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Along with an increase in opioid deaths, there has been a desire to increase the accessibility of naloxone. However, in the absence of respiratory depression, naloxone is unlikely to be beneficial and may be deleterious if it precipitates withdrawal in individuals with central nervous system (CNS) depression due to non-opioid etiologies.
The aim of this study was to evaluate how effective prehospital providers were in administering naloxone.
This is a retrospective study of naloxone administration in two large urban Emergency Medical Service (EMS) systems. The proportion of patients who had a respiratory rate of at least 12 breaths per minute at the time of naloxone administration by prehospital providers was determined.
During the two-year study period, 2,580 patients who received naloxone by prehospital providers were identified. The median (interquartile range) respiratory rate prior to naloxone administration was 12 (6-16) breaths per minute. Using an a priori respiratory rate of under 12 breaths per minute to define respiratory depression, only 1,232 (47.8%; 95% CI, 50.3%-54.2%) subjects who received naloxone by prehospital providers had respiratory depression.
This study showed that EMS providers in Los Angeles County, California (USA) frequently administered naloxone to individuals without respiratory depression.
ABSTRACT IMPACT: Analyzing the types of technical assistance (basic, targeted or intensive) provided by the Opioid Response Network (ORN) to unique and hard-to-reach populations (UHRP) informs addiction health services and translational research by identifying technical assistance needs in these populations which may require a higher level of intensity. OBJECTIVES/GOALS: To improve ORN dissemination and implementation efforts, the project classifies TA requests into one of three categories: basic, targeted, and intensive. This TA Framework assists the ORN project team in understanding the level of TA required in the delivery of evidence-based practices to address opioids with communities with respect to UHRP. METHODS/STUDY POPULATION: TA requests from April 1, 2019, to April 1, 2020, were selected. The ORN classifies TA requests in one of three categories: basic (dissemination & brief consultation), targeted (services to enhance readiness and capacity), and intensive (full incorporation of innovation considering context, culture, and linguistics) (Fixsen, et. al., 2009; Becker, et al., 2020). Unique and hard-to-reach populations (UHRP) are defined based on physical location (i.e., remote or isolated), social position, or other vulnerabilities (i.e. member of an ethnic or racial minority group) (Thurman, & Harrison, 2020). ORN classifies 26 types of UHRP these types are not mutually exclusive. A frequency analysis of the UHRP types was conducted. Bivariate correlations between UHRP types that had a minimum of 30 cases were performed. RESULTS/ANTICIPATED RESULTS: Among 746 TA requests selected, 226 had missing information about UHRP types and 29 had missing information TA levels. These requests were excluded from the frequency analysis. The three most common UHRP types were people living in rural or remote areas (n=262, 50%), people who are uninsured or underinsured (n=162, 31%), and people who inject drugs (n=158, 30%). Most TA requests were targeted (69%), 23% were intensive, and 9% were basic. Bivariate correlations were performed between 21 UHRP types. Moderate (Pearson’s r=0.4-0.6) or strong correlations (r>0.6) were found for 11 occurrences for the UHRP type of ‘LGBT’, 8 for ‘Mental Illness’, and 7 for ‘Veterans’. Strong correlations were found between ‘Justice Involved’ and ‘Incarcerated’ (r=0.645), and between ‘Disabilities’ and ‘Chronic Pain’ (r=0.603). DISCUSSION/SIGNIFICANCE OF FINDINGS: There were more TA requests at targeted and intensive levels than basic levels suggesting the need for services to enhance readiness and build capacity. The moderate/strong correlations indicate that UHRP types were likely to coexist with other types. Future research can explore combining UHRP types that have moderate/strong correlations.
Rapidly identifying patients colonized with multidrug-resistant organisms (MDROs) upon ICU admission is critical to control and prevent the spread of these pathogens in healthcare facilities. Electronic health records (EHR) provide a rich source of data to predict the likelihood of MDRO colonization at admission, whereas surveillance methods are resource intensive and results are not immediately available. Our objectives were (1) to predict VRE and CRO colonization at ICU admission and (2) to identify patient subpopulations at higher risk for colonization with these MDROs. Methods: We conducted a retrospective analysis of patients aged ≥16 years admitted to any of 6 medical or surgical intensive care units (ICU) in the Johns Hopkins Hospital from July 1, 2016, through June 30, 2018. Perirectal swabs were collected at ICU unit admission and were tested for VRE and CRO. Patient demographic data, prior hospitalizations, and preadmission clinical data, including prior medication administration, prior diagnoses, and prior procedures, were extracted to develop prediction models. We employed the machine-learning algorithms logistic regression (LR), random forest (RF), and XGBoost (XG). The sum of sensitivity and specificity (ie, Youden’s index) was selected as the performance metric. Results: In total, 5,033 separate ICU visits from 3,385 patients were included, where 555 (11%) and 373 (7%) admissions tested positive for VRE and CRO, respectively. The sensitivity and specificity of our models for VRE were 78% and 80% with LR, 80% and 82% with RF, and 77% and 87% with XG. Predictions for CRO were not as precise, with LR at 73% and 53%, RF at 81% and 48%, and XG at 69% and 61%. The XG algorithm was the best-performing algorithm for both VRE and CRO. Prior VRE colonization, recent (<180 days) long-term care facility stay, and prior hospitalization >60 days were the key predictors for VRE, whereas the primary predictor for CRO colonization was prior carbapenem use. Conclusions: We demonstrated that EHR data can be used to predict >75% of VRE positive cases with a <15% false-positive rate and ~70% of CRO cases with a <40% false-positive rate. Future studies using larger sample sizes may improve the prediction accuracy and inform model generalizability across sites and thus reduce the risk of transmission of MDROs by rapidly identifying MDRO-colonized patients.
Funding: This work was funded by the Centers for Disease Control and Prevention (CDC) Epicenters Program (Grant Number 1U54CK000447) and the CDC MInD-Healthcare Program (Grant Number 1U01CK000536).
Building on past research, we implement a hierarchical latent class model to analyze political participation from a comparative perspective. Our methodology allows simultaneously: (i) estimating citizens’ propensity to engage in conventional and unconventional modes of participation; (ii) classifying individuals into underlying “types” capturing within- and cross-country variations in participation; and (iii) assessing how this classification varies with micro- and macro-level factors. We apply our model to Latin American survey data. We show that our method outperforms alternative approaches used to study participation and derive typologies of political engagement. Substantively, we find that the distribution of participatory types is similar throughout the continent, and that it correlates strongly with respondents’ socio-demographic characteristics and crime victimization.
OBJECTIVES/GOALS: Regardless of their career choices, today’s biomedical researchers need to blend great science with core skills ininnovation and entrepreneurship (I&E). The objective of this NIH-funded education program was to develop and test a pragmatic training program to teach relevant I&E skills. METHODS/STUDY POPULATION: We used a modified Delphi approach to identify 15 relevant competencies for I&E and the essential topics to include in the program. Learner interviews identified preferences for online training programs (short, high-quality audio-visual content, ability to self-navigate, peer and instructor interactions). The inaugural program included 7 short, online courses that addressed how to identify and validate opportunities for innovation, sell your innovation to diverse audiences, assess its ethical consequences, work in teams, and develop resilience as an innovator. It also included mentor support, a team-based capstone project, and an optional in-person boot camp. RESULTS/ANTICIPATED RESULTS: 51 students enrolled and 41 participants from 9 institutions completed the program, including pre- and post-doctoral students and junior faculty. They organized into 10 teams to complete the capstone project, with 6 teams pitching their innovation to fellow students and mentors at the boot camp. Students rated satisfaction with courses highly overall, with 79% stating they would be disappointed if the program was no longer available. Preliminary results suggest participants increased their knowledge about and ability to perform tasks taught throughout the program. Suggestions for improvement included providing more practical advice and real-world examples to complement educational videos. DISCUSSION/SIGNIFICANCE OF IMPACT: The inaugural E4B program was well received and effective in increasing I&E skills. Improvements will include increased opportunity for mentor interactions and for advanced entrepreneurial training. The program is open for biomedical research trainees from all institutions with a CTSA award.
The Canadian Multiple Sclerosis Working Group has updated its treatment optimization recommendations (TORs) on the optimal use of disease-modifying therapies for patients with all forms of multiple sclerosis (MS). Recommendations provide guidance on initiating effective treatment early in the course of disease, monitoring response to therapy, and modifying or switching therapies to optimize disease control. The current TORs also address the treatment of pediatric MS, progressive MS and the identification and treatment of aggressive forms of the disease. Newer therapies offer improved efficacy, but also have potential safety concerns that must be adequately balanced, notably when treatment sequencing is considered. There are added discussions regarding the management of pregnancy, the future potential of biomarkers and consideration as to when it may be prudent to stop therapy. These TORs are meant to be used and interpreted by all neurologists with a special interest in the management of MS.
This article examines how public health addresses alcohol use through marketing — place, product, promotion, and price. The article reviews current product trends and how restrictions on certain products designs may reduce youth consumption; how product availability may be restricted through zoning; and the current advertising landscape.
The call for a public health approach to gun violence has largely ignored what role the nascent Second Amendment jurisprudence will play in hindering change. Given the state interest for infringing on Second Amendment rights is nearly always public safety, public health law doctrine provides an apt framework for analysis.
INVITED BY THE EDITORS of this volume to reflect on the reappearance and transformation of Kafka's metaphors in a variety of forms, I begin with the metaphor of transformation itself, asking, first, how it will already have undergone radical transformation within Kafka's own body of work, and, second, what implications this radicalization may have for a consideration of texts presumed to come and take after his. I take as my point of departure Kafka's Die Verwandlung, which, for reasons that will soon become apparent, I hesitate to translate simply as The Metamorphosis. I will then look at the graphic-novel adaptation by Eric Corbeyran and Richard Horne, with brief references to works by Peter Kuper and by David Zane Mairowitz and Robert Crumb. Like Vladimir Nabokov, who in his famous lecture on The Metamorphosis went against the author's explicit wish that the main character not be depicted on the cover or anywhere else in the text, the graphic novelists all test their artistic skills by giving visual form to the creature Gregor Samsa will have become.
Why this impulse to visualize, to discount the author's wishes and provide the reader with a concrete image of an eyesore variously described in the text as a monstrous vermin (“ungeheures Ungeziefer”) and an old dung beetle (“alter Mistkäfer”) but also, more objectifyingly, as the junk next door (“das Zeug von nebenan”), more negatively and postzoologically as an un-animal (“Untier”), and more impersonally as the neutral, genderless pronoun it (“es”)?
The impulse to visualize must at least in part be understood as a gesture of domestication. And yet Die Verwandlung is, if nothing else, a scandal of the home or domus, a narrative in which not only the domestic animal, Gregor, or the home of the Samsa family but the very notion of metamorphosis become increasingly unheimlich. As Freud noted in his famous essay, the uncanny (das Unheimliche) cannot simply be opposed to, cannot merely be viewed as the negation of, the Heimliche—of the homey and familiar in the etymological sense but also, less literally, in the all too familiar sense of the covert, clandestine, and secret. Like Poe's purloined letter, das Unheimliche is a secret hidden in the open, a contradiction in terms, a strange familiarity.
Does attentiveness matter in survey responses? Do more attentive survey participants give higher quality responses? Using data from a recent online survey that identified inattentive respondents using instructed-response items, we demonstrate that ignoring attentiveness provides a biased portrait of the distribution of critical political attitudes and behavior. We show that this bias occurs in the context of both typical closed-ended questions and in list experiments. Inattentive respondents are common and are more prevalent among the young and less educated. Those who do not pass the trap questions interact with the survey instrument in distinctive ways: they take less time to respond; are more likely to report nonattitudes; and display lower consistency in their reported choices. Inattentiveness does not occur completely at random and failing to properly account for it may lead to inaccurate estimates of the prevalence of key political attitudes and behaviors, of both sensitive and more prosaic nature.
Northern China has been identified as an independent centre of domestication for various types of millet and other plant species, but tracing the earliest evidence for the exploitation of wild cereals and thus the actual domestication process has proven challenging. Evidence from microscopic analyses of stone tools, including use-wear, starch and phytolith analyses, however, show that in the Shizitan region of north China, various plants have been exploited as far back as 28000 years ago, and wild millets have been harvested and processed by the time of the Last Glacial Maximum, 24000 years ago. This is some 18000–14000 years before the earliest evidence for domesticated millet in this region.
Neurologic conditions are among the more common concurrent medical conditions encountered during pregnancy. Table 44.1 shows the prevalence of several such neurologic diseases. Despite their cumulative prevalence, the relative rarity of many of these conditions limits the actual clinical experience of both the managing obstetrician and the neurologist. In addition, the individual practitioner is further hampered by the limited amount of pregnancy-specific information available. The frequent overlap of symptoms associated with common pregnancy complaints, the sometimes disabling and lethal consequences of the disease, and the fetal effects of the maternal disease and/or treatment make the diagnosis and management of neurologic disease during pregnancy an often-daunting task.
Lithium sulfur (Li–S) batteries have the potential to provide higher energy storage density at lower cost than conventional lithium ion batteries. A key challenge for Li–S batteries is the loss of sulfur to the electrolyte during cycling. This loss can be mitigated by sequestering the sulfur in nanostructured carbon–sulfur composites. The nanoscale characterization of the sulfur distribution within these complex nanostructured electrodes is normally performed by electron microscopy, but sulfur sublimates and redistributes in the high-vacuum conditions of conventional electron microscopes. The resulting sublimation artifacts render characterization of sulfur in conventional electron microscopes problematic and unreliable. Here, we demonstrate two techniques, cryogenic transmission electron microscopy (cryo-TEM) and scanning electron microscopy in air (airSEM), that enable the reliable characterization of sulfur across multiple length scales by suppressing sulfur sublimation. We use cryo-TEM and airSEM to examine carbon–sulfur composites synthesized for use as Li–S battery cathodes, noting several cases where the commonly employed sulfur melt infusion method is highly inefficient at infiltrating sulfur into porous carbon hosts.
The first part of this essay asks: What is the function, purpose and value of a museum? Has any museologist or philosopher given a credible account of philosophical problems associated with museums? Is there any set of properties shared by the diverse entities called museums? Overgeneralization is the principal problem here. The essay then examines a central kind of museum experience; one that invokes and relies upon nostalgia. I argue that the attraction of museums are varied but are best explained affectively and in terms of the orectic (appetitive, desiderative, wishing) rather than cognitively conatively (willing, deciding). Although this need not be taken as conflicting with the idea that museums are focused on scholarship, it is more consonant with the claim that exhibitions are central. Museums may at times both pique and satisfy our curiosity. However it is a mistake to see ‘curiosity’ as merely, or even primarily, a matter of cognition.
For more than a decade, increased scrutiny has been placed on the administration and integrity of democratic elections throughout the world (Levin and Alvarez 2012). The surge of interest in electoral integrity seems to be fueled by a number of different factors: an increase in the number of nations conducting elections, more concerns about election administration and voting technology, the increased use of social media, and a growing number of scholars throughout the world who are interested in the study of integrity and the possible manipulation of elections (Alvarez, Hall, and Hyde 2008).
Although there are many ways that the integrity of elections can be assessed – for example, by studying the opinions of voters about their confidence in the conduct of elections (Alvarez, Atkeson, and Hall 2012) or through election monitoring (Bjornlund 2004; Hyde 2007, 2011; Kelley 2013) – many methodologists, statisticians and computer scientists have contributed to the new and growing literature on “election forensics”. This body of research involves the development of a growing suite of tools – some as simple as looking at the distributions of variables, such as turnout in an election, and others that use more complex multivariate statistical models – to sift through observational data from elections to detect anomalies or outliers as potential indicators for election fraud and manipulation (Levin et al. 2009; Alvarez et al. 2014).
The literature on election forensics now has advanced a somewhat dizzying array of methods for detecting election anomalies, without providing guidance for when particular methods might best be utilized by analysts. That is, when is it best to look for anomalies in distributions of voter turnout? When should digit tests (such as Benford's Law) be applied? What about the use of regression models to detect outliers, either in single or multiple contests? How much statistical power do distributional tests have in common settings where you want to try to detect election outliers? These questions have motivated some of our recent research and have led us to consider the use of new techniques, such as machine learning, for the detection of election manipulation in nations like Venezuela (Alvarez et al. 2014).
Machine learning procedures use statistical tools to find patterns in the data that reveal new and relevant information that may prove useful for performing an action or task.
Objective: Idiopathic normal pressure hydrocephalus (INPH) is a neurological disorder presenting with gait, cognitive, and bladder symptoms in the context of ventricular enlargement. Although gait is the primary indicator for treatment candidacy and outcome, additional monitoring tools are needed. Line Tracing Test (LTT) and Serial Dotting Test (SDT), two psychomotor tasks, have been introduced as potential outcome measures but have not been widely studied. This preliminary study examined whether LTT and SDT are sensitive to motor dysfunction in INPH and determined if accuracy and time are important aspects of performance. Methods: Eighty-four INPH subjects and 36 healthy older adults were administered LTT and SDT. Novel error scoring procedures were developed to make scoring practical and efficient; interclass correlation showed good reliability of scoring procedures for both tasks (0.997; p<.001). Results: The INPH group demonstrated slower performance on SDT (p<.001) and made a greater number of errors on both tasks (p<.001). Combined Time/Error scores revealed poorer performance in the INPH group for original-LTT (p<.001), modified-LTT (p≤.001) and SDT (p<.001). Conclusions: These findings indicate LTT and SDT may prove useful for monitoring psychomotor skills in INPH. While completion time reflects impaired processing speed, reduced accuracy may suggest planning and self-monitoring difficulties, aspects of executive functioning known to be compromised in INPH. This is the first study to underscore the importance of performance accuracy in INPH and introduce practical/reliable error scoring for these tasks. Future work will establish reliability and validity of these measures and determine their utility as outcome tools. (JINS, 2016, 22, 341–349)