Odessa College

Introduction: Death certificates are the primary source for estimating the population-level burden of sepsis mortality, while ICD codes are often used to identify sepsis deaths in hospital claims data. Based on ICD codes, sepsis is present in up to 1 in 2 hospital decedents in the United States. A prior study comparing the number of sepsis decedents in hospital claims data and death certificates showed markedly lower figures among the latter, but the findings are dated and different ICD coding approaches were used for claims and death certificate data. We evaluated the contemporary concordance of similarly coded sepsis diagnosis between population-level hospital claims data and death certificates. Methods: We used a statewide dataset to identify all in-hospital decedents aged ≥18 years in Texas and the corresponding aggregate inpatient death certificate data from CDC WONDER during 2020-2023. An identical, previously reported ICD-10 code-based taxonomy was used to identify sepsis in claims data and death certificates. Normal approximation was used to estimate the rate difference [RD] and rate ratio [RR] in the frequency of sepsis diagnosis overall and in demographic and COVID-19 diagnosis strata, and for their comparisons across categories within examined strata. Results: There were 282,958 decedents in claims data and 321,660 in death certificates, with 136,886 (48.4%) and 67,212 (20.9%) reporting sepsis, respectively (RD 27.5% [95% CI 27.2-27.8]; RR 2.32 [95% CI 2.30-2.33]). RD in the frequency of sepsis diagnosis between claims data and death certificates ranged from 23.0% (non-COVID-19) to 41.6% (COVID-19), with corresponding RR 2.04 and 3.49, respectively. RD in the frequency of sepsis diagnosis between claims data and death certificates and their RR varied across the examined strata categories, being highest among decedents aged 18-44 years (vs ≥65 years), males (vs females), Hispanics (vs Whites), and those with COVID-19 (vs non-COVID-19). Conclusions: Death certificates substantially underestimated the burden of sepsis-associated mortality among hospital decedents, when compared to hospital claims data in Texas, with the use of an identical ICD code-based algorithm. The gaps in the frequency of sepsis diagnosis were greater among younger decedents, males, Hispanics, and those with COVID-19.

Introduction: Racial and ethnic minority status has been associated with increased risk of COVID-19-related critical illness, but evidence has been mixed on the prognostic impact of race and ethnicity among the critically ill. We examined the comparative trends in short-term mortality across race and ethnicity strata of critically ill patients with COVID-19. Methods: We used a statewide dataset to identify ICU admissions aged ≥18 years with a principal diagnosis of COVID-19 in Texas, from April 1, 2020 to December 31, 2023. COVID-19 was defined as ICD-10 code U071. Hierarchical logistic models were fit to estimate the association of time (quarters) with short-term mortality (defined as in-hospital death or discharge to hospice) among critically ill COVID-19 patients. Interaction terms were included between each racial and ethnic minority group (with Whites as reference) and time overall and on sensitivity analyses of older adults and the mechanically ventilated. Results: There were 164,719 ICU admissions with COVID-19 (49.1% aged ≥65 years; 44.4% female; 52.4% racial and ethnic minorities [32.3% Hispanics, 12.2% Blacks, 7.9% Other]). Overall short-term mortality was 20.0%. On adjusted analyses, short-term mortality decreased over time among Hispanics (adjusted odds ratio [aOR] 0.97/quarter [95% CI 0.96-0.98]) and Whites (aOR 0.94/quarter [95% CI 0.93-0.95]), but not among Blacks (aOR 0.98/quarter [95% CI 0.96-1.01]) or Other minorities (aOR 0.98/quarter [95% CI 0.96-1.01]). There were significant interactions among all race and ethnicity minorities (vs Whites) and time overall, but not among those aged ≥65 years or the mechanically ventilated. Compared to Whites, short-term mortality was higher over time among Hispanic ICU admissions (aOR/quarter 1.03 [95% CI 1.01-1.04]). Conclusions: Short-term mortality among critically ill patients with COVID-19 has decreased over time among White and Hispanic people, but not among Black individuals or Other racial and ethnic minorities. However, even among Hispanic individuals, these outcome gains were not shared equitably compared to Whites. Further studies are needed to examine the factors underlying the divergence of outcome trajectories across racial and ethnic groups among critically ill patients with COVID-19 during the latter pandemic years.

Intro: Peripheral venous stenting is an important treatment for iliocaval venous obstruction, but stent migration is a rare, serious complication with an incidence of 0.9–4.3% and mortality rates up to 60%. Migration to the heart or lungs can cause life-threatening events. Presentations are often vague—dyspnea, dizziness, chest discomfort—leading to delays in care. No standard surveillance guidelines exist. Early recognition is crucial to reducing morbidity and mortality. Aim: To emphasize early detection of venous stent migration through clinical vigilance and prompt imaging, and to highlight the importance of continued monitoring for thromboembolic complications post-retrieval. Description: A 52-year-old woman with hypertension, diabetes, hypothyroidism, and prior left iliac vein stenting for chronic venous insufficiency presented to primary care with postural dizziness, exertional dyspnea, and mild headache. Physical exam and vital signs were unremarkable. Given her history, a transthoracic echocardiogram was obtained, revealing a dislodged stent extending from the right atrium into the right ventricle. She was referred urgently to the hospital, where intravenous heparin was initiated. Percutaneous retrieval via transfemoral access was unsuccessful due to stent entrapment in cardiac structures. Open-heart surgical retrieval was performed following confirmation of normal coronary anatomy. Initial recovery was uneventful; however, several weeks later, she developed a segmental pulmonary embolism, treated successfully with apixaban. She returned to baseline without further complications. Early detection enabled timely intervention and likely prevented fatal outcomes. Discussion: Venous stent migration can cause embolism, valvular damage, arrhythmias, and tamponade. Diagnosis is challenging due to vague symptoms and lack of surveillance protocols. This case highlights the role of outpatient providers in early detection and referral. Multidisciplinary coordination among primary care, cardiology, vascular surgery, and radiology is essential. Vigilance must continue post-retrieval, as the patient’s pulmonary embolism illustrates the ongoing thromboembolic risk. Continued monitoring, anticoagulation, and follow-up imaging are critical to mitigating late complications. Conclusion: Venous stent migration, though rare, can have severe consequences. Early outpatient recognition, prompt imaging, and long-term surveillance are essential to improve patient outcomes.

Abstract This paper presents current advances and innovations in gas separation and regulation technologies to address high Gas-Liquid Ratio (GLR) and gas slugging conditions in petroleum wells equipped with Electric Submersible Pump (ESP) systems. The application of this design in severely problematic wells with significant gas production and slugging issues highlights the critical importance of separating and conditioning fluids before they reach the pump intake, serving as a bridge before transitioning to another artificial lift system. Effective gas separation in an ESP system, beyond the existing ESP gas separator, involves shrouding certain ESP components. The engineered design discussed in this paper utilizes casing to enhance gas separation through several stages. These stages include isolating the pump intake using a shroud, sealing the casing with a Triple Seal Cup-Type Packer, and combining outlet and inlet sections that reverse the flow path to significantly reduce fluid velocity. This reduced velocity aids in successful gas separation. A sealed shroud above the pump intake is connected to the gas separator below the sensor, ensuring gas-free liquid flow around the motor, which helps maintain optimal motor temperatures in wells with high gas content. A study on unconventional wellbore simulations, specifically focusing on toe-down completions, highlights the impact on slugging conditions. The formation of gas slugs under these conditions can negatively affect the operation of an electric submersible pump (ESP). An alternative design, which does not require a shroud, regulates gas flow through agitation, pressure and velocity changes, and increased retention time to mix gas slugs into the liquid pool. This creates a homogeneous flow regime, or dispersed bubble flow, which also contributes to maintaining optimal motor temperatures, improving pump efficiency, and preventing gas locking conditions. Case studies from the Permian Basin demonstrate the positive impact of selecting an appropriate downhole conditioning system. Significant improvements in sensor parameters will showcase the benefits of handling gas and sand before the pump intake, resulting in reduced shutdowns and non-productive time, ultimately enhancing fluid production. The flexibility of this design is also noteworthy, as it can be installed across a wide range of fluid production levels, gas-liquid ratios, and various tubing and casing sizes. These advanced technologies maximize ESP efficiency in gassy wells, either by using casing to enhance gas separation or by regulating gas surges with innovative designs that convert slug flow into homogeneous flow.

Background: Heart failure (HF) is a chronic condition with high morbidity and mortality rates, and is known to pose a significant burden on the healthcare system. Telemonitoring, an innovative approach using remote monitoring of patients' health data, has emerged as a potential solution to enhance HF management and improve patient outcomes. Research Question: This systematic review investigates whether telemonitoring interventions improve heart failure outcomes compared to standard care. Aim: We aim to synthesize the current evidence on the impact of telemonitoring on all-cause mortality, cardiovascular mortality, heart failure-related hospitalization, and health-related quality of life in patients with heart failure. Methods: We conducted a thorough search of electronic databases, including PubMed, Cochrane Library, Google Scholar, and PLOS Medicine, to identify relevant randomized controlled trials (RCTs) and systematic reviews/meta-analyses (SRs/MAs) evaluating telemonitoring interventions in heart failure. Studies were selected based on pre-defined criteria. A review of the literature and risk of bias assessment was performed independently by four reviewers. Results: Out of 16,778 articles reviewed, eight were chosen for this study, comprising 3 SRs/MAs and 5 RCTs. The findings suggest that using telemonitoring interventions, such as structured telephone support, mobile health interventions, and medication support, significantly reduces deaths and hospitalizations in heart failure patients compared to standard care. Longer telemonitoring duration (≥12 months) significantly lowered hospitalization rates. Conclusions: This systematic review suggests that telemonitoring may be associated with improved heart failure outcomes, including reduced mortality and hospitalization rates. However, further research is needed to explore telemonitoring interventions' long-term effects and cost-effectiveness in heart failure management.

Abstract Since fall 2019, Odessa College's dual credit program has grown by 67%. Texas’ initiatives, around college, career, and military readiness (CCMR), certainly provided an impetus for growth in dual credit, but this tremendous level of growth points to a number of structural changes Odessa College made to its dual credit program. The article focuses how the college created deeper, systemic partnerships between the dual credit program and the school districts.

Introduction: Patients with fibromyalgia are reported to have increased burden of comorbid conditions that were shown to be associated with increased risk of sepsis, and there have been conflicting findings on the population-level sepsis-related mortality rates among affected patients, compared to the general population. However, the association of fibromyalgia with case fatality in sepsis is unknown. Methods: We used a statewide data set to identify hospitalizations aged ≥18 years with sepsis in Texas during 2014-2017. Sepsis was defined by “explicit” ICD-9 and ICD-10 codes for severe sepsis (995.92, R65.20) and septic shock (785.52, R65.21). Fibromyalgia was identified using ICD-9 and ICD-10 codes 729.1 and M79.7. Hierarchical, mixed-effects logistic models were used to estimate the association of fibromyalgia with short-term mortality (defined as in-hospital death or discharge to hospice) among sepsis hospitalizations and for sensitivity analyses restricted to ICU admissions and those with septic shock. Results: Among 283,025 sepsis hospitalizations, 2,998 (1.0%) had fibromyalgia. Compared to those without fibromyalgia, sepsis hospitalizations with fibromyalgia were younger (aged ≥65 years, 40.4% vs 56.9%), more commonly female (90.3% vs 50.0%), and had lower mean [SD] Deyo comorbidity index (2.2 [2.0] vs 2.7 [2.4]) [p < 0.0001 for all comparisons], but similar rates of ICU admission (46.8% vs 46.0%; p = 0.3880) and septic shock (56.0% vs 57.6%; p = 0.0779). The short-term mortality among sepsis hospitalizations with vs without fibromyalgia was 17.1% vs 31.4%, respectively. On adjusted analyses, fibromyalgia remained associated with lower risk of short-term mortality (adjusted odds ratio [aOR] 0.58 [95% CI 0.52-0.65]), with similar findings on sensitivity analyses among ICU admissions (aOR 0.61 [95% CI 0.52-0.71]) and septic shock (aOR 0.59 [95% CI 0.52-0.68]). Conclusions: Fibromyalgia had, unexpectedly, a “protective” association with short-term mortality in septic patients. Additional studies are needed to corroborate these observations, and to determine the factors contributing to the observed associations.

Panchagnula, Neha1; Garza, John2; Dang, Thao3; Sidhu, Mandeep3; Mahmood, Saima3; Raheem, Abdur3; Tariq, Hina3; Oud, Lavi4 Author Information