Real, Recent, or Replica Ostapkowicz, Joanna; Hanna, Jonathan A; Siegel, Peter E ...
2021, 2021-04-20
eBook
Examines the largely unexplored topics in Caribbean archaeology of looting of heritage sites, fraudulent artifacts, and illicit trade of archaeological materialsReal, Recent, or Replica: Precolumbian ...Caribbean Heritage as Art, Commodity, and Inspiration is the first book-length study of its kind to highlight the increasing commodification of Caribbean Precolumbian heritage. Amerindian art, including "Tano" art, has become highly coveted by collectors, spurring a prolific and increasingly sophisticated black market of forgeries, but also contemporary artistic engagement, openly appreciated as modern artworks taking inspiration from the past. The contributors to this volume contend with difficult subject matter including the continued looting of archaeological sites in the region, the seismic increase of forgeries, and the imbalance of power and economic relations between the producers and consumers of neo-Amerindian art. The case studies document the considerable time depth of forgeries in the region (since the late nineteenth century), address the policies put in place by Caribbean governments and institutions to safeguard national patrimony, and explore the impact looted and forged artifacts have on how museums and institutions collect and ultimately represent the Caribbean past to their audiences. Overall, the volume emphasizes the continued desire for the "authentic" Precolumbian artifact, no matter the cost. It provides insights for archaeologists, museum professionals, art historians, and collectors to combat illegal trade and support communities in creating sustainable heritage industries.
In the Lesser Antilles, the Late Ceramic Age (AD 750-1500) witnessed widespread cultural differentiation and population fluctuation, often characterized as a time of introspection and decline. Using ...the adaptive cycles of resilience theory as a heuristic framework, this paper compares data from 25 settlements on Grenada with the available climate and vegetation records, as well as a sum probability (SPD) model of relative changes in the island's population to better understand the dramatic shifts in Late Ceramic material culture. The study finds this shift (including everything from ceramics to demographics to the appearance of petroglyphs and workstones) occurred during both heightened climatic instability and a population influx - likely of Arauquinoid groups from coastal South America. That is, the 'decline' in ceramic types was not an in situ phenomenon, but directly reflective of events occurring on the mainland.
Despite broad treatment recommendations, there are limited published reports comparing the efficacy of different antihypertensive agents in patients with isolated systolic hypertension or isolated ...diastolic hypertension. This study was a secondary analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. We compared the use of chlorthalidone, amlodipine, or lisinopril on the primary outcome of combined coronary heart disease, stroke, or all-cause mortality in patients with isolated systolic hypertension or isolated diastolic hypertension.
•New data against stepping-stone colonization of the Caribbean islands.•Evidence for Archaic Age presence (generally defined as ∼5000–500 BCE) in southern Lesser Antilles.•At least two historical ...groups have been lumped into the 'Island Carib' ethnicity.•Use of trapezoidal distributions to model ceramic phases with radiocarbon dates.
The pre-Columbian colonization of the Caribbean islands is typically described as a “stepping-stone” pattern moving from South America northward, with the southernmost island of Grenada (Eastern Caribbean) as the first “step.” This paper examines the extant radiocarbon sequence associated with fourteen pre-Columbian sites on Grenada, ranging from the Archaic to early French colonial periods (∼1500 BC - AD 1650). Where possible, sample ranges were refined with Bayesian methods, and those associated with diagnostic ceramics were modelled in trapezoidal distributions to help restructure the island's local ceramic chronology. It is argued that Ceramic Age populations did not settle Grenada until ∼AD 300 (hundreds of years after islands farther north), and few settlements predate AD 750. Additionally, these sites are shown to continue into the historic period, contradicting theories of population replacement by “Island Caribs” after AD 1250. Instead, Grenada's earliest sites remained occupied until French colonization, when two indigenous groups were reportedly present. It is hypothesized that the group labelled “Caraïbes” were in fact descendants of earlier inhabitants, while the “Galibis” had arrived more recently. That is, Grenada's “Caribs” were different than those called Island Caribs today, presenting a confounding factor to efforts linking historical Amerindians to a single pottery tradition.
We sought to examine readmission rates and predictors of hospital readmission following TAVR in patients with ESRD. End-stage renal disease (ESRD) is associated with poor outcomes following ...transcatheter aortic valve replacement (TAVR). We assessed index hospitalizations for TAVR from the National Readmissions Database from 2017 to 2018 and used propensity scores to match those with and without ESRD. We compared 90-day readmission for any cause or cardiovascular cause. Length of stay (LOS), mortality, and cost were assessed for index hospitalizations and 90-day readmissions. Multivariable logistic regression was performed to identify predictors of 90-day readmission. We identified 49,172 index hospitalizations for TAVR, including 1,219 patients with ESRD (2.5%). Patient with ESRD had higher rates of all-cause readmission (34.4% vs. 19.2%, HR 1.96, 95% CI 1.68-2.30, p<0.001) and cardiovascular readmission (13.2% vs. 7.7%, HR 1.85, 95% CI 1.44-2.38, p<0.001) at 90 days. During index hospitalization, patients with ESRD had longer length of stay (mean difference 1.9 days), increased hospital cost (mean difference $42,915), and increased in-hospital mortality (2.6% vs. 0.9%). Among those readmitted within 90 days, patients with ESRD had longer LOS and increased hospital charge, but similar in-hospital mortality. Diabetes (OR 1.86, 95% CI 1.31-2.64) and chronic pulmonary disease (OR 1.51, 95% CI 1.04-2.18) were independently associated with higher odds of 90-day readmission in patients with ESRD.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background Complex percutaneous coronary intervention (PCI) is increasingly performed in older adults (age ≥75 years) with stable ischemic heart disease. However, little is known about clinical ...outcomes. Methods and Results We derived a cohort of older adults undergoing elective PCI for stable ischemic heart disease across a large health system. We compared 12-month event-free survival (freedom from all-cause death, nonfatal myocardial infarction, stroke, and major bleeding), all-cause death, target lesion revascularization, and bleeding events for patients receiving complex versus noncomplex PCI and derived risk estimates with Cox regression models. We included 513 patients (mean age, 81±5 years). Patients receiving complex PCI versus noncomplex PCI did not significantly differ across a host of clinical characteristics including cardiovascular disease features, noncardiac comorbidities, guideline-directed medical therapy use, and frailty. Patients receiving complex PCI versus noncomplex PCI experienced worse event-free survival (80.4% versus 86.8%), which was not significant in adjusted analyses (hazard ratio HR, 1.38 95% CI, 0.88-2.16). All-cause death at 1 year for patients undergoing complex PCI was nearly double that seen for patients receiving noncomplex PCI (10.2% versus 5.9%), and the risk was significant in models adjusted for clinical characteristics (HR, 1.97 95% CI, 1.02-3.79). Target lesion revascularization risk was lower for patients receiving complex PCI (2.2% versus 3.5%, adjusted HR), but bleeding events were not statistically different between groups (25.3% versus 20.5%;
=0.19). Conclusions Complex PCI in older adults with stable ischemic heart disease was associated with lower risk of target lesion revascularization but higher all-cause death compared with noncomplex PCI.
Objectives
To characterize trends of adult epiglottitis presenting to the emergency department (ED) and analyze mortality.
Methods
We utilized the National Emergency Department Sample to characterize ...adult epiglottitis from 2007 to 2014 and used provided weights to obtain nationally representative data (all presented data are weighted). Univariate and multivariate analyses were conducted to determine predictors of mortality.
Results
A total of 33,549 cases were identified (weighted). Over the study period, the average patient age increased significantly from 47 to 51 (R2 > 0.5), with an overall mean age of 49. A total of 11.8% of patients were coded as having obstruction, and 68.3% of cases were admitted to the hospital. Across all years, < 1% received laryngoscopic or airway procedures in the ED. Utilization of both X‐ray and computed tomography was <10%. Over the 8 years, there were an average of 42 deaths per year (1.01% overall mortality). No clinical factors, except obstruction, were significant on univariate analysis (P < 0.05). Multivariate analysis indicated that patient age, degree of hospital urbanization, and smoking status also were nonsignificant.
Conclusions
Epiglottitis is still a significant pathology seen in EDs, is stable over the study period, and carries a mortality risk. There is an exceptionally low rate of documented clinical interventions in the ED, especially compared with inpatient studies of epiglottis. This suggests a lack of recognition of the need and utilization of critical airway interventions early in the patient encounter. Future research is needed to characterize the reasons for the low rate of early airway visualization and intervention of epiglottitis in the ED.
Level of Evidence
4 Laryngoscope, 129:1107–1112, 2019
Investigations were undertaken following the discovery of two Lucayan burials in an Atlantic coast sand dune on Long Island, The Bahamas (site LN‐101), in the aftermath of Hurricane Joaquin in 2015. ...The dune burials were the first of their kind to be documented and systematically excavated, and they were associated with uncommon Atlantic coast Lucayan sites. We describe the first systematic archaeological prospection and investigation of coastal geomorphology in the region, applying grain‐size analysis to assess the dune's natural history; basic geochemical analysis to detect anthropogenic impacts and determine agricultural potential; radiocarbon dating as a chronological anchor for reconstructing dune development; drone mapping and georeferencing to document landscape trajectories; and the potential of clay‐like soils with respect to pottery production. Significantly, the dune was relatively stable during and after Lucayan occupation, before Hurricane Joaquin stripped about 10 m from the dune face. The results contribute to refined modeling of past and future impacts, especially those attributed to modern climate change, by linking changes in geomorphology to human activities that began over 1000 years ago. The study contributes to a growing body of Caribbean research into the deep‐time impacts of sea‐level change, coastal geomorphology, erosion, climate change, and hurricane activity.
Therapeutic strategies that provide effective and broad-spectrum neutralization against HIV-1 infection are highly desirable. Here, we investigate the potential of nanoengineered CD4
T cell ...membrane-coated nanoparticles (TNP) to neutralize a broad range of HIV-1 strains. TNP displayed outstanding neutralizing breadth and potency; they neutralized all 125 HIV-1-pseudotyped viruses tested, including global subtypes/recombinant forms, and transmitted/founder viruses, with a geometric mean 80% inhibitory concentration (IC
) of 819
μg ml
(range, 72 to 8,570 μg ml
). TNP also selectively bound to and induced autophagy in HIV-1-infected CD4
T cells and macrophages, while having no effect on uninfected cells. This TNP-mediated autophagy inhibited viral release and reduced cell-associated HIV-1 in a dose- and phospholipase D1-dependent manner. Genetic or pharmacological inhibition of autophagy ablated this effect. Thus, we can use TNP as therapeutic agents to neutralize cell-free HIV-1 and to target HIV-1 gp120-expressing cells to decrease the HIV-1 reservoir.
HIV-1 is a major global health challenge. The development of an effective vaccine and/or a therapeutic cure is a top priority. The creation of vaccines that focus an antibody response toward a particular epitope of a protein has shown promise, but the genetic diversity of HIV-1 hinders this progress. Here we developed an approach using nanoengineered CD4
T cell membrane-coated nanoparticles (TNP). Not only do TNP effectively neutralize all strains of HIV-1, but they also selectively bind to infected cells and decrease the release of HIV-1 particles through an autophagy-dependent mechanism with no drug-induced off-target or cytotoxic effects on bystander cells.
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