Reaganism and the Poor Family: Life on AFDC after the Budget Cuts

Recent changes in federal and state welfare policies have had negative consequences for public welfare recipients. This paper summarizes a study which focused on the impact of these policy changes on the AFDC population in the most populous region of Oregon. Of particular importance are the changes in income levels, employment, and social service utilization of recipients. Personal reactions of recipients are also reviewed, as are expectations for the future. The differential economic impact of the policy changes on various categories of recipients is stressed

Fracture liaison programs

In view of the high imminent risk of having subsequent fractures after a fracture, early evaluation and treatment decisions to prevent subsequent fractures are advocated. After a hip fracture, the fracture liaison service (FLS) and orthogeriatric care are considered the most appropriate organisational approaches for secondary fracture prevention following a recent fracture.Their introduction and implementation have been shown to increase evaluation and treatment of patients at high risk for subsequent fracture. Of real-world cohort studies, most, but not all studies, indicate a lower incidence of fracture and longer survival after treatment with nitrogen-containing bisphosphonates. (C) 2019 Elsevier Ltd. All rights reserved.</p

The Effect of Dispersed Oil on the Calcification Rate of the Reef-Building Coral Diploria Strigosa

Hermatypic corals represent environmentally and economically important components of the reef ecosystem. Oil spills and clean-up operations in reef areas are potential sources of pollution impact. This paper presents an evaluation of the calcification rate of specimens of the reef-building coral Diploria strigosa in response to 24 hour treatments of chemically dispersed oil at concentrations of 20 ppm. The concentrations and durations were chosen to represent a scenario of a short-term oil spill treated with dispersant passing over a coral reef. Calcification rates were determined by the buoyant weight technique at several day intervals for up to 29 days following treatment. Results from laboratory experiments (Winter and Summer) conducted in a flow-through seawater system indicate that treated corals, both in comparison to untreated controls as well as to their pretreatment rates, experienced no depression in calcification. In contrast, a possible short-term enhancement of calcification for the treated corals was observed

The Effects of Oil and Oil Dispersants on the Skeletal Growth of the Hermatypic Coral Diploria strigosa

Specimens of the hermatypic coral species Diploria strigosa were exposed to various concentrations (1–50 ppm) of oil or oil plus dispersant for 6–24 h periods in four laboratory and two field experiments. After dosing, corals were transplanted to, or left in, the field and recollected approximately one year later for extension (linear) growth analysis by the alizarin stain method. The experiments were designed to assess the long-term effects of brief low-level concentrations of chemically dispersed oil and oil alone on corals in a situation, for example, where an oil slick (treated and non-treated with dispersants) passes over a reef. No significant differences between extension growth parameters (Septa increase, Columella increase) and a calical shape parameter (New Endotheca Length) of treated corals versus controls were found in any of the experiments. In two summer experiments calical relief (Fossa length) was found to be depressed in corals of some of the experimental treatments

Behavioural Effects of Chemically Dispersed Oil and Subsequent Recovery in Diploria strigosa (Dana)

Survival and behaviour of the hermatypic coral Diploria strigosa was studied during 6–24 h doses with water-accomodated fractions of chemically dispersed crude oil, and for a subsequent recovery period of 1 month. Experiments utilized a flow-through laboratory dosing procedure and incorporated petroleum hydrocarbon measurements in order to simulate a major but short-term oil spill in shallow subtidal benthic reef environments. Chemically dispersed oil treatments consisted of Arabian Light Crude oil with Corexit 9527 or BP1100WD at 1–20 ppm concentrations of oil. In general, effects observed were sub-lethal, temporary, and associated with the highest concentrations tested. Responses to the presence of dispersed oil at 20ppm for 24 h included mesenterial filament extrusion, extreme tissue contraction, tentacle retraction and localized tissue rupture. The nature and severity of reactions during the dosing phase varied between colonies and treatments, but colonies typically resumed normal behaviour within 2 h to 4 d of the recovery period. It therefore seems unlikely that observed biological effects would impair long-term viability

Prospective, randomized, multi-institutional clinical trial of a silver alginate dressing to reduce lower extremity vascular surgery wound complications

ObjectiveWound complications negatively affect outcomes of lower extremity arterial reconstruction. By way of an investigator initiated clinical trial, we tested the hypothesis that a silver-eluting alginate topical surgical dressing would lower wound complication rates in patients undergoing open arterial procedures in the lower extremity.MethodsThe study block-randomized 500 patients at three institutions to standard gauze or silver alginate dressings placed over incisions after leg arterial surgery. This original operating room dressing remained until gross soiling, clinical need to remove, or postoperative day 3, whichever was first. Subsequent care was at the provider's discretion. The primary end point was 30-day wound complication incidence generally based on National Surgical Quality Improvement Program guidelines. Demographic, clinical, quality of life, and economic end points were also collected. Wound closure was at the surgeon's discretion.ResultsParticipants (72% male) were 84% white, 45% were diabetic, 41% had critical limb ischemia, and 32% had claudication (with aneurysm, bypass revision, other). The overall 30-day wound complication incidence was 30%, with superficial surgical site infection as the most common. In intent-to-treat analysis, silver alginate had no effect on wound complications. Multivariable analysis showed that Coumadin (Bristol-Myers Squibb, Princeton, NJ; odds ratio [OR], 1.72; 95% confidence interval [CI], 1.03-2.87; P = .03), higher body mass index (OR, 1.05; 95% CI, 1.01-1.09; P = .01), and the use of no conduit/material (OR, 0.12; 95% CI, 0.82-3.59; P < .001) were independently associated with wound complications.ConclusionsThe incidence of wound complications remains high in contemporary open lower extremity arterial surgery. Under the study conditions, a silver-eluting alginate dressing showed no effect on the incidence of wound complications

In-hospital versus postdischarge adverse events following carotid endarterectomy

ObjectiveMost studies based on state and nationwide registries evaluating perioperative outcome after carotid endarterectomy (CEA) rely on hospital discharge data only. Therefore, the true 30-day complication risk after carotid revascularization may be underestimated.MethodsWe used the National Surgical Quality Improvement Program database 2005-2010 to assess the in-hospital and postdischarge rate of any stroke, death, cardiac event (new Q-wave myocardial infarction or cardiac arrest), and combined stroke/death and combined adverse outcome (S/D/CE) at 30 days following CEA. Multivariable analyses were used to identify predictors for in-hospital and postdischarge events separately, and in particular, those that predict postdischarge events distinctly.ResultsA total of 35,916 patients who underwent CEA during 2005-2010 were identified in the National Surgical Quality Improvement Program database; 59% were male, median age was 72 years, and 44% had a previous neurologic event. Thirty-day stroke rate was 1.6% (n = 591), death rate was 0.8% (n = 272), cardiac event rate was 1.0% (n = 350), stroke or death rate was 2.2% (n = 794), and combined S/D/CE rate was 2.9% (n = 1043); 33% of strokes, 53% of deaths, 32% of cardiac events, 40% of combined stroke/death, and 38% of combined S/D/CE took place after hospital discharge. Patients with a prior stroke or transient ischemic attack had similar proportions of postdischarge events compared with patients without prior symptoms. Independent predictors for postdischarge events, but not for in-hospital events were female sex (stroke [odds ratio (OR), 1.6; 95% confidence interval (CI), 1.2-2.1] and stroke/death [OR, 1.4; 95% CI, 1.1-1.7]), renal failure (stroke [OR, 3.0; 95% CI, 1.4-6.2]) and chronic obstructive pulmonary disease (death [OR, 2.5; 95% CI, 1.6-3.7], stroke/death [OR, 1.8; 95% CI, 1.4-2.4], and S/D/CE [OR 1.8, 95% CI 1.4-2.3]).ConclusionsWith 38% of perioperative adverse events after CEA happening posthospitalization, regardless of symptoms status, we need to be alert to the ongoing risks after discharge particularly in women, patients with renal failure, or chronic obstructive pulmonary disease. This emphasizes the need for reporting and comparing 30-day adverse event rates when evaluating outcomes for CEA, or comparing carotid stenting to CEA