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A new fossil site in a previously unexplored part of western Madagascar (the Beanka Protected Area) has yielded remains of many recently extinct vertebrates, including giant lemurs (Babakotia radofilai, Palaeopropithecus kelyus, Pachylemur sp., and Archaeolemur edwardsi), carnivores (Cryptoprocta spelea), the aardvark-like Plesiorycteropus sp., and giant ground cuckoos (Coua). Many of these represent considerable range extensions. Extant species that were extirpated from the region (e.g., Prolemur simus) are also present. Calibrated radiocarbon ages for 10 bones from extinct primates span the last three millennia. The largely undisturbed taphonomy of bone deposits supports the interpretation that many specimens fell in from a rock ledge above the entrance. Some primates and other mammals may have been prey items of avian predators, but human predation is also evident. Strontium isotope ratios (87Sr/86Sr) suggest that fossils were local to the area. Pottery sherds and bones of extinct and extant vertebrates with cut and chop marks indicate human activity in previous centuries. Scarcity of charcoal and human artifacts suggests only occasional visitation to the site by humans. The fossil assemblage from this site is unusual in that, while it contains many sloth lemurs, it lacks ratites, hippopotami, and crocodiles typical of nearly all other Holocene subfossil sites on Madagascar.
We argue that understanding of autism can be strengthened by increasing involvement of autistic individuals as researchers and by exploring cascading impacts of early sensory, perceptual, attentional, and motor atypicalities on social and communicative developmental trajectories. Participatory action research that includes diverse participants or researchers may help combat stigma while expanding research foci to better address autistic people's needs.
Under what conditions did the first Islamist movements organize? Which social and institutional contexts facilitated such mobilization? A sizable literature points to social and demographic changes, Western encroachment into Muslim societies, and the availability of state and economic infrastructure. To test these hypotheses, we match a listing of Muslim Brotherhood branches founded in interwar Egypt with contemporaneous census data on over 4,000 subdistricts. A multilevel analysis shows that Muslim Brotherhood branches were more likely in subdistricts connected to the railway and where literacy was higher. Branches were less likely in districts with large European populations, and where state administration was more extensive. Qualitative evidence also points to the railway as key to the movement’s propagation. These findings challenge the orthodoxy that contact between Muslims and the West spurred the growth of organized political Islam, and instead highlight the critical role of economic and state infrastructure in patterning the early contexts of Islamist activism.
Cardiometabolic diseases exhibit changes in lipid biology, which is important as lipids have critical roles in membrane architecture, signalling, hormone synthesis, homoeostasis and metabolism. However, Developmental Origins of Health and Disease studies of cardiometabolic disease rarely include analysis of lipids. This short review highlights some examples of lipid pathology and then explores the technology available for analysing lipids, focussing on the need to develop imaging modalities for intracellular lipids. Analytical methods for studying interactions between the complex endocrine and intracellular signalling pathways that regulate lipid metabolism have been critical in expanding our understanding of how cardiometabolic diseases develop in association with obesity and dietary factors. Biochemical methods can be used to generate detailed lipid profiles to establish links between lifestyle factors and metabolic signalling pathways and determine how changes in specific lipid subtypes in plasma and homogenized tissue are associated with disease progression. New imaging modalities enable the specific visualization of intracellular lipid traffic and distribution in situ. These techniques provide a dynamic picture of the interactions between lipid storage, mobilization and signalling, which operate during normal cell function and are altered in many important diseases. The development of methods for imaging intracellular lipids can provide a dynamic real-time picture of how lipids are involved in complex signalling and other cell biology pathways; and how they ultimately regulate metabolic function/homoeostasis during early development. Some imaging modalities have the potential to be adapted for in vivo applications, and may enable the direct visualization of progression of pathogenesis of cardiometabolic disease after poor growth in early life.
Dual sequential external defibrillation (DSED) is the process of near simultaneous discharge of two defibrillators with differing pad placement to terminate refractory arrhythmias. Previously used in the electrophysiology suite, this technique has recently been used in the emergency department and prehospital setting for out-of-hospital cardiac arrest (OHCA). We present a case of successful DSED in the emergency department with neurologically intact survival to hospital discharge after refractory ventricular fibrillation (RVF) and review the putative mechanisms of action of this technique.
Under what conditions can parties use social-service provision to generate political support? And what is the causal mechanism connecting social-service provision to citizen mobilization? I argue that service provision conveys to voters a politically valuable image of the provider organization’s competence and probity, which is particularly valuable when information about parties and platforms is contradictory or poor. Support comes from an in-depth investigation into the medical networks of the Egyptian Muslim Brotherhood. I combine qualitative evidence, including fieldwork and interviews with Brotherhood social-service providers, with an original 2,483-person survey experiment of Egyptians. Respondents exposed to factual information about the Brotherhood’s medical provision are significantly more likely to consider voting for the Brotherhood in elections. A causal mediation analysis, as well as qualitative evidence drawn from the survey instrument itself, supports the hypothesized mechanism by which respondents map the Brotherhood’s compassion and professionalism in the provision of medical services onto their views of Brotherhood candidates for elected office. Beyond adding to a growing comparative-politics literature on the politics of non-state social service provision, I identify why Egypt’s current rulers have expended such effort to uproot the Muslim Brotherhood’s nationwide network of social services.
To evaluate the impact of no-touch terminal room no-touch disinfection using ultraviolet wavelength C germicidal irradiation (UVGI) on C. difficile infection (CDI) rates on inpatient units with persistently high rates of CDI despite infection control measures.
Interrupted time-series analysis with a comparison arm.
3 adult hematology-oncology units in a large, tertiary-care hospital.
We conducted a 12-month prospective valuation of UVGI. Rooms of patients with CDI or on contact precautions were targeted for UVGI upon discharge using an electronic patient flow system. Incidence rates of healthcare-onset CDI were compared for the baseline period (January 2013–December 2013) and intervention period (February 2014–January 2015) on study units and non–study units using a mixed-effects Poisson regression model with random effects for unit and time in months.
During a 52-week intervention period, UVGI was deployed for 542 of 2,569 of all patient discharges (21.1%) on the 3 study units. The CDI rate declined 25% on study units and increased 16% on non-study units during the intervention compared to the baseline period. We detected a significant association between UVGI and decrease in CDI incidence (incidence rate ratio [IRR], 0.49; 95% confidence interval [CI], 0.26–0.94; P=.03) on the study units but not on the non-study units. The impact of UVGI use on average room-cleaning time and turnaround time was negligible compared to the baseline period.
Targeted deployment of UVGI to rooms of high-risk patients at discharge resulted in a substantial reduction of CDI incidence without adversely impacting room turnaround.
The 2010 American Heart Association Guidelines stress the importance of high quality cardiopulmonary resuscitation (CPR) as a predictor of survival from cardiac arrest. However, resuscitation training is often facilitated and evaluated by instructors without access to objective measures of CPR quality. This study aims to determine whether instructors experienced in the area of adult resuscitation (emergency department staff and senior residents) can accurately assess the quality of chest compressions as a component of their global assessment of a simulated resuscitation scenario.
This is a prospective observational study in which objective chest compression quality data (rate, depth, and fraction) were collected from the simulation manikin and compared to subjective instructor assessment. Data were collected during weekly simulation training sessions for residents, medical students, and nursing students.
We included data from 24 simulated resuscitation scenarios assessed by 1 of 15 instructors. Subjective assessment of chest compression quality identified an adequate compression rate (100–120 compressions per minute) with a sensitivity of 0.17 (confidence interval [CI] 0.02–0.32) and specificity of 0.06 (CI −0.04–0.15), adequate depth (>50 mm) with a sensitivity of 0 and specificity of 0.38 (CI 0.18–0.57), and adequate fraction (>80%) with a sensitivity of 1 and a specificity of 0.25 (CI 0.08–0.42).
Instructor assessment of chest compression rate, depth, and fraction demonstrates poor sensitivity and specificity when compared to the data from the simulation manikin. These results support the use of objective and technologically supported measures of chest compression quality for feedback during resuscitation education using simulators.
One of the highest priority invasive species at both Yosemite and Sequoia and Kings Canyon national parks is Holcus lanatus L. (common velvetgrass), a perennial bunchgrass that invades mid-elevation montane meadows. Despite velvetgrass being a high priority species, there is little information available on control techniques. The goal of this project was to evaluate the short-term response of a single application of common chemical and manual velvetgrass control techniques. The study was conducted at three montane sites in Yosemite National Park. Glyphosate spot-spray treatments were applied at 0.5, 1.0, 1.5, and 2.0% concentrations, and compared with hand pulling to evaluate effects on cover of common velvetgrass, cover of other plant species, and community species richness. Posttreatment year 1 cover of common velvetgrass was 12.1% ± 1.6 in control plots, 6.3% ± 1.5 averaged over the four chemical treatments (all chemical treatments performed similarly), and 13.6% ± 1.7 for handpulled plots. This represents an approximately 50% reduction in common velvetgrass cover in chemically- treated plots recoded posttreatment year 1 and no statistically significant reduction in hand pulled plots compared with controls. However, there was no treatment effect in posttreatment year 2, and all herbicide application rates performed similarly. In addition, there were no significant treatment effects on nontarget species or species richness. These results suggest that for this level of infestation and habitat type, (1) one year of hand pulling is not an effective control method and (2) glyphosate provides some level of control in the short-term without impact to nontarget plant species, but the effect is temporary as a single year of glyphosate treatment is ineffective over a two-year period.
Drowning is a major public health concern, yet little is known about the characteristics of drowning patients. The objectives of this study were to describe the demographic and clinical characteristics of out-of-hospital cardiac arrest (OHCA) attributed to drowning in Ontario and to compare the characteristics of OHCA attributed to drowning to those of presumed cardiac etiology.
A retrospective, observational study was carried out of consecutive OHCA patients of drowning etiology in Ontario between August 2006 and July 2011. Bivariate analysis was used to evaluate differences between drowning and presumed cardiac etiologies.
A total of 31,763 OHCA patients were identified, and 132 (0.42%) were attributed to drowning. Emergency medical services treated 98 patients, whereas the remaining 34 met the criteria for legislative death. Overall, 5.1% of drowning patients survived to hospital discharge. When compared to patients of presumed cardiac etiology, drowning patients were younger and their arrest was more likely to be unwitnessed, present with a nonshockable initial rhythm, occur in a public location, and receive bystander cardiopulmonary resuscitation (CPR). A nonsignificant trend was noted for drowning cases to more frequently have a public access AED applied. There were no significant differences in the gender ratio or paramedic response times. Drowning patients were more likely to be transported to hospital but had a trend to be less likely to arrive with a return of spontaneous circulation. They were also more
likely to be admitted to hospital but had no difference in survival to hospital discharge.
Significant differences exist between OHCA of drowning and presumed cardiac etiologies. Most drownings are unwitnessed, occur in public locations, and present with nonshockable initial rhythms, suggesting that treatment should focus on bystander CPR. Future initiatives should focus on strategies to improve supervision in targeted locations and greater emphasis on bystander-initiated CPR, both of which may reduce drowning mortality.