The coronavirus disease 2019 (COVID-19) pandemic required the rapid transition to telehealth with the aim of providing patients with medical access and supporting clinicians while abiding by the ...stay-at-home orders.
To assess demographic and socioeconomic factors associated with patient participation in telehealth during the COVID-19 pandemic.
This cohort study included all pediatric and adult patient encounters at the Department of Otolaryngology-Head & Neck Surgery in a tertiary care, academic, multisubspecialty, multisite practice located in an early hot spot for the COVID-19 pandemic from March 17 to May 1, 2020. Encounters included completed synchronous virtual, telephone, and in-person visits as well as visit no-shows.
Patient demographic characteristics, insurance status, and 2010 Census block level data as a proxy for socioeconomic status were extracted. Univariate and multivariate logistic regression models were created for patient-level comparisons.
Of the 1162 patients (604 females 52.0%; median age, 55 range, 0-97 years) included, 990 completed visits; of these, 437 (44.1%) completed a virtual visit. After multivariate adjustment, females (odds ratio OR, 1.71; 95% CI, 1.11-2.63) and patients with preferred provider organization insurance (OR, 2.70; 95% CI, 1.40-5.20) were more likely to complete a virtual visit compared with a telephone visit. Increasing age (OR per year, 0.98; 95% CI, 0.98-0.99) and being in the lowest median household income quartile (OR, 0.60; 95% CI, 0.42-0.86) were associated with lower odds of completing a virtual visit overall. Those patients within the second (OR, 0.53; 95% CI, 0.28-0.99) and lowest (OR, 0.33; 95% CI, 0.17-0.62) quartiles of median household income by census block and those with Medicaid, no insurance, or other public insurance (OR, 0.47; 95% CI, 0.23-0.94) were more likely to complete a telephone visit. Finally, being within the lower 2 quartiles of proportion being married (OR for third quartile, 0.49 95% CI, 0.29-0.86; OR for lowest quartile, 0.39 95% CI, 0.23-0.67) was associated with higher likelihood of a no-show visit.
These findings suggest that age, sex, median household income, insurance status, and marital status are associated with patient participation in telehealth. These findings identify vulnerable patient populations who may not engage with telehealth, yet still require medical care in a changing health care delivery landscape.
Population genetic analyses of local ancestry tracts routinely assume that the ancestral admixture process is identical for both parents of an individual, an assumption that may be invalid when ...considering recent admixture. Here, we present Parental Admixture Proportion Inference (PAPI), a Bayesian tool for inferring the admixture proportions and admixture times for each parent of a single admixed individual. PAPI analyzes unphased local ancestry tracts and has two components: a binomial model that leverages genome-wide ancestry fractions to infer parental admixture proportions and a hidden Markov model (HMM) that infers admixture times from tract lengths. Crucially, the HMM accounts for unobserved within-ancestry recombination by approximating the pedigree crossover dynamics, enabling inference of parental admixture times. In simulations, we find that PAPI’s admixture proportion estimates deviate from the truth by 0.047 on average, outperforming ANCESTOR and PedMix by 46.0% and 57.6%, respectively. Moreover, PAPI’s admixture time estimates were strongly correlated with the truth (R=0.76) but have an average downward bias of 1.01 generations that is partly attributable to inaccuracies in local ancestry inference. As an illustration of its utility, we ran PAPI on African American genotypes from the PAGE study (N = 5,786) and found strong evidence of assortative mating by ancestry proportion: couples’ ancestry proportions are highly correlated (R = 0.87) and are closer to each other than expected under random mating (p < 10−6). We anticipate that PAPI will be useful in studying the population dynamics of admixture and will also be of interest to individuals seeking to learn about their personal genealogies.
Phasing of Many Thousands of Genotyped Samples Williams, Amy L.; Patterson, Nick; Glessner, Joseph ...
American journal of human genetics,
08/2012, Letnik:
91, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Haplotypes are an important resource for a large number of applications in human genetics, but computationally inferred haplotypes are subject to switch errors that decrease their utility. The ...accuracy of computationally inferred haplotypes increases with sample size, and although ever larger genotypic data sets are being generated, the fact that existing methods require substantial computational resources limits their applicability to data sets containing tens or hundreds of thousands of samples. Here, we present HAPI-UR (haplotype inference for unrelated samples), an algorithm that is designed to handle unrelated and/or trio and duo family data, that has accuracy comparable to or greater than existing methods, and that is computationally efficient and can be applied to 100,000 samples or more. We use HAPI-UR to phase a data set with 58,207 samples and show that it achieves practical runtime and that switch errors decrease with sample size even with the use of samples from multiple ethnicities. Using a data set with 16,353 samples, we compare HAPI-UR to Beagle, MaCH, IMPUTE2, and SHAPEIT and show that HAPI-UR runs 18× faster than all methods and has a lower switch-error rate than do other methods except for Beagle; with the use of consensus phasing, running HAPI-UR three times gives a slightly lower switch-error rate than Beagle does and is more than six times faster. We demonstrate results similar to those from Beagle on another data set with a higher marker density. Lastly, we show that HAPI-UR has better runtime scaling properties than does Beagle so that for larger data sets, HAPI-UR will be practical and will have an even larger runtime advantage. HAPI-UR is available online (see Web Resources).
In the present manuscript we draw on the Multi-Threat Framework to explore gender-related math attitudes and how they put girls and women at risk for stereotype threats. Gunderson et al. (
2011
) ...detail how negative stereotypes about women’s math abilities are transmitted to girls by their parents and teachers, shaping girls’ math attitudes and ultimately undermining performance and interest in science, technology, engineering, and math (STEM) fields. The social psychological phenomenon of stereotype threat complements this approach and demonstrates the additional ways in which gender-related math attitudes undermine girls’ and women’s interest and performance in STEM domains. Considering the phenomenon of stereotype threat also identifies how stereotypes and other gender-related math attitudes can undermine women’s and girls’ interest and performance in STEM domains even when women and girls have positive math attitudes.
Simulations of close relatives and identical by descent (IBD) segments are common in genetic studies, yet most past efforts have utilized sex averaged genetic maps and ignored crossover interference, ...thus omitting features known to affect the breakpoints of IBD segments. We developed Ped-sim, a method for simulating relatives that can utilize either sex-specific or sex averaged genetic maps and also either a model of crossover interference or the traditional Poisson model for inter-crossover distances. To characterize the impact of previously ignored mechanisms, we simulated data for all four combinations of these factors. We found that modeling crossover interference decreases the standard deviation of pairwise IBD proportions by 10.4% on average in full siblings through second cousins. By contrast, sex-specific maps increase this standard deviation by 4.2% on average, and also impact the number of segments relatives share. Most notably, using sex-specific maps, the number of segments half-siblings share is bimodal; and when combined with interference modeling, the probability that sixth cousins have non-zero IBD sharing ranges from 9.0 to 13.1%, depending on the sexes of the individuals through which they are related. We present new analytical results for the distributions of IBD segments under these models and show they match results from simulations. Finally, we compared IBD sharing rates between simulated and real relatives and find that the combination of sex-specific maps and interference modeling most accurately captures IBD rates in real data. Ped-sim is open source and available from https://github.com/williamslab/ped-sim.
Objective
Postoperative pain for tonsillectomy with or without adenoidectomy or uvulopalatopharyngoplasty (UPPP) can be severe. Ketorolac is a nonsteroidal anti‐inflammatory drug that can be ...administered for analgesia in these patients. In the literature, ketorolac has been associated with an increased risk of hemorrhage after tonsillectomy with or without adenoidectomy. Many other surgical fields have successfully utilized this medicine for postoperative pain control without increased incidence of hemorrhage. The goal of this study was to analyze the effectiveness of ketorolac after tonsillectomy with or without adenoidectomy or UPPP in adults on postoperative hemorrhage rates.
Methods
Adult patients older than 18 years of age who underwent tonsillectomy with or without adenoidectomy and UPPP between 2013 and 2018 were assessed to determine hemorrhage rates. Hemorrhage rates were assessed based on patients presenting to the emergency department with complaint of hemorrhage.
Results
There was no significant difference between groups in the postoperative hemorrhage rates (P = .331) or the method of hemorrhage control.
Conclusion
Ketorolac did not increase postoperative hemorrhage rates in patients posttonsillectomy with or without adenoidectomy or UPPP.
Level of Evidence
4 Laryngoscope, 130:876–879, 2020
To report on the survival and the associations of treatments upon survival of patients with calciphylaxis seen at a single center.
Using the International Classification of Diseases, Ninth Revision ...diagnosis code of 275.49 and the keyword "calciphylaxis" in the dismissal narrative, we retrospectively identified 101 patients with calciphylaxis seen at our institution between January 1, 1999, through September 20, 2014, using a predefined, consensus-developed classification scheme.
The average age of patients was 60 years: 81 (80.2%) were women; 68 (68.0%) were obese; 19 (18.8%) had stage 0 to 2 chronic kidney disease (CKD), 19 (18.9%) had stage 3 or 4 CKD; 63 (62.4%) had stage 5 or 5D (dialysis) CKD. Seventy-five patients died during follow-up. Six-month survival was 57%. Lack of surgical debridement was associated with insignificantly lower 6-month survival (hazard ratio HR=1.99; 95% CI, 0.96-4.15; P=.07) and significantly poorer survival for the entire duration of follow-up (HR=1.98; 95% CI, 1.15-3.41; P=.01), which was most pronounced in stage 5 or 5D CKD (HR=1.91; 95% CI, 1.03-3.56; P=.04). Among patients with stage 5/5D CKD, subtotal parathyroidectomy (performed only in patients with hyperparathyroidism) was associated with better 6-month (HR=0.12; 95% CI, 0.02-0.90; P=.04) and overall survival (HR= 0.37; 95% CI, 0.15-0.87; P=.02).
Calciphylaxis is associated with a high mortality rate. Significantly effective treatments included surgical debridement and subtotal parathyroidectomy in patients with stage 5/5D CKD with hyperparathyroidism. Treatments with tissue-plasminogen activator, sodium thiosulfate, and hyperbaric oxygen therapy were not associated with higher mortality.
Clinical studies are ongoing to assess whether existing vaccines may afford protection against SARS-CoV-2 infection through trained immunity. In this exploratory study, we analyze immunization ...records from 137,037 individuals who received SARS-CoV-2 PCR tests. We find that polio, Haemophilus influenzae type-B (HIB), measles-mumps-rubella (MMR), Varicella, pneumococcal conjugate (PCV13), Geriatric Flu, and hepatitis A/hepatitis B (HepA-HepB) vaccines administered in the past 1, 2, and 5 years are associated with decreased SARS-CoV-2 infection rates, even after adjusting for geographic SARS-CoV-2 incidence and testing rates, demographics, comorbidities, and number of other vaccinations. Furthermore, age, race/ethnicity, and blood group stratified analyses reveal significantly lower SARS-CoV-2 rate among black individuals who have taken the PCV13 vaccine, with relative risk of 0.45 at the 5 year time horizon (n: 653, 95% CI (0.32, 0.64), p-value: 6.9e-05). Overall, this study identifies existing approved vaccines which can be promising candidates for pre-clinical research and Randomized Clinical Trials towards combating COVID-19.
To date, stereotype threat interventions have been considered interchangeable. Across 4 experiments, the present research demonstrates that stereotype threat interventions need to be tailored to the ...specific form of experienced stereotype threat to be effective. The Multi-Threat Framework (Shapiro & Neuberg, 2007) distinguishes between group-as-target stereotype threats-concerns that a stereotype-relevant performance will reflect poorly on the abilities of one's group-and self-as-target stereotype threats-concerns that a stereotype-relevant performance will reflect poorly on one's own abilities. The present experiments explored Black college students' performance on diagnostic intelligence tests (Experiments 1 and 3) and women's interest (Experiment 2) and performance (Experiment 4) in science, technology, engineering, and math (STEM). Across the 4 experiments, participants were randomly assigned to experience either a group-as-target or self-as-target stereotype threat. Experiments 1 and 2 revealed that role model interventions were successful at protecting only against group-as-target stereotype threats, and Experiments 3 and 4 revealed that self-affirmation interventions were successful at protecting only against self-as-target stereotype threats. The present research provides an experimental test of the Multi-Threat Framework across different negatively stereotyped groups (Black students, female students), different negatively stereotyped domains (general intelligence, STEM), and different outcomes (test performance, career interest). This research suggests that interventions should address the range of possible stereotype threats to effectively protect individuals against these threats. Through an appreciation of the distinct forms of stereotype threats and the ways in which interventions work to reduce them, this research aims to facilitate a more complete understanding of stereotype threat.
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