Evaluation of Seizures and Seizurelike Events

2021 ◽  
pp. 722-730
Author(s):  
Angela M. Parsons ◽  
Joseph F. Drazkowski
Keyword(s):  
Diagnostic Tests ◽  
Diagnostic Testing ◽  
The United States ◽  
Social Consequences ◽  
Altered Level ◽  
Safety Issues ◽  
The People ◽  
Level Of Consciousness ◽  
Self Reports ◽  
Proper Diagnosis

Correctly diagnosing seizures and seizurelike events is important for numerous reasons, including safety issues, social consequences, and therapy. Patients with transient neurologic events of unknown cause are commonly admitted to hospitals, and an estimated 10% of the people in the United States have a seizure in their lifetime. These facts highlight the importance of diagnostic accuracy. History taking is imperfect, but it is still a cornerstone in making the proper diagnosis of transient neurologic events. Focused, supporting diagnostic tests may add accuracy in arriving at the proper diagnosis, but even with a good history, diagnostic testing, and physical examination findings, the diagnosis may be inaccurate. Self-reports of seizure frequency are notoriously inaccurate and often miss more than 50% of focal-onset seizures, especially if the seizures begin in the dominant hemisphere (largely because the effects of the event cause an altered level of consciousness).

Abstract WP294: Utilization of Hospice Care and Patient Characteristics Associated With Discharge to Hospice in Acute Ischemic Stroke Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Syed F Ali ◽  
Nabeel Chauhan ◽  
Archana Hinduja
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Hospice Care ◽  
Private Insurance ◽  
Multivariable Analysis ◽  
The United States ◽  
Multicenter Studies ◽  
Altered Level ◽  
Factors Associated ◽  
Level Of Consciousness

Introduction: Hospice is an option in providing terminally ill patients with good quality end of life care. We sought to determine demographic and clinical factors associated with discharge to hospice in acute ischemic stroke (AIS) patients. Methods: Using our institutional GWTG database, we analyzed 2,363 consecutive AIS patients who were alive at the time of discharge, from Jan 2009 till July 2015. Univariate and multivariable analysis was performed to determine factors associated with discharge to hospice. Results: Out of 2,363 AIS patients, 100 (4.2%) were discharged to hospice care. Patients discharged to hospice care were more likely to be older, Caucasian and less likely to be African American. They more often had Medicare or private insurance, while less likely paid for the care themselves. Patients discharged to hospice more often had atrial fibrillation and heart failure, while less often had diabetes mellitus or were smoker. Altered level of consciousness at presentation was more often in patients discharged to hospice. Although the rates of thrombolysis and pneumonia were similar, UTI was more common in patients discharged to hospice. Thirty-seven percent of patients were made comfort measure prior to discharging them to hospice (Table). On multivariable analysis, older age [OR 1.04 (95% CI 1.01 - 1.07); p<0.001], higher NIHSS [OR 1.15 (95% CI 1.10 - 1.20); p<0.001] and altered level of consciousness at presentation [OR 2.42 (95% CI 1.29 - 4.55); p<0.001] were significantly associated with discharge to hospice care. Conclusion: The rates of discharge to hospice following AIS have substantially grown in the past decade and at our institution 4.2% were discharged to hospice. These patients were older, had higher median NIHSS and more often had altered level of consciousness upon presentation. Large, multicenter studies are needed to address the variation in the rates of hospice care across the United States.

Religion and Mythology in the Chilembwe Rising of 1915 in Nyasaland and the Easter Rising of 1916 in Ireland: Preparing for the End Times?

2017 ◽  
Vol 23 (1) ◽  
pp. 51-66
Author(s):  
T. Jack Thompson
Keyword(s):  
The United States ◽  
Religious Motivation ◽  
Easter Rising ◽  
British Rule ◽  
The People ◽  
Head Of State ◽  
Interesting Difference ◽  
Racial Injustice ◽  
Book Of Daniel ◽  
End Times

Superficially there are many parallels between the Chilembwe Rising of 1915 in Nyasaland and the Easter Rising of 1916 in Ireland – both were anti-colonial rebellions against British rule. One interesting difference, however, occurs in the way academics have treated John Chilembwe, leader of the Nyasaland Rising, and Patrick Pearse, one of the leaders of the Irish Rising and the man who was proclaimed head of state of the Provisional government of Ireland. For while much research on Pearse has dealt with his religious ideas, comparatively little on Chilembwe has looked in detail at his religious motivation – even though he was the leader of an independent church. This paper begins by looking at some of the major strands in the religious thinking of Pearse, before going on to concentrate on the people and ideas which influenced Chilembwe both in Nyasaland and the United States. It argues that while many of these ideas were initially influenced by radical evangelical thought in the area of racial injustice, Chilembwe's thinking in the months immediately preceding his rebellion became increasingly obsessed by the possibility that the End Time prophecies of the Book of Daniel might apply to the current political position in Nyasaland. The conclusion is that much more academic attention needs to be given to the millennial aspects of Chilembwe's thinking as a contributory motivation for rebellion.

A HISTORICAL REVIEW OF THE ACCOUNTING TREATMENT OF RESEARCH AND DEVELOPMENT COSTS

1992 ◽  
Vol 19 (1) ◽  
pp. 51-78 ◽  
Author(s):  
Paul E. Nix ◽  
David E. Nix
Keyword(s):  
United States ◽  
Research And Development ◽  
Alternative Treatment ◽  
Historical Review ◽  
The United States ◽  
Current Treatment ◽  
Social Consequences ◽  
Financial Accounting ◽  
Development Costs ◽  
Accounting Rules

This study reviews the literature and the practice of accounting for research and development (R&D) costs from the first reference in 1917 to the current treatment. The conceptual treatment of R&D is compared to current financial accounting rules and explanation of the evolution of the current rules is presented. The economic and social consequences of the current rules which require R&D costs to be expressed are examined. The paper explores possible alternative treatment of R&D costs. As a contrast to U.S. practice, the accounting treatment of R&D costs in other countries is discussed. Given the findings of this paper, a strong case can be made for changing the way that R&D costs are accounted for in the United States.

Political Community in Revolutionary Pennsylvania, 1774-1800

2018 ◽  
Author(s):  
Kenneth Owen
Keyword(s):  
American Revolution ◽  
Political Process ◽  
The United States ◽  
Political Community ◽  
Popular Sovereignty ◽  
Power Structures ◽  
Early American ◽  
The People ◽  
Governmental Institutions ◽  
Popular Mobilization

Political Community in Revolutionary Pennsylvania challenges the ways we understand popular sovereignty in the American Revolution, demonstrating how ordinary citizens wielded significant political power. Previous histories place undue focus on either elite political thought or class analysis; on the contrary, citizens cared most about the establishment of a representative, publicly legitimate political process. Popular activism constrained leaders, creating a system through which governmental actions were made more representative of the will of the community. This book analyzes developments in Pennsylvania from 1774, and the passage of the Intolerable Acts, through to 1800 and the election of Thomas Jefferson. It examines the animating philosophy of the Pennsylvania state constitution of 1776, a “radical manifesto” espousing a vision of popular sovereignty in which government was devolved from the people only where necessary. The legitimacy of governmental institutions rested on their demonstration that they operated through popular consent, expressed in a variety of forms of popular mobilization. This book examines how early Americans interacted with the power structures shaping the world in which they lived, recasting the nature of the American Revolution and illuminating the origins of modern American political practice. It investigates how political mobilization operated inside and outside formal channels of government. Mechanisms of popular mobilization helped a diverse population mediate with governmental institutions, providing the foundation of early American power. Histories that ignore this relationship miss one of the most significant founding characteristics of the United States—the importance of popular politics and democratic practice in the establishment of American government.

Populism and Liberal Democracy

2019 ◽  
Author(s):  
Takis S. Pappas
Keyword(s):  
United States ◽  
Liberal Democracy ◽  
The United States ◽  
Comprehensive Theory ◽  
The People ◽  
Original Definition ◽  
Key Issues ◽  
Great Relevance ◽  
Definition Of

Based on an original definition of modern populism as “democratic illiberalism” and many years of meticulous research, Takis Pappas marshals extraordinary empirical evidence from Argentina, Greece, Peru, Italy, Venezuela, Ecuador, Hungary, the United States, Spain, and Brazil to develop a comprehensive theory about populism. He addresses all key issues in the debate about populism and answers significant questions of great relevance for today’s liberal democracy, including: • What is modern populism and how can it be differentiated from comparable phenomena like nativism and autocracy? • Where in Latin America has populism become most successful? Where in Europe did it emerge first? Why did its rise to power in the United States come so late? • Is Trump a populist and, if so, could he be compared best with Venezuela’s Chávez, France’s Le Pens, or Turkey’s Erdoğan? • Why has populism thrived in post-authoritarian Greece but not in Spain? And why in Argentina and not in Brazil? • Can populism ever succeed without a charismatic leader? If not, what does leadership tell us about how to challenge populism? • Who are “the people” who vote for populist parties, how are these “made” into a group, and what is in their minds? • Is there a “populist blueprint” that all populists use when in power? And what are the long-term consequences of populist rule? • What does the expansion, and possibly solidification, of populism mean for the very nature and future of contemporary democracy? Populism and Liberal Democracy will change the ways the reader understands populism and imagines the prospects of liberal democracy.

scholarly journals Duodenoscope Medical Device Reports Associated with Patient Infection, Patient Exposure, or Device Contamination

2020 ◽  
Vol 41 (S1) ◽  
pp. s196-s197
Author(s):  
Jian Connell ◽  
Shanil Haugen ◽  
Ann Ferriter
Keyword(s):  
Medical Device ◽  
The United States ◽  
Risk Of Infection ◽  
Patient Exposure ◽  
Safety Issues ◽  
Device User ◽  
Infection Patient ◽  
Device Use ◽  
Serious Injuries ◽  
Patient Infection

Background: Each year, the FDA receives more than a million reports of suspected device-associated deaths, serious injuries, and malfunctions. Medical device reports (MDRs) are submitted to the FDA by mandatory reporters (manufacturers, importers, and device user facilities) and voluntary reporters such as healthcare professionals, patients, and consumers. The FDA uses MDRs to monitor device performance, including monitoring reports of infection or device contamination to detect potential device-related safety issues and to share this information in public communications. In this analysis, the FDA presents MDRs for duodenoscopes, which are a type of flexible endoscope that have been associated with infections in patients. Methods: For this analysis, we searched the MDR database for duodenoscope reports submitted between January 2015 and July 1, 2019. MDRs were classified into clinical risk categories based on the MDR’s text narratives as patient infection (indicated the presence of infection in patients potentially transmitted by the device), patient exposure (indicated a contaminated device has been used in a patient, but the MDR lacks clear mention of patient infection), or device contamination (indicated that the device was contaminated, but no mention of device use in patients or patient infection). Results: Overall, 1,115 duodenoscope reports related to a patient infection, patient exposure, or device contamination for devices marketed inside and outside the United States were received from January 2015 to mid-2019. Among them, 79 MDRs were received for deaths in patient infection, patient exposure, or device contamination reports. The number of reported infections decreased from 247 MDRs in 2015 to 55 MDRs in the first half of 2019. Furthermore, the number of reported deaths decreased from 25 MDRs in 2015 to 2 MDRs reported in the first half of 2019. Conclusions: The MDR data indicate a decrease in the number of reported infections. The decrease in infections suggests that efforts to reduce the risk of infection from duodenoscopes have yielded improvements; however, additional improvements are necessary to further decrease the risk of infection.Funding: NoneDisclosures: None

Stowaways at Bohemia's Shores: Undocumented Emigration and People-Smuggling Networks in Interwar East Central Europe

2020 ◽  
Vol 53 (3) ◽  
pp. 564-583
Author(s):  
Allison Schmidt
Keyword(s):  
Central Europe ◽  
The United States ◽  
First World War ◽  
World War ◽  
East Central Europe ◽  
East Central ◽  
The People ◽  
The First World War ◽  
Migrant Smuggling ◽  
First World

AbstractThis article investigates interwar people-smuggling networks, based in Germany and Czechoslovakia, that transported undocumented emigrants across borders from east-central Europe to northern Europe, where the travelers planned to sail to the United States. Many of the people involved in such networks in the Saxon-Bohemian borderlands had themselves been immigrants from Galicia. They had left a homeland decimated by the First World War and subsequent violence and entered societies with limited avenues to earn a living. The “othering” of these Galician immigrants became a self-fulfilling prophecy, as those on the margins of society then sought illegal ways to supplement their income. This article concludes that the poor economic conditions and threat of ongoing violence that spurred migrant clients to seek undocumented passage had driven their smugglers, who also faced social marginalization, to emigration and the business of migrant smuggling.

The Association Between Presenting Visual Impairment, Health, and Employment Status

2021 ◽  
Vol 115 (3) ◽  
pp. 204-214
Author(s):  
Michele C. McDonnall ◽  
Zhen S. McKnight
Keyword(s):  
Visual Impairment ◽  
Labor Force ◽  
Visual Impairments ◽  
Data Sets ◽  
Chi Square ◽  
Health And Nutrition ◽  
Labor Force Status ◽  
The People ◽  
Self Reports ◽  
Study Participants

Introduction: The purpose of this study was to investigate the effect of visual impairment and correctable visual impairment (i.e., uncorrected refractive errors) on being out of the labor force and on unemployment. The effect of health on labor force status was also investigated. Method: National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2008 ( N = 15,650) was used for this study. Participants were classified into three vision status groups: normal, correctable visual impairment, and visual impairment. Statistical analyses utilized were chi-square and logistic regression. Results: Having a visual impairment was significantly associated with being out of the labor force, while having a correctable visual impairment was not. Conversely, having a correctable visual impairment was associated with unemployment, while having a visual impairment was not. Being out of the labor force was not significantly associated with health for those with a visual impairment, although it was for those with correctable visual impairments and normal vision. Discussion: Given previous research, it was surprising to find that health was not associated with being out of the labor force for those with visual impairments. Perhaps other disadvantages for the people with visual impairments identified in this study contributed to their higher out-of-the-labor-force rates regardless of health. Implications for practitioners: Researchers utilizing national data sets that rely on self-reports to identify visual impairments should realize that some of those who self-identify as being visually impaired may actually have correctable visual impairments. Current research is needed to understand why a majority of people with visual impairments are not seeking employment and have removed themselves from the labor force.

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