MacDonald-Miller Correspondence

This file is an exchange of letters, e-mails, and documents between Norman Miller and Duncan MacDonald, MD, including a four-volume collection of MacDonald’s writings, over a 30-year period, all on witchcraft, some 600 pages extracted from the original 1100. As such, the following material is unfinished, presenting sketches of ideas, concepts, and arguments. Duncan MacDonald served as a physician in Zambia and Kenya, including a period as a Flying Doctor . He later served as a provincial psychiatrist in Cornwall, UK. His parallel interests in economic development and international witchcraft issues led to long-term research on these issues, the witchcraft concerns in conjunction with Norman Miller

Basic Life Support and Opioid Overdose Management: Knowledge and Attitudes Among Students Matriculating into Medical School - A Cross-Sectional Analysis to Inform Curricular Change

Purpose: While Basic Life Support (BLS) skills are typically included in undergraduate medical education (UME) curricula, graduating students continue to demonstrate substandard skills retention. In the setting of the opioid epidemic, effective opioid overdose management (OOM) training should likewise take place during UME. To date, there is a paucity of literature that describes incoming medical students’ knowledge and attitudes on these topics prior to beginning their studies. The purpose of this study is to describe medical students’ knowledge and attitudes towards BLS and OOM prior to their medical training to inform curricular change in UME. Methods: We conducted an observational, cross-sectional study of 1st-year medical students at a major academic medical school in Philadelphia, the epicenter of the opioid epidemic. Survey items assessed participants’ knowledge and attitudes on BLS and OOM. The survey was voluntary and deployed through Qualtrics. Results and Conclusions: 258 students of 272 (95% response rate) completed the survey. 32% of respondents had been previously certified in BLS / ACLS, and only 15% had previously received any level of OOM training. Students reported a moderate comfort level with administering chest compressions (5.14 [Likert Scale 1-10, 10=most comfortable]); and a low comfort level using an AED (4.80 3.1) or assisting an opioid victim (3.74 3.1). Up to 74% failed to correctly answer knowledge-based questions regarding basic management principles. Matriculating students do not have adequate BLS or OOM knowledge upon entering medical school, but wish to have these skills taught to them during their pre-clinical training. Findings should inform UME curricular changes to address the growing opioid epidemic

Survey of HIE Leaders: Assessment of HIE Research Participation and Perceptions

Introduction: Health information exchanges (HIEs) allow for healthcare providers to effectively and securely access patient information from various healthcare networks. Some HIEs have acknowledged the important role they can play in research, however, this is not standard practice despite recognition that availability of research and outcomes data is a main limitation to evidence-based practice. Methods: We created an electronic survey in collaboration with Health Share Exchange (an HIE in Philadelphia) with the aim of assessing HIE leader perceptions regarding the importance of and barriers to participation in research. The survey was disseminated via a Strategic Health Information Exchange Collaborative (the national association for HIEs) listserv that encompasses 70 HIEs in 49 states. Results: Leaders of HIEs from Philadelphia, Georgia, Colorado, and Michigan responded to our survey (n = 4). All HIEs represented in this survey either participate in research currently or indicated an interest in participating in research, and all noted that they face barriers to participating in research, including (but not limited to) legal concerns, logistical barriers to sharing data, and reluctance from clients to allow sharing of data for research purposes. HIEs that indicated the need for assistance with research participation noted that legal and policy-related support is needed to improve research participation. Conclusions: The HIEs that participated in our survey indicated that although they are interested in participating in research, there are legal and logistical barriers that prevent them from doing so. Future work should survey additional HIEs across the U.S. and discuss solutions to the barriers acknowledged in this work

Early Identification of Hospitalized Patients Lacking Prescription Drug Insurance

Background According to 2021 data from the US Department of Health and Human Services, 16% of persons in the United States under the age of 65 do not have prescription drug insurance.1Unsurprisingly, prior investigations have shown that the presence of prescription drug insurance is associated with reduced probability of hospital admission and length of stay for many common medical conditions.2A large majority of hospitalized patients are started on at least one new medication at the time of hospital discharge. Increasing the proportion of individuals with prescription drug insurance would have a substantial benefit on our population\u27s health. One care gap we seek to address is the timely identification of hospitalized patients who do not have prescription drug insurance well before hospital discharge. Within our health system, it is often the case that individuals lacking prescription drug insurance are not appropriately identified until the time of hospital discharge. This can have several consequences, including inadequate access to life-saving medications following hospital discharge, prolonged length of stay as these issues are addressed, or direct costs to the health system in the form of charity care that is pursued to facilitate timely discharge. This initiative\u27s purpose would be to screen patients for prescription drug insurance at the time of hospital admission to allow for ample time to plan for ongoing access to medications following hospital discharge

Improving Site-Specific STI Screening in a Philadelphia-Based Academic Family Medicine Office

Background In the last decade, rates of sexually transmitted infections (STIs) are rising both in Philadelphia and across the United States1, 2 STIs are often asymptomatic3 Site-specific screening for gonorrhea and chlamydia (GC/CT) infections may increase STI detection o Genitourinary (GU), pharyngeal, and rectal sites o GU is the most common site tested, but GU-only testing may lead to missed diagnoses

Cidofovir in the Treatment of BK Virus–Associated Hemorrhagic Cystitis Following Hematopoietic Stem Cell Transplantation; A Medication Use and Safety Analysis

BK virus hemorrhagic cystitis (BKV-HC) is a complication after allogeneic hematopoietic stem cell transplant (AlloHCT) for which optimal management is uncertain. Intravenous (IV) and intravesicular (IVES) cidofovir have been used with varying degrees of success in small case series of six to 33 patients. While some series have investigated side effects, none have examined medication errors. A retrospective single-center case series of AlloHCT patients with BKV-HC given IV or IVES cidofovir (CDV) from 2018 to 2022 at an urban cancer center in Detroit, MI. Our primary objective was to determine the incidence of CDV related medication errors (ME) and perform a root cause analysis (RCA) to determine factors contributing to such events. Secondary objectives were to describe the effectiveness of CDV for BKV-HC following AlloHCT. Six AlloHCT patients were treated with CDV. Median age was 48 years (range 32-63), with most being high risk for cytomegalovirus (R+) and experiencing acute graft versus host disease. CDV and BKV-HC characteristics are shown in Table 2. BKV-HC occurred a median of 53 days post Allo-HCT (range 27-179). Four patients received IV CDV only and two received both IV and IVES. Median number of doses was 2 (range 1-10). Median BKV-HC severity grade was 2.5, and three of six patients had BK viremia (Table 2). Five of six patients had microscopic resolution of hematuria (median time to resolution 30 days, range 1-116). However, 4 of 6 had died and 1 of 6 had recurrence of BKV-HC within 90 days. The most common CDV side effects were bladder pain/spasms (n=5) and acute kidney injury (n=4). There were 2 MEs; one near miss where CDV was incorrectly ordered IV but changed to IVES by a pharmacist, and one major safety event where an IVES dose was administered IV. RCA analysis revealed multiple contributing factors including similarity in appearance of doses and an overly simplified pump library without an option for IVES administration. In this first case series to describe medication errors in patients treated with CDV for BKV-HC, one in three patients experienced an ME. Clinicians caring for AlloHCT patients should have a high predisposition for error when cidofovir is being prescribed

HIL-validation of an extremum seeking-based controller for advanced der management

Paradigm shifts in electricity generation are leading to more renewable and distributed energy resources (DER) on the grid. There is a strong interest to utilize these resources for various grid services, but the practicality of commanding multiple DER is often an obstacle to such approaches. In this article, we seek to validate through Hardware-in-the-Loop (HIL) simulation an extremum seeking (ES) based control scheme proposed in previous work. The method aggregates and coordinates multiple distributed controllers to offer transmission grid level services. The HIL validation uses a prototype real-time implementation of the controller's logic on distributed devices and photovoltaic (PV) inverters operating on a simulated utility distribution feeder. Several grid services, including load following and voltage regulation, were validated to demonstrate the deployment feasibility of the ES control approach on equipment already installed on the grid

The novel 5-lipoxygenase inhibitor ABT-761 attenuates cerebral vasospasm in a rabbit model of subarachnoid hemorrhage

OBJECTIVE: Eicosanoids have been implicated in the pathogenesis of cerebral vasospasm after subarachnoid hemorrhage (SAH). Leukotrienes, 5-hydroxyperoxyeicosatetraenoic acid, and 5-hydroxyeicosatetraenoic acid are part of this group of substances, resulting from the 5-lipoxygenase activity on arachidonic acid metabolism. This study examined the effects of ABT-761, a new 5-lipoxygenase inhibitor, on cerebral vasospasm in an in vivo rabbit model of SAH. METHODS: A total of 48 rabbits were assigned to one of six groups: SAH + placebo (n = 8), SAH + ABT-761 20 mg/kg (n = 8), SAH + ABT-761 30 mg/kg (n = 8), control + placebo (n = 8), control + ABT-761 20 mg/kg (n = 8), and control + ABT-761 30 mg/kg (n = 8). Drug administration was initiated 30 minutes after induction of SAH and repeated 24 hours later. The animals were killed 48 hours after SAH, using the perfusion-fixation method. The cross sectional areas of basilar artery histological sections were measured by an investigator blinded to the treatment groups of the individual samples. RESULTS: In placebo-treated animals, the average luminal cross sectional area of the basilar artery was reduced by 68% after SAH as compared with controls (P < 0.0001). After SAH, the vasospastic response was attenuated in animals treated with 20 or 30 mg/kg representing a 28 or 35% reduction, respectively (P = 0.0011 and P = 0.0038). CONCLUSION: The results demonstrated that ABT-761 is effective in attenuating experimental cerebral vasospasm, indicating that this new drug represents a potential therapeutic agent for the treatment of vasospasm after SAH