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Time constraints have been suggested as a potential driver of antibiotic overuse for acute respiratory tract infections. In this cross-sectional analysis of national data from visits to offices and emergency departments, we identified no statistically significant association between antibiotic prescribing and the duration of visits for acute respiratory tract infections.
In March 2020, at the onset of the coronavirus disease 2019 (COVID-19) pandemic in the United States, the Southern California Extracorporeal Membrane Oxygenation (ECMO) Consortium was formed. The consortium included physicians and coordinators from the four ECMO centers in San Diego County. Guidelines were created to ensure that ECMO was delivered equitably and in a resource effective manner across the county during the pandemic. A biomedical ethicist reviewed the guidelines to ensure ECMO utilization would provide maximal community benefit of this limited resource. The San Diego County Health and Human Services Agency further incorporated the guidelines into its plans for the allocation of scarce resources. The consortium held weekly video conferences to review countywide ECMO capacity (including census and staffing), share data, and discuss clinical practices and difficult cases. Equipment exchanges between ECMO centers maximized regional capacity. From March 1 to November 30, 2020, consortium participants placed 97 patients on ECMO. No eligible patients were denied ECMO due to lack of resources or capacity. The Southern California ECMO Consortium may serve as a model for other communities seeking to optimize ECMO resources during the current COVID-19 or future pandemics.
The public health crisis of COVID-19 has compounded preexisting crises of democratic stability and effective governance, spurring debate about the ability of developed democracies to respond effectively to emergencies confronting their citizens. These crises, much discussed in recent political science, are joined by a further crisis which complicates and reinforces them: A migration crisis. Widespread travel and immigration restrictions instigated the largest and fastest decline in global human mobility in modern history, and COVID-19 may fundamentally change immigration over the longer term.
The migration crisis heightens three crucial and preexisting concerns within immigration policy: the role of visa design; the status of undocumented migrants and other migrants without recourse to public funds; and the interaction of immigration and the labor market policy. It could reinforce a rising tide of nationalism and anti-immigrant sentiment, protectionist sentiment within labor-market policy debates, and a K-shaped recovery in migration patterns.
Diagnosis of CHD substantially affects parent mental health and family functioning, thereby influencing child neurodevelopmental and psychosocial outcomes. Recognition of the need to proactively support parent mental health and family functioning following cardiac diagnosis to promote psychosocial adaptation has increased substantially over recent years. However, significant gaps in knowledge remain and families continue to report critical unmet psychosocial needs. The Parent Mental Health and Family Functioning Working Group of the Cardiac Neurodevelopmental Outcome Collaborative was formed in 2018 through support from an R13 grant from the National Heart, Lung, and Blood Institute to identify significant knowledge gaps related to parent mental health and family functioning, as well as critical questions that must be answered to further knowledge, policy, care, and outcomes. Conceptually driven investigations are needed to identify parent mental health and family functioning factors with the strongest influence on child outcomes, to obtain a deeper understanding of the biomarkers associated with these factors, and to better understand how parent mental health and family functioning influence child outcomes over time. Investigations are also needed to develop, test, and implement sustainable models of mental health screening and assessment, as well as effective interventions to optimise parent mental health and family functioning to promote psychosocial adaptation. The critical questions and investigations outlined in this paper provide a roadmap for future research to close gaps in knowledge, improve care, and promote positive outcomes for families of children with CHD.
Cycling is a sport characterised by high training load and adequate nutrition is essential for training and race performance. With increased popularity of indoor trainers, cyclists have a unique opportunity to practice and implement key nutritional strategies. This study aimed to assess carbohydrate intake and nutrition knowledge of cyclists training or racing in this unique scenario for optimising exercise nutrition. A mixed-methods approach consisting of a multiple-pass self-report food recall and questionnaire was used to determine total carbohydrate intake pre, during and post training or racing using a stationary trainer and compared to current guidelines for endurance exercise. Sub-analyses were also made for higher ability cyclists (>4.W.kg−1 functional threshold power), races vs. non-races and ‘key’ training sessions. Mean CHO intake pre and post ride was 0.7±0.6 and 1.0±0.8 g.kgBM−1 and 39.3±27.5 g.h−1 during. Carbohydrate intake was not different for races (pre/during/post, p=0.31, 0.23, 0.18 respectively), ‘key sessions’ (p=0.26, 0.89, 0.98), or higher ability cyclists (p=0.26, 0.76, 0.45). The total proportion of cyclists who failed to meet CHO recommendations was higher than those who met guidelines (pre=79%, during=86%, post=89%). Cyclists training or racing indoors do not meet current CHO recommendations for cycling performance. Due to the short and frequently high-intensity nature of some sessions, opportunity for during exercise feeding may be limited or unnecessary.
The basis for terrestrial life in Aristotle’s biology is the nutritive process by which living things (plants and animals) produce and maintain their uniform parts and the organs made of these uniform parts. The nutritive process is thus extremely general, across all kinds. But it is also general in being present in all stages of the life cycle. Thus, it starts with the beginning of life, increases as the living thing grows, and subsides and is extinguished with the end of life. This variation in quantity is possible because there are two sides to the process, one is the heat necessary for “cooking” food into the parts of the living thing, and the other is the soul which informs this cooking. While the heat can be more or less, the soul is either there or not. The process of feeding (trephein) is shown to be Aristotle’s single sufficient and necessary condition for all natural life. It is the assimilation of food (trophê) to the living thing in question, an activity which the soul performs, thus producing and maintaining the living body, using the body’s heat as an instrument to work on food.
How can political science classes best prepare undergraduate students for the field of peace and conflict studies (PACS)? We argue that well-designed experiential learning activities provide opportunities for students to embrace complexity and practice adaptability, fusing the theoretical and practical in ways that prepare them to engage in PACS. This article presents one such experiential learning approach: a conflict analysis activity. Through engaging in a messy learning process, students (1) gain an increased theoretical understanding of the complexity of conflict, (2) practice adaptability, and (3) increase their self-efficacy. We provide a step-by-step description of the Conflict Analysis Tool exercise and reflect on how well the activity enables the use of knowledge and skills relevant for PACS. Our goal is that the insights gained through our approach will be helpful to other educators—from PACS to international relations to American politics and beyond.
Introducing the special issue, this paper provides a state-of-the-art on established and new trends in the study of international retirement migration (IRM) and summarises the five papers that follow. Early studies on IRM were mainly within Europe and drew on the conceptual framework of lifestyle migration, with some reference to the transnational and mobilities paradigms. New frontiers in IRM are presented under three heads. Firstly, new geographical frontiers extend IRM to new destinations within and proximate to Europe, and to new locations in the global South such as Thailand and Ecuador. Secondly, new typological frontiers involve a broadening of the class and wealth backgrounds of the retirees, including the ‘return of retirement’ of labour migrants to their countries of origin, and attentiveness to IRM's gendered aspects. Thirdly, new conceptual and theoretical frontiers of IRM involve a more in-depth investigation of its transnational aspects, exploration of the various regimes of mobility and, most importantly, a political economy perspective which stresses global inequalities and histories of colonialism in shaping access to privileged lifestyles. In the final part of the paper, the original features of each paper in the special issue are highlighted, demonstrating how they are collectively integrated and contribute to the advancement of IRM research.
Concerns have been raised about the utility of self-report assessments in predicting future suicide attempts. Clinicians in pediatric emergency departments (EDs) often are required to assess suicidal risk. The Death Implicit Association Test (IAT) is an alternative to self-report assessment of suicidal risk that may have utility in ED settings.
A total of 1679 adolescents recruited from 13 pediatric emergency rooms in the Pediatric Emergency Care Applied Research Network were assessed using a self-report survey of risk and protective factors for a suicide attempt, and the IAT, and then followed up 3 months later to determine if an attempt had occurred. The accuracy of prediction was compared between self-reports and the IAT using the area under the curve (AUC) with respect to receiver operator characteristics.
A few self-report variables, namely, current and past suicide ideation, past suicidal behavior, total negative life events, and school or social connectedness, predicted an attempt at 3 months with an AUC of 0.87 [95% confidence interval (CI), 0.84–0.90] in the entire sample, and AUC = 0.91, (95% CI 0.85–0.95) for those who presented without reported suicidal ideation. The IAT did not add significantly to the predictive power of selected self-report variables. The IAT alone was modestly predictive of 3-month attempts in the overall sample ((AUC = 0.59, 95% CI 0.52–0.65) and was a better predictor in patients who were non-suicidal at baseline (AUC = 0.67, 95% CI 0.55–0.79).
In pediatric EDs, a small set of self-reported items predicted suicide attempts within 3 months more accurately than did the IAT.
What should be revitalized? This chapter considers possible targets for revitalization, taking into account factors such as available resources, whether the language is still spoken, in what domains and by whom. Different people in language revitalization movements have different aims and motivations, and choices must be made about what varieties should be prioritized (including elements of language such as topics, registers and vocabulary). The needs and desires of new and old speakers need to be balanced, with compromises between those who want to preserve a ‘pure’ variety of language and what people actually do - particularly new speakers, as the language expands into new domains and new terminology is needed. In the capsules, an activist describes his realisation that for revitalization purposes he needed to give up looking for ‘the pure Wymysiöeryś language’ and start listening to what people were actually saying. Purist attitudes to Spanish influence on Nahuatl are explored, showing how they had counter-productive effects on language survival. Some activists are now starting to encourage young people to create neologisms from within the heritage language.
Targeted drug development efforts in patients with CHD are needed to standardise care, improve outcomes, and limit adverse events in the post-operative period. To identify major gaps in knowledge that can be addressed by drug development efforts and provide a rationale for current clinical practice, this review evaluates the evidence behind the most common medication classes used in the post-operative care of children with CHD undergoing cardiac surgery with cardiopulmonary bypass.
We systematically searched PubMed and EMBASE from 2000 to 2019 using a controlled vocabulary and keywords related to diuretics, vasoactives, sedatives, analgesics, pulmonary vasodilators, coagulation system medications, antiarrhythmics, steroids, and other endocrine drugs. We included studies of drugs given post-operatively to children with CHD undergoing repair or palliation with cardiopulmonary bypass.
We identified a total of 127 studies with 51,573 total children across medication classes. Most studies were retrospective cohorts at single centres. There is significant age- and disease-related variability in drug disposition, efficacy, and safety.
In this study, we discovered major gaps in knowledge for each medication class and identified areas for future research. Advances in data collection through electronic health records, novel trial methods, and collaboration can aid drug development efforts in standardising care, improving outcomes, and limiting adverse events in the post-operative period.
Tim Groenland's The Art of Editing is an exciting new addition to the field of literary sociology, making a valuable contribution to a discipline which has seen a resurgence since the turn of the millennium. In his seminal early work in the field, John Sutherland traces the origins of this kind of publishing history to Robert Escarpit's Sociology of Literature (1958), which he describes as the beginning of “modern, serious work” in considering the effects of the literary marketplace on the fiction of a particular era. However, it is the first two decades of the twenty-first century that have seen the most significant growth in sociological studies of literary production, a trend that Alan Liu calls “the resurgent history of the book.” This is a “resurgence” that Liu argues has resulted in “restoring to view … vital nodes in the circuit” of literary production, including “editors, publishers, translators, booksellers,” and many others. This recent growth in scholarly interest in the production and circulation of literary texts includes other significant figures such as James F. English, Mark McGurl, John B. Thompson, Loren Glass, Paul Crosthwaite, and David D. Hall.