Risk Mitigation for Travelers: Managing Endemic and Emerging Threats

International travel continues to increase in numbers and complexity. Despite the availability of pretravel health advice, travelers remain at risk for exposure to common organisms as well as emerging pathogens. With low rates of travel clinic utilization, it is important for the general practitioner to remain aware of the importance of travel health, risk factors unique to individual patients, and evolving threats. This review highlights important considerations when evaluating ill travelers, incorporating emerging infectious threats

Art, Artifact, Archive: African American Experiences in the Nineteenth Century

Angelo Scarlato’s extraordinary and vast collection of art and artifacts related to the Civil War, and specifically to the Battle of Gettysburg, the United States Colored Troops, slavery and the African American struggle for emancipation, citizenship and freedom has proved to be an extraordinary resource for Gettysburg College students. The 2012-14 exhibition in Musselman Library’s Special Collections, curated by Lauren Roedner ’13, entitled Slaves, Soldiers, Citizens: African American Artifacts of the Civil War Era and its corresponding catalogue provided a powerful and comprehensive historical narrative of the period. This fall, students in my course at Gettysburg College “Art and Public Policy”—Diane Brennan, Maura Conley, Abigail Conner, Nicole Conte, Victoria Perez-Zetune, Savannah Rose, Kaylyn Sawyer, Caroline Wood and Zoe Yeoh—selected additional objects of material and print culture from Angelo’s private collection and drew from Lauren’s expertise for the exhibition Art, Artifact, Archive: African American Experiences in the Nineteenth Century to investigate public representations of a newly freed population as well as their more personal perspectives. [excerpt]https://cupola.gettysburg.edu/artcatalogs/1015/thumbnail.jp

Addressing Profound Disadvantages to Improve Indigenous Health and Reduce Hospitalisation: A Collaborative Community Program in Remote Northern Territory

BACKGROUND: Aboriginal people in rural and remote areas of the Northern Territory of Australia have suffered longstanding issues of homelessness and profound health and social inequities. The town and region of Katherine are particularly impacted by such inequities and have the highest rates of homelessness in Australia, composed almost entirely of Aboriginal people who represent 51% of the total population of 24,000 people. The region is serviced by a 60-bed hospital, and a small cohort of frequent attenders (FAs) represent 11% of the Emergency Department (ED) case load. The vast majority of FAs are Aboriginal and have very high burdens of social inequity and homelessness. FAs are a challenge to efficient and effective use of resources for most hospitals around the world, and investment in programs to address underlying social and chronic health issues contributing to frequent attendance have been demonstrated to be effective. METHODS: These are the interim findings of a prospective cohort study using five sources of linked health and related data to evaluate a community-based case management pilot in a culturally competent framework to support frequent attenders to the Katherine Hospital ED. FAs were defined as people with six or more presentations in 12 preceding months. The intervention composed of a community-based case management program with a multi-agency service delivery addressing underlying vulnerabilities contributing to ED presentations. RESULTS: Among this predominantly Aboriginal cohort (91%), there were high rates of homelessness (64%), food insecurity (60%) and alcohol misuse (64%), limited access to transport, and complex comorbidities (average of 2.8 chronic conditions per client). Following intervention, there was a statistically significant reduction in ED presentations (IRR 0.77, 95% CI 0.69-0.85), increased engagement with primary health care (IRR 1.90, 95% CI 1.78-2.03), and ambulance utilisation (IRR 1.21, 95% CI 1.07-1.38). Reductions in hospital admissions (IRR 0.93, 95% CI 0.77-1.10) and aeromedical retrievals (IRR 0.67, 95% CI 0.35-1.20) were not statistically significant. CONCLUSIONS: This study demonstrates the short-term impacts of community-led case management extending beyond the hospital setting, to address causes of recurrent ED presentations among people with complex social and medical backgrounds. Improving engagement with primary care is a particularly important outcome given the national impetus to reduce preventable hospital admissions

Association between circulating levels of sex steroid hormones and esophageal adenocarcinoma in the FINBAR Study

Funding: The study was supported by NIH Intramural Research Program, National Cancer Institute; Cancer Focus Northern Ireland (formerly the Ulster Cancer Foundation); the Northern Ireland R&D office; and the Health Research Board, Ireland. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Searching for Pulsars in Close Binary Systems

We present a detailed mathematical analysis of the Fourier response of binary pulsar signals whose frequencies are modulated by circular orbital motion. The fluctuation power spectrum of such signals is found to be \nu_orb-periodic over a compact frequency range, where \nu_orb denotes orbital frequency. Subsequently, we consider a wide range of binary systems with circular orbits and short orbital periods, and present a Partial Coherence Recovery Technique for searching for binary millisecond X-ray and radio pulsars. We use numerical simulations to investigate the detectability of pulsars in such systems with P_orb ~ 6 hours, using this technique and three widely used pulsar search methods. These simulations demonstrate that the Partial Coherence Recovery Technique is on average several times more sensitive at detecting pulsars in close binary systems when the data span is more than 2 orbital periods. The systems one may find using such a method can be used to improve the constraints on the coalescence rate of compact objects and they also represent those systems most likely to be detected with gravitational wave detectors such as LISA

Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group.

Cancer immunotherapy has transformed the treatment of cancer. However, increasing use of immune-based therapies, including the widely used class of agents known as immune checkpoint inhibitors, has exposed a discrete group of immune-related adverse events (irAEs). Many of these are driven by the same immunologic mechanisms responsible for the drugs\u27 therapeutic effects, namely blockade of inhibitory mechanisms that suppress the immune system and protect body tissues from an unconstrained acute or chronic immune response. Skin, gut, endocrine, lung and musculoskeletal irAEs are relatively common, whereas cardiovascular, hematologic, renal, neurologic and ophthalmologic irAEs occur much less frequently. The majority of irAEs are mild to moderate in severity; however, serious and occasionally life-threatening irAEs are reported in the literature, and treatment-related deaths occur in up to 2% of patients, varying by ICI. Immunotherapy-related irAEs typically have a delayed onset and prolonged duration compared to adverse events from chemotherapy, and effective management depends on early recognition and prompt intervention with immune suppression and/or immunomodulatory strategies. There is an urgent need for multidisciplinary guidance reflecting broad-based perspectives on how to recognize, report and manage organ-specific toxicities until evidence-based data are available to inform clinical decision-making. The Society for Immunotherapy of Cancer (SITC) established a multidisciplinary Toxicity Management Working Group, which met for a full-day workshop to develop recommendations to standardize management of irAEs. Here we present their consensus recommendations on managing toxicities associated with immune checkpoint inhibitor therapy

Message Passing for Optimization and Control of Power Grid: Model of Distribution System with Redundancy

We use a power grid model with $M$ generators and $N$ consumption units to optimize the grid and its control. Each consumer demand is drawn from a predefined finite-size-support distribution, thus simulating the instantaneous load fluctuations. Each generator has a maximum power capability. A generator is not overloaded if the sum of the loads of consumers connected to a generator does not exceed its maximum production. In the standard grid each consumer is connected only to its designated generator, while we consider a more general organization of the grid allowing each consumer to select one generator depending on the load from a pre-defined consumer-dependent and sufficiently small set of generators which can all serve the load. The model grid is interconnected in a graph with loops, drawn from an ensemble of random bipartite graphs, while each allowed configuration of loaded links represent a set of graph covering trees. Losses, the reactive character of the grid and the transmission-level connections between generators (and many other details relevant to realistic power grid) are ignored in this proof-of-principles study. We focus on the asymptotic limit and we show that the interconnects allow significant expansion of the parameter domains for which the probability of a generator overload is asymptotically zero. Our construction explores the formal relation between the problem of grid optimization and the modern theory of sparse graphical models. We also design heuristic algorithms that achieve the asymptotically optimal selection of loaded links. We conclude discussing the ability of this approach to include other effects, such as a more realistic modeling of the power grid and related optimization and control algorithms.Comment: 10 page