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The earliest monumentality in Western Europe is associated with megalithic structures, but where did the builders of these monuments live? Here, the authors focus on west-central France, one of the earliest centres of megalithic building in Atlantic Europe, commencing in the mid fifth millennium BC. They report on an enclosure at Le Peu (Charente), dated to the Middle Neolithic (c. 4400 BC), and defined by a ditch with two ‘crab claw’ entrances and a double timber palisade flanked by two timber structures—possibly defensive bastions. Inside, timber buildings—currently the earliest known in the region—were possibly home to the builders of the nearby Tusson long mounds.
The updated vancomycin guideline for treatment of serious methicillin-resistant Staphylococcus aureus infections prompted institutions to convert from trough to area-under-the-curve monitoring. The physician perception of the transition, coupled with that of pharmacists, was measured by pre- and postimplementation surveys. Both groups believed safety would be increased without efficacy changes.
Recently, defaults have become celebrated as a low-cost and easy-to-implement nudge for promoting positive outcomes, both at an individual and societal level. In the present research, we conducted a large-scale field experiment (N = 32,508) in an educational context to test the effectiveness of a default intervention in promoting participation in a potentially beneficial achievement test. We found that a default manipulation increased the rate at which high school students registered to take the test but failed to produce a significant change in students’ actual rate of test-taking. These results join past literature documenting robust effects of default framings on initial choice but marked variability in the extent to which those choices ultimately translate to real-world outcomes. We suggest that this variability is attributable to differences in choice-to-outcome pathways – the extent to which the initial choice is causally determinative of the outcome.
Asymmetric warfare and the reaction to its threats have implications in the way far-forward medical assistance is provided in such settings. Investments in far-forward emergency resuscitation and stabilization can contribute to saving lives and increase the resilience of health systems. Thus, it is proposed to extend the use of the Haddon Matrix to determine a set of strategies to better understand and prioritize activities to prepare for and set-up frontline care in the form of Trauma Stabilization Points (TSPs).
An expert consensus methodology was used to achieve the research aim. A small subject matter experts’ group was convened to create and validate the content of the Haddon Matrix.
The result of the expert group consultations presented an overview of TSP Preparedness and Operational Readiness activities within a Haddon Matrix framework. Main strategies to be adopted within the cycle from pre- to post-event had been identified and presented considering the identified opportunities in the context of the possibility of implementation. Of particular importance was the revision of a curriculum that fits the civilian medical system and facilitates its adaptation to the context and available resources.
The new framework to enhance frontline care preparedness and response using the Haddon Matrix facilitated the identification of a set of strategies to support frontline health care workers in a more efficient manner. Since the existing approach and tools are insufficient for modern warfare, additional research is needed.
The purpose of this document is to highlight practical recommendations to assist acute care hospitals to prioritize and implement strategies to prevent ventilator-associated pneumonia (VAP), ventilator-associated events (VAE), and non-ventilator hospital-acquired pneumonia (NV-HAP) in adults, children, and neonates. This document updates the Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA), and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
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.
Disaster Medicine (DM) education for Emergency Medicine (EM) residents is highly variable due to time constraints, competing priorities, and program expertise. The investigators’ aim was to define and prioritize DM core competencies for EM residency programs through consensus opinion of experts and EM professional organization representatives.
Investigators utilized a modified Delphi methodology to generate a recommended, prioritized core curriculum of 40 DM educational topics for EM residencies.
The DM topics recommended and outlined for inclusion in EM residency training included: patient triage in disasters, surge capacity, introduction to disaster nomenclature, blast injuries, hospital disaster mitigation, preparedness, planning and response, hospital response to chemical mass-casualty incident (MCI), decontamination indications and issues, trauma MCI, disaster exercises and training, biological agents, personal protective equipment, and hospital response to radiation MCI.
This expert-consensus-driven, prioritized ranking of DM topics may serve as the core curriculum for US EM residency programs.
The Society of Academic Emergency Medicine Disaster Medicine Interest Group, the Office of the Assistant Secretary for Preparedness and Response – Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE) team, and the National Institutes of Health Library searched disaster medicine peer-reviewed and gray literature to identify, review, and disseminate the most important new research in this field for academics and practitioners.
MEDLINE/PubMed and Scopus databases were searched with key words. Additional gray literature and focused hand search were performed. A Level I review of titles and abstracts with inclusion criteria of disaster medicine, health care system, and disaster type concepts was performed. Eight reviewers performed Level II full-text review and formal scoring for overall quality, impact, clarity, and importance, with scoring ranging from 0 to 20. Reviewers summarized and critiqued articles scoring 16.5 and above.
Articles totaling 1176 were identified, and 347 were screened in a Level II review. Of these, 193 (56%) were Original Research, 117 (34%) Case Report or other, and 37 (11%) were Review/Meta-Analysis. The average final score after a Level II review was 11.34. Eighteen articles scored 16.5 or higher. Of the 18 articles, 9 (50%) were Case Report or other, 7 (39%) were Original Research, and 2 (11%) were Review/Meta-Analysis.
This first review highlighted the breadth of disaster medicine, including emerging infectious disease outbreaks, terror attacks, and natural disasters. We hope this review becomes an annual source of actionable, pertinent literature for the emerging field of disaster medicine.
Powder X-ray diffraction was used to monitor the solvent-free synthesis of two-dimensional (2D) metal–organic frameworks (MOFs) via mechanochemical methods. For four isophthalic acid-based, alkoxide-functionalized organic ligands, optimal milling times were found to vary from 12 to 48 min. This work confirms that mechanochemical synthesis routes can be utilized to afford highly-crystalline, 2D MOFs.
Individuals with schizophrenia have deficits in social cognition that are associated with poor functional outcome. Unfortunately, current treatments result in only modest improvement in social cognition. Oxytocin, a neuropeptide with pro-social effects, has significant benefits for social cognition in the general population. However, studies examining the efficacy of oxytocin in schizophrenia have yielded inconsistent results. One reason for inconsistency may be that oxytocin has typically not been combined with psychosocial interventions. It may be necessary for individuals with schizophrenia to receive concurrent psychosocial treatment while taking oxytocin to have the context needed to make gains in social cognitive skills.
The current study tested this hypothesis in a 24-week (48 session) double-blind, placebo-controlled trial that combined oxytocin and Cognitive-Behavioral Social Skills Training (CBSST), which included elements from Social Cognition and Interaction Training (SCIT). Participants included 62 outpatients diagnosed with schizophrenia (placebo n = 31; oxytocin n = 31) who received 36 IU BID, with supervised administration 45 min prior to sessions on CBSST group therapy days. Participants completed a battery of measures administered at 0, 12, and 24 weeks that assessed social cognition.
CBSST generally failed to enhance social cognition from baseline to end of study, and there was no additive benefit of oxytocin beyond the effects of CBSST alone.
Findings suggest that combined CBSST and oxytocin had minimal benefit for social cognition, adding to the growing literature indicating null effects of oxytocin in multi-dose trials. Methodological and biological factors may contribute to inconsistent results across studies.
Turfgrass managers currently have few readily available means of evaluating herbicide resistance in annual bluegrass during the growing season. Research was conducted to determine if agar-based diagnostic tests developed for agronomic weeds could be used to reliably confirm herbicide resistance in annual bluegrass harvested from golf course turf. Annual bluegrass phenotypes with target-site resistance to acetolactate synthase (ALS; R3, R7), enolpyruvylshikimate-3-phosphate synthase (EPSPS; R5), and photosystem II (PSII; R3, R4) inhibiting herbicides were included in experiments along with an herbicidal susceptible phenotype (S). Single tiller plants were washed free of soil and transplanted into autoclavable polycarbonate plant culture boxes filled with plant tissue culture agar amended with a murashigee-skoog medium and trifloxysulfuron (6.25, 12.5, 25, 50, 75, 100, or 150 μM), glyphosate (0, 6, 12, 25, 50, 100, 200, or 400 μM), or simazine (0, 6, 12, 25, 50, 100, 200, or 400 μM). Mortality in agar was assessed 7 to 10 days after treatment (depending on herbicide) and compared to responses observed after treating individual plants of each phenotype with trifloxysulfuron (28 g ai ha-1), glyphosate (1120 g ae ha-1), or simazine (1120 g ai ha-1) in an enclosed spray chamber. Fisher’s exact test (α = 0.05) determined that mortality in agar with 12.5 μM trifloxysulfuron and 100 μM glyphosate was not significantly different than treating whole plants via traditional spray application. Mortality with all concentrations of simazine in agar was significantly different than that observed after treating resistant and susceptible phenotypes via traditional spray application. Our findings indicate that an agar-based diagnostic assay can be used to detect annual bluegrass resistance to ALS- or EPSPS-inhibiting herbicides in less than 10 days; however, additional research is needed to refine this assay for use with PSII-inhibiting herbicides.
Results from the “Potato Ecosystem Project,” a cropping systems study in northern Maine, were used to test the hypothesis that greater reliance on organic nutrient sources and less reliance on synthetic fertilizer sources can benefit weed management efforts. ‘Atlantic’ potato was grown in a 2-yr rotation within a factorial arrangement of three pest management systems, two soil management systems, and both rotation entry points. Weed control in the conventional (CONV) pest management system relied on full rates of herbicides, whereas the biointensive (BIO) system relied exclusively on cultivation. The reduced input (RI) pest management system relied on cultivation in 1991 and 1992 and on 50% of standard herbicide rates plus cultivation from 1993 to 1995. The two soil management systems, unamended (barley/red clover rotation crop; 1× synthetic fertilizer for potato) and amended (pea/oat/hairy vetch green manure rotation crop; manure, compost, and 0.5× synthetic fertilizer for potato) contrasted practices typical for the region to those designed to achieve rapid improvements in soil quality. Midseason weed biomass in potato was dominated by common lambsquarters. In 1991 and 1992, weed biomass in potato was least in the CONV system and did not differ between the RI and BIO systems. In 1993, weeds in both RI and CONV potatoes were effectively suppressed below the level measured in the BIO system. Soil management had no effect on weed biomass from 1991 to 1993 but became an important factor affecting weeds in the BIO system in 1994 and 1995. Weed biomass was 77% lower in 1994 and 72% lower in 1995 in the amended soil management system than in the unamended system. No significant yield loss due to weeds was detected in the 1994 BIO system, but in 1995 yield loss due to weeds was 37% in the unamended system compared to 12% in the amended system. Soil management effects on weeds in the 1994 BIO pest management system carried through to the following season's germinable seed bank. Density of germinable common lambsquarters seed (0 to 10 cm soil depth) in the 1995 BIO system was 4,082 m−2 in the unamended soil management system compared to 1,280 m−2 in the amended soil management system. We suggest that organic amendments and green manure promote a potato crop better able to compete with weeds and that these inputs be considered as potentially important components of integrated weed management systems that have minimal reliance on herbicides.
New records of Jefferson's ground sloth (Megalonyx jeffersonii) and elk-moose (Cervalces scotti) from Lang Farm provide the first precise temporal correlation of these taxa with the specific environments inhabited by them near the time of their extinction. Six AMS 14C measurements establish an age of 11,405 ± 50 14C yr B.P. for Lang Farm Cervalces and an age of 11,430 ± 60 or 11,485 ± 40 14C yr B.P. for the Megalonyx. These measurements represent the youngest 14C dates for these two genera based on direct dating. Comparison of the dates with pollen data from northern Illinois indicates that these species inhabited a nonanalog environment that was transitional from mid-latitude tundra to mixed conifer and deciduous woodland. Although spruce (Picea sp.) was dominant, it was less abundant than prior to 12,500 14C yr B.P. The presence of black ash (Fraxinus nigra) and fir (Abies sp.) indicates a wet climate and heavy winter precipitation. This may have been the preferred habitat for Cervalces because of its narrow geographic range. However, this habitat type was only one of many occupied by Megalonyx as indicated by its broad geographic distribution.
Prodiamine is a mitotic inhibiting herbicide regularly used to control annual bluegrass PRE. A population of annual bluegrass not controlled by prodiamine at 1,120 g a.i. ha−1 was identified on a golf course in Alcoa, TN, in 2012. A whole-plant hydroponics bioassay was used to screen this biotype for prodiamine resistance (PR) compared with a known susceptible population (SS). Multitiller (i.e., > 4 tillers) PR and SS annual bluegrass plants were established in hydroponic culture and exposed to 0, 0.001, 0.01, 0.10, 1.0, and 10.0 mM prodiamine. Exposure to prodiamine at 0.001 mM reduced root growth of the SS biotype to 26% of the nontreated check (i.e., 0 mM prodiamine) but had no effect on the PR biotype. When exposed to 10 mM prodiamine, root growth of the PR biotype was reduced to 24% of the nontreated check compared with 9% for the SS biotype. I50 values for the PR and SS biotypes were 0.04 and 2.8 × 10−6 mM prodiamine, respectively. The PR biotype measured lower in plant height and leaf width than the SS population. In field trials, prodiamine at 560, 840, 1,120, and 1,400 g ha−1 only controlled the PR biotype 0 to 22%. PRE applications of the cellulose biosynthesis inhibitor indaziflam at 35, 52.5, and 70 g a.i. ha−1 controlled this PR biotype 70 to 97%. This marks the second instance of annual bluegrass developing resistance to prodiamine in Tennessee during the past 5 yr. Future research should evaluate indaziflam efficacy for control of other prodiamine-resistant biotypes of annual bluegrass as well as annual bluegrass biotypes resistant to herbicidal inhibitors of 5-enolpyruvylshikimic acid-3-phosphate synthase, acetolactate synthase, and photosystem II.
In North America, terrestrial records of biodiversity and climate change that span Marine Oxygen Isotope Stage (MIS) 5 are rare. Where found, they provide insight into how the coupling of the ocean–atmosphere system is manifested in biotic and environmental records and how the biosphere responds to climate change. In 2010–2011, construction at Ziegler Reservoir near Snowmass Village, Colorado (USA) revealed a nearly continuous, lacustrine/wetland sedimentary sequence that preserved evidence of past plant communities between ~140 and 55 ka, including all of MIS 5. At an elevation of 2705 m, the Ziegler Reservoir fossil site also contained thousands of well-preserved bones of late Pleistocene megafauna, including mastodons, mammoths, ground sloths, horses, camels, deer, bison, black bear, coyotes, and bighorn sheep. In addition, the site contained more than 26,000 bones from at least 30 species of small animals including salamanders, otters, muskrats, minks, rabbits, beavers, frogs, lizards, snakes, fish, and birds. The combination of macro- and micro-vertebrates, invertebrates, terrestrial and aquatic plant macrofossils, a detailed pollen record, and a robust, directly dated stratigraphic framework shows that high-elevation ecosystems in the Rocky Mountains of Colorado are climatically sensitive and varied dramatically throughout MIS 5.
The vertebrate record at the Ziegler Reservoir fossil site (ZRFS) near Snowmass Village, Colorado ranges from ~140 to 77 ka, spanning all of Marine Oxygen Isotope Stage (MIS) 5. The site contains at least 52 taxa of macro- and microvertebrates, including one fish, three amphibian, four reptile, ten bird, and 34 mammal taxa. The most common vertebrate is Ambystoma tigrinum (tiger salamander), which is represented by >22,000 elements representing the entire life cycle. The mastodon, Mammut americanum, is the most common mammal, and is documented by >1800 skeletal elements making the ZRFS one of the largest accumulations of proboscidean remains in North America. Faunas at the ZRFS can be divided into two groups, a lake-margin group dating to ~140–100 ka that is dominated by woodland taxa, and a lake-center group dating to ~87–77 ka characterized by taxa favoring more open conditions. The change in faunal assemblages occurred between MIS 5c and 5a (vertebrates were absent from MIS 5b deposits), which were times of significant environmental change at the ZRFS. Furthermore, the ZRFS provides a well-dated occurrence of the extinct Bison latifrons, which has implications for the timing of the Rancholabrean Mammal Age in the region.