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Although the argument of the Essay on population originated in a family disagreement between Malthus and his father Daniel, who idolized Rousseau, and the Essay itself attacks Condorcet and Godwin, both of whom drew on Rousseau's ideas about human perfectibility, Malthus's project can plausibly be seen as an extension of the social theory set out above all in Rousseau's Discourse on the origin of inequality. Malthus was animated by some of Rousseau's characteristic concerns, and he deployed recognizable versions of some of Rousseau's distinctive arguments, in particular relating to the natural sociability and natural condition of humankind, conjectural history, and political economy, especially with respect to the question of balanced growth. His arguments about ‘decent pride’, furthermore, that were emphasized in later editions of the Essay map neatly onto what has been called ‘uninflamed amour-propre’ in the Rousseau literature. When we treat the social question as a nineteenth-century question, or when we locate its origins in the post-Revolutionary political controversies of the 1790s, we risk losing sight of the way in which what was being discussed were variations on mid-eighteenth-century themes.
Background: The antiquated standard reference range of 0.15–0.45 g/L for cerebrospinal fluid total protein (CSF-TP) is well entrenched in medical literature and laboratory operating procedures across the world. Methods: We conducted a web-based survey with a response rate of 34.9% through the listserv of the Canadian Neurological Sciences Federation. Additional laboratory reference data were collated by telephone interview of hospital laboratory technologists across Canada. Results: A total of 142 site responses were obtained: 64.1% from academic/tertiary hospitals and 35.9% from community hospitals. A strong majority (80.4%) of both types of institutions reported using a CSF-TP upper reference limit of 0.45 g/L or less. As a rule, no age adjustments were implemented in CSF-TP-level interpretation. Conclusions: Recent well-powered laboratory reference studies have documented CSF-TP upper reference limits that are above 0.6 g/L starting at age 50, with incremental limits partitioned by subsequent decades of age. The conventional 0.45 g/L limit could lead to false positive results. Our survey suggests there is a need to consider a wide adoption of data-driven, rather than historical, reference values.
Congenital and acquired heart diseases are highly prevalent in developing countries despite limited specialised care. Namibia established a paediatric cardiac service in 2009 with significant human resource and infrastructural constraints. Therefore, patients are referred for cardiac interventions to South Africa.
To describe the diagnoses, clinical characteristics, interventions, post-operative morbidity and mortality, and follow-up of patients referred for care.
Demographics, diagnoses, interventions, intra- and post-operative morbidity and mortality, as well as longitudinal follow-up data of all patients referred to South Africa, were recorded and analysed.
The total cohort constituted 193 patients of which 179 (93%) had CHD and 7% acquired heart disease. The majority of patients (78.8%) travelled more than 400 km to Windhoek before transfer. There were 28 percutaneous interventions. Palliative and definitive surgery was performed in 27 and 129 patients, respectively. Out of 156 patients, 80 (51.3%) had post-operative complications, of which 15 (9.6%) were a direct complication of surgery. Surgical mortality was 8/156 (5.1%, 95% confidence interval 2.2–9.8), with a 30-day mortality of 3.2%. Prolonged ICU stay was associated with a 5% increased risk of death with hazard ratio 1.05, 95% confidence interval 1.02–1.08, p=0.001. Follow-up was complete in 151 (78%) patients for more than 7 years.
Despite the challenges associated with a cardiac programme for referring patients seeking intervention in a neighbouring country and the adverse characteristics of multiple lesions and complexity associated with late presentation, we report good surgical and interventional outcomes. Our goal remains to develop a comprehensive sustainable cardiac service in Namibia.
Miconia (Miconia calvescens DC) was introduced to the East Maui Watershed (EMW) a half-century ago with more than 25 yr of management recorded. Using a historical spatiotemporal data set, we constructed a leptokurtic dispersal kernel with 99% of progeny confined to within 549 m of the nearest maternal source and the remaining 1% dispersed out to 1,636 m. Seedbank persistence, based on postdated recruitment, displayed an exponential decay projecting extinction beyond 20 yr. These parameters are highly congruent to independent interpretations of M. calvescens in Australia and Tahiti. In a simulated stage matrix model, we projected management efforts to locally eradicate a small incipient propagule bank wherein optimal management was achieved with an annual harvest rate that eliminated all juvenile recruits before reaching maturity, until extinction. Based on current pricing for helicopter herbicide ballistic technology (HBT) operations, the optimal, variable cost to locally eradicate this incipient propagule bank was estimated to be less than US$42,000, with ~90% of the effort searching for the most distant 1% of the progeny expended within the first 9 yr after the mature discovery. This variable cost was sensitive to seedbank size, recruitment rate, and dispersal range, but was most sensitive to harvest rates between suboptimal and excess. In a scenario prioritizing the upper region of EMW, we retroactively analyzed past HBT efforts eliminating satellite M. calvescens and determined that 27% of the total effort resulted in 87% of the total protection to this priority asset, with every US$1 invested potentially avoiding US$184 in future costs. Management outside the priority area was less economical, with returns in protection diminishing with distance from the priority upper region. Miconia calvescens is currently not eradicable in the EMW, and full containment of the invasion would require a substantial increase in stable, long-term funding. With limited resources, local eradication of satellite M. calvescens could be the most cost-effective alternative to protecting uninvaded areas prioritized for critical ecosystem functions.
The Pueblo population of Chaco Canyon during the Bonito Phase (AD 800–1130) employed agricultural strategies and water-management systems to enhance food cultivation in this unpredictable environment. Scepticism concerning the timing and effectiveness of this system, however, remains common. Using optically stimulated luminescence dating of sediments and LiDAR imaging, the authors located Bonito Phase canal features at the far west end of the canyon. Additional ED-XRF and strontium isotope (87Sr/86Sr) analyses confirm the diversion of waters from multiple sources during Chaco’s occupation. The extent of this water-management system raises new questions about social organisation and the role of ritual in facilitating responses to environmental unpredictability.
There is increasing awareness of the need to correct for freshwater as well as marine reservoir effects when undertaking radiocarbon (14C) dating of human remains. Here, we explore the use of stable hydrogen isotopes (δ2H), alongside the more commonly used stable carbon (δ13C) and nitrogen isotopes (δ15N), for correcting 14C freshwater reservoir offsets in 10 paired human-faunal dates from graves at the prehistoric cemetery of Shamanka II, Lake Baikal, southern Siberia. Excluding one individual showing no offset, the average human-faunal offset was 515±175 14C yr. Linear regression models demonstrate a strong positive correlation between δ15N and δ2H ratios, supporting the use of δ2H as a proxy for trophic level. Both isotopes show moderate but significant correlations (r2 ~ 0.45, p < 0.05) with 14C offsets (while δ13C on its own does not), though δ2H performs marginally better. A regression model using all three stable isotopes to predict 14C offsets accounts for approximately 65% of the variation in the latter (r2=0.651, p=0.025), with both δ13C and δ2H, but not δ15N, contributing significantly. The results suggest that δ2H may be a useful proxy for freshwater reservoir corrections, though further work is needed.
To describe the investigation and control of a cluster of Serratia marcescens bacteremia in a 505-bed tertiary-care center.
Cluster cases were defined as all patients with S. marcescens bacteremia between March 2 and April 7, 2014, who were found to have identical or related blood isolates determined by molecular typing with pulsed-field gel electrophoresis. Cases were compared using bivariate analysis with controls admitted at the same time and to the same service as the cases, in a 4:1 ratio.
In total, 6 patients developed S. marcescens bacteremia within 48 hours after admission within the above period. Of these, 5 patients had identical Serratia isolates determined by molecular typing, and were included in a case-control study. Exposure to the post-anesthesia care unit was a risk factor identified in bivariate analysis. Evidence of tampered opioid-containing syringes on several hospital units was discovered soon after the initial cluster case presented, and a full narcotic diversion investigation was conducted. A nurse working in the post-anesthesia care unit was identified as the employee responsible for the drug diversion and was epidemiologically linked to all 5 patients in the cluster. No further cases were identified once the implicated employee’s job was terminated.
Illicit drug use by healthcare workers remains an important mechanism for the development of bloodstream infections in hospitalized patients. Active mechanisms and systems should remain in place to prevent, detect, and control narcotic drug diversions and associated patient harm in the healthcare setting.
Objectives: The aim of this study was to evaluate the reliability and validity of three computerized neurocognitive assessment tools (CNTs; i.e., ANAM, DANA, and ImPACT) for assessing mild traumatic brain injury (mTBI) in patients recruited through a level I trauma center emergency department (ED). Methods: mTBI (n=94) and matched trauma control (n=80) subjects recruited from a level I trauma center emergency department completed symptom and neurocognitive assessments within 72 hr of injury and at 15 and 45 days post-injury. Concussion symptoms were also assessed via phone at 8 days post-injury. Results: CNTs did not differentiate between groups at any time point (e.g., M 72-hr Cohen’s d=−.16, .02, and .00 for ANAM, DANA, and ImPACT, respectively; negative values reflect greater impairment in the mTBI group). Roughly a quarter of stability coefficients were over .70 across measures and test–retest intervals in controls. In contrast, concussion symptom score differentiated mTBI vs. control groups acutely), with this effect size diminished over time (72-hr and day 8, 15, and 45 Cohen’s d=−.78, −.60, −.49, and −.35, respectively). Conclusions: The CNTs evaluated, developed and widely used to assess sport-related concussion, did not yield significant differences between patients with mTBI versus other injuries. Symptom scores better differentiated groups than CNTs, with effect sizes weaker than those reported in sport-related concussion studies. Nonspecific injury factors, and other characteristics common in ED settings, likely affect CNT performance across trauma patients as a whole and thereby diminish the validity of CNTs for assessing mTBI in this patient population. (JINS, 2017, 23, 293–303)
This study aimed to review available disaster training options for health care providers, and to provide specific recommendations for developing and delivering a disaster-response-training program for non-disaster-trained emergency physicians, residents, and trainees prior to acute deployment.
A comprehensive review of the peer-reviewed and grey literature of the existing training options for health care providers was conducted to provide specific recommendations.
A comprehensive search of the Pubmed, Embase, Web of Science, Scopus, and Cochrane databases was performed to identify publications related to courses for disaster preparedness and response training for health care professionals. This search revealed 7,681 unique titles, of which 53 articles were included in the full review. A total of 384 courses were found through the grey literature search, and many of these were available online for no charge and could be completed in less than six hours. The majority of courses focused on management and disaster planning; few focused on clinical care and acute response.
There is need for a course that is targeted toward emergency physicians and trainees without formal disaster training. This course should be available online and should utilize a mix of educational modalities, including lectures, scenarios, and virtual simulations. An ideal course should focus on disaster preparedness, and the clinical and non-clinical aspects of response, with a focus on an all-hazards approach, including both terrorism-related and environmental disasters.
HansotiB, KelloggDS, AberleSJ, BroccoliMC, FedenJ, FrenchA, LittleCM, MooreB, SabatoJJr., SheetsT, WeinbergR, ElmesP, KangC. Preparing Emergency Physicians for Acute Disaster Response: A Review of Current Training Opportunities in the US. Prehosp Disaster Med. 2016;31(6):643–647.
If you were a religious of the i ith or 12th centuries choosing the order in which you were to find your vocation, how did you distinguish order from order, monk from canon? How did you determine gradations of the ascetic life? If you were a founder or benefactor, planning to found a new religious house, how did you determine which order to favour? At a time when asceticism and the religious orders flourished as never before, choice must have been bewildering. There is a copious contemporary literature arguing the relative merits of this mode and that; and modern scholars have offered a remarkably wide variety of advice. Some have proceeded on the assumption that there must have been a fundamental difference and have pursued it as best they might; others, disappointed in the chase, have doubted if any true difference existed. Some have seen all such differences engulfed in the deeper stream of new impulses and modes which affected every approach to the religious life in this age; others have said that to lose track of such differences is to take a very superficial view of the meaning of the rules of St Augustine and St Benedict. It is very easy indeed to take an entirely sceptical view; and I propose to start by stating the case for saying there was no difference visible to all in every part of Europe – that no general statement of the difference stands up to close inspection. But to rest the matter there, I am sure, would be superficial and mistaken – and so in the second part of this paper I embark on the much more hazardous path of determining where the difference lay. I shall try not to add another definition to the scrap heap, but to show by looking at a number of local situations how it might have appeared both externally to a founder and at a deeper level to an educated man with some discernment of different approaches to the ascetic life and religious spirituality. Yet the ultimate abiding impression is of the strangeness of the central fact: at a time when men were seeking their own religious vocation in numbers never before approached in medieval Europe – and patrons lavishing resources on an unparalleled variety of new religious houses – it is especially difficult for us to observe in many cases where the differences lay.
Few incidents in thirteenth-century history have been more often described than the story of the Christmas crib at Greccio. Not long before his death St Francis arranged with a noble layman called John of Greccio to prepare a crib for midnight mass at Christmas, with plenty of hay and real animals, ox and ass, in attendance. Crowds flocked to the place and ‘the whole night resounded with jubilation’. Mass was celebrated over the crib. But not by Francis, for he was not a priest but a deacon; and he put on the deacon’s vestments, sang the gospel and preached. Strange as it may seem, it is only from this story in the First Life by Thomas of Celano, confirmed by some shreds of other evidence, that we know that Francis was in deacon’s orders. No explanation is given, no contemporary commentary expounds the fact. Yet it is abundantly clear that his deacon’s orders had some profound significance related to his conception of his Order and its members, and their relations one to another. It is a curious puzzle to discover what it was.
The history of women in the middle ages is difficult to write. Few women were literate; their opportunities to record their own thoughts and feelings and attitudes were restricted; the bulk of medieval records were written by men for men. Yet twelfth-century literature would be much impoverished in personal interest, and in human and intellectual content, if we lacked the writings of Heloïse and Hildegarde; and I remain stubbornly unconvinced that the letters of Heloïse were written by a man. Some of the best poetry of this and other centuries was written by women; and the cult of womankind is the essential centre and focus of the whole romantic, courtly tradition. At the other extreme White Annays and her colleagues figure in innumerable court records. A part of the relative neglect of medieval women has been due to the neglect of the history of marriage. This is now past: the academic world is full of the sound of symposia and conferences on matrimony; and a much better balance of interests between the sexes is one evident result. Catherine Morland’s gay jibe at history—’the men all so good-for-nothing and hardly any women at all’—had an edge to it in Jane Austen’s day and in the early and mid-twentieth century; it will hardly be so true of the history we study in the 1990s.
St Clare died on II August 1253, and the celebration of her seventh centenary in 1953 was accompanied by a revival of scholarly interest in her life and work scarcely to be paralleled since the Bollandists passed through August. Grau established the canon of her writings and published an annotated German translation: Hardick fixed the chronology of her life—born in 1193-4, received into the religious life at the age of 18 in 1212; from 1212 to 1253 head and leader (from 1216 abbess) of the community in San Damiano. Much else occurred besides in 1953 in scholarly publication and popular festivity; and little perhaps remains to be discovered about her life and works.