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This volume examines the phenomena of ancient Greek prophecy and divination. With contributions from a distinguished, international cast of scholars, it offers fresh perspectives and interpretations of key aspects of these practices. Considering issues such as comparativism, ethnography, cognitive function, orality, and intertextuality, the volume demonstrates their relevance to the elucidation of Greek prophetic practices. The volume also shows how multi- and inter-disciplinary approaches can be applied to a range of topics, from an examination of the very inception of Greek divination, explored within the frame of more archaic cult ideas, through emic elaboration of divinatory practice in Archaic and Classical periods, to consideration of intentional manipulation of prophecy, as depicted in Hellenistic and Imperial Roman sources. Collectively, the essays deepen our understanding of ancient Greek prophecy by offering insights into divinition astéhknē, the centrality or marginality of Delphi and the Pythic priestess, prophetic ambiguity, and cognition, including cognitive dissonance.
Health care costs in the United States are much higher than in other countries. These cost differences can be explained in part by a lack of competition in the United States. Some markets, such as pharmaceuticals and medical equipment, have elements of monopoly. Other markets, such as health insurance, have elements of monopsony. Many other markets may be subject to collusion on prices, such as generic drugs, or wages, such as the nurse labor market. Lawful monopoly and monopsony are beyond the reach of antitrust laws, but collusion is not. When appropriate, vigorous antitrust enforcement challenging anticompetitive conduct can aid in reducing health care costs. This book addresses monopoly, monopsony, cartels of sellers and buyers, horizontal and vertical merger policy, and antitrust enforcement through private suits as well as the efforts of the antitrust Agencies. The authors demonstrate how enforcing antitrust laws can ultimately promote competition and reduce health care costs.
The Fanshi Basin is one of the NE–SW-striking depocentres formed along the northern segment of the fault-bounded Shanxi rift. In order to understand the crustal driving stresses that led to the basin formation and development, a palaeostress analysis of a large quantity of fault-slip data collected mainly at the boundaries of the basin was accomplished. The stress inversion of these data revealed three stress regimes. The oldest SR1 was a Neogene stress regime giving rise to a strike-slip deformation with NE–SW contraction and NW–SE extension. SR1 activated the large faults trending NNE–NE, i.e. (sub)parallel to the main strike of the Shanxi rift, as right-lateral strike-slip faults. It was subjected to the Shanxi rift before the activation of the Fanshi Basin boundary fault, i.e. the Fanshi (or Wutai) fault, as a normal fault. The next is a short-lived NE–SW extensional stress regime SR2 in early Pleistocene time, which shows the inception of the basin’s extension. A strong NW–SE to NNW–SSE extensional stress regime SR3 has governed the northern segment of the Shanxi rift since late Pleistocene time and is the present-day extension. It gave rise to the current half-graben geometry of the Fanshi Basin by activating the Fanshi (or Wutai) fault as a normal fault in the southern part of the graben. Because of the dominance of the NW–SE to NNW–SSE extension, which is perpendicular to the NE–SW extension, mutual permutations between σ3 and σ2 due to inherited fault patterns might have occurred while the crustal stresses in the Fanshi Basin changed from the SR1 to SR3 stress regimes.
In this cross-sectional survey, we assessed knowledge, attitudes and behaviors regarding operating room air-change rates, climate change, and coronavirus disease 2019 (COVID-19) pandemic implications. Climate change and healthcare pollution were considered problematic. Respondents checked air exchange rates for COVID-19 and ∼25% increased them. Respondents had difficulty completing questions concerning hospital heating, ventilation and air conditioning (HVAC) systems.
Herbicide-resistant (HR) crops are widely grown throughout the United States and Canada. These crop-trait technologies can enhance weed management and therefore can be an important component of integrated weed management (IWM) programs. Concomitantly, evolution of HR weed populations has become ubiquitous in agricultural areas where HR crops are grown. Nevertheless, crop cultivars with new or combined (stacked) HR traits continue to be developed and commercialized. This review, based on a symposium held at the Western Society of Weed Science annual meeting in 2021, examines the impact of HR crops on HR weed management in the U.S. Great Plains, U.S. Pacific Northwest, and the Canadian Prairies over the past 25 yr and their past and future contributions to IWM. We also provide an industry perspective on the future of HR crop development and the role of HR crops in resistance management. Expanded options for HR traits in both major and minor crops are expected. With proper stewardship, HR crops can reduce herbicide-use intensity and help reduce selection pressure on weed populations. However, their proper deployment in cropping systems must be carefully planned by considering a diverse crop rotation sequence with multiple HR and non-HR crops and maximizing crop competition to effectively manage HR weed populations. Based on past experiences in the cultivation of HR crops and associated herbicide use in the western United States and Canada, HR crops have been important determinants of both the selection and management of HR weeds.
Annual balances of eight alpine glaciers were slightly negative for 1961–90 and highly negative for 1991–2018. We explain this by changes in positive degree-day sums and summer temperatures extrapolated to the median altitudes of the glaciers. We test a new way of calculating degree-day sums that performs better than the traditional method which used daily mean temperatures. Annual degree-day sums are highly correlated with May–September temperatures as suggested in 1866 by Karl von Sonklar. We find moderate correlations between annual balances and degree-day sums, and with May–September temperatures. Calculated degree-day factors for the eight glaciers cover the reported range for snow and ice ablation, while the temperature sensitivity of annual balance is from −0.4 to −1.0 m w.e. for a +1°C temperature change. We accurately predict mean balances for 1991–2018 using May–September temperatures in regression models calibrated for 1961–90. May–September temperatures in the Alps have already increased ~+3°C since 1880 and, if temperatures continue to rise, these glaciers will shrink rapidly. As annual balances are already negative for present-day temperatures, these glaciers will not be ‘safe’ under the further temperature increase permitted by the Paris Agreement.
South Africa has embarked on major health policy reform to deliver universal health coverage through the establishment of National Health Insurance (NHI). The aim is to improve access, remove financial barriers to care, and enhance care quality. Health technology assessment (HTA) is explicitly identified in the proposed NHI legislation and will have a prominent role in informing decisions about adoption and access to health interventions and technologies. The specific arrangements and approach to HTA in support of this legislation are yet to be determined. Although there is currently no formal national HTA institution in South Africa, there are several processes in both the public and private healthcare sectors that use elements of HTA to varying extents to inform access and resource allocation decisions. Institutions performing HTAs or related activities in South Africa include the National and Provincial Departments of Health, National Treasury, National Health Laboratory Service, Council for Medical Schemes, medical scheme administrators, managed care organizations, academic or research institutions, clinical societies and associations, pharmaceutical and devices companies, private consultancies, and private sector hospital groups. Existing fragmented HTA processes should coordinate and conform to a standardized, fit-for-purpose process and structure that can usefully inform priority setting under NHI and for other decision makers. This transformation will require comprehensive and inclusive planning with dedicated funding and regulation, and provision of strong oversight mechanisms and leadership.
The National Institute of Mental Health's Research Domain Criteria (RDoC) framework has prompted a paradigm shift from categorical psychiatric disorders to considering multiple levels of vulnerability for probabilistic risk of disorder. However, the lack of neurodevelopmentally based tools for clinical decision making has limited the real-world impact of the RDoC. Integration with developmental psychopathology principles and statistical methods actualize the clinical implementation of RDoC to inform neurodevelopmental risk. In this conceptual paper, we introduce the probabilistic mental health risk calculator as an innovation for such translation and lay out a research agenda for generating an RDoC- and developmentally informed paradigm that could be applied to predict a range of developmental psychopathologies from early childhood to young adulthood. We discuss methods that weigh the incremental utility for prediction based on intensity and burden of assessment, the addition of developmental change patterns, considerations for assessing outcomes, and integrative data approaches. Throughout, we illustrate the risk calculator approach with different neurodevelopmental pathways and phenotypes. Finally, we discuss real-world implementation of these methods for improving early identification and prevention of developmental psychopathology. We propose that mental health risk calculators can build a needed bridge between the RDoC multiple units of analysis and developmental science.
Poverty increases the risk of poorer executive function (EF) in children born full-term (FT). Stressors associated with poverty, including variability in parenting behavior, may explain links between poverty and poorer EF, but this remains unclear for children born very preterm (VPT). We examine socioeconomic and parental psychosocial adversity on parenting behavior, and whether these factors independently or jointly influence EF in children born VPT. At age five years, 154 children (VPT = 88, FT = 66) completed parent-child interaction and EF tasks. Parental sensitivity, intrusiveness, cognitive stimulation, and positive and negative regard were coded with the Parent-Child Interaction Rating Scale. Socioeconomic adversity spanned maternal demographic stressors, Income-to-Needs ratio, and Area Deprivation Index. Parents completed measures of depression, anxiety, inattention/hyperactivity, parenting stress, and social-communication interaction (SCI) problems. Parental SCI problems were associated with parenting behavior in parents of children born VPT, whereas socioeconomic adversity was significant in parents of FT children. Negative parenting behaviors, but not positive parenting behaviors, were related to child EF. This association was explained by parental depression/anxiety symptoms and socioeconomic adversity. Results persisted after adjustment for parent and child IQ. Findings may inform research on dyadic interventions that embed treatment for parental mood/affective symptoms and SCI problems to improve childhood EF.
Substance use disorders are highly prevalent, affecting millions of Americans directly (social, occupational, and health problems) and indirectly (billions of dollars in health care costs and lost revenues due to disability). This section briefly introduces the chemical classification and neurobehavioral properties of the most commonly misused substances.
Substantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code (IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases (ICD-11). The most recent publication of the IPCCC was in 2017. This manuscript provides an updated 2021 version of the IPCCC.
The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCC and ICD-11 is the IPCCC ICD-11 Nomenclature and is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHD through 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHO ICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHD thought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.
The members of ISNPCHD realize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCC that was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHD will again publish updated versions of IPCCC, as IPCCC continues to evolve.
The debate over the presence and nature of a single established church in England is perhaps the most important religious issue in the long eighteenth century. From the Elizabethan ‘Penal Laws’ designed to suppress Roman Catholicism to the ‘Clarendon Code’, intended to limit the civil participation of Protestant Nonconformists, the history of religious establishment in England reveals patterns of protectionism and exclusion necessary to maintain the privileged position of the Church ‘as by law established’. New ideas in the eighteenth century, such as toleration and deism, as well as the rise of Methodism, challenged but did not overcome this Anglican hegemony.
Nosocomial transmission of influenza is a major concern for infection control. We aimed to dissect transmission dynamics of influenza, including asymptomatic transmission events, in acute care.
Prospective surveillance study during 2 influenza seasons.
Volunteer sample of inpatients on medical wards and healthcare workers (HCWs).
Participants provided daily illness diaries and nasal swabs for influenza A and B detection and whole-genome sequencing for phylogenetic analyses. Contacts between study participants were tracked. Secondary influenza attack rates were calculated based on spatial and temporal proximity and phylogenetic evidence for transmission.
In total, 152 HCWs and 542 inpatients were included; 16 HCWs (10.5%) and 19 inpatients (3.5%) tested positive for influenza on 109 study days. Study participants had symptoms of disease on most of the days they tested positive for influenza (83.1% and 91.9% for HCWs and inpatients, respectively). Also, 11(15.5%) of 71 influenza-positive swabs among HCWs and 3 (7.9%) of 38 influenza-positive swabs among inpatients were collected on days without symptoms; 2 (12.5%) of 16 HCWs and 2 (10.5%) of 19 inpatients remained fully asymptomatic. The secondary attack rate was low: we recorded 1 transmission event over 159 contact days (0.6%) that originated from a symptomatic case. No transmission event occurred in 61 monitored days of contacts with asymptomatic influenza-positive individuals.
Influenza in acute care is common, and individuals regularly shed influenza virus without harboring symptoms. Nevertheless, both symptomatic and asymptomatic transmission events proved rare. We suggest that healthcare-associated influenza prevention strategies that are based on preseason vaccination and barrier precautions for symptomatic individuals seem to be effective.
Concerns have been raised about the utility of self-report assessments in predicting future suicide attempts. Clinicians in pediatric emergency departments (EDs) often are required to assess suicidal risk. The Death Implicit Association Test (IAT) is an alternative to self-report assessment of suicidal risk that may have utility in ED settings.
A total of 1679 adolescents recruited from 13 pediatric emergency rooms in the Pediatric Emergency Care Applied Research Network were assessed using a self-report survey of risk and protective factors for a suicide attempt, and the IAT, and then followed up 3 months later to determine if an attempt had occurred. The accuracy of prediction was compared between self-reports and the IAT using the area under the curve (AUC) with respect to receiver operator characteristics.
A few self-report variables, namely, current and past suicide ideation, past suicidal behavior, total negative life events, and school or social connectedness, predicted an attempt at 3 months with an AUC of 0.87 [95% confidence interval (CI), 0.84–0.90] in the entire sample, and AUC = 0.91, (95% CI 0.85–0.95) for those who presented without reported suicidal ideation. The IAT did not add significantly to the predictive power of selected self-report variables. The IAT alone was modestly predictive of 3-month attempts in the overall sample ((AUC = 0.59, 95% CI 0.52–0.65) and was a better predictor in patients who were non-suicidal at baseline (AUC = 0.67, 95% CI 0.55–0.79).
In pediatric EDs, a small set of self-reported items predicted suicide attempts within 3 months more accurately than did the IAT.
Few bryozoans have been described from the Cretaceous Western Interior Seaway (WIS), which is consistent with the low diversity of other typically stenohaline groups in this large expanse of relatively shallow marine water. Here we describe a new cheilostome bryozoan, Conopeum flumineum n. sp., based on well-preserved material from the Campanian Judith River Formation of the Upper Missouri River Breaks National Monument in north-central Montana. The new species shows strong morphological similarities with Conopeum seurati, a Recent species that is often categorized as brackish, but which is euryhaline and can also be found in marine and stenohaline environments. The new Campanian bryozoan species was found in a locality also containing fragmentary remains of dinosaurs and other terrestrial vertebrates, as well freshwater mollusks and terrestrial plant debris. The sedimentology and facies associations of the fossil-bearing site suggest that the depositional setting was a swamp or tidally influenced fluvial backwater on the Judith River coastal plain. The proximity of the site to the western shoreline of the WIS presumably made it susceptible to occasional marine flooding during storms or extreme tides. Previous occurrences of Conopeum in the Cretaceous of the Western Interior have also been associated with dinosaur remains, corroborating the very nearshore and at times even ‘upstream’ distribution of this euryhaline genus.
Evidence of a biologically plausible association between maternal smoking during pregnancy (MSP) and the risk of depression is discounted by null findings from two sibling studies. However, valid causal inference from sibling studies is subject to challenges inherent to human studies of MSP and biases particular to this design. We addressed these challenges in the first sibling study of MSP and depression conducted among adults past the peak age for the onset of depression, utilizing a prospectively collected and biologically validated measure of MSP and accounting for non-shared as well as mediating factors.
We fit GEE binomial regression models to correct for dependence in the risk of depression across pregnancies of the same mother. We also fit marginal structural models (MSM) to estimate the controlled direct effect of MSP on depression that is not mediated by the offspring's smoking status. Both models allow the estimation of within- and between-sibling risk ratios.
The adjusted within-sibling risk ratios (RRW) from both models (GEE: RRW = 1.97, CI 1.16–3.32; MSM: RRW = 2.08, CI 1.04–4.17) evinced an independent association between MSP and risk of depression. The overall effects from a standard model evinced lower associations (GEE: RRT = 1.12, CI 0.98–1.28; MSM: RRT = 1.18, CI 1.01–1.37).
Based on within-sibling information free of unmeasured shared confounders and accounting for a range of unshared factors, we found an effect of MSP on the offspring's risk of depression. Our findings, should they be replicated in future studies, highlight the importance of considering challenges inherent to human studies of MSP and affective disorders.
Cross-sectional studies indicate that hippocampal function is abnormal across stages of psychosis. Neural theories of psychosis pathophysiology suggest that dysfunction worsens with illness stage. Here, we test the hypothesis that hippocampal function is impaired in the early stage of psychosis and declines further over the next 2 years.
We measured hippocampal function over 2 years using a scene processing task in 147 participants (76 individuals in the early stage of a non-affective psychotic disorder and 71 demographically similar healthy control individuals). Two-year follow-up was completed in 97 individuals (50 early psychosis, 47 healthy control). Voxelwise longitudinal analysis of activation in response to scenes was carried out within a hippocampal region of interest to test for group differences at baseline and a group by time interaction.
At baseline, we observed lower anterior hippocampal activation in the early psychosis group relative to the healthy control group. Contrary to our hypothesis, hippocampal activation remained consistent and did not show the predicted decline over 2 years in the early psychosis group. Healthy controls showed a modest reduction in hippocampal activation after 2 years.
The results of this study suggest that hippocampal dysfunction in early psychosis does not worsen over 2 years and highlight the need for longer-term longitudinal studies.