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Micronutrient supplementation is recommended in Ebola Virus Disease (EVD). However, there is limited data on its therapeutic impacts. This study evaluated the association between vitamin A supplementation and mortality outcomes in EVD patients.
This retrospective cohort study accrued patients with EVD admitted to five International Medical Corps run Ebola Treatment Units (ETU) in two countries from 2014-2015. Protocolized treatments with antimicrobials and micronutrients were used at all ETUs. However, due to resource limitations and care variations, only a subset of patients received vitamin A. Standardized data on demographics, clinical characteristics, malaria status, and Ebola virus RT-PCR cycle threshold (CT) values were collected. The outcome of interest was mortality compared between cases treated with 200,000 International Units of vitamin A on care days one and two and those not. Propensity scores (PS) based on the first 48-hours of care were derived using the covariates of age, duration of ETU function, malaria status, CT values, symptoms of confusion, hemorrhage, diarrhea, dysphagia, and dyspnea. Treated and non-treated cases were matched 1:1 based on nearest neighbors with replacement. Covariate balance met predefined thresholds. Mortality proportions between cases treated and untreated with vitamin A were compared using generalized estimating equations to calculate relative risks (RR) with associated 95% confidence intervals (CI).
There were 424 cases analyzed, with 330 (77.8%) being vitamin A-treated cases. The mean age was 30.5 years and 57.0% were female. The most common symptoms were diarrhea (86%), anorexia (81%), and vomiting (77%). Mortality proportions among cases untreated and treated with vitamin A were 71.9% and 55.0%, respectively. In a propensity-matched analysis, mortality was significantly lower among cases receiving vitamin A (RR = 0.77 95%; CI:0.59-0.99; p = 0.041).
Early vitamin A supplementation was associated with reduced mortality in EVD patients and should be provided routinely during future epidemics.
Although the United States is often criticized for its lack of historical consciousness, historicity provides a compelling rhetorical trump in constitutional argument, particularly according to advocates of original understanding jurisprudence or “originalism.” Originalism has also proven to be quite popular as a constitutional position, especially in public discourse outside academe and the courts. I argue that originalism's appeal derives from Americans' interest in heritage. Using the literature on public history, memory, and cultural studies to distinguish the cultural phenomenon of heritage from history proper, I argue that originalism, like heritage, offers the possibility of an immediate and authentic encounter with the past tied to a critique of modernism as both antidemocratic and inauthentic. Originalism portrays the federal period as a special moment of civic unity, whose virtues have been preserved by the larger public, but have been eroded among elites by modernity.
Pluralism has become a buzzword in International Relations. It has emerged in a number of linked literatures and has drawn the support of an unusual coalition of scholars: advocates of greater methodological diversity; those who feel that IR has degenerated into a clash of paradigmatic “-isms”; those who favor a closer relationship between academics and policy-makers; and those who wish to see greater reflexivity within the field. Perhaps unsurprisingly, no single vision of pluralism unites these scholars; they appear to be using the term in divergent ways. Accordingly, our aim is threefold. First, we wish to highlight this odd state of affairs, by placing it in disciplinary and intellectual context. Second, we distinguish between plurality—the de facto recognition that IR has become a more diverse field—and pluralism—a normative position which values that diversity, given the public vocation of social science. Finally, we lay out a more consistent understanding and defense of pluralism in those latter terms. We argue that, properly understood, pluralism entails a position of epistemological skepticism: the straightforward claim that no single knowledge system, discipline, theory, or method can claim singular access to truth.
The mutual impact of violence and religious transformation in the recent experience of Latin America has reshaped the public presence of churches (both Catholic and Protestant) and altered their discourse and appeal. Many churches turned to promotion of human rights, protection of victims, and opposition to authoritarian rule. Others allied with repressive regimes in the name of a kind of Christian nationalism. The violence at issue ranges from the massive violence of repression, torture, and revolutionary struggle to the institutionalized violence of poverty, disease, and injustice, which is often accompanied by the violence of daily life and linked with migration, drugs, gangs, and domestic abuse. Religion itself has changed: the Catholic monopoly has been replaced by pluralism, as Protestant and Pentecostal churches reach new populations and offer potential converts a way of opting out of the violence of daily life through rebirth in a new religious community.
Venezuelan politics presents a puzzle to students of Latin America, and to anyone concerned with the comparative analysis of democratization and democracy. As the major countries of Latin America (and the majority of scholars) worked their way from authoritarianism through “transitions”to democracy and hopefully toward democracy’s consolidation, Venezuela moved in the opposite direction. After decades of political stability and social peace, beginning in 1987 Venezuela’s democratic order was shaken by widespread unrest and citizen disaffection, the decay of key parties and state institutions, attempted coups, and the impeachment and removal of the president in 1993.
When the Soviet Union collapsed, Russia and the other successor states lost much of their collective strategic significance for the international community. Russia's role as a new member of the nuclear club is potentially destabilizing but does not present the overriding nuclear threat once posed by the USSR. Although Russia is attempting to reestablish its traditional roles in Eurasia, the Balkans and eastern Europe, its political importance has generally decreased commensurate with the collapse of the Soviet military machine; Russia is important economically only insofar as it is a powerful magnet for western aid and investment. While this perception of gradual marginalization, apparently shared by western diplomats, academics and journalists, may be largely accurate, it is incomplete. It overlooks Russia's potential role as a source of natural resources.
We argue that Firestone & Scholl (F&S) provide worthwhile recommendations but that their critique of research by Levin and Banaji (2006) is unfounded. In addition, we argue that F&S apply unjustified level of skepticism about top-down effects relative to other broad hypotheses about the sources of perceptual intelligence.