Lifecourse Growth and Development Determinants of Mammographic Density in Black Women.

Background: High mammographic density is one of the strongest breast cancer risk factors; however, determinants of high mammographic density are understudied in Black women. We assessed growth and development factors across the lifecourse in relation to mammographic density.

Methods: Within the Black Women's Health Study, we used Cumulus software to assess percent mammographic density from digital screening mammograms for 5,905 women ages 40 to 74 years.

Implementation of a Cell-Enabled Remote Blood Pressure Monitoring Program During the Postpartum Period at a Safety-Net Hospital.

Background: Postpartum hypertension is a risk factor for severe maternal morbidity; however, barriers exist for diagnosis and treatment. Remote blood pressure (BP) monitoring programs are an effective tool for monitoring BP and may mitigate maternal health disparities. We aimed to describe and evaluate engagement in a remote BP monitoring program on BP ascertainment during the first 6-weeks postpartum among a diverse patient population.

Burden and trajectory of social needs after breast cancer diagnosis at a safety-net hospital.

Purpose: Unmet social needs pose barriers to cancer care, contributing to adverse outcomes and health inequities. A better understanding of how social needs change after cancer diagnosis can inform more effective, equity-focused interventions.

Methods: In this study, we examined self-reported social needs at 0, 3, and 6 months after a breast cancer diagnosis in a racially diverse, multilingual sample (n = 222) enrolled in patient navigation intervention at an urban safety-net hospital.

Disparities in Child Welfare Referrals for Patients Seen in a Pediatric Emergency Department for Unintentional Ingestions.

Objective: To examine the characteristics of patients visiting the pediatric emergency department (PED) for unintentional ingestions and associations between patient race and ethnicity in referrals to Child Protective Services (CPS) for supervisory neglect.

Methods: We conducted a cross-sectional analysis of children <12 years old who presented to the PED between October 2015 and December 2020 for an unintentional ingestion. Patients were identified by searching the electronic health record for diagnosis codes corresponding to unintentional ingestions.

Disparities in use of physical restraints at an urban, minority-serving hospital emergency department.

Background: Recent reports have identified associations between patient race and ethnicity and use of physical restraint while receiving care in the emergency department (ED). However, no study has assessed this relationship in hospitals primarily treating patients of color and underserved populations. The primary objective of this study was to evaluate the association between race/ethnicity and the use of restraints in an ED population at a minority-serving, safety-net institution.

Patient navigation to address sociolegal barriers for patients with cancer: A comparative-effectiveness study.

Background: Sociolegal barriers to cancer care are defined as health-related social needs like affordable healthy housing, stable utility service, and food security that may be remedied by public policy, law, regulation, or programming. Legal support has not been studied in cancer care.

Methods: The authors conducted a randomized controlled trial of patients who had newly diagnosed cancer at a safety-net medical center in Boston from 2014 through 2017, comparing standard patient navigation versus enhanced navigation partnered with legal advocates to identify and address sociolegal barriers.

Calculating power for the Finkelstein and Schoenfeld test statistic for a composite endpoint with two components.

The Finkelstein and Schoenfeld (FS) test is a popular generalized pairwise comparison approach to analyze prioritized composite endpoints (eg, components are assessed in order of clinical importance). Power and sample size estimation for the FS test, however, are generally done via simulation studies. This simulation approach can be extremely computationally burdensome, compounded by increasing number of composite endpoints and with increasing sample size.

Adaptation of a Simulation Model and Checklist to Assess Pediatric Emergency Care Performance by Prehospital Teams.

Introduction: Simulation tools to assess prehospital team performance and identify patient safety events are lacking. We adapted a simulation model and checklist tool of individual paramedic performance to assess prehospital team performance and tested interrater reliability.

Methods: We used a modified Delphi process to adapt 3 simulation cases (cardiopulmonary arrest, seizure, asthma) and checklist to add remote physician direction, target infants, and evaluate teams of 2 paramedics and 1 physician.

Racial equity in linkage to inpatient opioid use disorder treatment in patients that received emergency care.

Objectives: Opioid use disorder (OUD) is a national epidemic, and Black and Hispanic patients are less likely to receive treatment when compared to white patients. In this study, race was used as a proxy to assess potential effects of racism on the referral process for OUD treatment. Our primary aim was to examine whether Black or Hispanic patients experienced increased barriers to inpatient OUD detoxification (detox) placement at a community-integrated, substance use disorder support program based in an emergency department (ED).

Persistent inter-observer variability of breast density assessment using BI-RADS® 5th edition guidelines.

Objectives: Due to most states' legislation, mammographic density categorization has potentially far-reaching implications, but remains subjective based on BIRADS® guidelines. We aimed to determine 1) effect of BI-RADS® 5th edition (5th-ed) vs 4th-edition (4th-ed) guidelines on reader agreement regarding density assessment; 2) 5th-ed vs 4th-ed density distribution, and visual vs quantitative assessment agreement; 3) agreement between experienced vs less experienced readers.

Methods: In a retrospective review, six breast imaging radiologists (BIR) (23-30 years' experience) visually assessed density of 200 screening mammograms performed September 2012-January 2013 using 5th-ed guidelines.

Methods of assessing categorical agreement between correlated screening tests in clinical studies.

Advances in breast imaging and other screening tests have prompted studies to evaluate and compare the consistency between experts' ratings of existing with new screening tests. In clinical settings, medical experts make subjective assessments of screening test results such as mammograms. Consistency between experts' ratings is evaluated by measures of inter-rater agreement or association.

Measuring rater bias in diagnostic tests with ordinal ratings.

Diagnostic tests are frequently reliant upon the interpretation of images by skilled raters. In many clinical settings, however, the variability observed between experts' ratings plays a detrimental role in the degree of confidence in these interpretations, leading to uncertainty in the diagnostic process. For example, in breast cancer testing, radiologists interpret mammographic images, while breast biopsy results are examined by pathologists.

False negative point-of-care urine pregnancy tests in an urban academic emergency department: a retrospective cohort study.

Study Objective: To determine the prevalence of false negative point-of-care (POC) urine pregnancy tests among emergency department (ED) patients and among those with abdominal pain or vaginal bleeding.

Methods: We identified all female patients, ages 14-50 years without prior hysterectomy who had a negative POC urine pregnancy test (beta subunit of human chorionic gonadotropin [β-hCG]) performed by trained clinical staff in the ED between September 1, 2017 and December 31, 2018, as well as a subgroup we defined a priori as "high risk" for early pregnancy complications based on a triage chief complaint (text) of abdominal pain or vaginal bleeding. We identified those with a positive urine β-hCG, serum β-hCG >5 mIU/mL, or a diagnosis of pregnancy within 3 months of the initial ED visit (index visit).

A Comparison of Etomidate, Ketamine, and Methohexital in Emergency Department Rapid Sequence Intubation.

Background: Rapid sequence intubation (RSI) is routinely used for emergent airway management in the emergency department (ED). It involves the use of induction, and paralytic agents help facilitate endotracheal tube placement.

Objective: In response to a previous national drug shortage resulting in the use of alternative induction agents for RSI, we describe the effectiveness and safety of ED RSI with ketamine or methohexital compared with etomidate.

Point-of-care Lung Ultrasound Is More Sensitive than Chest Radiograph for Evaluation of COVID-19.

Introduction: Current recommendations for diagnostic imaging for moderately to severely ill patients with suspected coronavirus disease 2019 (COVID-19) include chest radiograph (CXR). Our primary objective was to determine whether lung ultrasound (LUS) B-lines, when excluding patients with alternative etiologies for B-lines, are more sensitive for the associated diagnosis of COVID-19 than CXR.

Methods: This was a retrospective cohort study of all patients who presented to a single, academic emergency department in the United States between March 20 and April 6, 2020, and received LUS, CXR, and viral testing for COVID-19 as part of their diagnostic evaluation.

Disparities in baseline neurocognitive testing for student concussion management in Massachusetts high schools.

Purpose: There is evidence of socioeconomic disparities with respect to the implementation of student-sports concussion laws nationally. The purpose of this study was to examine school sociodemographic characteristics associated with the provision of computerised baseline neurocognitive testing (BNT) in Massachusetts (MA) high schools, and to assess whether the scope of testing is associated with the economic status of student populations in MA.

Methods: A cross-sectional secondary analysis of surveys conducted with MA athletic directors (n=270) was employed to investigate school characteristics associated with the provision of BNT.

Measuring intrarater association between correlated ordinal ratings.

Variability between raters' ordinal scores is commonly observed in imaging tests, leading to uncertainty in the diagnostic process. In breast cancer screening, a radiologist visually interprets mammograms and MRIs, while skin diseases, Alzheimer's disease, and psychiatric conditions are graded based on clinical judgment. Consequently, studies are often conducted in clinical settings to investigate whether a new training tool can improve the interpretive performance of raters.

Loop Drainage Is Noninferior to Traditional Incision and Drainage of Cutaneous Abscesses in the Emergency Department.

Background: There is limited research on loop drainage (LD) compared to incision and drainage (I&D) for treatment of cutaneous abscesses. We investigated whether LD was noninferior to I&D for abscess resolution and whether there was any difference in repeat ED visits or complication rates between these techniques.

Methods: We performed a prospective randomized controlled trial, using a convenience sample at an urban academic emergency department (ED).

Health Literacy, Language, and Cancer-Related Needs in the First 6 Months After a Breast Cancer Diagnosis.

Purpose: Low health literacy (HL) and language negatively affect cancer screening and prevention behaviors; less is known about how they affect the patient's experience during cancer treatment. This study explores associations among HL, spoken language, and dimensions of cancer-related needs within 6 months of receiving a breast cancer diagnosis.

Methods: Women speaking English, Spanish, or Haitian Creole, enrolled in a patient navigation study at diagnosis, completed a survey in their primary spoken language at baseline and 6 months to characterize their cancer-related needs.

Measuring Agreement Among Prehospital Providers and Physicians in Patient Capacity Determination.

Objectives: If a patient wishes to refuse treatment in the prehospital setting, prehospital providers and consulting emergency physicians must establish that the patient possesses the capacity to do so. The objective of this study is to assess agreement among prehospital providers and emergency physicians in performing patient capacity assessments.

Methods: This study involved 139 prehospital providers and 28 emergency medicine physicians.

Bayesian hierarchical latent class models for estimating diagnostic accuracy.

The diagnostic accuracy of a test or rater has a crucial impact on clinical decision making. The assessment of diagnostic accuracy for multiple tests or raters also merits much attention. A Bayesian hierarchical conditional independence latent class model for estimating sensitivities and specificities for a large group of tests or raters is proposed, which is applicable to both with-gold-standard and without-gold-standard situations.

A paired kappa to compare binary ratings across two medical tests.

Agreement between experts' ratings is an important prerequisite for an effective screening procedure. In clinical settings, large-scale studies are often conducted to compare the agreement of experts' ratings between new and existing medical tests, for example, digital versus film mammography. Challenges arise in these studies where many experts rate the same sample of patients undergoing two medical tests, leading to a complex correlation structure between experts' ratings.

Marginal analysis of ordinal clustered longitudinal data with informative cluster size.

The issue of informative cluster size (ICS) often arises in the analysis of dental data. ICS describes a situation where the outcome of interest is related to cluster size. Much of the work on modeling marginal inference in longitudinal studies with potential ICS has focused on continuous outcomes.