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Ricci, Edmund M. "A Model for Evaluation of Disaster Management." Prehospital and Disaster Medicine 1, S1 (1985): 30–32. http://dx.doi.org/10.1017/s1049023x00043685.
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Our ability to manage disaster relief activities at regional, national or international levels of socio-political organization has, according to many analysts, not kept pace with the knowledge and technical capability presently available to contend with disasters. In a report released in 1977 a panel of experts assembled by the United Nations Association characterized disaster relief efforts as being routinely mismanaged. For example, the panel described what has been considered one of the better organized disaster relief efforts (the 1976 earthquake in Guatamala) in the following way.
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Nagata, T., T. Ishihara, H. Inasaka, T. Sakamoto, M. Akashi, Y. Otomo, K. Koriyama, H. Kobayashi, T. Ido, and S. Ishi. "(P1-111) Japan Medical Association Team (JMAT)." Prehospital and Disaster Medicine 26, S1 (May 2011): s135—s136. http://dx.doi.org/10.1017/s1049023x11004444.
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Disaster preparedness is one of the national priorities. In Japan, disaster medicine is defined as a part of the national medical plan initiated by Ministry of Health, Welfare and Labor. The Japan Medical Association is the largest professional physicians' group in Japan, and has contributed to all kinds of disaster relief work regionally and nation-wide for years. Based on past successes, the Japan Medical Association proposes a new disaster action plan named Japan Medical Association Team (JMAT). The primary mission of JMAT is to deploy to the disaster scene requested and work for disaster relief. JMAT covers the acute to sub-acute phase of disaster response, and also collaborate with other agencies. In the preparation and mitigation phases, the Japan Medical Association work for establishing mutual disaster aid partnerships, disaster plans, networks with other agencies, team building, disaster medicine training and education, etc. In Japan, the Disaster Medical Assistant Team (DMAT) has been established based on the experience of the 1995 Kobe Earthquake, when lots of preventable trauma deaths occurred because of delayed medical response. The mission of DMAT is to deploy to the scene immediately and triage/transfer the most serious disaster victims outside the scene for advanced medical care. DMAT covers the first 48 hours of disaster response phase, and then JMAT takes charge of the work. JMAT will also respond to chemical, biological, radiological and nuclear disasters, and international humanitarian work. The present issues of establishing JMAT are 1.training and education for Japan Medical Association members, 2.establising cooperation with other agencies, and 3.having presence at the Central Disaster Committee, Cabinet Office, Government of Japan.
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Wendl-Richter, H. U. "126-PA12 Support for the National Tuberculosis & Leprosy Programme in Uganda by German Leprosy Relief Association." Tubercle and Lung Disease 76 (October 1995): 112–13. http://dx.doi.org/10.1016/0962-8479(95)90420-4.
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Adler, Libby. "California's Holocaust Victim Insurance Relief Act and American Preemption Doctrine." German Law Journal 4, no. 11 (November 1, 2003): 1193–205. http://dx.doi.org/10.1017/s2071832200012049.
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On the same day that the United States Supreme Court handed down its much anticipated decisions on affirmative action in higher education, holding that the Equal Protection Clause of the Fourteenth Amendment to the United States Constitution permits a degree of race-consciousness in public university admissions, it also issued a far less heralded decision with implications for the ability of the states to address historical injustice. In American Insurance Association v. Garamendi (Garamendi), five members of the Court, led by Justice Souter, found that California's Holocaust Victim Insurance Relief Act of 1999 (HVIRA) “interferes with the National Government's conduct of foreign relations” and is therefore preempted.
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Novotny, Sandra K., and Thearin R. Wendel. "A COMPARISON OF REGULATIONS RELATED TO THE OIL SPCC PROGRAM." International Oil Spill Conference Proceedings 1989, no. 1 (February 1, 1989): 23–26. http://dx.doi.org/10.7901/2169-3358-1989-1-23.
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ABSTRACT Several federal agencies regulate selected aspects of the production, refining, transportation, and storage of petroleum and petroleum products. Based on analyses of such programs, the U.S. Environmental Protection Agency (EPA) may propose modifications to the Oil Spill Prevention, Control, and Countermeasures (SPCC) program. These proposed changes would be likely to result in improved consistency with other government and industry standards. Regulatory changes may occur in two extensive and significant areas: adoption of specific and widely recognized industry and regulatory tank standards, and mandatory contingency planning at all facilities covered by the SPCC regulations. Relevant industrial, trade association, and technical standards generated by the American Petroleum Institute, the Underwriters Laboratories, Inc., the National Fire Protection Association, the American National Standards Institute, and the National Association of Corrosion Engineers have been reviewed for applicability to the SPCC regulations. Areas of concern include materials specifications, welding requirements, pressure testing prior to service, overpressure and vacuum relief requirements, design specifications, hydrostatic testing requirements, and siting specifications.
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Suits, Julie M., and Gretchen D. Oliver. "Bilateral Tarsal Coalition in a National Collegiate Athletic Association Division I Basketball Player: A Case Report." Journal of Athletic Training 47, no. 6 (November 1, 2012): 724–29. http://dx.doi.org/10.4085/1062-6050-47.6.06.
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Objective To present a case of bilateral subtalar joint coalition in a National Collegiate Athletic Association Division I basketball player and the treatment plan that was used to manage the coalition from the beginning of conference play through the postseason. Background A 20-year-old male basketball athlete (height = 182.8 cm, mass = 83.4 kg) presented with bilateral subtalar joint tarsal coalition that became symptomatic in 2006 and resulted in constant pain with any form of activity. Differential Diagnosis Traumatic injury of the talocalcaneal joint. Treatment Nonsurgical intervention of conservative therapy was elected. Uniqueness Less than 13% of the overall population is affected with tarsal coalition, so it is safe to assume that very few athletes competing at the collegiate or elite level suffer from this condition. This is the first report in the literature to document conservative manual therapies used to manage the symptoms of subtalar joint tarsal coalition in a Division I basketball player. Conclusions After the intensive treatment program for tarsal coalition was implemented, the patient experienced pain relief and was able to continue to compete at a competitive level. This case represents the need to further explore and document a conservative treatment protocol for tarsal coalition.
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Choi, Woo-seok, Min-Ok Jung, and Yu-Jin Kwon. "The Association between the Stress Relief Method and High-Risk Alcohol Drinking: The 2005 Korea National Health and Nutrition Examination Survey." Korean Journal of Family Practice 9, no. 2 (April 20, 2019): 239–44. http://dx.doi.org/10.21215/kjfp.2019.9.2.239.
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Kumar, Pallavi, Laura Hatfield, Alexi A. Wright, Jennifer S. Temel, and Nancy Lynn Keating. "Associations between hospice use and end-of-life (EOL) care outcomes in patients with advanced cancer." Journal of Clinical Oncology 33, no. 29_suppl (October 10, 2015): 53. http://dx.doi.org/10.1200/jco.2015.33.29_suppl.53.
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53 Background: There are few data examining the association between hospice care (HC) and the quality of advanced cancer patients’ EOL care. We explored associations between HC and family-reported relief of patients’ symptoms, quality of EOL care, and concordance with patients’ previously expressed wishes for EOL care and place of death. Methods: We surveyed 2,307 family members of deceased patients with advanced lung cancer (LC) or colorectal cancer (CRC) who were enrolled in the Cancer Care Outcomes Research and Surveillance (CanCORS) study (a national prospective, observational cohort study). We used propensity score matching to compare family-reported outcomes for patients who did or did not receive HC, including prevalence and relief of common symptoms (pain, dyspnea, depression or anxiety), quality of EOL care, and concordance with wishes for EOL care and place of death. Results: In 985 matched pairs, patients with LC or CRC who received HC had higher pain, distress from pain, and depression and/or anxiety, but more appropriate relief of pain and dyspnea (Table). HC was associated with a higher family-reported quality of EOL care, greater concordance with patients’ EOL care wishes, and higher likelihood of death in a preferred place. Conclusions: Patients receiving HC had greater symptoms compared to non-hospice enrollees, but had more appropriate symptom relief. HC for patients with LC or CRC is also associated with higher quality of EOL care, and concordance with wishes for EOL care and place of death as reported by bereaved family members. These data demonstrate the need to improve hospice utilization for advanced cancer patients. [Table: see text]
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van Wijlick, Eric, Marian Verkerk, Alexander de Graeff, and Johan Legemaate. "Palliative Sedation in The Netherlands: Starting-points and Contents of a National Guideline." European Journal of Health Law 14, no. 1 (2007): 61–73. http://dx.doi.org/10.1163/092902707x185451.
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AbstractIn December 2005 the first national guideline for palliative sedation in the Netherlands was published. This guideline was developed by a committee of the Royal Dutch Medical Association, at the request of the Dutch government. The guideline defines palliative sedation as 'the intentional lowering of consciousness of a patient in the last phase of his or her life'. According to the guideline the objective of palliative sedation is to relieve suffering, and lowering consciousness is a means to achieve this. It is very important that palliative sedation is given for the right indication, proportionally, and adequately. It is the degree of symptom control, not the level to which consciousness is lowered, which determines the dose and combinations of the sedatives used and duration of treatment. The assessment and decision-making processes must focus on adequate relief of the patient's suffering, so that a peaceful and acceptable situation is created. Palliative sedation is given in the last phase of life, in the imminently dying patient. Palliative sedation raises several legal questions. In this article we describe the structure and contents of the guideline, with special attention for the main legal issues involved, like the distinction between palliative sedation and euthanasia and the process of informed conesnt.
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Errebo, Nancy, James Knipe, Karen Forte, Victoria Karlin, and Benek Altayli. "EMDR-HAP Training in Sri Lanka Following the 2004 Tsunami." Journal of EMDR Practice and Research 2, no. 2 (June 2008): 124–39. http://dx.doi.org/10.1891/1933-3196.2.2.124.
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On December 26, 2004, an earthquake in the Indian Ocean triggered a catastrophic tsunami. In Sri Lanka, 35,000 people died, 21,000 were injured, and more than half a million were displaced. An EMDR training program was conducted as a joint project of three organizations: EMDR Humanitarian Assistance Programs (HAP), International Relief Teams (IRT), and the Sri Lankan National Counselors Association (SRILNAC). Between March and December 2005, 30 Sri Lankan counselors were trained in EMDR. These counselors demonstrated competence in EMDR on several measures, treated more than 1,000 children and more than 350 adult tsunami victims with EMDR in 2005, provided narrative reports and outcome measures for most of their clients, and formed the Sri Lanka EMDR Association (SEA). The crucial steps in establishing and implementing this training program are explained, with a summary of the subjective impressions and learning experiences most valued by the training team, including an excerpt from a trainer’s journal. This information may be useful to future cross-cultural humanitarian efforts following large-scale disasters.
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Goodridge, DM, DD Marciniuk, D. Brooks, A. van Dam, S. Hutchinson, P. Bailey, S. Baxter, et al. "End-Of-Life Care for Persons with Advanced Chronic Obstructive Pulmonary Disease: Report of a National Interdisciplinary Consensus Meeting." Canadian Respiratory Journal 16, no. 5 (2009): e51-e53. http://dx.doi.org/10.1155/2009/987616.
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While systemic shortcomings in meeting the needs of individuals with progressive chronic illnesses at the end of life have been well documented, there is growing interest in improving both care and quality of life for persons with advanced chronic obstructive pulmonary disease (COPD). For instance, the American Thoracic Society has issued an official statement on palliative care for patients with respiratory diseases, affirming that the prevention, relief, reduction and soothing of symptoms “without affecting a cure” must become an integral component of standard care. A recent Medline search located 1015 articles related to palliative or end-of-life care for people with COPD published between 2001 and 2008, compared with only 336 articles published before 2001. To address the needs of Canadian patients, an interdisciplinary consensus meeting, funded by the Canadian Institutes of Health Research and supported by the Canadian Thoracic Society, the Canadian Respiratory Health Professionals and the Canadian Lung Association was convened in Toronto, Ontario, on November 22, 2008, to begin examining the quality of end-of-life care for individuals with COPD in Canada. The present report summarizes the background to and outcomes of this consensus meeting.
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Milette, Pierre, Denis Fontaine, and Miroslav V. Grandtner. "Soil and vegetation characteristics of a peatland near Lake Édouard in Mauricie National Park, Québec, Canada." Acta Societatis Botanicorum Poloniae 61, no. 1 (2014): 37–43. http://dx.doi.org/10.5586/asbp.1992.003.
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The majority of plant communities within the peatland near Lake Édouard belongs to the poor fen group. They are containing poor fen species such as <i>Myrica gale</i>, <i>Carex rostrata</i>, <i>Glyceria canadensis</i>, <i>Calamagrostis canadensis</i>, <i>Carex canescens</i>, <i>Carex stricta</i>, <i>Alnus rugosa</i> and <i>Sphagnum subsecundum</i>. Members of these taxa grow in association with a group of marsh species and with <i>Chamaedaphne calyculata</i> and <i>Sphagnum majus</i>, species characteristic of bogs. The soil are of the humisol great group, being well decomposed and relatively rich in nutrient elements but ranging from extremely to strongly acidic. Four new associations are noted: <i>Sphagno-Juncetum brevicaudati</i>, <i>Sphagno-Hypericetum boreale</i>, <i>Sphagno-Glycerietum canadensis</i> and <i>Carici canescenti</i>-<i>Sphagnetum maji</i>. The distribution of vegetation appears dependent on ground relief and, consequently, on the level and quality of water in the peatland.
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Lowe, Robert. "Richard Kluger's Simple Justice after 29 Years: Simple Justice." History of Education Quarterly 44, no. 1 (2004): 125–32. http://dx.doi.org/10.1111/j.1748-5959.2004.tb00154.x.
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Although it is obligatory to mark the anniversary of Brown v. Board of Education, why it deserves to be commemorated is not necessarily obvious at a distance of fifty years. The decision itself, Richard Kluger made clear in Simple Justice, was unprepossessing and unassertive. Delivered in pedestrian language, “the only soaring sentence,” he rightly pointed out, claimed that segregation could affect Black children's “hearts and minds in a way unlikely to be ever undone” (p. 705). The decision, in fact, emphasized the psychological damage African Americans putatively experienced rather than exposed the hypocrisy of Plessy v. Ferguson's contention that racial classifications were not designed to impose an inferior standing on Black people. Additionally, this emphasis on psychological damage was supported by social science citations which gave top billing to Kenneth Clark, whose dubious research on African-American children's doll preferences had been persuasively critiqued by opposing counsel John W. Davis, and, according to Kluger, had even been “the source of considerable derision” among some of the National Association for the Advancement of Colored People (NAACP) lawyers (p. 321). Finally, an implementation decision was deferred until Brown II, which a year later required that desegregation proceed “with all deliberate speed,” limited relief to plaintiffs in the offending districts, left the nature of that relief to the district judges who had ruled against desegregation, and unleashed vigorous white resistance across much of the South.
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Kachadourian-Marras, Alessia, Margarita M. Alconada-Magliano, José Joel Carrillo-Rivera, Edgar Mendoza, Felipe Herrerías-Azcue, and Rodolfo Silva. "Characterization of Surface Evidence of Groundwater Flow Systems in Continental Mexico." Water 12, no. 9 (September 2, 2020): 2459. http://dx.doi.org/10.3390/w12092459.
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The dynamics of the underground part of the water cycle greatly influence the features and characteristics of the Earth’s surface. Using Tóth’s theory of groundwater flow systems, surface indicators in Mexico were analyzed to understand the systemic connection between groundwater and the geological framework, relief, soil, water bodies, vegetation, and climate. Recharge and discharge zones of regional groundwater flow systems were identified from evidence on the ground surface. A systematic hydrogeological analysis was made of regional surface indicators, published in official, freely accessible cartographic information at scales of 1:250,000 and 1:1,000,000. From this analysis, six maps of Mexico were generated, titled “Permanent water on the surface”, “Groundwater depth”, “Hydrogeological association of soils”, “Hydrogeological association of vegetation and land use”, “Hydrogeological association of topoforms”, and “Superficial evidence of the presence of groundwater flow systems”. Mexico’s hydrogeological features were produced. The results show that 30% of Mexico is considered to be discharge zones of groundwater flow systems (regional, intermediate, and recharge). Natural recharge processes occur naturally in 57% of the country. This work is the first holistic analysis of groundwater in Mexico carried out at a national–regional scale using only the official information available to the public. These results can be used as the basis for more detailed studies on groundwater and its interaction with the environment, as well as for the development of integrative planning tools to ensure the sustainability of ecosystems and satisfy human needs.
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Hards, Marcus, Andrew Brewer, Gareth Bessant, and Sumitra Lahiri. "Efficacy of Prehospital Analgesia with Fascia Iliaca Compartment Block for Femoral Bone Fractures: A Systematic Review." Prehospital and Disaster Medicine 33, no. 3 (June 2018): 299–307. http://dx.doi.org/10.1017/s1049023x18000365.
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AbstractIntroductionFemoral fractures are painful injuries frequently encountered by prehospital practitioners. Systemic opioids are commonly used to manage the pain after a femoral fracture; however, regional techniques for providing analgesia may provide superior targeted pain relief and reduce opioid requirements. Fascia Iliaca Compartment Block (FICB) has been described as inexpensive and does not require special skills or equipment to perform, giving it the potential to be a suitable prehospital intervention.ProblemThe purpose of this systematic review is to summarize published evidence on the prehospital use of FICB in patients of any age suffering femoral fractures; in particular, to investigate the effects of a prehospital FICB on pain scores and patient satisfaction, and to assess the feasibility and safety of a prehospital FICB, including the success rates, any delays to scene time, and any documented adverse effects.MethodsA literature search of MEDLINE/PubMED, Embase, OVID, Scopus, the Cochrane Database, and Web of Science was conducted from January 1, 1989 through February 1, 2017. In addition, reference lists of review articles were reviewed and the contents pages of the British Journal of Anaesthesia (The Royal College of Anaesthetists [London, UK]; The College of Anaesthetists of Ireland [Dublin, Ireland]; and The Hong Kong College of Anaesthesiologists [Aberdeen, Hong Kong]) 2016 along with the journal Prehospital Emergency Care (National Association of Emergency Medical Service Physicians [Overland Park, Kansas USA]; National Association of State Emergency Medical Service Officials [Falls Church, Virginia USA]; National Association of Emergency Medical Service Educators [Pittsburgh, Pennsylvania USA]; and the National Association of Emergency Medical Technicians [Clinton, Mississippi USA]) 2016 were hand searched. Each study was evaluated for its quality and its validity and was assigned a level of evidence according to the Oxford Centre for Evidence-Based Medicine (OCEBM; Oxford, UK).ResultsSeven studies involving 699 patients were included (one randomized controlled trial [RCT], four prospective observational studies, one retrospective observational study, and one case report). Pain scores reduced after prehospital FICB across all studies, and some achieved a level of significance to support this. Out of a total of 254 prehospital FICBs, there was a success rate of 90% and only one adverse effect reported. Few studies have investigated the effects of prehospital FICB on patient satisfaction or scene time delays.Conclusions and Relevance:The FICB is suitable for use in the prehospital environment for the management of femoral fractures. It has few adverse effects and can be performed with a high success rate by practitioners of any background. Studies suggest that FICB is a useful analgesic technique, although further research is required to investigate its effectiveness compared to systemic opioids.HardsM, BrewerA, BessantG, LahiriS. Efficacy of prehospital analgesia with Fascia Iliaca Compartment Block for femoral bone fractures: a systematic review. Prehosp Disaster Med. 2018;33(3):299-307.
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Ali, Z. "Integrating Palliative Care in Cancer Care in Kenya." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 164s. http://dx.doi.org/10.1200/jgo.18.35700.
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Background and context: Most Africa countries now recognize the pain and suffering of many patients and families who have no access to cure (where cure is possible), cannot afford treatment of cancer or other progressive chronic illnesses, are stigmatized or discriminated against because of their illness among many other dehumanizing issues. This project aims to ensure that all those in need of palliative care and pain relief have access close to their homes. Aim: This project aims to ensure that all those in need of palliative care and pain relief have access close to their homes. Strategy/Tactics: In the recent past Kenya Hospices and Palliative Care Association has extensively advocated for the integration of palliative care into the Kenya health services; thus, resulting in many health care professionals being trained in palliative care; integration of palliative care in public, private and mission health institutions and integration of palliative care in undergraduate medical and nursing curricula, as well as policy documents. Program/Policy process: The process of integrating palliative care in public hospitals involved advocacy at the national level as well as at the institutional level, training of health care professionals and setting up services within the hospitals that we worked with. Technical support was provided to each individual institution as needed. Outcomes: Palliative care units have been set up in over 25 government hospitals across the country. National Palliative Care Guidelines have been developed. A Diploma in Palliative Care for nurses has been initiated at the Kenya Medical Training College since 2012. Palliative care has been included in all the relevant health policies/strategies. Kenya Essential Medicines List includes Opioids. The Ministry of Health is supplying morphine powder for the country. More patients are now able to access quality palliative care. What was learned: National associations are challenged by an enormous need for services, education and training of health care professionals as well as educating the public and policy makers. The government has no budget for palliative care and most of the work is donor funded. Cultural beliefs are a big barrier to accessing PC. Only a small fraction of patients in need of opioids for pain medication are receiving opioids due to lack of awareness; reluctance of HPCs to prescribe. For many years PC in Kenya has been provided by a few hospices, thus making access very limited to many who are in need. Regional and national associations in Africa should work together with African Ministries of Health and other relevant stakeholders to ensure that there is greater access to palliative care for cancer patients. This encompasses addressing issues of accessibility, affordability, quality palliative care (PC) and a human's right approach to PC.
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Ardis, Ann. "Making Middlebrow Culture, Making Middlebrow Literary Texts Matter: The Crisis, Easter 1912." Modernist Cultures 6, no. 1 (May 2011): 18–40. http://dx.doi.org/10.3366/mod.2011.0003.
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The Crisis was established in 1910 by the National Association for the Advancement of Colored People at the behest and under the editorship of W. E. B. DuBois. Its earliest years of publication are distinctive, as Anne E. Carroll has argued, for their dual focus on ‘protest[ing] against racial injustice and…affirm[ing] the achievement of African Americans’. Both building on and taking issue with recent research on the Crisis by Carroll and Russ Castronovo, this essay offers a materially based, object-oriented account of how the Crisis engaged an aspirational black middle class readership—and sought to make middlebrow literary texts matter—in its Easter 1912 issue. Instead of employing the methodologies of author-based literary study, I read Charles E. Chesnutt's ‘The Doll’ and Jesse Fauset's ‘Rondeau’ in tandem with and in relation to the magazine's non-literary and commercial content. Doing so not only brings into high relief the Crisis's outreach to an aspirational black middle class. It also helps us recognize the magazine's interest in having its readers find beauty in both a barbershop and in literary forms that cannot—or rather, should not—be subsumed within expansive new definitions of modernism.
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FRAMKE, MARIA. "‘We Must Send a Gift Worthy of India and the Congress!’ War and political humanitarianism in late colonial South Asia." Modern Asian Studies 51, no. 6 (November 2017): 1969–98. http://dx.doi.org/10.1017/s0026749x16000950.
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AbstractThe interwar period has recently been described as a highly internationalist one in South Asia, as a series of distinct internationalisms—communist, anarchist, social scientific, socialist, literary, and aesthetic1—took shape. At the same time, it has been argued that the Second Sino-Japanese War of 1937 drew to a close various opportunities for international association (at least, temporarily). Taking into account both these contradistinctive developments, this article deals with another—and thus far largely overlooked—South Asian internationalism in the form of wartime Indian humanitarianism. In 1938, the Indian National Congress helped organize an Indian medical mission to China to bring relief to Chinese victims of the Second Sino-Japanese War. By focusing on this initiative, this article traces the ideas, the practices, and the motives of Indian political humanitarianism. It argues that such initiatives, as they became part of much wider global networks of humanitarianism in the late 1930s and early 1940s, created new openings for Indian nationalists to establish international alliances. This article also examines the way in which political humanitarianism enabled these same nationalists to perform as independent leaders on an international stage, and argues that humanitarianism served as a tool of anti-colonial emancipation.
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Lebovics, Herman. "Protection Against Labor Troubles." International Review of Social History 31, no. 2 (August 1986): 147–65. http://dx.doi.org/10.1017/s0020859000008130.
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By introducing an economic cycle of a new sort in Europe the Great Depression of 1873–96 encouraged the alignment of iron and textile industrialists’ interests with those of the great growers and livestock raisers. The French version, perhaps best labelled the alliance of cotton and wheat, is the concern here, for since profits and sales for both agriculture and industry traced parallel curves, for the first time in French history, representatives of these interests could unite and press the new republican leadership for common relief against depression and intensifying foreign competition. They were also impelled to unite in the face of the growing militancy of the new working class emerging in the provinces. Their spokesmen of the Association de l'Industrie Française and the associated Société des Agriculteurs addressed themselves to the new incarnation of the social question by offering protective tariffs – and protected jobs and pay checks – to workers striking more frequently and organizing more solidly than ever before. Their slogan was “the protection of national labor”. Having no reforms to offer, the Opportunist republicans and their ex-monarchist allies offered the emergent industrial working class safe incomes and economic nationalism.
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Chia, Jean, Alfred Roy, Emma Jackman, Mark Inglis, and Christopher Wilson. "Short-Term Follow-Up of the PROSTALAC Implant for Primary Total Hip Arthroplasty in Patients with an Infected Native/Total Hip." Journal of Hip Surgery 05, no. 02 (June 2021): 074–77. http://dx.doi.org/10.1055/s-0041-1729869.
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AbstractInfection after a total hip replacement (THR) is a significant complication for patients and is costly for health services. The two-stage Prosthesis with Antibiotic Loaded Acrylic (PROSTALAC) procedure has been the gold standard treatment for managing THR infections. The aim of this study is to evaluate using a one-stage PROSTALAC procedure as an alternative for patients who would otherwise not be able to undergo THR surgery due to a previous hip infection.We evaluated nine cases where the PROSTALAC implant was used in the native hip. The reasons for surgery, clinical results, and complications were reviewed. An Australian Orthopaedic Association National Joint Replacement Registry data report verified that no patients were revised outside of our local center.All patients reported symptomatic relief and satisfactory function, one patient had a peri-prosthetic fracture after experiencing a fall, and one patient underwent surgery for loosening of the joint. No cases were revised to another implant or had further infection. Minimum follow-up was 2 years.Our results suggest that this implant is useful in patients with osteoarthritis of the hip with a history of previous infection or chronic infection of the native hip.
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Kimball, Bruce A. "The Disastrous First Fund-Raising Campaign in Legal Education: The Harvard Law School Centennial, 1914–1920." Journal of the Gilded Age and Progressive Era 12, no. 4 (October 2013): 535–78. http://dx.doi.org/10.1017/s1537781413000352.
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Between 1915 and 1925, Harvard University conducted the first national public fund-raising campaign in higher education in the United States. At the same time, Harvard Law School attempted the first such effort in legal education. The law school organized its effort independently, in conjunction with its centennial in 1917. The university campaign succeeded magnificently by all accounts; the law school failed miserably. Though perfectly positioned for this new venture, Harvard Law School raised scarcely a quarter of its goal from merely 2 percent of its alumni. This essay presents the first account of this campaign and argues that its failure was rooted in longstanding cultural and professional objections that many of the school's alumni shared: law students and law schools neither need nor deserve benefactions, and such gifts worsen the overcrowding of the bar. Due to these objections, lethargy, apathy, and pessimism suffused the campaign. These factors weakened the leadership of the alumni association, the dean, and the president, leading to inept management, wasted time, and an unlikely strategy that was pursued ineffectively. All this doomed the campaign, particularly given the tragic interruptions of the dean's suicide and World War I, along with competition from the well-run campaigns for the University and for disaster relief due to the war.
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Onyx, Jenny, Sue Kenny, and Kevin Brown. "Active Citizenship: An Empirical Investigation." Social Policy and Society 11, no. 1 (December 6, 2011): 55–66. http://dx.doi.org/10.1017/s1474746411000406.
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This paper reports on a study of what active citizenship means from the perspective of citizens who are active within third sector organisations. It is based on an empirical study involving 1,610 respondents across 11 towns in six countries. The study explored how active citizenship is manifested, by gathering data on attitudes towards social changes and the forms and practices of active citizenship. There are two major, and apparently contradictory themes emerging in the data. The first theme provides a portrait of active engagement, proactively, and sometimes oppositionally working for a better world. On the other hand, citizens by and large avoid active oppositional engagement in the political process. They prefer to work collaboratively with government and to work at the local level. This second theme can be understood as social maintenance, support for existing structures that facilitates community cohesion, while providing relief for the disadvantaged, often with a conservative charity or welfare orientation. Following the work of Touraine, the study revealed how citizens act at the local rather than the national level, and focus on concrete issues and interpersonal relations rather than political action aimed at wider policy change. While this form of citizenship action can reflect a conservative form of maintenance, it is equally a creative new form of association and mutual support.
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Carroll, Robert. "Finding the Words to Say It: The Healing Power of Poetry." Evidence-Based Complementary and Alternative Medicine 2, no. 2 (2005): 161–72. http://dx.doi.org/10.1093/ecam/neh096.
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My purpose in this paper is to help you experience for yourself the potential of poetry to heal by feeling its power through your own voice. Many people have an intuitive sense that voice in general and poetry in particular can be healing. We have all experienced the comfort of soothing words. Finding the words to articulate a traumatic experience can bring relief. A letter between friends who are fighting can heal a relational wound. People are frequently moved to write a poem in times of extremity. In mainstream culture there are subjects that are not talked about. They are taboo. For example, each of us is going to die, but we do not talk about dying. We are all in the dialogue of illness, death and dying, whether or not we are talking about it. Poetry gives us ways to talk about it. Multiple ways of utilizing poetry for healing, growth and transformation will be presented including the Poetry and Brain Cancer project at UCLA. Particular attention will be given to issues of Palliative care. The reader will be directed to the scientific evidence of the efficacy of utilizing expressive writing. The developing professional field of Poetry Therapy, and The National Association for Poetry Therapy will be discussed.
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Islam Talukder, Mohammed Quamrul, Saikat DasGupta, Mauin Uddin, Ishtiaque Syed Al Manzoo, Mohammad Ziaur Rahman, A. T. M. Khalilur Rahman, and Farooque Ahmed. "Midterm Outcome of Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy (HOCM): A Single-Center Observational Study." Heart Surgery Forum 23, no. 6 (November 24, 2020): E873—E879. http://dx.doi.org/10.1532/hsf.3287.
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Background: For years, septal myectomy has been considered the best available treatment for hypertrophic cardiomyopathy. In Bangladesh, however, this technique is only nascent. We present a case series of septal myectomy with outcomes after 1 to 6 years at the National Heart Foundation Hospital & Research Institute. Methods: For this study, 21 patients who underwent septal myectomy from 2014 to 2019 were monitored retrospectively. Evidence was collected from the hospital database and followed up via telephone conversations using a structured questionnaire. Patients’ preoperative, postoperative, and follow-up clinical data were collected and analyzed. Results: The results reveal that after septal myectomy, there were significant improvements in terms of left ventricular outflow gradient (P ≤ .01), septal thickness (P ≤ .01), left ventricular ejection fraction (P = .001), pulmonary arterial systolic pressure (P ≤ .01), mitral regurgitation (P ≤ .01), systolic anterior motion (P ≤ .01), and New York Heart Association class (P ≤ .01). Conclusion: This study suggests that septal myectomy be offered to symptomatic hypertrophic obstructive cardiomyopathy patients, as its survival benefits and symptoms relief are excellent. This study suggests that septal myectomy that dynamic obstruction at the left ventricular outflow tract is the major hemodynamic problem. We hope that with appropriate measures, new myectomy programs in our country can provide extended longevity and restore the quality of life.
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Archer, Kristin R., Ellen J. MacKenzie, Michael J. Bosse, Andrew N. Pollak, and Lee H. Riley. "Factors Associated With Surgeon Referral for Physical Therapy in Patients With Traumatic Lower-Extremity Injury: Results of a National Survey of Orthopedic Trauma Surgeons." Physical Therapy 89, no. 9 (September 1, 2009): 893–905. http://dx.doi.org/10.2522/ptj.20080321.
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Background Variation in referral rates for physical therapy exists at both the individual physician and practice levels. Objective The purpose of this study was to explore the influence of physician and practice characteristics on referral for physical therapy in patients with traumatic lower-extremity injury. Design A cross-sectional survey was conducted. Methods In 2007, a Web-based survey questionnaire was distributed to 474 surgeon members of the Orthopaedic Trauma Association. The questionnaire measured physician and practice characteristics, outcome expectations, and attitude toward physical therapy. Referral for physical therapy was based on case vignettes. Results The response rate was 58%. Surgeons reported that 57.6% of their patients would have a positive outcome from physical therapy and 24.2% would have a negative outcome. The highest physical therapy expectations were for the appropriate use of assistive devices (80.7%) and improved strength (force-generating capacity) (76.4%). The lowest outcome expectations were for improvements in pain (35.9%), coping with the emotional aspects of disability (44.1%), and improvements in workplace limitations (51.4%). Physicians reported that 32.6% of their patients referred for physical therapy would have no improvement beyond what would occur with a surgeon-directed home exercise program. Multivariate analyses showed positive physician outcome expectations to have the largest effect on referral for physical therapy (odds ratio=2.7, P<.001). Conclusions The results suggest that orthopedic trauma surgeons refer patients for physical therapy based mostly on expectations for physical and motor outcomes, but may not be considering pain relief, return to work, and psychosocial aspects of recovery. Furthermore, low referral rates may be attributed to a preference for surgeon-directed home-based rehabilitation. Future research should consider the efficacy of physical therapy for pain, psychosocial and occupational outcomes, and exploring the differences between supervised physical therapy and physician-directed home exercise programs.
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Albert, K., L. C. Hookey, A. J. Ruberto, J. Gareri, and M. Sivilotti. "P004: Hair cannabinoid concentrations in hyperemesis cannabis: a case-control study." CJEM 19, S1 (May 2017): S78—S79. http://dx.doi.org/10.1017/cem.2017.206.
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Introduction: Emergency physicians increasingly encounter young patients with protracted, forceful hyperemesis associated with heavy cannabis use, previously termed “cyclic vomiting.” The national discourse on liberalization of cannabis has largely ignored this poorly understood condition. We wondered to what degree hyperemesis cannabis is an idiosyncratic reaction, like motion sickness or migraine, versus a more predictable dose-response effect of heavy, prolonged use. Methods: As part of a larger case-control study using structured interviews, we measured cannabinoid concentrations in scalp hair of both cases and controls. Cases were required to have an emergency visit for vomiting, 2+ episodes of severe vomiting in the previous year, history of near-daily use of cannabis for 6+ months, positive urine Δ9-tetrahydrocannabinol (THC) and age 16-55 years; exclusion criteria were chronic opioid use, synthetic cannabinoid use, or established alternative diagnosis. Age- and sex-matched chronic cannabis-using controls without vomiting were identified via social referral primarily from the cases themselves. Scalp hair was analyzed for THC, cannabinol (CBN), cannabidiol (CBD) and 11-nor-9-carboxy-THC (THC-COOH) by LC-MS/MS (limit of quantification ~15 pg/mg hair; accuracy <5%) in an independent laboratory blinded to subject classification. Results: We obtained satisfactory hair and urine samples from 18 cases (median [IQR] age 27 [20,31] years; 12 male) and 13 controls. THC and CBN concentrations were higher in cases than controls (THC 240 [120,820] vs 99 [73, 290] pg/mg; CBN 63 [33, 260] vs 15 [negative, 76] pg/mg; each P<0.05). CBD and THC-COOH were often unquantifiable to undetectable in both cases and controls. Conclusion: Hyperemesis cannabis patients have substantially higher hair cannabinoid concentrations than their peers without vomiting, although there is some overlap. The association cannot demonstrate a direct dose-response with THC--confounding (e.g. other cannabinoids, external smoke deposition), altered metabolism and reverse causation (e.g. seeking temporary symptom relief by using more cannabis) could also yield a positive association. Nevertheless, these findings support counselling patients with hyperemesis to reduce or discontinue using cannabis. They also support national regulatory initiatives including education, labelling, and progressive taxation based on potency intended to discourage excessive use.
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Archer, James E., Siddhant Kapoor, Danielle Piper, and Abdulrahman Odeh. "The impact of COVID-19 on 30-day mortality in patients with neck of femur fractures." Bone & Joint Open 1, no. 7 (July 2020): 326–29. http://dx.doi.org/10.1302/2046-3758.17.bjo-2020-0066.r1.
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Aims The COVID-19 pandemic presents a significant threat to patients with neck of femur fractures. The 30-day mortality for these patients has gradually been reducing in the UK due to a multitude of inputs aimed at improving their outcomes. We provided an early assessment of 30-day mortality in neck of femur fracture patients who contracted COVID-19. Methods We identified 18 patients who were admitted from three acute hospital sites who underwent an operation for a neck of femur fracture and were diagnosed with COVID-19 between 25 March and 25 April 2020. We collected information on their age, American Association of Anesthesiologists (ASA) grade, diagnosis, surgical procedure, complications, and 30-day mortality. Results Our study identified 18 patients who were all diagnosed with a positive swab result during the postoperative period. Female patients made up two-thirds of the patient cohort and the mean age of patients was 82 years (55 to 101). In all, ten patients sustained intracapsular fractures with eight sustaining extracapsular fractures. The 30-day mortality in this group of patients was 22.2% as compared to 4% 30-day mortality in those without COVID-19. Conclusion Our results show a 30-day mortality of 22.2%, which is higher than the national average provided by the 2019 National Hip Fracture Database report. However, while 30-day mortality has increased in those patients with COVID-19, this should not impact upon the provision of hip fracture surgery as it provides significant benefits to the patient such as pain relief and early mobilization. However, the information presented in this study should form an important part of the informed consent process for surgery. A multidisciplinary approach is crucial in ensuring optimal care for this complex patient group. Cite this article: Bone Joint Open 2020;1-7:326–329.
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Jerosch-Herold, Christina, Julie Houghton, Julian Blake, Anum Shaikh, Edward CF Wilson, and Lee Shepstone. "Association of psychological distress, quality of life and costs with carpal tunnel syndrome severity: a cross-sectional analysis of the PALMS cohort." BMJ Open 7, no. 11 (November 2017): e017732. http://dx.doi.org/10.1136/bmjopen-2017-017732.
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ObjectivesThe Prediciting factors for response to treatment in carpal tunnel syndrome (PALMS) study is designed to identify prognostic factors for outcome from corticosteroid injection and surgical decompression for carpal tunnel syndrome (CTS) and predictors of cost over 2 years. The aim of this paper is to explore the cross-sectional association of baseline patient-reported and clinical severity with anxiety, depression, health-related quality of life and costs of CTS in patients referred to secondary care.MethodsProspective, multicentre cohort study initiated in 2013. We collected baseline data on patient-reported symptom severity (CTS-6), psychological status (Hospital Anxiety and Depression Scale), hand function (Michigan Hand Questionnaire) comorbidities, EQ-5D-3L (3-level version of EuroQol-5 dimension) and sociodemographic variables. Nerve conduction tests classified patients into five severity grades (mild to very severe). Data were analysed using a general linear model.Results753 patients with CTS provided complete baseline data. Multivariable linear regression adjusting for age, sex, ethnicity, duration of CTS, smoking status, alcohol consumption, employment status, body mass index and comorbidities showed a highly statistically significant relationship between CTS-6 and anxiety, depression and the EQ-5D (p<0.0001 in each case). Likewise, a significant relationship was observed between electrodiagnostic severity and anxiety (p=0.027) but not with depression (p=0.986) or the EQ-5D (p=0.257). National Health Service (NHS) and societal costs in the 3 months prior to enrolment were significantly associated with self-reported severity (p<0.0001) but not with electrodiagnostic severity.ConclusionsPatient-reported symptom severity in CTS is significantly and positively associated with anxiety, depression, health-related quality of life, and NHS and societal costs even when adjusting for age, gender, body mass index, comorbidities, smoking, drinking and occupational status. In contrast, there is little or no evidence of any relationship with objectively derived CTS severity. Future research is needed to understand the impact of approaches and treatments that address psychosocial stressors as well as biomedical factors on relief of symptoms from carpal tunnel syndrome.
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Matz, Paul G., Langston T. Holly, Michael W. Groff, Edward J. Vresilovic, Paul A. Anderson, Robert F. Heary, Michael G. Kaiser, et al. "Indications for anterior cervical decompression for the treatment of cervical degenerative radiculopathy." Journal of Neurosurgery: Spine 11, no. 2 (August 2009): 174–82. http://dx.doi.org/10.3171/2009.3.spine08720.
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Object The objective of this systematic review was to use evidence-based medicine to identify the indications and utility of anterior cervical nerve root decompression. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to surgical management of cervical radiculopathy. Abstracts were reviewed after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Anterior nerve root decompression via anterior cervical discectomy (ACD) with or without fusion for radiculopathy is associated with rapid relief (3–4 months) of arm/neck pain, weakness, and/or sensory loss compared with physical therapy (PT) or cervical collar immobilization. Anterior cervical discectomy and ACD with fusion (ACDF) are associated with longer term (12 months) improvement in certain motor functions compared to PT. Other rapid gains observed after anterior decompression (diminished pain, improved sensation, and improved strength in certain muscle groups) are also maintained over the course of 12 months. However, comparable clinical improvements with PT or cervical immobilization therapy are also present in these clinical modalities (Class I). Conflicting evidence exists as to the efficacy of anterior cervical foraminotomy with reported success rates of 52–99% but recurrent symptoms as high as 30% (Class III). Conclusions Anterior cervical discectomy, ACDF, and anterior cervical foraminotomy may improve cervical radicular symptoms. With regard to ACD and ACDF compared to PT or cervical immobilization, more rapid relief (within 3–4 months) may be seen with ACD or ACDF with maintenance of gains over the course of 12 months (Class I). Anterior cervical foraminotomy is associated with improvement in clinical function but the quality of data are weaker (Class III), and there is a wide range of efficacy (52–99%).
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Champaneria, Rita, Laila Shah, Jonathan Moss, Janesh K. Gupta, Judy Birch, Lee J. Middleton, and Jane P. Daniels. "The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness." Health Technology Assessment 20, no. 5 (January 2016): 1–108. http://dx.doi.org/10.3310/hta20050.
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BackgroundPelvic congestion syndrome (PCS) is described as chronic pelvic pain (CPP) arising from dilated and refluxing pelvic veins, although the causal relationship between pelvic vein incompetence (PVI) and CPP is not established. Non-invasive screening methods such as Doppler ultrasound and magnetic resonance venography are used before confirmation by venography. Percutaneous embolisation has become the principal treatment for PCS, with high success rates often cited.ObjectivesOur proposal aimed to systematically and critically review the definitions and diagnostic criteria of PCS, the association between PVI and CPP, the accuracy of various non-invasive imaging techniques and the effectiveness of embolisation for PVI; and to identify factors associated with successful outcome. We also wished to survey clinicians and patients to assess awareness and management of PCS and gauge the enthusiasm for further research.Data sourcesA comprehensive search strategy encompassing various terms for pelvic congestion, pain, imaging techniques and embolisation was deployed in 17 bibliographic databases, including MEDLINE, EMBASE and Web of Science. There was no restriction on study design.MethodsMethodological quality was assessed using appropriate tools. Online surveys were sent to clinicians and patients. The quality and heterogeneity generally precluded meta-analysis and so results were tabulated and described narratively.ResultsWe identified six association studies, 10 studies involving ultrasound, two studies involving magnetic resonance venography, 21 case series and one poor-quality randomised trial of embolisation. There were no consistent diagnostic criteria for PCS. We found that the associations between CPP and PVI were generally fairly similar, with three of five studies with sufficient data showing statistically significant associations (odds ratios of between 31 and 117). The prevalence of PVI ranged widely, although the majority of women with PVI had CPP. Transvaginal ultrasound with Doppler and magnetic resonance venography are both useful screening methods, although the data on accuracy are limited. Early substantial relief from pain symptoms was observed in approximately 75% of women undergoing embolisation, a figure which generally increased over time and was sustained. Reintervention rates were generally low. Transient pain was a common occurrence following foam embolisation, while there was a < 2% risk of coil migration. Confidence in the embolisation technique is reasonably high, although there is a desire to strengthen the evidence base. Even among women with CPP, fewer than half had any knowledge about PCS.ConclusionsThe data supporting the diagnosis and treatment of PCS are limited and of variable methodological quality. There is some evidence to tentatively support a causative association, but it cannot be categorically stated that PVI is the cause of CPP in women with no other pathology, as the six most pertinent drew on clinically disparate populations and defined PVI inconsistently. Embolisation appears to provide symptomatic relief in the majority of women and is safe. However, the majority of included studies of embolism were relatively small case series and only the randomised controlled trial was considered at risk of potential biases. There is scope and demand for considerable further research. The question of the association of PVI and CPP requires a well-designed and well-powered case–control study, which will also provide data to derive a diagnostic standard. An adequately powered randomised trial is essential to provide evidence on the effectiveness of embolisation, but this faces methodological challenges.Study registrationThis study is registered as PROSPERO CRD42012002237 and CRD42012002238.FundingThe National Institute for Health Research Health Technology Assessment programme.
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Hartz, N. B. "PARE0014 CANNABIS – HOW TO NAVIGATE BETWEEN PRESSURE FROM PATIENTS, LEGISLATION AND NEED FOR EVIDENCE." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1293.1–1293. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3048.
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Background:Around the world, focus on cannabis has been increasing immensely the last couple of years. Patients with RMD very often experience pain and many of these patients do not get adequate relieve from ordinary painkillers. Therefore, the pressure from patients wanting to try cannabis in order to ease their pain, is very understandable but also a difficult field to navigate in for a rheumatism association. Mainly because there are so many different interests in cannabis from many sides.Objectives:The Danish Rheumatism Association has taken a very active role in unfolding knowledge of the positive and negative effects of cannabis to patients with RMD. We want to show, that we are aware of our patients needs and interests and we wish to give independent information to patients with RMD about suitable pain relief also when this involves the use of cannabis.Methods:In order to get more knowledge about the need of the patients, the Danish Rheumatism Association has registered every inquiry from patients to our professional helpline in 2018 regarding cannabis. This information has been used in our political work with the Danish Ministry of Health and has given us a deeper understanding of the RMD-patients background and motivation for using cannabis.The Danish Rheumatism Association has supported cannabis research financially, and we have taken part in the public debate with editorials. On our website, we have fact sheets regarding cannabis along with a theme about cannabis in our magazine. The Danish Rheumatism Association has been very active politically in order to get RMD-patients to be part of a national project with medical cannabis to different groups of patients. We have an ongoing contact with the Danish Ministry of Health regarding RMD-patients experience in using cannabis and we pass on RMD-patients difficulties in even getting cannabis legally. In addition, to continuously gain knowledge about RMD-patients’ experience with cannabis, we have also conducted questionnaires and surveys both in collaboration with other patient organizations and through our own channels.Results:We have made it clear that we take an active role in the public debate regarding the use of cannabis and that we understand the desire from patients to have as many options as possible to choose from when it comes to relieve their pain. However, we also acknowledge the fact, that we need more evidence when it comes to the use of cannabis as an actual option for patients with RMD-related pain. We are a reliable partner that politicians and other stakeholders take very seriously.Unfortunately, patients with RMD did not get to be part of the national project in Denmark with medical cannabis, but nevertheless many of these patients are using cannabis and most of the patients buy it illegally.Conclusion:The use of cannabis is still a very “hot topic” in many countries and the legislation can vary a lot from country to country. It is important that the rheumatism associations across Europe have knowledge about cannabis so that they can advise patients with RMD in a serious, objective and evidence-based manner.References:NoneDisclosure of Interests:None declared
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AGUIRRE, C. A., R. R. PAZ, and A. B. BRIZUELA. "EFFECTS OF MESH RESOLUTION ON THE SIMULATION OF SEVERE THUNDERSTORM: THE NEED OF PARALLEL COMPUTING AND DISTRIBUTED TECHNIQUES." Latin American Applied Research - An international journal 44, no. 1 (January 31, 2014): 31–40. http://dx.doi.org/10.52292/j.laar.2014.416.
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In the design of civil structures, it is necessary to consider the effect of the dynamic loads caused by changes in meteorological conditions such as wind speeds or ice deposits. In Argentina, the Standard of the Argentine Electrotechnical Association (AEA, 2006) is used to calculate structures of electrical transmission networks. This Standard specifies the value that must be assigned to the load by effect of the wind. This value is obtained from the meteorological records measured at conventional meteorological stations such as those of the National Meteorological Service. Nevertheless, to fit this parameter, it is also necessary to carry out local studies with updated information, considering the roughness and, in certain cases, the relief of the ground. Computational mechanics addresses this problem and is currently being used to estimate the values of maximum winds by simulations of severe meteorological events. However, it is also necessary to evaluate the results of this tool to know its accuracy in relation to the parameters of the numerical model. This work shows the use of the Large-eddy Simulation considering two options in the choice of element size used for a geographical grid domain in the thunderstorm occurred in Aranguren, Argentina, in 1998. In the first option, a processor is used to compute this event through a 406-meter grid-spacing in horizontal direction and in the second option a four-processor parallel method is used to obtain a more refined 200meter grid-spacing. The last option allows simulating severe events such as down-burst or vortex occurrence with more details.
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Ingram, Alan. "Domopolitics and Disease: HIV/AIDS, Immigration, and Asylum in the UK." Environment and Planning D: Society and Space 26, no. 5 (January 1, 2008): 875–94. http://dx.doi.org/10.1068/d2208.
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Geographers and others have become increasingly interested in the intersections between globalization, disease, and security, particularly in relation to ‘short-wave’ public health threats such as SARS and pandemic influenza, but ‘long-wave’ epidemics such as HIV/AIDS are also often said to raise questions of security. While a literature is emerging to analyze the politics of security in relation to global HIV/AIDS relief, in this paper I argue that it is also important analytically and politically to connect and contrast this with the ways that HIV/AIDS is politicized as a security issue in relation to immigration and asylum within Western states themselves. Drawing on literatures in governmentality, biopolitics, and security, I examine the politics of HIV/AIDS, immigration, and asylum in the UK from 1997 to 2007 with particular reference to the reactionary press coverage that influenced policy formation and judicial rulings in this period. Following the work of William Walters, I trace the emergence of a ‘domopolitical’ rationality in press reporting around HIV/AIDS in terms of a number of imaginative geographies, and suggest that these imaginative geographies are both biopolitical in a classical sense and connected with the colonial dimensions of the present. The circulation of these imaginative geographies through policy and legal developments, the dilemmas they have raised, and resistance to them from medical, civil society, and parliamentary groups are then outlined. Reflecting on the disjuncture in approaches to HIV/AIDS between the global and national spheres, I argue that while the association of HIV/AIDS and security is enhancing life chances for many it is also reducing them for people caught in the wrong place at the wrong time.
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Chen, Lichan, Xiaohong Wu, Xisui Chen, and Chunjiao Zhou. "Efficacy of Auricular Acupressure in Prevention and Treatment of Chemotherapy-Induced Nausea and Vomiting in Patients with Cancer: A Systematic Review and Meta-Analysis." Evidence-Based Complementary and Alternative Medicine 2021 (August 3, 2021): 1–11. http://dx.doi.org/10.1155/2021/8868720.
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Background. More than 40% of patients with cancer have reported that chemotherapy-induced nausea and vomiting (CINV) remained the most debilitating side effects of treatment even in the era of new antiemetics. Objective. The purpose of this review was to systematically evaluate the clinical effect of auricular acupressure (AA) in prevention and treatment of chemotherapy-induced nausea and vomiting. Methods. The following databases were searched: PubMed, Cochrane Library, EMBASE, the Web of Science, Chinese Biological Medicine (CBM), Chinese National Knowledge Infrastructure (CNKI), Wanfang, and VIP (from database inception to April 2020). Eligible randomized controlled trials of auricular acupressure in treating CINV were collected, including crossover randomized design study. The meta-analysis was carried out by RevMan software (5.3). Results. Totally 19 RCTs with 1449 patients met the inclusion criteria. Compared with control groups, the relief efficiency of overall CINV was enhanced by AA combined with antiemetics (RR = 1.31, CI 1.22 to 1.41, p ≤ 0.001). Although the therapeutic effect on acute nausea and vomiting was not obvious, AA still played an important role in reducing delayed nausea and vomiting (delayed nausea frequency: RR = 0.68, CI −1.01 to −1.35, p ≤ 0.001; delayed vomiting frequency: RR = 0.91, CI −1.22 to −0.61, p ≤ 0.001). The likelihood of adverse reactions related to antiemetics was reduced by AA combined with antiemetics (RR = 0.62, CI 0.53 to 0.74, p ≤ 0.001). Statistically significant association was found between AA and incidence of constipation, diarrhea, and tiredness, while there was no statistically significant association between AA and abdominal distension or headache. Conclusion. Auricular acupressure supplementation benefited delayed chemotherapy-induced nausea and vomiting as well as constipation, diarrhea, and tiredness. AA alone or AA supplementation has little effect on acute nausea and acute vomiting. There is no conclusion on whether AA alone is superior to antiemetics in the management of delayed CINV. Further studies are needed to confirm the efficacy of auricular acupressure alone in delayed CINV and anticipatory CINV. The results of this review provided the basis for further research with more rigorous study designs, adequate sample sizes, and standardized implementation to confirm the efficacy of auricular acupressure.
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Wilhelm, Jess Alan, Ligia Paina, Mary Qiu, Henry Zakumumpa, and Sara Bennett. "The differential impacts of PEPFAR transition on private for-profit, private not-for-profit and publicly owned health facilities in Uganda." Health Policy and Planning 35, no. 2 (November 12, 2019): 133–41. http://dx.doi.org/10.1093/heapol/czz090.
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Abstract While transition of donor programs to national control is increasingly common, there is a lack of evidence about the consequences of transition for private health care providers. In 2015, President’s Emergency Plan for AIDS Relief (PEPFAR) identified 734 facilities in Uganda for transition from PEPFAR support, including 137 private not-for-profits (PNFP) and 140 private for-profits (PFPs). We sought to understand the differential impacts of transition on facilities with differing ownership statuses. We used a survey conducted in mid-2017 among 145 public, 29 PNFP and 32 PFP facilities reporting transition from PEPFAR. The survey collected information on current and prior PEPFAR support, service provision, laboratory services and staff time allocation. We used both bivariate and logistic regression to analyse the association between ownership and survey responses. All analyses adjust for survey design. Public facilities were more likely to report increased disruption of sputum microscopy tests following transition than PFPs [odds ratio (OR) = 5.85, 1.79–19.23, P = 0.005]. Compared with public facilities, PNFPs were more likely to report declining frequency of supervision for human immunodeficiency virus (HIV) since transition (OR = 2.27, 1.136–4.518, P = 0.022). Workers in PFP facilities were more likely to report reduced time spent on HIV care since transition (OR = 6.241, 2.709–14.38, P < 0.001), and PFP facilities were also more likely to discontinue HIV outreach following transition (OR = 3.029, 1.325–6.925; P = 0.011). PNFP facilities’ loss of supervision may require that public sector supervision be extended to them. Reduced HIV clinical care in PFPs, primarily HIV testing and counselling, increases burdens on public facilities. Prior PFP clients who preferred the confidentiality and service of private facilities may opt to forgo HIV testing altogether. Donors and governments should consider the roles and responses of PNFPs and PFPs when transitioning donor-funded health programs.
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Madunová, A., and M. Duračinská. "Practical Experience with Providing Specialized Social Services for Rare Disease Patients / Praktické skúsenosti v poskytovaní špeciálnych sociálnych služieb pre pacientov so zriedkavými chorobami." Acta Facultatis Pharmaceuticae Universitatis Comenianae 60, Supplementum-VIII (March 1, 2013): 47–54. http://dx.doi.org/10.2478/afpuc-2013-0010.
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Organization of Muscular Dystrophy in the Slovak Republic (OMD in SR) is the only specific organization in Slovakia which associates children and adults with muscular dystrophy and other types of neuromuscular diseases (hereafter only NMD) and their families. The organization was founded as an independent public association in 1993. It has been providing social counselling and other specialized social services for its members and clients. In its early years, it performed the community service and nonprofit activities on a voluntary basis; today, a professional team of nine takes part in its activities, seven of which are people with extensive disability, plus two assistants. This change could take place thanks to having obtained the status of a protected workplace in 2009. In accordance with EURORDIS recommendations, OMD in SR takes care of activities in 3 different areas: information services and help line, therapeutic recreational programmes, and respite care services. As a part of the information service, it provides specialized social counselling for disabled people via phone, email, in person or in the field − at a patient’s place. The organization also publishes its own quality magazine Ozvena (ECHO), which is distributed free-of-charge to all members four times a year. People with NMD are involved in the creation of the magazine from the position of experts and patients. The organization is particularly devoted to Recreational activities the camps for children with NMD, especially boys with Duchenne muscular dystrophy. Activities organized every year include also integrative national meetings of members. The group of relief services includes providing specialized social services in the Personal Assistance Services Agency founded under OMD in SR. It provides wide-range service for 180 personal assistance users in Bratislava region; however, counselling covers the whole Slovakia. For a long time, the organization has been making effort to change regulations in the legislation which concern several aspects essential for people with NMD. Slovakia is not doing enough to provide financial support for functioning of patient organizations − the subsidy system does not take them into account and donation support is non-existent. A tool for change could and should be the National Plan for Rare Disease, which will not be really implemented without providing subsidies for patient organizations working in the area of rare diseases. In 2012, the organization became a member of EURORDIS and Alliance TREAT - NMD.
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Taylor, Kimberly. "Alternative Options for Resolution of Property and Casualty Claims Arising out of Natural Disasters." Texas A&M Journal of Property Law 5, no. 2 (December 2018): 193–200. http://dx.doi.org/10.37419/jpl.v5.i2.4.
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At the time of this Article, at least twelve large wildfires are burn- ing in California across more than 1,000 square miles, having damaged or destroyed over 2,000 structures, according to the California Department of Forestry and Fire Protection (CAL FIRE). At least eight people have lost their lives. The Kilauea volcano continues to erupt in Hawaii, having destroyed 600 homes. The 2018 hurricane season is in full swing, and while there have been no catastrophic events to date, residents in Houston, Florida, Puerto Rico, and elsewhere are still recovering from the devastating winds and rains wrought by Har- vey, Maria, and Irma last year. Those hurricanes are estimated to have caused more than $200 billion in damages, making the 2017 hurricane season the costliest in U.S. history. Around the world, natural disasters such as deadly heat waves, flooding, mudslides, hurricanes, and tornadoes will cause untold losses as temperatures across the globe are rising. After the smoke clears, the ash settles, the waters subside, and initial recovery efforts restore basic functions like the delivery of food, water, and electricity, survivors face the task of rebuilding. Inevitably, property and business owners either look to their insurance carriers for relief or initiate tort actions against alleged wrongdoers. In 2007, more than 2,000 law suits were filed against San Diego Gas & Electric following a series of wildfires that engulfed San Diego County in California, where faulty power lines were blamed for some of the fires. Dozens of cases have been filed in Ventura and Santa Barbara counties in California relating to the deadly Thomas Fire and related devastating mudslides that killed twenty people and destroyed hundreds of homes late last year. Traditional litigation used to resolve these disputes has the potential to overwhelm the courts, consume limited resources of insurance carriers and others, and be unduly burdensome to survivors. Alternative dispute resolution (“ADR”) mechanisms such as mediation can offer significant relief to the parties, permitting them to negotiate a resolution in a less formal setting than the courthouse, and usually within a shorter time frame than typical litigation would require. In situations where a mass disaster does not easily lend itself to individual mediations, however, providers can customize the process to ensure that all parties—those parties that have suffered losses, insurance carriers, and potentially responsible parties—experience a fair, economic, and efficient resolution. National ADR providers such as JAMS and the American Arbitration Association offer comprehensive, customized processes that can be tailored to meet the needs of the parties and the unique requirements of each case. Individual mediators around the country routinely provide assistance with ADR process design for complex, multi-party matters. Some examples follow.
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Gardiner, Michael. "Nuclear Deficit: Why Nuclear Weapons Are Natural, but Scotland Doesn’t Need Nature." Humanities 8, no. 3 (September 2, 2019): 147. http://dx.doi.org/10.3390/h8030147.
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This article argues that millennial Scottish culture has been animated in large part by a push to overcome a historiographical compulsion built into the modern British state’s understanding of nature. This understanding of nature became the foundational principle of government during the Financial Revolution and British unification in the 1690s–1710, then was made the subject of a universal history by the Scottish Enlightenment of the later eighteenth century, and has remained in place to be extended by neoliberalism. The article argues more specifically that the British association of progress with dominion over the world as nature demands a temporal abstraction, or automation, reducing the determinability of the present, and that correspondingly this idea of nature ‘softens’ conflict in a way that points to weapons carrying perfectly abstracted violence. Nuclear weapons become an inevitable corollary of the nature of British authority. Against this, twenty-first century Scottish cultures, particularly a growing mainstream surrounding independence or stressing national specificity, have noticeably turned against both nuclear weapons and the understanding of nature these weapons protect. These cultures draw from a 1980s moment in which anti-nuclear action came both to be understood as ‘national’, and to stand in relief to the British liberal firmament. These cultures are ‘activist’ in the literal sense that they tend to interrupt an assumption of the eternal that stands behind both nuclear terror and its capture of nature as dominion over the world. A dual interruption, nuclear and counter-natural, can be read in pro-independence cultural projects including online projects like Bella Caledonia and National Collective, which might be described as undertaking a thorough ‘denaturing’. But if the question of nature as resources for dominion has been a topic for debate in the environmental humanities, little attention has been paid to this specifically British ‘worlding’ of nature, or to how later constitutional pressures on the UK also mean pressures on this worlding. Andreas Malm’s Fossil Capital (2016), for example, a powerful account of the automation of production in the British industrial revolution, might be related to the automation of ideas of progress pressed during the Scottish Enlightenment, and entrenching a dualism of owning subject and nature as object-world that would drive extraction in empire. Finally, this article suggests that this dualism, and the nature holding it in place, have also been a major target of the ‘wilderness encounters’ that form a large sub-genre in twenty-first century Scottish writing. Such ‘denaturing’ encounters can be read in writers like Alec Finlay, Linda Cracknell, Thomas A. Clark, and Gerry Loose, often disrupting the subject standing over nature, and sometimes explicitly linking this to a disruption of nuclear realism.
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Kananga, A. Mubeneshayi. "The Integration of Palliative Care in DR Congo “A Model Of Sustainability”: A Field Study." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 171s. http://dx.doi.org/10.1200/jgo.18.36900.
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Background and context: In DR Congo, many cancer patients in the terminal phase of their condition have minimal access to palliative care. There is a combined effect of poverty, the deterioration of the health system and the absence of a well-defined national policy on palliative care. Patients are for the most part abandoned to the care of inexperienced family members. Driven by the fact that the number of palliative patients has been increasing steadily over the past five years, the Palliafamilli association and its partners have taken leadership in the fight for palliative care. The major issue that blocks palliative care in RD Congo is the lack of knowledge about palliative care both in the population and even in health professionals. Most patients are treated at home with strong family involvement in many aspects of care. Aim: To promote good health practices at the community level and equip them with the knowledge and means to prevent their health problems, with a focus on palliative care and to contribute to the implementation of the Strategy for Strengthening the Health System of DR Congo by facilitating a program of access to palliative care for the entire Congolese population. Strategy/Tactics: During the last 7 years, we have organized conferences, congresses, various training sessions on pain management, sensitization activities, capacity building courses and advocacy activities within the Ministry of Health for national palliative care guidelines. Program/Policy process: - The organization of two International Congress of Palliative Care in Kinshasa in April 2013 (550 participants) and September 2015 (700 participants) - Training of 3 health professionals on the palliative approach in Uganda (2013) - Participation at the Second Francophone Palliative Care Congress in Montreal 2013 - A palliative care training course at the University of Kinshasa in 2015 (115 participants) - The organization of the International Colloquium of Pediatric Palliative Care in Kinshasa in 2015 - Participation in the 4th International Francophone Congress of Palliative Care in Geneva (2017) - Participating in the drafting of national guidelines for palliative care within the Ministry of Health (2017) - Capacity building for two members of PalliaFamilli thanks to the scholarship offered by the UICC. What was learned: In DR Congo, palliative care and pain relief require a cross-cutting approach, as resources are limited, many people are in need of care, and there are few nurses and doctors empowered to provide care. An effective approach is to involve community or volunteer caregivers supervised by health professionals, and Palliafamilli is successful due in its multidisciplinary and multisectoral approach, with adaptation to cultural, social and economic specificities and its integration with existing health systems, focusing on primary health care and community and home care.
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Lugovyi, V., O. Slyusarenko, and Zh Talanova. "From accreditation to ranking (functioning vs development)." International Scientific Journal of Universities and Leadership, no. 2(6) (December 30, 2018): 3–20. http://dx.doi.org/10.31874/2520-6702-2018-6-2-3-20.
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The essence, strengths and weaknesses of the accreditation and ranking mechanisms for assessing the institutional capacity and performance of higher education institutions are analyzed and systematically compared in the article. Significant advantages of the ranking over accreditation are proved, as well as the subordination of the second one to the first one, given the leading role of higher education in ensuring and accelerating human progress that has a research-innovative and competitive character. The necessity of urgent introduction, as well as the main stages of practical implementation of the national general and sectoral ranking based on the methodology of the Shanghai ranking (ARWU), are substantiated. It is proposed to use a national ranking for modernization of the national network of higher education institutions.
It is argued that accreditation and ranking are fundamentally different mechanisms for assessing education quality with significantly greater possibilities for ranking. Accreditation focuses on the thresholds (minimum) standards and requirements (conditions) and is not suitable for an objective comparative assessment of institutions (educational programmes), taking into account their level of excellence. The rank implies the ranking institutions in the order of their achievements, therefore, in terms of importance and significance, and can be used for relief modeling the landscape of the network of higher education institutions (not only in terms of their territorial or sectoral accumulation, but also in terms of competitiveness). Given this Ukraine with 289 successfully accredited institutions remains a white spot in Europe and the world according to interpretation of the Shanghai ranking of 2018. Unlike accreditation, which, due to limited capabilities, is unable to separate a mass low-order higher education from an innovative high-order higher education, the ranking mechanism reveals the first one as well as the second one.
It was clarified that in contrast to providing motivation of obligation (performance) for developing culture of the minimum sufficient quality by accreditation, the ranking forms motivation of encouragement (creativity) for developing culture of the maximum possible quality. The culture of the maximum possible quality under the current conditions of the research and innovation type of progress and competition is a priority because it enhancing competitiveness. In addition, ranking implies the existence of a developed autonomy, able to respond promptly and effectively to the results of the ranking assessment. Autonomy, basically, is non-critical for accreditation. The results of the ranking can be successfully used for accreditation under the conditions of real autonomy, but the conclusions of accreditation for the ranking of institutions – no. Accreditation is inherently affected by a subjective factor, at the same time, ranking (for example, ARWU) can be constructed with the exclusion of a subjective component, with transferring ranking functions to independent artificial intelligence in the future.
It has been shown that the research and innovation essence of higher education needs an appropriate valid mechanism of assessment of higher education institutions excellence, which is capable of permanently (for example, annually) to record level of institutions development in view of the ability to predict and project the future of society. Therefore, the trend of the rapid development and spread of international and national rankings is actual.
It is argued that the creation of the national ranking of higher education institutions is an urgent objective and should be carried out in several stages: its legislative regulation, the determination of the system of objective indicators agreed by the leading Ukrainian universities (it is advisable to unite them into the leading Association of Ukrainian Universities), organizational and legal, financial support for administration of the ranking (e.g. the National Higher Education Quality Assurance Agency), the annual ranking of institutions and according to its results elaboration and implementation of measures to improve the network of higher education institutions in Ukraine, primarily to consolidate and integrate them.
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Isobe, Kuniaki, and Toshiro Sugimura. "Mapping of Geospatial Information on Disasters Predicted to Occur in Wetland Areas of the Shonan Region." Abstracts of the ICA 1 (July 15, 2019): 1–2. http://dx.doi.org/10.5194/ica-abs-1-140-2019.
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<p><strong>Abstract.</strong> Ground damage, such as liquefaction events, occurred in the Kanto region during the Great East Japan Earthquake on March 11, 2011. Similar disasters can be expected to occur in the future. Disaster prevention and preparedness plans have been developed by municipal governments based on the principle of Jijo (self-aid), Kyojo (community assistance), and Kojo (government assistance). With national land information, including the latest satellite images and Jinsokusokuzu (QuickMap) prepared during the Meiji period, being compiled, consolidated and analysed, it is now expected that such national land information can be utilized in the field of disaster mitigation.</p><p>According to an old map, the old Kugenuma Lake used to be spread in the southeast of the city of Fujisawa, which is currently located in the dune lands in the Shonan region. This area is composed of sandbanks formed by the Hikichi River and the Sakai River. From the synthetic images based on satellite images and QuickMap, among other things, it is expected that a disaster may cause serious damage in areas of weak ground conditions along the old river ways and the brinks (cliffs) of the old Kugenuma Lake as they have been rapidly converted into residential areas (Figure 1). The evacuation map prepared based on this assumption indicates that nearby tsunami evacuation buildings should serve as an emergency evacuation centre for evacuees (Figure 2). In the vicinity of these emergency evacuation centres, however, there are various areas that may become impassable for evacuees and emergency vehicles due to the potential collapse of stone walls and utility poles, among other things.</p><p>From the synthetic images based on geospatial information, it is possible to identify areas prone to liquefaction in regions whose past land cover is related to water (Figure 1). The evacuation map, which has been prepared based on the reading of hazard maps and the results of our field investigation, has exposed a number of issues facing disaster-predicted areas (Figure 2). As a result, it is recommended that 1) a community association ensure to always keep evacuation routes operable and clear of any obstructions that may impede evacuation and 2) to conduct an emergency evacuation drill in different seasons and time zones. It is also essential to ensure that a community will develop its own technical capability and autonomous community-based capability to provide relief to its own community members through Kyojo.</p>
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Mazurenko, Olena, Justin Blackburn, Matthew Bair, Areeba Kara, and Christopher A. Harle. "3038 Examining the association between inpatient opioid prescribing and patient satisfaction." Journal of Clinical and Translational Science 3, s1 (March 2019): 121–22. http://dx.doi.org/10.1017/cts.2019.277.
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OBJECTIVES/SPECIFIC AIMS: Research overview: Providing patient-centered care is increasingly a top priority in the U.S. healthcare system.1,2 Hospitals are required to publicly report patient-centered assessments, including results from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction surveys.3 Furthermore, clinician and hospital reimbursements are partially determined by performance on patient satisfaction measures.3 Consequently, hospitals and clinicians may be incentivized to improve patient satisfaction scores over other important outcomes.4 Paradoxically then, the pursuit of patient-centered care may lead clinicians to fulfill patient requests for unnecessary and potentially harmful treatments.5 Opioid prescribing during hospitalizations may be particularly affected by clinicians’ seeking to optimize patient satisfaction scores.6,7 Satisfaction with pain care is an important predictor of overall patient satisfaction in the HCAHPS surveys,8,9 and clinicians report increased pressure to fulfill patient requests for immediate pain-relief.10,11 Therefore, clinicians may prescribe opioids to avoid receiving lower patient satisfaction scores.12,13 Furthermore, clinicians lack clear guidance on opioid prescribing for some populations, including non-surgical inpatients, who represent almost half of all hospitalizations.14 To reduce clinicians’ incentive to prescribe opioids as a means of achieving patient satisfaction, the Center for Medicare and Medicaid Services (CMS) temporarily removed questions related to patient satisfaction with pain care from the clinician and hospital reimbursement formulas beginning in 2018.15 Importantly, prior research16-20 has not rigorously tested the hypothesis implied by the CMS policy change: that certain opioid prescribing practices in inpatient pain care are associated with higher patient satisfaction. Objectives: The purpose of this study was to evaluate the association between the receipt/dose of opioids during non-surgical hospitalizations and patient satisfaction measured by the HCAHPS survey. METHODS/STUDY POPULATION: Methods/Study Population: We conducted a pooled cross-sectional study of adults (18 and older) with non-surgical hospitalizations within the 11-hospital healthcare system in a Midwestern state from 2011-2016. Data were extracted from electronic health records and linked to HCAHPS patient satisfaction surveys. We estimated the propensity score for receipt of any opioids during hospitalization and separately the receipt of high dose opioids (≥100 morphine milligram equivalent [MME]) based on patient, encounter, and facility characteristics for all hospitalizations with complete data. We used nearest neighbor matching to construct two matched samples to minimize selection bias and confounding by indication. We used a standardized difference threshold of < 0.1 as an indication of the balance between matched groups. Outcomes were compared with a test on the equality of proportions using large-sample statistics. All analysis was performed in STATA 14.0 analytical software. Main outcomes: We analyzed four dependent variables. Two pain-specific patient satisfaction variables were derived from the responses to the following survey questions: 1) “During this hospital stay, how often your pain was well controlled? (pain control)” and 2) “During this hospital stay, how often did the hospital staff do everything they could to help you with your pain? (pain help)”, with 4-point Likert scale responses ranging from “Never” to “Always.” We also used two global satisfaction measures derived from the responses to the following survey questions: 1) “Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay (overall patient satisfaction)?” and 2) “Would you recommend this hospital to your friends and family (willingness to recommend a hospital)? (4-point scale of “Definitely Yes” to “Definitely No”). Because the responses are not normally distributed, and the response options are truncated, we dichotomized each of these questions following previously published approaches8 and CMS methodology3 (e.g. “always” vs. all other responses or “9 or 10 rating” vs. all others). RESULTS/ANTICIPATED RESULTS: Results: Among 17,691 patients who reported that they needed pain medications during hospitalization in their HCAHPS survey, 43.7% (n=7,735) received opioids. Among the matched sample (n=8,848), 55% were female, 90% were white, 9% were black, 74% were emergency admissions, 29% had a circulatory diagnosis, 92% were discharged home, and the average pain score ranged from 0.2 to 7.1 during the hospital stay. Compared to matched patients hospitalized but did not receiving opioids, those who received opioids did not significantly differ in their rating of pain help (75% of patients without opioids rated that they always received help for their pain versus 75% of patients with opioids; p=.78), pain control (55% of patients without opioids reported that their pain was well controlled versus 54% on opioids; p=.93), willingness to recommend the hospital (69% of patients without opioids reported that they would definitely recommend a hospital versus 71% with opioids; p=.16) and overall rating of their care (47% of patients without opioids rated their hospitalization as 10 versus 46% on opioids; p=.22). DISCUSSION/SIGNIFICANCE OF IMPACT: Discussion: We found no evidence that receipt of opioids is associated with patient satisfaction, including at doses. To our knowledge, this is the first study that used propensity score matching to examine the association between inpatient opioid prescribing practices and patient satisfaction. Furthermore, our sample is unique in the inclusion of patients hospitalized for non-surgical indicators over a five year period in the multi-hospital healthcare system in a Midwestern state. Our findings add to the existing literature which has shown contradictory associations between opioid prescribing and patient satisfaction.16-22 Specifically, few studies that looked at surgical inpatients showed a lack of association between patient satisfaction16,18 and opioid prescribing, whereas others showed that receipt of opioids was associated with lower patient satisfaction.17-20 Our findings may imply that satisfaction with pain care may be achieved without administering opioids to non-surgical inpatients. Alternatively, satisfaction with pain care may not be influenced by opioid prescribing for non-surgical inpatients. Future research should further examine the association between opioid prescribing and patient satisfaction among non-surgical inpatients on a national scale to get a better understanding of the relationship between certain pain care practices and patient satisfaction.
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Gill, Thomas James, Andrew J. Wall, Frank W. Gwathmey, James Whalen, Amun Makani, Bertram Zarins, and David Berger. "Surgical Release of the Adductor Longus With or Without Sports Hernia Repair Is a Useful Treatment for Recalcitrant Groin Strains in the Elite Athlete." Orthopaedic Journal of Sports Medicine 8, no. 1 (January 1, 2020): 232596711989610. http://dx.doi.org/10.1177/2325967119896104.
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Background: Chronic strain and/or tendinopathy of the adductor longus tendon can be a cause of long-standing groin pain in the elite athlete, resulting in significant time lost from competition. Accurate diagnosis and treatment can expedite return to play. Purpose/Hypothesis: To evaluate return to sport and performance in National Collegiate Athletic Association (NCAA) Division I football players and National Football League (NFL) players following adductor longus release with or without sports hernia repair. We hypothesized that adductor release will be an effective method of treatment for recalcitrant groin/adductor pain in these athletes. Study Design: Case series; Level of evidence, 4. Methods: A cohort study was performed of all NFL players and NCAA Division I college athletes who had undergone an adductor longus tendon release with or without sports hernia repair by 1 of 2 fellowship-trained orthopaedic surgeons between May 1999 and January 2013. All patients reported groin pain below the inguinal ligament and localized to their adductor longus. Symptoms lasted longer than 10 weeks and limited their ability to effectively perform during sport, as assessed by their coach and self-assessment. Questionnaires were given to all 26 patients to assess long-term surgical outcomes. A subgroup analysis was performed for NFL players, in which “performance scores” were calculated according to individual player statistics while playing. Scores obtained before the diagnosis of chronic adductor longus tendinopathy or strain were compared with those after surgery. Patients with prior abdominal or pelvic surgery, radiographic evidence of degenerative joint disease of the hip, labral tears or femoral acetabular impingement, prostatic or urinary tract disease, or nerve entrapment of the ilioinguinal, genitofemoral, or lateral femoral cutaneous nerves were excluded from the study. Results: A total of 32 athletes underwent an adductor longus tenotomy during the study period. Of these patients, 28 were college- or professional-level athletes who underwent an adductor longus tenotomy, with a mean ± SD follow-up time of 6.2 ± 4.2 years (range, 12-178 months). Of the 32 patients, 20 had a concomitant sports hernia repair in addition to an adductor longus tenotomy. Thirty-one patients (97%) were able to return to their previous sport, and 30 (94%) were able to return at their previous level of play. Thirty patients (94%) reported that they were satisfied with their decision to have surgery. No player complained of weakness or a decrease in running speed or power. Mean return to play was 12 weeks from date of surgery. In the subgroup analysis of 16 NFL players, there were no statistically significant differences for the pre- versus postoperative comparisons of the athlete performance scores ( P = .74) and the percentage of the games started versus played ( P = .46). After separation of players who had a concomitant hernia repair from players who did not, there was no statistically significant difference in performance scores or percentages of games started. Conclusion: In this study of elite athletes, adductor longus tenotomy with or without a concomitant sports hernia repair provided overall acceptable and excellent results. Athletes were able to return to their previous level of athletic competition and performance with consistent relief of groin pain. Return to play in an NFL game averaged 12 weeks following surgery.
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Celano, A., S. Mingolla, I. Cinieri, and A. Marsico. "OP0320-PARE FIBROMYALGIA NETWORK – A MULTIDIMENSIONAL PROJECT FOR PEOPLE WITH FIBROMYALGIA SYNDROME." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 197–98. http://dx.doi.org/10.1136/annrheumdis-2020-eular.1782.
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Background:Fibromyalgia Syndrome (FMS) is a clinical non-joint syndrome characterized by diffuse, prolonged, and unexplained muscle pains. The health effects of FMS are pervasive and wide ranging. It is frequently associated with depression, anxiety and post-traumatic stress disorder. Patients describe living with daily unrelenting chronic widespread pain, persistent chronic fatigue, sleep issues, and cognitive effects. Fibromyalgia impacts all aspects of patients’ lives. Patients report severe limitations in maintaining relationships, performing at work or school, and caring for self and family. They experience stigma within society, social isolation, healthcare and financial challenges of treatment, and fears of living with an often misunderstood condition. In 2019 APMARR launched Fibromyalgia Network a project that aimed at improving the quality of life of patients with FMS.Objectives:Experiment a set of good practices at territorial level to be expanded nationally to improve the FMS patients’ conditionsCreate a multisectoral, patient-oriented network with different stakeholdersLaunch a communication campaign to inform and change the perception of the pathologyTrain the General Practitioners in order to increase early diagnosisEmpower the PatientsPromote innovative treatments and the data acquisition about hyperbaric oxygen therapyProvide free psychological and information supportMethods:The project was based on the assumption supported by evidence that a multi-modal treatment approach improves the quality of life of person with FMS including a combination of drug and non-drug treatments and a range of health care specialties. All the activities implemented were shaped on a holistic approach to treating Fibromyalgia, including lifestyle management, diet and exercise, and psychosocial techniques, in addition to medical treatments.Results:1) A territorial network coordinated by APMARR was created involving Puglia Region, Health Authorities, Professional board of Psychologists, National Association of People with FMS, Professional board of Physicians, Italian Society Of Rheumatology-Puglia2) A communication campaign was widely spread among social network, a brochure was written in collaboration with the Italian Society of Rheumatology and distributed to the general public, a national level conference was organized in Bari3) A training program acknowledged by the Italian Health Minister Program involved more than 120 GPs4) A patients expert program involved more than 100 patients5) A group of patients were tutored in their treatment with hyperbaric oxygen therapy and a report was sent to the HTA Italian Program in collaboration with the Puglia Region HTA Center. It was the first HTA report elaborated in collaboration with a patient organization in Italy6) Self-mutual help groups were organized with free psychological support, as well as an information desk and a toll-free number7) High satisfaction and pain relief of the participants as detected by a qualitative satisfaction questionnaireConclusion:The project demonstrated the good results of the holistic approach in the patients who took part in the program that reported the improvements of their quality of lives and relieve from their daily pains. The Self-mutual help group was the most appreciated free service, in which participants shared personal stories and perspectives thoughtfully and courageously. The training initiatives organized in collaboration with physicians helped them to learn tips for a better lifestyle management, diet and exercise, and psychosocial techniques but above all helped to overcame concerns and frustration regarding the lack of understanding in the medical community. The network succeeds to increased awareness and understanding of FMS across the public opinion and GPs.References:[1]Author: S.Mingolla, APMARR Project Manager; Co-authors: A.Celano, APMARR President; I. Cinieri, Psychologist, A. Marsico, RheumatologistDisclosure of Interests:None declared
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Terassi, Paulo Miguel De Bodas, Hélio Silveira, and Carlos Henrique Da Graça. "Regiões pluviométricas homogêneas e a erosividade das chuvas na unidade hidrográfica Pirapó, Paranapanema III e IV-Paraná / Homogeneous rainfall regions and rainfall erosivity in the hydrographic unit Pirapó, Paranapanema III and IV hydrographic (...)." Caderno de Geografia 26, no. 46 (May 2, 2016): 507. http://dx.doi.org/10.5752/p.2318-2962.2016v26n46p507.
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<p>O presente trabalho objetiva definir regiões pluviométricas homogêneas e investigar a relação entre o regime pluviométrico e o potencial da erosividade para a unidade hidrográfica Pirapó, Paranapanema III e IV - Paraná. Foram obtidos os dados de pluviosidade de trinta e cinco postos pluviométricos do Instituto das Águas do Paraná e de cinco estações meteorológicas do Instituto Agronômico do Paraná (IAPAR), Instituto Nacional de Meteorologia (INMET) e Sistema Meteorológico do Paraná (SIMEPAR), trabalhados com o segmento temporal de 1976 a 2012. O índice de erosividade da chuva utilizado foi calculado a partir da equação apresentada por Rufino, Biscaia e Merten (1993) para o estado do Paraná. Definiu-se que o método de agrupamento mais adequado é o método aglomerativo de Ward, tendo como medida de proximidade a distância euclidiana. A área de estudo apresenta uma variação espacial da pluviosidade que mostra a influência da orografia principalmente para a distribuição espacial na escala anual, enquanto que a localização dos grupos demonstra uma maior associação à dinâmica atmosférica, conforme consultado pela literatura, para a compreensão da distribuição mensal das chuvas. Sobretudo, a delimitação dos grupos pluviométricos homogêneos permitiu compreender a relação entre o relevo, as alturas pluviométricas e o potencial erosivo das chuvas.</p><p><strong>Palavras-chave</strong>: agrupamento, pluviosidade, potencial erosivo, bacia hidrográfica.</p><p> </p><p>Abstract</p><p>This paper aims to define homogeneous rainfall regions and to investigate the relationship between rainfall and the potential erosivity for Pirapó, Paranapanema III and IV hydrographic unit - Paraná. The rainfall data was collected from thirty five rain gauges at Paraná Water Institute and from five weather stations at Paraná Agronomy Institute (IAPAR), National Weather Institute (INMET) and Paraná Meteorological System (SIMEPAR) and were processed within the temporal segmentation 1976 to 2012. The erosivity index rain used was calculated from the equation presented by Rufino, Biscaia and Merten (1993) for the Paraná State. It was defined that the most appropriate clustering method is the agglomerative method of Ward, with the proximity measure the Euclidean distance. The study area presents a spatial variation of rainfall that shows the orography influence mainly to the spatial distribution in the annual scale, while the location of groups shows a greater association with the atmospheric dynamics, as referred in the literature, for understanding the monthly distribution of rainfall. Above all, the delimitation of homogeneous rainfall groups allowed to understand the relationship between relief, the rain heights and the erosive potential of rainfall.</p><p><strong>Keywords</strong>: clustering, rainfall, erosive potential, watershed.</p>
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Kiyange, F., V. Walusansa, G. Mandosela, H. Nzereka Kambale, E. Luyirika, and J. Orem. "The Role of South-to-South Partnerships in Developing Cancer Services in Africa." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 163s. http://dx.doi.org/10.1200/jgo.18.21200.
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Background and context: Despite being a growing public health concern in Africa, access to effective cancer treatment and pain relief is still limited in sub-Saharan Africa. The African Palliative Care Association (APCA) in collaboration with the American Cancer Society and the Ministry of Health of Swaziland have successfully implemented a South-to-South partnership which has facilitated the development and operation of a cancer unit in Mbabane National Hospital. Although the cancer burden continues to rise in Africa, many countries do not have established oncology services. They rely on cancer treatment, care and support through referral to neighboring countries or overseas, which is costly for governments and poses multiple challenges for patients and their families. Until recently, Swaziland has relied on cancer treatment and care in South Africa. This paper presents a model where the Uganda Cancer Institute (UCI) in Uganda has been facilitated to support the establishment of a cancer unit in Swaziland. Aim: The intervention aimed at providing technical assistance to the Ministry of Health of Swaziland to initiate and operate a cancer unit in Mbabane Government Hospital through a formal arrangement with the UCI. Strategy/Tactics: The planning and execution of activities was done by a tripartite of APCA, Uganda Cancer Institute a government entity and the Swazi Ministry of Health. Program/Policy process: Over a period of one year (Decemeber 2016 to December 2017) APCA, through a grant from the ACS formerly engaged the UCI to support the initiation and operation of a cancer unit in Swaziland. This was through expert exchange visits through which on-job training and mentorship was provided to a team of staff at Mbabane Government Hospital, with coordination by the Swaziland Ministry of Health. Experiential visits to Uganda were also organized for the lead pharmacist in Swaziland and a doctor to enable them set up and run a cancer unit in their country. The exchange visits provided a forum for both observation and application of knowledge and skills. Outcomes: A cancer unit was successfully established at Mbabane Government Hospital in Swaziland, which now provides services for patients, with breast cancer and expanding to include other cancers. The Swaziland Ministry of Health has been key to the success of this development and continues to identify human, financial and other resources to sustain the cancer unit. To date 69 patients have successfully undergone chemotherapy: 43 breast cancer, 22 Kaposi sarcoma, 2 colorectal cancer, 1 bladder cancer, 1 multiple myeloma. 21 health care workers were trained on cancer management; 9 doctors, 7 nurses and 5 pharmacists. What was learned: There are many opportunities for South-to-South partnership to support the establishment or improvement of cancer care. This model implemented in Swaziland can be replicated in other African countries. Documenting the model for replication in other countries is recommended.
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Begum, Shahnaz, Fatima Begum, Shamima Yeasmin, Tania Sultana, Afroza Begum, and Shamim MF Begum. "Follow up of Patients with Parathyroid Adenoma Detected by Parathyroid Scan." Bangladesh Journal of Nuclear Medicine 20, no. 2 (August 15, 2018): 119. http://dx.doi.org/10.3329/bjnm.v20i2.37395.
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<p><strong><em>Background:</em></strong> Primary hyperparathyroidism (PHPT) is the third most endocrine disorder after diabetes and thyroid disease. The objective of this study was to observe the outcome of those patients who had positive parathyroid scan with Technetium-99m (<sup>99m</sup>Tc) sestamibi scan referred to National Institute of Nuclear Medicine & Allied Sciences (NINMAS) to perform parathyroid scan.<strong></strong></p><p><strong><em>Patients and Methods</em></strong><em>:</em> This longitudinal observational type of study was carried out at NINMAS, from January 2016 to December 2016. A total number of 43 hyperparathyroid patients who had positive parathyroid scan were included in this study during one year follow up period. There clinical status, biochemical profile & treatment history were evaluated Chi-quire and paired t-test were used to analyze the variables.</p><p><strong><em>Results:</em></strong><strong> </strong>Among 43 study patients, number of male patients was 26 (60.5%) and female patients were 17 (39.5%). The mean ± SD age was 42.44 ± 12.11 years and majority was in age group 41-50 years<strong>. </strong>It was observed that 40 (93.0%) patients were symptomatic and only 3 (7.0%) were asymptomatic. Regarding symptoms, majority (81.4%) patients had bone pain followed by renal stone (58.1%). More than half (55.8%) patient had abdominal pain or cramps. Twenty nine (67.4.0%) patients undergone operation and 14 (32.6%) patients did not receive operative treatment at the one year follow up period. Among 43 patients 29 (67.4%) were operated and all operated patients relieved their symptoms whereas patients 14 (32.6%) had not undergone operation and their symptoms persisted. There was strong statistical significant association (P<0.05) between operation and relief of symptoms. The biochemical profile of study patients showed that preoperative mean serum calcium level was 10.92±2.85 mg/dl which reduced after operation (7.53±2.75 mg/dl). The mean value of serum parathyroid hormone (PTH) level also reduced from 748±744.77 pg/ml to 171.61±168.23 pg/ml.</p><p><strong><em>Conclusion:</em></strong> Among all patients, 67.4% received operative treatment and were relieved from symptoms at one year follow up. Significant number of hyperparathyroid patients (32.6%) failed to receive operative treatment due to poor economic condition. More awareness is needed among physicians and patients about immediate operative treatment to alleviate their sufferings as well as to avoid crippling complications.</p><p>Bangladesh J. Nuclear Med. 20(2): 119-123, July 2017</p>
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Hudaefi, Fahmi Ali, and Irfan Syauqi Beik. "Digital zakāh campaign in time of Covid-19 pandemic in Indonesia: a netnographic study." Journal of Islamic Marketing 12, no. 3 (January 8, 2021): 498–517. http://dx.doi.org/10.1108/jima-09-2020-0299.
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Purpose Despite the COVID-19 recession, the collection of zakat (almsgiving) managed by the National Board of Zakat Republic of Indonesia (BAZNAS RI) has increased, especially during Ramaḍān 1441 Hijra. Previous works show a positive relationship between digital zakat campaign and zakat collection. This paper aims to study the means of digital zakat campaign during COVID-19 outbreak. This topic is theoretically and practically important in the emerging debate of Islamic marketing, notably in Islamic social finance field. Design/methodology/approach This paper uses a qualitative research approach. A case study is engaged in the selection of BAZNAS RI for a detailed discussion of a zakat organisation. Meanwhile, a netnographic approach is used to analyse the number of 549 posts from BAZNAS RI’s social media, which are Facebook, Instagram, Twitter and YouTube. Furthermore, a qualitative software analysis of NVivo 12 Plus is used in performing the analytical procedures. Findings This work explains the means of digital zakat campaign during COVID-19 outbreak with a case of BAZNAS RI. It is identified the number of 6 parent nodes and 64 child nodes from the analysis using NVivo 12 Plus. The authors’ parent nodes are “donation”, “infaq” (Islamic spending for charities), “Ramaḍān matters”, “ṣadaqah” (voluntary charity), “virtual events” and “zakat”. These nodes detail digital campaign of BAZNAS RI posted in its social media during COVID-19 period in Ramaḍān. A theoretical implication of inclusive marketing is derived from the analysis. It explains that the inclusiveness of digital contents is practically significant in campaigning zakat as a religious obligation that contributes to social and financial benefits. Research limitations/implications This paper does not claim a positivist perspective on the relationship between digital zakat campaign and zakat collection. Instead, this paper explores in-depth the practice of digital zakat campaign, which the previous study confirms its association with a muzakki’s (Muslims who are obliged to pay zakat) decision to pay zakat. Practical implications This paper establishes the Islamic marketing theory that is derived from industrial practices. The inclusiveness of digital contents in zakat campaign is critical in activating zakat as a religious obligation that authentically shapes the social and economic processes of a Muslim community. This theory is practically important for 'amils (employees) of zakat institution who work in the marketing division, chiefly to create such contents to post in social media. Social implications The authors’ node of zakat distribution for COVID-19 relief indicates the importance of a formalised zakat institution to actualise zakat’s role in handling socioeconomic problems. Thus, paying zakat formally in an authorised organisation may contribute to a greater social contribution and maṣlaḥah (public interest) than paying it informally without any effective measurement. Originality/value This study contributes to the novelty in the Islamic marketing debate within two folds. First, this paper is among the pioneers in studying digital zakat campaign during COVID-19 outbreak by using a netnographic approach. Therefore, a theoretical implication derived from industrial practices is contributed. Second, this paper details the steps in using NVivo 12 Plus to analyse the unstructured data sampled from the internet. The future studies may thus refer to this work to understand the application of netnography and the procedures in analysing data from social media using this software.
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De Grace, Margaret, Diana Ericson, Harmony Folz, Wayne Greene, Kendall Ho, and Laurie Pearce. "Proceedings for the 5th Asia-Pacific Conference on Disaster Medicine: Creating an Agenda for Action." Prehospital and Disaster Medicine 16, no. 1 (March 2001): 18–21. http://dx.doi.org/10.1017/s1049023x00025498.
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AbstractDisaster medicine has come to the forefront and has become the focus of interest not only in the medical community, but also in the eyes of the public. The 5th APCDM was convened in Vancouver, Canada, 27–30 September 2000. It brought together over 300 delegates from 32 countries to share their experiences and thoughts regarding disaster events and how to effectively manage them.The conference was devoted to the task of establishing priorities and creating an Agenda for Action. From the discussions, key actions required were defined:Communications: (1) Identify existing regional telehealth groups and gather lessons to be learned from them; (2) Form a telehealth advisory group to work with regional groups to compile telehealth initiatives, identify international protocols in telehealth already in existence, and solicit feedback before setting international standards; and (3) Increase corporate partnerships in the fields of telehealth and telecommunications, and invite corporations to send delegates to future APCDM meetings. This should be an initiative of the APCDM, the World Association of Disaster and Emergency Medicine (WADEM), or the European Society of Emergency Medicine.Education and research: (1) Formalize education in disaster medicine and management. The World Health Organization and WADEM should take a leadership role; (2) WADEM is requested to hold a conference with a focus on qualitative research; (3) WHO is requested to continue the provision of international research teams, but to advocate for the development of national disaster research infrastructure; (4) Make research findings and reports available on web sites of such organizations as WHO and PAHO; (5) Develop the translation of research for community utilization. The WHO and PAHO are organizations that are requested to consider this action; and (6) WADEM/APCDM are requested to focus future conferences on applied research.Information and data: (1) Create an “Information and Data Clearinghouse on Disaster Management” to collect, collate, and disseminate information; (2) Collect data using standardized tools, such as CAR or Hazmat indices; (3) Analyze incentives and disincentives for disaster readiness and establish mechanisms for addressing the obstacles to preparedness; and (4) WADEM is requested to develop a web site providing a resource list of interdisciplinary institutions and response activities, organized by country, topic, and research interests. Links to other pertinent web sites should be provided.Interdisciplinary development: (1) Focus on the interdisciplinary nature of disaster response through more conferences encompassing grassroots efforts and through WADEM publications; (2)Develop and apply a standardized template of Needs Assessment for use by multidisciplinary teams. Team Needs Assessment is essential to determine the following: (a) Local response and international assistance required; (b) Appropriate command system; and (c) Psychosocial impact and support necessary.Psychosocial aspects: (1) Incorporate relief for caregivers into action plans. This should include prime family members who also are caregivers; and (2) Implement measures that give survivors control over the recovery process.Response management. (1) Define relationships and roles between governments, military and security personnel, non-governmental organizations (NGOs), and civic groups. Use an international legal framework and liability to reinforce accountability of disaster responders; (2) Establish a more sophisticated use of the media during disasters; (3) Establish standards in key areas. WADEM is requested to write “White Papers” on standards for the following areas: (a) management, (b) health/public health, (c) education/training, (d) psychosocial, and (e) disaster plans; (4) Establish task forces to anticipate and resolve issues around evolving and emerging disasters (e.g., chemical and biological terrorism, landmines, emerging infectious diseases). WADEM was again identified as the vehicle for promoting this action.The responsibility of the next meeting of the Asia-Pacific Conference on Disaster Medicine will be to measure progress made in these areas by assessing how well these collective decisions have been implemented.
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Morris, Claudia R., Fahd Ahmad, Jonathan Bennett, Seema Bhatt, Amanda Bogie, Kathleen M. Brown, T. Charles Casper, et al. "Pediatric Emergency Department Use of Intranasal Fentanyl to Treat Pain in Children with Sickel Cell Disease and Its Impact on Discharge Rates: A Multicenter Perspective." Blood 128, no. 22 (December 2, 2016): 1306. http://dx.doi.org/10.1182/blood.v128.22.1306.1306.
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Abstract Background: Pain is the leading cause of hospitalization and pediatric emergency department (ED) visits for children with sickle cell disease (SCD). The National Heart, Lung and Blood Institute (NHLBI) recommends an initial dose of parenteral opioids within 30 minutes (min) of triage for moderate-severe vaso-occlusive pain episodes (VOEs) in the acute care setting. Delays in pain management for children with SCD commonly occur across EDs despite these guidelines. Intranasal fentanyl (INF) provides rapid and powerful parenteral analgesia, with an onset of action of 5-10 min, and peak in 30 min. INF is a safe and effective method of pain management for children in the ED and other clinical settings. Objective:To assess the use and impact of INF and other common therapies for the treatment of children with SCD and VOE on discharge rates in EDs across the United States and Canada. Methods: A retrospective cohort study was performed evaluating practices in 20 consecutive charts per site from 20 high-volume EDs (n=400 charts total) including 14 Pediatric Emergency Care Applied Research Network (PECARN) sites, assessing children age 3-21 years with SCD/VOE requiring parenteral opioids. Variables evaluated for association with discharge included age, gender, triage level, time from triage/room placement (whichever came first) to 1st parenteral opioid use (intravenous (IV) or intranasal), INF use, dose of total parenteral opioid (TPO) equivalents (mg/kg/hr), ketorolac use, oral opioids, any use of IV fluids (bolus and/or maintenance), ED shift presentation (AM, PM or overnight) and site. Multiple logistic regression was performed using significant variables identified on univariate analysis. Regression analyses were restricted to the 15 sites that had INF available in their ED (n=294 subjects). Results: Mean age of the 400 children was 14±5 years; 54% were female; 92% had HbSS. Admission rate was 67%. All received parenteral opioids; 84% IV fluids, 66% ketorolac, and 26% oral opioids. INF was available at 15/20 sites and used at 10/20 sites; 19% (75/400) of all children received INF, 25% when restricted to the 15 sites with INF available. INF was used in 60% of patients receiving parenteral opioids within 30 min of triage/room placement at sites with INF available. Median time to 1st parenteral opioid in children receiving INF was 25 (26, 37) vs. 64 (38, 102) min (p<.0001) for those who received only IV opioids. The admission rate was 49% vs. 70%, p=.0009 (Fig 1) for those treated vs not treated with INF. Variables associated positively with discharge included: shorter time from triage to 1st parenteral opioid (p<0.05), INF use (p<.001), oral opioid use (p<.0001), younger age (p=0.03), and site (p<.0001), while increased TPO equivalents (p=0.05), and IV fluid use (p=.01) were negatively associated with discharge. On multiple logistic regression analysis, INF use, TPO, use of IV fluids and site remained in the model. The Odds Ratio (OR) and 95% Confidence Interval for INF use and ED discharge was 2.99[1.14, 7.82], p=.03 for those who received INF compared to those who did not. Time from triage to 1stopioid dose did not affect admission risk in multivariate analysis. Conclusions:It is notable that the odds of being discharged from the ED are nearly 3 times higher for patients who received INF compared to those who did not. Contrary to common belief, rapid delivery of first parenteral analgesia, a focus of the 2014 NHLBI guidelines for treatment of SCD/VOE, did not affect risk of admission in our cohort when controlling for other factors, although potential benefits related to pain relief and patient satisfaction were not evaluated. Variations in practice across the network and variables associated with ED discharge rate require further investigation. Causality of INF impact on discharge rates can't be shown without further study, however the rapid onset-of-action and ease of delivery without IV access offered by INF makes it an ideal initial parenteral analgesic in the treatment of children with SCD and pain in the acute care setting. Figure 1 Figure 1. Disclosures Morris: MAST: Research Funding; Pfizer: Consultancy; Calithera: Consultancy; Nourish Life: Patents & Royalties: I am the inventor of IP owned by UCSF-Benioff Children's Hospital that is licensed to NL; Endeavor: Consultancy; Nestle: Honoraria. Dampier:Eli Lilly and Company: Consultancy, Research Funding. Hsu:Gerson Lehman Group: Consultancy; Centers for Medicare and Medicaid Innovation: Research Funding; Astra Zeneca: Consultancy, Research Funding; Sancilio: Research Funding; Purdue Pharma: Research Funding; EMMI Solutions: Consultancy; Mast Therapeutics: Research Funding; Hilton Publishing: Consultancy, Research Funding; Eli Lilly: Research Funding; Pfizer: Consultancy, Research Funding.