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This case study presents an analysis of community-driven partnerships, focusing on the nonprofit Baltimore CONNECT (BC) network and its collaborative efforts with a Community-Engaged Research (CEnR) team of the Johns Hopkins Institute for Clinical and Translational Research (ICTR). BC has built a network of over 30 community-based organizations to provide health and social services in Baltimore City. The study emphasizes the role of CEnR in supporting community-led decision-making, specifically in the planning and implementation of community health resource fairs. These fairs address social determinants of health by offering a variety of services, including health education, screenings, vaccinations, and resource distribution. The paper details the methods, resource mobilization, and collaborative framing processes in the execution of these fairs in a community-academic collaboration with the ICTR. Results from a 2.5-year period show the positive impact of the fairs on individuals, families, and the community at large in East Baltimore. The findings underscore the importance of community-led collaborations in addressing health disparities and improving overall community well-being. It concludes by reflecting on the sustained engagement, trust-building, and shared learning that emerges from such partnerships, suggesting a model for future community-academic health initiatives.
Collision of two counterflowing gravity currents of equal densities and heights was investigated by means of three-dimensional high-resolution simulations with the goal of understanding the flow structures and energetics in the collision region in more detail. The lifetime of collision is approximately $3 \tilde {H}/\tilde {u}_f$, where $\tilde {H}$ is the depth of heavy and ambient fluids, and $\tilde {u}_f$ is the front velocity of the approaching gravity currents, and the lifetime of collision can be divided into three phases. During Phase I, $-0.2 \leqslant (\tilde {t}-\tilde {t}_c) \tilde {u}_f/\tilde {H} \leqslant 0.5$, where $\tilde {t}$ is the time, and $\tilde {t}_c$ is the time instance at which the two colliding gravity currents have fully osculated, geometric distortions of the gravity current fronts result in stretching of pre-existing vorticity in the wall-normal direction inside the fronts, and an array of vertical vortices extending throughout the updraught fluid column develop along the interface separating the two colliding gravity currents. The array of vertical vortices is responsible for the mixing between the heavy fluids of the two colliding gravity currents and for the production of turbulent kinetic energy in the collision region. The presence of the top boundary deflects the updraughts into the horizontal direction, and a number of horizontal streamwise vortices are generated close to the top boundary. During Phase II, $0.5 \leqslant (\tilde {t}-\tilde {t}_c) \tilde {u}_f/\tilde {H} \leqslant 1.2$, the horizontal streamwise vortices close to the top boundary induce turbulent buoyancy flux and break up into smaller structures. While the production of turbulent kinetic energy weakens, the rate of transfer of energy to turbulent flow due to turbulent buoyancy flux reaches its maximum and becomes the primary supply in the turbulent kinetic energy in Phase II. During Phase III, $1.2 \leqslant (\tilde {t}-\tilde {t}_c) \tilde {u}_f/\tilde {H} \leqslant 2.8$, the collided fluid slumps away from the collision region, while the production of turbulent kinetic energy, turbulent buoyancy flux and dissipation of energy attenuate. From the point of view of energetics, the production of turbulent kinetic energy and turbulent buoyancy flux transfers energy away from the mean flow to the turbulent flow during the collision. Our study complements previous experimental investigations on the collision of gravity currents in that the flow structures, spatial distribution and temporal evolution of the mean flow and turbulent flow characteristics in the collision region are presented clearly. It is our understanding that such complete information on the energy budgets in the collision region can be difficult to attain in laboratory experiments.
Youth suicide rates have increased markedly in some countries. This study aimed to estimate the population-attributable risk of psychiatric disorders associated with suicide among Taiwanese youth aged 10–24 years.
Methods
Data were obtained from the National Death Registry and National Health Insurance (NHI) claims database between 2007 and 2019. Youth who died by suicide were included, and comparisons, 1:10 matched by age and sex, were randomly selected from the Registry for NHI beneficiaries. We used multivariable logistic regression to estimate suicide odds ratios for psychiatric disorders. The population-attributable fractions (PAF) were calculated for each psychiatric disorder.
Results
A total of 2345 youth suicide and 23 450 comparisons were included. Overall, 44.8% of suicides had a psychiatric disorder, while only 7.9% of the comparisons had a psychiatric disorder. The combined PAF for all psychiatric disorders was 55.9%. The top three psychiatric conditions of the largest PAFs were major depressive disorder, dysthymia, and sleep disorder. In the analysis stratified by sex, the combined PAF was 45.5% for males and 69.2% for females. The PAF among young adults aged 20–24 years (57.0%) was higher than among adolescents aged 10–19 years (48.0%).
Conclusions
Our findings of high PAF from major depressive disorder, dysthymia, and sleep disorder to youth suicides suggest that youth suicide prevention that focuses on detecting and treating mental illness may usefully target these disorders.
Coronavirus disease (COVID-19) is a “disaster of uncertainty” with ambiguity about its nature and trajectory. These features amplify its psychological toxicity and increase the number of psychological casualties it inflicts. Uncertainty was fueled by lack of knowledge about the lethality of a disaster, its duration, and ambiguity in messaging from leaders and health care authorities. Human resilience can have a buffering effect on the psychological impact. Experts have advocated “flattening the curve” to slow the spread of the infection. Our strategy for crisis leadership is focused on flattening the rise in psychological casualties by increasing resilience among health care workers. This paper describes an approach employed at Johns Hopkins to promote and enhance crisis leadership. The approach is based on 4 factors: vision for the future, decisiveness, effective communication, and following a moral compass. We make specific actionable recommendations for implementing these factors that are being disseminated to frontline leaders and managers. The COVID-19 pandemic is destined to have a strong psychological impact that extends far beyond the end of quarantine. Following these guidelines has the potential to build resilience and thus reduce the number of psychological casualties and speed the return to normal – or at least the new normal in the post-COVID world.
This chapter examines the Vatican’s decision in 1939 to end its opposition to Chinese Catholic participation in Chinese rites, a position it had held since 1704. The historiography has traditionally interpreted the end of the Chinese rites as a progressive move by the Vatican to support calls for indigenization in China. Focusing on the career of Celso Costantini, the first apostolic delegate to China, this chapter argues that the decision to end the Chinese rites controversy must be understood as part of the Vatican’s geopolitical strategy to expand its influence in China. Revising its position on Chinese rites was a way to curry favor with the Chinese Nationalists; it also belonged to the Vatican’s anti-Communist outlook. This chapter argues that the end of the Chinese rites controversy must be read and understood within the context of the moment when the Catholic Church was also reconceptualizing its relationship to human rights.
Tuberous sclerosis complex (TSC) is a rare genetic disorder that commonly leads to drug-resistant epilepsy in affected patients. This study aimed to determine whether the underlying genetic mutation (TSC1 vs. TSC2) predicts seizure outcomes following surgical treatments for epilepsy.
Methods:
We retrospectively assessed TSC patients using the TSC Natural History Database core registry. Data review focused on outcomes in patients treated with surgical resection or vagus nerve stimulation.
Results:
A total of 42 patients with a TSC1 mutation, and 145 patients with a TSC2 mutation, were identified. We observed a distinct clinical phenotype: children with TSC2 mutations tended to be diagnosed with TSC at a younger age than those with a TSC1 mutation (p < 0.001), were more likely to have infantile spasms (p < 0.001), and to get to surgery at a later age (p = 0.003). Among this TSC2 cohort, seizure control following resective epilepsy surgery was achieved in less than half (47%) the study sample. In contrast, patients with TSC1 mutations tended to have more favorable postsurgical outcomes; seizure control was achieved in 66% of this group.
Conclusion:
TSC2 mutations result in a more severe epilepsy phenotype that is also less responsive to resective surgery. It is important to consider this distinct clinical disposition when counseling families preoperatively with respect to seizure freedom. Larger samples are required to better characterize the independent effects of genetic mutation, infantile spasms, and duration of epilepsy as they relate to seizure control following resective or neuromodulatory epilepsy surgery.
Hospitalized patients placed in isolation due to a carrier state or infection with resistant or highly communicable organisms report higher rates of anxiety and loneliness and have fewer physician encounters, room entries, and vital sign records. We hypothesized that isolation status might adversely impact patient experience as reported through Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, particularly regarding communication.
Design
Retrospective analysis of HCAHPS survey results over 5 years.
Setting
A 1,165-bed, tertiary-care, academic medical center.
Patients
Patients on any type of isolation for at least 50% of their stay were the exposure group. Those never in isolation served as controls.
Methods
Multivariable logistic regression, adjusting for age, race, gender, payer, severity of illness, length of stay and clinical service were used to examine associations between isolation status and “top-box” experience scores. Dose response to increasing percentage of days in isolation was also analyzed.
Results
Patients in isolation reported worse experience, primarily with staff responsiveness (help toileting 63% vs 51%; adjusted odds ratio [aOR], 0.77; P = .0009) and overall care (rate hospital 80% vs 73%; aOR, 0.78; P < .0001), but they reported similar experience in other domains. No dose-response effect was observed.
Conclusion
Isolated patients do not report adverse experience for most aspects of provider communication regarded to be among the most important elements for safety and quality of care. However, patients in isolation had worse experiences with staff responsiveness for time-sensitive needs. The absence of a dose-response effect suggests that isolation status may be a marker for other factors, such as illness severity. Regardless, hospitals should emphasize timely staff response for this population.
Harnessing the nonvolatility of magnetism and the power of electric control, magnetoelectric devices that control magnetism electrically promise to deliver next-generation electronics systems that can store and compute large amounts of information with minimal power consumption and ultrafast processing speed. We highlight progress in magnetoelectric memory and logic prototypes using the voltage-controlled magnetic anisotropy (VCMA) effect. First, important performance metrics of VCMA-based magnetoelectric random access memory (MeRAM) are benchmarked against embedded complementary metal oxide semiconductor and other emerging embedded nonvolatile memories. We then discuss scaling of MeRAM from the physics and materials perspectives of the VCMA effect, as well as the use of magnetoelectric logic devices and circuits to realize new computing paradigms with VCMA. Finally, challenges to realize the full potential of VCMA-based memory and logic are presented: VCMA coefficient of 1000 fJ/V-m for energy-efficient write with low errors and tunneling magnetoresistance of 1000% for high density and low noise margin readout. New approaches for deterministic switching based on VCMA are needed. We share perspectives to address these challenges using new materials and device operation schemes.
This article examines the life and ideas of Josef Schmidlin, the founder of Catholic ‘missionary science’ and the most influential German Catholic missionary theorist of the first half of the twentieth century. An admirer of the German Protestant missionary theologian Gustav Warneck, Schmidlin often appears in the historiography as a forerunner of the Protestant–Catholic ecumenical collaboration that emerged after the Second World War. Yet a close examination of his writing reveals a vigorous critic of Protestantism and the Protestant ecumenical movement. A sceptic of transnational missionary organizations, he remained a firm supporter of the German nation and imperial project. This article gestures towards both the continuities and the discontinuities between the early attempts at fostering confessional cooperation between Protestants and Catholics and the later iterations. It also examines how nineteenth-century entanglements between missions and empire shaped the ideas of Catholic missionary theory during the interwar years.
Cylindrical gravity currents, produced by a full-depth lock release, in a rotating system are investigated by means of three-dimensional high-resolution simulations of the incompressible variable-density Navier–Stokes equations with the Coriolis term and using the Boussinesq approximation for a small density difference. Here, the depth of the fluid is chosen to be the same as the radius of the cylindrical lock and the ambient fluid is non-stratified. Our attention is focused on the situation when the ratio of Coriolis to inertia forces is not large, namely $0.1\leqslant {\mathcal{C}}\leqslant 0.3$, and the non-rotating case, namely ${\mathcal{C}}=0$, is also briefly considered. The simulations reproduce the major features observed in the laboratory and provide more detailed flow information. After the heavy fluid contained in a cylindrical lock is released in a rotating system, the influence of the Coriolis effects is not significant during the initial one-tenth of a revolution of the system. During the initial one-tenth of a revolution of the system, Kelvin–Helmholtz vortices form and the rotating cylindrical gravity currents maintain nearly perfect axisymmetry. Afterwards, three-dimensionality of the flow quickly develops and the outer rim of the spreading heavy fluid breaks away from the body of the current, which gives rise to the maximum dissipation rate in the system during the entire adjustment process. The detached outer rim of heavy fluid then continues to propagate outward until a maximum radius of propagation is attained. The body of the current exhibits a complex contraction–relaxation motion and new outwardly propagating pulses form regularly in a period slightly less than half-revolution of the system. Depending on the ratio of Coriolis to inertia forces, such a contraction–relaxation motion may be initiated after or before the attainment of a maximum radius of propagation. In the contraction–relaxation motion of the heavy fluid, energy is transformed between potential energy and kinetic energy, while it is mainly the kinetic energy that is consumed by the dissipation. As a new pulse initially propagates outward, the potential energy in the system increases at the expense of decreasing kinetic energy, until a local maximum of potential energy is reached. During the latter part of the new pulse propagation, the kinetic energy in the system increases at the expense of decreasing potential energy, until a local minimum of potential energy is reached and another new pulse takes form. With the use of three-dimensional high-resolution simulations, the lobe-and-cleft structure at the advancing front can be clearly observed. The number of lobes is maintained only for a limited period of time before merger between existing lobes occurs when a maximum radius of propagation is approached. The high-resolution simulations complement the existing shallow-water formulation, which accurately predicts many important features and provides insights for rotating cylindrical gravity currents with good physical assumptions and simple mathematical models.
In 1898, the year before his death, the German missionary Ernst Faber reflected on his forty-year career in China. The account of his early missions work was suffused with a tone of failure and disappointment. He wrote openly about his difficulties in adjusting to the climate and environment of southern China, the diminutive numbers of converts to Christianity, his frustrations with learning Mandarin and the local dialects used in Guangdong, and the overwhelming feeling of loneliness that he encountered working in rural parishes.
The harmful impact of an adverse event ripples beyond injured patients and their families to affect physicians, nurses, and other health care staff that are involved. These “Second Victims” may experience intense feelings of anxiety, guilt, and fear. They may doubt their clinical competence or ability to continue working at all. Some go on to suffer post-traumatic stress disorder and depression.
Medical institutions long ignored this problem, preferring to believe that adverse events, or “errors,” occur due to incompetence — the unfortunate work of a few “bad” practitioners who deserve, if anything, a reprimand for their negligence. Study after study has rejected this attribution and shown that adverse events in health care stem primarily from systemic flaws, not “bad apples.” Devastating errors, in other words, can, do, and always will happen in the care of competent, well-trained, and caring practitioners.
Upon first glance, nineteenth-century German Catholic and Protestant missionary periodicals seem to come from different milieus. Compare two mastheads: an October 1895 issue of the monthly periodical of the Catholic Society of the Divine Word (SVD) and the Protestant Berlin Missionary Society's monthly periodical of November 1895. An ornate woodcut print inhabits the masthead of the SVD periodical, the Kleiner-Herz Jesu-Bote. Jesus, with his sacred heart exposed, stands on clouds and is flanked by two angels, Raphael and Gabriel. In the top left-hand corner, the reader sees the Archangel Michael militantly guarding over the frontispiece with sword and shield, while in the top right-hand corner, the one mortal, St. Francis, smiles benevolently, offering the reader absolution. The periodical's title is presented in lettering akin to an illuminated manuscript. Pictures of saints, relics, and martyrs adorn the rest of the issue.