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Altica is a rare first-farming village site in the Basin of Mexico that has survived to modern times. Thus, it provides a glimpse into life during the Early–Middle Formative period. While valuable archaeological information on the village was recovered in excavation, only four burials comprising four individuals were recovered, a very small sample. Two individuals are older-aged females; the third, a middle-aged male, was accompanied by prestigious nonperishable goods and indicates that there are status differences even at this early date. The final individual was a young male buried in a deviant manner, suggesting possible foul play. While all individuals have indicators of periods of poor health, stable isotopes of carbon and nitrogen paint a more complete picture of the types of foods these individuals consumed over their lifetime. Radiogenic strontium isotopes of tooth enamel identify one individual, the young male buried in a deviant manner, as non-native to the Altica region. Thus, there is mystery in the manner of death, but even in this small sample, the wider connections Altica had that are so evident in the artefactual analysis are found in the skeletons. In addition, accelerator mass spectrometry radiocarbon dating provides a chronology of occupation through the people.
Burning postharvest sugarcane residue is a standard practice to remove extraneous leaf material before spring regrowth. Live-fires were simulated from field-collected postharvest sugarcane residue and seeds of divine nightshade and itchgrass were exposed to dry and moistened postharvest residue (PHR) at four densities (6.1, 12.1, 18.2, and 24.2 Mg ha−1) and a nonburned control. The moisture content of residue exposed to simulated rainfall was 14% more in Experiment 2 than Experiment 1; however, burning PHR with 44% moisture when wind speeds were lower allowed the fire to continue and created a smoldering effect that reduced weed emergence by 23% when compared with burning PHR with 30% moisture during breezy conditions. The moistened 6.1 Mg ha−1 PHR treatment resulted in 53% more divine nightshade and itchgrass emergence when compared with dry 6.1 Mg ha−1 PHR after burning, and greater emergence was attributed to more seed survival for divine nightshade than itchgrass. The PHR moisture condition failed to influence the burn duration; however, the burn duration increased 103% and 56% as the amount of PHR increased from 6.1 to 12.1 Mg ha−1 and 12.1 to 18.2 Mg ha−1, respectively. The combination of high wind speeds and moistened PHR did not enhance the maximum burn temperature near the soil surface, but surface-deposited divine nightshade and itchgrass seeds were susceptible to prolonged exposure times at 100 C. Burning PHR from fields with poor stands or older ratoon, especially when PHR is abundantly wet, will not produce temperatures lethal to divine nightshade and itchgrass seeds. The fluid-filled and fleshy content that comprises divine nightshade fruit protected seed from short durations of high temperatures, but may not insulate seeds long enough when exposed to a smoldering fire.
Epistaxis is the most common ENT emergency. This study aimed to assess one-year mortality rates in patients admitted to a large teaching hospital.
This study was a retrospective case note analysis of all patients admitted to the Queen Elizabeth University Hospital in Glasgow with epistaxis over a 12-month period.
The one-year overall mortality for a patient admitted with epistaxis was 9.8 per cent. The patients who died were older (mean age 77.2 vs 68.8 years; p = 0.002), had a higher Cumulative Illness Rating Scale-Geriatric score (9.9 vs 6.7; p < 0.001) and had a higher performance status score (2 or higher vs less than 2; p < 0.001). Other risk factors were a low admission haemoglobin level (less than 128 g/dl vs 128 g/dl or higher; p = 0.025), abnormal coagulation (p = 0.004), low albumin (less than 36 g/l vs more than 36 g/l; p < 0.001) and longer length of stay (p = 0.046).
There are a number of risk factors associated with increased mortality after admission with epistaxis. This information could help with risk stratification of patients at admission and enable the appropriate patient support to be arranged.
Determining infectious cross-transmission events in healthcare settings involves manual surveillance of case clusters by infection control personnel, followed by strain typing of clinical/environmental isolates suspected in said clusters. Recent advances in genomic sequencing and cloud computing now allow for the rapid molecular typing of infecting isolates.
To facilitate rapid recognition of transmission clusters, we aimed to assess infection control surveillance using whole-genome sequencing (WGS) of microbial pathogens to identify cross-transmission events for epidemiologic review.
Clinical isolates of Staphylococcus aureus, Enterococcus faecium, Pseudomonas aeruginosa, and Klebsiella pneumoniae were obtained prospectively at an academic medical center, from September 1, 2016, to September 30, 2017. Isolate genomes were sequenced, followed by single-nucleotide variant analysis; a cloud-computing platform was used for whole-genome sequence analysis and cluster identification.
Most strains of the 4 studied pathogens were unrelated, and 34 potential transmission clusters were present. The characteristics of the potential clusters were complex and likely not identifiable by traditional surveillance alone. Notably, only 1 cluster had been suspected by routine manual surveillance.
Our work supports the assertion that integration of genomic and clinical epidemiologic data can augment infection control surveillance for both the identification of cross-transmission events and the inclusion of missed and exclusion of misidentified outbreaks (ie, false alarms). The integration of clinical data is essential to prioritize suspect clusters for investigation, and for existing infections, a timely review of both the clinical and WGS results can hold promise to reduce HAIs. A richer understanding of cross-transmission events within healthcare settings will require the expansion of current surveillance approaches.
Skeletal remains from Tlajinga 33 (33:S3W1) have been the focus of research in the southern sector of Teotihuacan since excavations took place in the 1980s. Recent excavations in Tlajinga Compounds 17 and 18 (17:S3E1 and 18:S3E1, respectively), located along the southern Street of the Dead, recovered nine additional skeletons. This article is a description of the burials from Compounds 17 and 18 and a comparative analysis of health, diet, and chronology across all three compounds (Compounds 17, 18, and 33). Here, we test the hypothesis that individuals between residential compounds at Tlajinga lived similar lives and that health and biogeochemical markers of individuals will reflect these similarities. Although the sample size is small, the paleopathological analysis of individuals at Compounds 17 and 18 indicates morbidity patterns similar to Tlajinga 33, but also that these residents were perhaps less susceptible to stressors during periods of juvenile growth. Stable carbon and nitrogen isotopes suggest that, overall, diets were analogous across compounds, but Compounds 17 and 18 were able to supplement their diet with a greater variety of plant resources. There were no clear dietary differences between higher and lower status individuals, however. Finally, accelerated mass spectrometry radiocarbon (AMS 14C) dates indicate that residential living may have occurred later at Compound 18 than at Compound 17 and Tlajinga 33.
Teotihuacan's Tlajinga district is a cluster of neighborhoods on the southern periphery of the city best known for earlier investigations at Compound 33:S3W1. New research includes excavations at two other apartment compounds and along the southern extension of the Street of the Dead. Excavation contexts, major finds, chronology, and preliminary interpretations are the subject of this article. We highlight evidence attesting to a major obsidian-blade workshop at Compound 17:S3E1, offerings, and other features at that compound and Compound 18:S3E1, and the tempo and processes of urbanization viewed through well-recorded stratigraphic sequences of the compounds and the Street of the Dead. We conclude that significant occupation began in the Miccaotli phase, but it was not until some point in the Early Tlamimilolpa phase that the dominant housing type became apartment compounds; the continuation of the axis of Street of the Dead in the district was accomplished by excavating in the volcanic tuft substrate (tepetate) and could have been undertaken by the inhabitants of the district themselves; and the presence of items such as a sculpted stone face, marine shell, and polychrome pottery demonstrates that commoners at Teotihuacan enjoyed some access to finer items within the interregional economy.
There is little consensus on how best to manage head and neck cancer with palliative intent. Predicting outcome is difficult and reported survival varies. The present study sought to delineate local practice and outcomes in patients treated with palliative intent.
The clinical records of all head and neck cancer patients treated with palliative intent presenting between 2015 and 2016 to our multidisciplinary team were reviewed.
Eighty-four patients (21.5 per cent) were treated with palliative intent. All had squamous cell carcinoma. Mean survival time was 151 days (standard deviation = 121.1; range, 8–536 days). Of the patients, 83.3 per cent had a palliative care referral; 74.1 per cent had a hospice referral. Patients received a variety of interventions, and there was an associated complication in 8.2 per cent. The mean number of days spent in hospital for interventions was 11.9 days (standard deviation = 12.5; range, 0–41 days).
Different interventions are used to manage head and neck cancer patients with palliative intent, and these may be associated with significant morbidity. Survival time is variable, often several months; thus, any treatment must take into account morbidity in conjunction with the patient's wishes.
We present a highly detailed study of calving dynamics at Tunabreen, a tidewater glacier in Svalbard. A time-lapse camera was trained on the terminus and programmed to capture images every 3 seconds over a 28-hour period in August 2015, producing a highly detailed record of 34 117 images from which 358 individual calving events were distinguished. Calving activity is characterised by frequent events (12.8 events h−1) that are small relative to the spectrum of calving events observed, demonstrating the prevalence of small-scale calving mechanisms. Five calving styles were observed, with a high proportion of calving events (82%) originating at, or above, the waterline. The tidal cycle plays a key role in the timing of calving events, with 68% occurring on the falling limb of the tide. Calving activity is concentrated where meltwater plumes surface at the glacier front, and a ~ 5 m undercut at the base of the glacier suggests that meltwater plumes encourage melt-under-cutting. We conclude that frontal ablation at Tunabreen may be paced by submarine melt rates, as suggested from similar observations at glaciers in Svalbard and Alaska. Using submarine melt rate to calculate frontal ablation would greatly simplify estimations of tidewater glacier losses in prognostic models.
Rayleigh–Bénard convection is one of the most well-studied models in fluid mechanics. Atmospheric convection, one of the most important components of the climate system, is by comparison complicated and poorly understood. A key attribute of atmospheric convection is the buoyancy source provided by the condensation of water vapour, but the presence of radiation, compressibility, liquid water and ice further complicate the system and our understanding of it. In this paper we present an idealized model of moist convection by taking the Boussinesq limit of the ideal-gas equations and adding a condensate that obeys a simplified Clausius–Clapeyron relation. The system allows moist convection to be explored at a fundamental level and reduces to the classical Rayleigh–Bénard model if the latent heat of condensation is taken to be zero. The model has an exact, Rayleigh-number-independent ‘drizzle’ solution in which the diffusion of water vapour from a saturated lower surface is balanced by condensation, with the temperature field (and so the saturation value of the moisture) determined self-consistently by the heat released in the condensation. This state is the moist analogue of the conductive solution in the classical problem. We numerically determine the linear stability properties of this solution as a function of Rayleigh number and a non-dimensional latent-heat parameter. We also present some two-dimensional, time-dependent, nonlinear solutions at various values of Rayleigh number and the non-dimensional condensational parameters. At sufficiently low Rayleigh number the system converges to the drizzle solution, and we find no evidence that two-dimensional self-sustained convection can occur when that solution is stable. The flow transitions from steady to turbulent as the Rayleigh number or the effects of condensation are increased, with plumes triggered by gravity waves emanating from other plumes. The interior dries as the level of turbulence increases, because the plumes entrain more dry air and because the saturated boundary layer at the top becomes thinner. The flow develops a broad relative humidity minimum in the domain interior, only weakly dependent on Rayleigh number when that is high.
Izapa is famous for its monumental architecture and extensive corpus of carved stelae dated to the Late Formative Guillén phase (300–100 cal b.c.). The site was first established, however, as the capital of a kingdom during the second half of the Middle Formative period (750–300 cal b.c.). Little is known of the first centuries of the site's occupation or how this early kingdom coalesced with Izapa as its capital. In 2012, the Izapa Regional Settlement Project (IRSP) excavated 21 test units and ran 10 radiocarbon accelerator mass spectrometry (AMS) dates in order to begin correcting this lacuna. These excavations were the first at the site to screen soil matrices and recover artifact samples that can be quantitatively analyzed.
We undertook excavations in areas north and south of Group B, the original center of Izapa. This work dates the northern expansion of the site's main platform (under Mound 30a) to the Terminal Formative Itstapa phase (cal a.d. 100–300) that resulted in a doubling of the platform's size. Further, we documented that there were three distinct construction episodes in the Terminal Formative expansion and that a central staircase and ramp were built of stone during the second episode. Buried below the Terminal Formative platform expansion was a white clay surface built during the Escalón phase (750–500 cal b.c.) and used through to Guillén times. At the long, linear Mound 62 that defines the eastern edge of Izapa's site core, we documented two episodes of Guillén-phase monumental construction. Buried below this construction fill at Mound 62, a hearth feature and stone alignment are dated to the late Middle Formative based on radiocarbon assays and the results of ceramic analysis. Excavations at Mound 72 and 73 documented that Izapa's E-Group (newly recognized with lidar [light detection and ranging] data) was established in the late Middle Formative period and then significantly augmented during the Guillén phase. The architectural program at Izapa saw its apogee during the Late Formative period, but was first established during the preceding centuries of the Middle Formative. Ten new AMS dates confirm the dating of the Escalón, Frontera, and Guillén phases to 750–100 cal b.c.
Ceramic analysis allowed us to differentiate quantitatively between midden deposits and construction fill through the site's occupation and to recognize domestic versus public spaces during the first centuries of the Izapa kingdom's coalescence. We identify late Middle Formative period middens based on the high density of ceramics in addition to good surface preservation of sherds and a lack of temporal mixing of types. The designation of high-artifact density middens contrasts with the contents of Late and Terminal Formative construction fill with lower ceramic sherd densities and mixing of temporally diagnostic types. Off-mound contexts (where construction fill was mined) had even lower ceramic densities than construction fill and the sherds were very eroded. Analysis of ceramic remains from late Middle Formative period midden deposits also allowed us to infer differences in public and domestic areas of the site during the first centuries of its occupation. Formal and metric variables from these ceramic assemblages identify dish-to-jar ratios that differentiate domestic contexts (with an assortment of vessel forms) from more publically oriented areas of the site (with more serving dishes). The differential distribution of rim diameters of fancy and plain dishes allows us to identify areas of Izapa where domestic activities predominate and indicate that more publically oriented feasting practices occurred at the site center near the main pyramid (Mound 30a) during the late Middle Formative period.
In Scotland, patients with suspected head and neck cancer are referred on the basis of the Scottish Referral Guidelines for Suspected Cancer, rather than the National Institute for Health and Care Excellence guidelines. A chest X-ray should be requested by the general practitioner at the same time as referral for persistent hoarseness. The evidence for this is level 4.
This audit identified adherence to this recommendation and X-ray results. All ‘urgent suspicion of cancer’ referrals to the ENT department in the National Health Service Greater Glasgow and Clyde for 2015–2016 were audited.
Persistent hoarseness for more than 3 weeks instigated referral in 318 patients (15.7 per cent). Chest X-ray was performed in 120 patients (38 per cent), which showed: no abnormality in 116 (96.7 per cent), features of infection in 2 (1.7 per cent) and something else in 2 patients (1.7 per cent). No chest X-ray altered the management of a patient.
Performance of chest X-ray does not alter management and its removal from the Scottish Referral Guidelines for Suspected Cancer is recommended.
The study of the mechanical properties of nanostructured systems has gained importance in theoretical and experimental research in recent years. Carbon nanotubes (CNTs) are one of the strongest nanomaterials found in nature, with Young’s Modulus (EY) in the order 1.25 TPa. One interesting question is about the possibility of generating new nanostructures with 1D symmetry and with similar and/or superior CNT properties. In this work, we present a study on the dynamical, structural, mechanical properties, fracture patterns and EY values for one class of these structures, the so-called pentagraphene nanotubes (PGNTs). These tubes are formed rolling up pentagraphene membranes (which are quasi-bidimensional structures formed by densely compacted pentagons of carbon atoms in sp3 and sp2 hybridized states) in the same form that CNTs are formed from rolling up graphene membranes. We carried out fully atomistic molecular dynamics simulations using the ReaxFF force field. We have considered zigzag-like and armchair-like PGNTs of different diameters. Our results show that PGNTs present EY ∼ 800 GPa with distinct elastic behavior in relation to CNTs, mainly associated with mechanical failure, chirality dependent fracture patterns and extensive structural reconstructions.
Recently, a new 2D carbon allotrope structure, named phagraphene (PG), was proposed. PG has a densely array of penta-hexa-hepta-graphene carbon rings. PG was shown to present low and anisotropic thermal conductivity and it is believed that this anisotropy should be also reflected in its mechanical properties. Although PG mechanical properties have been investigated, a detailed and comprehensive study is still lacking. In the present work we have carried out fully atomistic reactive molecular dynamics simulations using the ReaxFF force field, to investigate the mechanical properties and fracture patterns of PG membranes. The Young’s modulus values of the PG membranes were estimated from the stress-strain curves. Our results show that these curves present three distinct regimes: one regime where ripples dominate the structure and mechanical properties of the PG membranes; an elastic regime where the membranes exhibit fully planar configurations; and finally am inelastic regime where permanent deformations happened to the PG membrane up to the mechanical failure or fracture.
We describe the investigation of two temporally coincident illness clusters involving salmonella and Staphylococcus aureus in two states. Cases were defined as gastrointestinal illness following two meal events. Investigators interviewed ill persons. Stool, food and environmental samples underwent pathogen testing. Alabama: Eighty cases were identified. Median time from meal to illness was 5·8 h. Salmonella Heidelberg was identified from 27 of 28 stool specimens tested, and coagulase-positive S. aureus was isolated from three of 16 ill persons. Environmental investigation indicated that food handling deficiencies occurred. Colorado: Seven cases were identified. Median time from meal to illness was 4·5 h. Five persons were hospitalised, four of whom were admitted to the intensive care unit. Salmonella Heidelberg was identified in six of seven stool specimens and coagulase-positive S. aureus in three of six tested. No single food item was implicated in either outbreak. These two outbreaks were linked to infection with Salmonella Heidelberg, but additional factors, such as dual aetiology that included S. aureus or the dose of salmonella ingested may have contributed to the short incubation periods and high illness severity. The outbreaks underscore the importance of measures to prevent foodborne illness through appropriate washing, handling, preparation and storage of food.
The replacement of fish oil (FO) with vegetable oil (VO) in feed formulations reduces the availability of n-3 long-chain PUFA (LC-PUFA) to marine fish such as gilthead seabream. The aim of this study was to examine compositional and physiological responses to a dietary gradient of n-3 LC-PUFA. Six iso-energetic and iso-nitrogenous diets (D1–D6) were fed to seabream, with the added oil being a blend of FO and VO to achieve a dietary gradient of n-3 LC-PUFA. Fish were sampled after 4 months feeding, to determine biochemical composition, tissue fatty acid concentrations and lipid metabolic gene expression. The results indicated a disturbance to lipid metabolism, with fat in the liver increased and fat deposits in the viscera reduced. Tissue fatty acid profiles were altered towards the fatty acid compositions of the diets. There was evidence of endogenous modification of dietary PUFA in the liver which correlated with the expression of fatty acid desaturase 2 (fads2). Expression of sterol regulatory element binding protein 1 (srebp1), fads2 and fatty acid synthase increased in the liver, whereas PPARα1 pathways appeared to be supressed by dietary VO in a concentration-dependent manner. The effects in lipogenic genes appear to become measurable in D1–D3, which agrees with the weight gain data suggesting that disturbances to energy metabolism and lipogenesis may be related to performance differences. These findings suggested that suppression of β-oxidation and stimulation of srebp1-mediated lipogenesis may play a role in contributing toward steatosis in fish fed n-3 LC-PUFA deficient diets.
Our study adds to the Quaternary history of eolian systems and deposits in western Wisconsin, USA, primarily within the lower Chippewa River valley. Thickness and textural patterns of loess deposits in the region indicate transport by west-northwesterly and westerly winds. Loess is thickest and coarsest on the southeastern flanks of large bedrock ridges and uplands, similar in some ways to shadow dunes. In many areas, sand was transported up and onto the western flanks of bedrock ridges as sand ramps, presumably as loess was deposited in their lee. Long, linear dunes, common on the sandy lowlands of the Chippewa valley, also trend to the east-southeast. Small depressional blowouts are widespread here as well and often lie immediately upwind of small parabolic dunes. Finally, in areas where sediment was being exposed by erosion along cutbanks of the Chippewa River, sand appears to have been transported up and onto the terrace treads, forming cliff-top dunes. Luminescence data indicate that this activity has continued throughout the latest Pleistocene and into the mid-Holocene. Together, these landforms and sediments paint a picture of a locally destabilized landscape with widespread eolian activity throughout much of the postglacial period.
Healthy adults (n 30) participated in a placebo-controlled, randomised, double-blinded, cross-over study consisting of two 28 d treatments (β2-1 fructan or maltodextrin; 3×5 g/d) separated by a 14-d washout. Subjects provided 1 d faecal collections at days 0 and 28 of each treatment. The ability of faecal bacteria to metabolise β2-1 fructan was common; eighty-seven species (thirty genera, and four phyla) were isolated using anaerobic medium containing β2-1 fructan as the sole carbohydrate source. β2-1 fructan altered the faecal community as determined through analysis of terminal restriction fragment length polymorphisms and 16S rRNA genes. Supplementation with β2-1 fructan reduced faecal community richness, and two patterns of community change were observed. In most subjects, β2-1 fructan reduced the content of phylotypes aligning within the Bacteroides, whereas increasing those aligning within bifidobacteria, Faecalibacterium and the family Lachnospiraceae. In the remaining subjects, supplementation increased the abundance of Bacteroidetes and to a lesser extent bifidobacteria, accompanied by decreases within the Faecalibacterium and family Lachnospiraceae. β2-1 Fructan had no impact on the metagenome or glycoside hydrolase profiles in faeces from four subjects. Few relationships were found between the faecal bacterial community and various host parameters; Bacteroidetes content correlated with faecal propionate, subjects whose faecal community contained higher Bacteroidetes produced more caproic acid independent of treatment, and subjects having lower faecal Bacteroidetes exhibited increased concentrations of serum lipopolysaccharide and lipopolysaccharide binding protein independent of treatment. We found no evidence to support a defined health benefit for the use of β2-1 fructans in healthy subjects.
We have developed and tested a wide-field photometer to detect extrasolar planet transits from the South Pole. The discovery of transiting planets for which masses can be measured by radial velocity is vital to constrain the models of planet formation and evolution. Short of going to space, the South Pole is the best site from which to carry out a such a survey. Based on results from the Doppler velocity surveys and the Vulcan transit search, we expect to detect 10 to 15 transiting planets in two years of operation at the South Pole.
Patients with cardiovascular diseases are common in the emergency department (ED), and continuity of care following that visit is needed to ensure that they receive evidence-based diagnostic tests and therapy. We examined the frequency of follow-up care after discharge from an ED with a new diagnosis of one of three cardiovascular diseases.
We performed a retrospective cohort study of patients with a new diagnosis of heart failure, atrial fibrillation, or hypertension, who were discharged from 157 non-pediatric EDs in Ontario, Canada, between April 2007 and March 2014. We determined the frequency of follow-up care with a family physician, cardiologist, or internist within seven and 30 days, and assessed the association of patient, emergency physician, and family physician characteristics with obtaining follow-up care using cause-specific hazard modeling.
There were 41,485 qualifying ED visits. Just under half (47.0%) had follow-up care within seven days, with 78.7% seen by 30 days. Patients with serious comorbidities (renal failure, dementia, COPD, stroke, coronary artery disease, and cancer) had a lower adjusted hazard of obtaining 7-day follow-up care (HRs 0.77-0.95) and 30-day follow-up care (HR 0.76-0.95). The only emergency physician characteristic associated with follow-up care was 5-year emergency medicine specialty training (HR 1.11). Compared to those whose family physician was remunerated via a primarily fee-for-service model, patients were less likely to obtain 7-day follow-up care if their family physician was remunerated via three types of capitation models (HR 0.72, 0.81, 0.85) or via traditional fee-for-service (HR 0.91). Findings were similar for 30-day follow-up care.
Only half of patients discharged from an ED with a new diagnosis of atrial fibrillation, heart failure, and hypertension were seen within a week of being discharged. Patients with significant comorbidities were less likely to obtain follow-up care, as were those with a family physician who was remunerated via primarily capitation methods.