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Social outings can trigger influenza transmission, especially in children and elderly. In contrast, school closures are associated with reduced influenza incidence in school-aged children. While influenza surveillance modelling studies typically account for holidays and mass gatherings, age-specific effects of school breaks, sporting events and commonly celebrated observances are not fully explored. We examined the impact of school holidays, social events and religious observances for six age groups (all ages, ⩽4, 5–24, 25–44, 45–64, ⩾65 years) on four influenza outcomes (tests, positives, influenza A and influenza B) as reported by the City of Milwaukee Health Department Laboratory, Milwaukee, Wisconsin from 2004 to 2009. We characterised holiday effects by analysing average weekly counts in negative binomial regression models controlling for weather and seasonal incidence fluctuations. We estimated age-specific annual peak timing and compared influenza outcomes before, during and after school breaks. During the 118 university holiday weeks, average weekly tests were lower than in 140 school term weeks (5.93 vs. 11.99 cases/week, P < 0.005). The dampening of tests during Winter Break was evident in all ages and in those 5–24 years (RR = 0.31; 95% CI 0.22–0.41 vs. RR = 0.14; 95% CI 0.09–0.22, respectively). A significant increase in tests was observed during Spring Break in 45–64 years old adults (RR = 2.12; 95% CI 1.14–3.96). Milwaukee Public Schools holiday breaks showed similar amplification and dampening effects. Overall, calendar effects depend on the proximity and alignment of an individual holiday to age-specific and influenza outcome-specific peak timing. Better quantification of individual holiday effects, tailored to specific age groups, should improve influenza prevention measures.
We read with interest the recent editorial, “The Hennepin Ketamine Study,” by Dr. Samuel Stratton commenting on the research ethics, methodology, and the current public controversy surrounding this study.1 As researchers and investigators of this study, we strongly agree that prospective clinical research in the prehospital environment is necessary to advance the science of Emergency Medical Services (EMS) and emergency medicine. We also agree that accomplishing this is challenging as the prehospital environment often encounters patient populations who cannot provide meaningful informed consent due to their emergent conditions. To ensure that fellow emergency medicine researchers understand the facts of our work so they may plan future studies, and to address some of the questions and concerns in Dr. Stratton’s editorial, the lay press, and in social media,2 we would like to call attention to some inaccuracies in Dr. Stratton’s editorial, and to the lay media stories on which it appears to be based.
Ho JD, Cole JB, Klein LR, Olives TD, Driver BE, Moore JC, Nystrom PC, Arens AM, Simpson NS, Hick JL, Chavez RA, Lynch WL, Miner JR. The Hennepin Ketamine Study investigators’ reply. Prehosp Disaster Med. 2019;34(2):111–113
We assessed whether paternal demographic, anthropometric and clinical factors influence the risk of an infant being born large-for-gestational-age (LGA). We examined the data on 3659 fathers of term offspring (including 662 LGA infants) born to primiparous women from Screening for Pregnancy Endpoints (SCOPE). LGA was defined as birth weight >90th centile as per INTERGROWTH 21st standards, with reference group being infants ⩽90th centile. Associations between paternal factors and likelihood of an LGA infant were examined using univariable and multivariable models. Men who fathered LGA babies were 180 g heavier at birth (P<0.001) and were more likely to have been born macrosomic (P<0.001) than those whose infants were not LGA. Fathers of LGA infants were 2.1 cm taller (P<0.001), 2.8 kg heavier (P<0.001) and had similar body mass index (BMI). In multivariable models, increasing paternal birth weight and height were independently associated with greater odds of having an LGA infant, irrespective of maternal factors. One unit increase in paternal BMI was associated with 2.9% greater odds of having an LGA boy but not girl; however, this association disappeared after adjustment for maternal BMI. There were no associations between paternal demographic factors or clinical history and infant LGA. In conclusion, fathers who were heavier at birth and were taller were more likely to have an LGA infant, but maternal BMI had a dominant influence on LGA.
There is lack of evidence on the differential impact of maternal macronutrient consumption: carbohydrates (CHO), fats and protein on birth weight. We investigated the association between maternal dietary macronutrient intakes and their sub-components such as saccharides and fatty acids and birth weight. This analyses included 1,196 women with singleton pregnancies who were part of the CAffeine and REproductive health study in Leeds, UK between 2003 and 2006. Women were interviewed in each trimester. Dietary information was collected twice using a 24-h dietary recall about 8–12 weeks and 13–27 weeks of gestation. Multiple linear regression models adjusted for alcohol and smoking in trimester 1, showed that each additional 10 g/d CHO consumption was associated with an increase of 4 g (95 % CI 1, 7; P=0·003) in birth weight. Conversely, an additional 10 g/d fat intake was associated with a lower birth weight of 8 g (95 % CI 0, 16; P=0·04) when we accounted for energy contributing macronutrients in each model, and maternal height, weight, parity, ethnicity, gestational age at delivery and sex of the baby. There was no evidence of an association between protein intake and birth weight. Maternal diet in trimester 2 suggested that higher intakes of glucose (10 g/d) and lactose (1 g/d) were both associated with higher birth weight of 52 g (95 % CI 4, 100; P=0·03) and 5 g (95 % CI 2, 7; P<0·001) respectively. These results show that dietary macronutrient composition during pregnancy is associated with birth weight outcomes. An appropriately balanced intake of dietary CHO and fat during pregnancy could support optimum birth weight.
Accurate and reproducible patient positioning is a critical step in radiotherapy for breast cancer. This has seen the use of permanent skin markings becoming standard practice in many centres. Permanent skin markings may have a negative impact on long-term cosmetic outcome, which may in turn, have psychological implications in terms of body image. The aim of this study was to investigate the feasibility of using a semi-permanent tattooing device for the administration of skin marks for breast radiotherapy set-up.
Materials and methods
This was designed as a phase II double-blinded randomised-controlled study comparing our standard permanent tattoos with the Precision Plus Micropigmentation (PPMS) device method. Patients referred for radical breast radiotherapy were eligible for the study. Each study participant had three marks applied using a randomised combination of the standard permanent and PPMS methods and was blinded to the type of each mark. Follow up was at routine appointments until 24 months post radiotherapy. Participants and a blind assessor were invited to score the visibility of each tattoo at each follow-up using a Visual Analogue Scale. Tattoo scores at each time point and change in tattoo scores at 24 months were analysed by a general linear model using the patient as a fixed effect and the type of tattoo (standard or research) as covariate. A simple questionnaire was used to assess radiographer feedback on using the PPMS.
In total, 60 patients were recruited to the study, of which 55 were available for follow-up at 24 months. Semi-permanent tattoos were more visible at 24 months than the permanent tattoos. Semi-permanent tattoos demonstrated a greater degree of fade than the permanent tattoos at 24 months (final time point) post completion of radiotherapy. This was not statistically significant, although it was more apparent for the patient scores (p=0·071) than the blind assessor scores (p=0·27). No semi-permanent tattoos required re-marking before the end of radiotherapy and no adverse skin reactions were observed.
The PPMS presents a safe and feasible alternative to our permanent tattooing method. An extended period of follow-up is required to fully assess the extent of semi-permanent tattoo fade.
Objectives: Human immunodeficiency virus (HIV) disproportionately affects Hispanics/Latinos in the United States, yet little is known about neurocognitive impairment (NCI) in this group. We compared the rates of NCI in large well-characterized samples of HIV-infected (HIV+) Latinos and (non-Latino) Whites, and examined HIV-associated NCI among subgroups of Latinos. Methods: Participants included English-speaking HIV+ adults assessed at six U.S. medical centers (194 Latinos, 600 Whites). For overall group, age: M=42.65 years, SD=8.93; 86% male; education: M=13.17, SD=2.73; 54% had acquired immunodeficiency syndrome. NCI was assessed with a comprehensive test battery with normative corrections for age, education and gender. Covariates examined included HIV-disease characteristics, comorbidities, and genetic ancestry. Results: Compared with Whites, Latinos had higher rates of global NCI (42% vs. 54%), and domain NCI in executive function, learning, recall, working memory, and processing speed. Latinos also fared worse than Whites on current and historical HIV-disease characteristics, and nadir CD4 partially mediated ethnic differences in NCI. Yet, Latinos continued to have more global NCI [odds ratio (OR)=1.59; 95% confidence interval (CI)=1.13–2.23; p<.01] after adjusting for significant covariates. Higher rates of global NCI were observed with Puerto Rican (n=60; 71%) versus Mexican (n=79, 44%) origin/descent; this disparity persisted in models adjusting for significant covariates (OR=2.40; CI=1.11–5.29; p=.03). Conclusions: HIV+ Latinos, especially of Puerto Rican (vs. Mexican) origin/descent had increased rates of NCI compared with Whites. Differences in rates of NCI were not completely explained by worse HIV-disease characteristics, neurocognitive comorbidities, or genetic ancestry. Future studies should explore culturally relevant psychosocial, biomedical, and genetic factors that might explain these disparities and inform the development of targeted interventions. (JINS, 2018, 24, 163–175)
The purpose of this study was to evaluate a programme of lesion surgery carried out on patients with treatment-resistant depression (TRD).
This was a retrospective study looking at clinical and psychometric data from 45 patients with TRD who had undergone bilateral stereotactic anterior capsulotomy surgery over a period of 15 years, with the approval of the Mental Health Act Commission (37 with unipolar depression and eight with bipolar disorder). The Beck Depression Inventory (BDI) before and after surgery was used as the primary outcome measure. The Montgomery–Asberg Depression Rating Scale was administered and cognitive aspects of executive and memory functions were also examined. We carried out a paired-samples t test on the outcome measures to determine any statistically significant change in the group as a consequence of surgery.
Patients improved on the clinical measure of depression after surgery by −21.20 points on the BDI with a 52% change. There were no significant cognitive changes post-surgery. Six patients were followed up in 2013 by phone interview and reported a generally positive experience. No major surgical complications occurred.
With the limitations of an uncontrolled, observational study, our data suggest that capsulotomy can be an effective treatment for otherwise TRD. Performance on neuropsychological tests did not deteriorate.
To evaluate the reliability and validity of the FFQ administered to participants in the follow-up of the Melbourne Collaborative Cohort Study (MCCS), and to provide calibration coefficients.
A random sample stratified by country of birth, age, sex and BMI was selected from MCCS participants. Participants completed two FFQ and three 24 h recalls over 1 year. Reliability was evaluated by intraclass correlation coefficients (ICC). Validity coefficients (VC) were estimated from structural equation models and calibration coefficients obtained from regression calibration models.
Adults born in Australia, Greece or Italy.
Nine hundred and sixty-five participants consented to the study; of these, 459 participants were included in the reliability analyses and 615 in the validity and calibration analyses.
The FFQ showed good repeatability for twenty-three nutrients with ICC ranging from 0·66 to 0·80 for absolute nutrient intakes for Australian-born and from 0·51 to 0·74 for Greek/Italian-born. For Australian-born, VC ranged from 0·46 (monounsaturated fat) to 0·83 (Ca) for nutrient densities, comparing well with other studies. For Greek/Italian-born, VC were between 0·21 (Na) and 0·64 (riboflavin). Calibration coefficients for nutrient densities ranged from 0·39 (retinol) to 0·74 (Mg) for Australian-born and from 0·18 (Zn) to 0·54 (riboflavin) for Greek/Italian-born.
The FFQ used in the MCCS follow-up study is suitable for estimating energy-adjusted nutrients for Australian-born participants. However, its performance for estimating intakes is poorer for southern European migrants and alternative dietary assessment methods ought to be considered if dietary data are to be measured in similar demographic groups.
Fe deficiency anaemia during early pregnancy has been linked with low birth
weight and preterm birth. However, this evidence comes mostly from studies
measuring Hb levels rather than specific measures of Fe deficiency. The present
study aimed to examine the association between maternal Fe status during the
first trimester of pregnancy, as assessed by serum ferritin, transferrin
receptor and their ratio, with size at birth and preterm birth. In the Baby VIP
(Baby's Vascular health and Iron in Pregnancy) study, we recruited 362
infants and their mothers after delivery in Leeds, UK. Biomarkers were measured
in maternal serum samples previously obtained in the first trimester of
pregnancy. The cohort included sixty-four (18 %) small for gestational
age (SGA) babies. Thirty-three babies were born preterm (9 %; between 34
and 37 weeks). First trimester maternal Fe depletion was associated with a
higher risk of SGA (adjusted OR 2·2, 95 % CI 1·1,
4·1). This relationship was attenuated when including early pregnancy Hb
in the model, suggesting it as a mediator (adjusted OR 1·6, 95 %
CI 0·8, 3·2). For every 10 g/l increase in maternal Hb
level in the first half of pregnancy the risk of SGA was reduced by 30 %
(adjusted 95 % CI 0, 40 %); levels below 110 g/l were
associated with a 3-fold increase in the risk of SGA (95 % CI 1·0,
9·0). There was no evidence of association between maternal Fe depletion
and preterm birth (adjusted OR 1·5, 95 % 0·6, 3·8).
The present study shows that depleted Fe stores in early pregnancy are
associated with higher risk of SGA.
EPA has conducted several ex post assessments of regulatory compliance costs, with the ultimate goal of identifying ways to improve ex ante cost estimation. The work to date has culminated in four case studies that examine five regulations using a common conceptual framework. The standardized framework provides a systematic way to investigate key drivers of compliance costs to see if judgments can be made about why and how ex ante and ex post estimates of costs differ. In addition to describing this conceptual framework, we describe the criteria used to select the rules to be analyzed, summarize the main hypotheses for why ex ante and ex post cost estimates may differ and discuss some of the challenges encountered in conducting these ex post analyses.
What does it mean to think “I,” to say “I,” to write “I”? These foundational questions of subjectivity inform Annette von Droste-Hulshoff's literary production to such an extent that one might arguably define her oeuvre in terms of the early German Romantic notion of autopoiesis, the self-reflexive, self-critical self-creation of the subject, das Ich (the I), in and through poesy. Yet in contradistinction to the unitary structure of early Romantic subjectivity, for Droste the self frequently is presented as an object, an object often watched by—and at times watching—the subject, an object that is irreconcilable with the subject. significantly, many of these scenes of objectified self-definition are explicitly presented as aesthetic events, indicating their programmatic status in Droste's poetics, and they recur emblematically throughout her writing.
The following analysis seeks to elucidate Droste's object-driven conception of subjectivity and poetic production through a series of examples. The first section considers the early prose fragment Ledwina (1818/19–26). The second presents brief readings of a selection of her more famous poems and ballads, written between 1840 and 1844: “Das Spiegelbild” (The mirror image), “Im Moose” (In the moss), “Das Fraulein von Rodenschild” (Lady von Rodenschild), “Das erste Gedicht” (The first poem), “Das alte schloss” (The old castle), “Im Grase” (In the grass), “Die todte Lerche” (The dead lark), “Die Taxuswand” (The yew wall), “Die Mergelgrube” (The marl pit) and “Lebt wohl” (Farewell).
In 1807 Goethe formed a small chamber choir in Weimar, which he referred to on occasion as his “Singschule” (singing school), “Singechor” (singing choir), or “Singstunden” (singing class); in his diary he would often simply write that he spent time with “die Sänger” (the singers). Thanking Bettine Brentano for a packet of music she had sent him, he called the choir “meine kleine Hauscapelle” (my little chamber group) in a 24 February 1808 letter to her, and with irony he called the choir “meine kompendiose Hauskapelle” (my compendious chamber group) in a 22 April 1814 letter to his friend and musical advisor Carl Friedrich Zelter (MA 20.1:343). Years later in the Tag- und Jahreshefte he once again and more seriously referred to it as his “Hauskapelle” as he recalled its most successful season, 1810-11.
That the name recalls an earlier Hauskapelle, which Goethe created in the fictive world of Wilhelm Meisters Lehrjahre, is not accidental:
Serlo, ohne selbst Genie zur Musik zu haben, oder irgend ein Instrument zu spielen, wußte ihren hohen Wert zu schätzen; er suchte sich so oft als möglich diesen Genuß, der mit keinem andern verglichen werden kann, zu verschaffen. Er hatte wöchentlich einmal Konzert, und nun hatte sich ihm durch Mignon, den Harfenspieler und Laertes, der auf der Violine nicht ungeschickt war, eine wunderliche kleine Hauskapelle gebildet.
As many of his enemies have repeatedly emphasized, laughter is the devil. A long line of humorlessness, and especially a demonization of laughter, runs through the history of Christianity. Above all, it was the ancient Christian monkhood and the Church Fathers who accused laughter of being incompatible with human dignity. This tradition of an conservative hatred of laughter reaches from the seventeenth century's Jesuit and Jansenist critique of the comedy of the seventeenth century to Charles Baudelaire's essay De L'Essence du rire (1855), in which he reveals laughter to be the signature of fallen humanity, the trait of the satanic in mankind: “un des plus clairs signes sataniques de l'homme” (one of the clearest satanic signs of man). In paradise, laughter would have been unknown, and Christ never laughed—but he did cry—which, for Baudelaire, confirmed the antidivine character of laughter.
Two major works of modern art and literature, not least inspired by Baudelaire, have moved laughter into the sphere of evil. It is in Wagner's Parsifal that Kundry, the female main character, laughed at the cross-bearing Jesus on his journey of suffering and, as a result, was condemned like Ahasuerus, the eternal Jew, to wander through history until the end of days in “cursed laughter” (verfluchtem Lachen).
Jane Brown'sThe Persistence of Allegory (2007) brilliantly rethinks the history of the neoclassical aesthetic in literature and the visual arts over the past three hundred years. The study's interpretive frame, which Brown describes as “morphological in Goethe's sense of the word,” allows her to revisit the fluid relationship between the mimetic interests of an array of neoclassicisms from Shakespeare to Wagner and the disruptive allegorical interests of a variety of nonillusionist stage-practices. The following comments on Goethe's architectural idea are indebted to Brown's analysis of how the allegorical impulse “persisted” by adaptively reinscribing itself within the practices of neoclassical drama. Despite the enlistment of Aristotelian mimesis by the practitioners of literary neoclassicism, who displaced allegory with the illusion of reality, Brown repeatedly shows how allegory found ways to survive. Ultimately, allegory came to “haunt” the neoclassical stage for Brown in the sense that it unsettled the closely regulated household of dramatic verisimilitude, whether grounded in Aristotle's “material causality and psychological realism” or Vitruvius's perspectival stage-illusion (Persistence 113).
Following a similar line of argumentation, I contend that even after Goethe fell under the spell of Italy's ancient monuments, the gothic persevered in his system of architectural accounting whenever he took stock of what buildings are and how they should be perceived.
Es wird unmöglich sein, aus dem Modernismus von Hegels Diagnose neuerer Kunst die Prognose von deren Zukunft zu tilgen, ohne seine Theorie insgesamt umzuformulieren. An ihre Leistungen kann nur der anknüpfen, der die Bedingungen erkennt, unter denen ihre Defekte zustande kamen. Und seiner Fundamente kann man sich nur bedienen, wenn man erkennt, auf welchen Grund sie gelegt sind.
[It will be impossible to cut away the aspect of Hegel's forecast about the future of art from the general modernity of his diagnosis of recent art without reformulating his theory of art as a whole. Only one who knows the conditions under which its defects arose can begin this task of reformulation; one can make use of its foundations only when one understands the grounds on which the foundations were laid.]
“History” is a paradigm that emerges from what the conceptual historian Reinhart Koselleck calls the Sattelzeit, the period between 1750 and 1850; in other words, the concept of history itself has a history. For although history “als Kunde, Erzählung und Wissenschaft” (in the form of tidings, storytelling and scientific inquiry), as he explains, has been “ein alter Befund europäischer Kultur” (a part of European culture since antiquity), and although “das Geschichten-Erzählen zur Geselligkeit des Menschen [gehört]” (the telling of stories is inseparably bound up with human sociability), the notion that “es in der Geschichte um ‘Geschichte selber’ geht und nicht um eine Geschichte von etwas” (what is at stake in history is “history itself,” and not the history of something or other), is “eine moderne, eine neuzeitliche Formulierung” (a formulation specific to the modern era).
Invoking Goethe's name has become fashionable again. With new methods and technologies of reading threatening to render literature virtual and insubstantial, we have the sense that "Goethe's ghosts" - the otherwise neglected voices and traditions that, finding their most trenchant expression in Goethe, inform the Western storehouse of literature - can show us long-forgotten dimensions of literature. Inspired by the distinguished Goethe scholar Jane Brown, whose life's work has called attention to the allegorical modes haunting the mimetic forms that dominate modern literature, the contributors to this volume take a rich variety of approaches to Goethe: cultural studies, history of the book, semiotics, deconstruction, colonial studies, feminism, childhood studies, and eco-criticism. The persistence, omnipresence, and modalities of the "ghosts" they find suggest that more than influence or standards is at issue here. Goethe's work informs current debates on nineteenth-century nationalism, while his Faust increasingly serves to express contemporary culture's anxiety about new technologies. The stubborn reappearance of these revenants testifies to more fundamental issues concerning the status of literature and the task of the reader. As the contributors demonstrate, these questions acquire renewed urgency in writers as diverse as Hegel, Adorno, Benn, Droste-Hülshoff, and Nietzsche. Each of the essays testifies to the enduring salience and presence of Goethe. Contributors: Helmut Ammerlahn, Benjamin Bennett, Richard Block, Dieter Borchmeyer, Franz-Josef Deiters, Richard T. Gray, Martha B. Helfer, Meredith Lee, Clark Muenzer, Andrew Piper, Simon Richter, Jürgen Schroeder, Peter Schwartz, Patricia Simpson, Robert Tobin, David Wellbery, Sabine Wilke. Simon Richter is Professor of German Literature at the University of Pennsylvania. Richard Block is Associate Professor of German at the University of Washington.
Commentators have been practically unanimous about the general atmosphere of Goethe's little poem “Über allen Gipfeln.” Release of tension, imminent repose, harmony, and so on, make up the general view. My own sense of the poem—at least of its final version, as it appeared in print from 1815 on—is different. I find in it mainly nothing but dissonances, incongruities, and contradictions. And in the end, I think, the recognition of these qualities produces a distinctly better overall reading of the text than most others.
1. The first jarring element is the title: “Ein gleiches” (Of the same sort). Ordinarily we do not expect a poem's title to present interpretive difficulties—or if it does, then only after we have worked our way through the poem itself, as in the case of “Ganymed.” But the title “Ein gleiches”—with lower-case “g,” hence requiring to be completed by an understood noun—compels us to look elsewhere to discover what it refers to. For most commentators, “look elsewhere” means simply “look elsewhere on the same page”—in either the 1815 edition or the “Ausgabe letzter Hand”—where we find above our poem the poem “Wandrers Nachtlied” (Wanderer's night-song).