The Effect of State-Legalized Same-Sex Marriage on Social Security Benefits and Pensions

CRS ReportCRSSameSex.pdf: 788 downloads, before Oct. 1, 2020

The Effect of State-Legalized Same-Sex Marriage on Social Security Benefits and Pensions

With the 2004 legalization of same-sex marriage in Massachusetts, many have questioned how the legalization of such marriages at the state level may affect the eligibility for and payment of federal Social Security benefits and private pensions. Social Security benefits are currently paid to the spouses of disabled, retired, or deceased workers entitled to Social Security. However, under current law, same-sex spouses are not eligible for Social Security benefits because they are unable to meet the gender-based definitions of “wife” and “husband” in the Social Security Act and the gender-based definition of “marriage” established by the Defense of Marriage Act. Federal employee pensions and private-sector pensions regulated by the Employee Retirement Income Security Act (ERISA) are required to provide certain benefits to the spouse of a participant in the event of the participant’s death. Under the Defense of Marriage Act, both federal pensions and private-sector pensions regulated by ERISA are required to define a spouse only as “a person of the opposite sex who is a husband or a wife.” This report will be updated as legislative activity warrants

Broken Puppet Symposia

Broken Puppet Symposia introduces the reader to the contents of this double special issue on applied puppetry and health. It starts with the Editors’ definition of a Puppet to move on to important theoretical articles, revealing notes from the field (projects and practitioners), fascinating interviews with experts in performance in healthcare and beautiful illustrations. The Editors bring their experience of organising the Broken Puppet Symposia in Cork, Bath and Birmingham and the learning they gained from working with puppeteers, therapists and academics

Outcomes of stab wounds presenting to Kamuzu Central Hospital in Malawi

IntroductionInjuries are a leading cause of morbidity and mortality worldwide, necessitating that we understand the local burden of injury to improve injury-related trauma care and patient outcomes. The characteristics, outcomes, and risk factors for mortality following stab wounds in Malawi are poorly delineated.MethodsThis is a retrospective, descriptive analysis of patients presenting to Kamuzu Central Hospital in Lilongwe, Malawi, with stab wounds from February 2008 to May 2018. Univariate and bivariate analyses were performed to compare patient and injury characteristics based on mortality. We performed Poisson multivariate regression to predict the factors that increase the relative risk of mortality. Results During the study, 32,297 patients presented with assault. Of those patients, 2,352 (7.3%) presented with stab wounds resulting in a 3.2% (n=74) overall mortality. The majority of wounds were to the head or cervical spine (n=1,043, 44.6%), while injuries to the chest (n=319, 13.7%) were less frequent. We found an increased relative risk of mortality in patients who presented with an injury to the chest (RR 3.95, 95% CI 1.79-8.72, p=0.001) and who were brought in by the police (RR 33.24, 95% CI 11.23–98.35, p<0.001). ConclusionIn this study, stab wounds accounted for 7.3% of all assault cases, with a 3.2% mortality. Though the commonest site of stab was the head, wounds to the chest conferred the highest relative risk of mortality. A multifaceted approach to reducing mortality is needed. Incorporating training of first responders in basic life support, including the police, may reduce stab-related mortality

Ventilator Decision and Allocation Pathway for Surge Conditions

We created a deployment plan of the available ventilator fleet to be deployed during surge conditions. The plan includes appropriate allocation of acute care ventilators to manage complex respiratory patients, while a percentage of stable respiratory patients can be safely managed using a back-up ventilator

Publically Funded Recreation Facilities: Obesogenic Environments for Children and Families?

Increasing healthy food options in public venues, including recreational facilities, is a health priority. The purpose of this study was to describe the public recreation food environment in British Columbia, Canada using a sequential explanatory mixed methods design. Facility audits assessed policy, programs, vending, concessions, fundraising, staff meetings and events. Focus groups addressed context and issues related to action. Eighty-eighty percent of facilities had no policy governing food sold or provided for children/youth programs. Sixty-eight percent of vending snacks were chocolate bars and chips while 57% of beverages were sugar sweetened. User group fundraisers held at the recreation facilities also sold ‘unhealthy’ foods. Forty-two percent of recreation facilities reported providing user-pay programs that educated the public about healthy eating. Contracts, economics, lack of resources and knowledge and motivation of staff and patrons were barriers to change. Recreation food environments were obesogenic but stakeholders were interested in change. Technical support, resources and education are needed

Experiences of 'virtual' occupational therapy service delivery in Wales

Introduction: COVID-19 accelerated the implementation of virtual working at pace, which carries the risk of missed opportunities for shared learning across organisations and services. This study therefore investigated the experiences of ‘virtual working’ among occupational therapy (OT) staff and students in Wales. The objectives were to establish the meaning of virtual working for occupational therapists (OTs), identify the perceived advantages and disadvantages of the technologies used to support virtual working and explore the specific contextual factors that impact on service delivery. Method: An online questionnaire was completed by 191 registered and unregistered OT staff and students working in Wales, and 11 semi-structured interviews were conducted in a convergent mixed methods design. Results and Findings: The questionnaire data confirmed that the use of virtual working has increased and impacts all areas of service delivery. The semi-structured interviews identified three themes: the art of OT, keeping doors open and looking forward. Conclusion: Virtual working can improve access to services, but one size does not fit all and its use in person centred care should be carefully considered. Virtual working should not compromise high quality service provision and the risks of virtual working to staff’s mental and physical health needs to be considered

Learning from adversity: Occupational therapy staff experiences of coping during Covid-19

Introduction The Occupational Therapy profession is adaptable and flexible (Thorner (1991) and these characteristics have the potential to act as protective factors during the COVID-19 pandemic. Understanding the mechanisms that support coping during adversity can help promote future wellbeing. The aim of this study was to explore how Occupational Therapy staff felt and coped during the first peak of the pandemic. Method A questionnaire was developed to explore the experiences of Occupational Therapy staff during the first wave of the COVID-19 pandemic. The questions explored feelings, mechanisms of support and challenges to both practice and wellbeing. A total of 75 staff responded across one NHS Health Board and reflections were analysed using inductive content analysis. Findings Staff reflected on how their ability to adapt and remain flexible were protective factors. This combined with supportive family members, friends and colleagues led respondents to reflect on how well they coped. Barriers to coping included organisational challenges, personal challenges and professional challenges. Conclusion The importance of consistent communication, the need for staff to remain connected to their profession and the importance of engaging in meaningful occupations were highlighted as key to maintaining wellbeing during adversity

Difference in Postoperative Outcomes and Perioperative Resource Utilization Between General Surgeons and Pediatric Surgeons: A Systematic Review

Background: Both general surgeons (GS) and pediatric surgeons (PS) perform a high volume of appendectomies in pediatric patients, but there is a paucity of data on these outcomes based on surgeon training. We performed a systematic review and meta-analysis to compare postoperative outcomes and perioperative resource utilization for pediatric appendectomies.Methods: We searched PubMed to identify articles examining the association between surgeon specialization and outcomes for pediatric patients undergoing appendectomies. Study selection, data extraction, risk of bias assessment, and quality assessment were performed by one reviewer, with another reviewer to resolve discrepancies.Results: We identified 4799 articles, with 98.4% (4724/2799) concordance after initial review. Following resolution of discrepancies, 16 studies met inclusion criteria. Of the studies that reported each outcome, GS and PS demonstrated similar rates of readmission within 30 days (pooled RR 1.61 95% CI 0.66, 2.55) wound infections (pooled RR 1.07, 95% CI .55, 1.60), use of laparoscopic surgery (pooled RR 1.87, 95% CI .21, 3.53), postoperative complications (pooled RR 1.40, 95% CI .83, 1.97), use of preoperative imaging (pooled RR .98,95% CI .90, 1.05), and intra-abdominal abscesses (pooled RR .80, 95% CI .03, 1.58). Patients treated by GS did have a significantly higher risk of negative appendectomies (pooled RR 1.47, 95% CI 1.10, 1.84) when compared to PS.Discussion: This is the first meta-analysis to compare outcomes for pediatric appendectomies performed by GS compared to PS. Patient outcomes and resource utilization were similar among PS and GS, except for negative appendectomies were significantly more likely with GS

Variations in injury characteristics among paediatric patients following trauma: A retrospective descriptive analysis comparing pre-hospital and in-hospital deaths at Kamuzu Central Hospital, Lilongwe, Malawi

Background: Trauma is a major cause of paediatric mortality in sub-Saharan Africa. In absence of pre-hospital care, the injury mechanism and cause of death is difficult to characterise. Injury characteristics of pre-hospital deaths (PHD) versus in-hospital deaths (IHD) were compared.Methods: Using our trauma surveillance database, a retrospective, descriptive analysis of children (<18 years) presenting to Kamuzu Central Hospital in Lilongwe, Malawi from 2008 to 2013 was performed. Patient and injury characteristics of pre-hospital and in-hospital deaths were compared with univariate and bivariate analysis.Results: Of 30,462 paediatric trauma patients presenting between 2008 and 2013, 170 and 173 were PHD and IHD, respectively. In PHD and IHD patients mean age was 7.3±4.9 v 5.2±4.3 (p<0.001), respectively. IHD patients were more likely transported via ambulance than those PHD, 51.2% v 8.3% (p<0.001). The primary mechanisms of injury for PHD were road traffic injuries (RTI) (45.8%) and drowning (22.0%), with head injury (46.7%) being the predominant cause of death. Burns were the leading mechanism of injury (61.8%) and cause of death (61.9%) in IHD, with a mean total body surface area involvement of 24.7±16.0%.Conclusions: RTI remains Malawi’s major driver of paediatric mortality. A majority of these deaths attributed to head injury occur prior to hospitalisation; therefore the mortality burden is underestimated if accounting for IHD alone. Death in burn patients is likely due to under-resuscitation or sepsis. Improving pre-hospital care and head injury and burn management can improve injury related paediatric mortality