168-535: The Garbage Goat is a metal sculpture in Spokane, Washington 's Riverfront Park . It was created by Paula Mary Turnbull , a local artist known as the "welding nun", for Expo '74 , the city's 1974 world's fair . The sculpture was designed with an internal vacuum mechanism allowing the goat to "eat" trash held close to its mouth. It is also known as the Garbage-Eating Goat ; the sculpture does not have
336-477: A billy goat and constructed it in her studio from corten steel , welding pieces together using both gas and arc welding . Steel was used with the intention that it would form a coating of rust that would not require painting or maintenance. The goat's horns were fashioned from recycled springs, the legs from old pipe, and the eyes from the ends of railroad spikes. According to Turnbull, she "purposely kept him kind of spikey, so youngsters wouldn't climb on him." As
504-670: A cult following across generations of Spokanite parents and children. The goat has an unofficial Facebook page with thousands of followers and the Spokane County Regional Solid Waste System created a public educational outreach blog for the goat, with posts from "GG the Garbage Goat". The sculpture is credited with inspiring a "secret goat culture" in Spokane as well as a series of goat-themed businesses. A local brewery called Iron Goat Brewing
672-474: A radiosurgical procedure (e.g. irradiation of a tumor). Surgical procedures are commonly categorized by urgency, type of procedure, body system involved, the degree of invasiveness, and special instrumentation. Inpatient surgery is performed in a hospital, and the person undergoing surgery stays at least one night in the hospital after the surgery. Outpatient surgery occurs in a hospital outpatient department or freestanding ambulatory surgery center, and
840-525: A surgical procedure or surgical operation , or simply "surgery" or "operation". In this context, the verb "operate" means to perform surgery. The adjective surgical means pertaining to surgery; e.g. surgical instruments , surgical facility or surgical nurse . Most surgical procedures are performed by a pair of operators: a surgeon who is the main operator performing the surgery, and a surgical assistant who provides in-procedure manual assistance during surgery. Modern surgical operations typically require
1008-412: A surgical team that typically consists of the surgeon, the surgical assistant, an anaesthetist (often also complemented by an anaesthetic nurse ), a scrub nurse (who handles sterile equipment), a circulating nurse and a surgical technologist , while procedures that mandate cardiopulmonary bypass will also have a perfusionist . All surgical procedures are considered invasive and often require
1176-486: A $ 12.3 trillion loss in economic productivity by the year 2030. This was especially true in the poorest countries, which account for over one-third of the population but only 3.5% of all surgeries that occur worldwide. It emphasized the need to significantly improve the capacity for Bellwether procedures – laparotomy , caesarean section , open fracture care – which are considered a minimum level of care that first-level hospitals should be able to provide in order to capture
1344-500: A Component of Universal Health Coverage . The Lancet Commission for Global Surgery outlined the need for access to "available, affordable, timely and safe" surgical and anesthesia care; dimensions paralleled in ICESCR General Comment No. 14, which similarly outlines need for available, accessible, affordable and timely healthcare. Surgical treatments date back to the prehistoric era. The oldest for which there
1512-415: A billy goat." Besides losing its voice, the goat had other mechanical problems during the fair which may have been the result of overuse. Children were observed carrying garbage from nearby cans to feed to the goat, and one was "rumored to have hoarded trash at home and brought it with him to the fair". The internal vacuum became clogged many times. At one point, the sculpture's legs had to be cut off so that
1680-614: A component of universal health coverage." This not only mandated the WHO to prioritize strengthening the surgical and anesthesia care globally, but also led to governments of the member states recognizing the urgent need for increasing capacity in surgery and anesthesia. Additionally, the third edition of Disease Control Priorities (DCP3), published in 2015 by the World Bank , declared surgery as essential and featured an entire volume dedicated to building surgical capacity. Data from WHO and
1848-830: A distinct identity and illustrate the changes throughout the city's history. Most of Spokane's notable buildings and landmarks are in the Riverside neighborhood and the downtown commercial district, where many of the buildings were rebuilt after the Great Fire of 1889 in the Romanesque Revival style. Examples include the Great Northern clock tower, Review Building, Cathedral of Our Lady of Lourdes , First Congregational Church , Washington Water Power Post Street substation , Peyton Building, and The Carlyle. The principal architect of many buildings of this period
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#17328019737692016-411: A known official name, though Turnbull originally referred to the goat as "Billy". The Garbage Goat has become an iconic part of Spokane culture and one of its most popular tourist attractions. It has inspired a cult following, a "secret goat culture" in the city, and a series of goat-themed businesses. The debut of the Garbage Goat at Expo '74 was met with protests from dairy goat farmers, who objected to
2184-464: A male householder with no partner present, and 31.4% had a female householder with no partner present. The median household size was 2.21 and the median family size was 2.96. The age distribution was 18.8% under 18, 9.9% from 18 to 24, 30.8% from 25 to 44, 22.9% from 45 to 64, and 17.6% who were 65 or older. The median age was 38.6 years. For every 100 females, there were 101.4 males. Resection (surgery) Surgery
2352-530: A military physician". The researchers were impressed by the complexity of the brain surgical operation. In 1991 at the Polystylon fort in Greece, researchers discovered the head of a Byzantine warrior of the 14th century. Analysis of the lower jaw revealed that a surgery has been performed, when the warrior was alive, to the jaw which had been badly fractured and it tied back together until it healed. During
2520-513: A period of postoperative care (sometimes intensive care ) for the patient to recover from the iatrogenic trauma inflicted by the procedure. The duration of surgery can span from several minutes to tens of hours depending on the specialty , the nature of the condition, the target body parts involved and the circumstance of each procedure, but most surgeries are designed to be one-off interventions that are typically not intended as an ongoing or repeated type of treatment. In British colloquialism,
2688-498: A peripheral IV line is placed, and pre-operative medications (antibiotics, sedatives, etc.) are given. When the patient enters the operating room and is appropriately anesthetized, the team will then position the patient in an appropriate surgical position . If hair is present at the surgical site, it is clipped (instead of shaving). The skin surface within the operating field is cleansed and prepared by applying an antiseptic (typically chlorhexidine gluconate in alcohol, as this
2856-414: A person shows signs of infection and not as a preventative. A systematic review published by Cochrane (organisation) in 2016, though, concluded that topical antibiotics applied over certain types of surgical wounds reduce the risk of surgical site infections, when compared to no treatment or use of antiseptics . The review also did not find conclusive evidence to suggest that topical antibiotics increased
3024-403: A physical exam which did not indicate a chest x-ray. Routine x-ray examination is more likely to result in problems like misdiagnosis, overtreatment, or other negative outcomes than it is to result in a benefit to the person. Likewise, other tests including complete blood count , prothrombin time , partial thromboplastin time , basic metabolic panel , and urinalysis should not be done unless
3192-575: A plain that eventually rises sharply to the east towards the rugged, timbered Selkirk Mountains . The foothills of the Rockies —the Coeur d'Alene Mountains —rise about 25 miles (40 km) to the east in north Idaho. The city is in a transition area between the barren landscape of the Columbia Basin and the coniferous forests to the east; to the south are the lush prairies and rolling hills of
3360-550: A prehistoric individual from the Indus River valley show evidence of teeth having been drilled. Sushruta Samhita is one of the oldest known surgical texts and its period is usually placed in the first millennium BCE. It describes in detail the examination, diagnosis, treatment, and prognosis of numerous ailments, as well as procedures for various forms of cosmetic surgery, plastic surgery and rhinoplasty . In 1982 archaeologists were able to find significant evidence when
3528-436: A publicity stunt. Many Wobblies were incarcerated, including feminist labor leader Elizabeth Gurley Flynn , who published her account in the local Industrial Worker . After mining declined at the turn of the 20th century, agriculture and logging became the primary influences in the Spokane economy. The population explosion and the building of homes, railroads, and mines in northern Idaho and southern British Columbia fueled
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#17328019737693696-440: A recent study done with lumbar decompressions, the patient's length of stay was decreased by 1–3 days. The use of topical antibiotics on surgical wounds to reduce infection rates has been questioned. Antibiotic ointments are likely to irritate the skin, slow healing, and could increase risk of developing contact dermatitis and antibiotic resistance . It has also been suggested that topical antibiotics should only be used when
3864-466: A risk factor for adverse post-surgical outcomes. It has been linked to many disorders such as obesity hypoventilation syndrome, atelectasis and pulmonary embolism, adverse cardiovascular effects, and wound healing complications. If removable skin closures are used, they are removed after 7 to 10 days post-operatively, or after healing of the incision is well under way. It is not uncommon for surgical drains to be required to remove blood or fluid from
4032-480: A scrub cap, a sterile surgical gown, sterile latex or non-latex polymer gloves and a surgical mask), and they must scrub hands and arms with an approved disinfectant agent before each procedure. Prior to surgery, the person is given a medical examination , receives certain pre-operative tests, and their physical status is rated according to the ASA physical status classification system . If these results are satisfactory,
4200-487: A solitary wolf in Mount Spokane State Park. Although the ecoregion remains ecologically intact, it faces conservation challenges that include the negative effects of certain forestry management and logging practices, higher risks of forest fires due to the alteration of the trees that make up the forest composition, and habitat fragmentation as a result of urban sprawl and development, which endangers
4368-648: A specialty of medicine, rather than an accessory field. Basic surgical principles for asepsis etc., are known as Halsteads principles . There were some important advances to the art of surgery during this period. The professor of anatomy at the University of Padua , Andreas Vesalius , was a pivotal figure in the Renaissance transition from classical medicine and anatomy based on the works of Galen , to an empirical approach of 'hands-on' dissection. In his anatomic treaties De humani corporis fabrica , he exposed
4536-522: A tin can is stuffed in the goat's mouth, they feel, it is the victim of an insensitive racial slurp. As a compromise with the dairy farmers, the Expo '74 organizers installed a sign touting goats' milk production capabilities when fed a proper diet of the "finest of hays and grains". The sign said in part: This docile, loving animal is the world's largest producer of milk, cheese and other dairy products. A most economical, truly ecological animal. At one point,
4704-625: A total area of 60.02 square miles (155.45 km ), of which 59.25 square miles (153.46 km ) is land and 0.77 square miles (1.99 km ) is water. Spokane lies mostly within the Spokane Valley Outwash Plains at the periphery of the North Central Rockies forests ecoregion and partly within the eastern edge of the basaltic Channeled Scablands steppe of the Columbia Plateau ecoregion,
4872-470: A weekend, and also, decrease number and level of experience over a weekend. Postoperative pain affects an estimated 80% of people who underwent surgery. While pain is expected after surgery, there is growing evidence that pain may be inadequately treated in many people in the acute period immediately after surgery. It has been reported that incidence of inadequately controlled pain after surgery ranged from 25.1% to 78.4% across all surgical disciplines. There
5040-412: A work of interactive art , the sculpture features an internal vacuum mechanism capable of sucking up small pieces of garbage through the goat's mouth, allowing users to "feed" it. The trash passes through a 4.5-inch (110 mm) tube and empties into a hidden receptacle behind the goat. The roughly 200-pound (91 kg) sculpture was installed in a "Goat Grotto" made from basalt located just east of
5208-659: A year. Spokane's location, between the Cascades Range to the west and the Rocky Mountains to the east and north, protects it from weather patterns experienced in other parts of the Pacific Northwest . The Cascade Mountains form a barrier to the eastward flow of moist and relatively mild air from the Pacific Ocean in winter and cool air in summer. As a result of the rain shadow effect of
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5376-487: Is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery such as gastric bypass ), to reconstruct or improve aesthetics and appearance ( cosmetic surgery ), or to remove unwanted tissues ( body fat , glands , scars or skin tags ) or foreign bodies . The act of performing surgery may be called
5544-417: Is administered to prevent pain from the trauma of cutting, tissue manipulation, application of thermal energy, and suturing. Depending on the type of operation, anesthesia may be provided locally, regionally , or as general anesthesia . Spinal anesthesia may be used when the surgical site is too large or deep for a local block, but general anesthesia may not be desirable. With local and spinal anesthesia,
5712-942: Is also home to the Riverfront and Manito parks, the Smithsonian-affiliated Northwest Museum of Arts and Culture , the Davenport Hotel , and the Fox and Bing Crosby theaters. The Cathedral of Our Lady of Lourdes is the seat of the Roman Catholic Diocese of Spokane , and the Cathedral of St. John the Evangelist serves as that of the Episcopal Diocese of Spokane . The Spokane Washington Temple in
5880-647: Is among the controversial topics related to surgery in children. Doctors perform surgery with the consent of the person undergoing surgery. Some people are able to give better informed consent than others. Populations such as incarcerated persons , people living with dementia , the mentally incompetent, persons subject to coercion, and other people who are not able to make decisions with the same authority as others, have special needs when making decisions about their personal healthcare, including surgery. Global surgery has been defined as 'the multidisciplinary enterprise of providing improved and equitable surgical care to
6048-449: Is applied to the area of the person's body that will be operated on. Sterile drapes are placed around the operative site. Surgical masks are worn by the surgical team to avoid germs on droplets of liquid from their mouths and noses from contaminating the operative site. Work to correct the problem in body then proceeds. This work may involve: Blood or blood expanders may be administered to compensate for blood lost during surgery. Once
6216-444: Is being done to find a solution.As such, surgical care globally has been described as the 'neglected stepchild of global health,' a term coined by Paul Farmer to highlight the urgent need for further work in this area. Furthermore, Jim Young Kim , the former President of the World Bank , proclaimed in 2014 that "surgery is an indivisible, indispensable part of health care and of progress towards universal health coverage." In 2015,
6384-481: Is credited with the performance of the first thyroidectomy . Al-Zahrawi pioneered techniques of neurosurgery and neurological diagnosis, treating head injuries , skull fractures , spinal injuries , hydrocephalus , subdural effusions and headache . The first clinical description of an operative procedure for hydrocephalus was given by Al-Zahrawi, who clearly describes the evacuation of superficial intracranial fluid in hydrocephalic children. In Europe ,
6552-591: Is currently being renovated and modernized (as of October 2016). Manito Park and Botanical Gardens on Spokane's South Hill features the Duncan Gardens, a classical European Renaissance -style garden and the Nishinomiya Japanese Garden designed by Nagao Sakurai . Riverside State Park, close to downtown, is a site for outdoor activities such as hiking, mountain biking, and horse riding. The Spokane area has many trails and rail trails ,
6720-751: Is evidence is trepanation , in which a hole is drilled or scraped into the skull , thus exposing the dura mater in order to treat health problems related to intracranial pressure. Prehistoric surgical techniques are seen in Ancient Egypt , where a mandible dated to approximately 2650 BC shows two perforations just below the root of the first molar , indicating the draining of an abscessed tooth . Surgical texts from ancient Egypt date back about 3500 years ago. Surgical operations were performed by priests, specialized in medical treatments similar to today, and used sutures to close wounds. Infections were treated with honey. 9,000-year-old skeletal remains of
6888-561: Is increasingly recognized as an integral aspect of healthcare and therefore is evolving into a normative derivation of human right to health . The ICESCR Article 12.1 and 12.2 define the human right to health as "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health" In the August 2000, the UN Committee on Economic, Social and Cultural Rights (CESCR) interpreted this to mean "right to
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7056-500: Is insufficient evidence to determine if giving opioid pain medication pre-emptively (before surgery) reduces postoperative pain the amount of medication needed after surgery. Postoperative recovery has been defined as an energy‐requiring process to decrease physical symptoms, reach a level of emotional well‐being, regain functions, and re‐establish activities. Moreover, it has been identified that patients who have undergone surgery are often not fully recovered on discharge. In 2011, of
7224-456: Is made to access the surgical site. Blood vessels may be clamped or cauterized to prevent bleeding, and retractors may be used to expose the site or keep the incision open. The approach to the surgical site may involve several layers of incision and dissection, as in abdominal surgery, where the incision must traverse skin, subcutaneous tissue, three layers of muscle and then the peritoneum. In certain cases, bone may be cut to further access
7392-517: Is still trying to make the transition to a more service-oriented economy in the face of a less prominent manufacturing sector. Developing the city's strength in the medical and health sciences fields has seen some success, resulting in the expansion of the University District with two medical school branches. The city faces challenges such as a scarcity of high-paying jobs, pockets of poverty, and areas of high crime. The opening of
7560-401: Is that the physician might discover some unknown medical condition which would complicate the surgery, and that upon discovering this with the chest x-ray, the physician would adapt the surgery practice accordingly. However, medical specialty professional organizations recommend against routine pre-operative chest x-rays for people who have an unremarkable medical history and presented with
7728-610: Is the Washington-native rainbow trout , which is the official fish of Washington state. Big game common in eastern Washington include black and grizzly bears, caribou , Rocky Mountain elk , bighorn sheep, and cougar. Whitetail deer, mule deer, and moose are also found in abundance. The gray wolf population has been making a recovery in the Inland Northwest. As of June 2016, there are 16 wolf packs in eastern Washington. In August 2016, photo evidence confirmed
7896-613: Is the central business district of Spokane. The neighborhoods south of downtown Spokane are collectively known as the South Hill. Downtown Spokane contains many of the city's public facilities, including City Hall, Riverfront Park (site of Expo '74), and the Spokane Convention Center, First Interstate Center for the Arts and Spokane Arena. The Spokane County Courthouse and public safety campus is adjacent to downtown in
8064-627: Is the closest natural reserve, the closest National Forest is the Colville National Forest , the closest National Recreation Area is the Lake Roosevelt National Recreation Area and the closest national park is Mount Rainier National Park , approximately a four-and-a-half hour drive from Spokane. Spokane's neighborhoods range from the Victorian -style South Hill and Browne's Addition, to
8232-551: Is the official tree of the City of Spokane, which is where specimens were first collected by botanist David Douglas in 1826. The Canadian Rockies ecoregion supports 70 mammals, 16 reptiles and amphibians, 168 birds, and 41 fish species. There is a high concentration of raptors in the area, bald eagles are a common sight near Lake Coeur d'Alene in December and January when kokanee spawn. The most common fish present in area lakes
8400-424: Is twice as effective as povidone-iodine at reducing the risk of infection). Sterile drapes are then used to cover the borders of the operating field . Depending on the type of procedure, the cephalad drapes are secured to a pair of poles near the head of the bed to form an "ether screen", which separate the anesthetist / anesthesiologist 's working area (unsterile) from the surgical site (sterile). Anesthesia
8568-646: The 2010 census , Spokane had a population of 208,916, making it the 2nd-most populous city in Washington , and the 97th-most populous city in the United States . At the 2020 census , Spokane's population was 228,989. A 2023 estimate sets the population of the metropolitan area at 600,292. The first people to live in the area, the Spokane tribe (their name meaning "children of the sun" in Salishan ), lived off plentiful game. David Thompson explored
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#17328019737698736-470: The Chicago World's Fair in 1893, Cutter found work constructing many mansions for mining and railroad tycoons such as Patrick "Patsy" Clark and Daniel C. Corbin and son Austin. The older neighborhoods of the early 20th century, such as West Central, East Central, Logan , Hillyard, and much of the lower South Hill, feature a large concentration of American Craftsman style bungalows . In Hillyard,
8904-634: The Industrial Workers of the World (IWW), or "Wobblies" as they were often known, whose free speech fights had begun to garner national attention. Now, with grievances concerning the unethical practices of the employment agencies, they initiated a free speech fight in September 1908 by purposely breaking a city ordinance on soapboxing . With IWW encouragement, union members from many western states came to Spokane to take part in what had become
9072-524: The Islamic Golden Age , largely based upon Paul of Aegina 's Pragmateia , the writings of Albucasis (Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi), an Andalusian-Arab physician and scientist who practiced in the Zahra suburb of Córdoba , were influential. Al-Zahrawi specialized in curing disease by cauterization . He invented several surgical instruments for purposes such as inspection of
9240-486: The Looff Carrousel along the southern edge of the park. A button embedded in the stone wall is pressed to activate the vacuum. The original display at the fair included a tape recording of a voice saying, in part, "please feed me, I am hungry", that would play as people passed by. The Garbage Goat generated controversy and public debate before it was even installed at the fair. Dairy goat farmers were upset that
9408-498: The Oregon Treaty of 1846. The Hudson's Bay Company wound up its operations in the area over the next few years. In what is now Spokane, the first American settlers were J.J. Downing and S.R. Scranton, cattle ranchers who squatted and established a claim at Spokane Falls in 1871. Together they built a small sawmill on a claim near the south bank of the falls. James N. Glover and Jasper Matheney, Oregonians passing through
9576-709: The Palouse . The highest peak in Spokane County is Mount Spokane , at an elevation of 5,883 feet (1,793 m), on the eastern side of the Selkirk Mountains. The Spokane River is the area's most prominent water feature, a 111-mile (179 km) tributary of the Columbia River , originating from Lake Coeur d'Alene in northern Idaho. The river flows west across the Washington state line through downtown Spokane, meeting Latah Creek , then turns to
9744-602: The Queen Anne and early American Craftsman styles. The area houses the Northwest Museum of Arts and Culture. In northeast Spokane, the Hillyard neighborhood began in 1892 as the chosen site for James J. Hill's Great Northern Railway yard, placed outside Spokane city limits to avoid "burdensome taxes". The downtown Hillyard Business District, located on Market Street, was the first Spokane neighborhood listed in
9912-849: The River Park Square in 1999 served as a catalyst and sparked a downtown rebirth that included the building of the Spokane Arena and expansion of the Spokane Convention Center . Other major projects include the building of the Big Easy concert house (now the Knitting Factory ) and renovation of the historic Montvale Hotel , the Kirtland Cutter-designed Davenport Hotel (after being vacant for over 20 years),
10080-699: The Rocky Mountain foothills, 92 miles (148 km) south of the Canadian border , 18.5 miles (30 km) west of the Washington– Idaho border, and 279 miles (449 km) east of Seattle , along Interstate 90 . Spokane is the economic and cultural center of the Spokane metropolitan area , the Spokane–Coeur d'Alene combined statistical area , and the Inland Northwest . It is known as
10248-825: The Western Hockey League . The Spokane Velocity in USL League One with a women's first division team Spokane Zephyr FC in USL Super League . The Gonzaga Bulldogs collegiate basketball team competes at the Division ;I level. As of 2010, Spokane's major daily newspaper, The Spokesman-Review , had a daily circulation of over 76,000. The first humans to live in the Spokane area were hunter-gatherers that lived off plentiful fish and game; early human remains have been dated to 8,000 to 13,000 years ago. The Spokane tribe, after which
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#173280197376910416-419: The "welding nun", was appointed to the expo's Visual Arts Advisory Committee in 1972. Following the fair's ecology theme, Turnbull designed a sculpture that would encourage children to help keep the fairgrounds free of litter and teach them a lesson in cleanliness. The sculpture was commissioned by the "Make America Better" committee of Spokane's Women's Council of Realtors. Turnbull modeled her sculpture after
10584-412: The 1920s and 1930s remained slow but less drastically so, forcing city boosters to market the city as a quiet, comfortable place suitable for raising a family rather than a dynamic community full of opportunity. The Inland Empire was heavily dependent on natural resources and extractive goods produced from mines, forests, and farms, which experienced a fall in demand. The situation improved slightly with
10752-1015: The 1960s and 1970s where his main body of work was done in the modernist style, designing numerous residential houses, apartment buildings, and architectural embellishments. Some of his most noteworthy works in Spokane include The Parkade , Spokane International Airport, Spokane Regional Health Building, and the Burlington Northern Latah Creek Bridge over Hangman Valley. Other well-represented architectural styles downtown include Art Deco (Spokane City Hall, Paulsen Center , Fox Theater , John R. Rogers High School , City Ramp Garage), Renaissance Revival (Steam Plant Square, Thomas S. Foley Courthouse , Legion Building , San Marco ), Neoclassical (Masonic Center, Hutton Building , Bing Crosby Theater ), Chicago School ( U.S. Bank Building , Liberty Building, Old City Hall ) and Modernist ( The Parkade , Ridpath Hotel , Bank of America Financial Center). The tallest building in
10920-403: The 2000 comment to include timely access to "basic preventative, curative services… for appropriate treatment of injury and disability .". Obstetric care shares close ties with reproductive rights , which includes access to reproductive health. Surgeons and public health advocates, such as Kelly McQueen , have described surgery as "Integral to the right to health ". This is reflected in
11088-418: The 38.6 million hospital stays in U.S. hospitals, 29% included at least one operating room procedure. These stays accounted for 48% of the total $ 387 billion in hospital costs. The overall number of procedures remained stable from 2001 to 2011. In 2011, over 15 million operating room procedures were performed in U.S. hospitals. Data from 2003 to 2011 showed that U.S. hospital costs were highest for
11256-535: The Blue Zoo an interactive aquarium in the NorthTown Mall . The area supports an abundance of wildlife in part because of its varied geology and natural history. The area contains a wide range of vegetation, from densely wooded coniferous forests to rolling grassy hills and meadows. Ponderosa pine and Douglas fir are common in the drier and lower elevation areas throughout the region. The ponderosa pine
11424-648: The Browne's Addition neighborhood and residences contain the largest variety of residential architecture in the city. These residences are lavish and personalized, featuring many architectural styles that were popular and trendy in the Pacific Northwest from the late 19th century to 1930, such as the Victorian and Queen Anne styles. In high demand following his firms' design of the Idaho Building at
11592-560: The Cascades, the Spokane area has 16.5 inches (420 mm) average annual precipitation, less than half of Seattle's 39.3 inches (1,000 mm). Precipitation peaks in December, and summer is the driest time of the year. The Rockies shield Spokane from some of the winter season's coldest air masses traveling southward across Canada. In the summer season, Spokane, like much of the western United States , has been experiencing drier conditions and more frequent and larger wildfire events since
11760-503: The Coeur d'Alene region of northern Idaho lured prospectors. The Inland Empire erupted with numerous mining rushes from 1883 to 1892. Mining and smelting emerged as a major stimulus to Spokane. At the onset of the initial 1883 gold rush in the nearby Coeur d'Alene mining district , Spokane became popular with prospectors, offering low prices on everything "from a horse to a frying pan". It would keep this status for subsequent rushes in
11928-495: The Davenport District of Downtown, to the more contemporary neighborhoods of north Spokane. Spokane's neighborhoods are gaining attention for their history, as illustrated by the city being home to 18 recognized National Register Historical Districts . Some of Spokane's best-known neighborhoods are Riverside , Browne's Addition , and Hillyard . The Riverside neighborhood consists primarily of downtown Spokane and
12096-469: The Davenport Hotel cost two million dollars to complete and included new technologies at the time of its opening in September 1914, such as chilled water, elevators, and air cooling. In contemporary times, one of the city's foremost and influential architects has been Warren C. Heylman, who helped give the city a great breadth of mid-century architecture. Heylman's career was most prolific during
12264-696: The Fox Theater (now home to the Spokane Symphony) as well as the completion of the WSU Pharmaceutical and Biomedical Sciences Building in 2013 and the Davenport Grand Hotel in 2015, Ridpath Hotel in 2018 and the ongoing renovation of Riverfront Park (as of May 2019). The Kendall Yards development on the west side of downtown Spokane is one of the largest construction projects in the city's history. Directly across
12432-623: The Garbage Goat had "eaten" over 14,000 cubic yards of litter. The Garbage Goat has experienced downtimes and occasionally needs repairs. Vandals once twisted off the goat's horns and the vacuum system sometimes stops working when objects get lodged in the pipe. The sculpture was closed to the public while the Looff Carrousel was being repaired, but was finally reopened in May 2018. The Garbage Goat has inspired replicas in other communities. In 2002, Kennewick, Washington , unveiled its own "Billy
12600-606: The Garbage Goat" with plans to install the sculpture at Columbia Park next to the Playground of Dreams. Spokane, Washington Spokane ( / s p oʊ ˈ k æ n / spoh- KAN ) is the most populous city in and the county seat of Spokane County, Washington , United States. It is in eastern Washington , along the Spokane River , adjacent to the Selkirk Mountains , and west of
12768-724: The Lancet Commission on Global Surgery (LCoGS) published the landmark report titled "Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development", describing the large, pre-existing burden of surgical diseases in low- and middle-income countries (LMICs) and future directions for increasing universal access to safe surgery by the year 2030. The Commission highlighted that about 5 billion people lack access to safe and affordable surgical and anesthesia care and 143 million additional procedures were needed every year to prevent further morbidity and mortality from treatable surgical conditions as well as
12936-494: The National Register of Historic Places. Many of the former town's houses were built to house railroad workers, mainly immigrant laborers working in the local yard, who gave Hillyard an independent, blue-collar character. Hillyard has become a home for much of Spokane's growing Russian , Ukrainian , and Southeast Asian communities. Spokane neighborhoods contain a patchwork of architectural styles that give them
13104-622: The North West Company further south in search of furs. After establishing the Kullyspell House and Saleesh House trading posts in what are now Idaho and Montana, Thompson then attempted to expand further west. He sent out two trappers, Jacques Raphael Finlay and Finan McDonald, to construct a fur trading post on the Spokane River, which flows west from Lake Coeur d'Alene to the Columbia River , and trade with
13272-543: The Paliokastro on Thasos ten skeletal remains, four women and six men, who were buried between the fourth and seventh centuries A.D. Their bones illuminated their physical activities, traumas, and even a complex form of brain surgery. According to the researchers: "The very serious trauma cases sustained by both males and females had been treated surgically or orthopedically by a very experienced physician/surgeon with great training in trauma care. We believe it to have been
13440-486: The South Hill. Yet the rebuilding and development of the city was far from smooth: between 1889 and 1896 alone, all six bridges over the Spokane River were destroyed by floods before their completion. In the 1890s the city was subject to intrastate migration by African-Americans from Roslyn , looking for work after the closure of the area's mines. Two African-American churches, Calvary Baptist and Bethel African Methodist Episcopal, were founded in 1890. Just three years after
13608-456: The Spokane River from downtown, it will blend residential and retail space with plazas and walking trails. Spokane is located on the Spokane River in eastern Washington at an elevation of 1,843 feet (562 m) above sea level, about 18 miles (29 km) from Idaho , 92 miles (148 km) south of the Canadian border , 229 miles (369 km) due east of Seattle, and 279 miles (449 km) southwest of Calgary . The lowest elevation in
13776-650: The World Bank indicate that scaling up infrastructure to enable access to surgical care in regions where it is currently limited or is non-existent is a low-cost measure relative to the significant morbidity and mortality caused by lack of surgical treatment. In fact, a systematic review found that the cost-effectiveness ratio – dollars spent per DALYs averted – for surgical interventions is on par or exceeds those of major public health interventions such as oral rehydration therapy , breastfeeding promotion , and even HIV/AIDS antiretroviral therapy . This finding challenged
13944-556: The ancient land, called 'Alahana Pirivena' situated in Polonnaruwa, with ruins, was excavated. In that place ruins of an ancient hospital emerged. The hospital building was 147.5 feet in width and 109.2 feet in length. The instruments which were used for complex surgeries were there among the things discovered from the place, including forceps, scissors, probes, lancets, and scalpels. The instruments discovered may be dated to 11th century AD. In ancient Greece , temples dedicated to
14112-434: The anesthesia, he/she is either transferred to a surgical ward elsewhere in the hospital or discharged home. During the post-operative period, the person's general function is assessed, the outcome of the procedure is assessed, and the surgical site is checked for signs of infection. There are several risk factors associated with postoperative complications, such as immune deficiency and obesity. Obesity has long been considered
14280-597: The area with the westward expansion and establishment of the North West Company 's Spokane House in 1810. This trading post was the first long-term European settlement in Washington. Completion of the Northern Pacific Railway in 1881 brought many settlers from America to the Spokane area. The same year it was officially incorporated as a city under the name of Spokane Falls (it was re-incorporated under its current name ten years later). In
14448-562: The arrival of additional railroads. By 1910 the population had hit 104,000, and Spokane eclipsed Walla Walla as the commercial center of the Inland Empire. In time the city came to be known as the "capital" of the Inland Empire and the heart of a vast tributary region. After the arrival of the Northern Pacific, Union Pacific , Great Northern, and Chicago, Milwaukee, St. Paul and Pacific railroads, Spokane became one of
14616-531: The birthplace of Father's Day , and locally by the nickname of "Lilac City". Officially, Spokane goes by the nickname of Hooptown USA , due to Spokane's annual hosting of the Spokane Hoopfest , the world's largest basketball tournament. The city and the wider Inland Northwest area are served by Spokane International Airport , 5 miles (8 km) west of Downtown Spokane , which is located near another airfield at Fairchild Air Force Base . According to
14784-884: The city , at 288 feet (88 m), is the Bank of America Financial Center. Also of note is the Spokane County Courthouse in West Central (the building on the seal of Spokane County), the Cathedral of St. John the Evangelist in Rockwood, the Benewah Milk Bottles in Riverside and Garland, Mount Saint Michael in Hillyard, and the Cambern Dutch Shop Windmill in South Perry. As an early affluent Spokane neighborhood,
14952-686: The city is named (the name meaning "children of the sun" or "sun people" in Salishan ), are believed to be either their direct descendants, or descendants of people from the Great Plains . When asked by early white explorers, the Spokanes said their ancestors came from "up North." Early in the 19th century, the Northwest Fur Company sent two white fur trappers west of the Rocky Mountains to search for fur . These were
15120-618: The city of Spokane is the northernmost point of the Spokane River within city limits (in Riverside State Park ) at 1,608 feet (490 m); the highest elevation is on the northeast side, near the community of Hillyard (though closer to Beacon Hill and the North Hill Reservoir) at 2,591 feet (790 m). Spokane is part of the Inland Northwest region, consisting of eastern Washington, north Idaho , northwestern Montana , and northeastern Oregon . The city has
15288-575: The city was 80.7% White, 2.9% some other race, 2.5% Black or African American, 2.0% Asian, 0.8% Native American or Alaskan Native, and 0.5% Native Hawaiian or Other Pacific Islander, with 10.5% from two or more races. Hispanics or Latinos of any race were 8.1% of the population. Of the 101,130 households, 24.5% had children under the age of 18 living with them, 29.8% had seniors 65 years or older living with them, 35.9% were married couples living together, 7.9% were couples cohabitating, 24.8% had
15456-399: The city was reincorporated under the present name of "Spokane" in 1891. According to historian David H. Stratton, "From the late 1890s to about 1912, a great flurry of construction created a modern urban profile of office buildings, banks, department stores, hotels and other commercial institutions" which stretched from the Spokane River to the site of the Northern Pacific railroad tracks below
15624-480: The city. During this time of stagnation, unrest was prevalent among the area's unemployed, who became victimized by "job sharks", who charged a fee for signing up workers in the logging camps. Job sharks and employment agencies were known to cheat itinerant workers, sometimes paying bribes to periodically fire entire work crews, thus generating repetitive fees for themselves. Crime spiked in the 1890s and 1900s, with eruptions of violent activity involving unions such as
15792-510: The coldest month is over 26.6 °F (−3 °C), though in the US this threshold is often defined to be 32 °F (0 °C). The area typically has a warm, arid climate during the summer months, bracketed by short spring and fall seasons. On average, the warmest month is July and the coolest month is December; July averages 71.0 °F (21.7 °C), while December averages 29.1 °F (−1.6 °C). Daily temperature ranges are large during
15960-1087: The common misconception that surgical care is financially prohibitive endeavor not worth pursuing in LMICs. A key policy framework that arose from this renewed global commitment towards surgical care worldwide is the National Surgical Obstetric and Anesthesia Plan (NSOAP). NSOAP focuses on policy-to-action capacity building for surgical care with tangible steps as follows: (1) analysis of baseline indicators, (2) partnership with local champions, (3) broad stakeholder engagement, (4) consensus building and synthesis of ideas, (5) language refinement, (6) costing, (7) dissemination, and (8) implementation. This approach has been widely adopted and has served as guiding principles between international collaborators and local institutions and governments. Successful implementations have allowed for sustainability in terms of longterm monitoring, quality improvement, and continued political and financial support. Access to surgical care
16128-420: The completion of the railroad and its exact course, Matheney sold his interest in the claim to Glover. Glover confidently held on to his claim and became a successful Spokane business owner and the city's second mayor. He later came to be known as the "Father of Spokane". In 1880, Fort Spokane was established by U.S. Army troops under Lt. Col. Henry C. Merriam 56 miles (90 km) northwest of Spokane, at
16296-400: The council was not responsible for silencing the goat and it was later revealed that mechanical problems had caused the goat's audio to be temporarily disabled. Turnbull herself was unperturbed by the criticism, saying "I am not trying to malign goats. People have lost their sense of humor." She noted that the goat depicted could not produce milk anyhow, saying "my goat isn't a dairy goat, it's
16464-414: The demand grew for surgeons to formally study for many years before practicing; universities such as Montpellier , Padua and Bologna were particularly renowned. In the 12th century, Rogerius Salernitanus composed his Chirurgia , laying the foundation for modern Western surgical manuals. Barber-surgeons generally had a bad reputation that was not to improve until the development of academic surgery as
16632-662: The east of the county serves the Church of Jesus Christ of Latter-day Saints . Gonzaga University was established in 1887 by the Jesuits , and the private Presbyterian Whitworth University was founded three years later and moved to north Spokane in 1914. In sports, the region's professional and semi-professional sports teams include the Spokane Indians in Minor League Baseball . The Spokane Chiefs in
16800-494: The enjoyment of a variety of facilities, goods, services, and conditions necessary for the realization of the highest attainable health". Surgical care can be thereby viewed as a positive right – an entitlement to protective healthcare. Woven through the International Human and Health Rights literature is the right to be free from surgical disease. The 1966 ICESCR Article 12.2a described the need for "provision for
16968-554: The establishment of the WHO Global Initiative for Emergency and Essential Surgical Care in 2005, the 2013 formation of the Lancet Commission for Global Surgery, the 2015 World Bank Publication of Volume 1 of its Disease Control Priorities Project "Essential Surgery", and the 2015 World Health Assembly 68.15 passing of the Resolution for Strengthening Emergency and Essential Surgical Care and Anesthesia as
17136-418: The fairgrounds became the 100-acre (40 ha) Riverfront Park. The growth witnessed in the late 1970s and early 1980s was interrupted by another U.S. recession in 1981, in which silver, timber, and farm prices dropped. The period of decline for the city lasted into the 1990s and was also marked by a loss of many steady family-wage jobs in the manufacturing sector. At this time, market forces began to impact
17304-508: The fire, in 1892, James J. Hill 's Great Northern Railway arrived in the chosen site for Hill's rail yards , the newly created township of Hillyard (annexed by Spokane in 1924). Spokane became an important rail shipping and transportation hub for the Inland Empire, connecting mines in the Silver Valley with agricultural areas around the Palouse region. The city's population ballooned to 19,922 in 1890, and to 36,848 in 1900 with
17472-546: The first governor, Isaac Stevens , made an initial effort to make a treaty with Chief Garry and the Spokanes at Antoine Plantes' Ferry, not far from Millwood . After the last campaign of the Yakima Indian War , the Coeur d'Alene War of 1858 was brought to a close by the actions of Col. George Wright , who won decisive victories against a confederation of tribes in engagements at the battles of Four Lakes and Spokane Plains . The cessation of hostilities opened
17640-557: The first white men met by the Spokanes, who believed they were sacred, and set the trappers up in the Colville River valley for the winter. The explorer-geographer David Thompson , working as head of the North West Company 's Columbia Department , became the first European to explore the Inland Empire (now called the Inland Northwest ). Crossing what is now the Canada–US border from British Columbia , Thompson wanted to expand
17808-402: The goat could be flipped over for an "internal enlargement" that a visiting nursing executive described as "practically a resection ". Since its inception in 1974, the Garbage Goat has become an iconic landmark in Spokane and one of Riverfront Park's most popular attractions. It is especially popular with children, though toddlers' mittens are occasionally sucked up. The Garbage Goat developed
17976-503: The goat is fed hand-in-hand by a couple. At a 40th birthday celebration for the Garbage Goat in 2014, the City of Spokane held a goat-themed party for the public in its honor. The gathered crowd sang "Happy Birthday" to the goat and presented it with a slice of the birthday cake. The goat sucked out the candles on its cake before Turnbull "fed" it a slice. At the celebration, the Spokane Parks and Recreation Department estimated that
18144-485: The greatest surgeons of the ancient world and performed many audacious operations – including brain and eye surgery – that were not tried again for almost two millennia. Hippocrates stated in the oath ( c. 400 BCE ) that general physicians must never practice surgery and that surgical procedures are to be conducted by specialists Researchers from the Adelphi University discovered in
18312-467: The healer-god Asclepius , known as Asclepieia ( Greek : Ασκληπιεία , sing. Asclepieion Ασκληπιείον ), functioned as centers of medical advice, prognosis, and healing. In the Asclepieion of Epidaurus , some of the surgical cures listed, such as the opening of an abdominal abscess or the removal of traumatic foreign material, are realistic enough to have taken place. The Greek Galen was one of
18480-437: The historic West Central neighborhood. To the east of downtown is East Central and the adjacent University District and budding "International District". To the west of downtown is one of Spokane's oldest and densest neighborhoods, Browne's Addition. A National Historic District west of Downtown, Browne's Addition was Spokane's first prestigious address, notable for its array of old mansions built by Spokane's early elite in
18648-594: The hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes. People who are frail and elderly (score of 4 or 5) have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people. Surgery on children requires considerations that are not common in adult surgery. Children and adolescents are still developing physically and mentally making it difficult for them to make informed decisions and give consent for surgical treatments. Bariatric surgery in youth
18816-409: The indicated problem, minimize the risk of complications, optimize the time needed for recovery, and limit the surgical stress response. The intraoperative phase begins when the surgery subject is received in the surgical area (such as the operating theater or surgical department ), and lasts until the subject is transferred to a recovery area (such as a post-anesthesia care unit ). An incision
18984-438: The integrity of Spokane's street grid pattern is largely intact (especially the areas north of downtown and south of Francis Ave.), and the houses have backyard alleys for carports, deliveries, and refuse collection. Contemporary suburbs and architecture are prevalent at the north and south edges of Spokane as well as in the new Kendall Yards neighborhood north of downtown. In 1907, Spokane's board of park commissioners retained
19152-665: The inter-mountain valley of the Pacific Northwest to colonial expansion and safe habitation by settlers. Joint American–British occupation of Oregon Country , in effect since the Treaty of 1818 , eventually led to the Oregon Boundary Dispute after a large influx of American settlers along the Oregon Trail . Great Britain ceded its claims to lands in Puget Sound and the central and lower Columbia Basin by
19320-427: The interior of the urethra and for removing foreign bodies from the throat, the ear, and other body organs. He was also the first to illustrate the various cannulae and to treat warts with an iron tube and caustic metal as a boring instrument. He describes what is thought to be the first attempt at reduction mammaplasty for the management of gynaecomastia and the first mastectomy to treat breast cancer . He
19488-490: The interior of the body; for example, cutting the skull for brain surgery or cutting the sternum for thoracic (chest) surgery to open up the rib cage . Whilst in surgery aseptic technique is used to prevent infection or further spreading of the disease. The surgeons' and assistants' hands, wrists and forearms are washed thoroughly for at least 4 minutes to prevent germs getting into the operative field, then sterile gloves are placed onto their hands. An antiseptic solution
19656-555: The junction of the Columbia and Spokane Rivers, to protect the construction of the Northern Pacific Railway and secure a place for U.S. settlement. By June 30, 1881, the railway reached the city, bringing major European settlement to the area. The city was officially incorporated with a population of about 1,000 residents on November 29, 1881. When Spokane was officially incorporated in 1881, Robert W. Forrest
19824-473: The late 1850s in part due to the hilltops. The Palouse was and still is a breadbasket and was able to develop and grow with the completion of several railroad networks as well as a highway system that began to center around the city of Spokane, aiding farmers from around the region in distributing their products to market. Inland Empire farmers exported wheat, livestock and other agricultural products to ports such as New York, Liverpool and Tokyo. Local morale
19992-460: The late 19th century, gold and silver were discovered in the Inland Northwest. The local economy depended on mining, timber, and agriculture until the 1980s. Spokane hosted the first environmentally themed World's fair at Expo '74 . Many of the downtown area's older Romanesque Revival -style buildings were designed by architect Kirtland Kelsey Cutter after the Great Fire of 1889 . The city
20160-510: The late 20th century; the fine particulate matter in the smoke can be carried by the wind and blanket the region in a haze and impact Spokane's air quality . See or edit raw graph data . As of the 2022 American Community Survey estimates, there were 230,176 people and 101,130 households. The population density was 3,347.5 inhabitants per square mile (1,292.5/km ). There were 105,002 housing units at an average density of 1,527.1 per square mile (589.6/km ). The racial makeup of
20328-449: The local Kaiser Aluminum plant and layoffs, pension cuts, a 1998-1999 labor strike, and eventually bankruptcy in 2002 followed. Although this was a tough period, Spokane's economy had started to benefit from some measure of economic diversification; growing companies such as Key Tronic and other research, marketing, and assembly plants for technology companies helped lessen Spokane's dependence on natural resources. As of 2014, Spokane
20496-666: The local Indians. This post was established in 1810, at the confluence of the Little Spokane and Spokane rivers, becoming the first enduring European settlement of significance in what later became Washington state. Known as the Spokane House , or simply "Spokane", it was in operation from 1810 to 1826. Operations were run by the British North West Company and later the Hudson's Bay Company , and
20664-598: The logging industry. Although overshadowed in importance by the vast timbered areas on the coastal regions west of the Cascades, and burdened with monopolistic rail freight rates and stiff competition, Spokane became a noted leader in the manufacture of doors, window sashes , blinds, and other planing mill products. Rail freight rates were much higher in Spokane than the rates in coastal seaport cities such as Seattle and Portland, so much so that Minneapolis merchants could ship goods first to Seattle and then back to Spokane for less than shipping directly to Spokane, even though
20832-527: The long-term survival of vulnerable species such as mountain caribou and the American goshawk . Spokane has a warm-summer humid continental climate ( Dsb under the Köppen classification), a rare climate due to its elevation and significant winter precipitation; Spokane, however, is adjacent to and sometimes even classified as a warm-summer Mediterranean climate ( Csb ) because the average temperature for
21000-501: The many anatomical errors in Galen and advocated that all surgeons should train by engaging in practical dissections themselves. The second figure of importance in this era was Ambroise Paré (sometimes spelled "Ambrose" ), a French army surgeon from the 1530s until his death in 1590. The practice for cauterizing gunshot wounds on the battlefield had been to use boiling oil; an extremely dangerous and painful procedure. Paré began to employ
21168-459: The most architecturally intact neighborhood in Spokane, 85 percent of these buildings are historic. As the city expanded mainly to the north in the middle of the 20th century, the bungalows in the "minimal traditional" style commonplace from the 1930s to the 1950s tend to predominate in the Northwest, North Hill, and Bemiss neighborhoods. This architectural style occupies the neighborhoods where
21336-636: The most basic emergency surgical care. In terms of the financial impact on the patients, the lack of adequate surgical and anesthesia care has resulted in 33 million individuals every year facing catastrophic health expenditure – the out-of-pocket healthcare cost exceeding 40% of a given household's income. In alignment with the LCoGS call for action, the World Health Assembly adopted the resolution WHA68.15 in 2015 that stated, "Strengthening emergency and essential surgical care and anesthesia as
21504-428: The most important rail centers in the western U.S. Expansion abruptly stopped in the 1910s and was followed by a period of population decline, due in large part to Spokane's slowing economy. Control of regional mines and resources became increasingly dominated by national corporations rather than local people and organizations, diverting capital outside of Spokane and decreasing growth and investment opportunities in
21672-751: The most notable of which is the Spokane River Centennial Trail , which features over 37.5 miles (60.4 km) of paved trails running along the Spokane River from Spokane to the Idaho border. This trail continues on towards Coeur d'Alene for 24 miles (39 km) as the North Idaho Centennial Trail and is often used for alternative transportation and recreational use. In the summer, it has long been popular to visit North Idaho's "Lake Country", such as Lake Coeur d'Alene , Lake Pend Oreille , Priest Lake , or one of
21840-508: The need for extended care. Assessment of older people before elective surgery can accurately predict the person's recovery trajectories. One frailty scale uses five items: unintentional weight loss, muscle weakness , exhaustion, low physical activity, and slowed walking speed. A healthy person scores 0; a very frail person scores 5. Compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in
22008-620: The northwest, where it is joined by the Little Spokane River on its way to the Columbia River, north of Davenport . The Channeled Scablands and many of the area's numerous large lakes, such as Lake Coeur d'Alene and Lake Pend Oreille , were formed by the Missoula Floods after the ice-dammed Glacial Lake Missoula ruptured at the end of the last ice age. The Turnbull National Wildlife Refuge south of Cheney
22176-457: The other nearby bodies of water and beaches. In the winter, the public has access to five ski resorts within a couple hours of the city. The closest of these is the Mt. Spokane Ski and Snowboard Park , which has trails for cross-country skiing, snowshoeing, snowmobiling, and dog sledding. Zoological parks in Spokane include Cat Tales Zoological Park , a wildlife sanctuary primarily for big cats and
22344-410: The person requiring surgery signs a consent form and is given a surgical clearance. If the procedure is expected to result in significant blood loss, an autologous blood donation may be made some weeks prior to surgery. If the surgery involves the digestive system , the person requiring surgery may be instructed to perform a bowel prep by drinking a solution of polyethylene glycol the night before
22512-585: The person who had surgery is discharged the same working day. Office-based surgery occurs in a physician's office, and the person is discharged the same day. At a hospital , modern surgery is often performed in an operating theater using surgical instruments , an operating table , and other equipment. Among United States hospitalizations for non-maternal and non-neonatal conditions in 2012, more than one-fourth of stays and half of hospital costs involved stays that included operating room (OR) procedures. The environment and procedures used in surgery are governed by
22680-479: The positive role of the Garbage Goat in keeping the fairgrounds free of litter. One family wrote that they were planning to boycott the fair and another wrote that they were "repulsed and disgusted by such idiocy". Another letter described the goat as a "fastidious, clean and selective eater". Goat breeders stressed that the public be educated that goats needed to be fed properly like any other animal. A goat breeders association even contacted Congressman Tom Foley about
22848-621: The post was the headquarters of the fur trade between the Rocky and Cascade mountains for 16 years. After the latter business absorbed the North West Company in 1821, the major operations at the Spokane House were eventually shifted north to Fort Colville , reducing the post's significance. In 1836, Reverend Samuel Parker visited the area and reported that around 800 Native Americans were living in Spokane Falls. A medical mission
23016-475: The preferred option, and after successful negotiation to relocate the railroad facilities on Havermale Island, they executed on a proposal to host the first environmentally themed World's Fair in Expo '74 on May 4, becoming the smallest city at the time to host a World's Fair. This event transformed Spokane's downtown, removing a century of railroad infrastructure and re-inventing the urban core. After Expo '74,
23184-413: The principles of aseptic technique : the strict separation of "sterile" (free of microorganisms) things from "unsterile" or "contaminated" things. All surgical instruments must be sterilized , and an instrument must be replaced or re-sterilized if it becomes contaminated (i.e. handled in an unsterile manner, or allowed to touch an unsterile surface). Operating room staff must wear sterile attire ( scrubs ,
23352-422: The procedure is complete, sutures or staples are used to close the incision. Once the incision is closed, the anesthetic agents are stopped or reversed, and the person is taken off ventilation and extubated (if general anesthesia was administered). After completion of surgery, the person is transferred to the post anesthesia care unit and closely monitored. When the person is judged to have recovered from
23520-444: The procedure. People preparing for surgery are also instructed to abstain from food or drink (an NPO order after midnight on the night before the procedure), to minimize the effect of stomach contents on pre-operative medications and reduce the risk of aspiration if the person vomits during or after the procedure. Some medical systems have a practice of routinely performing chest x-rays before surgery. The premise behind this practice
23688-461: The rail line ran through Spokane on the way to the coast. The Inland Northwest region has also long been associated with farming, especially wheat production. Initially, the Palouse was thought to be unsuitable for wheat production due to the hilly terrain, believing wheat could not be cultivated on the tops of the hills, but the region showed great promise for wheat production when it began in
23856-430: The recovery period. A recent post-operative care philosophy has been early ambulation. Ambulation is getting the patient moving around. This can be as simple as sitting up or even walking around. The goal is to get the patient moving as early as possible. It has been found to shorten the patient's length of stay. Length of stay is the amount of time a patient spends in the hospital after surgery before they are discharged. In
24024-461: The reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child" which was subsequently interpreted to mean "requiring measures to improve… emergency obstetric services". Article 12.2d of the ICESCR stipulates the need for "the creation of conditions which would assure to all medical service and medical attention in the event of sickness", and is interpreted in
24192-409: The region due to its trade center status and accessibility to railroad infrastructure. Spokane's growth continued unabated until August 4, 1889, when a fire, now known as The Great Fire (not to be confused with the Great Fire of 1910 , which happened nearby), began just after 6:00 p.m., and destroyed the city's downtown commercial district. Due to technical problems with a pump station, there
24360-559: The region in 1873, recognized the value of the Spokane River and its falls for the purpose of water power. They realized the investment potential and bought the claims of 160 acres (65 ha) and the sawmill from Downing and Scranton for a total of $ 4,000. Glover and Matheney knew that the Northern Pacific Railroad Company had received a government charter to build a main line across this northern route . Amid many delays in construction and uncertainty over
24528-447: The results of these tests can help evaluate surgical risk. A surgical team may include a surgeon, anesthetist, a circulating nurse, and a "scrub tech", or surgical technician, as well as other assistants who provide equipment and supplies as required. While informed consent discussions may be performed in a clinic or acute care setting, the pre-operative holding area is where documentation is reviewed and where family members can also meet
24696-523: The risk of local skin reactions or antibiotic resistance. Through a retrospective analysis of national administrative data, the association between mortality and day of elective surgical procedure suggests a higher risk in procedures carried out later in the working week and on weekends. The odds of death were 44% and 82% higher respectively when comparing procedures on a Friday to a weekend procedure. This "weekday effect" has been postulated to be from several factors including poorer availability of services on
24864-515: The same site, is 100 acres (40 ha) in downtown Spokane and the site of some of Spokane's largest events. The park has views of the Spokane Falls and holds a number of civic attractions, including a skyride, a rebuilt gondola lift that carries visitors across the falls from high above the river gorge. The park also includes the historic hand-carved Riverfront Park Looff carousel created in 1909 by Charles I. D. Looff . Riverfront Park
25032-401: The sculpture as perpetuating the stereotype that goats are reputed to eat anything . The Garbage Goat debuted at Expo '74 , an environmentally-themed world's fair held in Spokane from May 4 to November 3, 1974. Roughly 5.6 million people attended the fair, which was held in downtown Spokane on land that later became Riverfront Park . Sister Paula Mary Turnbull , a local artist known as
25200-496: The sculpture perpetuated the stereotype that goats are reputed to eat anything . Kent Leach, the editor of The Dairy Goat Journal , wrote that the sculpture was "degrading, debasing, and grossly misleading". Expo organizers and local newspapers such as the Spokane Chronicle were inundated with letters against the sculpture. While some letters decried the public's habit of feeding trash to goats at fairs, others extolled
25368-483: The sculpture, emphasizing the goat industry's efforts to improve the image of the dairy goat. Columnists reported on the ongoing debate over the sculpture for the duration of the fair. William Stimson, writing in the Spokane Chronicle ' s "EXPOsitor" column, summed up the arguments of the critics thusly: These people say the idea that goats eat cans, glass, odds, ends and whatnot is low myth. Everytime
25536-742: The services of the Olmsted Brothers to draw up a plan for Spokane's parks. Much of Spokane's park land was acquired by the city prior to World War I, establishing it early on as a leader among Western cities in the development of a citywide park system. Spokane has a system of over 87 parks totaling 4,100 acres (17 km ) and includes six neighborhood aquatic centers. Some of the most notable parks in Spokane's system are Riverfront Park , Manito Park and Botanical Gardens , Riverside State Park , Saint Michael's Mission State Park , John A. Finch Arboretum , High Bridge Park and Liberty Park . Riverfront Park, created after Expo '74 and occupying
25704-443: The so-called "noninvasive surgery" ought to be more appropriately called minimally invasive procedures , which usually refers to a procedure that utilizes natural orifices (e.g. most urological procedures) or does not penetrate the structure being excised (e.g. endoscopic polyp excision , rubber band ligation , laser eye surgery ), are percutaneous (e.g. arthroscopy , catheter ablation , angioplasty and valvuloplasty ), or to
25872-402: The start of World War II as aluminum production commenced in Spokane due to the area's cheap electricity (produced from regional dams) and the increased demand for airplanes. After decades of stagnation and slow growth, Spokane businessmen formed Spokane Unlimited in the early 1960s, an organization that sought to revitalize downtown Spokane. A recreation park showcasing the Spokane Falls was
26040-544: The summer, often exceeding 30 °F (17 °C), and small during the winter, with a range just above 10 °F (5.6 °C). The record high and low are 112 °F (44 °C) and −30 °F (−34 °C), but temperatures of more than 100 °F (38 °C) or less than −5 °F (−21 °C) are rare. Temperatures of 90 °F (32 °C)+ occur an average of 21 days annually, temperatures of 100 °F (38 °C)+ occur an average of only 1 day annually, and those at or below 0 °F (−18 °C) average 2.2 days
26208-456: The surgical service line; the surgical service line costs were $ 17,600 in 2003 and projected to be $ 22,500 in 2013. For hospital stays in 2012 in the United States, private insurance had the highest percentage of surgical expenditure. in 2012, mean hospital costs in the United States were highest for surgical stays. Older adults have widely varying physical health. Frail elderly people are at significant risk of post-surgical complications and
26376-439: The surgical site is anesthetized, but the person can remain conscious or minimally sedated. In contrast, general anesthesia may render the person unconscious and paralyzed during surgery. The person is typically intubated to protect their airway and placed on a mechanical ventilator , and anesthesia is produced by a combination of injected and inhaled agents. The choice of surgical method and anesthetic technique aims to solve
26544-423: The surgical team. Nurses in the preoperative holding area confirm orders and answer additional questions of the family members of the patient prior to surgery. In the pre-operative holding area, the person preparing for surgery changes out of their street clothes and are asked to confirm the details of his or her surgery as previously discussed during the process of informed consent. A set of vital signs are recorded,
26712-601: The surgical wound during recovery. Mostly these drains stay in until the volume tapers off, then they are removed. These drains can become clogged, leading to abscess . Postoperative therapy may include adjuvant treatment such as chemotherapy , radiation therapy , or administration of medication such as anti-rejection medication for transplants. For postoperative nausea and vomiting (PONV), solutions like saline, water, controlled breathing placebo and aromatherapy can be used in addition to medication. Other follow-up studies or rehabilitation may be prescribed during and after
26880-555: The tape recording of the goat requesting to be fed stopped functioning. John Hollister and the Washington State Dairy Goat Council had made suggestions to change the goat's speech and to add a placard to the exhibit. In a letter to the editor, A.A. Sellen decried the situation, addressing Hollister, writing "You have literally taken candy from children, robbing them, also, of a chance to learn a valuable cleanliness lesson painlessly." Hollister replied that
27048-713: The term "surgery" can also refer to the facility where surgery is performed, or simply the office / clinic of a physician , dentist or veterinarian . As a general rule, a procedure is considered surgical when it involves cutting of a person's tissues or closure of a previously sustained wound. Other procedures that do not necessarily fall under this rubric, such as angioplasty or endoscopy , may be considered surgery if they involve "common" surgical procedure or settings, such as use of antiseptic measures and sterile fields, sedation / anesthesia , proactive hemostasis , typical surgical instruments , suturing or stapling . All forms of surgery are considered invasive procedures;
27216-674: The world's population, with its core belief as the issues of need, access and quality". Halfdan T. Mahler , the 3rd Director-General of the World Health Organization (WHO) , first brought attention to the disparities in surgery and surgical care in 1980 when he stated in his address to the World Congress of the International College of Surgeons, "'the vast majority of the world's population has no access whatsoever to skilled surgical care and little
27384-564: Was Kirtland Kelsey Cutter . Self-taught, he came to Spokane in 1886, and began by designing "Chalet Hohenstein" for himself and other residences for his family, while also working as a bank teller. Other structures designed by Cutter include the Spokane Club, Washington Water Power Substation, Monroe Street Bridge (featured in the city seal), the Steam Plant , and the Davenport Hotel . Built in renaissance and Spanish Revival style,
27552-477: Was affected for years by the collapse of the Division Street Bridge early in the morning on December 15, 1915, which killed five people and injured over 20, but a new bridge was built (eventually replaced in 1994). The 1920 census showed a net increase of just 35 individuals, which actually indicates that thousands left the city when considering the natural growth rate of a population. Growth in
27720-432: Was elected as the first mayor of the city, with a Council of seven, S.G. Havermale, A.M. Cannon, Dr. L.H. Whitehouse, L.W. Rima, F.R. Moore, George A. Davis, and W.C. Gray, all serving without pay. The marketing campaigns of transportation companies with affordable fertile land to sell along their trade routes lured many settlers into the region they dubbed "Spokane Country". The 1883 discovery of gold, silver, and lead in
27888-589: Was established by Marcus and Narcissa Whitman to cater for Cayuse Indians and hikers of the Oregon Trail at Walla Walla in the south. After the Whitmans were killed by Indians in 1847, Reverend Cushing Eells established Whitman College in their memory, also setting up the first church in the Spokane area. In 1853, two years after the establishment of the Washington Territory,
28056-486: Was named for the sculpture and features beers such as Garbage Pale Ale and Head Butt IPA. In 2018, during Christ Kitchen's annual gingerbread build-off in Spokane, the People's Choice award went to The Lilac Bakery, for its life-size gingerbread replica of the Garbage Goat, which could eat small pieces of garbage through an internal vacuum cleaner. Journalist Daniel Walters wrote that Spokane relationships are not official until
28224-401: Was no water pressure in the city when the fire started. In a desperate bid to starve the fire, firefighters began razing buildings with dynamite. Eventually, the winds and the fire died down; 32 blocks of Spokane's downtown core had been destroyed and one person was killed. Despite this catastrophe, and in part because of it, Spokane experienced a building boom. The downtown was rebuilt, and
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