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Toward the end of the first millennium ad, a burgeoning class of secular elites emerged throughout western Europe who developed local power centres to denote their prestige. Seigneurial investment was prioritised towards residences, as well as churches and chapels, the two elements often paired into single places in the landscape. In England, our understanding of these complexes is limited due to scant excavated evidence and skewed by the impact of the Norman Conquest, after which castles became the dominant form of aristocratic site. Previous approaches have often fetishised defensibility and promoted notions of national exceptionalism, but a more meaningful understanding of these places can be gained by adopting a broad chronological and thematic remit. Drawing upon the results of the AHRC-funded research project ‘Where Power Lies’, this paper offers a foundational evaluation of the landscape evidence for lordly centres, presenting data on their distribution in two regions, complemented by results from intensive investigation of case study locations (Bosham, West Sussex and Hornby, North Yorkshire). This allows a wider range of material signatures from lordly centres to be characterised, resulting in greater comprehension of how elites in England shaped and experienced a Europe-wide phenomenon.
Conventionally, research was conducted on children as objects to be observed or interviewed. My research, on child bereavement, did not use such methods. It would seem very unnatural and concerning to sit a child down, question them, and evoke an emotional response about someone who has died, where my only means of comfort would be to hand them a tissue. This unpleasant feeling acted as a catalyst for my interest in arts- based methods. My quest began to find methods for generating data that were appropriate for working with children on a sensitive issue. There was no checklist, outline, or flowchart that existed to tell me what would work best. I was guided by my supervisors and reflected on my own experience as a primary school teacher. With pupil- led learning high on the agenda in Scottish education, I wanted to maximise participation and have children involved at every step of the research process. My decision to use arts- based methods involving art, drama, and music came very early on in the process as a child- centred approach designed to encourage expression and generate multiple, creative voices other than oral. I wanted to facilitate opportunities for children to explore the topic of death and dying in creative ways to generate data. This was, essentially, my original plan. Soon, I started to question why I, as the lead researcher, should analyse the data without the children. It seemed I was stopping the creative process after data production and falling back into academic norms. It was at this point I deviated from my plan and designed an analytic method using theatre to involve participants in analysing and disseminating the data.
This chapter outlines how I facilitated the use of theatre to analyse data with a group of children. I reflect on my experience of generating plenty of creative qualitative data and subsequently using this in rehearsals to write a script and create a performance. Ownership of this performance belonged to everyone in the room: it was for the participants to write. Working with the data in this way added an extra layer of analysis and, in this chapter, I detail the process involved, including gaining ethical approval, key considerations related to performing data, and how to maximise children's participation in analysing data.
The moderation of user-generated content on online platforms remains a key solution to protecting people online, but also remains a perpetual challenge as the appropriateness of content moderation guidelines depends on the online community that they aim to govern. This challenge affects marginalized groups in particular, as they more frequently experience online abuse but also end up falsely being the target of content-moderation guidelines. While there have been calls for democratic, community-moderation, there has so far been little research into how to implement such approaches. Here, we present the co-creation of content moderation strategies with the users of an online platform to address some of these challenges. Within the context of AutSPACEs—an online citizen science platform that aims to allow autistic people to share their own sensory processing experiences publicly—we used a community-based and participatory approach to co-design a content moderation solution that would fit the preferences, priorities, and needs of its autistic user community. We outline how this approach helped us discover context-specific moderation dilemmas around participant safety and well-being and how we addressed those. These trade-offs have resulted in a moderation design that differs from more general social networks in aspects such as how to contribute, when to moderate, and what to moderate. While these dilemmas, processes, and solutions are specific to the context of AutSPACEs, we highlight how the co-design approach itself could be applied and useful for other communities to uncover challenges and help other online spaces to embed safety and empowerment.
To investigate the symptoms of SARS-CoV-2 infection, their dynamics and their discriminatory power for the disease using longitudinally, prospectively collected information reported at the time of their occurrence. We have analysed data from a large phase 3 clinical UK COVID-19 vaccine trial. The alpha variant was the predominant strain. Participants were assessed for SARS-CoV-2 infection via nasal/throat PCR at recruitment, vaccination appointments, and when symptomatic. Statistical techniques were implemented to infer estimates representative of the UK population, accounting for multiple symptomatic episodes associated with one individual. An optimal diagnostic model for SARS-CoV-2 infection was derived. The 4-month prevalence of SARS-CoV-2 was 2.1%; increasing to 19.4% (16.0%–22.7%) in participants reporting loss of appetite and 31.9% (27.1%–36.8%) in those with anosmia/ageusia. The model identified anosmia and/or ageusia, fever, congestion, and cough to be significantly associated with SARS-CoV-2 infection. Symptoms’ dynamics were vastly different in the two groups; after a slow start peaking later and lasting longer in PCR+ participants, whilst exhibiting a consistent decline in PCR- participants, with, on average, fewer than 3 days of symptoms reported. Anosmia/ageusia peaked late in confirmed SARS-CoV-2 infection (day 12), indicating a low discrimination power for early disease diagnosis.
Close-range sensors are employed to observe glaciological processes that operate over short timescales (e.g. iceberg calving, glacial lake outburst floods, diurnal surface melting). However, under poor weather conditions optical instruments fail while the operation of radar systems below 17 GHz do not have sufficient angular resolution to map glacier surfaces in detail. This letter reviews the potential of millimetre-wave radar at 94 GHz to obtain high-resolution 3-D measurements of glaciers under most weather conditions. We discuss the theory of 94 GHz radar for glaciology studies, demonstrate its potential to map a glacier calving front and summarise future research priorities.
Frontal ablation, the combination of submarine melting and iceberg calving, changes the geometry of a glacier's terminus, influencing glacier dynamics, the fate of upwelling plumes and the distribution of submarine meltwater input into the ocean. Directly observing frontal ablation and terminus morphology below the waterline is difficult, however, limiting our understanding of these coupled ice–ocean processes. To investigate the evolution of a tidewater glacier's submarine terminus, we combine 3-D multibeam point clouds of the subsurface ice face at LeConte Glacier, Alaska, with concurrent observations of environmental conditions during three field campaigns between 2016 and 2018. We observe terminus morphology that was predominately overcut (52% in August 2016, 63% in May 2017 and 74% in September 2018), accompanied by high multibeam sonar-derived melt rates (4.84 m d−1 in 2016, 1.13 m d−1 in 2017 and 1.85 m d−1 in 2018). We find that periods of high subglacial discharge lead to localized undercut discharge outlets, but adjacent to these outlets the terminus maintains significantly overcut geometry, with an ice ramp that protrudes 75 m into the fjord in 2017 and 125 m in 2018. Our data challenge the assumption that tidewater glacier termini are largely undercut during periods of high submarine melting.
OBJECTIVES/GOALS: 22q.11 deletion syndrome (22q11DS) is a genomic syndrome that elevates risk for psychosis >20-fold. We used a battery of cognitive and psychophysiological psychosis-risk biomarkers in 22q11DS patients and healthy subjects in order to identify biomarkers of psychosis in 22q11DS that could be used as translational targets in intervention studies. METHODS/STUDY POPULATION: We recruited 15 22q11DS individuals (Mean age=30, M/F=9/6) and 19 healthy controls (HCs; Mean age=34, M/F=5/14). Each individual completed the MATRICS Consensus Cognitive Battery (MCCB), the Wechsler Abbreviated Scale of Intelligence, Second edition (WASI-II) Verbal IQ subtests, and the computerized Wisconsin Card Sorting Task (WCST). To examine auditory EEG responses, each participant completed the 'Double-Deviant' target detection paradigm, which presents a pseudorandom sequence of frequent standard tones and infrequent deviant tones. Mismatch negativity (MMN) metrics were generated from this assessment. Welch's t-tests were completed for neurocognitive variables. One-Way ANOVAs were completed to examine EEG results, with sex entered as a separate factor and age entered as a covariate. RESULTS/ANTICIPATED RESULTS: Significant group differences were found in 8 of the 9 neurocognitive measurements (FDR-adjusted p's< 0.02, average Cohen's d=1.62, average observed power= 0.91) indicating widespread cognitive deficits in 22q11DS subjects across multiple domains. The Double-Deviant MMN ERP response was significantly smaller in absolute magnitude in the 22q11DS group (FDR-adjusted p=0.048, Cohen’s d= -0.864, observed power= 0.58). The MMN ERPs for the frequency and duration deviants were not significantly different (FDR-adjusted p's> 0.33). No group by sex interactions were observed in any of the measures. Neurocognitive variables were associated with psychosis positive, negative, general, and disorganized symptom scales. DISCUSSION/SIGNIFICANCE: Our results identify potential psychosis-risk biomarkers in 22q11DS. If replicated, these biomarkers could provide important translational targets for future clinical trials for individuals with 22q11DS and other individuals at-risk for psychosis syndromes.
The utilisation of massed therapy for treating posttraumatic stress disorder (PTSD) is gaining strength, especially prolonged exposure. However, it is unknown whether massed prolonged exposure (MPE) is non-inferior to standard prolonged exposure (SPE) protocols in the long term. The current study aimed to assess whether MPE was non-inferior to SPE at 12 months post-treatment, and to ascertain changes in secondary measure outcomes.
Methods
A multi-site non-inferiority randomised controlled trial (RCT) compared SPE with MPE in 12 clinics. The primary outcome was PTSD symptom severity (CAPS-5) at 12 months post-treatment commencement. Secondary outcome measures included symptoms of depression, anxiety, anger, disability, and quality of life at 12 weeks and 12 months post-treatment commencement. Outcome assessors were blinded to treatment allocation. The intention-to-treat sample included 138 Australian military members and veterans and data were analysed for 134 participants (SPE = 71, MPE = 63).
Results
Reductions in PTSD severity were maintained at 12 months and MPE remained non-inferior to SPE. Both treatment groups experienced a reduction in depression, anxiety, anger, and improvements in quality of life at 12 weeks and 12 months post-treatment commencement. Treatment effects for self-reported disability in the SPE group at 12 weeks were not maintained, with neither group registering significant effects at 12 months.
Conclusions
The emergence of massed protocols for PTSD is an important advancement. The current study provides RCT evidence for the longevity of MPE treatment gains at 12 months post-treatment commencement and demonstrated non-inferiority to SPE. Promisingly, both treatments also significantly reduced the severity of comorbid symptoms commonly occurring alongside PTSD.
The coronavirus disease 2019 (COVID-19) pandemic highlighted the lack of agreement regarding the definition of aerosol-generating procedures and potential risk to healthcare personnel. We convened a group of Massachusetts healthcare epidemiologists to develop consensus through expert opinion in an area where broader guidance was lacking at the time.
Dependencia theory is in vogue among social scientists throughout the world. Having originated in Latin America in the early 1960s, it was widely embraced both there and in parts of Europe and Africa by the end of the decade. In the 1970s, North Americans joined the flood of scholars attempting to grapple with the problems of underdevelopment in the so-called Third World from a perspective explicitly rejecting traditional theories of development. With this new stream of researchers came new tools and new approaches to the study of peripheral societies, tools and approaches intended to complement those previously used within the dependencia tradition.
A critical barrier to generating cumulative knowledge in political science and related disciplines is the inability of researchers to observe the results from the full set of research designs that scholars have conceptualized, implemented, and analyzed. For a variety of reasons, studies that produce null findings are especially likely to be unobserved, creating biases in publicly accessible research. While several approaches have been suggested to overcome this problem, none have yet proven adequate. We call for the establishment of a new discipline-wide norm in which scholars post short “null results reports” online that summarize their research designs, findings, and interpretations. To address the inevitable incentive problems that earlier proposals for reform were unable to overcome, we argue that decentralized research communities can spur the broader disciplinary norm change that would bring advantage to scientific advance. To facilitate our contribution, we offer a template for these reports that incorporates evaluation of the possible explanations for the null findings, including statistical power, measurement strategy, implementation issues, spillover/contamination, and flaws in theoretical priors. We illustrate the template’s utility with two experimental studies focused on the naturalization of immigrants in the United States and attitudes toward Syrian refugees in Jordan.
A short, effective therapy for posttraumatic stress disorder (PTSD) could decrease barriers to implementation and uptake, reduce dropout, and ameliorate distressing symptoms in military personnel and veterans. This non-inferiority RCT evaluated the efficacy of 2-week massed prolonged exposure (MPE) therapy compared to standard 10-week prolonged exposure (SPE), the current gold standard treatment, in reducing PTSD severity in both active serving and veterans in a real-world health service system.
Methods
This single-blinded multi-site non-inferiority RCT took place in 12 health clinics across Australia. The primary outcome was PTSD symptom severity measured by the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) at 12 weeks. 138 military personnel and veterans with PTSD were randomised. 71 participants were allocated to SPE, with 63 allocated to MPE.
Results
The intention-to-treat sample included 138 participants, data were analysed for 134 participants (88.1% male, M = 46 years). The difference between the mean MPE and SPE group PTSD scores from baseline to 12 weeks-post therapy was 0.94 [95% confidence interval (CI) −4.19 to +6.07]. The upper endpoint of the 95% CI was below +7, indicating MPE was non-inferior to SPE. Significant rates of loss of PTSD diagnosis were found for both groups (MPE 53.8%, SPE 54.1%). Dropout rates were 4.8% (MPE) and 16.9% (SPE).
Conclusions
MPE was non-inferior to SPE in significantly reducing symptoms of PTSD. Significant reductions in symptom severity, low dropout rates, and loss of diagnosis indicate MPE is a feasible, accessible, and effective treatment. Findings demonstrate novel methods to deliver gold-standard treatments for PTSD should be routinely considered.
Wildfires have become a regular seasonal disaster across the Western region of the United States. Wildfires require a multifaceted disaster response. In addition to fire suppression, there are public health and medical needs for responders and the general population in the path of the fire, as well as a much larger population impacted by smoke. This paper describes key aspects of the health and medical response to wildfires in California, including facility evacuation and shelter medical support, with emphasis on the organization, coordination, and management of medical teams deployed to fire incident base camps. This provides 1 model of medical support and references resources to help other jurisdictions that must respond to the rising incidence of large wildland fires.
The coronavirus disease 2019 (COVID-19) pandemic has significantly increased depression rates, particularly in emerging adults. The aim of this study was to examine longitudinal changes in depression risk before and during COVID-19 in a cohort of emerging adults in the U.S. and to determine whether prior drinking or sleep habits could predict the severity of depressive symptoms during the pandemic.
Methods
Participants were 525 emerging adults from the National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA), a five-site community sample including moderate-to-heavy drinkers. Poisson mixed-effect models evaluated changes in the Center for Epidemiological Studies Depression Scale (CES-D-10) from before to during COVID-19, also testing for sex and age interactions. Additional analyses examined whether alcohol use frequency or sleep duration measured in the last pre-COVID assessment predicted pandemic-related increase in depressive symptoms.
Results
The prevalence of risk for clinical depression tripled due to a substantial and sustained increase in depressive symptoms during COVID-19 relative to pre-COVID years. Effects were strongest for younger women. Frequent alcohol use and short sleep duration during the closest pre-COVID visit predicted a greater increase in COVID-19 depressive symptoms.
Conclusions
The sharp increase in depression risk among emerging adults heralds a public health crisis with alarming implications for their social and emotional functioning as this generation matures. In addition to the heightened risk for younger women, the role of alcohol use and sleep behavior should be tracked through preventive care aiming to mitigate this looming mental health crisis.
This is a longitudinal cohort study describing the demand, capacity and outcomes of adult specialist eating disorder in-patient services covering a population of 3.5 million in a South-East England provider collaborative before and since the COVID-19 pandemic, between July 2018 and March 2021.
Results
There were 351 referrals for admission; 97% were female, 95% had a diagnosis of anorexia nervosa and 19% had a body mass index (BMI) <13. Referrals have increased by 21% since the start of pandemic, coinciding with reduced capacity. Waiting times have increased from 33 to 46 days. There were significant differences in outcomes between providers. A novel, integrated enhanced cognitive behaviour theapy treatment model showed a 25% reduction in length of stay and improved BMI on discharge (50% v. 16% BMI >19), compared with traditional eclectic in-patient treatment.
Clinical implications
Integrated enhanced cognitive behaviour theapy reduced length of stay and improved outcomes, and can offer more effective use of healthcare resources.
The state of California, in the United States of America, has a population of nearly 40 million people and is the 5th largest economy in the world. During the coronavirus disease 2019 (COVID-19) pandemic in 2020-2021, the state experienced a medical surge that stressed its sophisticated health-care and public health system. During this period, ventilators, oxygen, and other equipment necessary for providing ventilatory support became a scarce resource in many health-care settings. When demand overwhelms supply, creative solutions are required at all levels of disaster management and health care. This study describes the disaster response by the state of California to mitigate the emergency demands for oxygen delivery resources.
Black, Asian and minority ethnicity groups may experience better health outcomes when living in areas of high own-group ethnic density – the so-called ‘ethnic density’ hypothesis. We tested this hypothesis for the treatment outcome of compulsory admission.
Methods
Data from the 2010–2011 Mental Health Minimum Dataset (N = 1 053 617) was linked to the 2011 Census and 2010 Index of Multiple Deprivation. Own-group ethnic density was calculated by dividing the number of residents per ethnic group for each lower layer super output area (LSOA) in the Census by the LSOA total population. Multilevel modelling estimated the effect of own-group ethnic density on the risk of compulsory admission by ethnic group (White British, White other, Black, Asian and mixed), accounting for patient characteristics (age and gender), area-level deprivation and population density.
Results
Asian and White British patients experienced a reduced risk of compulsory admission when living in the areas of high own-group ethnic density [odds ratios (OR) 0.97, 95% credible interval (CI) 0.95–0.99 and 0.94, 95% CI 0.93–0.95, respectively], whereas White minority patients were at increased risk when living in neighbourhoods of higher own-group ethnic concentration (OR 1.18, 95% CI 1.11–1.26). Higher levels of own-group ethnic density were associated with an increased risk of compulsory admission for mixed-ethnicity patients, but only when deprivation and population density were excluded from the model. Neighbourhood-level concentration of own-group ethnicity for Black patients did not influence the risk of compulsory admission.
Conclusions
We found only minimal support for the ethnic density hypothesis for the treatment outcome of compulsory admission to under the Mental Health Act.