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Importance of Participant-Centricity and Trust for a Sustainable Medical Information Commons
- Amy L. McGuire, Mary A. Majumder, Angela G. Villanueva, Jessica Bardill, Juli M. Bollinger, Eric Boerwinkle, Tania Bubela, Patricia A. Deverka, Barbara J. Evans, Nanibaa' A. Garrison, David Glazer, Melissa M. Goldstein, Henry T. Greely, Scott D. Kahn, Bartha M. Knoppers, Barbara A. Koenig, J. Mark Lambright, John E. Mattison, Christopher O'Donnell, Arti K. Rai, Laura L. Rodriguez, Tania Simoncelli, Sharon F. Terry, Adrian M. Thorogood, Michael S. Watson, John T. Wilbanks, Robert Cook-Deegan
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- Journal:
- Journal of Law, Medicine & Ethics / Volume 47 / Issue 1 / Spring 2019
- Published online by Cambridge University Press:
- 01 January 2021, pp. 12-20
- Print publication:
- Spring 2019
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- Article
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Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons (MIC). We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.
6 - Early Interventions for Trauma-Related Problems
- from Part III - Clinical Care and Interventions
- Edited by Robert J. Ursano, Carol S. Fullerton, Uniformed Services University of the Health Sciences, Maryland, Lars Weisaeth, Universitetet i Oslo, Beverley Raphael, Australian National University, Canberra
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- Book:
- Textbook of Disaster Psychiatry
- Published online:
- 02 June 2017
- Print publication:
- 23 May 2017, pp 87-100
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Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- Book:
- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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Assessment and Treatment of Adult Acute Responses to Traumatic Stress Following Mass Traumatic Events
- Patricia J. Watson, Arieh Y. Shalev
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- Journal:
- CNS Spectrums / Volume 10 / Issue 2 / February 2005
- Published online by Cambridge University Press:
- 07 November 2014, pp. 123-131
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Assessment and treatment of acute responses to traumatic stress has received much attention since September 11, 2001. This article elucidates principles of early intervention with adults in the immediate (within 48 hours) and early recovery phase (within the first week). The principles have been drawn from research on risk and recover factors, stress and traumatic stress theory, and expert consensus recommendations. The debriefing model is discussed, and principle interventions of psychological first aid, pharmacology, and mass trauma systems are described. This article concludes with brief guidelines for longer-term interventions and recommendations for future research.
6 - Religious and spiritual factors in resilience
- from Section 1 - Pathways to resilience
- Edited by Steven M. Southwick, Brett T. Litz, Boston University, Dennis Charney, Matthew J. Friedman
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- Book:
- Resilience and Mental Health
- Published online:
- 07 September 2011
- Print publication:
- 18 August 2011, pp 90-102
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Summary
Introduction
This chapter will examine how religion/spirituality plays an important role as a resource used by most people in coping with the immediate, as well as longer-term, consequences of highly stressful or traumatic experiences. First, working definitions of the key concepts of resilience and religion/spirituality will be given. Distinctions are made between definitions for general communications and operational definitions suitable for clinical and research purposes. Spirituality is conceptualized as a dynamic process that is an integral and inseparable part of humanity. A current conceptual model of spirituality as being multidimensional in nature is presented, and core dimensions are described. Findings from a selective review of current studies on religion and/or spirituality and resilience are presented. Four key obstacles, or “spiritual red flags,” are identified, and a group therapy module for addressing them is presented. Finally, conclusions about our current knowledge, as well as recommendations for future clinical and research applications are made.
Spirituality is acknowledged as an important part of life by most individuals. Annual Gallup polls consistently show that more than 90% of the US population report a “belief in God,” and approximately 70% report affiliation with a faith community and attending religious services. In addition, religion or spirituality has been consistently linked to positive mental (Nooney & Woodrum, 2002) and physical (Powell et al., 2003) health functioning, as well as increased longevity (Oxman et al., 1995). When mental health services are sought, clergy are most frequently the first point of contact, with more than 40% seeking counseling from them rather than mental health providers (Weaver et al., 1997). In the immediate aftermath of the terrorist attacks of September 11 2001, more than 90% of those surveyed reported that they coped by “turning to religion,” second only to “talking with others,” which was endorsed by 98% (Schuster et al., 2001). However, despite the widely recognized positive aspects of religion or spirituality, there are large gaps in our scientific knowledge of the dynamic processes of spirituality that could explain these relationships.
Contributors
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- By Brian Abaluck, Imran M. Ahmed, Torbjörn Åkerstedt, Sonia Ancoli-Israel, Anna Anund, Donna L. Arand, Isabelle Arnulf, Fiona C. Baker, Thomas J. Balkin, Christian R. Baumann, Michel Billiard, Michael H. Bonnet, Meredith Broderick, Christian Cajochen, Scott S. Campbell, Sarah Laxhmi Chellappa, Fabio Cirignotta, Yves Dauvilliers, David F. Dinges, Christopher L. Drake, Neil T. Feldman, Catherine S. Fichten, Charles F. P. George, Namni Goel, Christian Guilleminault, Shelby F. Harris, Melinda L. Jackson, Joseph Kaleyias, Göran Kecklund, William D. S. Killgore, Sanjeev V. Kothare, Andrew D. Krystal, Clete A. Kushida, Luc Laberge, Gert Jan Lammers, Christopher P. Landrigan, Sandrine H. Launois, Patrick Levy, Eva Libman, Yinghui Low, Jennifer L. Martin, Una D. McCann, Renee Monderer, Patricia J. Murphy, Sona Nevsimalova, Seiji Nishino, Eric A. Nofzinger, Maurice M. Ohayon, Masashi Okuro, Jean-Louis Pepin, Fabio Pizza, Anil N. Rama, David B. Rye, Paula K. Schweitzer, Hideto Shinno, Renaud Tamsier, Michael J. Thorpy, Astrid van der Heide, Hans P. A. Van Dongen, Mari Viola-Saltzman, Jim Waterhouse, Nathaniel F. Watson, Rajive Zachariah
- Edited by Michael J. Thorpy, Michel Billiard
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- Book:
- Sleepiness
- Published online:
- 04 February 2011
- Print publication:
- 27 January 2011, pp vii-x
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Part III - Clinical care and interventions
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- By Patricia J. Watson, National Center for PTSD VA Medical
- Edited by Robert J. Ursano, Uniformed Services University of the Health Sciences, Maryland, Carol S. Fullerton, Uniformed Services University of the Health Sciences, Maryland, Lars Weisaeth, Universitetet i Oslo, Beverley Raphael, University of Western Sydney
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- Book:
- Textbook of Disaster Psychiatry
- Published online:
- 09 August 2009
- Print publication:
- 01 November 2007, pp 119-120
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6 - Early intervention for trauma-related problems following mass trauma
- from Part III - Clinical care and interventions
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- By Patricia J. Watson, National Center for PTSD VA Medical
- Edited by Robert J. Ursano, Uniformed Services University of the Health Sciences, Maryland, Carol S. Fullerton, Uniformed Services University of the Health Sciences, Maryland, Lars Weisaeth, Universitetet i Oslo, Beverley Raphael, University of Western Sydney
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- Book:
- Textbook of Disaster Psychiatry
- Published online:
- 09 August 2009
- Print publication:
- 01 November 2007, pp 121-139
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Summary
This chapter addresses public mental health interventions in the immediate phase following disasters and mass violence. Studies on the relative contribution of early arousal to subsequent post-traumatic stress disorder (PTSD), and the possible pharmacological strategies to reduce expressed adrenergic activity, suggest that the initial stress response is a necessary but insufficient cause of traumatic stress disorders. Social resources, such as social support, socioeconomic status, and access to services, have shown strong effects on mental health and played a variety of roles in the stress process. While offering cognitive-behavioral therapy (CBT)-based trauma-focused interventions may be helpful for some disaster survivors in the first month after the trauma, it may be lower on the hierarchy of needs for survivors faced with complex and chronic stressors. Further research into the needs of disaster-affected populations will help guide the timing of interventions, of both early and later-stage interventions after disasters.
5 - Local regulators of bone turnover
- Edited by Janet E. Henderson, McGill University, Montréal, David Goltzman, McGill University, Montréal
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- Book:
- The Osteoporosis Primer
- Published online:
- 01 June 2011
- Print publication:
- 24 August 2000, pp 64-72
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Summary
Introduction
To attempt to understand a disease such as osteoporosis, we must come to a complete elucidation of the nature or pathology of the disorder, the cellular mechanisms whereby the pathology develops and, lastly, what caused the cellular machinery to go awry in the first place (e.g., control by genes, hormones, growth factors, vitamins, minerals, etc.). While many investigators may still disagree on a unified definition of osteoporosis which fully describes its pathology, for a number of years now we have fairly well understood the nature of the disease, and to describe the gross cellular mechanisms which do go awry. That is to say that we can all agree that the end result of undermineralized bone is due to a chronic imbalance of skeletal turnover whereby more mineral is removed than is incorporated into the matrix. It is only recently, however, that we have been able to tackle why the cellular machinery goes wrong, and that has resulted from a clearer understanding of the role(s) of growth factors and cytokines in the skeletal microenvironment. Both bone itself and the bone marrow compartment produce, store, and are influenced by a plethora of cytokines, stem factors and growth factors. However, in this brief chapter we will concentrate on those factors which are known to be both produced and stored within the matrix of bone itself; these are the insulin-like growth factors (IGFs), fibroblast growth factors (FGFs), transforming growth factor-β (TGF-β), and the bone morphogenic proteins (BMPs).
3 - Psychological first aid
- Edited by Michael Blumenfield, New York Medical College, Robert J. Ursano, Uniformed Services University of the Health Sciences, Maryland
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- Book:
- Intervention and Resilience after Mass Trauma
- Published online:
- 14 January 2010
- Print publication:
- 01 January 2000, pp 69-84
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Summary
Introduction
The management of acute stress reactions following disasters and mass violence generally aims to foster resiliency, prevent chronic emotional problems, and minimize long-term deterioration in quality of life following the trauma exposure. Although it is widely believed by traumatic stress specialists that early intervention can help prevent longer-term problems, evidence addressing this belief is limited at present.
This chapter will review the current empirical literature on early interventions following mass violence, and describe the principles of a consensus-recommended intervention called “psychological first aid.”
Background research: effects of disasters
Researchers wishing to conduct studies on acute interventions following disaster face many methodological challenges. Early interventions typically take place in chaotic and uncontrolled settings, with little pre-planning, funding or co-ordination between researchers and interventionists, a focus on action and assistance rather than research, and cross-community barriers between local responders and external researchers. Therefore, in the absence of well-controlled intervention studies, an initial examination of the effects of disasters, as well as risk and protective factors, has often been the basis for developing interventions that foster identified protective factors and ameliorate vulnerability factors.
Rates of traumatic stress disorders and functional impairment in the general population following disaster or mass violence may be somewhat low over time, as evidenced by recent epidemiological studies following the September 11 terrorism attack in New York (Galea et al., 2002). Galea found a sharp decline in post-traumatic stress disorder (PTSD) symptoms in New York over the course of 6 months, from 7.5% to 0.6%.