Living without the dead: finding solace in ancient Rome

Devastated by the death of his daughter Tullia, Cicero struggled to assuage his grief. Cicero did all that was expected of an elite man—seeking comfort from friends and philosophy, from reading and writing, from remembering and commemorating—yet to the dismay of his friends he was still unmanly in his grief. This paper looks at the strategies used and available both to express and control grief in the Roman world. How did the bereaved negotiate a new role both for themselves and for the dead? How did they both display and conceal their grief? Grief was both a public performance and a private journey, and, as Cicero discovered, for the bereaved the tensions between public and private could be an emotional and practical minefield. Focusing on evidence from the late Republic and first century CE, the paper explores how individuals, after the public performance of the funeral, lived with their grief. It investigates ideals and counter ideals (including gender stereotypes) for the behaviour of the bereaved, and how bereavements were rationalised and consoled through various mechanisms such as support networks, rituals, beliefs (religious and philosophical), public monuments, personal mementos, art and literature. The dead could not be brought back to life, but for those left behind the dead were often a potent presence which could have a negative or positive impact on the future of the bereaved

An Emperor's Tears: the significance of the mourning of the Julio-Claudian emperors.

At the death of Germanicus in 19 CE, the behaviour of the emperor Tiberius came under scrutiny. How would he react to his nephew’s death? According to Tacitus, the failure of Tiberius to make a public appearance was seen as telling, surely it indicated that Tiberius did not wish his lack of remorse and grief to be witnessed (Ann. 3.2-3). Tiberius’ behaviour as a mourner needed to match his behaviour as emperor – secretive, untrusting, inappropriate and quintessentially bad. This paper explores how the Roman emperors from Augustus to Nero were presented as mourning for those that they had lost, highlighting the importance of mourning in the evaluation of character. How an emperor acted as a mourner, whether, for example, he wept openly or shunned the public, could be a considered act of self-presentation, which was open both to contemporary popular scrutiny and posthumous evaluation. The emotion of grief, and the genuineness of its expression, especially through the shedding of tears, became part of a public performance as emperors negotiated the machinations of dynastic succession. How an emperor wept, who for and for how long, could be both a significant measure of his character and of the perceived character, and or importance, of the deceased. An emperor’s tears could come at a reputational price both for himself, and for others

Advocacy spurs innovation: promoting synergy between physical and biomedical sciences

Despite dramatic advances in decoding the genes, proteins, and pathways that drive cancer, the disease has evaded the reductionist approaches to defeat it. Recent work has highlighted cancer’s heterogeneity, complexity, and ability to develop resistance as major barriers to progress. To better understand and control the processes that govern the initiation, behavior, and progression of cancer, the National Cancer Institute (NCI) created the Physical Sciences-Oncology Center (PS-OC) Network in 2009. As a hub for scientific innovation and as an example of the transdisciplinary research model, the twelve centers within the PS-OC strive for the systematic convergence of the physical sciences with cancer biology. Promoting collaboration between biologists, physicists, mathematicians, chemists, biomedical engineers, and oncologists, the program offers a compelling vision of how new frontiers in physical sciences and oncology will permit the emergence of new scientific principles and opportunities, and of how the benefits of the current convergence revolution would be enhanced by vigorous public/advocacy support

A rare schizophrenia risk variant of CACNA1I disrupts CaV3.3 channel activity

CACNA1I is a candidate schizophrenia risk gene. It encodes the pore-forming human CaV3.3 α1 subunit, a subtype of voltage-gated calcium channel that contributes to T-type currents. Recently, two de novo missense variations, T797M and R1346H, of hCaV3.3 were identified in individuals with schizophrenia. Here we show that R1346H, but not T797M, is associated with lower hCaV3.3 protein levels, reduced glycosylation, and lower membrane surface levels of hCaV3.3 when expressed in human cell lines compared to wild-type. Consistent with our biochemical analyses, whole-cell hCaV3.3 currents in cells expressing the R1346H variant were ~50% of those in cells expressing WT hCaV3.3, and neither R1346H nor T797M altered channel biophysical properties. Employing the NEURON simulation environment, we found that reducing hCaV3.3 current densities by 22% or more eliminates rebound bursting in model thalamic reticular nucleus (TRN) neurons. Our analyses suggest that a single copy of Chr22: 39665939G > A CACNA1I has the capacity to disrupt CaV3.3 channel-dependent functions, including rebound bursting in TRN neurons, with potential implications for schizophrenia pathophysiology

Behavioral Health in Rural America: Understanding Citizen Perceptions and Willingness to Respond to Community Needs

Amid nationwide efforts to address behavioral health needs, rural communities often face unique challenges and a lack of resources. This study presents a bottom-up approach used by one rural community in the Midwest to respond to their needs regarding mental health and substance use. A survey instrument was developed from interviews with community stakeholders and disseminated in both online and paper formats. The survey sought to understand citizen perspectives regarding quality of life, barriers to treatment, and willingness to engage in efforts to address the community’s needs. Data from 1,303 respondents (71.5% women, 54.7% income \u3c$42,000) were analyzed using descriptive statistics and chi-square analyses. Results indicate that cost of treatment, shame, and lack of privacy were a barrier for most citizens’ treatment-seeking behavior. In addition, many citizens were willing to engage in strategies to address the community’s needs, including increased county spending, forming a neighborhood watch, and donating money. Differences associated with gender and income emerged across perceptions and willingness to support efforts. Implications for community efforts are discussed

Validation of a 5-item Tool to Measure Patient Assessment of Clinician Compassion in the Emergency Department.

BACKGROUND: To test if the 5-item compassion measure (a tool previously validated in the outpatient setting to measure patient assessment of clinician compassion) is a valid and reliable tool to quantify a distinct construct (i.e. clinical compassion) among patients evaluated in the emergency department (ED). METHODS: Cross-sectional study conducted in three academic emergency departments in the U.S. between November 2018 and April 2019. We enrolled adult patients who were evaluated in the EDs of the participating institutions and administered the 5-item compassion measure after completion of care in the ED. Validity testing was performed using confirmatory factor analysis. Cronbach\u27s alpha was used to test reliability. Convergent validity with patient assessment of overall satisfaction questions was tested using Spearman correlation coefficients and we tested if the 5-item compassion measure assessed a construct distinct from overall patient satisfaction using confirmatory factor analysis. RESULTS: We analyzed 866 patient responses. Confirmatory factor analysis found all five items loaded well on a single construct and our model was found to have good fit. Reliability was excellent (Cronbach\u27s alpha = 0.93) among the entire cohort. These results remained consistent on sub-analyses stratified by individual institutions. The 5-item compassion measure had moderate correlation with overall patient satisfaction (r = 0.66) and patient recommendation of the ED to friends and family (r = 0.57), but reflected a patient experience domain (i.e. compassionate care) distinctly different from patient satisfaction. CONCLUSIONS: The 5-item compassion measure is a valid and reliable tool to measure patient assessment of clinical compassion in the ED

Coming Back to Life: The Permeability of Past and Present, Mortality and Immortality, Death and Life in the Ancient Mediterranean

The lines between death and life were neither fixed nor finite to the peoples of the ancient Mediterranean. For most, death was a passageway into a new and uncertain existence. The dead were not so much extinguished as understood to be elsewhere, and many perceived the deceased to continue to exercise agency among the living. Even for those more skeptical of an afterlife, notions of coming back to life provided frameworks in which to conceptualize the on-going social, political, and cultural influence of the past. This collection of essays examines how notions of coming back to life shape practices and ideals throughout the ancient Mediterranean. All contributors focus on the common theme of coming back to life as a discursive and descriptive space in which antique peoples construct, maintain, and negotiate the porous boundaries between past and present, mortality and immortality, death and life

Setting our sights on infectious diseases

In May 2019, the Wellcome Centre for Anti-Infectives Research (WCAIR) at the University of Dundee, UK, held an international conference with the aim of discussing some key questions around discovering new medicines for infectious diseases and a particular focus on diseases affecting Low and Middle Income Countries. There is an urgent need for new drugs to treat most infectious diseases. We were keen to see if there were lessons that we could learn across different disease areas and between the preclinical and clinical phases with the aim of exploring how we can improve and speed up the drug discovery, translational, and clinical development processes. We started with an introductory session on the current situation and then worked backward from clinical development to combination therapy, pharmacokinetic/pharmacodynamic (PK/PD) studies, drug discovery pathways, and new starting points and targets. This Viewpoint aims to capture some of the learnings

Alpha 2 agonists for sedation to produce better outcomes from critical illness (A2B Trial): protocol for a multicentre phase 3 pragmatic clinical and cost-effectiveness randomised trial in the UK

Introduction: Almost all patients receiving mechanical ventilation (MV) in intensive care units (ICUs) require analgesia and sedation. The most widely used sedative drug is propofol, but there is uncertainty whether alpha2-agonists are superior. The alpha 2 agonists for sedation to produce better outcomes from critical illness (A2B) trial aims to determine whether clonidine or dexmedetomidine (or both) are clinically and cost-effective in MV ICU patients compared with usual care.Methods and analysis: Adult ICU patients within 48 hours of starting MV, expected to require at least 24 hours further MV, are randomised in an open-label three arm trial to receive propofol (usual care) or clonidine or dexmedetomidine as primary sedative, plus analgesia according to local practice. Exclusions include patients with primary brain injury; postcardiac arrest; other neurological conditions; or bradycardia. Unless clinically contraindicated, sedation is titrated using weight-based dosing guidance to achieve a Richmond-Agitation-Sedation score of −2 or greater as early as considered safe by clinicians. The primary outcome is time to successful extubation. Secondary ICU outcomes include delirium and coma incidence/duration, sedation quality, predefined adverse events, mortality and ICU length of stay. Post-ICU outcomes include mortality, anxiety and depression, post-traumatic stress, cognitive function and health-related quality of life at 6-month follow-up. A process evaluation and health economic evaluation are embedded in the trial.The analytic framework uses a hierarchical approach to maximise efficiency and control type I error. Stage 1 tests whether each alpha2-agonist is superior to propofol. If either/both interventions are superior, stages 2 and 3 testing explores which alpha2-agonist is more effective. To detect a mean difference of 2 days in MV duration, we aim to recruit 1437 patients (479 per group) in 40–50 UK ICUs.Ethics and dissemination: The Scotland A REC approved the trial (18/SS/0085). We use a surrogate decision-maker or deferred consent model consistent with UK law. Dissemination will be via publications, presentations and updated guidelines