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Chipped stone tools termed perforators and gravers are characterized by projections. Although the implied function of these tool types differs, there are no guidelines for classifying perforators and gravers based on their morphology. Consequently, researchers classify these tools differently, which precludes meaningful comparisons of the frequencies of these types between assemblages. A use-wear study confirmed the hypothesis that specimens with a thin projection and a sharp distal angle often had perforation use wear. Specimens with graver use wear were characterized by a range of projection perimeters and distal angles. We recommend that specimens with a projection perimeter of 20 mm or less and a distal angle of 40 degrees or less be classified as perforators and those with greater dimensions as gravers. This will achieve a consistent classification system for perforators and gravers, although it must be recognized that these type names may not be indicative of the function of individual specimens.
The nature and extent of interactions between the distant regions and cultures of Mesoamerica remain open to much debate. Close economic and political ties developed between Teotihuacan and the lowland Maya during the Early Classic period (AD 250–550), yet the relationship between these cultures continues to perplex scholars. This article presents an elaborately painted altar from an elite residential group at the lowland Maya centre of Tikal, Guatemala. Dating to the fifth century AD, the altar is unique in its display of Teotihuacan architectural and artistic forms, adding to evidence not only for cultural influence during this period, but also for an active Teotihuacan presence at Tikal.
Attacks on health care – which are potential war crimes – are increasingly observed in contemporary armed conflicts. The full-scale Russian invasion of Ukraine is no exception to this worrisome trend. War crime prosecutions of suspected deliberate attacks on health care facilities require proof that they were the intended target, which is extremely challenging. If health care facilities are attacked more than once, this may increase the likelihood of intent. The Ukrainian Healthcare Center (UHC) began documenting attacks on health infrastructure since the start of the full-scale Russian invasion of Ukraine. In this study, the aim was to assess repetitive attacks on Ukrainian health care facilities from February 24, 2022 through October 24, 2023.
Methods:
The Berkeley Protocol on Digital Open Source Investigations was used to identify and document health care attacks. Data collection for this study included temporal factors, location and type of facility, attack and weapon type, the number of health care personnel and civilians killed and injured, and whether the afflicted facilities were damaged, destroyed, and/or repeatedly attacked.
Results:
During the study period, there were 397 attacks on 281 Ukrainian health care facilities, damaging 237 facilities and destroying another 44. Fifty-three facilities (18.9%) were attacked more than once (total: 163 attacks; mean 3.1; median 2; range 2-10 attacks), and 27.7% of all health care attacks (110/397) concerned repeat attacks. The median time between attacks was 18 days (range: 0-289 days).
Conclusions:
From February 24, 2022 through October 24, 2023, one-in-five targeted health care facilities in Ukraine experienced repetitive attacks. Furthermore, one-in-four attacks on health care involved recurrent attacks. This observed pattern raises the possibility that health care facilities in Ukraine are being intentionally targeted.
This paper evaluates the back-and-forth between Mayo, Howson, and Achinstein over whether classical statistics commits the base-rate fallacy. I show that Mayo is correct to claim that Howson’s arguments rely on a misunderstanding of classical theory. I then argue that Achinstein’s refined version of the argument turns on largely undefended epistemic assumptions about “what we care about” when evaluating hypotheses. I end by suggesting that Mayo’s positive arguments are no more decisive than her opponents’: even if correct, they are unlikely to compel anyone not already sympathetic to the classical picture.
Non-traumatic back pain commonly leads people to seek health care from paramedics via triple-zero (emergency phone number in Australia), yet the management approaches by providers of ambulance services remain unclear.
Study Objectives:
This study aims to investigate paramedic management of non-traumatic back pain in New South Wales (NSW), Australia, including the call characteristics, provisional diagnoses, and the clinical care being delivered by paramedics.
Methods:
This study is a retrospective analysis of NSW Ambulance computer-aided dispatch and electronic medical records from January 1, 2017 through December 31, 2022. Adults who sought ambulance service with a chief complaint of back pain, were triaged as non-traumatic back pain, and subsequently received treatment by paramedics were included. Multivariable logistic regression models were used to explore factors associated with primary outcomes; ambulance transport, opioid use, and use of medication combinations were reported as odds ratios (ORs).
Results:
There were 73,128 calls to NSW Ambulance with a chief complaint of back pain that were triaged as non-traumatic back pain. Of these, 54,444 (74.4%) were diagnosed with spinal pain, of which 52,825 (97.1%) were categorized by the paramedic as back or neck pain, 1,573 (2.9%) as lumbar radicular pain, and 46 (0.1%) as serious spinal pathology. Eight out of ten patients with spinal pain were transported to emergency departments. The medicine most administered by a paramedic was an opioid (37.4% of patients with spinal pain). Older patients (OR = 1.36; 95% CI, 1.30 to 1.44) were more likely to be transported to an emergency department. Patients with moderate (OR = 4.39; 95% CI, 4.00 to 4.84) and severe pain (OR = 18.90; 95% CI, 17.18 to 20.79) were more likely to be administered an opioid.
Conclusions:
Paramedic management of non-traumatic back pain in NSW typically results in the administration of an opioid and transport to an emergency department.
This article re-thinks the development of Paul’s thought between 1 and 2 Corinthians. Instead of the traditional developmental interpretation of Paul that emphasizes the differences between 1 Cor 15:35–57 and 2 Cor 5:1–5, I argue that a discernable development is to be found between 1 Cor 12:13 and 2 Cor 4:7–12. I demonstrate significant parallels between the two latter texts in terms of topic, argumentation, and the conceptual structure on which Paul’s argumentation is built. Based on the parallels, I argue that 1 Cor 12:13 conceptually allows for the innovative idea of “ongoing transformation,” which is formulated in 2 Cor 3:18, and provides the conceptual structure of “double body-containers” in 2 Cor 4:7–12 to expound this new idea. In the context of 2 Corinthians, responding to opponents’ challenge against the apostle’s physical weakness in sufferings, Paul goes on to develop the idea of ongoing transformation further by transforming mortality. Mortality becomes a form of human participation in God’s cosmic war and is considered constructive to the ongoing transformation of the inner person and the complete transformation in the future.
This article examines the work of the composer Michelle Lou through its affective and formal mechanisms. I propose that Lou’s work has consistently retained a fundamental and specific orientation towards the listener, which I describe as distance or proximity. In addressing three works spanning eight years – Opening (2008), untitled three-part construction (2014) and HoneyDripper (2016) – I show how the idea of distance informs and is articulated through orchestration, gestural and phrasal construction, scenography and form, and thus frames one’s experience of sound, spatiality, memory, time and perception. While the sounds and materials employed by Lou are often formally cold and sonically abrasive, I argue that her work ultimately implicates and invites the listener in as a crucial element of its sonic ecology, even enacting a sort of phenomenological care over the listener.
Powered equipment for patient handling was designed to alleviate Emergency Medical Service (EMS) clinician injuries while lifting patients. This project evaluated the organizational rationale for purchasing powered equipment and the outcomes from equipment use.
Methods:
This project analyzed secondary data obtained via an insurance Safety Intervention Grant (SIG) program in Ohio USA. These data were primarily in reports from EMS organizations. Investigators applied a mixed-methods approach, analyzing quantitative data from 297 grants and qualitative data from a sample of 64 grants. Analysts abstracted data related to: work-related injuries or risk of musculoskeletal-disorders (MSD), employee feedback regarding acceptance or rejection, and impact on quality, productivity, staffing, and cost.
Results:
A total of $16.67 million (2018 adjusted USD) was spent from 2005 through 2018 for powered cots, powered loading systems, powered stair chairs, and non-patient handling equipment (eg, chest compression system, powered roller). Organizations purchased equipment to accommodate staff demographics (height, age, sex) and patient characteristics (weight, impairments). Grantees were fire departments (n = 254) and public (n = 19) and private (n = 24) EMS organizations consisting of career (45%), volunteer (20%), and a combination of career and volunteer (35%) staff. Powered equipment reduced reported musculoskeletal injuries, and organizations reported it improved EMS clinicians’ safety. Organization feedback was mostly positive, and no organization indicated outright rejection of the purchased equipment. Analyst-identified design advantages for powered cots included increased patient weight capacity and hydraulic features, but the greater weight of the powered cot was a disadvantage. The locking mechanism to hold the cot during transportation was reported as an advantage, but it was a disadvantage for older cots without a compatibility conversion kit. Around one-half of organizations described a positive impact on quality of care and patient safety resulting from the new equipment.
Conclusion:
Overall, organizations reported improved EMS clinicians’ safety but noted that not all safety concerns were addressed by the new equipment.
In this article we present the results of two geophysical surveys conducted at Cahokia Mounds State Historic Site. The goal was to reveal neighborhood settlement patterns at two locales located on the periphery of “Downtown” Cahokia—the densely populated administrative core—and to further understand the type and chronological affiliation of these settlements. We compared structure length and width ratios from Rattlesnake West and the Rouch Mound Group with datasets from the Cahokia and East St. Louis precincts as a proxy for chronological affiliation to understand changes to neighborhood density over time. Using noninvasive techniques to illuminate population density and neighborhood configurations, we gained a more detailed understanding of how Cahokia's communities and neighborhoods chose to adopt the building style and infrastructure of Cahokia's Downtown Precinct.
This article classifies individual lexemes in Chinese dialects into four categories: popular, learnèd, colloquial, and literary. Popular and learnèd refer to the origins of a word: whether it has been transmitted orally or learned in an educational context. Colloquial and literary refer to usage. The traditional Chinese terms for distinguishing character readings, wén 文 and bái 白, literally ‘written’ and ‘spoken’, do not correspond neatly to the four categories that are proposed here. This article illustrates the differences between all six terms, mainly by using standard Mandarin and Běijīng dialect, and secondarily by using words from Mĭn and other dialects.
Egon Wellesz’s Eastern Elements in Western Chant (1947, repr. 1967) is outdated but topical in that the resemblances he adduced between Eastern and Western chant continue to invite explanations. An assessment of his book and research since then on the topics of simple vs. complex melody, melodic resemblance, historical frameworks, musical communities and Semitic antecedents of Christian chant lead to the conclusion that the comparative study of medieval Christian chant repertories and of Jewish melodies from post-medieval sources cannot be shaped by simplistic assumptions, such as that simpler melodies are earlier or more primitive than more complicated ones, or that Christian practices must have had Jewish origins. Nor can melodies that resemble each other be assumed to be historically related. Studies of oral traditions show that what is transmitted is often a more abstract contour that can be realised in more than one way. Most importantly, no music can be studied apart from the community that makes or made it, and musical evidence must be interpreted within a framework of verifiable historical fact, especially when contacts between different communities are alleged.