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This book teaches students and scholars of Greco-Roman medical history how to use and critically assess archaeological materials. Ancient medicine is a subject dominated by textual sources, yet there is a wealth of archaeological remains that can be used to broaden our understanding of medicine in the past. In order to use the information properly, this book explains how to ask questions of an archaeological nature, how to access different types of archaeological materials, and how to overcome problems the researcher might face. It also acts as an introduction to the archaeology of medicine for archaeologists interested in this aspect of their subject. Although the focus is on the Greco-Roman period, the methods and theories explained within the text can be applied to other periods in history. The areas covered include text as material culture, images, artifacts, spaces of medicine, and science and archaeology.

The study of Roman frontiers tends to concentrate on the historical development and military tactics, in construction and actions, of the Roman army. Little attention has been given to the daily life of the soldiers; and those studies that address daily organisation tend to rely upon interpretations that were made about the Roman army in the late 19th and early 20th centuries. Furthermore, the scholars who have researched this aspect tend to apply their arguments to the army as a whole, believing it to have been an homogenous group of people. The early interpretations were often based on anachronistic views that the Roman army was organised and operated in a similar manner to the military system of the time these early archaeologists were writing. One area of the organisation of the Roman army that requires greater deliberation is health care, many aspects of which are taken for granted or interpreted on the basis of understandings made by scholars early on in the development of the discipline. The more recent theories about the system of medical care in the army are also based on rather sparse supporting evidence. It is, therefore, the aim of this thesis to make a two-fold examination of the subject by examining legionary and auxiliary fortifications on the Rhine, Upper and Middle Danube and British frontiers. Queries are raised about previous scholarship in order to see if there is sufficient evidence to support the interpretations and understandings on which more recent scholarshipis based. Following this, new questions are asked of the archaeological and epigraphical material, in the context of more recent anthropological, historical and theoretical archaeological methods not previously applied in studies of Roman military medicine. The main issues are: to see if there is evidence to support the idea of a single system of medical care in the army or if the evidence shows variation within the system, either between the provinces or units; whether there was a difference in care offered to the auxiliary and legionary units; if there is evidence for civilians being treated by military doctors; and if there is evidence for cultural variation of medical practice within the units. The questions are broached by comparing the epigraphical, archaeological and architectural remains relating to medical treatment. Inscriptions mentioning doctors are examined to see if these support the idea of differences in the types of doctors employed according to frontier and unit type. In order to gain information about the cultural background of doctors and the development of medical care in the army the home of the doctors and the dates of the inscriptions are also examined. Medical instruments are employed as a source of evidence to determine the distribution and range of health care in the army. Not only are the instruments compared between fortifications and frontiers to see if there is evidence for medical variation, but they are examined for their context and deposition.It is argued that depositional processes can tell us much about how people understood medical tools and their associations with disease, wounds and death. Finally, the archaeological evidence of buildings identified as military hospitals is considered. In particular, it is questioned whether there is enough evidence to support the definition of the 'hospitals' as hospitals. Artefactual remains from within 'hospitals' are examined and compared when known, as are the plan and layout of each structure that has been recognised as a hospital. The description of Roman hospitals is frequently presented as if they were planned to serve the same functions as modem hospitals, so a comparison of these buildings and their functions, both civilian and military, is made with later (medieval and early-post-medieval) hospitals. Questions of the cultural construction of space are brought into this chapter as a means of demonstrating that the construction and use of buildings is culturally variable and not always undertaken according to a common sense or functional approach as understood in the modem west. It is apparent that our current identification of certain structures as 'hospitals' is far from secure. The thesis concludes by arguing that there is no solid evidence for the existence of a single medical system within the Roman army. A combination of military events and circumstancesa long with cultural variation in the make-up of the units provides the most plausible explanation for this pattern of variability.

Zakrzewski reviews Practitioners, practices and patients; new approaches to medical archaeology and anthropology edited by Patricia Anne Baker and Gillian Carr.

A realist review of the evaluative evidence was conducted on integrated care (IC) programs for older adults to identify key processes that lead to the success or failure of these programs in achieving outcomes such as reduced healthcare utilization, improved patient health, and improved patient and caregiver experience. International academic literature was searched in 12 indexed, electronic databases and gray literature through internet searches, to identify evaluative studies. Inclusion criteria included evaluative literature on integrated, long-stay health and social care programs, published between January 1980 and July 2015, in English. Data were extracted on the study purpose, period, setting, design, population, sample size, outcomes, and study results, as well as explanations of mechanisms and contextual factors influencing outcomes. A total of 65 articles, representing 28 IC programs, were included in the review. Two context-mechanism-outcome configurations (CMOcs) were identified: (i) trusting multidisciplinary team relationships and (ii) provider commitment to and understanding of the model. Contextual factors such as strong leadership that sets clear goals and establishes an organizational culture in support of the program, along with joint governance structures, supported team collaboration and subsequent successful implementation. Furthermore, time to build an infrastructure to implement and flexibility in implementation, emerged as key processes instrumental to success of these programs. This review included a wide range of international evidence, and identified key processes for successful implementation of IC programs that should be considered by program planners, leaders and evaluators.

BackgroundMedical management of acute pain among hospital inpatients may be enhanced by mind-body interventions.ObjectiveWe hypothesized that a single, scripted session of mindfulness training focused on acceptance of pain or hypnotic suggestion focused on changing pain sensations through imagery would significantly reduce acute pain intensity and unpleasantness compared to a psychoeducation pain coping control. We also hypothesized that mindfulness and suggestion would produce significant improvements in secondary outcomes including relaxation, pleasant body sensations, anxiety, and desire for opioids, compared to the control condition.MethodsThis three-arm, parallel-group randomized controlled trial conducted at a university-based hospital examined the acute effects of 15-min psychosocial interventions (mindfulness, hypnotic suggestion, psychoeducation) on adult inpatients reporting “intolerable pain” or “inadequate pain control.” Participants (N = 244) were assigned to one of three intervention conditions: mindfulness (n = 86), suggestion (n = 73), or psychoeducation (n = 85).Key ResultsParticipants in the mind-body interventions reported significantly lower baseline-adjusted pain intensity post-intervention than those assigned to psychoeducation (p < 0.001, percentage pain reduction: mindfulness = 23%, suggestion = 29%, education = 9%), and lower baseline-adjusted pain unpleasantness (p < 0.001). Intervention conditions differed significantly with regard to relaxation (p < 0.001), pleasurable body sensations (p = 0.001), and desire for opioids (p = 0.015), but all three interventions were associated with a significant reduction in anxiety (p < 0.001).ConclusionsBrief, single-session mind-body interventions delivered by hospital social workers led to clinically significant improvements in pain and related outcomes, suggesting that such interventions may be useful adjuncts to medical pain management.Trial registrationTrial Registry: ClinicalTrials.gov; registration ID number: NCT02590029URL: https://clinicaltrials.gov/ct2/show/NCT02590029

1. Millions of shorebirds migrate each year through a small number of highly productive staging areas where they often conflict with fisheries interests. Delaware Bay, USA, is a major shorebird stopover site where, in spring, many thousands of shorebirds undergo rapid mass gain by feeding on the eggs of commercially harvested horseshoe crabs Limulus polyphemus. 2. Environmental factors may cause deviations from the best migration schedule. We used within-year mass gain data from red knot Calidris canutus caught in Delaware Bay between 1998 and 2005 to determine the degree of flexibility individuals have to vary migration speed. 3. Mass gain by birds below 133 g was shown to comprise 15·3% fat (39 kJ g⁻¹), the remainder being lean mass (6 kJ g⁻¹). Above this critical level, fat comprised 83·9% of mass deposition. The rates of energy deposition (kJ d⁻¹) were therefore fundamentally different between the two states but were among the highest ever recorded among vertebrates (5-7 x basic metabolic rate). 4. A total of 36-62% of the variation in observed rates of energy deposition between 1998 and 2002 was explained by a year factor, date and mass at initial capture and interaction terms, such that light-weight birds at the end of May had rates of mass gain or energy deposition two to three times higher than birds of similar mass in mid-May, indicating that birds were attempting to achieve a certain mass by a certain date. In 2003 and 2005, this relationship broke down as a result of lower densities of eggs. 5. Synthesis and application. The maintenance of high densities of crab eggs required for high rates of mass gain in red knot requires severe cuts in, or the complete cessation of, the crab harvest, reduced human and raptor-related disturbance as well as management of beaches to provide sufficient crab-spawning habitat. These findings are widely applicable to other systems where harvesting activities come into conflict with migrating animals and show that certain sections of the population, in this case the long-distance migrants from South America, will be impacted more than short-distance migrants whose physiology may give them access to alternative food resources.

Background Nutrition interventions commenced in ICU and continued through to hospital discharge have not been definitively tested in critical care to date. To commence a program of research, we aimed to determine if a tailored nutrition intervention delivered for the duration of hospitalisation delivers more energy than usual care to patients initially admitted to the Intensive Care Unit (ICU). Methods A multicentre, unblinded, parallel-group, phase II trial was conducted in twenty-two hospitals in Australia and New Zealand. Adult patients, requiring invasive mechanical ventilation (MV) for 72–120 h within ICU, and receiving < 80% estimated energy requirements from enteral nutrition (EN) were included. The intervention (tailored nutrition) commenced in ICU and included EN and supplemental parenteral nutrition (PN), and EN, PN, and/or oral nutrition after liberation from MV, and was continued until hospital discharge or study day 28. The primary outcome was daily energy delivery from nutrition (kcal). Secondary outcomes included duration of hospital stay, ventilator free days at day 28 and total blood stream infection rate. Main results The modified intention to treat analysis included 237 patients (n = 119 intervention and n = 118 usual care). Baseline characteristics were balanced; the median [interquartile range] intervention period was 19 [14–35] and 19 [13–32] days in the tailored nutrition and usual care groups respectively. Energy delivery was 1796 ± 31 kcal/day (tailored nutrition) versus 1482 ± 32 kcal/day (usual care)—adjusted mean difference 271 kcal/day, 95% CI 189–354 kcal. No differences were observed in any secondary outcomes. Conclusions A tailored nutrition intervention commenced in the ICU and continued until hospital discharge achieved a significant increase in energy delivery over the duration of hospitalisation for patients initially admitted to the ICU. Trial registration ClinicalTrials.gov Identifier NCT03292237 . First registered 25th September 2017. Last updated 10th Feb 2023.

Purpose The NIH Undiagnosed Diseases Network (UDN) evaluates participants with disorders that have defied diagnosis, applying personalized clinical and genomic evaluations and innovative research. The clinical sites of the UDN are essential to advancing the UDN mission; this study assesses their contributions relative to standard clinical practices. Methods We analyzed retrospective data from four UDN clinical sites, from July 2015 to September 2019, for diagnoses, new disease gene discoveries and the underlying investigative methods. Results Of 791 evaluated individuals, 231 received 240 diagnoses and 17 new disease–gene associations were recognized. Straightforward diagnoses on UDN exome and genome sequencing occurred in 35% (84/240). We considered these tractable in standard clinical practice, although genome sequencing is not yet widely available clinically. The majority (156/240, 65%) required additional UDN-driven investigations, including 90 diagnoses that occurred after prior nondiagnostic exome sequencing and 45 diagnoses (19%) that were nongenetic. The UDN-driven investigations included complementary/supplementary phenotyping, innovative analyses of genomic variants, and collaborative science for functional assays and animal modeling. Conclusion Investigations driven by the clinical sites identified diagnostic and research paradigms that surpass standard diagnostic processes. The new diagnoses, disease gene discoveries, and delineation of novel disorders represent a model for genomic medicine and science.

The quintessential clinical guide for audiologists on tinnitus and hyperacusis patient management Since publication of the first edition in 2005, new developments have impacted the treatment paradigm for tinnitus, such as sensory meditation and mindfulness. Tinnitus Treatment: Clinical Protocols, Second Edition, by world-renowned tinnitus experts and distinguished authors Richard S. Tyler and Ann Perreau provides comprehensive background information, up-to-date strategies, essential tools, and online supplementary materials grounded in years of clinical experience and research. It fills a gap in graduate education and available materials to empower audiologists to effectively treat patients suffering from bothersome to severely debilitating symptoms associated with tinnitus or hyperacusis. The textbook includes 15 chapters, starting with three chapters on tinnitus models, treatment approaches, and self-treatment options. The next three chapters summarize counseling approaches for audiologists and psychologists, including introduction of the three-track psychological counseling program for managing tinnitus. Chapters 7 and 8 discuss the use of hearing aids in patients with hearing loss-related tinnitus and sound therapy using wearable devices. Chapter 9 covers smartphone apps for tinnitus assessment, management, and education and wellness, including discussion of limitations. The last six chapters provide guidance on tinnitus management topics including treating children, implementing outcome measures, hyperacusis treatment, and future directions. Key Features * New relaxation/distraction tactics including meditation, mindfulness, guided imagery, biofeedback, progressive muscle relaxation, art and music therapy, exercise, and exploration of new hobbies * Treatment guidance for patients with tinnitus associated with Meniere's disease, vestibular schwannoma, unilateral sudden sensorineural hearing loss, and middle ear myoclonus * Discussion and research-based evidence covering Internet-delivered self-help treatment strategies * New supplemental videos, brochures, handouts, questionnaires, and datasheets enhance knowledge, scope of practice, and incorporation of effective approaches into clinical practice This is a must-have resource for every audiology student and advanced courses, as well as essential reading for all audiologists who feel underprepared in managing tinnitus and/or hyperacusis.

The American College of Cardiology's Guidelines Applied in Practice (GAP) initiative for acute myocardial infarction (AMI) has been shown to increase the use of guideline-based therapies and improve outcomes in patients with AMI. It is unknown whether hospitals that are more successful in using the standard discharge contract—a key component of GAP that emphasizes guideline-based medications, lifestyle modification, and follow-up planning—experience a proportionally greater improvement in patient outcomes. Medicare patients treated for AMI in all 33 participating GAP hospitals in Michigan were enrolled. We aggregated the hospitals into 3 tertiles based on the rates of discharge contract use: 0% to 8.4% (tertile 1), >8.4% to 38.0% (tertile 2), and >38.0% to 61.1% (tertile 3). We analyzed 1-year follow-up mortality both pre- and post-GAP and compared the mortality decline post-GAP with discharge contract use according to tertile. There were 1368 patients in the baseline (pre-GAP) cohort and 1489 patients in the post-GAP cohort. After GAP implementation, mortality at 1 year decreased by 1.2% ( P = .71), 1.2% ( P = .68), and 6.0% ( P = .03) for tertiles 1, 2, and 3, respectively. After multivariate adjustment, discharge contract use was significantly associated with decreased 1-year mortality in tertile 2 (odds ratio 0.43, 95% CI 0.22-0.84) and tertile 3 (odds ratio 0.45, 95% CI 0.27-0.75). Increased hospital utilization of the standard discharge contract as part of the GAP program is associated with decreased 1-year mortality in Medicare patient populations with AMI. Hospital efforts to promote adherence to guideline-based care tools such as the discharge contract used in GAP may result in mortality reductions for their patient populations at 1 year.