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Interest in electronic hand hygiene monitoring systems (EHHMSs) is now widespread throughout the infection control community. We tested 2 types of EHHMS for accuracy. The type B EHHMS captured more HH events with superior accuracy. Hospitals considering an EHHMS should assess the technology’s ability to accurately capture HH performance in the clinical workflow.
Cyber Operational Risk: Cyber risk is routinely cited as one of the most important sources of operational risks facing organisations today, in various publications and surveys. Further, in recent years, cyber risk has entered the public conscience through highly publicised events involving affected UK organisations such as TalkTalk, Morrisons and the NHS. Regulators and legislators are increasing their focus on this topic, with General Data Protection Regulation (“GDPR”) a notable example of this. Risk actuaries and other risk management professionals at insurance companies therefore need to have a robust assessment of the potential losses stemming from cyber risk that their organisations may face. They should be able to do this as part of an overall risk management framework and be able to demonstrate this to stakeholders such as regulators and shareholders. Given that cyber risks are still very much new territory for insurers and there is no commonly accepted practice, this paper describes a proposed framework in which to perform such an assessment. As part of this, we leverage two existing frameworks – the Chief Risk Officer (“CRO”) Forum cyber incident taxonomy, and the National Institute of Standards and Technology (“NIST”) framework – to describe the taxonomy of a cyber incident, and the relevant cyber security and risk mitigation items for the incident in question, respectively.Summary of Results: Three detailed scenarios have been investigated by the working party:
∙Employee leaks data at a general (non-life) insurer: Internal attack through social engineering, causing large compensation costs and regulatory fines, driving a 1 in 200 loss of £210.5m (c. 2% of annual revenue).
∙Cyber extortion at a life insurer: External attack through social engineering, causing large business interruption and reputational damage, driving a 1 in 200 loss of £179.5m (c. 6% of annual revenue).
∙Motor insurer telematics device hack: External attack through software vulnerabilities, causing large remediation / device replacement costs, driving a 1 in 200 loss of £70.0m (c. 18% of annual revenue).
Limitations: The following sets out key limitations of the work set out in this paper:
∙While the presented scenarios are deemed material at this point in time, the threat landscape moves fast and could render specific narratives and calibrations obsolete within a short-time frame.
∙There is a lack of historical data to base certain scenarios on and therefore a high level of subjectivity is used to calibrate them.
∙No attempt has been made to make an allowance for seasonality of renewals (a cyber event coinciding with peak renewal season could exacerbate cost impacts)
∙No consideration has been given to the impact of the event on the share price of the company.
∙Correlation with other risk types has not been explicitly considered.
Conclusions: Cyber risk is a very real threat and should not be ignored or treated lightly in operational risk frameworks, as it has the potential to threaten the ongoing viability of an organisation. Risk managers and capital actuaries should be aware of the various sources of cyber risk and the potential impacts to ensure that the business is sufficiently prepared for such an event. When it comes to quantifying the impact of cyber risk on the operations of an insurer there are significant challenges. Not least that the threat landscape is ever changing and there is a lack of historical experience to base assumptions off. Given this uncertainty, this paper sets out a framework upon which readers can bring consistency to the way scenarios are developed over time. It provides a common taxonomy to ensure that key aspects of cyber risk are considered and sets out examples of how to implement the framework. It is critical that insurers endeavour to understand cyber risk better and look to refine assumptions over time as new information is received. In addition to ensuring that sufficient capital is being held for key operational risks, the investment in understanding cyber risk now will help to educate senior management and could have benefits through influencing internal cyber security capabilities.
Environmental and biological factors contribute to sleep development during infancy. Parenting plays a particularly important role in modulating infant sleep, potentially via the serotonin system, which is itself involved in regulating infant sleep. We hypothesized that maternal neglect and serotonin system dysregulation would be associated with daytime sleep in infant rhesus monkeys. Subjects were nursery-reared infant rhesus macaques (n = 287). During the first month of life, daytime sleep-wake states were rated bihourly (0800–2100). Infants were considered neglected (n = 16) if before nursery-rearing, their mother repeatedly failed to retrieve them. Serotonin transporter genotype and concentrations of cerebrospinal fluid 5-hydroxyindoleacetic acid (5-HIAA) were used as markers of central serotonin system functioning. t tests showed that neglected infants were observed sleeping less frequently, weighed less, and had higher 5-HIAA than non-neglected nursery-reared infants. Regression revealed that serotonin transporter genotype moderated the relationship between 5-HIAA and daytime sleep: in subjects possessing the Ls genotype, there was a positive correlation between 5-HIAA and daytime sleep, whereas in subjects possessing the LL genotype there was no association. These results highlight the pivotal roles that parents and the serotonin system play in sleep development. Daytime sleep alterations observed in neglected infants may partially derive from serotonin system dysregulation.
Lieketso Dee Mohoto-Wa Thaluki, Performer, academic and live sound/voice artist who studied at the University of Cape Town's Drama Department before going on to freelance as a voice coach and performer with a primary interest in voice in performance practice.
South Africa has a vibrant and thought-provoking performance art scene. In this smorgasbord, the work of Chuma Sopotela has struck me as the most interesting. Sopotela is a young black South African woman artist who has been working in the industry in Cape Town for over 15 years and has also travelled internationally. Whether it is that her work stems from a fixation with the physical body or that her physical body reflects and comments on bodies like mine, which I refer to as ‘black woman bodies,’ I am not certain. Sopotela, an artist trained principally as a performer who then segued into performance art, has an ability to use multiple modalities and media in interesting ways. As a black woman, her body both unintentionally and in more pointedly performative ways insists on deconstructing, destabilising and deliberately bringing into question spectators’ ideas of what black woman bodies do and signify.
I have had several interviews with Sopotela, telephonically, via e-mail, and in person, primarily between 2014 and 2016, in which we discussed her work and the work of other artists. In our 2015 e-mail correspondence, Sopotela indicated that: ‘What interests me is the gaze that history has given us. Historical books are not written by us, the black female bodies, but by many white bodies … This gaze was then transferred from generation to generation … Our own gaze as Africans shifted from that of Historical Black Africans to that of the slave traders/oppressor.’
This expression of her interest in how history positions narratives about bodies, particularly black female bodies, resonates strongly with me, as do the corporeal aspects of her works. This chapter is an excavation of Inkukhu Ibeke Iqanda (‘The chicken has laid its eggs’), a work Sopotela first performed in Zurich in 2013, and in South Africa in 2014. In conversation with Sopotela and other theorists, I tease out the potentialities and implications of embodiment, social situatedness and what I see as her articulation of a black feminist performance language. I use these categories in an attempt to position Sopotela's layered and complex practice in the live art field in a context-specific way. I seek to concentrate on ‘the social and contextual nature of knowledge …
Healthcare-associated infections (HAIs) are an important, potentially preventable reason to maintain a clean healthcare environment. However, guidelines from Europe and North America do not concur—European guidelines recommend using neutral detergent (followed by chlorine-based disinfection (CBD) if required), whilst North American guidelines recommend using detergent or hospital-grade disinfectant-detergents for routine cleaning or decontamination of noncritical healthcare environmental surfaces. The objective of this study was to compare the effectiveness on rates of HAIs of: (i) disinfectant-detergents versus detergents; and (ii) the active ingredient of many disinfectant-detergents—quaternary ammonium compounds (QAC)—versus CBD.
A rapid review of systematic reviews was conducted using the following search terms: keywords and controlled vocabulary terms for the concepts of “healthcare environmental surfaces” AND (“QAC-based disinfectants” OR “disinfectant-detergents” OR “decontamination”) AND (“environmental contamination” OR “colonization” OR “HAIs”). The search filters included systematic reviews, guidelines, and technology reports. The following databases were searched: The Cochrane Library; PubMed; and health technology assessment and guideline websites for gray literature. Systematic reviews of studies comparing the effects of disinfectant-detergents with detergent, or comparing QAC with CBD, on rates of HAIs in the healthcare environment were included. Reviews on the cleaning or disinfection of body surfaces or disinfection of invasive medical devices were excluded. Quality assessment was not conducted. Data extraction was performed using a pro forma.
The literature search resulted in 356 titles. From ninety-four potentially relevant abstracts, fifty-seven full-texts were evaluated: fifty-one were excluded (eight non-English) and six were included. All review authors cautioned that the evidence was low level, methodologically poor, subject to confounding, and didn't address adverse outcomes. The reviews identified eight relevant primary studies, three of which compared disinfectant-detergents with detergent and found no difference in rates of HAI. Five studies compared QAC with CBD. All five demonstrated that CBD was superior to QAC and reduced Clostridium difficile infection rates in outbreak contexts. Furthermore, QAC may induce sporulation and microbial resistance.
Low-level evidence suggested that: there is no advantage in using disinfectant-detergents for routine cleaning of noncritical surfaces; CBD is superior to QAC-based disinfection in reducing clostridial infections; and QAC agents may induce sporulation or microbial resistance.
Effective patient engagement is central to patient-centered outcomes research. A well-designed infrastructure supports and facilitates patient engagement, enabling study development and implementation. We sought to understand infrastructure needs from recipients of Patient-Centered Outcomes Research Institute (PCORI) pilot grant awards.
We surveyed recipients of PCORI pilot project awards on self-perceived strengths in engagement infrastructure through PCORI’s Ways of Engaging-Engagement Activity Tool survey, and interviewed leaders of 8 projects who volunteered as exemplars. Descriptive statistics summarized the survey findings. We conducted a thematic analysis of the interview transcripts.
Of the 50 surveyed pilots, 22 answered the engagement infrastructure questions (44% response rate). Survey and interview findings emphasized the importance of committed institutional leadership, ongoing relationships with stakeholder organizations, and infrastructure funding through Clinical and Translational Science Awards, PCORI, and institutional discretionary funds.
These findings highlight the importance of and how to improve upon existing institutional infrastructure.
One of the seminar topics scheduled for the summer of 1955 by the Society for American Archaeology was “The American Southwest: A Problem in Cultural Isolation.” The assignment was to “… examine the assumption that these Southwestern cultures resulted from local acceptance and development of generalized and/or specific traits which can be isolated in distant cultural contexts at earlier times than their climactic developments can be observed in the Southwest.”
We aimed to explore multiple perspectives regarding barriers to and facilitators of advance care planning (ACP) among African Americans to identify similarities or differences that might have clinical implications.
Qualitative study with health disparities experts (n = 5), community members (n = 9), and seriously ill African American patients and caregivers (n = 11). Using template analysis, interviews were coded to identify intrapersonal, interpersonal, and systems-level themes in accordance with a social ecological framework.
Participants identified seven primary factors that influence ACP for African Americans: religion and spirituality; trust and mistrust; family relationships and experiences; patient-clinician relationships; prognostic communication, care preferences, and preparation and control. These influences echo those described in the existing literature; however, our data highlight consistent differences by group in the degree to which these factors positively or negatively affect ACP. Expert participants reinforced common themes from the literature, for example, that African Americans were not interested in prognostic information because of mistrust and religion. Seriously ill patients were more likely to express trust in their clinicians and to desire prognostic communication; they and community members expressed a desire to prepare for and control the end of life. Religious belief did not appear to negate these desires.
Significance of results
The literature on ACP in African Americans may not accurately reflect the experience of seriously ill African Americans. What are commonly understood as barriers to ACP may in fact not be. We propose reframing stereotypical barriers to ACP, such as religion and spirituality, or family, as cultural assets that should be engaged to enhance ACP. Although further research can inform best practices for engaging African American patients in ACP, findings suggest that respectful, rapport-building communication may facilitate ACP. Clinicians are encouraged to engage in early ACP using respectful and rapport building communication practices, including open-ended questions.
The construction chronology of three of the earliest Dunhuang Mogao Grottoes (Caves 268, 272, and 275) has been the subject of ongoing debate for over half a century. This chronology is a crucial topic in terms of further understanding of the establishment of the Dunhuang Mogao Grottoes, early Buddhism in the Gansu corridor, and its relationship with Buddhism developed in the Central Plains. Building upon archaeological, art historical and radiocarbon (14C) dating studies, we integrate new 14C data with these previously published findings utilizing Bayesian statistical modeling to improve the chronological resolution of this issue. Thus, we determine that all three of these caves were constructed around AD 410–440, suggesting coeval rather than sequential construction.
To determine how the movement of patients, equipment, materials, staff, and door openings within the operating room (OR) affect microbial loads at various locations within the OR.
Observation and sampling study.
Academic health center, public hospital.
We first analyzed 27 videotaped procedures to determine the areas in the OR with high and low numbers of people in transit. We then placed air samplers and settle plates in representative locations during 21 procedures in 4 different ORs during 2 different seasons of the year to measure microbial load in colony-forming units (CFU). The temperature and humidity, number of door openings, physical movement, and the number of people in the OR were measured for each procedure. Statistical analysis was conducted using hierarchical regression.
The microbial load was affected by the time of year that the samples were taken. Both microbial load measured by the air samplers and by settle plates in 1 area of the OR was correlated with the physical movement of people in the same area but not with the number of door openings and the number of people in the OR.
Movement in the OR is correlated with the microbial load. Establishing operational guidelines or developing OR layouts that focus on minimizing movement by incorporating desirable internal storage points and workstations can potentially reduce microbial load, thereby potentially reducing surgical site infection risk.
Our aim was to gain insight into the perspectives of patients, close relatives, nurses, and physicians on medication management for patients with a life expectancy of less than 3 months.
We conducted an empirical multicenter study with a qualitative approach, including in-depth interviews with patients, relatives, nurses, specialists, and general practitioners (GPs). We used the constant comparative method and ATLAS.ti (v. 7.1) software for our analysis.
Saturation occurred after 18 patient cases (76 interviews). Some 5 themes covering 18 categories were identified: (1) priorities in end-of-life care, such as symptom management and maintaining hope; (2) appropriate medication use, with attention to unnecessary medication and deprescription barriers; (3) roles in decision making, including physicians in the lead, relatives' advocacy, and pharmacists as suppliers; (4) organization and communication (e.g., transparency of tasks and end-of-life conversations); and (5) prerequisites about professional competence, accessibility and quality of medical records, and financial awareness. Patients, relatives, nurses, specialists, and GPs varied in their opinions about these themes.
Significance of Results:
This study adds to our in-depth understanding of the complex practice of end-of-life medication management. It provides knowledge about the diversity of the perspectives of patients, close relatives, nurses, and physicians regarding beliefs, attitudes, knowledge, skills, behavior, work setting, the health system, and cultural factors related to the matter. Our results might help to draw an interdisciplinary end-of-life medication management guide aimed at stimulating a multidisciplinary and patient-centered pharmacotherapeutic care approach.
To achieve a reliable radiocarbon (14C) date for an object, any contamination that may be of a different age must be removed prior to dating. Samples that have been conserved with treatments such as adhesives, varnishes or consolidants can pose a particular challenge to 14C dating. At the Oxford Radiocarbon Accelerator Unit (ORAU), common examples of such substances encountered include shellac, the acrylic polymers Paraloid B-67 and B-72, and vinyl acetate-derived polymers (e.g. PVA). Here, a non-carbon-containing absorbent substrate called Chromosorb® was deliberately contaminated with a range of varieties or brands of these conservation treatments, as well as two cellulose nitrate lacquers. A selection of chemical pretreatments was tested for their efficiency at removing them. While the varieties of shellac and Paraloid tested were completely removed with some treatments (water/methanol and acetone/methanol/chloroform sequential washes, respectively), no method was found that was capable of completely removing any of the vinyl acetate-derived materials or the cellulose nitrate lacquers. While Chromosorb is not an exact analog of archaeological wood or bone, for example, this study suggests that it may be possible to remove aged shellac and Paraloid from archaeological specimens with standard organic solvent-acid-base-acid pretreatments, but it may be significantly more difficult to remove vinyl acetate-derived polymers and cellulose nitrate lacquers sufficiently to provide reliable 14C dates. The four categories of conservation treatment studied demonstrate characteristic FTIR spectra, while highlighting subtle chemical and molecular differences between different varieties of shellac, Paraloid and cellulose nitrate lacquers, and significant differences between the vinyl acetate derivatives.
Papyri 10012A and 10012B from Illahun, Egypt, provide the earliest astro-chronological datum in history and, while calculated to various years in the 19th century BCE, have never been independently verified. As this datum enables the Middle Kingdom (MK) section of Egyptian historical chronology to be anchored in absolute time, it establishes the principal calendrical timeline for the eastern Mediterranean Bronze Age in the first half of the 2nd millennium BCE. AMS radiocarbon measurements of Papyrus 10012B establish its date range to 1886–1750 BCE, confirming the astronomical calculations and the essential reliability of Egyptian historical chronology for this period. Furthermore, all three leading estimates for the calendar year attribution of the document are supported by this analysis, with the role of a possible growing season effect determining which is most favored.
Single-year spikes in radiocarbon production are caused by intense bursts of radiation from space. Supernovae emit both high-energy particle and electromagnetic radiation, but it is the latter that is most likely to strike the atmosphere all at once and cause a surge in 14C production. In the 1990s, it was claimed that the supernova in 1006 CE produced exactly this effect. With the 14C spikes in the years 775 and 994 CE now attributed to extreme solar events, attention has returned to the question of whether historical supernovae are indeed detectable using annual 14C measurements. Here, we combine new and existing measurements over six documented and putative supernovae, and conclude that no such astrophysical event has yet left a distinct imprint on the past atmospheric 14C record.
Digital humanities researchers often collaborate with computer scientists, but most commonly with those computational researchers who work on the analysis of words and texts. Where collaborations have evolved around imaging, they tend to be on the capture of images, rather than analysis. Computer vision researchers spend their days extracting meaningful information from images and video, but there has been little work applying these techniques in the digital humanities field. In this chapter we describe preliminary work which collab oratively creates an approach to digital humanities that can deal with pictures as pictures, by analysing the visual properties of an image. This emerges through the development of a computational approach to modelling stylistic change, tested in a study of the work of Sir John ‘Kyffin’ Williams, a nationally renowned and prolific Welsh artist. Using images gathered from catalogues and online sources, we evaluate image-based descriptors that represent aspects of the paintings themselves: we investigate colour, edge orientation, and texture measures. We go on to estimate metadata from these descriptors using a leave-one-out methodology to classify paintings by year. We also investigate the incorporation of expert knowledge within this framework by considering a subset of paintings chosen as exemplars by a scholar familiar with Williams's work. This work shows a new avenue of research: analysing artefacts using their pictorial features and using this analysis to group and to classify the work directly. Such work is only possible, however, if the underlying data is openly accessible and suitable for analysis by emerging computational tools and methods.
Digitally enabled research in the humanities creates new knowledge through the use of digital content, using tools and ICT-based methods for the analysis and interpretation of this data, and communicating the results of this work to the widest possible audience using traditional and non-traditional publishing methods, allowing greater engagement with research and research data than was previously possible. This has been called e-Wissenschaft, reflecting that the best examples of digital humanities are a new intellectual practice with elements that distinguish qualitatively the practices of intellectual life in this emergent digital environment from print-based practices.
Radiocarbon dates on samples susceptible to inbuilt age are common in the chronological record of many archaeological and environmental sites. Indeed, fragments of charcoal and wood are sometimes the only materials sufficiently well preserved for dating. However, where high-precision estimates arc required the extra uncertainty associated with such measurements often renders them unusable. This article tests three Bayesian modeling approaches that are designed to tackle this problem. The findings of our study suggest that successful corrections can be made for the inherent age offsets. The most effective and versatile approach was based on a version of outlier analysis. It is hoped that this method will become more widely employed and enable samples susceptible to inbuilt age to be included in high-precision chronologies.