Patients' request for and emergency physicians' prescription of antimicrobial prophylaxis for anthrax during the 2001 bioterrorism-related outbreak

BACKGROUND: Inappropriate use of antibiotics by individuals worried about biological agent exposures during bioterrorism events is an important public health concern. However, little is documented about the extent to which individuals with self-identified risk of anthrax exposure approached physicians for antimicrobial prophylaxis during the 2001 bioterrorism attacks in the United States. METHODS: We conducted a telephone survey of randomly selected members of the Pennsylvania Chapter of the American College of Emergency Physicians to assess patients' request for and emergency physicians' prescription of antimicrobial agents during the 2001 anthrax attacks. RESULTS: Ninety-seven physicians completed the survey. Sixty-four (66%) respondents had received requests from patients for anthrax prophylaxis; 16 (25%) of these physicians prescribed antibiotics to a total of 23 patients. Ten physicians prescribed ciprofloxacin while 8 physicians prescribed doxycycline. CONCLUSION: During the 2001 bioterrorist attacks, the majority of the emergency physicians we surveyed encountered patients who requested anthrax prophylaxis. Public fears may lead to a high demand for antibiotic prophylaxis during bioterrorism events. Elucidation of the relationship between public health response to outbreaks and outcomes would yield insights to ease burden on frontline clinicians and guide strategies to control inappropriate antibiotic allocation during bioterrorist events

Cardiovascular Risk Reduction is Important for Improving Patient and Graft Survival After Ligation and Bypass Surgery for Popliteal Artery Aneurysm

OBJECTIVES: To report outcomes following ligation and bypass (LGB) surgery for popliteal artery aneurysm (PAA) and study factors influencing patient and graft survival. MATERIALS AND METHODS: A retrospective review of patients undergoing LGB surgery for PAA between September 1999 and August 2012 at a tertiary referral vascular unit was performed. Primary graft patency (PGP), primary-assisted graft patency (PAGP), and secondary graft patency (SGP) rates were calculated using survival analyses. Patient, graft aneurysm-free survival (GAFS), aneurysm reperfusion-free survival (ARFS), and amputation-free survival (AFS) rates were also calculated. Log-rank testing and Cox proportional hazards modeling were used to perform univariate and multivariate analysis of influencing factors, respectively. RESULTS: Eighty-four LGB repairs in 69 patients (mean age 71.3 years, 68 males) were available for study. The 5-year PGP, PAGP, SGP, and patient survival rates were 58.1%, 84.4%, 85.2%, and 81.1%, respectively. On multivariate analysis, the principal determinants of PGP were urgency of operation ( P = .009) and smoking status ( P = .019). The principal determinants of PAGP were hyperlipidemia status ( P = .048) and of SGP were hyperlipidemia ( P = .042) and cerebrovascular disease (CVD) status ( P = .045). The principal determinants of patient survival were previous myocardial infarction ( P = .004) and CVD ( P = .001). The 5-year GAFS, ARFS, and AFS rates were 87.9%, 91.6%, and 96.1%, respectively. CONCLUSION: This study has shown that traditional cardiovascular risk factors, such as a smoking and ischemic heart disease, are the most important predictors of early graft failure and patient death following LGB surgery for PAA

Volume–outcome relationships in open and endovascular repair of abdominal aortic aneurysm : administrative data 2006–2018

Background The aim of this study was to use recent evidence to investigate and update volume–outcome relationships after open surgical repair (OSR) and endovascular repair (EVAR) of abdominal aortic aneurysm in England. Methods Hospital Episode Statistics (HES) data from April 2006 to March 2018 were obtained. The primary outcome was in‐hospital death. Other outcomes included duration of hospital stay, readmissions within 30 days, and critical care requirements. Case‐mix adjustment included age, sex, HES year, deprivation index, weekend admission, mode of admission, type of procedure and co‐morbidities. Results Annual volume of all repairs combined appeared to be an appropriate measure of volume. After case‐mix adjustment, a significant relationship between volume and in‐hospital mortality was seen for OSR (P < 0·001) but not for EVAR (P = 0·169 for emergency and P = 0·363 for elective). The effect appeared to extend beyond 60 repairs per year to volumes above 100 repairs per year. There was no significant relationship between volume and duration of hospital stay or 30‐day readmissions. In patients receiving emergency OSR, higher volume was associated with longer stay in critical care. Conclusion Higher annual all‐procedure volumes were associated with significantly lower in‐hospital mortality for OSR, but such a relationship was not significant for EVAR. There was not enough evidence for a volume effect on other outcomes

Learning in the Time of a Pandemic and Implications for Returning to School: Effects of COVID-19 in Ghana

The Covid-19 pandemic led to school closures all over the world, leaving children across diverse contexts without formal education for nearly a year. Remote-learning programs were designed and rapidly implemented to promote learning continuity throughout the crisis. There were inequalities in who was able to access remote-learning during school closures, though little systematic evidence documenting these gaps exists, particularly in sub-Saharan Africa. In this study, we surveyed 1,844 children in the Greater Accra Region of Ghana, as well as their caregivers and teachers, regarding their engagement in remote learning, literacy and math test scores, and household economic hardships. We document inequalities in access to and engagement in remote-learning activities during the ten months in 2020 in which schools were closed in Ghana. Specifically, children in private schools and children in higher-socioeconomic status households engaged in remote-learning at higher rates and received more support from their schools and caregivers. Further, controlling for demographic characteristics and pre-pandemic learning outcomes, we document gaps in children’s literacy and math test scores, with food insecure and low-SES children, as well as children enrolled in public schools before the pandemic, performing significantly worse than their peers (0.2-0.3 SD gap). Finally, children in households that experienced more economic hardships during the pandemic engaged in fewer remote learning activities and had lower literacy and numeracy assessment scores. The findings speak to the potential consequences of increased inequalities due to the pandemic as schools re-open in Ghana and around the world and provide insight into how schools may address these inequalities as children return to the classroom

Families' social backgrounds matter : socio-economic factors, home learning and young children's language, literacy and social outcomes

Parental support with children's learning is considered to be one pathway through which socio-economic factors influence child competencies. Utilising a national longitudinal sample from the Millennium Cohort Study, this study examined the relationship between home learning and parents' socio-economic status and their impact on young children's language/literacy and socio-emotional competence. The findings consistently showed that, irrespective of socio-economic status, parents engaged with various learning activities (except reading) roughly equally. The socio-economic factors examined in this study, i.e., family income and maternal educational qualifications, were found to have a stronger effect on children's language/literacy than on social-emotional competence. Socio-economic disadvantage, lack of maternal educational qualifications in particular, remained powerful in influencing competencies in children aged three and at the start of primary school. For children in the first decade of this century in England, these findings have equity implications, especially as the socio-economic gap in our society widens

Development of the NASA/Baylor VAD

A cooperative effort between the NASA/Johnson Space Center (JSC) and the Baylor College of Medicine (BCM) has been underway since 1988 to develop a long-term implantable Ventricular Assist Device (VAD). The VAD is intended to boost the cardiac output of patients with deteriorated cardiac function. For many of these patients, the best alternative is heart transplantation. Heart transplantation is a complex and expensive procedure and usually requires a long waiting period for a donor heart. The condition of the patient often deteriorates during this waiting period which complicates the pre and post-operative care. Because of these factors, the need for a long-term implantable VAD for use as a bridge-to-transplant device or as a permanent assist device has become the focus of much research. The need for a VAD has been estimated at 50,000 to 60,000 patients per year in the United States alone. A device which satisfies all the system performance and reliability requirements has yet to be achieved. However, the development of the NASA/Baylor VAD has progressed to a state in which commercial viability can being to be considered. The device is small, simple, efficient and reliable which meets all requirements for a totally implantable VAD

Trends in Causes and Distribution, and Effects of Whitebark Pine Decline on Grizzly Bear Mortality in the Greater Yellowstone Ecosystem

Documented grizzly bear (Ursus arctos) mortalities have been increasing in recent years in the Greater Yellowstone Ecosystem (GYE), due, in part, to increases in bear numbers and range expansion. Previous research has documented that variable seed production of whitebark pine (WBP; Pinus albicaulis), an important fall food, is inversely related to grizzly bear fall mortality.  However, WBP has experienced widespread mortality during the last decade because of mountain pine beetle (Dendroctonus ponderosae) infestations. We investigated trends in causes and distribution of human-caused mortalities for independent-aged (? 2 yrs old) grizzly bears in the GYE during 1975–2012, and the effect of WBP cone production on numbers of fall (&gt; 1 August) mortalities (n = 172) during the period of WBP decline (2000-2012) using Poisson regression. During 1975–1982, 91 percent of mortalities occurred within the Grizzly Bear Recovery Zone and primary causes were poaching/malicious killings and losses related to conflicts with livestock. During the two most recent decades most mortalities were associated with ungulate hunting, usually involving self-defense kills, or anthropogenic sites, and an increasing percentage of mortalities occurred outside the recovery zone. Using predictor variables of cone production, sex, location in or out of the Recovery Zone, and year suggests: 1) annual cone production was still predictive of human-caused fall mortalities, 2) no evidence of a difference in annual numbers of fall mortalities between males and females, and 3) an increase in annual mortalities over the study period, with most of this increase outside the Recovery Zone

Denitrification and nitrous oxide emissions from riparian forests soils exposed to prolonged nitrogen runoff

Compared to upland forests, riparian forest soils have greater potential to remove nitrate (NO3) from agricultural run-off through denitrification. It is unclear, however, whether prolonged exposure of riparian soils to nitrogen (N) loading will affect the rate of denitrification and its end products. This research assesses the rate of denitrification and nitrous oxide (N2O) emissions from riparian forest soils exposed to prolonged nutrient run-off from plant nurseries and compares these to similar forest soils not exposed to nutrient run-off. Nursery run-off also contains high levels of phosphate (PO4). Since there are conflicting reports on the impact of PO4 on the activity of denitrifying microbes, the impact of PO4 on such activity was also investigated. Bulk and intact soil cores were collected from N-exposed and non-exposed forests to determine denitrification and N2O emission rates, whereas denitrification potential was determined using soil slurries. Compared to the non-amended treatment, denitrification rate increased 2.7- and 3.4-fold when soil cores collected from both N-exposed and non-exposed sites were amended with 30 and 60 μg NO3-N g-1 soil, respectively. Net N2O emissions were 1.5 and 1.7 times higher from the N-exposed sites compared to the non-exposed sites at 30 and 60 μg NO3-N g-1 soil amendment rates, respectively. Similarly, denitrification potential increased 17 times in response to addition of 15 μg NO3-N g-1 in soil slurries. The addition of PO4 (5 μg PO4–P g-1) to soil slurries and intact cores did not affect denitrification rates. These observations suggest that prolonged N loading did not affect the denitrification potential of the riparian forest soils; however, it did result in higher N2O emissions compared to emission rates from non-exposed forests

Translation and preliminary validation of a Korean version of the parental reflective functioning questionnaire

This study aimed to explore the factor structure, reliability, and validity of a Korean translation of the Parental Reflective Functioning Questionnaire (PRFQ). The PRFQ consists of three subscales: prementalizing modes , certainty about mental states , and interest and curiosity in mental states . A convenience sample of 163 Korean parents completed the K‐PRFQ. Exploratory factor analysis showed three factors mapped on to the original PRFQ factors, but items from the original prementalizing modes subscale clustered into two additional factors. Data from a subsample (n = 67) showed that the certainty about mental states and interest and curiosity in mental states subscales correlated positively with more optimal self‐reported parenting. We discuss the validity of using the PRFQ in collectivistic culture