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Disasters can damage the essential public health infrastructure and social protection systems required for vulnerable populations. This contributes to indirect mortality and morbidity as high as 70–90%, primarily due to an exacerbation of life-threatening conditions and chronic diseases. Despite this, the traditional focus of public health systems has been on communicable diseases. To address this challenge, disaster and health planners require access to repeatable and measurable methods to rank and prioritize the needs of people with life-threatening and chronic diseases before, during, and after a disaster.
Propose a repeatable and measurable method for ranking and prioritizing the needs of people with life-threatening and chronic diseases before, during, and after a disaster.
The research began with identifying the risk disasters pose to people with life-threatening and chronic diseases. The data gathered was then used to develop indicators and explore the use of DisasterAWARE™ (All-hazard Warnings, Analysis, and Risk Evaluation) to rank and prioritize the needs before, during, and after a disaster.
This research found people at greatest risk are those with underlying cardiovascular and respiratory diseases, unstable diabetes, renal diseases, and those undergoing cancer treatment. A sustainable method to help address this problem is to expand the use of DisasterAWARE™ (All-hazard Warnings, Analysis, and Risk Evaluation) to rank and prioritize needs at national and sub-national levels.
DisasterAWARE™ has been successfully applied to the assessment and prioritization of disaster risk and humanitarian assistance needs in Southeast Asia (ASEAN, Viet Nam), Central America (Guatemala, El Salvador, Honduras, Nicaragua), South America (Peru), and the Caribbean (Jamaica, Dominican Republic). Using the indicators developed through this research, this proven methodology can be seamlessly and easily translated to rank and prioritize the needs of people with life-threatening and chronic diseases before, during, and after a disaster.
Water exposures in healthcare settings and during healthcare delivery can place patients at risk for infection with water-related organisms and can potentially lead to outbreaks. We aimed to describe Centers for Disease Control and Prevention (CDC) consultations involving water-related organisms leading to healthcare-associated infections (HAIs).
Retrospective observational study.
We reviewed internal CDC records from January 1, 2014, through December 31, 2017, using water-related terms and organisms, excluding Legionella, to identify consultations that involved potential or confirmed transmission of water-related organisms in healthcare. We determined plausible exposure pathways and routes of transmission when possible.
Of 620 consultations during the study period, we identified 134 consultations (21.6%), with 1,380 patients, that involved the investigation of potential water-related HAIs or infection control lapses with the potential for water-related HAIs. Nontuberculous mycobacteria were involved in the greatest number of investigations (n = 40, 29.9%). Most frequently, investigations involved medical products (n = 48, 35.8%), and most of these products were medical devices (n = 40, 83.3%). We identified a variety of plausible water-exposure pathways, including medication preparation near water splash zones and water contamination at the manufacturing sites of medications and medical devices.
Water-related investigations represent a substantial proportion of CDC HAI consultations and likely represent only a fraction of all water-related HAI investigations and outbreaks occurring in US healthcare facilities. Water-related HAI investigations should consider all potential pathways of water exposure. Finally, healthcare facilities should develop and implement water management programs to limit the growth and spread of water-related organisms.
Pure and Nb-doped zirconium germanate materials of composition K2-xZr1-xNbxGe3O9.H2O where x = 0, 0.1, 0.2 and 0.25 with the structure of the mineral umbite have been successfully synthesised. The parent material displays negligible ion exchange of K+ for Cs+ but the doped materials shows much improved exchange. Synchrotron X-ray diffraction shows substantial peak splitting which varies with increasing niobium content. Preliminary Rietveld refinements suggest a two phase model with a caesium and potassium rich doped umbite phase.
Hyperbolic polariton modes are highly appealing for a broad range of applications in nanophotonics, including surfaced enhanced sensing, sub-diffractional imaging, and reconfigurable metasurfaces. Here we show that attenuated total reflectance (ATR) micro-spectroscopy using standard spectroscopic tools can launch hyperbolic polaritons in a Kretschmann–Raether configuration. We measure multiple hyperbolic and dielectric modes within the naturally hyperbolic material hexagonal boron nitride as a function of different isotopic enrichments and flake thickness. This overcomes the technical challenges of measurement approaches based on nanostructuring, or scattering scanning near-field optical microscopy. Ultimately, our ATR approach allows us to compare the optical properties of small-scale materials prepared by different techniques systematically.
Traditional ambulatory rhythm monitoring in children can have limitations, including cumbersome leads and limited monitoring duration. The ZioTM patch ambulatory monitor is a small, adhesive, single-channel rhythm monitor that can be worn up to 2 weeks. In this study, we present a retrospective cross-sectional analysis of the ZioTM monitor’s impact in clinical practice. Patients aged 0–18 years were included in the study. A total of 373 studies were reviewed in 332 patients. In all, 28.4% had structural heart disease, and 16.9% had a prior surgical, catheterisation, or electrophysiology procedure. The most common indication for monitoring was tachypalpitations (41%); 93.5% of these patients had their symptoms captured during the study window. The median duration of monitoring was 5 days. Overall, 5.1% of ZioTM monitoring identified arrhythmias requiring new intervention or increased medical management; 4.0% identified arrhythmias requiring increased clinical surveillance. The remainder had either normal-variant rhythm or minor rhythm findings requiring no change in management. For patients with tachypalpitations and no structural heart disease, 13.2% had pathological arrhythmias, but 72.9% had normal-variant rhythm during symptoms, allowing discharge from cardiology care. Notably, for patients with findings requiring intervention or increased surveillance, 56% had findings first identified beyond 24 hours, and only 62% were patient-triggered findings. Seven studies (1.9%) were associated with complications or patient intolerance. The ZioTM is a well-tolerated device that may improve what traditional Holter and event monitoring would detect in paediatric cardiology patients. This study shows a positive clinical impact on the management of patients within a paediatric cardiology practice.
We examine the role of status quo bias in the ballot wording of social issues that affect the rights of minority groups. We test the salience of this framing bias by conducting an experiment that randomly assigns different ballot wordings for five policies across survey respondents. We find that status quo bias changes the percent of individuals who vote for the ballot measure by 5–8 percentage points with the least informed individuals being the most affected by status quo bias.
Pure and Nb-doped zirconium germanate materials of composition K2-xZr1-xNbxGe3O9.H2O where x = 0, 0.1, 0.2 and 0.3 with the structure of the natural mineral umbite have been prepared in high yield using hydrothermal synthesis methods. The parent material displays virtually no ion exchange of the K+ for Cs+ but the doped materials show rapidly enhanced exchange with replacement of ca. 70% of the K+ by Cs+ for the 30% doped material. Rietveld analysis of the powder X-ray diffraction data is consistent with no change in the unit cell parameters or K+ bonding prior to the exchange, hence we propose the improved property is due to the creation of cation defect sites within the pores of the material that facilities greater cation mobility and leads to exchange.
A new instrument for high-resolution optical logging has been built and tested in Antarctica. Its purpose is to obtain records of volcanic products and other scattering features, such as bubbles and impurities, preserved in polar ice sheets, and it achieves this by using long wavelength near-infrared light that is absorbed by the ice before many scattering events occur. Longer wavelengths ensure that the return signal is composed primarily of a single or few backscattering event(s) that limit its spatial spread. The compact optical logger features no components on its body that draw power, which minimizes its size and weight. A prototype of the logger was built and tested at Siple Dome A borehole, and the results were correlated with prior optical logging profiles and records of volcanic products from collected ice core samples.
Trials evaluating efficacy of omega-3 highly unsaturated fatty acids (HUFAs) in major depressive disorder report discrepant findings.
To establish the reasons underlying inconsistent findings among randomised controlled trials (RCTs) of omega-3 HUFAs for depression and to assess implications for further trials.
A systematic bibliographic search of double-blind RCTs was conducted between January 1980 and July 2014 and an exploratory hypothesis-testing meta-analysis performed in 35 RCTs including 6665 participants receiving omega-3 HUFAs and 4373 participants receiving placebo.
Among participants with diagnosed depression, eicosapentaenoic acid (EPA)-predominant formulations (>50% EPA) demonstrated clinical benefits compared with placebo (Hedge's G = 0.61, P<0.001) whereas docosahexaenoic acid (DHA)-predominant formulations (>50% DHA) did not. EPA failed to prevent depressive symptoms among populations not diagnosed for depression.
Further RCTs should be conducted on study populations with diagnosed or clinically significant depression of adequate duration using EPA-predominant omega-3 HUFA formulations.
Molecular assays are often implemented by weed scientists for detection of
herbicide-resistant individuals; however, the utility of these assays can be
limited if multiple mechanisms of evolved resistance exist. Waterhemp
resistant to protoporphyrinogen oxidase (PPO)– inhibiting herbicides is
conferred by a target-site mutation in PPX2L (a gene coding
for PPO), resulting in the loss of a glycine at position 210 (ΔG210). This
ΔG210 mutation of PPX2L is the only known mechanism
responsible for PPO-inhibitor resistance (PPO-R) in waterhemp from five
states (Illinois, Indiana, Iowa, Kansas, and Missouri); however, a limited
number of populations have been tested, especially in Illinois. To verify
the ubiquity of the ΔG210 in PPO-R waterhemp populations in Illinois, a
previously published allele-specific PCR (asPCR) was used for the detection
of the ΔG210 mutation to associate this mutation with phenotypic resistance
in 94 Illinois waterhemp populations. The ΔG210 mutation was detected in all
populations displaying phenotypic resistance to lactofen (220 g ai
ha−1), indicating the deletion is likely the only mechanism of
resistance. With evidence that the ΔG210 mutation dominates PPO-R waterhemp
biotypes, molecular detection techniques have considerable utility.
Unfortunately, the previously published asPCR is time consuming, very
sensitive to PCR conditions, and requires additional steps to eliminate the
possibility of false negatives. To overcome these limitations, a streamlined
molecular method using the TaqMan® technique was developed, utilizing
allele-specific, fluorescent probes for high-throughput, robust
discrimination of each allele (resistant and susceptible) at the 210th amino
acid position of PPX2L.
Abuse or unintended overdose (OD) of opiates and heroin may result in prehospital and emergency department (ED) care. Prehospital naloxone use has been suggested as a surrogate marker of community opiate ODs. The study objective was to verify externally whether prehospital naloxone use is a surrogate marker of community opiate ODs by comparing Emergency Medical Services (EMS) naloxone administration records to an independent database of ED visits for opiate and heroin ODs in the same community.
A retrospective chart review of prehospital and ED data from July 2009 through June 2013 was conducted. Prehospital naloxone administration data obtained from the electronic medical records (EMRs) of a large private EMS provider serving a metropolitan area were considered a surrogate marker for suspected opiate OD. Comparison data were obtained from the regional trauma/psychiatric ED that receives the majority of the OD patients. The ED maintains a de-identified database of narcotic-related visits for surveillance of narcotic use in the metropolitan area. The ED database was queried for ODs associated with opiates or heroin. Cross-correlation analysis was used to test if prehospital naloxone administration was independent of ED visits for opiate/heroin ODs.
Naloxone was administered during 1,812 prehospital patient encounters, and 1,294 ED visits for opiate/heroin ODs were identified. The distribution of patients in the prehospital and ED datasets did not differ by gender, but it did differ by race and age. The frequency of naloxone administration by prehospital providers varied directly with the frequency of ED visits for opiate/heroin ODs. A monthly increase of two ED visits for opiate-related ODs was associated with an increase in one prehospital naloxone administration (cross-correlation coefficient [CCF]=0.44; P=.0021). A monthly increase of 100 ED visits for heroin-related ODs was associated with an increase in 94 prehospital naloxone administrations (CCF=0.46; P=.0012).
Frequency of naloxone administration by EMS providers in the prehospital setting varied directly with frequency of opiate/heroin OD-related ED visits. The data correlated both for short-term frequency and longer term trends of use. However, there was a marked difference in demographic data suggesting neither data source alone should be relied upon to determine which populations are at risk within the community.
LindstromHA, ClemencyBM, SnyderR, ConsiglioJD, MayPR, MoscatiRM. Prehospital Naloxone Administration as a Public Health Surveillance Tool: A Retrospective Validation Study. Prehosp Disaster Med. 2015;30(4):1–5.
A complete understanding of radioactive waste glass interactions with near-field materials is essential for appropriate nuclear waste repository performance assessment. In many geologic repository designs, Fe is present both in the natural environment and in the containers that will hold the waste glasses. In this paper we discuss investigations of the alteration of International Simple Glass (ISG) in the presence of Fe0 foil and hematite (Fe2O3). Based on solid analysis, ISG alteration is more pronounced in the presence of Fe0 than with hematite. Additionally, typical glass corrosion is observed for distances of 5 mm between Fe materials and ISG, but incorporation of Fe in the alteration layer is only observed for systems exhibiting full contact between Fe0 material and ISG. Solution analysis results indicate that diatomaceous earth minimizes corrosion to a larger extent than fumed silica does when present with iron and ISG.
Non-destructive investigation, chemically fingerprinting, and authentication of ceramic cultural artifacts is a challenging analytical problem. Electron paramagnetic resonance (EPR) spectroscopy is capable of distinguishing between clays based on the paramagnetic metals present, and firing temperature (TF) based on the complexes of these metals formed at different TF values. Unfortunately, the 9 GHz frequency of conventional X-band EPR restricts sample size to a few mm and limits its applicability to small fragments. Low frequency EPR (LFEPR) is based on an EPR spectrometer operating at a few hundred MHz. LFEPR can utilize larger samples on the order of a few cm, but has a lower sensitivity due to the smaller Boltzmann ratio. Additionally, LFEPR may not be capable of detecting a spectral transition if the LFEPR operating frequency is less then the zero-field splitting of the paramagnetic metal complex. We utilized an LFEPR operating at 300 MHz which scans the applied magnetic field between the local Earth’s magnetic field and 26 mT to determine the feasibility of detecting EPR signals from clays, pigments, and glazes. Various clay samples were studied at 100 < TF < 1200 °C. Spectral differences were seen as a function of both clay type and TF. Differences in the LFEPR spectra of Han, Egyptian, and Ultramarine blue support the ability to distinguish among pigments. Paramagnetic impurities in glass may allow distinction between glaze spectra. We have also explored the utility of LFESR by the use of a radio frequency surface coil rather than an enclosed resonator. Although the active volume of the surface coil is ∼1 cm3, objects as large as 20 cm in diameter might be easily characterized with our spectrometer.
Nanoscale metal–insulator–metal (MIM) diodes consisting of a nanoscale-thickness insulator layer sandwiched between two dissimilar metal layers offer the potential for very high frequency alternating current to direct current signal rectification. Active nanoscale tuning of electronic tunneling through the insulator layer to form point contact diodes has previously been limited to barriers composed of soft organic films due to the force limitations of conductive-atomic force microscopy. In this paper, MIM diodes with oxide-based insulators are formed in situ with sub-nanometer depth precision and characterized using a nanoindenter equipped with electrical testing capabilities. Simultaneous measurement of both electrical and nano-mechanical information is accomplished in an MIM stack of the form Nb/Nb2O5/boron-doped diamond nanoindenter tip. Using this technique, we show that the diode behavior can be electromechanically tuned over a range of more than 1 V at equivalent currents via small changes in indentation depth and the results can be modeled using a Fowler–Nordheim approximation.
Alzheimer's disease (AD) is an urgent public health challenge that is rapidly approaching epidemic proportions. New therapies that defer or prevent the onset, delay the decline, or improve the symptoms are urgently needed. All phase 3 drug development programs for disease-modifying agents have failed thus far. New approaches to drug development are needed. Translational neuroscience focuses on the linkages between basic neuroscience and the development of new diagnostic and therapeutic products that will improve the lives of patients or prevent the occurrence of brain disorders. Translational neuroscience includes new preclinical models that may better predict human efficacy and safety, improved clinical trial designs and outcomes that will accelerate drug development, and the use of biomarkers to more rapidly provide information regarding the effects of drugs on the underlying disease biology. Early translational research is complemented by later stage translational approaches regarding how best to use evidence to impact clinical practice and to assess the influence of new treatments on the public health. Funding of translational research is evolving with an increased emphasis on academic and NIH involvement in drug development. Translational neuroscience provides a framework for advancing development of new therapies for AD patients.