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The doctrine of divine aseity has played a significant role in the development of classical theism. However, very little attention has been paid in recent years to the question of how precisely aseity should be characterized. We argue that this neglect is unwarranted since extant characterizations of this central divine attribute quickly encounter difficulties. In particular, we present a new argument to show that the most widely accepted contemporary account of aseity is inconsistent. We then consider the prospects for developing a new account of aseity which avoids the pitfalls we have highlighted.
To assess trends of mortality attributable to child and maternal undernutrition (CMU), overweight/obesity and dietary risks of non-communicable diseases (NCD) in sub-Saharan Africa (SSA) using data from the Global Burden of Disease (GBD) Study 2015.
For each risk factor, a systematic review of data was used to compute the exposure level and the effect size. A Bayesian hierarchical meta-regression analysis was used to estimate the exposure level of the risk factors by age, sex, geography and year. The burden of all-cause mortality attributable to CMU, fourteen dietary risk factors (eight diets, five nutrients and fibre intake) and overweight/obesity was estimated.
All age groups and both sexes.
In 2015, CMU, overweight/obesity and dietary risks of NCD accounted for 826204 (95 % uncertainty interval (UI) 737346, 923789), 266768 (95 % UI 189051, 353096) and 558578 (95 % UI 453433, 680197) deaths, respectively, representing 10·3 % (95 % UI 9·1, 11·6 %), 3·3 % (95 % UI 2·4, 4·4 %) and 7·0 % (95 % UI 5·8, 8·3 %) of all-cause mortality. While the age-standardized proportion of all-cause mortality accounted for by CMU decreased by 55·2 % between 1990 and 2015 in SSA, it increased by 63·3 and 17·2 % for overweight/obesity and dietary risks of NCD, respectively.
The increasing burden of diet- and obesity-related diseases and the reduction of mortality attributable to CMU indicate that SSA is undergoing a rapid nutritional transition. To tackle the impact in SSA, interventions and international development agendas should also target dietary risks associated with NCD and overweight/obesity.
We observed pediatric S. aureus hospitalizations decreased 36% from 26.3 to 16.8 infections per 1,000 admissions from 2009 to 2016, with methicillin-resistant S. aureus (MRSA) decreasing by 52% and methicillin-susceptible S. aureus decreasing by 17%, among 39 pediatric hospitals. Similar decreases were observed for days of therapy of anti-MRSA antibiotics.
Greenhouse experiments were conducted to quantify resistance levels to the 4-hydroxyphenyl-pyruvate dioxygenase (HPPD)-inhibiting herbicides mesotrione (MES) and isoxaflutole (IFT) in NEB (Nebraska HPPD- and atrazine-resistant) and SIR (Stanford, IL, HPPD- and atrazine-resistant) waterhemp [Amaranthus tuberculatus (Moq.) J. D. Sauer] populations. These populations differ in their field-use histories and resistance levels to MES. Foliar growth responses were compared with ACR (HPPD sensitive; metabolic atrazine-resistant) and SEN (sensitive to HPPD and photosystem II [PSII] inhibitors). A greenhouse dose–response study was conducted with each herbicide at two POST timings: early (EPOST) (5 cm; 4 to 5 true leaves) and POST (10 cm; 8 to 9 true leaves). At the EPOST timing, SIR was 10-fold resistant to IFT and 32-fold resistant to MES, while NEB was 4-fold resistant to IFT and 7-fold resistant to MES when compared with ACR. At the POST timing, SIR was 17-fold resistant to IFT and 21-fold resistant to MES, while NEB was 3-fold resistant to IFT and 7-fold resistant to MES when compared with ACR. Results overall indicated greater fold-resistance levels to MES relative to IFT at each timing. However, POST treatments to SIR showed contrasting effects on resistance levels relative to EPOST. To investigate potential management strategies for resistant A. tuberculatus populations, a POST interaction study was conducted using combinations of metribuzin and either IFT or MES. A metribuzin rate (191 g ai ha−1) causing an approximately 20% biomass reduction was chosen for interaction studies and combined with varying rates of either IFT or MES. Results indicated 52.5 g ai ha−1 of MES combined with metribuzin displayed a synergistic effect on biomass reduction in SIR. However, other combinations of either MES or IFT and metribuzin resulted in additive effects on biomass reduction in both HPPD-resistant populations. These results provide insights into the joint activity between HPPD and PSII inhibitors for controlling metabolism-based, multiple herbicide–resistant A. tuberculatus.
Post-magmatic alteration of certain magmatic Ni sulfide ores in Western Australia, the Miitel deposit and the Sarah's Find prospect, produced Ni–As–PGE haloes around massive sulfides. A study of the composition of arsenide grains from these hydrothermal haloes, along with arsenides from various magmatic and hydrothermal mineralized environments in other localities, was conducted in order to compare their composition, and assess their potential use as indicator minerals for exploration vectoring, as well as to gain knowledge on their crystallization history. Concentrations in trace elements such as platinum-group elements (PGEs), Au and other metals was obtained by laser ablation inductively coupled plasma mass spectroscopy analyses. Results show that variations in PGEs and Au compositions can be related to the magmatic vs. hydrothermal origin of the grains; and to their provenance from deposits enriched in either Ni, Au or both. Magmatic NiCoFe sulfarsenides have strongly correlated, high IPGE (Os, Ir, Ru, Rh) contents up to 100 ppm Ir, compared with maximum values in hydrothermal sulfarsenides of ~1 ppm. Gold in hydrothermal sulfarsenides from Au-mineralized ultramafic rocks extends up to 500 ppm, with typical values of 3–30 ppm; similar values are also found in nickeline (also called niccolite). These results suggest that nickel arsenides could potentially be used as indicator minerals for nickel and gold exploration. Trace-element contents of arsenide grains in shear zones could be used to deduce the presence of Ni or Au mineralization upstream in the fluid pathway.
Pediatric and adolescent gynecology (PAG) is recognized as a specialist area and clinicians working in PAG need specific expertise. A wide spectrum of conditions needs to be addressed, ranging from simple disorders which respond to basic treatment to complex congenital anomalies with a genetic origin and life-long health consequences. Investigations must be appropriate and treatment should reduce symptoms and distress whilst optimizing gynecological and reproductive potential. Centered upon a series of common clinical presentations, this book includes stepwise guidance on the initial investigations, management, and treatment options. Guidance is supported by the most up-to-date evidence-base, written by clinicians with dedicated clinical and research experience in PAG. New techniques - such as laparoscopic surgery - are included and the importance of the psychological assessment of children with specific PAG disorders is highlighted. The book also includes an authoritative chapter on safeguarding - recognizing the unique opportunity for gynecologists in child protection.
It is not clear how to effectively recruit healthy research volunteers.
We developed an electronic health record (EHR)-based algorithm to identify healthy subjects, who were randomly assigned to receive an invitation to join a research registry via the EHR’s patient portal, letters, or phone calls. A follow-up survey assessed contact preferences.
The EHR algorithm accurately identified 858 healthy subjects. Recruitment rates were low, but occurred more quickly via the EHR patient portal than letters or phone calls (2.7 vs. 19.3 or 10.4 d). Effort and costs per enrolled subject were lower for the EHR patient portal (3.0 vs. 17.3 or 13.6 h, $113 vs. $559 or $435). Most healthy subjects indicated a preference for contact via electronic methods.
Healthy subjects can be accurately identified from EHR data, and it is faster and more cost-effective to recruit healthy research volunteers using an EHR patient portal.
Whether monozygotic (MZ) and dizygotic (DZ) twins differ from each other in a variety of phenotypes is important for genetic twin modeling and for inferences made from twin studies in general. We analyzed whether there were differences in individual, maternal and paternal education between MZ and DZ twins in a large pooled dataset. Information was gathered on individual education for 218,362 adult twins from 27 twin cohorts (53% females; 39% MZ twins), and on maternal and paternal education for 147,315 and 143,056 twins respectively, from 28 twin cohorts (52% females; 38% MZ twins). Together, we had information on individual or parental education from 42 twin cohorts representing 19 countries. The original education classifications were transformed to education years and analyzed using linear regression models. Overall, MZ males had 0.26 (95% CI [0.21, 0.31]) years and MZ females 0.17 (95% CI [0.12, 0.21]) years longer education than DZ twins. The zygosity difference became smaller in more recent birth cohorts for both males and females. Parental education was somewhat longer for fathers of DZ twins in cohorts born in 1990–1999 (0.16 years, 95% CI [0.08, 0.25]) and 2000 or later (0.11 years, 95% CI [0.00, 0.22]), compared with fathers of MZ twins. The results show that the years of both individual and parental education are largely similar in MZ and DZ twins. We suggest that the socio-economic differences between MZ and DZ twins are so small that inferences based upon genetic modeling of twin data are not affected.
Neuroticism, a ‘Big Five’ personality trait, has been associated with sub-clinical traits of both autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). The objective of the current study was to examine whether causal overlap between ASD and ADHD traits can be accounted for by genetic and environmental risk factors that are shared with neuroticism. We performed twin-based structural equation modeling using self-report data from 12 items of the Neo Five-Factor Inventory Neuroticism domain, 11 Social Responsiveness Scale items, and 12 Adult ADHD Self-Report Scale items obtained from 3,170 young adult Australian individual twins (1,081 complete pairs). Univariate analysis for neuroticism, ASD, and ADHD traits suggested that the most parsimonious models were those with additive genetic and unique environmental components, without sex limitation effects. Heritability of neuroticism, ASD, and ADHD traits, as measured by these methods, was moderate (between 40% and 45% for each respective trait). In a trivariate model, we observed moderate phenotypic (between 0.45 and 0.62), genetic (between 0.56 and 0.71), and unique environmental correlations (between 0.37and 0.55) among neuroticism, ASD, and ADHD traits, with the highest value for the shared genetic influence between neuroticism and self-reported ASD traits (rg = 0.71). Together, our results suggest that in young adults, genetic, and unique environmental risk factors indexed by neuroticism overlap with those that are shared by ASD and ADHD.
Efforts to address health disparities and achieve health equity are critically dependent on the development of a diverse research workforce. However, many researchers from underrepresented backgrounds face challenges in advancing their careers, securing independent funding, and finding the mentorship needed to expand their research.
Faculty from the University of Maryland at College Park and the University of Wisconsin-Madison developed and evaluated an intensive week-long research and career-development institute—the Health Equity Leadership Institute (HELI)—with the goal of increasing the number of underrepresented scholars who can sustain their ongoing commitment to health equity research.
In 2010-2016, HELI brought 145 diverse scholars (78% from an underrepresented background; 81% female) together to engage with each other and learn from supportive faculty. Overall, scholar feedback was highly positive on all survey items, with average agreement ratings of 4.45-4.84 based on a 5-point Likert scale. Eighty-five percent of scholars remain in academic positions. In the first three cohorts, 73% of HELI participants have been promoted and 23% have secured independent federal funding.
HELI includes an evidence-based curriculum to develop a diverse workforce for health equity research. For those institutions interested in implementing such an institute to develop and support underrepresented early stage investigators, a resource toolbox is provided.
Antimicrobial stewardship programs (ASPs) effectively optimize antibiotic use for inpatients; however, the extent of emergency department (ED) involvement in ASPs has not been described.
To determine current ED involvement in children’s hospital ASPs and to assess beliefs and preferred methods of implementation for ED-based ASPs.
A cross-sectional survey of 37 children’s hospitals participating in the Sharing Antimicrobial Resistance Practices collaboration was conducted. Surveys were distributed to ASP leaders and ED medical directors at each institution. Items assessed included beliefs regarding ED antibiotic prescribing, ED prescribing resources, ASP methods used in the ED such as clinical decision support and clinical care guidelines, ED participation in ASP activities, and preferred methods for ED-based ASP implementation.
A total of 36 ASP leaders (97.3%) and 32 ED directors (86.5%) responded; the overall response rate was 91.9%. Most ASP leaders (97.8%) and ED directors (93.7%) agreed that creation of ED-based ASPs was necessary. ED resources for antibiotic prescribing were obtained via the Internet or electronic health records (EHRs) for 29 hospitals (81.3%). The main ASP activities for the ED included production of antibiograms (77.8%) and creation of clinical care guidelines for pneumonia (83.3%). The ED was represented on 3 hospital ASP committees (8.3%). No hospital ASPs actively monitored outpatient ED prescribing. Most ASP leaders (77.8%) and ED directors (81.3%) preferred implementation of ED-based ASPs using clinical decision support integrated into the EHR.
Although ED involvement in ASPs is limited, both ASP and ED leaders believe that ED-based ASPs are necessary. Many children’s hospitals have the capability to implement ED-based ASPs via the preferred method: EHR clinical decision support.
This paper presents the first major data release and survey description for the ANU WiFeS SuperNovA Programme. ANU WiFeS SuperNovA Programme is an ongoing supernova spectroscopy campaign utilising the Wide Field Spectrograph on the Australian National University 2.3-m telescope. The first and primary data release of this programme (AWSNAP-DR1) releases 357 spectra of 175 unique objects collected over 82 equivalent full nights of observing from 2012 July to 2015 August. These spectra have been made publicly available via the WISEREP supernova spectroscopy repository.
We analyse the ANU WiFeS SuperNovA Programme sample of Type Ia supernova spectra, including measurements of narrow sodium absorption features afforded by the high spectral resolution of the Wide Field Spectrograph instrument. In some cases, we were able to use the integral-field nature of the Wide Field Spectrograph instrument to measure the rotation velocity of the SN host galaxy near the SN location in order to obtain precision sodium absorption velocities. We also present an extensive time series of SN 2012dn, including a near-nebular spectrum which both confirms its ‘super-Chandrasekhar’ status and enables measurement of the sub-solar host metallicity at the SN site.
The introduction of the Health and Social Care Bill (2011) changed the role of GPs to include commissioning of health services.
This study aimed to identify any differences in the media portrayal of GPs before and after the introduction of the Bill.
We retrospectively searched four British newspapers over the period 2009–2013 using the media database Nexis. In order to directly compare the findings of the study with the work of Tanner et al., articles relating to GP pay were analysed using thematic analysis. Themes were identified and each article was scored to determine whether it portrayed GPs positively or negatively.
GPs were portrayed slightly less negatively after the introduction of the Bill. The theme of ‘high salaries’ persisted despite reference to ‘pay freezes’. References to decreased trust in the patient–doctor relationship appeared after the introduction of the Bill.
Negative portrayal of GP pay has continued and a lack of trust in GPs has started to be portrayed. This trend may exacerbate the low morale amongst the profession and difficulties in recruiting and retaining GPs.