In the Midst of an Epidemic: How Print Media Shapes Policy Feedback to the Opioid Crisis

As opioid addiction has spread across the country, media discourse around opioid abuse has consistently increased. A content analysis of local newspaper articles from the state of Massachusetts reveals that political and administrative officials conceive of Narcan in distinct ways. Administrators, including police and fire officials, see Narcan as a means to accomplish their organizational mission. Conversely, elected officials are primarily concerned with cost, legal ramifications and the broad impact of the opioid crisis, remaining disconnected from street-level concerns. In delineating these divergent perspectives, this article provides two unique contributions: first, it applies policy feedback theory as a framework to address a real-world problem, bridging the gap between theory and practice in public administration. Second, it expounds upon the differences in rhetoric found in print media to outline specific ways in which the perspectives of elected and administrative officials may influence Narcan policy

Identification of Post-cardiac Arrest Blood Pressure Thresholds Associated With Outcomes in Children: An ICU-Resuscitation Study

INTRODUCTION: Though early hypotension after pediatric in-hospital cardiac arrest (IHCA) is associated with inferior outcomes, ideal post-arrest blood pressure (BP) targets have not been established. We aimed to leverage prospectively collected BP data to explore the association of post-arrest BP thresholds with outcomes. We hypothesized that post-arrest systolic and diastolic BP thresholds would be higher than the currently recommended post-cardiopulmonary resuscitation BP targets and would be associated with higher rates of survival to hospital discharge. METHODS: We performed a secondary analysis of prospectively collected BP data from the first 24 h following return of circulation from index IHCA events enrolled in the ICU-RESUScitation trial (NCT02837497). The lowest documented systolic BP (SBP) and diastolic BP (DBP) were percentile-adjusted for age, height and sex. Receiver operator characteristic curves and cubic spline analyses controlling for illness category and presence of pre-arrest hypotension were generated exploring the association of lowest post-arrest SBP and DBP with survival to hospital discharge and survival to hospital discharge with favorable neurologic outcome (Pediatric Cerebral Performance Category of 1-3 or no change from baseline). Optimal cutoffs for post-arrest BP thresholds were based on analysis of receiver operator characteristic curves and spline curves. Logistic regression models accounting for illness category and pre-arrest hypotension examined the associations of these thresholds with outcomes. RESULTS: Among 693 index events with 0-6 h post-arrest BP data, identified thresholds were: SBP \u3e 10th percentile and DBP \u3e 50th percentile for age, sex and height. Fifty-one percent (n = 352) of subjects had lowest SBP above threshold and 50% (n = 346) had lowest DBP above threshold. SBP and DBP above thresholds were each associated with survival to hospital discharge (SBP: aRR 1.21 [95% CI 1.10, 1.33]; DBP: aRR 1.23 [1.12, 1.34]) and survival to hospital discharge with favorable neurologic outcome (SBP: aRR 1.22 [1.10, 1.35]; DBP: aRR 1.27 [1.15, 1.40]) (all p \u3c 0.001). CONCLUSIONS: Following pediatric IHCA, subjects had higher rates of survival to hospital discharge and survival to hospital discharge with favorable neurologic outcome when BP targets above a threshold of SBP \u3e 10th percentile for age and DBP \u3e 50th percentile for age during the first 6 h post-arrest

Comparing Motivations for Including Enforcement in US COVID-19 State Executive Orders

The United States’ response to COVID-19 has been predominantly led by state governments. To understand if, why, and how state governments include enforcement language in their executive order response, this article conducts an analysis based on 1,357 coded executive orders. It is found that decisions to include enforcement language are influenced by a governor’s political circumstances and perceived risks associated with the crisis. This paper offers insight into how these findings are important for future research and an explanation of the distinct ways that US state governments are choosing to address COVID-19.IU Office of the Vice President for Researc