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1.
J Nurs Adm ; 50(2): 61-62, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31977942

RESUMEN

In this Inspiration Column, Pat Reid Ponte interviews Lisa J. Sundean, PhD, MHA, RN, associate professor, University of Massachusetts Boston. Dr Sundean has devoted her career to support the inclusion of nurses on boards.


Asunto(s)
Consejo Directivo/organización & administración , Rol de la Enfermera , Atención de Enfermería/organización & administración , Boston , Femenino , Historia del Siglo XX , Historia del Siglo XXI , Humanos
2.
Environ Sci Technol ; 54(3): 1677-1686, 2020 02 04.
Artículo en Inglés | MEDLINE | ID: mdl-31934748

RESUMEN

Short-term exposure to ultrafine particles (UFP; <100 nm in diameter), which are present at high concentrations near busy roadways, is associated with markers of cardiovascular and respiratory disease risk. To date, few long-term studies (months to years) have been conducted due to the challenges of long-term exposure assignment. To address this, we modified hybrid land-use regression models of particle number concentrations (PNCs; a proxy for UFP) for two study areas in Boston (MA) by replacing the measured PNC term with an hourly model and adjusting for overprediction. The hourly PNC models used covariates for meteorology, traffic, and sulfur dioxide concentrations (a marker of secondary particle formation). We compared model performance against long-term PNC data collected continuously from 9 years before and up to 3 years after the model-development period. Model predictions captured the major temporal variations in the data and model performance remained relatively stable retrospectively and prospectively. The Pearson correlation of modeled versus measured hourly log-transformed PNC at a long-term monitoring site for 9 years prior was 0.74. Our results demonstrate that highly resolved spatial-temporal PNC models are capable of estimating ambient concentrations retrospectively and prospectively with generally good accuracy, giving us confidence in using these models in epidemiological studies.


Asunto(s)
Contaminantes Atmosféricos , Contaminación del Aire , Boston , Monitoreo del Ambiente , Tamaño de la Partícula , Material Particulado , Estudios Prospectivos , Estudios Retrospectivos , Emisiones de Vehículos
3.
Ann Otol Rhinol Laryngol ; 129(3): 238-244, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31640405

RESUMEN

OBJECTIVES: Evidence shows that scribes can improve provider efficiency and satisfaction in several settings, but is mixed on whether scribes improve patient satisfaction. We studied whether scribes improved patient satisfaction in an academic otolaryngology clinic. METHODS: The authors performed a retrospective review of patient responses to the Press Ganey survey between 12/2016 and 12/2017. Their responses about satisfaction with the provider and wait times were examined. Three providers worked with scribes during this year; each spent six months with a scribe and six without. The authors compared survey responses from periods with and without scribes using the Fischer exact test. Average overall provider ratings were compared using the Student's t-test. RESULTS: A total of 87 patients filled out Press Ganey surveys for the 3 providers over the year: 54 for visits without scribes, and 33 for visits with scribes. Fischer exact analysis demonstrated no significant difference in satisfaction with providers and wait times for both individual providers and all providers combined (all P > .05). There was also no difference in patients' likelihood of recommending the provider's office (P = .91). Overall provider rating (0-10 scale) was high without scribes (9.48 ± 1.06) and was unchanged by the presence of scribes (9.53 ± 0.8) (P = .97). CONCLUSION: Patient satisfaction with wait times and providers was high overall and was not affected by the presence of a medical scribe.


Asunto(s)
Documentación , Registros Electrónicos de Salud , Satisfacción del Paciente/estadística & datos numéricos , Instituciones de Atención Ambulatoria , Boston , Humanos , Relaciones Médico-Paciente , Estudios Retrospectivos , Encuestas y Cuestionarios , Factores de Tiempo
4.
Sci Total Environ ; 709: 136196, 2020 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-31887518

RESUMEN

Ecosystem services provided by urban forests are increasingly included in municipal-level responses to climate change. However, the ecosystem functions that generate these services, such as biomass carbon (C) uptake, can differ substantially from nearby rural forest. In particular, the scaled effect of canopy spatial configuration on tree growth in cities is uncertain, as is the scope for medium-term policy intervention. This study integrates high spatial resolution data on tree canopy and biomass in the city of Boston, Massachusetts, with local measurements of tree growth rates to estimate the magnitude and distribution of annual biomass C uptake. We further project C uptake, biomass, and canopy cover change to 2040 under alternative policy scenarios affecting the planting and preservation of urban trees. Our analysis shows that 85% of tree canopy area was within 10 m of an edge, indicating essentially open growing conditions. Using growth models accounting for canopy edge effects and growth context, Boston's current biomass C uptake may be approximately double (median 10.9 GgC yr-1, 0.5 MgC ha-1 yr-1) the estimates based on rural forest growth, much of it occurring in high-density residential areas. Total annual C uptake to long-term biomass storage was equivalent to <1% of estimated annual fossil CO2 emissions for the city. In built-up areas, reducing mortality in larger trees resulted in the highest predicted increase in canopy cover (+25%) and biomass C stocks (236 GgC) by 2040, while planting trees in available road margins resulted in the greatest predicted annual C uptake (7.1 GgC yr-1). This study highlights the importance of accounting for the altered ecosystem structure and function in urban areas in evaluating ecosystem services. Effective municipal climate responses should consider the substantial fraction of total services performed by trees in developed areas, which may produce strong but localized atmospheric C sinks.


Asunto(s)
Biomasa , Boston , Carbono , Ciudades , Bosques , Massachusetts , Árboles
5.
Ambio ; 49(1): 187-196, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31020610

RESUMEN

This paper documents the changes that followed large nutrient (N and P) and organic matter input reductions to a major metropolitan marine bay, Boston Harbor (USA). Before input reduction, its N and P inputs fell in the upper range of the < 1-> 300 gN m-2 year-1 and < 0.1-> 40 gP m-2 year-1 for coastal systems. Elevated nutrient and organic matter inputs are recognized causes of coastal eutrophication. Treatment upgrades and then diversion of its wastewater discharges offshore, lowered its N, P, and organic C inputs by 80-90%. The input decreases lowered its trophic status from hypereutrophic to eutrophic-mesotrophic. With the reversal of hypereutrophication, pelagic production and phytoplankton biomass decreased, and the nitrogen limitation relative to phosphorus limitation increased. Benthic metabolism and dissolved inorganic N fluxes decreased, and benthic-pelagic coupling was altered. Bottom-water dissolved oxygen, already at healthy levels, increased, and seagrass expanded. Coastal management requires that the changes, following the nutrient and organic matter input reductions implemented to address eutrophication, be understood. Boston Harbor's recovery, because its water column was vertically well mixed and marine, was more pronounced than in many other systems.


Asunto(s)
Eutrofización , Aguas Residuales , Boston , Monitoreo del Ambiente , Nitrógeno , Fósforo , Fitoplancton
6.
Medicine (Baltimore) ; 98(49): e17963, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31804307

RESUMEN

Renin angiotensin aldosterone system inhibitors (RAASi) and diuretics are among the most frequently prescribed anti-hypertensives. Individuals with chronic kidney disease (CKD) are particularly at risk for electrolyte disturbances and kidney injury but the appropriate use of lab monitoring following RAASi or diuretic initiation is uncertain in CKD.We describe the frequency and time interval of lab monitoring during initiation of RAASi and diuretics in CKD and assess whether close lab monitoring associates with one-year risk of emergency department (ED) visit or hospitalization.We evaluated an observational cohort of 8,217 individuals with stage 3-5 non-dialysis CKD newly prescribed a RAASi (52.3%) or diuretic (47.7%) from thirty-six primary care offices affiliated with Brigham and Women's Hospital and Massachusetts General Hospital between 2009 and 2011.Overall, 3306 (40.2%) individuals did not have pre-prescription labs done within 2 weeks, and 5957 (72.5%) did not have post-prescription labs done within 2 weeks which includes 524 (6.4%) individuals without post-prescription within 1 year. Close monitoring occurred in only 1547 (20.1%) and was more likely in individuals prescribed diuretics compared to RAASi (adjusted OR 1.39; 95%CI 1.20-1.62), with CKD stage 4,5 compared with stage 3 (adjusted OR 1.47; 95%CI 1.16-1.86) and with cardiovascular disease (adjusted OR 1.42; 95%CI 1.21-1.66). Close monitoring was not associated with decreased risk of ED visit or hospitalization.Close lab monitoring during initiation of RAASi or diuretics was more common in participants with cardiovascular disease and advanced CKD suggesting physicians selected high-risk individuals for close monitoring. As nearly 80% of individuals did not receive close lab monitoring there may be value in future research on electronic physician decision tools targeted at lab monitoring.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Pruebas de Función Renal/estadística & datos numéricos , Insuficiencia Renal Crónica/epidemiología , Anciano , Anciano de 80 o más Años , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/administración & dosificación , Antihipertensivos/efectos adversos , Boston , Comorbilidad , Diuréticos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Antagonistas de Receptores de Mineralocorticoides/uso terapéutico , Potasio/sangre , Sistema Renina-Angiotensina/efectos de los fármacos , Índice de Severidad de la Enfermedad , Factores Socioeconómicos
7.
Health Serv Res ; 54(6): 1203-1213, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31742687

RESUMEN

OBJECTIVE: To evaluate the impact of TEAM UP-an initiative that fully integrates behavioral health services into pediatric primary care in three Boston-area Community Health Centers (CHCs)-on health care utilization and costs. DATA SOURCES: 2014-2017 claims data on continuously enrolled children from a Massachusetts Medicaid managed care plan. STUDY DESIGN: We used a difference-in-difference approach with inverse probability of treatment weights to compare outcomes in children receiving primary care at TEAM UP CHCs versus comparison site CHCs, in the pre (2014-2016q2)- versus post (2016q3-2017)-intervention periods. Utilization outcomes included emergency department visits, inpatient admissions, primary care visits, and outpatient/professional visits (all cause and those with mental health (MH) diagnoses). Cost outcomes included total cost of care (inpatient, outpatient, professional, pharmacy). We further assessed differential effects by baseline MH diagnosis. PRINCIPAL FINDINGS: After 1.5 years, TEAM UP was associated with a relative increase in the rate of primary care visits (IRR = 1.15, 95% CI 1.04-1.27, or 115 additional visits/1000 patients/quarter), driven by children with a MH diagnosis at baseline. There was no significant change in avoidable health care utilization or cost. CONCLUSIONS: Expanding the TEAM UP behavioral health integration model to other sites has the potential to improve primary care engagement in low-income children with MH needs.


Asunto(s)
Prestación Integrada de Atención de Salud/economía , Costos de la Atención en Salud/estadística & datos numéricos , Hospitales Pediátricos/economía , Medicaid/economía , Medicaid/estadística & datos numéricos , Servicios de Salud Mental/economía , Atención Primaria de Salud/economía , Adolescente , Boston , Niño , Preescolar , Prestación Integrada de Atención de Salud/estadística & datos numéricos , Femenino , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , Servicios de Salud Mental/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Estudios Retrospectivos , Estados Unidos
8.
BMC Oral Health ; 19(1): 254, 2019 11 21.
Artículo en Inglés | MEDLINE | ID: mdl-31752793

RESUMEN

BACKGROUND: Although several studies assessed the prevalence of alveolar bone loss, the association with several risk factors has not been fully investigated. The aim of this article is to measure the prevalence of periodontitis by calculating the mean alveolar bone loss/level of posterior teeth using bitewing radiographs among the patients enrolled in the clinics at Harvard School of Dental Medicine and address risk factors associated with the disease. METHODS: One thousand one hundred thirty-one patients were selected for radiographic analysis to calculate the mean alveolar bone loss/level by measuring the distance between the cementoenamel junction and the alveolar bone crest on the mesial and distal surfaces of posterior teeth. Linear regression with Multi-level mixed-effect model was used for statistical analysis adjusting for age, sex, race, median household income, and other variables. RESULTS: Mean alveolar bone level of the whole sample was 1.30 mm (±0.006). Overall periodontitis prevalence for the sample was 55.5% (±1.4%). Moderate periodontitis prevalence was 20.7% (±1.2%), while 2.8% (±0.5%) of the whole sample had severe periodontitis. Adjusted mean alveolar bone loss was higher in older age groups, males, Asian race group, ever smokers, and patients with low median household income. CONCLUSION: The effect of high household income on the amount of bone loss can be powerful to the degree that high household income can influence outcomes even for individuals who had higher risks of developing the disease. Public health professionals and clinicians need to collaborate with policy makers to achieve and sustain high quality of healthcare for everyone.


Asunto(s)
Pérdida de Hueso Alveolar , Periodontitis , Anciano , Pérdida de Hueso Alveolar/etiología , Proceso Alveolar , Boston/epidemiología , Atención Odontológica , Femenino , Humanos , Masculino , Periodontitis/complicaciones , Periodontitis/epidemiología , Prevalencia
9.
Water Res ; 167: 115134, 2019 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-31581037

RESUMEN

Development of sustainable and resilient water infrastructure is an urgent challenge for urban areas to secure long-term water availability and mitigate negative impacts of water consumption and urban development. A hybrid system that combines centralized water infrastructure and household decentralized water facilities, including rainwater harvesting and greywater recycling, may be a solution to more sustainable and resilient water management in urban areas. Understanding household and community preferences for decentralized water facilities is important to inform the design and ultimately the promotion and adoption of such systems. In this study, we conducted a discrete choice experiment, via Amazon Mechanical Turk, to collect data on household choices of different decentralized water facility designs in two U.S. cities, Atlanta, Georgia and Boston, Massachusetts. Based on the responses to the choice experiment, we then developed a latent-class choice model to predict households' preferences of decentralized system design features and examine the influence of socioeconomic and personal characteristics on heterogeneous class membership. We identified six major classes of preferences in Atlanta and Boston, respectively, and evaluated how readily each class is likely to choose a decentralized water facility. Atlanta and Boston have some classes sharing similar preferences for decentralized water systems, but the socioeconomic and personal characteristics of these classes in the two cities are different. We found that the early adoption of decentralized water facilities is positively related to neighbors' adoptions and pressure of water scarcity increases households' willingness to share a decentralized facility. The visualization of spatial distribution of the classes highlighted early demand of decentralized water facilities is likely to emerge in low-property-value communities, which creates a unique opportunity for introducing decentralized water facilities during water infrastructure renovations. Our study provides a framework through citizen engagement to understand social demand and to inform the promotion of decentralized water facilities.


Asunto(s)
Abastecimiento de Agua , Agua , Boston , Ciudades , Georgia , Massachusetts
10.
Mar Pollut Bull ; 145: 96-104, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31590839

RESUMEN

Coastal water clarity varies at high temporal and spatial scales due to weather, climate, and human activity along coastlines. Systematic observations are crucial to assessing the impact of water clarity change on aquatic habitats. In this study, Secchi disk depths (ZSD) from Boston Harbor, Buzzards Bay, Cape Cod Bay, and Narragansett Bay water quality monitoring organizations were compiled to validate ZSD derived from Landsat 8 (L8) imagery, and to generate high spatial resolution ZSD maps. From 58 L8 images, acceptable agreement was found between in situ and L8 ZSD in Buzzards Bay (N = 42, RMSE = 0.96 m, MAPD = 28%), Cape Cod Bay (N = 11, RMSE = 0.62 m, MAPD = 10%), and Narragansett Bay (N = 8, RMSE = 0.59 m, MAPD = 26%). This work demonstrates the value of merging in situ ZSD with high spatial resolution remote sensing estimates for improved coastal water quality monitoring.


Asunto(s)
Monitoreo del Ambiente/métodos , Imágenes Satelitales , Agua de Mar/análisis , Contaminación del Agua/análisis , Calidad del Agua , Boston , Ecosistema
11.
Artículo en Inglés | MEDLINE | ID: mdl-31590322

RESUMEN

Gulf War Illness (GWI) is a chronic multi-symptom disorder affecting the central nervous system (CNS), immune and gastrointestinal (GI) systems of Gulf War veterans (GWV). We assessed the relationships between GWI, GI symptoms, gut microbiome and inflammatory markers in GWV from the Boston Gulf War Illness Consortium (GWIC). Three groups of GWIC veterans were recruited in this pilot study; GWV without GWI and no gastrointestinal symptoms (controls), GWV with GWI and no gastrointestinal symptoms (GWI-GI), GWV with GWI who reported gastrointestinal symptoms (GW+GI). Here we report on a subset of the first thirteen stool samples analyzed. Results showed significantly different gut microbiome patterns among the three groups and within the GWI +/-GI groups. Specifically, GW controls had a greater abundance of firmicutes and the GWI+GI group had a greater abundance of the phyla bacteroidetes, actinobacteria, euryarchaeota, and proteobacteria as well as higher abundances of the families Bacteroidaceae, Erysipelotrichaceae, and Bifidobacteriaceae. The GWI+GI group also showed greater plasma levels of the inflammatory cytokine TNF-RI and they endorsed significantly more chemical weapons exposure during the war and reported significantly greater chronic pain, fatigue and sleep difficulties than the other groups. Studies with larger samples sizes are needed to confirm these initial findings.


Asunto(s)
Microbioma Gastrointestinal/fisiología , Síndrome del Golfo Pérsico/microbiología , Veteranos , Adulto , Anciano , Biomarcadores , Boston , Citocinas/sangre , Heces/microbiología , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto
12.
Pediatrics ; 144(4)2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31501233

RESUMEN

BACKGROUND AND OBJECTIVES: Food insecurity and pediatric obesity affect young children. We examine how food insecurity relates to obesity, underweight, stunting, health, and development among children <4 years of age. METHODS: Caregivers of young children participated in a cross-sectional survey at medical centers in 5 US cities. Inclusion criteria were age of <48 months. Exclusion criteria were severely ill or injured and private health insurance. The Household Food Security Survey Module defined 3 exposure groups: food secure, household food insecure and child food secure, and household food insecure and child food insecure. Dependent measures were obesity (weight-age >90th percentile), underweight (weight-age <5th percentile), stunting (height/length-age <5th percentile), and caregiver-reported child health and developmental risk. Multivariable logistic regression analyses, adjusted for demographic confounders, maternal BMI, and food assistance program participation examined relations between exposure groups and dependent variables, with age-stratification: 0 to 12, 13 to 24, 25 to 36, and 37 to 48 months of age. RESULTS: Within this multiethnic sample (N = 28 184 children, 50% non-Hispanic African American, 34% Hispanic, 14% non-Hispanic white), 27% were household food insecure. With 1 exception at 25 to 36 months, neither household nor child food insecurity were associated with obesity, underweight, or stunting, but both were associated with increased odds of fair or poor health and developmental risk at multiple ages. CONCLUSIONS: Among children <4 years of age, food insecurity is associated with fair or poor health and developmental risk, not with anthropometry. Findings support American Academy of Pediatrics recommendations for food insecurity screening and referrals to help families cope with economic hardships and associated stressors.


Asunto(s)
Desarrollo Infantil , Abastecimiento de Alimentos/estadística & datos numéricos , Trastornos del Crecimiento/epidemiología , Estado de Salud , Obesidad Pediátrica/epidemiología , Delgadez/epidemiología , Afroamericanos/estadística & datos numéricos , Factores de Edad , Arkansas/epidemiología , Baltimore/epidemiología , Boston/epidemiología , Cuidadores/estadística & datos numéricos , Preescolar , Estudios Transversales , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Minnesota/epidemiología , Encuestas Nutricionales , Philadelphia/epidemiología , Pobreza , Análisis de Regresión
13.
J Pediatr Orthop ; 39(9): e647-e651, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31503219

RESUMEN

BACKGROUND: Incarcerated medial epicondyle fractures in association with elbow trauma are rare and an absolute indication for intervention. Because of the infrequent nature, outcomes following this injury are not well documented. We studied a large cohort of these injuries to determine factors associated with functional outcomes. It was hypothesized that a greater duration between initial presentation and time of surgery would lead to poorer outcomes. METHODS: A total of 32 patients aged 18 and under who underwent surgical treatment for an incarcerated medical epicondyle fracture at a level-1 pediatric trauma center from 2003 to 2015 were identified. All patients had a confirmed diagnosis of an incarcerated medial epicondyle at surgery. Medical records and radiographs were reviewed to determine the patient demographics, mechanism of injury, preoperative neurological symptoms, time of primary presentation, time of elbow reduction, and time to surgical intervention. Postoperative outcomes, including pain, range of motion, and ulnar nerve symptoms, were also collected. The Roberts outcome score was determined for each subject. RESULTS: A radiographically confirmed elbow dislocation was identified in 25 subjects. The mean age at injury was 13.2 years (range, 7.3 to 17.8 y). Initial presentation was at a referring institution in 30 patients (94%). First closed reduction attempt of the ulnohumeral joint occurred in the emergency room in 24 subjects (75%); of these 7 subjects (22%) had a first reduction attempted in the emergency room at our institution, 2 patients experienced first elbow reduction during surgical intervention. The median time from first presentation to surgery was 21.9 hours (interquartile range, 15 to 40). Fourteen subjects displayed preoperative ulnar nerve symptoms. Of these, 9 subsequently reported postoperative ulnar nerve symptoms. There was no effect of time to surgical intervention on the Roberts outcome scores at follow-up, nerve symptoms, symptomatic hardware, or need for second surgery to remove hardware. There were 16 subjects with excellent outcomes, 13 with good outcomes, 3 with fair outcomes, and 0 with poor outcomes (based on the Roberts criteria). CONCLUSIONS: Incarcerated medial epicondyle fractures are commonly associated with ulnar nerve symptoms; however, they are not associated with a significant rate of other complications. There was no increased risk of complications in subjects who had a longer duration between initial presentation and surgery. This suggests that, while the presence of an incarcerated medial epicondyle fracture is certainly an indication for timely operative intervention; the injury in isolation does not need to be considered emergent. Other factors including neurovascular status and ability to achieve joint reduction may still necessitate emergency operative care. LEVEL OF EVIDENCE: Level IV-therapeutic study, case series.


Asunto(s)
Articulación del Codo/lesiones , Fracturas del Húmero/rehabilitación , Complicaciones Posoperatorias/epidemiología , Adolescente , Boston/epidemiología , Niño , Codo/lesiones , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/patología , Articulación del Codo/cirugía , Femenino , Fijación Interna de Fracturas , Humanos , Fracturas del Húmero/epidemiología , Fracturas del Húmero/patología , Fracturas del Húmero/cirugía , Luxaciones Articulares/cirugía , Masculino , Morbilidad , Radiografía , Rango del Movimiento Articular , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Nervio Cubital , Neuropatías Cubitales/epidemiología
14.
Bone Joint J ; 101-B(9): 1081-1086, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31474135

RESUMEN

AIMS: The practice of alternating operating theatres has long been used to reduce surgeon idle time between cases. However, concerns have been raised as to the safety of this practice. We assessed the payments and outcomes of total knee arthroplasty (TKA) performed during overlapping and nonoverlapping days, also comparing the total number of the surgeon's cases and the total time spent in the operating theatre per day. MATERIALS AND METHODS: A retrospective analysis was performed on the Centers for Medicare & Medicaid Services (CMS) Limited Data Set (LDS) on all primary elective TKAs performed at the New England Baptist Hospital between January 2013 and June 2016. Using theatre records, episodes were categorized into days where a surgeon performed overlapping and nonoverlapping lists. Clinical outcomes, economic outcomes, and demographic factors were calculated. A regression model controlling for the patient-specific factors was used to compare groups. Total orthopaedic cases and aggregate time spent operating (time between skin incision and closure) were also compared. RESULTS: A total of 3633 TKAs were performed (1782 on nonoverlapping days; 1851 on overlapping days). There were no differences between the two groups for length of inpatient stay, payments, mortality, emergency room visits, or readmission during the 90-day postoperative period. The overlapping group had 0.74 fewer skilled nursing days (95% confidence interval (CI) -0.26 to -1.22; p < 0.01), and 0.66 more home health visits (95% CI 0.14 to 1.18; p = 0.01) than the nonoverlapping group. On overlapping days, surgeons performed more cases per day (5.01 vs 3.76; p < 0.001) and spent more time operating (484.55 minutes vs 357.17 minutes; p < 0.001) than on nonoverlapping days. CONCLUSION: The study shows that the practice of alternating operating theatres for TKA has no adverse effect on the clinical outcome or economic utilization variables measured. Furthermore, there is opportunity to increase productivity with alternating theatres as surgeons with overlapping cases perform more cases and spend more time operating per day. Cite this article: Bone Joint J 2019;101-B:1081-1086.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Quirófanos/estadística & datos numéricos , Tempo Operativo , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/economía , Boston/epidemiología , Bases de Datos Factuales/estadística & datos numéricos , Eficiencia Organizacional/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/economía , Femenino , Humanos , Tiempo de Internación , Masculino , Medicare/estadística & datos numéricos , Persona de Mediana Edad , Quirófanos/organización & administración , Estudios Retrospectivos , Factores de Tiempo , Estados Unidos/epidemiología
15.
J Allied Health ; 48(3): 181-187, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31487356

RESUMEN

BACKGROUND: A decline in empathy has been demonstrated in college students over a 30-year period. While higher empathy levels have been measured in healthcare students vs non-healthcare students, reports show a disheartening decrease in student empathy scores over the course of professional healthcare education. OBJECTIVE: The purpose of this study was to assess self-reported empathy in students at two Doctor of Physical Therapy (DPT) programs, one of which used problem-based learning pedagogy while the other used a more traditional didactic teaching method. METHODS: This was a cross-sectional study of cohorts of students enrolled at two DPT programs between June 2016 and January 2017. Empathy levels were measured using the Jefferson Scale of Empathy-Health Professions Student version (JSE-HPS) at the start of each year in their DPT education. Demographic factors of gender and age were also examined. RESULTS: The majority of respondents were female (243/304) with an even distribution of respondents per year of educational experience. There was no significant difference in levels of empathy when comparing the cohorts of students from the two pedagogically different DPT programs. Females demonstrated higher levels of empathy than males. There was a greater level of empathy in third-year students than first-year students in both programs. CONCLUSION: No differences were found in empathy levels between students from two pedagogically different institutions. As empathy is correlated with improved patient outcomes and patient satisfaction, endeavors to understand, document, and increase students' empathy levels should be investigated.


Asunto(s)
Educación de Postgrado , Empatía , Modalidades de Fisioterapia/educación , Estudiantes del Área de la Salud/psicología , Adolescente , Adulto , Boston , Estudios Transversales , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Adulto Joven
16.
Int J Med Inform ; 130: 103938, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31442847

RESUMEN

OBJECTIVE: To assess the role of speech recognition (SR) technology in clinicians' documentation workflows by examining use of, experience with and opinions about this technology. MATERIALS AND METHODS: We distributed a survey in 2016-2017 to 1731 clinician SR users at two large medical centers in Boston, Massachusetts and Aurora, Colorado. The survey asked about demographic and clinical characteristics, SR use and preferences, perceived accuracy, efficiency, and usability of SR, and overall satisfaction. Associations between outcomes (e.g., satisfaction) and factors (e.g., error prevalence) were measured using ordinal logistic regression. RESULTS: Most respondents (65.3%) had used their SR system for under one year. 75.5% of respondents estimated seeing 10 or fewer errors per dictation, but 19.6% estimated half or more of errors were clinically significant. Although 29.4% of respondents did not include SR among their preferred documentation methods, 78.8% were satisfied with SR, and 77.2% agreed that SR improves efficiency. Satisfaction was associated positively with efficiency and negatively with error prevalence and editing time. Respondents were interested in further training about using SR effectively but expressed concerns regarding software reliability, editing and workflow. DISCUSSION: Compared to other documentation methods (e.g., scribes, templates, typing, traditional dictation), SR has emerged as an effective solution, overcoming limitations inherent in other options and potentially improving efficiency while preserving documentation quality. CONCLUSION: While concerns about SR usability and accuracy persist, clinicians expressed positive opinions about its impact on workflow and efficiency. Faster and better approaches are needed for clinical documentation, and SR is likely to play an important role going forward.


Asunto(s)
Documentación/métodos , Registros Electrónicos de Salud/estadística & datos numéricos , Registros Electrónicos de Salud/normas , Personal de Salud/estadística & datos numéricos , Errores Médicos/estadística & datos numéricos , Software de Reconocimiento del Habla/estadística & datos numéricos , Habla/fisiología , Adulto , Anciano , Boston , Femenino , Humanos , Masculino , Persona de Mediana Edad , Percepción , Encuestas y Cuestionarios , Flujo de Trabajo
17.
Res Q Exerc Sport ; 90(4): 578-588, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31430227

RESUMEN

Purpose: The purpose of this study was to examine whether structured physical activity (PA) in a family-based community exercise program affects PA of young children and parents. Method: Twenty-two children (mean ± SD; age, 4.9 ± 2.1 years) and their parents (age, 34.3 ± 7.6 years) participated in unstructured PA sessions followed by either short- or long-duration structured PA sessions, while wearing an ActiGraph GT9X activity monitor on their right hip to estimate PA. Independent t-tests compared children's and parents' PA during short- and long-structured PA sessions. Paired t-tests compared short- versus long-structured PA sessions. A mixed model ANOVA compared PA during unstructured versus structured sessions and between children and parents. Results: Children spent proportionately more time in moderate-to-vigorous PA (MVPA) and had higher accelerometer counts/min than parents during short-structured PA (children:60.9 ± 18.8% vs. parents:17.7 ± 6.8%, children:3870 ± 742 vs. parents:1836 ± 556 counts/min, p < .05) and long-structured PA (children:61.1 ± 20.1% vs. parents:12.6 ± 4.9%, children:3415 ± 758 vs. parents:1604 ± 633 counts/min, p < .05). No statistical differences were found between short- and long-structured PA sessions for proportion of time spent in MVPA or counts/min for children or parents (all, p > .05). Children spent proportionally more time in MVPA and had higher counts/min during unstructured PA compared to structured PA (unstructured MVPA:54.4 ± 3.9% vs. structured MVPA:38.2 ± 4.2%, unstructured counts/min:3830 ± 222 vs. structured counts/min:2768 ± 239 counts/min; p < .05). Conclusions: Children were more active than parents during both the unstructured and structured PA sessions. However, unstructured PA sessions resulted in 63-77% and 10-11% of PA recommendations for children and adults, respectively. Family-based exercise programming can provide an opportunity for children and their parents to attain MVPA during the week.


Asunto(s)
Ejercicio , Relaciones Padres-Hijo , Acelerometría/instrumentación , Adulto , Boston , Niño , Preescolar , Femenino , Monitores de Ejercicio , Humanos , Masculino , Evaluación de Programas y Proyectos de Salud , Conducta Sedentaria , Factores de Tiempo
18.
Environ Int ; 131: 104903, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31288179

RESUMEN

BACKGROUND: Maternal exposure to environmental phenols is common in pregnancy and has been linked to preterm birth, preeclampsia, and reduced fetal growth. One potential mechanism may be through increased maternal oxidative stress. OBJECTIVE: We examined the associations between a panel of 10 urinary phenols, including dichlorophenols, benzophenone-3, parabens, triclosan and triclocarban, and bisphenol-S, and two urinary oxidative stress biomarkers, 8-hydroxydeoxyguanosine (8-OHdG) and 8-isoprostane. All exposure and outcome biomarkers were measured at 4 time points in pregnancy. METHODS: We used repeated measures models to examine the association between repeated exposure and outcome biomarkers. Additionally, we used adaptive elastic net (AENET) to identify non-null associations accounting for the correlation structure of exposures, both for phenols and urinary phthalate metabolites that were previously associated with the oxidative stress biomarkers in our study population. RESULTS: In adjusted repeated measures models, we observed that dichlorophenols, benzophenone-3, triclosan, and some parabens were associated with increases in both oxidative stress biomarkers. The greatest effect estimates were observed for 2,5-dichlorophenol; an interquartile range (IQR) increase in this compound was associated with a 15.2% (95% confidence interval [CI] = 11.0, 19.6) increase in 8-OHdG and a 16.7% (95% CI = 9.66, 24.2) increase in 8-isoprostane. Bisphenol-S detection was associated with a clear increase in 8-isoprostane (18.5%, 95% CI = 7.68, 30.5) but a more modest increase in 8-OHdG (6.18%, 95% CI = -0.27, 13.1). However, AENET models did not consistently select any of the phenols as predictors of 8-OHdG or 8-isoprostane when phthalate metabolites were included in the model. CONCLUSION: Overall, urinary phenols were associated with increases in biomarkers of oxidative stress in pregnancy but either to a lesser extent, or due to correlation with, urinary phthalate metabolites.


Asunto(s)
/orina , Dinoprost/análogos & derivados , Exposición Materna , Estrés Oxidativo , Fenoles/orina , Ácidos Ftálicos/orina , Adulto , Biomarcadores/orina , Boston , Dinoprost/orina , Femenino , Humanos , Embarazo , Estudios Prospectivos , Análisis de Regresión , Adulto Joven
19.
Environ Sci Technol ; 53(15): 8957-8966, 2019 Aug 06.
Artículo en Inglés | MEDLINE | ID: mdl-31265266

RESUMEN

Simulation of the planetary boundary layer (PBL) is key for forecasting air quality and estimating greenhouse gas (GHG) emissions in cities. Here we conducted the first long-term and continuous study of PBL heights (PBLHs) in Boston, MA, using a compact lidar instrument. We developed an image recognition algorithm to estimate PBLHs from the lidar measurements and evaluated simulations of the PBL from seven numerical weather prediction (NWP) model versions, which showed different systematic errors and variability in simulating the PBLHs (discrepancies from -2.5 to 4.0 km). The NWP model with the best overall agreement for the fully developed PBL had R2 = 0.72 and a bias of only 0.128 km. However, this model predicted a notable number of anomalously high carbon dioxide concentrations at ground stations, because it occasionally significantly underestimated the PBLH. We also developed a novel method that combines lidar data with footprints from a Lagrangian particle dispersion model to identify long-range transport of air pollution in the nocturnal residual layer. Our framework was powerful in evaluating the performance of models used to estimate air pollution and GHG emissions in cities, which is critical to track progress on emission reduction targets and guide effective policies.


Asunto(s)
Contaminantes Atmosféricos , Contaminación del Aire , Gases de Efecto Invernadero , Boston , Ciudades , Monitoreo del Ambiente , Modelos Teóricos
20.
Sleep Health ; 5(5): 487-494, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31358470

RESUMEN

OBJECTIVES: Many do not sleep well, particularly middle-aged and older adults. Physical activity (PA) shows promise for improving sleep; however, populations with clinical sleep disturbances have been a research focus. It remains unclear whether low-impact daily PA, like walking, can affect sleep in healthy adults. DESIGN: The current study was embedded within a 4-week randomized controlled trial to increase PA. SETTING: Participants from the greater Boston area were recruited to participate in a 4-week walking intervention on a rolling basis between October 2015 and August 2016. PARTICIPANTS: Fifty-nine participants (72% female) were enrolled in the study, with an average age of 49.43 (±8.40) years. INTERVENTION: The 4-week intervention was aimed at increasing participants' daily steps as the primary outcome. The current, supplementary study examined relationships between monthly and daily PA and sleep. MEASUREMENTS: Steps and active minutes were measured daily using a Fitbit Zip. Self-reports of sleep quality and duration were assessed daily, along with before and after the intervention. RESULTS AND CONCLUSIONS: Averaged across the month, daily active minutes were positively related to sleep quality but not duration. Sex moderated this relationship; women who took more steps and were more active reported sleeping better than those less active. Within persons, on days that participants were more active than average, they reported better sleep quality and duration in both sexes. Results suggest that low-impact PA is positively related to sleep, more so in women than men. Findings also showed that PA plays a greater role in predicting sleep quality than duration.


Asunto(s)
Sueño/fisiología , Caminata/fisiología , Adulto , Boston , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo
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