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The Art of Child and Adolescent Psychiatry is an engaging and authoritative account of the essential skills required to practice child and adolescent psychiatry for all those working in children's mental health, from trainees to experienced professionals in paediatrics, psychiatry, psychology, and psychotherapy. The practical tasks of meeting the child and family, planning treatments, and working with colleagues are all covered, building on existing texts that mainly focus on diagnostic criteria, protocols, and laws. This book respects the evidence base, while also pointing out its limitations, and suggests ways in which to deal with these. Psychiatry is placed within broader frameworks including strategy, learning, management, philosophy, ethics, and interpersonal relations. With over 200 educational vignettes of the authors' vast experience in the field, the book is also highly illustrated. The Art of Child and Adolescent Psychiatry is an indispensable guide to thoughtful practice in children's mental health.
John Stuart Mill is the father of modern liberalism. His most remembered work, On Liberty, which was published in 1859, changed the course of the liberal tradition. What is less well-known is that his ideas have profoundly influenced the American constitutional rights tradition of the latter half of the twentieth century. Mill's “harm principle” inspired the constitutional right to privacy recognized in Griswold v Connecticut, Roe v Wade and other cases. His defense of freedom of expression influenced Justices Holmes, Brandeis, Douglas, Kennedy and others and led to greatly expanded freedom of speech in the twentieth century. Finally, Mill was an ardent feminist whose last important work, The Subjection of Women, was a full-scale and, for its time, radical defense of complete gender equality. This is a book for lawyers who want to understand the intellectual origins of modern constitutional rights, and for political philosophers interested in the constitutional implications of Mill's conception of freedom.
Exploring the 'Nahda', a cultural renaissance in the Arab world responding to massive social change, this study presents a crucial and often overlooked part of the Arab world's encounter with global capitalist modernity, an interaction which reshaped the Middle East over the course of the long nineteenth century. Seeing themselves as part of an expanding capitalist civilization, Arab intellectuals approached the changing world of the mid-nineteenth century with confidence and optimism, imagining utopian futures for their own civilizing projects. By analyzing the works of crucial writers of the period, including Butrus al-Bustani and Rifa'a al-Tahtawi, alongside lesser-known figures such as the prolific journalist Khalil al-Khuri and the utopian visionary Fransis Marrash of Aleppo, Peter Hill places these visions within the context of their local class- and state-building projects in Ottoman Syria and Egypt, which themselves formed part of a global age of capital. By illuminating this little-studied early period of the Arab Nahda movement, Hill places the transformation of the Arab region within the context of world history, inviting us to look beyond the well-worn categories of 'traditional' versus 'modern'.
The steady advances in computer performance and in programming raise the concern that the ability of computers would overtake that of the human brain, an occurrence termed ‘the Singularity’. While comparing the size of the human brain and the advance in computer capacity, the Singularity has been estimated to occur within a few decades although the capacity of conventional computers may reach its limits in the near future. However, in the last few years, there have been rapid advances in artificial intelligence. There are already programs that carry out pattern recognition and self-learning which, at least in limited fields such as chess and other games, are superior to the best human players. Furthermore, the quantum computing revolution, which is expected to vastly increase computer capacities, is already on our doorstep. It now seems inevitable that the Singularity will arrive within the foreseeable future. Biological life, on Earth and on extraterrestrial planets and their satellites, may continue as before, but humanity could be ‘replaced’ by computers. Older and more advanced intelligent life forms, possibly evolved elsewhere in the Universe, may have passed their Singularity a long time ago. Post Singularity life would probably be based not on biochemical reactions but on electronics. Their communication may use effects such as quantum entanglement and be undetectable to us. This may explain the Fermi paradox or at least the ‘Big Silence’ problem in SETI.
Brette contends that the neural coding metaphor is an invalid basis for theories of what the brain does. Here, we argue that it is an insufficient guide for building an artificial intelligence that learns to accomplish short- and long-term goals in a complex, changing environment.
The Single Ventricle Reconstruction Trial randomised neonates with hypoplastic left heart syndrome to a shunt strategy but otherwise retained standard of care. We aimed to describe centre-level practice variation at Fontan completion.
Centre-level data are reported as median or median frequency across all centres and range of medians or frequencies across centres. Classification and regression tree analysis assessed the association of centre-level factors with length of stay and percentage of patients with prolonged pleural effusion (>7 days).
The median Fontan age (14 centres, 320 patients) was 3.1 years (range from 1.7 to 3.9), and the weight-for-age z-score was −0.56 (−1.35 + 0.44). Extra-cardiac Fontans were performed in 79% (4–100%) of patients at the 13 centres performing this procedure; lateral tunnels were performed in 32% (3–100%) at the 11 centres performing it. Deep hypothermic circulatory arrest (nine centres) ranged from 6 to 100%. Major complications occurred in 17% (7–33%). The length of stay was 9.5 days (9–12); 15% (6–33%) had prolonged pleural effusion. Centres with fewer patients (<6%) with prolonged pleural effusion and fewer (<41%) complications had a shorter length of stay (<10 days; sensitivity 1.0; specificity 0.71; area under the curve 0.96). Avoiding deep hypothermic circulatory arrest and higher weight-for-age z-score were associated with a lower percentage of patients with prolonged effusions (<9.5%; sensitivity 1.0; specificity = 0.86; area under the curve 0.98).
Fontan perioperative practices varied widely among study centres. Strategies to decrease the duration of pleural effusion and minimise complications may decrease the length of stay. Further research regarding deep hypothermic circulatory arrest is needed to understand its association with prolonged pleural effusion.
Pediatric long-term care facilities were surveyed to assess infection control and antimicrobial stewardship practices. Policies mandated by the Centers of Medicare and Medicaid Services (CMS) were included. Only 40% of sites reported implementing >90% of surveyed CMS policies. The survey also identified several gaps in non–CMS-mandated policies.
When the US Army established the Institute for Creative Technologies (ICT) at the University of Southern California in 1999, the vision was to push the boundaries of immersive technologies for the purpose of enhancing training and education; not only for the military but also for the rest of society. Over the past two decades great progress has been made on the technologies that support this vision. Breakthroughs in graphics, computer vision, artificial intelligence (AI), affective computing, and mixed reality have already transformed how we interact with one another, with digital media, and with the world. Yet this is in many ways only a starting point, since the application of these technologies is just beginning to be realized. The potential for making a positive impact on individuals and society is great, but there is also the possibility of misuse. This chapter describes some of the capabilities underlying the emerging field of immersive digital media; provides a couple of examples of how they can be used in a positive way; and then discusses the inherent dangers from an ethical standpoint.
Central-line–associated bloodstream infections (CLABSI) cause morbidity and mortality in critically ill children. We examined novel and/or modifiable risk factors for CLABSI to identify new potential targets for infection prevention strategies.
This single-center retrospective matched case-control study of pediatric intensive care unit (PICU) patients was conducted in a 60-bed PICU from April 1, 2013, to December 31, 2017. Case patients were in the PICU, had a central venous catheter (CVC), and developed a CLABSI. Control patients were in the PICU for ≥2 days, had a CVC for ≥3 days, and did not develop a CLABSI. Cases and controls were matched 1:4 on age, number of complex chronic conditions, and hospital length of stay.
Overall, 72 CLABSIs were matched to 281 controls. Univariate analysis revealed 14 risk factors, and 4 remained significant in multivariable analysis: total number of central line accesses in the 3 days preceding CLABSI (80+ accesses: OR, 4.8; P = .01), acute behavioral health needs (OR, 3.2; P = .02), CVC duration >7 days (8–14 days: OR, 4.2; P = .01; 15–29 days: OR, 9.8; P < .01; 30–59 days: OR, 17.3; P < .01; 60–89 days: OR, 39.8; P < .01; 90+ days: OR, 4.9; P = .01), and hematologic/immunologic disease (OR, 1.5; P = .05).
Novel risk factors for CLABSI in PICU patients include acute behavioral health needs and >80 CVC accesses in the 3 days before CLABSI. Interventions focused on these factors may reduce CLABSIs in this high-risk population.
The air gap technique (AGT) is an approach to radiation dose optimisation during fluoroscopy where an “air gap” is used in place of an anti-scatter grid to reduce scatter irradiation. The AGT is effective in adults but remains largely untested in children. Effects are expected to vary depending on patient size and the amount of scatter irradiation produced.
Fluoroscopy and cineangiography were performed using a Phillips Allura Fluoroscope on tissue simulation anthropomorphic phantoms representing a neonate, 5-year-old, and teenager. Monte Carlo simulations were then used to estimate effective radiation dose first using a standard recommended imaging approach and then repeated using the AGT. Objective image quality assessments were performed using an image quality phantom.
Effective radiation doses for the neonate and 5-year-old phantom increased consistently (2–92%) when the AGT was used compared to the standard recommended imaging approaches in which the anti-scatter grid is removed at baseline. In the teenage phantom, the AGT reduced effective doses by 5–59%, with greater dose reductions for imaging across the greater thoracic dimension of lateral projection. The AGT increased geometric magnification but with no detectable change in image blur or contrast differentiation.
The AGT is an effective approach for dose reduction in larger patients, particularly for lateral imaging. Compared to the current dose optimisation guidelines, the technique may be harmful in smaller children where scatter irradiation is minimal.
The admiration of the Soviet Union amongst Britain's interwar scientific left is well known. This article reveals a parallel story. Focusing on the biologists Julian Huxley and Lancelot Hogben and the scientific journalist J.G. Crowther, I show that a number of scientific thinkers began to look west, to the US. In the mid- to late 1930s and into the 1940s, Huxley, Crowther and Hogben all visited the US and commented favourably on Roosevelt's New Deal, in particular its experimental approach to politics (in the form of planning). Huxley was first to appreciate the significance of the experiment; he looked to the Tennessee Valley Authority as a model of democratic planning by persuasion that could also be applied in Britain. Crowther, meanwhile, examined the US through the lens of history of science. In Famous American Men of Science (1937) and in lectures at Harvard University, he aimed to shed light on the flaws in the Constitution which were frustrating the New Deal. Finally, Hogben's interest in the US was related to his long-standing opposition to dialectical materialism, and when he finally saw the US at first hand, he regarded it as a model for how to bring about a planned socialist society through peaceful persuasion.
Major depressive disorder and neuroticism (Neu) share a large genetic basis. We sought to determine whether this shared basis could be decomposed to identify genetic factors that are specific to depression.
We analysed summary statistics from genome-wide association studies (GWAS) of depression (from the Psychiatric Genomics Consortium, 23andMe and UK Biobank) and compared them with GWAS of Neu (from UK Biobank). First, we used a pairwise GWAS analysis to classify variants as associated with only depression, with only Neu or with both. Second, we estimated partial genetic correlations to test whether the depression's genetic link with other phenotypes was explained by shared overlap with Neu.
We found evidence that most genomic regions (25/37) associated with depression are likely to be shared with Neu. The overlapping common genetic variance of depression and Neu was genetically correlated primarily with psychiatric disorders. We found that the genetic contributions to depression, that were not shared with Neu, were positively correlated with metabolic phenotypes and cardiovascular disease, and negatively correlated with the personality trait conscientiousness. After removing shared genetic overlap with Neu, depression still had a specific association with schizophrenia, bipolar disorder, coronary artery disease and age of first birth. Independent of depression, Neu had specific genetic correlates in ulcerative colitis, pubertal growth, anorexia and education.
Our findings demonstrate that, while genetic risk factors for depression are largely shared with Neu, there are also non-Neu-related features of depression that may be useful for further patient or phenotypic stratification.
A growing body of research investigates the factors that enhance the research productivity and creativity of political scientists. This work provides a foundation for future research, but it has not addressed some of the most promising causal hypotheses in the general scientific literature on this topic. This article explicates the latter hypotheses, a typology of scientific career paths that distinguishes how scientific careers vary over time with respect to creative ambitions and achievements, and a research agenda based on the preceding components for investigation of the publication success of political scientists.
This article explores the phenomenon of ‘disaggregation’ of disputes in international law, that is, the carving up of broader disputes into discrete legal claims based on different international legal rules and subject to the jurisdiction of different international tribunals. In particular, its focus is on certain under-explored consequences of this phenomenon for the jurisdiction of international tribunals, asking whether the relationship between the specific claims and the broader dispute might affect the jurisdiction of the tribunals. Employing the ongoing Ukraine/Russia dispute, which has yielded multiple claims before different international tribunals, the article offers an original analysis of these jurisdictional questions. It presents three approaches discernible from case law where tribunals face claims over which they appear to have jurisdiction that implicate a broader dispute over which they do not. The article ends with a consideration of possible explanations for why a tribunal might follow one approach over the others in any given case.
Schmidt-hammer exposure-age dating (SHD) of boulders on cryoplanation terrace treads and associated bedrock cliff faces revealed Holocene ages ranging from 0 ± 825 to 8890 ± 1185 yr. The cliffs were significantly younger than the inner treads, which tended to be younger than the outer treads. Radiocarbon dates from the regolith of 3854 to 4821 cal yr BP (2σ range) indicated maximum rates of cliff recession of ~0.1 mm/yr, which suggests the onset of terrace formation before the last glacial maximum. Age, angularity, and size of clasts, together with planation across bedrock structures and the seepage of groundwater from the cliff foot, all support a process-based conceptual model of cryoplanation terrace development in which frost weathering leads to parallel cliff recession and, hence, terrace extension. The availability of groundwater during autumn freezeback is viewed as critical for frost wedging and/or the growth of segregation ice during prolonged winter frost penetration. Permafrost promotes cryoplanation by providing an impermeable frost table beneath the active layer, focusing groundwater flow, and supplying water for sediment transport by solifluction across the tread. Snow beds are considered an effect rather than a cause of cryoplanation terraces, and cryoplanation is seen as distinct from nivation.
While echocardiographic parameters are used to quantify ventricular function in infants with single ventricle physiology, there are few data comparing these to invasive measurements. This study correlates echocardiographic measures of diastolic function with ventricular end-diastolic pressure in infants with single ventricle physiology prior to superior cavopulmonary anastomosis.
Data from 173 patients enrolled in the Pediatric Heart Network Infant Single Ventricle enalapril trial were analysed. Those with mixed ventricular types (n = 17) and one outlier (end-diastolic pressure = 32 mmHg) were excluded from the analysis, leaving a total sample size of 155 patients. Echocardiographic measurements were correlated to end-diastolic pressure using Spearman’s test.
Median age at echocardiogram was 4.6 (range 2.5–7.4) months. Median ventricular end-diastolic pressure was 7 (range 3–19) mmHg. Median time difference between the echocardiogram and catheterisation was 0 days (range −35 to 59 days). Examining the entire cohort of 155 patients, no echocardiographic diastolic function variable correlated with ventricular end-diastolic pressure. When the analysis was limited to the 86 patients who had similar sedation for both studies, the systolic:diastolic duration ratio had a significant but weak negative correlation with end-diastolic pressure (r = −0.3, p = 0.004). The remaining echocardiographic variables did not correlate with ventricular end-diastolic pressure.
In this cohort of infants with single ventricle physiology prior to superior cavopulmonary anastomosis, most conventional echocardiographic measures of diastolic function did not correlate with ventricular end-diastolic pressure at cardiac catheterisation. These limitations should be factored into the interpretation of quantitative echo data in this patient population.