Acceptability of Active Shooter Prevention Strategies on College and University Campuses

Colleges and universities are challenged with making their campuses safe from many threats of violence such as active shooters by using strategies that are effective and acceptable to their campus communities. Implementing strategies that are ineffective can waste resources and implementing strategies that are unacceptable may result in students, faculty, and staff that protest or leave the campus. The current study evaluated the acceptability of 11 different strategies to prevent active shooters on college/university campuses. Self-efficacy of the participants was measured to determine influences on acceptability ratings along with other demographic variables such as gender, race, and education levels. Results revealed differences in acceptability of active shooter prevention procedures and demographic variable influences. Implications for designing prevention measures on college and university campuses are discussed.

Age and the anaesthetist: considerations for the individual anaesthetist and workforce planning: Guidelines about the ageing anaesthetic workforce from the Association of Anaesthetists: Guidelines for the ageing anaesthetic workforce from the Association of Anaesthetists

There is clear evidence of a growing workforce gap and this is compounded by demographic data that show the current workforce is ageing. Within the current workforce, more doctors are taking voluntary early retirement and the loss of these experienced clinicians from departments can have wide-ranging effects. Older doctors are at risk of age-related health problems (e.g. sight, musculoskeletal, menopause) and are more susceptible to the effects of fatigue, which may increase the risk of error and or complaint. The purpose of this working party and advocacy campaign was to address concerns over the number of consultants retiring at the earliest opportunity and whether a different approach could extend the working career of consultant anaesthetists and SAS doctors. This could be viewed as 'pacing your career'. The earlier this is considered in a clinician's career the greater the potential mitigation on individuals.

Acceptability of School Shooting Prevention Procedures Among Parents

While gun violence has been declared a public health crisis, there is limited information concerning stakeholders such as parents' perceptions of acceptable procedures to prevent this violence in schools. This study explored 114 parents' degree of acceptance for an assortment of school shooting prevention interventions. Specifically, this study compared security measures, threat assessment, zero tolerance, and an exploratory procedure. While all procedures were deemed acceptable, parents rated the threat assessment as most acceptable, followed closely by security measures, which were significantly more acceptable than the exploratory procedure, and finally the zero tolerance procedures. Discussion is provided on possible factors influencing the acceptance of these procedures.

Prevalence and performance effects of neonatal disease in Thoroughbred and Standardbred foals in South-Eastern Australia

BACKGROUND

There is little information on foal mortality and the epidemiology of diseases in the neonatal period in Australian equine breeding enterprises.

METHODOLOGY

This was a prospective cohort study of 1219 foals on 15 breeding farms in south-eastern Australia to identify the proportion of foals recognised on farm as abnormal at birth or within the first 48 h postpartum, determine the prevalence and risk factors for neonatal disease and assess the subsequent performance of foals in the study population.

RESULTS

Overall, 27 foals died within 6 weeks of birth in the study population (2.2%), 142 foals (11.6%) were reported as abnormal at birth, and 304 (25.3%) were regarded as abnormal in the first 48 h postpartum. Non-septic orthopaedic disease (NSOD) was the most common abnormality recognised. Premature foals and foals born after dystocia or abnormal parturition were more likely to have clinical abnormalities recognised, but the intensity of nursing care did not predict outcome. Prophylactic administration of antimicrobial drugs was associated with increased mortality and septic disease. Maternal periparturient problems, foal gender, abnormality at birth and the presence of septic disease or neonatal maladjustment were associated with decreased performance outcomes, whereas measures to assess and augment passive immune transfer were associated with improved athletic performance.

CONCLUSIONS AND RELEVANCE

Information in the current study is important for the treatment and management decisions on farm and to identify industry welfare and production priorities. Although the incidence of all outcome variables was variable, factors recognised on farm in the peri-parturient period were predictive of subsequent athletic performance.

The Stroop smartphone application is a short and valid method to screen for minimal hepatic encephalopathy

Minimal hepatic encephalopathy (MHE) detection is difficult because of the unavailability of short screening tools. Therefore, MHE patients can remain undiagnosed and untreated. The aim of this study was to use a Stroop smartphone application (app) (EncephalApp_Stroop) to screen for MHE. The app and standard psychometric tests (SPTs; 2 of 4 abnormal is MHE, gold standard), psychometric hepatic encephalopathy score (PHES), and inhibitory control tests (ICTs) were administered to patients with cirrhosis (with or without previous overt hepatic encephalopathy; OHE) and age-matched controls from two centers; a subset underwent retesting. A separate validation cohort was also recruited. Stroop has an "off" state with neutral stimuli and an "on" state with incongruent stimuli. Outcomes included time to complete five correct runs as well as number of trials needed in on (Ontime) and off (Offtime) states. Stroop results were compared between controls and patients with cirrhosis with or without OHE and those with or without MHE (using SPTs, ICTs, and PHES). Receiver operating characteristic analysis was performed to diagnose MHE in patients with cirrhosis with or without previous OHE. One hundred and twenty-five patients with cirrhosis (43 previous OHE) and 134 controls were included in the original cohort. App times were correlated with Model for End-Stage Liver Disease (Offtime: r = 0.57; Ontime: r = 0.61; P < 0.0001) and were worst in previous OHE patients, compared to the rest and controls. Stroop performance was also significantly impaired in those with MHE, compared to those without MHE, according to SPTs, ICTs, and PHES (all P < 0.0001). A cutoff of >274.9 seconds (Ontime plus Offtime) had an area under the curve of 0.89 in all patients and 0.84 in patients without previous OHE for MHE diagnosis using SPT as the gold standard. The validation cohort showed 78% sensitivity and 90% specificity with the >274.9-seconds Ontime plus Offtime cutoff. App result patterns were similar between the centers. Test-retest reliability in controls and those without previous OHE was good; a learning effect on Ontime in patients with cirrhosis without previous OHE was noted.

CONCLUSION

The Stroop smartphone app is a short, valid, and reliable tool for screening of MHE.

PROMIS computerised adaptive tests are dynamic instruments to measure health-related quality of life in patients with cirrhosis

BACKGROUND

Cirrhotic patients have an impaired health-related quality of life (HRQOL), which is usually analysed using static paper-pencil questionnaires. The Patient Reported Outcomes Measurement Information System (PROMIS) computerised adaptive testing (CAT) are flexible, freely available, noncopyrighted, HRQOL instruments with US-based norms across 11 domains. CAT presents five to seven questions/domain depending on the patient's response, from large validated question banks. This provides brevity and precision equivalent to the entire question bank.

AIM

To evaluate PROMIS CAT tools against 'legacy instruments' for cirrhotics and their informal caregivers.

METHODS

A total of 200 subjects: 100 cirrhotics (70 men, 53% decompensated) and 100 caregivers were administered the PROMIS and legacy instruments [Sickness Impact Profile (SIP), Beck depression/anxiety inventories, Pittsburgh Sleep-Quality Index (PSQI) and Epworth Sleepiness scale (ESS)] concurrently. Both legacy and PROMIS results for patients were compared with caregivers and US norms. These were also compared between compensated and decompensated patients. Preference for SIP or PROMIS was inquired of a selected group (n = 70, 50% patients). Test - retest reliability was assessed in another group of 20 patients.

RESULTS

Patients had significant impairment on all PROMIS domains apart from anger and anxiety compared with caregivers and US norms (P < 0.02 to <0.0001). Decompensated patients had significantly worse sleep, pain, social and physical function scores compared with compensated ones, similar to legacy instruments. There was a statistically significant correlation between PROMIS and their corresponding legacy instruments. The majority (71%) preferred PROMIS over SIP. PROMIS tools had significant test - retest reliability (ICC range 0.759-0.985) when administered 12 ± 6 days apart.

CONCLUSION

PROMIS computerised adaptive testing tools had significant concurrent and discriminant validity, test - retest reliability and subject preference for assessing HRQOL in cirrhotic patients.

Glomerular expression of neuronal activity-regulated pentraxin precedes the development of anti-Thy-1-induced progressive glomerulosclerosis

Although it is clear that genetic predispositions play a role in progressive glomerulosclerosis, identification of specific genes is difficult because of natural genetic heterogeneity among individuals. We have reported a differential susceptibility to progressive glomerulosclerosis after induction of experimental glomerulonephritis anti-Thy-1 nephritis in Lewis rat substrains. Glomerular lesions in Lewis/Møllegard rats resolve spontaneously, whereas Lewis/Maastricht (Lew/Maa) rats develop progressive glomerulosclerosis. This predisposition for progressive glomerulosclerosis is governed by unknown genes that are expressed by renal cells. Here, differential gene expression analysis using a rat complementary DNA micro array revealed neuronal activity-regulated pentraxin (Narp) as a candidate gene involved in the remodeling or progression of damaged glomeruli. Glomerular Narp mRNA expression was monitored during disease in both Lewis sub strains. Immunohistochemistry revealed that Narp protein is exclusively expressed in Lew/Maa glomeruli 7 and 14 days after induction of anti-Thy-1 nephritis. Double-immunofluorescent staining showed that proliferating mesangial cells and parietal epithelial cells (PECs) at sites of adhesion to podocytes are partially Narp-positive, whereas podocytes fail to express Narp. Immunohistochemistry in nephritic Wistar, unilaterally nephrectomized Wistar and Sprague-Dawley rats showed that Narp protein is present only in strains that develop progressive glomerulosclerosis but never in strains that show remodeling. We conclude that Narp is a predictor for anti-Thy-1 nephritis-induced glomerulosclerosis and its expression by PECs may be involved in the progression to glomerulosclerosis.

Maximizing hemodynamic-independent effects of angiotensin II antagonists in fibrotic diseases

Better understanding of the hemodynamic-independent actions of the renin-angiotensin system (RAS) may lead to improved therapies for heart, kidney, and liver fibrosis. The conventional view of the RAS is that its role is solely hemodynamic. Pharmacologic blockade of the RAS is beneficial in treating hypertension, as well as primary renal and cardiac diseases. Recent findings from clinical trials and several laboratories that used different experimental approaches have revealed a whole new dimension to the RAS that is beyond the realm of hemodynamics. The RAS is best viewed as part of a system of interconnected molecules biologically designed to be activated after tissue injury to promote tissue repair and, when in excess, tissue fibrosis. This new understanding of the RAS has important clinical implications. It predicts and explains why blockade of the RAS with angiotensin-converting enzyme inhibitors (ACEI), the newer receptor antagonists, or both together, will significantly slow the progression of fibrotic disease. However, it further suggests that higher doses and/or a combination of angiotensin II blockade with another agent or agents might truly halt progressive fibrosis.

Vegetectomy: an alternative surgical treatment for infective endocarditis of the atrioventricular valves in drug addicts

The case of a patient in whom two separate episodes of infective endocarditis were treated by excision of the infected vegetation ("vegetectomy") is reported. In carefully selected patients, early conservative operation may preserve the native valve and avoid the hazards of anticoagulative medication and prosthetic endocarditis in habitual drug abusers.

Effect of buffer constituents on rat liver 3-hydroxy-3-methyl glutaryl coenzyme A reductase

Rat liver microsomes prepared in Tris buffer exhibited 3 to 10 times higher 3-hydroxy-3-methyl glutaryl CoA reductase specific activity than microsomes prepared with potassium phosphate buffer. This higher activity was observed in rats killed during mid-light cycle, but microsomes from rats killed during mid-dark cycle showed no significant difference in enzyme activity between buffers. When microsomes prepared in the 2 different buffers were preincubated with ATP and MG++, enzyme activity was inhibited to the same extent. The cytosol fraction in each of the 2 different buffer preparations possessed similar phosphatase activity. The higher 3-hydroxy-3-methyl reductase activity in Tris buffer, therefore, does not appear to be due to differences in phosphorylation or dephosphorylation activity.

Effects of delipidated serum and lipoprotein-deficient serum on sterol biosynthesis and efflux in cultured skin fibroblasts - a comparison of the behaviour of cells from a control with those from a heterozygote and homozygote for familial hypercholesterolaemia

The biosynthesis and efflux of sterols from cells into the medium were investigated in skin fibroblasts from a control, a patient with obligate heterozygous familial hypercholesterolaemia and a patient with the homozygous condition. The behaviour of the cells was studied in two lipid free media (lipoprotein deficient and delipidated serum), with and without the addition of low density lipoproteins (LDL) in order to find experimental conditions which showed maximum differences between the three cell lines. Incorporation of [14C]acetate into sterols in the presence (repression) and absence (induction) of LDL was similar in the normal and heterozygous cells, whereas the homozygous cells showed reduced repression and increased induction. In all three cell lines induction of sterol synthesis was greater with delipidated than lipoprotein deficient serum. The efflux of sterols in both the presence and absence of LDL did not differ between the three cell lines, but it was greater when LDL was added to the medium and when delipidated serum was used. Sterol biosynthesis and efflux from the cells of the heterozygote did not differ significantly from those of the control.

Infected ventricular septal defect

This paper reports a case of recurrent septic pulmonary emboli resulting from bacterial endocarditis on a ventricular septal defect. This was managed by the removal of vegetations, resection of the septal leaflet of the tricuspid valve, closure of the ventricular septal defect, and pulmonary embolectomy. The literature regarding the incidence and mortality of bacterial endocarditis on ventricular septal defects, and the management of the infected tricuspid valve, is reviewed. The patient remains well two and a half years after surgery.

Association in Long-Evans hooded rats of red cell 2,3-diphosphoglycerate levels with hemoglobin types

Two sublines of commercially available Long-Evans hooded rats have been developed by genetic selection. These sublines have widely differing levels of erythrocyte 2,3-diphosphoglycerate (DPG) due to different alleles at a single genetic locus. In the present work, it is shown that rats from the commercial population are also polymorphic at a hemoglobin locus, probably involving two alleles of the IIIbeta-globin chain locus. Particular hemoglobin types have been found to be strongly associated with certain DPG types, not only in the high-DPG and low-DPG lines but also in the commercial population. Two explanations for this association are considered. One is a single-locus hypothesis, with hemoglobin allelic variation causing DPG variation, and the other is a two-locus hypothesis, with marked linkage disequilibrium.

Lipid and lipoprotein concentrations in 1604 men and women in working populations in north-west London

Serum lipid and lipoprotein concentrations in men and women vary with age, and so-called "normal" limits should take account of this. Serum cholesterol, triglyceride, and phospholipid concentrations were measured in 1027 men and 577 women in five working populations in north-west London, and lipoprotein electrophoresis and quantitative analyses of lipoprotein concentrations were also performed. In men the best fit between serum cholesterol, triglycerides, and phospholipids, on the one hand, and age, on the other, was given by a curvilinear relationship expressed as a quadratic regression. In women the best fit was given by a linear regression. White men had higher serum cholesterol and triglyceride concentrations than Black men, and these differences were reflected in the distributions of the lipoproteins. There were no differences between values in White and Black women. Young women on oral contraceptives had lipid concentrations similar to those of older women not on these preparations. These data suggest that the adoption of concentrations of serum cholesterol (275-300 mg/100 ml (7-1-7-8 mmol/l) and triglycerides (175-200 mg/100 ml (2-0--2-3 mmol/l) recommended by a recent report on the prevention of coronary disease as limits above which special attention should be given to the management of hyperlipidaemia could result in as few as 2% of younger men or as many as 31% of older men being selected for treatment.