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Evidence-based concussion practices have been codified into legislation, yet implementation has been narrowly evaluated. We examined implementation of concussion practices in Massachusetts high schools and adopted a disproportionality lens to assess the relationship between school sociodemographic and policy implementation and examine whether differences in policy implementation represent systematic disparities consistent with the disproportionality literature.
Methods
A cross-sectional survey was sent to Massachusetts high school nurses (N=304). Responses (n=201; 68.1% response rate) were tallied so that higher scores indicated greater policy implementation. School demographic data were collected using publicly available datasets and were linked to survey responses. Descriptive statistics, correlations, k-means clustering, and groupwise comparisons were conducted.
Results
Policy implementation is varied across schools and is associated with school sociodemographic variables. As percentages of marginalized identities in student population increased, implementation rates decreased. K-means cluster analysis revealed two discrete groups based on policy implementation scores, with significant differences in sociodemographic variables between groups. Schools with low implementation scores had a greater percentage of students who identified as African American/Black and nurses with less experience.
Conclusions
Findings highlight current disparities in the implementation of concussion management policies and support adoption of a disproportionality lens in this sphere.
To characterise food group consumption, assess the contribution of food groups to energy and micronutrient intake, and estimate usual nutrient intake among adults in rural Sri Lanka.
Design:
A baseline survey (December 2020–February 2021) was conducted as part of an agriculture-based, nutrition-sensitive resilience program evaluation. Dietary intake was assessed using telephone-based 24-h recalls (n 1283), with repeat recalls from 769 participants. Mean daily intake of food groups and their contribution to energy and nutrient intakes were calculated. The National Cancer Institute method was used to estimate usual intakes and the prevalence of adequate micronutrient intake (PAI). Differences by sex, district, and wealth were assessed using t tests and ANOVA.
Setting:
Forty-five rural villages throughout Sri Lanka.
Participants:
Men and women from households in the program evaluation study area.
Results:
On average, grains and coconut milk provided 56 % and 12 % of energy, respectively. Rice, fish, dairy, and pulses were the primary sources of micronutrients. Participants consumed 118 ± 117 g of vegetables and 71 ± 243 g of fruit per day. PAI was < 25 % for calcium, zinc, niacin, folate, and vitamins B6, B12, and C, reflecting low consumption of animal-source foods (80 g/day), whole grains, fruit, and vegetables (F&V). Significant differences in food group consumption by socio-demographic subgroup were observed among districts and wealth quintiles.
Conclusions:
We observed high consumption of rice and coconut milk and low prevalence of micronutrient adequacy. We recommend increasing animal-source food, whole grain, and F&V consumption to close nutrient gaps, as well as research to identify effective solutions to increase micronutrient intake.
In March 2018, the US Department of Defense (DOD) added the smallpox vaccination, using ACAM2000, to its routine immunizations, increasing the number of persons receiving the vaccine. The following month, Fort Hood reported a cluster of 5 myopericarditis cases. The Centers for Disease Control and Prevention and the DOD launched an investigation.
Methods:
The investigation consisted of a review of medical records, establishment of case definitions, causality assessment, patient interviews, and active surveillance. A 2-sided exact rate ratio test was used to compare myopericarditis incidence rates.
Results:
This investigation identified 4 cases of probable myopericarditis and 1 case of suspected myopericarditis. No alternative etiology was identified as a cause. No additional cases were identified. There was no statistically significant difference in incidence rates between the observed cluster (5.23 per 1000 vaccinated individuals, 95% CI: 1.7–12.2) and the ACAM2000 clinical trial outcomes for symptomatic persons, which was 2.29 per 1000 vaccinated individuals (95% CI: 0.3–8.3).
Conclusions:
Vaccination with ACAM2000 is the presumptive cause of this cluster. Caution should be exercised before considering vaccination campaigns for smallpox given the clinical morbidity and costs incurred by a case of myopericarditis. Risk of myopericarditis should be carefully weighed with risk of exposure to smallpox.
There is limited evidence on the relationship between disability, experiences of gender-based violence (GBV), and mental health among refugee women in humanitarian contexts.
Methods
A cross-sectional analysis was conducted of baseline data (n = 209) collected from women enrolled in a cohort study of refugee women accessing GBV response services in the Dadaab refugee camps in Kenya. Women were surveyed about GBV experiences (past 12 months, before the last 12 months, before arriving in the refugee camps), functional disability status, and mental health (anxiety, depression, post-traumatic stress), and we explored the inter-relationship of these factors.
Results
Among women accessing GBV response services, 44% reported a disability. A higher proportion of women with a disability (69%) reported a past-year experience of physical intimate partner violence and/or physical or sexual non-partner violence, compared to women without a disability (54%). A higher proportion of women with a disability (32%) experienced non-partner physical or sexual violence before arriving in the camp compared to women without a disability (16%). Disability was associated with higher scores for depression (1.93, 95% confidence interval (CI) 0.54–3.33), PTSD (2.26, 95% CI 0.03–4.49), and anxiety (1.54, 95% CI 0.13–2.95) after adjusting for age, length of encampment, partner status, number of children, and GBV indicators.
Conclusions
A large proportion of refugee women seeking GBV response services have disabilities, and refugee women with a disability are at high risk of poor mental health. This research highlights the need for mental health and disability screening within GBV response programming.
The following position statement from the Union of the European Phoniatricians, updated on 25th May 2020 (superseding the previous statement issued on 21st April 2020), contains a series of recommendations for phoniatricians and ENT surgeons who provide and/or run voice, swallowing, speech and language, or paediatric audiology services.
Objectives
This material specifically aims to inform clinical practices in countries where clinics and operating theatres are reopening for elective work. It endeavours to present a current European view in relation to common procedures, many of which fall under the aegis of aerosol generating procedures.
Conclusion
As evidence continues to build, some of the recommended practices will undoubtedly evolve, but it is hoped that the updated position statement will offer clinicians precepts on safe clinical practice.
Some studies found that providing micronutrient powder (MNP) causes adverse health outcomes, but modifying factors are unknown. We aimed to investigate whether Fe status and inherited Hb disorders (IHbD) modify the impact of MNP on growth and diarrhoea among young Lao children. In a double-blind controlled trial, 1704 children of age 6–23 months were randomised to daily MNP (with 6 mg Fe plus fourteen micronutrients) or placebo for about 36 weeks. IHbD, and baseline and final Hb, Fe status and anthropometrics were assessed. Caregivers provided weekly morbidity reports. At enrolment, 55·6 % were anaemic; only 39·3 % had no sign of clinically significant IHbD. MNP had no overall impact on growth and longitudinal diarrhoea prevalence. Baseline Hb modified the effect of MNP on length-for-age (LAZ) (P for interaction = 0·082). Among children who were initially non-anaemic, the final mean LAZ in the MNP group was slightly lower (–1·93 (95 % CI –1·88, –1·97)) v. placebo (–1·88 (95 % CI –1·83, –1·92)), and the opposite occurred among initially anaemic children (final mean LAZ –1·90 (95 % CI –1·86, –1·94) in MNP v. –1·92 (95 % CI –1·88, –1·96) in placebo). IHbD modified the effect on diarrhoea prevalence (P = 0·095). Among children with IHbD, the MNP group had higher diarrhoea prevalence (1·37 (95 % CI 1·17, 1·59) v. 1·21 (95 % CI 1·04, 1·41)), while it was lower among children without IHbD who received MNP (1·15 (95 % CI 0·95, 1·39) v. 1·37 (95 % CI 1·13, 1·64)). In conclusion, there was a small adverse effect of MNP on growth among non-anaemic children and on diarrhoea prevalence among children with IHbD.
To assess iodine status among pregnant women in rural Zinder, Niger and to compare their status with the iodine status of school-aged children from the same households.
Design
Seventy-three villages in the catchment area of sixteen health centres were randomly selected to participate in the cross-sectional survey.
Setting
Salt iodization is mandatory in Niger, requiring 20–60 ppm iodine at the retail level.
Subjects
A spot urine sample was collected from randomly selected pregnant women (n 662) and one school-aged child from the same household (n 373). Urinary iodine concentration (UIC) was assessed as an indicator of iodine status in both groups. Dried blood spots (DBS) were collected from venous blood samples of pregnant women and thyroglobulin (Tg), thyroid-stimulating hormone and total thyroxine were measured. Iodine content of household salt samples (n 108) was assessed by titration.
Results
Median iodine content of salt samples was 5·5 ppm (range 0–41 ppm), 98 % had an iodine content <20 ppm. Median (interquartile range) UIC of pregnant women and school-aged children was 69·0 (38·1–114·3) and 100·9 (61·2–163·2) µg/l, respectively. Although nearly all pregnant women were euthyroid, their median (interquartile range) DBS-Tg was 34·6 (23·9–49·7) µg/l and 38·4 % had DBS-Tg>40 µg/l.
Conclusions
In this region of Niger, most salt is inadequately iodized. UIC in pregnant women indicated iodine deficiency, whereas UIC of school-aged children indicated marginally adequate iodine status. Thus, estimating population iodine status based solely on monitoring of UIC among school-aged children may underestimate the risk of iodine deficiency in pregnant women.
Angiopoietin-like protein 4 (ANGPTL4) is a lipoprotein lipase inhibitor that is involved in lipid metabolism and angiogenesis. Animal studies have suggested that the ANGPTL4 protein is modulated by the gut microbiota, possibly through increased concentrations of SCFA, such as C4, found in whole-fat milk or as a result of fermentation of inulin. This study investigated whether a standardised diet either high in fat content or supplemented with inulin powder would increase plasma ANGPTL4 in overweight men and whether this increase was mediated through a compositional change of the gut microbiota. The study had a crossover design with three arms, where participants were given a standardised isoenergetic diet supplemented with inulin powder, whole-fat milk or water (control). Plasma and urine samples were collected before and after each intervention period. Faecal samples and adipose tissue biopsies were collected after each intervention period. The study included twenty-one participants of whom eighteen completed the study. The dietary interventions did not change ANGPTL4 plasma concentration, nor was plasma ANGPTL4 associated with plasma lipids, TAG or NEFA concentration. The relative abundance of bifidobacteria following the inulin diet was higher, compared with the control diet. However, the changes in microbiota were not associated with plasma ANGPTL4 and the overall composition of the microbiota did not change between the dietary periods. Although weight was maintained throughout the dietary periods, weight was negatively associated with plasma ANGPTL4 concentration. In the adipose tissue, ANGPTL4 expression was correlated with leptin expression, but not with hypoxia-inducible factor 1α (HIF-1α) expression.
Microalgal blooms are a natural part of the seasonal cycle of photosynthetic organisms in marine ecosystems. They are key components of the structure and dynamics of the oceans and thus sustain the benefits that humans obtain from these aquatic environments. However, some microalgal blooms can cause harm to humans and other organisms. These harmful algal blooms (HABs) have direct impacts on human health and negative influences on human wellbeing, mainly through their consequences to coastal ecosystem services (fisheries, tourism and recreation) and other marine organisms and environments. HABs are natural phenomena, but these events can be favoured by anthropogenic pressures in coastal areas. Global warming and associated changes in the oceans could affect HAB occurrences and toxicity as well, although forecasting the possible trends is still speculative and requires intensive multidisciplinary research. At the beginning of the 21st century, with expanding human populations, particularly in coastal and developing countries, mitigating HABs impacts on human health and wellbeing is becoming a more pressing public health need. The available tools to address this global challenge include maintaining intensive, multidisciplinary and collaborative scientific research, and strengthening the coordination with stakeholders, policymakers and the general public. Here we provide an overview of different aspects of the HABs phenomena, an important element of the intrinsic links between oceans and human health and wellbeing.
Velocity Interferometer System for Any Reflector (VISAR) [Barker and Hollenbach, J. Appl. Phys. 43, 4669 (1972)] is a well-known diagnostic that is employed on many shock physics and pulsed-power experiments. With the VISAR diagnostic, the velocity on the surface of any metal flyer can be found. For most experiments employing VISAR, either a kinetic pressure [Grady, Mech. Mater. 29, 181 (1998)] or a magnetic pressure [Lemke et al., Intl J. Impact Eng. 38, 480 (2011)] drives the motion of the flyer. Moreover, reliable prediction of the time-dependent pressure is often a critical component to understanding the physics of these experiments. Although VISAR can provide a precise measurement of a flyer’s surface velocity, the real challenge of this diagnostic implementation is using this velocity to unfold the time-dependent pressure. The purpose of this paper is to elucidate a new method for quickly and reliably unfolding VISAR data.
We present preliminary results on a processing protocol by chemical activation that transforms organic waste product such as coconut husk into high surface area activated carbon. Dried raw materials of the coconut husk were carbonized anaerobically into char. The char was impregnated with KOH of different ratios and were activated at 800°C and 900°C. The transmission electron microscope was used to acquire structural and morphological information of the activated carbon, and the surface area and porosity analysis were performed using Micromeritics ASAP 2020 analyzer. The activated carbons show both micropores and mesopores with specific surface area as high as 2900m2/g.
We present the fabrication of a high-temperature stable thermoelectric generator based on nanocrystalline silicon. Highly doped silicon nanoparticles were sintered by a current activated sintering technique to get nanocrystalline bulk silicon. The metalization of silicon was realized by (electro-)chemical plating and the specific electrical contact resistance ρc of the semiconductor-metal interface was measured by a transfer length method. Values as low as $\rho _C< 1 \cdot 10^{ - 6} \,\Omega cm^2 $ were measured. The metalized nanocrystalline silicon legs were sintered to metalized ceramic substrates using a silver-based sinter paste. The device figure of merit of the thermoelectric generator was determined by a Harman measurement with a maximum ZT of approximately 0.13 at 600 °C.
We carry out a multi-wavelength analysis of star forming galaxies in the massive cluster MS0451.6-0305 at z∼0.54 to shed light on the evolution of the far-infrared-radio relationship in rich clusters. We have performed Spectral Energy Distribution (SED) fitting of IRAC 3.6μ, IRAC 4.5μ and MIPS 24μ photometry from Spitzer to derive the total infrared bolometric luminosity of spectroscopically confirmed cluster members with radio counterparts. The radio flux densities were measured from deep Very Large Array (VLA) radio continuum observations. The relationship between the infrared and radio luminosities for our sources show the strong correlation found between these two parameters for star forming galaxies. The far-infrared to radio luminosity ratio (qIR) values measured for these sources are comparable to those measured in low redshift clusters and indicative of an excess of radio emission.
Under- and over-nutrition during gestation may influence fetal hypothalamic development resulting in individuals predisposed to adverse health effects. This study examined fetuses from obese and control ewes to determine whether dam obesity alters hypothalamic expression of fetal appetite regulatory genes. A second objective was to contrast the expression of appetite regulatory genes in ewes that become the most obese to those that remained in moderate body condition on the same energy-rich diet. Multiparous, western white-faced ewes were weighed and individually fed 100% (control) or 150% (obese) of National Research Council requirements from day 60 before mating until day 75 of gestation. At day 75 of gestation, fetuses were collected and weighed. Hypothalamic tissue from fetal lambs and dams was collected and frozen for mRNA extraction. Dam obesity (P ⩾ 0.16), fetal sex (P ⩾ 0.44) or their interaction (P ⩾ 0.42) did not affect the relative expression of fetal hypothalamic regulators of appetite, including neuropeptide Y, agouti-related protein, pro-opiomelanocortin, cocaine- and amphetamine-regulated transcript and receptors for leptin. Maternal obesity at day 75 of gestation in ewes did not affect developmental mechanisms responsible for the expression of fetal appetite regulatory genes and would not be expected to predispose offspring to adult-onset obesity through disrupted appetite regulation at this developmental time point. In the ewe, appetite regulatory genes did not differ (P > 0.20) with ewe adiposity; however, expression of estrogen receptor α, but not β (P = 0.37), in the medial basal hypothalamus was greater (P = 0.04) in obese than in control ewes.
To remain successful, companies must respond to the challenge of achieving continual internal or core growth. But how is this done, and why do some strategies work better than others? In The Search for Organic Growth, leading writers on business strategy and organization offer authoritative analysis and practical guidance on implementing a strategy for organic growth. All businesses go through life cycles, and momentum can be created in many ways from new products and market extensions, to add-ons and enhancements. The book also answers crucial questions such as how to keep customers happy during periods of change, how to foster an entrepreneurial environment and satisfy individual potentials, and how to turn the immense short-term revenue pressures of a push towards growth to your advantage. A lively resource for business school faculty, MBAs and executives, this book is ideal for any reader interested in connections between latest business thought and practice.
The ultrastructure of immature exo-erythrocytic forms of Plasmodium berghei in rat hepatocytes was studied at stages between 25 and 51 h of development. A new method was successfully applied to localize the parasites in a small portion of the liver by temporary ligature of blood vessels to the majority of the liver, and from the spleen and the pancreas. Nuclear profiles appeared to be part of a highly lobed nuclear reticulum. Peripheral vesiculation and vacuolization of the cytoplasm was increasingly prominent and ushered in the formation of pseudocytomeres. Spacing between host- and parasite-derived membranes could first be observed after 43 h of development. In general, organellar development was found to follow closely that described for plasmodial oocysts.
Some of the clinical signs seen in horses during endurance races may result from increases in neuromuscular excitability and are related to plasma [K+] and [Ca++]. The present study aimed to test the following hypotheses: (1) Potassium supplementation will affect plasma [K+] and may result in clinical signs related to neuromuscular hyperexcitability during an 80 km endurance ride. (2) Plasma [Ca++] will reflect dietary cation–anion balance (DCAB) and calcium intake. Feeding with a high DCAB and high dietary calcium content (1.5% total calcium of daily ration) diets would lead to higher plasma [Ca++] during an endurance race than on feeding high DCAB diets with a moderate dietary calcium content (1% of total calcium of daily ration). The current study was undertaken during the 80 km endurance research ride in 2002 in Virginia, USA. Forty volunteer rider–horse pairs participated in the race. During the race, electrolyte mixtures with (EM+K) and without (EM − K) potassium were supplied to 18 and 22 horses, respectively. After the race, the horses receiving EM − K during the race were supplied with a recovery formula containing potassium (EM-REC). The horses were fed in addition to their own forage (hay and pasture) either their own commercial concentrate (CC; 1% calcium, n = 11) or one of two research-supplied concentrates during 3 months preceding the research ride, one concentrate rich in sugar and starch (SS; 2% calcium, n = 15) and the other rich in fat and fibre (FF; 2% calcium, n = 14). Peripheral blood samples were taken the day before, within 3 min of the arrival at the vet checks at 27, 48 and 80 km, and after 3 h of recovery. Plasma samples were analysed for pH, haematocrit (Hct), [Na+], [K+], [Cl− ], [Ca++], [Mg++], total protein (TP) and albumin [alb]. Effects of sampling times, treatments and interactions were evaluated by ANOVA in a mixed model with repeated measures and applied to the 25 horses that completed 80 km. Eliminated horses had their blood sampled before entering the elimination vet check and 3 h after elimination, and were compared with finishing horses by t-test. As the ride progressed, significant increases were found in plasma pH, [Na+], , [TP], [alb], Hct and osmolality; and decreases in [K+], [Mg++], PCO2, [Ca++] and [Cl− ]. Horses supplied with potassium-free, sodium-rich electrolyte formulae (EM − K) had 12.5% lower (P = 0.001) mean plasma [K+], 7.8% lower (P = 0.024) TP and 8.4% lower (P = 0.004) albumin at 80 km, and at 3 h after the race they had 6.8% lower (P = 0.045) TP, when compared with EM+K supplemented horses. Horses fed with SS and FF had higher [Ca++] at 27 (P = 0.027), 56 (P = 0.006) and 80 km (P = 0.022) when compared with horses fed with CC. The lower [K+] in the EM − K group, and the higher [Ca++] in the SS- and FF-supplemented horses may help prevent increases in neuromuscular excitability and related clinical signs. The lower TP and albumin indicate less dehydration in the EM − K group and could help prevent related disorders.
Neonates with congenital cardiac disease are a special population. They are often critically ill, and need prolonged intravenous access. To date, no study has evaluated the efficacy and safety of peripherally inserted central venous catheters placed in this unique population. Our goal was to evaluate the use of such catheters in neonates with critical congenital cardiac disease, and to study features such as duration of use, reasons for removal of catheters, and complications. We inserted a total of 124 catheters in 115 neonates with critical congenital cardiac disease who were admitted to the Intensive Care Unit at Texas Children's Hospital from August 2002 to August 2004. The patients had a mean age of 10 days, and a mean weight of 3.1 kilograms. The peripherally inserted catheters were in place for a mean of 22.3 days. Therapy was completed in 76.6% patients at the time of removal of the catheter. The incidence of occlusion, dislodgement, and thrombus was 4.0%, 2.4%, and 1.6%, respectively. The infection rate was 3.6 per 1000 catheter-days, with a median onset on 37 days after placement. We conclude that central venous catheters, when inserted peripherally, provide reliable and safe access for prolonged intravenous therapy in neonates with critical congenital cardiac disease.