Seasonal Variation in Out-of-Hospital Cardiac Arrest in Victoria 2008-2017: Winter Peak.

Background: Out-of-Hospital Cardiac Arrest (OHCA) incidence and survival rates are known to vary between seasons in some locations. The winter of 2017 saw the highest ever incidence and lowest survival rate of OHCA recorded in Victoria at the time. Seasonal variation of OHCA has not previously been examined in Australia and there may be a significant effect. We aimed to describe the seasonal incidence of OHCA and examine seasonal differences in survival to discharge and 12-month quality of life outcomes. In addition, we investigated whether recent respiratory infection or pre existing respiratory disease influenced OHCA outcomes. Methods: The Victorian Ambulance Cardiac Arrest Registry (VACAR) was used to identify OHCA occurring in Victoria between 2008 and 2017. We examined OHCA characteristics and outcomes between seasons. We then used multivariate logistic regression, adjusting for the Utstein factors, to examine if season, recent respiratory infection or preexisting respiratory disease is associated with survival to discharge and 12-month quality of life. Results: There were 44 973 OHCA cases of which 22 209 received an attempted resuscitation (49.4%). The incidence of OHCA was highest during winter (22 per 100 000 vs. 18 per 100 000 in summer). In winter, survival to discharge was lower for OHCA patients (12.2% vs. 15.9% in summer). Both recent respiratory infection (AOR: 0.67, 95% CI: 0.52 - 0.87) and OHCA occurring during winter (AOR: 0.79 95% CI: 0.70 - 0.91) were associated with lower odds of survival to discharge. Preexisting respiratory disease was associated with lower odds of moderate to good recovery at 12 months (AOR:0.60 95% CI: 0.41 - 0.89). Conclusion: In winter the incidence of OHCA was at its highest and survival to discharge was at its lowest compared to other seasons. Recent respiratory infection was associated with lower odds of survival to discharge. Measures targeted to vulnerable groups, such as preventative public health measures for respiratory infections and the influenza vaccine may reduce the incidence of OHCA and improve survival rates.

Public and private health-care financing with alternate public rationing rules.

We develop a model to analyze parallel public and private health-care financing under two alternative public sector rationing rules: needs-based rationing and random rationing. Individuals vary in income and severity of illness. There is a limited supply of health-care resources used to treat individuals, causing some individuals to go untreated. Insurers (both public and private) must bid to obtain the necessary health-care resources to treat their beneficiaries. Given individuals' willingnesses-to-pay for private insurance are increasing in income, the introduction of private insurance diverts treatment from relatively poor to relatively rich individuals. Further, the impact of introducing parallel private insurance depends on the rationing mechanism in the public sector. We show that the private health insurance market is smaller when the public sector rations according to need than when allocation is random.

Analysis of Lumbar Fusion and Lumbar Arthroplasty Videos on YouTube.

BACKGROUND: Patients often use the internet for information on their spinal surgeries. The goal of this study was to assess and compare the quality of lumbar fusion and arthroplasty videos on YouTube and to identify predictors of video quality. STUDY DESIGN: Cross-sectional. METHODS: YouTube was searched utilizing 3 search terms for both lumbar fusion and lumbar arthroplasty. Fifty videos from each search were categorized and analyzed. Videos were analyzed using 3 scoring systems: JAMA, informative, and clinical scores. The JAMA score rates online information based on 4 factors: authorship, attribution, disclosure, and currency. The informative score previously devised by Zhang et al was also applied to each video. Finally, 2 surgery-specific scores were created for lumbar fusion and lumbar arthroplasty based on peer-reviewed information. These were modeled on the informed consent procedure. Data analysis was conducted using the Jamovi 1.1.9.0. RESULTS: Eighty-four unique lumbar fusion videos and 82 lumbar arthroplasty videos were analyzed. Educational videos were the most common in fusion (78%) and arthroplasty (47%) groups; however, arthroplasty videos were more likely to be commercial (17%, P = 0.01). Fusion videos were more viewed (P < 0.001); however, arthroplasty videos had higher positivity ratings (P < 0.01). Overall, quality was poor for videos in both categories. Mean JAMA scores were 1.57 and 1.70 for fusion and arthroplasty, respectively, and did not differ significantly (P = 0.32). Fusion videos had higher informative scores (1.57 vs 1.23, P = 0.02) and higher clinical scores (21.8% vs 15.9%, P = 0.06). CONCLUSION: Information on YouTube for lumbar fusion and arthroplasty is poor. However, information on fusion is better than arthroplasty. Metadata can be used to help patients pick higher quality videos. CLINICAL RELEVANCE: This paper provides clinicians with an oversight of what their patients may accessing on the internet. Patients may have incorrect information regarding the surgical proceedure they are being offered. These misconceptions must be resovled in order to gain true informed consent from the patient and avoid damage to the surgeon-patient relationship.

Resolving spatiotemporal characteristics of the seasonal hypoxia cycle in shallow estuarine environments of the Severn River and South River, MD, Chesapeake Bay, USA.

The nature of emerging patterns concerning water quality stressors and the evolution of hypoxia within sub-estuaries of the Chesapeake Bay has been an important unresolved question among the Chesapeake Bay community. Elucidation of the nature of hypoxia in the tributaries of the Chesapeake Bay has important ramifications to the successful restoration of the Bay, since much of Bay states population lives within the watersheds of the tributaries. Very little to date, is known about the small sub-estuaries of the Chesapeake Bay due to limited resources and the difficulties in resolving both space and time dimensions on scales that are adequate to resolve this question. We resolve the spatio-temporal domain dilemma by setting up an intense monitoring program of water quality stressors in the Severn and South Rivers, MD. Volume rendered models were constructed to allow for a visual dissection of the water quality times series which illustrates the life cycle of hypoxia and anoxia at the mid to upper portions of the tidal tributaries. The model also shows that unlike their larger Virginian tributary counterparts, there is little to no evidence of severe hypoxic water intrusions from the main-stem of the Chesapeake Bay into these sub-estuaries.

Venous thrombosis in inflammatory bowel disease.

Patients with inflammatory bowel disease (IBD) have a threefold increased risk of venous thrombosis, a major cause of morbidity and mortality. Although the exact mechanism explaining the initiation of thrombosis remains unclear, it is likely to be a multifactorial process. Reported abnormalities include activation of markers of the coagulation cascade, disturbed fibrinolysis and the activation of platelets. The contribution of thrombophilic disorders such as factor V Leiden, prothrombin gene mutations and hyperhomocysteinaemia are discussed, but their role in thrombosis associated with IBD has remained unclear. Recent research has examined elevated CD40, P-selectin levels and tissue factor-bearing microvesicles in venous thrombosis, and the relevance of these observations to IBD is reviewed.

Analysis of nodal point pollution, variability, and sustainability in mesohaline tidal creeks.

Mesohaline tidal creeks are critical since they may lie at the crossroads of aquatic habitat and urban/sub-urban pressures. The emphasis of this study was to determine the water quality stressor variations within and between tidal creeks and determine whether they serve as nodes of pollutants into the sub-estuary. Measurements of water quality stressors were conducted over a six-year period. The study revealed that characterizing the variability of individual tidal creeks is critical to understanding the process and impacts of stressors in sub-estuarine environments and that the tidal creeks are actually nodal points of sediment and nutrient pollution. This results in hypoxia being controlled within tidal creeks rather than being imported from the parent estuary. The calculated metrics were then used to create a Sustainability Characterization Map. Methods incorporated in this study would be of value to restoration managers, and in the decision-making process of urban and suburban watershed planners.