Metropolitan Centers Research Articles

Asymmetric Hearing Loss in Adult Cochlear Implant Recipients: Results and Recommendations From a Multisite Prospective Clinical Trial.

A multisite clinical trial was conducted to obtain cochlear implant (CI) efficacy data in adults with asymmetric hearing loss (AHL) and establish an evidence-based framework for clinical decision-making regarding CI candidacy, counseling, and assessment tools. Study hypotheses were threefold: (1) 6-month postimplant performance in the poor ear (PE) with a CI will be significantly better than preimplant performance with a hearing aid (HA), (2) 6-month postimplant performance with a CI and HA (bimodal) will be significantly better than preimplant performance with bilateral HAs (Bil HAs), and (3) 6-month postimplant bimodal performance will be significantly better than aided, better ear (BE) performance. Forty adults with AHL from four, metropolitan CI centers participated. Hearing criteria for the ear to be implanted included (1) pure-tone average (PTA, 0.5, 1, 2 kHz) of >70 dB HL, (2) aided, monosyllabic word score of ≤30%, (3) duration of severe-to-profound hearing loss of ≥6 months, and (4) onset of hearing loss ≥6 years of age. Hearing criteria for the BE included (1) PTA (0.5, 1, 2, 4 kHz) of 40 to 70 dB HL, (2) currently using a HA, (3) aided, word score of >40%, and (4) stable hearing for the previous 1-year period. Speech perception and localization measures, in quiet and in noise, were administered preimplant and at 3-, 6-, 9-, and 12-months postimplant. Preimplant testing was performed in three listening conditions, PE HA, BE HA, and Bil HAs. Postimplant testing was performed in three conditions, CI, BE HA, and bimodal. Outcome factors included age at implantation and length of deafness (LOD) in the PE. A hierarchical nonlinear analysis predicted significant improvement in the PE by 3 months postimplant versus preimplant for audibility and speech perception with a plateau in performance at approximately 6 months. The model predicted significant improvement in postimplant, bimodal outcomes versus preimplant outcomes (Bil HAs) for all speech perception measures by 3 months. Both age and LOD were predicted to moderate some CI and bimodal outcomes. In contrast with speech perception, localization in quiet and noise was not predicted to improve by 6 months when comparing Bil HAs (preimplant) to bimodal (postimplant) outcomes. However, when participants' preimplant everyday listening condition (BE HA or Bil HAs) was compared with bimodal performance, the model predicted significant improvement by 3 months for localization in quiet and noise. Lastly, BE HA results were stable over time; a generalized linear model analysis revealed bimodal performance was significantly better than performance with a BE HA at all postimplant intervals for most speech perception measures and localization. Results revealed significant CI and bimodal benefit for AHL participants by 3-months postimplant, with a plateau in CI and bimodal performance at approximately 6-months postimplant. Results can be used to inform AHL CI candidates and to monitor postimplant performance. On the basis of this and other AHL research, clinicians should consider a CI for individuals with AHL if the PE has a PTA (0.5, 1, 2 kHz) >70 dB HL and a Consonant-Vowel Nucleus-Consonant word score ≤40%. LOD >10 years should not be a contraindication.

Extent and nature of poverty in Australia and the impact on rural health

The Senate Standing Committee on Community Affairs is conducting an Inquiry into the extent and nature of poverty in Australia.1 The National Rural Health Alliance (the Alliance) made a submission to this Inquiry in February 2023, with findings expected in October 2023.2 The Alliance believes that all Australians, wherever they live, should have access to comprehensive, accessible and high-quality health, disability and aged care, as well as other social assistance services. The Alliance does not consider that poor access to services, suffering ill health or premature death should be accepted outcomes of living in rural Australia. The Alliance highlights the multidirectional inter-relatedness of health, education and poverty and explores these concepts in further detail in its submission to the Senate Inquiry. Reducing poverty is good for health outcomes as well as social and economic outcomes. Investing in actions to address poverty, and other determinants of health, is an investment in human capital and is central to health and well-being in rural Australia, as are measures that ensure universal access to health care for those who experience inequity. Universal and structural social service approaches to reducing economic inequality are also essential to addressing poverty and health inequity. Due to the inter-relatedness of poverty and ill health, such approaches must work alongside co-designed and tailored solutions that are adaptable and flexible and build upon strengths and capabilities in local communities. This is especially critical in rural areas where there are thin or failed markets and services or support are lacking. Rural areas are not mini-metropolitan areas where a city solution can be ‘helicoptered in’ to solve a specific rural problem (no matter how well-intended). Tailored measures are likely to be more accepted and embraced by residents, especially if they are co-designed and inclusive of diversity within the community and when shared ownership can help drive the outcomes. The disparities also extend to research in rural Australia. Poverty is relative. It involves people experiencing deprivation and making difficult life decisions about necessities (for example, choosing to use limited finances to pay for meals or medications, but not both). The affordability of food, groceries, energy, housing, fuel or transport and other essentials (including medicines, out-of-pocket health costs) plays an important role in these decisions. Access to high-quality, affordable health care, regardless of where you live, is important to reducing poverty and improving the health, well-being and broader social and economic goals of rural communities. The Grattan Institute has noted that poorer people are not getting the GP services they need, with disadvantaged Australians facing barriers to care. Furthermore, there are even higher access barriers for allied health services. Compared with GP care, allied health services have higher average out-of-pocket charges and make up a bigger share of household spending on health.9 This is without considering barriers related to workforce shortages and long wait times in rural areas. The National Preventive Health Strategy 2021–2030† provides direction for preventive health action across the course of life. It also presents an opportunity to build sustainable systems, address increasing burden of disease and reduce health inequities, as well as improve preparedness for emerging health threats.10 Preventive health actions can build on strengths and mitigate risks. The focus on providing the best start in life and across the life course, and its potential to influence actions outside the health sector given the crossover in risks and protective factors, can provide a focus for community co-design. These principles align with the Primary care Rural Integrated Multidisciplinary Health Services (PRIM-HS) model proposed by the Alliance as a solution for providing primary care services in rural areas where the market is failing or has failed.‡ While the causes of poverty are complex, as are the multifaceted responses required, the Alliance argues that improving access to health care and supporting the healthcare workforce in rural Australia will lead to significant improvements in health and well-being and lower the rate of poverty experienced. This will, of course, advantage not only rural Australians but all who benefit from the food supply, exports and gross domestic product (GDP) supplied by the 30 per cent of the population who live outside metropolitan centres. Margaret Deerain: Writing – review and editing; writing – original draft.

Screening Results for Diabetic Retinopathy in Germany in a Real-world Cohort in a Metropolitan Diabetes Care Center.

Retinal screening is mandatory to prevent vision loss and blindness due to diabetic retinopathy (DR). The aim of the study was to determine retinopathy screening rates and potential barriers in a German metropolitan diabetes care center. Between May and October 2019, 265 patients with diabetes mellitus (95% type 2 diabetes; age 62±13.2 years; diabetes duration 11.1±8.5 years, HbA1c 7.4±1.0%) were referred to an ophthalmologist (referral form with order "Fundoscopy in diabetes mellitus, findings requested," completed documentation form "General practitioner's/diabetologist's report to the ophthalmologist" and prepared documentation form "Ophthalmologist's report"). A structured interview was used to assess the level of compliance with the guidelines and to identify potential barriers to retinopathy screening in a real-world setting, including the quantification of extra payments. All patients were interviewed at 7.9±2.5 months after the referral for retinopathy screening had been issued. According to patient reporting, fundoscopy was performed in 191 (75%) patients. Ophthalmological reports were obtained from 119/191 (62%) patients (46% of the entire cohort). 10/119 (8%) patients had been previously diagnosed with DR and 6/119 (5%) with new-onset DR. In 158/191 (83%) of patients, the referral had been accepted by the ophthalmology practice, of which 25,1% made a co-payment of 36.2±37.6 €. Despite a high screening performance in a real-world setting, complete screening in compliance with German guidelines, including written reporting, was found in less than half of the cohort. The prevalence and incidence of DR are high. Even when referred according to the regulations, one-quarter of patients made a co-payment. Efficient solutions to current barriers can emerge with mutual time-saving information prior to examination and feedback about the implementation of findings into treatment.

Ethics and frontline nursing during COVID-19: A qualitative analysis.

Nurses experienced intense ethical and moral challenges during the COVID-19 pandemic. Our 2020 qualitative parent study of frontline nurses' experiences during the COVID-19 pandemic identified ethics as a cross-cutting theme with six subthemes: moral dilemmas, moral uncertainty, moral distress, moral injury, moral outrage, and moral courage. We re-analyzed ethics-related findings in light of refined definitions of ethics concepts. To analyze frontline U.S. nurses' experiences of ethics during the COVID-19 pandemic. Qualitative analysis using a directed content methodology. The study included 43 nurses from three major metropolitan academic medical centers and one community hospital in the northeastern, mid-Atlantic, midwestern, and western United States. Participant privacy and data confidentiality were addressed. Moral dilemmas arose from many situations, most frequently related to balancing safety and patient care. Moral uncertainty commonly arose from lacking health information or evidence about options. Moral distress occurred when nurses knew the right thing to do, but were prevented from doing so, including with end-of-life issues. Moral injury (accompanied by suffering, shame, or guilt) occurred after doing, seeing, or experiencing wrongdoing, often involving authority figures. Nurses expressed moral outrage at events and people within and outside healthcare. Despite difficult ethical situations, some nurses exemplified moral courage, sometimes by resisting policies they perceived as preventing compassionate care, guided by thinking about what was best for patients. This content analysis of ethics-related subthemes revealed conceptual characteristics and clarified distinctions with corresponding exemplars. Conceptual clarity may inform responses and interventions to address ethical quandaries in nursing practice. Ethics education in nursing must address the moral dilemmas of pandemics, disasters, and other crises. Nurses need time and resources to heal from trying to provide the best care when no ideal option was available.

The development of a rural breast reconstruction service: patient reported outcomes and benefits.

In 2021, breast cancer was one of the most commonly diagnosed cancer in Australia. While a mastectomy remains a treatment of choice, only a small percentage of women have access to a breast reconstruction after. Women living in a rural area are less likely to have a breast reconstruction; compared to their metropolitan counterparts. This study analyses the impact of single breast reconstruction service on a Modified Monash 3 (MM3) region and informs consumers and providers of the importance of a breast reconstruction unit embedded in a rural health network. [Corrections added on 2 May 2023, after online publication. Expanded reference citations have been deleted from Abstract section.] METHODS: Following ethics approval, all 64 patients who had undergone a breast reconstruction with this service between 2017 and 2021 were contacted. Patient reported outcomes were recorded through phone interviews, using a standardized questionnaire. For each patient that presented to the rural centre, cost of travel and productivity loss were also calculated, and compared to the closest metropolitan centre. Ninety-seven percent of the 38 participants strongly valued having a breast reconstruction service within their community. Eighty percent of participants were satisfied with their result. Patients were estimated to save on average $8478, by attending the rural breast reconstruction service. Access to a breast reconstruction is significantly impacted by geographical barriers. A rural breast reconstruction service can improve patient access and satisfaction, while also reducing the financial burden on patients.

Relevance of Urban Geometry and Outdoor Thermal Comfort in Urban Heat Island Mitigation – A Review

UHIs’ environmental and energy implications are well-known, but their significance in aggravating heat stress in populations is only recently being recognised. Planners, health managers, and public administrators now prioritise UHI prevention. Urban geometry, material finishes, and green and blue infrastructure are prominent UHI mitigation options. This paper examines urban geometry as a key parameter and reviews UHI research. This report also identifies information gaps and emphasizes the need for this type of research in key Indian metropolitan centers. The anticipated study will help public health planners and administrators. Methods: Authors compiled extensive literature on UHI and related concepts. The outcome intent was to understand the relevance of urban geometry parameters in UHI intensity and how it impacts outdoor thermal comfort. Various electronic databases were searched for publications meeting the criteria of outdoor thermal comfort and urban planning characters (urban geometry) as a mitigation strategy, ranging from 2000 to 2020. Summary: The impact of UHI on human comfort conditions cannot be ignored. Appropriate planning measures at the initial stages of city planning via urban geometry parameters can certainly yield encouraging results to reduce the intensity of UHI and improve outdoor thermal comfort conditions.

Birthing on country service compared to standard care for First Nations Australians: a cost-effectiveness analysis from a health system perspective

Preterm birth is the leading cause of morbidity and mortality for children under five years with First Nations babies experiencing twice the rate of other Australians. The Birthing in Our Community (BiOC) service was implemented in a metropolitan centre in Australia and showed a significant reduction in preterm birth. We aimed to assess the cost-effectiveness of the BiOC service in reducing preterm births compared to Standard Care, from a health system perspective. Women who were carrying a First Nations baby and attending the Mater Mothers Public Hospital (Brisbane, QLD, Australia) were allocated to either BiOC or Standard Care service. Birth records were extracted from the hospital's routinely collected and prospectively entered database. The time horizon extended from first presentation in pregnancy up to six weeks after birth for mothers and 28 days for infants, or until discharged from hospital. All direct antenatal, birth, postnatal and neonatal costs were included. The proportion of preterm birth was calculated, and cost was estimated in 2019 Australian dollars. The incremental cost and proportion of preterm birth differences were adjusted using inverse probability of treatment weighting methods. Between Jan 1 2013, and Jun 30, 2019, 1816 mothers gave births to 1867 First Nations babies at the Mater Mothers Public Hospital. After exclusions, 1636 mother-baby pairs were included in the analyses: 840 in the Standard Care group and 796 in the BiOC service. Relative to Standard Care, the BiOC service was associated with a reduced proportion of preterm birth (-5.34%, [95% CI-8.69%,-1.98%]) and cost savings (-AU$4810, [95% CI-7519,-2101]) per mother-baby pair. The BiOC service was associated with better outcomes and cost less than Standard Care. The BiOC service offers a cost-effective alternative to Standard Care in reducing preterm birth for Australian First Nations families. The cost savings were driven by less interventions and procedures in birth and fewer neonatal admissions. Investing in comprehensive, community-led models of care improves outcomes at reduced cost. The Australian National Health and Medical Research Council (APP1077036).

Review: Spatial Revolution: Architecture and Planning in the Early Soviet Union

Review: <i>Spatial Revolution: Architecture and Planning in the Early Soviet Union</i>

The Principalship as a Career: Analyzing the Factors Shaping Interest in the Principalship in Ethiopia

ABSTRACT Based on survey data collected from 237 principals including narrative responses to open-ended items, this study explores how personal, institutional, and professional factors contribute to interest in principalship in Ethiopia. A key finding indicated earning a degree in a field other than educational leadership diminishes one’s proclivity for the principalship while another found working in metropolitan centers boosts the attraction for the role. As political loyalty trumps professional qualification in the appointment of the principalship in Ethiopia, policymakers must decouple politics from the principal recruitment processes, especially in rural schools where encroachment from local administration deters interests in the position.

Factors Associated with Antimicrobial Use at the End-Of-Life Among Hospitalized Cancer Patients.

Background: Antimicrobials are frequently administered at end-of-life (EOL) and their non-beneficial use may subject patients to unnecessary harms. Studies analyzing factors for antimicrobial prescribing in solid tumor cancer patients at the EOL are lacking. Thus, we aimed to identify factors and patterns associated with antimicrobial use in hospitalized adults with cancer at EOL. Methods: We used a retrospective cohort design to review electronic medical records of terminal hospitalized patients ≥18 years with solid tumors admitted to non-intensive care units in a metropolitan comprehensive cancer center during 2019 and assessed antimicrobial use in the last 7 days of life. Results: Among 633 cancer patients, 59% (n = 376) received antimicrobials (AM+) within the last 7 days of life. AM + patients were older (P = .012), mostly of male gender (55%), and non-Hispanic ethnicity (87%). AM + patients were significantly more likely to have a foreign device, suspected signs of infection, neutropenia, positive blood culture result, documented advance directive; receive laboratory or radiologic testing, and a palliative care or infectious disease consultation (all P < .05). No statistically significant differences were observed in the presence of documented goals of care discussions, or EOL discussions/EOL care orders. Conclusion: Antimicrobial use at the EOL is common in solid tumor cancer patients at the EOL and is associated with increased utilization of invasive interventions. There is an opportunity for infectious disease specialists to build primary palliative care skills and partner with antimicrobial stewardship programs to better advise patients, decision makers, and primary teams on the use of antimicrobials at the EOL.

Towards a better understanding of residential mobility and the environments in which adults reside: A nationwide geospatial study from Aotearoa New Zealand

This nationwide geospatial study from Aotearoa New Zealand describes the frequency and spatial patterning of residential mobility and examines the interplay between patterns of residential mobility and the environments in which adults reside.Data from the Integrated Data Infrastructure (n = 4,781,268 adults) defined levels of residential mobility in 2016–2020. We then used nationwide environmental data included within the New Zealand Healthy Location Index to define access to a range of health-promoting and health-constraining features.We identified 29 spatial clusters based on the mobility characteristics of the population living within selected administrative units that were further classified into five groups based on the similarity of residential mobility groups. Each group was described by its relation to the Healthy Location Index, urbanicity and ethnicity.A greater proportion of residential mobility was related to metropolitan and large regional centres, and Māori, Pacific and Asian ethnicities. Areas with higher levels of vulnerable mobile population were identified in the North Island (Northland, Gisborne, Whanganui and urban pockets of Auckland, Hamilton, Napier and Hastings). While there was poor access to health-promoting environments for the mobile population living in the inner cities, areas with higher residential mobility elsewhere are often associated with better access to health-promoting and neutral features.

Place-Making through the Creation of Common Spaces in Lima’s Self-Built Settlements: El Ermitaño and Pampa de Cueva as Case Studies for a Regional Urbanization Strategy

Lima has become the first Peruvian megacity with more than 10 million people, resulting from the migration waves from the countryside throughout the 20th century, which have also contributed to the diverse ethnic background of today’s city. The paper analyzes two neighborhoods located in the inter-district area of Northern Lima: Pampa de Cueva and El Ermitaño as paradigmatic cases of the city’s expansion through non-formal settlements during the 1960s. They represent a relevant case study because of their complex urbanization process, the presence of pre-Hispanic heritage, their location in vulnerable hillside areas in the fringe with a protected natural landscape, and their potential for sustainable local economic development. The article traces back the consolidation process of these self-built neighborhoods or barriadas within the context of Northern Lima as a new centrality for the metropolitan area. The analysis of urban form and mobility, heritage and environmental challenges, governance, and social integration leads to a proposal for neighborhood upgrading, capacity building with participatory processes, and a vision for future local development to decentralize the traditional metropolitan centers, which can be scaled to other peripheral neighborhoods.

Application of a forecasting model to mitigate the consequences of unexpected RSV surge: Experience from the post-COVID-19 2021/22 winter season in a major metropolitan centre, Lyon, France.

The emergence of COVID-19 triggered the massive implementation of non-pharmaceutical interventions (NPI) which impacted the circulation of respiratory syncytial virus (RSV) during the 2020/2021 season. A time-series susceptible-infected-recovered (TSIR) model was used early September 2021 to forecast the implications of this disruption on the future 2021/2022 RSV epidemic in Lyon urban population. When compared to observed hospital-confirmed cases, the model successfully captured the early start, peak timing, and end of the 2021/2022 RSV epidemic. These simulations, added to other streams of surveillance data, shared and discussed among the local field experts were of great value to mitigate the consequences of this atypical RSV outbreak on our hospital paediatric department. TSIR model, fitted to local hospital data covering large urban areas, can produce plausible post-COVID-19 RSV simulations. Collaborations between modellers and hospital management (who are both model users and data providers) should be encouraged in order to validate the use of dynamical models to timely allocate hospital resources to the future RSV epidemics.

Modelling the methane generation potential and decay constant for a tropical landfill

This study modelled the methane (CH4) generation for a landfill in a tropical climate in Brazil, adjusting the values of the parameters of methane generation potential (Lo) and decay constant (k), using the Intergovernmental Panel on Climate Change numerical model and LandGEM and Biogas (CETESB) software. Adopting published data from cell 6 (C6) of the Metropolitan Center Sanitary Landfill, 15 combinations of k and Lo were carried out to determine the range of values that best represented the generation of methane. The results of the study allowed to conclude that values of k between 0.1 and 0.15 year, and Lo between 60 and 70 m3/t, resulted in simulations with good capacity to predict methane for the chosen landfill, obtaining errors lower than 30%. Furthermore, these intervals identified a better representation of methane generation for values of k equal to 0.15/year and Lo equal to 60 m3/t. This combination showed estimation errors smaller than 6% when compared to methane measured at C6 between 2004 and 2009, showing the importance of having experimental values of k and Lo to adjust the simulations and calibrate the used tools.

Framing School Mathematics Challenges Inside and Outside Metropolitan Areas

Background/Context: The problems that school district leaders identify and how they frame them have consequences—for both policy implementation and the ways that teachers respond. Although that is likely true in all community contexts (from rural to urban, inside and outside metropolitan centers), the influence of broader discourses associated with accountability reforms centered around state standardized testing may not be uniform across those contexts. Purpose/Objective/Research Question or Focus of Study: In this article, we report the results of an interview study we conducted with leaders in 50 school districts across the U.S. state of Missouri, in which we investigated what they identified as—and how they framed—their districts’ most salient problems related to mathematics. Guiding our analysis were the following questions: (1) What do those who oversee school districts’ mathematics instruction and curriculum identify as mathematics-related problems, and how do they frame those problems? (2) Do leaders’ identification and framing of problems differ with respect to districts’ size and proximity to metropolitan centers? (3) If so, to what extent are institutional factors, including mathematics achievement, economic resources, the presence of a mathematics-specific leader, and the district’s pedagogical commitments, predictive of leaders’ identification and framing of problems? Research Design: In 50 school districts in Missouri, sampled from different categories of size and proximity to metropolitan centers, we interviewed the district leader most responsible for overseeing mathematics curriculum and instruction about their mathematics-related challenges. We also collected contextual information from governmental websites, including population data, student achievement rates, student racial and economic demographics, and district economic resources (i.e., per-pupil expenditures). Through qualitative analysis we identified what leaders identified as their most pressing challenge and how they framed that challenge. Through regression analysis we identified which community and district characteristics were predictive of leaders’ problem identification and framing. Conclusions/Recommendations: Our results point to meaningful differences in leaders’ identification and framing of problems related to whether they work within metropolitan areas. In particular, we argue that leaders in nonmetropolitan districts appear more likely to adopt the frame offered by the “corporate model of schooling,” defining and framing problems around improvement in standardized test scores, whereas leaders in metropolitan areas are more likely to define problems in terms of equity and the ways that students experience school mathematics. And leaders from smaller districts were more likely to employ a strictly “management” framing of outcomes-related problems, describing responses focused exclusively on changing district programs and structures (rather than a “learning” frame that foregrounds supporting and developing staff). Institutional factors predictive of leaders’ identification of problems concerning equity and student experience included per-pupil expenditures, higher rates of test proficiency, commitment to inquiry-based pedagogy, and the presence of a district mathematics leader.

Abstract WMP120: Development Of Smartphone Enabled Machine Learning Algorithms For Autonomous Stroke Detection

Background: We developed an automated smart phone application for detection of acute stroke using machine learning (ML) algorithms for recognition of facial asymmetry, arm weakness, and speech changes. Methods: We analysed prospectively collected data from patients admitted to 4 major metropolitan stroke centers with confirmed diagnosis of acute stroke. Speech and facial data were captured via video recording and arm data was captured via device sensors. A. Face. This module extracts 68 facial landmark points that are passed through a dimensionality reduction step and an asymmetry classifier. We implemented and compared 26 classification methods with neurologists' clinical impression and determined Quadratic Discriminative Analysis as the best one in terms of accuracy and interpretability. B. Arm. Using data extracted from 3D accelerometer, gyroscope, and magnetometer , we designed a grasp agnostic classifier based on AdaBoost to process motion trajectories and detect arm weakness.C. Speech. We developed an algorithm based on frequency analysis and Mel Frequency Cepstral Coefficients (MFCC) to detect abnormal/slurred speech. All tests were conducted within 72 hours of admission. Each of the three ML outputs was correlated with neurologists’ clinical impression. Results: Among the 269 analysed patients, 41% were female, the median age was 71, % had hemorrhagic and % had ischemic stroke. Final analyses of 18311 facial images revealed 99.42% sensitivity, 93.67% specificity, and 97.11% accuracy in detection of facial asymmetry. The results for 43 arm trajectories revealed 71.42% sensitivity, 72.41% specificity, and 72.09% accuracy in detection of arm weakness. Preliminary analysis of MFCC algorithms confirmed adequate features for abnormal speech detection Conclusions: Our preliminary results confirm that smartphone enabled ML-algorithms can reliably identify acute stroke features with accuracy comparable to neurologists’ clinical impression.

Abstract WP48: Air Versus Land Transfers For Endovascular Thrombectomy In A Hub-and-spoke Comprehensive Stroke Network

Background: Endovascular thrombectomy (EVT) is only available at larger comprehensive stroke centers, with inter-hospital transfer by road or air ambulance required for patients who first present to a primary stroke centre. We aimed to evaluate if there were differences in outcomes in patients transferred for EVT via air. Methods: The setting is a hub-and-spoke model, with one EVT center which receives patients from three metropolitan and 12 more distant regional primary stroke centers. Consecutive EVT patients were identified from a mandatory registry, which includes data on mode of transfer to the EVT center. The primary outcome was 90-day functional independence (modified Rankin scale ≤2). Secondary outcomes included successful recanalization (Thrombolysis In Cerebral Infarction score ≥2b), early neurological improvement (National Institutes of Health Stroke Scale (NIHSS) reduction by ≥8 points or a reduction to ≤1 at 24 hours), symptomatic intracranial hemorrhage, and 90-day mortality. Results: 1102 patients (622 (56%) men, median [interquartile range, IQR] age 69 [58-78], 966 (88%) anterior circulation strokes, median [IQR] baseline NIHSS 16 [11-20]) were identified. 801 (73%) patients presented to the EVT center by road and 301 (27%) regional patients transferred by air. The mean (standard deviation, SD) distance travelled to the EVT center was 9.6 (1.2) miles by road and 106.8 (50.9) miles by air. The two groups were well-matched at baseline except a higher thrombolysis rate in the air transfer group (53% vs 45%, p =0.022). Patients transferred by air had longer last-known-well to EVT groin puncture times (median [IQR] 365 [294-539] vs 225 [170-355] minutes, p &lt;0.001), however there were no differences in the proportion of patients with 90-day functional independence (151 (50%) by air vs 427 (53%); p =0.388) or 90-day mortality (44 (15%) by air vs 122 (15%); p =0.874), or any of the other secondary outcomes. Conclusions: In this hub-and-spoke model, patients transferred for EVT from regional centers by air had similar outcomes at 90-day to those presenting to a metropolitan center, despite the longer transfer times. Comprehensive stroke centers should not be discouraged from considering patients from more distant centers who require air transfer.

313 Assessment of racial differences of atopic dermatitis characteristics in a diverse outpatient cohort in the United States

Abstract Atopic dermatitis (AD) can present differently across racial groups. To promote equality and consistency, dermatologists and other providers should properly recognize the heterogeneous manifestations of AD across racial groups. Yet, little is known about differences in how the commonly different features of AD occur by race. We assessed racial differences in the proportions of select key features of AD. The healthcare claims database from a large metropolitan tertiary care medical centre was queried for patients with physician-diagnosed AD using International Classification of Disease, Tenth Revision and Clinical Modification codes L20.x. Medical records were reviewed for demographics, comorbidities and documentation of Hanifin-Rajka criteria. The frequency of each criterion was evaluated by race (White, Black, Asian and Multiracial–Other). Overall, 766 patients with AD were included in the study; 374 (48.8%) were White, 284 (37.1%) Black, 89 (11.6%) Asian and 19 (2.5%) multiracial/other, 558 (68.2%) were female, 50 (6.1%) were age &amp;lt;18 years, 456 (55.7%) age 18–49 years and 313 (38.2%) age ≥50 years. Compared to White patients, Black patients had significantly higher proportions of personal (81.4% vs. 57.3%) and family (63.3% vs. 42.2%) history of atopic disease, perifollicular accentuation (60.6% vs. 36.9%) and xerosis on physical exam (84.2% vs. 73.9%)(P ≤ 0.03 for all). Multiracial/other patients had elevated proportions of a history of dry skin (81.3%), xerosis on physical exam (86.7%) and elevated Immunoglobulin E levels (75.0%). Black and multiracial/other patients had food hypersensitivity compared to White patients (50.0% and 71.4% vs. 35.1%, P = 0.04). There were marginally significant differences in the proportion of early-age AD onset (56.9% vs. 41.8%, P = 0.07) and anterior neck fold involvement (42.6% vs. 25.3%, P = 0.06) in Asian compared to White patients. There were no significant racial differences in the likelihood of other Hanifin-Rajka criteria, including pruritus, flexural dermatitis, chronic dermatitis, ichthyosis, nipple eczema, hand/foot dermatitis, immediate skin reactivity, subcapsular cataracts, cutaneous infections, pruritus when sweating, intolerance to wool/lipid solvents, environmental/emotional factors worsening AD, or white dermatographism. Our results suggest there are racial differences in AD characteristics even within a single region. These differences may be attributable to population-differences in genetics, environmental exposures, skincare practices etc. Future research is needed to understand the mechanisms and treatment responses of these heterogeneous AD presentations.

An evaluation of a mental health literacy program for community sport leaders

Community sports coaches and leaders can have an important role to play as informal resources for sporting adolescents and adults at risk of mental ill-health. Supporting coach mental health literacy using programs has potential to enhance opportunities for coach-player support. This study aimed to evaluate a community sport mental health literacy program and its capacity to improve club leader confidence to support and refer (primary outcome), awareness of resources, beliefs about mental health and stigmatizing attitudes (social distance). A cluster-randomized controlled evaluation was conducted with measures taken at baseline (around 2 weeks prior to intervention), immediately post-program and at a nine-month follow up. Twenty-five community Australian Rules Football clubs from metropolitan and regional centres were sampled and matched by size and location. Coaches or sport leaders (n = 265) were randomized by club to either the intervention group or a waitlist control group. A multivariate analysis of variance (pre-test scores as covariates) revealed participants in the ‘Tackle Your Feelings’ (TYF) program reported improved outcomes compared to controls on measures tied to leader confidence to support and refer, knowledge of resources to support mental health, general help-seeking and stigmatizing attitudes tied to social distance. A fifth measure of beliefs about mental illness was not impacted by the program. A nine-month comparison group follow-up indicated some decay in scores over time. The results suggest that TYF programs can be effective at improving coach mental health literacy in community sporting club contexts.

Groundwater Vulnerability Assessment Phenomenon using DRASTIC &amp; Modified DRASTIC Modeling validated with Nitrate Concentration.

&lt;p&gt;Urbanized areas groundwater vulnerability and contamination are serious issues that require due attention. There are other models, notably the DRASTIC models employed to assess the vulnerability of groundwater. In a modified version of the DRASTIC model known as anthropogenic influence was incorporated into DRASTICA as a model parameter. The research used a cutting-edge methodology to define the anthropogenic employing satellite data of nighttime lighting to have an impact using human settlements as a stand-in and the Palani Taluk's surrounding land use/landcover. The spatial integration of various parameter maps was done using a geographic information system. According to data on groundwater vulnerability to pollution, around 29.98% of the area is in a very high vulnerability zone, followed by 23.68% of area covers high vulnerability, 25.18% comes under the range of moderate vulnerability, 12.14% covers the area in the zones of low vulnerability, and 8.97% area covers the total area in the ranges of very low vulnerability. Utilizing the amount of nitrate in ground water, the findings were confirmed. It was determined that in an urban environment, the suggested DRASTICA model achieved enhanced than the conservative DRASTIC model. The classifications are as follows: extremely high, high, medium, and low. Very high Vulnerability zones account for 214 values in Palani taluk, the research region, whereas very low vulnerability zones account for 3 values in Palani taluk. Urbanization index showed that anthropogenic impact and the depth of the water table had a substantial impact on groundwater susceptibility to contamination, indicating that manmade effect must be carefully taken into consideration in such studies. This study's modified-DRASTIC/DRASTICA model will aid in better classifying groundwater sensitive areas to contamination where manmade pollution is high, especially in and near metropolitan centers. The groundwater susceptibility possible map that is produced can be more successfully used as the main tool for managing, organizing, and safeguarding groundwater resources. Low nitrate concentrations are found in forests and arid terrain, whereas high nitrate values are found in urban areas. The majority of the Palani taluk has low to moderate nitrate concentrations. The Melkaraipatty and Thalaiyuthu Palani Taluk's urban areas are considered by high sensitivity because of low water levels and strong manmade effect.&lt;/p&gt;&#x0D;