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Most of the Ross Sea has been designated a marine protected area (MPA), proposed ‘to protect ecosystem structure and function’. To assess effectiveness, the Commission for the Conservation of Antarctic Marine Living Resources (CCAMLR) selected Adélie (Pygoscelis adeliae) and emperor (Aptenodytes forsteri) penguins, Weddell seals (Leptonychotes weddellii) and Antarctic toothfish (Dissostichus mawsoni) as ecosystem change ‘indicator species’. Stable for decades, penguin and seal populations increased during 1998–2018 to surpass historical levels, indicating that change in ecosystem structure and function is underway. We review historical impacts to population trends, decadal datasets of ocean climate and fishing pressure on toothfish. Statistical modelling for Adélie penguins and Weddell seals indicates that variability in climate factors and cumulative extraction of adult toothfish may explain these trends. These mesopredators, and adult toothfish, all prey heavily on Antarctic silverfish (Pleuragramma antarcticum). Toothfish removal may be altering intraguild predation dynamics, leading to competitive release of silverfish and contributing to penguin and seal population changes. Despite decades of ocean/weather change, increases in indicator species numbers around Ross Island only began once the toothfish fishery commenced. The rational-use, ecosystem-based viewpoint promoted by CCAMLR regarding toothfish management needs re-evaluation, including in the context of the Ross Sea Region MPA.
Many believe that weaker legal constraints make unilateral action easier to reverse than legislation. Yet in some cases, unilateralism survives a successor's determined opposition. I argue that legislative persistence and unilateral transience may arise not only from differences in legal status but also from a selection effect: unilateralism and subsequent rescission can both stem from weak underlying policy-demanding groups. But if unilateralism itself alters the landscape of group power through policy feedback effects, it can survive a purportedly opposed new president. An example is the Trump Administration's failure to depart from the Obama Justice Department's lax stance on cannabis. Weak constituents’ policy demands may thus need to rely on a sympathetic president's unilateral action to begin a feedback loop, subsequently softening opposition. This paper therefore identifies unilateral action as a key tool for shifting policy in an enduring way, explaining its success or failure in terms of interest group power.
Measurement is the weak link between theory and empirical test. Complex concepts such as ideology, identity, and legitimacy are difficult to measure; yet, without measurement that matches theoretical constructs, careful empirical studies may not be testing that which they had intended. Item response theory (IRT) models offer promise by producing transparent and improvable measures of latent factors thought to underlie behavior. Unfortunately, those factors have no intrinsic substantive interpretations. Prior solutions to the substantive interpretation problem require exogenous information about the units, such as legislators or survey respondents, which make up the data; limit analysis to one latent factor; and/or are difficult to generalize. We propose and validate a solution, IRT-M, that produces multiple, potentially correlated, generalizable, latent dimensions, each with substantive meaning that the analyst specifies before analysis to match theoretical concepts. We offer an R package and step-by-step instructions in its use, via an application to survey data.
Archaeological investigations carried out over more than a decade in advance of mineral extraction revealed a very low volume of archaeological features. Eight pits formed a small cluster, with one outlier to the south and a notable lack of features in the whole remaining area of the site, with the exception of two small, undated pits by the western limit of the area. The pit cluster contained a surprisingly dense group and range of finds and two radiocarbon dates confirm that it represents a relatively short-lived use of the site in the eighth or seventh century BC. An especially concentrated deposit of pottery vessels in particular suggests the filling of the pits was the result of feasting. As is often observed, there were no associated structural remains to indicate permanent settlement and it may be that some symbolic occasion was being celebrated in a one-off event. A linear ditch previously revealed in the quarry can now be seen to be at least 520 m long and may be a significant territorial boundary on the ridge: it seems to date to the Middle Iron Age.
Thames Valley Archaeological Services (TVAS) is undertaking a long-running archaeological recording action in advance of mineral extraction at the c.19 ha Chinham Farm Extension of Bowling Green Farm Quarry, Faringdon (SU 3155 9475) (Fig. 1). The work overall extended from May 2007 to September 2020. The results of the first seven years of the project (Phases 1–3, covering around 7.7 ha) were published in advance of completion of the rest, as there was then an interval of several years, and this report presents the results from the most recent seasons of the archaeological work (Phases 4 to 6, 2017–2020), covering a further 3.35 ha.
The site is between the market town of Faringdon and the village of Stanford-in-the-Vale in the south-west of Oxfordshire, on the northern side of the A417 (Fig. 1). It is located on the Corallian Ridge, with the top of the ridge locally at a height of c.103 m above OD sloping gradually down from south to north to the Frogmore Brook at c.95 m above OD. The underlying geology at the high point in the south is Stanford (Jurassic) Limestone, with alluvial clay, sand, gravel and sandstone silts filling on the valley edges to the north.
There are two reasons why the funeral speech of Demosthenes has largely been ignored by ancient historians. The first reason is that it has always been judged as less important than the great funeral speeches of Pericles, Lysias and Hyperides. The second is that many ancient historians have thought it unworthy of Demosthenes in terms of content and style. The lack of sustained research on this funeral speech is thus unsurprising. This speech, however, is of considerable historical interest. Demosthenes, like other funeral orators, may have manipulated the genre’s commonplaces, but his speech is the only example of the surviving ones that had to react to a crushing Athenian defeat. In this situation, evoking the glorious past, which was a mainstay of the genre, seemed inappropriate. This chapter discusses the historical context of this neglected work and compares its lines of argumentation with those of other funeral speeches. It attempts to explain why Demosthenes delivered the funeral speech of 338 at all and why he said what he did.
A striking feature of old comedy is its cannibalising of contemporaneous Athenian literature. The comic poets integrated the funeral oration into their comedies in three ways. Their first way was to bring on stage the funeral oration’s ancestors. Aristophanes characterised his choruses as such in three of his surviving plays. When these ancestors came to praise their own military exploits, they used the same terms as the funeral speeches and privileged the same historical period: the Persian Wars. Aristophanes clearly used this characterisation of the chorus for the sake of persuasion. By having these proud old men support the effort of a comic protagonist to bring peace, he defused the criticism that this effort went against the martial reputation of the Athenian people. The second way in which old comedy integrated the funeral oration was to warn theatregoers about the general dangers of praise. While Aristophanes sometimes quoted praise from dithyrambs as an example of what public speakers said in order to deceive the people, at other times, Aristophanes quoted from funeral speeches. The third way in which comedy engaged with the funeral oration was the deliberate confounding of the epitaphic genre’s characterisation of the Athenians as selfless and courageous.
This national pre-pandemic survey compared demand and capacity of adult community eating disorder services (ACEDS) with NHS England (NHSE) commissioning guidance.
Results
Thirteen services in England and Scotland responded (covering 10.7 million population). Between 2016–2017 and 2019–2020 mean referral rates increased by 18.8%, from 378 to 449/million population. Only 3.7% of referrals were from child and adolescent eating disorder services (CEDS-CYP), but 46% of patients were aged 18–25 and 54% were aged >25. Most ACEDS had waiting lists and rationed access. Many could not provide full medical monitoring, adapt treatment for comorbidities, offer assertive outreach or provide seamless transitions. For patient volume, the ACEDS workforce budget was 15%, compared with the NHSE workforce calculator recommendations for CEDS-CYP. Parity required £7 million investment/million population for the ACEDS.
Clinical implications
This study highlights the severe pressure in ACEDS, which has increased since the COVID-19 pandemic. Substantial investment is required to ensure NHS ACEDS meet national guidance, offer evidence-based treatment, reduce risk and preventable deaths, and achieve parity with CEDS-CYP.
Neuroleptic Malignant Syndrome (NMS) is a rare, life-threatening complication of antipsychotic medication. There are no gold standard tests to diagnose NMS, however various diagnostic criteria have been suggested. NMS is typically reported in patients who have recently commenced an antipsychotic or had a change in dose. This case report describes an elderly female who developed NMS after being treated with the same dose of antipsychotic for 7 years. We aimed to establish whether similar cases are commonly reported, and what the key learning outcomes are.
Methods
This case presents an 82-year-old female taking the same dose of zuclopenthixol for 7 years. She was admitted with increased confusion and was initially prescribed antibiotics for a possible infection. She later became pyrexial and developed hypertonia, at which point NMS was suspected. Her creatinine kinase titre was significantly elevated, and her antipsychotic was discontinued. A potential trigger was a significant rectal bleed occurring a few weeks prior with no other obvious triggers noted. She was switched to quetiapine but developed NMS again when this dose was increased.
Results
There are few reports of NMS occurring in patients taking a long-term and stable antipsychotic dose. One case describes NMS developing after 30 years on Clozapine with no clear trigger. Another reports NMS after 7 years on Olanzapine, however this was triggered by dehydration. This case is an example of NMS in an elderly patient with a complex medical history who was initially misdiagnosed with sepsis before NMS was suspected. This shows the importance of considering NMS not only in those who have recently commenced antipsychotics or recently changed dose, but also those who have been stable on medication for a number of years. In suspected NMS, we should aim to stop relevant medication immediately and commence conservative management. It is important to highlight these atypical presentations so that NMS can be recognised without delaying treatment, thereby reducing mortality and improving patient outcomes
Conclusion
This report highlights the importance of considering NMS in patients who have been prescribed the same dose of antipsychotic for an extended period. Awareness of potential risk factors such as medical comorbidity that may trigger an episode of NMS even in those on established antipsychotic treatment is vital. Symptoms may mimic infection and it is important to raise awareness of atypical presentations to effectively identify, and treat, NMS earlier to improve outcomes.
OBJECTIVES/GOALS: Silicosis is a highly fatal progressive fibrotic disease of the lungs characterized by accumulation and persistence of fibroblasts that excessively deposit Collagen1a1. We sought to eliminate Collagen1a1-expressing fibroblasts through a targeted genetic ablation strategy and hypothesized that this would arrest the progression of Silicosis. METHODS/STUDY POPULATION: Silicosis was induced with a single intratracheal (i.t.) instillation of silica particles ( RESULTS/ANTICIPATED RESULTS: Targeted ablation of Col1a1+ fibroblast in established Silicosis resulted in a decrease in: 1) Col1a1+ fibroblasts by flow cytometry and within fibrotic nodules by immunofluorescent staining, 2) total lung collagen content by histology and hydroxyproline assay, 3) tissue-associated disease by microCT and an increase in arterial oxygen saturation by pulse oximetry. Cessation of targeted Col1a1+ fibroblast ablation resulted in a rebound effect in Silicosis disease progression. Following ablation, Col1a1+ fibroblasts expanded by proliferation (Ki67+) and total lung collagen levels returned to pre-ablation levels. DISCUSSION/SIGNIFICANCE: Silicosis is a often fatal disease with no FDA approved therapies. These results suggest that targeted loss of Col1a1+ fibroblasts in Silicosis is sufficient to arrest disease progression. Thus, it is essential to understand how targeted loss of pro-fibrotic fibroblasts can alter disease progression as a tool to develop novel therapeutic strategies.
Twenty years ago the first publications began to appear in Argentina of a loosely confederated group of writers, leftist in political persuasion, who took strident exception in culture to both the old oligarchic tradition and to the parvenu peronista establishment. During the years of the peronista government, the writers and intellectuals who supported Perón had been successful in imposing their own persuasions on the universities and publishing media at the expense of the old guard, represented by the literary supplements, Sur, the Academia Argentina de Letras, and the Jockey Club. The young leftists born around 1920 had been snubbed by the old-time writers and persecuted by the peronista regime. Their emergence as a loosely unified assertion of leftist political and cultural values, supported by a similar affirmation in postwar Europe, is a major literary phenomenon in mid-century Argentia.
It was inevitable that after the demise of the series of military dictatorships that ruled Argentina so violently between 1976 and 1983, the return to democratic institutions would occasion an outpouring of the kinds of writing and cultural activities banned or censored by the generals. Movie distributors in Argentina today cannot keep up with the demand for films that could not be seen during these years (or were seen only with extensive and capricious cuts). Theaters are competing with each other to present works dealing with human rights violations and related themes. Television programming, which the military assiduously controlled, has now begun to evince some social consciousness. Meanwhile, the print media have filled bookstores and kiosks with myriad publications bearing witness to the attempt to recover a cultural tradition altered and fragmented by the so-called Proceso de Reorganización Nacional.
Numerical estimators of differential entropy and mutual information can be slow to converge as sample size increases. The offset Kozachenko–Leonenko (KLo) method described here implements an offset version of the Kozachenko–Leonenko estimator that can markedly improve convergence. Its use is illustrated in applications to the comparison of trivariate data from successive scene color images and the comparison of univariate data from stereophonic music tracks. Publicly available code for KLo estimation of both differential entropy and mutual information is provided for R, Python, and MATLAB computing environments at https://github.com/imarinfr/klo.
Protected areas have numerous roles (such as biodiversity preservation, the development of scientific research and the sustainable use of natural resources), but they are under threat from political and economic forces. The 837 000-ha Serra do Divisor National Park (SDNP) in the south-western Brazilian Amazon combines the conservation of natural resources and the maintenance of the productive activities of c. 400 resident families. The Brazilian and Peruvian governments have proposed a road linking Acre (Brazil) to Ucayali (Peru) that would bisect the SDNP. Another threat to the SDNP is a bill proposing its downgrading to an ‘environmental protection area’. This study aims to map the land cover of the SDNP and its surroundings from 1988 to 2018 and to analyse the dynamics of land-use change. Analysis of Landsat satellite images with supervised classification using the MaxVer algorithm show that, during the 30-year period, pasture showed the highest absolute land-cover gain, with 1986 ha in the interior and 7661 ha along the periphery of the SDNP. Only 1% of the park’s primary forest was lost by 2018, but the proposed road and potential downgrading may result in accelerated deforestation and forest degradation in the near future.
Pompe disease results from lysosomal acid α-glucosidase deficiency, which leads to cardiomyopathy in all infantile-onset and occasional late-onset patients. Cardiac assessment is important for its diagnosis and management. This article presents unpublished cardiac findings, concomitant medications, and cardiac efficacy and safety outcomes from the ADVANCE study; trajectories of patients with abnormal left ventricular mass z score at enrolment; and post hoc analyses of on-treatment left ventricular mass and systolic blood pressure z scores by disease phenotype, GAA genotype, and “fraction of life” (defined as the fraction of life on pre-study 160 L production-scale alglucosidase alfa). ADVANCE evaluated 52 weeks’ treatment with 4000 L production-scale alglucosidase alfa in ≥1-year-old United States of America patients with Pompe disease previously receiving 160 L production-scale alglucosidase alfa. M-mode echocardiography and 12-lead electrocardiography were performed at enrolment and Week 52. Sixty-seven patients had complete left ventricular mass z scores, decreasing at Week 52 (infantile-onset patients, change −0.8 ± 1.83; 95% confidence interval −1.3 to −0.2; all patients, change −0.5 ± 1.71; 95% confidence interval −1.0 to −0.1). Patients with “fraction of life” <0.79 had left ventricular mass z score decreasing (enrolment: +0.1 ± 3.0; Week 52: −1.1 ± 2.0); those with “fraction of life” ≥0.79 remained stable (enrolment: −0.9 ± 1.5; Week 52: −0.9 ± 1.4). Systolic blood pressure z scores were stable from enrolment to Week 52, and no cohort developed systemic hypertension. Eight patients had Wolff–Parkinson–White syndrome. Cardiac hypertrophy and dysrhythmia in ADVANCE patients at or before enrolment were typical of Pompe disease. Four-thousand L alglucosidase alfa therapy maintained fractional shortening, left ventricular posterior and septal end-diastolic thicknesses, and improved left ventricular mass z score.
Social Media Statement: Post hoc analyses of the ADVANCE study cohort of 113 children support ongoing cardiac monitoring and concomitant management of children with Pompe disease on long-term alglucosidase alfa to functionally improve cardiomyopathy and/or dysrhythmia.
Coronavirus disease 2019 (COVID-19) vaccination effectiveness in healthcare personnel (HCP) has been established. However, questions remain regarding its performance in high-risk healthcare occupations and work locations. We describe the effect of a COVID-19 HCP vaccination campaign on SARS-CoV-2 infection by timing of vaccination, job type, and work location.
Methods:
We conducted a retrospective review of COVID-19 vaccination acceptance, incidence of postvaccination COVID-19, hospitalization, and mortality among 16,156 faculty, students, and staff at a large academic medical center. Data were collected 8 weeks prior to the start of phase 1a vaccination of frontline employees and ended 11 weeks after campaign onset.
Results:
The COVID-19 incidence rate among HCP at our institution decreased from 3.2% during the 8 weeks prior to the start of vaccinations to 0.38% by 4 weeks after campaign initiation. COVID-19 risk was reduced among individuals who received a single vaccination (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.40–0.68; P < .0001) and was further reduced with 2 doses of vaccine (HR, 0.17; 95% CI, 0.09–0.32; P < .0001). By 2 weeks after the second dose, the observed case positivity rate was 0.04%. Among phase 1a HCP, we observed a lower risk of COVID-19 among physicians and a trend toward higher risk for respiratory therapists independent of vaccination status. Rates of infection were similar in a subgroup of nurses when examined by work location.
Conclusions:
Our findings show the real-world effectiveness of COVID-19 vaccination in HCP. Despite these encouraging results, unvaccinated HCP remain at an elevated risk of infection, highlighting the need for targeted outreach to combat vaccine hesitancy.
An open-label extension study (NCT02873208) evaluated the long-term tolerability, safety, and efficacy of combination olanzapine/samidorphan (OLZ/SAM) treatment in patients with schizophrenia. This qualitative sub study explored perceptions of benefit, burden, and satisfaction with previous medications and OLZ/SAM.
Methods
Semi-structured interviews (60 minutes; audio-recorded) were conducted. Interviewer sensitivity training, senior interviewer oversight, and a list of common medications to aid recall supported data collection. Interview transcripts were content coded and analyzed (NVivo v11.0).
Results
All 41 patients reported a lifetime burden with schizophrenia adversely impacting employment, relationships, emotional health, social activities, and daily tasks. Hospitalization for schizophrenia management was another reported aspect of disease burden. Although most (n=32) patients reported previous medication benefits, side effects affecting physical, emotional/behavioral, and cognitive functioning were reported by all (n=41). Following OLZ/SAM treatment, 39/41 patients (95%) reported improvements in symptoms including hallucinations, paranoia, depression, sleep, and concentration. Furthermore, patients described improvements in self-esteem, social activities, relationships, and daily activities. Twenty-three patients (56%) reported side effects attributed to OLZ/SAM; lack of energy (n=12 [29%]) and dry mouth (n= 5 [12%]) were most common. Twenty-four (59%) patients were “very satisfied” with OLZ/SAM; most (n=35 [85%]) preferred to continue OLZ/SAM vs switching to another medication. As most substudy patients (n=40; 98%) completed the extension study, satisfied patients may be overrepresented in this analysis.
Conclusion
This qualitative interview approach provided valuable insight into patients’ experiences with previous medications and OLZ/SAM. Overall, most patients reported treatment satisfaction and improvements in symptoms, function, and health-related quality of life with OLZ/SAM.
The steep rise in the rate of psychiatric hospital detentions in England is poorly understood.
Aims
To identify explanations for the rise in detentions in England since 1983; to test their plausibility and support from evidence; to develop an explanatory model for the rise in detentions.
Method
Hypotheses to explain the rise in detentions were identified from previous literature and stakeholder consultation. We explored associations between national indicators for potential explanatory variables and detention rates in an ecological study. Relevant research was scoped and the plausibility of each hypothesis was rated. Finally, a logic model was developed to illustrate likely contributory factors and pathways to the increase in detentions.
Results
Seventeen hypotheses related to social, service, legal and data-quality factors. Hypotheses supported by available evidence were: changes in legal approaches to patients without decision-making capacity but not actively objecting to admission; demographic changes; increasing psychiatric morbidity. Reductions in the availability or quality of community mental health services and changes in police practice may have contributed to the rise in detentions. Hypothesised factors not supported by evidence were: changes in community crisis care, compulsory community treatment and prescribing practice. Evidence was ambiguous or lacking for other explanations, including the impact of austerity measures and reductions in National Health Service in-patient bed numbers.
Conclusions
Better data are needed about the characteristics and service contexts of those detained. Our logic model highlights likely contributory factors to the rise in detentions in England, priorities for future research and potential policy targets for reducing detentions.
Reconstructions of prehistoric vegetation composition help establish natural baselines, variability, and trajectories of forest dynamics before and during the emergence of intensive anthropogenic land use. Pollen–vegetation models (PVMs) enable such reconstructions from fossil pollen assemblages using process-based representations of taxon-specific pollen production and dispersal. However, several PVMs and variants now exist, and the sensitivity of vegetation inferences to PVM selection, variant, and calibration domain is poorly understood. Here, we compare the reconstructions, parameter estimates, and structure of a Bayesian hierarchical PVM, STEPPS, both to observations and to REVEALS, a widely used PVM, for the pre–Euro-American settlement-era vegetation in the northeastern United States (NEUS). We also compare NEUS-based STEPPS parameter estimates to those for the upper midwestern United States (UMW). Both PVMs predict the observed macroscale patterns of vegetation composition in the NEUS; however, reconstructions of minor taxa are less accurate and predictions for some taxa differ between PVMs. These differences can be attributed to intermodel differences in structure and parameter estimates. Estimates of pollen productivity from STEPPS broadly agree with estimates produced for use in REVEALS, while comparison between pollen dispersal parameter estimates shows no significant relationship. STEPPS parameter estimates are similar between the UMW and NEUS, suggesting that STEPPS parameter estimates are transferable between floristically similar regions and scales.