Geoarchaeological research as part of the AHRC funded Living with Monuments (LwM) project investigated the upper Kennet river system across the Avebury World Heritage landscape. The results demonstrate that in the early–mid-Holocene (c. 9500–1000 bc) there was very low erosion of disturbed soils into the floodplain, with floodplain deposits confined to a naturally forming bedload fluvial deposit aggrading in a shallow channel of inter-linked deeper pools. At the time of the Neolithic monument building in the 4th–early 3rd millennium bc, the river was wide and shallow with areas of presumed braid plain. Between c. 4000 and 1000 bc, a human induced signature of soil erosion became a minor component of fluvial sedimentation in the Kennet palaeo-channel but it was small scale and localised. This strongly suggests that there is little evidence of widespread woodland removal associated with Neolithic farming and monument building, despite the evidently large timber requirements for Neolithic sites like the West Kennet palisade enclosures. Consequently, there was relatively light human disturbance of the hinterland and valley slopes over the longue durée until the later Bronze Age/Early Iron Age, with a predominance of pasture over arable land. Rather than large Neolithic monument complexes being constructed within woodland clearings, representing ancestral and sacred spaces, the substantially much more open landscape provided a suitable landscape with areas of sarsen spreads potentially easily visible. During the period c. 3000–1000 bc, the sediment load within the channel slowly increased with alluvial deposition of increasingly humic silty clays across the valley floor. However, this only represents small-scale landscape disturbance. It is from the Late Bronze Age–Early Iron Age when the anthropogenic signal of human driven alluviation becomes dominant and overtakes the bedload fluvial signal across the floodplain, with localised colluvial deposits on the floodplain margins. Subsequently, the alluvial archive describes more extensive human impact across this landscape, including the disturbance of loessic-rich soils in the catchment. The deposition of floodplain wide alluvium continues throughout the Roman, medieval, and post-medieval periods, correlating with the development of a low-flow, single channel, with alluvial sediments describing a decreasing energy in the depositional environment.

The personalised oncology paradigm remains challenging to deliver despite technological advances in genomics-based identification of actionable variants combined with the increasing focus of drug development on these specific targets. To ensure we continue to build concerted momentum to improve outcomes across all cancer types, financial, technological and operational barriers need to be addressed. For example, complete integration and certification of the ‘molecular tumour board’ into ‘standard of care’ ensures a unified clinical decision pathway that both counteracts fragmentation and is the cornerstone of evidence-based delivery inside and outside of a research setting. Generally, integrated delivery has been restricted to specific (common) cancer types either within major cancer centres or small regional networks. Here, we focus on solutions in real-world integration of genomics, pathology, surgery, oncological treatments, data from clinical source systems and analysis of whole-body imaging as digital data that can facilitate cost-effectiveness analysis, clinical trial recruitment, and outcome assessment. This urgent imperative for cancer also extends across the early diagnosis and adjuvant treatment interventions, individualised cancer vaccines, immune cell therapies, personalised synthetic lethal therapeutics and cancer screening and prevention. Oncology care systems worldwide require proactive step-changes in solutions that include inter-operative digital working that can solve patient centred challenges to ensure inclusive, quality, sustainable, fair and cost-effective adoption and efficient delivery. Here we highlight workforce, technical, clinical, regulatory and economic challenges that prevent the implementation of precision oncology at scale, and offer a systematic roadmap of integrated solutions for standard of care based on minimal essential digital tools. These include unified decision support tools, quality control, data flows within an ethical and legal data framework, training and certification, monitoring and feedback. Bridging the technical, operational, regulatory and economic gaps demands the joint actions from public and industry stakeholders across national and global boundaries.

Now that racism has been officially recognized in Brazil, and some universities have adopted affirmative-action admission policies, measures of the magnitude of racial inequality and analyses that identify the factors associated with changes in racial disparities over time assume particular relevance to the conduct of public debate. This study uses census data from 1950 to 2000 to estimate the probability of death in the early years of life, a robust indicator of the standard of living among the white and Afro-Brazilian populations. Associated estimates of the average number of years of life expectancy at birth show that the 6.6-year advantage that the white population enjoyed in the 1950s remained virtually unchanged throughout the second half of the twentieth century, despite the significant improvements that accrued to both racial groups. The application of multivariate techniques to samples selected from the 1960, 1980, and 2000 census enumerations further shows that, controlling for key determinants of child survival, the white mortality advantage persisted and even increased somewhat in 2000. The article discusses evidence of continued racial inequality during an era of deep transformation in social structure, with reference to the challenges of skin color classification in a multiracial society and the evolution of debates about color, class, and discrimination in Brazil.

Background: Healthcare-associated infections (HAIs) represent an ongoing problem for all clinics. Children’s clinics have waiting rooms that include toys and activities to entertain children, possibly representing reservoirs for HAIs. This study focuses on a newly constructed children’s outpatient clinic associated with a teaching hospital. We studied waiting room bacterial colonization of floors and play devices from the last phase of construction through 6 months of clinical use. Methods: Waiting room areas on the first 2 floors of the facility were studied due to high patient volume in those areas. In total, 16 locations were sampled: 11 on floors and 5 on play items. Using sterile double-transport swabs, all locations were sampled on 5 separate occasions over 2 months during the last phase of construction and 13 times over 6 months after the clinic was opened. After collection swabs were placed on ice, transported to a microbiology lab, and used to inoculate Hardy Diagnostics Cdiff Banana Broth (for Clostridium difficile - Cdiff), CHROM MRSA agar (for methicillin resistant Staphylococcus aureus - MRSA), Pseudomonas isolation agar (for Pseudomonas spp and P. aeruginosa), and tryptic soy agar to detect Bacillus spp. Media were incubated for 48 hours at 37°C and were scored for bacterial presence based on observation of colonies or change in the medium. Results: During the construction phase, waiting-room-floor bacterial colonies were dominated by Bacillus spp, and first-floor waiting rooms had nearly 7 times more colonies than those on the second floor (P < .05). A similar pattern was observed for C. difficile and MRSA. No Pseudomonas spp were observed during construction. Once patients were present, Bacillus spp contamination dropped for the first floor, but increased for the second floor. All other bacterial types (C. difficile, MRSA, Pseudomonas spp, and P. aeruginosa) increased on the second floor after the clinic opened (eg, from 23% to 42% for C. difficile and from 7% to 46% for MRSA; P < .05). The play devices showed small increases in bacterial load after clinic opening, most notably Pseudomonas spp. Conclusions: This study provides evidence that a shift from bacterial species associated with soil (eg, Bacillus spp) toward species commonly associated with humans occurred in waiting rooms after construction in this children’s outpatient clinic. Increases for MRSA, Pseudomonas spp, and P. aeruginosa were linked to patient presence. These data suggest that patients, their families, and clinic staff transport bacteria into clinic waiting rooms. This outpatient clinic environmental contamination may increase potential for HAIs and may represent a target for intervention.

Funding: None

Disclosures: None

Background: The bacteria that inhabit outpatient healthcare facilities influence patient outcomes and recovery, although the diversity and quantity of these bacterial communities is largely unknown. Whether differences in bacterial presence exist in individual medical specialty units of an outpatient clinic is also largely unknown. The purpose of this study was to compare bacterial species found in the general medicine and pulmonary units of an outpatient children’s clinic associated with a teaching hospital. Methods: In total, 6 locations (4 floor sites, counters, air ducts) were sampled in 3 rooms in the pulmonary (PUL) unit and 3 rooms in the general medicine (GM) unit on 13 days over a 6-month period. Sterile double transport swabs were utilized, transported on ice to a microbiology lab, and used to inoculate Hardy Diagnostics Cdiff Banana Broth (for Clostridium difficile), CHROM MRSA agar (for methicillin-resistant Staphylococcus aureus [MRSA]), eosin methylene blue (Levine-type, for Lac+ gram negatives [GN]), and Pseudomonas isolation agar (for Pseudomonas spp and P. aeruginosa [PS and PSA]). Media were incubated for 48 hours at 37°C and were scored for bacterial presence based on colonial observation. Results: The presence of bacteria isolated from GM and PUL units differed by species and location. Based on the percentage of positive swabs, the presence of GN was widespread in both units (Fig 1). Additionally, bacterial presence was greatest on the floors (GN ranged from 72% to 85% on floors in the 2 units), whereas counters had fewer positive swabs (GN ranged from 23% to 38% on counters), and swabs from return air ducts rarely led to bacterial growth. The 1 case in which swabs from the PUL unit resulted in higher levels of bacterial growth than for the GM unit was for PSA (GM, 8%; PUL, 13%). C. difficile detection was the same on both units (ie, 35% of floor samples showed contamination). Conclusions: The levels of environmental bacterial presence observed for these clinic units differed in some cases by unit and ranged from not detectable to very high levels. Detection of C. difficile on 35% of floor samples in both units could be problematic. Additionally, for the PUL unit, contamination of 13% of floor samples by PSA should raise concerns because many patients in this clinic have cystic fibrosis (CF). Although many CF patients are colonized by PSA, others may potentially contract an infection by this pathogen from the clinical environment. This observation supports current infection control recommendations for CF patients in outpatient settings.

Funding: None

Disclosures: None

Good education requires student experiences that deliver lessons about practice as well as theory and that encourage students to work for the public good—especially in the operation of democratic institutions (Dewey 1923; Dewy 1938). We report on an evaluation of the pedagogical value of a research project involving 23 colleges and universities across the country. Faculty trained and supervised students who observed polling places in the 2016 General Election. Our findings indicate that this was a valuable learning experience in both the short and long terms. Students found their experiences to be valuable and reported learning generally and specifically related to course material. Postelection, they also felt more knowledgeable about election science topics, voting behavior, and research methods. Students reported interest in participating in similar research in the future, would recommend other students to do so, and expressed interest in more learning and research about the topics central to their experience. Our results suggest that participants appreciated the importance of elections and their study. Collectively, the participating students are engaged and efficacious—essential qualities of citizens in a democracy.

The use of monthly intranasal mupirocin was associated with a significant reduction in the rate of methicillin-resistant Staphylococcus aureus transmission and Staphylococcus aureus invasive infection in a large neonatal intensive care unit. Resistance to mupirocin emerged over time, but it was rare and was not associated with adverse clinical outcomes.

Infect Control Hosp Epidemiol 2018;39:741–745

Field experiments were conducted in Alabama during 1999 and 2000 to test the hypothesis that any glyphosate-induced yield suppression in glyphosate-resistant cotton would be less with irrigation than without irrigation. Yield compensation was monitored by observing alterations in plant growth and fruiting patterns. Glyphosate treatments included a nontreated control, 1.12 kg ai/ha applied POST at the 4-leaf stage, 1.12 kg/ha applied DIR at the prebloom stage, and 1.12 kg/ha applied POST at 4-leaf and postemergence directed (DIR) at the prebloom cotton stages. The second variable, irrigation treatment, was established by irrigating plots individually with overhead sprinklers or maintaining them under dryland, nonirrigated conditions. Cotton yield and all measured parameters including lint quality were positively affected by irrigation. Irrigation increased yield 52% compared to nonirrigated cotton. Yield and fiber quality effects were independent of glyphosate treatments. Neither yield nor any of the measured variables that reflected whole plant response were influenced by glyphosate treatment or by a glyphosate by irrigation interaction.

The American experience with income taxes began with the Act of 1913, but it was not until 1921 that capital gains were identified separately and taxed differently from other sources of income. This fundamental revision of the income tax was justified on equity grounds; proponents of the change argued that it was unfair to tax income accrued over many years in the year that income was realized [6, p. 192].

The present capital gains provisions have been and are now—strongly attacked alternately as being too lenient and too strict [5, p. 184]. Unfortunately, this symmetry in the opposition to present capital gains treatment does not imply the present provisions are near the optimum.

Produce growers in Kentucky, North Carolina, and Tennessee were surveyed in 2002 to gather information about their decision making in the areas of planting, postharvest handling, marketing, and expected changes. North Carolina has proportionately more respondents with large operations, and Kentucky and Tennessee were more similar and concentrated in smaller farms. Tennessee and Kentucky respondents were less likely to have engaged in activities that were associated with the commercial distribution system. Greater reliance on the commercial distribution system on the part of North Carolina growers is consistent with more produce export activity.

Among the familiar sights crowding the landscape of English history from the dooms of Ine to that crown plucked from a hawthorn bush at Bosworth, none is more deeply cherished than the crisis of 1297 and the “Confirmation of the Charters” to which it gave rise. For, despite all the sharp differences over detail that the documentation for this crisis has engendered, scholars have shown remarkable agreement in seeing it as the one defeat suffered by Edward I in a long and notably successful reign. And to that defeat they have attributed great constitutional significance. Stubbs set the pattern, calling the “result singularly in harmony with what seems from history and experience to be the natural direction of English progress,” and Wilkinson is only one among the many who have recently elaborated on that theme: