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The ancient human footprints in valley-bottom sediments in Tularosa Valley, New Mexico, are fascinating and potentially important because they suggest interactions between Pleistocene megafauna as well as great antiquity. The dating of those footprints is crucial in interpretations of when humans first came to North America from Asia, but the ages have larger uncertainties than has been reported. Some of that uncertainty is related to the possibility of a radiocarbon reservoir in the water in which the dated propagules of Ruppia cirrhosa grew. As a test of that possibility, Ruppia specimens collected in 1947 from nearby Malpais Spring returned a radiocarbon age of ca. 7400 cal yr BP. We think it would be appropriate to devise and implement independent means for dating the footprints, thus lowering the uncertainty in the proposed age of the footprints and leading to a better understanding of when humans first arrived in the Americas.
OBJECTIVES/GOALS: The purpose of this group is to foster professional and personal growth as leaders, provide peer mentoring, integrate the roles of scientist, woman, and mother, and build a self-sustaining network of peers for ongoing support throughout their careers in an academic setting. METHODS/STUDY POPULATION: - Study population: 12 Health sciences research faculty (50% protected research time); identify as female; mother of school-age and/or younger children Methods: Year-long program; including a 2-day retreat based on Brene Brown's Dare to Lead RESULTS/ANTICIPATED RESULTS: - Despite the pandemic, 100% of participants continued in the program over the one-year duration and met the attendance requirement of 75% - Screening for burnout was effective - facilitator was able to intervene when severe burnout was noted.
To assess the training and the future workforce needs of paediatric cardiac critical care faculty.
REDCap surveys were sent May−August 2019 to medical directors and faculty at the 120 US centres participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database. Faculty and directors were asked about personal training pathway and planned employment changes. Directors were additionally asked for current faculty numbers, expected job openings, presence of training programmes, and numbers of trainees. Predictive modelling of the workforce was performed using respondents’ data. Patient volume was projected from US Census data and compared to projected provider availability.
Measurements and main results:
Sixty-six per cent (79/120) of directors and 62% (294/477) of contacted faculty responded. Most respondents had training that incorporated critical care medicine with the majority completing training beyond categorical fellowship. Younger respondents and those in dedicated cardiac ICUs were more significantly likely to have advanced training or dual fellowships in cardiology and critical care medicine. An estimated 49–63 faculty enter the workforce annually from various training pathways. Based on modelling, these faculty will likely fill current and projected open positions over the next 5 years.
Paediatric cardiac critical care training has evolved, such that the majority of faculty now have dual fellowship or advanced training. The projected number of incoming faculty will likely fill open positions within the next 5 years. Institutions with existing or anticipated training programmes should be cognisant of these data and prepare graduates for an increasingly competitive market.
To assess current demographics and duties of physicians as well as the structure of paediatric cardiac critical care in the United States.
REDCap surveys were sent by email from May till August 2019 to medical directors (“directors”) of critical care units at the 120 United States centres submitting data to the Society of Thoracic Surgeons Congenital Heart Surgery Database and to associated faculty from centres that provided email lists. Faculty and directors were asked about personal attributes and clinical duties. Directors were additionally asked about unit structure.
Measurements and main results:
Responses were received from 66% (79/120) of directors and 62% (294/477) of contacted faculty. Seventy-six percent of directors and 54% of faculty were male, however, faculty <40 years old were predominantly women. The majority of both groups were white. Median bed count (n = 20) was similar in ICUs and multi-disciplinary paediatric ICUs. The median service expectation for one clinical full-time equivalent was 14 weeks of clinical service (interquartile range 12, 16), with the majority of programmes (86%) providing in-house attending night coverage. Work hours were high during service and non-service weeks with both directors (37%) and faculty (45%).
Racial and ethnic diversity is markedly deficient in the paediatric cardiac critical care workforce. Although the majority of faculty are male, females make up the majority of the workforce younger than 40 years old. Work hours across all age groups and unit types are high both on- and off-service, with most units providing attending in-house night coverage.
This article engages with Meg Russell and Ruxandra Serban's (2021) argument that the Westminster model is ‘a concept stretched beyond repair’ that deserves ‘to be retired’. We examine the logic, theory and methods that led to such a powerful, potent and provocative argument. We suggest their approach may have inadvertently ‘muddied’ an already muddled concept. We assess the implications of ‘muddying’ for their conclusion that the Westminster model is, in essence, a dead concept in need of a decent funeral. We suggest the concept is ‘stretched but not snapped’ by developing a simple four-perspective broadening of the analytical lens. This approach aids understanding about what the concept covers, how it is operationalized and why it remains useful in comparative research.
Questions have been raised regarding differences in the standards of care that patients receive when they are admitted to or discharged from in-patient units at weekends.
To compare the quality of care received by patients with anxiety and depressive disorders who were admitted to or discharged from psychiatric hospital at weekends with those admitted or discharged during the ‘working week’.
Retrospective case-note review of 3795 admissions to in-patient psychiatric wards in England. Quality of care received by people with depressive or anxiety disorders was compared using multivariable regression analyses.
In total, 795 (20.9%) patients were admitted at weekends and 157 (4.8%) were discharged at weekends. There were minimal differences in quality of care between those admitted at weekends and those admitted during the week. Patients discharged at weekends were less likely to be given sufficient notification (48 h) in advance of being discharged (OR = 0.55, 95% CI 0.39–0.78), to have a crisis plan in place (OR = 0.65, 95% CI 0.46–0.92) or to be given medication to take home (OR = 0.45, 95% CI 0.30–0.66). They were also less likely to have been assessed using a validated outcome measure (OR = 0.70, 95% CI 0.50–0.97).
There is no evidence of a ‘weekend effect’ for patients admitted to psychiatric hospital at weekends, but the quality of care offered to those who were discharged at weekends was relatively poor, highlighting the need for improvement in this area.
Previous genetic association studies have failed to identify loci robustly associated with sepsis, and there have been no published genetic association studies or polygenic risk score analyses of patients with septic shock, despite evidence suggesting genetic factors may be involved. We systematically collected genotype and clinical outcome data in the context of a randomized controlled trial from patients with septic shock to enrich the presence of disease-associated genetic variants. We performed genomewide association studies of susceptibility and mortality in septic shock using 493 patients with septic shock and 2442 population controls, and polygenic risk score analysis to assess genetic overlap between septic shock risk/mortality with clinically relevant traits. One variant, rs9489328, located in AL589740.1 noncoding RNA, was significantly associated with septic shock (p = 1.05 × 10–10); however, it is likely a false-positive. We were unable to replicate variants previously reported to be associated (p < 1.00 × 10–6 in previous scans) with susceptibility to and mortality from sepsis. Polygenic risk scores for hematocrit and granulocyte count were negatively associated with 28-day mortality (p = 3.04 × 10–3; p = 2.29 × 10–3), and scores for C-reactive protein levels were positively associated with susceptibility to septic shock (p = 1.44 × 10–3). Results suggest that common variants of large effect do not influence septic shock susceptibility, mortality and resolution; however, genetic predispositions to clinically relevant traits are significantly associated with increased susceptibility and mortality in septic individuals.
This chapter provides an overview of the use of affect-based interventions to change behavior. Affect is defined in terms of affect proper and affect processing; both of these terms are used regularly in research on affect interventions. The evidence of direct modification of these affect constructs is then reviewed. Based on this evidence, step-by-step guides to techniques focusing on changing two key aspects of affective processing are provided: changing affective attitudes and anticipated affect. The guides to these techniques include typical means of delivery, target audience, behaviors, enabling or inhibiting factors, training and skills required, intensiveness, typical materials needed, and typical examples of implementation. In addition, application of implementation intentions, fear appeals, evaluative conditioning, and exercise games as other ways to change affect as a means to changing behavior are reviewed. Finally, two additional intervention pathways that could have impact on behavior change are reviewed: direct modification of other sources of behavioral influence (e.g., traditional social cognitive factors) in order to overcompensate for the impact of affect and self-regulation of the intensity of the affect experience as a means of inhibiting its impact.
The Colonial Revival house is an unavoidable context in cinematic and televisual representation. The ubiquity of Colonial Revival architecture – in the American landscape and in film and television – means that as a signifier it is both too empty and too full; there would appear to be too little and too much to say about this subject. The problem of Colonial Revival architecture itself is that it is an architecture of surfaces, appearances, facades, exteriors: it is a skin, the skin, we might say, of national fantasy. For not only is the term Colonial Revival in architectural history a loose, floating, perhaps even radically empty signifier (empty perhaps – as well – because overfull with too many contents), in actual architectural materiality, the term names the look of a house's exterior but indicates very little about the disposition of its interior spaces.
In a book dedicated to thinking about the house in American cinema, I have argued that when we look at houses on screen we are looking at what I call a ‘spectacle of property’. Whatever the nature or style or dimensions of the houses we see on-screen, when we look at a cinematic image of a house, we are in thrall to and enthralled by property, its images and its image-ness (Rhodes 2017). Cinema turns cinemagoers into shortterm tenants, whom I call ‘spectator tenants’ – subjects who (in the traditional context of theatrical moviegoing) ‘pay for the right to occupy a space in order to gaze up at a space they can never occupy’ (Rhodes 2017: 13 [italics in original]). This looking is structured slightly differently and receives different inflections according to the style of architecture that is being looked at. In the case of Colonial Revival architecture, an architecture of ubiquity, we seem to be looking at the omnipresent and inescapable nature of the property relation itself, a relation that houses and structures our intimate relationship to capitalism. Moreover, this architecture's emptiness, the lack of connection between its surfaces and its interiors, its malleability, plasticity, nominalism of reference and endless iteration (it is a ‘revival’ style, after all) mean that its architecture and moving images provide refracted but highly concrete embodiment of the endless fungibility of property relations in twentieth-century capitalism.
We evaluated whether a diagnostic stewardship initiative consisting of ASP preauthorization paired with education could reduce false-positive hospital-onset (HO) Clostridioides difficile infection (CDI).
Single center, quasi-experimental study.
Tertiary academic medical center in Chicago, Illinois.
Adult inpatients were included in the intervention if they were admitted between October 1, 2016, and April 30, 2018, and were eligible for C. difficile preauthorization review. Patients admitted to the stem cell transplant (SCT) unit were not included in the intervention and were therefore considered a contemporaneous noninterventional control group.
The intervention consisted of requiring prescriber attestation that diarrhea has met CDI clinical criteria, ASP preauthorization, and verbal clinician feedback. Data were compared 33 months before and 19 months after implementation. Facility-wide HO-CDI incidence rates (IR) per 10,000 patient days (PD) and standardized infection ratios (SIR) were extracted from hospital infection prevention reports.
During the entire 52 month period, the mean facility-wide HO-CDI-IR was 7.8 per 10,000 PD and the SIR was 0.9 overall. The mean ± SD HO-CDI-IR (8.5 ± 2.0 vs 6.5 ± 2.3; P < .001) and SIR (0.97 ± 0.23 vs 0.78 ± 0.26; P = .015) decreased from baseline during the intervention. Segmented regression models identified significant decreases in HO-CDI-IR (Pstep = .06; Ptrend = .008) and SIR (Pstep = .1; Ptrend = .017) trends concurrent with decreases in oral vancomycin (Pstep < .001; Ptrend < .001). HO-CDI-IR within a noninterventional control unit did not change (Pstep = .125; Ptrend = .115).
A multidisciplinary, multifaceted intervention leveraging clinician education and feedback reduced the HO-CDI-IR and the SIR in select populations. Institutions may consider interventions like ours to reduce false-positive C. difficile NAAT tests.
St Andrews was of tremendous significance in medieval Scotland. Its importance remains readily apparent in the buildings which cluster the rocky promontory jutting out into the North Sea: the towers and walls of cathedral, castle and university provide reminders of the status and wealth of the city in the Middle Ages. As a centre of earthly and spiritual government, as the place of veneration forScotland's patron saint and as an ancient seat of learning, St Andrews was the ecclesiastical capital of Scotland. This volume provides the first full study of this special and multi-faceted centre throughout its golden age. The fourteen chapters use St Andrews as a focus for the discussion of multiple aspects of medieval life in Scotland. They examine church, spirituality, urban society andlearning in a specific context from the seventh to the sixteenth century, allowing for the consideration of St Andrews alongside other great religious and political centres of medieval Europe.
Michael Brown is Professor of Medieval Scottish History, University of St Andrews; Katie Stevenson is Keeper of Scottish History and Archaeology, National Museums Scotland and Senior Lecturer in Late Medieval History, University of St Andrews.
Contributors: Michael Brown, Ian Campbell, David Ditchburn, Elizabeth Ewan, Richard Fawcett, Derek Hall, Matthew Hammond, Julian Luxford, Roger Mason, Norman Reid, Bess Rhodes, Catherine Smith, Katie Stevenson, Simon Taylor, Tom Turpie.