Firearm Curriculum for Pediatric Residents Improves Safe Storage Counseling

Objectives Firearms are the leading cause of death among children and adolescents. Despite evidence to support physician training in firearm safety counseling, formal curricula are limited in pediatric residency programs. We sought to develop and implement a resident-led, feasible, sustainable, and impactful firearm safety curriculum for pediatric residents. Methods A firearm safety curriculum was developed by pediatric residents using Kern’s curriculum development framework and delivered to their peers at a single academic center from 2019 - 2020. The three-part series included workshops on basic firearm safety counseling principles, case-based practice, and advocacy training and a gun lock program in collaboration with the local police department. Impact was measured by feasibility, sustainability, acquired knowledge, and provision of counseling to patients and families. Results A total of 31 residents participated in the three-hour lecture series. Sessions were integrated into the existing didactic curriculum, and no costs or faculty time were required for implementation. A total of 1,477 patient charts were reviewed from 2019 - 2021. Compared to a historical cohort, participants asked about presence of a firearm (27% to 69%, p \u3c .0001) and counseled on firearm safety more often (25% vs. 9%, p \u3c .0001). Conclusions A firearm safety curriculum designed specifically for pediatric residents was deemed feasible and resulted in a statistically significant improvement in inquiries about firearm ownership and safety counseling in an urban tertiary care continuity clinic. This study highlights the value in providing firearm safety education at the resident level to foster more discussions to keep children safe from firearm injuries

A Cross Sectional Study of the Association between Sanitation Type and Fecal Contamination of the Household Environment in Rural Bangladesh.

We conducted a cross sectional study to assess 1) the association between access to basic sanitation and fecal contamination of sentinel toy balls and 2) if other sanitation factors such as shared use and cleanliness are associated with fecal contamination of sentinel toy balls. We assessed sanitation facilities in 454 households with a child aged 6-24 months in rural Bangladesh. We defined "basic" sanitation as access to improved sanitation facilities (pit latrine with a slab or better) not shared with other households. In each household, an identical toy ball was given to the target child. After 24 hours, the balls were rinsed to enumerate fecal coliforms as an indicator of household fecal contamination. Households with basic sanitation had lower fecal coliform contamination than households with no access to basic sanitation (adjusted difference in means: -0.31 log10 colony forming units [CFU]/toy ball; 95% confidence interval [CI]: -0.61, -0.01). Shared sanitation facilities of otherwise improved type were more likely to have visible feces on the latrine slab compared with private facilities. Among households with access to improved sanitation, households with no visible feces on the latrine slab had less toy ball contamination than households with visible feces on the latrine slab (adjusted difference in means: -0.38 log10 CFU/toy ball; 95% CI: -0.77, 0.02). Access to basic sanitation may prevent fecal contamination of the household environment. An Improved sanitation facility used by an individual household may be better in preventing household fecal contamination compared with improved facilities shared with other households

Local randomness in Hardy's correlations: Implications from information causality principle

Study of nonlocal correlations in term of Hardy's argument has been quite popular in quantum mechanics. Recently Hardy's argument of non-locality has been studied in the context of generalized non-signaling theory as well as theory respecting information causality. Information causality condition significantly reduces the success probability for Hardy's argument when compared to the result based on non-signaling condition. Here motivated by the fact that maximally entangled state in quantum mechanics does not exhibit Hardy's non-local correlation, we do a qualitative study of the property of local randomness of measured observable on each side reproducing Hardy's non-locality correlation,in the context of information causality condition. On applying the necessary condition for respecting the principle of information causality, we find that there are severe restrictions on the local randomness of measured observable in contrast to results obtained from no-signaling condition.Still, there are some restrictions imposed by quantum mechanics that are not obtained from information causality condition.Comment: 6 pages, 2 tables, new references adde

Effect of Neighborhood Sanitation Coverage on Fecal Contamination of the Household Environment in Rural Bangladesh.

Enteric pathogens can be transmitted within the household and the surrounding neighborhood. The objective of this study was to understand the effect of neighborhood-level sanitation coverage on contamination of the household environment with levels of fecal indicator bacteria in rural Bangladesh. We conducted spot-check observations of sanitation facilities in neighboring households (NHs) within a 20-m radius of target households with children aged 6-24 months. Sanitation facilities were defined as improved (a private pit latrine with a slab or better) or unimproved. Fecal coliforms (FCs) on children's hands and sentinel toy balls were measured and used as indicators of household-level fecal contamination. We visited 1,784 NHs surrounding 428 target households. On average, sentinel toy balls had 2.11(standard deviation [SD] = 1.37) log10 colony-forming units (CFUs) of FCs/toy ball and children's hands had 2.23 (SD = 1.15) log10 CFU of FCs/two hands. Access to 100% private improved sanitation coverage in the neighborhood was associated with a small and statistically insignificant difference in contamination of sentinel toy balls (difference in means = -0.13 log10 CFU/toy ball; 95% confidence intervals [CI]: -0.64, 0.39; P = 0.63) and children's hands (difference in means = -0.11 log10 CFU/two hands; 95% CI: -0.53, 0.32; P = 0.62). Improved sanitation coverage in the neighborhood had limited measurable effect on FCs in the target household environment. Other factors such as access to improved sanitation in the household, absence of cow dung, presence of appropriate water drainage, and optimal handwashing practice may be more important in reducing FCs in the household environment

Impact of Vitamin D Supplementation on Arterial Vasomotion, Stiffness and Endothelial Biomarkers in Chronic Kidney Disease Patients

Background: Cardiovascular events are frequent and vascular endothelial function is abnormal in patients with chronic kidney disease (CKD). We demonstrated endothelial dysfunction with vitamin D deficiency in CKD patients; however the impact of cholecalciferol supplementation on vascular stiffness and vasomotor function, endothelial and bone biomarkers in CKD patients with low 25-hydroxy vitamin D [25(OH)D] is unknown, which this study investigated. Methods: We assessed non-diabetic patients with CKD stage 3/4, age 17–80 years and serum 25(OH)D ,75 nmol/L. Brachial artery Flow Mediated Dilation (FMD), Pulse Wave Velocity (PWV), Augmentation Index (AI) and circulating blood biomarkers were evaluated at baseline and at 16 weeks. Oral 300,000 units cholecalciferol was administered at baseline and 8-weeks. Results: Clinical characteristics of 26 patients were: age 50614 (mean61SD) years, eGFR 41611 ml/min/1.73 m2, males 73%, dyslipidaemia 36%, smokers 23% and hypertensives 87%. At 16-week serum 25(OH)D and calcium increased (43616 to 84629 nmol/L, p,0.001 and 2.3760.09 to 2.4260.09 mmol/L; p = 0.004, respectively) and parathyroid hormone decreased (10.868.6 to 7.464.4; p = 0.001). FMD improved from 3.163.3% to 6.163.7%, p = 0.001. Endothelial biomarker concentrations decreased: E-Selectin from 566662123 to 525662058 pg/mL; p = 0.032, ICAM-1, 3.4560.01 to 3.1061.04 ng/mL; p = 0.038 and VCAM-1, 54633 to 42633 ng/mL; p = 0.006. eGFR, BP, PWV, AI, hsCRP, von Willebrand factor and Fibroblast Growth Factor-23, remained unchanged. Conclusion: This study demonstrates for the first time improvement of endothelial vasomotor and secretory functions with vitamin D in CKD patients without significant adverse effects on arterial stiffness, serum calcium or FGF-23. Trial Registration: ClinicalTrials.gov NCT0200571

Continuous variable quantum key distribution with two-mode squeezed states

Quantum key distribution (QKD) enables two remote parties to grow a shared key which they can use for unconditionally secure communication [1]. The applicable distance of a QKD protocol depends on the loss and the excess noise of the connecting quantum channel [2-10]. Several QKD schemes based on coherent states and continuous variable (CV) measurements are resilient to high loss in the channel, but strongly affected by small amounts of channel excess noise [2-6]. Here we propose and experimentally address a CV QKD protocol which uses fragile squeezed states combined with a large coherent modulation to greatly enhance the robustness to channel noise. As a proof of principle we experimentally demonstrate that the resulting QKD protocol can tolerate more noise than the benchmark set by the ideal CV coherent state protocol. Our scheme represents a very promising avenue for extending the distance for which secure communication is possible.Comment: 8 pages, 5 figure

Using appreciative inquiry as a framework to enhance the patient experience

The following case depicts the journey of a non-profit hospital in an under-served community and its attempts to turn around suffering patient experience. The Hospital turned to the theories of Appreciative Inquiry and the power of a strengths-based approach to create a framework to support the patient experience initiatives. Hospital leadership led the formation of a Patient Experience Team to implement ten initiatives in order increase the top box score in the domain of willingness to recommend the hospital, as that was selected as a global measure of success for the overall improvement project

Graphics process unit accelerated lattice Boltzmann simulation of indoor air flow: Effects of sub-grid scale model in large-eddy simulation

In this present study, three-dimensional lattice Boltzmann method is implemented with the popular turbulence modeling method large-eddy simulation incorporating three different non-dynamic sub-grid scale models Smagorinsky, Vreman, and wall-adapting local eddy-viscosity for finding the inhomogeneous turbulent airflow patterns inside a model room with a partition. The large eddy simulation-lattice Boltzmann method code is validated with the experimental results of Posner’s model, where the model room having one partition at the bottom, one inlet, an outlet placed at top wall considered for the comparisons. The lattice Boltzmann method code is also validated without any sub-grid scale model with the results of lid-driven flow in a cubic cavity. The present numerical simulations are performed by the graphics process unit accelerated parallel programs using compute unified device architecture C platform. Double precession capable a Tesla k40 with 2880 compute unified device architecture cores NVIDIA graphics process unit card has been used for these simulations. Graphics processor units have gained popularity in recent years as a propitious platform for numerical simulation of fluid dynamics. In fact, faster computational task performance in graphics process units is one of the key factors for researchers to choose graphics process unit over conventional central processing units for the implementation of data-intensive numerical methods like lattice Boltzmann method. The effects of the sub-grid scale model have been evaluated in terms of the mean velocity profiles, streamlines as well as turbulence characteristics and found that there are significant differences in the results due to the different sub-grid scale models

The Glasgow-Maastricht foot model, evaluation of a 26 segment kinematic model of the foot

BACKGROUND: Accurately measuring of intrinsic foot kinematics using skin mounted markers is difficult, limited in part by the physical dimensions of the foot. Existing kinematic foot models solve this problem by combining multiple bones into idealized rigid segments. This study presents a novel foot model that allows the motion of the 26 bones to be individually estimated via a combination of partial joint constraints and coupling the motion of separate joints using kinematic rhythms. METHODS: Segmented CT data from one healthy subject was used to create a template Glasgow-Maastricht foot model (GM-model). Following this, the template was scaled to produce subject-specific models for five additional healthy participants using a surface scan of the foot and ankle. Forty-three skin mounted markers, mainly positioned around the foot and ankle, were used to capture the stance phase of the right foot of the six healthy participants during walking. The GM-model was then applied to calculate the intrinsic foot kinematics. RESULTS: Distinct motion patterns where found for all joints. The variability in outcome depended on the location of the joint, with reasonable results for sagittal plane motions and poor results for transverse plane motions. CONCLUSIONS: The results of the GM-model were comparable with existing literature, including bone pin studies, with respect to the range of motion, motion pattern and timing of the motion in the studied joints. This novel model is the most complete kinematic model to date. Further evaluation of the model is warranted

Treatment of Branch Retinal Vein Occlusion induced Macular Edema with Bevacizumab

BACKGROUND: Branch retinal vein occlusion is a frequent cause of visual loss with currently insufficient treatment options. We evaluate the effect of Bevacizumab (Avastin) treatment in patients with macular edema induced by branch retinal vein occlusion. METHODS: Retrospective analysis of 32 eyes in 32 patients with fluorescein angiography proven branch retinal vein occlusion, macular edema and Bevacizumab treatment. Outcome measures were best corrected visual acuity in logMAR and central retinal thickness in OCT. RESULTS: Visual acuity was significantly better 4 to 6 weeks after Bevacizumab treatment compared to visual acuity prior to treatment (before 0.7 +/- 0.3 and after 0.5 +/- 0.3; mean +/- standard deviation; p < 0.01, paired t-test). Gain in visual acuity was accompanied by a significant decrease in retinal thickness (454 +/- 117 to 305 +/- 129 microm, p < 0.01, paired t-test). Follow up (170, 27 - 418 days; median, range) shows that improvement for both visual acuity and retinal thickness last for several months after Bevacizumab use. CONCLUSION: We present evidence that intravitreal Bevacizumab is an effective and lasting treatment for macular edema after branch retinal vein occlusion