Search

People with limited English proficiency in the United States have suffered disproportionate negative health outcomes during the COVID-19 pandemic. Effective communications are critical tools in addressing inequities insofar as they can motivate adoption of protective behaviors and reduce incidence of disease; however, little is known about experiences of communities with limited English proficiency receiving relevant information during COVID-19 or other outbreaks. To address this gap and provide inputs for communication strategies, we completed a study based on 2 novel and nationally representative surveys conducted between June and August 2020 among Spanish and Chinese speakers with limited English proficiency (n = 764 and n = 355, respectively). Results first showed that Spanish and Chinese speakers did not consistently receive information about protective behaviors from key public health and government institutions early in the pandemic. Second, for such information, Spanish and Chinese speakers used a diverse set of information resources that included family and friends, social media, and traditional media from both inside and outside the United States. Third, Spanish and Chinese speakers faced challenges getting COVID-19 information, including receiving media messages that felt discriminatory toward Latinx or Chinese people. Together, these findings suggest gaps in effectively reaching Spanish and Chinese speakers. Data highlight the important role of bilingual materials to support sharing of information between Spanish or Chinese speakers and English speakers within their social networks, and the need for digital news content for traditional and social media. Finally, efforts are needed to address discriminatory messaging in media and to actively counter it in public health communications.

Domestic travel creates a serious risk of spreading COVID-19, including novel strains of the virus. Motivating potential travelers to take precautions is critical, especially for those at higher risk for severe illness. To provide an evidence base for communication efforts, we examined the experiences and views of travelers during the summer of 2020 through a telephone survey of 1,968 US adults, conducted in English and Spanish, July 2 through July 16, 2020. The survey found that more than one-quarter (28%) of adults had traveled domestically in the prior 30 days, most commonly for "vacation" (43%), and less than half wore masks (46%) or practiced social distancing (47%) "all of the time." Although high-risk adults were significantly less likely to travel than non-high-risk adults (23% vs 31%; P < .001), they were no more likely to take precautions. Many travelers did not wear a mask or practice social distancing because they felt such actions were unnecessary (eg, they were outside or with friends and family). Although a substantial share of travelers (43% to 53%) trusted public health agencies "a great deal" for information about reducing risks while traveling, more travelers (73%) trusted their own healthcare providers. Findings suggest that outreach may be improved by partnering with providers to emphasize the benefits of layering precautions and provide targeted education to high-risk individuals. Messages that are empathetic to the need to reduce stress and convey how precautions can protect loved ones may be particularly resonant after more than a year of pandemic-related restrictions.

Thioredoxins constitute a key class of oxidant defense enzymes that facilitate disulfide bond reduction in oxidized substrate proteins. While the WCGPCK active site motif is highly conserved in traditional model organisms, predicted thioredoxins from newly sequenced genomes show variability in this motif, making ascertaining which genes encode functional thioredoxins with robust activity a challenge. To address this problem, we conducted a semi-saturation mutagenesis screen of approximately 70 thioredoxin variants harboring mutations adjacent to their catalytic cysteines, making the substitutions in the Saccharomyces cerevisiae thioredoxin Trx2. Using this library, we determined how such substitutions impact oxidant defense in yeast along with how they influence disulfide reduction and interaction with binding partners in vivo. The majority of thioredoxin variants screened rescued the slow growth phenotype that accompanies deletion of the yeast cytosolic thioredoxins; however, the ability of these mutant proteins to protect against H2O2-mediated toxicity, facilitate disulfide reduction, and interact with redox partners varied widely, depending on the site being mutated and the substitution made. We report that thioredoxin is less tolerant of substitutions at its conserved tryptophan and proline in the active site motif, while it is more amenable to substitutions at the conserved glycine and lysine. Our work highlights a noteworthy plasticity within the active site of this critical oxidant defense enzyme.

Objective To describe survey methods used to examine reported experiences of discrimination against African Americans, Latinos, Asian Americans, Native Americans, women, and LGBTQ (lesbian, gay, bisexual, transgender, and queer) adults. Data source and study design Data came from a nationally representative, probability-based telephone survey of 3453 US adults, conducted January-April 2017. Methods We examined the survey instrument, sampling design, and weighting of the survey, and present selected survey findings. Principal findings Examining reported discrimination experienced by multiple groups in a telephone survey requires attention to details of sampling and weighting. In health care settings, 32 percent of African Americans reported discrimination, as did 23 percent of Native Americans, 20 percent of Latinos, 18 percent of women, 16 percent of LGBTQ adults, and 13 percent of Asian Americans. Also, 51 percent of LGBTQ adults, 42 percent of African Americans, and 38 percent of Native Americans reported identity-based violence against themselves or family members; 57 percent of African Americans and 41 percent of women reported discrimination in pay or promotions; 50 percent of African Americans, 29 percent of Native Americans, and 27 percent of Latinos reported being discriminated against in interactions with police. Conclusions Even the small selection of results presented in this article as examples of survey measures show a pattern of substantial reported discrimination against all six groups studied.

BACKGROUND: Seasonal influenza vaccination rates among pregnant women remain well below the Healthy People 2020 target of 80%. Obstetrician–gynecologist (OB/GYN) recommendations are a critical means of encouraging pregnant women to get vaccinated, but there are limited data about their views. MATERIALS AND METHODS: A nationally representative survey of 506 practicing OB/GYNs was completed between October 26, 2015, and May 8, 2016. Analyses included univariate distributions and comparisons based on age, size of practice, and academic affiliation using all-pairs, dependent t-tests. RESULTS: A majority of OB/GYNs report they ‘‘strongly recommend’’ seasonal influenza vaccination for their pregnant patients in the first (79%) or second and third trimesters (81%). Among those who do not strongly recommend the flu vaccine in the first trimester, many say this is because of their own concerns (28%) or their patients’ concerns (44%) about safety. Older OB/GYNs, those in smaller practices, and those without academic affiliation were less likely to recommend the vaccine and more likely to have safety concerns. For example, 72% of those age 60+ strongly recommended the vaccine in the second and third trimester, compared with 86% of those ages 30–44 and 83% of those ages 45–59 ( p < 0.05 for all comparisons). CONCLUSIONS: OB/GYNs across the country largely support seasonal flu vaccination among pregnant women. Nonetheless, safety is a concern for them and their patients. Outreach to support clinician decisions and conversations with pregnant patients may be most needed among older physicians, those in smaller practices, and those without academic affiliation.

Background: Medication use among pregnant women is widespread, despite limited evidence about the teratogenicity of most medications. Improved physician-patient communication about pregnancy-related medication safety has been identified as a strategy to address this critical issue; however, little is known about physicians' knowledge, attitudes, and practices that could inform tools for information access and sharing to support such communication. The primary objective of this study is to address gaps in what is known about obstetrician-gynecologist views, practices, and needs related to accessing and sharing pregnancy-related medication safety information with patients. Materials and Methods: The basis for this study is a nationally representative, randomized survey of 506 practicing obstetrician-gynecologists. The survey was completed by mail or online between October 26, 2015 and May 8, 2016 with a 52% response rate. Data were weighted to population parameters to reduce the risk of potential nonresponse biases. Analyses included univariate distributions and comparisons between physicians in different residency cohorts using all-pairs dependent t-tests. Results: Findings point to critical features of obstetrician-gynecologist access and sharing of medication safety information. Obstetrician-gynecologists often retrieve medication safety information during a clinical visit. There is widespread provision of potentially problematic "safe lists" to patients, particularly by younger cohorts, and limited counseling for reproductive-aged patients not actively planning a pregnancy. Conclusions: To improve clinical care, physician-patient communication may be enhanced with technical and policy solutions, including improved digital information tools for retrieving and discussing information in the clinical setting; evidence-based, written information for physicians to share with patients; and encouragement for counseling all women of reproductive age receiving teratogenic medications.

Background Using a survey conducted during the 2013–2014 polio outbreak in Somalia, this study examines attitudinal and knowledge-based threats to oral polio vaccine acceptance and commitment. Findings address a key gap, as most prior research focuses on endemic settings. Methods Between November 19 and December 21, 2013, we conducted interviews among 2003 caregivers of children under 5 years in select districts at high risk for polio transmission. Within each district, sample was drawn via a multi-stage cluster design with random route household selection. We calculated the percentage of caregivers who could not confirm recent vaccination and those uncommitted to future vaccination. We compared these percentages among caregivers with varying knowledge and attitudes, focusing on variables identified as threats in endemic settings, using controlled and uncontrolled comparisons. We also examined absolute levels of threat variables. Results Only 10% of caregivers could not confirm recent vaccination, but 32% were uncommitted to future vaccination. Being unvaccinated or uncommitted were related to multiple threat variables. For example, compared with relevant counterparts, caregivers were more likely to be unconfirmed and uncommitted if they did not trust vaccinators “a great deal” (unconfirmed: 9% vs. 2%; uncommitted: 49% vs. 28%), which is also true in endemic settings. Unlike endemic settings, symptom knowledge was related to commitment while rumor awareness was low and unrelated to past acceptance or commitment. Levels of trust and perceptions of OPV effectiveness were high, though perceptions of community support and awareness of logistics were lower. Conclusions As in endemic settings, outbreak responses will benefit from communications strategies focused on enhancing trust in vaccinators, institutions and the vaccine, alongside making community support visible. Disease facts may help motivate acceptance, and enhanced logistics information may help facilitate caregiver availability at the door. Quelling rumors early may be important to prevent them from becoming threats.

Antiviral drugs are likely to be a frontline countermeasure needed to minimize disease impact during an influenza pandemic. As part of pandemic influenza preparedness efforts, the Centers for Disease Control and Prevention, in coordination with state health departments, has plans in place to distribute and dispense antiviral drugs from public stockpiles. These plans are currently under review and include evaluation of the benefits of commercial distribution and dispensing through community pharmacies. To ensure this alternative distribution and dispensing system is viable, it is critical to assess pharmacist acceptability and to understand the pharmacist perspective on dispensing these antivirals during a response. In this study, we examine community pharmacist reactions to the proposed alternative antiviral distribution and dispensing system using a nationally representative survey of pharmacists. Overall, pharmacists were highly receptive to this alternative system and voiced a willingness to participate personally, and most thought their own pharmacy would participate in such an effort. This was true across pharmacists with different personal and professional backgrounds, as well as those in different pharmacy settings. However, sizable shares of pharmacists said they were worried about facing shortages of the antivirals, the risk of exposure to disease for themselves and their families, managing their usual patients who need their prescriptions filled for medications other than antivirals, keeping order in the pharmacy, and potential liability concerns. These findings should be interpreted as an indication of acceptability of the concept, encouragement for the next steps in alternative distribution and dispensing system design, and a guide to potential barriers that may need to be addressed proactively.

Travelers to areas with Zika virus transmission are at risk of infection and of transmitting the virus after returning home. While protective behaviors during and after travel can reduce these risks, information about traveler practices or underlying views is limited. We examined these issues using data from the first representative poll of travelers from US states to Zika-affected areas, including US territories and Miami, Florida, conducted December 1 to 23, 2016. We analyzed results among all travelers (

Introduction. Parents play a critical role in their children’s weight. This paper examines parents’ perceptions about the challenges to helping their kids maintain or achieve a healthy weight. Methods. We analyzed data in 2017 from a U.S. telephone poll conducted during October-November 2012 among parents or caregivers of children aged 2–17 years using a nationally representative sample of households. It included 667 White, 123 Black, and 167 Hispanic parents. Multiple logistic regressions were used to examine parent perceptions about the individual- and environmental-level challenges to helping their children maintain or achieve a healthy weight. Results. Overall, 45% of children have parents who reported challenges helping the child eat to maintain or achieve a healthy weight, and 35% have parents who reported challenges for exercise. According to parents, most children consumed snacks between 3 pm and bedtime during the school week (83%), and 63% of those children had an unhealthy snack. Parents did not express much concern about unhealthy snacks; 80% of children had parents who said that they did not mind since their child generally ate healthy food. Children with Hispanic and Black parents were more likely than those with White parents to have parents reporting environment challenges, such as unhealthy foods in schools. Conclusions. Helping children maintain a healthy weight through diet is a problem for many parents, regardless of their race or ethnicity. Differences by race/ethnicity in parent perceptions of food environment challenges to helping their child maintain or achieve a healthy weight suggest possible areas for future interventions.

Aim This study aimed to investigate the results of salvage abdominoperineal resection (APR) in patients with persistent or recurrent squamous cell carcinoma of the anus (SCCA). Method Patients with anal neoplasia were identified from a prospective database. Patients with invasive SCCA with demonstrated failure of chemoradiation therapy (CRT) who underwent salvage APR for one of three disease categories (persistent: 24 months) were included. The primary outcome was overall survival after salvage APR. Tumour size, metastatic lymph nodes (LN), circumferential-resection margin positivity (CRM), and neurolymphovascular invasion (NLVI) were correlated with the outcome. Results Thirty-six patients with a median 3-year overall survival of 46% (median follow-up: 24 months) underwent salvage APR due to persistent or recurrent SCCA (14 male, mean age 59 years). Eleven (31%) patients were diagnosed with persistent disease, 17 (47%) with early and 8 (22%) with late recurrence. Two-year overall survival of stage 0/I/II and III/IV disease was 81.5% and 33.74% (p=0.022). Overall disease stage was associated with disease categorization (p=0.009): patients with persistent disease or early recurrence had a significantly higher disease stage than patients with late recurrence (OR = 20.9 and 17.2). Despite apparently improved survival in patients with late disease recurrence on live table analysis, no significant difference was identified in overall survival when stratified by disease category on log-rank test analysis. Conclusion Persistent and recurrent disease does not show any significant difference in survival, but patients with late recurrence may have a better prognosis. This article is protected by copyright. All rights reserved.

Background: As public health leaders prepare for possible future influenza pandemics, the rapid spread of 2009 H1N1 influenza highlights the need to focus on measures the public can adopt to help slow disease transmission. Such measures may relate to hygiene (e.g., hand washing), social distancing (e.g., avoiding places where many people gather), and pharmaceutical interventions (e.g., vaccination). Given the disproportionate impact of public health emergencies on minority communities in the United States, it is important to understand whether there are differences in acceptance across racial/ethnic groups that could lead to targeted and more effective policies and communications. Objectives: This study explores racial/ethnic differences in the adoption of preventive behaviors during the 2009 H1N1 influenza pandemic. Patients/Methods Data are from a national telephone poll conducted March 17 to April 11, 2010, among a representative sample of 1123 white, 330 African American, 317 Hispanic, 268 Asian, and 262 American Indian/Alaska Native adults in the USA. Results: People in at least one racial/ethnic minority group were more likely than whites to adopt several behaviors related to hygiene, social distancing, and healthcare access, including increased hand washing and talking with a healthcare provider (P-values

The Latino population in the US is projected to grow substantially in the years ahead. Although often referred to as a single group, Latinos are not homogeneous. This article, based mainly on a national telephone survey of 1,478 Latino adults, examines the perspectives of six Latino heritage groups on the health care issues they face. The six groups differ in their reported health care experiences in: the types facilities they use in getting medical care, their ratings of the quality of care they receive, their experiences with discrimination in getting quality care, the level of confidence they have in being able to pay for a major illness. One thing the heritage groups agree on is that diabetes is the biggest health problem facing their families. Community health leaders, particularly at the state level, need to focus on the specific Latino groups in their state or area and their unique situations.

Using national polling data from the U.S.A., this study assessed differences between older (>64) and younger (18–64) adults in their levels of concern about getting sick from a hypothetical outbreak and their likelihood of adopting each of several protective behaviors in response to a warning and a recall. Concern levels among older adults were lower than younger adults when outbreak-related illnesses were reported in the same state or town as the respondent, but concern among both increased as cases were reported in closer geographic proximity. Majorities of both older and younger adults reported that they were very likely to adopt a range of recommended protective behaviors, but older adults were less likely to adopt many. For example, if the outbreak was described as mild (no deaths), older adults were less likely to stop purchasing affected items and throw out affected items in the home. Under a severe scenario (with deaths), older adults were also less likely to take several actions, including throwing out the affected item, not purchasing the affected item at stores that sell groceries and not ordering the affected item in restaurants. Practical Applications The findings from this study suggest there need to be improved communications to older adults in regard to foodborne illness outbreaks. Future communications should focus more on providing actionable information regarding ways that consumers can change their behavior to reduce their risk of infection. For example, it may be important to highlight clear directions for identifying recalled units of foods or drinks so older adults can easily find them if they are in their own kitchens. Communications should also include channels that are better targeted toward older consumers, such as networks of senior services. Materials should follow guidelines that have been shown to be effective with older adults, such as including basic changes like larger font sizes and clear graphics on printed materials.

Summary Background Eradication of poliovirus from endemic countries relies on vaccination of children with oral polio vaccine (OPV) many times a year until the age of 5 years. We aimed to determine caregivers' commitment to OPV in districts of Afghanistan at high risk for polio transmission and to examine what knowledge, attitudes, or experiences could threaten commitment. Methods We designed and analysed a poll using face-to-face interviews among caregivers of children under 5 years of age. The sample was drawn via a stratified multistage cluster design with random route household selection. We calculated the percentage of committed and uncommitted caregivers. All percentages were weighted. We then compared percentages of uncommitted caregivers among those with varying knowledge, attitudes, and experiences, using logistic regression to control for possible demographic confounders. Findings Between Dec 19, 2014, and Jan 5, 2015, we interviewed 1980 caregivers, 21% of whom were "uncommitted" to accepting OPV. Multiple measures of knowledge, attitudes, and experiences are associated with lack of commitment. For example, compared with their relevant counterparts, caregivers are more likely to be uncommitted if they did not trust vaccinators "a great deal" (54% vs 9%), if they do not know that polio spreads through contaminated water (41% vs 14%), or if they believe rumours that OPV is not halal (50% vs 21%). Interpretation To enhance OPV commitment, it might be useful to consider a multifactorial approach that highlights building trust in vaccinators, providing facts about transmission, sharing positive messages to overcome key rumours, and strengthening community support for vaccination. Funding Harvard T H Chan School of Public Health and UNICEF.

The 2001 anthrax attacks emphasized the need to develop outreach that would more effectively support racial/ethnic minority populations during a bioterrorism incident. Given the importance of antibiotic prophylaxis in a future anthrax attack, it should be a priority to better support racial/ethnic minorities in mass dispensing programs. To examine the needs and perspectives of racial/ethnic minorities, this study used a nationally representative poll of 1,852 adults, including 1,240 whites, 261 African Americans, and 282 Hispanics. The poll examined public reactions to a ''worst-case scenario'' in which cases of inhalation anthrax are discovered without an identified source and the entire population of a city or town is asked to receive antibiotic prophylaxis within 48 hours. Findings suggest willingness across all racial/ethnic groups to comply with recommendations to seek prophylaxis at dispensing sites. However, findings also indicate possible barriers for racial/ethnic minorities, including greater concern about pill safety and multiple attacks as well as lesser knowledge about inhalation anthrax. Across all racial/ethnic groups, roughly half would prefer to receive antibiotics at mass dispensing sites rather than through the US Postal Service. People in racial/ethnic minority groups were more likely to say this preference stems from a desire to speak with staff or to exchange medication formulation or type. Findings suggest the need for tailored outreach to racial/ethnic minorities through, for example, emphasis on key messages and enhanced understandability in communications, increased staff for answering questions in relevant dispensing sites, and long-term trust building with racial/ethnic minority communities.

Popular participation lies at the core of democratic governance, yet the mediated conversation of politics has largely been limited to elite sources and professional journalists. New technological alternatives to the mass communication model create opportunities for the non-elite “demotic voice” in the mediated public sphere. However, the expansion of who speaks is not without tensions or efforts by traditionally powerful voices to retain control over communication channels. This article analyzes struggles surrounding the growing role of the demotic voice through a case study analysis of the 2007 CNN/YouTube debates among candidates for the US presidency.

In the aftermath of Hurricane Katrina, race played a defining role in the public reckoning of the disaster. This study explores the relationship between the composition of images appearing in news stories, race, and attribution of responsibility with the events surrounding Katrina as the backdrop. In the context of this racially charged disaster, we seek to extend the existing research on the mechanisms underlying attribution of responsibility by focusing on the differences between Black and White U.S. citizens’ attribution patterns. The two fundamental concerns central to this undertaking are: Do images of victims make people more or less likely to believe the government was at fault for the human tragedy that followed the storm? And, do images affect White and Black people differently? News coverage is at the core of this discussion because it is the primary source of information that people have as distant events unfold. Prior communication research clearly suggests that the way the news is told broadly affects attribution of

Although political interviews have been a mainstay of U.S. television, they are undertheorized in the media effects tradition. This article seeks to ground possible interview effects into theory—particularly to recent developments in the study of incivility and its effect on public opinion. An experiment-based study finds that viewers are likely to think more negatively about journalists in an environment marked by uncivil interviewing. At the same time, exposure to interviews perceived as not sufficiently adversarial could also reduce trust in journalists, which suggests that the effect extends beyond the question of incivility, depending on viewers' expectations. Beyond the particular findings, this study indicates the possibilities of a research agenda centering on political televised interviews and their social implications. Les effets de l’interview : theorie et indices de l’impact des interviews politiques televisees sur les attitudes des telespectateurs E. Ben-Porath Bien que les interviews politiques constituent un pilier de la television americaine, elles sont sous-theorisees dans la tradition des effets mediatiques. Cet article cherche a ancrer des effets possibles des entrevues dans la theorie et particulierement dans certains recents developpements de l’etude du manque de civilite et de ses effets sur l’opinion publique. Une etude experimentale revele que les telespectateurs sont susceptibles de penser plus de mal des journalistes dans un environnement marque par des techniques d’interview manquant de civilite. Parallelement, l’exposition a des interviews percues comme n’etant pas suffisamment conflictuelles pourrait egalement reduire la confiance en les journalistes, ce qui suggere que l’effet va au-dela de l’enjeu du manque de civilite, tout dependant des attentes des telespectateurs. En-dehors des resultats specifiques, cette etude indique les possibilites d’un programme de recherche se concentrant sur les interviews politiques televisees et leurs consequences sociales. Intervieweffekte: Theorie und Evidenz fur einen Einfluss von politischen Interviews im Fernsehen auf die Einstellung der Zuschauer E. Ben-Porath Auch wenn politische Interviews im amerikanischen Fernsehen allgegenwartig sind, werden sie im Sinne einer Medienwirkungsperspektive theoretisch nicht ausreichend fundiert betrachtet. Dieser Artikel ist ein Versuch, mogliche Effekte von Interviews auf die offentliche Meinung herauszuarbeiten und zu diskutieren. Ergebnisse einer Experimentalstudie zeigen, dass Zuschauer eher negativ uber Journalisten denken, wenn das Interviewumfeld als eher unhoflich eingeschatzt wurde. Gleichzeitig verringern Interviews, die als nicht kontrovers genug eingeschatzt werden, das Vertrauen in den Journalisten, was wiederum darauf hindeutet, dass der Effekt uber den Aspekt der Unhoflichkeit hinausgeht und von den Erwartungen der Zuschauer abhangt. Neben diesen spezifischen Ergebnissen zeigt die Studie Moglichkeiten einer Forschungsagenda fur politische Fernsehinterviews und ihre sozialen Implikationen. Los Efectos de la Entrevista: La Teoria y Evidencia del Impacto de las Entrevistas Politicas Televisadas sobre las Actitudes de los Televidentes E. Ben-Porath Research SSRS, 53 W. Baltimore Pike, Media, PA 19063, USA Resumen Aunque las entrevistas politicas han sido una de las estadias principales de la television de los Estados Unidos, son poco teorizadas dentro de la tradicion de los efectos de los medios. Este articulo busca anclar los efectos posibles de la entrevista dentro de la teoria—particularmente los desarrollos en el estudio de la incivilidad y sus efectos sobre la opinion publica. Un estudio basado en un experimento encuentra que los televidentes piensan mas probablemente en forma negativa acerca de los periodistas en un ambiente marcado por la entrevista incivil. Al mismo tiempo, la exposicion a entrevistas percibidas como no suficientemente adversarias pueden reducir tambien la confianza en los periodistas, lo cual sugiere que los efectos se extienden mas alla de la pregunta sobre la incivilidad, dependiendo de las expectativas de los televidentes. Mas alla de los hallazgos particulares, este estudio indica las posibilidades de una agenda de investigacion centrada en las entrevistas politicas televisadas y las implicaciones sociales.

Televised political debates are highly effective tools for familiarizing prospective voters with the field of candidates during primary campaigns. However, the questions journalists ask in such debates often diminish the degree to which viewers can truly compare one candidate to the next. An analysis of questions asked in two debates at the height of the 2004 primaries finds the standard of comparability repeatedly violated as well as a clear pattern of inequity in the distribution of questions among candidates. Questions asked in these crucial debates imposed labels and domains on the candidates, through a particularly hostile line of questioning directed at the viable contenders. This article provides a tool for identifying question bias and emphasizes the need to address this understudied aspect of debates in light of its importance.

An analysis of presidential rhetoric in the post-Cold War era finds that in building the case for imminent war, presidents turn to narrative descriptions of specific atrocities, namely rape, torture, and victimization of children. By the same token, presidents wishing to avoid American involvement in war use abstract terms and statistical information concerning human rights crises, but refrain from detailing personalized stories of abuse. This study expands on the theory of savagery as a necessary component in enemy construction and on the literature concerning the changing rhetorical landscape of the post-Cold War era. The analysis finds the rhetoric of atrocities employed and avoided, in similar fashion, by three presidents and across several different settings. The implications are discussed in the article.

Unlike the edited news package, which dominates network and local news in America, the cable news channels recount the day's news predominantly through conversation, a format dubbed here dialogical news. At the center of this article is the concept of internal fragmentation, a consequence of the turn to conversation-based reporting, and its central implications: (1) the authority of the news reporter diminishes; (2) question-asking replaces fact-checking; (3) news organizations relinquish their accountability for news content; and (4) the news audience assumes the role of witness or participant rather than receiver. As dialogical news becomes prominent in the repertoire of viewers, short- and long-term prospects are suggested here. In the short-run, journalists are losing their battle to control their sources and maintain their gatekeeping function. In the long run, journalism might lose its significance as society's reflexive storyteller, reverting instead to its former role as a partisan instrument, a s...

ObjectiveTo provide a more comprehensive view than previously available of US physician preparedness for public health emergencies, this study examined physicians’ assessments of their preparedness, training, participation in institutional activities, information practices, and experiences with patient education. Four kinds of public health emergencies were considered: natural disasters, major airborne infections, major foodborne illness outbreaks, and chemical, biological, radiological, nuclear, or explosives (CBRNE) incidents.MethodsBetween October 19, 2011, and January 11, 2012, researchers conducted a national poll among 1603 practicing physicians in a range of specialties in hospital and nonhospital settings.ResultsMore than one-half of physicians felt prepared to handle a natural disaster, a major outbreak of an airborne infection, or a major foodborne illness outbreak, whereas one-third (34%) felt prepared to handle a CBRNE incident. About one-half of physicians (55%) had participated in training or a conference related to emergencies in the past 2 years. Sizable fractions of physicians were unaware of emergency response tools in their care setting. For example, nearly one-half in hospitals (44%) did not know whether their care setting had an emergency response plan, and less than one-quarter had participated in a drill using such a plan in the past 2 years. Less than one-third (31%) of physicians had signed up to receive alerts in the case of future emergencies. One in 10 reported sharing emergency information with patients at least “sometimes.”ConclusionsSignificant gaps remain in physician preparedness for public health emergencies, as well as in related training and participation in institutional activities. New efforts, with a focus on possible collaborations between public health institutions and health system leaders combined with effective use of online resources, are needed to bring more physicians on board and to develop relevant and useful key tools. New approaches, including those that rely on different types of care providers, may be needed to enhance patient education regarding emergency preparedness. (Disaster Med Public Health Preparedness. 2015;9:666–680)

Summary Background Elimination of poliovirus from endemic countries is a crucial step in eradication; however, vaccination programmes in these areas face challenges, especially in regions with conflict. We analysed interviews with caregivers of children living in two polio-endemic countries to assess whether these challenges are largely operational or also driven by resistance or misinformation in the community. Methods We designed and analysed polls based on face-to-face interviews of a random sample of parents and other caregivers of children younger than 5 years in regions of Pakistan and Nigeria at high risk for polio transmission. In both countries, the sample was drawn via a stratified multistage cluster design with random route household selection. The questionnaire covered awareness, knowledge, and attitudes about polio and oral polio vaccine (OPV), trust in vaccination efforts, and caregiver priorities for government action. We assessed experiences of caregivers in accessible higher-conflict areas and compared their knowledge and attitudes with those in lower-conflict areas. Differences were tested with two-sample t tests. Findings The poll consisted of 3396 caregivers from Pakistan and 2629 from Nigeria. About a third of caregivers who responded in higher-conflict areas of Pakistan (Federally Administered Tribal Areas [FATA], 30%) and Nigeria (Borno, 33%) were unable to confirm that their child was vaccinated in the previous campaign. In FATA, 12% of caregivers reported that they were unaware of polio, and in Borno 12% of caregivers reported that vaccinators visited but their child did not receive the vaccine or they did not know whether the child was vaccinated. Additionally, caregivers in higher-conflict areas are less likely to hold beliefs about OPV that could motivate acceptance and are more likely to hold concerns than are caregivers in lower-conflict areas. Interpretation Beyond the difficulties in reaching homes with OPV, challenges for vaccination programmes in higher-conflict areas extend to limited awareness, negative attitudes, and gaps in trust. Vaccination efforts might need to address underlying attitudes of caregivers through direct communications and the selection and training of local vaccinators. Funding Harvard T H Chan School of Public Health and UNICEF.

Disclosures outside of the scope of this work: Dr Wexn for Century Medial, Cubist, Incontinence Devices, Inc., K copy America, LifeBond, Mederi Therapeutics, Medt Pacira Pharmaceutical, Precision Therapeutics Renew, M Therapeutics. Dr Wexner also holds patents for Cov Endoscopy America, novoGI, Unique Surgical Innovat in LifeBond, and has other financial relationships with EZ Surgical, Intuitive Surgical, Neatstitch, and novoGI. have no additional disclosures.