Humanism in the Age of COVID-19: Renewing Focus on Communication and Compassion

The global COVID-19 pandemic has become one of the largest clinical and operational challenges faced by emergency medicine, and our EDs continue to see increased volumes of infected patients, many of whom are not only ill, but acutely aware and fearful of their circumstances and potential mortality. Given this, there may be no more important time to focus on staff-patient communication and expression of compassion.However, many of the techniques usually employed by emergency clinicians to provide comfort to patients and their families are made more challenging or impossible by the current circumstances. Geriatric ED patients, who are at increased risk of severe disease, are particularly vulnerable to the effects of isolation.Despite many challenges, emergency clinicians have at their disposal a myriad of tools that can still be used to express compassion and empathy to their patients. Placing emphasis on using these techniques to maximize humanism in the care of COVID-19 patients during this crisis has the potential to bring improvements to ED patient care well after this pandemic has passed

Trade and interdependence in the economic growth process: a multiplier analysis for Latin America

This paper illustrates alternative methodological approaches to the issue of trade and interdependence in the economic growth process with a focus on the countries of Latin America, drawing inspiration from earlier contributions by Machlup, Goodwin and Miyazawa. The world economy is divided into two main blocks ofcountries (Latin America and a selection of developed economies) with the rest of the world forming an aggregated third block. A time series of trade matrices for the period 1978-1991 has been constructed to explore the degree to which changes in one country spillover to the rest ofthe world and the degree to which the changes are symmetric or asymmetric. The approaches reveal that important insights into trade structure can be obtained, insights that will prove of value in the rapidly changing trade regimes of the current and next decades

Economic structural change over time: Brazil and the United States compared

Usando as matrizes de insumo-produto para as economias do Brasil e dos Estados Unidos, este estudo comparativo tem como objetivo analisar como a estrutura produtiva de dois grandes países, com níveis diferentes de desenvolvimento, mudou através do tempo (1958-77 para os Estados Unidos e 1959-80 para o Brasil). A mudança na estrutura produtiva e decomposta em três componentes iniciais (demanda final, tecnologia, e sua interação sinergética), após o que estes componentes são divididos em mudanças que são iniciadas dentro e fora do setor. A partir destas analises e possível identificar os padrões de mudanças estruturais nas duas economias. Os resultados indicam um grande grau de semelhança nos padrões do processo de crescimento de ambos os países, com diferenças mais significantes entre setores do que entre países. A análise capaz de capturar diferenças importantes na origem das mudanças da demanda, isto e mudanças internas versus mudanças externas ao setor.Using input-output tables for the economies of Brazil and the United States, this comparative study focuses on changes in the economic structure of two large countries with different levels of development over time (1958-77 for the United States and 1959-80 for Brazil). The change in the economic structure is decomposed into three initial components (final demand, technology, and their synergistic interaction) and thereafter these components are further divided into change initiated within the sector and outside the sector. From this analysis it is possible to identify patterns of structural change in the two economies. The results indicate a rather remarkable degree of commonality in the patterns of growth processes in both countries, with more significant differences between sectors than between countries. The analysis confirmed earlier findings about the role of demand changes but was able to capture important differences in internal-to-sector versus external-to-sector sources of demand change

Cambodians' Support for the Rule of Law on the Eve of the Khmer Rouge Trials

Cambodia is in the midst of trying some of the leaders of the Khmer Rouge for their actions during the time of the Killing Fields. Beyond the effects on individual victims and perpetrators, many will ask whether this process of historical accountability will have a broader impact on Cambodian society and political culture. One possible consequence of the trials is that the attitudes of ordinary Cambodians toward the rule of law will be affected. One hypothesis is that the trials will restore faith in the rule of law, a faith undermined by the failure of the state to take action against the miscreants for thirty years. Other hypotheses are also tenable. The purpose of this paper is to examine the attitudes of Cambodians toward the rule of law. Based on a nationally representative survey conducted in 2007 – well before the trials began – our evidence is that Cambodians hold an extremely strong preference for strict adherence to legal universalism. Because support for the rule of law is so strong, the trials are highly unlikely to make it stronger. From the point-of-view of transitional justice processes, we argue that (1) it is crucial to know the state of society prior to the implementation of justice processes so that change can be measured; (2) cultural values such as support for the rule of law are as likely to be causes of transitional justice processes as they are results; and (3) because much too little is known about the societal consequences of transitional justice processes, much more rigorous, quantitative analysis must be conducted

Salen Mn Complexes Mitigate Radiation Injury in Normal Tissues

Salen Mn complexes, including EUK-134, EUK-189 and a newer cyclized analog EUK-207, are synthetic SOD/catalase mimetics that have beneficial effects in many models of oxidative stress. As oxidative stress is implicated in some forms of delayed radiation injury, we are investigating whether these compounds can mitigate injury to normal tissues caused by ionizing radiation. This review describes some of this research, focusing on several tissues of therapeutic interest, namely kidney, lung, skin, and oral mucosa. These studies have demonstrated suppression of delayed radiation injury in animals treated with EUK-189 and/or EUK-207. While an antioxidant mechanism of action is postulated, it is likely that the mechanisms of radiation mitigation by these compounds in vivo are complex and may differ in the various target tissues. Indicators of oxidative stress are increased in lung and skin radiation injury models, and suppressed by salen Mn complexes. The role of oxidative stress in the renal injury model is unclear, though EUK-207 does mitigate. In certain experimental models, salen Mn complexes have shown “mito-protective” properties, that is, attenuating mitochondrial injury. Consistent with this, EUK-134 suppresses effects of ionizing radiation on mitochondrial function in rat astrocyte cultures. In summary, salen Mn complexes could be useful to mitigate delayed radiation injury to normal tissues following radiation therapy, accidental exposure, or radiological terrorism. Optimization of their mode of delivery and other key pharmaceutical properties, and increasing understanding of their mechanism(s) of action as radiation mitigators, are key issues for future study

Linkages and Multipliers in a Multiregional Framework: Integration of Alternative Approaches

In this paper, two literatures that have explored the structure of economies are brought together. In the first case, the approaches to key sector identification (initially associated with Hirschman and Rasmussen) that were modified by Cella, Clements and Rossi and Guilhoto et al. to reveal what may be referred to a pure linkage approach are related to the concerns of Miyazawa and his identification of internal and external multiplier effects. While Miyazawa was interested mainly in identifying the sources of change in an economy, his approach shares considerable commonality with the new ideas in key sector identification in which a sector or set of sectors are separated from the rest of the economy. Hence, in both cases, a decomposition of the economy needs to be considered; the present paper reveals the similarity of perspective and provides the formal link between the two methodologies

The Boston Medical Center Immigrant Task Force: An Alternative to Teaching Immigration Law to Health Care Providers

As healthcare providers engage in the politics of reforming and humanizing our immigration and asylum “system” it is critical that they are able to refer their patients whose health is directly impacted by our immigration laws and policies to experts who can help them navigate the system and obtain the healthcare they need

Linkages, key sectors and structural change: some new perspectives

Recent exchanges in the literature on the identification and role of key sectors in national and regional economies have highlighted the difficulties of consensus regarding terminology, appropriate measurement as well as economic interpretation. In this paper, some new perspectives are advanced which provide a more comprehensive view of an economy and offer the potential for uncovering alternative perspectives about the role of linkages and multipliers in input-output and expanded social accounting systems. The analysis draws on some pioneering work by Miyazawa in the identification of internal and external multiplier effects. The theoretical techniques are illustrated by reference to a set of input-output tables for the Brazilian economy. The paper thus provides a more comprehensive view than the ones proposed by Baer, Fonseca, and Guilhoto (1987), Hewings, Fonseca, Guilhoto, and Sonis (1989) and the recent contributions of Clements and Rossi (1991, 1992) that draw on some earlier work of Cella (1984)

Role of the Cyclooxygenase Pathway in Chemotherapy-Induced Oral Mucositis: A Pilot Study

Goals Oral mucositis can be a significant and dose-limiting complication of high-dose cancer therapy. Mucositis is a particularly severe problem in patients receiving myeloablative chemotherapy prior to bone marrow or hematopoetic stem cell transplant (HSCT). The cyclooxygenase (COX) pathway mediates tissue injury and pain through upregulation of pro-inflammatory prostaglandins, including prostaglandin E2 (PGE2) and prostacyclin (PGI2). The objective of this small (n=3) pilot study was to examine the role of the COX pathway in causing mucosal injury and pain in chemotherapy-induced oral mucositis. Materials and methods We collected blood, saliva, and oral mucosal biopsy specimens from three autologous HSCT patients at the following time-points before and after administration of conditioning chemotherapy: Day −10, +10, +28, and +100, where day 0 is day of transplant. RNA extracted from full-thickness tissue samples was measured by RT-PCR for the following: COX-1, COX-2, microsomal prostaglandin E synthase (mPGES), IL-1β, and TNF-α. Blood and saliva samples were measured by ELISA for PGE2 and PGI2, which are markers of COX activity. Severity of oral mucositis was determined using the Oral Mucositis Index. Severity of pain due to oral mucositis was measured using a Visual Analog Scale. Relationships between the different variables were examined using Spearman rank correlation coefficients. Main results Mean mucositis and pain scores increased significantly after administration of chemotherapy and then gradually declined. The correlation between changes in mucositis and pain scores was strong and statistically significant. The following additional correlations were statistically significant: between tissue COX-1 and pain; between tissue mPGES and pain; between salivary PGE1 and pain; between salivary PGI2 and pain. Other relationships were not statistically significant. Conclusions Our finding of significant associations of pain scores with tissue COX-1 and mPGES, as well as salivary prostaglandins, is suggestive of a role for the cyclooxygenase pathway in mucositis, possibly via upregulation of pro-inflammatory prostaglandins. However, our small sample size may have contributed to the lack of significant associations between COX-2 and other inflammatory mediators with mucosal injury and pain. Thus, additional studies with larger numbers of subjects are warranted to confirm the involvement of the cyclooxygenase pathway in chemotherapy-induced mucositis