Hunting Park Air Quality: Community, Public Health & Environmental Justice

The neighborhood of Hunting Park lies in the northern part of Philadelphia and is home to just over 20,000 people mostly African American and Hispanic. The neighborhood is unique because it is a residential community situated next to industrial facilities such as a construction demolition plant, a bus repair facility, and autobody paint shops as well as heavily traveled transportation corridors. Because of its proximity to these sites, the residents of Hunting Park were concerned about harmful exposures. Thus, with the assistance of the Public Interest Law Center of Philadelphia, EPA Region III, and the Hunting Park Stakeholders Group and residents, the community investigated the air quality in its neighborhood. They measured black carbon and Volatile Organic Compounds and did not find significant levels of either exposure in the air. However, we did notice some time trends in the black carbon concentrations that were notable. While the findings were not statistically significant, the Hunting Park air quality study provided an environmental justice service to the community, allowing the residents to acquire new information and influence regarding the industrial activities in their neighborhood

The Relationship Between Socioeconomic Disparities in Alabama Hospitals and Patient Experience

AbstractPatient satisfaction has been utilized to measure healthcare quality and outcomes, which affects reimbursement. Some claim such measures could be biased as they do not consider the patient’s socioeconomic status. Measuring the quality of care, Area Deprivation Index (ADI), and patient experience has been captured and publicly reported; and the measuring indicator Hospital Consumer Assessment of Healthcare Providers and Systems (HCHAPS), however, hospitals serving patients in low ADI areas generally score poorly. Grounded in the theory of Donabedian, the purpose of this quantitative correlational study was to examine the relationship between patient experience associated with socioeconomic disparities and how patients preserve their quality of care in Alabama. The research questions evaluated if there was a relationship between ADI zones in Alabama acute care hospitals and how patients responded to HCAHPS questions regarding nurse communication, physician communication, and if the patient recommended the hospital. Results were generated using data from the 2019 ADI scores and HCAHPS survey scores from 2020-2021. Using a t-test, the data showed there was no statistically significant relationship between ADI and HCAHPS when it came to patients understanding communications from the nurse and physicians, and neither with recommendation of the hospital. Additional research would explore multiple years of data to evaluate for a significant relationship between the variables. Positive social change may arise from these findings if administrators focus on socioeconomic disparities in low ADI by seeking to improve both physician and nurse communication with patients combined. Doing so would increase hospital reimbursement and the patient experience

The Relationship Between Socioeconomic Disparities in Alabama Hospitals and Patient Experience

Patient satisfaction has been utilized to measure healthcare quality and outcomes, which affects reimbursement. Some claim such measures could be biased as they do not consider the patient’s socioeconomic status. Measuring the quality of care, Area Deprivation Index (ADI), and patient experience has been captured and publicly reported; and the measuring indicator Hospital Consumer Assessment of Healthcare Providers and Systems (HCHAPS), however, hospitals serving patients in low ADI areas generally score poorly. Grounded in the theory of Donabedian, the purpose of this quantitative correlational study was to examine the relationship between patient experience associated with socioeconomic disparities and how patients preserve their quality of care in Alabama. The research questions evaluated if there was a relationship between ADI zones in Alabama acute care hospitals and how patients responded to HCAHPS questions regarding nurse communication, physician communication, and if the patient recommended the hospital. Results were generated using data from the 2019 ADI scores and HCAHPS survey scores from 2020-2021. Using a t-test, the data showed there was no statistically significant relationship between ADI and HCAHPS when it came to patients understanding communications from the nurse and physicians, and neither with recommendation of the hospital. Additional research would explore multiple years of data to evaluate for a significant relationship between the variables. Positive social change may arise from these findings if administrators focus on socioeconomic disparities in low ADI by seeking to improve both physician and nurse communication with patients combined. Doing so would increase hospital reimbursement and the patient experience

The Role of Critical Case Analysis in Interprofessional Education

Goals for interprofessional education include preparing students to work in collaborative practice, teaching them how to work in teams and to asses and improve the quality of patient care. (Barr, 2007, Thibault, 2013). Four core competency domains have been established to inform interprofessional education (Interprofessional Education Collaborative Expert Panel, 2011). These are ethics/values, roles/responsibilities, interprofessional communication and teams/teamwork. Various pedagogical approaches have been used to help students meet these competencies. The Josiah Macy, Jr. Foundation (2013) recommends development and implementation of innovative models to link interprofessional education and practice. Thibault (2013) recommends students engage in “real work” as part of their interprofessional education experience

Halo-model Analysis of the Clustering of Photometrically Selected Galaxies from SDSS

We measure the angular 2-point correlation functions of galaxies in a volume limited, photometrically selected galaxy sample from the fifth data release of the Sloan Digital Sky Survey. We split the sample both by luminosity and galaxy type and use a halo-model analysis to find halo-occupation distributions that can simultaneously model the clustering of all, early-, and late-type galaxies in a given sample. Our results for the full galaxy sample are generally consistent with previous results using the SDSS spectroscopic sample, taking the differences between the median redshifts of the photometric and spectroscopic samples into account. We find that our early- and late- type measurements cannot be fit by a model that allows early- and late-type galaxies to be well-mixed within halos. Instead, we introduce a new model that segregates early- and late-type galaxies into separate halos to the maximum allowed extent. We determine that, in all cases, it provides a good fit to our data and thus provides a new statistical description of the manner in which early- and late-type galaxies occupy halos.Comment: Accepted to MNRAS 11 pages, 6 figure

Successful TPV Implantation in a Pregnant Patient With Right Ventricle to Pulmonary Artery Conduit Obstruction

A patient with repaired double outlet right ventricle presented during early gestation with heart failure symptoms due to severe right ventricle–pulmonary artery conduit stenosis and insufficiency. In the first trimester, she underwent transcatheter therapy with Melody pulmonary valve implantation with excellent hemodynamic results and completed pregnancy without significant maternal complications. (Level of Difficulty: Advanced.

Non-malarial febrile illness: a systematic review of published aetiological studies and case reports from Africa, 1980-2015.

BACKGROUND: The availability of reliable point-of-care tests for malaria has heralded a paradigm shift in the management of febrile illnesses away from presumptive antimalarial therapy. In the absence of a definitive diagnosis, health care providers are more likely to prescribe empirical antimicrobials to those who test negative for malaria. To improve management and guide further test development, better understanding is needed of the true causative agents and their geographic variability. METHODS: A systematic review of published literature was undertaken to characterise the spectrum of pathogens causing non-malaria febrile illness in Africa (1980-2015). Literature searches were conducted in English and French languages in six databases: MEDLINE, EMBASE, Global Health (CABI), WHO Global Health Library, PASCAL, and Bulletin de la Société Française de Parasitologie (BDSP). Selection criteria included reporting on an infection or infections with a confirmed diagnosis, defined as pathogens detected in or cultured from samples from normally sterile sites, or serological evidence of current or past infection. A number of published articles (rather than incidence or prevalence) reporting a given pathogen were presented. RESULTS: A total of 16,523 records from 48 African countries were screened, of which 1065 (6.4%) met selection criteria. Bacterial infections were reported in 564 (53.0%) records, viral infections in 374 (35.1%), parasitic infections in 47 (4.4%), fungal infections in nine (0.8%), and 71 (6.7%) publications reported more than one pathogen group. Age range of the study population was not specified in 233 (21.9%) publications. Staphylococcus aureus (18.2%), non-typhoidal Salmonella (17.3%), and Escherichia coli (15.4%) were the commonly reported bacterial infections whereas Rift Valley fever virus (7.4%), yellow fever virus (7.0%), and Ebola virus (6.7%) were the most commonly reported viral infections. Dengue virus infection, previously not thought to be widespread in Africa, was reported in 54 (5.1%) of articles. CONCLUSIONS: This review summarises the published reports of non-malaria pathogens that may cause febrile illness in Africa. As the threat of antimicrobial resistance looms, knowledge of the distribution of infectious agents causing fever should facilitate priority setting in the development of new diagnostic tools and improved antimicrobial stewardship. TRIAL REGISTRATION: PROSPERO, CRD42016049281

Accuracy of the direct agglutination test for diagnosis of visceral leishmaniasis: a systematic review and meta-analysis

Background:Parasitological investigation of bone marrow, splenic or lymph node aspirations is the gold standard for the diagnosis of visceral leishmaniasis (VL). However, this invasive test requires skilled clinical and laboratory staff and adequate facilities, and sensitivity varies depending on the tissue used. The direct agglutination test (DAT) is a serological test that does not need specialised staff, with just minimal training required. While previous meta-analysis has shown DAT to have high sensitivity and specificity when using parasitology as the reference test for diagnosis, meta-analysis of DAT compared to other diagnostic techniques, such as PCR and ELISA, that are increasingly used in clinical and research settings, has not been done. Methods: We conducted a systematic review to determine the diagnostic performance of DAT compared to all available tests for the laboratory diagnosis of human VL. We searched electronic databases including Medline, Embase, Global Health, Scopus, WoS Science Citation Index, Wiley Cochrane Central Register of Controlled Trials, Africa-Wide Information, LILACS and WHO Global Index. Three independent reviewers screened reports and extracted data from eligible studies. A meta-analysis estimated the diagnostic sensitivity and specificity of DAT. Results: Of 987 titles screened, 358 were selected for full data extraction and 78 were included in the analysis, reporting on 32,822 participants from 19 countries. Studies included were conducted between 1987–2020. Meta-analysis of studies using serum and DAT compared to any other test showed pooled sensitivity of 95% (95%CrI 90–98%) and pooled specificity of 95% (95%CrI 88–98%). Results were similar for freeze-dried DAT and liquid DAT when analysed separately. Sensitivity was lower for HIV-positive patients (90%, CrI 59–98%) and specificity was lower for symptomatic patients (70%, CrI 43–89%). When comparing different geographical regions, the lowest median sensitivity (89%, CrI 67–97%) was in Western Asia (five studies). Conclusions: This systematic review and meta-analysis demonstrates high estimated pooled sensitivity and specificity of DAT for diagnosis of VL, although sensitivity and specificity were lower for different patient groups and geographical locations. This review highlights the lack of standardisation of DAT methods and preparations, and the lack of data from some important geographical locations. Future well-reported studies could provide better evidence to inform test implementation for different patient populations and use cases. PROSPERO registration: CRD4202124083

Risk Factors for Severe Diarrhea with an Afatinib Treatment of Non-Small Cell Lung Cancer: A Pooled Analysis of Clinical Trials

© 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).Afatinib is an effective therapy for metastatic non-small cell lung cancer (NSCLC) but it is associated with a relatively high incidence of severe diarrhea. The association between pre-treatment candidate predictors (age, sex, race, performance status, renal function, hemoglobin, and measures of body mass) and severe (grade ≥ 3) diarrhea was evaluated using logistic regression with pooled individual participant data from seven clinical studies. A risk score was developed based on the count of major risk factors. Overall, 184 of 1151 participants (16%) experienced severe diarrhea with use of afatinib. Body weight, body mass index, and body surface area all exhibited a prominent non-linear association where risk increased markedly at the lower range (p < 0.005). Low weight (<45 kg), female sex, and older age (≥60 years) were identified as major independent risk factors (p < 0.01). Each risk factor was associated with a two-fold increase in the odds of severe diarrhea, and this was consistent between individuals commenced on 40 mg or 50 mg afatinib. A simple risk score based on the count of these risk factors identifies individuals at lowest and highest risk (C-statistic of 0.65). Risk of severe diarrhea for individuals commenced on 40 mg afatinib ranged from 6% for individuals with no risk factors to 33% for individuals with all three risk factors