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We investigated labor force and health outcomes in cities experiencing fiscal difficulties to assess how those difficulties might impact their employees. We matched 23 cities with bond downgrades and 31 cities with stable bond ratings to sampling units in the Medical Expenditure Panel Survey. Starting the year before the downgrade and for the four subsequent years, the rate of separation from local public employment fell in the cities with downgrades relative to the comparison group. Self-reported health may have worsened, but there were no statistically significant effects on health care use or spending.
Aerobic exercise training has been shown to attenuate cognitive decline and reduce brain atrophy with advancing age. The extent to which resistance exercise training improves cognition and prevents brain atrophy is less known, and few studies include long-term follow-up cognitive and neuroimaging assessments. We report data from a randomized controlled trial of 155 older women, who engaged in 52 weeks of resistance training (either once- or twice-weekly) or balance-and-toning (twice-weekly). Executive functioning and memory were assessed at baseline, 1-year follow-up (i.e., immediately post-intervention), and 2-year follow-up. A subset underwent structural magnetic resonance imaging scans at those time points. At 2-year follow-up, both frequencies of resistance training promoted executive function compared to balance-and-toning (standardized difference [d]=.31–.48). Additionally, twice-weekly resistance training promoted memory (d=.45), reduced cortical white matter atrophy (d=.45), and increased peak muscle power (d=.27) at 2-year follow-up relative to balance-and-toning. These effects were independent of one another. These findings suggest resistance training may have a long-term impact on cognition and white matter volume in older women. (JINS, 2015, 21, 745–756)
The purpose of this study is to enhance the stability properties of our recently-developed numerical method [D. Kamensky, M.-C. Hsu, D. Schillinger, J.A. Evans, A. Aggarwal, Y. Bazilevs, M.S. Sacks, T.J.R. Hughes, “An immersogeometric variational framework for fluid-structure interaction: Application to bioprosthetic heart valves”, Comput. Methods Appl. Mech. Engrg., 284 (2015) 1005–1053] for immersing spline-based representations of shell structures into unsteady viscous incompressible flows. In the cited work, we formulated the fluid-structure interaction (FSI) problem using an augmented Lagrangian to enforce kinematic constraints. We discretized this Lagrangian as a set of collocated constraints, at quadrature points of the surface integration rule for the immersed interface. Because the density of quadrature points is not controlled relative to the fluid discretization, the resulting semi-discrete problem may be over-constrained. Semi-implicit time integration circumvents this difficulty in the fully-discrete scheme. If this time-stepping algorithm is applied to fluid-structure systems that approach steady solutions, though, we find that spatially-oscillating modes of the Lagrange multiplier field can grow over time. In the present work, we stabilize the semi-implicit integration scheme to prevent potential divergence of the multiplier field as time goes to infinity. This stabilized time integration may also be applied in pseudo-time within each time step, giving rise to a fully implicit solution method. We discuss the theoretical implications of this stabilization scheme for several simplified model problems, then demonstrate its practical efficacy through numerical examples.
Thiamine-related encephalopathy (Wernicke's encephalopathy) is a neuropsychiatric syndrome caused by a vitamin B1 (thiamine) deficiency often associated with alcoholism. Cancer predisposes patients to thiamine deficiency unrelated to alcoholism, though many cases are missed clinically. The present report adds to the literature on thiamine as a palliative tool for thiamine-related encephalopathy (TRE) in cancer.
From a larger series of TRE in cancer, we report on three cases with terminal illness.
Case 1. A 61-year old woman with Hodgkin's lymphoma developed TRE over 13 days. Precipitants included a hypermetabolic state in the background of subacute thiamine deficiency. Diagnosis was supported by abnormal serum thiamine and positive MRI findings. Mental status improved within 36 hours of initiating thiamine 500 mg IV t.i.d. Case 2. A 68-year-old man with colon cancer metastatic to liver and bone developed TRE precipitated by C. difficile–related diarrhea superimposed on 3 months of low appetite and weight loss. Diagnosis was supported by abnormal serum thiamine, and thiamine 500 mg IV t.i.d. was initiated. Improvements in mental status began within 36 hours. Case 3. An 80-year-old man with squamous cell carcinoma developed TRE precipitated by systemic infection in the context of three weeks of dysphagia. Antibiotic treatment did not reverse his cognitive symptoms, and a diagnosis of TRE was made based on operationalized criteria. Thiamine 100 mg IV daily did not reverse his symptoms. On his 30th day of admission, thiamine was increased to 500 mg IV t.i.d., resulting in a rapid reversal of altered mental status.
Significance of Results:
This report adds to the list of cancer types in which TRE/Wernicke's encephalopathy has been reported. It supports the use of higher doses of thiamine than are typically recommended in North America. Improvement following treatment allowed patients to engage with family and treatment teams prior to death.
Effective preparedness, response, and recovery from disasters require a well-planned, integrated effort with experienced professionals who can apply specialized knowledge and skills in critical situations. While some professionals are trained for this, others may lack the critical knowledge and experience needed to effectively perform under stressful disaster conditions. A set of clear, concise, and precise training standards that may be used to ensure workforce competency in such situations has been developed. The competency set has been defined by a broad and diverse set of leaders in the field and like-minded professionals through a series of Web-based surveys and expert working group meetings. The results may provide a useful starting point for delineating expected competency levels of health professionals in disaster medicine and public health.
(Disaster Med Public Health Preparedness. 2012;6:44–52)
Recently there have been a number of reports indicating concern relating to the effect of porosity, pore size distribution, and pore interconnectivity on the integration of highly porous ultra low-k organosilicate glasses (OSGs) as back-end-of-line (BEOL) interconnect dielectrics. In an effort to address these concerns a number of options to control the skeleton and pore structure of OSGs have been proposed, from adding alternative OSG precursors to alternative porogen precursors. In all these options there is a need to balance pore structure modification with critical film properties such as dielectric constant and mechanical strength. In this context, this paper examines porosity and its impact on film properties for highly porous ultra low dielectric constant films. A series of PDEMS® porous OSG films were deposited by plasma enchanced chemical vapor deposition (PECVD) from DEMS® precursor (diethoxymethylsilane) and porogen ATRP (alpha-terpenine). The percent porosity and pore interconnectivity of these films relative to the dielectric constant were measured by ellipsometric porosimetry (EP) and positron annihilation spectroscopy (PALS) respectively. Porosity and pore-size distribution for films deposited using several different species (structure former or porogen precursors) were examined using EP in an effort to understand the impact of the chemical nature of the precursor on pore morphology. Results from these depositions show that it is possible to deposit films with smaller pores using alternative structure formers (ASFs) with bulky organic groups, although there are tradeoffs with respect to other film characteristics. The addition of a separate porogen (ATRP) to the ASF lowered the dielectric constant and the addition of DEMS® precursor to the ASF/ATRP mix gave the films added structural integrity and mechanical strength. Such a fundamental understanding of structure-property relationships will help support successful integration of these porous OSG films.
Shipborne AIS provides independent traffic information to the bridge lookout on duty. This study examines the effect of AIS enhanced bridge lookout operation by means of a ship simulator. The two groups of participants, all qualified British deep sea deck officers, undertook identical simulation scenarios, but one group had the AIS on and the other did not. Significant differences were found between the two groups in reading the targets' privileged status and handling the head-on situation. Those with AIS information were found to avoid possible collisions faster than the group for whom AIS information was not available.
Large-scale catastrophic events typically result in a scarcity of essential medical resources and accordingly necessitate the implementation of triage management policies to minimize preventable morbidity and mortality. Accomplishing this goal requires a reconceptualization of triage as a population-based systemic process that integrates care at all points of interaction between patients and the health care system. This system identifies at minimum 4 orders of contact: first order, the community; second order, prehospital; third order, facility; and fourth order, regional level. Adopting this approach will ensure that disaster response activities will occur in a comprehensive fashion that minimizes the patient care burden at each subsequent order of intervention and reduces the overall need to ration care. The seamless integration of all orders of intervention within this systems-based model of disaster-specific triage, coordinated through health emergency operations centers, can ensure that disaster response measures are undertaken in a manner that is effective, just, and equitable. (Disaster Med Public Health Preparedness. 2008;2(Suppl 1):S35–S39)
Background: Various organizations and universities have developed competencies for health professionals and other emergency responders. Little effort has been devoted to the integration of these competencies across health specialties and professions. The American Medical Association Center for Public Health Preparedness and Disaster Response convened an expert working group (EWG) to review extant competencies and achieve consensus on an educational framework and competency set from which educators could devise learning objectives and curricula tailored to fit the needs of all health professionals in a disaster.
Methods: The EWG conducted a systematic review of peer-reviewed and non–peer reviewed published literature. In addition, after-action reports from Hurricane Katrina and relevant publications recommended by EWG members and other subject matter experts were reviewed for congruencies and gaps. Consensus was ensured through a 3-stage Delphi process.
Results: The EWG process developed a new educational framework for disaster medicine and public health preparedness based on consensus identification of 7 core learning domains, 19 core competencies, and 73 specific competencies targeted at 3 broad health personnel categories.
Conclusions: The competencies can be applied to a wide range of health professionals who are expected to perform at different levels (informed worker/student, practitioner, leader) according to experience, professional role, level of education, or job function. Although these competencies strongly reflect lessons learned following the health system response to Hurricane Katrina, it must be understood that preparedness is a process, and that these competencies must be reviewed continually and refined over time. (Disaster Med Public Health Preparedness. 2008;2:57–68)
In recent years, government and hospital disaster planners have recognized the increasing importance of pharmaceutical preparedness for chemical, biological, radiological, nuclear, and explosive (CBRNE) events, as well as other public health emergencies. The development of pharmaceutical surge capacity for immediate use before support from the (US) Strategic National Stockpile (SNS) becomes available is integral to strengthening the preparedness of local healthcare networks.
The Pharmaceutical Response Project served as an independent, multidisciplinary collaboration to assess statewide hospital pharmaceutical response capabilities. Surveys of hospital pharmacy directors were conducted to determine pharmaceutical response preparedness to CBRNE threats.
All 45 acute care hospitals in Maryland were surveyed, and responses were collected from 80% (36/45). Ninety-two percent (33/36) of hospitals had assessed pharmaceutical inventory with respect to biological agents, 92% (33/36) for chemical agents, and 67% (24/36) for radiological agents. However, only 64% (23/36) of hospitals reported an additional dedicated reserve supply for biological events, 67% (24/36) for chemical events, and 50% (18/36) for radiological events. More than 60% of the hospitals expected to receive assistance from the SNS within ≤48 hours.
From a pharmaceutical perspective, hospitals generally remain under-prepared for CBRNE threats and many expect SNS support before it realistically would be available. Collectively, limited antibiotics and other supplies are available to offer prophylaxis or treatment, suggesting that hospitals may have insufficient pharmaceutical surge supplies for a large-scale event. Although most state hospitals are improving pharmaceutical surge capabilities, further efforts are needed.
In September of 2004, we investigated 7 cases of post-myelography meningitis. Streptococcal species were recovered from blood or cerebrospinal fluid in all cases. Our findings suggest that droplet transmission of the oral flora of the clinician performing the procedure was the most likely source of these infections. The Centers for Disease Control and Prevention recommends the use of face masks by those performing myelograms.