Association Between Community Social Vulnerability and Preventable Hospitalizations.

Preventable hospitalizations are common and costly events that burden patients and our health care system. While research suggests that these events are strongly linked to ambulatory care access, emerging evidence suggests they may also be sensitive to a patient's social, environmental, and economic conditions. This study examines the association between variations in social vulnerability and preventable hospitalization rates. We conducted a cross-sectional analysis of county-level preventable hospitalization rates for 33 states linked with data from the 2020 Social Vulnerability Index (SVI). Preventable hospitalizations were 40% higher in the most vulnerable counties compared with the least vulnerable. Adjusted regression results confirm the strong relationship between social vulnerability and preventable hospitalizations. Our results suggest wide variation in community-level preventable hospitalization rates, with robust evidence that variation is strongly related to a community's social vulnerability. The human toll, societal cost, and preventability of these hospitalizations make understanding and mitigating these inequities a national priority.

Recovery and biological activity of filgrastim after injection through silicone rubber catheters.

The recovery and biological activity of filgrastim after injection through a silicone rubber catheter were studied. Various volumes of filgrastim injection 300 micrograms/mL (0.17, 0.34, 0.51, 0.68, 0.85, and 1.0 mL) were injected through silicone rubber catheters and collected in glass vials to simulate intravenous bolus injections. The catheters were flushed with 3 mL of 5% dextrose injection before and after the injections. For some catheters, the procedure was repeated to simulate the administration of a second filgrastim dose through the same catheter. The theoretical filgrastim concentration in the expelled fluid was 16.1, 30.5, 43.6, 55.4, 66.2, or 75.0 micrograms/mL (corresponding to the filgrastim injection volumes). Filgrastim concentrations in expelled fluid were measured with an enzyme-linked immunosorbent assay, and biological activity was measured with a mitogenic cell-culture assay. There was > or = 10% loss of filgrastim after the first injection when the injection volume was 0.17, 0.34, or 0.68 mL. Mean drug recovery after the second filgrastim injection exceeded that after the first for all six volumes and was > or = 90% for five volumes. The recovered filgrastim retained all of its activity. A > or = 10% loss of filgrastim occurred for three of six volumes after one injection through a silicon rubber catheter. Recovery was higher after a second injection through the same catheter. Biological activity was not affected.

Pharmacotherapy of preterm labor.

Preterm labor is defined as the onset of uterine contractions in a woman who has completed less than 37 weeks of pregnancy. It may be due to maternal, placental, fetal, or idiopathic causes, and it is associated with a number of risk factors. Nondrug measures such as bedrest and hydration have been used alone or in combination with drug therapy to treat the disorder. Pharmacologic (tocolytic) agents include ethanol, progesterone, indomethacin, nifedipine, beta-adrenergic agonists, and magnesium salts. The three most commonly used drugs are ritodrine, terbutaline, and magnesium.

Oral vancomycin-induced rash: case report and review of the literature.

Disseminated rash and pruritus are described in an 82-year-old woman with chronic renal failure following administration of oral vancomycin hydrochloride 125 mg q6h for the treatment of Clostridium difficile colitis. Renal function was estimated to be 0.27 mL/s based on a serum creatinine of 177 mumol/L. After eight days of therapy, she developed a slightly raised maculopapular rash on her legs and torso, which spread to her abdomen and arms with continued treatment. Vancomycin was discontinued and the patient was treated symptomatically. The rash cleared and did not recur. Rechallenge with vancomycin was not initiated. No other changes in medications or initiations of new medications occurred during the time of treatment with vancomycin. The patient denied any previous immunologically mediated reactions to medications. Maculopapular rash is rare secondary to vancomycin administration, particularly after oral administration. Although clinically significant serum concentrations can be obtained in patients treated with oral vancomycin who have concomitant C. difficile colitis and renal failure, there has not been a clear correlation between these concentrations and any reported adverse sequelae. This case supports the possible occurrence of a true allergic reaction secondary to low-dose oral vancomycin administration.

Relatedness and kin-structured migration in a founding population: Plymouth Colony, 1620-1633.

To test the common assumption of no genetic relationship in a founding population, we calculated average relatedness (r) for the emigrants to Plymouth Colony from Europe on seven voyages from 1620 to 1633. Of 355 individuals, 255 could be individually identified and 4 generations of genealogic depth accounted for. Mean r was 0.00399 (S.D. = 0.00395) and ranged from 0 for 76 individuals to 0.01574 for a single female. There was a strong sex difference in relatedness; 91 females had a mean r of 0.00557 (S.D. = 0.00428), and 161 males had a lower mean r of 0.00308 (S.D. = 0.00349) (t = 4.71, p less than 0.001). The major difference was in the lower proportion of females with no relations (n = 12, 13.2%) compared with males (n = 64, 39.8%) (t = 5.05; p less than 0.001). If relatedness is calculated only for those with relations, females still have a significantly higher mean r value (0.00641, S.D. = 0.00393) than males (0.00511, S.D. = 0.00312) (t = 2.38, p less than 0.05). Thus a higher proportion of females had relatives migrating to the colony, and relatedness is significantly higher among them. The majority of kin links (79.8%) were those within the nuclear family--parents, children or siblings. For the continuity of kin-structured migration, relatedness was highest among voyagers in the same boat load and lower between voyages, with no apparent time trend. The low relatedness value of the Plymouth migrants is a result of community history and recruitment practices for the new colony. For this European population average relatedness was approximately an order of magnitude below that of traditional groups, and the assumption of no genetic relationship is not unwarranted.

Geographic distribution of consanguinity in Europe.

Average consanguinity (alpha) of 20 large regional or national samples derived from Roman Catholic Dispensations or state archives shows a strong negative relationship with latitude (r = -0.738; P less than 0.001) which seems best explained by cultural-historical factors. Isolates show no such pattern and are more variable in their inbreeding levels. Two-way analysis of variance shows the sample division by population size to be significant, the division by geography to be not significant, with no significant interaction between the two factors. In a one-way analysis of variance only the mainstream samples showed significant geographic differences (P less than 0.001). There is no such geographic association in Japan which has greater cultural and historical homogeneity. The clinical patterning in average consanguinity may bias frequency estimates of rare alleles, including genetic disorders.

Application of the Kolmogorov-Smirnov test to seasonal phenomena may be inappropriate.

The Kolmogorov-Smirnov one-sample test is sometimes used to test seasonality in births or other annually cyclic phenomena. However, it is shown that the maximum deviation from expected (D) may differ by a factor of almost two if the cycle is initiated in different months. Thus, different results are possible from the same data. Unless there is a logical initiation point in a cycle, it is probably better to use other nonparametric statistical tests.

Age-specific variation in the secular trend for stature: a comparison of samples from industrialized and nonindustrialized regions.

Age-specific secular trend patterns for children in industrialized world regions have a regular pattern, beginning low at age 6 and increasing to a maximum at age 10 to 14, then declining. While magnitude differs, the patterns are ordinarily parallel, especially in the female samples. However, age-specific secular trend values for children from developing regions, or from areas of industrialized countries not benefitting substantially from development, are irregular in pattern and magnitude. Consequently, it is difficult to predict age at maximal secular change. We suggest that fluctuating environmental circumstances in these developing countries influence growth and, hence, the pattern of secular trend. As more stable environmental conditions relating to growth are present in the industrialized countries, this leads to more stable patterns of growth and age-specific patterns of secular change.

Secular trend for stature in adult male Yucatec Maya to 1968.

Statures for 64 adult male Yucatec Maya (18 + years old, sons of campesinos) were measured in 1968 and compared with mean statures presented in results for previous studies. There were no significant changes in mean stature since 1895. If the sample is divided into 5-year age groups, no secular trend is evident. Using osteological information from as early as the Late Preclassic, stature of adult Maya males has decreased 119 mm in a little more than 20 centuries (-0.06 cm/decade). Comparing the results with measurements from other Mesoamerican groups, only one--the Otomí--show evidence of significant secular change. It is possible that modern economic development schemes in Mesoamerica are too recent or ineffective to have had an effect on stature.

Experimenting With Perceptual Change Strategies.

Nonmetric multidimensional scaling procedures are employed in this experimental evaluation of perceptual changes resulting from differences in the presentation of information about stimuli. Longitudinal MDS techniques are found to be useful in monitoring perceptual changes produced by various communication alternatives. Communication strategies aimed at changing the relationships among stimuli are more effective than those designed to change the perceptual space structure. Furthermore, providing comparative information about groups of stimuli has more apparent impact than providing information about a single stimulus.