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Archaeologists working in eastern North America typically refer to precontact and early postcontact Native American maize-based agriculture as shifting or swidden. Based on a comparison with European agriculture, it is generally posited that the lack of plows, draft animals, and animal manure fertilization resulted in the rapid depletion of soil nitrogen. This required Indigenous farmers to move their fields frequently. In Northern Iroquoia, depletion of soil fertility is frequently cited as one reason why villages were moved to new locations every 20 to 40 years. Recent analysis of δ15N ratios of maize macrobotanical remains from Northern Iroquoia, however, suggests that Iroquoian farmers were able to maintain soil nitrogen in their maize fields. An expanded analysis of maize kernel δ15N ratios from three ancestral Mohawk villages indicates that farmers from those villages maintained soil nitrogen throughout the occupational spans of their villages. It further suggests that precontact Iroquoian agronomy was consistent with contemporary conservation agriculture practices.
In this paper, we mainly investigate the well-posedness of the four-order degenerate differential equation ($P_4$): $(Mu)''''(t) + \alpha (Lu)'''(t) + (Lu)''(t)$$=\beta Au(t) + \gamma Bu'(t) + Gu'_t + Fu_t + f(t),\,( t\in [0,\,2\pi ])$ in periodic Lebesgue–Bochner spaces $L^p(\mathbb {T}; X)$ and periodic Besov spaces $B_{p,q}^s\;(\mathbb {T}; X)$, where $A$, $B$, $L$ and $M$ are closed linear operators on a Banach space $X$ such that $D(A)\cap D(B)\subset D(M)\cap D(L)$ and $\alpha,\,\beta,\,\gamma \in \mathbb {C}$, $G$ and $F$ are bounded linear operators from $L^p([-2\pi,\,0];X)$ (respectively $B_{p,q}^s([-2\pi,\,0];X)$) into $X$, $u_t(\cdot ) = u(t+\cdot )$ and $u'_t(\cdot ) = u'(t+\cdot )$ are defined on $[-2\pi,\,0]$ for $t\in [0,\, 2\pi ]$. We completely characterize the well-posedness of ($P_4$) in the above two function spaces by using known operator-valued Fourier multiplier theorems.
The writings of Muhammad Siddiq Hasan well exemplify the argument of Francis Robinson's influential article on vernacular print publications that furthered a Protestant Reformation-like democratising of sacred knowledge. Both the number of his publications, and the personal empowerment enjoined by his Ahl-i Hadith jurisprudence, make him, in fact, an ideal exemplar of this kind of publication. He also, however, stands apart. First, his ‘vernacular’ included not only Urdu, but also Arabic and Persian. Second, beyond democratisation, print simultaneously enhanced scholarly authority, and it did so to an unusual extent for Siddiq Hasan because of his pioneering reach beyond India to the Ottoman lands, with Arabic works published and distributed from cities like Istanbul and Cairo. Third, Siddiq Hasan's publications served a diversity of purposes, like Persian publications that enhanced his princely status, and Arabic publications that not only forged transnational networks of like-minded scholars but also, in other hands, served modernist theologians and innovative literary scholars. Finally, in the end, the potential of print turned on him as officials used his publications to allege seditious intent. That denouement aside, the life of Siddiq Hasan's print publication points to a moment of rich intellectual life in the context of colonial rule, taking Robinson's insights on the potential of publication in unexpected directions.
Monoclonal antibody (mAb) treatment for coronavirus disease 2019 (COVID-19) has been underutilized due to logistical challenges, lack of access, and variable treatment awareness among patients and health-care professionals. The use of telehealth during the pandemic provides an opportunity to increase access to COVID-19 care.
Methods:
This is a single-center descriptive study of telehealth-based patient self-referral for mAb therapy between March 1, 2021, and October 31, 2021, at Baltimore Convention Center Field Hospital (BCCFH).
Results:
Among the 1001 self-referral patients, the mean age was 47, and most were female (57%). White (66%), and had a primary care provider (PCP) (62%). During the study period, self-referrals increased from 14/mo in March to 427 in October resulting in a 30-fold increase. Approximately 57% of self-referred patients received a telehealth visit, and of those 82% of patients received mAb infusion therapy. The median time from self-referral to onsite infusion was 2 d (1-3 IQR).
Discussion:
Our study shows the integration of telehealth with a self-referral process improved access to mAb infusion. A high proportion of self-referrals were appropriate and led to timely treatment. This approach helped those without traditional avenues for care and avoided potential delay for patients seeking referral from their PCPs.
Late preterm (LP, born between 34 0/7 and 36 6/7 weeks of gestation) infants may experience several adverse outcomes, similar to those experienced by low birthweight (LBW, birthweight <2500 g) infants. However, while LP infants are often born with LBW, the association between LP and LBW remains unknown. This study aimed to investigate LBW rate and independent risk factors for LBW in LP singleton neonates. We retrospectively analyzed data of LP singleton neonates, born between 2013 and 2017, from the Japan Society of Obstetrics and Gynecology Successive Pregnancy Birth Registry System. The exclusion criteria included stillbirths and infants with missing data. Logistic regression analyses were performed to investigate maternal and perinatal factors associated with LBW in LP singletons. LBW was observed in 62.5% (n = 35,113) of 56,160 LP singleton births. In the multiple logistic regression analysis, LBW in LP neonates was independently associated with modifiable maternal factors, including pre-pregnancy underweight, inadequate gestational weight gain, and smoking during pregnancy, as well as non-modifiable factors, including younger maternal age, nulliparity, hypertensive disorder of pregnancy, preeclampsia, cesarean section delivery, and female offspring. According to the Japanese pregnancy birth registry data, more than half of LP neonates were LBW. We previously discussed the issue of LBW regarding infants with different backgrounds, as there are many different causes of LBW. Several risk factors should be subdivided and considered for the risk of LP and LBW.
This paper presents a comprehensive study of flow-induced vibrations of a D-section prism with various angles of attack $\alpha$ ($= 0^{\circ }\unicode{x2013}180^{\circ }$) and reduced velocity $U^*$ (= 2–20) via direct numerical simulations at a Reynolds number ${Re} = 100$. The prism is allowed to vibrate in both streamwise and transverse directions. Based on the characteristics of vibration amplitudes and frequencies, the responses are classified into nine different regimes: typical VIV regime ($\alpha = 0^{\circ }\unicode{x2013}30^{\circ }$), hysteretic VIV regime ($\alpha = 35^{\circ }\unicode{x2013}45^{\circ }$), extended VIV regime ($\alpha = 50^{\circ }\unicode{x2013}55^{\circ }$), first transition response regime ($\alpha = 60^{\circ }\unicode{x2013}65^{\circ }$), dual galloping regime ($\alpha = 70^{\circ }$), combined VIV and galloping regime ($\alpha = 75^{\circ }\unicode{x2013}80^{\circ }$), narrowed VIV regime ($\alpha = 85^{\circ }\unicode{x2013}145^{\circ }$), second transition response regime ($\alpha = 150^{\circ }\unicode{x2013}160^{\circ }$) and transverse-only galloping regime (${\alpha = 165^{\circ }\unicode{x2013}180^{\circ }}$). In the typical and narrowed VIV regimes, the vibration frequencies linearly increase with increasing $U^*$. In the hysteretic and extended VIV regimes, the vibration amplitudes are large in a wider range of $U^*$ as a result of the closeness of the vortex shedding frequency to the natural frequency of the prism because of the shear layer reattachment and separation point movement. In the two galloping regimes, the transverse amplitude keeps increasing with $U^*$ while the streamwise amplitude stays small or monotonically increases with increasing $U^*$. In the combined VIV and galloping regime, the vibration amplitude is relatively small in the VIV region while drastically increasing with increasing $U^*$ in the galloping region. In the transition response regimes, the vibration frequencies are galloping-like but the divergent amplitude cannot persist at high $U^*$. Furthermore, a wake mode map in the examined parametric space is offered. Particular attention is paid to physical mechanisms for hysteresis, dual galloping and flow intermittency. Finally, we probe the dependence of the responses on Reynolds numbers, mass ratios and degrees of freedom, and analyse the roles of the shear layer reattachment and separation point movement in the appearance of multiple responses.
This longitudinal study aimed to validate the biosocial theory of borderline personality disorder (BPD) by examining the transactional relationship between individual vulnerabilities and parental invalidation, and their links to BPD symptoms. We recruited a sample of 332 adolescents (mean age = 14.18 years; 58.3% female) residing in Singapore and administered self-report measures across three time-points (six months apart). Results from our path analytic model indicated that parental invalidation, impulsivity, and emotional vulnerability exhibited unique predictive associations with emotion dysregulation six months later. There was also a reciprocal prospective relationship between emotion regulation difficulties and BPD symptoms. Using random-intercepts cross-lagged panel models, we found partial evidence for a within-individual reciprocal relationship between parental invalidation and emotional vulnerability, and a unidirectional relationship of within-individual changes in impulsivity positively predicting changes in parental invalidation six months later. Overall, the study provided partial empirical support for the biosocial model in a Singaporean context.
Previous research that explored sexual minority service users’ experiences of accessing NHS Talking Therapies for Anxiety and Depression Services highlighted the need for specific sexual orientation training. Inconsistent or lack of training may contribute to disparities in treatment outcomes between sexual minority service users and heterosexual service users. The aim of the study was to explore clinicians’ competencies working with sexual minority service users, their experiences of sexual orientation training, their view of current gaps in training provision, and ways to improve training. Self-reported sexual orientation competency scales and open-ended questions were used to address the aims of the study. Participants (n=83) included Psychological Wellbeing Practitioners (PWPs) and high-intensity CBT therapists (HITs). Responses on competency scales were analysed using Kruskal–Wallis tests and thematic analysis was used to analyse qualitative responses. Participants who identified as 25–29 years old had higher scores on the knowledge scale than 45+-year-olds. Bisexual participants also had higher scores on the knowledge subscale than heterosexual participants. Three over-arching themes were identified: (a) training received on sexual minority issues by Talking Therapies clinicians, (b) clinicians’ experiences of accessing and receiving sexual minority training, and (c) perceived gaps in current sexual minority training and ways to improve training. Findings were linked to previous literature and recommendations to stakeholders are made throughout the Discussion section with the view of improving sexual orientation training.
Key learning aims
(1) To understand current training provision of sexual orientation training across NHS Talking Therapies courses and services in England.
(2) To consider clinicians’ experiences of challenges and barriers that may prevent them from accessing or implementing sexual orientation training in clinical practice.
(3) To understand clinicians’ views of the current gaps in training and ways to improve training provision.
(4) To make recommendations to NHS Talking Therapies for Anxiety and Depression courses and services in ways to improve training on sexual orientation to better meet the learning needs of clinicians and service users.
Zinc deficiency is a common nutritional problem in calcareous agricultural soils, resulting in reduced crop yield and performance. The effects of zinc sulphate (0 and 40 kg/ha) on seed yield, its components and seed element contents of 21 wheat cultivars were investigated. Zinc sulphate application increased plant height, leaf area index (LAI), flag leaf area, biomass, spike length, number of seeds per spike, seed weight and harvest index (HI). The increase in HI indicates the greater effect of zinc on seed production compared to plant biomass. In most of the cultivars, zinc sulphate application decreased the content of phosphorus and nitrogen in seeds and increased the content of iron and potassium. The cultivars showed significant differences in all the traits measured, indicating the existence of genetic diversity in the cultivars studied. In the second year, which was hotter and drier than the first year, zinc sulphate application reduced the damage caused by drought and heat stress and improved seed yield and quality. The regression fit showed that newer cultivars had lower yields in unfertilized conditions compared to old cultivars and showed their superiority in zinc fertilized conditions. It seems that the newer varieties require more fertilizer because they have been bred on fertile soils.
The Puerto Rican Nightjar Antrostomus noctitherus is an endemic Caprimulgid found in dry coastal and lower montane forests of south-western Puerto Rico. Information on the species (e.g. abundance, nesting biology) has been mostly restricted to forest reserves (i.e. Guánica Forest and Susúa Forest) with limited information available from private lands. We collected stand-level vegetation structure and geographical information from forest reserves and private lands to model habitat suitability and distribution for the Nightjar. Results of the stand-level model indicated forest type and midstorey vegetation density best predicted Nightjar habitat. Our spatial model predicted considerably more Nightjar habitat (17,819.64 ha) located outside protected areas than previously reported. Further, the model highlighted several localities of importance for the species across southern Puerto Rico, all located within private lands. We used a patch occupancy approach to assess regions identified by the landscape-level model as suitable for the Nightjar and documented the presence of the species in 32 of 55 sites, located in 12 of 18 municipalities across southern Puerto Rico. The protection and restoration of forest across the southern coast of Puerto Rico would help to ensure the long-term persistence of the Nightjar across a considerable portion of its range. Addressing habitat needs may be the single most effective mechanism to achieve recovery of the species.
Sterol regulatory element-binding protein 2 (SREBP2) is considered to be a major regulator to control cholesterol homoeostasis in mammals. However, the role of SREBP2 in teleost remains poorly understand. Here, we explored the molecular characterisation of SREBP2 and identified SREBP2 as a key modulator for 3-hydroxy-3-methylglutaryl-coenzyme A reductase and 7-dehydrocholesterol reductase, which were rate-limiting enzymes of cholesterol biosynthesis. Moreover, dietary palm oil in vivo or palmitic acid (PA) treatment in vitro elevated cholesterol content through triggering SREBP2-mediated cholesterol biosynthesis in large yellow croaker. Furthermore, our results also found that PA-induced activation of SREBP2 was dependent on the stimulating of endoplasmic reticulum stress (ERS) in croaker myocytes and inhibition of ERS by 4-Phenylbutyric acid alleviated PA-induced SREBP2 activation and cholesterol biosynthesis. In summary, our findings reveal a novel insight for understanding the role of SREBP2 in the regulation of cholesterol metabolism in fish and may deepen the link between dietary fatty acid and cholesterol biosynthesis.
Vancomycin is often initiated in hospitalized patients; however, it may be unnecessary or continued for longer durations than needed. Oversight of all vancomycin orders may not be feasible with widespread prescribing and strategies to enlist other clinicians to serve as stewards of vancomycin use are needed. We implemented 2 sequential interventions: a protocol in which the pharmacist orders MRSA nasal swab followed by a protocol requiring approval from pharmacists to continue vancomycin for >72 hours.
Methods:
In this single-center, retrospective, quasi-experimental study, we evaluated vancomycin use after implementation of a pharmacy-driven MRSA nasal-swab ordering protocol and a vancomycin 72-hour restriction protocol. The primary outcome was the change in the standardized antibiotic administration ratio (SAAR) for antibacterial agents for resistant gram-positive infections. We also evaluated the impact on antibiotic utilization.
Results:
Following the MRSA swab protocol, the SAAR decreased from 1.26 to 1.13 (P < .001; 95% confidence interval [CI], 1.16–1.25). After the 72-hour approval process, the SAAR was 0.96 (P < .001; 95% CI, 1.0–1.12). Vancomycin utilization decreased from 138.9 to 125.3 days of therapy per 1,000 patient days following the MRSA swab protocol (P < .001) and to 112.7 (P < .001) following the 72-hour approval protocol. Interrupted time-series analysis identified a similar rate of decline in utilization following the 2 interventions (−0.3 and −0.5; P = .16). Both interventions combined resulted in a significant reduction (−1.5; P < .001).
Conclusion:
Implementation of a pharmacist-driven MRSA nasal-swab ordering protocol, followed by a 72-hour approval protocol, was associated with a significant reduction in the SAAR for antibiotics used in the treatment of resistant gram-positive infections and a reduction in vancomycin utilization. Leveraging the oversight of primary service clinical pharmacists through these protocols proved to be an effective strategy.
Not only care professionals are responsible for the quality of care but other stakeholders including regulators also play a role. Over the last decades, countries have increasingly invested in regulation of Long-Term Care (LTC) for older persons, raising the question of how regulation should be put into practice to guarantee or improve the quality of care. This scoping review aims to summarize the evidence on regulatory practices in LTC for older persons. It identifies empirical studies, documents the aims and findings, and describes research gaps to foster this field.
Design:
A literature search (in PubMed, Embase, Cinahl, APA PsycInfo and Scopus) was performed from inception up to December 12th, 2022. Thirty-one studies were included.
Results:
All included studies were from high-income countries, in particular Australia, the US and Northwestern Europe, and almost all focused on care provided in LTC facilities. The studies focused on different aspects of regulatory practice, including care users’ experiences in collecting intelligence, impact of standards, regulatory systems and strategies, inspection activities and policies, perception and style of inspectors, perception and attitudes of inspectees and validity and reliability of inspection outcomes.
Conclusion:
With increasingly fragmented and networked care providers, and an increasing call for person-centred care, more flexible forms of regulatory practice in LTC are needed, organized closer to daily practice, bottom-up. We hope that this scoping review will raise awareness of the importance of regulatory practice and foster research in this field, to improve the quality of LTC for older persons, and optimize their functional ability and well-being.
Whole-genome sequencing (WGS) is increasingly used to characterize hospital outbreaks of carbapenemase-producing Enterobacterales (CPE). However, access to WGS is variable and testing is often centralized, leading to delays in reporting of results.
Objective:
We describe the utility of a local sequencing service to promptly respond to facility needs over an 8-year period.
Methods:
The study was conducted at Royal Prince Alfred Hospital in Sydney, Australia. All CPE isolated from patient (screening and clinical) and environmental samples from 2015 onward underwent prospective WGS. Results were notified to the infection control unit in real time. When outbreaks were identified, WGS reports were also provided to senior clinicians and the hospital executive administration. Enhanced infection control interventions were refined based on the genomic data.
Results:
In total, 141 CPE isolates were detected from 123 patients and 5 environmental samples. We identified 9 outbreaks, 4 of which occurred in high-risk wards (intensive care unit and/or solid-organ transplant ward). The largest outbreak involved Enterobacterales containing an NDM gene. WGS detected unexpected links among patients, which led to further investigation of epidemiological data that uncovered the outpatient setting and contaminated equipment as reservoirs for ongoing transmission. Targeted interventions as part of outbreak management halted further transmission.
Conclusions:
WGS has transitioned from an emerging technology to an integral part of local CPE control strategies. Our results show the value of embedding this technology in routine surveillance, with timely reports generated in clinically relevant timeframes to inform and optimize local control measures for greatest impact.
Post-traumatic stress disorder (PTSD) after traumatic birth can have a debilitating effect on parents already adapting to significant life changes during the post-partum period. Cognitive therapy for PTSD (CT-PTSD) is a highly effective psychological therapy for PTSD which is recommended in the NICE guidelines (National Institute for Health and Care Excellence, 2018) as a first-line intervention for PTSD. In this paper, we provide guidance on how to deliver CT-PTSD for birth-related trauma and baby loss and how to address common cognitive themes.
Key learning aims
(1) To recognise and understand the development of PTSD following childbirth and baby loss.
(2) To understand how Ehlers and Clark’s (2000) cognitive model of PTSD can be applied to post-partum PTSD.
(3) To be able to apply cognitive therapy for PTSD to patients with perinatal PTSD, including traumatic baby loss through miscarriage or birth.
(4) To discover common personal meanings associated with birth trauma and baby loss and the steps to update them.
Boundary layers of Novec649, a low-global-warming potential fluid of interest for low-grade heat recovery, are investigated numerically by means of linear stability theory, direct numerical simulation (DNS) and large-eddy simulations (LES). This organic vapour is of interest in organic Rankine cycle (ORC) turbines and realistic thermodynamic conditions are selected. Under these conditions, the vapour behaves as a dense gas and, due to its high molecular complexity, real-gas effects occur. In addition, the fluid exhibits large and highly variable heat capacities and density- as well as temperature-dependent transport properties. More specifically we report the first direct and LES of transitional and turbulent boundary layers of Novec649 at high-subsonic conditions $M=0.9$. A controlled transition is performed by using oblique modes determined by linear stability theory extended to dense gases. An oblique-type transition is obtained as in low-speed air flows, where sinuous streaks develop by the lift-up mechanism and break down into turbulence. In the turbulent state, the profiles of dynamic flow properties (velocities, turbulent intensities, turbulent kinetic energy budgets) are little affected by the gas properties and remain very close to incompressible DNS, despite the high-subsonic flow speed. The fluctuations levels for thermodynamic properties have been quantified with respect to air flows. Notwithstanding a drastic reduction, genuine compressibility effects are present. For example, the fluctuating Mach number and the acoustic mode are characteristic of high-speed flows. The influence of forcing frequency and amplitude on the established turbulent state has been investigated using LES. An analysis of integral quantities shows a slow relaxation towards a canonical equilibrium turbulent state for all cases due to the high Reynolds numbers typical of dense gas flows. Overall the present DNS constitutes a valuable reference not only for forthcoming experiments but also for future studies of free-stream transition and loss mechanisms in ORC turbines.
To explore infection preventionists’ perceptions of hospital leadership support for infection prevention and control programs during the coronavirus disease 2019 (COVID-19) pandemic and relationships with individual perceptions of burnout, psychological safety, and safety climate.
Design:
Cross-sectional survey, administered April through December 2021.
Setting:
Random sample of non-federal acute-care hospitals in the United States.
Participants:
Lead infection preventionists.
Results:
We received responses from 415 of 881 infection preventionists, representing a response rate of 47%. Among respondents, 64% reported very good to excellent hospital leadership support for their infection prevention and control program. However, 49% reported feeling burned out from their work. Also, ∼30% responded positively for all 7 psychological safety questions and were deemed to have “high psychological safety,” and 76% responded positively to the 2 safety climate questions and were deemed to have a “high safety climate.” Our results indicate an association between strong hospital leadership support and lower burnout (IRR, 0.61; 95% CI, 0.50–0.74), higher perceptions of psychological safety (IRR, 3.20; 95% CI, 2.00–5.10), and a corresponding 1.2 increase in safety climate on an ascending Likert scale from 1 to 10 (β, 1.21; 95% CI, 0.93–1.49).
Conclusions:
Our national survey provides evidence that hospital leadership support may have helped infection preventionists avoid burnout and increase perceptions of psychological safety and safety climate during the COVID-19 pandemic. These findings aid in identifying factors that promote the well-being of infection preventionists and enhance the quality and safety of patient care.