Investigation of the Performance of Various Low-Cost Radon Monitors under Variable Environmental Conditions.

A comparison of low-cost radon monitors was conducted at the Laboratory of Natural Radiation (LNR). The monitors we evaluated were EcoQube, RadonEye, RadonEye Plus2, Spirit, ViewPlus, ViewRadon and WavePlus. An AlphaGUARD monitor calibrated at the Laboratory of Environmental Radioactivity of the University of Cantabria (LaRUC), accredited for testing and calibration according to ISO/IEC 17025, provided the reference value of radon concentration. The temporal stability of the monitors was studied, obtaining a percentage of missing records ranged from 1% to 19% of the data. The main technical characteristics studied were temporal stability, measurement ranges, accuracy, correlation and response time. The main results show that the measurement ranges align with those specified by their manufacturers, with percentage differences with respect to the reference monitor of between 5% and 16%. The diversity found for response time is remarkable, with values ranging from 1 to 15 h, with Pearson correlation factors between 0.63 and 0.90.

Disparities in pre-health advising across California's public universities.

BACKGROUND: The Supreme Court's decision in Students for Fair Admissions, Inc., v. Harvard College is likely to result in the matriculation of fewer students from historically excluded racial/ethnic groups at more selective colleges and universities and matriculation of more students at less selective colleges and universities. Because of this, it is important to understand how resources for pre-health advising, a modifiable factor that can help increase the diversity of the health workforce, vary across institutions with differing levels of selectivity. Colleges are known to vary in resources, structure, and investment in pre-health advising but data are lacking and there is no estimate of any pre-health advising resource gap. PURPOSE: To quantify availability of advising resources and identify perceived challenges in pre-health advising in California's highly diverse public and select private undergraduate institutions. METHODS: Structured 60-minute Zoom interviews from June 2022 -October 2022 at 18/23 CSU (California State Universities), 9/9 University of California (UC) institutions and 6 select private institutions with varying levels of selectivity. Two investigators independently analyzed interviews using a Grounded Theory Approach. The full study team reviewed transcripts and themes. KEY RESULTS: Pre-health advisor capacity varied greatly across the three types of institutions. CSU: mean = 1 FTE advisor: 24,620 graduates (range: 1: 1,059-1: 150,520); UC mean = 1 FTE advisor: 4,526 graduates (range: 1: 1,912-1: 10,920); private institutions mean = 1 FTE advisor:1,794 graduates (range: 1: 722-1: 5,300). Participants reported common challenges: advising capacity, lack of advisor training, advisor turnover, and student difficulties in accessing clinical opportunities and required coursework. CSU and UC participants noted that these had greatest impact for first generation and racially/ethnically underrepresented students for whom lack of informal professional networks, lack of other mentors, and financial responsibilities complicate college navigation and professional school application. CONCLUSIONS: Students at CSU campuses had 5 times less access to pre-health advising per graduate than UC students, and 13 times less than students at private institutions. Much greater investment is needed in California's public institutions, particularly CSUs, to increase equity in access to advising for pre-health professional students. Research should examine pre-health advising resource capacity in other states, especially those that are now facing race-neutral admissions policies at undergraduate institutions and health professions schools.

Assessment of gunshot residue detection on a large variety of surfaces by portable LIBS system for crime scene application.

The application of Laser-Induced Breakdown Spectroscopy (LIBS) in forensic science has garnered increasing attention. The ability to perform real-time, on-site analysis of Gunshot Residue (GSR) particles and potential elements originating from bullets or projectile cores on various surfaces holds the potential to assist in resolving firearms-related cases. This includes facilitating trajectory determination by locating distinct impact points and identifying the types of ammunition used. This study evaluates the utilization of a portable LIBS device for ballistic forensic purposes. Additionally, it focuses on the assessment of potential false positives and false negatives arising from the different materials where the shots have been fired. Since the system performs laser ablation of both surface particles and the substrate, it emphasizes the importance of conducting preliminary screening in an area with the same composition as the impact zone to minimize potential false positives during direct surface analysis. Furthermore, the results demonstrate the capability to detect the constituent elements of characteristic gunshot residue particles (GSR particles): lead (Pb), antimony (Sb), and barium (Ba) adhering to bullets, as well as the principal elements composing the jacket or core of the projectile: lead (Pb), copper (Cu), and zinc (Zn) through direct analysis, without the need for a sampling kit, on different surfaces such as walls, furniture, or fabrics. Analyses conducted a month after the shots were fired indicate the potential for finding residues in the vicinity of the bullet hole. Analyses conducted a month after the shots were fired indicate the possibility of finding residues in the area around the bullet hole.

Disparities in regional obesity rates in argentina by socioeconomic status / Disparidades en prevalencia de obesidad por región y estatus socioeconómico en Argentina

Abstract Background : Obesity rates in Latin America are increasing overall and among people with low socio economic status (SES). Obesity and SES disparities can vary by region-a valuable indicator of local drivers. The objective of this study was to examine regional and SES differences in obesity in Argentina. Methods : We used data from Argentina's 4th Na tional Risk Factors Survey (n = 29226) 2018 and defined obesity as BMI ≥ 30. Low SES was defined as not fin ished high school or having a household income in the lowest two quintiles. Descriptive analysis stratified by sex compared obesity rates by SES, province, and re gion. Age-adjusted logistic regression models explored the association between obesity, socioeconomic status, and region. Results : Obesity rates varied more by SES among women (39% for low SES vs. 26% for middle/high SES; p < 0.001) than among men (33% low SES vs. 29% middle/ high SES; p = 0.027). The Patagonian region had the high est obesity prevalence for both men (36%) and women (37%). A gender-stratified age-adjusted analysis with region and SES showed that low SES (OR 1.72, 95% CI 1.45, 2.03) and the Patagonian region (OR 1.29, 95% CI 1.02, 1.62) were the only significant predictors for women. Conclusions : SES associated disparities in obesity in Argentina were pronounced for women but not men. Disparities were particularly high in Patagonia. Further research is needed to understand the drivers behind these SES, regional, and gender disparities.

Resumen Introducción : Las tasas de obesidad en América La tina están aumentando, tanto en la población general como entre las personas con bajo nivel socioeconómi co (NSE). Las disparidades en obesidad y NSE pueden variar ampliamente según la región, un indicador po tencialmente valioso de fenómenos causales locales. El objetivo de este estudio fue examinar las diferencias en la prevalencia de obesidad a nivel regional y según el NSE en Argentina. Métodos : Utilizamos datos de la 4ª Encuesta Nacio nal de Factores de Riesgo realizada en Argentina en 2018 (n = 29226). Definimos obesidad como índice de masa corporal ≥ 30, y bajo NSE como no haber termi nado la escuela secundaria o tener un ingreso familiar en los dos quintiles más bajos. El análisis descriptivo estratificado por sexo comparó la prevalencia de obe sidad por NSE, provincia y región. Además, utilizamos modelos de regresión logística ajustados por edad para explorar la asociación entre obesidad, nivel socioeconó mico y región, tanto globalmente como estratificando por sexo.367 Resultados : Las tasas de obesidad variaron más por NSE entre las mujeres (39% NSE bajo vs. 26% NSE medio/ alto; p < 0.001) que entre los hombres (33% NSE bajo vs. 29% NSE medio/alto; p = 0.027). La región patagónica tuvo la mayor prevalencia de obesidad tanto para hom bres (36%) como para mujeres (37%). Un análisis estra tificado por género, con región y NSE como covariables, mostró que el bajo NSE (OR 1.72, IC 95% 1.45, 2.03) y la región patagónica (OR 1.29, IC 95% 1.02, 1.62) fueron los únicos predictores significativos para las mujeres; nin guno se asoció significativamente con un mayor riesgo de obesidad para los hombres. Conclusiones : Las disparidades asociadas al NSE en la obesidad en Argentina fueron pronunciadas entre mujeres, pero no entre hombres. Las disparidades fueron particularmente altas en la Patagonia. Se necesita más estudios para comprender los factores detrás de estas disparidades de NSE, regionales y de género.

Pharmacogenetic Guided Opioid Therapy Improves Chronic Pain Outcomes and Comorbid Mental Health: A Randomized, Double-Blind, Controlled Study.

Interindividual variability in analgesic response is at least partly due to well-characterized polymorphisms that are associated with opioid dosing and adverse outcomes. The Clinical Pharmacogenetics Implementation Consortium (CPIC) has put forward recommendations for the CYP2D6 phenotype, but the list of studied drug-gene pairs continues to grow. This clinical trial randomized chronic pain patients (n = 60), referred from primary care to pain unit care into two opioid prescribing arms, one guided by CYP2D6, µ-opioid receptor (OPRM1), and catechol-O-methyl transferase (COMT) genotypes vs. one with clinical routine. The genotype-guided treatment reduced pain intensity (76 vs. 59 mm, p < 0.01) by improving pain relief (28 vs. 48 mm, p < 0.05), increased quality of life (43 vs. 56 mm p < 0.001), and lowered the incidence of clinically relevant adverse events (3 [1-5] vs. 1 [0-2], p < 0.01) and 42% opioid dose (35 [22-61] vs. 60 [40-80] mg/day, p < 0.05) as opposed to usual prescribing arm. The final health utility score was significantly higher (0.71 [0.58-0.82] vs. 0.51 [0.13-0.67] controls, p < 0.05) by improving sleepiness and depression comorbidity, with a significant reduction of 30-34% for headache, dry mouth, nervousness, and constipation. A large-scale implementation analysis could help clinical translation, together with a pharmaco-economic evaluation.

Association of Language Barriers With Perioperative and Surgical Outcomes: A Systematic Review.

Importance: English language proficiency has been reported to correlate with disparities in health outcomes. Therefore, it is important to identify and describe the association of language barriers with perioperative care and surgical outcomes to inform efforts aimed at reducing health care disparities. Objective: To examine whether limited English proficiency compared with English proficiency in adult patients is associated with differences in perioperative care and surgical outcomes. Evidence Review: A systematic review was conducted in MEDLINE, Embase, Web of Science, Sociological Abstracts, and CINAHL of all English-language publications from database inception to December 7, 2022. Searches included Medical Subject Headings terms related to language barriers, perioperative or surgical care, and perioperative outcomes. Studies that investigated adults in perioperative settings and involved quantitative data comparing cohorts with limited English proficiency and English proficiency were included. The quality of studies was evaluated using the Newcastle-Ottawa Scale. Because of heterogeneity in analysis and reported outcomes, data were not pooled for quantitative analysis. Results are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guideline. Findings: Of 2230 unique records identified, 29 were eligible for inclusion (281 266 total patients; mean [SD] age, 57.2 [10.0] years; 121 772 [43.3%] male and 159 240 [56.6%] female). Included studies were observational cohort studies, except for a single cross-sectional study. Median cohort size was 1763 (IQR, 266-7402), with a median limited English proficiency cohort size of 179 (IQR, 51-671). Six studies explored access to surgery, 4 assessed delays in surgical care, 14 assessed surgical admission length of stay, 4 assessed discharge disposition, 10 assessed mortality, 5 assessed postoperative complications, 9 assessed unplanned readmissions, 2 assessed pain management, and 3 assessed functional outcomes. Surgical patients with limited English proficiency were more likely to experience reduced access in 4 of 6 studies, delays in obtaining care in 3 of 4 studies, longer surgical admission length of stay in 6 of 14 studies, and more likely discharge to a skilled facility than patients with English proficiency in 3 of 4 studies. Some additional differences in associations were found between patients with limited English proficiency who spoke Spanish vs other languages. Mortality, postoperative complications, and unplanned readmissions had fewer significant associations with English proficiency status. Conclusions and Relevance: In this systematic review, most of the included studies found associations between English proficiency and multiple perioperative process-of-care outcomes, but fewer associations were seen between English proficiency and clinical outcomes. Because of limitations of the existing research, including study heterogeneity and residual confounding, mediators of the observed associations remain unclear. Standardized reporting and higher-quality studies are needed to understand the impact of language barriers on perioperative health disparities and identify opportunities to reduce related perioperative health care disparities.

[Disparities in regional obesity rates in Argentina by socioeconomic status]. / Disparidades en prevalencia de obesidad por región y estatus socioeconómico en Argentina.

BACKGROUND: Obesity rates in Latin America are increasing overall and among people with low socioeconomic status (SES). Obesity and SES disparities can vary by region-a valuable indicator of local drivers. The objective of this study was to examine regional and SES differences in obesity in Argentina. METHODS: We used data from Argentina's 4th National Risk Factors Survey (n = 29226) 2018 and defined obesity as BMI = 30. Low SES was defined as not finished high school or having a household income in the lowest two quintiles. Descriptive analysis stratified by sex compared obesity rates by SES, province, and region. Age-adjusted logistic regression models explored the association between obesity, socioeconomic status, and region. RESULTS: Obesity rates varied more by SES among women (39% for low SES vs. 26% for middle/high SES; p < 0.001) than among men (33% low SES vs. 29% middle/ high SES; p = 0.027). The Patagonian region had the highest obesity prevalence for both men (36%) and women (37%). A gender-stratified age-adjusted analysis with region and SES showed that low SES (OR 1.72, 95% CI 1.45, 2.03) and the Patagonian region (OR 1.29, 95% CI 1.02, 1.62) were the only significant predictors for women. CONCLUSIONS: SES associated disparities in obesity in Argentina were pronounced for women but not men. Disparities were particularly high in Patagonia. Further research is needed to understand the drivers behind these SES, regional, and gender disparities.

Introducción: Las tasas de obesidad en América Latina están aumentando, tanto en la población general como entre las personas con bajo nivel socioeconómico (NSE). Las disparidades en obesidad y NSE pueden variar ampliamente según la región, un indicador potencialmente valioso de fenómenos causales locales. El objetivo de este estudio fue examinar las diferencias en la prevalencia de obesidad a nivel regional y según el NSE en Argentina. Métodos: Utilizamos datos de la 4° Encuesta Nacional de Factores de Riesgo realizada en Argentina en 2018 (n = 29226). Definimos obesidad como índice de masa corporal = 30, y bajo NSE como no haber terminado la escuela secundaria o tener un ingreso familiar en los dos quintiles más bajos. El análisis descriptivo estratificado por sexo comparó la prevalencia de obesidad por NSE, provincia y región. Además, utilizamos modelos de regresión logística ajustados por edad para explorar la asociación entre obesidad, nivel socioeconómico y región, tanto globalmente como estratificando por sexo.Resultados: Las tasas de obesidad variaron más por NSE entre las mujeres (39% NSE bajo vs. 26% NSE medio/alto; p < 0.001) que entre los hombres (33% NSE bajo vs. 29% NSE medio/alto; p = 0.027). La región patagónica tuvo la mayor prevalencia de obesidad tanto para hombres (36%) como para mujeres (37%). Un análisis estratificado por género, con región y NSE como covariables, mostró que el bajo NSE (OR 1.72, IC 95% 1.45, 2.03) y la región patagónica (OR 1.29, IC 95% 1.02, 1.62) fueron los únicos predictores significativos para las mujeres; ninguno se asoció significativamente con un mayor riesgo de obesidad para los hombres. Conclusiones: Las disparidades asociadas al NSE en la obesidad en Argentina fueron pronunciadas entre mujeres, pero no entre hombres. Las disparidades fueron particularmente altas en la Patagonia. Se necesita más estudios para comprender los factores detrás de estas disparidades de NSE, regionales y de género.

Racial and ethnic disparities in obstetric anesthesia: a scoping review.

PURPOSE: Health disparities continue to affect racial and ethnic marginalized obstetric patients disproportionally with increased risk of Cesarean delivery and pregnancy-related death. Yet, the literature on what influences such disparities in obstetric anesthesia service and its clinical outcomes is less well known. We set out to describe racial and ethnic disparities in obstetric anesthesia during the peripartum period in the USA via a scoping review of the recent literature. SOURCE: Using the Institute of Medicine's definition of disparities, we searched the National Library of Medicine's PubMed/Medline, Embase, Web of Science, APA PsycINFO, and Google Scholar for articles published between 1 January 2000 and 30 June 2022 to identify literature on racial and ethnic disparities in obstetric anesthesia. PRINCIPAL FINDINGS: Out of 8,432 articles reviewed, 15 met our inclusion criteria. All but one study was observational. Seven studies were single-institutional while the remaining used multicentre data/databases. All studies compared two or more race and ethnicity classifications. Studies in this review described disparities in the use of labour epidural analgesia, labour epidural request timing, anesthesia for Cesarean deliveries, postpartum pain management, and epidural blood patch for postdural puncture headaches. Several studies reported disparities observed in the unadjusted models becoming no longer significant when adjusted for other covariates. CONCLUSION: Based on the findings of the present scoping review on racial and ethnic disparities in obstetric anesthesia, we present an evidence map identifying knowledge gaps and propose a future research agenda.

RéSUMé: OBJECTIF: Les disparités en matière de santé continuent d'affecter de manière disproportionnée les patient·es en obstétrique marginalisé·es sur le plan racial et ethnique, avec un risque accru d'accouchement par césarienne et de décès lié à la grossesse. Pourtant, la littérature sur ce qui influence de telles disparités dans les services d'anesthésie obstétricale et leurs issues cliniques est moins bien connue. Notre objectif était de décrire les disparités raciales et ethniques en matière d'anesthésie obstétricale au cours de la période péripartum aux États-Unis via une étude de portée de la littérature récente. SOURCES: En utilisant la définition des disparités de l'Institute of Medicine, nous avons effectué des recherches dans les bases de données PubMed/Medline de la National Library of Medicine, Embase, Web of Science, APA PsycINFO et Google Scholar pour trouver des articles publiés entre le 1er janvier 2000 et le 30 juin 2022, afin d'identifier la littérature sur les disparités raciales et ethniques en anesthésie obstétricale. CONSTATATIONS PRINCIPALES: Sur 8432 articles examinés, 15 répondaient à nos critères d'inclusion. Toutes les études sauf une étaient observationnelles. Sept études étaient monocentriques tandis que les autres utilisaient des données/bases de données multicentriques. Toutes les études comparaient deux classifications de race et d'origine ethnique ou plus. Les études de cette revue décrivaient des disparités dans l'utilisation de l'analgésie péridurale obstétricale, le moment de la demande pour une péridurale obstétricale, l'anesthésie pour les accouchements par césarienne, la prise en charge de la douleur post-partum et les injections de sang autologue en péridural pour les céphalées post-ponction durale. Plusieurs études ont fait état de disparités observées dans les modèles non ajustés qui n'étaient plus significatives lors de l'ajustement pour tenir compte d'autres covariables. CONCLUSION: Sur la base des résultats de cette étude de portée sur les disparités raciales et ethniques en anesthésie obstétricale, nous présentons une carte des données probantes identifiant les lacunes dans les connaissances et proposons un futur programme de recherche.

Disparities in Treatment of Closed Distal Radius Fractures in Patients Aged 18-64 Years and ≥65 Years by Insurance Type.

PURPOSE: Type of and time to definitive treatment for distal radius fractures can influence the outcomes. The impact of social determinants of health (eg, insurance type) on distal radius fracture care remains unknown despite having health equity implications. Thus, we evaluate the association between insurance type and rate of surgery, the time to surgery, and the complication rate for distal radius fractures. METHODS: We conducted a retrospective cohort study using the PearlDiver Database. We identified adults with closed distal radius fractures. Patients were divided into subgroups by age (18-64 years, 65+ years) and further stratified on the basis of the insurance type (Medicare Advantage, Medicaid-managed care, and commercial). The primary outcome was the rate of surgical fixation. Secondary outcomes included the time to surgery and 12-month complication rates. Logistic regression modeling was used to calculate the odds ratios for each outcome, adjusting for age, sex, geographic region, and comorbidities. RESULTS: In patients aged ≥65 years, a lower proportion of Medicaid patients underwent surgery within 21 days of diagnosis compared with Medicare or commercially insured patients (12.1% vs 15.9% or 17.5%, respectively). Complication rates did not differ between Medicaid and other insurance types. In patients aged <65 years, fewer Medicaid patients underwent surgery compared with commercially insured patients (16.2% vs 21.1%). However, in this younger group, Medicaid patients had higher adjusted odds of malunion/nonunion (adjusted odds ratio [aOR] = 1.39 [95% CI, 1.31-1.47]) and subsequent repair (aOR = 1.38 [95% CI, 1.25-1.53]). DISCUSSION: Although older Medicaid patients experienced lower surgical rates, this may not lead to differential clinical outcomes. However, Medicaid patients aged <65 years experienced lower surgical rates that correlated with the increased rates of malunion or nonunion. CLINICAL RELEVANCE: In younger patients with a closed distal radius fracture and Medicaid insurance, system and patient-directed efforts should be considered to address delayed time to surgery and a higher odds for malunion/nonunion.

The PhenX Toolkit: Measurement Protocols for Assessment of Social Determinants of Health.

INTRODUCTION: Social determinants are structures and conditions in the biological, physical, built, and social environments that affect health, social and physical functioning, health risk, quality of life, and health outcomes. The adoption of recommended, standard measurement protocols for social determinants of health will advance the science of minority health and health disparities research and provide standard social determinants of health protocols for inclusion in all studies with human participants. METHODS: A PhenX (consensus measures for Phenotypes and eXposures) Working Group of social determinants of health experts was convened from October 2018 to May 2020 and followed a well-established consensus process to identify and recommend social determinants of health measurement protocols. The PhenX Toolkit contains data collection protocols suitable for inclusion in a wide range of research studies. The recommended social determinants of health protocols were shared with the broader scientific community to invite review and feedback before being added to the Toolkit. RESULTS: Nineteen social determinants of health protocols were released in the PhenX Toolkit (https://www.phenxtoolkit.org) in May 2020 to provide measures at the individual and structural levels for built and natural environments, structural racism, economic resources, employment status, occupational health and safety, education, environmental exposures, food environment, health and health care, and sociocultural community context. CONCLUSIONS: Promoting the adoption of well-established social determinants of health protocols can enable consistent data collection and facilitate comparing and combining studies, with the potential to increase their scientific impact.

Development and validation of the Self-Management Assessment for the Residuum and prosThesis system designed for persons with limb loss (SMART).

OBJECTIVE: To develop a system of reliable and valid knowledge assessments of self-management in persons with lower limb loss, along with the accompanying targeted educational interventions (TEIs), known as the Self-Management Assessment for the Residuum and prosThesis (SMART) system. DESIGN: This 2-phase study used mixed methodology. Phase 1 was development, face validation, and content validation of the 60-item knowledge assessment measure (SMART 60) and the TEI. Phase 2 assessed internal consistency reliability using Kuder-Richardson Formula 20 and the creation of the SMART system, consisting of modules developed from the SMART 60. Validity of the measures using known groups' comparison was analyzed by comparing clinicians (prosthetists and physical therapists) with persons with lower limb loss. Participants were recruited from the Amputee Coalition National Conference in 2018 and 2019. RESULTS: A total of 140 participants completed this study. Four modules from the SMART 60 were created and designed to integrate as a system. Face validity survey average scores found that 9/10 participants either agreed or strongly agreed that the SMART system has high readability, perceived usefulness, and value for both new and experienced prosthetic users. Measure length ranged from 10 to 45 items with a reliability ranging from Kuder-Richardson Formula 20 = 0.70-0.82. The SMART system demonstrated known-groups validity ( p < 0.05). CONCLUSION: The SMART system is an integrated series of self-management knowledge assessments with reasonable to good internal consistency reliability and known-groups validity. The TEIs provide directed solutions to identified knowledge gaps on the assessments.

Patients Who Have Limited English Proficiency Have Decreased Utilization of Revision Surgeries After Hip and Knee Arthroplasty.

BACKGROUND: While racial and ethnic disparities are well documented in access to total joint arthroplasty (TJA), little is known about the association between having limited English proficiency (LEP) and postoperative care access. This study seeks to correlate LEP status with rates of revision surgery after hip and knee arthroplasty. METHODS: This was a retrospective cohort study of patients aged ≥ 18 years who underwent either total hip or total knee arthroplasty between January 2013 and December 2021 at a single academic medical center. The predictor variable was English proficiency status, where LEP was defined as having a primary language that was not English. Multivariable regressions controlling for potential demographic and clinical confounders were used to calculate adjusted odds ratios of undergoing revision surgery within 1 and 2 years after primary arthroplasty for patients who have LEP, compared to English proficient patients. RESULTS: A total of 7,985 hip and knee arthroplasty surgeries were included in the analysis. There were 577 (7.2%) patients who were classified as having LEP. Patients who have LEP were less likely to undergo revision surgeries within 1 year (1.4% versus 3.2%, P = .01) and 2 years (1.7% versus 3.9%, P = .006) of primary TJA. Patients who have LEP had adjusted odds ratios of 0.45 (confidence interval: 0.22-0.92, P = .03) and 0.44 (confidence interval: 0.23-0.85, P = .01) of receiving revision surgery within 1 and 2 years, respectively. CONCLUSION: Patients who have LEP, compared to English proficient patients, were less likely to undergo revision surgeries at the same institution up to 2 years after hip and knee arthroplasty. These findings suggest that patients who have LEP may face barriers in accessing postoperative care.

A matter of trust: Commitment to act for health equity.

We believe these recommendations constitute "minimum requirements" for health care organizations to move toward greater health equity. As health systems, standards-setting organizations, national and private purchaser organizations, and thought leaders, we represent organizations in the health care ecosystem that can both advise on strategies for adopting the recommendations and have the power and leverage to cause their implementation. We commit individually and collectively to use our leverage to propel their implementation at our own institutions and across the county. We very much hope others will join us.

COVID-19 Vaccination Perceptions Among Young Adults of Color in the San Francisco Bay Area.

Background: COVID-19 vaccination rates among U.S. young adults, particularly in communities of color, remain lower than other age groups. We conducted a qualitative, community-based participatory study to explore beliefs and attitudes about COVID-19 vaccines among young adults in Black/African American, Latinx, and Asian American or Pacific Islander (AAPI) communities in the San Francisco Bay Area. Methods: We conducted six focus groups between June and August 2021. Participants were recruited by partnering with community-based organizations in the San Francisco Bay Area. Focus groups included Black/African American (N=13), Latinx (N=20), and AAPI (N=12) participants between 18 and 30 years of age. Emerging themes were identified using a modified Grounded Theory approach. Results: Prominent themes among all three racial-ethnic groups included mistrust in medical and government institutions, strong conviction about self-agency in health decision-making, and exposure to a thicket of contradictory information and misinformation in social media. Social benefit and a sense of familial and societal responsibility were often mentioned as reasons to get vaccinated. Young adult mistrust had a generational flavor fueled by anger about increasing inequity, the profit-orientation of pharmaceutical companies and health institutions, society's failure to rectify injustice, and pessimism about life prospects. Conclusion: Factors influencing vaccine readiness among Black/African American, Latinx, and AAPI young adults have a distinct generational and life-course texture. Outreach efforts should appeal to young adults' interest in family and social responsibility and the social benefits of vaccination, while being cognizant of the friction mandates pose for young adults' sense of self-agency. Efforts will be most effective coming from trusted messengers with a proven commitment to communities of color and health equity.

The Association of Limited English Proficiency With Morbidity and Mortality After Trauma.

INTRODUCTION: Disparities following traumatic injury by race/ethnicity and insurance status are well-documented. However, the relationship between limited English proficiency (LEP) and outcomes after trauma is poorly understood. This study describes the association between LEP and morbidity and mortality after traumatic injury. METHODS: A retrospective cohort study was conducted of adult trauma patients admitted to a level 1 trauma center from 2012 to 2018. Morbidity (length of stay [LOS], intensive care unit admission, intensive care unit LOS, discharge destination) and in-hospital mortality for LEP and English proficient (EP) patients were compared using univariate and multivariable logistic and generalized linear models controlling for patient demographics (age, sex, race/ethnicity, insurance) and clinical characteristics (mechanism, activation level, Glasgow Coma Scale, Injury Severity Score, traumatic brain injury). RESULTS: Of the 13,104 patients, 16% were LEP patients. LEP languages included Chinese (44%) and Spanish (38%), and 18% categorized as "Other," including 33 languages. In multivariable models, LEP was statistically significantly associated with increased hospital LOS (P = 0.003) and increased discharge to home with home health services (P = 0.042) or to skilled nursing facility/rehabilitation (P = 0.006). Mortality rate was 7% for LEP versus 4% for EP patients (P < 0.0001). In multivariable analysis, speaking an LEP language other than Chinese or Spanish was statistically significantly associated with increased mortality compared to EP (P = 0.006). CONCLUSIONS: Following traumatic injury, LEP patients experience increased hospital LOS and are more frequently discharged to home with home health services or to skilled nursing facilities/rehabilitation. LEP patients speaking languages other than Chinese or Spanish experience increased mortality compared to EP patients.

Limited English Proficiency Associated With Suboptimal Pain Assessment in Hospitalized Trauma Patients.

INTRODUCTION: Traumatic injury causes significant acute and chronic pain, and accurate pain assessment is foundational to optimal pain control. Prior literature has revealed disparities in the treatment of pain by race and ethnicity, but the effect of patient language on pain assessment remains unknown. We aimed to investigate the relationship between Limited English Proficiency (LEP) in pain assessment frequency and pain score magnitude for hospitalized trauma patients. METHODS: We conducted a cross-sectional, retrospective study including all hospitalized adult trauma patients from 2012 to 2018 at a single urban Level-1 trauma center. Patient language, 0-10 Numeric Rating Scale (NRS) pain scores, and demographic and clinical covariates were extracted from the electronic medical record. We used multivariable negative binomial regressions to compare NRS pain assessment frequency and multivariable linear regression to compare NRS pain score magnitude between LEP and English Proficient patients. RESULTS: Between 2012 and 2018, 9754 English proficient and 1878 LEP patients were hospitalized for traumatic injury. In multivariable models adjusted for demographic and injury characteristics, LEP patients had 2.4 fewer pain assessments per day compared to English proficient patients (7.21 versus 9.61, P = 0.001). Excluding days spent in the ICU, LEP patients had 2.6 fewer assessments per day (9.28 versus 11.88, P = 0.001). Median pain scores were lower in the LEP group (2.2 versus 3.61, P < 0.001), with a difference of 1.19 points in adjusted multivariable models. CONCLUSIONS: Compared to English Proficient patients, LEP patients had fewer pain assessments and lower NRS scores. Differences in pain assessment by patient language may be associated with disparities in pain management and morbidity.