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Fifteenth-century Italy witnessed sweeping innovations in the art of sculpture. Sculptors rediscovered new types of images from classical antiquity and invented new ones, devised novel ways to finish surfaces, and pushed the limits of their materials to new expressive extremes. The Art of Sculpture in Fifteenth-Century Italy surveys the sculptural production created by a range of artists throughout the peninsula. It offers a comprehensive overview of Italian sculpture during a century of intense creativity and development. Here, nineteen historians of Quattrocento Italian sculpture chart the many competing forces that led makers, patrons, and viewers to invest sculpture with such heightened importance in this time and place. Methodologically wide-ranging, the essays, specially commissioned for this volume, explore the vast range of techniques and media (stone, metal, wood, terracotta, and stucco) used to fashion works of sculpture. They also examine how viewers encountered those objects, discuss varying approaches to narrative, and ponder the increasing contemporary interest in the relationship between sculpture and history.
Founded on post-war optimism that a Europe of united democracies could provide both peace and prosperity, the European Union is slowly waking up to the fact that not all of its Member States are committed to democratic principles. Article 2 TEU pronounces (as fact) that “[t]he Union is founded on the values of respect for human dignity, freedom, democracy, equality, the rule of law and respect for human rights, including the rights of persons belonging to minorities.” And Article 2 goes on to assert (as fact) that “[t]hese values are common to the Member States in a society in which pluralism, non-discrimination, tolerance, justice, solidarity and equality between women and men prevail.” But for some EU member governments, these values no longer define the aspirational horizon. The requirements of Article 2 are simply no longer met in all Member States.
Making good decisions prospectively is difficult, especially when there is the perception that the stakes are high. There is often uncertainty regarding prognosis and emotions prevail both between a couple and in the interactions with their healthcare professional team. This is the case when parents have to decide about fetal therapy for congenital malformations and the health of their unborn child. Parents are usually unprepared for the often rare disease the fetus is found to have. Still in a state of shock, they receive a lot of detailed and difficult information, and need to decide whether to choose fetal therapy (which often carries risks of perinatal death or preterm birth as complications), expectant management, or sometimes the very difficult option of termination of pregnancy. The obstetrician or fetal medicine specialist aims to provide the parents with all the relevant factual information and to support them in their decision process.
Modern humans evolved in Africa approximately 200,000 years ago (Campbell and Tishkoff 2010). As groups migrated out of Africa they underwent bottlenecks leading to sharp reductions in population size and genetic diversity (Amos and Hoffman 2010; Harpending and Rogers 2000; Ramachandran et al. 2005). To this day, African populations retain the most genetic diversity globally (Auton et al. 2015). In order to survive both within and out of Africa, early human populations had to adapt to their novel environments, including new food resources, colder climates, higher altitudes, and, especially, infectious diseases (Balaresque et al. 2007; Fumagalli et al. 2011). These adaptive requirements, facilitated by natural selection, led to an increased frequency of alleles that were beneficial in that environment. Due to the fact that these adaptive requirements were driven by local environmental pressures, some of these evolutionarily advantageous alleles display geographic and ancestral specificity, as observed in the genomes of present-day humans (Fumagalli et al. 2011).
Describe common pathogens and antimicrobial resistance patterns for healthcare-associated infections (HAIs) that occurred during 2015–2017 and were reported to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN).
Data from central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), and surgical site infections (SSIs) were reported from acute-care hospitals, long-term acute-care hospitals, and inpatient rehabilitation facilities. This analysis included device-associated HAIs reported from adult location types, and SSIs among patients ≥18 years old. Percentages of pathogens with nonsusceptibility (%NS) to selected antimicrobials were calculated for each HAI type, location type, surgical category, and surgical wound closure technique.
Overall, 5,626 facilities performed adult HAI surveillance during this period, most of which were general acute-care hospitals with <200 beds. Escherichia coli (18%), Staphylococcus aureus (12%), and Klebsiella spp (9%) were the 3 most frequently reported pathogens. Pathogens varied by HAI and location type, with oncology units having a distinct pathogen distribution compared to other settings. The %NS for most pathogens was significantly higher among device-associated HAIs than SSIs. In addition, pathogens from long-term acute-care hospitals had a significantly higher %NS than those from general hospital wards.
This report provides an updated national summary of pathogen distributions and antimicrobial resistance among select HAIs and pathogens, stratified by several factors. These data underscore the importance of tracking antimicrobial resistance, particularly in vulnerable populations such as long-term acute-care hospitals and intensive care units.
To describe common pathogens and antimicrobial resistance patterns for healthcare-associated infections (HAIs) among pediatric patients that occurred in 2015–2017 and were reported to the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN).
Antimicrobial resistance data were analyzed for pathogens implicated in central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated pneumonias (VAPs), and surgical site infections (SSIs). This analysis was restricted to device-associated HAIs reported from pediatric patient care locations and SSIs among patients <18 years old. Percentages of pathogens with nonsusceptibility (%NS) to selected antimicrobials were calculated by HAI type, location type, and surgical category.
Overall, 2,545 facilities performed surveillance of pediatric HAIs in the NHSN during this period. Staphylococcus aureus (15%), Escherichia coli (12%), and coagulase-negative staphylococci (12%) were the 3 most commonly reported pathogens associated with pediatric HAIs. Pathogens and the %NS varied by HAI type, location type, and/or surgical category. Among CLABSIs, the %NS was generally lowest in neonatal intensive care units and highest in pediatric oncology units. Staphylococcus spp were particularly common among orthopedic, neurosurgical, and cardiac SSIs; however, E. coli was more common in abdominal SSIs. Overall, antimicrobial nonsusceptibility was less prevalent in pediatric HAIs than in adult HAIs.
This report provides an updated national summary of pathogen distributions and antimicrobial resistance patterns among pediatric HAIs. These data highlight the need for continued antimicrobial resistance tracking among pediatric patients and should encourage the pediatric healthcare community to use such data when establishing policies for infection prevention and antimicrobial stewardship.
This article explains why autocrats love constitutional pluralism and constitutional identity. Though these concepts were developed by scholars and jurists with the best of intentions in mind, we explain why they are also attractive to and inherently prone to abuse by autocrats. We then describe how the regimes in Hungary and Poland have made use of these concepts in their drive to consolidate autocracy. We conclude that given the dangers inherent in constitutional pluralism and its susceptibility to abuse, it should be replaced with a more traditional understanding of the primacy of EU law.
Early behaviors that differentiate later biomarkers for psychopathology can guide preventive efforts while also facilitating pathophysiological research. We tested whether error-related negativity (ERN) moderates the link between early behavior and later psychopathology in two early childhood phenotypes: behavioral inhibition and irritability. From ages 2 to 7 years, children (n = 291) were assessed longitudinally for behavioral inhibition (BI) and irritability. Behavioral inhibition was assessed via maternal report and behavioral responses to novelty. Childhood irritability was assessed using the Child Behavior Checklist. At age 12, an electroencephalogram (EEG) was recorded while children performed a flanker task to measure ERN, a neural indicator of error monitoring. Clinical assessments of anxiety and irritability were conducted using questionnaires (i.e., Screen for Child Anxiety Related Disorders and Affective Reactivity Index) and clinical interviews. Error monitoring interacted with early BI and early irritability to predict later psychopathology. Among children with high BI, an enhanced ERN predicted greater social anxiety at age 12. In contrast, children with high childhood irritability and blunted ERN predicted greater irritability at age 12. This converges with previous work and provides novel insight into the specificity of pathways associated with psychopathology.
A simplified model is introduced to study finite-amplitude thermo-acoustic oscillations in
-periodic annular combustion devices. Such oscillations yield undesirable effects and can be triggered by a positive feedback between heat-release and pressure fluctuations. The proposed model, comprising the governing equations linearized in the acoustic limit, and with each burner modelled as a one-dimensional system with acoustic damping and a compact heat source, is used to study the instability caused by cross-sector coupling. The coupling between the sectors is included by solving the one-dimensional acoustic jump conditions at the locations where the burners are coupled to the annular chambers of the combustion device. The analysis takes advantage of the block-circulant structure of the underlying stability equations to develop an efficient methodology to describe the onset of azimuthally synchronized motion. A modal analysis reveals the dominance of global instabilities (encompassing the large-scale dynamics of the entire system), while a non-modal analysis reveals a strong response to harmonic excitation at forcing frequencies far from the eigenfrequencies, when the overall system is linearly stable. In all presented cases, large-scale, azimuthally synchronized (coupled) motion is observed. The relevance of the non-modal response is further emphasized by demonstrating the subcritical nature of the system’s Hopf point via an asymptotic expansion of a nonlinear model representing the compact heat source within each burner.
There is an emerging consensus in developmental psychopathology that irritable youth are at risk for developing internalizing problems later in life. The current study explored if irritability in youth is multifactorial and the impact of irritability dimensions on psychopathology outcomes in adulthood.
We conducted exploratory factor analysis on irritability symptom items from a semi-structured diagnostic interview administered to a community sample of adolescents (ages 14–19; 42.7% male; 89.1% white). The analysis identified two factors corresponding to items from the mood disorders v. the oppositional defiant disorder (ODD) (Leibenluft and Stoddard) sections of the interview. These factors were then entered together into regression models predicting psychopathology assessed at age 24 (N = 941) and again at age 30 (N = 816). All models controlled for concurrent psychopathology in youth.
The two irritability dimensions demonstrated different patterns of prospective relationships, with items from the ODD section primarily predicting externalizing psychopathology, items from the mood disorder sections predicting depression at age 24 but not 30, and both dimensions predicting borderline personality disorder symptoms.
These results suggest that the current standard of extracting and compositing irritability symptom items from diagnostic interviews masks distinct dimensions of irritability with different psychopathological outcomes. Additionally, these findings add nuance to the prevailing notion that irritability in youth is specifically linked to later internalizing problems. Further investigation using more sensitive and multifaceted measures of irritability are needed to parse the meaning and clinical implications of these dimensions.
The science of studying diamond inclusions for understanding Earth history has developed significantly over the past decades, with new instrumentation and techniques applied to diamond sample archives revealing the stories contained within diamond inclusions. This chapter reviews what diamonds can tell us about the deep carbon cycle over the course of Earth’s history. It reviews how the geochemistry of diamonds and their inclusions inform us about the deep carbon cycle, the origin of the diamonds in Earth’s mantle, and the evolution of diamonds through time.
Classic conceptual frameworks explaining the relationship of personality traits to depression include the precursor and predisposition models. The former hypothesizes that depression is predicted by traits alone whereas the latter hypothesizes that stress, together with personality, predicts depression. Dynamic vulnerability models (DVM) expand on these perspectives by incorporating fluctuations in personality over time. The stress generation model provides an alternative view, positing that depression generates stress, creating a self-perpetuating cycle. However, these conceptual models are rarely directly compared.
We tested these models, focusing on neuroticism and stressful life events that the participant may have contributed to, using path analysis in a sample of 550 never-depressed, adolescent females assessed five times over 3 years.
A dynamic precursor model with stress generation was best supported. For the precursor component, neuroticism predicted subsequent depression across four assessment intervals. For the dynamic trait component, stressful life events predicted subsequent neuroticism at three of four intervals. Finally, in line with stress generation, depression consistently predicted subsequent stressful life events, and life events then predicted depression.
Finding support for the DVM is noteworthy, as this is the first comprehensive test of this model. Moreover, results supported integrating stress generation with trait vulnerability. Continued use of integrated approaches and refining the statistical implementation of these theories is necessary to advance understanding of the development of depression.
Despite the prevalence of quantitative approaches in applied linguistics (AL) and second language acquisition (SLA) research (Gass, 2009), evidence indicates a need for improvement in analyzing and reporting SLA data (e.g., Larson-Hall & Plonsky, 2015). However, to improve quantitative research, researchers must possess the statistical knowledge necessary to conduct quality research. This study assesses AL and SLA researchers’ knowledge of key statistical concepts on a statistical knowledge test. One hundred and ninety-eight AL and SLA researchers from North America and Europe responded to 26 discipline-specific questions designed to measure participants’ ability to (a) understand basic statistical concepts and procedures, (b) interpret statistical analyses, and (c) critically evaluate statistical information. Results indicate that participants generally understood basic descriptive statistics, but performance on items requiring more advanced statistical knowledge was lower. Quantitative research orientation, number of statistics courses taken, and frequent use of statistics textbooks had positive influences on researchers’ statistical knowledge.
Pulmonary hypertension is a complex and progressive condition that is either idiopathic or heritable, or associated with one or multiple health conditions, with or without congenital or acquired cardiovascular disease. Recent developments have tremendously increased the armamentarium of diagnostic and therapeutic approaches in children and young adults with pulmonary hypertension that is still associated with a high morbidity and mortality. These modalities include non-invasive imaging, pharmacotherapy, interventional and surgical procedures, and supportive measures. The optimal, tailored diagnostic and therapeutic strategies for pulmonary hypertension in the young are rapidly evolving but still face enormous challenges: Healthcare providers need to take the patient’s age, development, disease state, and family concerns into account when initiating advanced diagnostics and treatment. Therefore, there is a need for guidance on core and advanced medical training in paediatric pulmonary hypertension. The Association for European Paediatric and Congenital Cardiology working group “pulmonary hypertension, heart failure and transplantation” has produced this document as an expert consensus statement; however, all recommendations must be considered and applied in the context of the local and national infrastructure and legal regulations.
Needlestick and sharps injury (NSSI) is a common occupational hazard of orthopedic surgery training. The purpose of this study was to examine the incidence and surrounding circumstances of intraoperative NSSI in orthopedic surgery residents and fellows and to examine postexposure reporting.
A 35-question cross-sectional survey.
The study was conducted by orthopedic surgery residents and faculty at a nonprofit regional hospital.
The questionnaire was distributed to US allopathic orthopedic surgery residency and fellowship programs; 300 orthopedic surgery trainees participated in the survey.
Of 223 trainees who had completed at least 1 year of residency, 172 (77.1%) sustained an NSSI during residency, and 57 of 63 trainees (90.5%) who had completed at least 4 years sustained an NSSI during residency. The most common causes of NSSI were solid needles, followed by solid pins or wires. The surgical activity most associated with NSSI was wound closure, followed by fracture fixation. The type of surgery most frequently associated with NSSI was orthopedic trauma, followed by hip and knee arthroplasty. Of 177 trainees who had sustained a prior NSSI, 99 (55.9%) failed to report all events to their institution’s occupational health department.
The incidence of NSSI during residency training is high, with >90% of trainees in their fifth year or later of training having received an injury during their training, with a mean of >4 separate events. Most trainees with an NSSI did not report all of their events, which implies that changes are needed in the incident reporting process universally.
Terrorist attacks have increased globally since the late 1990s with clear evidence of psychological distress across both adults and children and young people (CYP). After the Manchester Arena terrorist attack, the Resilience Hub was established to identify people in need of psychological and psychosocial support.
To examine the severity of symptoms and impact of the programme.
The hub offers outreach, screening, clinical telephone triage and facilitation to access evidenced treatments. People were screened for trauma, depression, generalised anxiety and functioning who registered at 3, 6 and 9 months post-incident. Baseline scores were compared between screening groups (first screen at 3, 6 or 9 months) in each cohort (adult, CYP), and within groups to compare scores at 9 months.
There were significant differences in adults' baseline scores across screening groups on trauma, depression, anxiety and functioning. There were significant differences in the baseline scores of CYP across screening groups on trauma, depression, generalised anxiety and separation anxiety. Paired samples t-tests demonstrated significant differences between baseline and follow-up scores on all measures for adults in the 3-month screening group, and only depression and functioning measures for adults in the 6-month screening group. Data about CYP in the 3-month screening group, demonstrated significant differences between baseline and follow-up scores on trauma, generalised anxiety and separation anxiety.
These findings suggest people who register earlier are less symptomatic and demonstrate greater improvement across a range of psychological measures. Further longitudinal research is necessary to understand changes over time.