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Nietzsche controversially valorizes struggle and war as necessary ingredients of human flourishing. In this book, James S. Pearson reconstructs Nietzsche's rationale for placing such high value on relations of conflict. In doing so, Pearson reveals how Nietzsche's celebration of social discord is interwoven with his understanding of nature as universal struggle. This study thus draws together Nietzsche's writings on politics, culture, metaphysics, biology and human psychology. It also overcomes an entrenched dispute in the critical literature. In the past, commentators have tended to interpret Nietzsche either as an advocate of radical aristocratic violence or, by contrast, a defender of moderate democratic contest. This book navigates a path between these two opposed readings and shows how Nietzsche is able to endorse both violent strife and restrained competition without contradicting himself.
To assess the relationship between food insecurity, sleep quality, and days with mental and physical health issues among college students.
An online survey was administered. Food insecurity was assessed using the 10-item Adult Food Security Survey Module. Sleep was measured using the 19-item Pittsburgh Sleep Quality Index (PSQI). Mental health and physical health were measured using three items from the Healthy Days Core Module. Multivariate logistic regression was conducted to assess the relationship between food insecurity, sleep quality, and days with poor mental and physical health.
Twenty-two higher education institutions.
College students (n=17,686) enrolled at one of 22 participating universities.
Compared to food secure students, those classified as food insecure (43.4%) had higher PSQI scores indicating poorer sleep quality (p<.0001) and reported more days with poor mental (p<.0001) and physical (p<.0001) health as well as days when mental and physical health prevented them from completing daily activities (p<.0001). Food insecure students had higher adjusted odds of having poor sleep quality (adjusted odds ratio [AOR]:1.13, 95% confidence interval [CI]: 1.12-1.14), days with poor physical health (AOR: 1.01, 95% CI: 1.01-1.02), days with poor mental health (AOR: 1.03, 95% CI: 1.02-1.03), and days when poor mental or physical health prevented them from completing daily activities (AOR: 1.03, 95% CI: 1.02-1.04).
College students report high food insecurity which is associated with poor mental and physical health and sleep quality. Multi-level policy changes and campus wellness programs are needed to prevent food insecurity and improve student health-related outcomes.
The Southern dietary pattern, derived within the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort, is characterised by high consumption of added fats, fried food, organ meats, processed meats and sugar-sweetened beverages and is associated with increased risk of several chronic diseases. The aim of the present study was to identify characteristics of individuals with high adherence to this dietary pattern. We analysed data from REGARDS, a national cohort of 30 239 black and white adults ≥45 years of age living in the USA. Dietary data were collected using the Block 98 FFQ. Multivariable linear regression was used to calculate standardised beta coefficients across all covariates for the entire sample and stratified by race and region. We included 16 781 participants with complete dietary data. Among these, 34·6 % were black, 45·6 % male, 55·2 % resided in stroke belt region and the average age was 65 years. Black race was the factor with the largest magnitude of association with the Southern dietary pattern (Δ = 0·76 sd, P < 0·0001). Large differences in Southern dietary pattern adherence were observed between black participants and white participants in the stroke belt and non-belt (stroke belt Δ = 0·75 sd, non-belt Δ = 0·77 sd). There was a high consumption of the Southern dietary pattern in the US black population, regardless of other factors, underlying our previous findings showing the substantial contribution of this dietary pattern to racial disparities in incident hypertension and stroke.
Ancient concepts of the blood were described by Hippocrates and Galen 2000 years ago in their doctrine of “humors.” It was believed that the body was made up of four humors – blood, phlegm, black bile, and yellow bile – and that these four components had the qualities of heat (hot-blooded!), cold, moist, and dry. The Galenic concept of the blood prevailed through the Middle Ages. Health or disease were a result of an imbalance, between these humors. This was the basis of the practice of therapeutic bloodletting (which, fortunately, was performed infrequently on children) through the mid nineteenth century as a way to rid the body of the imbalance of humors believed to cause a wide variety of diseases.
This study evaluates the personal and professional experiences of physician mothers during the COVID-19 pandemic and the impact of the pandemic on the lives of physician mothers.
Using social media to reach a broad range of physicians, a convenience sample of physician mothers completed on-line survey posted between April 27-May 11. Members were encouraged to repost on social media and share with personal contacts resulting in a passive snowball sampling effect.
A total of 2709 physician mothers from 48 states, Puerto Rico and 19 countries representing more than 25 medical specialties completed the survey. Most were between 30-39 years of age, 67% self-identified as white, 17% as Asian, 4% as African American. Most had been working for 11-16 years. 91% had a spouse/partner of the opposite sex. Over half were practicing in an area they identified as high COVID19 density while 50% had personally cared for a person with COVID19. Physician mothers were most concerned about exposing their children to COVID19 and about the morale and safety of their staff.
This is one of the first studies to explore the personal and professional challenges facing physician mothers during a pandemic. Physician mothers were most concerned about exposing their families to COVID-19. Mothers continued to work and at times increased their work despite having domestic, childcare and schooling responsibilities.
The discovery of a dismantled stone circle—close to Stonehenge's bluestone quarries in west Wales—raises the possibility that a 900-year-old legend about Stonehenge being built from an earlier stone circle contains a grain of truth. Radiocarbon and OSL dating of Waun Mawn indicate construction c. 3000 BC, shortly before the initial construction of Stonehenge. The identical diameters of Waun Mawn and the enclosing ditch of Stonehenge, and their orientations on the midsummer solstice sunrise, suggest that at least part of the Waun Mawn circle was brought from west Wales to Salisbury Plain. This interpretation complements recent isotope work that supports a hypothesis of migration of both people and animals from Wales to Stonehenge.
The current study sought to describe and compare study type, research design and translation phase of published research in nutrition and dietetic journals in 1998 and 2018.
This was a repeat cross-sectional bibliographic analysis of Nutrition and Dietetics research. All eligible studies in the top eight Nutrition and Dietetics indexed journals in 1998 and 2018 were included. Two independent reviewers coded each study for research design (study type and study design) and translation phase (T0-T4) of the research using seminal texts in the field.
The number of publications (1998, n 1030; 2018, n 1016) has not changed over time, but the research type, design and translation phases have. The proportion of intervention studies in 1998 (43·8 %) was significantly higher than 2018 (19·4 %). In 2018, more reviews (46·9 % v. 15·6 % in 1998) and less randomised trials (14·3 % v. 37·8 % in 1998) were published. In regard to translation phase, there was a higher proportion of T2–T4 research in 2018 (18·3 % v. 3·8 % in 1998); however, the proportion of T3/T4 (dissemination, implementation and population-level research) research was still low (<3 %). Our sensitivity analysis with the four journals that remained in the top eight journal across the two time periods found no differences in the research type, design and translation phases across time.
There was a reduction in intervention and T0 publications, alongside higher publication of clinical study designs over time; however, published T3/T4 research in Nutrition and Dietetics is low. A greater focus on publishing interventions and dissemination and implementation may be needed.
The authors of this article consider the relationship in European prehistory between the procurement of high-quality stones (for axeheads, daggers, and other tools) on the one hand, and the early mining, crafting, and deposition of copper on the other. The data consist of radiocarbon dates for the exploitation of stone quarries, flint mines, and copper mines, and of information regarding the frequency through time of jade axeheads and copper artefacts. By adopting a broad perspective, spanning much of central-western Europe from 5500 to 2000 bc, they identify a general pattern in which the circulation of the first copper artefacts was associated with a decline in specialized stone quarrying. The latter re-emerged in certain regions when copper use decreased, before declining more permanently in the Bell Beaker phase, once copper became more generally available. Regional variations reflect the degrees of connectivity among overlapping copper exchange networks. The patterns revealed are in keeping with previous understandings, refine them through quantification and demonstrate their cyclical nature, with additional reference to likely local demographic trajectories.
In the journal article Did DI do it? The impact of a programme designed to improve literacy for Aboriginal and Torres Strait Islander students in remote schools, Guenther and Osborne (2020) compare schoolwide NAPLAN reading scale scores for 25 Very Remote Indigenous schools implementing Direct Instruction through the Flexible Literacy for Remote Primary Schools Program (‘Flexible Literacy’ or ‘the program’) with those for 118 Very Remote Indigenous schools not involved with the program, to assert the program has not improved literacy outcomes. Good to Great Schools Australia (GGSA) undertook an analysis of the same school data for Reading, Writing, Spelling and Grammar and Punctuation scores. Our findings contradict theirs. In all areas, schools participating in the program show significant growth compared with all Australian and all Very Remote Indigenous schools. In Reading, schools involved in the program from 2015 to 2017 averaged 124% growth, while the average growth for comparable ages was 19 and 34% for Australian and Very Remote Indigenous schools, respectively. In Grammar and Punctuation schools involved in the program in the same period grew 180%, whilst growth for Australian schools was 15%, and for Very Remote Indigenous schools, 28%. These contrasting results illustrate the importance of evaluating growth to assess the impact of educational programs, rather than achievement alone, particularly in the case of Very Remote Indigenous schools where achievement levels are far below Australian grade levels. Guenther and Osborne's comparison of achievement across schools rather than measuring growth within schools obscures real gains and is misleading.
The COVID-19 pandemic and mitigation measures are likely to have a marked effect on mental health. It is important to use longitudinal data to improve inferences.
To quantify the prevalence of depression, anxiety and mental well-being before and during the COVID-19 pandemic. Also, to identify groups at risk of depression and/or anxiety during the pandemic.
Data were from the Avon Longitudinal Study of Parents and Children (ALSPAC) index generation (n = 2850, mean age 28 years) and parent generation (n = 3720, mean age 59 years), and Generation Scotland (n = 4233, mean age 59 years). Depression was measured with the Short Mood and Feelings Questionnaire in ALSPAC and the Patient Health Questionnaire-9 in Generation Scotland. Anxiety and mental well-being were measured with the Generalised Anxiety Disorder Assessment-7 and the Short Warwick Edinburgh Mental Wellbeing Scale.
Depression during the pandemic was similar to pre-pandemic levels in the ALSPAC index generation, but those experiencing anxiety had almost doubled, at 24% (95% CI 23–26%) compared with a pre-pandemic level of 13% (95% CI 12–14%). In both studies, anxiety and depression during the pandemic was greater in younger members, women, those with pre-existing mental/physical health conditions and individuals in socioeconomic adversity, even when controlling for pre-pandemic anxiety and depression.
These results provide evidence for increased anxiety in young people that is coincident with the pandemic. Specific groups are at elevated risk of depression and anxiety during the COVID-19 pandemic. This is important for planning current mental health provisions and for long-term impact beyond this pandemic.
Seeking help for mental health concerns is critical for improving wellbeing and preventing the development of mental health disorders, yet many adolescents with mental health problems fail to seek professional help. It is well established that young people with mental health problems face a variety of barriers to help-seeking; however, little is known about the ways in which these barriers interact to impact upon the help-seeking process. Guided by the reasoned action approach, this study investigated the predictive relationship between factors that influence help-seeking. Results revealed that mental health knowledge significantly predicted help-seeking intentions, while attitudes did not. Gender differences were identified for help source preferences. The current study contributes to knowledge on the relationship between key variables that influence the adolescent help-seeking process. Findings highlight the importance of mental health knowledge in predicting help-seeking intentions and provide support for interventions that focus on improving mental health literacy in adolescents.
Further investigating the capacities of literary narrative to reveal intertwined environmental and social justice struggles, this chapter presents an overview of the current literature and critical debates at the intersection of magical realism and ecocriticism. Exploring the specific contexts of Alexis Wright’s Carpentaria and Linda Hogan’s People of the Whale, the chapter draws on perspectives from the overarching field of the environmental humanities, including postcolonial ecocriticism, indigenous scholarship and feminism, while it pursues these linked questions: how can and how does magical realism function as an ecocritical tool? In the course of the discussion, the essay aims to show how both Carpentaria and People of the Whale take up various 'nonhuman turns' – articulating the silence and violence imposed by anthropocentrism and its corollaries – while suggesting how techniques such as ecomagical realism may inspire us to bridge the manufactured divides underlying systemic exploitation and bolster the groundwork to demand real change.
This is the first report on the association between trauma exposure and depression from the Advancing Understanding of RecOvery afteR traumA(AURORA) multisite longitudinal study of adverse post-traumatic neuropsychiatric sequelae (APNS) among participants seeking emergency department (ED) treatment in the aftermath of a traumatic life experience.
We focus on participants presenting at EDs after a motor vehicle collision (MVC), which characterizes most AURORA participants, and examine associations of participant socio-demographics and MVC characteristics with 8-week depression as mediated through peritraumatic symptoms and 2-week depression.
Eight-week depression prevalence was relatively high (27.8%) and associated with several MVC characteristics (being passenger v. driver; injuries to other people). Peritraumatic distress was associated with 2-week but not 8-week depression. Most of these associations held when controlling for peritraumatic symptoms and, to a lesser degree, depressive symptoms at 2-weeks post-trauma.
These observations, coupled with substantial variation in the relative strength of the mediating pathways across predictors, raises the possibility of diverse and potentially complex underlying biological and psychological processes that remain to be elucidated in more in-depth analyses of the rich and evolving AURORA database to find new targets for intervention and new tools for risk-based stratification following trauma exposure.
The study aimed to estimate vitamin D intake and plasma/serum 25-hydroxyvitamin D (25(OH)D) concentrations, investigate determinants of 25(OH)D concentrations and compare two 25(OH)D assays. We conducted two nationwide cross-sectional studies in Sweden with 206 school children aged 10–12 years and 1797 adults aged 18–80 years (n 268 provided blood samples). A web-based dietary record was used to assess dietary intake. Plasma/serum 25(OH)D was analysed by liquid chromatography-mass spectrometry (LC-MS) and immunoassay in adults and LC-MS/MS in children. Most participants reported a vitamin D intake below the average requirement (AR), 16 % of children and 33 % of adults met the AR (7⋅5 μg). In adults, plasma 25(OH)D below 30 and 50 nmol/l were found in 1 and 18 % of participants during the summer period and in 9 and 40 % of participants during the winter period, respectively. In children, serum 25(OH)D below 30 and 50 nmol/l were found in 5 and 42 % of participants (samples collected March–May), respectively. Higher 25(OH)D concentrations were associated with the summer season, vacations in sunny locations (adults), and dietary intake of vitamin D and use of vitamin D supplements, while lower concentrations were associated with a higher BMI and an origin outside of Europe. Concentrations of 25(OH)D were lower using the immunoassay than with the LC-MS assay, but associations with dietary factors and seasonal variability were similar. In conclusion, vitamin D intake was lower than the AR, especially in children. The 25(OH)D concentrations were low in many participants, but few participants had a concentration below 30 nmol/l.
Vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) concentration <50 nmol/l) is recognised as a public health problem globally. The present study details the prevalence and predictors of vitamin D deficiency in a nationally representative sample (n 3250) of Australian Aboriginal and Torres Strait Islander adults aged ≥18 years. We used data from the 2012–2013 Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS). Serum 25(OH)D concentrations were measured by liquid chromatography-tandem MS. Survey-weighted logistic regression models were used to determine the independent predictors of vitamin D deficiency. Approximately 27 % of adult AATSIHS participants were vitamin D deficient. Vitamin D deficiency was more prevalent in remote areas (39 %) than in non-remote areas (23 %). Independent predictors of vitamin D deficiency included assessment during winter (men, adjusted OR (aOR) 5·7; 95 % CI 2·2, 14·6; women, aOR 2·2; 95 % CI 1·3, 3·8) and spring (men, aOR 3·3; 95 % CI 1·4, 7·5; women, aOR 2·6; 95 % CI 1·5, 4·5) compared with summer, and obesity (men, aOR 2·6; 95 % CI 1·2, 5·4; women, aOR 4·3; 95 % CI 2·8, 6·8) compared with healthy weight. Statistically significant associations were evident for current smokers (men only, aOR 2·0; 95 % CI 1·2, 3·4), remote-dwelling women (aOR 2·0; 95 % CI 1·4, 2·9) and university-educated women (aOR 2·4; 95 % CI 1·2, 4·8). Given the high prevalence of vitamin D deficiency in this population, strategies to maintain adequate vitamin D status through safe sun exposure and dietary approaches are needed.
Spasticity is a motor abnormality characterized by increased muscular tone. It results from a lesion of the corticospinal (or pyramidal) tract, which includes motor neurons in the cerebral cortex and their axonal white matter projections through the brain and spinal cord, to the point of synapse with lower motor neurons in the spinal cord. Patients with spasticity, or their caregivers, typically complain of stiffness, and the predominant associated examination findings are a velocity-dependent resistance to passive movement of an affected limb, hyperreflexia, and pathological reflexes such as a Babinski sign. Spasticity is typically accompanied by weakness and impaired motor control in affected muscle groups. Depending on the site of the lesion in the central nervous system, spasticity may be present in both legs (termed diparesis or paraparesis), all four limbs (quadriparesis or tetraparesis), or one side of the body (hemiparesis).
There are sparse data on the outcomes of endoscopic stapling of pharyngeal pouches. The Mersey ENT Trainee Collaborative compared regional practice against published benchmarks.
A 10-year retrospective analysis of endoscopic pharyngeal pouch surgery was conducted and practice was assessed against eight standards. Comparisons were made between results from the tertiary centre and other sites.
A total of 225 procedures were performed (range of 1.2–9.2 cases per centre per year). All centres achieved 90 per cent resumption of oral intake within 2 days. All centres achieved less than 2-day hospital stays. Primary success (84 per cent (i.e. abandonment of endoscopic stapling in 16 per cent)), symptom resolution (83 per cent) and recurrence rates (13 per cent) failed to meet the standard across the non-tertiary centres.
Endoscopic pharyngeal pouch stapling is a procedure with a low mortality and brief in-patient stay. There was significant variance in outcomes across the region. This raises the question of whether this service should become centralised and the preserve of either tertiary centres or sub-specialist practitioners.
Background: A large healthcare system in Georgia went live with an enhanced electronic infection surveillance system in August of 2018. The system was employed at its facilities using a staggered approach. Prior to the implementation of this infection surveillance platform, the healthcare system performed healthcare-associated infection (HAI) surveillance using an in-house culture-based system. The NHSN estimates that culture-based surveillance misses 50%–60% of true surgical site infections (SSIs). Due to the lack of clinical-based detection methods (eg, radiologic imaging), we were unable to appropriately detect all patient harm using the old surveillance system. Method: A retrospective analysis was performed to assess the change in HAI for colon (COLO), abdominal hysterectomy (HYST), hip prosthesis (HPRO), and knee prosthesis (KPRO). SSI cases that met NHSN surveillance criteria were reviewed to determine whether they would have been identified prior to launching the new enhanced electronic surveillance system. Results: Systemwide, 8 of 26 COLO SSIs (31%) and 9 of 18 HYST SSIs (50%) would have not been detected using our old surveillance system. HPRO SSIs and KPRO SSIs identified by our new surveillance system were detected using our old surveillance system, and no change was observed. Conclusion: This analysis showed an increase in COLO SSIs and HYST SSIs from enhanced surveillance. Electronic surveillance systems are not considered as a risk factor in the NHSN annual facility survey that aids in calculating a facility’s standardized infection ratio (SIR). These data help support NHSN consideration of modifying the logistic regression calculation used for the complex SSI models. This revision would allow facilities to compare themselves equitably to those using electronic infection surveillance.