BackgroundThe increased risk of developing attention-deficit hyperactivity disorder (ADHD) in extremely preterm infants is well-documented. Better understanding of perinatal risk factors, particularly those that are modifiable, can inform prevention efforts.MethodsWe examined data from the Extremely Low Gestational Age Newborns (ELGAN) Study. Participants were screened for ADHD at age 10 with the Child Symptom Inventory-4 (N = 734) and assessed at age 15 with a structured diagnostic interview (MINI-KID) to evaluate for the diagnosis of ADHD (N = 575). We studied associations (...) of pre-pregnancy maternal body mass index (BMI), pregestational and/or gestational diabetes, maternal smoking during pregnancy (MSDP), and hypertensive disorders of pregnancy (HDP) with 10-year and 15-year ADHD outcomes. Relative risks were calculated using Poisson regression models with robust error variance, adjusted for maternal age, maternal educational status, use of food stamps, public insurance status, marital status at birth, and family history of ADHD. We defined ADHD as a positive screen on the CSI-4 at age 10 and/or meeting DSM-5 criteria at age 15 on the MINI-KID. We evaluated the robustness of the associations to broadening or restricting the definition of ADHD. We limited the analysis to individuals with IQ ≥ 70 to decrease confounding by cognitive functioning. We evaluated interactions between maternal BMI and diabetes status. We assessed for mediation of risk increase by alterations in inflammatory or neurotrophic protein levels in the first week of life.ResultsElevated maternal BMI and maternal diabetes were each associated with a 55–65% increase in risk of ADHD, with evidence of both additive and multiplicative interactions between the two exposures. MSDP and HDP were not associated with the risk of ADHD outcomes. There was some evidence for association of ADHD outcomes with high levels of inflammatory proteins or moderate levels of neurotrophic proteins, but there was no evidence that these mediated the risk associated with maternal BMI or diabetes.ConclusionContrary to previous population-based studies, MSDP and HDP did not predict ADHD outcomes in this extremely preterm cohort, but elevated maternal pre-pregnancy BMI, maternal diabetes, and perinatal inflammatory markers were associated with increased risk of ADHD at age 10 and/or 15, with positive interaction between pre-pregnancy BMI and maternal diabetes. (shrink)

The drive to describe cultural history as an evolutionary process has two sources. One from within social theory is part of the impetus to convert social studies into "social sciences" providing them with the status accorded to the natural sciences. The other comes from within biology and biological anthropology in the belief that the theory of evolution must be universal in its application to all functions of all living organisms. The social scientific theory of cultural evolution is pre-Darwinian, employing a (...) developmental model of unfolding characterized by intrinsic directionality, by definable stages that succeed each other and by some criterion of progress. It is arbitrary in its definitions of progress and has had the political problem that a diachronic claim of cultural progress implies a synchronic differential valuation of present-day cultures. The biological scheme creates an isomorphism between the Darwinian mechanism of evolution and cultural history, postulating rules of cultural "mutation", cultural inheritance and some mechanism of natural selection among cultural alternatives. It uses simplistic ad hoc notions of individual acculturation and of the differential survival and reproduction of cultural elements. It is unclear what useful work is done by substituting the metaphor of evolution for history. (shrink)

In his critical response to our skeptical inquiry, “Does Culture Evolve?” , W. G. Runciman affirms that “Culture Does Evolve.” However, we find nothing in his essay that convinces us to alter our initial position. And we must confess that in composing an answer to Runciman, our first temptation was simply to urge those interested to read our original article—both as a basis for evaluating Runciman’s attempted refutation of it and as a framework for reading this essay, which addresses in (...) greater detail issues we have already raised. Runciman views the “selectionist paradigm” as a “scientific” “puzzle-solving device” now validated by an “expanding literature” that has successfully modeled social and cultural change as “evolutionary.” All paradigms, however, including scientific ones, give rise to self-validating “normal science.” The real issue, accordingly, is not whether explanations can be successfully manufactured on the basis of paradigmatic assumptions, but whether the paradigmatic assumptions are appropriate to the object of analysis. The selectionist paradigm requires the reduction of society and culture to inheritance systems that consist of randomly varying, individual units, some of which are selected, and some not; and with society and culture thus reduced to inheritance systems, history can be reduced to “evolution.” But these reductions, which are required by the selectionist paradigm, exclude much that is essential to a satisfactory historical explanation—particularly the systemic properties of society and culture and the combination of systemic logic and contingency. Now as before, therefore, we conclude that while historical phenomena can always be modeled selectionistically, selectionist explanations do no work, nor do they contribute anything new except a misleading vocabulary that anesthetizes history. (shrink)

Background. Decisions to test, enrol and disclose HIV status are among the ethical challenges that may influence adherence to antiretroviral therapy (ART) and HIV care and treatment in adolescents living with HIV. In the Tanzanian setting, how parental perceptions of ethical issues affect adolescents’ adherence to HIV care and treatment is not well known.Objective. To explore parental perceptions of ethical issues in adolescent HIV care and treatment. Methods. The study employed a descriptive qualitative exploratory design and was conducted at Temeke (...) Regional Referral Hospital in Dar es Salaam Care and Treatment Centre (CTC) in the Outpatient Department (OPD). The study population were parents and non-parent caregivers of HIV-infected adolescents 10 - 19 years of age. A total of 16 persons participated in semi-structured interviews after their consent was obtained. All interviews were audiotaped, transcribed verbatim in Swahili and back-translated into English. An inductive content analysis was used, and standards of qualitative rigour applied. Results. Three qualitative themes emerged: balancing adolescents’ autonomy with parents’ desire to protect their children; parental dilemmas regarding disclosure of adolescents’ HIV status; and parental reasons for delayed disclosure.Conclusion. Participants perceived that parental authority should override adolescents’ autonomy in HIV care and treatment. Disclosure of HIV status to adolescents is a challenge to parents. Delays in disclosure often occur because parents feel guilty and because they have fears of rejection by their adolescent children. (shrink)

We argue that there is a conflict among classical theism's commitments to divine simplicity, divine creative freedom, and omniscience. We start by defining key terms for the debate related to classical theism. Then we articulate a new argument, the Aloneness Argument, aiming to establish a conflict among these attributes. In broad outline, the argument proceeds as follows. Under classical theism, it's possible that God exists without anything apart from Him. Any knowledge God has in such a world would be wholly (...) intrinsic. But there are contingent truths in every world, including the world in which God exists alone. So, it's possible that God contingently has wholly intrinsic knowledge. But whatever is contingent and wholly intrinsic is an accident. So, God possibly has an accident. This is incompatible with classical theism. Finally, we consider and rebut several objections. (shrink)

Rhythm is key to language acquisition. Across languages, rhythmic features highlight fundamental linguistic elements of the sound stream and structural relations among them. A sensitivity to rhythmic features, which begins in utero, is evident at birth. What is less clear is whether rhythm supports infants' earliest links between language and cognition. Prior evidence has documented that for infants as young as 3 and 4 months, listening to their native language supports the core cognitive capacity of object categorization. This precocious link (...) is initially part of a broader template: listening to a non-native language from the same rhythmic class as and to vocalizations of non-human primates provide English-acquiring infants the same cognitive advantage as does listening to their native language. Here, we implement a machine-learning approach to ask whether there are acoustic properties, available on the surface of these vocalizations, that permit infants' to identify which vocalizations are candidate links to cognition. We provided the model with a robust sample of vocalizations that, from the vantage point of English-acquiring 4-month-olds, either support object categorization or fail to do so. We assess whether supervised ML classification models can distinguish those vocalizations that support cognition from those that do not, and which class of acoustic features best support that classification. Our analysis reveals that principal components derived from rhythm-relevant acoustic features were among the most robust in supporting the classification. Classifications performed using temporal envelope components were also robust. These new findings provide in principle evidence that infants' earliest links between vocalizations and cognition may be subserved by their perceptual sensitivity to rhythmic and spectral elements available on the surface of these vocalizations, and that these may guide infants' identification of candidate links to cognition. (shrink)

Members of the Clinical Ethics Consultation Affairs Standing Committee of the American Society for Bioethics and Humanities present a collection of insights and recommendations developed from their collective experience, intended for those engaged in the work of healthcare ethics consultation.

There have undoubtedly been ample reasons to discourage a translator from approaching this commentary on the Metaphysics. The reasons stem mainly from the lack of a critical text. As is well enough known, such a text is at present in preparation by the Dominicans. Until it appears, attempts even at discussing the many disconcerting problems about the commentary run the risk of proving futile. In consequence, discussions have fallen off in recent years. As Rowan is careful to point out in (...) his introduction, there is sufficient evidence not only that errors have been made through simple negligence in the editions of the commentary, but also that "all sorts of liberties" may have been taken with the text. What we have at present, moreover, might possibly be a running text based on redactions dating from different years in St. Thomas' teaching career. If one may judge from the way Rowan presents the different views, he personally prefers hypotheses that simplify the situation and allow the text now available to be considered as a single continuous writing left in its present form by Aquinas himself. (shrink)

Many theories of complex cognitive-motor skill learning are built on the notion that basic cognitive processes group actions into easy-to-perform sequences. The present work examines predictions derived from laboratory-based studies of motor chunking and motor preparation using data collected from the real-time strategy video game StarCraft 2. We examined 996,163 action sequences in the telemetry data of 3,317 players across seven levels of skill. As predicted, the latency to the first action is delayed relative to the other actions in the (...) group. Other predictions, inspired by the memory drum theory of Henry and Rogers, received only weak support. (shrink)

BackgroundAn analysis of the position statements of secular US medical and surgical professional societies on physician-assisted suicide (PAS) and euthanasia have not been published recently. Available statements were evaluated for position, content, and sentiment.MethodsIn order to create a comprehensive list of secular medical and surgical societies, the results of a systematic search using Google were cross-referenced with a list of societies that have a seat on the American Medical Association House of Delegates. Societies with position statements were identified. These statements (...) were divided into 5 categories: opposed to PAS and/or euthanasia, studied neutrality, supportive, acknowledgement without statement, and no statement. Linguistic analysis was performed using RapidMinder in order to determine word frequency and sentiment respective to individual statements. To ensure accuracy, only statements with word counts > 100 were analyzed. A 2-tailed independentttest was used to test for variance among sentiment scores of opposing and studied neutrality statements.ResultsOf 150 societies, only 12 (8%) have position statements on PAS and euthanasia: 11 for PAS (5 opposing and 4 studied neutrality) and 9 for euthanasia (6 opposing and 2 studied neutrality). Although the most popular words used in opposing and studied neutrality statements are similar, notable exceptions exist (suicide,medicine, andtreatmentappear frequently in opposing statements, but not in studied neutrality statements, whereaspsychologists,law, andindividualsappear frequently in studied neutrality statements, but not in opposing statements). Sentiment scores for opposing and studied neutrality statements do not differ (mean, 0.094 vs. 0.104;P = 0.90).ConclusionsFew US medical and surgical societies have position statements on PAS and euthanasia. Among them, opposing and studied neutrality statements share similar linguistic sentiment. Opposing and studied neutrality statements have clear differences, but share recommendations. Both opposing and studied neutrality statements cite potential risks of PAS legalization and suggest that good palliative care might diminish a patient’s desire for PAS. (shrink)

Focal brain metabolic effects detected by proton magnetic resonance spectroscopy (MRS) in obsessive-compulsive disorder (OCD) represent prospective indices of clinical status and guides to treatment design. Sampling bilateral pregenual anterior cingulate cortex (pACC), anterior middle cingulate cortex (aMCC), and thalamus in 40 adult patients and 16 healthy controls, we examined relationships of the neurometabolites glutamate+glutamine (Glx), creatine+phosphocreatine (Cr), and choline-compounds (Cho) with OCD diagnosis and multiple symptom types. The latter included OC core symptoms (Yale-Brown Obsessive-Compulsive Scale - YBOCS), depressive symptoms (...) (Montgomery-Åsberg Depression Rating Scale - MADRS), and general functioning (Global Assessment Scale - GAS). pACC Glx was 9.7% higher in patients than controls. Within patients, Cr and Cho correlated negatively with YBOCS and MADRS, while Cr correlated positively with the GAS. In aMCC, Cr and Cho correlated negatively with MADRS, while Cr in thalamus correlated positively with GAS. These findings present moderate support for glutamatergic and cingulocentric perspectives on OCD. Based on our prior metabolic model of OCD, we offer one possible interpretation of these group and correlational effects as consequences of a corticothalamic state of elevated glutamatergic receptor activity alongside below-normal glutamatergic transporter activity. (shrink)

We suggest that consciousness (C) should be addressed as a multilevel concept. We can provisionally identify at least three, rather than two, levels: Gray's system should relate at least to the lowest of these three levels. Although it is unlikely to be possible to develop a behavioural test for C, it is possible to speculate as to the evolutionary advantages offered by C and how C evolved through succeeding levels. Disturbances in the relationships between the levels of C could underlie (...) mental illness, especially schizophrenia. (shrink)

The problem of leaders and followers is a famous one in intellectual history. Marx once remarked wryly that he was not a Marxist. Dostoevski and Kierkegaard, in mordant moments, saw Christians severed from Jesus. What was the relation between Confucius (551-479 B.C.), an ineffective political adviser in a disintegrating feudal society, and the enormously influential Confucianists in the later highly organized bureaucratic imperial regimes?

Pancreatitis is a complex, progressively destructive inflammatory disorder. Alcohol was long thought to be the primary causative agent, but genetic contributions have been of interest since the discovery that rare PRSS1, CFTR and SPINK1 variants were associated with pancreatitis risk. We now report two associations at genome-wide significance identified and replicated at PRSS1-PRSS2 and X-linked CLDN2 through a two-stage genome-wide study. The PRSS1 variant likely affects disease susceptibility by altering expression of the primary trypsinogen gene. The CLDN2 risk allele is (...) associated with atypical localization of claudin-2 in pancreatic acinar cells. The homozygous CLDN2 genotype confers the greatest risk, and its alleles interact with alcohol consumption to amplify risk. These results could partially explain the high frequency of alcohol-related pancreatitis in men. © 2012 Nature America, Inc. All rights reserved. (shrink)

Surely God, as a perfectly rational being, created the universe for some _reason_. But is God’s creating the universe for a reason compatible with divine impassibility? That is the question I investigate in this article. The _prima facie_ tension between impassibility and God’s creating for a reason arises from impassibility’s commitment to God being uninfluenced by anything _ad extra_. If God is uninfluenced in this way, asks the detractor, how could he be moved to create anything at all? This _prima (...) facie_ tension has recently been formalized and dubbed the ‘Problem of Arbitrary Creation’. In this article, I defend a new extension of this problem. I begin by characterizing classical theism, divine simplicity, and divine impassibility. I then spell out the Problem of Arbitrary Creation as developed by R. T. Mullins. I next raise a worry for Mullins’ version of the argument. Finally, I extend the argument and show how my extension avoids the aforementioned worry. (shrink)

American football is played in a chaotic visual environment filled with relevant and distracting information. We investigated the hypothesis that collegiate football players show exceptional skill at shielding their response execution from the interfering effects of distraction ( interference control ). The performances of 280 football players from National Collegiate Athletic Association Division I football programs were compared to age-matched controls in a variant of the Eriksen flanker task ( Eriksen and Eriksen, 1974 ). This task quantifies the magnitude of (...) interference produced by visual distraction on split-second response execution. Overall, football athletes and age controls showed similar mean reaction times (RTs) and accuracy rates. However, football athletes were more proficient at shielding their response execution speed from the interfering effects of distraction (i.e., smaller flanker effect costs on RT). Offensive and defensive players showed smaller interference costs compared to controls, but defensive players showed the smallest costs. All defensive positions and one offensive position showed statistically smaller interference effects when compared directly to age controls. These data reveal a clear cognitive advantage among football athletes at executing motor responses in the face of distraction, the existence and magnitude of which vary by position. Individual differences in cognitive control may have important implications for both player selection and development to improve interference control capabilities during play. (shrink)

BackgroundThere is increasing need for peer reviewers as the scientific literature grows. Formal education in biostatistics and research methodology during residency training is lacking. In this pilot study, we addressed these issues by evaluating a novel method of teaching residents about biostatistics and research methodology using peer review of standardized manuscripts. We hypothesized that mentored peer review would improve resident knowledge and perception of these concepts more than non-mentored peer review, while improving review quality.MethodsA partially blinded, randomized, controlled multi-center study (...) was performed. Seventy-eight neurology residents from nine US neurology programs were randomized to receive mentoring from a local faculty member or not. Within a year, residents reviewed a baseline manuscript and four subsequent manuscripts, all with introduced errors designed to teach fundamental review concepts. In the mentored group, mentors discussed completed reviews with residents. Primary outcome measure was change in knowledge score between pre- and post-tests, measuring epidemiology and biostatistics knowledge. Secondary outcome measures included level of confidence in the use and interpretation of statistical concepts before and after intervention, and RQI score for baseline and final manuscripts.ResultsSixty-four residents (82%) completed initial review with gradual decline in completion on subsequent reviews. Change in primary outcome, the difference between pre- and post-test knowledge scores, did not differ between mentored (−8.5%) and non-mentored (−13.9%) residents (p = 0.48). Significant differences in secondary outcomes (using 5-point Likert scale, 5 = strongly agree) included mentored residents reporting enhanced understanding of research methodology (3.69 vs 2.61; p = 0.001), understanding of manuscripts (3.73 vs 2.87; p = 0.006), and application of study results to clinical practice (3.65 vs 2.78; p = 0.005) compared to non-mentored residents. There was no difference between groups in level of interest in peer review (3.00 vs 3.09; p = 0.72) or the quality of manuscript review assessed by the Review Quality Instrument (RQI) (3.25 vs 3.06; p = 0.50).ConclusionsWe used mentored peer review of standardized manuscripts to teach biostatistics and research methodology and introduce the peer review process to residents. Though knowledge level did not change, mentored residents had enhanced perception in their abilities to understand research methodology and manuscripts and apply study results to clinical practice. (shrink)

Since its founding in 1943, Medievalia et Humanistica has won worldwide recognition as the first scholarly publication in America to devote itself entirely to medieval and Renaissance studies. Since 1970, a new series, sponsored by the Modern Language Association of America and edited by an international board of distinguished scholars and critics, has published interdisciplinary articles. In yearly hardbound volumes, the new series publishes significant scholarship, criticism, and reviews treating all facets of medieval and Renaissance culture: history, art, literature, music, (...) science, law, economics, and philosophy. (shrink)

Coral bleaching has impacted reefs worldwide and the predictions of near‐annual bleaching from over two decades ago have now been realized. While technology currently provides the means to predict large‐scale bleaching, predicting reef‐scale and within‐reef patterns in real‐time for all reef users is limited. In 2020, heat stress across the Great Barrier Reef underpinned the region's third bleaching event in 5 years. Here we review the heterogeneous emergence of bleaching across Heron Island reef habitats and discuss the oceanographic drivers that (...) underpinned variable bleaching emergence. We do so as a case study to highlight how reef end‐user groups who engage with coral reefs in different ways require targeted guidance for how, and when, to alter their use of coral reefs in response to bleaching events. Our case study of coral bleaching emergence demonstrates how within‐reef scale nowcasting of coral bleaching could aid the development of accessible and equitable bleaching response strategies on coral reefs. Also see the video abstract here: https://youtu.be/N9Tgb8N-vN0. (shrink)

In California Dental Association v. FTC, 119 S. Ct. 1604, the U.S. Supreme Court reviewed a decision by the U.S. Court of Appeals for the Ninth Circuit that a nonprofit affiliation of dentists violated section 5 of the Federal Trade Commission Act, 15 U.S.C.A. § 45, which prohibits unfair competition. The Court examined two issues: the Federal Trade Commission's jurisdiction over the California Dental Association ; and the proper scope of antitrust analysis. The Court unanimously held that CDA was subject (...) to FTC's jurisdiction, but split 5-4 in its finding that the district court's use of abbreviated rule-of-reason analysis was inappropriate.CDA is a voluntary, nonprofit association of local dental societies. It boasts approximately 19,000 members, who constitute roughly threequarters of the dentists practicing in California. Although a nonprofit, CDA includes for-profit subsidiaries that financially benefit CDA members. CDA gives its members access to insurance and business financing, and lobbies and litigates on their behalf. Members also benefit from CDA marketing and public relations campaigns. (shrink)