Search

Spyridon Fortis,1,2 Yubo Gao,1,3 Amy M J O’Shea,1,3 Brice Beck,1 Peter Kaboli,1,3 Mary Vaughan Sarrazin1,3 1Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; 2Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupation Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA; 3Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USACorrespondence: Spyridon FortisDepartment of Internal Medicine, Division of Pulmonary, Critical Care and Occupation Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive – C33 GH, Iowa City, IA, 52242, USAEmail spyridon-fortis@uiowa.eduBackground: Non-invasive mechanical ventilation (NIV) use in patients admitted with acute respiratory failure due to COPD exacerbations (AECOPDs) varies significantly between hospitals. However, previous literature did not account for patients’ illness severity. Our objective was to examine the variation in risk-standardized NIV use after adjusting for illness severity.Methods: We retrospectively analyzed AECOPD hospitalizations from 2011 to 2017 at 106 acute-care Veterans Health Administration (VA) hospitals in the USA. We stratified hospitals based on the percentage of NIV use among patients who received ventilation support within the first 24 hours of admission into quartiles, and compared patient characteristics. We calculated the risk-standardized NIV % using hierarchical models adjusting for comorbidities and severity of illness. We then stratified the hospitals by risk-standardized NIV % into quartiles and compared hospital characteristics between quartiles. We also compared the risk-standardized NIV % between rural and urban hospitals.Results: In 42,048 admissions for AECOPD

This creative nonfiction essay collection, Not All Deaths are Created Equal: Essays on the Intersection of Death, Homelessness, and Inequality, is a journey to understand what happens to someone who dies while experiencing homelessness. Through creative and critical elements woven into personal essays that are informed by research on medical care, end-of-life care, and post-death care for those experiencing homelessness, as well as loss and grief, Shea bears witness to the disparities in death and dying faced by some of society’s most vulnerable and marginalized. This work seeks to engage a broad audience by utilizing the vast tools and creative elements provided by the essay form and structure such as narrative, scene, and dialogue while incorporating the rigor of academic research in a readable and engaging manner. The intention of this thesis is to increase awareness around the intersection of death, dying, and homelessness in order to advocate for a better quality of life and death for all, including those who are too often left behind. Some of the chapters and content explored in Not All Deaths are Created Equal includes, “Death by a Thousand Viewings,” which critically reviews the documentary, A Certain Kind of Death, and discusses how this film drove Shea to act and to focus her research on the indigent death. “Field Notes of a Tombstone Tourist” is rooted in visits to different cemeteries and explores the differences between burial places for those who have money and those who do not. “Sweet Feet” is a recounting of Shea’s experience as a foot care assistant at a homeless day shelter. This chapter moves us from death into dying through the health disparities faced by those living on the streets. “Deaths of Disparity” takes a deep dive into systemic issues around health care and end-of-life care and how homelessness is exacerbated by un- or undertreated health issues and how those health issues can lead to untimely deaths. This chapter also highlights some of

This creative nonfiction essay collection, Not All Deaths are Created Equal: Essays on the Intersection of Death, Homelessness, and Inequality, is a journey to understand what happens to someone who dies while experiencing homelessness. Through creative and critical elements woven into personal essays that are informed by research on medical care, end-of-life care, and post-death care for those experiencing homelessness, as well as loss and grief, Shea bears witness to the disparities in death and dying faced by some of society’s most vulnerable and marginalized. This work seeks to engage a broad audience by utilizing the vast tools and creative elements provided by the essay form and structure such as narrative, scene, and dialogue while incorporating the rigor of academic research in a readable and engaging manner. The intention of this thesis is to increase awareness around the intersection of death, dying, and homelessness in order to advocate for a better quality of life and death for all, including those who are too often left behind. Some of the chapters and content explored in Not All Deaths are Created Equal includes, “Death by a Thousand Viewings,” which critically reviews the documentary, A Certain Kind of Death, and discusses how this film drove Shea to act and to focus her research on the indigent death. “Field Notes of a Tombstone Tourist” is rooted in visits to different cemeteries and explores the differences between burial places for those who have money and those who do not. “Sweet Feet” is a recounting of Shea’s experience as a foot care assistant at a homeless day shelter. This chapter moves us from death into dying through the health disparities faced by those living on the streets. “Deaths of Disparity” takes a deep dive into systemic issues around health care and end-of-life care and how homelessness is exacerbated by un- or undertreated health issues and how those health issues can lead to untimely deaths. This chapter also highlights some of

This creative nonfiction essay collection, Not All Deaths are Created Equal: Essays on the Intersection of Death, Homelessness, and Inequality, is a journey to understand what happens to someone who dies while experiencing homelessness. Through creative and critical elements woven into personal essays that are informed by research on medical care, end-of-life care, and post-death care for those experiencing homelessness, as well as loss and grief, Shea bears witness to the disparities in death and dying faced by some of society’s most vulnerable and marginalized. This work seeks to engage a broad audience by utilizing the vast tools and creative elements provided by the essay form and structure such as narrative, scene, and dialogue while incorporating the rigor of academic research in a readable and engaging manner. The intention of this thesis is to increase awareness around the intersection of death, dying, and homelessness in order to advocate for a better quality of life and death for all, including those who are too often left behind. Some of the chapters and content explored in Not All Deaths are Created Equal includes, “Death by a Thousand Viewings,” which critically reviews the documentary, A Certain Kind of Death, and discusses how this film drove Shea to act and to focus her research on the indigent death. “Field Notes of a Tombstone Tourist” is rooted in visits to different cemeteries and explores the differences between burial places for those who have money and those who do not. “Sweet Feet” is a recounting of Shea’s experience as a foot care assistant at a homeless day shelter. This chapter moves us from death into dying through the health disparities faced by those living on the streets. “Deaths of Disparity” takes a deep dive into systemic issues around health care and end-of-life care and how homelessness is exacerbated by un- or undertreated health issues and how those health issues can lead to untimely deaths. This chapter also highlights some of

This creative nonfiction essay collection, Not All Deaths are Created Equal: Essays on the Intersection of Death, Homelessness, and Inequality, is a journey to understand what happens to someone who dies while experiencing homelessness. Through creative and critical elements woven into personal essays that are informed by research on medical care, end-of-life care, and post-death care for those experiencing homelessness, as well as loss and grief, Shea bears witness to the disparities in death and dying faced by some of society’s most vulnerable and marginalized. This work seeks to engage a broad audience by utilizing the vast tools and creative elements provided by the essay form and structure such as narrative, scene, and dialogue while incorporating the rigor of academic research in a readable and engaging manner. The intention of this thesis is to increase awareness around the intersection of death, dying, and homelessness in order to advocate for a better quality of life and death for all, including those who are too often left behind. Some of the chapters and content explored in Not All Deaths are Created Equal includes, “Death by a Thousand Viewings,” which critically reviews the documentary, A Certain Kind of Death, and discusses how this film drove Shea to act and to focus her research on the indigent death. “Field Notes of a Tombstone Tourist” is rooted in visits to different cemeteries and explores the differences between burial places for those who have money and those who do not. “Sweet Feet” is a recounting of Shea’s experience as a foot care assistant at a homeless day shelter. This chapter moves us from death into dying through the health disparities faced by those living on the streets. “Deaths of Disparity” takes a deep dive into systemic issues around health care and end-of-life care and how homelessness is exacerbated by un- or undertreated health issues and how those health issues can lead to untimely deaths. This chapter also highlights some of

This creative nonfiction essay collection, Not All Deaths are Created Equal: Essays on the Intersection of Death, Homelessness, and Inequality, is a journey to understand what happens to someone who dies while experiencing homelessness. Through creative and critical elements woven into personal essays that are informed by research on medical care, end-of-life care, and post-death care for those experiencing homelessness, as well as loss and grief, Shea bears witness to the disparities in death and dying faced by some of society’s most vulnerable and marginalized. This work seeks to engage a broad audience by utilizing the vast tools and creative elements provided by the essay form and structure such as narrative, scene, and dialogue while incorporating the rigor of academic research in a readable and engaging manner. The intention of this thesis is to increase awareness around the intersection of death, dying, and homelessness in order to advocate for a better quality of life and death for all, including those who are too often left behind. Some of the chapters and content explored in Not All Deaths are Created Equal includes, “Death by a Thousand Viewings,” which critically reviews the documentary, A Certain Kind of Death, and discusses how this film drove Shea to act and to focus her research on the indigent death. “Field Notes of a Tombstone Tourist” is rooted in visits to different cemeteries and explores the differences between burial places for those who have money and those who do not. “Sweet Feet” is a recounting of Shea’s experience as a foot care assistant at a homeless day shelter. This chapter moves us from death into dying through the health disparities faced by those living on the streets. “Deaths of Disparity” takes a deep dive into systemic issues around health care and end-of-life care and how homelessness is exacerbated by un- or undertreated health issues and how those health issues can lead to untimely deaths. This chapter also highlights some of