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The prevalence of childhood asthma has risen significantly over the past four decades. A family history of atopic disease is associated with an increased likelihood of developing asthma, and environmental triggers such as tobacco smoke significantly increase the severity of daily asthma symptoms and the frequency of acute exacerbations. The goal of asthma therapy is to control symptoms, optimize lung function, and minimize days lost from school. Acute care of an asthma exacerbation involves the use of inhaled beta2 agonists delivered by a metered-dose inhaler with a spacer, or a nebulizer, supplemented by anticholinergics in more severe exacerbations. The use of systemic and inhaled corticosteroids early in an asthma attack may decrease the rate of hospitalization. Chronic care focuses on controlling asthma by treating the underlying airway inflammation. Inhaled corticosteroids are the agent of choice in preventive care, but leukotriene inhibitors and nedocromil also can be used as prophylactic therapy. Long-acting beta2 agonists may be added to one of the anti-inflammatory medications to improve control of asthma symptoms. Education programs for caregivers and self-management training for children with asthma improve outcomes. Although the control of allergens has not been demonstrated to work as monotherapy, immunotherapy as an adjunct to standard medical therapy can improve asthma control. Sublingual immunotherapy is a newer, more convenient option than injectable immunotherapy, but it requires further study. Omalizumab, a newer medication for prevention and control of moderate to severe asthma, is an expensive option. [ABSTRACT FROM AUTHOR]

A small outbreak of the gypsy moth, Lymantria dispar (L.), was discovered in June 1995 in the South Woodford area of northeast London, near Epping Forest. The origin of this outbreak remains unknown, but the eggs may have been transported from continental Europe, where major outbreaks occurred in the early 1990s. A risk assessment concluded that severe defoliation by this forest pest was unlikely to occur in the UK under current climatic conditions, but if the gypsy moth did become established, then sporadic damage to amenity tree species could be expected. Therefore an eradication programme was undertaken, which involved determining the extent of the outbreak area via population monitoring, and chemical treatments of any larval infestations, to prevent further spread. A series of targeted publicity campaigns was carried out with the aim of raising public awareness of the pest in the wider outbreak area. Details of gypsy moth finds (egg masses and larvae) and pheromone trap catches (adult males) are given for the years 1995 - 2003. Pheromone traps were maintained at a relatively high density ( c. 188 per 1 km 2 ) in the immediate outbreak area--and similarly in an adjacent portion of the Epping Forest--and it remains a possibility that some mating disruption has occurred. Although Lymantria dispar persists at this site, the numbers of adult male moths trapped has declined markedly in comparison to the first 2 years (1995 - 1996). The outbreak is, however, continuing to persist at a very low level and may be becoming more widely dispersed, albeit very sparsely. It is also possible that observed population trends in terms of pheromone trap catches reflect a natural population cycle, and for these reasons work is continuing in an attempt to eradicate this damaging broadleaf tree pest from the UK. [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To develop, validate, and cross-validate a formula for predicting resting energy expenditure (REE) in African-American and European-American women. DESIGN:: A cross-sectional study of REE in women. Participants were randomly assigned to one of two groups. One group served to develop and validate a new equation for predicting REE while the second was used to cross-validate the prediction equation. The accuracy of the equation was compared to several existing formulae. SETTING:: University metabolic laboratory, Memphis, TN, USA. SUBJECTS:: Healthy, premenopausal African-American and European-American women between 18 and 39?y of age. The validation sample included 239 women (age: 28.4?y, wt: 70.7?kg, body mass index (BMI): 25.2?kg/m2, REE: 5840?kJ/day), while the cross-validation sample consisted of 232 women (age: 27.5?y, wt: 70.7?kg, BMI: 25.2?kg/m2, REE: 5784?kJ/day). RESULTS:: The prediction equation derived from the current sample, which included adjustments for ethnicity, was the only formula that demonstrated a high level of accuracy for predicting REE in both African-American and European-American women. The mean difference between REE predicted from the new formula and measured REE was 28?kJ/day (s.d.=668) for European-American women and 142?kJ/day (s.d.=584) for African-American women. CONCLUSIONS:: Previous equations for predicting energy needs may not be appropriate for both African-American and European-American women due to ethnic differences in REE. A new equation that makes adjustments in predicted REE based on ethnicity is recommended for determining energy needs in these groups (Predicted REE (kJ/day)=616.93-14.9 (AGE (y))+35.12 (WT (kg))+19.83 (HT (cm))-271.88 (ETHNICITY: 1=African American; 0=European American)). SPONSORSHIP:: Support for this study was provided by Grant #HL53261 from the National Heart, Lung, and Blood Institute.European Journal of Clinical Nutrition (2004) 58, 474-480. doi:10.1038/sj.ejcn.1601833 [ABSTRACT FROM AUTHOR]

This study examined the relationship between socioeconomic status (SES) and environmental tobacco smoke (ETS) exposure among non-smoking females, determined which SES variable(s) were most strongly associated with ETS exposure, and examined whether the relationship between SES and ETS exposure was the same for Blacks and Whites. Participants were 404 never-smoker females recruited in the community. Independent variables included income, education, occupation, median income within zip code of participants' residence, and ethnicity. Number of days per week exposed to ETS in the past year was the dependent variable. There was a significant correlation between CO levels (parts per million, ppm) and self-reported ETS exposure (r = 0.22, p < 0.001). The mean CO level exposure was 1.81 +/- 1.19 ppm, and the mean number of days per week of ETS exposure was 4.72 +/- 4.71. The most frequent source of ETS exposure was at public places (64.4%). Although Blacks tended to report higher ETS exposure than Whites (p = 0.08), this tendency disappeared when SES indicators were entered in the model. Correlations among SES indicators were either non-significant or very modest suggesting that different SES indicators may not measure the same construct. Education was the only SES variable that was significantly associated with ETS exposure in this population. The relationship between SES and ETS exposure was similar for both Blacks and Whites. These findings suggest that education may be the most important factor to be considered when designing interventions to decrease ETS exposure among young non-smoking females (e.g., public education of the hazards of ETS exposure and awareness of existing tobacco-control laws and regulations). [ABSTRACT FROM AUTHOR]

Focuses on the training and education of doctors. How to learn and develop competency in medical education; Details on evidence-based medicine; Focus of traditional evidence-based medicine.

This article informs that during the past year several woody ornamental plants have been examined in the Plant Clinic at Wye. Isolation from stained vascular tissue has shown the presence of Verticillium dahliae Kleb. in a number of instances. All of the Mahonia and Viburnum samples came from a 2-year-old nursery of plants on a holding in Pulborough, West Sussex. The ground had previously been cropped with soft fruit, including strawberries, a known host of V. dahliae and it is likely that the soil was infested with microsclerotia of the pathogen. The

Objectives: Identifying skilled nursing facility (SNF) patients at risk for hospitalization or death is of interest to SNFs, patients, and patients' families because of quality measures, financial penalties, and limited clinical staffing. We aimed to develop a predictive model that identifies SNF patients likely to be hospitalized or die within the next 7 days and validate the model's performance against clinician judgment., Design: Retrospective multivariate prognostic model development study., Setting and Participants: Patients in US SNFs that use the PointClickCare electronic health record (EHR) system. We used data from the first 100 days of skilled stays for 5,642,474 patients in 8440 SNFs, from January 1, 2019, through March 31, 2023., Methods: We used data collected in the course of clinical care to develop a machine learning model to predict the likelihood of patient hospitalization or death within the next 7 days. The data included vital signs, diagnoses, laboratory results, food intake, and clinical notes. We also asked SNF nurses and hospital case managers to make their own predictions as a comparison. The EHR was used as the source of information on whether the patient died or was hospitalized., Results: The model had sensitivity of 35%, specificity of 92%, positive predictive value (PPV) of 18%, and area under the receiver operator curve (AUC) of 0.75. A variation of the model in which we did not include progress notes and food intake achieved an AUC of 0.70. Nurse raters achieved a sensitivity of 61%, specificity of 73%, and PPV of 10%., Conclusions and Implications: Machine learning models can accurately predict the likelihood of hospitalization or death within the next 7 days among SNF patients. These models do not require additional SNF staff time and may be useful in readmission reduction programs by targeting more frequent monitoring proactively to those at highest risk., Competing Interests: Disclosure B.K., C.F., J.K., and D.S. are employees of PointClickCare Technologies, Inc. The model described in this paper is available to customers of PointClickCare Technologies, Inc. through additional modules, but is not included in the core electronic medical record. J.G.O. is a full-time employee of Florida Atlantic University (FAU) and currently receives support from PointClickCare Technologies, Inc. for work on the Interventions to Reduce Acute Care Transfers (INTERACT) program. He also serves as a paid advisor to and receives licensing royalties from Pathway Health. Work on funded INTERACT research and training has been approved by the FAU Financial Conflict of Interest Committee (COI), and he is not involved in primary data analyses based on the Committee's COI plan. He has also received support in the past from the National Institutes of Health, the Centers for Medicare & Medicaid Services, PointClickCare Technologies, The Commonwealth Fund, the Retirement Research Foundation, the Florida Medical Malpractice Joint Underwriting Association, Medline Industries, and Think Research., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'IV: perspectives on practice-lenses of appreciation', authors address the following themes: 'Relational connections in the doctor-patient partnership', 'Feminism and family medicine', 'Positive family medicine', 'Mindful practice', 'The new, old ethics of family medicine', 'Public health, prevention and populations', 'Information mastery in family medicine' and 'Clinical courage.' May readers nurture their curiosity through these essays., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Purpose: To investigate telehealth use for contraceptive service provision among rural and urban federally qualified health centers (FQHCs) in Alabama (AL) and South Carolina (SC) during the initial months of the COVID-19 pandemic., Methods: This is a mixed-methods study using data from the FQHC Contraceptive Care Survey and key informant interviews with FQHC staff in AL and SC conducted in 2020. Differences between rural and urban clinics in telehealth use for contraceptive service provision were assessed with a chi-square test of independence. Interviews were audio recorded, transcribed, and coded to identify facilitators and barriers to telehealth., Findings: Telehealth for contraceptive care increased during the early months of the pandemic relative to prepandemic. Fewer rural clinics than urban clinics provided telehealth for contraceptive counseling (16.3% vs 50.6%) (P = .0002), emergency contraception (0.0% vs 16.1%) (P = .004), and sexually transmitted infection care (16.3% vs 34.6%) (P = .031). Key facilitators of telehealth were reimbursement policy, electronic infrastructure and technology, and funding for technology. Barriers included challenges with funding for telehealth, limited electronic infrastructure, and reduced staffing capacity., Conclusions: Differences in telehealth service provision for contraceptive care between rural and urban FQHCs highlight the need for supportive strategies to increase access to care for low-income rural populations, particularly in AL and SC. It is essential for public and private entities to support the implementation and continuation of telehealth among rural clinics, particularly, investing in widespread and clinic-level electronic infrastructure and technology for telehealth, such as broadband and electronic health record systems compatible with telehealth technology., (© 2022 National Rural Health Association.)