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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.
The appendix outlines the micronations that we have explored or examined in this book. As we have noted, the nature of micronationalism and the ease with which they can be founded (and abandoned) means that our list and our study is necessarily incomplete. We have nonetheless endeavoured to note some of the more prominent micronations. In doing so, our list focuses on those that claim physical territory rather than virtual entities.
In declaring independence, drafting a constitution, regulating citizenship and issuing passports, micronations position themselves as rival sites of authority. In this chapter, we explore the different ways that internationally recognised states respond to micronations’ claims to sovereignty. This chapter reveals that even though micronations are largely ignored in the international relations, political science and legal literature, in practice states must take notice and consider appropriate ways to engage. In some cases, perceiving their existence as a provocation or threat to their own claims of authority and to jurisdiction, states act in swift and decisive ways to foreclose micronations’ scope of action. In other cases, states determine to ignore micronations, considering them to be unserious or unthreatening. In all circumstances, however, states deny the international legal personality of micronations and ensure that any encounter occurs entirely within and according to domestic law.
This chapter develops a detailed conceptual framework for micronations to better understand and interrogate their common features and considerable diversity. It does so by comparing and contrasting micronations to recognised sovereign states and other state-like entities. As we explain, a wide variety of entities with more or less effective government, more or less legitimate claims to statehood, and more or less recognition and acceptance by individual states and the international community, exist around the world. By developing a ‘statehood spectrum’ along which a range of state and state-like entities may be placed, these complexities can be unravelled and a clearer picture of what makes micronations distinct emerges. We find that micronations are self-declared nations that perform and mimic acts of sovereignty, and adopt many of the protocols of nations, but lack a foundation in domestic and international law for their existence and are not recognised as nations in domestic or international forums.
In 1967, Roy Bates, a former major in the British Army, declared himself the ruler of a decommissioned offshore naval fort outside the United Kingdom’s territorial waters in an effort to bypass legal restrictions on radio broadcasting. In 1977, Leonard Casley of the Principality of Hutt River, a 75-square-kilometre wheat farm, cabled a telegram to the Governor-General of Australia declaring war in an attempt to force his larger neighbour to recognise the Principality’s sovereignty. In 1992, Dean Kamen, the inventor of the Segway and ruler of the Kingdom of North Dumpling, a three-acre island off the coast of Connecticut, convinced his friend, President George HW Bush, to sign a faux non-aggression pact between their two countries. Micronations challenge and seek to engage with recognised states in diverse ways. Although none of these micronations achieved legal recognition, they considered their efforts a success. In compelling the state to respond, they considered that the state treated them – if only for a moment – as an equal.
In our conclusion, we consider the future of micronationalism. We begin by outlining five major themes gleaned from our exploration of micronations. We examine the relationship between micronations and recognised states, the creativity needed to identify supposed fissures in international and domestic law to build a (doomed) case for independence, the diversity of this phenomenon, the transitory nature of micronations, and the gendered quality of micronationalism. Recognising the varied motivations that underpin the decision to establish one’s own country, we then consider in detail the value gained by claiming statehood. Finally, we conclude by asking whether micronations succeed or fail. Even though no micronation has ever become a recognised sovereign state, we argue that the future of micronationalism is anything but gloomy.
Micronations are incredibly diverse. Some micronations are speculative experiments in statehood, perhaps utopian examples of how nations could or should be organised. Others are established for personal entertainment, fantasy or artistic expression. Where a town or small community supports the idea, micronationalism can even promote tourism and deliver an economic boost to a region. Others still are formed to challenge and critique statehood and sovereign authority or as a way to make quick money by fair or foul means. Some of the more enduring micronations emerge as personal grievances take on a political dimension as anger, frustration and desperation push individuals into taking extreme action. In this chapter, we undertake a survey of some of the most prominent micronations by focusing on the myriad of (often overlapping) motivations for their creation. This study complements our definition and conceptual framework, explored in the previous chapter, by expanding our knowledge of the justifications provided for micronations and the assorted rationales that underlie their assertions of statehood.
Micronations challenge existing conceptions of statehood and international legal personality. They do so by engaging in the rituals of statehood rather than contesting them. In practice, this means that although usually unqualified or unskilled in law, proponents act through their understanding of the law rather than acting outside the law. In this chapter we explore in more detail how micronations assert and perform sovereignty. We examine the legal instruments that micronationalists identify when seeking to find a lawful basis to justify secession and proclaim their independence, and outline their strained legal arguments.
The aim of the social and behavioral sciences is to understand human behavior across a wide array of contexts. Our theories often make sweeping claims about human nature, assuming that our ancestors or offspring will be prone to the same biases and preferences. Yet we gloss over the fact that our research is often based in a single temporal context with a limited set of stimuli. Political and moral psychology are domains in which the context and stimuli are likely to matter a great deal (Van Bavel, Mende-Siedlecki, Brady, & Reinero, 2016). In response to Yarkoni (see BBS issue), we delve into topics related to political and moral psychology that likely depend on features of the research. These topics include understanding differences between liberals and conservatives, when people are willing to sacrifice someone to save others, the behavior of political leaders, and the dynamics of intergroup conflict.
The human large intestinal microbiota thrives on dietary carbohydrates that are converted to a range of fermentation products. Short-chain fatty acids (acetate, propionate and butyrate) are the dominant fermentation acids that accumulate to high concentrations in the colon and they have health-promoting effects on the host. Although many gut microbes can also produce lactate, it usually does not accumulate in the healthy gut lumen. This appears largely to be due to the presence of a relatively small number of gut microbes that can utilise lactate and convert it to propionate, butyrate or acetate. There is increasing evidence that these microbes play important roles in maintaining a healthy gut environment. In this review, we will provide an overview of the different microbes involved in lactate metabolism within the gut microbiota, including biochemical pathways utilised and their underlying energetics, as well as regulation of the corresponding genes. We will further discuss the potential consequences of perturbation of the microbiota leading to lactate accumulation in the gut and associated disease states and how lactate-utilising bacteria may be employed to treat such diseases.
Political disagreement is a fact of life. It can prompt people to stand for public office and agitate for political change. Others take a different route; they start their own nation. Micronations and the Search for Sovereignty is the first comprehensive examination of the phenomenon of people purporting to secede and create their own country. It analyses why micronations are not states for the purposes of international law, considers the factors that motivate individuals to separate and found their own nation, examines the legal justifications that they offer and explores the responses of recognised sovereign states. In doing so, this book develops a rich body of material through which to reflect on conventional understandings of statehood, sovereignty and legitimate authority. Authored in a lively and accessible style, Micronations and the Search for Sovereignty will be valuable reading for scholars and general audiences.
Background: Despite significant morbidity and mortality, estimates of the burden of healthcare-associated viral respiratory infections (HA-VRI) for noninfluenza infections are limited. Of the studies assessing the burden of respiratory syncytial virus (RSV), cases are typically classified as healthcare associated if a positive test result occurred after the first 3 days following admission, which may miss healthcare exposures prior to admission. Utilizing an expanded definition of healthcare-associated RSV, we assessed the estimates of disease prevalence. Methods: This study included laboratory-confirmed cases of RSV in adult and pediatric patients admitted to acute-care hospitals in a catchment area of 8 counties in Tennessee identified between October 1, 2016, and April 30, 2019. Surveillance information was abstracted from hospital and state laboratory databases, hospital infection control databases, reportable condition databases, and electronic health records as a part of the Influenza Hospitalization Surveillance Network by the Emerging Infections Program. Cases were defined as healthcare-associated RSV if laboratory confirmation of infection occurred (1) on or after hospital day 4 (ie, “traditional definition”) or (2) between hospital day 0 and 3 in patients transferred from a chronic care facility or with a recent discharge from another acute-care facility in the 7 days preceding the current index admission (ie, “enhanced definition”). The proportion of laboratory-confirmed RSV designated as HA-VRI using both the traditional definition as well as with the added enhanced definition were compared. Results: We identified 900 cases of RSV in hospitalized patients over the study period. Using the traditional definition for HA-VRI, only 41 (4.6%) were deemed healthcare associated. Adding the cases identified using the enhanced definition, an additional 12 cases (1.3%) were noted in patients transferred from a chronic care facility for the current acute-care admission and 17 cases (1.9%) were noted in patients with a prior acute-care admission in the preceding 7 days. Using our expanded definition, the total proportion of healthcare-associated RSV in this cohort was 69 (7.7%) of 900 compared to 13.1% of cases for influenza (Figure 1). Although the burden of HA-VRI due to RSV was less than that of influenza, when stratified by age, the rate increased to 11.7% for those aged 50–64 years and to 10.1% for those aged ≥65 years (Figure 2). Conclusions: RSV infections are often not included in estimates of HA-VRI, but the proportion of cases that are healthcare associated are substantial. Typical surveillance methods likely underestimate the burden of disease related to RSV, especially for those aged ≥50 years.
Background: Healthcare-associated transmission of influenza leads to significant morbidity, mortality, and cost. Most studies classify healthcare-associated viral respiratory infections (HA-VRI) as those with a positive test result after the first 3 days following admission, which does not account for healthcare exposures prior to admission. Utilizing an expanded definition of healthcare-associated influenza, we aimed to improve the estimates of disease prevalence on a population level. Methods: This study included laboratory-confirmed cases of influenza in adult and pediatric patients admitted to any acute-care hospital in a catchment area of 8 counties Tennessee identified between October 1, 2012, and April 30, 2019. Surveillance information was abstracted from hospital and state laboratory databases, hospital infection control practitioner databases, reportable condition databases, and electronic health records as a part of the Influenza Hospitalization Surveillance Network (FluSurv-NET) by the Centers for Disease Control and Prevention (CDC) Emerging Infections Program (EIP). Cases were defined as healthcare-associated influenza laboratory confirmation of infection occurred (1) on or after hospital day 4 (“traditional definition”), or (2) between hospital days 0 and 3 in patients transferred from a chronic care facility or with a recent discharge from another acute-care facility in the 7 days preceding the current index admission (ie, enhanced definition). The proportion of laboratory-confirmed influenza designated as HA-VRI using both the traditional definition as well as with the added enhanced definition were compared. Data were imported into Stata software for analysis. Results: We identified 5,904 cases of laboratory-confirmed influenza in hospitalized patients over the study period. Using the traditional definition for HA-VRI, only 147 (2.5%, seasonal range 1.3%–3.4%) were deemed healthcare associated (Figure 1). Adding the cases identified using the enhanced definition, an additional 317 (5.4%, range 2.3%–6.7%) cases were noted in patients transferred from a chronic care facility for the current acute-care admission and 336 cases (5.7%; range, 4.1%–7.4%) were noted in patients with a prior acute-care facility admission in the preceding 7 days. Using our expanded definition, the total proportion of healthcare-associated influenza in this cohort was 772 of 5,904 (13.1%; range, 10.6%–14.8%). Conclusion: HA-VRI due to influenza is an underrecognized infection in hospitalized patients. Limiting surveillance assessment of this important outcome to just those patients with a positive influenza test after hospital day 3 captured only 19% of possible healthcare-associated influenza infections across 7 influenza seasons. These results suggest that the traditionally used definitions of healthcare-associated influenza underestimate the true burden of cases.
The aim of this paper is to describe key findings and recommendations of SUI reports regarding patients with a diagnosis of PD in East London NHS Foundation Trust (ELFT). Patients with a diagnosis of PD are often involved in SUIs with regards to risk to themselves or others. Contributing factors might be the nature of their disorder in terms of mood instability and impulsivity, self-harming or antisocial behaviour, and the difficulties posed to assessing clinicians in predicting risk.
Patients with PD present severe challenges to services. SUI findings thus serve as a lightning rod for issues in their management. With the emergence of NICE guidelines for borderline PD  and antisocial PD  regarding risk assessments, there has been greater optimism for management of PDs.
A case series of 50 SUI reports of patients with a diagnosis of PD were identified from the governance and risk management team of ELFT. Themes were categorized as positive practice, contributory factors, and recommendations. Findings are related to guidelines in NICE and RCPsychiatry. Any patient with a diagnosis of PD (of any sub-type) that was involved in a SUI in ELFT met the inclusion criteria. There were no exclusion criteria.
The most frequent themes in positive practice were ‘continuity of care’ and ‘clinical practice’. The most frequent subthemes in clinical practice were ‘assessments’ and ‘follow-up’. ‘Continuity of care’ included examples of collaborative working between various teams, as in joint assessments, good communication, and timely referrals. In contributory factors ‘poor documentation’ was the most frequent theme. 14 reports found no contributory factors. In recommendations the most frequent theme was the need for development and implementation of PD policies and for improved risk management.
NICE guidelines stress the importance of continuity of care and good clinical care and it is commendable that these were findings in positive practice. The importance of documentation being accurate and timely needs underlining in hard pressed time poor clinicians. Services would do well to review PD policies specifically regarding risk management at a wider Trust and local service level. Our findings point to the ongoing need for workforce development as recommended in the RCPSych position statement on PD published in January 2020.