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INTRODUCTION: Trauma Assessment Clinic (TAC) has become a very useful tool in managing busy trauma clinics and reducing attendances. There is good evidence of safety and efficacy. Extension of pre-existing TAC during the COVID pandemic has proven successful. Rapid start-up models for establishing TACs are not well described in the literature. This study aimed to prove that a modified TAC has similar efficacy and can be initiated in rapid start-up manner with minimal cost. METHODS: A new electronic pathway of referral with a template was created between the Emergency Department (ED) and the Orthopaedic department. RESULTS: Following introduction of our modified TAC 32% of patients referred to the TAC did not require in-person review thereby avoiding any additional hospital visit. Average time to first in-person review appointment was 15 days. Combining these, the projected reduction in all fracture clinic attendance was 48%. CONCLUSION: This paper describes the process of how a major teaching and tertiary referral orthopaedic unit developed an accelerated establishment process for a Trauma Assessment Clinic as an alternative to the traditional “Glasgow model”. This can be instituted quickly, safely, and is scalable for use in a large hospital. The template provided can be used as a guide or “blueprint” should other orthopaedic departments require a rapid start-up of a Trauma Assessment Clinic.

IntroductionPrescribing naloxone is recommended by the Centers for Disease Control and Prevention to reduce the risk of death from an opioid overdose. Naloxone is rarely prescribed, even when indicated; improving our understanding of how primary care providers (PCP) perceive their role in naloxone prescribing is essential to increase opioid medication safety. The objectives of this study were to: (1) describe how PCPs perceive their role in prescribing naloxone for patients who are at high risk of an overdose and (2) describe PCP-reported barriers and facilitators of naloxone prescribing.MethodsCurrently practicing providers completed semi-structured interviews, based on Theory of Planned Behavior, to understand their attitudes toward naloxone, their perceived role in naloxone prescribing, and facilitators/barriers to prescribing naloxone.ResultsEleven interviews were conducted with physicians (n=2), physician assistants (n=8), and a nurse practitioner (n=1). Providers held generally positive attitudes toward naloxone as a ‘rescue’ medication. Negative attitudes toward naloxone include the perception of facilitating risky opioid use. Providers suggested that whomever prescribes the opioid pain medication should be primarily responsible for prescribing naloxone. Providers noted that stigma may prevent them from discussing naloxone during clinic visits. Increasing visit time and receiving support/education from organizational and professional society leadership were identified as important facilitators of naloxone prescribing.ConclusionsWhile providers were aware of what naloxone was used for, there was reticence in discussing this medication with patients. Providers reported that whomever prescribes a pain medication should be primarily responsible for ensuring medication safety. If primary care organizations would like to improve opioid medication safety, ensuring that providers feel supported and receive needed education are essential.

Opioid use disorder (OUD) disproportionately affects military Veterans, who are more likely than the general population to experience chronic pain. A community–academic partnership launched a community-engaged research (CEnR) project designed to train Veteran peer mentor specialists to prevent and reduce opioid abuse among Veterans. A series of focus groups were conducted to obtain community input for the development of an opioid prevention curriculum to be utilized by peer mentor specialists. The focus group participants’ experiences contributed to nuanced perspectives that fostered appreciation of knowledge and service gaps by using a CEnR approach. The themes that emerged informed a curriculum with key concepts related to opioid abuse and recovery for peer mentor specialists providing peer support for Veterans. Integrating research with community input and partnerships optimizes the opportunity to address aspects of OUD experienced by Veterans and closes a significant gap in this area of study and practice.

Éphésiens 2 décrit l’offre de salut aux nations (les païens) comme ayant été rendue possible « par le sang de Christ » (2,13) et « par la croix du Christ » (2,16). La recherche actuelle tient pour acquis que le salut des nations dépend d’une troisième condition, à savoir leur incorporation dans la cité d’Israël. Une étude des lecteurs implicites et de l’auteur implicite de la lettre mène à une conclusion différente. Ce que Dieu accomplit dans le Christ a été ordonné avant la fondation du monde et a préséance sur toute revendication juive au privilège découlant des « alliances de la promesse ». Dans le Christ, Dieu abolit la Loi et fonde une nouvelle communauté de justice et de vérité. Les saints d’Éphèse y rejoignent les saints d’ailleurs dans le monde pour s’opposer à l’esprit à l’oeuvre dans l’Empire romain et aux fils de la désobéissance qui sont ses fidèles soutiens et alliés., Ephesians 2 describes the offer of salvation to the nations (pagans) as having been made possible “by the blood of Christ” (2:13) and “through the cross of Christ” (2:16). In current research, a third condition for the salvation of the nations is believed to be present. Researchers have taken for granted that pagans must first be incorporated into the commonwealth of Israel before they can be saved. A study of the implied readers and implied author of the letter points to other conclusions. What God is doing in Christ was ordained before the foundations of the world and thus supersedes any Jewish claims of privilege flowing from the historical “covenants of promise”. In Christ, God abolishes the Law and founds a new commonwealth of justice and truth, in which the saints at Ephesus join the saints everywhere in their opposition to the spirit at work in the Roman Empire and its supporters.

This paper presents a comparative study of teacher accountability between teachers in China and Canada. The investigation examined data using cultural and social differences toward accountability as a guide. A questionnaire developed was used to measure teacher dispositions toward internal (professional) accountability and external (bureaucratic) accountability and to determine if there were differences between teachers in the two countries, China and Canada. T-tests, analysis of variance (ANOVA), and other measures of central tendencies were used to analyze data in the Statistical Package for Social Sciences (SPSS) Version 20. Canadian teacher scores (n = 169) for external accountability (M = 4.55; SD = 0.44) were higher than teacher scores for internal accountability (M = 3.81; SD = 0.60). No differences between urban and rural areas were observed among Canadian teachers. Results showed that the means of external accountability (M = 4.13; SD = 0.59) were higher than those of internal accountability (M = 3.59; SD = 0.50) among Chinese teachers (n = 284). Canadian teacher scores were higher than Chinese teacher on both measures; the results for both external and internal accountability were found to be statistically significant. The differences suggest that further study and analyses are necessary to determine the cultural and educational implications of these differences.

Most attempts to explain Romans 13:1-7 proceed from the premise that Paul is speaking plainly and directly as he recommends that Christians adopt a respectful and obedient attitude towards those servants of god, the Roman authorities. Historically, Christians have read the passage as an endorsement of all governmental authority, a conclusion which appears repugnant to most exegetes in the wake of the Shoah and similar government-sponsored atrocities. While some authors explain the passage away by supposing it to be an interpolation, others maintain that it becomes understandable only if one takes into account a very particular set of historical circumstances. Given that elsewhere Paul clearly condemns the lords of the age and their magistrates—most notably for the crucifixion of Jesus and their corrupt practises—a reading of his recommendation in Romans 13 at face value produces insurmountable internal contradictions in the Pauline corpus. When this passage is approached with literary sensibilities, another interpretive option presents itself. The following article proposes an ironic reading of Romans 13:1-7 based on an analysis of a set of internal textual clues (suggested by the theoretical work of Wayne Booth) and supported by recent research into the relations between the nascent church and the oppressive Roman Principate.

Quel est le genre littéraire des évangiles ? Sont-ils des biographies ? Des légendes héroïques ? Faut-il les classer tous dans le même genre ? En cherchant une réponse à ces questions, la critique biblique a souvent eu recours à une approche de littérature comparée, cherchant des ressemblances entre les évangiles et d’autres ouvrages antiques. On essaie de repérer des ressemblances formelles entre deux contenus figés, entre deux corpus « apparemment » finis. Du moment où l’on abandonne l’idée du texte comme un objet statique en faveur d’une conception dynamique du texte comme événement vécu par le lecteur, cette approche se heurte à des obstacles majeurs. L’auteur prétend que la classification générique des évangiles exigerait un procédé plus subtil que la simple comparaison formelle ou thématique des textes et il essaie de montrer que le genre d’un texte ne peut se spécifier sans référence aux effets produits chez le lecteur., Are the gospels biographies ? Heroic legends ? To what literary genre do they belong ? Should they all be lumped into a single genre ? In seeking answers to questions such as these, biblical criticism often makes use of the techniques of comparative literature. Exegetes look for formal and thematic similarities between two static entities, two works that are, by all accounts, “finished.” The moment one abandons the idea of a text as a static object in favour of a more dynamic view of the text as an event which the reader experiences, this approach runs up against some major obstacles. The author maintains that the generic classification of the gospels requires a far more subtle approach than the simple comparison of texts on the basis of formal or thematic characteristics and tries to show that genre cannot be specified without reference to the effects produced in the reader.

Mc 4, 10-12 comporte une allusion évidente à Is 6, 9-10. Ayant déjà publié une étude sur le texte d'Isaïe, l'auteur met en parallèle le caractère ironique de la mission prophétique que reçoit Isaïe et les remarques « taquines » que Jésus adresse au lecteur ou à la lectrice, pour ainsi dire « dans le dos » des disciples. S'il est vrai que d'autres ont déjà décrit l'ironie des paroles de Jésus dans ce passage, cet article est le premier à suggérer que le ton du texte marcien s'inspire de l'ironie isaïenne.

In this chapter, I argue that the experience of literature is often liberating; at its best, it is transcendent. It would be a mistake to think such that experiences are only open to adults and not to children. Stories allow us to live vicariously, to assume new identities, to form new relationships with heretofore unknown persons and to reassess the world from novel vantage points. The literary imagination is infectious in its ability to suggest novel and hopeful ways of responding to the challenges life throws at us. Through narrative, we become conscious of our own ability to tell a new story about our everyday world. Things which we formerly accepted as incontrovertible facts, historically and scientifically established, prove to be malleable and open to amendment once we weave a new tale around them.

The sensitivity of state budgets to economic cycles contributes to fluctuations in health coverage, eligibility, benefits and provider payment levels in public programs, as well as support for safety net hospitals and community health centers (CHCs). The aftershocks of the 2001 recession on state budgets were felt well into 2004. More recently, the economic recovery allowed many states to restore cuts and, in some cases, expand health services for low-income people, according to findings from the Center for Studying Health System Change's (HSC) 2007 site visits to 12 nationally representative metropolitan communities. Along with bolstering support of safety net providers and raising Medicaid payments for private physicians, some states advanced even more ambitious health reform proposals. Yet across communities, safety net systems face mounting challenges of caring for more uninsured patients, and these pressures will likely increase given the current economic downturn.

As key providers of preventive and primary care for underserved people, including the uninsured, community health centers (CHCs) are the backbone of the U.S. health care safety net. Despite significant federal funding increases, community health centers are struggling to meet rising demand for care, particularly for specialty medical, dental and mental health services, according to findings from the Center for Studying Health System Change's (HSC) 2007 site visits to 12 nationally representative metropolitan communities. Health centers are responding to these pressures by expanding capacity and adding services but confront staffing, resource and other constraints. At the same time, CHCs are facing other demands, including increased quality reporting expectations, addressing racial and ethnic disparities, developing electronic medical records, and preparing for public health emergencies.

Provides a timely profile of how managed care plans—especially those at financial risk—structure their networks and pay providers, finding that contractual arrangements between plans and providers are complex and diverse across and within networks. Furthermore, HMO contracts with intermediate entities usually involve transferring a substantial degree of provider risk through capitation.

Utilisé comme test décisif pour la fiabilité historique de Luc, le décret apostolique d’Ac 15,23-29 impose quatre interdictions aux chrétiens non juifs. Bien que normalement considéré comme la raison d’être de la Conférence apostolique, la dispute à Antioche sur la commensalité entre Juifs et Gentils (Ga 2) s’avère postérieure au décret et révèle un conflit interprétatif concernant les implications du Décret (Böttrich). Dans un monde où rituel, politique et éthique sont inextricablement liés, le refus de participer aux rituels païens signifie aussi un éloignement des valeurs et structures oppressives de la méritocratie romaine. Ac 15 décrit la manière dont les chrétiens doivent résoudre des litiges (ethniques), une démarche qui contraste symboliquement avec la militaro-politique de Rome. Si Luc peut éluder certains détails historiques, il établit clairement une opposition entre la politique impériale et les valeurs égalitaire et pacifiste de la jeune ἐκκλησία chrétienne. Sur cette question centrale, lui et Paul parlent d’une seule voix., Used as a litmus test for Luke’s historical reliability, the Apostolic Decree of Ac 15,23-29 contains four prohibitions directed at Gentile Christians. Although normally considered to be the raison d’être of the apostolic conference, the dispute about table fellowship between Jews and Gentiles at Antioch (Ga 2) postdates the decree and in fact describes a dispute about the decree’s meaning (Böttrich). In a world where ritual, politics and ethics are inextricably linked, prohibiting Christians from participating in pagan temple activities will avoid any appearance of support for the values and oppressive structures of the Roman meritocracy. Acts 15 offers an example of how Christians should resolve (ethnic) disputes which contrasts symbolically with the militaristic politics of Rome. While Luke may be fudging historical details, the distance he establishes between imperial politics and Christian egalitarian and pacifist values is clear. On this central issue, he and Paul speak with one voice.

On considère généralement la série catéchétique Viens vers le Père (VVLP) comme le produit le plus achevé du renouveau catéchétique canadien. Étant donné l’absence de centre d’études supérieures en catéchétique au Canada durant les années 1950, les influences intellectuelles qui ont finalement façonné et le renouveau catéchétique canadien et la série VVLP, venaient principalement de sources européennes. L’auteur identifie les principales contributions des catéchètes français, belges et allemands, précise l’influence des Semaines internationales de catéchèse, et montre l’apport de ces divers facteurs dans la série VVLP., Viens vers le Père (VVLP), a landmark catechetical series, is widely regarded as the most important product of the Canadian catechetical renewal. Given the absence of centers for higher catechetical study in Canada in the 1950s, the intellectual influences which eventually gave shape to both the Canadian catechetical renewal and the VVLP series came principally from European sources. Having identified the chief contributions of the catechetical scenes in France, Belgium and Germany, as well as the influence of the International Catechetical Study Weeks, the author demonstrates where, specifically, these influences may be detected in VVLP.

Looks at the characteristics and responsibilities of organizations that mediate risk and care management responsibility between managed care organizations and individual providers, finding that some are experiencing serious financial problems.

Since enacting comprehensive health care reform in 2003, Maine's Dirigo Health program has helped expand coverage for low- and moderate-income individuals. By September 2006, about 16,100 individuals were enrolled in two coverage initiatives—DirigoChoice, a subsidized insurance product, and a Medicaid eligibility expansion for low-income parents of dependent children. While these programs are making health coverage more affordable to low-income individuals, small firms, and sole proprietors, with subsidies targeting those most in need, by late 2006 the initiatives had enrolled less than 10 percent of previously uninsured residents. To pay for this expanded coverage, Maine has utilized savings in the overall health care system due to lower uncompensated care and cost controls. However, the funds raised thus far are insufficient to pay for greater subsidized enrollment in Dirigo programs, leading to a search for other financing sources to sustain the program.

L’interprétation politique du NT a rencontré de sérieuses objections dans l’histoire de l’exégèse. Contre cette tendance, l’auteur tente ici une interprétation des récits néotestamentaires à l’aide de la critique idéologique. Plus spécifiquement, il interprète les évangiles comme contre-récit du récit dominant impérial en juxtaposant le Christ et l’empereur, les pratiques instituées de l’ekklēsia et celles de l’Empire. Cette comparaison s’appuie sur une analyse originale des rapports pouvant exister entre narrativité, religion et politique. La première étape de cette recherche consiste en une analyse de l’utilisation du genre narratif par des acteurs politiques ou religieux pour convaincre leur public de la viabilité de leur vision d’avenir., Biblical critics have traditionally objected to political interpretations of the NT. Bucking this trend, the author uses ideological criticism to interpret NT narratives from a political perspective. More specifically, he interprets the Christian story as a counter-story to the dominant narrative of imperial Rome, juxtaposing Christ and emperor, the institutionalized practices of ekklēsia and empire. This comparison is based on an original analysis of the relationships between narrative, religion and politics. As a first step, the author considers the use of the narrative genre by political or religious actors to convince an audience of the viability of their vision for the future.

Issue du monde anglo-americain, la critique reader-response demeure une methode peu connue des exegetes d'expression francaise. L'article introduit a celle-ci tout en la situant par rapport a ses concurrents hermeneutiques. L'oeuvre de Stanley Fish, un representant de l'aile radicale de cette approche interpretative, sert de point de repere dans la premiere partie de l'article. La deuxieme partie analyse l'application que Robert M. Fowler fait de la critique reader-response dans les etudes neo-testamentaires. L'auteur distingue la version fowlerienne de la version plus radicale de Fish.

Provides a timely profile of how managed care plans—especially those at financial risk—structure their networks and pay providers, finding that contractual arrangements between plans and providers are complex and diverse across and within networks.

Potatoes were planted on 5 May in Sunderland, Massachusetts. However, during the first week of Jun, ca. 9 inches of rain in a 2 day period destroyed the crop. Superior’ potatoes were replanted on 28 Jun. The soil type was a fine sandy loam with pH ca. 5.6. Treatments were replicated 3 times in a completely randomized design. Each plot consisted of two 30-ft rows, 3 ft apart. A fallow area of 6 ft separated each plot. Foliar applications were applied using a 3 gal stainless steel CO2-pressurized sprayer at 40 psi with a delivery rate of 60 gal per acre. Applications were made on 31 Jul, 7 Aug, 14 Aug and 20 Aug. Pydrin plus piperonyl butoxide (PBO) was applied to the Kryocide plus Pydrin plot on 31 Jul only. Thereafter, only Kryocide was applied. In addition to the preapplication count on 31 Jul, plots were evaluated 3-4 days following each application bv counting CPB adults and larvae on each of 10 randomly selected stalks per plot. Defoliation was evaluated on 16 Aug, rating plots from 1(0-15% defoliation) to 5(85-100%).