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Ancient Greek and Roman philosophy is often characterised in terms of competitive individuals debating orally with one another in public arenas. But it also developed over its long history a sense in which philosophers might acknowledge some other particular philosopher or group of philosophers as an authority and offer to that authority explicit intellectual allegiance. This is most obvious in the development after the classical period of the philosophical 'schools' with agreed founders and, most importantly, canonical founding texts. There also developed a tradition of commentary, interpretation, and discussion of texts which itself became a mode of philosophical debate. As time went on, the weight of a growing tradition of reading and appealing to a certain corpus of foundational texts began to shape how later antiquity viewed its philosophical past and also how philosophical debate and inquiry was conducted. In this book leading scholars explore aspects of these important developments.
Method of levels (MOL) is an innovative transdiagnostic cognitive therapy with potential advantages over existing psychological treatments for psychosis.
The Next Level study is a feasibility randomised controlled trial (RCT) of MOL for people experiencing first-episode psychosis. It aims to determine the suitability of MOL for further testing in a definitive trial (trial registration ISRCTN13359355).
The study uses a parallel group non-masked feasibilityRCT design with two conditions: (a) treatment as usual (TAU) and (b) TAU plus MOL. Participants (n = 36) were recruited from early intervention in psychosis services. Outcome measures are completed at baseline, 10 and 14 months. The primary outcomes are recruitment and retention.
Participants’ demographic and clinical characteristics are presented along with baseline data.
Next Level has recruited to target, providing evidence that it is feasible to recruit to a RCT of MOL for first-episode psychosis.
To compare the epidemiology, clinical characteristics, and mortality of patients with bloodstream infections (BSI) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) versus ESBL-producing Klebsiella pneumoniae (ESBL-KP) and to examine the differences in clinical characteristics and outcome between BSIs caused by isolates with CTX-M versus other ESBL genotypes
As part of the INCREMENT project, 33 tertiary hospitals in 12 countries retrospectively collected data on adult patients diagnosed with ESBL-EC BSI or ESBL-KP BSI between 2004 and 2013. Risk factors for ESBL-EC versus ESBL-KP BSI and for 30-day mortality were examined by bivariate analysis followed by multivariable logistic regression.
The study included 909 patients: 687 with ESBL-EC BSI and 222 with ESBL-KP BSI. ESBL genotype by polymerase chain reaction amplification of 286 isolates was available. ESBL-KP BSI was associated with intensive care unit admission, cardiovascular and neurological comorbidities, length of stay to bacteremia >14 days from admission, and a nonurinary source. Overall, 30-day mortality was significantly higher in patients with ESBL-KP BSI than ESBL-EC BSI (33.7% vs 17.4%; odds ratio, 1.64; P=.016). CTX-M was the most prevalent ESBL subtype identified (218 of 286 polymerase chain reaction-tested isolates, 76%). No differences in clinical characteristics or in mortality between CTX-M and non–CTX-M ESBLs were detected.
Clinical characteristics and risk of mortality differ significantly between ESBL-EC and ESBL-KP BSI. Therefore, all ESBL-producing Enterobacteriaceae should not be considered a homogeneous group. No differences in outcomes between genotypes were detected.
Chemical constituents trapped within glacial ice provide a unique record of climate, as well as repositories for biological material such as pollen grains, fungal spores, viruses, bacteria and dissolved organic carbon. Past research suggests that the veins of polycrystalline ice may provide a liquid microenvironment for active microbial metabolism fueled by concentrated impurities in the veins. Despite these claims, no direct measurements of impurity concentration in ice veins have been made. Using micro-Raman spectroscopy, we show that sulfate and nitrate concentrations in the veins of glacial ice from Greenland (Greenland Ice Sheet Project 2) and Antarctic (Newall Glacier and a Dominion Range glacier) core samples were 104 and 105 times greater than the concentrations measured in melted (bulk) core water. Methanesulfonate was not found in the veins, consistent with its presence as particulate matter within the ice. The measured vein concentration of molecular anions implies a highly acidic (pH < 3) vein environment with high ionic strength (mM-M). We estimate that the vein volume provides 16.7 and 576 km3 of habitable space within the Greenland and Antarctic ice sheets, respectively, which could support the metabolism of organisms that are capable of growing in cold, high ionic strength solutions with low pH.
To determine whether antimicrobial-impregnated textiles decrease the acquisition of pathogens by healthcare provider (HCP) clothing.
We completed a 3-arm randomized controlled trial to test the efficacy of 2 types of antimicrobial-impregnated clothing compared to standard HCP clothing. Cultures were obtained from each nurse participant, the healthcare environment, and patients during each shift. The primary outcome was the change in total contamination on nurse scrubs, measured as the sum of colony-forming units (CFU) of bacteria.
PARTICIPANTS AND SETTING
Nurses working in medical and surgical ICUs in a 936-bed tertiary-care hospital.
Nurse subjects wore standard cotton-polyester surgical scrubs (control), scrubs that contained a complex element compound with a silver-alloy embedded in its fibers (Scrub 1), or scrubs impregnated with an organosilane-based quaternary ammonium and a hydrophobic fluoroacrylate copolymer emulsion (Scrub 2). Nurse participants were blinded to scrub type and randomly participated in all 3 arms during 3 consecutive 12-hour shifts in the intensive care unit.
In total, 40 nurses were enrolled and completed 3 shifts. Analyses of 2,919 cultures from the environment and 2,185 from HCP clothing showed that scrub type was not associated with a change in HCP clothing contamination (P=.70). Mean difference estimates were 0.118 for the Scrub 1 arm (95% confidence interval [CI], −0.206 to 0.441; P=.48) and 0.009 for the Scrub 2 rm (95% CI, −0.323 to 0.342; P=.96) compared to the control. HCP became newly contaminated with important pathogens during 19 of the 120 shifts (16%).
Antimicrobial-impregnated scrubs were not effective at reducing HCP contamination. However, the environment is an important source of HCP clothing contamination.
Although trophic position or level is one of the most basic aspects of a benthic marine species' ecology, its evolutionary significance remains obscure. Gastropods offer a suitable model for examining the relationship between trophic level and evolution since they exhibit a wide variety of trophic strategies and their mode of life is often reflected in their shell form. We examined 196 genera of Paleozoic gastropods (≈ 1/3 of known genera) for which first appearance and last appearance could be specified to stage level and for which trophic strategy could be inferred with a reasonable degree of confidence. We classified these genera into four trophic categories on the basis of shell characters relating to locomotion and clamping. These trophic categories are: Suspension feeders, Grazers on firm substrata, Soft substrate Grazers/Detritivores, and Carnivores. Suspension feeders are the most unambiguously recognizable category, marked by clear indicators of a sessile mode of life such as a radial apertures and planispiral shell forms. Our central observation from these data is that suspension feeders have shorter generic longevities than the other three trophic groups. This pattern is robust to a variety of methods of analysis. The mean generic longevity of the suspension feeders is 15 MY less than the other trophic categories. Cumulative frequency of genera within trophic categories versus log duration shows suspension feeders to be statisticaly significantly shorter lived than the other three trophic categories. The other three categories are not distinguishable. This pattern is unchanged by the removal of taxa dying out at mass extinctions. Suspension feeders have lower origination rates and higher extinction rates than the other trophic classes. This is not a taxonomic artifact produced by ornamentation and the number of characters available. This background pattern is also present in the end Ordovician and Late Devonian mass extinctions. Suspension feeders loose about half their genera in these extinctions, the two classes of grazers loose about 1/3 of their genera, and the carnivores suffer almost no extinctions. Suspension feeding appears to carry a significant evolutionary detriment in both mass extinctions and background times. This may be reflected in the change in trophic distribution of gastropods from the Ordovician to the Recent. The end Permian extinction shows a different pattern of selectivity; detritivores suffer the least.
Museum exhibitions possess a long history of serving as useful tools for teaching both paleontology and evolutionary biology to college undergraduates. Yet, they are frequently under-appreciated and underutilized. However, they remain potentially outstanding resources because they can be used to meet a spectrum of learning objectives related to nature of science, real-world relevance, and student interest. Specifically, even small museum displays can provide: 1) authentic specimens, which often are more diverse, of higher quality, and historically more significant than those in teaching collections; 2) specimens in context, with other specimens and/or geological or biological background available; 3) examples of how fossils connect to virtually all of Earth and life sciences (explaining why they have so frequently been at the center of traditional “natural history”); 4) cross-disciplinary experiences, connecting science, art, technology, and history within a social context; and 5) opportunities for students to learn about teaching. A survey of instructor-developed activities performed within a host of natural history museums—with particular attention devoted to the Museum of the Earth, an affiliate of Cornell University—suggests that natural history exhibitions, regardless of size and scope, can complement and strengthen formal education in an undergraduate setting.
In a time of major medical education transformation, emergency medicine (EM) needs to nurture education scholars who will influence EM education practice. However, the essential ingredients to ensure a career with impact in EM education are not clear.
To describe how to prepare EM educators for a high-impact career.
The Canadian Association of Emergency Physicians (CAEP) Academic Section commissioned an “Education Impact” working group (IWG) to guide the creation of consensus recommendations from the EM community. EM educators from across Canada were initially recruited from the networks of the IWG members, and additional educators were recruited via snowball sampling. “High impact educators” were nominated by this network. The high impact educators were then interviewed using a structured question guide. These interviews were transcribed and coded for themes using qualitative methods. The process continued until no new themes were identified. Proposed themes and recommendations were presented to the EM community at the CAEP 2016 Academic Symposium. Feedback was then incorporated into a final set of recommendations.
Fifty-five (71%) of 77 of identified Canadian EM educators participated, and 170 names of high impact educators were submitted and ranked by frequency. The IWG achieved sufficiency of themes after nine interviews. Five recommendations were made: 1) EM educators can pursue a high impact career by leveraging either traditional or innovative career pathways; 2) EM educators starting their education careers should have multiple senior mentors; 3) Early-career EM educators should immerse themselves in their area of interest and cultivate a community of practice, not limited to EM; 4) Every academic EM department and EM teaching site should have access to an EM educator with protected time and recognition for their EM education scholarship; and 5) Educators at all stages should continuously compile an impact portfolio.
We describe a unique set of recommendations to develop educators who will influence EM, derived from a consensus from the EM community. EM leaders, educators, and aspiring educational scholars should consider how to implement this guide towards enhancing our specialty’s educational mission.
We explored the reliability of radiocarbon ages obtained on organic carbon phases in opal-rich Southern Ocean sediments. Paired biogenic carbonate and total organic carbon (TOC) 14C analyses for three Southern Ocean cores showed that the TOC ages were systematically younger than the carbonate ages. Carbonate ages were consistent with oxygen isotopic and bio-stratigraphy, indicating error in TOC ages that could be explained by 5–24% of modern carbon contamination of TOC samples. Two possible sources of contamination are: 1) adsorption of atmospheric CO2 or volatile organic compounds to reactive opal surface sites, and 2) fixation of atmospheric CO2 by chemosynthetic bacteria during core storage. In an effort to reduce the modern carbon contamination, diatoms were separated from sediments, purified, and pre-oxidized by concentrated nitric and perchloric acids to permit dating of opal-intrinsic organic carbon (~0.1–0.3% by weight). 14C ages of chemically pre-oxidized opal showed a significant amount of modern carbon contamination, from 11 to 32%, indicating adsorption from the atmosphere of modern carbon onto opal surfaces that were previously cleaned by acid oxidation. Several experiments designed to eliminate the modern C contamination were attempted, but so far we have not been able to obtain a radiocarbon age on 14C-dead Southern Ocean opal-rich sediments, either bulk TOC or purified diatom opal samples, as old as our procedural blank.
To demonstrate the feasibility of applying the Healthy Eating Index-2010 (HEI-2010) to the hunger relief setting, specifically by assessing the nutritional quality of foods ordered by food shelves (front-line food provider) from food banks (warehouse of foods).
This Healthy FOOD (Feedback On Ordering Decisions) observational study used electronic invoices detailing orders made by 269 food shelves in 2013 and analysed in 2015 from two large Minnesota, USA food banks to generate HEI-2010 scores. Initial development and processing procedures are described.
The average total HEI-2010 score for the 269 food shelves was 62·7 out of 100 with a range from 28 to 82. Mean component scores for total protein foods, total vegetables, fatty acids, and seafood and plant proteins were the highest. Mean component score for whole grains was the lowest followed by dairy, total fruits, refined grains and sodium. Food shelves located in micropolitan areas and the largest food shelves had the highest HEI-2010 scores. Town/rural and smaller food shelves had the lowest scores. Monthly and seasonal differences in scores were detected. Limitations to this approach are identified.
Calculating HEI-2010 for food shelves using electronic invoice data is novel and feasible, albeit with limitations. HEI-2010 scores for 2013 identify room for improvement in nearly all food shelves, especially the smallest agencies. The utility of providing HEI-2010 scores to decision makers in the hunger relief setting is an issue requiring urgent study.