I Object

Dimensions: 30 inches wide, 36 inches tallInkjet on matte paper, printed on both sides Letter 166 Paul Laurence Dunbar wrote to Booker T. Washington in response to his rebuttals of the commissioned song Dunbar was asked to write for the Tuskegee Institute. The Tuskegee Institute was the first higher education institute opened for African Americans. Booker T. Washington was one of the founders who helped establish the school. During the time of this letter, Dunbar was struggling with his tuberculosis diagnosis, however he was still writing and producing new work. Within this letter Dunbar debates Washington’s views and objections to various lyrics in which Dunbar believes are correctly placed and worded. One of the most important aspects of this reading is the relationship between Dunbar and Washington. While they had different views on the song it is made clear that Dunbar still has the utmost respect and admiration for Washington. Even within those feelings of great admiration, Dunbar still stands his ground and fights for the original written version of the song. This letter shows a confident side of Dunbar as he defends his work. The type palette is Adriane Text designed by Marconi Lima and IvyOra Display designed by Jan Maack. These type families were chosen because of their designers and the overall look and feel which was aesthetically pleasing and helped convey the overall message.https://ecommons.udayton.edu/stu_vad_dunbarletters/1007/thumbnail.jp

The value of cross border emergency management in adapting to climate change

Adapting to climate change is challenging in border regions where emergency situations can become amplified on a cross-border basis. Such amplification is largely the result of more agencies becoming involved in the response; groups that are often geographically dispersed, bring more divergent agendas to the ‘table’ and are often less well acquainted with each other. However, acting to build adaptive responses across international borders serves to increase resilience and decrease vulnerability to climate change. Over the coming decades climate change is likely to increase flood risk. On the island of Ireland, border regions are amongst the most vulnerable to hazards such as flooding. Developing effective cross-border emergency management will require collaborative planning, capacity building and innovative leadership. This paper sets out the urgency of adapting to climate change in border regions and provides an overview of progress and capacity building in moving towards greater shared services in border communities in Ireland

Models of Cross-Border Collaboration in a Post-Brexit Landscape – Insights from External EU Borders

Since the UK 2016 referendum, the border between Ireland and Northern Ireland has emerged as the most contested issue affecting the UK’s withdrawal from the European Union. The ‘backstop’ has consistently been the primary reason for the rejection by the House of Commons of the withdrawal deal negotiated between the EU and the UK government. The associated discourses on finding a border ‘solution’ have raised more questions than answers, with many contributors speculating on what might or might not work, rather than presenting any concrete or workable alternatives to the ‘backstop’. The wider debate on how to reconcile the UK’s withdrawal with maintaining an open border on the island of Ireland, in line with the EU’s fundamental freedoms, has highlighted the distinct differences, in several respects, between internal and external EU borders. Internal EU borders are frictionless and largely invisible, and their significance has declined, due to ongoing processes of European integration and the collaborative arrangements advanced by local-level stakeholders that emphasise commonalities and mutual benefits. Meanwhile, external EU borders are characterised by wide-ranging modes of interaction and governance in respect of cross-border cooperation, and while in some cases, contacts are limited, there are several models and experiences of engagement, and indeed, collaboration. The current debate about the future status and workability of a border on the island of Ireland necessitates an examination of practices across pre-existing external EU borders. This paper responds to this requirement by presenting two case studies, namely, Spain-Morocco and Romania-Republic of Moldova

The 1994-1995 National Health Interview Survey on Disability (NHIS-D): A Bibliography of 20 Years of Research

The 1994-1995 National Health Interview Survey on Disability (NHIS-D) has been one of the most unique and important data sources for studying disability, impairment, and health in the United States. In celebration of the NHIS-D’s twenty-year anniversary, we created an extensive bibliography (n=212) of research that has used these data

‘A silent epidemic of grief’: a survey of bereavement care provision in the UK and Ireland during the COVID-19 pandemic

Objectives: To investigate the experiences and views of practitioners in the UK and Ireland concerning changes in bereavement care during the COVID-19 pandemic. Design: Online survey using a snowball sampling approach. Setting: Practitioners working in hospitals, hospices, care homes and community settings across the UK and Ireland. Participants: Health and social care professionals involved in bereavement support. Interventions: Brief online survey distributed widely across health and social care organisations. Results: 805 respondents working in hospice, community, and hospital settings across the UK and Ireland completed the survey between 3 August and 4 September 2020. Changes to bereavement care practice were reported in: the use of telephone, video and other forms of remote support (90%); supporting people bereaved from non-COVID conditions (76%), from COVID-19 (65%) and people bereaved before the pandemic (61%); funeral arrangements (61%); identifying bereaved people who might need support (56%); managing complex forms of grief (48%) and access to specialist services (41%). Free-text responses demonstrated the complexities and scale of the impact on health and social care services, practitioners and their relationships with bereaved families, and on bereaved people. Conclusions: The pandemic has created major challenges for the support of bereaved people: increased needs for bereavement care, transition to remote forms of support and the stresses experienced by practitioners, among others. The extent to which services are able to adapt, meet the escalating level of need and help to prevent a ‘tsunami of grief’ remains to be seen. The pandemic has highlighted the need for bereavement care to be considered an integral part of health and social care provision

Early ultrasound surveillance of newly-created haemodialysis arteriovenous fistula

IntroductionWe assess if ultrasound surveillance of newly-created arteriovenous fistulas (AVFs) can predict nonmaturation sufficiently reliably to justify randomized controlled trial (RCT) evaluation of ultrasound-directed salvage intervention.MethodsConsenting adults underwent blinded fortnightly ultrasound scanning of their AVF after creation, with scan characteristics that predicted AVF nonmaturation identified by logistic regression modeling.ResultsOf 333 AVFs created, 65.8% matured by 10 weeks. Serial scanning revealed that maturation occurred rapidly, whereas consistently lower fistula flow rates and venous diameters were observed in those that did not mature. Wrist and elbow AVF nonmaturation could be optimally modeled from week 4 ultrasound parameters alone, but with only moderate positive predictive values (PPVs) (wrist, 60.6% [95% confidence interval, CI: 43.9–77.3]; elbow, 66.7% [48.9–84.4]). Moreover, 40 (70.2%) of the 57 AVFs that thrombosed by week 10 had already failed by the week 4 scan, thus limiting the potential of salvage procedures initiated by that scan’s findings to alter overall maturation rates. Modeling of the early ultrasound characteristics could also predict primary patency failure at 6 months; however, that model performed poorly at predicting assisted primary failure (those AVFs that failed despite a salvage attempt), partly because patency of at-risk AVFs was maintained by successful salvage performed without recourse to the early scan data.ConclusionEarly ultrasound surveillance may predict fistula maturation, but is likely, at best, to result in only very modest improvements in fistula patency. Power calculations suggest that an impractically large number of participants (>1700) would be required for formal RCT evaluation

A Multicenter, Randomized, Placebo‐Controlled Trial of Atorvastatin for the Primary Prevention of Cardiovascular Events in Patients With Rheumatoid Arthritis

Objective: Rheumatoid arthritis (RA) is associated with increased cardiovascular event (CVE) risk. The impact of statins in RA is not established. We assessed whether atorvastatin is superior to placebo for the primary prevention of CVEs in RA patients. Methods: A randomized, double‐blind, placebo‐controlled trial was designed to detect a 32% CVE risk reduction based on an estimated 1.6% per annum event rate with 80% power at P 50 years or with a disease duration of >10 years who did not have clinical atherosclerosis, diabetes, or myopathy received atorvastatin 40 mg daily or matching placebo. The primary end point was a composite of cardiovascular death, myocardial infarction, stroke, transient ischemic attack, or any arterial revascularization. Secondary and tertiary end points included plasma lipids and safety. Results: A total of 3,002 patients (mean age 61 years; 74% female) were followed up for a median of 2.51 years (interquartile range [IQR] 1.90, 3.49 years) (7,827 patient‐years). The study was terminated early due to a lower than expected event rate (0.70% per annum). Of the 1,504 patients receiving atorvastatin, 24 (1.6%) experienced a primary end point, compared with 36 (2.4%) of the 1,498 receiving placebo (hazard ratio [HR] 0.66 [95% confidence interval (95% CI) 0.39, 1.11]; P = 0.115 and adjusted HR 0.60 [95% CI 0.32, 1.15]; P = 0.127). At trial end, patients receiving atorvastatin had a mean ± SD low‐density lipoprotein (LDL) cholesterol level 0.77 ± 0.04 mmoles/liter lower than those receiving placebo (P < 0.0001). C‐reactive protein level was also significantly lower in the atorvastatin group than the placebo group (median 2.59 mg/liter [IQR 0.94, 6.08] versus 3.60 mg/liter [IQR 1.47, 7.49]; P < 0.0001). CVE risk reduction per mmole/liter reduction in LDL cholesterol was 42% (95% CI −14%, 70%). The rates of adverse events in the atorvastatin group (n = 298 [19.8%]) and placebo group (n = 292 [19.5%]) were similar. Conclusion: Atorvastatin 40 mg daily is safe and results in a significantly greater reduction of LDL cholesterol level than placebo in patients with RA. The 34% CVE risk reduction is consistent with the Cholesterol Treatment Trialists’ Collaboration meta‐analysis of statin effects in other populations