scholarly journals 10-Year Trends in Aortic Dissection: Mortality and Weekend Effect within the US Nationwide Emergency Department Sample (NEDS)

2021 ◽  
Vol 24 (2) ◽  
pp. E336-E344
Author(s):  
James Brown ◽  
Bushra Usmani ◽  
George Arnaoutakis ◽  
Derek Serna-Gallegos ◽  
Konstadinos Plestis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Multivariable Analysis ◽  
Patient Characteristics ◽  
The United States ◽  
Weekend Effect ◽  
Discharge Data ◽  
The Us ◽  
The Impact

Background: This study examined changes in aortic dissection (AD) mortality from 2006 to 2017 and assessed the impact of weekday versus weekend presentation upon mortality. Methods: This observational study analyzed all records in the Nationwide Emergency Department Sample (NEDS) database. NEDS aggregates discharge data from 984 hospitals in 36 states and the District of Columbia in the United States of America. All patients with thoracic and thoracoabdominal AD recorded as their principal diagnosis were identified via ICD codes. Results: Patient characteristics (weekday|weekend) count: 26,759|9,640, P = 0.016; age (years): 65.2 ± 15.8|64.7 ± 16.2, P = 0.016; women: 11,318 (42.3%)|4,086 (42.4), P = 0.883; Charlson comorbidity index: 2.3 ± 1.7|2.3 ± 1.6, P = 0.025. There were 36,399 ED visits with diagnosed AD. Annual AD diagnoses increased by 70% from 2006 to 2017. From 2012-2017, patients had lower in-hospital mortality (9.9% versus 11.9%, P < 0.001) compared with 2006-2011. Patients reporting during the weekend had higher in-hospital mortality (11.8% versus 10.4%, P < 0.001) compared with weekdays. On multivariable analysis, year of presentation remained independently associated with in-hospital mortality, with 2012-2017 being associated with reduced mortality (odds ratio (OR) 0.90, 95% CI: 0.82, 0.99, P = 0.031), as compared with 2006-2011. Weekend presentation remained independently associated with worse in-hospital mortality (OR 1.17, 95% CI: 1.05, 1.29, P = 0.003) compared with weekday presentation. Conclusion: Although AD mortality is decreasing, the patients presenting on the weekend were 13% more likely to die in the hospital compared with patients presenting during the week.

scholarly journals Reduced Mortality Associated with Acute Kidney Injury Requiring Dialysis in the United States

2016 ◽  
Vol 43 (4) ◽  
pp. 261-270 ◽  
Author(s):  
Jeremiah R. Brown ◽  
Michael E. Rezaee ◽  
William M. Hisey ◽  
Kevin C. Cox ◽  
Michael E. Matheny ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Incidence Rate ◽  
Hospital Admissions ◽  
Population Attributable Risk ◽  
Kidney Injury ◽  
The United States ◽  
Attributable Risk ◽  
Discharge Data ◽  
The Us

Background: Dialysis-requiring acute kidney injury (AKI-D) is a documented complication of hospitalization and procedures. Temporal incidence of AKI-D and related hospital mortality in the US population has not been recently characterized. We describe the epidemiology of AKI-D as well as associated in-hospital mortality in the US. Methods: Retrospective cohort of a national discharge data (n = 86,949,550) from the Healthcare Cost and Utilization Project's National Inpatient Sample, 2001-2011 of patients' hospitalization with AKI-D. Primary outcomes were AKI-D and in-hospital mortality. We determined the annual incidence rate of AKI-D in the US from 2001 to 2011. We estimated ORs for AKI-D and in-hospital mortality for each successive year compared to 2001 using multiple logistic regression models, adjusted for patient and hospital characteristics, and stratified the analyses by sex and age. We also calculated population-attributable risk of in-hospital mortality associated with AKI-D. Results: The adjusted odds of AKI-D increased by a factor of 1.03 (95% CI 1.02-1.04) each year. The number of AKI-D-related (19,886-34,195) in-hospital deaths increased almost 2-fold, although in-hospital mortality associated with AKI-D (28.0-19.7%) declined significantly from 2001 to 2011. Over the same period, the adjusted odds of mortality for AKI-D patients were 0.60 (95% CI 0.56-0.67). Population-attributable risk of mortality associated with AKI-D increased (2.1-4.2%) over the study period. Conclusions: The incidence rate of AKI-D has increased considerably in the US since 2001. However, in-hospital mortality associated with AKI-D hospital admissions has decreased significantly.

scholarly journals Evaluation of Penicillin Allergies and an Allergy Assessment Pilot in the Emergency Department

2021 ◽  
Vol 1 (S1) ◽  
pp. s39-s39
Author(s):  
Ashlyn Norris ◽  
Kalynn Northam ◽  
Lindsay Daniels ◽  
Mildred Kwan ◽  
Gary Burke ◽  
...  
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
The United States ◽  
Infectious Complications ◽  
Accurate Information ◽  
Convenience Sample ◽  
Patient Interview ◽  
The Us ◽  
Ige Mediated ◽  
The Impact

Penicillin (PCN) allergy is one of the most frequently reported medication allergies, with ~10% of the US population reporting a PCN allergy. However, studies have shown that only 1% of the US population have a true IgE-mediated reaction to PCN. Delabeling and appropriately updating patient allergy profiles could decrease the use of alternative broad-spectrum antibiotics, rates of infectious complications [C. difficile, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE)], antibiotic resistance, and overall healthcare cost. The emergency department (ED) is an important setting in which to assess PCN allergies and to delabel patients when appropriate because there are >130 million ED visits in the United States each year. We sought to determine the percentage of PCN allergy–labeled patients who could be delabeled through a PCN allergy assessment interview in an ED. Key secondary outcomes included the percentage of interviewed patients who could not be delabeled based on history alone but would be eligible for an amoxicillin oral challenge or a PCN skin test (PST). A prospective PCN allergy assessment pilot was performed for patients aged >18 years presenting to the UNC Medical Center ED between December 1 and December 17, 2020, with a documented PCN allergy. A pharmacist conducted penicillin allergy assessments on a convenience sample of patients presenting to the ED between 8 a.m. and 3 p.m. on weekdays. Based on patients’ reported and documented histories, charts were updated with the most accurate information and allergies were delabeled if appropriate. In total, 95 patients were assessed; 62 (65.3%) were interviewed and 15 (24.2%) were delabeled. In addition, 26 patients (41.9%) were deemed eligible for an oral amoxicillin challenge, 19 (30.6%) qualified for a PST, and 2 (3.2%) patients did not qualify for further assessment due to having a an IgE-mediated reaction in the past 5 years. Of the 15 patients who were delabeled, 6 (40.0%) received antibiotics during their admission: 4 (73.3%) of those patients received a penicillin and 2 (36.7%) received a cephalosporin, all without adverse reactions. Patient assessments took ~20 minutes to complete, including chart review, patient interview, and postinterview chart updating. The results from this pilot study demonstrate the impact of performing PCN allergy assessments in ED. Interdisciplinary opportunities should be explored to develop processes that will improve the efficiency and sustainability of PCN allergy assessments within the ED to allow this important stewardship intervention to continue.Funding: NoDisclosures: None

The Impact of Monetary and Fiscal Policies on the Stock Market in the United States (U.S); Evidence from Linear ARDL Framework

2020 ◽  
Vol 11 (1) ◽  
pp. 132-132
Author(s):  
Aref Emamian
Keyword(s):  
United States ◽  
Stock Market ◽  
The United States ◽  
Real Effective Exchange Rate ◽  
Annual Data ◽  
Fiscal Policies ◽  
Long Run ◽  
The Us ◽  
Short Run ◽  
The Impact

This study examines the impact of monetary and fiscal policies on the stock market in the United States (US), were used. By employing the method of Autoregressive Distributed Lags (ARDL) developed by Pesaran et al. (2001). Annual data from the Federal Reserve, World Bank, and International Monetary Fund, from 1986 to 2017 pertaining to the American economy, the results show that both policies play a significant role in the stock market. We find a significant positive effect of real Gross Domestic Product and the interest rate on the US stock market in the long run and significant negative relationship effect of Consumer Price Index (CPI) and broad money on the US stock market both in the short run and long run. On the other hand, this study only could support the significant positive impact of tax revenue and significant negative impact of real effective exchange rate on the US stock market in the short run while in the long run are insignificant. Keywords: ARDL, monetary policy, fiscal policy, stock market, United States

scholarly journals Spring Freeze Damage of Pecan Bloom: A Review

Horticulturae ◽  
2020 ◽  
Vol 6 (4) ◽  
pp. 82
Author(s):  
Amandeep Kaur ◽  
Louise Ferguson ◽  
Niels Maness ◽  
Becky Carroll ◽  
William Reid ◽  
...  
Keyword(s):  
Tree Height ◽  
The United States ◽  
Reproductive Organs ◽  
Tree Age ◽  
The Us ◽  
Nut Production ◽  
Freeze Damage ◽  
Terminal Buds ◽  
And Function ◽  
The Impact

Pecan is native to the United States. The US is the world’s largest pecan producer with an average yearly production of 250 to 300 million pounds; 80 percent of the world’s supply. Georgia, New Mexico, Texas, Arizona, Oklahoma, California, Louisiana, and Florida are the major US pecan producing states. Pecan trees frequently suffer from spring freeze at bud break and bloom as the buds are quite sensitive to freeze damage. This leads to poor flower and nut production. This review focuses on the impact of spring freeze during bud differentiation and flower development. Spring freeze kills the primary terminal buds, the pecan tree has a second chance for growth and flowering through secondary buds. Unfortunately, secondary buds have less bloom potential than primary buds and nut yield is reduced. Spring freeze damage depends on severity of the freeze, bud growth stage, cultivar type and tree age, tree height and tree vigor. This review discusses the impact of temperature on structure and function of male and female reproductive organs. It also summarizes carbohydrate relations as another factor that may play an important role in spring growth and transition of primary and secondary buds to flowers.

scholarly journals Mining Google and Apple mobility data: temporal anatomy for COVID-19 social distancing

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Corentin Cot ◽  
Giacomo Cacciapaglia ◽  
Francesco Sannino
Keyword(s):  
Infection Rate ◽  
The United States ◽  
Strong Decrease ◽  
Social Distancing ◽  
Mobility Data ◽  
Actual Measure ◽  
The Us ◽  
The Impact ◽  
Political Decisions ◽  
Mobility Reduction

AbstractWe employ the Google and Apple mobility data to identify, quantify and classify different degrees of social distancing and characterise their imprint on the first wave of the COVID-19 pandemic in Europe and in the United States. We identify the period of enacted social distancing via Google and Apple data, independently from the political decisions. Our analysis allows us to classify different shades of social distancing measures for the first wave of the pandemic. We observe a strong decrease in the infection rate occurring two to five weeks after the onset of mobility reduction. A universal time scale emerges, after which social distancing shows its impact. We further provide an actual measure of the impact of social distancing for each region, showing that the effect amounts to a reduction by 20–40% in the infection rate in Europe and 30–70% in the US.

scholarly journals 910. A Comprehensive, One Year, Hospital-Wide Snapshot of All Serious Infectious Complications in People Who Inject Drugs

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S489-S490
Author(s):  
John T Henderson ◽  
Evelyn Villacorta Cari ◽  
Nicole Leedy ◽  
Alice Thornton ◽  
Donna R Burgess ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Vertebral Osteomyelitis ◽  
The United States ◽  
Infectious Complications ◽  
Data Set ◽  
Cumulative Impact ◽  
Mortality And Morbidity ◽  
Icu Admission ◽  
Risk Of Death ◽  
The Impact

Abstract Background There has been a dramatic rise in IV drug use (IVDU) and its associated mortality and morbidity, however, the scope of this effect has not been described. Kentucky is at the epicenter of this epidemic and is an ideal place to better understand the health complications of IVDU in order to improve outcomes. Methods All adult in-patient admissions to University of Kentucky hospitals in 2018 with an Infectious Diseases (ID) consult and an ICD 9/10 code associated with IVDU underwent thorough retrospective chart review. Demographic, descriptive, and outcome data were collected and analyzed by standard statistical analysis. Results 390 patients (467 visits) met study criteria. The top illicit substances used were methamphetamine (37.2%), heroin (38.2%), and cocaine (10.3%). While only 4.1% of tested patients were HIV+, 74.2% were HCV antibody positive. Endocarditis (41.1%), vertebral osteomyelitis (20.8%), bacteremia without endocarditis (14.1%), abscess (12.4%), and septic arthritis (10.4%) were the most common infectious complications. The in-patient death rate was 3.0%, and 32.2% of patients were readmitted within the study period. The average length of stay was 26 days. In multivariable analysis, infectious endocarditis was associated with a statistically significant increase in risk of death, ICU admission, and hospital readmission. Although not statistically significant, trends toward mortality and ICU admission were identified for patients with prior endocarditis and methadone was correlated with decreased risk of readmission and ICU stay. FIGURE 1: Reported Substances Used FIGURE 2: Comorbidities FIGURE 3: Types of Severe Infectious Complications Conclusion We report on a novel, comprehensive perspective on the serious infectious complications of IVDU in an attempt to measure its cumulative impact in an unbiased way. This preliminary analysis of a much larger dataset (2008-2019) reveals some sobering statistics about the impact of IVDU in the United States. While it confirms the well accepted mortality and morbidity associated with infective endocarditis and bacteremia, there is a significant unrecognized impact of other infectious etiologies. Additional analysis of this data set will be aimed at identifying key predictive factors in poor outcomes in hopes of mitigating them. Disclosures All Authors: No reported disclosures

GPTs and growth: evidence on the technological adoption of electrical and electronic technologies in the 1920s

2020 ◽  
Author(s):  
Sergio Petralia
Keyword(s):  
The United States ◽  
General Purpose ◽  
Geographical Information ◽  
General Purpose Technologies ◽  
Technological Adoption ◽  
Transformative Potential ◽  
The Us ◽  
The Impact ◽  
Electronic Technologies ◽  
Patenting Activity

Abstract The pervasive diffusion of electricity-related technologies at the beginning of the twentieth century has been studied extensively to understand the transformative potential of general purpose technologies (GPTs). Most of what we know, however, has been investigated in relation to the diffusion of their use. This article provides evidence on the county-level economic impact of the technological adoption of electrical and electronic (E&E) technologies in the 1920s in the United States (US). It focuses on measuring the impact of a GPT on technological adopters, i.e., those who are able to develop, transform, and complement it. It is shown that places with patenting activity in E&E technologies grew faster and paid higher wages than others between 1920 and 1930. This analysis required constructing a novel database identifying detailed geographical information for historical patent documents in the US since 1836, as well as developing a text-mining algorithm to identify E&E patents based on patent descriptions.

Abstract 123: A Comparison of In-Hospital Acute Myocardial Infarction Management Between Portugal and the United States: 2000 - 2010

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Mariana F Lobo ◽  
Vanessa Azzone ◽  
Luis Azevedo ◽  
Armando Teixeira-Pinto ◽  
Jose Pereira Miguel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
The United States ◽  
Billing Data ◽  
Cross Sectional ◽  
Medical Technologies ◽  
Hospitalization Rates ◽  
The Us ◽  
International Comparative

Objectives: Because inter- and intra-country variations in the adoption of medical technologies exist, international comparative studies provide an opportunity to infer technology effectiveness. Few studies have characterized recent trends in acute myocardial infarction (AMI) management between countries. Methods: Repeated cross-sectional observational cohorts of hospitalized adults aged ≥20 years discharged between January 2000 and December 2010. We identified new AMI hospitalizations using a US national 20% inpatient sample and a 100% inpatient sample in all Portuguese public sector hospitals. Age, sex, comorbidities, and median length of stay (interquartile range [IQR]) were determined. Annual age-sex adjusted hospitalization rates (HR) for AMI, in-hospital procedures, and in-hospital mortality were directly standardized to the 2010 US population. Intra-country (2010 relative to 2000) and inter-country in 2010 (Portugal [PT] relative to US) rate ratios [RR] were estimated. Findings: We identified 1476808 AMI US hospitalizations and 126314 Portugal hospitalizations between 2000 and 2010. Portuguese patients were more male, younger, and had fewer comorbidities compared to US patients (Table). The age-sex adjusted AMI HR decreased from 21 per 1000 person-years to 15 in the US (RR=0.70; 95% CI = [0.70, 0.71]) but increased in PT (14 to 15 per 1000, RR = 1.17 [1.14, 1.21]). While crude procedure rates were uniformly lower in PT, only CABG rates differed after standardization (2010: RR=0.19 [0.14, 0.26]). PCI use increased annually in both countries and decreased for CABG in the US only (102 to 79, RR=0.77 [0.73, 0.81]). Standardized in-hospital mortality decreased within-country (US: 44 to 29 per 1000, RR= 0.65 [0.60, 0.72]; PT: 93 to 62 per 1000, RR= 0.67 [0.44, 1.00]). In 2010, PT mortality was twice that in the US. Conclusions: AMI hospitalization rates and use of medical technologies are higher in the US compared to Portugal. However, standardized rates reveal only CABG surgery rates differ significantly between the two countries. Outcomes, measured by hospital mortality and LOS, are generally better in the U.S. Inter-country disparities may be a consequence of differential use of technologies, differences in AMI epidemiology, patient risk, or quality of hospital billing data.

Utilization and patient characteristics for the trastuzumab originator, biosimilars, and other HER2 inhibitors in the United States.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 308-308
Author(s):  
Young Hee Nam ◽  
Aaron Mendelsohn ◽  
James Marshall ◽  
Nancy Lin ◽  
Jeffrey Brown ◽  
...  
Keyword(s):  
Endocrine Therapy ◽  
Metastatic Breast ◽  
Patient Characteristics ◽  
The United States ◽  
Baseline Period ◽  
Research Network ◽  
Health Plans ◽  
Clinical Practices ◽  
Full Data ◽  
The Us

308 Background: Biosimilars for trastuzumab, a HER2 inhibitor (HER2I), have been available for use in the US since in 2019, yet information on their utilization and patient characteristics is limited. We assessed utilization and patient characteristics for the trastuzumab originator, biosimilars, and other HER2Is in the US. Methods: We analyzed healthcare claims for 10/1/2016-up to 2/29/2020 (end date varied across health plans) from the Biologics and Biosimilars Collective Intelligence Consortium’s Distributed Research Network ( > 95 million persons) using the FDA’s Sentinel distributed analysis tools. We conducted descriptive analyses on the number of incident users and patients’ characteristics for each HER2I. Adults continuously enrolled in their health plan with medical and drug coverage ≥365 days (baseline period) prior to their incident HER2I use were eligible for analysis. Results: Of the incident users (incident to any HER2Is), we identified 6,631 originator trastuzumab users, 122 trastuzumab-anns, 116 ado-trastuzumab emtansine, 54 neratinib, and 54 lapatinib users. Trastuzumab-dkst and trastuzumab/hyaluronidase-oysk had < 11 users each. Mean age was the highest for trastuzumab/hyaluronidase-oysk (73.7 years; SD, 18.6) and similar between the trastuzumab originator and biosimilars (52.5-59.0). The number of incident users/100,000 person-years decreased for the trastuzumab originator from 13.5 in 2016 to 9.4 in 2020 and increased for trastuzumab-anns from 0.4 in 2019 to 4.9 in 2020. Of the baseline clinical characteristics examined, Charlson/Elixhauser comorbidity score was the highest for lapatinib (2.0), lowest for trastuzumab-dkst and neratinib (0.5), and similar between the trastuzumab originator (1.1) and trastuzumab-anns (1.3). The proportion of patients who received any chemotherapy during the baseline period was 38.9% for lapatinib, 18.5% for the trastuzumab originator, and 14.8% for trastuzumab-anns. The proportion of endocrine therapy users was the highest for neratinib (63.0%) and similar between the trastuzumab originator (11.1%) and trastuzumab-anns (10.7%). Among incident users with metastatic breast cancer, endocrine therapy receivers during the baseline period accounted for 19.3% for the trastuzumab originator and 69.6% for lapatinib. Conclusions: Though full data were not available for 2019-2020 for all health plans, these preliminary findings suggest that utilization of biosimilar trastuzumab-anns increased whereas the trastuzumab originator use decreased over time and that there is a variation in patient characteristics between HER2Is and by metastatic status while the characteristics were generally similar between the trastuzumab originator and trastuzumab-anns. We plan to conduct ongoing assessment of HER2I utilization as more data become available to help inform clinical practices and health policies.

scholarly journals The Impact of the US Financial Crisis on How Students Pay for College

2015 ◽  
Author(s):  
Arthur M. Hauptman
Keyword(s):  
The United States ◽  
Public Institutions ◽  
Federal Financial Aid ◽  
For Profit ◽  
American Students ◽  
The Us ◽  
Home Values ◽  
The Impact ◽  
Private Loan ◽  
Us Financial Crisis

The 2008 failure of major financial institutions in the United States may have dramatic ramifications on American students and whether/where they attend college. Several sources of funding may be at risk, including potential decreases in federal financial aid, the tightening of private loan availability, lowered home values impinging on equity-based lending, and stock market losses in college-fund savings. Public institutions, whose tuition is much lower than private or for-profit institutions, may see an increase in enrollment.

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