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Racial disparities in healthcare have been well documented in the United States. We hypothesise that there will be a racial variance in different clinical variables in single-ventricle patients through stages of palliation.
Materials and Methods:
Retrospective single-centre study stratified all single-ventricle patients who reached stage 2 palliation by race: Black and White. Other races were excluded. Demographic and clinical characteristics were compared, alongside follow-up survival data. Primary outcomes were progression to Fontan and overall survival.
Results:
Among 526 patients, 325 (61.8%) were White, and 201 (38.2%) were Black. Median age at stage 2 palliation was 150 days for White and 165 for Black patients (p = 0.005), with similar weights. Black patients exhibited higher median cardiopulmonary bypass times (87 vs. 74 minutes, p = 0.001) and a greater frequency of genetic syndromes (30.1% vs. 22.1%, p = 0.044). No significant differences were observed in outcomes between groups from stage 2 to stage 3, pre-stage 3 cardiac catheterisation variables, or perioperative outcomes. Multivariable regression analysis identified hypoplastic pulmonary arteries as the risk factor for mortality after stage 2. Survival analysis showed no difference in survival by race; however, occurrence of combined cardiovascular event was significantly higher in Black race.
Conclusions:
Significant racial disparities exist among single-ventricle patients regarding the timing of stage 2 palliation, cardiopulmonary bypass duration, and frequency of genetic syndromes. Black race was a risk factor for sub-optimal long-term outcome, although perioperative mortality was similar. These race-related factors warrant further studies to improve our understanding of the impact of race on outcomes.
An April 2022 Electroconvulsive Therapy Accreditation Services (ECTAS) review of electroconvulsive therapy (ECT) services in the Southern Sector of the Western Health and Social Care Trust highlighted that the follow up of service users' memory and cognitive side effects post-ECT needed to be improved to deliver safer and more effective care. The aim of this MDT quality improvement project was to transform the follow-up process from a baseline of 13% of service users receiving memory assessment 1–2 months post ECT to 100% of service users receiving memory assessment 1–2 months post ECT over a 16 month period.
Methods
In June 2022, an MDT working group was established with key stakeholders from inpatient and community mental health services. Using driver diagrams, opportunities for improvement were collectively identified and innovative ideas proposed to overcome these barriers. The primary drivers for change were communication, resources, and education. Systems were established and PDSA cycles used to review our data and decide whether we needed to make a further change. 17 service users received ECT and were followed up within the 16 month period. Our third change brought about the most significant and sustained improvement to the process; establish ECT champions within community teams. The ECT champion's role was to improve communication between inpatient and community teams in regards to service users needing memory follow up post ECT.
Results
The introduction of three ECT champions within the community teams significantly improved communication between the inpatient and outpatient teams resulting in an improvement in the standard of care to our service users. Initial figures show 100% of service users having memory assessment follow up at 1–2 months post ECT in July 2023, October 2023 & December 2023. No service users required follow-up within the service in August/September/November 2023. Performance monitoring is ongoing as part of the service's governance meeting.
Conclusion
In conclusion, by improving communication, utilising resources more effectively and educating through ECT champions, the percentage service users receiving memory assessments at 1–2 months follow up post ECT achieved ECTAS standard of 100%. This will benefit our service users by enabling us to identify those who need further input. Looking into the future, we need to undertake a clinical audit to assess for a sustained improvement and ensure that no unintended consequences have been introduced from this QIP. We have shared our learning within the wider trust and plan to spread and scale our changes across a wider area.
Edited by
William J. Brady, University of Virginia,Mark R. Sochor, University of Virginia,Paul E. Pepe, Metropolitan EMS Medical Directors Global Alliance, Florida,John C. Maino II, Michigan International Speedway, Brooklyn,K. Sophia Dyer, Boston University Chobanian and Avedisian School of Medicine, Massachusetts
Edited by
William J. Brady, University of Virginia,Mark R. Sochor, University of Virginia,Paul E. Pepe, Metropolitan EMS Medical Directors Global Alliance, Florida,John C. Maino II, Michigan International Speedway, Brooklyn,K. Sophia Dyer, Boston University Chobanian and Avedisian School of Medicine, Massachusetts
from
Chapter 13
-
Mass Gathering Events: Motor Sport Events
Edited by
William J. Brady, University of Virginia,Mark R. Sochor, University of Virginia,Paul E. Pepe, Metropolitan EMS Medical Directors Global Alliance, Florida,John C. Maino II, Michigan International Speedway, Brooklyn,K. Sophia Dyer, Boston University Chobanian and Avedisian School of Medicine, Massachusetts
Edited by
William J. Brady, University of Virginia,Mark R. Sochor, University of Virginia,Paul E. Pepe, Metropolitan EMS Medical Directors Global Alliance, Florida,John C. Maino II, Michigan International Speedway, Brooklyn,K. Sophia Dyer, Boston University Chobanian and Avedisian School of Medicine, Massachusetts
from
Chapter 13
-
Mass Gathering Events: Motor Sport Events
Edited by
William J. Brady, University of Virginia,Mark R. Sochor, University of Virginia,Paul E. Pepe, Metropolitan EMS Medical Directors Global Alliance, Florida,John C. Maino II, Michigan International Speedway, Brooklyn,K. Sophia Dyer, Boston University Chobanian and Avedisian School of Medicine, Massachusetts
from
Chapter 13
-
Mass Gathering Events: Motor Sport Events
Edited by
William J. Brady, University of Virginia,Mark R. Sochor, University of Virginia,Paul E. Pepe, Metropolitan EMS Medical Directors Global Alliance, Florida,John C. Maino II, Michigan International Speedway, Brooklyn,K. Sophia Dyer, Boston University Chobanian and Avedisian School of Medicine, Massachusetts
Edited by
William J. Brady, University of Virginia,Mark R. Sochor, University of Virginia,Paul E. Pepe, Metropolitan EMS Medical Directors Global Alliance, Florida,John C. Maino II, Michigan International Speedway, Brooklyn,K. Sophia Dyer, Boston University Chobanian and Avedisian School of Medicine, Massachusetts
Edited by
William J. Brady, University of Virginia,Mark R. Sochor, University of Virginia,Paul E. Pepe, Metropolitan EMS Medical Directors Global Alliance, Florida,John C. Maino II, Michigan International Speedway, Brooklyn,K. Sophia Dyer, Boston University Chobanian and Avedisian School of Medicine, Massachusetts
Edited by
William J. Brady, University of Virginia,Mark R. Sochor, University of Virginia,Paul E. Pepe, Metropolitan EMS Medical Directors Global Alliance, Florida,John C. Maino II, Michigan International Speedway, Brooklyn,K. Sophia Dyer, Boston University Chobanian and Avedisian School of Medicine, Massachusetts
Edited by
William J. Brady, University of Virginia,Mark R. Sochor, University of Virginia,Paul E. Pepe, Metropolitan EMS Medical Directors Global Alliance, Florida,John C. Maino II, Michigan International Speedway, Brooklyn,K. Sophia Dyer, Boston University Chobanian and Avedisian School of Medicine, Massachusetts
Mass medical deployments to large events, such as music festivals or sporting events, are increasing in number, size, and complexity. This textbook provides guidance and direction for rational, effective, and practical medical management of mass gathering events for medical leaders. This is the first authoritative text on mass event medicine, filling a much-needed gap in a large and important area of the specialty. An international group of contributors introduce the specialty and cover topics such as general deployment, staffing, equipment, and resources, moving on to more complex issues such as the business aspect of mass gathering medicine and the legal implications. There are also practical chapters on specific types of events and adverse events such as terrorism, severe weather, and civil disobedience. An invaluable text for all healthcare professionals planning for and attending mass events, particularly EMS professionals, large event planners and administrators, and law enforcement and security personnel.
The well-known self-propulsion, or swimming, of a deformable body in Stokes flow (i.e. at low Reynolds number) can be understood and modelled from the variation in the configuration-dependent hydrodynamic resistance tensor throughout the period of deformation. Remarkably, at the other extreme of high Reynolds number, a deformable body may also self-propel without doing any net work on the fluid in potential flow. As a body deforms, the mass of fluid displaced – the so-called added mass – depends on the instantaneous body configuration, and a net displacement is possible over a period of deformation. This potential swimming takes a form identical to that for Stokes swimmers with the configuration-dependent added mass replacing the hydrodynamic resistance tensor. Analytical insight into the swimming of a deformable body is obtained through an expansion of the nonlinear spatial dependence of the hydrodynamic interactions and connections between previous studies of swimming in Stokes flow to those in potential flow are made.
Since its development, Stokesian dynamics has been a leading approach for the dynamic simulation of suspensions of particles at arbitrary concentrations with full hydrodynamic interactions. Although developed originally for the simulation of passive particle suspensions, the Stokesian dynamics framework is equally well suited to the analysis and dynamic simulation of suspensions of active particles, as we elucidate here. We show how the reciprocal theorem can be used to formulate the exact dynamics for a suspension of arbitrary active particles, and then show how the Stokesian dynamics method provides a rigorous way to approximate and compute the dynamics of dense active suspensions where many-body hydrodynamic interactions are important.
In efforts to understand the potential impacts of the Marcellus Shale extraction activities on stream health, we performed a baseline study on a focal pair of small streams in the Tenmile Creek watershed in Greene County, Pennsylvania. Bates Fork had intensive Marcellus Shale well drilling activity and several violations upstream from our study site. A tributary, Fonner Run, served as a control stream site with no drilling activity. Through two years of monitoring, we established baselines for water chemistry and biological communities of bacteria, fish and salamanders. In addition, we compared population genetic diversity of two darter species with microsatellite markers. Although no conclusive differences were found between the stream-pair, we established baseline parameters and gained insight into refining tools to detect the signature of Marcellus Shale extraction impacts on small streams in southwestern Pennsylvania. We conclude this chapter with lessons learned from this case study, future directions and suggestions for improved monitoring and detection of Marcellus Shale impacts on streams in southwestern Pennsylvania.
Modern biomedical applications such as targeted drug delivery require a delivery system capable of enhanced transport beyond that of passive Brownian diffusion. In this work, an osmotic mechanism for the propulsion of a vesicle immersed in a viscous fluid is proposed. By maintaining a steady-state solute gradient inside the vesicle, a seepage flow of the solvent (e.g. water) across the semipermeable membrane is generated, which in turn propels the vesicle. We develop a theoretical model for this vesicle–solute system in which the seepage flow is described by a Darcy flow. Using the reciprocal theorem for Stokes flow, it is shown that the seepage velocity at the exterior surface of the vesicle generates a thrust force that is balanced by the hydrodynamic drag such that there is no net force on the vesicle. We characterize the motility of the vesicle in relation to the concentration distribution of the solute confined inside the vesicle. Any osmotic solute is able to propel the vesicle so long as a concentration gradient is present. In the present work, we propose active Brownian particles (ABPs) as a solute. To maintain a symmetry-breaking concentration gradient, we consider ABPs with spatially varying swim speed, and ABPs with constant properties but under the influence of an orienting field. In particular, it is shown that at high activity, the vesicle velocity is $\boldsymbol {U}\sim [K_\perp /(\eta _e\ell _m) ]\int \varPi _0^{swim} \boldsymbol {n}\,{\rm d}\varOmega$, where $\varPi _0^{swim}$ is the swim pressure just outside the thin accumulation boundary layer on the vesicle interior surface, $\boldsymbol {n}$ is the unit normal vector of the vesicle boundary, $K_\perp$ is the membrane permeability, $\eta _e$ is the viscosity of the solvent, and $\ell _m$ is the membrane thickness.
Studies of introduced subject matter in rock-art assemblages typically focus on themes of cross-cultural interaction, change and continuity, power and resistance. However, the economic frameworks guiding or shaping the production of an assemblage have often been overlooked. In this paper we use a case study involving a recently recorded assemblage of introduced subject matter from Marra Country in northern Australia's southwest Gulf of Carpentaria region to explore their production using a hybrid economy framework. This framework attempts to understand the nature of the forces that shape people's engagement with country and subsequently how it is being symbolically marked as adjustments to country occur through colonization. We argue that embedding these motifs into a hybrid economy context anchored in the pastoral industry allows for a more nuanced approach to cross-cultural interaction studies and adds another layer to the story of Aboriginal place-marking in colonial contexts. This paper aims to go beyond simply identifying motifs thought to represent introduced subject matter, and the cross-cultural framework(s) guiding their interpretation, and instead to direct attention to the complex network of relations that potentially underpin the production of such motifs.
Background: Antibiotics targeted against Clostridioides difficile bacteria are necessary, but insufficient, to achieve a durable clinical response because they have no effect on C. difficile spores that germinate within a disrupted microbiome. ECOSPOR-III evaluated SER-109, an investigational, biologically derived microbiome therapeutic of purified Firmicute spores for treatment of rCDI. Herein, we present the interim analysis in the ITT population at 8 and 12 weeks. Methods: Adults ≥18 years with rCDI (≥3 episodes in 12 months) were screened at 75 US and CAN sites. CDI was defined as ≥3 unformed stools per day for <48 hours with a positive C. difficile assay. After completion of 10–21 days of vancomycin or fidaxomicin, adults with symptom resolution were randomized 1:1 to SER-109 (4 capsules × 3 days) or matching placebo and stratified by age (≥ or <65 years) and antibiotic received. Primary objectives were safety and efficacy at 8 weeks. Primary efficacy endpoint was rCDI (recurrent toxin+ diarrhea requiring treatment); secondary endpoints included efficacy at 12 weeks after dosing. Results: Overall, 287 participants were screened and 182 were randomized (59.9% female; mean age, 65.5 years). The most common reason for screen failure was a negative C. difficile toxin assay. A significantly lower proportion of SER-109 participants had rCDI after dosing compared to placebo at week 8 (11.1% vs 41.3%, respectively; relative risk [RR], 0.27; 95% confidence interval [CI], 0.15–0.51; p-value <0.001). Efficacy rates were significantly higher with SER-109 vs placebo in both stratified age groups (Figure 1). SER-109 was well-tolerated with a safety profile similar to placebo. The most common treatment-emergent adverse events (TEAEs) were gastrointestinal and were mainly mild to moderate. No serious TEAEs, infections, deaths, or drug discontinuations were deemed related to study drug. Conclusions: SER-109, an oral live microbiome therapeutic, achieved high rates of sustained clinical response with a favorable safety profile. By enriching for Firmicute spores, SER-109 achieves high efficacy while mitigating risk of transmitting infectious agents, beyond donor screening alone. SER-109 represents a major paradigm shift in the clinical management of patients with recurrent CDI. Clinicaltrials.gov Identifier NCT03183128. These data were previously presented as a late breaker at American College of Gastroenterology 2020.