Overseer of the Poor

The year George Washington was finishing his first term as president, 1792, William Larned was beginning his first term as overseer of the poor for Providence, Rhode Island. Larned would be reelected for another thirty-five one-year terms and arguably exercised more authority over locals than any president could. Larned’s long career in this little-known but powerful local government position illustrates several aspects of early American poor laws. Overseers of the poor could be lifesavers to locals in need. They could also upend lives, forcing families out of town. They controlled the largest portion of local tax dollars, which dwarfed state and federal tax levies from the individual taxpayer’s perspective. Overseers used these tax dollars to provide food, housing, healthcare, and other necessaries to people in need. An ancillary benefit was that these dollars also buoyed the incomes of local government relief contractors.

Magnetic Tracking and Electrocardiography-Guided Tip Confirmation System Versus Fluoroscopy for Placement of Peripherally Inserted Central Catheters: A Randomized, Noninferiority Comparison

Purpose To determine whether the use of a magnetic tracking and electrocardiography-guided catheter tip confirmation system (TCS) is safe and noninferior to fluoroscopy concerning positioning accuracy of a peripheral inserted central catheter (PICC). Methods In this prospective, randomized, single-center study, adult patients scheduled for PICC insertion were assigned 1:1 either to TCS or fluoroscopy. The primary objective was a noninferiority comparison of correct PICC tip position confirmed by X-ray obtained immediately after catheter insertion. Time needed for PICC insertion and insertion-related complications up to 14 days after the procedure were secondary outcomes to be assessed for superiority. Results A total of 210 patients (62.3 ± 14.4 years, 63.8% male) were included at a single German center between June 2016 and October 2017. Correct PICC tip position was achieved in 84 of 103 TCS (82.4%) and 103 of 104 fluoroscopy patients (99.0%). One-sided 95% lower confidence limit on the difference between proportions was −23.1%. Thus, noninferiority of TCS was not established (p > 0.99). Insertion of PICC took longer with TCS compared to fluoroscopy (8.4 ± 3.7 min vs. 5.0 ± 2.7 min, p < 0.001). Incidence of complications within a mean follow-up of 5.0 ± 2.3 days did not differ significantly between groups. Conclusion Noninferiority of TCS to fluoroscopy in the incidence of correct PICC tip position was not reached. Ancillary benefit of TCS over fluoroscopy including less radiation exposure and lower resource requirements may nonetheless justify the use of TCS. The study is registered with Clinical.Trials.gov (Identifier: NCT02929368).

The impact of collaborative engagement on knowledge and performance gains in episodic collaborations

Purpose – Supply chains are embedded in a larger network of enterprises where firms exchange offerings, often compete for the same customers, and constantly innovate to improve their performance. In these dynamic environments, firms are increasingly dependent on the knowledge and expertise in external organizations to innovate, problem-solve, and improve performance. Firms are increasingly collaborating to exchange and pool skills and knowledge and deploy resources and capabilities not found in their own firm. This research using both structured interviews and survey data seeks to determine what are the direct benefits and the ancillary benefits of collaboration. The paper aims to discuss these issues. Design/methodology/approach – A mixed methodology approach was utilized, using qualitative structured interviews leading to developing a research model and then an empirical survey of 473 participants who are involved in their respective organization's collaboration projects. The data were analyzed using structural equation modeling to examine relationships between collaborative engagement, knowledge gained, operational outcomes and relational outcomes. Findings – The results of the study indicate that collaborative engagement has a direct effect on knowledge gained, operational outcomes and relational outcomes in collaboration. The ancillary benefit of collaboration is the learning that takes place leads to improved operational outcomes and relational outcomes. Research limitations/implications – In this research study all the constructs are only examined from a single perspective. This can be a limitation as it would be of greater value to collect data from all the members involved in the collaboration. Originality/value – Collaboration has been well studied in many fields but this research suggests an important ancillary benefit that needs to be considered when deciding to collaborate is the knowledge and learning that happens during a collaboration.

A multi-period analysis of a carbon tax including local health feedback: an application to Thailand

An ancillary benefit of Greenhouse Gas (GHG) mitigation refers to a benefit derived from GHG mitigation that is in addition to the reduction in adverse impacts of global climate change. One type of ancillary benefits of GHG mitigation is reduced local conventional pollutants, which is associated with improved health. Middle-income countries like Thailand are in unique positions to obtain large ancillary health gains from reduced local conventional pollutants when GHG is mitigated by curbing fossil fuel consumption.

Effect of splenectomy on tolerance to combination chemotherapy in patients with lymphoma

Enhanced tolerance to combination chemotherapy has been cited as an ancillary benefit of staging laparotomy and splenectomy in Hodgkin's disease. Seventeen patients with Hodgkin's disease and 15 with non- Hodgkin's lymphoma were subjected to nontherapeutic splenectomy as part of the staging procedure prior to their initial treatment with MOPP (nitrogen mustard, vincristine, procarbazine, and prednisone) or CVP (cyclophosphamide, vincristine, and prednisone) chemotherapy, respectively. Matched control patients of comparable age, pathologically proven stage, and presence or absence of bone marrow lymphoma and previous radiotherapy were selected. Although leukocyte (in non-Hodgkin's patients) and platelet counts (in both groups) were significantly higher in the patients with splenectomy during most of the first six cycles of therapy, there was no difference in the number of cycles during which a leukocyte count below 1000 (or below 2000 in Hodgkin's disease) or platelet count below 50,000 was recorded in the splenectomized and control patients. The total dose of all drugs actually delivered, time required to complete six cycles of treatment, and the portion of patients entering complete remission were not significantly different in the two groups. We have found no evidence that splenectomy per se, in lymphoma patients without findings of hypersplenism, improves the ability to administer planned amounts of drugs during initial combination chemotherapy.

Effect of splenectomy on tolerance to combination chemotherapy in patients with lymphoma

Enhanced tolerance to combination chemotherapy has been cited as an ancillary benefit of staging laparotomy and splenectomy in Hodgkin's disease. Seventeen patients with Hodgkin's disease and 15 with non- Hodgkin's lymphoma were subjected to nontherapeutic splenectomy as part of the staging procedure prior to their initial treatment with MOPP (nitrogen mustard, vincristine, procarbazine, and prednisone) or CVP (cyclophosphamide, vincristine, and prednisone) chemotherapy, respectively. Matched control patients of comparable age, pathologically proven stage, and presence or absence of bone marrow lymphoma and previous radiotherapy were selected. Although leukocyte (in non-Hodgkin's patients) and platelet counts (in both groups) were significantly higher in the patients with splenectomy during most of the first six cycles of therapy, there was no difference in the number of cycles during which a leukocyte count below 1000 (or below 2000 in Hodgkin's disease) or platelet count below 50,000 was recorded in the splenectomized and control patients. The total dose of all drugs actually delivered, time required to complete six cycles of treatment, and the portion of patients entering complete remission were not significantly different in the two groups. We have found no evidence that splenectomy per se, in lymphoma patients without findings of hypersplenism, improves the ability to administer planned amounts of drugs during initial combination chemotherapy.