Associations of U.S. hospital closure (2007-2018) with area socioeconomic disadvantage and racial/ethnic composition

PURPOSE

To examine whether hospital closure is associated with high levels of area socioeconomic disadvantage and racial/ethnic minority composition.

METHODS

Pooled cross-sectional analysis (2007-2018) of 6467 U.S. hospitals from the American Hospital Association's Annual Survey, comparing hospital population characteristics of closed hospitals to all remaining open hospitals. We used multilevel mixed-effects logistic regression models to assess closure as a function of population characteristics, including area deprivation index ([ADI], a composite measure of socioeconomic disadvantage), racial/ethnic composition, and rural classification, nesting hospitals within hospital service areas (HSAs) and hospital referral regions. Secondary analyses examined public or private hospital type.

RESULTS

Overall, 326 (5.0%) of 6467 U.S. hospitals closed during the study period. In multivariable models, hospitals in HSAs with a higher burden of socioeconomic disadvantage (per 10% above median ADI ZIP codes, AOR 1.05; 95% CI, 1.01-1.09) and Black Non-Hispanic composition (highest quartile, AOR 4.03; 95% CI, 2.62-6.21) had higher odds of closure. We did not observe disparities in closure by Hispanic/Latino composition or rurality. Disparities persisted for Black Non-Hispanic communities, even among HSAs with the lowest burden of disadvantage.

CONCLUSIONS

Disproportionate hospital closure in communities with higher socioeconomic disadvantage and Black racial composition raises concerns about unequal loss of healthcare resources in the U.S.

P91 HEMODYNAMICS NURSES ARE EVOLVING WITH INTERVENTIONAL CARDIOLOGY

Subject Matter

Hemodynamics deals with issues concerning ‘the bloodstream and the vascular system’ and the figure of nurses pursuing their activity within those settings is constantly growing and evolving. Nurses must keep on training in procedures, new techniques, different procedural approaches and required equipment. Furthermore, this training has to develop besides the fundamentals, i.e. throughout briefing and debriefing sections. In fact, patient care is complex and mechanistic and therefore documented and transversal in order to satisfy clinical needs of the on–going process. In the hemodynamics ward in Massa’s Ospedale del Cuore of the Fondazione Toscana Gabriele Monasterio, diagnostics and interventions performed on patients are consistently developing. A hemodynamic patient leads, affects and characterises the nurse who must be able of taking care of their adult patients and pediatric ones until their prematurity.

Objective

Highlighting nursing skills in hemodynamics wards and types of training and care of patients of different age groups during procedural approaches.

Methods and Materials

Shared approval among medical directors of training courses to select for the training plan; mentorship; periodical evaluation of trainee plans; on–the–job nursing training; training courses chaired by experts; simulation of intra–setting emergency; evaluation of panic ranges to detect and it is necessary to act promptly for.

Outcome

In consideration of creating a nursing team capable of facing scenarios and procedures which can include every life stage of patients, it is paramount that a nurse follows the whole process. The procedural activities include the realization of a job description for basic and specialised skills and its observation. Outcomes and steps outlined to carry out care–giving performances are overseen each year. Lastly, it is necessary to know patients in their pre– and post–procedural stage up until the outcome of care–giving treatments.

Conclusions

Hemodynamics nurses are able to face changes and clinical solutions development alongside with a cross–disciplinary team.

Skeletal muscle acidosis correlates with the severity of blood volume loss during shock and resuscitation

BACKGROUND

Continuous assessment of tissue perfusion and oxygen utilization may allow for early recognition and correction of hemorrhagic shock. We hypothesized that continuously monitoring skeletal muscle (SM) PO2, PCO2, and pH during shock would provide an easily accessible method for assessing the severity of blood loss and the efficacy of resuscitation.

METHODS

Thirteen anesthetized pigs (25-35 kg) underwent laparotomy and femoral vessel cannulation. Multiparameter fiberoptic sensors were placed in the deltoid (SM) and femoral artery. Ventilation was maintained at a PaCO2 of 40-45 mm Hg. Total blood volume (TBV) was measured using an Evans blue dye technique. Animals were bled for 15 minutes, maintained at a mean arterial pressure (MAP) of 40 mm Hg for 1 hour, resuscitated (shed blood + 2 times shed volume in normal saline) and observed for 1 hour. Four animals served as controls (sham hemorrhage). Blood and tissue samples were taken at each time point.

RESULTS

Blood loss ranged from 28.5-56% of TBV. SM pH and SM PO2 levels fell rapidly with shock. SM PO2 returned to normal with resuscitation; however, SM pH did not return to baseline. SM PCO2 significantly rose with shock, but returned to baseline promptly with resuscitation. There was a significant correlation between SM pH and blood volume loss at end shock (r2 = 0.73, p < 0.001) and recovery (r2 = 0.84, p < 0.001). Animals (n = 2) whose SM pH did not recover to 7.2 were found to have ongoing blood loss from biopsy sites and persistent tissue hypercarbia despite normal MAP.

CONCLUSION

Continuous multiparameter monitoring of SM provides a minimally invasive method for assessing severity of shock and efficacy of resuscitation. Both PCO2 and PO2 levels change rapidly with shock and resuscitation. SM pH is directly proportional to lost blood volume. Persistent SM acidosis (pH < 7.2) and elevated PCO2 levels suggest incomplete resuscitation despite normalized hemodynamics.

Grazing by two species of limpets on artificial reefs in the northwest Mediterranean

The extensive presence of artificial reefs in marine coastal habitats demands a better understanding of the extent to which these structures can be considered surrogates of natural rocky shores for populations of plants and animals. The primary aim of this study was to test the hypothesis that removing limpets from the midlittoral of artificial breakwaters in the northwest Mediterranean led to changes in assemblages similar to those observed on rocky shores in the same area. Orthogonal combinations of the presence/absence of two species of limpets, P. aspera and P rustica, were produced using manual removals from June 1997 to February 1998. To test the hypothesis that the effects of limpets were variable at spatial scales comparable to those investigated on rocky shores, we repeated the experiment at two locations tens of kilometres apart, and on two reefs within each location a few kilometres apart. The results revealed strong and relatively consistent negative effects of limpets on filamentous algae, whereas interactions with other members of assemblages were complex and variable. Several taxa (Cyanophyta, encrusting and articulated coralline algae, Ralfsia and Rissoella) were abundant at one location but nearly absent at the other. This large-scale variability in patterns of distribution generated inconsistencies in the effects of limpets between locations. Within locations, several effects of P. aspera and P. rustica were observed, ranging from independent effects on some organisms, to additive or interactive effects on others. Apparently, the removal of filamentous algae by limpets resulted in positive indirect effects on Ralfsia and Rissoella. Collectively, these effects were comparable to those described for rocky shores in the northwest Mediterranean. The processes accounting for large-scale variation in grazing, however, appeared different between the natural and the artificial habitat.

Isolation and culture of two cell populations from chick calvaria by density gradient: prostaglandin synthesis by the cells in culture and coculture

In previous studies we demonstrated that PTH stimulates production of prostaglandin E2 (PGE2) by intact chick calvaria. In the present series of experiments, two cell populations were isolated from chick calvaria by centrifugation on a 25%/55% Percoll gradient. Cells harvested from the upper band of the Percoll gradient (designated F-1) appeared large and spindle-shaped in culture. Cells harvested from the lower band of the Percoll gradient (designated F-2) were relatively small and polygonal-shaped. Both cell populations required fetal bovine serum (FBS) for attachment and proliferation. In the presence of FBS the cells formed multilayers, but they formed confluent monolayers in the presence of heat-inactivated FBS. The pattern of cAMP responses to different effectors and biochemical determinations for alkaline and acid phosphatase suggests that the F-2 fraction consists primarily of osteoblasts. No cells with osteoclastic patterns appeared in either fraction. Both cell types synthesized predominantly PGD2. PGE2 was also produced, however, in considerably smaller quantities. PG production in the presence of ionophore A23187 (1 microM) or arachidonate (10 microM) increased significantly when the F-1 and F-2 cells were cocultured at a 1:1 ratio. These results suggest that cell to cell or cell to matrix interactions normally present in intact bone influence PG synthesis.

Prostaglandin synthesis by cells comprising the calf pulmonary artery

Prostaglandin (PG) production was evaluated in the three cell types (endothelial, smooth muscle, and fibroblast) comprising the bovine pulmonary artery. Prostacyclin (PGI2) was the predominant prostaglandin (PG) produced by endothelial, smooth muscle, and fibroblast cells as they exist in culture or in freshly excised tissue fragments. In addition to PGI2, measurable amounts of PGE2, PGF2a, and thromboxane A2 (TXA2) were also produced by these cells. Endothelial cells were the most active producers of PGs. However, the type of PG produced was characteristic of the particular cell type, while the level of production was dependent on external factors. Prostaglandin production by cultured cells, both under basal conditions and in response to stimulatory agents, was quite similar to that of the respective freshly excised tissue fragments containing a given cell type. These cells in culture could be stimulated to produce PGI2 by both angiotensin and bradykinin at very low (physiological) concentrations, a further indication of the retention of the physiological responsiveness of these cells in culture. Endothelial cells and fibroblasts were activated by bradykinin at concentrations as low as 10(-12) M but did not respond to angiotensin. Smooth muscle cells in primary and first passage cultures were activated by both bradykinin and angiotensin at 10(-12) M concentrations. Serial subcultivations of smooth muscle cells resulted in a progressive loss in their responsiveness to bradykinin stimulation. The state of cell growth proved to be an important determinant of PG production. Actively growing cells in culture synthesized less PG when compared to cells which had entered into a "quiescent" nongrowth state.

The effect of ascorbate, hydroperoxides, and bradykinin on prostaglandin production by corneal and lens cells

Epithelial cells from the rabbit cornea, fibroblasts from the rabbit and calf cornea, and calf lens epithelial cells were placed in individual cultures. Prostaglandin (PG) synthesis by these cell types was determined. Lens epithelial cells produced no detectable PGs under basal conditions. Corneal fibroblasts primarily produced PGE2, while epithelial cells primarily produced thromboxane A2. PG production by corneal fibroblasts was highly responsive to bradykinin, ascorbic acid, hydrogen peroxide, and t-butyl hydroperoxide, an organic peroxide. Quantitative differences in PG production between the rabbit and calf corneal fibroblasts were observed. Our results suggest that the reported therapeutic actions of ascorbic acid in the eye may, at least in part, be mediated through the PGs. Our results also support the proposed role for hydroperoxides in the control of PG synthesis.