More speech, not less

In early December 2016, the High Court heard a test case brought by Mr. Salman Butt, a British Muslim labelled an extremist in a September 2015 press release by the Government’s Extremism Task Force. The litigation challenges the legitimacy of the Government’s ‘Prevent’ Strategy, which proscribes methods for identifying individuals allegedly expressing ‘vocal or active opposition to fundamental British values.’ The intent of ‘Prevent’ is ultimately to suppress the views of extremists, expression of which, according to ‘Prevent,’ puts society at risk of violent harm

Effect of Axial Load on the Flexural Properties of an Elastomeric Total Disc Replacement

Study Design. Twelve Cadisc-L devices were subjected to flexion (0°–6°) and extension (0° to -3°) motions at compressive loads between 500 N and 2000 N at a flexural rate between 0.25°/s and 3.0°/s.\ud \ud Objective. To quantify the change in flexural properties of the Cadisc-L (elastomeric device), when subjected to increasing magnitudes of axial load and at different flexural rates.\ud \ud Summary of Background Data. The design of motion preservation devices, used to replace degenerated intervertebral discs, is commonly based on a low-friction, ball-and-socket-articulating joint. Recently, elastomeric implants have been developed that attempt to provide mechanical and motion properties that resemble those of the natural disc more closely.\ud \ud Methods. Twelve Cadisc-L devices (MC-10 mm-9° and MC-10 mm-12° size) were supplied by Ranier Technology Ltd (Cambridge, United Kingdom). The devices were hydrated and tested using a Bose spinal disc-testing machine (Bose Corporation, ElectroForce Systems Group, Eden Prairie, MN) in Ringer's solution at 37°C. A static load of 500 N was applied to a device and it was then subjected to motions of 0° to 6° to 0° (flexion) and 0° to -3° to 0° (extension) at a flexural rate of 0.25°/s, 0.5°/s, 1.0°/s, 1.5°/s, 2.0°/s, and 3.0°/s. Tests were repeated at 1000 N, 1500 N, and 2000 N.\ud \ud Results. Regression analyses showed a significant ($R^2$ > 0.99, $\rho$< 0.05) linear increase in bending moment and flexural stiffness with flexion and extension angles (at 1000 N and higher loads)—a significant ($R^2$> 0.994, $\rho$< 0.05) linear decrease in flexural stiffness in flexion and extension as flexural rate increased.\ud \ud Conclusion. The bending moment of the Cadisc-L increased linearly with flexion and extension angles at 1000 N and higher loads. Flexural stiffness increased with compressive load but decreased with flexural rate.\ud \u

Improving Handoff Communication in the Emergency Department

Ineffective handoff communication has been recognized for years as a practice issue and is the most frequently reported cause of sentinel events in U.S. hospitals (Dufault et al., 2010) and responsible, at least in part, for 30% of all malpractice claims (Fucik, 2019). The development of standardized tools has been identified as a key component to improving handover practice. For this project, a standardized SBAR tool was modified for a local emergency department. The intervention was a process change in the emergency department to utilize an SBAR tool during handoff reports. The project was implemented by educating staff on the new process and tool during routine staff meetings and then launching the use of the new tool after scheduled staff meetings were completed. The project aimed to increase staff perception of “good handoff communication” measured by a pre and post survey questionnaire. The survey questionnaire consisted of 10 questions and was created by using the “Eight Quality Components of Handoff” to measure pre versus post implementation handoff behavior (Angelow & Specht, 2019). The desired outcome was to increase staff perception of effective handoff communication by 25% after 2 months of implementing the use of a standardized tool for handover reports. The project resulted in an overall increase in the quality of handoff measures. Staff perception of the quality of handoff using a standardized tool improved from an average score of 3.36 presurvey to 4.25 post survey on a 5-point Likert scale

Use of Mid-Upper Arm Circumference by Novel Community Platforms to Detect, Diagnose, and Treat Severe Acute Malnutrition in Children: A Systematic Review.

BACKGROUND: A stubborn persistence of child severe acute malnutrition (SAM) and continued gaps in program coverage have made identifying methods for expanding detection, diagnosis, and treatment of SAM an urgent public health need. There is growing consensus that making mid-upper arm circumference (MUAC) use more widely accessible among caregivers and community health workers (CHWs) is an important next step in further decentralizing SAM care and increasing program coverage, including the ability of CHWs to treat uncomplicated SAM in community settings. METHODS: We conducted a systematic review to summarize published and operational evidence published since 2000 describing the use of MUAC for detection and diagnosis of SAM in children aged 6-59 months by caregivers and CHWs, and of management of uncomplicated SAM by CHWs, all outside of formal health care settings. We screened 1,072 records, selected 43 records for full-text screening, and identified 22 studies that met our eligibility criteria. We extracted data on a number of items, including study design, strengths, and weaknesses; intervention and control; and key findings and operational lessons. We then synthesized the qualitative findings to inform our conclusions. The issue of treating children classified as SAM based on low weight-for-height, rather than MUAC, at household level, is not addressed in this review. FINDINGS: We found evidence that caregivers are able to use MUAC to detect SAM in their children with minimal risk and many potential benefits to early case detection and coverage. We also found evidence that CHWs are able to correctly use MUAC for SAM detection and diagnosis and to provide a high quality of care in the treatment of uncomplicated SAM when training, supervision, and motivation are adequate. However, the number of published research studies was small, their geographic scope was narrow, and most described intensive, small-scale interventions; thus, findings are not currently generalizable to public-sector health care systems. CONCLUSIONS: Scaling up the use of MUAC by caregivers and CHWs to detect SAM in household and community settings is a promising step toward improving the coverage of SAM detection, diagnosis, and treatment. Further research on scalability, applicability across a wider range of contexts, coverage impact, and cost is needed. The primary use of MUAC for SAM detection should also be explored where appropriate

Binary orbits as the driver of γ-ray emission and mass ejection in classical novae

Classical novae are the most common astrophysical thermonuclear explosions, occurring on the surfaces of white dwarf stars accreting gas from companions in binary star systems. Novae typically expel �10,000 solar masses of material at velocities exceeding 1,000 km/s. However, the mechanism of mass ejection in novae is poorly understood, and could be dominated by the impulsive flash of the thermonuclear runaway, prolonged optically thick winds, or binary interaction with the nova envelope. Classical novae are now routinely detected in GeV gamma-rays, suggesting that relativistic particles are accelerated by strong shocks in nova ejecta. Here we present high-resolution imaging of the gamma-ray-emitting nova V959 Mon at radio wavelengths, showing that its ejecta were shaped by binary motion: some gas was expelled rapidly along the poles as a wind from the white dwarf, while denser material drifted out along the equatorial plane, propelled by orbital motion. At the interface between the equatorial and polar regions, we observe synchrotron emission indicative of shocks and relativistic particle acceleration, thereby pinpointing the location of gamma-ray production. Binary shaping of the nova ejecta and associated internal shocks are expected to be widespread among novae, explaining why many novae are gamma-ray emitters

Mortality According to CD4 Count at Start of Combination Antiretroviral Therapy Among HIV-infected Patients Followed for up to 15 Years After Start of Treatment: Collaborative Cohort Study.

BACKGROUND: CD4 count at start of combination antiretroviral therapy (ART) is strongly associated with short-term survival, but its association with longer-term survival is less well characterized. METHODS: We estimated mortality rates (MRs) by time since start of ART (&lt;0.5, 0.5-0.9, 1-2.9, 3-4.9, 5-9.9, and ≥10 years) among patients from 18 European and North American cohorts who started ART during 1996-2001. Piecewise exponential models stratified by cohort were used to estimate crude and adjusted (for sex, age, transmission risk, period of starting ART [1996-1997, 1998-1999, 2000-2001], and AIDS and human immunodeficiency virus type 1 RNA at baseline) mortality rate ratios (MRRs) by CD4 count at start of ART (0-49, 50-99, 100-199, 200-349, 350-499, ≥500 cells/µL) overall and separately according to time since start of ART. RESULTS: A total of 6344 of 37 496 patients died during 359 219 years of follow-up. The MR per 1000 person-years was 32.8 (95% confidence interval [CI], 30.2-35.5) during the first 6 months, declining to 16.0 (95% CI, 15.4-16.8) during 5-9.9 years and 14.2 (95% CI, 13.3-15.1) after 10 years' duration of ART. During the first year of ART, there was a strong inverse association of CD4 count at start of ART with mortality. This diminished over the next 4 years. The adjusted MRR per CD4 group was 0.97 (95% CI, .94-1.00; P = .054) and 1.02 (95% CI, .98-1.07; P = .32) among patients followed for 5-9.9 and ≥10 years, respectively. CONCLUSIONS: After surviving 5 years of ART, the mortality of patients who started ART with low baseline CD4 count converged with mortality of patients with intermediate and high baseline CD4 counts

Mortality according to CD4 count at start of combination antiretroviral therapy among HIV-infected patients followed for up to 15 years after start of treatment:collaborative cohort study

Background. CD4 count at start of combination antiretroviral therapy (ART) is strongly associated with short-term survival, but its association with longer-term survival is less well characterised. Methods. We estimated mortality rates (MR) by time since start of ART (&lt;0.5, 0.5-0.9, 1-2.9, 3-3.9, 5-9.9 and ≥10 years) among patients from 18 European and North American cohorts who started ART during 1996-2001. Piecewise exponential models stratified by cohort were used to estimate crude and adjusted (for sex, age, transmission risk, period of starting ART [1996-7, 1998-9, 2000-1], AIDS and HIV-1 RNA at baseline) mortality rate ratios (MRR) by CD4 count at start of ART (0-49, 50-99, 100-199, 200-349, 350-499, ≥500 cells/μL) overall and separately according to time since start of ART. Results. 6,344 of 37,496 patients died during 359,219 years of follow up. The MR per 1000 person-years was 32.8 (95% CI 30.2-35.5) during the first 6 months, declining to 16.0 (15.4, 16.8) during 5-9.9 years and 14.2 (13.3-15.1) after 10 years duration of ART. During the first year of ART there was a strong inverse association of CD4 count at start of ART with mortality. This diminished over the next 4 years. The adjusted MRR per CD4 group were 0.97 (0.94-1.00), p=0.054 and 1.02 (0.98-1.07), p=0.32 among patients followed for 5-9.9 and &gt;10 years respectively. Conclusions. After surviving five years of ART, the mortality of patients who started ART with low baseline CD4 count converged with mortality of patients with intermediate and high baseline CD4 counts. </p

Non-Invasive Ventilation of the Neonate

The use of mechanical ventilation in the past few decades has greatly contributed to the survival of critically ill neonates, both preterm and term. With this, however, has come an accompanied rise in certain complications and neonatal co-morbidities. Avoiding mechanical ventilation, or at least minimizing the time a neonate is intubated, is considered a critical goal in the care of these patients. Different modes of non-invasive ventilation have developed over the course of the time to help address these issues

Health-Related Fitness Differences Amongst Allied and Non-Allied Undergraduate Health Majors

https://louis.uah.edu/research-horizons/1102/thumbnail.jp

Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics

Background HIV cohort collaborations, which pool data from diverse patient cohorts, have provided key insights into outcomes of antiretroviral therapy (ART). However, the extent of, and reasons for, between-cohort heterogeneity in rates of AIDS and mortality are unclear. Methods We obtained data on adult HIV-positive patients who started ART from 1998 without a previous AIDS diagnosis from 17 cohorts in North America and Europe. Patients were followed up from 1 month to 2 years after starting ART. We examined between-cohort heterogeneity in crude and adjusted (age, sex, HIV transmission risk, year, CD4 count and HIV-1 RNA at start of ART) rates of AIDS and mortality using random-effects meta-analysis and meta-regression. Results During 61 520 person-years, 754/38 706 (1.9%) patients died and 1890 (4.9%) progressed to AIDS. Between-cohort variance in mortality rates was reduced from 0.84 to 0.24 (0.73 to 0.28 for AIDS rates) after adjustment for patient characteristics. Adjusted mortality rates were inversely associated with cohorts' estimated completeness of death ascertainment [excellent: 96-100%, good: 90-95%, average: 75-89%; mortality rate ratio 0.66 (95% confidence interval 0.46-0.94) per category]. Mortality rate ratios comparing Europe with North America were 0.42 (0.31-0.57) before and 0.47 (0.30-0.73) after adjusting for completeness of ascertainment. Conclusions Heterogeneity between settings in outcomes of HIV treatment has implications for collaborative analyses, policy and clinical care. Estimated mortality rates may require adjustment for completeness of ascertainment. Higher mortality rate in North American, compared with European, cohorts was not fully explained by completeness of ascertainment and may be because of the inclusion of more socially marginalized patients with higher mortality ris