Messé, Steven R, Mullen, Michael T, Cox, Margueritte, Fonarow, Gregg C, Smith, Eric E, Saver, Jeffrey L, Reeves, Mathew J, Bhatt, Deepak L, Matsouaka, Roland, and Schwamm, Lee H
Journal of the American Heart Association, vol 7, iss 21
Humans, Acute Disease, Tissue Plasminogen Activator, Fibrinolytic Agents, Treatment Outcome, Patient Admission, Retrospective Studies, Cohort Studies, Aged, Quality of Health Care, Guideline Adherence, United States, Female, Male, Congresses as Topic, Stroke, quality indicators, stroke care, tissue‐type plasminogen activator, tissue-type plasminogen activator, and Cardiorespiratory Medicine and Haematology
Background Patients presenting to hospitals during non-weekday hours experience worse outcomes, often attributed to reduced staffing. The American Heart Association International Stroke Conference ( ISC ) is well attended by stroke clinicians. We sought to determine whether patients with acute ischemic stroke ( AIS ) admitted during the ISC receive less guideline-adherent care and experience worse outcomes. Methods and Results We performed a retrospective cohort study of US hospitals participating in Get With The Guidelines-Stroke and assessed use of intravenous tissue plasminogen activator, other quality measures, and outcomes for patients with AIS admitted during the ISC compared with those admitted the weeks before and after the conference. A total of 69 738 patients with AIS were included: mean age, 72 years; 52% women; 29% nonwhite. There was no difference between the average weekly number of AIS cases admitted during ISC weeks versus non- ISC weeks (1984 versus 1997; P=0.95). Patient and hospital characteristics were similar between ISC and non- ISC time periods. There were no significant differences in 14 quality metrics and 5 clinical outcomes between patients with AIS treated during the ISC versus non- ISC weeks. Patients with AIS who presented within 2 hours of onset had no difference in the likelihood of receiving intravenous tissue plasminogen activator within 3 hours (adjusted odds ratio, 0.89; 95% confidence interval, 0.77-1.03; P=0.13) or the likelihood of receiving intravenous tissue plasminogen activator within 60 minutes of arrival (adjusted odds ratio, 0.92; 95% confidence interval, 0.83-1.02; P=0.13). Conclusions Patients with acute stroke admitted to Get With The Guidelines-Stroke hospitals during ISC received the same quality care and had similar outcomes as patients admitted at other times.
World Congress of Local Governments for a Sustainable Future
World Congress of Local Governments for a Sustainable Future
In order to secure an environmentally sustainable future, the world's local governments must begin to restructure social and economic life at the local level. The problems of solid waste, water pollution, transnational air pollution, climate change, stratospheric ozonedepletion, forest and soil loss, and environmental degradation in the developing world cannot adequately be addressed without a thorough mobilization at the local governmentlevel. By the end of the 20th century more than half of the world's population will live in urban areas. As the centers of industrialized life, cities are the major sources of garbage, sewage, chemical wastes, greenhouse gases and ozone depleting compounds. Standards fordealing with these wastes can be set at the national and international government levels, but such standards can only be implemented in an effective and timely way with local government assistance. Globally, local governments are often in the best position to correct unsustainable land use, construction, transportation, energy, agriculture and waste management practices of modern life. As local government leaders, we gather for a World Congress of Local Governments for a Sustainable Future, as a first step in exchanging successful local strategies, in alliance with the United Nations for the development and implementation of a global environmentalagenda. We further call for the establishment of an International Secretariat for Local Environmental Initiatives to coordinate, assist and promote local government implementation of sound environmental policy.
Wish, Jay B, Charytan, Chaim, Chertow, Glenn M, Kalantar-Zadeh, Kamyar, Kliger, Alan S, Rubin, Robert J, Yee, Jerry, and Fishbane, Steven
American journal of kidney diseases : the official journal of the National Kidney Foundation, vol 68, iss 6
Humans, Kidney Diseases, Nephrology, Biomedical Research, Drug Utilization, United States, Congresses as Topic, Practice Guidelines as Topic, Biosimilar Pharmaceuticals, Biosimilar, anemia, biologic, cost, dialysis, drug approval, efficacy, end-stage renal disease, erythropoietin analogue, interchangeability, nephrology, pharmacovigilance, reference agent, regulatory, safety, therapeutic equivalency, Urology & Nephrology, Clinical Sciences, and Public Health and Health Services
Biosimilars are biologic medicines highly similar to the reference product with no meaningful clinical differences in terms of safety, purity, and potency. All biologic medicines are produced by living cells, resulting in an inherent heterogeneity in their higher order structures and post-translational modifications. In 2010, the US Congress enacted legislation to streamline the approval process for biosimilars of products losing patent protection, with the goal of decreasing costs and improving patient access to therapeutically important but expensive biologic agents. In 2015, the US Food and Drug Administration approved the first biosimilar agent through this pathway. Approval of additional biosimilar agents in the United States, including those used by nephrologists, is anticipated. Given the relative lack of knowledge regarding biosimilars and their approval process and a lack of trust by the nephrology community regarding their safety and efficacy, the National Kidney Foundation conducted a symposium, Introduction of Biosimilar Therapeutics Into Nephrology Practice in the U.S., September 17 to 18, 2015. Issues related to manufacturing, the regulatory approval process, interchangeability, substitution/switching, nomenclature, and clinician and patient awareness and acceptance were examined. This report summarizes the main discussions at the symposium, highlights several controversies, and makes recommendations related to public policy, professional and patient education, and research needs.
Political Science, Congress, Intraparty, and Party
The purpose of this dissertation is to supply a simple and synthetic theory to help us to understand the development and value of organized intraparty blocs. I will argue that lawmakers rely on these intraparty organizations to resolve several serious collective action and coordination problems that otherwise make it difficult for rank-and-file party members to successfully challenge their congressional leaders for control of policy outcomes. In the empirical chapters of this dissertation, I will show that intraparty organizations empower dissident lawmakers to resolve their collective action and coordination challenges by providing selective incentives to cooperative members, transforming public good policies into excludable accomplishments, and instituting rules and procedures to promote group decision-making. And, in tracing the development of intraparty organization through several well-known examples of party infighting, I will demonstrate that intraparty organizations have played pivotal -- yet largely unrecognized -- roles in critical legislative battles, including turn-of-the-century economic struggles, mid-century battles over civil rights legislation, and contemporary debates over national health care policy.