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The Flint Community Resilience Group (Flint, Michigan USA) and the Centers for Disease Control and Prevention (CDC; Atlanta, Georgia USA) assessed behavioral health concerns among community members to determine the impact of lead contamination of the Flint, Michigan water supply.
A Community Assessment for Public Health Emergency Response (CASPER) was conducted from May 17 through May 19, 2016 using a multi-stage cluster sampling design to select households and individuals to interview.
One-half of households felt overlooked by decision makers. The majority of households self-reported that at least one member experienced more behavioral health concerns than usual. The prevalence of negative quality of life indicators and financial concerns in Flint was higher than previously reported in the Michigan 2012 and 2014 Behavioral Risk Factor Surveillance System (BRFSS) survey.
The following can be considered to guide recovery efforts in Flint: identifying additional resources for behavioral health interventions and conducting follow-up behavioral health assessments to evaluate changes in behavioral health concerns over time; considering the impact of household economic factors when implementing behavioral health interventions; and ensuring community involvement and engagement in recovery efforts to ease community stress and anxiety.
FortenberryGZ, ReynoldsP, BurrerSL, Johnson-LawrenceV, WangA, SchnallA, PullinsP, KieszakS, BayleyegnT, WolkinA. Assessment of Behavioral Health Concerns in the Community Affected by the Flint Water Crisis — Michigan (USA) 2016. Prehosp Disaster Med. 2018;33(3):256–265.
To quantify associations of the dietary share of ultra-processed foods (UPF) with the overall diet quality of First Nations peoples.
A cross-sectional analysis of data from the First Nations Food, Nutrition and Environment Study, designed to contribute to knowledge gaps regarding the diet of First Nations peoples living on-reserve, south of the 60th parallel. A multistage sampling of communities was conducted. All foods from 24 h dietary recalls were categorized into NOVA categories and analyses were performed to evaluate the impact of UPF on diet quality.
Western and Central Canada.
First Nations participants aged 19 years or older.
The sample consisted of 3700 participants. UPF contributed 53·9 % of energy. Compared with the non-UPF fraction of the diet, the UPF fraction had 3·5 times less vitamin A, 2·4 times less K, 2·2 times less protein, 2·3 times more free sugars and 1·8 times more Na. As the contribution of UPF to energy increased so did the overall intakes of energy, carbohydrate, free sugar, saturated fat, Na, Ca and vitamin C, and Na:K; while protein, fibre, K, Fe and vitamin A decreased. Diets of individuals who ate traditional First Nations food (e.g. wild plants and game animals) on the day of the recall were lower in UPF.
UPF were prevalent in First Nations diets. Efforts to curb UPF consumption and increase intake of traditional First Nations foods and other fresh or minimally processed foods would improve diet quality and health in First Nations peoples.
This review article provides a reading guide to scholarly literature published in English about Nepal's political transformation since 2006, when Nepal's decade-long civil conflict between Maoist and state forces formally ended. The article is structured around four major themes: (1) the Maoist insurgency or ‘People's War’; (2) state formation and transformation; (3) identity politics; and (4) territorial and ecological consciousness. We also address the dynamics of migration and mobility in relation to all of these themes. Ultimately, we consider the Maoist movement as one element in a much broader process of transformation, which with the benefit of hindsight we can situate in relation to several other contemporaneous trajectories, including: democratization, identity-based mobilization, constitutional nationalism, international intervention, territorial restructuring, migration and the remittance economy, and the emergence of ecological and other new forms of consciousness. By looking across the disciplines at scholarship published on all of these themes, we aim to connect the dots between long-standing disciplinary traditions of scholarship on Nepal and more recent approaches to understanding the country's transformation.
There is growing interest in using instrumented indentation to characterize mechanical properties of soft materials, including tissue properties related to damage and disease. However, sample surface detection has been a major challenge. The multi-indent approach (MIA) is a novel method to indirectly detect the surface using data from multiple indents to determine the preload-induced indentation depth. Elastic modulus and shear modulus determined by MIA were equivalent to bulk measurements for 19 and 49 kPa gels. However, the traditional Oliver–Pharr approach significantly overestimated these properties. MIA is also important to accurate characterization of poroelastic properties and allows for much smaller probes and indentation depths to be used for all measurements. This is particularly important for poroelasticity, where the relaxation time scales with the size of the indenter. The novel approach helps to resolve the long-standing challenge of surface detection and has the potential to broaden the use of instrumented indentation for soft materials.
Objectives: Visuospatial processing deficits have been reported in Huntington’s disease (HD). To date, no study has examined associations between visuospatial cognition and posterior brain findings in HD. Methods: We compared 119 premanifest (55> and 64<10.8 years to expected disease onset) and 104 early symptomatic (59 stage-1 and 45 stage-2) gene carriers, with 110 controls on visual search and mental rotation performance at baseline and 12 months. In the disease groups, we also examined associations between task performance and disease severity, functional capacity and structural brain measures. Results: Cross-sectionally, there were strong differences between all disease groups and controls on visual search, and between diagnosed groups and controls on mental rotation accuracy. Only the premanifest participants close to onset took longer than controls to respond correctly to mental rotation. Visual search negatively correlated with disease burden and motor symptoms in diagnosed individuals, and positively correlated with functional capacity. Mental rotation (“same”) was negatively correlated with motor symptoms in stage-2 individuals, and positively correlated with functional capacity. Visual search and mental rotation were associated with parieto-occipital (pre-/cuneus, calcarine, lingual) and temporal (posterior fusiform) volume and cortical thickness. Longitudinally, visual search deteriorated over 12 months in stage-2 individuals, with no evidence of declines in mental rotation. Conclusions: Our findings provide evidence linking early visuospatial deficits to functioning and posterior cortical dysfunction in HD. The findings are important since large research efforts have focused on fronto-striatal mediated cognitive changes, with little attention given to aspects of cognition outside of these areas. (JINS, 2016, 22, 595–608)
Bronchiolitis is the leading cause of hospital admission for infants, but few studies have examined management of this condition in community hospital settings. We reviewed the management of children with bronchiolitis presenting to community hospitals in Ontario.
We retrospectively reviewed a consecutive cohort of infants less than 12 months old with bronchiolitis who presented to 28 Ontario community hospitals over a two-year period. Bronchiolitis was defined as first episode of wheezing associated with signs of an upper respiratory tract infection during respiratory syncytial virus season.
Of 543 eligible children, 161 (29.7%, 95% Confidence Interval (CI) 22.3 to 37.0%) were admitted to hospital. Hospital admission rates varied widely (Interquartile Range 0%-40.3%). Bronchodilator use was widespread in the emergency department (ED) (79.7% of patients, 95% CI 75.0 to 84.5%) and on the inpatient wards (94.4% of patients, 95% CI 90.2 to 98.6%). Salbutamol was the most commonly used bronchodilator. At ED discharge 44.7% (95% CI 37.5 to 51.9%) of patients were prescribed a bronchodilator medication. Approximately one-third of ED patients (30.8%, 95% CI 22.7 to 38.8%), 50.3% (95% CI 37.7 to 63.0%) of inpatients, and 23.5% (95% CI 14.4 to 32.7) of patients discharged from the ED were treated with corticosteroids. The most common investigation obtained was a chest x-ray (60.2% of all children; 95% CI 51.9 to 68.5%).
Infants with bronchiolitis receive medications and investigations for which there is little evidence of benefit. This suggests a need for knowledge translation strategies directed to community hospitals.
Given the recent publication of several large trials and systematic reviews, we undertook a study of the current management of bronchiolitis in Canadian pediatric emergency departments (EDs) and explored physicians’ rationale for their treatment decisions. The overarching purpose of this study was to assist in planning a future trial of combined epinephrine and dexamethasone for bronchiolitis.
Physicians in the Pediatric Emergency Research Canada (PERC) database received an 18-item electronic survey. A modified Dillman method was used.
Of the 271 physicians surveyed, 191 (70.1%) responded. The majority (120 of 271; 66.5%) reported ‘‘typically’’ giving a bronchodilator trial in the ED, with respondents almost evenly divided between treatment with salbutamol (n=62) and treatment with epinephrine (n=61). Of those who use salbutamol, 77.4% indicated that they prefer it because it can be prescribed for home use. Of those who use epinephrine, 80.3% indicated that they believe the medical literature supports its benefit over salbutamol. Few participants (2.6%) reported ‘‘always’’ using steroids, whereas the majority (62.8%) reported ‘‘sometimes’’ using them. The most common factor reported to influence steroid use was illness severity (73.3%). The majority (60.5%) reported that if corticosteroids were beneficial in bronchiolitis, they prefered treatment with a single dose in the ED as opposed to a multiday course.
Our results indicate that physicians practicing in Canadian pediatric EDs commonly use bronchodilators to manage bronchiolitis but use corticosteroids less commonly. They appear to be uncomfortable using corticosteroids, particularly longer courses, and have a stated preference for a single dose. Any future trial examining the role of corticosteroids in bronchiolitis should carefully consider the issue of steroid dosage.
The present study measured the perceived impact and political and implementation feasibility of state-level policy strategies related to increasing access to healthy foods and limiting unhealthy foods.
Potential state-level policy strategies to improve access to healthy foods were identified through a review of evidence-based literature and policy recommendations. Respondents rated the perceived impact and political and implementation feasibility of each policy on a five-point scale using online surveys.
Washington State policy process.
Forty-nine content experts (national researchers and subject experts), forty policy experts (state elected officials or their staff, gubernatorial or legislative policy analysts) and forty-five other stakeholders (state-level advocates, programme administrators, food producers).
In aggregate, respondents rated policy impact and implementation feasibility higher than political feasibility. Policy experts rated policy strategies as less politically feasible compared with content experts (P < 0·02) or other stakeholders (P < 0·001). Eight policy strategies were rated above the median for impact and political and implementation feasibility. These included policies related to nutrition standards in schools and child-care facilities, food distribution systems, urban planning projects, water availability, joint use agreements and breast-feeding supports.
Although they may be perceived as potentially impactful, some policies will be more difficult to enact than others. Information about the potential feasibility of policies to improve access to healthy foods can be used to focus limited policy process resources on strategies with the highest potential for enactment, implementation and impact.
Whilst debris discs orbiting main-sequence stars are well studied, very little is known regarding their fate when the star evolves onto the giant branch. For intermediate mass (A-type) stars, giants provide a unique opportunity to detect planets using the radial velocity technique, otherwise prohibited by high jitter levels and rotationally broadened lines in main-sequence intermediate mass (A-type) stars. Such stars can provide key insights into the structure of planetary systems around intermediate mass stars. In our Herschel OT1 program (PI Bonsor) we searched for the presence of debris discs orbiting a sample of 36 subgiants, half of which have RV detected companions. Our best detection is the resolved debris disc orbiting κ CrB.
Tree-of-heaven is an invasive, nonnative species that invades newly disturbed areas and forms large monospecific stands. It was surveyed from a vehicle along 5,175 km of roads in Virginia in 2004, 2005, 2010, and 2011. Fifty-eight percent of every 1.6-km road segment had at least one tree-of-heaven. Mean density of tree-of-heaven throughout the roads surveyed in Virginia was 39 km−1. The interaction between road classification (interstate, primary, and secondary) and physiographic region (mountain, piedmont, and tidewater) was significant; consequently, the density of tree-of-heaven along the different road classifications depended on the effect of the physiographic region and vice versa. Tree-of-heaven was fairly evenly distributed throughout Virginia ranging from 39 to 78% of 1.6-km road segments infested, but had a greater variation in density. Current areas with low densities could increase in density in the future. The highest density of tree-of-heaven was along interstate highways in the mountains (85 km−1), followed by the tidewater (63 km−1), and piedmont (46 km−1) regions. Primary roads had a moderate density of tree-of-heaven with a range of 24 to 36 km−1. Secondary roads had lower densities with 12 km−1 and 41 km−1 in the tidewater and mountain regions, respectively. Tree-of-heaven spreads primarily by wind-dispersed seeds from female trees, and populations bordering roadsides could serve as seed sources for further local and landscape spread.
Three-dimensional (3D) battery architectures have emerged as a new direction for powering microelectromechanical systems and other small autonomous devices. Although there are few examples to date of fully functioning 3D batteries, these power sources have the potential to achieve high power density and high energy density in a small footprint. This overview highlights the various architectures proposed for 3D batteries, the advances made in the fabrication of components designed for these devices, and the remaining technical challenges. Efforts directed at establishing design rules for 3D architectures and modeling are providing insight concerning the energy density and current uniformity achievable with these architectures. The significant progress made on the fabrication of electrodes and electrolytes designed for 3D batteries is an indication that a number of these battery architectures will be successfully demonstrated within the next few years.
A series of three lead borosilicate glasses were synthesized and analyzed for structural information with both 11B and 207Pb solid-state nuclear magnetic resonance (NMR) spectroscopic methods. Results showed that increasing lead content caused lead to take a more active role in the network as a former and that the populations in these sites can be approximately quantified. 207Pb phase-adjusted-spinning sidebands (PASS), 11B magic-angle spinning (MAS), and 11B multiple-quantum MAS (MQMAS) experiments were used to determine structural parameters for the two nuclei. The 207Pb PASS experiment showed that at higher lead content, more covalent bonding was present. This principle was demonstrated in both an overall shift of the spectral resonances and a quantitative change in site ratios. The 11B MAS experiment showed that the ratio of BO3 to BO4 units was dependent on the amount of lead and boron, consistent with previous studies. Preliminary 11B MQMAS experiments failed to detect any BO3– units, previously hypothesized to exist in this system.
Spark erosion provides a means for producing fine particles (5 nm to 75 um) of metals, alloys, and semiconductors. Since the powders are formed from liquid droplets solidified in a liquid dielectric, the rate of solidification of the particles can be very high, varying according to particle size and the dielectric used. This paper examines some effects of different dielectrics on the microstructures, magnetic properties,and crystallization characteristics of amorphous and crystalline metals. It is seen that these properties depend upon the quench rate provided by the dielectric. In the case of the organic dielectrics, the quench rate appears to be associated with specific properties of the dielectric.