Disposition Patterns Research Articles

Cardiac Arrest Mortality and Disposition Patterns in United States Emergency Departments.

Background: Despite resuscitative efforts, cardiac arrest (CA) continues to result in high mortality and poor prognosis. However, a gap remains in understanding the comparative outcomes of efforts in emergency departments (ED) over recent years. This study evaluated patients with CA during ED visits, with a particular focus on outcomes of mortality and transition of care. Methods: We conducted a retrospective cohort analysis using the National Emergency Department Sample (NEDS) database. The study population included patients aged 18 years or older who visited the ED between January 2016 and December 2020. Statistical analysis of patients and hospital characteristics included chi-squared tests for independence and multivariable logistic regression models to report the associations of factors with mortality in the ED and disposition from the ED. The primary outcome measured was mortality in the ED, and the secondary outcome included transition of care. Results: A total of 699,822,424 ED visits occurred between 2016 and 2020, with 1,414,060 (0.20%) CAs. The survival rate from CA ranged from 24.6% to 28.1%. In 2020, the rate of ED CA increased to 0.27%, with an inpatient mortality rate of 58.8%. There was no significant difference in mortality between sexes (p = 0.690). There was a trend for higher mortality in the ED among patients who were self-paid. Notably, the odds of transfer from the ED to other hospitals were significantly lower in minority groups. Conclusions: Our results showed significant disparities in ED mortality and patient disposition following cardiac arrest, highlighting the need for equitable healthcare resources and policies.

The Tissue-Specific Eco-Exposome: Differential Pharmaceutical Bioaccumulation and Disposition in Fish among Trophic Positions.

Though bioaccumulation of pharmaceuticals by aquatic organisms continues to receive scientific attention, the internal disposition of these contaminants among different tissue compartments of fish species has been infrequently investigated, particularly among fish at different trophic positions. We tested a human to fish biological read-across hypothesis for contaminant disposition by examining tissue-specific accumulation in three understudied species, longnose gar (Lepisosteus osseus; piscivore), gizzard shad (Dorosoma cepedianum; planktivore/detritivore), and smallmouth buffalo (Ictiobus bubalus; benthivore), from a river influenced by municipal effluent discharge. In addition to surface water, fish plasma, and brain, gill, gonad, liver, and lateral muscle fillet tissues were analyzed via isotope dilution liquid chromatography tandem mass spectrometry. Caffeine and sucralose, two common effluent tracers, were quantitated at low micrograms per liter levels in surface water, while an anticonvulsant, carbamazepine, was observed at levels up to 37 ng/L. The selective serotonin reuptake inhibitors (SSRIs) fluoxetine and sertraline and primary metabolites were detected in at least one tissue of all three species at low micrograms per kilogram concentrations. Within each species, brain and liver of select fish contained the highest levels of SSRIs compared to plasma and other tissues, which is generally consistent with human tissue disposition patterns. However, we observed differential accumulation among specific tissue types and species. For example, mean levels of sertraline in brain and liver tissues were 13.4 µg/kg and 1.5 µg/kg in gizzard shad and 1.3 µg/kg and 7.3 µg/kg in longnose gar, respectively. In contrast, smallmouth buffalo did not consistently accumulate SSRIs to detectable levels. Tissue-specific eco-exposome efforts are necessary to understand mechanisms associated with such marked bioaccumulation and internal dispositional differences among freshwater fish species occupying different trophic positions. Environ Toxicol Chem 2024;43:1894-1902. © 2024 The Author(s). Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Patterns of Acute Ischemic Stroke Treatment from 2010 to 2020: An Evolving Landscape in Stroke Management Following Thrombectomy Trials.

Population-based studies on stroke can help guide the care of patients with acute ischemic stroke (AIS) by providing health care communities with information regarding the current usage of stroke treatments. It remains unclear how rapidly new techniques, particularly endovascular stroke treatment (EST), are being adopted and whether there is any disparity in their availability. Although studies using the National Inpatient Sample (NIS) have been conducted, updated studies over a longer period may provide further insights. This study aimed to understand patterns of AIS treatment, discharge disposition, in-hospital mortality, and mean length of stay (LOS) for each modality from 2010 to 2020 using the NIS database. This retrospective longitudinal study was conducted using NIS data from 2010 to 2020. Patients were categorized into groups based on whether they received intravenous recombinant tissue plasminogen activator (rt-PA), EST, both rt-PA and EST (combined therapy), or supportive care alone. Demographic, socioeconomic, regional, insurance, and hospital data were also obtained. The primary outcome was the proportion of patients receiving each modality, whereas the secondary outcomes were in-hospital mortality, mean LOS, and discharge disposition. The usage rates increased (p < 0.001) in all groups between 2010 and 2020 (rt-PA: 5.09% to 8.39%, EST: 0.31% to 4.40%, and rt-PA+EST: 0.46% to 1.09%). The highest increase in usage was observed for EST, with a thirteen-fold increase. Mortality decreased from 2010 to 2020 in all groups (rt-PA: 8.45% to 3.54%, EST: 25.22% to 12.50%, and rt-PA+EST: 21.12% in 2010 to 9.30%) (p < 0.001). Combination therapy demonstrated the greatest improvement, with an 11.2% reduction in absolute mortality. Mean LOS was reduced for patients who received rt-PA (6.8 to 4.8 days), EST (9.3 to 8.9 days), and combined therapy (10.0 to 8.3 days) (p < 0.001) over the study period. The proportion of patients discharged to home increased for rt-PA (29.01% to 41.85%), EST (14.13% to 17.70%), and combined therapy (12.89% to 24.29%) (p < 0.001). Overall, stroke treatment usage was higher among the higher income groups, regardless of race. Higher usage was also observed for Whites in the West and Hispanic ethnicities in the South and West. Regardless of income or treatment method, utilization rates were lower for Black patients. Utilization rates were lower for Black patients with Medicare, Medicaid, or self-pay than for White patients. Our study demonstrated that endovascular stroke treatment continues to expand, leading to better outcomes for mortality, LOS, and home discharge. Despite these positive patterns, there are visible inequities across regions, income status, and races.

Pharmacokinetics of desflurane uptake and disposition in piglets.

Many respiratory but few arterial blood pharmacokinetics of desflurane uptake and disposition have been investigated. We explored the pharmacokinetic parameters in piglets by comparing inspiratory, end-tidal, arterial blood, and mixed venous blood concentrations of desflurane. Seven piglets were administered inspiratory 6% desflurane by inhalation over 2h, followed by a 2-h disposition phase. Inspiratory and end-tidal concentrations were detected using an infrared analyzer. Femoral arterial blood and pulmonary artery mixed venous blood were sampled to determine desflurane concentrations by gas chromatography at 1, 3, 5, 10, 20, 30, 40, 50, 60, 80, 100, and 120min during each uptake and disposition phase. Respiratory and hemodynamic parameters were measured simultaneously. Body uptake and disposition rates were calculated by multiplying the difference between the arterial and pulmonary artery blood concentrations by the cardiac output. The rates of desflurane body uptake increased considerably in the initial 5min (79.8ml.min-1) and then declined slowly until 120min (27.0ml.min-1). Similar characteristics of washout were noted during the subsequent disposition phase. Concentration-time curves of end-tidal, arterial, and pulmonary artery blood concentrations fitted well to zero-order input and first-order disposition kinetics. Arterial and pulmonary artery blood concentrations were best fitted using a two-compartment model. After 2h, only 21.9% of the desflurane administered had been eliminated from the body. Under a fixed inspiratory concentration, desflurane body uptake in piglets corresponded to constant zero-order infusion, and the 2-h disposition pattern followed first-order kinetics and best fitted to a two-compartment model.

How a nursing navigation role enhances patient recovery across Orthopedic Integrated Pathways

Introduction: Our academic urban institution developed an integrated care pathway that has significantly improved patient transitions to outpatient rehabilitation after total joint replacement (TJR) and as patients requested, supports their earlier discharge from a hospital to home to recover. Early recovery at home has identified a need for care navigation, particularly for patients with a higher complexity of medical and social issues. Implementation of a nursing role for care navigation into our existing integrated pathways would provide support for patients receiving TJR surgery ensuring better coordination of services in their community. &#x0D; Aims, Objectives and Methodology: Our objective was to evaluate an IC nursing lead (ICL) role embedded in our existing orthopedic TJR integrated pathway to support “extended” care patients to safely discharge home. Process mapping sessions conducted in 2019-20, that included key stakeholders and patient partners, identified gaps in communication and care coordination before and after surgery affecting overall patient experience and surgical recovery.&#x0D; “Extended” care patients were identified by the orthopedic care team using a standardized referral form developed in conjunction with the ICL. Patients were contacted 1-2 weeks pre-surgery and supported at various pre-operative time points with care coordination. An in-person visit with the patient occurred on the day of surgery and prior to discharge from hospital. A standard 24-hr post-op phone call was completed once the patient returned home. The ICL could be engaged by the patient or care team at any point across the TJR journey (between consent and day of surgery, acute inpatient stay, and up to 90 days post-surgery.&#x0D; Key Findings: The ICL role, piloted in March 2022, started with gradual enrolment of patients across 2 arthroplasty surgeons. By August 2022, all 6 arthroplasty care teams (surgeons, physiotherapist practitioners, fellows, physician assistants and admins) were committed to this model of care. ICL patients were 41% male and 59% female ranging in age from 50-92 (mean age of 78). Inpatient pts represented 94% (ALOS 1-2 days). Discharge (DC) disposition patterns aligned with existing best practice guidelines. Discharge coordination made up the bulk of support (82%) provided by the ICL. Other key themes and interventions included emotional reassurance (32%), education/expectation setting (30%), information on community resources and services (18%), arrangement of homecare (6%), other miscellaneous questions (5%). The average time spent for care coordination was 90 mins per patient over the 90 day period.&#x0D; Qualitative report from ICL patients revealed improved patient experience with the degree of detail and support provided. "I'm so glad I can call you. I don't always know who to talk to when I have questions". "It's so good to have someone pick up the phone when I need an answer when everything is closed".&#x0D; Conclusions: Early findings highlight the benefits of an ICL in improving care quality of patients undergoing TJR and enabling coordinated transitions post discharge from hospital through to their recovery at home. As hospital stays for TJR becoming exceedingly shorter this type of role becomes even more critical, especially with increased patient needs in the aftermath of COVID-19.&#x0D; &#x0D;

A Machine Learning Approach Unveils the Relationships between Sickness Behavior and Interoception after Vaccination: Suggestions for Psychometric Indices of Higher Vulnerability.

Prior research has suggested a possible connection between vaccination and manifestations of Sickness Behavior; however, a need remains to first delve deeper into this association and second examine how Interoceptive Awareness and emotional factors may modulate individuals' perceptions of their health status post vaccination. An online retrospective cross-sectional survey of 647 individuals who received a COVID-19 vaccination was conducted. Together with vaccination side effects, socio-demographic characteristics, health status, level of concern about vaccination, and Interoceptive Awareness were collected at the baseline level. Mood, sleep, and Sickness Behavior were assessed at baseline and after vaccination. Data were analyzed using inferential statistics and machine learning techniques. After vaccination, there was a significant increase in Sickness Behavior levels (mean (±SD) SicknessQ T0 = 1.57 (±2.72), mean (±SD) SicknessQ T1 = 5.54 (±5.51); p-value = 0.001; ES = 0.77). A Machine Learning analysis revealed specific patterns of individual dispositions (sex and age), baseline emotional characteristics (levels of depression, anxiety, stress, and concern about adverse reactions), as well as some components of Interoceptive Awareness (Noticing, Body Listening, and Attention Regulation), as predictors of high levels of Sickness Behavior, both in terms of overall scores (JRIP: 72.65% accuracy, AUC = 0.692, d = 0.709; F1 = 0.726) and individual items (JRIP: 75.77% accuracy, AUC = 0.694; d = 0.717; F1 = 0.754). Our results provide new insight into post-immune reactions by highlighting the contribution of Interoceptive Awareness in modulating the severity of Sickness Behavior. This sheds light on the role of awareness of bodily sensations in modulating perceptions of health status, helping to identify the characteristics that make individuals more prone to feeling sick.

Cross-Cultural Comparisons of Achievement Goal and Motivational Disposition Patterns of Middle School Students with and without risk for Learning Disability in South Korea and the United States Using Diagnostic Classification Model: Evidence From PISA 2018

Cross-Cultural Comparisons of Achievement Goal and Motivational Disposition Patterns of Middle School Students with and without risk for Learning Disability in South Korea and the United States Using Diagnostic Classification Model: Evidence From PISA 2018

Disparities Associated with Discharge Patterns in Firearm-Associated Ocular Trauma

Firearm injuries are associated with devastating visual outcomes. Several studies have demonstrated disparities in trauma care and discharge to rehabilitation and other advanced care facilities (ACFs) due to race and ethnicity and insurance status. The identification of possible disparities in disposition of patients admitted with firearms-associated ocular injuries (FAOIs) is a crucial step in moving toward health equity. To describe disposition patterns following admission for FAOI trauma. This retrospective analysis of National Trauma Data Bank (NTDB) from 2008 through 2014 used hospitalized trauma cases from over 900 US facilities detailed in the NTDB. Participants included patients admitted with ocular injuries. Statistical analysis was conducted between April 16, 2017, and December 15, 2021. Firearm injuries. Patients admitted with FAOIs were identified using International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes and E-codes. Demographic data, location, injury type and severity, and insurance status were documented. The primary outcome was the odds of discharge to ACFs. A total of 8715 of 235 254 firearms injuries involved the eye (3.7%). Of the 8715 included patients, 7469 were male (85.7%), 3050 were African American (35.0%), and 4065 White (46.6%), with a mean (SD) age of 33.8 (16.9) years. Common payments were government insurance (31.5%), self-paid insurance (29.4%), and commercial insurance plans (22.8%). Frequent dispositions were home (48.8%) and ACF (20.5%). Multivariate analysis demonstrated that the following factors were associated with the highest odds of discharge to an ACF: hospital stays 6 days or longer (odds ratio [OR], 3.05; 95% CI, 2.56-3.63; P < .001), age 65 years or older (OR, 2.94; 95% CI, 1.94-4.48; P < .001), associated traumatic brain injury (OR, 2.32; 95% CI, 1.94-2.78; P < .001), severe traumatic brain injury (OR, 2.10; 95% CI, 1.79-2.46; P < .001), and very severe Injury Severity Score (OR, 2.22; 95% CI, 1.88-2.62; P < .001). White race (OR, 2.00; 95% CI, 1.71-2.33; P < .001) was associated with higher odds than Medicare insurance (OR, 1.64; 95% CI, 1.16-2.31; P = .01). These findings suggest that older, more severely injured, Medicare-insured, or White patients have higher odds of ACF placement than younger, less severely injured, otherwise insured, and Black and Hispanic patients. This study is limited by its retrospective nature and the study team was unable to explore the basis for these disposition differences. Nevertheless, this work highlights that disparities may exist in disposition after FAOIs that may limit the rehabilitation potential of specific populations.

Changing disposition patterns in the era of COVID-19 after colon resections: A National Surgical Quality Improvement Program colectomy study

BackgroundThe COVID-19 pandemic severely impacted post-hospitalization care facilities in the United States and hindered their ability to accept new patients for various reasons. This study aimed to assess the impact of the pandemic on discharge disposition after colon surgery and associated postoperative outcomes. MethodsA retrospective cohort study was performed using the National Surgical Quality Improvement Participant Use File and targeted colectomy. Patients were divided into the following 2 cohorts: (1) pre-pandemic (2017–2019) and (2) pandemic (2020). The primary outcomes included discharge disposition—post-hospitalization facility versus home. The secondary outcomes were rates of 30-day readmissions and other postoperative outcomes. The multivariable analysis assessed for confounders and effect modification on discharge to home. ResultsDischarge to posthospitalization facilities decreased by 30% in 2020 compared to 2017 to 2019 (7% vs 10%, P < .001). This occurred despite an increase in emergency cases (15% vs 13%, P < .001) and open surgical approach (32% vs 31%, P < .001) in 2020. Multivariable analysis revealed that patients in 2020 had 38% lower odds of going to post-hospitalization facilities (odds ratio 0.62, P < .001) after adjusting for surgical indications and underlying comorbidities. This decrease in patients going to a post-hospitalization facility was not associated with an increased length of stay or an increase in 30-day readmissions or postoperative complications. ConclusionDuring the pandemic, patients undergoing colonic resection were less likely to be discharged to a post-hospitalization facility. This shift was not associated with an increase in 30-day complications. This should prompt further research to assess the reproducibility of these associations, especially in a setting without a global pandemic.

Demystifying treatment disposition patterns for psychiatrically high-risk youth referred for intensive outpatient psychiatric services: The role of demographics and telehealth.

Intensive outpatient (IOP) psychiatric treatment is increasingly deployed to meet the needs of psychiatrically high-risk youth; however, documentation of treatment disposition for in-person and/or telehealth modalities following treatment referral is largely unknown. The current study examined psychiatrically high-risk youth baseline treatment disposition patterns and explored variations according to treatment modality (telehealth vs. in-person). Using archival records of 744 adolescents (Mage = 14.91, SD = 1.60) admitted to a psychiatric IOP, multinomial logistic regressions revealed that commercially insured youth fared better than non-commercially insured youth with respect to treatment completion. When treatment modality was accounted for, youth treated on telehealth were no more likely to be psychiatrically hospitalized compared to youth treated with in-person services. However, youth treated on telehealth dropped out due to excessive absences or withdrawal/refusal to a greater extent than those treated in person. Future studies should examine clinical outcomes in addition to treatment disposition patterns to further understand youth's course of treatment at intermediate level of care settings (e.g., IOP).

Factors shaping faculty online teaching competencies during the Covid-19 pandemic.

In the rush for the Covid-19 pandemic's online transition, the pursuit of quality online learning was frequently overshadowed by the urgency of emergency instruction online. As blended and online teaching became an integral part of education, there emerged a need to investigate how faculty coped with this transition and what competencies they might be acquiring.In this paper, we report on international research about higher education faculty's elicited dispositions and needs while they engaged with online teaching (OT), as these shape aspects of teacher competencies for integrating technology. This study aims to identify factors that shaped faculty competencies as pandemic restrictions forced transitions to OT. Snapshot surveys were conducted at two different phases of the pandemic, i.e. during the acceleration phase and the stasis one, approximately twelve months later. The surveys inquired about internal (e.g. enthusiasm and resolutions) and external (e.g. support) factors of faculty's OT perceptions during two phases of the Covid-19 pandemic, enabling monitoring of the phenomenon beyond the assessment of the first response to the emergency. Results revealed different patterns of dispositions and diverse uses of technological affordances to foster online learning. These patterns were also found to differ over time, highlighting conditions possibly enabling or hindering the development of competencies for OT during different phases of the pandemic. One important finding is that there was a change from internal confidence to institutional support being a strong predictor of intentions to continue OT, over the course of the Covid-19 pandemic.

Disposition Patterns of Colorectal Surgery Patients in the Era of COVID-19

Disposition Patterns of Colorectal Surgery Patients in the Era of COVID-19

Cognitive Disposition, Self-Determination and Attitude to Keyboarding as Determinants of Students’ Achievement in Word Processing in Colleges of Education, South-West, Nigeria

The declining trend in performance of Business Education students in word processing has become worrisome to stakeholders most especially business education lecturers. This study therefore examined cognitive disposition, self-determination, and attitude to keyboarding as determinants of students’ achievement in word processing in colleges of education in South-West, Nigeria.This study adopted a descriptive survey research design type. A sample of 1,346 students was selected through stratified random sampling technique from a population of 6,035 college of education students in South-West, Nigeria. Five research instruments were used for data collection. They are: Demographic Data Inventory, Cognitive Disposition Inventory (=0.89), Self-Determination Scale (=0.86), Attitude to Keyboarding Scale (=0.76) and Word Processing Achievement Test (=0.89). The null hypotheses were tested using Multiple Regression Analysis at 0.05 level of significance.The finding revealed that cognitive disposition, self-determination, and attitude to keyboarding significantly predict students’ academic achievement in Word Processing (F(3, 1342) = 31.807, p &lt;.05). In the same vein, cognitive disposition (= .317, t=21.605, p &lt; .05), self-determination (=.226, t=12.449, p &lt; .05), and attitude to keyboarding (=.208, t=10.194, p &lt; .05) have relative contributions to the prediction of academic achievement in Word Processing among the students.It was therefore recommended, among others, that Business Education Lecturers in Colleges of Education should identify those strong cognitive disposition patterns in their classes and utilize fitting approaches to accommodate individual cognitive disposition preferences in their pedagogy. Educators should continually promote self-determination via both intrinsic and extrinsic motivation by helping learners to focus not only on the extrinsic rewards they gain after they accomplish tasks but to also inculcate the intrinsic value in their learning of Word Processing.

Waiting for Care: Length of Stay for ED Mental Health Patients by Disposition, Diagnosis, and Region (2009-2015).

ObjectiveEmergency departments (EDs) face increasing mental health visits on a backdrop of insufficient mental health resources. We study ED length of stay (LOS) and disposition by 1) mental health vs. medical visits; 2) psychiatric vs. substance use visits; and 3) the four regions of the United States. MethodsWe used weighted data from the National Hospital Ambulatory Medical Care Survey (2009-2015). Visits by patients ages 18-64 were categorized into mental health and medical groups. The mental health group was then subdivided into psychiatric, substance use, and co-occurring disorders. The LOS was compared by disposition. Mental health vs. medical LOS and disposition were examined across four regions of the US.ResultsAn estimated 28 million mental health and 526 million medical visits were included in the study. Mental health visits had a median (interquartile range [IQR]) of 3.7 (4.7) hours while medical visits had a median (IQR) of 2.6 (2.7) hours. Mental health compared to medical visits were more likely to result in admission or transfer and to last >6 and >12 hours. Mental health visits resulting in transfer had the longest LOS with a median (IQR) of 6.23 (7.7) hours. Of mental health visit types, co-occurring disorders visits were more likely to be >6 and >12 hours regardless of disposition. Across US regions, there was significant variation in disposition patterns for mental health vs. medical visits. The odds of mental health visits lasting >6 and >12 hours were greatest in the Northeast and the least in the South with a median (IQR) of 4.6 (5.8) hours and 3.3 (4.0) hours, respectively.ConclusionsMetal health compared to medical visits had longer LOS, especially when the patient had co-occurring disorders or required transfer. Regionally, there is a large variation in disposition for mental health vs. medical visits. This study makes it clear that there are no standards for managing psychiatric emergencies.

Imaging Tumor Heterogeneity and the Variations in Nanoparticle Accumulation Using Perfluorooctyl Bromide Nanocapsule X‐Ray Computed Tomography Contrast

AbstractSystemically administered nanoparticles can extravasate into solid tumors through active or passive processes, showing high inter‐ and intraindividual variability, leading to inconsistent nanomedicine disposition in tumor lesions and variable therapeutic outcomes. Radio‐opaque Perfluorooctyl bromide‐loaded PEGylated cholesteryl‐functionalized polycaprolactone (PEG‐b‐PCL(Ch)) nanocapsules (PFOB NC) are assessed as imaging probes via X‐ray Computed Tomography (CT) as means to estimate nanoparticle disposition in solid tumors. This imaging platform can enable precision medicine by screening tumors for likelihood of nanoparticle accumulation prior to treatment. Single‐ and double‐lateral xenograft models are employed for imaging‐based nanoparticle accumulation assessment using a preclinical multimodal imaging system. Differences in tumor accumulation and spatial distribution are verified as a function of xenograft type via X‐ray CT and further corroborated by optical imaging. Slow growing OVCAR‐8 xenografts display granular distribution pattern and higher levels of PFOB NC disposition on a volume‐normalized basis. A549 xenografts, displaying faster growth, are less susceptible to PFOB NC accumulation and show only a diffuse‐like spatial distribution of the nanocapsule contrast. A direct correlation between tumor dispositions of PFOB NC and a commercial PEGylated liposomal doxorubicin formulation is found. This study highlights the potential of using nanoparticle‐based radio‐opaque contrasts to better understand nanoparticle disposition and foster improved therapeutic outcomes in cancer nanomedicine.

Systems model identifies baseline cytokine concentrations as potential predictors of rheumatoid arthritis inflammatory response to biologics.

Circulating cytokines are central pathological mediators of inflammatory autoimmune diseases like rheumatoid arthritis. Immunological diversity in patients might contribute to inadequate responses to biological drugs. To address this therapeutic challenge, we developed a mathematical model that simultaneously describes temporal patterns of drug disposition for several biologics and their corresponding targeted cytokines, which were linked to triggering inflammatory responses. A modelling framework was applied to rheumatoid arthritis-relevant cytokines regulating C-reactive protein (CRP) as an inflammatory marker. Clinical data were extracted from the literature for anakinra, canakinumab, infliximab, secukinumab and tocilizumab, along with their corresponding cytokines, interleukin-1 receptor antagonist, IL-1β, tumour necrosis factor α (TNFα), IL-17A and IL-6 receptor (IL-6R). Based on prior knowledge of regulatory mechanisms, cytokines were integrated with CRP profiles. The model well captured all serum concentration-time profiles of cytokines and CRP ratios to respective baselines following drug treatment with good precision. On external validation, reasonable model performance on CRP dynamics, including rebound effects, was confirmed with clinical data not used in model development. Model-based simulations demonstrated that serum infliximab concentrations were accurately recapitulated in both a dose- and baseline TNFα-dependent manner. Furthermore, high baseline profiles of both IL-1β and/or targeted cytokines could be predictors of poor responses to biologics targeting TNFα and IL-6R, although the impact of IL-1β must be carefully interpreted. Our model provides a quantitative platform to guide targeting and dosing strategies, including combination and/or sequential therapy, according to distinct baseline cytokine patterns in rheumatoid arthritis patients.

Disparities in discharge patterns of admitted older patients with ocular trauma

PurposeIn older patients, poor vision from ocular trauma increases the likelihood of further injuries and repeat hospitalizations, underscoring the need for appropriate post-hospitalization care. We sought to evaluate disposition patterns of older patients admitted with ocular trauma. Methods/MaterialsThis retrospective observational study analyzed the National Trauma Data Bank (2008–2014) and de-identified data of patients, ≥65 years old, admitted with ocular trauma were identified using ICD-9CM and E-codes. Age, gender, race/ethnicity, type of ocular injury, comorbidities, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) score, length of hospital stay, location and US region, insurance, and discharge disposition were extracted. Analysis was performed with student's t-test, Chi-squared test, and odds ratios (OR) using SPSS software. Statistical significance was set at P <.05. Results58,074 (18.3%) of 316,485 patients admitted with ocular trauma were >65yrs. 26,346 (45.4%) were discharged home and 23,314 (40.1%) to an advanced care facility (ACF). Nursing home residents were most likely to return to ACF (OR, 4.76; 95%CI, 4.40–5.14; P < .001). Patients with severe traumatic brain injury (Glasgow coma score [GCS]<8) (OR, 4.57; 95%CI, 4.09–5.11; P < .001), very severe injury severity score (ISS ≥24) (OR, 3.73; 95%CI, 3.46–4.01; P < .001), females (OR, 1.27; 95%CI, 1.23–1.32; P < .001), white patients (OR, 1.29; 95%CI, 1.24–1.36; P < .001) and Medicare beneficiaries (OR, 1.14; 95%CI, 1.09–1.19; P < .001) were most likely to be discharged to an ACF. Demography-related discharge propensities prevailed nationwide and within insurance categories. Multivariate regression analysis revealed factors determining ACF placement were, in order: length of hospital stay, nursing home residency, GCS<8, ISS>24, female gender, white race, and Medicare insurance. ConclusionsHispanic, black, male, and self-paying patients were disproportionately discharged home. Ocular injuries had low impact on ACF placement. Understanding these disparities will assist in developing guidelines for appropriate and equitable post-trauma rehabilitation in this vulnerable population.

Migraine in the Emergency Department: A Prospective Multinational Study of Patient Characteristics, Management, and Outcomes

Background and Aim: Migraine headache is commonly diagnosed in emergency departments (ED). There is relatively little real-world information about the epidemiology, investigation, management, adherence to therapeutic guidelines and disposition of patients treated in ED with a final diagnosis of migraine. The primary aim of the current study is to get a snapshot of assessment and management patterns of acute migraine presentations to the different settings of EDs with a view to raise awareness. Methods: This is a planned sub-study of a prospective study conducted in 67 health services in 10 countries including Australia, New Zealand, Southeast Asia, Europe, and the UK investigating the epidemiology and outcome of adult patients presenting to ED with nontraumatic headache. Outcomes of interest for this study are demographics, clinical features (including severity), patterns of investigation, treatment, disposition, and outcome of patients diagnosed as having migraine as their final ED diagnosis. Results: The cohort comprises 1,101 patients with a mean age of 39 years (SD ± 13.5; 73.7% [811]) were female. Most patients had had migraine diagnosed previously (77.7%). Neuroimaging was performed in 25.9% with a very low diagnostic yield or significant findings (0.07%). Treatment of mild migraine was in accordance with current guidelines, but few patients with moderate or severe symptoms received recommended treatment. Paracetamol (46.3%) and nonsteroidal anti-inflammatory drugs (42.7%) were the most commonly prescribed agents. Metoclopramide (22.8%), ondansetron (19.2%), chlorpromazine (12.8%), and prochlorperazine (12.8%) were also used. Conclusions: This study suggests that therapeutic practices are not congruent with current guidelines, especially for patients with severe symptoms. Efforts to improve and sustain compliance with existing management best practices are required.

Deservingness and Punishment in Juvenile Justice: Do Black Youth Grow Up “Faster” in the Eyes of the Court?

The present study investigated whether race moderates the effect of age on juvenile court dispositions in ways that illuminate a subtler form of racial disparities than has been previously identified. Drawing on prior theory and research, we hypothesize that at young ages, virtually all youth are perceived as children and met with treatment-oriented responses. As youth grow older, however, we anticipate that Black defendants will be perceived as more culpable and more deserving of punishment than similarly-aged White defendants and that disposition patterns will reflect that differential perception. Using data from the Florida Department of Juvenile Justice ( N = 124,075), the present study examines a five-category disposition using a multinomial regression model with interactions between age and race variables. We found mixed support for the hypotheses. On the one hand, compared to similarly-aged White defendants, Black defendants became significantly less likely to be diverted—the most treatment-oriented disposition—and significantly more likely to be transferred—the most punitive disposition—as age increased. On the other hand, race did not moderate age effects for dismissal, probation, or commitment. There is thus some evidence that age may be racialized for some dispositions, but not others. Implications for research and policy are discussed.

What predicts the demand and sale of vacant public properties? Urban greening and gentrification in Chicago

Many post-industrial U.S. cities have developed programs to promote the greening of publicly-owned vacant lots, including initiatives in which homeowners can purchase nearby lots and turn them into yards or community gardens. These initiatives can result in greener landscapes in marginalized communities, but we know little about the spatial patterns of vacant land disposition and whether demand for and sale of publicly-owned lots are stronger in gentrifying neighborhoods. We examined the Chicago Large Lot Program and used neighborhood sociodemographic, environmental, and safety factors to predict the demand and sale of vacant lots. We found that the demand for Large Lots was significantly higher in tracts showing early signs of gentrification between 2000 and 2015 (those with higher increases of college graduates and White residents) and for tracts located closer to downtown. Also, the percentage of Large Lots sold was significantly larger in areas closer to downtown and farther from Lake Michigan but not associated with gentrification, which might be due to neighborhood political forces seeking to retain public control of vacant lots in gentrifying neighborhoods. Although other studies show that urban greening precedes gentrification, our findings suggest that the demand for urban greening might also follow early gentrification.