Telemedicine infectious diseases consultations and clinical outcomes: A systematic review

Background: Telemedicine use is increasing in many specialties, but its impact on clinical outcomes in infectious diseases has not been systematically reviewed. We reviewed the current evidence for clinical effectiveness of telemedicine infectious diseases consultations, including outcomes of mortality, hospital readmission, antimicrobial use, cost, length of stay, adherence, and patient satisfaction. Methods: We queried Ovid MEDLINE 1946-, Embase.com 1947-, Scopus 1823-, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov 1997- through August 5, 2019, for studies looking at clinical outcomes of infectious diseases in the setting of telemedicine use. We did not restrict by language or year of publication. Clinical outcomes searched included 30-day all-cause mortality, 30-day readmissions, patient compliance/adherence, patient satisfaction, cost or cost-effectiveness, length of hospital stay, antimicrobial use, and antimicrobial stewardship. Bias was assessed using standard methodologies. PROSPERO CRD42018105225. Results: From a search pool of 1154 studies, only 18 involved telemedicine infectious diseases consultation and our selected clinical outcomes. The outcomes tracked were heterogeneous, precluding meta-analysis, and the majority of studies were of poor quality. Overall, clinical outcomes with telemedicine infectious diseases consultation seem comparable to in-person infectious diseases consultation. Conclusions: Although in widespread use, the clinical effectiveness of telemedicine infectious diseases consultations has yet to be sufficiently studied. Further studies, or publication of previously collected and available data, are warranted to verify the cost-effectiveness of this widespread practice. Systematic review registration: PROSPERO CRD42018105225

Ancient Maya Regional Settlement and Inter-Site Analysis: The 2013 West-Central Belize LiDAR Survey

During April and May 2013, a total of 1057 km2 of LiDAR was flown by NCALM for a consortium of archaeologists working in West-central Belize, making this the largest surveyed area within the Mayan lowlands. Encompassing the Belize Valley and the Vaca Plateau, West-central Belize is one of the most actively researched parts of the Maya lowlands; however, until this effort, no comprehensive survey connecting all settlement had been conducted. Archaeological projects have investigated at least 18 different sites within this region. Thus, a large body of archaeological research provides both the temporal and spatial parameters for the varied ancient Maya centers that once occupied this area; importantly, these data can be used to help interpret the collected LiDAR data. The goal of the 2013 LiDAR campaign was to gain information on the distribution of ancient Maya settlement and sites on the landscape and, particularly, to determine how the landscape was used between known centers. The data that were acquired through the 2013 LiDAR campaign have significance for interpreting both the composition and limits of ancient Maya political units. This paper presents the initial results of these new data and suggests a developmental model for ancient Maya polities

Ancient Lowland Maya neighborhoods: Average Nearest Neighbor analysis and kernel density models, environments, and urban scale

Many humans live in large, complex political centers, composed of multi-scalar communities including neighborhoods and districts. Both today and in the past, neighborhoods form a fundamental part of cities and are defined by their spatial, architectural, and material elements. Neighborhoods existed in ancient centers of various scales, and multiple methods have been employed to identify ancient neighborhoods in archaeological contexts. However, the use of different methods for neighborhood identification within the same spatiotemporal setting results in challenges for comparisons within and between ancient societies. Here, we focus on using a single method—combining Average Nearest Neighbor (ANN) and Kernel Density (KD) analyses of household groups—to identify potential neighborhoods based on clusters of households at 23 ancient centers across the Maya Lowlands. While a one-size-fits all model does not work for neighborhood identification everywhere, the ANN/KD method provides quantifiable data on the clustering of ancient households, which can be linked to environmental zones and urban scale. We found that centers in river valleys exhibited greater household clustering compared to centers in upland and escarpment environments. Settlement patterns on flat plains were more dispersed, with little discrete spatial clustering of households. Furthermore, we categorized the ancient Maya centers into discrete urban scales, finding that larger centers had greater variation in household spacing compared to medium-sized and smaller centers. Many larger political centers possess heterogeneity in household clustering between their civic-ceremonial cores, immediate hinterlands, and far peripheries. Smaller centers exhibit greater household clustering compared to larger ones. This paper quantitatively assesses household clustering among nearly two dozen centers across the Maya Lowlands, linking environment and urban scale to settlement patterns. The findings are applicable to ancient societies and modern cities alike; understanding how humans form multi-scalar social groupings, such as neighborhoods, is fundamental to human experience and social organization

Changing patterns of social organization: The Late and Terminal Classic communities at San Lorenzo, Cayo District, Belize

Anthropology has persistently sought to understand the links between local contexts and larger, regional structures. Settlement survey and household archaeology in the Maya lowlands have demonstrated that Classic-period hinterland settlements were heterogeneous, but these findings are rarely incorporated into our models of Precolumbian Maya society. This dissertation addresses these issues through the examination of the social and economic organization of San Lorenzo, a Late-to-Terminal Classic (AD 600–890) hamlet in the Xunantunich polity in western Belize. Data from four seasons of survey and household-level excavations permit the comparison of the occupational histories, spatial organization, social composition, and construction techniques of the hamlet\u27s residential groups. The data reveal striking differences in material culture and architecture among the settlement\u27s 17 residential groups, which I use to evaluate a model of the development of Maya hinterland communities as localized lineages. I employ a practice or agent-oriented perspective that focuses on the roles of intra-community social interaction and changing practices of affiliation in constituting the local San Lorenzo community and its larger regional context. The data suggest a relatively weak role for lineage structures at San Lorenzo. In the context of polity formation and political expansion at Xunantunich, the residents of San Lorenzo negotiated multiple types of identity, in part through their manipulation of material culture to create and represent social bonds. Ceramic data attest to structured sets of practices that bridged gaps between the different inhabitants of the site, highlighting shared experiences and beliefs and reinforcing a shared sense of community. Practices of house construction, costuming, and hosting of ritual celebrations simultaneously helped to constitute and preserve inequalities within the hamlet, while linking the hamlet into the larger political and economic networks of the Xunantunich polity. Concurrent with the decline of Xunantunich in the Terminal Classic period, material differences at San Lorenzo all but disappear. The much smaller Terminal Classic community is notably homogeneous and lacks both the differentiating and the integrating practices of the preceding Late Classic

Mechanisms of Peer Review and their Potential Impact on Neurosurgeons: A Pilot Survey

INTRODUCTION: Physician peer review is a universal practice among United States hospitals. While there are many commonalities in peer review procedures, many of them established by law, there is also much institutional variation which should be well understood by practicing neurosurgeons. METHODS: We conducted a 13-question pilot survey of a sample of five hospital systems with whom members of the CSNS-Medicolegal committee are affiliated. Survey questions were constructed to qualitatively assess three features of Hospital Peer Review: (1) committee composition and process, (2) committee outcomes, and (3) legal protections and ramifications RESULTS: The most common paradigm for physician peer review committee (PPRC) was an interdisciplinary group with representatives from most major medical and surgical subspecialties. Referrals for peer review inquiry could be made by any hospital employee and were largely anonymous. Most institutions included a pre-committee screening process conducted by the PPRC leadership. The most common outcomes of an inquiry were resolution with no further action or ongoing focused professional practice evaluation (FFPE). Only in rare circumstances were hospital privileges reported to be revoked or terminated. Members of the PPRC were consistently protected from retaliatory litigation related to peer review participation. The majority of hospitals had a multi-layered decision process and availability of appeal to minimize the potential for punitive investigations. DISCUSSION: According to a recent study, only 62% of hospitals consider their peer review process to be highly or significantly standardized. This pilot survey provides commentary of potential areas of commonality and variation among hospital peer review practices