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The coronavirus disease 2019 (COVID-19) pandemic has demonstrated the importance of stewardship of viral diagnostic tests to aid infection prevention efforts in healthcare facilities. We highlight diagnostic stewardship lessons learned during the COVID-19 pandemic and discuss how diagnostic stewardship principles can inform management and mitigation of future emerging pathogens in acute-care settings. Diagnostic stewardship during the COVID-19 pandemic evolved as information regarding transmission (eg, routes, timing, and efficiency of transmission) became available. Diagnostic testing approaches varied depending on the availability of tests and when supplies and resources became available. Diagnostic stewardship lessons learned from the COVID-19 pandemic include the importance of prioritizing robust infection prevention mitigation controls above universal admission testing and considering preprocedure testing, contact tracing, and surveillance in the healthcare facility in certain scenarios. In the future, optimal diagnostic stewardship approaches should be tailored to specific pathogen virulence, transmissibility, and transmission routes, as well as disease severity, availability of effective treatments and vaccines, and timing of infectiousness relative to symptoms. This document is part of a series of papers developed by the Society of Healthcare Epidemiology of America on diagnostic stewardship in infection prevention and antibiotic stewardship.1
Yarkoni's analysis clearly articulates a number of concerns limiting the generalizability and explanatory power of psychological findings, many of which are compounded in infancy research. ManyBabies addresses these concerns via a radically collaborative, large-scale and open approach to research that is grounded in theory-building, committed to diversification, and focused on understanding sources of variation.
Preoperative mechanical ventilation is associated with morbidity and mortality following CHD surgery, but prior studies lack a comprehensive analysis of how preoperative respiratory support mode and timing affects outcomes.
We retrospectively collected data on children <18 years of age undergoing cardiac surgery at an academic tertiary care medical centre. Using multivariable regression, we examined the association between modes of preoperative respiratory support (nasal cannula, high-flow nasal cannula/noninvasive ventilation, or invasive mechanical ventilation), escalation of preoperative respiratory support, and invasive mechanical ventilation on the day of surgery for three outcomes: operative mortality, postoperative length of stay, and postoperative complications. We repeated our analysis in a subcohort of neonates.
A total of 701 children underwent 800 surgical procedures, and 40% received preoperative respiratory support. Among neonates, 243 patients underwent 253 surgical procedures, and 79% received preoperative respiratory support. In multivariable analysis, all modes of preoperative respiratory support, escalation in preoperative respiratory support, and invasive mechanical ventilation on the day of surgery were associated with increased odds of prolonged length of stay in children and neonates. Children (odds ratio = 3.69, 95% CI 1.2–11.4) and neonates (odds ratio = 8.97, 95% CI 1.31–61.14) on high-flow nasal cannula/noninvasive ventilation had increased odds of operative mortality compared to those on room air.
Preoperative respiratory support is associated with prolonged length of stay and mortality following CHD surgery. Knowing how preoperative respiratory support affects outcomes may help guide surgical timing, inform prognostic conversations, and improve risk stratification models.
While American political development scholars tend to focus on national or state-level politics, late nineteenth-century cities provided the lion's share of services: clean water, paved and lighted streets, and sanitation. How did cities innovate and build municipal capacity to do these things? We answer this question by looking at municipal responses to the garbage problem. As cities grew and trash piled up in the 1890s, cities explored ways to effectively collect the garbage. A government requires not just resources, but also the ability to marshal those resources. Corruption could provide such abilities. Looking at four corrupt cities—Pittsburgh, Charleston, New Orleans, and St. Louis—we consider whether corruption, and what type of corruption, fostered innovation and capacity. We compare these corrupt cities with a shadow study of the reformist government of Columbus. We found the following: (1) The logic of corruption is the most important factor to explain why municipal governments chose particular garbage strategies. Corrupt regimes chose garbage collection and disposal strategies that would benefit themselves—but these varied depending on what type of corruption dominated a city. (2) Corruption sometimes promoted innovation and capacity, but at other times, corruption hindered them. For better or worse, cities ruled by corruption gained the capacity that these informal regimes held.
Typically pediatric end-of-life decision-making studies have examined the decision-making process, factors, and doctors’ and parents’ roles. Less attention has focussed on what happens after an end-of-life decision is made; that is, decision enactment and its outcome. This study explored the views and experiences of bereaved parents in end-of-life decision-making for their child. Findings reported relate to parents’ experiences of acting on their decision. It is argued that this is one significant stage of the decision-making process.
A qualitative methodology was used. Semi-structured interviews were conducted with bereaved parents, who had discussed end-of-life decisions for their child who had a life-limiting condition and who had died. Data were thematically analysed.
Twenty-five bereaved parents participated. Findings indicate that, despite differences in context, including the child’s condition and age, end-of-life decision-making did not end when an end-of-life decision was made. Enacting the decision was the next stage in a process. Time intervals between stages and enactment pathways varied, but the enactment was always distinguishable as a separate stage. Decision enactment involved making further decisions - parents needed to discern the appropriate time to implement their decision to withdraw or withhold life-sustaining medical treatment. Unexpected events, including other people’s actions, impacted on parents enacting their decision in the way they had planned. Several parents had to re-implement decisions when their child recovered from serious health issues without medical intervention.
Significance of results
A novel, critical finding was that parents experienced end-of-life decision-making as a sequence of interconnected stages, the final stage being enactment. The enactment stage involved further decision-making. End-of-life decision-making is better understood as a process rather than a discrete once-off event. The enactment stage has particular emotional and practical implications for parents. Greater understanding of this stage can improve clinician’s support for parents as they care for their child.
Mental disorders of women during the postnatal period are a major public health problem. Compared with women's mental disorders, much less attention has been paid to men's mental disorders in the perinatal period. To date, there have been no reports in the literature describing secular changes of both maternal and paternal hospital admissions for mental disorders over the period covering the year before pregnancy (non-parents), during pregnancy (expectant parents) and up to the first year after birth (parents) based on linked parental data. The co-occurrences of couples' hospital admissions for mental disorders have not previously been investigated.
To describe maternal and paternal hospital admissions for mental disorders before and after birth. To compare the co-occurrences of parents' hospital admissions for mental disorder in the perinatal period.
This is a cohort study using paired parents' population data from the New South Wales (NSW) Perinatal Data Collection (PDC), Registry of Births, Deaths and Marriages (RBDM) and Admitted Patients Data Collection (APDC). The study included all parents (n=196 669 couples) who gave birth to their first child in NSW between 1 January 2003 and 31 December 2009.
The hospital admission rate for women with a principal mental disorder diagnosis in the period between the year before pregnancy and the first year after birth was significantly higher than that for men. Parents' mental disorders influenced each other. If a man was admitted to hospital with a principal mental disorder diagnosis, his wife or partner was more likely to be admitted to hospital with a principal mental disorder diagnosis compared with women whose partner had not had a hospital admission, and vice versa.
Mothers' mental disorders after birth increased more significantly than fathers. However, fathers' mental disorders significantly impacted the co-occurrence of mothers' mental disorders.
Background: Identifying individuals at risk for mental health problems after a disaster often involves assessing potentially traumatic exposures inherent to the disaster. Survivors of disasters also may have been exposed, both before and during the event, to trauma not directly related to the disaster. A substantial literature suggests exposure to interpersonal violence may have more severe negative outcomes than exposure to non-violent events; however, it is unclear whether violent vs nonviolent exposures before and during a disaster have differential effects on postdisaster psychological functioning.
Methods: We examined the associations of violent and nonviolent exposures before and during Hurricane Katrina with postdisaster psychological functioning in a sample of male military veterans.
Results: Violent and nonviolent exposures post-Hurricane Katrina as well as pre-Katrina violent exposures were significantly associated with symptoms of posttraumatic stress disorder, panic, and generalized anxiety disorder more than 2 years after the storm. Moreover, veterans who reported violent exposures pre-Katrina were more than 4 times more likely to have reexperienced interpersonal violence during Katrina than those who did not report such exposures.
Conclusions: Results suggest assessing disaster-specific experiences in addition to predisaster interpersonal violence may be important for identifying and triaging individuals at risk for postdisaster mental health problems.
(Disaster Med Public Health Preparedness. 2011;5:S227-S234)
The activities of the Commission have continued to focus on controlling unwanted light and radio emissions at observatory sites, monitoring of conditions at observatory sites, and education and outreach. Commission members have been active in securing new legislation in several locations to further the protection of observatory sites as well as in the international regulation of the use of the radio spectrum and the protection of radio astronomical observations.
The measure used to assess the success of any given assisted reproductive technology (ART) treatment is dependent upon whose perspective the outcome is being determined and the quality of the data available to populate the measure. The three most commonly used denominators to measure the success of ART treatment are initiated cycles, aspirations, and embryos transferred. Clinical pregnancy is the most widely used measure of the success of ART treatment. The choice of initiated cycle as the denominator is limited to differentiate the success rates between some ART procedures such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Cryopreservation of embryos is now routine practice. The dilemma is how to present success rates of ART treatment following transfer of thawed embryos. A higher success rate is also experienced with patients undertaking their first treatment cycle or who have a history of a live birth.
The past President of Division XII, Malcolm Smith, took the chair of the business meeting of C50, in the absence of the past President of C50, Richard Wainscoat. He described the procedure of the election in 2006 of the then-time vice-president of C50, Richard Wainscoat, as President of C50, after the untimely deatch of the then-time C50 President, Hugo Schwarz. He also described the procedure for electing the incoming OC members and officers.
The late twentieth century has witnessed astonishing technological advances that make information readily and widely available. In fact, people today are bombarded with information, to the point of what some have referred to as “information overload.” Political events are covered twenty-four hours a day by Cable News Network (CNN). Newspapers like USA Today inform us of these events in easily digestible pieces; some newspapers, such as the Washington Post, have news available on Internet, the new “information superhighway.” At any time of the day or night we can delve into the mass of political information at our fingertips and discover what is happening in the world. Making decisions when faced with this great quantity of information is daunting.
This book details how people come to make decisions, specifically concerning civil liberties issues, in light of new information. Almost every day we are confronted with stories about actual or potential infractions against a certain people's rights. Hate crimes, such as cross burnings or the vandalism of Jewish cemeteries, are not uncommon, and the passage of hate-crime laws to deter further actions by racist groups has become popular. Clashes between prolife and prochoice groups, and especially the recent murders of doctors who perform abortions, regularly make headline news. The influx of Haitian and Cuban refugees increases tensions in parts of the United States. Incidents of gay bashing and antihomosexual activities have gained particularly intensive news coverage, partly because of recent measures voted on in Oregon and Colorado.