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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.
OBJECTIVES/GOALS: Early HIV detection and treatment are key to reducing patient morbidity and mortality, yet 40% of people living with HIV do not know their status. “OPT-OUT” approaches to hiv testing, in which patients #_MSOCOM_1 are informed that an HIV test will be conducted unless they decline, are being increasingly recognized as a means to increase HIV testing. METHODS/STUDY POPULATION: the ed at Uhealth tower (UHT) implemented #_MSOCOM_1 the focus program that integrates routine “opt-out” HIV screening into the existing electronic medical record workflow to increase the number of individuals who know their HIV status, optimize linkage to care, and reduce stigma associated with HIV. the emr facilitates the opt-out screening model and maximizes the use of information systems to seamlessly integrate screening as a routine practice in a high-volume ed. our partnership with the florida department of health in miami dade (FDOH) allows uht to verify whether cases are new or known /out-of-care, link individuals immediately to care, and increase efficiencies with real-time data reconciliation. RESULTS/ANTICIPATED RESULTS: since implementation#_MSOCOM_1, from October 2019 - Dec 2022, the UHT ED screened 34, 314 eligible patients for HIV, of which, 17, 850 were tested. 228 people with hiv were identified; 37 were newly diagnosed. of HIV+ Diagnoses, 54.67% of HIV+ individuals were black and 36.89% HISPANIC. HIV+ individuals were referred to the doh with linkage to care at 81%. comparatively, before the onset of focus, the ED ordered 38 HIV tests, with one positive from Oct 2018 TO Sept. 2019. DISCUSSION/SIGNIFICANCE: UHT ED’s focus “OPT-OUT” HIV testing is a valuable conduit for HIV detection, prevention, and care. OPT-OUT screening removes the stigma associated with hiv testing, fosters earlier diagnoses and treatment, reduces health disparities, and decreases the risk of transmission.
Regulating war has long been a concern of the international community. From the Hague Conventions to the Geneva Conventions and the multiple treaties and related institutions that have emerged in the twentieth and twenty-first centuries, efforts to mitigate the horrors of war have focused on regulating weapons, defining combatants, and ensuring access to the battlefield for humanitarians. But regulation and legal codes alone cannot be the end point of an engaged ethical response to new weapons developments. This short essay reviews some of the existing ethical works on lethal autonomous weapon systems (LAWS), highlighting how rule- and consequence-based accounts fail to provide adequate guidance for how to deal with them. I propose a virtue-based account, which I link up with an Aristotelian framework, for how the international community might better address these weapons systems.
To assess the relative risk of hospital-onset Clostridioides difficile (HO-CDI) during each month of the early coronavirus disease 2019 (COVID-19) pandemic and to compare it with historical expectation based on patient characteristics.
Design:
This study used a retrospective cohort design. We collected secondary data from the institution’s electronic health record (EHR).
Setting:
The Ohio State University Wexner Medical Center, Ohio, a large tertiary healthcare system in the Midwest.
Patients or participants:
All adult patients admitted to the inpatient setting between January 2018 and May 2021 were eligible for the study. Prisoners, children, individuals presenting with Clostridioides difficile on admission, and patients with <4 days of inpatient stay were excluded from the study.
Results:
After controlling for patient characteristics, the observed numbers of HO-CDI cases were not significantly different than expected. However, during 3 months of the pandemic period, the observed numbers of cases were significantly different from what would be expected based on patient characteristics. Of these 3 months, 2 months had more cases than expected and 1 month had fewer.
Conclusions:
Variations in HO-CDI incidence seemed to trend with COVID-19 incidence but were not fully explained by our case mix. Other factors contributing to the variability in HO-CDI incidence beyond listed patient characteristics need to be explored.
In his recently published book Praxis, Friedrich Kratochwil argues that action should be at the centre of our investigations in International Relations (IR). In making that claim, he positions himself against two theoretical starting points: (1) the agent is simply a vessel for structural factors, so ‘causes’ matter more than ‘reasons’; and (2) there is no real agency because of the instability of the subject. One might argue that he is locating a middle ground between positivism (position 1) and post-structuralism (position 2). He does this through an overview of a wide range of themes at the intersection of international politics and international law.
In any work that seeks to recover a praxis-based approach, Aristotle is an obvious figure; indeed, Kratochwil’s subtitle to the book (On Acting and Knowing) comes directly from Aristotle’s two categories of virtues, the practical and the theoretical (Aristotle, 1941: 952). Aristotle has long been in the background and sometimes foreground of Kratochwil’s work. In Praxis, Kratochwil invokes Aristotle a number of times. At the same time, he critiques Aristotle for what Kratochwil argues is the former’s overly theoretical focus at the expense of practical politics. Instead, in Praxis, Kratochwil finds more benefit in the work of David Hume, about whom he has written previously (Kratochwil, 2011a [1981]).
In this chapter, I argue that Aristotle is more beneficial than Kratochwil makes him out to be for understanding the practical dimensions of international law and politics. In particular, I argue that Aristotle provides an alternative understanding of the rule of law and how it relates to the wider international political order, one that differs both from Kratochwil and from contemporary international law. As Kratochwil notes, Aristotle became a reference point for many in the early modern and modern periods in support of a law-governed polity. In recent years, this invocation of the rule of law has become a mantra for advocates of global governance, one that has lost any connection to the political context within which the rule of law might function.
What rules govern the conduct of warfare? Do state and non-state actors conduct themselves in accordance with rules? These are long-standing questions in the study and practice of war. There are, however, some underlying questions that may also be worthy of investigation. How stable are those rules? What foundations do they have? Even more provocatively, are rules the best way to govern the conduct of warfare? Many areas of public life are conducted in terms of rules, yet rules and rule following can become fetishized. Judith Skhlar’s famous critique of law and international criminal law introduced the idea of ‘legalism’, or the use of rules and laws to cover over ideological or political conflicts. Rules guide us through complex situations; at the same time, rules can constrain and limit our ability to respond when those situations change or when a rule simply does not work. In fact, rules can even generate their own forms of violence, especially when yoked to ideas like the national interest.
Nicholas Rengger did not address rules directly in his scholarship. Instead, the idea of rules and law formed a backdrop to many of his critical interventions in world politics. From his studies of order to just war, Rengger engaged with and contested the idea that law and rules alone could structure our political lives. At the same time, as I will argue in this chapter, Rengger did not set aside rules in their entirety, for he understood the necessity of rules in both domestic and international political order more broadly. Instead, Rengger argued for a more casuistic approach to political life. Drawn from ancient and medieval moral and political theory, this idea highlights the importance of the contexts within which rules operate. Rules and laws still play a role, but they cannot be seen as the only way to approach political conflict. As such, the focus of this chapter will be on Rengger as a reluctant rule follower.
The chapter will use Rengger’s writing on just war and violence to orient the argument. The first section sets out his understanding of rules and their relation to political order. Following this, and building upon it, the next section explores his reading of the Just War tradition as found in his book Just War and International Order.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, with its impact on our way of life, is affecting our experiences and mental health. Notably, individuals with mental disorders have been reported to have a higher risk of contracting SARS-CoV-2. Personality traits could represent an important determinant of preventative health behaviour and, therefore, the risk of contracting the virus.
Aims
We examined overlapping genetic underpinnings between major psychiatric disorders, personality traits and susceptibility to SARS-CoV-2 infection.
Method
Linkage disequilibrium score regression was used to explore the genetic correlations of coronavirus disease 2019 (COVID-19) susceptibility with psychiatric disorders and personality traits based on data from the largest available respective genome-wide association studies (GWAS). In two cohorts (the PsyCourse (n = 1346) and the HeiDE (n = 3266) study), polygenic risk scores were used to analyse if a genetic association between, psychiatric disorders, personality traits and COVID-19 susceptibility exists in individual-level data.
Results
We observed no significant genetic correlations of COVID-19 susceptibility with psychiatric disorders. For personality traits, there was a significant genetic correlation for COVID-19 susceptibility with extraversion (P = 1.47 × 10−5; genetic correlation 0.284). Yet, this was not reflected in individual-level data from the PsyCourse and HeiDE studies.
Conclusions
We identified no significant correlation between genetic risk factors for severe psychiatric disorders and genetic risk for COVID-19 susceptibility. Among the personality traits, extraversion showed evidence for a positive genetic association with COVID-19 susceptibility, in one but not in another setting. Overall, these findings highlight a complex contribution of genetic and non-genetic components in the interaction between COVID-19 susceptibility and personality traits or mental disorders.
This article argues that this special section reveals a practical global constitutionalism, or one that integrates a liberal constitutional set of ideas with the histories and practices of Asian states.
A laboratory intercomparison project was carried out on 20 annually resolved late-wood samples from the Danish oak record. The project included the following three laboratories: (1) the University of Arizona AMS Laboratory, University of Arizona, USA (AA); (2) HEKAL AMS Laboratory, MTA Atomki, Hungary (DeA); and (3) Aarhus AMS Centre (AARAMS), Aarhus University, Denmark (AAR). The large majority of individual data points (96%) lie within ±2σ of the weighted mean. Further assessment of the accuracy associated with the individual laboratories showed good agreement, indicating that consistent and reliable 14C measurements well in agreement with each other are produced at the three laboratories. However, the quoted analytical uncertainties appear to be underestimated when compared to the observed variance of differences from the geometric mean of the samples. This study provides a general quality check of the single-year tree-ring 14C measurements that are included in the new calibration curve.
In clinical practice, differentiating Bipolar Disorder (BD) from unipolar depression is challenging due to the depressive symptoms, which are the core presentations of both disorders. Patients with BD are often misdiagnosed during depressive episodes resulting in a delay in proper treatment and a poor management of their condition.
Objectives
The aim of the present study is to discriminate between unipolar depression and BD using a panel of RNA edited blood biomarkers.
Methods
Depressed patients were classified according to clinical scores in MADRS and IDSC-30 depression scales. After blood collection and RNA extraction, we used whole-transcriptome sequencing to identify differential A-to-I editing events, and Targeted Next Generation Sequencing to validate those biomarkers.
Results
We discovered 646 variants differentially edited between depressed patients and control in a discovery cohort of 57 participants. After using stringent criteria and biological pathway analysis, 6 biomarker candidates were singled out and tested in a validation cohort of 160 patients suffering from unipolar depression and 95 BD patients in a depressive episode, which allowed a differential diagnosis of BD with an AUC of 0.935 and high specificity (Sp=84.6%) and sensitivity (Se=90.9%).
Conclusions
We have shown that a combination of 6 blood RNA editing-related biomarkers allows to discriminate unipolar and bipolar depression This 6 BMKs panel may be crucial to improve BD diagnosis and orientate the treatment therefore addressing the needs of millions of patients suffering from misdiagnosis and incorrect treatment for their diseases. This will change the game for the management of patients.
The aim of this study was to identify factors associated with distress experienced by physicians during their first coronavirus disease 2019 (COVID-19) triage decisions.
Methods:
An online survey was administered to physicians licensed in New York State.
Results:
Of the 164 physicians studied, 20.7% experienced severe distress during their first COVID-19 triage decisions. The mean distress score was not significantly different between physicians who received just-in-time training and those who did not (6.0 ± 2.7 vs 6.2 ± 2.8; P = 0.550) and between physicians who received clinical guidelines and those who did not (6.0 ± 2.9 vs 6.2 ± 2.7; P = 0.820). Substantially increased odds of severe distress were found in physicians who reported that their first COVID-19 triage decisions were inconsistent with their core values (adjusted odds ratio, 6.33; 95% confidence interval, 2.03-19.76) and who reported having insufficient skills and expertise (adjusted odds ratio 2.99, 95% confidence interval 0.91-9.87).
Conclusion:
Approximately 1 in 5 physicians in New York experienced severe distress during their first COVID-19 triage decisions. Physicians with insufficient skills and expertise, and core values misaligned to triage decisions are at heightened risk of experiencing severe distress. Just-in-time training and clinical guidelines do not appear to alleviate distress experienced by physicians during their first COVID-19 triage decisions.
Concerns have emerged regarding infection transmission during flexible nasoendoscopy.
Methods
Information was gathered prospectively on flexible nasoendoscopy procedures performed between March and June 2020. Patients and healthcare workers were followed up to assess for coronavirus disease 2019 development. One-sided 97.5 per cent Poisson confidence intervals were calculated for upper limits of risk where zero events were observed.
Results
A total of 286 patients were recruited. The most common indication for flexible nasoendoscopy was investigation of ‘red flag’ symptoms (67 per cent). Forty-seven patients (16 per cent, 95 per cent confidence interval = 13–21 per cent) had suspicious findings on flexible nasoendoscopy requiring further investigation. Twenty patients (7.1 per cent, 95 per cent confidence interval = 4.4–11 per cent) had new cancer diagnoses. Zero coronavirus disease 2019 infections were recorded in the 273 patients. No. 27 endoscopists (the doctors and nurses who carried out the procedures) were followed up.The risk of developing coronavirus disease 2019 after flexible nasoendoscopy was determined to be 0–1.3 per cent.
Conclusion
The risk of coronavirus disease 2019 transmission associated with performing flexible nasoendoscopy in asymptomatic patients, while using appropriate personal protective equipment, is very low. Additional data are required to confirm these findings in the setting of further disease surges.
The international legal and institutional structure around climate change ascertains that the responsibility to react to the phenomena lies predominantly with states. Although states play a vital part in addressing climate change, these structural constrains leaves limited room for alternative actors to take action to react to the problem. This chapter proposes looking at responsibility in world affairs as a political concept; a political concept that reconstitutes norms, practices, and actions in a manner that advances new ways to mitigate climate change. Drawing on Hannah Arendt’s conceptualisation of political responsibility, and the activism of non-state and substate within the UNFCCC, we suggest that political responsibility gives agency and space for different actors within the international community to engage in practices that help advance the climate change agenda. This, we further suggest, constructs a common community in which various actors undertake political action in order to influence policymaking.
This essay explores the possibility of universal values. Universal values do not exist as Platonic ideals nor do they exist in clearly defined lists of rules or laws. Rather, universal ethical claims are constructed through the actions of individual political leaders, scholars, and activists. This essay explores how such normative constructions take place. It uses an initiative undertaken by the UN Office of Drugs and Crime to further education around corruption as an example of how such universal values come into existence. The initiative focused on developing teaching materials for higher education. The essay focuses on two particular modules, both their content and the process by which they were written.
The radiocarbon (14C) calibration curve so far contains annually resolved data only for a short period of time. With accelerator mass spectrometry (AMS) matching the precision of decay counting, it is now possible to efficiently produce large datasets of annual resolution for calibration purposes using small amounts of wood. The radiocarbon intercomparison on single-year tree-ring samples presented here is the first to investigate specifically possible offsets between AMS laboratories at high precision. The results show that AMS laboratories are capable of measuring samples of Holocene age with an accuracy and precision that is comparable or even goes beyond what is possible with decay counting, even though they require a thousand times less wood. It also shows that not all AMS laboratories always produce results that are consistent with their stated uncertainties. The long-term benefits of studies of this kind are more accurate radiocarbon measurements with, in the future, better quantified uncertainties.
Humanitarian intervention, while controversial, has become more acceptable as a reason for using military force in the last twenty years. But humanitarian intervention may be giving way to a related, yet distinct, form of intervention. This new form of intervention is characterised by a desire to punish wrongdoers, whether they are individual leaders or whole states, a phenomenon I call punitive intervention. Punitive intervention can be defined as the use of military force across national boundaries to alter the internal affairs of a state that has violated international law or other widely recognised international norms. A punitive intervention aims to deter future violations, to rehabilitate the offending state (usually by replacing its government), or to exact retribution.
US interventions in Panama (1989), Haiti (1994) and Somalia, especially to capture Mohammed Farah Aideed (1993), could be called punitive, as could the use of air power in Libya (1986) and Iraq (1993, 1998). The ongoing Russian intervention in Chechnya has a punitive dimension. The belated French intervention in Rwanda (1994) had punitive aspects. The NATO intervention in the former Yugoslavia has generated debate over whether or not the major powers should be in the business of capturing war criminals. The use of coercive air power by NATO against Serbia in 1999 sought to halt the violations of Albanian human rights but also to punish those responsible, particularly Slobodan Milosevic. The Israeli incursions into Lebanon (1982, 1996), like its campaigns since 2000 in the occupied territories, were partly designed to punish those who threaten Israeli security. The calls for intervention in Liberia in 2003 were in part humanitarian, but there was also an underlying desire to capture and punish President Charles Taylor. Finally, the US interventions in Afghanistan and Iraq following the attacks of 11 September 2001 have been couched largely in terms of punishing the states that allowed terrorists to operate on their territory and capturing those directly responsible. Indeed, the war on terrorism, which the Bush administration argues will be a long-term conflict, is punitive as well as preventive.
This use of military force to punish reflects an important normative shift in the international system. International law prohibits the use of force to punish; indeed, the concept of punishment is largely absent from international law.
Introduction: Each year, 3/1000 Canadians sustain a mild traumatic brain injury (mTBI). Many of those mTBI are accompanied by various co-injuries such as dislocations, sprains, fractures or internal injuries. A number of those patients, with or without co-injuries will suffer from persistent post-concussive symptoms (PPCS) more than 90 days post injury. However, little is known about the impact of co-injuries on mTBI outcome. This study aims to describe the impact of co-injuries on PPCS and on patient return to normal activities. Methods: This multicenter prospective cohort study took place in seven large Canadian Emergency Departments (ED). Inclusion criteria: patients aged ≥ 14 who had a documented mTBI that occurred within 24 hours of ED visit, with a Glasgow Coma Scale score of 13-15. Patients who were admitted following their ED visit or unable to consent were excluded. Clinical and sociodemographic information was collected during the initial ED visit. A research nurse then conducted three follow-up phone interviews at 7, 30 and 90 days post-injury, in which they assessed symptom evolution using the validated Rivermead Post-concussion Symptoms Questionnaire (RPQ). Adjusted risk ratios (RR) were calculated to estimate the influence of co-injuries. Results: A total of 1674 patients were included, of which 1023 (61.1%) had at least one co-injury. At 90 days, patients with co-injuries seemed to be at higher risk of having 3 symptoms ≥2 points according to the RPQ (RR: 1.28 95% CI 1.02-1.61) and of experiencing the following symptoms: dizziness (RR: 1.50 95% CI 1.03-2.20), fatigue (RR: 1.35 95% CI 1.05-1.74), headaches (RR: 1.53 95% CI 1.10-2.13), taking longer to think (RR: 1.50 95% CI 1.07-2.11) and feeling frustrated (RR: 1.45 95% CI 1.01-2.07). We also observed that patients with co-injuries were at higher risk of non-return to their normal activities (RR: 2.31 95% CI 1.37-3.90). Conclusion: Patients with co-injuries could be at higher risk of suffering from specific symptoms at 90 days post-injury and to be unable to return to normal activities 90 days post-injury. A better understanding of the impact of co-injuries on mTBI could improve patient management. However, further research is needed to determine if the differences shown in this study are due to the impact of co-injuries on mTBI recovery or to the co-injuries themselves.