Related Utilization Research Articles

Falanga: The clinical correlates of surgical outcomes as a result of foot whipping in a resource poor setting

BackgroundFalanga is a punishment that involves hitting the bare soles of a person's feet. The consequences of this punishment may be limb and life-threatening. Post-traumatic acute kidney injury (AKI) secondary to rhabdomyolysis is a well-documented complication. Patients often require prompt surgical intervention and renal replacement therapy (RRT). The clinical and biochemical presentation of these patients and subsequent outcomes are poorly understood. AimsThis prospective observational study describes the clinical presentation and effects of foot whipping on patient outcomes. MethodologyProspective data were collected over a one-year period for 135 patients presenting following blunt force assault admitted to a single centre. Presenting clinical characteristics and patient outcomes were recorded and correlations between presenting clinical characteristics and surgical and clinical outcomes were assessed. ResultsOf 138 patients presenting following blunt force assault 96% were male with a mean age of 28.8 ± 8.01. Thirty-six out of the 138 patients presenting following blunt force assault had received foot-whipping only (falanga group, FG). Ten of these 36 patients in the FG group required surgical intervention, with one requiring a below knee amputation, compared with only two patients who required surgical intervention in the group who experienced blunt force trauma not restricted to foot whipping (Sjambok group). Average length of stay was 4 days (range 2-38) in FG group compared with 5 (range 1-21) in SG group, with no mortalities in either group. For patients in the FG, Hb was higher at presentation compared to patients in the SG group (135.2 33.7 vs 124.2 21.3, p = 0.03) and correlated positively with the need for surgical intervention (r = 0.6, p < 0.01). In this same group, the presenting characteristics of CK (4251.3 3087.4, p = 0.1 vs 7422.6 12347.7, p = 0.1) and urine output (0.95 0.4 vs 0.7 0.4) positively correlated with RRT [CK r = 0.6, p < 0.01, UO r = 0.46, p < 0.01]. ConclusionPatients who present following falanga frequently require surgical intervention and the related healthcare utilisation and morbidity is high. Clinical indicators of a greater systemic injury at presentation may correlate with an increased likelihood of requiring surgical intervention or RRT.

Fe‐Based Catalysts for the Direct Photohydrogenation of CO2 to Value‐Added Hydrocarbons

AbstractThe solar‐driven conversion of CO2 into carbon‐based fuels and other valuable chemical feedstocks is actively being pursued as an approach for curbing greenhouse gas emissions. Herein, a series of novel Fe‐based catalysts with different chemical compositions are successfully fabricated through the hydrogen reduction of MgFeAl‐layered double hydroxide nanosheets at temperatures from 300 to 700 °C. The catalysts obtained are denoted herein as Fe‐x, where x is the reduction temperature in celsius. Fe‐500 offers outstanding activity for the photothermal conversion of CO2 to C2+ hydrocarbons under ultraviolet‐visible (UV‐Vis) irradiation (CO2 conversion 50.1%, C2+ selectivity 52.9%). Characterization studies using X‐ray diffraction, extended X‐ray absorption fine structure, Mössbauer spectroscopy, and high‐resolution transmission electron microscopy determine that the Fe‐500 catalyst is comprised of Fe and FeOx nanoparticles on a MgO–Al2O3 mixed metal oxide support. Density functional theory calculations establish that heterostructures consisting of partially oxidized metallic Fe nanoparticles improve the CC coupling ability of CO2 hydrogenation intermediates, thus enhancing the selectivity to C2+ products. This work introduces a novel photothermal hydrogenation strategy for converting CO2 into valuable chemicals and also opens new avenues toward the development of related solar energy utilization schemes.

Evaluation of the effect of store-and-forward teledermatology on in-person health care system utilization in a safety-net public health and hospital system

To the Editor: Store-and-forward (SAF) teledermatology has demonstrated cost effectiveness in several studies, particularly by reducing in-person dermatology visits and travel costs for patients.1-4 However, few studies have evaluated its effects on health care system utilization over a specific period. We sought to evaluate the effect of teledermatology on dermatology referral–related in-person health care facility utilization at Parkland Health and Hospital System (PHHS), a Dallas safety-net hospital system.

Burden of preschool wheeze and progression to asthma in the UK: Population-based cohort 2007 to 2017

Wheeze is one of the most common symptoms of preschool children (age 1-5 years), yet we have little understanding of the burden in the United Kingdom. We sought to determine prevalence and pattern of physician-confirmed preschool wheeze, related health care utilization, and factors associated with progression to school-age asthma. We used nationally representative primary and secondary care electronic medical records between 2007 and 2017 to identify preschool children with wheeze. Factors associated with asthma progression were identified in a nested cohort of children with follow-up from age 1 to 2 years, until at least age 8 years. From 1,021,624 preschool children, 69,261 were identified with wheeze. Prevalence of preschool wheeze was 7.7% in 2017. Wheeze events were lowest in August and highest in late-autumn/early-winter. During median follow-up of 2 years (interquartile range, 1.2-4.0 years), 15.8% attended an emergency department, and 13.9% had a hospital admission, for a respiratory disorder. The nested cohort with prolonged follow-up identified 15,085 children; 35.5% progressed to asthma between age 5 and 8 years. Of children with preschool wheeze, without an asthma diagnosis, 34.9% were prescribed inhaled corticosteroids and 15.6% oral corticosteroids. The factors most strongly associated with progression to asthma were wheeze frequency and severity, atopy, prematurity, maternal asthma severity, and first reported wheeze event occurring in September. Preschool wheeze causes considerable health care burden, and a large number of children are prescribed asthma medication and have unplanned secondary care visits. Multiple factors influence progression to asthma, including first wheeze event occurring in September.

Real-world assessment of “OFF” episode–related healthcare resource utilization among patients with Parkinson’s disease in the United States

Aims Within 5 years of initiating carbidopa/levodopa, ∼50% of patients with Parkinson’s disease (PD) experience “OFF” episodes; little is known about the cost burden. We investigated the association of “OFF” episodes with patient characteristics, healthcare resource utilization (HCRU), and healthcare costs. Methods Analyses used neurologist-provided data from the US-specific 2017 and 2019 Adelphi Real World Disease Specific Programme for PD, including duration of “OFF” episodes and HCRU for 10–12 consecutive patients. Patients were grouped by presence/absence of “OFF” episodes and by average hours of daily “OFF” time. Between-group differences were assessed for demographics, personal circumstances, and clinical characteristics. Regression analyses modeled the relationship of “OFF” episodes with HCRU and costs. Results Of 1,309 patients, 41% experienced “OFF” episodes, 25% of whom were “OFF” ≥4 h/day. Patients having “OFF” episodes had more severe PD, were diagnosed for longer, and were younger than those without “OFF” (p < .0001). “OFF” episodes were associated with a greater number of prescribed PD drugs (p < .0001). Patients without “OFF” episodes were more likely to have full-time employment and less likely to be retired or unemployed because of PD (p < .001). Patients with and without “OFF” episodes had different living situations (p < .001): patients experiencing “OFF” were less likely to live alone and more likely to live in a nursing home and have a professional caregiver (p < .001). In the past 12 months, the number of hospitalizations, intensive care admissions, and emergency room visits; nights hospitalized; costs of consultations and hospitalizations; and total direct costs were all higher for patients experiencing “OFF” episodes (p < .05). Conclusion Patients with PD and “OFF” episodes had higher HCRU and costs than those without “OFF,” suggesting that “OFF” episodes contribute to the economic burden of PD. Further research is warranted to examine the extent that current PD treatments and treatment patterns impact HCRU and costs.

Inhaled Corticosteroids Do Not Adversely Impact Outcomes in COVID-19 Positive Patients with COPD: An Analysis of Cleveland Clinic's COVID-19 Registry

Background: Inhaled Corticosteroids (ICS) are commonly prescribed to patients with severe COPD and recurrent exacerbations. Given the concern for increased viral shedding by corticosteroids, as observed with previous coronavirus strains, it is not known what impact ICS cause in terms of COVID-19 positivity or disease severity in COPD patients. Methods: This study examined 27,810 patients with COPD from the Cleveland Clinic COVID-19 registry between March and September 2020. Electronic health records (EHR) were used to determine diagnosis of COPD, ICS use, and clinical outcomes. Multivariate logistic regression was used to adjust for demographics and comorbidities known to be associated with increased risk for severe Coronavirus disease-19 disease. Findings: Amongst the COPD patients who were tested for COVID-19, 44.1% of those taking an ICS-containing inhaler tested positive for COVID-19 versus 47.2% who tested negative (p=0.033). Of those who tested positive, (n=1288), 371 (28.8%) required hospitalization. In-hospital outcomes were not significantly different when comparing ICS versus no ICS in terms of developing sepsis (28.4% vs 26.5%, p=0.77), ICU admission (36.8% vs 31.2%, p=0.30), endotracheal intubation (21.9% vs 16.5%, p=0.24), or mortality (18.4% vs 20.0%, p=0.80). Multivariate logistic regression demonstrated no significant differences in hospitalization (adj OR 1.12, CI: 0.90-1.38), ICU admission (adj OR: 1.31, CI: 0.82-2.10), need for mechanical ventilation (adj OR 1.65, CI: 0.69-4.02), or mortality (OR: 0.80, CI: 0.43-1.49). Interpretations: ICS therapy did not increase COVID-19 related healthcare utilization or mortality outcome in patients with COPD. These findings should encourage clinicians to continue ICS maintenance therapy for COPD patients during the COVID-19 pandemic. Funding: No sources of funding were used.Declaration of Interests: The authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.Ethics Approval Statement: This study and the registry were both approved by the Cleveland Clinic Institutional Review Board (IRB#20-391).

Universal SARS-CoV-2 Testing for Obstetric Inpatient Units Across the United States

Background: The purpose of this study was to estimate prevalence of asymptomatic SARS-CoV-2 infection among patients admitted to obstetric inpatient units throughout the United States as detected by universal screening. We sought to describe the relationship between obstetric inpatient asymptomatic infection rates and publicly available surrounding community infection rates. Methods: This was a cross-sectional study in which medical centers reported rates of positive SARS-CoV-2 testing in asymptomatic pregnant and immediate postpartum patients over a 1-3 month time span in 2020. Publicly reported SARS-CoV-2 case rates from the relevant county and state for each center were collected from the COVID Act Now dashboard and the COVID Tracking Project for correlation analysis. Findings: Data were collected from nine health centers, encompassing 18 hospitals. Participating health centers were located in Alabama, California, Illinois, Louisiana, New Jersey, North Carolina, Pennsylvania, Rhode Island, Utah, and Washington State. Each hospital had an active policy for universal SARS-CoV-2 testing on obstetric inpatient unit. A total of 10,147 SARS-CoV-2 tests were administered, of which 124 were positive (1·2%). Positivity rates varied by site, ranging from 0-3·2%. While SARS-CoV-2 infection rates were lower in asymptomatic obstetric inpatient groups than the surrounding communities, there was a positive correlation between positivity rates in obstetric inpatient units and their surrounding county (p=·003, r=·782) and state (p=·007, r=·708). Interpretation: Given the correlation between community and obstetric inpatient rates, the necessity of SARS-CoV-2 related healthcare resource utilization in obstetric inpatient units may be best-informed by surrounding community infection rates. Funding Information: Internal funding was used.Declaration of Interests: None to declare. Ethics Approval Statement: The study was IRB approved or determined exempt at each center.

Incidence of respiratory syncytial virus related health care utilization in the United States.

BackgroundRespiratory Syncytial Virus (RSV) is one of the most frequent causes of acute respiratory infection worldwide. Understanding age-specific health care utilization is necessary to guide effective prevention strategies. This retrospective database analysis assessed the incidence rates of RSV-related health care utilization in the USA over a 7-year period.MethodsEpisodes of RSV were identified in the Truven Health MarketScan® Commercial Claims and Encounters database between 2008 and 2014 using ICD-9-CM codes for pneumonia, bronchiolitis and RSV (480-486, 487.0, 466.1, 491.2, 079.6). Annual RSV-related health care utilization was calculated for the total population, by age group (<1, 1, 2-4, 5-17, 18-49, 50-64, 65-74, 75-84 and ≥85 years) and the proportion of cases for each setting (hospitalization, outpatient, or emergency department [ED] / urgent care [UC]).ResultsOver the 7-year study period, the mean rate of all RSV-associated health care utilization was 2.4 per 1000 person-years, with mean rates ranging from 2.0 to 2.6). The highest rate was seen in infants aged <1 year (mean 79.0 per 1000 over the 7-year period), which decreased with increasing age in the range 2-49 years before increasing with age in older adults (mean rate 8.1 per 1000 over the 7-year period in those ≥85 years). Of all RSV cases, 82% were reported in an outpatient setting, 11% in the ED/UC and 7% were hospitalized.ConclusionsThe annual RSV-related healthcare utilization rates were substantial, especially in infants and young children. These results underscore the need to accelerate the development of RSV prevention strategies to reduce the healthcare burden of RSV.

Status of Comorbid Congenital Anomalies and Their Influence on Resource Use in Pediatric Inpatients: A Serial Cross-Sectional Study in Shanghai, China.

Objectives: The status of children with comorbid congenital anomalies (CAs) and their effects on related hospital resource utilization have been minimally investigated. We aimed to describe the congenital anomalies comorbidity status and their effects on hospital resource utilization (length of stay, cost) by pediatric patients.Setting: This study was conducted in five tertiary care children's hospitals in Shanghai, China.Participants: Data were obtained from the inpatients' electronic health records; diagnoses were recorded using International Classification of Disease, Ninth Revision codes. In total, 7,890 children were diagnosed with congenital anomalies (13.13%), which were either primary or secondary.Primary and secondary outcome measures: The dependent variables were length of stay and cost. The independent variables were demographic and clinical characteristics and CA status.Results: In total, 50.98% of the hospitalized patients had comorbid CA conditions. Medical+CA patients were associated with a longer LOS (β = 2.656, P < 0.001), and CA+medical patients were associated with higher costs (β = 7.222, P < 0.001). Cardiovascular, musculoskeletal, and genitourinary diseases were the top three comorbid diseases. The average LOS for the top three comorbid diseases was longest in the medical+CA group, followed by CA+medical group. Cardiovascular disease was the most frequent comorbidity (ranking 1 in the medical+CA group and 2 in the CA+medical group), and the cost of cardiovascular disease was highest in all groups.Conclusions: A high prevalence of comorbid CA conditions was observed among pediatric inpatients in the sampled tertiary hospitals in China. Strategic planning should be improved to guide resource utilization for complex comorbid CA care.

Impact of COVID-19 on Emergency Utilization for Mental Health and Substance Use: A Rapid Review

Background: A prolonged COVID-19 pandemic has the potential to trigger a global mental health crisis increasing demand for mental health emergency services. We undertook a rapid review of the impact of pandemics and epidemics on emergency department utilization for mental health (MH) and substance use (SU).Methods: An information specialist searched Medline, Embase, Psycinfo, CINAHL, and Scopus on June 16, 2020 and updated the search on July 24, 2020. Our search identified 803 abstracts, 7 of which were included in the review. Six articles reported on the COVID-19 pandemic and one on the SARS epidemic.Findings: All studies reported a decrease in overall and MH related ED utilization during the early pandemic/epidemic. Two studies found an increase in SU related visits during the same period. No data were available for mid and late stage pandemics and the definitions for MH and SU related visits were inconsistent across studies.Interpretation: Our results suggest that COVID-19 has resulted in an initial decrease in ED visits for MH and an increase in visits for SU. Given the relative paucity of data on the subject and inconsistent analytic methods used in existing studies, there is an urgent need for investigation of pandemic-related changes in ED case-mix to inform system-level change the pandemic continues.Funding Statement: There was no dedicated funding for this work.Declaration of Interests: The authors have no conflicts of interest.Ethics Approval Statement: Ethics requirement was waived by the University of Alberta Research Ethics Board.

Differences in COVID-19 Related Testing and Healthcare Utilization by Race and Ethnicity in the Veterans Health Administration

Importance: Recent reports indicate differences in COVID-19 related care and outcomes between Black and White Americans.Objective: We examine the COVID-19 related healthcare utilization and mortality by race and ethnicity of patients tested for SARS-CoV-2 in the Veterans Health Administration (VHA).Design: A retrospective cohort study.Setting: We used the VHA COVID-19 shared data resources between February 1 and June 30, 2020.Participants: Veterans tested for SARS-CoV-2 virus by VHA.Exposure(s): Three racial-ethnicity groups of Black, Hispanic, and White (as reference).Main Outcome(s) and Measure(s): Main outcomes are testing rate, positivity rate, hospitalization rate, ICU admission rate, and in-hospital mortality. Controlling for sex, age and Elixhauser comorbidity index, we report adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) from logistic regression models.Results: Of 8,667,996 active veteran enrollees, 252,702 were tested by VHA from February to June, 2020, with 20,500 positive results and 4,790 hospitalizations. The testing rate was 4.4% among Black and 4.7% among Hispanic veterans compared to White veterans, 2.8%. The testing positivity rate was similarly elevated among Black and Hispanic veterans compared to White veterans. The aORs of hospitalization in Black veterans (1.88; 95% CI 1.74, 2.03) and Hispanic veterans (1.41; 95% CI 1.25, 1.60) were higher compared to White veterans. No significant differences by race and ethnicity were observed in OR or aOR of ICU admission and in-hospital death among hospitalized patients.Conclusions and Relevance: On a national level, the VHA was more likely to test and hospitalize Black and Hispanic veterans compared to White veterans, but there were no significant differences in ICU admission or in-hospital mortality among those hospitalized. This pattern of differences may relate to social determinants of health, implicit biases, or preferences for VHA care affecting initial care seeking, but not in-hospital outcomes.Funding Statement: The study is funded by seed funding from Baylor College of Medicine,Houston, Texas, United States, and the Center for Innovations in Quality, Effectiveness and Safety (VA HSRD CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, Texas, United States. Declaration of Interests: None to declareEthics Approval Statement: The study was approved by the institutional review board (IRB) of Baylor College of Medicine and the Research and Development Committee of the Michael E. DeBakey VA Medical Center.

S0816 Pediatric to Adult IBD Patient Care: A Comparison of Outcomes Between Transitional Clinic Care and Traditional Clinic Care

INTRODUCTION: Inflammatory bowel disease (IBD) is a chronic illness that impacts all age groups. For those diagnosed in childhood, transitioning from pediatric to adult IBD providers can be particularly difficult. We developed an IBD "transition clinic" (TC) at our center to help address these challenges. The aim of our study was to compare the health care utilization of patients who did and did not receive care in our IBD TC. METHODS: We performed a retrospective chart review of 18 to 26-year-old patients transitioning at our IBD center between 2017 and 2018. Data collected included demographic variables, IBD type and duration. IBD related health care resource utilization outcomes were also obtained. These include admissions and no-show rates since the start of TC or adult IBD clinic respectively and steroid use during the first two years since the start of these clinics. A chi-square test for categorical variables and student t-test for continuous variables was used for comparing the variables in both of the groups. All analysis was performed in SAS v9.4. RESULTS: We identified 50 IBD patients who were cared for in our TC and 65 who were not. While the patients seen in TC were significantly younger, each cohort had similar sex distribution, disease duration and disease type distribution (Table 1). TC patients demonstrated lower mean hospital admissions, and a trend toward fewer clinic no-shows (P = 0.05) (Table 1). CONCLUSION: We demonstrated that an IBD transition clinic can improve patient outcomes, as individuals receiving care in our TC were less likely to be admitted to the hospital. It is possible that other key outcomes (including disease activity, IBD complications and psychosocial variables) may also be impacted by this service. Thus, larger, objective studies evaluating these issues in TCs are still needed. Ultimately, identifying a more streamlined and structured, yet customizable, approach to the transition process in IBD is warranted.TABLE 1.: Demographic variables and health care utilization outcomes

Job mismatch: the phenomenon of overskilled employees as a result of poor managerial competences

Businesses in current era are challenged by many sustainability issues, where one extremely important is regarding labor market and HR transformation. In this article we have looked at the aspects of human capital which are necessary for long term sustainability, and that is the relation between the workplace design and the skills and abilities of the employees. The paper presents the views and opinions of various authors and the results of several research articles on skill and educational mismatch to highlight the importance of proper job design. The article also presents the results of own research of 200 Slovak companies focused on changes in HRM under the influence of ongoing changes. The main findings are the differences in skills and educational mismatch between countries, which have also been analyzed from the point of view of trust in management and quality of management as well as the involvement of line managers and HR departments in recruitment, selection and employee assessment processes. From the point of view of Slovak Republic, findings are presented which contradict the generally discussed topic of educational mismatch and point to the insufficient design of the workplaces and the related low utilization of the human capital potential in the country.

ICD-10-AM codes for cirrhosis and related complications: key performance considerations for population and healthcare studies

ObjectiveThe utility of International Classification of Diseases (ICD) codes relies on the accuracy of clinical reporting and administrative coding, which may be influenced by country-specific codes and coding rules. This...

Mental Health Services for Men Who Have Sex with Men in China.

This study explores the presence of mental health challenges and related service utilization among MSM in China. An online cross-sectional survey recruited 520 MSM in Guangdong, China, to evaluate the participants' psychiatric symptoms, service fulfillment, and challenges. A high proportion of the participants experienced at least one psychiatric symptom in the past year, but less than half of their mental health service needs were fulfilled. The preferred agencies for mental health services were provincial and city-level general hospitals or primary health centers. Lack of knowledge and misconceptions of mental health services were the primary reasons for not receiving necessary services. Mental health service fulfillment was associated with younger age, lower education, higher income, local residency, cohabitation, and disclosure of MSM status. The high rate of mental health issues and gaps in service seeking indicates an urgent need to increase mental health awareness among MSM.

Evaluation of Nutritional and Antinutritional Properties of African Yam Bean (Sphenostylis stenocarpa (Hochst ex. A. Rich.) Harms.) Seeds

African yam bean (Sphenostylis stenocarpa (Hochst ex. A. Rich.) Harms) is an annual legume with the capacity to produce bean seeds in a pod and produce tubers with varying seed patterns and colors. It is suggested to have the potential to significantly boost food security in sub-Saharan Africa due to its considerable nutritional qualities but still yet underutilized. Many farmers show limited interest in its production owing to limited knowledge of its nutritional profile, income generation capacity for small-holder farmers’, processing, and other related utilization concerns. This study evaluated the proximate and antinutrient composition of processed and unprocessed seeds of African yam bean (Sphenostylis stenocarpa (Hochst ex. A. Rich.) Harms.). Seeds were harvested from the experimental research field consisting of 50 accessions at the International Institute of Tropical Agriculture (IITA), Ibadan, Nigeria. They were divided into two portions; the first was processed by oven drying at 60°C for 24 hours and the second was left raw. There were significant differences (P&lt;0.05) in the levels of proximate and antinutrient in the forms in which the samples were analyzed. TSs104 had the highest protein content of 25.08%, while the lowest was TSs68 (20.50%). However, in the unprocessed seed, protein content ranged between 24.93% (TSs38) and 19.13% (TSs11). Both processed and unprocessed seeds had high carbohydrate contents. In processed seeds, TSs9 (62.93%) had the highest percentage and TSs1 (29.64%) recorded the lowest. In unprocessed seed, the percentage ranged between 67.36% (TSs4) and 54.23% (TSs38). The observed variation may suggest possible suitability of seed for various end-use products and targeted breeding programs for crop improvements. In sub-Saharan Africa, this lesser-known legume could be adapted as a promising food crop in combating protein-energy malnutrition.

Towards quantification of the national water footprint in rice production of China: A first assessment from the perspectives of single-double rice

Rice is one of the most important crops in China, contributing to approximately 28% of total cereal yield. Despite substantial production, given that rice is a high water-consuming crop, the water shortage due to the irreversible decline in available water resources on a global scale induced by undergoing climate change will pose grave challenges to rice reproductive growth and related water resources utilization. As a consequence, investigating the responses of rice productivity and water consumption to more pronounced climate changes is of great significance for water resources sustainable utilization in terms of reducing irrigation water requirements and ensuring food security. Present water footprint (WF) methods do not calculate the weighted average of each WF component at the national level when evaluating the effects of prospective climate change upon rice production. The national water footprint (NWF), i.e. taking the share of each province in the total production of crops as weighting factors, has been regarded as an effective approach to determine where each WF component is originally located. In this study, the temporal change characteristics of NWF for single-rice (SR), early-rice (ER) and late-rice (LR) in different agro-ecological zones across China during 2001–2010 were assessed for the first time. The results exhibited that NWF of rice was an estimated 304,848 million cubic meters (MCM) per year. The SR accounted for the greatest portion of NWF, followed by ER and LR. The NWF rank was SR-V > SR-I > ER-VI > SR-IV > LR-III > LR-VI > SR-II > ER-III. The blue water footprint (WFb) presents decreasing trends in most agro-ecological zones (SR-I, SR-II, SR-IV, ER-III and LR-VI), while green water footprint (WFg) exhibits increasing trends within these regions. This study provides a beneficial approach for decision-making processes aiming at better agricultural water resources management strategies to alleviate water resources scarcity and reduce food risk in the context of surging demand, which will support agricultural water resources management of China towards a more balanced direction at the national level.

1087-P: Hospital and Emergency Department Utilization in U.S. Veterans with Hyperkalemia

Background: Patiromer (PAT) is a sodium-free, non-absorbed potassium (K+) binder (KB) approved for the treatment of hyperkalemia (HK). HK is common in older pts with cardiorenal comorbidities and often leads to increased Healthcare Resource Utilization (HRU). Here we aim to describe electrolyte-related HRU in Veterans with HK who initiated PAT or discontinued RAAS inhibitor (RAASi DC) therapy and were not receiving a KB (1/1/2016−8/30/2018). Methods: Using retrospective, observational data, pts utilizing the hospital or ED during the 6 months (mos) prior to the index date were assessed at 1, 3, and 6 mos post-index. The index date was the date of PAT initiation or the date of RAASi DC in pts not receiving a KB (RAASi DC/no KB). All pts had a baseline serum K+ ≥5.1mEq/L and HF, DM, or non-dialysis CKD. Pts with continuous exposure (CE) to PAT and those who did not restart RAASi were analyzed. Results: 288 and 26,543 pts were included in the PAT and RAASi DC/no KB groups, respectively. Following CE to PAT at 1, 3, and 6 mos post-index, no electrolyte related ED or hospital utilization was observed. In the RAASi DC group, 2-5% of pts reutilized the ED or hospital within 6 mos (Figure). Conclusion: Of the pts who experienced an electrolyte-related hospitalization or ED visit within the 6 mos prior to PAT dispensing, no pts reutilized these services in the following 6 mos. Given the limited number of PAT users, additional investigation is warranted. Disclosure C.P. Kovesdy: Consultant; Self; Amgen, AstraZeneca, Bayer AG, Cara Therapeutics, Reata, Takeda Pharmaceutical Company Limited, Tricida. E. Gosmanova: None. S.D. Woods: Employee; Self; Relypsa, Inc. Stock/Shareholder; Self; Vifor Pharma Group. J.J. Fogli: Employee; Self; Relypsa, Inc. Stock/Shareholder; Self; Vifor Pharma Group. C.G. Rowan: Consultant; Self; AbbVie Inc., Covidia, Halozyme, Keryx, Relypsa, Inc., Vifor Pharma Group. Other Relationship; Self; COHRDATA. J.L. Hansen: Research Support; Self; COHRDATA. B.C. Sauer: Research Support; Self; COHRDATA. Funding Relypsa, Inc.

A Study on the Smart Tourism Awareness through Bigdata Analysis

Purpose: In the 4th industrial revolution, services that incorporate various smart technologies in the tourism sector have begun to gain popularity. Accordingly, academic discussions on smart tourism have also started to become active in various fields. Despite recent research, the definition of smart tourism is still ambiguous, and it is not easy to differentiate its scope or characteristics from traditional tourism concepts. Thus, this study aims to analyze the perception of smart tourism exposed online to identify the current point of smart tourism in Korea and present the research direction for conceptualizing smart tourism suitable for the domestic situation. Research design, data, and methodology: This study analyzes the perception of smart tourism exposed online based on 20,198 news data from portal sites over the past six years. Data on words used with smart tourism were collected from the leading portal sites Naver, Daum, and Google. Text mining techniques were applied to identify the social awareness status of smart tourism. Network analysis was used to visualize the results between words related to smart tourism, and CONCOR analysis was conducted to derive clusters formed by words having similarity. Results: As a result of keyword analysis, the frequency of words related to the development and construction of smart tourism areas was high. The analysis of the centrality of the connection between words showed that the frequency of keywords was similar, and that the words "smartphones" and "China" had relatively high connection centrality. The results of network analysis and CONCOR indicated that words were formed into eight groups including related technologies, promotion, globalization, service introduction, innovation, regional society, activation, and utilization guide. The overall results of data analysis showed that the development of smart tourism cities was a noticeable issue. Conclusions: This study is meaningful in that it clearly reflects the differences in the perception of smart tourism between online and research trends despite various efforts to develop smart tourism in Korea. In addition, this study highlights the need to understand smart tourism concepts and enhance academic discussions. It is expected that such academic discussions will contribute to improving the competitiveness of smart tourism research in Korea.

S100B single nucleotide polymorphisms exhibit sex-specific associations with chronic pain in sickle cell disease in a largely African-American cohort.

BackgroundPain in sickle cell disease (SCD) is severe and multifaceted resulting in significant differences in its frequency and intensity among individuals. In this study, we examined the influence of S100B gene single nucleotide polymorphisms (SNP) on acute and chronic pain variability in SCD.MethodsComposite pain index (CPI) scores captured chronic pain. Painful crisis related emergency care utilization recorded acute pain incidence. Genotyping was performed using MassARRAY iPLEX platform.ResultsRegression analysis revealed associations of increased CPI with rs9722 A allele in additive (p = 0.005) and dominant (p = 0.005) models. Rs1051169 G allele on the other hand was associated with decreased CPI in additive (p = 0.001), and dominant (p = 0.005) models. Sex-specific analysis found that these associations were significant in females but not males in this cohort. Linkage analysis identified two haploblocks. Block 1 (rs9983698-rs9722) haplotype T-A was associated with increased CPI (p = 0.002) while block 2 (rs1051169-rs11911834) haplotype G-G was associated with decreased CPI (p = 0.001). Both haplotypic associations were only significant in females. No association of S100B SNPs with utilization reached statistical significance.ConclusionsS100B SNPs and haplotypes are associated with chronic pain in female, but not male, patients with SCD, implicating a potential role of S100B polymorphism in SCD pain heterogeneity in a sex-dependent manner.