El estilo barroco mestizo o barroco del sur Andino es un estilo particular que se desarrolla en el altiplano de América del Sur y toma fuerzas en Bolivia en los actuales departamentos de La Paz, ...Oruro y Potosí. Uno de los mejores ejemplos de este estilo es la portada de San Francisco de La Paz que está constituida por tres partes claramente diferenciadas que se fueron alzando en el transcurso del tiempo. La portada retablo en su diseño y en su conjunto transmite un mensaje visual portador de las ideas evangelizadoras de los franciscanos en el siglo XVIII, con el paso del tiempo esa fachada, sigue dialogando con el paceño constituyéndose en un verdadero elemento comunicador de ideas.
•Climate and management influence salinity and temperature in coastal water bodies.•These changes can affect aquatic plants and their consumption by grazers.•Increased salinity and temperature had ...opposing effects on S. pectinata traits.•The highest grazing rates were in the highest temperature and salinity treatments.•These results can inform future management, conservation and restoration efforts.
Submerged macrophyte vegetation provides valuable ecosystem services, but climate- and management-driven changes may alter plant traits in unexpected and interactive ways. Further, such changes in plant traits may influence herbivore response, with feedback to bed characteristics. We manipulated temperature (20, 25, 30 °C) and salinity (0, 6, 12) in mesocosms to simulate current and predicted scenarios for the San Francisco Bay area. We measured traits of Stuckenia pectinata (sago pondweed) and subsequent effects on invertebrate (amphipod, Ampithoe valida) grazing. Counter to predictions, higher temperatures tended to have positive effects on plant traits (leaf area, aboveground biomass, nitrogen N, phosphorus P, protein, and total phenolic content). Also, unexpectedly, the highest salinity treatment had few negative effects except when temperature was coolest; i.e., 20 °C and a salinity of 12 led to decreased carbon C, N, P, protein, phenolic concentrations, and aboveground biomass. Conversely, the highest salinity (12) at the highest temperature (30 °C) produced the highest leaf N and P, and plants from this treatment suffered most from herbivory. Consumption rates significantly increased with lower leaf fiber and higher total leaf N and protein content; i.e., plants with more nutritious leaves and less structural defense were consumed most. Climate change is expected to increase both salinity and temperature, but manipulation of freshwater supply could lead to decreased salinity. The range of responses in S. pectinata traits and invertebrate grazing shown by our results imply that the specific combination and magnitude of human influences will differentially shape these submerged macrophyte beds and their functions.
Introduction and Aims
Substitution is operationalised as a conscious choice made by users to use one drug instead of, or in conjunction with another based on: perceived safety, level of addiction ...potential, effectiveness in relieving symptoms, access and level of acceptance. Harm reduction is a set of strategies that aim to minimise problems associated with drug use while recognising that for some users, abstinence may be neither a realistic nor a desirable goal. In this paper, we aim for deeper understandings of older adult cannabis users' beliefs and substitution practices as part of the harm reduction framework.
Design and Methods
We present selected findings from our qualitative study of Baby Boomer (born 1946–1964) marijuana users in the San Francisco Bay Area. Although the sample consisted of primary cannabis users, many had personal experience with other drugs throughout their lifetimes. Data collection consisted of an audio‐recorded, semi‐structured in‐depth life history interview followed by a questionnaire and health survey. Qualitative interviews were analysed to discover users' harm reduction beliefs and cannabis substitution practices.
Results
Study participants described using cannabis as a safer alternative for alcohol, illicit drugs and pharmaceuticals based on their perceptions of less adverse side effects, low‐risk for addiction and greater effectiveness at relieving symptoms, such as chronic pain.
Discussion and Conclusions
Cannabis substitution can be an effective harm reduction method for those who are unable or unwilling to stop using drugs completely. More research is needed on cannabis as a safer alternative. Lau N, Sales P, Averill S, Murphy F, Sato S, Murphy S. A safer alternative: Cannabis substitution as harm reduction. Drug Alcohol Rev 2015;34:654–659
To investigate factors associated with spectacle wear among low-income preschoolers who receive glasses through the See Well to Learn (SWTL) program.
Qualitative study of parental perceptions of ...factors contributing to compliance during a longitudinal study of eyeglass wear utilizing thematic analysis of a series of three scripted phone calls during the 2017-2018 school year. Participants were parents of 164 children ages 3-5, from 51 Head Start preschools in the greater San Francisco region.
A total of 470 scripted parental telephone calls were successfully completed during the study period. Six major themes affecting glasses compliance in this group were identified including: (1) awareness of need and noted visual improvement; (2) continuous efforts to improve compliance by working with parent; (3) collaborative efforts between home and school such as parent-teacher encouragement; (4) child comfort and eyewear preferences; (5) the importance of two functional pairs of eyewear to achieve full-time wear; and (6) coordination of care offered by the SWTL program.
This study offers insight into factors contributing to child eyewear compliance during critical years of vision development. These findings offer lessons to improve compliance and identify a need to adjust California’s current policies on vision coverage for children.▪
Neighborhood context shapes opportunities and barriers for residents to access healthcare and cancer screening. Neighborhood socioeconomic status (nSES) is associated with disparities in colorectal ...cancer (CRC) screening, but the extent to which the effectiveness of specific screening interventions vary by nSES has not been studied. The original trial conducted in San Francisco, CA from 2016 to 2017 randomly assigned patients eligible for CRC screening either to a multicomponent intervention including advanced notification, mailed fecal immunochemical test (FIT) kits and reminders or to a control group receiving usual care. For the nSES analysis addresses for 9699 patients were geocoded and stratified by city-wide nSES quintile (Q1 lowest, Q5 highest) using an established index at the census tract level. Compared to usual care, the outreach intervention improved FIT test completion at one year (58.7% vs 38.4%; OR 2.32 2.14, 2.52) but its effectiveness did not vary substantially by nSES quintile (adjusted OR Q1 2.64 2.30, 3.04; Q2 2.43 2.04, 2.90; Q3 2.31 1.84, 2.89; Q4 2.47 1.86, 3.28; Q5 2.64 1.83, 3.81; Wald test for interaction p = 0.87). The implementation of mailed FIT outreach has the potential to increase CRC screening completion without leading to disparities in screening related to nSES (ClinicalTrials.gov NCT02613260).
The San Francisco Bay Area in California is undergoing a technology‐driven wave of growth arguably more thoroughgoing than the first “dot‐com” bubble, fueling hypertrophic gentrification and tales of ...a deeply class‐divided, “Blade Runner kind of society”. While Silicon Valley is still the industry's employment center, San Francisco is seeing faster tech firm growth, and is transforming its downtown to become more “livable” and promoting public space as key to innovation. In this context, this paper offers a reading of urban public space not just as a consumption amenity but also as the “shop floor” of a labor process that goes beyond the walls of the firm to mobilize the social itself in the production of privately appropriated value. With innovation now the watchword of gentrification, the stakes of this shift oscillate between the total commodification of urban vitality and the recognition of the social process of value production itself.
Many adolescents are exposed to tobacco smoke, from either active smoking (CS) or secondhand smoke (SHS) exposure. Tobacco-specific biomarkers of exposure include cotinine (detects use in past 2-4 ...days) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL; detects use for a month or longer). NNAL is expected to detect more intermittent tobacco exposure. We compared NNAL and cotinine as biomarkers of exposure to tobacco in urban adolescents and determined the optimal NNAL cutoff point to distinguish CS from SHS exposure.
Surplus urine samples, collected from 466 adolescents attending pediatric well or urgent care visits at Zuckerberg San Francisco General Hospital in 2013 to 2014, were assayed for cotinine and NNAL.
Ninety-four percent of adolescents had measurable levels of NNAL compared with 87% for cotinine. The optimal NNAL cutoff point to distinguish CS from SHS was 9.6 pg/mL by latent class or 14.4 pg/mL by receiver-operating characteristic analysis. Cotinine and NNAL were strongly correlated, but the correlation slopes differed for active versus SHS-exposed adolescents. Among nonsmokers, NNAL levels were significantly higher in African American (median, 3.3 pg/mL) compared with other groups (0.9-1.9 pg/mL), suggesting greater exposure to SHS.
Urine NNAL screening finds a large majority (94%) of urban adolescents are exposed to tobacco. African Americans are exposed to higher levels of SHS than other ethnic/racial groups.
SHS is associated with significant medical morbidity in adolescents. Routine biochemical screening with NNAL or cotinine detects high prevalence of SHS exposure and should be considered as a tool to reduce SHS exposure in high-risk populations.
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ABSTRACT
Background
Although several models of evidence‐based practice (EBP) exist, there is a paucity of studies that have been conducted to evaluate their implementation in healthcare settings.
Aim
...The purpose of this study was to examine the impact of the Advancing Research and Clinical practice through close Collaboration (ARCC) Model on organizational culture, clinicians’ EBP beliefs and EBP implementation, and patient outcomes at one healthcare system in the western United States.
Design
A pre‐test, post‐test longitudinal pre‐experimental study was conducted with follow‐up immediately following full implementation of the ARCC Model.
Setting and Sample
The study was conducted at a 341‐bed acute care hospital in the western region of the United States. The sample consisted of 58 interprofessional healthcare professionals.
Methods
The ARCC Model was implemented in a sequential format over 12 months with the key strategy of preparing a critical mass of EBP mentors for the healthcare system. Healthcare professionals’ EBP beliefs, EBP implementation, and organizational culture were measured with valid and reliable instruments. Patient outcomes were collected in aggregate from the hospital's medical records.
Results
Findings indicated significant increases in clinicians’ EBP beliefs and EBP implementation along with positive movement toward an organizational EBP culture. Study findings also indicated substantial improvements in several patient outcomes.
Linking Evidence to Action
Implementation of the ARCC Model in healthcare systems can enhance clinicians’ beliefs and implementation of evidence‐based care, improve patient outcomes, and move organizational culture toward EBP.
Several earthquakes over the past two decades have demonstrated that bridges crossing fault rupture zones may suffer significant damage due to the combined effects of ground shaking and surface ...rupture. Although it is widely recommended to avoid building a bridge across a fault, it is not always possible to achieve this objective, especially in regions with a dense network of active faults. This review begins by compiling two databases: one of fault-crossing bridges damaged in past earthquakes and another of bridges crossing potentially active fault rupture zones. The article then continues to review findings of experimental, analytical and numerical studies, and to summarize seismic design provisions and recommendations related to fault-crossing bridges. The review ends with suggestions for future research directions in this area.
•Information about fault-crossing bridges damaged in past earthquakes is collected.•A database of well-documented cases of bridges crossing potentially active faults is compiled.•Small- and large-scale experimental studies of fault-crossing bridges are reviewed.•Analytical and numerical studies of bridges crossing fault rupture zones are summarized.•Seismic design provisions and recommendations for fault-crossing bridges are discussed.
We report measurements of seasonal variability in the C-N stable isotope ratios of plants collected across the habitat mosaic of San Francisco Bay, its marshes, and its tributary river system. ...Analyses of 868 plant samples were binned into 10 groups (e.g., terrestrial riparian, freshwater phytoplankton, salt marsh) to determine whether C-N isotopes can be used as biomarkers for tracing the origins of organic matter in this river-marsh-estuary complex. Variability of δ13C and δ15N was high (~-5-10‰) within each plant group, and we identified three modes of variability: (1) between species and their microhabitats, (2) over annual cycles of plant growth and senescence, and (3) between living and decomposing biomass. These modes of within-group variability obscure any source-specific isotopic signatures, confounding the application of C-N isotopes for identifying the origins of organic matter. A second confounding factor was large dissimilarity between the δ13C-δ15N of primary producers and the organic-matter pools in the seston and sediments. Both confounding factors impede the application of C-N isotopes to reveal the food supply to primary consumers in ecosystems supporting diverse autotrophs and where the isotopic composition of organic matter has been transformed and become distinct from that of its parent plant sources. Our results support the advice of others: variability of C-N stable isotopes within all organic-matter pools is high and must be considered in applications of these isotopes to trace trophic linkages from primary producers to primary consumers. Isotope-based approaches are perhaps most powerful when used to complement other tools, such as molecular biomarkers, bioassays, direct measures of production, and compilations of organic-matter budgets.
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