Receipt of palliative care (PC) in acute myeloid leukemia (AML) using data from the National Cancer Database (NCDB).

12087 Background: AML is an aggressive disease with high mortality and significant impact on quality of life. Palliative care (PC) services have become integral in managing patient’s symptoms during treatment as well as at the end of life. We hypothesize that socioeconomic factors such as achieving higher levels of education, and higher incomes, increases the odds of receiving PC. Methods: This is a retrospective analysis using NCDB data of 124,988 newly diagnosed non-M3 AML patients over 18 yrs from 2004-2016. Unadjusted and multivariate adjusted logistic regression analysis (MVA) evaluated the impact of socioeconomic variables on the receipt of PC. In the MVA, we adjusted for demographic variables and facility characteristics including facility type, facility volume, age, sex, race, Hispanic origin, income, education, urban/rural residence, Charlson-Deyo score, great circle distance, Medicaid expansion status state group, and insurance status. Patients with Medicaid expansion < 39yrs were excluded due to low patient numbers. Results: For the 124,988 patients, median age was 63 years (range 18-90) with 54% males and 86% White. 25% of patients lived in regions with the highest education level defined as < 6.3% of adults over 25 without a high school diploma. 35% of patients had a household income bracket of ≥ $63,333. A total of 3% of patients received PC. MVA showed that patients within the highest income bracket of ≥ $63,333 were less likely to have used PC services (OR 0.82, p < 0.01). More educated patients residing in regions with < 6.3% of adults without a high school diploma had higher odds of receiving PC treatment compared with patients with less education (OR 1.23, p < 0.01). Residence in states with Medicaid expansion in January 2014 or later was associated with greater utilization of PC services (Jan 2014 expansion states: OR 1.33 and late expansion states/after Jan 2014: OR 1.43, p < 0.01) compared to residence in non-expansion states. No difference was seen across races; except Hispanics with decreased use of PC services(OR 0.8, p = 0.022). Conclusions: In this large cohort, a small percentage of patients received PC. Higher education was associated with higher likelihood of using PC, while, surprisingly, higher income was associated with a lower likelihood of PC. Additionally, the higher use of PC services with Medicaid expansion suggests a broad impact of public health insurance in providing increased access to PC services.

Download Full-text

Hydroxychloroquine PK and exposure-response in pregnancies with lupus: the importance of adherence for neonatal outcomes

Lupus Science & Medicine ◽

10.1136/lupus-2021-000602 ◽

2022 ◽

Vol 9 (1) ◽

pp. e000602

Author(s):

Stephen J Balevic ◽

Daniel Weiner ◽

Megan E B Clowse ◽

Amanda M Eudy ◽

Anil R Maharaj ◽

...

Keyword(s):

Preterm Birth ◽

Pregnant Women ◽

Physiological Changes ◽

Third Trimester ◽

Exposure Response ◽

Multiple Gestations ◽

Adjusted Logistic Regression ◽

Using Data ◽

Poor Outcomes ◽

The Impact

ObjectiveEvaluate the impact of pregnancy physiology and medication non-adherence on serum hydroxychloroquine (HCQ) pharmacokinetics (PK) and exposure-response in SLE.MethodsWe conducted a PK analysis using data from two observational pregnancy registries. We enrolled pregnant women with SLE taking HCQ at least 3 months prior to, and throughout pregnancy, and excluded those with multiple gestations. Using the PK model, we conducted dosing simulations and imputed 0%/20%/40%/60% non-adherence to evaluate the impact of adherence versus physiological changes on HCQ concentrations. We compared the effect of pregnancy-average non-adherent concentrations (≤100 ng/mL vs >100 ng/mL) on preterm birth using adjusted logistic regression.ResultsWe enrolled 56 women who had 61 pregnancies. By the third trimester, mean apparent HCQ clearance increased by 59.6%. At a dosage of 400 mg/day, fully adherent patients are expected to have HCQ concentrations ≤100 ng/mL only 0.3% of the time, compared with 24.2% when 60% of doses are missed. Persistently low HCQ concentrations throughout pregnancy were associated with a significantly higher odds of preterm birth, controlling for lupus nephritis and race (OR 11.2; 95% CI 2.3 to 54.2; p=0.003).ConclusionsWe observed significant changes in HCQ PK during pregnancy, resulting in a shortening in the drug’s half-life by 10 days; however, medication non-adherence had a more pronounced effect on HCQ exposure compared with physiological changes alone. Moreover, pregnant women with non-adherent HCQ concentrations had significantly higher rates of preterm birth. Accordingly, optimising adherence in pregnancy may be more clinically meaningful than adjusting HCQ dosage to account for physiological changes. PK modelling indicates that serum HCQ concentrations ≤100 ng/mL are suggestive of non-adherence regardless of trimester and may help identify pregnancies at risk for poor outcomes.

Download Full-text

Wages and Working Conditions of Truck Drivers at the Ports of Long Beach and Los Angeles

Journal of the Transportation Research Forum ◽

10.5399/osu/jtrf.49.1.2511 ◽

2012 ◽

Vol 49 (1) ◽

Author(s):

Kristen Monaco

Keyword(s):

High School ◽

Los Angeles ◽

Working Conditions ◽

Southern California ◽

Truck Drivers ◽

Negative Externality ◽

High School Diploma ◽

Long Beach ◽

Low Levels ◽

Using Data

Using data from surveys conducted in 2004 and 2006, we examine the work and earnings of drayage drivers at the ports of Los Angeles and Long Beach. Though possessing relatively low levels of education (most have a high school diploma or less), these drivers average approximately $35,000 in earnings net of truck expenses, working on average 11.2 hours per day. Owner operators experience increased net earnings once their trucks are fully paid for, leading them to buy older, more polluting trucks. This negative externality is currently being addressed by both ports by enacting new regulations regarding truck drayage in Southern California.

Download Full-text

Medicaid Expansion and Not-For-Profit Hospitals’ Financial Status: National and State-Level Estimates Using IRS and CMS Data, 2011-2016

Medical Care Research and Review ◽

10.1177/10775587211009720 ◽

2021 ◽

pp. 107755872110097

Author(s):

Tatiane Santos ◽

Simone Singh ◽

Gary J. Young

Keyword(s):

Hospital Costs ◽

State Level ◽

Medicaid Expansion ◽

Financial Status ◽

For Profit ◽

Not For Profit ◽

Percentage Points ◽

The Difference ◽

Using Data ◽

The Impact

Several studies have shown that Medicaid expansion has improved hospital financial performance. All of these studies have either used data from the Internal Revenue Service (IRS) or the Centers for Medicare and Medicaid Services (CMS), and none of them has examined the state-level impact of expansion on hospital finances. Using data for not-for-profit hospitals from both IRS and CMS for 2011-2016, we described the difference in costs related to uncompensated care and Medicaid shortfalls. We then estimated the impact of Medicaid expansion on hospitals’ financial status nationally and by state. Nationally, the estimated net effect of expansion reduced not-for-profit hospital costs by 2 percentage points based on IRS data and 0.83 percentage points based on CMS data. Across expansion states, the estimated net effects varied widely with approximately a 10-fold difference for hospitals based on IRS data and a 2-fold difference based on CMS data. Future studies should further explore the differences across IRS and CMS data.

Download Full-text

Four Years Later: Insurance Coverage and Access to Care Continue to Diverge between ACA Medicaid Expansion and Non-Expansion States

AEA Papers and Proceedings ◽

10.1257/pandp.20191046 ◽

2019 ◽

Vol 109 ◽

pp. 327-333 ◽

Cited By ~ 4

Author(s):

Sarah Miller ◽

Laura R. Wherry

Keyword(s):

Affordable Care Act ◽

Low Income ◽

Access To Health Care ◽

Insurance Coverage ◽

Medicaid Expansion ◽

Access To Health ◽

Interview Survey ◽

Using Data ◽

The Impact ◽

Medicaid Expansions

This paper evaluates the impact of the Affordable Care Act Medicaid expansions four years after implementation using data from the 2010-2017 National Health Interview Survey. We find that low-income adults in states that implemented the Medicaid expansions experienced increases in insurance and Medicaid coverage and improvements in access to health care across several measures.

Download Full-text

Fierce Heat and Players’ Health: Examining the View on Japan High School Baseball

10.20944/preprints202112.0247.v1 ◽

2021 ◽

Author(s):

Eiji Yamamura

Keyword(s):

High School ◽

Young People ◽

Environmental Change ◽

High Temperatures ◽

Harsh Environment ◽

Highly Educated ◽

Internet Surveys ◽

Before And After ◽

Using Data ◽

The Impact

A summer high school baseball tournament is held every mid-summer in Koshien Stadium. “Koshien Baseball” is very popular in Japan; however, it faces the problem of extremely high temperatures during games. Thus, high school players are threatened by the harsh environment. For this reason, Internet surveys were conducted twice to purposefully engage the same individuals. Then, information on their views regarding the Koshien tournament before and after the provision of information regarding environmental change in Japan was gathered. Using data, this study examined how their views changed after having the information. Compared with the view before, it was found that (1) respondents were more likely to agree that the management rule of the Koshien tournaments should be altered to protect player’s health, and (2) the impact of providing information is larger for female respondents, young people, and highly educated respondents.

Download Full-text

Equivalent Pathways? Comparison of Job History for High School Graduates Versus GED Recipients

Innovation in Aging ◽

10.1093/geroni/igaa057.1959 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 586-586

Author(s):

Wenxuan Huang

Keyword(s):

High School ◽

Labor Market ◽

High School Graduates ◽

School To Work ◽

Early Career ◽

High School Diploma ◽

High School Degree ◽

Labor Force Status ◽

Paid Labor ◽

Using Data

Abstract Successful integration into the paid labor market serves as a critical milestone to adulthood. Yet, this school-to-work transition has become harder to reach due to the increasing precarity in the youth labor market. Using data from the NLSY97, this study compares the job histories of young adults whose terminal education credentials are high school diploma versus GED. I conducted sequence analysis of school-to-work states from age 16 to 30 between these two education groups. Findings show that GED holders are more likely to be exposed to enduring negative labor force status (e.g., periods of unemployment) than the high school graduates. Over half of the GED recipients experience precarious early career characterized by interruptions and long-term inactivity. Despite being “equivalent” to a high school diploma, the GED diploma does not translate into the same opportunity structure as the high school degree, launching a cumulative disadvantage process in the early life course.

Download Full-text

Inequality in Life Lost to Violence in the United States

10.31235/osf.io/29n67 ◽

2021 ◽

Author(s):

Alexander F. Roehrkasse

Keyword(s):

United States ◽

High School ◽

Life Expectancy ◽

Black Males ◽

Educational Inequality ◽

Cumulative Risk ◽

The United States ◽

High School Diploma ◽

White Males ◽

The Impact

This study uses demographic methods to describe ethnoracial and educational inequality in the cumulative risk of homicide death and life lost to violence in the United States. If age-specific homicides rates were to continue at 2018–2019 levels, more than 1 in 19 Black males without a high school diploma would die by homicide. In contrast, 1 in 152 White males without a high school diploma and 1 in 233 Black males with a bachelor's degree would be violently killed. Among Black males without a high school diploma, homicide led to a decrease in life expectancy at ages 15–19 of more than two years. The impact of U.S. violence on the life expectancy of socially marginalized people exceeds the population impact of all causes of death except heart disease and cancer.

Download Full-text

Collaborating for Equity in Urban Education: Comprehensive Reform in an Innovative University/School Partnership

Urban Education ◽

10.1177/00420859211017976 ◽

2021 ◽

pp. 004208592110179

Author(s):

Joanne Larson ◽

Shaun Nelms

Keyword(s):

High School ◽

Urban Education ◽

School Culture ◽

Instructional Practices ◽

Power Relations ◽

Comprehensive Reform ◽

School Partnership ◽

Using Data ◽

The University ◽

The Impact

Using data from a participatory ethnography of an urban high school slated for closure, this article examines the impact of comprehensive transformation on the university-school partnership’s goal to change from a culture of underachievement and negativity toward a culture of collaboration and excellence. We explore these question/s: How do comprehensive changes in infrastructure, policies, leadership, and instructional practices shape school culture? What role do shifting power relations (generative frictions) and authentic trust play in developing shared ownership of outcomes? We argue generative frictions produced changes in culture that impacted changes in outcomes.

Download Full-text

The Racially Disparate Effects of Drug Arrest on High School Dropout

Socius Sociological Research for a Dynamic World ◽

10.1177/23780231211027097 ◽

2021 ◽

Vol 7 ◽

pp. 237802312110270

Author(s):

Mariam Ashtiani

Keyword(s):

High School ◽

Racial Differences ◽

High School Dropout ◽

School Dropout ◽

War On Drugs ◽

Adult Health ◽

Drug Arrests ◽

Using Data ◽

Criminal Behaviors ◽

The Impact

Racial biases in law enforcement over the past three decades have been linked to the racialized policies of the war on drugs. The author examines the educational consequences of the war on drugs on the lives of youth by analyzing racial differences in the impact of a juvenile drug arrest on high school dropout. Using data from the National Longitudinal Study of Adolescent and Adult Health, the author finds that juvenile drug arrests are more consequential for Black and darker phenotype Latinx youth, who are less likely to be involved in delinquent and criminal behaviors than white youth with drug arrests. The author suggests that racial disparities in drug enforcement may be creating a racialized selection bias among drug arrestees, leading to racially disparate consequences for drug arrests, but not for other types of arrest. The results hold important implications for how drug arrests can produce and sustain racial disadvantages in educational attainment.

Download Full-text

Accent Policy and Accent Modification Enterprises as Potential Indicators of Intercultural Power Relations: A Call for an Updated Research Agenda

Perspectives on Global Issues in Communication Sciences and Related Disorders ◽

10.1044/gics3.1.22 ◽

2013 ◽

Vol 3 (1) ◽

pp. 22-33 ◽

Cited By ~ 1

Author(s):

Brynne D. Ovalle ◽

Rahul Chakraborty

Keyword(s):

International Relations ◽

Identity Construction ◽

Social Theory ◽

Power Relations ◽

Linguistic Diversity ◽

Cultural Organization ◽

Using Data ◽

The Individual ◽

The Impact ◽

The Relationship

This article has two purposes: (a) to examine the relationship between intercultural power relations and the widespread practice of accent discrimination and (b) to underscore the ramifications of accent discrimination both for the individual and for global society as a whole. First, authors review social theory regarding language and group identity construction, and then go on to integrate more current studies linking accent bias to sociocultural variables. Authors discuss three examples of intercultural accent discrimination in order to illustrate how this link manifests itself in the broader context of international relations (i.e., how accent discrimination is generated in situations of unequal power) and, using a review of current research, assess the consequences of accent discrimination for the individual. Finally, the article highlights the impact that linguistic discrimination is having on linguistic diversity globally, partially using data from the United Nations Educational, Scientific and Cultural Organization (UNESCO) and partially by offering a potential context for interpreting the emergence of practices that seek to reduce or modify speaker accents.

Download Full-text