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Understanding Modern Warfare has established itself as a leading text in professional military education and undergraduate teaching. This third edition has been revised throughout to reflect dramatic changes during the past decade. Introducing three brand new chapters, this updated volume provides in-depth analysis of the most pertinent issues of the 2020s and beyond, including cyber warfare, information activities, hybrid and grey zone warfare, multi-domain operations and recent conflicts in Ukraine, Gaza, and Syria. It also includes a range of features to maximise its value as a learning tool: a structure designed to guide students through key strategic principles; key questions and annotated reading guides for deeper understanding; text boxes highlighting critical thinkers and operational concepts; and a glossary explaining key terms. Providing debate driven analysis that encourages students to develop a balanced perspective, Understanding Modern Warfare remains essential reading both for officers and for students of international relations more broadly.
This book offers new ideas for aligning the American healthcare system to optimize health for everyone. Bridging real-world examples and innovative strategies, it leverages a patient-centric framework to explore healthcare lifecycles and identify primary groups in its ecosystem. Chapters explore critical topics from a comparative global perspective, including the role of government in driving access, the private sector's contribution to quality, and the value of integrating social determinants in policy to achieve health equity. By advocating for public-private collaboration, this work presents actionable solutions to challenges facing the country's modern healthcare system such as resource allocation and long wait times. Designed for healthcare professionals, policymakers, and advocates, it highlights the need for bipartisan approaches, cutting-edge patient care models, and the integration of empathy and culture in healthcare delivery. Addressing affordability, equity, and inclusivity, this book equips readers with a roadmap for reimagining healthcare systems that truly serve everyone.
Landscape evolution in karst terrains affects both subterranean and surface settings. For better understanding of controlling processes and connections between the two, multiple geochronometers were used to date sediments and speleothems in upper-level passages of Fitton Cave adjacent to the Buffalo River, northern Arkansas, within the southern Ozark Plateau. Burial cosmogenic-nuclide dating of coarse sediments indicates that gravel pulses washed into upper passages at 2.2 Ma and 1.25 Ma. These represent the oldest epigenetic cave deposits documented in this region. Associated sands and clay-rich sediments mostly have reversed magnetic polarity and thermally transferred optically stimulated luminescence dates of 1.2 to 1.0 Ma. Abandonment of these upper passages began before 0.72 Ma, when coarse sediment was deposited in a passage incised below older sediment. Maximum U-series dates of 0.7–0.4 Ma for flowstones capping clastic deposits mark the stabilization of older sediments and a change to vadose conditions that allowed post–0.4 Ma stalagmite growth. Resulting valley incision rates since 0.85 Ma are estimated at 27 m/Ma. Coarse cave-sediment pulses correlate to Laurentide glacial tills about 300 km to the north, suggesting climate influence on periglacial sediment production. Dated cave sediments also may correlate with undated older strath terraces preserved at similar heights above the Buffalo River.
Vitamin D deficiency is highly prevalent in the UK (1-2). Low exposure to the sun in winter months, as well as higher risk of deficiency amongst some ethnic minority populations (1), means that fortification of food and beverages remains an important potential route to ensure optimal vitamin D status. However, it is unclear as to whether type of fortified food affects ability to raise vitamin D status. Animal foods (e.g. dairy foods) would be expected to lead to higher vitamin D absorption than would non-animal-based foods (e.g. bread, juice), due to their higher fat content. The primary aim of this systematic review and meta-analysis was to investigate the effectiveness of animal and non-animal-based vitamin D fortified foods on raising serum 25-hydroxyvitamin D (25(OH)D).
The literature search was conducted using PubMed on 23 January 2024. Inclusion criteria were as follows: data on non-pregnant/non-lactating adults or data on children, randomised controlled trial; data for 25(OH)D measurement. Initial search results retrieved 701 publications, and 593 ineligible records were removed. Next, 108 records were screened by title and abstract, with 63 records excluded, for the following reasons: off topic (n=54); pregnant or breastfeeding (n=6); non-human (n=1); preterm infants (n=1) and duration <4 weeks (n=1). After full text eligibility screening, 28 publications remained for systematic review and meta-analysis. Ethical approval was not required as this was a literature review.
The end point data meta-analysis showed (for all studies combined) a significant increase in 25(OH)D (+23.4 (95% CI 17.0, 29.7) nmol/L (24 studies)). For specific food types, results were as follows: ‘animal’ +21.7 (95% CI 14.1, 29.3) nmol/L (17 studies); mixture of ‘animal’ and ‘non-animal’ +26.1 (95% CI 10.8, 41.4) nmol/L (1 study); ‘non-animal’ +28.1 (95% 12.0, 44.2) nmol/L (6 studies).
Contrary to what would be expected, non-animal mode of fortification (e.g. bread, juice) had a similar effect size to animal modes (e.g. dairy), so can be considered equivalent in effectiveness in raising 25(OH)D concentration. Differences in dose, duration and population groups between the non-animal and animal modes (in terms of health and baseline vitamin D status) mean the results should be taken with caution, and future studies where these factors are standardised could be useful to provide further evidence of effectiveness.
Functional impairment in daily activities, such as work and socializing, is part of the diagnostic criteria for major depressive disorder and most anxiety disorders. Despite evidence that symptom severity and functional impairment are partially distinct, functional impairment is often overlooked. To assess whether functional impairment captures diagnostically relevant genetic liability beyond that of symptoms, we aimed to estimate the heritability of, and genetic correlations between, key measures of current depression symptoms, anxiety symptoms, and functional impairment.
Methods
In 17,130 individuals with lifetime depression or anxiety from the Genetic Links to Anxiety and Depression (GLAD) Study, we analyzed total scores from the Patient Health Questionnaire-9 (depression symptoms), Generalized Anxiety Disorder-7 (anxiety symptoms), and Work and Social Adjustment Scale (functional impairment). Genome-wide association analyses were performed with REGENIE. Heritability was estimated using GCTA-GREML and genetic correlations with bivariate-GREML.
Results
The phenotypic correlations were moderate across the three measures (Pearson’s r = 0.50–0.69). All three scales were found to be under low but significant genetic influence (single-nucleotide polymorphism-based heritability [h2SNP] = 0.11–0.19) with high genetic correlations between them (rg = 0.79–0.87).
Conclusions
Among individuals with lifetime depression or anxiety from the GLAD Study, the genetic variants that underlie symptom severity largely overlap with those influencing functional impairment. This suggests that self-reported functional impairment, while clinically relevant for diagnosis and treatment outcomes, does not reflect substantial additional genetic liability beyond that captured by symptom-based measures of depression or anxiety.
Next-generation X-ray satellite telescopes such as XRISM, NewAthena and Lynx will enable observations of exotic astrophysical sources at unprecedented spectral and spatial resolution. Proper interpretation of these data demands that the accuracy of the models is at least within the uncertainty of the observations. One set of quantities that might not currently meet this requirement is transition energies of various astrophysically relevant ions. Current databases are populated with many untested theoretical calculations. Accurate laboratory benchmarks are required to better understand the coming data. We obtained laboratory spectra of X-ray lines from a silicon plasma at an average spectral resolving power of $\sim$7500 with a spherically bent crystal spectrometer on the Z facility at Sandia National Laboratories. Many of the lines in the data are measured here for the first time. We report measurements of 53 transitions originating from the K-shells of He-like to B-like silicon in the energy range between $\sim$1795 and 1880 eV (6.6–6.9 Å). The lines were identified by qualitative comparison against a full synthetic spectrum calculated with ATOMIC. The average fractional uncertainty (uncertainty/energy) for all reported lines is ${\sim}5.4 \times 10^{-5}$. We compare the measured quantities against transition energies calculated with RATS and FAC as well as those reported in the NIST ASD and XSTAR’s uaDB. Average absolute differences relative to experimentally measured values are 0.20, 0.32, 0.17 and 0.38 eV, respectively. All calculations/databases show good agreement with the experimental values; NIST ASD shows the closest match overall.
Parent depression is a well-established prospective risk factor for adverse offspring mental health. Multiple lines of evidence suggest that improvements in parent depression predicts improved offspring mental health. However, no systematic review has examined the impact on offspring of psychological treatment of purely parent depression after the postnatal period.
Aims:
To systematically review the literature of randomised controlled trials examining the impact on offspring mental health outcomes of psychological interventions for parental depression after the postnatal period.
Method:
We pre-registered our systematic review on PROSPERO (CRD42023408953), and searched the METAPSY database in April 2023 and October 2024, for randomised controlled trials of psychological interventions for adults with depression, which also included a child mental health or wellbeing outcome. We double screened 938 studies for inclusion using the ‘Paper in a Day’ approach. All included studies would be rated using the Cochrane Risk of Bias tool.
Results:
We found no studies that met our inclusion criteria.
Conclusions:
Robust research into psychological therapy for depression in adults outside the postnatal period has failed to consider the potential benefits for the children of those adults. This is a missed clinical opportunity to evaluate the potential preventive benefits for those children at risk of adverse psychological outcomes, and a missed scientific opportunity to test mechanisms of intergenerational transmission of risk for psychopathology. Seizing the clinical and scientific opportunities would require adult-focused mental health researchers to make inexpensive additions of child mental health outcomes measures to their evaluation projects.
Adverse childhood experiences (ACEs) are associated with physical and mental health difficulties in adulthood. This study examines the associations of ACEs with functional impairment and life stress among military personnel, a population disproportionately affected by ACEs. We also evaluate the extent to which the associations of ACEs with functional outcomes are mediated through internalizing and externalizing disorders.
Methods
The sample included 4,666 STARRS Longitudinal Study (STARRS-LS) participants who provided information about ACEs upon enlistment in the US Army (2011–2012). Mental disorders were assessed in wave 1 (LS1; 2016–2018), and functional impairment and life stress were evaluated in wave 2 (LS2; 2018–2019) of STARRS-LS. Mediation analyses estimated the indirect associations of ACEs with physical health-related impairment, emotional health-related impairment, financial stress, and overall life stress at LS2 through internalizing and externalizing disorders at LS1.
Results
ACEs had significant indirect effects via mental disorders on all functional impairment and life stress outcomes, with internalizing disorders displaying stronger mediating effects than externalizing disorders (explaining 31–92% vs 5–15% of the total effects of ACEs, respectively). Additionally, ACEs exhibited significant direct effects on emotional health-related impairment, financial stress, and overall life stress, implying ACEs are also associated with these longer-term outcomes via alternative pathways.
Conclusions
This study indicates ACEs are linked to functional impairment and life stress among military personnel in part because of associated risks of mental disorders, particularly internalizing disorders. Consideration of ACEs should be incorporated into interventions to promote psychosocial functioning and resilience among military personnel.
Family dynamics can significantly influence entrepreneurship, yet the temporal complexities of this relationship remain inadequately explored. This special issue addresses this gap by emphasizing the intricate interplay between internal family evolvability such as generational transitions and identity shifts, cultural continuity, and external adaptability to rapidly changing economic, institutional, and technological contexts in China. We introduce a dual tuning model that highlights how entrepreneurial and family firms (FFs) strategically synchronize their internal and external temporal rhythms to manage conflicts and optimize performance. This lead article reviews existing literature, articulates the dual tuning model, and synthesizes insights from the articles in this special issue to illuminate how Chinese FFs navigate tensions between evolving internal dynamics and external market demands. We conclude by identifying promising future research avenues that leverage this temporal perspective to deepen our understanding of family dynamics and entrepreneurship in China.
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.
Most cognitive studies of bipolar disorder (BD) have examined case–control differences on cognitive tests using measures of central tendency, which do not consider intraindividual variability (IIV); a distinct cognitive construct that reliably indexes meaningful cognitive differences between individuals. In this study, we sought to characterize IIV in BD by examining whether it differs from healthy controls (HCs) and is associated with other cognitive measures, clinical variables, and white matter microstructure.
Methods
Two hundred and seventeen adults, including 100 BD outpatients and 117 HCs, completed processing speed, sustained attention, working memory, and executive function tasks. A subsample of 55 BD participants underwent diffusion tensor imaging. IIV was operationalized as the individual standard deviation in reaction time on the Continuous Performance Test-Identical Pairs version.
Results
BD participants had significantly increased IIV compared to age-matched controls. Increased IIV was associated with poorer mean performance scores on processing speed, sustained attention, working memory, and executive function tasks, as well as two whole-brain white matter indices: fractional anisotropy and radial diffusivity.
Conclusions
IIV is increased in BD and appears to correlate with other cognitive variables, as well as white matter measures that index reduced structural integrity and demyelination. Thus, IIV may represent a neurobiologically informative cognitive measure for BD research that is worthy of further investigation.
This study examined whether supplementation with collagen peptides (CP) affects appetite and post-exercise energy intake in healthy active females.
In this randomised, double-blind crossover study, 15 healthy females (23 ± 3 y) consumed 15 g/day of CP or a taste matched non-energy control (CON) for 7 days. On day 7, participants cycled for 45 min at ∼55% Wmax, before consuming the final supplement. Sixty min post supplementation an ad libitum meal was provided, and energy intake recorded. Subjective appetite sensations were measured daily for 6 days (pre- and 30 min post-supplement), and pre (0 min) to 280 min post-exercise on day 7. Blood glucose and hormone concentrations (total ghrelin, glucagon-like peptide-1 (GLP-1), and peptide YY (PYY), cholecystokinin (CCK), dipeptidyl peptidase-4 (sDPP4), leptin, and insulin, were measured fasted at baseline (day 0), then pre-breakfast (0 min), post-exercise (100 min), post-supplement (115, 130, 145, 160 min) and post-meal (220, 280 min) on day 7.
Ad-libitum energy intake was ∼10% (∼41kcal) lower in the CP trial (P=0.037). There was no difference in gastrointestinal symptoms or subjective appetite sensations throughout the trial (P≥0.412). Total plasma GLP-1 (area under the curve, CON: 6369±2330; CP: 9064±3021 pmol/L; P<0.001) and insulin (+80% at peak) were higher after CP (P<0.001). Plasma ghrelin and leptin were lower in CP (condition effect; P≤0.032). PYY, CCK, sDPP4 and glucose were not different between CP and placebo (P≥0.100).
CP supplementation following exercise increased GLP-1 and insulin concentrations and reduced ad libitum energy intake at a subsequent meal in physically active females.
We compare the Emory 10-item, 4-choice Rey Complex Figure (CF) Recognition task with the Meyers and Lange (M&L) 24-item yes/no CF Recognition task in a large cohort of healthy research participants and in patients with heterogeneous movement disorder diagnoses. While both tasks assess CF recognition, they differ in key aspects including the saliency of target and distractor responses, self-selection versus forced-choice formats, and the length of the item sets.
Participants and Methods:
There were 1056 participants from the Emory Healthy Brain Study (EHBS; average MoCA = 26.8, SD = 2.4) and 223 movement disorder patients undergoing neuropsychological evaluation (average MoCA = 24.3, SD = 4.0).
Results:
Both recognition tasks differentiated between healthy and clinical groups; however, the Emory task demonstrated a larger effect size (Cohen’s d = 1.02) compared to the M&L task (Cohen’s d = 0.79). d-prime scoring of M&L recognition showed comparable group discrimination (Cohen’s d = 0.81). Unidimensional two-parameter logistic item response theory analysis revealed that many M&L items had low discrimination values and extreme difficulty parameters, which contributed to the task’s reduced sensitivity, particularly at lower cognitive proficiency levels relevant to clinical diagnosis. Dimensionality analyses indicated the influence of response sets as a potential contributor to poor item performance.
Conclusions:
Emory CF Recognition task demonstrates superior psychometric properties and greater sensitivity to cognitive impairment compared to the M&L task. Its ability to more precisely measure lower levels of cognitive functioning, along with its brevity, suggests it may be more effective for diagnostic use, especially in clinical populations with cognitive decline.
For Stokes waves in finite depth within the neighbourhood of the Benjamin–Feir stability transition, there are two families of periodic waves, one modulationally unstable and the other stable. In this paper we show that these two families can be joined by a heteroclinic connection, which manifests in the fluid as a travelling front. By shifting the analysis to the setting of Whitham modulation theory, this front is in wavenumber and frequency space. An implication of this jump is that a permanent frequency downshift of the Stokes wave can occur in the absence of viscous effects. This argument, which is built on a sequence of asymptotic expansions of the phase dynamics, is confirmed via energetic arguments, with additional corroboration obtained by numerical simulations of a reduced model based on the Benney–Roskes equation.
Threat sensitivity, an individual difference construct reflecting variation in responsiveness to threats of various types, predicts physiological reactivity to aversive stimuli and shares heritable variance with anxiety disorders in adults. However, no research has been conducted yet with youth to examine the heritability of threat sensitivity or evaluate the role of genetic versus environmental influences in its relations with mental health problems. The current study addressed this gap by evaluating the psychometric properties of a measure of this construct, the 20-item Trait Fear scale (TF-20), and examining its phenotypic and genotypic correlations with different forms of psychopathology in a sample of 346 twin pairs (121 monozygotic), aged 9–14 years. Analyses revealed high internal consistency and test-retest reliability for the TF-20. Evidence was also found for its convergent and discriminant validity in terms of phenotypic and genotypic correlations with measures of fear-related psychopathology. By contrast, the TF-20’s associations with depressive conditions were largely attributable to environmental influences. Extending prior work with adults, current study findings provide support for threat sensitivity as a genetically-influenced liability for phobic fear disorders in youth.
Multicenter clinical trials are essential for evaluating interventions but often face significant challenges in study design, site coordination, participant recruitment, and regulatory compliance. To address these issues, the National Institutes of Health’s National Center for Advancing Translational Sciences established the Trial Innovation Network (TIN). The TIN offers a scientific consultation process, providing access to clinical trial and disease experts who provide input and recommendations throughout the trial’s duration, at no cost to investigators. This approach aims to improve trial design, accelerate implementation, foster interdisciplinary teamwork, and spur innovations that enhance multicenter trial quality and efficiency. The TIN leverages resources of the Clinical and Translational Science Awards (CTSA) program, complementing local capabilities at the investigator’s institution. The Initial Consultation process focuses on the study’s scientific premise, design, site development, recruitment and retention strategies, funding feasibility, and other support areas. As of 6/1/2024, the TIN has provided 431 Initial Consultations to increase efficiency and accelerate trial implementation by delivering customized support and tailored recommendations. Across a range of clinical trials, the TIN has developed standardized, streamlined, and adaptable processes. We describe these processes, provide operational metrics, and include a set of lessons learned for consideration by other trial support and innovation networks.
This article describes the Implementation Science (IS) Scholars Program at the University of Arkansas for Medical Sciences (UAMS). The program’s goal is to translate knowledge, approaches, and methods from IS to front-line clinicians in an academic medical center, thereby supporting its goals as a learning health system and promoting a dynamic workforce of IS-informed change leaders. Initiated in 2020, the program is relatively unique in that it attempts to translate concepts and knowledge from IS to clinicians to improve their skills as implementers and change agents. The program is supported by the Translational Research Institute, the UAMS’ awardee of the Clinical and Translational Science Award Program. The two-year program provides 20% salary coverage, bespoke didactics, and close mentoring on a Scholar-initiated project to improve care in their clinical context. The program has trained four cohorts of Scholars over the program’s initial five years. We describe the program, our evaluation of it thus far, and future plans. The program has contributed to numerous healthcare improvements and served as a gateway to future implementation and other research activities among some Scholars.
Following the recent report of strongyloidiasis caused by Strongyloides fuelleborni within a semi-captive colony of baboons in a UK safari park, we investigated the genetic relationships of this isolate with other Strongyloides isolates across the world. Whole-genome sequencing data were generated with later phylogenetic analysis of mitochondrial (mt) cytochrome oxidase subunit 1 (cox1) and nuclear ribosomal 18S sequences against 300 published Strongyloides reference genotypes. The putative African origin of the UK S. fuelleborni was confirmed and full-length mt genome sequences were assembled to facilitate a more detailed phylogenetic analysis of 14 mt coding regions against all available Strongyloides species. Our analyses demonstrated that the UK isolate represented a novel African lineage not previously described. Additional complete mt genomes were assembled for several individual UK safari park worms to reveal a slightly altered mt genome gene arrangement, allowing clear separation from Asian S. fuelleborni. Furthermore, these UK worms possessed expanded intergenic regions of unknown function that increase their mt genome size to approximately 24 kilobases (kb) as compared with some 16 kb for Asian S. fuelleborni; this may have arisen from unique populational founder and genetic drift effects set within the peculiar mixed species baboon and drill ancestry of this semi-captive primate colony. A maximum likelihood phylogeny constructed from 14 mt coding regions also supported an evolutionary distinction between Asian and African S. fuelleborni.
We report the lattice parameters and cell volume for cristobalite powder added at 35 wt% to Ba-Al-Silicate glass (CGI930) as reflowed bulk glass bars where the embedded cristobalite phase is constrained within the glass matrix. Analysis confirms that the room temperature lattice parameters and cell volume obtained for the bulk glass–ceramic are larger compared with single-phase cristobalite powders. The increased volume of the cristobalite phase in a glass matrix is driven by tensile stresses developed at the interface between the cristobalite and matrix glass phase, and this stress impacts the phase transition temperature and thermal hysteresis of the cristobalite phase. In situ high-temperature measurements confirm that the tetragonal to cubic α–β phase transformation of the cristobalite phase within the glass matrix is ~195 °C with complete suppression of hysteresis behavior. In contrast, bulk glass–ceramic material ground to a powder form displays the expected thermal hysteresis behavior and more comparable phase transition temperatures of 245 °C on heating and 220 °C on cooling. Isothermal holds at varying temperatures above or near the α–β phase transition suggest that the cristobalite phase does not undergo significant relaxation within the matrix phase to reduce accumulated stress imposed by the constraining matrix glassy phase.