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McMurdo Dry Valley lake edge ‘moats’: the ecological intersection between terrestrial and aquatic polar desert habitats
- Michael S. Stone, Shawn P. Devlin, Ian Hawes, Kathleen A. Welch, Michael N. Gooseff, Cristina Takacs-Vesbach, Rachael Morgan-Kiss, Byron J. Adams, J.E. Barrett, John C. Priscu, Peter T. Doran
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- Journal:
- Antarctic Science , First View
- Published online by Cambridge University Press:
- 19 April 2024, pp. 1-17
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Aquatic ecosystems - lakes, ponds and streams - are hotspots of biodiversity in the cold and arid environment of Continental Antarctica. Environmental change is expected to increasingly alter Antarctic aquatic ecosystems and modify the physical characteristics and interactions within the habitats that they support. Here, we describe physical and biological features of the peripheral ‘moat’ of a closed-basin Antarctic lake. These moats mediate connectivity amongst streams, lake and soils. We highlight the cyclical moat transition from a frozen winter state to an active open-water summer system, through refreeze as winter returns. Summer melting begins at the lakebed, initially creating an ice-constrained lens of liquid water in November, which swiftly progresses upwards, creating open water in December. Conversely, freezing progresses slowly from the water surface downwards, with water at 1 m bottom depth remaining liquid until May. Moats support productive, diverse benthic communities that are taxonomically distinct from those under the adjacent permanent lake ice. We show how ion ratios suggest that summer exchange occurs amongst moats, streams, soils and sub-ice lake water, perhaps facilitated by within-moat density-driven convection. Moats occupy a small but dynamic area of lake habitat, are disproportionately affected by recent lake-level rises and may thus be particularly vulnerable to hydrological change.
A.1 A national eDelphi process to establish Canadian quality indicators for the care of adults hospitalized for neurological problems
- CD Foster, M Yaraskavitch, E Barrett, S Peters, C Bencsik, J Burton, KM Chapman, GS Gilmour, D Martino, SB Mitchell, C Kassardjian, H Khosravani, K Sauro, DF Tang-Wai, S Wiebe, LJ Cooke
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 50 / Issue s2 / June 2023
- Published online by Cambridge University Press:
- 05 June 2023, p. S48
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Background: Our aim was to develop a National Quality Indicators Set for the Care of Adults Hospitalized for Neurological Problems, to serve as a foundation to build regional or national quality initiatives in Canadian neurology centres. Methods: We used a national eDelphi process to develop a suite of quality indicators and a parallel process of surveys and patient focus groups to identify patient priorities. Canadian content and methodology experts were invited to participate. To be included, >70% of participants had to rate items as critical and <15% had to rate it as not important. Two rounds of surveys and consensus meetings were used identify and rank indicators, followed by national consultation with members of the Canadian Neurological Society. Results: 38 neurologists and methodologists and 56 patients/caregivers participated in this project. An initial list of 91 possible quality indicators was narrowed to 40 indicators across multiple categories of neurological conditions. 21 patient priorities were identified. Conclusions: This quality indicators suite can be used regionally or nationally to drive improvement initiatives for inpatient neurology care. In addition, we identified multiple opportunities for further research where evidence was lacking or patient and provider priorities did not align.
Building machines that learn and think for themselves
- Matthew Botvinick, David G. T. Barrett, Peter Battaglia, Nando de Freitas, Darshan Kumaran, Joel Z Leibo, Timothy Lillicrap, Joseph Modayil, Shakir Mohamed, Neil C. Rabinowitz, Danilo J. Rezende, Adam Santoro, Tom Schaul, Christopher Summerfield, Greg Wayne, Theophane Weber, Daan Wierstra, Shane Legg, Demis Hassabis
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- Journal:
- Behavioral and Brain Sciences / Volume 40 / 2017
- Published online by Cambridge University Press:
- 10 November 2017, e255
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We agree with Lake and colleagues on their list of “key ingredients” for building human-like intelligence, including the idea that model-based reasoning is essential. However, we favor an approach that centers on one additional ingredient: autonomy. In particular, we aim toward agents that can both build and exploit their own internal models, with minimal human hand engineering. We believe an approach centered on autonomous learning has the greatest chance of success as we scale toward real-world complexity, tackling domains for which ready-made formal models are not available. Here, we survey several important examples of the progress that has been made toward building autonomous agents with human-like abilities, and highlight some outstanding challenges.
Monsoonal circulation of the McMurdo Dry Valleys, Ross Sea region, Antarctica: signal from the snow chemistry
- Nancy A. N. Bertler, Paul A. Mayewski, Peter J. Barrett, Sharon B. Sneed, Michael J. Handley, Karl J. Kreutz
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- Journal:
- Annals of Glaciology / Volume 39 / 2004
- Published online by Cambridge University Press:
- 14 September 2017, pp. 139-145
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McMurdo Dry Valleys (MDV; Ross Sea region, Antarctica) precipitation exhibits extreme seasonality in ion concentration, 3–5 orders of magnitude between summer and winter precipitation. To identify aerosol sources and investigate causes for the observed amplitude in concentration variability, four snow pits were sampled along a coast–Polar Plateau transect across the MDV. The elevation of the sites ranges from 50 to 2400 m and the distance from the coast from 8 to 93 km. Average chemistry gradients along the transect indicate that most species have either a predominant marine or terrestrial source in the MDV. Empirical orthogonal function analysis on the snow-chemistry time series shows that at least 57% of aerosol deposition occurs concurrently. A conceptual climate model, based on meteorological observations, is used to explain the strong seasonality in the MDV. Our results suggest that radiative forcing of the ice-free valleys creates a surface low-pressure cell during summer which promotes air-mass flow from the Ross Sea. The associated precipitating air mass is relatively warm, humid and contains a high concentration of aerosols. During winter, the MDV are dominated by air masses draining off the East Antarctic ice sheet, that are characterized by cold, dry and low concentrations of aerosols. The strong differences between these two air-mass sources create in the MDV a polar version of the monsoonal flow, with humid, warm summers and dry, cold winters.
Solar forcing recorded by aerosol concentrations in coastal
- Nancy A.N. Bertler, Paul A. Mayewski, Sharon B. Sneed, Tim R. Naish, Uwe Morgenstern, Peter J. Barrett
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- Journal:
- Annals of Glaciology / Volume 41 / 2005
- Published online by Cambridge University Press:
- 14 September 2017, pp. 52-56
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Ice-core chemistry data from Victoria Lower Glacier, Antarctica, suggest, at least for the last 50 years, a direct influence of solar activity variations on the McMurdo Dry Valleys (MDV) climate system via controls on air-mass input from two competing environments: the East Antarctic ice sheet and the Ross Sea. During periods of increased solar activity, when total solar irradiance is relatively high, the MDV climate system appears to be dominated by air masses originating from the Ross Sea, leading to higher aerosol deposition. During reduced solar activity, the Antarctic interior seems to be the dominant air-mass source, leading to lower aerosol concentration in the ice-core record. We propose that the sensitivity of the MDV to variations in solar irradiance is caused by strong albedo differences between the ice-free MDV and the ice sheet.
Sociodemographic, lifestyle and behavioural factors associated with consumption of sweetened beverages among adults in Cambridgeshire, UK: the Fenland Study
- Peter Barrett, Fumiaki Imamura, Søren Brage, Simon J Griffin, Nicholas J Wareham, Nita G Forouhi
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- Journal:
- Public Health Nutrition / Volume 20 / Issue 15 / October 2017
- Published online by Cambridge University Press:
- 09 August 2017, pp. 2766-2777
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Objective
We aimed to identify sociodemographic, lifestyle and behavioural determinants of consumption of sugar-sweetened beverages (SSB) and artificially sweetened beverages (ASB) among adults in Cambridgeshire, UK.
DesignCross-sectional data were obtained from a cohort of 9991 adults born between 1950 and 1975. An FFQ was used to assess consumption of beverages and other dietary factors. Multivariable logistic regression was used to examine potential determinants of consuming SSB and ASB (≥1 serving/d).
SettingRecruitment from general practice surgeries to participate in the ongoing population-based Fenland Study.
SubjectsAdults (n 9991) aged 30–64 years from three areas of Cambridgeshire, UK.
ResultsPrevalence estimates for daily SSB and ASB consumption were 20·4 % (n 2041) and 8·9 % (n 893), respectively. SSB consumption (OR; 95 % CI) was more common in men than women (1·33; CI 1·17, 1·50) and among those reporting lower income (<£20 000/year) than those reporting higher income (>£40 000/year; 1·31; 1·09, 1·58). In contrast, daily ASB consumption was more common among women than men (1·62; 1·34, 1·96), those on weight-loss diets than those who were not (2·58; 2·05, 3·24) and those reporting higher income than lower income (1·53; 1·16, 2·00). Factors associated with higher consumption of each of SSB and ASB included being a younger adult, being overweight/obese, having shorter education, eating meals or snack foods while watching television, and skipping breakfast (P<0·05 each).
ConclusionsFrequent consumers of SSB and ASB differ by several sociodemographic characteristics. However, increased BMI, younger age and unhealthy eating behaviours are common to both groups.
Contributors
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- By Federica Agosta, Alberto Albanese, Timothy J. Amrhein, A. M. Barrett, Walter S. Bartynski, Felix Benninger, Thomas Brandt, Andrew G. Burke, Michelle Cameron, Elisa Canu, Louis R. Caplan, Christine M. Carr, Daniel J. A. Connolly, Firouz Daneshgari, John DeLuca, Marianne de Visser, Marianne Dieterich, Antonio E. Elia, Joseph H. Feinberg, Massimo Filippi, Lauren C. Frey, Gaëtan Garraux, Andrea Ginestroni, Peter J. Goadsby, Bronwyn E. Hamilton, Simon J. Hickman, Holly E. Hinson, Jon P. Jennings, Jan Kassubek, Horacio Kaufmann, David M. Kaylie, Joanna Kitley, Vladimir S. Kostic, C. T. Paul Krediet, Megan C. Leary, Farooq H. Maniyar, Ken R. Maravilla, Mario Mascalchi, Rajarshi Mazumder, Priyesh Mehta, Jacqueline A. Palace, Raj M. Paspulati, Christopher A. Potter, Angelo Quattrini, Louis P. Riccelli, Nilo Riva, Maria A. Rocca, Mirabelle B. Sajisevi, Richard Salazar-Montero, Nicholas D. Schiff, Jack H. Simon, Israel Steiner, Carl D. Stevens, Bart P. van de Warrenburg, Judith van Gaalen, William J. Weiner, Jane L. Weissman, Jay Yao, G. Bryan Young
- Edited by Massimo Filippi, Jack H. Simon
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- Book:
- Imaging Acute Neurologic Disease
- Published online:
- 05 October 2014
- Print publication:
- 11 September 2014, pp vi-viii
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- By Frank Andrasik, Melissa R. Andrews, Ana Inés Ansaldo, Evangelos G. Antzoulatos, Lianhua Bai, Ellen Barrett, Linamara Battistella, Nicolas Bayle, Michael S. Beattie, Peter J. Beek, Serafin Beer, Heinrich Binder, Claire Bindschaedler, Sarah Blanton, Tasia Bobish, Michael L. Boninger, Joseph F. Bonner, Chadwick B. Boulay, Vanessa S. Boyce, Anna-Katharine Brem, Jacqueline C. Bresnahan, Floor E. Buma, Mary Bartlett Bunge, John H. Byrne, Jeffrey R. Capadona, Stefano F. Cappa, Diana D. Cardenas, Leeanne M. Carey, S. Thomas Carmichael, Glauco A. P. Caurin, Pablo Celnik, Kimberly M. Christian, Stephanie Clarke, Leonardo G. Cohen, Adriana B. Conforto, Rory A. Cooper, Rosemarie Cooper, Steven C. Cramer, Armin Curt, Mark D’Esposito, Matthew B. Dalva, Gavriel David, Brandon Delia, Wenbin Deng, Volker Dietz, Bruce H. Dobkin, Marco Domeniconi, Edith Durand, Tracey Vause Earland, Georg Ebersbach, Jonathan J. Evans, James W. Fawcett, Uri Feintuch, Toby A. Ferguson, Marie T. Filbin, Diasinou Fioravante, Itzhak Fischer, Agnes Floel, Herta Flor, Karim Fouad, Richard S. J. Frackowiak, Peter H. Gorman, Thomas W. Gould, Jean-Michel Gracies, Amparo Gutierrez, Kurt Haas, C.D. Hall, Hans-Peter Hartung, Zhigang He, Jordan Hecker, Susan J. Herdman, Seth Herman, Leigh R. Hochberg, Ahmet Höke, Fay B. Horak, Jared C. Horvath, Richard L. Huganir, Friedhelm C. Hummel, Beata Jarosiewicz, Frances E. Jensen, Michael Jöbges, Larry M. Jordan, Jon H. Kaas, Andres M. Kanner, Noomi Katz, Matthew S. Kayser, Annmarie Kelleher, Gerd Kempermann, Timothy E. Kennedy, Jürg Kesselring, Fary Khan, Rachel Kizony, Jeffery D. Kocsis, Boudewijn J. Kollen, Hubertus Köller, John W. Krakauer, Hermano I. Krebs, Gert Kwakkel, Bradley Lang, Catherine E. Lang, Helmar C. Lehmann, Angelo C. Lepore, Glenn S. Le Prell, Mindy F. Levin, Joel M. Levine, David A. Low, Marilyn MacKay-Lyons, Jeffrey D. Macklis, Margaret Mak, Francine Malouin, William C. Mann, Paul D. Marasco, Christopher J. Mathias, Laura McClure, Jan Mehrholz, Lorne M. Mendell, Robert H. Miller, Carol Milligan, Beth Mineo, Simon W. Moore, Jennifer Morgan, Charbel E-H. Moussa, Martin Munz, Randolph J. Nudo, Joseph J. Pancrazio, Theresa Pape, Alvaro Pascual-Leone, Kristin M. Pearson-Fuhrhop, P. Hunter Peckham, Tamara L. Pelleshi, Catherine Verrier Piersol, Thomas Platz, Marcus Pohl, Dejan B. Popović, Andrew M. Poulos, Maulik Purohit, Hui-Xin Qi, Debbie Rand, Mahendra S. Rao, Josef P. Rauschecker, Aimee Reiss, Carol L. Richards, Keith M. Robinson, Melvyn Roerdink, John C. Rosenbek, Serge Rossignol, Edward S. Ruthazer, Arash Sahraie, Krishnankutty Sathian, Marc H. Schieber, Brian J. Schmidt, Michael E. Selzer, Mijail D. Serruya, Himanshu Sharma, Michael Shifman, Jerry Silver, Thomas Sinkjær, George M. Smith, Young-Jin Son, Tim Spencer, John D. Steeves, Oswald Steward, Sheela Stuart, Austin J. Sumner, Chin Lik Tan, Robert W. Teasell, Gareth Thomas, Aiko K. Thompson, Richard F. Thompson, Wesley J. Thompson, Erika Timar, Ceri T. Trevethan, Christopher Trimby, Gary R. Turner, Mark H. Tuszynski, Erna A. van Niekerk, Ricardo Viana, Difei Wang, Anthony B. Ward, Nick S. Ward, Stephen G. Waxman, Patrice L. Weiss, Jörg Wissel, Steven L. Wolf, Jonathan R. Wolpaw, Sharon Wood-Dauphinee, Ross D. Zafonte, Binhai Zheng, Richard D. Zorowitz
- Edited by Michael Selzer, Stephanie Clarke, Leonardo Cohen, Gert Kwakkel, Robert Miller, Case Western Reserve University, Ohio
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- Textbook of Neural Repair and Rehabilitation
- Published online:
- 05 May 2014
- Print publication:
- 24 April 2014, pp ix-xvi
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- By Frank Andrasik, Melissa R. Andrews, Ana Inés Ansaldo, Evangelos G. Antzoulatos, Lianhua Bai, Ellen Barrett, Linamara Battistella, Nicolas Bayle, Michael S. Beattie, Peter J. Beek, Serafin Beer, Heinrich Binder, Claire Bindschaedler, Sarah Blanton, Tasia Bobish, Michael L. Boninger, Joseph F. Bonner, Chadwick B. Boulay, Vanessa S. Boyce, Anna-Katharine Brem, Jacqueline C. Bresnahan, Floor E. Buma, Mary Bartlett Bunge, John H. Byrne, Jeffrey R. Capadona, Stefano F. Cappa, Diana D. Cardenas, Leeanne M. Carey, S. Thomas Carmichael, Glauco A. P. Caurin, Pablo Celnik, Kimberly M. Christian, Stephanie Clarke, Leonardo G. Cohen, Adriana B. Conforto, Rory A. Cooper, Rosemarie Cooper, Steven C. Cramer, Armin Curt, Mark D’Esposito, Matthew B. Dalva, Gavriel David, Brandon Delia, Wenbin Deng, Volker Dietz, Bruce H. Dobkin, Marco Domeniconi, Edith Durand, Tracey Vause Earland, Georg Ebersbach, Jonathan J. Evans, James W. Fawcett, Uri Feintuch, Toby A. Ferguson, Marie T. Filbin, Diasinou Fioravante, Itzhak Fischer, Agnes Floel, Herta Flor, Karim Fouad, Richard S. J. Frackowiak, Peter H. Gorman, Thomas W. Gould, Jean-Michel Gracies, Amparo Gutierrez, Kurt Haas, C.D. Hall, Hans-Peter Hartung, Zhigang He, Jordan Hecker, Susan J. Herdman, Seth Herman, Leigh R. Hochberg, Ahmet Höke, Fay B. Horak, Jared C. Horvath, Richard L. Huganir, Friedhelm C. Hummel, Beata Jarosiewicz, Frances E. Jensen, Michael Jöbges, Larry M. Jordan, Jon H. Kaas, Andres M. Kanner, Noomi Katz, Matthew S. Kayser, Annmarie Kelleher, Gerd Kempermann, Timothy E. Kennedy, Jürg Kesselring, Fary Khan, Rachel Kizony, Jeffery D. Kocsis, Boudewijn J. Kollen, Hubertus Köller, John W. Krakauer, Hermano I. Krebs, Gert Kwakkel, Bradley Lang, Catherine E. Lang, Helmar C. Lehmann, Angelo C. Lepore, Glenn S. Le Prell, Mindy F. Levin, Joel M. Levine, David A. Low, Marilyn MacKay-Lyons, Jeffrey D. Macklis, Margaret Mak, Francine Malouin, William C. Mann, Paul D. Marasco, Christopher J. Mathias, Laura McClure, Jan Mehrholz, Lorne M. Mendell, Robert H. Miller, Carol Milligan, Beth Mineo, Simon W. Moore, Jennifer Morgan, Charbel E-H. Moussa, Martin Munz, Randolph J. Nudo, Joseph J. Pancrazio, Theresa Pape, Alvaro Pascual-Leone, Kristin M. Pearson-Fuhrhop, P. Hunter Peckham, Tamara L. Pelleshi, Catherine Verrier Piersol, Thomas Platz, Marcus Pohl, Dejan B. Popović, Andrew M. Poulos, Maulik Purohit, Hui-Xin Qi, Debbie Rand, Mahendra S. Rao, Josef P. Rauschecker, Aimee Reiss, Carol L. Richards, Keith M. Robinson, Melvyn Roerdink, John C. Rosenbek, Serge Rossignol, Edward S. Ruthazer, Arash Sahraie, Krishnankutty Sathian, Marc H. Schieber, Brian J. Schmidt, Michael E. Selzer, Mijail D. Serruya, Himanshu Sharma, Michael Shifman, Jerry Silver, Thomas Sinkjær, George M. Smith, Young-Jin Son, Tim Spencer, John D. Steeves, Oswald Steward, Sheela Stuart, Austin J. Sumner, Chin Lik Tan, Robert W. Teasell, Gareth Thomas, Aiko K. Thompson, Richard F. Thompson, Wesley J. Thompson, Erika Timar, Ceri T. Trevethan, Christopher Trimby, Gary R. Turner, Mark H. Tuszynski, Erna A. van Niekerk, Ricardo Viana, Difei Wang, Anthony B. Ward, Nick S. Ward, Stephen G. Waxman, Patrice L. Weiss, Jörg Wissel, Steven L. Wolf, Jonathan R. Wolpaw, Sharon Wood-Dauphinee, Ross D. Zafonte, Binhai Zheng, Richard D. Zorowitz
- Edited by Michael E. Selzer, Stephanie Clarke, Leonardo G. Cohen, Gert Kwakkel, Robert H. Miller, Case Western Reserve University, Ohio
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- Textbook of Neural Repair and Rehabilitation
- Published online:
- 05 June 2014
- Print publication:
- 24 April 2014, pp ix-xvi
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Recent advances in understanding Antarctic climate evolution
- Martin J. Siegert, Peter Barrett, Robert DeConto, Robert Dunbar, Colm Ó Cofaigh, Sandra Passchier, Tim Naish
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- Antarctic Science / Volume 20 / Issue 4 / August 2008
- Published online by Cambridge University Press:
- 23 January 2008, pp. 313-325
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Geological evidence shows that the ice sheet and climate in Antarctica has changed considerably since the onset of glaciation around 34 million years ago. By analysing this evidence, important information concerning processes responsible for ice sheet growth and decay can be determined, which is vital for appreciating future changes in Antarctica. Geological records are diverse and their analyses require a variety of techniques. They are, however, essential for the establishment of hypotheses regarding past Antarctic changes. Numerical models of ice and climate are useful for testing such hypotheses, and in recent years there have been several advances in our knowledge relating to ice sheet history gained from these tests. This paper documents five case studies, employing a full range of techniques, to exemplify recent insights into Antarctic climate evolution from modelling ice sheet inception in the earliest Oligocene to quantifying Neogene ice sheet fluctuations and process-led investigations of recent (last glacial) changes.
Quality Standard for the Treatment of Bacteremia
- Peter A. Gross, Trisha L. Barrett, E. Patchen Dellinger, Peter J. Krause, William J. Martone, John E. McGowan, Jr, Richard L. Sweet, Richard P. Wenzel
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 15 / Issue 3 / March 1994
- Published online by Cambridge University Press:
- 02 January 2015, pp. 189-192
- Print publication:
- March 1994
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Objective:
The objective of this quality standard is to optimize the treatment of bacteremia in hospitalized patients by ensuring that the antibiotic given is appropriate in terms of the blood culture susceptibility of the pathogen. Although this standard may appear to be minimal in scope, it is needed because appropriate antimicrobial treatment is not given in 5% to 17% of cases. To implement the standard, physicians, pharmacists, and microbiologists will need to devise a coordinated strategy.
Options:We considered criteria for appropriate dosing, most cost-effective selection, proper antibiotic levels in serum, least toxicity, narrowest spectrum, specific clinical indications, and optimal duration of treatment. All these criteria were rejected as the basis for the standard because they were too controversial and too difficult to be applied by a nonphysician chart reviewer. In contrast, the selection of an antibiotic to which the pathogen is sensitive is a non-controversial criterion and easy for a chart reviewer to apply.
Outcomes:The standard is designed to reduce the incidence of adverse outcomes of septicemia such as renal failure, prolonged hos-pitalization, and death.
Evidence:Several well-designed clinical trials without randomization as well as case-controlled studies have confirmed the benefit of using an antibiotic that is appropriate in light of the susceptibility of the isolate in blood culture. Prospective, randomized, placebo-controlled trials are not available.
Values:Our premise is that the presence of bacteremia is a risk factor for serious adverse outcomes. We also believe that the administration of antibiotics must always be guided by the susceptibility report for the pathogen(s) obtained from blood cultures. This concern is more critical for pathogens from the blood than for those from most other body sites. We had evidence that susceptibility reports for pathogens from positive blood cultures were not always used properly. We used group discussion to reach a consensus among the members of the Quality Standards Subcommittee.
Benefits, Harms, and Costs:Through the implementation of this standard, at least 5% of bacteremias could be treated more appropriately. An unknown number of deaths would likely be prevented, and mortality from bacteremia treated inappropriately would probably be reduced. The primary undesirable feature of the standard is an increased workload of pharmacists and microbiologists.
Recommendations:Treatment of bacteremia with an antibiotic that is appropriate in terms of the pathogen's blood-culture susceptibility is a minimal standard of care for all patients.
Validation:We consulted more than 50 experts in infectious diseases from the fields of medicine, surgery, pediatrics, obstetrics and gynecology, nursing, epidemiology, pharmacology, and government. In addition, the methods for its implementation were reviewed by the American Society of Hospital Pharmacists and were tested by one of the members of the Quality Standards Subcommittee.
Sponsors:The Quality Standards Subcommittee of the Clinical Affairs Committee of the Infectious Diseases Society of America (IDSA) developed the standard. The subcommittee was composed of representatives of the IDSA (Drs. Gross and McGowan), the Society for Hospital Epidemiology of America (Dr. Wenzel), the Surgical Infection Society (Dr. Dellinger), the Pediatric Infectious Diseases Society (Dr. Krause), the Centers for Disease Control and Prevention (Dr. Martone), the Obstetrics and Gynecology Infectious Diseases Society (Dr. Sweet), and the Association of Practitioners of Infection Control (Ms. Barrett). Funding was provided by the IDSA and the other cooperating organizations. This standard is endorsed by the IDSA.
Consensus Development of Quality Standards
- Peter A. Gross, Trisha L. Barrett, E. Patchen Dellinger, Peter J. Krause, William J. Martone, John E. McGowan, Jr, Richard L. Sweet, Richard P. Wenzel
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 15 / Issue 3 / March 1994
- Published online by Cambridge University Press:
- 02 January 2015, pp. 180-181
- Print publication:
- March 1994
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Quality Standard for Antimicrobial Prophylaxis in Surgical Procedures
- E. Patchen Dellinger, Peter A. Gross, Trisha L. Barrett, Peter J. Krause, William J. Martone, John E. McGowan, Jr, Richard L. Sweet, Richard P. Wenzel
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 15 / Issue 3 / March 1994
- Published online by Cambridge University Press:
- 02 January 2015, pp. 182-188
- Print publication:
- March 1994
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Objective:
The objectives of this quality standard are 1) to provide an implementation mechanism that will facilitate the reliable administration of prophylactic antimicrobial agents to patients undergoing operative procedures in which such a practice is judged to be beneficial and 2) to provide a guideline that will help local hospital committees formulate policies and set up mechanisms for their implementation. Although standards in the medical literature spell out recommendations for specific procedures, agents, schedules, and doses, other reports document that these standards frequently are not followed in practice.
Options:We have specified the procedures in which the administration of prophylactic antimicrobial agents has been shown to be beneficial, those in which this practice is widely thought to be beneficial but in which compelling evidence is lacking, and those in which this practice is controversial. We have examined the evidence regarding the optimal timing of drug administration, the optimal dose, and the optimal duration of prophylaxis.
Outcomes:The intended outcome is more uniform and reliable administration of prophylactic antibiotics in those circumstances where their value has been demonstrated or their use has been judged by the local practicing medical community to be desirable. The result should be a reduction in rates of postoperative wound infection with a limitation on the quantities of antimicrobial agents used in circumstances where they are not likely to help.
Evidence:Many prospective, randomized, controlled trials comparing placebo with antibiotic and comparing one antibiotic with another have been conducted. In addition, some trials have compared the efficacy of different doses or methods of administration. Other papers have reported on the apparent efficacy of administration at different times and on actual practice in specific communities. Only a small group of relevant articles found through 1993 are cited herein. When authoritative reviews are available, these-rather than an exhaustive list of original references-are cited.
Values:We assumed that reducing rates of postoperative infection was valuable but that reducing the total amount of antimicrobial agents employed was also worthwhile. The cost of and morbidity attributable to postoperative wound infections should be weighed against the cost and potential morbidity associated with excessive use of antimicrobial agents.
Benefits, Harms, and Costs:More reliable administration of antimicrobial agents according to recognized guidelines should prevent some postoperative wound infections while lowering the total quantity of these drugs used. No harms are anticipated. The costs involved are those of the efforts needed on a local basis to design and implement the mechanism that supports uniform and reliable administration of prophylactic antibiotics.
Recommendations:All patients for whom prophylactic antimicrobial agents are recommended should receive them. The agents given should be appropriate in light of published guidelines. A short duration of prophylaxis (usually < 24 hours) is recommended.
Validation:More than 50 experts in infectious disease and 10 experts in surgical infectious disease and surgical subspecialties reviewed the standard. In addition, the methods for its implementation were reviewed by the American Society of Hospital Pharmacists.
Sponsors:The Quality Standards Subcommittee of the Clinical Affairs Committee of the Infectious Disease Society of America (IDSA) developed the standard. The subcommittee was composed of representatives of the IDSA (Drs. Gross and McGowan), the Society for Hospital Epidemiology of America (Dr. Wenzel), the Surgical Infection Society (Dr. Dellinger), the Pediatric Infectious Disease Society (Dr. Krause), the Centers for Disease Control and Prevention (Dr. Martone), the Obstetrics and Gynecology Infectious Diseases Society (Dr. Sweet), and the Association of Practitioners of Infection Control (Ms. Barrett). Funding was provided by the IDSA and the other cooperating organizations. The standard is endorsed by the IDSA.
Quality Standard for Assurance of Measles Immunity Among Health Care Workers
- Peter J. Krause, Peter A. Gross, Trisha L. Barrett, E. Patchen Dellinger, William J. Martone, John E. McGowan, Jr, Richard L. Sweet, Richard P. Wenzel
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 15 / Issue 3 / March 1994
- Published online by Cambridge University Press:
- 02 January 2015, pp. 193-199
- Print publication:
- March 1994
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Objective:
The objective of this quality standard is to prevent nosocomial transmission of measles by assuring universal measles-mumps-rubella (MMR) vaccination of all healthcare workers who lack immunity to measles. Although the primary emphasis is on healthcare workers in hospitals, those at other sites, such as clinics, nursing homes, and schools, are also included. It will be the responsibility of designated individuals at these institutions to implement the standard.
Options:We considered advocating the use of measles vaccine rather than MMR but chose the latter because it also protects against mumps and rubella and because it is more readily available.
Outcomes:The desired outcome is a reduction in the nosocomial transmission of measles.
Evidence:Although direct comparative studies are lacking, nosocomial outbreaks of measles have been reported (as recently as 1992) in institutions where measles immunization of nonimmune healthcare workers is not universal, whereas such outbreaks have not been reported in institutions with universal immunization.
Values and Validation:We consulted more than 50 infectious-disease experts in epidemiology, government, medicine, nursing, obstetrics and gynecology pediatrics, and surgery. In light of disagreement regarding the implementation of the standard, we used group discussions to reach a consensus.
Benefits, Harms, and Cost:The consequences of the transmission of measles (and of mumps and rubella) in a healthcare institution include not only the morbidity and mortality attributable to the disease, but also the significant cost of evaluating and containing an outbreak and the serious disruption of regular hospital routines when control measures are instituted. The potential harm to healthcare workers after the implementation of the standard consists of untoward effects of MMR vaccine, although the reactions of vaccines should be minimal with adherence to recommended vaccination procedures. Implementation of the standard should entail no expense to healthcare workers; the precise cost to institutions is unknown, but the expense would be mitigated by prevention of measles outbreaks.
Recommendations:We recommend MMR vaccination of all healthcare workers who lack immunity to measles.
Sponsors:The Quality Standards Subcommittee of the Clinical Affairs Committee of the Infectious Diseases Society of America (IDSA) developed the standard. The subcommittee was composed of representatives of the IDSA (Drs. Gross and McGowan), the Society for Hospital Epidemiology of America (Dr. Wenzel), the Surgical Infection Society (Dr. Dellinger), the Pediatric Infectious Diseases Society (Dr. Krause), the Centers for Disease Control and Prevention (Dr. Martone), the Obstetrics and Gynecology Infectious Diseases Society (Dr. Sweet), and the Association of Practitioners of Infection Control (Ms. Barrett). Funding was provided by the IDSA and the other cooperating organizations. The standard is endorsed by the IDSA.
1 - Time and place
- Edited by John Barrett, Richard J. Bradley, Martin T. Green
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- Book:
- Landscape, Monuments and Society
- Published online:
- 07 May 2010
- Print publication:
- 22 February 1991, pp 6-22
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- Chapter
- Export citation
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Summary
The archaeology of social reproduction
The main themes of our title, Landscape, monuments and society, often appear to be specific areas of archaeological interest. Monuments, for instance, are analysed in terms of their form and structural history, and the landscape provides a context for the distribution of monuments, revealing their spatial organisation and ecological setting. But what of society? If anything, society appears as the ghost in the machine, whose archaeologically verifiable existence is still contested. Let us therefore look at the relationship between society, the landscape and the monument.
Since the work of Gordon Childe, archaeologists have tended to treat ‘society’ as a system of institutions which are mapped by their material remains. Cultural archaeologists defined the social realm as a relatively closed set of shared beliefs. It was the acceptance of those beliefs which established cohesion between a society's members and the practical application of belief systems which produced regular patterns of material association (Childe 1956). The application of this rather straightforward idea has led to the chronological and geographical ordering of artefacts and monuments. Such ordering has appeared to reflect the nature, history and extent of a given belief system; and the categorisation and mapping of archaeological material in these terms remains part of the conceptual framework of British archaeology.
By now there have been numerous criticisms of such an approach to archaeology. One of the more sustained critiques has been developed by Renfrew (1977). He notes that the definition of cultural types has depended upon norms, arbitrarily drawn from rich assemblages of material.