The Classic Maya Collapse: The Importance of Ecological Prosperity

The relationship between humans and their environment is a heavily debated, multi-disciplinary discussion that has raised awareness about urgent issues, such as climate change. Earth’s booming population encourages globalization, greed, and over-consumption and has changed the basic composition of the planet, causing humans to continually possess a distorted view of their relationship to nature. This idea can be applied to the Classic Maya, as their success as a thriving civilization rested on their access to the resources around them. Around 900 CE, many of the heavily populated Maya cities were abandoned suddenly and the reason for this collapse is still heavily disputed to this day. The theory that has gained the most momentum in this debate is the drought theory. The Maya suffered a series of droughts during the Classic Maya era and the most significant was a megadrought that lasted from 800CE to 1000 CE. This particular drought had a catastrophic impact on the political stability, economic success, and societal prosperity of many of the great Maya cities. Through lake core sediment analysis, Curtis, Hodell, and Brenner observed that drought periods coincided with periods of Maya recession; a drought period at 862 ± 50 cal, yr. corresponded with the Classic Maya collapse and a drought period at 585 CE occurred during the Maya Hiatus. Both of these drought periods were times of monument decline, city abandonment, and social cataclysm (Curtis, 1996, p. 45). The megadrought that the Maya were faced with produced complete social upheaval, resulting in their eventual fall. As with any diminishing civilization, all aspects of society were under threat; the political nature of many Maya cities was ominous, economic stability disintegrated, health, happiness, and personal faith were dejected, and social contentment vanished completely. The megadrought and its fatal impact had been the driving force behind the Classic Maya collapse.

Using Multibeam Echosounders for Hydrographic Surveying in the Water Column: Estimating Wreck Least Depths

Wreck superstructure can extend into the water column and pose a danger to navigation if the least depth is not accurately portrayed to mariners. NOAA has several methods available to acquire a wreck least depth: lead line, wire drag, diver investigation, side scan shadow length, single beam bathymetry, and multibeam bathymetry. Previous studies have demonstrated that the bottom detection algorithm can fail to locate a wreck mast that is evident in the water column data. Modern multibeam sonars can record water column data in addition to bottom detections. NOAA’s current Hydrographic Specifications do not require water column collection; the best practice is to collect additional bathymetry data during wreck developments. Several multibeam bathymetry and multibeam water column datasets collected by NOAA vessels are evaluated and the wreck least depth results are compared to previous international field trials. A workflow to extract filtered and sidelobe suppressed water column point clouds is presented using currently available software packages. This paper explores the challenges encountered with water column data collection and processing and finds that analysis of water column data provides an improvement to finding wreck least depths, in some cases

Sale of Prescription Drugs Over the Internet

Online drugstores represent one of the hottest categories in electronic commerce. The Internet offers gr eat promise in expanding access to prescription drugs for the disabled, the elderly, and people living in rural areas. But with this promise comes the danger of eliminating the safeguards that protect consumers fr om inappropriate use of medications and adverse drug events. This Issue Brief highlights two studies that investigate the availability of prescription drugs over the Internet, and focuses on the alarming ease with which consumers can obtain drugs without seeing a physician or a pharmacist

De-Romanticizing Black Intergenerational Support: The Questionable Expectations of Welfare Reform

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73197/1/j.1741-3737.2001.00213.x.pd

Reflective Minds, Brighter Futures: Empowering Critical Reflection with a Guided Instructional Model

Critical thinking is recognised as instrumental for positive, personal and professional, long-term outlooks. It is also widely accepted that the development of students’ critical thinking skills can be achieved through explicit interventions. This paper documents the outcomes of a pilot study that investigated the value and impact of an instructional model for guiding critical thinking skills. The model was implemented as an explicit framework, with pre-tertiary students, at a regional campus of an Australian university. Student participants were tasked with using the Review, Connect, Extend, Apply (RCEA) Framework (James, 2015) to support their analysis and critical reflection on the concepts explored in a unit of study. Data revealed that students exhibited limited critical thinking skills prior to participation in the pilot program and evidenced improvement after engaging with the RCEA framework. However, some students struggled with expressing their reflections, evaluations, and applications of knowledge, which resulted in considerations about the importance of vocabulary. The findings directed the authors to note the importance of qualifying the notion of explicit interventions for teaching critical thinking. Accordingly, they propose the use of an explicit teaching model for enabling students’ critical thinking, which encompasses a structured format, a thinking framework, and pedagogy that incorporates the modelling of metacognition and metalanguage for critical thinking

Association of Patient Out-of-Pocket Costs With Prescription Abandonment and Delay in Fills of Novel Oral Anticancer Agents

High out-of-pocket (OOP) costs may limit access to novel oral cancer medications. In a retrospective study, nearly one third of patients whose OOP costs were $100 to$500 and nearly half of patients whose OOP costs were more than $2,000 failed to pick up their new prescription for an oral cancer medication, compared to 10$10 at the time of purchase. Delays in picking up prescriptions were also more frequent among patients facing higher OOP costs

Racial Differences in Surgeons and Hospitals for Endometrial Cancer Treatment

PURPOSE: To determine whether (1) black and white women with endometrial cancer were treated by different surgical specialties and in different types of hospitals and (2) differences in specialty and hospital type contributed to racial differences in survival. METHODS: Retrospective cohort study of 12,307 women aged 65 years and older who underwent surgical treatment of endometrial cancer between 1991 and 1999 in the 11 Surveillance Epidemiology and End Results registries. RESULTS: Black women were more likely to have a gynecologic oncologist to perform their surgery and to be treated at hospitals that were higher volume, larger, teaching, National Cancer Institute centers, urban, and where a greater proportion of the surgeries were performed by a gynecologic oncologist. In unadjusted models, black women were over twice as likely as white women who died because of cancer (hazards ratio [HR]: 2.33), but nearly all of the initial racial difference in survival was explained by differences in cancer stage, and grade as well as age and comorbidities at presentation (adjusted HR: 1.10). Surgical specialty was not associated with survival and, of the hospital characteristics studied, only surgical volume was associated with survival (P \u3c 0.005). Adjusting for hospital characteristics did not change the racial difference in survival (HR: 1.10). Adjustment for the specific hospital where the woman was treated eliminated the association between race and surgeon specialty and slightly widened the residual racial difference in survival (HR: 1.23 vs. 1.10). CONCLUSIONS: In contrast to several studies suggesting that blacks with breast cancer, colon cancer, or cardiovascular disease are treated in hospitals with lower quality indicators, black women diagnosed with endometrial cancer in Surveillance Epidemiology and End Results regions between 1991 and 1999 were more likely to be treated by physicians with advanced training and in high volume, large, urban, teaching hospitals. However, except for a modest association with hospital surgical volume, these provider and hospital characteristics were largely unrelated to survival for women with endometrial cancer. The great majority of the difference in survival was explained by differences in tumor and clinical characteristics at presentation

Development and Validation of an Instrument for Measuring Attitudes and Beliefs about Complementary and Alternative Medicine (CAM) Use among Cancer Patients

Despite cancer patients' extensive use of complementary and alternative medicine (CAM), validated instruments to measure attitudes, and beliefs predictive of CAM use are lacking. We aimed at developing and validating an instrument, attitudes and beliefs about CAM (ABCAM). The 15-item instrument was developed using the theory of planned behavior (TPB) as a framework. The literature review, qualitative interviews, expert content review, and cognitive interviews were used to develop the instrument, which was then administered to 317 outpatient oncology patients. The ABCAM was best represented as a 3-factor structure: expected benefits, perceived barriers, and subjective norms related to CAM use by cancer patients. These domains had Eigenvalues of 4.79, 2.37, and 1.43, and together explained over 57.2% of the variance. The 4-item expected benefits, 7-item perceived barriers, and 4-item subjective norms domain scores, each had an acceptable internal consistency (Cronbach's alpha) of 0.91, 0.76, and 0.75, respectively. As expected, CAM users had higher expected benefits, lower perceived barriers, and more positive subjective norms (all P < 0.001) than those who did not use CAM. Our study provides the initial evidence that the ABCAM instrument produced reliable and valid scores that measured attitudes and beliefs related to CAM use among cancer patients

Co-creation of a student-implemented allied health service in a First Nations remote community of East Arnhem Land, Australia

Objectives: To co-create a culturally responsive student-implemented allied health service in a First Nations remote community and to determine the feasibility and acceptability of the service. Design: Co-creation involved a pragmatic iterative process, based on participatory action research approaches. Feasibility and acceptability were determined using a mixed-method pre/postdesign. Setting: The service was in Nhulunbuy, Yirrkala and surrounding remote First Nations communities of East Arnhem Land, Northern Territory, Australia. Participants: Co-creation of the service was facilitated by the Northern Australia Research Network, guided by Indigenous Allied Health Australia leadership, with East Arnhem local community organisations and community members. Co-creation of the day-to-day service model involved local cultural consultants, service users and their families, staff of community organisations, students, supervisors, placement coordinators and a site administrator. Findings: A reciprocal learning service model was co-created in which culturally responsive practice was embedded. The service was feasible and acceptable: it was delivered as intended; resources were adequate; the service management system was workable; and the service was acceptable. Health outcome measures, however, were not appropriate to demonstrate impact, particularly through the lens of the people of East Arnhem. Recommendations for the service included: continuing the reciprocal learning service model in the long term; expanding to include all age groups; and connecting with visiting and community-based services. Conclusion: The co-created service was feasible and acceptable. To demonstrate the impact of the service, measures of health service impact that are important to First Nations people living in remote communities of northern Australia are required

Adjuvant Chemotherapy Use and Health Care Costs After Introduction of Genomic Testing in Breast Cancer

Genomic testing in patients with early-stage breast cancer is associated with decreased use of chemotherapy and lower costs in younger patients, and slightly increased use of chemotherapy and higher costs in older patients. Genomic testing in actual practice may “rule out” chemotherapy in younger women, and “rule in” chemotherapy in older women