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Lithium is the gold standard treatment for bipolar disorder, but its mechanism of action is not fully understood. Emerging research suggests structural and functional alterations in the retina of people with bipolar disorder and depression, including a thinner retinal nerve fibre layer and ganglion cell layer. Retinal structure and function can be characterised using several noninvasive imaging techniques, from which numerous quantitative metrics can be derived. We aimed to complete a systematic review of the literature to establish which parameters have been evaluated in relation to lithium use and what insights they provide into its potential retinal effects.
Methods:
Searches using the terms ‘Lithium’ AND ‘retina’ were carried out to identify peer reviewed studies assessing the impact of lithium on retinal structure or function. These included those with or without a control group comparison, pre- and post-lithium comparisons and observational studies. There were no exclusions based on the quantity or preparation of lithium administered, or the length of administration. Any studies where lithium was administered in combination with another intervention were excluded, unless it was directly compared to the other intervention without lithium. The main outcome of interest was optical coherence tomography (OCT) derived metrics, but any measure of structure or function was included.
Results:
Seven studies reporting structural outcomes, and 10 reporting functional outcomes, were identified.Structural outcomes were derived from optical coherence tomography (OCT) imaging studies which had multiple limitations. There was no evidence of statistically significant difference in the retinal nerve fibre layer (RNFL) between people with bipolar disorder taking lithium and healthy controls in two studies with larger numbers, indicating a protective effect on the retina. In four studies looking at differences in people with bipolar taking lithium and those taking valproate, two showed no signs of difference and two evidence of statistically thicker RNFL in the lithium group, also in line with a potential protective effect. For all other OCT derived metrics, the evidence was limited.
Studies reporting functional outcomes were highly heterogeneous with multiple limitations and no clear trends. The majority reported a statistically significant effect of lithium on at least one functional measure, derived from electrooculography, electroretinography, and dark adaptation threshold procedures.
Conclusion:
Trends indicate that lithium is likely to have an effect on both the structure and function of the retina, but significant limitations in all included studies mean that better designed and adequately powered prospective studies are required for both structural and functional measures of the retina.
We present 29 successfully recovered Civ time lags in Active Galactic Nuclei from the complete Dark Energy Survey Reverberation Mapping campaign. The AGN in this sample span a redshift range of 1.9 < z <3.5. We successfully measure the velocity dispersion from the Civ spectral linewidth for 25 of these 29 sources, and use these to calculate new high-redshift black hole mass estimates, finding masses between 0.8 and 1.3 billion solar masses. We also identify a selection effect due to the duration of the survey that can impact the radius-luminosity relation derived from this and other (high-redshift) data. This paper represents the culmination of the OzDES Civ campaign.
Over the last decade, the Australian Dark Energy (OzDES) collaboration has used Reverberation Mapping to measure the masses of high redshift supermassive black holes. Here we present the final review and analysis of this OzDES reverberation mapping campaign. These observations use $6-7$ years of photometric and spectroscopic observations of 735 Active Galactic Nuclei (AGN) in the redshift range $z\in [0.13, 3.85]$ and bolometric luminosity range $\log_{10}(L_{\mathrm{bol}})\in [44.3, 47.5] \; \mathrm{erg/s}$. Both photometry and spectra are observed in visible wavelengths, allowing for the physical scale of the AGN broad line region to be estimated from reverberations of the H$\beta$, MgII and CIV emission lines. We successfully use reverberation mapping to constrain the masses of 62 super-massive black holes, and combine with existing data to fit a power law to the lag-luminosity relation for the H$\beta$ and MgII lines with a scatter of $\sim0.25$ dex, the tightest yet identified, fit specifically for consistency with high redshift AGN. We fit a similarly constrained relation for CIV, resolving a tension with the low luminosity literature AGN by accounting for selection effects arising from finite survey length. We also examine the impact of emission line width and luminosity (related to accretion rate) in reducing the scatter of these scaling relationships and find no significant improvement over the lag-only approach for any of the three lines. Using these relations, we further estimate the masses and accretion rates of 246 AGN with single epoch methods. We also use these relations to estimate the relative sizes of the H$\beta$, MgII and CIV emitting regions, and find evidence that the MgII emission may occur further out than H$\beta$. In short, we provide a comprehensive benchmark of high redshift AGN reverberation mapping at the close of this most recent generation of surveys, including light curves, time-delays, and a set of significantly improved radius-luminosity relations for use with high-redshift populations.
This survey of the public, pharmacists, and other healthcare professionals identified factors affecting implementation of antibiotic stewardship in Canadian community pharmacies. Lack of support from non-pharmacist healthcare providers and pharmacy leadership were common barriers. Facilitators included providers’ perceived importance of antibiotic stewardship, pharmacists’ role as educators, and potential for healthcare cost savings.
The Centers for Disease Control and Prevention has recommended contact precautions for healthcare personnel caring for COVID-19 patients since the beginning of the pandemic. However, current scientific evidence points to transmission through small respiratory droplets or aerosols and not contaminated fomites as the dominant routes of transmission of SARS-CoV-2. We believe science shows there is no benefit and thus only negative consequences to patients, the environment, and the U.S healthcare system associated with ongoing contact precautions for patients with SARS-CoV-2 infection, and we advocate for updated guidelines reflecting current science.
Objectives/Goals: The objectives of this project were to (1) develop a multidimensional well-being index, reflecting personal capacities and environmental conditions, and (2) evaluate its association with preterm birth. The goal of this investigation was to illustrate the value of multidimensional well-being for understanding health outcomes. Methods/Study Population: The LIFE study was a retrospective cohort of postpartum US-born Black women (ages 18+) recruited 2009–2011 from a suburban Detroit hospital. Eligible participants self-identified as African American, had singleton births, and spoke English; exclusions included incarceration, cognitive impairment, or serious mental health conditions. Trained interviewers collected survey and medical data during postpartum stays. Of 1,410 recruits (71% response), 1,177 had complete data. Key variables were binarized; logistic regression models assessed associations with preterm birth. Results/Anticipated Results: Few of the 21 binarized variables showed individual statistical significance. Significant predictors included having someone to offer advice about a crisis or to listen when needing to talk about oneself or one’s problems, and self-rated physical and mental health satisfaction. Of the dimension scales, only the physical health scale (physical health rating, mental health rating, and mental health satisfaction) was significant. The overall well-being index was borderline significant for lower odds of preterm birth (OR=0.934, 95% CI: 0.887–1.002, p=0.0593), reaching significance when adjusted for maternal age (OR=0.938 95% CI: 0.883-0.998, p=0.0414). Discussion/Significance of Impact: This study’s findings underscore that well-being is best understood as a holistic interconnected construct. By centering context, this approach advances health equity, encourages systemic accountability and change, and inspires innovative public health research.
Why have England’s historic upper class come to the fore of public life? Britain’s protracted imperial decline in the twentieth century saw with it a decline and decomposition of its class structure defined by inheritance, status, exclusivity and traditionalism. Since 2016 this decline has been in the process of reversing as English society witnesses a resurgence of its upper class – a culturally and socially cohesive group of persons whose status, position and traditionalist worldviews have come to shape UK politics and English culture, and the sense of our collective future. The fall and rise of the English upper class examines how these traditionalist worldviews, while diverse in their application, are unified by a common thread. English society is imagined through idioms of kinship and inheritance, which take the form of a ‘house’. From our so-called ‘Establishment’ institutions to the ancestral homes of the landed gentry and aristocracy, through to the more unlikely areas of our society, such as the nostalgia for heritage clothing and the vogue for literature on Old Englishness, the kinship idiom underlying these institutions and cultural ideals is: who inherits the house, inherits England. By exploring the history of England’s passage to capitalism and its curious class structure, which combines status exclusivity with economic fortune, the book examines the writings of diverse upper-class gentlemen – from Rory Stewart to Adam Nicolson, Roger Scruton to Peter York – to illustrate how anxieties about the future of society always find their answer in the traditions of the past.
Chapter 4 explores Adam Nicolson’s attempts to ‘revive’ tradition at his ‘ancestral’ estate, Sissinghurst Castle, Kent. Here Sissinghurst becomes the beacon for his political philosophy of landscape, agriculture, and something approaching ‘England’ via his mythology of ‘Arcadia’. It is argued that Nicolson’s vision for Sissinghurst ought to be understood as a response to the central sociological problem aristocrats face: sinking status. Given that if one starts at the top, the only way is down, sinking status must develop strategies for upward nobility. The strategy of upward nobility that Nicolson has chosen is to turn his ancestors into sources of social and political power for the future. It is shown that Nicolson’s telling of Sissinghurst’s story as a story of decline and fall is seized upon as an opportunity to revive and bring back a way of life that can mitigate the problems and ills of the present. Here we see how Nicolson combines Sissinghurst’s twentieth-century renown and its representation in modernist literature with a political philosophy of agriculturalism that evokes the early organic movement, which took the small manor farm and attendant hierarchy of lord, yeoman and peasant as the basis for social harmony and economic prosperity.
Chapter 8 examines the fortunes of the twenty-first century in relation to two interlocking but competing sensibilities in English culture, Raymond Williams’ Country and the City. The city is London, and the country is the spiral of the Home Counties surrounding London: Middle England. Here we find two competing sensibilities in relation to the fortunes of the twenty-first century, one which recalls the aesthetics of the father of modern conservatism Edmund Burke. On the one hand, the fortunes of the twenty-first century appear as sublime, while, on the other, those who make such a judgement long for a more agreeable vision of fortunes and its accompanying aesthetic of beauty – a beauty sought for or revealed in either architecture or landscape of an England of old. As the fortunes of the twenty-first century cannot be easily divided by Old and New Money, a move away from a moral hierarchy of wealth has been replaced with an aesthetics of feeling and desire. Examining the writings of a disparate mix of upper-class gentlemen, critical sociologists and environmentalists we shall see how the fears of excessive, plutocratic capital accumulation is tied with an alternative aesthetic of beauty which is socially elaborated as an old imperial-colonial Englishness. The chapter demonstrates that within the traditionalism and empiricism idioms of the house of England, we can find a tradition of English socialism and radicalism which does not seek to revolt, to destroy, to overturn or break down but hopes for a piecemeal, gentle, prolonged reformation.
While the idiom of the house has been drawn up in a multitude of different areas of English social, political and cultural life in the present, it has not provided any satisfactory answers or directions for our future. As such it is suggested that the idiom of the house ought to be viewed as what the psychoanalyst Jacques Lacan called a Thing: an empty void into which we have projected our inaccessible desires to guarantee the preservation of a view of English society which is no longer possible, morally permissible, or even desirable. Instead, we could view ourselves not as heirs to a tradition but, rather, as contingent remainders: those people who signal more the crisis and imperfections of a society where kinship and inheritance play so central a role. We could give up the ghost of the house and think of ourselves as freer to be together in new and collaborative ways.
Chapter 6 consists of an ethnography of a provincial English town’s independent bookshop. Here, discussions about the role of reading, literature and the high-street reveal deep, underlying concerns on the meaning of ‘culture’ in English society and its relation to the ‘moral health’ of the nation. Awakening the debates on the meaning of ‘culture’ in the art-society tradition of the twentieth century, ranging from F. R. Leavis, Raymond Williams, Richard Hoggart, through C. P. Snow and the Birmingham School of Cultural Studies, the chapter shows how the meaning of culture becomes a debate about the ethical permissibility of a traditional Englishness. We find that through interviews with the upper-class gentlemen who frequent this bookshop, and in their artistic work as writers and critics, folklorists and as readers, an aesthetic of Old Englishness emerges, an aesthetic which is used by these individuals to form a critique of the shortcomings of the present. Through constructing an aesthetic of English society in arts and letters, these individuals then pit an avaricious, and ephemeral, modernity against the certainties found in Old England.
Chapter 7 consists of an examination of the writings of upper-class society journalist and commentator Peter York and his classic 1980s series Sloane Rangers. It argues that Sloane Rangers ought to be treated as continuing a tradition of English class categorisation where social status and economic interest are exaggerated by appeals to tradition in the idiom of kinship. Sloane Rangers arose in the 1980s as a response to English deindustrialisation and the rise of an advanced neo-liberal consumer economy: in contrast to new money and widening affluence, Sloane Rangers were offered as a long standing, inherited social position, part of what York called ‘the eternal stream of English life’. Through a critical examination of York’s writings, the chapter shows that the Sloane Ranger was invented to meet a challenge: to preserve forms of social behaviour, attitudes, practices and cultural worldviews which are seen as either dying out or from a time prior to the present. As such, the status symbols of the Sloane Ranger become another way in which the present needs of capitalism draw upon old ideologies and character traits. By extending the analysis of the Sloane Ranger through to its present reincarnations in brands such as Jack Wills, we see how this sense of social practices and status symbols being repetitions from a time prior to the present is one of the ways in which economic privilege and social exclusivity go hand in hand in England.
How can we explain the cultural fault lines which currently plague a post-Brexit Britain? The Introduction makes the claim that the culprit is the peculiarity of the English imagination, whose eternal and timeless utopia is Arcadia: a perfect England which existed once and has since been lost. It is demonstrated that this vision of a perfect England is a post-war invention as Britain underwent imperial and colonial decline. We can understand Brexit as a crisis of Englishness which tries to re-imagine a vision of British society as one of pastoral harmony organised around the manor house, and imperial power channelled through networks of overseas trade. The book argues that this vision of English society can be located in the upper-class house, and through the idioms of houses we can trace notions of belonging and social unity through the upper-class personages of which these houses are associated. The book’s overarching claim is that the idiom of the house, from the country house to the public school system, monarchy to lesser gentry, has been seized upon repeatedly in a variety of social, political and cultural beliefs and practices. In so doing, the English have turned their upper class into a ‘past’, a living form of ‘tradition’ beyond the empirical here-and-now. Fall and rise traces the various ways in which a vision of national hope and loss can be traced and read in the writings and practices of the English upper-class gentleman.
Chapter 2 confronts the problem that sociologists of class in Britain face: how to explain the persistence of a traditional upper class in an advanced modern society where class ought to prevail over status. It is argued that England’s agrarian capitalism gave rise to a form of societal membership and language of class that was never fully able to dispense with kinship terms of descent, inheritance and ancestry. The chapter explores this in three domains. First, by examining Sir Thomas Smith’s 1583 De Republica Anglorum, it demonstrates that the vision of British society as a multitude of households and families provided the means to dispense with a centralised vision of state sovereignty as found in the continental European tradition. Second, it suggests that the origins of the house-based society arise, first, in the vision of society as a ‘multitude of individual households’ and second, in the peculiar economic arrangement of the lease-copyhold which governed the economic relations and kinship structures of the early modern agrarian economy. Because economic interests were conceptually indistinguishable from kinship terms, the organic transformation from feudalism to capitalism in England preserved pre-modern status terminology within naked ‘class’ (economic) interests. Third, it argues that from Sir Gregory King’s Natural and Political Observations and Conclusions upon the State and Condition of England (1696) onwards, class categories continue a conflation of economic interests with status, and kinship terms of inheritance with financial power.