“You can’t un-ring the bell”: a mixed methods approach to understanding veteran and family perspectives of recovery from military-related posttraumatic stress disorder

Background Military-related posttraumatic stress disorder (PTSD) is a complex diagnosis with non-linear trajectories of coping and recovery. Current approaches to the evaluation of PTSD and treatment discontinuation often rely on biomedical models that dichotomize recovery based on symptom thresholds. This approach may not sufficiently capture the complex lived experiences of Veterans and their families. To explore conceptualizations of recovery, we sought perspectives from Veterans and their partners in a pilot study to understand: 1) how Veterans nearing completion of treatment for military-related PTSD and their partners view recovery; and 2) the experience of progressing through treatment towards recovery. Methods We employed a concurrent mixed methods design. Nine Veterans nearing the end of their treatment at a specialized outpatient mental health clinic completed quantitative self-report tools assessing PTSD and depressive symptom severity, and an individual, semi-structured interview assessing views on their treatment and recovery processes. Veterans’ partners participated in a separate interview to capture views of their partners’ treatment and recovery processes. Descriptive analyses of self-report symptom severity data were interpreted alongside emergent themes arising from inductive content analysis of qualitative interviews. Results While over half of Veterans were considered “recovered” based on quantitative assessments of symptoms, individual reflections of “recovery” were not always aligned with these quantitative assessments. A persistent narrative highlighted by participants was that recovery from military-related PTSD was not viewed as a binary outcome (i.e., recovered vs. not recovered); rather, recovery was seen as a dynamic, non-linear process. Key components of the recovery process identified by participants included a positive therapeutic relationship, social support networks, and a toolkit of adaptive strategies to address PTSD symptoms. Conclusions For participants in our study, recovery was seen as the ability to navigate ongoing issues of symptom management, re-engagement with meaningful roles and social networks, and a readiness for discontinuing intensive, specialized mental health treatment. The findings of this study highlight important considerations in balancing the practical utility of symptom severity assessments with a better understanding of the treatment discontinuation-related needs of Veterans with military-related PTSD and their families, which align with a contemporary biopsychosocial approach to recovery.

A qualitative assessment of QCA: method stretching in large-N studies and temporality

Qualitative Comparative Analysis (QCA) is a descriptive research method that can provide causal explanations for an outcome of interest. Despite extensive quantitative assessments of the method, my objective is to contribute to the scholarly discussion with insights constructed through a qualitative lens. Researchers using the QCA approach have less ability to incorporate and nuance information on set membership as the number of cases grows. While recognizing the suggested ways to overcome such challenges, I argue that since setting criteria for membership, calibrating, and categorizing are crucial QCA aspects that require in-depth knowledge, QCA is unfit for larger-N studies. Additionally, I also discuss that while the method is able to identify various parts of a causal configuration—the ‘what’—it falls short to shed light on the ‘how’ and ‘why,’ especially when temporality matters. Researchers can complement it with other methods, such as process tracing and case studies, to fill in these missing explanatory pieces or clarify contradictions—which begs the question of why they would also choose to use QCA.

Bayesian Estimation of real-time Epidemic Growth Rates using Gaussian Processes: local dynamics of SARS-CoV-2 in England

Quantitative assessments of the recent state of an epidemic and short-term projections into the near future are key public health tools that have substantial policy impacts, helping to determine if existing control measures are sufficient or need to be strengthened. Key to these quantitative assessments is the ability to rapidly and robustly measure the speed with which the epidemic is growing or decaying. Frequently, epidemiological trends are addressed in terms of the (time-varying) reproductive number R. Here, we take a more parsimonious approach and calculate the exponential growth rate, r, using a Bayesian hierarchical model to fit a Gaussian process to the epidemiological data. We show how the method can be employed when only case data from positive tests are available, and the improvement gained by including the total number of tests as a measure of heterogeneous testing effort. Although the methods are generic, we apply them to SARS-CoV-2 cases and testing in England, making use of the available high-resolution spatio-temporal data to determine long-term patterns of national growth, highlight regional growth and spatial heterogeneity.

Artificial Intelligence in Prenatal Ultrasound Diagnosis

The application of artificial intelligence (AI) technology to medical imaging has resulted in great breakthroughs. Given the unique position of ultrasound (US) in prenatal screening, the research on AI in prenatal US has practical significance with its application to prenatal US diagnosis improving work efficiency, providing quantitative assessments, standardizing measurements, improving diagnostic accuracy, and automating image quality control. This review provides an overview of recent studies that have applied AI technology to prenatal US diagnosis and explains the challenges encountered in these applications.

Analysis of Structures’ Orientations in Archaeoastronomy

In the scope of archaeoastronomy, the analysis of a large number of structures through the frequency histograms for their azimuths and declinations can identify singular patterns of orientation. Conclusions often rely on qualitative assessments. Quantitative assessments have been proposed by using as null hypothesis a pure random distribution of azimuths over the 360º horizon. In some cases, such as orientation of Christian churches, the histograms or spectra are composite, with peaks overlapping a continuous and not uniform background. This paper presents a methodology for assessing the statistical significance of the net area of a peak in the histogram in relation to the local background level. The spectra use Normal kernel functions. The background contribution is estimated from the area of the trapezoidal polygon under the peak, and it is interpreted as the probability parameter for a Binomial distribution. The methodology is illustrated with a real case study which includes the azimuth and declination histograms for a set of churches from southern Spain dedicated to the Virgin of the Assumption. The method is more restrictive than previous approaches.

Stages of Grief Portrayed on the Internet: A Systematic Analysis and Critical Appraisal

Kübler-Ross’s stage model of grief, while still extremely popular and frequently accepted, has also elicited significant criticisms against its adoption as a guideline for grieving. Inaccurate portrayal of the model may lead to bereaved individuals feeling that they are grieving incorrectly. This may also result in ineffectual support from loved ones and healthcare professionals. These harmful consequences make the presentation of the five stages model an important area of concern. The Internet provides ample resources for accessing information about grief, raising questions about portrayal of the stages model on digital resources. We therefore conducted a systematic narrative review using Google to examine how Kübler-Ross’s five stages model is presented on the internet. We specifically examined the prominence of the model, whether warnings, limitations and criticisms are provided, and how positively the model is endorsed. A total of 72 websites were eligible for inclusion in the sample. Our analyses showed that 44 of these (61.1%) addressed the model, indicating its continued popularity. Evaluation scores were calculated to provide quantitative assessments of the extent to which the websites criticized and/or endorsed the model. Results indicated low criticalness of the model, with sites often neglecting evaluative commentary and including definitive statements of endorsement. We conclude that such presentation is misleading; a definitive and uncritical portrayal of the model may give the impression that experiencing the stages is the only way to grieve. This may have harmful consequences for bereaved persons. It may alienate those who do not relate to the model. Presentation of the model should be limited to acknowledging its historical significance, should include critical appraisal, and present contemporary alternative models which better-represent processes of grief and grieving.

Participatory characterization of the performance of corn landraces and commercial varieties with family farmers

The objective of this study was to compare the performance of landraces and commercial varieties to identify which variety is the most suitable for family farmers. The experimental design was a completely randomized block design with three replicates and 10 varieties. Qualitative and quantitative parameters were evaluated in the useful plot. The qualitative analyses were performed in the field with the participation of farmers, who scored the evaluated parameters as 1 - poor, 2 - average, 3 - good, or 4 - excellent. Quantitative analyses were performed without the participation of farmers. The data obtained (qualitative and quantitative) were subjected to analysis of variance, and the means were compared by the Scott-Knott test (p<0.05). The Pontinha and Adelaide varieties had the best quality variables in the farmers’ view. In the quantitative analysis, the landrace varieties showed similar results to the commercial varieties, but the highest yields were obtained with Pontinha and Adelaide. The results of the qualitative and quantitative assessments reaffirm the importance of farmers’ knowledge of corn cultivation in the studied municipality.

Predation Pressure of Invasive Marsh Frogs: A Threat to Native Amphibians?

Anurans have been introduced in many parts of the world and have often become invasive over large geographic areas. Although predation is involved in the declines of invaded amphibian populations, there is a lack of quantitative assessments evaluating the potential risk posed to native species. This is particularly true for Pelophylax water frogs, which have invaded large parts of western Europe, but no studies to date have examined their predation on other amphibians in their invaded range. Predation of native amphibians by marsh frogs (Pelophylax ridibundus) was assessed by stomach flushing once a month over four months in 21 ponds in southern France. Nine percent of stomachs contained amphibians. Seasonality was a major determinant of amphibian consumption. This effect was mediated by body size, with the largest invaders ingesting bigger natives, such as tree frogs. These results show that invasive marsh frogs represent a threat through their ability to forage on natives, particularly at the adult stage. The results also indicate that large numbers of native amphibians are predated. More broadly, the fact that predation was site- and time-specific highlights the need for repeated samplings across habitats and key periods for a clear understanding of the impact of invaders.

Quantitative assessments of late radiation-induced skin and soft tissue toxicity and correlation with RTOG scales and biological equivalent dose in breast cancer

Purpose Radiation-induced toxicity (RIT) is usually assessed by inspection and palpation. Due to their subjective and unquantitative nature, objective methods are required. This study aimed to determine whether a quantitative tool is able to assess RIT and establish an underlying BED-response relationship in breast cancer. Methods Patients following seven different breast radiation protocols were recruited to this study for RIT assessment with qualitative and quantitative examination. The biologically equivalent dose (BED) was used to directly compare different radiation regimens. RIT was subjectively evaluated by physicians using the Radiation Therapy Oncology Group (RTOG) late toxicity scores. Simultaneously an objective multiprobe device was also used to quantitatively assess late RIT in terms of erythema, hyperpigmentation, elasticity and skin hydration. Results In 194 patients, in terms of the objective measurements, treated breasts showed higher erythema and hyperpigmentation and lower elasticity and hydration than untreated breasts (p < 0.001, p < 0.001, p < 0.001, p = 0.019, respectively). As the BED increased, Δerythema and Δpigmentation gradually increased as well (p = 0.006 and p = 0.002, respectively). Regarding the clinical assessment, the increase in BED resulted in a higher RTOG toxicity grade (p < 0.001). Quantitative assessments were consistent with RTOG scores. As the RTOG toxicity grade increased, the erythema and pigmentation values increased, and the elasticity index decreased (p < 0.001, p = 0.016, p = 0.005, respectively). Conclusions The multiprobe device can be a sensitive and simple tool for research purpose and quantitatively assessing RIT in patients undergoing radiotherapy for breast cancer. Physician-assessed toxicity scores and objective measurements revealed that the BED was positively associated with the severity of RIT.