Analyzing the Potential Moderating Effect of School SES on the Relationship Between Student Sexuality and Mental Health

Background: It is estimated 1 in 5 children in the United States of America have a diagnosable mental health disorder, with only 21% of these children receiving treatment (American Academy of Pediatrics, 2017). Lesbian, gay, bisexual, and transgender (LBGT) youth mental health issues have been a consistent area of concern (Gonsiorek, 1988). The presence or absence of health-related resources and programs in schools has been shown to alter the health outcomes of students in their care (Leger, 1999). However, the extent to which a school can implement programs depends largely on a school’s socioeconomic status (SES). This study uses publicly accessible data from several sources to evaluate the moderating effect of school SES on the relationship between sexual orientation and mental health among primary and secondary students. Methods: Surveys were collected from 15,624 students in grades 9-12 through the National Youth Risk Behavior Survey (YRBS) (CDC, 2015). Data related to student sexuality and their mental health was extracted from this dataset. Students surveyed were also divided into 18 distinct large urban school districts and this was used to find the funding per student for each student surveyed in each district. A three variable cross tabulation analysis was conducted to assess the role of SES on the relationship between sexual orientation and mental health among the students surveyed. Discussion and Conclusion: The results of this analysis indicate that school socioeconomic status does not have a large moderating effect in the relationship between student sexuality and mental health. This finding is of particular interest because it suggests that school SES does not impact LGBT students’ mental health any more than their relatively mentally healthier peers. It may be worthwhile for schools with more funding available per student to direct efforts to specifically benefit groups who are disproportionately affected by mental health disorders, such as LGBT students

Fall-Related Emergency Department Traumas at Thomas Jefferson University Hospital: A Retrospective Analysis of Elderly Adult Trends

Falls are the most common reason for non-fatal injuries treated at Emergency Departments (EDs) in the United States (US), excluding those ages 15-24. Pennsylvania (PA) spends $2.7 billion treating fall-related injuries yearly, with an average per-hospitalization cost of$58,529. PA also has the 5th highest state senior population, and Philadelphia has the 5th oldest senior population among the major American cities. Examining the 2016 Thomas Jefferson University (TJU) ED trauma database, we analysed fall-related traumas in adults ages 65 and over. The sample was stratified into 3 age groups (65-74, 75-84, and ³85) and SAS 9.4 was used to investigate age group trends for fall type, average length of stay (LOS), post-ED destination, loss of consciousness (LOC), incidents by month, and if LOC impacted patient LOS. We found a significant association between LOC and LOS, with those experiencing an LOC staying in hospital an average of 1.7 days. We did not observe significant differences across age groups for fall type, length of stay, post-ED destination, LOC, or number of incidents by month. While results are not significant they are suggestive and may reveal patients being more likely to experience a simple fall (defined as a fall without a slip or trip) as age increases, and less likely to experience a fall with a trip as age increases. All patients, regardless of age group, have average LOS of approximately 7 days. Analysis of our study sample (n=400) describes trends in elderly adult fall-related trauma patients at the TJU ED. We observed that LOC due to a fall is associated with an increased LOS, and for several utilization comparisons there are no significant differences between age groups. This study helps to better understand the patients we serve and identify trends in utilization that may contribute to ongoing fall-prevention efforts at TJU

Primary Care Patient Experience in Pneumonia Patient and the Effects of Readmissions

Patient primary care experience is an essential component of patient care. Research has consistently demonstrated that patient experience correlates with clinical processes of care for prevention and disease management and with better health outcomes. Patients who are admitted to the hospital face numerous challenges upon discharge, including high readmission rates. In fact, one-fifth of Medicare patients admitted to the hospital will be readmitted within 30 days of discharge. With the Affordable Care Act’s creation of the Hospital Readmission Reduction Program (HRRP), hospitals are now penalized for excess readmission rates for common admitting diagnoses such as pneumonia. The purpose of this study was to examine how patients’ baseline primary care experiences relate to the likelihood of readmission. Patients diagnosed with pneumonia were identified during their initial hospitalization and administered the CG-CAHPS 3.0 and Supplementary CAHPS PCMH. The results of these surveys were compared between readmitted and non-readmitted patients. Also, the differences between the primary care experiences of the pneumonia patient cohort and patients at the hospital system’s primary care sites were examined. Results showed that 5 patients out of the 33 patients surveyed were readmitted with non-pneumonia related causes. Patients across 18 primary care sites report higher levels of satisfaction with their PCP (88.7%) compared to patients hospitalized for Pneumonia (66.7%; X2 =14.9,

Differential Expressed Genes Identified Between African American and European American Keloid Fibroblasts

Keloids are benign fibroproliferative tumors due to dysregulation of collagen remodeling and abnormal wound healing. Although worldwide, there is a higher incidence of keloid disease (KD) in skin of color, little is known about this predisposition. In this study, we used one tissue micro array slide comprised of six AA and 6 EA punch biopsies of primary untreated keloid tissue from the head and neck area was created, following the NanoString® DSP Technology Access Program protocol. The GeoMx Human Whole Transcriptome Atlas Assay was performed, using morphology marker FAP. Polygonal region of interests selection strategy for Fibroblast Activation Protein (FAP) positive cells was conducted. Univariate analysis was performed, using linear regression models to identify differentially expressed genes (DEG) at a false discovery rate (FDR) of 0.05. Ingenuity pathway analysis (IPA) software was used to determine DEG pathway enrichment. 1,450 DEG were identified (p-va

Ventral Hernia Repairs: 10 year Single Institution Review at Thomas Jefferson University Hospital

Abstract Background Definitive repair of recurrent ventral hernias using abdominal wall reconstruction techniques is an essential tool in the armentarium for general and plastic surgeons. Ramirez 1 et al describes the “component separation” technique to mobilize the rectus-abdominus internal oblique and external oblique flap to correct the defect. The recurrence rate of incisional hernias increases to 20% after gastric bypass or extensive weight loss.2 The incidence of ventral hernias after failed recurrent hernia repair increases to 40%.3 It has been reported that utilizing the sliding myofascial flap repair technique, the recurrence rate was reduced to 8.5%.4 Materials and Methods This retrospective institutional study reviews 10 years of myofascial flap reconstruction 1996-2006 at TJUH. Several techniques and prosthetic materials (alloderm, permacol, vicryl, composix) were used in our institutional review by multiple surgeons in this time period. Our goal is to identify risk factors (i.e. smoking, diabetes, obesity, size of defect, peripheral vascular disease, enterocutaneous fistula, infection) that predict or categorize patients that are at increased risk for failure of primary repair, measure the complication rates (i.e. infection, recurrence, seroma, hematoma) and evaluate the techniques and long term effectiveness of several prosthetic materials. Results Three thousand twenty ventral hernia repairs were performed at TJUH between 1996 and 2006. Two thousand three hundred eighty three approximated the rectus abdominus primarily and of these 645 utilized a component separation technique. The recurrence rate for component separations was 18.5% and 83% for primary repairs. The average follow up was 5.49 years. Statistically significant risk factors (p\u3c0.05) for recurrence were obesity (BMI\u3e30 kg/m2), age\u3e65 years, male gender, preoperative infection and postoperative seroma. Conclusion Myofascial flaps are a safe, reliable therapy for recurrent ventral hernias that addresses the population of patients that have failed conventional primary closure and reduce the recurrence rates greater than 40 percent to 18.5 percent in the carefully selected patient population

Remote physiological monitoring: Clinical, financial, and behavioral outcomes in a heart failure population

This article reports on the outcomes associated with remote physiological monitoring (RPM) conducted as part of a heart failure disease management program. Claims data, medical records, data transmission records, and survey results for 91 individuals ages 50–92 (mean 74 years) successfully completing a heart failure RPM program were analyzed for time periods before, during, and after the monitoring intervention. The program was associated with significant reductions in per member per month costs and emergency room and hospital utilization. More detailed analyses were performed for specific gender and age subgroups. Participant surveys indicated high levels of satisfaction, and improvements in self-perceived health status, self-efficacy, and self-management behaviors. This study is the first to assess the impact of a RPM program following removal of the monitoring equipment. The results indicate that RPM, as a component of a traditional disease management program, has a sustained, beneficial effect on participants’ lifestyles after the monitoring period has ended