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In 362/363 the Roman emperor Julian composed a treatise titled Against the Galileans in which he set forth his reasons for abandoning Christianity and returning to devotion to the traditional Greco-Roman deities. Sixty years later Cyril, bishop of Alexandria, composed a response. His resulting treatise Against Julian would dwarf the size of Julian's original work and in fact serves as our primary source for the fragments of it that have survived. Julian's treatise was the most sophisticated critique of Christianity to have been composed in antiquity and Cyril's rebuttal was equally learned. The Christian bishop not only responded directly to Julian's own words but drew upon a wide range of ancient literature, including poetry, history, philosophy, and religious works to undermine the emperor's critiques of the Christian Bible and bolster the intellectual legitimacy of Christian belief and practice. This is the first full translation of the work into English.
Prior reports of healthcare-associated respiratory syncytial virus (RSV) have been limited to cases diagnosed after the third day of hospitalization. The omission of other healthcare settings where RSV transmission may occur underestimates the true incidence of healthcare-associated RSV.
Design:
Retrospective cross-sectional study.
Setting:
United States RSV Hospitalization Surveillance Network (RSV-NET) during 2016–2017 through 2018–2019 seasons.
Patients:
Laboratory-confirmed RSV-related hospitalizations in an eight-county catchment area in Tennessee.
Methods:
Surveillance data from RSV-NET were used to evaluate the population-level burden of healthcare-associated RSV. The incidence of healthcare-associated RSV was determined using the traditional definition (i.e., positive RSV test after hospital day 3) in addition to often under-recognized cases associated with recent post-acute care facility admission or a recent acute care hospitalization for a non-RSV illness in the preceding 7 days.
Results:
Among the 900 laboratory-confirmed RSV-related hospitalizations, 41 (4.6%) had traditionally defined healthcare-associated RSV. Including patients with a positive RSV test obtained in the first 3 days of hospitalization and who were either transferred to the hospital directly from a post-acute care facility or who were recently discharged from an acute care facility for a non-RSV illness in the preceding 7 days identified an additional 95 cases (10.6% of all RSV-related hospitalizations).
Conclusions:
RSV is an often under-recognized healthcare-associated infection. Capturing other healthcare exposures that may serve as the initial site of viral transmission may provide more comprehensive estimates of the burden of healthcare-associated RSV and inform improved infection prevention strategies and vaccination efforts.
The first unequivocal fossil of a tupinambine in North America is described on the basis of a single thoracic vertebra from a middle Miocene (Barstovian 2) paleocoastal deposit in southwestern Georgia, USA. Wautaugategu formidus n. gen. n. sp. is a mid- to large-bodied taxon with a unique mosaic of tupinambine features. Vertebral position of the fossil was determined both by qualitative and quantitative methods. This record is coeval with the warmest part of the Neogene, the Middle Miocene Climatic Optimum, when increased temperatures would have made the southeastern United Sates more habitable for this hyperthermic group of lizards. Although the arrival time of tupinambines into North America is still unclear, an increasing number of endemic South American reptiles, including the large-bodied iguanid Ctenosaura, dispersed as far North as Panama by the early Miocene before formation of the Panamanian Isthmus.
The radio telescopes of the European VLBI Network (EVN) and the University of Tasmania (UTAS) conducted an extensive observation campaign of the European Space Agency’s (ESA) Mars Express (MEX) spacecraft between 2013 and 2020. The campaign, carried out under the Planetary Radio Interferometry and Doppler Experiment (PRIDE) framework, aimed to study interplanetary phase scintillation and assess the noise budget in the closed-loop Doppler observations. The average closed-loop Doppler noise was determined to be approximately 10 mHz at a 10-second integration time, reaffirming the technique’s suitability for radio science experiments. We evaluated how different observational parameters such as the solar elongation, antenna size, and elevation angle impact the Doppler noise. A key part of the analysis involved comparing results from co-located telescopes to investigate system noise effects. Co-located telescopes at both Wettzell and Hobart provided highly consistent results, with any deviations serving as diagnostic tools to identify station-dependent issues. Additionally, the use of phase calibration tones during spacecraft tracking showed that the instrumental noise contribution is of the order of 5% of the total noise. This study provides a detailed noise budget for closed-loop Doppler observations with VLBI telescopes while emphasizing the effectiveness of the co-location method in isolating system-level noise. These findings are important for optimizing future radio science and VLBI tracking missions using stations outside the the Deep Space Network (DSN) and European Space Tracking (ESTRACK) network.
Objectives/Goals: Manual skin assessment in chronic graft-versus-host disease (cGVHD) can be time consuming and inconsistent (>20% affected area) even for experts. Building on previous work we explore methods to use unmarked photos to train artificial intelligence (AI) models, aiming to improve performance by expanding and diversifying the training data without additional burden on experts. Methods/Study Population: Common to many medical imaging projects, we have a small number of expert-marked patient photos (N = 36, n = 360), and many unmarked photos (N = 337, n = 25,842). Dark skin (Fitzpatrick type 4+) is underrepresented in both sets; 11% of patients in the marked set and 9% in the unmarked set. In addition, a set of 20 expert-marked photos from 20 patients were withheld from training to assess model performance, with 20% dark skin type. Our gold standard markings were manual contours around affected skin by a trained expert. Three AI training methods were tested. Our established baseline uses only the small number of marked photos (supervised method). The semi-supervised method uses a mix of marked and unmarked photos with human feedback. The self-supervised method uses only unmarked photos without any human feedback. Results/Anticipated Results: We evaluated performance by comparing predicted skin areas with expert markings. The error was given by the absolute difference between the percentage areas marked by the AI model and expert, where lower is better. Across all test patients, the median error was 19% (interquartile range 6 – 34) for the supervised method and 10% (5 – 23) for the semi-supervised method, which incorporated unmarked photos from 83 patients. On dark skin types, the median error was 36% (18 – 62) for supervised and 28% (14 – 52) for semi-supervised, compared to a median error on light skin of 18% (5 – 26) for supervised and 7% (4 – 17) for semi-supervised. Self-supervised, using all 337 unmarked patients, is expected to further improve performance and consistency due to increased data diversity. Full results will be presented at the meeting. Discussion/Significance of Impact: By automating skin assessment for cGVHD, AI could improve accuracy and consistency compared to manual methods. If translated to clinical use, this would ease clinical burden and scale to large patient cohorts. Future work will focus on ensuring equitable performance across all skin types, providing fair and accurate assessments for every patient.
Objectives/Goals: We aimed to discover treatment candidates for uterine fibroids, a common benign tumor with adverse impacts on quality of life. Repurposing already approved medications for fibroids can expedite treatment option expansion. Using genetic proxies, we identified novel fibroid drug candidates and estimated their effect on risk of fibroid diagnosis. Methods/Study Population: We performed a genetically predicted gene expression (GPGE) analysis using S-PrediXcan and GTEx tissue models with multi-ancestry genome-wide association study (GWAS) summary statistics of fibroids (cases = 74,294, controls = 465). There were 81 genes significantly associated with fibroid risk. Querying drug–gene interaction databases identified 56 approved medications that target these genes, including two antihypertensives, hydralazine, and spironolactone. Using independent multi-ancestry GWAS summary statistics (N = 635,969) for systolic (SBP) and diastolic blood pressure (DBP), we conducted GPGE analyses. Blood pressure (exposure) and fibroids (outcome) GPGE summary statistics in the same tissues were used for two-sample Mendelian randomization (MR) analyses to proxy medication effects. Results/Anticipated Results: GPGE analyses identified hydralazine/tumor protein P53 (TP53) activity and spironolactone/thyroid hormone receptor beta (THRB) activity as drug-gene candidate pairs. Both drugs increase gene activity of their paired gene. Increased TP53 expression was associated with SBP in four tissues (exposure). The MR results indicated hydralazine use, proxied by increased TP53 expression, may reduce fibroid risk by 42% per standard deviation of gene expression (odds ratio [OR] = 0.58, p = 1.43E-12). Increased THRB expression was associated with DBP in eight tissues and were included in the MR (exposure). The MR results suggest spironolactone use, proxied by increased THRB expression, may reduce fibroid risk by 23% per standard deviation of gene expression (OR = 0.77, p = 5.94E-6). Discussion/Significance of Impact: We provide biologically plausible evidence for repurposing hydralazine and spironolactone for reducing risk of fibroid diagnosis. Repurposing these hypertension medications could provide novel preventative treatments for fibroids, particularly for individuals disproportionately affected by both conditions.
Using National Healthcare Safety Network data, an interrupted time series of intravenous antimicrobial starts (IVAS) among hemodialysis patients was performed. Annual adjusted rates decreased by 6.64% (January 2012–March 2020) and then further decreased by 8.91% until December 2021. IVAS incidence trends have decreased since 2012, including during the early COVID-19 pandemic.
This is a study of the dynamics of partisan polarization in the United States. It has three objectives: (1) to identify and explain why some Republicans and Democrats – but not others – have polarized, particularly over the last twenty years; (2) to demonstrate that they have done so not on this or that issue but systematically, programmatically – domain versus issue sorting; and (3) to bring into the open profound asymmetries in polarization between the two parties, not least that Republicans polarized early and thoroughly on issues of race, while Democrats in the largest number stayed neutral or even conservative until only recently. Emerging from the reasoning and results is a revised theory of party identification that specifies the conditions under which ordinary Republicans and Democrats can become ideological partisans – real-life conservatives and liberals in their behavior – in the choices they make on candidates, policies, and parties.
One of the challenges for bryozoans is to avoid refiltering water that has already had its plankton removed. Larger colonies develop colony-wide maculae-centered feeding currents to avoid refiltering water and generally have elevated maculae (monticules). We hypothesize that the height and density of spacing of monticules are inversely proportional to curvature of the colony surface. Larger, flatter colonies should have higher and more closely spaced monticules. We compare two Permian stenolaemate bryozoans whose colonies form branches with elliptical cross sections: the smaller and more elliptical cystoporate Evactinostella crucialis (Hudleston, 1883) from Western Australia (N = 17) and the larger and flatter trepostome Tabulipora sp. from eastern North Greenland (N = 15). Using calipers and digital elevation models, we measured curvature, monticule height, and number of monticules per area. Results indicate that Evactinostella branches are at least twice as curved as those of Tabulipora, their monticules are half the height of Tabulipora, and their monticules are 22% less densely spaced than those of Tabulipora. In Evactinostella colonies, surface curvature is inversely proportional to monticule height and spatial density, which is not true for Tabulipora. Therefore, we conclude that the smaller and more curved the colony surface, the less the colony needs robust colony-wide feeding currents created by tall, closely spaced monticules.
This special issue of The Asia-Pacific Journal: Japan Focus on “The ‘Comfort Women’ as Public History,” edited by Edward Vickers and Mark Frost, analyzes the turn since the early 2000s towards “heritagization” of this controversial issue. Papers include testimony from scholars involved in campaigns on behalf of comfort women, or in movements for their commemoration (Shin, Su, Norma); more conventional academic analyses of transnational efforts to secure recognition for comfort women, whether through litigation (Hao) or heritage activism (Vickers, Schumacher); and personal reflections by an academic educator (Heo) and filmmaker (Dezaki) who in different ways have sought to promote international understanding of this issue. An introductory essay by the editors, Frost and Vickers, examines how the reframing of this issue as “heritage” has been accompanied by increasing entanglement with the global politics of atrocity commemoration. Questioning any necessary equation between heritagization and reconciliation, they stress the need for representation of comfort women as public history to pay due regard to nuance and complexity.
In this introductory essay to the special issue of The Asia-Pacific Journal: Japan Focus on “The Comfort Women as Public History,” we analyze the turn since the early 2000s towards “heritagization” of this controversial issue. After reviewing the political, cultural and historiographical background to ongoing disputes over “comfort women,” we examine how the reframing of this issue as “heritage” has been accompanied by increasing entanglement with the global politics of atrocity commemoration, and associated tropes. Prominent among such tropes is the claim that commemoration fosters “peace”. However, following recent critical scholarship on this issue, and drawing on the papers that comprise this special issue, we question any necessary equation between heritagization and reconciliation. When done badly, the drive to commemorate a contentious issue as public history can exacerbate rather than resolve division and hatred. We therefore emphasise the need for representation of comfort women as public history to pay due regard to nuance and complexity, for example regarding the depiction of victims versus perpetrators; the transnational dimension of the system; and its relationship with the broader history of gender politics and the sexual subjugation of women.
Edited by
Dharti Patel, Mount Sinai West and Morningside Hospitals, New York,Sang J. Kim, Hospital for Special Surgery, New York,Himani V. Bhatt, Mount Sinai West and Morningside Hospitals, New York,Alopi M. Patel, Rutgers Robert Wood Johnson Medical School, New Jersey
The cardiovascular pharmacology chapter focuses on therapeutic agents utilized by anesthesiologists in the treatment of a myriad of pathologies encountered in the operating room environment and elsewhere. The chapter provides a succinct outline of major classes of cardiovascular drugs that are an integral part of the practice of anesthesiology. The aim of the chapter is to deliver said material in an easy to read format to those preparing for board examinations and as a review for the practicing anesthesiology resident physician
Quantum field theory predicts a nonlinear response of the vacuum to strong electromagnetic fields of macroscopic extent. This fundamental tenet has remained experimentally challenging and is yet to be tested in the laboratory. A particularly distinct signature of the resulting optical activity of the quantum vacuum is vacuum birefringence. This offers an excellent opportunity for a precision test of nonlinear quantum electrodynamics in an uncharted parameter regime. Recently, the operation of the high-intensity Relativistic Laser at the X-ray Free Electron Laser provided by the Helmholtz International Beamline for Extreme Fields has been inaugurated at the High Energy Density scientific instrument of the European X-ray Free Electron Laser. We make the case that this worldwide unique combination of an X-ray free-electron laser and an ultra-intense near-infrared laser together with recent advances in high-precision X-ray polarimetry, refinements of prospective discovery scenarios and progress in their accurate theoretical modelling have set the stage for performing an actual discovery experiment of quantum vacuum nonlinearity.
We examined the association between influenza vaccination policies at acute care hospitals and influenza vaccination coverage among healthcare personnel for the 2021–22 influenza season. Mandatory vaccination and masking for unvaccinated personnel were associated with increased odds of vaccination. Hospital employees had higher vaccination coverage than licensed independent practitioners.
Resilience of the healthcare system has been described as the ability to absorb, adapt, and respond to stress while maintaining the provision of safe patient care. We quantified the impact that stressors associated with the COVID-19 pandemic had on patient safety, as measured by central line-associated bloodstream infections (CLABSIs) reported to the Centers for Disease Control and Prevention’s National Healthcare Safety Network.
Design:
Acute care hospitals were mandated to report markers of resource availability (staffing and hospital occupancy with COVID-19 inpatients) to the federal government between July 2020 and June 2021. These data were used with community levels of COVID-19 to develop a statistical model to assess factors influencing rates of CLABSIs among inpatients during the pandemic.
Results:
After risk adjustment for hospital characteristics, measured stressors were associated with increased CLABSIs. Staff shortages for more than 10% of days per month were associated with a statistically significant increase of 2 CLABSIs per 10,000 central line days versus hospitals reporting staff shortages of less than 10% of days per month. CLABSIs increased with a higher inpatient COVID-19 occupancy rate; when COVID-19 occupancy was 20% or more, there were 5 more CLABSIs per 10,000 central line days versus the referent (less than 5%).
Conclusions:
Reporting of data pertaining to hospital operations during the COVID-19 pandemic afforded an opportunity to evaluate resilience of US hospitals. We demonstrate how the stressors of staffing shortages and high numbers of patients with COVID-19 negatively impacted patient safety, demonstrating poor resilience. Understanding stress in hospitals may allow for the development of policies that support resilience and drive safe care.
Drag has a long history in the LGBTQ community as a means of political engagement, activism, protest, and community building. Today, drag is popular in the LGBTQ community and in the rest of society. At the same time, it is routinely a target of conservative backlash against the LGBTQ community. Despite drag’s inherently political nature, political science has failed to engage substantially with the influence of drag. This article offers a justification and research agenda to bring drag into the mainstream of political science.
The Automated Meteorology—Ice—Geophysics Observation System 3 (AMIGOS-3) is a multi-sensor on-ice ocean mooring and weather, camera and precision GPS measurement station, controlled by a Python script. The station is designed to be deployed on floating ice in the polar regions and operate unattended for up to several years. Ocean mooring sensors (SeaBird MicroCAT and Nortek Aquadopp) record conductivity, temperature and depth (reported at 10 min intervals), and current velocity (hourly intervals). A Silixa XT fiber-optic distributed temperature sensing system provides a temperature profile time-series through the ice and ocean column with a cadence of 6 d−1 to 1 week−1 depending on available station power. A subset of the station data is telemetered by Iridium modem. Two-way communication, using both single-burst data and file transfer protocols, facilitates station data collection changes and power management. Power is supplied by solar panels and a sealed lead-acid battery system. Two AMIGOS-3 systems were installed on the Thwaites Eastern Ice Shelf in January 2020, providing data well into 2022. We discuss the components of the system and present several of the data sets, summarizing observed climate, ice and ocean conditions.
Electronic health records and patient portals are increasingly utilized to enhance research recruitment efficiency, yet response patterns across patient groups remain unclear. We examined 10 studies at Emory Healthcare that used these tools to identify and recruit 24,000 patients over 1 year. Response rates were lower among males and Black individuals, though study interest was higher among respondents. Interest was also greater among those with frequent healthcare interactions and lower comorbidity. In a large academic health system, portal-based recruitment offered a streamlined approach to research recruitment and patient engagement, with minor variations across patient characteristics warranting continued study.