Prevalence of Restricted Spirometry within Two Eastern Kentucky Counties A Cross Sectional Study

Objective: This study examines the prevalence of restrictive spirometry in Eastern Kentucky and its association among men and women with various demographic and exposure (occupational and environmental) factors. Methods: A cross sectional, cluster sample (N = 685) of participants from Letcher and Harlan Counties, aged 21 and over, answered a questionnaire focused on risk factors for respiratory health outcomes including questions on demographic, health, occupational, and environmental exposures variables. Pulmonary function tests were administered to all participants with no significant cardiovascular or cerebrovascular events within the past 30 days. Log-binomial regression was used to calculate prevalence ratios (PRs) adjusted for multiple covariates. Results: The prevalence of restricted spirometric pattern (RSP) among men and women was 24.3% and 30.6%, respectively. RSP prevalence was particularly high among men and women with comorbidities. Significant associations for restricted spirometry among women included Age35-64: adjusted prevalence (PR: 5.49, 95% CI 1.69 to 17.8, p=0.005), Age≥65 (PR:7.23, 95% CI 2.20 to 23.7, p=0.001), widowed, single or divorced women (PR: 1.78, 95% CI 1.02 to 3.10, p=0.043), one comorbidity (PR: 1.79, 95% CI: 1.14 to 2.80) and obesity (PR: 2.21, 95% CI 1.05 to 4.64, p=0.036). Significant associations for restricted spirometry among men was obesity (PR: 2.68, 95% CI 1.05 to 6.80, p=0.039). Conclusions: The prevalence of RSP in Central Appalachia is substantially higher when compared with previous literature. Increased RSP in our cohort is multifactorial but may be due to higher prevalence of obesity and comorbid conditions, which is in line with previous studies. Occupational and environmental exposures did not show association with RSP despite many participants living in proximity to coal mines and mining activities

Assessing Training Impact: Exploring Perspectives on Leadership Training in Healthcare through a Multi-frame Lens

A major concern for most leadership development teams is aligning training and development goals to desired outcomes, especially when looking at overall costs to plan and implement effective training programs. Leadership training in healthcare is increasing due to the complexity of duties and the need to deal with conflicting situations on a regular basis. This study explored whether goals and assessment instruments identified and applied by program development managers were adequate to reflect a multi-frame perspective, and whether participant feedback articulates benefits encompassing multiple frames. Four main questions were used in the study: “What potential benefits do leadership development staff who select, design, and evaluate training articulate; and do they capture a multi-frame perspective? How do the goals of the program development managers align with the assessment of evaluation instruments, and do the assessments reflect a multi-frame perspective? How does the perception of training benefits align with leadership development goals and multi-frame perspective? What effect does training in competencies such as, problem-solving, conflict management, and effective communication have on leaders in healthcare?” To highlight a potential link between behavior, change and organizations; Social Cognitive, Human Needs, and Systems Theories were utilized. A mixed-method design applying Interpretative Phenomenological Analysis and Descriptive Statistics was used. Results of the study indicate that the goals identified by leadership development do align with trainees outcomes in terms of: serving as a support mechanism to ensure effective team-building; facilitating growth towards promotion through education and effective feedback; and enhancing leadership core competencies such as, emotional intelligence, conflict management and communication skills

Personal Injury Law, Defense v. Plaintiff: A Return to Civility

This particular seminar is designed to educate attorneys on the importance of communicating and navigating a civil case while maintaining a level of professionalism, civility, and integrity to the profession, opposing party, and the court. Learning Outcomes include: How to maintain a level of civility while competently represent clients in civil cases in Florida Review standards of conduct in the context of a lawyer’s responsibility to perceive and protect the image of the profession The Florida Bar CLE credits - General 2.0, Ethics 0.5 The Florida Bar Certification Credits - Civil Trial 2.

‘Around Us, History Never Stops’: Interrogating Post-quake Haiti in Évelyne Trouillot’s Absences sans Frontières

Immediately following the 2010 earthquake, Évelyne Trouillot imbued her corpus with what Rachel Douglas refers to as ‘archival impulses’ (Douglas, 2016: 389), in the form of op-eds, poetry, essays and short fiction. These ‘impulses’ were then further documented with the publication of 'Absences sans frontières' (Trouillot, 2013), a novel about post-quake Haiti. This article interrogates how Évelyne Trouillot uses 'Absences sans frontières' to interpret both the aesthetics of humanitarianism and the global political responses that emerged in the wake of the 2010 earthquake in Haiti. Informed by elements such as the evasive language of Trouillot’s narrator when reflecting upon the earthquake and the narrator’s father’s observations of Haiti-related media coverage in the United States, this article adopts a dual approach to examining 'Absences sans frontières'. In so doing, it identifies the narrative strategies employed by Trouillot that are used to invert the subjectivity of the earthquake victims/humanitarian workers paradigm. The novel is, in essence, a series of snapshots that provide alternative perspectives that humanise the victims of the tremor and challenge the motives of the humanitarian workers. To a lesser extent, the article equally considers the intrinsic relationship between humanitarianism and politics. It consequently analyses 'Absences sans frontières'’ nuanced perspective on the United States’ political reactions, which affected both Haitians within Haiti and the diaspora

Paradigm of the Post Natural: Critiquing Capitalist Ideals Through Environmental Degradation

There is an unspoken value in the destructiveness caused by design that is exposed through the exploitation of natural resources. This thesis seeks to exemplify the aesthetic value inherent within these newly defined environments. Nature is a source for human consumption, and as such it has developed into a commodity. By now it should be made evident that humanity’s presence is everywhere. There is no ecosystem left unturned by human manipulation Iin this respect, nature is dead. Deforested sites of oil fracking leave mile long toxic ponds highlighting the destructive pursuits that capitalism creates. Chernobyl showcases how human errors in design can lead to catastrophic changes to an ecosystem, changing the way animals and humans inhabit these spaces for decades to come. Monocultures and factory farms exploit nature, and with technological advancements, have taken over, creating a loss of biodiversity that upsets the ecological balance. This exploitation is also evident within our treatment of the non-human, going so far as to design animals for human pleasure and economic gain. Deriving from the ideas of the aesthetic sublime, it should be emphasized that the sublime is not an idea but rather an experience. This definition can pertain to the evolution of our thesis, in which it is not only necessary to allude to the sublime, but it is also important to experience it. To encounter this we could imagine an immersive experience that evokes and designs the specific senses one might feel if they were captivated by this environment. From the imagined odors, colors, and textures that are present we can evolve our perception of the real and artificial as a harmonious endeavor. This immersive experience could be used to further design and manipulate our generated landscapes and continue to disrupt rationality and form as the ultimate aesthetic. Acknowledging and embracing the irrational would allows the audience to incorporate their emotions as they experience the obscurity that designers incorporate in their design processes. It serves to awaken the senses of those who chose to neglect the reality of architecture and the way in which we discriminatorily design through human-centered approaches. Further observing the way in which one could transform the environment through their movements, adding another layer of destruction. This explores the contradictions of design aesthetics that are set forth through the use of our initial visuals. Developing once again a feedback loop where further designing these landscapes would in turn design the rationale of the user. Ultimately we aim to create this immersive experience in order to emphasize the aesthetics of destruction. The experience as a whole represents the sublime, making the viewer question what the role of design and aesthetics has on environmental degradation

Physician associates advance patient safety

As the physician associate (PA) profession grows and awareness about the role increases, it is important to understand how PAs promote patient safety. In this article, we explore the current literature regarding the contribution of PAs to patient safety, considering their training, day-to-day clinical work and influence on recognised factors that affect patient safety

Paradigms of the Post-Natural: Depicting Alternative Futures

Paradigms of the Post Natural is a thesis that utilizes imagery and storytelling to critique present practices of design which disregard the protection of our environment. We are interested in current environmental degradation characteristics of the era of the anthropocene where human-centric design methods have manipulated and exploited the ecosystem in which we coexist with other organisms as destructive pursuits of human development. Our inspiration developed from a shared interest in the conservation of non-human organisms. Specifically, we are interested in ecocides, areas in which animals are forced to adapt as they experience the human destruction of their habitat. Examining areas of environmental exploitation has made us aware of the extreme genetic adaptations that species are undergoing. In order to depict these unimaginable environments that are a result of human destruction, we chose to collaborate with artificial intelligence (AI). Throughout this thesis, we imagined how these ecosystems and the accompanying organisms would look if we continued to practice design and construction the way we do currently. Our thesis depicts the possible evolution of these environments and the species affected. The atlas we produced was devised to mimic a National Geographic issue in the year 2550. We hypothesize that in 2550 every square mile of Earth will continue to thrive, despite extreme ecological conditions. By speculating on imagined ecosystems, we challenge present practices which contribute to climate change and environmental degradation. This thesis aims to present a future world created by humans, determined to exhaust natural resources and ignore environmental signs of change

Preparing physician associates to prescribe: evidence, educational frameworks and pathways

There are approximately 2,850 physician associates (PAs) in the UK, and this number is growing. PAs are unable to prescribe due to an absence of statutory regulation and necessary prescribing legislation. While PAs cannot prescribe, they must have an adequate level of pharmacology knowledge to safely manage patients. There is an expectation that this is taught as part of the core syllabus on PA programmes. The Department of Health and Social Care (DHSC) recently announced the introduction of statutory regulation of Medical Associate Professionals (MAPs) that include PAs under the General Medical Council. With the introduction of regulation, PAs may be able to prescribe as part of their role. A working group is considering how this might be achieved in terms of education and supervision requirements, delivery of the training and scope of practice. This paper explores the current approach to delivering pharmacology across UK PA programmes. We evaluate what constitutes acceptable training and assessment, and determine if programmes have the capacity to prepare students for prescribing rights. We compare UK PA programmes with those in the USA, with the V300 Independent/Supplementary Prescribing course and with the Prescribing Safety Assessment examination

Physician associate prescribing: perspectives, practices and pathways.

With the introduction of statutory regulation of physician associates (PAs) through the General Medical Council (GMC) expected in 2024, we anticipate a consultation on whether PAs will be given prescribing rights and how this will happen. In anticipation of this consultation, we surveyed the opinions of PAs and healthcare professionals (HCPs) who work with them regarding prescribing rights for PAs. We had a combined response of more than 500 and the survey results show that the vast majority of respondents across the two groups are in favour of prescribing rights for PAs. While both HCPs and PAs overall feel that PAs should have prescribing rights, PAs prefer generalised rights while HCPs recommend specialist rights only. To ensure safe prescribing, we advocate for a safety assessment followed by a period of supervision in their specialty before prescribing rights are given: our data show that confidence, knowledge and safety increases with length of time in specialty. Prescribing rights for PAs will help them become more independent and valuable assets to the healthcare team, increasing efficiency and improving patient care