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To understand healthcare workers’ (HCWs) beliefs and practices toward blood culture (BCx) use.
Design:
Cross-sectional electronic survey and semi-structured interviews.
Setting:
Academic hospitals in the United States.
Participants:
HCWs involved in BCx ordering and collection in adult intensive care units (ICU) and wards.
Methods:
We administered an anonymous electronic survey to HCWs and conducted semi-structured interviews with unit staff and quality improvement (QI) leaders in these institutions to understand their perspectives regarding BCx stewardship between February and November 2023.
Results:
Of 314 HCWs who responded to the survey, most (67.4%) were physicians and were involved in BCx ordering (82.3%). Most survey respondents reported that clinicians had a low threshold to culture patients for fever (84.4%) and agreed they could safely reduce the number of BCx obtained in their units (65%). However, only half of them believed BCx was overused. Although most made BCx decisions as a team (74.1%), a minority reported these team discussions occurred daily (42.4%). A third of respondents reported not usually collecting the correct volume per BCx bottle, half were unaware of the improved sensitivity of 2 BCx sets, and most were unsure of the nationally recommended BCx contamination threshold (87.5%). Knowledge regarding the utility of BCx for common infections was limited.
Conclusions:
HCWs’ understanding of best collection practices and yield of BCx was limited.
How much continuity was there in the allusive practices of the ancient world? This chapter explores this question here by considering the early Greek precedent for the so-called ‘Alexandrian footnote’, a device often regarded as one of the most learned and bookish in a Roman poet’s allusive arsenal. Ever since Stephen Hinds opened his foundational Allusion and Intertext with this device, it has been considered the preserve of Hellenistic and Roman scholar-poets. This chapter, however, argues that we should back-date the phenomenon all the way to the archaic age. By considering a range of illustrative examples from epic (Iliad, Odyssey, Hesiod), lyric (Sappho, Pindar, Simonides), and tragedy (Sophocles, Euripides, Theodectes), it demonstrates that the ‘Alexandrian footnote’ has a long history before Alexandria.
The Bali myna Leucopsar rothschildi has long suffered heavy trapping, leading to its near extinction in the wild and categorization as Critically Endangered on the IUCN Red List. Decades of conservation breeding, release of birds and post-release management at Bali Barat National Park have, until recently, failed to secure a viable wild population. However, over the past decade, population increases, expansion into new areas of the National Park and beyond, and successful breeding in both artificial and natural nest sites have occurred. These recent successes are associated with a change in approach by the National Park authority from concentrating efforts on the last refugium of the species (an area protected from trapping but with potentially suboptimal habitat) and towards the human-dominated landscapes around the main road through the National Park. Bali mynas tended to favour areas with extensive shorter grass cover and open canopies and to shun denser woodland. Anthropogenic landscapes such as farmland and plantations presumably mimic the original savannah habitat of the species, but nestbox provision has probably been crucial in these areas in the absence of natural cavities. A potential further factor in the increases in myna numbers and range has been a scheme involving local people in commercial breeding of the species, thereby reducing its market price, and working with communities to reduce trapping pressure. We encourage continuing operation of this management strategy inside the National Park and its further extension into adjacent tourist areas, which appear to have myna-friendly socio-ecological conditions.
This chapter explores the indexical potential of time in three ways: chronological perspective, the use of temporal adverbs and adjectives to situate an episode within a larger span of literary history; marked iteration, the self-reflexive replay or foreshadowing of other events; and epigonal self-consciousness, the direct or indirect appeal to poetic predecessors. All three tropes are active in archaic epic and lyric, but with differing accents. In epic, references to time and iteration mark intratextual and intertextual cross-references and doublets, while epic heroes’ epigonal relationships with their πρότεροι figure the tensions of the poet’s relationship with his predecessors. In lyric poetry, temporal references similarly index tradition; δηὖτε marks both generic and intertextual repetition; and direct appeals to πρότεροι follow and challenge both whole genres and specific texts. Indexical temporality was deeply embedded in archaic Greek poetics from the very start.
This chapter explores how archaic Greek poets evoke and challenge prior traditions and texts through appeals to hearsay (e.g. φασί, λόγος). Case studies include the Iliad’s appropriation of theogonic and Theban myth; Homeric allusion to specific character traits (Antilochus’ speed, Nestor’s age, Achilles’ ancestry, Odysseus’ cunning); agonistic engagement with other traditions (the Iliad’s countering of Achillean immortality, the Odyssey’s positioning of Penelope against the Catalogue of Women); and further indexed allusions across the works of Hesiod, the Homeric Hymns, and other epic fragments. Indexical hearsay is even more prominent in lyric poetry, from Archilochus to Pindar: case studies include Archilochus and fable, Simonides on Hesiod’s Arete, Theognis’ Atalanta, Bacchylides’ Heracles, Ibycus’ Cassandra, Sappho’s Tithonus, sympotic skolia on both Ajax and the tyrannicides, and Pindar’s flexible mythologising. Poets employed this device to signal mastery of tradition, to challenge alternative myths, to foreground major intertextual models, to invite audiences to supplement untold details, and to authorise creative reworkings of tradition. The ‘Alexandrian footnote’ has a long history before Alexandria.
This chapter considers how the language of memory and knowledge indexes tradition. In Homeric epic, characters’ memories coincide with the audience’s recollection of intertextual and intratextual episodes (e.g. Aeneas’s flight from Achilles, Heracles’ labours, Diomedes’ wounding of Ares) and sometimes mark selective retellings of tradition (e.g. Agamemnon on recruiting Odysseus). On occasion, characters’ knowledge even extends proleptically to the future (e.g. Hector on Achilles’ death). Few comparable cases of characters’ mythical recall are visible elsewhere in archaic epic or lyric poetry because of our fragmentary evidence and differences in narratological presentation. But lyric poets also index tradition through the memories of their narrators, evoking both other myths (e.g. Theognis on Odysseus) and their own wider cycles of song (e.g. Sappho). They also appeal directly to the audience’s knowledge (e.g. Pindar on Ajax, Bacchylides on Thebes). From Homer onwards, memory and knowledge proved recurring but varied indices of allusion.
This chapter introduces the main concerns and aims of this book with an opening case study on Phoenix’s Meleager exemplum in Iliad 9. It then surveys the recent developments of scholarship on allusive marking, especially in Latin poetry: it explores the ‘Alexandrian footnote’ and other tropes of allusion; challenges the assumption that such devices are distinctively bookish and scholarly; and introduces a new term for the phenomenon (‘indexicality’). The second half of the introduction outlines the author’s methodological approach to early Greek allusion, incorporating elements of both neoanalysis and traditional referentiality. The author focuses on ‘mythological intertextuality’ in archaic epic, exemplified through a close reading of the ‘Nestor’s cup’ inscription. This section considers the reconstruction of lost traditions, the question of Homeric allusion to Near Eastern poetry, and the gradual transition to ‘textual intertextuality’. No specific watershed can be pinpointed. The growing practice of citing other poets by name attests to increasingly greater engagement with specific texts, but the Iliad and Odyssey already provide a plausible example of direct intertextual allusion. The chapter closes by addressing three further issues of context that are central to this study: audiences and performance, poetic agonism, and authorial self-consciousness.
The epilogue draws out some broader conclusions from this study, encouraging us to rethink traditional narratives of ancient literary history. Archaic poets already participated in a sophisticated and well-developed allusive system, and Hellenistic/Roman poets’ ‘footnoting’ habits are not as novel, bookish or scholarly as we might think. The epilogue further asks why these indices have not been identified or studied at such length before; it explores variation in indexical practice across genres and time; and it highlights further avenues for further research.
Challenging many established narratives of literary history, this book investigates how the earliest known Greek poets (seventh to fifth centuries BCE) signposted their debts to their predecessors and prior traditions – placing markers in their works for audiences to recognise (much like the 'Easter eggs' of modern cinema). Within antiquity, such signposting has often been considered the preserve of later literary cultures, closely linked with the development of libraries, literacy and writing. In this wide-ranging new study, Thomas Nelson shows that these devices were already deeply ingrained in oral archaic Greek poetry, deconstructing the artificial boundary between a supposedly 'primal' archaic literature and a supposedly 'sophisticated' book culture of Hellenistic Alexandria and Rome. In three interlocking case studies, he highlights how poets from Homer to Pindar employed the language of hearsay, memory and time to index their allusive relationships, as they variously embraced, reworked and challenged their inherited tradition.
The Hierarchical Taxonomy of Psychopathology (HiTOP) has emerged out of the quantitative approach to psychiatric nosology. This approach identifies psychopathology constructs based on patterns of co-variation among signs and symptoms. The initial HiTOP model, which was published in 2017, is based on a large literature that spans decades of research. HiTOP is a living model that undergoes revision as new data become available. Here we discuss advantages and practical considerations of using this system in psychiatric practice and research. We especially highlight limitations of HiTOP and ongoing efforts to address them. We describe differences and similarities between HiTOP and existing diagnostic systems. Next, we review the types of evidence that informed development of HiTOP, including populations in which it has been studied and data on its validity. The paper also describes how HiTOP can facilitate research on genetic and environmental causes of psychopathology as well as the search for neurobiologic mechanisms and novel treatments. Furthermore, we consider implications for public health programs and prevention of mental disorders. We also review data on clinical utility and illustrate clinical application of HiTOP. Importantly, the model is based on measures and practices that are already used widely in clinical settings. HiTOP offers a way to organize and formalize these techniques. This model already can contribute to progress in psychiatry and complement traditional nosologies. Moreover, HiTOP seeks to facilitate research on linkages between phenotypes and biological processes, which may enable construction of a system that encompasses both biomarkers and precise clinical description.
Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
Aims
To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
Method
Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
Results
Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
Conclusions
AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.