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Migration, Mobility and Language Contact in and around the Ancient Mediterranean is the first volume to show the different ways in which surviving linguistic evidence can be used to track movements of people in the ancient world. Eleven chapters cover a number of case studies, which span the period from the seventh century BC to the fourth century AD, ranging from Spain to Egypt, from Sicily to Pannonia. The book includes detailed study of epigraphic and literary evidence written in Latin and Greek, as well as work on languages which are not so well documented, such as Etruscan and Oscan. There is a subject index and an index of works and inscriptions cited.
Advances in digital technology have a profound impact on conventional healthcare systems. We examine the trailblazing use of online interventions to enable autonomous psychological care which can greatly enhance individual- and population-level access to services. There is strong evidence supporting online cognitive–behavioural therapy and more engaging programmes are now appearing so as to reduce user ‘attrition’. The next generation of autonomous psychotherapy programmes will implement adaptive and personalised responses, moving beyond impersonalised advice on cognitive and behavioural techniques. This will be a more authentic form of psychotherapy that integrates therapy with the actual relationship experiences of the individual user.
This article makes two main propositions about the role of due diligence in international law, in response to recent interest in the topic. First, a legal requirement to exercise due diligence may be a component part of a primary rule of international law, but this can only be determined by referring back to the primary rule in question (eg what degree of fact-finding does treaty provision X require a State party to that treaty to undertake, either explicitly or implicitly, to act consistently with its terms?). In other words, there is no ‘general principle of due diligence’ in international law. Second, States undertake what could be characterised as ‘due diligence’ activity (eg by introducing policy guidance for their officials), some elements of which may be a result of a legal requirement and some of which may not (eg where done solely for policy reasons). Current practice of the United Kingdom and United States is used to illustrate the point. The lack of a distinction between the ‘legal’ and ‘non-legal’ elements of conduct in a given area gives States the flexibility to act without feeling unduly constrained by international law, and at the same time actually promotes compliance with international law and may assist in its development over time. In contrast, pushing for a ‘general principle of due diligence’ in international law is unnecessary, and risks having a chilling effect on this positive legal/policy ‘due diligence’ behaviour by States.
Antibiotics are widely used by all specialties in the hospital setting. We evaluated previously defined high-risk antibiotic use in relation to Clostridioides difficile infections (CDIs).
We analyzed 2016–2017 data from 171 hospitals. High-risk antibiotics included second-, third-, and fourth-generation cephalosporins, fluoroquinolones, carbapenems, and lincosamides. A CDI case was a positive stool C. difficile toxin or molecular assay result from a patient without a positive result in the previous 8 weeks. Hospital-associated (HA) CDI cases included specimens collected >3 calendar days after admission or ≤3 calendar days from a patient with a prior same-hospital discharge within 28 days. We used the multivariable Poisson regression model to estimate the relative risk (RR) of high-risk antibiotic use on HA CDI, controlling for confounders.
The median days of therapy for high-risk antibiotic use was 241.2 (interquartile range [IQR], 192.6–295.2) per 1,000 days present; the overall HA CDI rate was 33 (IQR, 24–43) per 10,000 admissions. The overall correlation of high-risk antibiotic use and HA CDI was 0.22 (P = .003), and higher correlation was observed in teaching hospitals (0.38; P = .002). For every 100-day (per 1,000 days present) increase in high-risk antibiotic therapy, there was a 12% increase in HA CDI (RR, 1.12; 95% CI, 1.04–1.21; P = .002) after adjusting for confounders.
High-risk antibiotic use is an independent predictor of HA CDI. This assessment of poststewardship implementation in the United States highlights the importance of tracking trends of antimicrobial use over time as it relates to CDI.
We investigated a large multistate outbreak that occurred in the United States in 2015–2016. Epidemiologic, laboratory, and traceback studies were conducted to determine the source of the infections. We identified 907 case-patients from 40 states with illness onset dates ranging from July 3, 2015 to March 2, 2016. Sixty-three percent of case-patients reported consuming cucumbers in the week before illness onset. Ten illness sub-clusters linked to events or purchase locations were identified. All sub-clusters investigated received cucumbers from a single distributor which were sourced from a single grower in Mexico. Seventy-five cucumber samples were collected, 19 of which yielded the outbreak strain. Whole genome sequencing performed on 154 clinical isolates and 19 cucumber samples indicated that the sequenced isolates were closely related genetically to one another. This was the largest US foodborne disease outbreak in the last ten years and the third largest in the past 20 years. This was at least the fifth multistate outbreak caused by contaminated cucumbers since 2010. The outbreak is noteworthy because a recall was issued only 17 days after the outbreak was identified, which allowed for the removal of the contaminated cucumbers still available in commerce, unlike previous cucumber associated outbreaks. The rapid identification and response of multiple public health agencies resulted in preventing this from becoming an even larger outbreak.
May argues that framing effects do not undermine moral beliefs, because they affect only a minority of moral judgments in small ways. We criticize his estimates of the extent of framing effects on moral judgments, and then we argue that framing effects would cause trouble for moral judgments even if his estimates were correct.
This paper extends the work of Thompson, Beauvais, and Lyness (1999, Journal of Vocational Behavior, 54, 392–415) on work–family culture by considering the role co-workers play. The proposed extended measure encompasses non-work spheres beyond the family as it has been established that much of the extant research does not include a large part of the workforce – those without childcare responsibilities (Kelliher, Richardson & Boiarintseva [2019, Human Resource Management Journal, 29, 101]). The extended measure constitutes Thompson et al.'s (1999) three original dimensions plus two additional dimensions: co-worker involvement (support and consequences) and gender expectations. Two quantitative studies confirmed that the extended measure is robust for different types of workers (part- and full-time, males and females). The co-worker dimensions were significantly associated with several outcome measures; however, the gender expectation dimensions added little additional variance in relation to employee outcomes. The results support the inclusion of co-workers as an important dimension of the workplace environment that supports work and life balance.
Scholars of Chinese society have predominantly regarded the region's money to represent an unusually “social” artefact. The dramatic proliferation of “digital money” services within Chinese social media platforms in the last decade would seem to further confirm the social character of Chinese money. I present a comparison of the diverse views held by migrant factory workers in Shenzhen towards different digital payment platforms which, however, suggests that rather than digital money necessarily being more or less social, different platforms instead extend the possibilities of sociality in varying ways. I argue that acknowledging the production of such novel working-class subjectivities through digital money ought to be central to efforts to assess the potential of these technologies for addressing the social, institutional and economic exclusions faced by Chinese migrant labourers. This in turn can enrich our understanding of the emergence of a new “digital working-class” in China by revealing how such contemporary working-class subjectivities are shifting, contextual and processual in nature.
This article discusses the votive dedications to the goddess Reitia at the sanctuary of Este-Baratella (Veneto) as evidence for the acquisition of literacy in Italy c. 350–150 b.c. These dedications, which take the form of bronze writing-tablets and styluses, are inscribed with Venetic dedicatory formulae, abecedaria and other writing exercises. This article shows how these texts function as writing exercises — some of the earliest evidence of elementary education methods in Italy. Many of the votives were dedicated by women, and this article argues that women were active participants in literacy and education in this period. It also sets the dedications in their Italian and Mediterranean context by comparing them to votive and funerary deposits of abecedaria from across Italy and the ancient world.
Open neural tube defects or myelomeningoceles are a common congenital condition caused by failure of closure of the neural tube early in gestation, leading to a number of neurologic sequelae including paralysis, hindbrain herniation, hydrocephalus and neurogenic bowel and bladder dysfunction. Traditionally, the condition was treated by closure of the defect postnatally but a recently completed randomized controlled trial of prenatal versus postnatal closure demonstrated improved neurologic outcomes in the prenatal closure group. Fetal surgery, or more precisely maternal-fetal surgery, raises a number of ethical issues that we address including who the patient is, informed consent, surgical innovation and equipoise as well maternal assumption of risk. As the procedure becomes more widely adopted into practice, we suggest close monitoring of new fetal surgery centers, in order to ensure that the positive results of the trial are maintained without increased risk to both the mother and fetus.
A nationwide survey indicated that screening for asymptomatic carriers of C. difficile is an uncommon practice in US healthcare settings. Better understanding of the role of asymptomatic carriage in C. difficile transmission, and of the measures available to reduce that risk, are needed to inform best practices regarding the management of carriers.
Introduction: Alberta has one of the highest rates of domestic violence (DV) in the country. Emergency departments (EDs) and urgent care centres (UCCs) are significant points of opportunity to screen for DV and intervene. In Alberta, the Calgary Zone began a universal education and direct inquiry program for DV in EDs and UCCs for patients > = 14 years in 2003. The Calgary model is unique in that (a) it provides universal education in addition to screening and (b) screening is truly universal as it includes all age groups and genders. While considering expanding this model provincially, we engaged in the GRADE Adolopment process, to achieve multi-stakeholder consensus on a provincial approach to DV screening, as herewith described. Methods: Using GRADE, we synthesized and rated the quality of evidence on DV screening and presented it to an expert panel of stakeholders from the community, EDs, and Alberta Health Services. There was moderate certainty evidence that screening improved DV identification in antenatal clinics, maternal health services and EDs. There was no evidence of harm and low certainty evidence of improvement in patient-important outcomes. As per Adolopment, the expert panel reviewed the evidence in the context of: a) values and preferences b) benefits and harms, and c) acceptability, feasibility, and resource implications. Results: The panel came to a unanimous decision to conditionally recommend universal screening, i.e., screening all adults above 14 years of age in EDs and UCCs. By conditional, the panel noted that EDs and UCCs must have support resources in place for patients who screen positive to realize the full benefit of screening and avoid harm. The panel deemed universal screening to be a logistically easier recommendation, compared to training healthcare professionals to screen certain subpopulations or assess for specific symptoms associated with DV. The panel noted that despite absence of evidence that screening would impact patient-important outcomes, there was evidence that effective interventions following a positive screen could positively impact these outcomes. The panel stressed the importance of evidence creation in the context of absence of evidence. Conclusion: A GRADE Adolopment process achieved consensus on provincial expansion of an ED-based DV screening program. Moving forward, we plan to gather evidence on patient-important outcomes and understudied subpopulations (i.e. men and the elderly).
The primary insect pests in Canadian carrot production are carrot rust fly (Psila rosae (Fabricius); Diptera: Psilidae) and carrot weevil (Listronotus oregonensis (LeConte); Coleoptera: Curculionidae). An integrated pest management programme for these pests exists in Québec and Ontario, where most Canadian carrot (Daucus carota subsp. sativus (Hoffmann) Schübler and Martens; Apiaceae) production occurs. As current carrot insect integrated pest management recommendations are decades old, laboratory and field trials were performed to evaluate the carrot insect integrated pest management recommendations. Carrot weevil populations were evaluated in the laboratory for resistance to the primary product used for control, phosmet. Ontario carrot weevils exhibited negligible mortality when exposed to phosmet compared with > 80% mortality in a susceptible strain. Using data from a carrot integrated pest management programme, weather data was correlated with monitoring and damage data of both pests from historical records. Increased carrot weevil captures were weakly related to increased damage. Carrot weevil damage was reduced by following integrated pest management recommendations in one of three trials. No strong relationship between weather and carrot rust fly captures was identified, suggesting the degree day model for carrot rust fly activity needs revision. In field trials, carrot rust fly damage was negligible despite integrated pest management recommendations for insecticide applications. Future research should include improving carrot weevil monitoring and control and increasing the carrot rust fly action threshold to optimise insecticide applications.
The majority of paediatric Clostridioides difficile infections (CDI) are community-associated (CA), but few data exist regarding associated risk factors. We conducted a case–control study to evaluate CA-CDI risk factors in young children. Participants were enrolled from eight US sites during October 2014–February 2016. Case-patients were defined as children aged 1–5 years with a positive C. difficile specimen collected as an outpatient or ⩽3 days of hospital admission, who had no healthcare facility admission in the prior 12 weeks and no history of CDI. Each case-patient was matched to one control. Caregivers were interviewed regarding relevant exposures. Multivariable conditional logistic regression was performed. Of 68 pairs, 44.1% were female. More case-patients than controls had a comorbidity (33.3% vs. 12.1%; P = 0.01); recent higher-risk outpatient exposures (34.9% vs. 17.7%; P = 0.03); recent antibiotic use (54.4% vs. 19.4%; P < 0.0001); or recent exposure to a household member with diarrhoea (41.3% vs. 21.5%; P = 0.04). In multivariable analysis, antibiotic exposure in the preceding 12 weeks was significantly associated with CA-CDI (adjusted matched odds ratio, 6.25; 95% CI 2.18–17.96). Improved antibiotic prescribing might reduce CA-CDI in this population. Further evaluation of the potential role of outpatient healthcare and household exposures in C. difficile transmission is needed.
Objectives: The current study used a mixed-method design to qualitatively examine parents’ definitions of resilience and factors they believed optimized their child’s early outcome following neonatal brain injury. This was followed by quantitative analyses of early developmental and mental health outcomes and their relation to salient biopsychosocial factors. Methods: Participants were parents of children diagnosed with neonatal brain injury due to stroke or hypoxic-ischemic encephalopathy (N=51; age range of children 18 months to 8 years). The Parent Experiences Questionnaire (PEQ) was used to qualitatively analyze parents’ open-ended responses about their child’s early experiences and outcome. The Child Behavior Checklist (CBCL) and Scales of Independent Behaviour Early Developmental Form (SIB-ED) parent ratings were used to measure child resilience from a quantitative perspective, identifying “at-risk” and “resilient” children using standard cutoffs. “Resilient” and “at-risk” children were compared on biopsychosocial variables using univariate t tests and chi-square analyses. Results: Parents provided five unique definitions of their child’s positive outcomes, and many children demonstrated resilience based on parent perspectives and quantitative definitions. Supporting factors included close medical follow-up, early intervention, and intrinsic factors within the child and parent. Group comparisons of “resilient” and “at-risk” children highlighted the importance of parent mental health across these early developmental and mental health outcomes. Conclusions: Many children were described as resilient during the early years by parents using qualitative and quantitative approaches. Findings highlighted the importance of parent well-being in promoting optimal early outcomes. (JINS, 2019, 25, 390–402.)
In this paper I wish to outline, very provisionally, a proposition for understanding more clearly the nature and operation of (mainly musical) tradition. It is, in essence, an argument concerning a fundamental social entity rather than an instrumental concept, the sort of discussion which Immanuel Wallerstein considers “always diffïcult“: