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40 años de Comunidades Imaginadas. Vidas y sobrevidas de un clásico

Abstract Background Persistent symptoms attributed to Lyme borreliosis often include self-reported cognitive impairment. However, it remains unclear whether these symptoms can be substantiated by objective cognitive testing. Methods For this observational study, cognitive performance was assessed in 280 adults with persistent symptoms attributed to Lyme borreliosis (as part of baseline data collected for the Dutch PLEASE study). Cognitive testing covered the five major domains: episodic memory, working memory / attention, verbal fluency, information-processing speed and executive function. Patients’ profiles of test scores were compared to a large age-, education- and sex-adjusted normative sample using multivariate normative comparison. Performance validity was assessed to detect suboptimal effort, and questionnaires were administered to measure self-reported cognitive complaints, fatigue, anxiety, depressive symptoms and several other psychological factors. Results Of 280 patients, one was excluded as the test battery could not be completed. Of the remaining 279 patients, 239 (85.4%) displayed sufficient performance validity. Patients with insufficient performance validity felt significantly more helpless and physically fatigued, and less orientated. Furthermore, they had a lower education level and less often paid work. Of the total study cohort 5.7% (n = 16) performed in the impaired range. Among the 239 patients who displayed sufficient performance validity, 2.9% (n = 7) were classified as cognitively impaired. No association between subjective cognitive symptoms and objective impairment was found. Conclusions Only a small percentage of patients with borreliosis-attributed persistent symptoms have objective cognitive impairment. Performance validity should be taken into account in neuropsychological examinations of these patients. Self-report questionnaires are insufficiently valid to diagnose cognitive impairment. Trial registration ClinicalTrials.gov NCT01207739. Registered 23 September 2010.

Reseña de: Alimento, Antonella & Stapelbroek, Koen (eds.), The Politics of Commercial Treaties in the Eighteenth Century: Balance of Power, Balance of Trade, Palgrave, Macmillan, 2017, 472 pp., ISBN: 978-3-319-53574-6

Resumen: Introducción: El trastorno por déficit de atención con hiperactividad (TDAH) y su comorbilidad repercuten en la ansiedad social de niños y adolescentes, no obstante, apenas hay estudios que aborden este tema en la adolescencia. El objetivo era evaluar el grado de ansiedad social y analizar la presencia de comorbilidades psiquiátricas (CPS). Metodología: Estudio observacional transversal en el que se incluyeron pacientes de 12-18 años con diagnóstico confirmado de TDAH (DSM-5). Se recogió información sobre la presencia y tipo de CPS y se evaluó la ansiedad social mediante la escala Social Anxiety Scale for Adolescents (SAS-A). Resultados: Participaron 46 especialistas de psiquiatría del niño y del adolescente o neuropediatría, que incluyeron a 234 pacientes. El 68,8% (159) eran varones y el 31,2% (72) mujeres, con edad media de 14,9 años (IC 95%: 14,6-15,1). El 51,7% (121) tenía TDAH de tipo combinado (TC), el 37,2% (87) con predominio del déficit de atención (TDA) y el 9% (21) con predominio hiperactivo-impulsivo (TH). El 97,9% (229 pacientes) recibía tratamiento farmacológico: metilfenidato en el 78,6% (184), lisdexanfetamina en el 15% (35) y atomoxetina en el 4,3% (10).El 50,4% (118) presentaba alguna CPS, con predominio de los trastornos del aprendizaje y de la comunicación (47, 20,1%) y los trastornos de ansiedad (45, 19,2%). Se observó un grado de ansiedad social significativamente mayor en comparación con los valores normales de la escala en la población sana. Los adolescentes con TDA presentaron peores puntuaciones en la escala SAS-A en comparación con adolescentes con TH (p = 0,015). La presencia de trastornos de ansiedad comórbidos se relacionó con peores puntuaciones en la escala SAS-A, reflejando una mayor ansiedad social en estos pacientes (p

Introduction: Attention-deficit/hyperactivity disorder (ADHD) and its comorbidities have an impact on the social anxiety of children and adolescents, but there are practically no studies addressing this topic in adolescence. Our objective was to assess the degree of social anxiety and to analyse the presence of psychiatric comorbidities (PSCs) in adolescents with ADHD. Methodology: We conducted a cross-sectional observational study in patients aged 12–18 years with a confirmed diagnosis of ADHD (DSM-5). We collected data on the presence and type of PSCs and assessed social anxiety by means of the Social Anxiety Scale for Adolescents (SAS-A). Results: Forty-six child and adolescent psychiatrists and paediatric neurologists participated in the study and recruited 234 patients. Of the total patients, 68.8% (159) were male and 31.2% (72) female, with a mean age in the sample of 14.9 years (95% CI, 14.6–15.1). The type of ADHD was combined type (C) in 51.7% (121), predominantly inattentive (PI) in 37.2% (87), and predominantly hyperactive-impulsive (PH) in 9% (21). Of all patients, 97.9% (229) received pharmacological therapy: 78.6% (184) methylphenidate, 15% (35) lisdexamfetamine and 4.3% (10) atomoxetine.We found PSCs in 50.4% of the patients (118), of which the most frequent were learning and communication disorders (20.1%, n = 47) and anxiety disorders (19.2%, n = 45). The patients scored significantly higher in the SAS-A compared to reference values in the healthy population. The scores in the SAS-A were less favourable in adolescents with the PI type compared to those with the PH type (P = .015). The presence of a comorbid anxiety disorder was associated with worst scores in SAS-A (P

The treatment of persistent symptoms attributed to Lyme disease remains controversial. Recently, the PLEASE study did not demonstrate any additional clinical benefit of longer-term versus shorter-term antibiotic treatment. However, the economic impact of the antibiotic strategies has not been investigated.This prospective economic evaluation, adhering a societal perspective, was performed alongside the PLEASE study, a multicenter, placebo-controlled, double-blind 1:1:1 randomized clinical trial in which all patients received open-label intravenous ceftriaxone for two weeks before the 12-week randomized blinded oral antibiotic regimen (doxycycline, clarithromycin plus hydroxychloroquine, or placebo). Between 2010 and 2013, patients (n = 271) with borreliosis-attributed persistent symptoms were enrolled and followed for one year. Main outcomes were costs, quality-adjusted life years, and incremental net monetary benefit of longer-term versus shorter-term antibiotic therapy.Mean quality-adjusted life years (95% CI) were not significantly different (p = 0.96): 0.82 (0.77-0.88) for ceftriaxone/doxycycline (n = 82), 0.81 (0.76-0.88) for ceftriaxone/clarithromycin-hydroxychloroquine (n = 93), and 0.81 (0.76-0.86) for ceftriaxone/placebo (n = 96). Total societal costs per patient (95% CI) were not significantly different either (p = 0.35): €11,995 (€8,823-€15,670) for ceftriaxone/doxycycline, €12,202 (€9,572-€15,253) for ceftriaxone/clarithromycin-hydroxychloroquine, and €15,249 (€11,294-€19,781) for ceftriaxone/placebo. Incremental net monetary benefit (95% CI) for ceftriaxone/doxycycline compared to ceftriaxone/placebo varied from €3,317 (-€2,199-€8,998) to €4,285 (-€6,085-€14,524) over the willingness-to-pay range, and that of ceftriaxone/clarithromycin-hydroxychloroquine compared to ceftriaxone/placebo from €3,098 (-€888-€7,172) to €3,710 (-€4,254-€11,651). For every willingness-to-pay threshold, the incremental net monetary benefits did not significantly differ from zero.The longer-term treatments were similar with regard to costs, effectiveness and cost-effectiveness compared to shorter-term treatment in patients with borreliosis-attributed persistent symptoms after one year of follow-up. Given the results of this study, and taking into account the external costs associated with antibiotic resistance, the shorter-term treatment is the antibiotic regimen of first choice.

The main results of a transient climate simulation of the last 500 years with a coupled atmosphere-ocean model driven by estimated solar variability, volcanic activity and atmospheric concentrations of greenhouse gases are presented and compared with several empirical climate reconstructions. Along the last five centuries the climate model simulates a climate colder than mean 20th century conditions almost globally, and the degree of cooling is clearly larger than in most empirical reconstructions of global and North hemispheric near-surface air temperature (MANN et al., 1998; JONES et al., 1998). The simulated temperatures tend to agree more closely with the reconstruction of ESPER et al. (2002) based on extratropical tree-ring chronologies. The model simulates two clear minima of the global mean temperature around 1700 A.D. (the Late Maunder Minimum) and around 1820 A.D. (the Dalton Minimum). The temperature trends simulated after the recovery from these minima are as large as the observed warming in the 20th century. More detailed results concerning the simulated Late Maunder Minimum, together with a spatially resolved historical reconstruction of the temperature field in Europe, are presented. It is found that the broad patterns of temperature deviations are well captured by the model, with stronger cooling in Central and Eastern Europe and weaker cooling along the Atlantic coast. However, the model simulates an intense drop of air-temperature in the North Atlantic ocean, together with an extensive sea-ice cover south of Greenland and lower salinity in North Atlantic at high latitudes, reminiscent of the Great Salinity Anomaly. Also, during the Late Maunder Minimum the intensities of the Golf Stream and the Kuroshio are reduced. This weakening is consistent with a reduced wind-stress forcing upon the ocean surface.

Artificial intelligence (AI), which includes computing for perception, cognition, and action, raises complicated legal issues. This research investigates AI’s influence and legal implications, focusing on its autonomy in communication and creativity, which raises problems about language, intellectual property, and ethical accountability. Discussions differ depending on whether they are influenced by the Common Law or Civil Law systems. While Common Law defines AI as “computer-generated work,†Civil Law tends to see AI as a legal thing. This research aims to formulate a solid ground for an AI legal framework in the Indonesian national legal system. The research undertaken involves a thorough analysis of academic literature, focusing on the legal and ethical implications of AI, highlighting the need for a nuanced perspective to define its subjectivity. In conclusion, the complex interplay between artificial intelligence (AI) and legal principles involves reframing old terminology. Existing models for AI duty are called into question, and vicarious liability is one possible answer. AI is a derived law problem, so it needs to be carefully calibrated for responsible innovation while also keeping ethics and technological progress in check.

Abstract Artificial Intelligence (AI), encompassing computation for perception, reasoning, and action, poses complex legal considerations. This study explores AI’s impact and its legal ramifications, particularly its autonomy in communication and creation, raising concerns about language, intellectual property, and ethical accountability. Influenced by Common Law and Civil Law systems, discussions vary. Evaluating AI creator liability uncovers intricate connections between AI’s autonomy, intentionality, and creators’ roles. The approach used in this article are based on normative method with multidisciplinary discipline. The results are that though AI creators aren’t directly liable, vicarious liability could link actions to AI behaviors based on programming choices. Balancing innovation and accountability calibrated “creator immunities” are vital. Unchecked immunities could impede responsible AI development; measured immunities might encourage ethical practices, considering AI nuances and societal impacts. Positioning AI as a legal subject necessitates tailored approaches within ethical boundaries. The proposition of AI as a derivative legal subject while setting clear limits is pivotal. Adapting legal systems to evolving AI landscapes and reconciling advancement with societal well-being, is crucial. AI’s intricate accountability, its legal standing, and creator liabilities and immunities demand reshaping legal frameworks for an ethical AI environment. Abstrak Kecerdasan Buatan (AI), yang mencakup komputasi persepsi, penalaran, dan tindakan, menimbulkan pertimbangan hukum yang kompleks. Studi ini mengeksplorasi dampak AI dan konsekuensi hukumnya, terutama otonominya dalam komunikasi dan kreasi, yang menimbulkan kekhawatiran tentang bahasa, kekayaan intelektual, dan akuntabilitas etis. Melalui sistem Common Law dan Civil Law, pembahasannya pun beragam. Mengevaluasi pertanggungjawaban pencipta AI mengungkap hubungan yang rumit antara otonomi, kesengajaan, dan peran pencipta AI. Pendekatan yang digunakan didasarkan pada metode normatif dengan disiplin ilmu yang beragam. Hasilnya adalah bahwa meskipun pencipta AI tidak bertanggung jawab secara langsung, doktrin vicarious liability dapat menghubungkan tindakan dengan perilaku AI berdasarkan pilihan pemrograman. Menyeimbangkan inovasi dan akuntabilitas, kekebalan pencipta yang terukur sangat penting. Kekebalan yang tidak terkendali dapat menghambat pengembangan AI yang bertanggung jawab; kekebalan yang terukur dapat mendorong praktik-praktik etis, dengan mempertimbangkan nuansa AI dan dampak sosial. Memosisikan AI sebagai subjek hukum memerlukan pendekatan yang disesuaikan dengan batasan etika. Proposisi AI sebagai subjek hukum turunan sambil menetapkan batasan yang jelas sangat krusial. Mengadaptasi sistem hukum dengan lanskap AI yang terus berkembang dan menyelaraskan kemajuan dengan kesejahteraan masyarakat, sangatlah vital. Pertanggungjawaban AI yang rumit, kedudukan hukumnya, dan kewajiban serta kekebalan pencipta menuntut pembentukan kembali kerangka kerja hukum untuk lingkungan AI yang etis.