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The demise of America's state mental hospital system, or “deinstitutionalization,” has received much attention from sociologists and historians of medicine. Less understood is the manner in which the public experienced and came to terms with it. Using elements of folklore and horror studies, I will examine how popular films accommodated audiences to institutional decline and confirmed popular antistatist pessimism. The Exorcist (1973), One Flew over the Cuckoo's Nest (1975), Halloween (1978), and When a Stranger Calls (1979) helped weave a tapestry of distrust. By endorsing popular conceptions of institutional failure and presenting mythical narratives of individualist triumph, these films helped pave a path towards the conservative Reagan era to come.
We report on results obtained from experiments using specially prepared carbon substrates and treatment of the data by means of recently introduced theory. Medium Z grids with known parameters have been coated on top of pyrolytic carbon substrates to achieve well defined absorption geometries. The various copper grids exhibit satisfactory performance in terms of mechanical stability, homogeneity and uniformity of the coating. A detailed study of the measurement results shows that there is a more rapid increase of the associated C-Kα countrate from the coated samples compared to the pure elements and is attributed to the contribution of secondary enhancement effects, including those resulting from photoelectrons generated after the primary ionization.
To examine the relationship between protein intake and the risk of incident premenstrual syndrome (PMS).
Nested case–control study. FFQ were completed every 4 years during follow-up. Our main analysis assessed protein intake 2–4 years before PMS diagnosis (for cases) or reference year (for controls). Baseline (1991) protein intake was also assessed.
Nurses’ Health Study II (NHS2), a large prospective cohort study of registered female nurses in the USA.
Participants were premenopausal women between the ages of 27 and 44 years (mean: 34 years), without diagnosis of PMS at baseline, without a history of cancer, endometriosis, infertility, irregular menstrual cycles or hysterectomy. Incident cases of PMS (n 1234) were identified by self-reported diagnosis during 14 years of follow-up and validated by questionnaire. Controls (n 2426) were women who did not report a diagnosis of PMS during follow-up and confirmed experiencing minimal premenstrual symptoms.
In logistic regression models adjusting for smoking, BMI, B-vitamins and other factors, total protein intake was not associated with PMS development. For example, the OR for women with the highest intake of total protein 2–4 years before their reference year (median: 103·6 g/d) v. those with the lowest (median: 66·6 g/d) was 0·94 (95 % CI 0·70, 1·27). Additionally, intakes of specific protein sources and amino acids were not associated with PMS. Furthermore, results substituting carbohydrates and fats for protein were also null.
Overall, protein consumption was not associated with risk of developing PMS.
While the short-term effects of disasters on health care utilization are well documented, less is known regarding potential longer-term effects. This study investigates the effects of Hurricane Katrina on the health care utilization of older individuals with diabetes.
We examined Medicare claims and enrollment data for the 2002-2004 and 2006-2008 time periods for older individuals with diabetes. Our quasi-experimental design analyzed utilization across 2 treated and 3 control groups. We compared the proportion of individuals who received a screen related to diabetes before and after Katrina in the treated groups to the proportions in the control groups. Our regression analysis employs individual and year fixed effects to control for factors specific to a given individual or to a given year.
We found that utilization rates in the 2002-2004 period exhibited roughly parallel trends for the treated and control groups, which provides support for our research design. The 2006-2008 utilization rates were generally lower for the treated groups than they were for the control groups. The differences were especially pronounced for older age cohorts.
Our study suggests that the effects of disasters on health care utilization may persist for years after the event. Recovery efforts may be improved by addressing both short-term and long-term health care interruptions. (Disaster Med Public Health Preparedness. 2018;page 1 of 8)
Fuscopannaria leucosticta is a rare and understudied cyanolichen with an interesting and unusual distribution in tertiary relict hotspots worldwide. There is a relatively large population in eastern North America, where it occurs mostly throughout the Appalachian Mountains and reaches its northernmost extent in New Brunswick and Nova Scotia, Canada. The ability to detect this species, and thus determine its habitat requirements, is critical for understanding how it might be affected by human-induced environmental degradation. Maximum entropy modelling with MaxEnt was used to predict the distribution of suitable habitat for this species in Nova Scotia using 62 presence locations, 1405 pseudo-absence locations and four environmental covariates: depth to water table (a proxy for relative soil moisture), distance to the coast and mean annual temperature and precipitation. Our predictive maps identify important habitat features and areas of high suitability in Nova Scotia with an area under the curve value of 0·85. The predicted distribution of this lichen was most affected by temperature. This study elucidates locations as well as species-habitat relationships for F. leucosticta, providing land managers with baseline data that can aid in the discovery of additional populations and provide a better understanding of its ecological requirements which will support the development of sound conservation strategies for this rare lichen.
OBJECTIVES/SPECIFIC AIMS: To study the role functional capacity plays in surgical outcomes for head and neck cancers. METHODS/STUDY POPULATION: In this single-institution cohort study, we combined preoperative anesthesia assessment information with oncology registry data for newly-diagnosed patients with squamous cell carcinoma of the oral cavity, pharynx, and larynx (HNSCC) treated with definitive surgery at Siteman Cancer Center from 2012 to 2016. Patient-reported exercise capacity was assessed as metabolic equivalents. Metabolic equivalents<4 was defined as poor functional capacity. The primary outcome measure was overall survival (OS). Kaplan-Meir survival analysis was used to compare the survival of patients with poor functional capacity (PFC) and patients with normal functional capacity (NFC). Cox proportional hazard regression was used to explore the independent prognostic role of functional capacity on overall survival after controlling for other factors. RESULTS/ANTICIPATED RESULTS: A total of 671 patients underwent surgical treatment for HNSCC. The average age was 62 years (range: 19–94 years). Majority of the patients were male (n=481; 72%), White race (n=589; 88%), and smokers (n=528; 79%). Of 671 patients, 22% (n=146) had PFC. Two-year OS rate in PFC patients was 70% compared with 85% in NFC patients (15% difference; 95% CI: 7%–23%). Unadjusted Cox proportional hazard analysis showed that PFC patients had 2.2 times higher risk of death (95% CI: 1.5–3.2) than NFC patients. After adjustment for age at surgery, BMI, preoperative weight loss, comorbidity score, tumor site, and TNM stage the magnitude of the association between functional capacity and OS decreased (aHR=1.3; 95% CI: 0.88–1.98). DISCUSSION/SIGNIFICANCE OF IMPACT: Poor functional capacity is associated with decreased overall survival, but the magnitude of the association, while clinically meaningful, decreases after controlling for other important patient and tumor factors. Nevertheless, we believe preoperative functional capacity status is an important patient factor to consider when discussing prognosis and attempting risk stratification. We also believe that functional capacity may be associated with 30-day unplanned readmissions and 90-day complications and are currently performing chart review to ascertain this information.
In beef cattle, feeding behaviour and activity are associated with feed efficiency and methane (CH4) emissions. This study aimed to understand the underlying traits responsible for the contribution of cattle behaviour to individual differences in feed efficiency, performance and CH4 emissions. A total of 84 steers (530±114 kg BW) of two different breeds (crossbreed Charolais and Luing) were used. The experiment was a 2×2×3 factorial design with breed, basal diets (concentrate v. mixed) and dietary treatments (no additive, calcium nitrate or rapeseed cake) as the main factors. The individual dry matter intake (DMI; kg) was recorded daily and the BW was measured weekly over a 56-day period. Ultrasound fat depth was measured on day 56. Based on the previous data, the indexes average daily gain, food conversion and residual feed intake (RFI) were calculated. The frequency of meals, the duration per visit and the time spent feeding per day were taken as feeding behaviour measures. Daily activity was measured using the number of steps, the number of standing bouts and the time standing per day. Agonistic interactions (including the number of contacts, aggressive interactions, and displacements per day) between steers at the feeders were assessed as indicators of dominance. Temperament was assessed using the crush score test (which measures restlessness when restrained) and the flight speed on release from restraint. Statistical analysis was performed using multivariate regression models. Steers that spent more time eating showed better feed efficiency (P=0.039), which can be due to greater secretion of saliva. Feeding time was longer with the mixed diet (P<0.001), Luings (P=0.009) and dominant steers (P=0.032). Higher activity (more steps) in the pen was associated with poorer RFI, possibly because of higher energy expenditure for muscle activity. Frequent meals contributed to a reduction in CH4 emissions per kg DMI. The meal frequency was higher with a mixed diet (P<0.001) and increased in more temperamental (P=0.003) and dominant (P=0.017) steers. In addition, feed intake was lower (P=0.032) in more temperamental steers. This study reveals that efficiency increases with a longer feeding time and CH4 emissions decrease with more frequent meals. As dominant steers eat more frequently and for longer, a reduction in competition at the feeder would improve both feed efficiency and CH4 emissions. Feed efficiency can also be improved through a reduction in activity. Selection for calmer cattle would reduce activity and increase feed intake, which may improve feed efficiency and promote growth, respectively.
Brittle ice, which occurs in all intermediate-depth and deep ice cores retrieved from high-latitude regions, presents a challenge for high-resolution measurements of water isotopes, gases, ions and other quantities conducted with continuous flow analysis (CFA). We present a novel method of preserving brittle ice for CFA stable water isotope measurements using data from a new ice core recovered by the Roosevelt Island Climate Evolution (RICE) project. Modest modification of the drilling technique and the accommodation of non-horizontal fractures (‘slanted breaks’) in processing led to a substantial improvement in the percentage of brittle ice analyzed with CFA (87.8%). Whereas traditional processing methods remove entire fragmented pieces of ice, our method allowed the incorporation of a total of 3 m of ice (1% of the 261 m of brittle ice and ~1300 years of climate history) that otherwise would not have been available for CFA. Using the RICE stable water isotope CFA dataset, we demonstrate the effect of slanted breaks and analyze the resulting smoothing of the data with real and simulated examples. Our results suggest that retaining slanted breaks are a promising technique for preserving brittle ice material for CFA stable water isotope measurements.
To assess the influence of a mobile produce market (MPM) on fruit and vegetable access.
Novel application of a structured assessment (five dimensions of access framework) to examine fruit and vegetable access through self-administered surveys on shopping behaviours, and perceptions and experiences of shopping at the MPM.
Low-income neighbourhoods with limited access to fruits and vegetables.
Older (≥60 years) and younger (18–59·9 years) shoppers.
Participants were more likely to be women and non-White, one-third lived alone and nearly half were older adults. Compared with younger, older participants had different shopping behaviours: tended to purchase food for one person (P < 0·001), be long-term shoppers (P=0·002) and use electronic benefit transfer (EBT) cards (P=0·012). Older adults were more likely to like the market location (P=0·03), while younger adults were more likely to want changes in location (P=0·04), more activities (P=0·04), taste sampling (P=0·05) and nutritional counselling (P=0·01). The MPM captured all dimensions of access: availability, indicated by satisfaction with the produce variety for nearly one-third of all participants; accessibility, indicated by participants travelling <1 mile (<1·6 km; 72·2 %) and appreciation of location (72·7 %); affordability, indicated by satisfaction with price (47·6 %); acceptability, indicated by appreciation of produce quality (46·2 %); and accommodation, indicated by satisfaction with safety of location (30·1 %) and high EBT use among older adults (41·8 %).
MPM may influence fruit and vegetable access in low-income urban neighbourhoods by facilitating the five dimensions of access and may especially benefit older adults and individuals living alone.
This manuscript provides a global perspective on physician and nursing education and training in paediatric cardiac critical care, including available resources and delivery of care models with representatives from several regions of the world including Africa, Israel, Asia, Australasia, Europe, South America, and the United States of America.