Epidemiology of shoulder dislocations presenting to United States emergency departments:An updated ten-year study

BACKGROUND Glenohumeral dislocation is a common injury that may predispose patients to chronic pain and instability.However,there is a paucity of current data available regarding the epidemiological trends of this injury.AIM To provide an updated,comparative assessment of the epidemiology of shoulder dislocations presenting to emergency departments in the United States.We also sought to analyze patient demographic risk factors and consumer products associated with dislocation events.METHODS Data were obtained from the national electronic injury surveillance system database for glenohumeral dislocations between 2012 and 2021.Incidence,age,sex,and injury characteristics were analyzed using weighted population statistics as well as incidence rates and 95%confidence intervals(CI).RESULTS In total,an estimated 773039 shoulder dislocations(CI:640598-905481)presented to emergency rooms across the United States during the study period.The annual incidence rate was 23.96 per 100000 persons and the average patient age at the time of injury was 37.1 years.Significantly more male patients sustained dislocations than female patients(537189,69.5%,vs 235834,30.5%,P<0.001).With regard to associated consumer products,sports and recreation equipment were involved in the highest proportion of incidents(44.31%),followed by home structures and construction materials(21.22%),and home furnishings,fixtures,and accessories(21.21%).Regarding product sub-groups,stairs,ramps,landings,floors was cited in the greatest number of cases(131745).CONCLUSION The national annual incidence rate of glenohumeral dislocations throughout the study period was approximately 23.92 per 100000 persons.Male adolescents sustained the highest proportion of dislocations,with a peak incidence in age group 15-20 years,predominantly secondary to participation in sporting and recreational activities.Conversely,women experienced a relatively consistent incidence of dislocation throughout their lifespan.After age 63,the incidence rate of dislocations in females was found to surpass that observed in males.

Emergency department visits:Why adults choose the emergency room over a primary care physician visit during regular office hours?

BACKGROUND:It has been estimated that up to one third of all emergency department(ED)visits may be"inappropriate"or non-emergent.Factors that have been speculated to be associated with non-emergent use have been noted to include low socioeconomic status,lack of access to primary care,lack of insurance,convenience of"on demand care"and the patient's individual perception of their complaint urgency.The objective of this study is to identify the reasons contributing to self-perceived non-emergent adult emergency department visits during primary care physician office hours of operation.METHODS:This study was a single-center,descriptive study with questionnaire.The questionnaire was collected from patients meeting exclusion/inclusion criteria who were triaged into an acute or fast track part of the emergency department during regular business hours on Monday through Friday,8:00 am-5:00 pm during the months of July 2011 and August 2011.Questionnaire data were categorical and summarized using counts and percentages.Data collected included patient demographics,information about the patient's primary care provider,and information about the emergency department visit in question.All responses were compared among patients with visits considered to be non-emergent to those considered to be emergent by using individual chi-square tests.RESULTS:There were 262 patients available for the study.The patients were grouped according to their perception of the severity of their complaints.Roughly half of the patients placed themselves into the non-emergent category(n=129),whereas the other half of the patients categorized themselves into the emergent group(n=131).There were statistically significant differences in marital status and employment status between the two groups.It was found that 61.5%of the non-emergent patients were single,while 58.3%of the emergent patients were married.In the non-emergent group,59.7%were unemployed,but in the emergent group 60.3%were employed(P<0.05).However,no other factors were significantly different.CONCLUSIONS:Our study did not identify a statistically significant factor to the reasoning behind why patients choose the emergency department over a primary care physician during regular office hours.The only significant demographic indicating who was more likely to make this choice during the specified time frame was being single and employed with perceived non-emergent complaint.Patients without insurance and/or without a primary care physician were no more likely to visit the emergency department with a self-perceived non-emergent issue than patients with insurance and/or with an established primary care physician.

SOX A Comparison With the South African Status Quo

Auditor independence provisions enshrined in the Sarbanes-Oxley Act （SOX） were promulgated in 2002 in response to the Errron-Anderson scandal leading to a diminution of trust in the audit profession. In seeking to regulate auditor independence in the name of investor protection, SOX has been heralded as ＂ground-breaking＂ public interest reform. Ironically, when one considers the substance of these reforms and contrasts them with the situation prevailing in South Africa, a different impression results. Despite the fact that South Africa is classified as a ＂developing＂ nation and one which has only recently transitioned to democracy, many of the auditor independence principles legislated under SOX have been part of generally accepted practice in South Africa since the 1950s. Accordingly, SOX may not be the progressive example of auditor regulation that it is generally perceived to be.

未定的角色与尴尬的部门--美国联邦教育部成立45周年的回顾与讨论

1979年10月,美国联邦教育部正式成立,开启了联邦干预教育的新时代。然而,自提出成立联邦教育部的立法提案开始,呼吁裁撤该部门的声音便从未停止。尽管联邦政府教育权的扩张已经在相当范围内达成了共识,社会对联邦教育部的接受度不断上升,但由于美国独特的政治体制和教育分权传统,人们对联邦政府干预教育的合法性和合理性充满了质疑。自联邦教育部成立以来,其角色和地位不断变化,这些质疑和变化是深入理解美国教育的一个重要窗口。

从单向到协同:美国研究生学位授权审核中的大学自主性

大学自主性对美国研究生学位授权审核体系发展完善至关重要。美国研究生学位授权审核体系发展历经宗主国主导、州政府主导和多模式授权审核等三个重要阶段。在制度层面,每个阶段形塑大学自主性的制度环境分别具有宽泛自由、强化边界和分类协调等特征;在技术层面,不同阶段大学自主性发展表现出在“叛逆”中探索、在争持中磨合和在张力中平衡等特征。两个层面自主性互动从机械对接渐趋协同互嵌,不断生成能适应研究生教育治理情境的大学自主性。提高自我评估的地位和权威性、增强大学自主意识和优化多元主体参与机制等经验,可供我国在研究生学位授权审核机制中进一步提升和彰显大学自主性借鉴与反思。

美国循环经济领域科技项目资助情况分析与启示

随着全球绿色转型不断深入,循环经济逐渐成为绿色技术创新前沿与国际合作热点。本文系统梳理分析了美国国家科学基金会和能源部在循环经济领域的研究资助情况,结果表明:美国重视循环经济科技创新,2021年以来投入政府经费超7亿美元,重点资助生物质利用、新能源器件和关键矿产资源回收以及塑料循环利用方面的研究,将循环经济作为支撑航空等难减排行业净零排放、新能源产业可持续发展和塑料污染治理的重要途径。美国通过加强顶层设计促进基础研究和应用基础研究协同发力,以滚动资助培育重大成果,运用多种资助形式深化产学研融合的做法,对我国循环经济领域后续科技计划部署提供了有益借鉴与参考。

Performance-driven design with the support of digital tools： Applying.discrete event simulation and space syntax on the design of the emergency department

Ptanning the design of the emergency department （ED） is a complex process. Hospital readers and architects must consider many complex and interdependent factors, including evolving market demands, patient volume, care models, operational processes, staffing, and medical equipment. The application of digital toots, such as discrete event simulation （DES） and space syntax analysis （SSA）, arrows hospital administrators and designers to quantitativety and objectively optimize their facilities. This paper presents a case study that utitized both DES and SSA to optimize the care process and to design the space in an ED environment. DES was apptied in three phases： master planning, process improvement in the existing ED, and designing the new ED. SSA was used to compare the new design with the existing layout to evatuate the effectiveness of the new design in supporting visuat surveiltance and care coordination. This case study demonstrates that DES and SSA are effective toots for facilitating decision-making retated to design, reducing capital and operational costs, and improving organizational performance. DES focuses on operational processes and care flow. SSA complements DES with its strength in linking space to human behavior. Combining both tools can lead to high-performance ED design and can extend to broad applications in health care.

Comparison of aerosol optical depth of UV-B Monitoring and Research Program （UVMRP）, AERONET and MODIS over continental United States

The concern about the role of aerosols as to their effect in the Earth-Atmosphere system requires observation at multiple temporal and spatial scales. The Moderate Resolution Imaging Spectroradiameters （MODIS） is the main aerosol optical depth （AOD） monitoring satellite instrument, and its accuracy and uncertainty need to be validated against ground based measurements routinely. The comparison between two ground AOD measurement programs, the United States Department of Agriculture （USDA） Ultmviolet-B Monitoring and Research Program （UVMRP） and the Aerosol Robotic Network （AERONET） program, confirms the consistency between them. The intercomparison between the MODIS AOD, the AERONET AOD, and the UVMRP AOD suggests that the UVMRP AOD measurements are suited to be an alternative ground-based validation source for satellite AOD products. The experiments show that the spatial-temporal dependency between the MODIS AOD and the UVMRP AOD is positive in the sense that the MODIS AOD compare more favorably with the UVMRP AOD as the spatial and temporal intervals are increased. However, the analysis shows that the optimal spatial interval for all time windows is defined by an angular subtense of around 1° to 1.25°, while the optimal time window is around 423 to 483 minutes at most spatial intervals. The spatial-temporal approach around 1.25° ＆ 423 minutes shows better agreement than the prevalent strategy of 0.25° ＆ 60 minutes found in other similar investigations.

国有企业政治关联、政府审计质量和企业绩效——基于我国A股市场的实证研究

在我国,国有上市公司既拥有股权政治关联又拥有高管政治关联。相对于樊纲指数,更为微观的政府审计质量是影响政治关联对国有企业绩效作用发挥的重要因素。在不考虑政府审计质量的情况下,国有股权政治关联会降低企业的绩效,而高管政治关联会提升企业绩效;在考虑政府审计质量的情况下,政府审计质量越高,高管政治关联提升作用越不明显,也越会降低股权政治关联对企业绩效的损害作用。因此,提高政府审计质量可以改善国有企业的生存环境,优化资源的配置,促进企业的健康发展。

奥巴马内阁、党派性与中美贸易发展走势

当前,美国贸易政策的制定过程中充斥着浓厚的党派性色彩,两党对待贸易议题的态度针锋相对,这使得美国贸易自由化的进程严重受阻。刚刚宣誓就职的民主党总统立足未稳,党派纷争愈演愈烈,金融危机又对美国经济造成了巨大的冲击,在此背景下,自由贸易更是受到了前所未有的挑战。在未来,中美双方只有通过友好的对话来解决双边贸易中存在的问题,积极诚恳地审视自身经济政策的缺陷,双边贸易才能走上健康发展之路,为两国经济发展做出应有的贡献。

2016美国妇产科医师协会意见:妇产科医师感染HBV、HCV和HIV的管理

为防止血源性病原体传播,医疗保健者坚持标准的预防措施、遵循基本的感染控制原则并使用适当的流程技术十分重要。所有提供临床保健的妇产科医生都应接种HBV疫苗。美国流行病学医疗保健协会已经建立了感染HBV、HCV和人类免疫缺陷病毒（HIV）的医疗服务者的管理指南。该指南根据血源性传播病原体的风险程度对典型的妇产科程序进行分类,且包括根据这些类别和病毒载量对医疗保健者的临床行为提出的建议。

美国专科临床药师培训模式介绍

目的:介绍美国专科临床药师的工作模式及培养过程。方法:参观学习美国专科临床药师的培训工作,分析美国专科临床药师在药学监护中工作内容,了解其工作模式、职责,查房方式,美国对专科临床药师的培养过程及考核要求。结果和结论:美国临床药师工作更加细化,它的培养体系呈三级化的药师工作制度,专科临床药师在药学监护中发挥着重要的作用。

美国食品安全监管的第三方审核机制研究

2010年美国通过了《FDA食品安全现代化法》,对进口食品安全监管首次引入第三方审核制度。这一规定背后反映的是美国在食品供应链全球化之后,传统的监管机制日益不敷现实之需而借鉴私人监管创新的结果。本文梳理了该法规定的第三方审核机制的适用范围和主要制度安排,同时考察了美国食品安全第三方审核机制的实践,深入分析了其存在的问题和面临的挑战。最后,作者探讨了美国这一机制对我国加强食品安全监管可能具有的启示。

1916年《国家公园局组织法》与美国国家公园管理的体制化

19世纪末20世纪初,一系列国家公园不断建立的同时,美国内政部主导下的国家公园管理面临诸多问题与挑战。在此背景下,美国一些民间保护主义者、联邦政府官员等有识之士开始认识到,必须设立专门行政机构来改进国家公园管理模式。于是,在他们的推动下,国会于1916年通过了《国家公园局组织法》。该法宣告了专门服务于国家公园管理的联邦政府机构——国家公园局的诞生,确立了美国国家公园管理的使命和基本原则,为国家公园体系化发展和全国性管理政策的形成奠定了法律基础,标志着美国国家公园管理体制的初步确立。

国家机关受贿罪问题研究

文章从一起典型案例的分析入手,提出国家机关不应成为单位受贿罪的主体,对其不应成为 受贿罪主体的原因进行了理论与实践两个层面的分析,并建议立法机关以特别法的形式修改刑法第三十条。

中、美、英三国审计理念的比较研究

审计理念是指在一定的社会环境条件下,审计为达到其目标、实现其职能而对社会所产生的价值判断。它既是审计实践的理论升华,也是一种制度安排。审计理念广泛存在于审计工作过程中,并且对审计工作有着深刻的影响。文章围绕审计理念的制度安排问题,对中、英、美三国审计理念的认知状况和法规影响展开对比分析,并进一步研究了我国现阶段对审计理念的定位及认知程度,旨在探索一种具有中国特色的审计理念路子。

国家审计利用外部人才相关问题探讨

科学利用外部人才是我国国家审计人力资源整合的重要举措之一,我国国家审计可以利用的外部人才包括学者、社会审计人员、内审人员、咨询公司专业人员和企业高级专业人才等专业人才.外部人才服务国家审计的基本途径有咨询、承包、短期聘用和临时指导与名誉职务;要利用好外部人才首先要建立外部人才档案,其次就是要对外部人才进行有效的管理与激励,才能发挥其特长,为国家审计工作献计献力.

中美跨境会计审计冲突:根本诱因、基本表现与应对措施

中美跨境会计审计冲突为中概股企业的海外上市和跨境监管带来了现实难题,冲突背后的重大问题和深层逻辑亦成为实务界和学术界的重要研究焦点。构建中美跨境会计审计冲突的系统研究架构,应遵循“根本诱因—基本表现—应对措施”这一逻辑主线。冲突的根本诱因源于主权原则与国家安全观的分歧,受到文化背景、法律制度差异、市场发展水平差距以及系列“中概股”财务信息质量问题等要素共同作用的影响。冲突的基本表现则体现在信息披露问题及跨境监管上,前者聚焦于审计底稿披露和数据安全问题,后者关注中美跨境监管的执法障碍及跨境监管的合作困境。冲突的应对措施则主要围绕“合作”与“提升”两个视域展开。“合作”主要关注未来中国能否更大程度融入多边监管合作体系以及完善中美双边监管合作框架,“提升”则更多从中国资本市场自身发展出发,强调提升自身的监管水平。

美国对不良资产救助计划持续跟踪审计情况及启示

2008年美国发生次贷危机,为了应对金融体系崩溃的风险,美国国会通过了《经济紧急稳定法案》授权财政部7000亿美元救市随后2010年继续出台《多德-弗兰克法案》将资金缩减为4750亿美元。法案还要求美国审计署(GAO)每60天要对不良资产救助计划进行一次审计,并报告审计结果。本文整理了审计署近8年来的审计报告,简要介绍了审计内容、审计方法及审计效果,希望对我国的审计工作有参考意义。

美国能源部资助产出的三螺旋创新网络研究

探索美国能源部资助产出的三螺旋创新网络结构与特征,有助于把握美国能源产业的创新发展模式,对推动我国能源产业的创新发展,具有重要的借鉴意义。选择美国能源部资助产出的SCI论文为数据样本,通过综合运用多种国际前沿科研软件,对样本数据进行了不同层次的分析与提炼,绘制了美国能源部资助产出论文的整体三螺旋创新网络和产业(公司)的三螺旋创新子网络。揭示了代表政府的国家实验室在三螺旋创新网络中发挥着重要的地位和作用;大学成为三螺旋创新网络中最广泛的主体;产业与政府和大学之间形成了较好的三螺旋创新网络。