Obstetrical ultrasound imaging is an important part of prenatal care, though not all patients have readily available access to ultrasound services. This study aimed to assess the association between ...sociodemographic and geographic factors and (1) having a second trimester complete obstetrical ultrasound and (2) overall obstetrical ultrasound utilization.
All pregnancies and obstetrical ultrasound exams billed from 2014-2018 in Saskatchewan, Canada were identified from province-wide databases. Generalized estimating equation (GEE) models with binomial and Poisson distributions were used to identify factors associated with having a second trimester ultrasound and overall obstetrical ultrasound utilization, respectively.
80,536 pregnancies from 57,881 individuals were included. Of 57,186 pregnancies carried to ≥23 weeks, a second trimester ultrasound was performed in 50,180 (87.7%). Patients living in rural areas (adjusted odds ratio aOR, 0.70; 95% confidence interval CI, 0.63-0.77; p <0.0001), remote areas (aOR, 0.35 for greatest vs. least remoteness level; 95% CI, 0.32-0.39; p <0.0001), and status First Nations individuals (aOR, 0.50; 95% CI, 0.46-0.53; p <0.0001) were less likely to have a second trimester ultrasound. Patients living in higher income neighbourhoods (aOR, 1.86 for highest vs. lowest quintile; 95% CI, 1.62-2.13; p <0.0001) were more likely to have a second trimester ultrasound. GEE Poisson regression analysis demonstrated these same factors, except rural residence, were associated with overall obstetrical ultrasound utilization.
Substantial disparities in obstetrical ultrasound utilization exist among patients in remote geographic areas, Indigenous peoples, and patients in low income neighbourhoods. Addressing barriers which these demographic groups face in accessing ultrasound imaging is critical to ensure health equity.
Abstract
We present a systematic study of the most luminous (
M
IR
Vega magnitudes brighter than −14) infrared (IR) transients discovered by the
SPitzer
InfraRed Intensive Transients Survey (SPIRITS) ...between 2014 and 2018 in nearby galaxies (
D
< 35 Mpc). The sample consists of nine events that span peak IR luminosities of
M
4.5,peak
between −14 and −18.2, show IR colors between 0.2 < (3.6–4.5) < 3.0, and fade on timescales between 55 days <
t
fade
< 480 days. The two reddest events (
A
V
> 12) show multiple, luminous IR outbursts over several years and have directly detected, massive progenitors in archival imaging. With analyses of extensive, multiwavelength follow-up, we suggest the following possible classifications: five obscured core-collapse supernovae (CCSNe), two erupting massive stars, one luminous red nova, and one intermediate-luminosity red transient. We define a control sample of all optically discovered transients recovered in SPIRITS galaxies and satisfying the same selection criteria. The control sample consists of eight CCSNe and one Type Iax SN. We find that 7 of the 13 CCSNe in the SPIRITS sample have lower bounds on their extinction of 2 <
A
V
< 8. We estimate a nominal fraction of CCSNe in nearby galaxies that are missed by optical surveys as high as
(90% confidence). This study suggests that a significant fraction of CCSNe may be heavily obscured by dust and therefore undercounted in the census of nearby CCSNe from optical searches.
The detonation of a helium shell on a white dwarf (WD) has been proposed as a possible explosion triggering mechanism for SNe Ia. Here, we report ZTF 18aaqeasu (SN 2018byg/ATLAS 18pqq), a peculiar ...Type I supernova, consistent with being a helium-shell double-detonation. With a rise time of 18 days from explosion, the transient reached a peak absolute magnitude of MR −18.2 mag, exhibiting a light curve akin to sub-luminous SN 1991bg-like SNe Ia, albeit with an unusually steep increase in brightness within a week from explosion. Spectra taken near peak light exhibit prominent Si absorption features together with an unusually red color (g − r 2 mag) arising from nearly complete line blanketing of flux blueward of 5000 . This behavior is unlike any previously observed thermonuclear transient. Nebular phase spectra taken at and after 30 days from peak light reveal evidence of a thermonuclear detonation event dominated by Fe-group nucleosynthesis. We show that the peculiar properties of ZTF 18aaqeasu are consistent with the detonation of a massive ( 0.15 ) helium shell on a sub-Chandrasekhar mass ( 0.75 ) WD after including mixing of 0.2 of material in the outer ejecta. These observations provide evidence of a likely rare class of thermonuclear supernovae arising from detonations of massive helium shells.
Hospitalization is a major source of morbidity among patients with ESRD undergoing maintenance hemodialysis and is a significant contributor to health care costs. To identify subgroups at the highest ...risk of hospitalization, we analyzed by sex, age, and race, adjusting for demographic and clinical characteristics, the hospitalization rates, and 30-day readmissions for 333,756 hospitalizations among 111,653 patients undergoing maintenance hemodialysis in facilities operated by a large dialysis organization in the United States (2007-2011). The overall hospitalization rate was 1.85 hospitalizations per person-year and was much higher among women than among men (2.08 versus 1.68 hospitalizations per year for women versus men,
<0.001). Age group-specific hospitalization rates were consistently higher for women than for men of the same race, and the differences were greatest in younger age groups (for example, women aged 18-34 years and ≥75 years had 54% 95% confidence interval, 42% to 67% and 14% 95% confidence interval, 11% to 18% higher hospitalization rates, respectively, than did men of respective ages). Women also had substantially higher risk for 30-day readmission, with the largest differences at younger ages. Women had a significantly lower serum albumin level than men, and stratification by serum albumin level attenuated sex differences in the age group-specific hospitalization and 30-day readmission rates. These findings suggest that women undergoing maintenance hemodialysis have substantially higher risks for hospitalization and 30-day readmission than men. In this cohort, the sex differences were greatest in the younger age groups and were attenuated by accounting for differences in health status reflected by serum albumin level.
Palomar Gattini-IR is a new wide-field, near-infrared (NIR) robotic time domain survey operating at Palomar Observatory. Using a 30 cm telescope mounted with a H2RG detector, Gattini-IR achieves a ...field of view (FOV) of 25 sq. deg. with a pixel scale of 8 7 in J-band. Here, we describe the system design, survey operations, data processing system and on-sky performance of Palomar Gattini-IR. As a part of the nominal survey, Gattini-IR scans 7500 square degrees of the sky every night to a median 5 depth of 15.7 AB mag outside the Galactic plane. The survey covers 15,000 square degrees of the sky visible from Palomar with a median cadence of 2 days. A real-time data processing system produces stacked science images from dithered raw images taken on sky, together with point-spread function (PSF)-fit source catalogs and transient candidates identified from subtractions within a median delay of 4 hr from the time of observation. The calibrated data products achieve an astrometric accuracy (rms) of 0 7 with respect to Gaia DR2 for sources with signal-to-noise ratio > 10, and better than 0 35 for sources brighter than 12 Vega mag. The photometric accuracy (rms) achieved in the PSF-fit source catalogs is better than 3% for sources brighter than 12 Vega mag and fainter than the saturation magnitude of 8.5 Vega mag, as calibrated against the Two Micron All Sky Survey catalog. The detection efficiency of transient candidates injected into the images is better than 90% for sources brighter than the 5 limiting magnitude. The photometric recovery precision of injected sources is 3% for sources brighter than 13 mag, and the astrometric recovery rms is 0 9. Reference images generated by stacking several field visits achieve depths of 16.5 AB mag over 60% of the sky, while it is limited by confusion in the Galactic plane. With a FOV 40× larger than any other existing NIR imaging instrument, Gattini-IR is probing the reddest and dustiest transients in the local universe such as dust obscured supernovae in nearby galaxies, novae behind large columns of extinction within the galaxy, reddened microlensing events in the Galactic plane and variability from cool and dust obscured stars. We present results from transients and variables identified since the start of the commissioning period.
Utilising a flexible intracortical microprobe to record/stimulate neurons minimises the incompatibility between the implanted microprobe and the brain, reducing tissue damage due to the brain ...micromotion. Applying bio-dissolvable coating materials temporarily makes a flexible microprobe stiff to tolerate the penetration force during insertion. However, the inability to adjust the dissolving time after the microprobe contact with the cerebrospinal fluid may lead to inaccuracy in the microprobe positioning. Furthermore, since the dissolving process is irreversible, any subsequent positioning error cannot be corrected by re-stiffening the microprobe. The purpose of this study is to propose an intracortical microprobe that incorporates two compressible structures to make the microprobe both adaptive to the brain during operation and stiff during insertion. Applying a compressive force by an inserter compresses the two compressible structures completely, resulting in increasing the equivalent elastic modulus. Thus, instant switching between stiff and soft modes can be accomplished as many times as necessary to ensure high-accuracy positioning while causing minimal tissue damage. The equivalent elastic modulus of the microprobe during operation is ≈ 23 kPa, which is ≈ 42% less than the existing counterpart, resulting in ≈ 46% less maximum strain generated on the surrounding tissue under brain longitudinal motion. The self-stiffening microprobe and surrounding neural tissue are simulated during insertion and operation to confirm the efficiency of the design. Two-photon polymerisation technology is utilised to 3D print the proposed microprobe, which is experimentally validated and inserted into a lamb’s brain without buckling.
Objective This study examined prospective data from the Third National Health and Nutrition Examination Survey (NHANES III) cohort to investigate the relationship between cadmium exposure and cancer ...mortality, and the specific cancers associated with cadmium exposure, in the general population. Methods Vital status and cause of death through 31 December 2006 were obtained by the National Center for Health Statistics for NHANES III participants. The cadmium concentration of spot urine samples was measured and corrected for urine creatinine (uCd). Weighted Cox proportional hazards regression with age as the time metric was applied to estimate sex-specific adjusted HRs (aHRs) of mortality associated with uCd for all cancers and the cancers responsible for the most deaths in the USA. Estimates were stratified by smoking history and adjusted for education, body mass index and race. Results uCd was associated with cancer mortality (aHR per twofold higher uCd (95% CI), men: 1.26 (1.07 to 1.48); women: 1.21 (1.04 to 1.42)). In men, mortality from lung cancer, pancreatic cancer and non-Hodgkin lymphoma was associated with uCd; an association with leukaemia mortality was suggested. In women, associations were suggested with mortality due to lung cancer, leukaemia, ovarian and uterine cancer, but evidence was weaker than in men. Conclusions Cadmium appears to be associated with overall cancer mortality in men and women, but the specific cancers associated differ between men and women, suggesting avenues for future research. Limitations of the study include the possibility of uncontrolled confounding by cigarette smoking or other factors, and the limited number of deaths due to some cancers.
The purpose of this study was to conduct an exploratory analysis of the START examining the effects of resistance exercise training (RET) and aerobic exercise training (AET) on sarcopenia, dynapenia, ...and associated quality of life (QoL) changes in breast cancer (BC) patients receiving adjuvant chemotherapy. Participants were randomized to usual care (UC) (
n
= 70), AET (
n
= 64), or RET (
n
= 66) for the duration of chemotherapy. Measures of sarcopenia skeletal muscle index (SMI) and dynapenia upper extremity (UE) and lower extremity (LE) muscle dysfunction (MD) were normalized relative to age-/sex-based clinical cut-points. QoL was assessed by the Functional Assessment of Cancer Therapy-Anemia (FACT-An) scales. At baseline, 25.5 % of BC patients were sarcopenic and 54.5 % were dynapenic with both conditions associated with poorer QoL. ANCOVAs showed significant differences favoring RET over UC for SMI (0.32 kg/m
2
;
p
= 0.017), UE-MD (0.12 kg
/
kg;
p
< 0.001), and LE-MD (0.27 kg/kg;
p
< 0.001). Chi-square analyses revealed significant effects of RET, compared to UC/AET combined, on reversing sarcopenia (
p
= 0.039) and dynapenia (
p
= 0.019). The reversal of sarcopenia was associated with clinically relevant improvements in the FACT-An (11.7 points 95 % confidence interval (CI) −4.2 to 27.6), the Trial Outcome Index-Anemia (10.0 points 95 % CI −4.0 to 24.1), and fatigue (5.3 points 95 % CI −1.5 to 12.1). Early-stage BC patients initiating adjuvant chemotherapy have higher than expected rates of sarcopenia and dynapenia which are associated with poorer QoL. RET during adjuvant chemotherapy resulted in the reversal of both sarcopenia and dynapenia; however, only the reversal of sarcopenia was associated with clinically meaningful improvements in QoL.
Patients living in many rural and remote areas do not have readily available access to ultrasound services because of a lack of sonographers and radiologists in these communities. The objective of ...this study was to determine the feasibility of using telerobotic ultrasound to establish a service delivery model to remotely provide access to diagnostic ultrasound in rural and remote communities.
Telerobotic ultrasound clinics were developed in three remote communities more than 500 km away from our academic medical center. Sonographers remotely performed all ultrasound examinations using telerobotic ultrasound systems, and examinations were subsequently interpreted by radiologists at an academic medical center. Diagnostic performance was assessed by each interpreting radiologist using a standardized reporting form. Patient experience was assessed through quantitative and qualitative analysis of survey responses. Operational challenges and solutions were identified.
Eighty-seven telerobotic ultrasound examinations were remotely performed and included in this study, with the most frequent examination types being abdominal (n = 35), first-trimester obstetrical (n = 26), and second-trimester complete obstetrical (n = 12). Across all examination types, 70% of telerobotic ultrasound examinations were sufficient for diagnosis, minimizing travel or reducing wait times for these patients. Ninety-five percent of patients would be willing to have another telerobotic ultrasound examination in the future. Operational challenges were related to technical infrastructure, human resources, and coordination between clinic sites.
Telerobotic ultrasound can provide access to diagnostic ultrasound services to underserved rural and remote communities without regular ultrasound services, thereby reducing disparities in access to care and improving health equity.
Telerobotic ultrasound technology allows radiologists and sonographers to remotely provide ultrasound services in underserved areas. This study aimed to compare costs associated with using ...telerobotic ultrasound to provide ultrasound services in rural and remote communities to costs associated with alternate models.
A cost-minimization approach was used to compare four ultrasound service delivery models: telerobotic ultrasound (Model 1), telerobotic ultrasound and an itinerant sonographer (Model 2), itinerant sonographer without telerobotic ultrasound (Model 3), and travel to another community for all exams (Model 4). In Models 1-3, travel was assumed when exams could not be successfully performed telerobotically or by an itinerant sonographer. A publicly funded healthcare payer perspective was used for the reference case and a societal perspective was used for a secondary non-reference case. Costs were based on the literature and experience using telerobotic ultrasound in Saskatchewan, Canada. Costs were expressed in 2020 Canadian dollars.
Average cost per ultrasound exam was $342, $323, $368, and $478 for Models 1, 2, 3, and 4, respectively, from a publicly funded healthcare payer perspective, and $461, $355, $447, and $849, respectively, from a societal perspective. In one-way sensitivity analyses, Model 2 was the lowest cost from a payer perspective for communities with population >2075 people, distance >350 km from the nearest ultrasound facility, or >47% of the population eligible for publicly funded medical transportation.
Health systems may wish to consider solutions such as telerobotic ultrasound and itinerant sonographers to reduce healthcare costs and improve access to ultrasound in rural and remote communities.
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