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An outpatient parenteral antimicrobial therapy team from a Veterans Affairs facility managed patients discharged from their own facility and neighboring community hospitals. There were no significant differences in adverse outcomes between the groups, but a majority of regimens were modified from those initially proposed by community providers.
The presence of a penicillin allergy label in a patient’s medical chart is associated with negative clinical and economic outcomes. Given that less than 10% of reported reactions are truly immunoglobulin E-mediated, removal of unverified penicillin allergy labels is a public health priority and an area of ongoing implementation research. The Veterans Health Administration (VHA) is the largest integrated healthcare system in the United States, with almost 9 million veterans currently enrolled. However, studies analyzing the impact of the penicillin allergy label in this population are limited to single facilities and largely focus on short-term outcomes of allergy documentation correction, usage of β-lactams, and avoidance of antibiotic-related side effects. Broader, national VHA studies focusing on health outcomes and costs are lacking. As with non-VHA facilities, penicillin allergy evaluations are limited owing to the absence of formal allergy/immunology services at most VHA facilities. Pharmacy-driven screening and referral for clinic-based penicillin skin testing is a promising and frequently discussed modality in the literature, but its scalability within the VHA is not yet proven. Broader, evidence-based strategies that can be adapted to the available resources of individual VHA facilities, including those without on-site access to allergy providers, are needed.
Rural areas tend to be inhabited by more older people and thus have a higher prevalence of dementia. Combined with lower population densities and more sparse geography, rural areas pose numerous barriers and costs relating to support and resource provision. This may leave people with dementia in rural places at a significant disadvantage, leading to a heavy reliance on informal support networks. The present study explores the personal experiences of people living with dementia and carers living in rural areas, seeking to discover both benefits and challenges, as well as recommendations within the literature for improving the lives of those affected by dementia in rural areas. A scoping review following the framework of Arksey and O'Malley identified 60 studies that describe or discuss the personal experience of dementia (either by the person with dementia or carer), in relation to living in rural or remote geographical areas. Four overarching themes were derived, namely the possible benefits of living in a rural community (supportive rural communities), sources of strength described by people affected by dementia in rural areas (managing and coping), detrimental aspects of living in a rural community (rural community challenges) and difficulties with dementia care services. Three further themes yielded recommendations for improving the experience of dementia in rural areas. This review highlights some potential opportunities related to living in rural areas for people living with dementia. These often come with parallel challenges, reflecting a delicate balance between being well-supported and being in crisis for those living in rural areas. Given the limited access to formal services, supporting people with dementia in rural areas requires input and innovation from the people, organisations and services local to those communities.
Work-related musculoskeletal disorders in ENT surgeons are common and detrimental, yet few are aware of preventative measures. We evaluate the evidence for interventions to prevent work-related musculoskeletal disorders in ENT surgeons.
A systematic search of databases up to 8 June 2021 was performed using Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and predetermined inclusion criteria.
Seven prospective cohort studies and 2 case series were identified (51 participants). Interventions included novel equipment (n = 3), patient positioning (n = 2), clinician positioning (n = 3) and operative technique (n = 1). Five studies reported Rapid Upper Limb Assessment scores as outcome measures of strain. Strain decreased when adopting a favourable operating posture, using a supportive chair and keeping patients supine for clinic procedures.
A small number of low-quality studies were identified. Modifiable risk factors exist, and ergonomic education may help prevent work-related musculoskeletal disorders. Further studies with longer term follow up are required.
Children with conduct problems (CP) exhibit problematic externalizing behaviors that violate the rights of others and/or societal norms, are likely to present with comorbid psychological problems, engage in high-risk behaviours during adolescence and in turn, display poorer prospective health in adulthood. However, little known about their adolescent quotidian behaviors, such as their sleep behaviours, which may contribute to these poorer outcomes.
Using a sample designed to assess the longitudinal consequences of CP, the current study examines how histories of CP and comorbidity with depressive symptoms and/or attention-hyperactivity problems are associated with sleep difficulties during adolescence.
744 participants from an ongoing longitudinal study in Québec, Canada were assessed for CP and comorbidities when they were 6 to 10-years-old. They were classified as without CP, CP only, CP and depressive symptoms, CP and attention-hyperactivity problems, or CP, depressive symptoms and attention-hyperactivity problems based on parent and teacher-reported indices. Sleep difficulties were assessed 7 years later, using self and parent-reported indices. Regression analyses controlling for sex, age, family income, maternal education and medications were conducted.
demonstrated that youth and parents from all CP groups reported more sleep difficulties than youth without histories of CP. Participants from the CP, depressive symptoms and attention-hyperactivity problem group reported more sleep difficulty than all other groups, while their parents did not.
These findings suggest that histories of CP, regardless of comorbidity, predispose youth to future sleep difficulties and highlight the importance of incorporating self and parental indices of sleep as well as examining the effect of comorbidity.
The city of Teotihuacan (AD 1–550) was a major multiethnic urban center that attracted migrants from as far away as west Mexico and the Maya region. Past research in the Tlajinga district at Teotihuacan using oxygen isotopes from human remains estimated that nearly 30% of the population of Tlajinga 33, a single apartment compound, were migrants. This study takes a dual-isotope approach (87Sr/86Sr and δ18Op) to reevaluate the proportion of in-migration at Tlajinga and includes data from two additional apartment compounds, Tlajinga 17 and 18 (n = 23). New results indicate that migrants comprised ~45% of the Tlajinga population. Previously acquired radiocarbon dates combined with mortuary and isotope data suggest that immigration to Tlajinga was highest during the first centuries of compound occupation. Nevertheless, migration was a continual process throughout its history. Additionally, a new finding suggests that residents of Tlajinga 33 ingested foods with higher 87Sr/86Sr ratios than did those of Tlajinga 17 and 18. We hypothesize that the incorporation of imported lime for the nixtamalization process skewed the 87Sr/86Sr ratios of human remains, a potentially important finding for future studies at Teotihuacan.
Sugar-sweetened beverage (SSB) consumption in early childhood is a public health concern. Adequate hydration in early childhood is also important. We developed a national research agenda to improve beverage consumption patterns among 0–5-year-olds. This article focuses on the process used to develop this research agenda.
A mixed methods, multi-step process was used to develop the research agenda, including: (i) a scientific advisory committee; (ii) systematic reviews on strategies to reduce SSB consumption and increase water access and consumption; (iii) two stakeholder surveys to first identify and then rank strategies to reduce SSB consumption and increase water access and consumption; (iv) key informant interviews to better understand determinants of beverage consumption and strategies to improve beverage consumption patterns among high-risk groups; (v) an in-person convening with experts; and (vi) developing the final research agenda.
This process included research and stakeholders from across the United States.
A total of 276 participants completed survey 1 and 182 participants completed survey 2. Key informant interviews were conducted with 12 stakeholders. Thirty experts attended the convening, representing academia, government, and non-profit sectors.
Thirteen key issue areas and 59 research questions were developed. Priority topics were beverage consumption recommendations, fruit-flavoured drink consumption, interventions tailored to high-risk groups, and family engagement in childcare.
This research agenda lays the groundwork for research efforts to improve beverage patterns of young children. The methods used can be a template to develop research agendas for other public health issues.
Altica is a rare first-farming village site in the Basin of Mexico that has survived to modern times. Thus, it provides a glimpse into life during the Early–Middle Formative period. While valuable archaeological information on the village was recovered in excavation, only four burials comprising four individuals were recovered, a very small sample. Two individuals are older-aged females; the third, a middle-aged male, was accompanied by prestigious nonperishable goods and indicates that there are status differences even at this early date. The final individual was a young male buried in a deviant manner, suggesting possible foul play. While all individuals have indicators of periods of poor health, stable isotopes of carbon and nitrogen paint a more complete picture of the types of foods these individuals consumed over their lifetime. Radiogenic strontium isotopes of tooth enamel identify one individual, the young male buried in a deviant manner, as non-native to the Altica region. Thus, there is mystery in the manner of death, but even in this small sample, the wider connections Altica had that are so evident in the artefactual analysis are found in the skeletons. In addition, accelerator mass spectrometry radiocarbon dating provides a chronology of occupation through the people.
Skeletal remains from Tlajinga 33 (33:S3W1) have been the focus of research in the southern sector of Teotihuacan since excavations took place in the 1980s. Recent excavations in Tlajinga Compounds 17 and 18 (17:S3E1 and 18:S3E1, respectively), located along the southern Street of the Dead, recovered nine additional skeletons. This article is a description of the burials from Compounds 17 and 18 and a comparative analysis of health, diet, and chronology across all three compounds (Compounds 17, 18, and 33). Here, we test the hypothesis that individuals between residential compounds at Tlajinga lived similar lives and that health and biogeochemical markers of individuals will reflect these similarities. Although the sample size is small, the paleopathological analysis of individuals at Compounds 17 and 18 indicates morbidity patterns similar to Tlajinga 33, but also that these residents were perhaps less susceptible to stressors during periods of juvenile growth. Stable carbon and nitrogen isotopes suggest that, overall, diets were analogous across compounds, but Compounds 17 and 18 were able to supplement their diet with a greater variety of plant resources. There were no clear dietary differences between higher and lower status individuals, however. Finally, accelerated mass spectrometry radiocarbon (AMS 14C) dates indicate that residential living may have occurred later at Compound 18 than at Compound 17 and Tlajinga 33.
A survey was conducted at 88 sites in Montana in 1984 and 1985 to determine the distribution of Urophora affinis Frauenfeld and U. quadrifasciata (Meigen), two seed head flies released on spotted knapweed (Centaurea maculosa Lam. # CENMA) in North America. U. affinis, released in Montana during 1973 to 1977, was found at 40 of the 88 sites. The fly was concentrated within a short radius (about 5 to 8 km) of release sites, even at sites having well-established populations. U. quadrifasciata, released in British Columbia in 1972, but not in the United States, was found at 84 sites. The data suggest that the fly entered the state in the northwest corner and dispersed in a southeasterly direction. There was a strong positive relationship between mean number of galls per seed head and percent infestation for both fly species.
Leafy spurge (Euphorbia spp.), an aggressive noxious perennial weed of North America, is a complex group that has been designated as several different species, including E. esula L. (# EPHES) and E. virgata Wald. & Kit. [E. waldsteinii (Sojak) Radcliffe-Smith]. Current classification keys are unsatisfactory in assigning plants in the field to specific taxa (or to a single taxon). These keys rely heavily upon morphological characteristics of leaves, but great variation in the leaves has been noted by us and previously reported by others. In this study we demonstrate qualitatively and quantitatively that the within-plant, within-clone, among-clone, and among-site variation in leaf morphology and triterpenoid content of the latex of leafy spurge is inherently high. Leaf characters were of little value in separating any of the accessions considered in our study. Latex triterpenoid profiles were useful in distinguishing E. lucida W. & K. × salicifolia Host. and E. salicifolia from European E. esula, E. waldsteinii, and E. sequieriana Neck. ssp. seguieriana, and all Montana accessions previously described from morphological studies. We concluded that Montana leafy spurge and the European E. esula, E. waldsteinii, and E. sequieriana belong to a single taxon: Euphorbia esula L.
Spotted knapweed (Centaurea maculosa Lam. # CENMA) communities were sampled to determine the relationship between age and the number of root rings, and the population age structure. Spotted knapweed taproots add one ring of secondary xylem annually. In 1984, populations were expanding with high densities of individuals in the early age classes, followed by a steady decline in the older classes. In 1985, the majority of the individuals in knapweed populations were in the older age classes. This change in the population age structure was attributed to high mortality among the young age classes due to a drought in 1985. The maximum age class at the sites ranged from 5 to 9 yr. The percentage of plants with floral stalks increased with age to a peak of 75% in the fifth year in 1984 and in the seventh year in 1985.
Spotted knapweed is an important weed of rangeland in the northwestern United States. A study was conducted near Corvallis, MT, during 1992 to 1994 in order to assess the relationship among the growth attributes of spotted knapweed to identify a minimum set of measurable plant characteristics that are representative of spotted knapweed vigor. Spotted knapweed growth attributes that were examined included plant age, root diameter, plant height, number of stems per plant, aboveground biomass, number of capitula (seed heads) per plant, and number of capitula per stem. Spotted knapweed age was positively correlated with root diameter, number of stems per plant, aboveground biomass, and proportion of bolted plants. Most spotted knapweed plants did not bolt until the third or fourth year. Although plant age is not measured easily in the field, it may be useful as a covariate in an analysis of experiments involving plant competition or nonlethal biological control agents. Root diameter can be used as a nondestructive measure of approximate plant age, especially for the first 5 yr of growth. Root diameter was also highly correlated with many growth measurements, including number of capitula per plant and aboveground biomass, which are most relevant to assessing overall plant vigor. Plant height was positively correlated with aboveground biomass, number of capitula per plant, and mean number of capitula per stem. Number of stems per plant was positively correlated with plant height, aboveground biomass, and number of capitula per plant. Aboveground biomass was positively correlated to number of capitula per plant and mean number of capitula per stem. Measurements of root diameter, plant height, and number of stems are easy to perform and should provide a good indication of plant vigor.
The Antarctic Roadmap Challenges (ARC) project identified critical requirements to deliver high priority Antarctic research in the 21st century. The ARC project addressed the challenges of enabling technologies, facilitating access, providing logistics and infrastructure, and capitalizing on international co-operation. Technological requirements include: i) innovative automated in situ observing systems, sensors and interoperable platforms (including power demands), ii) realistic and holistic numerical models, iii) enhanced remote sensing and sensors, iv) expanded sample collection and retrieval technologies, and v) greater cyber-infrastructure to process ‘big data’ collection, transmission and analyses while promoting data accessibility. These technologies must be widely available, performance and reliability must be improved and technologies used elsewhere must be applied to the Antarctic. Considerable Antarctic research is field-based, making access to vital geographical targets essential. Future research will require continent- and ocean-wide environmentally responsible access to coastal and interior Antarctica and the Southern Ocean. Year-round access is indispensable. The cost of future Antarctic science is great but there are opportunities for all to participate commensurate with national resources, expertise and interests. The scope of future Antarctic research will necessitate enhanced and inventive interdisciplinary and international collaborations. The full promise of Antarctic science will only be realized if nations act together.
We describe the performance of the Boolardy Engineering Test Array, the prototype for the Australian Square Kilometre Array Pathfinder telescope. Boolardy Engineering Test Array is the first aperture synthesis radio telescope to use phased array feed technology, giving it the ability to electronically form up to nine dual-polarisation beams. We report the methods developed for forming and measuring the beams, and the adaptations that have been made to the traditional calibration and imaging procedures in order to allow BETA to function as a multi-beam aperture synthesis telescope. We describe the commissioning of the instrument and present details of Boolardy Engineering Test Array’s performance: sensitivity, beam characteristics, polarimetric properties, and image quality. We summarise the astronomical science that it has produced and draw lessons from operating Boolardy Engineering Test Array that will be relevant to the commissioning and operation of the final Australian Square Kilometre Array Path telescope.
Indonesia has the highest human mortality from highly pathogenic avian influenza (HPAI) A (H5N1) virus infection in the world.
A survey of households (N=2520) measured treatment sources and beliefs among symptomatic household members. A survey of physicians (N=554) in various types of health care facilities measured knowledge, assessment and testing behaviors, and perceived clinical capacity.
Households reported confidence in health care system capacity but infrequently sought treatment for potential HPAI H5N1 signs/symptoms. More clinicians were confident in their knowledge of diagnosis and treatment than in the adequacy of related equipment and resources at their facilities. Physicians expressed awareness of the HPAI H5N1 suspect case definition, yet expressed only moderate knowledge in questioning symptomatic patients about exposures. Self-reported likelihood of testing for HPAI H5N1 virus was high after learning of certain exposures. Knowledge of antiviral treatment was moderate, but it was higher among clinicians in puskesmas. Physicians in private outpatient clinics, the most heavily used facilities, reported the lowest confidence in their diagnostic and treatment capabilities.
Educational campaigns can encourage recall of possible poultry exposure when patients are experiencing signs/symptoms and can raise awareness of the effectiveness of antivirals to drive people to seek health care. Clinicians may benefit from training regarding exposure assessment and referral procedures, particularly in private clinics. (Disaster Med Public Health Preparedness. 2016;10:838–847)
Not only is depression associated with increased inflammation but inflammation is a risk factor for the genesis of depression. Many of the environmental risk factors for depression are transduced through inflammatory signaling. Anti-inflammatory agents show promise for the management of depression in preclinical, epidemiological, and early clinical studies. This opens the door to the potential for anti-inflammatory agents to treat and prevent depression. There are no evidence-based pharmacotherapies for depression prevention.
ASPREE-D, aspirin in the prevention of depression in the elderly, is a sub study of ASPREE, which explores the potential of aspirin to prevent a range of inflammation related disorders in the elderly. With a sample size of 19,114, and a duration of 5 years, this placebo controlled study will be one of the largest randomized controlled trials in psychiatry and will provide definitive evidence on the ability of aspirin to prevent depression.
This paper presents the rationale for the study and presents a summary of the study design.
ASPREE-D may not only define novel therapy but will provide mechanistic proof of concept of the role of inflammation in depression.
Our knowledge of the universe comes from recording the photon and particle fluxes incident on the Earth from space. We thus require sensitive measurement across the entire energy spectrum, using large telescopes with efficient instrumentation located on superb sites. Technological advances and engineering constraints are nearing the point where we are recording as many photons arriving at a site as is possible. Major advances in the future will come from improving the quality of the site. The ultimate site is, of course, beyond the Earth’s atmosphere, such as on the Moon, but economic limitations prevent our exploiting this avenue to the degree that the scientific community desires. Here we describe an alternative, which offers many of the advantages of space for a fraction of the cost: the Antarctic Plateau.
Conditions on the high Antarctic Plateau would appear to be extremely favourable for a wide range of astronomical research. Before a decision can be made on constructing an observatory, data are required on site conditions at the most promising locations. To enable these data to be collected, a Lockheed Automated Geophysical Observatory is being purchased. This facility will be fitted with a suite of astronomical site-testing instruments, and deployed to several sites on the Antarctic Plateau. This program will allow a definitive assessment of the site conditions to be made by the end of this century.
The University of NSW’s Automated Patrol Telescope is a modified Baker-Nunn satellite tracking camera, now used for CCD imaging of astronomical objects. The f/1 Baker-Nunn optical design gives a 30° field of view with an approximately spherical focal surface of radius ≈500 mm. While the focal plane curvature is tolerable across the 1.4° × 1.0° field of the present CCD, it becomes unacceptable when a larger CCD is used. In addition, the use of glass filters in the highly convergent beam produces intolerable spherical aberration. We present a design modification to the original Baker-Nunn which enables a 5° diameter flat field to be produced when using B, V, R or I filters. By making this modification, we plan to perform multicolour imaging, using a new large-format CCD with a 2.9° × 1.9° field of view.