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OBJECTIVES/GOALS: Ebolavirus disease survivors report persistent, debilitating health concerns dubbed Post-Ebola Syndrome (PES). Attention to PES in young survivors is lacking, we describe PES in pediatric EVD survivors in Eastern Sierra Leone. Additionally, we introduce our proposal investigating differential presentations of PES in pediatric survivors. METHODS/STUDY POPULATION: EVD survivors were enrolled a median of 2.5 years after resolution of disease. Survivors were eligible if listed in a national register maintained by the Sierra Leone Association of Ebola Survivors. Household contacts (HCs) were identified by survivors. Participants were assigned into three comparison groups: pediatric (7-11), adolescent (12-17) and young adult (18-25). A self-reported symptom questionnaire, and a physical exam were conducted. Variables were clustered within organ system and compared across groups. RESULTS/ANTICIPATED RESULTS: Pediatric survivors had lower levels of long-term sequelae compared to adolescents and young adults. Symptoms and abnormal physical exam signs increase with age. Musculoskeletal, psychiatric, ophthalmologic, and GI signs and symptoms were significantly different between groups. Pediatric survivors had significantly more persistent sequelae than age-matched HCs with no history of EVD; particularly within the cardiac/GI (p=.006) and psychiatric/neurological (p=.025) clusters. PES is heterogeneous with respect to age, calling for a deeper understanding of age-based differences. Even the youngest group of survivors experienced significantly more sequelae than HCs, highlighting the elevated symptom burden in these children over their peers. DISCUSSION/SIGNIFICANCE: Understanding mechanistic drivers will ultimately improve targeted treatments for PES. We will characterize symptom groups defining PES in children, determine the relationship between accelerated aging and PES in this population, and test how immune profiles associated with accelerated aging relate to the development of PES in children.
Loss of control eating is more likely to occur in the evening and is uniquely associated with distress. No studies have examined the effect of treatment on within-day timing of loss of control eating severity. We examined whether time of day differentially predicted loss of control eating severity at baseline (i.e. pretreatment), end-of-treatment, and 6-month follow-up for individuals with binge-eating disorder (BED), hypothesizing that loss of control eating severity would increase throughout the day pretreatment and that this pattern would be less pronounced following treatment. We explored differential treatment effects of cognitive-behavioral guided self-help (CBTgsh) and Integrative Cognitive-Affective Therapy (ICAT).
Methods
Individuals with BED (N = 112) were randomized to receive CBTgsh or ICAT and completed a 1-week ecological momentary assessment protocol at baseline, end-of-treatment, and 6-month follow-up to assess loss of control eating severity. We used multilevel models to assess within-day slope trajectories of loss of control eating severity across assessment periods and treatment type.
Results
Within-day increases in loss of control eating severity were reduced at end-of-treatment and 6-month follow-up relative to baseline. Evening acceleration of loss of control eating severity was greater at 6-month follow-up relative to end-of-treatment. Within-day increases in loss of control severity did not differ between treatments at end-of-treatment; however, evening loss of control severity intensified for individuals who received CBTgsh relative to those who received ICAT at 6-month follow-up.
Conclusions
Findings suggest that treatment reduces evening-shifted loss of control eating severity, and that this effect may be more durable following ICAT relative to CBTgsh.
The hypothesis that chemical remanent magnetization (CRM) in argillaceous rocks may be due to release of Fe during smectite illitization has been tested by study of spatial and temporal relationships of CRM acquisition, smectite illitization, and organic-matter maturation to deformation in the Montana Disturbed Belt. New K-Ar ages and stacking order and percentages of illite layers in illite-smectite (I-S) are consistent with conclusions from previous studies that smectite illitization of bentonites in Subbelts I and II of the Disturbed Belt was produced by thrust-sheet burial resulting from the Laramide Orogeny. Internally concordant, early Paleogene, K-Ar age values (55–57 Ma) were obtained from clay subfractions of thick bentonites which were significantly different in terms of their ages (i.e. Jurassic Ellis Formation and late Cretaceous Marias River Shale), further supporting a model of smectite illitization as a result of the Laramide Orogeny. Internally concordant K-Ar ages were found also for clay sub-fractions from a thick bentonite at Pishkun Canal (54 Ma) and from an undeformed bentonite near Vaughn on the Sweetgrass Arch (48 Ma). In Subbelts I and II, a greater degree of smectite illitization corresponds to increased thermal maturation, increased natural remanent magnetization intensity, and increased deformation (dip of beds). A dissolution-precipitation model over a short duration is proposed for the formation of illite layers in Subbelts I and II. A characteristic remanent magnetization was developed before or just after folding began in the early Paleogene. More smectite-rich I-S, low thermal maturity, and the absence of a CRM were noted in one outcrop of an undeformed rock on the Sweetgrass Arch. Strontium isotope data allow for the possibility that internal or externally derived fluids may have influenced illitization, but the K-Ar age values suggest that illitization was probably in response to conductive heating after the overthrusting had occurred. The differences in K-Ar dates among the bentonites studied herein may be due to differences in the timing of peak temperature related to differences in distance below the overthrust slab, in rates of burial and exhumation, and in initial temperature.
Various water-based heater-cooler devices (HCDs) have been implicated in nontuberculous mycobacteria outbreaks. Ongoing rigorous surveillance for healthcare-associated M. abscessus (HA-Mab) put in place following a prior institutional outbreak of M. abscessus alerted investigators to a cluster of 3 extrapulmonary M. abscessus infections among patients who had undergone cardiothoracic surgery.
Methods:
Investigators convened a multidisciplinary team and launched a comprehensive investigation to identify potential sources of M. abscessus in the healthcare setting. Adherence to tap water avoidance protocols during patient care and HCD cleaning, disinfection, and maintenance practices were reviewed. Relevant environmental samples were obtained. Patient and environmental M. abscessus isolates were compared using multilocus-sequence typing and pulsed-field gel electrophoresis. Smoke testing was performed to evaluate the potential for aerosol generation and dispersion during HCD use. The entire HCD fleet was replaced to mitigate continued transmission.
Results:
Clinical presentations of case patients and epidemiologic data supported intraoperative acquisition. M. abscessus was isolated from HCDs used on patients and molecular comparison with patient isolates demonstrated clonality. Smoke testing simulated aerosolization of M. abscessus from HCDs during device operation. Because the HCD fleet was replaced, no additional extrapulmonary HA-Mab infections due to the unique clone identified in this cluster have been detected.
Conclusions:
Despite adhering to HCD cleaning and disinfection strategies beyond manufacturer instructions for use, HCDs became colonized with and ultimately transmitted M. abscessus to 3 patients. Design modifications to better contain aerosols or filter exhaust during device operation are needed to prevent NTM transmission events from water-based HCDs.
The study of disputing has been a central concern of law and society scholars for nearly fifty years. Rather than focusing narrowly on cases litigated in state courts, law and society scholars broadened their perspective to include the handling of conflict in myriad fora throughout society, from neighborhood councils to consumer complaint boards to the interventions of shamans and village leaders. Law and society researchers working in Asian settings are no exception. Some earlier studies were village-based, highlighting the largely conciliatory practices of mediators who sought to maintain harmony by promoting apology, restitution, and spiritual well-being. Recent studies examine the relationship between litigation and nonjudicial dispute resolution, highlighting the ways in which courts and judges are influenced by the handling of conflict outside state law. A third type involves state’s attempts to divert litigated cases to “alternative dispute resolution” procedures established as adjuncts to the formal system. Although ADR is sometimes promoted as a restoration of traditional community mediation, law and society researchers have generally demonstrated that its close connection to the official legal system raises complex issues of justice and the protection of rights by persons who lack sufficient wealth or power to succeed within formal judicial arenas.
Legal mobilization refers to the use of law to express claims and desires in order to achieve change or protect interests. It can be carried out by individuals or by a collective of people. Importantly, legal mobilization encompasses more than going to court to litigate disputes, an action that may prove ineffective or even irrelevant in some Asian contexts. In addition to litigation, legal mobilization occurs in other ways, even when an individual or group merely articulates a problem to a confidante in terms of rights or other legal concepts. In Asia, this broader concept of legal mobilization is especially apropos, since so much “legal” activity—broadly construed—takes place far from the justice institutions the state has established. In this chapter, the readings illustrate the range of tactics used by those who mobilize the law to achieve their goals. They also illustrate both the risks and rewards associated with the invocation of legal rights in Asian societies. As the authors make clear, rights can have paradoxical effects, and can simultaneously empower and disempower or stigmatize those who use them. In some instances, however, the results are hugely beneficial to those who felt hopeless in the absence of legal protection.
This chapter illustrates how law and society scholars conduct empirical research to pursue questions and build theory about law in Asian societies. It is not a manual for how to use various research methods or for asking and answering research questions. Rather, its purpose is to provide examples of how Asian law and society scholars go about their work, what challenges they encounter, and how they address them. It features both classic and new and innovative approaches. One set of readings illustrates how researchers obtained access to their subjects and how they collected data. A second set of readings shows how researchers wrestled with aspects of their own identities in relation to the research site and the people whom they study. A third set illustrates law and society researchers practicing their craft in the digital age, using social media and other advancements in technologies to pursue their research questions. All the readings are drawn from studies that appear in earlier chapters. In this way, readers get a peek behind the curtain, so to speak, and gain a better understanding of how the authors featured in this book struggled with the challenges faced by all researchers—and how they overcame them.
Legal pluralism studies of Asian law and society are of three types. Some law and society scholars rely on the concept of legal pluralism to theorize official law in relation to various other legal orders operating in the same space. Legal pluralism provides them with a means to describe each of the multiple systems of law and to consider the ways in which they interact with one another. Other law and society scholars, adopting a more state-centric perspective, have studied how different Asian governments address the plurality of legal orders familiar to different population groups or different sectors of social life—such as the family, land, and property; labor and employment; or religious affairs. They show how Asian states—colonial and postcolonial—use legal pluralism to legitimate and extend their power over Asia’s diverse peoples. For a third group of law and society scholars, legal pluralism provides a framework for their “bottom up” research on law in everyday life. They show how individuals pick and choose among various legal orders as they deal with disputes, family matters, economic and social exchanges, claims to land and water, and other matters.
This introductory chapter defines and describes the field of law and society in general and the rapidly expanding body of law and society research conducted in Asia in particular. It distinguishes law and society research from three close intellectual "cousins": traditional legal scholarship, law and development studies, and critical legal studies. It then traces the various strands of Asian law and society scholarship as they developed quite differently in four Asian countries: Indonesia, Japan, China, and India. The Introduction concludes with a description of the nine chapters contained in the Reader and the five crosscutting themes that appear in each chapter.
This chapter examines courts in Asia as cultural symbols, social organizations, and political battlegrounds. As cultural symbols, courts are often embedded in religions, colonial legacies, and local norms. These cultural symbols are found in both informal tribunals and more institutionalized religious and secular courts. As social organizations, courts are intertwined with bureaucratic hierarchies, political influences, and the career trajectories of judges. This is particularly salient in civil law jurisdictions across Asia. As political battlegrounds, courts provide a space for the judicialization of politics as well as a soil for judicial corruption. The readings also examine the complexity of judicial decision-making in different national contexts. In addition, the readings highlight the nature and impact of judicial reforms, which take place amid broader political and social changes in both democratic and authoritarian contexts and can lead to tensions as well as encourage new alliances.