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The article discusses the results of a study on the link between the mortality rate of COVID-19 and medical complications during hospital admissions of patients in the Southeastern U.S. Topics mentioned include the relation between code status downgrades, patient complications, and mortality, the impact of COVID-19 on palliative care and informed code status downgrades, and a discussion on life-sustaining interventions.

The vast majority of U.S. school districts are considered independent and have taxing authority; the remaining districts rely on revenue and budgetary approval from their local government. In the latter case, localities often use some form of negotiated process to determine the amount of revenue their school districts will receive. Typically, a school district develops a budget based on its projected needs and wants, often exceeding what it actually expects to get. The local government announces a prospective revenue transfer for the schools--an amount that is often lower than what it will likely provide. Like other school districts in Virginia, Prince William County Public Schools (PWCS) depends on the county government for overall budget appropriation and for a share of local revenues. This school district uses a revenue-sharing agreement with the county government to reduce animosity, add transparency, and enhance revenue forecasts.

Septima Poinsette Clark is a name that should be as familiar to us as Rosa Parks. Both women contributed significantly to the African American freedom struggle, and striking similarities exist [...]

Describes the nature of elementary particles, quarks, leptons, and bosons. Indicates the possibility of a fourth family of quarks. Predicts the nature of the lepton relatives. (YP)

An excerpt from the book "Creating Choice: A Community Responds to the Need for Abortion and Birth Control, 1961-1973," by David P. Cline is presented which focuses on the incidence of abortion and birth control in Massachusetts.

An interview with African-American athlete and civil rights activist John Carlos is presented. He describes his childhood in Harlem, New York City and the impact of the widespread use of heroin on his community. Carlos explains his move to protest against racial discrimination at the 1968 Olympics. He also discusses the influence of several African-American leaders, including Marcus Garvey, Malcolm X and Dr. Martin Luther King Jr.

Introduction: The HEART Pathway is a diagnostic protocol designed to identify low-risk patients presenting to the emergency department with chest pain that are safe for early discharge. This protocol has been shown to significantly decrease health care resource utilization compared with usual care. However, the impact of the HEART Pathway on the cost of care has yet to be reported.Methods and Results: We performed a cost analysis of patients enrolled in the HEART Pathway trial, which randomized participants to either usual care or the HEART Pathway protocol. For low-risk patients, the HEART Pathway recommended early discharge from the emergency department without further testing. We compared index visit cost, cost at 30 days, and cardiac-related health care cost at 30 days between the 2 treatment arms. Costs for each patient included facility and professional costs. Cost at 30 days included total inpatient and outpatient costs, including the index encounter, regardless of etiology. Cardiac-related health care cost at 30 days included the index encounter and costs adjudicated to be cardiac-related within that period. Two hundred seventy of the 282 patients enrolled in the trial had cost data available for analysis. There was a significant reduction in cost for the HEART Pathway group at 30 days (median cost savings of $216 per individual), which was most evident in low-risk (Thrombolysis In Myocardial Infarction score of 0-1) patients (median savings of $253 per patient) and driven primarily by lower cardiac diagnostic costs in the HEART Pathway group.Conclusions: Using the HEART Pathway as a decision aid for patients with undifferentiated chest pain resulted in significant cost savings. [ABSTRACT FROM AUTHOR]

Background: The HEART Pathway is a decision aid designed to identify emergency department patients with acute chest pain for early discharge. No randomized trials have compared the HEART Pathway with usual care.Methods and Results: Adult emergency department patients with symptoms related to acute coronary syndrome without ST-elevation on ECG (n=282) were randomized to the HEART Pathway or usual care. In the HEART Pathway arm, emergency department providers used the HEART score, a validated decision aid, and troponin measures at 0 and 3 hours to identify patients for early discharge. Usual care was based on American College of Cardiology/American Heart Association guidelines. The primary outcome, objective cardiac testing (stress testing or angiography), and secondary outcomes, index length of stay, early discharge, and major adverse cardiac events (death, myocardial infarction, or coronary revascularization), were assessed at 30 days by phone interview and record review. Participants had a mean age of 53 years, 16% had previous myocardial infarction, and 6% (95% confidence interval, 3.6%-9.5%) had major adverse cardiac events within 30 days of randomization. Compared with usual care, use of the HEART Pathway decreased objective cardiac testing at 30 days by 12.1% (68.8% versus 56.7%; P=0.048) and length of stay by 12 hours (9.9 versus 21.9 hours; P=0.013) and increased early discharges by 21.3% (39.7% versus 18.4%; P<0.001). No patients identified for early discharge had major adverse cardiac events within 30 days.Conclusions: The HEART Pathway reduces objective cardiac testing during 30 days, shortens length of stay, and increases early discharges. These important efficiency gains occurred without any patients identified for early discharge suffering MACE at 30 days.Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique Identifier: NCT01665521. [ABSTRACT FROM AUTHOR]

Abstract: This review updates concepts of hypertension evaluation and management in patients presenting to the emergency department. It outlines the current challenges faced by emergency physicians in the identification and management of hypertensive patients: In spite of published emergency care guidelines, identification and referral rates remain low in patients presenting to the emergency department with moderate blood pressure (BP) elevations. In patients with severely elevated BP, the evaluation for acute end organ damage remains inconsistent and is symptom-based. Using current consensus guidelines, this review provides an algorithm for the management of the hypertensive emergency department patient. The final section of this review outlines management strategies for specific hypertensive emergencies. [Copyright &y& Elsevier]

Objectives: We describe clinician-reported knowledge of the Joint National Committee (JNC7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure definitions of Stage I hypertension; perceived causes of elevated blood pressure; barriers to blood pressure re-assessment; risk of adverse events associated with the elevated blood pressure. Methods: Health care providers from five emergency departments completed a questionnaire assessing knowledge of blood pressure criteria for hypertension, perceived causes of elevated blood pressures, barriers to re-assessment, and perceived risk of an adverse event at one year in a patient within three defined systolic and diastolic blood pressure ranges. Descriptive statistics were used to analyze the data. Results: Seventy-two percent (379/524) of providers (68 attending physicians, 87 residents, 209 nurses, and 15 nurse practitioners) completed questionnaires. One hundred and four providers (27%) correctly listed the systolic and diastolic criteria for Stage 1 hypertension. Nurses and physicians rated uncontrolled, known hypertension [mean (standard deviation)] [8.7 (2.1), 8.9 (1.9)] the highest and pain [8.3 (2.3), 8.3 (2.1)] as the second highest cause of elevated BP. Nurses and physicians rated the lack of time to perform a reassessment [5.2 (3.4), 4.7 (2.8)] and a lack of adequate staffing [4.7 (3.4), 4.6 (2.9)] the highest as barriers to re-assessment. Nurses'' mean adverse risk assessment twice that of physicians. Discussion: Twenty seven percent of providers were aware of the JNC7 criteria and often attributed elevated blood pressures to chronic, uncontrolled hypertension, pain or anxiety. No single barrier to repeating elevated blood pressures was identified. [Copyright &y& Elsevier]

A sexual assault nurse examiner role exemplifies the high-stress and highly emotional patient interactions that are often associated with burnout. The purpose of this study was to examine the frequency of burnout among sexual assault nurse examiners in North Carolina. This cross-sectional study was an anonymous survey of practicing sexual assault nurse examiners within North Carolina using the Maslach Burnout Inventory and additional demographics. Results were analyzed with odds ratios, confidence intervals, Fisher exact, chi-square, and Kruskal Wallis tests as appropriate. Among 95 respondents, burnout was more frequent in sexual assault nurse examiners who stopped both emergency and nurse examiner work (55.6%, odds ratio 4.41, 95% confidence interval 1.07-18.06) and in dual function nurses (both emergency and nurse examiner work, 35.7%, odds ratio 2.71, 95% confidence interval 1.04-7.06). Sexual assault nurse examiners who had a high percentage of pediatric cases (above the median of 40%) were more likely to meet burnout thresholds for emotional exhaustion scores > 26 (48.78% vs 25.93%, χ2 = 5.30, P =.02) and more likely to meet burnout thresholds for depersonalization scores > 9 (48.78% vs 24.07%, χ2 = 6.28, P =.01). Higher frequency of burnout threshold criteria was found in those people who worked concurrently as a sexual assault nurse examiner and an emergency nurse and in those who had retired from both specialties. We also found that sexual assault nurse examiners with a higher case mix of pediatric cases had higher emotional exhaustion scores and higher depersonalization scores. [ABSTRACT FROM AUTHOR]

The article discusses the advocacy of Janine Licare-Andrews, founder of Kids Saving the Rainforest, to preserve the condition of rainforest in Costa Rica. It states that Licare-Andrews was helped by her friend Aislin Livingstone to sell painted rocks and crafts wherein the proceed was used to finance the protection of rainforest and endangered wildlife. It also cites the teaching strategies on how to increase students awareness on the importance of protecting rainforest.