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Dysphagia is common in hospitalized patients post-extubation and associated with poor outcomes. Laryngeal sensation is critical for airway protection and safe swallowing. However, current understanding of the relationship between laryngeal sensation and aspiration in post-extubation populations is limited. Acute respiratory failure patients requiring intensive care unit admission and mechanical ventilation received a Flexible Endoscopic Evaluation of Swallowing (FEES) within 72 h of extubation. Univariate and multivariable analyses were performed to examine the relationship between laryngeal sensation, length of intubation, and aspiration. Secondary outcomes included pharyngolaryngeal secretions, pneumonia, and diet recommendations. One-hundred and three patients met inclusion criteria. Fifty-one patients demonstrated an absent laryngeal adductor reflex (LAR). Altered laryngeal sensation correlated with the presence of secretions (p = 0.004). There was a significant interaction between the LAR, aspiration, and duration of mechanical ventilation. Altered laryngeal sensation was significantly associated with aspiration on FEES only in patients with a shorter length of intubation (p = 0.008). Patients with altered laryngeal sensation were prescribed significantly more restricted liquid (p = 0.03) and solid (p = 0.001) diets. No relationship was found between laryngeal sensation and pneumonia. There is a high prevalence of laryngeal sensory deficits in mechanically ventilated patients post-extubation. Altered laryngeal sensation was associated with secretions, aspiration, and modified diet recommendations especially in those patients with a shorter length of mechanical ventilation. These results demonstrate that laryngeal sensory abnormalities impact the development of post-extubation dysphagia.

We compare domestic architectural features in New England and the Maritime Peninsula to investigate the relationship between the adoption of horticulture and its relationship to social and settlement change during the Woodland Period. Horticulture was not practiced on the Maritime Peninsula until after European contact, despite cultural and environmental similarity to New England. In New England, horticulture has been implicated in profound social and settlement changes. However, aggregated villages, a unit typically investigated for evidence of social change, have proven elusive in the archaeological record. We compiled and analyzed a dataset of dwelling features instead of relying on identifiable villages. This novel quantitative approach uses dwelling feature shape and size as a proxy for social and settlement change, considering these changes at the scale of the house. We find that, during the Woodland Period, dwelling size was overall slightly larger in New England than on the Maritime Peninsula, but ranges heavily overlapped. After the introduction of horticulture, however, dwellings in New England grew in size overall and assumed bimodally distinct larger and smaller forms, which likely necessitated a restructuring of social and economic behavior. This pattern correlates maize horticulture with changes in social and economic lifestyle in Late Woodland New England. , Nous comparons des structures d'habitation domestiques de sites archéologiques de la Nouvelle-Angleterre et de la péninsule maritime afin d'explorer les conséquences de l'adoption généralisée de l'horticulture en termes de changements sociaux et de transformation des modes d’établissement en Nouvelle-Angleterre à la période Sylvicole. L'horticulture ne fut pas pratiquée dans la péninsule maritime avant la période du contact européen, malgré de fortes similarités culturelles et environnementales avec la Nouvelle-Angleterre. En Nouvelle-Angleterre, l'horticulture est présentée comme ayant été la source de changements sociaux profonds et d'une transformation des modes d’établissement. Au niveau archéologique cependant les sites de village font défaut, alors qu'ils constituent habituellement un repère pour l'identification et l’étude des changements sociaux; cette situation a provoqué des débats sur l'impact socio-économique de l'horticulture. Nous analysons ici un ensemble de données concernant des structures d'habitation individuelles en faisant fi de l'idée selon laquelle l’étude d'un village bien défini est nécessaire. Cette approche quantitative novatrice nous permet d'aborder la question des changements sociaux et de l’évolution des modes d’établissement à l’échelle de l'habitation, par l'intermédiaire de la forme et des dimensions des structures. Nous observons que durant la période sylvicole la taille des structures d'habitation était en général légèrement plus grande en Nouvelle-Angleterre que dans la péninsule maritime, malgré une fourchette de dimensions comparable pour les deux régions. Les habitations de la Nouvelle-Angleterre voient toutefois leur taille augmenter après l'introduction de l'horticulture, alors que se développe une division bimodale entre de grandes et de petites structures, changements rendus possibles par une probable réorganisation des comportements économiques et sociaux. Cette tendance met en corrélation la culture du maïs avec une transformation des modes de vie économiques et sociaux en Nouvelle-Angleterre durant le sylvicole supérieur.

Restraint stress (RS) induces neurotoxicity in the hippocampus, yet most of the studies have employed protracted RS (i.e., = 21 days). Binge ethanol can induce brain toxicity, an effect affected by age. It could be postulated that RS may facilitate ethanol-induced neurotoxicity, perhaps to a greater extent in adolescent vs. older subjects. We analyzed whether adolescent, adult or middle-aged male rats exposed to five episodes of RS followed, 72h later, by binge ethanol (i.e., two administrations of 2.5 g/kg ethanol) exhibited hippocampal neurotoxicity. Adolescents, but not adult or middle-aged rats, exhibited sensitivity to the neurotoxic effects of ethanol at dorsal CA2, ventral CA3 and ventral DG, and a neurotoxic effect of stress at dorsal CA1. Moreover, the combination of ethanol and stress exerted a synergistic effect upon cell degeneration at ventral CA1 and CA2, which was restricted to adolescents. Ethanol also increased cell degeneration, irrespective of age or stress, in dorsal CA3 and in dorsal DG; and ethanol and stress had, across all ages, a synergistic effect upon cell degeneration at the dorsal CA1. The greater neurotoxic response of adolescents to ethanol, stress, or ethanol+stress can put them at risk for the development of alcohol problems. Copyright © 2019 Elsevier B.V. All rights reserved.

Alcohol use is associated with a variety of negative consequences, including heightened likelihood of cognitive impairment, proclivity to alcohol use disorders (AUD), and alterations in the drinker's offspring. Children and rodents exposed to alcohol during pregnancy, or those whose fathers consumed alcohol prior to mating, often exhibit neurodevelopmental, physiological, and behavioral deficits. The present study assessed cognitive function and alcohol intake in male and female rats that were offspring of alcohol-exposed fathers. Adult male rats were exposed to alcohol or vehicle (0.0 or 2.0 g/kg, respectively; twice daily for 2 days followed by a rest day, for a total of eight alcohol or vehicle exposure days), or were left untreated and then mated with non-manipulated females. The offspring were assessed for alcohol intake, via intraoral infusion, followed by cognitive assessment via an alternating T-maze task. The results indicated that paternal ethanol exposure, prior to breeding, resulted in offspring that consumed significantly more ethanol than vehicle or untreated controls. Furthermore, the offspring of alcohol-exposed fathers exhibited a significant failure to initiate and complete the T-maze performance tests. Although, when they did engage in the tests they performed at the level of controls (i.e., 80% correct). The present results add to a growing body of literature suggesting that paternal pre-conception alcohol exposure can have deleterious effects on the offspring. Copyright © 2018 Elsevier Inc. All rights reserved.

Political leadership of various states in India is under tremendous pressure to provide instant relief to the farmers reeling under debt trap, resulting in suicides in several cases. Often, suicides by peasants are widely covered in the media which in turn sway the people’s perception about apparent indifference of the government towards the farming communities of the country. This certainly brings in concerns related to political economy revolving around judicious distribution of wealth and national income of the country. State governments of India are generally reluctant to waive off the farm loans as a matter of routine due to concomitant burden on exchequer that might adversely affect their fiscal balances. However, political parties tend to use farm loan waiver as tactics to come to power in spite of the fact that such populist measures are not good for the economy, nor do they offer a long-term solution to the age-old problem of higher degree of incidence of indebtedness among the farming communities. This article explores the antecedents and consequences of farm loan waivers and the way forward. Besides, it also reconnoitres whether the state takes such decisions as farm loan waiver purely on the basis of economics or any hidden political agenda.

Ongoing racism, structural inequity, dehumanizing institutional bureaucracies, unresponsive service delivery systems, and gaps in services for emerging needs are just some of the pervasive challenges in need of social work leadership. The multidisciplinary nature of social work practice also requires value-based leadership processes on multiple ecological levels to address the challenges inherent within social delivery systems. Social work encourages all social workers to lead these change efforts, but research on front-line social work leadership is lacking. Constructionist conceptualizations of leadership as social influence processes provide a unit of analysis to examine front-line leadership. A secondary analysis of qualitative data examining social work practice that promotes well-being and social justice revealed leadership processes in multiple social work practice settings. Findings Front-line social workers demonstrate three overarching leadership processes in their practice: challenging injustice and changing mindsets, conduit for change, and organizing resources and relationships. Applications Conceptualizing leadership as social influence processes identifies and acknowledges the leadership of front-line social workers, expanding the profession's capacity to collectively articulate and initiate change with a range of social problems and systemic challenges in organizations and communities.

This paper examines to what extent the 129 members of the Urban Public Libraries Council meet the Section 508 standards for accessibility under the Rehabilitation Act, the minimum acceptable standard for accessibility under the Americans with Disabilities Act. Using an HTML evaluation tool, WAVE, the HTML coding of the libraries’ homepages was evaluated according to the Section 508 criteria for accessibility. After one-to-one deep examination to determine the accessibility of the library websites, the results tended to mirror other studies showing that most library websites have some coding deficiencies that limit the accessibility of the websites. Notably, only 7 of the 122 libraries that were surveyed had no Section 508 errors present with their homepages.

Individuals with autism spectrum disorder (ASD) often have co-morbid anxiety and depression. Alexithymia and emotion regulation difficulties are commonly seen in individuals with ASD and in mood disorders. We hypothesized that alexithymia and emotional regulation would mediate the relationship between autistic features and anxiety/depression symptom severity. We collected data about emotional regulation, alexithymia, autistic symptoms and depression/anxiety in a sample of 64 young adults with ASD. We constructed two serial multiple mediator models, using autistic features as the independent variable and anxiety/depression symptoms as outcome variables. The serial relationship between alexithymia and emotional regulation mediated associations between autistic features and depression and anxiety, separately. The findings suggest that targeting alexithymia may benefit therapies designed to alleviate mood disorders in ASD.

Background: Increased death due to the opioid epidemic in the United States has necessitated the development of new strategies to treat addiction. Monoclonal antibodies and antidrug vaccines provide a tool that both aids addiction management and reduces the potential for overdose. Dual drug vaccines formulated by successive conjugation or by mixture have certain drawbacks. The current study examines an approach for combatting the dangers of fentanyl-laced heroin, by using a hapten with one epitope that has domains for both fentanyl and heroin. Results: We evaluated a series of nine vaccines developed from chemically contiguous haptens composed of both heroin- and fentanyl-like domains. Analysis of the results obtained by SPR and ELISA revealed trends in antibody affinity and titers for heroin and fentanyl based on epitope size and linker location. In antinociception studies, the best performing vaccines offered comparable protection against heroin as our benchmark heroin vaccine, but exhibited attenuated protection against fentanyl compared to our fentanyl vaccine. Conclusion: After thorough investigation of this strategy, we have identified key considerations for the development of a chemically contiguous heroin-fentanyl vaccine. Importantly, this is the first report of such a strategy in the opioid-drug-vaccine field.

The search for an ethical vendor who is honest and trustworthy in the exchange process is conceptualized as the Diogenes Effect, an innovative concept. In the light of this effect, the theoretical framework of the current study's model involved retail buyer responses to vendor persuasive communications. The model was tested by having a sample of retailer buyers complete a survey of information processing in the search for a product and vendor. This study innovatively links vendor communication effects to retailer buyer decision-making and evaluations by incorporating and integrating elements of Elaboration Likelihood Theory. Contributing to theory-building, it was found that when retailer buyers searched for a vendor with an ethical orientation, the result was intensified central processing of information and decreased peripheral information processing. This was especially salient when retailer buyers had greater longevity of professional experience. The next stage, information processing, led to feedback that enabled assessment of vendor trustworthiness. Finally, the research measured the level of fulfillment in the post-purchase phase. In the end, typical outcomes included the generation of favorable expectations of vendor performance, as well as the positive impact of those heightened favorable expectations on greater satisfaction with the value ultimately received from the vendor.

In traditional medical practice, the diagnostic interview is focused on symptom collection, diagnosis, and treatment. The psychiatric interview is based on the medical model, but mental health clinicians lack the tests found in general medicine. Rapport is the most essential tool for the psychiatrist to uncover symptoms and develop a diagnosis and treatment plan. This article brings a scientific lens to the psychiatric interview. Under this microscope the value of eliciting the patient's well-being at the outset of the interview becomes clear. Using positive psychology, an evidenced-based rationale for the positive assessment is outlined and methodology and practice of the assessment reviewed. Copyright © 2018 Elsevier Inc. All rights reserved.

An Archaelogy of Days contains new poetry from Vivian Shipley. Connecticut State University Distinguished Professor, Vivian Shipley teachesat Southern Connecticut State University where she was named FacultyScholar in 2000, 2005 and 2008. Her eleventh book, Perennial, was publishedin 2015 by Negative Capability Press and was nominated for the PulitzerPrize and named the Paterson Poetry Prize Finalist. The Poet, her tenth book,was published in 2015 by Louisiana Literature Press, Southeastern LouisianaUniversity. All of Your Messages Have Been Erased (Louisiana Literature Press,SLU, 2010) was nominated for the Pulitzer Prize, won the Sheila MottonBook Prize from the New England Poetry Club, the Paterson Award forSustained Literary Achievement and the CT Press Club Award for BestCreative Writing. Her sixth chapbook is Greatest Hits: 1974-2010 (PuddingHouse Press, Youngstown, Ohio, 2010). She has received the Library ofCongress’s Connecticut Lifetime Achievement Award for Service to theLiterary Community and a Connecticut Book Award for Poetry two times.Most recently, she won the 2017-18 Steve Kowit Prize for Poetry for “Cargo”from San Diego Arts & Entertainment Guild. In 2015, she won the HackneyLiterary Award for Poetry for “Foxfire.”

Functional analyses of the 4.4 Ma hominin Ardipithecus ramidus postcrania revealed a previously unknown and unpredicted locomotor pattern combining arboreal clambering and a form of terrestrial bipedality. To date, all of the fossil evidence of Ar. ramidus locomotion has been collected from the Aramis area of the Middle Awash Research Project in Ethiopia. Here, we present the results of an analysis of additional early Pliocene Ar. ramidus fossils from the Gona Project study area, Ethiopia, that includes a fragmentary but informative partial skeleton (GWM67/P2) and additional isolated manual remains. While we reinforce the original functional interpretations of Ar. ramidus of having a mixed locomotor adaptation of terrestrial bipedality and arboreal clambering, we broaden our understanding of the nature of its locomotor pattern by documenting better the function of the hip, ankle, and foot. The newly recovered fossils document a greater adaptation to bipedality in the Ar. ramidus ankle and hallux than previously recognized. In addition, a newly discovered scaphoid bone with a fusing os centrale provides further evidence about the nature of hominin hand evolution. Copyright © 2018 Elsevier Ltd. All rights reserved.

The capacity of Homo sapiens for the intergenerational accumulation of complex technologies, practices, and beliefs is central to contemporary accounts of human distinctiveness. However, the actual antiquity and evolutionary origins of cumulative culture are not known. Here we propose and exemplify a research program for studying the origins of cumulative culture using archaeological evidence. Our stepwise approach disentangles assessment of the observed fidelity of behavior reproduction from inferences regarding required learning mechanisms (e.g., teaching, imitation) and the explanation of larger-scale patterns of change. It is empirically grounded in technological analysis of artifact assemblages using well-validated experimental models. We demonstrate with a case study using a toolmaking replication experiment to assess evidence of behavior copying across three 2.6 Ma Oldowan sites from Gona, Ethiopia. Results fail to reveal any effects of raw material size, shape, quality, or reduction intensity that could explain the observed details of intersite technological variation in terms of individual learning across different local conditions. This supports the view that relatively detailed copying of toolmaking methods was already a feature of Oldowan technological reproduction at ca. 2.6 Ma. We conclude with a discussion of prospects and implications for further research on the evolution of human cumulative culture.

This quantitative correlational study was designed to investigate whether the core and enrichment college readiness program needs within high-poverty urban schools significantly varied with respect to grade level and stakeholder perceptions. Statistically significant differences were discovered in parent, student, and faculty perceptions in core and enrichment programs related to high-poverty urban school needs. The findings provide valuable information about how to design student academic and counseling services strategically and effectively to increase college and career readiness for low-income, urban students. Findings also provide effective strategies for school leaders, educators, and counselors regarding urban school college and career readiness program needs so that resources can be intentionally distributed in areas of greatest importance.

We explore the origins of the young B-type stars found by Casetti-Dinescu et al. (2014) at the outskirts of the Milky-Way disk in the sky region of Leading Arm of the Magellanic Stream. High-resolution spectroscopic observations made with the MIKE instrument on the Magellan Clay 6.5m telescope for nine stars are added to the previous sample analyzed by Zhang et al. (2017). We compile a sample of fifteen young stars with well-determined stellar types, ages, abundances and kinematics. With proper motions from Gaia DR2 we also derive orbits in a realistic Milky-Way potential. We find that our previous radial-velocity selected LA candidates have substantial orbital angular momentum. The substantial amount of rotational component for these stars is in contrast with the near-polar Magellanic orbit, thus rendering these stars unlikely members of the LA. There are four large orbital-energy stars in our sample. The highest orbital-energy one has an age shorter than the time to disk crossing, with a birthplace z = 2.5 kpc and R GC ~ 28 kpc. Therefore, the origin of this star is uncertain. The remaining three stars have disk runaway origin with birthplaces between 12 and 25 kpc from the Galactic center. Also, the most energetic stars are more metal poor ([Mg/H] =-0.50 +/- 0.07) and with larger He scatter (sigma [He/H] = 0.72) than the inner disk ones ([Mg/H] = 0.12 +/- 0.36, sigma [He/H] = 0.15). While the former group's abundance is compatible with that of the Large Magellanic Cloud, it could also reflect the metallicity gradient of the MW disk and their runaway status via different runaway mechanisms.