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While global financial capital is abundant, it flows into corporate investments and real estate rather than climate change actions in cities. Political will and public pressure are crucial to redirecting funds. Studies of economic impacts underestimate the costs of climate disasters, especially in cities, so they undermine political commitments while understating potential climate-related returns. The shift of corporate approaches towards incorporating environmental, social, and governance (ESG) impacts offers promise for private-sector climate investments but are recently contested. Institutional barriers remain at all levels, particularly in African cities. Since the Global North controls the world's financial markets, new means of increasing funding for the Global South are needed, especially for adaptation. Innovative financial instruments and targeted use of environmental insurance tools can upgrade underdeveloped markets and align urban climate finance with ESG frameworks. These approaches, however, require climate impact data collection, programs to improve cities' and countries' creditworthiness, and trainings. This title is also available as open access on Cambridge Core.
Efficient chemical weed management considers precise application of herbicides, maximizing herbicide retention and absorption, reducing the impact of abiotic factors, and mitigating off-target movement in order to optimize herbicide efficacy. Hence, this study assessed the employability and cost-efficiency of an unmanned aerial vehicle (UAV) for preplanting application and postemergence selective weed control of grasses infesting legume cover crops (LCCs) in an immature oil palm (Elaeis guineensis Jacq.) plantation. Field experiments were conducted in 2020 and 2021 at a research center and an oil palm replanting area in Jerantut, Pahang, Malaysia. Droplet deposition and distribution analyses revealed that the pressure at 0.25 MPa yielded better spray coverage and increased droplet counts compared with 0.15 MPa. For preplanting application, both the UAV and mist blower resulted in total weed control. Meanwhile for selective grass control in the LCCs, conventional knapsack sprayer (CKS) application provided slightly better weed control than the UAV over the 12-wk observation. However, a cost-efficiency analysis revealed that UAV spraying yielded economically favorable results for areas greater than 3,000 ha, with potential savings ranging from 4% to 28%. Furthermore, UAV spraying demonstrated superior operational efficiency and reduced working hours by 37%, water consumption by 91%, and human labor expenses by 81% compared with both conventional methods. These findings underscore the potential of UAV-based spraying for large-scale weed control in oil palm plantations and highlight its efficiency, comparable effectiveness, and cost-saving benefits.
Oat being a rabi/winter crop in Kashmir, experiences extremely low temperatures which has detrimental effects on its growth and development. Therefore, this study was designed to evaluate a set of 130 oat genotypes in multi-location trials across temperate conditions of Kashmir valley from 2018 to 2022. From the preliminary data of 56 genotypes, including five checks, were selected and evaluated for nutritional and yield attributing traits under cold stress conditions at two locations. The results demonstrated significant genetic variation and high heritability for majority of traits, except for days to 50% flowering, days to maturity and dry fodder. Positive correlations were observed between green fodder yield and other traits, indicating their potential for enhancing yield. Principal component analysis identified four principal components that accounted for 69.87% of the total variation. Cluster analysis categorized the genotypes into two main clusters and six sub-clusters. Frost damage assessment was conducted at tillering stage after the snow melted in late January 2021 and 2022 using cold tolerance rating scale and subsequently tested for chilling injury through an electrolyte leakage test. From field and lab data analysis, five most promising cold tolerant, nutritious and high-yielding genotypes were identified. These genotypes have significant potential for utilization in future breeding programmes to improve cold tolerance in cultivated oats within the Kashmir valley thus promoting agricultural productivity and sustainability. The outcomes also provide valuable insights into the genetic variation, heritability, genotype-by-environment interactions, correlations and cold tolerance of oat genotypes in Kashmir.
OBJECTIVES/GOALS: * Patients with skin of color (SOC) are disproportionately affected by systemic lupus erythematosus (SLE) and cutaneous lupus erythematosus (CLE). In this study, we aim to address this disparity and characterize the real-world efficacy and tolerability of anifrolumab in CLE patients using validated disease activity instruments. METHODS/STUDY POPULATION: This single-center, prospective observational cohort study includes SLE patients with severe or refractory CLE who have received ≥ 1 dose of anifrolumab. Cutaneous disease activity is assessed periodically at 2, 6, 9, 12, and 18 months using the Cutaneous Lupus Disease Area and Severity Index (CLASI). Adverse events and concurrent treatments are also routinely evaluated. To date, 22 patients have been enrolled, with 6-month follow-up data available for 15. At the time of anifrolumab initiation, 95% of participants had discoid LE (DLE), 60% had mucosal DLE, and 13% had subacute CLE. Nine patients identified as SOC, two as White, and four did not report race/ethnicity. RESULTS/ANTICIPATED RESULTS: A Friedman test showed statistically significant changes over time in CLASI activity score (CLASI-A) (χ2(2) =20, p<0.0001) (Figure 1) and CLASI damage score (CLASI-D) (χ2(2) =9.5789, p=0.0083) (Figure. To estimate effect sizes, we employed linear mixed models, which demonstrated statistically significant reductions in the CLASI-A score from baseline by an average of 14 points at 2 months (p<0.001) and 18 points at 6 months (p<0.001); notably, a reduction in CLASI-A of 4 is considered clinically meaningful. At 2 months, 20% of patients experienced a 50% or more reduction in CLASI, which increased to 60% of patients at 6 months. Patients on systemic corticosteroids could taper off. Adverse events were minimal and did not lead to treatment discontinuation. Fig. 1:[blob:https://acts.slayte.com/045319b4-7272-4351-a771-78ba9ee57f5c] Fig. 2:[blob:https://acts.slayte.com/67df7653-0cd8-4e8e-a3e1-d5c565b19dce] DISCUSSION/SIGNIFICANCE: As SOC patients with CLE have significant potential for permanent pigmentary alternations, early treatment is imperative. Effective treatments for refractory CLE are elusive. Our study represents the largest single-center cohort of CLE patients treated with anifrolumab and suggests that it is a promising therapeutic option for patients with SOC.
Limited analyses based on national samples have assessed whether early attention-deficit/hyperactivity disorder (ADHD) symptoms predict later internalizing and externalizing symptoms in youth and the influence of sex and pubertal timing on subsequent psychiatric symptoms. This study analyzed data (n = 2818) from the Environmental influences on Child Health Outcomes Program national cohort. Analyses used data from early childhood (mean age = 5.3 years) utilizing parent-reported ADHD symptoms to predict rates of internalizing and externalizing symptoms from late childhood/adolescence (mean age = 11.9 years). Within a subsample age at peak height velocity (APHV) acted as a proxy to assess pubertal timing from early childhood (mean age = 5.4 years) to adolescence (mean age = 12.3 years). Early-childhood ADHD symptoms predicted later psychiatric symptoms, including anxiety, depression, aggressive behavior, conduct problems, oppositional defiant disorder, and rule-breaking behavior. Earlier APHV was associated with increased Conduct Disorder symptoms from late childhood to adolescence for females only. A stronger relation between ADHD symptoms and later aggression was observed in females with earlier APHV, whereas this same pattern with aggression, conduct problems and depression was observed in males with later APHV. Clinicians should consider that both young girls and boys with elevated ADHD symptoms, particularly with off-set pubertal timing, may be at risk for later psychiatric symptoms.
Evaluate the association between provider-ordered viral testing and antibiotic treatment practices among children discharged from an ED or hospitalized with an acute respiratory infection (ARI).
Design:
Active, prospective ARI surveillance study from November 2017 to February 2020.
Setting:
Pediatric hospital and emergency department in Nashville, Tennessee.
Participants:
Children 30 days to 17 years old seeking medical care for fever and/or respiratory symptoms.
Methods:
Antibiotics prescribed during the child’s ED visit or administered during hospitalization were categorized into (1) None administered; (2) Narrow-spectrum; and (3) Broad-spectrum. Setting-specific models were built using unconditional polytomous logistic regression with robust sandwich estimators to estimate the adjusted odds ratios and 95% confidence intervals between provider-ordered viral testing (ie, tested versus not tested) and viral test result (ie, positive test versus not tested and negative test versus not tested) and three-level antibiotic administration.
Results:
4,107 children were enrolled and tested, of which 2,616 (64%) were seen in the ED and 1,491 (36%) were hospitalized. In the ED, children who received a provider-ordered viral test had 25% decreased odds (aOR: 0.75; 95% CI: 0.54, 0.98) of receiving a narrow-spectrum antibiotic during their visit than those without testing. In the inpatient setting, children with a negative provider-ordered viral test had 57% increased odds (aOR: 1.57; 95% CI: 1.01, 2.44) of being administered a broad-spectrum antibiotic compared to children without testing.
Conclusions:
In our study, the impact of provider-ordered viral testing on antibiotic practices differed by setting. Additional studies evaluating the influence of viral testing on antibiotic stewardship and antibiotic prescribing practices are needed.
The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS) will be held in Washington DC, USA, from Saturday, 26 August, 2023 to Friday, 1 September, 2023, inclusive. The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery will be the largest and most comprehensive scientific meeting dedicated to paediatric and congenital cardiac care ever held. At the time of the writing of this manuscript, The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery has 5,037 registered attendees (and rising) from 117 countries, a truly diverse and international faculty of over 925 individuals from 89 countries, over 2,000 individual abstracts and poster presenters from 101 countries, and a Best Abstract Competition featuring 153 oral abstracts from 34 countries. For information about the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery, please visit the following website: [www.WCPCCS2023.org]. The purpose of this manuscript is to review the activities related to global health and advocacy that will occur at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery.
Acknowledging the need for urgent change, we wanted to take the opportunity to bring a common voice to the global community and issue the Washington DC WCPCCS Call to Action on Addressing the Global Burden of Pediatric and Congenital Heart Diseases. A copy of this Washington DC WCPCCS Call to Action is provided in the Appendix of this manuscript. This Washington DC WCPCCS Call to Action is an initiative aimed at increasing awareness of the global burden, promoting the development of sustainable care systems, and improving access to high quality and equitable healthcare for children with heart disease as well as adults with congenital heart disease worldwide.
A popular genre of television shows is medical dramas. Although the primary objective of watching these shows is entertainment, acquiring medical knowledge is a passive by-product. Surgical procedures constitute a large part of the storyline of these shows. This could either serve as a source of medical knowledge or provide false information, the effect being especially important in individuals with no prior medical exposure.
Objectives
This study aims to assess the impact medical TV shows can have on the surgical knowledge of non-healthcare students and the difference in knowledge between different demographic groups (among those with relatives in the medical community and those without).
Methods
A cross-sectional study was conducted among the non-healthcare students of Lahore, Pakistan. A self-administered questionnaire was used containing socio-demographic factors (age, gender, educational discipline), history, and hours of medical TV shows watched. It also contained ten questions each with a score of 1 to assess surgical knowledge. Data was analyzed using SPSS v.26.
Results
Among the 1097 respondents, 450 (41%) had a history of watching medical TV shows. The majority, 319 (29.1%), had seen these shows for < 24 hours. The mean score of all respondents was 5.79 out of a maximum score of 10. Respondents with a history of watching medical TV shows were more knowledgeable than those who did not (p < 0.001). Similarly, respondents with a history of watching more hours of medical TV shows were more knowledgeable than those who watched for a lesser number of hours (p < 0.001). Respondents with relatives in the healthcare profession were also more knowledgeable than those without (p = 0.049).
Conclusions
If properly developed, while maintaining their primary entertainment value, medical TV shows can also be used as efficient learning tools. Quality controls must also be applied to minimize the risk of false information.
Body Dysmorphic Disorder (BDD) is a psychiatric, obsessive-compulsive disorder characterized by persistent, pre-occupying, intrusive thoughts regarding defects in one’s physical appearance. This leads to potentially harmful behaviors such as constant mirror checking, avoiding socialization, and the need to seek constant validation. The recent increase in social media usage and influence, especially the use of photo-editing apps, has been correlated with a steep decline in body satisfaction due to the perpetuation of unrealistic beauty standards.
Objectives
This study aimed to determine the current prevalence of BDD in the general population of Pakistan and assess the association of BDD with social media usage.
Methods
A descriptive cross-sectional study was conducted from August 2022 to October 2022 on the general population of Pakistan using an online self-administered, anonymous, pretested questionnaire. It contained socio-demographic factors (age, gender, marital status, educational discipline, and household income). Participants were screened for BDD using a pre-tested Body Dysmorphic Disorder Questionnaire (BDDQ) modified to fit the revised DSM-5 criteria. They were further asked about the specifics of the defects they were concerned about, and whether or not they compared their appearance with people online. Characteristics of social media use such as the types of applications used and time spent on them were also asked. Data was analyzed using SPSS v.26.
Results
Out of 779 participants, 5.3% (41) screened positive for BDD. The most repeated behaviors in BDD-positive participants were a comparison of how they looked with other people and checking themselves in the mirror to see how they look. Their most common defect of concern was skin (acne, scars, wrinkles, paleness, redness) followed by the shape or size of the nose, mouth, jaws, or lips. There was a significant association between age and BDD diagnosis (p < 0.001) and between the tendency to compare themselves with people online and BDD diagnosis (p = 0.001). However, no statistically significant differences were found in the BDD-positive and negative groups concerning gender, the number of social media applications used, or time spent on social media.
Conclusions
There is a need to educate the public about the risk of BDD, especially the more susceptible age, and promote safe social networking. Counseling about the harmful effects of social media could be helpful. This is the first study of its kind done on the Pakistani population and one of the few studies that exist on this topic worldwide. Hence, to reach a conclusive decision, there is a dire need to carry out similar investigations with larger sample sizes and on populations that have yet not been studied.
Western Himalayan region is a rich repository of common bean genetic resources evolved over generations of farmer selection. The bean variability encompasses various use categories such as dry, snap and shelled beans. The present study aimed to characterize 40 small-seeded red common bean genotypes collected from different districts of Kashmir valley as well as Poonch, Rajouri and Bhaderwah areas of Jammu which are world famous for their beans. Based on 5-year evaluation, there was substantial variability for various qualitative traits as well as quantitative traits. Among variability parameters, higher PCV and GCV values were recorded for plant height, seed yield per plant and number of pods per plant and low for days to maturity, seed length and pod length. High heritability was recorded for all the traits ranging from 78.72 to 94.87%. There was substantial variability in root traits scored in laboratory and greenhouse as well as canopy temperature depression and relative water content. Various genotypes were found resistant to bean common mosaic virus (WB-N-1, WB-N-11, WB-1318, WB-401, WB-451, WB-1634); anthracnose (WB-1634 WB-83, WB-258, WB-1282, WB-1304); angular leaf spot (WB-6, WB-1634, WB-258, WB-451, N-1 and N-10); Fusarium wilt (WB-341, WB-451, WB-N-1 and WB-1587) and Ascochyta blight (WB-6). Similarly WB-92 was highly resistant to shattering. The genotypes WB-341, WB-1634, WB-N-1 performed better under water stress, WB-N-1 and WB-1634 were resistant to multiple diseases and WB-1634 had better cooking quality. The genotypes identified can be used in bean improvement programmes and have also been submitted to NBPGR for long-term storage.
OBJECTIVES/GOALS: The spectrum of disease caused by SARS-CoV-2 ranges from asymptomatic detection to severe illness, with varying presentations by age. Therefore, we aimed to compare the clinical characteristics between children and adults with SARS-CoV-2. METHODS/STUDY POPULATION: From March 20, 2020, to August 18, 2021, we conducted SARS-CoV-2 surveillance in individuals from metropolitan Nashville, TN. Children with multisystem inflammatory syndrome were excluded. Analyses were restricted to individuals with SARS-CoV-2 infection confirmed by detection of viral RNA in nasal specimens using reverse-transcription quantitative polymerase chain reaction (RT-qPCR) and/or by detection of serum IgG to the SARS-CoV-2 spike and nucleocapsid proteins using enzyme-linked immunosorbent assay (ELISA). Those with negative RT-qPCR results, but a positive ELISA within 4-6 weeks of symptom onset, were classified as SARS-CoV-2 positive. Clinical characteristics between children and adults were compared with Pearson’s chi square. Illness duration was compared using Kaplan Meier estimators. RESULTS/ANTICIPATED RESULTS: Overall, 426/826 (49%) individuals (children: 57 [13%); adults: 369 [87%]) were SARS-CoV-2 positive, with median ages of 12 and 41 years, respectively. Most individuals were female (54%) and white, non-Hispanic (79%). Compared to adults, children were more likely to be asymptomatic (children: 16% vs. adults: 5%; p=0.001). In contrast, symptomatic adults were more likely to report cough (71% vs. 56%), wheezing (21% vs. 8%), shortness of breath (45% vs. 19%), ageusia (67% vs. 23%), and anosmia (64% vs 27%) than symptomatic children (p<0.05). Mean illness duration was shorter in children than adults: 7 days (95% CI: 5.1, 8.9) vs. 14 days (95% CI: 12.4,15.0), respectively. A total of 5% (18/352) of adults reported symptoms lasting ? 4 weeks (range: 31-96 days), whereas all symptoms in children resolved by 31 days. DISCUSSION/SIGNIFICANCE: Overall, children with SARS-CoV-2 present with a shorter and milder disease course compared to adults. Further studies are needed to understand SARS-CoV-2 illness severity across the lifespan.
Despite the hot climate and high humidity in the Jazan Region of Saudi Arabia, which increases risk for dehydration, no previous studies have assessed awareness of dehydration and fluid intake practice among adults in this region. Therefore, the aim of this cross-sectional study was to determine awareness of the dehydration state and fluid intake practices among 440 adults in the Jazan Region of Saudi Arabia. Out of the total, 51⋅8 % were male and 48⋅2 % were females. Good knowledge of dehydration definition and prevention and recommended minimum water intake was observed in 98, 95 and 75 % of the participants, respectively. Fifty-nine percent of the participants met the minimum daily requirement of 3 l or more per day. The age (95 % CI 1⋅003, 1⋅017, P value = 0⋅006), diabetes (95 % CI 1⋅028, 1⋅459, P value = 0⋅023) and prior hospitalisation due to dehydration (95 % CI 1⋅010, 1⋅378, P value = 0⋅037) were associated with higher water intake. Additional glasses of coffee (95 % CI 1⋅02, 1⋅115, P value = 0⋅004) and juice (95 % CI 1⋅039, 1⋅098, P value < 0⋅001) were associated with more water intake. The participants exhibited good knowledge of dehydration definition, symptoms and consequences. Intake of fluids such as ‘juice and coffee’ enhances more water intake. Although two-thirds of the participants met the recommended daily water intake, still one-third of them did not meet this level. Innovative approaches to enhance healthy drinking are warranted and may include partnering with patients to take an active role in hydration monitoring and increasing communication with the different healthcare providers.
Schizophrenia is a heterogeneous disorder with substantial heritability. The use of endophenotypes may help clarify its aetiology. Measures from the smooth pursuit and antisaccade eye movement tasks have been identified as endophenotypes for schizophrenia in twin and family studies. However, the genetic basis of the overlap between schizophrenia and these oculomotor markers is largely unknown. Here, we tested whether schizophrenia polygenic risk scores (PRS) were associated with oculomotor performance in the general population.
Methods
Analyses were based on the data of 2956 participants (aged 30–95) of the Rhineland Study, a community-based cohort study in Bonn, Germany. Genotyping was performed on Omni-2.5 exome arrays. Using summary statistics from a recent meta-analysis based on the two largest schizophrenia genome-wide association studies to date, we quantified genetic risk for schizophrenia by creating PRS at different p value thresholds for genetic markers. We examined associations between PRS and oculomotor performance using multivariable regression models.
Results
Higher PRS were associated with higher antisaccade error rate and latency, and lower antisaccade amplitude gain. PRS showed inconsistent patterns of association with smooth pursuit velocity gain and were not associated with saccade rate during smooth pursuit or performance on a prosaccade control task.
Conclusions
There is an overlap between genetic determinants of schizophrenia and oculomotor endophenotypes. Our findings suggest that the mechanisms that underlie schizophrenia also affect oculomotor function in the general population.
In this paper, we propose a frequency-reconfigurable antenna structure consisting of a dielectric resonator (DR) topped by a superstrate material. Two metasurfaces (MSs) are placed upon the DR and the superstrate, where these two MSs are utilized to synthesize a localized reduction of the dielectric constant of the DR. By placing switches into one of the MSs, the distribution of dielectric constant of the DR can be switched to one of two predefined distributions, which is equivalent to switching the DR length to two different lengths. Consequently, the frequency response of the proposed structure can be tuned to one of two operating bands. The excited modes inside the proposed antenna were obtained analytically and through simulations. Also, the dielectric constant value of substrates topped by MSs was analyzed. The antenna was fabricated and measured, and good agreement between simulation and measurement was attained. The antenna bandwidths are 7–8.1 GHz (14.7%) and 8.5–9.2 GHz (8%) and the gains are 5.1 and 7.8 dB, in the cases of having switches off and on, respectively.
In this paper, a reduced-size dielectric resonator antenna with switchable diversity patterns is proposed. Ring- and linear-shaped slots are etched in the ground plane of the antenna so as to generate two modes $TE_{\delta 11}^x$ and $TE_{\delta 12}^x$ at a center frequency of 19 GHz. Moreover, two groups of PIN diodes are integrated into these slots to short one group of slots, and let the other group generates the required mode. Thus, the antenna is able to generate two switchable patterns with an envelope correlation coefficient of 0.4. Furthermore, the antenna size is reduced to half of its original size by placing a copper sheet over certain plane of the antenna structure. The antenna achieves wide bandwidths of 17.6–20.9 GHz (17.1$\percnt $) and 18.3–21.6 GHz (13.8$\percnt $) in cases of exciting $TE_{\delta 11}^x$ and $TE_{\delta 12}^x$ modes, respectively. The antenna also attainsa high gain of 7.1 and 3.2 dB at the center frequency.
The present analysis has been developed to investigate the heat transfer phenomenon in peristaltic flow of Carreau fluid in a curved channel with rhythmic contraction and expansion of waves along the walls (similar to blood flow in tubes). Magnetic field is imposed in radial direction. The heat transfer aspect is further studied with viscous dissipation effect. The curved channel walls are influenced by flow and thermal partial slip. In addition the flow stream comprised porous medium. The system of relevant non-linear PDEs have been reduced to ODEs by utilizing the long wavelength approximation. The striking features of flow and temperature characteristics under the involved parameters are examined by plotting graphs. The generation of fluid temperature and velocity due to viscous dissipation and gravitational efforts are recorded respectively. Moreover indicated results signify activation of velocity, temperature and heat transfer rate with Darcy number.
Across the history of radiotherapy, with gradual technological progress and various methods of irradiation, the purpose has always been to deliver homogeneously 100% of the prescribed dose to 100% of the target volume containing the identifiable tumour and/or tumour cells potentially present while limiting the dose to adjacent normal tissues.
Material and methods
The formula for triple point conformity scale is: CS3=(V95+V100+V105)/3VT. (a) Lower limit determination: CS3=(VT+0·93 VT+0·0)/3VT=0·643; (b) Upper limit determination: in order to find out an empirical relation in between V105 and VT, we studied over 593 cancer patients of various sites by taking planning target volume as target, and an empirical relation is derived out as: V105/VT=0·0007. Hence, CS3=(VT+VT+0·0007 VT)/3VT=0·6667~0·667.
Result
Upper and lower limits of CS3 have been calculated at 0·643 and 0·667, respectively. Maximum value of CS3 index is recorded 0·656 while minimum value is 0·478.
Discussion
The CS3 scale constitutes an attractive tool because it could facilitate decisions during analysis of various treatment plans proposed for conformal radiotherapy. Its major advantages are its simplicity and integration of multiple parameters.
Conclusion
The triple point conformity scale (CS3) provides better qualitative information about radiotherapy plans as compared to other conformity indices. This study advises the users to use the CS3 scale to evaluate a conformal radiotherapy plan which encompasses a wide range of relevant clinical volumes, and is able to extract qualitative dosimetric information.
The Khyber Pakhtunkhwa province of North-West Pakistan has endured increased levels of violence in recent years. The psychological sequelae of such trauma including the presence of dissociative symptoms has been minimally investigated to date. The study examines psychopathology experienced including the presence of dissociative symptoms, and ascertain what factors are potentially predictive of these symptoms.
Method
Third-level students (n=303) completed psychometric instruments relating to their experience of traumatic events and assessed depression, anxiety and dissociative symptoms.
Results
Symptoms suggestive of post-traumatic stress disorder were evident in 28% of individuals. Symptoms relating to intrusive experiences and alterations in reactivity predicted dissociative, depressive and anxiety symptoms (p<0.01).
Conclusion
Trauma related to violence in this study was associated with significant pathology including dissociative symptoms. Identification and subsequent treatment of dissociative symptoms in individuals who have experienced trauma, may have a significant ameliorating effect on levels of functioning and thus should be included in clinical assessment.