Artists before Columbus: A multi-method characterization of the materials and practices of Caribbean cave art

This study represents the first positive identification of plant gum binding media in pre-Columbian art, and the first dates from indigenous cave art in the Caribbean. Mona Island reveals an extensive and well-preserved pre-Columbian and early colonial subterranean cultural landscape with dense concentrations of newly-discovered cave art in up to 30 caves. A multi-method approach to the research of pigments and binding media, charcoal, and cave sediments was used to elucidate the technologies, chronologies and processes of indigenous art and artists. Analyses included on-site use of a portable X-ray fluorescence (P-XRF) device to inform sample selection, scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM/EDX) on paint and charcoal samples, polarized light microscopy (PLM) for material characterizations, and gas chromatography - mass spectrometry (GC-MS) and X-ray diffraction (XRD) for detailed chemical analysis of paint structures and composition. In addition direct dates of cave art using radiocarbon (C14) and Uranium-thorium (U-Th) dating methods are discussed. Results demonstrate multiple centuries of cave use during indigenous occupation and multiple phases and techniques of mark-making in dark zone locations within extensive cave systems. Visitors set out on pre-meditated journeys underground, making rock art using pigments from the cave floors, which they mixed into complex paints with the addition of plant gums from outside. This study is the first of its kind in the Caribbean providing insight into native paint recipes, material choices, and mark-making techniques. The methods have scope for widespread application and advance the integration of cave art research in archaeology

Attitudes Toward Influenza, Pertussis, and COVID-19 Vaccines Among Economically Underserved Black Women/Birthing People: A Mixed-Methods Approach

Vaccination during pregnancy is critical to the health of birthing persons and infants. Yet, persistent racial disparities in vaccination threaten health outcomes in the U.S. (Lu et al., 2015). Vaccination coverage remains low among non-Hispanic Blacks and other racial minorities – a situation magnified by the COVID-19 pandemic (Freimuth, Jamison, An, Hancock, & Quinn, 2017; Stokes et al., 2020). Consequently, understanding vaccine attitudes for systemically disadvantaged groups is paramount to promoting public health. Illuminating barriers to vaccine uptake creates space for new strategies to reduce hesitancy. To investigate Black women’s/birthing people attitudes toward influenza and pertussis vaccination during pregnancy, we conducted four focus groups and one interview between September-November 2019. Our sample included eighteen pregnant/recently pregnant Black women/birthing people from Baltimore, MD. Additionally, with the genesis of the COVID-19 pandemic, we returned to the same community between December 2020-March 2021. We conducted surveys with forty-two Black women/birthing people to examine the group’s attitudes towards COVID-19 vaccinations, as well. Attitudes towards influenza and pertussis immunizations ranged from favorable to rejection. Yet, participants generally affirmed more favorable sentiments towards pertussis vaccines. Willingness to vaccinate was strongly connected to bolstering health. Even among those willing to vaccinate, participants voiced skepticism about vaccine safety. Barriers to vaccination included possible side effects; limited reliable information; and distrust. Finally, most participants planned to decline COVID-19 vaccines for themselves and their children. For future communication strategies aimed at enhancing vaccine uptake, ensuring messages are delivered from trusted sources in local communities is critical (Fu, Haimowitz, & Thompson, 2019). Other possible methods include digital/social media campaigns and open conversations about hesitancy. Additionally, acknowledging decision-making processes of Black women/birthing people; listening to their opinions, and respecting their medical agency are essential

HIV testing implementation in two urban cities: Practice, policy and perceived barriers

Background Although funding has supported the scale up of routine, opt-out HIV testing in the US, variance in implementation mechanisms and barriers in high-burden jurisdictions remains unknown. Methods We conducted a survey of health care organizations in Washington, DC and Houston/Harris County to determine number of HIV tests completed in 2011, policy and practices associated with HIV testing, funding mechanisms, and reported barriers to testing in each jurisdiction and to compare results between jurisdictions. Results In 2012, 43 Houston and 35 DC HIV-testing organizations participated in the survey. Participants represented 85% of Department of Health-supported testers in DC and 90% of Department of Health-supported testers in Houston. The median number of tests per organization was 568 in DC and 1045 in Houston. Approximately 50% of organizations in both DC and Houston exclusively used opt-in consent and most conducted both pre- and post-test counseling with HIV testing (80% of organizations in DC, 70% in Houston). While the most frequent source of funding in DC was the Department of Health, Houston organizations primarily billed the patient or third-party payers. Barriers to testing most often reported were lack of funding, followed by patient discomfort/refusal with more barriers reported in DC. Conclusions Given unique policies, resources and programmatic contexts, DC and Houston have taken different approaches to support routine testing. Many organizations in both cities reported opt-in consent approaches and pre-test counseling, suggesting 2006 national HIV testing recommendations are not being followed consistently. Addressing the barriers to testing identified in each jurisdiction may improve expansion of testing

The evolving paleobathymetry of the circum-Antarctic Southern Ocean since 34 Ma – A key to understanding past cryosphere-ocean developments

The Southern Ocean is a key player in the climate, ocean and atmospheric system. As the only direct connection between all three major oceans since the opening of the Southern Ocean gateways, the development of the Southern Ocean and its relationship with the Antarctic cryosphere has influenced the climate of the entire planet. Although the depths of the ocean floor have been recognized as an important factor in climate and paleoclimate models, appropriate paleobathymetric models including a detailed analysis of the sediment cover are not available. Here, we utilize more than 40 years of seismic reflection data acquisition along the margins of Antarctica and its conjugate margins, along with multiple drilling campaigns by the International Ocean Discovery Program (IODP) and its predecessor programs. We combine and update the seismic stratigraphy across the regions of the Southern Ocean and calculate ocean-wide paleobathymetry grids via a backstripping method. We present a suite of high-resolution paleobathymetric grids from the Eocene-Oligocene Boundary to modern times. The grids reveal the development of the Southern Ocean from isolated basins to an interconnected ocean affected by the onset and vigor of an Antarctic Circumpolar Current, as well as the glacial sedimentation and erosion of the Antarctic continent. The ocean-wide comparison through time exposes patterns of ice sheet development such as switching of glacial outlets and the change from wet-based to dry-based ice sheets. Ocean currents and bottom-water production interact with the sedimentation along the continental shelf and slope and profit from the opening of the ocean gateways

The role of intratidal oscillations in sediment resuspension in a diurnal, partially mixed estuary

Using detailed observations of the mean and turbulent properties of flow, salinity and turbidity that spanned 2001/02, we examined the physical mechanisms underpinning sediment resuspension in the low-energy Swan River estuary, Western Australia. In this diurnal tidally-dominated estuary, the presence of intratidal oscillations, a tidal inequality lasting 2 to 3 hours on the flood tide, generated by interactions of the four main diurnal and semidiurnal astronomical constituents, K₁, O₁, M₂, and S₂, played a major role in modifying vertical stratification and mixing. These intratidal oscillations are controlled by phase differences between the tropic and synodic months rather than being temporally-fixed by bed friction, as occurs in semidiurnal estuaries. Intratidal oscillations are largest, at around 0.1 m, near to the Austral solstice when the lunar and solar declination are in-phase. Despite the seemingly small change in water level, shear-induced interfacial mixing caused destratification of the water column with the top-to-bottom salinity (ΔS) difference of 3.5 present early in the flood tide eroded to less than 0.3 by the end of the intratidal oscillation. High turbidity peaks, of 250 nephelometric turbidity units, coincided with these intratidal oscillations and could not be explained by bed friction since shear stress from mean flow did not exceed threshold criteria. High Reynolds stresses of ∼1 Nm⁻² did, however, exceed τcr and together with negative Reynolds fluxes indicate a net downward transport of material. Destratification of the water column induced by shear instabilities resulted in large overturns capable of moving in situ material towards the bed during intratidal oscillations and these turbidities were ∼10 times greater than those from bed-generated resuspension observed later during the flood tide

Arduous implementation: Does the Normalisation Process Model explain why it's so difficult to embed decision support technologies for patients in routine clinical practice

Background: decision support technologies (DSTs, also known as decision aids) help patients and professionals take part in collaborative decision-making processes. Trials have shown favorable impacts on patient knowledge, satisfaction, decisional conflict and confidence. However, they have not become routinely embedded in health care settings. Few studies have approached this issue using a theoretical framework. We explained problems of implementing DSTs using the Normalization Process Model, a conceptual model that focuses attention on how complex interventions become routinely embedded in practice.Methods: the Normalization Process Model was used as the basis of conceptual analysis of the outcomes of previous primary research and reviews. Using a virtual working environment we applied the model and its main concepts to examine: the 'workability' of DSTs in professional-patient interactions; how DSTs affect knowledge relations between their users; how DSTs impact on users' skills and performance; and the impact of DSTs on the allocation of organizational resources.Results: conceptual analysis using the Normalization Process Model provided insight on implementation problems for DSTs in routine settings. Current research focuses mainly on the interactional workability of these technologies, but factors related to divisions of labor and health care, and the organizational contexts in which DSTs are used, are poorly described and understood.Conclusion: the model successfully provided a framework for helping to identify factors that promote and inhibit the implementation of DSTs in healthcare and gave us insights into factors influencing the introduction of new technologies into contexts where negotiations are characterized by asymmetries of power and knowledge. Future research and development on the deployment of DSTs needs to take a more holistic approach and give emphasis to the structural conditions and social norms in which these technologies are enacte

Author Correction: Rapidly-migrating and internally-generated knickpoints can control submarine channel evolution (Nature Communications, (2020), 11, 1, (3129), 10.1038/s41467-020-16861-x)

© 2020, The Author(s). The original version of this Article contained an error in the labelling of the cross-section in Fig. 2g and the vertical axis in Fig. 2b. This has been corrected in both the PDF and HTML versions of the Article

Caring Leadership: A Heideggerian Perspective

This paper develops the idea of caring leadership based on Heidegger’s philosophy of care. From this perspective, caring leadership is grounded in the practices of ‘leaping-in’ and ‘leaping-ahead’ as modes of intervention in the affairs of the world and the efforts of others. This involves gauging and taking responsibility for the ramifications of intervention, balancing the urge for certainty of outcome and visibility of contribution with the desire to encourage and enable others. Our analysis suggests several twists to contemporary leadership debates. We argue that the popular models of transactional and transformational leadership are to be critiqued not for their over-reliance, but rather, their under-reliance on agency. This is a different kind of agency to that of heroic or charismatic models. It involves tolerance of complexity and ambivalence; a rich sense of temporal trajectory; concern for one’s presence in the world; and crucially, the ability to resist the soothing normativity of ‘best practice’. From this position, we argue that the problem with the growing scholarly interest in an ethic of care is that it provides too tempting a recipe to follow. In a Heideggerian view, caring leadership has little to do with compassion, kindness or niceness; it involves and requires a fundamental organization and leadership of self

Responsiveness of sphingosine phosphate lyase insufficiency syndrome to vitamin B6 cofactor supplementation

Sphingosine- 1- phosphate (S1P) lyase is a vitamin B6- dependent enzyme that degrades sphingosine- 1- phosphate in the final step of sphingolipid metabolism. In 2017, a new inherited disorder was described caused by mutations in SGPL1, which encodes sphingosine phosphate lyase (SPL). This condition is referred to as SPL insufficiency syndrome (SPLIS) or alternatively as nephrotic syndrome type 14 (NPHS14). Patients with SPLIS exhibit lymphopenia, nephrosis, adrenal insufficiency, and/or neurological defects. No targeted therapy for SPLIS has been reported. Vitamin B6 supplementation has therapeutic activity in some genetic diseases involving B6- dependent enzymes, a finding ascribed largely to the vitamin’s chaperone function. We investigated whether B6 supplementation might have activity in SPLIS patients. We retrospectively monitored responses of disease biomarkers in patients supplemented with B6 and measured SPL activity and sphingolipids in B6- treated patient- derived fibroblasts. In two patients, disease biomarkers responded to B6 supplementation. S1P abundance and activity levels increased and sphingolipids decreased in response to B6. One responsive patient is homozygous for an SPL R222Q variant present in almost 30% of SPLIS patients. Molecular modeling suggests the variant distorts the dimer interface which could be overcome by cofactor supplementation. We demonstrate the first potential targeted therapy for SPLIS and suggest that 30% of SPLIS patients might respond to cofactor supplementation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162713/2/jimd12238.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162713/1/jimd12238_am.pd

Whole Slide Imaging Versus Microscopy for Primary Diagnosis in Surgical Pathology: A Multicenter Blinded Randomized Noninferiority Study of 1992 Cases (Pivotal Study)

Most prior studies of primary diagnosis in surgical pathology using whole slide imaging (WSI) versus microscopy have focused on specific organ systems or included relatively few cases. The objective of this study was to demonstrate that WSI is noninferior to microscopy for primary diagnosis in surgical pathology. A blinded randomized noninferiority study was conducted across the entire range of surgical pathology cases (biopsies and resections, including hematoxylin and eosin, immunohistochemistry, and special stains) from 4 institutions using the original sign-out diagnosis (baseline diagnosis) as the reference standard. Cases were scanned, converted to WSI and randomized. Sixteen pathologists interpreted cases by microscopy or WSI, followed by a wash-out period of ≥4 weeks, after which cases were read by the same observers using the other modality. Major discordances were identified by an adjudication panel, and the differences between major discordance rates for both microscopy (against the reference standard) and WSI (against the reference standard) were calculated. A total of 1992 cases were included, resulting in 15,925 reads. The major discordance rate with the reference standard diagnosis was 4.9% for WSI and 4.6% for microscopy. The difference between major discordance rates for microscopy and WSI was 0.4% (95% confidence interval, -0.30% to 1.01%). The difference in major discordance rates for WSI and microscopy was highest in endocrine pathology (1.8%), neoplastic kidney pathology (1.5%), urinary bladder pathology (1.3%), and gynecologic pathology (1.2%). Detailed analysis of these cases revealed no instances where interpretation by WSI was consistently inaccurate compared with microscopy for multiple observers. We conclude that WSI is noninferior to microscopy for primary diagnosis in surgical pathology, including biopsies and resections stained with hematoxylin and eosin, immunohistochemistry and special stains. This conclusion is valid across a wide variety of organ systems and specimen types