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While various supraglottic airway devices are available for use during out-of-hospital cardiac arrest (OHCA) resuscitation, comparisons of patient outcomes by device are limited. In this study, we aimed to compare outcomes of OHCA patients who had airway management by emergency medical services (EMS) with the iGel or King-LT. We used the 2018-2021 ESO Data Collaborative public use research datasets for this retrospective study. All patients with non-traumatic OHCA who had iGels or King-LTs inserted by EMS were included. Our primary outcome was survival to discharge to home, and secondary outcomes included first-pass success, return of spontaneous circulation (ROSC), and prehospital rearrest. We examined the association between airway device and each outcome using two-level mixed effects logistic regression with EMS agency as the random effect, adjusted for standard Utstein variables and failed intubation prior to supraglottic airway insertion. Average treatment effects were calculated through propensity score matching. A total of 286,192 OHCA patients were screened, resulting in 93,866 patients eligible for inclusion in this analysis. A total of 9,456 transported patients (59.8% iGel) had associated hospital disposition data. Use of the iGel was associated with greater survival to discharge to home (aOR:1.36 [1.06, 1.76]; ATE: 2.2%[+0.5, +3.8]; n = 7,576), first pass airway success (aOR:1.94 [1.79, 2.09]; n = 73,658), and ROSC (aOR:1.19 [1.13, 1.26]; n = 73,207) in comparison to airway management with the King-LT. iGel use was associated with lower odds of experiencing a rearrest (aOR:0.73 [0.67, 0.79]; n = 20,776). Among patients who received a supraglottic device as a primary airway, use of the iGel was not associated with significantly greater survival to discharge to home (aOR:1.26 [0.95, 1.68]). Among patients who received a supraglottic device as a rescue airway following failed intubation, use of the iGel was associated with greater odds of survival to discharge to home (aOR:2.16 [1.15, 4.04]). In this dataset, use of the iGel during adult OHCA resuscitation was associated overall with better outcomes compared to use of the King-LT. Subgroup analyses suggested that use of the iGel was associated with greater odds of achieving the primary outcome than the King-LT when used as a rescue device but not when used as the primary airway management device. [ABSTRACT FROM AUTHOR]

Prehospital post-resuscitation hypotension and hypoxia have been associated with adverse outcomes in the context of out-of-hospital cardiac arrest (OHCA). We aimed to investigate the association between clinical outcomes and post-resuscitation hypoxia alone, hypotension alone, and combined hypoxia and hypotension. We used the 2018–2021 ESO annual datasets to conduct this study. All EMS-treated non-traumatic OHCA patients who had a documented prehospital return of spontaneous circulation (ROSC) and two or more SpO2 readings and systolic blood pressures recorded were evaluated for inclusion. Patients who were less than 18 years of age, pregnant, had a do-not-resuscitate order or similar, achieved ROSC after bystander CPR only, or had an EMS-witnessed cardiac arrest were excluded. Multivariable logistic regression adjusted for standard Utstein factors and highest prehospital Glasgow Coma Scale (GCS) score was used to investigate the association between hypoxia, hypotension, and outcomes. We analyzed data for 17,943 patients, of whom 3,979 had hospital disposition data. Hypotension and hypoxia were not documented in 1,343 (33.8%) patients, 1,144 (28.8%) had only hypoxia documented, 507 (12.7%) had only hypotension documented, and 985 (24.8%) had both hypoxia and hypotension documented. In comparison to patients who did not have documented hypotension or hypoxia, patients who had documented hypoxia (aOR: 1.76 [1.38, 2.24]), documented hypotension (aOR: 3.00 [2.15, 4.18]), and documented hypoxia and hypotension combined (aOR: 4.87 [3.63, 6.53]) had significantly increased mortality. The relationship between mortality and vital sign abnormalities (hypoxia and hypotension > hypotension > hypoxia) was observed in every evaluated subgroup. In this large dataset, hypotension and hypoxia were independently associated with mortality both alone and in combination. Compared to patients without documented hypotension and hypoxia, patients with documented hypotension and hypoxia had nearly five-fold greater odds of mortality. [ABSTRACT FROM AUTHOR]

Building energy codes are essential tools for achieving energy efficiency in buildings. However, the full energy savings potential of these codes can only be realized if buildings are constructed in compliance with them. Therefore, evaluating building energy code compliance is crucial in bridging the gap between the energy efficiency requirements set by energy codes and the actualized energy savings achieved. An energy code compliance evaluation serves as a mechanism to assess construction practices, evaluate the effectiveness of code enforcement, identify gaps in compliance, and guide strategies for improvement through training and education. Conducting code compliance evaluation activities involves field studies that require careful design and significant resources. Historically, more emphasis has been placed on developing and adopting building energy codes, while efforts to evaluate compliance have been relatively limited and lacking consistent approaches. The passage of the 2009 American Recovery and Reinvestment Act (ARRA), which mandated that states create plans for achieving 90% compliance within eight years, stimulated the need for an energy code compliance evaluation. As a result, federal, state, and local governments, and utilities have invested in the development of methodologies and tools for code compliance evaluation studies. This paper reviews the code compliance evaluation studies conducted in the United States over the past three decades. It describes and compares the methodologies and metrics used to assess building energy code compliance, summarizes the general elements and steps involved in the evaluation process, and discusses common issues in these studies. Over time, code compliance evaluation methodologies have evolved from isolated development within individual states, regions, and utilities, to widely accepted protocols applicable across different states and local jurisdictions. There has been a transition in compliance metrics, shifting from historical compliance rates to energy-consumption-oriented approaches. [ABSTRACT FROM AUTHOR]

Pediatric obesity and Attention Deficit Hyperactivity Disorder (ADHD) are rising health concerns in the United States, especially among Hispanic children and adolescents. Research on Hispanic children and adolescents indicates disproportionately higher prevalence rates of obesity in this community but scant data on ADHD prevalence rates. In contrast, a plethora of research studies across the general population examines the relationship between childhood obesity and ADHD. In addition, there is a lack of research that examines the role of ethnicity and sub-ethnic group correlations in ADHD, particularly in the Hispanic population. Existing studies in the general population indicate ADHD may be a risk factor for being overweight compared to normal controls. The objective of the present study is to examine the prevalence of obesity in children with ADHD compared to children in the general population in a predominately Hispanic sample on the US-Mexico border. A total of 7,270 pediatric medical records were evaluated. The retrospective analysis included Body Mass Index (BMI) and related health variables, and ethnicity and showed that children with ADHD are more likely to be underweight. In conclusion, no significant relationship existed between obesity and ADHD among Hispanic children on the US-Mexico Border, and instead we found the opposite correlation. [ABSTRACT FROM AUTHOR]

Background: It is common practice to observe patients during an overnight stay (ONS) following a catheter ablation procedure for the treatment of atrial fibrillation (AF). Objectives: To investigate the safety and economic impact of a same‐day discharge (SDD) protocol after cryoballoon ablation for treatment of AF in high‐volume, geographically diverse US hospitals. Methods: We retrospectively reviewed 2374 consecutive patients (1119 SDD and 1180 ONS) who underwent cryoballoon ablation for AF at three US centers. Baseline characteristics, acute procedure‐related complications, and longer‐term evaluations of safety were recorded during routine clinical follow‐up. The mean cost of an ONS was used in a one‐way sensitivity analysis to evaluate yearly cost savings as a function of the percentage of SDD cases per year. Results: The SDD and ONS cohorts were predominately male (69% vs. 67%; p =.3), but SDD patients were younger (64 ± 11 vs. 66 ± 10; p <.0001) with lower body mass index (30 ± 6 vs. 31 ± 61; p <.0001) and CHA2DS2‐VASc scores (1.4 ± 1.0 vs. 2.2 ± 1.4; p <.0002). There was no difference between SDD and ONS in the 30‐day total complication rate (n = 15 [1.26%] versus n = 24 [2.03%]; p =.136, respectively). The most common complication was hematoma in both the SDD (n = 8; 0.67%) and ONS (n = 11; 0.93%) cohorts. Sensitivity analysis demonstrated that when 50% of every 100 patients treated were discharged the same day, hospital cost savings ranged from $45 825 to $83 813 per year across US hospitals. Conclusions: SDD following cryoballoon ablation for AF appears to be safe and is associated with cost savings across different US hospitals. [ABSTRACT FROM AUTHOR]

Auditors in Medicare overpayment or False Claims Act (FCA) cases often use statistical extrapolation to estimate a health-care provider's total liability from a small sample of audited claims. Courts treat statistical extrapolation differently depending on the context. They generally afford the government substantial discretion in using statistical extrapolation in overpayment cases. By contrast, courts typically more closely scrutinize the use of extrapolation in FCA cases involving multiple damages and civil penalties to ensure that the sample truly reflects the entire universe of claims and that the extrapolation rests on a sound methodological foundation. In recent cases, however, multiple courts have allowed the use of extrapolation in FCA cases. When auditors attempt to use statistical extrapolation, providers should closely inspect the sample and challenge the extrapolation when any reasonable argument exists that the sample does not constitute a reliable or accurate representation of all the provider's claims. [ABSTRACT FROM AUTHOR]

Background: The frequency of lethal overdose due to prescription and non-prescription drugs is increasing in North America. The aim of this study was to estimate overall and regional variation in incidence and outcomes of out-of-hospital cardiac arrest due to overdose across North America.Methods: We conducted a retrospective cohort study using case data for the period 2006-2010 from the Resuscitation Outcomes Consortium, a clinical research network with 10 regional clinical centers in United States and Canada. Cases of out-of-hospital cardiac arrest due to drug overdose were identified through review of data derived from prehospital clinical records. We calculated incidence of out-of-hospital cardiac arrest due to overdose per 100,000 person-years and proportion of the same among all out-of-hospital cardiac arrests. We analyzed the association between overdose cardiac arrest etiology and resuscitation outcomes.Results: Included were 56,272 cases, of which 1351 were due to overdose. Regional incidence of out-of-hospital cardiac arrest due to overdose varied between 0.5 and 2.7 per 100,000 person years (p<0.001), and proportion of the same among all treated out-of-hospital cardiac arrests ranged from 0.8% to 4.0%. Overdose cases were younger, less likely to be witnessed, and less likely to present with a shockable rhythm. Compared to non-overdose, overdose was directly associated with return of spontaneous circulation (OR: 1.55; 95% CI: 1.35-1.78) and survival (OR: 2.14; 95% CI: 1.72-2.65).Conclusions: Overdose made up 2.4% of all out-of-hospital cardiac arrest, although incidence varied up to 5-fold across regions. Overdose cases were more likely to survive than non-overdose cases. [ABSTRACT FROM AUTHOR]

The United States has been in pursuit of a conflicting objective--pursuing an "all of the above" energy policy while trying to reduce emissions that drive climate change. As the United States pursues climate mitigation objectives, renewable energy must be built out in every region of the country. This article explores the tension between renewable energy development and its visible conflicts with land and wildlife conservation and environmental protection goals. While it is certain that climate change will bring devastating harms to the planet, the adoption of an aggressive renewable energy build-out will also have environmental impacts. Managing these impacts is an important component of a sustainable energy strategy. [ABSTRACT FROM AUTHOR]

Addressing climate change demands a fundamental change in United States energy policy and a major infrastructure for a renewable energy future. Yet the boom in natural gas development and expanding demand for energy in developing nations argue poorly for reductions in fossil fuel use. This Article documents how the federal government has resorted to some measure of environmental exceptionalism by rationing environmental law to expedite renewable energy development in the context of the seismic shifts in U.S. energy policy. Despite the many arguments in opposition to rationing environmental law, this Article concludes that the realities of climate change and the lack of progress despite other minor administrative efforts support rationing as a measured response necessary to human survival. [ABSTRACT FROM AUTHOR]

Introduction. In the United States, out-of-hospital cardiac arrest from drug overdose (OD-OHCA) caused over 38,000 deaths in 2010. A study in Pittsburgh found that OD-OHCA patients differed demographically and in the resuscitation treatments they received, despite identical AHA resuscitation guidelines. We hypothesized that health-care provider perceptions affect decision-making in the treatment of OD-OHCA versus non-OD OHCA. Methods. We conducted this survey at the National Association of EMS Physicians 2013 Scientific Assembly. Physicians and non-physician health-care providers were given one of two surveys containing 19 questions pertaining to the respondents' affiliated EMS agencies, the estimated proportion of OD-OHCA as well as the drugs involved, and the respondents' belief about the treatments for OD versus non-OD OHCA. Results. One hundred ninety-three respondents participated in this survey. Of the 193, 144 (75%) were physicians and 49 (25%) were nonphysicians. Seventy-nine percent of physicians identified current status as a medical director and 76% of nonphysicians identified as a paramedic. Participants estimated the average monthly proportion of all OHCA due to OD to be 9.4%. Participants ranked opioids, alcohol, antidepressants, and benzodiazepines as the most commonly utilized agents in OD-OHCA. The majority of physicians (42%) felt that the incidence of OD-OHCA was not changing while the majority of nonphysicians (53%) felt the incidence was increasing. Eighty-four percent of all respondents reported the use of naloxone during OD-OHCA resuscitation, while 13% reported administering naloxone during non-OD OHCA resuscitation. Eighty-nine percent of physicians and 67% of nonphysicians indicated that OD-OHCA patients had different demographics than non-OD OHCA, with primary reported differences being age, comorbidities, and socioeconomic status. Sixty-three percent of physicians and 71% of nonphysicians felt that OD-OHCA patients should be treated differently, with primary differences being the incorporation of etiology-specific treatments, performing different CPR with a focus on airway support, and transporting earlier. Conclusions. When surveyed, physicians and nonphysician providers report perceiving OD-OHCA treatment, outcomes, and patient demographics differently than non-OD OHCA and making different treatment decisions based on these perceptions. This may result in etiology-oriented resuscitation in the out-of-hospital setting, despite the lack of OD-specific resuscitation guidelines. [ABSTRACT FROM AUTHOR]

The article focuses on the conversion of Rocky Mountain Arsenal National Wildlife Refuge (RMA Refuge) located in Colorado to a community asset. Topics discussed include a brief history of the Rocky Mountain Arsenal (RMA) Refuge, use of the RMA Refuge as a military installation, the significance of the RMA Refuge for the development of the Denver region, and the restoration of RMA Refuge for biological integrity, identification of causes of environmental degradation and environmental protection.

The article focuses on role of the False Claims Act (FCA) for managing and regulating the fraud. Topics discussed include the role of the U.S. Department of Justice (DOJ) in investigating the claims related to fraud, role of FCA in the reimbursement of reasonable legal fees and expenses and role of the U.S. Food and Drug Administration (FDA) in providing licenses to the healthcare industry. It further discusses the legislative history of the case law.

Introduction: The manifold consequences of adverse childhood experiences (ACEs) are well-documented. Recent research has demonstrated that sexual and gender minorities (SGMs) typically encounter ACEs more often than cisgender heterosexual individuals. Given the higher exposure rate, the measurement of frequency of exposure to traumatic events may be relevant for SGMs.Methods: We changed the response options of the ACEs index from dichotomous to a five-point Likert scale that described frequency of exposure. As part of a larger community-based participatory research study, the Likert ACEs measure was distributed to a large and diverse sample of SGM participants in San Antonio.Results: A cross-validation design demonstrated that the Likert ACEs scores outperformed the traditional ACEs index in predicting self-reported anxiety and post-traumatic stress disorder. Half of the SGMs in this sample experienced 3 or more ACEs, compared to only 10% of Americans in a nationally representative sample.Limitations: These analyses were based on retrospective self-report data instead of structured clinical interviews. Since only the Likert ACEs was administered, we had to assume that any response other than "never" on Likert ACEs corresponded to "yes" on the ACEs Index.Conclusions: Future research may assess the utility of the Likert ACEs approach with other minoritized or intersectional populations. For clinical practitioners, these results suggest that a better way to measure ACEs for SGMs is to ask them how often they were exposed, rather than asking whether they were exposed. [ABSTRACT FROM AUTHOR]

In this paper we seek to contribute to a greater understanding of legal citizenship by exploring the gendered experiences of Latin- American-origin immigrants in the greater Phoenix metropolitan area as they go through the legalization process. To explore this gendered angle we rely on in-depth interviews conducted from 1998 through 2008 with women and men from Guatemala, El Salvador, Honduras, and Mexico. The data reveal that although immigration policies and procedures are presumably gender neutral, they are in fact inflected with gendered meanings and enacted in gendered social structures. Gender ideologies permeate the processes to differentially affect the legalization, permanent legal residence, and citizenship processes of immigrant women and men. This article points to key gender inequalities in immigration law. [ABSTRACT FROM AUTHOR]

The article offers information on the amendments made to the False Claims Act (FCA) in the U.S. for recovering funds lost to fraud or abuse. It states that the U.S. Senate and the House of the Congress had put forward several amendments including expansion in the scope of reverse false claim provision to prevent concealing obligation to pay the government, revising the definition of claim and obligation. However, the expansion of the subsection to reach contingent liabilities was not accepted by the Congress.

This paper identifies a number of social demographic issues in the Latino population, including the growth and regional distribution of this population, settlement patterns, and issues related to language capabilities. The implications of these demographic issues for society, services, and social justice are discussed. [ABSTRACT FROM AUTHOR]

Reports that the federal government has increasingly used the False Claim Act against health care industry in the U.S. Primary litigative tool of the government for combating fraud; Empowerment of both the Attorney General and private persons; Institution of civil actions to enforce the Act.

Discusses several issues concerning the use of physical restraint devices and bed side rails in the geriatric rehabilitation setting in the U.S. Background on perceptions of the use of physical restraints and bed side rails to enhance patient safety and prevent injury; Details of guidelines and standards for the use of such devices; Information on several mechanisms for reporting adverse patient events.

Few studies have focused on the situation of the undocumented Mexican alien population in this country. The descriptive study reported in this article sought information on the effect of the immigrant status of documented and undocumented Mexican families, on the degree of stress they experienced, on the use of community services by the two groups, and on the motivation of undocumented aliens for emigrating from Mexico. [ABSTRACT FROM AUTHOR]

The article describes a practice model that can be used by school social workers when helping culturally diverse families. Despite the creation of numerous programs to help children achieve success, the public school system has fallen short of meeting this goal for all children. Culturally sensitive supports and interventions are receiving increased attention as key factors in the formulation of effective strategies for achieving the National Educational Goals. As increasing numbers of culturally diverse children enter schools, they will encounter students and professionals who are not of their cultural background. This situation is especially evident in the Los Angeles Unified School District, where students and staff are identified in seven major racial or ethnic groups. The 633,000 students enrolled in 1994 included 66.6 percent Hispanics, 14.4 percent African Americans, 11.6 percent whites, 4.8 percent Asian Americans, 1.9 percent Filipinos, 0.4 percent Pacific Islanders, and 0.3 percent American Indians involved with minority children and their families is based on the experiences of such families in a racist society.

This article reports that meeting the social service needs of groups disenfranchised because of social class and culture is a continuing challenge to the social work profession. In the case of the undocumented Mexican immigrant, this challenge has not yet been met. The exact number of undocumented persons in this country is unknown. The most widely publicized estimate provided to the Immigration and Naturalization Service (INS) several years ago by Lesko Associates was of 5.2 million from Mexico alone. Just as undocumented persons are outside the scope of services taken for granted by society, they are also outside the purview of academic attention. Historical literature is primarily descriptive and seeks to isolate background factors that contribute to the movement of undocumented persons. The INS and law enforcement agencies, through their arrest and immigration records provide a second major source of information on the movement of undocumented persons. The present study was conducted in Los Angeles, California between December 1980, and June 1981. The focus of the research was to explore the undocumented families' perceptions of stress, and the use of community services and informal sources of support.

This article focuses on a cross-cultural exploratory study designed to gain information specific to each ethnic group for the purpose of tailoring social services to each distinctive culture in meeting the Asian elderly service needs. The general purpose of the study was to compare specific variables between four major Asian elderly sub-groups, that is, the Japanese, Chinese, Filipino, and Korean. The more specific objectives were to obtain information on the socioeconomic conditions among the four groups; to learn where they seek assistance for their health needs; and, to discover how the Asian elderly perceive their problems of aging. The Asian elderly sampled utilized formal services with a heavy reliance on community based ethnic agencies such as senior citizens clubs, nutrition programs, and church associations. Exploration revealed that the sample's use of the Social Security office and the County Hospital only occurred when an ethnic agency employee acted as their interpreter and advocate. An important variant in the use of formal services were the Chinese, who made little use of formal service and much use of ethnic community agencies.

Outlines trends and issues regarding the involvement of physicians in home health medicine in the U.S. as of June 1999. Attempts to design reimbursement strategies and incentives to physicians; Facts on the education of physicians; Information on literature documenting physician interest and involvement in home health medicine.

Discusses the trend involves in the transition of clinical research from acute care to skilled and long-term care facilities in the U.S. Role of an institutional review board; Responsibility of the U.S. Agency for Health Care Policy and Research; Opportunities for the future of research, development and treatment.

The article describes the role of social workers during political campaigns. Challenge of political campaigns; factors that need to be considered by social workers to be effective in political campaign work; need to develop human relations skills are also discussed in the article. Meeting the social welfare needs of people affected by Reaganomics is a continuing concern of the social work profession. The impetus for social workers to become involved in politics has never been greater than in these conservative times. As an ongoing policy, Reaganomics affects, daily, the lives of many people and determines the availability of social service programs to, meet peoples' needs. U.S. President Ronald Reagan's policies concerning the best use of the taxpayer's dollar in curbing inflation have resulted in major cutbacks in social welfare programs. These cutbacks have forced social workers to advocate for the maintenance of many existing programs and to protest against any further cutbacks. In the 1980s social workers in social welfare have encountered enormous controversy regarding the need for social welfare programs. Not to participate in political activities is tantamount to acceding to the drastic cuts in funding and to the practice of narrowing the eligibility criteria to such an extent that only restricted groups.