Spatial and temporal structure of typhoid fever in Washington, D.C., 1895-1909: a geographic information systems exploration of urban health concerns

The period between 1880 and 1920 was one of the most dynamic in the history of medicine. Morbidity and mortality rates for infectious diseases dropped quickly. Concurrently, miasmatic theory gave way to germ theory. Many of these dynamic changes occurred in the urban centers of North America, which were also entering into a period of dramatic growth and change. Following the 1905 completion of infrastructure improvements intended to improve public health in Washington, D.C., typhoid fever rates unexpectedly increased. Previously, for mitigation purposes, Dr. George Kober investigated a typhoid epidemic in 1895, and as a result of the 1906 increase in typhoid morbidity the United States Public Health and Marine-Hospital Service conducted investigations between 1906 and 1909 to better understand the origins of typhoid in the city. These studies include dot maps of typhoid case locations for the entire 1895 epidemic, at two-week intervals for 1906, 1907, and 1908, and monthly intervals for 1909. These point locations are used to construct a geographic information system (GIS) displaying the spatial distribution of individual typhoid cases. The creation of this GIS allows for the investigation of urban typhoid at a localized geographic scale. The temporal resolution of the data and supplementary data included in the reports provides an opportunity to explore urban typhoid within years, between years, to compare morbidity to mortality, and to compare the spatial pattern of multiple diseases. This dissertation describes the creation of this GIS and the results of the spatial analyses using Ripley’s K-function and the Gi* statistic to evaluate spatial clustering patterns. The Gi* statistic identified localized hotspots that refute the conclusions of the original reports. Typhoid clusters varied in size and location, and lacked temporal stability. The findings of this dissertation indicate that typhoid in early twentieth century Washington, D.C. originated from multiple sources whose impact decreased over time. Studies of this type make use of geospatial approaches unavailable when the original data were collected, in order to investigate potential patterns of typhoid fever invisible a century ago. This research helps to provide a better understanding of the historical geography of urban health in general

Elementary education teachers’ acceptability of reading curriculum-based measurements

With prevention models, such as Response to Intervention (RtI), becoming increasingly implemented by schools, it is important to examine special and general elementary education teachers\u27 acceptability of reading curriculum-based measurement (R-CBM). A national sample of 26 elementary education teachers (23 general education, 3 special education) completed an online survey regarding R-CBM. The survey examined teacher acceptability, knowledge, training, resources, and belief that R-CBM is a valid general outcome measure of reading. Results indicated that special education teachers\u27 reported knowledge of R-CBM was statistically greater than general education teachers\u27. In addition, there was a significant positive correlation between overall knowledge and acceptability of R-CBM. Teachers\u27 belief regarding both resources and that R-CBM is a valid general outcome measure of reading had a significant positive correlation with overall acceptability. Lastly, there was a significant positive correlation between low acceptability of R-CBM and both resources and belief that it is a general outcome measure of reading. Implications for practice and further research are discussed

Perceptions of Immediate Written Feedback Provided to SLP Graduate Clinicians During Tele-Therapy Sessions

Given the status of clinical practice and the heavy reliance on technology due to COVID-19, it is important to investigate clinical supervision practices. The purpose of this study was to determine whether immediate feedback using technology was beneficial for a university clinical setting specifically where current supervision of students is undertaken via a virtual platform. The chat function via the Zoom teletherapy platform was used to deliver immediate written feedback to SLP graduate clinicians. Utilizing technology allowed supervisors to provide immediate, in-session written feedback to SLP graduate clinicians. The objective was to investigate the perceptions of immediate feedback for the SLP graduate clinicians and their supervisors. The objective was met through the utilization of surveys at the end of the study which indicated a preference for immediate feedback for both the supervisors and the SLP graduate clinicians. Having the ability to use technology helped supervisors support the SLP graduate clinicians discretely, especially given the nature of remote supervision. Immediate written feedback utilizing technology should be considered as a means of supporting the SLP graduate clinicians in developing their clinical skills

Prescribed Fire Monitoring Report, Tallgrass Prairie National Preserve 2014 (IQCS fire number 285382, 285383, 266782, 285677)

Introduction In 2014, the preserve’s federal and NGO partners conducted prescribed fires during March, April, and October that encompassed 8129.8 acres of Tallgrass Prairie National Preserve (TAPR). This was a unique burn year in that prescribed burns occurred in the spring, the traditional burn season, and the fall. Fall burns were conducted to support needed archaeological surveys as part of the environmental compliance for a symphony event scheduled for June 2015 at the preserve. Burns at TAPR were coordinated with local US Fish and Wildlife Service (USFWS), The Nature Conservancy (TNC), and various units of the National Park Service. Burns conducted in spring 2014 included: Red House Pasture, Crusher Hill Pasture, the southwest portion of Windmill Pasture, Big Pasture-North, Two Section, East Traps, and Bottomland Restorations (Fields 4, 8, and 18, and the east half of Field 20). In fall 2014, they included: the northeast portion of Windmill Pasture, Big Pasture-South, Southwind Nature Trail/Headquarters, and the northeast portion of Red House Pasture. These areas were successfully burned over the course of three days in the spring and two days in the fall (Table 1; See figure 8 for map of all burned areas.). The fire ecologist was unable to participate in the spring burn events, but was onsite for one day of fall burning. This report presents the 2014 monitoring data in the context of available long-term data that has been collected at TAPR since 2010

Spatial and temporal structure of typhoid outbreaks in Washington, D.C., 1906–1909: evaluating local clustering with the G(i)* statistic

BACKGROUND: To better understand the distribution of typhoid outbreaks in Washington, D.C., the U.S. Public Health Service (PHS) conducted four investigations of typhoid fever. These studies included maps of cases reported between 1 May – 31 October 1906 – 1909. These data were entered into a GIS database and analyzed using Ripley's K-function followed by the G(i)* statistic in yearly intervals to evaluate spatial clustering, the scale of clustering, and the temporal stability of these clusters. RESULTS: The Ripley's K-function indicated no global spatial autocorrelation. The G(i)* statistic indicated clustering of typhoid at multiple scales across the four year time period, refuting the conclusions drawn in all four PHS reports concerning the distribution of cases. While the PHS reports suggested an even distribution of the disease, this study quantified both areas of localized disease clustering, as well as mobile larger regions of clustering. Thus, indicating both highly localized and periodic generalized sources of infection within the city. CONCLUSION: The methodology applied in this study was useful for evaluating the spatial distribution and annual-level temporal patterns of typhoid outbreaks in Washington, D.C. from 1906 to 1909. While advanced spatial analyses of historical data sets must be interpreted with caution, this study does suggest that there is utility in these types of analyses and that they provide new insights into the urban patterns of typhoid outbreaks during the early part of the twentieth century

Cardiovascular consequences of KATP overactivity in Cantu syndrome

Cantu syndrome (CS) is characterized by multiple vascular and cardiac abnormalities including vascular dilation and tortuosity, systemic hypotension, and cardiomegaly. The disorder is caused by gain-of-function (GOF) mutations in genes encoding pore-forming (Kir6.1, KCNJ8) and accessory (SUR2, ABCC9) ATP-sensitive potassium (KATP) channel subunits. However, there is little understanding of the link between molecular dysfunction and the complex pathophysiology observed, and there is no known treatment, in large part due to the lack of appropriate preclinical disease models in which to test therapies. Notably, expression of Kir6.1 and SUR2 does not fully overlap, and the relative contribution of KATP GOF in various cardiovascular tissues remains to be elucidated. To investigate pathophysiologic mechanisms in CS we have used CRISPR/Cas9 engineering to introduce CS-associated SUR2[A478V] and Kir6.1[V65M] mutations to the equivalent endogenous loci in mice. Mirroring human CS, both of these animals exhibit low systemic blood pressure and dilated, compliant blood vessels, as well dramatic cardiac enlargement, the effects being more severe in V65M animals than in A478V animals. In both animals, whole-cell patch-clamp recordings reveal enhanced basal KATP conductance in vascular smooth muscle, explaining vasodilation and lower blood pressure, and demonstrating a cardinal role for smooth muscle KATP dysfunction in CS etiology. Echocardiography confirms in situ cardiac enlargement and increased cardiac output in both animals. Patch-clamp recordings reveal reduced ATP sensitivity of ventricular myocyte KATP channels in A478V, but normal ATP sensitivity in V65M, suggesting that cardiac remodeling occurs secondary to KATP overactivity outside of the heart. These SUR2[A478V] and Kir6.1[V65M] animals thus reiterate the key cardiovascular features seen in human CS. They establish the molecular basis of the pathophysiological consequences of reduced smooth muscle excitability resulting from SUR2/Kir6.1-dependent KATP GOF, and provide a validated animal model in which to examine potential therapeutic approaches to treating CS

Exploring experiences of people with knee osteoarthritis who received a physiotherapist-delivered dietary weight loss and exercise intervention: a mixed methods study.

Explore the experiences of people with knee osteoarthritis who received a very low energy diet (VLED) and exercise program from a physiotherapist. Mixed methods study involving questionnaires (n=42) and semi-structured interviews (n=22) with randomized control trial participants with knee osteoarthritis who had received a 6-month physiotherapist-delivered VLED weight loss and exercise intervention. Questionnaires measured participant satisfaction, and perceptions about physiotherapist's skills/knowledge in delivery of the dietary intervention (measured on 5-7 point Likert scales). Interviews explored participant's experiences and were analysed based on the principles of reflexive thematic analysis. Questionnaire response: 90%. Participants were satisfied with the program (95%), confident their physiotherapist had the required skills (84%) and knowledge (79%) to deliver the dietary intervention, felt comfortable talking to the physiotherapist about weight (74%), and would recommend others see a physiotherapist for the intervention they undertook (71%). Four themes were developed from the interviews: 1) one-stop-shop of exercise and diet; 2) physiotherapist-delivered weight loss works (unsure initially; successfully lost weight); 3) physiotherapists knowledge and skills (exercise is forte; most thought physiotherapists had the necessary weight loss skills/knowledge, but some disagreed); 4) physiotherapists have a role in weight loss (physiotherapists are intelligent, credible, and trustworthy; specific training in weight loss necessary). This study provides, to our knowledge, the first documented perspectives from people with osteoarthritis who have received a physiotherapist-delivered weight loss intervention. Findings suggest physiotherapists may have a role in delivering a protocolised dietary intervention for some people with knee osteoarthritis with overweight and obesity. [Abstract copyright: This article is protected by copyright. All rights reserved.

Specific treatment of problems of the spine (STOPS): design of a randomised controlled trial comparing specific physiotherapy versus advice for people with subacute low back disorders

<p>Abstract</p> <p>Background</p> <p>Low back disorders are a common and costly cause of pain and activity limitation in adults. Few treatment options have demonstrated clinically meaningful benefits apart from advice which is recommended in all international guidelines. Clinical heterogeneity of participants in clinical trials is hypothesised as reducing the likelihood of demonstrating treatment effects, and sampling of more homogenous subgroups is recommended. We propose five subgroups that allow the delivery of specific physiotherapy treatment targeting the pathoanatomical, neurophysiological and psychosocial components of low back disorders. The aim of this article is to describe the methodology of a randomised controlled trial comparing specific physiotherapy treatment to advice for people classified into five subacute low back disorder subgroups.</p> <p>Methods/Design</p> <p>A multi-centre parallel group randomised controlled trial is proposed. A minimum of 250 participants with subacute (6 weeks to 6 months) low back pain and/or referred leg pain will be classified into one of five subgroups and then randomly allocated to receive either physiotherapy advice (2 sessions over 10 weeks) or specific physiotherapy treatment (10 sessions over 10 weeks) tailored according to the subgroup of the participant. Outcomes will be assessed at 5 weeks, 10 weeks, 6 months and 12 months following randomisation. Primary outcomes will be activity limitation measured with a modified Oswestry Disability Index as well as leg and back pain intensity measured on separate 0-10 Numerical Rating Scales. Secondary outcomes will include a 7-point global rating of change scale, satisfaction with physiotherapy treatment, satisfaction with treatment results, the Sciatica Frequency and Bothersomeness Scale, quality of life (EuroQol-5D), interference with work, and psychosocial risk factors (Orebro Musculoskeletal Pain Questionnaire). Adverse events and co-interventions will also be measured. Data will be analysed according to intention to treat principles, using linear mixed models for continuous outcomes, Mann Whitney U tests for ordinal outcomes, and Chi-square, risk ratios and risk differences for dichotomous outcomes.</p> <p>Discussion</p> <p>This trial will determine the difference in outcomes between specific physiotherapy treatment tailored to each of the five subgroups versus advice which is recommended in guidelines as a suitable treatment for most people with a low back disorder.</p> <p>Trial registration</p> <p>Australia and New Zealand Clinical Trials Register (ANZCTR): <a href="http://www.anzctr.org.au/ACTRN12609000834257.aspx">ACTRN12609000834257</a>.</p