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We use ceramic and obsidian data from the ancient Maya port site of Vista Alegre to discuss long-distance exchange during the Terminal Classic (c. AD 850–1100) period. This is a time often associated with increased international trade relations and the growth of Chichen Itza as a dominant regional power in the northern Maya lowlands. Critical to the increased volume of international trade were the merchants who transported goods along the coast of Yucatan in large trading canoes. By combining a macroscopic assessment of the ceramics with visual, XRF, and INAA analyses of the obsidian artifacts, we gain insight into the various socioeconomic forces at work moving goods around the Peninsula. Given the paucity of Terminal Classic settlement in the interior Yalahau region, Vista Alegre appears to be an isolated site during this period, approximately 40 km from the nearest coastal neighbor. This allows us to focus on coastal exchange as the sole means by which goods arrived at the site. Our preliminary data contribute to the growing literature on the role market economies played in the Maya area, and the increased opportunities this afforded coastal peoples as circum-peninsular trade became more common through time.
In studies of extragalactic radio sources with multiple compact components the determination of which components, if any, are stationary and which moving is of importance. In order to learn about the radio properties of the individual components it is also relevant to be able to register maps made at several wavelengths. Both tasks are usually not possible with VLBI because of the irrecoverable corruption of the fringe phase introduced by the propagation medium and the instrumentation. However, when two or more compact radio sources are separated by only a small angle from each other difference techniques can be used to help tackle both questions.
Introduction: Trauma teams have been shown to improve outcomes in severely injured patients. The criteria used to mobilize trauma teams is highly variable and debated. This study was undertaken to define the triage accuracy at our level 1 trauma centre and identify the criteria predictive of appropriate activations. Methods: A 3-month prospective observational study was performed and all patients presenting to the ER who received a trauma flag were identified. Patient demographics, vital signs, trauma team activation and criteria for activation were documented. Trauma activations were deemed appropriate if the patient met any of the following; airway intervention, needle/tube thoracostomy, resuscitative thoracotomy, ED blood product transfusion, invasive hemodynamic monitoring, central line insertion, emergent OR (<8 hours), admission to ICU, and death within 72 hours. Over and undertriage rates were calculated and a multivariate logistic regression was performed to identify activation criteria predictive of appropraite activations. The activation criteria were then modified and the prospective study was repeated to assess the impact on triage accuracy. Results: Between September to December 2015, 188 patients received a trauma flag. 137 patients met the activation criteria, however only 78 received a trauma team activation. 57% of patients who had TTA met the definition of appropriate activation, while 45% who met criteria for activation met the definition of appropriate. The rates of under and overtriage were 30.4% and 30.3%, respectively. Logistic regression revealed the following criteria to be predictive of appropriate activation; hypotension (OR 10.2 95% CI 2.3,45.5), arrival by HEMS (OR 3.2, 95% CI 1.4,7.6), pedestrian struck (OR 3.5, 95% CI 1.4,8.5) and fall (OR 5.1, 95% CI 1.7, 15.1). Tachycardia (OR 1.1, 95% 0.3,4.6) and high energy MVC (OR 1.4, 95% CI 0.7,3.1) were not found to be predictive. The post-modification study occured between September to December 2016. Data analysis to assess the impact of criteria alteration are currently underway and will be presented at CAEP 2017. Conclusion: Triage accuracy for the mobilization of a multi-disciplinary trauma team is important, both to ensure optimal patient care as well as to reduce unnecessary resource strain. Our previous criteria lead to high rates of undertriage and subsequent modifications have been made. The impact of these changes will be ascertained and presented at CAEP 2017.
The ‘voice quality symbols’ (VoQS) transcription system for voice quality was introduced some 20 years ago, and no major revision has been undertaken since then. In this account we describe the first major revision of the VoQS chart, these changes being mostly in the form of additions to the section on phonation types, but include also changes to the layout of the supralaryngeal settings section. These reflect recent developments in the understanding of the physiological underpinnings of sounds produced in the larynx including certain phonation types.
Few studies have validated ICD-9-CM diagnosis codes for surgical site infection (SSI), and none have validated coding for noninfectious wound complications after mastectomy.
To determine the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes in health insurer claims data to identify SSI and noninfectious wound complications, including hematoma, seroma, fat and tissue necrosis, and dehiscence, after mastectomy.
We reviewed medical records for 275 randomly selected women who were coded in the claims data for mastectomy with or without immediate breast reconstruction and had an ICD-9-CM diagnosis code for a wound complication within 180 days after surgery. We calculated the positive predictive value (PPV) to evaluate the accuracy of diagnosis codes in identifying specific wound complications and the PPV to determine the accuracy of coding for the breast surgical procedure.
The PPV for SSI was 57.5%, or 68.9% if cellulitis-alone was considered an SSI, while the PPV for cellulitis was 82.2%. The PPVs of individual noninfectious wound complications ranged from 47.8% for fat necrosis to 94.9% for seroma and 96.6% for hematoma. The PPVs for mastectomy, implant, and autologous flap reconstruction were uniformly high (97.5%–99.2%).
Our results suggest that claims data can be used to compare rates of infectious and noninfectious wound complications after mastectomy across facilities, even though PPVs vary by specific type of postoperative complication. The accuracy of coding was highest for cellulitis, hematoma, and seroma, and a composite group of noninfectious complications (fat necrosis, tissue necrosis, or dehiscence).
We describe the performance of the Boolardy Engineering Test Array, the prototype for the Australian Square Kilometre Array Pathfinder telescope. Boolardy Engineering Test Array is the first aperture synthesis radio telescope to use phased array feed technology, giving it the ability to electronically form up to nine dual-polarisation beams. We report the methods developed for forming and measuring the beams, and the adaptations that have been made to the traditional calibration and imaging procedures in order to allow BETA to function as a multi-beam aperture synthesis telescope. We describe the commissioning of the instrument and present details of Boolardy Engineering Test Array’s performance: sensitivity, beam characteristics, polarimetric properties, and image quality. We summarise the astronomical science that it has produced and draw lessons from operating Boolardy Engineering Test Array that will be relevant to the commissioning and operation of the final Australian Square Kilometre Array Path telescope.
A simple model is presented for electron acceleration in extragalactic radio sources with two hot spots. The effect of diffusive shock acceleration by multiple shocks is calculated numerically, with adiabatic and synchrotron losses included. It is found for the sources 3C 20 and 3C 268·4 that a consistent set of model parameters exists which reproduce the observations. The model fails to reproduce the observations for the source 3C 196.
Shock drift acceleration of the electrons which produce herringbone structure in type II bursts is considered. A non-coplanar component of the magnetic field within the shock front and an electric field across the shock are taken into account. A quantitative difficulty with shock drift acceleration is identified, and possible ways of overcoming the difficulty are outlined.
Increasing recognition of the extent to which nitrous oxide (N2O) contributes to climate change has resulted in greater demand to improve quantification of N2O emissions, identify emission sources and suggest mitigation options. Agriculture is by far the largest source and grasslands, occupying c. 0·22 of European agricultural land, are a major land-use within this sector. The application of mineral fertilizers to optimize pasture yields is a major source of N2O and with increasing pressure to increase agricultural productivity, options to quantify and reduce emissions whilst maintaining sufficient grassland for a given intensity of production are required. Identification of the source and extent of emissions will help to improve reporting in national inventories, with the most common approach using the IPCC emission factor (EF) default, where 0·01 of added nitrogen fertilizer is assumed to be emitted directly as N2O. The current experiment aimed to establish the suitability of applying this EF to fertilized Scottish grasslands and to identify variation in the EF depending on the application rate of ammonium nitrate (AN). Mitigation options to reduce N2O emissions were also investigated, including the use of urea fertilizer in place of AN, addition of a nitrification inhibitor dicyandiamide (DCD) and application of AN in smaller, more frequent doses. Nitrous oxide emissions were measured from a cut grassland in south-west Scotland from March 2011 to March 2012. Grass yield was also measured to establish the impact of mitigation options on grass production, along with soil and environmental variables to improve understanding of the controls on N2O emissions. A monotonic increase in annual cumulative N2O emissions was observed with increasing AN application rate. Emission factors ranging from 1·06–1·34% were measured for AN application rates between 80 and 320 kg N/ha, with a mean of 1·19%. A lack of any significant difference between these EFs indicates that use of a uniform EF is suitable over these application rates. The mean EF of 1·19% exceeds the IPCC default 1%, suggesting that use of the default value may underestimate emissions of AN-fertilizer-induced N2O loss from Scottish grasslands. The increase in emissions beyond an application rate of 320 kg N/ha produced an EF of 1·74%, significantly different to that from lower application rates and much greater than the 1% default. An EF of 0·89% for urea fertilizer and 0·59% for urea with DCD suggests that N2O quantification using the IPCC default EF will overestimate emissions for grasslands where these fertilizers are applied. Large rainfall shortly after fertilizer application appears to be the main trigger for N2O emissions, thus applicability of the 1% EF could vary and depend on the weather conditions at the time of fertilizer application.
There has been considerable uncertainty in the nature of the regions from which carbon and narrow hydrogen lines have been observed. Specifically there are two different models. In model I the lines originate in low-density Hiregions that are basically atomic, and stimulated emission enhances the line intensity by an order of magnitude. In model II the lines originate in the outer layers of very dense molecular regions and are due primarily to spontaneous emission. The first model is generally accepted and used by the astronomical community. However, we believe that the second is correct.
The National Healthcare Safety Network classifies breast operations as clean procedures with an expected 1%–2% surgical site infection (SSI) incidence. We assessed differences in SSI incidence following mastectomy with and without immediate reconstruction in a large, geographically diverse population.
Retrospective cohort study
Commercially insured women aged 18–64 years with ICD-9-CM procedure or CPT-4 codes for mastectomy from January 1, 2004 through December 31, 2011
Incident SSIs within 180 days after surgery were identified by ICD-9-CM diagnosis codes. The incidences of SSI after mastectomy with and without immediate reconstruction were compared using the χ2 test.
From 2004 to 2011, 18,696 mastectomy procedures among 18,085 women were identified, with immediate reconstruction in 10,836 procedures (58%). The incidence of SSI within 180 days following mastectomy with or without reconstruction was 8.1% (1,520 of 18,696). In total, 49% of SSIs were identified within 30 days post-mastectomy, 24.5% were identified 31–60 days post-mastectomy, 10.5% were identified 61–90 days post-mastectomy, and 15.7% were identified 91–180 days post-mastectomy. The incidences of SSI were 5.0% (395 of 7,860) after mastectomy only, 10.3% (848 of 8,217) after mastectomy plus implant, 10.7% (207 of 1,942) after mastectomy plus flap, and 10.3% (70 of 677) after mastectomy plus flap and implant (P<.001). The SSI risk was higher after bilateral compared with unilateral mastectomy with immediate reconstruction (11.4% vs 9.4%, P=.001) than without (6.1% vs 4.7%, P=.021) immediate reconstruction.
SSI incidence was twice that after mastectomy with immediate reconstruction than after mastectomy alone. Only 49% of SSIs were coded within 30 days after operation. Our results suggest that stratification by procedure type facilitates comparison of SSI rates after breast operations between facilities.
be a line arrangement in the complex projective plane
. We define and describe the inclusion map of the boundary manifold, the boundary of a closed regular neighbourhood of
, in the exterior of the arrangement. We obtain two explicit descriptions of the map induced on the fundamental groups. These computations provide a new minimal presentation of the fundamental group of the complement.
This paper describes the system architecture of a newly constructed radio telescope – the Boolardy engineering test array, which is a prototype of the Australian square kilometre array pathfinder telescope. Phased array feed technology is used to form multiple simultaneous beams per antenna, providing astronomers with unprecedented survey speed. The test array described here is a six-antenna interferometer, fitted with prototype signal processing hardware capable of forming at least nine dual-polarisation beams simultaneously, allowing several square degrees to be imaged in a single pointed observation. The main purpose of the test array is to develop beamforming and wide-field calibration methods for use with the full telescope, but it will also be capable of limited early science demonstrations.
To evaluate the efficacy of a Belly Board immobilisation device for rectal cancer patients.
Materials and methods
A randomised trial in patients receiving neo-adjuvant chemoradiation for rectal carcinoma was established. Patients were treated, prone with control arm, according to standard departmental protocol and experimental arm with the use of a Belly Board. All treatments were planned using a three-field technique. The primary endpoints were reproducibility and irradiated small bowel volume. Questionnaires were used to assess secondary endpoints of patient comfort, ease of set-up and acute toxicities.
Pre-planned interim analysis was performed after recruiting 30 patients. In all, 348 portal images were analysed retrospectively. Around 8 out of 12 parameters measuring set-up reproducibility were in favour of the Belly Board arm. Random error in the anterior–posterior direction was improved and statistically significant in the experimental arm (95% CI; p≤0·05). Small bowel V15 was significantly lower in the Belly Board position (mean V15=14·5%) compared with the standard position (mean V15=21·4%), paired t-test 95% CI; p=0·035. Also, patients’ comfort satisfaction was greater in the Belly Board arm.
Set-up reproducibility, small bowel V15, patient comfort and satisfaction were all significantly improved by the use of the Belly Board.
In horses, successful in vitro fertilization procedures are limited by our inability to consistently mature equine oocytes by in vitro methods. Growth hormone (GH) is an important regulator of female reproduction in mammals, playing an important role in ovarian function, follicular growth and steroidogenesis. The objectives of this research were to investigate: the effects of equine growth hormone (eGH) and insulin-like growth factor-I (IGF-I) on the in vitro maturation (IVM) of equine oocytes, and the effects of eGH in addition to estradiol (E2), gonadotropins (FSH and LH) and fetal calf serum (FCS) on IVM. We also evaluated the cytoskeleton organization of equine oocytes after IVM with eGH. Equine oocytes were aspirated from follicles <30 mm in diameter and matured for 30 h at 38.5°C in air with 5% CO2. In experiment 1, selected cumulus–oocyte complexes (COCs) were randomly allocated as follows: (a) control (no additives); (b) 400 ng/ml eGH; (c) 200 ng/ml IGF-I; (d) eGH + IGF-I; and (e) eGH + IGF-I + 200 ng/ml anti-IGF-I. In addition to these treatment groups, we also added 1 μg/ml E2, 5 IU/ml FSH, 10 IU/ml LH and 10% FCS in vitro (experiment 2). Oocytes were stained with markers for microtubules (anti-α-tubulin antibody), microfilaments (AlexaFluor 488 Phalloidin) and chromatin (TO-PRO3-iodide) and assessed via confocal microscopy. No difference was observed when eGH and IGF-I was added into our IVM system. However, following incubation with eGH alone (40%) and eGH, E2, gonadotropins and FCS (36.6%) oocytes were classified as mature v. 17.6% of oocytes in the control group (P < 0.05). Matured equine oocytes showed that a thin network of filaments concentrated within the oocyte cortex and microtubules at the metaphase spindle showed a symmetrical barrel-shaped structure, with chromosomes aligned along its midline. We conclude that the use of E2, gonadotropins and FCS in the presence of eGH increases the number of oocytes reaching oocyte competence.
This article revives consideration of the Industrial Areas Foundation (IAF), a network of Alinsky-style community organizing institutions supported by the Catholic Church, as an object of theological and ethical reflection. After describing the IAF and its organizing practices, it advances two claims. First, the IAF offers Catholic social teaching a concept of power that can sharpen its understanding of social change. Second, the IAF offers a promising model of parish social ministry. Specifically, it offers a pedagogy and praxis of political agency that enhances the parish's ability to live out its calling to be the church, and to be a mediating institution of public life. Such a model integrates evangelical impulses into the “public church” framework for conceiving Christianity's relationship to civil society.