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4 results

  • Chapter 9 - Transamerican Literature
  • from Part II - Networks
  • Edited by Cody Marrs, University of Georgia
  • Book: American Literature in Transition, 1851–1877
  • Published online: 15 June 2022
  • Print publication: 23 June 2022, pp 145-158
  • View extract

    Summary

    More than four decades before the USA and Spain engaged in the open warfare that resulted in the end of direct Spanish imperialism in the western hemisphere, a minor diplomatic incident nearly plunged the two countries into early war. On February 28, 1854, the cargo steamship the Black Warrior entered the port of Havana as it had dozens of times previously, but on this occasion, the ship was seized by the Spanish colonial authorities. Under the leadership of Captain Bullock, the ship, with its cargo of goods and transit passengers, was detained, accused of failing to pay taxes on the commercial goods. A dispute over a mere technicality about the ship’s right to modify its customs declarations escalated into a full-blown international incident that immediately drew national and international attention, and even US President Pierce and the House of Representatives issued an official public inquiry into the matter.1 After several weeks of tense exchange and negotiations, the ship and its cargo were released with a fine of approximately $6000. The matter had, it seemed, been put to rest; however, the fallout of the affair simmered and intensified, threatening to trigger a war and exposing some of the most important issues affecting the nation.

  • PP399 Analysis Of Referral Patterns To Specialized Centers In Idiopathic Pulmonary Fibrosis To Define A New Regional Care Pathway
  • Rossella Di Bidino, Luca Richeldi, Paola Rogliani, Alfredo Sebastiani, Alberto Ricci, Francesco Varone, Americo Cicchetti
  • Journal: International Journal of Technology Assessment in Health Care / Volume 36 / Issue S1 / December 2020
  • Published online by Cambridge University Press: 28 December 2020, p. 33
  • Print publication: December 2020
  • View abstract
    Introduction

    Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease. Due to insufficient awareness of the disease, and the lack of specificity of clinical and physiological signs, the diagnosis of IPF is often delayed. In the Lazio Region (Italy) four reference centers manage patients with IPF. The objective of this analysis is to support the definition of a new regional care and therapeutic pathway (Percorso Diagnostico Terapeutico Assistenziale [PDTA]) for IPF to anticipate the moment of diagnosis by reference centers. The delayed referral to specialized centers has clinical consequences both in terms of survival and access to treatments.

    Methods

    A survey collected aggregated evidence on factors associated with referral patterns to specialized centers for IPF. Its content was defined on the basis of a literature search, the experience of involved clinicians, and hospital data sources. The survey considered patients diagnosed with IPF by the network of reference centers from 2014 to 2018. Aggregated data on the pre-diagnosis pathway and evidence on organizational features of each reference center were collected.

    Results

    Patients with a confirmed diagnosis of IPF increased from 2014 (n = 81) to 2018 (n = 344). A similar trend emerged considering only older patients. Incidence rates reached 11.33 cases per 100,000 residents in 2018. The majority of patients had a diagnosis in time to access to available treatments (87% in 2018). The number of specialists in multidisciplinary teams didn't change in a significant way. GPs, pneumologists, and IPF centers emerged as the pillar of the de-facto PDTA.

    Conclusions

    A new regional care and therapeutic pathway has been proposed to improve treatment of IPF. The first goal is to improve interaction among GPs, pneumologists, and IPF centers along the natural course of the disease. Criteria for referral to IPF centers has been defined (i.e. high-resolution computed tomography) as well as for adoption of a hub-and-spoke approach based on telemedicine.