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An average of 1300 adults develop First Episode Psychosis (FEP) in Ireland each year. Early Intervention in Psychosis (EIP) is now widely accepted as best practice in the treatment of conditions such as schizophrenia. A local EIP programme was established in the Dublin South Central Mental Health Service in 2012.
Methods:
This is a cross-sectional study of service users presenting to the Dublin South Central Mental Health Service with FEP from 2016 to 2022 following the introduction of the EIP programme. We compared this to a previously published retrospective study of treatment as usual from 2002 to 2012.
Results:
Most service users in this study were male, single, unemployed and living with their partner or spouse across both time periods. Cognitive Behavioural Therapy for psychosis was provided to 12% (n = 8) of service users pre-EIP as compared to 52% (n = 30) post-programme introduction (p < 0.001), and 3% (n = 2) of service users engaged with behavioural family therapy pre-EIP as opposed to 15% (n = 9) after (p < 0.01). Rates of composite baseline physical healthcare monitoring improved significantly (p < 0.001).
Conclusion:
Exclusive allocation of multidisciplinary team staff to EIP leads to improved compliance with recommended guidelines, particularly CBT-p, formal family therapy and physical health monitoring.
In an important contribution to scholarship on measuring democratic performance, Little and Meng suggest that bias among expert coders accounts for erosion in ratings of democratic quality and performance observed in recent years. Drawing on 19 waves of survey data on US democracy from academic experts and from the public collected by Bright Line Watch (BLW), this study looks for but does not find manifestations of the type of expert bias that Little and Meng posit. Although we are unable to provide a direct test of Little and Meng’s hypothesis, several analyses provide reassurance that expert samples are an informative source to measure democratic performance. We find that respondents who have participated more frequently in BLW surveys, who have coded for V-Dem, and who are vocal about the state of American democracy on Twitter are no more pessimistic than other participants.
Merlin is, of course, familiar to all readers of this journal as the great magician of the Arthurian cycle. More than that, he can within that cycle's own terms of reference be regarded as its originating author: it is he who devised the Round Table, he who engineered the conception of Arthur himself, he whose foreknowledge contained the whole glory and downfall of the Arthurian age. But what are the roots of this enigmatic figure? Much has been written about the many aspects of this question. The present contribution will review this scholarship; indeed, as the reader will see, most of the associations and interpretations to be discussed below have already been proposed by other, often much earlier, scholars. Building on the work of these illustrious predecessors, I shall undertake to approach the problem anew: examining the earliest evidence, placing it in the broader context of the narrative traditions of the Celtic peoples, and suggesting possible sources.
This study will involve comparanda in the literatures of both Wales and Ireland; there are various ways in which such similarities can be explained. A resemblance may be purely coincidental: this becomes less likely the closer the resemblance but should never be ruled out categorically. The Welsh sources may reflect Irish influence: scholars are no longer making the sweeping claims for such influence that were formerly taken for granted, but there is no doubt that it existed, and that it was important. Or the Irish sources may reflect Welsh (or more generally British) influence, as is, for instance, generally held to be true of the story of Suibne (to be discussed below). It can also be the case that both Ireland and Wales have drawn on the same external sources, whether written or oral; or, finally, both may draw upon the more ancient traditions of the ‘common Celtic’ culture from which both descend.5 Each instance must be judged on its own merits, with no preconceived preference for one or another of these scenarios.
In a search for Merlin's kindred, it is natural to turn first to the twelfth-century author Geoffrey of Monmouth. By some scholars, indeed, Geoffrey has been taken to have invented Merlin outright.
Public health officials have faced resistance in their efforts to promote mask-wearing to counter the spread of COVID-19. One approach to promoting behavior change is to alert people to the fact that a behavior is common (a descriptive norm). However, partisan differences in pandemic mitigation behavior mean that Americans may be especially (in)sensitive to information about behavioral norms depending on the party affiliation of the group in question. In July–August 2020, we tested the effects of providing information to respondents about how many Americans, co-partisans, or out-partisans report wearing masks regularly on both mask-wearing intentions and on the perceived effectiveness of masks. Learning that a majority of Americans report wearing masks regularly increases mask-wearing intentions and perceived effectiveness, though the effects of this information are not distinguishable from other treatments.
European urban dark earth investigations have aided our understanding of Late Roman and early medieval populations and their activities. Deposits from two locations below Exeter Cathedral were compared in a geoarchaeological study and contrasting uses of space were identified. This supports the need for case-by-case investigations of urban deposits.
Conspiracy theories are central to political discourse in Venezuela and are widely supported. In the Americas Barometer Venezuela survey from 2016 to 2017, 54 percent of respondents expressed agreement for at least one of three political conspiracy narratives unsupported by evidence. Political loyalties to Chavismo or to the anti-Chavista opposition drive much conspiracy theory belief, but not all. Politically motivated reasoning pushes some citizens toward a given conspiracy narrative but others away. Other factors that are distinct from political loyalties, including low education levels, predispositions toward Manichaeanism and fatalism, and belief in the supernatural are associated with conspiracism. This article presents new data on conspiracy theory beliefs in Venezuela as well as analysis of its individual-level correlates, then discusses how the current Venezuelan political environment fosters conspiracy and what changes might mitigate this phenomenon.
When a party or candidate loses the popular vote but still wins the election, do voters view the winner as legitimate? This scenario, known as an electoral inversion, describes the winners of two of the last six presidential elections in the United States. We report results from two experiments testing the effect of inversions on democratic legitimacy in the US context. Our results indicate that inversions significantly decrease the perceived legitimacy of winning candidates. Strikingly, this effect does not vary with the margin by which the winner loses the popular vote, nor by whether the candidate benefiting from the inversion is a co-partisan. The effect is driven by Democrats, who punish inversions regardless of candidate partisanship; few effects are observed among Republicans. These results suggest that the experience of inversions increases sensitivity to such outcomes among supporters of the losing party.
There were various kinds of sacred space in the medieval world, as there still are: the consecrated spaces of churches and burial grounds but also the ‘Holy Places’ of pilgrimage. To these may be added locations pertaining to another version of the supernatural: the hills and lakes and wild places associated with the fairies, and Otherworlds outside the framework of mortal space. In the matière de Bretagne, and in the medieval Celtic literatures, these different kinds of sacred space are repeatedly juxtaposed, or even identified with one another.
In this contribution, I note those instances of such juxtaposition of which I am aware in Arthurian literature and in the Breton lais, together with a range of comparanda from medieval Ireland. Although I have a strong interest in Arthurian matters, I am by training a Celticist and not an Arthurian scholar per se: I offer the Irish specimens as parallels to a phenomenon that can be observed in the ‘matter of Britain’, in the hope that the resemblances may be of interest to specialists in the field. I do not, however, undertake to interrogate the evidence in terms of current Arthurian criticism, something for which others are better qualified.
Avalon and Glastonbury
Where is Avalon? The name first appears, so far as I am aware, in Geoffrey of Monmouth's Historia regum Britanniae (c. 1136): here we are told that this is the island where Arthur's sword Caliburnus was forged and to which the king was taken ‘for the healing of [his] wounds’, after having been ‘mortally’ struck in his last battle. This Avalon is evidently identical with the ‘Island of Apples’ (Insula Pomorum) included in a catalogue of islands in Geoffrey's Vita Merlini (c. 1150): the latter is described as a paradise of fertility and long life, ruled over by nine sisters who are skilled in healing and able to assume the forms of birds. ‘Morgen’ was the chief of these, and it was to her care that the wounded Arthur was entrusted. Thereafter, Avalon appears repeatedly in medieval literature as an elusive Otherworld, a place of delights and the home of beautiful fairy women.
Scholars undertaking to reconstruct the mythology of the ancient Celts often point to the Túatha Dé Danann and Fomoiri of Irish legend as representing earlier gods of light opposed to gods of darkness and chaos; the hostilities between them are regarded as the Irish reflex of an Indo-European ‘War of the Gods’. The prevalence of this polarized model is largely due to two influential texts, Cath Maige Tuired and Lebor Gabála Érenn: elsewhere in the tradition, in sources of all periods, the connotations of the two terms overlap repeatedly, and the nature of their relationship is profoundly ambiguous. This contribution undertakes to survey the evidence – arguing that, for the Irish, darkness was by no means incompatible with divinity.
Keywords: Irish mythology, dualism, giants, Book of Invasions, Battle of Mag Tuired
In his pioneering study of the medieval Irish evidence for Celtic mythology, published in 1884, Henri d’Arbois de Jubainville wrote that ‘in the divine world of Ireland, we find two groups knit together by the closest ties of relationship, and yet at war one with the other’: these are, on the one hand, the Túatha Dé Donann (‘Tribes of the Goddess Donann’) or Túatha Dé (‘Tribes of the Gods’), the medieval reflections of the deities of the pre-Christian Irish; and, on the other, a race of beings called Fomoiri (singular Fomoir), whom Arbois de Jubainville described as ‘a mythical group corresponding to the Indian Asura and the Greek Titans’. The latter are ‘gods of Death, of Evil, and of Night’, in contrast to the Túatha Dé, whom he called ‘gods of Day, of Righteousness, and of Life’. In 1940, Marie-Louise Sjoestedt reaffirmed this view, likening the Fomoiri to ‘the forces of chaos: eternally “latent”, and enemies of all Cosmos’; and essentially the same idea is apparent in Proinsias Mac Cana's Celtic Mythology three decades later, where the Fomoiri are described as a ‘race of demonic beings’, and as ‘demonic powers’ who ‘wage a continual struggle against the gods’.
Pilot programs are integral to catalyzing and accelerating research at Clinical and Translational Science Award (CTSA) hubs. However, little has been published about the structure and operationalization of pilot programs or how they impact the translational research enterprise at CTSAs. The North Carolina Translational and Clinical Science Institute (NC TraCS), the CTSA hub at the University of North Carolina at Chapel Hill (UNC-CH) conducted an evaluation case study to describe the pilot program structure, assess process outcomes, and provide a framework for other institutions to utilize for the evaluation of their respective pilot programs.
Methods:
We describe the operationalization of our pilot program, the evaluation framework utilized to evaluate the program, and how we analyzed available data to understand how our pilot funding opportunities were utilized by investigators. We calculated application volumes and funding rates by investigator position title and pilot application type. We also reviewed feedback provided by pilot Principal Investigators (PIs) to understand how many pilot projects were completed, NC TraCS service utilization, and barriers to research. Limited data on publications and subsequent funding was also reviewed.
Results:
Between 2009 and 2019 the NC TraCS Pilot Program received 2343 applications and funded 933 projects, ranging from $2000 to $100,000 in amount, with an overall funding rate of 39.8%. Utilization of NC TraCS services had positive impacts on both resubmission funding and project completion rates.
Conclusion:
This process evaluation indicates that the program is being operationalized in a way that successfully fulfills the program mission while meeting the needs of a diverse group of researchers.
Background: Prevention of central-line–associated bloodstream infections (CLABSIs) and methicillin-resistant Staphylococcus aureus (MRSA) infections requires a multifaceted approach including strategies to decrease cutaneous bacterial colonization. Prior studies have shown benefit from chlorhexidine-gluconate (CHG) skin application on CLABSI and MRSA infection rates in intensive care units (ICUs); however, the use of CHG in the non-ICU population has not been well studied. Methods: We performed a quasi-experimental before-and-after study to evaluate the use of daily 2% CHG wipes in non-ICU patients at a 1,000 bed acute-care teaching hospital beginning in November 2017. The study population included adult and pediatric patients with central venous catheters on non-ICU units, excluding patients on the following units: stem cell transplant and hematologic malignancy (these units had already established use of CHG skin application as a standard prior to the intervention), labor and delivery, and psychiatry. CHG was applied according to the manufacturer’s instruction by nurses or nurse aides and random monthly auditing of compliance was performed. NHSN CLABSI, hospital-onset MRSA bacteremia, and hospital-onset MRSA LabID rates were compared for the period 24 months before the intervention (November 1, 2015, through October 31, 2017) to the 24-month period after the intervention (November 1, 2017, through October 31, 2019) using a paired t test. Notably, the health system also discontinued the use of contact precautions for patients with MRSA (excluding MRSA from open, draining wounds) 11 months prior to onset of this intervention. Results: The CLABSI rate decreased by 26% from 0.594 events per 1,000 central-line days (n = 50) before the intervention to 0.438 events per 1,000 central-line days (n = 38) after the intervention (P = 0.19). The number of CLABSIs with gram-positive organisms also decreased by 29%. MRSA LabID rates decreased by 37% from 0.301 events per 1,000 patient days (n = 119) to 0.189 events per 1,000 patient days (n = 75) (P = 0.01). MRSA bacteremia rates decreased by 79% from 0.058 events per 1,000 patient days (n = 23) to 0.012 events per 1,000 patient days (n = 5) (P < 0.01). Compliance with the intervention was 83% (n = 225). Conclusions: Daily CHG skin application in non-ICU patients with central venous catheters is an effective strategy to prevent CLABSIs and MRSA infections. We observed a decrease in MRSA LabID and bacteremia rates despite discontinuation of contact precautions. These findings suggest that a horizontal prevention approach of daily CHG skin application may be an effective alternative to contact isolation to interrupt transmission of MRSA in hospitalized patients outside the ICU setting.
OBJECTIVES/GOALS: The North Carolina Translational and Clinical Sciences Institute (NC TraCS) supports faculty and staff in carrying out clinical and translational research at UNC-Chapel Hill. To better understand customer satisfaction and impact, a survey was administered among NC TraCS users. METHODS/STUDY POPULATION: NC TraCS has 13 program areas that range from Biostatistics to Community and Stakeholder Engagement. These programs provide services to faculty, staff, students, and outside researchers in the area of clinical and translational science. A customer feedback survey was administered in Spring 2019 to anyone who had used at least one NC TraCS service between March 1st, 2017 and February 28th, 2019. A total of 856 survey invitations were sent. The survey included questions around users’ perception of the ease of access, helpfulness, outcome, and promptness of the services received using 6-point Likert scale. The survey also addressed career impact, communications, and suggestions for improvement. RESULTS/ANTICIPATED RESULTS: We received 268 responses, (31% response). Majority of respondents were satisfied with Overall Helpfulness (95%), Outcome of Service (96%), Ease of Access (93%), and Promptness of Service (90%). They also noted that their careers had at least slightly improved in the following areas: Mentorship (76%), Research Methods (75%), Skill Development (77%), Research Direction (71%) and Collaboration (80%). Furthermore, 96% responded positively to returning to TraCS. The feedback received was shared with service administrators and NC TraCS leadership to identify areas of improvement and further strengthen their services. Concerns, when present, were addressed by service directors or the overall PI’s. DISCUSSION/SIGNIFICANCE OF IMPACT: Need to communicate expectations to customers the expected turn-around time for help emerged as a clear take-away. In response, TraCS leadership is working to improve staffing and workflows for efficient service delivery including expectation management, especially among the most popular services.
OBJECTIVES/GOALS: The goals of this evaluation were 1) to describe the pilot grant application cycle and processes at NC TraCS, 2) to illustrate the impact of pilot grants on extramural grant funding, and 3) to provide a framework for other institutions to utilize for the evaluation of pilot grant programs. METHODS/STUDY POPULATION: From 2009-2019 the NC TraCS pilot program funded 925 projects, varying from $2,000 to $100,000. Pilot grants are available to any researcher affiliated with the university as well as partner institutions and community stakeholders. For this evaluation we analyzed data on pilot applicants (demographics, type of pilot, funding status, resubmissions, etc.) and outcomes (extramural funding, publications, etc.) yielded from funded pilots. In addition to summary statistics, we also calculated return on investment (ROI) for the program as a whole and by specific grant type. We will use bibliometric network analysis to assess productivity, citation impact, and scope of collaboration. RESULTS/ANTICIPATED RESULTS: There have been 2,777 submitted proposals with an acceptance rate of 33.3%. Unfunded proposals can resubmit, 61.8% of resubmitted applications are successfully funded, and 29.6% of funded applications are resubmissions. The $2,000 awards accounted for 43.4% of all grants awarded but only accounted for 6.4% of all pilot funds awarded. Success of proposals was proportional to the number of applications from each academic unit. 60.8% of funded applicants were affiliated with the School of Medicine and account for 65.3% of all funding awarded from 2009-2019. Additionally, we plan on analyzing return on investment rates to illustrate the impact of pilot awards on future research funding. DISCUSSION/SIGNIFICANCE OF IMPACT: Pilot grants can lead to subsequent extramural grants, publications, and successful translation of research into practice. This evaluation will assist our institution in understanding the impact of pilot grants and will provide a road map for other institutions evaluating their own programs.
To enhance the performance evaluation of Clinical and Translational Science Award (CTSA) hubs, we examined the utility of advanced bibliometric measures that go beyond simple publication counts to demonstrate the impact of translational research output.
Methods:
The sampled data included North Carolina Translational and Clinical Science Institute (NC TraCS)-supported publications produced between September 2008 and March 2017. We adopted advanced bibliometric measures and a state-of-the-art bibliometric network analysis tool to assess research productivity, citation impact, the scope of research collaboration, and the clusters of research topics.
Results:
Totally, 754 NC TraCS-supported publications generated over 24,000 citation counts by April 2017 with an average of 33 cites per article. NC TraCS-supported research papers received more than twice as many cites per year as the average National Institute of Health-funded research publications from the same field and time. We identified the top productive researchers and their networks within the CTSA hub. Findings demonstrated the impact of NC TraCS in facilitating interdisciplinary collaborations within the CTSA hub and across the CTSA consortium and connecting researchers with right peers and organizations.
Conclusion:
Both improved bibliometrics measures and bibliometric network analysis can bring new perspectives to CTSA evaluation via citation influence and the scope of research collaborations.
Medieval Ireland had a rich apocalyptic literature, encompassing treatments of the end-times, eschatology, and the afterlife. This chapter surveys several of the main texts, with special attention to themes that are particularly characteristic of Irish apocalyptic.
This chapter shows that preferences do not differ greatly when we separate students out by their race/ethnicity, gender, or socioeconomic background. All groups favor applicants and faculty candidates from underrepresented minority racial/ethnic and socioeconomic groups. The one area where we see preference polarization is with respect to gender non-binary applicants and faculty candidates. Women tend to favor gender non-binary individuals but men disfavor them, consistent with intolerance among men toward gender non-conformity.
This chapter describes the preferences we estimate on attitudes toward undergraduate admissions and faculty recruitment across our full population of student particpants. It shows that students prioritize academic and professional achievement most, but also that they give preference to all underrepresented minority racial and ethnic groups over whites, to women and gender non-binary applicants over men, and to applicants from disadvantaged socioeconomic backgrounds over the wealthy. They also give preference to recruited varsity athletes and to legacy applicants.