Casablanca Bombings, Preventing Violent Extremism, Imam Training Program, Commander of the Faithful, Religious Pluralism

Following the 2003 Casablanca Bombings in Morocco there was an increased concern in protecting the physical and spiritual security of the nation. The state immediately responded by issuing a large crackdown on Salafists where many were arrested, imprisoned, and deprived of their rights. Due to the rise of extremist rhetoric in the mosques, particularly in rural and impoverished areas, the state also responded by closing any mosques they deemed to not be promoting moderate Islam and removed their imams. Out of this, a Preventing Violent Extremism Program was created that was composed of security and religious-based policies. The security policies entailed increased intelligence and arrests, and the religious policies a promotion of a state-sponsored Moroccan Islam, the control of all religious institutions and education, and the development of an Imam Training Program. This paper seeks to examine the efficacy of the Imam Training Program in preventing violent extremism through the analysis of newspaper articles, scholarly pieces, and first-hand interviews. The purpose of this paper is to show that the Imam Training Program, and the broader Preventing Violent Extremism Program, are more effective in strengthening the power of the king as Commander of the Faithful and in limiting religious pluralism than in preventing extremism. This study contributes to the discussion of preventing violent extremism strategies by suggesting marginalization and socioeconomic adversity as targets for action

The Relationship between Gram-Negative Colonisation and Bloodstream Infections in Neonates: A Systematic Review and Meta-Analysis.

OBJECTIVES: Neonates admitted to Neonatal Intensive Care Units (NICU) are at significant risk of developing bloodstream infections (BSIs). Gram-negative bacteria (GNB) both colonise and infect, but the association between these entities is unclear. By conducting a systematic literature review, we aimed to explore the impact of factors on the association between GN colonisation and GN-BSI at both baby level and unit level. METHODS: We searched Medline, Embase, and Cochrane Library. Observational cohort studies published after 2000 up to June 2016 reporting data on the total number of neonates (0-28 days) colonised with GNB assessed by rectal/skin swab culture and the total number of neonates with GN-BSI (same bacteria) were included. Studies were excluded if data on skin/rectal colonisation, neonates, and GNB could not been identified separately. The meta-analyses along with multivariate meta-regression with random-effect model were performed to investigate factors associated with the GN colonisation and GN-BSI at baby-level and unit-level. RESULTS: 27 studies fulfilled our inclusion criteria, 15 for the baby-level and 12 for the unit-level analysis. Study heterogeneity was high, with suboptimal overall quality of reporting assessed by the STROBE-NI statement (44.8% of items adequately reported). In 1,984 colonised neonates, 157 (7.9%) developed GN-BSI compared with 85 of 3,583 (2.4%) non-colonised neonates. Considerable heterogeneity across studies was observed. Four factors were included in the meta-regression model: Gross domestic product (GDP), pathogen, outbreak, and frequency of screening. There was no statistically significant impact of these factors on GN colonisation and GN-BSI in baby level. We were unable to perform the multivariate meta-regression due to the insufficient reported data for unit level. CONCLUSIONS: Study limitations include the small number and the high heterogeneity of the included studies. While this report shows a correlation between colonisation and BSI risk, this data currently doesn't support routinely screening for GNB. The analysis of large cohorts of colonised neonates with clinical outcomes is still needed to define the major determinants leading from colonisation to infection

Carbon Monoxide Poisoning In Children: Diagnosis And Management In The Emergency Department

Approximately 5000 children present to the emergency department annually with unintentional carbon monoxide poisoning. Children may be more vulnerable to carbon monoxide poisoning because of their increased metabolic demand and their inability to vocalize symptoms or recognize a dangerous exposure, and newborn infants are more vulnerable to carbon monoxide poisoning because of the persistence of fetal hemoglobin. Mild carbon monoxide poisoning may present as viral symptoms in the absence of fever. While headache, nausea, and vomiting are the most common presenting symptoms in children, the most common symptom in infants is consciousness disturbance. This review discusses the limitations of routine pulse oximetry and carboxyhemoglobin measurement in determining carbon monoxide exposure, and notes effects of co-ingestions and comorbidities. Although the mainstay of treatment is 100% oxygen, the current evidence and controversies in the use of hyperbaric oxygen therapy in pediatric patients is reviewed, along with its possible benefit in preventing delayed neurologic sequelae

A Rare Cause of Right Lower Quadrant Pain in an 11-Year-Old Female

Case report of an 11-year-old premenarchal female with a history of constipation, sickle cell trait, and obesity who presented to the emergency department with 5 days of abdominal pain

A Child With an Unusual Retained Oral Foreign Body

BACKGROUND: Pediatric foreign-body ingestions are common. Oral foreign bodies are rare but can be life-threatening. Management of their extraction requires knowledge and careful consideration of removal techniques, pharmacology, and potential complications. CASE REPORT: A 5-year-old boy presented to the emergency department with a wooden block retained in his mouth after a fall. The block was lodged behind the patient\u27s primary central incisors without causing apparent oral or dental trauma. Initial manipulation was unsuccessful given patient apprehension and muscle spasm. The patient was given i.v. diazepam for anxiolysis and muscle relaxation, and a tenaculum was used to extract the object. He was observed for a period of time and had no complications. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Retained oral foreign bodies in children require a careful approach and understanding of pharmacologic anxiolysis, as patients may not be candidates for moderate sedation. Emergency physicians must be aware of potential complications of oral foreign bodies, including palatal injury, temporomandibular joint dislocation, epiglottitis, and retained foreign bodies

Carbon Monoxide Exposure in Youth Ice Hockey

OBJECTIVE: To examine the effect of ice resurfacer type on carboxyhemoglobin levels in youth hockey players. We hypothesized that players in arenas with electric resurfacers would have normal, stable carboxyhemoglobin levels during games, whereas those in arenas with internal combustion engine (IC) resurfacers would have an increase in carboxyhemoglobin levels. DESIGN: Prospective cohort study. SETTING: Enclosed ice arenas in the northeastern United States. PARTICIPANTS: Convenience sample of players aged 8 to 18 years old in 16 games at different arenas. Eight arenas (37 players) used an IC ice resurfacer and 8 arenas (36 players) an electric resurfacer. INTERVENTIONS: Carboxyhemoglobin levels (SpCO) were measured using a pulse CO-oximeter before and after the game. Arena air was tested for carbon monoxide (CO) using a metered gas detector. Players completed symptom questionnaires. MAIN OUTCOME MEASURES: The change in SpCO from pregame to postgame was compared between players at arenas with electric versus IC resurfacers. RESULTS: Carbon monoxide was present at 6 of 8 arenas using IC resurfacers, levels ranged from 4 to 42 parts per million. Carbon monoxide was not found at arenas with electric resurfacers. Players at arenas with IC resurfacers had higher median pregame SpCO levels compared with those at electric arenas (4.3% vs 1%, P \u3c 0.01). Players in the IC group also had a significant increase in their SpCO level during a hockey game compared with those in the electric group (2.8% vs 1%, P = 0.01). There were no significant differences in symptom scores. CONCLUSIONS: Players at arenas operating IC resurfacers had significantly higher SpCO levels. CLINICAL RELEVANCE: Youth hockey players in arenas with IC resurfacers have an increase in carboxyhemoglobin during games and have elevated baseline carboxyhemoglobin levels compared with players at arenas with electric resurfacers. Electric resurfacers decrease the risk of CO exposure

Effect of Screen Time on Recovery From Concussion: A Randomized Clinical Trial

Importance: There are limited data to guide screen time recommendations after concussion. Objective: To determine whether screen time in the first 48 hours after concussion has an effect on the duration of concussive symptoms. Design, Setting, and Participants: This randomized clinical trial was conducted in the pediatric and adult emergency departments of a tertiary medical center between June 2018 and February 2020. Participants included a convenience sample of patients aged 12 to 25 years presenting to the emergency department within 24 hours of sustaining a concussion. A total of 162 patients were approached, 22 patients met exclusion criteria, and 15 patients declined participation; 125 participants were enrolled and randomized. Interventions: Patients were either permitted to engage in screen time (screen time permitted group) or asked to abstain from screen time (screen time abstinent group) for 48 hours after injury. Main Outcomes and Measures: The primary outcome was days to resolution of symptoms, defined as a total Post-Concussive Symptom Scale (PCSS) score of 3 points or lower. Patients completed the PCSS, a 22-symptom scale that grades each symptom from 0 (not present) to 6 (severe), each day for 10 days. Kaplan-Meier curves and Cox regression modeling were used to compare the 2 groups. A Wilcoxon rank sum test was also performed among participants who completed the PCSS each day through recovery or conclusion of the study period. Results: Among 125 patients with concussion, the mean (SD) age was 17.0 (3.4) years; 64 participants (51.2%) were male. A total of 66 patients were randomized to the screen time permitted group, and 59 patients were randomized to the screen time abstinent group. The Cox regression model including the intervention group and the patient\u27s self-identified sex demonstrated a significant effect of screen time (hazard ratio [HR], 0.51; 95% CI, 0.29-0.90), indicating that participants who engaged in screen time were less likely to recover during the study period. In total, 91 patients were included in the Wilcoxon rank sum test (47 patients from the screen time permitted group, and 44 patients from the screen time abstinent group). The screen time permitted group had a significantly longer median recovery time of 8.0 days (interquartile range [IQR], 3.0 to \u3e 10.0 days) compared with 3.5 days (IQR, 2.0 to \u3e 10.0 days; P = .03) in the screen time abstinent group. The screen time permitted group reported a median screen time of 630 minutes (IQR, 415-995 minutes) during the intervention period compared with 130 minutes (IQR, 61-275 minutes) in the screen time abstinent group. Conclusions and Relevance: The findings of this study indicated that avoiding screen time during acute concussion recovery may shorten the duration of symptoms. A multicenter study would help to further assess the effect of screen time exposure. Trial Registration: ClinicalTrials.gov Identifier: NCT03564210