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One of Tom Dishion's most significant contributions to prevention science was the development of affordable, ecologically valid interventions, such as the Family Check-Up, that screen for child and family risk factors broadly, but concentrate family-specific interventions on those with greatest potential for population impact. In the spirit of this approach, investigators examined effects of a brief, universal postnatal home visiting program on child emergency medical care and billing costs from birth to age 24 months. Family Connects is a community-wide public health intervention that combines identification and alignment of community services and resources with brief, postpartum nurse home visits designed to assess risk, provide supportive guidance, and connect families with identified risk to community resources. Over 18 months, families of all 4,777 resident Durham County, North Carolina, births were randomly assigned based on even or odd birth date to receive a postnatal nurse home visiting intervention or services as usual (control). Independently, 549 of these families were randomly selected and participated in an impact evaluation study. Families, blind to study goals, provided written consent to access hospital administrative records. Results indicate that children randomly assigned to Family Connects had significantly less total emergency medical care (by 37%) through age 24 months, with results observed across almost all subgroups. Examination of billing records indicate a $3.17 decrease in total billing costs for each $1 in program costs. Overall, results suggest that community-wide postpartum support program can significantly reduce population rates of child emergency medical care through age 24 months while being cost-beneficial to communities.
How to restore citizens’ trust and cooperation with the police in the wake of civil war? We report results from an experimental evaluation of the Liberian National Police’s (LNP) “Confidence Patrols” program, which deployed teams of newly retrained, better-equipped police officers on recurring patrols to rural communities across three Liberian counties over a period of 14 months. We find that the program increased knowledge of the police and Liberian law, enhanced security of property rights, and reduced the incidence of some types of crime, notably simple assault and domestic violence. The program did not, however, improve trust in the police, courts, or government more generally. We also observe higher rates of crime reporting in treatment communities, concentrated almost entirely among those who were disadvantaged under prevailing customary mechanisms of dispute resolution. We consider implications of these findings for post-conflict policing in Liberia and weak and war-torn states more generally.
Population-based registries report 95% 5-year survival for children undergoing surgery for CHD. This study investigated paediatric cardiac surgical outcomes in the Australian indigenous population.
All children who underwent cardiac surgery between May, 2008 and August, 2014 were studied. Demographic information including socio-economic status, diagnoses and co-morbidities, and treatment and outcome data were collected at time of surgery and at last follow-up.
A total of 1528 children with a mean age 3.4±4.6 years were studied. Among them, 123 (8.1%) children were identified as indigenous, and 52.7% (62) of indigenous patients were in the lowest third of the socio-economic index compared with 28.2% (456) of non-indigenous patients (p⩽0.001). The indigenous sample had a significantly higher Comprehensive Aristotle Complexity score (indigenous 9.4±4.2 versus non-indigenous 8.7±3.9, p=0.04). The probability of having long-term follow-up did not differ between groups (indigenous 93.8% versus non-indigenous 95.6%, p=0.17). No difference was noted in 30-day mortality (indigenous 3.2% versus non-indigenous 1.4%, p=0.13). The 6-year survival for the entire cohort was 95.9%. The Cox survival analysis demonstrated higher 6-year mortality in the indigenous group – indigenous 8.1% versus non-indigenous 5.0%; hazard ratio (HR)=2.1; 95% confidence intervals (CI): 1.1, 4.2; p=0.03. Freedom from surgical re-intervention was 79%, and was not significantly associated with the indigenous status (HR=1.4; 95% CI: 0.9, 1.9; p=0.11). When long-term survival was adjusted for the Comprehensive Aristotle Complexity score, no difference in outcomes between the populations was demonstrated (HR=1.6; 95% CI: 0.8, 3.2; p=0.19).
The indigenous population experienced higher late mortality. This apparent relationship is explained by increased patient complexity, which may reflect negative social and environmental factors.
We present simulation results from a version of the Regional Ocean Modeling System modified for ice shelf/ocean interaction, including the parameterisation of basal melting by molecular diffusion alone. Simulations investigate the differences in melting for an idealised ice shelf experiencing a range of cold to hot ocean cavity conditions. Both the pattern of melt and the location of maximum melt shift due to changes in the buoyancy-driven circulation, in a different way to previous studies. Tidal forcing increases both the circulation strength and melting, with the strongest impact on the cold cavity case. Our results highlight the importance of including a complete melt parameterisation and tidal forcing. In response to the 2.4°C ocean warming initially applied to a cold cavity ice shelf, we find that melting will increase by about an order of magnitude (24 × with tides and 41 × without tides).
The pandemic of carbapenem-resistant Enterobacteriaceae (CRE) was primarily due to clonal spread of blaKPC producing Klebsiella pneumoniae. Thus, thoroughly studied CRE cohorts have consisted mostly of K. pneumoniae.
To conduct an extensive epidemiologic analysis of carbapenem-resistant Enterobacter spp. (CREn) from 2 endemic and geographically distinct centers.
CREn were investigated at an Israeli center (Assaf Harofeh Medical Center, January 2007 to July 2012) and at a US center (Detroit Medical Center, September 2008 to September 2009). blaKPC genes were queried by polymerase chain reaction. Repetitive extragenic palindromic polymerase chain reaction and pulsed-field gel electrophoresis were used to determine genetic relatedness.
In this analysis, 68 unique patients with CREn were enrolled. Sixteen isolates (24%) were from wounds, and 33 (48%) represented colonization only. All isolates exhibited a positive Modified Hodge Test, but only 93% (27 of 29) contained blaKPC. Forty-three isolates (63%) were from elderly adults, and 5 (7.4%) were from neonates. Twenty-seven patients died in hospital (40.3% of infected patients). Enterobacter strains consisted of 4 separate clones from Assaf Harofeh Medical Center and of 4 distinct clones from Detroit Medical Center.
In this study conducted at 2 distinct CRE endemic regions, there were unique epidemiologic features to CREn: (i) polyclonality, (ii) neonates accounting for more than 7% of cohort, and (iii) high rate of colonization (almost one-half of all cases represented colonization). Since false-positive Modified Hodge Tests in Enterobacter spp. are common, close monitoring of carbapenem resistance mechanisms (particularly carbapenemase production) among Enterobacter spp. is important.
Infect. Control Hosp. Epidemiol. 2015;36(11):1283–1291
CHD is frequently associated with a genetic syndrome. These syndromes often present specific cardiovascular and non-cardiovascular co-morbidities that confer significant peri-operative risks affecting multiple organ systems. Although surgical outcomes have improved over time, these co-morbidities continue to contribute substantially to poor peri-operative mortality and morbidity outcomes. Peri-operative morbidity may have long-standing ramifications on neurodevelopment and overall health. Recognising the cardiovascular and non-cardiovascular risks associated with specific syndromic diagnoses will facilitate expectant management, early detection of clinical problems, and improved outcomes – for example, the development of syndrome-based protocols for peri-operative evaluation and prophylactic actions may improve outcomes for the more frequently encountered syndromes such as 22q11 deletion syndrome.
A wetland deposit from the southern Appalachian mountains of North Carolina, USA, has been radiocarbon dated and shows continuous deposition from the early Holocene to the present. Non-coastal records of Holocene paleoenvironments are rare from the southeastern USA. Increased stable carbon isotope ratios (?13C) of sedimentary organic matter and pollen percentages indicate warm, dry early- to mid-Holocene conditions. This interpretation is also supported by n-alkane biomarker data and bulk sedimentary C/N ratios. These warm, dry conditions coincide with a mid-Holocene hypsithermal, or altithermal, documented elsewhere in North America. Our data indicate that the southeastern USA warmed concurrently with much of the rest of the continent during the mid-Holocene. If the current "warming hole" in the southeastern USA persists, during a time of greenhouse gas-induced warming elsewhere, it will be anomalous both in space and time.
We have developed a new method for controlling the size, crystallinity, and polydispersity of 100–2000 nm tetrafluoride phosphor particles. Five polyol-based deep eutectic solvents (DESs) were downselected out of a set of more than 130 candidates. We analyzed their benefits in synthesizing phosphor matrix particles of β-NaYF4, β-NaYbF4, and β-NaGdF4. We produced green (λmax = 540 nm) and blue/UV (λmax = 450 nm) upconverting phosphors in DES using Yb,Er and Yb,Tm codopants, respectively. The blue/UV phosphor reaction was scaled the up to 25 L, yielding nearly 400 g of high-quality, bright photoluminescent, β-phase product under mild conditions. We conclude that polyol-based DES systems offer a uniquely specialized and useful toolkit for phosphor synthesis.