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The Bell Jar (1963) is a semi-autobiographical novel written by the confessional poet, novelist and short-story writer Sylvia Plath (1932–1963). It has been often cited as a recommended reading within the medical humanities, because of its powerful description of depression and the understanding-by-experience of the related psychiatric treatments. This brief article, primarily directed at the clinically oriented reader, presents a selection of excerpts from The Bell Jar to illustrate the main diagnostic features of clinical depression and the vital role of therapeutic relationship quality in hindering or facilitating treatment outcomes and recovery.
Research on serious mental disorders, particularly psychosis, has revealed highly variable symptom profiles and developmental trajectories prior to illness-onset. As Dante Cicchetti pointed out decades before the term “transdiagnostic” was widely used, the pathways to psychopathology emerge in a system involving equifinality and multifinality. Like most other psychological disorders, psychosis is associated with multiple domains of risk factors, both genetic and environmental, and there are many transdiagnostic developmental pathways that can lead to psychotic syndromes. In this article, we discuss our current understanding of heterogeneity in the etiology of psychosis and its implications for approaches to conceptualizing etiology and research. We highlight the need for examining risk factors at multiple levels and to increase the emphasis on transdiagnostic developmental trajectories as a key variable associated with etiologic subtypes. This will be increasingly feasible now that large, longitudinal datasets are becoming available and researchers have access to more sophisticated analytic tools, such as machine learning, which can identify more homogenous subtypes with the ultimate goal of enhancing options for treatment and preventive intervention.
Le présent article se propose de concevoir l’influence de la notion de légitimité au-delà du rôle lui étant communément attribué en droit international humanitaire (DIH), en s’intéressant particulièrement à la relation entre ce dernier et les causes de la guerre, la nature des acteurs impliqués dans les conflits armés ainsi que les motivations des parties. En remettant notamment en question de l’idée d’une stricte séparation entre jus in bello et jus ad bellum, il est soutenu que les tentatives visant à isoler le DIH de ces questions de légitimité sont à la fois vaines, mais également à rebours de l’évolution et des logiques du régime. Il est en revanche défendu que la notion de légitimité en DIH se manifeste à travers deux modes de légitimation — l’un dérivant du statut, l’autre de la cause — à partir desquels la distribution de droits, devoirs, immunités, privilèges ou encore statuts s’opère et se voit justifiée au sein du régime. Ce faisant, de nombreux discours empruntant au second registre, souvent qualifiés d’aberrations du point de vue du DIH, ou dont la nature juridique est contestée, s’avèrent finalement être des arguments juridiques parfaitement valides et ancrés dans l’évolution et les logiques du DIH.
To evaluate the economic costs of reducing the University of Virginia Hospital’s present “3-negative” policy, which continues methicillin-resistant Staphylococcus aureus (MRSA) contact precautions until patients receive 3 consecutive negative test results, to either 2 or 1 negative.
Design:
Cost-effective analysis.
Settings:
The University of Virginia Hospital.
Patients:
The study included data from 41,216 patients from 2015 to 2019.
Methods:
We developed a model for MRSA transmission in the University of Virginia Hospital, accounting for both environmental contamination and interactions between patients and providers, which were derived from electronic health record (EHR) data. The model was fit to MRSA incidence over the study period under the current 3-negative clearance policy. A counterfactual simulation was used to estimate outcomes and costs for 2- and 1-negative policies compared with the current 3-negative policy.
Results:
Our findings suggest that 2-negative and 1-negative policies would have led to 6 (95% CI, −30 to 44; P < .001) and 17 (95% CI, −23 to 59; −10.1% to 25.8%; P < .001) more MRSA cases, respectively, at the hospital over the study period. Overall, the 1-negative policy has statistically significantly lower costs ($628,452; 95% CI, $513,592–$752,148) annually (P < .001) in US dollars, inflation-adjusted for 2023) than the 2-negative policy ($687,946; 95% CI, $562,522–$812,662) and 3-negative ($702,823; 95% CI, $577,277–$846,605).
Conclusions:
A single negative MRSA nares PCR test may provide sufficient evidence to discontinue MRSA contact precautions, and it may be the most cost-effective option.
The increasing integration of digital technologies in business processes calls for a deeper understanding of their impact on business model efficiency. This study explores how digital alignment, composed by strategic decision support and operational support, affects business model efficiency, while also examining the extent to which strategic flexibility moderates this relationship. To test the proposed hypotheses, we adopt a quantitative approach on a sample of Italian small and medium-sized enterprises in the manufacturing industry. In particular, a regression analysis, complemented by a necessary condition analysis, is performed. We find that digital alignment, both in terms of strategic decision support and operational support, fosters business model efficiency. Strategic flexibility strengthens the relationship between strategic decision support and business model efficiency. To the best of our knowledge, this study is the first to operationalise digital alignment as composed of strategic decision support and operational support. Accordingly, this study contributes to the extant literature on digital alignment and business models.
This article focuses on Watchlist, a new play written by Alex Vickery-Howe, placing it in a context of contemporary Australian political writing for the stage which sees playwrights, such as Stephen Sewell and Suzie Miller, adopt an international outlook in order to tell stories of activism. By creating nuanced characters and engaging with the popular, these playwrights are inspiring activism in their audiences in engaging and challenging ways, arguing that what is deemed off-limits should not be left off-stage.
In this work we prove that every shift of finite type (SFT), sofic shift, and strongly irreducible shift on locally finite groups has strong dynamical properties. These properties include that every sofic shift is an SFT, every SFT is strongly irreducible, every strongly irreducible shift is an SFT, every SFT is entropy minimal, and every SFT has a unique measure of maximal entropy, among others. In addition, we show that if every SFT on a group is strongly irreducible, or if every sofic shift is an SFT, then the group must be locally finite, and this extends to all of the properties we explore. These results are collected in two main theorems which characterize the local finiteness of groups by purely dynamical properties. In pursuit of these results, we present a formal construction of free extension shifts on a group G, which takes a shift on a subgroup H of G, and naturally extends it to a shift on all of G.
The Soviet campaign in support of the Democratic Republic of Vietnam in the Vietnam War saturated Soviet public culture in the late 1960s and early 1970s. It was the longest solidarity action in Soviet history and the first to reach mass television audiences. This article examines the production and reception of a televised documentary film about the Vietnam War made by Konstantin Simonov – a celebrity writer who played a crucial role in Soviet culture during World War II, and then, in the post-war period, in the struggle to come to terms with terrible truths about Stalinism and the chaos and trauma that war had rendered. Simonov's film presented the Vietnam War in lyrical rather than analytical terms, calling upon viewers to draw connections between the suffering of the Vietnamese and the Soviet wartime experience and to enact their solidarity with the Vietnamese in terms of feeling. The film proposes a solidarity of pain and an understanding of war and wartime suffering as elemental and overwhelming. In dozens of letters to Simonov, we find an understanding and appreciation of this vision, which decentres Vietnam and instead sends viewers on a journey back to Soviet history and trauma.
The growing literature on Covid-19 and theatre has demonstrated how the pandemic has intensified gendered precarities in theatrical labour.1 However, the pandemic has also provided feminist theatre makers with unexpected or unlikely resources, albeit with limitations. The Istanbul Municipal Theatre's (İstanbul Büyükşehir Belediyesi Şehir Tiyatroları or İBBŞT) production of Melek that premiered in 2020 is an indicative example of such rare and largely invisible cases of pandemic theatre. Critically engaging with the archives and repertoires of tuberculosis (TB) melodrama and the Turkish lives of the genre, Melek conducts an experiential mapping of the performativity of death and the porous borders between everyday performance and artistic performance. The production offered independent feminist theatre practitioners, who otherwise maintain a precarious existence in Turkey's theatre world, access to new spaces, resources and audiences. Combining archival with ethnographic research, I will demonstrate how, in the case of Melek, the intersections between actual and fictive viral contagion – what I define as viral interstitiality – constitute inclusive economies amidst the Covid-19 pandemic. In somatics, the interstitial is theorized and enacted as suspensions of static schisms that shape relational empowerment.2 Drawing upon this grasp of the interstitial as connective thresholds, viral interstitiality sheds light on the practices and the economies of care that emerge from the porous dynamism between the viral and the theatrical.
To safeguard peace in multi-ethnic countries, scholars and practitioners recommend territorial autonomy. However, there is limited cross-national research on how autonomy affects subnational ethnic conflict, and increasing concern that it redirects ethnic violence from the national to the subnational level. Addressing this gap, I argue that autonomy generates tensions over subnational government control and the distribution of local economic goods. However, whether these turn violent depends on ethnic representation in the central government. If groups are unequally represented, violent escalation is more likely due to information and commitment problems and subnational majoritarianism. To test these arguments, I provide new time-variant data on subnational boundaries, territorial autonomy, and ethnically attributed violence. I conduct a systematic analysis of all multi-ethnic countries between 1989 and 2019, instrumental variable analyses, and tests of my argument’s intermediate implications. My findings underline the importance of complementing autonomy with inclusive central governments to attenuate the risks of subnational violence.
The history of Soviet “rights defenders” is seemingly well known. Emerging in the 1960s in response to fears of a creeping re-Stalinization, the rights movement was part of the broader dissident milieu that coalesced in the Khrushchev and Brezhnev eras. Drawing on new documents from the Ukrainian KGB, this article broadens the canon of what we consider “Soviet rights talk” by focusing on a group completely ignored in the existing history of Soviet rights defenders: African students. As the article demonstrates, Soviet citizens were not the only people to draw on a discursive repertoire of civil and universal rights to articulate their demands against the Soviet state. By closely examining the letters and petitions activists produced, it becomes clear that African students’ language of rights grew alongside and, in many respects, pre-empted the Soviet rights movement. The article concludes by considering why, despite sharing the same discursive and physical spaces, neither African nor Soviet rights defenders succeeded in building bridges between their respective islands of protest. Examining this failure to build meaningful solidarities demonstrates the value of pursuing the social history of internationalism; it is only in the banality of the everyday that the capacity for Soviet internationalism to create unanticipated frictions and conflicts reveals itself.
Low self-esteem is an important factor associated with body dysmorphic concerns. In treatment, self-esteem cannot always be adequately addressed. Internet-based interventions offer a low-threshold and cost-efficient possibility for treating body dysmorphic disorder (BDD).
Aims:
For this reason, we conducted two studies to explore the effectiveness of an internet-based intervention targeting improving self-esteem in adults with BDD symptoms.
Method:
The first study investigated the differential effects of a 1-week self-esteem training compared with a 1-week attention-focus training. Two hundred twenty adults with elevated body dysmorphic symptoms were randomly assigned to one of the two trainings. Our second study (n = 58 adults with body dysmorphic symptoms) evaluated an extended 2-week stand-alone self-esteem training.
Results:
In the first study, self-esteem in different domains (appearance, performance and social), self-focused attention, and BDD symptom severity improved in both groups. Other-focused attention only increased in the attention training group. Participants’ overall adherence was high. In the second study we observed significant improvements in self-esteem, BDD symptom severity, and other secondary outcomes, with additional improvements in most outcomes in the second week. Adherence was again high.
Conclusions:
Together, these findings show that a brief internet-based intervention may be a highly accepted and effective way of improving self-esteem in people suffering from BDD symptoms.
The development of L2 utterance fluency has been extensively researched, whereas that of cognitive fluency has rarely been examined. This study investigated the longitudinal development of L2 utterance and cognitive fluency and their relationship. Thirty-one Chinese learners of English completed speaking tasks and a set of tasks for cognitive fluency before and after 5 months’ study abroad. The results showed that participants made a significant improvement in mean syllable duration, end-clause pause frequency, and the speed of syntactic encoding and articulation but not in mid-clause pause frequency or lexical retrieval speed. Mixed-effects modeling confirmed a significant relationship between syntactic encoding speed and mean syllable duration and mid-clause pausing. Furthermore, the significant relationships were maintained over time. The findings highlight (a) the differences between mid-clause and end-clause pausing in terms of their developmental patterns and relationship with cognitive fluency and (b) a significant role of syntactic encoding speed in L2 utterance fluency.
Tissues form from collections of cells that interact together mechanically via cell-to-cell adhesion, mediated by transmembrane cell adhesion molecules. Under a sufficiently large amount of induced stress, these tissues can undergo elastic deformation in the direction of tension, where they then elongate without any topological changes, and experience plastic deformation within the tissue. In this work, we present a novel mathematical model describing the deformation of cells, where tissues are elongated in a controlled manner. In doing so, the cells are able to undergo remodelling through elastic and then plastic deformation, in accordance with experimental observation. Our model describes bistable sizes of a cell that actively deform under stress to elongate the cell. In the absence of remodelling, the model reduces to the standard linear interaction model. In the presence of instant remodelling, we provide a bifurcation analysis to describe the existence of the bistable cell sizes. In the case of general remodelling, we show numerically that cells within a tissue may populate both the initial and elongated cell sizes, following a sufficiently large degree of stress.
The politics of our post-Covid times are expressed through various registers. In Kolkata, one especially powerful artistic medium for such expressions was the revival of street theatre as young and senior theatre practitioners plunged into exploring critical issues that have been all-pervasive since the beginning of the pandemic. As people finally started to venture out, content to be amidst human congregations, street plays, being located in open-air spaces, proved both economical and safe. The issues these street performances highlighted and their modes of presentations could be described as what Tony Fisher calls ‘activist theatre’ – which mobilizes the people by interpellating its audience around a specific grievance or issue that possesses an emotional appeal.1 These performances are a form of artistic activism, or ‘artivism’ as termed by Chantal Mouffe: the use of aesthetic means for political activism, ‘as a counter-hegemonic move against the capitalist appropriation of aesthetics’.2