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This essay which analyses the contribution made by Malthus opens by describing the intellectual context offered by the late 18th and early 19th centuries when scientific discoveries and technological advances inspired some thinkers to envision utopia. Malthus wrote his first treatise on population to further a debate with his father. In his essay Malthus elaborated on the ideas of other thinkers about the limits of subsistence and population increase to reveal their socioeconomic implications. Malthus could envision no human means that would prevent population from growing faster than its means of subsistence and he disputed the perfectibility of man or human society. Because of his essay Malthus was appointed professor of political economy at a college in Hertfordshire and spent the rest of his life revising his first effort and publishing another major work. Malthus believed that charity could have a detrimental effect on poverty and that the impoverished would be better served if they were given an opportunity to work or an education. He argued that initiatives to alleviate a problem could exacerbate it if they were based on an inadequate understanding. Malthus affected other thinkers such as Darwin and Wallace Herbert Spencer and Marx (who deplored Malthuss ideas) and blazed a trail of influence into the 20th century. The continued existence of the two opposing views that science can solve all problems and that poverty can not be eliminated may reflect a difference of predisposition rather than the force of reason. The impending crisis caused by unchecked consumption of nonrenewable resources and population growth is of such magnitude today that few are willing to accept its inevitability.

This article describes decision making leadership and political organization among the indigenous Nambiquara of Brazil. The author describes the Nambiquara before their contact with Western civilization. The Nambiquara live in western Brazil near the Bolivian border. Their habitat was discovered around 1910 and then ignored until around 1960 when a road was built parallel to the old telegraph lines. The region is a mix of savanna and forest. Villages are comprised of two or three thatched houses of related kin. Trees are felled for gardens and left in place before burning which provides the soil with nutrients before the bush takes over. Gardens include staples such as corn and manioc as well as beans peppers tobacco cotton yams and sweet potatoes. The Nambiquara move away after all the good gardening places are used up. Meat is obtained by men hunting with bows and arrows. Animals are only raised as pets. Women are responsible for gardening. The associations of men with animals and women with plants is captured in the symbolism of songs the shape of rituals and the meaning of their myths. Sharing is a basic value. Although there is no word for "generosity" there is a word for "stinginess." Important decisions are made by consensus even though this is a slow process. Men are the political authorities. When a member of the group is unwilling to maintain the group norms he leaves to live elsewhere. The Nambiquara identify the village as their social group and recognize one leader ("a capable one") per village. Leaders must be hunters and gardeners generous wise and not bossy. The relationship between leaders and followers is influence and not authority. Political life is a balance of individualism and equality and shaped by abundance.

Life on Earth is driven by energy. Autotrophs take it from solar radiation and heterotrophs take it from autotrophs. Energy captured slowly by photosynthesis is stored up, and as denser reservoirs of energy have come into being over the course of Earth's history, heterotrophs that could use more energy evolved to exploit them.Homo sapiens is such a heterotroph; indeed, the ability to use energy extra-somatically (outside the body) enables human beings to use far more energy than any other heterotroph that has ever evolved. The control of fire and the exploitation of fossil fuels have made it possible forHomo sapiens to release, in a short time, vast amounts of energy that accumulated long before the species appeared. By using extrasomatic energy to modify more and more of its environment to suit human needs, the human population effectively expanded its resource base so that for long periods it has exceeded contemporary requirements. This allowed an expansion of population similar to that of species introduced into extremely propitious new habitats, such as rabbits in Australia or Japanese beetles in the United States. The world's present population of over 5.5 billion is sustained and continues to grow through the use of extrasomatic energy. But the exhaustion of fossil fuels, which supply three quarters of this energy, is not far off, and no other energy source is abundant and cheap enough to take their place. A collapse of the earth's human population cannot be more than a few years away. If there are survivors, they will not be able to carry on the cultural traditions of civilization, which require abundant, cheap energy. It is unlikely, however, that the species itself can long persist without the energy whose exploitation is so much a part of itsmodus vivendi. The human species may be seen as having evolved in the service of entropy, and it cannot be expected to outlast the dense accumulations of energy that have helped define its niche. Human beings like to believe they are in control of their destiny, but when the history of life on Earth is seen in perspective, the evolution ofHomo sapiens is merely a transient episode that acts to redress the planet's energy balance.

Neuromuscular blocking agents (NMBAs), or “paralytics,” often are deployed in the sickest patients in the intensive care unit (ICU) when usual care fails. Despite the publication of guidelines on the use of NMBAs in the ICU in 2002, clinicians have needed more direction to determine which patients would benefit from NMBAs and which patients would be harmed. Recently, new evidence has shown that paralytics hold more promise when used in carefully selected lung injury patients for brief periods of time. When used in early acute respiratory distress syndrome (ARDS), NMBAs assist to establish a lung protective strategy, which leads to improved oxygenation, decreased pulmonary and systemic inflammation, and potentially improved mortality. It also is increasingly recognized that NMBAs can cause harm, particularly critical illness polyneuromyopathy (CIPM), when used for prolonged periods or in septic shock. In this review, we address several practical considerations for clinicians who use NMBAs in their practice. Ultimately, we conclude that NMBAs should be considered a lung protective adjuvant in early ARDS and that clinicians should consider using an alternative NMBA to the aminosteroids in septic shock with less severe lung injury pending further studies.

A 44-year-old African-American woman was admitted with four months of intermittent “shock-like” sensations in her chest radiating to both arms; she developed left arm weakness just prior to admission. A cervical spine magnetic resonance imaging (MRI) demonstrated intramedullary enhancement from C1 to T1 (Fig. 1 Panel a). Figure 1. Cervical spine magnetic resonance imaging (MRI) of a 44-year-old African-American woman. Panel a: MRI with gadolinium contrast 3 weeks prior to admission. Panel b: MRI with gadolinium contrast after 8 weeks of corticosteroid therapy. Neurologic examination showed 4/5 strength of left wrist flexors and extensors, decreased bilateral light touch and pinprick sensation from C5 to T5, and hyperalgesia bilaterally from T1 to T3. Chest x-ray showed hilar adenopathy. Serum angiotensin converting enzyme level was 191 U/L (normal 9–67). Lumbar puncture was remarkable for a protein of 54 mg/dl (normal 15–45) and glucose of 30 mg/dl (normal 45–80; serum glucose 106). Transbronchial biopsy showed non-caseating granulomas. Sarcoidosis is an idiopathic inflammatory disease characterized by non-caseating granulomas affecting any organ. Neurologic involvement occurs in 5–17 % of sarcoidosis patients, with 0.43 % having spinal cord involvement.1 The most common cerebrospinal fluid findings are elevated protein and hypoglycorrhachia, presumably a manifestation of chronic meningeal inflammation.2 Owing to the invasive nature of spinal cord biopsy, neurosarcoidosis is often diagnosed with extraneural tissue and the appropriate clinical syndrome.3,4 Treatment generally includes immunosuppressive agents. This patient’s neurological deficits and radiographic abnormalities improved with corticosteroids (Fig. ​(Fig.11 Panel b).