Ab.l'tract.Despite the frequent associ;.ntl..-m of respiratory symptoms and signs with malarial morbidity and mortality in sub-Saharan Africa, the value of m..ii\.idual symptoms and signs has rarely been assessed. We have prospectively examined the association of indivt~u3.\ clinical findings with the summary diagnosis of respiratory distress, outcome, and the presence of metabolic aL=:ldl..'~is in children admitted with severe malaria to a Kenyan district hospital. Respiratory distress was present in 119 (.'r:-the 350 children included in the study and in 23 of the 30 deaths (relative risk := 6.5, 95% confidence interval = ::~-14.4).The features of a history of dyspnea, nasal flaring, and indrawing or deep breathing (Kussmaul's respiration-. ' \\'ere individually most closely associated with the summary diagnosis of respiratory distress. Of these, deep breatlnm~. which was sensitive (91 %) and specific (83%) for the presence of severe metabolic acidosis (base excess :5 -12). ~:,; the best candidate sign to represent the prognostically important syndrome of malarial respiratory distress, Therefo~-, it warrants further prospective evaluation in different clinical settings and areas of different malaria endemicity.

BackgroundIn patients with acute hypercapnic respiratory failure (AHRF) during exacerbations of COPD, mortality can be high despite noninvasive ventilation (NIV). For some, AHRF is terminal and NIV is inappropriate. However there is no definitive method of identifying patients who are unlikely to survive. The aim of this study was to identify factors associated with inpatient mortality from AHRF with respiratory acidosis due to COPD.MethodsCOPD patients presenting with AHRF and who were treated with NIV were studied prospectively. The forced expiratory volume in 1 second (FEV1), World Health Organization performance status (WHO-PS), clinical observations, a composite physiological score (Early Warning Score), routine hematology and biochemistry, and arterial blood gases prior to commencing NIV, were recorded.ResultsIn total, 65 patients were included for study, 29 males and 36 females, with a mean age of 71 ± 10.5 years. Inpatient mortality in the group was 33.8%. Mortality at 30 days and 12 months after admission were 38.5% and 58.5%, respectively. On univariate analysis, the variables associated with inpatient death were: WHO-PS ≥ 3, long-term oxygen therapy, anemia, diastolic blood pressure < 70 mmHg, Early Warning Score ≥ 3, severe acidosis (pH < 7.20), and serum albumin < 35 g/L. On multivariate analysis, only anemia and WHO-PS ≥ 3 were significant. The presence of both predicted 68% of inpatient deaths, with a specificity of 98%.ConclusionWHO-PS ≥ 3 and anemia are prognostic factors in AHRF with respiratory acidosis due to COPD. A combination of the two provides a simple method of identifying patients unlikely to benefit from NIV.

In-hospital deaths from AECOPD may be predicted by assessment of WHO-PS and EWS on admission to hospital.

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Objective: Assess levels of disaster preparedness in institutions of higher education (IHEs) in the United States.Design: An anonymous, 57-question survey targeted individuals responsible for emergency management at IHEs across the US descriptive statistics and bivariate chi-square analysis were reported. Using the established threshold score of the initial Cities Readiness Initiative from the CDC, an individual respondent’s composite score of 70 percent or higher across 23 specific questions within the 57-question survey was labeled as “prepared.”Results: Chi-square analysis identified variables associated with lower preparedness levels at IHEs not achieving the minimum 70 percent score. Having a campus law enforcement officer serve the additional role of emergency manager had a negative association with being prepared [χ 2 (1) = 10.18, p 0.001]. Having emergency management as a separate university function from campus law enforcement had a positive relationship with being prepared [χ 2 (1) = 18.55, p 0.001]. Staffing the emergency management function with a professional having less than 3 years of emergency management experience had a negative association with being prepared.Conclusions: Our results indicate that minimizing the mission of emergency management by simply tasking a campus law enforcement officer with the extra responsibility of emergency management or entertaining less professionally qualified personnel to lead emergency management’s complex mission can lead to disastrous results. Not only is preparedness impacted, but also resilience when facing disaster situations. Our nation continues to strive to become more resilient when facing such adverse events, as formally embraced and emphasized in the 2017 National Security Strategy. Research continues to offer best practices and unfortunately continues to highlight gaps. While the higher education community is not one of the 16 federal critical infrastructure sectors, identified gaps such as those presented in our findings as well as those published by the National Academies of Sciences are cause for alarm. Not only are higher education campuses generating invaluable contributions to society in general, bio-innovation, public health, and medicine, to name a few, they are a core stakeholder in resilience research and implementation. Yet, research continues to indicate preparedness and therefore resilience gaps in this sector. The authors propose implications for practice, policy, and research to assist IHEs in achieving a more comprehensive, sustainable level of resilience.