The Gettysburg Campaign

The Battle of Gettysburg has inspired a more voluminous literature than any single event in American military history for at least three major reasons. First, after three days of fighting on July 1–3, 1863, General Robert E. Lee’s Confederate Army of Northern Virginia and Major General George G. Meade’s Army of the Potomac lost more than 51,000 dead, wounded, captured, and missing, making Gettysburg the costliest military engagement in North American history. Second, President Abraham Lincoln endowed Gettysburg with special distinction when he visited in November 1863 to dedicate the soldiers’ cemetery and delivered his immortal Gettysburg Address. Finally, Gettysburg gave the Union its first significant victory over General Lee; the subsequent euphoria helped to fix in popular memory – if not in objective history – an enduring image of Gettysburg as the turning point of the Civil War

Soldiers and Sailors Memorial Hall: A Place for Quiet Reflection

Much has been written about place and Civil War memory, but how do we personally remember and commemorate this part of our collective past? How do battlefields and other historic places help us understand our own history? What kinds of places are worth remembering and why? In this collection of essays, some of the most esteemed historians of the Civil War select a single meaningful place related to the war and narrate its significance. Included here are meditations on a wide assortment of places--Devil\u27s Den at Gettysburg, Hollywood Cemetery in Richmond, the statue of William T. Sherman in New York\u27s Central Park, Burnside Bridge at Antietam, the McLean House in Appomattox, and more. Paired with a contemporary photograph commissioned specifically for this book, each essay offers an unusual and accessible glimpse into how historians think about their subjects

The Papers of Henry Clay. Volume 10. Candidate, Compromiser, Elder Statesman. January 1, 1844-June 29, 1852

The culminating volume in The Papers of Henry Clay begins in 1844, the year when Clay came within a hair\u27s breadth of achieving his lifelong goal-the presidency of the United States. Volume 10 of Clay\u27s papers, then, more than any other, reveals the Great Compromiser as a major player on the national political stage. Here are both the peak of his career and the inevitable decline. On a tour through the southern states in the spring of 1844, Clay seemed certain of gaining the Whig nomination and the national election, until a series of highly publicized letters opposing the annexation of Texas cost him crucial support in both South and North. In addition to the Texas issue, the bitter election was marked by a revival of charges of a corrupt bargain, the rise of nativism, the influence of abolitionism, and voter fraud. Democrat James K. Polk defeated Clay by a mere 38,000 popular votes, partly because of illegal ballots cast in New York City. Speaking out against the Mexican War, in which his favorite son was a casualty, the Kentuckian announced his willingness to accept the 1848 Whig nomination. But some of his closest political friends, including many Kentucky Whig leaders, believed he was unelectable and successfully supported war hero Zachary Taylor. The disconsolate Clay felt his public career was finally finished. Yet when a crisis erupted over the extension of slavery into the territories acquired from Mexico, he answered the call and returned to the United States Senate. There he introduced a series of resolutions that ultimately passed as the Compromise of 1850, the most famous of his three compromises. Clay\u27s last years were troubled ones personally, yet he remained in the Senate until his death in 1852, continuing to warn against sectional extremism and to stress the importance of the Union-messages that went unheeded as the nation Clay had served so well moved inexorably toward separation and civil war. Publication of this book is being assisted by a grant from the National Historical Publications and Records Commission. Melba Porter Hay is a specialist in the history of Kentucky and was associate editor of volumes 8 and 9 of The Papers of Henry Clay.https://uknowledge.uky.edu/upk_political_science_papers/1011/thumbnail.jp

The clean air strategy for Alberta : a case study in consensus decision making for sustainable development

Thesis (M.C.P.)--Massachusetts Institute of Technology, Dept. of Urban Studies and Planning, 1992.Includes bibliographical references (leaves 98-104).by Carol T. Reardon.M.C.P

Comparison of FEV6 and FVC for detection of airway obstruction in a community hospital pulmonary function laboratory

SummaryThe National Lung Health Education Program recommends that primary care providers perform spirometry tests on cigarette smoking patients 45 years or older in order to detect airways obstruction and aid smoking cessation efforts [Ferguson GT, Enright Pl, Buist AS, et al. Office spirometry for lung health assessment in adults: a consensus statement from the national lung education program. Chest 2000; 117: 1146–61]. An abbreviated forced expiratory maneuver that requires exhalation for 6s (FEV6) has recently been proposed as a substitute for forced vital capacity (FVC) to facilitate performance of such spirometry. We set out to assess the accuracy of diagnosis of obstruction and abnormal pulmonary function using FEV6 in comparison to FVC in a community hospital population. One hundred pulmonary function tests performed at a community hospital were randomly selected and retrospectively analyzed. Sixty-three of the 100 tests had satisfactory 6-s expiration and were subject to further analysis. We compared the spirometric interpretation using Morris predictive equations for FEV1/FVC and Hankison predictive equations for FEV1/FVC and FEV1/FEV6. The Hankison set of equations is the only published reference formulas for prediction of FEV6. We found that versus our Morris gold standard, Hankison based FEV1/FVC interpretation was 100% sensitive and 67% specific for the diagnosis of obstruction and 100% sensitive and 65% specific for the diagnosis of any abnormality. The Hankison based FEV1/FEV6 interpretation was 97% sensitive and 47% specific for diagnosing obstruction and 100% sensitive and 50% specific for identifying any abnormality versus the Morris FVC based gold standard. In conclusion, in our hospital based pulmonary function laboratory, FEV6 based interpretation has excellent sensitivity for detection of spirometric abnormalities. However, its moderate specificity may hinder its utility as a screening test. Further testing is necessary to determine its reliability in different patient populations with less highly trained operators

Epidemiology of ventilator-associated pneumonia in a long-term acute care hospital

objective. To characterize the epidemiology and microbiology of ventilator-associated pneumonia (VAP) in a long-term acute care hospital (LTACH). design. Retrospective study of prospectively identified cases of VAP. setting. Single-center, 207-bed LTACH with the capacity to house 42 patients requiring mechanical ventilation, evaluated from April 1, 2006, through January 31, 2008 methods. Data on the occurrence of VAP were collected prospectively as part of routine infection surveillance at Radius Specialty Hospital. After March 2006, Radius Specialty Hospital implemented a bundle of interventions for the prevention of VAP (hereafter referred to as the VAP-bundle approach). A case of VAP was defined as a patient who required mechanical ventilation at Radius Specialty Hospital for at least 48 hours before any symptoms of pneumonia appeared and who met the Centers for Disease Control and Prevention criteria for VAP. Sputum samples were collected from a tracheal aspirate if there was clinical suspicion of VAP, and these samples were semiquantitatively cultured. results. During the 22-month study period, 23 cases of VAP involving 19 patients were associated with 157 LTACH admissions (infection rate, 14.6%), corresponding to a rate of 1.67 cases per 1,000 ventilator-days, which is a 56% reduction from the VAP rate of 3.8 cases per 1,000 ventilator-days reported before the implementation of the VAP-bundle approach ( ). Microbiological data were available for P ! .001 21 (91%) of 23 cases of VAP. Cases of VAP in the LTACH were frequently polymicrobial (mean number ‫ע‬ SD, pathogens per 1.78 ‫ע‬ 1.0 case of VAP), and 20 (95%) of 21 cases of VAP had at least 1 pathogen (Pseudomonas species, Acinetobacter species, gram-negative bacilli resistant to more than 3 antibiotics, or methicillin-resistant Staphylococcus aureus) cultured from a sputum sample. LTACH patients with VAP were more likely to have a neurological reason for ventilator dependence, compared with LTACH patients without VAP (69.6% of cases of VAP vs 39% of cases of respiratory failure; ). In addition, patients with VAP had a longer length of LTACH stay, compared P p .014 with patients without VAP (median length of stay, 131 days vs 39 days; ). In 6 (26%) of 23 cases of VAP, the patient was eventually P p .002 weaned from use of mechanical ventilation. Of the 19 patients with VAP, 1 (5%) did not survive the LTACH stay. conclusions. The VAP rate in the LTACH is lower than the VAP rate reported in acute care hospitals. Cases of VAP in the LTACH were frequently polymicrobial and were associated with multidrug-resistant pathogens and increased length of stay. The guidelines from the Centers for Disease Control and Prevention that are aimed at reducing cases of VAP appear to be effective if applied in the LTACH setting. Ventilator-associated pneumonia (VAP) is the second most common nosocomial infection in the critical care setting. Infect Control Hosp Epidemiol 1 It is associated with increased morbidity and increased use of healthcare resources. 2 The epidemiology of VAP in intensive care units (ICUs) of acute care hospitals has been widely characterized

Epidemiology of ventilator-associated pneumonia in a long-term acute care hospital

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Prolonged survival in patients with breast cancer and a history of brain metastases: results of a preplanned subgroup analysis from the randomized phase III BEACON trial

Purpose: Conventional chemotherapy has limited activity in patients with breast cancer and brain metastases (BCBM). Etirinotecan pegol (EP), a novel long-acting topoisomerase-1 inhibitor, was designed using advanced polymer technology to preferentially accumulate in tumor tissue including brain metastases, providing sustained cytotoxic SN38 levels. Methods: The phase 3 BEACON trial enrolled 852 women with heavily pretreated locally recurrent or metastatic breast cancer between 2011 and 2013. BEACON compared EP with treatment of physician’s choice (TPC; eribulin, vinorelbine, gemcitabine, nab-paclitaxel, paclitaxel, ixabepilone, or docetaxel) in patients previously treated with anthracycline, taxane, and capecitabine, including those with treated, stable brain metastases. The primary endpoint, overall survival (OS), was assessed in a pre-defined subgroup of BCBM patients; an exploratory post hoc analysis adjusting for the diagnosis-specific graded prognostic assessment (GPA) index was also conducted. Results: In the trial, 67 BCBM patients were randomized (EP, n = 36; TPC, n = 31). Treatment subgroups were balanced for baseline characteristics and GPA indices. EP was associated with a significant reduction in the risk of death (HR 0.51; P < 0.01) versus TPC; median OS was 10.0 and 4.8 months, respectively. Improvement in OS was observed in both poorer and better GPA prognostic groups. Survival rates at 12 months were 44.4% for EP versus 19.4% for TPC. Consistent with the overall BEACON population, fewer patients on EP experienced grade ≥3 toxicity (50 vs. 70%). Conclusions: The significant improvement in survival in BCBM patients provides encouraging data for EP in this difficult-to-treat subgroup of patients. A phase three trial of EP in BCBM patients is underway (ClinicalTrials.gov NCT02915744)

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo