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Water plays a critical role in the production of food and preparation of nutritious meals, yet few studies have examined the relationship between water and food insecurity. The primary objective of this study, therefore, was to examine how experiences of household water insecurity (HWI) relate to experiences of household food insecurity (HFI) among a pastoralist population living in an arid, water-stressed region of northern Kenya.
Design:
We implemented the 12-item Household Water Insecurity Experiences (HWISE, range 0-36) Scale and the 9-item Household Food Insecurity Access Scale (HFIAS, range 0-27) in a cross-sectional survey to measure HWI and HFI, respectively. Data on sociodemographic characteristics and intake of meat and dairy in the prior week were collected as covariates of interest.
Setting:
Northern Kenya, June-July 2019.
Participants:
Daasanach households (n=136) from seven communities.
Results:
In the prior 4 weeks, 93.4% and 98.5% of households had experienced moderate-to-severe HWI and HFI, respectively. Multiple linear regression analyses indicated a strong association between HWI and HFI. Each point higher HWISE score was associated with a 0.44-point (95%CI: 0.22, 0.66, P=0.003) higher HFIAS score adjusting for socio-economic status and other covariates.
Conclusions:
These findings demonstrate high prevalence and co-occurrence of HWI and HFI among Daasanach pastoralists in northern Kenya. This study highlights the need to address HWI and HFI simultaneously when developing policies and interventions to improve the nutritional well-being of populations whose subsistence is closely tied to water availability and access.
The Homa Peninsula has been known to science since 1911, and fossil specimens from the area comprise many type specimens for common African mammalian paleospecies. Here we discuss the fauna and the paleoenvironmental information from the Homa Peninsula. The Homa Peninsula is a 200 km2 area in Homa Bay County, situated on the southern margin of the Winam Gulf of Lake Victoria in Kenya (Figure 29.1). Lake Victoria is estimated to be the third largest lake in the world, with a surface area of 68,900 km2 and a maximum length of approximately 616 km. Although its catchment is extensive, it is relatively shallow compared to any other lake of similar size, with a maximum depth of 84 m. Lake Victoria is located in a depression formed by the western and eastern branches of the East African Rift System (EARS), and is at an average elevation of 1135 m a.s.l. (Database for Hydrological Time Series of Inland Waters, 2017).
To satisfy customer needs in the best way, companies offer them an almost infinite number of product variants. Although, an identical product was not built before, the values of its attributes must be determined during the product configuration process. This paper introduces a methodical approach to predict the values of product attributes based on customer feature configurations using machine learning. Machine learning reduces the effort compared to rule-based expert systems and is both, more accurate and faster. The approach was validated by predicting vehicle weights using industrial data.
A clinical decision tree was developed using point-of-care characteristics to identify patients with culture-proven sepsis due to extended-spectrum β-lactamase–producing Enterobacterales (ESBL-PE). We compared its performance with the clinical gestalt of emergency department (ED) clinicians and hospital-based clinicians. The developed tree outperformed ED-based clinicians but was comparable to inpatient-based clinicians.
This study investigated death anxiety in patients with primary brain tumor (PBT). We examined the psychometric properties of two validated death anxiety measures and determined the prevalence and possible determinants of death anxiety in this often-overlooked population.
Methods
Two cross-sectional studies in neuro-oncology were conducted. In Study 1, 81 patients with PBT completed psychological questionnaires, including the Templer Death Anxiety Scale (DAS). In Study 2, 109 patients with PBT completed similar questionnaires, including the Death and Dying Distress Scale (DADDS). Medical and disease-specific variables were collected across participants in both studies. Psychometric properties, including construct validity, internal consistency, and concurrent validity, were investigated. Levels of distress were analyzed using frequencies, and determinants of death anxiety were identified using logistic regression.
Results
The DADDS was more psychometrically sound than the DAS in patients with PBT. Overall, 66% of PBT patients endorsed at least one symptom of distress about death and dying, with 48% experiencing moderate-severe death anxiety. Generalized anxiety symptoms and the fear of recurrence significantly predicted death anxiety.
Significance of results
The DADDS is a more appropriate instrument than the DAS to assess death anxiety in neuro-oncology. The proportion of patients with PBT who experience death anxiety appears to be higher than in other advanced cancer populations. Death anxiety is a highly distressing symptom, especially when coupled with generalized anxiety and fears of disease progression, which appears to be the case in patients with PBT. Our findings call for routine monitoring and the treatment of death anxiety in neuro-oncology.
Few studies have examined burnout in psychosocial oncology clinicians. The aim of this systematic review was to summarize what is known about the prevalence and severity of burnout in psychosocial clinicians who work in oncology settings and the factors that are believed to contribute or protect against it.
Method
Articles on burnout (including compassion fatigue and secondary trauma) in psychosocial oncology clinicians were identified by searching PubMed/MEDLINE, EMBASE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Web of Science Core Collection.
Results
Thirty-eight articles were reviewed at the full-text level, and of those, nine met study inclusion criteria. All were published between 2004 and 2018 and included data from 678 psychosocial clinicians. Quality assessment revealed relatively low risk of bias and high methodological quality. Study composition and sample size varied greatly, and the majority of clinicians were aged between 40 and 59 years. Across studies, 10 different measures were used to assess burnout, secondary traumatic stress, and compassion fatigue, in addition to factors that might impact burnout, including work engagement, meaning, and moral distress. When compared with other medical professionals, psychosocial oncology clinicians endorsed lower levels of burnout.
Significance of results
This systematic review suggests that psychosocial clinicians are not at increased risk of burnout compared with other health care professionals working in oncology or in mental health. Although the data are quite limited, several factors appear to be associated with less burnout in psychosocial clinicians, including exposure to patient recovery, discussing traumas, less moral distress, and finding meaning in their work. More research using standardized measures of burnout with larger samples of clinicians is needed to examine both prevalence rates and how the experience of burnout changes over time. By virtue of their training, psychosocial clinicians are well placed to support each other and their nursing and medical colleagues.
The three-dimensional (3D) revolution promised to transform archaeological practice. Of the technologies that contribute to the proliferation of 3D data, photogrammetry facilitates the rapid and inexpensive digitization of complex subjects in both field and lab settings. It finds additional use as a tool for public outreach, where it engages audiences ranging from source communities to artifact collectors. But what has photogrammetry's function been in advancing archaeological analysis? Drawing on our previous work, we review recent applications to understand the role of photogrammetry for contemporary archaeologists. Although photogrammetry is widely used as a visual aid, its analytical potential remains underdeveloped. Considering various scales of inquiry—graduating from objects to landscapes—we address how the technology fits within and expands existing documentation and data visualization routines, while evaluating the opportunity it presents for addressing archaeological questions and problems in innovative ways. We advance an agenda advocating that archaeologists move from proof-of-concept papers toward greater integration of photogrammetry with research.
Hydrilla is an invasive aquatic plant that has rapidly spread through many inland water bodies across the globe by outcompeting native aquatic plants. The negative impacts of hydrilla invasion have become a concern for water resource management authorities, power companies, and environmental scientists. The early detection of hydrilla infestation is very important to reduce the costs associated with control and removal efforts of this invasive species. Therefore, in this study, we aimed to develop a tool for rapid, frequent, and large-scale monitoring and predicting spatial extent of hydrilla habitat. This was achieved by integrating in situ and Landsat 8 Operational Land Imager satellite data for Lake J. Strom Thurmond, the largest US Army Corps of Engineers lake east of the Mississippi River, located on the border of Georgia and South Carolina border. The predictive model for presence of hydrilla incorporated radiometric and physical measurements, including remote-sensing reflectance, Secchi disk depth (SDD), light-attenuation coefficient (Kd), maximum depth of colonization (Zc), and percentage of light available through the water column (PLW). The model-predicted ideal habitat for hydrilla featured high SDD, Zc, and PLW values, low values of Kd. Monthly analyses based on satellite images showed that hydrilla starts growing in April, reaches peak coverage around October, begins retreating in the following months, and disappears in February. Analysis of physical and meteorological factors (i.e., water temperature, surface runoff, net inflow, precipitation) revealed that these parameters are closely associated with hydrilla extent. Management agencies can use these results not only to plan removal efforts but also to evaluate and adapt their current mitigation efforts.
Thermoelectronic energy conversion can potentially provide an exceptionally efficient way to convert heat into electric power. Key components of such converters are materials with designed, small work functions. We present the principles of thermoelectronic energy conversion and discuss the advantages and challenges of the conversion process, as well the state of the art of the respective research.
We aimed to evaluate emergency medical services (EMS) data as disaster metrics and to assess stress in surrounding hospitals and a municipal network after the closure of Bellevue Hospital during Hurricane Sandy in 2012.
Methods
We retrospectively reviewed EMS activity and call types within New York City’s 911 computer-assisted dispatch database from January 1, 2011, to December 31, 2013. We evaluated EMS ambulance transports to individual hospitals during Bellevue’s closure and incremental recovery from urgent care capacity, to freestanding emergency department (ED) capability, freestanding ED with 911-receiving designation, and return of inpatient services.
Results
A total of 2,877,087 patient transports were available for analysis; a total of 707,593 involved Manhattan hospitals. The 911 ambulance transports disproportionately increased at the 3 closest hospitals by 63.6%, 60.7%, and 37.2%. When Bellevue closed, transports to specific hospitals increased by 45% or more for the following call types: blunt traumatic injury, drugs and alcohol, cardiac conditions, difficulty breathing, “pedestrian struck,” unconsciousness, altered mental status, and emotionally disturbed persons.
Conclusions
EMS data identified hospitals with disproportionately increased patient loads after Hurricane Sandy. Loss of Bellevue, a public, safety net medical center, produced statistically significant increases in specific types of medical and trauma transports at surrounding hospitals. Focused redeployment of human, economic, and social capital across hospital systems may be required to expedite regional health care systems recovery. (Disaster Med Public Health Preparedness. 2016;10:333–343)
Let $\mathbb{F}_{q}^{n}$ be a vector space of dimension $n$ over the finite field $\mathbb{F}_{q}$. A $q$-analog of a Steiner system (also known as a $q$-Steiner system), denoted ${\mathcal{S}}_{q}(t,\!k,\!n)$, is a set ${\mathcal{S}}$ of $k$-dimensional subspaces of $\mathbb{F}_{q}^{n}$ such that each $t$-dimensional subspace of $\mathbb{F}_{q}^{n}$ is contained in exactly one element of ${\mathcal{S}}$. Presently, $q$-Steiner systems are known only for $t\,=\,1\!$, and in the trivial cases $t\,=\,k$ and $k\,=\,n$. In this paper, the first nontrivial $q$-Steiner systems with $t\,\geqslant \,2$ are constructed. Specifically, several nonisomorphic $q$-Steiner systems ${\mathcal{S}}_{2}(2,3,13)$ are found by requiring that their automorphism groups contain the normalizer of a Singer subgroup of $\text{GL}(13,2)$. This approach leads to an instance of the exact cover problem, which turns out to have many solutions.
Experiments on the National Ignition Facility show that multi-dimensional effects currently dominate the implosion performance. Low mode implosion symmetry and hydrodynamic instabilities seeded by capsule mounting features appear to be two key limiting factors for implosion performance. One reason these factors have a large impact on the performance of inertial confinement fusion implosions is the high convergence required to achieve high fusion gains. To tackle these problems, a predictable implosion platform is needed meaning experiments must trade-off high gain for performance. LANL has adopted three main approaches to develop a one-dimensional (1D) implosion platform where 1D means measured yield over the 1D clean calculation. A high adiabat, low convergence platform is being developed using beryllium capsules enabling larger case-to-capsule ratios to improve symmetry. The second approach is liquid fuel layers using wetted foam targets. With liquid fuel layers, the implosion convergence can be controlled via the initial vapor pressure set by the target fielding temperature. The last method is double shell targets. For double shells, the smaller inner shell houses the DT fuel and the convergence of this cavity is relatively small compared to hot spot ignition. However, double shell targets have a different set of trade-off versus advantages. Details for each of these approaches are described.
Despite immense achievements in the past century in hygiene control, and the development of vaccines and antibiotics, infectious diseases continue to pose a tremendous threat to public health globally. There are still devastating infections for which there are no effective vaccines or antimicrobial therapies. Moreover, the problem of drug resistance in bacteria and viral populations and the increasing appreciation that pathologies resulting from infections are responsible for a number of chronic conditions, are creating an ever-growing need for novel preventive and therapeutic approaches. In line with this, a new host-targeted approach has been suggested for antimicrobial drug research that exploits the central role of the host cell during infection. Decades of research have taught us that infections are supported by host cell functions, and that infection pathology is frequently host dependent. Accordingly, the pharmacological targeting of host cell factors promises novel opportunities to prevent and treat infectious disease. Such an approach may be anticipated to expand the number of druggable targets, produce broad-spectrum compounds and impede the generation of resistance. The discovery of RNA interference (RNAi) has created opportunities to explore gene functions in cellular systems in a targeted manner. RNAi loss-of-function approaches have proved invaluable for the identification of host proteins important for pathogen viability. These approaches can be applied on a high-throughput scale, which demands sophisticated liquid handling and high-content image analysis. Here, we provide an overview of the current status of high-content screening (HCS) in loss-of-function analyses in infectious disease research and discuss how these powerful techniques can be applied to identify host factors with previously unknown roles in infection and its pathology.
The challenge of fighting infectious diseases
Infections by pathogenic species of bacteria, viruses, fungi and protozoa have had considerable impact on mankind throughout history. Advances in our understanding of the importance of hygiene control, and later, improvements in diagnostics and the development and successful employment of vaccines and antimicrobial drugs, have substantially benefited human health, and provided social and economic benefits.
Hospital Ebola preparation is underway in the United States and other countries; however, the best approach and resources involved are unknown.
OBJECTIVE
To examine costs and challenges associated with hospital Ebola preparation by means of a survey of Society for Healthcare Epidemiology of America (SHEA) members.
DESIGN
Electronic survey of infection prevention experts.
RESULTS
A total of 257 members completed the survey (221 US, 36 international) representing institutions in 41 US states, the District of Columbia, and 18 countries. The 221 US respondents represented 158 (43.1%) of 367 major medical centers that have SHEA members and included 21 (60%) of 35 institutions recently defined by the US Centers for Disease Control and Prevention as Ebola virus disease treatment centers. From October 13 through October 19, 2014, Ebola consumed 80% of hospital epidemiology time and only 30% of routine infection prevention activities were completed. Routine care was delayed in 27% of hospitals evaluating patients for Ebola.
LIMITATIONS
Convenience sample of SHEA members with a moderate response rate.
CONCLUSIONS
Hospital Ebola preparations required extraordinary resources, which were diverted from routine infection prevention activities. Patients being evaluated for Ebola faced delays and potential limitations in management of other diseases that are more common in travelers returning from West Africa.
Observations show that glaciers around the world are in retreat and losing mass. Internationally coordinated for over a century, glacier monitoring activities provide an unprecedented dataset of glacier observations from ground, air and space. Glacier studies generally select specific parts of these datasets to obtain optimal assessments of the mass-balance data relating to the impact that glaciers exercise on global sea-level fluctuations or on regional runoff. In this study we provide an overview and analysis of the main observational datasets compiled by the World Glacier Monitoring Service (WGMS). The dataset on glacier front variations (∼42 000 since 1600) delivers clear evidence that centennial glacier retreat is a global phenomenon. Intermittent readvance periods at regional and decadal scale are normally restricted to a subsample of glaciers and have not come close to achieving the maximum positions of the Little Ice Age (or Holocene). Glaciological and geodetic observations (∼5200 since 1850) show that the rates of early 21st-century mass loss are without precedent on a global scale, at least for the time period observed and probably also for recorded history, as indicated also in reconstructions from written and illustrated documents. This strong imbalance implies that glaciers in many regions will very likely suffer further ice loss, even if climate remains stable.
This paper describes the system architecture of a newly constructed radio telescope – the Boolardy engineering test array, which is a prototype of the Australian square kilometre array pathfinder telescope. Phased array feed technology is used to form multiple simultaneous beams per antenna, providing astronomers with unprecedented survey speed. The test array described here is a six-antenna interferometer, fitted with prototype signal processing hardware capable of forming at least nine dual-polarisation beams simultaneously, allowing several square degrees to be imaged in a single pointed observation. The main purpose of the test array is to develop beamforming and wide-field calibration methods for use with the full telescope, but it will also be capable of limited early science demonstrations.
Although the physical remains of early hominins are often touted as the most important aspects of the palaeoanthropological record, the evidence of our hominin ancestry in pieces of stone chipped to make sharp edges is far more plentiful. Stone artifacts represent the dawn of human material culture. Currently there is no reason to believe that our early Pliocene ancestors did not use organic tools prior to the appearance of the earliest stone industries (Panger et al. 2002). However, the durability of the stone artifact record provides archaeologists with a rich record of behaviour over millions of years. The earliest evidence of tool use in the archaeological record comes from indirect evidence of butchery practices. The new discovery of marks indicating butchery on two bones from the Dikika region of Ethiopia confirms the use of stone as a medium for tool use at 3.2 million years ago (Ma) (McPherron et al. 2010). However, the earliest evidence of chipped stone artifacts begins some 2.6 Ma. This record extends through to the Holocene. This chapter will focus almost exclusively on the human use of stone tools in Africa from 2.6 Ma until around 1.5 Ma. The assemblages of stone tools from Africa have frequently been assigned to the classic tripartite system (i.e., Earlier, Middle and Later Stone Age; Goodwin 1945) that was inherited from a European framework of stone industries (Lartet & Christy 1865–75). This chapter covers the earliest stages of stone-tool production, referred to as the Earlier Stone Age, and some of the beginnings of the Middle Stone Age. It will use major regions of Africa as a framework, mostly because the history of research in certain areas influences the study of the sequences of industries. In addition, major units of time that do not necessarily correspond with industrial names (e.g., Developed Oldowan) will provide further structure for this chapter. However, these units of time do not represent any meaningful temporal divisions.
This white paper identifies knowledge gaps and new challenges in healthcare epidemiology research, assesses the progress made toward addressing research priorities, provides the Society for Healthcare Epidemiology of America (SHEA) Research Committee's recommendations for high-priority research topics, and proposes a road map for making progress toward these goals. It updates the 2010 SHEA Research Committee document, “Charting the Course for the Future of Science in Healthcare Epidemiology: Results of a Survey of the Membership of SHEA,” which called for a national approach to healthcare-associated infections (HAIs) and a prioritized research agenda. This paper highlights recent studies that have advanced our understanding of HAIs, the establishment of the SHEA Research Network as a collaborative infrastructure to address research questions, prevention initiatives at state and national levels, changes in reporting and payment requirements, and new patterns in antimicrobial resistance.
Considering the discussion on implementing routine dementia screening in Germany, the objective of the current study was to validate the German version of the Perceptions Regarding Investigational Screening for Memory in Primary Care (PRISM-PC) questionnaire and to determine the acceptance of Alzheimer's disease screening in elderly German adults.
Methods:
The German version of the PRISM-PC was administered to a subsample of participants who attended the Berlin Aging Study II (n = 506). The questionnaire was validated by exploratory as well as confirmatory factor analysis.
Results:
Regarding acceptance of Alzheimer's disease screening (Section B) a single factor structure fitted best. In terms of attitudes regarding Alzheimer's disease (Section D), a hierarchical factor structure was modeled with the higher-order factor “Harms” covering the domains “Family Burden,” “Dependence,” “Emotional Suffering,” “Stigma,” and “Medical Care” on the one hand and the domain “Future Planning” on the other hand. Internal consistency of the different scales reached from α = 0.67 to α = 0.94. Overall, 71.2% of the participants indicated that they wanted to be screened for Alzheimer's disease on a regular basis.
Conclusions:
This study suggests that acceptance can reliably be assessed with the section “Acceptance of Alzheimer's disease screenings” of the German PRISM-PC questionnaire. Furthermore, the majority of elderly German adults would like to be screened for Alzheimer's disease regularly, which might be an effective starting point in order to implement routine dementia screenings. As the sample is a convenience sample of (relatively) healthy older adults, generalizability of these results is limited.