This chapter aims to assist in this process by providing an overview of the evolution of Australian civil-military relations with a focus on three important areas. In Australia, the subject of civil-military relations remains a neglected and undertheorized field of study. The fact that the term is commonly used by scholars to explain the relationship existing in Australia's defense organization between the public service bureaucracy and the professional military makes analysis even more difficult. As a result, the central concern of civil-military relations in Western liberal democracies-namely the examination of a political-military relationship between a government and the armed forces-has largely been absorbed into studies of Australia's defense organizational leadership. Important though these twentieth-century incidents are to understanding the fundamental aspects of Australian civil-military relations, one must also consider the analysis of two major incidents from the twenty-first century, the children overboard affair of 2001 and the Skype scandal of 2011.

Certified orientation and mobility specialists (COMS) work with clients who are blind or visually impaired (BVI) to help them travel independently with confidence. Part of this process involves creating a narrative description of a route and using specific techniques to help the client internalize it. We focus on the problem of automatically generating a narrative description of an indoor route based on a recording from a smartphone. These automatically generated narrations could be used in cases where a COMS is not available or to enable clients to independently practice routes that were originally learned with the help of a COMS. Specifically, we introduce Clew3D, a mobile app that leverages LIDAR-equipped iOS devices to identify orientation and mobility (O&M) landmarks and their relative location along a recorded route. The identified landmarks are then used to provide a spoken narration modeled after traditional O&M techniques. Our solution is co-designed with COMS and uses methods and language that they employ when creating route narrations for their clients. In addition to presenting Clew3D, we report the results of an analysis conducted with COMS regarding techniques and terminology used in traditional, in-person O&M instruction. We also discuss challenges posed by vision-based systems to achieve automatic narrations that are reliable. Finally, we provide an example of an automatically generated route description and compare it with the same route provided by a COMS.

For years, adult psychological research has benefitted from web-based data collection. There is growing interest in harnessing this approach to facilitate data collection from children and adolescents to address foundational questions about cognitive development. To date, however, few studies have directly tested whether findings from in-lab developmental psychology tasks can be replicated online, particularly in the domain of value-based learning and decision-making. To address this question, we set up a pipeline for online data collection with children, adolescents, and adults, and conducted a replication of Decker et al. (2016). The original in-lab study employed a sequential decision-making paradigm to examine shifts in value-learning strategies from childhood to adulthood. Here, we used the same paradigm in a sample of 151 children (N = 50; ages 8 - 12 years), adolescents (N = 50; ages 13 - 17 years), and adults (N = 51; ages 18 - 25 years) and replicated the main finding that the use of a "model-based" learning strategy increases with age. In addition, we adapted a new index of abstract reasoning (MaRs-IB; Chierchia et al. 2019) for use online, and replicated a key result from Potter et al. (2017), which found that abstract reasoning ability mediated the relation between age and model-based learning. Our re-analyses of two previous in-lab datasets alongside our analysis of our online dataset revealed few qualitative differences across task administrations. These findings suggest that with appropriate precautions, researchers can effectively examine developmental differences in learning computations through unmoderated, online experiments.

Coulomb explosion velocity-map imaging is a new and potentially universal probe for gas-phase chemical dynamics studies, capable of yielding direct information on (time-evolving) molecular structure. The approach relies on a detailed understanding of the mapping between the initial atomic positions within the molecular structure of interest and the final velocities of the fragments formed via Coulomb explosion. Comprehensive on-the-fly ab initio trajectory studies of the Coulomb explosion dynamics are presented for two prototypical small molecules, formyl chloride and cis-1,2-dichloroethene, in order to explore conditions under which reliable structural information can be extracted from fragment velocity-map images. It is shown that for low parent ion charge states, the mapping from initial atomic positions to final fragment velocities is complex and very sensitive to the parent ion charge state as well as many other experimental and simulation parameters. For high-charge states, however, the mapping is much more straightforward and dominated by Coulombic interactions (moderated, if appropriate, by the requirements of overall spin conservation). This study proposes minimum requirements for the high-charge regime, highlights the need to work in this regime in order to obtain robust structural information from fragment velocity-map images, and suggests how quantitative structural information may be extracted from experimental data.

The most effective way for the Western profession of arms to use history is to disavow the purism and narrow specialisation of today's academia in favour of developing a contemporary approach to the subject. The latter aims to foster a range of applied diagnostic skills that transcend the temporal dimensions of past, present, and future. A contemporary approach to history for military professionals emphasises the use of inter-disciplinary war studies to enhance policy relevance. In any defense and security organisation, history must be usable in the sense of providing cognitive and interpretative skills for probing relationships between possibility and actuality, between experience and expectation, and between singularity and repetition. Using history to examine such dialectical interconnections is particularly valuable when military establishments confront their essential task of analyzing emerging trends in the future of war.

Question Are deficits in goal-directed planning better identified by self-reported compulsivity or a diagnosis of obsessive-compulsive disorder? Findings In this cross-sectional study of 285 patients diagnosed with obsessive-compulsive disorder, generalized anxiety disorder, or both, self-reported compulsivity was more strongly associated with goal-directed deficits than a diagnosis of obsessive-compulsive disorder compared with generalized anxiety disorder. Meaning This study suggests that transdiagnostic compulsivity symptoms may have greater biological validity than a diagnosis of obsessive-compulsive disorder. Importance Dimensional definitions of transdiagnostic mental health problems have been suggested as an alternative to categorical diagnoses, having the advantage of capturing heterogeneity within diagnostic categories and similarity across them and bridging more naturally psychological and neural substrates. Objective To examine whether a self-reported compulsivity dimension has a stronger association with goal-directed and related higher-order cognitive deficits compared with a diagnosis of obsessive-compulsive disorder (OCD). Design, Setting, and Participants In this cross-sectional study, patients with OCD and/or generalized anxiety disorder (GAD) from across the United States completed a telephone-based diagnostic interview by a trained rater, internet-based cognitive testing, and self-reported clinical assessments from October 8, 2015, to October 1, 2017. Follow-up data were collected to test for replicability. Main Outcomes and Measures Performance was measured on a test of goal-directed planning and cognitive flexibility (Wisconsin Card Sorting Test [WCST]) and a test of abstract reasoning. Clinical variables included DSM-5 diagnosis of OCD and GAD and 3 psychiatric symptom dimensions (general distress, compulsivity, and obsessionality) derived from a factor analysis. Results Of 285 individuals in the analysis (mean [SD] age, 32 [12] years; age range, 18-77 years; 219 [76.8%] female), 111 had OCD; 82, GAD; and 92, OCD and GAD. A diagnosis of OCD was not associated with goal-directed performance compared with GAD at baseline (beta [SE], -0.02 [0.02]; P = .18). In contrast, a compulsivity dimension was negatively associated with goal-directed performance (beta [SE], -0.05 [0.02]; P = .003). Results for abstract reasoning task and WCST mirrored this pattern; the compulsivity dimension was associated with abstract reasoning (beta [SE], 2.99 [0.63]; P < .001) and several indicators of WCST performance (eg, categories completed: beta [SE], -0.57 [0.09]; P < .001), whereas OCD diagnosis was not (abstract reasoning: beta [SE], 0.39 [0.66]; P = .56; categories completed: beta [SE], -0.09 [0.10]; P = .38). Other symptom dimensions relevant to OCD, obsessionality, and general distress had no reliable association with goal-directed performance, WCST, or abstract reasoning. Obsessionality had a positive association with requiring more trials to reach the first category on the WCST at baseline (beta [SE], 2.92 [1.39]; P = .04), and general distress was associated with impaired goal-directed performance at baseline (beta [SE],-0.04 [0.02]; P = .01). However, unlike the key results of this study, neither survived correction for multiple comparisons or was replicated at follow-up testing. Conclusions and Relevance Deficits in goal-directed planning in OCD may be more strongly associated with a compulsivity dimension than with OCD diagnosis. This result may have implications for research assessing the association between brain mechanisms and clinical manifestations and for understanding the structure of mental illness. This cross-sectional study assesses whether deficits in goal-directed planning are better identified by self-reported compulsivity or a diagnosis of obsessive-compulsive disorder.

Habits are repetitive behaviors that become ingrained with practice, routine, and repetition. The more we repeat an action, the stronger our habits become. Behavioral and clinical neuroscientists have become increasingly interested in this topic because habits may contribute to aspects of maladaptive human behavior, such as compulsive behavior in psychiatry. Numerous studies have demonstrated that habits can be induced in otherwise healthy rats by simply overtraining stimulus-response behaviors. However, despite growing interest in this topic and its application to psychiatry, a similar body of work in humans is absent. Only a single study has been published in humans that shows the effect of extensive training on habit expression. Here, we report five failed attempts to demonstrate that overtraining instrumental behavior leads to the development of inflexible habits in humans, using variants of four previously published outcome devaluation paradigms. Extensive training did not lead to greater habits in two versions of an avoidance learning task, in an appetitive slips-of-action task, or in two independent attempts to replicate the original demonstration. The finding that these outcome devaluation procedures may be insensitive to duration of stimulus-response training in humans has implications for prior work in psychiatric populations. Specifically, it converges with the suggestion that the failures in outcome devaluation in compulsive individuals reflect dysfunction in goal-directed control, rather than overactive habit learning. We discuss why habits are difficult to experimentally induce in healthy humans, and the implications of this for future research in healthy and disordered populations.

BACKGROUND:There is conflicting evidence regarding the role of peritumoral lymphatic vessel density (LVD) and blood microvessel density (MVD) in the metastasis and prognosis of head and neck squamous cell carcinoma (HNSCC). Existing studies are limited to one or two head and neck subsites and/or small sample sizes. A larger study incorporating multiple sub-sites is needed to address the role of peritumoral LVD and MVD in HNSCC metastasis and prognosis.METHODS:Tissue samples from 200 HNSCC cases were stained simultaneously using immunohistochemistry (IHC) for markers of peritumoral LVD (lymphatic vessel marker D240) and MVD (blood vessel marker CD31). Of the stained slides, 166 and 167 were evaluable for LVD and MVD, respectively. The results were then correlated with clinicopathologic features and patient outcomes.RESULTS:Patients with metastatic disease were more likely to have high peritumoral MVD. Through multivariable analyses, MVD was not significantly related to DFS and OS, while low LVD was related to higher risk of disease progression and poor survival.CONCLUSIONS:Peritumoral MVD was found to be positively associated with metastasis, while LVD was found to be inversely related to both metastasis and progression of HNSCC. These findings may suggest a prognostic role of both peritumoral LVD and MVD in patients with HNSCC.

Fear memories are characterized by their permanence and a fierce resistance to unlearning by new experiences. We considered whether this durability involves a process of memory segmentation that separates competing experiences. To address this question, we used an emotional-learning task designed to measure recognition memory for category exemplars encoded during competing experiences of fear conditioning and extinction. Here, we show that people recognized more fear-conditioned exemplars encoded during conditioning than conceptually related exemplars encoded immediately after a perceptual event boundary that separates conditioning from extinction. Selective episodic memory depended on a period of consolidation, an explicit break between competing experiences, and was unrelated to within-session arousal or the explicit realization of a transition from conditioning to extinction. Collectively, these findings suggest that event boundaries guide selective consolidation to prioritize emotional information in memory—at the expense of related but conflicting information experienced shortly thereafter. We put forward a model whereby event boundaries bifurcate related memory traces for incompatible experiences. This is in contrast to a mechanism that integrates related experiences for adaptive generalization1–3, and reveals a potentially distinct organization by which competing memories are adaptively segmented to select and protect nascent fear memories from immediate sources of interference. Short breaks in a stimulus stream are sufficient to create event boundaries during fear conditioning, which modulate the recognition rate for in-episode stimuli.

Trisomy 10 is a rare disorder, with only 35 cases reported in the literature. Anesthetic management may be challenging in this patient population because of craniofacial, cardiac, and renal abnormalities commonly seen in the disorder. We describe a 16-year-old male with an anesthetic history notable for prolonged emergence, postoperative hypoxia, postoperative reintubation, and unexpected hospital admission presenting for dental extraction of impacted teeth. We utilized intravenous caffeine, a respiratory stimulant used in preterm infants, to facilitate recovery from anesthesia.

Objectives: Esophageal adenosquamous carcinoma (ASC) is a rare tumor with characteristics of adenocarcinoma (AC) and squamous cell carcinoma (SCC), the two most common esophageal cancers. Its behavior is aggressive but poorly understood. Using the National Cancer Database (NCDB), the clinical features and overall survival of ASC were compared with AC and SCC. Methods: The NCDB was queried for patients with esophageal ASC, AC, and SCC. Univariate association of histology with patient characteristics and overall survival were analyzed and socioeconomic characteristics were balanced. Results: Clinical M stage was 0 in a significantly lower proportion of ASC (69.0%) than in AC (70.9%) or SCC (75.6%) (p < 0.001). Median survival was lower in patients with ASC (9.6 months) than with AC (13.5) or SCC (9.7) and 2-year OS was lower in patients with ASC (23.8%) than with AC (34.6%) or SCC (26.5%) (p < 0.001). The OS hazard ratio for ASC was 1.14 when compared to AC (95% CI = 1.016-1.267, p = 0.025) and 1.10 when compared to SCC, but the latter was not significant (95% CI = 0.980-1.222, p = 0.111). Conclusion: ASC is a rare tumor among esophageal carcinomas with a greater burden of metastatic disease than AC or SCC and worse OS than AC.

A reminder can temporarily renew flexibility of consolidated memories, referred to as reconsolidation. Pavlovian threat-conditioning studies suggest that a reminder can renew flexibility of threat responses but that episodic memories remain stable. In contrast, outside the threat-conditioning domain, studies testing memory for word lists or stories find that a reminder can renew flexibility of episodic memory. This discrepancy in findings leaves it unclear if episodic memories reconsolidate, or only Pavlovian responses. Here we unite the different approaches in the field and show that a reminder can retroactively strengthen episodic memory for Pavlovian threat-conditioned events, but that, in contrast to threat-conditioning studies with simple sensory stimuli, extinction after a reminder fails to prevent recovery of generalized threat responses. Our results indicate the episodic memories also reconsolidate, allowing strengthening of relevant memories. These findings also suggest that generalized threat responses and episodic memories are less susceptible to be modified by reminder-interventions procedures.

Background Though warfarin has historically been the primary oral anticoagulant for stroke prevention in newly diagnosed atrial fibrillation ( AF ), several new direct oral anticoagulants may be preferred when anticoagulation control with warfarin is expected to be poor. This study developed a prediction model for time in therapeutic range ( TTR ) among newly diagnosed AF patients on newly initiated warfarin as a tool to assist decision making between warfarin and direct oral anticoagulants. Methods and Results This electronic medical record–based, retrospective study included newly diagnosed, nonvalvular AF patients with no recent warfarin exposure receiving primary care services through a large healthcare system in rural Pennsylvania. TTR was estimated as the percentage of time international normalized ratio measurements were between 2.0 and 3.0 during the first year following warfarin initiation. Candidate predictors of TTR were chosen from data elements collected during usual clinical care. A TTR prediction model was developed and temporally validated and its predictive performance was compared with the SAM e‐ TT 2 R 2 score (sex, age, medical history, treatment, tobacco, race) using R 2 and c‐statistics. A total of 7877 newly diagnosed AF patients met study inclusion criteria. Median (interquartile range) TTR within the first year of starting warfarin was 51% (32, 67). Of 85 candidate predictors evaluated, 15 were included in the final validated model with an R 2 of 15.4%. The proposed model showed better predictive performance than the SAM e‐ TT 2 R 2 score ( R 2 =3.0%). Conclusions The proposed prediction model may assist decision making on the proper mode of oral anticoagulant among newly diagnosed AF patients. However, predicting TTR on warfarin remains challenging.

Background: The nature versus nurture debate is one of the oldest issues in the study of longevity, health and successful aging. Objective: We present a 97-year-old man (I.K.) as an example of the effects of habitual exercise on the aging process. Methods: Extensive assessments included medical examinations, interviews, musculoskeletal structure, performance characteristics, cognitive function and gut microbiota composition. Results: I.K. suffers from iatrogenic hypogonadism, prostate cancer, hypothyroidism and a history of deep popliteal thrombosis. Notwithstanding, he cycles up to 5,000 km a year and participates in competitive sports. His musculoskeletal properties, athletic performance, cognitive function and gut microbiota are outstanding. Some traits even exceed those seen in middle-aged men. Conclusions: His long-term physically and intellectually active lifestyles combined with extensive social interactions have most likely contributed to his exercise capacity, despite his medical history.

e15541 Background: Esophageal adenosquamous carcinoma (ASC) is a rare, mixed-histology tumor with aggressive clinical behavior. Having characteristics of both adenocarcinoma (AC) and squamous cell carcinoma (SCC), the two most common esophageal cancers, its behavior is poorly understood, with the current literature limited to case studies and small case series. Using the National Cancer Database (NCDB), an outcomes directory representing approximately 70% of new cancer diagnoses in the United States, we compared the largest number of known cases of esophageal ASC to AC and SCC in terms of patient demographics, clinicopathologic features, and overall survival. Methods: The NCDB was queried for patients diagnosed with esophageal ASC, AC, and SCC between 1998 and 2011. Univariate association with histologic group was analyzed using the χ2 test and ANOVA, where appropriate. Univariate association with overall survival was analyzed using Cox proportional hazard model and log-rank tests. Kaplan-Meier plots were used to compare survival by histologic group. Propensity score weighting was applied to balance demographic and socioeconomic characteristics among patients. Results: Between 1998 and 2011, 897 patients in the NCDB were identified as having esophageal ASC, 69,877 as having esophageal AC, and 34,312 as having esophageal SCC. The patients were commonly male (79.5% of ASC, 85.3% of AC, and 64.5% of SCC) and Caucasian (89.2% of ASC, 95.2% of AC, and 65.5% of SCC). The median age at diagnosis was 65 for both ASC and AC and 67 for SCC. The median size of tumor was 4.5 cm for both ASC and SCC and 4.0 cm for AC. Clinical N stage was > 1 in 58.3% of ASC, 54.6% of AC, and 53.7% of SCC. Clinical m stage was 0 in 69% of ASC, 70.9% of AC, and 75.6% of SCC. Median survival was 9.6 months in ASC, 9.7 months in SCC, and 13.5 months in AC. Two-year overall survival was 23.8% in ASC, 26.5% in SCC, and 34.6% in AC. All p < 0.001. By propensity score weighting, the overall survival hazard ratio for ASC was 1.1 when compared to SCC (95% CI = 1.18-1.01, p = 0.02), and 1.23 when compared to AC (95% CI = 1.33-1.15, p < 0.001). Conclusions: ASC is a rare tumor subtype among esophageal carcinomas with aggressive clinical behavior and a prognosis worse than either AC or SCC.

BACKGROUND: Although statins are considered safe and effective, they have been associated with statin intolerance (SI) in clinical and observational studies.OBJECTIVE: The objective of this study was to describe the clinical and economic consequences of SI through comparison of an SI cohort of patients with matched controls.METHODS: This study used data extracted from an integrated health system's electronic health records from 2008 to 2014. Adults with SI were matched to controls using a propensity score. Patients were hierarchically classified into 6 mutually exclusive cardiovascular (CV)-risk categories: recent acute coronary syndrome (ACS; <= 12 months preindex), coronary heart disease, ischemic stroke, peripheral artery disease, diabetes, or primary prevention. The study endpoints, low-density lipoprotein cholesterol (LDL-C) goal attainment, medical costs, and time to first CV event were compared using conditional logistic regression, generalized linear, and Cox proportional hazards models, respectively.RESULTS: Patients with SI (n = 5190) were matched with controls (11 = 15,570). Patients with SI incurred higher medical costs and were less likely to reach LDL-C goals than controls. Patients with SI were at higher risk for revascularization procedures in all CV risk categories except ACS, and those in the diabetes risk category were at higher risk for any CV event. There was a lower risk of all-cause death among patients with SI.CONCLUSIONS: Patients with SI were less likely to reach LDL-C goals, incurred higher health care costs, and experienced a higher risk for nonfatal CV events than patients without SI. Alternative management strategies are needed to better treat high CV risk patients. (C) 2016 National Lipid Association. All rights reserved.

Background/Aims: Recent advances in genomic sequencing have provided new opportunities to identify individuals with familial hypercholesterolemia. The accessibility and usage of sequencing data for diagnosis and treatment of disease states has been scarce in medical practice but promises to be more widely available in the near future. Models for how to deliver genomic results to unsuspecting patients and provide postreturn care are needed. Our aim is to describe the first-of-its-kind multidisciplinary patient-centered model to deliver and provide care for patients with familial hypercholesterolemia identified through the MyCode® Community Health Initiative. Methods: At Geisinger the return of genomic sequencing results has been made possible through MyCode. The initiative began in 2006, and so far more than 50,000 patients have had exome sequencing completed. Over the next few years Geisinger aims to return results for certain actionable genetic conditions. An early-targeted population is those with familial hypercholesterolemia identified by analyzing exome sequence data obtained from MyCode participants. A review of current literature and internal care processes at Geisinger was conducted to determine the most appropriate delivery of care. Results: Based on review of current literature and Geisinger care processes, there was substantial evidence to support a patient-centered multidisciplinary care team approach. Geisinger has previously seen excellent results in collaborative hyperlipidemia clinics. Our proposed multidisciplinary team will be comprised of two groups: 1) a core team (provider, pharmacist, dietician), and 2) an auxiliary team (cardiologist, primary care physician, obstetrician/gynecologist, genetic counselor). An initial visit will include a discussion of genetic results with patients, cascade testing of family members, baseline assessment, determination of patient-specific treatment goals and referral to cardiology if necessary. Subsequent visits will be led by clinical pharmacists and focus on maximizing familial hypercholesterolemia therapy, targeting treatment goals and responding to patient concerns. Initial qualitative feedback will be collected from team members and patients. Conclusion: The development of this novel multidisciplinary team will allow us to provide patients with vital information about their health in a supportive environment. Future analysis will include a comparison of pharmacist-led team management to management provided by usual care on clinical, social and economic outcomes.

This article argues that, despite an ongoing global revolution in urban demography, most Western military research into urbanization is narrowly focused and remains disengaged from the interdisciplinary expertise of urban studies. Because so many cities are sui generis in terms of their governance, architectural design and demographic composition, the art of war must seek closer interaction with the science of cities. In the coming years, in order to control armed violence and reduce casualties across an urbanizing world, military analysts must seek greater cooperation with urban specialists. The common aim must be to develop an urban-oriented strand of strategic studies that is firmly based on a sophisticated understanding of the ecology of cities. Such a cooperative approach will assist in the development of military methods of operating in cities using appropriate rules of engagement that embrace international humanitarian law.