Early COVID-19 pandemic modeling: Three compartmental model case studies from Texas, USA.

The novel coronavirus (SARS-CoV-2) emerged in late 2019 and spread globally in early 2020. Initial reports suggested the associated disease, COVID-19, produced rapid epidemic growth and caused high mortality. As the virus sparked local epidemics in new communities, health systems and policy makers were forced to make decisions with limited information about the spread of the disease. We developed a compartmental model to project COVID-19 healthcare demands that combined information regarding SARS-CoV-2 transmission dynamics from international reports with local COVID-19 hospital census data to support response efforts in three Metropolitan Statistical Areas (MSAs) in Texas, USA: Austin-Round Rock, Houston-The Woodlands-Sugar Land, and Beaumont-Port Arthur. Our model projects that strict stay-home orders and other social distancing measures could suppress the spread of the pandemic. Our capacity to provide rapid decision-support in response to emerging threats depends on access to data, validated modeling approaches, careful uncertainty quantification, and adequate computational resources.

Cumulative live birth rates and perinatal outcomes with the use of time-lapse imaging incubators for embryo culture: a retrospective cohort study of 1882 ART cycles.

OBJECTIVE: Comparison of live birth rates and the perinatal outcomes after fresh and frozen embryo transfer between time-lapse imaging (TLI) and standard culture (SC) incubators. DESIGN: Retrospective cohort study. SETTING: A single tertiary level IVF unit. POPULATION: Women undergoing IVF between January 2014 and October 2015. METHODS: Comparison was done between 1064 IVF cycles using TLI (TLI cycles) and 818 IVF cycles using SC (SC cycles). MAIN OUTCOME MEASURES: Cumulative live birth rate per oocyte retrieval and perinatal outcomes including birthweight, gestational age, preterm birth (PTB) (<37 weeks), early preterm birth (PTB; <32 weeks), low birthweight (LBW; <2500 g), very LBW (<1500 g) and macrosomia (>4500 g). RESULTS: The fresh embryo transfer live birth rate was noted to be higher for TLI cycles [TLI 36.8 versus SC 33.9%, adjusted odds ratio (aOR) 1.28, 95% CI 1.05-1.57], but the frozen embryo transfer live birth rates were not significantly different. The mean birthweight was higher in the TLI group after both fresh [adjusted mean difference (aMD) 174.78 g, 95% CI 64.80-284.77] and frozen embryo transfers (aMD 175.91 g, 95% CI 16.98-334.84). After a fresh embryo transfer, there was a lower risk of early PTB and very LBW in the TLI group. Among frozen embryo transfers, there was a lower risk of early PTB and LBW in the TLI group. CONCLUSIONS: TLI incubators are associated with improved perinatal outcomes and higher mean birthweight after fresh and frozen embryo transfer. TWEETABLE ABSTRACT: Time-lapse imaging incubators in IVF improve perinatal outcomes after both fresh and frozen embryo transfers.

The early history of the court.

The history of the juvenile court precedes its formal beginnings in the Illinois Juvenile Court Act of 1899. This article traces key trends in the early history of the court, beginning with the founding of separate penal institutions for children in the 1820s and ending with the development of critical analyses of court practice in the 1930s. The Illinois statute distinguished between delinquent and dependent youths. However, early nineteenth-century intervention typically did not make such a distinction: children convicted of crimes and children who were abandoned, abused, or simply very poor were often housed in the same institutions. Both criminal behavior and poverty were viewed as threats to the social order. In the second half of the nineteenth century, efforts were made to treat dependent and delinquent children differently. Private sectarian agencies were founded to remove noncriminal youths from their homes or the almshouses and "place them out," often either with families in other states or in industrial schools. The reform efforts behind the passage of the Illinois statute were intended to create improvements in the institutions that intervened on behalf of children. Reformers showed little concern for the procedures used in these interventions, and the resulting statutory language provides few procedural guidelines. Nineteenth-century practice had focused on assessing the children who came before the court for their fitness for rehabilitation and de-emphasized the adjudication of the offense itself. This practice continued after the development of the juvenile court at the turn of the century. The model for ideal juvenile court judicial practice--epitomized by judge Ben Lindsey of the Denver, Colorado, court--called for a rapport between judge and child and the personal involvement of the judge in the child's reformation. This personal treatment, though popular, came at the expense of the child's due process rights. The movement in the early twentieth century to involve mental health professionals in this rehabilitation diminished the court's direct involvement but did nothing to address procedural inadequacies. These were finally resolved in the due process cases of the 1960s and 1970s.

Negotiating the purchase of an HIS.

To summarize, do your homework. Don't accept the contract as it is presented. Negotiate the best deal you can. Be fair. And if you have done everything exactly right, keep your fingers crossed and hope the system doesn't crash.

Psychopathology and developmental delay in homeless children: a pilot study.

The authors report a survey of 50 parent-child pairs from homeless families housed in New York City hotels. The purpose of the survey was to determine the extent of emotional or behavioral disturbances and of developmental delays in homeless children aged 4 through 10 years, the presence of depression or a history of depression or other psychiatric problems in the parents of these children, and to determine whether the children and adults had mental health needs. The results indicate that nearly all of the children showed some difficulties. Sixty-one percent of the children had receptive verbal functioning at or below the first percentile for age, 29% were functioning at the fifth percentile for age in psychomotor ability, and 38% exhibited emotional and behavioral problems. Twenty-eight percent of the parents exhibited evidence of mild to severe depression; a smaller percentage admitted to past psychiatric problems.

Evaluation of a closed-tracheal suction system.

A new tracheo-bronchial closed-suction system has been recently introduced. The Trach Care catheter can be connected to the endotracheal tube of a patient on mechanical ventilation and be left in place as long as 24 h. Thus, suctioning does not require disconnection from the mechanical ventilator. We evaluated the benefits of this new system in 20 patients receiving mechanical ventilation; ten patients required PEEP of 10 cm H2O and under, while the other ten patients needed PEEP over 10 cm H2O to maintain acceptable oxygenation. PaCO2, arterial oxygen saturation, and alveolar-arterial oxygen tension difference were measured before and after suctioning, using a conventional catheter and the Trach Care closed-suction method. Oxygenation only deteriorated when the open technique was used in patients receiving over 10 cm H2O of PEEP. The changes were statistically, but not clinically, significant. The Trach Care system is approximately 25 times as expensive as conventional suctions catheter, so its use cannot be justified economically. A potential advantage of the technique is preventing the dissemination of contaminated secretions, which are dispersed when the patient is disconnected from the ventilator and inspiratory gas flow persists. While no universal advantage of the closed-suction system was found, potential benefits may be considered on a case-by-case basis.