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The adolescent brain may be susceptible to the influences of illicit drug use. While compensatory network reorganization is a unique developmental characteristic that may restore several brain disorders, its association with methamphetamine (MA) use-induced damage during adolescence is unclear.
Using independent component (IC) analysis on structural magnetic resonance imaging data, spatially ICs described as morphometric networks were extracted to examine the effects of MA use on gray matter (GM) volumes and network module connectivity in adolescents (51 MA users v. 60 controls) and adults (54 MA users v. 60 controls).
MA use was related to significant GM volume reductions in the default mode, cognitive control, salience, limbic, sensory and visual network modules in adolescents. GM volumes were also reduced in the limbic and visual network modules of the adult MA group as compared to the adult control group. Differential patterns of structural connectivity between the basal ganglia (BG) and network modules were found between the adolescent and adult MA groups. Specifically, adult MA users exhibited significantly reduced connectivity of the BG with the default network modules compared to control adults, while adolescent MA users, despite the greater extent of network GM volume reductions, did not show alterations in network connectivity relative to control adolescents.
Our findings suggest the potential of compensatory network reorganization in adolescent brains in response to MA use. The developmental characteristic to compensate for MA-induced brain damage can be considered as an age-specific therapeutic target for adolescent MA users.
This consensus statement by the Society for Healthcare Epidemiology of America (SHEA) and the Society for Post-Acute and Long-Term Care Medicine (AMDA), the Association for Professionals in Epidemiology and Infection Control (APIC), the HIV Medicine Association (HIVMA), the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP) recommends that coronavirus disease 2019 (COVID-19) vaccination should be a condition of employment for all healthcare personnel in facilities in the United States. Exemptions from this policy apply to those with medical contraindications to all COVID-19 vaccines available in the United States and other exemptions as specified by federal or state law. The consensus statement also supports COVID-19 vaccination of nonemployees functioning at a healthcare facility (eg, students, contract workers, volunteers, etc).
Psychotropics are overprescribed for adults with intellectual disabilities; there are few studies in children and young people.
To investigate antipsychotic and antidepressant prescribing in children and young people with and without intellectual disabilities, and prescribing trends.
Scotland's annual Pupil Census, which identifies pupils with and without intellectual disabilities, was record-linked to the Prescribing Information System. Antidepressant and antipsychotic data were extracted. Logistic regression was used to analyse prescribing between 2010 and 2013.
Of the 704 297 pupils, 16 142 (2.29%) had a record of intellectual disabilities. Antipsychotic and antidepressant use increased over time, and was higher in older pupils; antipsychotic use was higher in boys, and antidepressant use was higher in girls. Overall, antipsychotics were prescribed to 281 (1.74%) pupils with intellectual disabilities and 802 (0.12%) without (adjusted odds ratio 16.85, 95% CI 15.29–18.56). The higher use among those with intellectual disabilities fell each year (adjusted odds ratio 20.19 in 2010 v. 14.24 in 2013). Overall, 191 (1.18%) pupils with intellectual disabilities and 4561 (0.66%) without were prescribed antidepressants (adjusted odds ratio 2.28, 95% CI 2.03–2.56). The difference decreased each year (adjusted odds ratio 3.10 in 2010 v. 2.02 in 2013).
Significantly more pupils with intellectual disabilities are prescribed antipsychotics and antidepressants than are other pupils. Prescribing overall increased over time, but less so for pupils with intellectual disabilities; either they are not receiving the same treatment advances as other pupils, or possible overprescribing in the past is changing. More longitudinal data are required.
Fifteenth-century England was notoriously litigious and recent studies have fruitfully revealed the extent to which women were regularly caught up in legal business. Nevertheless, while we know an increasing amount about women's use of the common law courts, customary courts, the spiritual courts and those petitioning the equitable jurisdictions of chancery and requests in this period, comparatively little has been written about the female litigants who petitioned the prerogative court of Star Chamber. In one sense this is understandable. In the sixteenth and seventeenth centuries this court would attract thousands of litigants, particularly following its development and promotion under Thomas Wolsey (chancellor 1515–29). In the late fifteenth century, however, its activities remained embedded within the king's council; its personnel and processes fluid and not yet fully formalised. There was no separate court of Star Chamber; rather the ‘Star Chamber’ was primarily a location within the palace of Westminster where the king's councillors would conduct their varied business. Nevertheless, because the king's council had the power to hear all sorts of petitions it drew an increasing number of litigants in the late fifteenth century, many of whom believed that redress would come from the council sitting ‘in the sterre chambre’. Consequently, their petitions and the related pleadings and proofs generated a body of material unusually rich in detailing individuals’ interactions with the law. These records have not been entirely neglected and have proved attractive to local and regional historians, as demonstrated by the early twentieth-century flurry of printed transcriptions and abstracts in several county record series. Yet, their potential as sources for broader social, legal or cultural analyses of the early Tudor period has not been fully realised. Furthermore, those that have been published have been consciously or unconsciously biased towards male litigants. Geoffrey Elton's Star Chamber Stories, for example, consisted of six tales, which reflected mid-twentieth-century interests in the religious, economic and educational aspects of life in Tudor England; all the litigants were male, and women rarely featured in the narratives.
This essay will assess more fully the value of these documents for an understanding of female litigation, and the way in which women resorted to Henry VII's council in their attempts to access justice.
This article considers the opportunities available to, and the constraints to be negotiated by, female litigants at the court of Star Chamber during the reigns of the early Tudor kings. Star Chamber was a prerogative court and grew in popularity following the transformation and clarification of its judicial functions under Thomas Wolsey in the early sixteenth century. While it has suffered losses to its records, around five thousand cases still survive from the early Tudor period, including nearly one thousand cases involving female litigants. Unlike those in other Westminster courts, such as Common Pleas, Chancery, or the Court of Requests, Star Chamber cases have yet to be fully examined for what they can tell us about women's access to justice and their experience of legal process. This article begins by surveying the number of cases involving female litigants, showing that far more women came to the court as plaintiffs than as defendants. The numbers were significant—in line with Chancery—but still show women as a minority. Drawing on a wide range of examples, the paper explores the major factors determining, and limiting, women's active roles as litigants, taking into consideration cultural expectations, legal practice (including the operation of coverture), and, where detected, individual decision-making.
Gona in the Afar region of Ethiopia has yielded the earliest Oldowan stone tools in the world. Artefacts from the East Gona (EG) 10 site date back 2.6 million years. Analysis of the lithic assemblage from EG 10 reveals the earliest-known evidence for refitting and conjoining stone artefacts. This new information supplements data from other Oldowan sites in East Africa, and provides an important insight into the technological capacities and evolutionary development of hominins during this period.
In recent years a growing number of studies have explored the legal experiences of fifteenth- and sixteenth-century women. Drawing on a range of court records, reassessments have been made on women's knowledge of the law, their engagement with legal procedure and their agency in initiating petitions. In considering the varying opportunities offered by different jurisdictions, the material generated by the central law courts at Westminster – notably those of King's Bench, Common Pleas and Chancery – has proved particularly fruitful. Less well-explored for this purpose, however, has been the court of Star Chamber, perhaps because it is considered to have the smallest female participation rate. This is unfortunate, because the documentation produced by the court makes for vivid reading and is important not simply for the stories told, but, as Geoffrey Elton pointed out over half a century ago, because the reported voices belong to people ‘who would never ordinarily make the headlines’. The oversight is particularly unhelpful for late medieval Wales where local jurisdiction in the marcher lordships meant its inhabitants were excluded from the central common law courts of King's Bench and Common Pleas. It was the king's claim to offer justice to all his subjects and provide ‘common treatment’, which gave the Welsh access to prerogative courts such as Star Chamber.
Our purpose was to rigorously examine the nature of family meetings as conducted in an inpatient hospice care unit in order to generate an inductive theoretical model.
In this two-phase project, we first interviewed eight members of the interdisciplinary care team who participated in multiple family meetings each week. Interview questions explored why and how they conducted family meetings. Using an observation template created from these interview data, we subsequently conducted ethnographic observations during family meetings. Using the methods of grounded theory, our findings were synthesized into a theoretical model depicting the structure and process of formal family meetings within this setting.
The core of the family meeting was characterized by cognitive and affective elements aimed at supporting the family and facilitating quality care by clarifying the past, easing the present, and protecting the future. This inductive model was subsequently found to be highly aligned with a sense of coherence, an important influence on coping, and adaptation to the stress of a life-limiting illness.
Significance of Results:
Provider communication with family members is particularly critical during advanced illness and end-of-life care. The National Consensus Project clinical practice guidelines for quality palliative care list regular family meetings among the recommended practices for excellent communication during end-of-life care, but do not provide specific guidance on how and when to provide such meetings. Our findings provide a theoretical model that can inform the design of a family meeting to address family members' needs for meaningful and contextualized information, validation of their important contributions to care, and preparation for the patient's death.
The bizarre morphology of living Pycnogonida, known colloquially as sea spiders, has long fueled dissent over their status within the arthropods. Pycnogonids figure prominently in recent analyses of anterior limb homologies and ancestral crown-group euarthropod relationships, with support for the concept of Pycnogonida as sister taxon to Euchelicerata now contested by proponents of a more basal position between Radiodonta and all other arthropods. A challenge to further elucidation of their phylogenetic position is the exceptional rarity and disjunct distribution of pycnogonids in the fossil record, due largely to their fragile unmineralized exoskeletons. New fossil discoveries therefore have the potential to add significantly to knowledge of their evolution, paleoecology, and paleobiogeography. Here we report the first known occurrence of fossil pycnogonids from rocks of Ordovician age, bridging a 65 Myr gap between controversial late Cambrian larval forms and a single documented Silurian specimen. The new taxon, Palaeomarachne granulata n. gen. n. sp., from the Upper Ordovician (ca. 450 Ma) William Lake Konservat-Lagerstätte deposit in Manitoba, Canada, is also the first reported from Laurentia. It is the only record thus far of a fossil sea spider in rocks of demonstrably shallow marine origin. Four incomplete, partially disarticulated molts represent a relatively large, robust animal with a series of five segment-like elements in a ‘head’ region that does not incorporate the first of four preserved limb-bearing trunk segments. This unique pattern may reflect the plesiomorphic condition prior to complete fusion of anterior ‘head’ elements and first trunk segment to form a cephalosoma, as seen in all eupycnogonids. Palaeomarachne granulata is interpreted as occupying a basal stem-group position in the Pycnogonida.
The seventh annual Teaching and Learning Conference (TLC) was held in Philadelphia, Pennsylvania, from February 5 to 7, 2010, with 224 attendees onsite. The theme for the meeting was “Advancing Excellence in Teaching Political Science.” Using the working-group model, the TLC track format encourages in-depth discussion and debate on research dealing with the scholarship of teaching and learning.
To assess feeding practices of infants born to HIV-positive women in Dar es Salaam, Tanzania. These data then served as a proxy to evaluate the adequacy of current infant feeding counselling.
A cross-sectional survey of infant feeding behaviours.
Four clinics in greater Dar es Salaam in early 2008.
A total of 196 HIV-positive mothers of children aged 6–10 months recruited from HIV clinics.
Initiation of breast-feeding was reported by 95·4 % of survey participants. In the entire sample, 80·1 %, 34·2 % and 13·3 % of women reported exclusive breast-feeding (EBF) up to 2, 4 and 6 months, respectively. Median duration of EBF among women who ever breast-fed was 3 (interquartile range (IQR): 2·1, 4·0) months. Most non-breast-milk foods fed to infants were low in nutrient density. Complete cessation of breast-feeding occurred within 14 d of the introduction of non-breast-milk foods among 138 of the 187 children (73·8 %) who had ever received any breast milk. Of the 187 infants in the study who ever received breast milk, 19·4 % received neither human milk nor any replacement milks for 1 week or more (median duration of no milk was 14 (IQR: 7, 152) d).
Infant feeding practices among these HIV-positive mothers resulted in infants receiving far less breast milk and more mixed complementary feeds than recommended, thus placing them at greater risk of both malnutrition and HIV infection. An environment that better enables mothers to follow national guidelines is urgently needed. More intensive infant feeding counselling programmes would very likely increase rates of optimal infant feeding.
It is difficult to overestimate the importance of land to England's elite. It was the basis of wealth and the tangible symbol of social and political dominance. Late medieval nobles held vast estates that stretched over several counties, yet it was the gentry, collectively, who held the larger percentage of property. In the North Riding of Yorkshire, the gentry owned forty-five per cent of the manors, while in Humphrey's county of Cheshire the proportion was especially high: over three-quarters of manors were in gentry hands, and the smaller estate far outnumbered the larger.
It was land that formed the basis of Humphrey's gentility, provided his major source of income and played a pivotal role in his upward social mobility. Like many gentlemen, his total landholdings were confined to the county and were geographically concentrated. While he held a few scattered lands and rents in south and west Cheshire, the main foci were the estates of Newton and Pownall in Macclesfield hundred, lying in the north-east of the county (Map 2). Newton was the ancestral home and the early focus of Humphrey's energies to improve his family's income and status. It remained his main project for eight years until it was superseded by the larger estate of Pownall, which was acquired through marriage and quickly made the permanent family residence. In common with other gentry landlords, Humphrey invested considerable time and effort in the estates both personally and via a team of paid officials.
God would judge the soul, but medieval gentle society would judge by outward appearances. Gentility did not merely reside in the solidity of land and wealth, but in the often intangible qualities of presentation and display. Status was reflected in homes and material possessions, in personal appearance and modes of behaviour. While good birth could not be taken away, claims to gentility had to be continually demonstrated and justified: a gentleman was expected to lead a particular way of life.
The dual purpose of a gentle lifestyle was to convey exclusivity and superiority. Peter Coss has argued that one definition of gentility would be the well-developed sense of social difference between the aristocracy and the rest of the population. The formation of a class-conscious group was reflected in the development of distinctive codes of conduct which were predicated on the view that outward behaviour reflected inner virtues. By the fifteenth century, these codes prioritised the qualities of courtesy, generosity, piety, self-discipline, polite conversation, knowledge and wisdom, and were expressed through activities such as service and patronage. Reputation and display were central to the gentle identity. Many of the signs and gestures involved in these actions will not have troubled the historical record. The visual impact of a house or hairstyle, or the reception of a nod or comment, are rarely found. More readily available are the written works that might have informed decisions and set the rules of appropriate behaviour.
Humphrey was not only a reader but a writer, and a confident one at that. There can have been few aspects of his life that did not involve making a written record. As previous chapters have revealed, Humphrey placed a great deal of trust in written documents, while recognising the issues of forgery and mistakes. Debt repayments, the selling of sheep, a new medical recipe or a snippet of local history were all reasons to take up the pen and make a note. While this was not a rare action in late medieval society, it was far from common among the general population. Humphrey had grown up at a time when writing was still considered a specialised skill, usually taught separately from reading. Not everyone would have bothered or needed to write on a daily basis. It was hardly necessary to the labourer in the field, and the nobility could pay to have the onerous task executed for them. The use of secretaries was widespread among the landed classes, letters were dictated, and oral testimony still valued.
Nevertheless, a growing need to write can be found among tradespeople, in the expanding bureaucracies of England, and within the houses of the gentry. Alison Truelove's work points to the increasing likelihood of gentlemen writing their own letters in the fifteenth century. How many of the gentry could or chose to write is difficult to gauge, and it is impossible to generalise on the degrees of competence or the regularity with which the skill was used.