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A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
We have previously shown that the minor alleles of vascular endothelial growth factor A (VEGFA) single-nucleotide polymorphism rs833069 and superoxide dismutase 2 (SOD2) single-nucleotide polymorphism rs2758331 are both associated with improved transplant-free survival after surgery for CHD in infants, but the underlying mechanisms are unknown. We hypothesised that one or both of these minor alleles are associated with better systemic ventricular function, resulting in improved survival.
This study is a follow-up analysis of 422 non-syndromic CHD patients who underwent neonatal cardiac surgery with cardiopulmonary bypass. Echocardiographic reports were reviewed. Systemic ventricular function was subjectively categorised as normal, or as mildly, moderately, or severely depressed. The change in function was calculated as the change from the preoperative study to the last available study. Stepwise linear regression, adjusting for covariates, was performed for the outcome of change in ventricular function. Model comparison was performed using Akaike’s information criterion. Only variables that improved the model prediction of change in systemic ventricular function were retained in the final model.
Genetic and echocardiographic data were available for 335/422 subjects (79%). Of them, 33 (9.9%) developed worse systemic ventricular function during a mean follow-up period of 13.5 years. After covariate adjustment, the presence of the VEGFA minor allele was associated with preserved ventricular function (p=0.011).
These data support the hypothesis that the mechanism by which the VEGFA single-nucleotide polymorphism rs833069 minor allele improves survival may be the preservation of ventricular function. Further studies are needed to validate this genotype–phenotype association and to determine whether this mechanism is related to increased vascular endothelial growth factor production.
The strong self-damped Lyman α absorption systems present in the spectra of high redshift QSOs represent a unique population of absorber which has recently been associated with the precursors of current disk galaxies. In a low resolution survey for what we have come to call “Lyman α disk systems” performed at Lick Observatory (Wolfe, et al. 1986, Ap. J. Suppl. 61, 249) approximately 18 systems with confirmed damped Lyman α profiles and rest frame equivalent widths greater than 5 Å were detected in a sample of 68 high redshift QSOs (Smith, Cohen and Bradley 1986, Ap. J. 310, 583). Subsequent higher resolution study has shown these systems to have the following properties (Turnshek, et al. 1988, Ap. J., in press):
2.Low-mixed ionization state. Typically the low ionization states dominate the high ionization states (e.g. CII ≫ CIV). Some enrichment has occurred, −2≲[X/H]⊙ ≲0.
3.Gas density, n ≲ 1 cm−3.
4.The gas shows two components, a quiescent (disk) component, σν ≲ 10 km s−1, and a turbulent (halo) component, σν ≲ 20 km s−1. Some systems show only the low velocity dispersion component.
5.At least one system intervening toward a radio QSO (Pks 0458-020) shows 21-cm absorption. The system shows multiple cloud structure with σν ≈ 6 km s−1, Ts ≈ 100 K, and structure extended over several kpc on the sky.
6.There is evidence that these systems may be self gravitating with scale height of the order of 300 pc.
7.These systems represent a unique population of absorber (distinct from the ‘Lyman a forest’ and heavy element systems) covering approximately 20% of the sky to z ≈ 3 and accounting for all of the baryonic matter at that redshift.
The only pulsating early-type star observed by EUVE, the β Cephei variable β CMa, displays periodic variability in its Lyman continuum which is basically consistent with the long-known optical and UV variability. The amplitude of the primary pulsation component is significantly larger in the EUV than in the optical or UV. This is consistent with a temperature change being the explanation for the variability. It is notable that the pulsations have been detected in the Lyman continuum because this part of the spectrum is formed in a much higher layer of the photosphere than either the UV or optical continua.
Updated information on the epidemiology of dementia due to Alzheimer’s disease (AD) is needed to ensure that adequate resources are available to meet current and future healthcare needs. We conducted a systematic review and meta-analysis of the incidence and prevalence of AD.
The MEDLINE and EMBASE databases were searched from 1985 to 2012, as well as the reference lists of selected articles. Included articles had to provide an original population-based estimate for the incidence and/or prevalence of AD. Two individuals independently performed abstract and full-text reviews, data extraction and quality assessments. Random-effects models were employed to generate pooled estimates stratified by age, sex, diagnostic criteria, location (i.e., continent) and time (i.e., when the study was done).
Of 16,066 abstracts screened, 707 articles were selected for full-text review. A total of 119 studies met the inclusion criteria. In community settings, the overall point prevalence of dementia due to AD among individuals 60+ was 40.2 per 1000 persons (CI95%: 29.1-55.6), and pooled annual period prevalence was 30.4 per 1000 persons (CI95%: 15.6-59.1). In community settings, the overall pooled annual incidence proportion of dementia due to AD among individuals 60+ was 34.1 per 1000 persons (CI95%: 16.4-70.9), and the incidence rate was 15.8 per 1000 person-years (CI95%: 12.9-19.4). Estimates varied significantly with age, diagnostic criteria used and location (i.e., continent).
The burden of AD dementia is substantial. Significant gaps in our understanding of its epidemiology were identified, even in a high-income country such as Canada. Future studies should assess the impact of using such newer clinical diagnostic criteria for AD dementia such as those of the National Institute on Aging–Alzheimer’s Association and/or incorporate validated biomarkers to confirm the presence of Alzheimer pathology to produce more precise estimates of the global burden of AD.
Dementia is a common neurological condition affecting many older individuals that leads to a loss of independence, diminished quality of life, premature mortality, caregiver burden and high levels of healthcare utilization and cost. This is an updated systematic review and meta-analysis of the worldwide prevalence and incidence of dementia.
The MEDLINE and EMBASE databases were searched for relevant studies published between 2000 (1985 for Canadian papers) and July of 2012. Papers selected for full-text review were included in the systematic review if they provided an original population-based estimate for the incidence and/or prevalence of dementia. The reference lists of included articles were also searched for additional studies. Two individuals independently performed abstract and full-text review, data extraction, and quality assessment of the papers. Random-effects models and/or meta-regression were used to generate pooled estimates by age, sex, setting (i.e., community, institution, both), diagnostic criteria utilized, location (i.e., continent) and year of data collection.
Of 16,066 abstracts screened, 707 articles were selected for full-text review. A total of 160 studies met the inclusion criteria. Among individuals 60 and over residing in the community, the pooled point and annual period prevalence estimates of dementia were 48.62 (CI95%: 41.98-56.32) and 69.07 (CI95%: 52.36-91.11) per 1000 persons, respectively. The respective pooled incidence rate (same age and setting) was 17.18 (CI95%: 13.90-21.23) per 1000 person-years, while the annual incidence proportion was 52.85 (CI95%: 33.08-84.42) per 1,000 persons. Increasing participant age was associated with a higher dementia prevalence and incidence. Annual period prevalence was higher in North America than in South America, Europe and Asia (in order of decreasing period prevalence) and higher in institutional compared to community and combined settings. Sex, diagnostic criteria (except for incidence proportion) and year of data collection were not associated with statistically significant different estimates of prevalence or incidence, though estimates were consistently higher for females than males.
Dementia is a common neurological condition in older individuals. Significant gaps in knowledge about its epidemiology were identified, particularly with regard to the incidence of dementia in low- and middle-income countries. Accurate estimates of prevalence and incidence of dementia are needed to plan for the health and social services that will be required to deal with an aging population.
Hypoplastic left heart syndrome is the most expensive birth defect managed in the United States, with a 5-year survival rate below 70%. Increasing evidence suggests that hospital volumes are inversely associated with mortality for infants with single ventricles undergoing stage 1 surgical palliation. Our aim was to examine the relative effects of surgeon and institutional volumes on outcomes and resource utilisation for these children.
A retrospective study was conducted using the Pediatric Health Information System database to examine the effects of the number of procedures performed per surgeon and per centre on mortality, costs, and post-operative length of stay for infants undergoing Risk Adjustment for Congenital Heart Surgery risk category six operations at tertiary-care paediatric hospitals, from 1 January, 2004 to 31 December, 2013. Multivariable modelling was used, adjusting for patient and institutional characteristics. Gaussian kernel densities were constructed to show the relative distributions of the effects of individual institutions and surgeons, before and after adjusting for the number of cases performed.
A total of 2880 infants from 35 institutions met the inclusion criteria. Mortality was 15.0%. Median post-operative length of stay was 24 days (IQR 14–41). Median standardized inpatient hospital costs were $156,000 (IQR $108,000–$248,000) in 2013 dollars. In the multivariable analyses, higher institutional volume was inversely associated with mortality (p=0.001), post-operative length of stay (p=0.004), and costs (p=0.001). Surgeon volume was associated with none of the measured outcomes. Neither institutional nor surgeon volumes explained much of the wide variation in outcomes and resource utilization observed between institutions and between surgeons.
Increased institutional – but not surgeon – volumes are associated with reduced mortality, post-operative length of stay, and costs for infants undergoing stage 1 palliation.
This study explored the experiences of 32 male Aboriginal students from regional and remote towns and communities while they attended a metropolitan boarding school away from home and family in Perth, Western Australia. Using narrative interviews it specifically investigated how these Aboriginal students construct meaning around the transition experience to boarding school. Three major themes emerged from the data: (1) Decision Making and the subthemes of Choice-less Choice and Opportunity; (2) Organisational Climate and the subthemes of School Environment and Belonging, Culture Shock, Homesickness, Identity, Code Switching, Teachers, Academic Expectations, Residential Life, and Friendships and Peer Relations; and (3) Relational Change and the subthemes of Family Dynamics, Friendships at Home, and Cultural Connectedness. This study emphasises the importance of conceptualising and understanding social phenomena from the perspective of those who actually undertake the experience, and the findings are discussed in terms of policy and practice relevant to Australian boarding schools.
Recent developments in instrumentation mean that chemical analysis of large drill cores taken for geological purposes can be performed rapidly at sub-millimetre scales using core scanners equipped with energy-dispersive X-ray fluorescence spectrometers. The present study describes the development of a calibration for the Itrax Core Scanner (Cox Analytical, Sweden), intended for whole cores of coal-seam sections, without the need for sample preparation. The calibration was developed for key major elements (Al, Si, P, S, K, Ca, Ti, and Fe) based on pressed pellets of reference coals, allowing semi-quantitative and, at times, quantitative analyses. The influence of core curvature and surface roughness compared with an ideal flat-surface was also examined using model samples, and their influence on the apparent sample composition evaluated.
Psychomotor slowing has been documented in depression. The digital Clock Drawing Test (dCDT) provides: (i) a novel technique to assess both cognitive and motor aspects of psychomotor speed within the same task and (ii) the potential to uncover subtleties of behavior not previously detected with non-digitized modes of data collection. Using digitized pen technology in 106 participants grouped by Age (younger/older) and Affect (euthymic/unmedicated depressed), we recorded cognitive and motor output by capturing how the clock is drawn rather than focusing on the final product. We divided time to completion (TTC) for Command and Copy conditions of the dCDT into metrics of percent of drawing (%Ink) versus non-drawing (%Think) time. We also obtained composite Z-scores of cognition, including attention/information processing (AIP), to explore associations of %Ink and %Think times to cognitive and motor performance. Despite equivalent TTC, %Ink and %Think Command times (Copy n.s.) were significant (AgeXAffect interaction: p=.03)—younger depressed spent a smaller proportion of time drawing relative to thinking compared to the older depressed group. Command %Think time negatively correlated with AIP in the older depressed group (r=−.46; p=.02). Copy %Think time negatively correlated with AIP in the younger depressed (r=−.47; p=.03) and older euthymic groups (r=−.51; p=.01). The dCDT differentiated aspects of psychomotor slowing in depression regardless of age, while dCDT/cognitive associates for younger adults with depression mimicked patterns of older euthymics. (JINS, 2014, 20, 1–9)
Although the Neolithic of northern China is better known due to a longer history of research, South China, with new discoveries and research over the past thirty years, is now a focus of intensive archaeological study concerning the beginnings of the Neolithic, the origins of agriculture and other issues related to the growth and spread of farming societies and their cultural and sociopolitical development. The earliest Neolithic cultures appear in South China after a lengthy but poorly understood transitional period from the Late (or Upper) Palaeolithic hunter-gatherer cultures of the Terminal Pleistocene. Between 12,500 and 9000 cal bp, hunter-gatherer groups in the Middle and Lower Yangzi River regions establish the first sedentary villages in South China, concomitant with parallel and perhaps related shifts in Northeast China and the North China Plain. While pottery appears before 20,000 cal bp in South China, it is in otherwise hunter-gatherer contexts, and so it is the cultural assemblages associated with these villages ten millennia later that we recognise as the earliest “Neolithic” cultures. Interestingly, these sedentary villages appear several millennia before the farming of domesticated plants (particularly rice) probably occurs, and certainly before domesticates contribute a significant amount to overall subsistence: farming, agriculture and the primary domestication of rice (along with a suite of other plants) do not appear rapidly with sedentism and the other initial technological, social and ideological changes that accompany Neolithisation, but rather over a period covering the first 4 millennia of the Holocene. Here we discuss regional cultural developments through the Neolithic across South China, including the beginnings of rice agriculture, changing settlement structures, burial practices, ritual and symbolic activities and craft production.
This white paper identifies knowledge gaps and new challenges in healthcare epidemiology research, assesses the progress made toward addressing research priorities, provides the Society for Healthcare Epidemiology of America (SHEA) Research Committee's recommendations for high-priority research topics, and proposes a road map for making progress toward these goals. It updates the 2010 SHEA Research Committee document, “Charting the Course for the Future of Science in Healthcare Epidemiology: Results of a Survey of the Membership of SHEA,” which called for a national approach to healthcare-associated infections (HAIs) and a prioritized research agenda. This paper highlights recent studies that have advanced our understanding of HAIs, the establishment of the SHEA Research Network as a collaborative infrastructure to address research questions, prevention initiatives at state and national levels, changes in reporting and payment requirements, and new patterns in antimicrobial resistance.