bluuebunny/crossref_metadata_2025 huggingface dataset:
On the modelling of self-gravitation for full 3-D global seismic wave propagation
Authors: van Driel M , Kemper J , Boehm C
Published: June 2021

We present a new approach to the solution of the Poisson equation present in the coupled gravito-elastic equations of motion for global seismic wave propagation in time domain aiming at the inclusion of the full gravitational response into spectral element solvers. We leverage the Salvus meshing software to include the external domain using adaptive mesh refinement and high order shape mapping. Together with Neumann boundary conditions based on a multipole expansion of the right-hand side this minimizes the number of additional elements needed. Initial conditions for the iterative solution of the Poisson equation based on temporal extrapolation from previous time steps together with a polynomial multigrid method reduce the number of iterations needed for convergence. In summary, this approach reduces the extra cost for simulating full gravity to a similar order as the elastic forces. We demonstrate the efficacy of the proposed method using the displacement from an elastic global wave propagation simulation (decoupled from the Poisson equation) at $200\, \mbox{s}$ dominant period to compute a realistic right-hand side for the Poisson equation.
Staffing the United Nations: China's motivations and prospects
Authors: Fung Courtney J , Lam Shing-hon
Published: June 2021

A developing public commentary views China as exerting influence in international organizations to legitimize and disseminate PRC foreign policy values and interests. This article examines an understudied source identified by PRC elites to promote influence in the United Nations system: dispatching PRC nationals as international civil servants, specifically in a targeted pursuit of executive leadership positions. Using decades of UN staffing data, we find that apart from Russia, China holds the fewest executive leadership posts among the aspiring and permanent members of the UN Security Council. Moreover, China is yet to lead an agency addressing international security matters. US and European staff contributions are significantly higher at all staffing levels of the international civil service. Still, the data shows that China made modest, targeted gains in most specialized UN agencies, and agencies headed by PRC nationals show faster increases in PRC staff members, though all base numbers were low. We draw from Chinese-language sources to discuss issues facing China in increasing its international civil service numbers, affecting the country's ability to shape global governance.
Cannabinoids in Oral Fluid: Limiting Potential Sources of Cannabidiol Conversion to Δ9- and Δ8-Tetrahydrocannabinol
Authors: Coulter Cynthia , Wagner Jarrad R
Published: June 2021

In late 2019, the National Laboratory Certification Program (NLCP) published an article reporting on the potential analytical conversion of 7-carboxy cannabidiol (CBD-COOH) to 11-nor-9-carboxy-Δ9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH) in urine samples. The same conversion is possible in oral fluid with the parent analyte cannabidiol (CBD) converting to Δ9-tetrahydrocannabinol (Δ9-THC) and Δ8-tetrahydrocannabinol (Δ8-THC) under strong acidic conditions. With the recent rise in states legalizing the use of THC and the availability of products containing only CBD, unless the analytical in vitro conversions are controlled, the detection of Δ9-THC or Δ8-THC in oral fluid may not clarify whether the donor was using a CBD product or licit or illicit THC product. Authentic oral fluid samples submitted for cannabinoid analysis were subjected to multiple sample preparation procedures and extraction methods to determine the conditions that allow CBD to convert to THC. CBD single analyte controls prepared from a certified THC-free source were added to the batch to monitor the rate of conversion. Samples were prepared using a base hydrolysis, solid phase extraction, derivatization and analysis by liquid chromatography with tandem mass spectrometry (LC–MS-MS). The base hydrolysis and derivatization were tested independently and did not contribute to the conversion rate. Adjusting the pH of the sample preparation and extraction from pH 2.0 to pH 5.0 changed the conversion rate from 5 to 1%. A pH of 6.0 was not strong enough to extract the cannabinoids efficiently. Removing the acid component of the preparation and extraction procedure eliminated the conversion to THC; however, this did reduce the analyte recovery depending on which extraction column was used. Processing time also contributed to the conversion rate. With smaller trial runs, conversion was not always seen, but with larger validation batches low-level conversion of 1–2% was observed. A fully validated LC–MS-MS method utilizing solid-phase extraction was developed for CBD, Δ9-THC, Δ8-THC and cannabinol. The method specifically targets those analytes found in oral fluid after CBD administration and those that are seen during in vitro CBD conversion. CBD administration was performed using a certified THC-free CBD control.
Face Burns: A 4-Year Experience
Authors: Rasmussen Stephanie A , Romanowski Kathleen S , Sen Soman , Palmieri Tina L , Greenhalgh David G
Published: June 2021

Burns on the face pose unique management challenges because they are in a place that is constantly visible, so scars are hard to hide. The goal of this study was to review our experience of adult patients who had face burns. We performed a retrospective review of adult patients (≥18 years old) who were admitted to a regional burn center from July 2015 to June 2019 with face burns. Sex, age, ethnicity, burn etiology, burn size, and discharge status were collected from electronic medical records of the patients who met study criteria. Descriptive statistics, Student’s t-tests, and chi-square tests were performed in Stata/SE 16.1. Significance was defined as a P-value < .05. In 4 years, 595/1705 patients (~35% of admissions) were admitted with face burns. The mean age was 44.9 ± 17.0 (mean ± SD) years, with the majority being men (475, 80%). The mean burn size was 19.8 ± 20.9% TBSA with 10.1 ± 19.8% TBSA being third degree. The mean head burn size for any face burn was 2.8 ± 1.8% TBSA. The majority of burns were due to flames (478, 80%) and of those 122 (21%) were from accelerant use and 43 (7%) resulted from propane or butane use. Scalds caused 53 (9%), electric 25 (4%), hot tar 5 (1%), and chemical 5 (1%). Overall, 208 (35%) patients had grafting of some portion of their body, but only 31 patients (5.2%) had face grafting. The mean age of those with face grafting compared with patients who did not need grafting was 45.9 ± 13.8 and 44.9 ± 17.2 years, respectively. Patients who needed grafting had a mean third-degree burn size of 31.7 ± 25.4% TBSA and a mean head (including face) burn size of 4.7 ± 2.0% TBSA, whereas patients who did not need grafting had a mean third-degree burn size of 8.9 ± 18.7% TBSA and a mean head burn size of 2.7 ± 1.8% head TBSA. Patients requiring face grafts had longer lengths of stay, intensive unit stays, ventilator days, and mortality than those whose face burns healed spontaneously. Overall, head burns in adults were common within the 4-year time span we studied, but only a small fraction (5%) had face grafts. The patients who needed grafting for their head burns had significantly larger total body and face burns and had a 2.4-fold higher mortality rate compared to patients who did not need grafting. Most face burns were caused by flame, especially the use of accelerants or flammable gases. Prevention efforts should focus on avoiding the use of accelerants and being careful with flammable gases.
Injected Breast Materials: Review of Imaging Features and Characteristics
Authors: Gao Yukun , Karimova E Jane , Phillips Jordana , Fein-Zachary Valerie , Dialani Vandana , Mehta Tejas S , Mehta Rashmi , Slanetz Priscilla J
Published: June 2021

In the United States, silicone and saline breast implants with their familiar radiologic appearance are the mainstays of breast augmentation. However, less well-known sequelae of unconventional injected materials introduced for cosmetic and noncosmetic purposes may also be encountered on breast imaging—for example, free silicone, paraffin and/or oil, polyacrylamide gel, autologous fat, and hyaluronic acid, which are encountered in the setting of breast augmentation. Breast injection of go-yak is not cosmetic but also results in characteristic imaging findings. Breast changes due to extravasation of chemotherapy or interstitial brachytherapy can mimic the appearance of injected noncosmetic materials. Because many of these materials can mimic or obscure imaging findings of breast cancer, it is important to recognize their varied appearances and the limitations of imaging alone in delineating breast injection material from cancer. Given the relatively uncommon incidence of injected materials into the breast, this article aims to review the imaging appearance in order to aid radiologists in maximizing cancer detection and ensuring optimal patient management.
Femoral cartilage damage occurs at the zone of femoral head necrosis and can be accurately detected on traction MR arthrography of the hip in patients undergoing joint preserving hip surgery
Authors: Schmaranzer F , Lerch T D , Steppacher S D , Siebenrock K A , Schmaranzer E , Tannast M
Published: June 2021

The primary purpose was to answer the following question: What is the location and pattern of necrosis and associated chondrolabral lesions and can they be accurately detected on traction MR arthrography compared with intra-operative findings in patients undergoing hip preservation surgery for femoral head necrosis (FHN)? Retrospective, diagnostic case series on 23 patients (23 hips; mean age 29 ± 6 years) with diagnosis of FHN undergoing open/arthroscopic joint preserving surgery for FHN and pre-operative traction MR arthrography of the hip. A MR-compatible device for weight-adapted application of leg traction (15–23 kg) was used and coronal, sagittal and radial images were acquired. Location and pattern of necrosis and chondrolabral lesions was assessed by two readers and compared with intra-operative findings to calculate diagnostic accuracy of traction MR arthrography. On MRI all 23 (100%) hips showed central FHN, most frequently antero-superiorly (22/23, 96%) where a high prevalence of femoral cartilage damage was detected (18/23, 78%), with delamination being the most common (16/23, 70%) damage pattern. Intra-operative inspection showed central femoral head cartilage damage most frequently located antero-superiorly (18/23, 78%) with femoral cartilage delamination being most common (14/23, 61%). Traction MR arthrography enabled detection of femoral cartilage damage with a sensitivity/specificity of 95%/75% for reader 1 and 89%/75% for reader 2. To conclude, femoral cartilage damage occurs at the zone of necrosis and can be accurately detected using traction MR arthrography of the hip which may be helpful for surgical decision making in young patients with FHN.
Aboveground biomass and its biotic and abiotic modulators of a main food bamboo of the giant panda in a subalpine spruce–fir forest in southwestern China
Authors: Xiong Xinyu , Zhu Jiangling , Li Sheng , Fan Fan , Cai Qiong , Ma Suhui , Su Haojie , Ji Chengjun , Tang Zhiyao , Fang Jingyun
Published: June 2021

As one of the main food bamboo species of the giant panda (Ailuropoda melanoleuca), Fargesia denudata is widely distributed in the understory of spruce–fir forests in the mountainous area of southwestern China. However, the driving factors of its biomass and distribution in the forests are still unclear. We conducted a systematic investigation of the tree and shrub layers (including bamboos) of 209 subplots (20 m × 20 m) in a Forest Global Earth Observatory plot, the Wanglang Plot (25.2 ha), to explore the effects of abiotic (topographic and soil characteristics) and biotic (tree density, total basal area (TBA), shrub coverage, etc.) factors on the aboveground biomass of F. denudata (bamboo biomass hereafter). Bamboo biomass averaged 1.17 ton/ha, with a large variation from 0 to 4.88 ton/ha (95% confidence interval) among the 209 subplots. Bamboo biomass increased significantly with elevation, slope and mean diameter at breast height of trees, and decreased significantly with tree density, shrub coverage and soil pH. However, bamboo biomass was not significantly correlated with tree TBA, aspect, soil organic matter or total nitrogen content. The random forest model indicated that topographic factors and biotic factors had greater influences on the bamboo biomass than soil characteristics in general. Specifically, topographic factors mainly affected the bamboo biomass by changing tree density and soil characteristics. Our results can provide valuable guidance for the protection of giant pandas and the management of subalpine spruce–fir forests.
Nutrient availability in urban food waste: carbohydrate bias in the Philadelphia–Camden urban matrix
Authors: Carpenter Melissa , Savage Amy M
Published: June 2021

Urban areas provide animals with both a unique set of challenges and resources. One of the novel resources available in urban areas is an abundance of human food waste. Although it is known that many urban-dwelling animals are consuming human food waste at some level, there is not a good understanding of the nutrients provided by this novel resource. Given that human food waste is unlikely to resemble an animal’s natural diet, there could be health consequences for an animal consuming human food waste. In some animals, nutritional imbalances can also lead to behavioral changes, making it important to understand more precisely what they are eating. To answer the question of what nutrients were available in urban food waste, we surveyed food waste in the Philadelphia–Camden urban matrix. We found that human food waste contained ∼1000% more carbohydrates than other nutrient types. Given the impact that carbohydrate-rich diets can have on human health, there may be important consequences for the animals in urban environments that consume this food waste. Therefore, it is possible that human food subsidies have cascading consequences for entire communities and their ecosystem services in cities.
Communication, Empathy, and Compassion
Authors: Merlo Gia
Published: June 2021

The state of modern healthcare is often not conducive to empathy or effective communication because physicians are pressured to see as many patients as they possibly can, sometimes forcing them to forsake emotional connection. However, empathy and communication are among the most vital skills for providing excellent care to patients. Incorporation of empathy and communication have been found to result in fewer malpractice suits, better adherence to treatment plans, fewer errors, and improved outcomes. The components of effective communication include active listening, offering feedback, and being able to apologize for past errors or miscommunication. The challenges associated with patients that are labelled “difficult” are discussed. The neurological processes of empathy are highlighted including the regions of the brain that are implicated. The chapter also frames empathy as a broad concept with emotive, moral, cognitive, and behavioral components, and that compassion is an empathic response that may facilitate feelings of engagement and protect against burnout. Increasingly, medical schools are incorporating training in building empathy and compassion into their curricula.
Developing Cultural Praxis
Authors: Merlo Gia
Published: June 2021

The ever-evolving composition of the U.S. population prompts healthcare systems to adapt in order to provide care to diverse populations. Health disparities exist, and it is part of our responsibility as medical professionals to reflect on how the sociocultural determinants of health affect outcomes and uncover our unconscious or implicit biases to work towards health equity. The author defines this process as cultural praxis, drawing from Freire’s theory on developing a critical consciousness and understanding cultural humility. Physicians must also understand the systematic problems that lead to inequities in healthcare; the author defines this as structural competence. As in professional identity formation, development of a critical consciousness is an ongoing process that requires reflection, and cultural praxis is more than a set of competencies to be satisfied. This discusses strategies for developing cultural praxis, and provide reflective opportunities in scenarios in which cultural praxis is particularly important, such as in end-of-life care.
Gravito-turbulence and dynamo in poorly ionized protostellar discs – I. Zero-net-flux case
Authors: Riols A , Xu W , Lesur G , Kunz M W , Latter H
Published: June 2021

In their early stages, protoplanetary discs are sufficiently massive to undergo gravitational instability (GI). This instability is thought to be involved in mass accretion, planet formation via gas fragmentation, the generation of spiral density waves, and outbursts. A key and very recent area of research is the interaction between the GI and magnetic fields in young protoplanetary discs, in particular whether this instability is able to sustain a magnetic field via a dynamo. We conduct 3D, stratified shearing-box simulations using two independent codes, PLUTO and Athena++, to characterize the GI dynamo in poorly ionized protostellar discs subject to ambipolar diffusion. We find that the dynamo operates across a large range of ambipolar Elssaser number Am (which characterizes the strength of ambipolar diffusion) and is particularly strong in the regime Am = 10–100, with typical magnetic to thermal energy ratios of order unity. The dynamo is only weakly dependent on resolution (at least for Am ≲ 100), box size, and cooling law. The magnetic field is produced by the combination of differential rotation and large-scale vertical roll motions associated with spiral density waves. Our results have direct implications for the dynamo process in young protoplanetary discs and possibly some regions of active galactic nucleus discs.
Observability of forming planets and their circumplanetary discs – III. Polarized scattered light in near-infrared
Authors: Szulágyi J , Garufi A
Published: June 2021

There is growing amount of very high resolution polarized scattered light images of circumstellar discs. Nascent giant planets are surrounded by their own circumplanetary discs that may scatter and polarize both the planetary and stellar light. Here, we investigate whether we could detect circumplanetary discs with the same technique and what can we learn from such detections. Here, we created scattered light mock observations at 1.245 microns (J band) for instruments like SPHERE and GPI, for various planetary masses (0.3, 1.0, 5.0, and 10.0 $\rm {\mathrm{ M}_{Jup}}$), disc inclinations (90, 60, 30, and 0 deg), and planet position angles (0, 45, and 90 deg). We found that the detection of a circumplanetary disc at 50 au from the star is significantly favoured if the planet is massive (${\ge} 5 \,\rm {\mathrm{ M}_{Jup}}$) and the system is nearly face-on (≤30°). In these cases, the accretion shock front on the surface of the circumplanetary discs is strong and bright enough to help the visibility of this subdisc. Its detection is hindered by the neighbouring circumstellar disc that also provides a strong polarized flux. However, the comparison between the PI and the Qϕ maps is a viable tool to pinpoint the presence of the circumplanetary disc within the circumstellar disc, as the two discs are behaving differently on those images.
Collisions in a gas-rich white dwarf planetary debris disc
Authors: Swan Andrew , Kenyon Scott J , Farihi Jay , Dennihy Erik , Gänsicke Boris T , Hermes J J , Melis Carl , von Hippel Ted
Published: June 2021

WD 0145+234 is a white dwarf that is accreting metals from a circumstellar disc of planetary material. It has exhibited a substantial and sustained increase in 3–5 $\mu$m flux since 2018. Follow-up Spitzer photometry reveals that emission from the disc had begun to decrease by late 2019. Stochastic brightening events superimposed on the decline in brightness suggest the liberation of dust during collisional evolution of the circumstellar solids. A simple model is used to show that the observations are indeed consistent with ongoing collisions. Rare emission lines from circumstellar gas have been detected at this system, supporting the emerging picture of white dwarf debris discs as sites of collisional gas and dust production.
Detection of a possible high-confidence radio quasi-periodic oscillation in the BL Lac PKS J2134–0153
Authors: Ren Guo-Wei , Ding Nan , Zhang Xiong , Xue Rui , Zhang Hao-Jing , Xiong Ding-Rong , Li Fu-Ting , Li Hui
Published: June 2021

Using the Lomb–Scargle periodogram and the weighted wavelet Z-transform techniques, we have searched for quasi-periodic oscillations (QPOs) of the BL Lacertae object (BL Lac), PKS J2134–0153, in the 15-GHz radio light curve announced by the Owens Valley Radio Observatory 40-m telescope during the period from 2008 January 5 to 2019 May 18. This is the first time that the search for periodic radio signals in the BL Lac PKS J2134–0153 has used these two methods, which consistently reveal a QPO of 4.69 ± 0.14 yr (>5σ confidence level). We discuss possible causes for this QPO, and we expect that the binary black hole scenario, where the QPO is caused by the precession of a binary black hole, is the most likely explanation. Thus, the BL Lac PKS J2134–0153 could be a good candidate for a binary black hole. In the binary black hole scenario, the distance between the primary black hole and the secondary black hole is a ∼ 1.83 × 1016 cm.
Pair production in the millisecond pulsar J0030+0451
Authors: Jones P B
Published: June 2021

The electric field accelerating electrons in the Timokhin–Arons polar-cap model as applied to millisecond pulsars is so high that the electron Lorentz factors are limited either by radiation reaction or by the Breit–Wheeler process. In the former case, it is possible to obtain an upper limit for curvature-radiation momentum components perpendicular to the local magnetic field that is independent of the flux-line radius of curvature. The threshold value for single-photon conversion to pairs is high but is possibly reached in J0030+0451. However, owing to the high polar-cap temperature reported, direct pair production by the Breit–Wheeler process is probably more important. If the existence of coherent radio emission in millisecond pulsars is assumed to need a high-multiplicity pair plasma, then it follows that the primary electrons also produce gamma-rays in the Fermi-LAT energy band for which the magnetosphere is completely transparent. The absence of these, in phase with the radio emission, would be an immediate indication that ultra-high-energy electrons and an active Timokhin–Arons polar cap are not present in J0030+0451.
Apophatic science: how computational modeling can explain consciousness
Authors: Bridewell Will , Isaac Alistair M C
Published: June 2021

This study introduces a novel methodology for consciousness science. Consciousness as we understand it pretheoretically is inherently subjective, yet the data available to science are irreducibly intersubjective. This poses a unique challenge for attempts to investigate consciousness empirically. We meet this challenge by combining two insights. First, we emphasize the role that computational models play in integrating results relevant to consciousness from across the cognitive sciences. This move echoes Alan Newell’s call that the language and concepts of computer science serve as a lingua franca for integrative cognitive science. Second, our central contribution is a new method for validating computational models that treats them as providing negative data on consciousness: data about what consciousness is not. This method is designed to support a quantitative science of consciousness while avoiding metaphysical commitments. We discuss how this methodology applies to current and future research and address questions that others have raised.
First Female Neurosurgeon in the United States: Dorothy Klenke Nash, MD
Authors: Casillo Stephanie M , Venkatesh Anisha , Muthiah Nallammai , McDowell Michael M , Agarwal Nitin
Published: June 2021

Dr Dorothy Klenke Nash (1898-1976) became the first female neurosurgeon in the United States in 1928 and maintained her status as the country's only female neurosurgeon until 1960. She graduated with her medical degree from the Columbia College of Physicians and Surgeons in 1927 and then trained at the Neurologic Institute of New York under Dr Byron Stookey. During her training, she contributed to the advancement of neurosurgical practice through academic research. In 1931, she married Charles B. Nash, and together they had 2 children, George (1932) and Dorothy Patricia (1937). Dr Nash became a senior surgeon at St. Margaret's Hospital in Pittsburgh in 1942. Shortly thereafter, she joined the inaugural University of Pittsburgh Department of Neurosurgery led by Dr Stuart N. Rowe and became an instructor of neurosurgery at the University of Pittsburgh School of Medicine. In acknowledgment of her advocacy for public access to services for mental health and cerebral palsy, Dr Nash was recognized as a Distinguished Daughter of Pennsylvania (1953) and honored by Mercy Hospital (1957), Bryn Mawr College (1960), and Columbia University (1968). She retired from neurosurgical practice in 1965, at which time she devoted herself to her grandchildren and her Catholic faith. She died on March 5, 1976 at the age of 77. With unwavering tenacity, Dr Nash paved the way for all women in neurosurgery.
Tobacco Use Among 1 310 716 Women of Reproductive age (15–49 Years) in 42 Low- and Middle-Income Countries: Secondary Data Analysis From the 2010-2016 Demographic and Health Surveys
Authors: Shukla Radha , Kanaan Mona , Siddiqi Kamran
Published: June 2021

Introduction

Tobacco use among women, especially during pregnancy is a public health concern. There is a need to understand the diverse nature of their tobacco consumption across the globe.

Methods

We used Demographic and Health Surveys (DHS) data collected between 2010 and 2016 from 42 low- and middle-income countries (LMICs) to estimate the prevalence of smoking, smokeless tobacco, and dual use among pregnant and non-pregnant women of reproductive age (15–49 y). We compared tobacco use between both groups adjusted for age, type of residence, education and combined wealth index, and a subgroup analysis for the South-East Asia Region (SEAR) as the tobacco use in SEAR among women is far more diverse than in other regions primarily due to the popularity of smokeless tobacco use in this region.

Results

Based on the data of 1 310 716 women in 42 LMICs, the prevalence of smoking was 0.69%(95%CI: 0.51–0.90) among pregnant women and 1.09%(95%CI: 0.81–1.42) among non-pregnant women. The prevalence of smokeless tobacco use was 0.56%(95%CI: 0.33–0.84) among pregnant women and 0.78%(95%CI: 0.35–1.37) among non-pregnant women. The relative risk ratios(RRR) for smoking (0.85; 95%CI: 0.67–1.09) and smokeless tobacco use (0.81; 95%CI:0.67–1.00) were not-significantly lower among pregnant women than non-pregnant women and education and wealth index had an inverse relationship with both forms of tobacco. In SEAR, among pregnant women, the prevalence of smoking and smokeless tobacco use was 1.81% and 0.45%, respectively. However, pregnant women were 7%(RRR 1.07; 95%CI:1.02–1.12) more likely to use smokeless tobacco than non-pregnant women.

Conclusion

Despite the added risk of foetal harm during pregnancy, there is no evidence that the tobacco consumption between pregnant and non-pregnant women differ in 42 LMICs. A significantly higher use of smokeless tobacco among pregnant women in SEAR is of particular concern and warrants further investigation.

Implications

Tobacco use among women in low- and middle-income countries (LMICs) is lower than high-income countries (HICs), but this may be because LMICs are earlier in the epidemiological transition of tobacco use. If ignored as a public health issue and the tobacco industry continues to market its products to women, the level of tobacco use may rise as it did in HICs. Also, despite low prevalence rates and with no evidence that these differ among pregnant and non-pregnant women, is concerning as tobacco consumption in any form during pregnancy is associated with poor birth outcomes. This suggests a need for raising awareness about the harms of tobacco use among women in LMICs, especially during pregnancy. There is a need to develop preventive and cessation interventions to decrease tobacco use (smoking and smokeless) among women who are from low socio-economic status and less educated, as they bear the greatest burden of tobacco use.
Neither Blood Culture Positivity nor Time to Positivity Is Associated With Mortality Among Patients Presenting With Severe Manifestations of Sepsis: The FABLED Cohort Study
Authors: Paquette Katryn , Sweet David , Stenstrom Robert , Stabler Sarah N , Lawandi Alexander , Akhter Murtaza , Davidson Adam C , Gavric Marko , Jinah Rehman , Saeed Zahid , Demir Koray , Sangsari Sassan , Huang Kelly , Mahpour Amirali , Shamatutu Chris , Caya Chelsea , Troquet Jean-Marc , Clark Greg , Wong Titus , Yansouni Cedric P , Cheng Matthew P
Published: June 2021

Background

Sepsis is a leading cause of morbidity, mortality, and health care costs worldwide.

Methods

We conducted a multicenter, prospective cohort study evaluating the yield of blood cultures drawn before and after empiric antimicrobial administration among adults presenting to the emergency department with severe manifestations of sepsis. Enrolled patients who had the requisite blood cultures drawn were followed for 90 days. We explored the independent association between blood culture positivity and its time to positivity in relation to 90-day mortality.

Results

Three hundred twenty-five participants were enrolled; 90-day mortality among the 315 subjects followed up was 25.4% (80/315). Mortality was associated with age (mean age [standard deviation] in those who died was 72.5 [15.8] compared with 62.9 [17.7] years among survivors; P < .0001), greater Charlson Comorbidity Index (2 [interquartile range {IQR}, 1–3] vs 1 [IQR, 0–3]; P = .008), dementia (13/80 [16.2%] vs 18/235 [7.7%]; P = .03), cancer (27/80 [33.8%] vs 47/235 [20.0%]; P = .015), positive quick Sequential Organ Failure Assessment score (57/80 [71.2%] vs 129/235 [54.9%]; P = .009), and normal white blood cell count (25/80 [31.2%] vs 42/235 [17.9%]; P = .02). The presence of bacteremia, persistent bacteremia after antimicrobial infusion, and shorter time to blood culture positivity were not associated with mortality. Neither the source of infection nor pathogen affected mortality.

Conclusions

Although severe sepsis is an inflammatory condition triggered by infection, its 90-day survival is not influenced by blood culture positivity nor its time to positivity.

Clinical Trials Registration

NCT01867905.
Factors Associated With Longer Than Recommended Durations of Antibiotic Therapy for Uncomplicated Ambulatory Infections in an Integrated Healthcare System
Authors: Vazquez Deida Axel A , Shihadeh Katherine C , Aragon Deborah , Knepper Bryan C , Jenkins Timothy C
Published: June 2021

Across the ambulatory care network of an integrated health care system, durations of antibiotic therapy prescribed for uncomplicated infections were longer than recommended in 39% of cases. By logistic regression, site of care, prescriber characteristics, and type of infection were independently associated with longer than recommended durations of therapy.
Islam and Exceptionalism in the Western Policy Imagination
Authors: Mandaville Peter
Published: June 2021

During the twentieth century, US foreign policy, as pursued by administrations of both major political parties, regarded Islam as a useful force for advancing US strategic interests in certain world regions. More recently Islam has come to be associated in both American policy discourse and the US public sphere with instability, violence, and terrorism. This chapter argues that recent US foreign policy has treated Islam fundamentally differently from how it regards other world religions. More specifically, the United States has created diplomatic positions and a wide array of outreach programs that single out Muslims and Muslim-ness in ways that differ significantly from the way America treats the members of other world religions (who tend to be engaged as citizens of particular nation-states rather than as the holders of particular religious identities).
The Act Lectures of John Prideaux
Authors: Hampton Stephen
Published: June 2021

Chapter 1 focuses on the Act Lectures that Prideaux delivered in Oxford between 1616 and 1624. The series exhibits the breadth, interconnectedness, and pastoral orientation of the Reformed Conformist vision of grace. As the teaching that Oxford’s senior theology professor delivered on the most public occasion in the university calendar, Prideaux’s Act Lectures represent something close to an official statement of English orthodoxy. They are useful both in terms of the range of topics that they cover and because they offer a coherent account of Reformed Conformist teaching on grace that locates specific debates on the topic within their wider theological context.
Imperial Women within the Imperial Family
Authors: Boatwright Mary T.
Published: June 2021

Starting with Faustina the Younger, whose fecundity and imperial ties suggest her as a model imperial woman, this chapter explores the imperial domus—house, household, family—and women’s roles within it from Augustus through the Severans. That domus was a cornerstone of Augustus’ new principate, becoming ever more important during the principate. Flavian dynastic emphasis is noted, as is the growing attention to family in the motherless imperial families of Nerva, Trajan, and Hadrian. A high point comes with Faustina the Elder and Faustina the Younger, but familial emphasis continues under the Severans. The chapter also discusses nontraditional imperial families, including “concubines” and the same-sex relationship of Hadrian with Antinous, and various terms for the imperial house such as domus divina. The chapter reveals both that “the imperial family” was a cornerstone of the principate, but that it was hard for imperial women to gain individual visibility within that construct.
Models and Exemplars: Statues of Imperial Women
Authors: Boatwright Mary T.
Published: June 2021

Starting with the over-life-size greywacke statue of Agrippina the Younger from the Caelian, this chapter explores imperial women’s representation through sculpture and relief, and the associated topic of their exemplarity. Topics include the history and status of women’s statues in Rome, damnatio memoriae, and body types for female standing statues. The Caelian statue of Agrippina is contrasted to three other installations once featuring her in Rome; their epigraphic remains suggest that the display of imperial women’s statues could vary greatly even while including the males of the family. The concluding discussion of Matidia the Younger’s standing statue from Suessa Aurunca underscores the apparent blandness characterizing most imperial women’s imaging. Perhaps more than others, this chapter underlines imperial women’s connections with other Roman females sharing a privileged background.
Conclusions: Agency and Constraints
Authors: Boatwright Mary T.
Published: June 2021

The extant evidence for imperial women reveals their general powerlessness and silence, starkly contrasting with anecdotes about their abuse of resources, influence, and privilege. Their relation to the emperor put them at the center of power, yet their gender, and the princeps’ dominance, prohibited them from exercising control. At the principate’s beginning, some disclosed their resources through patronage or personal adornment. Such displays were increasingly censured. Imperial women’s diminishing visibility in Rome, including at religious functions, paradoxically correlates with their increasing portrayal on central coinage. Although their roles in Rome’s imperial cult had positive effects for women in the empire, their own gains are harder to detect and their personal agency cannot be discerned in the available sources. Their investigation, however, uncovers a remarkable history that illuminates individuals and the principate as a whole, including its obstinate misogyny.
Conclusion
Authors: Robinson Elizabeth C.
Published: June 2021

This chapter emphasizes the elements of continuity that have emerged from the consideration of multiple types of evidence. It answers the three questions posed in the introduction, and refers back to the three theoretical models adopted in the analysis. It discusses the ways that the results of this site biography differ from previously published studies while at the same time providing a synthesis of Larinum’s history from 400 bce to 100 ce. It then examines the ways in which Larinum is representative or anomalous when compared to other Italian towns. It also compares this local-level case study of Larinum to the conclusions of other local-level studies, especially ones that focus on the site of Taranto. It concludes by making the case for the creation of more local-level site biographies, using the study of Larinum as a model. It pushes the field of Roman conquest studies toward a new paradigm of social change that is contingent on highly specific, local issues, rather than global movements.
Learning to Feel Comfortable on Gut Strings: The Left Hand
Authors: Reiter Walter S.
Published: June 2021

This lesson guides the fingers of the left hand, in coordination with the ear, into a healthy understanding of how gut strings, more supple than modern ones, behave. An exercise explores the amount of pressure each finger needs for the sound to be clear and how to avoid excessive pressure. The rest of the lesson deals with the fingers as “slaves of our inner voice,” conveying to the string the intricate subtleties of phrasing and timing that spring from our artistry and our imagination. Two basic ways of lowering and raising the fingers (active and passive) are discussed, but this is not a merely technical issue: it is a way of unblocking the channel between intention and realization, releasing the flow from our inner singing voice through the medium of our physical movements and on unimpeded into the sound.
The Seam in Babbitt’s Compositional Development
Authors: Bernstein Zachary
Published: June 2021

The years around 1960 saw Babbitt’s style change in three critical ways: he adopted the time-point system, began writing electronic music, and started using all-partition, rather than trichordal, arrays. The pivotal piece in these developments is Composition for Tenor and Six Instruments. A close analysis of this piece in light of its predecessors and its successors is revealing about a range of Babbitt’s priorities, and it provides a case study of his views on perception and cognition. During the preceding decade, Babbitt had pursued a growing interest in contrapuntal complexity, including four techniques detailed in this chapter. These techniques form the basis of Composition for Tenor and Six Instruments. Yet Babbitt felt that he had pushed contrapuntal complexity too far. The all-partition array—with complex counterpoint but simple lines—was a solution that balanced his competing aesthetic desires. The work also sheds light on Babbitt’s early use of the time-point system.
An Architecture of Opportunism
Authors: Ferguson Kate
Published: June 2021

The irregular dynamics that emerged with the support of Croatian state structures may not have been either as planned or as efficient as their Serbian counterparts, but pro-Croat paramilitary groups enjoyed a similarly varied degree of patronage from their political and military authorities. Irregulars were responsible for some of the worst atrocities committed against non-Croats in Croatia and in Bosnia. The chapter explains that the majority of irregular perpetrators of the documented crimes fit into the Croat architecture of violence and were only rarely genuinely independent combatants. While the various paramilitary, militia and local defence units contributed numbers and ideology to the evolution of the Croatian military architecture, the military police force ran like a central artery through emergent armed commands in both Croatia and Bosnia. Ultimately, the Croatian strategy was characterised by the pragmatic pursuit of its political objectives through violent and diplomatic means.
An Irregular Architecture of Defence
Authors: Ferguson Kate
Published: June 2021

When violence began in spring 1992, the Sarajevo government was forced to rely on a loose coalition of irregular armed groups, some of which were created under the auspices of state and pro-government forces, while others were genuine grassroots paramilitary groups. The chapter explains that the Army of the Republic of Bosnia-Herzegovina emerged disjointed, at first made up of a network of units organised along roughly conventional military lines and spontaneously created militia formations. The spontaneity of the Bosnian defence came out of necessity rather than design, and meant that irregular armed groups were the foundation of military capabilities. But as the conflict progressed, central authorities were constantly seeking to create a disciplined regular command structure. An irregular, spontaneous, and unified armed coalition meant that the Bosnian government was ill equipped to effectively protect its populations and was hampered in its efforts to convince the international community of their urgent need for protection.
Criminal Structures
Authors: Ferguson Kate
Published: June 2021

Mass atrocity crimes are inherently political. They are, above all, about power. The architectures this book explores are similar in many respects to those of mafias and organised crime. There is a clear logic to arguing that the criminology of modern mass atrocities can be understood as scaled up forms of organised crime. Certainly, conceptualising mass atrocities as organised crime puts focus upon their logic, rather than the all too often misunderstood ‘causes’ of atrocities. This chapter explores the overlap and collaboration between the architectures of mass atrocity and the architectures of organised crime. Understanding the criminal dynamics of mass atrocities as part of the larger violent and irregular architecture is crucial not only for post-atrocity reconstruction, but for prevention strategies too. This chapter therefore explores how cultures of organised crime and corruption can be created by elite structures but can also stimulate more spontaneous or day-to-day participation in criminal activity and can shift perceptions of what is and is not legally or morally permissible.
Problems of Polarization
Authors: Talisse Robert B.
Published: June 2021

Political commentators across the spectrum point to polarization as the cause of dysfunctions that recently have beset democratic societies. But the concept of polarization is rarely examined. This chapter presents several distinct kinds of polarization, starting by distinguishing political polarization from belief polarization, and offers a view of how their interaction gives rise to political problems ranging from legislative deadlock and partisan animosity to escalating extremism. Although the aim of the chapter is largely diagnostic, it concludes with an indication of how polarization might be managed.
Realism about Structure
Authors: North Jill
Published: June 2021

This chapter rebuts objections to the account, dispelling concerns about taking the mathematical structures of our best physical theories seriously. It outlines further aspects of the book’s realism about structure and explains what this realism is, and what it is not, committed to. It discusses the ideas of reasonably straightforward interpretations of physics; of perspicuous formulations of physics; and of direct and indirect representations. It argues against a different kind of realism about structure in physics, which is at once both stronger and weaker than the realism about structure defended in the book. It ends by arguing against focusing on the structure of a theory’s models in our physical theorizing in general, and the model isomorphism criterion for theoretical equivalence in particular.
Wellbeing Policy Evaluation and Appraisal
Authors: Frijters Paul , Krekel Christian
Published: June 2021

The third chapter offers a methodology for those readers who are tasked with actually conducting policy evaluations and appraisals based on subjective wellbeing data, including wellbeing cost-effectiveness and cost-benefit analyses, impact assessments, or business plans. It first gives a simple and fairly non-formal exposition of how wellbeing cost-effectiveness works. It then sets up the methodology formally and discusses the various technical standards and issues that might arise when implementing them, for example double-counting of impacts. The chapter illustrates the methodology using various examples, ranging from simple to more technical. It also introduces and discusses data sources related to wellbeing, with a particular focus on the United Kingdom at present but also beyond, as well as rules of thumb and matters associated with the use of evidence and literature on wellbeing more generally.
The Matter of Kinship
Authors: Ivanič Suzanna
Published: June 2021

Alongside natural matter, the ‘matter of kinship’ was a channel through which to negotiate divine power in the cosmos. Objects were integral to constituting kinship and forming devotional communities before God. Gifts exchanged between kith and kin on the occasion of baptism, marriage, and death reveal the dynamic nexus of objects and kinship within the cosmos, to which love was central. Gifts, bequests, trades, transfers, and exchanges of all kinds acted to create and sustain kinship bonds as an important part of devotion. Such objects were not only important during the moment of their initial production and use, but also as they were embedded in the daily life of the family and became constant reminders of the Christian lifecycle. Over time such items were woven more deeply into the fabric of daily family life by being given, used, or inherited down the generations.
A Cosmos in the Making
Authors: Ivanič Suzanna
Published: June 2021

Objects can be examined to decipher beliefs in the cosmos, but the material environment of the home was also an agent in making and sustaining religious beliefs, practices, and identities. Objects were tools with which to teach members of the household across generations, and they were prompts to pious living. Items such as glass beakers, knives, and clocks, studied here, perpetuated and reinforced beliefs in the cosmos, but they also reveal a cosmos in the making. They show how the material environment of the home shaped a mentalité by forming a didactic environment and conditioning responses to objects. Building on the work of Bourdieu, this chapter makes the case that these material environments played an instrumental role in the formation of a material devotional habitus that was ‘historically conditioned’ and open to change.