Early and Middle Holocene Hunter-Gatherer Occupations in Western Amazonia: The Hidden Shell Middens

We report on previously unknown early archaeological sites in the Bolivian lowlands, demonstrating for the first time early and middle Holocene human presence in western Amazonia. Multidisciplinary research in forest islands situated in seasonally-inundated savannahs has revealed stratified shell middens produced by human foragers as early as 10,000 years ago, making them the oldest archaeological sites in the region. The absence of stone resources and partial burial by recent alluvial sediments has meant that these kinds of deposits have, until now, remained unidentified. We conducted core sampling, archaeological excavations and an interdisciplinary study of the stratigraphy and recovered materials from three shell midden mounds. Based on multiple lines of evidence, including radiocarbon dating, sedimentary proxies (elements, steroids and black carbon), micromorphology and faunal analysis, we demonstrate the anthropogenic origin and antiquity of these sites. In a tropical and geomorphologically active landscape often considered challenging both for early human occupation and for the preservation of hunter-gatherer sites, the newly discovered shell middens provide evidence for early to middle Holocene occupation and illustrate the potential for identifying and interpreting early open-air archaeological sites in western Amazonia. The existence of early hunter-gatherer sites in the Bolivian lowlands sheds new light on the region's past and offers a new context within which the late Holocene "Earthmovers" of the Llanos de Moxos could have emerged. © 2013 Lombardo et al

Peritoneal metastases in breast cancer patients: Differences in survival depending on histological subtype

e12024 Background: Distant spread from breast cancer is commonly found in bones, lungs, liver, and central nervous system. Metastatic involvement of peritoneum and retroperitoneum is unusual and unexpected. The aim of the study was to perform a comprehensive analysis of breast cancer patients with peritoneal metastases and to compare survivals depending on biological subtypes. Methods: 44 breast cancer pts with peritoneal metastases were detected out of a database of 2,500 breast cancer patients treated in one institution between 1995 and 2005. Clinical characteristics such as estrogen receptor and progesterone receptor as well as survivals were analized based on breast cancer subtypes. Results: Mean patient age was 54 years, 25 patients (56%) had ductal invasive carcinoma while 19 (44%) were diagnosed lobular invasive carcinoma. 30 (68%) patients had endocrine responsive tumors. A HER-2 percentage is not provided due to the lack of data before the year 2000. Median survival calculated from peritoneal metastases in histologic subgroups was as follows: Median progression free survival was 36.5 months for ductal invasive carcinoma, and 23.5 months for lobular invasive breast cancer. Median overall survival was 46 (Std 38.5) months for ductal invasive breast cancer and 32 (Std 54.5) months for lobular invasive breast cancer. Conclusions: Patients with peritoneal metastases are a heterogenous group with a different outcome. The histologic subtype seems to be an important predictive factor as lobular invasive breast cancer is associated with worsened progression free an overall survival rates. No significant financial relationships to disclose. </jats:p

Differences in observed and self-reported compliance with ‘Five Moments for Hand Hygiene’ as a function of the empathy of healthcare workers

Background: Hand hygiene at critical time-points (as established by the World Health Organization's model 'Five Moments for Hand Hygiene') remains the leading measure for minimizing the risk of healthcare-associated infections. While many interventions have been tested to improve hand hygiene compliance (HHC) of healthcare workers (HCWs), little is known about the relationship between HHC and empathy of HCWs.Aim: To investigate the relationship between moment-specific HHC rates and empathy of HCWs at both individual and ward levels. Methods: HHC data were collected via observation and self-report, and empathy levels were measured using an established questionnaire. The survey was conducted on 38 wards of three tertiary care hospitals in Germany. Observation data were obtained via in-house observations conducted <8 months before or after the survey.Findings: Evidence for the expected correlation between empathy of HCWs and moment-specific HHC was found for both observed HHC (Moment 1: r=0.483, P=0.031; Moment 2: r=588, P=0.006) and self-reported HHC (Moment 1: r=0.093, P=0.092; Moment 2: r=0.145, P=0.008). In analyses of variance, the critical interaction effect between empathy (i.e. lower vs higher empathy) and designated time-point of hand hygiene (i.e. before vs after reference task) was also significant.Conclusion: Empathy of HCWs should be considered as an important factor in explaining differences between moment-specific HHC rates. In consequence, empathy comes into focus not only as a crucial factor for high-quality patient care, but also as an important contributor to improving HHC. 2022 The Authors. Published by Elsevier Ltd on behalf of The Healthcare Infection Society. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Improved emergency management by a loosely coupled logistic system

We investigate a robust and intelligent logistic system for emergency management where existing commercial logistic systems are loosely coupled with logistic systems of emergency management organizations and armed forces. This system is used to supply the population in case of a disaster where a high impact of environmental conditions on logistics can be seen. Very important are robustness as the ability of a logistic system to remain effective under these conditions and intelligent behavior for automated ad-hoc decisions facing unforeseen events. Scenario technique, roadmapping, as well as surveys are used as qualitative methodologies to identify current weaknesses in emergency management logistics and to forecast future development of loosely coupled logistic systems. Text mining and web mining analysis as quantitative methodologies are used to improve forecasting. As a result, options are proposed for governmental organizations and companies to enable such a loosely coupled logistic system within the next 20 years