Cash transfers as a response to COVID-19: Experimental evidence from Kenya.

We deliver one month's average profit to a randomly selected group of female microenterprise owners in Dandora, Kenya, arriving just in advance of an exponential growth in COVID-19 cases. Relative to a control group, firms recoup about one third of their initial decline in profit, and food expenditures increase. Control profit responds to economic conditions and government announcements during our study period, and treatment effects are largest when control profit is at its lowest. PPE spending and precautionary management practices increase to mitigate the health risks of more intensive firm operation, but only among those who perceive COVID-19 as a major risk.

Prison-Based Interventions for Early Adults with Mental Health Needs: A Systematic Review.

Rates of mental health needs of incarcerated young adults (15-35 year olds) are concerning, however, mental health interventions targeting this population are under studied. This article systematically reviews published, peer-reviewed research in nine databases pertaining to mental health interventions for incarcerated young adults. Only original studies conducted in the United States and determined to be valid though NIH assessment tools were included in this analysis. The review includes 19 original studies testing 14 intervention programs exploring mental health outcomes such as depression, PTSD, self-harm, and bipolar symptoms. Overall, findings were mixed about the impact of reviewed programs. The variety of interventions, outcomes, study settings, and implementation procedures complicates the ability to determine the impact of mental health programming in carceral settings. This review also reveals the lack of depth and replication of research in this area. Findings suggest additional efforts are needed to establish efficacy and best practices when treating mental health needs among this population.

The Factors that Motivate Law Enforcement's Use of Force: A Systematic Review.

Media attention relevant to law enforcement use of force in the last decade finally alerted the scientific community to the need for more research regarding law enforcement discretion and decision making. The purpose of this study was to synthesize the existing literature to explore the motivating factors for law enforcement use of force. This study will utilize a social-ecological framework to systematically examine factors that impact officer decisions to use force at the individual and community levels. The paper includes recommendations for research and practice through an equity lens that highlights the disparate use of force against men of color in particular. Interventions, trainings, education, and research to stop the promotion of perceived safety over justice will be highlighted.

Parathyroid Computed Tomography Angiography: Early Experience with a Novel Imaging Technique in Primary Hyperparathyroidism.

OBJECTIVES: To describe parathyroid computed tomography angiography (PCTA), determine its accuracy, and, as a secondary objective, calculate its mean radiation dosimetry. STUDY DESIGN: Retrospective chart review of patients who underwent parathyroidectomy for primary hyperparathyroidism from 2007 to 2015. SETTING: Single-center tertiary care academic military hospital. SUBJECTS AND METHODS: PCTA is a 2-phase computed tomography imaging technique that uses individualized timing of contrast infusion and novel patient positioning to accurately identify parathyroid adenomas. Consecutive patients who underwent parathyroidectomy for primary hyperparathyroidism from 2007 to 2015 were reviewed; 55% of patients were women. The mean age was 50.9 years (range, 26-68 years). Sensitivity and specificity were calculated as well as mean radiation dosimetry and timing of contrast. RESULTS: A total of 108 procedures were performed during the study period. Twenty-one patients undergoing 22 PCTAs after prior sestamibi scans were nonlocalizing or equivocal. In this group, there were 15 true-positive, 3 false-positive, 4 true-negative, and 0 false-negative PCTAs. This represents a sensitivity of 100% (95% CI, 74.7%-100%) and a specificity of 57% (95% CI, 20%-88%). The mean calculated radiation dose was 5.15 mSv. In the most recent studies, a mean dose of 4.1 mSv was calculated. The ideal time of image acquisition contrast administration varied from 20 to 30 seconds after contrast infusion. CONCLUSIONS: PCTA is a new technique in anatomic imaging for hyperparathyroidism. In a single-center, single-radiologist retrospective study, it demonstrates excellent accuracy for patients with parathyroid adenomas that are otherwise difficult to localize preoperatively. Preliminary experience suggests that its use may be indicated as a primary imaging modality in the future.

African American Patient Preferences for Glaucoma Education.

PURPOSE: The objectives of the study were to examine (a) the types of questions that African American patients have about glaucoma for their providers and (b) how patients' sociodemographic characteristics are associated with where and from whom they would like to learn about glaucoma and glaucoma medications. METHODS: Forty-nine adult African American patients with glaucoma were recruited at a private ophthalmology clinic where they completed a questionnaire for this cross-sectional study. RESULTS: African American patients had a mean of 3.9 questions for their ophthalmologists; the questions that patients checked as having most often were "What is my prognosis with glaucoma?" (49%) and "What is my intraocular pressure?" (45%). Seventy-six percent of patients preferred that an educational program about glaucoma be offered at the doctor's office and 39% preferred it be offered at a community or senior citizen center. Ninety percent said that the education program should be offered by doctors. Patients under the age of 70 were significantly more likely to want a program on the Internet than patients age 70 and over (Pearson χ = 4.7, P = .03). If an educational program was developed patients reported being most interested in the following topics, glaucoma medications (84%), what is glaucoma and what does it mean to have it? (83%). CONCLUSIONS: African American patients have many questions about glaucoma for their eye care providers. African American patients would prefer glaucoma educational programs be offered at their provider's office. Our findings could be used to develop educational programs for African American patients with glaucoma.

Emergency department clinical redesign, team-based care and improvements in hospital performance: A time series analysis.

OBJECTIVE: The objective was to evaluate the impact of an ED clinical redesign project that involved team-based care and early senior assessment on hospital performance. METHODS: This was an interrupted time series analysis performed using daily hospital performance data 6 months before and 8 months after the implementation of the clinical redesign intervention that involved Emergency Consultant-led team-based care, redistribution of ED beds and implementation of a senior nursing coordination roles in the ED. The primary outcome was the daily National Emergency Access Target (NEAT) performance (proportion of total daily ED presentations that were admitted to an inpatient ward or discharged from ED within 4 h of arrival). Secondary outcomes were daily ALOS in ED, inpatient Clinical Emergency Response System (CERS) calls and hospital mortality. Autoregressive Integrated Moving Average analysis was used to model NEAT performance. Hospital mortality was modelled using negative binomial regression. RESULTS: After adjusting for patient volume, inpatient admissions, ambulance, hospital occupancy, weekends ED Consultant numbers, weekends and underlying trends, there was a 17% improvement in NEAT associated with the post-intervention period (95% CI 12, 19% P < 0.001). There was no change in the number of CERS calls and the median daily hospital mortality rate reduced from 1.04% to 0.96% (P = 0.025). CONCLUSION: An ED-focused clinical redesign project was associated with a 17% improvement in NEAT performance with no evidence of an increase in clinical deterioration on inpatient wards and evidence for an improvement in hospital mortality.

Using Pharmacies in a Structural Intervention to Distribute Low Dead Space Syringes to Reduce HIV and HCV Transmission in People Who Inject Drugs.

Ongoing injection drug use contributes to the HIV and HCV epidemics in people who inject drugs. In many places, pharmacies are the primary source of sterile syringes for people who inject drugs; thus, pharmacies provide a viable public health service that reduces blood-borne disease transmission. Replacing the supply of high dead space syringes with low dead space syringes could have far-reaching benefits that include further prevention of disease transmission in people who inject drugs and reductions in dosing inaccuracies, medication errors, and medication waste in patients who use syringes. We explored using pharmacies in a structural intervention to increase the uptake of low dead space syringes as part of a comprehensive strategy to reverse these epidemics.

Engagement in outpatient care for persons living with HIV in the United States.

Prior studies that have assessed engagement within the various stages of care for persons living with HIV (PLWH) studied patients receiving care in HIV medical care facilities. These data are not representative of care received throughout the United States, as not all PLWH receive care in HIV clinics. This study evaluated engagement in outpatient care and healthcare utilization for PLWH, beyond facilities that specialize in HIV. Cross-sectional data were from the 2009-2010 National Hospital Ambulatory Medical Care Survey. Levels of care included receiving any care, receiving HIV-related care, established in care, engaged in care, and prescribed antiretroviral therapy (ARV). Factors associated with ARV prescription were determined by logistic regression. We analyzed data for ∼2.6 million outpatient clinic visits for PLWH. Of these, 90% were receiving HIV-related care, 86% were established in care, 75% were engaged in care, and 65% were prescribed ARV. In stratified analysis, the proportion of PWLH who were engaged in care varied by race/ethnicity (p<0.001) and ARV prescription varied significantly across the three age groups (p=0.004). Clinic visits within the past year did not differ for those prescribed ARV vs. not prescribed ARV [median, IQR=3.3 visits (1.8-5.6) vs. 3.6 visits (1.3-5.9); p=0.7]. Seeing a physician was associated with ARV prescription (OR=0.27, 95% CI=0.15-0.51), whereas routine engagement in care was not associated with ARV prescription (OR=0.99, 95% CI=0.96-1.03). Given that non-ARV-treated PLWH utilized outpatient care services at rates similar to ARV-treated PLWH, these routine clinic visits are missed opportunities for increasing ARV prescription in untreated patients.

National trends in hospitalization and mortality rates for patients with HIV, HCV, or HIV/HCV coinfection from 1996-2010 in the United States: a cross-sectional study.

BACKGROUND: The comparative impact of chronic viral monoinfection versus coinfection on inpatient outcomes and health care utilization is relatively unknown. This study examined trends, inpatient utilization, and hospital outcomes for patients with HIV, HCV, or HIV/HCV coinfection. METHODS: Data were from the 1996-2010 National Hospital Discharge Surveys. Hospitalizations with primary ICD-9-CM codes for HIV or HCV were included for HIV and HCV monoinfection, respectfully. Coinfection included both HIV and HCV codes. Demographic characteristics, select comorbidities, procedural interventions, average hospital length of stay (LOS), and discharge status were compared by infection status (HIV, HCV, HIV/HCV). Annual disease estimates and survey weights were used to generate hospitalization rates. RESULTS: ~6.6 million hospitalizations occurred in patients with HIV (39%), HCV (56%), or HIV/HCV (5%). The hospitalization rate (hospitalizations per 100 persons with infection) decreased in the HIV group (29.8 in 1996; 5.3 in 2010), decreased in the HIV/HCV group (2.0 in 1996; 1.5 in 2010), yet increased in the HCV group (0.2 in 1996; 0.9 in 2010). Median LOS from 1996 to 2010 (days, interquartile range) decreased in all groups: HIV, 6 (3-10) to 4 (3-8); HCV, 5 (3-9) to 4 (2-6); HIV/HCV, 6 (4-11) to 4 (2-7). Age-adjusted mortality rates decreased for all three groups. The rate of decline was least pronounced for those with HCV monoinfection. CONCLUSION: Hospitalizations have declined more rapidly for patients with HIV infection (including HIV/HCV coinfection) than for patients with HCV infection. This growing disparity between HIV and HCV underscores the need to allocate more resources to HCV care in hopes that similar large-scale improvements can also be accomplished for patients with HCV.

Differences in outpatient care and treatment utilization for patients with HIV/HCV coinfection, HIV, and HCV monoinfection, a cross-sectional study.

BACKGROUND: Few studies have explored how utilization of outpatient services differ for HIV/HCV coinfected patients compared to HIV or HCV monoinfected patients. The objectives of this study were to (1) compare annual outpatient clinic visit rates between coinfected and monoinfected patients, (2) to compare utilization of HIV and HCV therapies between coinfected and monoinfected patients, and (3) to identify factors associated with therapy utilization. METHODS: Data were from the 2005-2010 U.S. National Hospital Ambulatory Medical Care Surveys. Clinic visits with a primary or secondary ICD-9-CM codes for HIV or HCV were included. Coinfection included visits with codes for both HIV and HCV. Monoinfection only included codes for HIV or HCV, exclusively. Patients <15 years of age at time of visit were excluded. Predictors of HIV and HCV therapy were determined by logistic regressions. Visits were computed using survey weights. RESULTS: 3,021 visits (11,352,000 weighted visits) met study criteria for patients with HIV/HCV (8%), HIV (70%), or HCV (22%). The HCV subgroup was older in age and had the highest proportion of females and whites as compared to the HIV/HCV and HIV subgroups. Comorbidities varied significantly across the three subgroups (HIV/HCV, HIV, HCV): current tobacco use (40%, 27%, 30%), depression (32%, 23%, 24%), diabetes (9%, 10%, 17%), and chronic renal failure (<1%, 3%, 5%), (p < 0.001 for all variables). Annual visit rates were highest in those with HIV, followed by HIV/HCV, but consistently lower in those with HCV. HIV therapy utilization increased for both HIV/HCV and HIV subgroups. HCV therapy utilization remained low for both HIV/HCV and HCV subgroups for all years. Coinfection was an independent predictor of HIV therapy, but not of HCV therapy. CONCLUSION: There is a critical need for system-level interventions that reduce barriers to outpatient care and improve uptake of HCV therapy for patients with HIV/HCV coinfection.

In vivo fluorescence of medullary carcinoma of the thyroid: a technology with potential to improve visualization of malignant tissue at surgical resection.

Medullary carcinoma of the thyroid requires aggressive treatment because of its potential to metastasize and because of the current limitations of preoperative localization and systemic therapy. If these tumors could be made to fluoresce in vivo with tagged fluorophore antibodies against tumor antigens, surgeons would be able to obtain additional information in the operating room to facilitate a more complete resection. Based on the success of our previous work in breast and colon cancer models, we conducted an animal study of in vivo tumor fluorescence of a human medullary thyroid cell line in which bright tumor fluorescence is visible during dissection. To accomplish this, we used an inexpensive and commercially available handheld, blue (470 nm), light-emitting diode flashlight and filtered goggles (520 nm). This procedure, which we call the fluorescent antibody-assisted surgical technique (FAAST), is easy to perform, requires no complex or expensive technical equipment, and has the potential to be applied to a wide variety of tumors. To the best of our knowledge, this is the first experiment of its kind to be reported in the literature.

Graft harvesting for revascularization in the head and neck.

The techniques for revascularization in the neurocranium, skull base, and neck continue to evolve at an exciting pace. In this body of literature, however, techniques for harvesting radial artery and saphenous vein grafts are mainly reported using traditional open techniques. Minimally invasive procedures are fast becoming an alternative to open techniques in many fields and have the potential to become the standard of care. The cardiovascular literature is replete with reports of endoscopically harvested vascular grafts. This article reviews both methods, since the current state of the art involves knowledge of open and endoscopic harvesting techniques.

Unmodified prolactin (PRL) promotes PRL secretion and acidophil hypertrophy and is associated with pituitary hyperplasia in female rats.

In this study, we have tested the hypothesis that unmodified prolactin (U-PRL) and phosphorylated prolactin (P-PRL) have differential roles in the autoregulation of PRL secretion in vivo. Recombinant human U-PRL and a molecular mimic of P-PRL (S179D PRL) were administered to male rats and to female rats in different physiological states and the effect on rat PRL release was measured. Administration of U-PRL elevated rat PRL in all female animals, but was without effect in males. By contrast, S179D PRL was inactive in females, but inhibited PRL release in males. Morphometric and immunohistochemical analyses demonstrated acidophil hypertrophy and evidence of increased PRL secretion in the pituitaries of U-PRL-treated females. Analysis of the two forms of PRL during prolactinoma induction in two differentially susceptible strains of rats found a strong temporal correlation among increased ratios of U-PRL: P-PRL, increased circulating PRL, and increased cell proliferation. We conclude (1). that the autoregulatory mechanism(s) can distinguish between the two major forms of PRL and that higher proportions of U-PRL not only allow for higher circulating levels of PRL, but are also autostimulatory, (2). that the autoregulatory mechanism( s) are set differently in males and females such that females are more sensitive to autostimulation by U-PRL and less sensitive to inhibition by P-PRL, and (3). that U-PRL and P-PRL may also have differential roles in the regulation of pituitary cell proliferation.

Three-layer reconstruction for large defects of the anterior skull base.

OBJECTIVES: To evaluate and discuss a three-layer rigid reconstruction technique for large anterior skull base defects. STUDY DESIGN: Prospective, nonrandomized, non-blinded. SETTING: Tertiary teaching medical center. METHODS: Twenty consecutive patients underwent craniofacial resection for a variety of pathology. All patients had large anterior cranial base defects involving the cribriform plate, fovea ethmoidalis, and medial portion of the roof of the orbit at least on one side. A few patients had more extensive defects involving both roof of the orbits, planum sphenoidale, and bones of the upper third of the face. The defects were reconstructed with a three-layer technique. A watertight seal was obtained with a pericranial flap separating the neurocranium from the viscerocranium. Rigid support was provided by bone grafts fixed to a titanium mesh, anchored laterally to the orbital roofs. All patients had a computed tomography scan of the skull on the first or second postoperative day. Patients were observed for immediate and long-term postoperative complications after such reconstruction. RESULTS: Postoperative computed tomography scans showed small pneumocephalus in all patients. It resolved spontaneously and did not produce neurologic deficits in any patient. There was no cerebrospinal fluid leak, hematoma, or infection. On long-term follow-up, exposures of bone graft or mesh, brain herniation, or transmission of brain pulsation to the eyes were not observed in any patient. CONCLUSIONS: Three-layer reconstruction using bone grafts, titanium mesh, and pericranial flap provides an alternative technique for repair of large anterior cranial base defects. It is safe and effective, and provides rigid protection to the brain.