scholarly journals Availability of Resources for After-Hours Surgical Management of Eye Injuries

2018 ◽  
Vol 10 (01) ◽  
pp. e92-e97
Author(s):  
Tina Chen ◽  
Kathryn Colby ◽  
Sarah Rodriguez ◽  
Mark Slidell ◽  
Jessica Kandel ◽  
...  
Keyword(s):  
Program Directors ◽  
The United States ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Eye Injuries ◽  
Eye Surgery ◽  
Wide Range ◽  
Clinician Satisfaction ◽  
After Hours ◽  
The Impact

Background Approximately 2.4 million eye injuries per year occur in the United States. Because of the complexity of these injuries, many of these cases present to academic institutions. Ophthalmology residency programs have a wide range of resources available for eye injuries requiring after-hours surgical intervention. Purpose The purpose of this study was to determine availability of resources for after-hours eye surgery and their effect on clinician satisfaction. Methods Association of University Professors of Ophthalmology (AUPO) program directors were surveyed to assess the availability of eye-trained operating room (OR) nurses, functional operating microscopes, and suitable surgical supplies. The primary outcome measure was the availability of resources for after-hours eye surgery. Secondary outcome measures included the impact of resources on clinician satisfaction. Results Fifty-seven program directors completed the survey. Most programs operated at level 1 trauma centers (95%), had access to a functional microscope (95%), and had frequent adequate surgical supplies (88%). On the other hand, only 28 (49%) programs reported consistent access to OR nurses with ophthalmologic training. Clinician satisfaction scores were three times higher for programs with frequent access to trained surgical OR staff than for programs without (p < 0.001). Conclusion Approximately half of programs report consistent access to ophthalmologic-trained OR staff after hours. In contrast, most programs report access to a functional microscope and surgical supplies. The results of this survey suggest that directing resources toward improving access to after-hours staffing with specialty OR staff may improve clinician satisfaction.

A New World Economic order formation

2021 ◽  
pp. 932-950
Author(s):  
Vladislav Vyacheslavovich Emelyanov
Keyword(s):  
Oil And Gas ◽  
World Order ◽  
The United States ◽  
New Order ◽  
The West ◽  
Wide Range ◽  
The World ◽  
The Usa ◽  
World Economic Order ◽  
The Impact

Every few decades, the world order changes due to various geopolitical, economic and other circumstances. For example, as a result of globalization, the world order has undergone significant changes in the last forty years. Globalization has led to the destruction of the postwar world order, as well as to world leadership by the United States and the West. However, in recent decades, as a result of globalization, the U.S. and the West began to cede their leadership to developing countries, so there is now a change in the economic structure of relations in the world system. Today the center of economic growth is in the East, namely in Asia. There are no new superpowers in the world at the moment, but the unipolar world will cease to exist due to the weakening of the U. S. leadership, which will lead to a change in the world order. A new leader, which may replace the U. S., will not have as wide range of advantages as the USA has. Most likely, the essence of the new order will be to unite the largest countries and alliances into blocks, for example, the USA together with the Trans-Pacific Partnership, the EU, etc. The article outlines forecasts of GDP growth rates as well as the global energy outlook; analyzes the LNG market as well as the impact of the pandemic on the global oil and gas market; and lists the characteristics of U. S. geopolitics.

scholarly journals Quebec’s Economic and Commercial Linkages with the United States, 1994–2017

2017 ◽  
Author(s):  
Earl H. Fry
Keyword(s):  
United States ◽  
Trade Agreement ◽  
The United States ◽  
The North ◽  
Nation States ◽  
Wide Range ◽  
The Us ◽  
Us Government ◽  
Big Picture ◽  
The Impact

This article examines the ebb and flow of the Quebec government’s economic and commercial relations with the United States in the period 1994–2017. The topic demonstrates the impact of three major forces on Quebec’s economic and commercial ties with the US: (1) the North American Free Trade Agreement (NAFTA) which became operational in 1994 and was fully implemented over a 15-year period; (2) the onerous security policies put in place by the US government in the decade following the horrific events of 11 September 2001; and (3) changing economic circumstances in the United States ranging from robust growth to the worst recession since the Great Depression of the 1930s. The article also indicates that the Quebec government continues to sponsor a wide range of activities in the United States, often more elaborate and extensive than comparable activities pursued by many nation-states with representation in the US. 1 1 Stéphane Paquin, ‘Quebec-U.S. Relations: The Big Picture’, American Review of Canadian Studies 46, no. 2 (2016): 149–61.

scholarly journals The Impact of Rehabilitation-oriented Virtual Reality Device in Patients With Ischemic Stroke in the Early Subacute Recovery Phase: Study Protocol for a Phase III, Single-Blinded, Randomized, Controlled Clinical Trial

2020 ◽  
Vol 12 ◽  
pp. 117957351989947
Author(s):  
Nima Ahmed ◽  
Vitor A Queiroz Mauad ◽  
Olga Gomez-Rojas ◽  
Ammu Sushea ◽  
Gelanys Castro-Tejada ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Ischemic Stroke ◽  
The United States ◽  
Functional Independence ◽  
Recovery Phase ◽  
Phase Iii ◽  
Secondary Outcome ◽  
Randomized Controlled ◽  
The Impact ◽  
Be The Change

Background and rationale: Stroke is considered the most common cause of adult disability. Intensive rehabilitation protocols outperform nonintensive counterparts. The subacute stroke phase represents a potential window to recovery. Virtual reality (VR) has been shown to provide a more stimulating environment, allowing for increased patient compliance. However, the quality of current literature comparing VR with standard therapies is limited. Our aim is to measure the impact of VR versus standard therapy on the recovery of the upper limb motor function in patients with stroke in the early subacute recovery phase. Method: This is a randomized, controlled trial that will assign 262 patients to tailor-made standard rehabilitation (TMSR) or TMSR plus immersive VR device. The trial will be conducted in an urban rehabilitation clinic in the United States with expertise in the management of poststroke patients. Patients will be 18 to 70 years of age and in the early subacute period (30-90 days post ischemic stroke). The primary outcome will be the change of Fugl-Meyer Assessment—Upper Extremity (FMA-UE) score, measured at baseline and 13 weeks after randomization. The secondary outcome will be the change in the UK Functional Independence Measure and Functional Assessment Measure (UK FIM-FAM) score at the same time points. Discussion: If the use of VR in the rehabilitation of patients with stroke proves to have a significant impact on their motor recovery, it will constitute an extremely important step into decreasing the functional impairment associated with stroke and the related health care expense burden.

scholarly journals Living and Teaching Internationally: Teachers Talk about Personal Experiences, Benefits, and Challenges

2020 ◽  
Vol 19 (1) ◽  
pp. 38-53
Author(s):  
Nelly Sierra Ospina ◽  
Sergio Lopera Medina
Keyword(s):  
Classroom Management ◽  
Cultural Awareness ◽  
School Administrators ◽  
The United States ◽  
Structured Interview ◽  
Study Data ◽  
Intercultural Development ◽  
Life Styles ◽  
Wide Range ◽  
The Impact

This study reports on the impact of international visiting faculty’s teaching experiences in the United States on their personal, professional, and intercultural development. It is based on the principles of qualitative research and can be described as a case study. Data collection involved a questionnaire, a written narrative, and a semi-structured interview with each of a number of teachers. Participants included a group of 22 visiting faculty. Three main categories, each of which can be subdivided into benefits and challenges, emerged from the analysis: intercultural matters, professional matters, and personal matters. A wide range of benefits was identified, suggesting that the participants adapted to new life styles, became more mature, obtained a deeper understanding of themselves, reaffirmed their own educational values and philosophies, raised cultural awareness, became more flexible, and developed attitudes that involved tolerance and respect. Conversely, visiting faculty reported that they faced challenges related to language barriers, interaction with native speakers, classroom management, lack of support from school administrators, and separation from family.

Assessment in American Higher Education: The Role of Admissions Tests

2019 ◽  
Vol 683 (1) ◽  
pp. 130-148 ◽  
Author(s):  
Rebecca Zwick
Keyword(s):  
Higher Education ◽  
United States ◽  
The United States ◽  
College Performance ◽  
Admissions Tests ◽  
Higher Education System ◽  
Wide Range ◽  
Test Optional ◽  
The Impact

In this article, I review the role of college admissions tests in the United States and consider the fairness issues surrounding their use. The two main tests are the SAT, first administered in 1926, and the ACT, first given in 1959. Scores on these tests have been shown to contribute to the prediction of college performance, but their role in the admissions process varies widely across colleges. Although test scores are consistently listed as one of the most important admissions factors in national surveys of postsecondary institutions, an increasing number of schools have adopted “test-optional” policies. At these institutions, test score requirements are seen as a barrier to campus diversity because of the large performance gaps among ethnic and socioeconomic groups. Fortunately, the decentralized higher education system in the United States can accommodate a wide range of admissions policies. It is essential, however, that the impact of admissions policy changes be studied and that the resource implications of these changes be thoroughly considered.

Palliative treatment of unresectable pancreatico-biliary cancer by either gemcitabine or octreotide/imatinib: Impact on biomarkers of angiogenesis

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15101-15101
Author(s):  
G. Treiber ◽  
T. Wex ◽  
P. Malfertheiner
Keyword(s):  
Pancreatic Cancer ◽  
Primary Outcome Measure ◽  
Ampullary Cancer ◽  
Secondary Outcome ◽  
Combination Group ◽  
Group I ◽  
Low Levels ◽  
Group Ii ◽  
Changes Over Time ◽  
The Impact

15101 Background: Gemcitabine represents standard Tx for unresectable cancers of the pancreas / distal biliary tract. Recent interest has focused on antiangiogenic properties in a mouse model of pancreatic cancer (JCI 2003); either VEGF or PDGF inhibition alone were less effective than the combination of both in terms of angiogenesis. In humans, imatinib (targeting PDGF) alone has been shown to be equivalent to gemcitabine in terms of survival (Cancer Lett. 2006;233:328–37), while most trials for octreotide (targeting IGF-1, VEGF) were disappointing. In HCC pts. we recently evaluated the impact of biomarkers on disease progression and survival (Cancer Res Clin Oncol 2006; 132:699–708). Methods: To investigate in a phase I/II trial the feasability of a combination (group I, n=11) of octreotide (30 mg im every 4 weeks, targeting VEGF-A) plus imatinib (400 mg po daily, targeting PDGF-B) vs gemcitable (group II, n=11, 1000mg/m2 weekly for 7/8 wks, then for 3/4 wks). Pts had either unresectable pancreatic cancer (n=18) or ampullary cancer (n=4). Primary outcome measure were changes in biomarkers (VEGF-A, PDGF-BB, soluble E-selectin, Ca19–9, CEA). Secondary outcome measures were TTP and OS. Results: 19/22 pts. had biomarker data available within the first 12 wks, changes over time are shwon in table . Median TTP was 109 vs 166 days (p<0.05) and median OS was 163 vs 325 days (p=NS) for group I vs II. Baseline Ca19–9 levels correlated with prognosis independent of Tx (p=0.05). In group I, high levels of PDGF-BB and VEGF-A levels at wk 12 but in group II, low levels of VEGF-A and s-E-selectin correlated with a better OS (p<0.05 each). TTP showed no correlations with biomarkers. Conclusions: The combination of octreotide plus imatinib is clinically less effective compared to gemcitabine. Although the absolute changes of angiogenesis markers are comparable between groups, chemotherapy compared to targeted therapy has a different impact on these in terms of survival. [Table: see text] No significant financial relationships to disclose.

Empirical Investigation of Interactive Highway Safety Design Model Accident Prediction Algorithm: Rural Intersections

2003 ◽  
Vol 1840 (1) ◽  
pp. 78-86 ◽  
Author(s):  
Craig Lyon ◽  
Jutaek Oh ◽  
Bhagwant Persaud ◽  
Simon Washington ◽  
Joe Bared
Keyword(s):  
Research Effort ◽  
Methodological Approach ◽  
The United States ◽  
Highway Safety ◽  
Design Model ◽  
Prediction Algorithm ◽  
Parameter Estimates ◽  
Wide Range ◽  
Safety Design ◽  
The Impact

One major gap in transportation system safety management is the ability to assess the safety ramifications of design changes for both new road projects and modifications to existing roads. To fulfill this need, FHWA and its many partners are developing a safety forecasting tool, the Interactive Highway Safety Design Model (IHSDM). The tool will be used by roadway design engineers, safety analysts, and planners throughout the United States. As such, the statistical models embedded in IHSDM will need to be able to forecast safety impacts under a wide range of roadway configurations and environmental conditions for a wide range of driver populations and will need to be able to capture elements of driving risk across states. One of the IHSDM algorithms developed by FHWA and its contractors is for forecasting accidents on rural road segments and rural intersections. The methodological approach is to use predictive models for specific base conditions, with traffic volume information as the sole explanatory variable for crashes, and then to apply regional or state calibration factors and accident modification factors (AMFs) to estimate the impact on accidents of geometric characteristics that differ from the base model conditions. In the majority of past approaches, AMFs are derived from parameter estimates associated with the explanatory variables. A recent study for FHWA used a multistate database to examine in detail the use of the algorithm with the base model-AMF approach and explored alternative base model forms as well as the use of full models that included nontraffic-related variables and other approaches to estimate AMFs. That research effort is reported. The results support the IHSDM methodology.

scholarly journals Impact of non-pharmaceutical interventions for SARS-CoV-2 on norovirus outbreaks: an analysis of outbreaks reported by 9 US States

2020 ◽  
Author(s):  
Alicia N.M. Kraay ◽  
Peichun Han ◽  
Anita K. Kambhampati ◽  
Mary E. Wikswo ◽  
Sara A. Mirza ◽  
...  
Keyword(s):  
United States ◽  
South Carolina ◽  
The United States ◽  
Respiratory Pathogen ◽  
Secondary Outcome ◽  
Interrupted Time Series Analysis ◽  
Official Position ◽  
The Impact ◽  
Pharmaceutical Interventions ◽  
Outbreak Size

AbstractImportanceThe impact of non-pharmaceutical interventions (NPIs) in response to the SARS-CoV-2 pandemic on incidence of other infectious diseases is still being assessed.ObjectiveTo determine if the observed change in reported norovirus outbreaks in the United States was best explained by underreporting, seasonal trends, or reduced exposure due to NPIs. We also aimed to assess if the change in reported norovirus outbreaks varied by setting.DesignAn ecologic, interrupted time series analysis of norovirus outbreaks from nine states reported to the National Outbreak Reporting System (NORS) from July 2012–July 2020.SettingSurveillance data from Massachusetts, Michigan, Minnesota, Ohio, Oregon, South Carolina, Tennessee, Virginia, and Wisconsin were included in the analysis.Participants9,226 reports of acute gastroenteritis outbreaks with norovirus as an epidemiologically suspected or laboratory-confirmed etiology were included in the analysis, resulting in more than 8 years of follow up. Outbreak reports from states that participated in NoroSTAT for at least 4 years were included in the analysis (range: 4–8 years).ExposureThe main exposure of interest was time period: before (July 2012–February 2020) or after (April 2020–July 2020) the start of NPIs in the United StatesMain outcomeThe main outcome of interest was monthly rate of reported norovirus outbreaks. As a secondary outcome, we also examined the average outbreak size.ResultsWe found that the decline in norovirus outbreak reports was significant for all 9 states considered (pooled incidence rate ratio (IRR) comparing April 2020-July 2020 vs. all pre-COVID months for each state= 0.14, 95% CI: 0.098, 0.21; P=<0.0001), even after accounting for typical seasonal decline in incidence during the summer months. These patterns were similar across a variety of settings, including nursing homes, child daycares, healthcare settings, and schools. The average outbreak size was also reduced by 61% (95% CI: 56%, 42.7%; P=<0.0001), suggesting that the decline does not reflect a tendency to report only more severe outbreaks due to strained surveillance systems, but instead reflects a decline in incidence.Conclusions and relevanceWhile NPIs implemented during the spring and summer of 2020 were intended to reduce transmission of SARS-CoV-2, these changes also appear to have impacted the incidence of norovirus, a non-respiratory pathogen. These results suggest that NPIs may provide benefit for preventing transmission of other human pathogens, reducing strain to health systems during the continued SARS-CoV-2 pandemic.DisclaimerThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention (CDC).

scholarly journals Current Practices of Suicide Risk Management Protocols in Research

Crisis ◽  
2010 ◽  
Vol 31 (1) ◽  
pp. 7-11 ◽  
Author(s):  
Steven Vannoy ◽  
Ursula Whiteside ◽  
Jürgen Unützer
Keyword(s):  
Mental Health ◽  
United States ◽  
Risk Management ◽  
Suicide Risk ◽  
Qualitative Methodology ◽  
Descriptive Analysis ◽  
The United States ◽  
Convenience Sample ◽  
Wide Range ◽  
The Impact

Background: Participant safety is an important concern in mental-health-oriented research. Investigators conducting studies in the United States that include potentially suicidal individuals are often required to develop written suicide risk management (SRM) protocols. But little is known about these protocols. It is possible that such protocols could serve as templates for suicide risk management in clinical settings. Aims: To elucidate common (best) practices from mental health intervention researchers. Methods: We conducted a systematic descriptive analysis of written SRM protocols. A convenience sample of studies funded by the United States’ National Institute of Mental Health in 2005 were scanned to discover projects in which investigators were likely to identify and take responsibility for suicide risk in their participant pool. Qualitative methodology was used to create a checklist of tasks perceived to be operationally significant for insuring the safety of suicidal participants. The checklist was applied to all protocols to determine the variability of patient safety tasks across protocols. Results: We identified 45 candidate studies, whereof 38 investigators were contacted, resulting in the review of 21 SRM protocols. Three main categories emerged: overview, entry/exit, and process. Overall, 19 specific tasks were identified. Task frequency varied from 7% to 95% across protocols. Conclusions: The SRM checklist provides a framework for comparing the content of SRM protocols. This checklist may assist in developing SRM protocols in a wide range of settings. Developing guidelines and standard methodologies is an important step to further development of suicide prevention strategies. More research is necessary to determine the impact of SRM protocols on participant safety.

scholarly journals Cold War Supreme Court: Analysing the Change in Constitutional Interpretation between Dennis v. U.S. (1951) and Yates v. U.S. (1957)

2021 ◽  
Author(s):  
◽  
Hayden Thorne
Keyword(s):  
United States ◽  
Cold War ◽  
Supreme Court ◽  
Media Coverage ◽  
The United States ◽  
Red Scare ◽  
Wide Range ◽  
Legal Strategy ◽  
The Impact ◽  
Smith Act

<p>During the early Cold War, America was gripped by an intense domestic Red Scare. This thesis explores how the United States Supreme Court dealt with the Alien Registration Act (Smith Act) and the issue of freedom of speech in the context of that Red Scare. In particular, this thesis focuses on the change in interpretation which occurred between the 1951 decision in Dennis v. United States, and the 1957 decision in Yates v United States. Dennis upheld the constitutionality of the Smith Act, and upheld the convictions of eleven Communist Party of the United States of America (CPUSA) leaders. Yates overturned the convictions of a group of California CPUSA officials, and placed strict limitations on the use of the Smith Act in a drastic change in interpretation.  This thesis aims to explore that change in interpretation by drawing on three different lines of reasoning: the impact of changes to the wider Cold War context, the impact of changes to the personnel making up the Supreme Court, and changes in legal strategy on behalf of the defendants in the two cases. To achieve this, the thesis draws on a wide range of sources, beginning with a discussion of existing literature, and moving to explore previously untapped sources from both a historic and a legal perspective. This includes looking at the records of law firms acting in both cases, analysing other Supreme Court opinions from the time, and drawing on more traditional historical sources like media coverage of various events.  This thesis argues that, contrary to most existing scholarship, the change in interpretation is best explained by a multi-causal approach. The changes to the court’s makeup and changes to the context amongst which the cases occurred were only part of the reason for the change in interpretation. The impact of a change in legal strategy also played an important role in causing the Supreme Court’s change in interpretation.</p>

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