Brown Computer Company (United States)

Background:Hypertension disparities persist across communities, driven by interactions between social determinants of health (SDOH) and behavioral factors. This study examines geographic and demographic patterns of hypertension in Nashville, Tennessee, to assess how socioeconomic, environmental, and behavioral factors contribute to inequities in prevalence, treatment, and control. Granular ZIP code-level analyses highlight community-specific drivers and the need for policy reforms to advance health equity.Methods and Results:Using 2022 data from the U.S. Census Bureau’s American Community Survey and CDC PLACES, we analyzed 199 Nashville ZIP codes. K-means clustering identified five population clusters. Lower-income clusters (e.g., Hardship Heartland: 37.2% hypertension prevalence; Urban Renters: 33.7%) exhibited elevated physical inactivity (30.9%), insufficient sleep (38.9%), smoking (22.6%), alongside limited healthcare access. Affluent clusters (Elite Enclaves: 30.8%) demonstrated better cardiovascular health. Non-Hispanic Black residents in urban cores faced disproportionately higher hypertension rates (35.4%) compared to non-Hispanic white residents in the same clusters (e.g., 43.8% white residents in Urban Renters).Conclusions:Structural inequities—poverty, housing instability, and unequal healthcare access—drive hypertension disparities. Multi-sector interventions targeting upstream SDOH (e.g., affordable housing, equitable healthcare, and community wellness programs) are critical to reduce cardiovascular risk. Policy reforms prioritizing place based strategies in high-burden communities could mitigate disparities and improve population health.

Background: Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing lung disease that predominantly affects older adults. Structured exercise is a useful therapy in IPF. Home-based exercise enabled by mobile health monitoring may remove some accessibility barriers associated with center-based rehabilitation, but may also introduce technology-related use barriers among older adults. Subjects: Seventeen adults with IPF [7 female, mean age 67.4 ± 9 (SD)] Methods: In-depth, semi-structured interviews explored the usability and user experience associated with a remote monitoring system among adults with IPF, after 16 weeks of interaction with medical-grade pulse oximetry, as part of a randomized controlled trial of a 12-week home exercise intervention (NCT04838275). Results: Participants felt that the use of medical-grade pulse oximetry (1) enhanced safety during exercise, (2) enabled tracking of progress, and (3) empowered autonomy and real-time decision-making about intensity pacing and supplemental oxygen use. Barriers to pulse oximetry usability included (4) problems syncing and sharing pulse oximetry data with the study team. Despite some usability challenges, participants reported a positive overall experience with the system, with 94% perceiving medical-grade pulse oximetry as a strong exercise facilitator in IPF. Conclusions: Medical-grade pulse oximetry enhances perceived safety and autonomy during home exercise in adults with IPF, facilitating increased confidence when making decisions about exercise intensity pacing and supplemental oxygen use. As IPF disproportionately affects older adults, pulse oximetry monitoring systems should incorporate older adult-centered design principles to improve the user experience of adults with IPF during home exercise. Key words: digital health, idiopathic pulmonary fibrosis, pulse oximetry, structured exercise, usability

Noncemented primary total knee arthroplasty (TKA) compromises over 14% of all primary TKA procedures reported in the American Joint Replacement Registry. While studies have indicated similar outcomes for cemented and noncemented TKA in obese individuals, the efficacy and safety of noncemented TKA in morbidly obese patients (body mass index [BMI] ≥ 40 kg/m2) remain unexplored. This study compares short-term postoperative outcomes and complications between noncemented and cemented TKA in morbidly obese patients. A retrospective review of 605 cases of patients with a BMI of at least 40 kg/m2 (22.5% of 2,691 total cases at a single tertiary center) who underwent TKA was conducted. All patients had a minimum follow-up of 1 year. Data collected included age, BMI, sex, race, ethnicity, American Society of Anesthesiologists status, and the Charlson Comorbidity Index. Postoperative complications were tracked, including 90-day readmission, 1-year mortality, 1-year revision surgery, wound complications, fractures, and infections. Categorical variables were analyzed with chi-square tests and continuous variables with t-tests. Of the included patients with a BMI ≥ 40 kg/m2, 40 (6.6%) received noncemented TKA. The noncemented TKA group had a lower mean BMI (43.3 ± 3.1 vs. 45.0 ± 4.4; P = 0.012) and a higher proportion of male patients compared with the cemented group (n = 17 [42.5%] vs. n = 143 [25.3%]; P = 0.028). Surgical time was shorter for noncemented TKA (97 ± 27 minutes) than for cemented TKA (118.0 ± 39.4 minutes; P = 0.001). No significant differences were found in length of stay and postoperative complications, including 90-day readmission, 1-year mortality, revision surgery rates, wound complications, fractures, and infections. The findings of the study suggest that noncemented TKA may be a feasible, safe alternative and not inferior to the standard cemented TKA in patients with morbid obesity with the benefit of decreasing surgical time.

Patients with culture-negative pulmonary TB (PTB) can face delays in diagnosis that worsen outcomes and lead to ongoing transmission. An understanding of current trends and characteristics of culture-negative PTB can support earlier detection and access to care. Describe epidemiology of culture-negative PTB. We utilized Alameda County TB surveillance data from 2010 to 2019. Culture-negative PTB cases met clinical but not laboratory criteria for PTB per US National Tuberculosis Surveillance System definitions. We calculated trends in annual incidence and proportion of culture-negative PTB using Poisson and weighted linear regression, respectively. We further compared demographic and clinical characteristics among culture-negative versus culture-positive PTB cases. During 2010-2019, there were 870 cases of PTB, of which 152 (17%) were culture-negative. The incidence of culture-negative PTB declined by 76%, from 1.9/100 000 to 0.46/100 000 ( P for trend <.01), while the incidence of culture-positive PTB reduced by 37% (6.5/100 000 to 4.1/100 000, P for trend =.1). Culture-negative PTB case-patients were more likely than culture-positive PTB case-patients to be younger (7.9% were children <15 years old vs 1.1%; P < .01), recent immigrants within 5 years of arrival (38.2% vs 25.5%; P < .01), and have a TB contact (11.2% vs 2.9%; P < .01). Culture-negative PTB case-patients were less likely than culture-positive PTB case-patients to be evaluated because of TB symptoms (57.2% vs 74.7%; P < .01) or have cavitation on chest imaging (13.1% vs 38.8%; P < .01). At the same time culture-negative PTB case-patients were less likely to die during TB treatment (2.0% vs 9.6%; P < .01). The incidence of culture-negative PTB disproportionately declined compared with culture-positive TB and raises concern for gaps in detection. Expansion of screening programs for recent immigrants and TB contacts and greater recognition of risk factors may increase detection of culture-negative PTB.

Coronavirus disease (COVID-19) is an illness that was sudden, unexpected, and global. Primarily a disease of the vascular endothelium, the virus threatens all of core systems, as well as behavioral and mental health, during the acute and long-term phases. Attention is now being given to the identification and care of post-acute sequelae of COVID-19. This article presents the case of a "long hauler" who presented post-cardiac arrest with a history of COVID-19. Diagnosed with Brugada syndrome, his assessment, diagnosis, and care are discussed. In addition, the need for early identification and care for patients with post-COVID-19 symptoms is addressed.

This chapter offers a review of the preliminary hazard analysis (PHA) process and evaluation of prevention measures. The PHA model provides an analysis of the “current state” risk levels, and the “future state” risk levels with proposed risk reduction measures. Prior to a PHA, a preliminary hazard list is commonly used to identify and compile a list of potential, significant hazards associated with a system's design. PHAs often include a basic review of potential energy or hazardous materials and their potential uncontrolled release. PHA is appropriate to include a list of fundamental principles that apply to the system safety approach. A preliminary hazard and risk analysis (PHRA) is essential to the preventive and proactive aspect of a safety management system. PHRA is primarily used to identify hazards, assess the initial risks, identify potential control measures and estimation of risk reduction.

Inequality After the Transition: Political Parties, Party Systems, and Social Policy in Southern and Postcommunist Europe. By Ekrem Karakoç. Oxford: Oxford University Press, 2018. 352p. $95.00 cloth. - Volume 18 Issue 1

An increasing number of researchers are examining the benefits and outcomes of caregiver-implemented interventions for young children with delays or disabilities. Most report the incorporation of multiple coaching strategies within their approach; however, definitions and descriptions of coaching strategies and processes continue to be limited. This scoping review examined the use of various coaching strategies across models of caregiver coaching in early intervention, with a specific focus on problem solving and reflection coaching strategies occurring in the literature between 2011 and 2018. Problem solving and reflection are 2 coaching strategies incorporated into coaching approaches to build caregiver competency, confidence, and independence within intervention implementation. The results of this review may guide the field in further defining caregiver coaching as well as specific coaching strategies, such as problem solving and reflection.

The geriatric (≥65 years of age) population is one of the fastest growing age groups in the United States. As this number increases, so does the number of geriatric trauma patients. Because this group has higher mortality rates and requires more resources, a Geriatric Trauma Palliative Care Program was created at a Level 1 Trauma Center in Dallas, TX, to provide concurrent lifesaving therapies and primary palliative care to older adults. The trauma program implemented the American College of Surgeons (ACS) Trauma Quality Improvement Program Palliative Care Best Practices Guidelines () to better care for acute traumatic injuries as well as the specific spiritual, emotional, and psychiatric needs of the geriatric trauma palliative care patient and family. Using the guidelines, the team performed a gap analysis, carried out program development, created a palliative care pathway to guide our evidence-based practice implementation, and performed retrospective chart reviews for 3-month pre- and postimplementation analysis. Using Person's χ test and Fisher's exact test, our initial evaluation of the program showed statistically significant (p < .001) improvements in the measures related to the implementation of primary palliative care, pain and symptom management, and end-of-life care. The guidelines gave the team a consistent framework for implementing the basic competencies required to deliver primary palliative care, pain and symptom management, and end-of-life care to trauma patients.

Standard evaluation practice in public health remains limited to evaluative measures linked to individual projects, even if multiple interrelated projects are working toward a common impact. Enterprise evaluation seeks to fill this policy gap by focusing on cross-sector coordination and ongoing reflection in evaluation. We provide an overview of the enterprise evaluation framework and its 3 stages: collective creation, individual data collection, and collective analysis. We illustrate the application of enterprise evaluation to the Gulf Region Health Outreach Program, 4 integrated projects that aimed to strengthen health care in Louisiana, Mississippi, Alabama, and the Florida Panhandle after the Deepwater Horizon oil spill. Shared commitment to sustainability and strong leadership were critical to Gulf Region Health Outreach Program's success in enterprise evaluation. Enterprise evaluation provides an important opportunity for funding agencies and public health initiatives to evaluate the impact of interrelated projects in a more holistic and multiscalar manner than traditional siloed approaches to evaluation.