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John Maynard Keynes died in 1946 but his ideas and his example remain relevant today. In this distinctive new account, Peter Clarke shows how Keynes's own career was not simply that of an academic economist, nor that of a modern policy advisor. Though rightly credited for reshaping economic theory, Keynes's influence was more broadly based and is assessed here in a rounded historical, political and cultural context. Peter Clarke re-examines the full trajectory of Keynes public career from his role at Versailles to Bretton Woods. He reveals how Keynes's insights as an economic theorist were rooted in his wider intellectual and cultural milieu including Bloomsbury and his friendship with Virginia Woolf as well as his involvement in government business. Keynes in Action uncovers a much more pragmatic Keynes whose concept of 'truth' needs to be interpreted in tension with an acknowledgement of 'expediency' in implementing public policy.
Over three decades ago, international donors declared that there was a learning crisis in developing countries. In the years since, large investments have been made towards education, yet there has been an apparent relative lack of progress in student learning. This book unpicks this disparity, and explores the implications of evidence-based donor programming for quality education. It undertakes an in-depth analysis of the interventions financed by the main donors in primary education, such as infrastructure development, provision of instructional material, teacher training and community mobilization, and argues that the research undertaken during this period was unable to provide answers. The author outlines an alternative model for evidence generation that can assist in the design of relevant and targeted interventions for learning, to ultimately inform and improve future education programmes. Timely and radical, this book is essential reading for researchers and students in the fields of education research and education reform.
The definitive guide to Molière's world and his afterlife, this is an accessible contextual guide for academics, undergraduates and theatre professionals alike. Interdisciplinary and diverse in scope, each chapter offers a different perspective on the social, cultural, intellectual, and theatrical environment within which Molière operated, as well as demonstrating his subsequent impact both within France and across the world. Offering fresh insight for those working in the fields of French Studies, Theatre and Performance Studies and French History, Molière in Context is an exceptional tribute to the premier French dramatist on the 400th anniversary of his birth.
From early medieval bards to the bands of the 'Cool Cymru' era, this book looks at Welsh musical practices and traditions, the forces that have influenced and directed them, and the ways in which the idea of Wales as a 'musical nation' has been formed and embedded in popular consciousness in Wales and beyond. Beginning with early medieval descriptions of musical life in Wales, the book provides both an overarching study of Welsh music history and detailed consideration of the ideas, beliefs, practices and institutions that shaped it. Topics include the eisteddfod, the church and the chapel, the influence of the Welsh language and Welsh cultural traditions, the scholarship of the Celtic Revival and the folk song movement, the impacts of industrialization and digitization, and exposure to broader trends in popular culture, including commercial popular music and sport.
In 1972, James Lovelock and Lynn Margulis began collaborating on the Gaia hypothesis. They suggested that over geological time, life on Earth has had a major role in both producing and regulating its own environment. Gaia is now an ecological and environmental worldview underpinning vital scientific and cultural debates over environmental issues. Their ideas have transformed the Earth and life sciences, as well as contemporary conceptions of nature. Their correspondence describes these crucial developments from the inside, showing how their partnership proved decisive for the development of the Gaia hypothesis. Clarke and Dutreuil provide historical background and explain the concepts and references introduced throughout the Lovelock-Margulis correspondence, while highlighting the major landmarks of their collaboration within the sequence of almost 300 letters written between 1970 and 2007. This book will be of interest to researchers in ecology, history of science, environmental history and climate change, and cultural science studies.
Immunohistochemistry has progressed from humble beginnings as experimental techniques to what is now considered routine and essential analytical tools. Technologies available today in the research sphere may be adopted for standard practice in the near future. Multiplex assays can help pathology facilities extract more information from less tissue and improved amplification methods may reveal ultra-low expressing proteins that have escaped detection before. New forms of 'tagging' antibodies using nucleotides and quantum dots may replace traditional chromogen and fluorochrome protocols. Next-generation immunohistochemistry enlisting mass spectrometry principles to not only localize antigens in tissue but to also quantify the amount present has real clinical potential. Digital pathology and whole slide imaging have made significant progress to the point of being financially viable. All of these developments are standing at the doorway to the future of immunohistochemistry. Whether they are accepted and implemented in diagnostic laboratories remains to be seen. It is exciting to witness the continuing progression of immunohistochemistry.
One of the most important financial decisions that pension participants make concerns how they access their pension assets when they terminate employment with their plan sponsor. Their choices depend both on own preferences and the options offered by their retirement plan. This paper examines both past and future pension withdrawal choices for those with defined benefit (DB) and defined contribution (DC) pensions, separately. Our data are drawn from a set of pension distribution questions we fielded in the Understanding American Study. Results show significant differences in distribution choices based on the type of retirement plan, with individuals covered by DB plans significantly more likely to select annuities compared to similar employees covered by DC plans. We also find differences in how higher annual income affects annuity choices based on coverage by DB plans. Individuals with lower levels of financial literacy and lower annual income have less knowledge of basic pension characteristics.
There has been a significant increase in presentations of people with eating disorders (ED) within CAMHS in relation to the pandemic with a significant pressure on services to continue to provide evidence-based treatments for an expanding number of severely unwell patients. The first aim was to assess the quality of referrals received for patients with suspected ED and to then implement an intervention regarding the way that referrals are handled. The second aim was to establish a process for handling and monitoring patients already open to the service.
Methods
An initial and repeat survey was sent to staff within the team. The survey included the Mental Health Professional Stress Scale (MHPSS). An audit was conducted to establish the quality of referrals from GPs based on the Junior Marsipan guidelines. Data were collected on physical measures and the written content of referrals for March 2020–21 and March 2021–22.
Duty clinicians were asked to screen referrals and prompt GPs to submit recordings of physical parameters for the referrals to be triaged. In addition, a weekly meeting in a “board round” format was implemented to discuss new referrals and 40–50 existing patients each week depending on risk. We developed a physical health monitoring clinic once per week.
Results
MHPSS scores remained high between initial and follow-up surveys, with slightly increased mean scores for workload, organisational structure and processes, and lack of resources. Referrals from 2020–2021 (N = 26) and those from 2021–2022 (N = 39) were screened. The majority had a diagnosis of anorexia nervosa. Most referrals had records of height and weight (73.1 to 82.1%). 53.8% of referrals in the re-audit period required prompting for physical recordings to be submitted. There was no change in the written content of referrals at re-audit, with only 46.2% recording risk, 51.3% recording estimated onset and 56.4% documenting body image.
There was a slight reduction in the mean time between referral and diagnosis from 44.1 to 34.2 days. The weekly board round received positive feedback (N = 10) with 70–100% answering agree/strongly agree to statements such as manage patients’ care safely, obtaining urgent advice and physical monitoring.
Conclusion
The processes summarised above have been successful in improving the efficiency surrounding the management of patients with ED. Unfortunately, there has been no improvement in the stress levels of staff; we hope to conduct a focus group to better understand this. A referral proforma should be developed by the wider service for GPs to complete.
To audit completed liaison service high risk care plans against local and national guidelines.
Methods
Sample comprised of a snapshot of all liaison patients currently on the case load on 14th December 2021. Electronic notes were reviewed to identify High Risk Care Plans (HRCPs) and audit completion against local guidance. Currently there is no national guidelines.
In addition staff from the liaison team were surveyed to consider their confidence in completing HRCPs in order to direct staff training. Acute hospital staff were also surveyed to ascertain positive and negative aspects of the current HRCPs, in order to suggest quality improvements ahead of the upcoming integration of new Digital notes system.
Results
Sample size 284. High Risk Care Plans completed 11, with an additional 2 required but not found in the notes.
Non pharmacological deescalation advice was specified in only 2/11.
Regular medication was documented in 5/11.
Specialist rapid tranquillisation medication advice in 8/11.
8/11 made reference to the local rapid tranquillisation policy, which was not made available in the notes.
Absconsion risk is documented in 8/11 and advised level of observation 10/11.
Conclusion
According to local guidelines High Risk Care Plans were appropriate for 4.6% of the liaison case load, but record was included in the notes for 3.9%. Of those completed mandatory fields including non pharmacological deescalation and rapid tranquillisation advice were not always complete. Reference to rapid tranquillisation policy not immediately available in the notes is largely unhelpful in an emergency.
Our local target is for 100% completion of appropriate high risk care plans and full documentation for each of the mandatory fields in the high risk care plan. Improved training and record keeping is required.
Staff survey suggested unfamiliarity with document and unclear boundaries between standard and patient specific information impaired utility of high risk care plans. We recommend familiarising staff with the document and encourage highlighted font for key information.
Ophiolitic mélanges in Anatolia represent Mesozoic subduction-accretion complexes, which are unusually poor in land-derived coarse-clastic rocks. A segment of the ophiolitic mélange in the Beynam region south of Ankara was studied. The ophiolitic mélange consists of three accretionary units (AUs), which are distinguished by lithology, structure, age and geochemistry. At the base there is a serpentinite mélange, which is overlain by a semi-intact Upper Jurassic ophiolite with boninite geochemistry. The topmost AU consists of ocean-island-like alkali basalts with seamount-derived Triassic shallow-marine limestones and Jurassic radiolarian cherts, which are stratigraphically overlain by Upper Cretaceous fore-arc turbidites. The base of the fore-arc sequence is palaeontologically and isotopically dated to the early to middle Campanian (c. 81 Ma). Detrital zircons from the fore-arc sequence indicate a Late Cretaceous (87–81 Ma) magmatic arc as a source. The formation of the subduction-accretion complex was a two-stage process. The first stage took place during the Late Jurassic – Early Cretaceous, when supra-subduction type oceanic crust was generated, and subduction accretion was intra-oceanic. In the second stage during the Late Cretaceous the subduction jumped inboard, creating an Andean-type convergent margin, and the Jurassic oceanic crust was incorporated in the subduction-accretion complex. The lack of land-derived sandstones in the ophiolitic mélange can be attributed to the intra-oceanic subduction and to the limestone deposition in the upper plate during the main phase of subduction accretion in the Late Jurassic – Early Cretaceous.
Cognitive science is in some sense the science of the mind. But an increasingly influential theme, in recent years, has been the role of the physical body, and of the local environment, in promoting adaptive success. No right-minded cognitive scientist, to be sure, ever claimed that body and world were completely irrelevant to the understanding of mind. But there was, nonetheless, an unmistakeable tendency to marginalize such factors: to dwell on inner complexity whilst simplifying or ignoring the complex inner–outer interplays that characterize the bulk of basic biological problem-solving. This tendency was expressed in, for example, the development of planning algorithms that treated real-world action as merely a way of implementing solutions arrived at by pure cognition (more recent work, by contrast, allows such actions to play important computational and problem-solving roles). It also surfaced in David Marr’s depiction of the task of vision as the construction of a detailed three-dimensional image of the visual scene. For possession of such a rich inner model effectively allows the system to ‘throw away’ the world and to focus subsequent computational activity on the inner model alone.
Electroanatomic mapping systems are increasingly used during ablations to decrease the need for fluoroscopy and therefore radiation exposure. For left-sided arrhythmias, transseptal puncture is a common procedure performed to gain access to the left side of the heart. We aimed to demonstrate the radiation exposure associated with transseptal puncture.
Methods:
Data were retrospectively collected from the Catheter Ablation with Reduction or Elimination of Fluoroscopy registry. Patients with left-sided accessory pathway-mediated tachycardia, with a structurally normal heart, who had a transseptal puncture, and were under 22 years of age were included. Those with previous ablations, concurrent diagnostic or interventional catheterisation, and missing data for fluoroscopy use or procedural outcomes were excluded. Patients with a patent foramen ovale who did not have a transseptal puncture were selected as the control group using the same criteria. Procedural outcomes were compared between the two groups.
Results:
There were 284 patients in the transseptal puncture group and 70 in the patent foramen ovale group. The transseptal puncture group had a significantly higher mean procedure time (158.8 versus 131.4 minutes, p = 0.002), rate of fluoroscopy use (38% versus 7%, p < 0.001), and mean fluoroscopy time (2.4 versus 0.6 minutes, p < 0.001). The acute success and complication rates were similar.
Conclusions:
Performing transseptal puncture remains a common reason to utilise fluoroscopy in the era of non-fluoroscopic ablation. Better tools are needed to make non-fluoroscopic transseptal puncture more feasible.
This Element discusses the problem of mathematical knowledge, and its broader philosophical ramifications. It argues that the challenge to explain the (defeasible) justification of our mathematical beliefs ('the justificatory challenge'), arises insofar as disagreement over axioms bottoms out in disagreement over intuitions. And it argues that the challenge to explain their reliability ('the reliability challenge'), arises to the extent that we could have easily had different beliefs. The Element shows that mathematical facts are not, in general, empirically accessible, contra Quine, and that they cannot be dispensed with, contra Field. However, it argues that they might be so plentiful that our knowledge of them is unmysterious. The Element concludes with a complementary 'pluralism' about modality, logic and normative theory, highlighting its surprising implications. Metaphysically, pluralism engenders a kind of perspectivalism and indeterminacy. Methodologically, it vindicates Carnap's pragmatism, transposed to the key of realism.
Background: Despite a higher prevalence of traumatic spinal cord injury (TSCI) amongst Canadian Indigenous peoples, there is a paucity of studies focused on Indigenous TSCI. We present the first Canada-wide study comparing TSCI amongst Canadian Indigenous and non-Indigenous peoples. Methods: This study is a retrospective analysis of prospectively-collected TSCI data from the Rick Hansen Spinal Cord Injury Registry (RHSCIR) from 2004-2019. We divided participants into Indigenous and non-Indigenous cohorts and compared them with respect to demographics, injury mechanism, level, severity, and outcomes. Results: Compared with non-Indigenous patients, Indigenous patients were younger, more female, less likely to have higher education, and less likely to be employed. The mechanism of injury was more likely due to assault or transportation-related trauma in the Indigenous group. The length of stay for Indigenous patients was longer. Indigenous patients were more likely to be discharged to a rural setting, less likely to be discharged home, and more likely to be unemployed following injury. Conclusions: Our results suggest that more resources need to be dedicated for transitioning Indigenous patients sustaining a TSCI to community living and for supporting these patients in their home communities. A focus on resources and infrastructure for Indigenous patients by engagement with Indigenous communities is needed.
Over the last 25 years, radiowave detection of neutrino-generated signals, using cold polar ice as the neutrino target, has emerged as perhaps the most promising technique for detection of extragalactic ultra-high energy neutrinos (corresponding to neutrino energies in excess of 0.01 Joules, or 1017 electron volts). During the summer of 2021 and in tandem with the initial deployment of the Radio Neutrino Observatory in Greenland (RNO-G), we conducted radioglaciological measurements at Summit Station, Greenland to refine our understanding of the ice target. We report the result of one such measurement, the radio-frequency electric field attenuation length $L_\alpha$. We find an approximately linear dependence of $L_\alpha$ on frequency with the best fit of the average field attenuation for the upper 1500 m of ice: $\langle L_\alpha \rangle = ( ( 1154 \pm 121) - ( 0.81 \pm 0.14) \, ( \nu /{\rm MHz}) ) \,{\rm m}$ for frequencies ν ∈ [145 − 350] MHz.
Although it is well known that parental depression is transmitted within families across generations, the etiology of this transmission remains unclear. Our goal was to develop a novel study design capable of explicitly examining the etiologic sources of intergenerational transmission. We specifically leveraged naturally-occurring variations in genetic relatedness between parents and their adolescent children in the 720 families participating in the Nonshared Environment in Adolescent Development (NEAD) study, 58.5% of which included a rearing stepparent (nearly always a stepfather). Results pointed squarely to the environmental transmission of psychopathology between fathers and children. Paternal depression was associated with adolescent depression and adolescent behavior problems (i.e., antisocial behavior, headstrong behavior, and attention problems) regardless of whether or not fathers and their children were genetically related. Moreover, these associations persisted to a subset of “blended” families in which the father was biologically related to one participating child but not to the other, and appeared to be mediated via father–child conflict. Such findings are not only fully consistent with the environmental transmission of psychopathology across generations, but also add to extant evidence that parent–child conflict is a robust and at least partially environmental predictor of adolescent psychopathology.
Effective incident management is essential for coordinating efforts of multiple disciplines and stakeholders when responding to emergencies, including public health disasters such as the ongoing coronavirus disease 2019 (COVID-19) pandemic.
Methods:
Existing research frameworks tend to focus on formal structures and doctrine (eg, ICS-NIMS); however, organizational processes that underlie incident management have not been systematically assessed and synthesized into a coherent conceptual framework.
Results:
The lack of a framework has hindered the development of measures of performance that could be used to further develop the evidence base and facilitate process improvement. To address this gap, we present a conceptual framework of incident management drawn from expert feedback and a review of literature on incident management and related fields. The framework features 23 measurement constructs grouped into 5 domains: (1) situational awareness and information sharing, (2) incident action and implementation planning, (3) resource management and mobilization, (4) coordination and collaboration, and (5) feedback and continuous quality improvement.
Conclusions:
As such, the article provides a first step toward the development of robust measures for assessing the performance and effectiveness of incident management systems.
Background: Postacute sequelae of SARS-CoV-2 (PASC) include fatigue, dyspnea, anxiety, and cognitive impairment. Few studies have explored the prevalence or presentation of PASC among nursing home (NH) residents. Method: A case–control study was conducted at 1 NH in Michigan in December 2021. Cases were defined as residents with SARS-CoV-2 infection between November 2, 2020, and October 8, 2021. Controls lived at the same NH during this interval and never tested positive for SARS CoV-2. Patient characteristics were compared between cases and controls using the Fisher exact test and Wilcoxon rank-sum test. Primary outcomes were functional decline, cognition, and adverse health outcomes. Outcomes were assessed by comparing measures on last observation to observations before COVID-19 diagnosis (cases) or to earliest observation (controls). Multivariable logistic regression assessed correlation between COVID-19 diagnosis and outcomes. Results: In total, 152 residents were identified for inclusion (147 included in final analyses, 76 cases, 71 controls); 5 were excluded due to insufficient data. We collected the following resident characteristics: 66% were aged ≥80 years; 73% were female; 95% were non-Hispanic white; 82% were long-stay residents; median of 3 comorbidities (IQR, 2–4). The mean number of follow-up observations was 2.60 (SD, 1.25). No significant differences in population characteristics were detected between cases and controls. Moreover, 106 patients (46 cases and 60 controls) had at least 1 follow-up visit and were thus included in the analyses to evaluate long-term outcomes. Among them, cases experienced significant declines in completing transfers (OR 5.65, p Conclusions: Nursing home residents with COVID-19 are more likely to enter hospice and have a higher mortality rate in the year following infection. Survivors experience significant functional decline in basic activities of daily living, specifically in the ability to transfer and dress. Larger studies are needed to further characterize our findings and to design interventions that can help overcome these long-term sequelae from COVID-19.