Evaluation of Social Determinants of Health on Dysphagia Care Pathways at a Tertiary Care Facility.

OBJECTIVES: Limited research exists evaluating the impact of social determinants of health in influencing care pathways for patients with dysphagia. A better understanding of whether these determinants correlate to altered care and resource utilization is essential as it relates to patient outcomes. STUDY DESIGN: Retrospective chart review. METHODS: All adult patients seen at a tertiary midwestern hospital were screened for ICD codes of dysphagia diagnoses from 2009 to 2019. Demographic information was collected from these patients with dysphagia including sex, race, ethnicity, and insurance status. Subgroup analysis was performed to assess referral pattern rates and types of diagnostic interventions ordered (none, videofluoroscopic swallow study, esophagram, and esophagogastroduodenoscopy). RESULTS: A total of 31,858 patients with dysphagia were seen at our institution during the study period, with a majority being female (56.36%), Caucasian (79.83%), and publicly insured (63.16%), at a median age of 60.35 years. There were no significant care delivery pattern differences based on geography/zip code analyses. African American patients were significantly more likely to have imaging or interventions performed (odds ratio [OR] 1.463, p = 0.005). Patients with public insurance also had higher rates of diagnostic study utilization (OR 1.53, p = 0.01). Only 3% of all patients with dysphagia were seen by laryngologists. CONCLUSION: No significant differences were seen in dysphagia evaluation modalities based on zip code analyses surrounding this tertiary care facility. African American patients and those with public insurance had significantly higher utilization of subsequent testing and intervention for dysphagia care. Further studies are necessary to delineate causes and outcome differences for these measurable differences in dysphagia care pathways. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:1139-1146, 2024.

Cobalt oxide-alumina catalysts for the methane-assisted selective catalytic reduction of SO2 to sulfur.

Preventing emission of pollutants in any kind, is a way to protect global environment. The objective of this study is to develop cobalt catalysts supported on alumina for the conversion of the toxic gas SO2 into elemental sulfur using methane. Although several useful catalysts have been proposed, there is still a need to synthesize a catalyst with a high sulfur yield that is also persistent during on-stream stability. To this end, four different catalysts were prepared using the wet impregnation technique, with Co3O4 content ranging from 0 to 15 wt%. Catalytic activity tests were carried out at atmospheric pressure and temperatures ranging from 550 to 800 °C. The Al2O3-Co (15 %) catalyst exhibited superior performance, with a sulfur yield of 98.1 % at 750 °C. The catalytic stability of the best catalyst was examined using a 20 h on-stream stability test under the optimized conditions including an SO2/CH4 molar feed ratio of 2 at 750 °C. The structural changes of the used catalyst after the stability test were investigated using XRD and TPO analyses. It was revealed that sulfidation of Co3O4 after a short while, results in decreasing the sulfur yield from 98.1 % to 89.8 %.

A risk identification model for detection of patients at risk of antidepressant discontinuation.

Purpose: Between 30 and 68% of patients prematurely discontinue their antidepressant treatment, posing significant risks to patient safety and healthcare outcomes. Online healthcare forums have the potential to offer a rich and unique source of data, revealing dimensions of antidepressant discontinuation that may not be captured by conventional data sources. Methods: We analyzed 891 patient narratives from the online healthcare forum, "askapatient.com," utilizing content analysis to create PsyRisk-a corpus highlighting the risk factors associated with antidepressant discontinuation. Leveraging PsyRisk, alongside PsyTAR [a publicly available corpus of adverse drug reactions (ADRs) related to antidepressants], we developed a machine learning-driven algorithm for proactive identification of patients at risk of abrupt antidepressant discontinuation. Results: From the analyzed 891 patients, 232 reported antidepressant discontinuation. Among these patients, 92% experienced ADRs, and 72% found these reactions distressful, negatively affecting their daily activities. Approximately 26% of patients perceived the antidepressants as ineffective. Most reported ADRs were physiological (61%, 411/673), followed by cognitive (30%, 197/673), and psychological (28%, 188/673) ADRs. In our study, we employed a nested cross-validation strategy with an outer 5-fold cross-validation for model selection, and an inner 5-fold cross-validation for hyperparameter tuning. The performance of our risk identification algorithm, as assessed through this robust validation technique, yielded an AUC-ROC of 90.77 and an F1-score of 83.33. The most significant contributors to abrupt discontinuation were high perceived distress from ADRs and perceived ineffectiveness of the antidepressants. Conclusion: The risk factors identified and the risk identification algorithm developed in this study have substantial potential for clinical application. They could assist healthcare professionals in identifying and managing patients with depression who are at risk of prematurely discontinuing their antidepressant treatment.

Impacts of Socioeconomic Status on Dentoalveolar Trauma.

INTRODUCTION: Children sustain dentoalveolar trauma and lose teeth at the same rate regardless of socioeconomic status; however, debate surrounds these rates in adults. It is known socioeconomic status plays a major role in access and treatment in health care. This study aims to clarify the role of socioeconomic status as a risk factor for dentoalveolar trauma in adults. METHODS: A single center retrospective chart review took place from January 2011 through December 2020 for patients requiring oral maxillofacial surgery consultation in the emergency department, due to either dentoalveolar trauma (Group 1) or other dental condition (Group 2). Demographic information including age, sex, race, marital status, employment status, and type of insurance were collected. Odds ratios were calculated by chi-square analysis with significance set at P < 0.05. RESULTS: Over the course of 10 years, 247 patients (53% female) required an oral maxillofacial surgery consultation, with 65 (26%) sustaining dentoalveolar trauma. Within this group, there were significantly more subjects who were Black, single, insured with Medicaid, unemployed, and 18 - 39 years old. In the nontraumatic control group, there were significantly more subjects who were White, married, insured with Medicare, and 40 - 59 years old. CONCLUSIONS: Among those seen in the emergency department requiring an oral maxillofacial surgery consultation, those with dentoalveolar trauma have an increased likelihood of being single, Black, insured with Medicaid, unemployed, and 18 - 39 years old. Further research is needed to determine causality and the most critical/influential socioeconomic status factor in sustaining dentoalveolar trauma. Identifying these factors can assist in developing future community-based prevention and educational programs.

Association between body-mass index, patient characteristics, and obesity-related comorbidities among COVID-19 patients: A prospective cohort study.

OBJECTIVE: Obesity is a major risk factor for adverse outcomes after COVID-19 infection. However, it is unknown if the worse outcomes are due to the confounding effect of demographic and obesity-related comorbidities. The study objective is to analyze associations between body mass index, patient characteristics, obesity-related comorbidity, and clinical outcomes in COVID-19 patients. METHODS: In this prospective cohort study, we chose patient records between March 1st, 2020, and December 1st, 2022, in a large tertiary care center in southeast Wisconsin in the United States. Patients over the age of 18 who tested positive were included in the study. Clinical outcomes included hospitalization, intensive care unit (ICU) admission, mechanical ventilation, and mortality rates. We examined the characteristics of patients who had positive clinical outcomes. We created unadjusted logistic regression models, sequentially adjusting for demographic and comorbidity variables, to assess the independent associations between BMI, patient characteristics, obesity-related comorbidities, and clinical outcomes. RESULTS: From a record of 1.67 million inpatients and outpatients at Froedtert Health Center, 55,299 (BMI: 30.5 ± 7.4 kg/m2, 62.5 % female) tested COVID-19 positive during the study period. 17,580 (31.8 %) patients were admitted to hospitals, and of hospitalized patients required ICU admission. 1038 (36.3 %) required mechanical ventilation, and 462 (44.5 %) died after a positive test for COVID-19. We found female patients show a higher hospitalization rate, while male patients have a higher rate of ICU admission, mechanical ventilation, and mortality. Obesity-related comorbidities are associated with worse outcomes compared to simple obesity without comorbidities. In logistic regression models, we found four similar V-shaped associations between BMI and four clinical outcomes. Patients with a BMI of 25 kg/m2 are at the lowest risk for clinical outcomes. Patients with a BMI lower than 18 kg/m2 or higher than 30 kg/m2 are associated with a higher risk of hospitalization, ICU, mechanical ventilation, and death. After adjusting the model for demographic factors and hypertension and diabetes as two common comorbidities, we found that demographic factors do not significantly increase the risk. Obesity alone does not significantly increase the risk of severe clinical outcomes. Obesity-related comorbidities, on the other hand, resulted in a significantly higher risk of outcomes. CONCLUSION: Obesity alone does not increase the risk of worse clinical outcomes after COVID-19 infection. It may suggest that the worse clinical outcomes of patients with obesity are mediated via hypertension and type 2 diabetes. Patients with obesity and comorbidities have a higher risk of poor outcomes. Obesity-related comorbidities, including hypertension and diabetes, are independently associated with poorer clinical outcomes among COVID-19 patients. At a BMI of more than 30 kg/m2 or less than 18 kg/m2, we found an increase in the risk of severe COVID-19 outcomes leading to hospitalization, ICU, mechanical ventilation, and death. The increased risk of severe outcomes is not attributed to patient characteristics but can be attributed to hypertension and diabetes.

Study of MoO3-γAl2O3 catalysts behavior in selective catalytic reduction of SO2 toxic gas to sulfur with CH4.

In the present study, a detailed investigation was carried out on MoO3 alumina-supported catalysts behavior in selective catalytic reduction of SO2 to sulfur with CH4. At first, four different molybdenum catalysts with weight rates of 0, 5, 10, and 15 were impregnated on γ-alumina to be characterized using XRD, SEM, BET, BJH, and N2 adsorption. Then, to find the most active catalyst, temperature dependency test was performed on all of the prepared catalysts and the result representing Al2O3-Mo10 as the best catalyst. In next step, the effects of feed gas composition, space velocity, and long-term activity, as an important industrial factor, were tested on Al2O3-Mo10. It was revealed instantaneously from the beginning, MoO3 specie started to convert mainly into MoS2 and MoO2, and a minor part into Mo2C, which is terminated after 750 min achieving a stable condition. Thereafter, SO2 conversion and sulfur selectivity increased from 85.8 to 89.4% and 99.4 to 99.7%, respectively. XRD graph of the used catalyst and TPO thermogravimetric/mass-spectra proved possible happening of the proposed mechanism in long-term activity. At the end, mean activation energy was determined based on Arrhenius model in temperature range of 550 to 800 °C, with a value of 0.33 eV for Al2O3-Mo10.

Serum levels of vascular endothelial growth factor in chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a third leading cause of death. METHODS: In this case control study, we prepared 5 cc bloods from the antecubital vein of 100 COPD patients and 40 healthy individuals as control group. Vascular endothelial growth factor (VEGF) expression protein level was measured by ELISA in both groups. RESULTS: We found that concentration of VEGF in blood serum of patients with COPD (189.9±16pg/ml) was significantly higher than the control group (16.4±3.48pg/ml) (p<0.001). While VEGF serum level in emphysematous patients wasn't significantly different with control group (p=0.07). Furthermore VEGF serum level in COPD patients was proportionally increased with severity of disease (p<0.001). Besides all COPD patients, regardless of their smoking status, were experienced significantly higher levels of VEGF than healthy ones (p=0.001; z=4.3). CONCLUSION: Our results suggest VEGF serum concentration as the sensitive index for severity and activity of COPD and its prognosis.