The potential impact of the medieval climatic anomaly on human populations in the western Mojave Desert

During the late 1980s and early 1990s, a model was proposed for changing settlement and subsistence patterns in the western Mojave Desert. The model posits that environmental fluctuations over the last 4,000 years were potential causal mechanisms for culture change in this region. One of these fluctuations was the environmental episode known as the Medieval Climatic Anomaly (MCA), a series of droughts that took place between about 1,200 and 650 B.P. The intent of this study was to determine whether apparent culture changes that began about 1,200 years ago in the western Mojave Desert are associated with the MCA. To accomplish this goal, a comparison of site and regional archaeological data sets was made in order to illuminate the effects proposed in this study; Examining numerous archaeological assemblages from sites in the western Mojave Desert that were excavated between the 1970s and 2000s, certain trends became apparent. As such, the data from this study support the hypothesis that various culture traits evident in the western Mojave Desert were either directly or indirectly impacted by the MCA, including an extreme subsistence focus on lagomorphs during the Rose Spring Period, expansion of the bow and arrow at about the same time, a severe reduction in obsidian use during the Late Prehistoric Period, human population increase during the Rose Spring Period and subsequent population decrease during the Late Prehistoric Period, and the Numic expansion; To what degree environmental episodes play a role in cultural transitions depends largely on the severity and duration of such episodes. The conclusion of this study is that the MCA was of sufficient severity and duration to have been a motivating factor for much of the culture change discussed in detail within this study

Paleonutrition

The study of paleonutrition provides valuable insights into shifts and changes in human history. This is the most comprehensive book on the topic. Intended for students and professionals, it describes the nature of paleonutrition studies, reviews the history of research, discusses methodological issues in the reconstruction of prehistoric diets, presents theoretical frameworks frequently used in research, and showcases examples in which analyses have been successfully conducted on prehistoric individuals, groups, and populations. It offers an integrative approach to understanding state-of-the-art anthropological dietary, health, and nutritional assessments. The most recent and innovative methods used to reconstruct prehistoric diets are discussed, along with the major ways in which paleonutrition data are recovered, analyzed, and interpreted. The book includes five contemporary case studies that illustrate the mutually beneficial linkages between ethnography and archaeology

The University of Exeter’s Roadmap for EPSRC’s Research Data Management Expectations

This document describes how the University of Exeter will work to conform to EPSRC expectations concerning the management and provision of access to EPSRC-funded research data between May 2012 and May 2015. It is a live document which will be updated and adapted regularly.JIS

A cost effectiveness study of integrated care in health services delivery: a diabetes program in Australia

BACKGROUND: Type 2 diabetes is rapidly growing as a proportion of the disease burden in Australia as elsewhere. This study addresses the cost effectiveness of an integrated approach to assisting general practitioners (GPs) with diabetes management. This approach uses a centralized database of clinical data of an Australian Division of General Practice (a network of GPs) to co-ordinate care according to national guidelines. METHODS: Long term outcomes for patients in the program were derived using clinical parameters after 5 years of program participation, and the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model, to project outcomes for 40 years from the time of diagnosis and from 5 years postdiagnosis. Cost information was obtained from a range of sources. While program costs are directly available, and costs of complications can be estimated from the UKPDS model, other costs are estimated by comparing costs in the Division with average costs across the state or the nation. The outcome and cost measures are used derive incremental cost-effectiveness ratios. RESULTS: The clinical data show that the program is effective in the short term, with improvement or no statistical difference in most clinical measures over 5 years. Average HbA1c levels increased by less than expected over the 5 year period. While the program is estimated to generate treatment cost savings, overall net costs are positive. However, the program led to projected improvements in expected life years and Quality Adjusted Life Expectancy (QALE), with incremental cost effectiveness ratios of $A8,106 per life-year saved and$A9,730 per year of QALE gained. CONCLUSIONS: The combination of an established model of diabetes progression and generally available data has provided an opportunity to establish robust methods of testing the cost effectiveness of a program for which a formal control group was not available. Based on this methodology, integrated health care delivery provided by a network of GPs improved health outcomes of type 2 diabetics with acceptable cost effectiveness, which suggests that similar outcomes may be obtained elsewhere

Defining a Paradigm for the Dissemination of Health Information to Immigrant Populations at the Fletcher Free Library

Abstract: In recent years, the surge of refugee families to the greater Burlington area has lead to a significant increase in the minority population of the city. The Fletcher Free Library (FFL) represents a potential health information resource for this population; it is, however, little utilized. Our project sought to target one of these minority populations, the Somali Bantu, and to diminish the barriers to the use of the FFL’s resources within the Somali population itself. To reduce barriers to access of health information by the Somali Bantu population, we educated the FFl’s reference librarians on Somali culture, developed a compendium of health information in both English and Somali for inclusion within the library’s collection, and staged a one-day intervention at the Community Health Center of Burlington to present the FFL as a potential source of health information for refugee populations. Somali Bantu use of the library, as well as reference librarian confidence in serving this minority population,was objectively assessed via pre- and post-interventional surveys.https://scholarworks.uvm.edu/comphp_gallery/1022/thumbnail.jp

Quiet Time for Mechanically Ventilated Patients in The Medical Intensive Care Unit

Objective: Sleep disruption occurs frequently in critically ill patients. The primary aim of this study was to examine the effect of quiet time (QT) on patient sedation frequency, sedation and delirium scores; and to determine if consecutive QTs influenced physiologic measures (heart rate, mean arterial blood pressure and respiratory rate). Method: A prospective study of a quiet time protocol was conducted with 72 adult patients on mechanical ventilation. Setting: A Medical Intensive Care Unit (MICU) in the Midwest region of the United States. Results: Sedation was given less frequently after QT (p = 0.045). Those who were agitated prior to QT were more likely to be at goal sedation after QT (p \u3c 0.001). Although not statistically significant, the majority of patients who were negative on the Confusion Assessment Method (CAM-ICU) prior to QT remained delirium free after QT. Repeated measures analysis of variance (ANOVA) for three consecutive QTs showed a significant difference for respiratory rate (p = 0.035). Conclusion: QT may influence sedation administration and promote patient rest. Future studies are required to further understand the influence of QT on mechanically ventilated patients in the intensive care unit

Reference Group Data for the Functional Gait Assessment

Background and Purpose: The Functional Gait Assessment (FGA) is a clinical tool for evaluating performance in walking. The purpose of this study was to determine age-referenced norms for performance on the FGA in community-living older adults. Subjects: Subjects were 200 adults, ages 40 to 89 years, living independently. Methods: Each subject completed the FGA one time and was scored simultaneously by 2 testers. Results: The intraclass correlation coefficient for interrater reliability was .93. Mean scores for the FGA ranged from 29/30 for adults in their 40s to 21/30 for adults in their 80s. Discussion and Conclusion: Patient performance on the FGA can be compared with age-referenced norms for expected performance. Further research is needed to determine the FGA\u27s usefulness in tracking clinical changes or predicting falls. The FGA is a reliable test for people without disease, and it is able to detect decreases in gait performance among typical older adults

Career choices and global health engagement: 24-year follow-up of U.S. participants in the Indiana University-Moi University elective

Background Global health experiences evoke a profound awareness of cultural differences, inspire learners to prioritize professional values, and provide a lens for addressing global health care challenges. This study compares the long-term career and practice choices of participants in a 2-month Indiana University-Moi University, Kenya elective from 1989–2013 with those of a control group. Methods Global health elective (GHE) participants and a random sample of alumni without GHE experience were surveyed on their clinical practice, public health and global health activities. Results Responses from 176 former participants were compared with a control group of 177 alumni. GHE participants were more likely than similar controls to provide care to underserved U.S. populations (p=0.037), spend time in global health, public health, and public policy activities (p=0.005) and be involved in global health advocacy (p=0.001). Using multivariable analysis, GHE participants were more likely to be generalists (p<0.05), report that healthcare costs influenced medical decision-making (p<0.05), and provide healthcare outside the U.S. for ≥1 week/year (p<0.001). Conclusions Many years out of training, GHE participants were more likely to be generalists working with underserved populations, to be cost-conscious in their healthcare decision-making, and to be involved in global health, public health or public policy. Implications With the primary care provider shortage and need for greater awareness among providers of healthcare costs, our study shows that that global health experiences may yield broader benefits to the U.S. medical system