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In January 2017, Washington, DC, hosted the 58th United States presidential inauguration. The DC Department of Health leveraged multiple health surveillance approaches, including syndromic surveillance (human and animal) and medical aid station–based patient tracking, to detect disease and injury associated with this mass gathering.
Patient data were collected from a regional syndromic surveillance system, medical aid stations, and an internet-based emergency department reporting system. Animal health data were collected from DC veterinary facilities.
Of 174 703 chief complaints from human syndromic data, there were 6 inauguration-related alerts. Inauguration attendees who visited aid stations (n = 162) and emergency departments (n = 180) most commonly reported feeling faint/dizzy (n = 29; 17.9%) and pain/cramps (n = 34;18.9%). In animals, of 533 clinical signs reported, most were gastrointestinal (n = 237; 44.5%) and occurred in canines (n = 374; 70.2%). Ten animals that presented dead on arrival were investigated; no significant threats were identified.
Use of multiple surveillance systems allowed for near-real-time detection and monitoring of disease and injury syndromes in humans and domestic animals potentially associated with inaugural events and in local health care systems.
The current study examined whether social status and social integration, two related but distinct indicators of an adolescent's standing within a peer network, mediate the association between risky symptoms (depressive symptoms and deviant behavior) and substance use across adolescence. The sample of 6,776 adolescents participated in up to seven waves of data collection spanning 6th to 12th grades. Scores indexing social status and integration were derived from a social network analysis of six schools and subsequent psychometric modeling. Results of latent growth models showed that social integration and status mediated the relation between risky symptoms and substance use and that risky symptoms mediated the relation between social standing and substance use during the high school transition. Before this transition, pathways involving deviant behavior led to high social integration and status and in turn to substance use. After this transition, both deviant behavior and depressive symptoms led to low social integration and status and in turn greater substance use. These findings suggest that the high school transition is a risky time for substance use related to the interplay of increases in depressive symptoms and deviant behavior on the one hand and decreases in social status and integration on the other.
This article examines key barriers to business sustainability discussed at a multidisciplinary conference held at the Harvard Business School in 2018. Drawing on perspectives from both the historical and business literatures, speakers debated the historical success of and future opportunities for voluntary business actions to advance sustainability. Roadblocks include misaligned incentives, missing institutions, inertia of economic systems, and the concept of sustainability itself. Overcoming these roadblocks will require systematic interventions and alternative normative concepts.
Timing of weed emergence and seed persistence in the soil influence the ability to implement timely and effective control practices. Emergence patterns and seed persistence of kochia populations were monitored in 2010 and 2011 at sites in Kansas, Colorado, Wyoming, Nebraska, and South Dakota. Weekly observations of emergence were initiated in March and continued until no new emergence occurred. Seed was harvested from each site, placed into 100-seed mesh packets, and buried at depths of 0, 2.5, and 10 cm in fall of 2010 and 2011. Packets were exhumed at 6-mo intervals over 2 yr. Viability of exhumed seeds was evaluated. Nonlinear mixed-effects Weibull models were fit to cumulative emergence (%) across growing degree days (GDD) and to viable seed (%) across burial time to describe their fixed and random effects across site-years. Final emergence densities varied among site-years and ranged from as few as 4 to almost 380,000 seedlings m−2. Across 11 site-years in Kansas, cumulative GDD needed for 10% emergence were 168, while across 6 site-years in Wyoming and Nebraska, only 90 GDD were needed; on the calendar, this date shifted from early to late March. The majority (>95%) of kochia seed did not persist for more than 2 yr. Remaining seed viability was generally >80% when seeds were exhumed within 6 mo after burial in March, and declined to <5% by October of the first year after burial. Burial did not appear to increase or decrease seed viability over time but placed seed in a position from which seedling emergence would not be possible. High seedling emergence that occurs very early in the spring emphasizes the need for fall or early spring PRE weed control such as tillage, herbicides, and cover crops, while continued emergence into midsummer emphasizes the need for extended periods of kochia management.
This study aimed to (a) examine eHealth literacy, beliefs, and behaviours in parents of children with complex CHD, and (b) identify parents’ preferences for the content, format, features, and functions of eHealth resources for CHD.
Materials and methods
Families (n=198) of children born between 2008 and 2011 and diagnosed with CHD requiring surgery were mailed a survey assessing a range of variables including eHealth literacy, beliefs, and behaviours as well as preferences for the format, functions, features, and content of eHealth resources for CHD.
A total of 132 parents (83 mothers, 49 fathers) completed the survey (response rate: 50%). Mothers (96%) were more likely to access eHealth resources than fathers (83%, χ2=6.74, p=0.009). Despite high eHealth resource use, eHealth literacy was relatively low, with results demonstrating considerable and widespread gaps in awareness of, access to, and communication about eHealth resources. Over 50% of parents reported that decisions regarding their child’s healthcare were influenced, to some extent, by web-based resources. Barriers to doctor–patient communication about eHealth included limited consultation time and concern about doctors’ disapproval. Participants demonstrated a strong desire for “eHealth prescriptions” from their child’s healthcare team, and perceived a wide range of eHealth topics as highly important, including treatment-related complications as well as physical, cognitive, and emotional development in children with CHD.
Results suggest a need for stronger, more proactive partnerships between clinicians, researchers, educators, technologists, and patients and families to bring about meaningful innovations in the development and implementation of eHealth interventions in paediatric cardiology.
New optical observations of field stars in the Large Magellanic Cloud from the ground and with the Hubble Space Telescope provide the basis for investigations of the history of field star formation in our nearest galactic neighbor. Results from WFPC2 photometry of field stars indicate that the stellar initial mass function for stars around 1 M⊙ is similar to that in the solar neighborhood. Long-term variations occurred in the average SFR with enhanced activity in the past 2–4 Gyr, a fallow period about 2–10 Gyr in the past, and an initial phase of astration ~12 Gyr ago. The recent increase in field star formation is less than that for the birth of compact star clusters; the cluster formation rate does not give a complete evolutionary picture.
We present here preliminary results of our program to obtain rough abundance estimates for > 104 red giant branch and red clump stars in four fields of the LMC. The derived abundance distributions will be a strong constraint on models of the LMC's star-formation history based on field star color-magnitude diagrams.
The Large Magellanic Cloud (LMC) is unique among galaxies in the Local Group in that it is the most massive non-spiral, is relatively gas-rich, and is actively forming stars. Determining its star-formation rate (SFR) as a function of time will be a cornerstone in our understanding of galaxy evolution. The best method of deriving a galaxy's past SFR is to compare the densities of stars in a color-magnitude diagram (CMD), a Hess diagram, with model Hess diagrams. The LMC has a complex stellar population with ages ranging from 0 to ~ 14 Gyr and metallicities from −2 ≲ [Fe/H] ≲ −0.4, and deriving its SFR and simultaneously constraining model input parameters (distance, age-metallicity relation, reddening, and stellar models) requires well-populated CMDs that span the magnitude range 15 ≤ V ≤ 24. Although existing CMDs of field stars in the LMC show tantalizing evidence for a significant burst of star formation that occurred ~ 3 Gyr ago (for examples, see Westerlund et al. 1995; Vallenari et al. 1996; Elson, et al. 1997; Gallagher et al. 1999, and references therein), estimates of the enhancement in the SFR vary from factors of 3 to 50. This uncertainty is caused by the relatively large photometric errors that plague crowded ground-based images, and the small number statistics that plague CMDs created from single Wide Field Planetary Camera 2 (WFPC2) images.
The benefits of fetoscopic laser photocoagulation (FLP) for treatment of twin-to-twin transfusion syndrome (TTTS) have been recognized for over a decade, yet access to FLP remains limited in many settings. This means at a population level, the potential benefits of FLP for TTTS are far from being fully realized. In part, this is because there are many centers where the case volume is relatively low. This creates an inevitable tension; on one hand, wanting FLP to be readily accessible to all women who may need it, yet on the other, needing to ensure that a high degree of procedural competence is maintained. Some of the solutions to these apparently competing priorities may be found in novel training solutions to achieve, and maintain, procedural proficiency, and with the increased utilization of ‘competence based’ assessment and credentialing frameworks. We suggest an under-utilized approach is the development of collaborative surgical services, where pooling of personnel and resources can improve timely access to surgery, improve standardized assessment and management of TTTS, minimize the impact of the surgical learning curve, and facilitate audit, education, and research. When deciding which centers should offer laser for TTTS and how we decide, we propose some solutions from a collaborative model.
Brain-derived neurotrophic factor (BDNF) Val66Met polymorphism contributes to the development of depression (major depressive disorder, MDD), but it is unclear whether neural effects observed in healthy individuals are sustained in MDD.
To investigate BDNF Val66Met effects on key regions in MDD neurocircuitry: amygdala, anterior cingulate, middle frontal and orbitofrontal regions.
Magnetic resonance imaging scans were acquired in 79 persons with MDD (mean age 49 years) and 74 healthy volunteers (mean age 50 years). Effects on surface area and cortical thickness were examined with multiple comparison correction.
People who were Met allele carriers showed reduced caudal middle frontal thickness in both study groups. Significant interaction effects were found in the anterior cingulate and rostral middle frontal regions, in which participants in the MDD group who were Met carriers showed the greatest reduction in surface area.
Modulatory effects of the BDNF Val66Met polymorphism on distinct subregions in the prefrontal cortex in MDD support the neurotrophin model of depression.
The fourth season of the Fezzan Project continued the interdisciplinary approaches of previous seasons. Geographical and environmental work focused principally in sampling sediments for scientific dating and with integrating ground observation with remote sensing data. Excavations continued at Old Germa, where the site has now reached Garamantian levels. In a separate development, the tentative identification has been made of an early mosque at the site, in an area adjacent to the G1 excavation trench. Substantial results were gained from work aimed at enhancing the important data recorded by Charles Daniels in his earlier excavations and survey in the Wadi al-Hayat. The enhancement of the Daniels' survey archive was integrated with completion of the wider prospection being undertaken by the new project. This survey included fieldwalking, standing building survey, analysis of the foggara irrigation systems and recording of rock art scenes. Finds work comprised the finalisation of a pottery type series for the Germa area, the study of small finds from the recent survey work, botanical analysis and completion of lithics recording. A programme of radiocarbon dating is now being undertaken to improve the phasing of sites and monuments. The first two volumes of final reports are now in preparation.
The ‘Burials and Identity’ team of the Desert Migrations Project carried out two main excavations in the 2009 season, at the monumental Garamantian cemeteries of TAG001 and TAG012, by the Taqallit headland. In addition, a detailed survey was made of cemeteries and other sites on the west side of the Taqallit headland, to set the two main cemetery excavations in context. A total of over 2,100 individual burials was recorded in this small area of a few square kilometres. This cemetery survey was combined with further research on the well-preserved foggara systems in this area, which originate at the escarpment among the cemeteries and run in a north-westerly direction towards the valley centre, where some additional Garamantian settlement sites were also located. The foggara research also involved excavation at four locations to try to elucidate issues relating to the dating of these.
A total of 22 burials was investigated at TAG001, an imposing cemetery of stone-built stepped tombs that had been badly damaged by illegal bulldozing in the 1990s. Although these had been subjected to robbing at some point in the past, many preserved considerable parts of the skeletons buried within and some surprisingly complete artifact groups. Of particular importance are a series of Garamantian necklaces in ostrich eggshell, carnelian and glass beads, which we were able to lift in perfect sequence and restring. At TAG012, about 2 km north of the Taqallit headland, we excavated an area of a mudbrick cemetery, exposing 12 square/rectangular tombs. Two further burials were excavated at the dispersed cemetery TAG006, in both cases involving tombs that had an interesting stratigraphical relationship with foggara spoil mounds.
Survey by the DMP Burials and Identity team around the Tāqallit headland in 2009–2010 has revealed in exceptional detail a well-preserved Garamantian landscape, comprising extensive cemeteries, foggara irrigation systems and numerous oasis settlements. However, this remarkable survival of the Garamantian landscape was found in 2010 to be under direct and imminent threat of destruction. This report describes the landscape features recorded and the steps taken to try to preserve the evidence from obliteration in the face of modern agricultural development. Important new information was recorded about the date and furnishing of some key types of Proto-Urban tombs, linking with a refined view of the relationship of these cemeteries to contemporary foggara construction and the creation of pioneer farming settlement in the Tāqallit region. Significant additional details of the foggara systems were recorded through a combination of satellite image interpretation, surface observation and selective descent into rock-cut shafts. The discovery of an unexpected number of ancient settlements and structures of Garamantian date represents another major achievement of the work. The composite picture of the Garamantian landscape encompassing cemeteries, foggaras and settlements is arguably the most complete yet recorded in the FP/DMP work.
Survey and excavation by the Burials and Identity team of the Desert Migrations Project (DMP) focused in 2011 on the so-called Royal Cemetery of the Garamantes close to the Jarma escarpment, a few km south of Old Jarma. This Late Garamantian cemetery contains two distinct zones (GSC030 and GSC031) of monumental rectangular stepped tombs, which were plaster-coated and fronted by massive offering tables and stelae. Previous dating evidence has suggested they span the fourth to sixth centuries AD. However, many questions remain about the cemetery and the overall recording of the monuments had hitherto been left incomplete. The 2011 work focused on the excavation of one of the larger monuments in GSC030 and several of the smaller tombs in the neighbouring GSC031, along with an overall survey of both cemetery areas and a detailed record of the stelae and offering tables still present in considerable numbers. In addition, the team made a survey along the escarpment between the Royal Cemetery and Zinkekrā, completing and uniting the various surveys carried out by the DMP around Zinkekrā, Watwāt and the Jarma Escarpment. A survey of foggaras and settlement in the ad-Dīsa embayment was also undertaken.