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ObjectivesTo identify and characterise clusters of emergency department (ED) visits for fall injuries during the 2007–2008 winter season.MethodsHospital ED chief complaints and diagnoses from hospitals reporting to the Centers for Disease Control and Prevention BioSense system were analysed. The authors performed descriptive analyses, used time series charts on data aggregated by metropolitan statistical areas (MSAs), and used SaTScan to find spatial–temporal clusters of visits from falls.ResultsIn 2007–2008, 17 clusters of falls in 13 MSAs were found; the median number of excess ED visits for falls was 71 per day. SaTScan identified 11 clusters of falls, of which seven corresponded to MSA clusters found by time series and five included more than one state/district. Most clusters coincided with known periods of snowfall or freezing rain.ConclusionThe results show the role that a national automated system can play in tracking widespread injuries. Such a system could be harnessed to assist with prevention strategies.

Although dengue is endemic in Puerto Rico (PR), 2007 and 2010 were recognized as epidemic years. In the continental United States (US), outside of the Texas-Mexico border, there had not been a dengue outbreak since 1946 until dengue re-emerged in Key West, Florida (FL), in 2009-2010. The objective of this study was to use electronic and manual surveillance systems to identify dengue cases in Veterans Affairs (VA) healthcare facilities and then to clinically compare dengue cases in Veterans presenting for care in PR and in FL. Outpatient encounters from 1/2007-12/2010 and inpatient admissions (only available from 10/2009-12/2010) with dengue diagnostic codes at all VA facilities were identified using VA's Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE). Additional case sources included VA data from Centers for Disease Control and Prevention BioSense and VA infection preventionists. Case reviews were performed. Categorical data was compared using Mantel-Haenszel or Fisher Exact tests and continuous variables using t-tests. Dengue case residence was mapped. Two hundred eighty-eight and 21 PR and FL dengue cases respectively were identified. Of 21 FL cases, 12 were exposed in Key West and 9 were imported. During epidemic years, FL cases had significantly increased dengue testing and intensive care admissions, but lower hospitalization rates and headache or eye pain symptoms compared to PR cases. There were no significant differences in clinical symptoms, laboratory abnormalities or outcomes between epidemic and non-epidemic year cases in FL and PR. Confirmed/probable cases were significantly more likely to be hospitalized and have thrombocytopenia or leukopenia compared to suspected cases. Dengue re-introduction in the continental US warrants increased dengue surveillance and education in VA. Throughout VA, under-testing of suspected cases highlights the need to emphasize use of diagnostic testing to better understand the magnitude of dengue among Veterans.

An embedding of a graph on a translation surface is said to be \\emph{systolic} if each vertex of the graph corresponds to a singular point (or marked point) and each edge corresponds to a shortest saddle connection on the translation surface. The embedding is said to be \\emph{cellular} (respectively \\emph{essential}) if each complementary region is a topological disk (respectively not a topological disk). In this article, we prove that any finite graph admits an essential-systolic embedding on a translation surface and estimate the genera of such surfaces. For a wedge \\(\\Sigma_n\\) of \\(n\\) circles, \\(n\\geq2\\), we investigate that \\(\\Sigma_n\\) admits cellular-systolic embedding on a translation surface and compute the minimum and maximum genera of such surfaces. Finally, we have identified another rich collection of graphs with more than one vertex that also admit cellular-sytolic embedding on translation surfaces.

We examined the representativeness of the nonfederal hospital emergency department (ED) visit data in the National Syndromic Surveillance Program (NSSP). We used the 2012 American Hospital Association Annual Survey Database, other databases, and information from state and local health departments participating in the NSSP about which hospitals submitted data to the NSSP in October 2014. We compared ED visits for hospitals submitting data with all ED visits in all 50 states and Washington, DC. Approximately 60.4 million of 134.6 million ED visits nationwide (~45%) were reported to have been submitted to the NSSP. ED visits in 5 of 10 regions and the majority of the states were substantially underrepresented in the NSSP. The NSSP ED visits were similar to national ED visits in terms of many of the characteristics of hospitals and their service areas. However, visits in hospitals with the fewest annual ED visits, in rural trauma centers, and in hospitals serving populations with high percentages of Hispanics and Asians were underrepresented. NSSP nonfederal hospital ED visit data were representative for many hospital characteristics and in some geographic areas but were not very representative nationally and in many locations. Representativeness could be improved by increasing participation in more states and among specific types of hospitals. (Disaster Med Public Health Preparedness. 2016;10:562-569).

Background Although dengue is endemic in Puerto Rico (PR), 2007 and 2010 were recognized as epidemic years. In the continental United States (US), outside of the Texas-Mexico border, there had not been a dengue outbreak since 1946 until dengue re-emerged in Key West, Florida (FL), in 2009-2010. The objective of this study was to use electronic and manual surveillance systems to identify dengue cases in Veterans Affairs (VA) healthcare facilities and then to clinically compare dengue cases in Veterans presenting for care in PR and in FL. Methodology Outpatient encounters from 1/2007-12/2010 and inpatient admissions (only available from 10/2009-12/2010) with dengue diagnostic codes at all VA facilities were identified using VA's Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE). Additional case sources included VA data from Centers for Disease Control and Prevention BioSense and VA infection preventionists. Case reviews were performed. Categorical data was compared using Mantel-Haenszel or Fisher Exact tests and continuous variables using t-tests. Dengue case residence was mapped. Findings Two hundred eighty-eight and 21 PR and FL dengue cases respectively were identified. Of 21 FL cases, 12 were exposed in Key West and 9 were imported. During epidemic years, FL cases had significantly increased dengue testing and intensive care admissions, but lower hospitalization rates and headache or eye pain symptoms compared to PR cases. There were no significant differences in clinical symptoms, laboratory abnormalities or outcomes between epidemic and non-epidemic year cases in FL and PR. Confirmed/probable cases were significantly more likely to be hospitalized and have thrombocytopenia or leukopenia compared to suspected cases. Conclusions Dengue re-introduction in the continental US warrants increased dengue surveillance and education in VA. Throughout VA, under-testing of suspected cases highlights the need to emphasize use of diagnostic testing to better understand the magnitude of dengue among Veterans.

A surface in the Teichm\"uller space, where the systole function admits its maximum, is called a maximal surface. For genus two, a unique maximal surface exists, which is called the Bolza surface, whose systolic geodesics give a triangulation of the surface. We define a surface as Bolza-like if its systolic geodesics decompose the surface into \\((p, q, r)\\)-triangles for some integers \\(p,q,r\\). In this article, we will provide a construction of Bolza-like surfaces for infinitely many genera \\(g\\geq 9\\). Next, we see an intriguing application of Bolza-like surfaces. In particular, we construct global maximal surfaces using these Bolza-like surfaces. Furthermore, we study a symmetric property satisfied by the systolic geodesics of our Bolza-like surfaces. We show that any simple closed geodesic intersects the systolic geodesics at an even number of points.

By the end of the Ebola epidemic, death reporting in Sierra Leone (SL) became more acceptable amongst local populations, with nearly all deaths being reported to the Ebola hot line alert centers. To continue the positive momentum generated by the epidemic, the Sierra Leone Ministry of Health and Sanitation (MoHS) and the US Centers for Disease Control and Prevention (CDC) organized and conducted the two-day Inter-agency Consultations on Improving Mortality Reporting in Sierra Leone (Consultations). In conjunction with the Consultations, participants were also offered a one-day, in-person training on the major components, characteristics, and uses of a national Civil Registration and Vital Statistics (CRVS) system. To understand processes used by governmental and non-governmental organizations in collection of death data before and during the Ebola epidemic, and to develop recommendations on improving death reporting and CRVS in Sierra Leone. The Inter-agency Consultations were conducted in person over two days in October, 2015. Real-time notes were kept by CDC staff for later abstraction and summarizing. Presenters agreed to share their materials (usually PowerPoint presentations) and approved the summaries. Challenges to implementation and suggestions for improving death reporting were drawn from the presentations and from anonymous suggestions collected at the end of each of three days of the Consultations. The Consultations attracted more than 80 participants from 28 Sierra Leone governmental, business, and other non-governmental organizations. Over the course of 18 presentations, participants presented and discussed the ways deaths were reported before and during the Ebola epidemic and ways in which the CRVS in Sierra Leone might be improved. The presentations made clear the need to improve death reporting in order to improve the health status of Sierra Leone. Many presenters and participants discussed the challenges to improvements, including lack of infrastructure and country diversity. In addition, participants generally agreed upon the need for improving the government’s understanding of the benefits of death reporting at multiple levels: from local chiefdom authorities and councils to the community and individual families. Despite the many challenges identified, all participants stressed the need for modernizing and improving death registration in Sierra Leone. The recommendations from the presentations and notes collected at the end of each day can be categorized within the following five domains: capacity building (organizational, staffing, infrastructure, policies, guidelines and tools), awareness and sensitization (including strategies to use best practices and emerging technologies), political will (governmental support and prioritization), funding (providing resources to achieve sustainability), and monitoring and evaluation (developing charts of existing death reporting pathways and identifying challenges).

An A-CASI survey of 197 men with a history of incarceration, ages 18–29, revealed that 50% and 17% of participants, respectively, had used substances or had sex while confined. Univariate regression analyses indicated that these two behaviors were correlated and both were associated with being older, having spent more years incarcerated, being sexual abused, and being involved with gangs and violence during incarceration. Multiple regression analyses showed that the likelihood of any substance use during incarceration was higher for men who were affiliated with a gang. Men were more likely to have had sex during incarceration if they reported having had a male sex partner in the community. The prevalence of sexual behavior also differed across sites. Findings document the occurrence of substance use and sexual behavior among incarcerated men, and highlight the need for continued research into the context of these behaviors.

Objectives: The objectives of this study were to describe preincarceration risk behaviors of young men and identify correlates of unprotected sex with multiple partners during the 3 months before incarceration. Study: Data on preincarceration risk behaviors were obtained from 550 men, aged 18 to 29 years, in state prisons in California, Mississippi, Rhode Island, and Wisconsin. Correlates of unprotected sex with multiple partners were determined by logistic regression. Results: Of 550 participants, 71% had multiple sex partners, 65.1% had sex with a partner they perceived as risky, and 45.3% engaged in unprotected sex with multiple partners. Men who drank heavily (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.112.54) or who had a risky partner (OR, 3.90; 95% CI, 2.60-5.85) were more likely to report unprotected sex with multiple partners. Men who attended religious gatherings (OR, 0.66; 95% CI, 0.46-0.96) or lived in stable housing (OR, 0.69; 95% CI, 0.48-1.00) were less likely to report unprotected sex with multiple partners. Conclusions: Most participants engaged in behaviors that could result in a sexually transmitted disease, including HIV. Prevention programs should address the relationship between heavy alcohol use and risky sexual behavior. Discharge planning should address housing needs. Faith-based community organizations may play an important role for some young men in their transition to the community.