Gun Ownership and Firearm-related Deaths

BACKGROUND: A variety of claims about possible associations between gun ownership rates, mental illness burden, and the risk of fi rearm-related deaths have been put forward. However, systematic data on this issue among various countries remain scant. Our objective was to assess whether the popular notion "guns make a nation safer" has any merits.METHODS: Data on gun ownership were obtained from the Small Arms Survey, and for fi rearm-related deaths from a European detailed mortality database (World Health Organization), the National Center for Health Statistics, and others. Crime rate was used as an indicator of safety of the nation and was obtained from the United Nations Surveys of Crime Trends. Age-standardized disability-adjusted life- year rates due to major depressive disorder per 100,000 inhabitants with data obtained from the World Health Organization database were used as a putative indicator for mental illness burden in a given country.RESULTS: Among the 27 developed countries, there was a significant positive correlation between guns per capita per country and the rate of fi rearm-related deaths ( r ¼ 0.80; P < .0001). In addition, there was a positive correlation (r ¼ 0.52; P ¼ .005) between mental illness burden in a country and fi rearm-related deaths. However, there was no significant correlation (P ¼ .10) between guns per capita per country and crime rate ( r ¼ .33), or between mental illness and crime rate ( r ¼ 0.32; P ¼ .11). In a linear regression model with fi rearm-related deaths as the dependent variable with gun ownership and mental illness as independent covariates, gun ownership was a significant predictor ( P < .0001) of fi rearm-related deaths, whereas mental illness was of borderline significance ( P ¼ .05) only.CONCLUSION: The number of guns per capita per country was a strong and independent predictor of fi rearm-related death in a given country, whereas the predictive power of the mental illness burden was of borderline significance in a multivariable model. Regardless of exact cause and effect, however, the current study debunks the widely quoted hypothesis that guns make a nation safer

Flow distributed oscillation, flow velocity modulation and resonance

We examine the effects of a periodically varying flow velocity on the standing and travelling wave patterns formed by the flow-distributed oscillation (FDO) mechanism. In the kinematic (or diffusionless) limit, the phase fronts undergo a simple, spatiotemporally periodic longitudinal displacement. On the other hand, when the diffusion is significant, periodic modulation of the velocity can disrupt the wave pattern, giving rise in the downstream region to travelling waves whose frequency is a rational multiple of the velocity perturbation frequency. We observe frequency locking at ratios of 1:1, 2:1 and 3:1, depending on the amplitude and frequency of the velocity modulation. This phenomenon can be viewed as a novel, rather subtle type of resonant forcing.Comment: submitted to Phys. Rev.

Impact of a community pharmacist-led medication review on medicines use in patients on polypharmacy - a prospective randomised controlled trial

In 2010 the 'Polymedication Check' (PMC), a pharmacist-led medication review, was newly introduced to be delivered independently from the prescriber and reimbursed by the Swiss health insurances. This study aimed at evaluating the impact of this new cognitive service focusing on medicines use and patients' adherence in everyday life.; This randomised controlled trial was conducted in 54 Swiss community pharmacies. Eligible patients used ≥4 prescribed medicines over &gt;3 months. The intervention group received a PMC at study start (T-0) and after 28 weeks (T-28) while the control group received only a PMC at T-28. Primary outcome measure was change in patients' objective adherence, calculated as Medication Possession Ratio (MPR) and Daily Polypharmacy Possession Ratio (DPPR), using refill data from the pharmacies and patient information of dosing. Subjective adherence was assessed as secondary outcome by self-report questionnaires (at T-0 and T-28) and telephone interviews (at T-2 and T-16), where participants estimated their overall adherence on a scale from 0-100 %.; A total of 450 patients were randomly allocated to intervention (N = 218, 48.4 %) and control group (N = 232, 51.6 %). Dropout rate was fairly low and comparable for both groups (N Int = 37 (17.0 %), NCont = 41 (17.7 %), p = 0.845). Main addressed drug-related problem (DRP) during PMC at T-0 was insufficient adherence to at least one medicine (N = 69, 26.7 %). At T-28, 1020 chronic therapies fulfilled inclusion criteria for MPR calculation, representing 293 of 372 patients (78.8 %). Mean MPR and adherence to polypharmacy (DPPR) for both groups were equally high (MPRInt = 88.3, SD = 19.03; MPRCont = 87.5, SD = 20.75 (p = 0.811) and DPPRInt = 88.0, SD = 13.31; DPPRCont = 87.5, SD = 20.75 (p = 0.906), respectively). Mean absolute change of subjective adherence between T-0 and T-2 was +1.03 % in the intervention and -0.41 % in the control group (p = 0.058). The number of patients reporting a change of their adherence of more than ±5 points on a scale 0-100 % between T-0 and T-2 was significantly higher in the intervention group (NImprovement = 30; NWorsening = 14) than in the control group (NImprovement = 20; NWorsening = 24; p = 0.028).; Through the PMC pharmacist were able to identify a significant number of DRPs. Participants showed high baseline objective adherence of 87.5 %, providing little potential for improvement. Hence, no significant increase of objective adherence was observed. However, regarding changes in subjective adherence of more than ±5 % the PMC showed a positive effect.; Clinical trial registry database, NCT01739816 ; first entry on November 27, 2012

Lesen im Bild: Zur Ikonographie von Buch und Lektüreakten vom 16. bis zum 20. Jahrhundert

Over the past twenty or more years, scholarship on the history of reading has augmented its study of textual sources by making use of images. Images do not merely serve to illustrate and confirm established insights into the history of reading practices; they also reveal additional circumstances unique to the roles of images in the history of reading. By focusing on the image - whether illustration, woodcut, oil-painting, etching, lithograph, photograph, or drawing - history of reading identifies and permits systematic analysis of, on the one hand, the involuntary and topical representations of reading and using codices, books, newspapers, manuscripts, letters, etc. On the other hand, this systematic analysis also extends to innovative and even idiosyncratic depictions of reading. Discursive (verbal) representations and visual depictions of reading do not always correspond and often feature alternative or diverging elements. Although images open up history of reading to new lines of inquiry and can serve as correctives to long-standing theoretical approaches, a systematic analysis of depictions of reading requires a cohesive corpus of material, a critique of the image as such, and a method tailored to the specific medial qualities of the image. As it stands, history of reading cannot proceed any further without taking into account the visual sources that constitute that history's fac

Utilisation des logiciels d'ingénierie assistée par ordinateur dans la division ST

De juin à septembre 2000, une enquête portant sur l'utilisation des logiciels d'Ingénierie Assistée par Ordinateur (IAO) a été menée dans la division ST. Cent cinquante-trois personnes, fonctionnaires et prestataires de services, ont été interrogées sur les logiciels IAO utilisés, AutoCAD en particulier. Ce document présente les résultats statistiques bruts de cette enquête ainsi que les principales interprétations qui ont été dégagées de l'analyse de ces résultats. Il débouche, ensuite, sur des propositions concrètes dont certaines ont déjà été mises en oeuvre

Use of the AFIX Model to Improve Adolescent HPV Vaccination: A Pilot Research Study

Problem: The CDC estimates one person every 20 minutes every day acquires an HPV-related cancer. Kentucky’s HPV associated cancer burden is among the highest in the nation. Adolescent HPV vaccination rates in Kentucky are far below HealthyPeople 2020 goals. Barriers are multifaceted and include provider, patient and system barriers. The AFIX model is an evidenced based quality improvement program that addresses key provider barriers. The USPSTF findings identify a gap in the literature related to AFIX methods to improve rates of adolescent vaccines. Objectives: The purpose of this study was to evaluate the effects of an intervention using the AFIX model and provider education focusing on the HPV vaccine as cancer prevention. Goal: To evaluate provider knowledge & attitudes of the HPV vaccine and evaluate the effects of provider education on vaccine rates. Specific Aims: 1. Evaluate frequency of use of CDC Talking Points (rubric) 2. Evaluate changes in vaccination with use of rubric. Methods: Utilizing the Assessment Feedback Incentives eXchange (AFIX) model, this quasi-experimental pilot research project included four phases: a retrospective chart review to establish baseline rates of HPV vaccination and a provider survey to identify barriers and facilitators (Phase 1), an educational intervention focused on presenting the HPV vaccine as cancer prevention (Phase 2), a process/outcome evaluation (Phase 3&4) to assess use and feasibility of the CDC talking points rubric and an outcome evaluation to assess any change in vaccine uptake. Primary outcome variable: adolescents age 11-17, with no prior history of the HPV vaccine receiving at least one dose. Results: 63 of 100 medical records reviewed met inclusion criteria. 79% of adolescents received one dose of the HPV vaccine at a well-child visit. Only 34% received dose 2, and only 8% received dose 3. Significant demographic findings: older adolescents and non-Hispanics were less likely to initiate HPV vaccine. Provider survey results revealed the most commonly reported barrier at 80% was the HPV vaccine not being required for school entry. Participation in the Vaccines for children (VFC) program was the most commonly reported facilitator at 82%. The post-intervention process evaluation revealed 50% of the providers changed the way they presented the HPV vaccine to parents. None of the providers used the CDC rubric and the most common barrier was not having a copy to refer to. Two-thirds of the providers felt uptake of the vaccine had increased since the 2-dose series introduced. Only 83% offer vaccine to females & males 100% of the time. None of the providers feel the vaccine is accepted 100% of the time. Summary/Implications: At 79%, the proportion of adolescents at HealthFirst Bluegrass age 11-17 with one dose of the HPV vaccine was above the statewide average of 58%. The proportion with 2 and 3 doses were on par with national averages, but were still below benchmark. Because the baseline rates were just below the 80% goal and the provider surveys revealed the school requirement barrier, the PI chose to shift the focus to a policy intervention at the school level. Using a CDC drafted school nurse letter to parents of adolescents, the PI proposed a new version of the 5th grade letter to be sent to all Fayette county incoming middle school students. The current letter only lists the 2 state required vaccines (Tdap, MCV) and not the third ACIP recommended HPV vaccine. Given the recent change in the ACIP recommendation to a 2-dose regimen for young teens, this provides a prime opportunity to promote the HPV vaccine to Fayette county middle school students and their parents