An Investigation of Neurological soft signs as a discriminating factor between Veterans with Post-traumatic Stress Disorder, mild Traumatic Brain Injury, and co-occurring Post-traumatic Stress Disorder and mild Traumatic Brain Injury

While multiple Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans suffer from mild Traumatic Brain Injury (mTBI), Post-traumatic Stress Disorder (PTSD), and co-morbid mTBI and PTSD, there remains difficulty disentangling the specific symptoms associated with each disorder using self-report and neurocognitive assessments. We propose that neurological soft signs (NSS), which are tasks associated with general neurologic compromise, may prove useful in this regard. Based on our review of the literature we hypothesized that individuals with PTSD would present with a greater number of NSS than controls or individuals with mTBI. Further, we hypothesized a synergistic effect, such that individuals with mTBI + PTSD would present with the greatest number of NSS. To test these hypotheses, we analyzed a subset of individuals (N=238) taken from a larger study of neurocognitive functioning in veterans. Participants completed a battery of neuropsychological measures, which included the Behavioral Dyscontrol Scale (BDS), the current study’s measure of NSS. A subset of other neuropsychological measures were also included to examine the utility of NSS over and above traditional neuropsychological measures. Individuals were removed from the study if they sustained a moderate/severe TBI or did not meet validity criteria on the Green’s Word Memory Test or the Negative Impression Management subscale of the Personality Assessment Inventory. Binomial logistic and multinomial logistic regression were used to examine the ability of NSS to discriminate between the study groups, first by themselves and then after the variance explained by the traditional neuropsychological measures was accounted for. Exploratory cluster analyses were performed on neuropsychological measures and NSS to identify profiles of cognitive performance in the data set. Results indicated that individuals in the mTBI and/or PTSD group had more NSS compared to controls. Of the individual NSS items only a go/no-go task of the BDS discriminated between groups, with worse performance among individuals in the mTBI, PTSD, and mTBI + PTSD group compared to controls. In contrast, the overall BDS score and individual NSS, in general, did not discriminate between the mTBI, PTSD, and mTBI + PTSD group. Overall, the current study suggests that, when eliminating participants who do not meet validity criteria, NSS do not aid in discriminating between individuals with mTBI, PTSD, and mTBI + PTSD

Revisionism Misplaced: Why This is Not the Time to Bury Autonomy

For the past twenty years, bioethics has exerted a profound influence on American medicine. Although its full impact cannot be precisely measured, one need only speak to European physicians and clinical investigators to grasp the full extent of the change. Americans may debate the sufficiency of the information that physicians share with their patients, but hear a European doctor exclaim angrily that it is criminal to ask a woman to decide whether to have a radical mstectomy or lumpectomy, and you know that bioethics has made a significant difference in the United States. So too, Americans, far more intensely than Europeans, will fiercly contest any proposed exception to informed consent in research protocols, and our Institutional Review Boards (IRBs) are unmatched for the protections they provide human subjects. Not only foreign comparisons but daily events point to the difference that bioethics has made: consider the newspaper space devoted to bioethical considerations, whether the case be multiple births, AIDS testing in Africa, cloning, or organ donation, to choose recent examples; or the readiness of lawyers to have clients sign an advanced directive and proxy assignment; or the intensity of public debate on physician-assisted suicide. Bioethics has clearly become the stuff of referendum campaigns and dinner-table discussions

The Effect of Pre-Deployment Physiology as a Predictor of Post-Traumatic Stress Disorder Among a Sample of United States Army National Guard and Reserve Soldiers

Potential risk factors for development of Post-Traumatic Stress Disorder (PTSD) are still unclear. One potential risk factor for the development of PTSD is an individual’s cardiovascular reactivity and recovery in response to stressor tasks. The current study was conducted with 763 Army National Guard and Army Reserve soldiers. Participants completed a stressful induction along with self-report measures prior to deployment. Post-deployment, self-report measures were completed to assess PTSD symptomatology and experiences related to deployment and combat. Multiple regression was used to determine the ability of blood pressure response to stress to predict PTSD symptoms immediately and one-year after return from deployment. Results indicated that soldiers who had a less reactive systolic blood pressure response to and recovery from stressor tasks reported more PTSD symptomatology immediately after and one year after return from deployment. These results suggest that soldiers who develop PTSD after deployment have less pre-deployment emotion regulation ability

Building an Islamic psychology and psychotherapy : a grounded theory study

At a time when there is increasing focus on the need to adapt approaches to psychotherapy to align with the cultural and religious/spiritual orientations of clients, this thesis explores the ontological foundations of psychology from an Islamic paradigm and how these foundational assumptions about human nature can inform practical applications for Islamic psychotherapy. The thesis presents a detailed literature review and two phases of the research study that both used a constructivist version of the grounded theory approach. In the first phase of the study, 18 scholars of Islam were interviewed as “key informants” whose input provided insights into the various branches of knowledge within the Islamic tradition that are relevant to the construction of an Islamic paradigm of human psychology. From the analysis of the interview transcripts, codes were created relating to concepts of the psyche, notions of human development, and understanding of the structure of the soul from the participants’ understanding of Islamic religious sources. An Islamic model of the soul was constructed from these findings. This is presented as a framework for the development of clinical applications in psychotherapy. In the second phase, 18 clinicians who integrate Islamic principles in their approaches with clients in psychotherapy were interviewed. From the analysis of the interview transcripts, codes were created based on the theoretical categories from the first phase, explicating how the Islamic model of the soul generated in that phase can be used to inform practical approaches to therapeutic application. The codes covered theoretical approaches to clinical assessment, treatment goals, and therapeutic interventions. Findings from this phase are presented across two chapters dealing with (i) therapeutic conceptualizations of the nature and structure of the soul in Islamic psychotherapy and (ii) the clinical scope of Islamic psychotherapy and how it is situated both within the Islamic tradition and within the context iii of contemporary psychotherapy. Through the implementation of a grounded theory approach, the Islamic model of the soul that is presented earlier in the thesis is now extended to incorporate the psychotherapeutic practice context. The resultant model of care that was constructed from the analysis represents a uniquely Islamic approach to psychotherapy grounded in the ontological assumptions about human nature from the Islamic tradition. In conclusion, the thesis develops a framework for Islamic psychology and a preliminary model for a theoretical orientation to Islamic psychotherapy. Consistent with the aims of grounded theory work, it is hoped the findings can contribute towards the further development of an overarching theory of Islamic psychology, provide a foundation for the development of informed clinical interventions, and help in understanding human nature and development from an Islamic perspective

Carbon transit through degradation networks

The decay of organic matter in natural ecosystems is controlled by a network of biologically, physically, and chemically driven processes. Decomposing organic matter is often described as a continuum that transforms and degrades over a wide range of rates, but it is difficult to quantify this heterogeneity in models. Most models of carbon degradation consider a network of only a few organic matter states that transform homogeneously at a single rate. These models may fail to capture the range of residence times of carbon in the soil organic matter continuum. Here we assume that organic matter is distributed among a continuous network of states that transform with stochastic, heterogeneous kinetics. We pose and solve an inverse problem in order to identify the rates of carbon exiting the underlying degradation network (exit rates) and apply this approach to plant matter decay throughout North America. This approach provides estimates of carbon retention in the network without knowing the details of underlying state transformations. We find that the exit rates are approximately lognormal, suggesting that carbon flow through a complex degradation network can be described with just a few parameters. These results indicate that the serial and feedback processes in natural degradation networks can be well approximated by a continuum of parallel decay rates.National Science Foundation (U.S.) (Grant EAR-0420592)United States. National Aeronautics and Space Administration (Grant NNA08CN84A

Inverse method for estimating respiration rates from decay time series

Long-term organic matter decomposition experiments typically measure the mass lost from decaying organic matter as a function of time. These experiments can provide information about the dynamics of carbon dioxide input to the atmosphere and controls on natural respiration processes. Decay slows down with time, suggesting that organic matter is composed of components (pools) with varied lability. Yet it is unclear how the appropriate rates, sizes, and number of pools vary with organic matter type, climate, and ecosystem. To better understand these relations, it is necessary to properly extract the decay rates from decomposition data. Here we present a regularized inverse method to identify an optimally-fitting distribution of decay rates associated with a decay time series. We motivate our study by first evaluating a standard, direct inversion of the data. The direct inversion identifies a discrete distribution of decay rates, where mass is concentrated in just a small number of discrete pools. It is consistent with identifying the best fitting "multi-pool" model, without prior assumption of the number of pools. However we find these multi-pool solutions are not robust to noise and are over-parametrized. We therefore introduce a method of regularized inversion, which identifies the solution which best fits the data but not the noise. This method shows that the data are described by a continuous distribution of rates, which we find is well approximated by a lognormal distribution, and consistent with the idea that decomposition results from a continuum of processes at different rates. The ubiquity of the lognormal distribution suggest that decay may be simply described by just two parameters: a mean and a variance of log rates. We conclude by describing a procedure that estimates these two lognormal parameters from decay data. Matlab codes for all numerical methods and procedures are provided