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The Loeb translates lines 15–16 ʻlet him remember that mortal are the limbs he clothes and that earth is the last garment of all he will wear'. It is debatable whether τελευτάν is an adverbial accusative with ἁπάντων added as a qualifying genitive, as it seems more natural to take the phrase as a simple apposition to γᾶν. But there is a real difficulty in that τελευτὰν ἁπάντων could be taken to indicate that death is ‘the end of everything’ (or ʻof all men') and that contradicts indications elsewhere in Pindar that death is not, or at least not quite, the end.
For he [sc. Melissus, the victor] resembles the boldness of loudly roaring wild lions in his heart during the struggle, but in skill he is a fox, which rolls on its back to check the eagle's swoop. One must do everything to diminish one's opponent.
The pandemic that convulsed the globe in 2020 was long foretold but still surprising to many. Within a few months of its appearance, COVID-19 became one of the leading causes of death worldwide. Governments struggled at first to comprehend what was happening – and then reacted in very different ways. Most political leaders followed the advice of epidemiologists. Many declared states of emergency. A few pursued autocratic agendas. And some did almost nothing.
During emergencies, constitutional scholars normally worry about executive aggrandizement at the expense of human rights and democratic values. Emergencies often require national executives to act quickly and forcefully to stave off threats. But emergencies also give national executives the opportunity to consolidate power, just when parliaments and courts are least keen to take responsibility. As we will show, the pandemic has provided a textbook example of this phenomenon, reinforcing what we know from the literature on emergencies that “executive overreach” is a serious problem.
The concept of the Anthropocene has highlighted the significant global impact of human activities on ecological systems on a geological scale (Crutzen 2002). This concept has come to significantly influence a scientific and political agenda orientated towards documenting and denouncing multiple negative anthropogenic factors that have led to global change. Nevertheless, not all large-scale environmental transformations by human societies have been intrinsically destructive. Many indigenous communities in the Neotropics, Palearctic, sub-Saharan Africa, North America, Indo-Malaya and Australasia have radically – albeit often constructively – modified the physical and biotic conditions of the ecological systems that they inhabit (Ellis 2015). It is necessary to revise the assumption that human actions always degrade the environment, through a reconceptualization that we have previously called ‘anthropogenesis’ (Rivera-Núñez et al. 2020). Instead of the naïve portrayal of the ‘good Anthropocene’ (Hamilton 2015, Fremaux & Barry 2019), anthropogenesis seeks to enrich the biodiversity debate with the historical human expressions of constructed environments that the conservation-focused ‘Edenic sciences’ and the ‘pristine syndrome’ (Robbins & Moore 2013) tend to ignore, or ‘Anthropo-not-see’ (de la Cadena 2019). The objective of this comment paper is to urge the academic community, grassroots organizations and governments to employ a concept of ‘palimpsest’ (from the Ancient Greek for ‘again scraped’, implying that something is scraped clear ready to be used again) in the reconceptualization of biodiversity conservation from a historical perspective that implements research and policy agendas that incorporate the human propensity for environmental construction in a deeper and more inclusive manner.
Legal scholars are familiar with the problem of executive overreach, especially in emergencies. But sometimes, instead of being too audacious or extreme, a national executive's attempts to address a true threat prove far too limited and insubstantial. In this Essay, we seek to define and clarify the phenomenon of executive underreach, with special reference to the COVID-19 crisis; to outline ways in which such underreach may compromise constitutional governance and the international legal order; and to suggest a partial remedy.
Background: A prolonged outbreak of carbapenemase-producing Serratia marcescens (CPSM) was identified in our quaternary healthcare center over a 2-year period from 2015 through 2017. A reservoir of IMP-4–producing S. marcescens in sink drains of clinical hand basins (CHB) was implicated in propagating transmission, supported by evidence from whole-genome sequencing (WGS). We assessed the impact of manual bioburden reduction intervention on further transmission of CPSM. Methods: Environmental sampling of frequently touched wet and dry areas around CPSM clinical cases was undertaken to identify potential reservoirs and transmission pathways. After identifying CHB as a source of CPSM, a widespread annual CHB cleaning intervention involving manual scrubbing of sink drains and the proximal pipes was implemented. Pre- and postintervention point prevalence surveys (PPS) of CHB drains performed to assess for CPSM colonization. Surveillance for subsequent transmission was conducted through weekly screening of patients and annual screening of CHB in transmission areas, and 6-monthly whole-hospital PPS of patients. All CPSM isolates were assessed by WGS. Results: In total, 6 patients were newly identified with CPSM from 2015 to 2017 (4.3 transmission events per 100,000 surveillance bed days [SBD]; 95% CI, 1.6–9.4). All clinical CPSM isolates were linked to CHB isolates by WGS. The CHB cleaning intervention resulted in a reduction in CHB colonization with CPSM in transmission areas from 72% colonization to 28% (ARR, 0.44; 95% CI, 0.25–0.63). A single further clinical case of CPSM linked to the CHB isolates was detected over 2 years of surveillance from 2017 to 2019 following the implementation of the annual CHB cleaning program (0.7 transmissions per 100,000 SBD; 95% CI, 0.0–3.9). No transmissions were linked to undertaking the cleaning intervention. Conclusions: A simple intervention targeted at reducing the biological burden of CPSM in CHB drains at regular intervals was effective in preventing transmission of carbapenemase-producing Enterobacterales from the hospital environment to patients over a prolonged period of intensive surveillance. These findings highlight the importance of detailed cleaning for controlling the spread of multidrug-resistant organisms from healthcare environments.
Ferroelectrics and related materials (e.g., non-traditional ferroelectrics such as relaxors) have long been used in a range of applications, but with the advent of new ways of modeling, synthesizing, and characterizing these materials, continued access to astonishing breakthroughs in our fundamental understanding come each year. While we still rely on these materials in a range of applications, we continue to re-write what is possible to be done with them. In turn, assumptions that have underpinned the use and design of certain materials are progressively being revisited. This perspective aims to provide an overview of the field of ferroelectric/relaxor/polar-oxide thin films in recent years, with an emphasis on emergent structure and function enabled by advanced synthesis, processing, and computational modeling.
Housekeeping genes (HKG) are paramount for accurate gene expression analysis during preimplantation development. Markedly, quantitative reverse transcription polymerase chain reaction (RT-qPCR) in ovine embryos currently lacks HKGs. Therefore, we tested 11 HKGs for RT-qPCR normalization during ovine parthenogenetic preimplantation development. Seven HKGs reached the qPCR efficiency threshold (97.20–105.96%), with correlation coefficients ranging from −0.922 to −0.998 and slopes from −3.22 to −3.59. GeNorm ranked glyceraldehyde 3-phosphate dehydrogenase (GAPDH) and TATA-binding protein (TBP) as the best HKG pair, while H3 histone, family 3A (H3F3A) was the third HKG. Relative gene expression was measured for zinc finger protein X-linked (ZFX) and developmental pluripotency-associated 3 (DPPA3) transcripts during ovine parthenogenetic preimplantation development. ZFX did not show any transcript abundance fluctuation among oocytes, cleavage-stage embryos, and morulae. DPPA3 transcript abundance was also similar among all developmental stages, therefore suggesting that it may not display a maternal gene expression profile. In silico analysis of ovine DPPA3 mRNA and protein showed high conservation to bovine orthologues. However, DPPA3 orthologues differed in regulatory motifs. In conclusion, GAPDH, TBP and H3F3A are stable HKGs in ovine parthenogenetic embryos and allow accurate RT-qPCR-based gene expression analysis.
Bishops played a crucial part in the government of England and in the consolidation of the Anglo-Norman regime after 1066. Yet in spite of their fundamental importance, many of the Conqueror's bishops remain shadowy figures, especially those who began their careers as secular clerks rather than monks. Their political contribution can often be detected most clearly in contemporary documentary sources. Nowhere is this more apparent than in the corpus of texts associated with the Domesday survey of 1086, through which the Conqueror sought to formalize and codify his conquest.
Exeter, Cathedral Library, MS 3500, better known as Exon Domesday, is the earliest surviving product of the survey. It is a remarkable witness to a formidable administrative undertaking. The manuscript is a partially preserved record of the stage of the Domesday process immediately anterior to the compilation of Great Domesday Book, for the five south-western counties which comprised ‘Circuit II’ of the survey. The majority of the text consists of entries about manors, structured like the entries in Great Domesday Book, though containing extra information which is omitted from Great Domesday, especially material concerning livestock.
The text has been edited only once, by Henry Ellis in 1816, and is unavailable in translation. Now, however, the AHRC-funded project ‘The Conqueror's Commissioners: Unlocking the Domesday Survey in the South West of England’ is working towards redressing that neglect. Its aim is to make material relating to Exon more accessible to scholars, including an online facsimile, expanded Latin text, English translation, and a full palaeographical and codicological description, and thereby to offer valuable new insights into long-standing debates about the execution and the purpose of the survey.
In its current form, this main portion of the text (hereafter referred to as Exon Fiefs) is incomplete. It covers all of Somerset and Cornwall and most of Devon, but only about half of Dorset and a single manor in Wiltshire. The entries are arranged feudally, with the lands of each tenant-in-chief grouped together. There is a major divide between entries pertaining to Devon, Cornwall and Somerset, on the one hand, and Dorset and Wiltshire on the other. Thus the estates of tenants-in-chief like William de Moyon (d. after 1090), who held land in Wiltshire, Dorset, Somerset and Devon, are recorded in two separate sections.
OBJECTIVES/GOALS: The objectives of this presentation are to discuss 1) the implementation of Consent to Contact at an Academic Medical Center; 2) the access to lists of potential participants by study teams; and 3) the challenges and adjustments made to the initial conceptualized process. METHODS/STUDY POPULATION: Participant recruitment is critical to the success of all research studies. It is particularly challenging when investigators do not have a patient population from which to recruit. Thus, the University of Miami launched the CTC initiative in 2016 to facilitate study recruitment. Study investigators can request access to a registry of participants who agreed to be contacted and meet the initial study eligibility criteria. A multidisciplinary Operational Committee provides oversight and regulates access to the CTC registry. RESULTS/ANTICIPATED RESULTS: The registry has over 110K patients who have agreed to be contacted for eligible research studies. The demographic distribution of the patients in the registry mirrors the diversity of the UHealth population. As of January 2018, when the registry became available to the research community, 25 study teams from different departments, including the All of Us Research Program, have requested potential participant lists. The process of requesting access to patient lists is adapted to studies’ needs, with particular reference to sensitive populations, such as HIV/AIDS, substance abuse, etc. Results on utilization and satisfaction of the CTC initiative are being collected and will be presented. DISCUSSION/SIGNIFICANCE OF IMPACT: The CTC initiative allows UHealth patients to opt-in to the registry for research studies. The Operational Committee continues to monitor the successful consent of patients to participate in individual research studies and improving the request process.
We analyzed the δ2H composition of n-alkanes isolated from Laguna Zoncho, a small lake in southern Pacific Costa Rica, to reconstruct paleohydrology. Using a core that spans the past 3600 years, we found evidence of dry periods, most notably during the Terminal Classic Drought (TCD; ~1200 cal yr BP) and the Little Ice Age (~400 cal yr BP). Previous work at Laguna Zoncho, using bulk sedimentary δ13C and geochemical analysis, found that agriculture began to decline during the TCD. Our δ2H records confirm the occurrence of arid conditions coincident with the TCD at Laguna Zoncho and show that, despite receiving more than 3000 mm of precipitation per year, this region is susceptible to multidecadal droughts.
The deposition of Edward II was a watershed in the legal history of later medieval England. However, the significance of the church in its accomplishment has remained controversial. This article offers a reassessment by providing a brief narrative of the episcopate's involvement in events; analysing the importance of their contribution, with particular reference to the quasi-legal aspect of proceedings; considering whether this participation reflected their own initiative or was something about which they had no choice; and questioning why so many bishops turned to oppose Edward II. It becomes evident that prelates played a key part in Edward II's downfall, and that they became involved as a consequence of the oppressive treatment which he had meted out to them, to their families and to political society more broadly.
Introduction: The Emergency Departments (ED) is a gateway to the health care system for many psychiatric patients. As a consequence of hospital administrative factors and overcrowding, admitted psychiatric patients are often boarded in the ED while waiting for an inpatient bed. There is currently a lack of evidence to quantify the effect that ED boarding has on psychiatric patients. The primary objective of this study is to determine whether a patient's length of stay is related to longer ED boarding time. Methods: This study is a retrospective cohort using data from an administrative source, which was obtained from patient records captured in the Sunrise Clinical Manager EMR used across Calgary, Alberta EDs from 2014-2018. A hierarchical Bayesian regression analysis was used to model the several patient-level and hospital-level factors. The mean and variance was defined by the exposure of interest, namely hours in the Emergency Department after admission to psychiatry unit expressed as a continuous variable. An interaction between this exposure and patient-level confounders was used to model the changing effect of a patient's severity in the ED on their boarding time. Results: The median boarding time for patients in our study was 6.6 hours (standard deviation 17.3), while the average was 13.6 hours. Patients who were boarded for greater than 6 hours more frequently required an antipsychotic (37% vs 11%; SMD 0.651), sedative (52% vs 29%; SMD 0.483) or restraints (18% vs. 14%; SMD 0.102). In crude analysis there was no difference in median length of stay for patients that were boarding more than 6 hours compared to those boarded for less than 6 hours (8 days vs 9 days; SMD 0.012).The rate ratio for length of stay is 1.05 with 95% posterior interval 1.04 - 1.06 for each 24 hour increase in boarding time. This means that for each 1 day worth of boarding time, the length of stay (in days) increases 1.05 times (or 0.05 days/day boarding time). Conclusion: Boarding time is associated with a small but absolute increase in length of stay for psychiatric patients. Decreasing boarding time could have ripple effects for ED efficiency and overall patient outcomes.
The Irish Mental Health Act (MHA) 2001 brings Irish health legislation into line with the European Convention for the protection of Human Rights.It replaced the older 1945 Act.The purpose of this study was to assess the impact of the MHA 2001 on involuntary admissions to a private psychiatric hospital before and after its implementation.
All involuntary patients admitted to the hospital over a 3 year period for 2 years before and 1 year after the act was introduced were included.A retrospective case note review was undertaken.Data collected included number of days as an involuntary patient and discharge diagnosis.Data was analysed using SPSSv14.
A total of 204 patients files were examined. 94 and 70 patients were admitted in the 2 years before the introduction of the MHA, this fell to 40 admissions in the year after the MHA.The mean number of days that patients were involuntarily admitted for 2 years before the Act was 68.6, this fell to 24.9 days in the year after the act, p value < .001.The percentage of involuntary patients with a diagnosis of dementia fell and the percentage of admissions with schizophrenia and BPAD increased.
There was a considerable reduction in the number of involuntary admissions and average length of stay after the introduction of the 2001 MHA.More bed numbers may be needed for acute adult admissions and less for long stay admissions.Patients human rights have been improved by the new act which is a positive consequence.
There are no large scale studies on Epilepsy in populations with Learning disability in Ireland. As many as one fifth of these clients have epilepsy. Aggressive treatment may lead to diminishing returns in terms of symptomatic control, while causing unwanted effects.
1. We aimed to quantify rates of epilepsy, aetiology and anti- epileptic drug (AED) use in our population.
2. To look at degree of disability and correlation with AED use.
3. To look at management/ quality of life issues using a validated instrument.
1. Medline review using search terms Intellectual OR Learning difficult* OR Mental Retard* AND Epilepsy.
2. Simple questionnaire used to identify all clients with Epilepsy. Database analysed using SPSS analysis.
3. 11 cases selected for review looking at qualitative aspects, using Semi structured interview and GEOS scale.
· 210 patients found to have a history of epilepsy (42% of clients).
· Multiple Aetiologies identified. Commonest known Aetiology: Trisomy 21.
· Polypharmacy is common. Most commonly used AED: Sodium Valproate. Mean AED use: 1.595 (SD+- 1.077).
· Clients with Trisomy 21 aged less than 40 tended to be on more medication (2.05, SD= +-1.38) than those over 40 years (1.43, SD= +- 0.89)
· Greater concerns on qualitative measures regarding clients with refractory epilepsy or where epilepsy changed over time.
Our study highlights previously recognised changing patterns in aetiology of Learning Disability and also the changes over time in these clients. More study is required.
The aim of this study was to identify the features of first episode schizophrenia that predict adherence antipsychotic medication at six-month follow-up. We used validated instruments to assess clinical and socio-demographic variables in all patients with first episode schizophrenia from a defined geographical area admitted to a Dublin psychiatric hospital over a four-year period (N = 100). At six-month follow-up (N = 60) we assessed adherence to medication using the Compliance Interview. One third of patients with schizophrenia were non-adherent with medication within six months of their first episode of illness. High levels of positive symptoms at baseline, lack of insight at baseline, alcohol misuse at baseline and previous drug misuse predict non-adherence. These results indicate that an identifiable subgroup of patients with first episode schizophrenia is at high risk of early non-adherence to medication. While high positive symptom scores pre-date and predict non-adherence in most patients, reduced insight is the best predictor of non-adherence in patients who do not misuse alcohol or other drugs.
Individuals with schizophrenia who participated in a psychosocial and educative rehabilitation programme showed a 46% improvement in quality of life in the absence of any significant change in symptom severity. In contrast, there was no significant change in quality of life for individuals who continued with supportive rehabilitation. Our preliminary findings highlight the ‘quality of life’ benefits of psychosocial and educative rehabilitation for individuals with schizophrenia who are clinically stable and living in the community.