A case of methotrexate toxicity from intralesional treatment of squamous cell carcinoma of the hands in a peritoneal dialysis patient is reported.
A 68-year-old Caucasian man receiving peritoneal ...dialysis for end-stage renal disease complained to his primary care physician of shortness of breath, mouth and hand sores, nausea, and general malaise. Four days before his office visit, the patient received 25 mg of methotrexate intralesionally for refractory squamous cell carcinoma of his hands. The patient had several pustular lesions on both hands. On admission, the patient had a normal complete blood cell count and elevated liver enzyme levels. On hospital day 3, the patient's white blood cell count was 1,300 cells/μL, platelet count was 134,000 platelets/μL, hemoglobin value was 12.4 g/dL, and hematocrit was 37%. Folic acid 1 mg i.v. every six hours and leucovorin 10 mg/m(2) (20 mg) i.v. every six hours was initiated. His serum methotrexate concentration was 0.03 μmol/L on hospital day 6. The leucovorin dosage was increased to 200 mg i.v. every six hours. Platelets were administered, and the patient was switched to four-hour treatments of high-flux membrane hemodialysis for two consecutive days. The patient was discharged on hospital day 14. Mild mucositis was still present, but the patient had improved substantially and was discharged to a rehabilitation facility.
A 68-year-old peritoneal dialysis patient who was treated with 25 mg of intralesional methotrexate for squamous cell carcinoma of the hands developed pancytopenia, mucositis, and hepatotoxicity as a result of systemic absorption and prolonged elimination.
The assault and subsequent collapse of the World Trade Center towers in New York City on September 11, 2001 (9/11), released more than a million tons of debris and dust into the surrounding area, ...engulfing rescue workers as they rushed to aid those who worked in the towers, and the thousands of nearby civilians and children who were forced to flee. In December 2015, almost 15 years after the attack, and 5 years after first enactment, Congress reauthorized the James Zadroga 9/11 Health and Compensation Act, a law designed to respond to the adverse health effects of the disaster. This reauthorization affords an opportunity to review human inhalation exposure science in relation to the World Trade Center collapse. In this Special Article, we compile observations regarding the collective medical response to the environmental health disaster with a focus on efforts to address the adverse health effects experienced by nearby community members including local residents and workers. We also analyze approaches to understanding the potential for health risk, characterization of hazardous materials, identification of populations at risk, and shortfalls in the medical response on behalf of the local community. Our overarching goal is to communicate lessons learned from the World Trade Center experience that may be applicable to communities affected by future environmental health disasters. The World Trade Center story demonstrates that communities lacking advocacy and preexisting health infrastructures are uniquely vulnerable to health disasters. Medical and public health personnel need to compensate for these vulnerabilities to mitigate long-term illness and suffering.
New York After 9/11 Opotow, Susan; Shemtob, Zachary Baron; Arad, Michael ...
09/2018
eBook
Examines New York's recovery and adaptation to life after 9/11 over the truly long term: not merely a "one year later" profile, but sustained studies engaging with five, ten, fifteen, or more years ...of changes.Details the changes to life in New York City across a truly diverse set of dimensions: journalism, public health, race and policing, building safety, commemoration
An estimated 2 billion people around the world watched the catastrophic destruction of the World Trade Center. The enormity of the moment was immediately understood and quickly took on global proportions. What has been less obvious is the effect on the locus of the attacks, New York City, not as a seat of political or economic power, but as a community; not in the days and weeks afterward, but over months and years.New
York after 9/11offers insightful and critical observations about the processes set in motion by September 11, 2001 in New York, and holds important lessons for the future.
This interdisciplinary collection brings together experts from diverse fields to discuss the long-term recovery of New York City after 9/11. Susan Opotow and Zachary Baron Shemtob invited experts in architecture and design, medicine, health, community advocacy, psychology, public safety, human rights, law, and mental health to look back on the aftereffects of that tragic day in key spheres of life in New York City. With a focus on the themes of space and memory, public health and public safety, trauma and conflict, and politics and social change, this comprehensive account of how 9/11 changed New York sets out to answer three questions: What were the key conflicts that erupted in New York City in 9/11's wake? What clashing interests were involved and how did they change over time? And what was the role of these conflicts in the transition from trauma to recovery for New York City as a whole?
Contributors discuss a variety of issues that emerged in this tragedy's wake, some immediately and others in the years that followed, including: PTSD among first responders; conflicts and design challenges of rebuilding the World Trade Center site, the memorial, and the museum; surveillance of Muslim communities; power struggles among public safety agencies; the development of technologies for faster building evacuations; and the emergence of chronic illnesses and fatalities among first responders and people who lived, worked, and attended school in the vicinity of the 9/11 site. A chapter on two Ground Zeros -in Hiroshima and New York - compares and historicizes the challenges of memorialization and recovery. Each chapter offers a nuanced, vivid, and behind-the-scenes account of issues as they unfolded over time and across various contexts, dispelling simplistic narratives of this extended and complicated period. Illuminating a city's multifaceted response in the wake of a catastrophic and traumatic attack,New York after 9/11illustrates recovery as a process that is complex, multivalent, and ongoing.
Brings together credible experts from diverse fields for a comprehensive, respectful account of how 9/11 changed New York.
The dissertation, in two parts, addresses the unique role of the anchorite in medieval society and the curious imbalance of gender representation in Europe’s anchorholds. While over 600 anchorites ...lived during the Middle Ages, approximately 80% of them were women. This significant inequity must be attributed to more than religion, demographics, or economics. With a focus on two primary sources, this study contends that gendered circumstances added to this feminine preponderance as much as these other elements previously theorized by anchoritic scholars. The “Letter of Inquiry for Becoming an Anchoress,” a 1329 church document existing in Shere, Surrey, England, provides insight into the process an individual would have taken to become an anchoress, including the vetting she endured by the bishop or his suffragan. His investigation included the determination that the woman be “not feignedly but in truth” requesting a more saintly life in the anchorhold. This wording exposes the Church’s concern that a number of women affected a pious mien in order to gain entrance to the secluded residence. The Ancrene Wisse, or Guide for Anchoresses, indicates the rules the mediatrix must follow once sequestered in the hermitage. The very existence of this document reveals that some women were not ascetically inclined. They had untoward relationships, owned and held property, kept pets and livestock, taught school, gossiped, and enjoyed full social lives and an elevated communal status from within their anchorholds. The critical portion of the dissertation asserts that some used the anchorage as a secular refuge. Although their place in time precludes their being labeled feminists, these women, by extreme means, sought sovereignty in a patriarchal culture and, therefore, can be conceived as proto-feminists. This theory is the impetus for the creative portion of the dissertation, a historical novel entitled Squint. Christiana, a young girl whose limited life choices make the austere anchorhold seem a viable option, petitions the bishop for enclosure and uses her wiles to conceal a secret from her family and friends, her clergy, and the villagers she counsels.
Older persons including those with diabetes are at increased risk for loss of protective sensation in the feet. The 5.07 (10-g) monofilament is recognized as a valid instrument to test for the ...presence or absence of protective sensation in the foot. Few studies report reliability and no studies report responsiveness for a multisite examination using the 10-g monofilament. The purpose of this study was to determine the responsiveness and reliability for the 10-g monofilament in evaluating protective sensation in the feet.
A convenience sample of 28 (20 women and 8 men) participants between the ages 50 and 78 years were recruited for the study. Sensory testing was performed on 18 different sites (9 per foot) by 3 testers for each participant using the 10-g monofilament. Participants were tested on 2 occasions with approximately 1 week between tests. Participants' eyes were closed for the duration of the examination to blind them to the tester. Testers were blinded to each other and previous test results.
Intratester and intertester reliability were calculated using intraclass correlation coefficients (ICC). Intratester ICC (3, 1) and minimal detectable change at the 95% confidence level (MDC(95)) were calculated for each tester and then averaged yielding the following: ICC = 0.76 (95% CI: 0.68-0.84), MDC(95) = 2.83. Intertester ICC (2, 1) was 0.78 (95% CI: 0.64-0.88). MDC(95) was 2.81. This gives an MDC(95) for this test of 3 sites.
The results of this study support the use of the 10-g monofilament as a reliable clinical tool to assess changes in protective sensation of the feet for our participant pool. An 18-site sensory examination using the 10-g monofilament must result in sensory change at 3 or more sites to indicate actual change in protective sensation.
Health Impacts of 9/11 Michael Crane; Kimberly Flynn; Roberto Lucchini ...
New York After 9/11,
09/2018
Book Chapter
The attacks on World Trade Center’s Twin Towers by nineteen terrorists on September 11, 2001, caused severe damage, fires, and the collapse of those two iconic buildings in Lower Manhattan. Almost ...three thousand people were killed, and more than six thousand others were wounded that day. The buildings’ collapse produced tons of toxic rubble and a dense dust cloud that exposed thousands of people to toxins.¹ Over time, workers on the site, including first responders, recovery, and cleanup workers; people who lived, worked, and attended school in the vicinity; and visitors to the site on 9/11 developed chronic and sometimes
Joint Applied Project
The objective of this project is to conduct an analysis of the CECOM Contracting Center's Paperless Contracting Folder program in regards to maintaining its DoD 5015.2 ...certification. The desired outcomes will be the creation of a File Plan and User Guide to assist with DoD 5015.2 certification.
"Submitted in partial fulfillment of the requirements for the degree of Master of Contract Management from the Naval Postgraduate School, June 2010."
Advisor(s): Doelling, Michael C. ; Brinkley, ...Douglas E. "June 2010." "Joint applied project"--Cover. Joint authors: .Grasso, Colleen E. ; Boorom, Eric W. Description based on title screen as viewed on July 14, 2010. Author(s) subject terms: Paperless Contract Folder's (PCF) DoD 5015.2 certification Includes bibliographical references (p. 97). Also available in print.
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