This article traces a speculative and critical engagement with histories of health care disparity and medical exploitation shared across fictions by Ralph Ellison and Toni Morrison, and the artwork of Ellen Gallagher. It argues that insistent returns to racialized experimentation and scientific modes of looking form a significant interrogation of a wider set of US promises and attritions. Specifically, it asks how postwar African American culture takes up scopic questions to address dominant accounts of progress and the modern, both via reference to visual orders and technologies, and via formal choices regarding iteration, perspective and scale.

Evidence-based psychotherapies (EBPs) are underused in health care settings. Aligning implementation of EBPs with the needs of health care leaders (i.e., operational stakeholders) can potentially accelerate their uptake into routine practice. Operational stakeholders (such as hospital leaders, clinical directors, and national program officers) can influence development and oversight of clinical programs as well as policy directives at local, regional, and national levels. Thus, engaging these stakeholders during the implementation and dissemination of EBPs is critical when targeting wider use in health care settings. This article describes how research–operations partnerships were leveraged to increase implementation of an empirically supported psychotherapy – brief Cognitive Behavioral Therapy (brief CBT) – in Veterans Health Administration (VA) primary care settings. The partnered implementation and dissemination efforts were informed by the empirically derived World Health Organization’s ExpandNet framework. A steering committee was formed and included several VA operational stakeholders who helped align the brief CBT program with the implementation needs of VA primary care settings. During the first 18 months of the project, partnerships facilitated rapid implementation of brief CBT at eight VA facilities, including training of 12 providers who saw 120 patients, in addition to expanded program elements to better support sustainability (e.g., train-the-trainer procedures).

Localized contamination from research-related activities and its effects on macrofauna communities in the marine environment were investigated at Palmer Station, a medium-sized Antarctic research station. Relatively low concentrations of polycyclic aromatic hydrocarbons (PAHs; 32–302 ng g-1) and total petroleum hydrocarbons (TPHs; 0.9–8.9 μg g-1) were detected in sediments adjacent to the sewage outfall and pier, where most human activities were expected to have occurred, and at even lower concentrations at two seemingly reference areas (PAHs 6–30 ng g-1, TPHs 0.03–5.1 μg g-1). Elevated concentrations of PAHs in one sample taken in one reference area (816 ng g-1) and polychlorinated biphenyls (353 ng g-1) and dichloro-diphenyl-trichloroethane (3.2 and 25.3 ng g-1) in two samples taken adjacent to the sewage outfall indicate spatial heterogeneity of localized sediment contamination. Limpet (Nacella concinna) tissues collected adjacent to Palmer Station had high concentrations of PAHs, copper, lead, zinc and several other metals relative to outlying islands. Sediment and limpet tissue contaminant concentrations have decreased since the early 1990s following the Bahía Paraíso spill. Natural sediment characteristics affected macrofaunal community composition more than contamination adjacent to Palmer Station, presumably because of the low overall contamination levels.

Background: Prevention of central-line–associated bloodstream infections (CLABSIs) and methicillin-resistant Staphylococcus aureus (MRSA) infections requires a multifaceted approach including strategies to decrease cutaneous bacterial colonization. Prior studies have shown benefit from chlorhexidine-gluconate (CHG) skin application on CLABSI and MRSA infection rates in intensive care units (ICUs); however, the use of CHG in the non-ICU population has not been well studied. Methods: We performed a quasi-experimental before-and-after study to evaluate the use of daily 2% CHG wipes in non-ICU patients at a 1,000 bed acute-care teaching hospital beginning in November 2017. The study population included adult and pediatric patients with central venous catheters on non-ICU units, excluding patients on the following units: stem cell transplant and hematologic malignancy (these units had already established use of CHG skin application as a standard prior to the intervention), labor and delivery, and psychiatry. CHG was applied according to the manufacturer’s instruction by nurses or nurse aides and random monthly auditing of compliance was performed. NHSN CLABSI, hospital-onset MRSA bacteremia, and hospital-onset MRSA LabID rates were compared for the period 24 months before the intervention (November 1, 2015, through October 31, 2017) to the 24-month period after the intervention (November 1, 2017, through October 31, 2019) using a paired t test. Notably, the health system also discontinued the use of contact precautions for patients with MRSA (excluding MRSA from open, draining wounds) 11 months prior to onset of this intervention. Results: The CLABSI rate decreased by 26% from 0.594 events per 1,000 central-line days (n = 50) before the intervention to 0.438 events per 1,000 central-line days (n = 38) after the intervention (P = 0.19). The number of CLABSIs with gram-positive organisms also decreased by 29%. MRSA LabID rates decreased by 37% from 0.301 events per 1,000 patient days (n = 119) to 0.189 events per 1,000 patient days (n = 75) (P = 0.01). MRSA bacteremia rates decreased by 79% from 0.058 events per 1,000 patient days (n = 23) to 0.012 events per 1,000 patient days (n = 5) (P < 0.01). Compliance with the intervention was 83% (n = 225). Conclusions: Daily CHG skin application in non-ICU patients with central venous catheters is an effective strategy to prevent CLABSIs and MRSA infections. We observed a decrease in MRSA LabID and bacteremia rates despite discontinuation of contact precautions. These findings suggest that a horizontal prevention approach of daily CHG skin application may be an effective alternative to contact isolation to interrupt transmission of MRSA in hospitalized patients outside the ICU setting.

Funding: None

Disclosures: None

Prevention and control of respiratory disease is a major contributor to antibiotic use in swine. A systematic review was conducted to address the question, ‘What is the comparative efficacy of antimicrobials for the prevention of swine respiratory disease?’ Eligible studies were controlled trials published in English evaluating prophylactic antibiotics in swine, where clinical morbidity, mortality, or total antibiotic use was assessed. Four databases and the gray literature were searched for relevant articles. Two reviewers working independently screened titles and abstracts for eligibility followed by full-text articles, and then extracted data and evaluated risk of bias for eligible trials. There were 44 eligible trials from 36 publications. Clinical morbidity was evaluated in eight trials where antibiotics were used in nursery pigs and 10 trials where antibiotics were used in grower pigs. Mortality was measured in 22 trials in nursery pigs and 12 trials in grower pigs. There was heterogeneity in the antibiotic interventions and comparisons published in the literature; thus, there was insufficient evidence to allow quantification of the efficacy, or relative efficacy, of antibiotic interventions. Concerns related to statistical non-independence and quality of reporting were noted in the included trials.

A systematic review and network meta-analysis (MA) was conducted to address the question, ‘What is the efficacy of bacterial vaccines to prevent respiratory disease in swine?’ Four electronic databases and the grey literature were searched to identify clinical trials in healthy swine where at least one intervention arm was a commercially available vaccine for one or more bacterial pathogens associated with respiratory disease in swine, including Mycoplasma hyopneumoniae, Actinobacillus pleuropneumonia, Actinobacillus suis, Bordetella bronchiseptica, Pasteurella multocida, Stretococcus suis, Haemophils parasuis, and Mycoplasma hyorhinis. To be eligible, trials had to measure at least one of the following outcomes: incidence of clinical morbidity, mortality, lung lesions, or total antibiotic use. There were 179 eligible trials identified in 146 publications. Network MA was undertaken for morbidity, mortality, and the presence or absence of non-specific lung lesions. However, there was not a sufficient body of research evaluating the same interventions and outcomes to allow a meaningful synthesis of the comparative efficacy of the vaccines. To build this body of research, additional rigor in trial design and analysis, and detailed reporting of trial methods and results are warranted.

Pollen analysis of a 9.03-m-long lake sediment core from Pender Island on the south coast of British Columbia was used to reconstruct the island's vegetation history over the last 10,000 years. The early Holocene was characterized by open mixed woodlands with abundant Pseudotsuga menziesii and a diverse understory including Salix and Rosaceae shrubs and Pteridium aquilinum ferns. The establishment of Quercus garryana savanna-woodland with P. menziesii and Acer macrophyllum followed deposition of the Mazama tephra until ~ 5500 cal yr BP, when these communities gave way to modern mixed P. menziesii forest. Charcoal analyses of the uppermost sediments revealed low charcoal accumulation over the last 1300 years with a mean fire return interval (mFRI) of 88 years. Fires were more frequent (mFRI = 50 yr) during the Medieval Climate Anomaly (MCA) with warm, dry conditions facilitating a higher fire frequency than during the Little Ice Age, when fires were infrequent. Given the projected warming for the next 50–100 years, land managers considering the reintroduction of fire to the Gulf Islands National Park Reserve may want to consider using the mFRI of the MCA as a baseline reference in prescribed burning strategies.

The majority of terrestrial scanning projects in archaeology have focused on heritage documentation, preservation, and the three-dimensional (3D) reconstruction of prominent sites and objects. While these are very important archaeological foci, not many have used terrestrial scanning methods for prospection and feature analysis, similar to the way many have employed airborne LiDAR. While airborne LiDAR scanning is able to situate and analyze archaeological sites on an expansive scale, the ground-based method also captures and defines any landscape anomalies or depressions from cultural features that have remained invisible to the naked eye due to environmental restrictions. In an attempt to test this recording method, we set out to paint a non-invasive, 3D digitized picture of the ancient Maya site of Pacbitun, Belize, using terrestrial scanning to distinctly detail Pacbitun’s structures, plazas, causeways, and karst features. This paper details the process through which 3D terrestrial scanning was executed at Pacbitun and three associated peripheral caves during the 2012 and 2013 field seasons. We discuss the potential laser scanning has for visual analysis in archaeology and evaluate application difficulties encountered in the field, as well as current data interpretation issues.

This article explores Toni Morrison's preoccupation with, and reimagining of, the landscape of the so-called New World. Drawing on scholarship that has investigated dominant discourses about freedom, bounty, and possibility located within the Americas, it identifies various counternarratives in Morrison's fiction, tracing these through the earlier Song of Solomon (1977), Tar Baby (1981), and Beloved (1987), but primarily arguing for their centrality to A Mercy (2008). The mapping of seventeenth-century North America in the author's ninth novel both exposes colonial relations to place and probes African American experiences of the natural world. In particular, A Mercy is found to recalibrate definitions of “wilderness” with a sharpened sensitivity to the position of women and the racially othered within them. The dynamic between the perspectives towards the environment of Anglo-Dutch farmer and trader Jacob Vaark and Native American orphan and servant Lina, is examined, as well as the slave girl Florens's formative encounters in American space. Bringing together diverse narrative views, A Mercy is shown to trouble hegemonic settler and masculinist notions of the New World and, especially through Florens's voicing, shape an alternative engagement with landscape. The article goes some way towards meeting recent calls for attention to the intersections between postcolonial approaches and ecocriticism.

This randomised, clinical trial tested whether The Emotional Freedom Technique (EFT) reduced food cravings. This study involved 96 overweight or obese adults who were allocated to the EFT treatment or 4-week waitlist condition. Degree of food craving, perceived power of food, restraint capabilities and psychological symptoms were assessed pre- and post- a 4-week treatment program (mixed method ANOVA comparative analysis), and at 6-month follow-up (repeated measure ANOVA with group data collapsed). EFT was associated with a significantly greater improvement in food cravings, the subjective power of food and craving restraint than waitlist from pre- to immediately post-test (p < .05). Across collapsed groups, an improvement in food cravings and the subjective power of food after active EFT treatment was maintained at 6 months, and a delayed effect was seen for craving restraint. Although there was a significant reduction in measures of psychological distress immediately after treatment (p < .05), there was no between-group difference. These findings are consistent with the hypothesis that EFT can have an immediate effect on reducing food cravings and can result in maintaining reduced cravings over time.

The early onset of depression following traumatic brain injury (TBI) is associated with poorer psychosocial outcomes; however, the direction of this relationship is unclear. This study investigated the relationship between progress in resuming preinjury lifestyle (transition events), change in perceived functioning and level of depressive symptoms at discharge and 3-months postdischarge. As part of a prospective longitudinal study of brain injury outcomes, 96 consecutively discharged patients with TBI completed measures of transition events (Sentinel Events Questionnaire) and perceived functioning (Mayo-Portland Adaptability Inventory-4 Ability and Adjustment indices) at discharge and 3-months follow-up. Level of depressive symptoms was assessed at discharge and 3-months follow-up using the Depression Anxiety Stress Scale 21. After controlling for age and discharge depressive symptoms, change in perceived functioning was found to mediate the relationship between total transition events and depressive symptoms at 3-months postdischarge (β reduced from .21 to .14), with a significant indirect effect observed. The present findings indicate that lack of progress in resuming preinjury lifestyle contributes to postdischarge depressive symptoms through an influence on perceived functioning, thus providing an improved conceptualization of reactive depression in the context of brain injury. (JINS, 2011, 17, 000–000)