Little is known about co-occurring tuberculosis (TB) and COVID-19 in low TB incidence settings. We obtained a cross-section of 333 persons in the United States co-diagnosed with TB and COVID-19 ...within 180 days and compared them to 4,433 persons with TB only in 2020 and 18,898 persons with TB during 2017‒2019. Across both comparison groups, a higher proportion of persons with TB–COVID-19 were Hispanic, were long-term care facility residents, and had diabetes. When adjusted for age, underlying conditions, and TB severity, COVID-19 co-infection was not statistically associated with death compared with TB infection only in 2020 (adjusted prevalence ratio 1.0 95% CI 0.8‒1.4). Among TB–COVID-19 patients, death was associated with a shorter interval between TB and COVID-19 diagnoses, older age, and being immunocompromised (non-HIV). TB–COVID-19 deaths in the United States appear to be concentrated in subgroups sharing characteristics known to increase risk for death from either disease alone.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Purpose:
The U.S. is struggling with dual crises of chronic pain and opioid overdoses. To improve statewide pain and addiction care, the Arizona Department of Health Services and 18 health education ...programs collaboratively created the evidence-based, comprehensive
Arizona Pain and Addiction Curriculum
which includes a Toolbox for Operationalization with adult learning theory applications and an annual program survey to assess curriculum implementation. The purpose of this study is to analyze the first year's survey data to better understand the implementation of a novel curriculum across all programs in the state.
Materials and Methods:
Program surveys were sent 6 months after curriculum publication to all 18 health education programs in Arizona to assess the 6 Ds of curriculum implementation: Degree of implementation, Difficulty of implementation, Delivery methods, Faculty Development, Didactic dissonance and Discussion Opportunities.
Results:
Responses from all program types (14/18 programs) indicated that there was widespread implementation of the curriculum, with 71% reporting that all ten Core Components had been included in the past academic year. The majority of programs did not find the Components difficult to implement and had implemented them through lectures. Seventy-seven percent of programs did not have a process to ensure clinical rotation supervisors are teaching content consistent with the curriculum, 77% reported not addressing student's didactic dissonance, and 77% of programs did not report asking students about their interactions with industry representatives.
Conclusion:
In < 1 year after creation of the
Arizona Pain and Addiction Curriculum
, all program types reported wide implementation with little difficulty. This may represent a first step toward the transformation of pain and addiction education, and occurred statewide, across program types. Further focus on didactic dissonance, problem solving and faculty development is indicated, along with systematic education on pharmaceutical and industry influence on learners. Other programs may benefit from adopting this curriculum and may not experience significant challenges in doing so.
Abstract
Background
We describe a measles outbreak and control measures implemented at a privately operated detention facility housing US Immigration and Customs Enforcement detainees in 2016.
...Methods
Case-patients reported fever and rash and were either laboratory-confirmed or had an epidemiological link to a laboratory-confirmed case-patient. Immunoglobulin G (IgG) avidity and plaque reduction neutralization tests distinguished between primary acute and reinfection case-patients. Measles-specific IgG was measured to assess detainee immunity levels. We compared attack rates (ARs) among detainees and staff, between IgG-negative and IgG-positive detainees, and by detainee housing units and sexes.
Results
We identified 32 measles case-patients (23 detainees, 9 staff); rash onsets were during 6 May–26 June 2016. High IgG avidity and neutralizing-antibody titers >40000 to measles (indicating reinfection) were identified in 18 (95%) and 15 (84%) of 19 tested case-patients, respectively. Among 205 unit A detainees tested for presumptive immunity, 186 (91%) had detectable IgG. Overall, the AR was 1.65%. ARs were significantly higher among detainees in unit A (7.05%) compared with units B-F (0.59%), and among male (2.33%) compared with female detainees (0.38%); however, ARs were not significantly different between detainees and staff or between IgG-negative and IgG-positive detainees. Control measures included the vaccination of 1424 of 1425 detainees and 190 of 510 staff, immunity verification for 445 staff, case-patient isolation, and quarantine of affected units.
Conclusions
Although ARs were low, measles outbreaks can occur in intense-exposure settings, despite a high population immunity, underscoring the importance of high vaccination coverage and containment in limiting measles transmission.
Although attack rates were low, measles outbreaks can occur in high-contact exposure settings with high immunity levels. Detention facilities are at risk for measles outbreaks.
The U.S. is struggling with dual crises of chronic pain and opioid overdoses. To improve statewide pain and addiction care, the Arizona Department of Health Services and 18 health education programs ...collaboratively created the evidence-based, comprehensive
which includes a Toolbox for Operationalization with adult learning theory applications and an annual program survey to assess curriculum implementation. The purpose of this study is to analyze the first year's survey data to better understand the implementation of a novel curriculum across all programs in the state.
Program surveys were sent 6 months after curriculum publication to all 18 health education programs in Arizona to assess the 6 Ds of curriculum implementation: Degree of implementation, Difficulty of implementation, Delivery methods, Faculty Development, Didactic dissonance and Discussion Opportunities.
Responses from all program types (14/18 programs) indicated that there was widespread implementation of the curriculum, with 71% reporting that all ten Core Components had been included in the past academic year. The majority of programs did not find the Components difficult to implement and had implemented them through lectures. Seventy-seven percent of programs did not have a process to ensure clinical rotation supervisors are teaching content consistent with the curriculum, 77% reported not addressing student's didactic dissonance, and 77% of programs did not report asking students about their interactions with industry representatives.
In < 1 year after creation of the
, all program types reported wide implementation with little difficulty. This may represent a first step toward the transformation of pain and addiction education, and occurred statewide, across program types. Further focus on didactic dissonance, problem solving and faculty development is indicated, along with systematic education on pharmaceutical and industry influence on learners. Other programs may benefit from adopting this curriculum and may not experience significant challenges in doing so.
The purpose of the current project is to investigate the United States (US)state immunization exemption laws and the relation of these laws to annual state pertussis incidence. Pertussis is a ...communicable respiratory disease caused by the Bordetella pertussis pathogen found only in humans. This disease is often referred to as “whooping cough,” the sound commonly made by infected infants. Pertussis is classified as an acute respiratory infection caused by the B. pertussismicrobe. The communicable nature of pertussis makes it particularly important to understand state immunization exemption policies and how these policies may impact pertussis in the US. A recent resurgence of reported pertussis cases in the US in 2012 drew attention to this vaccine-preventable disease. In 2012 there were 48,277 known reported cases of pertussis. This marked the greatest number of annual cases since 1955, when there were 62,786 reported cases of pertussis in the US (Table 1). This retrospective study, completed in 2014, aims to evaluate all 50 US state immunization exemption policies (including the District of Columbia) and all reported cases of pertussis from 1993 to 2012.Since the first immunization law established in Massachusetts in 1809 mandating smallpox vaccination, courts have granted substantial deference to state legislatures to create individual state laws regarding immunization and immunization exemption.Many states, even neighboring states, have adopted different immunization exemption laws leading to discontinuity between state approaches to control of vaccine-preventable diseases across the US. The individual control each state has over its immunization exemption policies may lead to a lack of uniformity amongst different state vaccine-preventable disease practices. The discontinuity between states’ immunization exemption policies can be problematic when trying to assess trends in state pertussis incidence.Currently, all US states offer one or more of three broad categories of exemptions to their immunization requirements: medical exemption; religious exemption; and philosophical or personal belief exemption.The aim of the project was to explore the relationship between individual state immunization exemption laws and state pertussis incidence throughout the US using a 20-year trend analysis. Although the published literature includes other studies of the possible relationship between states’ immunizationexemption policies and vaccine preventable disease outbreaks, there is not a current all-state analysis of pertussis data over an extended time period.The Centers for Disease Control and Prevention (CDC), the US federal agency designed to protect the public’s health through control and prevention,states “We don’t know exactly why the number of cases of pertussis is increasing…”. This statement and the absence of current multi-year studies covering all 50 states inspired this current project.
On May 25, 2016, a detainee at a US Immigration and Customs Enforcement detention center in Arizona who had been hospitalized with fever and a generalized maculopapular rash was confirmed to have ...measles by real-time polymerase chain reaction (rPCR). A second case of measles in a staff member was confirmed by rPCR the next day. Epidemiologic investigations by local and state health departments and CDC identified 31 total cases of measles in 22 detainees and nine staff members, with rash onsets occurring May 6-June 26. Recommendations for implementing measles control policies for detention and correctional facilities, similar to those recommended in health care facilities, could be considered. If permissible, contractual and interagency agreements could include similar provisions, such as requiring MMR vaccination for staff members who work in detention facilities and do not have documented evidence of immunity.
The heterogeneity with regard to findings on family meetings (or conferences) suggests a need to better understand factors that influence family meetings. While earlier studies have explored ...frequency or timing of family meetings, little is known about how factors (such as what is said during meetings, how it is said, and by whom) influence family meeting quality. Objectives: (1) To develop an evaluation tool to assess family meetings (Phase 1); (2) to identify factors that influence meeting quality by evaluating 34 family meetings (Phase 2).
For Phase 1, methods included developing a framework, cognitive testing, and finalizing the evaluation tool. The tool consisted of Facilitator Characteristics (i.e., gender, experience, and specialty of the person leading the meeting), and 22 items across 6 Meeting Elements (i.e., Introductions, Information Exchanges, Decisions, Closings, Communication Styles, and Emotional Support) and sub-elements.
For Phase 2, methods included training evaluators, assessing family meetings, and analyzing data. We used Spearman's rank-order correlations to calculate meeting quality. Qualitative techniques were used to analyze free-text.
No Facilitator Characteristic had a significant correlation with meeting quality. Sub-elements related to communication style and emotional support most strongly correlated with high-quality family meetings, as well as whether “next steps” were outlined (89.66%) and whether “family understanding” was elicited (86.21%). We also found a significant and strong positive association between overall proportion scores and evaluators' ratings (rs=0.731, p<0.001).
We filled a gap by developing an evaluation tool to assess family meetings, and we identified how what is said during meetings impacts quality.
•We developed an evaluation tool that can be used to assess family meetings and skills used during meetings.•We found that no facilitator characteristic was significant for meeting quality. Thus, who leads the meeting may not be relevant.•We found that every sub-element associated with communication style and emotional support were strongly correlated with high-quality family meetings.
Networks of well-known dynamical units but unknown interaction topology arise across various fields of biology, including genetics, ecology, and neuroscience. The collective dynamics of such networks ...is often sensitive to the presence (or absence) of individual interactions, but there is usually no direct way to probe for their existence. Here we present an explicit method for reconstructing interaction networks of leaky integrate-and-fire neurons from the spike patterns they exhibit in response to external driving. Given the dynamical parameters are known, the approach works well for networks in simple collective states but is also applicable to networks exhibiting complex spatio-temporal spike patterns. In particular, stationarity of spiking time series is not required.
PDF
