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Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.
Methods
T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).
Results
PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).
Conclusions
PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.
National policy in England recommends that young people be admitted to mental health wards that are age-appropriate. Despite this, young people continue to be admitted to adult wards.
Aims
To explore the impact of young people’s admissions to adult wards, from the perspectives of young people, parents/carers and mental health professionals working in adult services.
Method
Semi-structured interviews were conducted with 29 participants to explore experiences of receiving and delivering care in adult mental health wards. Participants were four young people (aged 16–17 years), four parents/carers and 21 mental health professionals from adult mental health services in England. Data were analysed using framework analysis.
Results
Young people’s admissions to adult wards tend to occur out of hours, at a time of crisis and when no suitable adolescent bed is available. Admissions were conceptualised as a short-term safety measure rather than for any therapeutic input. Concerns were raised about safeguarding, limited treatment options and a lack of education provision for young people on adult wards. However, exceptionally, for older adolescents, an adult ward might be clinically or socially appropriate. Recommendations to reduce adult ward admissions included better integration of adolescent and adult services, having more flexible policies and increasing community provision.
Conclusions
Our findings emphasise the importance of young people being admitted to age-appropriate in-patient facilities. Earlier intervention and increased provision of specialist care in the community could prevent young people’s admissions to adult wards.
Increasing resources are devoted to osteoarthritis surgical care in Australia annually, with significant expenditure attributed to hip and knee arthroplasties. Safe, efficient, and sustainable models of care are required. This study aimed to determine the impact on healthcare costs of implementing an enhanced short-stay model of care (ESS-MOC) for arthroplasty at a national level.
Methods
Budget impact analysis was conducted for hospitals providing arthroplasty surgery over the years 2023 to 2030. Population-based sample projections obtained from clinical registry and administrative datasets of individuals receiving hip or knee arthroplasty for osteoarthritis were applied. The ESS-MOC assigned 30 percent of eligible patients to a shortened acute-ward-stay pathway and outpatient rehabilitation. The remaining 70 percent received a current practice pathway. The primary outcome was total healthcare cost savings post-implementation of the ESS-MOC, with return on investment (ROI) ratio and hospital bed-days utilized also estimated. Costs are presented in Australian dollars (AUD) and United States dollars (USD), at 2023 prices.
Results
Estimated hospital cost savings for the years 2023 to 2030 from implementing the ESS-MOC were AUD641 million (USD427 million) (95% CI: AUD99 million [USD66 million] to AUD1,250 million) [USD834 million]). This corresponds to a ROI ratio of 8.88 (1.3 to 17.9) dollars returned for each dollar invested in implementing the care model. For the period 2023 to 2030, an estimated 337,000 (261,000 to 412,000) acute surgical ward bed-days, and 721,000 (471,000 to 1,028,000) rehabilitation bed-days could be saved. Total implementation costs for the ESS-MOC were estimated at AUD72 million (USD46 million) over eight years.
Conclusions
Implementation of an ESS-MOC for eligible arthroplasty patients in Australia would generate significant cost and healthcare resource savings. This budget impact analysis demonstrates a best practice approach to comprehensively assessing value, at a national level, of implementing sustainable models of care in high-burden healthcare contexts. Findings are relevant to other settings where hospital stay following joint arthroplasty remains excessively long.
The formation of iddingsite by the oxidative weathering of Fo80 olivine begins by solution of Mg from planar fissures, 20 Å wide and spaced 200 Å apart, parallel to (001). Oxidation of Fe within the remaining olivine provides nuclei for the topotactic growth of goethite. Cleavage cracks < 50 Å in diameter allow Na, Al, and Ca from adjacent minerals, particularly plagioclase, to enter the altering olivine while Mg and Si diffuse away. In the early stages of weathering, strips of Fe-rich smectite (saponite), 20–50 Å wide and 1–7 layers thick, form bridges 50–100 Å long across the planar fissures. Dioctahedral smectite crystallizes on the margins of wider cleavage-controlled fissures; with further weathering halloysite is formed away from the fissure walls. In the ultimate stages of alteration, the saponite and dioctahedral smectite are lost, leaving a porous, oriented aggregate of goethite crystals each measuring about 50 × 100 × 200 Å (X, Y, Z, respectively), with sporadic veins of halloysite crossing the pseudomorph.
Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a major cause of bloodstream infection among hospitalized patients in low- and middle-income countries (LMICs). CRAB infections can be difficult to treat and are devastating in neonates (~30% mortality). CRAB outbreaks are hypothesized to arise from reservoirs in the hospital environment, but outbreak investigations in LMICs seldom incorporate whole-genome sequencing (WGS). Methods: WGS (Illumina NextSeq) was performed at the National Institute for Communicable Diseases (South Africa) on 43 preserved A. baumannii isolates from a 530-bed referral hospital in Gaborone, Botswana, from March 2021–August 2022. This included 23 blood-culture isolates from 21 unique patients (aged 2 days–69 years) and 20 environmental isolates collected at the 36-bed neonatal unit in April–June 2021. Infections were considered healthcare-associated if the culture was obtained >72 hours after hospital arrival (or sooner in inborn infants). Blood cultures were incubated using an automated system (BACT/ALERT, BioMérieux) and were identified using manual methods. Environmental isolates were identified using selective or differential chromogenic media (CHROMagarTM). Taxonomic assignment, multilocus sequence typing (MLST), antimicrobial resistance gene identification, and phylogenetic analyses were performed using publicly accessible analysis pipelines. Single-nucleotide polymorphism (SNP) matrices were used to assess clonal lineage. Results: All 23 blood isolates and 5 (25%) of 20 environmental isolates were confirmed as A. baumannii; thus, 28 A. baumannii isolates were included in the phylogenetic analysis. MLST revealed that 22 (79%) of 28 isolates were sequence type 1 (ST1), including all 19 healthcare-associated blood isolates and 3 (60%) of 5 environmental isolates. Genes encoding for carbapenemases (blaNDM-1, blaOXA-23) and biocide resistance (qacE) were present in all 22 ST1 isolates; colistin resistance genes were not identified. Phylogenetic analysis of the ST1 clade demonstrated spatial clustering by hospital unit. Related isolates spanned wide ranges in time (>1 year), suggesting ongoing transmission from environmental sources (Fig. 1). An exclusively neonatal clade (0–2 SNPs) containing all 8 neonatal blood isolates was closely associated with 3 environmental isolates from the neonatal unit: a sink drain, bed rail, and a healthcare worker’s hand. Conclusions: WGS analysis of clinical and environmental A. baumannii revealed the presence of unit-specific CRAB clones, with evidence of ongoing transmission likely driven by persistent environmental reservoirs. This research highlights the potential of WGS to detect hospital outbreaks and reaffirms the importance of environmental sampling to identify and remediate reservoirs (eg, sinks) and vehicles (eg, hands and equipment) within the healthcare environment.
In post-Brexit and post-devolution Britain, relationships among the four nations appear fragile. This article aims to discover where British citizens draw the symbolic boundaries that define in-group and out-group members between nations—in particular, England, Scotland, and Wales—and within England. Within England, we also examine class divides and the North–South divide. We operationalize symbolic boundaries through a set of new innovative measures administered in an online survey in 2019. Questions ascertain agreement that the various groups “share my values,” are “people I could get on with,” and are “straightforward and honest.” Results of our descriptive analysis suggest that boundaries are blurred between the British and the Welsh but sharper for the Scottish. We also find sharp but asymmetrical boundaries within England, between the working class and the middle class, and between Northerners and Southerners. Regional differences in perceptions of Southerners map closely onto those of how well Westminster looks after regional interests, which suggests that power imbalances reduce social cohesion.
People with psychosis in Malawi have very limited access to timely assessment and evidence-based care, leading to a long duration of untreated psychosis and persistent disability. Most people with psychosis in the country consult traditional or religious healers. Stigmatising attitudes are common and services have limited capacity, particularly in rural areas. This paper, focusing on pathways to care for psychosis in Malawi, is based on the Wellcome Trust Psychosis Flagship Report on the Landscape of Mental Health Services for Psychosis in Malawi. Its purpose is to inform Psychosis Recovery Orientation in Malawi by Improving Services and Engagement (PROMISE), a longitudinal study that aims to build on existing services to develop sustainable psychosis detection systems and management pathways to promote recovery.
Depression and anxiety are common and highly comorbid, and their comorbidity is associated with poorer outcomes posing clinical and public health concerns. We evaluated the polygenic contribution to comorbid depression and anxiety, and to each in isolation.
Methods
Diagnostic codes were extracted from electronic health records for four biobanks [N = 177 865 including 138 632 European (77.9%), 25 612 African (14.4%), and 13 621 Hispanic (7.7%) ancestry participants]. The outcome was a four-level variable representing the depression/anxiety diagnosis group: neither, depression-only, anxiety-only, and comorbid. Multinomial regression was used to test for association of depression and anxiety polygenic risk scores (PRSs) with the outcome while adjusting for principal components of ancestry.
Results
In total, 132 960 patients had neither diagnosis (74.8%), 16 092 depression-only (9.0%), 13 098 anxiety-only (7.4%), and 16 584 comorbid (9.3%). In the European meta-analysis across biobanks, both PRSs were higher in each diagnosis group compared to controls. Notably, depression-PRS (OR 1.20 per s.d. increase in PRS; 95% CI 1.18–1.23) and anxiety-PRS (OR 1.07; 95% CI 1.05–1.09) had the largest effect when the comorbid group was compared with controls. Furthermore, the depression-PRS was significantly higher in the comorbid group than the depression-only group (OR 1.09; 95% CI 1.06–1.12) and the anxiety-only group (OR 1.15; 95% CI 1.11–1.19) and was significantly higher in the depression-only group than the anxiety-only group (OR 1.06; 95% CI 1.02–1.09), showing a genetic risk gradient across the conditions and the comorbidity.
Conclusions
This study suggests that depression and anxiety have partially independent genetic liabilities and the genetic vulnerabilities to depression and anxiety make distinct contributions to comorbid depression and anxiety.
Following the report of the first COVID-19 case in Nepal on 23 January 2020, three major waves were documented between 2020 and 2021. By the end of July 2022, 986 596 cases of confirmed COVID-19 and 11 967 deaths had been reported and 70.5% of the population had received at least two doses of a COVID-19 vaccine. Prior to the pandemic, a large dengue virus (DENV) epidemic affected 68 out of 77 districts, with 17 932 cases and six deaths recorded in 2019. In contrast, the country's Epidemiology and Disease Control Division reported 530 and 540 dengue cases in the pandemic period (2020 and 2021), respectively. Furthermore, Kathmandu reported just 63 dengue cases during 2020 and 2021, significantly lower than the 1463 cases reported in 2019. Serological assay showed 3.2% positivity rates for anti-dengue immunoglobulin M antibodies during the pandemic period, contrasting with 26.9–40% prior to it. Real-time polymerase chain reaction for DENV showed a 0.5% positive rate during the COVID-19 pandemic which is far lower than the 57.0% recorded in 2019. Continuing analyses of dengue incidence and further strengthening of surveillance and collaboration at the regional and international levels are required to fully understand whether the reduction in dengue incidence/transmission were caused by movement restrictions during the COVID-19 pandemic.
Edited by
Mark Williams, International Christian University, Tokyo,Van Gessel, Brigham Young University, Utah,Yamane Michihiro, Notre Dame Seishin University
Nagai Takashi used the biblical concept of hansai (a burnt sacrifice) in describing the atomic bombing of the Catholic Urakami district of Nagasaki and regarded the bombing as an event guided by setsuri (divine providence). His use of hansai is a pastoral device for the Catholics of Urakami, aimed at encouraging one's surrender to divine providence. Situating his conception of hansai in a theologically orthodox conception of divine providence demonstrates the ways in which Nagai seeks in his poetry and artworks to convey for Urakami Catholics a similetic or symbolic resemblance between a burnt offering and the atomic bombing of Urakami.
Introduction
This chapter explores the encounter with Catholic Christianity and issues of Christian discipleship in the life and work of the Catholic convert, radiologist and atomic bomb survivor Nagai Takashi (1908–1951). Among western scholars, Nagai is best known for his reference, in his book Nagasaki no kane (The Bells of Nagasaki,* 1949), to the biblical concept of hansai, or a “burnt sacrifice,” in describing the atomic bombing of the largely Catholic Urakami district of Nagasaki and for regarding the bombing as one manifestation of the ineluctable operations of setsuri, or divine providence. Nagai's use of the concept of hansai in conjunction with setsuri has in fact been taken by the vast majority of scholars to constitute a theologically heterodox explanation or theodicy of the atomic bombing of Urakami.
Here I aim to challenge this conventional interpretation of Nagai's use of the concepts of hansai and setsuri and to lay the foundations for what will be argued is a theologically consistent and orthodox interpretation of Nagai's use of hansai as a unique pastoral device for assisting the Catholics of Urakami—the center of Christianity in Japan at the time of the atomic bombing—to gain some semblance of peace and comfort through self-surrender to divine providence. Essential in this task is laying out the historical, biographical and theological contexts in which Nagai developed his conception of setsuri and deployed the concept of hansai.
“Hansai-setsu” and atonement
As already noted, Nagai's best-known reference to hansai features in the final chapter of his first book, The Bells of Nagasaki. Here we find an edited form of the funeral address Nagai gave, in November 1945, for the victims of the bomb in front of the ruined Urakami Cathedral.
We examine the redshifts of a comprehensive set of published Type Ia supernovae, and provide a combined, improved catalogue with updated redshifts. We improve on the original catalogues by using the most up-to-date heliocentric redshift data available; ensuring all redshifts have uncertainty estimates; using the exact formulae to convert heliocentric redshifts into the Cosmic Microwave Background (CMB) frame; and utilising an improved peculiar velocity model that calculates local motions in redshift-space and more realistically accounts for the external bulk flow at high-redshifts. We review 2607 supernova redshifts; 2285 are from unique supernovae and 322 are from repeat-observations of the same supernova. In total, we updated 990 unique heliocentric redshifts, and found 5 cases of missing or incorrect heliocentric corrections, 44 incorrect or missing supernova coordinates, 230 missing heliocentric or CMB frame redshifts, and 1200 missing redshift uncertainties. The absolute corrections range between $10^{-8} \leq \Delta z \leq 0.038$, and RMS$(\Delta z) \sim 3{\times 10^{-3}}$. The sign of the correction was essentially random, so the mean and median corrections are small: $4{\times 10^{-4}}$ and $4{\times 10^{-6}}$ respectively. We examine the impact of these improvements for $H_0$ and the dark energy equation of state w and find that the cosmological results change by $\Delta H_0 = -0.12\,\mathrm{km\,s}^{-1}\mathrm{Mpc}^{-1}$ and $\Delta w = 0.003$, both significantly smaller than previously reported uncertainties for $H_0$ of 1.0 $\mathrm{km\,s}^{-1}\mathrm{Mpc}^{-1}$ and w of 0.04 respectively.
De la vie d'oraison is an early and neglected work by Jacques Maritain. Exploring its major themes and biographical context reveals a tension in Maritain between his commitment to orthodox Catholic mystical theology and his belief in his godfather Léon Bloy's unique, tripartite vocation of lay mystic, prophet, and artist. This tension, I argue, has been overlooked due to Maritain's public image as an esteemed Thomist philosopher, but becomes clear when we study Maritain's defense of Bloy, especially in his dialogues with his Dominican peers and church authorities. I suggest that this tension reveals two deep-seated convictions at work in Maritain's life and writings. The first is that the reasons for the necessity of lay Catholic mysticism, and the diverse forms it may take, need to be spelled out more clearly. The second is that for Maritain, his godfather is an exemplar of such lay Catholic mysticism. Understanding Maritain's reasons for these convictions can open up a pathway for Catholic mystical theology to better accommodate and conceptualize alternative forms of mystical life among laypeople whose mystical and artistic experiences spill over traditional theological categories.
A Roman villa building at Mud Hole, Boxford, West Berkshire, was examined by excavation in 2017 and 2019, and found to be of probable fourth-century date. One room of this otherwise seemingly modest villa contained a remarkable late fourth-century figured mosaic, which features a number of rare mythological subjects not previously encountered in Britain. Inscriptions suggest the name of the villa owner (Caepio) and his wife (Fortunata), with a possible Spanish connection. The mosaic's central panel is ornamented with the triumphs of Pelops and Bellerophon, the former known only from two other mosaics, in Syria and Spain. The borders also contain depictions of stories unknown on other mosaics, but all concerned with aspects of triumph. The central panel is upheld by walking telamones (giants), otherwise only known on a mosaic from Tusculum, and the mosaicists have attempted to use foreshortening to give the floor a trompe l'oeil effect. The rare subjects depicted on the floor all relate to either Poseidon, Pelops, Bellerophon or Atlas, and suggest high standards of mythological knowledge and longevity of classical culture amongst the villa-owning inhabitants of late fourth-century Berkshire. The mosaic shows a connection to earlier depictions of the Pelops story, but is highly original in its interpretation of them and follows a contemporary trend, not previously encountered in Britain, of its subjects breaking out from their ornamental borders. The mosaic is an altogether exceptional discovery and can be considered an important example of late Roman art so far found in Britain.
The Middle Mississippian component at Aztalan was a mixed, Late Woodland / Mississippian occupation sited within a heavily fortified habitation and mound center that is located on a tributary of the Rock River in Wisconsin. It represents the northernmost large Cahokian-related village recorded. The Oneota Lake Koshkonong Locality of the Rock River drainage is located approximately 20 km south of Aztalan, and it consists of a 25 km2 area along the northwest shore with a small cluster of habitation settlements. Sixty-eight radiocarbon measurements have been obtained from Aztalan, and 52 from Oneota settlements in the Lake Koshkonong Locality. We discuss how to best interpret this dataset, and we use Bayesian chronological modeling to analyze these dates. The results suggest that (1) Aztalan's Late Woodland (Kekoskee phase) occupation began in the AD 900s or early AD 1000s, (2) Aztalan's Mississippian occupation ceased in the AD 1200s, (3) Oneota occupations at Lake Koshkonong began after AD 1050 and were established by the AD 1200s, and (4) Oneota occupations at Lake Koshkonong continued after Aztalan's Mississippian abandonment until at least the late AD 1300s. Additionally, the results demonstrate that Aztalan was fortified with a palisade with bastions for much of the Mississippian occupation, suggesting a contested presence in a multiethnic landscape.
Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is inversely associated with type 2 diabetes mellitus (T2DM) risk. Metabolic changes due to DASH adherence and their potential relationship with incident T2DM have not been described. The objective is to determine metabolite clusters associated with adherence to a DASH-like diet in the Insulin Resistance Atherosclerosis Study cohort and explore if the clusters predicted 5-year incidence of T2DM. The current study included 570 non-diabetic multi-ethnic participants aged 40–69 years. Adherence to a DASH-like diet was determined a priori through an eighty-point scale for absolute intakes of the eight DASH food groups. Quantitative measurements of eighty-seven metabolites (acylcarnitines, amino acids, bile acids, sterols and fatty acids) were obtained at baseline. Metabolite clusters related to DASH adherence were determined through partial least squares (PLS) analysis using R. Multivariable-adjusted logistic regression was used to explore the associations between metabolite clusters and incident T2DM. A group of acylcarnitines and fatty acids loaded strongly on the two components retained under PLS. Among strongly loading metabolites, a select group of acylcarnitines had over 50 % of their individual variance explained by the PLS model. Component 2 was inversely associated with incident T2DM (OR: 0·89; (95 % CI 0·80, 0·99), P-value = 0·043) after adjustment for demographic and metabolic covariates. Component 1 was not associated with T2DM risk (OR: 1·02; (95 % CI 0·88, 1·19), P-value = 0·74). Adherence to a DASH-type diet may contribute to reduced T2DM risk in part through modulations in acylcarnitine and fatty acid physiology.
The protected Tel-Dor coastal embayment in the eastern Mediterranean preserves an unusually complete stratigraphic record that reveals human–environmental interactions throughout the Holocene. Interpretation of new seismic profiles collected from shallow marine geophysical transects across the bay show five seismic units were correlated with stratigraphy and age dates obtained from coastal and shallow-marine sediment cores. This stratigraphic framework permits a detailed reconstruction of the coastal system over the last ca. 77 ka as well as an assessment of environmental factors that influenced some dimensions of past coastal societies. The base of the boreholes records lowstand aeolian deposits overlain by wetland sediments that were subsequently flooded by the mid-Holocene transgression. The earliest human settlements are submerged Pottery Neolithic (8.25–7 ka) structures and tools, found immediately above the wetland deposits landward of a submerged aeolianite ridge at the mouth of the bay. The wetland deposits and Pottery Neolithic settlement remains are buried by coastal sand that records a middle Holocene sea-level rise ca. 7.6–6.5 ka. Stratigraphic and geographic relationships suggest that these coastal communities were displaced by sea-level transgression. These findings demonstrate how robust integration of different data sets can be used to reconstruct the geomorphic evolution of coastal settings as well as provide an important addition to the nature of human–landscape interaction and cultural development.
Pharmacogenomic testing has emerged to aid medication selection for patients with major depressive disorder (MDD) by identifying potential gene-drug interactions (GDI). Many pharmacogenomic tests are available with varying levels of supporting evidence, including direct-to-consumer and physician-ordered tests. We retrospectively evaluated the safety of using a physician-ordered combinatorial pharmacogenomic test (GeneSight) to guide medication selection for patients with MDD in a large, randomized, controlled trial (GUIDED).
Materials and Methods
Patients diagnosed with MDD who had an inadequate response to ≥1 psychotropic medication were randomized to treatment as usual (TAU) or combinatorial pharmacogenomic test-guided care (guided-care). All received combinatorial pharmacogenomic testing and medications were categorized by predicted GDI (no, moderate, or significant GDI). Patients and raters were blinded to study arm, and physicians were blinded to test results for patients in TAU, through week 8. Measures included adverse events (AEs, present/absent), worsening suicidal ideation (increase of ≥1 on the corresponding HAM-D17 question), or symptom worsening (HAM-D17 increase of ≥1). These measures were evaluated based on medication changes [add only, drop only, switch (add and drop), any, and none] and study arm, as well as baseline medication GDI.
Results
Most patients had a medication change between baseline and week 8 (938/1,166; 80.5%), including 269 (23.1%) who added only, 80 (6.9%) who dropped only, and 589 (50.5%) who switched medications. In the full cohort, changing medications resulted in an increased relative risk (RR) of experiencing AEs at both week 4 and 8 [RR 2.00 (95% CI 1.41–2.83) and RR 2.25 (95% CI 1.39–3.65), respectively]. This was true regardless of arm, with no significant difference observed between guided-care and TAU, though the RRs for guided-care were lower than for TAU. Medication change was not associated with increased suicidal ideation or symptom worsening, regardless of study arm or type of medication change. Special attention was focused on patients who entered the study taking medications identified by pharmacogenomic testing as likely having significant GDI; those who were only taking medications subject to no or moderate GDI at week 8 were significantly less likely to experience AEs than those who were still taking at least one medication subject to significant GDI (RR 0.39, 95% CI 0.15–0.99, p=0.048). No other significant differences in risk were observed at week 8.
Conclusion
These data indicate that patient safety in the combinatorial pharmacogenomic test-guided care arm was no worse than TAU in the GUIDED trial. Moreover, combinatorial pharmacogenomic-guided medication selection may reduce some safety concerns. Collectively, these data demonstrate that combinatorial pharmacogenomic testing can be adopted safely into clinical practice without risking symptom degradation among patients.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
I examine Jacques Maritain's assertion that his godfather, the Catholic writer Léon Bloy, was both an artist and a mystic, capable of reaching the heights of mystical contemplation of God. First examining this assertion in light of Maritain's mystical theology and philosophy of creativity, I show that a conventional reading of their operative principles renders mystical experience and artistic experience essentially different in their respective modes and objects of knowledge. Drawing on Maritain's personal reflections on Bloy and recent developments in Maritain scholarship, however, I then make the case that by virtue of relatively unexplored elements in Maritain's testimony and theoretical principles, the Christian artist can also have the experience of the Christian mystic when they direct their work to the mysteries of the Christian faith. I call this convergence ‘Infused-Poetic Contemplation’.