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In 362/363 the Roman emperor Julian composed a treatise titled Against the Galileans in which he set forth his reasons for abandoning Christianity and returning to devotion to the traditional Greco-Roman deities. Sixty years later Cyril, bishop of Alexandria, composed a response. His resulting treatise Against Julian would dwarf the size of Julian's original work and in fact serves as our primary source for the fragments of it that have survived. Julian's treatise was the most sophisticated critique of Christianity to have been composed in antiquity and Cyril's rebuttal was equally learned. The Christian bishop not only responded directly to Julian's own words but drew upon a wide range of ancient literature, including poetry, history, philosophy, and religious works to undermine the emperor's critiques of the Christian Bible and bolster the intellectual legitimacy of Christian belief and practice. This is the first full translation of the work into English.
The description and delineation of trematode species is a major ongoing task. Across the field there has been, and currently still is, great variation in the standard of this work and in the sophistication of the proposal of taxonomic hypotheses. Although most species are relatively unambiguously distinct from their congeners, many are either morphologically very similar, including the major and rapidly growing component of cryptic species, or are highly variable morphologically despite little to no molecular variation for standard DNA markers. Here we review challenges in species delineation in the context provided to us by the historical literature, and the use of morphological, geographical, host, and molecular data. We observe that there are potential challenges associated with all these information sources. As a result, we encourage careful proposal of taxonomic hypotheses with consideration for underlying species concepts and frank acknowledgement of weaknesses or conflict in the data. It seems clear that there is no single source of data that provides a wholly reliable answer to our taxonomic challenges but that nuanced consideration of information from multiple sources (the ‘integrated approach’) provides the best possibility of developing hypotheses that will stand the test of time.
The Hippoboscidae are ectoparasites of birds and mammals, which, as a group, are known to vector multiple diseases. Avipoxvirus (APV) is mechanically vectored by various arthropods and causes seasonal disease in wild birds in the United Kingdom (UK). Signs of APV and the presence of louse flies (Hippoboscidae) on Dunnocks Prunella modularis were recorded over a 16·5-year period in a rural garden in Somerset, UK. Louse flies collected from this site and other sites in England were tested for the presence of APV DNA and RNA sequences. Louse flies on Dunnocks were seen to peak seasonally three weeks prior to the peak of APV lesions, an interval consistent with the previously estimated incubation period of APV in Dunnocks. APV DNA was detected on 13/25 louse flies, Ornithomya avicularia and Ornithomya fringillina, taken from Dunnocks, both with and without lesions consistent with APV, at multiple sites in England. Collectively these data support the premise that louse flies may vector APV. The detection of APV in louse flies, from apparently healthy birds, and from sites where disease has not been observed in any host species, suggests that the Hippoboscidae could provide a non-invasive and relatively cheap method of monitoring avian diseases. This could provide advanced warnings of disease, including zoonoses, before they become clinically apparent.
We examined a zooarchaeological assemblage from Badger Island, a 12.4 km2 landbridge island in the Furneaux Group, Bass Strait, south-eastern Australia. The accumulation consisted of Pleistocene and Holocene strata that were rich in mammal remains. Small mammal remains were accumulated by owls, whereas large mammal remains were accumulated by people and/or autochthonous mortality. The Pleistocene fauna was dominated by grassland mammals, particularly Mastacomys fuscus (Broad-toothed Rat), but these gradually declined and were largely replaced by forest–woodland dwelling mammals in the Holocene. The same pattern of faunal change has been observed on the large main island of Tasmania (∼65,000 km2), suggesting changes observed at Beeton Rockshelter are representative of the region. Because all of the Furneaux Group Islands were united as one landmass in the past, the fossil fauna observed in Beeton Rockshelter is relevant to conservation-oriented mammal-restoration initiatives, which are being considered throughout the entire Furneaux Group.
Having a relapse of schizophrenia or recurrent psychosis is feared by patients, can cause social and personal disruption and has been suggested to cause long-term deterioration, possibly because of a toxic biological process.
Aims
To assess whether relapse affected the social and clinical outcomes of people enrolled in a 24-month randomised controlled trial of antipsychotic medication dose reduction versus maintenance treatment.
Methods
The trial involved participants with a diagnosis of schizophrenia or recurrent, non-affective psychosis. Relapse was defined as admission to hospital or significant deterioration (assessed by a blinded end-point committee). We analysed the relationship between relapse during the trial and social functioning, quality of life, symptom scores (Positive and Negative Syndrome Scale) and rates of being in employment, education or training at 24-month follow-up. We also analysed changes in these measures during the trial among those who relapsed and those who did not. Sensitivity analyses were conducted examining the effects of ‘severe’ relapse (i.e. admission to hospital).
Results
During the course of the trial, 82 out of 253 participants relapsed. There was no evidence for a difference between those who relapsed and those who did not on changes in social functioning, quality of life, symptom scores or overall employment rates between baseline and 24-month follow-up. Those who relapsed showed no change in their social functioning or quality of life, and a slight improvement in symptoms compared to baseline. They were more likely than those who did not relapse to have had a change in their employment status (mostly moving out of employment, education or training), although numbers changing status were small. Sensitivity analyses showed the same results for those who experienced a ‘severe’ relapse.
Conclusions
Our data provide little evidence that relapse has a detrimental effect in the long term in people with schizophrenia and recurrent psychosis.
Building on the success of EUP's highly acclaimed Atlas of Global Christianity, this volume is the seventh in a series of reference works that takes the analysis of worldwide Christianity to a deeper level of detail. It focuses on Christianity in North America, covering every country and offering both reliable demographic information and original interpretative essays by locally based scholars and practitioners. It maps patterns of growth and decline, assesses major traditions and movements, analyzes key themes, and examines current trends. As a comprehensive account of the presence of Christianity in every part of North America, this volume will become a standard work of reference in its field.
Long-term birth cohorts are essential for studying health and disease over the life course. The retention of participants remains a challenge in study design. Previous research works on attrition are limited in length of follow-up time and lack of racial/ethnic diversity. Using data from the Wayne County Health, Environment, Allergy, and Asthma Longitudinal Study (WHEALS; United States cohort born between 2004 and 2007, n = 1258), we first performed longitudinal latent class analyses to identify patterns of participation spanning the prenatal period and six follow-up timepoints: 1, 6, 12, and 24 months; 3–6 years; and 10–12 years. Data collection included a combination of in-person visits, home visits, home specimen kits, and staff-administered questionnaires. We examined associations between baseline factors and participation class using multinomial logistic regression modeling, and with conditional inference modeling to identify variables most strongly associated with class. We identified four participation classes: high early participation with gradual loss-to-follow-up, sporadic participation, consistently high participation, and consistently low participation. Multiple baseline characteristics were associated with participation class. The “consistently high participation” class was disproportionately composed of participants who were older, were of higher education, had private insurance, had suburban residence, and were with higher income. Conditional inference trees identified maternal education, insurance, and income as most strongly associated with participation class. Through latent class modeling, we show that participants who were lost to follow-up fell into distinct groupings of participation. In the future, preparatory communications with those who are at the highest risk of study discontinuation may improve long-term retention.
Pharmacogenomic (PGx) testing identifies individual genetic variation that may inform medication treatment. Sentiment and barriers may limit PGx testing. Here we compare confidence in utilizing PGx testing and barriers to implementation by type of provider and treatment condition as identified in a survey.
Methods
Healthcare providers in the primary care setting were targeted between November 2022 and February 2023 via the Medscape Members paid market research program. The survey included 5 demographic, 5 multiple-choice, and 4 multi-component five-point Likert scale questions to assess PGx sentiments, use, and education in mental health (e.g., depression) and primary care (e.g., cardiovascular disease) conditions. Responses were descriptively compared.
Results
Of 305 U.S. provider respondents [40% nurse practitioners (NPs), 33% frontline MDs/DOs, 3% physician assistants (PAs), 24% other], 32% of NPs/PAs and 29% of MDs/DOs had used PGx testing for mental health conditions. The major barriers to adopt PGx testing were similar for mental health and primary care conditions yet differed by provider type. NPs/PAs (72-77%) were more concerned with patient cost than MDs/DOs (46-55%), whereas MDs/DOs were more concerned with evidence of clinical utility (54-59%) than NPs/PAs (40-42%). In respondents who use PGx testing, MDs/DOs reported slightly more confidence utilizing PGx than NPs/PAs. For both groups, confidence in using PGx for mental health conditions was somewhat greater than for non-mental health conditions.
Conclusions
These data illuminate the implementation barriers and confidence levels of clinicians utilizing PGx testing. Increasing awareness around patient cost and evidence of clinical utility for PGx testing may improve utilization.
Pharmacogenomic (PGx) testing identifies individual genetic variation that may inform medication treatment. Lack of awareness and education may be barriers to implementing routine PGx testing. To characterize current PGx testing utilization and educational needs we conducted a survey of various provider types.
Methods
Healthcare providers in the primary care setting were targeted between November 2022 and February 2023 via the Medscape Members paid market research program. The survey included 5 demographic, 5 multiple-choice, and 4 multi-component five-point Likert scale questions to assess PGx sentiments, use, and education in mental health (e.g., depression) and primary care (e.g., cardiovascular disease) conditions. Responses were descriptively compared.
Results
Of 305 U.S. provider respondents [40% nurse practitioners (NPs), 33% frontline MDs/DOs, 3% physician assistants (PAs), 24% other], most indicated that they “don’t use” (44-49%) or “have never heard of” (19-20%) PGx testing for mental health conditions. The most helpful sources to learn about PGx testing were accredited CE/CME activities (55-61%) and peer-reviewed publications (57-59%). Most NPs/PAs preferred webinars (62%) or online learning portal (57%) formats. MDs/DOs had no preference for webinars or learning portals over conferences, written materials, or academic presentations (45-47%). NPs/PAs were more interested in learning about PGx testing than MDs/DOs (4.29/5 vs. 3.96/5 average score).
Conclusions
These data reveal awareness level and desired learning opportunities for PGx testing between types of healthcare providers. Education should be tailored to meet providers’ preferred learning formats and information sources, such as offering CE/CME through an online learning portal.
Trifludimoxazin is a protoporphyrinogen oxidase (PPO)-inhibiting herbicide currently under development for preplant burndown and soil-residual weed control in soybean [Glycine max (L.) Merr.] and other crops. Greenhouse dose–response experiments with foliar applications of trifludimoxazin, fomesafen, and saflufenacil were conducted on susceptible and PPO inhibitor–resistant (PPO-R) waterhemp [Amaranthus tuberculatus (Moq.) Sauer] and Palmer amaranth (Amaranthus palmeri S. Watson) biotypes. These PPO-R biotypes contained the PPO2 target-site (TS) mutations ΔG210 (A. tuberculatus and A. palmeri), R128G (A. tuberculatus), and V361A (A. palmeri). The resistant/susceptible (R/S) ratios for fomesafen and saflufenacil ranged from 2.0 to 9.2 across all PPO-R biotypes. In contrast, the response of known PPO inhibitor–susceptible and PPO-R biotypes to trifludimoxazin did not differ within each Amaranthus species. In 2017 and 2018, experiments at the Meigs and Davis Purdue Agriculture Centers were conducted in fields with native A. tuberculatus populations composed of 3% and 30% PPO-R plants (ΔG210 mutation), respectively. At Meigs in 2018, A. tuberculatus control following foliar applications of fomesafen, lactofen, saflufenacil, and trifludimoxazin was greater than 95%. When averaged across the other 3 site-years, applications of 25 g ai ha−1 trifludimoxazin resulted in 95% control of A. tuberculatus at 28 DAA, while applications of fomesafen (343 g ai ha−1), lactofen (219 g ai ha−1), or saflufenacil (25.0 or 50 g ai ha−1), resulted in 80% to 88% control. Thus, at these relative application rates, the foliar efficacy of trifludimoxazin was comparable or greater on A. tuberculatus when compared with other commercial PPO inhibitors, even in populations where low frequencies of PPO-R plants exist. The lack of cross-resistance for common PPO2 TS mutations to trifludimoxazin and the level of foliar field efficacy observed on populations containing PPO-R individuals suggest that trifludimoxazin may be a valuable herbicide in an integrated approach for managing herbicide-resistant Amaranthus weeds.
Ion cyclotron resonance heating is a versatile heating method that has been demonstrated to be able to efficiently couple power directly to the ions via the fast magnetosonic wave. However, at temperatures relevant for reactor grade devices such as DEMO, electron damping becomes increasingly important. To reduce electron damping, it is possible to use an antenna with a power spectrum dominated by low parallel wavenumbers. Moreover, using an antenna with a unidirectional spectrum, such as a travelling wave array antenna, the parallel wavenumber can be downshifted by mounting the antenna in an elevated position relative to the equatorial plane. This downshift can potentially enhance ion heating as well as fast wave current drive efficiency. Thus, such a system could benefit ion heating during the ramp-up phase and be used for current drive during flat-top operation. To test this principle, both ion heating and current drive have been simulated in a DEMO-like plasma for a few different mounting positions of the antenna using the FEMIC code. We find that moving the antenna off the equatorial plane makes ion heating more efficient for all considered plasma temperatures at the expense of on-axis heating. Moreover, although current drive efficiency is enhanced, electron damping is reduced for lower mode numbers, thus reducing the driven current in this part of the spectrum.
In this paper I present a class of discrete choice models for ordinal response variables based on a generalization of the stereotype model. The stereotype model can be derived and generalized as a random utility model for ordered alternatives. Random utility models can be specified to account for heteroscedastic and correlated utilities. In the case of the generalized stereotype model this includes category-specific random effects due to individual differences in response style. But unlike standard random utility models the generalized stereotype model is better suited for ordinal response variables and can be interpreted as a kind of unidimensional unfolding model. This paper discusses the specification, interpretation, identification, and estimation of generalized stereotype models. Two applications are provided for illustration.
This paper proposes a general approach to accounting for individual differences in the extreme response style in statistical models for ordered response categories. This approach uses a hierarchical ordinal regression modeling framework with heterogeneous thresholds structures to account for individual differences in the response style. Markov chain Monte Carlo algorithms for Bayesian inference for models with heterogeneous thresholds structures are discussed in detail. A simulation and two examples based on ordinal probit models are given to illustrate the proposed methodology. The simulation and examples also demonstrate that failing to account for individual differences in the extreme response style can have adverse consequences for statistical inferences.
The global population and status of Snowy Owls Bubo scandiacus are particularly challenging to assess because individuals are irruptive and nomadic, and the breeding range is restricted to the remote circumpolar Arctic tundra. The International Union for Conservation of Nature (IUCN) uplisted the Snowy Owl to “Vulnerable” in 2017 because the suggested population estimates appeared considerably lower than historical estimates, and it recommended actions to clarify the population size, structure, and trends. Here we present a broad review and status assessment, an effort led by the International Snowy Owl Working Group (ISOWG) and researchers from around the world, to estimate population trends and the current global status of the Snowy Owl. We use long-term breeding data, genetic studies, satellite-GPS tracking, and survival estimates to assess current population trends at several monitoring sites in the Arctic and we review the ecology and threats throughout the Snowy Owl range. An assessment of the available data suggests that current estimates of a worldwide population of 14,000–28,000 breeding adults are plausible. Our assessment of population trends at five long-term monitoring sites suggests that breeding populations of Snowy Owls in the Arctic have decreased by more than 30% over the past three generations and the species should continue to be categorised as Vulnerable under the IUCN Red List Criterion A2. We offer research recommendations to improve our understanding of Snowy Owl biology and future population assessments in a changing world.
To understand healthcare workers’ (HCWs) beliefs and practices toward blood culture (BCx) use.
Design:
Cross-sectional electronic survey and semi-structured interviews.
Setting:
Academic hospitals in the United States.
Participants:
HCWs involved in BCx ordering and collection in adult intensive care units (ICU) and wards.
Methods:
We administered an anonymous electronic survey to HCWs and conducted semi-structured interviews with unit staff and quality improvement (QI) leaders in these institutions to understand their perspectives regarding BCx stewardship between February and November 2023.
Results:
Of 314 HCWs who responded to the survey, most (67.4%) were physicians and were involved in BCx ordering (82.3%). Most survey respondents reported that clinicians had a low threshold to culture patients for fever (84.4%) and agreed they could safely reduce the number of BCx obtained in their units (65%). However, only half of them believed BCx was overused. Although most made BCx decisions as a team (74.1%), a minority reported these team discussions occurred daily (42.4%). A third of respondents reported not usually collecting the correct volume per BCx bottle, half were unaware of the improved sensitivity of 2 BCx sets, and most were unsure of the nationally recommended BCx contamination threshold (87.5%). Knowledge regarding the utility of BCx for common infections was limited.
Conclusions:
HCWs’ understanding of best collection practices and yield of BCx was limited.