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In this book, Dennis C. Dickerson examines the long history of the African Methodist Episcopal Church and its intersection with major social movements over more than two centuries. Beginning as a religious movement in the late eighteenth century, the African Methodist Episcopal Church developed as a freedom advocate for blacks in the Atlantic World. Governance of a proud black ecclesia often clashed with its commitment to and resources for fighting slavery, segregation, and colonialism, thus limiting the full realization of the church's emancipationist ethos. Dickerson recounts how this black institution nonetheless weathered the inexorable demands produced by the Civil War, two world wars, the civil rights movement, African decolonization, and women's empowerment, resulting in its global prominence in the contemporary world. His book also integrates the history of African Methodism within the broader historical landscape of American and African-American history.
The near-infrared reflectance spectra of Pluto and its satellites are rich with diagnostic absorption bands of ices of CH4, N2, CO, H2O, and an incompletely identified ammonia-bearing molecule. Following years of investigation of the spectra of Pluto and Charon with ground-based telescopes, NASA’s New Horizons spacecraft obtained spectral maps of these bodies and three small satellites on its passage through the system on July 14, 2015, showing the distribution of these ices, as well as a colored, non-ice component. Spectral modeling mapped the distribution of the various ices and showed their abundance and mixing details in relationship to regions of differing surface elevation, albedo, and geologic structure. Additionally, owing to their greatly different degrees of volatility, the ices of Pluto are distributed in patterns responsive to Pluto’s climatic changes on both short and long terms. The surface of Charon is dominated spectrally by H2O ice with one or more ammoniated compounds, and three of the four very small satellites show both H2O ice and the ammonia signature.
Neonates may require increased red cell mass to optimise oxygen content after stage 1 palliation; however, data informing transfusion practices are limited. We hypothesise there is a patient-, provider-, and institution-based heterogeneity in red cell transfusion decision-making after stage 1 palliation.
We conducted an online survey of Pediatric Cardiac Intensive Care Society practitioners in 2016. Respondents answered scenario-based questions that defined transfusion indications and identified haematocrit transfusion thresholds. Respondents were divided into restrictive and liberal groups based on a haematocrit score. Fisher’s exact test was used to determine the associations between transfusion likelihood and patient, provider, and institutional characteristics. Bonferroni correction was applied to adjust the p-value to 0.004 for multiple comparisons.
There was a 21% response rate (116 responses). Most were male (58.6%), attending physicians (85.3%) with >5 year of intensive care experience (88.7%) and subspeciality training in critical care medicine (47.4%). The majority of institutions were academic (96.6%), with a separate cardiac ICU (86.2%), and performed >10 stage 1 palliation cases annually (68.1%). After Bonferroni correction, there were no significant patient, respondent, or institutional differences between the restrictive and liberal groups. No respondent or institutional characteristics influenced transfusion decision-making after stage 1 palliation.
Decision-making around red cell transfusion after stage 1 palliation is heterogeneous. We found no clear relationships between patient, respondent, or institutional characteristics and transfusion decision-making among surveyed respondents. Given the lack of existing data informing red cell transfusion after stage 1 palliation, further studies are necessary to inform evidence-based guidelines.
Mental health patients can experience involuntary treatment as disempowering and stigmatising, and contact with recovered peers is cited as important for countering stigma and fostering agency and autonomy integral to recovery.
To advance understanding of the interaction between involuntary treatment and contact with recovered peers, and explore hypothesised relationships to mechanisms of self-evaluation relevant to recovery.
Eighty-nine adults diagnosed with serious mental illness completed items to assess involuntary treatment experience and the extent of prior contact with recovered peers, the Internalised Stigma of Mental Illness Scale, the Self-efficacy for Personal Recovery Scale, the Questionnaire about the Process of Recovery and relevant demographic and clinical scales.
Contact with recovered peers was found to moderate the effects of involuntary treatment on internalised stigma. Sequential conditional process models (i.e. moderated mediation) then demonstrated that conditional internalised stigma (i.e. moderated by contact with recovered peers) mediated the indirect effect of involuntary treatment on recovery-specific self-efficacy, which in turn influenced recovery. Compared with those with low contact with recovered peers, recovery scores were 3.54 points higher for those with high contact.
Although study methods limit causative conclusions, findings are consistent with proposals that contact with recovered peers may be helpful for this patient group, and suggest this may be particularly relevant for those with involuntary treatment experience. Directions for future research, to further clarify measurement and conceptual tensions relating to the study of (dis)empowering experiences in mental health services, are discussed in detail.
This chapter discusses the four main components of acute ischemic stroke care. The sections on prevention of complications, and recovery and rehabilitation, are applicable to both ischemic and hemorrhagic stroke patients.
Non-contrast CT (NCCT) of the head remains the standard procedure for the initial evaluation of stroke.
In the emergent initial evaluation of an acute stroke patient in the emergency department, NCCT remains the imaging modality utilized in most hospitals worldwide, with the exception of a few centers that have dedicated MRI capabilities for stroke. NCCT has the advantages of being widely available, relatively inexpensive, and fast to perform, but the disadvantages of radiation exposure and not being able to exclude stroke mimics such as complicated migraine and peripheral vertigo, as compared to MRI. The clinical presentation of a patient with an intracerebral hemorrhage can be indistinguishable from that of an ischemic stroke.
In this chapter, we consider spontaneous hemorrhage into the brain parenchyma and ventricles (intracerebral hemorrhage, ICH). Non-traumatic bleeding into the subarachnoid space (subarachnoid hemorrhage, SAH) is covered in Chapter 13. Traumatic subdural and epidural hemorrhages are not covered in this book.
Intracerebral hemorrhage is associated with very high morbidity and mortality. It is important to realize that, as with acute ischemic strokes, time is of the essence in ICH. The reason for this is that the blood accumulates rapidly, and the volume of the hematoma is the most important determinant of outcome.
As acute stroke therapies have developed, the context in which stroke care is provided has become more important. Creating and maintaining the organization of stroke care within a region or even a hospital requires much commitment and effort. High-quality stroke care requires coordination and communication between multiple stakeholders in the prehospital and in-hospital settings in what the American Heart Association (AHA) and American Stroke Association (ASA) term the “stroke chain of survival” (Table 14.1).
This chapter covers the diagnosis and management of spontaneous subarachnoid hemorrhage due to rupture of intracranial aneurysms. At the end of the chapter we also discuss unruptured intracranial aneurysms. Much SAH management is not based on good-quality evidence. Much of what is recommended here comes from published practice guidelines and what is commonly practiced. Options for therapy might be limited by the availability and experience of persons performing surgery, endovascular therapy, and neurointensive care.
The following initial measures apply to all stroke patients. They are necessary to stabilize and assess the patient, and prepare for definitive therapy. All current and, probably, future stroke therapies for both ischemic and hemorrhagic stroke are best implemented as fast as possible, so these things need to be done quickly. This is the general order to do things, but in reality, in order to speed the process, these measures are usually dealt with simultaneously. They are best addressed in the ED, where urgent care pathways for stroke should be established and part of the routine (see Chapter 14).