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This article is a detailed critical review of all the major scholarly publications in the rapidly expanding field of the Justinianic Plague published from 2000 through 2018. It updates the article in this journal by Dionysios Stathakopoulos from 2000, while also providing a detailed appraisal of the state of the field across all disciplines, including: literary studies, archaeology, DNA evidence, climatology, and epidemiology. We also identify the current paradigm for the Justinianic Plague as well as survey possible avenues forward for the field in the future.1
The objectives were to evaluate the, usability, feasibility of use, satisfaction, and safety of the Syqe Inhaler Exo (Syqe Inhaler), a metered dose, Pharmacokinetics-validated, cannabis inhaler device in a cohort of hospitalized patients that were using medical cannabis under license as a part of their ongoing medical treatment.
Before and after inhaling from the Syqe Inhaler, participants were asked to fill a questionnaire regarding pain reduction on a visual analog scale from 0 to 10 and, if relevant, reduction in chemotherapy-induced nausea and vomiting and/or spasticity. A patient satisfaction questionnaire and a usability questionnaire were filled in following the last use. Prescribed treatment included 4 daily doses of 500 μg tetrahydrocannabinol each delivered from 16 mg cannabis flos per inhalation plus up to an additional four SOS (distress code for more doses of cannabis) doses.
Daily cannabis dose consumed during hospitalization with the Syqe Inhaler was 51 mg (20–96) versus 1,000 mg (660-3,300) consumed prehospitalization. Patients were easily trained and continued to use Syqe Inhaler for the duration of their hospitalization (5 [3–7] days). Pain intensity 30–60 minutes following inhalations was reported to be significantly lower than preinhalation 4 [1–5] versus 7 [2–9]). Participants ranked their satisfaction with Syqe Inhaler as 6 (5–7). Three participants reported mild cough, which resolved spontaneously.
Significance of results
Cannabis inhalation by combustion is not feasible for hospitalized patients. The use of Syqe Inhaler during hospitalization yielded high levels of patients and staff satisfaction with no complications.
In daily clinical practice, the smooth, timely and comprehensive transfer of information between care settings is important and reflects a cornerstone of high-quality patient care. The integration of nutritional information in the medical information transfer is currently not included in an evidence-based approach. It was, therefore, the aim of this study to develop a nutritional documentation tool (NDoc) on the basis of evidence and test it for its usability in daily clinical practice. Based on the results of a literature review, the authors collected core content using a modified Delphi survey from experts across Europe and included the information collected in a structured, NDoc. The subsequently developed tool included thirty items and was tested for its usability on a daily basis among primary care physicians and clinical physicians. The new NDoc can be introduced for use in any computer-based hospital information system regionally and adapted for worldwide use.
Throughout the tropics, hunting and fishing are critical livelihood activities for many Indigenous peoples. However, these practices may not be sustainable following recent socio-economic changes in Indigenous populations. To understand how human population growth and increased market integration affect hunting and fishing patterns, we conducted semi-structured interviews in five Kukama-Kukamilla communities living along the boundary of the Pacaya-Samiria National Reserve, in the Peruvian Amazon. Extrapolated annual harvest rates of fish and game species by these communities amounted to 1,740 t and 4,275 individuals (67 t), respectively. At least 23 fish and 27 game species were harvested. We found a positive correlation between village size and annual community-level harvest rates of fish and a negative relationship between market exposure and mean per-capita harvest rates of fish. Catch-per-unit-effort (CPUE) analyses indicated local depletion of fish populations around larger, more commercial communities. Catch-per-unit-effort of fish was lower in more commercial communities and fishers from the largest village travelled further into the Reserve, where CPUE was higher. We found no effect of village size or market exposure on harvest rates or CPUE of game species. However, larger, more commercial communities targeted larger, economically valuable species. This study provides evidence that human population growth and market-driven hunting and fishing pose a growing threat to wildlife and Indigenous livelihoods through increased harvest rates and selective harvesting of species vulnerable to exploitation.
Empathy plays a central role in prosocial behavior and human cooperation. Very few twin researchers have investigated innate and environmental effects in adult empathy, and twin research on gender differences in these effects is sparse. The goal of this study was to examine innate and environmental influences on three components of an empathy scale frequently used with adults — the expression of cognitive (CE), emotional (EE), and social skills (SS) empathy — and to explore gender differences in the influences. Study participants were ~1,700 twins (18–65 years) enrolled in the Italian Twin Registry. Empathy was assessed with the Italian version of the Empathy Quotient (EQ), for which the three-factor structure (i.e., CE, EE, and SS) was confirmed. Twin correlations in monozygotic and dizygotic pairs, and males and females were estimated for the total EQ and subscale scores, and univariate genetic model fitting was carried out. Women's empathy (i.e., total EQ as well as CE and EE subdimensions) was predominantly driven by genetic factors and individual experiences, whereas for males, no genetic contribution or important shared and individual environmental effects emerged. Although of large magnitude, the gender differences did not reach statistical significance. Age did not moderate empathy heritability in adulthood. Only for the SS subscale were genetic and environmental proportions of variance similar for men and women. This study suggests possible gender-specific innate and environmental influences on empathy and its cognitive and emotional components that need to be confirmed in future studies.
The use of information technology in healthcare has accelerated progress toward the long-term goal of a learning healthcare system, in which data from prior clinical experience provides an ever-expanding resource to guide continuous improvements in health care. Although still in its early stages, the use of data from clinical experience to supplement data from premarket testing is changing the roles of Food and Drug Administration (FDA) and public and private health insurers in healthcare innovation and technology assessment. It could change who decides what research questions to pursue, whose evidentiary standards decide what counts as actionable knowledge, and who pays the costs of research. The shape and direction of resulting changes will depend on which actors and institutions decide to step forward and claim a larger role in healthcare innovation in response to technological and regulatory change.
Previous research suggests that mothers’ and fathers’ parenting may be differentially influenced by marital and child factors within the family. Some research indicates that marital stress is more influential in fathers’ than mothers’ parenting, whereas other research shows that children's difficult behavior preferentially affects mothers’ parenting. The present study examined marital stress and children's externalizing behavior in middle childhood as predictors of mothers’ versus fathers’ consistency, monitoring, and support and care in early adolescence, and the subsequent associations of these parenting behaviors with externalizing behavior 1.5 years later. Pathways were examined within a longitudinal mediation model testing for moderation by parent gender (N = 276 mothers, N = 229 fathers). Children's externalizing behavior in middle childhood was found to more strongly inversely predict mothers’ versus fathers’ monitoring in early adolescence. In contrast, marital stress more strongly predicted low monitoring for fathers than for mothers. Regardless of parent gender, marital stress predicted lower levels of parental consistency, and children's externalizing behavior predicted lower levels of parental support. Mothers’ monitoring and fathers’ support in early adolescence predicted lower levels of externalizing behavior 1.5 years later. The results are discussed with respect to family transactions relative to parent gender and implications for intervention.
We consider an insurance entity endowed with an initial capital and a surplus process modelled as a Brownian motion with drift. It is assumed that the company seeks to maximise the cumulated value of expected discounted dividends, which are declared or paid in a foreign currency. The currency fluctuation is modelled as a Lévy process. We consider both cases: restricted and unrestricted dividend payments. It turns out that the value function and the optimal strategy can be calculated explicitly.
Much of my work has addressed two issues. One is the development of empathy-related responding in children and its relation to prosocial behavior (e.g., helping and sharing) and to moral judgment and behavior. The other is emotion-related self-regulation and its relation to individuals’ positive social functioning and indices of maladjustment, including externalizing problems (e.g., aggression, defiance, and delinquency) and internalizing problems (e.g., depression, anxiety, and social withdrawal). Perhaps my most important findings are those that emerged from my work on empathy and led to my work on differences among people in the degree to which they regulate their emotions and associated behavior.
In my early work on prosocial behavior, I found that preschool children who spontaneously shared with other children at a cost to themselves (e.g., giving up toys they were using) were more likely than their peers to experience empathy or sympathy. Empathy is experiencing an emotion similar to that of another in response to comprehending what the other is feeling or is likely to experience (e.g., observers feeling sad when exposed to someone who is sad or likely to experience sadness). Sympathy is feelings of concern for another based on some understanding of their emotional state or situation (akin to compassion – e.g., feeling concern for a person who is sad rather than solely feeling sadness).
Those children who engaged in spontaneous prosocial behavior also were relatively likely to refer to others’ needs or feelings when discussing hypothetical moral dilemmas in which children had to decide whether to assist others at a cost to the self. Moreover, they engaged in more neutral and positive social interactions with peers and were assertive when they needed to be; their peers also reacted positively to them when they did engage in prosocial actions.
In contrast, children who were high in prosocial behavior mainly in response to peers’ requests (verbal or often non-verbal, e.g., reaching for an object) tended to be non-assertive and less social with peers than those who were spontaneously prosocial. Peers often would state or non-verbally indicate that they wanted help or reach for what children high in such requested or compliant prosocial behavior were playing with; thus, children high in requested prosocial behavior frequently seemed to be easy targets for peers wanting objects or assistance.
This chapter by the late distinguished Cornell Law professor proposes the development of a national civil justice survey to improve our base of knowledge of civil justice needs. Using a large data sample from households across the country, this survey would estimate the incidence of civil legal problems that people face, and document how they address them, if they do at all. It would gather demographic data about the respondents including where they live and their age, gender, race, and income level. The survey data would offer a comprehensive tool for understanding what civil legal needs exist and how they might be addressed.
Civil justice issues play a prominent role in society. Family law issues such as divorce and child custody, consumer victimization issues raised by questionable trade practices, and tort issues raised by surprisingly high estimated rates of medical malpractice, questionable prescription drug practices, and other behaviors are part of the fabric of daily life. Policymakers and interest groups regularly debate and assess whether civil problems are best resolved by legislative action, agency action, litigation, alternative dispute resolution, other methods, or some combination of actions. Yet we lack systematic quantitative knowledge about the primary events in daily life that generate civil justice issues. This chapter explores the desirability of, and issues related to, creating what I refer to as a national civil justice survey (NCJS), analogous to the National Crime Victimization Survey (NCVS).
The NCVS is the primary source of information on criminal victimization. The survey enables the Bureau of Justice Statistics (BJS) to estimate the likelihood of many crimes “for the population as a whole as well as for segments of the population such as women, the elderly, members of various racial groups, city dwellers, or other groups.” In 2005, U.S. residents age twelve or older experienced about twenty violent crimes per 1,000 people and about 150 property crimes per 1,000 people. In comparison, decades-old national research on incidence of civil problems suggests that adults experience a long-term risk of serious personal injury at the rate of 120 per 1,000 and a risk of serious property damage of 400 per 1,000. A more geographically limited early 1980s survey found that a three-year risk of having a civil justice grievance was 416 per 1,000.
Generative type abstractions – present in Haskell, OCaml, and other languages – are useful concepts to help prevent programmer errors. They serve to create new types that are distinct at compile time but share a run-time representation with some base type. We present a new mechanism that allows for zero-cost conversions between generative type abstractions and their representations, even when such types are deeply nested. We prove type safety in the presence of these conversions and have implemented our work in GHC.
Although meta-analytic neuroimaging studies demonstrate a relative lack of specificity in the brain, this evidence may be the result of limits inherent to these types of studies. From this perspective, we review recent findings that suggest that brain function is most appropriately categorized according to the computational capacity of each brain system, rather than the specific task states that elicit its activity.
Although ethics is an essential component of undergraduate medical education, research suggests that current medical ethics curricula face considerable challenges in improving students’ ethical reasoning. This article discusses these challenges and introduces a promising new mode of graduate and professional ethics instruction for overcoming them. We begin by describing common ethics curricula, focusing in particular on established problems with current approaches. Next, we describe a novel method of ethics education and assessment for medical students that we have devised: the Medical Ethics Bowl (MEB). Finally, we suggest the pedagogical advantages of the MEB when compared to other ethics curricula.
Despite the significant impact of malnutrition in hospitalised patients, it is often not identified by clinical staff in daily practice. To improve nutritional support in hospitals, standardised routine nutritional screening is essential. The Graz Malnutrition Screening (GMS) tool was developed for the purpose of malnutrition risk screening in a large hospital setting involving different departments. It was the aim of the present study to validate the GMS against Nutritional Risk Screening (NRS) and Mini Nutritional Assessment-short form (MNA-sf) in a randomised blinded manner. A total of 404 randomly selected patients admitted to the internal, surgical and orthopaedic wards of the University Hospital Graz were screened in a blinded manner by different raters. Concurrent validity was determined by comparing the GMS with the NRS and in older patients (70+ years) with the MNA-sf additionally. According to GMS, 31·9 or 28·5 % of the admitted patients were categorised as at ‘risk of malnutrition’ (depending on the rater). According to the reference standard of NRS, 24·5 % of the patients suffered from malnutrition. Pearson’s r values of 0·78 compared with the NRS and 0·84 compared with the MNA showed strong positive correlations. Results of accuracy (0·85), sensitivity (0·94), specificity (0·77), positive predictive value (0·76) and negative predictive value (0·95) of GMS were also very high. Cohen’s κ for internal consistency of the GMS was 0·82. GMS proves to be a valid and reliable instrument for the detection of malnutrition in adult patients in acute-care hospitals.
We contribute to the literature on the relations of temperament to externalizing and internalizing problems by considering parental emotional expressivity and child gender as moderators of such relations and examining prediction of pure and co-occurring problem behaviors during early to middle adolescence using bifactor models (which provide unique and continuous factors for pure and co-occurring internalizing and externalizing problems). Parents and teachers reported on children's (4.5- to 8-year-olds; N = 214) and early adolescents’ (6 years later; N = 168) effortful control, impulsivity, anger, sadness, and problem behaviors. Parental emotional expressivity was measured observationally and with parents’ self-reports. Early-adolescents’ pure externalizing and co-occurring problems shared childhood and/or early-adolescent risk factors of low effortful control, high impulsivity, and high anger. Lower childhood and early-adolescent impulsivity and higher early-adolescent sadness predicted early-adolescents’ pure internalizing. Childhood positive parental emotional expressivity more consistently related to early-adolescents’ lower pure externalizing compared to co-occurring problems and pure internalizing. Lower effortful control predicted changes in externalizing (pure and co-occurring) over 6 years, but only when parental positive expressivity was low. Higher impulsivity predicted co-occurring problems only for boys. Findings highlight the probable complex developmental pathways to adolescent pure and co-occurring externalizing and internalizing problems.
At approximately 30, 42, and 54 months of age (N = 231), the relations among children's externalizing symptoms, intrusive maternal parenting, and children's effortful control (EC) were examined. Both intrusive parenting and low EC have been related to psychopathology, but children's externalizing problems and low EC might affect the quality of parenting and one another. Mothers’ intrusive behavior with their children was assessed with observations, children's EC was measured with mothers’ and caregivers’ reports, and children's externalizing symptoms were assessed with mothers’, fathers’, and caregivers’ reports. In a structural equation panel model, bidirectional relations between intrusive parenting and EC were found: EC at 30 and 42 months predicted low levels of intrusive parenting a year later, controlling for prior levels of parenting and vice versa. Moreover, high levels of children's externalizing problems at both 30 and 42 months negatively predicted EC a year later, controlling for prior levels of EC. Although externalizing problems positively predicted high EC over time, this appeared to be a suppression effect because these variables had a strong negative pattern in the zero-order correlations. Moreover, when controlling for the stability of intrusive parenting, EC, and externalizing (all exhibited significant stability across time) and the aforementioned cross-lagged predictive paths, EC and externalizing problems were still negatively related within the 54-month assessment. The findings are consistent with the view that children's externalizing behavior undermines their EC and contributes to intrusive mothering and that relations between intrusive parenting and EC are bidirectional across time. Thus, interventions that focus on modifying children's externalizing problems (as well as the quality of parenting) might affect the quality of parenting they receive and, hence, subsequent problems with adjustment.