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The objective was to describe a feasible, multidisciplinary pediatric mass casualty event (MCE) simulation format that was less than 2 h within emergency department space and equipment constraints.
Methods:
This was a prospective cohort study of an MCE in situ simulation program from June-October 2019. Participants rotated through 3 modules: (1) triage, (2) caring for a critical patient in an MCE setting, and (3) being in a disaster leadership role. Triage accuracy, knowledge, self-evaluation of preparedness, and MCE skills by means of pre- and post-test surveys were measured. Wilcoxon matched pairs signed rank test scores and McNemar’s matched pair chi-squared test were performed to evaluate for statistically significant differences.
Results:
Forty-six physicians (MD), 1 physician’s assistant (PA), and 22 nurses participated over 4 simulation d. Among the MD/PA group, there was a statistically significant 7% knowledge increase (95% confidence interval [CI], 3%-11%). Nurses did not show a statistically significant knowledge difference (0.04, 95% CI, 0.04%, 14%). There was a statistically significant increase in triage and resource use preparedness (P < 0.01) for all participants.
Conclusion:
This efficient, feasible model for a multidisciplinary ED disaster drill provides a multi-modular exposure while improving both MD and PA knowledge and all staff preparedness for MCE.
Schistosomiasis has been subjected to extensive control efforts in the People's Republic of China (China) which aims to eliminate the disease by 2030. We describe baseline results of a longitudinal cohort study undertaken in the Dongting and Poyang lakes areas of central China designed to determine the prevalence of Schistosoma japonicum in humans, animals (goats and bovines) and Oncomelania snails utilizing molecular diagnostics procedures. Data from the Chinese National Schistosomiasis Control Programme (CNSCP) were compared with the molecular results obtained.
Sixteen villages from Hunan and Jiangxi provinces were surveyed; animals were only found in Hunan. The prevalence of schistosomiasis in humans was 1.8% in Jiangxi and 8.0% in Hunan determined by real-time polymerase chain reaction (PCR), while 18.3% of animals were positive by digital droplet PCR. The CNSCP data indicated that all villages harboured S. japonicum-infected individuals, detected serologically by indirect haemagglutination assay (IHA), but very few, if any, of these were subsequently positive by Kato-Katz (KK).
Based on the outcome of the IHA and KK results, the CNSCP incorporates targeted human praziquantel chemotherapy but this approach can miss some infections as evidenced by the results reported here. Sensitive molecular diagnostics can play a key role in the elimination of schistosomiasis in China and inform control measures allowing for a more systematic approach to treatment.
In 829 hospital encounters for patients with COVID-19, 73.2% included orders for antibiotics; however, only 1.8% had respiratory cultures during the first 3 hospital days isolating bacteria. Case–control analysis of 30 patients and 96 controls found that each antibiotic day increased the risk of isolating multidrug-resistant gram-negative bacteria (MDR-GNB) in respiratory cultures by 6.5%.
The coronavirus disease 2019 (COVID-19) has greatly impacted health-care systems worldwide, leading to an unprecedented rise in demand for health-care resources. In anticipation of an acute strain on established medical facilities in Dallas, Texas, federal officials worked in conjunction with local medical personnel to convert a convention center into a Federal Medical Station capable of caring for patients affected by COVID-19. A 200,000 square foot event space was designated as a direct patient care area, with surrounding spaces repurposed to house ancillary services. Given the highly transmissible nature of the novel coronavirus, the donning and doffing of personal protective equipment (PPE) was of particular importance for personnel staffing the facility. Furthermore, nationwide shortages in the availability of PPE necessitated the reuse of certain protective materials. This article seeks to delineate the procedures implemented regarding PPE in the setting of a COVID-19 disaster response shelter, including workspace flow, donning and doffing procedures, PPE conservation, and exposure event protocols.
In this paper, we use finite element analysis (FEA) to study the linear viscoelastic response of polyurea, a type of hard–soft block copolymer. A Niblack's algorithm-based technique employed on atomic force microscopy images provides geometry inputs for the FEA model, while the viscoelastic master curves of the soft matrix are obtained via a combination of dynamic mechanical analysis data and molecular dynamic (MD) estimations. In this microstructural image-based FEA framework, we introduce an interphase area of altered properties between the hard and soft domains. Both spatial and property distributions of this interphase area affect the viscoelastic response of the copolymer system. To quantitatively investigate the impact of structural and property features of the interphase on the energy storage and dissipation of a system during linear perturbation, we develop a statistical descriptor representation of the interphase region related to physical parameters. Utilizing decision-tree and random forest concepts from machine learning, we apply a ranking algorithm to identify the most significant features for four different mechanical response descriptors. Results show that the total interphase volume fraction and shifting factor distributions in the interphase area dominate the magnitude of the tan δ peak, whereas the magnitudes of the shifting factors primarily affect the tan δ peak location in frequency space. This method allows us to readily identify the dominant features impacting individual properties and paves the way for material design of hard–soft block copolymer systems.
Smoking contributes to health inequalities for people with severe mental illness (SMI). Although smoking cessation interventions are effective in the short term, there are few long-term trial-based estimates of abstinence. The SCIMITAR trials programme includes the largest trial to date of a smoking cessation intervention for people with SMI, but this was underpowered to detect anticipated long-term quit rates. By pooling pilot and full-trial data we found that quit rates were maintained at 12 months (OR = 1.67, 95% CI 1.02–2.73, P = 0.04). Policymakers can now be confident that bespoke smoking cessation interventions produce successful short- and long-term quitting.
We apply two methods to estimate the 21-cm bispectrum from data taken within the Epoch of Reionisation (EoR) project of the Murchison Widefield Array (MWA). Using data acquired with the Phase II compact array allows a direct bispectrum estimate to be undertaken on the multiple redundantly spaced triangles of antenna tiles, as well as an estimate based on data gridded to the uv-plane. The direct and gridded bispectrum estimators are applied to 21 h of high-band (167–197 MHz; z = 6.2–7.5) data from the 2016 and 2017 observing seasons. Analytic predictions for the bispectrum bias and variance for point-source foregrounds are derived. We compare the output of these approaches, the foreground contribution to the signal, and future prospects for measuring the bispectra with redundant and non-redundant arrays. We find that some triangle configurations yield bispectrum estimates that are consistent with the expected noise level after 10 h, while equilateral configurations are strongly foreground-dominated. Careful choice of triangle configurations may be made to reduce foreground bias that hinders power spectrum estimators, and the 21-cm bispectrum may be accessible in less time than the 21-cm power spectrum for some wave modes, with detections in hundreds of hours.
The SCIMITAR+ trial was commissioned to evaluate the effectiveness of a bespoke smoking cessation intervention for people with severe mental ill health compared with usual services. It is difficult to define what constitutes usual care in smoking cessation services. We aimed to define what this was during the trial. Twenty-two National Health Service healthcare providers participated in a bespoke survey asking about usual care in their area.
Results
All sites offered smoking cessation support; however, service provider and service type varied substantially. In some cases services were not streamlined, meaning that people received smoking cessation counselling from one organisation and smoking cessation medication from another.
Clinical implications
To better implement the National Institute for Health and Care Excellence guideline PH48, clearer referral pathways need to be implemented and communicated to patients, staff and carers. People with severe mental ill health need to be able to access services that combine nicotine replacement therapy and behavioural support in a streamlined manner.
To examine urban–rural disparity in childhood stunting, wasting and malnutrition at national and subnational levels in Chinese primary-school children in 2010 and 2014.
Design
Data were obtained from two nationwide cross-sectional surveys conducted in 2010 and 2014. Malnutrition was classified using the Chinese national ‘Screening Standard for Malnutrition of Children’.
Setting
All twenty-seven mainland provinces and four municipalities of mainland China.
Participants
Children aged 7–12 years (n 215 214; 107 741 in 2010 and 107 473 in 2014) from thirty-one provinces.
Results
Stunting, wasting and malnutrition prevalence were 1·9, 12·3 and 13·7 % in 2010, but decreased to 1·0, 9·4 and 10·2 % in 2014, respectively. The prevalence of stunting, wasting and malnutrition in both urban and rural children was higher in western provinces, while lower in eastern provinces. Although the prevalence of wasting and malnutrition was higher in rural children than their urban counterparts, the urban–rural disparity in both wasting and malnutrition decreased from 2010 to 2014 (prevalence OR: wasting, 1·35 to 1·16; malnutrition, 1·50 to 1·27). A reversal occurred in 2014 in several eastern provinces where the prevalence of wasting and malnutrition in urban children surpassed their rural peers. The urban–rural disparity was larger in western provinces than eastern provinces.
Conclusions
The shrinking urban–rural disparity and the reversal in wasting and malnutrition suggest that the malnutrition situation has improved during the post-crisis period, especially in the western provinces. Region-specific policies and interventions can be useful to sustainably mitigate malnutrition in Chinese children, especially in rural areas and the western provinces.
Mental illness is one of the leading causes of disability, with direct and indirect costs posing a significant financial burden. Previously, a large prospective economic utility study (n>13,000) showed that the GeneSight® test, a psychiatric pharmacogenomic decision support tool powered by CPGx® technology, reduced medication costs, increased adherence, andreduced polypharmacy for patients who had failed monotherapy for psychiatric disorders. The current study, which is a sub-analysis of this larger study, assessed cost savings associated with combinatorial pharmacogenomic testing in patients with generalized anxiety disorder (GAD) and major depressive disorder (MDD). Medication costs were extracted using pharmacy claims data provided by Medco, a large pharmacy benefits manager, for patients with GAD (n=318) and MDD (n=459). Medication cost savings per member per year (PMPY) for 1 year following the test were compared between patients whose medication regimens were congruent with the test recommendations and those whose medication regimens were incongruent with these recommendations. When healthcare providers’ decisions were congruent with combinatorial pharmacogenomic testing, PMPY savings was $6,747 (p<0.004) for GAD patients and $3,738 (p<0.004) for MDD patients versus incongruent decisions within these disease states. Among the congruent group, GAD patients experienced greater savings in central nervous system (CNS) medications (2-fold) compared to MDD patients. Additionally, analysis of a subset of patients prescribed at least one benzodiazepine six months prior to testing (n=660) demonstrated a significant decrease in benzodiazepine drug counts (p<0.001) and refills (p<0.001) after testing. Using the GeneSight test as a treatment decision support tool for patients with GAD or MDD resulted in significant medication cost savings when HCPs made congruent decisions with the combinatorialpharmacogenomic results. Furthermore, use of the GeneSight test decreased the use of benzodiazepines.
Randomised controlled trials comparing low- v. high-fat diets on cardiometabolic risk factors in people with overweight or obesity have shown inconsistent results, which may be due to the mixed metabolic status of people with excess adiposity. The role of dietary fat manipulation in modifying cardiometabolic indicators in people with overweight or obese without metabolic disturbance is unclear. Thus, meta-analysis was conducted to compare low- v. high-fat diets on cardiometabolic indicators in people who are overweight or obese without metabolic disturbance in the present study. Databases were searched until October 2016. The pooled effects of outcomes with heterogeneity were calculated with a random-effects model, heterogeneities were analysed by subgroup and meta-regression. As a result, twenty studies with 2106 participants were included in the meta-analysis. Total cholesterol and LDL-cholesterol levels were lower following low-fat diets compared with high-fat diets: weighted mean difference (WMD) was −7·05 mg/dl (−0·18 mmol/l; 95 % CI −11·30, −2·80; P=0·001) and −4·41 mg/dl (−0·11 mmol/l; 95 % CI −7·81, −1·00; P=0·011), respectively. Conversely, significant higher level of TAG (WMD: 11·68 mg/dl (0·13 mmol/l), 95 % CI 5·90, 17·45; P<0·001) and lower level of HDL-cholesterol (WMD: −2·57 mg/dl (−0·07 mmol/l); 95 % CI −3·85, −1·28; P<0·001) were found following low-fat diets compared with high-fat diets. In conclusion, dietary fat manipulation has a significant influence on blood lipid levels in people with overweight or obesity without metabolic disturbances.
Childhood adversity (CA) is known to predict sensitization to proximal stressors. Researchers have suggested that disruptions in hypothalamus–pituitary–adrenal axis functioning may be a biological mechanism. If so, CA may predict altered associations between proximal life stress and markers of cortisol secretion. We examined whether CA moderates associations between recent episodic stress and (a) the cortisol awakening response (CAR), and (b) depressive symptoms, in 241 adolescents aged 14–17 years (cortisol n = 196). Salivary cortisol was sampled at 0, 30, and 60 min postawakening for 2 days. The CAR was calculated as the area under the curve with respect to increase and waking cortisol. CA and episodic stress were assessed using contextual-threat-method-coded objective interviews. CA significantly interacted with episodic stress to predict both the CAR and depression. Among those with low CA, episodic stress predicted increased CAR but did not predict depression. For adolescents with high CA, episodic stress predicted lower CAR and higher depression. These interactions were found only for independent (uncontrollable, fateful) events, and not for dependent (self-generated) stress. Increased allostatic load resulting from CA exposure may interfere with adolescents' ability to optimally regulate their CAR in relation to recent stress, contributing to increased depression risk.
Public interest law organizations (PILOs) are important institutions for providing access to justice in the United States. How have political, economic, and institutional factors shaped PILOs? How do PILOs vary in the services they offer and in their geographical location relative to poverty and population in the United States? This article investigates these questions by combining original survey data from a representative sample of public interest law organizations with GIS data on population and poverty. We find that the presence of a PILO is positively related to political progressiveness and population at the county level, but negatively related to the concentration of poverty. Our analysis reveals a two-tier system of public interest representation in which national organizations engage in a variety of social change strategies, whereas local and regional organizations utilize more limited strategies and depend more on governmental funding. These patterns have implications for access to justice in the United States today.
Schistosomiasis in China has been substantially reduced due to an effective control programme employing various measures including bovine and human chemotherapy, and the removal of bovines from endemic areas. To fulfil elimination targets, it will be necessary to identify other possible reservoir hosts for Schistosoma japonicum and include them in future control efforts. This study determined the infection prevalence of S. japonicum in rodents (0–9·21%), dogs (0–18·37%) and goats (6·9–46·4%) from the Dongting Lake area of Hunan province, using a combination of traditional coproparasitological techniques (miracidial hatching technique and Kato-Katz thick smear technique) and molecular methods [quantitative real-time PCR (qPCR) and droplet digital PCR (ddPCR)]. We found a much higher prevalence in goats than previously recorded in this setting. Cattle and water buffalo were also examined using the same procedures and all were found to be infected, emphasising the occurrence of active transmission. qPCR and ddPCR were much more sensitive than the coproparasitological procedures with both KK and MHT considerably underestimating the true prevalence in all animals surveyed. The high level of S. japonicum prevalence in goats indicates that they are likely important reservoirs in schistosomiasis transmission, necessitating their inclusion as targets of control, if the goal of elimination is to be achieved in China.
Nanoindentation is an effective approach for measuring mechanical properties of
nanoscale films coated on substrates, yet results obtained through the classic
Oliver–Pharr model require additional consideration due to the existence
of a “substrate effect” when the film is much more compliant than
the substrate. In this study, different models for removing this substrate
effect are compared, with focus on the Gao model, the Saha–Nix model, and
the Hay model and the use of a direct finite element (FE) approach is discussed.
Validity of these models is examined using load–displacement data
obtained from simulated indentation of an elastic–plastic film in FEs. It
is found that the performance of the analytical models varies significantly with
different testing parameters, including ratio between film modulus and substrate
modulus (Ef/Es),
indenting ratio (hmax/film thickness), and yield
strain. Choices of using a nanoindentation model to process experimental data
should be made according to estimated indentation depth and modulus difference
between film and substrate. An example of applying substrate removal models to
experimental data is also shown.
This study aims to assess the validity of maternal recall for several perinatal variables 8–10 years after pregnancy in a twin sample. Retrospective information was collected 8–10 years after the delivery event in a cohort of mothers from the University of Southern California Twin Study (N = 611) and compared with medical records for validity analysis. Recall of most variables showed substantial to perfect agreement (κ = 0.60–1.00), with notable exceptions for specific medical problems during pregnancy (κ ≤ 0.40) and substance use when mothers provided continuous data (e.g., number of cigarettes per day; r ≤ 0.24). With the exception of delivery method, neonatal intensive care unit admission, birth weight, neonatal information, and post-delivery complications were also recalled with low accuracy. For mothers of twins, maternal recall is generally a valid measure for perinatal variables 10 years after pregnancy. However, caution should be taken regarding variables such as substance use, medical problems, birth length, and post-delivery complications.
The goal of the division is to address the scientific issues that were developed at the 2009 IAU General Assembly in Rio de Janeiro. These are:
• Astronomical constants
—Gaussian gravitational constant, Astronomical Unit, GMSun, geodesic precession-nutation
• Astronomical software
• Solar System Ephemerides
—Pulsar research
—Comparison of dynamical reference frames
• Future Optical Reference Frame
• Future Radio Reference Frame
• Exoplanets
—Detection
—Dynamics
• Predictions of Earth orientation
• Units of measurements for astronomical quantities in relativistic context
• Astronomical units in the relativistic framework
• Time-dependent ecliptic in the GCRS
• Asteroid masses
• Review of space missions
• Detection of gravitational waves
• VLBI on the Moon
• Real time electronic access to UT1-UTC
In pursuit of these goals Division I members have made significant scientific and organizational progress, and are organizing a Joint Discussion on Space-Time Reference Systems for Future Research at the 2012 IAU General Assembly. The details of Division activities and references are provided in the individual Commission and Working Group reports in this volume. A comprehensive list of references related to the work of the Division is available at the IAU Division I website at http://maia.usno.navy.mil/iaudiv1/.
This paper reports on new experimental findings and conclusions regarding the pulsed-laser-induced melting-and-solidification behavior of PECVD a-Si films. The experimental findings reveal that, within the partial-melting regime, these a-Si films can melt and solidify in ways that are distinct from, and more complex than, those encountered in microcrystalline-cluster-rich LPCVD a-Si films. Specifically (1) spatially dispersed and temporally stochastic nucleation of crystalline solids occurring relatively effectively at the moving liquid-amorphous interface, (2) very defective crystal growth that leads to the formation of fine-grained Si proceeding, at least initially after the nucleation, at a sufficiently rapidly moving crystal solidification front, and (3) the propensity for local preferential remelting of the defective regions and grain boundaries (while the beam is still on) are identified as being some of the fundamental factors that can participate and affect how these PECVD films melt and solidify.