PARENTAL UNDERSTANDING OF ANESTHESIA RISK FOR DENTAL TREATMENT

Purpose: To determine which method of anesthesia risk presentation parents understand and prefer across their demographic variables Methods: As a cross-sectional study, questionnaires were distributed to 50 parents of patients (\u3c7 years of age) in the VCU Pediatric Dental Clinic. Parents were asked of their own and their children’s demographics, previous dental and anesthesia experiences, and anesthesia understanding. Parents were then asked to rate the level of risk of several risk presentations and finally asked which method of risk presentation they most understood or preferred. Data analysis was performed using descriptive statistics, correlation coefficients, likelihood chi square tests, and repeated measures logistic regression. Results: There was no evidence of a differential preference due to gender (P = 0.28), age (P \u3e .9), education (P = 0.39) or whether they incorrectly answered any risk question (P \u3e 0.7). There was some evidence that the three types were not equally preferred (likelihood ratio chi- square = 5.31, df =2, P-value = 0.0703). The best estimate is that 60% prefer charts, 34% prefer numbers, and 36% prefer activity comparisons. There was a relationship between the average relative risk of general anesthesia and age (r = –0.38, P = 0.0070). Younger individuals indicate High risk more often and older individuals indicate Low risk more often. Conclusion: There was no preference of risk presentation type due to gender, age, or education, but there was evidence that each was not equally preferred. Healthcare providers must be able to present the risk of anesthesia in multiple ways to allow for full patient understanding

When Everything is Small: The Regulatory Challenge of Scale in the Sharing Economy

The sharing economy—the rapidly evolving sector of peer-to-peer home- sharing and ride-hailing transactions facilitated by platforms like Airbnb and Uber—offers the potential for economic growth, greater sustainability, and expanded access for underserved groups. But the massive number of small-scale activities that these platforms facilitate also causes negative cumulative impacts and exposes regulatory fractures, from the loss of long-term rental housing to discrimination against protected classes to increased burdens on public infrastructure. This Article contends that scale is a defining feature and fundamental challenge of the sharing economy. Small may be beautiful, but when everything is small, the regulatory challenge is immense. Small-scale activities that once fit the criteria for light or no regulation are occurring at scales at which non-regulation makes little sense. As the sharing economy becomes an increasingly large segment of the public accommodations and transportation markets, the traditional ways we distinguish between activities that we should regulate and those we treat with regulatory leniency no longer fit. Existing regulatory systems, from civil rights and environmental law to consumer protection and tax law, do not map neatly onto the configuration of scale in the sharing economy. This regulatory misfit threatens to result in inequitable and discriminatory outcomes across the sharing economy. Effective governance of the sharing economy requires a more complete understanding of the role of scale. This Article investigates the implications of scale in the sharing economy, focusing on the prominent sectors of home- sharing and ride-hailing. The Article begins by exploring governance of small-scale activities, unpacking why regulatory systems tend to treat small-scale activities with reduced stringency and how increasing numbers can shift the governance response. It then analyzes the implications of scale in the sharing economy, examining how massive numbers of home-sharing and ride-hailing activities produce negative cumulative impacts and expose regulatory fractures, which threaten to undermine a range of important public policies—including affordable housing, civil rights, and consumer protection. The Article concludes by considering possible legal regimes for responding to scale, such as co-regulation, aggregate regulation, and cooperative models

Utilizing Doppler Ultrasound to Detect Arteriole Blood Flow Within the Median Nerve Sheath

Diagnostic medical sonographers (DMS) are at an increased risk for developing work-related musculoskeletal disorders, such as carpal tunnel syndrome (CTS). CTS is characterized by inflammation of the median nerve within the carpal tunnel and a literature review supports that hypervascularization is seen within the nerve sheath. Currently, only invasive procedures such as nerve conduction testing and dynamic contrast magnetic resonance imaging are utilized in diagnosing CTS. This feasibility study was the first of its kind to detect and quantify arteriole blood flow within the median nerve with spectral and power Doppler ultrasound. Five DMS had their wrists scanned with a hand carried ultrasound unit over a 10-week period both before and after scanning neonatal heads. The results showed the qualitative measure of blood flow with color Doppler was consistently seen on each scanning session, whereas the quantitative measure with spectral Doppler was obtained only half of the time. The pre and post measures of peak systolic (PS) velocity and end diastolic (ED) velocity were not statistically significant, but showed very low blood flow on average - PS = 4.36 cm/s and ED = 0.76 cm/s. While these measures were not consistently obtained, this study proved acquiring quantitative blood flow within the median nerve with spectral Doppler ultrasound is feasible. There were many limitations of this study and key among these was the short evaluation, nested inside a larger work day. This was a feasibility study; therefore a more rigorous controlled study is needed to find the true sensitivity of spectral Doppler ultrasound to quantify blood flow in the median nerve. A longitudinal and comprehensive data collection is needed that reflects the entire work load. Therefore, this research underlines the importance of understanding the related physiology and technique to find a noninvasive alternative in diagnosing CTS.No embarg

Associations Between Chronic Pain and Use of Pharmacotherapy for Smoking Cessation

Chronic pain and tobacco dependence are two highly prevalent and comorbid conditions. The rate of smoking among persons in pain may be greater than twice the rate observed in the general population. Smokers tend to experience more adverse pain-treatment outcomes than do nonsmokers, and there is mounting evidence to suggest that smokers with comorbid pain disorders may have more difficulty abstaining from tobacco. The main goal of the current study was to examine cross-sectional relations between chronic pain status and past use of pharmacotherapy for smoking cessation. We also tested associations between chronic pain status and frequency of past quit attempts. Data were derived from a nationally-representative survey of households in the continental United States. After adjusting for sociodemographic factors, substance use, mood and anxiety disorders, and number of attempts to quit smoking, smokers with chronic pain were found to be 1.67 times more likely to endorse past use of pharmacotherapy for smoking cessation, relative to smokers with no chronic pain. Chronic pain status was not associated with number of past attempts to quit smoking. These data suggest that smokers with chronic pain are motivated to quit smoking, and may be particularly amenable to pharmacologic intervention. Results are discussed with regard to clinical implications and directions for future research

Sharing Property

The sharing economy-the rapidly evolving sector of peer-topeer transactions epitomized by Airbnb and Uber-is the subject of heated debate about whether it is so novel that no laws apply, or whether the sharing economy should be subject to the same regulations as its analog counterparts. The debate has proved frustrating and controversial in large part because we lack a doctrinally cohesive and normatively satisfying way of talking about the underlying activities taking place in the sharing economy. In part, this is because property-sharing activities-renting your car out to a tourist for a day, paying to spend the weekend in a stranger\u27s spare bedroom-blur the familiar binary divisions of personal and commercial, gratuitous and nongratuitous, formal and informal, that the law employs to characterize human activities. Because we lack a coherent analysis of these underlying property-sharing activities, any judgment about the sharing economy\u27s social value or attempts to regulate it are incomplete and confusing at best, and possibly inaccurate or counter-productive as well. This Article brings definitional clarity and coherence to this discourse by unpacking the underlying activities taking place within the sharing economy and developing a conceptual framework and taxonomy of sharing. By being more precise about what we mean when we talk about the sharing economy, and situating these activities with respect to existing legal institutions and shifting social norms, this Article provides an essential foundation for academics producing future scholarship, as well as for policymaker

Shedding Light on Endometriosis: Patient and Provider Perspectives on a Challenging Disease

Background: Endometriosis is a serious yet understudied medical condition impacting millions of women worldwide. Methods: This mixed methods study aimed to understand health care provider perceptions and patient experiences with endometriosis in the United States. Providers were surveyed to assess their understanding of disease prevalence. A subset of providers also participated in short, open-ended interviews about treating patients who have or are suspected to have endometriosis. Interviews were also conducted with women diagnosed with endometriosis to understand their experiences with the disease. Means and frequencies were calculated for survey data; interviews were transcribed and separately analyzed by two coders using an iterative coding process until agreement was reached. Results: Fifty-three providers completed surveys. Six out of 53 providers (11%) accurately identified the prevalence of endometriosis. Four providers and 12 patients completed interviews. Emergent themes among providers included limited training, difficulty of diagnosis, complexity of the referral process, a challenging patient-provider dynamic, and the importance of multidisciplinary collaboration. Emergent themes from patients included the psychological impact of the disease, difficulties interacting with the healthcare system, self-advocacy, quality of life, and limited treatment options. Conclusion: Providers are frequently unfamiliar with the far-reaching scope of endometriosis and cite many challenges caring for patients with the disease. Patients equally find the disease challenging to live with as it encroaches on physical, mental, and emotional well-being

Urban Development Legislation for Cities, by Cities

Thank you so much for inviting me to speak as part of this symposium. It is a great honor to be here in the company of such distinguished speakers to learn about the impressive legacy of Senator Muskie. My presentation today connects the legacy of Senator Muskie, and specifically, his work on urban development and Model Cities, to contemporary urban development legislation. Thus, this presentation picks up where my co-panelist, Don Nicoll, left off, by considering how the Model Cities legacy is both a foundation of and a counterpoint to contemporary urban development policies and programs. While urban development legislation can come from any level of government, some of the most innovative legislative responses to the challenges faced by cities today are being crafted by local governments themselves. Everyone here can probably think of examples of urban development legislation from their own city, whether it’s Detroit addressing abandoned and vacant housing through a blight reduction plan; Seattle passing a living wage ordinance that will help accommodate the high cost of living in that city; San Francisco promoting community health through urban agriculture zoning; or New Orleans redeveloping public housing in the Treme by integrating subsidized and market-priced housing in a mixed-use development

Urban Development Legislation for Cities, by Cities

Thank you so much for inviting me to speak as part of this symposium. It is a great honor to be here in the company of such distinguished speakers to learn about the impressive legacy of Senator Muskie. My presentation today connects the legacy of Senator Muskie, and specifically, his work on urban development and Model Cities, to contemporary urban development legislation. Thus, this presentation picks up where my co-panelist, Don Nicoll, left off, by considering how the Model Cities legacy is both a foundation of and a counterpoint to contemporary urban development policies and programs. While urban development legislation can come from any level of government, some of the most innovative legislative responses to the challenges faced by cities today are being crafted by local governments themselves. Everyone here can probably think of examples of urban development legislation from their own city, whether it’s Detroit addressing abandoned and vacant housing through a blight reduction plan; Seattle passing a living wage ordinance that will help accommodate the high cost of living in that city; San Francisco promoting community health through urban agriculture zoning; or New Orleans redeveloping public housing in the Treme by integrating subsidized and market-priced housing in a mixed-use development