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Philosophers, archeologists, and other heritage professionals often take a rather negative view of heritage reconstruction, holding that it is inappropriate or even impermissible. In this essay, we argue that taking such hardline attitudes toward the reconstruction of heritage is unjustified. To the contrary, we believe that the reconstruction of heritage can be both permissible and beneficial, all things considered. In other words, sometimes we have good reasons, on balance, to pursue reconstructions, and doing so can be morally acceptable. In defending this claim, we discern a number of arguments made against heritage reconstruction and demonstrate that these arguments are either exaggerated or lack support.
Background: Candidemia is associated with high morbidity and mortality. Although risk factors for candidemia and other bloodstream infections (BSIs) overlap, little is known about patient characteristics and the outcomes of polymicrobial infections. We used data from the CDC Emerging Infections Program (EIP) candidemia surveillance to describe polymicrobial candidemia infections and to assess clinical differences compared with Candida-only BSIs. Methods: During January 2017–December 2017 active, population-based candidemia surveillance was conducted in 45 counties in 9 states covering ~6% of the US population through the CDC EIP. A case was defined as a blood culture with Candida spp in a surveillance-area resident; a blood culture >30 days from the initial culture was considered a second case. Demographic and clinical characteristics were abstracted from medical records by trained EIP staff. We examined characteristics of polymicrobial cases, in which Candida and ≥1 non-Candida organism were isolated from a blood specimen on the same day, and compared these to Candida-only cases using logistic regression or t tests using SAS v 9.4 software. Results: Of the 1,221 candidemia cases identified during 2017, 215 (10.2%) were polymicrobial. Among polymicrobial cases, 50 (23%) involved ≥3 organisms. The most common non-Candida organisms were Staphylococcus epidermidis (n = 30, 14%), Enterococcus faecalis (n = 26, 12%), Enterococcus faecium (n = 17, 8%), and Staphylococcus aureus, Klebsiella pneumoniae, and Stenotrophomonas maltophilia (n = 15 each, 7%). Patients with polymicrobial cases were significantly younger than those with Candida-only cases (54.3 vs 60.7 years; P < .0004). Healthcare exposures commonly associated with candidemia like total parenteral nutrition (relative risk [RR], 0.82; 95% CI, 0.60–1.13) and surgery (RR, 0.99; 95% CI, 0.77–1.29) were similar between the 2 groups. Polymicrobial cases had shorter median time from admission to positive culture (1 vs 4 days, P < .001), were more commonly associated with injection drug use (RR, 1.95; 95% CI, 1.46–2.61), and were more likely to be community onset-healthcare associated (RR, 1.91; 95% CI, 1.50–2.44). Polymicrobial cases were associated with shorter hospitalization (14 vs 17 days; P = .031), less ICU care (RR, 0.7; 95% CI, 0.51–0.83), and lower mortality (RR, 0.7; 95% CI, 0.50–0.92). Conclusions: One in 10 candidemia cases were polymicrobial, with nearly one-quarter of those involving ≥3 organisms. Lower mortality among polymicrobial cases is surprising but may reflect the younger age and lower severity of infection of this population. Greater injection drug use, central venous catheter use, and long-term care exposures among polymicrobial cases suggest that injection or catheter practices play a role in these infections and may guide prevention opportunities.
Background: Well-designed infection prevention programs include basic elements aimed at reducing the risk of transmission of infectious agents in healthcare settings. Although most acute-care facilities have robust infection prevention programs, data are sporadic and often lacking in other healthcare settings. Infection control assessment tools were developed by the CDC to assist health departments in assessing infection prevention preparedness across a wide spectrum of health care including acute care, long-term care, outpatient care, and hemodialysis. Methods: The North Carolina Division of Public Health collaborated with the North Carolina Statewide Program for Infection Control and Epidemiology (SPICE) to conduct a targeted number of on-site assessments for each healthcare setting. Three experienced infection preventionists recruited facilities, conducted on-site assessments, provided detailed assessment findings, and developed educational resources. Results: The goal of 250 assessments was exceeded, with 277 on-site assessments completed across 75% of North Carolina counties (Table 1). Compliance with key observations varied by domain and type of care setting (Table 2). Conclusions: Comprehensive on-site assessments of infection prevention programs are an effective way to identify gaps or breaches in infection prevention practices. Gaps identified in acute care primarily related to competency validation: however, gaps presenting a threat to patient safety (ie, reuse of single dose vials, noncompliance with sterilization and/or high-level disinfection processes) were identified in other care settings. Infection control assessment and response findings underscore the need for ongoing assessment, education, and collaboration among all healthcare settings.
CHD remains one of the leading causes of mortality of children in the United States. There is limited research about the experience of parents from the diagnosis of their child with CHD through the death of their child. A prior study has shown that adults with heart failure go through a series of four transitions: 1) learning the diagnosis, 2) reframing the new normal, 3) taking control of the illness, and 4) understanding death is inevitable. In our qualitative study, we performed semi-structured interviews with parents who have a child die of CHD to determine whether the four transitions in adults apply to parents of children with CHD. We found that these four transitions were present in the parents we interviewed and that there were two novel transitions, one that proceeded the first Jones et al transition (“Prenatal diagnosis”) and one that occurred after the final Jones et al transition (“Adjustment after death”). It is our hope that identification of these six transitions will help better support families of children with CHD.
Reward Deficiency Syndrome (RDS) is an umbrella term for all drug and nondrug addictive behaviors, due to a dopamine deficiency, “hypodopaminergia.” There is an opioid-overdose epidemic in the USA, which may result in or worsen RDS. A paradigm shift is needed to combat a system that is not working. This shift involves the recognition of dopamine homeostasis as the ultimate treatment of RDS via precision, genetically guided KB220 variants, called Precision Behavioral Management (PBM). Recognition of RDS as an endophenotype and an umbrella term in the future DSM 6, following the Research Domain Criteria (RDoC), would assist in shifting this paradigm.
Emergency Medical Services (EMS) systems have developed protocols for prehospital activation of the cardiac catheterization laboratory for patients with suspected ST-elevation myocardial infarction (STEMI) to decrease first-medical-contact-to-balloon time (FMC2B). The rate of “false positive” prehospital activations is high. In order to decrease this rate and expedite care for patients with true STEMI, the American Heart Association (AHA; Dallas, Texas USA) developed the Mission Lifeline PreAct STEMI algorithm, which was implemented in Los Angeles County (LAC; California USA) in 2015. The hypothesis of this study was that implementation of the PreAct algorithm would increase the positive predictive value (PPV) of prehospital activation.
This is an observational pre-/post-study of the effect of the implementation of the PreAct algorithm for patients with suspected STEMI transported to one of five STEMI Receiving Centers (SRCs) within the LAC Regional System. The primary outcome was the PPV of cardiac catheterization laboratory activation for percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The secondary outcome was FMC2B.
A total of 1,877 patients were analyzed for the primary outcome in the pre-intervention period and 405 patients in the post-intervention period. There was an overall decrease in cardiac catheterization laboratory activations, from 67% in the pre-intervention period to 49% in the post-intervention period (95% CI for the difference, -14% to -22%). The overall rate of cardiac catheterization declined in post-intervention period as compared the pre-intervention period, from 34% to 30% (95% CI, for the difference -7.6% to 0.4%), but actually increased for subjects who had activation (48% versus 58%; 95% CI, 4.6%-15.0%). Implementation of the PreAct algorithm was associated with an increase in the PPV of activation for PCI or CABG from 37.9% to 48.6%. The overall odds ratio (OR) associated with the intervention was 1.4 (95% CI, 1.1-1.8). The effect of the intervention was to decrease variability between medical centers. There was no associated change in average FMC2B.
The implementation of the PreAct algorithm in the LAC EMS system was associated with an overall increase in the PPV of cardiac catheterization laboratory activation.
The Antarctic Treaty of 1959, which dedicates the continent to peace and international scientific cooperation in the face of rising east–west tensions, is informed in part by a shared scientific imaginary created by the UK and other nations which maintained scientific bases in Antarctica at the time. In this article, the poet offers works extracted from her longer sequence “Met Obs,” based on meteorological reports and journals from the UK station at Port Lockroy written in advance of the 1957–1958 International Geophysical Year (IGY). The poems engage with the work and circumstances which helped foster such an imaginary, as well as with the nexus of Antarctic “values” endorsed by the Treaty, and the later Madrid Protocol. The commentary further contextualises these literary responses in terms of the attitudes of the men working there as well as the “wilderness and aesthetic values” recognised by the later Protocol on Environmental Protection. The world of the poems may belong to 1950s Antarctica, but their observations reach beyond that experience, making a case for the continued relevance of Treaty values, and for the importance of artistic, as well as scientific, responses to the environment in a world under threat from accelerating climate change and competition for resources.
The Fees Must Fall campaign that swept across South Africa between 2015 and 2017 was the most significant youth political movement in the country's democratic era. Students of this movement were inspired by the anti-apartheid struggles of the 1970s and 1980s, in which black youth were the most prominent actors. The radical and contentious politics of the 1980s also found expression among Afrikaner youth, one expression of which was the rise and popularisation of a short-lived but significant artistic and social movement known as Voelvry.
During the 1970s Yeoville, particularly Rockey-Raleigh Street, saw the emergence of several nightclubs and became the hub of a youthful counterculture, which complemented Yeoville's enduring reputation for cosmopolitanism. From the mid-1980s onwards, Yeoville's clubs came to play a crucial role in the development of Voelvry. Literally ‘free as a bird’, better rendered as ‘outlaw’, Voelvry (voël: bird; vry: free) was both a social movement and a subversive and satirical anti-apartheid punk-inspired rock ‘n’ roll. Sung in Afrikaans, and dubbed ‘boere punk’ (Allan 1989), this music was performed by the so-called Voelvryers (members of Voelvry), mostly white, youngish, Afrikaans-speaking male artists from middle-class backgrounds (Grundlingh 2004: 487). They were deeply dissatisfied with the government, represented by the National Party (NP). Based on interviews with Yeoville residents and individuals who patronised its entertainment spots from the 1970s onwards, this chapter focuses on how the nightclubs that thrived in the high street of Yeoville during the course of the 1980s enabled counterculture Afrikaans-speaking youths to escape transgress and oppose the legal and socially sanctioned codes of behaviour of the dominant society. They did so by performing, dancing and listening to witty punk-rock. What could be conveyed in 1980s Yeoville through light-hearted performances and concert parties was in stark conflict with the hegemonic – and allegedly homogeneous and monolithic – Afrikaner cultural identity, which was carefully produced and protected by the official nationalist institutions run by, or aligned with, the NP government through a number of both legal and secret organisations (O’ Meara 1996: 44).
As more debates in American politics become constitutional questions, effective citizens must engage in constitutional interpretation. While most Americans venerate the Constitution as a part of a national, civil religion, levels of constitutional knowledge are also very low. In this paper, we analyze how ordinary Americans approach the task of constitutional interpretation. An analysis of two cross-sectional surveys indicates constitutional hermeneutics are a product of political factors, religious affiliation, and biblical interpretive preferences. We also present the results of a survey experiment where the manipulation of a clergy's interpretation of a biblical passage affects how respondents interpret both scripture and the Constitution, providing a potential causal mechanism for learning how to engage in hermeneutics.