Cerebral Myiasis Associated with Angiosarcoma of the Scalp

Neurosurgery ◽  
2007 ◽  
Vol 61 (1) ◽  
pp. E167-E167 ◽  
Author(s):  
Samuel H. Cheshier ◽  
Simon R. Bababeygy ◽  
Dominique Higgins ◽  
Julie Parsonnet ◽  
Stephen L. Huhn
Keyword(s):  
United States ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Skilled Nursing Facility ◽  
Rare Condition ◽  
Developed Countries ◽  
The United States ◽  
Skilled Nursing ◽  
Contact Exposure ◽  
A Minor

Abstract OBJECTIVE Primary human cerebral myiasis is an exceedingly rare condition and is almost never encountered by physicians in developed countries. The case report summarizes a case of extensive cerebral myiasis in a periurban community in the United States. CLINICAL PRESENTATION After a minor motor vehicle accident, police brought a 75-year-old man to the emergency room because he was observed to have a large cranial lesion. Examination revealed a 15 × 17 cm frontal bone defect with eroded frontal dura, exposed cortex, and massive cortical maggot infestation. INTERVENTION The patient was empirically treated with intravenous antibiotics for meningitis. Maggots (Phaenicia sericata, or the green bottle fly) were removed by suction, attrition, and gentle contact exposure to a mild bleach solution. Biopsy of the scalp and cranium revealed angiosarcoma, for which operative treatment was refused. The patient was transferred to a skilled nursing facility for palliative care where he died 3 months later. CONCLUSION This is the first published case of cerebral myiasis in the United States. Although human cerebral myiasis is rare, conditions do exist in this country that permit myiasis.

scholarly journals Transmission of Carbapenemase-Producing Hypervirulent Klebsiella pneumoniae in Georgia, 2018–2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s414-s415
Author(s):  
Jeanne Negley ◽  
Elizabeth Smith ◽  
Maroya Walters ◽  
Tonia Parrott ◽  
Richard Stanton ◽  
...  
Keyword(s):  
United States ◽  
Klebsiella Pneumoniae ◽  
Infection Control ◽  
Skilled Nursing Facility ◽  
The United States ◽  
Case Patient ◽  
Skilled Nursing ◽  
Patient Transfers ◽  
Critical Access Hospital ◽  
Invasive Infections

Background: In April 2019, the Georgia Department of Public Health (DPH) initiated whole-genome sequencing (WGS) on NDM-producing Enterobacteriaceae identified since January 2018. The WGS data analyzed at CDC identified related Klebsiella pneumoniae isolates with hypervirulence markers from 2 patients. Carbapenemase-producing hypervirulent K. pneumoniae (CP-hvKP) are rarely reported in the United States, but they can to cause serious, highly resistant, invasive infections. We conducted an investigation to identify cases and prevent spread. Methods: We defined a case as NDM-producing K. pneumoniae with ≥4 hypervirulence markers identified by WGS, isolated from any specimen source from a Georgia patient. We reviewed the case patient’s medical history to identify potentially affected facilities. We also performed PCR-based colonization screening and retrospective and prospective laboratory-based surveillance. Finally, we assessed facility infection control practices. Results: Overall, 7 cases from 3 case patients (A, B, and C) were identified (Fig. 1). The index case specimen was collected from case-patient A at ventilator-capable skilled nursing facility 1 (vSNF1) in May 2018. Case-patient A had been hospitalized for 1 month in India before transfer to the United States. Case-patient B’s initial isolate was collected in January 2019 on admission to vSNF2 from a critical access hospital (CAH). The CAH laboratory retrospectively identified case-patient C, who overlapped with case-patient B at the CAH in October 2018. The CAH and the vSNF2 are geographically distant from vSNF1. Case-patients B and C had no known epidemiologic links to case-patient A. Colonization screening occurred at vSNF1 in May 2018, following detection of NDM-producing K. pneumoniae from case-patient A ∼1 year before determining that the isolate carried hypervirulence markers. Among 30 residents screened, 1 had NDM and several had other carbapenemases. Subsequent screening did not identify additional NDM. Colonization screening of 112 vSNF2 residents and 13 CAH patients in 2019 did not reveal additional case patients; case-patient B resided at vSNF2 at the time of screening and remained colonized. At all 3 facilities, the DPH assessed infection control practices, issued recommendations to resolve lapses, and monitored implementation. The DPH sequenced all 27 Georgia NDM–K. pneumoniae isolates identified since January 2018; all were different multilocus sequence types from the CP-hvKP isolates, and none possessed hypervirulence markers. Conclusions: We hypothesize that CP-hvKP was imported by a patient hospitalized in India and spread to 3 Georgia facilities in 2 distinct geographic regions through indirect patient transfers. Although a response to contain NDM at vSNF1 in 2018 likely limited CP-hvKP transmission, WGS identified hvKP and established the relatedness of isolates from distinct regions, thereby directing the DPH’s additional containment activities to halt transmission.Funding: NoneDisclosures: None

Stress State Dependence of Human Placenta Mechanical Behavior

2011 ◽  
Author(s):  
Benjamin Weed ◽  
Ali Borazjani ◽  
Sourav Patnaik ◽  
Rajkumar Prabhu ◽  
Thomas Franz ◽  
...  
Keyword(s):  
United States ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
State Dependence ◽  
The United States ◽  
Maternal Trauma ◽  
Abruptio Placentae ◽  
Common Cause ◽  
Vehicle Accident ◽  
Stress State Dependence

Maternal trauma affects 5–8% of all pregnancies and is the leading nonobstetric cause of maternal death in the United States [1]. The most common cause of trauma is motor vehicle accident (MVA) and the most common pathology is abruptio placentae, detachment of the placenta from uterus, which leads to serious maternal and fetal consequences [2].

The Washington Consensus, liberal ideas and terms of the military-technological policy

2020 ◽  
Vol 16 (11) ◽  
pp. 2103-2123
Author(s):  
V.L. Gladyshevskii ◽  
E.V. Gorgola ◽  
D.V. Khudyakov
Keyword(s):  
United States ◽  
Production Management ◽  
Developed Countries ◽  
The United States ◽  
Internal Quality ◽  
Industrial Complex ◽  
Active Involvement ◽  
Military Industrial Complex ◽  
Industrial Complexes ◽  
The Military

Subject. In the twentieth century, the most developed countries formed a permanent military economy represented by military-industrial complexes, which began to perform almost a system-forming role in national economies, acting as the basis for ensuring national security, and being an independent military and political force. The United States is pursuing a pronounced militaristic policy, has almost begun to unleash a new "cold war" against Russia and to unwind the arms race, on the one hand, trying to exhaust the enemy's economy, on the other hand, to reindustrialize its own economy, relying on the military-industrial complex. Objectives. We examine the evolution, main features and operational distinctions of the military-industrial complex of the United States and that of the Russian Federation, revealing sources of their military-technological and military-economic advancement in comparison with other countries. Methods. The study uses military-economic analysis, scientific and methodological apparatus of modern institutionalism. Results. Regulating the national economy and constant monitoring of budget financing contribute to the rise of military production, especially in the context of austerity and crisis phenomena, which, in particular, justifies the irrelevance of institutionalists' conclusions about increasing transaction costs and intensifying centralization in the industrial production management with respect to to the military-industrial complex. Conclusions. Proving to be much more efficient, the domestic military-industrial complex, without having such access to finance as the U.S. military monopolies, should certainly evolve and progress, strengthening the coordination, manageability, planning, maximum cost reduction, increasing labor productivity, and implementing an internal quality system with the active involvement of the State and its resources.

Rehabilitation Intensity and Patient Outcomes in Skilled Nursing Facilities in the United States: A Systematic Review

2021 ◽  
Author(s):  
Rachel A Prusynski ◽  
Allison M Gustavson ◽  
Siddhi R Shrivastav ◽  
Tracy M Mroz
Keyword(s):  
United States ◽  
Systematic Review ◽  
Patient Outcomes ◽  
Hospital Readmissions ◽  
The United States ◽  
Skilled Nursing Facilities ◽  
Functional Improvement ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
The Relationship

Abstract Objective Exponential increases in rehabilitation intensity in skilled nursing facilities (SNFs) motivated recent changes in Medicare reimbursement policies, which remove financial incentives for providing more minutes of physical therapy, occupational therapy, and speech therapy. Yet there is concern that SNFs will reduce therapy provision and patients will experience worse outcomes. The purpose of this systematic review was to synthesize current evidence on the relationship between therapy intensity and patient outcomes in SNFs. Methods PubMed, Medline, Scopus, Embase, CINAHL, PEDro, and COCHRANE databases were searched. English-language studies published in the United States between 1998 and February 14, 2020, examining the relationship between therapy intensity and community discharge, hospital readmission, length of stay (LOS), and functional improvement for short-stay SNF patients were considered. Data extraction and risk of bias were performed using the American Academy of Neurology (AAN) Classification of Evidence scale for causation questions. AAN criteria were used to assess confidence in the evidence for each outcome. Results Eight observational studies met inclusion criteria. There was moderate evidence that higher intensity therapy was associated with higher rates of community discharge and shorter LOS. One study provided very low-level evidence of associations between higher intensity therapy and lower hospital readmissions after total hip and knee replacement. There was low-level evidence indicating higher intensity therapy is associated with improvements in function. Conclusions This systematic review concludes, with moderate confidence, that higher intensity therapy in SNFs leads to higher community discharge rates and shorter LOS. Future research should improve quality of evidence on functional improvement and hospital readmissions. Impact This systematic review demonstrates that patients in SNFs may benefit from higher intensity therapy. Because new policies no longer incentivize intensive therapy, patient outcomes should be closely monitored to ensure patients in SNFs receive high-quality care.

Driving and Public Health

2021 ◽  
Keyword(s):  
Public Health ◽  
United States ◽  
Health Problem ◽  
Cell Phone ◽  
Motor Vehicle ◽  
Electronic Device ◽  
Public Health Problem ◽  
The United States ◽  
Distracted Driving ◽  
The Past

Distracted driving is defined in the Oxford English Dictionary as “the practice of driving a motor vehicle while engaged in another activity, typically one that involves the use of a mobile phone or other electronic device.” However, other distractions not involving the use of a cell phone or texting are important as well, contributing to this burgeoning public health problem in the United States. Examples include talking to other passengers, adjusting the radio or other controls in the car, and daydreaming. Distracted driving has been linked to increased risk of motor vehicle crashes (MVCs) in the United States, representing one of the most preventable leading causes of death for youth ages 16 to 24 years. Undoubtedly, the proliferation of cell phone, global positioning system (GPS), and other in-vehicle and personal electronic device use while driving has led to this rise in distracted driving prevalence. This behavior has impacted society—including individual and commercial drivers, passengers, pedestrians—in countless numbers of ways, ranging from increased MVCs and deaths to the enactment of new driving laws. In 2016, for example, 20 percent of all US pediatric deaths (nearly 4,000 children and adolescents) were due to fatal MVCs. It has been estimated that at any given time, more than 650,000 drivers are using cell phones or manipulating electronic devices while driving. In the United States, efforts are underway to reduce this driving behavior. In the past two decades, state and federal laws have specifically targeted cell phone use and texting while driving as priority areas for legal intervention. Distracted driving laws have become “strategies of choice” for tackling this public health problem, though their enforcement has emerged as a major challenge and varies by jurisdiction and location. Multimodal interventions using models such as the “three Es” framework—Enactment of a law, Education of the public about the law and safety practices, and Enforcement of the law—have become accepted practice or viewed as necessary steps to successfully change this behavior caused by distractions while driving. This Oxford Bibliographies review introduces these and other aspects (including psychological influences and road conditions) of distracted driving through a presentation of annotated resources from peer- and non-peer-reviewed literature. This selective review aims to provide policymakers, program implementers, and researchers with a reliable source of information on the past and current state of American laws, policies, and priorities for distracted driving.

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