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PubMed2004

Mass casualties in the Oklahoma City bombing.

The Alfred P. Murrah Federal Building in Oklahoma City was partially destroyed by a terrorist bomb on April 19, 1995. Injuries were sustained by 759 people, 168 of whom died. Fatalities occurred primarily among victims in the collapse zone of the federal building. Only 83 survivors required hospitalization. Twenty-two surviving victims sustained multiple fractures. Most victims arrived at local emergency departments by private vehicle within 2 hours. More severely injured survivors were transported by ambulance. The closer receiving hospitals used emergency department facilities and minor treatment areas. Few survivors were extricated from the bombing site more than 3 hours after the detonation. Mass casualty plans must provide for improved communications, diversion and retriage from facilities nearest the disaster site, and effective coordination of community and hospital resources.

Blast Injuries↗

PubMed2005

Comparing reactions to two severe tornadoes in one Oklahoma community.

The authors compared the effect of the 3 May 1999 F5 and 8 May 2003 F3 tornadoes on the community of Moore, Oklahoma, by canvassing damaged areas after both tornadoes and surveying residents. Significantly more 1999 than 2003 residents reported property damage and injuries. Television and tornado sirens were the most common warnings each year, however, more 1999 residents received and responded to television warnings. Importantly, storm shelters were used more frequently in 2003. Fifty-one per cent of residents who experienced both tornadoes took the same amount of protective action in 2003 as they had in 1999; 22% took less; and 27% took more. Residents who took less action said that the reason for doing so was inadequate warning and shelter. First-hand experience of tornadoes prompts people to heed warnings when adequate notification is received and to take effective protective action when adequate shelter is available.

Disaster Planning↗

PubMed1992

Identification of Oklahoma isolate as a strain of Pseudomonas pseudomallei.

Based on the morphological, physiological, biochemical and nutritional characteristics, cellular fatty acid and lipid composition, ubiquinone-8 as the major respiratory quinone, guanine-plus-cytosine content of DNA, DNA-DNA homology value, and sequence alignment of 16S rRNA nucleotides, Oklahoma isolate was reidentified as a strain of Pseudomonas pseudomallei.

Anti-Bacterial Agents↗

PubMed1985

Isolation of Naegleria australiensis from an Oklahoma Lake.

Eight isolates of Naegleria australiensis were obtained from a small lake in Tulsa, Oklahoma. The eight strains were isolated during the hot summer months of July through September, when water temperatures ranged from 27 to 33 degrees C. All eight isolates were pathogenic for mice. The mean time to death for mice was 10 days (range 6-13 days). This pathogenic free-living ameba has not before been reported from the United States or the Western Hemisphere.

Amoeba↗

PubMed1998

Networks and the fiscal performance of rural hospitals in Oklahoma: are they associated?

This paper uses regression analysis to explore the relation of network membership to the financial performance of rural hospitals in Oklahoma during fiscal year 1995. After adjusting for the scope of service, as measured by the number of facilities or services offered by the hospital, indicators of fiscal status are (1) the cash receipts derived from net patient revenue; (2) the cash disbursements related to operating costs, net of interest and depreciation expense, labor costs and nonlabor costs; and (3) net cash flow, defined as the difference between cash receipts and disbursements. Controlling for the effects of the hospital's structural attributes, operating characteristics and market conditions, the results indicate that members of a network reported lower net operating costs, labor costs and nonlabor expenses per service than nonmembers. Hence, the analysis seems to suggest that the membership of rural hospitals in a network is associated with lower cash disbursements and an improved net cash flow, outcomes that may preserve their fiscal viability and the access of the population at risk to service.

Case-Control Studies↗

PubMed2003

Impact of conversion to critical access hospital status for Oklahoma's rural hospitals.

CONTEXT: The Medicare Rural Hospital Flexibility Grant Program established a new hospital category, the Critical Access Hospital, designed to provide financial stability to small rural hospitals that were losing money after changes in the Prospective Payment System implemented by Medicare. PURPOSE: This article describes the impact of conversion to Critical Access Hospital (CAH) status for 15 small rural hospitals in Oklahoma. Objectives of the study were to identify how conversion to CAH affected hospital utilization and finances for the first year after conversion. METHODS: A telephone survey was used to collect information from hospital administrators. Fifteen of 16 eligible hospitals participated in the study. FINDINGS: In general, services and patient census declined slightly with conversion to CAH. All 15 hospitals had reported losses prior to conversion, totaling $6,985,033. Ten hospitals reported losses after conversion. After converting to CAH status, the hospitals reported total losses of $3,094,547. The hospitals had a net change of $4,293,040. CONCLUSIONS: Most of the 15 study hospitals greatly improved their financial situation in the first year after conversion to CAH status, but in aggregate still operated at a loss.

Critical Care↗

PubMed2000

Clinical research. Flawed cancer study leads to shake-up at University of Oklahoma.

Allegations of lax safety procedures and flawed management in a clinical cancer trial have cost four researchers and administrators their jobs at the University of Oklahoma. They have also led to a temporary shutdown of 75 clinical trials at the university's Health Science Center in Tulsa and a sweeping overhaul of the school's process for approving human experiments. University officials emphasize that none of the roughly 100 patients involved in the 3-year-old study of an experimental cancer vaccine was known to have been harmed, and that most trials will soon be restarted.

Cancer Vaccines↗

PubMed1994

Antimicrobial susceptibilities of bacteria from nursing home residents in Oklahoma.

In vitro antimicrobial susceptibilities for 2,832 isolates from nursing home patients in Oklahoma (1992) were compiled retrospectively. An appreciable proportion of antimicrobial resistance was detected for ampicillin, sulfamethoxazole-trimethoprim and ciprofloxacin among gram-negative bacilli. Of 301 Staphylococcus aureus isolates tested, 70% were resistant to methicillin and 72% resistant to ciprofloxacin. Vancomycin resistance occurred in 22% of Enterococcus faecium isolates. These findings herald a high incidence of antimicrobial resistance in nursing home residents.

Aged↗

PubMed1993

Reproductive genetic services in rural Oklahoma.

The system of reproductive care as it relates to genetic services for women in rural Oklahoma is addressed. Description of reproductive services and genetic reproductive services for rural women is described and barriers to accessing reproductive genetic care are identified. The barriers and any progress that has been made in breaking these barriers will be described under four general categories: (1) financial barriers; (2) system capacity barriers; (3) organizational practices and atmosphere of services, and (4) cultural, personal and other system barriers.

Culture↗

PubMed1975

Extrapulmonary tuberculosis in Oklahoma, 1965 to 1973.

Three hundred seventy cases of extrapulmonary tuberculosis were reported to the Oklahoma State Department of Health between January 1, 1965 and December 31, 1973. The annual number of cases reported showed no tendency to decrease with time. A greater proportion of cases reported in recent years had bacteriologic confirmation. When compared to the distribution of all newly diagnosed cases of tuberculosis in the population, a greater proportion of newly diagnosed cases of extrapulmonary tuberculosis occurred in nonwhites. This was especially true to tuberculous meningitis, tuberculous lymphadenitis, and miliary tuberculosis. Possible reasons for the failure of the number of newly reported cases of extrapulmonary tuberculosis to decrease in recent years are presented.

Adolescent↗

PubMed1979

Pulmonary sporotrichosis in Oklahoma in susceptibilities in vitro.

Six cases of pulmonary sporotichosis were observed in 2 institutions in Oklahoma City, Okla. Three of the patients were treated with iodides with or without surgery. Although one patient required a second course of iodides, the patients have remained well after at least 34 months of follow-up. Three patients treated with amphotericin B, single course as well as multiple courses, and other antifungal agents (hydroxystilbamidine and miconazole) have all relapsed. These cases and a reviewed of more than 40 cases of pulmonary sporotrichosis susceptibilities of Sporothrix schenckii that we observed in vitro suggest that amphotericin B is not an effective agent for the treatment of pulmonary sporotrichosis. It is our opinion that the treatment of choice for pulmonary sporotrichosis is a supersaturated solution of potassium iodide. If the patient is allergic to the medication or fails to respond, then a combination of amphotericin B plus flucytosine may be tried.

Adult↗

PubMed1999

Clinical needs assessment of middle and high school students following the 1995 Oklahoma City bombing.

OBJECTIVE: This clinical assessment was designed to identify middle and high school students in need of formal evaluation for posttraumatic response symptoms following the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City. METHOD: A clinical needs assessment instrument was developed and administered to grade 6 through 12 students 7 weeks after the bombing (N = 3,218). RESULTS: More than 40% of the students reported knowing someone injured, and more than one-third reported knowing someone killed in the blast. Posttraumatic stress symptoms at 7 weeks significantly correlated with gender, exposure through knowing someone injured or killed, and bomb-related television viewing. CONCLUSIONS: This study documents the intensity of community exposure to the bombing and the lingering symptoms of stress. The assessment was used in planning for clinical service delivery, training professional responders, and supporting funding requests.

Adolescent↗

PubMed2002

Psychiatric disorders in rescue workers after the Oklahoma City bombing.

OBJECTIVE: Psychiatric disorders were studied in a volunteer group of 181 firefighters who served as rescue/recovery workers after the Oklahoma City bombing. METHOD: Approximately 34 months after the disaster, the authors retrospectively assessed psychopathology both before and after the bombing with the Diagnostic Interview Schedule. Findings for male rescue workers were compared with those of male primary victims who had been in the direct path of the blast and who had been assessed with the same instrument. RESULTS: The prevalence of posttraumatic stress disorder related to the bombing was significantly lower in male rescue workers (13%) than in male primary victims (23%). High rates of alcohol disorders (postdisaster: 24%; lifetime: 47%) were seen among all rescue workers, with virtually no new cases occurring after the bombing. CONCLUSIONS: The resilience seen in firefighters may be related to their career selection, their preparedness and experience, the fewer injuries they suffered, and postdisaster mental health interventions. However, alcohol disorders were endemic before the disaster, indicating a need for ongoing programs targeting this problem.

Adult↗

PubMed2002

Mortality of mental health service recipients in Vermont and Oklahoma.

The authors compared statewide mortality rates for people with severe mental illness who were served in public mental health systems of care in Vermont and Oklahoma. In both states, mortality rates for younger service recipients, but not for older recipients, were significantly higher than those for the general population. In interpreting cross-region comparisons, several possible causes of variation, including differences in caseload composition and causes outside the control of the public mental health authority, must be considered.

Adolescent↗

PubMed1997

Traumatic reactions as predictors of posttraumatic stress six months after the Oklahoma City bombing.

OBJECTIVE: This study attempted to identify remembered reactions of Oklahoma City residents at the time of the April 1995 terrorist bombing that predicted later development of posttraumatic stress symptoms. METHODS: Eighty-six adults who sought help for distress related to the bombing six months after it occurred completed a survey about demographic characteristics, level of exposure to the event, symptoms of grief, retrospective reports of reactions at the time of the trauma, current posttraumatic stress symptoms, and coping strategies. To identify immediate bombing reactions predictive of later distress, retrospective reports of reactions to the trauma were correlated with current posttraumatic stress symptoms. Multiple regression analysis was used to determine which reactions predicted the emergence of posttraumatic stress symptoms. RESULTS: Reactions of being nervous and being upset by how other people acted when the bombing occurred accounted for about one-third of the total variation in posttraumatic stress symptom scores and thus were major predictors of posttraumatic stress. CONCLUSIONS: These results differ from those of other studies in which peritraumatic dissociation, or dissociation at the time of the event, was more predictive than anxiety for developing later distress. The results suggest that persons who experience significant anxiety at the time of the traumatic event may continue to experience distress. Those who are overly concerned about others' actions may be showing diminished interpersonal trust, evidence of terrorism's ability to erode social harmony.

Adult↗

PubMed2003

Seroprevalence of antibodies to Sarcocystis neurona in equids residing in Oklahoma.

A sampling of equids from the state of Oklahoma produced an estimate of seroprevalence of antibody to Sarcocystis neurona to be about 89.2%. This figure represents the highest currently reported regional seroprevalence of antibody to this organism. Regional differences in seroprevalence were found in the western quadrants of the state relative to the eastern quadrants of the state, with a significantly higher seroprevalence in the eastern regions. Thoroughbreds were found to exhibit a statistically significant lower seroprevalence as a breed group when compared with other breeds sampled.

Animals↗

PubMed1989

A serological survey of Ehrlichia canis, Ehrlichia equi, Rickettsia rickettsii, and Borrelia burgdorferi in dogs in Oklahoma.

Serum samples from 259 dogs were tested for antibodies to Ehrlichia canis, Ehrlichia equi, Rickettsia rickettsii, and Borrelia burgdorferi using the indirect fluorescent antibody test. The sera were obtained from submissions to the Oklahoma Animal Disease Diagnostic Laboratory during a 14-month period from June 1986 through July 1987. The rate for positive antibody titers to E. canis was 53%, to E. equi was 33%, to R. rickettsii was 38%, and to B. burgdorferi was 18%. Higher percentages of sera serologically positive to E. canis were found in the spring through the fall months, but there were no seasonal variations for E. equi, R. rickettsii, and B. burgdorferi. There was no consistent pattern of titers to the 4 antigens when age-groups of the dogs were compared. Forty-four different breeds were tested.

Age Factors↗

PubMed1990

A serologic survey of Oklahoma cats for antibodies to feline immunodeficiency virus, coronavirus, and Toxoplasma gondii and for antigen to feline leukemia virus.

A serologic survey was done on 618 cat sera submitted to the Oklahoma Animal Disease Diagnostic Laboratory between July 1, 1987 and June 30, 1988. The samples were collected from clinically normal and sick cats. The sera were tested for the presence of antibodies to feline immunodeficiency virus by a commercial immunoassay, to a coronavirus by an indirect fluorescent antibody test, and to Toxoplasma gondii by a commercial latex agglutination test and for the presence of feline leukemia virus antigen with one of 3 different commercial assay kits. Ten percent of the sera had antibodies to feline immunodeficiency virus, 35% had antibodies to a coronavirus, and 22% had antibodies to Toxoplasma gondii. Feline leukemia virus antigen was detected in 15% of the sera. Thirty-two percent of the sera had evidence of exposure to 2 or more of the agents.

Animals↗