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This edited volume argues that democracy is broader and more diverse than the dominant state-centered, modern representative democracies, to which other modes of democracy are either presumed subordinate or ignored. The contributors seek to overcome the standard opposition of democracy from below (participatory) and democracy from above (representative). Rather, they argue that through differently situated participatory and representative practices, citizens and governments can develop democratic ways of cooperating without hegemony and subordination, and that these relationships can be transformative. This work proposes a slow but sure, nonviolent, eco-social and sustainable process of democratic generation and growth with the capacity to critique and transform unjust and ecologically destructive social systems. This volume integrates human-centric democracies into a more mutual, interdependent and sustainable system on earth whereby everyone gains.
The Homa Peninsula has been known to science since 1911, and fossil specimens from the area comprise many type specimens for common African mammalian paleospecies. Here we discuss the fauna and the paleoenvironmental information from the Homa Peninsula. The Homa Peninsula is a 200 km2 area in Homa Bay County, situated on the southern margin of the Winam Gulf of Lake Victoria in Kenya (Figure 29.1). Lake Victoria is estimated to be the third largest lake in the world, with a surface area of 68,900 km2 and a maximum length of approximately 616 km. Although its catchment is extensive, it is relatively shallow compared to any other lake of similar size, with a maximum depth of 84 m. Lake Victoria is located in a depression formed by the western and eastern branches of the East African Rift System (EARS), and is at an average elevation of 1135 m a.s.l. (Database for Hydrological Time Series of Inland Waters, 2017).
Arrhythmogenic right ventricular cardiomyopathy is an uncommon diagnosis in the paediatric population, most commonly presenting with arrhythmia. We report an 11-year-old male presenting with right heart failure due to biventricular systolic dysfunction found to have arrhythmogenic right ventricular cardiomyopathy with de novo Desmin and MYH7 mutations.
The Mayo Normative Studies (MNS) represents a robust dataset that provides demographically corrected norms for the Rey Auditory Verbal Learning Test. We report MNS application to an independent cohort to evaluate whether MNS norms accurately adjust for age, sex, and education differences in subjects from a different geographic region of the country. As secondary goals, we examined item-level patterns, recognition benefit compared to delayed free recall, and derived Auditory Verbal Learning Test (AVLT) confidence intervals (CIs) to facilitate clinical performance characterization.
Participants from the Emory Healthy Brain Study (463 women, 200 men) who were administered the AVLT were analyzed to demonstrate expected demographic group differences. AVLT scores were transformed using MNS normative correction to characterize the success of MNS demographic adjustment.
Expected demographic effects were observed across all primary raw AVLT scores. Depending on sample size, MNS normative adjustment either eliminated or minimized all observed statistically significant AVLT differences. Estimated CIs yielded broad CI ranges exceeding the standard deviation of each measure. The recognition performance benefit across age ranged from 2.7 words (SD = 2.3) in the 50–54-year-old group to 4.7 words (SD = 2.7) in the 70–75-year-old group.
These findings demonstrate generalizability of MNS normative correction to an independent sample from a different geographic region, with demographic adjusted performance differences close to overall performance levels near the expected value of T = 50. A large recognition performance benefit is commonly observed in the normal aging process and by itself does not necessarily suggest a pathological retrieval deficit.
Virtual reality has emerged as a unique educational modality for medical trainees. However, incorporation of virtual reality curricula into formal training programmes has been limited. We describe a multi-centre effort to develop, implement, and evaluate the efficacy of a virtual reality curriculum for residents participating in paediatric cardiology rotations.
A virtual reality software program (“The Stanford Virtual Heart”) was utilised. Users are placed “inside the heart” and explore non-traditional views of cardiac anatomy. Modules for six common congenital heart lesions were developed, including narrative scripts. A prospective case–control study was performed involving three large paediatric residency programmes. From July 2018 to June 2019, trainees participating in an outpatient cardiology rotation completed a 27-question, validated assessment tool. From July 2019 to February 2020, trainees completed the virtual reality curriculum and assessment tool during their cardiology rotation. Qualitative feedback on the virtual reality experience was also gathered. Intervention and control group performances were compared using univariate analyses.
There were 80 trainees in the control group and 52 in the intervention group. Trainees in the intervention group achieved higher scores on the assessment (20.4 ± 2.9 versus 18.8 ± 3.8 out of 27 questions answered correctly, p = 0.01). Further analysis showed significant improvement in the intervention group for questions specifically testing visuospatial concepts. In total, 100% of users recommended integration of the programme into the residency curriculum.
Virtual reality is an effective and well-received adjunct to clinical curricula for residents participating in paediatric cardiology rotations. Our results support continued virtual reality use and expansion to include other trainees.
Clozapine is the only drug licensed for treatment-resistant schizophrenia (TRS) but the real-world clinical and cost-effectiveness of community initiation of clozapine is unclear.
The aim was to assess the feasibility and cost-effectiveness of community initiation of clozapine.
This was a naturalistic study of community patients recommended for clozapine treatment.
Of 158 patients recommended for clozapine treatment, 88 (56%) patients agreed to clozapine initiation and, of these, 58 (66%) were successfully established on clozapine. The success rate for community initiation was 65.4%; which was not significantly different from that for in-patient initiation (58.82%, χ2(1,88) = 0.47, P = 0.49). Following clozapine initiation, there was a significant reduction in median out-patient visits over 1 year (from 24.00 (interquartile range (IQR) = 14.00–41.00) to 13.00 visits (IQR = 5.00–24.00), P < 0.001), and 2 years (from 47.50 visits (IQR = 24.75–71.00) to 22.00 (IQR = 11.00–42.00), P < 0.001), and a 74.71% decrease in psychiatric hospital bed days (z = −2.50, P = 0.01). Service-use costs decreased (1 year: –£963/patient (P < 0.001); 2 years: –£1598.10/patient (P < 0.001). Subanalyses for community-only initiation also showed significant cost reductions (1 year: –£827.40/patient (P < 0.001); 2 year: –£1668.50/patient (P < 0.001) relative to costs prior to starting clozapine. Relative to before initiation, symptom severity was improved in patients taking clozapine at discharge (median Positive and Negative Syndrome Scale total score: initial visit: 80 (IQR = 71.00–104.00); discharge visit 50.5 (IQR = 44.75–75.00), P < 0.001) and at 2 year follow-up (Health of Nation Outcome Scales total score median initial visit: 13.00 (IQR = 9.00–15.00); 2 year follow-up: 8.00 (IQR = 3.00–13.00), P = 0.023).
These findings indicate that community initiation of clozapine is feasible and is associated with significant reductions in costs, service use and symptom severity.
Understanding how cardiovascular structure and physiology guide management is critically important in paediatric cardiology. However, few validated educational tools are available to assess trainee knowledge. To address this deficit, paediatric cardiologists and fellows from four institutions collaborated to develop a multimedia assessment tool for use with medical students and paediatric residents. This tool was developed in support of a novel 3-dimensional virtual reality curriculum created by our group.
Educational domains were identified, and questions were iteratively developed by a group of clinicians from multiple centres to assess understanding of key concepts. To evaluate content validity, content experts completed the assessment and reviewed items, rating item relevance to educational domains using a 4-point Likert scale. An item-level content validity index was calculated for each question, and a scale-level content validity index was calculated for the assessment tool, with scores of ≥0.78 and ≥0.90, respectively, representing excellent content validity.
The mean content expert assessment score was 92% (range 88–97%). Two questions yielded ≤50% correct content expert answers. The item-level content validity index for 29 out of 32 questions was ≥0.78, and the scale-level content validity index was 0.92. Qualitative feedback included suggestions for future improvement. Questions with ≤50% content expert agreement and item-level content validity index scores <0.78 were removed, yielding a 27-question assessment tool.
We describe a multi-centre effort to create and validate a multimedia assessment tool which may be implemented within paediatric trainee cardiology curricula. Future efforts may focus on content refinement and expansion to include additional educational domains.
OBJECTIVES/GOALS: This study examined patterns in helpline call data as the COVID-19 pandemic evolved including the impact of stay-at-home orders, relaxing of restrictive orders, and stages of vaccine uptake, as well as differences in call volume by Chicago neighborhood health indicators. METHODS/STUDY POPULATION: From November 1, 2018 to June 30, 2021, 56 NAMI-Chicago workers accepted 26,173 helpline calls from 9,374 individuals from 438 zip codes across northeastern Illinois with the majority of calls from high poverty Chicago communities. Descriptive and time series analyses examined patterns in call volume related to the onset of the COVID-19 pandemic, Illinois Stay-at-Home Order, and Illinois reopening and vaccine uptake plan relative to comparable times the prior year. Health indicators from the Chicago Health Atlas (https://chicagohealthatlas.org/) were examined to determine patterns related to NAMI call volume and various health indicators at the zip code level. RESULTS/ANTICIPATED RESULTS: Time series analysis indicated the greatest number of calls occurred in 2020; specifically, there was a 212% increase in call volume and 331% increase in repeat callers (three or more calls per caller) during the first and second phase (March 20th to May 28th) of Illinois Stay-at-Home Order from 2019 to 2020. Analysis of the callers primary need indicated NAMI provided resources and referrals to people with unmet basic needs such as housing, food, and access to healthcare during the height of COVID-19 Pandemic in 2020. A series of ANOVAs indicated that individuals from Chicago zip codes with high levels of uninsured rates, poverty rates, households using SNAP benefits, and economic diversity called NAMI significantly more than those with low levels of these health indicators. DISCUSSION/SIGNIFICANCE: Helplines are a much-needed model to assess needs and implement services during public health crises, particularly in communities experiencing economic hardship and stress. Implications for behavioral health service needs both during and following the pandemic will be discussed.
The geology of the Schroeder Hill region near the head of the Shackleton Glacier, central Transantarctic Mountains, consists of Triassic Fremouw Formation and overlying Falla Formation strata intruded by Jurassic Ferrar Dolerite sills. At ‘Alfie’s Elbow', south-east of Schroeder Hill, upper Fremouw strata are overlain by Upper Cenozoic Sirius Group deposits. These upper Fremouw beds differ from all other examined upper Fremouw strata in the Shackleton Glacier region in being carbonaceous. Quartz-pebble conglomerate characterizes the basal Falla beds, emphasizing a change in provenance. Sirius Group beds occur as a stratigraphic succession draped on modern topography and as structureless sand wedged in modern microtopography. Fremouw beds locally are arched with the fold axis approximately parallel to regional normal faulting related to the uplift and formation of the Transantarctic Mountains.
The relationships among depression, personality factors, and cognitive decline in the elderly are complex. Depressed elders score higher in neuroticism than nondepressed older individuals. Presence of neuroticism worsens cognitive decline in depressed older adults. Yet little is known about changes in neuroticism among older adults being treated for depression and the impact of these changes on cognitive decline.
Longitudinal observational study.
Academic Health Center.
We examined 68 participants in the neurobiology of late-life depression (LLD) study to test the hypothesis that older depressed subjects with more improvement in neuroticism would experience less cognitive decline compared with those with less change in neuroticism.
We measured neuroticism using the NEO-Personality Inventory-Revised at baseline and 1 year. Study psychiatrists measured depression using the Montgomery–Åsberg depression rating scale (MADRS). Global cognitive performance was measured using the Consortium to Establish a Registry for Alzheimer’s disease (CERAD) battery at baseline and annually over 3 years. Regression models of 1-year change in neuroticism and 3-year change in CERAD included sex, age, race, education, and 1-year change in MADRS score as covariates.
We found that among older adults, 1-year change in neuroticism was inversely associated with 3-year change in CERAD total score.
Our findings challenge the notion of longitudinal stability of measures of personality, especially among older depressed individuals. They highlight the importance of repeated personality assessment, especially of neuroticism, in the management of LLD. Future studies in larger samples followed for longer periods are needed to confirm our results and to extend them to examine both cognitive change and development of dementia.
Six field experiments were conducted to investigate any interaction between pyroxasulfone and flumioxazin on soybean tolerance and control of multiple-herbicide-resistant (MHR) waterhemp in soybean during 2016 and 2017 in Ontario, Canada. There was a synergistic increase in soybean injury with the co-application of pyroxasulfone and flumioxazin at all rates evaluated at 2 wk after emergence (WAE), the two highest rates evaluated (134/106 and 268/211 g ai ha–1) at 4 WAE, and the highest rate (268/211 g ai ha–1) evaluated at 8 WAE. Soybean injury with all pyroxasulfone and flumioxazin treatments was transient and had no adverse effect on soybean grain yield. Pyroxasulfone applied preemergence at 45, 89, 134, and 268 g ai ha–1 controlled MHR waterhemp up to 72%, 89%, 92%, and 95%, respectively. Flumioxazin applied preemergence at 35, 70, 106, and 211 g ai ha–1 controlled MHR waterhemp up to 78%, 90%, 93%, and 96%, respectively. Pyroxasulfone/flumioxazin applied preemergence at 45/35, 89/70, 134/106, and 268/211 g ai ha–1 controlled MHR waterhemp up to 92%, 96%, 98%, and 100%, respectively. There were no significant antagonistic or synergistic interactions for the control of MHR waterhemp with pyroxasulfone/flumioxazin at rates evaluated except at 268/211 g ai ha–1, which provided a synergistic increase in MHR waterhemp control at 4 WAE. The MHR waterhemp biomass and density reductions followed a trend similar trend to visible control. Pyroxasulfone/flumioxazin at 268/211 g ai ha–1 caused a synergistic response in biomass reduction (9% difference). Based on these results, there is an additive increase in MHR waterhemp control and potential for a synergistic increase in soybean injury with the co-application of pyroxasulfone plus flumioxazin.
The mental health impact of the initial years of military service is an under-researched area. This study is the first to explore mental health trajectories and associated predictors in military members across the first 3–4 years of their career to provide evidence to inform early interventions.
This prospective cohort study surveyed Australian Defence personnel (n = 5329) at four time-points across their early military career. Core outcomes were psychological distress (K10+) and posttraumatic stress symptoms [four-item PTSD Checklist (PCL-4)] with intra-individual, organizational and event-related trajectory predictors. Latent class growth analyses (LCGAs) identified subgroups within the sample that followed similar longitudinal trajectories for these outcomes, while conditional LCGAs examined the variables that influenced patterns of mental health.
Three clear trajectories emerged for psychological distress: resilient (84.0%), worsening (9.6%) and recovery (6.5%). Four trajectories emerged for post-traumatic stress, including resilient (82.5%), recovery (9.6%), worsening (5.8%) and chronic subthreshold (2.3%) trajectories. Across both outcomes, prior trauma exposure alongside modifiable factors, such as maladaptive coping styles, and increased anger and sleep difficulties were associated with the worsening and chronic subthreshold trajectories, whilst members in the resilient trajectories were more likely to be male, report increased social support from family/friends and Australian Defence Force (ADF) sources, and use adaptive coping styles.
The emergence of symptoms of mental health problems occurs early in the military lifecycle for a significant proportion of individuals. Modifiable factors associated with wellbeing identified in this study are ideal targets for intervention, and should be embedded and consolidated throughout the military career.
From 2014 to 2020, we compiled radiocarbon ages from the lower 48 states, creating a database of more than 100,000 archaeological, geological, and paleontological ages that will be freely available to researchers through the Canadian Archaeological Radiocarbon Database. Here, we discuss the process used to compile ages, general characteristics of the database, and lessons learned from this exercise in “big data” compilation.
Two studies were conducted to ascertain the biologically effective dose (BED) of flumioxazin and pyroxasulfone for multiple herbicide–resistant (MHR) waterhemp [Amaranthus tuberculatus (Moq.) Sauer] control in soybean [Glycine max (L.) Merr.] in southwestern Ontario, Canada, during 2016 and 2017. In the flumioxazin study, the predicted flumioxazin doses for 50%, 80%, and 90% MHR A. tuberculatus control were 19, 37, and 59 g ai ha−1 at 2 wk after application (WAA) and 31, 83, and 151 g ai ha−1, respectively, at 12 WAA. The predicted flumioxazin doses to cause 5% and 10% soybean injury were 129 and 404 g ai ha−1, respectively, at 2 wk after emergence (WAE), and the predicted flumioxazin doses to obtain 50%, 80%, and 95% of the weed-free control plot’s yield were determined to be 3, 14, and 65 g ai ha−1, respectively. In the pyroxasulfone study, the predicted pyroxasulfone doses that provided 50%, 80%, and 90% MHR A. tuberculatus visible control were 25, 50, and 88 g ai ha−1 at 2 WAA and 41, 109, and 274 g ai ha−1 at 12 WAA, respectively. The dose of pyroxasulfone predicted for 80% reduction in MHR A. tuberculatus density was 117 g ai ha−1, and the doses of pyroxasulfone predicted for 80% and 90% reduction in A. tuberculatus biomass were 204 and 382 g ai ha−1, respectively. The predicted doses of pyroxasulfone that caused 5% and 10% injury in soybean at 2 WAE were 585 and 698 g ai ha−1, respectively. The predicted doses of pyroxasulfone required to obtain 50%, 80%, and 95% yield relative to the weed-free plots were 6, 24, and 112 g ai ha−1, respectively. Flumioxazin and pyroxasulfone applied preemergence at the appropriate doses provided early-season MHR A. tuberculatus control in soybean.
Shakespeare, the first and still greatest psychologist of the modern (post-Medieval) era, shows us in his plays the psychological evidence leading to and confirming three great discoveries. First, that the moral emotions of shame and guilt, along with the moral value systems they motivate (shame and guilt ethics), although intended to prevent violence, actually stimulate violence, toward others (shame) or the self (guilt). Second: with the scientific revolution, the traditional sources of moral authority (custom and tradition, God and religion, and beliefs consisting of assertions unsubstantiated by evidence) lost their credibility. Thus, Hamlet could find no answer to his question: What should I do? Third, violence can be prevented by replacing the moral emotions of shame and guilt with love, the emotion that transcends morality, making it unnecessary and redundant, and replacing moral value judgments and commandments with psychological understanding and evidence-based knowledge – thus restoring relationships and trust.
In King Lear and Coriolanus Shakespeare shows how parents who shame their children motivate them to commit violence that ultimately consumes the parent and child. To call this a perversion of parental love is virtually an understatement. Lear shames Goneril and Regan by loving Cordelia more than he loves them – so they bring about the deaths of both Lear and Cordelia. And Gloucester shames Edmund, who has his father’s eyes gouged out – an atrocity committed by American murderers we have seen – since people feel shamed in the eyes of others. Coriolanus shows how a mother’s teaching her son to achieve honor through violence ultimately rebounds on her and the very community she meant him to protect.
Both Othello and Macbeth show how men can be shamed by other people into committing murder, and how guilt can motivate self-murder. Othello felt humiliated when Iago deceived him into believing Desdemona had made him into a “cuckold.” When he discovers she has actually been faithful, he feels so guilty he punishes himself by suicide – as many such murderers still do. Iago shames Othello into ruining himself because he felt Othello had shamed him. Lady Macbeth shames Macbeth into murdering Duncan, which finally leads to so many murders that she feels guilty enough to kill herself; and he feels so exhausted he longs for death as the only face-saving way to rest in peace – again, like many murderers we have seen.