Employers\u27 Perceptions of Intimate Partner Violence among a Diverse Workforce

Objectives Intimate partner violence (IPV) is a significant global public health concern, affecting 5.3 million US individuals annually. An estimated 1 in 3 women globally are abused by an intimate partner in their lifetime, and the effects carry over into the workplace. This article examines employers\u27 perceptions of IPV in the workplace, targeting supervisors of Latina employees. Methods Fourteen employers and supervisors of small service-sector companies in Oregon were interviewed using semi-structured interviews. Interpretive description was used to identify themes. These qualitative interviews preceded and helped to formulate a larger workplace intervention study. Results The following themes were found and are detailed: (1) factors associated with recognizing IPV in the workplace, (2) effects of IPV on the work environment and (3) supervisors\u27 responses to IPV-active vs. passive involvement. Also, supervisors\u27 suggestions for addressing IPV in the workplace are summarized. Conclusion These findings demonstrate the need for more IPV-related resources in the workplace to be available to supervisors as well as survivors and their coworkers. The needs of supervisors and workplaces vary by site, demonstrating the need for tailored interventions, and culturally appropriate workplace interventions are needed for Latinas and other racially and ethnically diverse populations

Uniqueness properties of the Kerr metric

We obtain a geometrical condition on vacuum, stationary, asymptotically flat spacetimes which is necessary and sufficient for the spacetime to be locally isometric to Kerr. Namely, we prove a theorem stating that an asymptotically flat, stationary, vacuum spacetime such that the so-called Killing form is an eigenvector of the self-dual Weyl tensor must be locally isometric to Kerr. Asymptotic flatness is a fundamental hypothesis of the theorem, as we demonstrate by writing down the family of metrics obtained when this requirement is dropped. This result indicates why the Kerr metric plays such an important role in general relativity. It may also be of interest in order to extend the uniqueness theorems of black holes to the non-connected and to the non-analytic case.Comment: 30 pages, LaTeX, submitted to Classical and Quantum Gravit

A Collaborative In Situ Simulation-based Pediatric Readiness Improvement Program for Community Emergency Departments

Background More than 30 million children are cared for across 5,000 U.S. emergency departments (EDs) each year. Most of these EDs are not facilities designed and operated solely for children. A Web-based survey provided a national and state-by-state assessment of pediatric readiness and noted a national average score was 69 on a 100-point scale. This survey noted wide variations in ED readiness with scores ranging from 61 in low-pediatric-volume EDs to 90 in the high-pediatric-volume EDs. Additionally, the mean score at the state level ranged from 57 (Wyoming) to 83 (Florida) and for individual EDs ranged from 22 to 100. The majority of prior efforts made to improve pediatric readiness have involved providing Web-based resources and online toolkits. This article reports on the first year of a program that aimed to improve pediatric readiness across community hospitals in our state through in situ simulation-based assessment facilitated by our academic medical center. The primary aim was to improve the pediatric readiness scores in the 10 participating hospitals. The secondary aim was to explore the correlation of simulation-based performance of hospital teams with pediatric readiness scores. Methods This interventional study measured the Pediatric Readiness Survey (PRS) prior to and after implementation of an improvement program. This program consisted of three components: 1) in situ simulations, 2) report-outs, and 3) access to online pediatric readiness resources and content experts. The simulations were conducted in situ (in the ED resuscitation bay) by multiprofessional teams of doctors, nurses, respiratory therapists, and technicians. Simulations and debriefings were facilitated by an expert team from a pediatric academic medical center. Three scenarios were conducted for all teams and include: a 6-month-old with respiratory failure, an 8-year-old with diabetic ketoacidosis (DKA), and a 6-month-old with supraventricular tachycardia (SVT). A performance score was calculated for each scenario. The improvement of PRS was compared before and after the simulation program. The correlation of the simulation performance of each hospital and the PRS was calculated. Results Forty-one multiprofessional teams from 10 EDs in Indiana participated in the study, five were of medium pediatric volume and five were medium- to high-volume EDs. The PRS significantly improved from the first to the second on-site verification assessment (58.4 ± 4.8 to 74.7 ± 2.9, p = 0.009). Total adherence scores to scenario guidelines were 54.7, 56.4, and 62.4% in the respiratory failure, DKA, and SVT scenarios, respectively. We found no correlation between simulation performance and PRS scores. Medium ED pediatric volume significantly predicted higher PRS scores compared to medium-high pediatric ED volume (β = 8.7; confidence interval = 0.72–16.8, p = 0.034). Conclusions Our collaborative improvement program that involved simulation was associated with improvement in pediatric readiness scores in 10 EDs participating statewide. Future work will focus on further expanding of the network and establishing a national model for pediatric readiness improvement

A spacetime characterization of the Kerr metric

We obtain a characterization of the Kerr metric among stationary, asymptotically flat, vacuum spacetimes, which extends the characterization in terms of the Simon tensor (defined only in the manifold of trajectories) to the whole spacetime. More precisely, we define a three index tensor on any spacetime with a Killing field, which vanishes identically for Kerr and which coincides in the strictly stationary region with the Simon tensor when projected down into the manifold of trajectories. We prove that a stationary asymptotically flat vacuum spacetime with vanishing spacetime Simon tensor is locally isometric to Kerr. A geometrical interpretation of this characterization in terms of the Weyl tensor is also given. Namely, a stationary, asymptotically flat vacuum spacetime such that each principal null direction of the Killing form is a repeated principal null direction of the Weyl tensor is locally isometric to Kerr.Comment: 23 pages, No figures, LaTeX, to appear in Classical and Quantum Gravit

Regression of left ventricular mass following conversion from conventional hemodialysis to thrice weekly in-centre nocturnal hemodialysis

<p>Abstract</p> <p>Background</p> <p>Increased left ventricular mass (LVM) is associated with adverse outcomes in patients receiving chronic hemodialysis. Among patients receiving conventional hemodialysis (CHD, 3×/week, 4 hrs/session), we evaluated whether dialysis intensification with in-centre nocturnal hemodialysis (INHD, 3×/week, 7-8 hrs/session in the dialysis unit) was associated with regression of LVM.</p> <p>Methods</p> <p>We conducted a retrospective cohort study of CHD recipients who converted to INHD and received INHD for at least 6 months. LVM on the first echocardiogram performed at least 6 months post-conversion was compared to LVM pre-conversion. In a secondary analysis, we examined echocardiograms performed at least 12 months after starting INHD. The effect of conversion to INHD on LVM over time was also evaluated using a longitudinal analysis that incorporated all LVM data on patients with 2 or more echocardiograms.</p> <p>Results</p> <p>Thirty-seven patients were eligible for the primary analysis. Mean age at conversion was 49 ± 12 yrs and 30% were women. Mean pre-conversion LVM was 219 ± 66 g and following conversion, LVM declined by 32 ± 58 g (p = 0.002). Among patients whose follow-up echocardiogram occurred at least 12 months following conversion, LVM declined by 40 ± 56 g (p = 0.0004). The rate of change of LVM decreased significantly from 0.4 g/yr before conversion, to -11.7 g/yr following conversion to INHD (p < 0.0001).</p> <p>Conclusion</p> <p>Conversion to INHD is associated with a significant regression in LVM, which may portend a more favourable cardiovascular outcome. Our preliminary findings support the need for randomized controlled trials to definitively evaluate the cardiovascular effects of INHD.</p

From Cancer to Diarrhea: The Moving Target of Public Concern about Environmental Health Risks

Public concern about the environment can be unpredictable because it is influenced by numerous factors. Environmental health issues often emerge as important because the public is worried about their health especially when it comes to cancer. Public fear of cancer from environmental exposures is reinforced by many of the US regulations that set pollutant limits based on reducing the risk of cancers rather than other health outcomes. While fear of cancer will never dissipate, recent foodborne outbreaks are contributing to raising public awareness of the health effects from microbes. This paper adds to the dialogue about the challenges of enhancing public understanding of environmental health issues. Internal factors, such as worry, that contribute to public outrage are sometimes more important than external factors such as the media. In addition, relying on the media to inform the public about imminent public health risks may be an ineffective approach to enhancing understanding. In the end, scientists and risk communicators are forced to compete with politicians who are often very effective at manipulating public understanding of risk

Searching for a Stochastic Background of Gravitational Waves with LIGO

The Laser Interferometer Gravitational-wave Observatory (LIGO) has performed the fourth science run, S4, with significantly improved interferometer sensitivities with respect to previous runs. Using data acquired during this science run, we place a limit on the amplitude of a stochastic background of gravitational waves. For a frequency independent spectrum, the new limit is $\Omega_{\rm GW} < 6.5 \times 10^{-5}$. This is currently the most sensitive result in the frequency range 51-150 Hz, with a factor of 13 improvement over the previous LIGO result. We discuss complementarity of the new result with other constraints on a stochastic background of gravitational waves, and we investigate implications of the new result for different models of this background.Comment: 37 pages, 16 figure

Higher Serum Testosterone Concentration in Older Women is Associated with Insulin Resistance, Metabolic Syndrome, and Cardiovascular Disease

Context: Early postmenopausal women with higher testosterone (T) levels have increased insulin resistance (IR) and cardiovascular risk factors, but whether this translates into increased cardiovascular disease later in life is unknown. Objective: The objective of the study was to determine whether higher T levels are associated with IR, the metabolic syndrome (MetSyn), and coronary heart disease (CHD) in elderly women. Design: Total T and free T by equilibrium dialysis were measured using ultrasensitive assays in 344 women aged 65–98 yr enrolled in the Cardiovascular Health Study. Cross-sectional analyses were performed to examine the associations between total and free T and IR, MetSyn, and CHD. Results: There was a stepwise increase in the homeostasis model assessment of insulin resistance with increasing total (P = 0.0.003) and free T (P = 0.02) level and a corresponding decrease in Quantitative Insulin Sensitivity Check Index (P < 0.001 and P = 0.002, respectively). In adjusted models, higher levels of both total and free T were strongly associated with abdominal obesity and high fasting glucose, the two MetSyn components most strongly linked to IR. After adjustment, women in the top quartile of total T levels had a 3-fold greater odds of MetSyn (odds ratio 3.15, 95% confidence interval 1.57–6.35) than those in the bottom quartile and a 3-fold greater odds of CHD (odds ratio 2.95, 95% confidence interval 1.2–7.3) than those in second quartile, whereas free T was not significantly associated with MetSyn or CHD. Conclusions: Higher levels of T are associated with IR, MetSyn, and CHD in elderly women. Whether T is a marker or mediator of cardiovascular disease in this population merits further investigation

Dynamics of ampicillin-resistant Enterococcus faecium clones colonizing hospitalized patients: data from a prospective observational study

<p>Abstract</p> <p>Background</p> <p>Little is known about the dynamics of colonizing <it>Enterococcus faecium </it>clones during hospitalization, invasive infection and after discharge.</p> <p>Methods</p> <p>In a prospective observational study we compared intestinal <it>E. faecium </it>colonization in three patient cohorts: 1) Patients from the Hematology Unit at the University Hospital Basel (UHBS), Switzerland, were investigated by weekly rectal swabs (RS) during hospitalization (group 1a, n = 33) and monthly after discharge (group 1b, n = 21). 2) Patients from the Intensive Care Unit (ICU) at the University Medical Center Utrecht, the Netherlands (group 2, n = 25) were swabbed weekly. 3) Patients with invasive <it>E. faecium </it>infection at UHBS were swabbed at the time of infection (group 3, n = 22). From each RS five colonies with typical <it>E</it>. <it>faecium </it>morphology were picked. Species identification was confirmed by PCR and ampicillin-resistant <it>E. faecium </it>(ARE) isolates were typed using Multiple Locus Variable Number Tandem Repeat Analysis (MLVA). The Simpson's Index of Diversity (SID) was calculated.</p> <p>Results</p> <p>Out of 558 ARE isolates from 354 RS, MT159 was the most prevalent clone (54%, 100%, 52% and 83% of ARE in groups 1a, 1b, 2 and 3, respectively). Among hematological inpatients 13 (40%) had ARE. During hospitalization, the SID of MLVA-typed ARE decreased from 0.745 [95%CI 0.657-0.833] in week 1 to 0.513 [95%CI 0.388-0.637] in week 3. After discharge the only detected ARE was MT159 in 3 patients. In the ICU (group 2) almost all patients (84%) were colonized with ARE. The SID increased significantly from 0.373 [95%CI 0.175-0.572] at week 1 to a maximum of 0.808 [95%CI 0.768-0.849] at week 3 due to acquisition of multiple ARE clones. All 16 patients with invasive ARE were colonized with the same MLVA clone (<it>p </it>< 0.001).</p> <p>Conclusions</p> <p>In hospitalized high-risk patients MT159 is the most frequent colonizer and cause of invasive <it>E. faecium </it>infections. During hospitalization, ASE are quickly replaced by ARE. Diversity of ARE increases on units with possible cross-transmission such as ICUs. After hospitalization ARE are lost with the exception of MT159. In invasive infections, the invasive clone is the predominant gut colonizer.</p