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Objectives To describe the impact of the COVID‐19 pandemic on New York City's (NYC) 9‐1‐1 emergency medical services (EMS) system and assess the efficacy of pandemic planning to meet increased demands. Methods Longitudinal analysis of NYC 9‐1‐1 EMS system call volumes, call‐types, and response times during the COVID‐19 peak‐period (March 16–April 15, 2020) and post‐surge period (April 16–May 31, 2020) compared with the same 2019 periods. Results EMS system received 30,469 more calls from March 16–April 15, 2020 compared with March 16–April 15, 2019 (161,815 vs 127,962; P

Objective To determine whether World Trade Center (WTC)-exposure intensity and post-traumatic stress disorder (PTSD) are associated with subjective cognitive change in rescue/recovery workers. Method The population included 7875 rescue/recovery workers who completed a subjective cognition measure, the Cognitive Function Instrument (CFI), between 3/1/2018 and 2/28/2019 during routine monitoring, indicating whether they had experienced cognitive and functional difficulties in the past year. Higher scores indicated greater self-perceived cognitive change. Probable PTSD, depression, and alcohol abuse were evaluated by validated mental health screeners. Logistic regression assessed the associations of WTC exposure and current PTSD with top-quartile (≥2) CFI score, and of early post-9/11 PTSD with top-quartile CFI in a subpopulation (N = 6440). Models included demographics, smoking, depression, and alcohol abuse as covariates. Results Mean age at CFI completion was 56.7 ± 7.7 (range: 36-81). Participants with high-intensity WTC exposure had an increased likelihood of top-quartile CFI score (odds ratio[OR] vs. low exposure: 1.32, 95%CI: 1.07-1.64), controlling for covariates. Current and early PTSD were both associated with top-quartile CFI (OR: 3.25, 95%CI: 2.53-4.19 and OR: 1.56, 95%CI: 1.26-1.93) respectively. Conclusions High-intensity WTC exposure was associated with self-reported cognitive change 17 years later in rescue/recovery workers, as was PTSD. Highly WTC-exposed subgroups may benefit from additional cognitive evaluation and monitoring of cognition over time.

A 56-year old male was evaluated for exertional dyspnea. He had previously undergone mechanical aortic valve replacement and aortic coarctation repair. Following uncomplicated coronary angiography using Judkins left and right catheters, aortography revealed that the loud murmur was related to an unusual, extra-anatomic surgical repair: transverse aorta to descending aorta bypass. Recognition of an extra-anatomic surgical bypass of coarctation is important, as this repair would leave a continuous murmur on exam.

The importance of our inner microbial communities for proper immune responses against invading pathogens is now well accepted, but the mechanisms underlying this protection are largely unknown. In this study, we used Caenorhabditis elegans to investigate such mechanisms. Since very little is known about the microbes interacting with C. elegans in its natural environment, we began by taking the first steps to characterize the C. elegans microbiota. We established a natural-like environment in which initially germfree, wild-type larvae were grown on enriched soil. Bacterial members of the adult C. elegans microbiota were isolated by culture and identified using 16S rRNA gene sequencing. Using pure cultures of bacterial isolates as food, we identified two, Bacillus megaterium and Pseudomonas mendocina , that enhanced resistance to a subsequent infection with the Gram-negative pathogen Pseudomonas aeruginosa . Whereas protection by B. megaterium was linked to impaired egg laying, corresponding to a known trade-off between fecundity and resistance, the mechanism underlying protection conferred by P. mendocina depended on weak induction of immune genes regulated by the p38 MAPK pathway. Disruption of the p38 ortholog, pmk-1 , abolished protection. P. mendocina enhanced resistance to P. aeruginosa but not to the Gram-positive pathogen Enterococcus faecalis . Furthermore, protection from P. aeruginosa was similarly induced by a P. aeruginosa gacA mutant with attenuated virulence but not by a different C. elegans -associated Pseudomonas sp. isolate. Our results support a pivotal role for the conserved p38 pathway in microbiota-initiated immune protection and suggest that similarity between microbiota members and pathogens may play a role in such protection.

In many coating and display applications, quantitative determination of the sample color is required. Standard procedures exist for converting an experimentally measured reflectivity spectrum into color coordinates such as CIE L*a*b*. In this paper we evaluate CIE L*a*b* color coordinates using a reflectivity spectrum which is calculated from an optical model determined by a spectroscopic ellipsometry (SE) analysis of the sample. The accuracy of the SE-determined color coordinates are compared with traditional color measurements, and the advantages of using SE for color determination are discussed.

This study evaluates the effects of carbohydrate injections on the growth and vitality of live oak (Quercus virginiana P. Miller). Glucose, sucrose, or a 50:50 mixture of both carbohydrates at increasing concentrations [0, 40, 80, and 120 g/L (0, 5.3, 10.6, and 16.0 oz/gal)] were injected into live oaks. Trunk and root growth, net photosynthesis, root and twig carbohydrate concentration, and chlorophyll fluorescence were monitored. Isotope composition of twig and root samples was measured as an indicator of injected carbohydrate distribution. There were significant differences (P < 0.05) in trunk growth among types of carbohydrates, but no significant differences for carbohydrate concentrations. The mixtures of sucrose and glucose had the largest effect on growth compared to either sugar alone, suggesting that glucose and sucrose alone were used in processes other than trunk growth. 50:50 mixtures caused a greater effect on overall mean growth indices than either sugar alone. Glucose content in twigs and starch in roots were significantly different (P < 0.05) among overall means for concentrations with increased levels found in trees treated with the greatest concentrations. Chlorophyll fluorescence Fv/Fm revealed highly significant differences (P < 0.001) among overall concentrations. Carbon isotope values did not reveal a definite trend that corroborated the exogenous carbohydrate distribution. Results from this experiment suggest that carbohydrate trunk injections can have an impact on growth and vitality of live oak.

Ceratocystis fagacearum causes the destructive tree disease called oak wilt. One means of pathogen spread is by insect vectors (Nitidulidae) that transmit spores into fresh wounds on healthy trees. Experiments were conducted in central Texas on native live oaks (Quercus fusiformis) to test pruning methods and paints on disease development. Three treatment combinations were tested on 30 trees (10 trees/treatment): flush cut unpainted, flush cut painted, and unpainted pruning cuts made according to the Shigo method. Unpainted puncture wounds were made on the lower trunks of an additional 20 trees as controls. C. fagacearum spores were applied to the pruning cuts and half of the puncture wounds (positive controls) after treatment, whereas the other half of the punctures received distilled water as negative controls. Oak wilt symptoms first appeared in the flush cut unpainted treatment 31 days after inoculation. Infection rates, in decreasing order, were; positive control (70%), flush cut unpainted (60%), Shigo pruning method (40%), flush cut painted (20%), and negative control (10%). Pruning wounds, regardless of method, were effective infection courts for the oak wilt pathogen. Fewer trees became infected when pruning cuts were painted, but differences among infection rates for pruning cuts were not statistically significant. Tree diameters and stem aspect ratio had no bearing on infection rates. The Shigo method is recognized as a superior method for pruning, but there is no reason to change current recommendations to paint fresh wounds on susceptible oaks in high-hazard oak wilt areas.

Context After the World Trade Center (WTC) collapse, 15% (1,767) of rescue workers from the Fire Department of the City of New York (FDNY) considered themselves to be current cigarette smokers. Post-WTC collapse, 98% reported acute respiratory symptoms, and 81% reported health concerns. Nonetheless, 29% of current smokers increased tobacco use, and 23% of ex-smokers resumed cigarette smoking. Objective To determine the effect of a comprehensive tobacco-cessation program using combination tobacco-dependency treatment medications adjusted to the individual's daily tobacco use. Design FDNY cigarette smokers enrolled in “Tobacco Free With FDNY,” a no-cost quit-smoking program providing counseling, support, and medications. At the end of the 3-month treatment phase and at the 6-month and 12-month follow-up visits, abstinence rates were confirmed by expired carbon monoxide levels or by the verification of a household member. Setting FDNY Bureau of Health Services between August 1, 2002 and October 30, 2002. Participants A total of 220 current cigarette smokers from the FDNY. Results At study enrollment, the mean (± SD) tobacco use was 20 ± 7 cigarettes per day, and the mean tobacco dependency, as assessed by a modified Fagerstrom test score, was 6.7 ± 2.5 (maximum score, 10). Based on tobacco use, 20% of enrollees used three types of nicotine medications, 64% used two types, 14% used one type, and 3% used no medications. Additionally, 14% of enrollees used bupropion sustained release. The confirmed continuous abstinence rates were 47%, 36%, and 37%, respectively, after 3 months of treatment and at the 6-month and 12-month follow-up. Abstinence rates did not correlate with the history of tobacco use but correlated inversely with tobacco dependency. Adverse events and maximal nicotine medication use were unrelated, and no one experienced a serious adverse event. Conclusion Tobacco dependency treatment using combination nicotine medications is effective and safe. Future studies should consider the following: (1) both history of tobacco use and withdrawal symptoms to determine the number and dose of nicotine medications; and (2) continuing combination treatment for > 3 months.

SummaryRoot distribution was determined for apple trees [Malus sylvestris (L.) Mill. var. domestica (Borkh.) Mansf. ‘Fuji’/’M.26’ (syn. M. domestica Borkh. non Poir.)] 1, 2 and 3 years after planting in trellised orchards in central Texas. Using a soil-coring method, measurable differences were detected in root-length density (RLD; root length per unit volume of soil) by tree age, soil depth, radial distance from the tree, and spatial bearing within and across rows (P ≤ 0.05). For fine roots (root diameters < 1 mm), mean RLD values were 0.1028, 0.1139 and 0.2911 cm cm–3 for 1, 2 and 3 year-old plantings, respectively. For coarse roots (root diameters 1–5 mm), mean RLD values were 0.0006, 0.0009 and 0.0015 cm cm–3 for 1, 2 and 3 year-old plantings, respectively. Mean RLD values declined for both fine and coarse roots of all ages with increasing soil depth and radial distance from the trunk (P ≤ 0.05). Similar patterns were observed for the number of soil cores containing measurable roots. The percentage of...

This study examines healthcare utilization over time in Bronx, New York schoolchildren with asthma who were previously identified via parent surveys in six elementary schools. Four of the schools have on-site school-based health centers (SBHCs), and two do not have on-site health services (control schools). At baseline, we reported an asthma prevalence of 20%, and high rates of emergency department (ED) use (46%) in the previous year. To determine if asthma morbidity (specifically, ED use, community provider use, and hospitalizations for asthma) could be reduced by incorporating an aggressive intervention at two schools with SBHCs, we prospectively followed children for up to 3 years. Parents were scheduled for interviews every 6 months, and were queried about their children's use of health services for asthma in the prior 6 months. In multivariate models, children in the two intervention SBHC schools were less likely to have visited a community provider for asthma (relative rate ratio, 0.52; 95% confidence interval (CI), 0.30-0.88) or an emergency department for asthma (odds ratio, 0.44; 95% CI, 0.14-1.38; P = 0.059) in the prior 6 months compared to children attending control schools. There was no difference in community provider use or emergency department use for asthma between children attending nonintervention SBHCs and control schools. However, school type did not affect asthma hospitalization rates, which declined in all groups. Our findings support the effectiveness of aggressive school-based asthma services provided by SBHCs to reduce asthma morbidity and complement community health services.

This study analyzed health care utilization at three school-based health centers (SBHCs) in the Bronx, New York City, and compared characteristics of “frequent” and “average” service users. Encounter form data for visits by 2,795 students who received services at least once between September 7, 1998, and June 30, 1999, were reviewed. Demographic comparisons between clinic users and the total school population, and between “frequent” (five or more visits/year) and “average” (one to four visits/year) users were made. The two groups also were compared after primary diagnoses were classified into five general categories. Some 96% (3,469/3,614) of students were registered in the SBHCs, of whom 81% (2,795/3,469) used clinic services at least once during the school year. Clinic users did not differ from the general school population by gender, but were younger (p < 0.01). “Frequent” users were more likely than “average” users to be older (p < 0.01), but they did not differ by gender, race/ethnicity, or insurance status. “Frequent” users comprised 28% of the clinic-using population, but accounted for 72.5% of all visits. Similarly, “average” users comprised 72.4% of the clinic-using population, but accounted for 27.5% of all visits. “Frequent” users generated most visits for mental health and chronic medical conditions, while “average” users generated most visits for preventive care, acute medical care, and injuries/emergencies (p < 0.01 for all). Important challenges for elementary SBHCs include developing new approaches that meet children's needs while protecting clinic resources, like scheduling group interventions for those with on-going health care needs who require frequent use of school health services.

OBJECTIVES To describe the proportion of at-risk World Trade Center (WTC)-exposed rescue/recovery workers with polysomnogram-confirmed obstructive sleep apnea (OSA) and examine the relationship between WTC exposure, physician-diagnosed gastroesophageal reflux disease (GERD), and rhinosinusitis and OSA. METHODS A total of 636 male participants completed polysomnography from September 24, 2010, to September 23, 2012. Obstructive sleep apnea was classified as mild, moderate, or severe. Associations were tested using nominal polytomous logistic regression. RESULTS Eighty-one percent of workers were diagnosed with OSA. Using logistic regression models, severe OSA was associated with WTC exposure on September 11, 2001 (odds ratio, 1.91; 95% confidence interval, 1.15 to 3.17), GERD (odds ratio, 2.75; 95% confidence interval, 1.33 to 5.70), and comorbid GERD/rhinosinusitis (odds ratio, 2.31; 95% confidence interval, 1.22 to 4.40). CONCLUSIONS We found significant associations between severe OSA and WTC exposure, and with diseases prevalent in this population. Accordingly, we recommend clinical evaluation, including polysomnography, for patients with high WTC exposure, other OSA risk factors, and a physician diagnosis of GERD or comorbid GERD and rhinosinusitis.

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Obstructive sleep apnea (OSA) is characterized by intermittent hypoxia (IH). In animal models, IH has been shown to protect the myocardium during periods of ischemia by reducing infarct size. However, this phenomenon of “ischemic preconditioning” has not been investigated among OSA patients with acute myocardial infarction (MI). This study investigates the role of OSA on MI severity as measured by cardiac enzymes, specifically troponin-T, among patients with an acute MI. This is an observational cohort study of patients ≥18 years of age who were hospitalized with an acute MI. Each participant underwent portable sleep monitoring (Apnea Link Plus); OSA was defined as an apnea–hypopnea index ≥5/h. Multivariable regression analysis was conducted to assess the relationship between OSA and highly sensitive troponin-T levels. In our entire cohort of acute MI patients (n = 136), 77 % of the sample had evidence of sleep disordered breathing, with 35 % of the sample having OSA (i.e., an AHI >5). Higher AHI was associated with lower peak troponin-T levels in partially adjusted models (β = −0.0320, p = 0.0074, adjusted for age, gender, and race) and fully adjusted models (β = −0.0322, p = 0.0085) (additionally adjusted for smoking, hypertension, hyperlipidemia, body mass index, history of prior cardiovascular or cerebrovascular disease, diabetes and baseline admission creatinine levels). The mean value of the log-transformed peak troponin-T variable was used to dichotomize the outcome variable. In both partially (OR 0.949, CI 0.905–0.995, p = 0.03) and fully adjusted (OR 0.918, CI 0.856–0.984, p = 0.0151) logistic regression models, the OR for AHI suggests a protective effect on high troponin-T level. Our study demonstrates that patients with OSA have less severe cardiac injury during an acute non-fatal MI when compared to patients without OSA. This may suggest a cardioprotective role of sleep apnea during acute MI via ischemic preconditioning.

Oak wilt, caused by Ceratocystis fagacearum, annually causes losses of epidemic proportions in towns and cities throughout central Texas. Live oaks (Quercus fusiformis and Q. virginiana) are the most seriously affected Quercus spp. because of their prevalence and subsequent high values. Oak wilt epidemiology is influenced by host characteristics, climate, and reproductive traits of the pathogen. These factors have been studied to develop the key elements of a comprehensive, integrated oak wilt management program. Under most conditions, this program can be used in Texas to successfully minimize losses. The program relies on disruption of root connections, intravascular injection with propiconazole, proper pruning and wound treatments (including dressings), and various sanitation practices. Preventative measures are the most effective means of reducing losses, making prompt, reliable diagnoses of new oak wilt infection foci essential. A five step protocol is recommended to distinguish oak wilt in live oak from other diseases in Texas and facilitate disease control. Cooperation among federal, state, and local agencies working with commercial arborists has had a dramatic impact on public understanding of oak wilt and resulted in significantly controlling the disease.

The relative disease susceptibilities of 14 Quercus species from Texas and California were tested in three inoculation studies with different isolates of the oak wilt pathogen, Ceratocystis fagacearum. Ten of the oaks were evergreen or semi-evergreen live oaks while the remaining four were deciduous species. The species represented 3 different Quercus sub-genera. All species were susceptible to the pathogen, but there was significant variability in disease response. In the first study, there was variability among different selections of live oak from Texas, and there were distinct differences in disease response among the California oaks in the other two experiments. In two of the studies, the most susceptible species was the exotic cork oak, Q. suber. Q. kelloggii, the only deciduous red oak inoculated, responded similarly to Q. suber, an evergreen white oak. The two evergreen red oaks, Q. agrifolia and Q. wislizenii, were the least susceptible in one of the studies while the two evergreen "intermediate" oaks, Q. chrysolepisand Q. tomentella, were the least susceptible in another. Significant differences in pathogenicity were observed between two Texas isolates of C. fagacearum. The implications of these results forthe California oak woodlands is discussed.

World Health Organization defined anemia of aging (AOA) when men and women greater than 65 years, respectively, have unexplained hemoglobin (Hgb) less than 13 and 12 g/dl. Recent evidence suggests that this is likely a chronic inflammatory process involving interleukins (IL) 6, 12, and C-reactive protein. Among elderly with obstructive sleep apnea (OSA), hypoxic stimulation of erythropoiesis may obscure AOA. Treatment of OSA may paradoxically restore AOA. We sought to identify OSA and AOA coexistence and OSA treatment AOA interaction. Records of 101 successive patients older than 65 years and with OSA who were treated with continuous positive airway pressure were analyzed retrospectively. Differences among pre/post-treatment of OSA hemograms were assessed using paired two-tailed Student’s t test. Hemogram changes were compared to apnea–hypopnea index (AHI), respiratory effort related arousals (RERA), and duration patients slept with oxyhemoglobin saturation

Chronic volume overload from chronic severe mitral regurgitation (MR) results in neuroendocrine activation similar to the heart failure syndrome despite normal left ventricular (LV) ejection fraction (EF). Hence, the hypothesis that beta-blocker (BB) therapy may have a beneficial effect in these patients was tested using a large observational cohort. Our echocardiographic database was searched for patients with severe MR and normal LVEF. Full chart reviews were conducted for clinical and pharmacologic data. Survival was analyzed as a function of BB therapy. The search produced 895 patients aged 68 +/- 17 years, 44% men, with LVEF 66 +/- 7%. Of these, 32% were on BB therapy. Use of a BB was associated with a significantly decreased mortality hazard of 0.62 (95% confidence interval 0.46 to 0.83, p = 0.002), which was unchanged after adjusting for age, gender, LVEF, coronary artery disease, diabetes mellitus, hypertension, and cardiac valve surgery. The independent beneficial effect of BBs was seen in patients with or without coronary artery disease, those with or without hypertension, and patients managed both medically and surgically. In conclusion, use of BB therapy was associated with a significant independent survival benefit in patients with chronic severe MR with normal LVEF. This benefit was seen in patients with or without coronary artery disease, as well as patients managed both medically and surgically. Use of BBs in patients with severe MR despite normal LVEF is suggested.

Potential insolvency has always played an important role in insurance regulation. In fact, concerns about the public interest are such that the insurance industry is required to establish guarantee funds so that, in the event a particular company is unable to meet its obligations to policyholders, the insureds would still be covered. Even so, the number and magnitude of insurance carrier insolvencies have risen dramatically in the past few years. Probably the most serious was the Mission Insurance Company in 1987. The original cost was estimated at $520 million, which has since grown to be in excess of $1.5 billion (New York Times, November 15, 1988). In addition, the size of the guarantee funds has grown eleven-fold in just the past four years to approximately $917 million in 1987.

There are more than 8 million workplace injuries per year compensated by private insurers or competitive state funds under the various workers compensation programs. Of these only 5 percent are sufficiently severe to result in permanent disability or the death of the injured workers, yet this subsample accounts for some 75 percent of all incurred claims costs. Identifying the more severe injuries is of substantial importance both in the estimating the costs of the workers compensation system, as well as in the effort to contain those costs.

After the World Trade Center (WTC) collapse, 15% (1,767) of rescue workers from the Fire Department of the City of New York (FDNY) considered themselves to be current cigarette smokers. Post-WTC collapse, 98% reported acute respiratory symptoms, and 81% reported health concerns. Nonetheless, 29% of current smokers increased tobacco use, and 23% of ex-smokers resumed cigarette smoking.To determine the effect of a comprehensive tobacco-cessation program using combination tobacco-dependency treatment medications adjusted to the individual's daily tobacco use.FDNY cigarette smokers enrolled in "Tobacco Free With FDNY," a no-cost quit-smoking program providing counseling, support, and medications. At the end of the 3-month treatment phase and at the 6-month and 12-month follow-up visits, abstinence rates were confirmed by expired carbon monoxide levels or by the verification of a household member.FDNY Bureau of Health Services between August 1, 2002 and October 30, 2002.A total of 220 current cigarette smokers from the FDNY.At study enrollment, the mean (+/- SD) tobacco use was 20 +/- 7 cigarettes per day, and the mean tobacco dependency, as assessed by a modified Fagerstrom test score, was 6.7 +/- 2.5 (maximum score, 10). Based on tobacco use, 20% of enrollees used three types of nicotine medications, 64% used two types, 14% used one type, and 3% used no medications. Additionally, 14% of enrollees used bupropion sustained release. The confirmed continuous abstinence rates were 47%, 36%, and 37%, respectively, after 3 months of treatment and at the 6-month and 12-month follow-up. Abstinence rates did not correlate with the history of tobacco use but correlated inversely with tobacco dependency. Adverse events and maximal nicotine medication use were unrelated, and no one experienced a serious adverse event.Tobacco dependency treatment using combination nicotine medications is effective and safe. Future studies should consider the following: (1) both history of tobacco use and withdrawal symptoms to determine the number and dose of nicotine medications; and (2) continuing combination treatment for3 months.

Our kinetic studies have characterized the mechanisms of deoxyhemoglobin S polymer depolymerization when exposed to CO (used as a model for oxygen because rates can be controlled photolytically). Fibers dissolve slowly, losing monomers from their ends at low partial pressure, and very rapidly at higher partial pressures that induce fiber fracture and therefore many new ends. Slow dissolution that is not complete in the time red cells traverse the pulmonary microvasculature will generate residual arterial polymers (RAPs), enhancing pathogenesis by seeding nucleation of new polymers, accelerating repolymerization and increasing its extent.We now demonstrate, to the best of our knowledge for the first time by direct observation, that anaerobically drawn arterial blood of sickle patients shows birefringence in many red cells and therefore RAPs exist, which we confirm by EM observation of aligned polymers. RAPs exist not only under hypoxemic conditions, when they can be explained by limited solubility due to the presence of deoxyHbS, but also when hypoxemia is absent. RAPs without hypoxemia imply that slow depolymerization kinetics are responsible. One minute of voluntary hyperventilation and (separately) brief nasal oxygen greatly decrease RAPs. RAPs increase during sleep. We attribute these results to accelerated depolymerization at increasing levels of oxygen that cooperatively induce polymer fracture (fracture, using CO, exhibits a 4.7 power dependence on pCO). These results and the interdependent progress of oxygen saturation, partial pressure, fracture rate and remaining polymer that we model bear on pathogenesis and particularly on vaso-occlusive crises, which result from red cell rigidification and from cellular adhesion due to polymer-dependent cellular damage. Under these mechanisms, the lungs may play an important role in initiating pathology; and remediation of dysfunction by breathing assists is potentially prophylactic.

Background About 1400 school-based health centers (SBHCs) provide care to 1.1 million children. However, it is unknown if access to on-site services is associated with a better outcome. Objective To compare outcomes including hospitalizations, emergency department visits, and school absenteeism in elementary schoolchildren with asthma who were grouped according to their enrollment at schools that have or do not have SBHCs. Setting Six elementary schools in The Bronx, NY (4 schools with and 2 without SBHCs). Participants Nine hundred forty-nine inner-city schoolchildren with asthma. Design To collect baseline data for a longitudinal study, we surveyed parents to identify children with asthma, and to obtain information about symptoms and the use of health services in the last 12 months. Participating schools provided absenteeism information. Results Of 6433 parents surveyed, 74% completed the questionnaires. The prevalence of asthma was 19.9% and the morbidity was high—during the previous year, 46.2% had been treated for asthma in an emergency department; 12.6% had been hospitalized. Emergency department use was not associated with SBHCs. However, in univariate and multivariate analyses, the rate of hospitalization was higher among children enrolled at schools without an SBHC (rate ratio, 1.5; 95% confidence interval, 1.1-1.9). In addition, schoolchildren with asthma enrolled in the schools without an SBHC missed more days of school than those enrolled in schools with an SBHC (mean [SD], 21.3 [15.4] vs 18.2 [13.0], respectively; P = .02). Conclusion Access to SBHCs was associated with a reduction in the rate of hospitalization and a gain of 3 days of school for schoolchildren who have asthma.

American inner-city children are disproportionately affected by asthma. During the 1999–2000 school year, we conducted a survey of 6 Bronx, New York City elementary schools to assess the prevalence of asthma and asthma-like symptoms as reported by parents. Children with probable asthma had symptoms within the last 12 months and parents who indicated that their child had asthma. Children with possible asthma had symptoms within the last 12 months but lacked a diagnosis. Overall, 74% (4,775/6,433) of parents returned completed surveys, identifying 20% (949/4,775) of children as probable asthmatics, and 12% (589/4,775) as possible asthmatics. In multivariate analyses, probable asthma was associated with: Puerto Rican, Black, and white race/ethnicity, male gender, having health insurance, and registration at the poorest school. Possible asthma was associated with lack of health insurance and female gender, but was not associated with any specific race/ethnicity. Our findings support the effectiveness of school-based surveys to identify children at high risk for asthma. The challenge remains to engage children and families in appropriate follow-up care and to manage their illness, either through the use of school-based health centers or stronger links to community services.Pediatr Pulmonol. 2002; 34:105–111. © 2002 Wiley-Liss, Inc.

Fifteen years ago, Open Airways for Schools (OAS) was found to be an effective asthma education program for elementary school children when taught by professionals. To determine whether OAS is effective when taught by college students and whether it could withstand potential cohort effects, 54 inner-city fourth and fifth graders were taught OAS. Paired t-tests revealed that OAS improved asthma knowledge, self-efficacy, self-management skills, social support, and perception of well-being (p < 0.05). Fifteen years later, OAS continues to improve children's self-management skills. Facilitators with little prior experience who received brief training in asthma knowledge and group leadership skills can effectively teach OAS.

R. C. KaplanDepartment of Epidemiology and Population Health,Albert Einstein College of Medicine, Bronx, NY, USAS. RedlineBrigham and Women’s Hospital and Beth Israel DeaconessMedical Center, Harvard Medical School, Boston, MA, USAH. K. YaggiSection of Pulmonary, Critical Care, and Sleep Medicine,DepartmentofInternalMedicine,YaleUniversitySchoolofMedicine,New Haven, CT, USASleep Breath (2013) 17:1119DOI 10.1007/s11325-012-0793-0

1 Have Increases in Workers' Compensation Benefits Paid for Themselves?.- 2 Heterogeneity Bias in the Estimation of the Determinants of Workers' Compensation Loss Distributions.- 3 Workers' Compensation Disability Benefits During Retirement Years: Proper and Present Role.- 4 Rehabilitation and Workers' Compensation: Incompatible or Inseparable?.- 5 Mostly on Monday: Is Workers' Compensation Covering Off-the-Job Injuries?.- 6 Premium and Loss Cycles in Workers' Compensation.- 7 Discounted Cash-Flow Ratemaking Models in Property-Liability Insurance.