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ABSTRACT IMPACT: This project demonstrates that addressing low-value care, which has the potential to cause patient harm, relies on novel data tools and collaboration between health system and research stakeholders. OBJECTIVES/GOALS: Reducing low-value care, or patient care that offers no net benefit in specific clinical scenarios, is an important approach to improving value as it can simultaneously lower health care spending and improve quality. We describe an initiative to identify such care in a large statewide employer. METHODS/STUDY POPULATION: Claims data for self-funded University of California (UC) Preferred Provider Organization (PPO) plan members during 2019 were abstracted from the University of California Health (UCH) Clinical Data Warehouse, a unique central database that includes electronic medical record data from >5 million patients across UC medical campuses and all claims from UC self-funded health plans. UCH spans six academic health systems across California. The Milliman MedInsight Health Waste Calculator, a proprietary algorithm-based software tool, was used to identify low-value care and estimate associated spending. The HWC measures 48 low-value services using recommendations from the Choosing Wisely Campaign, the US Preventive Services Task Force, and other clinical specialty guidelines. RESULTS/ANTICIPATED RESULTS: Of 43,882 members of the UC PPO, 11,174 (25.4%) received at least one low-value service. The HWC identified 50,103 eligible services and classified 35% as low-value. Total spending on low-value services ranged between $2,209,516 and $5,089,866, based on a more or less conservative estimate. Across the five sites, the proportion of low-value services ranged from 31% to 39%. Five services comprised 65% of costs from low-value care: annual EKGs, preoperative baseline labs for low-risk surgeries, vitamin D deficiency screening, imaging for eye disease, and headache imaging. The top five services by order frequency were annual EKGs, vitamin D tests, preoperative labs, antibiotics for upper respiratory infections, and imaging for eye disease. DISCUSSION/SIGNIFICANCE OF FINDINGS: Low-value care is prevalent and costly within a large statewide employer. Collaborative multidisciplinary partnerships between employers, health systems, informatics, and researchers can leverage existing data to identify opportunities for improving the value of care for covered populations.
The rapid spread of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) throughout key regions of the United States in early 2020 placed a premium on timely, national surveillance of hospital patient censuses. To meet that need, the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN), the nation’s largest hospital surveillance system, launched a module for collecting hospital coronavirus disease 2019 (COVID-19) data. We present time-series estimates of the critical hospital capacity indicators from April 1 to July 14, 2020.
From March 27 to July 14, 2020, the NHSN collected daily data on hospital bed occupancy, number of hospitalized patients with COVID-19, and the availability and/or use of mechanical ventilators. Time series were constructed using multiple imputation and survey weighting to allow near–real-time daily national and state estimates to be computed.
During the pandemic’s April peak in the United States, among an estimated 431,000 total inpatients, 84,000 (19%) had COVID-19. Although the number of inpatients with COVID-19 decreased from April to July, the proportion of occupied inpatient beds increased steadily. COVID-19 hospitalizations increased from mid-June in the South and Southwest regions after stay-at-home restrictions were eased. The proportion of inpatients with COVID-19 on ventilators decreased from April to July.
The NHSN hospital capacity estimates served as important, near–real-time indicators of the pandemic’s magnitude, spread, and impact, providing quantitative guidance for the public health response. Use of the estimates detected the rise of hospitalizations in specific geographic regions in June after they declined from a peak in April. Patient outcomes appeared to improve from early April to mid-July.
We have found a class of circular radio objects in the Evolutionary Map of the Universe Pilot Survey, using the Australian Square Kilometre Array Pathfinder telescope. The objects appear in radio images as circular edge-brightened discs, about one arcmin diameter, that are unlike other objects previously reported in the literature. We explore several possible mechanisms that might cause these objects, but none seems to be a compelling explanation.
The Rapid ASKAP Continuum Survey (RACS) is the first large-area survey to be conducted with the full 36-antenna Australian Square Kilometre Array Pathfinder (ASKAP) telescope. RACS will provide a shallow model of the ASKAP sky that will aid the calibration of future deep ASKAP surveys. RACS will cover the whole sky visible from the ASKAP site in Western Australia and will cover the full ASKAP band of 700–1800 MHz. The RACS images are generally deeper than the existing NRAO VLA Sky Survey and Sydney University Molonglo Sky Survey radio surveys and have better spatial resolution. All RACS survey products will be public, including radio images (with
15 arcsec resolution) and catalogues of about three million source components with spectral index and polarisation information. In this paper, we present a description of the RACS survey and the first data release of 903 images covering the sky south of declination
made over a 288-MHz band centred at 887.5 MHz.
The coronavirus disease 2019 (COVID-19) has greatly impacted health-care systems worldwide, leading to an unprecedented rise in demand for health-care resources. In anticipation of an acute strain on established medical facilities in Dallas, Texas, federal officials worked in conjunction with local medical personnel to convert a convention center into a Federal Medical Station capable of caring for patients affected by COVID-19. A 200,000 square foot event space was designated as a direct patient care area, with surrounding spaces repurposed to house ancillary services. Given the highly transmissible nature of the novel coronavirus, the donning and doffing of personal protective equipment (PPE) was of particular importance for personnel staffing the facility. Furthermore, nationwide shortages in the availability of PPE necessitated the reuse of certain protective materials. This article seeks to delineate the procedures implemented regarding PPE in the setting of a COVID-19 disaster response shelter, including workspace flow, donning and doffing procedures, PPE conservation, and exposure event protocols.
OBJECTIVES/GOALS: Access to pediatric subspecialty care varies by sociodemographic factors. Providers for gender diverse youth (GDY) are rare, and GDY face health disparities, stigma, and discrimination. We examined the association between GDY access to medical and mental health care and rurality, race, parental education, and other GDY-specific factors. METHODS/STUDY POPULATION: We surveyed parents of GDY (<18 years old) across the United States. Participants were recruited through online communities and listserves specific to parents of GDY. We determined associations between access to gender-specific medical or mental health providers and rurality, race, parental education, as well as other GDY-specific factors including age, time since telling their parent their gender identity, parent-adolescent communication, parent stress, and gender identity using chi-square or Fisher’s exact tests. We calculated adjusted odds ratios using logistic regression models. RESULTS/ANTICIPATED RESULTS: We surveyed 166 parents and caregivers from 31 states. The majority (73.2%) identified as white, 66.5% had earned a bachelor’s degree or higher, and 7.6% lived in a zip code designated rural by the Federal Office of Rural Health Policy. We found no evidence of association between reported GDY access to medical or mental health care and race, parental education, or rurality. We did find a significant univariate association between access to mental health care and feminine (either female or transfeminine/transfemale) gender identity (p = 0.033, OR 2.60, 95% CI 1.06 – 6.36). After controlling for parent-adolescent communication in a backwards elimination logistic regression model, it was no longer significant (p = 0.137, OR 2.05, 95% CI 0.80 – 5.25). DISCUSSION/SIGNIFICANCE OF IMPACT: Despite rurality, race, and parental education impacting access to pediatric subspecialty care, we failed to find these associations among GDY accessing gender care. There is a need to better understand structural and societal barriers to care for this population including the impact of stigma and discrimination.
Progressive gray matter volume reductions have been found in schizophrenia and greater changes seem to be related to poorer outcome1,2. As patients with schizophrenia who use cannabis have a worse prognosis 3, the progressive gray matter change in these patients might be even greater.
Fifty-one patients with recent-onset schizophrenia (cannabis users n=19; non-users n=32) and thirty-one matched healthy comparison subjects were included in this five year longitudinal MRI study. All subjects were assessed at inclusion and after five years. Total brain, gray and white matter, cerebellar, lateral and third ventricle volumes were measured. Percentages of volume change over time were calculated. Univariate analysis of covariance and pairwise comparisons were performed.
Cannabis using patients, non-using patients and healthy comparison subjects differed significantly in total brain, gray matter, lateral and third ventricles and cerebellum volumes. No change in white matter was observed between the groups.
Cannabis using patients with schizophrenia showed a more rapid decrease in total brain and cerebellar volume and increase in lateral and third ventricle volumes as compared to healthy subject and non-using patients. Gray matter volume decrease occurred in all patients with schizophrenia as compared to healthy subjects, but was significantly greater in patients using cannabis.
In schizophrenia progressive gray matter volume decrease occurs during the first five years of illness. Cannabis use causes an additional decrease of gray matter in patients with schizophrenia and could be explained by either a worse illness outcome or the effects of cannabis.
The Maghrib has a rich tradition of archaeological studies. However, this research has been biased from the chronological and cultural points of view. This is due to different reasons, relating to both the nature of the archaeological record and the ideological and political circumstances that developed successively under colonial rule and, from the mid-twentieth century, in the modern independent states of the area.
In general, comparatively little attention has been paid to the indigenous cultures of the pre-Roman period, in particular as regards dwelling sites, which generally underlie thick stratigraphic deposits of later periods. The situation is somewhat different with regard to funerary archaeology, as North Africa, especially its eastern portion, is characterised by the existence of a surprising number and diversity of pre-Roman sepulchral monuments.
The previous chapter introduced the Garamantes, an ancient Saharan people, whose story can be traced archaeologically through the first millennium BC and first millennium AD (see also Figs 1.1and 1.2 for location maps). This chapter presents evidence on the funerary practices of the Garamantian heartlands in the Wadi al-Ajal in the Libyan Fazzan (Central Sahara). The Wadi al-Ajal is a long and thin oasis depression running for c.150 km from al-Abyad (to the south-west of Fazzan’s modern capital at Sabha) to Ubari. Our work has been particularly focused on the area around Jarma (ancient Garama, the Garamantian capital about 40 km east of Ubari). The burials in these Garamantian heartlands differ in certain significant ways from those recorded by the Italian mission at Aghram Nadharif and Fewet, and an interesting aspect of the discussion we shall develop below seeks to explain this difference.
Despite more than 150 years of archaeological research in the Maghrib and the Sahara, it is still difficult to establish a universally accepted chronological framework for Moroccan protohistory. While it is generally agreed that its beginning corresponds with the appearance of metal objects around the start of the third millennium BC, its end is much more imprecise, vague and uncertain. The Mediterranean littoral and its hinterland first entered written history around the eighth century BC, at the date of the earliest evidence for a Phoenician presence. However, the other continental regions of Morocco were not part of this schema. These areas were at the margins of ancient knowledge. During the centuries of the ‘Phoenician presence’, only the urban centres changed their character; the countryside, on the other hand, retained a protohistoric lifestyle.
Situated in the hinterland of the eastern Niger Bend in north-east Burkina Faso (Fig. 12.1), in the so-called Gourma area (that is, the bush-land on the right bank of the Niger River), the archaeological site of Kissi consists of an extensive cluster of adjacent settlement areas, including several burial grounds (Fig. 12.2). Its occupation during almost the whole Iron Age (c.third century BC to twelfth century AD) provides the opportunity to follow certain developments that local society underwent over more than a millennium. Spreading over an area of more than 300 hectares, the archaeological site lies on the northern shore of the Mare de Kissi (see Fig. 12.2), a small rainwater-fed lake, similar to – though smaller than – several other lakes in this region (that is, Mare d’Oursi c.35 km to the west, Mare de Darkoy c.6 km to the north, or Mare de Markoye c.15 km to the east, to name but the largest).
The Middle Nile (from Aswan in Egypt to Khartoum in Sudan, Fig. 6.1) is quite exceptional in Sub-Saharan Africa. It is a region where, from the beginning, archaeological frameworks have been constructed largely on the basis of cemetery excavations. This has, of course, much to do with regionally specific research histories and emergent archaeological practices associated with them. The traditions of materially rich mortuary cultures encountered in the Middle Nile, dating back to the early Neolithic period (here the sixth millennium BC), has continued to attract significant archaeological attention. Numerous, often large, cemeteries are still routinely being explored within the context of both research and rescue archaeology. Their material abundance continues to fascinate. The first extensive archaeological survey of Nubia, completed in 1911, excavated more than 8,200 graves in 151 cemeteries within a ‘survey’ area limited to the riverine oasis and covering an area of less than 250 km2.