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The article presents a discussion on future pharmacy practice and patient care delivery adapted from the American Society of Health-System Pharmacists (ASHP) leaders in June 2023. Topics covered include the need for collaboration around innovation as this creates synergy, boosts advocacies, and addresses staffing shortages, and the optimal patient care and healthcare system resiliency effected by an engaged workforce. Also noted is the ASHP's continuing efforts on diversity and inclusion.

Looks at the impact of the U.S.-led 1991 Persian Gulf War in Iraq. U.S. government's claims that only military targets were destroyed; War planners' effort to match weapons with target to minimize collateral damage; Spread of air campaign throughout Iraq and Kuwait; Casualties of war; Public facilities damaged and destroyed by the war in Iraq; Destructive conventional weapons used in the war.

Focuses on the need to reevaluate the U.S. strategic force posture. Debates regarding the size and deployment mode of the small intercontinental ballistic missile or 'Midgetman' points; Confrontations over the production of the nuclear-tipped 'missile experimental' or MX; Full-scale engineering of weapons in the U.S.

Background: This paper aims to contribute to the discussion about patient‐centred care in surgery. It is contended here that the paradigm shift towards patient‐centred decision‐making in health care does not mean that patient values alone (or those of their proxies) should, uncritically, be the lead decision makers in determining surgical care. Methods: In support of that contention, three clarifications to our conception of autonomy will be offered. Results: First, autonomy may not be best positioned as the lead principle guiding healthcare decision‐making. Second, arguably, our traditional understanding of autonomy, as it might be applied to health care, is incomplete. Third, where autonomy is vested is contentious, and proxy decision makers can further complicate the decision‐making process. Conclusion: It will be argued that an approach of inclusive, non‐coercive and reflective dialogue seeking a consensual decision amongst all those affected is more appropriate for moral decision‐making in surgery. This dialogue is set in the actual reality of the patient's illness. During the discourse, each participant has equal rights to contribute and to be heard, equal duties not to coerce and equal co‐responsibilities to share the perspectives of others in the discourse, with an aim to reach consensus. [ABSTRACT FROM AUTHOR]

Background Septic shock is common and has unacceptably high morbidity, mortality, and associated cost with numerous failed attempts at developing effective therapies. Endotoxin, one of the most potent mediators of sepsis, is found in high levels in approximately 50% of patients with septic shock. Polymyxin B (PMX) hemoperfusion has been shown in numerous studies to successfully remove endotoxin and potentially improve outcomes. EUPHRATES (Evaluating the Use of Polymyxin B Hemoperfusion in a Randomized controlled trial of Adults Treated for Endotoxemia and Septic shock) is a theragnostic trial (matching blood measurement to treatment capability) of PMX hemoperfusion in patients with septic shock and confirmed endotoxemia as measured by the endotoxin activity assay (EAA). Methods EUPHRATES is a pivotal regulatory trial that is multi-centered, placebo-controlled and blinded. The trial is being conducted in fifty ICUs in the United States and Canada and is powered to enroll 360 patients. Patients with persistent septic shock despite adequate fluid resuscitation on vasopressors for more than 2 and less than 30 hours are eligible for measurement of the EAA. Those with EAA ⩾0.60 are eligible to be randomized to treatment with two sessions of PMX hemoperfusion 24 hours apart. The primary endpoint for the trial is 28-day all-cause mortality. Discussion Unique features of the trial include absence of systemic inflammatory response (SIRS) criteria as a requirement for inclusion, use of the EAA to confirm endotoxemia as a requisite for treatment, and use of a detailed "façade" hemoperfusion event as a blinding mechanism. The outcomes of the second interim analysis included a resizing of the trial to 650 patients and the addition of an exclusion criterion of subjects with multiple organ dysfunction score (MODS) ⩽ 9. Results are anticipated in 2016. [ABSTRACT FROM AUTHOR]

National material stock (MS) accounts have been a neglected field of analysis in industrial ecology, possibly because of the difficulty in establishing such accounts. In this research, we propose a novel method to model national MS based on historical material flow data. This enables us to avoid the laborious data work involved with bottom-up accounts for stocks and to arrive at plausible levels of stock accumulation for nations. We apply the method for the United States and Japan to establish a proof of concept for two very different cases of industrial development. Looking at a period of 75 years (1930-2005), we find that per capita MS has been much higher in the United States for the entire period, but that Japan has experienced much higher growth rates throughout, in line with Japan's late industrial development. By 2005, however, both Japan and the United States arrive at a very similar level of national MS of 310 to 375 tonnes per capita, respectively. This research provides new insight into the relationship between MS and flows in national economies and enables us to extend the debate about material efficiency from a narrow perspective of throughput to a broader perspective of stocks. [ABSTRACT FROM AUTHOR]

The author reflects on the diversity, equity and inclusion program of the American Society of Health-System Pharmacists (ASHP). Topics include the effects of the COVID-19 pandemic on people of color in the U.S., the ASHP Task Force on Racial Diversity, Equity, and Inclusion recommendation like hiring of Black, Indigenous, or People of Color (BIPOC) into residency programs, and the need to expand diversity and inclusion programs in areas like hospitals and health systems.

Lignocellulosic feedstocks have high energy content and have been co-digested with sewage or manure biosolids in Europe for many years. However, it is unclear whether the current U.S. anaerobic digesters are capable of co-digesting lignocellulosic feedstocks without experiencing operational problems. We evaluated co-digestion of switchgrass with sewage biosolids under laboratory conditions similar to common U.S. digesters. Results indicated that finely-ground or ensiled switchgrass could be readily co-digested with sewage biosolids under typical U.S. digester conditions. Concentration up to 4% solids (representing up to 47% of VS added) achieved good specific methane yields and up to 74% energy conversion efficiency while maintaining acceptable VS removal. No evidence of solids accumulation, mixing problems, or floating debris was noted. However, fine-grinding switchgrass is energy intensive and likely to be cost-prohibitive. Moreover, ensiling produced a wide array of particle sizes and the effects of ensiling could not be fully separated from effects due to smaller particle size. Coarsely ground switchgrass, however, did not digest well. It had a low specific methane yield and quickly led to digester operational problems, even at the 2% solids level. Further research is needed to identify pretreatment methods that are more practical than fine-grinding. Ensiling appears promising, and should be studied under full-scale ensiling and digestion conditions to assure that observed effects were not due to smaller particle sizes achieved under laboratory conditions. Other, low-cost pretreatment methods also deserve study as a means of allowing lignocellulosic feedstocks to be co-digested in current U.S. anaerobic digesters. [ABSTRACT FROM PUBLISHER]

The article discusses the legality of the move by the U.S. Department of Defense (DoD) to initiate a cyberattack that dismantled an online forum that was allegedly created by the U.S. Central Intelligence Agency (CIA). The attack was reportedly made by the Maryland-based Joint Functional Component Command-Network Warfare. The law that covers such military action is the National Security Act of 1947.

Objective: To determine how many of the orthodontic cases covered by Indiana Medicaid between 1999–2001 would be classified pretreatment as having a malocclusion severe enough to warrant treatment Methods: Six examiners were trained and then paired together to examine 249 patient orthodontic case records, consisting either of pre-treatment photographs only, pre-treatment models only, or both pre-treatment models and photos. The examiners applied the Index of Orthodontic Treatment Needs (IOTN) to assign each case a Grade of One to Five, with Grade One representing Ideal Occlusion and Grade Five being Extreme Malocclusion. When two examiners within a pair could not agree, a third examiner reviewed the case record to determine agreement. Results: Of the 249 patient cases examined, 9 were not gradable. In the cases where only pretreatment models were available (n=157), 10% received a Grade of One or Two (Ideal Occlusion or Mild Malocclusion, respectively). Among the cases in which both pretreatment models and photos were available (n=46), 44% of the photos were graded One or Two, while only 2% of the models were graded as One or Two. In the cases where only pretreatment photographs were available (n=37), 27% of cases were Grade One or Two. Conclusion: While several of the cases (11%) submitted during the time period of 1999 to 2001 to the Indiana State Medicaid Division for reimbursement were rated as having Ideal Occlusions or Mild Malocclusions, the vast majority (89 %) were scored as having either Moderate, Severe, or Extreme Malocclusion. [ABSTRACT FROM AUTHOR]

Reports the provisions under the 1964 Economic Report laying the groundwork of Economic Opportunity Act for the poor in the United States. Theory of using taxes as means of influencing the poor; Income taxation of the poor; Taxation of participants in the employment training programs.

Focuses on the proposals for regulation of pension plans by the Committee on Employee Benefits in the United States. Prohibition on the limitation of plan coverage to salaried employees; Criticisms of the private pension system; Establishment of a pension regulatory agency.

Presents several reports on taxation of committee chairmen at the midyear meeting of council in New Orleans, Louisiana. Regulations on administrative procedure act; Legislation on affiliated and related corporations; Rules on banking institutions and regulated investment companies.

Emphasizes on the need for speech educators to plan for the effective use of improved techniques of communication. Prospects of growth of frequency modulation (FM) broadcasting; Possibility of using television in the educational field; Information supplied by the U.S. Office of Education on the use of FM technique in schools.

The article discusses the teach-ins, organized in several U.S. universities and colleges, to increase awareness about the threat of nuclear war. The Union of Concerned Scientists' (UCS), a nonprofit, public interest organization, focused on national security and arms control issues for events organized by UCS on November 11 teach ins or convocations. Seminars, speakers, marches, concerts and film festivals were attended by an estimated 10,000 students, with speakers ranging from military and government representatives to scientists and media personalities. UCS issued a "Scientists declaration," signed by prominent scientists who recommend ban on missile testing and intensive programs for nuclear non-proliferation.

Reports the activities of the committee on partnerships in the United States. Recommendations in the problem of partnerships; Explanation of a complex family partnership arrangement; Views on the Technical Corrections Act.

Presents a report of the Committee on Partnerships of the Section of Taxation of the American Bar Association. Provision of comments on the Tax Reform Act of 1976; Review of the 'Blueprint for Basic Tax Reform'; Development of definition of a partnership status for tax purposes.

Focuses on the annual report of the Committee on Employee Benefits of the American Bar Association. Integration of social security and pension plans through regulation or legislation; Guidelines for rulings on qualified plans; Recommendations from the Inter-Agency Staff Committee.

Presents a letter to the editor concerning an article about professional certification of pediatric dentists in the U.S.

The article reports that the Livestock and Urban Waste Research Team at Illinois State University has developed a systems approach for treating liquid swine manure and land applying the separated effluent that meets the regulations proposed by the U.S. Environmental Protection Agency, especially regarding odor and nutrient management. The solid/liquid separation system removes 98+% of the settleable solids, 98+% of the total suspended solids, 50+% of the nitrogen (N), and 90+% of the phosphorous (P) from raw slurry. The system would allow producers to capture the N content of separated effluent in a more stable form for use as a soil amendment without concern for the P content.

Background: Heroin smoking is associated with deprivation, early onset severe emphysema, premature morbidity and mortality, and high use of health care, but individuals engage poorly with traditional health services., Methods: In this cross-sectional study, we screened a population of heroin smokers, prescribed opiate substitution therapy by community drug services, for airway disease. We assessed drug exposure, respiratory symptoms, health status, and COPD prevalence. Subjects completed spirometry, completed Medical Research Council (MRC) Dyspnea Scale, COPD Assessment Tool (CAT) questionnaire, recorded drug exposure, and provided feedback., Results: A total of 753 people (73% of those approached) completed screening, with 260 participants (35%) having COPD using FEV 1 /FVC < 0.7 and 293 (39%) participants having COPD using the lower limit of normal. A further 112 participants (15%) had asthma-COPD overlap (ACO) with features of COPD and asthma. Compared with those with normal spirometry, participants with COPD were more breathless (MRC score 3.1 vs 1.9; P < .001) and had worse health status (CAT score 22.9 vs 13.4; P < .001), respectively. Individuals with COPD had smoked cigarettes (P < .001), heroin (P < .001), and crack (P = .03) for longer and were more likely to still be smoking heroin (P < .01). Feedback was strongly positive, with 92% of respondents happy for other health-care appointments to be colocated with drug key worker appointments., Conclusions: Most heroin smokers had COPD or ACO, most commonly mild to moderate disease. In high-risk areas, screening this population provides an opportunity to reduce symptoms and risk. Anchoring respiratory health screening to drug center appointments delivers high completion and satisfaction and is an appropriate model for screening other hard-to-reach populations., (Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Background: Lung cancer is the leading cause of death in the United States, with reported inferior survival among African-Americans., Patients and Methods: Kaplan-Meier and Cox regression methods were used to compare survival outcomes of 569 patients diagnosed with stage I non-small cell lung cancer from 2001-2010., Results: African-Americans and Whites differed significantly by age, sex, and insurance type. The median follow-up was 2.3 years. The 2-, 5- and 8-year overall survival was 72%, 47%, and 38%, respectively. Age, stage, insurance type, and surgery were significant predictors of overall survival which remained significant after adjusting for other variables, including race, gender, histology, smoking history, treatment era, chemotherapy or radiotherapy which were not., Conclusion: Insurance status but not race is an important predictor of survival in patients with stage I non-small cell lung cancer., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Background: It is known that lung cancer incidence and mortality rate are higher in African Americans (AA) than whites. In Eastern North Carolina, there is a higher percentage of AA population than the national average (30.2% vs. 12.4%) and a higher incidence of lung cancer in this region. We investigated demography and survival of lung cancer patients diagnosed and treated in a single institution., Methods: The study includes 2351 patients diagnosed with lung cancer between 2001 and 2010 at East Carolina University. AA and whites were compared by age, sex, race, stage, histology, smoking history and insurance information using chi-square analyses. Patient survival was modeled using Cox proportional hazards regression (SAS version 9.2)., Results: The distribution of lung cancer was 70% in whites and 30% in AA. The proportion of AA and whites differed significantly for age, sex, histology, stage, and insurance. Patients aged > 70 (p < 0.0001) and 51-70 (p = 0.0064) died sooner than those ≤ 50 years old. Compared with squamous cell, SCLC had inferior survival (HR = 2.0, 95% CI = 1.7-2.3). Privately insured patients survived longer than those with medicare (p < 0.0001), medicaid (p = 0.0009), or no insurance (p < 0.0001). The survival disadvantage for medicaid (p = 0.0076) and no insurance (p = 0.0033) persisted on multivariable analysis. Race was not a significant predictor of survival on multivariable analysis (p = 0.66)., Conclusion: This is one of the largest lung cancer patient populations from a single institution showing demographic differences between the two races with similar survival outcome. Age, histology and type of insurance were strong predictors of survival outcome. Older age, small cell histology and medicaid and no insurance had significantly shorter overall survival., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Context: Lung cancer is the leading cause of cancer death in the United States. Surgical resection for stage I or II non-small cell cancer remains the only reliable treatment for cure. Patients who do not undergo surgery have a median survival of less than 1 year. Despite the survival disadvantage, many patients with early-stage disease do not receive surgical care and rates are even lower for black patients., Objectives: To identify potentially modifiable factors regarding surgery in patients newly diagnosed with early-stage lung cancer and to explore why blacks undergo surgery less often than whites., Design, Setting, and Patients: Prospective cohort study with patients identified by pulmonary, oncology, thoracic surgery, and generalist practices in 5 communities through study referral or computerized tomography review protocol. A total of 437 patients with biopsy-proven or probable early-stage lung cancer were enrolled between December 2005 and December 2008. Before establishment of treatment plans, patients were administered a survey including questions about trust, patient-physician communication, attitudes toward cancer, and functional status. Information about comorbid illnesses was obtained through chart audits., Main Outcome Measure: Lung cancer surgery within 4 months of diagnosis., Results: A total of 386 patients met full eligibility criteria for lung resection surgery. The median age was 66 years (range, 26-90 years) and 29% of patients were black. The surgical rate was 66% for white patients (n = 179/273) compared with 55% for black patients (n = 62/113; P = .05). Negative perceptions of patient-physician communication manifested by a 5-point decrement on a 25-point communication scale (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.32-0.74) and negative perception of 1-year prognosis postsurgery (OR, 0.27; 95% CI, 0.14-0.50; absolute risk, 34%) were associated with decisions against surgery. Surgical rates for blacks were particularly low when they had 2 or more comorbid illnesses (13% vs 62% for <2 comorbidities; OR, 0.04 [95% CI, 0.01-0.25]; absolute risk, 49%) and when blacks lacked a regular source of care (42% with no regular care vs 57% with regular care; OR, 0.20 [95% CI, 0.10-0.43]; absolute risk, 15%)., Conclusions: A decision not to undergo surgery by patients with newly diagnosed lung cancer was independently associated with perceptions of communication and prognosis, older age, multiple comorbidities, and black race. Interventions to optimize surgery should consider these factors.