COVID-19 Vaccine Hesitancy Among Health Care Workers in Four Health Care Systems in Atlanta.

Coronavirus disease 2019 (COVID-19) vaccine hesitancy among health care workers (HCWs) undermines community vaccine confidence. Predictors and reasons for HCW hesitancy in the Atlanta region were evaluated using a survey between May and June 2021. Vaccine hesitancy was highest in younger and less educated HCWs. Interventions to address vaccine hesitancy in HCWs are necessary.

Clinical characteristics and social determinants of health associated with 30-day hospital readmissions of patients with COVID-19.

COVID-19 readmissions are associated with increased patient mortality and healthcare system strain. This retrospective cohort study of PCR-confirmed COVID-19 positive adults (>18 years) hospitalized and readmitted within 30 days of discharge from index admission was performed at eight Atlanta hospitals from March to December 2020. The objective was to describe COVID-19 patient-level demographics and clinical characteristics, and community-level social determinants of health (SDoH) that contribute to 30-day readmissions. Demographics, comorbidities, COVID-19 treatment, and discharge disposition data were extracted from the index admission. ZIP codes were linked to a demographic/lifestyle database interpolating to community-level SDoH. Of 7155 patients with COVID-19, 463 (6.5%) had 30-day, unplanned, all-cause hospital readmissions. Statistically significant differences were not found in readmissions stratified by age, sex, race, or ethnicity. Patients with a high-risk Charlson Comorbidity Index had higher odds of readmission (OR 4.8 (95% CI: 2.1 to 11.0)). Remdesivir treatment and intensive care unit (ICU) care were associated with lower odds of readmission (OR 0.5 (95% CI: 0.4 to 0.8) and OR 0.5 (95% CI: 0.4 to 0.7), respectively). Patients residing in communities with larger average household size were less likely to be readmitted (OR 0.7 (95% CI: 0.5 to 0.9). In this cohort, patients who received remdesivir, were cared for in an ICU, and resided in ZIP codes with higher proportions of residents with increased social support had lower odds of readmission. These patient-level factors and community-level SDoH may be used to identify patients with COVID-19 who are at increased risk of readmission.

Clinical, behavioural and social factors associated with racial disparities in COVID-19 patients from an integrated healthcare system in Georgia: a retrospective cohort study.

OBJECTIVES: To identify sociodemographic, clinical and behavioural drivers of racial disparities and their association with clinical outcomes among Kaiser Permanente Georgia (KPGA) members with COVID-19. DESIGN: Retrospective cohort of patients with COVID-19 seen from 3 March to 29 October 2020. We described the distribution of underlying comorbidities, quality of care metrics, demographic and social determinants of health (SDOH) indicators across race groups. We also described clinical outcomes in hospitalised patients including length of stay, intensive care unit (ICU) admission, readmission and mortality. We performed multivariable analyses for hospitalisation risk among all patients with COVID-19 and stratifyied by race and sex. SETTING: KPGA, an integrated healthcare system. PARTICIPANTS: 5712 patients who all had laboratory-confirmed COVID-19. Of them, 57.8% were female, 58.4% black, 29.5% white, 8.5% Hispanic and 3.6% Asian. RESULTS: Black patients had the highest proportions of living in neighborhoods under the federal poverty line (12.4%) and in more deprived locations (neighbourhood deprivation index=0.4). Overall, 14.4% (n=827) of this cohort was hospitalised. Asian patients had the highest rates of ICU admission (53.1%) and mechanical ventilation (21.9%). Among all patients, Hispanics (adjusted 1.60, 95% CI (1.08, 2.37)), blacks (1.43 (1.13, 1.83)), age in years (1.03 (1.02, 1.04)) and living in a zip code with high unemployment (1.08 (1.03, 1.13)) were associated with higher odds of hospitalisation. COVID-19 patients with chronic obstructive pulmonary disease (2.59 (1.67, 4.02)), chronic heart failure (1.79 (1.31, 2.45)), immunocompromised (1.77 (1.16, 2.70)), with glycated haemoglobin >8% (1.68 (1.19, 2.38)), depression (1.60 (1.24, 2.06)), hypertension (1.5 (1.21, 1.87)) and physical inactivity (1.25 (1.03, 1.51)) had higher odds of hospitalisation. CONCLUSIONS: Black and Hispanic KPGA patients were at higher odds of hospitalisation, but not mortality, compared with other race groups. Beyond previously reported sociodemographics and comorbidities, factors such as quality of care, lifestyle behaviours and SDOH indicators should be considered when designing and implementing interventions to reduce COVID-19 racial disparities.

Objective quantification of trochlear dysplasia: Assessment of the difference in morphology between control and chronic patellofemoral instability patients.

BACKGROUND: Trochlear dysplasia is an important risk factor associated with patellofemoral instability, but it remains difficult to classify with consistency. Currently there is no objective way to quantify the dysplasia. The purpose of this study is to define and quantify objectively the trochlear morphology by volume and length via computed tomography (CT). METHODS: One-hundred control patients (136 knees) were retrospectively reviewed and compared to 36 consecutive patients (72 knees) who were treated surgically for recurrent patellar instability and known trochlear dysplasia based on a lateral radiograph. Trochlear morphology was analyzed from a pre-operative CT and data presented as trochlear sulcus volume trochlear length. To determine where along the trochlear length dysplasia is most variable, the trochlear length was radiographically divided into thirds, volume was quantified along that section and compared to control trochlear. RESULTS: A significant difference in trochlear morphology exists between cohorts, volume (1.98 vs 3.77cm3) and length (31.97 vs 34.66mm) (p<0.05). However, there appears to be a gender based difference in trochlea morphology. The trochlea volumetric analysis between the female cohorts (L: 2.02cm3 vs. 2.94cm3, R: 1.95cm3 vs. 2.93cm3) demonstrated significantly less volume in instability patients (p<0.001). The proximal third of the trochlear contributed the majority of dysplasia difference determined by comparing mean trochlear volume, 95% of the difference. This difference decreased in distal sections, 53% and 32% respectively. CONCLUSION: This reproducible technique can be used to quantify the trochlea morphology, in order to describe the severity of a dysplasia.

Donor Site Morbidity After Anterior Iliac Bone Graft Harvesting.

OBJECTIVES: The objective of this study was to evaluate donor site morbidity associated with anterior iliac crest bone graft harvesting for orthopaedic trauma reconstructions. DESIGN: Retrospective case series. SETTING: Level 1 trauma center. PATIENTS: Forty-Six consecutive patients who had undergone anterior iliac crest bone graft harvesting more than a 7-year period were reviewed. INTERVENTION: Grafts were taken by removing the inner table of the ilium from 2 cm posterior to the Anterior Superior Iliac Spine. The abductor insertion was left intact and the external contour of the ilium remained unaffected. MAIN OUTCOME MEASURE: Visual analog scale and modified Questionnaires. RESULTS: Thirty-seven of the 46 patients were evaluated at average follow-up of 4.5 years after anterior iliac bone graft harvesting for nonunion or fusion for posttraumatic arthrosis. No patient complained of pain at final follow-up with all patients having a visual analog scale pain of 0 at final follow-up. Three patients reported some scar numbness, however, none complained of thigh numbness. Three patients, if they needed grafting in the future would seek alternative sources based on their remembrance of significant postoperative pain. CONCLUSIONS: Anterior inner table bone graft harvesting resulted in minimal morbidity and neither pain nor functional limitations at an average of 4.5 years. This technique has lower donor-site morbidity than previous reports of posterior graft sites. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

7,12-dimethylbenz(a)anthracene treatment of a c-rel mouse mammary tumor cell line induces epithelial to mesenchymal transition via activation of nuclear factor-kappaB.

The aberrant expression of the nuclear factor-kappaB (NF-kappaB) c-Rel subunit that occurs in many human breast cancers can play a causal role in tumorigenesis as judged by findings with a mouse mammary tumor virus (MMTV)-c-rel transgenic mouse model, in which 31.6% of mice developed one or more mammary tumors after a long latency. Interestingly, none of the cell lines established from the mammary tumors grew in soft agar. To begin to test the hypothesis that a prototypic carcinogen insult can promote a more invasive, mesenchymal phenotype, a cell line established from a MMTV-c-rel mammary tumor rel-3983 was treated in culture with the polycyclic aromatic hydrocarbon 7,12-dimethylbenz(a)anthracene (DMBA; rel-3983D cells) or DMSO vehicle (rel-3983V cells). Rel-3983D cells displayed an increased rate of proliferation, displayed growth to a higher cell density, and acquired the ability to grow in soft agar and in Matrigel compared with the parental rel-3983 or vehicle-treated rel-3983V cells. Consistent with a more mesenchymal phenotype, rel-3983D cells showed loss of E-cadherin expression as judged by immunofluorescence microscopy. Compared with control cells, rel-3983D displayed increased NF-kappaB binding and higher levels of the NF-kappaB transactivating subunits c-Rel, RelA, and RelB, which seemed functional as judged by induction of c-Myc and vimentin, products of two NF-kappaB target genes. Ectopic expression of a super repressor mutant of IkappaB-alpha reduced rel-3983D cell growth and invasive morphology in Matrigel, confirming the role of NF-kappaB in epithelial to mesenchymal transition (EMT). Thus, DMBA treatment of c-Rel-transformed mammary tumor cells in culture is shown here for the first time to result in EMT via activation of NF-kappaB. The aberrant c-Rel expression present in most human breast cancers suggests that this mechanism may play an important role in carcinogenesis.