Modern Approaches to Addressing the Mass Incarceration of America\u27s Mentally Ill Population

Correctional facilities negatively affect individuals with pre-existing mental and behavioral health concerns while also creating an environment that manifests future mental illness. Issues include facility overcrowding, restrictive housing practices, lack of accessible services, and ill-informed practices and procedures when working with individuals with mental illness. Incarcerated individuals with mental illness also face disparities through (1) sentence length, (2) race/ethnicity and gender, and (3) increased risk in victimization. This paper draws attention to a long-standing, yet current critical issue in the American criminal justice system—the use of jails and prisons as modern-day psychiatric hospitals. This literature yields many options for disrupting this practice, including both proactive and reactive reforms that seek to reduce mass incarceration of those with mental illness as well as improve correctional facility conditions for this incarcerated population

Epidemiology of traumatic myiasis due to Chrysomya bezziana in Indonesia

&lt;p&gt;Epidemiology of traumatic myiasis in Indonesia was studied by the widespread collection of fly larvae from infested livestock in passive case detection surveys involving veterinary clinics. In addition, monthly data from Kediri regency in Eastern Java were analysed from 2006-2009 to explore the seasonality of myiasis. Larvae from a total of 260 cases from the nationwide survey and 341 cases from Kediri were identified. Except for 5 cases of chicken infestation due to Musca species in the nationwide survey, all other cases were exclusively caused by the Old World screwworm (OWS) fly, Chrysomya bezziana (Diptera: Calliphoridae). The monthly numbers of cases at Kediri were very variable, with cases in all months, but there was statistical evidence for an increase in cases in January and December, during the rainy season. The greatest numbers of infestations recorded were from cattle and goats. The most frequently infested sites nationwide and in Kediri were the vulva and umbilicus, associated with calving, which is a major risk period for traumatic myiasis. Mitochondrial DNA typing of 176 specimens was useful for detecting multiple infestations, but no association was found between genetic lineage and host. The equatorial climate of Indonesia, combined with poor husbandry systems are factors that help to support OWS fly development year round. Even if not considered a disease of strategic importance, screwworm myiasis remains a threat to livestock production in Indonesia and a major welfare issue that requires constant interventions by farmers. The new and collated epidemiological data presented represent the most extensive survey of traumatic myiasis in Indonesia to date and provide a valuable baseline to support integrated pest management programs.&lt;/p&gt;</jats:p

Evaluating Cumulative Ecosystem Response to Restoration Projects in the Lower Columbia River and Estuary, 2009

This is the sixth annual report of a seven-year project (2004 through 2010) to evaluate the cumulative effects of habitat restoration actions in the lower Columbia River and estuary (LCRE). The project, called the Cumulative Effects Study, is being conducted for the U.S. Army Corps of Engineers Portland District (USACE) by the Marine Sciences Laboratory of the Pacific Northwest National Laboratory (PNNL), the Pt. Adams Biological Field Station of the National Marine Fisheries Service (NMFS), the Columbia River Estuary Study Taskforce (CREST), and the University of Washington. The goal of the Cumulative Effects Study is to develop a methodology to evaluate the cumulative effects of multiple habitat restoration projects intended to benefit ecosystems supporting juvenile salmonids in the 235-km-long LCRE. Literature review in 2004 revealed no existing methods for such an evaluation and suggested that cumulative effects could be additive or synergistic. From 2005 through 2009, annual field research involved intensive, comparative studies paired by habitat type (tidal swamp versus marsh), trajectory (restoration versus reference site), and restoration action (tidegate replacement vs. culvert replacement vs. dike breach)

New Tests of Magnetospheric Accretion in T Tauri Stars

We examine 3 analytic theories of magnetospheric accretion onto classical T Tauri stars under the assumption that the magnetic field strength does not vary appreciably from star to star. From these investigations we derive predicted relationships among the stellar mass, radius, rotation period, and disk accretion rate. Data from 5 studies of the accretion parameters of CTTSs are used to test the predicted correlations. We generally find that the data do not display the predicted correlations except for that predicted by the model of Shu et al. as detailed by Ostriker and Shu and extended here to include non-dipole field topologies. Their identification of the trapped flux as an important quantity in the model appears to be critical for reconciling the observed data to the theory. While the data do generally support the extended Ostriker and Shu predictions, only one of the two studies for which the requisite data exist show the highest correlation when considering all the relevant parameters. This suggests great care must be taken when trying to use existing observations to test the theory.Comment: 36 pages, including figure

American Association of Colleges of Pharmacy (AACP) Co-Curriculum Toolkit

The co-curriculum is intended to run parallel to the formal curriculum and support the development of students’ professional knowledge, skills, abilities, behaviors, and attitudes, including scientific foundation, knowledge application, and practice competencies. Additionally, the co-curriculum can also support proficiency in skills and achievement of competencies that are concurrently taught within the formal curriculum. ACPE evaluates the way programs assess students’ acquisition of knowledge and application of knowledge to practice within co-curricular experiences and especially how they advance the professional development of students within affective domain areas of learning

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Evaluation of Cumulative Ecosystem Response to Restoration Projects in the Lower Columbia River and Estuary, 2010

This is the seventh and final annual report of a project (2004–2010) addressing evaluation of the cumulative effects of habitat restoration actions in the 235-km-long lower Columbia River and estuary. The project, called the Cumulative Effects (CE) study, was conducted for the U.S. Army Corps of Engineers Portland District by a collaboration of research agencies led by the Pacific Northwest National Laboratory. We achieved the primary goal of the CE study to develop a methodology to evaluate the cumulative effects of habitat actions in the Columbia Estuary Ecosystem Restoration Program. We delivered 1) standard monitoring protocols and methods to prioritize monitoring activities; 2) the theoretical and empirical basis for a CE methodology using levels-of-evidence; 3) evaluations of cumulative effects using ecological relationships, geo-referenced data, hydrodynamic modeling, and meta-analyses; and 4) an adaptive management process to coordinate and coalesce restoration efforts in the LCRE. A solid foundation has been laid for future comprehensive evaluations of progress made by the Columbia Estuary Ecosystem Restoration Program to understand, conserve, and restore ecosystems in the lower Columbia River and estuary

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

The National Early Warning Score and its subcomponents recorded within ±24 hours of emergency medical admission are poor predictors of hospital-acquired acute kidney injury

YesBackground: Hospital-acquired Acute Kidney Injury (H-AKI) is a common cause of avoidable morbidity and mortality. Aim: To determine if the patients’ vital signs data as defined by a National Early Warning Score (NEWS), can predict H-AKI following emergency admission to hospital. Methods: Analyses of emergency admissions to York hospital over 24-months with NEWS data. We report the area under the curve (AUC) for logistic regression models that used the index NEWS (model A0), plus age and sex (A1), plus subcomponents of NEWS (A2) and two-way interactions (A3). Likewise for maximum NEWS (models B0,B1,B2,B3). Results: 4.05% (1361/33608) of emergency admissions had H-AKI. Models using the index NEWS had the lower AUCs (0.59 to 0.68) than models using the maximum NEWS AUCs (0.75 to 0.77). The maximum NEWS model (B3) was more sensitivity than the index NEWS model (A0) (67.60% vs 19.84%) but identified twice as many cases as being at risk of H-AKI (9581 vs 4099) at a NEWS of 5. Conclusions: The index NEWS is a poor predictor of H-AKI. The maximum NEWS is a better predictor but seems unfeasible because it is only knowable in retrospect and is associated with a substantial increase in workload albeit with improved sensitivity.The Health Foundatio