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The 2017 solar eclipse was associated with mass gatherings in many of the 14 states along the path of totality. The Kentucky Department for Public Health implemented an enhanced syndromic surveillance system to detect increases in emergency department (ED) visits and other health care needs near Hopkinsville, Kentucky, where the point of greatest eclipse occurred.
EDs flagged visits of patients who participated in eclipse events from August 17–22. Data from 14 area emergency medical services and 26 first-aid stations were also monitored to detect health-related events occurring during the eclipse period.
Forty-four potential eclipse event-related visits were identified, primarily injuries, gastrointestinal illness, and heat-related illness. First-aid stations and emergency medical services commonly attended to patients with pain and heat-related illness.
Kentucky’s experience during the eclipse demonstrated the value of patient visit flagging to describe the disease burden during a mass gathering and to investigate epidemiological links between cases. A close collaboration between public health authorities within and across jurisdictions, health information exchanges, hospitals, and other first-response care providers will optimize health surveillance activities before, during, and after mass gatherings.
Insomnia is a risk factor (odds ratio 39,8) as well as symptom of depressive disorder and other psychiatric conditions. Therefore, psychiatrists require appropriate training in diagnosing and treating insomnia. To date, there is no data available in Europe on training in sleep medicine for early career psychiatrists.
To establish how accessible training in insomnia management is to European early career Psychiatrists, and how confident they feel in treating this disorder.
Europe wide survey carried out jointly by the European and World Psychiatric Associations Early Career Psychiatrists Committees. Representatives of Early career Psychiatrists from each participating European country filled in a questionnaire about training in sleep medicine in their country. Early Career Psychiatrists were also invited to fill out a questionnaire at the EPA congress in Nice in 2013.
55 participants from 27 European countries responded. Only 24% had sleep medicine training mandatorily included in their national training curriculum. A majority (60%) felt that the quality of training they did receive was either average or below average. 88% felt either very or fairly confident in treating insomnia. However, when asked to select the correct management options for insomnia from a provided list of 6 options, only 19% and 33% of respondents chose the two correct options.
There is a clear gap between the level of confidence and the clinical judgements being made to treat insomnia among European Early Career Psychiatrists. There is a definite need to improve the availability and structure of insomnia training in Europe.
Dietary patterns describe the combination of foods and beverages in a diet and the frequency of habitual consumption. Better understanding of childhood dietary patterns and antenatal influences could inform intervention strategies to prevent childhood obesity. We derived empirical dietary patterns in 1142 children (average age 6·0 (sd 0·2) years) in New Zealand, whose mothers had participated in the Screening for Pregnancy Endpoints (SCOPE) cohort study and explored associations with measures of body composition. Participants (Children of SCOPE) had their diet assessed by FFQ, and dietary patterns were extracted using factor analysis. Three distinct dietary patterns were identified: ‘Healthy’, ‘Traditional’ and ‘Junk’. Associations between dietary patterns and measures of childhood body composition (waist, hip, arm circumferences, BMI, bioelectrical impedance analysis-derived body fat % and sum of skinfold thicknesses (SST)) were assessed by linear regression, with adjustment for maternal influences. Children who had higher ‘Junk’ dietary pattern scores had 0·24 (sd 0·08; 95 % CI 0·04, 0·13) cm greater arm and 0·44 (sd 0·05; 95 % CI 0·01, 0·10) cm greater hip circumferences and 1·13 (sd 0·07; 95 % CI 0·03, 0·12) cm greater SST and were more likely to be obese (OR 1·74; 95 % CI 1·07, 2·82); those with higher ‘Healthy’ pattern scores were less likely to be obese (OR 0·62; 95 % CI 0·39, 1·00). In a large mother–child cohort, a dietary pattern characterised by high-sugar and -fat foods was associated with greater adiposity and obesity risk in children aged 6 years, while a ‘Healthy’ dietary pattern offered some protection against obesity. Targeting unhealthy dietary patterns could inform public health strategies to reduce the prevalence of childhood obesity.
This paper examines the joint impact of infrastructure capital and institutional quality on economic growth using a large panel dataset covering 99 countries and spanning the years 1980–2015. The empirical strategy involves estimating a simple growth model where, in addition to standard controls, infrastructure, institutional quality, and their interaction are included as explanatory variables. Potential endogeneity concerns are addressed by employing generalized method of moments estimators that utilize internal instruments. We find that the interaction terms between infrastructure capital and institutional quality show a positive and significant impact on economic growth. These results are robust to a variety of alternative specifications and institutional quality measures. Hence, our results suggest that maximizing returns from infrastructure capital requires improving the quality of institutions.
This chapter examines the role of selection in driving certain aspects of pelvic morphology, particularly the differences between mediolateral breadths and anteroposterior breadths. The chapter is divided into three sections, representing the three key selection pressures researchers have spent the most time on – namely, obstetrics, locomotion and thermoregulation. Data for the role of each of these on pelvic morphology are considered, as is discussion of the myriad ways human populations have mixed and matched morphological traits to manage these selection pressures. Clearly, there is not a single strategy for handling the interactive nature of these pressures.
In this chapter, we discuss evidence about the evolutionary forces that have shaped the evolution of the human pelvis, both in its entirety as well as portions of the pelvis, focusing on studies that have investigated pelvic evolution using experimental and quantitative genetic methods. These methods are tied to information from Chapter 4 about pelvis development, with emphasis placed on the importance of understanding the difficulty of tying development and growth with evolutionary processes. Special attention is placed on the concept of the palimpsest. Further, we review these findings in light of three principal hypotheses broadly offered about the processes that selected for pelvic shape (as reviewed in Chapters 2 and 3): locomotion, obstetric sufficiency and thermoregulation. We show from multiple studies that the human pelvis evolved in response to natural selection as well as through neutral evolutionary processes (e.g. genetic drift). A key conclusion from these studies is that parts of the pelvis evolved in different manners in response to these (and other) selection factors; thus, the shape of the human pelvis reflects a modular response to various sources of selection.
This chapter provides an overview of the anatomy of the primate pelvis, with a particular focus on the features of the hominoid (ape) and human pelvic morphologies. Underlying sources of morphological variation such as phylogenetic signals, sexual dimorphism and obstetric function are examined, as well as general patterns of pelvic anatomical variation within Homo sapiens.
In light of the various sources of evidence presented in the preceding chapters, we are left to conclude that the human (in the broadest sense of recent humans and their ancestors) pelvis represents various experiments in evolution. A diversity in pelvic sizes and shapes has marked hominin history, as each population and each species responded to selection pressures in sometimes unique and sometimes convergent ways. These were situated in the distinctive population histories of each of these groups, creating a mosaic of patterns underlain both by responses to evolution and changing patterns of covariance within development. To understand the diversity we observe among fossils, as well as variation within recent humans, we must therefore cultivate a multidisciplinary expertise in biomechanics, kinematics, fossil evidence, developmental biology and evolutionary theory. This book represents an attempt at bringing together these various sources of evidence to better understand the factors, patterns and potential processes that shaped the evolution of the pelvis.
Even before the focus on bipedalism as the ‘hallmark’ of the human lineage (Robinson, 1972), interest in the pelvis was stimulated by discussions across different disciplines, including the growing field of obstetrics (see review in Walrath, 2003), as well as by multiple fossil discoveries (Pycraft, 1930; Dart, 1949). It was also clear at the outset that the pelvis was going to serve as a crucial part of the evolutionary history of humans, given that it had obvious functional implications in its role in locomotion, which included dramatic differences between other species grouped with humans taxonomically and then phylogenetically, including the African and Asian apes.
To investigate pelvis evolution and to understand the sources of its variation, we must comprehend its development. We review developmental processes that form the pelvis from three perspectives: cell layers and tissues, genomic information and overall growth. At tissue level, the pelvis forms largely from lateral plate mesoderm as well as from somites. The os coxa forms from cartilaginous precursor tissues that grow and ossify, especially in two major regions that become the ischiopubis and the ilium. The sacrum and coccyx form from multiple ossification centres. Numerous secondary ossification centres form, with the last fusing by the mid-twenties. The importance of multiple genes and molecular factors are discussed, including interactions among and differences in timing and locations of expression, emphasising Islet1, Emx2, Pbx and Hox. We review the importance of differences in timing of ossification among skeletal elements, their interactions with mechanical loading and sex hormones, and environmental factors affecting individual growth. These processes are linked to morphological integration and are the origins of the morphological variation on which evolutionary forces act.
This chapter examines the fossil record of hominoid and hominin pelvic remains from the Miocene through to the Late Pleistocene. The interpretation of functional demands shaping hominin pelvic morphology including locomotion, obstetrics and thermoregulation are discussed, as well as evidence for pelvic sexual dimorphism in hominin species. The long-standing view of a relatively linear pattern of hominin pelvic evolution from Australopiths, through early Homo, to Neanderthals, broken only by the appearance of the somewhat divergent morphology of Homo sapiens is examined in light of recent fossil pelvis discoveries that point to greater diversity in the hominin pelvic morphology. These fossils add to evidence from elsewhere in the postcranium that indicate there were multiple ways to be a bipedal hominin.
There is a paucity of long-term prospective disaster studies of the psychological sequelae among survivors.
At 1½ and 25 years after the Spitak earthquake, 142 early adolescents from two cities were assessed: Gumri (moderate–severe exposure) and Spitak (very severe exposure). The Gumri group included treated and not-treated subjects, while the Spitak group included not-treated subjects. Instruments included: DSM-III-R PTSD-Reaction Index (PTSD-RI); DSM-5 PTSD-Checklist (PCL); Depression Self-Rating Scale (DSRS); and Center for Epidemiological Studies-Depression Scale (CES-D).
(1) Between 1½ and 25 years, PTSD rates and mean scores decreased significantly in the three groups (over 50%). However, at 25 years 9.1–22.4% met DSM-5 PTSD criteria. (2) At 1½ years, the Spitak group had higher PTSD-RI (p < 0.001) and DSRS scores (p < 0.001) compared to the Gumri-not-treated group. At 25 years, the Spitak group that had experienced fewer post-earthquake adversities (p < 0.03), had a greater decrease in PTSD-RI scores (p < 0.02), and lower CES-D scores (p < 0.01). (3) Before treatment, PTSD-RI and DSRS scores did not differ between the Gumri-treated and not-treated groups. At 25-years, the Gumri-treated group showed a greater decrease in PTSD-RI scores (p < 0.03), and lower mean PTSD-RI (p < 0.02), PCL (p < 0.02), and CES-D (p < 0.01) scores. (4) Predictors of PTSD symptom severity at 25-years included: home destruction, treatment, social support, post-earthquake adversities, and chronic medical illnesses.
Post-disaster PTSD and depressive symptoms can persist for decades. Trauma-focused treatment, alleviation of post-disaster adversities, improving the social ecology, and monitoring for chronic medical illnesses are essential components of recovery programs.
Prevention of Clostridioides difficile infection (CDI) is a national priority and may be facilitated by deployment of the Targeted Assessment for Prevention (TAP) Strategy, a quality improvement framework providing a focused approach to infection prevention. This article describes the process and outcomes of TAP Strategy implementation for CDI prevention in a healthcare system.
Hospital A was identified based on CDI surveillance data indicating an excess burden of infections above the national goal; hospitals B and C participated as part of systemwide deployment. TAP facility assessments were administered to staff to identify infection control gaps and inform CDI prevention interventions. Retrospective analysis was performed using negative-binomial, interrupted time series (ITS) regression to assess overall effect of targeted CDI prevention efforts. Analysis included hospital-onset, laboratory-identified C. difficile event data for 18 months before and after implementation of the TAP facility assessments.
The systemwide monthly CDI rate significantly decreased at the intervention (β2, −44%; P = .017), and the postintervention CDI rate trend showed a sustained decrease (β1 + β3; −12% per month; P = .008). At an individual hospital level, the CDI rate trend significantly decreased in the postintervention period at hospital A only (β1 + β3, −26% per month; P = .003).
This project demonstrates TAP Strategy implementation in a healthcare system, yielding significant decrease in the laboratory-identified C. difficile rate trend in the postintervention period at the system level and in hospital A. This project highlights the potential benefit of directing prevention efforts to facilities with the highest burden of excess infections to more efficiently reduce CDI rates.