Understanding contributors to racial and ethnic inequities in COVID-19 incidence and mortality rates

BACKGROUND: Racial inequities in Coronavirus 2019 (COVID-19) have been reported over the course of the pandemic, with Black, Hispanic/Latinx, and Native American individuals suffering higher case rates and more fatalities than their White counterparts. METHODS: We used a unique statewide dataset of confirmed COVID-19 cases across Missouri, linked with historical statewide hospital data. We examined differences by race and ethnicity in raw population-based case and mortality rates. We used patient-level regression analyses to calculate the odds of mortality based on race and ethnicity, controlling for comorbidities and other risk factors. RESULTS: As of September 10, 2020 there were 73,635 confirmed COVID-19 cases in the State of Missouri. Among the 64,526 case records (87.7% of all cases) that merged with prior demographic and health care utilization data, 12,946 (20.1%) were Non-Hispanic (NH) Black, 44,550 (69.0%) were NH White, 3,822 (5.9%) were NH Other/Unknown race, and 3,208 (5.0%) were Hispanic. Raw cumulative case rates for NH Black individuals were 1,713 per 100,000 population, compared with 2,095 for NH Other/Unknown, 903 for NH White, and 1,218 for Hispanic. Cumulative COVID-19-related death rates for NH Black individuals were 58.3 per 100,000 population, compared with 38.9 for NH Other/Unknown, 19.4 for NH White, and 14.8 for Hispanic. In a model that included insurance source, history of a social determinant billing code in the patient\u27s claims, census block travel change, population density, Area Deprivation Index, and clinical comorbidities, NH Black race (OR 1.75, 1.51-2.04, p\u3c0.001) and NH Other/Unknown race (OR 1.83, 1.36-2.46, p\u3c0.001) remained strongly associated with mortality. CONCLUSIONS: In Missouri, COVID-19 case rates and mortality rates were markedly higher among NH Black and NH Other/Unknown race than among NH White residents, even after accounting for social and clinical risk, population density, and travel patterns during COVID-19

In Support of a Patient-Driven Initiative and Petition to Lower the High Price of Cancer Drugs

Comment in Lowering the High Cost of Cancer Drugs--III. [Mayo Clin Proc. 2016] Lowering the High Cost of Cancer Drugs--I. [Mayo Clin Proc. 2016] Lowering the High Cost of Cancer Drugs--IV. [Mayo Clin Proc. 2016] In Reply--Lowering the High Cost of Cancer Drugs. [Mayo Clin Proc. 2016] US oncologists call for government regulation to curb drug price rises. [BMJ. 2015

Transformational leadership and safety in steel mills: A quantitative study in a high hazard environment

During the past decade occupational health and safety performance has increasingly been used as a measure of organizational excellence. Companies in all sectors and of all sizes are making improvements to safety programs not only because it is a matter of compliance, but also to improve productivity and reduce liability. These organizations have come to expect real and lasting value from improvements to their safety programs. Steel mills are among the most hazardous work environments in the industrial sector. The processes employed to manufacture steel in the mini-mill environment are not highly variable, yet there is evidence that some mills perform much better with respect to safety outcome measures, such as Occupational Safety and Health (OSHA) recordable injury rates and lost-time work days, than others. Since the process of making steel does not vary substantially from mill to mill, it stands to reason that other variables impact safety performance within the steel production environment. Previous research has shown predictive associations between a transformational leadership style and other organizational outcomes. The research undertaken to date has not, however, adequately evaluated the possible association between safety outcome metrics (e.g. OSHA recordable injury rates and OSHA severity rates) and a transformational leadership behaviors. The intent of this research is to evaluate the leadership behaviors of the positional leaders and correlate that to safety performance. Three non-union, Midwestern steel production facilities were asked to participate in the study. The transformational leadership behaviors of the leaders in the organization were evaluated by individuals who report to the person being evaluated. The transformational leadership behaviors displayed by the leader was correlated with safety performance. Data were analyzed to determine if there is a statistically significant association between leadership behaviors and safety performance. It was found transformational leadership has a significant association with OSHA injury rates but not with OSHA severity rates. Findings and implications for practice and research are discussed

Outcome of operative treatment of metastatic fractures of the humerus: a systematic review of twenty three clinical studies

This systematic review aims to provide an overview of functional outcome and complications after surgery for metastatic humerus fractures. A literature search was performed in September 2013 using the Pubmed, Embase and Cochrane database. We included 23 studies reporting on 29 treatment arms: intramedullary nailing (19 studies, 596 cases), plate-screw fixation (five studies, 150 cases), endoprosthetic reconstruction (three studies, 81 cases), and diaphysis prosthesis (two studies, 82 cases), totalling 909 fractures. There were 414 pathological and 56 impending fractures. In 439 cases the type of fracture was not specified. Four studies reported functional outcome. Average Musculoskeletal Tumor Society score ranged from 64 to 79 (three studies, 100 patients) after intramedullary nailing, was 90 (one study, 24 patients) after plate-screw fixation, and 73 (one study, 30 patients) after endoprosthetic reconstruction. Re-operation rate varied from 0 to 10 % after intramedullary nailing (overall 4.4 %), 5-14 % after plate-screw fixation (overall 9.3 %), 14-16 % after diaphysis prosthesis (overall 14.6 %), and 0-6 % after endoprosthetic reconstruction (overall 2.5 %). Systemic complication rate varied between 0 and 26 % after intramedullary nailing (overall 2.2 %), between 0 and 6 % after plate-screw fixation (overall 4.8 %), was 0 % after endoprosthetic reconstruction, and varied between 0 and 16 % after diaphysis prosthesis (overall 9.7 %). Reported complication rates help surgeons inform their patients and could aid in surgical decision making. Functional outcome, pain and quality of life were poorly reported. Patient reported outcomes are therefore an important direction for future researc