Search

Resilient systems can absorb and recover from disturbances and adapt to changed conditions to maintain system functionality. Uncertainty about the meaning of resilience and the attributes it requires has limited the application of resilience thinking in biosecurity. However, considering increasing pressures from trade, travel and climate change, enhancing the resilience of biosecurity systems is likely to be critical to reduce the impacts of pests and diseases on economies, societies and environments.Here we provide a pathway for resilience thinking into risk management. Based on a literature review we discuss its benefits, develop an operational definition of resilience for biosecurity systems and identify the fundamental attributes that support resilience.We show that resilient biosecurity systems can anticipate disturbances, cope with low‐probability high‐impact events and adapt to new and changing circumstances. The status of biosecurity system resilience can be measured using evaluative rubrics, which give decision‐makers an overall performance rating and insight into system weaknesses. General measures, objective functions and simulation approaches are potential avenues for quantifying biosecurity system resilience in practice.Policy implications: Adopting resilience thinking into biosecurity risk management has the potential to reduce the damages caused by invading pests and diseases. If resilience thinking is used alongside traditional risk analysis, then regulators can more effectively address and prepare for the systemic consequences of high‐impact incursions and outbreaks of pests and diseases, which are unpredictable, low‐probability events. However, the design of resilience‐enhancing measures should be guided by economic principles and consider the rate of return of these measures over time. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the Comprehensive Care for Joint Replacement (CJR) model, a mandatory episode‐based payment program for knee and hip replacement surgery, affected patient‐reported measures of quality. Data Sources: Surveys of Medicare fee‐for‐service beneficiaries who had hip or knee replacement surgery, collected between July 2018 and March 2019, secondary Medicare administrative data, the Provider of Services file, CJR and Bundled Payments for Care Improvement participant lists from the Centers for Medicare & Medicaid Services, and the Area Health Resource Files. Study Design: In 2018, participation in the CJR model was mandatory for nearly all hospitals in 34 randomly selected, metropolitan statistical areas (MSAs) that had high historical Medicare payments for lower‐extremity joint replacements surgery. The control group included 47 high‐payment MSAs randomly assigned as controls. We estimated risk‐adjusted differences in self‐reported measures of functional status and pain, satisfaction with care, and caregiver help between respondents in CJR hospitals and respondents in hospitals located in the control group. Data Collection: We selected a census of CJR patients and an equal number of control patients to survey. We fielded two waves of surveys using a mail and phone protocol, yielding 8433 CJR and 9014 control respondents. Principal Findings: CJR respondents were slightly more likely to depend on caregivers for certain activities of daily living when they got home (either directly from the hospital or after an institutional post‐acute care stay). On a 100‐point scale, differences ranged from −2.6 points (p < 0.01) for help needed bathing to −1.7 points (p < 0.05) for help needed using the toilet. However, differences in eight measures of self‐reported functional status approximately 90–120 days after hospital discharge were not statistically significant, ranging from −1.1% (p = 0.087) to 0.7% (p = 0.437). Conclusions: CJR did not harm patient health or affect patient satisfaction on average but did increase reliance on caregivers during recovery. [ABSTRACT FROM AUTHOR]

Sophisticated neuroimaging strategies demonstrate alterations in functional connectivity at school age, adolescence, and young adulthood in individuals born preterm. Recent data suggest these alterations are present in the postnatal period prior to term-equivalent age in neonates born preterm. Likewise, functional organization increases across development, but the influence of preterm birth on this fundamental infrastructure is immediate and unchanging. This article briefly reviews the current methods of measuring functional connectivity throughout development in those born preterm, and the association of functional connectivity with language disorders. Taken together, these data suggest that the effects of preterm birth on the functional organization of language in the developing brain are both proximate and long-lasting. [ABSTRACT FROM AUTHOR]

Research Objective: The Comprehensive Care for Joint Replacement (CJR) model is intended to encourage participant hospitals to reduce Medicare payments by coordinating care with the physicians, post‐acute care (PAC) providers, and other providers involved in an episode of care for a lower extremity joint replacement (LEJR), which comprises the surgery plus the services provided in the 90 days after hospital discharge. Previous studies have documented reductions in institutional PAC attributable to the model.1 The shift towards less intensive PAC could affect patient experiences and recovery. We surveyed Medicare fee‐for‐service (FFS) beneficiaries after LEJR surgery to document their self‐reported functional status, pain, satisfaction with care management and overall recovery, care transitions, and dependence on caregivers for help with activities of daily living. These patient‐reported outcomes are important indicators of quality that cannot be measured using secondary data. Study Design: In 2018, participation in CJR was mandatory for hospitals that that did not meet rural or low‐volume exemptions, and were located in 34 randomly‐selected, historically high‐payment metropolitan statistical areas (MSAs). We surveyed a census of Medicare FFS beneficiaries who had LEJR surgery in mandatory CJR hospitals, and those who had LEJR surgery in hospitals within 47 high‐payment MSAs randomly assigned to the control group. Patients received the survey approximately 90 to 120 days after hospital discharge. We estimated risk‐adjusted differences between CJR and control respondents. Population Studied: We sampled beneficiaries who had LEJR surgery in March, April, August or September 2018 from the CJR group (12,478 beneficiaries) and the control group (13,137 beneficiaries). Response rates for the survey were similar for the CJR and control groups (67.6% and 68.6%, respectively). Principal Findings: The CJR model did not have a significant impact on patient‐reported functional status, pain, satisfaction with care management or satisfaction with overall recovery. However, CJR respondents were 1.2 percentage points less likely to report that they received the right amount of care in the two weeks after hospital discharge than control respondents (p < 0.01), and CJR respondents required more caregiver help at home than control respondents (a difference of 1.9 points on a 100‐point scale, p < 0.01). Conclusions: The CJR model resulted in a small increase in the number of respondents who reported that they needed caregiver help after returning home. This is consistent with previous findings that CJR patients were less likely to use institutional PAC and were more likely to go directly home after surgery than control respondents. However, this did not result in decreased functional status or satisfaction with care management and recovery. This suggests that greater dependence on caregivers did not translate to lower satisfaction or worse functional recovery. Implications for Policy or Practice: Results show that CJR reduced Medicare payments by reducing institutional PAC.1 Despite decreasing the use of institutional PAC, the model generally did not affect patient‐reported functional recovery or satisfaction. However, more research is needed to assess the possible impact of the model on caregivers and on patients with physical or social risk factors who may be more vulnerable to changes in care. 1https://innovation.cms.gov/Files/reports/cjr‐secondannrpt.pdf Primary Funding Source: Centers for Medicare and Medicaid Services. [ABSTRACT FROM AUTHOR]

Aim To compare the impact of low-grade haemorrhage on neurocognitive function in 16-year-old adolescents born preterm, by grade of intraventricular haemorrhage, and term controls. Methods We evaluated 338 preterm adolescents (birth weight 600-1250 g) for intelligence, executive function and memory tasks. Eleven had grade 3-4 haemorrhage, 44 had grade 2, 31 had grade 1, and 251 had no haemorrhage. Group comparisons were made with 102 term age-matched controls, and regression models used to identify the risk that low-grade haemorrhage posed for cognitive, executive function and memory deficits. Results Preterm adolescents with grade 2 haemorrhage had higher deficit rates of verbal intelligence, receptive vocabulary, phonemic fluency, cognitive flexibility and phonological fluency than preterm adolescents with grade 1 or no haemorrhage, compared with term controls. After excluding preterm adolescents with both grade 2 haemorrhage and cystic periventricular leukomalacia, those with isolated grade 2 haemorrhage remained at greater risk of cognitive and executive function deficits than term controls and of cognitive deficits than preterm adolescents with no haemorrhage. Conclusion Our findings suggest that preterm adolescents born in the early 1990s with isolated grade 2 haemorrhage are at increased risk of learning challenges, including cognitive and executive function deficits. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Evaluation of safety and postoperative outcomes of the laryngeal mask airway (LMA) during pediatric tonsil surgery compared to use of the endotracheal tube (ETT). Study Design: Randomized controlled trial. Methods: A population-based sample of 117 patients ages 2 to 18 years requiring adenotonsillectomy, adenoidectomy, or tonsillectomy was studied. Evaluation forms covering 36 safety, surgery duration, and patient comfort variables were given to the surgeon, anesthesiologist, and phase I and phase II recovery nurses to collect data on the intra- and postoperative course. A phone survey was conducted 24 hours after surgery. Results: At the α level following Bonferroni correction, LMA showed less coughing or gagging during the anesthesia phase for all surgeries combined (48% for ETT vs. 20% for LMA; χ2 = 10.153, P = .002), and for ETT nontonsillectomy vs. LMA nontonsillectomy (48% for ETT vs. 3% for LMA; χ2 = 15.196, P = .000), spontaneous ventilation was used more often in the LMA group when comparing all surgeries (χ2 = 19.493, P = .000), and when comparing ETT tonsillectomy and LMA tonsillectomy (χ2 = 11.131, P = .000). Conclusions: Use of the LMA during pediatric tonsil surgery does not appear to have any major disadvantages compared to use of the ETT. In fact, analysis of safety, comfort, complications, and postoperative problems suggests that LMA may be superior for some outcome variables such as coughing and gagging. Use of spontaneous ventilation is more common among LMA patients, although the significance of this finding is uncertain. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Prison populations are made up of individuals from disadvantaged, often abusive backgrounds, who are more likely to suffer from psychological problems than the general community. Aim This study aimed to determine associations between current psychological distress and history of having experienced sexual coercion and/or physical assault among prisoners in two Australian states (Queensland and New South Wales). Methods We conducted a random sample survey of prisoners by computer-assisted telephone interview. Prisoners were asked about forced sexual encounters in or outside prison, and physical assault in prison. Psychological distress was estimated using a dichotomised score obtained from the Kessler 6-Item Psychological Distress Scale (K6), and a logistic regression analysis was employed to investigate associations. Results A total of 2426 prisoners were interviewed of 3055 prisoners invited to participate, a response rate of 79%. We categorised 236 men (12%) and 63 women (19%) as 'severely' psychologically distressed according to the K6, and 13% of the men and 60% of the women reported that they had been sexually coerced prior to imprisonment. Physical assault in prison was common, reported by 34% of the men and 24% of the women. On multivariate analysis, prisoners were more likely to be psychologically distressed if they had ever been threatened with sexual assault in prison or physically assaulted in prison. Sexual coercion outside prison was an important associate of psychological distress among men but not among women. Conclusions As psychological distress and experiences of assault are closely statistically linked among male prisoners and both are very common among female prisoners, their screening for psychological distress should include efforts to find out about sexual and violent assaults against them both before and during imprisonment. Further, longitudinal research with prisoners is required to establish causal relationships. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The role of human papillomavirus (HPV) in the genesis of cervical cancer has been well documented, and an increasing body of literature exists with regard to the role of HPV in other cancers, including cancers of the head and neck. With the recent expansion of the United States Food and Drug Administration's approval of the quadrivalent HPV virus-like particle vaccine to include men and boys and approval of the bivalent vaccine this year, the controversies regarding who should be vaccinated, at what age is vaccination most appropriate, and the limitations of the available HPV vaccines are increasing. Health care providers are challenged with evaluating the current, but continually changing, clinical evidence when making critical decisions for their patients. A literature search of MEDLINE and SciVerse Scopus was conducted for articles published from 1998-April 2010 regarding HPV, HPV- related cancers, and HPV vaccines. Although both HPV vaccines were greater than 90% effective in the prevention of cervical cancer precursors in an according-to-protocol cohort, both vaccines were significantly less effective in the intent-to-treat population. In patients who achieved seroconversion, the geometric mean titers decrease dramatically within the first 2 years after vaccination, and then continue to decline at a slower rate. No effective antibody titer has been defined for either vaccine, and no studies have been conducted with documented HPV exposure after vaccination. With low efficacy rates in an intent-to-treat population and the potential for waning immunity, it is imperative for women to continue to receive regular Pap tests and gynecologic examinations. Although vaccine administration was shown to be cost-effective when administered to adolescent girls, many of these simulations overestimated the durability of protection, efficacy rates in sexually active women, impact of incomplete vaccination, or necessity of boosters in the future. Whereas the introduction of the HPV vaccine was an enormous advancement in the cancer prevention research arena, optimization of its clinical use is still needed. [ABSTRACT FROM AUTHOR]

Objective:  To assess the blood pressure of former preterm and term matched adolescent controls and to identify risk factors associated with blood pressure at 16 years.Design:   Observational cohort study. Secondary analysis of a randomized clinical trial.Setting: Three academic centres participating in the Multicenter Indomethacin IVH Prevention Trial.Participants:   A total of 296 children born in 1989-1992 with birth weights 600 to <1250 g who participated in the Multicenter Indomethacin IVH Prevention Trial and 95 term controls were evaluated at 16 years.Main Outcome Measures:   Blood pressure and predictors of blood pressure.Results:   The adjusted mean difference in blood pressure for preterm adolescents was 5.1 mm Hg; p=0.002 for systolic and 2.1 mm Hg; p=0.027 for diastolic blood pressure. Among preterms, the primary predictors of increased systolic blood pressure were weight gain velocity between birth and 36 months (b=8.54, p<0.001), pre-eclampsia (b=5.67, p=0.020), non-white race (b=3.77, p=0.04) and male gender (b=5.09). Predictors of diastolic blood pressure were weight gain velocity between birth and 36 months (b=4.69, p=0.001), brain injury (b=6.51, p=0.002) and male gender (b=-2.4, p=0.02).Conclusions:   Early programming secondary to increased early weight gain velocity, intrauterine stress and neonatal brain injury may all contribute to risk of increased blood pressure among former preterm adolescents. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate the extent to which electronic prescribing (e-prescribing) alters communication about medication use between geriatric patients and their clinicians, as well as geriatric patients' perceptions regarding e-prescribing. DESIGN: Cross-sectional. SETTING: Thirty-five physician practices in six states using e-prescribing. PARTICIPANTS: Convenience sample of patients (n=244) aged 65 and older. MEASUREMENTS: Patient perceptions regarding discussions with their doctors regarding medication costs, adherence, and potential side effects, as well as expectations about and satisfaction with e-prescribing collected on a voluntary survey. RESULTS: Of patients at e-prescribing practices, 53% reported ever receiving e-prescriptions. Patients who reported having e-prescriptions were more likely to feel favorably toward the electronic method, whereas most of those who reported never receiving e-prescriptions preferred paper prescriptions. Patients reporting use of e-prescriptions were somewhat more likely to have adherence discussions often or most of the time than patients who had not used e-prescriptions. Regardless of e-prescribing experience, few patients reported that they would tell their physicians if they did not want a drug or did not plan to pick up the drug from the pharmacy. CONCLUSION: E-prescribing technology solutions may provide opportunities for earlier and enhanced communication between geriatric patients and their clinicians; geriatric patients may require more education to appreciate the value of e-prescribing. [ABSTRACT FROM AUTHOR]