The Impact of Race/Ethnicity on Preoperative Time to Hip Stabilization Procedure after Hip Fracture

Introduction: A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. Hip fractures affect elderly populations, necessitate hospital admissions and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65–98 years), and most (53, 70.7%) were women. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in the COVID-19-positive group (10/20, 50%) compared to the COVID-19-negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0–22.5). The mean time from admission to surgery was 43.1 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of viral pneumonitis which resulted in mortality (70% of mortality). 30% ( n = 6) contracted the COVID-19 infection in the community, and 70% ( n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest X-ray for patients presenting with hip fractures help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.

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IoT-Based Patient Movement Monitoring: The Post-Operative Hip Fracture Rehabilitation Model

Future Internet ◽

10.3390/fi13080195 ◽

2021 ◽

Vol 13 (8) ◽

pp. 195

Author(s):

Akash Gupta ◽

Adnan Al-Anbuky

Keyword(s):

Hip Fracture ◽

Real Time ◽

System Performance ◽

Digital Health ◽

Time Behavior ◽

Functional Requirements ◽

Rehabilitation Process ◽

Rehabilitation Model ◽

The Impact ◽

Movement Monitoring

Hip fracture incidence is life-threatening and has an impact on the person’s physical functionality and their ability to live independently. Proper rehabilitation with a set program can play a significant role in recovering the person’s physical mobility, boosting their quality of life, reducing adverse clinical outcomes, and shortening hospital stays. The Internet of Things (IoT), with advancements in digital health, could be leveraged to enhance the backup intelligence used in the rehabilitation process and provide transparent coordination and information about movement during activities among relevant parties. This paper presents a post-operative hip fracture rehabilitation model that clarifies the involved rehabilitation process, its associated events, and the main physical movements of interest across all stages of care. To support this model, the paper proposes an IoT-enabled movement monitoring system architecture. The architecture reflects the key operational functionalities required to monitor patients in real time and throughout the rehabilitation process. The approach was tested incrementally on ten healthy subjects, particularly for factors relevant to the recognition and tracking of movements of interest. The analysis reflects the significance of personalization and the significance of a one-minute history of data in monitoring the real-time behavior. This paper also looks at the impact of edge computing at the gateway and a wearable sensor edge on system performance. The approach provides a solution for an architecture that balances system performance with remote monitoring functional requirements.

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AB0142 SOCIOECONOMIC STATUS (SES) AND MEDICATION USE IN RHEUMATOID ARTHRITIS (RA): A SCOPING REVIEW

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3439 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1098.2-1099

Author(s):

O. Russell ◽

S. Lester ◽

R. Black ◽

C. Hill

Keyword(s):

Rheumatoid Arthritis ◽

Socioeconomic Status ◽

Scoping Review ◽

Research Training ◽

Medication Use ◽

Study Group ◽

Knowledge Gaps ◽

Coverage Area ◽

Race Ethnicity ◽

The Impact

Background:Socioeconomic status (SES) influences disease outcomes in rheumatoid arthritis (RA) patients. (1, 2) Differences in medication use could partly explain this association. (3) A scoping review was used to identify research conducted on this topic and determine what knowledge gaps remain.Objectives:To determine what research has been conducted on this topic, how this research has defined SES and medication use, and establish what knowledge gaps remain.Methods:MEDLINE, EMBASE and PsychInfo were searched from their inception until May 2019 for studies which assessed SES and medication use as outcome variables. Studies were included if they measured medication use and incorporated an SES measure as a comparator variable.SES was defined using any of the “PROGRESS” framework variables (4) including patients’ stated gender, age, educational attainment, employment, occupational class, personal income, marital status, health insurance coverage, area- (neighbourhood) level SES, or patients’ stated race and/or ethnicity. Medication use was broadly defined as either prescription or dispensation of a medicine, medication adherence, or delays in treatment. Data was extracted on studies’ primary objectives, measurement of specific SES measures, patients’ medication use, and whether studies assessed for differences in patients’ medication use according to SES variables.Results:1464 studies were identified by this search from which 74 studies were selected for inclusion, including 52 published articles. Studies’ publication year ranged from 1994-2019, and originated from 20 countries; most commonly from the USA.Studies measured a median of 4 SES variables (IQR 3-6), with educational achievement, area level SES and race/ethnicity the most frequently recorded.Likelihood of disease modifying antirheumatic drug (DMARD) prescription was the most frequent primary objective recorded.96% of studies reported on patients’ use of DMARDs, with glucocorticoids and analgesics being reported in fewer studies (51% and 23% respectively.)Most included studies found at least one SES measure to be significantly associated with differences in patients’ medication use. In some studies, however, this result was not necessarily drawn from the primary outcome and therefore may not have been adjusted for covariates.70% of published studies measuring patients’ income (n=14 of 20) and 58% of those that measured race/ethnicity (n=14 of 24) documented significant differences in patients’ medication use according to these SES variables, although the direction of this effect – whether it led to ‘greater’ or ‘lesser’ medication use – varied between studies.Conclusion:Multiple definitions of SES are used in studies of medication use in RA patients. Despite this, most identified studies found evidence of a difference in medication use by patient groups that differed by an SES variable, although how medication use differed was found to vary between studies. This latter observation may relate to contextual factors pertaining to differences in countries’ healthcare systems. Further prospective studies with clearly defined SES and medication use measures may help confirm the apparent association between SES and differences in medication use.References:[1]Jacobi CE, Mol GD, Boshuizen HC, Rupp I, Dinant HJ, Van Den Bos GA. Impact of socioeconomic status on the course of rheumatoid arthritis and on related use of health care services. Arthritis Rheum. 2003;49(4):567-73.[2]ERAS Study Group. Socioeconomic deprivation and rheumatoid disease: what lessons for the health service? ERAS Study Group. Early Rheumatoid Arthritis Study. Annals of the rheumatic diseases. 2000;59(10):794-9.[3]Verstappen SMM. The impact of socio-economic status in rheumatoid arthritis. Rheumatology (Oxford). 2017;56(7):1051-2.[4]O’Neill J, Tabish H, Welch V, Petticrew M, Pottie K, Clarke M, et al. Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. J Clin Epidemiol. 2014;67(1):56-64.Acknowledgements:This research was supported by an Australian Government Research Training Program Scholarship.Disclosure of Interests:None declared

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Impact of Rehabilitation Dose on Nutritional Status at Discharge from a Convalescent Rehabilitation Ward in Malnourished Patients with Hip Fracture

Healthcare ◽

10.3390/healthcare9060722 ◽

2021 ◽

Vol 9 (6) ◽

pp. 722

Author(s):

Yusuke Ito ◽

Hidetaka Wakabayashi ◽

Shinta Nishioka ◽

Shin Nomura ◽

Ryo Momosaki

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Hip Fracture ◽

Nutritional Status ◽

Logistic Regression Analysis ◽

Short Form ◽

Mini Nutritional Assessment ◽

Functional Independence ◽

Rehabilitation Ward ◽

The Impact

The object of this study is to determine the impact of the rehabilitation dose on the nutritional status at discharge from a convalescent rehabilitation ward in malnourished patients with hip fracture. This retrospective case-control study involved malnourished patients with hip fracture aged 65 years or older who had been admitted to a convalescent rehabilitation ward and whose data were registered in the Japan Rehabilitation Nutrition Database. The primary outcome was nutritional status at discharge. Patients were classified according to whether nutritional status was improved or not at discharge, according to the Mini Nutritional Assessment-Short Form® (MNA-SF) score. The association between improved nutritional status and rehabilitation dose was assessed by a logistic regression analysis. Data were available for 145 patients (27 men, 118 women; mean age 85.1 ± 7.9 years). Daily rehabilitation dose was 109.5 (median 94.6–116.2) min and the MNA-SF score at admission was 5 (median 4–6). Nutritional status was improved in 97 patients and not improved in 48. Logistic regression analysis showed the following factors to be independently associated with nutritional status at discharge: Functional Independence Measure score (OR 1.042, 95% CI 1.016–1.068), energy intake (OR 1.002 CI 1.000–1.004), daily rehabilitation dose (OR 1.023, 95% CI 1.002–1.045), and length of hospital stay (OR 1.026, 95% CI 1.003–1.049). The daily rehabilitation dose in malnourished patients with hip fracture may positively impact nutritional status at discharge.

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Conservation and natural resource management: where are all the women?

Oryx ◽

10.1017/s0030605320001349 ◽

2021 ◽

pp. 1-8

Author(s):

Robyn James ◽

Bridget Gibbs ◽

Laura Whitford ◽

Craig Leisher ◽

Ruth Konia ◽

...

Keyword(s):

Resource Management ◽

Literature Review ◽

Natural Resource Management ◽

Natural Resource ◽

Positive Relationship ◽

Cultural Norms ◽

Conservation Actions ◽

Race Ethnicity ◽

Management Institutions ◽

The Impact

Abstract There is evidence from the development and humanitarian sectors that purposeful engagement of women can increase the impact of development. We conducted a literature review to examine whether this is also evident in conservation and natural resource management. The following themes emerged from our review: existing societal and cultural norms affect and generally limit how women can engage in conservation and natural resource management; women interact differently with the environment than men, so if they are excluded, their knowledge and perspectives on particular resources may not be considered in conservation actions; and there is often a lack of resources or dedicated effort by conservation or natural resource management programmes to understand and address the barriers that prevent women's engagement. Although there was evidence of a positive relationship between the engagement of women and environmental outcomes, some studies showed that positive conservation outcomes do not necessarily benefit women, and when women are not considered, conservation activities can perpetuate existing inequities. We conclude that although the importance of integrating gender into conservation is acknowledged in the literature, there is a need to examine how women can be meaningfully engaged in conservation. This must go beyond treating women as a homogenous group, to consider intersectionality including race, ethnicity, age, religion, poverty and disability. In addition, conservation and natural resource management institutions need to address the inclusion of women in their own staff and programmes.

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Racial Disparities in Virologic Failure and Tolerability During Firstline HIV Antiretroviral Therapy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz022 ◽

2019 ◽

Vol 6 (2) ◽

Cited By ~ 1

Author(s):

Priya Bhagwat ◽

Shashi N Kapadia ◽

Heather J Ribaudo ◽

Roy M Gulick ◽

Judith S Currier

Keyword(s):

Antiretroviral Therapy ◽

Adverse Events ◽

Socioeconomic Factors ◽

Ethnic Groups ◽

Virologic Failure ◽

Virologic Suppression ◽

Factors Associated ◽

Race Ethnicity ◽

The Impact ◽

Racial Ethnic

Abstract Background Racial/ethnic disparities in HIV outcomes have persisted despite effective antiretroviral therapy. In a study of initial regimens, we found viral suppression varied by race/ethnicity. In this exploratory analysis, we use clinical and socioeconomic data to assess factors associated with virologic failure and adverse events within racial/ethnic groups. Methods Data were from AIDS Clinical Trial Group A5257, a randomized trial of initial regimens with either atazanavir/ritonavir, darunavir/ritonavir, or raltegravir (each combined with tenofovir DF and emtricitabine). We grouped participants by race/ethnicity and then used Cox-proportional hazards regression to examine the impact of demographic, clinical, and socioeconomic factors on the time to virologic suppression and time to adverse event reporting within each racial/ethnic group. Results We analyzed data from 1762 participants: 757 self-reported as non-Hispanic black (NHB), 615 as non-Hispanic white (NHW), and 390 as Hispanic. The proportion with virologic failure was higher for NHB (22%) and Hispanic (17%) participants compared with NHWs (9%). Factors associated with virologic failure were poor adherence and higher baseline HIV RNA level. Prior clinical AIDS diagnosis was associated with virologic failure for NHBs only, and unstable housing and illicit drug use for NHWs only. Factors associated with adverse events were female sex in all groups and concurrent use of medications for comorbidities in NHB and Hispanic participants only. Conclusions Clinical and socioeconomic factors that are associated with virologic failure and tolerability of antiretroviral therapy vary between and within racial and ethnic groups. Further research may shed light into mechanisms leading to disparities and targeted strategies to eliminate those disparities.

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Recognizing Human Races through Machine Learning—A Multi-Network, Multi-Features Study

Mathematics ◽

10.3390/math9020195 ◽

2021 ◽

Vol 9 (2) ◽

pp. 195

Author(s):

Adrian Sergiu Darabant ◽

Diana Borza ◽

Radu Danescu

Keyword(s):

Race And Ethnicity ◽

Large Scale ◽

Recognition Rate ◽

Social Signals ◽

Image Characteristics ◽

Race Effect ◽

Race Ethnicity ◽

The Impact ◽

Facial Images ◽

Ethnicity Classification

The human face holds a privileged position in multi-disciplinary research as it conveys much information—demographical attributes (age, race, gender, ethnicity), social signals, emotion expression, and so forth. Studies have shown that due to the distribution of ethnicity/race in training datasets, biometric algorithms suffer from “cross race effect”—their performance is better on subjects closer to the “country of origin” of the algorithm. The contributions of this paper are two-fold: (a) first, we gathered, annotated and made public a large-scale database of (over 175,000) facial images by automatically crawling the Internet for celebrities’ images belonging to various ethnicity/races, and (b) we trained and compared four state of the art convolutional neural networks on the problem of race and ethnicity classification. To the best of our knowledge, this is the largest, data-balanced, publicly-available face database annotated with race and ethnicity information. We also studied the impact of various face traits and image characteristics on the race/ethnicity deep learning classification methods and compared the obtained results with the ones extracted from psychological studies and anthropomorphic studies. Extensive tests were performed in order to determine the facial features to which the networks are sensitive to. These tests and a recognition rate of 96.64% on the problem of human race classification demonstrate the effectiveness of the proposed solution.

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Meta-analysis and metaregression of risk factors associated with mortality in hip fracture patients during the COVID-19 pandemic

Scientific Reports ◽

10.1038/s41598-021-89617-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Firas J. Raheman ◽

Djamila M. Rojoa ◽

Jvalant Nayan Parekh ◽

Reshid Berber ◽

Robert Ashford

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Case Fatality Rate ◽

Excess Mortality ◽

Meta Analysis ◽

Case Fatality ◽

Pooled Analysis ◽

Fatality Rate ◽

Increased Risk ◽

The Impact

AbstractIncidence of hip fractures has remained unchanged during the pandemic with overlapping vulnerabilities observed in patients with hip fractures and those infected with COVID-19. We aimed to investigate the independent impact of COVID-19 infection on the mortality of these patients. Healthcare databases were systematically searched over 2-weeks from 1st–14th November 2020 to identify eligible studies assessing the impact of COVID-19 on hip fracture patients. Meta-analysis of proportion was performed to obtain pooled values of prevalence, incidence and case fatality rate of hip fracture patients with COVID-19 infection. 30-day mortality, excess mortality and all-cause mortality were analysed using a mixed-effects model. 22 studies reporting 4015 patients were identified out of which 2651 (66%) were assessed during the pandemic. An excess mortality of 10% was seen for hip fractures treated during the pandemic (OR 2.00, p = 0.007), in comparison to the pre-pandemic controls (5%). Estimated mortality of COVID-19 positive hip fracture patients was four-fold (RR 4.59, p < 0.0001) and 30-day mortality was 38.0% (HR 4.73, p < 0.0001). The case fatality rate for COVID-19 positive patients was 34.74%. Between-study heterogeneity for the pooled analysis was minimal (I2 = 0.00) whereas, random effects metaregression identified subgroup heterogeneity for male gender (p < 0.001), diabetes (p = 0.002), dementia (p = 0.001) and extracapsular fractures (p = 0.01) increased risk of mortality in COVID-19 positive patients.

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