Just Culture: Practical Implementation for Radiologist Peer Review

Peer review is a cornerstone of quality improvement programs and serves to support the peer learning process. Peer review in radiology incorporates the review of diagnostic imaging interpretation, interventional procedures, communication, and the evaluation of untoward patient events. A just culture is an environment in which errors and near-miss events are evaluated in a deliberately nonpunitive framework, avoiding a culture of blame and responsibility and focusing instead on error prevention and fostering a culture of continuous quality improvement. Adoption of a just culture requires careful attention to detail and relies on continuous coaching of individuals and teams to ensure future systems improvements and a culture of safety. The authors describe the practical implementation of a just culture framework for peer review in an academic radiology department and highlight its application to interpretive, noninterpretive, and procedural domains through case examples.     

International Tourists’ Reactions to a Natural Disaster: Experiences of the 2015 Earthquake in Nepal Among Israeli Travelers

There is a scarcity of research exploring the experiences of foreign travelers exposed to natural disasters while abroad. This qualitative study explored the experiences of the 2015 earthquake in Nepal among international travelers immediately following the earthquake. In‐depth interviews were conducted with 21 Israeli backpackers who were traveling in Nepal at the time of the earthquake. Thematic analysis revealed 4 themes: emotional turmoil, quick recovery, springing into action, and connection to the army. Findings suggest that foreign travelers initially respond with emotional turmoil to the disaster. Then they actively search for ways to effectively cope with the situation by problem solving, creating a community of action and support, and searching their own history for similar circumstances that can provide a sense of competence or clear directions for coping. Implications and limitations of the study, as well as suggestions for future research are discussed.     

Amyloid-β disrupts ongoing spontaneous activity in sensory cortex

The effect of Alzheimer’s disease pathology on activity of individual neocortical neurons in the intact neural network remains obscure. Ongoing spontaneous activity, which constitutes most of neocortical activity, is the background template on which further evoked-activity is superimposed. We compared in vivo intracellular recordings and local field potentials (LFP) of ongoing activity in the barrel cortex of APP/PS1 transgenic mice and age-matched littermate Controls, following significant amyloid-β (Aβ) accumulation and aggregation. We found that membrane potential dynamics of neurons in Aβ-burdened cortex significantly differed from those of nontransgenic Controls: durations of the depolarized state were considerably shorter, and transitions to that state frequently failed. The spiking properties of APP/PS1 neurons showed alterations from those of Controls: both firing patterns and spike shape were changed in the APP/PS1 group. At the population level, LFP recordings indicated reduced coherence within neuronal assemblies of APP/PS1 mice. In addition to the physiological effects, we show that morphology of neurites within the barrel cortex of the APP/PS1 model is altered compared to Controls. These results are consistent with a process where the effect of Aβ on spontaneous activity of individual neurons amplifies into a network effect, reducing network integrity and leading to a wide cortical dysfunction.     

The absolute chronology of Boker Tachtit (Israel) and implications for the Middle to Upper Paleolithic transition in the Levant

The Initial Upper Paleolithic (IUP) is a crucial lithic assemblage type in the archaeology of southwest Asia because it marks a dramatic shift in hominin populations accompanied by technological changes in material culture. This phase is conventionally divided into two chronocultural phases based on the Boker Tachtit site, central Negev, Israel. While lithic technologies at Boker Tachtit are well defined, showing continuity from one phase to another, the absolute chronology is poorly resolved because the radiocarbon method used had a large uncertainty. Nevertheless, Boker Tachtit is considered to be the origin of the succeeding Early Upper Paleolithic Ahmarian tradition that dates in the Negev to ∼42,000 y ago (42 ka). Here, we provide ¹⁴C and optically stimulated luminescence dates obtained from a recent excavation of Boker Tachtit. The new dates show that the early phase at Boker Tachtit, the Emirian, dates to 50 through 49 ka, while the late phase dates to 47.3 ka and ends by 44.3 ka. These results show that the IUP started in the Levant during the final stages of the Late Middle Paleolithic some 50,000 y ago. The later IUP phase in the Negev chronologically overlaps with the Early Upper Paleolithic Ahmarian of the Mediterranean woodland region between 47 and 44 ka. We conclude that Boker Tachtit is the earliest manifestation of the IUP in Eurasia. The study shows that distinguishing the chronology of the IUP from the Late Middle Paleolithic, as well as from the Early Upper Paleolithic, is much more complex than previously thought.

The spread of modern humans from Africa into Eurasia is certainly one of the most important events in human history (1–3). The appearance of Homo sapiens at the transition between the Middle Paleolithic (MP) and the Upper Paleolithic (UP) periods corresponds with the demise of Neanderthals in Europe and west Asia (4). This demographic process, known in the literature as the “Recent African Origin” (5), has undergone refinements since it was first introduced (6). Today, this dispersal event is thought to be a multifaceted process that involved several events and genetic admixture between H. sapiens and Neanderthals (7–12).Recognizing demographic changes in the archaeological record is not always straightforward, mainly because of a lack of human fossils. Still, transformations in material culture are often conceived as a reliable indicator for demographic change (13, 14). In the Levant, as in Europe, such changes occurred during the transition from the MP to the UP, namely, the replacement of Levallois technology by blade technologies and the introduction of systematically produced tools on bone and antler (15–18). The nature and timing of the MP to UP transition has been investigated for almost a century (18–24). While the characteristics of the material culture changes are more or less defined, the absolute chronology and the origins of the transitional industries are under debate (25–30).One of the major reasons for this uncertainty is the fact that many of the key sites with supposedly “transitional” lithic industries in the south Levant, such as Emireh and el-Wad caves, were excavated in the beginning of the 20th century and their stratigraphies are challenging (24). An important exception is the site of Boker Tachtit in the Negev Highlands, Israel, that comprises a series of intact stratigraphic layers with refitted lithic assemblages, which are separated by sterile sediments (31, 32). Here, we report the results of an excavation at Boker Tachtit and in particular the chronology based on radiocarbon and optically stimulated luminescence (OSL) dates.Boker Tachtit is located in the Wadi Zin basin in the central Negev region, Israel (Fig. 1). The site was discovered and excavated by A. Marks in the framework of the Central Negev Project (31). The excavation revealed well-preserved archaeological horizons (Levels 1 through 4 from the bottom up) composed of flint artifacts, a few hammer stones, and charcoal pieces, including the presence of a hearth feature in Level 1. Comprehensive lithic studies enabled technological reconstructions of the lithic industries at the site as well as spatial aspects of these occupations (32–34). The refitting study demonstrated a technological continuity from the lowermost Level 1 to the uppermost Level 4 and indicated on-site flint knapping. This later point is additionally supported by a study of the microflints from Marks’ excavation section D (35). Marks conceived Boker Tachtit as an MP to UP transitional site bearing two consecutive cultural phases: the Emirian (Levels 1 through 3), which he associated with the MP, and the Initial UP (IUP) (Level 4), which was predominantly UP (28). Later studies by Kuhn that included sites in the north Levant redefined the IUP and incorporated the Emirian into this phase (16). In this paper, we follow Kuhn''s definition for the IUP.Open in a separate windowFig. 1.Location of Boker Tachtit and other sites mentioned in the text.The original chronology of Boker Tachtit was based on five radiocarbon dates using the ¹⁴C decay counting method (31). Four samples (GY-3642, SMU-184, SMU-580, and SMU-259) were from Level 1 and one sample (SMU-579) from Level 4. Two samples were of infinite ages (GY-3642, >33,000 BC; SMU-184, >43,620 BC), and one (SMU-579, 33,105 ± 4,100 BC) appeared to be an outlier. Another (SMU-580, 44,330 ± 9,050 BC) had an extremely wide uncertainty range of 9,000 y. The only supposedly reliable date (SMU-259, 44,980 ± 2,420 BC) was used to set the chronology of the site to ∼47 ka BP. The latter date was perceived by Marks and many others to reflect the age of the MP to UP transition in the Levant (1, 13). The few samples analyzed and the large uncertainties are related to the methodology used and probably also to the quality of the charred material analyzed.More recent MP to UP chronological studies based on radiocarbon dating of charred material and marine shells from new and old excavations at other sites have initiated a debate about the chronology of the transition, and the age of Boker Tachtit was suggested to be too old compared with northern Levantine sites (25, 27, 29, 30, 36). The problems lie in the disparities in the documented timing of the transition. While these differences may reflect a time lag in the transition between Boker Tachtit and the northern Levantine sites, problems with the quality of dated material or their context should not be overlooked (i.e., stratigraphic provenience and/or diagenesis) (e.g., refs. 25, 29, 30).     

Preconception care—when and what: the attitude of Israeli gynaecologists to preconception counseling

Objectives Preconception care is a form of preventive care and its implementation might improve general women’s health as well as improving pregnancy outcome. Our aim was to survey the attitudes of Israeli gynecologists regarding preconception counseling. Methods E mailed questionnaires were sent to gynecologists in an Israeli gynecology network. The questionnaire included two identical sets of questions; one was regarding the care of reproductive aged women who visit their gynecologist for various reasons and the second was regarding the care of women in their first prenatal visit. Answers were scored (from 3-always to 0-never), summed and compared using Chi-square and paired t tests. Results Mean score for the preconception set was significantly lower than the prenatal set 11.3 (62.7%) versus 16.9 (93.7%) respectively, P < 0.001. Folic acid supplementation and genetic screening tests were recommended to most women in 99 and 94% of first prenatal care visit compared to only 42 and 62% of women who were not pregnant (P < 0.001). Conclusions Gynecologists fail to recognize proper opportunities for preconception care. Increased awareness and concrete guidelines concerning timing and content of preconception counseling might be helpful.