scholarly journals Asynchronous Teleconsultations: The US Military Experience in the Pacific

2021 ◽  
Author(s):  
Jennifer Mbuthia ◽  
Mechelle Miller
Keyword(s):  
Medical Center ◽  
Geographic Distance ◽  
Age Groups ◽  
Cost Effective ◽  
Asia Pacific ◽  
Healthcare Settings ◽  
System A ◽  
The Pacific ◽  
The Us ◽  
Path System

Tripler Army Medical Center (TAMC), located in Honolulu, Hawaii, serves as the US military’s tertiary medical referral center for the Western Pacific. Over 20 years ago, the TAMC Department of Pediatrics developed an asynchronous provider-to-provider teleconsultation pilot program, eventually named the Pacific Asynchronous TeleHealth (PATH) system. A secure teleconsultation platform for pediatric sub-specialty provider-to-provider advice, the platform grew based on the needs of users, eventually expanding to serve all age-groups, with over 60 different specialties based at TAMC providing teleconsultation. Eventually, the success of PATH drove further expansion to serve military clinicians located in other overseas locations beyond the Asia-Pacific. This cost-effective model can be applied to civilian healthcare settings, particularly where geographic distance or limited connectivity are challenges to delivery of synchronous telehealth or in-person specialty care.

scholarly journals China and the US Alliance System

2017 ◽  
Vol 233 ◽  
pp. 137-165 ◽  
Author(s):  
Adam P. Liff
Keyword(s):  
Cold War ◽  
English Language ◽  
Asia Pacific ◽  
Strategic Competition ◽  
System A ◽  
The Us ◽  
Regional Order ◽  
Zero Sum ◽  
Alliance System ◽  
Language Literature

AbstractIn recent years, scholarship examining US and security allies’ responses to China's rapidly growing power and “assertive” policies towards its neighbours has proliferated. The English-language literature remains relatively one-sided, however. Crucial to understanding the complex forces driving strategic competition in the contemporary Asia-Pacific are comprehensive surveys of how Chinese views are evolving. This study draws extensively on Chinese sources to update existing scholarship, much of it two decades old, with a particular focus on recent Chinese reactions to major developments concerning the US-centred alliance system – a foundational element of the 65-year-old regional order. Beijing expresses deepening frustration towards, and even open opposition to, recent alliance strengthening, and instead champions alternative security architectures free of what it alleges to be “exclusive,” “zero-sum,” “Cold-war relic” US-centred alliances. Proposals for concrete pathways to operationalizing these abstract visions that take into account contemporary political and security realities (for example, North Korea), however, appear less forthcoming.

scholarly journals A Missed Partnership: Russia and the US at the Pacific

2019 ◽  
Vol 12 (1) ◽  
pp. 159-184
Author(s):  
D. V. Suslov
Keyword(s):  
United States ◽  
The United States ◽  
Asia Pacific ◽  
Asia Pacific Region ◽  
The Pacific ◽  
The Us ◽  
The Face ◽  
Soviet Space ◽  
Favorable Conditions ◽  
Post Soviet Space

Both Russia and the United States consider the Asia-Pacific as the center of the world economy and politics and assume the active presence in the region crucial for their security and economic development. They did not have such sharp contradictions there as in Europe or in the post-Soviet space. Moreover, some of their interests in the Asia-Pacific Region coincide – such as preventing Chinese hegemony. In this regard, the Russian-American dialogue and cooperation in the Asia-Pacific could be an important pillar of the positive agenda of their relations and a factor in their sustainability. Due to foreign policy inertia, the inflexibility of the agenda of Russian-American relations and the inability of the parties to go beyond the usual pattern, such a dialogue has not even begun. Both sides demonstrated strategic myopia. This weakened the resilience of US-Russian relations in the face of new challenges and accelerated their deterioration and disruption to a new confrontation. The Asia-Pacific has become another theater of the US-Russian systemic confrontation. However, it is in the interest of bothRussia and the United States to separate relations in this region from their general confrontation. This will create favorable conditions for Russia to build a balanced partnership system in the Asia-Pacific, which is necessary to consolidate its role as an independent global great power. In addition, the Russian-American dialogue on the Asia-Pacific, or at least the weakening of their confrontation in this region, will reduce its polarization and prevent tensions between the US and its Asian allies and partners.

scholarly journals "Hiroshima Sublime": Trauma, Japan, and the US Asia/Pacific Imaginary

2021 ◽  
Vol 58 (2) ◽  
pp. 46-61
Author(s):  
Rob Wilson
Keyword(s):  
World War Ii ◽  
Cold War ◽  
Persian Gulf War ◽  
Asia Pacific ◽  
World War ◽  
The Pacific ◽  
The Us ◽  
The Pacific Ocean ◽  
The Persian Gulf ◽  
The Cold War

As an ethical and aesthetic mandate for the new millenium, the Cold War repression of Hiroshima within the American political imaginaryneeds to be symbolically confronted and undoneat national as well as global levels.As Americans and as Japanese citizens of the liberal global order, we must mutually move beyond the Cold War situation of historical repression that had obtained in 1965, when novelist Kenzaburo Ōelamented, “To put the matter plainly and bluntly, people everywhere on this earth are trying to forget Hiroshima and the unspeakable tragedy perpetrated there.” However traumatic, Americans and their allies must try to remember this Hiroshima sublimeas a trauma of geopolitical dominationand racialized hegemony across the Pacific Ocean. By thinking through and re-imagining the techno-euphoric grandeur of this Hiroshima sublime, as well as representing the ideological complicity of ordinary Americans in their own sublime (rapturedby these technological forces of sublimity as manifesting and globally installingPatriot missilesas signs of theirglobal supremacy) and ordinary Japanese (citizens of the Empire of the Sun fascinatedby self-sublation into zeros of solar force) in the production of this nuclear sublime, we can begin to mutually recognize that a ‘post-nuclear’era offers new possibilities and symbolic ties between America and Japan as Pacific powers. This post-nuclear era emerges out of World War II freighted with terror and wonder as a double possibility:at once urging the globe towards annihilation andyet also towards transactional and dialogical unityat the transnational border of national self-imagining. The phobic masochism of the sublime can no longer operate in a transnational world of global/local linkages, although the technological sublimity of the Persian Gulf War had suggested otherwise, withits “sublime Patriot”missiles and quasi-nuclear landscapes lingering in the world deserts from Iraq and Afganistan to Nevada and North Korea.

scholarly journals GUAM, THE CENTER OF ASIA PACIFIC: A SOURCE OF GEO-STRATEGIC RIVALRY BETWEEN CHINA AND THE US

2018 ◽  
Vol 3 (2) ◽  
pp. 52-60
Author(s):  
Barkat Ali ◽  
Nazim Rahim ◽  
Muhammad Usman Ullah
Keyword(s):  
Air Force ◽  
United States Of America ◽  
Pacific Islands ◽  
Marine Corps ◽  
Asia Pacific ◽  
Global Order ◽  
National Interests ◽  
The Pacific ◽  
The Us ◽  
The U.S

Guam is the U.S. unincorporated territory and military (base), which lies in the western part of the Pacific Islands. Guam serves as the lynchpin for the U.S. influence in the Pacific, is became the flashpoint between two nuclear powers of the region i.e. United States of America and China, due to its strategic geopolitical position. Nevertheless, Guam remained a conducive place for the U.S. naval basing as well as the territory to provide shorten and strategic edge for Washington to sustain her hegemony and influence in the region. The aim of this research paper is that, could the U.S. sustain her hold over Guam while facing the Chinese mesmerizing and clear empirical indicators of its military forces, particularly its navy, air force, missile technology, and its rapidly expanding marine corps, as the arbiters of a new global order—one that stands opposed to U.S. national interests and threat to its close allies in the region.

scholarly journals Shifting Up Cutoff Value of D-Dimer in the Evaluation of Pulmonary Embolism: A Viable Option? Possible Risks and Benefits

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Bennidor Raviv ◽  
Shlomo H. Israelit
Keyword(s):  
Pulmonary Embolism ◽  
Medical Center ◽  
Age Groups ◽  
Cost Effective ◽  
Patient Characteristics ◽  
Viable Option ◽  
Cutoff Values ◽  
The Subject ◽  
The One ◽  
D Dimer

Objectives.To evaluate the viability of the possibility to use a higher D-dimer value than the one used today in the clinical algorithms evaluating patients suspected to have pulmonary embolism.Methods.A retrospective analysis of 300 serial patients for whom D-dimer values were taken during a 10 month period in the emergency room of a tertiary medical center.Results.Our analysis showed that it may be safe and cost effective to use a D-dimer value of 900 ng/ml rather than the value of 500 ng/ml accepted today, with sensitivity of 94.4%. In younger patients [under 40 years] the sensitivity reached was even higher—100%.Conclusions.Raising cutoff values of D-dimer in screening for pulmonary embolism seems a viable option. There may be a place for “tailoring” cutoff values according individual patient characteristics, such as according age groups. More studies of the subject are warranted.

scholarly journals Determinants of Hip and Knee Replacement: The Role of Social Support and Family Dynamics

2019 ◽  
Vol 56 ◽  
pp. 004695801983743
Author(s):  
Berna Demiralp ◽  
Lane Koenig ◽  
Jennifer T. Nguyen ◽  
Samuel A. Soltoff
Keyword(s):  
Social Support ◽  
Family Dynamics ◽  
Elderly Women ◽  
Age Groups ◽  
Cost Effective ◽  
Familial Support ◽  
Gender And Age ◽  
The Us ◽  
Support Mechanisms

The objective of this study was to examine variations in the determinants of joint replacement (JR) across gender and age, with emphasis on the role of social support and family dynamics. We analyzed data from the US Health and Retirement Study (1998-2010) on individuals aged 45 or older with no prior receipt of JR. We used logistic regression to analyze the probability of receiving knee or hip replacement by gender and age (<65, 65+). We estimated the effect of demographic, health needs, economic, and familial support variables on the rate of JR. We found that being married/partnered with a healthy spouse/partner is positively associated with JR utilization in both age groups (65+ group OR: 1.327 and <65 group OR: 1.476). While this finding holds for men, it is not statistically significant for women. Among women younger than 65, having children younger than 18 lowers the odds (OR: 0.201) and caring for grandchildren increases the odds (1.364) of having a JR. Finally, elderly women who report availability of household assistance from a child have higher odds of receiving a JR as compared with elderly women without a child who could assist (OR: 1.297). No effect of available support from children was observed for those below 65 years old and elderly men. Our results show that intrafamily dynamics and familial support are important determinants of JR; however, their effects vary by gender and age. Establishing appropriate support mechanisms could increase access to cost-effective JR among patients in need of surgery.

scholarly journals Variability of springtime transpacific pollution transport during 2000–2006: the INTEX-B mission in the context of previous years

2010 ◽  
Vol 10 (3) ◽  
pp. 1345-1359 ◽  
Author(s):  
G. G. Pfister ◽  
L. K. Emmons ◽  
D. P. Edwards ◽  
A. Arellano ◽  
T. Campos ◽  
...  
Keyword(s):  
Transport Model ◽  
Pollution Transport ◽  
Chemistry Transport Model ◽  
Pollution Levels ◽  
Annual Variability ◽  
Source Regions ◽  
Time Period ◽  
The Pacific ◽  
The Us ◽  
Transport Experiment

Abstract. We analyze the transport of pollution across the Pacific during the NASA INTEX-B (Intercontinental Chemical Transport Experiment Part B) campaign in spring 2006 and examine how this year compares to the time period for 2000 through 2006. In addition to aircraft measurements of carbon monoxide (CO) collected during INTEX-B, we include in this study multi-year satellite retrievals of CO from the Measurements of Pollution in the Troposphere (MOPITT) instrument and simulations from the chemistry transport model MOZART-4. Model tracers are used to examine the contributions of different source regions and source types to pollution levels over the Pacific. Additional modeling studies are performed to separate the impacts of inter-annual variability in meteorology and dynamics from changes in source strength. Interannual variability in the tropospheric CO burden over the Pacific and the US as estimated from the MOPITT data range up to 7% and a somewhat smaller estimate (5%) is derived from the model. When keeping the emissions in the model constant between years, the year-to-year changes are reduced (2%), but show that in addition to changes in emissions, variable meteorological conditions also impact transpacific pollution transport. We estimate that about 1/3 of the variability in the tropospheric CO loading over the contiguous US is explained by changes in emissions and about 2/3 by changes in meteorology and transport. Biomass burning sources are found to be a larger driver for inter-annual variability in the CO loading compared to fossil and biofuel sources or photochemical CO production even though their absolute contributions are smaller. Source contribution analysis shows that the aircraft sampling during INTEX-B was fairly representative of the larger scale region, but with a slight bias towards higher influence from Asian contributions.

scholarly journals Survival Analysis of 3 Different Age Groups and Prognostic Factors among 402 Patients with Skeletal High-Grade Osteosarcoma. Real World Data from a Single Tertiary Sarcoma Center

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 486
Author(s):  
Richard E. Evenhuis ◽  
Ibtissam Acem ◽  
Anja J. Rueten-Budde ◽  
Diederik S. A. Karis ◽  
Marta Fiocco ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Medical Center ◽  
Age Groups ◽  
High Grade ◽  
Real World Data ◽  
Poor Overall Survival ◽  
Histopathological Response ◽  
Curative Intent ◽  
Entire Cohort ◽  
High Grade Osteosarcoma

Age is a known prognostic factor for many sarcoma subtypes, however in the literature there are limited data on the different risk profiles of different age groups for osteosarcoma survival. This study aims to provide an overview of survival in patients with high-grade osteosarcoma in different age groups and prognostic variables for survival and local control among the entire cohort. In this single center retrospective cohort study, 402 patients with skeletal high-grade osteosarcoma were diagnosed and treated with curative intent between 1978 and 2017 at the Leiden University Medical Center (LUMC). Prognostic factors for survival were analyzed using a Cox proportional hazard model. In this study poor overall survival (OS) and event-free survival (EFS) were associated with increasing age. Age groups, tumor size, poor histopathological response, distant metastasis (DM) at presentation and local recurrence (LR) were important independent prognostic factors influencing OS and EFS. Differences in outcome among different age groups can be partially explained by patient and treatment characteristics.

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