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101.
Hannah R. Meredith Emerson Arehart Kyra H. Grantz Alexander Beams Theresa Sheets Richard Nelson Yue Zhang Russell G. Vinik Darryl Barfuss Jacob C. Pettit Keegan McCaffrey Angela C. Dunn Michael Good Shannon Frattaroli Matthew H. Samore Justin Lessler Elizabeth C. Lee Lindsay T. Keegan 《Emerging infectious diseases》2021,27(5):1259
The coronavirus disease pandemic has highlighted the key role epidemiologic models play in supporting public health decision-making. In particular, these models provide estimates of outbreak potential when data are scarce and decision-making is critical and urgent. We document the integrated modeling response used in the US state of Utah early in the coronavirus disease pandemic, which brought together a diverse set of technical experts and public health and healthcare officials and led to an evidence-based response to the pandemic. We describe how we adapted a standard epidemiologic model; harmonized the outputs across modeling groups; and maintained a constant dialogue with policymakers at multiple levels of government to produce timely, evidence-based, and coordinated public health recommendations and interventions during the first wave of the pandemic. This framework continues to support the state’s response to ongoing outbreaks and can be applied in other settings to address unique public health challenges. 相似文献
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Modupeola Diyaolu Anne-Laure Thomas Lauren SY Wood Jordan Taylor James CY Dunn 《Journal of pediatric surgery》2021,56(1):5-10
BackgroundShort gut syndrome, a condition characterized by inadequate absorption of nutrients owing to decreased bowel length, has minimal avenues for treatment. We have proposed spring-mediated distraction enterogenesis to lengthen bowel in porcine jejunum as a treatment for short gut. We aim to evaluate the extent of mesenteric neovascularization in segments of lengthened bowel via spring-mediated enterogenesis.MethodsFemale juvenile Yucatan pigs underwent laparotomy and insertion of gelatin-encapsulated compressed nitinol springs, held in place with plication sutures, into the jejunum. At surgery and sacrifice, macroscopic mesenteric blood vessels were counted between the plication sites. Histologic samples of the mesentery were obtained to evaluate microscopic vasculature.ResultsA statistically significant increase in macroscopic mesenteric blood vessels was seen after intestinal lengthening (before: 1.9 ± 0.7 vessels, after: 4.7 ± 1.2 vessels, p = 0.001). A statistical significance is also seen in the density of arterioles (control: 3.0 ± 3.0 vessels/mm, spring: 7.0 ± 9.0 vessels/mm, p = 0.01) and venules (control: 4.0 ± 3.0 vessels/mm, spring: 8.0 ± 8.0 vessels/mm, p = 0.003).ConclusionIntestinal segments lengthened by intraluminal springs demonstrated total greater number of macroscopic vessels and microscopic blood vessels per length of mesentery as compared to control. This suggests local changes within the mesentery to recruit blood supply to growing intestine.Level of evidenceN/AType of studyTreatment study. 相似文献
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Lauren SY Wood Hadi S Hosseini Modupeola Diyaolu Anne-Laure Thomas Jordan S Taylor James CY Dunn 《Journal of pediatric surgery》2021,56(7):1192-1198
Introductionshort bowel syndrome is marked by inadequate intestinal surface area to absorb nutrients. Current treatments are focused on medical management and surgical reconfiguration of the dilated intestine. We propose the use of spring-mediated distraction enterogenesis as a novel intervention to increase intestinal length. Given our previous success lengthening intestinal segments using springs with spring constant ~7 N/m that exerts 0.46 N or higher, we sought to determine the minimal force needed to lengthen porcine small intestinal segments, and to explore effects on intestine over time.MethodsJuvenile Yucatan pigs underwent laparotomy with enterotomy to introduce nitinol springs intraluminally (n = 21 springs). Bowel segments (control, spring-distracted) were retrieved on post-operative day (POD) 7 and 14, and lengths measured. Thickness of cross-sectional intestinal layers were measured using H&E, and submucosal collagen fiber orientation measured using trichrome stained sections.Resultsall pigs survived to POD7 and 14. Spring constants of at least 2 N/m exerting a minimum force of 0.10 N significantly lengthened intestinal segments (p <0.0001). The stronger the spring force, the greater the induced thickness of various intestinal layers at POD7 and 14. Collagen fiber orientation was also more disordered because of stronger springs.Conclusiona spring constant of approximately 2 N/m exerting 0.10 N and greater significantly lengthens intestinal segments and stimulates intestinal structural changes at POD7 and 14. This suggests a decreased force is capable of inducing spring-mediated distraction enterogenesis. 相似文献
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Viral hepatitis is the most common serious contagious disease caused by viruses that attack the liver. Approximately 70,000 cases are reported to the Centers for Disease Control each year, representing only a fraction of U.S. cases. There are five types of viral hepatitis currently known: Hepatitis A--formerly called infectious hepatitis; Hepatitis B--formerly called serum hepatitis, and the most serious form; Hepatitis C--formerly called non-A, non-B hepatitis; Hepatitis D--formerly called delta hepatitis; Hepatitis E--formerly called enteric or epidemic non-A, non-B hepatitis. The following Open Forum, prepared by leading EMS experts, explores the differences among the types of hepatitis, signs and symptoms, and EMS implications. 相似文献
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Dunn S 《Emergency medical services》1990,19(8):13, 15-13, 16
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Dunn R 《Topics in health record management》1990,11(1):25-31
Comprehensive quality management is a goal that requires major corporate commitment to implement and maintain. The best results in a quality management program will be achieved when all components are tied together in a comprehensive program. To do that, a significant investment in personnel and equipment is required. As the benefits of having a program such as the one as described above become more widely known and accepted, more and more managed care insurers and providers will adopt these or similar standards. The question, "How do you know that patients are getting high-quality and sufficient care?" cannot be answered today by insurers who do not have such a program. 相似文献