Gender and racial disparity for hospital emergency service usage in USA: a quantitative analysis for various age groups during 2010–2017.

Background: Annually emergency department (ED) services are utilized by more than 100 million Americans making ED usage trends important determinants of healthcare quality, outcomes and cost. Previous workers have demonstrated the existence of disparity in various healthcare services in USA although a comprehensive analysis has not been undertaken. Dahlgren and Whitehead rainbow model has offered insights for multiple factors of influence on an individual’s health and focuses on the relationships among these factors. The Commission on Social Determinants of Health (CSDH; WHO initiatives) suggests that the social and environmental factors are at the root of most of the inequalities responsible for both communicable and non-communicable diseases. Methods: The objectives of this study were to quantify the existing disparity in ED usage between 2010– 2017 by age, race and gender primarily using the Federal and State databases and comparing the quantitative trends with prior works from 2006–2020 that shed lights on health disparity. Single user normalization was developed to achieve randomization to reduce the heterogeneity of the database. Results: Each age group was represented by the usage pattern of the “single” average individual revealing significantly different ED usage for different age groups. Black and white Americans as well as males and females showed large variation indicative of racial and gender disparity. Conclusions: This is the first comprehensive meta-analysis demonstrating racial and gender specific variation in the usage of emergency health care services that exist in USA and seem to be multifactorial and age specific. Using a tool of single user normalization developed in this work as a means of randomization these disparities were quantified and may help identify such disparity trends in other regions that suffer from similar disparities

Preventable deaths involving opioids in England and Wales, 2013–2022: a systematic case series of coroners’ reports

Background Opioid deaths have increased in England and Wales. Coroners’ Prevention of Future Deaths reports (PFDs) provide important insights that may enable safer use and avert harms, yet reports implicating opioids have not been synthesized. We aimed to identify opioid-related PFDs and explore coroners’ concerns to prevent future deaths. Methods In this systematic case series, we screened 3897 coronial PFDs dated between 01 July 2013 and 23 February 2022, obtained by web scraping the UK’s Courts and Tribunals Judiciary website. PFDs were included when an opioid was implicated in the death. Included PFDs were descriptively analysed, and content analysis was used to assess concerns reported by coroners. Results Opioids were involved in 219 deaths reported in PFDs (5·6% of PFDs), equating to 4418 years of life lost (median 33 years/person). Morphine (29%), methadone (23%) and diamorphine (16%) were the most common implicated opioids. Coroners most frequently raised concerns regarding systems and protocols (52%) or safety issues (15%). These concerns were most often addressed to National Health Service (NHS) organizations (51%), but response rates were low overall (47%). Conclusions Opioids could be used more safely if coroners’ concerns in PFDs were addressed by national organizations such as NHS bodies, government agencies and policymakers, as well as individual prescribing clinicians

HIV-1 specific IgA detected in vaginal secretions of HIV uninfected women participating in a microbicide trial in Southern Africa are primarily directed toward gp120 and gp140 specificities.

CAPRISA, 2014.Abstract available in pdf

The combustion of bulk metals in a high-speed oxidizing flow

The ignition of titanium in bulk form when exposed to a supersonic flow of oxygen is studied. Prior studies have shown that the ignition of various bulk metals was possible and suggested that, despite air at ambient conditions (1 bar, 300 K) being outside the ignition envelope of these metals, they are capable of igniting in pure oxygen at elevated pressure and may continue to burn in air once ignited. The data from prior studies were relatively sparse in their measurement of the oxygen partial pressure and flow (or projectile) velocity required to observe bulk metal combustion. The present study focuses on performing a systematic investigation of the envelope of projectile velocities and oxygen pressures for which exothermic reaction is observed to occur for titanium projectiles. Projectiles, consisting of spheres 3.175 mm (0.125 in) in diameter, were launched at speeds of 0.7 to 1.8 km/s (Mach 2.0 to 5.4) using a single-stage light-gas gun into a test section of oxygen with pressure varying between 1 and 5.5 bar in order to determine the conditions necessary to observe combustion. The projectile is observed using a combination of high-speed photography, photodetectors, and spectrometers to quantify the luminosity emitted. The results are correlated with the melting and boiling points of titanium, the adiabatic flame temperature, and the stagnation conditions of the supersonic flow. A model was also developed and successfully reproduced the main experimental trends as well as corroborated the above claim that combustion was occurring.L'allumage de titane en vrac lorsqu'il est exposé à un écoulement supersonique d'oxyène est étudiée. Des études antérieures on montré que l'allumage de divers métaux en vrac étaient possible et a suggéré que, en depit de l'air dans les conditions ambiantes (1 bar, 300 K) étant à l'extérieur de l'enveloppe de l'allumage de ces métaux, ils sont capables d'allumer dans l'oxygène pur à des pressions élevées et peuvent continuer à brûler dans l'air une fois allumés. Les données provenant d'études antérieures étaient relativement rares dans leur mesure de la pression partielle d'oxygène et la vitesse du projectile requise pour observer la combustion du métal en vrac. La présente étude se concentre sur la réalisation d'une étude systématique de l'enveloppe de vitesses des projectiles et des pressions d'oxygène pour lesquels on observe une réaction exothermique se produire pour les projectiles de titane. Les projectiles, composé de sphères 3,175 mm (0.125 po) de diamètre, ont été lancés à des vitesses de 0,7 à 1,8 km/s (Mach 2,0 à 5,4) par un canon à gaz léger à un seul étage dans une section d'essai de l'oxygène avec une pression variant entre 1 et 5,5 bar afin de déterminer les conditions nécessaires pour observer la combustion. Le projectile est observée à l'aide d'une combinaison de la photographie à haute vitesse, des photodétecteurs, et spectromètres pour quantifier la luminosité émise. Les résultats sont en corrélation avec les points de fusion et d'ébullition de titane, la température de flamme adiabatique, et des conditions de stagnation de l'écoulement supersonique. Un modèle a également été élaboré et reproduit avec succès les principales tendances éxperimentales ainsi que corroboré la demande ci-dessus que la combustion se produisait

THE ANTICIPATION, EXPERIENCE, AND RECOLLECTION OF TEST ANXIETY.

Abstract not availabl

Review of strategies to investigate low sample return rates in remote tobacco trials: A call to action for more user-centered design research

Remote collection of biomarkers of tobacco use in clinical trials poses significant challenges. A recent meta-analysis and scoping review of the smoking cessation literature indicated that sample return rates are low and that new methods are needed to investigate the underlying causes of these low rates. In this paper we conducted a narrative review and heuristic analysis of the different human factors approaches reported to evaluate and/or improve sample return rates among 31 smoking cessation studies recently identified in the literature. We created a heuristic metric (with scores from 0 to 4) to evaluate the level of elaboration or complexity of the user-centered design strategy reported by researchers. Our review of the literature identified five types of challenges typically encountered by researchers (in that order): usability and procedural, technical (device related), sample contamination (e.g., polytobacco), psychosocial factors (e.g., digital divide), and motivational factors. Our review of strategies indicated that 35% of the studies employed user-centered design methods with the remaining studies relying on informal methods. Among the studies that employed user-centered design methods, only 6% reached a level of 3 in our user-centered design heuristic metric. None of the studies reached the highest level of complexity (i.e., 4). This review examined these findings in the context of the larger literature, discussed the need to address the role of health equity factors more directly, and concluded with a call to action to increase the application and reporting of user-centered design strategies in biomarkers research

Clinical Characteristics and Outcomes for Solitary Fibrous Tumor (SFT): A Single Center Experience.

Solitary fibrous tumor (SFT) is a mesenchymal neoplasm of fibrous origin. The 2013 WHO classification of soft tissue tumors defines malignant forms as hypercellular, mitotically active (>4 mitosis/10 high-power fields), with cytological atypia, tumor necrosis, and/or infiltrative margins. With an IRB-approved protocol, we investigated patient records and clinicopathologic data from our Sarcoma Database to describe the clinical characteristics of both benign and malignant SFT. All pathology specimens were reviewed by two pathologists. Descriptive statistics and univariate/multivariate survival analysis were performed. Patient records and Social Security Death Index were used to evaluate vital status. Of 82 patients, 47 (57%) were women and 73 (89%) were Caucasian. Median age was 62 years (range, 20 to 89). Thirty-two (39%) patients succumbed to the disease. Primary tumor site was lung/pleura in 28 (34%), abdomen/pelvis in 23 (28%), extremity in 13 (16%), and head/neck in 9 (11%) patients. Pathology was described as benign in 42 (51%) and malignant in 40 (49%) patients. Compared to benign SFT, malignant histology is associated with larger tumor size, higher mitotic counts, metastatic disease at diagnosis, and greater use of chemotherapy and radiation therapy. Gender, age, and tumor site were not significantly different between benign and malignant subtypes. By univariate analysis, only benign vs. malignant variant and complete resection positively impacted overall survival (P = 0.02 and P<0.0001, respectively). In the multivariable analysis of overall survival, receiving chemotherapy or not receiving surgery were two variables significantly associated with higher failure rate in overall survival: patients with chemotherapy vs. no chemotherapy (P = 0.003, HR = 4.55, with 95% CI: 1.68-12.34) and patients without surgery vs. with surgery (P = 0.005, HR = 25.49, with 95% CI: 2.62-247.57). Clear survival differences exist between benign and malignant SFT. While surgery appears to be the best treatment option for benign and malignant SFT, better systemic therapies are needed to improve outcomes of patients with metastatic, malignant SFT

Overall survival curve of benign versus malignant.

<p>Overall survival curve of benign versus malignant.</p

An outline of the chemotherapy types and how many patients received each.

<p>*Taxane based regimens used: Carboplatinum/Taxotere, gemcitabine/docetaxol or taxotere, docetaxol, paclitaxel</p><p>**TKIs used: Imatinib, Sunitinib</p><p>^†Experimental treatments used: GARFT inhibitor, anti-CD40 monoclonal antibody</p><p>^‡Other treatments used: Dacarbazine, pemetrexed, Rapamycin, doxorubicin/cisplatinum, adriamycin/carboplatinum, cytarabine, avastin, cisplatinum, doxorubicin/ifosfamide</p><p>Note: Four of the five patients with benign histology who received chemotherapy had large tumors and two had incomplete resections</p><p>An outline of the chemotherapy types and how many patients received each.</p