Short-term surgical outcomes for colon adenocarcinoma: Racial-Ethnic comparisons in a universal access health system.

Evidence of elevated microplastic accumulation in Pacific Island mangrove sediments.

The recruitment of underrepresented racial and ethnic groups in clinical trials remains a challenge. The ClinicalTrials.gov database was queried for phase III trials related to non-Hodgkin lymphoma (NHL), leukemia, and multiple myeloma (MM). A reference population was sourced from the Surveillance, Epidemiology, and End Results (SEER) database. A total of 53,821 pooled participants from 119 phase III trials were included in the analyses. Race and ethnicity data were reported in 95.8% and 81.5% of trials, respectively. Globally, the majority of participants were predominantly White (77.3%), followed by Asian (8.2%), Black/African American (5.4%), American Indian/Alaska Native (0.4%), and Native Hawaiian/Other Pacific Islander (0.2%), while Hispanic/Latino individuals constituted 11.0% of trial participants. In comparison to data in SEER, the proportions were lower for Asian/Pacific Islander and Hispanic/Latino across all cancers, and for Black/African American and American Indian/Alaska Native in leukemia and MM in US only trials. Despite progress, reporting and representation of non-White population remain insufficient in trials. Innovative strategies to enhance representation in trial enrollment are warranted, as well as the utilization of real-world data to establish recruitment goals by more effectively assessing the demographic and geographic distribution of target patient populations.

Mental health self-stigma moderates the effect of social support on depression, anxiety and stress among young adult Pacific Islanders

There is a dearth of psychological research on the effects of racial discrimination on the mental health of Pacific Islander (PI) individuals in the United States in general, but more specially among Pacific Islander men. The objective of this study was to examine the intersections of racial discrimination, depression, anxiety, stress, anger, forgiveness, and self-esteem in a sample of 249 Latter-day Saint Pacific Islander men in the United States through an online Qualtrics survey. Specifically, this study also sought to examine the effects of racial discrimination and the indirect effects of forgiveness and self-esteem on anger and depression, anxiety, and stress among this Pacific Islander group. Elevated experiences of racial discrimination were linked to increased levels of anger and negative psychological outcomes, including depression, anxiety, and stress. Furthermore, experiences of racial discrimination were inversely correlated with forgiveness and self-esteem. Forgiveness and self-esteem partially mediated the relationship between racial discrimination and mental health outcomes, including anger, depression, anxiety, and stress. Implications are provided regarding psychological impacts of racial discrimination among Pacific Islander men in the United States. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

OBJECTIVES We examined nursing home use from 2012 to 2019 by children <18 years old and evaluated disparities in short-term stays (≤100 days) and long-term care nursing home stays across racial and ethnic groups. METHODS We categorized children into five groups: Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Asian, Hispanic, and an “Other” group, which included American Indian or Alaska Native, Native Hawaiian or Pacific Islander, multiracial or multiethnic children, and children with unknown race or ethnicity. To examine changes in the total number of short-term and long-term nursing home stays among children, we aggregated the number of stays by year and used negative binomial regression models to assess the yearly trends. RESULTS From 2012 to 2019, there were 22,351 nursing home stays by children <18 years old, of which 50.4% were by NHW children, 23.2% were NHB children, 15.4% were Hispanic children, 4.4% were Asian children, and 6.7% were by children in the Other racial and ethnic group. Nursing home use among children declined over the study period for both short- and long-term stays. The proportion of non-Hispanic White (NHW) children decreased in both types of stays, while the proportions of non-Hispanic Black (NHB) and those in the Other racial and ethnic category increased. CONCLUSIONS Together, the findings suggest a worsening racial disparity in care delivery for medically complex children. Research to understand the causes of these shifts, such as changes in the demographics of the population at risk, access to care, or treatment preferences, is urgently needed.

ABSTRACT Numerous studies have explored the Feldstein – Horioka puzzle. Despite this, consensus remains absent. This article revisits the puzzle by estimating a time-varying cointegration model using annual data from 1970 to 2022 for countries in the Pacific region. To the degree that the coefficients capture aspects of international capital mobility from the region, the key empirical results we find are as follows. First, we observe that Fiji, PNG, Kiribati, Solomon Islands, and Tonga, have had effective policies in maintaining external balance and ensuring the sustainability of their current account positions. Second, Vanuatu, Samoa, Nauru, Tuvalu, Micronesia, Cook Islands, and Palau stress incidence of very high capital mobility pointing towards weaker policy management targeting current account sustainability. Third, the average time-varying saving retention coefficient for the entire sample shows a steady decline. Fourth, the FH coefficient shows no monotonic trends and often persists below zero. Fifth, evidence of greater capital account convertibility emerges across the Pacific since the early 2000s. Finally, Pacific Island countries with high aid dependence, high remittances (post-2010) and high resource wealth exhibit increasing capital mobility overtime. Policy implications are briefly discussed.

With hospital-based obstetric care declining in rural areas, risk-appropriate care, which aligns patient clinical conditions with hospital capabilities using level of care, may be limited for pregnant rural residents, especially those with higher-risk conditions that necessitate specialty or subspecialty obstetric care. To assess the proportion of higher-risk pregnant rural residents who receive risk-appropriate care during childbirth and identify factors associated with not receiving risk-appropriate care. This cross-sectional study used linked vital statistics and hospital discharge data for pregnant rural residents with higher-risk clinical conditions who had hospital-based births in Michigan (2010-2020), Oregon (2010-2020), Pennsylvania (2010-2018), and South Carolina (2010-2020). Data analyses were performed between December 2023 and July 2025. Birth hospital maternal level of care (I, basic; II, specialty; III, subspeciality; IV, regional perinatal). The main outcome was birth in a hospital with risk-appropriate care, defined as having the necessary level of care for the patient's clinical condition. Covariates included age, race and ethnicity, insurance, education, prenatal care utilization, medical and obstetric comorbidities, distance to the closest risk-appropriate hospital (quartile 1: 0.50-5.57 miles, quartile 2: 5.58-18.90 miles, quartile 3: 18.91-33.93 miles, quartile 4: 33.94-209.80 miles), year, and state. A total of 199 225 higher-risk pregnant rural residents (mean [SD] maternal age, 27.9 [5.6] years) were included, of whom 11 651 (5.9%) identified as Hispanic, 3054 (1.5%) as non-Hispanic American Indian or Alaska Native, 1370 (0.7%) as non-Hispanic Asian or Pacific Islander, 18 296 (9.2%) as non-Hispanic Black, 5320 (2.7%) as non-Hispanic other race, and 159 253 (79.9%) as non-Hispanic White. Birth at a risk-appropriate hospital occurred for 38 441 of 70 647 individuals (54.4%) with conditions requiring level II care, 4611 of 9270 (49.7%) with conditions requiring level III care, and 1793 of 6527 (27.5%) with conditions requiring level IV care. Those with significantly higher rates of not receiving risk-appropriate care included American Indian or Alaska Native (adjusted incidence rate ratio [aIRR], 1.13; 95% CI, 1.10-1.17), or Hispanic (aIRR, 1.06; 95% CI, 1.03-1.08) individuals (compared with White individuals), those without private insurance (public: aIRR, 1.03; 95% CI, 1.01-1.04; uninsured: aIRR, 1.07; 95% CI, 1.01-1.14), those who were younger and had less education (age <20 years: aIRR, 1.05; 95% CI, 1.03-1.08, compared with 30-34 years; some high school: aIRR, 1.04; 95% CI, 1.03-1.06, compared with high school degree), and those who lived further from a risk-appropriate hospital (furthest quartile: aIRR, 23.86; 95% CI, 20.48-27.79, compared with closest quartile). In this study, lack of risk-appropriate care was common for pregnant rural residents with clinical complexity. Associated factors, including race, ethnicity, insurance, age, education, and distance, highlight the barriers and need for increasing access to subspecialty care for pregnant rural residents.

Health literacy and the Pacific: A scoping literature review of journal articles.

There is a global need for effective strategies to improve acceptance and uptake of the human papillomavirus (HPV) vaccine, particularly in the Pacific where cervical screening and treatment options are limited. While the Pacific Island nation of Tonga has high routine childhood vaccine coverage, HPV vaccine uptake has remained low since its introduction in 2022. To improve vaccine acceptance and uptake, recent evidence supports the use of community engagement approaches like the Vaccine Champions program, which trains health and community leaders to advocate for vaccines. We assessed the reach, effectiveness, adoption, implementation, and maintenance of the Vaccine Champions program in Tonga. In March 2023 we conducted a co-design workshop with government and non-government stakeholders to adapt the program and establish key features. Diverse Vaccine Champions were trained in June to run vaccine information sessions in their communities until December 2023. We used the RE-AIM framework to evaluate program implementation and impact through surveys and interviews with co-design participants, Vaccine Champions, and community members. Co-design participants (n = 29) agreed to focus on the HPV vaccine, identified leading barriers and potential Vaccine Champions. We trained 27 Vaccine Champions including teachers, local officials, nurses, and representatives from disability, youth, and sports groups. Most were female (19/27; 70%) and had no health background (25/27; 93%). Training increased Vaccine Champions’ trust and support for vaccines, and confidence to communicate about vaccines. Vaccine Champions ran 57 vaccine information sessions, reaching 1138 community members. Parent or caregiver intention to vaccinate their daughters against HPV increased from 70% to 88% after attending a community session. The Vaccine Champions program is a culturally tailored community engagement approach to increase HPV vaccine acceptance and uptake, supporting global efforts towards cervical cancer elimination. It is continuing in Tonga in 2025 with strong national support. Implementation and evaluation process findings can support program localisation elsewhere.

Purpose The purpose of this study is to engage classroom teachers with picture books featuring Asian Americans and Pacific Islanders (AAPI) experiences (AAPI-PBs), supporting their understanding of Asian American communities and preparing them to lead critical conversations with their students. Design/methodology/approach This qualitative study analyzes participants’ interpretations and responses during AAPI-PB discussions informed by AsianCrit and Culturally Sustaining Pedagogy. Findings The findings of this study demonstrate how, guided by AsianCrit tenets, teachers began to approach AAPI-PBs with a critical lens and how the professional learning community created space to deepen their understanding of the complexity and unique struggles of AAPI communities. Research limitations/implications This study introduced AsianCrit theory to teachers who were previously unfamiliar, providing them with a novel critical lens to approach and analyze AAPI-PBs and revise their thinking about classroom implications; this supports the value of professional learning connecting critical theories of particular identity groups to practice. The findings of this study suggest the need for ongoing support to disrupt pervasive stereotypes. Practical implications This study bridges the gap between theory and practice by helping teachers recognize the multiple instructional opportunities embedded in AAPI-PBs through deepening their own knowledge of AAPI experiences. This study also encourages teachers to apply this critical lens to literature representing other marginalized groups. Originality/value This paper offers a unique focus on teachers’ understandings of AsianCrit, drawing insights from participants with varied teaching experiences across rural, suburban and urban settings in three states in the USA.

Background: Parental alcohol use has been associated with the development of antisocial behavior in children and adolescents. However, little is known about the mechanisms through which parental alcohol use may impact antisocial behavior development. In this study, we explored mechanisms through which parent alcohol use during adolescence may impact the development of antisocial behavior from adolescence into adulthood. Objectives: We investigated whether parental monitoring during adolescence (ages 16-17), observed family conflict during adolescence, or young adult alcohol use (ages 21-22), mediated the relationship between parent alcohol during adolescence and antisocial behavior in adulthood (ages 26-30). We completed a secondary data analysis using a longitudinal, community-based sample of families in the Northwestern United States (n = 998; target children were 42% White, 29% Black, 2% Native American, 7% Hispanic or Latinx, 5% Asian American, 1% Pacific Islander, and 53% male; data collection was conducted from 1996 to 2017). Using observational and survey data, we ran a series of mediation models to examine three hypothesized mechanisms. Results: Our findings supported a relationship between parental alcohol use during adolescence and adult antisocial behavior ten years later. Parental monitoring and family conflict during adolescence did not serve as mediators. Young adult alcohol use significantly mediated the relationship between parent alcohol use during adolescence and adult antisocial behavior. Conclusions: Our findings support young adult alcohol use as a mechanism through which parent alcohol use during adolescence is associated with adult antisocial behavior. These results highlight the potential impact of parent alcohol use well into adulthood and offer implications for targeted preventive interventions.

Abstract Purpose of Review In the United States (US), hypertension is more prevalent among certain ethnic and racial groups including: Black-African Americans (BAA), Hispanics, American Indian and Alaska Native (AI/AN) and Asian and Pacific Islander (API); these populations also experience higher hypertension- and stroke-related mortality rates among both non-pregnant and pregnant adults compared to non-Hispanic White (NHW) Americans. The causes for the increased prevalence and higher case-fatality rate are unclear; however, social determinants of health (SDoH) and systemic racism likely play significant roles. Recent Findings While genetic factors may contribute to hypertension, no definitive genetic variations have been identified. Candidate traits show only inconclusive links to the disproportionate burden of hypertension among BAA. Socio-economic factors, environmental factors, and other SDoH likely drive the observed higher rates of hypertension and stroke morbidity in BAA and other ethnic groups. Hypertensive disorders are a leading cause of maternal mortality disproportinately affecting BAA women. Studies estimate that up to one-third of disparities in hypertension management in the US can be attributed to SDoH. Healthcare disparities in obstetric patients with stroke are similar to those among non-childbearing adults; however, notable differences include access to prenatal care and parental factors. Despite advances in medical treatments, improved patient education and substantial healthcare spending, maternal mortality and morbidity rates have risen in recent years. The impact of the disparities, in the case of obstetric patients, may also affect fetal development and subsequent neonatal and pediatric health. Summary Racial and ethnic minorities in the US, namely BAA and Hispanics, AI/AN and API, continue to experience disparities in the incidence, prevalence, and treatment of hypertension and stroke. Factors such as socioeconomic status, structural racism and healthcare access affect hypertension prevalence and outcomes, as may noise pollution, sleep hygiene, air quality and other environmental factors. In pregnant women, these disparities have a negative impact on mortality rates and stroke risk. Despite ongoing research, racial and ethnic minorities remain underrepresented in clinical studies, underscoring the need for more inclusive research to improve hypertension management in diverse populations.

From birth, many young Pacific people in Aotearoa New Zealand experience a disproportionately high burden of psychological distress, metabolic disease, and socioeconomic disparities within education and employment which contribute to significant health inequalities. Further research is needed to understand the drivers influencing these outcomes. This paper provides a comprehensive overview of the quantitative component of the Pacific Island Families Study: Ala mo Tupulaga Pasifika Aotearoa (PIF:ATP; Life Course Trajectories for Young Pasifika in Aotearoa), the latest follow-up of the longitudinal PIF birth cohort study, which uses a mixed-methods approach. The PIF Study is a multidisciplinary longitudinal study that tracks the health and development of 1398 Pacific children born in 2000 at Middlemore Hospital, South Auckland, Aotearoa, New Zealand. Data collection has occurred at 10 time points from infancy through young adulthood, with this PIF:ATP assessment phase occurring at ages 25-26 years, which aims to reach at least 750 cohort members. The assessments will take place at participants' homes or at Auckland University of Technology for those residing in Auckland. Data collection will be conducted across multiple sites, including Auckland, Wellington, Hamilton, and Whangārei in Aotearoa New Zealand, as well as Brisbane, Sydney, and Melbourne in Australia. Physical measurements such as weight, height, waist and hip circumferences, grip strength, body fat mass and muscle mass, blood pressure and pulse, glucose and lipid screening, and skin carotenoid concentration will be undertaken. In addition, self-reported data will be collected on psychological well-being (eg, depression, anxiety, and family functioning), nutritional and metabolic well-being (eg, food intake and physical activity), and economic well-being (eg, educational attainment, employment status, and job occupation and industry). Data collection is scheduled to commence in June 2025 and conclude by December 2026. The first set of results and analysis is expected to be published from December 2027 onward. Reporting of all results will comply with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines. This paper presents the protocol for the 25-year follow-up of the first Pacific longitudinal cohort study, which will comprehensively examine psychological, nutritional, metabolic, and economic well-being of Pacific young adults. With 25 years of longitudinal data and extensive expertise in life course research, this protocol outlines the design, methodology, and scope of the quantitative component of the PIF:ATP research program. This phase is uniquely positioned to address key issues identified by Pacific communities and generate evidence to inform meaningful interventions and guide policy development while providing robust, contemporary, high-quality empirical evidence.

The American Cancer Society (ACS) Guideline Score captures collective adherence to health behavior recommendations, including a healthy diet, physical activity (PA), alcohol intake, and body mass index (BMI). Exploring the role of social determinants of health (SDoH) in health behavior engagement may present opportunities for improving health equity. To identify SDoH associated with co-occurring health behaviors captured by the ACS Guideline Score in a large US cohort. This cross-sectional study included adults in the Cancer Prevention Study-3 who enrolled between 2006 and 2013 at ACS community events across 35 US states, the District of Columbia, and Puerto Rico using data from comprehensive follow-up surveys administered in 2015. Data were analyzed from June to September 2024. Self-reported race and ethnicity, marital status, education, household income, secondhand smoke exposure, and work status were examined. Rural-Urban Commuting Area codes and food desert status were classified according to US Department of Agriculture definitions. Co-occurring health behaviors were measured using a 0-to-8-point score quantifying adherence to the 2020 ACS Guidelines for Diet and PA for Cancer Prevention on diet, alcohol, healthy BMI maintenance, and PA. Scores of 8 represent complete adherence. Ordinal logistic regression models were used to cross-sectionally assess SDoH factors associated with co-occurring health behaviors measured by ACS Guideline Scores. Of 142 085 participants (mean [SD] age, 52.0 [9.6] years; 111 694 women [78.6%]), 2415 identified as Asian, Native Hawaiian, or Pacific Islander (1.7%), 3267 identified as Black (2.3%), 7814 identified as Latino (5.5%), 126 739 identified as non-Hispanic White (89.2%), and 1989 identified as another racial and/or ethnic group (1.4%). The mean (SD) ACS Guideline Score was 4.6 (1.7). Compared with White participants, Asian, Native Hawaiian, and Pacific Islander participants had increased odds of higher ACS Guideline Scores (odds ratio [OR], 1.99; 95% CI, 1.86-2.14). Holding a graduate degree was associated with a 33% higher likelihood of a higher ACS Guideline Score (OR, 1.33; 95% CI, 1.30-1.36) compared with college graduates. Compared with working full-time, working part-time (OR, 1.62; 95% CI, 1.57-1.66) or being retired (OR, 1.26; 95% CI, 1.22-1.30) was associated with a higher score. In this cross-sectional study, multiple SDoH factors associated with co-occurring health behaviors for diet, PA, BMI, and alcohol consumption were identified. These findings may aid in identifying populations most vulnerable to poor health behaviors, guiding future approaches for advancing health equity.

Social dominance orientation, or SDO, reflects a preference for group-based inequality and is one of the strongest predictors of a variety of political attitudes, including support for affirmative action, nationalism, and even support for torture. Yet how SDO emerges is unclear. Although some work suggests that SDO primarily forms around adolescence, the present set of studies suggests that SDO can emerge earlier in development and meaningfully shape how children view social inequality. Across three studies (N = 314), we show that children's (ages 5-12; M = 7.75, SD = 1.58, 116 boys, 183 girls, 133 White, 47 Black, 24 Asian, 11 Hispanic/Latine, one Native Hawaiian or Pacific Islander, 32 multiracial, 66 unreported) self-reported levels of SDO are associated with less desire to rectify inequality, lower likelihood to believe claims of inequality from low-status groups, and less sympathy for outgroup suffering. We also examine the role of group status and status essentialism in shaping SDO, finding some support that group status and status essentialism jointly influence self-reported SDO. These data also suggest that SDO and ingroup bias are different processes and highlight the utility of taking a developmental perspective to discuss how social dominance theory and social identity theory may be both conceptually and empirically distinguishable. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

The Air Medical Prehospital Triage (AMPT) score may attenuate disparities observed in recent data that demonstrated significantly lower odds of prehospital air medical transport (AMT) use among injured patients of minoritized race and ethnicity groups compared to non-Hispanic White patients. To evaluate if using the AMPT score is associated with a reduction in racial and ethnic disparities in prehospital AMT use or a mortality benefit in patients who meet AMPT criteria. This was a retrospective cohort study of the Pennsylvania Trauma Outcomes Study database from January 2000 to December 2020. Participants included injured patients aged 16 years and older who underwent ground or helicopter emergency medical service transport from the scene of injury, excluding those with transport distances less than 5 miles from the trauma center. Race and ethnicity were reported as per the dataset, which used patient self-report. Data were analyzed from February to August 2025. AMPT-assigned transport mode. Actual prehospital transport mode (air vs ground) and AMPT-assigned transport mode were evaluated; in-hospital mortality was assessed by AMPT triage assignment. Socioenvironmental context was evaluated using the Area Deprivation Index (ADI), Social Deprivation Index (SDI), and Distressed Communities Index (DCI). The study cohort included 307 831 patients (mean [SD] age, 50.0 [25.3] years; 185 288 [60.2%] male; 2727 [0.9%] non-Hispanic Asian, 30 570 [10.2%] non-Hispanic Black, 8471 [2.8%] Hispanic/Latino, 253 491 [84.5%] non-Hispanic White, 4643, and [1.6%] other [including Alaskan Native, American Indian, and Asian, and Pacific Islander]). Non-Hispanic Asian, Non-Hispanic Black, and Hispanic/Latino patients were significantly less likely to undergo prehospital AMT compared to White patients. When assigning prehospital transport mode based on the AMPT score, no significant associations were observed between race and ethnicity and AMT use. Prehospital air vs ground transport was associated with 24% lower odds of mortality among patients who had an AMPT score of 2 or greater (adjusted odds ratio [aOR], 0.76; 95% CI, 0.58-0.99; P = .40). As ADI, DCI, and SDI scores increased, AMT use varied by race and ethnicity. Causal mediation analyses demonstrated that 38% (mediation effect, 0.38; 95% CI, 0.35-0.42), 40% (mediation effect, 0.40; 95% CI, 0.38-0.43), and 13% (mediation effect, 0.13; 95% CI, 0.11-0.18) of the effect of race and ethnicity on prehospital transport mode were explained by ADI, DCI, and SDI scores, respectively. The results of this cohort study indicate that standard use of the AMPT score during air medical triage may improve equity in prehospital AMT use.

Aims/backgroundAs cannabis use continues to increase in the United States, racialized stereotypes and structural barriers to care might lead to inequitable treatment uptake across racialized groups. A greater understanding of racial disparities in cannabis treatment uptake and perceived treatment need among people with cannabis use disorder (CUD) in community-based samples is needed.MethodsNationally representative data from the 2002–2019 National Survey on Drug Use and Health (N=1,005,421) included community-based people ages 12+ First, we assessed trends in CUD (i.e., meeting 2+ DSM-5 proxy CUD criteria) by racialized group. Among people with CUD (n=48,768), weighted logistic models regressed any CUD treatment, specialty CUD treatment, and perceived need for CUD treatment on racialized group and year, adjusting for age, gender, education, insurance, and criminal legal system exposure. We use interaction terms to examine group-specific trend differences.ResultsOverall, 2.64% of the US population ages 12+ had CUD, including 2.47% of white, 1.23% of AAPI (Asian American and Pacific Islander), 4.83% of AIAN (American Indian and Alaska Native), 3.70% of Black, and 2.71% of Hispanic people. CUD increased slightly across all groups (overall annual OR: 1.01, 95% CI =1.01,1.02), with AAPI, Hispanic and people with more than one race seeing steeper increases (ORs: 1.02-1.04). Treatment use and perceived need decreased consistently and there were no group differences in these trends across racialized groups with CUD (ORs: 0.93-0.97). Black people with CUD had 21% lower odds of any treatment than white people (aOR: 0.79, 95% CI=0.65, 0.95). All racialized groups (except AAPI people) had higher odds of perceived need than white people (aORs: 1.59–1.73).ConclusionAlthough all racialized groups had increasing CUD and decreasing CUD treatment use during the study period, the observed racialized disparities also persisted. For example, despite a higher prevalence of CUD among Black people compared to white people, Black people with CUD were less likely than their white counterparts to receive treatment and more likely to report perceived need. These disparities in CUD, treatment use, and perceived need underscore the need for CUD-related services overall and tailored services for racialized minorities, and especially Black people.

Introduction: High quality of post-cardiac arrest care has been linked to improved outcomes, but data is limited on compliance with current best practices. As part of the ICECAP (Influence of Cooling duration on Efficacy in Cardiac Arrest Patients) trial on targeted temperature management, regular physiologic assessments are collected for each patient, to include hourly measurements of deviations from protocolized pulse-oximetry (SpO2) goals. Hypothesis: We hypothesize that there is a wide distribution of deviations from protocolized care for measured physiologic parameters both between patients and across clinical sites that enroll patients in the ICECAP trial. Aims: To quantify and compare the incidence and duration of SpO2 transgressions across ICECAP sites and identify patterns of variability within and between clinical centers. Methods: Clinical trial case report forms for daily physiologic transgressions were reviewed for all patients included in the ICECAP trial through March 20 2025. Durations of deviations from protocolized care were calculated for each patient for hourly measurements of pulse-oximetry (&lt;90% or &gt;98%). The burden of transgression was expressed as the percentage of monitored time spent outside the target range and split by sex and race. We compared transgression burdens across sites, using Levene’s test for within-site variability and Kruskal-Wallis for between-site differences. Results: 1100 patients were included with a median age of 61 years (Q1 51, Q3 70), 421 (38%) female, 674 (61%) male. American Indian or alaska native - 4 (0.36%), Asian - 37 (3%), Black or African American - 421 (38%), Native hawaiian or Pacific Islander - 7 (0.64%), White - 546 (49.6%), multiple/unknown 85 (7.7%). Hypoxia (SpO2 &lt; 90%) was rare, with a median burden of 0% (mean [SD]: 4.8% [12.2]; Q1-Q3: 0%-4.1%). In contrast, presumed hyperoxia (SpO2 &gt; 98%) was common, with a median reported burden of hyperoxia of 66.7% (mean [SD]: 61.6% [29.4]; Q1-Q3: 39.3%-88%). Transgression burdens differed significantly between sites (p &lt;0.0001), but were consistent within sites (SpO2 &lt; 90%, p = 0.64; SpO2 &gt; 98%, p = 0.26), suggesting variation in institutional practices. Conclusions: While there may be a reporting bias, adherence to strict oxygen levels is not consistently done, in particular in regards to presumed hyperoxia. A substantial number of patients are spending over half of their reported monitored time above the recommended range.

Background: Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) carries high morbidity and mortality. Mechanical circulatory support (MCS) devices are critical in management, but racial and ethnic disparities in MCS utilization remain understudied. Research Question: Do disparities exist in the utilization of MCS and healthcare resources among racial and ethnic groups with AMI-CS in the United States? Methods: We extracted data from the National Inpatient Sample database from 2018 to 2020. We included patients aged ≥18 years with AMI and CS listed as primary or secondary diagnosis, identified using ICD-10-CM (AMI: I21.0–I21.4; CS: R57.0). Racial/ethnic groups analyzed included White, Black, Hispanic, and Asian or Pacific Islander. The primary outcome was in-hospital mortality. Secondary outcomes included MCS utilization, hospital length of stay (LOS), total hospital charges, acute kidney injury (AKI)/hemodialysis, and sepsis. Multivariable logistic and linear regression models were used to assess associations between race/ethnicity and in-hospital outcomes, adjusting for potential covariates. Results: Among 89,125 hospitalizations for AMI-CS, Hispanic individuals had lower odds of in-hospital mortality compared to White individuals (OR 0.86; 95% CI, 0.76–0.96), while no significant differences were observed for other racial and ethnic groups. The odds of receiving MCS were higher among Asian or Pacific Islander (OR 1.35; 95% CI, 1.14–1.60) and Hispanic individuals (OR 1.15; 95% CI, 1.01–1.30) relative to White individuals. Compared to White individuals, Hispanic individuals had longer hospital stays (β = 1.3 days; 95% CI, 0.78–1.7), whereas Black individuals had shorter stays (β = –0.50 days; 95% CI, –0.91 - –0.10). The odds of AKI or hemodialysis were higher in Hispanic (OR 1.26; 95% CI, 1.12–1.42), Black (OR 1.59; 95% CI, 1.40–1.79), and Asian or Pacific Islander individuals (OR 1.39; 95% CI, 1.18–1.64) compared to White individuals. Hispanic individuals also had higher odds of developing sepsis (OR 1.18; 95% CI, 1.04–1.34). Additionally, total hospital charges were significantly greater for Hispanic ($53,770; 95% CI, $39,307–$68,233) and Asian or Pacific Islander individuals ($33,737; 95% CI, $8,954–$58,520) compared to White individuals. Conclusion: Racial and ethnic disparities in MCS use and clinical outcomes persist among patients with AMI and CS, highlighting the need for targeted strategies to improve AMI care.