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Implementation assessment plans are crucial for clinical trials to achieve their full potential. Without a proactive plan to implement trial results, it can take decades for one-fifth of effective interventions to be adopted into routine care settings. The Veterans Health Administration Office of Research and Development is undergoing a systematic transformation to embed implementation planning in research protocols through the Cooperative Studies Program, its flagship clinical research program. This manuscript has two objectives: 1) to introduce an Implementation Planning Assessment (IPA) Tool that any clinical trialist may use to facilitate post-trial implementation of interventions found to be effective and 2) to provide a case study demonstrating the IPA Tool’s use. The IPA Tool encourages study designers to initially consider rigorous data collection to maximize acceptability of the intervention by end-users. It also helps identify and prepare potential interested parties at local and national leadership levels to ensure, upon trial completion, interventions can be integrated into programs, technologies, and policies in a sustainable way. The IPA Tool can alleviate some of the overwhelming nature of implementation science by providing a practical guide based on implementation science principles for researchers desiring to scale up and spread effective, clinical trial-tested interventions to benefit patients.
The objective of Ancient Oaxaca is to understand and account for the sudden appearance of a new city on a mountain, Monte Albán, about 500 BC, and the consequences of that event, which in the following few centuries would transform almost every aspect of cultural life. These developments in the Valley of Oaxaca region were part of and contributed to the creation of the sociocultural formations that characterized the world system or civilization of Mesoamerica.
The Neolithic Revolution saw the invention of diverse political, economic, religious, and other social institutions in highland Oaxaca and across Early Formative Mesoamerica, including: varying forms and degrees of social differentiation in prestige, personhood, and social ranking; aggregation sites and large villages; dual organization, cosmology, and ritual practice; writing systems; and institutions for long-distance trade.
Monte Albán conforms to broader cross-cultural expectations, one pattern being the disembedded capital city; other expectations are measurable degrees of collective action in planned urban nucleation, modest social segregation by spatial separation, and city plan facilitating communication and large gatherings.
These analyses indicate that causality did not have a preferred scale of operation, so a multiscalar method is required; likewise, in both nonstate and state societies an expanded institutional approach reveals greater complexity than in theories that assume ruler or elite dominance. The case illustrates a coactive causal process in which collective action policies by the state resulted in population growth, urbanization, production intensity, market participation, and material standard of living across social sectors, which in turn fed back to the state-building process.
The founding of Monte Albán as a new political capital superseding the polities of its constituents immediately entailed urbanization, an expanding hinterland, migration, and population growth. Institution building was expressed by monumentality in public spaces, buildings, and stone sculpture.
Monte Albán endured for 1,200 years, much longer than other Mesoamerican cities. Perhaps the mix of cooperating interests and institutions present since its founding allowed society to respond to new challenges creatively and effectively. Today it is a UNESCO World Heritage Site.
With its rich archaeological data from surveys and excavations, Monte Albán and its regional context in highland Oaxaca, along with cross-cultural comparative science, are useful for evaluating current theories about sociocultural evolution. Older theories and persistent ideas about only two paths to state building – premodern (Oriental) and modern democratic (Occidental) – are less effective as explanations than those that recognize alternative pathways, heterarchy, and multiple important institutions. Collective action theory shows significant promise.
The origins of the state in Oaxaca lie in the founding of Monte Albán, which in turn led to consequences much in evidence by the Late Formative (100 BC): hierarchy development, warfare, urban and rural demographic growth, social stratification, local irrigation projects and other new agricultural strategies, and an inclusive religious cult associated with fertility. Economic behavior changed with marketplace exchange, more output by craft specialists, and increased spending on house construction and portable goods (standard of living, economic growth).
Over two thousand years ago, Oaxaca, Mexico, was the site of one of the New World's earliest episodes of primary state formation and urbanism, and today it is one of the world's archaeologically best-studied regions. This volume, which thoroughly revises and updates the first edition, provides a highly readable yet comprehensive path to acquaint readers with one of the earliest and best-known examples of Native American state formation and its consequences as seen from the perspectives of urbanism, technology, demography, commerce, households, and religion and ritual. Written by prominent archaeological researchers who have devoted decades to Oaxacan research and to the development of suitable social theory, the book places ancient Oaxaca within the context of the history of ideas that have addressed the causes and consequences of social evolutionary change. It also critically evaluates the potential applicability of more recent thinking about state building grounded in collective action and related theories.
Monte Albán, one of Mexico’s earliest cities, was founded in the Valley of Oaxaca around 500 bc as a central fulcrum in a dynamic episode of change that grounds subsequent regional history. Proposed explanations for the establishment of Monte Albán are numerous and diverse; yet, to date, they tend to emphasize only the agency of the elite. Here, we offer new theoretical perspectives on the dynamic processes associated with this multifaceted, transitional episode. Adopting a multiscalar approach, we view this transition as the outcome of innovative social negotiations that yielded new opportunities and social contracts that ultimately advantaged both certain powerful individuals as well as larger segments of the population. The collective mode of governance that was instituted (ca. 500 bc) at this early Mesoamerican city proved to be resilient, enduring for more than a millennium, despite challenges, adjustments, and changes over time.
The aim of this study was to evaluate the safety and feasibility of a passive range of motion exercise programme for infants with CHD.
This non-randomised pilot study enrolled 20 neonates following Stage I palliation for single-ventricle physiology. Trained physical therapists administered standardised 15–20-minute passive range of motion protocol, for up to 21 days or until hospital discharge. Safety assessments included vital signs measured before, during, and after the exercise as well as adverse events recorded through the pre-Stage II follow-up. Feasibility was determined by the percent of days that >75% of the passive range of motion protocol was completed.
A total of 20 infants were enrolled (70% males) for the present study. The median age at enrolment was 8 days (with a range from 5 to 23), with a median start of intervention at postoperative day 4 (with a range from 2 to 12). The median hospital length of stay following surgery was 15 days (with a range from 9 to 131), with an average of 13.4 (with a range from 3 to 21) in-hospital days per patient. Completion of >75% of the protocol was achieved on 88% of eligible days. Of 11 adverse events reported in six patients, 10 were expected with one determined to be possibly related to the study intervention. There were no clinically significant changes in vital signs. At pre-Stage II follow-up, weight-for-age z-score (−0.84±1.20) and length-for-age z-score (−0.83±1.31) were higher compared with historical controls from two earlier trials.
A passive range of motion exercise programme is safe and feasible in infants with single-ventricle physiology. Larger studies are needed to determine the optimal duration of passive range of motion and its effect on somatic growth.
Atmospheric dust constitutes particles <100 μm, or deposits thereof (continental or marine); dust includes ‘loess,’ defined as continental aeolian silt (4–62.5 μm). Dust is well-known from Earth's near-time (mostly Quaternary) record, and recognized as a high-fidelity archive of climate, but remains under-recognized for deep time. Attributes such as thickness, grain size, magnetism, pedogenesis, and provenance of dust form valuable indicators of paleoclimate to constrain models of atmospheric dustiness. Additionally, dust acts as an agent of climate change via both direct and indirect effects on radiative forcing, and on productivity, and thus the biosphere and carbon cycling. Dust from the late Paleozoic of western equatorial Pangea reflects ultimate derivation from orogens (ancestral Rocky Mountains, Central Pangean Mountains), whereas dust from southwestern Pangea (Bolivia) reflects both proximal volcanism and crustal material. Records of dust conducive to cyclostratigraphic analysis, such as data on dust inputs from carbonate sections, or magnetism in paleo-loess, reveal dust cyclicity at Milankovitch timescales, but resolution is compromised if records are too brief, or irregular in interval or magnitude of the attribute being measured. Climate modeling enables identification of the primary regions of dust sourcing in deep time, and impacts of dust on radiative balance and biogeochemistry. Deep-time modeling remains preliminary, but is achievable, and indicates principal dust sources in the Pangean subtropics, with sources increasing during colder climates. Carbon cycle modeling suggests that glacial-phase dust increases stimulated extreme productivity, potentially increasing algal activity and perturbing ecosystem compositions of the late Paleozoic.