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Jeff Strickland tells the powerful story of Nicholas Kelly, the enslaved craftsman who led the Charleston workhouse slave rebellion, the largest slave revolt in the history of the antebellum American South. With two accomplices, some sledgehammers, and pickaxes, Kelly risked his life and helped thirty-two fellow enslaved people escape the workhouse where they had been sent by their enslavers to be tortured. While Nat Turner, Gabriel Prosser, and Denmark Vesey remain the most recognizable rebels, the pivotal role of Kelly is often forgotten. All for Liberty centers his rebellion as a decisive moment leading up to the secession of South Carolina from the United States in 1861. This compelling micro-history navigates between Kelly's story and the Age of Atlantic Revolutions, while also considering the parallels between race and incarceration in the nineteenth century and in modern America. Never before has the story of Nicholas Kelly been so eloquently told.
Surrey and Borders NHS Foundation Trust's AVATr (Augmented Virtual-reality Avatar in Training) is a unique ground-breaking Virtual Patient Simulation System, which uses the Xenodu platform to train learners in essential clinical and complex communication skills. Over 30 patient scenarios have been developed after identifying learner-specific development needs, including exploration of overt psychosis, assessment of capacity, sharing bad news, and neglect in care home residents. Actors are filmed responding to several domains of clinical questions, further categorised into three narrative-modes of being ‘Engaged, Neutral or Disengaged’, to build a bank of scenarios. During the session, the trainee is projected on to a large screen, using a camera and video special effects, which results in a life-like interaction with the Virtual Patient. Trainees can view themselves interacting with the Virtual Patient in real-time, from a unique ‘out-of-body' perspective, immersed in a custom-designed interactive virtual environment. The simulation facilitator engages with the learner and determines the appropriate choices of responses for the Virtual Patient and if needed, can prompt with explorative cues to continue the narrative-linked conversation. AVATr model pioneered in United Kingdom the use of an innovative ‘self-observational approach’ in Psychiatry training. This is different to a first-person perspective used in virtual or augmented-reality systems in several clinical specialties. The use of Facilitated-Debrief and Peer-Debrief in sessions, render another layer to the simulation experience.
During the COVID-19 pandemic, we evolved the AVATr model to remote or hybrid sessions, where simulations were digitally enhanced, and have been run through Microsoft Teams. The simulation facilitator is connected to a multi-user video call, enabling the Virtual Patient to be projected as an attendee using Microsoft Teams.
The hybrid model of AVATr has received tremendous feedback, as it now simulates video-consultations that a vast majority of Psychiatry trainees, especially community-based, undertake due to COVID-19 restrictions. The format of AVATr simulation sessions has remained unchanged, and the remote delivery has been particularly successful as it allows trainees to log in from different remote locations to come together for an interactive training session, without any physical restrictions.
Since 2015, our simulation platform has been utilised for Post-Graduate Medical Education, to enhance essential professional skills and stimulate professional growth. Currently the hybrid model of AVATr is being expanded to Nursing, Psychology and Allied Health Professional (AHP) clinical training streams, along with Undergraduate Medical Education, to address identified gaps in face-to-face training amidst COVID-19 pandemic.
This paper examines how the context of civil war in the Anglo-Norman and Angevin realms c. 1100–c. 1216 might further accentuate the challenges faced by leaders in making the critical decision as to whether to avoid or to commit to battle. Whereas a commander confronting an external opponent might withdraw or refusal battle until a more advantageous moment presented itself, a ruler whose legitimacy was contested could ill-afford to harm his authority by being seen to refuse trial by battle. If defeated, however, such authority could be gravely undermined and, as shown by the case of King Stephen's capture in 1141, the sacrality of kingship itself damaged. Conversely, while victory would bolster prestige and legitimacy, as well as striking a potentially decisive blow to rival forces, a leader's own desire to give battle might be compromised by fear of disloyalty and defection before or during battle, or thwarted by the nobility's deep-rooted reluctance to engage in a potentially self-destructive combat. While many nobles shrank from fighting against the person of the king during rebellion, battles fought in the context of civil wars reveal the significance of disinherited magnates in aggressive attacks upon their erstwhile lords.
“A greater event cannot take place among men than one wherein lies the fortunes of all the land, the state of the prince and the life of an infinite number of persons, the honour or dishonour of the overlord, the knights and all the nobility.” So wrote Christine de Pizan in her Livre des faites d’armes et de chevalerie, composed around 1410, concerning the enormous stakes that a pitched battle could involve. Much of her text comprises a vernacular reworking of Vegetius’ De re militari, and it has been the debate concerning the nature of “Vegetian strategy” and the place of battle within strategic thinking that has run, from the very first issue of the Journal of Medieval Military History, as a rich thematic seam through research on medieval warfare across a wide chronological and geographical span.
Transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is possible among symptom-free individuals. Patients are avoiding medically necessary healthcare visits for fear of becoming infected in the healthcare setting. We screened 489 symptom-free healthcare workers for SARS-CoV-2 and found no positive results, strongly suggesting that the prevalence of SARS-CoV-2 was <1%.
Rural Long-term Care (LTC) providers face unique challenges when planning, preparing for, and responding to disasters. We sought to better understand challenges and identify best practices for LTC in rural areas.
Case studies including key informant interviews and site visits were conducted with LTC staff and emergency planning, preparedness, and response partners in three rural communities. Themes were identified across sites using inductive coding.
Communication across disaster phases continues to be a challenge for LTC providers in rural communities for all disaster types. Communication challenges limit LTC providers’ ability to address patient needs during emergencies and limit the resilience of providers and patients to future disasters. Limited coordination among local leadership and LTC providers prevents dissemination of information, resources, and services, and slows response and recovery time. Including LTC providers as stakeholders in planning and exercises may improve communication and coordination.
More than two decades into efforts to increase preparedness of health care systems to all hazards, rural LTC facilities still face challenges related to communication and coordination. Agencies at the federal, state, and local level should include input from rural LTC stakeholders to address gaps in communication and coordination and increase their disaster resilience.
Evaluate the safety and tolerability of aripiprazole once-monthly (ARI-OM) initiation in patients stabilized on oral antipsychotics other than aripiprazole. Previous pivotal Phase III trials have evaluated initiating ARI-OM in patients stabilized on oral aripiprazole1.
Eligible patients were treated with oral atypical antipsychotics other than aripiprazole with a history of oral aripiprazole tolerability. The study included a screening phase (30 days) and a treatment phase (28 days). Patients were stabilized per investigator's judgment for ≥14 days on risperidone, olanzapine, quetiapine, or ziprasidone, before administration of ARI-OM (400 mg). Current oral antipsychotic was co-administered with ARI-OM for 2 weeks to determine safety and tolerability of a single ARI-OM dose following treatment initiation. Safety assessments were adverse events (AEs); extrapyramidal symptoms (EPSs) using standard objective rating scales; Columbia-Suicide Severity Rating Scale; clinical laboratory measures; and weight changes.
60 patients initiated ARI-OM, while continuing treatment for ≤2 weeks with oral risperidone (n=24), quetiapine (n=28), ziprasidone (n=5) or olanzapine (n=3). Treatment-emergent (TE) AEs (≥5%) were fatigue, injection-site pain, and restlessness (risperidone); insomnia, dystonia, injection-site pain, and toothache (quetiapine); and muscle spasm, tooth abscess, and toothache (ziprasidone). Prior olanzapine did not cause any AEs. Incidence of TE-EPSs were similar in all groups (< 5%). There were no unusual changes in objective EPS rating scales, suicidality, weight, laboratory values or fasting metabolic parameters across all groups.
The AE profile of patients receiving ARI-OM concomitant with oral atypical antipsychotics other than aripiprazole was consistent with prior reports1.
This study directly compares the effectiveness of aripiprazole once-monthly 400 mg (AOM) and paliperidone palmitate once-monthly (PP) on the validated and symptom-focused Heinrichs-Carpenter Quality-of-Life Scale (QLS) in schizophrenia.
A 28-week, randomized, open-label rater-blinded, head-to-head study (NCT01795547) of AOM and PP in adult patients (18-60 years) needing a change from current oral antipsychotic treatment for any reason. The study comprised oral conversion, initiation of AOM or PP treatment according to labels, and treatment continuation with injections every 4 weeks. The primary endpoint assessed non-inferiority and subsequently superiority on change from baseline to week 28 in QLS total score analyzed using a mixed model for repeated measurements.
Of 295 randomized patients, 100/148 (67.6%) of AOM and 83/147 (56.5%) of PP patients completed 28 weeks of treatment. In treated patients, adverse events (AEs) were the most frequent reason for discontinuation; AOM: 16/144 (11.1%), PP: 27/137 (19.7%). The difference in change from baseline to week 28 on QLS total score was statistically significant (4.67 [95%CI: 0.32;9.02], p=0.036), confirming non-inferiority and establishing superiority of AOM compared to PP. The respective changes were 7.47±1.53 for AOM and 2.80±1.62 for PP. AEs occurring at rates ≥5% in either group in the treatment continuation phase were weight increased (AOM: 12/119 [10.1%]; PP: 17/109 [15.6%]), psychotic disorder (AOM: 3/119 [2.5%]; PP: 6/109 [5.5%]) and insomnia (AOM: 3/119 [2.5%]; PP: 6/109 [5.5%]).
Superior improvements on the clinician-rated QLS and lower rates of all-cause discontinuation suggest greater overall effectiveness for aripiprazole once-monthly vs paliperidone palmitate.
To evaluate the initial (3 months) all-cause discontinuation and safety of aripiprazole once-monthly 400mg (AOM-400mg), an extended release injectable suspension of aripiprazole, stratified by previous treatment.
These two studies (NCT00705783 & NCT00706654) were double-blind, placebo- or active-controlled assessing the efficacy and safety of AOM-400mg. Detailed study designs have been reported previously (1, 2). This analysis was conducted on the pooled population in the first 3 months after initiating AOM-400mg treatment, on patients who received at least one dose of AOM-400mg. Outcome measures are reported for groups stratified by prior treatment.
During the first 3 months of treatment, discontinuation due to all-causes (except for those who discontinued due to the sponsor stopping the NCT00705783 study early after pre-specified efficacy parameters were met) as well as due to adverse events are presented in Table 1. The rates of insomnia and akathisia are shown in Table 1
Aripiprazole once-monthly 400mg appeared equally safe and effective (as measured by all cause discontinuation) in the first 3 months after initiation, regardless of treatment prior to entering trials.
Antipsychotic other than oral aripiprazole (converted) n=581
Across the United States over time, numbers of registered interest groups have continued to increase, but these populations mask the total amount of lobbying that is occurring within America's statehouses. Among registered interests, average numbers of hired lobbyists have increased markedly since the late 1980s. This study both quantifies this increase and identifies a set of causal variables. Previous studies have proposed a variety of short-term, political and long-term, institutional factors that govern rates of lobbying. Using a new data set spanning multiple decades, I find that changes in lobbying can largely be ascribed to institutional variables, including the implementation of term limits and regulations on lobbying. Lobby regulations, one-party dominance, and legislative expenditures also appear to play a role in determining rates of multiclient lobbying. Direct democracy and state spending do not affect the hiring of lobbyists by registered interest groups.
Goldin-Meadow & Brentari (G-M&B) argue that, for sign language users, gesture – in contrast to linguistic sign – is iconic, highly variable, and similar to spoken language co-speech gesture. We discuss two examples (telicity and absolute gradable adjectives) that challenge the use of these criteria for distinguishing sign from gesture.
To assess the effects of aripiprazole once-monthly 400 mg (AOM 400) on clinical symptoms and global improvement in schizophrenia after switching from an oral antipsychotic.
In a multicenter, open-label, mirror-image, naturalistic study in patients with schizophrenia (>1 year, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision [DSM-IV-TR] criteria), changes in efficacy measures were assessed during prospective treatment (6 months) with AOM 400 after switching from standard-of-care oral antipsychotics. During prospective treatment, patients were cross-titrated to oral aripiprazole monotherapy (1–4) weeks followed by open-label AOM 400 (24 weeks). Mean change from baseline of the open-label AOM 400 phase in Positive and Negative Syndrome Scale (PANSS) scores (total, positive and negative subscales) and Clinical Global Impression–Severity (CGI-S) scores; mean CGI–Improvement (CGI-I) score; and proportion of responders (≥30% decrease from baseline in PANSS total score or CGI-I score of 1 [very much improved] or 2 [much improved]) were assessed.
PANSS and CGI-S scores improved from baseline (P<0.0001) and CGI-I demonstrated improvement at all time points. By the end of the study, 49.0% of patients were PANSS or CGI-I responders.
In a community setting, patients with schizophrenia who were stabilized at baseline and switched to AOM 400 from oral antipsychotics showed clear improvements in clinical symptoms.
This article examines early Protestant discussion of the historic puzzle in New Testament study known as the Synoptic Problem, which deals with the potential literary relationship between the Gospels of Matthew, Mark and Luke. The subject was addressed by John Calvin, pioneer Reformer, and by the early Lutheran Martin Chemnitz. Calvin made a puissant contribution by constructing the first three-column Gospel harmony. Chemnitz contributed nascent redaction-critical assessments of Matthew's use of Mark. Thus, far from simply being a concern to post-Enlightenment critics (as is often assumed), interest in the Gospel sources was present from the earliest days of the Reformation.
We present results from the detection of relativistic winds launched near the innermost stable circular orbits of supermassive black holes. A recent detection of a powerful wind in the X-ray-bright narrow absorption line (NAL) z=1.51 quasar HS 0810+2554 strengthens the case that quasars play a significant role in feedback. In both deep Chandra and XMM-Newton observations of HS 0810 we detected blueshifted absorption lines implying outflowing velocities ranging from 0.1c and 0.4c. The presence of both an emission line at 6.8 keV and an absorption line at 7.8 keV in the spectral line profile of HS 0810 is a characteristic feature of a P-Cygni profile supporting the presence of an expanding outflowing highly ionized Fe absorber. A hard excess component is detected in the XMM-Newton observation of HS 0810 possibly originating from reflection off the disk. Modelling of the XMM-Newton spectrum constrains the inclination angle to be < 35° (68% confidence). The presence of relativistic winds in both low inclination angle NAL quasars as well as in high inclination angle BAL quasars implies that the solid angle of quasar winds may be quite large. The larger solid angle of quasar winds would also indicate that their contribution to the regulation of the host galaxy may be more important than previously thought.
Materials adsorbed onto the surface of a fluid – for instance, crude oil, biogenic slicks or industrial/medical surfactants – will move in response to surface waves. Owing to the difficulty of non-invasive measurement of the spatial distribution of a molecular monolayer, little is known about the dynamics that couple the surface waves and the evolving density field. Here, we report measurements of the spatiotemporal dynamics of the density field of an insoluble surfactant driven by gravity–capillary waves in a shallow cylindrical container. Standing Faraday waves and travelling waves generated by the meniscus are superimposed to create a non-trivial surfactant density field. We measure both the height field of the surface using moiré imaging, and the density field of the surfactant via the fluorescence of NBD-tagged phosphatidylcholine, a lipid. Through phase averaging stroboscopically acquired images of the density field, we determine that the surfactant accumulates on the leading edge of the travelling meniscus waves and in the troughs of the standing Faraday waves. We fit the spatiotemporal variations in the two fields using an ansatz consisting of a superposition of Bessel functions, and report measurements of the wavenumbers and energy damping factors associated with the meniscus and Faraday waves, as well as the spatial and temporal phase shifts between them. While these measurements are largely consistent for both types of waves and both fields, it is notable that the damping factors for height and surfactant in the meniscus waves do not agree. This raises the possibility that there is a contribution from longitudinal waves in addition to the gravity–capillary waves.
Well versed in natural history, particularly geology and ornithology, Hugh Edwin Strickland (1811–53) became fascinated by the dodo and mankind's influence on its extinction. Seeking to investigate this flightless bird and other extinct species from islands in the Indian Ocean, he invited the comparative anatomist Alexander Gordon Melville (1819–1901) to help him separate myth from reality. Divided into two sections, this 1848 monograph begins with Strickland's evaluation of the evidence, including historical reports as well as paintings and sketches, many of which are reproduced. Melville then analyses the osteology of the dodo and Rodrigues solitaire, describing his findings from dissections of the few available specimens and making comparisons with similar species. A seminal work, it correctly concluded that the dodo was more closely related to pigeons than vultures, and the book also inspired others to take up the search for new fossil evidence.