We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The rapid spread of coronavirus disease 2019 (COVID-19) required swift preparation to protect healthcare personnel (HCP) and patients, especially considering shortages of personal protective equipment (PPE). Due to the lack of a pre-existing biocontainment unit, we needed to develop a novel approach to placing patients in isolation cohorts while working with the pre-existing physical space.
Objectives:
To prevent disease transmission to non–COVID-19 patients and HCP caring for COVID-19 patients, to optimize PPE usage, and to provide a comfortable and safe working environment.
Methods:
An interdisciplinary workgroup developed a combination of approaches to convert existing spaces into COVID-19 containment units with high-risk zones (HRZs). We developed standard workflow and visual management in conjunction with updated staff training and workflows. The infection prevention team created PPE standard practices for ease of use, conservation, and staff safety.
Results:
The interventions resulted in 1 possible case of patient-to-HCP transmission and zero cases of patient-to-patient transmission. PPE usage decreased with the HRZ model while maintaining a safe environment of care. Staff on the COVID-19 units were extremely satisfied with PPE availability (76.7%) and efforts to protect them from COVID-19 (72.7%). Moreover, 54.8% of HCP working in the COVID-19 unit agreed that PPE monitors played an essential role in staff safety.
Conclusions:
The HRZ model of containment unit is an effective method to prevent the spread of COVID-19 with several benefits. It is easily implemented and scaled to accommodate census changes. Our experience suggests that other institutions do not need to modify existing physical structures to create similarly protective spaces.
The implementation of mandatory influenza vaccination policies among healthcare personnel (HCP) is controversial. Thus, we examined the affect of mandatory influenza vaccination policies among HCP working in outpatient settings.
Setting:
Four Veterans’ Affairs (VA) health systems and three non-VA medical centers.
Methods:
We analyzed rates of influenza and other viral causes of respiratory infections among HCP working in outpatient sites at 4 VA health systems without mandatory influenza vaccination policies and 3 non-VA health systems with mandatory influenza vaccination policies.
Results:
Influenza vaccination was associated with a decreased risk of influenza (odds ratio, 0.17; 95% confidence interval [CI], 0.13–0.22) but an increased risk of other respiratory viral infections (incidence rate ratio, 1.26; 95% CI, 1.02–1.57).
Conclusions:
Our fitted regression models suggest that if influenza vaccination rates in clinics where vaccination was not mandated had equalled those where vaccine was mandated, HCP influenza infections would have been reduced by 52.1% (95% CI, 51.3%–53.0%). These observations, their possible causes, and additional strategies to reduce influenza and other viral respiratory illnesses among HCP working in ambulatory clinics warrant further investigation.
To determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP).
DESIGN
Retrospective observational cohort study.
SETTING
This study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies.
PARTICIPANTS
The study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites.
METHODS
To determine the incidence and duration of absenteeism in outpatient settings, HCP participating in the Respiratory Protection Effectiveness Clinical Trial at both mandatory and nonmandatory vaccination sites over 3 viral respiratory illness (VRI) seasons (2012–2015) reported their influenza vaccination status and symptomatic days absent from work weekly throughout a 12-week period during the peak VRI season each year. The adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models.
RESULTS
The proportion of participants who received influenza vaccination was lower each year at nonmandatory than at mandatory vaccination sites (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.07–0.11). Among HCP who reported at least 1 sick day, vaccinated HCP had lower symptomatic days absent compared to unvaccinated HCP (OR for 2012–2013 and 2013–2014, 0.82; 95% CI, 0.72–0.93; OR for 2014–2015, 0.81; 95% CI, 0.69–0.95).
CONCLUSIONS
These data suggest that mandatory HCP influenza vaccination policies increase influenza vaccination rates and that HCP symptomatic absenteeism diminishes as rates of influenza vaccination increase. These findings should be considered in formulating HCP influenza vaccination policies.
This collection of essays pays tribute to Nancy Freeman Regalado, a ground-breaking scholar in the field of medieval French literature whose research has always pushed beyond disciplinary boundaries. The articles in the volume reflect the depth and diversity of her scholarship, as well as her collaborations with literary critics, philologists, historians, art historians, musicologists, and vocalists - in France, England, and the United States. Inspired by her most recent work, these twenty-four essays are tied together by a single question, rich in ramifications: how does performance shape our understanding of medieval and pre-modern literature and culture, whether the nature of that performance is visual, linguistic, theatrical, musical, religious, didactic, socio-political, or editorial? The studies presented here invite us to look afresh at the interrelationship of audience, author, text, and artifact, to imagine new ways of conceptualizing the creation, transmission, and reception of medieval literature, music, and art.
EGLAL DOSS-QUINBY is Professor of French at Smith College; ROBERTA L. KRUEGER is Professor of French at Hamilton College; E. JANE BURNS is Professor of Women's Studies and Adjunct Professor of Comparative Literature at the University of North Carolina, Chapel Hill.
Contributors: ANNE AZÉMA, RENATE BLUMENFELD-KOSINSKI, CYNTHIA J. BROWN, ELIZABETH A. R. BROWN, MATILDA TOMARYN BRUCKNER, E. JANE BURNS, ARDIS BUTTERFIELD, KIMBERLEE CAMPBELL, ROBERT L. A. CLARK, MARK CRUSE, KATHRYN A. DUYS, ELIZABETH EMERY, SYLVIA HUOT, MARILYN LAWRENCE, KATHLEEN A. LOYSEN, LAURIE POSTLEWATE, EDWARD H. ROESNER, SAMUEL N. ROSENBERG, LUCY FREEMAN SANDLER, PAMELA SHEINGORN, HELEN SOLTERER, JANE H. M. TAYLOR, EVELYN BIRGE VITZ, LORI J. WALTERS, AND MICHEL ZINK.
As duchess of Brittany [1491-1514] and twice queen of France [1491-98; 1498-1514], Anne de Bretagne set a benchmark by which to measure the status of female authority in Europe at the dawn of the Renaissance. Although at times a traditional political pawn, when men who ruled her life were involved in reshaping European alliances, Anne was directly or indirectly involved with the principal political and religious European leaders of her time and helped define the cultural landscape of her era. Taking a variety of cross-disciplinary perspectives, these ten essays by art historians, literary specialists, historians, and political scientists contribute to the ongoing discussion of Anne de Bretagne and seek to prompt further investigations into her cultural and political impact. At the same time, they offer insight of a broader nature into related areas of intellectual interest - patronage, the history of the book, the power and definition of queenship and the interpretation of politico-cultural documents and court spectacles - thereby confirming the extensive nature of Anne's legacy.
CYNTHIA J. BROWN is Professor of French at the University of California, Santa Barbara.
Invasive plants are a common problem in the management and restoration of degraded lands in the semiarid western United States, but are often not the primary focus of restoration ecologists. Likewise, restoring native vegetation has not been a major concern of weed scientists. But trends in the literature demonstrate increasing overlap of these fields, and greater collaboration between them can lead to improved efficacy of restoration efforts. Succession and ecosystem development are the products of complex interactions of abiotic and biotic factors. Our greatest restoration and invasive plant management successes should result when we take advantage of these natural processes. Recent shifts in management objectives have generated approaches to directing plant community development that utilize species that are strong competitors with invasive species as a bridge to the establishment of native perennial vegetation. Soil water and nutrient characteristics and their interactions can affect desired and undesired plant species differentially and may be manipulated to favor establishment and persistence of desired perennial plant communities. Selection of appropriate plant materials is also essential. Species assemblages that suppress or exclude invaders and competitive plant materials that are well adapted to restoration site conditions are important keys to success. We provide guidelines for restoration based on the fundamental ecological principles underlying succession. Knowledge of the complex interactions among the biotic and abiotic factors that affect successional processes and ecosystem development, and increased collaboration between weed scientists and restoration ecologists hold promise for improving restoration success and invasive species management.
Downy brome (Bromus tectorum L.), an invasive winter annual grass, may be increasing in extent and abundance at high elevations in the western United States. This would pose a great threat to high-elevation plant communities and resources. However, data to track this species in high-elevation environments are limited. To address changes in the distribution and abundance of downy brome and the factors most associated with its occurrence, we used field sampling and statistical methods, and niche modeling. In 2007, we resampled plots from two vegetation surveys in Rocky Mountain National Park for presence and cover of downy brome. One survey was established in 1993 and had been resampled in 1999. The other survey was established in 1996 and had not been resampled until our study. Although not all comparisons between years demonstrated significant changes in downy brome abundance, its mean cover increased nearly fivefold from 1993 (0.7%) to 2007 (3.6%) in one of the two vegetation surveys (P = 0.06). Although the average cover of downy brome within the second survey appeared to be increasing from 1996 to 2007, this slight change from 0.5% to 1.2% was not statistically significant (P = 0.24). Downy brome was present in 50% more plots in 1999 than in 1993 (P = 0.02) in the first survey. In the second survey, downy brome was present in 30% more plots in 2007 than in 1996 (P = 0.08). Maxent, a species–environmental matching model, was generally able to predict occurrences of downy brome, as new locations were in the ranges predicted by earlier generated models. The model found that distance to roads, elevation, and vegetation community influenced the predictions most. The strong response of downy brome to interannual environmental variability makes detecting change challenging, especially with small sample sizes. However, our results suggest that the area in which downy brome occurs is likely increasing in Rocky Mountain National Park through increased frequency and cover. Field surveys along with predictive modeling will be vital in directing efforts to manage this highly invasive species.
It is essential that we improve our ability to predict which nonnative species will become invasive in order to prevent their introduction and spread. Past attempts to foresee invasions have met with limited success, but increased computing power, increased availability of information about exotic species, and comprehensive evaluations of invasion potential are improving our ability to predict which species are likely to invade most successfully. We used data from Colorado and other states to develop an effective means of predicting the spread of invasive plant species among states. Qualitative criteria were used to develop a numerical threat index, which rates potential invaders based on distribution and abundance with respect to climate, biological characteristics, and preferred habitats of the species. Out of a compiled list of 388 species, we identified six invasive nonnative plants that are highly likely to invade Colorado, 10 with medium invasive potential and five with low potential. Species found to be likely to invade Colorado included garlic mustard, smooth distaff thistle, and Syrian beancaper.
This article examines female networks in two French royal families of the late medieval and early Renaissance periods through a study of the paratextual dynamics in books chosen by women for other women. I concentrate on the female lineage generated by Anne de France (1461–1522), duchess of Bourbon, daughter and sister of two kings (Louis XI, Charles VIII) and unofficial regent of France (1483–1491), and Anne de Bretagne (1477–1514), twice queen of France as spouse of Charles VIII and Louis XII. Not only were these two women interconnected through Charles VIII, but an important correlation can be established between their progeny and the posterity of their books. Because neither of the two Annes produced a male heir, their cultural legacies can be partially measured through the manuscripts they had made for their female offspring.
In focusing on two works whose creation was initiated by these mothers for their daughters, Anne de France's Enseignements [Lessons] and the Primer of Claude de France, commissioned by Anne de Bretagne, I wish to argue that French family female networking relied on the book as a site of convergence, rather than a site of struggle and contestation, as was often the case of male-authored works for and about women. To contextualize the remarkable way in which the duchess and queen had these material objects and gifts fashioned for their female offspring, I first examine the traditional mode of the transfer of knowledge to women – from male to female – in Symphorien Champier's Nef des dames vertueuses.
Inviting Anne de France and her daughter Suzanne de Bourbon (1491–1521) to consider examples of female virtue, Symphorien Champier dedicated his printed edition of the Nef des dames vertueuses, published in Lyon in 1503, to both mother and daughter, thereby bonding them in a simultaneous sharing of his work. Book I of the Nef des dames, which exploits the popular famous-women topos, begins not with a verbal dedication to the duchess, like many contemporary works, but rather with a literary tribute to Anne de France, who is integrated into the prologue's allegorical staging of the work: following Lady Prudence's request that the author–narrator write a defense of women, a figure suddenly appears on the scene in the guise of the duchess of Bourbon to serve as a model of virtue.
Elizabeth A. R. Brown provides below a list of Anne's children, based on Patrick Van Kerrebrouck, Les Valois (pp. 157–9, 166–7).
With Charles VIII (30 June 1470–7 April 1498)
Charles-Orland, dauphin of Viennois (10 Oct. 1492–16 Dec. 1495), buried at Saint-Martin of Tours.
Unnamed (Aug. 1493), buried at Notre-Dame of Cléry.
Unnamed (March 1495).
Charles, dauphin of Viennois (8 Sept. 1496–2 Oct. 1496), buried at Saint-Martin of Tours.
François, dauphin of Viennois (1497), buried at Saint-Martin of Tours.
Anne (20 March 1498), buried at Saint-Martin of Tours.
With Louis XII (27 June 1462–1 Jan. 1515)
Claude, duchess of Brittany, countess of Blois (13 Oct. 1499–20 July 1524), married 18 May 1514 to François, duke of Valois and Milan, count of Angoulême, the future François Ier (12 Sept. 1494–31 March 1547), crowned queen of France 10 May 1517, buried at Saint-Denis.
Unnamed (21 Jan. 1503), perhaps buried at Blois.
Renée, duchess of Chartres, countess of Gisors (25 Oct. 1510–12 June 1575), married 10 Feb. 1528 to Hercule of Este, duke of Ferrara (4 April 1508–3 Oct. 1560); buried at Montargis.
As queen of France and duchess of Brittany, Claude de France (r.1515–24) ostensibly possessed the same politico-cultural stature as her mother, Anne de Bretagne (r.1491–98, 1499–1514), who earlier bore the same titles. While we know little about the actual relationship between Anne and Claude, their sharing of cultural space, a unique circumstance in Medieval and Renaissance Europe, can be measured through an examination of their joint appearance in contemporary books. One of the earliest known images of the princess and her mother decorates the king's copy of Petrarch's Remèdes de l'une ou l'autre Fortune (BnF MS ffr. 225, folio 165r) (Figure 9). Featuring Anne holding an adult-looking four-year-old Claude on her lap, surrounded by her ladies-in-waiting, the miniature appears to venerate the females of the French court as its own self-contained unit.
This portrayal of royal mother and daughter is nonetheless ambiguous, for in its mise en scène of Louis XII's confrontation with Fortune and Reason, the text accompanying the illustration conveys anxieties about the lack of a male heir. Anne, who looks downward as if shamed, and Claude thus essentially emblematize the queen's failure in her most anticipated function as spouse. Their stature is all the more diminished by the larger, more imposing and accusatory figure of King Louis XII above them in the center of the miniature, accompanied by Cardinal Georges d'Amboise and the king's courtiers. The portrait of Faith and Hope at Reason's feet is offset by the presence of Adversity and Fortune in the left background along with Fear and Grief.
Figure 9. Louis XII complains to Reason about the lack of a male heir, Petrarch, Remèdes de l'une ou l'autre Fortune
(Paris, Bibliothèque nationale de France, MS fr. 225, fol. 165r)
This ‘sharing’ of a book's paratextual space by Anne and Claude is more favorably cast in the primer of Claude of France (c.1505–10), currently housed in the Fitzwilliam Museum (Cambridge MS 159). Destined for the daughter's instruction, this manuscript stages verbal and visual scenes of women (St Anne) teaching children (the Virgin Mary, Claude) to read. And yet the identification of the figure depicted in the liminal miniature has been disputed. Some scholars assume the female kneeling beside Mary represents Claude herself, but Binski and Panayotova (p. 231), followed by Wieck (p. 269), claim that the opening illustration portrays Anne de Bretagne as commissioner of the book kneeling before her daughter's patron, St Claude.
