Growth in reading and how children spend their time outside of school

Running title: Growth in readingIncludes bibliographical references (leaves 36-38)Performed pursuant to contract no. 400-81-0030 of the National Institute of Educatio

Public health and the economy could be served by reallocating medical expenditures to social programs.

As much as 30% of US health care spending in the United States does not improve individual or population health. To a large extent this excess spending results from prices that are too high and from administrative waste. In the public sector, and particularly at the state level, where budget constraints are severe and reluctance to raise taxes high, this spending crowds out social, educational, and public-health investments. Over time, as spending on medical care increases, spending on improvements to the social determinants of health are starved. In California the fraction of General Fund expenditures spent on public health and social programs fell from 34.8% in fiscal year 1990 to 21.4% in fiscal year 2014, while health care increased from 14.1% to 21.3%. In spending more on healthcare and less on other efforts to improve health and health determinants, the state is missing important opportunities for health-promoting interventions with a strong financial return. Reallocating ineffective medical expenditures to proven and cost-effective public health and social programs would not be easy, but recognizing its potential for improving the public's health while saving taxpayers billions of dollars might provide political cover to those willing to engage in genuine reform. National estimates of the percent of medical spending that does not improve health suggest that approximately $5 billion of California's public budget for medical spending has no positive effect on health. Up to 10,500 premature deaths could be prevented annually by reallocating this portion of medical spending to public health. Alternatively, the same expenditure could help an additional 418,000 high school students to graduate

Hypoxia-Induced Loss of Consciousness in Multiple Synchronized Swimmers During a Workout

Hyperventilation by swimmers can lead to hypoxia and loss of consciousness. In this retrospective case series we describe the simultaneous onset of hypoxia in multiple 13-15-year-old female synchronized swimmers of an elite synchronized swim team based on review of Health Department and emergency medical service reports. All six swimmers performing hypoxic drills developed hypoxic symptoms (fatigue, inability to move legs, disorientation, tunnel vision, and/or loss of consciousness) and four required rescue. All swimmers regained consciousness at the scene and recovered. Two swimmers not performing hypoxic drills were unaffected. Of the environmental evaluations, only pool water temperature was higher than the recommended levels. Hyperventilation with hypoxic training can be life-threatening and should be prohibited. Duration of hypoxic drills should be limited. Emergency response plans should be practiced

Chinese immigrant parents' vaccination decision making for children: A qualitative analysis

Background: While immunization coverage rates for childhood routine vaccines in Hong Kong are almost 100%, the uptake rates of optional vaccines remain suboptimal. Understanding parental decision-making for children's vaccination is important, particularly among minority groups who are most vulnerable and underserved. This study explored how a subsample of new immigrant mothers from mainland China, a rapidly-growing subpopulation in Hong Kong, made decisions on various childhood and adolescent vaccines for their offspring, and identified key influences affecting their decision making. Methods. Semi-structured in-depth interviews were conducted with 23 Chinese new immigrant mothers recruited by purposive sampling. All interviews were audio-taped, transcribed and analyzed using a Grounded Theory approach. Results: Participants' conversation revealed five underlying themes which influenced parents' vaccination decision-making: (1) Institutional factors, (2) Insufficient vaccination knowledge and advice, (3) Affective impacts on motivation, (4) Vaccination barriers, and (5) Social influences. The role of social norms appeared overwhelmingly salient influencing parents' vaccination decision making. Institutional factors shaped parent's perceptions of vaccination necessity. Fear of vaccine-targeted diseases was a key motivating factor for parents adopting vaccination. Insufficient knowledge about vaccines and targeted diseases, lack of advice from health professionals and, if provided, suspicions regarding the motivations for such advice were common issues. Vaccination cost was a major barrier for many new immigrant parents. Conclusions: Social norms play a key role influencing parental vaccination decision-making. Insight gained from this study will help inform healthcare providers in vaccination communication and policymakers in future vaccination programme. © 2014 Wang et al.; licensee BioMed Central Ltd.Link_to_subscribed_fulltex

Analysis and Rebuttal of Development of an In-Water Intervention in a Lifeguard Protocol

We review the paper by Hunsucker and Davison published in the International Journal of Aquatic Research and Education in 2010. The authors’ two-part goal was to describe a protocol they named “in-water intervention” (IWI) that uses abdominal thrusts (ATs) and to report on its effectiveness at assisting drowning victims in waterparks. We identify serious shortcomings in the paper’s methodology, interpretation and use of the literature, and ethical principles. We conclude that their primary assertions were unsubstantiated by the evidence they presented

Primary and Secondary Drowning Interventions: The American Red Cross Circle of Drowning Prevention and Chain of Drowning Survival

Creating awareness about primary and secondary interventions that can be used in situations involving drowning is an important prevention strategy. Consistent among reports from almost all countries is that drowning injury steals life from young children, followed by youth, and then young adults. As a result of the on-going need to reduce these types of statistics, the American Red Cross Scientific Advisory Council – Aquatic Sub Council established two intervention programs to address both sides of drowning events. Content of this manuscript is based on work by members of the Aquatic Sub Council. It focuses on describing and providing scientific rationale for two educational programs designed to approach the issue of drowning from both a primary and secondary intervention perspective. Presented are the Circle of Drowning Prevention and the Chain of Drowning Survival along with the thought processes and foundational research that brought them into existence. Both intervention programs are currently being used in educational materials and marketing efforts within American Red Cross water safety materials

Segmentations of MRI images of the female pelvic floor: A study of inter- and intra-reader reliability

Purpose: To describe the inter- and intra-operator reliability of segmentations of female pelvic floor structures. Materials and Methods: Three segmentation specialists were asked to segment out the female pelvic structures in 20 MR datasets on three separate occasions. The STAPLE algorithm was used to compute inter- and intra-segmenter agreement of each organ in each dataset. STAPLE computed the sensitivity, specificity, and positive predictive values (PPV) for inter- and intra-segmenter repeatability. These parameters were analyzed using intra-class correlation analysis. Correlation of organ volume to PPV and sensitivity was also computed. Results: Mean PPV of the segmented organs ranged from 0.82 to 0.99, and sensitivity ranged from 33 to 96%. Intra-class correlation ranged from 0.07 to 0.98 across segmenters. Pearson correlation of volume to sensitivity were significant across organs, ranging from 0.54 to 0.91. Organs with significant correlation of PPV to volume were bladder (−0.69), levator ani (−0.68), and coccyx (−0.63). Conclusion: Undirected manual segmentation of the pelvic floor organs are adequate for locating the organs, but poor at defining structural boundaries. J. Magn. Reson. Imaging 2011;33:684–691. © 2011 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/83166/1/22478_ftp.pd

Pregnancy incidence and correlates during the HVTN 503 Phambili HIV vaccine trial conducted among South African women

BACKGROUND: HIV prevention trials are increasingly being conducted in sub-Saharan Africa. Women at risk for HIV are also at risk of pregnancy. To maximize safety, women agree to avoid pregnancy during trials, yet pregnancies occur. Using data from the HVTN 503/"Phambili" vaccine trial, we report pregnancy incidence during and after the vaccination period and identify factors, measured at screening, associated with incident pregnancy. METHODS: To enrol in the trial, women agreed and were supported to avoid pregnancy until 1 month after their third and final vaccination ("vaccination period"), corresponding to the first 7 months of follow-up. Unsterilized women, pooled across study arms, were analyzed. Poisson regression compared pregnancy rates during and after the vaccination period. Cox proportional hazards regression identified associations with first pregnancy. RESULTS: Among 352 women (median age 23 yrs; median follow-up 1.5 yrs), pregnancy incidence was 9.6/100 women-years overall and 6.8/100 w-yrs and 11.3/100 w-yrs during and after the vaccination period, respectively [Rate Ratio = 0.60 (0.32-1.14), p = 0.10]. In multivariable analysis, pregnancy was reduced among women who: enrolled at sites providing contraception on-site [HR = 0.43, 95% CI (0.22-0.86)]; entered the trial as injectable contraceptive users [HR = 0.37 (0.21-0.67)] or as consistent condom users (trend) [HR = 0.54 (0.28-1.04)]. Compared with women with a single partner of HIV-unknown status, pregnancy rates were increased among women with: a single partner whose status was HIV-negative [HR = 2.34(1.16-4.73)] and; 2 partners both of HIV-unknown status [HR = 4.42(1.59-12.29)]. Women with 2 more of these risk factors: marijuana use, heavy drinking, or use of either during sex, had increased pregnancy incidence [HR = 2.66 (1.24-5.72)]. CONCLUSIONS: It is possible to screen South African women for pregnancy risk at trial entry. Providing injectable contraception for free on-site and supporting consistent condom use may reduce incident pregnancy. Screening should determine the substance use, partnering, and HIV status of both members of the couple for both pregnancy and HIV prevention. Trial Registration SA National Health Research Database DOH-27-0207-1539; Clinicaltrials.gov NCT0041372