Search

Party vibrancy can help parties reproduce themselves, but many long-lasting parties have exhausted former levels of vibrancy, and many new parties emerge and never form the intense connections that vibrancy entails. Yet while entrepreneurs forming parties under democracy may have the option to sidetrack developing party structures, new parties can and do build extensive grassroots networks. I suspect that many parties that Luna et al. code as fulfilling the core tasks of political parties would generate sufficient attachment from activists that Rosenblatt would code them as being vibrant, while most diminished subtype parties would not. Party History and Organization Ackerman focuses on the opportunities parties have to build connections with the public, and Van Dyck focuses on the incentives that parties have to do so. [Extracted from the article]

While political accountability requires that voters can form an accurate picture of government performance, public evaluations of government performance in established democracies are often distorted by partisan considerations. We test whether the same factors bias evaluations of government performance in a new democracy where partisanship is less stable and defined. This analysis estimates individual-level models of retrospective national economic evaluations in South Korea's 2017 presidential election. South Korea has unstable party politics, low levels of party institutionalization, and high levels of public distrust in political parties. Yet even in this context we find that voters' economic evaluations are significantly affected by political loyalties such as party identification. This endogeneity is sufficiently large that it results in aggregate consumer evaluations of the economy that systematically vary across regions depending upon the relationship of the president to that region. The findings confirm that party identification shapes citizen opinions even in a context where its effect would likely be weak. [ABSTRACT FROM AUTHOR]

Economic voting models usually assume that the economy is usually salient to the public, especially during a recession, yet the public's attention to the economy is likely to wane when other, more pressing issues are salient. This analysis tests whether health outcomes during the pandemic pushed the economy off the public's agenda. Cross-sectional survey data from July 2020 show that individuals who experienced a personal economic setback during the first few months of the pandemic did not significantly differ in their evaluations of President Trump from those whose finances had not been similarly affected. Instead, presidential approval was lower among those who had gotten sick/knew someone who had gotten sick or who were afraid of getting sick. Time series analyses confirm the economy's importance has diminished; President Trump's approval ratings were less strongly connected to economic outcomes in the post-pandemic period than they were in the first three years he was in office. In the context of a health emergency, the public seems to value minimizing health threats, not limiting the economic fallout from the pandemic and thus the dynamics underlying presidential approval during the pandemic differ from normal times and previous crises. [ABSTRACT FROM AUTHOR]

The association between how citizens perceive economic performance, insecurity, or corruption and how they evaluate the president varies systematically across Latin American countries and within them over time. In particular, while presidential popularity reflects these outcomes in the average Latin American country, survey data from 2006–17 confirm that the connection between government performance and presidential approval is generally stronger when unfragmented party systems or single-party majority governments make assessments of political responsibility easier. While these results suggest that the region's citizens do not blindly blame the president for outcomes where political responsibility should be shared, they also remind us that there are many countries in the region where fragmented party systems weaken the conditions for effective political accountability. [ABSTRACT FROM AUTHOR]

Theories of democratic legitimacy argue that people who believe the government is well managed and represents their interests are likely to defend the democratic status quo. Principal-agent theory predicts, however, that these same groups are also more likely to support executive actions that threaten vertical or horizontal accountability. Citizens who feel represented by an ideologically sympathetic and competent executive may be willing to delegate the president additional authority to enact their agenda, even at the expense of democratic principles. Survey data from Latin America are largely consistent with the principal-agent hypothesis; those who voted for the ruling party in the previous election or who perceive that the economy is strong say they not only like democracy and oppose coups but also support limits on critical actors and opposition parties and are willing to let the president bypass the legislature and court. Thus to understand the breakdown of democracy, we must not only examine the conditions that leave the losers of political and economic processes satisfied with the process that culminated in their defeat but also identify conditions when winners tolerate electoral and institutional challenges and are willing to protect space for public criticism. [ABSTRACT FROM AUTHOR]

While there is a strong correlation between district magnitudes and electoral fragmentation, studies of national-level electoral system reforms provide mixed evidence that such reforms actually change levels of party system fragmentation because reforms are often endogenous to the outcomes they purport to explain. We propose that the reallocation of seats at the district level in PR systems (which hold geographic boundaries constant) provide better leverage to test how the electoral system affects the party system because these reforms are not politically manipulated in the way that national-level reforms are. We look at the effect of changing district magnitude on the effective number of parties winning seats, the number of parties running for office, and the effective number of parties winning votes in 20 countries. Adding seats increases the number of parties that run for office, the number of parties who win votes, and the number of parties who win seats in the subsequent election. The effects on electoral fragmentation is especially large in ethnically and politically divided countries. While the mechanical effect of adding seats is larger than is the psychological effects on parties or voters, these data provide strong evidence that electoral system reforms directly affect election outcomes. [ABSTRACT FROM AUTHOR]

Objectives. The objectives of this study were to identify the randomised controlled trials in breast cancer occurring in low and middle income countries (LMICs) generally and within Sub-Saharan Africa specifically, to describe the current status and identify opportunities for further research in these areas. Materials and Methods. Data for this study were obtained from ClinicalTrials.gov. The search term “Breast Cancer Research” was used, and relevant information extracted and analysed. Results. 2414 trials were identified, of which 1099 were eligible for inclusion. 69 of these trials occurred in LMICs. Of the 52 LMICs globally, 30% were participating in breast cancer research. Of the 17 LMICs in Africa, 77% are situated in Sub-Saharan Africa; 23% were participating in breast cancer research, which accounted for 9% of total Sub-Saharan African studies. Conclusion. This study provides current evidence for the need for breast cancer research in LMICs globally and within Sub-Saharan Africa. Within LMIC regions where research is active, the type and numbers of studies are unevenly distributed. High quality research within such areas should be encouraged as the results may have both local and global applications, particularly in the provision of affordable health care. [ABSTRACT FROM AUTHOR]

ABSTRACT Economically vulnerable voters are expected to hold politicians accountable for their management of the economy because these voters are more likely to be personally affected by economic shocks and less able to cope with the resulting dislocation. Evidence from the informal sector in Argentina, where the lack of formal registration increases income volatility and denies unemployment benefits, is consistent with this hypothesis. Data from Argentina from 2005 to 2006 show that the association between evaluations of the economy and evaluations of President Néstor Kirchner was stronger among those working without formal employment guarantees. The implication is that the electoral support of Latin America's many informal workers may very well be fickle and dependent on economic performance. [ABSTRACT FROM AUTHOR]

While political polarization may lead to gridlock and other negative policy outcomes, representation is likely to be enhanced when parties differentiate themselves from each other and make it easier for voters to see the connection between their personal ideologies and the electoral offerings. These differences between parties may be especially important in developing democracies, where voters are still learning parties' priorities and where parties do not always emphasize issues when campaigning. To test this proposition, I develop a measure of elite polarization in Latin America since the early 1990s based on legislative surveys. Individual-level voting patterns from mass survey data confirm that the connection between voters' self-placement on the left-right scale and their electoral choice is stronger in polarized party systems, even when controlling for other party system factors like the age of the party system or electoral fragmentation. This effect on voting behavior is not immediate, however, as voters take time to recognize the new cues being provided by the changing party system. [ABSTRACT FROM AUTHOR]

Pancreaticoduodenectomy (PD) has historically required perioperative blood transfusion in 40 to 60 per cent of cases. Growing data suggest that transfusions may be deleterious in the surgical patient. We recently initiated a minimal transfusion approach to PD consisting of limited postoperative blood draws, early iron supplementation, changes in surgical technique, and elimination of hemoglobin transfusion triggers. Predictors of perioperative transfusion were analyzed in 130 consecutive patients undergoing PD by a single surgeon between 2008 and 2013, divided into two eras with 65 patients each. Patients in each era were similar with respect to age, comorbidities, American Society of Anesthesiologists class, body mass index, and diagnosis. The transfusion rate for the entire group was 22 per cent. Nonsignificant predictors of perioperative transfusion include American Society of Anesthesiologists class ≥3 (P = 0.41), vascular resections (P = 0.56), body mass index ≥30 (P = 0.72), and intraoperative blood loss (P = 0.89). Significant predictors of transfusion include PD performed in Era 1 as well as preoperative hemoglobin levels <10 g/dL. In Era 1, 38 per cent of patients required transfusion compared with 6 per cent in Era 2 (P < 0.01). Shorter length of stay and a trend toward decreased pancreatic fistulae were seen in Era 2. Transfusions can be almost completely eliminated in PD and this may contribute to improved outcomes. [ABSTRACT FROM AUTHOR]

Abstract: There is an ongoing debate within the economic voting literature about whether the economy's salience systematically fluctuates over time or is constant. The recent global economic slowdown provides leverage to test the proposition that voters give greater weight to economic performance when it is weak. Data on voters' issue priorities from 2000 to 2011 shows that voters were more likely to consider the economy an important issue during periods of bad or volatile economic performance. A weak economy also focuses voter attention on corruption and crime while reducing attention to social policy and foreign affairs. Crime rates, terrorist attacks, globalization, and the level of development also affect the economy's place on the electoral agenda. Thus one impact of the recent financial downturn was a shift toward economic voting in countries where it was deepest. [Copyright &y& Elsevier]

Economic perceptions affect incumbent support, but debate persists over whether voters focus on past or future performance and whether they view the economy in primarily sociotropic or egotropic terms. We theorize the nature of economic voting depends on the context. Evidence from 18 Latin American countries (1995–2009) suggest prospective voting predominates early in the election cycle, but retrospective voting gains traction as the incumbent’s record develops. Voters emphasize the national economy over personal finances except in the least developed countries. Thus the contexts in which voters are embedded not only affect the degree of economic voting but also its very nature. [ABSTRACT FROM PUBLISHER]

Voters who perceive the economy to be weak are generally less likely to support the incumbent government. Yet there is a debate over whether all people respond equally to economic shifts or if the state of the economy is more salient for those who feel economically vulnerable. This article examines whether insecure employment situations and employability concerns strengthen responses to the government's economic record. Data from Latin America and Eastern Europe confirm that workers who feel anxious about being fired or who believe it would be difficult to find a new job place significantly greater weight on sociotropic evaluations than do those with more secure employment situations. Thus incumbents who create risks for vulnerable workers are sanctioned, while those who create opportunities are rewarded most. [ABSTRACT FROM AUTHOR]

In districts where only one seat is contested, the electoral formula (plurality or majority) should be a major determinant of the number of parties that receive votes. Specifically, plurality rule should generate two-party competition while other institutional arrangements should generate electoral fragmentation. Yet tests of these propositions using district-level data have focused on a limited number of cases; they rarely contrast different electoral systems and have reached mixed conclusions. This study analyses district-level data from 6,745 single-member district election contests from 53 democratic countries to test the evidence for Duverger's Law and Hypothesis. Double-ballot majoritarian systems have large numbers of candidates, as predicted, but while the average outcome under plurality rule is generally consistent with two-party competition, it is not perfectly so. The two largest parties typically dominate the districts (generally receiving more than 90 per cent of the vote), and there is very little support for parties finishing fourth or worse. Yet third-place parties do not completely disappear, and ethnic divisions shape party fragmentation levels, even under plurality rule. Finally, institutional rules that generate multiparty systems elsewhere in the country increase electoral fragmentation in single-member plurality districts. [ABSTRACT FROM PUBLISHER]

Latin America's political economy has shifted in the three decades since the return to democratization, with the inflationary crises of the 1980s fading into the past. One consequence of this change is a reduction in the electoral salience of inflation. While electoral support for the incumbent in the 1980s and 1990s was strongly tied to his or her ability to prevent increases in prices, in the 2000-2010 period there was no significant association between inflation rates and election outcomes. Instead, incumbents who presided over a growing economy in the last decade reaped electoral benefits. The importance of the economy for electoral outcomes varies over time and even across economic indicators [ABSTRACT FROM AUTHOR]

BACKGROUND: Alcohol intoxication in pediatric trauma is underappreciated. The aim of this study was to characterize alcohol screening rates in pediatric trauma METHODS: The Los Angeles County Trauma System Database was queried for all patients aged < 18 years who required admission between 2003 and 2008. Patients were compared by age and gender. RESULTS: A total of 18,598 patients met the inclusion criteria; 4,899 (26.3%) underwent blood alcohol screening, and 2,797 (57.1%) of those screened positive. Screening increased with age (3.3% for 0-9 years, 15.1% for 10-14 years, and 45.4% for 15-18 years; P < .01), as did alcohol intoxication (1.9% for 0-9 years, 5.8% 10-14 years, and 27.3% for 15-18 years; P < .01). Male gender predicted higher mortality in those aged 15 to 18 years (adjusted odds ratio, 1.7; P < .01), while alcohol intoxication did not (adjusted odds ratio, .97; P = .84). CONCLUSIONS: Alcohol intoxication is common in adolescent trauma patients. Screening is en-couraged for pediatric trauma patients aged >10 years who require admission. [ABSTRACT FROM AUTHOR]

Abstract: Background: We undertook the current study to determine the impact of elevated admission systolic blood pressure (SBP) on trauma patients without severe brain injury. Materials and methods: We conducted a retrospective review of the Los Angeles County Trauma System database to identify all patients with moderate to severe injuries (injury severity score >9) admitted between 2003 and 2008. Patients with head abbreviated injury score >3 were excluded. We divided the remaining patients into three age cohorts and conducted multivariate regression modeling at increasing SBP thresholds to identify independent predictors of mortality. Results: A total of 23,931 patients met inclusion criteria. Overall mortality was 8.6% and it increased with age across the three groups. The admission SBP thresholds associated with significantly increased mortality in the young and middle-aged were >190 mm Hg (AOR 1.5, P = 0.04) and >180 mm Hg (AOR 1.5, P = 0.01), respectively. In the elderly, no admission SBP threshold was associated with significantly increased mortality. Interestingly, several elevated admission SBP thresholds were associated with significantly reduced mortality in the elderly (>150 mm Hg AOR 0.6, P < 0.01; >160 mm Hg AOR 0.6, P < 0.01; and >170 mm Hg AOR 0.7, P = 0.02). Conclusions: The admission SBP thresholds that predicted higher mortality for the young and middle-aged were >190 mm Hg and >180 mm Hg, respectively. Elderly trauma patients tolerated higher admission SBP than their younger counterparts and multiple elevated SBP thresholds were associated with significantly reduced mortality in the elderly. [Copyright &y& Elsevier]

Abstract: Background: Complications after inferior vena cava (IVC) injury, including venous thromboembolism (VTE), are expected, but the exact incidence is poorly defined. The purpose of this study is to examine the VTE rate following ligation versus repair of IVC injuries. Materials and methods: The California State Inpatient Database was queried for all adult patients (age >14 y) admitted between 2005 and 2008 with IVC injuries. Demographic data, mechanism of injury, operative technique (ligation versus repair), and outcomes were recorded. Outcomes were compared according to operative technique. Results: A total of 308 patients with IVC injuries were evaluated. The study population was mostly male (81.2%), young (median age 24 y), and Hispanic (43.2%). Overall mortality was 37.3%. The mechanisms of injury included gunshot wounds (52.3%), stab wounds (14.0%), and motor vehicle collisions (14.9%). Associated injuries were present in 100% of cases, with duodenal injuries being the most common. The majority of injuries were managed by primary repair (76.6%), with ligation performed in 23.4%. Patients who underwent ligation had a longer hospital stay (median 9 versus 6 d, P = 0.04) and a trend towards a higher mortality (45.8% versus 34.8%, P = 0.10), with no difference in VTE rate (4.2% versus 1.7%, P > 0.99). Conclusions: As expected, IVC injuries carry a very high mortality rate and are always associated with other injuries. We demonstrated a surprisingly low rate of VTE after operative management for IVC injury, which was similar for patients undergoing ligation and repair. [Copyright &y& Elsevier]

Previous investigations suggest outcome differences at Level I and Level II trauma centers. We examined use of intracranial pressure (ICP) monitors at Level I and Level II trauma centers after traumatic brain injury (TBI) and its effect on mortality. The 2007 to 2008 National Trauma Data- bank was reviewed for patients with an indication for ICP monitoring based on Brain Trauma Foundation (BTF) guidelines. Demographic and clinical outcomes at Level I and Level II centers were compared by regression modeling. Overall, 15,921 patients met inclusion criteria; 11,017 were admitted to a Level I and 4,904 to a Level II trauma center. Patients with TBI admitted to a Level II trauma center had a lower rate of Injury Severity Score greater than 16 (80 vs 82%, P < 0.01) and lower frequency of head Abbreviated Injury Score greater than 3 (80 vs 82%, P < 0.01). After regression modeling, patients with TBI admitted to a Level II trauma center were 31 per cent less likely to receive an ICP monitor (adjusted odds ratio [AOR], 0.69; P < 0.01) and had a significantly higher mortality (AOR, 1.12; P < 0.01). Admission to a Level II trauma center after severe TBI is associated with a decreased use of ICP monitoring in patients who meet BTF criteria as well as an increased mortality. These differences should be validated prospectively to narrow these discrepancies in care and outcomes between Level I and Level II centers. [ABSTRACT FROM AUTHOR]

Abstract: Background: Increasing evidence suggests that the spleen harbors stem cells that act as precursors to insulin-producing pancreas cells. Additionally, small studies with short-term follow-up associate splenectomy with increased rates of diabetes mellitus. The purpose of this study was to analyze the long-term effect of trauma splenectomy on blood glucose. Materials and methods: Patients were included if a blood glucose level was measured more than 5 y after trauma splenectomy or laparotomy with bowel repair. Mean blood glucose level was then compared between the two groups. Results: During the 10-y study period 61 patients underwent trauma splenectomy and 50 survived until discharge. In comparison, 229 patients underwent trauma laparotomy and bowel repair and 207 survived until discharge. Nine splenectomy patients compared with 12 control patients had, blood glucose measured at least 5 y after initial trauma. Mean follow-up period was not significantly different between groups (splenectomy 82.8 ± 17.6 mo versus control 96.0 ± 44.3 mo, P = 0.41). In the splenectomy cohort mean glucose level was significantly higher compared with the control (114 ± 34 mg/dL versus 90 ± 13 mg/dL, P = 0.04), as was the number of patients with recorded blood glucose level greater than 130 mg/dL (4 patient versus 0 patients P = 0.02). One new diagnosis of diabetes mellitus was noted only in the trauma splenectomy cohort. Conclusions: This small study suggests that trauma splenectomy may be associated with hyperglycemia at long-term follow-up. [Copyright &y& Elsevier]

Studies linking election outcomes to economics frequently assume that the economy’s salience is constant. This study shows that the economy’s salience systematically fluctuates. The number of voters focused on economic issues shifted dramatically throughout the 2008 campaign as the recession worsened and this change occurred well before the financial markets collapsed in September 2008. However, even during the recession substantial numbers of individuals said their vote was based on non-economic issues and for these individuals there was no relationship between their assessment of the economy and their electoral choice. Consistent with extant theories of issue attention, citizens who were the hardest hit by the recession and those who had the most anxiety about suffering a financial dislocation in the future were most likely to consider economic performance electorally important while secure voters were less likely to be economic voters. [Copyright &y& Elsevier]

This study measures support for the basic rights, liberties, and practices associated with polyarchy in 12 Latin American democracies. Specifically, it identifies five profiles of support for polyarchy’s core values and norms—public contestation, inclusive participation, limits on executive authority, and institutional checks and balances. Although citizens who fit the polyarch profile accept all of polyarchy’s principles, those who fit one of the four mixed support profiles (power constrainer, power checker, power delegator, power restrainer) accept only some of them while rejecting other core democratic principles. Long-run factors emphasized by modernization and cultural theories (e.g., education, wealth, political engagement) are closely associated with the polyarch support profile. However, short-range performance factors (e.g., economic perceptions; crime, discrimination, and corruption victimization; voting for losing presidential candidates; presidential approval) may better explain why citizens fit one particular mixed profile over another and particularly explain willingness to delegate authority to the executive at the expense of other institutions. [ABSTRACT FROM PUBLISHER]

While scholars have hypothesised that a strong welfare state should reduce voters' incentives to base their votes on economic outcomes, evidence for this proposition remains mixed. This article tests whether differences in welfare protections across American states affect the relationship between economic performance and support for the president's party in 430 state legislative elections from 1970 to 1989. Analysing the results of over 42,000 contests in which an incumbent was running for re-election, it finds that while unemployment insurance programmes do not affect the importance of economic performance, the electoral fortunes of presidential co-partisans are less strongly tied to the national economy in states with generous anti-poverty programmes. Thus by reducing vulnerability to poverty, economic safety-nets lower the salience of the economy and provide electoral cover for politicians during economic slowdowns. [ABSTRACT FROM AUTHOR]

Abstract: A central tenet of electoral systems'' research is that more parties should get votes in districts with large magnitudes than in districts with smaller magnitudes. This proposition is largely untested at the district level, even though that is the level at which relevant pressures are expected to work. At the aggregate level, research has found that there are systematic deviations from Duverger''s law related to incentives from ethnolinguistic fragmentation, institutions, and strategic voting. This analysis confirms that many of these results hold at the district level, which is the most appropriate level for testing Duverger''s law. District level party-system fragmentation patterns in 44 countries support Duverger''s basic hypotheses. The effect of electoral institutions is contingent, however, upon the presence of social cleavages that generate pressures for additional parties, the establishment of patterns of party-system competition that help voters evaluate contenders'' viability, and the absence of competing incentives generated by districts of varying magnitudes. These effects are robust to different specifications of social heterogeneity. However, we find no evidence that institutional features like federalism or presidentialism reduce the strategic effects of district level factors. [Copyright &y& Elsevier]

Previous studies of economic voting in Mexico have reached mixed conclusions about the role of economic performance on electoral behavior. In this paper, I argue that the effect of economic performance on voting is contingent upon two factors. First, even when voters perceive a weak economy and are dissatisfied with the incumbent, they differ on who the best replacement is. In the context of the 2006 campaign, López Obrador did not receive the support of many voters who thought the economy was weak because they perceived him as too large of a risk. Second, the impact of the economy is contingent upon its have a prominent place on the political agenda. The combination of high levels of economic vulnerability, the fall of the regime cleavage as an alternative motive for electoral choice, and the emphasis on economic issues in the campaign dialogue and advertising strategy of the major political parties in the 2006 election made economic issues especially salient. While the weak performance of the Mexican economy in 2001-2003 opened doors for the pan's challengers, the economic recovery in the second half of Fox's term thus proved sufficient to garner the narrow victory for Calderon. [ABSTRACT FROM AUTHOR]

Recent years have seen increased attention to integrating what we know about individual citizens with what we know about macro-level contexts that vary across countries. This article discusses the growing literature on how people's interpretations, opinions, and actions are shaped by variable contextual parameters and provides a novel substantive application. Using surveys conducted in 20 European democracies, the authors examine the effect of income inequality on people's attitudes about the functioning of the political system and trust in public institutions. They find that citizens in countries with higher levels of income inequality express more negative attitudes toward public institutions. Moreover, they show that the negative effect of inequality on attitudes toward the political system is particularly powerful among individuals on the political left. In contrast, inequality's negative effect on people's faith in the system is muted among those on the right. [ABSTRACT FROM AUTHOR]

The deliberative-development approach to policy-making has gained popularity in both academic and policy circles. However, insufficient attention has been paid to the requirements necessary for deliberation to have beneficial effects on policy, some of which are detailed in this article, in particular the need for equality among deliberators. The article examines Bolivia's 2000 National Dialogue and demonstrates the effects of inequality — not between elites and non-elites, but between groups within civil society — on the legitimacy of the outcome. Its findings have important implications for the design of deliberative-development institutions. [ABSTRACT FROM AUTHOR]

Performs transgenic analysis of the smad family of TGF-beta signal transducers in Drosophila melanogaster. Discovery of novel roles and interactions between family members; Examination of gain-of-function phenotypes.

Metallic nanostructures with nanogap features can confine electromagnetic fields into extremely small volumes. In particular, as the gap size is scaled down to sub‐nanometer regime, the quantum effects for localized field enhancement reveal the ultimate capability for light–matter interaction. Although the enhancement factor approaching the quantum upper limit has been reported, the grand challenge for surface‐enhanced vibrational spectroscopic sensing remains in the inherent randomness, preventing uniformly distributed localized fields over large areas. Herein, a strategy to fabricate high‐density random metallic nanopatterns with accurately controlled nanogaps, defined by atomic‐layer‐deposition and self‐assembled‐monolayer processes, is reported. As the gap size approaches the quantum regime of ≈0.78 nm, its potential for quantitative sensing, based on a record‐high uniformity with the relative standard deviation of 4.3% over a large area of 22 mm × 60 mm, is demonstrated. This superior feature paves the way towards more affordable and quantitative sensing using quantum‐limit‐approaching nanogap structures. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic (March 2020-May 2023) had a profound effect around the world with vulnerable people being particularly affected, including worsening existing health inequalities. This article explores the impact of the pandemic on health services for First Nations people living with HIV (FN-PWLE) in Manitoba, Canada. This study investigated perceptions of both health care providers and FN-PWLE through qualitative interviews occurring between July 2020 and February 2022 to understand their experience and identify lessons learned that could be translated into health system changes. Methods: Using a qualitative, participatory-action, intentional decolonizing approach for this study we included an Indigenous knowledge keeper and Indigenous research associates with lived experience as part of the study team. A total of twenty-five [25] in-depth semi-structured interviews were conducted with eleven healthcare providers (HCPs) and fourteen First Nation people with lived HIV experience (FN-PWLE). In total, 18/25 or 72% of the study participants self-identified as First Nation people. Results: The COVID-19 pandemic negatively impacted health services access for FN-PWLE, a) disrupted relationships between FN-PWLE and healthcare providers, b) disrupted access to testing, in-person appointments, and medications, and c) intersectional stigma was compounded. Though, the COVID-19 pandemic also led to positive effects, including the creation of innovative solutions for the health system overall. Conclusions: The COVID-19 pandemic exaggerated pre-existing barriers and facilitators for Manitoba FN-PWLE accessing and using the healthcare system. COVID-19 impacted health system facilitators such as relationships and supports, particularly for First Nation people who are structurally disadvantaged and needing more wrap-around care to address social determinants of health. Innovations during times of crisis, included novel ways to improve access to care and medications, illustrated how the health system can quickly provide solutions to long-standing barriers, especially for geographical barriers. Lessons learned from the COVID-19 pandemic should be considered for improvements to the health system's HIV cascade of care for FN-PWLE and other health system improvements for First Nations people with other chronic diseases and conditions. Finally, this study illustrates the value of qualitative and First Nation decolonizing research methods. Further studies are needed, working together with First Nations organizations and communities, to apply these recommendations and innovations to change health care and people's lives. [ABSTRACT FROM AUTHOR]

Background: The United States is currently experiencing a heroin epidemic. Recent reports have demonstrated a three-fold increase in heroin use among Americans since 2007 with a shift in demographics to more women and white Americans. Furthermore, there has been a correlation between the recent opioid epidemic and an increase in heroin abuse. Much has been written about epidemiology and prevention of heroin abuse, but little has been dedicated to the surgical implications, complications, and resource utilization. Discussion: This article focuses on the surgical problems encountered from heroin abuse and how to manage them in a constant effort to improve morbidity and mortality for these heroin abusers. [ABSTRACT FROM AUTHOR]