scholarly journals Projected long-term impact of the COVID-19 pandemic on hepatitis C outcomes in the United States: a modelling study

2021 ◽  
Author(s):  
Joshua A Barocas ◽  
Alexandra Savinkina ◽  
Sara Lodi ◽  
Rachel L Epstein ◽  
Tara C Bouton ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Linkage To Care ◽  
The United States ◽  
Virologic Response ◽  
Case Scenario ◽  
Scenario Analyses ◽  
The U.S

Abstract Background The COVID-19 pandemic disrupted access to and uptake of hepatitis C (HCV) care services in the U.S. It is unknown how substantially the pandemic will impact long-term HCV-related outcomes. Methods We used a microsimulation to estimate the 10-year impact of COVID-19 disruptions in healthcare delivery on HCV outcomes including identified infections, linkage to care, treatment initiation and completion, cirrhosis, and liver-related death. We modeled hypothetical scenarios consisting of an 18-month pandemic-related disruption in HCV care starting in March 2020 followed by varying returns to pre-pandemic rates of screening, linkage, and treatment through March 2030 and compared them to a counterfactual scenario in which there was no COVID-19 pandemic or disruptions in care. We also performed alternate scenario analyses in which the pandemic disruption lasted for 12- and 24-months. Results Compared to the ‘no pandemic’ scenario, in the scenario in which there is no return to pre-pandemic levels of HCV care delivery, we estimate 1,060 fewer identified cases, 21 additional cases of cirrhosis, and 16 additional liver-related deaths per 100,000 people. Only 3% of identified cases initiate treatment and <1% achieve sustained virologic response (SVR). Compared to ‘no pandemic’, the best-case scenario in which an 18-month care disruption is followed by a return to pre-pandemic levels, we estimated a smaller proportion of infections identified and achieving SVR. Conclusions A recommitment to the HCV epidemic in the U.S. that involves additional resources coupled with aggressive efforts to screen, link, and treat people with HCV is needed to overcome the COVID-19-related disruptions.

THE INFLUENCE OF SCOTTISH ACCOUNTANTS IN THE UNITED STATES: THE EARLY CASE OF THE SOCIETY OF ACCOUNTANTS IN EDINBURGH

1997 ◽  
Vol 24 (1) ◽  
pp. 117-141 ◽  
Author(s):  
T. A. LEE
Keyword(s):  
United States ◽  
General Theory ◽  
Research Program ◽  
The United States ◽  
The World ◽  
Early Case ◽  
The Impact ◽  
Chartered Accountants ◽  
The U.S

This study represents part of a long-term research program to investigate the influence of U.K. accountants on the development of professional accountancy in other parts of the world. It examines the impact of a small group of Scottish chartered accountants who emigrated to the U.S. in the late 1800s and early 1900s. Set against a general theory of emigration, the study's main results reveal the significant involvement of this group in the founding and development of U.S. accountancy. The influence is predominantly with respect to public accountancy and its main institutional organizations. Several of the individuals achieved considerable eminence in U.S. public accountancy.

scholarly journals How Family Physicians Practice the Principle of Remission Along the Glycemic Continuum

2020 ◽  
Vol 11 ◽  
pp. 215013272097774
Author(s):  
Stephanie T. Fulleborn ◽  
Paul F. Crawford ◽  
Jeremy T. Jackson ◽  
Christy J.W. Ledford
Keyword(s):  
Type 2 Diabetes ◽  
Medical Record ◽  
The United States ◽  
Case Scenario ◽  
Cross Sectional ◽  
Normal Glucose ◽  
Normal Glucose Regulation

Introduction Recent evidence reveals that diabetes and prediabetes (preDM) can be reversed to normal glucose regulation (NGR) through significant weight loss, but how physicians clinically identify the principles of partial and complete remission of diabetes is largely unknown. Methods As part of the cross-sectional omnibus survey conducted in March 2019 at a professional annual meeting in the United States, physician participants answered case scenario questions about the diagnosis and documentation of patients with preDM and type 2 diabetes (T2DM). Results Of the registered conference attendees, 387 (72.7%) responded. When presented with the initial case of preDM, 201 physicians (70.8%) selected R73.03 Prediabetes. In a follow-up encounter with improved lab results, 118 physicians (58.7%) indicated that they would not chart any diabetes-related code and 62 (30.8%) would chart preDM again. When presented with the case of T2DM, 256 physicians (90.1%) indicated E11.0–E11.9 Type 2 Diabetes. In the follow-up encounter, only 38 (14.8%) coded a diagnosis reflecting remission from T2DM to prediabetes and 211 (82.4%) charted T2DM. Conclusion Physicians may be reluctant to document diabetes regression as there is little evidence for long-term outcomes and “downgrading” the diagnosis in the medical record may cause screenings to be missed. Documenting this regression in the medical record should communicate the accurate point on the continuum of glucose intolerance with both the patient and the care team.

scholarly journals Hepatitis C virus-associated cryoglobulinemic vasculitis: A 20-year experience with treatment

2017 ◽  
Vol 89 (5) ◽  
pp. 46-52 ◽  
Author(s):  
T M Ignatova ◽  
L V Kozlovskaya ◽  
N B Gordovskaya ◽  
O A Chernova ◽  
S Yu Milovanova ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Combined Therapy ◽  
Multivariate Logistic Regression Analysis ◽  
Virologic Response ◽  
Term Treatment ◽  
Cryoglobulinemic Vasculitis ◽  
Multidisciplinary Therapy ◽  
Long Term Treatment

Aim. To summarize the experience of a multidisciplinary therapy hospital in treating patients with hepatitis C virus (HCV)-associated cryoglobulinemic vasculitis (CV). Subjects and methods. Seventy-two patients (mean age, 49.4±10.3 years) with HCV-associated CV were examined and followed up for an average period of 2.8±3.6 years. The efficiency of traditional (corticosteroids ± cyclophosphamide) and selective (rituximab) immunosuppressive therapy (IST) was estimated in 31 and 15 observations, respectively, and that of antiviral therapy (AVT) in 25. Vasculitis activity was assessed using the Birmingham vasculitis activity score (BVAS). The patients’ survival was studied; multivariate logistic regression analysis was carried out. Results. 24 (33.4%) of the 72 patients had a stage of liver cirrhosis (LC). The pretreatment mean BVAS was 11.9±7.2 (range 2 to 36). Severe CV (BVAS ≥15) was present in 30.6% of the patients. AVT was accompanied by achievement of sustained virologic response in 48% of the patients, clinical remission in 68% and had an advantage over IST in relation to long-term treatment results. Rituximab was significantly more effective than traditional immunosuppressants (remission rates of 73 and 13%, respectively). Combined therapy (rituximab and AVT) was most effective in patients with severe forms of vasculitis. Sixteen patients died from complications of vasculitis (37.5%), infection (37.5%), and LC (25%). The factors adversely affecting prognosis were age >55 years (odds ratio (OR), 4.49), the presence of LC (OR, 3.68), renal failure (OR, 4.66) and the use of glucocorticosteroids (OR, 3.91). Conclusion. HCV-associated CV can determine the prognosis of chronic HСV infection. AVT is the treatment of choice in all patients with HСV-associated CV. AVT must be combined with rituximab therapy in patients with severe forms of vasculitis.

scholarly journals Sample-Selection Biases and the Industrialization Puzzle

2017 ◽  
Vol 77 (1) ◽  
pp. 171-207 ◽  
Author(s):  
Howard Bodenhorn ◽  
Timothy W. Guinnane ◽  
Thomas A. Mroz
Keyword(s):  
United States ◽  
Selection Bias ◽  
Meta Analysis ◽  
Sample Selection ◽  
Well Being ◽  
The United States ◽  
Compelling Evidence ◽  
Long Term Changes ◽  
The U.S

Understanding long-term changes in human well-being is central to understanding the consequences of economic development. An extensive anthropometric literature purports to show that heights in the United States declined between the 1830s and the 1890s, which is when the U.S. economy modernized. Most anthropometric research contends that declining heights reflect the negative health consequences of industrialization and urbanization. This interpretation, however, relies on sources subject to selection bias. Our meta-analysis shows that the declining height during industrialization emerges primarily in selected samples. We also develop a parsimonious diagnostic test that reveals, but does not correct for, selection bias in height samples. When applied to four representative height samples, the diagnostic provides compelling evidence of selection.

Youth Negotiate Deportation

2019 ◽  
pp. 135-146
Author(s):  
Lauren Heidbrink
Keyword(s):  
United States ◽  
Young People ◽  
The United States ◽  
Children And Youth ◽  
Ethnographic Research ◽  
Institutional Practices ◽  
Unaccompanied Children ◽  
Forced Return ◽  
The U.S

This chapter chronicles how young people experience deportation from the United States to Guatemala. It examines the policies and institutional practices that govern the removal of unaccompanied children and trace the ways in which young people and their families understand and navigate these policies and practices. Through multi-sited ethnographic research in the United States and Guatemala, the chapter reveals the various impacts of the forced “repatriation” of children, exacerbating the very conditions that spurred their migration and causing new interrelated uncertainties and related risks as “deportees.” As they are physically expelled from the United States, deported young people move out of U.S. legal systems. The effects of a forced “return” to their nations of origin produce new challenges such as feelings of isolation and vulnerability as well as danger, such that, in many ways, they continue to be in and moving through regimes of illegality. Demonstrating the long-term and geographically distant effects of the U.S. government’s deportation of children and youth, the chapter outlines the confining character of being out of a system, especially if once in it.

Overview of the U.S. Department of Energy Advanced Waste Forms Development

2018 ◽  
Author(s):  
Kimberly Gray ◽  
John Vienna ◽  
Patricia Paviet
Keyword(s):  
Nuclear Fuel ◽  
Fuel Cycle ◽  
Nuclear Fuel Cycle ◽  
The United States ◽  
Department Of Energy ◽  
High Level Waste ◽  
Fuel Cycles ◽  
Waste Forms ◽  
The U.S

In order to maintain the U.S. domestic nuclear capability, its scientific technical leadership, and to keep our options open for closing the nuclear fuel cycle, the Department of Energy, Office of Nuclear Energy (DOE-NE) invests in various R&D programs to identify and resolve technical challenges related to the sustainability of the nuclear fuel cycle. Sustainable fuel cycles are those that improve uranium resource utilization, maximize energy generation, minimize waste generation, improve safety and limit proliferation risk. DOE-NE chartered a Study on the evaluation and screening of nuclear fuel cycle options, to provide information about the potential benefits and challenges of nuclear fuel cycle options and to identify a relatively small number of promising fuel cycle options with the potential for achieving substantial improvements compared to the current nuclear fuel cycle in the United States. The identification of these promising fuel cycles helps in focusing and strengthening the U.S. R&D investment needed to support the set of promising fuel cycle system options and nuclear material management approaches. DOE-NE is developing and evaluating advanced technologies for the immobilization of waste issued from aqueous and electrochemical recycling activities including off-gas treatment and advanced fuel fabrication. The long-term scope of waste form development and performance activities includes not only the development, demonstration, and technical maturation of advanced waste management concepts but also the development and parameterization of defensible models to predict the long-term performance of waste forms in geologic disposal. Along with the finding of the Evaluation and Screening Study will be presented the major research efforts that are underway for the development and demonstration of waste forms and processes including glass ceramic for high-level waste raffinate, alloy waste forms and glass ceramics composites for HLW from the electrochemical processing of fast reactor fuels, and high durability waste forms for radioiodine.

Characterizing healthcare delivery in the United States using Census Bureau’s County Business Patterns (2000–2016)

2020 ◽  
Vol 41 (6) ◽  
pp. 723-728
Author(s):  
Astha KC ◽  
Melissa K. Schaefer ◽  
Nimalie D. Stone ◽  
Joseph Perz
Keyword(s):  
Long Term Care ◽  
Healthcare Delivery ◽  
The United States ◽  
Healthcare Sector ◽  
Nursing Facilities ◽  
Term Care ◽  
The North ◽  
The Us ◽  
Care Facilities

AbstractBackground:The US Census Bureau’s County Business Patterns (CBP) series provides a unique opportunity to describe the healthcare sector using a single, national data source.Methods:We analyzed CBP data on business establishments in the healthcare industry for 2000–2016 for all 50 states and the District of Columbia. Setting and facility types were defined using the North American Industry Classification System.Results:In 2016, CBP enumerated 707,634 US healthcare establishments (a 34% increase from 2000); 86.5% were outpatient facilities and services followed by long-term care facilities (12.5%) and acute-care facilities (1.0%). Between 2000 and 2016, traditional facilities such as general medical surgical and surgical hospitals (−0.4%) and skilled nursing facilities (+0.1%) decreased or remained flat, while other long-term care and outpatient providers grew rapidly.Conclusion:This analysis highlights the steady growth and increased specialization of the US healthcare sector, particularly in long-term care and outpatient settings.

Financial toxicity in thyroid cancer: An analysis from the North American Thyroid Cancer Survivorship study.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 17-17 ◽  
Author(s):  
Jonas A. De Souza ◽  
Raymon Grogan ◽  
Brisa Aschebrook-Kilfoy
Keyword(s):  
Thyroid Cancer ◽  
Cancer Survivorship ◽  
North American ◽  
Multivariate Analyses ◽  
Healthcare Delivery ◽  
The United States ◽  
Financial Toxicity ◽  
The North ◽  
The U.S ◽  
Out Of Pocket Costs

17 Background: Financial toxicity (FTox) has been associated with worse health-related quality-of-life (HRQoL), compliance, and even survival in cancer patients (pts). Measuring FTox and understanding its predictors are of paramount importance when planning intervention strategies, the value of care, and healthcare policies. We report FTox and its predictors in a large cohort of thyroid cancer pts and survivors. Methods: Pts with thyroid cancer were surveyed in the North American Thyroid Cancer Survivorship Study. FTox was assessed by the previously validated COmprehensive Score for financial Toxicity (COST), as well as by questions related to financial distress (out-of-pocket costs, loss of income and bankruptcy). Data on sociodemographics, income, type of disease, length of diagnosis (LOD), and prior therapies were collected. Predictors of FTox were assessed in multivariate analyses, controlling for potential confounders, such as HRQoL (as measured by the thyroid cancer-specific City of Hope instrument), type of treatment received, and LOD. Results: 591 pts with thyroid cancer within the past 6 years were surveyed in 2 countries: 553 (93.5%) in the United States (U.S.), and 38 (6.5%) in Canada. Most were women (n = 518 pts, 88%). The median LOD was 857 days (range 105-2176 days), and 430 pts (72.8%) had papillary thyroid cancer. There were 61 pts (10.3%) with Stage IV, and 11 (1.9%) were on tyrosine kinase inhibitors. Overall, 234 pts (39.5%) stated that their out-of-pocket costs were higher than previously thought; 207 pts (35%) felt their disease resulted in loss of income; 44 pts (7.4%) were unable to meet their monthly expenses; and 7 pts (1.2%) declared bankruptcy after diagnosis. The median COST value was 24 (range 0-44). In multivariate analyses, the independent predictors of worse FTox were lower income (p < 0.001), female gender (p = 0.01), lower educational level (p = 0.002), healthcare delivery in the U.S., (p = 0.002), and worse HRQoL (p < 0.001). Conclusions: A significant proportion of thyroid cancer pts experience FTox. We identified pts characteristics (gender, education, income), as well as geographical differences (healthcare delivery in the U.S.) as predictors of FTox.

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