Economic Impact and Health Disparities of Firearm Injuries Treated within the Thomas Jefferson University Health System

Introduction: Firearms are a significant cause of morbidity and mortality in the United States. In 2015, firearms killed over 36,000 Americans (CDC, 2017), and in 2013 were responsible for $229 billion in healthcare and other costs (Cerdá 2016). On an average day in Philadelphia, 4 people are injured or killed by firearms (Beard 2017). This purpose of this project is to further investigate these trends in the context of the Thomas Jefferson University Health System. Objective: To date, no research exists to examine firearm violence within the Thomas Jefferson University Hospital (TJUH) System. The purpose of this study is to fill that gap by exploring the geographic distribution, demographics, and cost associated with firearm injuries at TJUH. This information could help identify high-risk patient groups, and contribute to targeted interventions, education, and policy in the future. Methods: This study is a 10-year retrospective analysis of TJUH medical records. ICD codes were used to identify patients treated between January 2008 and December 2017 for firearm-related injuries. Information such as patient zip code, age, ethnicity, insurance, and past medical history are being collected. This data is being entered into REDCap for analysis. Results: There were 505 cases of firearm injuries recorded at TJUH between January 2008 and December 2017. Data are still being collected, so final results are forthcoming. Conclusion: Firearms are a pervasive and deadly threat to public health across the United States. Data collection is ongoing, so firm conclusions cannot yet be drawn. However, there were more cases of firearm violence within the study period than were expected. This stresses the importance of quantifying and studying this problem, so we may be better informed and better prepared to address it

The Use of Wearable Technology in the Detection of Operator Fatigue

Introduction: Operator fatigue is a prevalent cause of injury and death. Many studies have proven reliable ways of determining operator fatigue through the use of engineering and technological advances including blink rate, lid lag, respiratory rate, cardiac rate, chest expansion, etc. However the implementation of these advances has yet to be utilized. This systematic literature review seeks to elucidate the need for implementation of wearable technology for those who suffer from operator fatigue. Methods: The target population includes anyone who operates a vehicle including drivers, aviation pilots, train conductors/engineers, marine pilots, operators of heavy machinery, fishermen and professional/overnight drivers. All technological and engineering interventions used in the detection of operator fatigue will be analyzed with successful detection of driver fatigue being the outcome. Data is being compiled form PubMed, Scopus, Cochrane Library and TRID. Results: We are in the process of publishing a preferred reporting items for systematic review and meta-analyses protocol (PRISMA-P). In addition, the results from each database suggest wearable technology is successful in detecting operator fatigue. Discussion: The PRISMA-P is a necessary step to provide validity for a systematic literature review to show we aren’t manipulating parameters to skew our results. Upon publishing this, we anticipate that our PRISMA P will further support the need for a systematic literature review on the use of wearable technology in the detection of operator fatigue

Goals Of Care Rapid Response Team at a Comprehensive Cancer Center: Feasibility and Preliminary Outcomes

Parema Enriquez pictured.https://openworks.mdanderson.org/aprn-week-22/1012/thumbnail.jp

Central Iliac Arteriovenous Anastomosis for Hypertension: Targeting Mechanical Aspects of the Circulation

Dr. Lobo reports personal fees from ROX Medical, St Jude Medical, and Cardiosonic, and grants from Medtronic. Dr. Stanton reports that ROX Medical funded the ROX CONTROL HTN study. Dr. Sobotka reports personal fees and equity from ROX Medical; equity in Cibiem, Ablative Solutions, and Rainbow Medical; and personal fees from Abbott Ventures and Boston Scientific

Could the Pharmaceutical Industry Benefit from Full-Scale Adoption of Radio-Frequency Identification (RFID) Technology with New Regulations?

Healthcare regulators are directing attention to the pharmaceutical supply chain with the passage of the Drug Quality and Security Act (DQSA) and the Drug Supply Chain Security Act (DSCSA). Adoption of Radio-Frequency Identification (RFID) technology has the ability to improve compliance, reduce costs, and improve safety in the supply chain but its implementation has been limited; primarily because of hardware and tag costs. The purpose of this research study was to analyze the benefits to the pharmaceutical industry and healthcare system of the adoption of RFID technology as a result of newly implemented supply chain regulations. The methodology was a review following the steps of a systematic review with a total of 96 sources used. With the DSCSA, pharmaceutical companies must track and trace prescription drugs across the supply chain, and RFID can resolve many track-and-trace issues with manufacturer control of data. The practical implication of this study is that pharmaceutical companies must continue to have the potential to increase revenues, decrease associated costs, and increase compliance with new FDA regulations with RFID. Still, challenges related to regulatory statute wording, implementation of two-dimensional barcode technology, and the variety of interfaces within the pharmaceutical supply chain have delayed adoption and its full implementation

Evaluation of Firearm Suicide among Patients Treated across the Jefferson Enterprise

Introduction and Objective: Firearm suicide is a leading cause of mortality. This study aims to identify risk factors associated with patients who attempt suicide with a firearm. The hypothesis is that adolescents of non-Hispanic white race/ethnicity are at the highest risk of firearm suicide. Methods: Patients treated at Thomas Jefferson University Hospital between 3/1/2017 and 12/1/2020 for a self-inflicted gunshot wound and/or attempted suicide were included in the study. Patients were identified through ICD-10 codes and a clinical research software tool known as TriNetX was used to analyze incidence of suicide as well as potential risk factors such as patient demographics and past medical history. For risk factor identification and stratification, patients who attempted suicide with a firearm were compared to those who attempted suicide via other mechanisms. Results: Of the 407 patients identified as having attempted suicide, 55 attempted suicide with a firearm. In analyzing all patients that attempted suicide, the average age was 42, 49% were male, 52% were of white race/ethnicity, and 59% had a history of a mood disorder. Among those who attempted suicide with a firearm, the average age was 53, 82% were male, 78% were of white race/ethnicity, and 75% had a history of a mood disorder. Discussion: These results do not entirely support the hypothesis as the highest incidence of firearm suicide was identified in middle-aged males of white race/ethnicity with a history of a mood disorder. Risk factors identified through this study will provide clinicians with the evidence necessary to improve firearm suicide prevention strategies

Molecular characterization of a multidrug resistance IncF plasmid from the globally disseminated Escherichia coli ST131 clone.

Escherichia coli sequence type 131 (E. coli ST131) is a recently emerged and globally disseminated multidrug resistant clone associated with urinary tract and bloodstream infections. Plasmids represent a major vehicle for the carriage of antibiotic resistance genes in E. coli ST131. In this study, we determined the complete sequence and performed a comprehensive annotation of pEC958, an IncF plasmid from the E. coli ST131 reference strain EC958. Plasmid pEC958 is 135.6 kb in size, harbours two replicons (RepFIA and RepFII) and contains 12 antibiotic resistance genes (including the blaCTX-M-15 gene). We also carried out hyper-saturated transposon mutagenesis and multiplexed transposon directed insertion-site sequencing (TraDIS) to investigate the biology of pEC958. TraDIS data showed that while only the RepFII replicon was required for pEC958 replication, the RepFIA replicon contains genes essential for its partitioning. Thus, our data provides direct evidence that the RepFIA and RepFII replicons in pEC958 cooperate to ensure their stable inheritance. The gene encoding the antitoxin component (ccdA) of the post-segregational killing system CcdAB was also protected from mutagenesis, demonstrating this system is active. Sequence comparison with a global collection of ST131 strains suggest that IncF represents the most common type of plasmid in this clone, and underscores the need to understand its evolution and contribution to the spread of antibiotic resistance genes in E. coli ST131

Priority for the Worse Off and the Social Cost of Carbon

The social cost of carbon (SCC) is a monetary measure of the harms from carbon emission. Specifically, it is the reduction in current consumption that produces a loss in social welfare equivalent to that caused by the emission of a ton of CO2. The standard approach is to calculate the SCC using a discounted-utilitarian social welfare function (SWF)—one that simply adds up the well-being numbers (utilities) of individuals, as discounted by a weighting factor that decreases with time. The discounted-utilitarian SWF has been criticized both for ignoring the distribution of well-being, and for including an arbitrary preference for earlier generations. Here, we use a prioritarian SWF, with no time-discount factor, to calculate the SCC in the integrated assessment model RICE. Prioritarianism is a well-developed concept in ethics and theoretical welfare economics, but has been, thus far, little used in climate scholarship. The core idea is to give greater weight to well-being changes affecting worse off individuals. We find substantial differences between the discounted-utilitarian and non-discounted prioritarian SCC

Applying the AcciMap methodology to investigate the tragic Mirsharai road accident in Bangladesh

A serious road accident happened on Monday, 11 July, 2011 afternoon in Mirsharai sub-district of Bangladesh's Chittagong district, that killed at least 44 schoolboys injured many more when the truck in which they were traveling skidded off a highway and plunged into a canal. In this study, the AcciMap methodology is applied, an extension to Rasmussen’s Risk Management Framework. This sociotechnical framework provides an insight into the interactions between different levels of a system, and supports the development of recommendations that could mitigate or prevent the outcomes of such an incident in the future. In the case of Mirsharai accident, the police and social media put the blame on the truck driver alone; however, this study, based on popular media reports, accident investigation reports and local interviews revealed mismanagement and an apparent disregard for safety across different levels of the socio-technical system. By integrating the different levels of the system, from international committees to end users, the road accident scenario of Bangladesh can be improved through developing a systematic approach to accident analysis