BACKGROUND: Hypotension during surgery is frequent in the elderly population and is associated with acute kidney and myocardial injury, which are, themselves, associated with increased 30-day ...mortality. The present study compared the hemodynamic effects of hypobaric unilateral spinal anesthesia (HUSA) to general anesthesia (GA) in patients ≥70 years of age undergoing hip fracture surgery. METHODS: We conducted a single-center, prospective, randomized study. In the HUSA group, patients were positioned with the operated hip above, and the hypobaric anesthetic solution was composed of 9 mg ropivacaine, 5 µg sufentanil, and 1 mL of sterile water. Anesthesia was adjusted for the GA group. Mean arterial pressure (MAP) was measured with a noninvasive blood pressure upper arm cuff every 3 minutes. Hypotension was treated with a bolus of ephedrine and then a continuous intravenous of norepinephrine to obtain a MAP ≥65 mm Hg. Primary outcome was the occurrence of severe hypotension, defined as a MAP <65 mm Hg for >12 consecutive minutes. RESULTS: A total of 154 patients were included. Severe hypotension was more frequent in the GA group compared to the HUSA group (odds ratio, 5.6; 95% confidence interval, 2.7–11.7; P < .001). There was no significant difference regarding the short-term outcomes between the HUSA and GA groups: acute kidney injury (respectively, 5.1% vs 11.3%; P = .22), myocardial injury (18.0% vs 14.0%; P = .63), and 30-day mortality (2.4% vs 4.7%; P = .65). CONCLUSIONS: HUSA leads to fewer episodes of severe intraoperative hypotension compared to GA in an elderly population undergoing hip fracture surgery.
Disparities in Access to Oral Health Care Northridge, Mary E; Kumar, Anjali; Kaur, Raghbir
Annual review of public health,
04/2020, Letnik:
41, Številka:
1
Journal Article
Recenzirano
Odprti dostop
In the United States, people are more likely to have poor oral health if they are low-income, uninsured, and or members of racial ethnic minority, immigrant, or rural populations who have suboptimal ...access to quality oral health care. As a result, poor oral health serves as the national symbol of social inequality. There is increasing recognition among those in public health that oral diseases such as dental caries and periodontal disease and general health conditions such as obesity and diabetes are closely linked by sharing common risk factors, including excess sugar consumption and tobacco use, as well as underlying infection and inflammatory pathways. Hence, efforts to integrate oral health and primary health care, incorporate interventions at multiple levels to improve access to and quality of services, and create health care teams that provide patient-centered care in both safety net clinics and community settings may narrow the gaps in access to oral health care across the life course.
Assembling a collection of very prominent researchers in the field, the Handbook of Spatial Statistics presents a comprehensive treatment of both classical and state-of-the-art aspects of this ...maturing area. It takes a unified, integrated approach to the material, providing cross-references among chapters.The handbook begins with a historical intro
Data Matching Christen, Peter
2012, 2012-07-04, c2012
eBook
Data matching (also known as record or data linkage, entity resolution, object identification, or field matching) is the task of identifying, matching and merging records that correspond to the same ...entities from several databases or even within one database. Based on research in various domains including applied statistics, health informatics, data mining, machine learning, artificial intelligence, database management, and digital libraries, significant advances have been achieved over the last decade in all aspects of the data matching process, especially on how to improve the accuracy of data matching, and its scalability to large databases.Peter Christens book is divided into three parts: Part I, "Overview, introduces the subject by presenting several sample applications and their special challenges, as well as a general overview of a generic data matching process. Part II, "Steps of the Data Matching Process, then details its main steps like pre-processing, indexing, field and record comparison, classification, and quality evaluation. Lastly, part III, "Further Topics, deals with specific aspects like privacy, real-time matching, or matching unstructured data. Finally, it briefly describes the main features of many research and open source systems available today.By providing the reader with a broad range of data matching concepts and techniques and touching on all aspects of the data matching process, this book helps researchers as well as students specializing in data quality or data matching aspects to familiarize themselves with recent research advances and to identify open research challenges in the area of data matching. To this end, each chapter of the book includes a final section that provides pointers to further background and research material. Practitioners will better understand the current state of the art in data matching as well as the internal workings and limitations of current systems. Especially, they will learn that it is often not feasible to simply implement an existing off-the-shelf data matching system without substantial adaption and customization. Such practical considerations are discussed for each of the major steps in the data matching process.
Aims Subclassification of large B cell lymphoma (LBCL) is challenging due to the overlap in histopathological, immunophenotypical and genetic data. In particular, the criteria to separate diffuse ...large B cell lymphoma (DLBCL) and high‐grade B cell lymphoma (HGBL) are difficult to apply in practice. The Lunenburg Lymphoma Biomarker Consortium previously reported a cohort of over 5000 LBCL that included fluorescence in‐situ hybridisation (FISH) data. This cohort contained 209 cases with MYC rearrangement that were available for a validation study by a panel of eight expert haematopathologists of how various histopathological features are used. Methods and results Digital whole slide images of haematoxylin and eosin‐stained sections allowed the pathologists to visually score cases independently as well as participate in virtual joint review conferences. Standardised consensus guidelines were formulated for scoring histopathological features and included overall architecture/growth pattern, presence or absence of a starry‐sky pattern, cell size, nuclear pleomorphism, nucleolar prominence and a range of cytological characteristics. Despite the use of consensus guidelines, the results show a high degree of discordance among the eight expert pathologists. Approximately 50% of the cases lacked a majority score, and this discordance spanned all six histopathological features. Moreover, none of the histological variables aided in prediction of MYC single versus double/triple‐hit or immunoglobulin‐partner FISH‐based designations or clinical outcome measures. Conclusions Our findings indicate that there are no specific conventional morphological parameters that help to subclassify MYC ‐rearranged LBCL or select cases for FISH analysis, and that incorporation of FISH data is essential for accurate classification and prognostication.
Although it is well known that the performance of attribute control charts decreases significantly when the assumption of known process parameters is invalid, this assumption is prevalent in the ...pertinent literature. However, in most practical applications, the process parameters have to be estimated from a finite in-control Phase I sample, and therefore the performance of attribute control charts should be evaluated from the perspective of estimated process parameters. In this paper, we compare the run length properties of the hypergeometric np chart in both the known and estimated parameter cases. In particular, we investigate the required number of Phase I samples and new specific chart parameters that allow the hypergeometric np chart with estimated parameter p to have approximately the same in-control performance as in the known parameters case. Moreover, we perform a comprehensive in-control and out-of-control comparison of the hypergeometric np chart with its binomial counterpart. In order to achieve these objectives, we also present a new approach to effectively compute the probability distribution of the sum of independent and identically hypergeometric-distributed random variables. The proposed approximation reduces the computational effort to a few seconds while keeping a remarkable high accuracy with only negligible deviations compared to the exact distribution obtained via convolution.
IMPORTANCE: Workplace mistreatment can manifest as microaggressions that cause chronic, severe distress. As physician burnout becomes a global crisis, quantitative research to delineate the impact of ...microaggressions is imperative. OBJECTIVES: To examine the prevalence and nature of sexist and racial/ethnic microaggressions against female and racial/ethnic–minority surgeons and anesthesiologists and assess the association with physician burnout. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey evaluated microaggressions and physician burnout within a diverse cohort of surgeons and anesthesiologists in a large health maintenance organization. A total of 1643 eligible participants were sent a recruitment email on January 8, 2020, 1609 received the email, and 652 replied, for a response rate of 41%. The study survey remained open until February 20, 2020. A total of 588 individuals (37%) were included in the study after exclusion criteria were applied. EXPOSURES: The Maslach Burnout Inventory, the Racial Microaggression Scale, and the Sexist Microaggression Experience and Stress Scale. MAIN OUTCOMES AND MEASURES: The primary outcomes were prevalence and nature of sexist and racial/ethnic microaggressions against female and racial/ethnic–minority surgeons and anesthesiologists using the Sexist Microaggression Experience and Stress Scale and Racial Microaggression Scale. Secondary outcomes were frequency and severity of microaggressions, prevalence of physician burnout, and associations between microaggressions and physician burnout. RESULTS: Data obtained from 588 respondents (249 44% female, 367 62% racial/ethnic minority, 224 38.1% 40-49 years of age) were analyzed. A total of 245 of 259 female respondents (94%) experienced sexist microaggressions, most commonly overhearing or seeing degrading female terms or images. Racial/ethnic microaggressions were experienced by 299 of 367 racial/ethnic–minority physicians (81%), most commonly reporting few leaders or coworkers of the same race/ethnicity. Criminality was rare (18 of 367 5%) but unique to and significantly higher for Hispanic and Black physicians. Individuals who identified as underrepresented minorities were more likely to experience environmental inequities (odds ratio OR, 4.21; 95% CI, 1.6-10.75; P = .002) and criminality (OR, 14.93; 95% CI, 4.5-48.5; P < .001). The prevalence of physician burnout was 47% (280 of 588 physicians) and higher among female physicians (OR, 1.60; 95% CI, 1.03-2.47; P = .04) and racial/ethnic–minority physicians (OR, 2.08; 95% CI, 1.31-3.30; P = .002). Female physicians who experienced sexist microaggressions (racial/ethnic–minority female physicians: OR, 1.84; 95% CI, 1.04-3.25; P = .04; White female physicians: OR, 1.99; 95% CI, 1.07-3.69; P = .03) were more likely to experience burnout. Racial/ethnic–minority female physicians (OR, 1.86; 95% CI, 1.03-3.35; P = .04) who experienced racial microaggressions were more likely to report burnout. Racial/ethnic–minority female physicians who had the compound experience of sexist and racial/ethnic microaggressions (OR, 2.05; 95% CI, 1.14-3.69; P = .02) were more likely to experience burnout. CONCLUSIONS AND RELEVANCE: The prevalence of sexist and racial/ethnic microaggressions against female and racial/ethnic–minority surgeons and anesthesiologists was high and associated with physician burnout. This study provides a valuable response to the increasing call for evidence-based data on surgical workplace mistreatment.
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