The COVID-19 pandemic has affected the entire global health care system. In California, because of a high burden of cases, a lockdown order was announced on March 19, 2020. This study investigated ...the impact of the lockdown on the epidemiology and outcomes of trauma admissions at the largest trauma center in Los Angeles.
A retrospective study comparing epidemiological and clinical characteristics and outcomes of trauma admissions during the lockdown period (March 20, 2020, to June 30, 2020) to a similar period in the previous year (March 20, 2019, to June 30, 2019) was performed. Data collection included demographics, mechanism of injury, prehospital transportation, substance use, injury severity, resource utilization, and outcomes.
There were 1,202 admissions during the lockdown period in 2020 and 1,143 during the same calendar period in 2019. Following the lockdown, there was a reduction in the automobile versus pedestrian admissions by 42.5%, motorcycle injuries by 38.7%, and bicycle accidents by 28.4% but no significant effect on the number of motor vehicle accident admissions. There was an increase in ground level falls by 32.5%, especially in the elderly group. The absolute number of gunshot wounds increased by 6.2% and knife injuries by 39.3%. Suicides increased by 38.5%. Positive testing for substance use increased by 20.9%. During the lockdown, patients suffered less severe trauma, with Injury Severity Score of <9 (p < 0.001), as well as less severe head (p = 0.001) and severe chest trauma (p < 0.001). Trauma deaths were reduced by 27.9%, and the crude overall mortality was significantly lower during the lockdown period (4.1% vs. 5.9%, p = 0.046). Intensive care unit admission rates, mechanical ventilation, and intensive care unit length of stay were all reduced.
The COVID-19 lockdown in 2020 had a significant effect on the epidemiology, clinical characteristics, and critical care resource utilization of trauma admissions in a large academic trauma center. These findings may help in planning and optimization of hospital resources during the pandemic.
Epidemiological study, level III; Retrospective observational, level III.
Background Breast cancer incidence has been rising since at least 1935–1939, but recent US data reveal a statistically significant decline in breast cancer incidence in 2003 that persisted through ...2004. Identifying the specific contributions of the potential causes of this long-term increase and the recent decrease in incidence has been challenging. Marked changes in rates of mammography screening and use of menopausal hormone therapy since 1980 have added further complexity. We examined the potential association between menopausal hormone therapy use and recent changes in breast cancer incidence. Methods Using tumor registry, clinical, pathology, and pharmacy data from Kaiser Permanente Northwest, a large prepaid US health plan, we compared age-specific and age-adjusted breast cancer incidence rates (2-year moving averages) with use of screening mammography and dispensed menopausal hormone therapy prescriptions between 1980 and 2006. Temporal changes in incidence rates were assessed via joinpoint regression. Results A total of 7386 incident invasive breast cancers were diagnosed in plan members from 1980 through 2006. Overall age-adjusted breast cancer incidence rates per 100000 women rose 25% from the early 1980s (105.6) to 1992–1993 (131.7) and an additional 15% through 2000–2001 (151.3), then dropped by 18% to 2003–2004 (123.6) and edged up slightly in 2005–2006 (126.2). These patterns were largely restricted to women aged 45 years or older and to estrogen receptor–positive (ER+) breast cancers. Incidence rates of ER-negative tumors experienced neither of the rises seen for ER+ tumors but also fell precipitously from 2003 through 2006. Rates of mammography screening sharply increased from 1980 to 1993 but then leveled off, and 75%–79% of women aged 45 years or older received a mammogram at least once every 2 years from 1993 through 2006. Menopausal hormone therapy dispensings, particularly of estrogen-plus-progestin formulations, increased from 1988 to 2002 but then dropped by approximately 75% after 2002. Conclusions From 1980 through 2006, quantitative and qualitative trends in breast cancer incidence rates, particularly for ER+ tumors, parallel major changes in patterns of mammography screening and use of menopausal hormone therapy.
Michael Angelo Morales, 46, had been rescheduled to be put to death at 7:30 p.m. Tuesday and become the 14th inmate executed since California reinstated the death penalty in 1977. He was convicted 23 ...years ago for the 1981 rape and murder of Terri Lynn Winchell of Lodi. His move toward the execution chamber ignited new debate over how the state practices capital punishment. Morales' lawyers have argued that lethal injection violates constitutional prohibitions against cruel and unusual punishment. Last week, Jeremy Fogel gave the state a choice of having doctors on hand to make sure the process was done humanely, or to use only a single dose of sodium thiopental to carry out the execution. After Fogel's ruling Tuesday, defense lawyers filed an emergency request asking the California Supreme Court to stay Morales' execution, calling the aborted effort to carry out the lethal injection and hurried efforts to get it back on track "psychologically torturous, inhumane and barbaric."
Mortality among children with acute illness in low-income and middle-income settings remains unacceptably high and the importance of post-discharge mortality is increasingly recognised. We aimed to ...explore the epidemiology of deaths among young children with acute illness across sub-Saharan Africa and south Asia to inform the development of interventions and improved guidelines.
In this prospective cohort study, we enrolled children aged 2–23 months with acute illness, stratified by nutritional status defined by anthropometry (ie, no wasting, moderate wasting, or severe wasting or kwashiorkor), who were admitted to one of nine hospitals in six countries across sub-Saharan Africa and south Asia between Nov 20, 2016, and Jan 31, 2019. We assisted sites to comply with national guidelines. Co-primary outcomes were mortality within 30 days of hospital admission and post-discharge mortality within 180 days of hospital discharge. A priori exposure domains, including demographic, clinical, and anthropometric characteristics at hospital admission and discharge, as well as child, caregiver, and household-level characteristics, were examined in regression and survival structural equation models.
Of 3101 children (median age 11 months IQR 7–16), 1120 (36·1%) had no wasting, 763 (24·6%) had moderate wasting, and 1218 (39·3%) had severe wasting or kwashiorkor. Of 350 (11·3%) deaths overall, 234 (66·9%) occurred within 30 days of hospital admission and 168 (48·0%) within 180 days of hospital discharge. 90 (53·6%) post-discharge deaths occurred at home. The proportion of children who died following discharge was relatively preserved across nutritional strata. Numerically large high-risk and low-risk groups could be disaggregated for early mortality and post-discharge mortality. Structural equation models identified direct pathways to mortality and multiple socioeconomic, clinical, and nutritional domains acting indirectly through anthropometric status.
Among diverse sites in Africa and south Asia, almost half of mortality occurs following hospital discharge. Despite being highly predictable, these deaths are not addressed in current guidelines. A fundamental shift to a child-centred, risk-based approach to inpatient and post-discharge management is needed to further reduce childhood mortality, and clinical trials of these approaches with outcomes of mortality, readmission, and cost are warranted.
The Bill & Melinda Gates Foundation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
•This is the first paper to explore food waste dynamics in an alternative food network.•We found food waste levels significantly lower than in conventional retail literature.•Exact reasons for lower ...values are difficult to assess, as many factors influence food waste.•The AFN has a higher degree of autonomy and more freedom to prevent and handle food waste.•The AFN is not mainly driven by maximizing profit unlike conventional retail.
This paper investigates food waste dynamics in a retail alternative food network (AFN). We provide a first contribution to assess food waste in an AFN in terms of 1) food waste levels, 2) food waste causes, and 3) food waste management practices (i.e. food waste reduction and handling). We use an exploratory case-study to investigate food waste in a Polish AFN. We place the results of this case-study in the context of conventional retail, by reviewing retail food waste literature. Quantitative results show that food waste levels at the AFN are very low compared to conventional retail literature. Qualitative results show that food waste causes at the AFN are partly shared with conventional retail, and partly specific to the AFN. Possible explanations for low food waste are provided by the food waste management strategies, in which food waste prevention is a key component of the AFN practices.
Two other possible explanations are the degree of flexibility and the main drivers of the organization. Conventional retail is ruled by top-down policies, focusing on profit-maximization. The AFN we studied is small-scale, independently organized, and non-profit. Its main driver is to balance financial viability, accessibility and ethical guidelines. Looking beyond profit allows for a high concern with food waste, while the autonomy of the organization gives its members flexibility to develop ways to prevent and handle food waste. Future research can build on our approach of combining food waste estimations with qualitative investigation of food waste causes and management practices. Food waste dynamics should be further investigated in other (retail) AFNs, in small-scale conventional and organic food retail, and in small and large-scale cooperative supermarkets.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Consumption of goods and services is a complex phenomenon at the root of environmental problems, but it is still often framed in terms of individual behaviour, which can be related to a lack of wide ...cross-disciplinary explanations for consumption. To contribute to filling this gap, we conducted a literature review across ten disciplines. We provide a cross-disciplinary overview of what influences consumption, juxtaposing dominant with less-heard explanations for consumption and adding cross-disciplinary evidence to counter the view of consumption as a chiefly individual phenomenon. The resulting conceptual framework depicts consumption as influenced by three levels that undergo historical transformations: the micro level of consumers, purposes and products; the meso level of the direct context in which consumption takes place; and the macro level of societal contexts and agents. Future research should investigate which kinds of interactions between levels, agents and contexts can lead to minimising social and environmental impacts of consumption.
•Contrasting explanations for consumption from ten different disciplines.•New cross-disciplinary theoretical framework on what influences consumption.•Cross-disciplinary evidence for a systemic depiction of consumption.•Emphasising that many contexts and agents, beyond consumers, influence consumption.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Gliomas account for approximately 80 % of all primary malignant brain tumors and, despite improvements in clinical care over the last 20 years, remain among the most lethal tumors, underscoring the ...need for gaining new insights that could translate into clinical advances. Recent genome-wide association studies (GWAS) have identified seven new susceptibility regions. We conducted a new independent GWAS of glioma using 1,856 cases and 4,955 controls (from 14 cohort studies, 3 case–control studies, and 1 population-based case-only study) and found evidence of strong replication for three of the seven previously reported associations at 20q13.33 (
RTEL
), 5p15.33 (
TERT
), and 9p21.3 (
CDKN2BAS
), and consistent association signals for the remaining four at 7p11.2 (
EGFR
both loci), 8q24.21 (
CCDC26
) and 11q23.3 (
PHLDB1
). The direction and magnitude of the signal were consistent for samples from cohort and case–control studies, but the strength of the association was more pronounced for loci rs6010620 (20q,13.33;
RTEL
) and rs2736100 (5p15.33,
TERT
) in cohort studies despite the smaller number of cases in this group, likely due to relatively more higher grade tumors being captured in the cohort studies. We further examined the 85 most promising single nucleotide polymorphism (SNP) markers identified in our study in three replication sets (5,015 cases and 11,601 controls), but no new markers reached genome-wide significance. Our findings suggest that larger studies focusing on novel approaches as well as specific tumor subtypes or subgroups will be required to identify additional common susceptibility loci for glioma risk.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
A retrospective cohort study.
To assess whether patient outcomes and cost-effectiveness of adult spinal deformity (ASD) surgery have improved over the past decade.
Surgery for ASD is an effective ...intervention, but one that is also associated with large initial healthcare expenditures. Changes in the cost profile for ASD surgery over the last decade has not been evaluated previously.
ASD patients who received surgery between 2008 and 2019 were included. Analysis of covariance was used to establish estimated marginal means for outcome measures complication rates, reoperations, health-related quality of life, total cost, utility gained, quality adjusted life years (QALYs), cost-efficiency (cost per QALY) by year of initial surgery. Cost was calculated using the PearlDiver database and represented national averages of Medicare reimbursement for services within a 30-day window including length of stay and death differentiated by complication/comorbidity, revision, and surgical approach. Internal cost data was based on individual patient diagnosis-related group codes, limiting revisions to those within two years (2Y) of the initial surgery. Cost per QALY over the course of 2008-2019 were then calculated.
There were 1236 patients included. There was an overall decrease in rates of any complication (0.78 vs . 0.61), any reoperation (0.25 vs . 0.10), and minor complication (0.54 vs . 0.37) between 2009 and 2018 (all P <0.05). National average 2Y cost decreased at an annual rate of $3194 ( R2 =0.6602), 2Y utility gained increased at an annual rate of 0.0041 ( R2 =0.57), 2Y QALYs gained increased annually by 0.008 ( R2 =0.57), and 2Y cost per QALY decreased per year by $39,953 ( R2 =0.6778).
Between 2008 and 2019, rates of complications have decreased concurrently with improvements in patient reported outcomes, resulting in improved cost effectiveness according to national Medicare average and individual patient cost data. The value of ASD surgery has improved substantially over the course of the last decade.
Genome-wide association studies (GWAS) have transformed our understanding of glioma susceptibility, but individual studies have had limited power to identify risk loci. We performed a meta-analysis ...of existing GWAS and two new GWAS, which totaled 12,496 cases and 18,190 controls. We identified five new loci for glioblastoma (GBM) at 1p31.3 (rs12752552; P = 2.04 × 10
, odds ratio (OR) = 1.22), 11q14.1 (rs11233250; P = 9.95 × 10
, OR = 1.24), 16p13.3 (rs2562152; P = 1.93 × 10
, OR = 1.21), 16q12.1 (rs10852606; P = 1.29 × 10
, OR = 1.18) and 22q13.1 (rs2235573; P = 1.76 × 10
, OR = 1.15), as well as eight loci for non-GBM tumors at 1q32.1 (rs4252707; P = 3.34 × 10
, OR = 1.19), 1q44 (rs12076373; P = 2.63 × 10
, OR = 1.23), 2q33.3 (rs7572263; P = 2.18 × 10
, OR = 1.20), 3p14.1 (rs11706832; P = 7.66 × 10
, OR = 1.15), 10q24.33 (rs11598018; P = 3.39 × 10
, OR = 1.14), 11q21 (rs7107785; P = 3.87 × 10
, OR = 1.16), 14q12 (rs10131032; P = 5.07 × 10
, OR = 1.33) and 16p13.3 (rs3751667; P = 2.61 × 10
, OR = 1.18). These data substantiate that genetic susceptibility to GBM and non-GBM tumors are highly distinct, which likely reflects different etiology.
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IJS, NUK, SBMB, UL, UM, UPUK
Abstract
Aims
Bioprosthetic heart valves (BHVs), made from glutaraldehyde-fixed heterograft materials, are subject to more rapid structural valve degeneration (SVD) in paediatric and young adult ...patients. Differences in blood biochemistries and propensity for disease accelerate SVD in these patients, which results in multiple re-operations with compounding risks. The goal of this study is to investigate the mechanisms of BHV biomaterial degeneration and present models for studying SVD in young patients and juvenile animal models.
Methods and results
We studied SVD in clinical BHV explants from paediatric and young adult patients, juvenile sheep implantation model, rat subcutaneous implants, and an ex vivo serum incubation model. BHV biomaterials were analysed for calcification, collagen microstructure (alignment and crimp), and crosslinking density. Serum markers of calcification and tissue crosslinking were compared between young and adult subjects. We demonstrated that immature subjects were more susceptible to calcification, microstructural changes, and advanced glycation end products formation. In vivo and ex vivo studies comparing immature and mature subjects mirrored SVD in clinical observations. The interaction between host serum and BHV biomaterials leads to significant structural and biochemical changes which impact their functions.
Conclusions
There is an increased risk for accelerated SVD in younger subjects, both experimental animals and patients. Increased calcification, altered collagen microstructure with loss of alignment and increased crimp periods, and increased crosslinking are three main characteristics in BHV explants from young subjects leading to SVD. Together, our studies establish a basis for assessing the increased susceptibility of BHV biomaterials to accelerated SVD in young patients.
Graphical Abstract
Graphical Abstract
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