Overrepresentation of Indigenous students in school suspension, exclusion, and enrolment cancellation in Queensland: is there a case for systemic inclusive school reform?

Well-established evidence of the ill-effects of exclusionary school discipline, its disproportionate use on students of colour, and association with the “school-to-prison pipeline” has, in the last decade, led to systemic reforms in the United States, which are successfully reducing exclusion and improving outcomes. Few studies, however, have similarly investigated overrepresentation in Australia, with little attention to systemic reform as a result. In this study, we analysed suspension, exclusion, and enrolment cancellation rates in Queensland (QLD) government schools between 2013 and 2019 and found Indigenous students were consistently overrepresented. Suspension incidents proportionate to enrolments increased for all students, but this increase was faster for Indigenous than non-Indigenous students and driven primarily by steep rises in short suspensions during primary school (Preparatory-6). Exclusions increased—again disproportionately—for Indigenous students, chiefly in secondary school (7–12). During 2019, Physical Misconduct had the highest incident rate for both groups; however, Indigenous students were most overrepresented in suspensions for Disruptive/Disengaged behaviours. Further, while Indigenous students were overrepresented in all QLD regions, one region’s Indigenous suspension rate was higher than all others despite no difference in the distribution of Indigenous/non-Indigenous enrolments across regions. The scale and nature of Indigenous overrepresentation in exclusionary discipline incidents in QLD indicate clear need for further research to secure political commitment to systemic inclusive school reform, as well as to produce high-quality evidence capable of guiding that reform.

Facial Trauma During the COVID-19 Pandemic

Study Design Retrospective cohort study. Objective The purpose of this study is to evaluate the impact of the COVID-19 global pandemic on the regional trends in facial trauma at a tertiary care, level 1 trauma center in Central New York. Methods The study sample was derived from the population of patients who presented with facial trauma to the emergency department at the Downtown and/or Community Campuses of SUNY Upstate University Hospital between March 1, 2020, and May 15, 2020, and compared to two historical controls in 2018 and 2019. Descriptive and bivariate statistics were calculated for study variables in each cohort. Poisson regression was used to compare incident rate ratios (IRR) with 95% confidence intervals with significance set at P < .05. Results Sixty five patients presented during the COVID-19 pandemic, while 83 presented in 2019 and 95 in 2018. For the study period, the most common mechanism was assault in 47.7%. IRR was significantly lower than in 2018 (IRR = 1.46, P = .018), but not significantly different from 2019 (IRR = 1.28, P = .14). During lockdown, IRR was significantly decreased compared to 2019 (IRR = 1.84, P = .0029) and 2018 (IRR = 2.16, P < .001). Conclusion The volume of facial trauma seen in Central New York appears undeterred in the absence of “shelter in place” orders. Analysis of pandemic and regional trauma variations can offer valuable insight for improved resource allocation to better prepare for potentially high-risk procedures.

Effects of demolishing abandoned buildings on firearm violence: a moderation analysis using aerial imagery and deep learning

PurposeDemolishing abandoned buildings has been found to reduce nearby firearm violence. However, these effects might vary within cities and across time scales. We aimed to identify potential moderators of the effects of demolitions on firearm violence using a novel approach that combined machine learning and aerial imagery.MethodsOutcomes were annual counts of fatal and non-fatal shootings in Rochester, New York, from 2000 to 2020. Treatment was demolitions conducted from 2009 to 2019. Units of analysis were 152×152 m grid squares. We used a difference-in-differences approach to test effects: (A) the year after each demolition and (B) as demolitions accumulated over time. As moderators, we used a built environment typology generated by extracting information from aerial imagery using convolutional neural networks, a deep learning approach, combined with k-means clustering. We stratified our main models by built environment cluster to test for moderation.ResultsOne demolition was associated with a 14% shootings reduction (incident rate ratio (IRR)=0.86, 95% CI 0.83 to 0.90, p<0.001) the following year. Demolitions were also associated with a long-term, 2% reduction in shootings per year for each cumulative demolition (IRR=0.98, 95% CI 0.95 to 1.00, p=0.02). In the stratified models, densely built areas with higher street connectivity displayed following-year effects, but not long-term effects. Areas with lower density and larger parcels displayed long-term effects but not following-year effects.ConclusionsThe built environment might influence the magnitude and duration of the effects of demolitions on firearm violence. Policymakers may consider complementary programmes to help sustain these effects in high-density areas.

Association between pulse pressure and progression of chronic kidney disease

The aim of this study was to investigate the association between pulse pressure (PP) and chronic kidney disease (CKD) progression among the general population in Japan. We conducted a population-based cohort study of the residents of Iki Island, Nagasaki, Japan, from 2008 to 2018. We identified 1042 participants who had CKD (estimated glomerular filtration rate(eGFR) < 60 mL/min/1.73 m2 or the presence of proteinuria) at baseline. Cox’s proportional hazard model was used to evaluate the association between PP and progression of CKD. During a 4.66-year mean follow-up, there were 241 cases of CKD progression (incident rate: 49.8 per 1000 person-years). A significant increase existed in CKD progression per 10 mmHg of PP elevation, even when adjusted for confounding factors [adjusted hazard ratio 1.17 (1.06–1.29) p < 0.001]. Similar results were obtained even after dividing PP into quartiles [Q2: 1.14 (0.74–1.76), Q3: 1.35 (0.88–2.06), Q4: 1.87 (1.23–2.83) p = 0.003 for trend]. This trend did not change significantly irrespective of baseline systolic or diastolic blood pressures. PP remained a potential predictive marker, especially for eGFR decline. In conclusion, we found a significant association between PP and CKD progression. PP might be a potential predictive marker for CKD progression.

Value of ocular trauma score in predicting the incidence of secondary glaucoma after closed globe injury

Aim To analyze the visual acuity (VA) and the incidence of secondary glaucoma among patients with closed globe injury (CGI). To determine the correlations between the ocular trauma score (OTS) with surgery rate, and evaluate the applicability of OTS in secondary glaucoma prediction and treatment. Methods We conducted a retrospective review of 265 patients (265 eyes) with CGI admitted to Xijing Hospital between January 2014 and December 2016. The clinical characteristics; VA, IOP, injury zone, surgery, and IOP-lowering medications were collected at the initial visit and at six months. The patients with secondary glaucoma were scored and assessed by the OTS system. The correlation of the anti-glaucoma surgery with the OTS was evaluated. The difference in the number of IOP-lowering medications between the initial visit and six months was analyzed. Results The average age of the patients was 33.5 ± 20.7 years with 80.8% being males. The final VA outcome improved in its totality after treatment. 35 patients developed glaucoma, with an incident rate of 13.2% over six months. All glaucoma patients had an injury in zone I and II, and 12 of them had an injury in zone III. The severity of the OTS category showed a strong correlation with the anti-glaucoma surgery rate. After the surgical intervention, the number of IOP-lowering medications in OTS category 2, 3, and 4 significantly reduced. Conclusions The OTS has predictive value in the incidence of secondary glaucoma after CGI. A patient with a low score is more likely to develop secondary glaucoma and might require surgical intervention.

Integrated Care of Atrial Fibrillation Using the ABC (Atrial fibrillation Better Care) Pathway Improves Clinical Outcomes in Chinese Population: An Analysis From the Chinese Atrial Fibrillation Registry

Background: “Atrial fibrillation Better Care” (ABC) pathway has been proposed to improve the management of patients suffered from atrial fibrillation (AF). This integrated or holistic management approach comprise of three aspects, including “A” Avoid stroke or Anticoagulation; “B” Better symptom control with rate or rhythm control strategies; “C” Cardiovascular risk factor and Concomitant diseases management. We aimed to confirm the beneficial evidence of ABC pathway compliance in a Chinese AF cohort.Method and Results: From the Chinese Atrial Fibrillation registry (CAFR) dataset, a total of 19,187 non-valvular AF patients were enrolled, of which 4.365 (22.8%) were ABC pathway compliant (ABC compliance group). During a median follow-up of 4.1 ± 1.8 years, The incident rate of all-cause death in ABC compliance group and non-ABC compliance group is 2.7 and 1.1 per 100 person-year (p &lt; 0.001), the incident rate of ischemic stroke is 1.3 and 0.8% per 100 person-year (p &lt; 0.001), the incident rate of composite outcome, which consist of all-cause death, ischemic stroke and intracranial hemorrhage, is 3.8 and 1.9 per 100 person-year (p &lt; 0.001). On Cox multivariable analysis, ABC pathway shows an independently association with reduction of all-cause death [hazard ratio (HR) = 0.82; 95% confidence interval (CI) = 0.70–0.95] and the composite outcome (HR 0.86, 95% CI 0.76–0.96). The increasingly components of ABC integrated care compliance is associated with lower risk of all-cause death and composite events.Conclusion: In a large cohort of Chinese AF patients, ABC pathway compliance shows an independently association with reduction of all-cause death and composite outcome of all-cause death, ischemic stroke and intracranial hemorrhage. Better compliance of ABC integrated care contributes to lower HR for adverse events.

Ideal Cardiovascular Health Metric and Its Change With Lifetime Risk of Cardiovascular Diseases: A Prospective Cohort Study

Background Cardiovascular health (CVH) status is associated with cardiovascular diseases (CVD). However, evidence for association of CVH change with risk of CVD is scarce. Methods and Results Seven metrics (smoking status, body mass index, physical activity, diet, total cholesterol, blood pressure, and fasting blood glucose) were used to evaluate the CVH status. Having 0 to 2, 3 to 4, and 5 to 7 ideal cardiovascular metrics were categorized as low, moderate, and high CVH status, respectively. Change in CVH status was assessed from 2006/2007 to 2010/2011. We calculated lifetime risk of CVD using a modified Kaplan–Meier method, and life expectancy was evaluated via the multistate lifetable method. There were 82 349 participants included in our analysis. At 35 years index age, the age‐adjusted incident rate and lifetime risk of CVD were increased with decreasing number of ideal CVH metrics. The direction of change in status of CVH was consistently associated with age‐adjusted incident rate and lifetime risk of CVD. At 35 years index age, improvement from low to moderate (37.6% [95% CI, 32.8%–42.4%]) or to high status (24.4% [95% CI, 12.7%–36.0%]) had lower lifetime risk of CVD compared with consistently low status (44.6% [95% CI, 40.8%–48.5%]). The improvement in CVH could prolong the years of life free from CVD. The pattern of incident rate and lifetime risk across change in CVH status was similar at 45 and 55 years index age. Conclusions Higher number of CVH metrics was associated with lower lifetime risk of CVD. The improvement of CVH status could reduce the lifetime risk of CVD and prolonged the year of life free from CVD.

1441. Significant Decrease in the Incidence Rate of Common Outpatient Upper Respiratory Tract Infection Diagnoses per Clinic Visit in the First Respiratory Season of October 2020 to March 2021 During the Covid-19 Pandemic. A Report From an Outpatient Antimicrobial Stewardship Program at a community hospital in Brooklyn

Background As part of our outpatient Antimicrobial Stewardship Program, we do surveillance of diagnoses and antibiotic use for common upper respiratory tract infections such as acute upper respiratory tract infection, acute bronchitis, sinusitis, and pharyngitis. We sought to evaluate the impact of the Covid-19 pandemic on the incidence rate of upper respiratory tract infection diagnoses per clinic visit during October 2020 to March 2021 season compared to the three prior respiratory seasons. We also sought to reflect of impact of increase in televisits and overlapping symptoms of COVID 19 and upper respiratory tract infections. Methods Our cohort study extending from October 2017 to March 2021. We collected number of diagnoses of upper respiratory infections and number of unique clinic visits during four consecutive respiratory seasons at our primary care sites via electronic health records. Results During the recent October 2020 to March 2021 respiratory season which coincided with the second NYC Covid-19 wave, we had 11569 unique clinic visits and 39 diagnoses of an upper respiratory tract infection - incident rate of 1.29. In the three prior respiratory seasons combined, we had 40939 unique clinic visits and 833 diagnoses of an upper respiratory tract infection – incident rate of 1.49. The incident rates showed a dramatic decline using the test based method and the chi square-statistic p&lt; 0.0001 with an incident rate ratio using a poisson exact method of 6.0359. Statistical comparisons of the current season to each prior individual season yielded similar results. The percentage of Tele-visits during the current season was 19% compared to 0% in the 3 prior seasons. Conclusion During the first respiratory season from October 2020 to March 2021 in midst of the Covid-19 pandemic which also coincided with the second Covid-19 wave in New York, we saw a statistically significant decrease in incidence of common upper respiratory tract infection diagnoses per clinic visit compared to the three prior respiratory seasons. Overlapping signs and symptoms of upper respiratory tract infections and Covid-19 with the added percentage in Tele-visits did not cause an increase in incidence rates of upper respiratory tract infection diagnoses. Covid-19 related mitigation efforts may have played a role. Disclosures All Authors: No reported disclosures

Incidence of SARS-CoV-2 infection in a cohort of workers from the University of Porto

Background: Repeated serosurveys in the same population provide more accurate estimates of the frequency of SARS-CoV-2 infection and more comparable data than notified cases. We aimed to estimate the incidence of SARS-CoV-2 infection, identify associated risk factors, and assess time trends in the ratio of serological/molecular diagnosis in a cohort of university workers. Methods: Participants had a serological rapid test for SARS-CoV-2 Immunoglobulins M and G, and completed a questionnaire, in May-July 2020 (n=3628) and November 2020-January 2021 (n=2661); 1960 participated in both evaluations and provided data to compute the incidence proportion and the incident rate. Crude and adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CI) were computed using generalised linear models with Poisson regression. Results: The incidence rate was 1.8/100 person-month (95%CI 1.6-2.1), and the 6 months cumulative incidence was 10.7%. The serological/molecular diagnosis ratio was 10:1 in the first evaluation and 3:1 in the second. Considering newly identified seropositive cases at the first (n=69) and second evaluation (n=202), 29.0% and 9.4% never reported symptoms, respectively, 14.5% and 33.3% reported contact with a confirmed case and 82.6%, and 46.0% never had a molecular test. Males (aIRR: 0.59; 95%CI: 0.42-0.83) and "high-skilled white-collar" workers (aIRR: 0.73, 95%CI: 0.52-1.02) had lower incidence of infection. Conclusion: University workers presented a high SARS-CoV-2 incidence while restrictive measures were in place. The time decrease in the proportion of undiagnosed cases reflected the increased access to testing, but opportunities continued to be missed, even in the presence of COVID-19 like symptoms.