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Recent Anglophone scholarship has successfully shown that Nietzsche's thought makes important contributions to a wide range of contemporary philosophical debates. In so doing, however, scholarship has lost sight of another important feature of Nietzsche's project, namely his desire to challenge the very conception of philosophy that has been used to assess his merits as a philosopher. In other words, contemporary scholarship has overlooked Nietzsche's contributions to metaphilosophy, i.e. debates around the nature, methods, and aims of philosophy. This important new collection of essays brings together an international group of distinguished scholars to explore and discuss these contributions and debates. It will appeal to anyone interested in metaphilosophy, Nietzsche studies, German studies, or intellectual history.
Evidence suggests that sub-optimal maternal nutrition has implications for the developing offspring. We have previously shown that exposure to a low-protein diet during gestation was associated with upregulation of genes associated with cholesterol transport and packaging within the placenta. This study aimed to elucidate the effect of altering maternal dietary linoleic acid (LA; omega-6) to alpha-linolenic acid (ALA; omega-6) ratios as well as total fat content on placental expression of genes associated with cholesterol transport. The potential for maternal body mass index (BMI) to be associated with expression of these genes in human placental samples was also evaluated. Placentas were collected from 24 Wistar rats at 20-day gestation (term = 21–22-day gestation) that had been fed one of four diets containing varying fatty acid compositions during pregnancy, and from 62 women at the time of delivery. Expression of 14 placental genes associated with cholesterol packaging and transfer was assessed in rodent and human samples by quantitative real time polymerase chain reaction. In rats, placental mRNA expression of ApoA2, ApoC2, Cubn, Fgg, Mttp and Ttr was significantly elevated (3–30 fold) in animals fed a high LA (36% fat) diet, suggesting increased cholesterol transport across the placenta in this group. In women, maternal BMI was associated with fewer inconsistent alterations in gene expression. In summary, sub-optimal maternal nutrition is associated with alterations in the expression of genes associated with cholesterol transport in a rat model. This may contribute to altered fetal development and potentially programme disease risk in later life. Further investigation of human placenta in response to specific dietary interventions is required.
In January of 2010, North Carolina (NC) USA implemented state-wide Trauma Triage Destination Plans (TTDPs) to provide standardized guidelines for Emergency Medical Services (EMS) decision making. No study exists to evaluate whether triage behavior has changed for geriatric trauma patients.
The impact of the NC TTDPs was investigated on EMS triage of geriatric trauma patients meeting physiologic criteria of serious injury, primarily based on whether these patients were transported to a trauma center.
This is a retrospective cohort study of geriatric trauma patients transported by EMS from March 1, 2009 through September 30, 2009 (pre-TTDP) and March 1, 2010 through September 30, 2010 (post-TTDP) meeting the following inclusion criteria: (1) age 50 years or older; (2) transported to a hospital by NC EMS; (3) experienced an injury; and (4) meeting one or more of the NC TTDP’s physiologic criteria for trauma (n = 5,345). Data were obtained from the Prehospital Medical Information System (PreMIS). Data collected included proportions of patients transported to a trauma center categorized by specific physiologic criteria, age category, and distance from a trauma center.
The proportion of patients transported to a trauma center pre-TTDP (24.4% [95% CI 22.7%-26.1%]; n = 604) was similar to the proportion post-TTDP (24.4% [95% CI 22.9%-26.0%]; n = 700). For patients meeting specific physiologic triage criteria, the proportions of patients transported to a trauma center were also similar pre- and post-TTDP: systolic blood pressure <90 mmHg (22.5% versus 23.5%); respiratory rate <10 or >29 (23.2% versus 22.6%); and Glascow Coma Scale (GCS) score <13 (26.0% versus 26.4%). Patients aged 80 years or older were less likely to be transported to a trauma center than younger patients in both the pre- and post-TTDP periods.
State-wide implementation of a TTDP had no discernible effect on the proportion of patients 50 years and older transported to a trauma center. Under-triage remained common and became increasingly prevalent among the oldest adults. Research to understand the uptake of guidelines and protocols into EMS practice is critical to improving care for older adults in the prehospital environment.
This is not a book about Hamza Alavi (1921–2003), the Pakistani Marxist sociologist/anthropologist, but about social science in Pakistan, with a particular focus on its political economy, broadly interpreted. Specifically, this book is trying to understand why, how and with what consequences did one particular theoretical perspective come to exercise such a dominating influence on the analysis of state and society in post-independence Pakistan. There was much brilliant and insightful work done in the 1970s and 1980s on agrarian transition (S. Ahmad 1977; Khan 1975; Khan 1981; Hussain 1980), on industrial concentration (Amjad 1983), ethnicity (Ahmed 1998), and democratisation (A. Ahmad 1985, 2000). Yet it was Alavi's overdeveloped state thesis that dominated discussions and continued to determine how the Pakistani state was envisaged.
One possible explanation why Hamza Alavi's thesis has persisted and dominated, especially in the context of Pakistani scholarship, is the sheer breadth of Alavi's intellectual and practical engagement. Many of the studies and academics mentioned above are essential references confined to relatively narrower terms of engagement and disciplines, but wherever one approaches Pakistan through the broad political economy perspective, one finds that Alavi's pioneering work to be of noted relevance.
Before casting the spotlight on this one intervention, a quick digression on the extraordinary range of Alavi's career and scholarship would be worth our while. After all, he ‘was one of the most important intellectuals from the Asian subcontinent to participate in (and in many cases formulate the terms of) debates from the 1960s onwards about Third World development’ (TB 2004:341). This digression may help us understand some aspects of his overdeveloped state thesis.
Alavi started his career in the Bank of India as a Research Officer in 1945 and by 1952 he was one of its five principal officers. Unlike most (if not quite all) Marxist intellectuals, Alavi left a comfortable career and moved to Tanzania to take up farming. He later enrolled for a PhD at the London School of Economics and then pursued a more conventional academic career at the Universities of Sussex, Leeds and Manchester. He was editor of Pakistan Today and was on the editorial boards of the Journal of Contemporary Asia and the Journal of Peasant Studies.
The genesis of this book lies in teaching a course on the economic development of South Asia, at both Oxford University and the School of Oriental and African Studies (SOAS) at the University of London, and in trying to assess and explore ideas about the political economy of regions and states other than those of India. Unlike the rich academic literature on studying India and other countries of the Global South across a variety of schools of thought in economics, politics and political economy, the limited focus on Pakistan has largely been dominated by a single framework, one proposed by Hamza Alavi, which focused on the notion of an overdeveloped state, with regard to Pakistan and, later, Bangladesh, in a paper published in the New Left Review in 1972. One option for teaching such a course was to use the comparative nature of scholarship, primarily one based on the Indian academic and social science tradition and historical context, and consider its relevance for Pakistan. However, as academics, researchers and scholars of India, or the other countries which constitute South Asia realise, that while this is how much of the academic teaching and research in and on South Asia usually functions, it is a very suboptimal choice of teaching and scholarship, given the specificities of the different countries. Pakistan, like the other South Asian countries, differs substantially from India, given its political economy and history, and requires an examination based on its own terms and in its own context. While exceptional scholarship of social scientists from India and those who work on India is now increasingly providing theoretical and empirical evidence redefining numerous theoretical paradigms – as we find in this volume as well – what has been lacking for at least four decades now is rigorous assessment of Pakistan's political economy, which, until recently, has continued to be dominated by the work and influence of Hamza Alavi.
In February 2016, Professor Matthew McCartney and his student Muhammad Ali Jan organised a workshop in Oxford sponsored by Wolfson College and the Contemporary South Asian Studies Programme (CSASP) to address this problem and to assess the state of scholarship in the social sciences and of the political economy of Pakistan, almost four-and-a-half decades after Alavi's thesis.
Social anxiety lies on a continuum, and young adults with elevated symptoms are at risk for developing a range of psychiatric disorders. Yet relatively little is known about the factors that govern the hour-by-hour experience and expression of social anxiety in the real world.
Here we used smartphone-based ecological momentary assessment (EMA) to intensively sample emotional experience across different social contexts in the daily lives of 228 young adults selectively recruited to represent a broad spectrum of social anxiety symptoms.
Leveraging data from over 11 000 real-world assessments, our results highlight the central role of close friends, family members, and romantic partners. The presence of such close companions was associated with enhanced mood, yet socially anxious individuals had fewer confidants and spent less time with the close companions that they do have. Although higher levels of social anxiety were associated with a general worsening of mood, socially anxious individuals appear to derive larger benefits – lower levels of negative affect, anxiety, and depression – from their close companions. In contrast, variation in social anxiety was unrelated to the amount of time spent with strangers, co-workers, and acquaintances; and we uncovered no evidence of emotional hypersensitivity to these less-familiar individuals.
These findings provide a framework for understanding the deleterious consequences of social anxiety in emerging adulthood and set the stage for developing improved intervention strategies.
Recent years have seen an exponential increase in the variety of healthcare data captured across numerous sources. However, mechanisms to leverage these data sources to support scientific investigation have remained limited. In 2013 the Pediatric Heart Network (PHN), funded by the National Heart, Lung, and Blood Institute, developed the Integrated CARdiac Data and Outcomes (iCARD) Collaborative with the goals of leveraging available data sources to aid in efficiently planning and conducting PHN studies; supporting integration of PHN data with other sources to foster novel research otherwise not possible; and mentoring young investigators in these areas. This review describes lessons learned through the development of iCARD, initial efforts and scientific output, challenges, and future directions. This information can aid in the use and optimisation of data integration methodologies across other research networks and organisations.
Patient assessment is a fundamental feature of community paramedicine, but the absence of a recognized standard for assessment practices contributes to uncertainty about what drives care planning and treatment decisions. Our objective was to summarize the content of assessment instruments and describe the state of current practice in community paramedicine home visit programs.
We performed an environmental scan of all community paramedicine programs in Ontario, Canada, and used content analysis to describe current assessment practices in home visit programs. The International Classification on Functioning, Disability, and Health (ICF) was used to categorize and compare assessments. Each item within each assessment form was classified according to the ICF taxonomy.
A total of 43 of 52 paramedic services in Ontario, Canada, participated in the environmental scan with 24 being eligible for further investigation through content analysis of intake assessment forms. Among the 24 services, 16 met inclusion criteria for content analysis. Assessment forms contained between 13 and 252 assessment items (median 116.5, IQR 134.5). Most assessments included some content from each of the domains outlined in the ICF. At the subdomain level, only assessment of impairments of the functions of the cardiovascular, hematological, immunological, and respiratory systems appeared in all assessments.
Although community paramedicine home visit programs may differ in design and aim, all complete multi-domain assessments as part of patient intake. If community paramedicine home visit programs share similar characteristics but assess patients differently, it is difficult to expect that the resulting referrals, care planning, treatments, or interventions will be similar.
This commentary highlights the observation that social motivation is usually an imprecisely specified construct. We suggest four social motivation conceptualizations across levels of analysis and explore where the target article situates among these. We then offer theoretical and practical guidance for operationalization and measurement of social motivation to support more comprehensive future research on this complex construct in the autism literature.
To sustainably improve cleaning of high-touch surfaces (HTSs) in acute-care hospitals using a multimodal approach to education, reduction of barriers to cleaning, and culture change for environmental services workers.
The study was conducted in 2 academic acute-care hospitals, 2 community hospitals, and an academic pediatric and women’s hospital.
Frontline environmental services workers.
A 5-module educational program, using principles of adult learning theory, was developed and presented to environmental services workers. Audience response system (ARS), videos, demonstrations, role playing, and graphics were used to illustrate concepts of and the rationale for infection prevention strategies. Topics included hand hygiene, isolation precautions, personal protective equipment (PPE), cleaning protocols, and strategies to overcome barriers. Program evaluation included ARS questions, written evaluations, and objective assessments of occupied patient room cleaning. Changes in hospital-onset C. difficile infection (CDI) and methicillin-resistant S. aureus (MRSA) bacteremia were evaluated.
On average, 357 environmental service workers participated in each module. Most (93%) rated the presentations as ‘excellent’ or ‘very good’ and agreed that they were useful (95%), reported that they were more comfortable donning/doffing PPE (91%) and performing hand hygiene (96%) and better understood the importance of disinfecting HTSs (96%) after the program. The frequency of cleaning individual HTSs in occupied rooms increased from 26% to 62% (P < .001) following the intervention. Improvement was sustained 1-year post intervention (P < .001). A significant decrease in CDI was associated with the program.
A novel program that addressed environmental services workers’ knowledge gaps, challenges, and barriers was well received and appeared to result in learning, behavior change, and sustained improvements in cleaning.
Internalizing and externalizing psychopathology factors explain much of the covariance among psychiatric conditions, especially at the level of genetic risk. However, few studies have examined internalizing and externalizing factors in middle-aged samples, especially their ability to predict later symptoms across midlife. The goals of the current study were (i) to quantify the genetic and environmental influences on internalizing and externalizing psychopathology in individuals in their early 40s, and (ii) examine the extent to which these genetic and environmental influences predict self-reported measures of internalizing and externalizing symptoms 15–20 years later.
1484 male twins completed diagnostic interviews of psychopathology at mean age 41 and self-reported measures of anxiety, depression, substance use, and related variables at up to two time-points in late middle age (mean ages 56 and 62).
Structural equation modeling of the diagnostic interviews confirmed that internalizing and externalizing factors accounted for most of the genetic variance in individual disorders, with substantial genetic (ra = 0.70) and environmental (re = 0.77) correlations between the factors. Internalizing psychopathology at age 41 was correlated with latent factors capturing anxiety, depression, and/or post-traumatic stress symptoms at ages 56 (r = 0.51) and 62 (r = 0.43). Externalizing psychopathology at age 41 was correlated r = 0.67 with a latent factor capturing aggression, tobacco use, and alcohol use at age 56. Stability of both factors was driven by genetic influences.
These findings demonstrate the considerable stability of internalizing and externalizing psychopathology symptoms across middle age, especially their genetic influences. Diagnostic interviews effectively predict self-reported symptoms and behaviors 15–20 years later.