Deficient Response to COVID-19 Makes the Case for Evolving the Public Health System

Coronavirus disease 2019 (COVID-19) has affected more than 14 million individuals and caused more than 600,000 deaths as of July 20, 2020, rapidly spreading across large cities as well as many rural areas. In parallel with rising cases and deaths globally, the situation in local communities fluctuates daily while knowledge about the disease and transmission evolves. Public health agencies play a critical role in managing disease epidemics. Agencies are on the front lines to conduct disease surveillance, facilitate resource distribution including personal protective equipment (PPE), establish alternative care sites, and provide diagnostic support through laboratory testing. The public health response to COVID-19 has been criticized for being too slow, lacking transparency, and insufficient. This essay examines reasons behind the sluggish response to COVID-19. The authors then argue for an evolved public health system following the crisis, which is better prepared for emergencies and equipped to support population health for the future

Indiana\u27s Public Health Investment Holds Insights for Other States

Indiana has a business-friendly environment, but historical underinvestment in public health has yielded poor health outcomes. In 2023, when trust in governmental public health was strained nationwide, Indiana increased public health spending by 1,500 percent. In this article, we explain how Indiana achieved this unprecedented legislative victory for public health, describing the context, approach, and lessons learned. Specifically, an Indiana University report linking economic vitality and overall health sparked the creation of a governor\u27s commission charged with exploring ways to address Indiana\u27s shortcomings. Working with the Indiana Department of Health, the commission developed multisectoral coalitions and business and government partnerships, and it maintained consistent and coordinated communication with policy makers. Lessons learned included the value of uncoupling public health from partisan narratives, appointing diverse commission membership with strategically selected cochairs, involving local leaders, and ensuring local decision-making control. We believe that Indiana\u27s approach holds insights for other states interested in strengthening public health funding in the current era

1-Methyl-3-(naphthalen-1-yl)-3,3a,4,9b-tetra­hydro-1H-chromeno[4,3-c]isoxazole-3a-carbonitrile

In the title compound, C22H18N2O2, the pyran ring of the chromene unit is fused with an isoxazole ring, which adopts an N-envelope conformation with the N atom lying 1.3291 (14) Å from the mean plane of the remaining ring atoms [maximum deviation = 0.341 (2) Å]. The dihedral angle between the isoxazole and chromene units is 43.74 (8)° and that between the iosxazole ring and the naphthalene ring system is 58.82 (8)°. In the crystal, the molecules are linked by weak C—H⋯π inter­actions

Effect of colour vision status on insect prey capture efficiency of captive and wild tamarins (Saguinus spp.)

The colour vision polymorphism of most New World primates is a model system to study the function of colour vision. Theories for the evolution of primate trichromacy focus on the efficient detection and selection of ripe fruits and young leaves amongst mature leaves, when trichromats are likely to be better than dichromats. We provide data on whether colour vision status affects insect capture in primates. Trichromatic tamarins (Saguinus spp.) catch more prey than dichromats, but dichromats catch a greater proportion of camouflaged prey than trichromats. The prey caught does not differ in size between the two visual phenotypes. Thus two factors may contribute to the maintenance of genetic polymorphism of middle- to long-wavelength photopigments in Platyrrhines: the advantage in finding fruit and leaves, which supports the maintenance of the polymorphism through a heterozygote advantage, and the dichromats’ exploitation of different (e.g., camouflaged) food, which results in frequency-dependent selection on the different colour vision phenotypes

Simulating spatial and temporal evolution of multiple wing cracks around faults in crystalline basement rocks

Fault zones are structurally highly spatially heterogeneous and hence extremely complex. Observations of fluid flow through fault zones over several scales show that this structural complexity is reflected in the hydrogeological properties of faults. Information on faults at depth is scarce, hence, it is highly valuable to understand the controls on spatial and temporal fault zone development. In this paper we increase our understanding of fault damage zone development in crystalline rocks by dynamically simulating the growth of single and multiple splay fractures produced from failure on a pre-existing fault. We present a new simulation model, MOPEDZ (Modeling Of Permeability Evolution in the Damage Zone surrounding faults), that simulates fault evolution through solution of Navier's equation with a combined Mohr-Coulomb and tensile failure criteria. Simulations suggest that location, frequency, mode of failure and orientation of splay fractures are significantly affected both by the orientation of the fault with respect to the maximum principal compressive stress and the conditions of differential stress. Model predictions compare well with published field outcrop data, confirming that this model produces realistic damage zone geometries

Development of novel clinical examination scales for the measurement of disease severity in Creutzfeldt-Jakob disease

OBJECTIVE: To use a robust statistical methodology to develop and validate clinical rating scales quantifying longitudinal motor and cognitive dysfunction in sporadic Creutzfeldt-Jakob disease (sCJD) at the bedside. METHODS: Rasch analysis was used to iteratively construct interval scales measuring composite cognitive and motor dysfunction from pooled bedside neurocognitive examinations collected as part of the prospective National Prion Monitoring Cohort study, October 2008-December 2016.A longitudinal clinical examination dataset constructed from 528 patients with sCJD, comprising 1030 Motor Scale and 757 Cognitive Scale scores over 130 patient-years of study, was used to demonstrate scale utility. RESULTS: The Rasch-derived Motor Scale consists of 8 items, including assessments reliant on pyramidal, extrapyramidal and cerebellar systems. The Cognitive Scale comprises 6 items, and includes measures of executive function, language, visual perception and memory. Both scales are unidimensional, perform independently of age or gender and have excellent inter-rater reliability. They can be completed in minutes at the bedside, as part of a normal neurocognitive examination. A composite Examination Scale can be derived by averaging both scores. Several scale uses, in measuring longitudinal change, prognosis and phenotypic heterogeneity are illustrated. CONCLUSIONS: These two novel sCJD Motor and Cognitive Scales and the composite Examination Scale should prove useful to objectively measure phenotypic and clinical change in future clinical trials and for patient stratification. This statistical approach can help to overcome obstacles to assessing clinical change in rapidly progressive, multisystem conditions with limited longitudinal follow-up

Method overtness, forensic autopsy, and the evidentiary suicide note: A multilevel national violent death reporting system analysis

© 2018 Rockett et al. Objective Higher prevalence of suicide notes could signify more conservatism in accounting and greater proneness to undercounting of suicide by method. We tested two hypotheses: (1) an evidentiary suicide note is more likely to accompany suicides by drug-intoxication and by other poisoning, as less violent and less forensically overt methods, than suicides by firearm and hanging/suffocation; and (2) performance of a forensic autopsy attenuates any observed association between overtness of method and the reported presence of a note. Methods This multilevel (individual/county), multivariable analysis employed a generalized linear mixed model (GLMM). Representing the 17 states participating in the United States National Violent Death Reporting System throughout 2011–2013, the study population comprised registered suicides, aged 15 years and older. Decedents totaled 32,151. The outcome measure was relative odds of an authenticated suicide note. Results An authenticated suicide note was documented in 31% of the suicide cases. Inspection of the full multivariable model showed a suicide note was more likely to manifest among drug intoxication (adjusted odds ratio [OR], 1.70; 95% CI, 1.56, 1.85) and other poisoning suicides (OR, 2.12; 1.85, 2.42) than firearm suicides, the referent. Respective excesses were larger when there was no autopsy or autopsy status was unknown (OR, 1.86; 95% CI, 1.61, 2.14) and (OR, 2.25; 95% CI, 1.86, 2.72) relative to the comparisons with a forensic autopsy (OR, 1.62, 95% CI, 1.45, 1.82 and OR, 2.01; 95% CI, 1.66, 2.43). Hanging/suffocation suicides did not differ from the firearm referent given an autopsy. Conclusions Suicide requires substantial affirmative evidence to establish manner of death, and affirmation of drug intoxication suicides appears to demand an especially high burden of proof. Findings and their implications argue for more stringent investigative standards, better training, and more resources to support comprehensive and accurate case ascertainment, as the foundation for developing evidence-based suicide prevention initiatives

Reclaiming revolutionary feminism

Generally, saying: ‘feminist’, is revolutionary enough in this day and age, it’s far more of a statement now than it was back in the eighties. And no, I wouldn’t say I was a Revolutionary Feminist now ‘cos I’m less separatist than I was at that time and I think it’s got overladen with such baggage that I’d have to spend about ten minutes defining what I meant. (Interview with Al Garthwaite, Leeds, 20 January 2012)In this article, I shall explore some understandings, and misunderstandings, of the school or type of feminism known as Revolutionary Feminism, a uniquely British school of feminism, founded in 1977. The quote above is taken from my interview with a prominent and influential British Revolutionary Feminist activist named Al Garthwaite. The interview forms the basis of this article and the research was part of my PhD on the British Women’s Liberation Movement (WLM) from the 1970s to today. Among many of her legacies, Al founded the Reclaim the Night (RTN) marches in the United Kingdom in November 1977, traditionally women’s night-time, street protest marches against male violence against women (VAW). Also involved in the establishment and running of the UK WLM national newsletter ‘WIRES’,1 Al was at the hub of organising in the feminist hotbed that was Leeds, in Yorkshire in the North of England, in the 1970s and 1980s

Population Point Prevalence of SARS-CoV-2 Infection Based on a Statewide Random Sample — Indiana, April 25–29, 2020

During April 25–29, 2020, Indiana conducted statewide random sample testing of persons aged ≥12 years to assess prevalence of active infection and presence of antibodies to SARS-CoV-2; additional nonrandom sampling was conducted in racial and ethnic minority communities to better understand the impact of the virus in certain racial and ethnic minority populations.Nir Menachemi reports a grant from State of Indiana which funded this study. Virginia Caine reports that she is a member of the MMWR Editorial Board. Brian E. Dixon and William F. Fadel report grants from the Indiana State Department of Health. Paul K. Halverson reports a grant from the State of Indiana. No other potential conflicts of interest were disclosed