Search

Performances and performative instantiations respond to the urgencies of "pressure" and its effects. What is the work of performance when wrung by such pressures as financial constraint, racial subordination, misogyny, and sexism? [ABSTRACT FROM AUTHOR]

Postpartum pain is common, yet patient experiences and clinical management varies greatly. In the United States, pain-related expectations and principles of adequate pain management have been framed within established norms of Western clinical medicine and a biomedical understanding of disease processes. Unfortunately, this positioning of postpartum pain and the corresponding coping strategies and pain treatments is situated within cultural biases and systemic racism. This paper summarizes the history and existing literature that examines racial inequities in pain management to propose guiding themes and suggestions for innovation. This work is critical for advancing ethical practice and establishing more effective care for all patients. [ABSTRACT FROM AUTHOR]

The article argues that the New York Police Department's (NYPD) gang database violates the Equal Protection Clause of the 14th Amendment to the U.S. Constitution. Topics discussed include the legal case Floyd v. City of New York, the history of stop and frisk in New York City, and the gang database's disparate racial impact and the historical background of racial profiling in the NYPD.

Introduction: Management of patients with suspected heparin‐induced thrombocytopenia (HIT) can lead to significant costs. Reported cost‐saving initiatives have focused on minimizing inappropriate testing in low‐risk patients and optimizing alternative anticoagulant selection. We sought to further investigate how utilizing various HIT laboratory testing models would impact total cost of testing and alternative anticoagulant use. Methods: Utilizing a retrospective cohort of adult patients tested for HIT over three years within our institution, we evaluated how utilization of four distinct laboratory models impacted total number of HIT test combinations completed, time to HIT testing finalization, percentage of patients discharged from the hospital prior to HIT testing finalization, total alternative anticoagulant days, and total anticipated major bleed events. Additionally, we calculated cost of laboratory testing and alternative anticoagulant associated with each model. Results: A total of 482 patients were included in our cohort. A laboratory testing model that utilized an in‐house platelet factor 4 (PF4)‐heparin enzyme‐linked immunosorbent assay (ELISA) completed three days weekly, and reflex serotonin release assay (SRA) with a five‐day turnaround resulted in the shortest mean time to HIT testing finalization, lowest percentage of patients discharged prior to HIT testing finalization, and lowest total alternative anticoagulant days. Conclusions: Institutions should evaluate current HIT laboratory testing practices and assess for opportunities for optimization. Testing models utilizing a PF4‐heparin antibody ELISA with a reflex SRA for positive results may improve testing metrics and lead to lower utilization of alternative anticoagulants. [ABSTRACT FROM AUTHOR]

The article argues that the New York Police Department's (NYPD) gang database violates the Equal Protection Clause of the 14th Amendment to the U.S. Constitution. Topics discussed include the legal case Floyd v. City of New York, the history of stop and frisk in New York City, and the gang database's disparate racial impact and the historical background of racial profiling in the NYPD.

The public and nonprofit sectors generally pay less than the private sector, and individuals are willing to forgo higher salaries in exchange for greater intrinsic satisfaction derived from making a contribution to society. However, personal financial considerations, such as education debt, may discourage individuals from pursuing careers in lower paying sectors even if they are predisposed to public service motivation (PSM). We surveyed a sample of graduating students to investigate if (a) education debt discourages students from pursuing lower paying public or nonprofit careers and (b) whether PSM overrides the considerations students might make about entering lower paying sectors as their education debt rises. First, we find that education debt has a marginal effect on initially selecting private over public and nonprofit careers. Rising education debt may discourage students from public sector careers after controlling for PSM. We also find that rising education debt may discourage students from nonprofit careers even with high levels of PSM. The present study enhances our understanding of how financial considerations, in the form of education debt, may influence a student's initial choice in pursuing public, private, and nonprofit careers. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether the frequency of pain assessment and treatment differed by patient race and ethnicity for women after cesarean birth.Methods: We performed a retrospective cohort study of all women who underwent cesarean birth resulting in a liveborn neonate at a single institution between July 1, 2014, and June 30, 2016. Pain scores documented and medications administered after delivery were grouped into 0-24 and 25-48 hours postpartum time periods. Number of pain scores recorded, whether any pain score was 7 of 10 or greater, and analgesic medication administered were calculated. Models were adjusted for propensity scores incorporating maternal age, body mass index, gestational age, nulliparity, primary compared with repeat cesarean delivery, classical hysterotomy, and admission to the neonatal intensive care unit.Results: A total of 1,987 women were identified, and 1,701 met inclusion criteria. There were 30,984 pain scores documented. Severe pain (7/10 or greater) was more common among black (28%) and Hispanic (22%) women than among women who identified as white (20%) or Asian (15%). In the first 24 hours after cesarean birth, non-Hispanic white women had more documented pain assessments (adjusted mean 10.2) than, black, Asian, and Hispanic women (adjusted mean 8.4-9.5; P<.05). Results at 25-48 hours were similar, compared with non-Hispanic white women (adjusted mean 8.3). Black, Asian, and Hispanic women and women who were identified as other all received less narcotic medication at 0-24 hours postpartum (adjusted mean 5.1-7.5 oxycodone tablet equivalents; P<.001-.05), as well as at 25-28 hours postpartum.Conclusion: Racial and ethnic inequities in the experience, assessment and treatment of postpartum pain were identified. A limitation of our study is that we were unable to assess the role of patient beliefs about expression of pain, patient preferences with regards to pain medication, and beliefs and potential biases among health care providers. [ABSTRACT FROM AUTHOR]

The article analyzes how "BLACK GIRL: Linguistic Play (BGLP)," a full-length dance work by Camille A. Brown and Dancers (CABD) company, illustrates the world of African American womanhood through movement, soundscape and performance. Topics covered include Clark Hine's dissemblance theory and the politics of tenderness, softness and expanse of BGLP and how BGLP theorize African American womanhood in non-verbal performance.

We examine the relevance of suggestive findings and assumptions about immigrant philanthropy to a diaspora from a high-income country of origin, whose members are generally highly educated and professionally employed: the Lithuanian diaspora. We investigate whether this immigrant group's voluntary sector participation, despite these differences, may evolve similar to that of other immigrant groups studied. The study casts doubt on the generalizability of the current claims from the literature—which is largely derived from cases of immigrants migrating from the South to the North—to immigrant and diaspora groups who are highly skilled and originating from relatively more industrialized countries (North–North migration). The findings highlight the need to examine the voluntary sector participation of a greater variety of diasporas and to recognize that not all groups will behave similarly. Some of the differentiated behavior may stem from demographic characteristics specific to North–North migration. [ABSTRACT FROM AUTHOR]

The article discusses the continued safety and preservation of the health care workforce has vital for the ongoing coronavirus disease 2019 pandemic. Topics include the Society for Maternal-Fetal Medicine administered a national survey to designated state liaisons regarding generalized testing and access; and the survey has distributed electronically to 315 state liaisons.

OBJECTIVE: To examine whether exposure to community or neighborhood socioeconomic disadvantage as measured by the ADI (Area Deprivation Index) is associated with risk of abnormal birth weight among nulliparous individuals with singleton gestations. METHODS: This was a secondary analysis from the prospective cohort NuMoM2b study (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be). Participant addresses at cohort enrollment between 6 and 13 weeks of gestation were geocoded at the Census tract level and linked to the 2015 ADI. The ADI, which incorporates the domains of income, education, employment, and housing quality into a composite national ranking of neighborhood socioeconomic disadvantage, was categorized by quartiles (quartile 1, least disadvantaged, reference; quartile 4, most disadvantaged). Outcomes were large for gestational age (LGA; birth weight at or above the 90th percentile) and small for gestational age (SGA; birth weight below the 10th percentile) compared with appropriate for gestational age (AGA; birth weight 10th-90th percentile) as determined with the 2017 U.S. natality reference data, standardized for fetal sex. Multinomial logistic regression models were adjusted for potential confounding variables. RESULTS: Of 8,983 assessed deliveries in the analytic population, 12.7% (n51,143) were SGA, 8.2% (n5738) were LGA, and 79.1% (n57,102) were AGA. Pregnant individuals living in the highest ADI quartile (quartile 4, 17.8%) had an increased odds of delivering an SGA neonate compared with those in the lowest referent quartile (quartile 1, 12.4%) (adjusted odds ratio [aOR] 1.32, 95% CI 1.09-1.55). Pregnant individuals living in higher ADI quartiles (quartile 2, 10.3%; quartile 3, 10.7%; quartile 4, 9.2%) had an increased odds of delivering an LGA neonate compared with those in the lowest referent quartile (quartile 1, 8.2%) (aOR: quartile 2, 1.40, 95% CI 1.19-1.61; quartile 3, 1.35, 95% CI 1.09-1.61; quartile 4, 1.47, 95% CI 1.20-1.74). CONCLUSION: Neonates of nulliparous pregnant individuals living in U.S. neighborhoods with higher area deprivation were more likely to have abnormal birth weights at both extremes. [ABSTRACT FROM AUTHOR]

• Inorganic arsenic was measureable in all amniotic fluid specimens. • This suggest ubiquitous maternal, and thus fetal, exposure. • This expands our scope of knowledge in environmental contaminants in amniotic fluid. [ABSTRACT FROM AUTHOR]

Introduction: People of color and low-income and uninsured populations in the United States have elevated risks of adverse maternal health outcomes alongside low levels of postpartum visit attendance. The postpartum period is a critical window for delivering health care services to reduce health inequities and their transgenerational effects. Evidence is needed to identify predictors of postpartum visit attendance in marginalized populations. Methods: We conducted a systematic review of the peer-reviewed literature to identify studies that quantified patient-, provider-, and health system-level predictors of postpartum health care use by people of color and low-income and uninsured populations. We extracted study design, sample, measures, and outcome data from studies meeting our eligibility criteria, and used a modified Cochrane Risk of Bias tool to evaluate risk of bias. Results: Out of 2,757 studies, 36 met our criteria for inclusion in this review. Patient-level factors consistently associated with postpartum care included higher socioeconomic status, rural residence, fewer children, older age, medical complications, and previous health care use. Perceived discrimination during intrapartum care and trouble understanding the health care provider were associated with lower postpartum visit use, while satisfaction with the provider and having a provider familiar with one's health history were associated with higher use. Health system predictors included public facilities, group prenatal care, and services such as patient navigators and appointment reminders. Discussion: Postpartum health service research in marginalized populations has predominantly focused on patient-level factors; however, the multilevel predictors identified in this review reflect underlying inequities and should be used to inform the design of structural changes. [ABSTRACT FROM AUTHOR]

Preoperative knowledge of surgical risks can improve perioperative care and patient outcomes. However, assessments requiring clinician examination of patients or manual chart review can be too burdensome for routine use. We conducted a multicentre retrospective study of 243 479 adult noncardiac surgical patients at four hospitals within the Mass General Brigham (MGB) system in the USA. We developed a machine learning method using routinely collected coding and patient characteristics data from the electronic health record which predicts 30-day mortality, 30-day readmission, discharge to long-term care, and hospital length of stay. Our method, the Flexible Surgical Set Embedding (FLEX) score, achieved state-of-the-art performance to identify comorbidities that significantly contribute to the risk of each adverse outcome. The contributions of comorbidities are weighted based on patient-specific context, yielding personalised risk predictions. Understanding the significant drivers of risk of adverse outcomes for each patient can inform clinicians of potential targets for intervention. FLEX utilises information from a wider range of medical diagnostic and procedural codes than previously possible and can adapt to different coding practices to accurately predict adverse postoperative outcomes. [ABSTRACT FROM AUTHOR]

Do interlocking boards provide advantage in the grants marketplace? Drawing upon board data from nine public grant-making organizations in two metropolitan areas and their grant recipients, we test the mediating and moderating relationships between interlocking boards, organizational size, and the size of the grants received. We find that organizational size is not a predictor of grant allocations independent of network characteristics. Larger organizations have larger and better-connected boards, which is associated with larger grants. [ABSTRACT FROM AUTHOR]

The article presents several essays which illustrate the relations between black performance and black reproduction in the U.S. Topics discussed include singer-songwriter Erykah Badu's ambulatory acts in her music video "Window Seat," the airy poetics of black performance and blackness, and the generational schism between the Black Lives Matter movement and the civil rights movement.

Objective The objective of this study was to describe antenatal/intrapartum management and survival of liveborn infants with known trisomy 13 (T13) or trisomy 18 (T18) based on planned neonatal care. Study Design This is a retrospective cohort study of singleton pregnancies complicated by T13/T18 at a tertiary center from 2004 to 2015. We included pregnancies with antenatal or neonatal cytogenetic T13/T18 diagnosis and excluded those which were terminated or had a fetal demise < 20 weeks. We compared antenatal/intrapartum management and neonatal survival by planned neonatal care, defined as either neonatal intervention (INT), including neonatal cardiopulmonary resuscitative measures or comfort care (CC) without resuscitative measures. Results In this study, 32 women (10 with T13 and 22 with T18) met study criteria; 12 (38%) elected INT and 20 (62%) CC. Compared with those who elected INT, women who elected CC weremore likely to undergo elective induction (40 vs. 0%, p = 0.01), have an intrapartum stillbirth (0 vs. 32%, p = 0.14), and deliver vaginally (25 vs. 63%, p < 0.01). In neonatal survival analysis (n = 26), median survival was longer in the INT group compared with CC group (64 days [interquartile range, IQR: 2, 155) vs. 3 days [IQR]: 0.3, 42), p = 0.28), but survival to hospital discharge was similar (53 vs. 57%, p = 0.95). Conclusion Regardless of desired level of neonatal INT, many women who continue pregnancies complicated by T13/18 have infants who survive beyond hospital discharge. [ABSTRACT FROM AUTHOR]

In a prospectively evaluated nulliparous cohort, allostatic load in early pregnancy is associated with adverse pregnancy outcomes, including hypertensive disorders of pregnancy. OBJECTIVE: To assess the association between allostatic load, as an estimate of chronic stress, and adverse pregnancy outcomes. METHODS: This was a secondary analysis of nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be), a prospective observational cohort study. Our primary exposure was dichotomous high allostatic load in the first trimester, defined as 4 or more of 12 biomarkers in the "worst" quartile. The primary outcome was a composite adverse pregnancy outcome: hypertensive disorders of pregnancy (HDP), preterm birth, small for gestational age (SGA), and stillbirth. Secondary outcomes included components of the composite. Multivariable logistic regression was used to test the association between high allostatic load and adverse pregnancy outcomes, adjusted for potential confounders. Mediation and moderation analyses were conducted to assess the role of allostatic load along the causal pathway between racial disparities and adverse pregnancy outcomes. RESULTS: Among 4,266 individuals, 34.7% had a high allostatic load. Composite adverse pregnancy outcome occurred in 1,171 (27.5%): 14.0% HDP, 8.6% preterm birth (48.0% spontaneous and 52.2% indicated), 11.0% SGA, and 0.3% stillbirth. After adjustment for maternal age, gravidity, smoking, bleeding in the first trimester, and health insurance, high allostatic load was significantly associated with a composite adverse pregnancy outcome (adjusted odds ratio [aOR] 1.5, 95% CI 1.3, 1.7) and HDP (aOR 2.5, 95% CI 2.0–2.9), but not preterm birth or SGA. High allostatic load partially mediated the association between self-reported race and adverse pregnancy outcomes. The association between allostatic load and HDP differed by self-reported race, but not for a composite adverse pregnancy outcome, preterm birth, or SGA. CONCLUSION: High allostatic load in the first trimester is associated with adverse pregnancy outcomes, particularly HDP. Allostatic load was a partial mediator between race and adverse pregnancy outcomes. The association between allostatic load and HDP differed by self-reported race. [ABSTRACT FROM AUTHOR]

Select Drug Category Opiates/Opioids Topic Tolerance/Dependence Abstract Detail Clinical - Epidemiology Abstract Category Original Research Characterize the relationship between intraoperative opioid administration and postoperative pain and opioid requirements. We conducted a retrospective cohort study of 61,250 adult patients who received non-cardiac surgery under general anesthesia at a quaternary care center between 2016 and 2020. The exposure variable was intraoperative fentanyl and intraoperative hydromorphone average effect site concentration. The primary study outcomes were maximal pain score during post-anesthesia care unit (PACU) stay and cumulative opioids administered in the PACU in morphine milligram equivalents (MME). Secondary outcomes included frequency of uncontrolled pain at 24 hours, new instances of chronic pain diagnosis, total opioid use at 24 hours and in-hospital, opioid prescriptions at 30, 90, and 180 postoperative days, frequency of new persistent opioid use, maximal pain score in the first 24 hours and in-hospital, and incidence of opioid related complications in PACU. We used multivariate propensity weighting to control for confounding and estimated the counterfactual difference in outcomes after administration of an additional 100 mcg fentanyl or 500 mcg hydromorphone intraoperatively. Increased intraoperative fentanyl and intraoperative hydromorphone were both associated with reduced maximum pain scores in the PACU. Both exposures were also associated with a reduced probability and reduced total dosage of opioid administration in the PACU. We found that increased fentanyl administration in particular was associated with lower frequency of uncontrolled pain, decreased chronic pain at 3-months, fewer opioid prescriptions at 30-, 90-, and 180-days, and decreased persistent opioid use, without significant increases in side effects. Our results show that intraoperative opioid administration is significantly associated with short- and long-term effects on post-operative pain and opioid outcomes. Contrary to prevailing trends, reduced opioid administration during surgery may have the unintended consequence of increasing postoperative pain and opioid consumption. Our analysis suggests that significant improvements in long-term outcomes might be achieved by optimizing opioid administration during surgery. [ABSTRACT FROM AUTHOR]

Although minerals are known to affect the environmental fate and transformation of heavy-metal ions, little is known about their interaction with the heavily exploited silver nanoparticles (AgNPs). Proposed here is a combination of hitherto under-utilized micro-Raman-based mapping and chemometric methods for imaging the distribution of AgNPs on various mineral surfaces and their molecular interaction mechanisms. The feasibility of the Raman-based imaging method was tested on two macro- and microsized mineral models, muscovite [KAl2(AlSi3O10)(OH)2] and corundum (α-Al2O3), under key environmental conditions (ionic strength and pH). Both AgNPs- and AgNPs+ were found to covalently attach to corundum (pHpzc = 9.1) through the formation of Ag-O-Al- bonds and thereby to potentially experience reduced environmental mobility. Because label-free Raman imaging showed no molecular interactions between AgNPs- and muscovite (pHpzc = 7.5), a label-enhanced Raman imaging approach was developed for mapping the scarce spatial distribution of AgNPs- on such mineral surfaces. Raman maps comprising of n = 625-961 spectra for each sample/control were rapidly analyzed in Vespucci, a free open-source software, and the results were confirmed via ICP-OES, AFM, and SEM-EDX. The proposed Raman-based imaging requires minimum to no sample preparation; is sensitive, noninvasive, cost-effective; and might be extended to other environmentally relevant systems. [ABSTRACT FROM AUTHOR]

Simple Summary: The equipment in the poultry house can occlude top view images of broiler chickens and limit the efficiency of vision-based target detection. In this study, we sought to improve the efficiency of a previously developed method to detect and restore broiler chicken areas blocked by feeders and drinkers. To do this, we developed and tested linear and elliptical fitting restoration methods under different occlusion scenarios to restore occluded broiler chicken areas. The restoration method correctly restored the occluded broiler chicken area >80% of the time. This study provides a practical approach to enhancing the image quality in applying a machine vision-based method for monitoring poultry health and welfare. The presence equipment (e.g., water pipes, feed buckets, and other presence equipment, etc.) in the poultry house can occlude the areas of broiler chickens taken via top view. This can affect the analysis of chicken behaviors through a vision-based machine learning imaging method. In our previous study, we developed a machine vision-based method for monitoring the broiler chicken floor distribution, and here we processed and restored the areas of broiler chickens which were occluded by presence equipment. To verify the performance of the developed restoration method, a top-view video of broiler chickens was recorded in two research broiler houses (240 birds equally raised in 12 pens per house). First, a target detection algorithm was used to initially detect the target areas in each image, and then Hough transform and color features were used to remove the occlusion equipment in the detection result further. In poultry images, the broiler chicken occluded by equipment has either two areas (TA) or one area (OA). To reconstruct the occluded area of broiler chickens, the linear restoration method and the elliptical fitting restoration method were developed and tested. Three evaluation indices of the overlap rate (OR), false-positive rate (FPR), and false-negative rate (FNR) were used to evaluate the restoration method. From images collected on d2, d9, d16, and d23, about 100-sample images were selected for testing the proposed method. And then, around 80 high-quality broiler areas detected were further evaluated for occlusion restoration. According to the results, the average value of OR, FPR, and FNR for TA was 0.8150, 0.0032, and 0.1850, respectively. For OA, the average values of OR, FPR, and FNR were 0.8788, 0.2227, and 0.1212, respectively. The study provides a new method for restoring occluded chicken areas that can hamper the success of vision-based machine predictions. [ABSTRACT FROM AUTHOR]

The proper spatial distribution of chickens is an indication of a healthy flock. Routine inspections of broiler chicken floor distribution are done manually in commercial grow-out houses every day, which is labor intensive and time consuming. This task requires an efficient and automatic system that can monitor the chicken's floor distributions. In the current study, a machine vision-based method was developed and tested in an experimental broiler house. For the new method to recognize bird distribution in the images, the pen floor was virtually defined/divided into drinking, feeding, and rest/exercise zones. As broiler chickens grew, the images collected each day were analyzed separately to avoid biases caused by changes of body weight/size over time. About 7000 chicken areas/profiles were extracted from images collected from 18 to 35 days of age to build a BP neural network model for floor distribution analysis, and another 200 images were used to validate the model. The results showed that the identification accuracies of bird distribution in the drinking and feeding zones were 0.9419 and 0.9544, respectively. The correlation coefficient (R), mean square error (MSE), and mean absolute error (MAE) of the BP model were 0.996, 0.038, and 0.178, respectively, in our analysis of broiler distribution. Missed detections were mainly caused by interference with the equipment (e.g., the feeder hanging chain and water line); studies are ongoing to address these issues. This study provides the basis for devising a real-time evaluation tool to detect broiler chicken floor distribution and behavior in commercial facilities. [ABSTRACT FROM AUTHOR]