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“What is philosophy?” is a question first raised by Plato when he invented the term and drew a sharp distinction between philosophical inquiry, on the one hand, and Homeric poetry, pre-Socratic natural science, and Sophistic argumentation, on the other. Plato’s definitional answer was that philosophy is the love of wisdom, which meant a search for truth, conducted primarily in the foundational areas of ontology, epistemology, and philosophy of mind, and having important consequences for the axiological fields of ethics, politics, and aesthetics. This answer remained constant throughout the subsequent history of philosophy, despite the important glosses added by Aristotle’s teleology, Descartes’ dualism, Hume’s skepticism, Kant’s idealism, Hegel’s historicism, and Schopenhauer’s voluntarism.
Healthcare-associated bloodstream infections (HABSIs) are a significant cause of mortality and morbidity in the neonatal intensive care unit (NICU) population. Our objectives were to review the epidemiology of HABSIs in our NICU and to examine the applicability of National Healthcare Safety Network (NHSN) definitions to the NICU population.
We performed a retrospective review of all neonates admitted to the 54-bed, level IV NICU at Yale-New Haven Children’s Hospital with a HABSI between January 1, 2013, and December 31, 2018. Clinical definitions per NICU team and NHSN site-specific definitions used for source identification were compared using the McNemar χ2 test.
We identified 86 HABSIs with an incidence rate of 0.80 per 1,000 patient days. Only 13% of these were CLABSIs. Both CLABSIs and non–catheter-related bloodstream infections occurred primarily in preterm neonates, but the latter were associated with a significantly higher incidence of comorbidities and the need for respiratory support. The NHSN definitions were less likely to identify a source compared to the clinical definitions agreed upon by our NICU treating team (P < .001). Furthermore, 50% of patients without an identified source of infection by NHSN definitions were bacteremic with a mucosal barrier injury organism, likely from gut translocation.
HABSIs occur primarily in premature infants with comorbidities, and CLABSIs account for a small proportion of these infections. With the increasing focus on HABSI prevention, there is a need for better NHSN site-specific definitions for the NICU population to prevent misclassification and direct prevention efforts.
While there have been growing calls for historians to listen to the past, there are also significant barriers to integrating music in particular into broader historical practice. This article reflects on both the gains and difficulties of this integration, moving from an interrogation of the category of music to three case studies. These concern musical terms, compositional practices and cultures from the fifteenth to eighteenth centuries, revisiting some key debates in musicology: first, the highly charged language of sweetness deployed in the fifteenth century; second, connections discerned in nineteenth-century music history between medieval polyphony and contemporary attitudes towards time and authority; and, third, debate over the anti-Jewish implications of Handel's music, which we approach through his Dixit Dominus and a history of psalm interpretation stretching back to late antiquity. Through these case studies, we suggest the contribution of music to necessarily interdisciplinary fields including the study of temporality and emotions, but also explore how a historical hermeneutic with a long pedigree – ‘diversity of times’ (diversitas temporum) – might help to reframe arguments about musical interpretation. The article concludes by arguing that the very difficulty and slipperiness of music as a source can encourage properly reflective historical practice.
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.
This article provides a brief summary of the aims, methods and results of a programme of training carried out by the EAMENA project in partnership with the Tunisian Institut National du Patrimoine and the Libyan Department of Antiquities. The focus was on the use of freely available satellite imagery for archaeological site identification and monitoring, on compiling and maintaining spatial databases - including the on-the-ground location of sites with the use of a GPS - and on the observation of patterns of preservation and threat within Geographical Information Systems to inform heritage management decisions at both regional and national levels. Three pairs of workshops took place in Tunis in 2017, 2018 and 2019, with interim support being given to participants by a Training Manager and Research Assistant based at the University of Leicester. The work was part of a larger scheme offered to heritage professionals across the Middle East and North Africa by the EAMENA project thanks to a grant received from the Cultural Protection Fund. In general this training has been very well received. Not only has it successfully achieved the propagation of desirable and much needed skills within partner institutions, it has also raised awareness of issues affecting the protection of cultural heritage within the broader community.
We undertook a quality improvement project to address challenges with pulmonary artery catheter (PAC) line maintenance in a setting of low-baseline central-line infection rates. We observed a subsequent reduction in Staphylococcal PAC line infections and a trend toward a reduction in overall PAC infection rates over 1 year.
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.