Creating a library holding group: an approach to large system integration.

PURPOSE: Faced with resource constraints, many hospital libraries have considered joint operations. This case study describes how Providence Health & Services created a single group to provide library services. METHODS: Using a holding group model, staff worked to unify more than 6,100 nonlibrary subscriptions and 14 internal library sites. RESULTS: Our library services grew by unifying 2,138 nonlibrary subscriptions and 11 library sites and hiring more library staff. We expanded access to 26,018 more patrons. CONCLUSIONS: A model with built-in flexibility allowed successful library expansion. Although challenges remain, this success points to a viable model of unified operations

Social Movement Gains and Losses : Dilemmas of Arena Creation

Social movements never entirely win or lose, nor do they suddenly appear or disappear. Just as their component parts recombine and continue in other forms, so movements have dozens of impacts of various kinds. To make sense of this complexity we propose examining the outcomes of political interactions for a variety of players (including individuals) across a range of arenas. Given the acknowledged tradeoffs and dilemmas of collective action, we would expect packages of outcomes to appear together sometimes; for example, gains in street mobilization may lead to losses in the form of a damaged reputation or police repression. The first step to explaining such patterns is to identify and name them. We examine one of these outcome patterns, the arena-ownership package, through the case of Seattle's historic $15 per hour wage law passed in 2014, the first ever in a major U.S. city. The players who crafted the bill included an avowed Socialist, the owner of Seattle's iconic Space Needle tower, many representatives of the city's labor movement, and the newly elected Democratic Mayor Ed Murray. These diverse players moved through a series of complex arenas to arrive at the legislative outcome. In this case, we find players who create new arenas, rather than only using already-existing arenas. This move is associated with a typical package of gains and losses: increased control for the player on the one hand, but corresponding losses and risks—the alienation of excluded players and increased perception of responsibility. The creating player is blamed for the arena's failures as well as credited with its successes.Peer reviewe

“Race”, “Nation”, “People”: Ethnic Identity-Construction in 1 Peter 2.9

publication-status: Publishedtypes: Article© 2012 by Cambridge University Press. Publisher's version.1 Peter 2.4–10 is a significant passage within the letter, rich in material from the Jewish scriptures. Verse 9 is particularly significant for the construction of Christian group-identity in that it uniquely applies three words from the vocabulary of ethnic identity to the Church: γένος, ἔθνος, and λαός, widely translated as ‘race’, ‘nation’, and ‘people’. A survey of these words in pre-Christian Jewish literature (especially the LXX), in the NT, and in other early Christian literature, reveals how crucial this text in 1 Peter is to the process by which Christian identity came to be conceived in ethnoracial terms. Drawing on modern definitions of ethnic identity, and ancient evidence concerning the fluidity of ethnic identities, it becomes clear that ‘ethnic’ and ‘racial’ identities are constructed, believed, and sustained through discourse. 1 Peter, with both aggregative and oppositional modes of ethnic reasoning, makes a crucial contribution to the construction of an ethnic form of Christian identity

Western Gull Foraging Behavior as an Ecosystem State Indicator in Coastal California

With accelerating climate variability and change, novel approaches are needed to warn managers of changing ecosystem state and to identify appropriate management actions. One strategy is using indicator species—like seabirds as ecosystem sentinels—to monitor changes in marine environments. Here, we explore the utility of western gulls (Larus occidentalis) breeding on Southeast Farallon Island as a proxy of ecosystem state in coastal California by investigating the interannual variability in gull foraging behavior from 2013 to 2019 in relation to upwelling conditions, prey abundances, and overlap with humpback whales (Megaptera novaeangliae) as gulls frequently feed in association with whales. Western gulls have a flexible diet and forage on land and at-sea. We combined gull GPS tracking data during the incubation phase, ecosystem survey data on multiple predator and prey species, and derived oceanographic upwelling products. When foraging at sea, gulls overlapped with cool upwelled waters. During 2015–2017, 25% more gull foraging trips visited land than in other years, where land trips were on average ∼8 h longer and 40% further than sea trips, which coincided with high compression of coastally upwelled waters (habitat compression) in 2015–2016. Gull foraging behavior was related to local prey abundances, where more foraging occurred near shore or on land when prey abundances were low. However, visual surveys indicated that ∼70% of humpback whale observations co-occurred with gulls, and the year with the most foraging on land (2017) corresponded to regionally low relative whale abundances, suggesting gull movement patterns could be an indicator of whale presence. Further, both whales and gulls forage near-shore under high upwelling habitat compression and low krill abundance. Hence, the deployment of year-round tags on gulls with the capability of near real-time data accessibility could provide important fine-scale metrics for conservation and management of the threatened yet recovering eastern Pacific humpback whale population between infrequent and coarse surveys. Entanglement in fishing gear and ship strikes are major inhibitors to whale recovery and have increased concomitantly with human use of ocean resources. Moreover, as climate variability and change increase, novel indicators should be explored and implemented to inform marine spatial planning and protect species across multiple scales from new risks

Anthelminthic treatment during pregnancy is associated with increased risk of infantile eczema: randomised-controlled trial results

BACKGROUND: Allergy is commoner in developed than in developing countries. Chronic worm infections show inverse associations with allergy, and prenatal exposures may be critical to allergy risk. OBJECTIVE: To determine whether anthelminthic treatment during pregnancy increases the risk of allergy in infancy. METHODS: A randomised, double-blind, placebo-controlled trial on treatment in pregnancy with albendazole versus placebo and praziquantel versus placebo was conducted in Uganda, with a 2 × 2 factorial design; 2507 women were enrolled; infants' allergy events were recorded prospectively. The main outcome was doctor-diagnosed infantile eczema. RESULTS: Worms were detected in 68% of women before treatment. Doctor-diagnosed infantile eczema incidence was 10.4/100 infant years. Maternal albendazole treatment was associated with a significantly increased risk of eczema [Cox HR (95% CI), p: 1.82 (1.26-2.64), 0.002]; this effect was slightly stronger among infants whose mothers had no albendazole-susceptible worms than among infants whose mothers had such worms, although this difference was not statistically significant. Praziquantel showed no effect overall but was associated with increased risk among infants of mothers with Schistosoma mansoni [2.65 (1.16-6.08), interaction p = 0.02]. In a sample of infants, skin prick test reactivity and allergen-specific IgE were both associated with doctor-diagnosed eczema, indicating atopic aetiology. Albendazole was also strongly associated with reported recurrent wheeze [1.58 (1.13-2.22), 0.008]; praziquantel showed no effect. CONCLUSIONS: The detrimental effects of treatment suggest that exposure to maternal worm infections in utero may protect against eczema and wheeze in infancy. The results for albendazole are also consistent with a direct drug effect. Further studies are required to investigate mechanisms of these effects, possible benefits of worms or worm products in primary prevention of allergy, and the possibility that routine deworming during pregnancy may promote allergic disease in the offspring

Life-course of atopy and allergy-related disease events in tropical sub-Saharan Africa: A birth cohort study.

BACKGROUND: In high-income countries, allergy-related diseases (ARDs) follow a typical sequence, the 'Atopic March'. Little is known about the life-course of ARDs in the markedly different, low-income, tropical environment. We describe ARDs in a tropical, African birth cohort. METHODS: Ugandan children were followed from birth to 9 years. ISAAC questionnaires were completed at intervals; doctor-diagnosed ARDs were recorded throughout follow-up. Skin prick tests (SPTs) were performed at 3 and 9 years. Atopy was defined as ≥1 positive SPT. RESULTS: Of the 2345 live-born children, 1214 (52%) were seen at 9 years. Wheeze and eczema were common in infancy, but by 9 years, only 4% reported recent wheeze, 5% eczema and 5% rhinitis. Between 3 and 9 years, atopy prevalence increased from 19% to 25%. Atopy at 3 or 9 years was associated with reported ARD events at 9 years, for example OR = 5.2 (95% CI 2.9-10.7) for atopy and recent wheeze at 9 years. Reported or doctor-diagnosed ARD events in early childhood were associated with the same events in later childhood, for example OR = 4.4 (2.3-8.4) for the association between reported wheeze before 3 years with reported recent wheeze at 9 years, but progression from early eczema to later rhinitis or asthma was not observed. CONCLUSION: Allergen sensitization started early in childhood and increased with age. Eczema and wheeze were common in infancy and declined with age. Atopy was strongly associated with ARD among the few affected children. The typical Atopic March did not occur. Environmental exposures during childhood may dissociate atopy and ARD

Atorvastatin reduces T-cell activation and exhaustion among HIV-infected cART-treated suboptimal immune responders in Uganda: a randomised crossover placebo-controlled trial.

OBJECTIVE: T-cell activation independently predicts mortality, poor immune recovery and non-AIDS illnesses during combination antiretroviral therapy (cART). Atorvastatin showed anti-immune activation effects among HIV-infected cART-naïve individuals. We investigated whether adjunct atorvastatin therapy reduces T-cell activation among cART-treated adults with suboptimal immune recovery. METHODS: A randomised double-blind placebo-controlled crossover trial, of atorvastatin 80 mg daily vs. placebo for 12 weeks, was conducted among individuals with CD4 increase <295 cells/μl after seven years of suppressive cART. Change in T-cell activation (CD3 + CD4 + /CD8 + CD38 + HLADR+) and in T-cell exhaustion (CD3 + CD4 + /CD8 + PD1 + ) was measured using flow cytometry. RESULTS: Thirty patients were randomised, 15 to each arm. Atorvastatin resulted in a 28% greater reduction in CD4 T-cell activation (60% reduction) than placebo (32% reduction); P = 0.001. Atorvastatin also resulted in a 35% greater reduction in CD8-T-cell activation than placebo (49% vs. 14%, P = 0.0009), CD4 T-cell exhaustion (27% vs. 17% in placebo), P = 0.001 and CD8 T-cell exhaustion (27% vs. 16%), P = 0.004. There was no carry-over/period effect. Expected adverse events were comparable in both groups, and no serious adverse events were reported. CONCLUSION: Atorvastatin reduced T-cell immune activation and exhaustion among cART-treated adults in a Ugandan cohort. Atorvastatin adjunct therapy should be explored as a strategy to improve HIV treatment outcomes among people living with HIV in sub-Saharan Africa

Climate vulnerability assessment for Pacific salmon and steelhead in the California Current Large Marine Ecosystem.

Major ecological realignments are already occurring in response to climate change. To be successful, conservation strategies now need to account for geographical patterns in traits sensitive to climate change, as well as climate threats to species-level diversity. As part of an effort to provide such information, we conducted a climate vulnerability assessment that included all anadromous Pacific salmon and steelhead (Oncorhynchus spp.) population units listed under the U.S. Endangered Species Act. Using an expert-based scoring system, we ranked 20 attributes for the 28 listed units and 5 additional units. Attributes captured biological sensitivity, or the strength of linkages between each listing unit and the present climate; climate exposure, or the magnitude of projected change in local environmental conditions; and adaptive capacity, or the ability to modify phenotypes to cope with new climatic conditions. Each listing unit was then assigned one of four vulnerability categories. Units ranked most vulnerable overall were Chinook (O. tshawytscha) in the California Central Valley, coho (O. kisutch) in California and southern Oregon, sockeye (O. nerka) in the Snake River Basin, and spring-run Chinook in the interior Columbia and Willamette River Basins. We identified units with similar vulnerability profiles using a hierarchical cluster analysis. Life history characteristics, especially freshwater and estuary residence times, interplayed with gradations in exposure from south to north and from coastal to interior regions to generate landscape-level patterns within each species. Nearly all listing units faced high exposures to projected increases in stream temperature, sea surface temperature, and ocean acidification, but other aspects of exposure peaked in particular regions. Anthropogenic factors, especially migration barriers, habitat degradation, and hatchery influence, have reduced the adaptive capacity of most steelhead and salmon populations. Enhancing adaptive capacity is essential to mitigate for the increasing threat of climate change. Collectively, these results provide a framework to support recovery planning that considers climate impacts on the majority of West Coast anadromous salmonids

Mutations in the PP2A regulatory subunit B family genes PPP2R5B, PPP2R5C and PPP2R5D cause human overgrowth

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