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The Battle of al-Qadisiyyah (c. AD 637/8) was a crucial victory by the Arab Muslims over the forces of the Sasanian Empire during the early Islamic conquests. Analysis of satellite imagery of south-west Iraq has now revealed the likely location of this important historic battle.
The effect of exposing Lymnaea stagnalis (Gastropoda: Pulmonata), infected with Diplostomum spathaceum (Trematoda: Diplostomatidae), to 100 μg l−1 cadmium for 7 days on survival characteristics (survival, tail loss, decaudized cercarial life-span) of emerged cercariae was investigated. Exposure of L. stagnalis to cadmium resulted in significantly increased D. spathaceum cercarial survival and an inhibited tail loss compared to controls. The normal parallel relationship which exists over time between decreasing cercarial survival and increasing tail loss in controls was changed in cercariae from cadmium-exposed hosts with an increased proportion of cercarial deaths occurring without tail loss. The decaudized cercarial life-span over the survival period of the cercarial population did not significantly change. However comparisons between individuals decaudized during the initial 24 h time period with those which were decaudized during the final period of cercarial survival showed a significantly altered life span which did not occur in the control population. As a potential indicator of penetration ‘fitness’ comparisons were also undertaken between control and exposed cercariae decaudized during the initial 24 h time period, which revealed that the decaudized cercarial life-span from the exposed hosts was significantly different from controls. This may have important implications for the ability of cercariae to migrate through the tissues of their target host. The importance and relevance of these results to parasite transmission are discussed.
The effect of cadmium exposure of the snail first intermediate host Lymnaea peregra on the incidence of encystment of Echinoparyphium recurvatum (Digenea: Echinostomatidae) cercariae without emergence from the snail was investigated. Exposure to 100 μg l−1 Cd for 72 h caused a significant increase in the incidence of first host encystment when compared to controls. In addition, autometallographic staining of E. recurvatum daughter rediae and developing cercariae showed that there was metal accumulation within their body tissues. The significance of these findings to parasite transmission in metal-polluted environments is discussed.
The effects of cadmium and zinc mixtures at concentrations ranging from 0.1 to 10,000 μg l−1 on the life-span of decaudized cercarial bodies (cercariae that have shed their tails) of Diplostomum spathaceum (Trematoda: Diplostomatidae) was investigated. Cercariae were exposed to metal mixtures of equal and unequal concentrations, and a low-dose pre-treatment followed by a high-dose exposure mixtures. Metal mixtures demonstrated variable effects on decaudized cercariae either by increasing or reducing their life-span compared to single metal exposures dependent on concentration and the type of mixed metal treatment. Prolonged exposure to equal metal mixtures at low concentrations (0.1–100 μg l−1) resulted in a reduction in the life-span of decaudized cercariae at 0.1 and 100 μg l−1 in those individuals decaudized during the initial 24 h exposure period compared with those decaudized during the final 24 h period of cercarial survival, whilst in controls there was no significant life-span change between the two time periods. Decaudized cercariae which were exposed to low concentrations (0.1–100 μg l−1) of equal metal mixtures were also evaluated for their role as an indicator of larval ‘fitness’ for migrating through the tissues of their target fish host for those individuals decaudized during the initial 24 h exposure period, and demonstrated only a limited change in their life-span compared to control and single metal exposures. The importance of metal mixtures in parasite establishment in the fish host is discussed.
The toxicity of cadmium to a population of Lymnaea peregra and L. stagnalis naturally infected with a range of digeneans and collected from a number of sites in the lower Thames Valley, UK was investigated. Lymnaeid snails were exposed to 100 μg l-1 cadmium and the effects on host survival and emergence of cercariae recorded. Overwintered L. peregra, but not L. stagnalis, showed significantly reduced survival compared to seasonally infected snails, i.e. snails which have acquired an infection during the spring or summer. A significant increase in survival with increasing snail size was demonstrated for L. stagnalis and for seasonally infected L. peregra only. Only L. stagnalis infected with Diplostomum spathaceum and L. peregra infected individually with D. spathaceum, Sanguinicola inermis, Echinoparyphium recurvatum and Notocotylus attenuatus demonstrated a significantly reduced survival compared to laboratory-bred controls. The exposure of L. stagnalis to cadmium resulted in a significant reduction in the emergence of D. spathaceum over a 5-day period but cadmium-exposed L. peregra showed no difference in the emergence of E. recurvatum cercariae over a 3-day exposure period. The mechanisms and importance of metal toxicity to snail–digenean interactions are discussed.
The toxicity of cadmium, zinc and Cd/Zn mixtures to the transmission of Echinoparyphium recurvatum (Digenea: Echinostomatidae) cercariae into the snail second intermediate hosts was investigated at concentrations ranging from 100 μg l-1 to 10 000 μg l-1 in both soft and hard water. A differential response in the infectivity of metal-exposed cercariae into Lymnaea peregra and Physa fontinalis was demonstrated which was dependent on the snail species being infected. Exposure of L. peregra, P. fontinalis, and L. stagnalis to heavy metals caused a differing susceptibility to E. recurvatum cercariae depending on the snail species being exposed. The mechanism and effects of metal toxicity, together with the importance of the parasite/host strain on cercarial transmission are discussed.
Despite evidence for its efficacy, exposure therapy for anxiety is rarely used in routine care settings. Efforts to address one major barrier to its use – therapists’ negative beliefs about exposure – have included therapist-level implementation strategies, such as training and consultation. Experiential training, in which therapists themselves undergo exposures, has recently demonstrated feasibility, acceptability and preliminary effectiveness for increasing exposure use.
Aims:
This study aimed to assess: (1) therapists’ perceptions of experiential training and (2) barriers and facilitators to implementing exposure following training.
Method:
Therapists who underwent experiential training (n=12) completed qualitative interviews and quantitative questionnaires. Interviews were coded using an integrated approach, combining both inductive and deductive approaches. Mixed methods analyses examined how themes varied by practice setting (community mental health versus private practice) and exposure use.
Results:
Results highlight how therapist-level factors, such as clinician self-efficacy, interact with inner- and outer-setting factors. Participants reported positive perceptions of exposure after training; they noted that directly addressing myths about exposure and experiencing exposures themselves improved their attitudes toward exposure. Consistent with prior literature, issues such as insufficient supervisory support, organizational constraints, and client characteristics made it challenging to implement exposures.
Discussion:
Results highlight the benefits of experiential training, while also highlighting the need to consider contextual determinants. Differences in responses across practice settings highlight areas for intervention and the importance of tailoring implementation strategies. Barriers that were specific to therapists who did not use exposure (e.g. hesitancy about its appropriateness for most clients) point to directions for future implementation efforts.
Cognitive Bias Modification for paranoia (CBM-pa) is a novel, theory-driven psychological intervention targeting the biased interpretation of emotional ambiguity associated with paranoia. Study objectives were (i) test the intervention's feasibility, (ii) provide effect size estimates, (iii) assess dose–response and (iv) select primary outcomes for future trials.
Methods
In a double-blind randomised controlled trial, sixty-three outpatients with clinically significant paranoia were randomised to either CBM-pa or an active control (text reading) between April 2016 and September 2017. Patients received one 40 min session per week for 6 weeks. Assessments were given at baseline, after each interim session, post-treatment, and at 1- and 3-months post-treatment.
Results
A total of 122 patients were screened and 63 were randomised. The recruitment rate was 51.2%, with few dropouts (four out of 63) and follow-up rates were 90.5% (1-month) and 93.7% (3-months). Each session took 30–40 min to complete. There was no statistical evidence of harmful effects of the intervention. Preliminary data were consistent with efficacy of CBM-pa over text-reading control: patients randomised to the intervention, compared to control patients, reported reduced interpretation bias (d = −0.48 to −0.76), improved symptoms of paranoia (d = −0.19 to −0.38), and lower depressed and anxious mood (d = −0.03 to −0.29). The intervention effect was evident after the third session.
Conclusions
CBM-pa is feasible for patients with paranoia. A fully powered randomised control trial is warranted.
To determine the usefulness of adjusting antibiotic use (AU) by prevalence of bacterial isolates as an alternative method for risk adjustment beyond hospital characteristics.
AU in days of therapy per 1,000 patient days and microbiologic data from 2015 and 2016 were collected from 26 hospitals. The prevalences of Pseudomonas aeruginosa, extended-spectrum β-lactamase (ESBL)–producing bacteria, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE) were calculated and compared to the average prevalence of all hospitals in the network. This proportion was used to calculate the adjusted AU (a-AU) for various categories of antimicrobials. For example, a-AU of antipseudomonal β-lactams (APBL) was the AU of APBL divided by (prevalence of P. aeruginosa at that hospital divided by the average prevalence of P. aeruginosa). Hospitals were categorized by bed size and ranked by AU and a-AU, and the rankings were compared.
Results:
Most hospitals in 2015 and 2016, respectively, moved ≥2 positions in the ranking using a-AU of APBL (15 of 24, 63%; 22 of 26, 85%), carbapenems (14 of 23, 61%; 22 of 25; 88%), anti-MRSA agents (13 of 23, 57%; 18 of 26, 69%), and anti-VRE agents (18 of 24, 75%; 15 of 26, 58%). Use of a-AU resulted in a shift in quartile of hospital ranking for 50% of APBL agents, 57% of carbapenems, 35% of anti-MRSA agents, and 75% of anti-VRE agents in 2015 and 50% of APBL agents, 28% of carbapenems, 50% of anti-MRSA agents, and 58% of anti-VRE agents in 2016.
Conclusions:
The a-AU considerably changes how hospitals compare among each other within a network. Adjusting AU by microbiological burden allows for a more balanced comparison among hospitals with variable baseline rates of resistant bacteria.
The Scaling-up Health-Arts Programme: Implementation and Effectiveness Research (SHAPER) project is the world's largest hybrid study on the impact of the arts on mental health embedded into a national healthcare system. This programme, funded by the Wellcome Trust, aims to study the impact and the scalability of the arts as an intervention for mental health. The programme will be delivered by a team of clinicians, research scientists, charities, artists, patients and healthcare professionals in the UK's National Health Service (NHS) and the community, spanning academia, the NHS and the charity sector. SHAPER consists of three studies – Melodies for Mums, Dance for Parkinson's, and Stroke Odysseys – which will recruit over 800 participants, deliver the interventions and draw conclusions on their clinical impact, implementation effectiveness and cost-effectiveness. We hope that this work will inspire organisations and commissioners in the NHS and around the world to expand the remit of social prescribing to include evidence-based arts interventions.
The personality traits of neuroticism, openness, and conscientiousness are relevant factors for cognitive aging outcomes. The present study examined how these traits were associated with cognitive abilities and corresponding resting-state functional connectivity (RSFC) of the default mode network (DMN) in an older and predominantly minority sample. A sample of 58 cognitively unimpaired, largely African-American, older adults (M age = 68.28 ± 8.33) completed a standard RSFC magnetic resonance imaging sequence, a Big Five measure of personality, and delayed memory, Stroop, and verbal fluency tasks. Personality trait associations of within-network connectivity of the posterior cingulate cortex (PCC), a hub of the DMN, were examined using a seed-based approach. Trait scores were regressed on cognitive performance (delayed memory for neuroticism, Stroop for conscientiousness, and verbal fluency for openness). Greater openness predicted greater verbal fluency and greater RSFC between the PCC and eight clusters, including the medial prefrontal cortex, left middle frontal gyrus, and precuneus. Greater PCC–precuneus connectivity predicted greater verbal fluency. Neuroticism and conscientiousness did not significantly predict either cognitive performance or RSFC. Although requiring replication and elaboration, the results implicate openness as a contributing factor to cognitive aging via concomitant cognitive performance and connectivity within cortical hubs of the DMN and add to the sparse literature on these variables in a diverse group of older adults.
A good practice carried to an extreme and worked in accordance with the letter of the law becomes a positive evil.
A military historian once remarked that the history of man is the history of war and the history of war is the history of man. History tells us that peace is not the norm despite mankind's efforts to achieve lasting peace. For much of history, conflict has been a barbaric clash of wills with the strong prevailing. In large measure, good rarely triumphed over evil. Though early attempts were made to extend some type of civility to the battlefield, use of law and regulation in protecting combatants is a modern phenomenon. Only in the past fifty years have we seen a comprehensive legal regime evolve that attempts to regulate conduct in conflict.
Despite the establishment of the laws of armed conflict in the past century, modern conflict involves actors who do not follow any international norms and who ignore basic humanitarian principles. The dirty wars of the twentyfirst century will mirror conflict not seen since the Dark Ages. Actors in these conflicts choose to use fear, terror, and suffering as a weapon of war, preying upon the most vulnerable members of society – mainly women and children.
The international community is not prepared to predict, prevent, and fight in these types of conflicts. Even though the development of law in this area has flourished and the jurisprudence from the various international tribunals has developed the ability to hold combatants who do not follow the rule of law on the battlefield accountable, conflict itself has moved backward in many parts of the world where the standard is “no quarter.” Kill or be killed is the new norm in this evolving century.
Along with this devolution in conflict, we see the world in extremes as the final visages of the fifty-year-long Cold War slide away into history. It can be argued that the twentieth century was almost a century-long conflict that historians have broken up into three wars: World War I, World War II, and the Cold War.
Commissions of inquiry (‘commissions’) have been loosely characterized as a new form of adjudication. This Chapter assesses the current and potential role of commissions in the overall legal framework regarding the use of force. The Chapter thus aims to locate commissions within the greater jus ad bellum architecture. While inquiry reports are formally non-binding, they interact with other institutions and actors, and may have wider normative ramifications. The Chapter portrays the diversity of the inquiry landscape and zeroes in on the Kosovo and Iraq Inquiries as concrete examples of inquiry practice operating in situations that evoked fundamental jus ad bellum questions. Given the Human Rights Council’s frequent practice of establishing commissions, the Chapter specifically examines whether future HRC commissions may become more active in the jus ad bellum domain in light of the potential activation of the International Criminal Court’s jurisdiction over the crime of aggression. The Chapter concludes with some reflections on the accountability-potential of commissions of inquiry.
The Balkan Wars, the Rwanda genocide, and the crimes against humanity in Cambodia and Sierra Leone spurred the creation of international criminal tribunals to bring the perpetrators of unimaginable atrocities to justice. When Richard Goldstone, David Crane, Robert Petit, and Luis Moreno-Ocampo received the call - each set out on a unique quest to build an international criminal tribunal and launch its first prosecutions. Never before have the founding International Prosecutors told the behind-the-scenes stories of their historic journey. With no blueprint and little precedent, each was a path-breaker. This book contains the first-hand accounts of the challenges they faced, the obstacles they overcame, and the successes they achieved in obtaining justice for millions of victims.
This extraordinary book project began over a glass of wine during the annual International Humanitarian Dialogs at the world famous Chautauqua Institution in 2015. Each year, most of the world's international chief prosecutors gather to reflect upon the various issues and challenges pertaining to modern international criminal law. The prosecutors are all friends, and the meetings are informal and collegial. One evening, sitting together on the famous porches of the Athenaeum Hotel while we sipped our wine, I asked my colleagues, somewhat rhetorically, whether any one of us ever actually had asked for the unique job of being a chief prosecutor of an international war crimes tribunal? Not one of us actually asked for, sought out, or applied for the positions we would eventually fill in Yugoslavia, Rwanda, Sierra Leone, or Cambodia, even as prosecutors of the International Criminal Court.
As it turns out, as we went around telling our selection stories, we all got what we called “the phone call.” Unexpected, surprising, and/or “out of the blue,” so to speak, we received that call asking us whether we would consider being a chief prosecutor. Four of us got the call not only to be prosecutors, but also to help create a brand new tribunal.
After we all left Chautauqua, as I flew home to Maggie Valley in North Carolina, I realized that there have only been five individuals who have created an international justice mechanism. Four of us exist in the modern era. The first was Robert H. Jackson, who had passed decades earlier. As I continued to mull this over, I came to the realization that no chief prosecutor has ever written about how they created the prosecution office of their tribunals. Wouldn't it be amazing if I could get my colleagues who created the five modern international tribunals to write about that experience in a book? Hence the idea of The Founders was floated by those founding chief prosecutors, and each agreed to write a chapter on their experiences in the creation of the tribunals in Yugoslavia, Rwanda, Sierra Leone, the ICC, and Cambodia. As one of those founders for the tribunal in Sierra Leone, I would write that chapter.