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The Late Intermediate period in the south-central Andes is known for the widespread use of open sepulchres called chullpas by descent-based ayllus to claim rights to resources and express idealized notions of how society should be organized. Chullpas, however, were rarer on the coast, with the dead often buried individually in closed tombs. This article documents conditions under which these closed tombs were used at the site of Quilcapampa on the coastal plain of southern Peru, allowing an exploration into the ways that funerary traditions were employed to both reflect and generate community affiliation, ideals about sociopolitical organization, and land rights. After a long hiatus, the site was reoccupied and quickly expanded through local population aggregation and highland migrations. An ayllu organization that made ancestral claims to specific resources was poorly suited to these conditions, and the site's inhabitants instead seem to have organized themselves around the ruins of Quilcapampa's earlier occupation. In describing what happened in Quilcapampa, we highlight the need for a better understanding of the myriad ways that Andean peoples used mortuary customs to structure the lives of the living during a period of population movements and climate change.
Advanced practice providers (APPs) are being employed at increasing rates in order to meet new in-hospital care demands. Utilising the Paediatric Acute Care Cardiology Collaborative (PAC3) hospital survey, we evaluated variations in staffing models regarding first-line providers and assessed associations with programme volume, acuity of care, and post-operative length of stay (LOS).
The PAC3 hospital survey defined staffing models and resource availability across member institutions. A resource acuity score was derived for each participating acute care cardiology unit. Surgical volume was obtained from The Society of Thoracic Surgeons database. Pearson’s correlation coefficients were used to evaluate the relationship between staffing models and centre volume as well as unit acuity. A previously developed case-mix adjustment model for total post-operative LOS was utilised in a multinomial regression model to evaluate the association of APP patient coverage with observed-to-expected post-operative LOS.
Surveys were completed by 31 (91%) PAC3 centres in 2017. Nearly all centres (94%) employ APPs, with a mean of 1.7 (range 0–5) APPs present on weekday rounds. The number of APPs present has a positive correlation with surgical volume (r = 0.49, p < 0.01) and increased acuity (r = 0.39, p = 0.03). In the multivariate model, as coverage by APPs increased from low to moderate or high, there was greater likelihood of having a shorter-than-expected post-operative LOS (p < 0.001).
The incorporation of paediatric acute care cardiology APPs is associated with reduced post-operative LOS. Future studies are necessary to understand how APPs impact these patient-specific outcomes.
Introduction: Prehospital sepsis alerts assist paramedics in identifying patients with sepsis and in communicating this diagnosis to receiving facilities. Following the prospective implementation study of our regional systemic inflammatory response syndrome-based alert criteria (Alert), the purpose of this sub-study was to determine the cause of Alert false negatives (patients without an Alert that subsequently met sepsis criteria in the Emergency Department (ED)). Additionally, the sensitivity of the Alert for detecting sepsis was compared to the Quick Sequential Organ Failure Assessment (qSOFA) and Hamilton Early Warning Score (HEWS). Methods: This study was an additional analysis of the prospective Alert implementation study. Included patients were ≥ 18 years old, transported by a regional Emergency Medical Service and met severe sepsis or septic shock criteria (SS/SS, 2012 Surviving Sepsis Guidelines) in regional EDs in 2013. False negative patients were identified prospectively and reviewed by comparing paramedic determined Alert status to the retrospective application of the Alert criteria to Paramedic Call Report (PCR) data. The Alert sensitivity was first calculated from prospective data, then retrospective sensitivities of the Alert, qSOFA and HEWS were calculated by retrospectively applying these tools to PCRs, using ED diagnosis of SS/SS as reference standard. Results: In 2013, 229 patients met SS/SS criteria in the ED and had PCRs available; 115 (50.2%) were male and median age [interquartile range] was 76.0 [63.0-84.0]. Of 229, 149 (65.0%) arrived in the ED without an Alert (false negatives) and 46 (30.9%) of these met Alert criteria retrospectively and were therefore missed by paramedics. Sensitivity of the Alert was 34.9% when applied by paramedics and 41.5% when applied retrospectively to PCRs. The retrospective sensitivities of the qSOFA and HEWS were 37.6% and 67.7%, respectively. Conclusion: In ED patients diagnosed with SS/SS who arrived with no Alert, the majority (69.1%) were missed by the Alert criteria, rather than by paramedic application of the tool. The Alert had a sensitivity of 34.9%. When applied retrospectively and compared to the Alert, qSOFA had similar sensitivity and HEWS had increased sensitivity. Future research should focus on deriving improved alerts or implementing those with higher accuracy, such as HEWS.
To describe the development of a service addressing the needs of adults with ADHD, and to survey the caseload of this service.
This review describes the process of setting up a new service for adults with ADHD. This includes drawing up a service plan to look at the resources required, and arranging shared-care agreements with general practitioners. The service was developed in two phases, with the initial phase accepting transitional patients with an established diagnosis of ADHD, and phase two looking at the assessment of individuals without a previous diagnosis. All referrals to the service were surveyed, and information was collated on age, gender, diagnosis, co-morbidity, medication and employment.
The service was set up in November 2007, and over a period of 10 months, 32 referrals were accepted, having met the criteria for assessment. Cases were accepted on the basis that they had a previous diagnosis of ADHD, the majority originating from Child and Adolescent services.
The caseload review revealed high levels of comorbidity. The majority of patients were treated with stimulant medication. The ratio of male to females was higher, as expected. The incidence of substance misuse and conduct disorder was consistent with other studies.
The demand for a service addressing the needs of adults with ADHD has been high, as evidenced by the volume of referrals received. ADHD persists into adulthood in approximately 50% of children with the diagnosis so follow up into adulthood is crucial.
ADHD has long been considered to affect males more than females. It has been suggested that this difference is not as marked in the adult population. Differences in prevalence in adolescents may be contributed to by underdiagnosis in females. While these differences have been explored in children, there are limited data for the adult population with ADHD. Our study looked at a community sample of adults with ADHD and we examined differences in varying areas of comorbidity between males and females.
We looked at a sample of 50 patients in the adult ADHD clinic. On the basis of gender, differences were recorded in a variety of areas including alcohol and illicit drug use (including cannabis), forensic history, age of diagnosis of ADHD, family history and psychiatric comorbidity.
The full results are pending. Preliminary findings suggest an increased prevalence of substance misuse amongst males. Male patients were more likely to have a forensic history. Female patients are more likely to suffer with comordid anxiety and depression while male patients have a higher prevalence of autistic spectrum disorders and learning difficulties.
Service provision for adult ADHD has to be structured according to the needs of the population served rather than focussing on provison of prescribing services alone. The treatment approach for females with ADHD may diiffer from that for males. The use of psychotherapy in this population is particularly benficial. Comorbidity amongst females may complicate treatment with stimulants as this may worsen features of anxiety and depression.
Stictococcus vayssierei is a major pest of root and tuber crops in central Africa. However, data on its ecology are lacking. Here we provide an updated estimate of its distribution with the aim of facilitating the sustainable control of its populations. Surveys conducted in nine countries encompassing 13 ecological regions around the Congo basin showed that African root and tuber scale was present in Cameroon, Central African Republic, Congo, Democratic Republic of Congo, Equatorial Guinea, Gabon and Uganda. It was not found on the sites surveyed in Chad and Nigeria. The pest occurred in the forest and the forest-savannah mosaic as well as in the savannah where it was never recorded before. However, prevalence was higher in the forest (43.1%) where cassava was the most infested crop, compared to the savannah (9.2%) where aroids (cocoyam and taro) were the most infested crops. In the forest habitat, the pest was prevalent in all but two ecological regions: the Congolian swamp forests and the Southern Congolian forest-savanna mosaic. In the savannah habitat, it was restricted to the moist savannah highlands and absent from dry savannahs. The scale was not observed below 277 m asl. Where present, the scale was frequently (87.1% of the sites) attended by the ant Anoplolepis tenella. High densities (>1000 scales per plant) were recorded along the Cameroon–Gabon border. Good regulatory measures within and between countries are required to control the exchange of plant materials and limit its spread. The study provides information for niche modeling and risk mapping.
Large, ‘complex’ pre-Neolithic hunter-gatherer communities thrived in southern China and northern Vietnam, contemporaneous with the expansion of farming. Research at Con Co Ngua in Vietnam suggests that such hunter-gatherer populations shared characteristics with early farming communities: high disease loads, pottery, complex mortuary practices and access to stable sources of carbohydrates and protein. The substantive difference was in the use of domesticated plants and animals—effectively representing alternative responses to optimal climatic conditions. The work here suggests that the supposed correlation between farming and a decline in health may need to be reassessed.
Preparing investigators to competently conduct community-engaged research is critical to achieving Clinical and Translational Science Award (CTSA) program goals. The purpose of this study is to describe the perspectives of members of a long-standing community engagement advisory board (CEAB) on investigators’ readiness to engage communities and indicators of investigator competence in community-engaged research, in order to suggest core competencies to guide the development of CTSA-sponsored educational programs. Two 90-minute focus groups were conducted with a subset of members of a CEAB (n=19) affiliated with the Center for Clinical and Translational Science at the University of Illinois at Chicago. CEAB members identified a range of investigator skills and practices that demonstrate readiness to engage in community-engaged research. Eight competencies were identified that should be incorporated in providing education to enhance the readiness and competency of CTSA-affiliated researchers planning to engage communities in research. CEAB observations demonstrate the necessity of developing competency-based educational programs that prepare clinical and translational scientists at all levels for the important work of community-engaged research.
Community engagement is deemed as critical to the success of the CTSA program. In 2009, to improve research engagement and build capacity for community-engaged research across the translational spectrum, the Center for Clinical and Translational Science at the University of Illinois at Chicago created a Community Engagement Advisory Board (CEAB). Here, we report results of our ongoing evaluation efforts.
CEAB activities are evaluated using mixed methods. Annual CEAB evaluation surveys were completed from 2010 to 2016 (n=106 respondents). In 2014, two 90-minute focus groups were conducted with a subset of recent CEAB members (n=19).
Survey data suggest respondents perceive their consultations to be helpful in improving the capacity of researchers (90%) and the quality of research projects (80%). Further, CEAB members perceive themselves to have personally benefitted from their involvement including obtaining new knowledge (84%), expansion of their networks (76%), and forming new community linkages (51%). Results of the qualitative data were consistent with survey data.
Our CEAB has improved research engagement and developed institutional capacity to conduct community-engaged research in several ways. Our findings can inform the establishment or enhancement of community engagement services for CTSA-affiliated researchers and community partners.
The purpose of this paper is to describe the formation, operation, and evaluation of a Community Engagement Advisory Board (CEAB) that serves as a resource of the University of Illinois at Chicago’s (UIC) Center for Clinical and Translational Sciences (CCTS).
Current CEAB roles and functions, operating procedures for research consultations and program evaluation strategies were described. Investigators receiving a consultation from 2009 to 2017 (n=91, response rate 78%) were surveyed via an online survey immediately after the consultation and at 12-month follow-up.
Overall, CEAB members were viewed as having sufficient information (92%) and expertise (79%) to provide consultation. Satisfaction levels with the specific consultation received and the overall consultation service were high. The majority of investigators indicated that they would come back to the CEAB for a future consultation, if needed, and would recommend a consultation to others (93% and 96%, respectively). At 12-months, 87% of respondents indicated they had implemented at least some of the recommendations received and 93% said that the consultation influenced their subsequent research.
Data from recent annual evaluations highlight the benefits of CEAB for consulting investigators. Our model can be used to inform the development of future CEAB boards.
The purpose of this study was to obtain feedback from a diverse group of community advisory board members about different clinic or hospital-based approaches to increasing research participation.
Members of an established community engagement advisory board (n=16) provided qualitative and survey data regarding attitudes and preferences for 3 hospital and clinic system strategies to recruit patients into clinical research including universal consent for research, patient registries, and patient portals.
Overall, there was moderate support for each of the 3 approaches discussed. Board members described advantages and disadvantages of each method. Based on the qualitative data, universal consent was viewed as the best strategy for consenting high volumes of patients for research. However, patient registries and portals were seen as more acceptable, less-intrusive and more likely to result in higher participation rates. Survey data were consistent with qualitative findings.
Input from community stakeholders is needed to identify strategies to enhance participation and increase diversity in clinical research. Members of our CEAB identified patient registries and portals as feasible and nonintrusive approaches to increasing research participation. Additional research is needed to confirm these findings and to establish best practices for supporting patients in using registry approaches.
The chaotic dynamics of low-dimensional systems, such as Lorenz or Rössler flows, is guided by the infinity of periodic orbits embedded in their strange attractors. Whether this is also the case for the infinite-dimensional dynamics of Navier–Stokes equations has long been speculated, and is a topic of ongoing study. Periodic and relative periodic solutions have been shown to be involved in transitions to turbulence. Their relevance to turbulent dynamics – specifically, whether periodic orbits play the same role in high-dimensional nonlinear systems like the Navier–Stokes equations as they do in lower-dimensional systems – is the focus of the present investigation. We perform here a detailed study of pipe flow relative periodic orbits with energies and mean dissipations close to turbulent values. We outline several approaches to reduction of the translational symmetry of the system. We study pipe flow in a minimal computational cell at
, and report a library of invariant solutions found with the aid of the method of slices. Detailed study of the unstable manifolds of a sample of these solutions is consistent with the picture that relative periodic orbits are embedded in the chaotic saddle and that they guide the turbulent dynamics.
Objectives: Careful characterization of how functional decline co-evolves with cognitive decline in older adults has yet to be well described. Most models of neurodegenerative disease postulate that cognitive decline predates and potentially leads to declines in everyday functional abilities; however, there is mounting evidence that subtle decline in instrumental activities of daily living (IADLs) may be detectable in older individuals who are still cognitively normal. Methods: The present study examines how the relationship between change in cognition and change in IADLs are best characterized among older adults who participated in the ACTIVE trial. Neuropsychological and IADL data were analyzed for 2802 older adults who were cognitively normal at study baseline and followed for up to 10 years. Results: Findings demonstrate that subtle, self-perceived difficulties in performing IADLs preceded and predicted subsequent declines on cognitive tests of memory, reasoning, and speed of processing. Conclusions: Findings are consistent with a growing body of literature suggesting that subjective changes in everyday abilities can be associated with more precipitous decline on objective cognitive measures and the development of mild cognitive impairment and dementia. (JINS, 2018, 24, 104–112)
We present an age-structured mathematical model of malaria and pneumonia to study the effect of two capacity-building interventions: Integrated Management of Infectious Diseases (IMID) and On-site Support Services (OSS). IMID leads to a reduction in malaria prevalence by more than 2·4% across the [0,5), [5,14) and [14,50) age groups. IMID + OSS reduces it by more than 16·0% across all age groups. IMID decreases pneumonia prevalence by more than 3·0% across all age groups while IMID + OSS decreases it by more than 1·0% across all age groups. The number of malaria and pneumonia deaths is reduced by 7·8% by IMID across all age groups and IMID + OSS decreases this number by 30·5% across all age groups, which translates to saving a life of a child per month. Prevalence of malaria-pneumonia for the [0,5) age group is 0·52% at baseline, and IMID and IMID + OSS reduce it by 6·6% and 23·6%, respectively. There is no change in incidence of malaria or pneumonia disease episodes. The results also indicate that triaging of children contributes more than 50% to the effect of the interventions in reduction of deaths and a range of 14–91% in reduction of disease cases.
Clinical databases in congenital and paediatric cardiac care provide a foundation for quality improvement, research, policy evaluations and public reporting. Structured audits verifying data integrity allow database users to be confident in these endeavours. We report on the initial audit of the Pediatric Cardiac Critical Care Consortium (PC4) clinical registry.
Materials and methods
Participants reviewed the entire registry to determine key fields for audit, and defined major and minor discrepancies for the audited variables. In-person audits at the eight initial participating centres were conducted during a 12-month period. The data coordinating centre randomly selected intensive care encounters for review at each site. The audit consisted of source data verification and blinded chart abstraction, comparing findings by the auditors with those entered in the database. We also assessed completeness and timeliness of case submission. Quantitative evaluation of completeness, accuracy, and timeliness of case submission is reported.
We audited 434 encounters and 29,476 data fields. The aggregate overall accuracy was 99.1%, and the major discrepancy rate was 0.62%. Across hospitals, the overall accuracy ranged from 96.3 to 99.5%, and the major discrepancy rate ranged from 0.3 to 0.9%; seven of the eight hospitals submitted >90% of cases within 1 month of hospital discharge. There was no evidence for selective case omission.
Based on a rigorous audit process, data submitted to the PC4 clinical registry appear complete, accurate, and timely. The collaborative will maintain ongoing efforts to verify the integrity of the data to promote science that advances quality improvement efforts.
On 30 May 2012, Surrey and Sussex Health Protection Unit was called by five nurseries reporting children and staff with sudden onset vomiting approximately an hour after finishing their lunch that day. Over the following 24 h 50 further nurseries supplied by the same company reported cases of vomiting (182 children, 18 staff affected). Epidemiological investigations were undertaken in order to identify the cause of the outbreak and prevent further cases. Investigations demonstrated a nursery-level attack rate of 55 out of 87 nurseries (63·2%, 95% confidence interval 52·2–73·3). Microbiological tests confirmed the presence of Bacillus cereus in food and environmental samples from the catering company and one nursery. This was considered microbiologically and epidemiologically consistent with toxin from this bacterium causing the outbreak. Laboratory investigations showed that the conditions used by the caterer for soaking of pearl haricot beans (known as navy bean in the USA) used in one of the foods supplied to the nurseries prior to cooking, was likely to have provided sufficient growth and toxin production of B. cereus to cause illness. This large outbreak demonstrates the need for careful temperature control in food preparation.
Based on the analysis of data from the numerous dedicated experiments on plasma disruptions in the TEXTOR tokamak the mechanisms of the formation of runaway electron (RE) beams and their losses are proposed. The plasma disruption is caused by a strong stochastic magnetic field formed due to nonlinearly excited low-mode-number magneto-hydro-dynamics (MHD) modes. It is hypothesized that the RE beam is formed in the central plasma region confined by an intact magnetic surface due to the acceleration of electrons by the inductive toroidal electric field. In the case of plasmas with the safety factor
the most stable RE beams are formed by the outermost intact magnetic surface located between the magnetic surface
and the closest low-order rational surface
. The thermal quench (TQ) time caused by the fast electron transport in a stochastic magnetic field is calculated using the collisional transport model. The current quench (CQ) stage is due to the particle transport in a stochastic magnetic field. The RE beam current is modelled as a sum of a toroidally symmetric part and a small-amplitude helical current with a predominant
component. The REs are lost due to two effects: (i) by outward drift of electrons in a toroidal electric field until they touch the wall and (ii) by the formation of a stochastic layer of REs at the beam edge. Such a stochastic layer for high-energy REs is formed in the presence of the
MHD mode. It has a mixed topological structure with a stochastic region open to the wall. The effect of external resonant magnetic perturbations on RE loss is discussed. A possible cause of the sudden MHD signals accompanied by RE bursts is explained by the redistribution of runaway current during the resonant interaction of high-energetic electron orbits with the
Parasite dynamics can be mediated by host behaviours such as sociality, and seasonal changes in aggregation may influence risk of parasite exposure. We used little brown bats (Myotis lucifugus) captured during the autumn mating/swarming period to test the hypothesis that seasonal and demographic-based variation in sociality affect ectoparasitism. We predicted that ectoparasitism would: (1) be higher for adult females and young of the year (YOY) than adult males because of female coloniality; (2) increase for adult males throughout swarming because of increasing contact with females; (3) decrease for adult females and YOY throughout swarming because of reduced coloniality and transmission of individual ectoparasites to males; (4) be similar for male and female YOY because vertical transmission from adult females should be similar. Ectoparasitism was lowest for adult males and increased for males during swarming, but some effects of demographic were unexpected. Contrary to our prediction, ectoparasitism increased for adult females throughout swarming and YOY males also hosted fewer ectoparasites compared with adult and YOY females. Interestingly, females in the best body condition had the highest parasite loads. Our results suggest that host energetic constraints associated with future reproduction affect pre-hibernation parasite dynamics in bats.