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Biodiversity is in rapid decline, but the extent of loss is not well resolved for poorly known groups. We estimate the number of extinctions for Australian non-marine invertebrates since the European colonisation of the continent. Our analyses use a range of approaches, incorporate stated uncertainties and recognise explicit caveats. We use plausible bounds for the number of species, two approaches for estimating extinction rate, and Monte Carlo simulations to select combinations of projected distributions from these variables. We conclude that 9,111 (plausible bounds of 1,465 to 56,828) Australian species have become extinct over this 236-year period. These estimates dwarf the number of formally recognised extinctions of Australian invertebrates (10 species) and of the single invertebrate species listed as extinct under Australian legislation. We predict that 39–148 species will become extinct in 2024. This is inconsistent with a recent pledge by the Australian government to prevent all extinctions. This high rate of loss is largely a consequence of pervasive taxonomic biases in community concern and conservation investment. Those characteristics also make it challenging to reduce that rate of loss, as there is uncertainty about which invertebrate species are at the most risk. We outline conservation responses to reduce the likelihood of further extinctions.
We investigated the impact of workflow times on the outcomes of patients treated with endovascular thrombectomy (EVT) in the late time window.
Methods:
Individual patients’ data who underwent EVT in the late time window (onset to imaging >6 hours) were pooled from seven registries and randomized clinical trials. Multiple time intervals were analyzed. Mixed-effects logistic regression was used to estimate the likelihood of functional independence at 90 days (modified Rankin Scale 0–2). Mixed-effects negative binomial regression was used to evaluate the relationship between patient characteristics and workflow time intervals.
Results:
608 patients were included. The median age was 70 years (IQR: 58–71), 307 (50.5%) were female, and 310 (53.2%) had wake-up strokes. Successful reperfusion was achieved in 493 (81.2%) patients, and 262 (44.9%) achieved 90-day mRS 0–2. The estimated odds of functional independence decreased by 13% for every 30 minute delay from emergency department (ED) arrival to imaging time and by 7% from ED arrival to the end of EVT in the entire cohort. Also, the estimated odds of functional independence decreased by 33% for every 30 minute delay in the interval from arterial puncture to end of EVT, 16% in the interval from arrival in ED to end of EVT and 6% in the interval from stroke onset to end of EVT among patients who had a wake-up stroke.
Conclusion:
Faster workflow from ED arrival to end of EVT is associated with improved functional independence among stroke patients treated in the late window.
Over the past few years postmodernism has been gaining popularity. Because the works of writers such as Jacques Derrida, Michel Foucault, Gilles Deleuze, Jacques Lacan, and Félix Guattari, for example, are now readily available to the English reader, a novel intellectual force is present that must be assessed (Hassan, 1985). Terms such as “mise en abîme”, “libido”, “schizo-analysis”, “undecidables”, and so forth must be explained and their relevance for social analysis deciphered. Furthermore, a conception of knowledge, a research methodology, and an image of social order that are consistent with these somewhat odd ideas have been introduced, and thus must be evaluated with respect to their sociological importance. At first, due to the strange language that is adopted and the nature of the philosophy offered, postmodernism appears to the uninitiated as an attempt to subvert rational discussion.
Critical Theory is usually associated with an intellectual tradition which emerged from the work of a group of social philosophers who coalesced around the Institute for Social Research, established in Frankfurt in 1923. This tradition is now considered to have two major branches: the first related to the work of Theodor Adorno, Max Horkheimer, Herbert Marcuse, Erich Fromm, Leo Lowenthal, and Walter Benjamin, while the second pertains to the expansion of this original work which has been proffered by Jürgen Habermas, Claus Offe, Niklas Luhmann, Karl-Otto Apel, and others. It should be immediately noted that Critical Theory does not form a unity, for it does mean different things to both its early and current adherents. Without overstating the case, however, the common theme which unites these theorists is a dislike for the types of determinism which saw socialism arising automatically from either appropriate social conditions or at the behest of elite party members. In each case the belief was inadvertently advanced that people do not make their own history. In line with the work of Lukács and Korsch, these critical theorists wanted to develop a more vital Marxist theory, one which understands human praxis to be at the center of social development and, thus, human liberation.
As Perelman suggests, rhetoric has always been concerned with understanding the basic nature of an audience. Considering this view, the perennial question posed by rhetoric might be: How does one discourse properly with an audience? Using the terminology supplied by Bitzer, this query might be rephrased to read: How does one “uncover and make available the public knowledge needed in our time and give body and voice to the universal public”. Of key importance is that the rhetorician must secure a base of knowledge that will allow communication to commence between a speaker and an audience. If discourse is to be successful a speaker must address an audience in a style that can be understood, and therefore must substantiate all social intercourse on knowledge that is “public” or held in common. At first this might sound quite pedestrian, yet throughout the history of rhetoric this assumption has proven to be quite problematic.
Many contemporary writers are claiming that society is becoming rapidly deanimated. However, this idea is not entirely new. During the past century, the same observation has been made by critics as disparate as Durkheim and Marx. In general, they pointed out that as an outgrowth of industrialization, social relationships were beginning to deteriorate. In point of fact, complaints about social fragmentation and the emergence of bureaucracies were commonplace. Simply put, citizens were beginning to feel powerless and overwhelmed by their institutions. Recently, Baudrillard referred to this sentiment as indicative of the “Golden Age of Alienation.”
This study aimed to evaluate the proportion of Irish medical students exposed to ‘badmouthing’ of different specialities and to ascertain: the degree of criticism of specialities based on the seniority of clinical or academic members of staff; if ‘badmouthing’ influenced student career choice in psychiatry; and attitudes of medical students towards psychiatry as a speciality and career choice.
Methods:
Medical students in three Irish universities were invited to complete an online survey to determine the frequency and effect of non-constructive criticism on choice of medical specialty. The online questionnaire was distributed to Royal College of Surgeons in Ireland (RCSI), University of Galway (UoG) and University College Dublin (UCD) in the academic year 2020–2021.
Results:
General practice (69%), surgery (65%) and psychiatry (50%) were the most criticised specialties. Criticism was most likely to be heard from medical students. 46% of students reported reconsidering a career in psychiatry due to criticism from junior doctors. There was a positive perception of psychiatry with 27% of respondents considering psychiatry as a first-choice specialty.
Conclusions:
Criticism of psychiatry by doctors, academics and student peers negatively influences students’ career choice, which could be contributing to recruitment difficulties in psychiatry.
Transcutaneous vagus nerve stimulation (tVNS) is a promising potential intervention for Alzheimer's disease (AD) due to its influence on brain functions and mechanisms important in disease progression. Regions of interest include projection to the nucleus of the solitary tract, locus coeruleus, and hippocampus. Deterioration of the hippocampus is one of the most prominent early characteristics of AD, particularly during the mild cognitive impairment (MCI) stage. tVNS could modify function of the hippocampus. We examined resting state functional connectivity from the bilateral hippocampus in response to tVNS in patients with MCI.
Participants and Methods:
Fifty older adults (28 women, 60-89 years of age) diagnosed with MCI were assessed. MCI was confirmed via diagnostic consensus conference with a neurologist and neuropsychologist (sources of information: Montreal Cognitive Assessment Test [MoCA], Clinical Dementia Rating scale [CDR], Functional Activities Questionnaire (FAQ), Hopkins Verbal Learning Test - Revised [HVLT-R] and medical record review). Resting state functional magnetic resonance imaging (fMRI) was collected on a 3T Siemens Prisma scanner while participants received either unilateral tVNS (left tragus, n = 25) or sham stimulation (left ear lobe, n = 25). fMRI data were processed using CONN toolbox v18b and hippocampal seed to voxel (whole brain) analyses were conducted with voxel and cluster level multiple comparison correction.
Results:
Contrasting tVNS and sham stimulation, whole-brain seed-to-voxel analysis demonstrated significant changes in connectivity from the left hippocampus to several cortical and subcortical regions bilaterally. Specifically, there was increased connectivity to prefrontal regions and cingulate gyri, and decreased connectivity to anterior and medial temporal lobes. A seed-to-voxel analysis from the right hippocampus indicated significant decrease in connectivity to a single cluster of regions in the left anterior temporal lobe in response to tVNS.
Conclusions:
In conclusion, tVNS modified connectivity from the hippocampus to multiple brain regions implicated in semantic and salience functions, in which disruption correlates with deterioration in AD. These findings indicate afferent target engagement of tVNS. Future work is needed to investigate the long-term effects of tVNS in patients with MCI and whether it could contribute to meaningful cognitive change and subsequent improvements in quality of life.
This Element argues that Southeast Asia's failure to develop stronger social protection systems has been, at its root, a matter of politics and power. It has reflected the political dominance within the region of predatory and technocratic elements, and the relative weakness of progressive elements. From the mid-1980s, democratisation, the emergence of political entrepreneurs seeking to mobilise mass electoral support, and the occurrence of severe economic and social crises generated pressure on governments within the region to strengthen their social protection systems. But while such developments shifted policy in a more progressive direction, they have been insufficient to produce far-reaching change. Rather, they have produced a layering effect. Innovations have built upon pre-existing policy and institutional arrangements without fundamentally altering these arrangements, ensuring that social protection systems continue to have strong conservative, productivist and predatory attributes.
Rapid antigen detection tests (Ag-RDT) for SARS-CoV-2 with emergency use authorization generally include a condition of authorization to evaluate the test’s performance in asymptomatic individuals when used serially. We aim to describe a novel study design that was used to generate regulatory-quality data to evaluate the serial use of Ag-RDT in detecting SARS-CoV-2 virus among asymptomatic individuals.
Methods:
This prospective cohort study used a siteless, digital approach to assess longitudinal performance of Ag-RDT. Individuals over 2 years old from across the USA with no reported COVID-19 symptoms in the 14 days prior to study enrollment were eligible to enroll in this study. Participants throughout the mainland USA were enrolled through a digital platform between October 18, 2021 and February 15, 2022. Participants were asked to test using Ag-RDT and molecular comparators every 48 hours for 15 days. Enrollment demographics, geographic distribution, and SARS-CoV-2 infection rates are reported.
Key Results:
A total of 7361 participants enrolled in the study, and 492 participants tested positive for SARS-CoV-2, including 154 who were asymptomatic and tested negative to start the study. This exceeded the initial enrollment goals of 60 positive participants. We enrolled participants from 44 US states, and geographic distribution of participants shifted in accordance with the changing COVID-19 prevalence nationwide.
Conclusions:
The digital site-less approach employed in the “Test Us At Home” study enabled rapid, efficient, and rigorous evaluation of rapid diagnostics for COVID-19 and can be adapted across research disciplines to optimize study enrollment and accessibility.
As wildfires and air pollution become more common across the United States, it is increasingly important to understand the burden they place on public health. Previous studies have noted relationships between air quality and use of Emergency Medical Services (EMS), but until now, these studies have focused on day-to-day air quality. The goal of this study is to investigate the effect of sustained periods of poor air quality on EMS call characteristics and volume.
Methods:
Using a time-stratified case-crossover design, the effect of exposure to periods of poor air quality on number and type of EMS calls in California, USA from 2014-2019 was observed. Poor air quality periods greater than three days were identified at the United States Environmental Protection Agency’s (EPA’s) Air Quality Index (AQI) levels of Unhealthy for Sensitive Groups (AQI 100) and Unhealthy (AQI 150). Periods less than three days apart were combined. Each poor air quality period was matched with two one-week controls, the first being the closest preceding week that did not intersect a different case. The second control was the closest week at least three days after the case and not intersecting with a different case. Due to seasonal variation in EMS usage, from the initial cases, cases were used only if it was possible to identify controls within 28 days of the case. A conditional Poisson regression calculated risk ratios for EMS call volume.
Results:
Comparing the case periods to the controls, significant increases were found at AQI >100 for total number of calls, and the primary impressions categories of emotional state or behavior, level of consciousness, no patient complaint, other, respiratory, and abdominal. At an AQI >150, significance was found for the primary impressions categories of other, pain, respiratory, and digestive.
Conclusion:
These data demonstrate increased EMS calls during sustained poor air quality, and that several EMS primary impression categories are disproportionately affected. This study is limited by the imprecision of the primary impression’s classification provided by the EMS clinician responding to the EMS call. More research is needed to understand the effects of periods of poor air quality on the EMS system for more efficient deployment of resources.
This chapter reviews the critical role that a contract research organization performs in developing new therapeutics for Alzheimer’s disease (AD). Late-phase AD trials are lengthy, expensive, and require specialized expertise and experience in order to optimize signal detection. We review the intricacies of AD protocol design, selection of optimal neuropsychiatric tests for different AD stages, rater training, imaging technologies, and use of biomarkers. Careful planning of trials involves well-thought-out investigator selection, site monitoring, and patient recruitment and retention strategies. Examples of operational issues in large global trials are also given, including adaptations necessary due to the COVID pandemic.
It is widely accepted that tort law operates according to a hierarchy of protected interests. Some commentators suggest that this hierarchy can be put to dispositive uses in cases characterised by a clash of interests held respectively by the claimant and defendant (the inferior interest giving way). Others argue that thinking in terms of a hierarchy of interests sheds light on three unusual aspects of tort law: viz. the existence of torts that are actionable per se, the existence of strict liability torts, and the existence of actions in which injunctive relief is routinely awarded even though compensatory damages are tort law's default remedy. This article tests both claims. It concludes that an intuitively appealing hierarchy of interests can be identified, and that it might well possess dispositive significance all other things being equal. But it also observes that all other things are seldom equal, and that departures from the hierarchy occur for various reasons that can be clearly identified and which should be borne in mind when thinking about its dispositive utility. It also urges caution in making connections between the status of certain interests and the fact that they are protected by torts that are actionable per se, strict liability torts and torts in connection with which injunctions are awarded almost as a matter of course.
Lithium is a gold standard maintenance treatment in bipolar affective disorder. It has a narrow therapeutic range, and at higher serum lithium levels there is a risk of adverse effects and toxicity. There are three patterns of lithium intoxication: acute, acute-on-chronic and chronic. We describe risk factors for lithium intoxication, mechanisms of toxicity and clinical symptoms seen in lithium intoxication. We describe both the acute and chronic effects of lithium toxicity. Lithium intoxication may be life-threatening and associated with longer-term sequelae. The management of lithium intoxication involves determining the type of intoxication. We discuss treatment strategies aimed at reducing absorption and increasing elimination of lithium. We discuss clinical indications for extracorporeal methods such as dialysis, which are used to limit the time and degree of exposure of the central nervous system to toxic lithium concentrations. Haemodialysis is the most rapid method of eliminating lithium from the body, but careful monitoring is required. Preventive strategies to mitigate the risk for lithium intoxication are discussed.
Leading Irish academics and policy practitioners present a comprehensive study of policy analysis in Ireland. Contributors investigate the roles of the EU, the public, science, the media and gender expertise in policy analysis. This text examines policy analysis at different levels of government and identifies future challenges for policy analysis.
To assess the burden of respiratory virus coinfections with severe acute respiratory coronavirus virus 2 (SARS-CoV-2), this study reviewed 4,818 specimens positive for SARS-CoV-2 and tested using respiratory virus multiplex testing. Coinfections with SARS-CoV-2 were uncommon (2.8%), with enterovirus or rhinovirus as the most prevalent target (88.1%). Respiratory virus coinfection with SARS-CoV-2 remains low 1 year into the coronavirus disease 2019 (COVID-19) pandemic.
Two introduced carnivores, the European red fox Vulpes vulpes and domestic cat Felis catus, have had extensive impacts on Australian biodiversity. In this study, we collate information on consumption of Australian birds by the fox, paralleling a recent study reporting on birds consumed by cats. We found records of consumption by foxes on 128 native bird species (18% of the non-vagrant bird fauna and 25% of those species within the fox’s range), a smaller tally than for cats (343 species, including 297 within the fox’s Australian range, a subset of that of the cat). Most (81%) bird species eaten by foxes are also eaten by cats, suggesting that predation impacts are compounded. As with consumption by cats, birds that nest or forage on the ground are most likely to be consumed by foxes. However, there is also some partitioning, with records of consumption by foxes but not cats for 25 bird species, indicating that impacts of the two predators may also be complementary. Bird species ≥3.4 kg were more likely to be eaten by foxes, and those <3.4 kg by cats. Our compilation provides an inventory and describes characteristics of Australian bird species known to be consumed by foxes, but we acknowledge that records of predation do not imply population-level impacts. Nonetheless, there is sufficient information from other studies to demonstrate that fox predation has significant impacts on the population viability of some Australian birds, especially larger birds, and those that nest or forage on the ground.