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This volume introduces the legal philosopher Adolf Reinach and his contributions to speech act theory, as well as his analysis of basic legal concepts and their relationship to positive law. Reinach's thorough analysis has recently garnered growing interest in private law theory, yet his 'phenomenological realist' philosophical approach is not in line with contemporary mainstream approaches. The essays in this volume resuscitate and interrogate Reinach's unique account of the foundations of private law, situating him in contemporary private law theory and broader philosophical currents. The work also makes Reinach's methods more accessible to those unfamiliar with early phenomenology. Together these contributions prove that while Reinach's perspective on private law shares similarities and points of departure with trends in today's legal theory, many of his insights remain singular and illuminating in their own right. This title is also available as Open Access on Cambridge Core.
To describe the real-world clinical impact of a commercially available plasma cell-free DNA metagenomic next-generation sequencing assay, the Karius test (KT).
Methods:
We retrospectively evaluated the clinical impact of KT by clinical panel adjudication. Descriptive statistics were used to study associations of diagnostic indications, host characteristics, and KT-generated microbiologic patterns with the clinical impact of KT. Multivariable logistic regression modeling was used to further characterize predictors of higher positive clinical impact.
Results:
We evaluated 1000 unique clinical cases of KT from 941 patients between January 1, 2017–August 31, 2023. The cohort included adult (70%) and pediatric (30%) patients. The overall clinical impact of KT was positive in 16%, negative in 2%, and no clinical impact in 82% of the cases. Among adult patients, multivariable logistic regression modeling showed that culture-negative endocarditis (OR 2.3; 95% CI, 1.11–4.53; P .022) and concern for fastidious/zoonotic/vector-borne pathogens (OR 2.1; 95% CI, 1.11–3.76; P .019) were associated with positive clinical impact of KT. Host immunocompromised status was not reliably associated with a positive clinical impact of KT (OR 1.03; 95% CI, 0.83–1.29; P .7806). No significant predictors of KT clinical impact were found in pediatric patients. Microbiologic result pattern was also a significant predictor of impact.
Conclusions:
Our study highlights that despite the positive clinical impact of KT in select situations, most testing results had no clinical impact. We also confirm diagnostic indications where KT may have the highest yield, thereby generating tools for diagnostic stewardship.
Hand, foot and mouth disease (HFMD) is a contagious communicable disease, with a high incidence in children aged under 10 years. It is a mainly self-limiting disease but can also cause serious neurological or cardiopulmonary complications in some cases, which can lead to death. Little is known about the burden of HMFD on primary care health care services in the UK. The aim of this work was to describe trends in general practitioner (GP) consultations for HFMD in England from January 2017 to December 2022 using a syndromic surveillance network of GPs. Daily GP consultations for HFMD in England were extracted from 1 January 2017 to 31 December 2022. Mean weekly consultation rates per 100,000 population and 95% confidence intervals (CI) were calculated. Consultation rates and rate ratios (RR) were calculated by age group and sex. During the study period, the mean weekly consultation rate for HFMD (per 100,000 registered GP patients) was 1.53 (range of 0.27 to 2.47). In England, children aged 1–4 years old accounted for the largest affected population followed by children <1 years old. We observed a seasonal pattern of HFMD incidence during the non-COVID years, with a seasonal peak of mean weekly rates between months of September and December. HFMD is typically diagnosed clinically rather than through laboratory sampling. Therefore, the ability to look at the daily HFMD consultation rates provides an excellent epidemiological overview on disease trends. The use of a novel GP-in-hours surveillance system allowed a unique epidemiological insight into the recent trends of general practitioner consultations for HFMD. We demonstrate a male predominance of cases, the impact of the non-pharmaceutical interventions during the COVID-19 pandemic, and a change in the week in which the peak number of cases happens post-pandemic.
Nineteen different anthropometric measures were obtained on all members of each of two racial groups. A procedure was developed and applied to the data to give maximum differentiation between the groups. The method is applicable wherever we have a large number of independent variables and a dependent variable. In such cases, the conventional methods for determining multiple regression constants are very laborious. An iteration method is presented which is more rapid than any with which the writers are familiar. The method selects in sequence those variables which together yield the largest multiple correlation with the criterion. At each step in the procedure, rapid estimates of the regression weights and the multiple correlation at that point are available.
There is no clear evidence about how to support people with borderline personality disorder (BPD) during the perinatal period. Perinatal emotional skills groups (ESGs) may be helpful, but their efficacy has not been tested.
Aims
To test the feasibility of conducting a randomised controlled trial (RCT) of perinatal ESGs for women and birthing people with BPD.
Method
Two-arm parallel-group feasibility RCT. We recruited people from two centres, aged over 18 years, meeting DSM-5 diagnostic criteria for BPD, who were pregnant or within 12 months of a live birth. Eligible individuals were randomly allocated on a 1:1 ratio to ESGs + treatment as usual (TAU), or to TAU. Outcomes were assessed at 4 months post randomisation.
Results
A total of 100% of the pre-specified sample (n = 48) was recruited over 6 months, and we obtained 4-month outcome data on 92% of randomised participants. In all, 54% of participants allocated to perinatal ESGs attended 75% of the full group treatment (median number of sessions: 9 (interquartile range 6–11). At 4 months, levels of BPD symptoms (adjusted coefficient −2.0, 95% CI −6.2 to 2.1) and emotional distress (−2.4, 95% CI −6.2 to 1.5) were lower among those allocated to perinatal ESGs. The directionality of effect on well-being and social functioning also favoured the intervention. The cost of delivering perinatal ESGs was estimated to be £918 per person.
Conclusions
Perinatal ESGs may represent an effective intervention for perinatal women and birthing people with BPD. Their efficacy should be tested in a fully powered RCT, and this is a feasible undertaking.
The Durness Group of NW Scotland records deposition on the Laurentian margin from the basal Miaolingian (Cambrian, 509 Ma) to the Dapingian–Darriwilian boundary interval (Middle Ordovician, 470.3–468.9 Ma). The 930 m thick succession of peritidal and subtidal carbonates was deposited on the Scottish promontory, a nearly 120° deflection in the Palaeozoic continental margin between the Appalachian and Greenland sectors. These sediments were deposited as part of the Great American Carbonate Bank, a non-uniformitarian, continent-scale carbonate platform developed on the peneplaned craton. Measurement and description of a bed-by-bed composite section through the Durness Group provide a high-resolution reference framework that integrates conodont biostratigraphy, chemostratigraphy and sequence stratigraphy, including correlation with the Sauk megasequence and its subdivisions. The Sauk II–Sauk III sequence boundary marks the base of the group. The top of the group is faulted against rocks of the Moine thrust zone, generated by the Scandian orogeny, but sedimentation was probably terminated by the earlier Grampian arc–continent collision at 470–469 Ma. The highly mature quartz arenites of the underlying Ardvreck Group (Cambrian Series 2) indicate that there was no source-to-sink depositional continuity from the Hebridean foreland to the Dalradian Supergroup, which has coeval clastic sedimentary rocks of contrasting composition.
Advances in artificial intelligence (AI) have great potential to help address societal challenges that are both collective in nature and present at national or transnational scale. Pressing challenges in healthcare, finance, infrastructure and sustainability, for instance, might all be productively addressed by leveraging and amplifying AI for national-scale collective intelligence. The development and deployment of this kind of AI faces distinctive challenges, both technical and socio-technical. Here, a research strategy for mobilising inter-disciplinary research to address these challenges is detailed and some of the key issues that must be faced are outlined.
With the advent of COVID-19, adaptation became a norm. Research data-collection methods similarly required adaptation, birthing the use of virtual platforms as first-line data collection tools to adhere to COVID-19 restrictions. This chapter presents an autoethnographic account of virtual qualitative data collection. A PhD candidate shares her experience of conducting individual and focus group interviews virtually in a developing nation. A discussion of the narrative and recommendations for virtual qualitative data collection are provided.
The introduction of digital approaches is perhaps the most significant change to the way that healthcare research is conducted that has been seen since computers first came into use. This introductory chapter will set the tone for the rest of the book. The book is divided into two parts: 1. digital platforms, and 2. approaches to healthcare research that are either uniquely digital or are adaptations of existing approaches to the online context. Within each of these parts, a collection of chapters by distinguished and rising authors present digital platforms and techniques and consider these as applied to a wide range of healthcare studies. This introduction will consider the broad area that the book addresses and will similarly be divided into the same two sections. The unique aspects of digital research approaches will be highlighted and emphasised, and the reader will be prepared for the chapters that follow.
Digital methods in healthcare research have been steadily gaining ground but, until recently, were superseded by conventional face-to-face approaches wherever possible. However, the COVID-19 pandemic rendered in-person forms of data collection largely impossible, propelling digital approaches to the forefront. This book offers a digital lens in the participatory perspective of ethnography, a qualitative methodology. A series of chapters from internationally distinguished and rising authors present digital platforms and techniques and apply these to a wide range of healthcare studies. The authors highlight the different aspects of digital research approaches as well as reflecting on and proffering digital approaches to qualitative research for the future. Will these new digital health techniques be embraced, or will researchers be keen to revert to the traditional methods? With its unique approach, this is an invaluable resource for both prospective and experienced qualitative researchers in a broad array of medical and health disciplines.
Soper's ‘pain and brain’ evolutionary theory of suicide has significant explanatory power and deserves wider consideration and scrutiny in the mainstream psychiatric literature. It provides a novel framework for thinking about the problem of suicide and could have an important impact on research as well as clinical practice. However, we raise questions and concerns regarding the prediction the theory makes regarding common mental disorders being anti-suicide adaptations.
Disease-modifying therapies (DMTs) for Alzheimer’s disease (AD) are emerging following successful clinical trials of therapies targeting amyloid beta (Aβ) protofibrils or plaques. Determining patient eligibility and monitoring treatment efficacy and adverse events, such as Aβ-related imaging abnormalities, necessitates imaging with MRI and PET. The Canadian Consortium on Neurodegeneration in Aging (CCNA) Imaging Workgroup aimed to synthesize evidence and provide recommendations on implementing imaging protocols for AD DMTs in Canada.
Methods:
The workgroup employed a Delphi process to develop these recommendations. Experts from radiology, neurology, biomedical engineering, nuclear medicine, MRI and medical physics were recruited. Surveys and meetings were conducted to achieve consensus on key issues, including protocol standardization, scanner strength, monitoring protocols based on risk profiles and optimal protocol lengths. Draft recommendations were refined through multiple iterations and expert discussions.
Results:
The recommendations emphasize standardized acquisition imaging protocols across manufacturers and scanner strengths to ensure consistency and reliability of clinical treatment decisions, tailored monitoring protocols based on DMTs’ safety and efficacy profiles, consistent monitoring regardless of perceived treatment efficacy and MRI screening on 1.5T or 3T scanners with adapted protocols. An optimal protocol length of 20–30 minutes was deemed feasible; specific sequences are suggested.
Conclusion:
The guidelines aim to enhance imaging data quality and consistency, facilitating better clinical decision-making and improving patient outcomes. Further research is needed to refine these protocols and address evolving challenges with new DMTs. It is recognized that administrative, financial and logistical capacity to deliver additional MRI and positron emission tomography scans require careful planning.