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Kansas City (kansas + city)
Selected AbstractsUNINTENTIONAL OVERDOSE WITH INTRATHECAL ZICONOTIDEPAIN MEDICINE, Issue 2 2002Article first published online: 4 JUL 200 Steven G. Charapata MD, Research Medical Center, Kansas City, MO; David Ellis MD, PhD, Elan Pharmaceuticals, South San Francisco, CA Ziconotide is a novel, N-type, voltage-sensitive calcium channel (VSCC) blocker, with well-documented efficacy as an intrathecal (IT) analgesic. Ziconotide has been administered to over 1000 chronic pain patients in nine clinical trials. Over 350 patients have been on ziconotide IT therapy for more than three months in a long-term safety and tolerability study. Common adverse events for ziconotide include dizziness, nausea, nystagmus, abnormal gait, constipation, urinary retention, somnolence, postural hypotension, vomiting, confusion and abnormal vision. Ziconotide adverse events are recognizable, reversible and manageable, by dose adjustment and slow dose titration. Case reports of unintentional overdose in six chronic pain patients treated with IT ziconotide are presented. These unintentional overdoses were attributable to pump programming or dilution errors; none were lethal. The patient who received the highest overdose was administered 31 mcg/hr over 24 hours, or nearly 750 mcg ziconotide, total. This hourly dose rate is 300-fold the current recommended initial dose rate of 0.1 mcg/hr. This patient was sedated, but arousable; vital signs were stable and patient had no change in blood pressure. His symptoms resolved within 24 hours. His Visual Analog Score of Pain Intensity (VASPI) was reduced from 82 at baseline to 2.5 at the end of the titration period. The patient elected to continue in the long-term IT ziconotide study. The other 5 cases of inadvertent overdose were less severe, with dose rate at 5 mcg/hr or less. Associated adverse events also resolved within 24-hours of discontinuing ziconotide infusion. Unlike an unintentional overdose with IT morphine, which slows respiration and could potentially lead to hypoxia, coma or death; ziconotide does not produce respiratory depression. No tolerance to the analgesic effect of ziconotide, or withdrawal symptoms after discontinuation of the drug have been reported. Ziconotide has a wide margin of safety as an IT analgesic. [source] Alan Greenspan on the Economic Implications of Population AgingPOPULATION AND DEVELOPMENT REVIEW, Issue 4 2004Article first published online: 15 DEC 200 At the 2004 annual symposium of central bank leaders sponsored by the Federal Reserve Bank of Kansas City at Jackson Hole, Wyoming, Alan Greenspan, Chairman of the US Federal Reserve Board, devoted his opening remarks on 27 August to a discussion of the economic implications of population aging. The full text of his remarks is reproduced below. Greenspan's high prestige and great influence on US economic policy lend special interest to his views on this much-discussed subject (see also the next Documents item in this issue). He outlines the coming demographic shift in the United States in language that is characteristically cautious and qualified. (The elderly dependency ratio will "almost certainly" rise as the baby boom generation retires, Greenspan says, although elsewhere he terms the process, more accurately, inexorable.) The main factor responsible for population aging he identifies as the decline of fertility. Immigration is an antidote, but, to be effective, its size would have to be much larger than is envisaged in current projections. Greenspan's assessment of the economic consequences of the changing age structure highlights the prospect of a deteriorating fiscal situation in the United States: chronic deficits in the Social Security program over the long haul, assuming that existing commitments for benefits per retiree are met, and even greater difficulties for the health care system for the elderly,Medicare,in which the effects of increasing numbers in old age are amplified by advances in medical technology and the bias inherent in the current system of subsidized third-party payments. The sober outline of policy choices imposed by population aging,difficult in the United States, but less so, Greenspan notes, than in Europe and Japan,underlies the need for counteracting the declining growth of the population of labor force age through greater labor force participation and later retirement. Beyond that, growth of output per worker can provide the key "that would enable future retirees to maintain their expected standard of living without unduly burdening future workers." This requires continuation of policies that enhance productivity, such as deregulation and globalization, and greater investment. In turn, the latter presupposes greater domestic saving, both personal and by the government, as the United States cannot "continue indefinitely to borrow saving from abroad." Demographic aging requires a new balance between workers and retirees. Curbing benefits once bestowed is difficult: only benefits that can be delivered should be promised. Public programs should be recalibrated, providing incentives for individuals to adjust to the inevitable consequences of an aging society. [source] Fear and loathing in Kansas City: Political harassment and the making of moderates in America's abortion wars (Respond to this article at http://www.therai.org.uk/at/debate)ANTHROPOLOGY TODAY, Issue 4 2010Alexander Thomas T. Smith The pro-life movement regularly employs tactics of political harassment in its campaign against abortion. As the murder of the controversial abortion doctor George Tiller in Wichita, Kansas, demonstrated last year, such tactics often betray a potential for violence. This paper explores how the militant tactics of the pro-life movement in the 1990s have contributed to the formation of a ,new' political identity in Kansas politics: that of the moderate Republican. But for those that seek to counter-mobilize against the Christian right, the political stakes remain high. [source] Pediatric Out-of-hospital Emergency Medical Services Utilization in Kansas City, MissouriACADEMIC EMERGENCY MEDICINE, Issue 6 2009Melissa K. Miller MD Abstract Objectives:, The objective was to describe epidemiologic features and usage patterns of pediatric emergency medical services (EMS) transports in Kansas City, Missouri. Methods:, The study consisted of a retrospective analysis of transports from January 1, 2002, to December 31, 2004, for Kansas City, Missouri, residents younger than 15 years of age (excluding interfacility transports. Data included demographics, insurance, day and time of transport, patient zip code, chief complaint, and number of individual transports. Rates were calculated using intercensal estimates for the denominator. All rates were expressed as number of transports per 1,000 persons per year (PPY). Results:, A total of 5,717 pediatric transports occurred in the 3-year study period. Transport rates were 18 PPY for all users, 42 PPY for those <1 year old, 23 PPY for ages 1,4 years, 12 PPY for ages 5,9 years, and 14 PPY for ages 10,14 years. Infants <1 year were more likely than children aged 5,9 years to use EMS (relative risk [RR] = 3.7, 95% confidence interval [CI] = 3.4 to 4.0). Males were more likely than females to use EMS (RR = 1.2, 95% CI = 1.1 to 1.3). Most (64%) were insured by Medicaid. Transports peaked between 4 pm and 8 pm, and lowest usage was 4 am to 8 am (p < 0.001). Overall usage did not vary by weekday or season. Respiratory transports were more common in the fall and winter, while trauma transports were more common in the summer (p < 0.001). The most common diagnoses were trauma (27%), neurologic (19%), and respiratory (18%). Eleven percent of users accessed EMS more than once (26% of all transports). There was a significant inverse linear relationship between transport rate and median family income by zip code (r = ,0.36, p < 0.001). Conclusions:, Children in zip codes with lower incomes, infants, and males were more likely to use EMS. Factors related to these increased transport rates are unknown. [source] Searching for a Role for Citizens in the Budget ProcessPUBLIC BUDGETING AND FINANCE, Issue 1 2004Carol Ebdon Citizen participation in the local budget process is not prevalent, despite encouragement from scholars and professional organizations. This case study of two Kansas cities that have used a variety of input mechanisms in the budget process analyzes the effectiveness of citizen budget participation. Limited effectiveness was found, which may largely be due to the timing of the input, unstated or unclear goals, implementation difficulties, and political and environmental constraints. Citizen input appears to have had little effect on budget decisions, and neither city has institutionalized participation in the process. However, the input mechanisms serve other purposes, such as education and support for specific proposals. Describing the benefits as well as the difficulty of involving citizens in a meaningful way is beneficial to other governments as they wrestle with the issue of defining the citizens' role in the budget process. [source] Is everything up to date in Kansas city?NATIONAL CIVIC REVIEW, Issue 2 2007Why "citizen involvement" may soon be obsolete First page of article [source] | ||||||||||||||||