People, Animals, Protected Places, and Archaeology: A Complex Collaboration in Belize

The authors of this chapter direct the Stann Creek Regional Archaeology Project (SCRAP), featuring a multi-year, multi-site, multidisciplinary program of archaeological research along the south-eastern margins of the Maya Mountains, Stann Creek District, Belize. While we and our team members most frequently direct our academic efforts in an attempt to reconstruct and understand the complicated suite of developmental processes, experiences, and life histories of the inhabitants of this region more than 1000 years ago, this ancient past represents only one of the two dominant spatio-temporal and socio-political contexts with which we engage on a regular basis. In this chapter, we shift our focus to the interactions with present-day individuals, communities, and institutions that structure our archaeological work. For some perspective, we will discuss the history of the development of the Cockscomb Basin Wildlife Sanctuary and connected forest reserves—totaling some 1011 km2 of nominally ‘protected’ space—and ongoing co-management organization and use relationships with adjacent Indigenous Maya communities. We frame this development within the United Nations Declaration on the Rights of Indigenous Peoples, and supplement historical records with informally gathered impressions from local rights-holders and stakeholders, as well as through our own experiences and observations. We conclude by returning to the subject of our own operations within the region to highlight how SCRAP has attempted to learn from this history—particularly with respect to co-management and community engagement—and to propose areas for improvement.

INNV-05. MULTIDISCIPLINARY SPINE ONCOLOGY CARE ACROSS THE DISEASE CONTINUUM - UPDATES FOR THE BEDSIDE AND THE BOARDS

In response to the increased prevalence and complexity of metastatic and primary spine oncology, there has been a resultant increase in stakeholders, treatments and outcomes. A subset of the global multidisciplinary authors will present a timely and concise review of the contents of NOP’s Volume-7, supplement-1, “Multidisciplinary Spine Oncology Care Across the Disease Continuum”. The first portion will review: Epidemiology, Tumor Types, Presentation, Initial Tumor-directed Management, Initial Symptom-directed Management, Subsequent Tumor-directed Management, Subsequent Symptom-directed Management, and Multidisciplinary Program Development and Resources for Stakeholders. The second portion will challenge the current state of care and engage the attendees toward developing initiatives needed for a future state of care. Attendees will receive an update for both the bedside and the boards.

P094 DIASTASIS POST-PREGNANCY PROGRAM

Aim This study aims to summarize our knowledge in rectus abdominis diastasis based on the experience collected by the multidisciplinary program. Material and Methods Retrospective analysis of a prospective database. The diastasis post-pregnancy program is an interdisciplinary protocol that aims to restore the anatomical and functional structure of the abdominal wall after the degenerative process of pregnancy. Used a systematic multidisciplinary evaluation that included an abdominal walls surgeon, plastic surgeon, physiotherapist, and radiologist. Following the findings, we propose a classification, adapting the specific treatment according to the degree of the patient's condition. Grade I only performed physiotherapy; Grade II: started physiotherapy plan, with associated surgical treatment due to lack of response; Grade III underwent surgery as the first treatment in addition to physiotherapy protocol. Endoscopic-assisted linea alba reconstruction plus mesh have using to repair midline hernias in association with diastasis. Results From January 2017 and June 2019, 1085 patients completed the program. Clinical classification: Grade I: 760 patients (70 %) and Grade II: 248 patients (64%) performed physiotherapy as first-line treatment, with associated surgical treatment being necessary for 89 patients (36%); Grade III: 77 patients (7%) underwent surgery as first-line treatment, associated with physiotherapy postoperative protocol. Postoperative complications were: 31 seromas(14%) , 11 omphalitis (5%), 5 hematoma (2%) 1 (0.44%) required surgical dressing. Mc Gill and Us Check-up post-treatment test showed improvement in 77 % of patients. Please insert your text here. Conclusions Evaluation and treatment, in post-pregnant patients, using a multidisciplinary approach concept showed good initial results with important improvement anatomical, functional, clinical, and aesthetic.

Catastrophizing, Anxiety, and Depression in Patients with Chronic Non-Malignant Pain

The aim of this study was to determine the level of anxiety and depression and the intensity of pain in patients with chronic non-malignant pain, the correlation of catastrophizing with these factors, and the interaction of a multidisciplinary program for the treatment of chronic pain and the level of catastrophizing, anxiety, depression and pain intensity. The study was conducted on a sample of 44 participants aged 32 to 80 years who participated in the multidisciplinary program for chronic pain management at the Institute for Pain Management of the Clinical Medical Center Osijek. Pain intensity was measured using the Visual Analog Scale (VAS); the Depression, Anxiety and Stress Scale (DASS-21) was used to measure anxiety and depression; while catastrophizing was measured using the Pain Catastrophizing Scale (PCS). There was a moderate positive correlation between anxiety, depression, and pain intensity in patients with chronic non-malignant pain; a positive correlation between anxiety, depression, pain intensity, and catastrophic factors; and a reduction of anxiety, depression, pain intensity and catastrophization at the end of a multidisciplinary chronic pain treatment program. The findings contribute to a better understanding of the relation between emotional distress, cognitions and pain intensity in patients with chronic non-malignant pain.

Million Hearts Cardiac Rehabilitation Think Tank: Accelerating New Care Models

This article describes the October 2020 proceedings of the Million Hearts Cardiac Rehabilitation Think Tank: Accelerating New Care Models, convened with representatives from professional organizations, cardiac rehabilitation (CR) programs, academic institutions, federal agencies, payers, and patient representative groups. As CR delivery evolves, terminology is evolving to reflect not where activities occur (eg, center, home) but how CR is delivered: in-person synchronous, synchronous with real-time audiovisual communication (virtual), or asynchronous (remote). Patients and CR staff may interact through ≥1 delivery modes. Though new models may change how CR is delivered and who can access CR, new models should not change what is delivered—a multidisciplinary program addressing CR core components. During the coronavirus disease 2019 (COVID-19) public health emergency, Medicare issued waivers to allow virtual CR; it is unclear whether these waivers will become permanent policy post-public health emergency. Given CR underuse and disparities in delivery, new models must equitably address patient and health system contributors to disparities. Strategies for implementing new CR care models address safety, exercise prescription, monitoring, and education. The available evidence supports the efficacy and safety of new CR care models. Still, additional research should study diverse populations, impact on patient-centered outcomes, effect on long-term outcomes and health care utilization, and implementation in diverse settings. CR is evolving to include in-person synchronous, virtual, and remote modes of delivery; there is significant enthusiasm for implementing new care models and learning how new care models can broaden access to CR, improve patient outcomes, and address health inequities.