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To evaluate variables that affect risk of contamination for endoscopic retrograde cholangiopancreatography and endoscopic ultrasound endoscopes.
Observational, quality improvement study.
University medical center with a gastrointestinal endoscopy service performing ∼1,000 endoscopic retrograde cholangiopancreatography and ∼1,000 endoscopic ultrasound endoscope procedures annually.
Duodenoscope and linear echoendoscope sampling (from the elevator mechanism and instrument channel) was performed from June 2020 through September 2021. Operational changes during this period included standard reprocessing with high-level disinfection with ethylene oxide gas sterilization (HLD–ETO) was switched to double high-level disinfection (dHLD) (June 16, 2020–July 15, 2020), and duodenoscopes changed to disposable tip model (March 2021). The frequency of contamination for the co-primary outcomes were characterized by calculated risk ratios.
The overall pathogenic contamination rate was 4.72% (6 of 127). Compared to duodenoscopes, linear echoendoscopes had a contamination risk ratio of 3.64 (95% confidence interval [CI], 0.69–19.1). Reprocessing using HLD-ETO was associated with a contamination risk ratio of 0.29 (95% CI, 0.06–1.54). Linear echoendoscopes undergoing dHLD had the highest risk of contamination (2 of 18, 11.1%), and duodenoscopes undergoing HLD-ETO and the lowest risk of contamination (0 of 53, 0%). Duodenoscopes with a disposable tip had a 0% contamination rate (0 of 27).
We did not detect a significant reduction in endoscope contamination using HLD-ETO versus dHLD reprocessing. Linear echoendoscopes have a risk of contamination similar to that of duodenoscopes. Disposable tips may reduce the risk of duodenoscope contamination.
Throughout the second half of the twentieth century, Latin America became something of a dumping ground for U.S. priests suspected of sexual abuse, with north-to-south clerical transfers sending predatory priests to countries where pedophilia did not exist in any kind of ontological sense. This article, in response, engages the case of Father David Roney of the Archdiocese of Saint Paul and Minneapolis, Minnesota. After a career of accusations and payouts, with Roney entering and exiting Church-mandated therapy programs, Bishop Raymond Lucker retired this notoriously predatory priest to rural Guatemala in 1994. By placing Roney beyond the reach of psychiatrists, psychologists, and spiritual directors, the Roman Catholic Church leveraged a psychological and juridical difference between two geographical settings in order to render the pedophilia of this priest effectively non-existent, thereby insulating itself from further reputational damage and additional litigation. Given that the Roman Catholic Church has long been an empirical point of reference for studies of subject formation—from pastoralism and mysticism to ritual and the confession—this article adds that the Church also provides ample evidence of an opposite process: of unmaking people.
Pentecostal drug rehabilitation centres in Guatemala City are informal responses to drug use, with these all-male institutions attempting to save drug users from what some Christians call ‘the devil’. Of ethnographic interest is that the mothers, sisters and wives not only pay for the capture and captivity of their loved ones but also volunteer their labour to support these centres. This article, in response, assesses not only the Christian impulse to domesticate sinners but also the extent to which a cult of domesticity organises Guatemala's war on drugs.
Hoerl & McCormack (H&M) propose a two-system account of temporal cognition. We suggest that, following other classic proposals where cognitive systems are putatively independent, H&M's two-system hypothesis should, at a minimum, involve (1) a difference in the nature of the representations upon which each system operates, and (2) a difference in the computations they carry out. In this comment we offer two challenges aimed at showing that H&M's proposal does not meet the minimal requirements (1) and (2).
Based largely on research completed in the North American context, scholars of prisons detail the multiple ways in which carceral practices extend beyond prison walls to transform a wide variety of spaces, ultimately assessing how carceral imaginaries inhabit the most intimate aspects of everyday life. In Latin America, this division between the inside and the outside of prison breaks down even further when read from the perspective of survival. Drawing on ethnographic research across Guatemala's penitentiary system, this article explores how the deep interdependencies that develop between male prisoners and female visitors sustain not just these prisoners and their visitors but also the prison system itself.
Cover crops are suites of non-marketable plants grown to improve soil tilth and reduce erosion. Despite these agronomic benefits, the use of cover crops is often limited because they do not provide a direct source of revenue for producers. Integrating livestock to graze cover crops could provide both an expeditious method for cover crop termination and an alternative source of revenue. However, there has been little research on the agronomic impacts of grazing for cover crop termination, especially in horticultural market-gardens. We conducted a 3-year study comparing the effects of sheep grazing to terminate a four species cover crop (buckwheat, sweetclover, peas and beets) with those of mowing on soil quality indicators, cover crop termination efficacy, and subsequent cash-crop yields. In addition, we tested the nutritional quality of the cover crop as forage. Compared with mowing, sheep grazing did not affect soil chemistry, temperature or moisture. Our study demonstrates that sheep grazing removed more cover crop biomass than mowing at termination. The assessment of nutritional indices suggests that the four-species cover crop mixture could provide high-quality forage with a potential value of US$144.00–481.80 ha−1 of direct revenue as a grazing lease. Cash-crop yields did not differ between previously grazed and previously mowed plots in the subsequent growing season. We conclude that integrating sheep grazing into market vegetable garden operations could make cover crops more economically viable without having adverse effects on subsequent cash crops.
The image appeared on the cover of a Sunday bulletin, produced and distributed by one of Guatemala City's most conservative neo-Pentecostal mega-churches. The picture presented the face of a young teenage girl, her eyes closed, lips wet, and skin kissed by a soft, transcendent light; the young woman's head was even tilted to the side in what Jacques Lacan would call jouissance (1998). Across her pink lips read Psalm 4:6: “In peace, I lay myself down.” This image, stitched together by the church's media relations department, makes a sly reference to Gian Lorenzo Bernini's sculpture, St. Teresa in Ecstasy (1652). The statue in Rome presents one of Teresa of Ávila's (1515–1582) mystical experiences of God, which the sixteenth-century Spanish saint narrates with unblinkingly erotic imagery. In her autobiography, St. Teresa writes how “the great love of God” often left her “utterly consumed,” “penetrated to [her] entrails,” and made her “utter several moans” for both the “intense pain” and its “sweetness” (Peers 1927: 197). With St. Teresa in mind, my own reaction to the church bulletin parroted Jacques Lacan's response to Bernini's statue. “She's coming,” Lacan commented, “There's no doubt about it” (1998: 76).
Our craft is all in reading the other: gaps, inverses, undersides; the veiled; the dark; the buried, the feminine; alterities.
— J. M. Coetzee, White Writing, 81
… those who have indulged in gluttony and violence and drunkenness, and have taken no pains to avoid them, are likely to pass into the bodies of asses and other beasts of that sort. And those who have chosen injustice and tyranny and robbery pass into the body of wolves …
Plato, Phaedo 81E–82A
What happens to David Lurie in Disgrace? Having been dispossessed of his place and identity in the world of reason, he discovers, or rediscovers, a new way of knowing, as well as a new way of being, that exist, and have always existed, beyond the reach of traditional Western categories of mind and body. Coetzee, through Lurie, privileges the body and the senses as vehicles for knowing and being, and in so doing he reveals a profound connection between his protagonist and the animals whose bodies, passions, and senses traditional philosophy has devalued or ignored, and among whom Lurie, dispossessed, spends more and more of his life. I will argue further that Coetzee's rejection of Western rationalism and his emphasis on embodiment and on the human connection to animal bodies and feelings is anything but celebratory. It is, rather, tragic. Coetzee privileges the body without a glimmer of the hope that marks other contemporary approaches that see the rediscovery of the body as a cause for celebration.
Carbon single-walled nanotubes (SWNTs) have been studied extensively as hydrogen storage materials. Herein, a novel hydrogen sorbtion behavior was observed for alkali metal reduced SWNTs and the mechanism of hydrogen binding in these materials has now been elucidated. SWNTs prepared by laser vaporization and purified by oxidation were reduced with Na in combination with naphthalene in tetrahydrofuran (THF) solution. The product, initially formulated as (Na+)xSWNTx-, was dark colored and insoluble in all common solvents examined. Temperature programmed desorption studies showed that hydrogen amounting to 3.5-4.2% w/w was released between 200 and 500°C from the Na-reduced material. This is consistent with hydrogenation of the reduced nanotubes to form C-H bonds with a C2H empirical formula. It appears that SWNT radical anions produced by reaction with sodium deprotonate THF to form hydrogenated nanotubes and the THF cleavage products ethylene and sodium enolate, as confirmed by isotope labeling. A structure consisting of pairs of lines of C-H units that spiral about the long tube axis with a coverage of 50% of the tube carbons is proposed.
The number of periodic arrangements of point vortices – point vortex streets – in two-dimensional fluid flow that are stationary is known to be finite for a generic choice of vortex circulations. When all circulations are the same in absolute value, however, stationary vortex street configurations have been associated with the zeros of certain trigonometric polynomials containing free complex parameters. The presence of these parameters may prove useful in constructing point vortex models of shear layers and wakes. In this paper it is shown that such a continuum of stationary configurations exists in a much wider class of point vortex street systems. The circulations may take on many values, not just two, providing increased flexibility in the modelling context. A simple method for computing these configurations is derived. The effects of symmetries on the solution polynomials are described, and illustrated with examples. In addition, novel translating vortex street configurations are found having arbitrary translation velocity and containing free parameters for vortex circulations ±1 and also for vortex circulations +1, −2.
Experimental wet chemical approaches have been demonstrated in the synthesis of a new chainlike (C60-Fe-C60-Fe)n complex. This structure has been proposed based on 13C solid-state nuclear magnetic resonance, electron paramagnetic resonance, high-resolution transmission electron microscopy, energy-dispersive spectroscopy, and X-ray diffraction. Furthermore, this structure has been shown to have unique binding sites for dihydrogen molecules with the technique of temperature-programmed desorption. The new adsorption sites have binding energies that are stronger than that observed for hydrogen physisorbed on planar graphite, but significantly weaker than a chemical C-H bond. Volumetric measurements at 77 K and 2 bar show a hydrogen adsorption capacity of 0.5 wt%. Interestingly, the BET surface area is ∼31 m2/g after degassing, which is approximately an order of magnitude less than expected given the measured experimental hydrogen capacity. Nitrogen and hydrogen isotherms performed at 75 K also show a marked selectivity for hydrogen over nitrogen for this complex, indicating hidden surface area for hydrogen adsorption.
Emerging developments in geographic information systems and distributed computing offer a roadmap towards an unprecedented spatial data infrastructure in the climate sciences. Key to this are the standards developments for digital geographic information being led by the International Organisation for Standardisation (ISO) technical committee on geographic information/geomatics (TC211) and the Open Geospatial Consortium (OGC). These, coupled with the evolution of standardised web services for applications on the internet by the World Wide Web Consortium (W3C), mean that opportunities for both new applications and increased interoperability exist. These are exemplified by the ability to construct ISO-compliant data models that expose legacy data sources through OGC web services. This paper concentrates on the applicability of these standards to climate data by introducing some examples and outlining the challenges ahead. An abstract data model is developed, based on ISO standards, and applied to a range of climate data–both observational and modelled. An OGC Web Map Server interface is constructed for numerical weather prediction (NWP) data stored in legacy data files. A W3C web service for remotely accessing gridded climate data is illustrated. Challenges identified include the following: first, both the ISO and OGC specifications require extensions to support climate data. Secondly, OGC services need to fully comply with W3C web services, and support complex access control. Finally, to achieve real interoperability, broadly accepted community-based semantic data models are required across the range of climate data types. These challenges are being actively pursued, and broad data interoperability for the climate sciences appears within reach.
An energetic material has been routinely manufactured from nano-metric powders of aluminum (Al) and molybdenum trioxide (MoO3). When optimized, the burn-rate of these materials (∼400 m/s) exceeds that of conventional thermites (based on micron-sized powders), but is less than that of conventional explosives. Similar burn-rates around 350 m/s are measured for these “super-thermites” using n-Al powder in the size range between 30 and 90 nm in diameter (20–60 m2/g, 60–80 wt%Al) and an oxygen to fuel (O/F) mass ratio of 1.4. The burn-rate decreases when the surface area of the MoO3 is decreased from 64 to 40 m2/g, or when O/F is changed from 1.2. Thus, for each average particle diameter, there is an optimum burn-rate at an O/F ratio that depends on the wt%Al present in the material and the particle size distribution of the powder. The burn-rate is dependent on several materials and processing factors such as the quality of the nano-metric ingredients, the processing method, and exposure to air and light, so the effect of aging and environmental exposure on the individual ingredients has been investigated. The results of this powder aging study suggests that the surface area of n-MoO3 can decrease two-fold within 10–12 days, and the Al-metal content in n-Al can decrease as much as 50% over two years. Adequate handling and storage procedures must therefore be followed for the effective use of nano-metric powders and their super-thermite mixes.
Twenty-six women who had been sexually abused in childhood were assessed by means of structured interviews as to the nature of the abusive experience and subsequent psychiatric disorder. Nineteen (73.1%) fulfilled the criteria of Post Traumatic Stress Disorder and a comparison was made between PTSD and non-PTSD groups with regard to quantitative abuse variables. The phenomenon of latency or delay in onset in PTSD symptomatology was investigated. The possible implications of those findings were discussed.