The State of Preschool 2007

Provides data on state-funded pre-K programs for the 2006-2007 school year, such as percentages of children enrolled at different ages, spending per child, and the number of quality standard benchmarks met. Includes state rankings and profiles

Resistance of Aedes aegypti (Diptera: Culicidae) Populations to Deltamethrin, Permethrin, and Temephos in Cambodia.

Dengue fever is a major public health concern, including 185,000 annual cases in Cambodia. Aedes aegypti is the primary vector for dengue transmission and is targeted with insecticide treatments. This study characterized the insecticide resistance status of Ae aegypti from rural and urban locations. The susceptibility to temephos, permethrin, and deltamethrin of Ae aegypti was evaluated in accordance with World Health Organization instructions. All the field populations showed lower mortality rate to temephos compared with the sensitive strain with resistance ratio 50 (RR50) varying from 3.3 to 33.78 and RR90 from 4.2 to 47 compared with the sensitive strain, demonstrating a generalized resistance of larvae to the temephos in Cambodia. Ae aegypti adult populations were highly resistant to permethrin regardless of province or rural/urban classification with an average mortality of 0.02%. Seven of the 8 field populations showed resistance to deltamethrin. These results are alarming for dengue vector control, as widespread resistance may compromise the entomological impact of larval control operations. Innovative vector control tools are needed to replace ineffective pesticides in Cambodia

Reactive case-detection of malaria in Pailin Province, Western Cambodia: lessons from a year-long evaluation in a pre-elimination setting.

BACKGROUND: As momentum towards malaria elimination grows, strategies are being developed for scale-up in elimination settings. One prominent strategy, reactive case detection (RACD), involves screening and treating individuals living in close proximity to passively detected, or "index" cases. This study aims to use RACD to quantify Plasmodium parasitaemia in households of index cases, and identify risk factors for infection; these data could inform reactive screening approaches and identify target risk groups. METHODS: This study was conducted in the Western Cambodian province of Pailin between May 2013 and March 2014 among 440 households. Index participants/index cases (n = 270) and surrounding households (n = 110) were screened for Plasmodium infection with rapid diagnostic tests (RDT), microscopy and real-time polymerase chain reaction (PCR). Participants were interviewed to identify risk factors. A comparison group of 60 randomly-selected households was also screened, to compare infection levels of RACD and non-RACD households. In order to identify potential risk factors that would inform screening approaches and identify risk groups, multivariate logistic regression models were applied. RESULTS: Nine infections were identified in households of index cases (RACD approach) through RDT screening of 1898 individuals (seven Plasmodium vivax, two Plasmodium falciparum); seven were afebrile. Seventeen infections were identified through PCR screening of 1596 individuals (15 P. vivax, and 22 % P. falciparum/P. vivax mixed infections). In the control group, 25 P. falciparum infections were identified through PCR screening of 237 individuals, and no P. vivax was found. Plasmodium falciparum infection was associated with fever (p = 0.013), being a member of a control household (p ≤ 0.001), having a history of malaria infection (p = 0.041), and sleeping without a mosquito net (p = 0.011). Significant predictors of P. vivax infection, as diagnosed by PCR, were fever (p = 0.058, borderline significant) and history of malaria infection (p ≤ 0.001). CONCLUSION: This study found that RACD identified very few secondary infections when targeting index and neighbouring households for screening. The results suggest RACD is not appropriate, where exposure to malaria occurs away from the community, and there is a high level of treatment-seeking from the private sector. Piloting RACD in a range of transmission settings would help to identify the ideal environment for feasible and effective reactive screening methods

Effect Of Biofeedback Devices In Partial Weight-Bearing Orthopaedic Patients

Partial weight-bearing (PWB) instructions are commonly given to orthopaedic patients. However, the ability of patients to comply with these instructions is poorly defined. Recent advances in technology have created biofeedback devices capable of offering real-time feedback to patients given PWB instructions. These devices could potentially increase patient compliance with PWB instructions following orthopaedic surgery. This thesis was designed to evaluate the effectiveness of modulating partial weight-bearing using the SmartStepTM biofeedback device. Fifty asymptomatic subjects aged 21-72 years were given three educational interventions designed to train them to limit weight-bearing on a lower extremity: verbal instructions, training with a bathroom scale, and training with a biofeedback device. Weight-bearing was measured after each activity to determine the effectiveness of biofeedback as compared to other clinical teaching methods. Additionally, another 14 subjects were given biofeedback training and retention was measured over a 24-hour period to assess retention of biofeedback training. Subjects given only verbal touch down weight-bearing instructions (25lbs) initially bore an average of 61.25± 4.80lbs (average ± standard error). This was reduced to 51.50 ± 4.47lbs after training with a bathroom scale and was further reduced to 30.01 ± 2.33lbs after biofeedback training. Likewise, subjects given verbal partial weight-bearing instructions (75lbs) initially bore an average of 89.06 ± 5.58lbs. There was no improvement with the use of a bathroom scale, with an average of 88.47 ± 4.75lbs. After training with a biofeedback device, weight-bearing improved to an average of 68.11 ± 2.46lbs. Mixed model analysis found age was not a significant predictor of subject compliance. However, higher BMI and male gender were predictive of heavier weight-bearing. Additionally, subjects in the retention study initially bore 20.4 ± 2.12 lbs (average ± standard error) after biofeedback training. Retention tests during the 24 hour period showed no significant difference from the original testing, with 2-4 hour retention of 19.98 ± 4.75 lbs; 6-8 hour retention of 25.07 ± 6.60 lbs; and 24 hour retention of 21.75 ± 4.58 lbs. Biofeedback training leads to superior compliance with touch down and partial weight-bearing instructions as compared to verbal instructions or training with a bathroom scale. Compliance was negatively affected by BMI and male gender, but not age. Additionally, biofeedback training shows retention up to 24-hours. As partial weight-bearing instructions are commonly given to orthopaedic patients, training with such a device may be appropriately considered

Improving Documentation In Shoulder Dystocia

Shoulder dystocia (SD) is difficult to predict and one of the most highly litigated obstetrical emergencies. Consequently, our institution implemented a standardized SD form in order to help facilitate adequate and accurate documentation in cases of SD. Our study aimed to utilize the information recorded in the newly implemented SD form to investigate the demographics of patients, practices, and outcomes in SD cases at Yale-New Haven Hospital (YNHH) and to study the effect of implementing a standardized SD form on medical record documentation practices. We collected 41 discrete data points from the SD form and the medical record in cases of SD occurring at our institution. We identified SD cases beginning in January 2004 and tracked inclusion of delivery information in the SD form and in narrative delivery notes for one year before and four years after implementation. Overall, 152 consecutive cases of SD were included and the presence as well as the mean and standard deviation, or percentage, for each data point was collected and calculated. Elements from the SD form increased significantly in narrative delivery notes after implementation of the form (p=.011). Data elements included at higher rates in the medical record after implementation included estimated prepregnancy maternal weight (13% to 28%, p=.043), total maternal pregnancy weight gain (19% to 36%, p=.033), estimated fetal weight (60% to 77%, p=.025), time of onset of active labor (40% to 65%, p=.004), time of onset of second stage (27% to 52%, p=.003), and time of head delivery (4% to 30%, p=\u3c.001). The demographics of our patient population were comparable to that of others reported in the literature. Our results show that use of a mandatory SD form results in significant improvements in documentation within provider narrative delivery notes and may improve the attention of providers to more complete and accurate charting. Such improvements in documentation may better demonstrate standards of care in the management of SD cases and decrease litigation exposure when events are reviewed

Interactions of Ar(9+) and metastable Ar(8+) with a Si(100) surface at velocities near the image acceleration limit

Auger LMM spectra and preliminary model simulations of Ar(9+) and metastable Ar(8+) ions interacting with a clean monocrystalline n-doped Si(100) surface are presented. By varying the experimental parameters, several yet undiscovered spectroscopic features have been observed providing valuable hints for the development of an adequate interaction model. On our apparatus the ion beam energy can be lowered to almost mere image charge attraction. High data acquisition rates could still be maintained yielding an unprecedented statistical quality of the Auger spectra.Comment: 34 pages, 11 figures, http://pikp28.uni-muenster.de/~ducree

Determining the efficacy of guppies and pyriproxyfen (Sumilarv® 2MR) combined with community engagement on dengue vectors in Cambodia: study protocol for a randomized controlled trial.

BACKGROUND: Evidence on the effectiveness of low-cost, sustainable, biological vector-control tools for the Aedes mosquitoes is limited. Therefore, the purpose of this trial is to estimate the impact of guppy fish (guppies), in combination with the use of the larvicide pyriproxyfen (Sumilarv® 2MR), and Communication for Behavioral Impact (COMBI) activities to reduce entomological indices in Cambodia. METHODS/DESIGN: In this cluster randomized controlled, superiority trial, 30 clusters comprising one or more villages each (with approximately 170 households) will be allocated, in a 1:1:1 ratio, to receive either (1) three interventions (guppies, Sumilarv® 2MR, and COMBI activities), (2) two interventions (guppies and COMBI activities), or (3) control (standard vector control). Households will be invited to participate, and entomology surveys among 40 randomly selected households per cluster will be carried out quarterly. The primary outcome will be the population density of adult female Aedes mosquitoes (i.e., number per house) trapped using adult resting collections. Secondary outcome measures will include the House Index, Container Index, Breteau Index, Pupae Per House, Pupae Per Person, mosquito infection rate, guppy fish coverage, Sumilarv® 2MR coverage, and percentage of respondents with knowledge about Aedes mosquitoes causing dengue. In the primary analysis, adult female Aedes density and mosquito infection rates will be aggregated over follow-up time points to give a single rate per cluster. This will be analyzed by negative binomial regression, yielding density ratios. DISCUSSION: This trial is expected to provide robust estimates of the intervention effect. A rigorous evaluation of these vector-control interventions is vital to developing an evidence-based dengue control strategy and to help direct government resources. TRIAL REGISTRATION: Current Controlled Trials, ID: ISRCTN85307778 . Registered on 25 October 2015

All-atom Molecular Dynamics simulations of spin labelled double and single-strand DNA for EPR studies

We report the first application of fully atomistic molecular dynamics (MD) simulations to the prediction of electron paramagnetic resonance (EPR) spectra of spin labelled DNA. Models for two structurally different DNA spin probes with either rigid or flexible position of the nitroxide group in the base pair, employed in experimental studies previously, have been developed. By the application of the combined MD-EPR simulation methodology we aimed at the following. Firstly, to provide a test bed against a sensitive spectroscopic technique for the recently developed an improved version of the parmbsc1 force field for MD modelling of DNA. The predicted EPR spectra show good agreement with the experimental ones available form the literature, thus confirming the accuracy of the currenly employed DNA force fields. Secondly, to provide quantative interpretation of the motional contributions into the dynamics of spin probes in both duplex and single-strand DNA fragments and to analyse their perturbing effects on the local DNA structure. Finally, a combination of MD and EPR allowed us to test the validity of the application of the Model-Free (M-F) approach coupled with partial averaging of magnetic tensors to the simulation of EPR spectra of DNA systems by comparing the resulting EPR spectra with those simulated directly from MD trajectories. The advantage of the M-F based EPR simulation approach over the direct propagation techniques is that it requires motional and order parameters that can be calculated from shorter MD trajectories. The reported MD-EPR methodology is transferable to the prediction and interpretation of EPR spectra of higher order DNA structures with novel types of spin labels