Cholera revolts: a class struggle we may not like

Few have studied cholera revolts comparatively, and certainly not over the vast terrain from Asiatic Russia to Quebec or across time from the first European cholera wave of the 1830s to the twentieth century. Scholars have instead concentrated on the first European cholera wave in the 1830s and have tended to explain cholera’s social violence within the political contexts of individual nations, despite these riots raging across vast differences in political landscapes from Czarist Russia to New York City but with similar fears and conspiracy theories of elites inventing cholera to cull populations of the poor. Moreover, the history of cholera’s social toxins runs against present generalizations on why epidemics spawn blame and violence against others. Cholera riots continued, and in Italy and Russia became geographically more widespread, vicious, and destructive long after the disease had lost its mystery. The article then poses the question of why historians on the left have not studied the class struggles provoked by cholera, with riots of 10,000, murdering state officials and doctors, destroying hospitals, town halls, and in the case of Donetsk, an entire city. Finally, the article draws parallels between Europe’s cholera experiences and those in West Africa with Ebola in 2014

Communication system features dual mode range acquisition plus time delay measurement

Communication system combines range acquisition system and time measurement system for tracking high velocity aircraft and spacecraft. The range acquisition system uses a pseudonoise code to determine range and the time measurement system reduces uncontrolled phase variations in the demodulated signal

Improved capacitance multiplier circuit

Circuit multiplies capacitance without increasing overall circuit gain. In addition, circuit may be designed to include lag or lead/lag transfer function and independent gain adjustment

The significance of marine-derived biogenic nitrogen in anadromous Pacific salmon freshwater food webs

Thesis (Ph.D.) University of Alaska Fairbanks, 1991The natural abundance of the stable isotope ratios \sp{15}N/\sp{14}N and \sp{13}C/\sp{12}C expressed as \delta\sp{15}N and \delta\sp{13}C was used to trace biogenic nutrients delivered by returning adult anadromous Pacific salmon into freshwater systems. These systems were Sashin Creek, a rapidly flushing stream located on Baranof Island, southeastern Alaska and Iliamna Lake, the major sockeye salmon, Oncorhynchus nerka, nursery lake in the Kvichak River watershed, Bristol Bay, southwestern Alaska. Marine-derived nitrogen (MDN) was quantifiable by use of an isotope mixing model based on comparison of biota \delta\sp{15}N in areas used for spawning by anadromous salmon with salmon-free controls within the same watershed. Control periphyton (benthic primary producers) \delta\sp{15}N values $\sim$0 suggested that the control N pool was derived from N\sb2 fixation without significant recycling. In contrast, periphyton abundant in areas of intense spawning activity or carcass aggregation had \delta\sp{15}N $\sim$ +7. These two values were the basis for comparison of \delta\sp{15}N values of higher trophic level biota. A mixing model relating \delta\sp{15}N to MDN with trophic level was used to estimate consumer MDN through incorporation of a priori isotopic trophic enrichment factors established in the literature. Distinctive \delta\sp{13}C signatures along the Sashin Creek stream gradient and between Iliamna Lake littoral and limnetic production were used in concert with \delta\sp{15}N. Sashin Creek fishes reflected isotopic signatures of periphyton and thus production within the same stream section. Isotopic data suggested an overall importance of limnetic production in Iliamna Lake resident fish and juvenile sockeye salmon diets. Salmon eggs and emergent fry retaining the parental marine isotopic signature were distinguishable from autochthonous production derived from marine N, and appear to be a minor dietary component in both Sashin Creek or Iliamna Lake fishes. The proportion of MDN in resident fish N, including juvenile salmon after turnover of the natal N pool, was proportional to the escapement of spawners. Thus there is now direct evidence for a significant natural fertilization process: the flow of remineralized marine-derived biogenic nutrients from returning anadromous Pacific salmon into freshwater food webs

Anxiety Associated With Increased Risk for Emergency Department Recidivism in Patients With Low-Risk Chest Pain

Anxiety contributes to the chest pain symptom complex in 30% to 40% of patients with low-risk chest pain seen in the emergency department (ED). The validated Hospital Anxiety Depression Scale-Anxiety subscale (HADS-A) has been used as an anxiety screening tool in this population. The objective was to determine the prevalence of abnormal HADS-A scores in a cohort of low-risk chest pain patients and test the association of HADS-A score with subsequent healthcare utilization and symptom recurrence. In a single-center, prospective, observational cohort study of adult ED subjects with low-risk chest pain, the HADS-A was used to stratify participants into 2 groups: low anxiety (score <8) and high anxiety (score ≥8). At 45-day follow-up, chest pain recurrence was assessed by patient report, whereas ED utilization was assessed through chart review. Of the 167 subjects enrolled, 78 (47%) were stratified to high anxiety. The relative risk for high anxiety being associated with at least one 30-day ED return visit was 2.6 (95% confidence interval 1.4 to 4.7) and this relative risk increased to 9.1 (95% confidence interval 2.18 to 38.6) for 2 or more ED return visits. Occasional chest pain recurrence was reported by more subjects in the high anxiety group, 68% vs 47% (p = 0.029). In conclusion, 47% of low-risk chest pain cohort had abnormal levels of anxiety. These patients were more likely to have occasional recurrence of their chest pain and had an increased risk multiple ED return visits

Emergency Department Cardiopulmonary Evaluation of Low-Risk Chest Pain Patients with Self-Reported Stress and Anxiety

Background Chest pain is a high-risk emergency department (ED) chief complaint; the majority of clinical resources are directed toward detecting and treating cardiopulmonary emergencies. However, at follow-up, 80%–95% of these patients have only a symptom-based diagnosis; a large number have undiagnosed anxiety disorders. Objective Our aim was to measure the frequency of self-identified stress or anxiety among chest pain patients, and compare their pretest probabilities, care processes, and outcomes. Methods Patients were divided into two groups: explicitly self-reported anxiety and stress or not at 90-day follow-up, then compared on several variables: ultralow (<2.5%) pretest probability, outcome rates for acute coronary syndrome (ACS) and pulmonary embolism (PE), radiation exposure, total costs at 30 days, and 90-day recidivism. Results Eight hundred and forty-five patients were studied. Sixty-seven (8%) explicitly attributed their chest pain to “stress” or “anxiety”; their mean ACS pretest probability was 4% (95% confidence interval 2.9%–5.7%) and 49% (33/67) had ultralow pretest probability (0/33 with ACS or PE). None (0/67) were diagnosed with anxiety. Seven hundred and seventy-eight did not report stress or anxiety and, of these, 52% (403/778) had ultralow ACS pretest probability. Only one patient (0.2%; 1/403) was diagnosed with ACS and one patient (0.4%; 1/268) was diagnosed with PE. Patients with self-reported anxiety had similar radiation exposure, associated costs, and nearly identical (25.4% vs. 25.7%) ED recidivism to patients without reported anxiety. Conclusions Without prompting, 8% of patients self-identified “stress” or “anxiety” as the etiology for their chest pain. Most had low pretest probability, were over-investigated for ACS and PE, and not investigated for anxiety syndromes

A Quality Improvement Project to Improve Weight-Based Dosing of Cefazolin in the Perioperative Setting Among Patients Undergoing Knee Arthroplasty

Surgical site infections (SSIs) continue to be a problem that affect the healthcare system not only on a national level, but on a local level as well. Adequate weight-based prophylactic antibiotic dosing is imperative in prevention of surgical site infections. Cefazolin is the most prevalent perioperative antibiotic administered. According to current guidelines, patients weighing greater than or equal to 120 kilograms (kg) should receive three grams of cefazolin. This project is a quality improvement project using the Plan-Do-Study-Act model for creation and dissemination of an original educational video on antibiotic stewardship and implementation of an electronic medical record (EMR) intervention for patients undergoing knee arthroplasty. Based on chart-reviewed data, it was determined that there is decreased compliance with current antibiotic dosing guidelines regarding both prescribing and administration. Evidence-based interventions included a web-based educational video discussing the institution’s current perioperative antibiotic prophylaxis guidelines; additionally, an embedded hyperlink was created in the EMR in both the anesthesia record and Epic ordering screen to offer an easy access reference to both the ordering provider and administering provider. Pre- and post-implementation data were analyzed. Post-implementation data did not reveal increased compliance with prescribing and administration of cefazolin in patients undergoing knee arthroplasty

Utilizing lipopolysaccharide in exhaled breath condensate to diagnose gram negative pneumonia

A device for collecting exhaled breath condensate from a subject. The device comprises a plunger assembly and a stopper. The stopper is connected to the plunger disk of the plunger assembly by a plurality of support pins and is configured for sealing engagement. The device is utilized to collect exhaled breath condensate from both spontaneously breathing and mechanically ventilated subjects and the devices utilized to determine whether lipopolysaccharide is present in the collected exhaled breath condensate