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Multiple sclerosis (MS) is a debilitating neurological disease associated with a variety of psychological, cognitive, and motoric symptoms. Walking is among the most important functions compromised by MS. Dual-task walking (DTW), an everyday activity in which people walk and engage in a concurrent, discrete task, has been assessed in MS, but little is known about how it relates to other MS symptoms. Self-awareness theory suggests that DTW may be a function of the interactions among psychological, cognitive, and motor processes.
Cognitive testing, self-report assessments for depression and falls self-efficacy (FSE), and walk evaluations [DTW and single-task walk (STW)] were assessed in seventy-three people with MS in a clinical care setting. Specifically, we assessed whether psychological factors (depression and FSE) that alter subjective evaluations regarding one’s abilities would moderate the relationships between physical and cognitive abilities and DTW performance.
DTW speed is related to diverse physical and cognitive predictors. In support of self-awareness theory, FSE moderated the relationship between STW and DTW speeds such that lower FSE attenuated the strength of the relationship between them. DTW costs – the change in speed normalized by STW speed – did not relate to cognitive and motor predictors. DTW costs did relate to depressive symptoms, and depressive symptoms moderated the effect of information processing on DTW costs.
Findings indicate that an interplay of physical ability and psychological factors – like depression and FSE – may enhance understanding of walking performance under complex, real-world, DTW contexts.
Violence, both physical and nonphysical, is central to any society, but it is a version of the problem that it claims to solve. This Element examines how states in ancient East Asia, from the late Shang through the end of the Han dynasty, wielded violence to create and display authority, and also how their licit violence was entangled in the 'savage' or 'criminal' violence whose suppression justified their power. The East Asian cases are supplemented through citing comparable Western ones. The themes examined include the emergence of the warrior as a human type, the overlap of hunts and combat (and the overlap between treatments of alien species and alien peoples), sacrifice of both alien captives and 'death attendants' from one's own groups, the impact of military specialization and the increased scale of armies, the emergent ideal of self-sacrifice, and the diverse aspects of violence in the regime of law.
Gatherings where people are eating and drinking can increase the risk of getting and spreading SARS-CoV-2 among people who are not fully vaccinated; prevention strategies like wearing masks and physical distancing continue to be important for some groups. We conducted an online survey to characterise fall/winter 2020–2021 holiday gatherings, decisions to attend and prevention strategies employed during and before gatherings. We determined associations between practicing prevention strategies, demographics and COVID-19 experience. Among 502 respondents, one-third attended in person holiday gatherings; 73% wore masks and 84% practiced physical distancing, but less did so always (29% and 23%, respectively). Younger adults were 44% more likely to attend gatherings than adults ≥35 years. Younger adults (adjusted prevalence ratio (aPR) 1.53, 95% CI 1.19–1.97), persons who did not experience COVID-19 themselves or have relatives/close friends experience severe COVID-19 (aPR 1.56, 95% CI 1.18–2.07), and non-Hispanic White persons (aPR 1.57, 95% CI 1.13–2.18) were more likely to not always wear masks in public during the 2 weeks before gatherings. Public health messaging emphasizing consistent application of COVID-19 prevention strategies is important to slow the spread of COVID-19.
Monoclonal antibody therapeutics to treat coronavirus disease (COVID-19) have been authorized by the US Food and Drug Administration under Emergency Use Authorization (EUA). Many barriers exist when deploying a novel therapeutic during an ongoing pandemic, and it is critical to assess the needs of incorporating monoclonal antibody infusions into pandemic response activities. We examined the monoclonal antibody infusion site process during the COVID-19 pandemic and conducted a descriptive analysis using data from 3 sites at medical centers in the United States supported by the National Disaster Medical System. Monoclonal antibody implementation success factors included engagement with local medical providers, therapy batch preparation, placing the infusion center in proximity to emergency services, and creating procedures resilient to EUA changes. Infusion process challenges included confirming patient severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity, strained staff, scheduling, and pharmacy coordination. Infusion sites are effective when integrated into pre-existing pandemic response ecosystems and can be implemented with limited staff and physical resources.
Patients with functional neurological disorders (FND) often present with multiple motor, sensory, psychological and cognitive symptoms. In order to explore the relationship between these common symptoms, we performed a detailed clinical assessment of motor, non-motor symptoms, health-related quality of life (HRQoL) and disability in a large cohort of patients with motor FND. To understand the clinical heterogeneity, cluster analysis was used to search for subgroups within the cohort.
One hundred fifty-two patients with a clinically established diagnosis of motor FND were assessed for motor symptom severity using the Simplified Functional Movement Disorder Rating Scale (S-FMDRS), the number of different motor phenotypes (i.e. tremor, dystonia, gait disorder, myoclonus, and weakness), gait severity and postural instability. All patients then evaluated each motor symptom type severity on a Likert scale and completed questionnaires for depression, anxiety, pain, fatigue, cognitive complaints and HRQoL.
Significant correlations were found among the self-reported and all objective motor symptoms severity measures. All self-reported measures including HRQoL correlated strongly with each other. S-FMDRS weakly correlated with HRQoL. Hierarchical cluster analysis supplemented with gap statistics revealed a homogenous patient sample which could not be separated into subgroups.
We interpret the lack of evidence of clusters along with a high degree of correlation between all self-reported and objective measures of motor or non-motor symptoms and HRQoL within current neurobiological models as evidence to support a unified pathophysiology of ‘functional’ symptoms. Our results support the unification of functional and somatic syndromes in classification schemes and for future mechanistic and therapeutic research.
I have been asked to write an afterword to a collection of outstanding scholarly essays, which taken together, make up the most important volume in English which is dedicated entirely to the Contra Celsum of Origen. This is the longest work of the foremost Christian thinker before Nicaea which survives entirely in Greek; it has a claim to be either the greatest exercise in ante-Nicene apologetic or else the first experiment in a new genre. It is of all the more interest, to classicists and historians a well as to theologians, because it reproduces copious extracts from the text that it is rebutting, thus providing our most substantial specimen of pagan invective against Christianity before Constantine. The difficulties of reconstructing this work, its value as a document of late pagan religiosity, its status as a philosophical text and the identity of the Jew whom it employs as a mouthpiece are all examined in the present book by scholars more qualified to speak on these matters than I am; by contrast there is not so much (though what there is is excellent) on Origen’s response. I propose in this afterword, not indeed to undertake anything close to a full discussion of Origen’s work’s probable goals and the innovative features of the treatise, but to bring out its peculiar character, first by surveying the intellectual milieu in which both Christian apologetic and the polemic of Celsus were born, and then by showing how Origen turned his own book into a deeper meditation on the conflict between the Gospel and Greek culture. In the course of my argument I shall have occasion to comment on other contributions, never in a spirit of contention but always with the aim of amplifying rather than contradicting that which has already been well said.
The aim of this learned and enterprising book is to elucidate the structure and intention of Clement's Stromateis by comparing it with pagan texts from the first and second centuries of our era which belong, as we might now say, to the same genre. This term, which is chaperoned by quotation marks on p. 15, has proved itself heuristically indispensable, but has no closer equivalent in ancient Greek than genos, which is as likely to denote the style or metre of a work as its place in a critical taxonomy. Strict conventions governed versification and the composition of speeches for given occasions, but it is we who have all but invented the epyllion and coined our own names for the novel, the autobiography and the didactic poem. While Heath proposes on p. 138 to render Stromateis as ‘layout’, ‘miscellany’ is the term that is now most commonly applied to this and other ancient texts whose amorphous character seems to resist taxonomy. As Heath observes, however (p. 24), there are all too many specimens of Greek and Latin writing which are in some sense miscellaneous: she might have quoted the thesis of her namesake, Malcolm Heath, that abrupt transitions, divagations and surprises were not aberrations from the classical norm, but calculated devices to heighten the pleasure or whet the interest of the reader, both in poetry and in prose. The culture of ubiquitous imitation was also a culture of unceasing improvisation, and both practices are amply illustrated in Heath's comparison of the Stromateis with four books from the second century to which it bears an obvious resemblance: the Natural history of Pliny the Elder, the Convivial questions of Plutarch, the Attic nights of Aulus Gellius and the Deipnosophistae of Athenaeus.
Reflex-mediated syncope occurs in 15% of children and young adults. In rare instances, pacemakers are required to treat syncopal episodes associated with transient sinus pauses or atrioventricular block. This study describes a single centre experience in the use of permanent pacemakers to treat syncope in children and young adults.
Materials and methods:
Patients with significant pre-syncope or syncope and pacemaker implantation from 1978 to 2018 were reviewed. Data collected included the age of presentation, method of diagnosis, underlying rhythm disturbance, age at implant, type of pacemaker implanted, procedural complications and subsequent symptoms.
Fifty patients were identified. Median age at time of the first syncopal episode was 10.2 (range 0.3–20.4) years, with a median implant age of 14.9 (0.9–34.3) years. Significant sinus bradycardia/pauses were the predominant reason for pacemaker implant (54%), followed by high-grade atrioventricular block (30%). Four (8%) patients had both sinus pauses and atrioventricular block documented. The majority of patients had dual-chamber pacemakers implanted (58%), followed by ventricular pacemakers (38%). Median follow-up was 6.7 (0.4–33.0) years. Post-implant, 4 (8%) patients continued to have syncope, 7 (14%) had complete resolution of their symptoms, and the remaining reported a decrease in their pre-syncopal episodes and no further syncope. Twelve (24%) patients had complications, including two infections and eight lead malfunctions.
Paediatric patients with reflex-mediated syncope can be treated with pacing. Complication rates are high (24%); as such, permanent pacemakers should be reserved only for those in whom asystole from sinus pauses or atrioventricular block has been well documented.
Books 8–10 of The City of God complete the polemical interrogation of pagan culture. As Augustine says, the last five of these ten are addressed to the philosophers whose connivance with the blasphemies of the civic cult exposes the insufficiency of reason as a means to the knowledge of God and the perfection of moral character. In the three books discussed here, his interlocutors are the Platonists Apuleius and Porphyry, one the foremost African man of letters before Augustine himself, the other a trenchant critic of the scriptures who had derided Christianity as the superstitious worship of a dead man. Augustine’s case against both is that, notwithstanding their adherence to a school which had come close to Christianity in its consciousness of the unity and sovereignty of God, they had returned to the most demotic form of polytheism, making human access to the gods depend on a race of aerial spirits who are inferior in piety and benevolence to the best denizens of earth. Augustine’s aim is to show that their speculations are inconsistent not only with scriptural teaching on the origin of demons, but with the genuine traditions of Platonism, the confession of the ancient prophet Hermes Trismegistus and Porphyry’s own intimations of the true nature of God.
The growing unmet demand for suitable organ donors increases each year. Despite relative contraindications for thoracic organ donation after previous cardiac surgery, experienced programmes and surgeons can successfully utilise the lungs from select donors who have undergone prior cardiac surgery. This is the first reported case of double lung en bloc procurement from a donor who had a previous arterial switch operation as an infant.
The Subglacial Antarctic Lakes Scientific Access (SALSA) Project accessed Mercer Subglacial Lake using environmentally clean hot-water drilling to examine interactions among ice, water, sediment, rock, microbes and carbon reservoirs within the lake water column and underlying sediments. A ~0.4 m diameter borehole was melted through 1087 m of ice and maintained over ~10 days, allowing observation of ice properties and collection of water and sediment with various tools. Over this period, SALSA collected: 60 L of lake water and 10 L of deep borehole water; microbes >0.2 μm in diameter from in situ filtration of ~100 L of lake water; 10 multicores 0.32–0.49 m long; 1.0 and 1.76 m long gravity cores; three conductivity–temperature–depth profiles of borehole and lake water; five discrete depth current meter measurements in the lake and images of ice, the lake water–ice interface and lake sediments. Temperature and conductivity data showed the hydrodynamic character of water mixing between the borehole and lake after entry. Models simulating melting of the ~6 m thick basal accreted ice layer imply that debris fall-out through the ~15 m water column to the lake sediments from borehole melting had little effect on the stratigraphy of surficial sediment cores.
This chapter discusses the evidence for the existence of creeds before Nicaea and the purpose for which they might have been employed. The rival accounts of the origin of the Nicene formula are compared, together with the variants in the wording and the different accounts of its origin. The biblical texts that lie behind each verse of the creed are examined, and Beatrice’s argument for a pagan origin of the term homoousios is weighed against other theories. The anathemas require particular study, since the anathema on the term ktiston (“created”) is not preserved in all sources, but is crucial to the argumentation of Athanasius, who claims that it has the authority of Eusebius. The chapter then asks how the Nicene Creed was regarded after the end of the council, and whether subsequent creedal formulations were meant to reinforce or supersede it, and how it attained the form that is now regularly employed in churches.
In recent years, a variety of efforts have been made in political science to enable, encourage, or require scholars to be more open and explicit about the bases of their empirical claims and, in turn, make those claims more readily evaluable by others. While qualitative scholars have long taken an interest in making their research open, reflexive, and systematic, the recent push for overarching transparency norms and requirements has provoked serious concern within qualitative research communities and raised fundamental questions about the meaning, value, costs, and intellectual relevance of transparency for qualitative inquiry. In this Perspectives Reflection, we crystallize the central findings of a three-year deliberative process—the Qualitative Transparency Deliberations (QTD)—involving hundreds of political scientists in a broad discussion of these issues. Following an overview of the process and the key insights that emerged, we present summaries of the QTD Working Groups’ final reports. Drawing on a series of public, online conversations that unfolded at www.qualtd.net, the reports unpack transparency’s promise, practicalities, risks, and limitations in relation to different qualitative methodologies, forms of evidence, and research contexts. Taken as a whole, these reports—the full versions of which can be found in the Supplementary Materials—offer practical guidance to scholars designing and implementing qualitative research, and to editors, reviewers, and funders seeking to develop criteria of evaluation that are appropriate—as understood by relevant research communities—to the forms of inquiry being assessed. We dedicate this Reflection to the memory of our coauthor and QTD working group leader Kendra Koivu.1
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
We summarize some of the past year's most important findings within climate change-related research. New research has improved our understanding of Earth's sensitivity to carbon dioxide, finds that permafrost thaw could release more carbon emissions than expected and that the uptake of carbon in tropical ecosystems is weakening. Adverse impacts on human society include increasing water shortages and impacts on mental health. Options for solutions emerge from rethinking economic models, rights-based litigation, strengthened governance systems and a new social contract. The disruption caused by COVID-19 could be seized as an opportunity for positive change, directing economic stimulus towards sustainable investments.
A synthesis is made of ten fields within climate science where there have been significant advances since mid-2019, through an expert elicitation process with broad disciplinary scope. Findings include: (1) a better understanding of equilibrium climate sensitivity; (2) abrupt thaw as an accelerator of carbon release from permafrost; (3) changes to global and regional land carbon sinks; (4) impacts of climate change on water crises, including equity perspectives; (5) adverse effects on mental health from climate change; (6) immediate effects on climate of the COVID-19 pandemic and requirements for recovery packages to deliver on the Paris Agreement; (7) suggested long-term changes to governance and a social contract to address climate change, learning from the current pandemic, (8) updated positive cost–benefit ratio and new perspectives on the potential for green growth in the short- and long-term perspective; (9) urban electrification as a strategy to move towards low-carbon energy systems and (10) rights-based litigation as an increasingly important method to address climate change, with recent clarifications on the legal standing and representation of future generations.
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Stronger permafrost thaw, COVID-19 effects and growing mental health impacts among highlights of latest climate science.
Early Christians were certainly inclined to look upon Plato as an ally. The first part of this chapter considers how far Eusebius and other apologists succeeded in making out the case that the Bible and Plato proclaim the same God. In the second part it proposes that the Johannine concept of the Logos was at once more foreign to Plato and more palatable to certain of his followers than Augustine supposed it to be. It concludes by examining two indictments of the hermeneutic method of the Fathers – first, that they co-opted the Platonic device of allegoresis to overwrite the plain sense of the scriptures, and secondly that under Platonic influence they surrendered faith to philosophy in their mystical readings of the Song of Songs.
This chapter examines further changes in elite honor and shame in the Eastern Han. First, it traces the elevation of writing, earlier treated as consolation for a failed political career or entertainment that demeaned the author. During the late Western and Eastern Han, several writers invoked the ideal of the hermit to justify a life of retirement devoted to study and writing. Historical figures such as Confucius or the Duke of Zhou were portrayed as writers, as were the hidden sages of the Zhuangzi. This facilitated new genres—funeral inscription, critical essay, and shorter verse forms for self-expression—where the late Han sought honor through writing. Second, it examines the emergence in the late Han of “factions (dang ?)” defined in part through the practice of “pure discussion (qing yi ??).” These groups, like the newly celebrated writers, cited the ideal of “social eremitism” to justify refusing government offices. They criticized eunuchs and imperial affines, as well as leading officials and scholars who still served the state.