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Little is known about methylphenidate (MPH) use and mortality outcomes.
To investigate the association between MPH use and mortality among children with an attention-deficit hyperactivity disorder (ADHD) diagnosis.
This population-based cohort study analysed data from Taiwan's National Health Insurance Research Database (NHIRD). A total of 68 096 children and adolescents aged 4–17 years with an ADHD diagnosis and prescribed MPH between 2000 and 2010 were compared with 68 096 without an MPH prescription, matched on age, gender and year of first ADHD diagnosis. All participants were followed to death, migration, withdrawal from the National Health Insurance programme or 31 December 2013. MPH prescriptions were measured on a yearly basis during the study period, and the association between MPH use and mortality was analysed using a repeated-measures time-dependent Cox regression model. The outcome measures included all-cause, unnatural-cause (including suicide, accident and homicide) and natural-cause mortality, obtained from linkage to the National Mortality Register in Taiwan.
The MPH group had lower unadjusted all-cause, natural-, unnatural- and accident-cause mortality than the comparison group. After controlling for potential confounders, MPH use was associated with a significantly lower all-cause mortality (adjusted hazard ratio AHR = 0.81, 95% CI 0.67–0.98, P = 0.027), delayed use of MPH was associated with higher mortality (AHR = 1.05, 95% CI 1.01–1.09) and longer MPH use was associated with lower mortality (AHR = 0.83, 95% CI 0.70–0.98).
MPH use is associated with a reduced overall mortality in children with ADHD in this cohort study, but unmeasured confounding cannot be excluded absolutely.
The Tabula Alimentaria of Veleia records the details of two second-century a.d. imperial alimentary schemes at the northern Italian town of Veleia, providing a rare insight into the workings of these schemes. Imperial loans are made to local landowners in exchange for pledges of specified property. Interest paid by landowners is used to fund cash subsidies for the upbringing of selected local children. In the early twentieth century, the French scholar Félix de Pachtere came close to demonstrating a consistent arithmetical relationship between a landowner's declared property value and the loan received. However, anomalies remained. This article proposes a revised formula which establishes a precise and consistent linkage between loan amounts and property declarations. Based on this arithmetical dataset, the paper proposes some hypotheses about how these fractional computations might have been performed in second-century Rome.
This article revisits Nelson Polsby's classic article “The Institutionalization of the U.S. House of Representatives” fifty years after its publication, to examine whether the empirical trends that Polsby identified have continued. This empirical exploration allows us to place Polsby's findings in broader historical context and to assess whether the House has continued along the “institutionalization course”—using metrics that quantify the degree to which the House has erected impermeable boundaries with other institutions, created a complex institution, and adopted universalistic decision-making criteria. We empirically document that careerism plateaued right at the point Polsby wrote “Institutionalization,” and that the extension of the careerism trend has affected Democrats more than Republicans. The House remains complex, but lateral movement between the committee and party leadership systems began to reestablish itself a decade after “Institutionalization” was published. Finally, the seniority system as a mechanism for selecting committee chairs—the primary measure of universalistic decision-making criteria—has been almost thoroughly demolished. Thus, most of the trends Polsby identified have moderated, but have not been overturned. We conclude by considering the larger set of interpretive issues that our empirical investigation poses.
Good education requires student experiences that deliver lessons about practice as well as theory and that encourage students to work for the public good—especially in the operation of democratic institutions (Dewey 1923; Dewy 1938). We report on an evaluation of the pedagogical value of a research project involving 23 colleges and universities across the country. Faculty trained and supervised students who observed polling places in the 2016 General Election. Our findings indicate that this was a valuable learning experience in both the short and long terms. Students found their experiences to be valuable and reported learning generally and specifically related to course material. Postelection, they also felt more knowledgeable about election science topics, voting behavior, and research methods. Students reported interest in participating in similar research in the future, would recommend other students to do so, and expressed interest in more learning and research about the topics central to their experience. Our results suggest that participants appreciated the importance of elections and their study. Collectively, the participating students are engaged and efficacious—essential qualities of citizens in a democracy.
A common lament is that business history has been marginalized within mainstream business and management research. We propose that the remedy lies in part with more extensive engagement with organization theory. We illustrate our argument by exploring the potentialities for business history of three cognitive frameworks: institutional entrepreneurship, evolutionary theory, and Bourdieusian social theory. Exhibiting a higher level of theoretical fluency might enable business historians to accrue scholarly capital within the business and management field by producing theoretically informed historical discourse, demonstrating the potential of business history to extend theory, generate constructs, and elucidate complexities in unfolding relationships, situations, and events.
No study on hospital staff preparedness for managing blast injuries has been conducted in Libya. The internal conflict in Libya since 2011 and the difficulties faced by the hospitals has highlighted the need for such studies.
Physicians working in Tripoli (capital city Libya) hospitals are inadequately prepared for the management of blast injuries.
A survey was conducted in all 13 hospitals in Tripoli between June 2014 and May 2015 by using interviews based on a questionnaire consisting of 29 questions covering physicians’ education related to blast injury, hospital management of mass casualties, and aspects of hospital preparedness for such incidents.
Of 3,799 physicians working in Tripoli hospitals, 607 physicians were interviewed (16.0%). All but one of the physicians reported that there was no disaster response plan, none of them had read such a plan, 496 (81.7%) reported that hospitals were not prepared, and 471 (77.6%) that hospitals were not equipped for blast injuries. Though 414 (68.2%) reported that radiological equipment was available, 597 (98.3%) revealed that hospitals do not adopt training for blast injury. Only 39 (6.4%) had received professional training, though 183 (30.1%) were seeing blast injury patients at least once a week in their daily practice. Nevertheless, 185 (30.5%) had previous knowledge and experience in blast injuries management and 338 (55.70%) were aware of the major physical findings, but only 75 (12.4%) were following specific guidelines. According to approximately one-third of the physicians (192; 31%), staff and patient safety were not priorities for the hospital administration. Almost all (606; 99.9%) revealed that personal protective equipment for chemical and nuclear accidents was not available.
Preparedness for blast injuries in Tripoli hospitals is seriously deficient. Planning optimized blast and disaster management in Libya is essential.
OunAM, HadidaEM, StewartC. Assessment of the Knowledge of Blast Injuries Management among Physicians Working in Tripoli Hospitals (Libya). Prehosp Disaster Med. 2017;32(3):311–316.
This study aimed to document the growth and challenges encountered in the decade since inception of the National Ambulance Service (NAS) in Ghana, West Africa. By doing so, potentially instructive examples for other low- and middle-income countries (LMICs) planning a formal prehospital care system or attempting to identify ways to improve existing emergency services could be identified.
Data routinely collected by the Ghana NAS from 2004-2014 were described, including: patient demographics, reason for the call, response location, target destination, and ti1mes of service. Additionally, the organizational structure and challenges encountered during the development and maturation of the NAS were reported.
In 2004, the NAS piloted operations with 69 newly trained emergency medical technicians (EMTs), nine ambulances, and seven stations. The NAS expanded service delivery with 199 ambulances at 128 stations operated by 1,651 EMTs and 47 administrative and maintenance staff in 2014. In 2004, nine percent of the country was covered by NAS services; in 2014, 81% of Ghana was covered. Health care transfers and roadside responses comprised the majority of services (43%-80% and 10%-57% by year, respectively). Increased mean response time, stable case holding time, and shorter vehicle engaged time reflect greater response ranges due to increased service uptake and improved efficiency of ambulance usage. Specific internal and external challenges with regard to NAS operations also were described.
The steady growth of the NAS is evidence of the need for Emergency Medical Services and the effects of sound planning and timely responses to changes in program indicators. The way forward includes further capacity building to increase the number of scene responses, strengthening ties with local health facilities to ensure timely emergency medical care and appropriateness of transfers, assuring a more stable funding stream, and improving public awareness of NAS services.
ZakariahA, StewartBT, BoatengE, AchenaC, TansleyG, MockC. The Birth and Growth of the National Ambulance Service in Ghana. Prehosp Disaster Med. 2017;32(1):83–93.
Demand for organic meat is partially driven by consumer perceptions that organic foods are more nutritious than non-organic foods. However, there have been no systematic reviews comparing specifically the nutrient content of organic and conventionally produced meat. In this study, we report results of a meta-analysis based on sixty-seven published studies comparing the composition of organic and non-organic meat products. For many nutritionally relevant compounds (e.g. minerals, antioxidants and most individual fatty acids (FA)), the evidence base was too weak for meaningful meta-analyses. However, significant differences in FA profiles were detected when data from all livestock species were pooled. Concentrations of SFA and MUFA were similar or slightly lower, respectively, in organic compared with conventional meat. Larger differences were detected for total PUFA and n-3 PUFA, which were an estimated 23 (95 % CI 11, 35) % and 47 (95 % CI 10, 84) % higher in organic meat, respectively. However, for these and many other composition parameters, for which meta-analyses found significant differences, heterogeneity was high, and this could be explained by differences between animal species/meat types. Evidence from controlled experimental studies indicates that the high grazing/forage-based diets prescribed under organic farming standards may be the main reason for differences in FA profiles. Further studies are required to enable meta-analyses for a wider range of parameters (e.g. antioxidant, vitamin and mineral concentrations) and to improve both precision and consistency of results for FA profiles for all species. Potential impacts of composition differences on human health are discussed.
Demand for organic milk is partially driven by consumer perceptions that it is more nutritious. However, there is still considerable uncertainty over whether the use of organic production standards affects milk quality. Here we report results of meta-analyses based on 170 published studies comparing the nutrient content of organic and conventional bovine milk. There were no significant differences in total SFA and MUFA concentrations between organic and conventional milk. However, concentrations of total PUFA and n-3 PUFA were significantly higher in organic milk, by an estimated 7 (95 % CI −1, 15) % and 56 (95 % CI 38, 74) %, respectively. Concentrations of α-linolenic acid (ALA), very long-chain n-3 fatty acids (EPA+DPA+DHA) and conjugated linoleic acid were also significantly higher in organic milk, by an 69 (95 % CI 53, 84) %, 57 (95 % CI 27, 87) % and 41 (95 % CI 14, 68) %, respectively. As there were no significant differences in total n-6 PUFA and linoleic acid (LA) concentrations, the n-6:n-3 and LA:ALA ratios were lower in organic milk, by an estimated 71 (95 % CI −122, −20) % and 93 (95 % CI −116, −70) %. It is concluded that organic bovine milk has a more desirable fatty acid composition than conventional milk. Meta-analyses also showed that organic milk has significantly higher α-tocopherol and Fe, but lower I and Se concentrations. Redundancy analysis of data from a large cross-European milk quality survey indicates that the higher grazing/conserved forage intakes in organic systems were the main reason for milk composition differences.
The Help America Vote Act (HAVA) was the most important direct federal response to the 2000 electoral fiasco in Florida. HAVA has many provisions, some directly inspired by the controversy, others that came along for the ride. In addition to mandating certain changes in how states conducted federal elections, HAVA appropriated $3 billion for the improvement of voting systems, most of which went to purchase new voting machines.
It is natural to ask whether this was money well spent. Are elections better administered in the United States than before? Have the shortcomings targeted by HAVA improved? It is the purpose of this chapter to address these questions.
But first, we must try to understand what problems HAVA aimed to address and how they were identified as problems in the first place. The Florida recount controversy featured shortcomings of the election system in Florida that almost everyone agreed presented problems, such as inconsistent recount criteria, malfunctioning voting machines, and poorly designed ballots. Specific features of HAVA address these precise problems. At the same time, other issues that did not feature prominently in the Florida drama, such as the difficulty that visually impaired voters had in casting ballots independently, are also addressed by HAVA. Where did these provisions come from, and what does their presence say about the policy process in the realm of election administration?