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This paper uses evidence from a previously unresearched ecclesiastical textile associated with Archbishop John Morton (c 1420−1500) to generate new insights into the material culture of the Roman Catholic faith before, during and after the penal period in England (c 1558−1829). This composite textile was initially thought to be made up of fragments of a late 1400s cope bearing Morton’s rebus, reconfigured as an altar frontal, which had survived in the house of an important Roman Catholic family. The embroidered motifs include a unique Lily Crucifix. The textile’s complex biography is ‘unpicked’ using physical and textual evidence to understand its changing forms, roles and significance. Analysis of the material and construction, combined with evidence gained through X-radiography, showed the frontal to be composed of parts of a cope and at least one other vestment, with a now missing image of the Annunciation. Mapping the stages of fragmentation, removal and re-modelling demonstrates the transformation of significant mainstream vestments into other forms. The paper illuminates aspects of Morton’s faith and provides new insights into the practices of recusant Roman Catholics.
Although the argument of the Essay on population originated in a family disagreement between Malthus and his father Daniel, who idolized Rousseau, and the Essay itself attacks Condorcet and Godwin, both of whom drew on Rousseau's ideas about human perfectibility, Malthus's project can plausibly be seen as an extension of the social theory set out above all in Rousseau's Discourse on the origin of inequality. Malthus was animated by some of Rousseau's characteristic concerns, and he deployed recognizable versions of some of Rousseau's distinctive arguments, in particular relating to the natural sociability and natural condition of humankind, conjectural history, and political economy, especially with respect to the question of balanced growth. His arguments about ‘decent pride’, furthermore, that were emphasized in later editions of the Essay map neatly onto what has been called ‘uninflamed amour-propre’ in the Rousseau literature. When we treat the social question as a nineteenth-century question, or when we locate its origins in the post-Revolutionary political controversies of the 1790s, we risk losing sight of the way in which what was being discussed were variations on mid-eighteenth-century themes.
Background: The antiquated standard reference range of 0.15–0.45 g/L for cerebrospinal fluid total protein (CSF-TP) is well entrenched in medical literature and laboratory operating procedures across the world. Methods: We conducted a web-based survey with a response rate of 34.9% through the listserv of the Canadian Neurological Sciences Federation. Additional laboratory reference data were collated by telephone interview of hospital laboratory technologists across Canada. Results: A total of 142 site responses were obtained: 64.1% from academic/tertiary hospitals and 35.9% from community hospitals. A strong majority (80.4%) of both types of institutions reported using a CSF-TP upper reference limit of 0.45 g/L or less. As a rule, no age adjustments were implemented in CSF-TP-level interpretation. Conclusions: Recent well-powered laboratory reference studies have documented CSF-TP upper reference limits that are above 0.6 g/L starting at age 50, with incremental limits partitioned by subsequent decades of age. The conventional 0.45 g/L limit could lead to false positive results. Our survey suggests there is a need to consider a wide adoption of data-driven, rather than historical, reference values.
Congenital and acquired heart diseases are highly prevalent in developing countries despite limited specialised care. Namibia established a paediatric cardiac service in 2009 with significant human resource and infrastructural constraints. Therefore, patients are referred for cardiac interventions to South Africa.
To describe the diagnoses, clinical characteristics, interventions, post-operative morbidity and mortality, and follow-up of patients referred for care.
Demographics, diagnoses, interventions, intra- and post-operative morbidity and mortality, as well as longitudinal follow-up data of all patients referred to South Africa, were recorded and analysed.
The total cohort constituted 193 patients of which 179 (93%) had CHD and 7% acquired heart disease. The majority of patients (78.8%) travelled more than 400 km to Windhoek before transfer. There were 28 percutaneous interventions. Palliative and definitive surgery was performed in 27 and 129 patients, respectively. Out of 156 patients, 80 (51.3%) had post-operative complications, of which 15 (9.6%) were a direct complication of surgery. Surgical mortality was 8/156 (5.1%, 95% confidence interval 2.2–9.8), with a 30-day mortality of 3.2%. Prolonged ICU stay was associated with a 5% increased risk of death with hazard ratio 1.05, 95% confidence interval 1.02–1.08, p=0.001. Follow-up was complete in 151 (78%) patients for more than 7 years.
Despite the challenges associated with a cardiac programme for referring patients seeking intervention in a neighbouring country and the adverse characteristics of multiple lesions and complexity associated with late presentation, we report good surgical and interventional outcomes. Our goal remains to develop a comprehensive sustainable cardiac service in Namibia.
Miconia (Miconia calvescens DC) was introduced to the East Maui Watershed (EMW) a half-century ago with more than 25 yr of management recorded. Using a historical spatiotemporal data set, we constructed a leptokurtic dispersal kernel with 99% of progeny confined to within 549 m of the nearest maternal source and the remaining 1% dispersed out to 1,636 m. Seedbank persistence, based on postdated recruitment, displayed an exponential decay projecting extinction beyond 20 yr. These parameters are highly congruent to independent interpretations of M. calvescens in Australia and Tahiti. In a simulated stage matrix model, we projected management efforts to locally eradicate a small incipient propagule bank wherein optimal management was achieved with an annual harvest rate that eliminated all juvenile recruits before reaching maturity, until extinction. Based on current pricing for helicopter herbicide ballistic technology (HBT) operations, the optimal, variable cost to locally eradicate this incipient propagule bank was estimated to be less than US$42,000, with ~90% of the effort searching for the most distant 1% of the progeny expended within the first 9 yr after the mature discovery. This variable cost was sensitive to seedbank size, recruitment rate, and dispersal range, but was most sensitive to harvest rates between suboptimal and excess. In a scenario prioritizing the upper region of EMW, we retroactively analyzed past HBT efforts eliminating satellite M. calvescens and determined that 27% of the total effort resulted in 87% of the total protection to this priority asset, with every US$1 invested potentially avoiding US$184 in future costs. Management outside the priority area was less economical, with returns in protection diminishing with distance from the priority upper region. Miconia calvescens is currently not eradicable in the EMW, and full containment of the invasion would require a substantial increase in stable, long-term funding. With limited resources, local eradication of satellite M. calvescens could be the most cost-effective alternative to protecting uninvaded areas prioritized for critical ecosystem functions.
The Pueblo population of Chaco Canyon during the Bonito Phase (AD 800–1130) employed agricultural strategies and water-management systems to enhance food cultivation in this unpredictable environment. Scepticism concerning the timing and effectiveness of this system, however, remains common. Using optically stimulated luminescence dating of sediments and LiDAR imaging, the authors located Bonito Phase canal features at the far west end of the canyon. Additional ED-XRF and strontium isotope (87Sr/86Sr) analyses confirm the diversion of waters from multiple sources during Chaco’s occupation. The extent of this water-management system raises new questions about social organisation and the role of ritual in facilitating responses to environmental unpredictability.
There is increasing awareness of the need to correct for freshwater as well as marine reservoir effects when undertaking radiocarbon (14C) dating of human remains. Here, we explore the use of stable hydrogen isotopes (δ2H), alongside the more commonly used stable carbon (δ13C) and nitrogen isotopes (δ15N), for correcting 14C freshwater reservoir offsets in 10 paired human-faunal dates from graves at the prehistoric cemetery of Shamanka II, Lake Baikal, southern Siberia. Excluding one individual showing no offset, the average human-faunal offset was 515±175 14C yr. Linear regression models demonstrate a strong positive correlation between δ15N and δ2H ratios, supporting the use of δ2H as a proxy for trophic level. Both isotopes show moderate but significant correlations (r2 ~ 0.45, p < 0.05) with 14C offsets (while δ13C on its own does not), though δ2H performs marginally better. A regression model using all three stable isotopes to predict 14C offsets accounts for approximately 65% of the variation in the latter (r2=0.651, p=0.025), with both δ13C and δ2H, but not δ15N, contributing significantly. The results suggest that δ2H may be a useful proxy for freshwater reservoir corrections, though further work is needed.
To describe the investigation and control of a cluster of Serratia marcescens bacteremia in a 505-bed tertiary-care center.
Cluster cases were defined as all patients with S. marcescens bacteremia between March 2 and April 7, 2014, who were found to have identical or related blood isolates determined by molecular typing with pulsed-field gel electrophoresis. Cases were compared using bivariate analysis with controls admitted at the same time and to the same service as the cases, in a 4:1 ratio.
In total, 6 patients developed S. marcescens bacteremia within 48 hours after admission within the above period. Of these, 5 patients had identical Serratia isolates determined by molecular typing, and were included in a case-control study. Exposure to the post-anesthesia care unit was a risk factor identified in bivariate analysis. Evidence of tampered opioid-containing syringes on several hospital units was discovered soon after the initial cluster case presented, and a full narcotic diversion investigation was conducted. A nurse working in the post-anesthesia care unit was identified as the employee responsible for the drug diversion and was epidemiologically linked to all 5 patients in the cluster. No further cases were identified once the implicated employee’s job was terminated.
Illicit drug use by healthcare workers remains an important mechanism for the development of bloodstream infections in hospitalized patients. Active mechanisms and systems should remain in place to prevent, detect, and control narcotic drug diversions and associated patient harm in the healthcare setting.
Objectives: The aim of this study was to evaluate the reliability and validity of three computerized neurocognitive assessment tools (CNTs; i.e., ANAM, DANA, and ImPACT) for assessing mild traumatic brain injury (mTBI) in patients recruited through a level I trauma center emergency department (ED). Methods: mTBI (n=94) and matched trauma control (n=80) subjects recruited from a level I trauma center emergency department completed symptom and neurocognitive assessments within 72 hr of injury and at 15 and 45 days post-injury. Concussion symptoms were also assessed via phone at 8 days post-injury. Results: CNTs did not differentiate between groups at any time point (e.g., M 72-hr Cohen’s d=−.16, .02, and .00 for ANAM, DANA, and ImPACT, respectively; negative values reflect greater impairment in the mTBI group). Roughly a quarter of stability coefficients were over .70 across measures and test–retest intervals in controls. In contrast, concussion symptom score differentiated mTBI vs. control groups acutely), with this effect size diminished over time (72-hr and day 8, 15, and 45 Cohen’s d=−.78, −.60, −.49, and −.35, respectively). Conclusions: The CNTs evaluated, developed and widely used to assess sport-related concussion, did not yield significant differences between patients with mTBI versus other injuries. Symptom scores better differentiated groups than CNTs, with effect sizes weaker than those reported in sport-related concussion studies. Nonspecific injury factors, and other characteristics common in ED settings, likely affect CNT performance across trauma patients as a whole and thereby diminish the validity of CNTs for assessing mTBI in this patient population. (JINS, 2017, 23, 293–303)
This study aimed to review available disaster training options for health care providers, and to provide specific recommendations for developing and delivering a disaster-response-training program for non-disaster-trained emergency physicians, residents, and trainees prior to acute deployment.
A comprehensive review of the peer-reviewed and grey literature of the existing training options for health care providers was conducted to provide specific recommendations.
A comprehensive search of the Pubmed, Embase, Web of Science, Scopus, and Cochrane databases was performed to identify publications related to courses for disaster preparedness and response training for health care professionals. This search revealed 7,681 unique titles, of which 53 articles were included in the full review. A total of 384 courses were found through the grey literature search, and many of these were available online for no charge and could be completed in less than six hours. The majority of courses focused on management and disaster planning; few focused on clinical care and acute response.
There is need for a course that is targeted toward emergency physicians and trainees without formal disaster training. This course should be available online and should utilize a mix of educational modalities, including lectures, scenarios, and virtual simulations. An ideal course should focus on disaster preparedness, and the clinical and non-clinical aspects of response, with a focus on an all-hazards approach, including both terrorism-related and environmental disasters.
HansotiB, KelloggDS, AberleSJ, BroccoliMC, FedenJ, FrenchA, LittleCM, MooreB, SabatoJJr., SheetsT, WeinbergR, ElmesP, KangC. Preparing Emergency Physicians for Acute Disaster Response: A Review of Current Training Opportunities in the US. Prehosp Disaster Med. 2016;31(6):643–647.
Results of protein residue and lithic microwear analyses are reported for Paleoindian and Early Archaic stone tools from a Carolina bay sand rim on the Aiken Plateau of South Carolina, USA. Protein residue analysis is performed using crossover Immunoelectrophoresis (CIEP), and indicates positive results for Bovidae, Cervidae, Galliformes, and Meleagris gallopavo. These results are complemented by a larger immunological study of 135 diagnostic hafted bifaces from South Carolina and Georgia. Among other species identified, bovid residue was found on multiple Paleoindian hafted bifaces, an Early Archaic hafted biface, and a Middle Archaic hafted biface. Results suggest continuity of species selection and availability across the Pleistocene/Holocene boundary and provide no support for the exploitation of extinct fauna. The data do provide compelling evidence for a demographic shift and/or regional extirpation of Bovidae possibly as late as the early mid-Holocene in the Southeast. In addition, microwear analysis of artifacts from Flamingo Bay indicate intensive hide scraping, antler boring, bone graving/planing/pointing, wood whittling, and hafting traces. Microwear data suggest intentional snap-fracture or bipolarization of exhausted or broken Clovis points for reuse as hide scrapers, and use of large bifacial knives and unifacial scrapers in intensive defleshing activities consistent with large animal butchery.
Limited data exist comparing the performance of computerized neurocognitive tests (CNTs) for assessing sport-related concussion. We evaluated the reliability and validity of three CNTs—ANAM, Axon Sports/Cogstate Sport, and ImPACT—in a common sample. High school and collegiate athletes completed two CNTs each at baseline. Concussed (n=165) and matched non-injured control (n=166) subjects repeated testing within 24 hr and at 8, 15, and 45 days post-injury. Roughly a quarter of each CNT’s indices had stability coefficients (M=198 day interval) over .70. Group differences in performance were mostly moderate to large at 24 hr and small by day 8. The sensitivity of reliable change indices (RCIs) was best at 24 hr (67.8%, 60.3%, and 47.6% with one or more significant RCIs for ImPACT, Axon, and ANAM, respectively) but diminished to near the false positive rates thereafter. Across time, the CNTs’ sensitivities were highest in those athletes who became asymptomatic within 1 day before neurocognitive testing but was similar to the tests’ false positive rates when including athletes who became asymptomatic several days earlier. Test–retest reliability was similar among these three CNTs and below optimal standards for clinical use on many subtests. Analyses of group effect sizes, discrimination, and sensitivity and specificity suggested that the CNTs may add incrementally (beyond symptom scores) to the identification of clinical impairment within 24 hr of injury or within a short time period after symptom resolution but do not add significant value over symptom assessment later. The rapid clinical recovery course from concussion and modest stability probably jointly contribute to limited signal detection capabilities of neurocognitive tests outside a brief post-injury window. (JINS, 2016, 22, 24–37)