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The history of maize in Central America and surrounding areas has implications for the slow transition from hunting and gathering to agriculture. The spread of early forms of domesticated maize from southern Mexico across Mesoamerica and into South America has been dated to about 8,700–6,500 years ago on the basis of a handful of studies relying primarily on the analysis of pollen, phytoliths, or starch grains. Recent genomic data from southern Belize have been used to identify Archaic period south-to-north population movements from lower Central America, suggesting this migration pattern as a mechanism that introduced genetically improved maize races from South America. Gradually, maize productivity increased to the point that it was suitable for use as a staple crop. Here we present a summary of paleoecological data that support the late and uneven entry of maize into the Maya area relative to other regions of Central America and identify the Pacific coastal margin as the probable route by which maize spread southward into Panama and South America. We consider some implications of the early appearance of maize for Late Archaic populations in these areas; for example, with respect to the establishment of sedentary village life.
Background: Bacterial coinfections with COVID-19 appear to be rare, yet antibiotic use in this population is high. Limited guidance is available regarding the use of antibiotics in these patients. In response, a multidisciplinary group of physicians and pharmacists from 5 VISN9 facilities developed a guideline for the use of antibiotics with COVID-19 in July 2021. This guideline created a network-wide standard for antibiotic use and facilitates the assessment of antibiotic appropriateness in hospitalized veterans with COVID-19. Methods: In this observational, cross-sectional study, we reviewed veterans diagnosed with COVID-19 from August 1 through September 30, 2021, who were admitted to VISN9 facilities. Use of antibiotics was assessed during the first 4 days of admission. If antibiotics were prescribed, their use was determined to be appropriate or inappropriate based on the presence or absence of a finding concerning for bacterial coinfection as outlined in the guideline (Table 1). Additional data including procalcitonin results as well as positive sputum cultures were collected. Results: In total, 377 veterans were admitted for COVID-19 during the study period. Among them, 42 veterans (11%) received antibiotics for nonrespiratory infections and were removed from this analysis. Of the remaining 335 veterans, 229 (68%) received antibiotics and 116 (51%) of those met guideline criteria that were concerning for bacterial coinfection. Additionally, 32 (14%) of the 229 veterans who received antibiotics had >1 finding concerning for bacterial coinfection. Procalcitonin levels were obtained in 97 (42%) of 229. Only 33 veterans (14%) who received antibiotics had an elevated procalcitonin, and only 19 (8%) had a positive sputum culture. Conclusions: Antibiotic use was common in hospitalized veterans with COVID-19 in VISN9 facilities. This results are comparable to findings in the published literature. Among those receiving antibiotics early in their hospitalization, half were considered appropriate based on our guideline. Quality improvement initiatives are needed to improve implementation of the network guideline to reduce the overuse of antibiotics for management of COVID-19. Additionally, procalcitonin may be a helpful tool for hospitalized veterans with COVID-19.
A retrospective evaluation was undertaken of the clinical and economic effectiveness of three in-patient rehabilitation units across one London National Health Service trust. Information on admission days and costs 2 years before and 2 years after the rehabilitation placement, length of rehabilitation placement and the discharge pathway was collected on 22 service users.
There were statistically significant reductions in hospital admission days in the 2 years following rehabilitation compared with the 2 years before, further reflected in significantly lower bed costs. Longer length of rehabilitation placement was correlated with fewer admission days after the placement. A substantial proportion of the sample went into more independent living, some with no further admissions at follow-up.
The findings suggest that in-patient rehabilitation is both clinically and cost effective: if benefits are sustained they will offset the cost of the rehabilitation placement.
Sorcerers are too common; cunning men, wizards, and white witches as they call them, in every village, which, if they be sought unto, will help almost all infirmities of body and mind.
(Richard Burton, 1621, cited by Thomas (1973))
Epistemology, ethics and genetics
Developments in genetics ‘pose challenging questions for the application of traditional legal principles’ (Kennedy and Grubb, 1993). This much was recognised, for example, at the Asilomar conference in 1975, where a group of molecular biologists recommended a moratorium on genetic manipulation while arrangements were made to regulate recombinant DNA techniques (Maddox, 1993). Without precedent, the scientific research community was inviting regulation from the legislature for its own activities. Indeed, writing in 1971 James Watson (the elucidator, with Francis Crick, of the structure of DNA) had suggested, of the possible developments in human reproductive research, that techniques for the manipulation of human eggs in vitro were likely to be in general medical practice, capable of routine performance in many major nations, within some 10 to 20 years, and that international agreement was a preferred method of control. On some matters there might even be ‘a sufficient international consensus… to make possible some forms of international agreement before the cat is totally out of the bag’ (Watson, 1971).
The particular difficulties that lawyers and ethicists will want to address are the functional analogue of the difficulties that the genome project discloses in general:
Physically, printing the names of the three billion base pairs would require the number of pages in at least thirteen sets of the Encyclopaedia Britannica, and this does not take into account the heterogeneity of human beings. […]
Before Odysseus navigates the rocks on which live Scylla and Charybdis he is lulled by the Sirens, promising advance disclosure of earthly adventures. Forewarned by Circe, he enjoins his crew first to contain him; later (on pain of death) to release him from the mast to which he is bound. Held to his originally expressed wishes, they refuse, and bind him more tightly. In this way, Odysseus creates what may have been one of the first advance directives. Its enforcement illustrates one of the concerns which have latterly been expressed about making binding health care choices, possibly many years before they might take effect
‘People do not always mean what they say; they do not always say what they want; and they do not always want what they say they want. That much is, if not exactly clear, at least uncontroversial. What is controversial is, recognizing this, how to proceed.’
We shall have to evolve problem-solvers—galore since each problem they solve creates ten problems more
— Piet Hein
The new reproductive technologies, especially in vitro fertilization (IVF), have extended the possi- bilities of assisted reproduction to the benefit of the childless couples. At the same time these technologies and their added techniques, however, have fragmented reproduction and exposed the human egg to intervention yet unknown:
The embryo may be divided into several embryos; may be sold; donated; cryopreserved; borne by another woman and returned; or used for research;
Genetic parentage may be present without sexual intercourse, may be different from social parentage and the natural time-span between fertilization and birth may be interrupted.