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Objectives/Goals: This scoping review examines how socioeconomic status (SES) and sociodemographic status (SDS) disparities are considered in transition interventions for congenital heart disease (CHD) patients. By identifying gaps, it aims to guide future research and interventions to address inequities in transitional care. Methods/Study Population: A systematic search of the literature was performed using PubMed, Scopus, and Web of Science. Literature was searched from January 1990 to October 2024 and revealed 823 articles. Upon initial screening, 71 duplicates, 76 non-SES focused articles, and an additional 128 irrelevant articles were excluded. A total of 548 full-text articles were reviewed. Articles that did not focus on transition interventions for CHD patients were excluded. Studies were analyzed for factors affecting care transitions with special attention to SDS and SES factors. SDS factors were defined as age, gender, race/ethnicity, and geographic location, while SES factors were defined as income level, education, employment status, and access to care. Results/Anticipated Results: Out of 548 articles reviewed, only 18 addressed SES factors, and 10 examined SDS factors in the transition from pediatric to adult care. The most common interventions were patient education (33%), care coordination (29%), and family support (21%), but they lacked tailoring to SES/SDS factors. Patients from low-income households were 50% more likely to experience care discontinuities and 40% less likely to participate in transition programs. Health literacy interventions were generic, overlooking socioeconomic differences. Tailored transition programs are needed to address low health literacy and financial barriers, potentially improving outcomes for disadvantaged patients in rural and underserved areas. Discussion/Significance of Impact: This review exposes the limited focus on SES and SDS disparities in CHD transition interventions. Disadvantaged patients face barriers like limited access to care and low health literacy. Developing tailored programs to address these gaps is crucial for enhancing transitions and improving long-term outcomes for vulnerable CHD patients.
Plastics in the environment have moved from an “eye-sore” to a public health threat. Hospitals are one of the biggest users of single-use plastics, and there is growing literature looking at not only plastics in the environment but health care’s overall contribution to its growth.
Methods
This study was a retrospective review at a 411-bed level II trauma hospital over 47 months pre and post the last wave of COVID-19 affecting this hospital. Deidentified data were gathered: daily census in the emergency department, hospital census, and corresponding number of admitted COVID-19 patients. Additionally, for the same time frame, personal protective equipment (PPE) supply purchases and gross tonnage of nonhazardous refuse were obtained.
Results
There was a large increase in PPE purchased without a significant change in gross tonnage of weight of trash.
Conclusions
PPE is incredibly important to protect health care workers. However, single-use plastic is not sustainable for the environment or public health. Understanding the full effect of the pandemic on hospital waste production is critically important as health care institutions focus on strategies to decrease their carbon footprint and increase positive impacts on public health and the environment.
Hospital waste in the United States (US) generates 7,000 tonnes of waste daily. During the pandemic, hospitals had to increase the amount of personal protective equipment (PPE) worn by healthcare providers. The aim of this study was to compare pre and present COVID-19 waste generation amounts in comparison with hospital census and PPE purchased.
Method:
This research examined the solid waste generated at a level II trauma center from January 2018-December 2021. Data examined included: the amount of solid waste generated, monthly patient census, COVID-19 census, policy changes, and the amount of purchased PPE pre and during the pandemic.
Results:
PPE product numbers purchased varied with a noticeable increase in mask and gown ordering. The number of admitted COVID-19 patients peaked at 46. Hospital waste tonnage fluctuated but did not show a statistically significant change.
Conclusion:
The COVID-19 pandemic has caused hospitals to increase their PPE posture to help safeguard its employees and patients. In our hospital setting, the use of PPE increased and overall hospital census decreased. This has profound implications for not only the hospital’s revenue, but also with less census volume, there was curiously the same amount of hospital waste generated. This work needs to be continued in other healthcare PPE heavy settings, to better understand the downstream consequences of infectious diseases on responsible hospital waste management and environmental sustainability.
Individuals are often ambiguity-averse when choosing among purely chance-based prospects (Ellsberg, 1961). However, they often prefer apparently ambiguous ability-based prospects to unambiguous chance-based prospects. According to the competence hypothesis (Heath & Tversky, 1991), this pattern derives from favorable perceptions of one’s competence. In most past tests of the competence hypothesis, ambiguity is confounded with personal controllability and the source of the ambiguity (e.g., chance vs. missing information). We unconfound these factors in three experiments and find strong evidence for independent effects of both ambiguity aversion and competence. In Experiment 1, participants preferred an unambiguous chance-based option to an ambiguous ability-based option when the ambiguity derived from chance rather than uncertainty about one’s own ability. In Experiments 2 and 3, which used different operationalizations of ambiguity in choice contexts with actual consequences, participants attempted to avoid both ambiguity and chance insofar as they could. These findings support and extend the competence hypothesis by demonstrating ambiguity aversion independent of personal controllability and source of ambiguity.
To reduce inappropriate antibiotic prescribing for acute respiratory infections (ARIs) by employing peer comparison with behavioral feedback in the emergency department (ED).
Design:
A controlled before-and-after study.
Setting:
The study was conducted in 5 adult EDs at teaching and community hospitals in a health system.
Patients:
Adults presenting to the ED with a respiratory condition diagnosis code. Hospitalized patients and those with a diagnosis code for a non-respiratory condition for which antibiotics are or may be warranted were excluded.
Interventions:
After a baseline period from January 2016 to March 2018, 3 EDs implemented a feedback intervention with peer comparison between April 2018 and December 2019 for attending physicians. Also, 2 EDs in the health system served as controls. Using interrupted time series analysis, the inappropriate ARI prescribing rate was calculated as the proportion of antibiotic-inappropriate ARI encounters with a prescription. Prescribing rates were also evaluated for all ARIs. Attending physicians at intervention sites received biannual e-mails with their inappropriate prescribing rate and had access to a dashboard that was updated daily showing their performance relative to their peers.
Results:
Among 28,544 ARI encounters, the inappropriate prescribing rate remained stable at the control EDs between the 2 periods (23.0% and 23.8%). At the intervention sites, the inappropriate prescribing rate decreased significantly from 22.0% to 15.2%. Between periods, the overall ARI prescribing rate was 38.1% and 40.6% in the control group and 35.9% and 30.6% in the intervention group.
Conclusions:
Behavioral feedback with peer comparison can be implemented effectively in the ED to reduce inappropriate prescribing for ARIs.
Localized contamination from research-related activities and its effects on macrofauna communities in the marine environment were investigated at Palmer Station, a medium-sized Antarctic research station. Relatively low concentrations of polycyclic aromatic hydrocarbons (PAHs; 32–302 ng g-1) and total petroleum hydrocarbons (TPHs; 0.9–8.9 μg g-1) were detected in sediments adjacent to the sewage outfall and pier, where most human activities were expected to have occurred, and at even lower concentrations at two seemingly reference areas (PAHs 6–30 ng g-1, TPHs 0.03–5.1 μg g-1). Elevated concentrations of PAHs in one sample taken in one reference area (816 ng g-1) and polychlorinated biphenyls (353 ng g-1) and dichloro-diphenyl-trichloroethane (3.2 and 25.3 ng g-1) in two samples taken adjacent to the sewage outfall indicate spatial heterogeneity of localized sediment contamination. Limpet (Nacella concinna) tissues collected adjacent to Palmer Station had high concentrations of PAHs, copper, lead, zinc and several other metals relative to outlying islands. Sediment and limpet tissue contaminant concentrations have decreased since the early 1990s following the Bahía Paraíso spill. Natural sediment characteristics affected macrofaunal community composition more than contamination adjacent to Palmer Station, presumably because of the low overall contamination levels.
—Eric Garner, George Floyd, Manuel Ellis, Derrick Scott, Byron Williams, Vincente Villela, Ngozi Mbegu, Willie Ray Banks, James Brown…
On May 1, 2020, Justa Barrios, a New York City home-care worker and labor activist, passed away from COVID-19. After working twenty-four-hour shifts for fourteen years, Barrios had injuries and compounding medical issues, including asthma, stomach difficulties, and heart problems. Her doctor determined that she could no longer work twenty-four-hour shifts. Yet when the home-care agency received a letter from the doctor requesting Barrios be assigned to eight-hour shifts, the agency dropped her. Barrios fought back. She found her voice in the “Ain't I a Woman?!” Campaign; comrades described her as a “fearless leader.” Stemming from an alliance among female immigrants and US-born garment, plastics, office, and home-care workers, via workers’ centers such as the National Mobilization Against Sweatshops, this organizing effort has sought to end twenty-four-hour days—and the legally permissible practice of paying for only thirteen hours—in New York state through direct action, the courts, union arbitration, and state legislation prohibiting twenty-four -hour shifts. Women such as Justa Barros, Lai Yee Chan, Mei Kum Chu, Seferina Rosario, and Sileni Martinez see the “Aint I a Woman?!” Campaign as a “new women's movement fighting for control over our time, health, respect and payment.” As a cross-racial group, members chose to invoke Sojourner Truth, who tied together the causes of slavery abolition and women's rights, emancipation from coerced labor and from patriarchy, the dignity of women's labor and the dignity of release from work. But this legislation, which would seem so obviously humane and jarringly anachronistic, has been stalled in the New York legislature and ignored by Governor Andrew Cuomo for over a year.
To evaluate whether incorporating mandatory prior authorization for Clostridioides difficile testing into antimicrobial stewardship pharmacist workflow could reduce testing in patients with alternative etiologies for diarrhea.
Design:
Single center, quasi-experimental before-and-after study.
Setting:
Tertiary-care, academic medical center in Ann Arbor, Michigan.
Patients:
Adult and pediatric patients admitted between September 11, 2019 and December 10, 2019 were included if they had an order placed for 1 of the following: (1) C. difficile enzyme immunoassay (EIA) in patients hospitalized >72 hours and received laxatives, oral contrast, or initiated tube feeds within the prior 48 hours, (2) repeat molecular multiplex gastrointestinal pathogen panel (GIPAN) testing, or (3) GIPAN testing in patients hospitalized >72 hours.
Intervention:
A best-practice alert prompting prior authorization by the antimicrobial stewardship program (ASP) for EIA or GIPAN testing was implemented. Approval required the provider to page the ASP pharmacist and discuss rationale for testing. The provider could not proceed with the order if ASP approval was not obtained.
Results:
An average of 2.5 requests per day were received over the 3-month intervention period. The weekly rate of EIA and GIPAN orders per 1,000 patient days decreased significantly from 6.05 ± 0.94 to 4.87 ± 0.78 (IRR, 0.72; 95% CI, 0.56–0.93; P = .010) and from 1.72 ± 0.37 to 0.89 ± 0.29 (IRR, 0.53; 95% CI, 0.37–0.77; P = .001), respectively.
Conclusions:
We identified an efficient, effective C. difficile and GIPAN diagnostic stewardship approval model.
There is overlap between pathological mitral regurgitation seen in borderline rheumatic heart disease using World Heart Federation echocardiography criteria and physiologic regurgitation found in normal children. One possible contributing factor is higher rates of anaemia in endemic countries.
Objective:
To investigate the contribution of anaemia as a potential confounder in the diagnosis of rheumatic heart disease detected in echocardiographic screening.
Method/Design:
A novel Server 2012 data warehouse tool was used to incorporate haematology and echocardiography databases. The study included a convenience sample of patients from 5 to 18 years old without structural or functional heart disease that had a haemoglobin value within 1 month prior to an echocardiogram. Echocardiogram images were reviewed to determine presence or absence of World Heart Federation criteria for rheumatic heart disease. The rate of rheumatic heart disease among anaemic and non-anaemic children according to gender- and age-based norms groups was compared.
Results:
Of the 935 patients who met the study inclusion criteria, 406 were classified as anaemic. There was no difference in the rate of echocardiograms meeting criteria for borderline rheumatic heart disease in anaemic (2.0%, 95% CI 0.6–3.3%) and non-anaemic children (1.3%, 95% CI 0.3–2.3%). However, there was a statistically significant increase in rates of mitral regurgitation of unclear significance among anaemic versus non-anaemic patients (8.6 versus 3.6%; p = 0.0012).
Conclusion:
Anaemia does not increase the likelihood of meeting echocardiographic criteria for borderline rheumatic heart disease. Future studies should evaluate for the correlation between anaemia and mitral regurgitation in endemic settings.
In the United States, tornadoes are the third leading cause of fatalities from natural disasters1. To aid prevention and mitigation of tornado-related morbidity and mortality, improvement in standardizing tornado specific threat analysis terminology was assessed. The largest number of tornado-related fatalities has occurred in the state of Texas for over a hundred years. The occurrence of tornadic clusters or “outbreaks” has not been formally standardized. The concept of “tornado outbreaks” is better defined and its role in fatality mitigation is addressed in this Institutional Review Board (IRB) approved study.
Aim:
To understand the role of “tornado outbreaks” related clusters in Texas in relationship to morbidity and mortality.
Methods:
This IRB approved (IRB2017- 0507) research study utilized GIS tools and statistical analysis of historical data to examine the relationship between tornado severity (based on the Fujita Scale), the number of tornadoes, and the trends in morbidity and mortality. This study was funded in part from The National Science Foundation grant (NSF Grant #1560106) in support of the CyberHealthGIS Research Experience for Undergraduates (REU).
Results:
A statistically significant difference was demonstrated between the severity of a tornado and related morbidity and mortality during “tornado outbreaks” in Texas during a defined 30-year period.
Discussion:
Understanding the role and discerning the impacts of “tornado outbreaks” as related to tornado severity has critical implications to disaster preparedness. Applications of this conclusion may improve shelter planning/preparation, timely warning, and educating the at-risk public. Subsequently, examining the likelihood and improved descriptions of “tornado outbreaks” may aid in reducing the number of tornado-related injuries and fatalities nationally.
In 2017, dicamba-resistant (DR) soybean was commercially available to farmers in the United States. In August and September of 2017, a survey of 312 farmers from 60 Nebraska soybean-producing counties was conducted during extension field days or online. The objective of this survey was to understand farmers’ adoption and perceptions regarding DR soybean technology in Nebraska. The survey contained 16 questions and was divided in three parts: (1) demographics, (2) dicamba application in DR soybean, and (3) dicamba off-target injury to sensitive soybean cultivars. According to the results, 20% of soybean hectares represented by the survey were planted to DR soybean in 2017, and this number would probably double in 2018. Sixty-five percent of survey respondents own a sprayer and apply their own herbicide programs. More than 90% of respondents who adopted DR soybean technology reported significant improvement in weed control. Nearly 60% of respondents used dicamba alone or glyphosate plus dicamba for POST weed control in DR soybean; the remaining 40% added an additional herbicide with an alternative site of action (SOA) to the POST application. All survey respondents used one of the approved dicamba formulations for application in DR soybean. Survey results indicated that late POST dicamba applications (after late June) were more likely to result in injury to non-DR soybean compared to early POST applications (e.g., May and early June) in 2017. According to respondents, off-target dicamba movement resulted both from applications in DR soybean and dicamba-based herbicides applied in corn. Although 51% of respondents noted dicamba injury on non-DR soybean, 7% of those who noted injury filed an official complaint with the Nebraska Department of Agriculture. Although DR soybean technology allowed farmers to achieve better weed control during 2017 than previous growing seasons, it is apparent that off-target movement and resistance management must be addressed to maintain the viability and effectiveness of the technology in the future.
The built environment, which includes not only buildings but infrastructure, mediates several important climate impacts on public health and is also subject to diverse legal requirements. It is a subject of particular focus for policy efforts aimed at promoting adaptive responses to climate change on the part of institutions and individuals. This chapter presents key examples of public health impacts that arise from climate change but are mediated – possibly mitigated, possibly exacerbated – by elements of the built environment. It also describes the process and substance of adaptive responses to those impacts. Having presented these physical and policy contexts in its first section, this chapter’s second section considers the role the law could play as individuals, organizations, and localities react to climate-driven harms and seek to adapt.
The United States saw a rapid transformation of its labor market when the female employment to population ratio nearly doubled from 1950 to 2000. As women shift their hours from the home sector to the market sector, goods that were previously produced in the home may be replaced by market services. This paper uses the Panel Study for Income Dynamics, Consumer Expenditure Survey, and the American Time Use Survey to analyze the extent to which households replace home production with purchased market services, and how the relationship between men’s and women’s labor supplies affects these decisions. We show that women who are employed spend less time on home production activities that have close market alternatives than women who are not employed. Additionally, expenditures on market services that can replace home production are higher for married households in which the woman is employed compared to those with nonworking women.
Tun Mustapha Park, in Sabah, Malaysia, was gazetted in May 2016 and is the first multiple-use park in Malaysia where conservation, sustainable resource use and development co-occur within one management framework. We applied a systematic conservation planning tool, Marxan with Zones, and stakeholder consultation to design and revise the draft zoning plan. This process was facilitated by Sabah Parks, a government agency, and WWF-Malaysia, under the guidance of the Tun Mustapha Park steering committee and with support from the University of Queensland. Four conservation and fishing zones, including no-take areas, were developed, each with representation and replication targets for key marine habitats, and a range of socio-economic and community objectives. Here we report on how decision-support tools informed the reserve design process in three planning stages: prioritization, government review, and community consultation. Using marine habitat and species representation as a reporting metric, we describe how the zoning plan changed at each stage of the design process. We found that the changes made to the zoning plan by the government and stakeholders resulted in plans that compromised the achievement of conservation targets because no-take areas were moved away from villages and the coastline, where unique habitats are located. The design process highlights a number of lessons learned for future conservation zoning, which we believe will be useful as many other places embark on similar zoning processes on land and in the sea.
Within the COST action EMBOS (European Marine Biodiversity Observatory System) the degree and variation of the diversity and densities of soft-bottom communities from the lower intertidal or the shallow subtidal was measured at 28 marine sites along the European coastline (Baltic, Atlantic, Mediterranean) using jointly agreed and harmonized protocols, tools and indicators. The hypothesis tested was that the diversity for all taxonomic groups would decrease with increasing latitude. The EMBOS system delivered accurate and comparable data on the diversity and densities of the soft sediment macrozoobenthic community over a large-scale gradient along the European coastline. In contrast to general biogeographic theory, species diversity showed no linear relationship with latitude, yet a bell-shaped relation was found. The diversity and densities of benthos were mostly positively correlated with environmental factors such as temperature, salinity, mud and organic matter content in sediment, or wave height, and related with location characteristics such as system type (lagoons, estuaries, open coast) or stratum (intertidal, subtidal). For some relationships, a maximum (e.g. temperature from 15–20°C; mud content of sediment around 40%) or bimodal curve (e.g. salinity) was found. In lagoons the densities were twice higher than in other locations, and at open coasts the diversity was much lower than in other locations. We conclude that latitudinal trends and regional differences in diversity and densities are strongly influenced by, i.e. merely the result of, particular sets and ranges of environmental factors and location characteristics specific to certain areas, such as the Baltic, with typical salinity clines (favouring insects) and the Mediterranean, with higher temperatures (favouring crustaceans). Therefore, eventual trends with latitude are primarily indirect and so can be overcome by local variation of environmental factors.
We sought to conduct a major objective of the CAEP Academic Section, an environmental scan of the academic emergency medicine programs across the 17 Canadian medical schools.
Methods
We developed an 84-question questionnaire, which was distributed to academic heads. The responses were validated by phone by the lead author to ensure that the questions were answered completely and consistently. Details of pediatric emergency medicine units were excluded from the scan.
Results
At eight of 17 universities, emergency medicine has full departmental status and at two it has no official academic status. Canadian academic emergency medicine is practiced at 46 major teaching hospitals and 13 specialized pediatric hospitals. Another 69 Canadian hospital EDs regularly take clinical clerks and emergency medicine residents. There are 31 full professors of emergency medicine in Canada. Teaching programs are strong with clerkships offered at 16/17 universities, CCFP(EM) programs at 17/17, and RCPSC residency programs at 14/17. Fourteen sites have at least one physician with a Master’s degree in education. There are 55 clinical researchers with salary support at 13 universities. Sixteen sites have published peer-reviewed papers in the past five years, ranging from four to 235 per site. Annual budgets range from $200,000 to $5,900,000.
Conclusion
This comprehensive review of academic activities in emergency medicine across Canada identifies areas of strengths as well as opportunities for improvement. CAEP and the Academic Section hope we can ultimately improve ED patient care by sharing best academic practices and becoming better teachers, educators, and researchers.
We have selected cold and massive (M > 100M⊙) cores as candidates for early phases of star formation from millimeter continuum surveys without associations at short wavelengths. We compared the millimeter continuum peak positions with IR and radio catalogs and excluded cores that had sources associated with the cores’ peaks. We compiled a list of 173 cores in over 117 regions that are candidates for very early phases of Massive Star Formation (MSF). Now with the Spitzer and Herschel archives, these cores can be characterized further. We are compiling this data set to construct the complete spectral energy distribution (SED) in the mid- and far-infrared with good spatial resolution and broad spectral coverage. This allow us to disentangle the complex regions and model the SED of the deeply embedded protostars/clusters. We present a status report of our efforts: a preview of the IR properties of all cores and their embedded source inferred from a grey body fit to the compiled SEDs.