Attachment--and loss.

Much has been written about theory and practice in the law, and the tension between practitioners and theorists. Judges do not cite theoretical articles often; they rarely "apply" theories to particular cases. These arguments are not revisited. Instead the Essay explores the working and interaction of theory and practice, practitioners and theorists. The Essay starts with a story about solving a legal issue using our intellectual tools - theory, practice, and their progenies: experience and "gut." Next the Essay elaborates on the nature of theory, practice, experience and "gut." The third part of the Essay discusses theories that are helpful to practitioners and those that are less helpful. The Essay concludes that practitioners theorize, and theorists practice. They use these intellectual tools differently because the goals and orientations of theorists and practitioners, and the constraints under which they act, differ. Theory, practice, experience and "gut" help us think, remember, decide and create. They complement each other like the two sides of the same coin: distinct but inseparable.

Of Theory and Practice

Research on divorce during the past decade has focused on a range of topics, including the predictors of divorce, associations between divorce and the well-being of children and former spouses, and interventions for divorcing couples. Methodological advances during the past decade include a greater reliance on nationally representative longitudinal samples, genetically informed designs, and statistical models that control for time-invariant sources of unobserved heterogeneity. Emerging perspectives, such as a focus on the number of family transitions rather than on divorce as a single event, are promising. Nevertheless, gaps remain in the research literature, and the review concludes with suggestions for new studies.

Research on Divorce: Continuing Trends and New Developments

The explanation of heterogeneity plays an important role in meta-analysis. The random effects meta-regression model allows the inclusion of trial-specific covariates which may explain a part of the heterogeneity. We examine the commonly used tests on the parameters in the random effects meta-regression with one covariate and propose some new test statistics based on an improved estimator of the variance of the parameter estimates. The approximation of the distribution of the newly proposed tests is based on some theoretical considerations. Moreover, the newly proposed tests can easily be extended to the case of more than one covariate. In a simulation study, we compare the tests with regard to their actual significance level and we consider the log relative risk as the parameter of interest. Our simulation study reflects the meta-analysis of the efficacy of a vaccine for the prevention of tuberculosis originally discussed in Berkey et al. The simulation study shows that the newly proposed tests are superior to the commonly used test in holding the nominal significance level.

Improved tests for a random effects meta-regression with a single covariate

Background: Bleeding is the most frequent cause of preventable death after severe injury. Coagulopathy associated with severe injury complicates the control of bleeding and is associated with increased morbidity and mortality in trauma patients. The causes and mechanisms are multiple and yet to be clearly defined. Methods: Articles addressing the causes and consequences of trauma-associated coagulopathy were identified and reviewed. Clinical situations in which the various mechanistic causes are important were sought along with quantitative estimates of their importance. Results: Coagulopathy associated with traumatic injury is the result of multiple independent but interacting mechanisms. Early coagulopathy is driven by shock and requires thrombin generation from tissue injury as an initiator. Initiation of coagulation occurs with activation of anticoagulant and fibrinolytic pathways. This Acute Coagulopathy of Trauma-Shock is altered by subsequent events and medical therapies, in particular acidemia, hypothermia, and dilution. There is significant interplay between all mechanisms. Conclusions: There is limited understanding of the mechanisms by which tissue trauma, shock, and inflammation initiate trauma coagulopathy. Acute Coagulopathy of Trauma-Shock should be considered distinct from disseminated intravascular coagulation as described in other conditions. Rapid diagnosis and directed interventions are important areas for future research.

The coagulopathy of trauma: a review of mechanisms.

Background: Recent civilian studies have documented a relationship between increased mortality and the presence of an early coagulopathy of trauma diagnosed in the emergency department (ED). We hypothesized that acute coagulopathy (international normalized ratio ≥1.5) in combat casualties was associated with increased injury severity and mortality as is seen in civilian trauma patients. Methods: A retrospective study of combat casualties who received a blood transfusion at a single combat support hospital between September 2003 and December 2004 was performed. Coagulation status, pH, base deficit, and temperature were recorded at arrival to the ED. These were analyzed by Injury Severity Score (ISS), associated injury patterns, and mortality. Results: A total of 3,287 patients were treated at the combat support hospital during the study period. Of these, 391 patients were transfused and primarily admitted, thus meeting the study criteria, 347 had coagulation data, and 92% had a penetrating mechanism. The prevalence of acute coagulopathy in transfused casualties measured with point-of-care devices at arrival in the ED was 38%. Mortality in those who were coagulopathic at arrival to the ED was 24% (32/133) versus 4% (8/214) in those not presenting with coagulopathy (p < 0.001). The prevalence of mortality by coagulopathy increased as ISS increased. Coagulopathy and acidosis were associated with mortality, odds ratio (OR), 5.38 [95% confidence interval (CI), 1.55-11.37] and 6.9 (95% CI, 2.1-19.5), respectively. Temperature did not affect outcomes (OR, 1.1; 95% CI, 0.4-2.6). Conclusions: The early coagulopathy of trauma was rapidly diagnosed in the ED and present in more than one-third of combat casualties who received a transfusion, similar to the incidence found in civilian trauma patients. Coagulopathy, independent of hypothermia but strongly correlated with acidosis and ISS, was associated with mortality in combat casualties, similar to that found in civilian trauma patients. Early diagnosis and treatment of acute traumatic coagulopathy with new resuscitation paradigms may improve outcomes.

Increased mortality associated with the early coagulopathy of trauma in combat casualties.

On the basis of a large, nationally representative multiwave panel, this research examines the extent to which parents' marital disruption process affects children's academic performance and psychological well-being at 2 time points prior to and 2 time points after parental divorce. The results of a pooled time-series analysis show that compared with peers in intact families, children of divorce fare less well in most well-being measures at all 4 time points, from approximately 3 years before divorce to 3 years after divorce. Interestingly, whereas the effects of the disruption process on students' test scores demonstrate a linear decline over time, the effects on their social-psychological measures exhibit a U-shaped time pattern. Families in the process of marital disruption are also characterized by a deficit in economic and social resources at various time points of this process. These differences in family resources either partially or completely mediate the detrimental effects of the disruption process over time. Furthermore, the process of marital disruption appears to affect girls to the same extent that it does boys. Finally, the causal role of divorce in affecting children is also discussed. Key Words: academic achievement, child well-being, divorce, family structure, longitudinal studies. An increasing number of family researchers have begun to view parents' marital disruption as a continuous process, during which children may be affected both prior to and after parental divorce/ separation. In line with this conceptualization, earlier longitudinal studies have consistently shown that deficits in various child outcomes precede parental divorce and remain observable years after it (e.g., Block, Block, & Gjerde, 1986; Cherlin et al., 1991; Doherty & Needle, 1991; Sun, 2001; Sun & Li, 2001). Despite this evidence, two important implications of this continuous process argument remain to be thoroughly assessed. First, most previous longitudinal studies are based on a two-wave panel in which child outcomes are measured at only 1 time point both before and after divorce. Such a research design is unable to detect change of the deficit in child outcomes at different time points during either the predivorce or post-- divorce period. Consequently, relatively little is known about whether the effects of the disruption process form similar time paths before and after divorce. Second, relatively little has been done to examine the mechanisms through which children are affected continuously. Although several previous studies (e.g., Cherlin et al., 1991) have proposed that children's maladjustment during the process of parents' marital disruption is linked to a dysfunctional family environment, empirical tests of this argument are limited. Specifically, most of the existing longitudinal studies (e.g., Cherlin et al.; Sun & Li) have only examined the extent to which certain predivorce family features mediate the postdivorce damage to child outcomes. Thus, it remains to be assessed how child outcomes are related to family features at multiple time points during the disruption process. On the basis of a large, multiwave panel of American adolescents, the current study addresses these limitations of the previous research. We first measure students' academic performance and psychological well-being at 2 time points (approximately 3 years and 1 year) before parental divorce and at two points (approximately 1 year and 3 years) after divorce. This research design allows us to assess the effects of the disruption process on these two domains of students' lives at 4 sequential time points, from approximately 3 years before divorce to 3 years after it. We then examine whether social and financial resources in students' families mediate the effects of the disruption process at these time points. Finally, we examine whether the marital disruption process affects boys and girls differently over time. …

Children's Well-Being during Parents' Marital Disruption Process: A Pooled Time-Series Analysis

Objective: A number of studies have reported associations between Toxoplasma gondii (T. gondii) infection and the risk of schizophrenia. Most existing studies have used small populations and postdiagnosis specimens. As part of a larger research program, the authors conducted a hypothesis-generating case control study of T. gondii antibodies among individuals discharged from the U.S. military with a diagnosis of schizophrenia and serum specimens available from both before and after diagnosis. Method: The patients (N=180) were military members who had been hospitalized and discharged from military service with a diagnosis of schizophrenia. Healthy comparison subjects (3:1 matched on several factors) were members of the military who were not discharged. The U.S. military routinely collects and stores serum specimens of military service members. The authors used microplate-enzyme immunoassay to measure immunoglobulin G (IgG) antibody levels to T. gondii, six herpes viruses, and influenza A and B viruses and immunoglobulin M (IgM) antibody levels to T. gondii in pre- and postdiagnosis serum specimens. Results: A significant positive association between the T. gondii IgG antibody and schizophrenia was found; the overall hazard ratio was 1.24. The association between IgG and schizophrenia varied by the time between the serum specimen collection and onset of illness. Conclusion: The authors found significant associations between increased levels of scaled T. gondii IgG antibodies and schizophrenia for antibodies measured both prior to and after diagnosis.

https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2007.06081254

Selected infectious agents and risk of schizophrenia among U.S. military personnel.

The U.S. Environmental Protection Agency (EPA) revised the National Ambient Air Quality Standards (NAAQS) for ozone in 1997 based largely on short-term ozone studies published up to 1995. The U.S. EPA's conclusions must now be updated because (1) the agency did not consider many new studies published since 1995 and (2) the agency did not critically review the studies published before 1995 (i.e., it accepted the stated conclusions). In this article, we examine many recently published short-term ozone studies including 17 hospital admissions studies, 10 mortality studies, and 6 summercamp studies. Almost all of these studies reported a significant association between ambient levels of ozone and adverse health effects. However, on close examination, it is apparent that there are mixed findings from one study to another and even within the results of a single study. Moreover, questionable statistical analyses and failure to consider confounders make a number of the reported findings doubtful and even negative.

Assessment of recent ozone short-term epidemiologic studies.

Although previous research has noted the detrimental impact of parents' marital disruption on children's schooling, less is known about whether such detriments are observable prior to the disruption. Based on two waves of a nationally representative longitudinal data set, this study has found that even prior to family dissolution, both boys and girls from families that subsequently dissolve perform less well than their peers whose parents remain married. Families at the predisruption stage are also characterized by a shortage of financial, cultural, human, and social capital, even after demographics are controlled. In addition, some parental investment measures yield a smaller educational return for students whose families subsequently dissolve than for those whose parents remain married. Our results also indicate that the negative postdisruption effects on children's academic achievement can be either largely or completely predicted by performance and investment differences at the predisruption stage.

Yuanzhang Li

Papers

Increased mortality associated with the early coagulopathy of trauma in combat casualties.

Children's Well-Being during Parents' Marital Disruption Process: A Pooled Time-Series Analysis

Selected infectious agents and risk of schizophrenia among U.S. military personnel.

Assessment of recent ozone short-term epidemiologic studies.

Marital Disruption, Parental Investment, and Children's Academic Achievement A Prospective Analysis