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To illustrate how a partnership between an academic medical center and a public health department successfully responded to a large tuberculosis (TB) exposure at a community daycare center.
Setting:
A multidisciplinary team rapidly established a dedicated TB Exposure Clinic to evaluate and screen exposed children requiring window prophylaxis.
Patients:
The exposure affected 592 individuals, including 359 children under five—those at highest risk for severe disease.
Interventions:
Given the vulnerability of young children to TB infection, timely evaluation and initiation of window prophylaxis were prioritized.
Results:
Over two days, 162 children were assessed for TB window prophylaxis, and 110 additional children underwent TB screening.
Conclusions:
By leveraging clinical expertise, interdisciplinary collaboration, and informatics infrastructure, the TB Exposure Clinic delivered rapid, comprehensive care while minimizing disruption to local healthcare systems. This model underscores the essential role of academic medical centers in supporting public health responses.
Temporal variability and methodological differences in data normalization, among other factors, complicate effective trend analysis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) wastewater surveillance data and its alignment with coronavirus disease 2019 (COVID-19) clinical outcomes. As there is no consensus approach for these analyses yet, this study explored the use of piecewise linear trend analysis (joinpoint regression) to identify significant trends and trend turning points in SARS-CoV-2 RNA wastewater concentrations (normalized and non-normalized) and corresponding COVID-19 case rates in the greater Las Vegas metropolitan area (Nevada, USA) from mid-2020 to April 2023. The analysis period was stratified into three distinct phases based on temporal changes in testing protocols, vaccination availability, SARS-CoV-2 variant prevalence, and public health interventions. While other statistical methodologies may require fewer parameter specifications, joinpoint regression provided an interpretable framework for characterization and comparison of trends and trend turning points, revealing sewershed-specific variations in trend magnitude and timing that also aligned with known variant-driven waves. Week-level trend agreement corroborated previous findings demonstrating a close relationship between SARS-CoV-2 wastewater surveillance data and COVID-19 outcomes. These findings guide future applications of advanced statistical methodologies and support the continued integration of wastewater-based epidemiology as a complementary approach to traditional COVID-19 surveillance systems.
To evaluate the impact of a mobile-app-based central line-associated bloodstream infection (CLABSI) prevention program in oncology clinic patients with peripherally inserted central catheters (PICCs).
Design:
Pre-post prospective cohort study with baseline (July 2015–December 2016), phase-in (January 2017–April 2017), and intervention (May 2017–November 2018). Generalized linear mixed models compared intervention with baseline frequency of localized inflammation/infection and dressing peeling. Cox proportional hazards models compared days-to-removal of lines with localized inflammation/infection. Chi-square test compared bacteremia rates before and after intervention.
Setting:
Oncology clinic at a large medical center.
Patients:
Oncology clinic adult patients with PICCs.
Intervention:
CLABSI prevention program consisting of an actionable scoring system for identifying insertion site infection/inflammation coupled with a mobile-app enabling photo-assessments and automated physician alerting for remote response.
Results:
We completed 5,343 assessments of 569 PICCs in 401 patients (baseline: 2,924 assessments, 300 PICCs, 216 patients; intervention: 2,419 assessments, 269 PICCs, 185 patients). The intervention was associated with a 92% lower likelihood of having a dressing with peeling (OR 0.08, 95%CI 0.04-0.17, P < 0.001), 53% lower local inflammation/infection (OR 0.47, 95%CI 0.27-0.84, P < 0.011), and 24% (non-significant) lower CLABSI rates (P = .63). Physician mobile-app alerting and response enabled 80% lower risk of lines remaining in place after inflammation/infection was identified (HR 0.20, 95%CI:0.14-0.30, P < 0.001) and 85% faster removal of infected lines from mean (SD) 11.1 (9.7) to 1.7 (2.4) days.
Conclusions:
A mobile-app-based CLABSI prevention program decreased frequency of inflamed/infected central line insertion sites and increased speed of removal when inflammation/infection was found.
The 9th Circuit ruled the MAS ban to be constitutional, but with a twist. They kicked it back to Judge Tashima giving more explicit direction about potential constitutional violations that state representatives may have engaged in while creating the legislation and banning the program. At this point in time, there was a huge change in the legal team as Wallstreet firm Weil, Gotshal & Magnes LLP agreed to take the case pro bono. It was the first time that MAS supporters would have more legal resources than the state.
In addition to discussing the testimony of “bit” players as well as “missing” witnesses – witnesses the state planned to call but didn’t – this chapter examines closely the testimony of two witnesses for the state, Kathryn Hrabluk and Elliott Hibbs, who were instrumental in showing that the superintendent’s finding of violation was prejudged and predetermined, revealing that the reasons offered by Horne and Huppenthal were pretextual. While there were not as many fireworks as the testimonies of Horne and Huppenthal, these were critically important in establishing the factual basis, which eventually led to the final ruling.
UNIDOS was the center of the youth movement in support of MAS, and their takeover of the TUSD school board meeting (4/26/11) made national headlines. The students engaged in civil disobedience because the state found TUSD out of compliance and the school board was going to take the first steps toward eliminating the program without substantive public input. This chapter details those events from a firsthand account, the massive militarization of subsequent school board meetings (e.g., 150 armed officers, many in riot gear, at a meeting of 500 people), and the subsequent conspiracy theories that rose to prominence (e.g., that former Ethnic Studies professor Ward Churchill orchestrated the whole thing).
The MAS court case moved to the 9th Circuit Court of Appeals, and one of the premier First Amendment scholars in the country, Erwin Chemerinsky (Dean, Bolt Hall, UC Berkeley), agreed to do the oral arguments. Meanwhile, back in Tucson, co-founders of the MAS program Sean Arce and Auggie Romero got into a public fight that almost came to blows at the annual NAME (National Association of Multicultural Education) conference with multiple MAS teachers in attendance. Finally, John Huppenthal again found TUSD out of compliance with state law even after the elimination of MAS citing hip-hop legend KRS-One’s lyrics as evidence.
This chapter details the ways that core anti-MAS leaders in Arizona and throughout the country helped foment attacks on the program through a massive, loosely coordinated misinformation campaign involving official public statements from elected officials, legislation, television appearances, op-eds, and rightwing radio shows. The rhetoric is directly compared to that used to currently attack and sometimes ban Critical Race Theory throughout the country.
In response to the civil disobedience detailed in Chapter 4, TUSD decided to appeal the ruling that they were out of compliance with state law. However, the administrative law hearing detailed in this chapter – including a board member testifying that MAS represented “cult-like behavior” – was more of a kangaroo court because the state superintendent of public instruction was not required to abide by the ruling. Regardless, it was an important point in the movement as it became clear where the key actors stood in relation to MAS.
Three Stanford-educated Chicanos took the stand in support of MAS, and these witnesses were central in Judge Tashima’s final ruling. Specifically, they detailed in a scholarly way the academic integrity of the department, the efficacy of taking the classes, and also demonstrated how state representatives used racist “code words” in cementing their opposition to the program. We detail their times testifying, how the state desperately tried to trip them up.
Tom Horne and John Huppenthal, the former state superintendents of public instruction, were central in the elimination of MAS and keepingpressure on TUSD to eliminate any type of race-conscious educational offerings. This chapter details their time on the stand in the federal trial, where each of them unapologetically doubled down on their racist rhetoric, sometimes even diving into moments of absurdity.
This chapter details the formation of the MAS movement from the local teachers, students, artists, and activists to the national-level support (e.g., professional/scholarly organizations, hip hop/funk group Ozomatli, and cartoonist Lalo Alcaraz). Of particular importance was the formation of the “Tucson 11” – a group of MAS educators who filed a federal lawsuit challenging the constitutionality of the state law on First and Fourteenth Amendment grounds. Additionally, in this chapter, we explore both the importance of the documentary Precious Knowledge in supporting this movement and how the director’s alleged rape of one of the former MAS students was the beginning of lasting community wounds that ran throughout the movement.
This chapter links the creation of MAS to the historical creation of Ethnic Studies – setting the record straight on the nature of this type of education amidst massive amounts of local and national misinformation. It details what MAS was, the effects of the program on student academic success, while examining how critically engaged, educated Mexican American students came to be seen as such a “threat” to the state.