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Few studies have used genomic epidemiology to understand tuberculosis (TB) transmission in rural and remote settings – regions often unique in history, geography and demographics. To improve our understanding of TB transmission dynamics in Yukon Territory (YT), a circumpolar Canadian territory, we conducted a retrospective analysis in which we combined epidemiological data collected through routine contact investigations with clinical and laboratory results. Mycobacterium tuberculosis isolates from all culture-confirmed TB cases in YT (2005–2014) were genotyped using 24-locus Mycobacterial Interspersed Repetitive Units-Variable Number of Tandem Repeats (MIRU-VNTR) and compared to each other and to those from the neighbouring province of British Columbia (BC). Whole genome sequencing (WGS) of genotypically clustered isolates revealed three sustained transmission networks within YT, two of which also involved BC isolates. While each network had distinct characteristics, all had at least one individual acting as the probable source of three or more culture-positive cases. Overall, WGS revealed that TB transmission dynamics in YT are distinct from patterns of spread in other, more remote Northern Canadian regions, and that the combination of WGS and epidemiological data can provide actionable information to local public health teams.
The US Department of Agriculture’s Summer Food Service Program and Seamless Summer Option (summer nutrition programmes (SNP)) aim to relieve food insecurity for children and teens during summer months. More needs to be known about when and where SNP are available, and how availability varies by community characteristics, particularly in rural areas where food insecurity and reduced food access are more prevalent.
The present study examined the geographic availability of SNP and summer meal uptake rates in 2016, using state-wide administrative claims data.
Public schools and SNP in California, USA.
Schools (n 8842) and SNP (n 4685).
Urban counties were more likely than rural counties to have higher summer uptake rates, calculated as the percentage of summer meals served relative to eligible students utilizing school meal programmes during the academic school year, but uptake overall was low at 18·2 % of target populations. Geographic availability analyses showed that 63·9 % of public urban schools had an SNP available within 1·6 km (1 mile), but availability was significantly higher within the proximity of larger, higher-poverty high schools with diverse or majority non-White students, and those with higher school-year breakfast participation rates. Availability of an SNP within 16 km (10 miles) of rural schools averaged 68·1 % but was significantly higher around larger schools, higher-poverty schools and those with diverse or majority non-White students.
While many communities have SNP available, much more work is needed to increase the availability of these programmes to reduce summer food insecurity for children, particularly in rural communities.
Investigate short- and long-term effects of Superstorm Sandy on multiple morbidities among the elderly.
We examined emergency department visits; outpatient visits; and hospital admissions for cardiovascular disease (CVD), respiratory disease, and injury among residents residing in 8 affected counties immediately, 4 months, and 12 months following Superstorm Sandy. Control groups were defined as visits/admissions during the identical time window in the 5 years before (2007-2011) and 1 year after (2013-2014) the storm in affected and nonaffected counties in New York. We performed Poisson regression to test whether there was an association of increased visits/admissions for periods following Superstorm Sandy while controlling for covariates.
We found that the risk for CVD, respiratory disease, and injury visits/admissions was more than twice as high immediately, 4 months, and 12 months after the storm than it was in the control periods. Women were at greater risk at all time periods for CVD (risk ratio [RR], 2.04) and respiratory disease (RRs: 1.89 to 1.92). Whites had higher risk for CVD, respiratory disease, and injury than other racial groups during each period.
We observed increases in CVD, respiratory disease, and injury up to a year following Superstorm Sandy. Findings demonstrate the need to incorporate short- and long-term health effects into public health recovery. (Disaster Med Public Health Preparedness. 2019;13:28-32)
The McCann FitzGerald library provides a library and information service to one of Ireland's premier law firms. As Megan Guthrie explains, it was decided to reclassify the library collection using the Moys Classification Scheme for Legal Materials1 to enhance and improve the flow of the collection. It also provided an opportunity to conduct a stocktake of library material. The project was broken down into three main steps: assigning a Moys number, relabelling the physical material and updating the library management system. There were a number of challenges including the need to modify or add to the Moys numbers and finding the optimal process for relabelling and accounting for the material. It was necessary to adapt the initial plan throughout the project to account for any obstacles or restrictions that were encountered.
To develop and pilot a clinician-rated outcome scale to evaluate symptomatic outcomes in liaison psychiatry services. Three hundred and sixty patient contacts with 207 separate individuals were rated using six subscales (mood, psychosis, cognition, substance misuse, mind–body problems and behavioural disturbance) plus two additional items (side-effects of medication and capacity to consent for medical treatment). Each item was rated on a five-point scale from 0 to 5 (nil, mild, moderate, severe and very severe).
The liaison outcome measure was acceptable and easy to use. All subscales showed acceptable interrater reliability, with the exception of the mind–body subscale. Overall, the measure appears to show stability and sensitivity to change.
The measure provides a useful and robust way to determine symptomatic change in a liaison mental health setting, although the mind–body subscale requires modification.
Services provided by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) were interrupted in 2012 when Superstorm Sandy struck New York State (NYS). The present study evaluates the impact on WIC providers.
A focus group, telephone interviews and anonymous online survey were conducted. Qualitative data were analysed by coding transcribed text into key words and identifying major and minor themes for strengths, challenges and recommendations using national public health preparedness capabilities. Survey responses were analysed quantitatively; reported challenges were classified by preparedness capability.
The focus group was held at a 2014 regional WIC meeting. Interviews and a survey were conducted via telephone in 2014 and online in 2015, respectively.
WIC staff representing New York City and three NYS counties.
In the focus group (n 12) and interviews (n 6), ‘emergency operations coordination’ was the most cited capability as a strength, ‘environmental health protection’ (against environmental hazards) as a challenge and ‘flexibility’ (on rules and procedures) as a recommendation. In the survey (n 24), the capability ‘information sharing’ was most often cited as a challenge. Most staff (66·6 %) reported their programmes were at least somewhat prepared for future weather-related disasters. Only 16·7 % indicated having practiced a work-related emergency response plan since Sandy. Staff who practiced an emergency response plan were more likely to indicate they were prepared (P < 0·05).
The study identified WIC programme areas requiring preparedness improvements. The research methodology can be utilized to assess the continuity of other public health services during disasters.
This article examines the history of development and forced labor in Barue, a rural district in central Mozambique, in the late 1950s and early 1960s. Throughout the 1940s and 1950s, Barue was designated as a labor reserve, whose economic role was to send forced workers into migrant labor elsewhere. This was slated to change in the early 1960s, with the rise of a new developmental discourse in the Portuguese empire. This discourse promised to transform the economic model of Barue and other rural districts, by outlawing forced labor, minimizing migrant labor, and promoting rural agriculture. The Portuguese government, however, lacked the resources and the commitment necessary to actually change Barue's economy. Instead of development transforming Barue's economic model, the economic model transformed development, which was redefined as a series of modest social and economic improvements which neither changed Barue's economy nor reduced its dependence upon migrant labor. Nonetheless, while this narrower definition of “development” did not fulfill the transformative promise of its discursive progenitor, it was compatible with development's broader objective of defending and justifying the Portuguese empire against the threat of decolonization. The ultimate goal of safeguarding Portuguese rule made it possible to reconcile a discourse founded on change with a reality marked by continuity.
OBJECTIVES/SPECIFIC AIMS: Thionamides are anti-thyroid drugs (ATD) that are commonly used to treat autonomous thyrotoxicosis. Although efficacious, these medications carry a risk of neutropenia or agranulocytosis in a small but finite proportion of the patients who receive them. Some risk factors for thionamide-induced neutropenia have been identified, including body mass index (BMI) and dose, but the role of race and ethnicity in the pathogenesis of this potentially life-threatening side effect is not known. We hypothesize that there will be no effect of race or ethnicity on the change in absolute neutrophil count (ANC) following initiation of thionamide therapy among adult patients with thyrotoxicosis. METHODS/STUDY POPULATION: Data from the electronic medical record at UNM HSC were obtained using a standard database query for the years 2000–2016. Inclusion criteria were the prescription of an ATD, an ANC recorded within 30 days of initiating ATD therapy (pre-ATD), and an ANC recorded between 75 and 365 days after starting an ANC (post-ATD). Patients taking other agents known to cause neutropenia and agranulocytosis, such as clozapine, allopurinol, or chemotherapy, were excluded. Patients were assigned to racial and ethnic groups as follows: Hispanic, non-Hispanic Caucasian (NHC), native American, Black, and Asian. The post-ATD ANC was defined as the nadir ANC observed after the ATD was started. “Delta ANC” was defined as [(post-ATD ANC)−(pre-ATD ANC)]. ANOVA analysis with Bonferroni-adjusted post-hoc testing was performed to examine differences in the mean changes of ANC across ethnic groups. RESULTS/ANTICIPATED RESULTS: In total, 123 adult patients met inclusion and exclusion criteria and were included in the analysis. No significant difference was found between any of the racial groups with regard to age, sex, BMI, pre-ATD ANC, or the pre-ATD to post-ATD ANC interval. The native American group showed a significantly greater post-ATD ANC (not shown) and Delta-ANC as compared with the other groups. Delta ANC Hispanic=−1.4±3.3, Caucasian=−0.6±3.3, Black=−0.9±4.1, Asian=−3.8±4.8, native American=3.6±5.1 (all units per mm3; p<0.001). DISCUSSION/SIGNIFICANCE OF IMPACT: In this cohort of New Mexicans with thyrotoxicosis, native American race was protective against thionamide-induced neutropenia.
‘Aber doch,’ sagte Goethe, 'ist alles [im Faust] sinnlich und wird, auf dem Theater gedacht, jedem gut in die Augen fallen. Und mehr habe ich nicht gewollt. Wenn es nur so ist, daß die Menge der Zuschauer Freude an der Erscheinung hat; dem Eingeweihten wird zugleich der höhere Sinn nicht entgehen, wie es ja auch bei der Zauberflöte und andern Dingen der Fall ist. (Goethe to Eckermann, 29 January 1827).
[But really everything [in Faust] is for the senses and, when realized in the theatre, will be easily appreciated by the eye. And that is all I wanted. If the majority of spectators only take pleasure in what they see, at the same time, to the initiated, the higher sense will not be lost, as is indeed the case with the Magic Flute and other things.]
Goethe emphasized the importance of spectacle in Faust as part of an audience's total sensual (‘sinnlich’) experience of the work on stage. At the same time, for the initiated, the work's deeper meaning lay beyond what simply meets the eye. As the Director states in ‘Vorspiel auf dem Theater’ [Prelude at the Theatre], the masses come to the theatre to see spectacle and action, but the Poet reminds him that this must be combined with poetry. Goethe's Faust embraces the most diverse kinds of poetry and some of the most lyrical. It is just as much a work for the ear as it is for the eye. In addition to the many sections of the text that call for musical accompaniment or musical interludes, or those that have inspired countless composers to Lieder and opera, the poetry itself embraces all registers of language and creates an unparalleled range of musical effects.
As a work for the stage Faust presents great challenges to the director. Peter Stein's production, premiered at EXPO Hannover in 2000, was, it was claimed, the first ever unabridged production of both parts of the play by a professional theatre company.
Differences in the distributions of v sin i for various samples of B-type stars may reflect different mechanisms of star formation. The overall distribution of v sin i for late B-type stars in clusters at low galactic latitudes is bimodal, but normal class V field stars may have a Maxwellian distribution of v. The spin axes of stars in tightly bound clusters may be preferentially aligned perpendicular to the galactic plane. Early B-type stars in the youngest subgroups of associations may have a Maxwellian distribution of v, but there is a prominent excess of slow rotators among stars in older subgroups and field stars. This excess cannot be entirely accounted for by tidal or magnetic braking during main-sequence evolution.
By the outbreak of the Second World War in Britain, critics had spent several decades negotiating the supposed distinctions between highbrow and lowbrow culture, as recent scholarship has shown. What has received comparatively little attention is how the demands of wartime living changed the stakes of the debate. This article addresses this lacuna, exploring how war invited a reassessment of the relative merits of art and popular music. Perhaps the most iconic British singer of the period, Vera Lynn provides a case study. Focusing on her first film vehicle, We'll Meet Again (1942), I explore how Lynn's character mediated the highbrow/lowbrow conflict – for example, by presenting popular music as a site of community, while disparaging art music for its minority appeal. In so doing, I argue, the film not only promoted Lynn's star persona, but also intervened in a broader debate about the value of entertainment for a nation at war.
This article presents a 12-month case series to determine the fraction of ward referrals of adults of working age who needed a liaison psychiatrist in a busy tertiary referral teaching hospital.
The service received 344 referrals resulting in 1259 face-to-face contacts. Depression accounted for the most face-to-face contacts. We deemed the involvement of a liaison psychiatrist necessary in 241 (70.1%) referrals, with medication management as the most common reason.
A substantial amount of liaison ward work involves the treatment and management of severe and complex mental health problems. Our analysis suggests that in the majority of cases the input of a liaison psychiatrist is required.
This study identified the predictors of incident loneliness in a group of seriously ill older adults (aged 65+) receiving home care.
Existing data collected with the Resident Assessment Instrument for Home Care (RAI–HC) were utilized. A cohort of clients (N = 2,499) with two RAI–HC assessments and no self-reported loneliness at time 1 were included. Self-reported loneliness, upon reassessment, was the outcome of interest. Clients with a prognosis of less than six months or severe health instability were included.
The average length of time between assessments was 5.9 months (standard deviation = 4.10). During that time, 7.8% (n = 181) of the sample developed loneliness. In a multivariate regression model, worsening symptoms of depression, a decline in social activities, and not living with a primary caregiver all increased the risk of loneliness.
Significance of results:
These results highlight how changes in psychosocial factors over time can contribute to loneliness, which can inform clinicians as they seek to identify those who may be at risk for loneliness.