Slow Down: New-Onset Atrial Fibrillation Challenges for Ambulatory Surgical Facilities

As patient safety liaisons (PSLs), we are continually educating and collaborating with our Pennsylvania healthcare facilities. We often are asked questions about reportable events under the Medical Care Availability and Reduction of Error (MCARE) Act. One of the most common examples we discuss is cancellations and transfers out of an ambulatory surgical facility (ASF). The top three reasons for cancellations include preop instructions not followed, missed medical issues identified during preop screening, and no shows. The top three reasons for transfers include cardiac arrhythmias, aspiration, and hypertension. Interestingly, between discussions with facilities and review of event reports, new-onset atrial fibrillation (AF) has come up often as a common reason for cancellations or transfers out of the ASF setting, especially in gastrointestinal (GI) procedures. In fact, as PSLs, when educating ASFs on reportable events we often give the example of placing a patient on the cardiac monitor in preop and the patient is found to be in AF. In 2009, it was estimated that 13.1% of AF cases were undiagnosed,3 which may explain why patients are presenting with new-onset AF. People with AF are at an increased risk of complications (e.g., stroke);3,4 therefore, a cancellation or transfer may be necessary depending on the patient’s condition. These events are considered reportable to the Pennsylvania Patient Safety Reporting System (PA-PSRS) under MCARE.

Minimalistic Character Education

After the promulgation of the Character Education Promotion Act, one is left asking the question: is character education, which is currently being conducted in all directions and at all levels, from elementary schools to universities, actually succeeding in reversing the deteriorating character failures seen throughout society? I think it’s fair to say that it would be difficult for anyone to answer this question positively. Nevertheless, research papers boasting the many successes of character education have continued to pour in. How can this disparity be explained? In order to adequately answer this question, one must understand that character education is missing a key component. Therefore, we need to reexamine the fundamental premise of the discourses and programs surrounding character education in its various applications, both before and after the promulgation of the Character Education Promotion Act. This paper intends to propose ‘minimalistic character education’ as a new paradigm of character education-one that will replace the fundamental premise found in the type of character education we’ve been implementing thus far. Briefly put, minimalistic character education starts by changing the paradigm: “Basically, doing is better than not doing” to the paradigm: “Basically, not doing is better than doing.” This new paradigm will enable us to overcome the paradox found in the current manifestation of character education by preventing it from becoming a key link in the vicious cycle of avoiding responsibility.

Secondary suites: a methodological approach to estimate their prevalance within the city of Toronto

With the introduction of Bill 140 - Strong Communities Through Affordable Housing Act, one increasingly popular housing typology is secondary suites. However, their role within local housing markets has never been fully substantiated, numerically or functionally, Over the past decade, government agencies have employed a variety of techniques to estimate the number of secondary suites within local housing markets. However, due to a number of inherent limitations associated with available data sources and collection techniques, accurately estimated their prevalence is difficult because many secondary suites are not reported. As such, most data sources do not provide a complete estimate. In an effort to overcome these limitations, the following research paper has employed a methodological approach that combined MPAC data with visual surveys. The results of this approach will help provide a more accurate picture of the entire secondary suite rental market, identifying both reported and unreported units within Toronto.

Secondary suites: a methodological approach to estimate their prevalance within the city of Toronto

With the introduction of Bill 140 - Strong Communities Through Affordable Housing Act, one increasingly popular housing typology is secondary suites. However, their role within local housing markets has never been fully substantiated, numerically or functionally, Over the past decade, government agencies have employed a variety of techniques to estimate the number of secondary suites within local housing markets. However, due to a number of inherent limitations associated with available data sources and collection techniques, accurately estimated their prevalence is difficult because many secondary suites are not reported. As such, most data sources do not provide a complete estimate. In an effort to overcome these limitations, the following research paper has employed a methodological approach that combined MPAC data with visual surveys. The results of this approach will help provide a more accurate picture of the entire secondary suite rental market, identifying both reported and unreported units within Toronto.

Risk, Responsibility, and Procreative Asymmetries

The author argues for a theory of responsibility for outcomes of imposed risk, based on whether it was permissible to impose the risk. When one tries to apply this persuasive model of responsibility for outcomes of risk imposition to procreation, which is a risk imposing act, one finds that it doesn’t match one’s intuitions about responsibility for outcomes of procreative risk. This mismatch exposes a justificatory gap for procreativity, namely, that procreation cannot avail itself of the shared vulnerability to risks and their constraints—to the balance one is forced to strike between one’s interest in being free to impose risks on others and one’s interest in being safe from harm resulting from the risk imposed by others—which serves to justify risk imposition, generally. Whereas most risk impositions involve trade-offs of liberty and security among people who share the vulnerabilities associated with the taking, imposing, or being constrained from imposing risks, procreation involves the introduction of people into that position of vulnerability in the first place. Thus, when one procreates, one imposes risks in the absence of the shared vulnerability that usually serves as a justification for risk imposition. Procreative risks may not be wrongfully imposed, but they aren’t permissibly imposed in a manner fully comparable to other permissibly imposed risks. This makes procreation a unique form of risk imposition, with unique implications for its justification and for one’s responsibility for its outcomes. This insight can help explain several puzzling procreative asymmetries.