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This Element examines the many facets of ethical realism and the issues at stake in metaethical debates about it—both between realism and non-realist alternatives, and between different versions of realism itself. Starting with a minimal core characterization of ethical realism focused on claims about meaning and truth, we go on to develop a narrower and more theoretically useful conception by adding further claims about objectivity and ontological commitment. Yet even this common understanding of ethical realism captures a surprisingly heterogeneous range of views. In fact, a strong case can be made for adding several more conditions in order to arrive at a proper paradigm of realism about ethics when understood in a non-deflationary way. We then develop this more robust realism, bringing out its distinctive take on ethical objectivity and normative authority, its unique ontological commitments, and both the support for it and some challenges it faces.
Seed retention, and ultimately seed shatter, are extremely important for the efficacy of harvest weed seed control (HWSC) and likely influenced by various agro-ecological and environmental factors. Field studies investigated seed shattering phenology of 22 weed species across three soybean [Glycine max (L.) Merr.] producing regions in the US. We further evaluated the potential drivers of seed shatter in terms of weather conditions, growing degree days, and plant biomass. Based on the results, weather conditions had no consistent impact on weed seed shatter. However, there was a positive correlation between individual weed plant biomass and delayed weed-seed shattering rates during harvest. This work demonstrates that HWSC can potentially reduce weed seedbank inputs of plants that have escaped early season management practices and retained seed through harvest. However, smaller individuals of plants within the same population that shatter seed before harvest pose a risk of escaping early season management and HWSC.
Harms brought about through negligence are typically morally blameworthy despite being unintended and often unforeseen. How is this best understood? A natural approach parallels a common approach to blameworthiness for unwitting wrongdoing, i.e., acts performed in ignorance of their wrongness: blameworthiness for the act or harm in question is taken to be derivative from more straightforward blameworthiness for relevant earlier failures. I have argued elsewhere for a derivative blameworthiness approach to unwitting wrongdoing that appeals to reasonable expectations about available steps the agent could have taken to avoid or remedy the ignorance in question; and contra Gideon Rosen and Neil Levy, such claims about reasonable expectations do not depend on there being episodes of clear-eyed akrasia in the agent’s past management of her beliefs, so that the account allows for blame in a much wider range of cases. My aim here is to extend this approach to a variety of forms of negligence, defending a similarly broad reasonable expectations version of a derivative blameworthiness view. In particular, I will distinguish and explore cases involving (i) self-conscious negligence, (ii) negligence involving false beliefs about relevant norms of due care, (iii) thoughtless negligence, and (iv) harms due to pure forgetting – though I will argue that the latter often turn out not to be cases of negligence at all, at least for purposes of moral blame.
To assess the effect of individual compared to clinic-level feedback on guideline-concordant care for 3 acute respiratory tract infections (ARTIs) among family medicine clinicians caring for pediatric patients.
Cluster randomized controlled trial with a 22-month baseline, 26-month intervention period, and 12-month postintervention period.
Setting and participants:
In total, 26 family medicine practices (39 clinics) caring for pediatric patients in Virginia, North Carolina, and South Carolina were selected based upon performance on guideline-concordance for 3 ARTIs, stratified by practice size. These were randomly allocated to a control group (17 clinics in 13 practices) or to an intervention group (22 clinics in 13 practices).
All clinicians received an education session and baseline then monthly clinic-level rates for guideline-concordant antibiotic prescribing for ARTIs: upper respiratory tract infection (URI), acute bacterial sinusitis (ABS), and acute otitis media (AOM). For the intervention group only, individual clinician performance was provided.
Both intervention and control groups demonstrated improvement from baseline, but the intervention group had significantly greater improvement compared with the control group: URI (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.37–1.92; P < 0.01); ABS (OR, 1.45; 95% CI, 1.11–1.88; P < 0.01); and AOM (OR, 1.59; 95% CI, 1.24–2.03; P < 0.01). The intervention group also showed significantly greater reduction in broad-spectrum antibiotic prescribing percentage (BSAP%): odds ratio 0.80, 95% CI 0.74-0.87, P < 0.01. During the postintervention year, gains were maintained in the intervention group for each ARTI and for URI and AOM in the control group.
Monthly individual peer feedback is superior to clinic-level only feedback in family medicine clinics for 3 pediatric ARTIs and for BSAP% reduction.
ClinicalTrials.gov identifier: NCT04588376, Improving Antibiotic Prescribing for Pediatric Respiratory Infection by Family Physicians with Peer Comparison.
Intraventricular lesions are challenging pathologies in neurosurgery. Walter Dandy had a major impact in advancing our understanding of the management of these lesions. Furthermore, the introduction of the microscope and microsurgical techniques have improved the surgical outcomes of these lesions. Several approaches have been described to address ventricular lesions, and can be classified anatomically as anterior, lateral, or posterior. The operative corridor for each of these approaches transgresses unaffected neural tissues. Therefore, tailoring the approach to individual patient lesion characteristics and anatomy is crucial to maximize exposure and minimize morbidity. The majority of open and endoscopic approaches to the third ventricle use the interhemispheric anterior transcallosal, frontal transsulcal, or frontal transcortical corridor to access the lateral ventricle. Once inside the lateral ventricle, the operative corridors to the third ventricle include working through the foramen of Monroe (transforaminal approach) for small lesions located in the anterior superior part of the third ventricle, or through the choroidal fissure (transchoroidal or subchoroidal) which provide access to lesions located in, or extending into, the middle or posterior parts of the roof of the third ventricle. In this chapter, we will discuss the transchoroidal, subchoroidal, and combined transchoroidal and subchoroidal approaches to the third ventricle.
Necrotising enterocolitis (NEC) is a devastating gastrointestinal disease of prematurity that typically develops after the administration of infant formula, suggesting a link between nutritional components and disease development. One of the most significant complications that develops in patients with NEC is severe lung injury. We have previously shown that the administration of a nutritional formula that is enriched in pre-digested Triacylglyceride that do not require lipase action can significantly reduce the severity of NEC in a mouse model. We now hypothesise that this ‘pre-digested fat (PDF) system’ may reduce NEC-associated lung injury. In support of this hypothesis, we now show that rearing newborn mice on a nutritional formula based on the ‘PDF system’ promotes lung development, as evidenced by increased tight junctions and surfactant protein expression. Mice that were administered this ‘PDF system’ were significantly less vulnerable to the development of NEC-induced lung inflammation, and the administration of the ‘PDF system’ conferred lung protection. In seeking to define the mechanisms involved, the administration of the ‘PDF system’ significantly enhanced lung maturation and reduced the production of reactive oxygen species (ROS). These findings suggest that the PDF system protects the development of NEC-induced lung injury through effects on lung maturation and reduced ROS in the lung and also increases lung maturation in non-NEC mice.
Iron deficiency is associated with worse outcomes in children and adults with systolic heart failure. While oral iron replacement has been shown to be ineffective in adults with heart failure, its efficacy in children with heart failure is unknown. We hypothesised that oral iron would be ineffective in replenishing iron stores in ≥50% of children with heart failure.
We performed a single-centre retrospective cohort study of patients aged ≤21 years with systolic heart failure and iron deficiency who received oral iron between 01/2013 and 04/2019. Iron deficiency was defined as ≥2 of the following: serum iron <50 mcg/dL, serum ferritin <20 ng/mL, transferrin >300 ng/mL, transferrin saturation <15%. Iron studies and haematologic indices pre- and post-iron therapy were compared using paired-samples Wilcoxon test.
Fifty-one children with systolic heart failure and iron deficiency (median age 11 years, 49% female) met inclusion criteria. Heart failure aetiologies included cardiomyopathy (51%), congenital heart disease (37%), and history of heart transplantation with graft dysfunction (12%). Median dose of oral iron therapy was 2.9 mg/kg/day of elemental iron, prescribed for a median duration of 96 days. Follow-up iron testing was available for 20 patients, of whom 55% (11/20) remained iron deficient despite oral iron therapy.
This is the first report on the efficacy of oral iron therapy in children with heart failure. Over half of the children with heart failure did not respond to oral iron and remained iron deficient.
In US government courses, simulations have been shown to increase students’ engagement and knowledge retention. We present an original simulation that focuses on both the interactions between political institutions that contribute to policy making and the normative ideas underlying politics. By exploring a civil rights or liberties policy area, students learn about the importance of both political institutions and foundational political ideas such as liberty and equality. Students role-play members of Congress, lobbyists for a pro- or anti-natural gas pipeline group, and Supreme Court justices. Although the goal of simulations in many US government courses is to teach students about the ways that institutions shape policy, this is the first (to our knowledge) that also integrates normative reflection on the ideas behind political arguments. Assessment indicates that the simulation was effective in increasing students’ knowledge of and/or interest in American political institutions and eminent domain.
Reintroductions are challenging, and success rates are low despite extensive planning and considerable investment of resources. Improving predictive models for reintroduction planning is critical for achieving successful outcomes. The IUCN Guidelines for Reintroductions and Other Conservation Translocations recommend that habitat suitability assessments account for abiotic and biotic factors specific to the species to be reintroduced and, where needed, include habitat quality variables. However, habitat assessments are often based on remotely-sensed or existing geographical data that do not always reliably represent habitat quality variables. We tested the contribution of ground-based habitat quality metrics to habitat suitability models using a case study of the swift fox Vulpes velox, a mesocarnivore species for which a reintroduction is planned. Field surveys for habitat quality included collection of data on the main threat to the swift fox (the coyote Canis latrans), and for swift fox prey species. Our findings demonstrated that the inclusion of habitat quality variables derived from field surveys yielded better fitted models and a 16% increase in estimates of suitable habitat. Models including field survey data and models based only on interpolated geographical and remotely-sensed data had little overlap (38%), demonstrating the significant impact that different models can have in determining appropriate locations for a reintroduction. We advocate that ground-based habitat metrics be included in habitat suitability assessments for reintroductions of mesocarnivores.
To estimate population-based rates and to describe clinical characteristics of hospital-acquired (HA) influenza.
US Influenza Hospitalization Surveillance Network (FluSurv-NET) during 2011–2012 through 2018–2019 seasons.
Patients were identified through provider-initiated or facility-based testing. HA influenza was defined as a positive influenza test date and respiratory symptom onset >3 days after admission. Patients with positive test date >3 days after admission but missing respiratory symptom onset date were classified as possible HA influenza.
Among 94,158 influenza-associated hospitalizations, 353 (0.4%) had HA influenza. The overall adjusted rate of HA influenza was 0.4 per 100,000 persons. Among HA influenza cases, 50.7% were 65 years of age or older, and 52.0% of children and 95.7% of adults had underlying conditions; 44.9% overall had received influenza vaccine prior to hospitalization. Overall, 34.5% of HA cases received ICU care during hospitalization, 19.8% required mechanical ventilation, and 6.7% died. After including possible HA cases, prevalence among all influenza-associated hospitalizations increased to 1.3% and the adjusted rate increased to 1.5 per 100,000 persons.
Over 8 seasons, rates of HA influenza were low but were likely underestimated because testing was not systematic. A high proportion of patients with HA influenza were unvaccinated and had severe outcomes. Annual influenza vaccination and implementation of robust hospital infection control measures may help to prevent HA influenza and its impacts on patient outcomes and the healthcare system.
To identify the impact of universal masking on COVID-19 incidence and putative SARS-CoV-2 transmissions events among children’s hospital healthcare workers (HCWs).
Single academic free-standing children’s hospital.
We performed whole-genome sequencing of SARS-CoV-2- PCR-positive samples collected from HCWs 3 weeks before and 6 weeks after implementing a universal masking policy. Phylogenetic analyses were performed to identify clusters of clonally related SARS-CoV-2 indicative of putative transmission events. We measured COVID-19 incidence, SARS-CoV-2 test positivity rates, and frequency of putative transmission events before and after the masking policy was implemented.
HCW COVID-19 incidence and test positivity declined from 14.3 to 4.3 cases per week, and from 18.4% to 9.0%, respectively. Putative transmission events were only identified prior to universal masking.
A universal masking policy was associated with reductions in HCW COVID-19 infections and occupational acquisition of SARS-CoV-2.
Measurement burst designs, in which assessments of a set of constructs are made at two or more times in quick succession (e.g., within days), can be used as a novel method to improve the stability of basic measures typically used in longitudinal peer research. In this Element, we hypothesized that the stabilities for adolescent-reported peer acceptance, anxiety, and self-concept would be stronger when using the measurement burst approach versus the single time observation. Participants included youth between 10 and 13 years old who completed (a) sociometric assessments of acceptance, and measures of (b) social and test anxiety, and (c) self-concept across three times with two assessments made at each burst. Findings broadly showed that the stabilities were significantly stronger with the measurement burst when compared to the single time assessment, supporting our main hypothesis. We discuss the utility of the measurement burst in a broader context and considerations for researchers.
Arumberia is an enigmatic sedimentary surface texture that consists of parallel, sub-parallel or radiating ridges and grooves, most commonly reported from upper Neoproterozoic – lower Palaeozoic strata. It has variably been interpreted as the impression of a small metazoan, a ‘vendobiont’, a physical sedimentary structure formed on a substrate with or without a microbial mat covering, or a non-actualistic microbial community. In this paper we contribute new insights into the origin of Arumberia, resulting from the discovery of the largest contiguous bedding plane occurrence of the texture reported to date: a 300 m2 surface in the lower Cambrian Port Lazo Formation of Brittany, NW France. We compare the characteristic features of Arumberia at this locality with 38 other global records, revealing four defining characteristics: (1) the three-dimensional (3D) morphology of exposed Arumberia lines (either positive relief ‘ridges’ or negative relief ‘grooves’) records fully preserved cords within clay laminae; (2) lines may transition laterally into reticulated patterns; (3) characteristic parallel and sub-parallel Arumberia lines can become modified by desiccation on emergent substrates prior to interment; and (4) Arumberia are streamlined with palaeoflow in successions showing evidence of unidirectional currents, but are organized parallel to ripple crests where strata were sculpted by oscillatory flows. These characteristics indicate that Arumberia records a 3D entity, distinct in material properties from its host sediment, which occurred in very shallow water settings where it was prone to passive reorganization in moving water, and desiccation when water drained. A literature survey of all known Arumberia occurrences reveals that the most reliable examples of the form are stratigraphically restricted to a 40 Ma interval straddling the Ediacaran–Cambrian boundary (560–520 Ma). Together these characteristics suggest that Arumberia records the remains of extinct, sessile filamentous organisms (microbial or algal?) that occupied very shallow water and emergent environments across the globe at the dawn of the Phanerozoic Eon.
We consider a uniform ellipsoid of potential vorticity (PV), where we exploit analytical solutions derived for a balanced model at the second order in the Rossby number, the next order to quasi-geostrophic (QG) theory, the so-called QG+1 model. We consider this vortex in the presence of an external background shear flow, acting as a proxy for the effect of external vortices. For the QG model the system depends on four parameters, the height-to-width aspect ratio of the vortex, $h/r$, as well as three parameters characterising the background flow, the strain rate, $\gamma$, the ratio of the background rotation rate to the strain, $\beta$, and the angle from which the flow is applied, $\theta$. However, the QG+1 model also depends on the PV, as well as the Prandtl ratio, $f/N$ ($f$ and $N$ are the Coriolis and buoyancy frequencies, respectively). For QG and QG+1 we determine equilibria for different values of the background flow parameters for increasing values of the imposed strain rate up to the critical strain rate, $\gamma _c$, beyond which equilibria do not exist. We also compute the linear stability of this vortex to second-order modes, determining the marginal strain $\gamma _m$ at which ellipsoidal instability erupts. The results show that for QG+1 the most resilient cyclonic ellipsoids are slightly prolate, while anticyclonic ellipsoids tend to be more oblate. The highest values of $\gamma _m$ occur as $\beta \to 1$. For large values of $f/N$, changes in the marginal strain rates occur, stabilising anticyclonic ellipsoids while destabilising cyclonic ellipsoids.