A longitudinal and experimental study of the impact of knowledge on the bases of institutional trust

This study examined a knowledge-centered theory of institutional trust development. In the context of trust in water regulatory institutions, the moderating impact of knowledge was tested to determine if there were longitudinal changes in the bases of institutional trust as a function of increases in knowledge about a target institution. We hypothesized that as people learn about an institution with which they were previously unfamiliar, they begin to form more nuanced perceptions, distinguishing the new institution from other institutions and relying less upon their generalized trust to estimate their trust in that institution. Prior to having specific, differential information about a new institution, we expected institutional trust to be a function of generalized trust variables such as dispositional trust and trust in government. The longitudinal experiment involved 185 college students randomly assigned to one of three information conditions. Every 3 months for 15 months, participants read information about water regulatory institutions or a control institution. At each time point, participants reported their trust in and perceptions of the trust- and distrust-worthiness of the water regulatory institutions. Participants also completed measures of knowledge of water regulatory institutions, dispositional trust, and governmental trust. Our manipulation check indicated that, as expected, those in the experimental group increased in subjective knowledge of water regulatory institutions to a greater extent than those in the control condition. Consistent with our hypotheses, there was some evidence that, compared to the control group, the experimental group relied less on their general trust in government as a basis for their trust in water regulatory institutions. However, contrary to our hypotheses, there was no evidence the experimental group relied less on dispositional trust as a basis for institutional trust. There also was some evidence the experimental group\u27s trust in water regulatory institutions was less affected by fluctuations of trustworthiness (but not distrustworthiness) perceptions over time. This suggests that knowledge results in the development of more stable institutional trust attitudes, but that trustworthiness and distrustworthiness perceptions may operate somewhat differently when impacting trust in specific institutions

The impact of hyperhidrosis on patients' daily life and quality of life : A qualitative investigation

Background: An understanding of the daily life impacts of hyperhidrosis and how patients deal with them, based on qualitative research, is lacking. This study investigated the impact of hyperhidrosis on the daily life of patients using a mix of qualitative research methods. Methods: Participants were recruited through hyperhidrosis patient support groups such as the Hyperhidrosis Support Group UK. Data were collected using focus groups, interviews and online surveys. A grounded theory approach was used in the analysis of data transcripts. Data were collected from 71 participants, out of an initial 100 individuals recruited. Results: Seventeen major themes capturing the impacts of hyperhidrosis were identified; these covered all areas of life including daily life, psychological well-being, social life, professional /school life, dealing with hyperhidrosis, unmet health care needs and physical impact. Conclusions: Psychosocial impacts are central to the overall impacts of hyperhidrosis, cutting across and underlying the limitations experienced in other areas of life.Peer reviewe

Efficacy and safety with ticagrelor in patients with prior myocardial infarction in the approved European label: insights from PEGASUS-TIMI 54

Aims In PEGASUS-TIMI 54, ticagrelor significantly reduced the risk of the composite of major adverse cardiovascular (CV) events by 15–16% in stable patients with a prior myocardial infarction (MI) 1–3 years earlier. We report the efficacy and safety in the subpopulation recommended for treatment in the European (EU) label, i.e. treatment with 60 mg b.i.d. initiated up to 2 years from the MI, or within 1 year after stopping previous adenosine diphosphate receptor inhibitor treatment. Methods and results Of the 21 162 patients enrolled in PEGASUS-TIMI 54, 10 779 patients were included in the primary analysis for this study, randomized to ticagrelor 60 mg (n = 5388) or matching placebo (n = 5391). The cumulative proportions of patients with events at 36 months were calculated by the Kaplan–Meier (KM) method. The composite of CV death, MI, or stroke occurred less frequently in the ticagrelor group (7.9% KM rate vs. 9.6%), hazard ratio (HR) 0.80 [95% confidence interval (CI) 0.70–0.91; P = 0.001]. Ticagrelor also reduced the risk of all-cause mortality, HR 0.80 (0.67–0.96; P = 0.018). Thrombolysis in myocardial infarction major bleeding was more frequent in the ticagrelor group 2.5% vs. 1.1%; HR 2.36 (1.65–3.39; P < 0.001). The corresponding HR for fatal or intracranial bleeding was 1.17 (0.68–2.01; P = 0.58). Conclusion In PEGASUS-TIMI 54, treatment with ticagrelor 60 mg as recommended in the EU label, was associated with a relative risk reduction of 20% in CV death, MI, or stroke. Thrombolysis in myocardial infarction major bleeding was increased, but fatal or intracranial bleeding was similar to placebo. There appears to be a favourable benefit-risk ratio for long-term ticagrelor 60 mg in this population. Clinical trial registration http://www.clinicaltrials.gov NCT0122556

Reduction in Subtypes and Sizes of Myocardial Infarction With Ticagrelor in PEGASUS-TIMI 54

Background: Ticagrelor reduced cardiovascular death, myocardial infarction (MI), or stroke in patients with prior MI in PEGASUSTIMI 54 (Prevention of Cardiovascular Events [eg, Death From Heart or Vascular Disease, Heart Attack, or Stroke] in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin). MI can occur in diverse settings and with varying severity; therefore, understanding the types and sizes of MI events prevented is of clinical importance. Methods and Results: MIs were adjudicated by a blinded clinical events committee and categorized by subtype and fold elevation of peak cardiac troponin over the upper limit of normal. A total of 1042 MIs occurred in 898 of the 21 162 randomized patients over a median follow-up of 33 months. The majority of the MIs (76%) were spontaneous (Type 1), with demand MI (Type 2) and stent thrombosis (Type 4b) accounting for 13% and 9%, respectively; sudden death (Type 3), percutaneous coronary intervention–related (Type 4a) and coronary artery bypass graft–related (Type 5) each accounted for <1%. Half of MIs (520, 50%) had a peak troponin ≥10x upper limit of normal and 21% of MIs (220) had a peak troponin ≥1009 upper limit of normal. A total of 21% (224) were ST-segment–elevation MI STEMI. Overall ticagrelor reduced MI (4.47% versus 5.25%, hazard ratio 0.83, 95% confidence interval 0.72–0.95, P=0.0055). The benefit was consistent among the subtypes, including a 31% reduction in MIs with a peak troponin ≥1009 upper limit of normal (hazard ratio 0.69, 95% confidence interval 0.53–0.92, P=0.0096) and a 40% reduction in ST-segment elevation MI (hazard ratio 0.60, 95% confidence interval 0.46–0.78, P=0.0002). Conclusions: In stable outpatients with prior MI, the majority of recurrent MIs are spontaneous and associated with a high biomarker elevation. Ticagrelor reduces the MI consistently among subtypes and sizes including large MIs and ST-segment elevation MI

The Age of Lone Wolf Terrorism

The lethality of lone-wolf terrorism has reached an all-time high in the United States. Isolated individuals using firearms with high-capacity magazines are committing brutally efficient killings with the aim of terrorizing others, yet there is little consensus on what connects these crimes and the motivations behind them. In The Age of Lone Wolf Terrorism, terrorism experts Mark S. Hamm and Ramón Spaaij combine criminological theory with empirical and ethnographic research to map the pathways of lone-wolf radicalization, helping with the identification of suspected behaviors and recognizing patterns of indoctrination. Reviewing comprehensive data on these actors, including more than two hundred terrorist incidents, Hamm and Spaaij find that a combination of personal and political grievances lead lone wolves to befriend online sympathizers—whether jihadists, white supremacists, or other antigovernment extremists—and then announce their intent to commit terror when triggered. Hamm and Spaaij carefully distinguish between lone wolves and individuals radicalized within a group dynamic. This important difference is what makes this book such a significant manual for professionals seeking richer insight into the transformation of alienated individuals into armed warriors. Hamm and Spaaij conclude with an analysis of recent FBI sting operations designed to prevent lone-wolf terrorism in the United States, describing who gets targeted, strategies for luring suspects, and the ethics of arresting and prosecuting citizens

Endgame? Sports Events as Symbolic Targets in Lone Wolf Terrorism

This article explores how terrorists acting alone or in small groups have used sports events as symbolic targets in their performance of terrorism. Drawing on a comparative analysis of the attacks on the 1996 Atlanta Olympic Games and the 2013 Boston Marathon, it is argued that terrorist target selection of major sports events should be understood in relation to the grievances and desires of the perpetrators. The article finds that rather than being the primary target of their attacks, sports events are among a broader range of densely crowded spaces that terrorist actors may seek to target as part of their violent struggle against their adversaries. The findings are contextualized in relation to broader patterns and trends in lone wolf terrorism, including the significance of a copycat phenomenon and inspiration effect