OBJECTIVES/GOALS: Cognitive Processing Therapy (CPT) is a cognitive behavioral treatment for posttraumatic stress disorder (PTSD). CPT is effective in treating combat-related PTSD among Veterans and active duty service members. It is unknown whether improvement in PTSD is related to accommodation of patient preference of the modality of therapy, such as in-office, telehealth, and in-home settings. An equipoise-stratified randomization design allows for complete randomization of participants who are interested and eligible for all three treatment arms. It also allows participants to reject one treatment arm if they are not interested or eligible. Participants who elect to opt out of one arm are randomized to one of the two remaining treatment arms. The primary aim of this study was to evaluate differences in patient satisfaction, treatment stigma beliefs, and credibility beliefs based on patient treatment modality preference. The second aim of this study was to examine if baseline satisfaction, stigma beliefs, and credibility beliefs predicted PTSD treatment outcomes. METHODS/STUDY POPULATION: Active duty service members and veterans with PTSD (N = 123) were randomized to one of three arms using an equipoise stratified randomization. Participants underwent diagnostic interviews for PTSD at baseline and post-treatment and completed self-report measures of satisfaction, stigma, credibility and expectancies of therapy. RESULTS/ANTICIPATED RESULTS: A series of ANOVAs indicated that there were group differences on patient stigma beliefs regarding mental health, F = 5.61, p = .001, and therapist credibility, F = 5.11, p = .002. Post hoc analyses revealed that participants who did not opt of any treatment arm demonstrated lower levels of stigma beliefs compared to participants who opted-out of in-office, p = .001. Participants who opted out of in-home viewed the therapist as less credible compared to participants who did not opt of any arm, p = .004. Multiple regression analysis found that baseline patient satisfaction, stigma beliefs, and credibility beliefs were not predictive of PTSD treatment outcomes, p > .05. DISCUSSION/SIGNIFICANCE OF IMPACT: Combat PTSD patients may opt out of in-office therapy due to mental health stigma beliefs, and visibility in mental health clinics may be a concern. For patients who opted out of in-home therapy, lack of credibility may have decreased participants’ desire for therapists to enter their home. Despite concerns of mental health stigma and the credibility of the therapy in certain treatment arms, patients in each treatment arm significantly improved in PTSD symptomotology. Moreover, patient characteristics, including satisfaction, stigma, and credibility of the therapy, did not significantly predict treatment outcomes, which demonstrates the robustness of Cognitive Processing Therapy.

This study examines the relationship between long-term intake of six flavonoid classes and incidence of CVD and CHD, using a comprehensive flavonoid database and repeated measures of intake, while accounting for possible confounding by components of a healthy dietary pattern. Flavonoid intakes were assessed using a FFQ among the Framingham Offspring Cohort at baseline and three times during follow-up. Cox proportional hazards regression was used to characterise prospective associations between the natural logarithms of flavonoid intakes and CVD incidence using a time-dependent approach, in which intake data were updated at each examination to represent average intakes from previous examinations. Mean baseline age was 54 years, and 45 % of the population was male. Over an average 14·9 years of follow-up among 2880 participants, there were 518 CVD events and 261 CHD events. After multivariable adjustment, only flavonol intake was significantly associated with lower risk of CVD incidence (hazard ratios (HR) per 2·5-fold flavonol increase=0·86, P trend=0·05). Additional adjustment for total fruit and vegetable intake and overall diet quality attenuated this observation (HR=0·89, P trend=0·20 and HR=0·92, P trend=0·33, respectively). There were no significant associations between flavonoids and CHD incidence after multivariable adjustment. Our findings suggest that the observed association between flavonol intake and CVD risk may be a consequence of better overall diet. However, the strength of this non-significant association was also consistent with relative risks observed in previous meta-analyses, and therefore a modest benefit of flavonol intake on CVD risk cannot be ruled out.

An efficient market has been described by Fama (1970) as one in which prices always fully reflect all available information. Of the three tests of efficiency discussed, the weak form test is concerned with the randomness of price movements and measures the ability to predict future price changes from past and present changes. There are two general ways to evaluate weak form efficiency: statistical tests and mechanical trading rules. Statistical methods, including serial correlation, spectral analysis and nonparametric runs tests, permit hypothesis testing, but Fama and Blume (p. 227) point out that they may be of limited value with complex or irregular price structures.

In the second half of the twentieth century there was a renaissance of liberalism and a new interest in freedom in modern Western industrialised nations. Theologians responded to the intellectual discourse in various ways while treating the concept of freedom in theology. Here three different engagements with the understanding of freedom and liberalism at the end of the century are introduced. The first is a critique of liberalism and rejection of modern accounts of freedom as autonomy. This account draws upon historical and theological resources in the presentation of modern liberalism as a negative development in theology and in understandings of society. In the article here, this first approach is presented in the context of its social and political orientation and contemporary context in the later twentieth century. While some of the contours of this first approach are viewed critically, one aspect of its intentions is praised. The second example is an adoption of the discourse of modern liberalism and a justification of it with an account of the Reformation as its progenitor. This account draws upon a narrative of progressive liberation in modern human history. The second approach is addressed here in its particular context after the Second World War and in the specific cultural and theological framework of the latter part of the twentieth century. While the revival of modern liberal theology in the latter part of the twentieth century is presented here as a necessary development in the wake of radical early twentieth century anti-liberalism, some of the sweeping claims of this approach are viewed critically. Finally, a third mediatory approach is presented. This general group sought to advance a form of the liberal theological tradition while also theologically challenging Enlightenment conceptions of autonomy. Three brief examples are drawn upon to illustrate this approach. One is concerned with providing orientation for the basic doctrinal question of human freedom and sin. The second example deals with the systematic theological specification of human freedom in the postmodern context and its relation to an understanding of divine freedom. The third example deals with the ethical implications of a theologically grounded understanding of freedom.

The Nature Conservancy takes a strategic and systematic approach to conservation planning. Ecoregional assessments are used to set goals and identify geographical priorities, and Conservation Action Planning is used to develop strategic plans for conservation areas. This study demonstrates how these planning processes were applied at the seascape scale based on a case study of Kimbe Bay, Papua New Guinea. Conservation Action Planning was used to identify key threats and strategies, and systematic conservation planning (similar to that used for ecoregional assessments) was used to design a network of marine protected areas to be resilient to the threat of climate change. The design was based on an assessment of biodiversity and socio-economic values, and identified 14 Areas of Interest that meet specific conservation goals. A detailed community-based planning process is now underway with local communities that own and manage these areas to refine and implement the marine protected area network.

Two models of local policy formation can be set forth. Although they are complementary rather than competing models, for heuristic purposes it is useful to present them as contrasting approaches. Since the first, the bargaining model, is well known, I shall concentrate in this paper on elaborating and applying a second, unitary model of policy making. The paper is divided into four main parts. After briefly identifying the limitations of the bargaining model, the first part develops the theoretical rationale for the unitary model. The second part uses the model to analyse empirically differences in the revenue sources for national, state and local governments. Part 3 does the same for expenditure policies, and, in the course of the analysis, distinguishes among three types of public policy – developmental, allocational and redistributive. In the final part, hypotheses deduced from the model are tested by means of a regression analysis of state and local expenditures.

An examination of executive-legislative conflict occurring in US congressional committees between 1947 and 1990 reveals that, despite current concerns of gridlock, the overall level of conflict declined during this period. There are two structural sources of inter-branch conflict – constituent and partisan. The constituent basis for conflict in the United States is rooted in the differing manner in which members of the two branches are elected. Because the executive has a national constituency, it is primarily concerned with matters of national policy. Members of Congress, who have smaller, more homogeneous constituencies, are more concerned with the geographically distributive effects of these policies. The authors' evidence suggests that conflict between the executive and legislative in the United States is greatest on issues that are of both national and distributive significance. The partisan basis for conflict, long established in the House and increasingly visible in the Senate, is reinforced by competitive political contests. Yet conflict between members of Congress and executive officials of the opposite party did not increase between 1947 and 1990. And conflict with executive officials of the same party declined, producing an overall drop in executive-legislative conflict.

We are researching the interaction between the rule and the ontology layers of the Semantic Web, by comparing two options: 1) using OWL and its rule extension SWRL to develop an integrated ontology/rule language, and 2) layering rules on top of an ontology with RuleML and OWL. Toward this end, we are developing the SWORIER system, which enables efficient automated reasoning on ontologies and rules, by translating all of them into Prolog and adding a set of general rules that properly capture the semantics of OWL. We have also enabled the user to make dynamic changes on the fly, at run time. This work addresses several of the concerns expressed in previous work, such as negation, complementary classes, disjunctive heads, and cardinality, and it discusses alternative approaches for dealing with inconsistencies in the knowledge base. In addition, for efficiency, we implemented techniques called extensionalization, avoiding reanalysis, and code minimization.

It was recently revealed that some processes of hydrating tricalcium silicate are altered by the addition of dicalcium silicate. Previous neutron scattering results revealed two critical tri/dicalcium silicate compositions. At one composition, changes in the early time hydration kinetics were observed that result in the formation of more products (reflected in increased 28 day strength), despite dicalcium silicate being essentially unreactive at early times. At the other composition, changes in the early-time hydration kinetics were observed that correspond to reduced strength. The current work uses scanning electron microscope analysis with backscattered electron imaging of 50 day hydrated tri- and dicalcium silicate mortars to reveal that at the former critical composition increased hydration of the tricalcium silicate phase occurs, and at the latter critical composition, the amount of dicalcium silicate reacted is decreased.

Between a.d. 760 and 930, millions of Maya disappeared from the Earth. We examine changes in the physical environment in which the Maya lived. The ice-core evidence from Greenland indicates that around the time of the Maya Collapse, a minimum in solar insolation and a low in solar activity occurred, accompanied by severe cold and dryness over Greenland, indicating hemispheric climatic conditions propitious for drought in the Maya Lowlands. In the northeastern Caribbean, sea-surface salinity (SSS) was lowered. The most severe drought of the past 7,000 years devastated the Yucatan Peninsula. Large Maya cities collapsed in four phases of abandonment spaced about fifty years apart around a.d. 760, 810, 860, and 910. A new core taken from Lake Chichancanab in Quintana Roo shows three peak episodes of brutal drought within a 150- to 200-year drought. A marine core from the Cariaco Basin off Venezuela precisely dates four severe drought episodes to 760, 810, 860, and 910, coincident with the four phases of abandonment of cities. The long-term drought appears to have lasted from 760 to 930 in the Cariaco Basin. The climatic changes were the most drastic the Maya had faced in the preceding 1,500 years and the most severe of the preceding 7,000 years.

Small-angle scattering (SAS) and ultra small-angle scattering techniques, employing x-rays and neutrons, were used to characterize six different aluminum nanopowders and nanopowders composed of molybdenum trioxide and tungsten trioxide nanoparticles. Each material has different primary particle morphology and aggregate and agglomerate geometry, and each is important to the development of nano-energetic materials. The combination of small-angle and ultra small-angle techniques allowed a wide range of length scales to be probed, providing a more complete characterization of the materials. For the aluminum-based materials, differences in the scattering of x-rays and neutrons from aluminum and aluminum oxide provided sensitivity to the metal core and metal oxide shell structure of the primary nanoparticles. Small-angle scattering was able to discriminate between particle size and shape and agglomerate and aggregate geometry, allowing analysis of both aspects of the structure. Using the results of these analyses and guided by scanning electron microscopy (SEM) images, physical models were developed, allowing for a quantitative determination of particle morphology, mean nanoparticle size, nanoparticle size distribution, surface layer thickness, and aggregate and agglomerate fractal dimension. Particle size distributions calculated using a maximum entropy algorithm or by assuming a log-normal particle size distribution function were comparable. Surface area and density determinations from the small-angle scattering measurements were comparable to those obtained from other, more commonly used analytical techniques: gas sorption using Brunauer–Emmett–Teller analysis, thermogravimetric analysis, and helium pycnometry. Particle size distribution functions derived from the SAS measurements agreed well with those obtained from SEM.

There are many reasons for seeking to create a global database with which to record the outcomes of therapy for congenital heart disease. Such a database can function as a tool to support a variety of purposes: