Comparison of Risk of Recrudescent Fever in Children With Kawasaki Disease Treated With Intravenous Immunoglobulin and Low-Dose vs High-Dose Aspirin

Importance: Timely initiation of intravenous immunoglobulin plus aspirin is necessary for decreasing the risk of recrudescent fever and coronary artery abnormalities in children with Kawasaki disease (KD). The optimal dose of aspirin, however, remains unclear. Objective: To evaluate whether initial treatment with low-dose compared with high-dose aspirin in children with KD is associated with an increase in fever recrudescence. Design, Setting, and Participants: A retrospective cohort study of 260 children with KD at Riley Hospital for Children, Indianapolis, Indiana, between January 1, 2007, and December 31, 2018, was conducted. Children aged 0 to 18 years with a first episode of KD, identified by International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes treated within 10 days of symptom onset with high-dose intravenous immunoglobulin plus aspirin were eligible. Patients who received an alternative diagnosis, experienced a second episode of KD, did not receive intravenous immunoglobulin plus aspirin for initial treatment, were not treated within 10 days of symptoms, or had incomplete records were excluded. Exposures: High-dose (≥10 mg/kg/d) or low-dose (<10 mg/kg/d) aspirin therapy. Main Outcomes and Measures: The primary outcome was recrudescent fever necessitating retreatment of KD. The secondary outcomes were coronary artery abnormalities and hospital length of stay. Results: Among the 260 patients included, the median (interquartile range) age was 2.5 (1.6-4.3) years, 103 (39.6%) were girls, 166 (63.8%) were non-Hispanic white, 57 (21.9%) were African American, 22 (8.5%) were Asian, 11 (4.2%) were Hispanic, and 4 (1.5%) were of unknown race/ethnicity. One hundred-forty-two patients (54.6%) were treated with low-dose aspirin. There was no association between recrudescent fever and aspirin dose, with 39 children (27.5%) having recrudescent fever in the low-dose group compared with 26 children (22.0%) in the high-dose group (odds ratio [OR], 1.34; 95% CI, 0.76-2.37; P = .31), with similar results after adjusting for potential confounding variables (OR, 1.63; 95% CI, 0.89-2.97; P = .11). In a subset analysis of 167 children with complete KD, however, there was nearly a 2-fold difference in the odds of recrudescent fever with low-dose aspirin (OR, 1.87; 95% CI, 0.82-4.23; P = .14), although this difference did not reach statistical significance. In addition, no association was identified between treatment group and coronary artery abnormalities (low-dose, 7.4% vs high-dose, 9.4%; OR, 0.86; 95% CI, 0.48-1.55; P = .62) or median (interquartile range) length of stay (3 [3-5] days for both groups; P = .27). Conclusions and Relevance: In this study, low-dose aspirin for the initial treatment of children with KD was not associated with fever recrudescence or coronary artery abnormalities. Given the potential benefits, further study of low-dose aspirin to detect potentially clinically relevant outcome differences is warranted to inform treatment decisions and guideline development

Review of Sovereign Defaults Before International Courts and Tribunals

This book review probes Michael Waibel’s new book, Sovereign Defaults Before International Courts and Tribunals. Waibel\u27s project is ambitious, exploring international attempts to address sovereign defaults over the past century and a half. Through painstaking and comprehensive historical analysis, Waibel shows how we\u27ve been here before -- a sober reminder for those thinking Argentina is simply part of a new fad in financial default. With the UN now turning its attention to sovereign debt issues, this study is especially timely. Although somewhat disappointing in the lightness of its normative content, the book should nevertheless prove helpful to those considering the role adjudicative tribunals (especially arbitral ones) might play in this current round of reform recommendations

Hampton Roads Sea Level Rise Preparedness and Resilience Intergovernmental Pilot Project. Phase 1 Report: Accomplishments and Lessons Learned

Executive Summary Initiated in June 2014, the Hampton Roads Sea Level Rise Preparedness and Resilience Intergovernmental Pilot Project (Intergovernmental Pilot Project or IPP) convened at Old Dominion University is an effort to use the knowledge skills and expertise of all regional stakeholders to create a framework or template for intergovernmental strategic planning that can be used outside the region; and, to implement that integrated strategy in Hampton Roads, Virginia creating an effective and efficient method for planning holistically for sea level rise and recurrent flooding. With active stakeholders from the Department of Defense, federal agencies and the White House as well as the Commonwealth of Virginia and many localities across Hampton Roads, Virginia, the IPP is truly a “whole of government” effort. Knowing water knows no jurisdictional bounds, that level of intergovernmental collaboration is necessary to develop integrated regional solutions and implement effective sea level rise preparedness and resilience strategies. Additionally, the wider community in Hampton Roads recognizes that they too will be affected by not only sea level rise itself, but also the adaptation strategies implemented in preparation. Thus, IPP stakeholders include representatives from private industry, infrastructure, non-profits, the real estate community, and vulnerable communities. Furthermore, while the IPP was conceived in Hampton Roads, the IPP recognizes that sea level rise affects the entire Commonwealth, and a successful ‘whole of government and community’ approach must eventually include regions beyond Hampton Roads and reach across the Coastal Virginia and the Commonwealth as a whole. Throughout the past year stakeholders have attended numerous IPP meetings and many supporting events, but they have also, through their own personal and professional lives driven the resilience conversation in Hampton Roads and beyond. The IPP is completely unfunded and exists not as an entity, but as an experiment, bringing together the community, and leveraging and building upon other initiatives from the Secure Commonwealth Panel’s Subcommittee on Sea Level Rise to Urban Land Institute’s Resilient Region Reality Checks to NOAA and NASA scientists. The first Phase of this two-Phase, two-year project came to completion during the summer of 2015 with a daylong leadership retreat. This report summarizes the stakeholder engagement and due-diligence process stakeholders undertook during Phase 1, but does not detail each meeting or event that took place. Phase 2 will continue to build on other initiatives and count on stakeholders to use these networks and knowledge to create an enduring entity, organization, or strategy to continue using economies of scale and the “whole of government and community” model for sea level rise preparedness and resilience in Hampton Roads and elsewhere

SB37-08/09: LGBTIQ Bills in the Montana Legislature

SB37-08/09: LGBTIQ Bills in the Montana Legislature. This resolution passed 18Y-1N on a roll call vote during the February 4, 2009 meeting of the Associated Students of the University of Montana (ASUM)

Mapping it Out: Developing a Library Internship Program

Background Newly graduated librarians often do not possess the knowledge and skills essential to practicing in a health sciences library. This mismatch in experience and expectations stems from a lack of exposure to health sciences librarianship and the typically general nature of graduate education in library and information science. This gap in skills and understanding stems from a lack of opportunities to develop in these areas. At the same time, many experienced health sciences librarians do not have the supervisory roles as a regular part of their work, resulting in fewer opportunities to build managerial skills and experience. In 2019 a health sciences library at an urban academic health sciences institution decided to develop an internship program to address both of these issues. Description This presentation will address the development of the internship program, including collaboration between the department head and librarians to develop the program. It will also address how the COVID-19 pandemic affected the program and continued evolution of the program. The presentation will also highlight lessons learned, challenges, and the next steps to ensure the program\u27s sustainability. Conclusions After hosting two interns over a three-year period, the internship program continues to evolve. This talk will focus on future areas for assessment and lessons learned including efforts made to balance program goals while also providing the intern with broad exposure to different aspects of health sciences librarianship while also addressing the intern\u27s personal development goals. Perspectives from librarian managers will also be discussed

Successes and Challenges of Being Interim Leaders During a Pandemic

Background Assuming an interim leadership role presents personal opportunities for professional growth and organizational challenges. These challenges may stem from the temporary nature of the position and a lack of clear direction or decision-making authority. External forces, in this case the COVID-19 pandemic, also contribute to interim leaders\u27 challenges. Library administration at a large public research university with multiple interim positions worked to identify potential challenges and possible solutions for those designated to interim leadership roles. Description This session will describe a plan created to facilitate the transition into and out of interim positions, set expectations for these roles, and ensure clear communication across interim positions at all levels of the organization. The session will be from the perspective of two librarians designated to co-lead a department over a period of 13 months. The department consisted of six librarians with liaison responsibilities, a staff member, a library intern (hourly staff), and a student worker . Emphasis will be placed on describing the challenges of supervising and motivating the department during a time of transition and uncertainty. There will also be a discussion on how continuing responsibilities were prioritized/balanced with interim leadership responsibilities. This was a critical consideration when creating the reporting and responsibility structure. Conclusions The plan related to interim leadership was a success and provided both interim department heads with an opportunity to grow professionally. As a result, both interim leaders transitioned smoothly back into their roles within the department while making a meaningful contribution to the department\u27s direction. During the period of interim leadership, there were two notable accomplishments. A five-year plan tool/program was created to mentor those in the department regarding their professional growth. In addition, a mission statement was created that gave the members of the department a clear idea of the purpose of the work of the department

Sovereign Defaults Before International Courts and Tribunals

This book review probes Michael Waibel’s new book, Sovereign Defaults Before International Courts and Tribunals. Waibel\u27s project is ambitious, exploring international attempts to address sovereign defaults over the past century and a half. Through painstaking and comprehensive historical analysis, Waibel shows how we\u27ve been here before -- a sober reminder for those thinking Argentina is simply part of a new fad in financial default. With the UN now turning its attention to sovereign debt issues, this study is especially timely. Although somewhat disappointing in the lightness of its normative content, the book should nevertheless prove helpful to those considering the role adjudicative tribunals (especially arbitral ones) might play in this current round of reform recommendations

Sovereign Defaults Before International Courts and Tribunals

This book review probes Michael Waibel’s new book, Sovereign Defaults Before International Courts and Tribunals. Waibel\u27s project is ambitious, exploring international attempts to address sovereign defaults over the past century and a half. Through painstaking and comprehensive historical analysis, Waibel shows how we\u27ve been here before -- a sober reminder for those thinking Argentina is simply part of a new fad in financial default. With the UN now turning its attention to sovereign debt issues, this study is especially timely. Although somewhat disappointing in the lightness of its normative content, the book should nevertheless prove helpful to those considering the role adjudicative tribunals (especially arbitral ones) might play in this current round of reform recommendations

Molecular shape as a means to control the incidence of the nanostructured twist bend phase

Liquid crystalline phases with a spontaneous twist-bend modulation are most commonly observed for dimers and bimesogens with nonamethylene spacers. In order to redress this balance we devised a simple chemical intermediate that can be used to prepare unsymmetrical bimesogens; as a proof of concept we prepared and studied eleven novel materials with all found to exhibit the twist-bend phase and exhibit a linear relationship between TN-I and TTB-N. A computational study of the conformational landscape reveals the octamethyleneoxy spacer to have a broader distribution of bend-angles than the nonamethylene equivalent, leading to reductions in the thermal stability of the TB phase. This result indicates that a tight distribution of bend-angles should stabilise the TB phase and lead to direct TB-Iso phase transitions, and conversely a broader distribution should destabilise the TB phase which may allow new states of matter that are occluded by the incidence of this phase to be revealed