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OBJECTIVES/GOALS: Trichomonas vaginalis (TV) has a prevalence of 26% in Baltimore and is associated with preterm delivery (PTD). Yet screening and treatment of TV is not advised due to conflicting data on harms. Our goal is to investigate the association between asymptomatic TV treatment and PTD. METHODS/STUDY POPULATION: This is a retrospective cohort study of women who delivered a child at The Johns Hopkins Hospital between 7/1/16 – 11/19/19. Exclusion criteria included multiple gestation, stillborn, miscarriage, diabetes, hypertension/ preeclampsia, HIV, and history of PTD. Chart review and ICD-10 diagnosis codes were used to collect data on demographics, STI test results, lab encounter diagnoses, STI treatment during pregnancy, and labor encounter diagnoses. Preliminary analysis for crude incidence of PTD in asymptomatic and symptomatic women treated for TV was performed using TriNetx, a global research network compiling all de-identified data within the Hopkins system. RESULTS/ANTICIPATED RESULTS: Three hundred and eighty women were tested for TV, 240 (63%) were asymptomatic and 140 (37%) women were symptomatic. Mean ages were 26 (SD:5) and 26 (SD:5) years, respectively. Black women comprised 87% of the asymptomatic cohort and 93% of the symptomatic cohort. Women of Hispanic ethnicity were represented by 4% of the asymptomatic cohort and 7% of the symptomatic cohort. Crude incidence of PTD was 4.1% among asymptomatic women and 7.1% among symptomatic women. Incidence ratio comparing asymptomatic PTD incidence to symptomatic PTD incidence was 0.58 with 95% CI (0.22, 1.56). DISCUSSION/SIGNIFICANCE OF IMPACT: Preliminary data from our study suggests there is no difference in PTD between asymptomatic and symptomatic women treated for TV. Future steps include multiple linear regression using a larger dataset. These preliminary data suggest TV should be considered for screening during pregnancy.
Competition and cooperation are the two fundamental mechanisms of service procurement in the NHS and represent the tools for ‘getting things done’. This chapter presents empirical findings from a longitudinal, qualitative case study research project into the use of competition and cooperation by local NHS commissioners following the HSCA 2012.
As outlined in Chapter 2, the economics of markets (and their opposite, hierarchies) in conjunction with more sophisticated theories of cooperation underpin the analysis of competition and cooperation in the NHS quasi-market. For a market to operate competitively, there needs to be sufficient numbers of buyers and sellers of goods and services. A key assumption is that purchasers have sufficient information about the goods or services to make rational choices and maximise their utility. The market will produce value for money by allocating resources to the best use at the most efficient price (Allen, 2013).
Competition in the NHS is realised through several models. Competition for the market is a result of tendering processes whereby different providers compete to deliver a particular service and one provider wins the whole market. Competition within the market exists when a number of providers are accredited to provide a particular service and they compete to attract patients. An example of the competition for the market is tendering out of community health services, and an example of competition within the market is the patient choice of elective secondary or community-based care.
In order to analyse cooperation the theory of ‘co-opetition’ and the work of Elinor Ostrom (2005) are utilised. Co-opetition suggests that organisations can compete and cooperate simultaneously to mutual benefit (Brandenburger and Nalebuff, 1996). Ostrom suggests that individuals can self-organise to solve collective problems, without direct control by the government, and can establish and enforce rules limiting the appropriation of common pool resources.
In terms of defining cooperation, there are a number of closely related terms such as collaboration, coordination, integrated care, networking and partnership. Integrated care implies the coordination of separate but interconnected components which should function together to perform a shared task (Kodner and Spreeuwenberg, 2002).
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.
To help eliminate perinatal HIV transmission, the US Department of Health and Human Services recommends against breastfeeding for women living with HIV, regardless of viral load or combined antiretroviral therapy (cART) status. However, cART radically improves HIV prognosis and virtually eliminates perinatal transmission, and breastfeeding's health benefits are well-established. In this setting, pregnancy is increasing among American women with HIV, and a harm reduction approach to those who breastfeed despite extensive counseling is suggested. We assess the evidence and ethical justification for current policy, with attention to pertinent racial and health disparities. We first review perinatal transmission and breastfeeding data relevant to US infants. We compare hypothetical risk of HIV transmission from breastmilk to increased mortality from sudden infant death syndrome, necrotizing enterocolitis and sepsis from avoiding breastfeeding, finding that benefits may outweigh risks if mothers maintain undetectable viral load on cART. We then review maternal health considerations. We conclude that avoidance of breastfeeding by women living with HIV may not maximize health outcomes and discuss our recommendation for revising national guidelines in light of autonomy, harm reduction and health inequities.
Evidence suggests a role of Mg and the ratio of Ca:Mg intakes in the prevention of colonic carcinogenesis. The association between these nutrients and oesophageal adenocarcinoma – a tumour with increasing incidence in developed countries and poor survival rates – has yet to be explored. The aim of this investigation was to explore the association between Mg intake and related nutrients and risk of oesophageal adenocarcinoma and its precursor conditions, Barrett’s oesophagus and reflux oesophagitis. This analysis included cases of oesophageal adenocarcinoma (n 218), Barrett’s oesophagus (n 212), reflux oesophagitis (n 208) and population-based controls (n 252) recruited between 2002 and 2005 throughout the island of Ireland. All the subjects completed a 101-item FFQ. Unconditional logistic regression analysis was applied to determine odds of disease according to dietary intakes of Mg, Ca and Ca:Mg ratio. After adjustment for potential confounders, individuals consuming the highest amounts of Mg from foods had significant reductions in the odds of reflux oesophagitis (OR 0·31; 95 % CI 0·11, 0·87) and Barrett’s oesophagus (OR 0·29; 95 % CI 0·12, 0·71) compared with individuals consuming the lowest amounts of Mg. The protective effect of Mg was more apparent in the context of a low Ca:Mg intake ratio. No significant associations were observed for Mg intake and oesophageal adenocarcinoma risk (OR 0·77; 95 % CI 0·30, 1·99 comparing the highest and the lowest tertiles of consumption). In conclusion, dietary Mg intakes were inversely associated with reflux oesophagitis and Barrett’s oesophagus risk in this Irish population.
This editorial explores the implications of social media practices whereby
people with mental health problems share their experiences in online public
spaces and challenge mental health stigma. Social media enable individuals
to bring personal experience into the public domain with the potential to
affect public attitudes and mainstream media. We draw tentative conclusions
regarding the use of social media by campaigning organisations.
The straw itch mite, Pyemotes tritici Lagrèze-Fossat and Montané (Acari: Pyemotidae), was discovered parasitising the goldspotted oak borer, Agrilus auroguttatus Schaeffer (Coleoptera: Buprestidae), an invasive exotic species to California, United States of America, and the Mexican goldspotted oak borer, Agrilus coxalis Waterhouse (Coleoptera: Buprestidae), during surveys for natural enemies for a classical biological control programme for A. auroguttatus. Pyemotes tritici caused low levels of mortality to each species of flatheaded borer, but it will likely not be a good candidate for a biological control programme because it is a generalist parasitoid with deleterious human health effects.
Long-term monitoring programmes of a comparatively small area complement larger scale, but temporally limited surveys and can provide extensive datasets on seasonal occurrence and fine-scale habitat use of multiple species. A marine mammal monitoring programme, involving year-round, land-based observations, has been conducted in Broadhaven Bay candidate Special Area of Conservation, north-west Ireland, during 2002, 2005 and 2008–2011. Nine cetacean and two seal species have been recorded, with grey seal, harbour porpoise, common and bottlenose dolphins, and minke whale present throughout the year. Generalized additive models, taking into account observer effort, sighting conditions (sea state) and interannual variation, did not reveal any significant seasonal patterns in the occurrence of grey seals, bottlenose dolphins and minke whales. On the other hand, common dolphin presence in Broadhaven Bay was highest during autumn and winter. Bottlenose dolphins could be separated spatially from both common dolphins and minke whales in a classification tree by their preferential use of the shallower inshore areas of the bay (<30 m depth). However, common dolphins and minke whales, which occurred mainly in the deeper outer section of Broadhaven Bay, could not be spatially distinguished from each other, and grey seals were distributed over the entire bay. Broadhaven Bay represents an important marine mammal habitat with respect to overall species diversity and the regular occurrence of bottlenose dolphin, harbour porpoise, grey and harbour seals (all listed under Annex II of the EU Habitats Directive).
In recent decades, invasive phloem and wood borers have become important pests in North America. To aid tree sampling and survey efforts for the newly introduced goldspotted oak borer, Agrilus auroguttatus Schaeffer (Coleoptera: Buprestidae), we examined spatial patterns of exit holes on the boles (trunks) of 58 coast live oak, Quercus agrifolia Née (Fagaceae), trees at five sites in San Diego County, southern California, United States of America. Agrilus auroguttatus exit hole densities were greater at the root collar than at mid-boles (6.1 m above ground). Dispersion patterns of exit holes on lower boles (≤1.52 m) were random for trees with low exit hole densities and aggregated for trees with high exit hole densities. The mean exit hole density measured from three randomly chosen quadrats (0.09 m2) provided a statistically reliable estimate of the true mean exit hole density on the lower bole, with <25% error from the true mean. For future sampling and survey efforts in southern California oak forests and woodlands, exit hole counts within a 0.09 m2 quadrat could be made at any three locations on lower Q. agrifolia boles to accurately estimate A. auroguttatus exit hole densities at the individual tree level.
This paper reports a study of the religious, spiritual and philosophical responses to spouse bereavement. Twenty-five bereaved spouses aged 60 or more years living in the south of England and from Christian backgrounds were followed from the first to the second anniversary of the loss. The participants expressed a range of attitudes, from devout religious belief to well-articulated secular conceptions of the meaning of life, but the largest group had moderate spiritual beliefs that were characterised by doubts as much as hopes. Uncertain faith was more often associated with depressive symptoms and low levels of experienced meaning. Nine case studies are presented that illustrate different levels of adjustment to bereavement and both changing and stable expressions of faith across the one year of observation. Attention is drawn to the importance of both secular agencies and religious organisations developing a better understanding of older people's spiritual responses to loss. Although to many British older people, practise of the Christian faith may be less evident now than in their childhood, quality of life assessment should not ignore sources of spiritual satisfaction and dissatisfaction. Moreover, previous and especially early-life religious experiences provide useful points of reference for understanding present religious and spiritual attitudes. The study suggests that there may be a substantial need for pastoral counselling among today's older people, especially those of uncertain or conflicted belief.
From its foundation in 1930 until the end of 1934 the Irish Hospitals Sweepstake sold the overwhelming majority of its tickets in Great Britain. Alarmed at the success of an enterprise that was illegal in its jurisdiction and that resulted in a considerable financial drain to the Irish Free State’s hospital service, the British government enacted a Betting and Lotteries Act in 1934 to curtail the sale of Irish sweepstake tickets there. The result was a substantial decline in British contributions to the sweepstake and in the overall income from ticket sales. The British action threatened the continued existence and success of the venture.