Abstract: Background On April 28, 2014, an EF-4 tornado struck the town of Louisville, Mississippi. The local, rural hospital was damaged to the point of closure and 10 people were killed. A temporary, mobile emergency site was established, but little data was available to guide the expected patient population and clinical needs. Our objective was to perform a descriptive analysis of patients who were treated in a rural, temporary emergency care site in the immediate aftermath of a tornado. Methods A retrospective chart review was performed of all patients seen at the temporary emergency site in the immediate aftermath of the tornado. Patient charts were reviewed for patient demographics, diagnosis, and disposition. Diagnoses were categorized into categories and subcategories for review. Descriptive statistics were utilized as indicated. Results A total of 323 patients were seen from April 29, 2014 to May 17, 2014. The average age was 39.6 years, with 17% pediatric and 83% adult patients. The majority of patients (88%) were discharged to home, while 35 patients (12%) required transfer to another facility for a higher level of care. Traumatic and infectious injuries were the most common diagnostic categories at 38% (117/309) and 23% (72/309), respectively. The majority of the traumatic and skin/soft tissue infections were related to the storm. Conclusion In this analysis, the majority of the patients seen in a temporary, emergency site were adult, low acuity patients who were dispositioned home, though many did require transfer. A large number of patients were seen directly due to the tornado or recovery efforts. These results may inform future disaster response and suggest the mobile response unit provided necessary care following the storm and hospital’s damage.
Background:Maternal mortality and morbidity rates in the Southeastern states of the US are among the highest in the nation. Arkansas, Mississippi, and Louisiana are ranked first, second and fifth, respectively, in maternal mortality. This retrospective policy surveillance systematically documents legislation enacted to address maternal health disparities and ameliorate maternal health. Methods:The Maternal and Child Health Legislative Database of the National Conference of State Legislators was searched for all legislation relating to maternal health in Arkansas, Louisiana, and Mississippi between 2018-2023. Two reviewers independently identified the laws passed by year and state and cross-checked to verify results. The legislative screening process is documented on a modified PRISMA flow diagram. Data extracted included the specific maternal health population targeted, the general health area addressed by the bill, and the directive of the bill. Results:126 pieces of legislation were identified using the database (41 AR, 12 MS, and 73 LA). There were no duplicates identified; 2 laws were identified outside of the database (1 AR, 1 MS). All 128 legislation titles and summaries were screened and laws pertaining to issues other than maternal health were excluded (28 AR, 9 MS, and 48 LA). 43 full text bills were retrieved and reviewed in their entirety to assess eligibility for inclusion. 40 pieces of legislation were included (11 AR, 4 MS, and 25 LA) in this policy surveillance. Discussion:Louisiana enacted the most laws targeting and addressing maternal health, while Mississippi enacted the least. The legislation enacted addresses a broad range of health aspects, such as maternal mental health, incarcerated pregnant population reproductive health, and postpartum Medicaid coverage extension. Together with the task forces, committees, and study commissions created, the legislation enacted has the potential to address current inequities and improve maternal health outcomes in this vulnerable population by increasing access to and/or utilization of care, extending duration and/or type of evidence-based care available, and decreasing racial disparities in maternal health with the eventual goal of rooting out preventable morbidity and mortality.
This column was started to provide a place for computer designers to present their ideas, opinions, cries for help, and almost anything else short of Social Implications, which all belong to Harry Larson. It is in danger of turning into a monologue unless you keep sending in ideas, opinions, cries for help, etc. Anything short and to-the-point will be published as-is; while longer stuff will usually be abstracted along with your name and address for the benefit of those who want to inquire further. Things that look like regular articles may be referred to the regular editors for regular handling. Send material for this column to Jim Haynes, Applied Sciences, University of California, Santa Cruz, Ca. 95060. Phone (408) 429-2916.
Trade losses can be used in a number of ways: • by reducing your income for the year ended 5 April 2014 and if your income is nil or less than the loss by reducing your capital gains for the year ended 5 April 2014 • by claiming for relief to be calculated by reference to your income for the year ended 5 April 2013 and if your income is nil or less than the loss by reducing your capital gains for the year ended 5 April 2013 • by claiming for relief to be calculated by reference to your income for earlier years • by claiming for relief to be calculated by reference to profit of the same trade in earlier years • by carry forward against future profits of the same trade or income from the company (where you transfer your trade to a company in exchange for shares in that company), or post-cessation receipts.
Fifteen nations offer fathers the right to reduce work hours to care for children. Incorporating a gender perspective, this study uses a mixed‐methods approach to examine the implementation of this policy in the first nation to offer it, Sweden. It investigates whether the institutional and cultural environment exerts pressure on companies to facilitate fathers’ hours reduction, companies’ levels of support for fathers’ use of this entitlement and correlates of company support. The persistence of the “male model of work” appears to be an important barrier to implementation of a policy that offers promise in offering fathers time to care.
Trade losses can be used in a number of ways: • by reducing your income for the year ended 5 April 2014 and if your income is nil or less than the loss by reducing your capital gains for the year ended 5 April 2014 • by claiming for relief to be calculated by reference to your income for the year ended 5 April 2013 and if your income is nil or less than the loss by reducing your capital gains for the year ended 5 April 2013 • by claiming for relief to be calculated by reference to your income for earlier years • by claiming for relief to be calculated by reference to profit of the same trade in earlier years • by carry forward against future profits of the same trade or income from the company (where you transfer your trade to a company in exchange for shares in that company), or post-cessation receipts.
Background/Objective Many pediatric emergency departments in the United States have adopted a staged ultrasound and CT pathway for the diagnosis of acute appendicitis. However, most algorithms only include radiology-performed ultrasound (RUS) and not emergency physician- performed bedside ultrasound (BUS). Our objective was to determine if emergency physician-performed BUS provides sufficient diagnostic accuracy for acute appendicitis in a pediatric population, thereby limiting additional cost and/or delays in disposition. Methods This is a single-center prospective study of pediatric patients with concern for and requiring further work-up for acute appendicitis. Each patient had a focused bedside ultrasound (BUS) performed by an emergency physician with training in BUS. Diagnostic accuracy was compared with surgical pathology standard, as well as radiology- performed ultrasound (RUS), computed tomography (CT), and clinical follow-up. Results Among46 enrolledpatients, 12were diagnosed with acute appendicitis (26%). There were no negative laparotomies in those who had surgery. There was one case of missed appendicitis at 4-week follow-up. BUS had a sensitivity of 100% (95% Cl: 72% to 100%) and. a specificity of 81% (61% to 93%) when the app6ndix'was visualized (37). This resulted in positive likelihood ratio of5.2 and a negative likelihood ratio ofo. In the cases where the appendix was not visualized on BUS (9), 1 patient was diagnosed with appendicitis, and the other 8 patients were negative for appendicitis. In RUS both the sensitivity and specificity was 100% when the appendix was visualized. The sensitivity and specificity of CT in our studywas 90% and 100% respectively. Conclusions Emergency physicians can perform bedside ultrasound with high accuracy for acute appendicitis in a pediatric population. When the appendix is not visualized by ultrasound, a staged ultrasound and CT pathway should be considered.
