The Scope of the Public Duty/Special Duty Doctrine in Illinois: Municipal Liability for Failure to Provide Police Protection

This comment examines the development of the public duty doctrine and its special duty exception. It focuses on Illinois\u27 treatment of the special duty exception and its application in cases involving an alleged failure of a municipality to provide police protection. The author concludes that the control element of Illinois\u27 special duty test is overly restrictive, and advocates a balancing approach in its place

Anthropometric indices of Gambian children after one or three annual rounds of mass drug administration with azithromycin for trachoma control.

BACKGROUND: Mass drug administration (MDA) with azithromycin, carried out for the control of blinding trachoma, has been linked to reduced mortality in children. While the mechanism behind this reduction is unclear, it may be due, in part, to improved nutritional status via a potential reduction in the community burden of infectious disease. To determine whether MDA with azithromycin improves anthropometric indices at the community level, we measured the heights and weights of children aged 1 to 4 years in communities where one (single MDA arm) or three annual rounds (annual MDA arm) of azithromycin had been distributed. METHODS: Data collection took place three years after treatment in the single MDA arm and one year after the final round of treatment in the annual MDA arm. Mean height-for-age, weight-for-age and weight-for-height z scores were compared between treatment arms. RESULTS: No significant differences in mean height-for-age, weight-for-age or weight-for-height z scores were found between the annual MDA and single MDA arms, nor was there a significant reduction in prevalence of stunting, wasting or underweight between arms. CONCLUSIONS: Our data do not provide evidence that community MDA with azithromycin improved anthropometric outcomes of children in The Gambia. This may suggest reductions in mortality associated with azithromycin MDA are due to a mechanism other than improved nutritional status

Psychological outcomes of extended reality interventions in spinal cord injury rehabilitation:a systematic scoping review

STUDY DESIGN: Systematic scoping review.OBJECTIVES: Extended reality (XR) is becoming a recognisable tool for assisting in spinal cord injury (SCI) rehabilitation. While the success of XR mediated interventions is often evaluated based on improvements in physical and functional performance, the present systematic scoping review aimed to identify and synthesize evidence on reported psychological outcomes of XR interventions in SCI rehabilitation. In doing so, we aimed to contribute towards an adaptation of XR that is meaningful for individuals living with SCI.METHODS: Seven bibliometric databases were systematically searched. Included studies needed to be peer-reviewed, test structured and targeted XR interventions in an adult (≥ 16 years) SCI population, and assess any psychological construct. Individual double-screening against a pre-defined eligibility criteria was performed. Data from the included studies were extracted, tabulated, and analysed.RESULTS: A total of 964 unique studies were initially identified. 13 studies were included in the analysis. The psychological outcomes most frequently quantified were depression, self-esteem, and anxiety. Among other things, qualitative evidence suggests VR-based interventions provided enjoyment, relaxation, and a source of positive distraction.CONCLUSION: Immersive XR interventions in SCI rehabilitation have been positively evaluated, both qualitatively and quantitatively, based on the psychological outcomes of participants. While further research is needed, we find immersive XR to be an emerging treatment option with promise for maintaining and improving psychological health during SCI rehabilitation.</p

Setting research priorities to improve global newborn health and prevent stillbirths by 2025.

BACKGROUND: In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013-2025. METHODS: We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts. RESULTS: Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour. CONCLUSION: These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakeholders, governments, NGOs, and research institutes in these priorities, while encouraging research funders to support them. We will track research funding, relevant requests for proposals and trial registers to monitor if the priorities identified by this exercise are being addressed

Baby Observational Selective Control AppRaisal (BabyOSCAR):Scores at 3 months predict functional ability, spastic cerebral palsy distribution, and diagnosis at 2 years

Aim: To assess the predictive capabilities of the Baby Observational Selective Control AppRaisal (BabyOSCAR) tool, administered at 3 months corrected age, in determining spastic cerebral palsy (CP) outcome, functional abilities, and body topography at 2 years of age or later. Method: Independent joint motions were measured at age 10 to 16 weeks from video recordings of spontaneous movement using BabyOSCAR in a sample of 75 infants. All included infants had known 2-year outcomes (45 with spastic CP and 30 without CP) including Gross Motor Functional Classification System (GMFCS) levels and CP body distribution. Receiver operating characteristic curves and cut points indicating greatest sensitivity and specificity were generated for predictive performance. Results: Total BabyOSCAR score was a strong predictor of future outcome of spastic CP (cut score of 22.5, sensitivity = 98%, specificity = 100%, area under the curve = 0.99), and was able to distinguish children classified in GMFCS levels I and II from those in III to V (cut score of 13.5, sensitivity = 92%, specificity = 89%, area under the curve = 0.94). Having an (absolute) asymmetry score on the BabyOSCAR of more than 5 was a predictor of having unilateral CP at age 2 years (sensitivity = 56%, specificity = 100%, area under the curve = 0.86). Interpretation: BabyOSCAR scores are predictors of diagnosis, body distribution, and future gross motor function in infants with spastic CP at 2 years of age or later.</p

Subgroups of non-suicidal self-injury in a large diverse sample of online help-seekers

IntroductionMany young people access information and resources for nonsuicidal self-injury (NSSI) online; yet our understanding of who accesses such information is limited. NSSI is a behavior with varied presentations. Understanding heterogeneity can help guide person-centered intervention. The present study aimed to (1) empirically identify classes of individuals with NSSI and (2) compare the classes according to demographic and clinical characteristics.MethodsData were collected from a survey posted to a national advocacy group website. Latent class analysis was used to derive classes based on characteristics associated with NSSI severity. Relationships between the latent classes and variables along five dimensions (behavior change, consequences or life interference, expectancies, functions, and NSSI across lifetime) were explored via logistic regression models.Results11,262 individuals reporting past month NSSI were included in analyses. The 4-class model provided the most clinically interpretable groups. Class 1 was the smallest (16.8%), scored highest on all items and reported the youngest age of onset. Class 3 was the largest (31.8%), scored lowest on all items and reported the latest age of onset. Classes 2 (29.3%) and 4 (22.2%) had moderate scores on most items and differed in levels of suicidal ideation.ConclusionClasses presented with more severe symptoms than what is typical in samples in extant literature underscoring the importance of tailoring interventions for dissemination in online contexts

Gerinnungsveränderungen unter In-vitro-Fertilisationstherapie

Unterschiedliche Hormonpräparate, wie beispielsweise orale Kontrazeptiva oder Substitutionspräparate in der Menopause sind in den letzten Jahren vermehrt in die Schlagzeilen geraten. Es wurden viele Studien veröffentlicht, die zeigten, daß es unter bestimmten Hormongaben zu Veränderungen der Blutgerinnung kommt im Sinne von Steigerung des pro- bzw. Reduktion des antikoagulatorischen Potentials. Somit besteht ein erhöhtes Thromboserisiko unter Verwendung bestimmter Hormonpräparate, insbesondere, wenn weitere Risikofaktoren für thromboembolische Ereignisse (Rauchen, Adipositas, Immobilisation usw.) hinzu kommen. Da die In-vitro-Fertilisation in den letzten 20 Jahren immer mehr an Bedeutung gewonnen hat und während eines IVF-Zyklus Hormone in hoher Dosierung verabreicht werden, stellte sich die Frage, ob und inwieweit es auch hier zu Gerinnungsveränderungen kommt. In der vorliegenden Arbeit konnten wir anhand unterschiedlicher Gerinnungs-parameter und Hormonwertbestimmungen bei zwei unterschiedlichen IVF-Stimu-lations-Protokollen zeigen, daß es unter In-vitro-Fertilisations-Therapie zu Veränderungen der Blutgerinnung der Patientinnen kommt. In beiden von uns untersuchten Patientengruppen (LONG- versus SHORT-Protokoll Programm) wiesen sowohl die Globaltests der plasmatischen Gerinnung (Quick-Wert, aPTT und Fibrinogen) als auch die Gerinnungsaktivierungsparameter Prothrombinfragment F1+2 und D-Dimer auf eine Erhöhung des prokoagulatorischen Potentials bzw. eine Gerinnungsaktivierung hin. Die in den letzten Jahren auf dem Gebiet der Gerinnungsaktivierung bzw. -inhibierung erst genauer erforschten Faktoren Tissue factor und Tissue factor pathway inhibitor verhielten sich unterschiedlich in den beiden von uns untersuchten Gruppen und zeigten keine eindeutig signifikanten Veränderungen. In bezug auf die Hormonwertveränderungen unter IVF-Therapie konnten wir zeigen, daß die Gerinnungswerte, insbesondere Prothrombinfragment F1+2 und D-Dimer, der Patientinnen beider Protokolle signifikant mit den Progesteron-Werten korrelierten. Estrogen-Spiegel scheinen dagegen bei der In-vitro-Fertilisations-Hormontherapie eine untergeordnete Rolle zu spielen in bezug auf die Gerinnungsaktivierung. Zwischen den beiden Patientengruppen bestanden kaum Unterschiede hinsichtlich Ansteigen bzw. Abfallen der einzelnen Parameter. Lediglich in bezug auf die Höhe des jeweiligen Anstiegs bzw. Abfalls konnte gezeigt werden, daß, außer bei den F 1+2-Werten, jeweils die Endwerte der Patientinnen der LONG-Protokoll Gruppe deutlich über bzw. unter denen der SHORT-Protokoll Gruppe lagen, was auf ein stärkeres Ansteigen des prokoagulatorischen Potentials in diesem Protokoll weist, insbesondere im Zusammenhang mit dem auch in dieser Gruppe stärkeren Ansteigen des Progesterons

Vaccination coverage and timeliness in three South African areas: a prospective study

<p>Abstract</p> <p>Background</p> <p>Timely vaccination is important to induce adequate protective immunity. We measured vaccination timeliness and vaccination coverage in three geographical areas in South Africa.</p> <p>Methods</p> <p>This study used vaccination information from a community-based cluster-randomized trial promoting exclusive breastfeeding in three South African sites (Paarl in the Western Cape Province, and Umlazi and Rietvlei in KwaZulu-Natal) between 2006 and 2008. Five interview visits were carried out between birth and up to 2 years of age (median follow-up time 18 months), and 1137 children were included in the analysis. We used Kaplan-Meier time-to-event analysis to describe vaccination coverage and timeliness in line with the Expanded Program on Immunization for the first eight vaccines. This included Bacillus Calmette-Guérin (BCG), four oral polio vaccines and 3 doses of the pentavalent vaccine which protects against diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type B.</p> <p>Results</p> <p>The proportion receiving all these eight recommended vaccines were 94% in Paarl (95% confidence interval [CI] 91-96), 62% in Rietvlei (95%CI 54-68) and 88% in Umlazi (95%CI 84-91). Slightly fewer children received all vaccines within the recommended time periods. The situation was worst for the last pentavalent- and oral polio vaccines. The hazard ratio for incomplete vaccination was 7.2 (95%CI 4.7-11) for Rietvlei compared to Paarl.</p> <p>Conclusions</p> <p>There were large differences between the different South African sites in terms of vaccination coverage and timeliness, with the poorer areas of Rietvlei performing worse than the better-off areas in Paarl. The vaccination coverage was lower for the vaccines given at an older age. There is a need for continued efforts to improve vaccination coverage and timeliness, in particular in rural areas.</p> <p>Trial registration number</p> <p>ClinicalTrials.gov: <a href="http://clinicaltrials.gov/ct2/show/NCT00397150">NCT00397150</a></p

Challenges in measuring measles case fatality ratios in settings without vital registration

Measles, a highly infectious vaccine-preventable viral disease, is potentially fatal. Historically, measles case-fatality ratios (CFRs) have been reported to vary from 0.1% in the developed world to as high as 30% in emergency settings. Estimates of the global burden of mortality from measles, critical to prioritizing measles vaccination among other health interventions, are highly sensitive to the CFR estimates used in modeling; however, due to the lack of reliable, up-to-date data, considerable debate exists as to what CFR estimates are appropriate to use. To determine current measles CFRs in high-burden settings without vital registration we have conducted six retrospective measles mortality studies in such settings. This paper examines the methodological challenges of this work and our solutions to these challenges, including the integration of lessons from retrospective all-cause mortality studies into CFR studies, approaches to laboratory confirmation of outbreaks, and means of obtaining a representative sample of case-patients. Our experiences are relevant to those conducting retrospective CFR studies for measles or other diseases, and to those interested in all-cause mortality studies