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Nineteen Eighty-Four has become part of our collective mental furniture. Its phrases structure our journalism. Its ideas inform our critiques of the present and the politics it shapes. Its future has become our past, yet its account of that future determines how we talk about the present as it continually threatens to transform into something menacing, unpredictable, and strange. This chapter reflects on the implications of what this inseparability of imagined past, increasingly fictional present, and not-yet-assured future says about our attitude to the dystopian imaginary and the place of Orwell’s novel within it. The chapter also examines why we value Nineteen Eighty-Four, sometimes unthinkingly, offering a commentary on its popularity and prestige at times of creeping authoritarian politics. It discusses the relevance of Orwell’s novel to more recent debates about post-truth politics, surveillance, with gestures to theories of simulation, culturalization, and the hyperreal.
A wealth of research documents the rise of affective polarization, or the increasing disdain for the out-party in American politics. In this paper, we analyze ANES data from 1988 to 2016 to investigate the contribution of core value polarization to the phenomenon of out-party enmity. We find that greater differences in fundamental principles relate significantly to emotionally intense evaluations of the opposing party and its candidates, as well as the ideological out-group, independent of issue attitude extremity and the strength of one's partisan and ideological identities. Moreover, ANES panel data from 1992 to 1996 reveal that past value extremity promotes future affective polarization. These results are important for our understanding of the nature and extent of value-based polarization in American politics.
An important component of reintroduction is acclimatization to the release site. Movement parameters and breeding are common metrics used to infer the end of the acclimatization period, but the time taken to locate preferred food items is another important measure. We studied the diet of a reintroduced population of brushtail possums Trichosurus vulpecula in semi-arid South Australia over a 12 month period, investigating changes over time as well as the general diet. We used next-generation DNA sequencing to determine the contents of 253 scat samples, after creating a local plant reference library. Vegetation surveys were conducted monthly to account for availability. Dietary diversity and richness decreased significantly with time since release after availability was accounted for. We used Jacob's Index to assess selectivity; just 13.4% of available plant genera were significantly preferred overall, relative to availability. The mean proportion of preferred plant genera contained within individual samples increased significantly with time since release, but the frequency of occurrence of preferred plants did not. Five genera (Eucalyptus, Petalostylis, Maireana, Zygophyllum and Callitris) were present in more than half of samples. There was no difference in dietary preferences between sexes (Pianka overlap = 0.73). Our results suggest that acclimatization periods may be longer than those estimated via reproduction, changes in mass and movement parameters, but that under suitable conditions a changeable diet should not negatively affect reintroduction outcomes. Reintroduction projects should aim to extend post-release monitoring beyond the dietary acclimatization period and, for dry climates, diet should be monitored through a drought period.
It is traditionally taught that the location to place an ultrasound probe to detect a pneumothorax with point-of-care ultrasound (POCUS) is the anterior chest, given the theory that air will collect at the least dependent area in the supine patient. There is a wide variety of scanning protocols with varying accuracy and completeness. We sought to assess the optimal area to scan for diagnosing pneumothorax by mapping the location of traumatic pneumothorax on computed tomography (CT).
Patients were selected after a retrospective cohort of adult patients who presented to a regional trauma center with a pneumothorax diagnosed on CT. Data were extracted using a standardized data collection tool, and 20% of charts were reviewed by two reviewers. Predefined zones were used to map the areas of pneumothoraces. Theoretical sensitivity and 95% confidence intervals (CIs) are reported.
A total of 203 traumatic pneumothoraces were reviewed from 2006 to 2016. The majority of the pneumothoraces were found in an area defined by the para-sternal border and the mid-clavicular line from the inferior aspect of the clavicle to the physiologic lung point (liver on the right, heart on the left). The theoretical sensitivity for pneumothorax of scanning this area was 91.6% (95% CI, 86.9–95%).
This study suggests any POCUS scanning protocol for traumatic pneumothorax should include an area from the inferior border of the clavicle at the parasternal border down to the liver or cardiac lung points and then the mid clavicular line down to the liver or cardiac lung points.
Intravenous tissue-type plasminogen activator (IVtPA) is a proven treatment for acute ischemic stroke; however, diabetes mellitus (DM) and previous cerebral infarction (PCI) were considered relative contraindications for thrombolysis within the 3–4.5 h period.
The study aimed to determine the safety and efficacy of IVtPA among diabetic patients with PCI presenting with acute ischemic stroke.
Studies which evaluated the outcome of IVtPA in terms of symptomatic intracerebral hemorrhage (sICH), functional outcome in modified Rankin scale, and death among diabetic patients with PCI presenting with acute ischemic stroke within the 3–4.5 h period were systematically searched until July 2019. Screening and eligibility criteria were applied. Risk of bias was evaluated using the Newcastle–Ottawa Scale. Odds ratios (ORs) with 95% confidence interval (CI) were used to compare measures of treatment effect. Mantel–Haenszel method and random-effects model were also employed.
Four registry-based studies with a total of 44,572 patients were included for quantitative synthesis. Giving IVtPA among DM+/PCI+ patients did not result in significantly increased rate of sICH (OR, 1.09; 95% CI, 0.88, 1.36) compared to No DM+/PCI+ patients. However, there was significantly higher mortality (OR, 1.81; 95% CI, 1.60, 2.06) in the DM+/PCI+ group. Conversely, among those who survived, the DM+/PCI+ patients were more functionally independent at 3 months (OR, 0.76; 95% CI, 0.61, 0.94).
Limited evidence suggests that thrombolysis in DM+/PCI+ patients does not result in significantly higher incidence of sICH and may improve functional independence. However, the significantly higher mortality in this group warrants an assessment of the individualized risk–benefit ratio in the use of IVtPA.
UK Biobank is a well-characterised cohort of over 500 000 participants including genetics, environmental data and imaging. An online mental health questionnaire was designed for UK Biobank participants to expand its potential.
Describe the development, implementation and results of this questionnaire.
An expert working group designed the questionnaire, using established measures where possible, and consulting a patient group. Operational criteria were agreed for defining likely disorder and risk states, including lifetime depression, mania/hypomania, generalised anxiety disorder, unusual experiences and self-harm, and current post-traumatic stress and hazardous/harmful alcohol use.
A total of 157 366 completed online questionnaires were available by August 2017. Participants were aged 45–82 (53% were ≥65 years) and 57% women. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status. Lifetime depression was a common finding, with 24% (37 434) of participants meeting criteria and current hazardous/harmful alcohol use criteria were met by 21% (32 602), whereas other criteria were met by less than 8% of the participants. There was extensive comorbidity among the syndromes. Mental disorders were associated with a high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
The UK Biobank questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed because of selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
New collections are reported of the monospecific genus Polypyrenula, an apparently extinct and doubtfully lichenized fungus, typically classified in the Pyrenulaceae. Anatomical studies reveal that it is facultatively lichenized. The structure of its hamathecium suggests affinities with Dothideomycetes rather than Eurotiomycetes. Molecular analysis using nuLSU and mtSSU markers demonstrates for the first time its inclusion in Trypetheliaceae, outside the core genera as part of the early diverging lineages in this family. The known distribution of Polypyrenula is extended to Mexico and South America, new information on its phorophyte associations is provided, and the name Polypyrenula sexlocularis is reinstated as the correct name for this species.
Refractory ventricular fibrillation encountered during cardiac arrest has a mortality rate of 97%.1 As per the advanced cardiac life support (ACLS) guidelines, the management algorithm of ventricular fibrillation consists of chest compressions, epinephrine, defibrillation, and anti-arrhythmics.2 There have been reports describing the use of the fast-acting selective β-blocker, esmolol, and dual-sequential defibrillation in the management of ventricular fibrillation that is refractory to standard ACLS. We present a case of a 24-year-old male who had an out-of-hospital cardiac arrest, with refractory ventricular fibrillation despite high-quality cardiopulmonary resuscitation (CPR) and ACLS management. Along with standard ACLS, triple-sequential defibrillation was used to achieve return of spontaneous circulation (ROSC) after 82 minutes of downtime. An electrocardiogram (ECG) after ROSC showed an ST-elevation myocardial infarction (MI), and the patient underwent angiography showing a 100% occlusion of his left anterior descending artery. Following management of his coronary artery disease, he was discharged from the hospital 16 days later and was neurologically intact.
Louis-Napoléon Geoffroy is usually credited as the author of the first ‘alternate history’. Karen Hellekson asserts confidently that ‘the alternate history did not exist in Western literature until 1836’, the ‘year that saw the first novel-length alternate history, Louis-Napoléon Geoffroy- Château's Napoléon et la conquête du monde 1812–32’ (Alternate History 13), and Paul K. Alkon describes Geoffroy's novel as ‘the first uchronia of alternate history’ (Origins of Futuristic Fiction 146). This belief connects with a larger thesis, to which many scholars of science fiction subscribe, that the late eighteenth-century flourish of political revolutions across Europe and America, into which we may bracket the effectively global Napoleonic wars to which they gave rise, reconfigured the logic of the genre; that, as Darko Suvin puts it, ‘around 1800, space loses its monopoly upon the location of estrangement and the alternative horizons shift from space to time’ (Positions and Suppositions in Science Fiction 89). Revolution, the argument runs, challenged the older preconceptions about history as such, undid perceived inevitabilities and opened the door to imagined alterities. Out of this rupture emerged, inter alia, alternate history as a new sub-genre, fully formed in Geoffroy's novel, as abruptly as Athena bursting from the forehead of Jove. It is an argument unlikely to be disturbed by the observation that, in fact, there were many earlierpublished novels with good claims to be alternate histories, going back to the middle of the seventeenth century.
So instead of trying to unseat Geoffroy from his position of absolute priority, this chapter will start with the observation that there is a reason why his name stands, conventionally, at the origin point of alternate history. Something about Geoffroy's particular approach proved influential in subsequent iterations of the mode, sometimes at secondhand; and this fact has had profound consequences for how history as such is portrayed in science fiction. And indeed we need not look far to see what this is: the ideological valence of his subject, the way Napoleon blasts through the obstacle of ‘actual’ history by sheer force of military, political, and persona charisma. Geoffroy was a man who hero-worshipped Napoleon (he changed his first name from Louis to Louis-Napoléon in homage, for instance), and the whole of his novel makes quite plain his investment in a ‘great man’ model of history.
The SCN5A gene is implicated in many arrhythmogenic and cardiomyopathic processes. We identified a novel SCN5A variant in a family with significant segregation in individuals affected with progressive sinus and atrioventricular nodal disease, atrial arrhythmia, dilated cardiomyopathy, and early sudden cardiac arrest.
A patient pedigree was created following the clinical evaluation of three affected individuals, two monozygotic twins and a paternal half-brother, which lead to the evaluation of a paternal half-sister (four siblings with the same father and three mothers) all of whom experienced varying degrees of atrial arrhythmias, conduction disease, and dilated cardiomyopathy in addition to a paternal history of unexplained death in his 50s with similar autopsy findings. The index male underwent sequencing of 58 genes associated with cardiomyopathies. Sanger sequencing was used to provide data for bases with insufficient coverage and for bases in some known regions of genomic segmental duplications. All clinically significant and novel variants were confirmed by independent Sanger sequencing.
All relatives tested were shown to have the same SCN5A variant of unknown significance (p. Asp197His) and the monozygotic twins shared a co-occurring NEXN (p. Glu575*). Segregation analysis demonstrates likely pathogenic trait for the SCN5A variant with an additional possible role for the NEXN variant in combination.
There is compelling clinical evidence suggesting that the SCN5A variant p. Asp197His may be re-classified as likely pathogenic based on the segregation analysis of our family of interest. Molecular mechanism studies are pending.
Apolipoprotein E (APOE) E4 is the main genetic risk factor for Alzheimer’s disease (AD). Due to the consistent association, there is interest as to whether E4 influences the risk of other neurodegenerative diseases. Further, there is a constant search for other genetic biomarkers contributing to these phenotypes, such as microtubule-associated protein tau (MAPT) haplotypes. Here, participants from the Ontario Neurodegenerative Disease Research Initiative were genotyped to investigate whether the APOE E4 allele or MAPT H1 haplotype are associated with five neurodegenerative diseases: (1) AD and mild cognitive impairment (MCI), (2) amyotrophic lateral sclerosis, (3) frontotemporal dementia (FTD), (4) Parkinson’s disease, and (5) vascular cognitive impairment.
Genotypes were defined for their respective APOE allele and MAPT haplotype calls for each participant, and logistic regression analyses were performed to identify the associations with the presentations of neurodegenerative diseases.
Our work confirmed the association of the E4 allele with a dose-dependent increased presentation of AD, and an association between the E4 allele alone and MCI; however, the other four diseases were not associated with E4. Further, the APOE E2 allele was associated with decreased presentation of both AD and MCI. No associations were identified between MAPT haplotype and the neurodegenerative disease cohorts; but following subtyping of the FTD cohort, the H1 haplotype was significantly associated with progressive supranuclear palsy.
This is the first study to concurrently analyze the association of APOE isoforms and MAPT haplotypes with five neurodegenerative diseases using consistent enrollment criteria and broad phenotypic analysis.
The 14C/12C ratio of living organisms is largely determined by the 14C/12C ratio of consumed diet as well as by the atmospheric 14C concentration together with the body’s metabolic processes. The measured 14C content of living matter compared to the atmospheric radiocarbon level can provide invaluable information about developmental processes. Our aim was to determine the 14C content of ten different tissues of the human eye using the 14C bomb-pulse dating signature. The 14C content of the atmosphere, so called 14C “bomb-pulse” has labeled humanity offering an opportunity to determine these special formation, turnover and substitution courses in biology. The results allowed us to construct a 14C map of the bomb-peak labeled human eye. According to the anatomical location of the tissues, an unexpected picture emerged as in moving from the outer parts towards the inner parts of the eye, the 14C content of each tissue decreased. The data presented here are compatible with the view that the oldest parts of the eye are the sclera, the limbus and the cornea, in this order, and moving further inside, the youngest tissue of the eye is the retina.
Primary care physicians can play a key role in supporting patients after behavioural weight loss, though little is known about communication between patients and physicians during this time. Adults (n=139) in a behavioural weight loss trial (delivered outside of primary care) who attended a primary care appointment after an initial weight loss period were surveyed to assess weight-related communication at their most recent appointment. Most participants (78%) reported discussing weight with their physician. Participants who discussed weight, compared to those who did not, lost more weight, had higher blood pressure, and were more likely to be male. Most (89%) reported that their physician was supportive of their weight loss, but only a few participants (6.9%) reported that their physician gave feedback on medical parameters. Areas for improvement identified include physicians providing universal support for modest weight changes and providing interpretation of medical measurements that changed due to weight loss.
The pessimistic arguments May challenges depend on an anti-Kantian philosophical assumption. That assumption is that what I call philosophical optimists about moral reason are also committed to empirical optimism, or what May calls “optimistic rationalism.” I place May's book in the literature by explaining how that assumption is resisted by Christine Korsgaard, one of May's examples of a contemporary Kantian.
To assess trends of mortality attributable to child and maternal undernutrition (CMU), overweight/obesity and dietary risks of non-communicable diseases (NCD) in sub-Saharan Africa (SSA) using data from the Global Burden of Disease (GBD) Study 2015.
For each risk factor, a systematic review of data was used to compute the exposure level and the effect size. A Bayesian hierarchical meta-regression analysis was used to estimate the exposure level of the risk factors by age, sex, geography and year. The burden of all-cause mortality attributable to CMU, fourteen dietary risk factors (eight diets, five nutrients and fibre intake) and overweight/obesity was estimated.
All age groups and both sexes.
In 2015, CMU, overweight/obesity and dietary risks of NCD accounted for 826204 (95 % uncertainty interval (UI) 737346, 923789), 266768 (95 % UI 189051, 353096) and 558578 (95 % UI 453433, 680197) deaths, respectively, representing 10·3 % (95 % UI 9·1, 11·6 %), 3·3 % (95 % UI 2·4, 4·4 %) and 7·0 % (95 % UI 5·8, 8·3 %) of all-cause mortality. While the age-standardized proportion of all-cause mortality accounted for by CMU decreased by 55·2 % between 1990 and 2015 in SSA, it increased by 63·3 and 17·2 % for overweight/obesity and dietary risks of NCD, respectively.
The increasing burden of diet- and obesity-related diseases and the reduction of mortality attributable to CMU indicate that SSA is undergoing a rapid nutritional transition. To tackle the impact in SSA, interventions and international development agendas should also target dietary risks associated with NCD and overweight/obesity.
Science fiction was being written throughout the seventeenth and eighteenth centuries, but it underwent a rapid expansion of cultural dissemination and popularity at the end of the nineteenth and beginning of the twentieth century. This Element explores the ways this explosion in interest in 'scientific romance', that informs today's global science fiction culture, manifests the specific historical exigences of the revolutions in publishing and distribution technology. H. G. Wells, Jules Verne and other science fiction writers embody in their art the advances in material culture that mobilize, reproduce and distribute with new rapidity, determining the cultural logic of twentieth-century science fiction in the process.
Absorbed residue studies have been used in subsistence research for decades. Only more recently have the chemical methods employed been used to explore the consumption of ritual concoctions such as those including cacao, yaupon holly, and alcohol. In this article we use mass spectrometry to identify Datura residues in prehistoric contexts from western Mexico and the American Southeast. Datura is a genus of flowering plants that contain hallucinogenic alkaloids. Their use in both regions is known historically and still continues today. This study sampled 55 pottery vessels and 18 shell vessels using both a traditional burr method and a water-based sonicator sampling method. Datura residues were found in 13 pottery vessels and 14 shell vessels using both sampling approaches. These results demonstrate that it is possible to identify Datura residue in pottery and shell vessels and that the use of Datura extends back into prehistory in both regions. The form and decoration of pottery vessels with Datura residues show correlations with specific motifs and themes. Historically, shell vessels were used in the Southeast for the consumption of another ritual beverage, called the Black Drink. The presence of Datura shows that those vessels were used for other kinds of beverages as well.