RESUMEN
Background Various socioeconomic and demographic factors play a role in determining treatment outcomes across numerous conditions. Different studies have shown that certain demographic factors, such as income status, directly correlate with treatment outcomes. In this study, we analyze the effect of some of these variables, namely, insurance and age, on various endpoints, including length of stay and discharge status, among heart failure patients. Methodology The data used in this project were retrieved from the HealthCare Utilization Project. We sorted the data by insurance, age, length of stay, and discharge status. To compare discharge status between different insurance types and age groups, we used Stata to compute odds ratios and 95% confidence intervals. To compare the length of stay among different age groups and insurance types, we conducted an unpaired two-tailed Student's t-test. Results Across all age groups, we found that younger patients with heart failure are more likely to discharge against medical advice compared to older patients. The average length of stay for heart failure patients was the same across all age groups except those 85 and older. Moreover, patients with a lower socioeconomic status, as determined by insurance type, were more likely to discharge against medical advice and less likely to die within hospitals. Conclusions Our results speak to the socioeconomic inequalities seen in medicine today. Studies have shown that those with a lower socioeconomic status tend to have worse outcomes across various conditions. Our analysis shows this phenomenon holds true for heart failure as well. In addition, our study helps to determine which groups are at higher risk of making medical decisions, such as discharging against medical advice, that will negatively affect their condition. Identifying these high-risk groups is a key first step to counteracting such behavior.
RESUMEN
Bacillus subtilis produces dormant, highly resistant endospores in response to extreme environmental stresses or starvation. These spores are capable of persisting in harsh environments for many years, even decades, without essential nutrients. Part of the reason that these spores can survive such extreme conditions is because their chromosomal DNA is well protected from environmental insults. The α/ß-type small acid-soluble proteins (SASPs) coat the spore chromosome, which leads to condensation and protection from such insults. The histone-like protein HBsu has been implicated in the packaging of the spore chromosome and is believed to be important in modulating SASP-mediated alterations to the DNA, including supercoiling and stiffness. Previously, we demonstrated that HBsu is acetylated at seven lysine residues, and one physiological function of acetylation is to regulate chromosomal compaction. Here, we investigate if the process of sporulation or the resistance properties of mature spores are influenced by the acetylation state of HBsu. Using our collection of point mutations that mimic the acetylated and unacetylated forms of HBsu, we first determined if acetylation affects the process of sporulation, by determining the overall sporulation frequencies. We found that specific mutations led to decreases in sporulation frequency, suggesting that acetylation of HBsu at some sites, but not all, is required to regulate the process of sporulation. Next, we determined if the spores produced from the mutant strains were more susceptible to heat, ultraviolet (UV) radiation and formaldehyde exposure. We again found that altering acetylation at specific sites led to less resistance to these stresses, suggesting that proper HBsu acetylation is important for chromosomal packaging and protection in the mature spore. Interestingly, the specific acetylation patterns were different for the sporulation process and resistance properties of spores, which is consistent with the notion that a histone-like code exists in bacteria. We propose that specific acetylation patterns of HBsu are required to ensure proper chromosomal arrangement, packaging, and protection during the process of sporulation.
