Search

Anna D Coutinho,1 Tasneem Lokhandwala,1 Robert L Boggs,2 Anand A Dalal,2 Pamela B Landsman-Blumberg,1 Julie Priest,2 David A Stempel3 1Real World Evidence, Xcenda LLC, Palm Harbor, FL, 2US Health Outcomes, GlaxoSmithKline, Research Triangle Park, NC, 3US Medical Affairs, GlaxoSmithKline, Research Triangle Park, NC, USA Background: The aim of this study was to extend previous findings and determine the value of prompt initiation of maintenance treatment (MT) following COPD exacerbations requiring hospitalization or an emergency department (ED) visit.Patients and methods: Administrative claims data (collected between January 1, 2009 and June 30, 2012) from an employer-sponsored commercially insured population were retrospectively used to identify patients with a COPD exacerbation resulting in hospitalization or an ED visit. Patients initiating approved MT for COPD within 30 days of discharge/diagnosis (prompt) were compared with those initiating MT within 31–180 days (delayed). COPD-related total, medical, and prescription drug costs during a 1-year follow-up period were evaluated using semilog ordinary least square regressions, controlling for baseline characteristics plus COPD-related costs from the previous year. The odds and number of subsequent COPD-related exacerbations during the follow-up were compared between the prompt and delayed cohorts using logistic regression and zero-inflated negative binomial models, respectively. Results: A total of 6,521 patients with a COPD-related hospitalization or an ED visit were included, of whom 4,555 received prompt MT and 1,966 received delayed MT. Adjusted COPD-related total and medical costs were significantly lower for the prompt MT than the delayed MT cohorts (US$3,931 vs US$4,857 and US$2,327 vs US$3,087, respectively; both P

Introduction: Ultrasonography allows high-resolution visualisation of the peripheral nerves for quantitative and qualitative analyses. We report cross-sectional area values (quantitative measure) and echo intensity values (qualitative measure) for 46 peripheral nerve sites in upper and lower extremities in cadaveric specimens., Objective: To determine cross-sectional area values and echo intensity values of peripheral nerves of upper and lower extremities at 46 nerve sites., Methods: Nerve measurements were obtained using electronic callipers and ultrasonography for linear dimension and cross-sectional area measurements, respectively, in six cadaveric specimens for 46 peripheral nerve sites. Ultrasound images were further analysed to estimate echo intensity percentage values for 46 nerves., Results: We present normal cross-sectional area values of various nerves of upper and lower extremities with their respective echo intensity values. Calculated cross-sectional area values from linear dimensions did not match the measured cross-sectional area values via trace method., Conclusion: Cross-sectional area values (quantitative measure) and echo intensity values (qualitative measure) for 46 peripheral nerve sites in upper and lower extremities in cadaveric specimens are presented. The estimation of cross-sectional area via linear measurement is not a good approximation of the cross-sectional area (cross-sectional area measured by trace method on ultrasound image)., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (© The Author(s) 2022.)

Background: COVID-19 drastically changed the school choice landscape as families considered schools with varying public health protocols as well as academic and demographic characteristics. Our understanding of families' preferences during the pandemic is limited, however, because it primarily derives from surveys asking parents about a single school characteristic., Objective: We aimed to understand how families' preferences for schools' racial composition and public health policies may interdepend., Methods: We conducted an original school choice survey experiment with U.S. White parents in August 2021. Parents indicated their willingness to enroll their student in hypothetical schools with experimentally randomized school quality ratings, racial and socioeconomic demographics, and COVID mitigation strategies (i.e. instructional modalities, mask and vaccination mandates)., Results: We find novel causal evidence that White parents' preferences for schools' racial demographics and public health policies are interdependent. Among otherwise similar schools, parents expressed stronger preferences to avoid Black, Latinx, and Asian schools when there were fewer COVID mitigation policies. Relatedly, parents required more stringent COVID protocols for their children to attend predominantly Black, Latinx, and Asian schools while showing no preferences for COVID policies among predominantly White schools. The interdependence of preferred racial demographics and public health polices was amplified among White parents who held stigmatizing beliefs about Asian populations carrying the COVID virus and pro-White sentiments. Although Democrats expressed stronger preferences for schools with more COVID mitigation strategies than Republicans, for White parents across the political spectrum school racial composition and COVID mitigation preferences interdepended., Conclusions: This study suggests families may leverage flexible student assignment policies and schools of choice to enroll in or avoid schools based on both preferred public health policies and racial demographics. Districts should consider how adopting strong public health policies during infectious disease outbreaks may help mitigate hardened racial avoidance and school racial segregation., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Computed tomography angiography (CTA) has been the gold standard imaging modality for vascular imaging due to a variety of factors, including the widespread availability of computed tomography (CT) scanners, the ease and speed of image acquisition, and the high sensitivity of CTA for vascular pathology. However, the radiation dose experienced by the patient during imaging has long been a concern of this image acquisition method. Advancements in CT image acquisition techniques in combination with advancements in non-ionizing radiation imaging techniques including magnetic resonance angiography (MRA) and contrast-enhanced ultrasound (CEUS) present growing opportunities to reduce total radiation dose to patients. This review provides an overview of advancements in imaging technology and acquisition techniques that are helping to minimize radiation dose associated with vascular imaging.

Aims: While glycemic control is key in effective type 2 diabetes mellitus management, many patients fail to reach their individualized glycemic goal. This analysis aimed to describe a real-world picture of diabetes management: individualized hemoglobin A 1c (HbA 1c ) goals, rate of goal attainment, HbA 1c at each line of therapy, and patient awareness of their glycemic goal. Secondly, we aimed to understand physician satisfaction with HbA 1c amongst patients aware vs. those unaware of HbA 1c goal., Methods: Analysis of physicians and the next ten consulting patients with type 2 diabetes mellitus conducted in Europe and the USA including medical record data abstraction/assessment by physicians, a patient-reported survey and a physician survey. Patients were diagnosed for 3 months or more with a known current and target HbA 1c . For the sub-analysis assessment of patient awareness of HbA 1c goal, in addition to the above, these patients had to have completed a patient-reported questionnaire and answer the question on awareness of HbA 1c goal., Results: A total of 730 physicians provided data on 8794 patients with type 2 diabetes mellitus; 5331 patients were eligible for this analysis. Overall, mean (standard deviation, SD) individualized HbA 1c goal was 6.8% (0.68%). Of eligible patients, 39.1% met their HbA 1c goal; of 60.9% of patients not reaching their HbA 1c goal, the mean distance from individualized HbA 1c goal was 0.9% (SD 1.0%). Physicians progressed patients' antihyperglycemic therapy when HbA 1c was 8% or higher. Among 2560 patients who were included in the sub-analysis assessing the effect of patient awareness of their HbA 1c goal on multiple parameters, 70.5% were aware of their HbA 1c goal; mean HbA 1c goal was 6.8% (0.7%) and current mean HbA 1c value 7.1% (1.2%). A total of 949 patients in the sub-analysis (39.2%) achieved their goal; achieving HbA 1c goal was not related to knowledge of goal. Patients aware of their HbA 1c goal were slightly more adherent to their antihyperglycemic medication. They also were prescribed more antihyperglycemic agents, more often on a later therapy line receiving a GLP-1 receptor agonist, SGLT2i, or insulin, and more often tested their blood glucose levels than patients who were unaware. Physicians were not satisfied with the current blood glucose level of one third of their patients, believing that more of those who were aware of their HbA 1c goal could achieve better glucose control (32.4% of aware vs. 28.2% of unaware patients; p = 0.003)., Conclusions: Our results showed that the proportion of patients with type 2 diabetes mellitus achieving their goals for glycemic control was suboptimal when compared to current guideline criteria, with only about 40% of patients achieving their individualized HbA 1c goal. Treatment intensification was often delayed until HbA 1c was 8% and higher. Patients aware of their HbA 1c goal were slightly more adherent to their antihyperglycemic medication; however, awareness of HbA 1c goal did not enhance goal attainment. This highlights the need for a holistic approach to diabetes management, involving patient education, and patient-physician communication and partnership., (© 2021. The Author(s).)

Research in sociology demonstrates the way social connections shape access to information about job opportunities. In education, we understand less about how social networks impact the job process for marginalized teachers and teachers in nontraditional labor markets. This study examines how teachers in New Orleans and Detroit, cities with high concentrations of charter schools, use their networks to search for jobs, and how their experiences vary by race and gender. We find that in choice-rich environments, there was an extensive reliance on social networks in the hiring process, and teachers had different access to key social networks that can help to land jobs. Hiring decisions and unequal access to job opportunities among teacher candidates, in part due to the reliance on networks, created conditions where teachers who cultivated stronger networks, or with access to the "right" networks, had greater opportunity, with implications for racial and gender equity and diversity.