet retaining an awareness of uncertainty and ambiguity. Furthermore, disruptive innovations such as “technology enhanced learning” may be leveraged to improve education, especially for trainees from low- and middle-income countries. Each of these initiatives will require resources, widespread advocacy and raised awareness, and publication of supporting data, and so it is especially gratifying that Cardiology in the Young has fostered a progressive approach, agreeing to publish one or two articles in each journal issue in this domain.
Chapter 3 theorizes border settlement as a bargaining process. Information and commitment problems as the most common obstacles to concluding border delimitation negotiations. Information exchange is facilitated by numerous mechanisms; commitment problems are driven by the value of the territory. Two broad categories of border territory are identified. Territory that contains a power endowment, defined as characteristics of the border capable of affecting state power, and territory that does not. The presence of these power endowments may trigger a commitment problem, making border settlement less likely. We identify alternative explanations for failed border settlement based on information problems. We also integrate expectations from theories of conflict management, with a focus on bilateral negotiations, third party mediation and legal methods. Bilateral negotiations help surmount the challenge of incomplete information, but cannot easily allay the fears underlying commitment problems. Third parties help with either challenge but, when addressing commitment problems, legal methods are more effective than mediation.
Chapter 1 lays out our motivation, puzzle, and research questions. Borders are one of the defining institutions of international relations. Borders establish the sovereign domain of the territorial state, within which actors have the right to govern, tax, conscript, and exploit resources. Stable borders facilitate bilateral trade, tourism, and threat reduction, the latter of which allows states to spend a larger percentage of finite resources on domestic infrastructure and social programs rather than defense. Some neighbors, however, experience failed settlement, producing some of the most violent and enduring conflict between states in modern international relations history. Despite the importance of borders, we know little about what causes failed delineation; nor have we adequately explored the consequences of that failure. Our book addresses this puzzle by answering three interconnected questions. What factors increase and decrease the likelihood of successful delineation of territorial borders, what effect does failed settlement have on rivalry formation, and how do rivals eventually settle their disputed borders and terminate these enduring competition?
Chapter 5 presents a theory of borders and rivalry onset. When a border region contains attributes capable of affecting state power, a commitment problem is more likely to develop. The commitment problem undermines the settlement process by threatening the stability of any settlement agreement that might be signed, and therefore, encourages the involved states to eschew reaching an agreement in the first place, leaving borders unsettled and disputed. States then invest in foreign policy tools to compete over the insecure border, in the hopes of gaining a future bargaining advantage that will allow them to overcome the commitment problem and achieve a favorable and durable settlement. The competition produces a rivalry relationship between the states. We derive three hypotheses connecting unsettled borders, power endowments, and rivalry relations. In order to address alternative theoretical explanations, four additional hypotheses are presented relating rivalry initiation to regime type, power relations, alliances, and ethnic identify claims.
Chapter 4 evaluates the hypotheses introduced in Chapter 3. First, we provide descriptions of our variables and justifies a key sampling choice to focus only on contiguous dyads. Second, we implement our research design, presenting the evidence for evaluating the hypotheses. Patterns in the data suggest border settlement is less likely when power endowments are present in the border region, consistent with the expectations of the commitment problem framework. We find mixed support for the information problem hypotheses. Democratic neighbors are more likely than nondemocratic neighbors to settle their borders, allied states are more likely to settle borders than non-allied states, and power relations do not appear to affect settlement. When bargaining over territory that lacks power endowments, conflict management efforts foster border settlement. When power endowments are present, states are significantly less likely to settle their borders, and conflict management proves ineffective. The exception is legal methods, which generally increase the likelihood of settlement when power endowments are present.
In Chapter 9, the concluding chapter, we provide an overview of the main theoretical and empirical contributions. We then lay out what we see as a path forward for future research. This includes but is not limited to a need for additional research into the process by which borders settle. We offer insights into factors that influence the process but more research is needed about how that process unfolds. Second, one implication of this book is that there are multiple paths to rivalry, only one of which is explored here. The path to rivalry for those not competing over borders, or for non-neighbors, demands an alternative theory. Third, we uncover that some rivalries persist even after border settlement, even if their behavior toward each other changes. We do not yet know why these rivalries persist. Fourth, we find evidence consistent with the expectations that conflict management effectiveness vary based on the tools chosen and type of bargaining problem experienced. We discuss the implications of these findings for conflict management research, particularly as it relates to legalized dispute resolution mechanisms.
Chapter 2 introduces two concepts that form the core of the theoretical argument presented in the book: settled borders and commitment problems. The concept of border settlement can encompass either mutual agreement on or mutual satisfaction with (i.e., acceptance of) a territorial border division, and scholars sometimes slip between these two meanings. Our argument relies on a conceptualization of border settlement as the mutual agreement of a border’s delimitation under international law. We also argue that the lack of border settlement contributes to interstate rivalry via a commitment problem. We offer an innovation within the rivalry program by connecting rivalries to a theory of bargaining breakdown. In particular, we argue that many unsettled borders are the product of a commitment problem. Commitment problems are a negotiating obstacle often resolved through war. Yet we propose that states might manage commitment problems through interstate rivalries as well. The second part of the chapter therefore explains the origins of commitment problems and why initiating and maintaining a rivalry might be a valid method for managing certain subsets of them.
Chapter 6 evaluates the relationship between border settlement and the onset of interstate rivalry. We estimate a series of models based on existing rivalry research. These models provide a baseline comparison to our fully specified models, which include unsettled borders and power endowments. Several key findings emerge. Strong support is found for all the expectations derived from the commitment problem framework. Unsettled borders are associated with an increased likelihood of rivalry initiation. Power endowments feature disproportionately more often in contiguous dyad-years with unsettled borders relative to settled borders. Neighboring states are more likely to form rivalries when contesting territory with power endowments. Mixed and relatively weak evidence is found for alternative explanations. Democratic neighbors are less likely to form rivalries but the results are not consistent across models. States closer in power are more likely to form rivalries but again the results are inconsistent. No relationship is found between allied states and rivalry formation, and little evidence is found that disputed ethnic identify claims are related to rivalry initiation.