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We explore the long-term environmental and human history of a small outer coast archipelago on the Northwest Coast in western Canada. Using relative sea-level change, we reconstruct ancient landscapes to design archaeological surveys that document a rich archaeological record spanning at least 11 000 years and demonstrate the cultural centrality of this geographically marginal landscape.
From 2014 to 2020, we compiled radiocarbon ages from the lower 48 states, creating a database of more than 100,000 archaeological, geological, and paleontological ages that will be freely available to researchers through the Canadian Archaeological Radiocarbon Database. Here, we discuss the process used to compile ages, general characteristics of the database, and lessons learned from this exercise in “big data” compilation.
To assess preventability of hospital-onset bacteremia and fungemia (HOB), we developed and evaluated a structured rating guide accounting for intrinsic patient and extrinsic healthcare-related risks.
HOB preventability rating guide was compared against a reference standard expert panel.
A 10-member panel of clinical experts was assembled as the standard of preventability assessment, and 2 physician reviewers applied the rating guide for comparison.
The expert panel independently rated 82 hypothetical HOB scenarios using a 6-point Likert scale collapsed into 3 categories: preventable, uncertain, or not preventable. Consensus was defined as concurrence on the same category among ≥70% experts. Scenarios without consensus were deliberated and followed by a second round of rating.
Two reviewers independently applied the rating guide to adjudicate the same 82 scenarios in 2 rounds, with interim revisions. Interrater reliability was evaluated using the κ (kappa) statistic.
Expert panel consensus criteria were met for 52 scenarios (63%) after 2 rounds.
After 2 rounds, guide-based rating matched expert panel consensus in 40 of 52 (77%) and 39 of 52 (75%) cases for reviewers 1 and 2, respectively. Agreement rates between the 2 reviewers were 84% overall (κ, 0.76; 95% confidence interval [CI], 0.64–0.88]) and 87% (κ, 0.79; 95% CI, 0.65–0.94) for the 52 scenarios with expert consensus.
Preventability ratings of HOB scenarios by 2 reviewers using a rating guide matched expert consensus in most cases with moderately high interreviewer reliability. Although diversity of expert opinions and uncertainty of preventability merit further exploration, this is a step toward standardized assessment of HOB preventability.
ABSTRACT IMPACT: This study will answer key questions that spine surgeons have regarding techniques used in cement augmentation of vertebral compression fractures and will ultimately advance patient care for such injuries. OBJECTIVES/GOALS: The objective of this study is to determine if a difference exists in load-bearing characteristics and load-to-fracture between injecting cement anteriorly prior to screw placement versus cement augmentation via fenestrated pedicle screws. We also expect differences in load-to-failure characteristics between different cement volumes. METHODS/STUDY POPULATION: This study will be performed in a bioengineering laboratory that has access to a Materials Testing System (MTS). Eight cadaveric specimens will be selected from our stock after pre-screening via CT for inclusion and exclusion criteria. The levels T8-L1 will be dissected from the vertebral column along with any soft tissue structures. The vertebral bodies will be potted in an epoxy mold. From each spine, there are 2 groups of three. One vertebral body from each spine will serve as an internal control, one will be augmented with cement via a cannula and then instrumented with a non-fenestrated screw and the third will be instrumented will a fenestrated screw and then augmented with cement. After appropriate curing time, repeat CT imaging will be completed. The specimens will then be loaded to failure and the results analyzed. RESULTS/ANTICIPATED RESULTS: We hypothesize that we will see a better anterior spread with the cannula/non-fenestrated screw method as compared to the fenestrated screw. The reason being is that we would expect the fenestrated screw to experience more cement extruding from the fenestration rather than being directed anteriorly. We believe a better anterior spread of the cement will lead to a greater load-bearing capacity for the vertebral body. We also believe that a difference will exist in load-to-failure testing with the two volumes being tested, though we cannot predict to what a degree this difference will be impactful as there have been few studies prior looking at this. DISCUSSION/SIGNIFICANCE OF FINDINGS: This study is significant because it will aid in determining the optimal technique to implement in the setting of vertebral compression fractures. This will lead to improved patient care as well as a greater understanding of the instrumentation used in such procedures. The results will lay the groundwork for future research on this procedure.
Cardiac surgical interventions for children with trisomy 18 and trisomy 13 remain controversial, despite growing evidence that definitive cardiac repair prolongs survival. Understanding quality of life for survivors and their families therefore becomes crucial. Study objective was to generate a descriptive summary of parental perspectives on quality of life, family impact, functional status, and hopes for children with trisomy 18 and trisomy 13 who have undergone heart surgery.
A concurrent mixed method approach utilising PedsQL™ 4.0 Generic Core Parent Report for Toddlers or the PedsQL™ Infant Scale, PedsQL™ 2.0 Family Impact Module, Functional Status Scale, quality of life visual analogue scale, and narrative responses for 10 children whose families travelled out of state to access cardiac surgery denied to them in their home state due to genetic diagnoses.
Parents rated their child’s quality of life as 80/100, and their own quality of life as 78/100 using validated scales. Functional status was rated 11 by parents and 11.6 by providers (correlation 0.89). On quality of life visual analogue scale, all parents rated their child’s quality of life as “high” with mean response 92.7/100. Parental hopes were informed by realistic perspective on prognosis while striving to ensure their children had access to reaching their full potential. Qualitative analysis revealed a profound sense of the child’s relationality and valued life meaning.
Understanding parental motivations and perceptions on the child’s quality of life has potential to inform care teams in considering cardiac interventions for children with trisomy 18 and trisomy 13.
The role of aromatherapy in supportive symptom management for pediatric patients receiving palliative care has been underexplored. This pilot study aimed to measure the impact of aromatherapy using validated child-reported nausea, pain, and mood scales 5 minutes and 60 minutes after aromatherapy exposure.
The 3 intervention arms included use of a symptom-specific aromatherapy sachet scent involving deep breathing. The parallel default control arm (for those children with medical exclusion criteria to aromatherapy) included use of a visual imagery picture envelope and deep breathing. Symptom burden was sequentially assessed at 5 and 60 minutes using the Baxter Retching Faces scale for nausea, the Wong-Baker FACES scale for pain, and the Children's Anxiety and Pain Scale (CAPS) for anxious mood. Ninety children or adolescents (mean age 9.4 years) at a free-standing children's hospital in the United States were included in each arm (total n = 180).
At 5 minutes, there was a mean improvement of 3/10 (standard deviation [SD] 2.21) on the nausea scale; 2.6/10 (SD 1.83) on the pain scale; and 1.6/5 (SD 0.93) on the mood scale for the aromatherapy cohort (p < 0.0001). Symptom burden remained improved at 60 minutes post-intervention (<0.0001). Visual imagery with deep breathing improved self-reports of symptoms but was not as consistently sustained at 60 minutes.
Significance of results
Aromatherapy represents an implementable supportive care intervention for pediatric patients receiving palliative care consults for symptom burden. The high number of children disqualified from the aromatherapy arm because of pulmonary or allergy indications warrants further attention to outcomes for additional breathing-based integrative modalities.
Understanding perceptions of family caregivers’ roles and responsibilities regarding their child with complex cardiac needs has potential to help care teams better support parents. Paternal experience has been under-explored in pediatric cardiac cohorts.
Ten fathers of children undergoing cardiac surgery completed quantitative surveys on their knowledge needs and preferred format of communication. In face-to-face recorded interviews, they responded to open-ended questions about the definition of being a good father to a child with a complex cardiac condition, perceived paternal responsibilities, personal growth as a parent to a child with a complex heart condition, support needs, and recommendations to medical staff for paternal inclusion. Semantic content analysis was utilised. The study reports strictly followed COnsolidated criteria for REporting Qualitative research guidelines.
The fathers reported high preference for knowledge about the child’s heart condition, communication about the treatment plan, and desire for inclusion in the care of their child. Paternal role was defined thematically as: providing a supportive presence, being there, offering bonded insight, serving as strong provider, and acting as an informed advocate. The fathers revealed that their responsibilities sometimes conflicted as they strove to serve as an emotional and economic stabiliser for their family, while also wanting to be foundationally present for their child perioperatively.
This study provides insight into paternal experience and strategies for paternal inclusion. This summary of the self-defined experience of the fathers of pediatric cardiac patients offers constructive and specific advice for medical teams.
Over the last decade, archaeologists have turned to large radiocarbon (14C) data sets to infer prehistoric population size and change. An outstanding question concerns just how direct of an estimate 14C dates are for human populations. In this paper we propose that 14C dates are a better estimate of energy consumption, rather than an unmediated, proportional estimate of population size. We use a parametric model to describe the relationship between population size, economic complexity and energy consumption in human societies, and then parametrize the model using data from modern contexts. Our results suggest that energy consumption scales sub-linearly with population size, which means that the analysis of a large 14C time-series has the potential to misestimate rates of population change and absolute population size. Energy consumption is also an exponential function of economic complexity. Thus, the 14C record could change semi-independent of population as complexity grows or declines. Scaling models are an important tool for stimulating future research to tease apart the different effects of population and social complexity on energy consumption, and explain variation in the forms of 14C date time-series in different regions.