IMPORTANCE: Serotonin reuptake inhibitors (SRIs) are the only medications approved for obsessive-compulsive disorder (OCD), yet most patients taking SRIs exhibit significant symptoms. Adding exposure/response prevention (EX/RP) therapy improves symptoms, but it is unknown whether patients maintain wellness after discontinuing SRIs. OBJECTIVE: To assess whether patients with OCD who are taking SRIs and have attained wellness after EX/RP augmentation can discontinue their SRI with noninferior outcomes compared with those who continue their SRI therapy. DESIGN, SETTING, AND PARTICIPANTS: A 24-week, double-blind, randomized clinical trial was performed from May 3, 2013, to June 25, 2018. The trial took place at US academic medical centers. Participants included 137 adults with a principal diagnosis of OCD (≥1 year) who were taking an SRI (≥12 weeks), had at least moderate symptoms (defined as Yale-Brown Obsessive-Compulsive Scale [Y-BOCS] score ≥18 points), and received as many as 25 sessions of EX/RP therapy. Those who attained wellness (Y-BOCS score ≤14 points; 103 patients [75.2%]) were study eligible. Data were analyzed from June 29, 2019, to October 2, 2021. INTERVENTION: Participants were randomly assigned either to receive taper to placebo (taper group) or to continue their SRI (continuation group) and monitored for 24 weeks. MAIN OUTCOME AND MEASURES: The Y-BOCS score (range, 0-40 points) was the primary outcome; the Hamilton Depression Rating Scale (HDRS; range, 0-52 points) and the Quality-of-Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF; range, 0%-100%) scores were secondary outcomes. Outcomes were assessed at 8 time points by independent evaluators who were blinded to randomization. The taper regimen was hypothesized to be noninferior to continuation at 24 weeks using a 1-sided α value of .05. RESULTS: A total of 101 patients (mean [SD] age, 31.0 [11.2] years; 55 women [54.5%]) participated in the trial: 51 patients (50.5%) in the taper group and 50 patients (49.5%) in the continuation group. At 24 weeks, patients in the taper group had noninferior results compared with patients in the continuation group (mean [SD] Y-BOCS score: taper group, 11.47 [6.56] points; continuation group: 11.51 [5.97] points; difference, -0.04 points; 1-sided 95% CI, -∞ to 2.09 points [below the noninferiority margin of 3.0 points]; mean [SD] HDRS score: taper group, 5.69 [3.84] points; continuation group, 4.61 [3.46] points; difference, 1.08 points; 1-sided 95% CI, -∞ to 2.28 points [below the noninferiority margin of 2.5 points]; mean [SD] Q-LES-Q-SF score: taper group, 68.01% [15.28%]; continuation group, 70.01% [15.59%]; difference, 2.00%; 1-sided 95% CI, -∞ to 6.83 [below the noninferiority margin of 7.75]). However, the taper group had higher rates of clinical worsening (23 of 51 [45%] vs 12 of 50 [24%]; P = .04). CONCLUSIONS AND RELEVANCE: Results of this randomized clinical trial show that patients with OCD who achieve wellness after EX/RP therapy could, on average, discontinue their SRI with noninferior outcomes compared with those who continued their SRI. Those who tapered the SRI had higher clinical worsening rates. Future research should evaluate if SRI half-life alters these rates. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01686087.

Mainstream parties in Western Europe are increasingly struggling to hold together their base of support. As a lens for exploring this changing electoral landscape, this article focuses on the growing share of the electorate that is cross-pressured between conservative and progressive attitudes on economic and cultural issues. It argues that a stable asymmetry characterizes Western European mass attitudes: while support for the left is common among voters with progressive attitudes on both issues, it is enough to be conservative on one issue to turn right. Analyzing survey data collected from 1990 to 2017, the study shows that cross-pressures are resolved in favor of the right and examines the trade-offs this poses to center-right parties. These findings contribute to debates on electoral dealignment and realignment and shed light on the electoral choices of the center-right.

Over the past decade, an increasingly sophisticated literature has sought to capture the nature, sources, and consequences of a novel empirical phenomenon in world politics: the growing complexity of global governance. However, this literature has paid only limited attention to questions of measurement, which is a prerequisite for a more comprehensive understanding of global governance complexity across space and time. In taking a first step in this direction, we make two contributions in the article. First, we propose new quantitative measures that gauge the extent of complexity in global governance, which we conceptualize as the degree to which global governance institutions overlap. Dyadic, weighted, directed-dyadic, and monadic measures enable a multifaceted understanding of this important development in world politics. Second, we illustrate these measures by applying them to an updated version of the most comprehensive data set on the design of intergovernmental organizations (IGOs): the Measure of International Authority (MIA). This allows us to identify cross-sectional and temporal patterns in the extent to which important IGOs, which tend to form the core of sprawling regime complexes in many issue areas, overlap. We conclude by outlining notable implications for, and potential applications of, our measures for research on institutional design and evolution, legitimacy, and legitimation, as well as effectiveness and performance. This discussion underscores the utility of the proposed measures, as both dependent and independent variables, to researchers examining the sources and consequences of institutional overlap in global governance and beyond.

This NeuroView is intended for graduate students who are not sure how to choose or what to expect from a mentor as well as mentors who are uncertain what to give mentees. Two principal investigators and a current mentee will share their perspectives on this bidirectional relationship.

Background: Modern warfare in a civilian setting may expose combatants to severe moral challenges. Whereas most of these challenges are handled effectively, some potentially morally injurious events (PMIEs) may have deleterious psychological effects on the combatants, such as suicide ideation (SI). Self-disclosure, which includes sharing distressing thoughts and emotions, has been recognized as a protective factor against SI in the aftermath of stressful events. The current study is the first to examine the moderating role of self-disclosure in the relationship between PMIE exposure and SI among combat veterans. Method: A sample of 190 recently discharged Israeli combat veterans completed validated self-report questionnaires measuring combat exposure, PMIEs, depressive symptoms, SI, and self-disclosure in a cross-sectional design study. Results: PMIE dimensions and self-disclosure significantly contributed to current SI. Notably, the moderating model indicated that self-disclosure moderated the link between PMIE-Self and current SI, as PMIE-Self and current SI demonstrated a stronger association among veterans with low self-disclosure than among those with high self-disclosure. Limitations: Cross-sectional design of volunteers, the findings may not be directly generalizable to veterans' population. Conclusion: Self-disclosure, as a factor promoting a sense of belongingness, interpersonal bonding, and support, might diminish SI risk following PMIE exposure. Various mechanisms accounting for these associations are suggested, and the clinical implications of these interactions are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Background A growing body of literature reports associations between exposure to particulate matter with diameter ≤2.5 μm (PM2.5) during pregnancy and birth outcomes. However, findings are inconsistent across studies. Objectives To assess the association between PM2.5 and birth outcomes of fetal growth in a cohort with high prevalence of siblings by multilevel models accounting for geographical- and mother-level correlations. Methods In Israel, we used Maccabi Healthcare Services data to establish a population-based cohort of 381,265 singleton births reaching 24–42 weeks’ gestation and birth weight of 500–5000 g (2004–2015). Daily PM2.5 predictions from a satellite-based spatiotemporal model were linked to the date of birth and maternal residence. We generated mean PM2.5 values for the entire pregnancy and for exposure periods during pregnancy. Associations between exposure and birth outcomes were modeled by using multilevel logistic regression with random effects for maternal locality of residence, administrative census area (ACA) and mother. Results In fully adjusted models with a mother-level random intercept only, a 10-μg/m3 increase in PM2.5 over the entire pregnancy was positively associated with term low birth weight (TLBW) (Odds ratio, OR = 1.25, 95% confidence interval, CI: 1.09,1.43) and small for gestational age (SGA) (OR = 1.15, 95% CI: 1.06,1.26). Locality- and ACA-level effects accounted for <0.4% of the variance while mother-level effects explained ∼50% of the variability. Associations varied by exposure period, infants’ sex, birth order, and maternal pre-pregnancy BMI. Conclusions Consideration of mother-level variability in a region with high fertility rates provides new insights on the strength of associations between PM2.5 and birth outcomes.

In the past three decades, scholars have frequently used the concept of framing effects to assess the competence of citizens' political judgments and how susceptible they are to elite influence. Yet prior framing studies have reached mixed conclusions, and few have provided systematic cumulative evidence. This study evaluates the overall efficacy of different types of framing effects in the political domain by systematically meta-analyzing this large and diverse literature. A combined analysis of 138 experiments reveals that when examined across contexts, framing exerts medium-sized effects on citizens' political attitudes and emotions. However, framing effects on behavior are negligible, and small effects are also found in more realistic studies employing frame competition. These findings suggest that although elites can influence citizens by framing issues, their capacity to do so is constrained. Overall, citizens appear to be more competent than some scholars envision them to be.

Housing preferences in the Middle East are largely family-oriented. With the increase in the number of university graduates who have experienced life outside traditional Arab settings, housing preferences are arguably changing toward a more western career-centered orientation. Yet familial allegiances have not disappeared. This study hypothesizes that residential preferences of Middle-Eastern knowledge-workers differ from their Western counterparts. We offer a new value-based conceptual framework for analyzing the residential preferences of knowledge-workers from communities with a history of tribal belonging, tight kinship structures, and strong familial ties in determining residential choice. The analyzed case study focuses on young Palestinian knowledge-workers preferences between traditional housing in the hometown and medium-density neighborhoods in larger cities. The new conceptual framework explores the role of individualistic values (i.e., career, privacy, lifestyle) versus collectivist values (i.e., family and community life), urban amenities, and the perceived locus of opportunities. The framework offers an alternative to the current practice assessing knowledge-workers residential preferences solely based on individualistic values and location amenities. The framework is validated using a multiple-indicators, multiple-causes (MIMIC) model estimated with a sample of Israeli-Palestinian knowledge-workers in Israel.

This article revisits claims made a decade ago about the importance of the word ?sharing? in the context of social network sites (SNSs). Based on an analysis of the home pages of 61 SNSs between the years 2011 and 2020, the findings incontrovertibly show that ?sharing? has lost its central place in the terminology employed by social media platforms in their self-presentation. Where in the mid-2000s SNSs relied heavily on a rhetoric of sharing to promote their services, by 2020, this rhetoric had been almost entirely dropped. The research reported here implies that social media platforms no longer feel a need or desire to be associated with these cultural beliefs. Given this, questions are raised as to whether ?sharing? remains a keyword for social media.

Whom do individuals blame for intergroup conflict? Do people attribute responsibility for intergroup conflict to the in-group or the out-group? Theoretically integrating the literatures on intergroup relations, moral psychology, and judgment and decision-making, we propose that unpacking a group by explicitly describing it in terms of its constituent subgroups increases perceived support for the view that the unpacked group shoulders more of the blame for intergroup conflict. Five preregistered experiments (N = 3,335 adults) found support for this novel hypothesis across three distinct intergroup conflicts: the Israeli-Palestinian conflict, current racial tensions between White people and Black people in the United States, and the gender gap in wages in the United States. Our findings (a) highlight the independent roles that entrenched social identities and cognitive, presentation-based processes play in shaping blame judgments, (b) demonstrate that the effect of unpacking groups generalizes across partisans and nonpartisans, and (c) illustrate how constructing packed versus unpacked sets of potential perpetrators can critically shape where the blame lies.

This study examines the relations between memory, social media experience, and testimony in the Eva Stories Instagram project. By conducting a combined visual and multimodal analysis of the stories, as well as a close analysis of the relations between social media experience and testimony, we claim that Eva Stories establishes a new responsive space for remembering the Holocaust. This space enables users to inscribe themselves into mediated Holocaust memory and to become media witnesses through the co-creation of socially mediated experiences. The self-inscription of the user is made possible by three interrelated modes of media witnessing, which continuously evoke user engagement. These new modes, we argue, indicate a new kind of agency in relation to media witnessing: the ability to testify on one’s own present social media engagement with mediated memory, and become a witness to it.

Transport is usually viewed as means to get tourists to their destinations and to move about the destinations. Hence, transport projects intended to improve access by tourists to and within destinations are largely assessed according to their contribution to visitors' satisfaction. Yet, not all tourist destinations are the same. Heritage and religious destinations are particular sets of destinations. This paper seeks to identify the issues that have to be discussed when considering transport projects to such destinations. To this end the proposed cable car to the City of David and Western Wall in Jerusalem is discussed. On the basis of some of the objections raised against this project the underlying dilemmas are identified. The main dilemmas and issues raised are whether it is indeed desirable and appropriate to improve access to historic sites that may be over-crowded, what are the equity facets of such transport projects, particularly the distribution of benefits and cost between locals and tourists, and to what extent do the transport projects contribute to the heretization of such site – the social and political processes involved in presenting the story of such sites.

Israeli politicians strongly support inter-urban rail investment and network development connecting peripheral localities, while transport experts voice criticism and oppose many of the planned investments. This study focuses on the lacuna in transportation scholarship regarding elected officials' expectations from rail investment in peripheral areas and its potential to reduce spatial disparities, stressing that there is little research effort to reveal the reasoning of politicians when promoting transport investment and the extent to which some of the political considerations may reflect an authentic representation of public sentiments. First, an explorative qualitative study was conducted, using multiple data sets, including 12 in-depth interviews with elected officials and transport decision makers, newspaper articles, and professional documents. Analysis identified four main themes with conflicting perspectives between transport experts and politicians: Marginal vis-a-vis revolutionary effects; daily vis-a-vis less frequent activities; transport link vis-a-vis emotional link and social justice vis-a-vis social commitment. These themes reflect the tension between the discourse of accessibility led by experts and the implied discourse of mobility by politicians. The second stage was based on a large scale survey of 2008 respondents from peripheral and central localities in Israel, aimed at revealing public beliefs and preferences regarding rail investment in peripheral localities. Results showed that differences of opinion between experts and politicians do not stem only from political bias or irrelevant interests but reflect experts' inability to consider benefits that are appreciated by both politicians and the general public. The study also draws attention to different approaches to the goals of transportation systems. While the dominant voice in scholarly discourse considers accessibility gains as the main goal of transport policy, both elected politicians and residents from peripheral localities also appreciate mobility gains.