Teaching Notes for CHAPTER 15: Reconsidering Reintegration

Teaching Notes for Reconsidering Reintegration, by Kim Fletcher. This case is designed to be taught in three separate parts; however, the first two parts can also stand alone from the third. In Part I the students are introduced to the characters and they begin to get emotionally involved in the story. They are forced to make a decision that faces many child soldiers: commit an atrocity against your family or in your own town, or be killed. At this point in the case the students may start to recognize some of the broader problems of delineating victims from perpetrators in conflict situations in which some combatants are kidnapped and forced to fight, but it will be made more explicit in Part II. In Part II several dilemmas are illustrated in the case, each of which reflects larger policy dilemmas. The blurry line between victims and perpetrators is drawn out. Additionally, reintegration programs typically seek to focus on the former child soldier, inadvertently at the expense of his or her family and community. In Part III the students have the chance to consider the dilemmas posed in Parts I and II in designing their own post-conflict programs. As in most cases, there is no correct solution. Instead the students have the opportunity to confront some the many challenges facing IGOs and INGOs in post-conflict situations. They should walk away with a better appreciation of the many actors involved, their interests, and the ways in which competing interests may impact the implementation of programs on the ground

Combining Grievance and Feasibility: Improving our Understanding of Civil Conflict Onset

This study seeks to improve our understanding of the drivers of civil conflict through a synthesis of the grievance and feasibility approaches. It begins with two premises. The first is that the proponents of the feasibility explanation of conflict onset—who suggest that civil conflict will occur where it can happen—did not use theoretically justified measures of grievance in making their determination that motives have little bearing as drivers of conflict. The second premise is that the grievance literature that improved upon those measures did not fully consider feasibility in their models, leaving questions remaining regarding whether and to what degree more sound measures of grievance improve our current understanding of when and where conflict occurs. The research presented here seeks to address those limitations by adding updated grievance measures to the feasibility model to determine whether the feasibility hypothesis ought to be reconsidered. In this study several of the new measures of grievance remain significantly related with onset when they are added to the feasibility model, suggesting that grievance levels do influence civil conflict likelihood. However, the inclusion of the improved grievance measures does not statistically improve the ability of the feasibility model to classify onset and non-conflict periods correctly. Therefore, while grievances may be related with conflict onset, the onus is still on those in the “grievance camp” to illustrate the manner in which knowing grievance levels improves our ability to predict civil conflict onset

Socioeconomic Determinants of HIV Status in Kenya

The spread of Human Immunodeficiency Virus (HIV) is one of the greatest threats to stability and development in Kenya. The country\u27s infection rate is estimated between seven and eight percent, making it one of the highest in the world. Several studies have been done that examine subpopulations such as truck drivers, sex workers, and migrants. However, to date there is little research that examines who, across the country, is contracting HIV. Kenya\u27s 2003 Demographic and Health Survey includes data that make it possible to determine which groups have the highest odds of being infected. The question of who is contracting HIV in Kenya was examined using a structural violence framework. Proponents of the theory suggest that those marginalized for social or economic reasons in any society are at the highest risk of contracting infectious diseases. Because marginalization occurs in different spheres and to different degrees for men and women, only women were included in the analysis. Logistic regression was used in analyzing the data, with HIV status entered as the dependent variable. While a few of the hypotheses suggested by structural violence were supported by the data, the theory did not provide an adequate explanation for who is contracting the disease. However, the findings do have practical implications regarding who to target when trying to slow the spread of HIV in sub-Saharan Africa

Redox Signaling in Colonial Hydroids: Many Pathways for Peroxide

Studies of mitochondrial redox signaling predict that the colonial hydroids Eirene viridula and Podocoryna carnea should respond to manipulations of reactive oxygen species (ROS). Both species encrust surfaces with feeding polyps connected by networks of stolons; P. carnea is more ‘sheet-like’ with closely spaced polyps and short stolons, while E. viridula is more ‘runner-like’ with widely spaced polyps and long stolons. Treatment with the chemical antioxidant vitamin C diminishes ROS in mitochondrion-rich epitheliomuscular cells (EMCs) and produces phenotypic effects (sheet-like growth) similar to uncouplers of oxidative phosphorylation. In peripheral stolon tips, treatment with vitamin C triggers a dramatic increase of ROS that is followed by tissue death and stolon regression. The enzymatic anti-oxidant catalase is probably not taken up by the colony but, rather, converts hydrogen peroxide in the medium to water and oxygen. Exogenous catalase does not affect ROS in mitochondrion-rich EMCs, but does increase the amounts of ROS emitted from peripheral stolons, resulting in rapid, runner-like growth. Treatment with exogenous hydrogen peroxide increases ROS levels in stolon tips and results in somewhat faster colony growth. Finally, untreated colonies of E. viridula exhibit higher levels of ROS in stolon tips than untreated colonies of P. carnea. ROS may participate in a number of putative signaling pathways: (1) high levels of ROS may trigger cell and tissue death in peripheral stolon tips; (2) more moderate levels of ROS in stolon tips may trigger outward growth, inhibit branching and, possibly, mediate the redox signaling of mitochondrion-rich EMCs; and (3) ROS may have an extra-colony function, perhaps in suppressing the growth of bacteria

Use of a Structured Mirrors Intervention Does Not Reduce Delirium Incidence But May Improve Factual Memory Encoding in Cardiac Surgical ICU Patients Aged Over 70 Years: A Pilot Time-Cluster Randomized Controlled Trial.

Introduction: Post-operative delirium remains a significant problem, particularly in the older surgical patient. Previous evidence suggests that the provision of supplementary visual feedback about ones environment via the use of a mirror may positively impact on mental status and attention (core delirium diagnostic domains). We aimed to explore whether use of an evidence-based mirrors intervention could be effective in reducing delirium and improving post-operative outcomes such as factual memory encoding of the Intensive Care Unit (ICU) environment in older cardiac surgical patients. Methods: This was a pilot time-cluster randomized controlled trial at a 32-bed ICU, enrolling 223 patients aged 70 years and over, admitted to ICU after elective or urgent cardiac surgery from October 29, 2012 to June 23, 2013. The Mirrors Group received a structured mirrors intervention at set times (e.g., following change in mental status). The Usual Care Group received the standard care without mirrors. Primary outcome was ICU delirium incidence; secondary outcomes were ICU delirium days, ICU days with altered mental status or inattention, total length of ICU stay, physical mobilization (balance confidence) at ICU discharge, recall of factual and delusional ICU memories at 12 weeks, Health-Related Quality of Life at 12 weeks, and acceptability of the intervention. Results: The intervention was not associated with a significant reduction in ICU delirium incidence [Mirrors: 20/115 (17%); Usual Care: 17/108 (16%)] or duration [Mirrors: 1 (1-3); Usual Care: 2 (1-8)]. Use of the intervention on ICU was predictive of significantly higher recall of factual (but not delusional) items at 12 weeks after surgery (p = 0.003) and acceptability was high, with clinicians using mirrors at 86% of all recorded hourly observations. The intervention did not significantly impact on other secondary outcomes. Conclusion: Use of a structured mirrors intervention on the post-operative ICU does not reduce delirium, but may result in improved factual memory encoding in older cardiac surgical patients. This effect may occur via mechanisms unrelated to delirium, altered mental status, or inattention. The intervention may provide a new means of improving outcomes in patients at risk of post-ICU anxiety and/or Post-Traumatic Stress Disorder. Trial Registration: Clinicaltrials.gov identifier NCT01599689

Unexpected Long-Term Variability in Jupiter's Tropospheric Temperatures

An essential component of planetary climatology is knowledge of the tropospheric temperature field and its variability. Previous studies of Jupiter hinted at periodic behavior that was non-seasonal, as well as dynamical relationships between tropospheric and stratospheric temperatures. However, these observations were made over time frames shorter than Jupiter's orbit or they used sparse sampling. We derived upper-tropospheric (300-mbar) temperatures over 40 years, extending those studies to cover several orbits of Jupiter, revealing unexpected results. Periodicities of 4, 7 8-9 and 10-14 years were discovered that involved different latitude bands and seem disconnected from seasonal changes in solar heating. Anti-correlations of variability in opposite hemispheres were particularly striking at 16, 22 and 30 degrees from the equator. Equatorial temperature variations are also anticorrelated with those 60-70 km above. Such behavior suggests a top-down control of equatorial tropospheric temperatures from stratospheric dynamics. Realistic future global climate models must address the origins of these variations in preparation for their extension to a wider array of gas-giant exoplanets.Comment: Primary file: 16 pages, 5 figures. Supplemental File (attached): 12 pages, 3 figures, 1 tabl

Physiologically based pharmacokinetic modelling prediction of the effects of dose adjustment in drug–drug interactions between levonorgestrel contraceptive implants and efavirenz-based ART

Background HIV-positive women receiving efavirenz-based ART and levonorgestrel contraceptive implants are at risk of low levonorgestrel exposure and unintended pregnancy. Objectives To investigate clinically applicable dose-adjustment strategies to overcome the known drug–drug interaction (DDI) between levonorgestrel and efavirenz, using a physiologically based pharmacokinetic (PBPK) modelling-based approach. Methods A PBPK model was qualified against clinical data to predict levonorgestrel plasma concentrations when standard-dose (150 mg) levonorgestrel implants were administered alone (control group), as well as when standard-dose or increased-dose (300 mg) levonorgestrel implants were coadministered with either 600 or 400 mg of efavirenz. Results No difference was seen between in vivo clinical and PBPK-model-simulated levonorgestrel plasma concentrations (P > 0.05). Simulated levonorgestrel plasma concentrations were ∼50% lower at 48 weeks post-implant-placement in virtual individuals receiving standard-dose levonorgestrel with either 600 or 400 mg of efavirenz compared with the control group (efavirenz:control geometric mean ratio = 0.42 and 0.49, respectively). Conversely, increased-dose levonorgestrel in combination with either 600 or 400 mg of efavirenz was sufficient to restore levonorgestrel concentrations to levels similar to those observed in the 150 mg levonorgestrel control group 48 weeks post-implant-placement (efavirenz:control geometric mean ratio = 0.86 and 1.03, respectively). Conclusions These results suggest that the clinically significant DDI between efavirenz and levonorgestrel is likely to persist despite efavirenz dose reduction, whereas dose escalation of implantable levonorgestrel may represent a successful clinical strategy to circumvent efavirenz–levonorgestrel DDIs and will be of use to inform clinical trial design to assess coadministration of efavirenz and levonorgestrel implants

New Frontiers-class Uranus Orbiter: Exploring the feasibility of achieving multidisciplinary science with a mid-scale mission

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Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio