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During the Late Epipalaeolithic and Early Neolithic, societies across the Levant transformed their social, cultural and economic organisation, with new forms of food production, architecture and material culture. But to what extent were regional developments connected and how, in particular, did ideas and objects flow between the most southern and northern reaches of Southwest Asia? Finds from the Pre-Pottery Neolithic site of WF16 in southern Jordan resonate with those from Gobekli Tepe and other sites hundreds of kilometres to the north. Emphasising shared symbolism and ideology, the authors explore how connections may have arisen and how they were maintained, revealing expansive social networks spanning Southwest Asia that underpinned the emergence of farming. Keywords: Levant, Epipalaeolithic, Neolithic, iconography, cultural connectivity, Introduction The transition from hunter-gatherer to farming lifestyles involved changes in all aspects of human lifeways: how food was acquired; technology, mobility, settlement and architecture; demography and social relations; ideas [...]

The recently completed HIV prevention trials network study 052 is a landmark collaboration demonstrating that HIV transmission in discordant couples can be dramatically reduced by treating the infected individual with antiretroviral therapy (ART). However, the cellular and virological events that occur in the female reproductive tract (FRT) during ART that result in such a drastic decrease in transmission were not studied and remain unknown. Here, we implemented an in vivo model of ART in BM/liver/thymus (BLT) humanized mice in order to better understand the ability of ART to prevent secondary HIV transmission. We demonstrated that the entire FRT of BLT mice is reconstituted with human [CD4.sup.+] cells that are shed into cervicovaginal secretions (CVS). A high percentage of the [CD4.sup.+] T cells in the FRT and CVS expressed CCR5 and therefore are potential HIV target cells. Infection with HIV increased the numbers of [CD4.sup.+] and [CD8.sup.+] T cells in CVS of BLT mice. Furthermore, HIV was present in CVS during infection. Finally, we evaluated the effect of ART on HIV levels in the FRT and CVS and demonstrated that ART can efficiently suppress cell-free HIV-RNA in CVS, despite residual levels of HIV-RNA* cells in both the FRT and CVS., Introduction Most clinical trials of HIV prevention have aimed at preventing HIV acquisition by topical or systemic administration of preventative antiretroviral drugs to uninfected individuals (1-10). Results from these clinical [...]

Objective: This study examines staffing, funding sources, reimbursement, and financing of medically-oriented child protection teams. Method: A 16-item questionnaire on the composition, size, and services of the team, program costs, revenue sources, reimbursement rates, and perceptions of funding stability was mailed to a sample of 118 medically-oriented child protection teams. Results: After excluding 10 programs, an overall response rate of 68% was obtained. Teams varied in configuration, services, charges, and funding. Over 50% identified funding as being important, yet, demonstrated varying levels of awareness of budget and reimbursement issues. Many generally relied on patient care reimbursement from health care and government payers. Some programs seemed to be doing well financially while others were struggling. Approximately one-third of the respondents indicated that funding was unstable. Conclusions: Many programs are innovatively knitting together patch-works of funding and support to serve children and families in need. Team leaders should increase their knowledge of fiscal issues in order to be effective advocates at the institutional level for continued team support. A potential way of accomplishing this would be to utilize the existing structure of a national professional association and its national meeting to provide a forum for relatively successful programs to showcase their 'ideal models' of team financing. Key Words - Child abuse, Cost. Insurance, Interdisciplinary teams.

Today's physician must not only be aware of continuous change in health care, but be involved in that change itself with the goal of continuous improvement. A commitment to improvement involves the setting of goals as well as the ability to recognize the difference between improvement and mere change. With a commitment to quality in mind, it is also essential to recognize what portions of process interfere with improvement, and development team methods to change and overcome those limitations., Physicians must be ready to assume an active role in the design, implementation, and improvement of emerging models of health care delivery. Knowledge and skill in continuous improvement prepare them to engage seriously in the processes of change, on the basis of the same scientific principles they always have relied on in the use of evidence to improve outcomes. This includes include the ability to 1) identify the health needs of the individuals and communities for which they provide health services; 2) assess the impact of current practice with appropriate outcome measures; 3) discover what in the process of health care may be contributing to less than desired outcomes; 4) design and test interventions to change the process of care to improve outcomes; 5) act as an effective member of the interdisciplinary team required to complete these tasks; and 6) consider ethical principles and professional values when making decisions about change in health services delivery. Graduate medical education presents special opportunities and challenges for learning about continuous improvement. Early experiences at Rainbow Babies and Children's Hospital in Cleveland and Children's Hospital in Boston suggest how we might prepare pediatricians and other physicians to create positive change and continually improve health care. Pediatrics 1998;101:768-774; managed care, graduate medical education, total quality management., ABBREVIATIONS. PDSA, Plan-Do-Study-Act (cycle); GME, graduate medical education; MDI, metered-dose inhaler. When young physicians earn their medical degrees, they also earn a special responsibility for the health of patients, families, [...]

The Rochester criteria for the evaluation of infants with fever may accurately identify infants who are unlikely to have serious bacterial infections (SBI). The Rochester criteria, also called the low-risk criteria, relies upon physical examination, patient history, and laboratory test results. Researchers studied 1005 healthy-looking infants with fevers who were two months old or younger. Of these patients, 511 satisfied the low-risk criteria while 494 did not. Laboratory testing identified SBI in 1% of infants categorized as low-risk. Twelve percent of infants who were not categorized as low-risk were diagnosed with SBI. Almost 99% of infants identified as being at low-risk will not have SBI. Based upon these findings, infants with fever who are two months old or younger and fit the low-risk criteria should be managed by observation only.

Blood masses within the brain of a newborn may be a result of abuse of the pregnant mother. A premature infant born at 34 weeks of pregnancy was found to have a deformed head with split connections between the bones of the skull. An ultrasound of the head revealed large blood masses inside the brain. The mother reported being beaten at least eight times during her pregnancy, and she noticed fewer fetal movements with this infant as compared to other pregnancies. The pattern of injuries was similar to that seen in shaken baby syndrome., Subdural hematomas in the neonate are unusual, with a difficult delivery accounting for most cases. As obstetric methods have improved, the incidence of this complication has declined, making subdurals even [...]