National Hospital Care Survey Demonstration Projects: Examination of Inpatient Hospitalization and Risk of Mortality Among Patients Diagnosed With Pneumonia

NHSR 167

Population homogeneity for the antibody response to COVID-19 BNT162b2/Comirnaty vaccine is only reached after the second dose across all adult age ranges

While mRNA vaccines are administrated worldwide in an effort to contain the COVID-19 pandemic, the heterogeneity of the humoral immune response they induce at the population scale remains unclear. Here, in a prospective, longitudinal, cohort-study, including 1245 hospital care workers and 146 nursing home residents scheduled for BNT162b2 vaccination, together covering adult ages from 19 to 99 years, we analyse seroconversion to SARS-CoV-2 spike protein and amount of spike-specific IgG, IgM and IgA before vaccination, and 3-5 weeks after each dose. We show that immunogenicity after a single vaccine dose is biased to IgG, heterogeneous and reduced with increasing age. The second vaccine dose normalizes IgG seroconversion in all age strata. These findings indicate two dose mRNA vaccines is required to reach population scale humoral immunity. The results advocate for the interval between the two doses not to be extended, and for serological monitoring of elderly and immunosuppressed vaccinees.

The Diabetes Transition of Hospital Care (DiaTOHC) Pilot Study: A Randomized Controlled Trial of an Intervention Designed to Reduce Readmission Risk of Adults with Diabetes

Hospital readmission within 30 days of discharge (30-day readmission) is a high-priority quality measure and cost target. The purpose of this study was to explore the feasibility and efficacy of the Diabetes Transition of Hospital Care (DiaTOHC) Program on readmission risk in high-risk adults with diabetes. This was a non-blinded pilot randomized controlled trial (RCT) that compared usual care (UC) to DiaTOHC at a safety-net hospital. The primary outcome was all-cause 30-day readmission. Between 10/16/2017 and 05/30/2019, 115 patients were randomized. In the intention-to-treat (ITT) population, 14 (31.1%) of 45 DiaTOHC subjects and 15 (32.6%) of 46 UC subjects had a 30-day readmission (p=0.88) while 35.6% DiaTOHC and 39.1% UC subjects had a 30-day readmission or ED visit (p=0.72). The Intervention:UC cost ratio was 0.33 (0.13-0.79)95%CI (p<0.01). Among the 69 subjects with baseline HbA1c >7.0% (53 mmol/mol), 30-day readmission rates were 23.5% (DiaTOHC) and 31.4% (UC, p=0.46) and composite 30-day readmission or ED visit rates were 26.5% (DiaTOHC) and 40.0% (UC, p=0.23). In this subgroup, the Intervention:UC cost ratio was 0.21 (0.08-0.58)95%CI (p=0.002). The DiaTOHC Program is feasible and may decrease combined 30-day readmission/ED visit risk as well as healthcare costs among patients with higher HbA1c levels.

Contraband Hospital, Freedmen’s Hospital, and Alexander Augusta

The tens of thousands of enslaved Blacks liberated by union forces during the American Civil War were considered seized property and thus were referred to as contraband. As wartime refugees they sought protection in federal military installations, popularly known as contraband camps, located throughout the occupied South. One of the largest was Camp Baker in the rural northwestern sector of Washington, DC, where about 40,000 persons were sheltered. To provide basic medical care, the military outfitted, in 1863, an infirmary called the Contraband Hospital, later renamed Freedmen’s Hospital. From its founding in 1867 the medical department of Howard University was attached to Freemen’s Hospital, which in 1975 was renamed the Howard University Hospital, the two institutions establishing a long partnership of medical education and hospital care that continues to the present day.

Antimicrobial Mechanisms and Mode of Actions of Nanoemulsion Against Drug-Resistant ESKAPE Pathogens

An enhancement of antibiotic resistance in bacteria is associated with increased morbidity, mortality, and health infrastructure and hospital care charges. The Infectious Diseases Society of America (IDSA) has highlighted a section of antibiotic resistant bacteria termed as ESKAPE pathogens. These pathogens are proficient in ‘escaping' the biocidal effect of antibiotics and mutually representing new paradigms in transmission of diseases, pathogenesis, and resistance in their genetic materials. Essential oil-based nanoemulsions (NEs) have great interest towards the “natural” therapies as potential antimicrobial agents. Thermodynamic properties and kinetically stable potential of biphasic system of nanoemulsion enable them to be used as an effective nano-carrier with controlled release at the targeted point. This chapter describes the mechanisms of ESKAPE pathogens and the mode of the mechanisms of antimicrobial action of nanoemulsions for the treatment of MDR human pathogens.