Trauma Patient Satisfaction Survey Opens Discussion about Bias in Health Care

Background Patient satisfaction is an important part of quality care, and patient backgrounds can influence satisfaction with care. Since trauma disproportionately affects the underserved, this study aimed to determine the effects of race and insurance status on trauma patient satisfaction. Methods The validated Trauma Patient Satisfaction Survey (TPSS) was administered to 143 hospitalized trauma patients. ANOVA and Chi2 statistics were used to compare demographics with patient satisfaction. Qualitative data were analyzed with EZ-Text. Results Of the 143 patients surveyed, 95 (66%) were African American, 33 (23%) were Caucasian, and 15 (10%) were Latino. Sixty-one patients (43%) were uninsured. No statistically significant differences for any item were noted by race or insurance status on the TPSS. No patients perceived biased care by race, but three African American patients felt that care was different because of their insurance (2%, p=0.34). Patients who did perceive bias were less satisfied with their care (p=0.03). Conclusions In this exploratory survey of hospitalized trauma patients, we did not demonstrate a significant association between race or insurance status and patient satisfaction. Though we did not detect systemic disparities with respect to bias or satisfaction with care, patients who did perceive bias were less satisfied with their care

Rorschach determinants of creativity

This psychological investigation has its origin and incentive in the keen interest aroused by Professor Austin E. Grigg in the Rorschach Test, chiefly through his course in Clinical and Projective Tests

The ecology of congeneric resprouters and reseeders (Hypericum spp.) along fire-frequented pine savanna ecoclines

Resprouting and reseeding shrubs are predicted to be restricted to habitats with long and short return intervals of natural disturbances, respectively. Nonetheless, resprouters and reseeders co-occur along Gulf of Mexico coastal ecoclines where lightning-ignited fires were historically frequent. In this collection of studies, I examine fire responses, habitat associations, distribution limits, and seedling recruitment of Hypericum species along ecoclines in pine savannas of the St. Joe Bay State Buffer Preserve in Gulf County of Florida. In this area, ecoclines are characterized by topographic, soil moisture, and fire heterogeneity gradients. Hypericum microsepalum, an obligate resprouter, primarily resprouts following disturbances that remove aboveground stems. It is associated with upland, dry habitats that frequently burn, but can survive over a wide range of habitats along ecoclines. Hypericum chapmanii, an obligate reseeder, is killed by fires and recruits with a pulse of seedlings. Hypericum brachyphyllum, a facultative reseeder/resprouter, both reseeds and resprouts after low intensity disturbances, but only reseeds after high intensity disturbances. Hypericum brachyphyllum and H. chapmanii are associated with intermediate, mesic areas along ecoclines where fires become increasingly heterogeneous to rare as they move down slopes. These species have low survival outside of their original habitats. Direct effects of fire, specifically removal of aboveground biomass and litter, increase seedling recruitment of H. brachyphyllum and H. chapmanii. Fires have no direct effect on the growth of H. brachyphyllum to juvenile and reproductive adult stages, but indirectly increase growth of H. chapmanii. This is likely the result of fire facilitating regeneration of associated nurse plants. Therefore, fires are important for seedling recruitment and growth of Hypericum species. Time to reproduction is longer for H. chapmanii (3+ years) and H. brachyphyllum (3 years) than H. microsepalum (2 years). Differences in time to reproduction should cause species to segregate along a fire frequency gradient. I thus conclude that heterogeneous fires within a high fire frequency landscape may increase persistence of Hypericum resprouters and reseeders in higher and lower areas along ecoclines, respectively. It should also allow plants with different life histories to co-occur in intermediate areas along ecoclines where fires are patchy and vary in intensity

Recurrent violent injury: magnitude, risk factors, and opportunities for intervention from a statewide analysis.

INTRODUCTION: Although preventing recurrent violent injury is an important component of a public health approach to interpersonal violence and a common focus of violence intervention programs, the true incidence of recurrent violent injury is unknown. Prior studies have reported recurrence rates from 0.8% to 44%, and risk factors for recurrence are not well established. METHODS: We used a statewide, all-payer database to perform a retrospective cohort study of emergency department visits for injury due to interpersonal violence in Florida, following up patients injured in 2010 for recurrence through 2012. We assessed risk factors for recurrence with multivariable logistic regression and estimated time to recurrence with the Kaplan-Meier method. We tabulated hospital charges and costs for index and recurrent visits. RESULTS: Of 53 908 patients presenting for violent injury in 2010, 11.1% had a recurrent violent injury during the study period. Trauma centers treated 31.8%, including 55.9% of severe injuries. Among recurrers, 58.9% went to a different hospital for their second injury. Low income, homelessness, Medicaid or uninsurance, and black race were associated with increased odds of recurrence. Patients with visits for mental and behavioral health and unintentional injury also had increased odds of recurrence. Index injuries accounted for $105 million in costs, and recurrent injuries accounted for another$25.3 million. CONCLUSIONS: Recurrent violent injury is a common and costly phenomenon, and effective violence prevention programs are needed. Prevention must include the nontrauma centers where many patients seek care

Modernizing Biomedical Training: Replacing Live Animal Laboratories with Human Simulation

This chapter reviews the global trend towards a modernization of biomedical education in favor of simulation-based training methods, which studies confirm improve student learning and transference of applied skills to clinical practice, reduce laboratory costs, and spare animals from harmful procedures

Genetic Diversity, Population Structure, and Demographic History of Exploited Sea Urchin Populations (Tripneustes Gratilla) in the Philippines

The sea urchin Tripneustes gratilla is ecologically and economically important in the Indo-Pacific region. We use population genetic methods to investigate the population structure and historical demography of exploited populations in the Philippines. Sea urchins sampled in 6 localities in western Luzon and 4 outgroup sites were sequenced for mitochondrial cytochrome oxidase-1 gene (n = 282) and genotyped for seven microsatellite loci (n = 277). No significant genetic structure was found for either class of markers, indicating either extensive gene flow across the archipelago, or that populations have high genetic diversity and have not yet attained equilibrium between genetic drift and migration following large changes in demography. Interestingly, demographic inferences from the two types of markers were discordant. Mitochondrial lineages showed demographic expansion during the Pleistocene while microsatellite data indicated population decline. Estimates for the date of each event suggest that a Pleistocene expansion could have preceded a more recent population decline, but we also discuss other hypotheses for the discordant inferences.The high genetic diversity and broad distribution of haplotypes in populations that recently recovered from fishery collapse indicate that this species is very resilient over evolutionary timescales

Humanitarianism 2.0

It is difficult to overstate the importance of trust in a world where global networks facilitate the constant flow of contradictory information. The search for verifiable leads and trusted sources is a central facet of daily communication and is becoming more so as our connections with one another become more decontextualised, geographically distant and, increasingly entirely virtual. The swell of internet connection rates across the world has meant an explosion of interaction and allowed new opportunities for global collective action. Whilst countless words have been written exploring the dangers of this global network and the threats that “new media” represents to social structures and moral fabrics, this collection seeks to explore the role that new social technologies are having in the world of humanitarianism and conflict response

Advanced glycation endproducts interacting with their endothelial receptor induce expression of vascular cell adhesion molecule-1 (VCAM-1) in cultured human endothelial cells and in mice. A potential mechanism for the accelerated vasculopathy of diabetes.

This is the published version. Copyright 1995 American Society for Clinical Investigation.Vascular cell adhesion molecule-1 (VCAM-1), an inducible cell-cell recognition protein on the endothelial cell surface (EC), has been associated with early stages of atherosclerosis. In view of the accelerated vascular disease observed in patients with diabetes, and the enhanced expression of VCAM-1 in diabetic rabbits, we examined whether irreversible advanced glycation endproducts (AGEs), could mediate VCAM-1 expression by interacting with their endothelial cell receptor (receptor for AGE, RAGE). Exposure of cultured human ECs to AGEs induced expression of VCAM-1, increased adhesivity of the monolayer for Molt-4 cells, and was associated with increased levels of VCAM-1 transcripts. The inhibitory effect of anti-RAGE IgG, a truncated form of the receptor (soluble RAGE) or N-acetylcysteine on VCAM-1 expression indicated that AGE-RAGE-induced oxidant stress was central to VCAM-1 induction. Electrophoretic mobility shift assays on nuclear extracts from AGE-treated ECs showed induction of specific DNA binding activity for NF-kB in the VCAM-1 promoter, which was blocked by anti-RAGE IgG or N-acetylcysteine. Soluble VCAM-1 antigen was elevated in human diabetic plasma. These data are consistent with the hypothesis that AGE-RAGE interaction induces expression of VCAM-1 which can prime diabetic vasculature for enhanced interaction with circulating monocytes

LIPid Intensive Drug therapy for Sepsis Pilot (LIPIDS-P): Phase I/II clinical trial protocol of lipid emulsion therapy for stabilising cholesterol levels in sepsis and septic shock.

INTRODUCTION: Sepsis is a life-threatening, dysregulated response to infection. Both high-density lipoprotein and low-density lipoprotein cholesterol should protect against sepsis by several mechanisms; however, for partially unknown reasons, cholesterol levels become critically low in patients with early sepsis who experience poor outcomes. An anti-inflammatory lipid injectable emulsion containing fish oil is approved by the Food and Drug Administration as parenteral nutrition for critically ill patients and may prevent this decrease in serum cholesterol levels by providing substrate for cholesterol synthesis and may favourably modulate inflammation. This LIPid Intensive Drug therapy for Sepsis Pilot clinical trial is the first study to attempt to stabilise early cholesterol levels using lipid emulsion as a treatment modality for sepsis. METHODS AND ANALYSIS: This is a two-centre, phase I/II clinical trial. Phase I is a non-randomised dose-escalation study using a Bayesian optimal interval design in which up to 16 patients will be enrolled to evaluate the safest and most efficacious dose for stabilising cholesterol levels. Based on phase I results, the two best doses will be used to randomise 48 patients to either lipid injectable emulsion or active control (no treatment). Twenty-four patients will be randomised to one of two doses of the study drug, while 24 control group patients will receive no drug and will be followed during their hospitalisation. The control group will receive all standard treatments mandated by the institutional sepsis alert protocol. The phase II study will employ a permuted blocked randomisation technique, and the primary endpoint will be change in serum total cholesterol level (48 hours - enrolment). Secondary endpoints include change in cholesterol level from enrolment to 7 days, change in Sequential Organ Failure Assessment score over the first 48 hours and 7 days, in-hospital and 28-day mortality, lipid oxidation status, inflammatory biomarkers, and high-density lipoprotein function. ETHICS AND DISSEMINATION: Investigators are trained and follow good clinical practices, and each phase of the study was reviewed and approved by the institutional review boards of each institution. Results of each phase will be disseminated through presentations at national meetings and publication in peer-reviewed journals. If promising, data from the pilot study will be used for a larger, multicentre, phase II clinical trial. TRIAL REGISTRATION NUMBER: NCT03405870

Deadly Partners: Interdependence of Alcohol and Trauma in the Clinical Setting

Trauma is the leading cause of death for Americans aged 1 to 45. Over a third of all fatal motor vehicle collisions and nearly eighty percent of completed suicides involve alcohol. Alcohol can be both a cause of traumatic injury as well as a confounding factor in the diagnosis and treatment of the injured patient. Fortunately, brief interventions after alcohol-related traumatic events have been shown to decrease both trauma recidivism and long-term alcohol use. This review will address the epidemiology of alcohol-related trauma, the influence of alcohol on mortality and other outcomes, and the role of prevention in alcohol-related trauma, within the confines of the clinical setting