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This study seeks to extend research evaluating tools to assess the disclosure of sexually abusive behavior. The subjects were 239 male youth (ages 10–20 years) who were court-ordered to participate in a community-based collaborative intervention for sexual offending that includes outpatient and probationary services. All youth participated in an interview to capture referral incident details about admission, responsibility, empathy, and remorse at intake, during intervention, and at discharge. Intake, treatment, discharge, and recidivism measures were also collected from multiple sources. Latent class analysis identified three classes based on the intake interview: Empathetic Admitters (22%), Unempathetic Admitters (38%), and Unempathetic Deniers (40%). Significant class differences were found on intake (e.g., use of physical force, caregiver denial of youth responsibility), treatment (e.g., any sanctions/violations), and discharge measures (e.g., successful treatment, probation officer ratings), but not in recidivism rates. The findings extend efforts to identify and target different disclosure patterns whose clinical monitoring may support a comprehensive intervention.

Auto-identification of rock blocks on 3D models is a useful new tool for rock engineering. It has the potential, when undertaken with rock engineering professionals, to delineate remotely, potentially unstable rock blocks associated with adverse discontinuities. An alternative approach is proposed to semi-automatically delineate rock blocks on 3D meshes, which does not require prior extraction and fitting of discontinuity planes. The proposed approach starts with trace extraction, exploiting the fact that the contact between two rock blocks is most often manifested by a trace (i.e., an exposed line) on the rock surface. Geometrically, the trace is usually either a concave edge or a depressed line. These traces are first extracted due to their higher concavity or darkness compared to their neighbouring mesh faces. After post-processing, the mesh is segmented into sub-meshes around the extracted trace lines. The algorithms are implemented in Python and are tested on three rock slopes, including: (1) a rock slope in Ouray, USA; (2) a natural rock outcrop in Ma Shi Chau, Hong Kong; and (3) a rock slope in a former quarry currently being redeveloped as part of a large-scale site development in Hong Kong. Our approach can enrich the rock mapping results and help identify critical rock blocks which may be at risk of planar failure.

Although advances have been made in facilitating the implementation of evidence-based treatments, little is known about the most effective way to sustain their use over time. The current study examined the sustainability of one evidence-based treatment, Parent–Child Interaction Therapy (PCIT), following a statewide implementation trial testing three training methods: Cascading Model, Learning Collaborative, and Distance Education. Participants included 100 clinicians and 50 administrators from 50 organizations across Pennsylvania. Clinicians and administrators reported on sustainability at 24-months, as measured by the number of clients receiving PCIT and the continued use of the PCIT protocol. Multi-level path analysis was utilized to examine the role of training on sustainability. Clinicians and administrators reported high levels of sustainability at 24-months. Clinicians in the Cascading Model reported greater average PCIT caseloads at 24-months, whereas clinicians in the Learning Collaborative reported greater full use of the PCIT protocol at 24-months. Attending consultation calls was associated with delivering PCIT to fewer families. Implications for the sustainable delivery of PCIT beyond the training year as well as for the broader field of implementation science are discussed.

Background The Ottawa subarachnoid haemorrhage (SAH) rule and the Emerald SAH rule are clinical decision tools to aid in the decision for computed tomography (CT) of the head in patients attending an emergency department (ED) with acute non-traumatic headache. The objective of this study was to analyse the performance of these rules in a contemporary UK cohort. Methods We performed a retrospective external validation study. Patients undergoing CT of the head for the evaluation and treatment of non-traumatic headaches over a 6-month period in the ED at two tertiary centres were assessed. Each patient’s Ottawa rule and Emerald rule were calculated and compared with their final diagnosis. Results The cohort consisted of 366 patients and there were 16 cases of SAH (based on CT findings or the presence of xanthochromia in cerebrospinal fluid). The Ottawa rule identified 288 patients requiring CT of the head. The sensitivity of the Ottawa rule was 100% (95% confidence interval (CI) 71–100%) and the specificity was 22% (95% CI 18–27%). The Emerald rule identified 267 patients who required CT, and achieved a sensitivity of 81% (95% CI 54–96%) and a specificity of 27% (95% CI 23–32%). Conclusions The Ottawa SAH rule correctly identified all patients with SAH in this contemporary cohort. The Emerald rule did not perform as well in this cohort and is unsuitable for clinical use. The Ottawa rule is a useful tool to aid in the decision for CT of the head in patients presenting with acute non-traumatic headache to the ED.

This study evaluates the impact of a 6-month care management intervention for 206 children diagnosed with comorbid attention deficit hyperactivity disorder (ADHD) from a sample of 321 five- to 12-year-old children recruited for treatment of behavior problems in 8 pediatric primary care offices. Practices were cluster-randomized to Doctor Office Collaboration Care (DOCC) or Enhanced Usual Care (EUC). Chart reviews documented higher rates of service delivery, prescription of medication for ADHD, and titration in DOCC (vs EUC). Based on complex conditional models, DOCC showed greater acute improvement in individualized ADHD treatment goals and follow-up improvements in quality of life and ADHD and oppositional defiant disorder goals. Medication use had a significant effect on acute and follow-up ADHD symptom reduction and quality of life. Medication continuity was associated with some long-term gains. A collaborative care intervention for behavior problems that incorporated treatment guidelines for ADHD in primary care was more effective than psychoeducation and facilitated referral to community treatment.

The plays of Shakespeare's second tetralogy "Richard II", "Henry IV, Parts 1 and 2" and "Henry V" - are performed more frequently than any of the other history plays, and their three kings, thanks to Shakespeare, are among the most renowned in English history. "Theater and World" examines the theoretical and interpretive problems posed by the four plays. As he probes the complex relationships between drama and history, Jonathan Hart places his work in a wide critical context, from early Shakespearean critics to deconstructionalists and new historicists.

BackgroundSuccessful containment strategies for SARS-CoV-2, the causative virus of the COVID-19 pandemic, have involved widespread population testing that identifies infections early and enables rapid contact tracing. In this study, we developed a rapid and inexpensive RT- qPCR testing pipeline for population-level SARS-CoV-2 detection, and used this pipeline to establish a clinical laboratory dedicated to COVID-19 testing at the University of California San Diego (UCSD) with a processing capacity of 6,000 samples per day and next-day result turnaround times.Methods and findingsUsing this pipeline, we screened 6,786 healthcare workers and first responders, and 21,220 students, faculty, and staff from UCSD. Additionally, we screened 6,031 preschool-grade 12 students and staff from public and private schools across San Diego County that remained fully or partially open for in-person teaching during the pandemic. Between April 17, 2020 and February 5, 2021, participants provided 161,582 nasal swabs that were tested for the presence of SARS-CoV-2. Overall, 752 positive tests were obtained, yielding a test positivity rate of 0.47%. While the presence of symptoms was significantly correlated with higher viral load, most of the COVID-19 positive participants who participated in symptom surveys were asymptomatic at the time of testing. The positivity rate among preschool-grade 12 schools that remained open for in-person teaching was similar to the positivity rate at UCSD and lower than that of San Diego County, with the children in private schools being less likely to test positive than the adults at these schools.ConclusionsMost schools across the United States have been closed for in-person learning for much of the 2020-2021 school year, and their safe reopening is a national priority. However, as there are no vaccines against SARS-CoV-2 currently available to the majority of school-aged children, the traditional strategies of mandatory masking, physical distancing, and repeated viral testing of students and staff remain key components of risk mitigation in these settings. The data presented here suggest that the safety measures and repeated testing actions taken by participating healthcare and educational facilities were effective in preventing outbreaks, and that a similar combination of risk-mitigation strategies and repeated testing may be successfully adopted by other healthcare and educational systems.

Mental health providers encounter and provide treatment to patients who identify as lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) in various treatment settings. Understanding this unique population is essential in delivering culturally competent, appropriate, and effective care to LGBTQ+ patients. This article begins by discussing the existing stigma and the resulting disparities in mental health problems for LGBTQ+ people compared to their cisgender heterosexual counterparts, such as the increased risk of suicide. Then, presented are practical adaptations for the psychological assessment and treatment of LGBTQ+ patients that maintain fidelity to treatment protocols while allowing for flexibility in addressing their unique values, preferences, and challenges. [ Psychiatr Ann. 2019;49(10):436–440.]

We report an unusual radiological appearance in a patient with myelin oligodendrocyte glycoprotein-associated disease (MOGAD).1 A 53-year-old Caucasian man presented with a 2-week history of pain on eye movements and a 1-week history of reduced vision. The patient had a history of tuberculosis as a child and hypertension. Optic nerve function was markedly reduced with acuities of counting fingers in the right eye and only perception of light in the left. His optic discs were swollen with some right peripapillary haemorrhage. There were no other neurological features of note. Investigations including full blood picture, renal and liver profiles, B12, folate and serum ACE were normal. His CRP was less than 2.0 mg/L. Tests for HIV, Varicella Zoster Virus, Cat scratch disease, Lyme disease and syphilis were negative. His initial MRI scan was performed without dedicated orbital images or Gadolinium-based contrast. As such the views of the optic nerves on …

A 39-year-old woman presented with acute visual loss in her right eye. Brain and orbit MRI demonstrated T2 hyperintensity along a long section of her right optic nerve, chiasm, and tract with no evidence of decussation of the inflammation. Subsequent seropositivity for the aquaporin 4 antibody confirmed a diagnosis of neuromyelitis optica. Posterior pathway involvement is typical in neuromyelitis optica and supports the hypothesis that the condition is an astrocytopathy. Furthermore, the absence of decussation in the condition may be a function of astrocyte localization within the chiasm.

• Novel case report highlighting association of COVID-19 precipitating symptoms of CADASIL • Multiple internal border zone infarcts in a patient with COVID-19 and CADASIL • Proposed mechanism is endothelial injury with microvascular thrombosis and cerebral dysautoregulation • We advise to consider patients with CADASIL a vulnerable group during the pandemic

Ranjan Ghosh and J. Hillis Miller provide different but productive ways to think about poetics and to read poetry closely and with attention. As a poet, reader and critic of poetry, I welcome their thoughts on the theory and practice of poetry. Whereas Miller sees the reading of poems as subjective and selective, Ghosh views it as universal and shared. Both readers help us in the drama of meaning, the tension between them. As convivial and suggestive as that difference between Miller and Ghosh may be, it allows us to experience the different sides of poetry and the philosophy of poetry, if we think about, say the Socratic, Platonic, and Aristotelian tradition of thinking about poetry and even Philip Sidney's response on the one hand and the rhetorical tradition of reading poetry on the other. Ghosh, although having mastered Western literature and poetry, as Miller has, also provides us with Eastern views, and this is also of great benefit to the reader of Thinking Literature Across Continents ( 2016 ). One of the great centres of literature is language and poetry is compressed and memorable language that forms the heart of literature: it is a key to thinking about Ghosh and Miller thinking literature across the various parts of the world.

Sarcoidosis is a systemic, idiopathic and granulomatous disease, which most commonly affects the skin, lungs and lymph nodes but can affect virtually any organ. Neurosarcoidosis can be the presenting or the only clinical manifestation accounting for 5%–15% of sarcoid diagnoses. In contrast to uveitis which is the most common ophthalmic manifestation, neuro-ophthalmic signs are uncommon in sarcoidosis. Optic neuropathy is the most common neuro-ophthalmic sign (70% in one series). Sarcoid-related optic neuropathy commonly presents with a picture similar to optic neuritis. Less commonly, optic nerve involvement occurs secondary to compressive lesions, or from direct granulomatous infiltration. Neuroimaging is crucial to identify the location of the lesion. We describe a case of sarcoid-related compressive optic neuropathy and third nerve palsy and highlight the challenging nature of neurosarcoidosis in a patient without a prior diagnosis of the disease.

This article will discuss the historical context of translation in literature and religion, examine the role of translation and cultural encounter or exchange between English and other languages like Spanish, French, and Chinese, especially as they relate to and surround figures like Bartolome de Las Casas, Matteo Ricci, and Ezra Pound. Translation in religion and literature is intricate and although not the original, adds something to the language and culture of the translating culture. In fact, translation is necessary for the identity of cultures, including that of English, a global language. By examining different texts, especially in the sixteenth and seventeenth centuries, we can see, at a crucial time in the history of England of English language and culture, how important texts about culture and cultural contact are to the formation of identity surrounding religion, culture, and language.

"To choose among national, comparative, and world literatures is a false choice. They are complementary. We cannot deny that we have nations today, partly created from internal colonization, and that colonization went hand in hand with external colonization.... The linguistic, cultural, and political borders of countries have changed over time, so territory is not the only way to look at literatures.... There is no one centre, but identity and otherness, unity and multiplicity are bound together. There are many national, comparative, and world literatures. Texts and images are mobile and multiple, even if they can also be used to assert identity. The one and the other are intertwined, and the same is true in fields, and in the ways we divide and unite under the rubric of literature."

"The contributors to this special issue demonstrate innovative ways to explore comparative literature and world literature, which we have examined under the rubric, “Literary Texts and Contexts: Comparing the World and the World of Comparison.” This is not an issue seeking consensus, but one that brings scholars from different parts of the world to discuss the theory and practice of literature, its texts and contexts, from theory to film and television. National, comparative, world, and other designations for the study of literature all come into this debate. This issue, then, is a forum in which diversity and difference express themselves."

Embroidery within Boundaries is an important contribution to women studies as it provides fascinating and honest accounts of resilience, consciousness raising and women’s power who underscore the i...

Objective Pediatric primary care providers (PCPs) work in challenging environments and are increasingly called to implement complex interventions, such as behavioral health (BH) service integration. We explore how perceived stressful practice climates (1) change over time in and (2) influence provider perceptions of collaborative care versus usual care, 2 models of integrated BH care. Methods Secondary exploratory analysis using hierarchical linear modeling was performed on an 18-month cluster-randomized trial of 8 pediatric primary care practices to Doctor-Office Collaborative Care (DOCC), where an on-site care manager delivered BH services in coordination with PCPs, or Enhanced Usual Care (EUC), where a care manager facilitated referrals to local BH providers. Various indicators of PCP perceptions of BH services, including satisfaction with practice, burdens and beliefs regarding psychosocial problems, and effectiveness in treating behavioral problems, were assessed as outcomes. Moderators were 2 domains of stressful climates, role conflict and role overload. Results Role conflict and role overload stayed stable in both conditions. Role conflict strengthened the positive effect of DOCC on PCP perceived effectiveness in treating behavioral problems (β [SE], 0.04 [0.02]; p = 0.04) and improvement in managing oppositional/aggressive behavior (0.02 [0.01]; p = 0.02). Role overload strengthened the positive effect of DOCC on PCP-perceived improvement in managing attention-deficit hyperactivity disorder (0.03 [0.01]; p = 0.01). Stressful climates did not influence perceptions for EUC providers. Conclusions Providers experiencing more stressful practice climates developed more positive perceptions of collaborative care. This may encourage stressed providers to make effective practice changes and promote practice integration of BH services.