To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Scholarly literature claims that health declines in populations when optimism about investing in the future wanes. This claim leads us to describe collective optimism as a predictor of selection in utero. Based on the literature, we argue that the incidence of suicide gauges collective optimism in a population and therefore willingness to invest in the future. Using monthly data from Sweden for the years 1973–2016, we test the hypothesis that the incidence of suicide among women of child-bearing age correlates inversely with male twin births, an indicator of biological investment in high-risk gestations. We find that, as predicted by our theory, the incidence of suicide at month t varies inversely with the ratio of twin to singleton male births at month t + 3. Our results illustrate the likely sensitivity of selection in utero to change in the social environment and so the potential for viewing collective optimism as a component of public health infrastructure.
The National Academy of Sciences-National Research Council (NAS-NRC) Twin Registry is one of the oldest, national population-based twin registries in the USA. It comprises 15,924 White male twin pairs born in the years 1917–1927 (N = 31.848), both of whom served in the armed forces, chiefly during World War II. This article updates activities in this registry since the most recent report in Twin Research and Human Genetics (Page, 2006). Records-based data include information from enlistment charts and Veterans Administration data linkages. There have been three major epidemiologic questionnaires and an education and earnings survey. Separate data collection efforts with the NAS-NRC registry include the National Heart, Lung, and Blood Institute (NHLBI) subsample, the Duke Twins Study of Memory in Aging and a clinically based study of Parkinson’s disease. Progress has been made on consolidating the various data holdings of the NAS-NRC Twin Registry. Data that had been available through the National Academy of Sciences are now freely available through National Archive of Computerized Data on Aging (NACDA).
To evaluate the clinical impact of an antimicrobial stewardship program (ASP) on high-risk pediatric patients.
Retrospective cohort study.
Free-standing pediatric hospital.
This study included patients who received an ASP review between March 3, 2008, and March 2, 2017, and were considered high-risk, including patients receiving care by the neonatal intensive care (NICU), hematology/oncology (H/O), or pediatric intensive care (PICU) medical teams.
The ASP recommendations included stopping antibiotics; modifying antibiotic type, dose, or duration; or obtaining an infectious diseases consultation. The outcomes evaluated in all high-risk patients with ASP recommendations were (1) hospital-acquired Clostridium difficile infection, (2) mortality, and (3) 30-day readmission. Subanalyses were conducted to evaluate hospital length of stay (LOS) and tracheitis treatment failure. Multivariable generalized linear models were performed to examine the relationship between ASP recommendations and each outcome after adjusting for clinical service and indication for treatment.
The ASP made 2,088 recommendations, and 50% of these recommendations were to stop antibiotics. Recommendation agreement occurred in 70% of these cases. Agreement with an ASP recommendation was not associated with higher odds of mortality or hospital readmission. Patients with a single ASP review and agreed upon recommendation had a shorter median LOS (10.2 days vs 13.2 days; P < .05). The ASP recommendations were not associated with high rates of tracheitis treatment failure.
ASP recommendations do not result in worse clinical outcomes among high-risk pediatric patients. Most ASP recommendations are to stop or to narrow antimicrobial therapy. Further work is needed to enhance stewardship efforts in high-risk pediatric patients.
Dietary quality (DQ), as assessed by the Alternative Healthy Eating Index for Pregnancy (AHEI-P), and conception and pregnancy outcomes were evaluated.
In this prospective cohort study on couples planning their first pregnancy. Cox proportional hazards regression assessed the relationship between AHEI-P score and clinical pregnancy, live birth and pregnancy loss.
Participants were recruited from the Northeast region of the USA.
Participants: Healthy, nulliparous couples (females, n 132; males, n 131; one male did not enrol).
There were eighty clinical pregnancies, of which sixty-nine resulted in live births and eleven were pregnancy losses. Mean (sd) female AHEI-P was 71·0 (13·7). Of those who achieved pregnancy, those in the highest tertile of AHEI-P had the greatest proportion of clinical pregnancies; however, this association was not statistically significant (P = 0·41). When the time it took to conceive was considered, females with the highest AHEI-P scores were 20 % and 14 % more likely to achieve clinical pregnancy (model 1: hazard ratio (HR) = 1·20; 95 % CI 0·66, 2·17) and live birth (model 1: HR = 1·14; 95 % CI 0·59, 2·20), respectively. Likelihood of achieving clinical pregnancy and live birth increased when the fully adjusted model, including male AHEI-P score, was examined (clinical pregnancy model 4: HR = 1·55; 95 % CI 0·71, 3·39; live birth model 4: HR = 1·36; 95 % CI 0·59, 3·13).
The present study is the first to examine AHEI-P score and achievement of clinical pregnancy. DQ was not significantly related to pregnancy outcomes, even after adjustments for covariates.
OBJECTIVES/SPECIFIC AIMS: Engaging patients and consumers in research is a complex process where innovative strategies are needed to effectively translate scientific discoveries into improvements in the public’s health (Wilkins et. al., 2013; Terry et. al., 2013). The Clinical Translational Science Awards (CTSA)—supported by the National Institute of Health (NIH) under the auspices of the National Center for Advancing Translational Sciences (NCATS)—aim to provide resources and support needed to strengthen our nation’s clinical and translational research (CTR) enterprise. In 2008, Stanford University was awarded a CTSA from the NIH, establishing Spectrum (Stanford Center for Clinical and Translational Research and Education) and its Community Engagement (CE) Program aimed at building long-standing community-academic research partnerships for translational research in the local area surrounding Stanford University. To date, the CE Pilot Program has funded 38 pilot projects from the 2009-2017 calendar year. The purpose of this study was to understand, through a unique pilot program, the barriers, challenges, and facilitators to community-engaged research targeting health disparities as well as community-academic partnerships. METHODS/STUDY POPULATION: Investigators conducted a qualitative study of the community engagement pilot program. Previous pilot awardees were recruited via email and phone to participate in a one-hour focus group to discuss their pilot project experience—describing any barriers, challenges, and facilitators to implementing their pilot project. RESULTS/ANTICIPATED RESULTS: The focus group revealed that community engage research through the pilot program was not only appreciated by faculty, but projects were successful, and partnerships developed were sustained after funding. Specifically, the pilot program has seen success in both traditional and capacity building metrics: the initial investment of $652,250.00 to fund 38 projects has led to over $11 million dollars in additional grant funding. In addition, pilot funding has led to peer-reviewed publications, data resources for theses and dissertations, local and national presentations/news articles, programmatic innovation, and community-level impact. Challenges and barriers were mainly related to timing, grant constraints, and university administrative processes. DISCUSSION/SIGNIFICANCE OF IMPACT: The Community Engagement Pilot Program demonstrates an innovative collaborative approach to support community-academic partnerships. This assessment highlights the value and importance of pilot program to increase community engaged research targeting health disparities. Challenges are mainly administrative in nature: pilot awardees mentioned difficulties working on university quarterly timelines, challenges of subcontracting or sharing money with community partners, onerous NIH prior approval process, and limitations to carryover funding. However, pilot grants administered through the program strengthen the capacity to develop larger scale community-based research initiatives.
OBJECTIVES/SPECIFIC AIMS: Our objective was to compare the proteomics of HDL between youth with T1DM and healthy controls (HC). METHODS/STUDY POPULATION: We did chromatography-based HDL purification and SWATH-MS-based proteomic quantitation. Proteomic alterations of HDL fractions and their association with glycemic control was examined. Study population: 26 patients with T1DM and 13 HC. RESULTS/ANTICIPATED RESULTS: We quantified 78 proteins in isolated HDL, using mass spectrometry and label-free SWATH quantification. Youth with T1DM had significantly higher protein levels of A1BG (P = 0.008), A2AP (P = 0.0448), APOA4 (P = 0.0366), CFAH (P = 0.0476), FHR2 (P = 0.0005), ITIH4(P = 0.01), PGRP2 (P = 0.0167) and lower levels of ALBU (P = 0.0164) and CO3 (P = 0.019) compared to HC. A1BG (r=0.541, P<0.001) and ITIH4 (r=0.357, P = 0.026) were significantly positively correlated with HbA1c. DISCUSSION/SIGNIFICANCE OF IMPACT: Youth with T1DM have proteomic alterations of their HDL compared to HC, despite similar concentration of HDL cholesterol, that might affect the cardioprotective mechanisms of HDL. Future efforts should focus on investigating the role of these HDL associated proteins in regard to HDL function and their role in CVD risk in patients with T1DM.
To verify the previously untested assumption that eating more salad enhances vegetable intake and determine if salad consumption is in fact associated with higher vegetable intake and greater adherence to the Dietary Guidelines for Americans (DGA) recommendations.
Individuals were classified as salad reporters or non-reporters based upon whether they consumed a salad composed primarily of raw vegetables on the intake day. Regression analyses were applied to calculate adjusted estimates of food group intakes and assess the likelihood of meeting Healthy US-Style Food Pattern recommendations by salad reporting status.
Cross-sectional analysis of data collected in 2011–2014 in What We Eat in America, the dietary intake component of the National Health and Nutrition Examination Survey.
US adults (n 9678) aged ≥20 years (excluding pregnant and lactating women).
On the intake day, 23 % of adults ate salad. The proportion of individuals reporting salad varied by sex, age, race, income, education and smoking status (P<0·001). Compared with non-reporters, salad reporters consumed significantly larger quantities of vegetables (total, dark green, red/orange and other), which translated into a two- to threefold greater likelihood of meeting recommendations for these food groups. More modest associations were observed between salad consumption and differences in intake and likelihood of meeting recommendations for protein foods (total and seafood), oils and refined grains.
Study results confirm the DGA message that incorporating more salads in the diet is one effective strategy (among others, such as eating more cooked vegetables) to augment vegetable consumption and adherence to dietary recommendations concerning vegetables.
We discuss a variational model, given by a weighted sum of perimeter, bending and Riesz interaction energies, that could be considered as a toy model for charged elastic drops. The different contributions have competing preferences for strongly localized and maximally dispersed structures. We investigate the energy landscape in dependence of the size of the ‘charge’, that is, the weight of the Riesz interaction energy.
In the two-dimensional case, we first prove that for simply connected sets of small elastica energy, the elastica deficit controls the isoperimetric deficit. Building on this result, we show that for small charge the only minimizers of the full variational model are either balls or centred annuli. We complement these statements by a non-existence result for large charge. In three dimensions, we prove area and diameter bounds for configurations with small Willmore energy and show that balls are the unique minimizers of our variational model for sufficiently small charge.
Financial and economic sanctions are often adopted to serve multiple ends, including deterrence and prevention, but they are best understood as a tool to incentivize change in a target's behavior. In pursuit of this coercive objective, it is generally—but not always—the case that sanctions are more effective when they are imposed multilaterally, and the broader the coalition the better. This is because multilateral sanctions leverage the diverse sources of pressure that coalition partners can bring to bear on a target and carry with them the legitimacy of broad international support. Taken to its extreme, this argument may suggest that sanctions should always be multilateral, whether adopted through the United Nations, another forum, or an ad hoc coalition. But as we explain below, there are at least two significant reasons that militate in favor of unilateral sanctions. First, within the broad limits of international law, every country must retain the authority to impose sanctions to protect its sovereign security interests, even when it cannot muster a coalition of like-minded allies or a sufficient number of votes—and avoid a veto—on the UN Security Council. Second, imposing “smart” sanctions is actually a difficult business, requiring a complex administrative apparatus to design, build, implement, enforce, and defend them. International institutions, including the United Nations, are inherently less able to build the necessary structures to effectively enforce sanctions. For all of these reasons, two systems of sanctions—one national, one supranational—will likely coexist into the future.
We retrospectively evaluated the effect of penicillin adverse drug reaction (ADR) labeling on surgical antibiotic prophylaxis. Cefazolin was administered in 86% of penicillin ADR-negative (−) and 28% penicillin ADR-positive (+) cases. Broad-spectrum antibiotic use was more common in ADR(+) cases and was more commonly associated with perioperative adverse drug events.
Objectives: The cognitive indicators of preclinical behavioral variant Frontotemporal Dementia (bvFTD) have not been identified. To investigate these indicators, we compared cross-sectional performance on a range of cognitive measures in 12 carriers of pathogenic MAPT mutations not meeting diagnostic criteria for bvFTD (i.e., preclinical) versus 32 demographically-matched familial non-carriers (n = 44). Studying preclinical carriers offers a rare glimpse into emergent disease, environmentally and genetically contextualized through comparison to familial controls. Methods: Evaluating personnel blinded to carrier status administered a standardized neuropsychological battery assessing attention, speed, executive function, language, memory, spatial ability, and social cognition. Results from mixed effect modeling were corrected for multiplicity of comparison by the false discovery rate method, and results were considered significant at p < .05. To control for potential interfamilial variation arising from enrollment of six families, family was treated as a random effect, while carrier status, age, gender, and education were treated as fixed effects. Results: Group differences were detected in 17 of 31 cognitive scores and spanned all domains except spatial ability. As hypothesized, carriers performed worse on specific measures of executive function, and social cognition, but also on measures of attention, speed, semantic processing, and memory storage and retrieval. Conclusions: Most notably, group differences arose on measures of memory storage, challenging long-standing ideas about the absence of amnestic features on neuropsychological testing in early bvFTD. Current findings provide important and clinically relevant information about specific measures that may be sensitive to early bvFTD, and advance understanding of neurocognitive changes that occur early in the disease. (JINS, 2019, 25, 184–194)
It is a joy to be hidden and a disaster not to be found.
—D. W. Winnicott 1965
MY AIM IN THIS ESSAY lies in forging a link between the works of Canadian Nobel Prize-winning short-story writer Alice Munro and American cartoonist Alison Bechdel, author of two best-selling graphic memoirs. Several features motivate my interest in comparing Munro's Who Do You Think You Are? (1978) to Bechdel's first graphic memoir, Fun Home: A Family Tragicomic (2006). Both authors work within non-canonical genres—the short story and the graphic narrative, respectively— to probe existential questions related to lineage, inheritance, and identity. Recalling Munro's title, Fun Home poses a related question: “Why am I who I am?” (Mitchell 2009). Both Munro's and Bechdel's narratives align identity with the uncanny, intergenerational workings of shame. Perhaps Ann Cvetkovich best describes their shared preoccupation when she notes that Fun Home is “haunted by questions about the effects of growing up in the vicinity of a powerful combination of violence and secrecy, including forms of secrecy that in the interest of protecting children's innocence seem only to harm them” (2008, 113). Inflected by gothic notions of uncanny inheritance, Bechdel's and Munro's narratives locate the most corrosive, shaming mechanisms of social reproduction within the private recesses of the home.
Drawing on my previous scholarship on Munro's treatment of shame and the imposition of normative gender roles, in what follows I trace Bechdel's equally complex re-staging of related traumatic, shame-filled events associated with the formation of her sexual and gender identity as a lesbian. A central comic (happy) strand of Fun Home traces Alison's coming out. But this story remains subordinate to the narrative that commemorates the tragic life of her father, Bruce Bechdel, a closeted homosexual attracted to adolescent boys, who died in 1980 when he was forty-four. Born in 1936, in the isolated, rural town of Beech Creek, Pennsylvania, Bruce worked in his hometown as a part-time mortician and a high-school English teacher. As a young man, he aspired to a bohemian, artistic life abroad in Europe, but he was called home after his father had a heart attack in order to run the family business—the Bechdel Funeral Home, founded by Bruce's great-grandfather.
Food insufficiency, defined by the experience of hunger, is known to be prevalent and a source of health-related harm among-street involved youth, but little is known about its relationship with depression in this population. Therefore, we sought to assess the association between food insufficiency and symptoms of depression among a cohort of street-involved youth.
Multivariable logistic regression was used to assess the relationship between food insufficiency, defined as being hungry but not having enough money to buy food, and depression as measured by the Center for Epidemiological Studies Depression (CES-D) scale.
Data from April 2006 to November 2013 were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth who use illicit drugs in Vancouver, Canada.
There were 1066 street-involved youth enrolled in the study, including 340 (31·9 %) females.
Of 1066 youth enrolled in the study, 724 (67·9 %) reported some food insufficiency and 565 (53·0 %) met criteria for depression. Compared with youth who did not report food insufficiency, those who reported often experiencing food insufficiency had a higher likelihood of reporting depression (adjusted OR=2·52; 95 % CI 1·74, 3·67), as did those who reported sometimes experiencing food insufficiency (adjusted OR=1·99; 95 % CI 1·47, 2·70).
Food insufficiency was prevalent and associated in a dose-dependent trend with symptoms of depression among street-involved youth in our setting. Findings highlight the need to address the nutritional and mental health needs of youth and identify pathways by which food insufficiency may contribute to depression among vulnerable populations.
Jessica Berman, Humanities at the University of Maryland, Baltimore County (UMBC).,
Jane Goldman, Reader in English at Glasgow University,
Susan Sellers, Professor of English at St Andrews University.,
Bryony Randall, Senior Lecturer in English Literature at the University of Glasgow.,
Madeleine Detloff, Professor of English and Global and Intercultural Studies at Miami University.
I will put my cards on the table—I never wanted to edit a Companion—to Virginia Woolf or any other writer. In fact, companions scare me. They create the appearance of coverage or the definitive word on any particular topic or subject. The very notion of a “companion” presumes familiarity, comradery, or friendship—or at least the prospect of these relations. Handbooks, even at their most perspicacious, invite us to think the topic can be made ready “to hand,” and often must find ways to make that possible—excising the unfamiliar, the far flown, or the foreign. The Cambridge Companion to Modernism, admittedly, a 1999 volume updated more than five years ago, barely ventures outside Anglo-American writing, except by reference to Picasso, Freud, Marx, et al., and rarely moves outside of the period between the last decade of the 19th century and WWII. I wonder, what happens to a writer like Gustave Flaubert in these models— or that painter of modern life, Charles Baudelaire? What happens to the writers in the colonies, whose lack of access to cultural and economic power often means they don't “do” modernism or modernity until the second half of the century? In an effort to make these volumes less about traditional categories of coverage, Cambridge has begun to issue companions that look more like conventional essay collections, such as The Cambridge Companion to Literature and the Posthuman, or a recent one I've contributed to: The Cambridge Companion to Transnational American Literature. This is a good impulse, but it is hard to know why these should still be called “companions,” when those are, by their own definition, “a series of authoritative guides, written by leading experts, offering lively, accessible introductions to major writers, artists, philosophers, topics, and periods.” Not to pick on Cambridge—Wiley Blackwell has also started to make more topical and less generic companions, like the Feminist Companion to Shakespeare, now in its second edition. This looks like a terrific book, with a whole section on “Race and Colonialism,” and another on “Performing Sexuality.” But I fear that companions are crowding out other work in the field, making it harder to publish groundbreaking monographs or other adventurous work that doesn't purport to provide a general overview.
According to the Oxford English Dictionary Arnold Bennett, no less, the famed pantomime rival of Bloomsbury, is the earliest source in Britain of queer's modern “chiefly derogatory” usage. He uses it in a diary entry of 26 March 1915 (published in 1932)—although it is difficult to assess how derogatory, if at all, this instance is: “An immense reunion of art students, painters, and queer people. Girls in fancy male costume, queer dancing, etc.” (OED; Bennett 550).
Turning to the source, we discover that the evening in question was a thoroughly Bloomsbury affair, involving a visit to an exhibition of radical art by the London Group (“some nice things but all imitative”), and thence to dinner with Lady Ottoline Morrell where Bennett finds “Lowes Dickinson, Bertrand Russell, Whitehouse. All these very much upset by the war, convinced that the war and government both wrong, etc.” (Bennett 127). Having witnessed the Bloomsbury related art and pacifism that inform many of the contributions to Queer Bloomsbury, Bennett's account of his evening with the Morrells concludes with a glimpse of Bloomsbury masquerade, orientalism and queer sexualities too:
Afterwards, an immense reunion of Art Students, painters, and queer people. Girls in fancy male costume, queer dancing etc. A Japanese dancer. We left at 12.15. Pianola. Fine pictures. Glorious drawings by Picasso. Excellent impression of host and hostess. (Bennett 127)
The “queer people” on this occasion did not include Virginia Woolf whose debut novel, The Voyage Out, was published the day after this party (i.e. 26 March 1915) and who was convalescing in a nursing home following a bout of mental illness, but it seems likely that her sister and other Bloomsbury members were present. Her novel, which incidentally Vanessa Bell on its publication described as “a queer business” (Spalding VB 137), “appeared amid a season of unparalleled gaiety,” according to Frances Spalding, when “[a]s if in defiance of the war, Lady Ottoline Morrell was holding parties every Thursday” (Spalding VB 137).