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Healthcare workers (HCWs) are a high-priority group for coronavirus disease 2019 (COVID-19) vaccination and serve as sources for public information. In this analysis, we assessed vaccine intentions, factors associated with intentions, and change in uptake over time in HCWs.
Methods:
A prospective cohort study of COVID-19 seroprevalence was conducted with HCWs in a large healthcare system in the Chicago area. Participants completed surveys from November 25, 2020, to January 9, 2021, and from April 24 to July 12, 2021, on COVID-19 exposures, diagnosis and symptoms, demographics, and vaccination status.
Results:
Of 4,180 HCWs who responded to a survey, 77.1% indicated that they intended to get the vaccine. In this group, 23.2% had already received at least 1 dose of the vaccine, 17.4% were unsure, and 5.5% reported that they would not get the vaccine. Factors associated with intention or vaccination were being exposed to clinical procedures (vs no procedures: adjusted odds ratio [AOR], 1.39; 95% confidence interval [CI], 1.16–1.65) and having a negative serology test for COVID-19 (vs no test: AOR, 1.46; 95% CI, 1.24–1.73). Nurses (vs physicians: AOR, 0.24; 95% CI, 0.17–0.33), non-Hispanic Black (vs Asians: AOR, 0.35; 95% CI, 0.21–0.59), and women (vs men: AOR, 0.38; 95% CI, 0.30–0.50) had lower odds of intention to get vaccinated. By 6-months follow-up, >90% of those who had previously been unsure were vaccinated, whereas 59.7% of those who previously reported no intention of getting vaccinated, were vaccinated.
Conclusions:
COVID-19 vaccination in HCWs was high, but variability in vaccination intention exists. Targeted messaging coupled with vaccine mandates can support uptake.
Agitation is a common complication of Alzheimer’s dementia (Agit-AD) associated with substantial morbidity, high healthcare service utilization, and adverse emotional and physical impact on care partners. There are currently no FDA-approved pharmacological treatments for Agit-AD. We present the study design and baseline data for an ongoing multisite, three-week, double-blind, placebo-controlled, randomized clinical trial of dronabinol (synthetic tetrahydrocannabinol [THC]), titrated to a dose of 10 mg daily, in 80 participants to examine the safety and efficacy of dronabinol as an adjunctive treatment for Agit-AD. Preliminary findings for 44 participants enrolled thus far show a predominately female, white sample with advanced cognitive impairment (Mini Mental Status Examination mean 7.8) and agitation (Neuropsychiatric Inventory-Clinician Agitation subscale mean 14.1). Adjustments to study design in light of the COVID-19 pandemic are described. Findings from this study will provide guidance for the clinical utility of dronabinol for Agit-AD. ClinicalTrials.gov Identifier: NCT02792257.
To determine the changes in severe acute respiratory coronavirus virus 2 (SARS-CoV-2) serologic status and SARS-CoV-2 infection rates in healthcare workers (HCWs) over 6-months of follow-up.
Design:
Prospective cohort study.
Setting and participants:
HCWs in the Chicago area.
Methods:
Cohort participants were recruited in May and June 2020 for baseline serology testing (Abbott anti-nucleocapsid IgG) and were then invited for follow-up serology testing 6 months later. Participants completed monthly online surveys that assessed demographics, medical history, coronavirus disease 2019 (COVID-19), and exposures to SARS-CoV-2. The electronic medical record was used to identify SARS-CoV-2 polymerase chain reaction (PCR) positivity during follow-up. Serologic conversion and SARS-CoV-2 infection or possible reinfection rates (cases per 10,000 person days) by antibody status at baseline and follow-up were assessed.
Results:
In total, 6,510 HCWs were followed for a total of 1,285,395 person days (median follow-up, 216 days). For participants who had baseline and follow-up serology checked, 285 (6.1%) of the 4,681 seronegative participants at baseline seroconverted to positive at follow-up; 138 (48%) of the 263 who were seropositive at baseline were seronegative at follow-up. When analyzed by baseline serostatus alone, 519 (8.4%) of 6,194 baseline seronegative participants had a positive PCR after baseline serology testing (4.25 per 10,000 person days). Of 316 participants who were seropositive at baseline, 8 (2.5%) met criteria for possible SARS-CoV-2 reinfection (ie, PCR positive >90 days after baseline serology) during follow-up, a rate of 1.27 per 10,000 days at risk. The adjusted rate ratio for possible reinfection in baseline seropositive compared to infection in baseline seronegative participants was 0.26 (95% confidence interval, 0.13–0.53).
Conclusions:
Seropositivity in HCWs is associated with moderate protection from future SARS-CoV-2 infection.
Cpefat/fat mice have a point mutation in carboxypeptidase E (Cpe), an exopeptidase that removes C-terminal basic amino acids from intermediates to produce bioactive peptides. The mutation renders the enzyme inactive and unstable. The absence of Cpe activity in these mutants leads to abnormal processing of many peptides, with elevated levels of intermediates and greatly reduced levels of the mature peptides. Cpefat/fat mice develop obesity, diabetes and infertility in adulthood. We examined whether anxiety- and/or depressive-like behaviours are also present. Anxiety-like responses are not evident in young Cpefat/fat mice (∼60 d), but appear in older animals (>90 d). These behaviours are reversed by acute treatment with diazepam or fluoxetine. In contrast, increased immobilities in forced swim and tail suspension are evident in all age groups examined. These behaviours are reversed by acute administration of reboxetine. In comparison acute treatments with fluoxetine or bupropion are ineffective; however, immobility times are normalized with 2 wk treatment. These data demonstrate that Cpefat/fat mice display depressive-like responses aged ∼60 d, whereas anxiety-like behaviours emerge ∼1 month later. In tail suspension, the reboxetine findings show that noradrenergic actions of antidepressants are intact in Cpefat/fat mice. The ability of acute fluoxetine treatment to rescue anxiety-like while leaving depressive-like responses unaffected suggests that serotonin mechanisms underlying these behaviours are different. Since depressive-like responses in the Cpefat/fat mice are rescued by 2 wk, but not acute, treatment with fluoxetine or bupropion, these mice may serve as a useful model that resembles human depression.
How are relationships between corporate clients and law firms evolving? Drawing on interview and survey data from 166 chief legal officers of S&P 500 companies from 2006–2007, we find that—contrary to standard depictions of corporate client-provider relationships—(1) large companies have relationships with ten to twenty preferred providers; (2) these relationships continue to be enduring; and (3) clients focus not only on law firm platforms and lead partners, but also on teams and departments within preferred providers, allocating work to these subunits at rival firms over time and following “star” lawyers, especially if they move as part of a team. The combination of long-term relationships and subunit rivalry provides law firms with steady work flows and allows companies to keep cost pressure on firms while preserving relationship-specific capital, quality assurance, and soft forms of legal capacity insurance. Our findings have implications for law firms, corporate departments, and law schools.
This volume of new essays is based on a conference with the same title held at the University of Exeter in 2005. All those speaking on that occasion have written chapters in this volume, along with Riccardo Chiaradonna whose chapter has been specially prepared for the volume. The aim of this volume, like the conference on which it is based, is to contribute to the upsurge of new research on Galen by focusing on a topic that bridges the interests of specialists in ancient medical history and Classicists and philosophers more generally. The conference also represents the convergence of two current focuses of research in the Department of Classics and Ancient History at Exeter, on ancient medicine especially Galen and on Hellenistic and Imperial Greek culture more generally.
We would like to acknowledge the support for the funding of the conference provided by the British Academy, the Classical Association, the Society for the Promotion of Hellenic Studies and the University of Exeter. We wish to thank most warmly all the contributors to the volume for their illuminating essays, and also the other participants at the conference whose comments helped to inform the final version of the papers. We are grateful to Michael Sharp, Classics Editor for Cambridge University Press, and the general editors of the series in which the volume appears, for their support and guidance.
The recent discovery of Galen's treatise On the Avoidance of Grief in a monastery in Thessaloniki provides a vivid picture of his intellectual life in Rome. Writing in the familiar ancient genre of the consolation, in the manner of Cicero, Seneca or Plutarch, Galen responds to the letters from an unnamed friend who admired his fortitude. Galen had managed to refrain from grief in the face of disaster, first an epidemic of plague among his slaves, and then the destruction of his books, drug supplies and medical instruments in the terrible fire that swept through the Temple of Peace and nearby buildings close to the Palatine hill in Rome in AD 192. With much topographical detail, Galen gives a clear description of the Temple of Peace district and the libraries and storehouses built around the Via Sacra, and his attempts to move valuable items he had at home into store for safe-keeping while he went on a trip to Campania. Disastrously, fire struck and he lost more cinnamon than the merchants could replace, a number of medical instruments, in particular wax moulds for special instruments he was about to commission from the metalworkers, and many books. The books included classic works by Theophrastus, Aristotle and Chrysippus, many of them annotated by Galen, with errors in punctuation and other anomalies removed.
Galen is the most important medical writer in Graeco-Roman antiquity, and also extremely valuable for understanding Graeco-Roman thought and society in the second century AD. This volume of essays locates him firmly in the intellectual life of his period, and thus aims to make better sense of the medical and philosophical 'world of knowledge' that he tries to create. How did Galen present himself as a reader and an author in comparison with other intellectuals of his day? Above all, how did he fashion himself as a medical practitioner, and how does that self-fashioning relate to the performance culture of second-century Rome? Did he see medicine as taking over some of the traditional roles of philosophy? These and other questions are freshly addressed by leading international experts on Galen and the intellectual life of the period, in a stimulating collection that combines learning with accessibility.