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Darwin’s theory, in its uniformitarianism, its materialism, and its elimination of all metaphysical explanations and any element of intelligent agency from the world’s biological phenomena has been taken as an important influence in the growth of the idea that all living creatures are automata – more or less “conscious machines.” Darwin himself, in a least four different aspects of his writing, belies this inference from his theories: the metaphorical work done by his dominant idea – natural selection; his anthropomorphism; his views on instinct; and his theory of sexual selection.
The Cambridge Cognitive Examination for Down's Syndrome (CAMCOG-DS) was developed to assess cognitive functioning and dementia-related cognitive decline in people with Down's Syndrome (DS). It has been translated into different languages and is often used in international studies. Although adapted for people with intellectual disabilities (ID), many tasks involve verbal responses and instructions are presented orally. Therefore, the administration for people with severe language deficits can be challenging. The aim of this retrospective data analysis is to examine the influence of language ability and reasoning on CAMCOG-DS performance. Study 1 examined the relationship between CAMCOG-DS, picture naming, single word comprehension and reasoning in adults with DS. Study 2 replicates and broadens the findings in a sample of children and adults with DS.
Participants and Methods:
Study 1 included 40 adults with DS between 18 and 51 years (M = 28.6, SD = 8.4). 25 had a mild and 15 a moderate ID. CAMCOG-DS, the short form of the Boston Naming test (BNT), a test for single word comprehension from the Werdenfelser Testbatterie (WTB) and the Colored Progressive Matrices (CPM) were administered. Study 2 included 38 participants between 8 and 59 years (23 children, M = 11.4; 15 adults; M = 31.3). 3 had a borderline, 23 a mild, and 12 a moderate ID. The same tasks as in Study 1 were applied, but the CPM was replaced by its successor, the Raven's 2.
Results:
In Study 1, participants with mild ID performed better in all tasks than those with moderate ID (p < .05). Moderate relationships were found between CAMCOG-DS total score and the language tasks (r = .56 and r = .46), which remained significant when level of ID was controlled for. There was also a moderate relationship between CAMCOG-DS and reasoning (r = .46). Regression analysis showed that BNT performance predicted CAMCOG-DS performance (R2 = .31). In Study 2, those with mild ID, compared to those with moderate ID, performed better in all tasks (p < .05), however, regarding the CAMCOG-DS and language tasks, this effect was larger in adults than in children. Adults performed better than children in the CAMCOG-DS and BNT (p < .05), but not in single word comprehension or reasoning. As in Study 1, moderate to large correlations were revealed between CAMCOG-DS and language tasks and between CAMCOG-DS and reasoning (r > .52), remaining significant when age and ID level were controlled for. Regression analysis showed that both naming and reasoning but not single word comprehension or age predicted CAMCOG-DS performance (R2 = .69), however, performance was best predicted by naming (R2 = .65).
Conclusions:
Our results suggest that language ability and reasoning relate to CAMCOG-DS performance, which is best predicted by BNT picture naming. This should be considered in CAMCOG-DS interpretation, as the capabilities of patients with lesser language ability might be underestimated. Future developments of dementia assessments for people with ID should include more nonverbal tasks.
This series focuses on the legacy of several iconic figures, and key themes, in the origins and development of literary theory. Each book in the series attempts to isolate the influence, legacy and the impact of thinkers. Each figure addressed not only bequeathed specific concepts and doctrines to literary study, but they effectively opened up new critical landscapes for research. It is this legacy that this series tries to capture, with every book being designed specifically for use in literature departments. Throughout each book the concept of ‘After’ is used in 3 ways: After in the sense of trying to define what is quintessential about each figure: ‘What has each figure introduced into the world of literary studies, criticism and interpretation?’ After in a purely chronological sense: ‘What comes after each figure?’, ‘What has his/her influence and legacy been?’ and ‘How have they changed the landscape of literary studies?’ Lastly, After in a practical sense: ‘How have their respective critical legacies impacted on an understanding of literary texts?’ Each book is a collaborative volume with an international cast of critics and their level is suited for recommended reading on courses.
To reduce inappropriate antibiotic prescribing for acute respiratory infections (ARIs) by employing peer comparison with behavioral feedback in the emergency department (ED).
Design:
A controlled before-and-after study.
Setting:
The study was conducted in 5 adult EDs at teaching and community hospitals in a health system.
Patients:
Adults presenting to the ED with a respiratory condition diagnosis code. Hospitalized patients and those with a diagnosis code for a non-respiratory condition for which antibiotics are or may be warranted were excluded.
Interventions:
After a baseline period from January 2016 to March 2018, 3 EDs implemented a feedback intervention with peer comparison between April 2018 and December 2019 for attending physicians. Also, 2 EDs in the health system served as controls. Using interrupted time series analysis, the inappropriate ARI prescribing rate was calculated as the proportion of antibiotic-inappropriate ARI encounters with a prescription. Prescribing rates were also evaluated for all ARIs. Attending physicians at intervention sites received biannual e-mails with their inappropriate prescribing rate and had access to a dashboard that was updated daily showing their performance relative to their peers.
Results:
Among 28,544 ARI encounters, the inappropriate prescribing rate remained stable at the control EDs between the 2 periods (23.0% and 23.8%). At the intervention sites, the inappropriate prescribing rate decreased significantly from 22.0% to 15.2%. Between periods, the overall ARI prescribing rate was 38.1% and 40.6% in the control group and 35.9% and 30.6% in the intervention group.
Conclusions:
Behavioral feedback with peer comparison can be implemented effectively in the ED to reduce inappropriate prescribing for ARIs.
To my astonishment, I find myself not “old,” not as we all feel at least for moments during middle age, but really old: eighty-seven-years-plus as I write this piece. It won't be finished until I am eighty-eight! That hard-to-swallow fact is what allows me this rather self-indulgent retrospective on a Victorianist career that has spanned several generations of criticism and scholarship. Perhaps, I dare to think, a look back at the arc of that career might be of interest to someone beside myself, moving as it does from the time—around Christmas 1958, when I began writing on a portable electric typewriter a dissertation on George Eliot and determinism—to this moment, when writing a dissertation on a single author seems rather risky and professionally unhelpful, especially if one tries to do it on a typewriter.
OBJECTIVES/SPECIFIC AIMS: The first aim of the study is to evaluate the accuracy of serum biomarkers of acute GVHD measured after four weeks of corticosteroid therapy to predict 6 month NRM. The second aim of this study is to compare the accuracy of the biomarker algorithm to that of clinical response to corticosteroids after four weeks. The third aim of the study is to develop a novel regression model that uses weekly biomarker measurements over the first month of corticosteroid therapy to predict 6 month NRM. METHODS/STUDY POPULATION:. Patients who received HCT at one of 22 IRB-approved centers and provided blood samples to the Mount Sinai Acute GVHD International Consortium (MAGIC) biorepository and developed GVHD between January 2008 to May 2018 are included in this study. Patients were divided by time into a training set (Jan 2008-Dec 2015, n=233) for model development and a validation set (Jan 2015-May 2018, n=357) to evaluate the predictive performance of the model. The later time of the validation set was chosen deliberately to model contemporaneous GVHD treatment practices. The size of each group was designed so that there would be roughly equal numbers of deaths in both groups. RESULTS/ANTICIPATED RESULTS:. Serum concentrations of GVHD biomarkers after one month of corticosteroid therapy were measured in the validation set, and the predicted probability of NRM ($\hat{\rm p}$) was computed according to the previously published algorithm: $\log[-\log(1 - \hat{\rm p})]=-11.263 + 1.844({\rm logST}2)+ 0.577({\rm logREG}3\alpha)$. The performance of the biomarker algorithm was evaluated by creating receiver operating characteristic (ROC) curves and calculating the area under the curve (AUC) in the validation set. The AUC of the biomarker algorithm was a significantly better predictor of 6 month NRM than clinical response to treatment after four weeks of corticosteroids (0.84 vs. 0.64, p<0.001), which is a clinically relevant improvement in accuracy. To evaluate serial biomarker monitoring, serum biomarker concentrations will be measured weekly at five time points from treatment initiation to one month after corticosteroid therapy. We will use these values in the training set to develop a regression model for 6 month NRM that accounts for repeated biomarker measurements. The performance of this model will be tested in the validation set and the accuracy of the serial biomarker measurements will be compared to the accuracy of measuring biomarkers at the single time point after four weeks of corticosteroid therapy. An AUC improvement of 0.05 would be considered clinically significant. DISCUSSION/SIGNIFICANCE OF IMPACT: Clinical response to treatment after four weeks has been the standard endpoint in GVHD interventional trials for decades. If biomarkers measured at the same time more accurately predict long term mortality, this study would provide the basis for a novel endpoint in GVHD trials and enable more accurate determination of effect size of experimental interventions. An accurate biomarker algorithm will prove useful in guiding immunosuppressive treatment decisions for patients with GVHD. Patients identified by the algorithm as low-risk may benefit from reduced-dose corticosteroid therapy, potentially reducing lethal opportunistic infections. Patients identified as high-risk will be candidates for more intensive immunosuppression or investigational therapies. This precision medicine approach tailors therapy to the individual patient’s biology.
We construct, over any CM field, compatible systems of $l$-adic Galois representations that appear in the cohomology of algebraic varieties and have (for all $l$) algebraic monodromy groups equal to the exceptional group of type $E_{6}$.
This second edition of The Cambridge Companion to George Eliot includes several new chapters, providing an essential introduction to all aspects of Eliot's life and writing. Accessible essays by some of the most distinguished scholars of Victorian literature provide lucid and original insights into the work of one of the most important writers of the nineteenth century, author most famously of Middlemarch, Adam Bede, The Mill on the Floss, and Daniel Deronda. From an introduction that traces her originality as a realist novelist, the book moves on to extensive considerations of each of Eliot's novels, her life and her publishing history. Chapters address the problems of money, philosophy, religion, politics, gender and science, as they are developed in her novels. With its supplementary materials, including a chronology and an extensive section of suggested readings, this Companion is an invaluable tool for scholars and students alike.
For those of us for whom “literary Darwinism,” which bases its “scientific” approach to literary criticism on evolutionary psychology, has seemed an intellectual disaster, but who continue to believe that it is important to incorporate science cooperatively into our study of literature; for those who are concerned about how art and literature matter in a world so troubled and dangerous; for those convinced Darwinians who find themselves skeptical about and uneasy with the mechanico-materialist version of Darwinism that Richard Dawkins and Daniel Dennett have made popular; for those who find that the science they credit is yet inadequately attentive to women's perspectives, Richard Prum's The Evolution of Beauty offers a potentially marvelous option. A distinguished ornithologist, Prum has undertaken an enormously ambitious project, whose implications run from evolutionary biology to aesthetics. From the perspective of a very unscientific literary guy and a wannabe birder, I slightly distrust my enthusiasm for the book. But Prum's arguments are creatively provocative and brilliantly argued, even when they get rather iffily hypothetical; his ornithological studies are intrinsically fascinating, even to nonbirders, and at the same time they have potentially transformative implications. What he has to say, even if his inferences can and should be challenged, deserves the most serious engagement.
This major new reading of the novels of Thomas Hardy, by leading critic George Levine, disentangles the author's often elaborately distanced prose from his beautiful poetic and precise renderings of the natural world. Clear, direct and minimally academic in his own writing, Levine provides an overview of Hardy's entire fictional canon, with extensive discussions of his early and late novels including his last, The Well-Beloved. Levine draws new attention to the way Hardy absorbed both the ideas and the writing strategies of Charles Darwin, and develops new perspectives first articulated in the criticism of great novelists - in particular Virginia Woolf and D. H. Lawrence. Levine departs from the critical norm by reading Hardy in the context of his deep feeling for the natural world and all living things, and the implicit affirmation of life that sometimes drives his bleakest narratives.