The Chanka: Archaeological Research in Andahuaylas (Apurimac), Peru

In AD 1438 a battle took place outside the city of Cuzco that changed the course of South American history. The Chanka, a powerful ethnic group from the Andahuaylas region, had begun an aggressive program of expansion. Conquering a host of smaller polities, their army had advanced well inside the territory of their traditional rival, the Inca. In a series of unusual maneuvers, the Inca defeated the invading Chanka forces and became the most powerful people in the Andes. Many scholars believe that the defeat of the Chanka represents a defining moment in the history of South America as the Inca then continued to expand and establish the largest empire of the Americas. Despite its critical position in South American history, until recently the Chanka heartland remained unexplored and the cultural processes that led to their rapid development and subsequent defeat by the Inca had not been investigated. From 2001 to 2004, Brian Bauer conducted an archaeological survey of the Andahuaylas region. This project represents an unparalleled opportunity to examine theoretical issues concerning the history and cultural development of late-prehistoric societies in this area of the Andes. The resulting book includes an archaeological analysis on the development of the Chanka and examines their ultimate defeat by the Inca. Series: Monographs 6

The effectiveness of cognitive analytic therapy for borderline personality disorder : utilizing a withdrawal experimental design to improve sensitivity to abandonment

Objectives A primary methodological weakness of the single‐case experimental design (SCED) outcome studies conducted of the treatment of personality disorder with cognitive analytic therapy (CAT) is that they have failed to employ a withdrawal phase or cross‐over design and so are deemed quasi‐experimental. This study sought to implement a withdrawal design, in order to improve the internal validity of the study to make it a true SCED, and also in order to enable the patient to explore abandonment dynamics. Design The study employed an A1/B1/A2/B2 with extended follow‐up SCED with a female patient treated with CAT meeting diagnostic criteria for borderline personality disorder (BPD). Following the 6‐week baseline period ‘A1’, treatment occurred in two phases (21 sessions ‘B1’ and 24 sessions ‘B2’) sandwiching a 12‐week treatment withdrawal phase (‘A2’) and a 24‐week structured follow‐up phase. Seven idiographic daily measures were collected that created a N = 698 day timeline. Nomothetic outcome measures were collected at baseline and at the end of each phase of the study, and the Session Impact Scale was completed after each treatment session. Results There was a significant increase in the task focus of treatment sessions. Ideographically, CAT was an effective treatment for improving the participant’s self‐to‐self relationship, as their self‐hate reduced and their sense‐of‐self increased. There was a broad pattern of deterioration during the second treatment phase (B2) and follow‐up phase across the ideographic measures, and CAT was ineffective for BPD ideographic emotional or self‐to‐other measures. Reliable change occurred on the primary BPD nomothetic outcome measure from baseline to end of first treatment phase. Conclusions The study suggests that the CAT intervention was partially successful and that it is possible to integrate good research practice with clinical innovation. The methodological strengths and limitations of the design and the clinical implications of the results are discussed. Practitioner points Cognitive analytic therapy was partially effective in the treatment of BPD in a case that had been unresponsive to other psychological interventions. Therapists need to complete lengthy and structured follow‐up to capture any emerging relapse. Therapists need to discuss the patient’s thoughts and feelings about termination regularly in a relationally informed manner

Assessment of Identity Disturbance: Factor Structure and Validation of the Personality Structure Questionnaire in an Italian Sample

here are few brief measures of identity disturbance for use in clinical practice that have been subject to any cross - culturally validation . This study investigated the construct validity of the Personality Structure Questionnaire (PSQ) in Italian clinical (N=237) and community ( N=296) samples . Confirmatory factor analysis was conducted to investigate the internal structure of the PSQ. A three – factor structure (i.e., differing self - states, mood variability and behavioral loss of control) including a second - order factor provided the best fit to the data . This structure was demonstrated to be invariant across sex and clinical diagnosis , with clinical diagnosis significantly predicting increased PSQ scores . A g lobal PSQ score of between 26 - 28 was found to be an appropriate cut-off for assisting in diagnostic processes. Implications for the assessment and treatment of psychological disorders with a marked identity disturbance component are discussed

Day-case surgery for total hip and knee replacement: how safe and effective is it?

Multimodal protocols for pain control, blood loss management and thromboprophylaxis have been shown to benefit patients by being more effective and as safe (fewer iatrogenic complications) as conventional protocols. Proper patient selection and education, multimodal protocols and a well-defined clinical pathway are all key for successful day-case arthroplasty. By potentially being more effective, cheaper than and as safe as inpatient arthroplasty, day-case arthroplasty might be beneficial for patients and healthcare systems

The acceptability, effectiveness, and durability of cognitive analytic therapy : Systematic review and meta‐analysis

Objectives This paper sought to conduct a meta‐analysis of the effectiveness and durability of cognitive analytic therapy (CAT) and assess the acceptability of CAT in terms of dropout rates. Design Systematic review and meta‐analysis. Methods PROSPERO registration: CRD42018086009. Searches identified CAT treatment outcome studies eligible to be narratively synthesized. Pre–post/post‐follow‐up effect sizes (ESs) were extracted and synthesized in a random‐effects meta‐analysis. Variations in effect sizes were explored using moderator analyses. Dropout rates were extracted. Secondary analyses synthesized between‐group ES from trials of CAT. Results Twenty‐five studies providing pre–post CAT treatment outcomes were aggregated across three outcome comparisons of functioning, depression, and interpersonal problems. CAT produced large pre–post improvements in global functioning (ES = 0.86; 95% CI 0.71–1.01, N = 628), moderate‐to‐large improvements in interpersonal problems (ES = 0.74, 95% CI 0.51–0.97, N = 460), and large reductions in depression symptoms (ES = 1.05, 95% CI 0.80–1.29, N = 586). All these effects were maintained or improved upon at follow‐up. Limited moderators of CAT treatment effect were identified. CAT demonstrated small–moderate, significant post‐treatment benefits compared to comparators in nine clinical trials (ES = 0.36–0.53; N = 352). The average dropout rate for CAT was 16% (range 0–33%). Conclusions Patients with a range of presenting problems appear to experience durable improvements in their difficulties after undergoing CAT. Recommendations are provided to guide the further progression of the CAT outcome evidence base

Effectiveness of the unified protocol for treating co-morbid health anxiety and depression : an empirical case study

Aims: The unified protocol (UP) is indicated when patients present with co-morbidity, but no studies have previously investigated the effectiveness of the UP with co-morbid health anxiety and depression. Method: An A/B single case design evaluated outcomes for a 27-year-old male presenting with health anxiety and co-morbid depression. Following a 21-day assessment-baseline period containing three sessions, the manualised UP was delivered across a 42-day period containing seven intervention sessions. Four idiographic measures (occurrence and duration of health checking, sleep duration and food intake satisfaction) were collected daily throughout, and two nomothetic measures were collected at four time points. Results: All sessions were attended. Number of health checking episodes reduced from four per day to two per day. A 59 minute per day reduction in time spent health checking occurred, and sleep increased by 100 minutes per night. There was little apparent change in terms of food intake satisfaction. There was a reliable and clinically significant reduction in depression. Discussion: Further testing of the effectiveness of the UP with co-morbid health anxiety and depression in true single case experimental designs is now indicated

Predicting optimal treatment allocation for cognitive analytic‐guided self‐help versus cognitive behavioural‐guided self‐help

Objectives Given the ubiquity in routine services of low-intensity guided self-help (GSH) psychological interventions, better patient selection for these brief interventions would be organizationally efficient. This study therefore sought to define who would respond best to two different types of GSH for anxiety to enable better future treatment matching. Methods The study used outcome data from a patient preference trial (N = 209) comparing cognitive analytic therapy-guided self-help (CAT-GSH) with cognitive behavioural therapy-guided self-help (CBT-GSH). Elastic Net regularization and Boruta random forest variable selection methods were applied. Regression models calculated the patient advantage index (PAI) to designate which GSH was likely the most effective for each patient. Outcomes were compared for those receiving their PAI-indicated optimal and non-optimal GSH. Results Lower baseline depression and anxiety severity predicted better outcomes for both types of GSH. Patient preference status was not associated with outcome during either GSH. Sixty-three % received their model indicating optimal GSH and these had significantly higher rates of reliable and clinically significant reductions in anxiety at both post-treatment (35.9% vs. 16.6%) and follow-up (36.6% vs. 19.2%). No single patient with a large PAI had a reliable and clinically significant reduction in anxiety at post-treatment or follow-up when they did not receive their optimal GSH. Conclusions Treatment matching algorithms have the potential to support evidenced-based treatment selection for GSH. Treatment selection and supporting patient choice needs to be integrated. Future research needs to investigate the use of the PAI for GSH treatment matching, but with larger and more balanced samples

The Diagnostic Potential of Transition Region Lines under-going Transient Ionization in Dynamic Events

We discuss the diagnostic potential of high cadence ultraviolet spectral data when transient ionization is considered. For this we use high cadence UV spectra taken during the impulsive phase of a solar flares (observed with instruments on-board the Solar Maximum Mission) which showed excellent correspondence with hard X-ray pulses. The ionization fraction of the transition region ion O V and in particular the contribution function for the O V 1371A line are computed within the Atomic Data and Analysis Structure, which is a collection of fundamental and derived atomic data and codes which manipulate them. Due to transient ionization, the O V 1371A line is enhanced in the first fraction of a second with the peak in the line contribution function occurring initially at a higher electron temperature than in ionization equilibrium. The rise time and enhancement factor depend mostly on the electron density. The fractional increase in the O V 1371A emissivity due to transient ionization can reach a factor of 2--4 and can explain the fast response in the line flux of transition regions ions during the impulsive phase of flares solely as a result of transient ionization. This technique can be used to diagnostic the electron temperature and density of solar flares observed with the forth-coming Interface Region Imaging Spectrograph.Comment: 18 pages, 6 figure

Lunar elemental composition and ivestigations with D-CIXS x-ray mapping spectrometer on SMART-1

The D-CIXS Compact X-ray Spectrometer on ESA SMART-1 successfully launched in Sept 2003 can derive 45 km resolution images of the Moon with a spectral resolution of 185 eV, providing the first high-resolution global map of rock forming element abundances

Numerical simulation of unconstrained cyclotron resonant maser emission

When a mainly rectilinear electron beam is subject to significant magnetic compression, conservation of magnetic moment results in the formation of a horseshoe shaped velocity distribution. It has been shown that such a distribution is unstable to cyclotron emission and may be responsible for the generation of Auroral Kilometric Radiation (AKR) an intense rf emission sourced at high altitudes in the terrestrial auroral magnetosphere. PiC code simulations have been undertaken to investigate the dynamics of the cyclotron emission process in the absence of cavity boundaries with particular consideration of the spatial growth rate, spectral output and rf conversion efficiency. Computations reveal that a well-defined cyclotron emission process occurs albeit with a low spatial growth rate compared to waveguide bounded simulations. The rf output is near perpendicular to the electron beam with a slight backward-wave character reflected in the spectral output with a well defined peak at 2.68GHz, just below the relativistic electron cyclotron frequency. The corresponding rf conversion efficiency of 1.1% is comparable to waveguide bounded simulations and consistent with the predictions of kinetic theory that suggest efficient, spectrally well defined radiation emission can be obtained from an electron horseshoe distribution in the absence of radiation boundaries.Publisher PD