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IntroductionEffective, equity-promoting interventions implemented by health care systems are needed to address health care disparities and population-level health disparities. We evaluated the impact of a clinical decision support tool to improve evidence-based thiazide diuretic prescribing among Black patients to address racial disparities in hypertension control.MethodsWe employed an interrupted time series design and qualitative interviews to evaluate the implementation of the tool. Our primary outcome measure was the monthly rate of thiazide use among eligible patients before and after implementation of the tool (January 2013-December 2016). We modeled month-to-month changes in thiazide use for Black and White patients, overall, and by sex and medical center racial composition. We conducted key informant interviews to identify modifiable facilitators and barriers to implementation of the tool across medical centers.ResultsOf the 318,720 patients, 15.5% were Black. We observed no change in thiazide use or blood pressure control following the implementation of the tool in either racial subgroup. There was a slight but statistically significant reduction (2.32 percentage points, p < 0.01) in thiazide use among Black patients following the removal the tool that was not observed among White patients. Factors affecting the tool's implementation included physician and pharmacist resistance to thiazide use and a lack of ongoing promotion of the tool.DiscussionThe clinical decision support tool was insufficient to change prescribing practices and improve blood pressure control among Black patients.ConclusionsFuture interventions should consider physician attitudes about thiazide prescribing and the importance of multilevel approaches to address hypertension disparities.

This is a review of the book Harry Potter and the Other; Race, Justice and Difference in the Wizarding World edited by Sarah Park Dahlen and Ebony Elizabeth Thomas. of MacDonald's more unorthodox beliefs and how they actually fit into traditional interpretations of Christianity rather than being outlandish or sui generis, as is sometimes said about MacDonald's ideas. Moreover, this work demonstrates how MacDonald was both a visionary and also a man of his times, a voice of hope in a world that had gone dark, a reassuring presence in a world that seemed destined for chaos. --James Hamby, Harry Potter and the Other; Race, Justice and Difference in the Wizarding World, edited by Sarah Park Dahlen and Ebony Elizabeth Thomas, and Open at the Close: Literary Essays on [...]

An emerging body of opinion cites the Daenerys subplot in George R. R. Martin's A Song of Ice and Fire (1996-) as a white savior narrative. This article argues against this. Martin presents his emblematic medievalist Occident as equally barbaric as his Orient, disabling the Manichean colonialist allegory some scholars perceive in his work. Although Daenerys certainly thinks like a colonialist savior, such discourse makes most sense as Bakhtinian image of a language, exhibited by Martin in concert with depictions of the intractable problems her actions cause, to mount a polemic authorial critique of colonialist literature. Support for this reading can be found elsewhere in Martin's work, in which he frequently critiques uncritical espousals of literary tropes, and in his careful moral variegation of the peoples Daenerys conquers., In Medievalism in A Song of Ice and Fire and Game of Thrones, Shiloh Carroll takes issue with George R. R. Martin's portrayal of Daenerys Targaryen's adventures in Essos, the [...]

Why do foreign militaries attack some insurgencies and not others? Although foreign involvement in civil conflicts is on the rise, many insurgencies are not targeted militarily by external powers. Current research suggests organizations that are lethal or that attack democracies should be targeted more often. We argue that organizations that have vital markers of capabilities, such as alliances with other violent non-state actors (VNSAs) and territorial control, and the ability to attack members of a powerful country, in this case, U.S. citizens at home or abroad, are more likely to be targeted. Our empirical analysis supports this contention: we use a logistic regression model and, in post-estimation, predicted probabilities and a Classification and Regression Tree (CART) model to understand the effect of potential factors on international military interventions. [ABSTRACT FROM AUTHOR]

Does foreign aid reduce violence during ongoing wars? In the policy community, there has been growing optimism about the prospect for aid to improve conflict-affected and fragile areas. We investigate whether foreign aid decreases, or even increases, violence during ongoing armed conflict. We advance a theoretical argument that concentrated foreign assistance allocated during ongoing armed conflicts increases military fatalities but decreases civilian fatalities. Using geographically coded data on all sub-Saharan African countries in conflict between 1989 and 2008, within a matching frontier design and supplemented by instrumental variable analysis, we find strong substantive and statistical support for our expectations about military conflict intensity though less support for the expectations about civilian fatalities. The paper provides novel insights about the effects of concentrated aid on military versus civilian conflict intensity, characterizes the effects at a sub-national level, and expands the spatial-temporal period of the analysis. We also probe the plausibility of the causal mechanism using interview evidence drawn from ex-commanders of the Lord's Resistance Army and generals of the Ugandan People's Defence Forces in northern Uganda. The paper offers both academic and policy insights, including that foreign aid allocated during ongoing wars may be more problematic than it is helpful. [ABSTRACT FROM AUTHOR]

With the annual incidence of hip fractures and hip fracture fixation rising, the need for conversion total hip arthroplasty has also risen. About half of the 280,000 hip fractures that occur annually in the United States are extracapsular. Commonly extracapsular hip fractures are treated with either cephalomedullary nails (CMNs) or sliding hip screws (SHS). More recently, there has been a shift toward increased CMN use due to increased training with this fixation method as well as perioperative and biomechanical benefits. Given this shift, orthopedic surgeons need to understand the factors that lead to CMN failure. Failed CMN treatment leaves both patients and surgeons with few management options including revision fixation with or without osteotomy, conversion total hip arthroplasty, and conversion hemiarthroplasty. Surgeons must consider the patient and injury characteristics before deciding the best treatment plan. Conversion total hip arthroplasty is indicated in younger patients without femoral head and/or acetabular articular injury, degenerative joint disease, or avascular necrosis. Conversion total arthroplasty is a technically demanding and resource-intensive surgery associated with lower success rates and outcomes than primary total hip arthroplasty. Orthopedic surgeons should have thorough understanding of preoperative workup needed prior to surgery, implant selection associated with best outcomes, most common surgical approaches used, intraoperative considerations, and complications associated with conversion total hip arthroplasty. A comprehensive understanding of these concepts gives patients the best chance of having a successful outcome. [ABSTRACT FROM AUTHOR]

Deglaciation of the northwestern Laurentide Ice Sheet in the central Mackenzie Valley opened the northern portion of the deglacial Ice-Free Corridor between the Laurentide and Cordilleran ice sheets and a drainage route to the Arctic Ocean. In addition, ice-sheet saddle collapse in this section of the Laurentide Ice Sheet has been implicated as a mechanism for delivering substantial freshwater influx into the Arctic Ocean on centennial timescales. However, there is little empirical data to constrain the deglaciation chronology in the central Mackenzie Valley where the northern slopes of the ice saddle were located. Here, we present 30 new 10Be cosmogenic nuclide exposure dates across six sites, including two elevation transects, which constrain the timing and rate of thinning of the Laurentide Ice Sheet from the area. Our new 10Be dates indicate that the initial deglaciation of the eastern summits of the central Mackenzie Mountains began at ~15.8 ka (17.1 - 14.6 ka), ~1,000 years earlier than previous reconstructions. The main phase of ice-saddle collapse occurred between ~14.9 and 13.2 ka, consistent with numerical modelling simulations, placing this event within the Bølling-Allerød interval (14.6 - 12.9 ka). Our new dates require a revision of ice margin retreat dynamics, with ice retreating more easterly rather than southward along the Mackenzie Valley. In addition, we quantify a total sea level rise contribution from the Cordilleran-Laurentide ice saddle region of ~11.2 m between 16 ka and 13 ka. [ABSTRACT FROM AUTHOR]