Policing and Population Health: Past, Present, and Future.

Policy Points A growing body of research suggests that policing, as a form of state-sanctioned racial violence, operates as a social determinant of population health and racial or ethnic health disparities. A lack of compulsory, comprehensive data on interactions with police has greatly limited our ability to calculate the true prevalence and nature of police violence. While innovative unofficial data sources have been able to fill these data gaps, compulsory and comprehensive data reporting on interactions with police, as well as considerable investments in research on policing and health, are required to further our understanding of this public health issue.

Neighborhood 'Disamenities': local barriers and cognitive function among Black and white aging adults.

BACKGROUND: This study examined the association between cognitive function and three neighborhood 'disamenities' that may pose local barriers to utilizing community resources and increase risk for cognitive decline. METHOD: Using national data from 21,165 urban- and suburban-dwelling Black and white adults (mean age: 67 years) in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, we assessed global cognitive function through a factor score of five cognitive screening tests. General Additive Mixed Models (GAMM) tested whether residing in areas with more polluting sites, highways, and limited walkability was associated with worse cognitive function. RESULTS: Limited walkability and the presence of polluting sites had a significant negative association with cognitive function after controlling for individual and neighborhood factors. CONCLUSION: Neighborhood disamenities may be linked to cognitive function among aging residents. Identifying neighborhood factors that pose barriers to accessing community resources may inform upstream policy applications to reduce risk for cognitive decline.

Risk of being killed by police use of force in the United States by age, race-ethnicity, and sex.

We use data on police-involved deaths to estimate how the risk of being killed by police use of force in the United States varies across social groups. We estimate the lifetime and age-specific risks of being killed by police by race and sex. We also provide estimates of the proportion of all deaths accounted for by police use of force. We find that African American men and women, American Indian/Alaska Native men and women, and Latino men face higher lifetime risk of being killed by police than do their white peers. We find that Latina women and Asian/Pacific Islander men and women face lower risk of being killed by police than do their white peers. Risk is highest for black men, who (at current levels of risk) face about a 1 in 1,000 chance of being killed by police over the life course. The average lifetime odds of being killed by police are about 1 in 2,000 for men and about 1 in 33,000 for women. Risk peaks between the ages of 20 y and 35 y for all groups. For young men of color, police use of force is among the leading causes of death.

Neighborhood active aging infrastructure and cognitive function: A mixed-methods study of older Americans.

Physical exercise benefits cognitive functioning and can protect against neurodegeneration. Neighborhood environments may be pivotal to physically active aging, and thus help shape older adults' cognitive function. This mixed-methods study investigated where older adults exercised outside the home, and whether availability of these neighborhood sites was associated with cognitive function. We thematically analyzed qualitative data from semi-structured interviews in 2015 with 125 older adults (mean age = 71) in the Minneapolis (MN) metropolitan area. Results identified nearby public parks, fitness/sports amenities, and walkable destinations as motivators for recreational exercise and active transit among participants. These findings informed quantitative analysis of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national sample of older Black and white Americans (n = 21,151; mean age at assessment = 67; data collected 2006-2017). We used generalized additive multilevel models to examine whether neighborhood features that qualitative participants identified as encouraging physical activity were associated with elevated levels of cognitive function. Results indicated that residing in neighborhoods with greater availability of local parks, access to recreational amenities, and business density was associated with higher levels of cognitive function. We found no evidence to suggest a significant association between availability of these neighborhood resources and rate of cognitive decline. This study identifies specific neighborhood active aging infrastructure that may support cognitive function among older adults aging in place.

Values-Alignment Messaging Boosts Adolescents' Motivation to Control Social Media Use.

Two preregistered experiments with 2,733 U.S. high school students (age range = 13-19 years) compared the impact of different messages on adolescents' motivation to control social media use (SMU). A traditional message emphasized the benefits of avoiding SMU, whereas a values-alignment message framed controlling SMU as being consistent with autonomy and social justice. Compared to no message or a traditional message, in both studies, a values-alignment message led to greater motivation to control SMU immediately afterward, and in Study 2, awareness of "addictive" social media designs 3 months later. As hypothesized, values-alignment messaging was more motivating for girls than boys. Results offer preliminary support for leveraging adolescents' drives for autonomy and social justice to motivate self-regulation of SMU.

Measuring Gait Velocity and Stride Length with an Ultrawide Bandwidth Local Positioning System and an Inertial Measurement Unit.

One possible modality to profile gait speed and stride length includes using wearable technologies. Wearable technology using global positioning system (GPS) receivers may not be a feasible means to measure gait speed. An alternative may include a local positioning system (LPS). Considering that LPS wearables are not good at determining gait events such as heel strikes, applying sensor fusion with an inertial measurement unit (IMU) may be beneficial. Speed and stride length determined from an ultrawide bandwidth LPS equipped with an IMU were compared to video motion capture (i.e., the "gold standard") as the criterion standard. Ninety participants performed trials at three self-selected walk, run and sprint speeds. After processing location, speed and acceleration data from the measurement systems, speed between the last five meters and stride length in the last stride of the trial were analyzed. Small biases and strong positive intraclass correlations (0.9-1.0) between the LPS and "the gold standard" were found. The significance of the study is that the LPS can be a valid method to determine speed and stride length. Variability of speed and stride length can be reduced when exploring data processing methods that can better extract speed and stride length measurements.

Linking History to Contemporary State-Sanctioned Slow Violence through Cultural and Structural Racism.

Environmental scientists started documenting the racial inequities of environmental exposures (e.g., proximity to waste facilities or to industrial pollution) in the 1970s and 1980s. Since then, research has documented inequities in exposures to nearly every studied environmental hazard, showing that American society delivers racial violence toward non-White families. Through cultural racism, a resilient social hierarchy is set where the lives of some groups of people are considered more valuable than others; then, through structural racism, institutions unequally mete and dole environmental benefits and burdens to these groups. We argue that the "slow violence" of environmental racism is linked to other forms of racial violence that have been enacted throughout history. We discuss the meaning of cultural racism as it pertains to the hierarchy of groups of people whose lives are valued unequally and its link to structural racism. To remedy this environmental racial violence, we propose shifts in the empirical research on environmental inequities that are built upon, either implicitly or explicitly, the interconnected concepts of cultural and structural racism that link historical to contemporary forms of racial violence.

COVID-19 in recent heart transplant recipients: Clinicopathologic features and early outcomes.

BACKGROUND: The impact of COVID-19 on heart transplant (HTx) recipients remains unclear, particularly in the early post-transplant period. METHODS: We share novel insights from our experience in five HTx patients with COVID-19 (three within 2 months post-transplant) from our institution at the epicenter of the pandemic. RESULTS: All five exhibited moderate (requiring hospitalization, n = 3) or severe (requiring ICU and/or mechanical ventilation, n = 2) illness. Both cases with severe illness were transplanted approximately 6 weeks before presentation and acquired COVID-19 through community spread. All five patients were on immunosuppressive therapy with mycophenolate mofetil (MMF) and tacrolimus, and three that were transplanted within the prior 2 months were additionally on prednisone. The two cases with severe illness had profound lymphopenia with markedly elevated C-reactive protein, procalcitonin, and ferritin. All had bilateral ground-glass opacities on chest imaging. MMF was discontinued in all five, and both severe cases received convalescent plasma. All three recent transplants underwent routine endomyocardial biopsies, revealing mild (n = 1) or no acute cellular rejection (n = 2), and no visible viral particles on electron microscopy. Within 30 days of admission, the two cases with severe illness remain hospitalized but have clinically improved, while the other three have been discharged. CONCLUSIONS: COVID-19 appears to negatively impact outcomes early after heart transplantation.

A Systematic Literature Review of Peripheral Nerve Stimulation Therapies for the Treatment of Pain.

OBJECTIVE: To conduct a systematic literature review of peripheral nerve stimulation (PNS) for pain. DESIGN: Grade the evidence for PNS. METHODS: An international interdisciplinary work group conducted a literature search for PNS. Abstracts were reviewed to select studies for grading. Inclusion/exclusion criteria included prospective randomized controlled trials (RCTs) with meaningful clinical outcomes that were not part of a larger or previously reported group. Excluded studies were retrospective, had less than two months of follow-up, or existed only as abstracts. Full studies were graded by two independent reviewers using the modified Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment, the Cochrane Collaborations Risk of Bias assessment, and the US Preventative Services Task Force level-of-evidence criteria. RESULTS: Peripheral nerve stimulation was studied in 14 RCTs for a variety of painful conditions (headache, shoulder, pelvic, back, extremity, and trunk pain). Moderate to strong evidence supported the use of PNS to treat pain. CONCLUSION: Peripheral nerve stimulation has moderate/strong evidence. Additional prospective trials could further refine appropriate populations and pain diagnoses.

A Systematic Literature Review of Dorsal Root Ganglion Neurostimulation for the Treatment of Pain.

OBJECTIVE: To conduct a systematic literature review of dorsal root ganglion (DRG) stimulation for pain. DESIGN: Grade the evidence for DRG stimulation. METHODS: An international, interdisciplinary work group conducted a literature search for DRG stimulation. Abstracts were reviewed to select studies for grading. General inclusion criteria were prospective trials (randomized controlled trials and observational studies) that were not part of a larger or previously reported group. Excluded studies were retrospective, too small, or existed only as abstracts. Studies were graded using the modified Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment, the Cochrane Collaborations Risk of Bias assessment, and the US Preventative Services Task Force level-of-evidence criteria. RESULTS: DRG stimulation has Level II evidence (moderate) based upon one high-quality pivotal randomized controlled trial and two lower-quality studies. CONCLUSIONS: Moderate-level evidence supports DRG stimulation for treating chronic focal neuropathic pain and complex regional pain syndrome.

The Evolution of Neuromodulation in the Treatment of Chronic Pain: Forward-Looking Perspectives.

BACKGROUND: The field of neuromodulation is continually evolving, with the past decade showing significant advancement in the therapeutic efficacy of neuromodulation procedures. The continued evolution of neuromodulation technology brings with it the promise of addressing the needs of both patients and physicians, as current technology improves and clinical applications expand. DESIGN: This review highlights the current state of the art of neuromodulation for treating chronic pain, describes key areas of development including stimulation patterns and neural targets, expanding indications and applications, feedback-controlled systems, noninvasive approaches, and biomarkers for neuromodulation and technology miniaturization. RESULTS AND CONCLUSIONS: The field of neuromodulation is undergoing a renaissance of technology development with potential for profoundly improving the care of chronic pain patients. New and emerging targets like the dorsal root ganglion, as well as high-frequency and patterned stimulation methodologies such as burst stimulation, are paving the way for better clinical outcomes. As we look forward to the future, neural sensing, novel target-specific stimulation patterns, and approaches combining neuromodulation therapies are likely to significantly impact how neuromodulation is used. Moreover, select biomarkers may influence and guide the use of neuromodulation and help objectively demonstrate efficacy and outcomes.

Unique Characteristics of the Dorsal Root Ganglion as a Target for Neuromodulation.

OBJECTIVE: The dorsal root ganglion (DRG) is a novel target for neuromodulation, and DRG stimulation is proving to be a viable option in the treatment of chronic intractable neuropathic pain. Although the overall principle of conventional spinal cord stimulation (SCS) and DRG stimulation-in which an electric field is applied to a neural target with the intent of affecting neural pathways to decrease pain perception-is similar, there are significant differences in the anatomy and physiology of the DRG that make it an ideal target for neuromodulation and may account for the superior outcomes observed in the treatment of certain chronic neuropathic pain states. This review highlights the anatomy of the DRG, its function in maintaining homeostasis and its role in neuropathic pain, and the unique value of DRG as a target in neuromodulation for pain. METHODS: A narrative literature review was performed. RESULTS: Overall, the DRG is a critical structure in sensory transduction and modulation, including pain transmission and the maintenance of persistent neuropathic pain states. Unique characteristics including selective somatic organization, specialized membrane characteristics, and accessible and consistent location make the DRG an ideal target for neuromodulation. Because DRG stimulation directly recruits the somata of primary sensory neurons and harnesses the filtering capacity of the pseudounipolar neural architecture, it is differentiated from SCS, peripheral nerve stimulation, and other neuromodulation options. CONCLUSIONS: There are several advantages to targeting the DRG, including lower energy usage, more focused and posture-independent stimulation, reduced paresthesia, and improved clinical outcomes.

Risk of Police-Involved Death by Race/Ethnicity and Place, United States, 2012-2018.

OBJECTIVES: To estimate the risk of mortality from police homicide by race/ethnicity and place in the United States. METHODS: We used novel data on police-involved fatalities and Bayesian models to estimate mortality risk for Black, Latino, and White men for all US counties by Census division and metropolitan area type. RESULTS: Police kill, on average, 2.8 men per day. Police were responsible for about 8% of all homicides with adult male victims between 2012 and 2018. Black men's mortality risk is between 1.9 and 2.4 deaths per 100 000 per year, Latino risk is between 0.8 and 1.2, and White risk is between 0.6 and 0.7. CONCLUSIONS: Police homicide risk is higher than suggested by official data. Black and Latino men are at higher risk for death than are White men, and these disparities vary markedly across place. Public Health Implications. Homicide reduction efforts should consider interventions to reduce the use of lethal force by police. Efforts to address unequal police violence should target places with high mortality risk.

A rare case of endobronchial and lung metastasis in basal cell carcinoma.

Basal cell carcinoma (BCC) is the most common skin cancer, but rarely metastasizes. This article describes diagnosis and treatment of an extremely rare case of BCC metastasizing to the lung and endobronchial tissue.

Intracaval resection of a partially obstructing intravascular hemangioma using deep hypothermic circulatory arrest.

We report a case of an obstructing hemangioma within the lumen of the inferior vena cava adjacent to the hepatic veins. The technique of resection and pathology are described.

'My neighbourhood is fuzzy, not hard and fast': Individual and contextual associations with perceived residential neighbourhood boundaries among ageing Americans.

Neighborhoods are fluid social and spatial constructs that vary by person and place. How do residential neighborhoods shift as people age? This mixed-method study investigates how perceived neighborhood boundaries and size vary by individual and contextual characteristics. Semi-structured interviews with 125 adults aged 55-92 living in the Minneapolis (Minnesota) metropolitan area suggested that neighborhood boundaries are "fuzzy". Qualitative thematic analysis identified duration of residence and housing stability, race, life-space mobility, social capital, sense of safety, and the built and social environment as key neighborhood determinants. This informed quantitative analyses among 7,811 respondents (mean age 72) from the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study who self-reported how many blocks composed their neighborhoods. We tested individual and contextual factors identified in the qualitative results as related to perceived neighborhood size. Three-level gamma regression models showed that being older, white, less educated, lower income, less physically and cognitively healthy, less active, less socially supported, and feeling unsafe were significantly associated with smaller self-reported neighborhood sizes. Further, living in less racially diverse, less dense, and less affluent areas were significantly associated with smaller neighborhoods. The mixed-methods findings deepen understanding of scale in neighborhood-based research, inform urban planning interventions, and help understand what "neighborhood" means among diverse aging Americans.

Unconventional Approach: Steroid Treatment for Eosinophilic Myocarditis Despite Negative Endomyocardial Biopsy.

Eosinophilic myocarditis (EM) is a rare type of myocarditis that can present acutely with rapidly progressing symptoms leading to high rates of morbidity and mortality. EM is defined by eosinophilic infiltration of the myocardium and can be difficult to diagnose even with gold-standard techniques, such as endomyocardial biopsy (EMB), given the possibility of patchy myocardial infiltration. Here, we present a case of idiopathic EM complicated by a cardiac arrest that was empirically treated with high-dose intravenous steroids after negative EMB. The patient's symptoms and cardiac function significantly improved after treatment. This case highlights the ambiguity of certain presentations of EM, its complications, and the importance of empiric treatment to avoid poor outcomes.

The influence of midsole shear on running economy and smoothness with a 3D-printed midsole.

The objectives of this study were to first determine whether a newly designed 3D-printed midsole, configured with a mechanism to increase anterior-posterior deformation, could increase anterior midsole shear during the stance phase of running. We then wanted to determine whether these shoes could affect running economy and smoothness. Two footwear conditions, differing in midsole technology, were used in this study. The control condition consisted of a thermoplastic polyurethane midsole (TPU-Control), whereas the prototype shoes (3D-Shear) were constructed with a 3D-printed lattice midsole designed for greater anterior foot displacement during early to mid-stance. Twenty male participants ran on a treadmill for 6 min in each condition, and data were collected during the final 2 min. Midsole shear was measured using 3D kinematic data; running smoothness was quantified with peak acceleration and jerk magnitudes from the foot, sacrum, and head; and running economy was determined with oxygen consumption data. As hypothesised, the anterior midsole shear was greater in the 3D-Shear condition compared to the TPU-Control. The 3D-Shear did not improve running economy. Runners exhibited significantly lower peak accelerations at the sacrum, along with lower magnitudes of jerk at the foot, sacrum, and head in the 3D-Shear condition, indicating smoother running patterns.

Segregated Patterns of Hospital Care Delivery and Health Outcomes.

Importance: Residential segregation has been shown to be a root cause of racial inequities in health outcomes, yet little is known about current patterns of racial segregation in where patients receive hospital care or whether hospital segregation is associated with health outcomes. Filling this knowledge gap is critical to implementing policies that improve racial equity in health care. Objective: To characterize contemporary patterns of racial segregation in hospital care delivery, identify market-level correlates, and determine the association between hospital segregation and health outcomes. Design, Setting, and Participants: This cross-sectional study of US hospital referral regions (HRRs) used 2018 Medicare claims, American Community Survey, and Agency for Healthcare Research and Quality Social Determinants of Health data. Hospitalization patterns for all non-Hispanic Black or non-Hispanic White Medicare fee-for-service beneficiaries with at least 1 inpatient hospitalization in an eligible hospital were evaluated for hospital segregation and associated health outcomes at the HRR level. The data analysis was performed between August 10, 2022, and September 6, 2023. Exposures: Dissimilarity index and isolation index for HRRs. Main Outcomes and Measures: Health outcomes were measured using Prevention Quality Indicator (PQI) acute and chronic composites per 100 000 Medicare beneficiaries, and total deaths related to heart disease and stroke per 100 000 residents were calculated for individuals aged 74 years or younger. Correlation coefficients were used to compare residential and hospital dissimilarity and residential and hospital isolation. Linear regression was used to examine the association between hospital segregation and health outcomes. Results: This study included 280 HRRs containing data for 4386 short-term acute care and critical access hospitals. Black and White patients tended to receive care at different hospitals, with a mean (SD) dissimilarity index of 23 (11) and mean (SD) isolation index of 13 (13), indicating substantial variation in segregation across HRRs. Hospital segregation was correlated with residential segregation (correlation coefficients, 0.58 and 0.90 for dissimilarity and isolation, respectively). For Black patients, a 1-SD increase in the hospital isolation index was associated with 204 (95% CI, 154-254) more acute PQI hospitalizations per 100 000 Medicare beneficiaries (28% increase from the median), 684 (95% CI, 488-880) more chronic PQI hospitalizations per 100 000 Medicare beneficiaries (15% increase), and 6 (95% CI, 2-9) additional deaths per 100 000 residents (6% increase) compared with 68 (95% CI, 24-113; 6% increase), 202 (95% CI, 131-274; 8% increase), and 2 (95% CI, 0 to 4; 3% increase), respectively, for White patients. Conclusions and Relevance: This cross-sectional study found that higher segregation of hospital care was associated with poorer health outcomes for both Black and White Medicare beneficiaries, with significantly greater negative health outcomes for Black populations, supporting racial segregation as a root cause of health disparities. Policymakers and clinical leaders could address this important public health issue through payment reform efforts and expansion of health insurance coverage, in addition to supporting upstream efforts to reduce racial segregation in hospital care and residential settings.

Acute COVID-19 Pneumonia Unmasking a Large Left Atrial Myxoma.

This is a case of acute coronavirus disease 2019 pneumonia that revealed an incidental large atrial myxoma with obstructive physiology that ultimately required emergent treatment with a definitive atriotomy and resection of the underlying myxoma.