7 research outputs found
Regionalizing Government in Maine: Opportunities for the Future
In keeping with his promise to make government work better for the people of Maine, Governor Angus King commissioned the Task Force on Regional Options for Better Government. The Governor charged the task force with recommending some alternative regional arrangements for the delivery of government services currently provided by state or local government. The task force evaluated three services in which regionalism offered some advantages: economic development; demand response transportation; and municipal management information systems
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Combating Adverse Childhood Experiences
Purpose: The purpose of this service project was to design educational interventions to implement at community food bank in Sunnyslope, Arizona to aid in building community resilience to overcome the adverse health events associated by the high prevalence of Adverse Childhood Experiences (ACEs).
Methods: This project utilized The Model for Quality Improvement framework to design and assess the efficacy of trauma-informed educational interventions for staff and volunteers at a local food bank. The project involved a collaborative effort to enhance the interactions between clients and staff by promoting understanding and recognition of ACEs and fostering an environment of trust.
Results: A pre-recorded lecture and educational pre and post evaluation was designed and will be offered to all staff and volunteers beginning in December of 2022. The food bank partners plan to utilize an ab breviated version of the activity to be shown on a closed-captioned television system in the food bank to help clients recognize adverse childhood events and encourage them to ask about available resources at the food bank.
Discussion: Food banks attempt to treat the root causes of food insecurity and are increasingly recogniz ing the value of moving toward trauma informed approaches aiming to decrease the stigma frequently experienced by the clients served. Food banks are better served developing a trauma informed framework in order to acquire deeper understanding of ACE’s prevalence in order to implement screenings and appropriate referral. The impact of implementing trauma informed trainings for employees and volunteers at food banks, such a Desert Mission, allow for person centered communication and promote optimal patient health outcomes with a holistic view of the social determinants of health
Transmission and infectivity studies on Nosema kingi in Drosophila willistoni and other drosophilids
Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study
Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general
anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use
of neuromuscular blocking agents is associated with postoperative pulmonary complications.
Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in
28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital
procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge
were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination
within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative
pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were
adjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) and
adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513.
Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscular
blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who
had undergone general anaesthesia (1658 [7·6%] of 21694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj –4·4%, 95% CI
–5·5 to –3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised
without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49;
ARRadj –2·6%, 95% CI –3·9 to –1·4) and the administration of reversal agents (1·23, 1·07–1·41; –1·9%, –3·2 to –0·7)
were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex
instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj –0·3%, 95% CI –2·4 to 1·5) nor extubation at
a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; –0·4%, –3·5 to 2·2) was associated with better pulmonary outcomes.
Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an
increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of
neuromuscular blockade against the increased risk of postoperative pulmonary complications