Ethnic differences in cardiac structure and function assessed by MRI in healthy South Asian and White European people: A UK Biobank Study.

BACKGROUND: Echocardiographic studies indicate South Asian people have smaller ventricular volumes, lower mass and more concentric remodelling than White European people, but there are no data using cardiac MRI (CMR). We aimed to compare CMR quantified cardiac structure and function in White European and South Asian people. METHODS: Healthy White European and South Asian participants in the UK Biobank Imaging CMR sub-study were identified by excluding those with a history of cardiovascular disease, hypertension, obesity or diabetes. Ethnic groups were matched by age and sex. Cardiac volumes, mass and feature tracking strain were compared. RESULTS: 121 matched pairs (77 male/44 female, mean age 58 ± 8 years) of South Asian and White European participants were included. South Asian males and females had smaller absolute but not indexed left ventricular (LV) volumes, and smaller absolute and indexed right ventricular volumes, with lower absolute and indexed LV mass and lower LV mass:volume than White European participants. Although there were no differences in ventricular or atrial ejection fractions, LV global longitudinal strain was higher in South Asian females than White European females but not males, and global circumferential strain was higher in both male and South Asian females than White European females. Peak early diastolic strain rates were higher in South Asian versus White European males, but not different between South Asian and White European females. CONCLUSIONS: Contrary to echocardiographic studies, South Asian participants in the UK Biobank study had less concentric remodelling and higher global circumferential strain than White European subjects. These findings emphasise the importance of sex- and ethnic- specific normal ranges for cardiac volumes and function.

Acute heart failure presentation, management, and outcomes in cancer patients: a national longitudinal study.

AIMS: Currently, little evidence exists on survival and quality of care in cancer patients presenting with acute heart failure (HF). The aim of the study is to investigate the presentation and outcomes of hospital admission with acute HF in a national cohort of patients with prior cancer. METHODS AND RESULTS: This retrospective, population-based cohort study identified 221 953 patients admitted to a hospital in England for HF during 2012-2018 (12 867 with a breast, prostate, colorectal, or lung cancer diagnosis in the previous 10 years). We examined the impact of cancer on (i) HF presentation and in-hospital mortality, (ii) place of care, (iii) HF medication prescribing, and (iv) post-discharge survival, using propensity score weighting and model-based adjustment. Heart failure presentation was similar between cancer and non-cancer patients. A lower percentage of patients with prior cancer were cared for in a cardiology ward [-2.4% age point difference (ppd) (95% CI -3.3, -1.6)] or were prescribed angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists (ACEi/ARB) for heart failure with reduced ejection fraction [-2.1 ppd (-3.3, -0.9)] than non-cancer patients. Survival after HF discharge was poor with median survival of 1.6 years in prior cancer and 2.6 years in non-cancer patients. Mortality in prior cancer patients was driven primarily by non-cancer causes (68% of post-discharge deaths). CONCLUSION: Survival in prior cancer patients presenting with acute HF was poor, with a significant proportion due to non-cancer causes of death. Despite this, cardiologists were less likely to manage cancer patients with HF. Cancer patients who develop HF were less likely to be prescribed guideline-based HF medications compared with non-cancer patients. This was particularly driven by patients with a poorer cancer prognosis.

Increasing medicare charge-to-payment ratios for dermatologists from 2012 to 2017.

Government-backed medical insurance plans have undergone significant changes in the last decade, but more information is needed to understand reimbursement trends, particularly for specialist medical services. The objective of this study was to identify the ratios of submitted dermatology service charges to allowed Medicare payments over the years. Further variables studied include regional or state variations, gender of provider, hierarchical condition category (HCC) risk scores of patient complexity, and number of services. Data were collected from publicly available Medicare Part B Provider Utilization and Payment Data: Physician and Other Supplier 2012-2017 datasets. All data analysis was performed on SAS 9.4 Statistical Software.Total dermatology related medicare charges-to-payment ratios steadily increased over the years (1.77 [in 2012], 1.82 [2013], 1.87 [2014], 1.95 [2015], 2.02 [2016], and 2.06 [2017]). This suggests that for every $2.06 charged in 2017, dermatology providers could expect $1 of actual payment. When further stratified into medical services vs. drug services, this upward trend remained for medical charges but drug service ratios have remained constant. There was also significant geographic variation in total medicare charges-to-payment ratios as states in the Midwest (mean total ratio: 2.48) had higher charges to payment gaps than states in the Northeast (2.26), West (2.16), and South (1.99; p = 0.01).This study identifies trends and variables associated with dermatology medicare payments. Providers may use this information to better understand changing payment structures in their own practices and hopefully these results can be valuable in future policy discussions.

Trends in brand and generic drug utilization for dermatology providers from 2013-2019.

BACKGROUND: Prescription drug costs have risen considerably in the United States and are projected to reach $560 billion by 2028. OBJECTIVE: To evaluate brand and generic drug utilization and cost proportions within Medicare Part D. METHODS: Prescription data for dermatology providers were obtained from the Centers for Medicare and Medicaid Services 2013-2019 Medicare Part D Prescribers by Provider datasets. Percentage of brand vs. generic drug claims and costs and cumulative annual growth rates (CAGRs) were calculated. For the most recent year of data (2019), we conducted additional sub-analyses for calculated percentages by prescriber variables. RESULTS: The proportion of brand drug claims increased from 7.4% (in 2013) to 10.5% (2019) with a CAGR of 8.66%. In comparison, generic drug claims increased at a lower rate (CAGR 4.47%). The percentage of brand drug costs increased from 27.5% (in 2013) to 75.1% (2019). LIMITATIONS: Inability to assess and generalize data for prescription patterns under non-Medicare plans. CONCLUSIONS: Our study demonstrates a disproportionate rise in dermatologic brand drug claims and a substantial increase in costs associated with brand drugs. Brand-name drugs are associated with higher out-of-pocket expenses for patients, which can lead to decreased access and adherence to treatment.

Limited sun safety education in high school curricula: a pilot study and call to action.

Although tanning is widespread, the use of both indoor and outdoor tanning most often begins in adolescence and young adulthood and is more prevalent in adolescents and young adults (AYA) than any other age group. Despite this, information regarding sun safety education in high school curricula is limited. In this pilot study, we sought to characterize the presence of education regarding sun safety in the curricula of US public high schools. Cross-sectional survey administered to random sample stratified by state of public high schools in the US. 31 high schools from 22 states submitted survey responses (Fig. 1). Ten high schools (32.2%) provided curricula regarding sun safety. Southern high schools were less likely to provide sun safety education (p = 0.01). The lack of an association between sociodemographic characteristics of the high school and the provision of sun safety curricula suggests that the lack of sun safety education may be widespread. These findings support a call to action regarding further research to better characterize the efficacy of implementing sun safety education in high school curricula. Educational interventions designed to inform high school students about sun safety present a unique opportunity to intervene in the rising skin cancer rates in the AYA population. As rates of skin cancer in AYA continue to rise, it is vital to develop strategies to implement education regarding sun safety and skin cancer risk factors in high school curricula.

Modeling Cases and Deaths per Million using Daily-Aggregated Facebook COVID-19 Symptom Survey Data.

We develop a novel analytic approach to modeling future COVID-19 risk using COVID-19 Symptom Survey data aggregated daily by US state, joined with daily time-series data on confirmed cases and deaths. Specifically, we model N-day forward-looking estimates for per-US-state-per-day change in deaths per million (DPM) and cases per million (CPM) using a multivariate regression model to below baseline error (65% and 38% mean absolute percentage error for DPM/CPM, respectively). Additionally, we model future changes in the curvature of CPM/DPM as "increasing" or "decreasing" using a random forest classifier to above 72% accuracy. In sum, we develop and characterize models to establish a relationship between behaviors and beliefs of individuals captured via the Facebook COVID-19 Symptom Surveys and the trajectory of COVID-19 outbreaks evidenced in terms of CPM and DPM. Such information can be helpful in assessing collective risks of infection and death during a pandemic as well as in determining the effectiveness of appropriate risk mitigation strategies based on behaviors evidenced through survey responses.

Inflation-Adjusted Trends in Medicare Reimbursement for Common Dermatologic Procedures, 2007-2021.

IMPORTANCE: Medicare enrollment, dermatologist utilization of Medicare, and dermatologic procedural volume have all increased over time. Despite this, there are limited studies evaluating changes in Medicare reimbursement within dermatology. OBJECTIVE: To identify trends in Medicare reimbursement for 46 common dermatologic procedures from 2007 to 2021. DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, reimbursement data were obtained from the Centers for Medicare & Medicaid Services Physician Fee Schedule for commonly used dermatologic Current Procedural Terminology (CPT) codes from 2007 to 2021. The CPT codes in several major dermatologic categories were analyzed, including skin biopsy, shave removal, benign/premalignant/malignant destruction, benign/malignant excision, Mohs micrographic surgery, simple/intermediate/complex repair, flap, graft, and laser/phototherapy. All procedure prices were adjusted for inflation to January 2021 dollar value. MAIN OUTCOMES AND MEASURES: The primary outcomes were percentage changes and cumulative annual growth rates of pricing for each dermatologic procedure. RESULTS: From 2007 to 2021, there was a mean decrease in dermatologic procedure reimbursement of -4.8% after adjusting for inflation. Mean inflation-adjusted changes in reimbursements during this time period significantly varied by procedure type, including skin biopsy (+30.3%), shave removal (+24.5%), benign/premalignant/malignant destruction (-7.5%), Mohs micrographic surgery (-14.4%), benign/malignant excision (-3.9%), simple/intermediate/complex repair (-9.9%), flap repair (-14.1%), graft repair (-12.0%), and laser/phototherapy (-6.6%; P < .001). Changes in reimbursement did not vary by anatomical risk categories. CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional analysis suggest that changes in Medicare reimbursement can have several downstream effects, including concomitant private insurance changes and decreased patient access. Future adjustments in reimbursement should balance high-value care with sustainable pricing to optimize patient access.

Phase Transitions for Nonlinear Nonlocal Aggregation-Diffusion Equations.

We are interested in studying the stationary solutions and phase transitions of aggregation equations with degenerate diffusion of porous medium-type, with exponent 1 < m < ∞ . We first prove the existence of possibly infinitely many bifurcations from the spatially homogeneous steady state. We then focus our attention on the associated free energy, proving existence of minimisers and even uniqueness for sufficiently weak interactions. In the absence of uniqueness, we show that the system exhibits phase transitions: we classify values of m and interaction potentials W for which these phase transitions are continuous or discontinuous. Finally, we comment on the limit m → ∞ and the influence that the presence of a phase transition has on this limit.

Trends in emergency department visits due to sunburn and factors associated with severe sunburns in the United States.

Little is known regarding the burden of sunburns leading to emergency department (ED) visits in the United States (US). The objectives of this research were to characterize the burden of sunburn ED visits, investigate predictors of severe sunburns, and evaluate risk factors for increased cost of care in patients presenting to the ED for sunburn. In this nationally representative cross-sectional study of the National Emergency Department Sample (NEDS, 2013-2015), multivariable models were created to evaluate adjusted odds for sunburn ED visits, seasonal/regional variation in sunburn ED visits, adjusted odds for second and third degree sunburns, and risk factors for increased ED expenditure. 82,048 sunburn ED visits were included in this study. On average, the cost of care for a sunburn ED visit was $1132.25 (± $28.69). The prevalence and cost of ED visits due to sunburn increased during the summer months. Controlling for sociodemographic factors, comorbidities, and hospital characteristics, patients presenting to the ED for all sunburns (and for severe sunburns) were most likely to be lower income young adult men. Older, higher income patients in metropolitan hospitals had more expensive ED visits. This research provides nationally representative estimates of visits to the ED due to sunburn in the US, as well as evaluates determinants for severe sunburns and more expensive sunburn ED visits. Ultimately, characterizing the national burden of ED visits due to sunburn is critical in the development of interventions to reduce the impact of sunburn ED visits on the US healthcare system.

Readability of online Spanish patient education materials in dermatology.

Decreased health literacy is associated with worse outcomes for a variety of dermatologic conditions. Hispanic adults have the lowest average health literacy of any racial or ethnic group in the United Sates. Although patients are increasingly using online patient education materials (PEMs) for dermatologic care, limited information exists regarding the readability of these resources. The objective of this study is to evaluate the readability of online Spanish language PEMs in dermatology. Online Spanish language PEMs relevant to dermatology were gathered from the United States National Library of Medicine (USNLM) MedlinePlus health library and top Google, Yahoo, and Bing search results for "Spanish patient education dermatology." Spanish text was analyzed for readability using two validated programs: Spanish Lexile Analyzer and Índice Flesch-Szigriszt (INFLESZ). Pearson's correlation coefficient was used to examine the association between the two readability measures. ANOVA without post hoc correction was performed to determine variability between PEMs. A total of 254 Spanish language PEMs were collected and analyzed from nine online sources. The average article length was 601 words. The average Lexile measure was 1005 L (SD = 144 L) and the average INFLESZ score was 64.60 (SD = 7.53). Readability scores equated to an 8-10th grade reading level and was varied based on the source of information (p < 0.001). Online Spanish language PEMs related to dermatology are generally written at a reading level that exceeds national recommendations and may reduce comprehension for Hispanic patients. Targeted initiatives to address and improve online health information for Spanish-speaking patients are warranted.

Impact of congenital cutaneous hemangiomas on newborn care in the United States.

Little is known regarding the characteristics of newborns with congenital cutaneous hemangioma (CH) and the burden of CH on newborn care. The objective of this study is to describe the burden of CH on newborn inpatient stays in the United States. Specific aims include characterizing newborns with CH, assessing factors predictive of CH and procedures performed during hospitalization, determining characteristics associated with increased cost of care and length of stay in newborns with CH, and investigating trends in prevalence, length of stay, and cost of care. This is a nationally representative retrospective cohort study (National Inpatient Sample, 2009-2015). Sociodemographic factors associated with CH and risk factors for increased cost of care/length of stay were evaluated using weighted multivariable regression models. Overall prevalence of CH is 17.0 per 10,000 newborns. Cost of care and length of stay for newborns with CH are increasing over time. Controlling for all covariates, white (aOR 1.69), female (aOR 1.52) newborns from higher income families (aOR 1.44) were more likely to be born with CH (p < 0.001). Newborns with CH who were premature (aOR 3.88), underwent more procedures (aOR 8.81), and born in urban teaching hospitals (aOR 2.66) had the greatest cost of care (p < 0.001). Premature (aOR 3.74) newborns with CH in urban teaching hospitals (aOR 1.31) had the longest hospital stays (p < 0.001). The burden of CH in newborns is substantial and increasing over time. Understanding contributors to costly hospital stays is critical in developing evidence-based guidelines to reduce the growing impact of CH on newborn care.

Association of Serum Bilirubin with Acute Ischemic Stroke – An Observational Study

@#Introduction: Stroke is a common cause of mortality and morbidity and has an increasing prevalence across the world.1 Bilirubin is now being considered an antioxidant which increases in response to diseases associated with increased oxidative stress. Hence the present observational study was undertaken to assess the bilirubin levels with the outcome of acute ischemic stroke. Methods: This observational study was conducted from January 2018 to December 2018 on 64 ischemic stroke patients admitted at KLE’S Dr. Prabhakar kore hospital at Belagavi, Karnataka. All adult patients above 18 years of age presenting with cerebrovascular accident and proved as ischemic stroke on CT scan or MRI scan were included. The patients were empirically divided into different Groups based on the bilirubin level. They were then analysed with their NIHSS scores for assessing stroke severity. Results: A total of 64 patients were included in the final analysis. The mean total bilirubin level in the patients was 0.68±0.34 mg/dl ( mean±SD). 34.3% (22) of ischemic stroke patients in the study had serum total bilirubin levels 0.7 mg/dl or more. Mean NIHSS Score for Group 1(Low) total bilirubin group was 9.37 and for Group 2(High) bilirubin group was 10.9, which was statistically not significant. This indicates that there was no significant correlation between total bilirubin and severity of symptoms at the time of admission.There was no statistically significant correlation between NIHSS and direct bilirubin levels Conclusion: The current study has documented no association between the bilirubin levels and stroke severity and prognosis.