Reason, conscience and equity: bishops as the king's judges in later Medieval England

It has long been recognized that many late medieval bishops were heavily involved in secular government. Scholars have tended to characterize these activities in fairly general terms, labelling those who chose to serve the crown as ‘administrators’, ‘bureaucrats’ or ‘civil servants’. In fact, they are better described as king’s judges, for a large part of what bishops did in government was dispensing justice in the king’s name. The first part of this article explores the contexts of this judicial activity, showing that bishops were especially active in institutions such as parliament, chancery and the council which offered justice to the king’s subjects on a discretionary basis. Discretionary justice was closely informed by the precepts of natural law, which in turn derived authority from the abstract notion of the divine will. The second half of the article suggests that the strong theological underpinning of discretionary justice meant that bishops’ involvement in secular government did not stand in opposition to their spiritual vocation or their role as leaders of the church. I argue that the sweeping and rather disparaging contemporary and modern characterizations of ‘civil-servant’ bishops as self-serving careerists ought to be replaced by a more nuanced understanding of the rationale and motivation of those senior clergymen who involved themselves in secular governance

Impact of synoptic atmospheric forcing on the mean ocean circulation

The impact of synoptic atmospheric forcing on the mean ocean circulation is investigated by comparing simulations of a global eddy-permitting ocean-sea ice model forced with and without synoptic atmospheric phenomena. Consistent with previous studies, transient atmospheric motions such as weather systems are found to contribute significantly to the time-mean wind stress and surface heat loss at mid and high latitudes owing to the nonlinear nature of air-sea turbulent fluxes. Including synoptic atmospheric forcing in the model has led to a number of significant changes. For example, wind power input to the ocean increases by about 50%, which subsequently leads to a similar percentage increase in global eddy kinetic energy. The wind-driven subtropical gyre circulations are strengthened by about 10-15%, whereas even greater increases in gyre strength are found in the subpolar oceans. Deep convection in the northern North Atlantic becomes significantly more vigorous, which in turn leads to an increase in the Atlantic Meridional Overturning Circulation (AMOC) by as much as 55%. As a result of the strengthened horizontal gyre circulations and the AMOC, the maximum global northward heat transport increases by almost 50%. Results from this study show that synoptic atmospheric phenomena such as weather systems play a vital role in driving the global ocean circulation and heat transport, and therefore should be properly accounted for in paleo and future climate studies

A cholinergic neuroskeletal interface promotes bone formation during postnatal growth and exercise.

The autonomic nervous system is a master regulator of homeostatic processes and stress responses. Sympathetic noradrenergic nerve fibers decrease bone mass, but the role of cholinergic signaling in bone has remained largely unknown. Here, we describe that early postnatally, a subset of sympathetic nerve fibers undergoes an interleukin-6 (IL-6)-induced cholinergic switch upon contacting the bone. A neurotrophic dependency mediated through GDNF-family receptor-α2 (GFRα2) and its ligand, neurturin (NRTN), is established between sympathetic cholinergic fibers and bone-embedded osteocytes, which require cholinergic innervation for their survival and connectivity. Bone-lining osteoprogenitors amplify and propagate cholinergic signals in the bone marrow (BM). Moderate exercise augments trabecular bone partly through an IL-6-dependent expansion of sympathetic cholinergic nerve fibers. Consequently, loss of cholinergic skeletal innervation reduces osteocyte survival and function, causing osteopenia and impaired skeletal adaptation to moderate exercise. These results uncover a cholinergic neuro-osteocyte interface that regulates skeletogenesis and skeletal turnover through bone-anabolic effects

Imagining Gendered Adulthood

In this article, the authors draw on two qualitative, longitudinal studies of young people’s transitions to adulthood and how they construct these transitions over time in social, cultural and material terms. The authors focus on the hopes, anxieties and imagined futures of young women. They discuss the individualization thesis, and the contradiction for female individualization between expectations of equality and the reality of inequality between the genders. The debate is moved beyond ‘pitiful girls’ and ‘can-do girls’ by exploring how young women in the UK and Finland anticipate and try to avoid being locked into the lives of adult women

Have the changes introduced by the 2004 Higher Education Act made higher education admissions in England wider and fairer?

'Widening participation' and 'fair access' have been contested policy areas in English higher education since at least the early 1990s. They were key facets of the 2003 White Paper - The Future of Higher Education - and the subsequent 2004 Higher Education Act, with stated objectives that the reach of higher education should be wider and fairer. In particular, there has been considerable concern about admissions to 'top universities', which have remained socially as well as academically exclusive. The principal policy tools used by the Act were the introduction of variable tuition fees, expanded student grants, discretionary bursaries and the new Office for Fair Access (OFFA). This paper draws on publicly available statistics to assess whether the changes implemented by the 2004 Act have indeed made access to English higher education wider and fairer in relation to young people progressing from state schools and colleges and from lower socio-economic groups. It concludes that, while there is some evidence for modest improvements, these have been concentrated outside the 'top universities', which have seen slippage relative to the rest of the sector. The paper concludes with a discussion of the reasons why financial inducements appear to be a flawed and naive approach to influencing student demand. © 2011 Taylor & Francis

Errores de medicación en pediatría

Concerns regarding patient safety affect healthcare, and medication errors are the most frequent category of medical errors and linked with severe consequences. This study discusses epidemiologic characteristics of medication errors in pediatric patients and points out prevention strategies. Approximately 8% of the studies on the subject of medication errors identified in different national and international databases are distinctively related to the pediatric population. Children are vulnerable to medication errors due to intrinsic factors, such as proper anatomic and physiological characteristics; and due to extrinsic factors, with emphasis on the lack of public health politics and changes in the pharmaceutical industry to attend children's needs. The available evidences indicate, as imperative, the implementation of strategies to prevent medication errors, contributing to promote patient safety.La seguridad del paciente es un problema de salud pública y los errores con medicamentos son los más frecuentes y más graves. Este artículo describe características epidemiológicas de errores de medicación en áreas de atención pediátrica y algunas estrategias de prevención. Aproximadamente 8% de las investigaciones sobre errores de medicación identificadas en las bases de datos nacionales e internacionales se refieren específicamente a niños. Los niños tienen mayor vulnerabilidad a la ocurrencia de errores debidos a factores intrínsecos, con destaque para características anatómicas y fisiológicas, e extrínsecos, en particular con respecto a falta de políticas sanitarias y de la industria farmacéutica orientada a la atención de tales características. Evidencias muestran la necesidad de aplicar estrategias para prevenir errores de medicación, promoviendo la seguridad del paciente.A segurança do paciente constitui problema de saúde pública, e erros com medicamentos são os mais freqüentes e graves. O artigo apresenta características epidemiológicas dos erros de medicação em diferentes áreas de atendimento pediátrico, e aponta estratégias de prevenção. Aproximadamente 8% das pesquisas sobre erros de medicação identificadas em bases de dados nacionais e internacionais referem-se à população pediátrica. Crianças apresentam maior vulnerabilidade à ocorrência de erros devido a fatores intrínsecos, destacando-se características anatômicas e fisiológicas; e extrínsecos, relativos à falta de políticas de saúde e da indústria farmacêutica voltadas ao atendimento de tais especificidades. As evidências apontam para a necessidade de implementação de estratégias de prevenção de erros de medicação, contribuindo para promover a segurança do paciente.Universidade Federal de São Paulo (UNIFESP) Departamento de EnfermagemUNIFESP, Depto. de EnfermagemSciEL

Exploring miniature insect brains using micro-CT scanning techniques

This is an open access article. This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article's Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0

Psychosocial Risk Factors in Disordered Gambling: A Descriptive Systematic Overview of Vulnerable Populations

Background: Gambling is a behaviour engaged in by millions of people worldwide; for some, gambling can become a severely maladaptive behaviour, and previous research has identified a wide range of psychosocial risk factors that can be considered important for the development and maintenance of disordered gambling. Although risk factors have been identified, the homogeneity of risk factors across specific groups thought to be vulnerable to disordered gambling is to date, unexplored. Methods: To address this, the current review sought to conduct a systematic overview of literature relating to seven vulnerable groups: young people and adolescents, older adults, women, veterans, indigenous peoples, prisoners, and low socio-economic/income groups. Results: Multiple risk factors associated with disordered gambling were identified; some appeared consistently across most groups, including being male, co-morbid mental and physical health conditions, substance use disorders, accessibility and availability of gambling, form and mode of gambling, and experience of trauma. Further risk factors were identified that were specific to each vulnerable group. Conclusion: Within the general population, certain groups are more vulnerable to disordered gambling. Although some risk factors are consistent across groups, some risk factors appear to be group specific. It is clear that there is no homogenous pathway in to disordered gambling, and that social, developmental, environmental and demographic characteristics can all interact to influence an individual’s relationship with gambling

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability