Rural trauma presents unique problems for surgical care. While military surgeons are prepared to provide care at or near the scene of battle, civilian literature is devoid of reports for care provided by surgeons at sites of injury occurrences. Although these injuries are infrequent, they are more likely to occur in rural trauma settings. This article describes two cases of extremity injury that required amputation at the scene and presents a proposal for swift mobilization of appropriately trained surgeons to the scene with adequate instrumentation and lighting, which can significantly reduce the morbidity and mortality of these victims.
Climate change is a major threat to food security in Pacific Island countries, with declines in food production and increasing variability in food supplies already evident across the region. Such impacts have already led to observed consequences for human health, safety and economic prosperity. Enhancing the adaptive capacity of Pacific Island communities is one way to reduce vulnerability and is underpinned by the extent to which people can access, understand and use new knowledge to inform their decision-making processes. However, effective engagement of Pacific Island communities in climate adaption remains variable and is an ongoing and significant challenge. Here, we use a qualitative research approach to identify the impediments to engaging Pacific Island communities in the adaptations needed to safeguard food security. The main barriers include cultural differences between western science and cultural knowledge, a lack of trust among local communities and external scientists, inappropriate governance structures, and a lack of political and technical support. We identify the importance of adaptation science, local social networks, key actors (i.e., influential and trusted individuals), and relevant forms of knowledge exchange as being critical to overcoming these barriers. We also identify the importance of co-ordination with existing on-ground activities to effectively leverage, as opposed to duplicating, capacity.
Dr. Loran B. Smith passed away in Topeka, Kansas, on July 24, 2009. He was born on July 23, 1946. He was the son of Gordon T and Edith A (Hibbard) Smith of Medford, Massachusetts. Loran received his bachelors degree at Salem State College (Massachusetts) in 1968, a masters from Oklahoma State in 1971, and then taught at Black Hills State (Spearfish, South Dakota) from 1971–1974 and Augustana College in Souix Falls from 1974–1977. He received his Ph.D. from the University of Nebraska-Lincoln in 1980 and taught at Missouri Southern State College in Joplin until 1982. He then came to Washburn University of Topeka, where he taught until his death. While "Doc" Smith (as the students referred to him) published sufficiently enough to be awarded tenure and promotion to professor, that was not his forte. Loran was a gifted teacher. His CV lists 23 teaching awards, including Washburn's Faculty Certificate of Merit, a university-wide teaching honor based on student elections, from 1985–1998. Loran was also extremely active in faculty governance and other service to the university and the Topeka community. He was on the university's faculty governing body from 1996–2006, serving as its vice president in 2002 and president from 2003–2005. He was the chairman of the Social Science Division almost all of the 1990s and he also served as the chairman of the college's curriculum committee during that same time span. As Washburn is an open-admission university, we have retention problems not experienced by most universities. Loran researched, organized, and ran a college experience program for at-risk students. He was very active in ASPA, serving as the Kansas chapter president from 1987–1988, indeed, his auto license plate read "KS ASPA" and was purchased for him by students he had recruited into ASPA. Loran's main area of academic interest was state and local government and he was the election night expert for one of the local TV stations here in the capital of Kansas from 1984–1992. What occupied most of his time and energy outside of his official academic duties was serving as the faculty advisor for a local chapter of the Sigma Phi Epsilon fraternity. Doc Smith took what was a typical college fraternity and turned it into a modern association of men that consistently had the highest average GPA of all the fraternities and sororities on campus. It was not unusual for Loran to pay for a student's tuition and fraternity house bill, buy students books, and lend money to a needy student. Loran had a reputation for frugality (his apartment had a TV but no cable, a rotary phone, and he rented all of his furniture and appliances). Loran's tightness with money turned out to be a big benefit for the fraternity. One chapter official put it this way, "Through his notorious tight-fisted watch over finances, the Chapter was able to wipe out a significant debt to the National Housing Corporation ahead of schedule and helped the chapter build a significant savings by 2000." People who knew Loran thought that he was not married but Loran was married to his job. Not only was Loran in his office nearly every evening until 10:00 p.m., but he was there all day Saturday and Sunday too, and, more often than not, there was a student in that office talking with him.
Three studies were conducted to explore the psychological determinants of COVID-deterrent behaviors. In Study 1, using data collected and analyzed both before and after the release of COVID-19 vaccines, mask-wearing, other preventative behaviors like social distancing, and vaccination intentions were positively related to assessments of the Coronavirus Behavioral Health Mindset (CVBHM); belief in the credibility of science; progressive political orientation; less use of repressive and more use of sensitization coping; and the attribution of COVID-19 safety to effort rather than ability, powerful forces, fate, or luck. In Study 2, favorable COVID-19 vaccination intentions were related to greater willingness to work, lower emotional distress, and greater customer experience mindset. Study 3 examined the personality and motives of individuals who volunteered to help deliver COVID-19 inoculations to the local community. The vaccine-giving volunteers, especially those with prosocial motives, had high CVBHM scores, belief in the credibility of science, low use of repressive coping, greater attribution of COVID-19 protection to effort, low likelihood of voting conservative, were older, and had more education than others. The majority of public health volunteers expressed prosocial motives to help people or join a cause (60.7%), but many (39.3%) expressed the personal motives of getting the COVID-19 vaccination for themselves, conveying a public image of compassion, or structuring time. Based on the three research studies, a COVID-19 Mindset Hierarchy model is proposed to integrate the results.
This paper analyzes in detail the role of environmental and economic shocks in the migration of the 1930s. The 1940 US Census of Population asked every inhabitant where they lived five years earlier, a unique source for understanding migration flows and networks. Earlier research documented migrant origins and destinations, but we will show how short-term and annual weather conditions at sending locations in the 1930s explain those flows, and how they operated through agricultural success. Beyond demographic data, we use data about temperature and precipitation, plus data about agricultural production from the agricultural census. The widely known migration literature for the 1930s describes an era of relatively low migration, with much of the migration that did occur radiating outward from the Dust Bowl region and the cotton South. Our work about the complete United States will provide a fuller examination of migration in this socially and economically important era.
Contemplating Maternity explore how discourses of choice shape and are shaped by womenOs identities and experiences as (non)mothers and how those same discourses affect and reflect private practices and public policies related to reproduction and motherhood. This volume is unique because it investigates discourses of choice across the arc of maternity and as enacted through various (non)maternal subject positions.
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Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings: Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p<0·001), and full lockdowns (0·57, 0·54-0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation: Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services.