Differences In Access Research Articles

Do Community-level Disadvantages Account for Racial Disparities in the Safety of Spine Surgery? A Large Database Study Based on Medicare Claims.

Racial health disparities across orthopaedic surgery subspecialties, including spine surgery, are well established. However, the underlying causes of these disparities, particularly relating to social determinants of health, are not fully understood. (1) Is there a racial difference in 90-day mortality, readmission, and complication rates ("safety outcomes") among Medicare beneficiaries after spine surgery? (2) To what degree does the Centers for Disease Control and Prevention Social Vulnerability Index (SVI), a community-level marker of social determinants of health, account for racial disparities in safety outcomes? To examine racial differences in 90-day mortality, readmission, and complications after spine surgery, we retrospectively identified all 419,533 Medicare beneficiaries aged 65 or older who underwent inpatient spine surgery from 2015 to 2019; we excluded 181,588 patients with endstage renal disease or Social Security disability insurance entitlements, who were on Medicare HMO, or who had missing SVI data. Because of the nearly universal coverage of those age 65 or older, Medicare data offer a large cohort that is broadly generalizable, provides improved precision for relatively rare safety outcomes, and is free of confounding from differential insurance access across races. The Master Beneficiary Summary File includes enrollees' self-reported race based on a restrictive list of mutually exclusive options. Even though this does not fully capture the entirety of racial diversity, it is self-reported by patients. Identification of spine surgery was based on five Diagnosis Related Groups labeled "cervical fusion," "fusion, except cervical," "anterior-posterior combined fusion," "complex fusion," and "back or neck, except fusion." Although heterogeneous, these cohorts do not reflect inherently different biology that would lead us to expect differences in safety outcomes by race. We report specific types of complications that did and did not involve readmission. Although complications vary in severity, we report them as composite measures while being cognizant of the inherent limitations of making inferences based on aggregate measures. The SVI was chosen as the mediating variable because it aggregates important social determinants of health and has been shown to be a marker of high risk of poor public health response to external stressors. Patients were categorized into three groups based on a ranking of the four SVI themes: socioeconomic status, household composition, minority status and language, and housing and transportation. We report the "average race effects" among Black patients compared with White patients using nearest-neighbor Mahalanobis matching by age, gender, comorbidities, and spine surgery type. Mahalanobis matching provided the best balance among propensity-type matching methods. Before matching, Black patients in Medicare undergoing spine surgery were disproportionately younger with more comorbidities and were less likely to undergo cervical fusion. To estimate the contribution of the SVI on racial disparities in safety outcomes, we report the average race effect between models with and without the addition of the four SVI themes. After matching on age, gender, comorbidities, and spine surgery type, Black patients were on average more likely than White patients to be readmitted (difference of 1.5% [95% CI 0.9% to 2.1%]; p < 0.001) and have complications with (difference of 1.2% [95% CI 0.5% to 1.9%]; p = 0.002) or without readmission (difference of 3.6% [95% CI 2.9% to 4.3%]; p < 0.001). Adding the SVI to the model attenuated these differences, explaining 17% to 49% of the racial differences in safety, depending on the outcome. An observed higher rate of 90-day mortality among Black patients was explained entirely by matching using non-SVI patient demographics (difference of 0.00% [95% CI -0.3% to 0.3%]; p = 0.99). However, even after adjusting for the SVI, Black patients had more readmissions and complications. Social disadvantage explains up to nearly 50% of the disparities in safety outcomes between Black and White Medicare patients after spine surgery. This argument highlights an important contribution of socioeconomic circumstances and societal barriers to achieving equal outcomes. But even after accounting for the SVI, there remained persistently unequal safety outcomes among Black patients compared with White patients, suggesting that other unmeasured factors contribute to the disparities. This is consistent with evidence documenting Black patients' disadvantages within a system of seemingly equal access and resources. Research on racial health disparities in orthopaedics should account for the SVI to avoid suggesting that race causes any observed differences in complications among patients when other factors related to social deprivation are more likely to be determinative. Focused social policies aiming to rectify structural disadvantages faced by disadvantaged communities may lead to a meaningful reduction in racial health disparities. Level III, therapeutic study.

Colour morph predicts social behaviour and contest outcomes in a polymorphic lizard (Podarciserhardii)

Space is a limited resource in which many animals need to perform basic functions such as feeding and reproducing. Competition over access to space can induce a variety of behaviours that may result in differential access to crucial resources related to survival and fitness. The Aegean wall lizard, Podarcis erhardii , is a colour-polymorphic lizard that inhabits dry stone walls where they access food, safely thermoregulate, shelter from predators and interact with other lizards. Many colour-polymorphic species have morphs with distinct behavioural strategies, which may play a role in morph evolution and maintenance. Here, we conducted the first behavioural experiments on P. erhardii colour morphs. Our goal was to compare morph competitive ability and characterize morph differences in social behaviours using laboratory contest experiments over limited heated space on a stone wall in a neutral arena. Contest experiments revealed that colour morph, not size, predicted intermorph contest outcomes. White and yellow morphs were associated with winning and the orange morph was associated with losing contests. Male colour morphs exhibited different levels of aggressive, boldness, chemical signalling and visual signalling behaviours depending on which morph they were in contest with. White morphs always performed aggressive and scent-marking behaviours more frequently during contests with other morphs. Yellow morphs performed aggressive, bold, chemical signalling and visual signalling behaviours at intermediate frequencies relative to other morphs. Orange morphs performed aggressive behaviours equally often when in contest with yellow morphs but performed all other behaviours less frequently against yellow and white morphs. Considering these results, behavioural variation among P. erhardii colour morphs may promote morph maintenance. • Male lizard colour morphs differed in their ability to win staged contests for space. • White and yellow morphs were associated with winning contests over space. • Larger orange morphs were associated with losing and were the least aggressive. • White morphs were the most aggressive and scent-marked territories often. • Different social strategies among morphs may help maintain polymorphism.

Gender differentials in value addition and lean season market participation in the grasshopper value chain in Uganda

AbstractGender gaps in agrifood value chains are manifested in differential access to and control of productive resources, upgrading activities, market participation, farm productivity and food security among women and men. These gender gaps threaten economic development in sub‐Saharan Africa. With low‐resource requirements, edible insects have emerged as a promising agrifood value chain with income opportunities for women and men. However, it is not clear how gender gaps are manifested in the participation in value addition and lean season market of the edible insect value chain with a potential to improve household welfare. In this paper, we analyse the gender gaps of retailers' participation in value addition and lean season market in the grasshopper value chain in Uganda. Multivariate probit and tobit models are used in the empirical analyses. We find that women are 15% more likely to participate in primary value addition. However, there are no gender gaps in the participation in secondary value addition and the lean season market. The study also shows that grasshopper business is an important source of income for many retailers. Therefore, the development of the grasshopper value chain, especially the aspects of value addition and lean season market, could contribute to gender equality and improvement of livelihoods of women and men.

Sociodemographic Survival Disparities for Lung Cancer in the United States, 2000-2016.

Understanding the impact of patient and tumor characteristics on lung cancer survival can help build personalized prognostic models and identify health disparities. We identified 557 555 patients aged 25 years and older diagnosed with lung or bronchus carcinoma from the Surveillance, Epidemiology, and End Results database, 2000-2016. We estimated hazard ratios (HR) for demographic (sex, age, race and ethnicity), tumor (stage, histology, year of diagnosis), and geographic characteristics (census tract-level urbanicity, socioeconomic status [SES]), as well as selected interactions, on the rate of lung cancer-specific death using multivariable proportional hazards models. Women had a higher survival (lower hazard) of lung cancer-specific death than men (HR = 0.83, 95% confidence interval [CI] = 0.82 to 0.83). Hazards differed by race and ethnicity. Regional (HR = 2.41, 95% CI = 2.37 to 2.44) and distant (HR = 6.61, 95% CI = 6.53 to 6.69) tumors were associated with a lower survival (higher hazard) than localized tumors. Small cell tumors were associated with a lower survival (HR = 1.19, 95% CI = 1.18 to 1.20) than non-small cell tumors. Patients diagnosed after 2009 had lower hazards (HR = 0.86, 95% CI = 085 to 0.86) than those diagnosed 2000-2009. Lung cancer-specific survival did not depend on urbanicity after adjusting for census tract-level SES, but survival decreased with decreasing census tract-level SES. Differences in survival between non-Hispanic Black and White patients were greater for younger patients and localized tumors and increased with census tract-level SES. Differences by sex were greatest for young patients and localized tumors. Disparities in survival after lung cancer diagnosis remain, with intersectional patterns suggesting differential access to and quality of care. Efforts are needed to ensure that high-risk groups receive guideline-concordant treatment.

Association of vulvar lichen sclerosus with endometrial and ovarian cancer

Association of vulvar lichen sclerosus with endometrial and ovarian cancer

496 Differential chromatin accessibility and gene expression suggest Th17 polarization in activated and skin-homing T cells

We generated 1,090 ATAC-seq and 1,057 T-cell RNA-seq libraries from 153 subjects, derived from 8 flow-sorted T-cell subsets (defined by CD4/CD8, CLA+/ CLA-, and 0/24h CD3/CD28 stimulation). Effects of activation and skin-homing were analyzed by DESeq2. After peak calling, 78,234 consensus peaks were present in ≥ 30 ATAC-seq libraries. A Wald test examining simple main effects identified 9,072, 3,934, and 21,174 consensus peaks as differentially accessible regions (DAR; FDR < 0.05, |log2 FC|≥ 0.585) in CD4 vs CD8, CLA+ vs CLA-, and resting vs.

150 Thinking beyond race: No racial differences found in access to biologics among US psoriasis patients

Multiple socio-demographic factors, such as age and English proficiency, have been associated with differential access to biologics among psoriasis patients. Although race plays a significant role in healthcare access, conflicting data exists regarding its influence on biologics access. This study compared biologic use among psoriasis patients of different races. A cross-sectional population-based study of US psoriasis patients was conducted using the 2003-2018 Medical Expenditure Panel Survey national database.

GenomeSidekick: A user-friendly epigenomics data analysis tool.

Recent advances in epigenomics measurements have resulted in a preponderance of genomic sequencing datasets that require focused analyses to discover mechanisms governing biological processes. In addition, multiple epigenomics experiments are typically performed within the same study, thereby increasing the complexity and difficulty of making meaningful inferences from large datasets. One gap in the sequencing data analysis pipeline is the availability of tools to efficiently browse genomic data for scientists that do not have bioinformatics training. To bridge this gap, we developed genomeSidekick, a graphical user interface written in R that allows researchers to perform bespoke analyses on their transcriptomic and chromatin accessibility or chromatin immunoprecipitation data without the need for command line tools. Importantly, genomeSidekick outputs lists of up- and downregulated genes or chromatin features with differential accessibility or occupancy; visualizes omics data using interactive volcano plots; performs Gene Ontology analyses locally; and queries PubMed for selected gene candidates for further evaluation. Outputs can be saved using the user interface and the code underlying genomeSidekick can be edited for custom analyses. In summary, genomeSidekick brings wet lab scientists and bioinformaticians into a shared fluency with the end goal of driving mechanistic discovery.

Drought-Induced Challenges and Different Responses by Smallholder and Semicommercial Livestock Farmers in Semiarid Limpopo, South Africa—An Indicator-Based Assessment

Increased seasonal climatic variability is a major contributor to uncertainty in livestock-based livelihoods across Southern Africa. Erratic rainfall patterns and prolonged droughts have resulted in the region being identified as a climate ‘vulnerability hotspot’. Based on fieldwork conducted in the dry seasons in a semiarid region of South Africa, we present an interdisciplinary approach to assess the differential effects of drought on two types of livestock systems. Organic matter digestibility, faecal crude protein, C/N ratio and the natural abundance of faecal 15N and 13C isotopes were used as ecophysiological feed quality indicators between smallholder and semicommercial systems. These measurements were complemented with qualitative surveys. In a novel approach, we tested the potential of the isotopic signature to predict feed quality and present a significant relationship between organic matter digestibility and isotopic ratios. Indicators assessed smallholder feed quality to be significantly higher than semicommercial feed. However, animals from semicommercial farms were in significantly better condition than those from smallholding farms. Differential access to feed resources suggests that a complex feed–water–land nexus pushes smallholders into high reliance on off-farm supplements to bridge drought-induced feed deficits. The paper thus offers a contribution to intersectional work on drought effects on livestock keepers of semiarid South Africa and illustrates how ecophysiological indicators mirror socioeconomic differences.

Differential chromatin accessibility in peripheral blood mononuclear cells underlies COVID-19 disease severity prior to seroconversion

SARS-CoV-2 infection triggers profound and variable immune responses in human hosts. Chromatin remodeling has been observed in individuals severely ill or convalescing with COVID-19, but chromatin remodeling early in disease prior to anti-spike protein IgG seroconversion has not been defined. We performed the Assay for Transposase-Accessible Chromatin using sequencing (ATAC-seq) and RNA-seq on peripheral blood mononuclear cells (PBMCs) from outpatients with mild or moderate symptom severity at different stages of clinical illness. Early in the disease course prior to IgG seroconversion, modifications in chromatin accessibility associated with mild or moderate symptoms were already robust and included severity-associated changes in accessibility of genes in interleukin signaling, regulation of cell differentiation and cell morphology. Furthermore, single-cell analyses revealed evolution of the chromatin accessibility landscape and transcription factor motif accessibility for individual PBMC cell types over time. The most extensive remodeling occurred in CD14+ monocytes, where sub-populations with distinct chromatin accessibility profiles were observed prior to seroconversion. Mild symptom severity was marked by upregulation of classical antiviral pathways, including those regulating IRF1 and IRF7, whereas in moderate disease, these classical antiviral signals diminished, suggesting dysregulated and less effective responses. Together, these observations offer novel insight into the epigenome of early mild SARS-CoV-2 infection and suggest that detection of chromatin remodeling in early disease may offer promise for a new class of diagnostic tools for COVID-19.

Impact of health insurance type on access to vaccination and mortality due to COVID-19 on patients with cancer in Colombia: a cohort study

BackgroundIn Colombia, all paid workers earning minimum wage or higher contribute part of their salary for access to the national health-care system through a type of insurance called contributive plan, which supports the remaining low-income population that is enrolled on the subsidised plan. During the COVID-19 pandemic, Colombia documented high mortality rate in patients with cancer, with higher mortality among low-income patients, according to data from our national registry of COVID-19 infection in patients with cancer. The aim of this research was to establish the differential access to COVID-19 vaccination depending on health insurance type, and its impact on mortality due to COVID-19 infection.MethodsA cohort study was conducted with data from the Colombian National Cancer and COVID-19 Registry. Data were collected between June 1, 2021, when COVID-19 vaccines became available for patients with cancer in Colombia, and Oct 31, 2021. Included patients were aged 18 years or older, had a diagnosis of a solid tumour, were receiving active treatment or on follow-up, and had a confirmed SARS-CoV-2 infection. The cumulative incidence of mortality in the vaccinated and unvaccinated cohorts was compared. The estimation of the effect was done through relative risk (RR), and a multivariate analysis (generalised linear model, binomial family) was then done to estimate the effect of the type of health insurance.Findings896 patients were included. 470 (52%) were older than 60 years; 530 (59%) were women and 366 (41%) were men. 172 (19%) patients were vaccinated and 724 (81%) patients were not vaccinated (resulting in a ratio of 1:4). According to the type of health insurance, the vaccine was administered to 26 (12%) of 211 patients in the subsidised plan and to 146 (21%) of 685 patients in the contributive plan. The rate of vaccination according with socioeconomic status was 69 (16%) of 430 patients in the low-income group, 75 (23%) of 329 in middle-income group, and 12 (29%) of 42 in high-income group. The cumulative incidence of mortality for all causes was 17% (n=123) in the non-vaccinated cohort and 5% (n=8) in vaccinated cohort. The cumulative incidence of mortality per health-care insurance was 24% (n=50) in the subsidised plan and 12% (n=81) in the contributive plan. The adjusted RR for mortality was 3·4 (95% CI 1·7–6·8) in unvaccinated versus vaccinated patients, and 1·8 (1·3–2·4) in patients on the subsidised versus the contributive plan.InterpretationPatients on the subsidised health plan in Colombia had higher mortality due to COVID-19 infection and less access to vaccines than patients with a contributive plan. Strategies to promote COVID-19 vaccination for all patients with cancer should be strengthened, with implementation of special measures to improve care for the low-income population.FundingNone.

Forests, Fields, and Pastures: Unequal Access to Brazil Nuts and Livelihood Strategies in an Extractive Reserve, Brazilian Amazon

This article examines access to an economically important forest product (Brazil nuts) and its relationship with livelihood strategies in the Cazumbá–Iracema Extractive Reserve (CIER), Acre, Brazil. The objective is twofold: (i) to clarify how social mechanisms regulating access to Brazil nuts operate and (ii) to analyse the relationship between differential access to Brazil nuts and livelihood diversification in terms of cash income. For this, we conducted 55 semi-structured interviews with household heads in three rubber tapper (seringueiro) communities. Our findings indicate that Brazil nuts are important to seringueiro livelihoods, although both access to Brazil nuts and livelihood strategies are highly variable between households and communities. Limited access to Brazil nuts is partly overcome through informal arrangements and investment in wage labour, swidden agriculture, and cattle raising, as part of highly diversified livelihood portfolios. However, restrictions to agriculture and cattle raising generate considerable tensions between many seringueiros and environmental managers. We highlight the importance of viewing livelihood diversification and adaptability as important components of the long-term viability of the extractive reserve model, particularly in the context of the growing uncertainties and risks associated with accelerating climate and socio-environmental change as well as amidst ongoing political dynamics in Brazil.

Examining the impact of COVID-19 vaccination rates on differential access to critical care

The measurement of potential access to health care has focused primarily on what might be called “place-based” access or the differential access among geographic locations rather than between different populations. The vaccination program to inoculate the population against the effects of the COVID-19 virus has created two different at-risk populations. This research examines the impact of COVID-19 vaccination rates on access to critical care for persons fully-vaccinated versus those not fully-vaccinated. In this situation, additional tools are necessary to understand: 1) if there is a significant difference in accessibility between different populations, 2) the magnitude of this difference and how it is distributed across accessibility levels, and 3) how the differences between groups are distributed across the state. A study of access to intensive care unit (ICU) beds by these two populations for the state of Illinois found that although there was a statistically significant difference in access, the magnitude of differences was small. A more important difference was being located in the Chicago Area of the state. The not-fully vaccinated in the Chicago Area had higher than expected spatial access due to the lower need for ICU beds by a higher percentage of fully vaccinated people.

Parenting in a new world: migration, social class, and parenting, and links to academic outcomes in China

Existing research has conceptualized educational inequalities between migrant and urban youth in China primarily as an issue of differential access to education. Focusing on parenting practices and the intersection of migrant and social class status—and in particular parental education—we use a novel dataset of six-year-olds in Shanghai and show that although migrants, on average, use less effective parenting practices than urbanites overall, these differences reverse, or lessen, after taking parental education into account. Moreover, parental education is more important for both parenting and children’s education outcomes for migrant families than urban families, suggesting the differential importance of social class for migrant groups.

Who Bears the Brunt of Lockdown Policies? Evidence from Tele-workability Measures Across Countries

Lockdowns imposed around the world to contain the spread of the COVID-19 virus and its variants had a differential impact on economic activity and jobs owing to differences in the ability to work remotely. This paper presents a new index of the feasibility to work from home to investigate which types of jobs are most at risk for 35 advanced and emerging market economies. Cross-country heterogeneity in the ability to work remotely reflects differential access to and use of technology, sectoral mix, and occupational selection. Workers least likely to work remotely tend to be young, without a college education, working for non-standard contracts, employed in smaller firms, and those at the bottom of the earnings distribution, suggesting that the pandemic has exacerbated inequality. Policies should account for demographic and distributional considerations both during the crisis and in its aftermath.

Reducing the Fuel Use Intensity of Fisheries: Through Efficient Fishing Techniques and Recovered Fish Stocks

Understanding the drivers of greenhouse gas emissions in food production systems is becoming urgent. For wild capture fisheries, fuel use during the fishing phase generally dominates emissions and is highly variable between fisheries. Fuel use is also essential for the economy of the fisheries, but fuel-intensive fisheries can still be profitable due to fuel subsidies, in particular, if the target species is of high value. Developing an innovative bottom-up approach based on detailed catch and spatial fishing effort data, in the absence of direct fuel data, we analysed the fuel use intensity (fuel use per kg landed) and economic efficiency (landing value per litre fuel used) of Danish capture fisheries for the period 2005-2019. An overall decline in fishing effort did not significantly affect the overall fuel use intensity and efficiency, which was stable for most of the fleet segments and marine species. Robust differences in fuel use intensity among individual fisheries, reflected differential spatial accessibility and vulnerability of target species to fishing. In addition, different fishing techniques targeting the same set of species showed differences in fuel use per unit landed. Danish seining and gillnets had a lower fuel use intensity and higher economic efficiency than demersal trawling; and purse seining than pelagic trawling. The variability between stocks and fleets also indicates that there is generally potential for improvement in overall efficiency from improved stock status. Short-term management actions to promote the best available fuel-efficient fishing techniques combined with additional long-term actions to secure the recovery of stocks have the potential to reduce fishery greenhouse gas emissions. Sustainable fisheries and normative environmental management are crucial to developing incentives towards reducing fuel use whenever the fishing sector industry and science work jointly at implementing solutions, as incentives for the industry to reduce fuel use are limited as long as the fishing activity is profitable.

Identification and classification of cis-regulatory elements in the amphipod crustacean Parhyale hawaiensis.

Emerging research organisms enable the study of biology that cannot be addressed using classical 'model' organisms. New data resources can accelerate research in such animals. Here, we present new functional genomic resources for the amphipod crustacean Parhyale hawaiensis, facilitating the exploration of gene regulatory evolution using this emerging research organism. We use Omni-ATAC-seq to identify accessible chromatin genome-wide across a broad time course of Parhyale embryonic development. This time course encompasses many major morphological events, including segmentation, body regionalization, gut morphogenesis and limb development. In addition, we use short- and long-read RNA-seq to generate an improved Parhyale genome annotation, enabling deeper classification of identified regulatory elements. We discover differential accessibility, predict nucleosome positioning, infer transcription factor binding, cluster peaks based on accessibility dynamics, classify biological functions and correlate gene expression with accessibility. Using a Minos transposase reporter system, we demonstrate the potential to identify novel regulatory elements using this approach. This work provides a platform for the identification of novel developmental regulatory elements in Parhyale, and offers a framework for performing such experiments in other emerging research organisms.

Experiences and Perceived Outcomes of a Grocery Gift Card Program for Low-Income Households at Risk of Food Insecurity

ObjectivesHousehold food insecurity negatively affects children’s diet quality, physical and mental health, and academic performance. I Can for Kids’ (IC4K) grocery gift card (GGC) program provides GGC to low-income households with school-aged children at risk of household food insecurity in Calgary, Canada. This study described program recipients’ and facilitators’ experiences and perceived outcomes of accessing or facilitating IC4K’s GGC program. MethodsThis study used qualitative descriptive methodology. Data generation and analysis were guided by Freedman et al’s theoretical framework of nutritious food access. Semi-structured interviews were conducted between August and November 2020 with 37 program recipients and 17 program facilitators who were purposively recruited. Directed content analysis was used to analyze the data using a deductive-inductive approach. Codes were combined into subthemes and themes that summarized program recipients’ and facilitators’ experiences and perceived outcomes of receiving or distributing GGC, and suggestions to improve IC4K’s GGC program. ResultsThree themes were generated from the data: 1) IC4K’s GGC program promoted a sense of autonomy and dignity among program recipients; 2) recipients used GGC to purchase foods that improved household dietary patterns and food skills, including foods that aligned with health-related food needs and cultural foodways and; 3) program logistical strengths and limitations, including the program’s impact on facilitators’ connection with clients and their workload, experiences of differential access to GGC among recipients, and the importance of increasing program awareness to reach more food insecure households. ConclusionsIC4K’s GGC program enhanced recipients’ access to nutritious foods, had positive impacts on household finances and diet quality, as well as recipients’ social health and emotional wellbeing. However, differential access to GGC among recipients was also identified. Study findings were used to inform three recommendations to improve IC4K’s GGC program: 1) increase the number of GGC that recipients can receive; 2) establish concrete guidelines governing GGC distribution and; 3) increase program awareness. Funding SourcesO’Brien Institute for Public Health.

Optimising the use of physiotherapy resources after manipulation under anaesthetic for frozen shoulder.

Manipulation under anaesthetic (MUA) is a successful treatment for frozen shoulder (FS), and the recovery period and recurrence rates may be reduced by postoperative physiotherapy. This study evaluates two physiotherapy pathways for patients undergoing MUA for FS. Between 2016 and 2018, 248 age- and sex-matched patients presented to either a NHS secondary care upper limb service or the lead author's independent practice with a diagnosis of FS. The patients had differential access to postprocedure physiotherapy based on which service they presented to. In Group1, physiotherapy advice only was given to the patient. In Group2, supervised hydrotherapy and physiotherapy occurred postoperatively. Pre- and postprocedure Oxford Shoulder Scores (OSS) were collected for each group. Analysis of covariance (ANCOVA) was used to measure the effect of physiotherapy on postoperative OSS. Group2 showed a significantly greater improvement in postprocedure OSS when compared with Group 1 (18.2 vs 16.7) p<0.001). The estimated maximum effect of physiotherapy on postoperative OSS was an increase of 3.2. Following MUA for FS, a statistically significant increase in OSS was detected in patients receiving postprocedure physiotherapy compared with advice alone. There was no difference in recurrence rates. The increase in OSS (3.2) is below the minimal clinically important difference, raising questions regarding the relative importance of postprocedure physiotherapy in a resource-limited environment.

Validation of a neighborhood-level COVID Local Risk Index in 47 large U.S. cities.

ObjectivesTo present the COVID Local Risk Index (CLRI), a measure of city- and neighborhood-level risk for SARS COV-2 infection and poor outcomes, and validate it using sub-city SARS COV-2 outcome data from 47 large U.S. cities.MethodsCross-sectional validation analysis of CLRI against SARS COV-2 incidence, percent positivity, hospitalization, and mortality. CLRI scores were validated against ZCTA-level SARS COV-2 outcome data gathered in 2020–2021 from public databases or through data use agreements using a negative binomial model.ResultsCLRI was associated with each SARS COV-2 outcome in pooled analysis. In city-level models, CLRI was positively associated with positivity in 11/14 cities for which data were available, hospitalization in 6/6 cities, mortality in 13/14 cities, and incidence in 33/47 cities.ConclusionsCLRI is a valid tool for assessing sub-city risk of SARS COV-2 infection and illness severity. Stronger associations with positivity, hospitalization and mortality may reflect differential testing access, greater weight on components associated with poor outcomes than transmission, omitted variable bias, or other reasons. City stakeholders can use the CLRI, publicly available on the City Health Dashboard (www.cityhealthdashboard.com), to guide SARS COV-2 resource allocation.