Mobile stroke care expedites intravenous thrombolysis and endovascular thrombectomy

BackgroundThe number of mobile stroke programmes has increased with evidence, showing they expedite intravenous thrombolysis. Outstanding questions include whether time savings extend to patients eligible for endovascular therapy and impact clinical outcomes.ObjectiveOur mobile stroke unit (MSU), based at an academic medical centre in upstate New York, launched in October 2018. We reviewed prospective observational data sets over 26 months to identify MSU and non-MSU emergency medical service (EMS) patients who underwent intravenous thrombolysis or endovascular thrombectomy for comparison of angiographic and clinical outcomes.ResultsOver 568 days in service, the MSU was dispatched 1489 times (2.6/day) and transported 300 patients (20% of dispatches). Intravenous tissue plasminogen activator (tPA) was administered to 57 MSU patients and the average time from 911 call-to-tPA was 42.5 min (±9.2), while EMS transported 73 patients who received tPA at 99.4 min (±35.7) (p<0.001). Seven MSU patients (12%) received tPA from 3.5 hours to 4.5 hours since last known well and would likely have been outside the window with EMS care. Endovascular thrombectomy was performed on 21 MSU patients with an average 911 call-to-groin puncture time of 99.9 min (±18.1), while EMS transported 54 patients who underwent endovascular thrombectomy (ET) at 133.0 min (±37.0) (p=0.0002). There was no difference between MSU and traditional EMS in modified Rankin score at 90-day clinic follow-up for patients undergoing intravenous thrombolysis or endovascular thrombectomy, whether assessed as a dichotomous or ordinal variable.ConclusionsMobile stroke care expedited both intravenous thrombolysis and endovascular thrombectomy. There is an ongoing need to show improved functional outcomes with MSU care.

Feeling Ashamed: A Parsesciencing Inquiry

The universal humanuniverse living experience of feeling ashamed was explored using the Parsesciencing mode of inquiry. The inquiry stance was: What is the discerning extant moment of the universal humanuniverse living experience of feeling ashamed? Historians were 10 adults living in a community in upstate New York. The major discovery of this Parsesciencing inquiry was the discerning extant moment: Feeling ashamed is penetrating encumbrance with isolating concealment emerging with diverse affiliations.

Facilitators and Barriers to Implementing the International Dysphagia Diet Standardisation Initiative in Care Facilities in Upstate New York

Introduction: Dysphagia is a swallowing disorder that can result in aspiration, asphyxiation, or other complications. One method of facilitating safer swallowing is modification of the diet and fluids of individuals living with dysphagia. The International Dysphagia Diet Standardisation Initiative (IDDSI) is a globally standardized framework for texture modification. Its implementation has been recommended in the United States, but adoption is not yet universal. This study investigated implementation issues by surveying health care professionals in health care facilities in rural, Upstate New York. Method: A questionnaire created through the SurveyMonkey platform was distributed to health care facilities within a predetermined geographical area in Upstate New York. The survey consisted of 22 questions and utilized a mixed-methods design. Results: Forty-six participants from 10 individual professions and nine types of facilities completed the study. Twenty texture modification labels and 10 fluid modification labels were described. Analysis of qualitative data yielded three main barriers to implementation: funding, education, and communication. Within each barrier, awareness and resources were recurrent themes. Discussion: The variety of modification labels in comparison with the sample size demonstrates a lack of standardization of texture modification processes across facilities. While nearly half the respondents had not heard of IDDSI prior to the survey, 89% agreed that a standardized dysphagia diet would improve patient health and safety. This demonstrated a willingness to adopt IDDSI and indicated that staff attitudes may not be a barrier to its implementation. Participants felt that training was needed for successful implementation and expressed concern about the lack of availability of financial resources. Supplemental Material: https://doi.org/10.23641/asha.17270861

Nonprofit Board Governance Policy Adoption: Toward an Integrated Board Interlock Network and Institutional Perspectives

Previous research lags behind in illuminating theoretical mechanisms that shape governance decision-making on board practices. Using an integrated theoretical approach, I examine how board interlock network and institutional factors are associated with board governance policy adoption in nonprofit organizations. A linear regression model is employed to investigate policies adopted by a panel of public charities in three cities in Upstate New York during 2008 and 2014. Results show that not only the presence of board interlock networks but also central network positions relate to extensive policy adoption. Results also reveal that the use of paid professionals in management relates to institutional isomorphism reflected by more extensive governance policy adoption. These results provide insights for nonprofit leaders seeking to facilitate good governance practices by paying attention to board members’ affiliations and institutional environment considerations.

Acceptability of Supervised Injection Facilities Among Persons Who Inject Drugs in Upstate New York

Background Supervised injection facilities (SIFs) provide spaces where persons who inject drugs (PWID) can inject under medical supervision and access harm reductions services. Though SIFs are not formally established in the US, such facilities are being considered for approval in several New York State (NYS) communities. No data exists from PWID in NYS, and little from outside major US urban centers, on willingness to use SIFs and associated factors. Methods This analysis included 285 PWID (mean age=38.7; 57.7% male; 72.3% non-Hispanic white) recruited for a study on hepatitis C prevalence among PWID in Upstate New York, where participants were recruited from syringe exchange programs (n=80) and able to refer other PWID from their injection networks (n=223). Participants completed an electronic questionnaire that included a brief description of SIFs and assessed willingness to use SIFs. We compared sociodemographic characteristics, drug use/harm reduction history, healthcare experience, and stigma between participants who were willing vs. unwilling to use such programs. Results Overall, 67.4% were willing to use SIFs, 18.3% unwilling, and 14.4% unsure. Among those reporting being willing or unwilling, we found higher willingness among those who were currently homeless (91.8% vs. 74.6%; p=0.004), who had interacted with police in the past 12 months (85.7% vs. 74.5%; p=0.04), and who were refused service within a healthcare setting (100% vs. 77.1%; p=0.03). Conclusion Our results support SIF acceptability in several Upstate New York PWID communities, particularly among those reporting feelings of marginalization. A large proportion reported being unsure about usage of SIFs, suggesting room for educating PWID on the potential benefits of this service. Our results support SIF acceptability in NYS and may facilitate reaching PWID subgroups that are most marginalized, should SIFs become available.

The Empire Club Strikes Back

A key flaw in the standard, culturalist interpretation is that prohibitionism was a “whitelash” of conservative, rural, nativists “disciplining” of immigrants and blacks. The reality of 1840s New York was completely different: not only were Irish immigrants more likely to be temperate than their nativist, American counterparts (Chapter 5), but the focus of temperance activism—the money-making liquor traffic—was actually in the hands of established white nativists like “Captain” Isaiah Rynders, “Boss” Tweed, and the corrupt Tammany Hall machine. In upstate New York, temperance-abolitionist-suffragist reformers--including Frederick Douglass, Elizabeth Cady Stanton, Amelia Bloomer, and Susan B. Anthony--began a movement for women’s equality born of their temperance activism. Concurrent with the 1853 World’s Fair in New York, Rynders and his Know-Nothings clashed, physically, with the equal-rights reformers from upstate, whose temperance threatened the financial foundations of the Tammany Hall political machine.