The economy of the Central American Common Market : an update

Cover title."December, 1979."Includes bibliographical references (pages 26-27)

The future of accessibility in disaster conditions: How wireless technologies will transform the life cycle of emergency management

By describing a transformed life cycle of emergency management, this paper re-envisions how emergency managers may prepare for, respond to, recover from, and mitigate against disaster impacts in the future. Additionally, this paper also reveals how the broader social, political, economic, and cultural levels must change to foment a culture of safety with and for people with disabilities. The authors use the framework to identify how future wireless technologies can empower people with disabilities with regards to individual (or household) emergency preparedness and in coping with the drastic life changes following a disaster

Visits to rheumatologists for arthritis: The role of access to primary care physicians, geographic availability of rheumatologists, and socioeconomic status

Objective. This multilevel study examines access to rheumatologists for all arthritis and inflammatory arthritis, taking into account geographic availability of rheumatologists, access to primary care physicians (PCPs), and population characteristics (e.g., socioeconomic status [SES]). Methods. We analyzed data from the population (age ≤18 years) living in the 105 health planning areas in Ontario, Canada on visits to physicians for arthritis and musculoskeletal disorders. Using data from a survey of rheumatologists and Geographic Information System analysis, an index of geographic availability for rheumatologists was calculated, incorporating distance between the population and rheumatologist locations and the number of hours per week of rheumatologist care. Multilevel Poisson regression was used to examine factors associated with the rates of rheumatology visits for inflammatory arthritis and all arthritis. Results. Controlling for age and sex, the rheumatologist availability index was associated with visit rates for all arthritis, but not inflammatory arthritis. Patients living in areas with low access to PCPs or low SES were less likely to have office visits to rheumatologists for all arthritis and inflammatory arthritis. Conclusion. Besides potential deficiencies in rheumatology provision, there may be access barriers to rheumatology services, particularly for populations with low access to PCPs or low SES. This is of special concern for patients with inflammatory arthritis for whom rheumatologist care is necessary. In developing models of care for arthritis, this study points to the need to pay attention to areas with low PCP resources and areas of low SES, as well as the location and amount of rheumatology services available

Urothelial Cancer With Occult Bone Marrow Metastases and Isolated Thrombocytopenia

AbstractBladder cancer rarely presents clinically with a myelophthisic picture from diffuse bone marrow infiltration especially in the absence of detectable skeletal metastases. A 75-year old man presented with newly diagnosed urothelial cell carcinoma of the bladder. Pathology from transurethral resection of bladder tumor demonstrated muscle-invasive disease. Pre-therapy imaging including CT abdomen/pelvis, CXR and bone scan demonstrated liver lesions concerning for metastatic disease but no skeletal metastases. Labs were notable for isolated thrombocytopenia, hypercalcemia and acute kidney injury prompting hospitalization. Hematologic work-up including bone marrow aspiration and biopsy revealed diffuse infiltration of the bone marrow by urothelial cancer. The case illustrates the importance of fully investigating otherwise unexplained clinical findings in patients with clinically localized urothelial cancer prior to curative intent surgery

Archaeological Investigations at the Pettigrew Site on the University of North Carolina Campus, Chapel Hill, North Carolina

Research Report No. 20, Research Laboratories of Archaeology, University of North Carolina at Chapel Hill. Reports in this series discuss the findings of archaeological excavations and research projects undertaken by the RLA between 1984 and present

Review of boat wake wave impacts on shoreline erosion and potential solutions for the Chesapeake Bay

[Introduction] The goal of this technical review was to evaluate 1) the potential impacts of boat generated waves on shoreline stability and attendant ecosystem properties, and 2) policy options to minimize any adverse effects. We reviewed available literature, examined relevant data and information from Chesapeake Bay, discussed modeling approaches and highlighted data gaps to further quantify effects on shorelines and ecosystems, and detailed available management and policy actions to minimize potential boat wake impacts. The major findings are: 1) The literature review indicates an unequivocal connection between boat wake energy and shoreline erosion, sediment resuspension and nearshore turbidity. 2) There is not currently enough data to determine the extent (spatially and in magnitude) to which boat wakes are contributing to erosion or turbidity of the Chesapeake Bay 3) Recommended next steps are to identify highly vulnerable waterways and implement management or policy actions to minimize adverse effects

Open Collaboration: A Problem Solving Strategy That Is Redefining NASA's Innovative Spirit

In 2010, NASA?s Space Life Sciences Directorate announced the successful results from pilot experiments with open innovation methodologies. Specifically, utilization of internet based external crowd sourcing platforms to solve challenging problems in human health and performance related to the future of spaceflight. The follow-up to this success was an internal crowd sourcing pilot program entitled NASA@work, which was supported by the InnoCentive@work software platform. The objective of the NASA@work pilot was to connect the collective knowledge of individuals from all areas within the NASA organization via a private web based environment. The platform provided a venue for NASA Challenge Owners, those looking for solutions or new ideas, to pose challenges to internal solvers, those within NASA with the skill and desire to create solutions. The pilot was launched in 57 days, a record for InnoCentive and NASA, and ran for three months with a total of 20 challenges posted Agency wide. The NASA@work pilot attracted over 6000 participants throughout NASA with a total of 183 contributing solvers for the 20 challenges posted. At the time of the pilot?s closure, solvers provided viable solutions and ideas for 17 of the 20 posted challenges. The solver community provided feedback on the pilot describing it as a barrier breaking activity, conveying that there was a satisfaction associated with helping co-workers, that it was "fun" to think about problems outside normal work boundaries, and it was nice to learn what challenges others were facing across the agency. The results and the feedback from the solver community have demonstrated the power and utility of an internal collaboration tool, such as NASA@work

Behavioural micro-dynamics of car ownership and travel in the Seattle metropolitan region from 1989 to 2002

In this paper data from 230 households observed in ten different occasions (waves) from 1989 to 2002 in the Puget Sound region are used to explore relationships among number of cars owned, number of trips driving alone, and number of trips sharing cars with household members. Using a mixture latent class Markov model we identify four distinct groups that are a High Mobility group with more cars and car trips, an Average Mobility group with lower car ownership and trips driving alone, a third group with relatively high car ownership but few car sharing trips, and a fourth group of Low Mobility characterized by the low car ownership and trips. Households change behaviour adapting to internal and external changes to their environment but they also anticipate changes and go through a "preparation" stage (e.g., adding another car in their fleet in expectation of adding another employed person). Land use plays a somewhat secondary role. The analysis also reveals three classes (hidden Markov chains) of households underlying behavioural dynamics with increases in the low car ownership categories (zero and one car per household), decreases in the high car ownership (three cars and four or more cars per household) and stable behaviour in the two cars per household group. Household membership in these classes is significantly influenced by householder ratings to parking availability, schedule flexibility, bus transfers, and day-to-day costs of driving. The findings here show attitudes and land use enhance understanding of longitudinal heterogeneity

Patient-Reported Outcomes of Primary Total Ankle Arthroplasty in Patients Aged \u3c50 Years

Background: Compared to more prevalent arthritic conditions, ankle arthritis is complicated by an earlier age of onset. Recently published data demonstrates excellent survivorship and complication rates in short-/midterm follow-up of younger patients who received a primary total ankle arthroplasty (TAA). Additionally, older TAA patients display comparable reported outcomes relative to hip/knee arthroplasty. However, there remains a paucity of literature surrounding the reported outcomes of younger patients undergoing TAA. Thus, our aim was to assess the reported outcomes of individuals aged \u3c50 years receiving a primary TAA. Methods: A retrospective cohort analysis of adult patients \u3c50 years who received a primary total ankle replacement was conducted. Patient demographics, diagnosis, treatment, and outcome characteristics were recorded from a chart review of 41 patients with at least 1 year of postoperative clinical follow-up. Postoperative reported outcomes were obtained via telephone interviews. Primary outcomes that were measured included emotional and physical health, activity limitation, ambulation, and global health. Measures used included the 36-Item Short Form Health Survey (SF-36), Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health, and Sickness Impact Profile Ambulation. The functional outcomes in our study sample were compared with age- and gender-matched norms from a general US population, and 95% CIs were calculated for each functional outcome mean. Student t test was used for continuous variables, and χ2 analysis was used for categorical variables. Results: Thirty-one of 41 eligible patients were reached for interview. The average age at surgery was 39.7 years. Clinical and radiographic follow-up was a mean of 51.6 months and 31.2 months following TAA, respectively. General health as measured with the SF-36 was not significantly different from age-/gender-matched norms. Eighty-seven percent of patients would choose to have a TAA again. Although 58% reported being limited in vigorous activities, 61% were able to ambulate frequently for long periods of time. On average, the patients did not report ongoing pain, and only 16% reported fatigue that hindered activities. Eighty-one percent reported returning to full employment and performing their duties without difficulty, and 84% reported they resumed all normal social activities. Primary implant survivorship was 93%. Conclusion: Despite a younger age and potentially increased demands, patients aged \u3c50 years undergoing primary TAA are generally satisfied with their index procedure at a mean follow-up of nearly 5 years. Our findings of positive outcomes on their health and well-being may improve surgeon insight for TAA as an alternative treatment for younger individuals with end-stage ankle arthritis. Level of Evidence: Level IV, case series