Proximal Outcomes Research Articles

Applying an Individual Word-Problem Intervention to a Small-Group Setting: A Pilot Study’s Evidence of Improved Word-Problem Performance for Students Experiencing Mathematics Difficulty

The purpose of this pilot study was to determine whether positive results from a word-problem intervention implemented one-to-one contributed to similar outcomes when implemented in small groups of three to four students. Third-grade students experiencing mathematics difficulty (N = 76) were randomly assigned to word-problem intervention (n = 56) or business-as-usual comparison (n = 20). Intervention occurred for 13 weeks, 3 times per week, 30 min per session. Multilevel models revealed the intervention condition significantly outperformed the BaU on a proximal word-problem outcome, corroborating results from our prior individual intervention. When comparing student performance in the individual versus small-group intervention, findings suggest students received added benefit from the individual intervention. The word-problem intervention successfully translated to a small-group setting, which holds important implications for educators working with students in supplemental, targeted, or Tier 2 mathematics intervention settings.

An online, single-session intervention for adolescent self-injurious thoughts and behaviors: Results from a randomized trial

BackgroundAcross 50 years of research, existing interventions for self-injurious thoughts and behaviors (SITBs) in adolescents have remained largely ineffective and inaccessible. Single-session interventions, interventions designed to last one session, may be a low-cost and timely resource for adolescents engaging in SITBs who may not otherwise receive treatment. Method565 adolescents (Mage = 14.95 years) endorsing recent engagement in non-suicidal self-injury (NSSI) were randomized to receive a 30-min, web-based, single-session intervention—“Project SAVE”—or an active, attention-matched control program. Proximal outcomes were measured at baseline and immediately post-intervention. Long-term outcomes were measured at baseline and 3-month follow-up. ResultsAdolescents rated Project SAVE as acceptable; 80% of participants randomized to SAVE completed the intervention. Between-group effects were non-significant for pre-registered outcomes: post-intervention likelihood of future NSSI; 3-month frequencies of NSSI and suicidal ideation at follow-up. Relative to control-group participants, SAVE participants reported short-term improvements in two exploratory outcomes: self-hatred (d = −.35, p<.001) and desire to stop future NSSI (d = .25, p = .003). ConclusionsProject SAVE is an acceptable resource for adolescents engaging in SITBs—with short-term effects on clinically-relevant outcomes. Future research may evaluate SAVE as an easy-to-access, short-term coping resource for youth engaging in SITBs. Clinical Trials.gov identifierNCT04498143.

A ‘wicked problem’: rethinking history education in the Anthropocene

ABSTRACT In seeking to attune history education to a relational, ecological, and ethical future orientation, we turned to scholarship in other fields that teach similar or proximate outcomes: Indigenous studies, environmental history, and climate change education. We suggest that the challenge in history is not just teaching about climate variation over time and its consequences, but also recognizing that the Anthropocene is a multidimensional phenomenon requiring adaptation in ways of being and understanding ourselves. We draw on the literature in each of the above-mentioned fields to leverage theory, content, and pedagogical cues to begin envisioning how history teachers and learners can seek meaning, when the terms within which we have made meaning in the past may slip away. In this article, we offer a prospective agenda for provoking history education to make significant change, particularly in Canada where we are situated. Our suggestions for history teaching and learning practice may be deployed in many different contexts to help educators confront the climate crisis. As historians and educators, we must provide these opportunities to learn about the past because as Davis and Todd state, ‘the story we tell ourselves about environmental crises, the story of humanity’s place on the earth and its presence within geological time determines how we understand how we got here, where we might like to be headed, and what we need to do’.

Comparative Effectiveness of Digital Breast Tomosynthesis and Mammography in Older Women.

BackgroundDigital breast tomosynthesis (DBT) has become a prevalent mode of breast cancer screening in recent years. Although older women are commonly screened for breast cancer, little is known about screening outcomes using DBT among older women.ObjectiveTo assess proximal screening outcomes with DBT compared to traditional two-dimensional(2-D) mammography among women 67–74 and women 75 and older.DesignCohort study.ParticipantsMedicare fee-for-service beneficiaries aged 67 years and older with no history of prior cancer who received a screening mammogram in 2015.Main MeasuresUse of subsequent imaging (ultrasound and diagnostic mammography) as an indication of recall, breast cancer detection, and characteristics of breast cancer at the time of diagnosis. Analyses used weighted logistic regression to adjust for potential confounders.Key ResultsOur study included 26,406 women aged 67–74 and 17,001 women 75 and older who were screened for breast cancer. Among women 75 and older, the rate of subsequent imaging among women screened with DBT did not differ significantly from 2-D mammography (91.8 versus 97.0 per 1,000 screening mammograms, p=0.37). In this age group, DBT was associated with 2.1 additional cancers detected per 1,000 screening mammograms compared to 2D (11.5 versus 9.4, p=0.003), though these additional cancers were almost exclusively in situ and stage I invasive cancers. For women 67–74 years old, DBT was associated with a higher rate of subsequent imaging than 2-D mammography (113.9 versus 100.3, p=0.004) and a higher rate of stage I invasive cancer detection (4.7 versus 3.7, p=0.002), but not other stages.ConclusionsBreast cancer screening with DBT was not associated with lower rates of subsequent imaging among older women. Most additional cancers detected with DBT were early stage. Whether detecting these additional early-stage cancers among older women improves health outcomes remains uncertain.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07132-6.

Quantifying the influence of informal payments on self-rated health: evidence from 26 post-communist countries.

In contrast to previous studies that have focused on proximal outcomes such as access to and the utilization of healthcare, this study establishes and quantifies the influence of informal payments (IP) directly on population self-rated health, which can be considered the ultimate outcome. More specifically, we examine how making informal payments influences self-rated health by testing several theoretically grounded explanations of the influence of making IP. Using the quasi-experimental instrumental variable technique increases the likelihood that our findings are not the result of reverse causality, omitted variable problem and measurement error. Our main finding is that overall, making informal payments have a negative influence on self-rated health. However, this influence is higher for men, those who are poorer, live in rural areas, have a university education and have lower social capital. Theoretical approaches that have stood out in explanations regarding the effects of making IP on self-rated health are Public Choice Theory, Institutional Theory, and Sociological Theories of Differences in Life Opportunities, Social Determinants of Health and Social Capital.

A Taxonomy of Employee Motives for Telework.

This qualitative research contributes to the telework research literature by identifying and categorizing employee motives for teleworking. Motives for telework contextualize teleworking behavior, represent proximal telework outcomes, and serve as potential boundary conditions for telework-outcome relationships. Role identity theory (Burke & Tully Social Forces, 55(4), 881-897, 1977) and the uncertainty-reduction hypothesis (Hogg & Terry Academy of Management Review, 25, 121-140, 2000) suggest that motives may be driven by role salience and the ability to meet work and nonwork demands. In this research, we sought to identify a comprehensive list of motives as well as reconcile the wide range of categories and labels given to telework motives in the literature. We asked two independent samples of workers comprised of two subsamples of teleworkers (n1 = 195; n2 = 97) and a subsample of nonteleworkers (n3 = 947) why they telework or would like to telework. A total of 2504 reasons were gathered across the three subsamples. Most respondents reported multiple reasons, especially when encouraged to list all of their reasons. After distinguishing preconditions from motives to telework, ten categories emerged from the qualitative data with “avoid commute” emerging as the most frequently reported motive. Other frequently reported motives included “tend to family demands” and “productivity.” Additional motives are discussed along with implications for telework research and policy development and implementation.

Impacts of Patient‐Centered Inpatient Psychiatric Care on Trust and Post‐Discharge Engagement with Care

Research ObjectiveInpatient psychiatry lacks empirical evidence for its benefits, with some evidence of iatrogenic harm. Research suggests that safety events, including restraint and seclusion, are not uncommon. Within 30‐days of discharge, the risk for suicide is 180 times the rate in the general population, about a third of patients have an unplanned readmission, and only about 50% have a follow‐up appointment. These increased risks for negative outcomes and disengagement with care might relate to the quality of inpatient care experiences, yet research investigating these associations is sparse.The current study aimed to understand the relationship between patients' reports of patient‐centered care (PCC) in inpatient psychiatry and proximal outcomes of trust and post‐discharge engagement with care. This is the first known study to examine these relationships.Study DesignWe used a retrospective cohort design. Participants were recruited online in 2021 and administered a survey. PCC was measured using a valid and reliable instrument, the Combined Assessment of Psychiatric Environments. Participants were asked to report the degree of trust they had in the hospital at time of admission, the extent to which their trust in mental health providers decreased or increased due to their hospitalization, the extent to which their willingness to disclose distressing thoughts to outpatient providers decreased or increased due to their hospitalization, and the extent to which their willingness to go to the hospital voluntarily decreased or increased due to their hospitalization. Participants also reported global impacts of the hospitalization on wellbeing (positive, negative, mixed, neutral), whether they received follow‐up care within 30‐days of discharge, clinical characteristics, and demographic characteristics.Logistic regression models were fit for each outcome, with PCC serving as the primary predictor. Models controlled for baseline trust/expectations in the quality of hospital care at time of admission, voluntary status, suicidality, prior admissions, demographic characteristics, and year.Population StudiedThe population included adults (18+) who were hospitalized for psychiatric treatment in the United States within the past five years.Principal FindingsA total of 733 participants completed the survey. Relative to those in the top quartile of PCC, those in the bottom quartile were more likely to have their trust reduced (predicted probability [PP] = 0.75 versus 0.40, p &lt; 0.001), willingness to disclose distressing thoughts reduced (PP = 0.63 versus 0.18, p &lt; 0.001), willingness to go to the hospital voluntarily reduced (PP = 0.86 versus 0.08, p &lt; 0.001), were more likely to report that the hospitalization had only a negative impact (PP = 0.53 versus 0.02, p &lt; 0.001), and were less likely to have a 30‐day follow‐up (PP = 0.68 versus 0.88, p &lt; 0.001).These patterns persisted when examining positive outcomes of increased trust and engagement, and were robust even when restricted to those hospitalized on an involuntary basis.ConclusionsLow ratings of PCC were associated with reported reductions in trust and decreased engagement, whereas high PCC was associated with increased trust and increased engagement.Implications for Policy or PracticeThese findings demonstrate the importance of PCC on outcomes. Payers and policy makers should expand patient experience measurement to inpatient psychiatry (e.g., HCAHPS). Systematic measurement of PCC could be used within feedback and incentive designs.Primary Funding SourceNational Institutes of Health.

Effects on corporate performance through ISS-enabled strategy-making on dynamic and improvisational capabilities

PurposeThis study develops the idea that resource orchestration (RO) of ISS-enabled strategy-making (ISS-SM) can influence dynamic and improvisational capabilities in innovation resulting in corporate performance (CP) gains under a hostile environment.Design/methodology/approachThe structural equation modeling is applied to the data collected from 551 Brazilian firms.FindingsThe results suggest that ISS-SM facilitates dynamic and improvisational capabilities in innovation, consequently promoting CP. The research also showed that, under conditions of high environmental hostility, the impact of improvisational capabilities in innovation on CP is significantly amplified. Finally, in the specific case of high hostility, ISS-SM is especially important in enabling organizational capabilities on CP, for digital mastery firms, large firms in the manufacturing and services sectors.Practical implicationsThe findings provide insights on how RO of ISS and resource management action enable strategy-making to leverage innovation and corporate performance during an uncertain environment.Originality/valueThis study developed an original contribution to resource orchestration, information systems strategies, and strategy-making literature through developing a novel construct of ISS-enabled strategy-making to enhance proximate and distal outcomes under a hostile environment.

A Longitudinal Study on the Impact of Indoor Temperature on Proximal Heat-Related Symptoms in Older Adults Living in Non-Air-Conditioned Households

BACKGROUND AND AIM: Heat waves result in a significant health burden, causing particular concern for at-risk populations such as older adults. Outdoor temperatures are often assessed as the exposure of interest and are used for heat warning systems despite individuals spending most of their time indoors. Additionally, many studies utilize ecological designs, where death or hospitalizations are the studied outcomes. Proximal outcomes should also be assessed to better understand early symptoms for refining prevention efforts. In this study, we assessed the relationship between indoor temperature and proximal symptoms in individuals 60 years and older living in non-air-conditioned households in Montérégie, Quebec during the 2017-2018 summer months. METHODS: We recruited 277 participants and gathered continuously measured temperature and humidity data from nearable sensors and health-related questionnaires administered by health professionals across three periods of increasing outdoor temperatures, where the reference measurement (T1) occurred during a cool period with a target temperature of 18ºC-22ºC and two measurements (T2 and T3) occurred during warmer periods with a target temperature of 28ºC-30ºC and 30ºC-33ºC, respectively. We collected information on stress, fatigue and other heat-related symptoms. We used Generalized Estimating Equations with Poisson regression models to estimate risk ratios for the relationship between temperature and heat-related symptoms. RESULTS:We found that higher indoor temperatures increased the risk of dry mouth, fatigue, thirst, more frequent urination, and dark urine as well as trouble sleeping compared to the reference cool-period. With the exception of dark urine and depression, we identified a non-linear relationship with identified thresholds varying across symptoms of interest. CONCLUSIONS:This study identified that increasing indoor temperatures are an etiologic factor in the development of these proximal symptoms. By considering the prevalence of these early-stage outcomes and indoor temperature exposures, adaptation strategies may be improved to minimize the burden of heat among vulnerable communities. KEYWORDS: Environmental epidemiology, temperature, temperature extremes

The impact of international experience on individual-level outcomes: A meta-analysis

This meta-analysis aggregates the insights of 202 studies on the relationships between international experience (IE) and a range of individual-level outcomes including cultural intelligence, cross-cultural adjustment, and work-related satisfaction, performance, and turnover intentions. We provide a conceptual framework to organize the literature, review and integrate existing research on IE-outcome links, explore the impact that different types of IE operationalization and measurement have on the direction and magnitude of effects, and establish the incremental predictive validity of IE beyond commonly used predictors, such as personality traits, general mental ability, and language proficiency. We find that effect sizes are generally small; however, subgroup analyses of different types of IE operationalization and measurement yield substantially larger effect sizes. Additionally, we show incremental predictive validity of IE for more proximal outcomes beyond a set of established predictors. We discuss the implications of our findings for theory development and measurement of IE and offer avenues for future research.

The Order in Disorder: The Effects of Leader Sequence in Job Rotation

In job rotation programs, higher level managers or human resource specialists often assign multiple leaders to an employee following a random sequence, because they have no method or no prior knowledge about this decision. In this paper, we focus on a destructive leader experience— working with an abusive leader. Random leader sequence in job rotation implies that some employees are assigned with an abusive supervisor early on while others are assigned with one late in the process. It thus creates an interesting theoretical tension: is it better off to have primacy-based leader sequence (i.e., abusive supervisors should appear early in the sequence) or recency-based leader sequence (i.e., abusive supervisors should appear late in the sequence)? Based on a 4-month job rotation program that involves 291 nurses and 513 nurse supervisors, we found that a primacy-based abusive supervision sequence consistently has a positive effect on both proximal rotation outcome (i.e., qualified exam performance and job performance) and distal rotation outcomes (i.e., job performance and bonus). The model not only adds a new inquiry of the leader sequence problem to leadership and job rotation research, but also offers much needed action implications to managers about how to assign leaders in job rotation.

Impact of a Pharmacy Management Course for Pharmacists Working Within Brazil’s Public Health System

Objective. To assess the impact of a continuing education course that focused on the development of management competencies on pharmacists working in Brazil's public health system.Methods. A specialization blended in-service course (360 hours) entitled Pharmaceutical Service and Access to Medicine Management was offered to pharmacists working within the Brazilian public health system. Data on course outcomes were collected through individual interviews with pharmacists who worked in the Brazilian public health system, as well as from focus groups and records of researchers' observations. The analysis was based on models of learning and training evaluation theory.Results. The findings showed proximal outcomes on students' knowledge, skills, and attitudes; behavioral changes; and programmatic outcomes in the organization and management of health services, promoting the recognition and integration of the "pharmaceutical services division" - a dedicated sector within the health departments in municipalities and states. The inputs (course content, structure, and in-service hands-on activities) were directly linked to the outcomes reported by participants and helped them to overcome some of the barriers to using knowledge and skills in the workplace.Conclusion. A well-structured course including leaning activities to intervene in the workplace had a positive impact on pharmacists' behavior and contributed to the capacity building of the organizations in which they operate.

I got this! resource bundles and adversity: A situated entrepreneurial optimism perspective

Remaining optimistic in the face of adversity is critical during the entrepreneurial process. Entrepreneurship research has overwhelmingly focused on the consequences of optimism. Here, we shift this attention to the “whence” of optimism. Integrating micro- and macro-level resource theories, we build a situated entrepreneurial optimism framework to contend that resource combinations are associated with entrepreneurial optimism. To explore resource configurations, we use fuzzy-set qualitative comparative analysis (fsQCA) and examine five resource components tapping into human, social, and financial capital. We find that entrepreneurial optimism does not rest on one resource component but on the combination of at least two. Human and social capital components form a part of most configurations consistently associated with entrepreneurial optimism. This study extends entrepreneurship research by shifting the theoretical and empirical focus to the antecedents of optimism and contributes to macro-level resource theories by linking resources to more proximal venture outcomes.

Stimulation of Employees’ Green Creativity through Green Transformational Leadership and Management Initiatives

Drawing upon the componential theory of creativity and social information processing theory, this research elucidates how and why the synergy of green HR practices and green strategies stimulate green creativity. It also explores the possible mediation effect of green transformational leadership (TFL) on the relationship between organizational interventions and green creativity. Survey questionnaires were used to collect data from managers working in large manufacturing firms. The structural equation modeling technique was applied to test the hypothesized relationships. Findings of research revealed that green management initiatives and green TFL stimulate green creativity. Moreover, the intervening impact of green TFL on the relationship between the aforementioned relationships was also established. Policymakers should devise green strategies and provide support to green HR practices for the stimulation of green creativity, whereas HR managers must ensure the compatibility of HR functions with corresponding organizational green strategies. Employees involved in green creative behaviors should be rewarded and retained. Training must be provided in order to keep employees abreast of the latest practices for environment conservation. Furthermore, managers should exhibit a green TFL style to advance green management initiatives and fuel green creativity among employees. This study highlights the significance of the synergy between green HR practices and the firm’s green strategies to stimulate employees’ green creativity. Furthermore, green management initiatives were also found to be the contextual precursor of green TFL, which enhances our understanding of the green TFL style. Lastly, the mediation effect of green TFL implies that it can serve as a proximal HR outcome to implement the organizational green agenda.

School-based intervention for adolescents with attention-deficit/hyperactivity disorder: Effects on academic functioning

Multi-component training interventions such as the Challenging Horizons Program (CHP) improve organization skills and academic functioning of middle school students with attention-deficit/hyperactivity disorder (ADHD); however, few studies have investigated treatment for high school students. We explored the extent to which CHP adapted for high school would improve proximal (e.g., organization skills, homework performance) and distal (e.g., report card grades) academic outcomes through 6-month follow-up relative to a community care (CC) condition. Participants included 186 adolescents who were randomly assigned to CHP (n = 92; 80% male; M age = 15.0; SD = 0.8) or CC (n = 94; 78% male; M age = 15.1; SD = 0.9) with CHP delivered over one school year. Parent, teacher, and self-report ratings of organization skills and academic performance, report card grades, and achievement tests were collected across multiple occasions. Intent-to-treat analyses using hierarchical linear modeling revealed significant improvements of small to medium magnitude (d range = 0.32 to 0.58) for parent-rated organization skills, homework performance, and academic functioning at 6-month follow-up. CHP effect on grades was small, but associated with a less steep decline than that found for CC. No statistically significant effects on teacher or self-report ratings were obtained. CHP appears efficacious for ameliorating organization skills and homework performance deficits exhibited by high school students with ADHD and can protect against decline in report card grades experienced by these students. CHP may require supplementation with academic skills instruction for some students and may need implementation beyond one school year to produce durable effects.

Comprehensive Meta-Analysis of Attention-Deficit/Hyperactivity Disorder Psychosocial Treatments Investigated Within Between Group Studies

Interventions for attention-deficit/hyperactivity disorder (ADHD) include positive behavior supports (e.g., parent training, school-based contingency management, behavioral peer interventions), training interventions (e.g., organizational skills training, social skills training, etc.), and other interventions (e.g., academic accommodations/modifications, self-monitoring). There is a need to conduct a comprehensive meta-analysis of psychosocial treatments for ADHD given discrepancies between meta-analyses. The present meta-analysis reports the results of between-group studies that compared a psychosocial treatment to a control condition from 1968 to 2016. In total, 226 studies were identified that met inclusion criteria. Results of the meta-analysis were organized by treatment type, rater, and domain of outcome assessed. Results indicated considerable variability across these parameters, with the strongest effects for proximal outcomes of behavioral parent training (improvements in parenting behaviors yielded a standardized mean difference of 0.70) and improvements in child behavior following implementation of behavioral school intervention (standardized mean difference of 0.66 and 0.72 for teacher ratings of ADHD symptoms and impairment, respectively). Other interventions were not extensively studied as stand-alone approaches. Results are discussed in light of current support for the use of psychosocial interventions for individuals with ADHD.

School belonging constellations considering complete mental health in primary schools

ABSTRACT Introduction: The investigation of school belonging is crucial due to its established significant associations with mental health, academic achievement, and risky behaviours coupled with the limited research documenting the configurations of children’s school belonging experiences. Objective: This study sought to better understand elementary students’ experiences of school belonging and how they correspond to mental health outcomes. Method: The current study explores school belonging in upper elementary school California students (N = 619). Latent profile analysis was conducted to determine the constellations of experiences. Path analyses were then added to the model to determine mental health outcomes for each emerging profile. Results: Latent profile analysis revealed the best fit for a three-profile solution: Low School Belonging, Moderate School Belonging, and High School Belonging. The majority of students were classified in the Low and Moderate School Belonging profiles. Demographic covariates indicated that female and Latinx students were more likely to experience high belonging than males and non-Latinx students. Concerning proximal outcomes, students in the High School Belonging profile reported higher psychological strengths and lower psychological distress. Conclusion: Practical implications include assessing and promoting school belonging more effectively in students, given the small percentage of students who perceive high levels of school belonging.

Enhancement of operational performance through strategic hrm practices: A case of banking industry

Based on the Guest 1997 organizational outcome model, this explanatory study examined the effects of five dimensions of practices of HR. i.e. performance evaluation, recruitment & selection, compensation & reward, career opportunities within organization and training & development on proximal business outcomes (Flexibility & Quality of Operations). The study validates components of GUEST model by integrating between HRM dimensions and banking operations, thus strengthens the existing theoretical model of GUEST by improving the comprehensiveness as it provides analytical framework for studying HR. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was utilized in the current study, and tested the study hypotheses by SEM to analyze the proposed conceptual model. It was found that all five chosen HR practices had significant influence on the quality of operations however for flexibility of operations, performance appraisals and career within organization have shown significant role for banking industry of the country, Pakistan. The study contributed to the construction and validation of structural. path and measurement models(MM) of SHRM practices and two selected operational competitive outcomes based on theoretical and empirical foundations, which will help progress the human resource management future researches and important implications for HR mangers, as very little work has been done on interdisciplinary framework of HR and OM specifically within context of South Asian banking Industry.

#36: A Review of Maternal and Neonatal Characteristics and Outcomes in Pregnant Women with Serious Infectious Complications from Injection Drug Use

Abstract Background Pregnant people who inject drugs (PWID) and their infants are unique populations that have emerged from the opioid epidemic. Numerous studies have evaluated vertical transmission of HIV, HCV, sequelae of neonatal abstinence syndrome, and maternal and fetal mortality in these mother-infant dyads; however there still remains a large knowledge gap regarding how serious infections in pregnant PWID affect more proximal outcomes such as fetal and maternal distress leading to preterm delivery, risk of neonatal sepsis, need for invasive diagnostic procedures to rule-out neonatal sepsis such as lumbar puncture, neonatal intensive care unit (NICU) admission, and potential consequences of prolonged intrauterine antibiotic exposure. Methods We identified pregnant PWID ≥18 years old with serious infectious complications (defined as (sepsis, endocarditis, osteomyelitis, epidural abscesses, septic arthritis/bursitis, thrombophlebitis, and skin and soft tissue infections requiring IV antibiotics) admitted between 2017–2018 to the University of Kentucky Medical Center and their neonates treated at Kentucky Children’s Hospital. Patients were identified using positive urine or serum pregnancy test results, IVDU-associated ICD9/10 codes, infectious disease, neonatology, and obstetrics notes. Results 261 women with infectious complications from IVDU were identified, 25 were pregnant and 16 dyads were able to be matched with identification of 14 viable neonates born at the University of Kentucky. Mean maternal age was 31 years and median 30 years. Mean gestational age (GA) at time of admission was 25 weeks with median 29 weeks. Sepsis was the most common complication reported 18 (72%) followed by endocarditis 11 (44%). Staphylococcus aureus was the most isolated organism (16) 64% with 12 (48%) of isolates identified as MRSA and MSSA comprising 4 (16%). 96% were screened for HCV, with 72% HCV antibody positive and 32% with detectable viral load. There was 1 reported maternal death, 1 spontaneous abortion and 2 intrauterine fetal demises (IUFD) in the 3rd trimester and no neonatal deaths. Average GA at time of delivery was 33 weeks with median 36 weeks. 6 (42%) were routine deliveries with 3 (22%) deliveries for emergent maternal indications and 5 emergent deliveries for fetal indications (36%). 12 neonates (86%) required NICU admission with average length of stay 17 days and median 10 days. 10 (71%) underwent limited sepsis screen with 9 (64%) receiving at least 48 hours of antibiotics and 3 (22%) receiving an extended course. However none of the blood cultures yielded any organisms. All passed their hearing screening and had no evidence of renal dysfunction or cytopenias. Conclusions Pregnant PWID dyads may be at increased risk for morbidity and mortality secondary to infectious complications of IVDU. The majority of neonates were delivered early for either fetal distress or maternal distress. 2 mothers suffered IUFD in the 3rd trimester and the majority of the neonates required NICU admission (86%) due to prematurity-related factors, concern for neonatal abstinence syndrome or concern for infectious complications. Over half received 48+ hours of antibiotics in the NICU however none of the neonatal blood cultures yielded an organism. Larger cohort studies are needed to better ascertain risk in these expanding populations.

Regional and racial disparity in proximal gastric cancer survival outcomes 1996-2016: Results from SEER and China National Cancer Center database.

BackgroundGiven the growing incidence and aggressive biological behavior of proximal gastric cancer (PGC) as reported, it is important to understand which regional or racial populations are at poor prognosis so that interventions can be treated appropriately. We sought to explore regional treatment differences as well as racial genes influence survival outcomes in China and the US patients with PGC.MethodsPGC patients defined as tumors with the epicenter located in cardia (C16.0) or fundus (C16.1) from 1996 to 2016 were identified from the Surveillance Epidemiology and End Results (SEER) in the United States as well as data from a high‐volume National Cancer Center Database in China. Overall survival (OS) curves were plotted for different regional or racial groups, respectively, using the Kaplan‐Meier method and compared statistically using the log‐rank test. Differentially expressed genes (DEGs) analysis was performed using TCGA database.ResultsFinally, the cohort consistent of 40973 PGC patients who enrolled in SEER database (n = 36305) or China National Cancer Center (n = 4668), and divided into 4 racial groups: Chinese (n = 5179), Black (n = 2429), White (n = 31185), and Others (n = 2096). After controlling for confounding variables, racial factors were independently associated with poor survival included Black ethnicity (HR = 1.376, 95% CI: 1.066–1.7760, p = 0.014) and White ethnicity (HR = 1.262, 95% CI: 1.005–1.583, p = 0.045) when compared to Chinese ethnicity in total PGC patients. Even in the same region for only US group, Chinese PGC patients also showed better prognosis.ConclusionsIn conclusion, we demonstrated the different survival outcomes of PGC patients in different regions or races from two high‐volume database SEER and China National Cancer Center database. These survival differences are likely influenced by a number of factors (e.g., access to screening, quality of gastrectomy, neo/adjuvant therapy, and biological genes itself). More importantly, a better understanding of these disparities could lead to interventions that may help to abolish these disparities.