Disparities in postpartum readmission by patient- and hospital-level social risk factors in the United States: a retrospective multistate analysis, 2015-2020.

BACKGROUND: Postpartum readmission is an area of focus for improving obstetric care and reducing costs. We examined disparities in all-cause 30-day postpartum readmission by patient- and hospital-level factors in the United States. METHODS: We conducted a retrospective cohort study using 2015-2020 records from the State Inpatient Databases from four states. Generalized linear mixed models were constructed to estimate the effects of individual patient- and hospital-level factors on adjusted odds of 30-day readmission after controlling for confounders. Stratified analyses by delivery and anesthesia type (New York only) and interaction models were performed. RESULTS: Black mothers were more likely than White mothers to be readmitted within 30-days postpartum (aOR 1.57, 95% CI 1.52 to 1.61). Mothers with public insurance had increased odds of readmission compared with those with private insurance (Medicare: aOR 2.13, 95% CI 1.95 to 2.32; Medicaid: aOR 1.14, 95% CI 1.11 to 1.17). Compared with mothers in the lowest income quartile, those in the highest quartile experienced a 14% lower odds of readmission (aOR 0.86, 95% CI 0.83 to 0.89). There were no significant associations between hospital-level characteristics and readmission. Black mothers were more likely to be readmitted regardless of delivery type and most combinations of delivery and anesthesia type. Black mothers from the highest income quartile were more likely to be readmitted than White mothers from the lowest income quartile. CONCLUSION: Substantial disparities in 30-day postpartum readmissions by patient-level social factors were observed, particularly amongst Black mothers. Action is needed to address and mitigate disparities in postpartum readmission.

United States rural residence is associated with increased acute maternal end-organ injury or mortality after birth: a retrospective multi-state analysis, 2007-2018.

BACKGROUND: Geographic-based healthcare determinants and choice of anesthesia have been shown to be associated with maternal morbidity and mortality. We explored whether differences in maternal outcomes based on maternal residence, and anesthesia type for cesarean and vaginal birth, exist. METHODS: This study was a retrospective multi-state analysis; patient residence was the predictor variable of interest and a composite binary measure of maternal end-organ injury or inpatient mortality was the primary outcome. Our secondary outcomes included a binary measure of anesthesia type for cesarean birth (general vs. neuraxial [NA]) and NA analgesia for vaginal birth (no NA vs. NA). Our predictor variable of interest was patient residency (reference category central metropolitan areas of >1 million population), fringe large metropolitan county, medium metropolitan, small metropolitan, micropolitan, and non-metropolitan or micropolitan county. RESULTS: Women residing in micropolitan (OR 1.17; 95% CI 1.09 to 1.27) and non-metropolitan or micropolitan counties (OR 1.14; 95% CI 1.04 to 1.24) had the highest adjusted increased odds of adverse maternal outcomes. Those residing in suburban, medium, and small metropolitan areas underwent general anesthesia less often during cesarean births than those residing in urban areas. Patients residing in micropolitan rural (OR 2.07; 95% CI 2.02 to 2.12) and non-metropolitan or micropolitan (2.25; 95% CI 2.16 to 2.34) counties underwent vaginal births without NA analgesia more than twice as often as those residing in urban areas. CONCLUSIONS: Rural-urban disparities in maternal end-organ damage and mortality exist and anesthesia choice may play an important role in these disparate outcomes.

Obstructive sleep apnea is associated with adverse maternal outcomes using a United States multistate database cohort, 2007-2014.

BACKGROUND: Obstructive sleep apnea affects approximately 11% of women of reproductive age, although it is often undetected and untreated. Previous studies suggest an association between obstructive sleep apnea and adverse maternal outcomes. Herein, we aim to better characterize the relationship between obstructive sleep apnea and maternal outcomes. METHODS: Using the State Inpatient Databases, we performed a retrospective analysis of parturients ≥18 years old having inpatient deliveries in Florida, New York, California, Maryland, and Kentucky from 2007 to 2014. Outcomes included maternal pre-existing conditions, in-hospital mortality, maternal-fetal conditions and complications, and hospital length of stay >5 days. RESULTS: Our cohort consisted of 6 911 916 parturients of whom 4326 (0.06%) had obstructive sleep apnea. Women with obstructive sleep apnea were more likely to present with pre-existing conditions, such as obesity and pre-pregnancy diabetes. After adjusting for patient- and hospital-level confounders in our multivariate analysis, obstructive sleep apnea status was associated with an increased odds of maternal-fetal conditions and complications, including pre-eclampsia (aOR 2.05, 95% CI 1.87 to 2.26), pulmonary edema (aOR 4.73, 95% CI 2.84 to 7.89), cesarean delivery (aOR 1.96, 95% CI 1.81 to 2.11), early onset delivery (aOR 1.28, 95% CI 1.17 to 1.40), and length of stay >5 days (aOR 2.42, 95% CI 2.21 to 2.65). Obstructive sleep apnea was not significantly associated with a higher risk of in-hospital mortality. CONCLUSIONS: Pregnant women with obstructive sleep apnea have a significantly higher adjusted risk of adverse maternal outcomes compared with women without obstructive sleep apnea.

Achieving 'excellent' indoor air quality in commercial offices equipped with air-handling unit--respirable suspended particulate.

UNLABELLED: A study was carried out to investigate the feasibility of achieving ultra low respirable suspended particulates (RSP) in commercial offices without major modification of existing ventilation systems by enhancing the particulates removal efficiency of existing central ventilation systems. Four types of filters which include pre-filters, cartridge filters, bag filters and high efficiency particulates air (HEPA) filters were tested in a commercial building in Causeway Bay. The results show that an RSP objective of <20 microg/m3 could be met by removing RSP from both the return air and outdoor air supply simultaneously. This level of performance is classed as 'excellent' by the Hong Kong Government, Environmental Protection Department. Filters with efficiency that exceed 80% placed both in the return air and outdoor air were sufficient to meet the objective. It is not necessary to install HEPA filters to achieve the 'excellent' class. The outdoor air filter has great influence on the steady state indoor RSP concentration while the effective cleaning rate is governed by the return air filter. Higher efficiency filters increased the static drop but the volume flow of the air fan was not affected significantly. The additional cost incurred was <5% of the existing operation cost. PRACTICAL IMPLICATIONS: This paper reports a field study of RSP control for an indoor office environment. The results are directly applicable to building service engineering in the design of ventilation systems using air-handling units. Field observations indicated that indoor RSP in an office environment could be suppressed below 20 microg/m3 within 1 h by the simultaneous filtration of outdoor air and return air. Outdoor air filtration has a great influence on the steady state indoor concentration and return air filtration governs the cleaning rate. It is believed that the results of this study could be extended to the cleaning of other indoor pollutants such as volatile organic compounds.

Indirect flat-panel detector with avalanche gain: fundamental feasibility investigation for SHARP-AMFPI (scintillator HARP active matrix flat panel imager).

An indirect flat-panel imager (FPI) with avalanche gain is being investigated for low-dose x-ray imaging. It is made by optically coupling a structured x-ray scintillator CsI(Tl) to an amorphous selenium (a-Se) avalanche photoconductor called HARP (high-gain avalanche rushing photoconductor). The final electronic image is read out using an active matrix array of thin film transistors (TFT). We call the proposed detector SHARP-AMFPI (scintillator HARP active matrix flat panel imager). The advantage of the SHARP-AMFPI is its programmable gain, which can be turned on during low dose fluoroscopy to overcome electronic noise, and turned off during high dose radiography to avoid pixel saturation. The purpose of this paper is to investigate the important design considerations for SHARP-AMFPI such as avalanche gain, which depends on both the thickness d(Se) and the applied electric field E(Se) of the HARP layer. To determine the optimal design parameter and operational conditions for HARP, we measured the E(Se) dependence of both avalanche gain and optical quantum efficiency of an 8 microm HARP layer. The results were used in a physical model of HARP as well as a linear cascaded model of the FPI to determine the following x-ray imaging properties in both the avalanche and nonavalanche modes as a function of E(Se): (1) total gain (which is the product of avalanche gain and optical quantum efficiency); (2) linearity; (3) dynamic range; (4) gain nonuniformity resulting from thickness nonuniformity; and (5) effects of direct x-ray interaction in HARP. Our results showed that a HARP layer thickness of 8 microm can provide adequate avalanche gain and sufficient dynamic range for x-ray imaging applications to permit quantum limited operation over the range of exposures needed for radiography and fluoroscopy.

An amorphous selenium based positron emission mammography camera with avalanche gain.

Early diagnosis of breast cancer is crucial for effective treatment, and the need exists for greater detection ability and specificity than possible by screening x-ray mammography (currently the primary imaging technique for the detection of breast lesions). Positron Emission Tomography (PET) using the radiotracer 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) offers a noninvasive, highly sensitive method for the diagnosis of breast cancer. Images from PET contain unique metabolic information that is not available from anatomical imaging techniques. We propose a Positron Emission Mammography (PEM) imaging system that maintains the established high specificity of FDG PET while providing improved collection efficiency for the radiotracer signal and the potential for images with better spatial resolution. This PEM system will enable detection of lesions that are considerably smaller than those that can be visualized using whole body PET imaging. The compact dual-head PEM camera will be based on an amorphous selenium (a-Se) avalanche photodetector and the scintillator lutetium oxyorthosilicate (LSO). The camera promises high collection efficiency by combining the fast scintillation light decay and high light yield of LSO with the excellent quantum efficiency, large avalanche gain, and rapid response time of a-Se. We have measured the gain and readout time of an 8 microm a-Se layer and demonstrated the feasibility of the proposed PEM camera.

Role of embolization in the management of splenic trauma.

The management of splenic trauma is determined by factors related to a patient's clinical state. Currently, non-surgical management is favoured because of morbidity related to laparotomy and splenectomy. However, the presence of a pseudoaneurysm might necessitate selective splenic arteriography and embolization. Even though this also has associated morbidity, conservation of viable splenic tissue is a desired result.

The effects of aging in the medial geniculate nucleus: a comparison with the inferior colliculus and auditory cortex.

A common problem among the elderly is a difficulty in discriminating speech. One factor that may contribute to this is deterioration in the ability to process the dynamic components of speech such as formant transitions. The frequency-modulated (FM) sweep is a useful stimulus for investigating the neural basis of temporal processing speed since it has features in common with formant transitions. Previously, we showed that when cells in the auditory cortex of aged animals were presented with FM sweeps, they exhibited a decrease in temporal processing speed when compared to cells recorded from young animals. However, this was not the case for cells in the inferior colliculus (IC) where neural responses did not appear to be affected by aging. One question that remains is how the auditory thalamus is affected by aging: Is it similar to that of the auditory cortex or of the IC. To this end, single units were recorded from the ventral division of the medial geniculate nucleus (MGNv) of young and aged anaesthetized rats in response to FM sweeps. Results showed that there were no age-related differences in speed or direction selectivity of FM sweep responses in the MGNv. When compared with units recorded from the IC and AI, the responses of MGNv neurons were similar to those of the IC. This suggests that temporal processing speed is affected by aging in the cortex, but not in the auditory thalamus or midbrain.

Frequency modulated sweep responses in the medial geniculate nucleus.

A basic feature of communication signals is a dynamic change in frequency. One stimulus that lends itself well to investigating the frequency changes contained in these signals is the frequency modulated (FM) sweep. While many studies have investigated FM sweep responses in the auditory midbrain and cortex, relatively few have examined them in the thalamus. To this end, we investigated the responses of single units in the ventral division of the medial geniculate nucleus (MGNv) of the rat to FM sweeps. Both upward- (changing from low to high frequency) and downward-directed (changing from high to low frequency) FM sweeps were presented at four rates of frequency modulation (i.e., speed). Results showed that the majority (76%) of the cells preferred fast or medium FM sweeps. For direction selectivity, just under half of the units (47%) exhibited a preference for the direction of FM sweep. The results suggest that there is a greater degree of direction but not speed selectivity at progressively higher levels in the auditory pathway.

The appeal cycle in three cultures: an exploratory comparison of child development.

Mother-child behaviors were studied in three cultural groups: Caucasian American (CA), overseas Japanese (JPN), and Chinese Vietnamese (CVN) immigrants. The children were sixteen to twenty-five months old, and the appeal cycle, with its descriptive analytic method, was the research paradigm. Group differences were found in appeal cycle occurrence and phase frequencies. CA mothers promoted independence through encouragement of decision making and toddler-initiated play, and through nonintrusive interactions. Neither JPN nor CVN mothers encouraged independence. JPN mothers were subtly directive; CVN mothers overtly so. Generally, CA toddlers played independently, evincing a beginning capacity for self-regulation. JPN and CVN toddlers reacted to separation by staying close to their mothers, and fewer were observed to play independently than in the CA group. CVN toddlers played independently more frequently than JPN toddlers, but less frequently than CA toddlers. Quantitative measures of dyadic behaviors generally support the descriptive findings, though methodological constraints did not permit comparison of phase sequencing. The findings reflect cultural differences in child development thought to influence psychic structure formation.

Acidification of the male reproductive tract by a proton pumping (H+)-ATPase.

An acidic luminal pH (ref. 1-3) is involved in sperm maturation, and in maintaining sperm in an immotile state in the epididymis and vas deferens (2,4-6). Neutralization by prostatic fluid is one of a complex series of events that triggers sperm motility (2,7,8). Failure of the acidification mechanism might, therefore, result in poor sperm maturation, premature motility and infertility. We have shown that a vacuolar (H+)-ATPase is expressed at high levels on the luminal plasma membrane of specialized cells in the epididymis (9), which closely resemble acid-secreting kidney intercalated cells (10,11). We now show that similar cells are also present in the vas deferens, and that a bafilomycin-sensitive proton flux can be detected using a noninvasive proton-selective vibrating probe. Up to 80% of the net proton secretion in the vas deferens is inhibited by bafilomycin, consistent with a major role of a vacuolar-type (H+)-ATPase in this process. This acidification mechanism is a potential target for novel strategies aimed at modulating the acidification capacity of parts of the male reproductive tract and, therefore, in regulating male fertility.

Effects of alveolar macrophage conditioned media from interstitial lung disease patients on the procollagen mRNA expression in human lung fibroblasts.

Progressive inflammation and fibrosis are the central processes in the pathogenesis of pulmonary fibrosis. It is believed that macrophages in areas of chronically inflamed lung play a key role in fibrotic response. Therefore, we investigated the effects of alveolar macrophage (Am phi) conditioned media from interstitial lung disease (ILD) patients on lung fibroblast proliferation and procollagen mRNA expression. After stimulating with Am phi conditioned media from ILD patients, the fibroblast proliferation increased 71.4% compared with the control, but for media from bronchial carcinoma (BC) patients, it just increased 14.3%. There is a significant difference between the two groups (P < 0.05). The procollagen alpha, (I) mRNA in fibroblasts stimulated with Am phi conditioned media from ILD patients was increased 21.3%, and alpha 1 (III) was 37.2% higher than control (P < 0.05). It increased 6.8% and 12.8% for media from BC patients respectively, but there was no difference when compared to the control. We considered that Am phi from ILD patients might be in an activated state and could release some growth factors to stimulate fibroblast proliferation and promote collagen DNA expression.

Localization of the CHIP28 water channel in reabsorptive segments of the rat male reproductive tract.

The water channel protein CHIP28 is responsible for the high constitutive plasma membrane permeability to water of erythrocytes, renal proximal tubule, and thin descending limb of Henle. The male reproductive tract is embryologically related to kidney and some segments, particularly the efferent ducts, exhibit a high rate of solute flux-dependent reabsorption of luminal fluid. To determine whether this could occur through water channels in the plasma membrane of reproductive tract epithelial cells, we used anti-CHIP28 antibodies to localize this protein by Western blotting and immunocytochemistry. Western blotting of proteins from efferent duct homogenate indicated the presence of CHIP28 in the efferent duct cells. By indirect immunofluorescence and protein A-gold immunolabeling, CHIP28 was localized to the brush-border and basolateral membranes of nonciliated cells. Ciliated cells in the same epithelium showed no plasma membrane staining for CHIP28. In accord with immunocytochemical findings, freeze-fracture of nonciliated efferent duct cells revealed a plasma membrane organization resembling that of renal proximal tubule cells that are rich in CHIP28. The anti-CHIP28 antibodies also stained plasma membranes of epithelial cells in the ampulla of the vas deferens, seminal vesicles, and prostate, but not the cells in seminiferous tubules, epididymis, and proximal parts of the vas deferens. Therefore, CHIP28 may be a principal mediator of the transmembrane water transport in absorptive epithelial cells of efferent ducts, as well as in epithelial of several other segments of the male reproductive tract that show both secretory and reabsorptive functions.

A plasma membrane proton ATPase in specialized cells of rat epididymis.

Acidification of the luminal fluid in the epididymis is believed to play an important role in sperm maturation. Previous studies have shown that specialized cells in the epithelium lining the epididymis contain high levels of carbonic anhydrase and that these cells have rod-shaped intramembraneous particles when examined by freeze fracture. Both of these features are characteristic of proton-transporting intercalated cells in the kidney collecting duct. We now show that apical cells in the head of the epididymis and clear cells in the body and tail of the epididymis express high levels of a vacuolar proton-pumping adenosinetriphosphatase on their apical plasma membranes and on intracellular vesicles. By analogy with kidney intercalated cells, these cell types may be specialized for acid secretion in the epididymis.

Self-concept among hearing Chinese children of deaf parents.

This paper discusses a study of Chinese children in Hong Kong that compared the self-concepts of hearing children of deaf parents with the self-concepts of hearing children of hearing parents. The study was based on the responses to a questionnaire given to 42 deaf couples and their 70 hearing children, and 41 hearing couples and their 82 hearing children. It found no differences in the self-concepts of hearing children of deaf parents and hearing children of hearing parents. However, it did find that deaf parents had lower self-concepts than hearing parents.

Radioactive iodine exchange reaction of HIPDM: kinetics and mechanism.

In conjunction with single photon emission computed tomography (SPECT), iodine-123 (123I)-labeled N,N,N'-trimethyl-[2-hydroxy-3-methyl-5-iodobenzyl]-1,3-propanediamine (HIPDM) has been used clinically as a regional cerebral perfusion imaging agent. The [123I]HIPDM can be prepared by a simple aqueous exchange reaction in a kit form. We synthesized unlabeled HIPDM by condensation of 2-hydroxy-3-methyl-5-iodobezaldehyde and N,N,N'-trimethyl-1,3-propanediamine, followed by a sodium borohydride reduction reaction. The kinetics of the radioactive iodine exchange reaction for the preparation of [123I]HIDM is controlled by the pH, the temperature, and the presence of reductant (sodium bisulfite), and oxidant (sodium iodate). The reaction is a second order iodine-iodine exchange with an activation energy of 30.6 kcal/mole. The mechanism of this reaction probably involves the formation of an active 1+ or iodine free radical, which is sensitive to the presence of a reductant, such as sodium bisulfite.