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Platonism has played a central role in Christianity and is essential to a deep understanding of the Christian theological tradition. At times, Platonism has constituted an essential philosophical and theological resource, furnishing Christianity with an intellectual framework that has played a key role in its early development, and in subsequent periods of renewal. Alternatively, it has been considered a compromising influence, conflicting with the faith's revelatory foundations and distorting its inherent message. In both cases the fundamental importance of Platonism, as a force which Christianity defined itself by and against, is clear. Written by an international team of scholars, this landmark volume examines the history of Christian Platonism from antiquity to the present day, covers key concepts, and engages issues such as the environment, natural science and materialism.
The proceedings of the Los Angeles Caltech-UCLA 'Cabal Seminar' were originally published in the 1970s and 1980s. Large Cardinals, Determinacy and Other Topics is the final volume in a series of four books collecting the seminal papers from the original volumes together with extensive unpublished material, new papers on related topics and discussion of research developments since the publication of the original volumes. This final volume contains Parts VII and VIII of the series. Part VII focuses on 'Extensions of AD, models with choice', while Part VIII ('Other topics') collects material important to the Cabal that does not fit neatly into one of its main themes. These four volumes will be a necessary part of the book collection of every set theorist.
We combine the results of a radiocarbon (14C) dating program with archaeogenetic, osteological and sparse stratigraphic data, to construct a Bayesian chronological model for a multi-generational sequence situated entirely on a plateau in the 14C calibration curve. Calibrated dates of individual human bones from the Late Neolithic gallery grave at Niedertiefenbach, Hesse, Germany, span the entire calibration plateau in the late 4th millennium (ca. 3350–3100/3000 cal BC), but our model restricts the overall period of burial to 3–6 generations centered on the later 3200s, and provides narrower absolute date ranges for specific individuals and associated events. We confirm the accuracy and robustness of this model by sensitivity tests of each of its components. Beyond providing a more dynamic narrative for the formation of the heterogenous burial population at Niedertiefenbach, our results show that calibration plateaus are suitable periods for Bayesian chronological modeling of even relatively brief sequences, provided that all the information employed is correct. Prior information constraining both the order of events, and of potential date differences between them, is essential for the model to give accurate, unimodal estimates of the dates of these events.
The Biofire® Film Array Meningitis Encephalitis (FAME) panel can rapidly diagnose common aetiologies but its impact in Colombia is unknown. A retrospective study of adults with CNS infections in one tertiary hospital in Colombia. The cohort was divided into two time periods: before and after the implementation of the Biofire® FAME panel in May 2016. A total of 98 patients were enrolled, 52 and 46 were enrolled in the Standard of Care (SOC) group and in the FAME group, respectively. The most common comorbidity was human immunodeficiency virus infection (47.4%). The median time to a change in therapy was significantly shorter in the FAME group than in the SOC group (3 vs. 137.3 h, P < 0.001). This difference was driven by the timing to appropriate therapy (2.1 vs. 195 h, P < 0.001) by identifying viral aetiologies. Overall outcomes and length of stay were no different between both groups (P > 0.2). The FAME panel detected six aetiologies that had negative cultures but missed identifying one patient with Cryptococcus neoformans. The introduction of the Biofire FAME panel in Colombia has facilitated the identification of viral pathogens and has significantly reduced the time to the adjustment of empirical antimicrobial therapy.
We describe a widespread laboratory surveillance program for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) at an integrated medical campus that includes a tertiary-care center, a skilled nursing facility, a rehabilitation treatment center, and temporary shelter units. We identified 22 asymptomatic cases of SARS-CoV-2 and implemented infection control measures to prevent SARS-CoV-2 transmission in congregate settings.
A web interface that allows for easy upload of CSV text data to time-based visualizations
Implementation of change points analysis to identify and display points where event rates increased or decreased
customizable plots where the user can change point shapes, color, etc.
customizable and advanced filtering support
support for plot comparisons and exports
METHODS/STUDY POPULATION: We used the R/Shiny framework to develop a web application for visualization of time stamped data. The Research and Exploratory Analysis Driven Time-data Visualization (READ-TV) application allows for user-friendly mining for longitudinal patterns in data. READ-TV is built specifically for FD analysis, but is easily adaptable to other clinical use cases, as we allow for the use of general metadata on events and cases.The building of a quantitative framework for event analysis starts with the application of homogeneous Poisson processes, which relate the times of occurrence of events in terms of an underlying rate. To understand the changes in this underlying rate, changepoint analysis is used to model the rate as a function of time using piecewise constant approximations. The changepoint analysis allows us to identify the specific periods of time where the rate of FD is increased relative to a baseline or a desired operating range. RESULTS/ANTICIPATED RESULTS: READ-TV application allows for import of time stamped event data from multiple cases. Event and case metadata are supported to facilitate filtering and mining of interesting subsets of data. Stem plots are used for visualization of selected event timelines in chosen cases. This visualization is accompanied with summary of the number and estimates of rates of occurrence of specific event types (e.g. types of FD). Change-point analysis is implemented using the ‘changepoint‘ R library. These analyses allow the users to quickly understand whether the rates of events (FD) is changing across the case timeline and where exactly these changes are occurring. DISCUSSION/SIGNIFICANCE OF IMPACT: We have demonstrated the READ-TV application to the team of the AHRQ-funded Human Factors and Systems Integration in High Technology Surgery (HF-SIgHTS) study. The ability to visualize and perform quantitative analysis of the study data was received with unanimous positive feedback and enthusiasm. We continue READ-TV development focusing on (1) increased user-friendliness using the HF-SIgHTS as our focus group, (2) increased functionality, and (3) use of more general localization terminology to allow for other applications.
Subglacial Antarctic aquatic environments are important targets for scientific exploration due to the unique ecosystems they support and their sediments containing palaeoenvironmental records. Directly accessing these environments while preventing forward contamination and demonstrating that it has not been introduced is logistically challenging. The Whillans Ice Stream Subglacial Access Research Drilling (WISSARD) project designed, tested and implemented a microbiologically and chemically clean method of hot-water drilling that was subsequently used to access subglacial aquatic environments. We report microbiological and biogeochemical data collected from the drilling system and underlying water columns during sub-ice explorations beneath the McMurdo and Ross ice shelves and Whillans Ice Stream. Our method reduced microbial concentrations in the drill water to values three orders of magnitude lower than those observed in Whillans Subglacial Lake. Furthermore, the water chemistry and composition of microorganisms in the drill water were distinct from those in the subglacial water cavities. The submicron filtration and ultraviolet irradiation of the water provided drilling conditions that satisfied environmental recommendations made for such activities by national and international committees. Our approach to minimizing forward chemical and microbiological contamination serves as a prototype for future efforts to access subglacial aquatic environments beneath glaciers and ice sheets.
Circular features made from mammoth bone are known from across Upper Palaeolithic Eastern Europe, and are widely identified as dwellings. The first systematic flotation programme of samples from a recently discovered feature at Kostenki 11 in Russia has yielded assemblages of charcoal, burnt bone and microlithic debitage. New radiocarbon dates provide the first coherent chronology for the site, revealing it to be one of the oldest such features on the Russian Plain. The authors discuss the implications for understanding the function of circular mammoth-bone features during the onset of the Last Glacial Maximum.
Approximately 30% of patients with schizophrenia experience auditory hallucinations that are refractory to antipsychotic medications. Here, we evaluated the feasibility and efficacy of transcranial alternating current stimulation (tACS) that we hypothesized would improve auditory hallucination symptoms by enhancing synchronization between the frontal and temporo-parietal areas of the left hemisphere.
22 participants were randomized to one of three arms and received twice daily, 20 min sessions of sham, 10 Hz 2 mA peak-to-peak tACS, or 2 mA tDCS over the course of 5 consecutive days. Symptom improvement was assessed using the Auditory Hallucination Rating Scale (AHRS) as the primary outcome measure. The Positive and Negative Syndrome Scale (PANSS) and the Brief Assessment of Cognition in Schizophrenia (BACS) were secondary outcomes.
Primary and secondary behavioral outcomes were not significantly different between the three arms. However, effect size analyses show that tACS had the greatest effect based on the auditory hallucinations scale for the week of stimulation (1.31 for tACS; 1.06 and 0.17, for sham and tDCS, respectively). Effect size analysis for the secondary outcomes revealed heterogeneous results across measures and stimulation conditions.
To our knowledge, this is the first clinical trial of tACS for the treatment of symptoms of a psychiatric condition. Further studies with larger sample sizes are needed to better understand the effect of tACS on auditory hallucinations.
A collision-radiation model of the solid sample cesium sputter ion source led to the rediscovery of anion production by ion-pair production. The model revealed physical processes that may produce high current outputs from such sources and suggested new ways of obtaining high outputs at lower heat and conductive stress to the source. Primary among these solutions is the electron excitation of primary Cs0 recycled from the sample to provide states that efficiently create chosen anions. Here we look at how the processes might apply to gas-fed ion sources.
In recent years, the discovery of massive quasars at
has provided a striking challenge to our understanding of the origin and growth of supermassive black holes in the early Universe. Mounting observational and theoretical evidence indicates the viability of massive seeds, formed by the collapse of supermassive stars, as a progenitor model for such early, massive accreting black holes. Although considerable progress has been made in our theoretical understanding, many questions remain regarding how (and how often) such objects may form, how they live and die, and how next generation observatories may yield new insight into the origin of these primordial titans. This review focusses on our present understanding of this remarkable formation scenario, based on the discussions held at the Monash Prato Centre from November 20 to 24, 2017, during the workshop ‘Titans of the Early Universe: The Origin of the First Supermassive Black Holes’.
Research mentor training is a valuable professional development activity. Options for training customization (by delivery mode, dosage, content) are needed to address the many critical attributes of effective mentoring relationships and to support mentors in different institutional settings.
We conducted a pilot randomized controlled trial to evaluate a hybrid mentor training approach consisting of an innovative, 90-minute, self-paced, online module (Optimizing the Practice of Mentoring, OPM) followed by workshops based on the Entering Mentoring (EM) curriculum. Mentors (n = 59) were randomized to intervention or control arms; the control condition was receipt of a two-page mentoring tip sheet. Surveys (pre, post, 3-month follow up) and focus groups assessed training impact (self-appraised knowledge, skills, behavior change) and participants’ perceptions of the blended training model.
The intervention (∼6.5 hours) produced significant improvements in all outcomes, including skills gains on par with those reported previously for the 8-hour EM model. Knowledge gains and intention-to-change mentoring practices were realized after completion of OPM and augmented by the in-person sessions. Mentors valued the synergy of the blended learning format, noting the unique strengths of each modality and specific benefits to completing a foundational online module before in-person engagement.
Findings from this pilot trial support the value of e-learning approaches, both as standalone curricula or as a component of hybrid implementation models, for the professional development of research mentors.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
Current healthcare delivery challenges are multi-faceted, requiring multiple perspectives to be addressed using a systems approach. However, a significant amount of healthcare systems design research work is carried out within single disciplines or at best a few disciplines working together. There appears to be little deliberate attempt to draw together a wide range of disciplines committed to working together to overcome differences and tackle some of the complex challenges in healthcare delivery. In this paper, we report on the initial outcomes of such an international initiative that, in the form of a workshop held at the University of Cambridge, brought together researchers and practitioners from a wide range of disciplines to explore the foundations of a community for Healthcare Systems Design Research and Practice.
Antimicrobial stewardship programs (ASPs) are effective in developed countries. In this study, we assessed the effectiveness of an infectious disease (ID) physician–driven post-prescription review and feedback as an ASP strategy in India, a low middle-income country (LMIC).
Design and setting:
This prospective cohort study was carried out for 18 months in 2 intensive care units of a tertiary-care hospital, consisting of 3 phases: baseline, intervention, and follow up. Each phase spanned 6 months.
Patients aged ≥15 years receiving 48 hours of study antibiotics were recruited for the study.
During the intervention phase, an ID physician reviewed the included cases and gave alternate recommendations if the antibiotic use was inappropriate. Acceptance of the recommendations was measured after 48 hours. The primary outcome of the study was days of therapy (DOT) per 1,000 study patient days (PD).
Overall, 401 patients were recruited in the baseline phase, 381 patients were recruited in the intervention phase, and 379 patients were recruited in the follow-up phase. Antimicrobial use decreased from 831.5 during the baseline phase to 717 DOT per 1,000 PD in the intervention phase (P < .0001). The effect was sustained in the follow-up phase (713.6 DOT per 1,000 PD). De-escalation according to culture susceptibility improved significantly in the intervention phase versus the baseline phase (42.7% vs 23.6%; P < .0001). Overall, 73.3% of antibiotic prescriptions were inappropriate. Recommendations by the ID team were accepted in 60.7% of the cases.
The ID physician–driven implementation of an ASP was successful in reducing antibiotic utilization in an acute-care setting in India.
By combining a focused inert-gas ion beam instrument and a custom magnetic-sector mass spectrometer, high spatial resolution imaging and chemical analysis are provided within a single instrument. Sub-nanometer image resolution is achieved by secondary electron (SE) imaging, limited only by the probe-size of the primary beam, while the spatial resolution for chemical mapping obtained via secondary ion mass spectrometry (SIMS) is limited mainly by beam-sample interactions to about 10 nm. This article introduces the background behind this development, describes the instrument and its various operating modes, and presents examples of its applications.
Given the frequency of natural hazards in Haiti, disaster risk reduction is crucial. However, evidence suggests that many people exposed to prior disasters do not engage in disaster preparedness, even when they receive training and have adequate resources. This may be partially explained by a link between mental health symptoms and preparedness; however, these components are typically not integrated in intervention.
The current study assesses effectiveness of an integrated mental health and disaster preparedness intervention. This group-based model was tested in three earthquake-exposed and flood-prone communities (N = 480), across three time points, using a randomized controlled trial design. The 3-day community-based intervention was culturally-adapted, facilitated by trained Haitian lay mental health workers, and focused on enhancing disaster preparedness, reducing mental health symptoms, and fostering community cohesion.
Consistent with hypotheses, the intervention increased disaster preparedness, reduced symptoms associated with depression, post-traumatic stress disorder, anxiety, and functional impairment, and increased peer-based help-giving and help-seeking. Mediation models indicated support for the underlying theoretical model, such that the effect of the intervention on preparedness was mediated by mental health, and that effects on mental health were likewise mediated by preparedness.
The community-based mental health-integrated disaster preparedness intervention is effective in improving mental health and preparedness among community members in Haiti vulnerable to natural hazards. This brief intervention has the potential to be scaled up for use with other communities vulnerable to earthquakes, seasonal flooding, and other natural hazards.