12 results on '"Buchanan, Ian"'
Search Results
2. WINTER WONDERLAND.
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BUCHANAN, IAN
- Subjects
SCHOOL building maintenance & repair ,SNOW removal ,WINTER ,SCHOOLS ,COST control ,HEATING ,AIR conditioning - Abstract
The article discusses on the need of institutions' preplanning to methods for managing essential services including snow surface treatments and maintenance services in order to cut costs before beginning winter season in the U.S. Topics discussed include the effects of winter weather on daily operations in institutions, increase in cost in seasonal products and services in winter weather, and steps for maintaining heating, ventilation and air conditioning (HVAC) systems.
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- 2015
3. TREATISE ON MILITARISM.
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Buchanan, Ian
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MILITARISM ,VIETNAM War, 1961-1975 ,MILITARY policy ,MILITARY sociology - Abstract
The article discusses the shift in the nature of militarism in the United States. Vietnam War is said to be the victorious mode of militarism in the U.S. Due to "Vietnam Syndrome," military realized that the U.S. public would not tolerate a high casualty rate amongst its own troops. The U.S. military banked on technology to achieve zero-casualty approach to its elective wars. The author concludes that war has entered the age of intelligent machines and unintelligent government.
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- 2006
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4. PRACTICAL DELEUZISM AND POSTMODERN SPACE.
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Buchanan, Ian
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SPACE perception , *POSTMODERNISM (Philosophy) , *MOTION picture industry - Abstract
Focuses on the propositions of several authors relating to the analysis of contemporary space. Qualities of transitory spaces that give meaning to contemporary existence according to Edward Casey; Information on the concept of the body without organs according to Gilles Deleuze; Implications of the view of Deleuze that no aesthetic developments were occurring in the motion picture industry in the U.S.
- Published
- 2005
5. Carbon primer.
- Author
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Buchanan, Ian
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BICYCLE equipment ,CARBON content in metals ,INORGANIC fibers ,CARBON fibers - Abstract
The article presents queries and answers pertaining to a carbon bicycle in the U.S. A reader is concerned on differences between the expensive inexpensive carbon frames. The author explained that the common perception is that frames and parts built of the same material are similar. But carbon fiber is arguably the most quality-dependent material of all the materials commonly used for frame building.
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- 2008
6. Early Readmission After Ventricular Shunting in Adults with Hydrocephalus: A Nationwide Readmission Database Analysis.
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Donoho DA, Buchanan IA, Patel A, Ding L, Cen S, Wen T, Giannotta SL, Attenello F, and Mack WJ
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- Adolescent, Adult, Age Factors, Aged, Brain Neoplasms complications, Comorbidity, Female, Heart Atria, Humans, Hydrocephalus etiology, Hydrocephalus, Normal Pressure surgery, Insurance, Health statistics & numerical data, Length of Stay statistics & numerical data, Male, Medicaid, Medicare, Middle Aged, Odds Ratio, Pleura, Risk Factors, Spinal Dysraphism complications, United States, Ventriculoperitoneal Shunt methods, Young Adult, Cerebrospinal Fluid Shunts methods, Hydrocephalus surgery, Patient Readmission statistics & numerical data
- Abstract
Background: Ventricular shunting is one of the primary modalities for addressing hydrocephalus in both children and adults. Despite advances in shunt technology and surgical practices, shunt failure is a persistent challenge for neurosurgeons, and shunt revisions account for a substantial proportion of all shunt-related procedures. There are a wealth of studies elucidating failure patterns and patient demographics in pediatric cohorts; however, data in adults are less uniform. We sought to determine the rates of all-cause and shunt failure readmission in adults who underwent the insertion of a ventricular shunt., Methods: We queried the Nationwide Readmissions Database from 2010 to 2014 to evaluate new ventricular shunts placed in adults with hydrocephalus. We sought to determine the rates of all-cause and shunt revision-related readmissions and to characterize factors associated with readmissions. We analyzed predictors including patient demographics, hospital characteristics, shunt type, and hydrocephalus cause., Results: Analysis included 24,492 initial admissions for shunt placement in patients with hydrocephalus. Of patients, 9.17% required a shunt revision within the first 6 months; half of all revisions occurred within the first 41 days. There were 4044 (16.50%) 30-day and 5758 (28.8%) 90-day all-cause readmissions. In multivariable analysis, patients with a ventriculopleural shunt, Medicare insurance, and younger age had increased likelihood for shunt revision. Notable predictors for all-cause readmission were insurance type, length of hospitalization, age, comorbidities, and hydrocephalus cause., Conclusions: Most shunt revisions occurred during the first 2 months. Readmissions occurred frequently. We identified patient factors that were associated with all-cause and shunt failure readmissions., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2019
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7. Increased Hospital Surgical Volume Reduces Rate of 30- and 90-Day Readmission After Acoustic Neuroma Surgery.
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Babadjouni R, Wen T, Donoho DA, Buchanan IA, Cen SY, Friedman RA, Amar A, Russin JJ, Giannotta SL, Mack WJ, and Attenello FJ
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- Adult, Aged, Databases, Factual, Female, Humans, Male, Middle Aged, Odds Ratio, Patient Protection and Affordable Care Act, Postoperative Complications epidemiology, Risk Factors, United States, Hospitals, High-Volume statistics & numerical data, Neuroma, Acoustic surgery, Patient Readmission statistics & numerical data
- Abstract
Background: Hospital readmissions are commonly linked to elevated health care costs, with significant financial incentive introduced by the Affordable Care Act to reduce readmissions., Objective: To study the association between patient, hospital, and payer factors with national rate of readmission in acoustic neuroma surgery., Methods: All adult inpatients undergoing surgery for acoustic neuroma in the newly introduced Nationwide Readmissions Database from 2013 to 2014 were included. We identified readmissions for any cause with a primary diagnosis of neurological, surgical, or systemic complication within 30- and 90-d after undergoing acoustic neuroma surgery. Multivariable models were employed to identify patient, hospital, and administrative factors associated with readmission. Hospital volume was measured as the number of cases per year., Results: We included patients representing a weighted estimate of 4890 admissions for acoustic neuroma surgery in 2013 and 2014, with 355 30-d (7.7%) and 341 90-d (9.1%) readmissions. After controlling for patient, hospital, and payer factors, procedural volume was significantly associated with 30-d readmission rate (OR [odds ratio] 0.992, p = 0.03), and 90-d readmission rate (OR 0.994, p = 0.047). The most common diagnoses during readmission in both 30- and 90-d cohorts included general central nervous system complications/deficits, hydrocephalus, infection, and leakage of cerebrospinal fluid (rhinorrhea/otorrhea)., Conclusion: After controlling for patient, hospital, and payer factors, increased procedural volume is associated with decreased 30- and 90-d readmission rate for acoustic neuroma surgery. Future studies seeking to improve outcomes and reduce cost in acoustic neuroma surgery may seek to further evaluate the role of hospital procedural volume and experience., (Copyright © 2018 by the Congress of Neurological Surgeons.)
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- 2019
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8. State of the Union in Open Neurovascular Training.
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Fredrickson VL, Strickland BA, Ravina K, Rennert RC, Donoho DA, Buchanan IA, Russin JJ, Mack WJ, and Giannotta SL
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- Arteriovenous Malformations surgery, Craniotomy education, Craniotomy statistics & numerical data, Endarterectomy, Carotid education, Endarterectomy, Carotid statistics & numerical data, Fellowships and Scholarships statistics & numerical data, Humans, Intracranial Aneurysm surgery, Learning Curve, Neurosurgical Procedures statistics & numerical data, Training Support statistics & numerical data, United States, Vascular Surgical Procedures statistics & numerical data, Internship and Residency statistics & numerical data, Neurosurgical Procedures education, Vascular Surgical Procedures education
- Abstract
Background: The evolution of minimally invasive endovascular approaches and training paradigms has reduced open neurovascular case exposure for neurosurgical residents. There are no published estimates of open neurovascular case volumes during residency or Committee on Advanced Subspecialty Training (CAST) accredited fellowships., Methods: Case volumes from residency programs submitting data for CAST accredited fellowship applications were collected and analyzed. The study period covered the academic years of 2013-2016. Case index volumes were calculated to provide an estimate of total volume of cases each trainee participated in a given year. The case index volume was defined as the total volume of cases per year divided by the total training complement., Results: Over the study period, institutional data from 46 programs were available. Of those programs, 9 programs had CAST accredited open cerebrovascular fellowships. Across all 46 programs, the median number of vascular cases was 246 (interquartile range [IQR]: 148-340), whereas the median number of open vascular cases was 105 (IQR: 67-152). The median number of open aneurysm cases among programs with CAST cerebrovascular fellowships was 80 (IQR: 54-103) and among programs without CAST cerebrovascular fellowships was 34 (IQR: 24-63). The median open aneurysm case index volume for trainees at programs with and without CAST cerebrovascular fellowships was 23 (IQR: 14-29) and 19 (IQR: 11-24)., Conclusions: Strong neurovascular training can be obtained through dedication and planning. Completion of a CAST accredited cerebrovascular fellowship will often more than double aneurysm case exposure of trainees., (Copyright © 2018 Elsevier Inc. All rights reserved.)
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- 2019
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9. Treatment at Safety-Net Hospitals Is Associated with Delays in Coil Embolization in Patients with Subarachnoid Hemorrhage.
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Donoho DA, Patel A, Buchanan IA, Chow F, Ding L, Amar AP, Attenello F, and Mack WJ
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- Adult, Aged, Databases, Factual, Endovascular Procedures, Female, Humans, Male, Medicaid, Medically Uninsured, Middle Aged, Multivariate Analysis, United States, Embolization, Therapeutic, Healthcare Disparities, Safety-net Providers statistics & numerical data, Subarachnoid Hemorrhage therapy, Time-to-Treatment statistics & numerical data
- Abstract
Background: Successful endovascular management of aneurysmal subarachnoid hemorrhage (aSAH) requires timely access to substantial resources. Prior studies suggest an association between time to treatment and patient outcome. Patients treated at safety-net hospitals are thought to be particularly vulnerable to disparities in access to interventions that require substantial technologic resources. We hypothesized that patients with aSAH treated at safety-net hospitals are at greater risk for delayed access to endovascular treatment., Methods: Adults undergoing endovascular coiling procedures between 2002 and 2011 in the Nationwide Inpatient Sample were included. Hospitals in the quartile with the highest proportion of Medicaid or uninsured patients were defined as safety-net hospitals. A multivariate model including patient-level and hospital-level factors was constructed to permit analysis of delays in endovascular treatment (defined as time to treatment >3 days)., Results: Analysis included 7109 discharges of patients with aSAH undergoing endovascular coil embolization procedures from 2002 to 2011. Median time to coil embolization in all patients was 1 day; 10.1% of patients waited >3 days until treatment. In multivariate analysis, patients treated at safety-net hospitals were more likely to have a prolonged time to coil embolization (odds ratio = 1.32, P < 0.01) compared with patients treated at low-burden hospitals., Conclusions: After controlling for patient and hospital factors, individuals with aSAH treated at safety-net hospitals from 2002 to 2011 were more likely to have a delay to endovascular coil embolization than individuals treated at non-safety-net hospitals. This disparity could affect patient outcomes., (Copyright © 2018 Elsevier Inc. All rights reserved.)
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- 2018
- Full Text
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10. Factors associated with burnout among US neurosurgery residents: a nationwide survey.
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Attenello FJ, Buchanan IA, Wen T, Donoho DA, McCartney S, Cen SY, Khalessi AA, Cohen-Gadol AA, Cheng JS, Mack WJ, Schirmer CM, Swartz KR, Prall JA, Stroink AR, Giannotta SL, and Klimo P
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- Adult, Career Choice, Female, Health Surveys, Humans, Internship and Residency, Job Satisfaction, Male, Risk Factors, United States, Young Adult, Burnout, Professional etiology, Neurosurgery education
- Abstract
OBJECTIVEExcessive dissatisfaction and stress among physicians can precipitate burnout, which results in diminished productivity, quality of care, and patient satisfaction and treatment adherence. Given the multiplicity of its harms and detriments to workforce retention and in light of the growing physician shortage, burnout has garnered much attention in recent years. Using a national survey, the authors formally evaluated burnout among neurosurgery trainees.METHODSAn 86-item questionnaire was disseminated to residents in the American Association of Neurological Surgeons database between June and November 2015. Questions evaluated personal and workplace stressors, mentorship, career satisfaction, and burnout. Burnout was assessed using the previously validated Maslach Burnout Inventory. Factors associated with burnout were determined using univariate and multivariate logistic regression.RESULTSThe response rate with completed surveys was 21% (346/1643). The majority of residents were male (78%), 26-35 years old (92%), in a stable relationship (70%), and without children (73%). Respondents were equally distributed across all residency years. Eighty-one percent of residents were satisfied with their career choice, although 41% had at some point given serious thought to quitting. The overall burnout rate was 67%. In the multivariate analysis, notable factors associated with burnout included inadequate operating room exposure (OR 7.57, p = 0.011), hostile faculty (OR 4.07, p = 0.008), and social stressors outside of work (OR 4.52, p = 0.008). Meaningful mentorship was protective against burnout in the multivariate regression models (OR 0.338, p = 0.031).CONCLUSIONSRates of burnout and career satisfaction are paradoxically high among neurosurgery trainees. While several factors were predictive of burnout, including inadequate operative exposure and social stressors, meaningful mentorship proved to be protective against burnout. The documented negative effects of burnout on patient care and health care economics necessitate further studies for potential solutions to curb its rise.
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- 2018
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11. Predictors of 30- and 90-day readmission following craniotomy for malignant brain tumors: analysis of nationwide data.
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Donoho DA, Wen T, Babadjouni RM, Schwartzman W, Buchanan IA, Cen SY, Zada G, Mack WJ, and Attenello FJ
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- Aged, Brain Neoplasms economics, Craniotomy economics, Databases, Factual, Economics, Hospital, Humans, Medicaid, Medicare, Middle Aged, Patient Discharge economics, Patient Discharge statistics & numerical data, Patient Readmission economics, Postoperative Complications economics, United States, Brain Neoplasms epidemiology, Brain Neoplasms surgery, Craniotomy statistics & numerical data, Patient Readmission statistics & numerical data, Postoperative Complications epidemiology
- Abstract
Hospital readmissions are a major contributor to increased health care costs and are associated with worse patient outcomes after neurosurgery. We used the newly released Nationwide Readmissions Database (NRD) to describe the association between patient, hospital and payer factors with 30- and 90-day readmission following craniotomy for malignant brain tumor. All adult inpatients undergoing craniotomy for primary and secondary malignant brain tumors in the NRD from 2013 to 2014 were included. We identified all cause readmissions within 30- and 90-days following craniotomy for tumor, excluding scheduled chemotherapeutic procedures. We used univariate and multivariate models to identify patient, hospital and administrative factors associated with readmission. We identified 27,717 admissions for brain tumor craniotomy in 2013-2014, with 3343 (13.2%) 30-day and 5271 (25.7%) 90-day readmissions. In multivariate analysis, patients with Medicaid and Medicare were more likely to be readmitted at 30- and 90-days compared to privately insured patients. Patients with two or more comorbidities were more likely to be readmitted at 30- and 90-days, and patients discharged to skilled nursing facilities or home health care were associated with increased 90-day readmission rates. Finally, hospital procedural volume above the 75th percentile was associated with decreased 90-day readmission rates. Patients treated at high volume hospitals are less likely to be readmitted at 90-days. Insurance type, non-routine discharge and patient comorbidities are predictors of postoperative non-scheduled readmission. Further studies may elucidate potentially modifiable risk factors when attempting to improve outcomes and reduce cost associated with brain tumor surgery.
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- 2018
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12. Management of in-flight medical emergencies: are senior medical students prepared to respond to this community need?
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Katzer RJ, Duong D, Weber M, Memmer A, and Buchanan I
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- Adult, Cross-Sectional Studies, Emergencies, Female, Humans, Male, Needs Assessment, Self-Assessment, Surveys and Questionnaires, United States, Aerospace Medicine education, Clinical Competence statistics & numerical data, Education, Medical, Undergraduate, Emergency Medicine education, Travel
- Abstract
Introduction: In-flight medical emergencies on commercial aircraft are common in both domestic and international flights. We hypothesized that fourth-year medical students feel inadequately prepared to lend assistance during in-flight medical emergencies. This multicenter study of two U.S. medical schools obtains a baseline assessment of knowledge and confidence in managing in-flight medical emergencies., Methods: A 25-question survey was administered to fourth-year medical students at two United States medical schools. Questions included baseline knowledge of in-flight medicine (10 questions) and perceived ability to respond to in-flight medical emergencies., Results: 229 participants completed the survey (75% response rate). The average score on the fund of knowledge questions was 64%. Responses to the 5-point Likert scale questions indicated that, on average, students did not feel confident or competent responding to an in-flight medical emergency. Participants on average also disagreed with statements that they had adequate understanding of supplies, flight crew training, and ground-based management., Conclusion: This multicenter survey indicates that fourth-year medical students do not feel adequately prepared to respond to in-flight medical emergencies and may have sub-optimal knowledge. This study provides an initial step in identifying a deficiency in current medical education.
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- 2014
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