Ethnicity, discrimination and health outcomes: a secondary analysis of hospital data from Victoria, Australia

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-0420Discrimination is difficult to measure objectively in clinical settings, although it has been identified as a significant cause of ethnic health disparities. Proxy quantitative indicators relating to differential outcomes based on quality of care can begin to shed some light on the possible discrimination, but current data are largely from countries where there is differential access to healthcare as a result of health insurance schemes, and this is a major confounder in the findings. Using data from Victoria, Australia, where there is currently universal healthcare coverage, we explored a number of quality of care-relatedclinical outcomes across ethnic groups. The aim was to explore the relationship between ethnicity and clinical outcomes for postpartum haemorrhage, sepsis and cardiac rehabilitation in Victoria, Australia, as the first step to developing methods for research into discrimination in quality of care. We drew on the Victorian Admitted Episodes Dataset and undertook a secondary data analysis based on recategorisation of country of birth data. A multivariate logistic regression was used to examine the relationship between ethnicity and specified clinical outcomes. Results showed that the risk for postpartum haemorrhage was higher in ethnic minority groups, and access to intensive care for sepsis lower; however, there was no association with access to cardiac care. Our analyses did not support any strong or consistent barriers to access or pooroutcomes of care for particular ethnic groups. This may be an indication of the protection provided by universal health coverage. However, research in this area in Australia is in its infancy and there is a lack of systematically collected administrative data on ethnicity. Growing ethnic minority populations, not just in Australia but also in many other high-income countries, highlight a critical need for the development of data collection systems that are conceptually sound and useful for the monitoring of ethnic minority health in gene.https://www.primescholars.com/articles/ethnicity-discrimination-and-health-outcomes-a-secondary-analysis-of-hospital-data-from-victoria-australia-94736.html4pubpub

Gastrointestinal Perforations: Examining the Overlooked Unintentional Consequences of Our Nation’s Epidemic of Antibiotic Exposure

Objective: More than 266 million courses of antibiotics are dispensed to outpatients annually in the US, with the rising elderly population consuming a substantial number of antibiotics. At least 30% of these antibiotics prescribed are unnecessary. Alterations in gut microbiome are known to cause stomach and small intestine (SSI) perforations. However, the impact of antibiotic exposure outcomes of SSI perforations among the elderly has not been studied. We examined the relationship between antibiotic exposure, as a proxy for microbiome modulation, and SSI perforation outcomes in a nationwide sample of elderly patients. Methods: A 5% random sample of Medicare beneficiaries (2009-2011) was queried to identify patients with SSI perforations. Previous outpatient antibiotic exposure (0-30, 31-60, 61-90 days prior to admission) was assessed. Clinical characteristics were compared between no previous antibiotic exposure (NPA) and previous antibiotic exposure (PA) patients. Primary outcome was in-hospital mortality. Secondary outcomes included length of stay and 30-day readmission. Univariate and multivariable regression analyses were performed. Results: Overall, 401 patients ≥ 65 years had SSI perforations (68.3% with NPA and 31.7 % with PA). Mean age (± SD) was 80 years (± 8). Overall in-hospital mortality was 13%. There was a significant difference in the rates of mortality (12% in NPA vs. 18 % in 0-30 days PA, 17% 31-60 days PA, and 8% 61-90 days PA, P= 0.002). After adjustment of other factors, a trend toward increased in-hospital mortality was observed among patients in 0-30 days PA (odds ratio [OR] 2.0, 95% confidence interval [CI] (0.9, 4.7) and was significantly associated with ICU admission (OR 4.3, 95% CI (1.8, 10.2). Conclusion: Recent antibiotic use increases illness severity and may increase mortality among elderly patients with SSI perforations. Exposure to antibiotics, one of the most modifiable determinants of microbiota, should be minimized in the outpatient setting

UB CANSAT Competition 2017

Our mission objective is to create a solar powered science glider that can sample the atmospheric conditions like pressure, temperature, altitude and positioning during flight and compete in the CanSat competition. To model and design a solar powered glider and re-entry container. The glider is designed in such a way as to hold all the sensors for sampling and solar panels to power up the glider. To make the glider move in a circular pattern during descent with a diameter not more than 1000m

Genetic relatedness and molecular characterization of multidrug resistant Acinetobacter baumannii isolated in central Ohio, USA

<p>Abstract</p> <p>Background</p> <p>Over the last decade, nosocomial infections due to <it>Acinetobacter baumannii </it>have been described with an increasing trend towards multidrug resistance, mostly in intensive care units. The aim of the present study was to determine the clonal relatedness of clinical isolates and to elucidate the genetic basis of imipenem resistance.</p> <p>Methods</p> <p><it>A. baumannii </it>isolates (n = 83) originated from two hospital settings in central Ohio were used in this study. Pulsed-field gel electrophoresis genotyping and antimicrobial susceptibility testing for clinically relevant antimicrobials were performed. Resistance determinants were characterized by using different phenotypic (accumulation assay for efflux) and genotypic (PCR, DNA sequencing, plasmid analysis and electroporation) approaches.</p> <p>Results</p> <p>The isolates were predominantly multidrug resistant (>79.5%) and comprised of thirteen unique pulsotypes, with genotype VII circulating in both hospitals. The presence of <it>bla</it>_OXA-23in 13% (11/83) and IS_{<it>Aba1 </it>}linked <it>bla</it>_OXA-66in 79.5% (66/83) of clinical isolates was associated with high level imipenem resistance. In this set of OXA producing isolates, multidrug resistance was bestowed by <it>bla</it>_ADC-25, class 1 integron-borne aminoglycoside modifying enzymes, presence of sense mutations in <it>gyrA</it>/<it>parC </it>and involvement of active efflux (with evidence for the presence of <it>adeB </it>efflux gene).</p> <p>Conclusion</p> <p>This study underscores the major role of carbapenem-hydrolyzing class D β-lactamases, and in particular the acquired OXA-23, in the dissemination of imipenem-resistant <it>A. baumannii</it>. The co-occurrence of additional resistance determinant could also be a significant threat.</p

Cerebral Venous Sinus Thrombosis (CVST): Long-Term Single-Center Experience

CVST is a rare location of thrombosis involving Dural/ cerebral venous sinuses. It affects around 5-10 people per million population annually. It is an uncommon but life-threatening form of stroke affecting younger individuals. Therefore, identifying and treating in a timely manner is critical. Rarer thrombotic disorders like paroxysmal nocturnal hemoglobinuria (PNH) or Janus Kinase 2 (JAK2) mutation positive myeloproliferative neoplasms (MPN) can rarely present with CVST. It can also present during pregnancy for the first time. Diagnosis is often established by Computed Tomography (CT) or Magnetic Resonance Imaging (MRI). Infections, certain medication use (asparaginase or birth control pills) could lead to CVST. Patients often present with headaches, seizures or neurological deficits. Management is often with systemic anticoagulation despite intraparenchymal hemorrhage. Reducing intracranial pressure by invasive approaches is sometimes needed.https://digitalcommons.unmc.edu/surp2022/1024/thumbnail.jp

Familial Papillary Thyroid Carcinoma: A Retrospective Analysis

Background. Whether or not the familial form of papillary thyroid carcinoma is more aggressive than the sporadic form of the disease remains controversial. Methods. To explore this question and whether or not increased aggressiveness is more apparent in families with multiple affected members, we performed a chi square by trend analysis on our patients clinical and pathologic data comparing: first degree families with three or more affected members versus first degree families with two affected members versus sporadic cases of papillary thyroid carcinoma. Results. No statistically significant trends were seen for any presenting surgical pathology parameter, age at presentation, length of follow-up or gender distribution. The familial groups exhibited significant trends for higher rates of reoperation (P = 0.05) and/or requiring additional radioactive iodine therapy (P = 0.03), distant metastases (P = 0.003) and deaths (P = 0.01). These aggressive features were most apparent in certain families with three or more affected members. Conclusions. Using the chi square by trend analysis, a significant trend was seen for the familial form of papillary thyroid cancer to possess more aggressive features than the sporadic disease. Prompt recognition of the familial nature of the disease may provide earlier diagnosis and treatment in similarly affected family members

Smartphone-based neuropsychological assessment in Parkinson's disease: feasibility, validity, and contextually driven variability in cognition

OBJECTIVES: The prevalence of neurodegenerative disorders demands methods of accessible assessment that reliably captures cognition in daily life contexts. We investigated the feasibility of smartphone cognitive assessment in people with Parkinson's disease (PD), who may have cognitive impairment in addition to motor-related problems that limit attending in-person clinics. We examined how daily-life factors predicted smartphone cognitive performance and examined the convergent validity of smartphone assessment with traditional neuropsychological tests. METHODS: Twenty-seven nondemented individuals with mild-moderate PD attended one in-lab session and responded to smartphone notifications over 10 days. The smartphone app queried participants 5x/day about their location, mood, alertness, exercise, and medication state and administered mobile games of working memory and executive function. RESULTS: Response rate to prompts was high, demonstrating feasibility of the approach. Between-subject reliability was high on both cognitive games. Within-subject variability was higher for working memory than executive function. Strong convergent validity was seen between traditional tests and smartphone working memory but not executive function, reflecting the latter's ceiling effects. Participants performed better on mobile working memory tasks when at home and after recent exercise. Less self-reported daytime sleepiness and lower PD symptom burden predicted a stronger association between later time of day and higher smartphone test performance. CONCLUSIONS: These findings support feasibility and validity of repeat smartphone assessments of cognition and provide preliminary evidence of the effects of context on cognitive variability in PD. Further development of this accessible assessment method could increase sensitivity and specificity regarding daily cognitive dysfunction for PD and other clinical populations.RF1 AG062109 - NIA NIH HHSPublished versio

New religious travel segment

The focus of this study is on the emergence of a new religious travel segment: Umrah Do It Yourself (DIY) travelers. The Umrah journey is organised by a specially licenced travel agent who handles all of the necessary arrangements, including flights and trip itineraries. However, a small percentage of travellers choose not to use such agencies and instead make their own arrangements, and the Saudi Arabian government's intention to launch a Tourist e-Visa in September 2019 has provided a window of opportunity to legalise Umrah DIY excursions. The study's objectives are to investigate how travel motivations contribute to the success of Umrah DIY. A hermeneutic phenomenological technique was employed to address the research gap. Participants were recruited via an Umrah DIY Facebook group, where 20 people volunteered and signed consent forms to help with the research process. According to the findings, the most crucial reason to engage on this quest is flexibility. This study aims to fill the gap of "religion" as a travel element, which is seen as an opportunity for suppliers and industry participants to address this segment by gaining a better understanding of their travel motivations as the foundation for developing relevant religious tourism products and services. Religious and spiritual journeys in Islam are classified into three types: Hajj, Umrah, and Ziyara (Hassan et al., 2015; Timothy & Olsen, 2006). While Umrah is part of the journey to Mecca, Muslims are only required to perform the first Umrah. According to Hassan et al. (2015), Umrah can be performed more than once, and it can be repeated dependent on the individual's physical and financial abilities. Hajj and Umrah travel have been mostly organised in a closely controlled manner in - packaged group tours (Haq & Jackson, 2009). According to Hassan et al. (2016), Umrah package travellers are those who buy products (Umrah package travel) from local tour operators and travel agents for religious and spiritual reasons, combining lodging, transportation, itinerary, and meals. The Kingdom of Saudi Arabia issued over four million Umrah visas in 2013 to travellers from 70 countries, and the number of visitors increased year after year until the outbreak of COVID-19 (Muneeza & Mustapha, 2021). Recent trends in Umrah individualism and Do-it-yourself (DIY) travel can be seen (Almuhrzi & Alsawafi, 2017). This is also demonstrated by the Umrah DIY Facebook forum, which has 10,000 members, and current articles about Umrah DIY conducted in Indonesia (Lailatul & Melinda, 2018; Ubaidillah, 2021). Despite the fact that significant proof has already been provided on Umrah travellers' journeys, there is a lack of explanation on Umrah DIY travellers. The only study on Umrah DIY found focused on the feasibility of Umrah backpackers among young Indonesian travellers (Lailatul & Melinda, 2018; Fakhruddin & Ubaidillah, 2021), and Hajj backpackers on the possibilities and obstacles of religious travellers (Kusumaningtyas, 2019). With the Saudi Arabian government's reform of the E-Umrah Visa policy in 2019, there is an increasing trend of international pilgrims travelling to the holy sites to perform their Umrah on their own rather than through travel agencies. Flexibility, information sources, familiarity, travel quality, companion, budget travel, and spirituality are emerging themes that explain why Umrah DIYers choose to organise and handle their most significant lifetime journey on their own. Furthermore, as travellers seek ways to maximise their experiences, this research could aid in the development of DIY Umrah travel choices

GRFS and CRFS in alternative donor hematopoietic cell transplantation for pediatric patients with acute leukemia.

We report graft-versus-host disease (GVHD)-free relapse-free survival (GRFS) (a composite end point of survival without grade III-IV acute GVHD [aGVHD], systemic therapy-requiring chronic GVHD [cGVHD], or relapse) and cGVHD-free relapse-free survival (CRFS) among pediatric patients with acute leukemia (n = 1613) who underwent transplantation with 1 antigen-mismatched (7/8) bone marrow (BM; n = 172) or umbilical cord blood (UCB; n = 1441). Multivariate analysis was performed using Cox proportional hazards models. To account for multiple testing, P \u3c .01 for the donor/graft variable was considered statistically significant. Clinical characteristics were similar between UCB and 7/8 BM recipients, because most had acute lymphoblastic leukemia (62%), 64% received total body irradiation-based conditioning, and 60% received anti-thymocyte globulin or alemtuzumab. Methotrexate-based GVHD prophylaxis was more common with 7/8 BM (79%) than with UCB (15%), in which mycophenolate mofetil was commonly used. The univariate estimates of GRFS and CRFS were 22% (95% confidence interval [CI], 16-29) and 27% (95% CI, 20-34), respectively, with 7/8 BM and 33% (95% CI, 31-36) and 38% (95% CI, 35-40), respectively, with UCB (P \u3c .001). In multivariate analysis, 7/8 BM vs UCB had similar GRFS (hazard ratio [HR], 1.12; 95% CI, 0.87-1.45; P = .39), CRFS (HR, 1.06; 95% CI, 0.82-1.38; P = .66), overall survival (HR, 1.07; 95% CI, 0.80-1.44; P = .66), and relapse (HR, 1.44; 95% CI, 1.03-2.02; P = .03). However, the 7/8 BM group had a significantly higher risk for grade III-IV aGVHD (HR, 1.70; 95% CI, 1.16-2.48; P = .006) compared with the UCB group. UCB and 7/8 BM groups had similar outcomes, as measured by GRFS and CRFS. However, given the higher risk for grade III-IV aGVHD, UCB might be preferred for patients lacking matched donors. © 2019 American Society of Hematology. All rights reserved

Identifying the fundamental structures and processes of care contributing to emergency general surgery quality using a mixed-methods Donabedian approach

BACKGROUND: Acute Care Surgery (ACS) was developed as a structured, team-based approach to providing round-the-clock emergency general surgery (EGS) care for adult patients needing treatment for diseases such as cholecystitis, gastrointestinal perforation, and necrotizing fasciitis. Lacking any prior evidence on optimizing outcomes for EGS patients, current implementation of ACS models has been idiosyncratic. We sought to use a Donabedian approach to elucidate potential EGS structures and processes that might be associated with improved outcomes as an initial step in designing the optimal model of ACS care for EGS patients. METHODS: We developed and implemented a national survey of hospital-level EGS structures and processes by surveying surgeons or chief medical officers regarding hospital-level structures and processes that directly or indirectly impacted EGS care delivery in 2015. These responses were then anonymously linked to 2015 data from the American Hospital Association (AHA) annual survey, Medicare Provider Analysis and Review claims (MedPAR), 17 State Inpatient Databases (SIDs) using AHA unique identifiers (AHAID). This allowed us to combine hospital-level data, as reported in our survey or to the AHA, to patient-level data in an effort to further examine the role of EGS structures and processes on EGS outcomes. We describe the multi-step, iterative process utilizing the Donabedian framework for quality measurement that serves as a foundation for later work in this project. RESULTS: Hospitals that responded to the survey were primarily non-governmental and located in urban settings. A plurality of respondent hospitals had fewer than 100 inpatient beds. A minority of the hospitals had medical school affiliations. DISCUSSION: Our results will enable us to develop a measure of preparedness for delivering EGS care in the US, provide guidance for regionalized care models for EGS care, tiering of ACS programs based on the robustness of their EGS structures and processes and the quality of their outcomes, and formulate triage guidelines based on patient risk factors and severity of EGS disease. CONCLUSIONS: Our work provides a template for team science applicable to research efforts combining primary data collection (i.e., that derived from our survey) with existing national data sources (i.e., SIDs and MedPAR)