Who pays for the next wave? The American welfare state and responsibility for flood risk

In preparing for and responding to natural hazards and disasters, the welfare state establishes a social contract, distributing responsibilities for what will be collectively managed and what will be individually borne. Drawing on archival, interview, and ethnographic data, this article examines the renegotiation of that social contract through the lens of contested efforts to reform the massively indebted US National Flood Insurance Program (NFIP) from 2011 to 2014. In the face of a morally charged debate about deservingness and individual choice, Congress passed legislation that committed to incorporating need-based considerations to the NFIP for the first time. The result defined “deservingness” in terms of ability to pay for risk exposure, qualifying an individualization of responsibility for addressing the problem of flood loss—a problem that might instead demand broader risk sharing, particularly as climate change worsens the threat of flooding

It's not a lack of information that stops many Americans from adapting to flood risks; it's a lack of cash.

The devastating effects of Hurricane Harvey on the south coast of the US have raised new questions about how Americans deal with flood risk. Drawing on her research on how New York responded to the aftermath of Hurricane Sandy, Rebecca Elliott argues that giving people in flood prone areas more information about flood risk is not enough; policymakers need to ..

The detrimental effects of emotional process dysregulation on decision-making in substance dependence

Substance dependence is complex and multifactorial, with many distinct pathways involved in both the development and subsequent maintenance of addictive behaviors. Various cognitive mechanisms have been implicated, including impulsivity, compulsivity, and impaired decision-making. These mechanisms are modulated by emotional processes, resulting in increased likelihood of initial drug use, sustained substance dependence, and increased relapse during periods of abstinence. Emotional traits, such as sensation-seeking, are risk factors for substance use, and chronic drug use can result in further emotional dysregulation via effects on reward, motivation, and stress systems. We will explore theories of hyper and hypo sensitivity of the brain reward systems that may underpin motivational abnormalities and anhedonia. Disturbances in these systems contribute to the biasing of emotional processing toward cues related to drug use at the expense of natural rewards, which serves to maintain addictive behavior, via enhanced drug craving. We will additionally focus on the sensitization of the brain stress systems that result in negative affect states that continue into protracted abstinence that is may lead to compulsive drug-taking. We will explore how these emotional dysregulations impact upon decision-making controlled by goal-directed and habitual action selections systems, and, in combination with a failure of prefrontal inhibitory control, mediate maladaptive decision-making observed in substance dependent individuals such that they continue drug use in spite of negative consequences. An understanding of the emotional impacts on cognition in substance dependent individuals may guide the development of more effective therapeutic interventions

The Attitudes about Complex Therapy Scale (ACTS) in Type 2 Diabetes and Cardiovascular Disease: Development, Validity and Reliability

Background: Type 2 diabetes is associated with cardiovascular disease, and patients with both conditions are prescribed complex medication regimens. Aim: The aim was to develop a reliable and valid measure of attitudes associated with the prescription and management of multiple medicines in patients with Type 2 diabetes and cardiovascular disease. Methods: Principal component analysis (PCA) and Cronbach alpha assessed the reliability of the Attitudes about Complex Therapy Scale (ACTS). Examinations of relationships with related measures inform concurrent validity. Questionnaires were sent to a cross-sectional sample of 480 people prescribed multiple medicines for co-morbid Type 2 diabetes. Results: Cronbach alpha was 0.76, indicating the scale had good internal reliability. PCA rotated a four factor model accounting for 37% of the variance. Four subscales identified; 1. Concerns about multiple medicines and increasing numbers of medicines; 2.Anxiety over missed medicines; 3. Desires to substitute medicines and reduce the number of medicines prescribed and; 4. Perceptions related to organising and managing complex therapy. The ACTS showed significant relationships with measures of anxiety, depression, general beliefs about medicines and self-efficacy. Also, the ACTS significantly correlated with adherence to medicines, showing good predictive validity. Conclusion: The ACTS was designed to assess negative attitudes towards complex therapy and multiple medication management. This tool could aid prescribing decisions and may identify people who are intentionally non-adherent to all or some of their medicines

Manually defining regions of interest when quantifying paravertebral muscles fatty infiltration from axial magnetic resonance imaging : a proposed method for the lumbar spine with anatomical cross-reference

Background: There is increasing interest in paravertebral muscle composition as a potential prognostic and diagnostic element in lumbar spine health. As a consequence, it is becoming popular to use magnetic resonance imaging (MRI) to examine muscle volume and fatty infiltration in lumbar paravertebral muscles to assess both age-related change and their clinical relevance in low back pain (LBP). A variety of imaging methods exist for both measuring key variables (fat, muscle) and for defining regions of interest, making pooled comparisons between studies difficult and rendering post-production analysis of MRIs confusing. We therefore propose and define a method as an option for use as a standardized MRI procedure for measuring lumbar paravertebral muscle composition, and to stimulate discussion towards establishing consensus for the analysis of skeletal muscle composition amongst clinician researchers. Method: In this descriptive methodological study we explain our method by providing an examination of regional lumbar morphology, followed by a detailed description of the proposed technique. Identification of paravertebral muscles and vertebral anatomy includes axial E12 sheet-plastinates from cadaveric material, combined with a series of axial MRIs that encompass sequencing commonly used for investigations of muscle quality (fat-water DIXON, T1-, and T2-weighted) to illustrate regional morphology; these images are shown for L1 and L4 levels to highlight differences in regional morphology. The method for defining regions of interest (ROI) for multifidus (MF), and erector spinae (ES) is then described. Results: Our method for defining ROIs for lumbar paravertebral muscles on axial MRIs is outlined and discussed in relation to existing literature. The method provides a foundation for standardising the quantification of muscle quality that particularly centres on examining fatty infiltration and composition. We provide recommendations relating to imaging parameters that should additionally inform a priori decisions when planning studies examining lumbar muscle tissues with MRI. Conclusions: We intend this method to provide a platform towards developing and delivering meaningful comparisons between MRI data on lumbar paravertebral muscle quality

Advancing imaging technologies for patients with spinal pain : with a focus on whiplash injury

Background: Radiological observations of soft-tissue changes that may relate to clinical symptoms in patients with traumatic and non-traumatic spinal disorders are highly controversial. Studies are often of poor quality and findings are inconsistent. A plethora of evidence suggests some pathoanatomical findings from traditional imaging applications are common in asymptomatic participants across the life span, which further questions the diagnostic, prognostic, and theranostic value of traditional imaging. Although we do not dispute the limited evidence for the clinical importance of most imaging findings, we contend that the disparate findings across studies may in part be due to limitations in the approaches used in assessment and analysis of imaging findings. Purpose: This clinical commentary aimed to (1) briefly detail available imaging guidelines, (2) detail research-based evidence around the clinical use of findings from advanced, but available, imaging applications (eg, fat and water magnetic resonance imaging and magnetization transfer imaging), and (3) introduce how evolving imaging technologies may improve our mechanistic understanding of pain and disability, leading to improved treatments and outcomes. Study Design/Setting: A non-systematic review of the literature is carried out. Methods: A narrative summary (including studies from the authors' own work in whiplash injuries) of the available literature is provided. Results: An emerging body of evidence suggests that the combination of existing imaging sequences or the use of developing imaging technologies in tandem with a good clinical assessment of modifiable risk factors may provide important diagnostic information toward the exploration and development of more informed and effective treatment options for some patients with traumatic neck pain. Conclusions: Advancing imaging technologies may help to explain the seemingly disconnected spectrum of biopsychosocial signs and symptoms of traumatic neck pain

An adjudicated hermeneutic single-case efficacy design study of experiential therapy for panic/phobia

This paper illustrates the application of an adjudicated form of Hermeneutic Single Case Efficacy Design (HSCED), a critical-reflective method for inferring change and therapeutic influence in single therapy cases. The client was a 61 year-old European-American male diagnosed with panic and bridge phobia. He was seen for 23 sessions of individual Process-Experiential/Emotion-Focused Therapy. In this study, affirmative and skeptic teams of researchers developed opposing arguments regarding whether the client changed over therapy and whether therapy was responsible for these changes. Three judges representing different theoretical orientations then assessed data and arguments, rendering judgments in favor of the affirmative side. We discuss clinical implications and recommendations for the future interpretive case study research

Conditional or unconditional? The effects of implementation intentions on driver behavior

Implementation intentions (IF-THEN plans) exert conditional effects on behavior, meaning that their ability to change behavior is conditional upon encountering the critical situation specified in the IF component of the plan. In the present study, we tested whether implementation intentions can exert unconditional effects on behavior. Consistent with the process of operant generalization, we hypothesized that implementation intentions would change behavior, not only in situations that are contextually identical to those specified in the IF component but also in contextually similar situations. Implementation intentions were not expected to generate behavior-change in contextually different situations to those specified. Participants (N = 139) completed questionnaires measuring speeding behavior and motivation to speed. Experimental participants then specified implementation intentions to avoid speeding in critical situations that were either contextually identical, similar or different to those subsequently encountered on a driving simulator. Control participants received educational information about the risks of speeding. All participants then drove on a driving simulator. Consistent with the hypotheses, participants in both the contextually identical and similar conditions exceeded the speed limit less frequently than did controls. There was no difference in speeding behavior between the contextually different and control conditions. Implications of the findings for behavior-change are discussed

Parathyroid hormone secretion is controlled by both ionized calcium and phosphate during exercise and recovery in men

Context: The mechanism by which PTH is controlled during and after exercise is poorly understood due to insufficient temporal frequency of measurements. Objective: The objective of the study was to examine the temporal pattern of PTH, PO4, albumin-adjusted calcium, and Ca2+ during and after exercise. Design and Setting: This was a laboratory-based study with a crossover design, comparing 30 minutes of running at 55%, 65%, and 75% maximal oxygen consumption, followed by 2.5 hours of recovery. Blood was obtained at baseline, after 2.5, 5, 7.5, 10, 15, 20, 25, and 30 minutes of exercise, and after 2.5, 5, 7.5, 10, 15, 20, 25, 30, 60, 90, and 150 minutes of recovery. Participants: Ten men (aged 23 ± 1 y, height 1.82 ± 0.07 m, body mass 77.0 ± 7.5 kg) participated. Main Outcome Measures: PTH, PO4, albumin-adjusted calcium, and Ca2+ were measured. Results: Independent of intensity, PTH concentrations decreased with the onset of exercise (−21% to −33%; P ≤ .001), increased thereafter, and were higher than baseline by the end of exercise at 75% maximal oxygen consumption (+52%; P ≤ .001). PTH peaked transiently after 5–7.5 minutes of recovery (+73% to +110%; P ≤ .001). PO4 followed a similar temporal pattern to PTH, and Ca2+ followed a similar but inverse pattern to PTH. PTH was negatively correlated with Ca2+ across all intensities (r = −0.739 to −0.790; P ≤ .001). When PTH was increasing, the strongest cross-correlation was with Ca2+ at 0 lags (3.5 min) (r = −0.902 to −0.950); during recovery, the strongest cross-correlation was with PO4 at 0 lags (8 min) (r = 0.987–0.995). Conclusions: PTH secretion during exercise and recovery is controlled by a combination of changes in Ca2+ and PO4 in men