Negative Binomial Regression Methods Research Articles

Psychiatric-related Revisits to the Emergency Department Following Rapid Expansion of Community Mental Health Services.

Repeat visits (revisits) to emergency departments (EDs) for psychiatric care reflect poor continuity of care and impose a high financial cost. We test whether rapid expansion of community health centers (CHCs)-which provide regional, low-cost primary care-correspond with fewer repeat psychiatric-related ED visits (PREDVs). We obtained repeated cross-sectional time-series data for 7.8 million PREDVs from the State Emergency Department Database for four populous U.S. states (California, Florida, North Carolina, and New York) from 2006 to 2011. We specified as the outcome variable the count of repeat visits per ED visitor with a psychiatric diagnosis. We retrieved aggregate-level mental health visits at CHCs from the Uniform Data System. Negative binomial regression methods controlled for individual-level confounders, county health system and sociodemographic attributes, year fixed effects, and county fixed effects. The risk of a repeat PREDV decreased with a county-level increase in mental health patients seen at CHCs (incidence rate ratio= 0.986, 95% confidence interval= 0.98 to 0.99). Conversion of this rate ratio to the number of revisits averted indicated 34,000 fewer repeat PREDVs in these four states statistically associated with a 1% expansion in CHC mental health visits. Exploratory analyses found that revisits decline for relatively mild/moderate illnesses (e.g., mood, anxiety disorders) but not for severe illnesses (e.g., schizophrenia/psychoses). An increase in mental health services at CHCs corresponds with a modest decline in repeat PREDVs. This decline concentrates among those with less severe mental illnesses.

Association of Primary Language with Outcomes After Operations Typically Performed to Treat Cancer: Analysis of a Statewide Database.

Few studies have evaluated the effect of primary language on surgical outcomes, and no studies have addressed operations typically performed for cancer diagnoses. This study aimed to determine the effect of primary languages other than English on outcomes after surgical oncology operations. This study retrospectively analyzed adults undergoing operations typically performed to treat cancer using the NJ Healthcare Cost and Utilization Project State Inpatient Database during the interval of 2009-2014. Language was grouped according to English-, Spanish-, and non-English/non-Spanish (NENS)-speaking groups. The study evaluated in-hospital mortality, 7-day readmission, and hospital length of stay (LOS). Logistic and negative binomial regression methods were applied, and generalized linear mixed models were used to account for nesting within a hospital. This study analyzed 37,531 cases. Non-English speakers were of lower economic status, more likely to be admitted on the weekend, and more likely to undergo higher-risk operations. The likelihood of death in the risk-adjusted multi-level models did not differ between Spanish speakers (odds ratio [OR], 0.67; 95% confidence interval [CI], 0.41-1.10) and NENS speakers (OR, 1.16; 95% CI, 0.77-1.75). Readmission rates exhibited high inter-hospital variability (intra-class correlation, 53%). The odds of readmission among Spanish speakers in the non-hierarchical model was increased (OR, 1.50; 95% CI, 1.11-2.02), but this was ameliorated in the multilevel modeling that accounted for variability between hospitals (OR, 1.29; 95% CI, 0.93-1.80). No changes in LOS were observed. No independent association was observed between primary language and outcomes after operations typically performed to treat cancer in the study population. The higher proportion of weekend admissions may suggest more acute or advanced presentations for non-English speakers. Long-term outcomes may be necessary to discern an impact.

Usefulness of Right Ventricular to Pulmonary Circulation Coupling as an Indicator of Risk for Recurrent Admissions in Heart Failure With Preserved Ejection Fraction

In recent years, the study of right ventricular (RV) to pulmonary circulation (PC) coupling in heart failure with preserved ejection fraction (HFpEF) has been a matter of special interest. Tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio has emerged as a reliable noninvasive index of RV to PC coupling. Thus, we hypothesized that TAPSE/PASP would be a predictor of readmission burden in HFpEF. One thousand one hundred and twenty seven consecutive HFpEF patients discharged for acute HF were included. In 367 patients (32.6%), PASP could not be accurately measured by echocardiography, leaving the final sample size to be 760 patients. Negative binomial regression method was used to evaluate the association between TAPSE/PASP ratio and recurrent admissions. Mean age of the cohort was 75.6 ± 9.7 years and 68.3% were women. At a median (interquartile range) follow-up of 2.0 (2.9) years, 352 (46.3%) patients died and 1,214 readmissions were registered in 482 patients (63.4%), being 506 of them HF-related. There was a stepwise increase in the rates of all-cause and HF readmissions by decreasing TAPSE/PASP ratio. After multivariable adjustment, TAPSE/PASP <0.36 was associated with a higher risk of HF-related recurrent admissions (incidence rate ratio [IRR] 1.51, 95% confidence interval [CI], 1.01 to 2.24; p = 0.040), whereas patients in the lowest quintile (TAPSE/PASP <0.28) exhibited the highest risk of both all-cause and HF-related recurrent admissions (IRR 1.40, 95% CI 1.04 to 1.87, p = 0.025; and IRR 1.85, 95% CI 1.22 to 2.80, p = 0.004, respectively). In conclusion, TAPSE/PASP ratio, as a noninvasive index of RV-PC coupling, emerges as a strong predictor of recurrent hospitalizations in HFpEF.

Effects of Network Closure on Cooperative Innovation: Evidence from Dongying’s Petroleum Equipment Industry in China

There are two opposing viewpoints on which kind of network configuration provides a more competitive advantage, namely, network closure or structural holes, with the latter occupying the dominant position in the literature. Using social network analysis and negative binomial regression methods, we graph the co-patent network of Dongying’s petroleum equipment industry in China and explore its impact on enterprise innovation. The analysis is based on 17 face-to-face interviews, 31 enterprise questionnaires, and 354 co-patent records from the China State Intellectual Property Office identifying cooperative innovation for the years 1988–2013. We find that this network is closed, controlled by state-owned enterprises, and its closure has positive effects on enterprise innovation performance. This may be related to China’s unique industrial development history, state system and policies, regional culture and circumstances, and enterprise characteristics. Therefore, for some industries in specific regions, the advantages usually attributed to structural holes and open innovation may not necessarily apply.

Spatial Interaction Modeling of OD Flow Data: Comparing Geographically Weighted Negative Binomial Regression (GWNBR) and OLS (GWOLSR)

Due to the emergence of new big data technology, mobility data such as flows between origin and destination areas have increasingly become more available, cheaper, and faster. These improvements to data infrastructure have boosted spatial and temporal modeling of OD (origin-destination) flows, which require the consideration of spatial dependence and heterogeneity. Both ordinary least square (OLS) and negative binomial (NB) regression methods have been used extensively to calibrate OD flow models by processing flow data as different types of dependent variables. This paper aims to compare both global and local spatial interaction modeling of OD flows between traditional and geographically weighted OLS (GWOLSR) and NB (GWNBR) modeling methods. From this study with empirical data it is concluded that GWNBR outperforms GWOLSR in reducing spatial autocorrelation and in detecting spatial non-stationarity. Although, it is noted that both local modeling methods show improvement when compared against the equivalent global models.

The impact of corruption on analyst coverage

PurposeThis study aims to investigate the impact of country-level corruption and firms’ anti-bribery policies on analyst coverage. Analyst coverage has been identified as a powerful tool to detect fraud and should equally act as a possible tool to reduce corruption.Design/methodology/approachThis study used a negative binomial count regression method on a longitudinal data set of a sample of S&amp;P Global 1200 companies for the years 2010-2015. To control for potential endogeneity bias and improve the reliability of the estimation, both country-level corruption and firms’ anti-bribery policies variables were instrumented.FindingsAfter controlling potential endogeneity bias, the results show that the adoption of anti-bribery policies at firm level attracts more analysts to follow a firm. The results for corruption at country level show that analyst coverage increases in less corrupted countries indicating that the costs of corruption exceed its potential benefits. When the variables corruption at country level and anti-bribery policies are interacted, the relationship is positive and highly significant.Practical implicationsGiven the potential important role played by anti-corruption measures, firms are encouraged to adopt them to reduce the incidence of corruption and to increase analyst coverage, which will reinforce the benign effect of monitoring.Originality/valueAlthough the literature on corruption at the country level is rich, it is geared towards the determinants of corruption in contrast to its consequences, and fewer studies have focused on the impact of corruption at firm level because of data limitations. This paper addresses this gap and contributes to the literature on the consequences of corruption at firm level.

Social network ties to nightlife and healthcare professionals and prescription drug misuse among young adults

BackgroundNightlife scenes have been characterized as risk environments where social ecology and network ties facilitate substance use. In contrast to other substances, the prescription drug problem also has been shaped by the healthcare system. How network ties to professionals in these domains are associated with prescription drug misuse remains a key area of study. MethodsWe analyzed a sample of 404 young adults who misuse prescription drugs, recruited from nightlife venues primarily via time-space sampling. We evaluated nine types of network ties via friends and family (5 nightlife professions and 4 healthcare professions) as well as total ties in each occupational domain and their relationship to three different outcomes – frequency of misuse, escalation to non-oral use, and substance-related problems. Negative binomial, logistic, and linear regression methods were employed. We then examined mechanisms by which these network associations may operate. ResultsTies to party promoters (p < .05) and bouncers (p < .01) were positively associated with all three outcomes. A single outcome each was associated with ties to DJs (problems, p < .01), musicians (frequency, p < .05), and bartenders (escalation, p < .05). The total number of network ties in the nightlife domain was positively associated with all three outcomes, with each additional tie increasing frequency (20.3%, p < .001), odds of escalation (OR = 42.9%, p < .01), and problems (12.5%, p < .01). The number of sources, peer norm context, and social bonding were explanatory mechanisms for all three outcomes for nightlife networks. Specific occupational ties and the total number of ties to healthcare professionals were not associated with any outcome. ConclusionEmbeddedness in nightlife networks is related to patterns of prescription drug misuse, and some of this association can be explained by multiple mechanisms of social networks. By contrast, ties to healthcare professionals are not associated with patterns of misuse among such young adults.

Structural Embeddedness and Firms’ Impact on the Technology Standard Setting Process

The extant literatures often focus on the efficiency of standard committees to coordinate conflicts between members and how regulatory capture occurs, thus neglecting the impact of cooperation behaviour on the technology standard setting process. This paper aims to explore how structural embeddedness affects firms’ impact on the technology standard setting process. We construct a network with the national standard data in China's communications industry in 2000-2017. With 326 firms participating in the standard formulation as the research sample, we use the negative binomial regression method to explore the relationship between structural embeddedness of technology sponsors and the impacts on the technology standard setting process. We find that while there is an inverted U-shaped relationship between the number of direct collaborators and firms’ impacts on the technology standard setting process, the structural holes positively affect firms’ impacts on the technology standard setting process. The conclusions obtained from this paper have important managerial implications for firms participating the technology standard setting processes.

Parental status and psychological distress among older Thais

This study examines whether childless older Thais are more vulnerable to psychological distress relative to older adults with children. Drawing from the 2011 Survey of Older Persons in Thailand (n = 37,936), zero‐inflated negative binomial regression methods examine psychological distress of childless older adults relative to coresident and noncoresident parents. Analyses further explore how gender and marital status moderate this relationship. Results show that 40% of older Thais did not experience any symptoms of psychological distress in the past month. Compared to coresident parents, noncoresident parents showed a higher likelihood of experiencing psychological distress but being childless was associated with increased symptoms of psychological distress. While the relationship between parental status and psychological distress did not significantly differ by gender, marital status presents a significant moderating effect. Specifically, widowed childless older adults and widowed noncoresident parents experienced more symptoms of psychological distress relative to their married counterparts. In collectivistic societies, where the family unit is highly valued, and institutional support is weak, being childless and unmarried may negatively affect one's psychological well‐being in later life. Children and marriage are protective for older Thais’ psychological well‐being. The implications for social welfare policies are discussed.

Bayesian negative binomial regression for differential expression with confounding factors.

Rapid adoption of high-throughput sequencing technologies has enabled better understanding of genome-wide molecular profile changes associated with phenotypic differences in biomedical studies. Often, these changes are due to multiple interacting factors. Existing methods are mostly considering differential expression across two conditions studying one main factor without considering other confounding factors. In addition, they are often coupled with essential sophisticated ad-hoc pre-processing steps such as normalization, restricting their adaptability to general experimental setups. Complex multi-factor experimental design to accurately decipher genotype-phenotype relationships signifies the need for developing effective statistical tools for genome-scale sequencing data profiled under multi-factor conditions. We have developed a novel Bayesian negative binomial regression (BNB-R) method for the analysis of RNA sequencing (RNA-seq) count data. In particular, the natural model parameterization removes the needs for the normalization step, while the method is capable of tackling complex experimental design involving multi-variate dependence structures. Efficient Bayesian inference of model parameters is obtained by exploiting conditional conjugacy via novel data augmentation techniques. Comprehensive studies on both synthetic and real-world RNA-seq data demonstrate the superior performance of BNB-R in terms of the areas under both the receiver operating characteristic and precision-recall curves. BNB-R is implemented in R language and is available at https://github.com/siamakz/BNBR. Supplementary data are available at Bioinformatics online.

Estimated rates of influenza-associated outpatient visits during 2001-2010 in 6 US integrated healthcare delivery organizations.

BackgroundPopulation‐based estimates of influenza‐associated outpatient visits including both pandemic and interpandemic seasons are uncommon. Comparisons of such estimates with laboratory‐confirmed rates of outpatient influenza are rare.ObjectiveTo estimate influenza‐associated outpatient visits in 6 US integrated healthcare delivery organizations enrolling ~7.7 million persons.MethodsUsing negative binomial regression methods, we modeled rates of influenza‐associated visits with ICD‐9‐CM‐coded pneumonia or acute respiratory outpatient visits during 2001‐10. These estimated counts were added to visits coded specifically for influenza to derive estimated rates. We compared these rates with those observed in 2 contemporaneous studies recording RT‐PCR‐confirmed influenza outpatient visits.ResultsOutpatient rates estimated with pneumonia visits were 39 (95% confidence interval [CI], 30‐70) and 203 (95% CI, 180‐240) per 10 000 person‐years, respectively, for interpandemic and pandemic seasons. Corresponding rates estimated with respiratory visits were 185 (95% CI, 161‐255) and 542 (95% CI, 441‐823) per 10 000 person‐years. During the pandemic, children aged 2‐17 years had the largest increase in rates (when estimated with pneumonia visits, from 64 [95% CI, 50‐121] to 381 [95% CI, 366‐481]). Rates estimated with pneumonia visits were consistent with rates of RT‐PCR‐confirmed influenza visits during 4 of 5 seasons in 1 comparison study. In another, rates estimated with pneumonia visits during the pandemic for children and adults were consistent in timing, peak, and magnitude.ConclusionsEstimated rates of influenza‐associated outpatient visits were higher in children than adults during pre‐pandemic and pandemic seasons. Rates estimated with pneumonia visits plus influenza‐coded visits were similar to rates from studies using RT‐PCR‐confirmed influenza.

El consumo máximo de oxígeno predice los ingresos recurrentes por insuficiencia cardiaca con fracción de eyección conservada

Introduction and objectivesHeart failure with preserved ejection fraction (HFpEF) is a highly prevalent syndrome with an elevated risk of morbidity and mortality. To date, there is scarce evidence on the role of peak exercise oxygen uptake (peak VO2) for predicting the morbidity burden in HFpEF. We sought to evaluate the association between peak VO2 and the risk of recurrent hospitalizations in patients with HFpEF. MethodsA total of 74 stable symptomatic patients with HFpEF underwent a cardiopulmonary exercise test between June 2012 and May 2016. A negative binomial regression method was used to determine the association between the percentage of predicted peak VO2 (pp-peak VO2) and recurrent hospitalizations. Risk estimates are reported as incidence rate ratios. ResultsThe mean age was 72.5 ± 9.1 years, 53% were women, and all patients were in New York Heart Association functional class II to III. Mean peak VO2 and median pp-peak VO2 were 10 ± 2.8mL/min/kg and 60% (range, 47-67), respectively. During a median follow-up of 276 days [interquartile range, 153-1231], 84 all-cause hospitalizations in 31 patients (41.9%) were registered. A total of 15 (20.3%) deaths were also recorded. On multivariate analysis, accounting for mortality as a terminal event, pp-peak VO2 was independently and linearly associated with the risk of recurrent admission. Thus, and modeled as continuous, a 10% decrease of pp-peak VO2 increased the risk of recurrent hospitalizations by 32% (IRR, 1.32; 95%CI, 1.03-1.68; P = .028). ConclusionsIn symptomatic elderly patients with HFpEF, pp-peak VO2 predicts all-cause recurrent admission.Full English text available from: www.revespcardiol.org/en

Estimating influenza and respiratory syncytial virus-associated mortality in Western Kenya using health and demographic surveillance system data, 2007-2013.

BackgroundInfluenza and respiratory syncytial virus (RSV) associated mortality has not been well-established in tropical Africa.MethodsWe used the negative binomial regression method and the rate-difference method (i.e. deaths during low and high influenza/RSV activity months), to estimate excess mortality attributable to influenza and RSV using verbal autopsy data collected through a health and demographic surveillance system in Western Kenya, 2007–2013. Excess mortality rates were calculated for a) all-cause mortality, b) respiratory deaths (including pneumonia), c) HIV-related deaths, and d) pulmonary tuberculosis (TB) related deaths.ResultsUsing the negative binomial regression method, the mean annual all-cause excess mortality rate associated with influenza and RSV was 14.1 (95% confidence interval [CI] 0.0–93.3) and 17.1 (95% CI 0.0–111.5) per 100,000 person-years (PY) respectively; and 10.5 (95% CI 0.0–28.5) and 7.3 (95% CI 0.0–27.3) per 100,000 PY for respiratory deaths, respectively. Highest mortality rates associated with influenza were among ≥50 years, particularly among persons with TB (41.6[95% CI 0.0–122.7]); and with RSV were among <5 years. Using the rate-difference method, the excess mortality rate for influenza and RSV was 44.8 (95% CI 36.8–54.4) and 19.7 (95% CI 14.7–26.5) per 100,000 PY, respectively, for all-cause deaths; and 9.6 (95% CI 6.3–14.7) and 6.6 (95% CI 3.9–11.0) per 100,000 PY, respectively, for respiratory deaths.ConclusionsOur study shows a substantial excess mortality associated with influenza and RSV in Western Kenya, especially among children <5 years and older persons with TB, supporting recommendations for influenza vaccination and efforts to develop RSV vaccines.

Peak Exercise Oxygen Uptake Predicts Recurrent Admissions in Heart Failure With Preserved Ejection Fraction

Introduction and objectivesHeart failure with preserved ejection fraction (HFpEF) is a highly prevalent syndrome with an elevated risk of morbidity and mortality. To date, there is scarce evidence on the role of peak exercise oxygen uptake (peak VO2) for predicting the morbidity burden in HFpEF. We sought to evaluate the association between peak VO2 and the risk of recurrent hospitalizations in patients with HFpEF. MethodsA total of 74 stable symptomatic patients with HFpEF underwent a cardiopulmonary exercise test between June 2012 and May 2016. A negative binomial regression method was used to determine the association between the percentage of predicted peak VO2 (pp-peak VO2) and recurrent hospitalizations. Risk estimates are reported as incidence rate ratios. ResultsThe mean age was 72.5 ± 9.1 years, 53% were women, and all patients were in New York Heart Association functional class II to III. Mean peak VO2 and median pp-peak VO2 were 10 ± 2.8mL/min/kg and 60% (range, 47-67), respectively. During a median follow-up of 276 days [interquartile range, 153-1231], 84 all-cause hospitalizations in 31 patients (41.9%) were registered. A total of 15 (20.3%) deaths were also recorded. On multivariate analysis, accounting for mortality as a terminal event, pp-peak VO2 was independently and linearly associated with the risk of recurrent admission. Thus, and modeled as continuous, a 10% decrease of pp-peak VO2 increased the risk of recurrent hospitalizations by 32% (IRR, 1.32; 95%CI, 1.03-1.68; P = .028). ConclusionsIn symptomatic elderly patients with HFpEF, pp-peak VO2 predicts all-cause recurrent admission.

A new model for determining the traffic accident black spots using GIS-aided spatial statistical methods

Traffic accidents are one of the important problems in our country as it in the world. The World Health Organization case reports published in 2015 stated that approximately 1.25 million people died each year and more than 50 million people injured as a result of traffic accidents in the world. Considering this situation, it is seen that traffic accidents are mostly human originated and one of the major problems that is negatively affecting life. In this context, many investments and many studies have been performed on the determination of traffic accident black spots to reduce traffic accidents.The current study aimed to get a descriptive model for determining the traffic accident black spots using model-based spatial statistical methods. These methods are Poisson regression, Negative Binomial regression and Empirical Bayesian method. The ultimate goal of this study was to build a model that allowed evaluating all the methods together in Geographic Information Systems (GIS) which is quite widely used nowadays.In the present study, the data were obtained from 300 thousand traffic accidents occurred on 2408 different state roads during the years from 2005 to 2013 from the General Directorate of Highways. The state roads of Turkey were divided into 32,107 sub-segments with the length of 1km. Based on the study results, 126 sub-segments were determined as traffic accident black spots depending on the method used. According to comparison of the methods used in the present study, the Empirical Bayesian method provided the best results in terms of accuracy and consistency.

The Effect of Utilization Review on Emergency Department Operations

Increasingly, hospitals are using utilization review software to reduce hospital admissions in an effort to contain costs. Such practices have the potential to increase the number of unsafe discharges, particularly in public safety-net hospitals. Utilization review software tools are not well studied with regard to their effect on emergency department (ED) operations. We study the effect of prospectively used admission decision support on ED operations. In 2012, Los Angeles County+ University of Southern California Medical Center implemented prospective use of computerized admission criteria. After implementation, only ED patients meeting primary review (diagnosis-based criteria) or secondary review (medical necessity as determined by an on-site emergency physician) were assigned inpatient beds. Data were extracted from electronic medical records from September 2011 through December 2013. Outcomes included operational metrics, 30-day ED revisits, and 30-day admission rates. Excluding a 6-month implementation period, monthly summary metrics were compared pre- and postimplementation with nonparametric and negative binomial regression methods. All adult ED visits, excluding incarcerated and purely behavioral health visits, were analyzed. The primary outcomes were disposition rates. Secondary outcomes were 30-day ED revisits, 30-day admission rate among return visitors to the ED, and estimated cost. Analysis of 245,662 ED encounters was performed. The inpatient admission rate decreased from 14.2% to 12.8%. Increases in discharge rate (82.4% to 83.4%) and ED observation unit utilization (2.5% to 3.4%) were found. Thirty-day revisits increased (20.4% to 24.4%), although the 30-day admission rate decreased (3.2% to 2.8%). Estimated cost savings totaled $193.17 per ED visit. The prospective application of utilization review software in the ED led to a decrease in the admission rate. This was tempered by a concomitant increase in ED observation unit utilization and 30-day ED revisits. Cost savings suggest that resources should be redirected to the more highly affected ED and ED observation unit, although more work is needed to confirm the generalizability of these findings.

Declines in Human Papillomavirus (HPV)-Associated High-Grade Cervical Lesions After Introduction of HPV Vaccines in Connecticut, United States, 2008-2015.

Trends in human papillomavirus (HPV)-associated cervical lesions can provide an indication of vaccine impact. Our purpose was to measure trends in cervical lesions during 2008-2015 and to consider possible explanations including vaccination coverage, changes in screening for cervical cancer, and risk behaviors for acquiring HPV. Connecticut (CT) implemented mandatory reporting of cervical intraepithelial neoplasia grades 2/3 and adenocarcinoma in situ (cervical intraepithelial neoplasia grade 2 or higher [CIN2+]) in 2008. Trends by age and birth cohort were modeled using negative binomial regression and change-point methods. To evaluate possible explanations for changes, these trends were compared to changes in HPV vaccination coverage, cervical cancer screening, an antecedent event to detection of a high-grade lesion, and changes in sexual behaviors and Chlamydia trachomatis, an infection with similar epidemiology to and shared risk factors for HPV. A significant decline in CIN2+ was first evident among women aged 21 years in 2010, followed by successive declines in women aged 22-26 years during 2011-2012. During 2008-2015, the rates of CIN2+ declined by 30%-74% among women aged 21-26 years, with greater declines observed in the younger women. Birth cohorts between 1985 and 1994 all experienced significant declines during the surveillance period, ranging from 25% to 82%. Ecological comparisons revealed substantial increases in HPV vaccination during this time period, and more modest reductions in cervical cancer screening and sexual risk behaviors. The age and cohort patterns in our data suggest that declines in CIN2+ during 2008-2015 are more likely driven by HPV vaccination, introduced in 2006, than by changes in screening or risk behavior.

Echocardiographic pulmonary artery pressure estimation and heart failure rehospitalization burden in patients with acute heart failure

Pulmonary hypertension (PH) is a strong predictor of mortality in patients with heart failure (HF). However, the relationship between PH, through echocardiographic pulmonary artery pressure (PASP) estimation, and the risk of HF rehospitalizations remains unclear. MethodsWe prospectively included 2343 consecutive patients discharged for acute heart failure (AHF). PH was estimated by echocardiography through PASP determination during the index admission. Patients were categorized as follows across PASP: non-measurable, normal (≤35mmHg), mild (36–45mmHg), moderate (46–60mmHg), or severe PH (>60mmHg). Negative binomial regression method was used to evaluate the association between PASP and recurrent HF hospitalizations across preserved (HFpEF: ≥50%), mid-range (HFmrEF: 40–49%) and reduced ejection fraction (HFrEF: <40%). ResultsMean age of the cohort was 72.8±11.2years, 1187 (50.5%) were women, and 1252 (53.4%) and 410 (17.5%) showed HFpEF and HFmrEF, respectively. At a median (interquartile range) follow-up of 2.3 (0.8–4.5) years, we registered 1114 (47.6%) deaths, and 1834 HF-related rehospitalizations in 943 (40.2%) patients. After multivariable adjustment, and compared to patients with normal PASP, severe PH exhibited an independent higher risk of recurrent HF admissions only in HFpEF (IRR=1.66; 95% confidence interval (CI), 1.16–2.38; p=0.005), whereas in HFmrEF patients there was a non-significant trend to higher HF readmissions (IRR: 1.73; 95% CI, 0.85–3.55; p=0.132). Severe PH was not related with recurrent hospitalizations in HFrEF (IRR: 1.19; 95% CI, 0.66–2.14; p=0.553). ConclusionsEchocardiography-derived PASP evaluated during an episode of AHF is related to HF readmission burden, particularly in those patients with HFpEF.

Quantifying morbidity attributable to traumatic injury using a population-based matched cohort in Australia

ABSTRACT&#x0D; ObjectiveThis study aims to quantify 12-month morbidity attributable to traumatic injury using a population-based matched cohort in Australia.&#x0D; ApproachA population-based matched cohort study of individuals ≥18 years using linked emergency department (ED) presentation, hospital separation and mortality records from three Australian states during 1 January 2008 to 31 December 2010. Injury admissions were identified using a principal diagnosis of injury (ICD-10-AM: S00-T75 or T79). The first injury-related hospital admission during 2009 was identified as the index injury admission and pre and post-index injury health service use was examined. The non-injured comparison cohort was randomly selected from the electoral roll and was matched 1:1 on age, gender, and postcode of residence at the date of the index injury admission of their matched counterpart. Comorbidities were identified using diagnosis classifications and a 1-year lookback period. Injury severity was estimated using the International Classification of Injury Severity Score (ICISS): minor (≥0.99), moderate (0.942-&lt;0.99) and serious (&lt;0.942).&#x0D; Negative binomial and Poisson regression methods will be used to quantify associations between injury and counts of hospital admissions 12-month post-index injury health service use.&#x0D; ResultsThere were 166,032 individuals injured in 2009 and admitted to hospital in New South Wales, South Australia or Queensland with a matched comparison. Males represented 57% of those injured, 30.1% were aged 18-34 years, 37.9% were aged 35-64 years, 32.1% were aged ≥65 years and 65.1% resided in an urban location. Comorbidities were more common in the injured cohort (χ² =9384.5, df (2), p&lt;0.0001). The most common injuries were fall-related (38.4%) and as a result of road trauma (12.4%). The majority of injuries were minor (43.9%) or moderate (37.2%), with 18.9% serious injuries. Attributable risk and adjusted rate ratios for injured versus matched non-injured comparison will be presented for pre and post health service use controlling for key confounding characteristics.&#x0D; ConclusionThrough the use of national data linkage, this study contributes to informing research efforts on better quantifying the attributable burden of injury-related disability in Australia.

Write More Articles, Get More Grants: The Impact of Department Climate on Faculty Research Productivity.

Many studies find that female faculty in academic medicine, science, and engineering experience adverse workplace climates. This study longitudinally investigates whether department climate is associated with future research productivity and whether the associations are stronger for female than male faculty. Two waves of a faculty climate survey, institutional grant records, and publication records were collected for 789 faculties in academic medicine, science, and engineering at the University of Wisconsin-Madison between 2000 and 2010. Research productivity was measured as Number of Publications and Number of Grants awarded, and department climate was measured with scales for professional interactions, department decision-making practices, climate for underrepresented groups, and work/life balance. Ordinary least squares and negative binomial regression methods were used to assess gender differences in productivity, influences of department climate on productivity, and gender differences in effects of climate on productivity. Female faculty published fewer articles and were awarded fewer grants in the baseline period, but their productivity did not differ from male faculty on these measures in subsequent years. Number of Publications was positively affected by professional interactions, but negatively affected by positive work/life balance. Number of Grants awarded was positively affected by climate for underrepresented groups. These main effects did not differ by gender; however, some three-way interactions illuminated how different aspects of department climate affected productivity differently for men and women in specific situations. In perhaps the first study to assess the longitudinal impact of department climate on faculty research productivity, positive department climate is associated with significantly greater productivity for all faculty-women and men. However, some positive aspects of climate (specifically, work/life balance) may be associated with lower productivity for some female faculty at specific career periods. These findings suggest that departments that wish to increase grants and publications would be wise to foster a positive workplace climate.