Correspondence: From James W. Walker to Jacob F. Bryan on Children\u27s Medical Group Letterhead, 1968-12-21

James Walker offers some suggestions and recommendations for the Duval County Medical Center\u27s pediatric departmen

Cost effectiveness of bio-ethanol to reduce carbon dioxide emissions in Greece

The purpose of this study is to evaluate ethanol cost- effectiveness with regards to carbon dioxide emissions. Actually, bio-fuel production is only viable thanks to the tax credit policy resulting in economic ‘deadweight’ loss. The environmental performance is assessed under the Life Cycle Assessment (LCA) framework. Economic burden to society to support the activity divided by avoided CO2 equivalent emissions indicates the bio-ethanol cost effectiveness. Agricultural feedstock supply that comprises of sugarbeets, grains and industrial processing sub-models are articulated in a regional sector model. The maximization of total welfare determines optimal crop mix for farmers and the best configurations for industry. This is illustrated for bio-ethanol produced by the ex-sugar industry in Thessaly, Greece. Life cycle activity analysis showed that, at the optimum, CO2 emission is reduced between 1 and 1.5 t of carbon dioxide equivalent per ton of ethanol. The unitary cost falls in the range of 100 to 250 euro per ton of CO2 and it is remarkably dependent on the agricultural policy scenario.Cost effectiveness, ethanol, mathematical programming, life cycle assessment, greenhouse gases

Signs of Psychosis Leading to a Diagnosis of Progressive Multifocal Leukoencephalopathy: A Case Report

Introduction: Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating process of the central nervous system that occurs in in the setting of severe immunocompromise. Patients with PML develop varying focal neurological deficits and mental status changes that have not been well-described previously. Clinical findings: We present a patient who was found by security wandering the lobby of this hospital. He was oriented only to self and unable to state a reason for presentation. Medical records were limited and included a visit to an outside hospital that documented a past medical history of HIV infection. He exhibited multiple signs of psychosis such as thought blocking and a disorganized thought process. Main diagnoses, therapeutic interventions, and outcomes: After thorough evaluation, he was diagnosed with HIV-associated PML based on a CD4 count of 68 cells/microliter, subcortical white matter signal abnormalities on brain MRI, and positive CSF PCR for JC polyomavirus. Despite initiation of antiretroviral therapy, he unfortunately clinically declined and was ultimately transitioned to hospice care. Conclusions: While survival from PML has significantly improved with the advent of antiretroviral therapy, the overall prognosis remains poor. This case report emphasizes that PML should be included in the differential diagnosis for any immunocompromised patients with mental status changes even if they do not present with overt focal neurological deficits. It also highlights the importance of continuous HIV medical care to minimize the risk of patients developing such devastating complications

COVID-19 Vaccine Hesitancy Resources in Northern New York

COVID-19 continues to be a significant health threat and has caused significant disease and mortality in the fall 2021 wave largely driven by the Delta Variant and complicated by unvaccinated patients. In the state of NY, approximately 40 patients died per day (7 day moving average) from serious COVID-19 illness during this time period. During this time, approximately 35% of Clinton County’s population is not vaccinated for COVID-19 and is subsequently unprotected from serious COVID-19 illness. This work discusses reasons for non-vaccination and strategies to combat vaccine hesitancy. Additionally, it includes a pamphlet for local distribution as well as a dot phrase to be utilized for patients seen in the outpatient setting to serve as a personalized reminder on the importance of receiving vaccination against COVID-19 and to answer questions identified as concerns for vaccine hesitancy.https://scholarworks.uvm.edu/fmclerk/1837/thumbnail.jp

Perioperative VTE Chemical Prophylaxis at Jefferson Hospital: A Retrospective Review of the Department of Surgery

Only 26.1% of patients are receiving perioperative VTE chemical prophylaxis for elective cases in the Department of Surger

Using a Resident-Led Process Improvement Committee to Change Pain Medication Prescribing Habits: Early Results

The aims of this project were to: Streamline the ordering of IV and PO pain meds Encourage the appropriate ordering of Ofirmev

Over-the-Counter Analgesic Use Patterns in Appalachian Older Adults, Focusing on Non-Steroidal Anti-Inflammatory Drugs

Introduction Over-the-counter (OTC) medications are commonly used by elderly patients to self-manage pain symptoms. Medications such as non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen and topical analgesics are readily available and therefore may seem harmless to patients. In the growing population of those 65 years and older, providers need to inquire about OTC medication use due to the increased risk for adverse reactions in this population. Complications related to these medications can be worsened by chronic disease, variable metabolism, polypharmacy, etc. which become more common in the older adults. Methods A survey was created to determine the prevalence and habits of OTC use in the central Appalachian population, as well as the potential harms involved related to provider awareness, chronic disease, and polypharmacy. Results Of surveyed Appalachian seniors (n = 307), 86.3% take OTC medications. Of these, 57.4% report that they do not tell their provider and 51.3% do not take the medication as directed. Within this population, 19.2% of those on blood thinners, 22.4% of those with hypertension, 34.8% of those with chronic kidney disease, and 30.6% of those with gastrointestinal issues are not only using NSAIDs but also do not inform their physician nor follow the packaging instructions. Discussion Potential complications of NSAID use related to these medical comorbidities are well known. Providers need to regularly ask their older adult patients about the use of OTC medication to prevent adverse events in this vulnerable population

Rhode Island’s Health Equity Zones: Addressing Local Problems with Local Solutions

The Rhode Island Department of Health (RIDOH) describes the strategies and infrastructure it has developed to fund its placed-based initiatives to address the social determinants of health to eliminate health disparities. Using a data driven and community-led approach, RIDOH funded 10 local collaboratives, each with its own, geographically-defined “Health Equity Zone,” or “HEZ,” and, to support the collaboratives, created a new “Health Equity Institute,” a “HEZ Team” of 9 seasoned project managers, and direct lines of communications between these assets and the Office of the Director of Health

Nursing Poster - 2019

Nursing Posters - 2019https://scholarlycommons.libraryinfo.bhs.org/research_education/1007/thumbnail.jp