It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Sunday, October 24, 2021
Study: Massachusetts gun-control legislation has had no effect on violent crime
Researcher suggests lawmakers ensure measure is being implemented as intended
Although many Americans favor expanding background checks for gun purchases, gun-control measures in Congress have failed to garner enough votes to pass. In contrast, some state legislatures have enacted measures to reduce gun violence in their communities. A new study examined the impact changes to background checks and licensing policies has made on different types of violent crime in Massachusetts. The study found no immediate impact, suggesting that state lawmakers may want to ensure their legislation is being implemented as intended.
The study, by a researcher at American University (AU), appears in Justice Quarterly, a publication of the Academy of Criminal Justice Sciences.
“Gun violence remains at the forefront of the public policy debate when it comes to enacting new or strengthening existing gun legislation in the United States,” explains Janice Iwama, assistant professor of justice, law, and criminology at AU, who conducted the study. “Yet the political polarization and relatively limited scholarly research on guns and gun violence make it difficult for policymakers and practitioners to enact and implement legislation that addresses the public health and safety issues associated with gun violence.”
In 2014, Massachusetts passed new requirements related to background checks for firearms sold at gun shows or through private sales and created changes to firearm regulations by adopting new gun licensing procedures; the new law went into effect in January 2015. Research on the effects of gun legislation has yielded mixed findings and the effectiveness of Massachusetts’ law is unclear.
Iwama explored the differential effects of the new legislation on public safety outcomes, including violent crime, in Massachusetts counties from 2006 to 2016. She used data from the Firearms Records Bureau, a statewide agency that maintains a database of issued licenses and records of firearms sales by gun dealers, as well as private transfers of weapons.
The study used models to predict counts of violent crimes, using data from the FBI, and considering variables that represent the percentage of all denied applications, the percentage of denied applications due to unsuitability, and the percentage of denied applications due to statutory disqualification (e.g., criminal history record, mental health record, fugitive status) at the county level.
Based on the percent of firearms licenses, about 1 to 5 percent of adult residents had a firearms license in Massachusetts counties. But Iwama found no consistent effect of the new legislation on reducing four types of violent crime (murder or nonnegligent manslaughter, aggravated assault, robbery, rape).Her study did find that a one-percent increase in denied firearm licenses and denied firearm licenses following statutory disqualifications increased robberies 7.3 and 8.9 percent, respectively.
While the percentage of denied firearms licenses and firearms license applications had little to no effect on violent crimes, Iwama suggests state lawmakers revisit their legislation to ensure that it is being implemented as intended and address challenges identified. In particular, are these findings the result of a longer-than-expected lag in enforcement following passage of the legislation? Are they due to individuals obtaining firearms in nearby states with looser gun laws? Or is it possible that the 2014 law is being enforced differentially by county?
“It is important for policymakers, practitioners, and researchers to consider the magnitude of effects of their laws and how they may be influenced by different levels of enforcement in the state or by the lack of enforcement in surrounding states,” cautions Iwama.
Among the study’s limitations, Iwama notes that the data collected from the FBI was not complete because of changes in reporting practices. In addition, the percentage of firearms licenses, which she used as a proxy for gun ownership, represents neither a perfect measure of gun owners nor an accurate count of the number of firearms available by county. Finally, the small size of the study’s sample hindered the author’s ability to examine patterns across different counties in the state.
NIH/NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES (NCATS)
A new, retrospective study of medical and insurance records indicates health care costs for people with a rare disease have been underestimated and are three to five times greater than the costs for people without a rare disease. The study, led by the National Institutes of Health’s National Center for Advancing Translational Sciences (NCATS), provides new evidence of the potential impact of rare diseases on public health, suggesting that nationwide medical costs for individuals with rare diseases are on par with those for cancer and heart failure. The study’s results were published Oct. 21 in the Orphanet Journal of Rare Diseases.
Most of the approximately 7,000 to 10,000 known rare diseases disproportionately affect children, adolescents and young adults. Individually, most rare diseases might affect only a few hundred to a few thousand people worldwide. However, rare diseases are collectively common, affecting an estimated 25 million to 30 million people in the United States. Many of these diseases have a genetic cause, are serious or life-threatening and are hard to diagnose and treat.
The pilot study was a collaborative effort among NCATS; Eversana Life Sciences, Chicago; Oregon Health & Science University, Portland; Sanford Health, Sioux Falls, South Dakota; and a health insurer in Australia. Pariser and colleagues analyzed patients’ diagnosis information in medical records and billing codes. They used International Classification of Diseases (ICD) codes, which designate a disease diagnosis and other methods, to determine those individuals with rare diseases and their direct medical costs for 14 rare diseases in four health care systems compared to non-rare disease patients of a similar age.
The pilot study aimed to test the feasibility of this approach in analyzing data on rare diseases prevalence and costs. The 14 rare diseases represented a diverse set of disorders that differ in prevalence, organ systems affected, age of onset, clinical course, and availability of an approved treatment or specific ICD code. Examples of the selected rare diseases include sickle cell disease, muscular dystrophy and eosinophilic esophagitis.
The team determined approximate medical costs by examining healthcare system data from NCATS and Eversana. In every case, the cost per patient per year (PPPY) for those with a rare disease exceeded costs for non-rare diseases patients of the same age. According to the Eversana healthcare system database, which included estimates from commercial and insurance payors over nearly 15 years, PPPY costs ranged from $8,812 to $140,044 for rare diseases patients compared to $5,862 for those without a rare disease. The NCATS data, which drew from estimates mostly from Florida Medicaid information over five years, indicated PPPY costs ranging from $4,859 to $18,994 for rare diseases patients versus $2,211 for those without a rare disease.
The team reported that extrapolating the average costs estimate for the approximately 25 to 30 million individuals with rare diseases in the United States would result in total yearly direct medical costs of approximately $400 billion, which is similar to annual direct medical costs for cancer, heart failure and Alzheimer’s disease.
The researchers also used patient medical records to trace the diagnostic journeys of four people with a rare disease, including two individuals who had a form of Batten disease, an inherited neurological disorder, and two others with cystic fibrosis, an inherited disease that severely affects the lungs. The journey “maps” provided detailed descriptions of direct medical costs, such as for hospitalizations and procedures associated with these diseases, and provided insights into patient clinical management before and after disease diagnosis.
Such commonalities among rare disease patients could point to the potential use of machine learning techniques on healthcare system databases to improve diagnoses, said NCATS Acting Director Joni L. Rutter, Ph.D., a co-author on the study.
The research team also would like to determine if the methodologies they used for exploring the prevalence and associated costs for a small set of rare diseases could be scaled to thousands of other known rare diseases.
“Ultimately, to improve the lives of people with rare diseases,” said Rutter, “we need to find innovative ways, including new technologies, to help shorten the lengthy diagnostic odysseys so many patients and families experience and make more treatments available faster.”
About the National Center for Advancing Translational Sciences (NCATS): NCATS conducts and supports research on the science and operation of translation — the process by which interventions to improve health are developed and implemented — to allow more treatments to get to more patients more quickly. For more information about how NCATS helps shorten the journey from scientific observation to clinical intervention, visit https://ncats.nih.gov.
About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit https://www.nih.gov.
NIH…Turning Discovery Into Health®
JOURNAL
Orphanet Journal of Rare Diseases
METHOD OF RESEARCH
Data/statistical analysis
ARTICLE TITLE
The IDeaS initiative: pilot study to assess the impact of rare diseases on patients and healthcare systems.
ARTICLE PUBLICATION DATE
21-Oct-2021
US COVID-19 pandemic lockdowns sharply increased bicycle-related injuries; gun-related injuries rose too
Study results from trauma centers in four different regions may provide a roadmap for allocating trauma resources in the next pandemic
IMAGE: THE EFFECT OF CORONAVIRUS SHUTDOWNS ON NATIONWIDE TRAUMA PATTERNS. SCIENTIFIC FORUM PRESENTATION. AMERICAN COLLEGE OF SURGEONS CLINICAL CONGRESS.view more
CREDIT: AMERICAN COLLEGE OF SURGEONS
Key takeaways
Despite regional variations in COVID-19-related restrictions, trends in trauma center activity followed similar patterns in four trauma centers in different regions of the United States.
Trauma cases involving bicycle-related injuries increased 100 percent, and gunshot wounds increased 23.5 percent, during lockdown.
Study findings indicate allocating more resources for wellness may be a priority in future pandemic-related lockdowns.
CHICAGO: Despite regional variations in COVID-19-related restrictions last year during the lockdown phase of the pandemic, similar trends emerged in activity at Level I trauma centers in four different cities from the Southeast to the Northwest, according to research presented at the virtual American College of Surgeons (ACS) Clinical Congress 2021.
The data could help inform public policy decision-making for the next pandemic, study authors said.
A retrospective review of 27,652 trauma cases from 2019 to 2020 at four Level I trauma centers in Orange County, California; Portland, Oregon; Miami, Florida; and Tulsa, Oklahoma, found that overall activity followed similar patterns in these locations, with cases for motor vehicle collisions declining while those for gunshot wounds and bicycle accidents increased significantly.
“We were trying to assess if the different variations in COVID-19 shutdowns across the country affected trends,” said presenter Leonardo Alaniz, a third-year medical student at the University of California, Irvine. The findings bore out the study hypothesis—that trauma centers in four different cities with different levels of pandemic restrictions demonstrated similar trauma case patterns.
“Overall, what we discovered is that there was a substantial increase in bicycle-related trauma rates of about 100 percent,” he said (p < 0.01). “We also saw an increase in gunshot wounds (GSW) by about 23.5 percent. However, we did see a substantial reduction in motor vehicle crash (MVC)-related trauma rates, about 12.7 percent.” (p values for both GSW and MVC-related trauma are <0.01.)
The trend for GSW was somewhat unexpected, senior author Cristobal Barrios, Jr., MD, FACS, said. “We thought we might see an uptick in the percentage of GSW given the percentages of MVC were down and the percentages might need to go up to cover that mechanism of injury; but we were mildly surprised that not only did the percentage go up, but the actual raw numbers of gun injuries went up,” said Dr. Barrios, a health sciences clinical professor in surgery and assistant dean of admissions at UC Irvine. “That was true across all the trauma centers that contributed data to the study.”
While the percentage changes in those three metrics varied among the individual centers, the overall trends followed the same pattern. The changes at each individual site are:
In Orange County, GSW increased 55 percent (p < 0.01), MVC decreased 10.2 percent (p < 0.01), and bicycle injuries increased 30.8 percent (p = 0.01).
Dr. Barrios said the trends in MVC- and bicycle-related injuries during lockdown are understandable. “People weren’t going anywhere for any real large distances because there was nowhere to go during lockdown, but maybe they were utilizing their bicycles to get around a little bit, to get some exercise, and to get out of the house,” Dr. Barrios said. In June 2020, bicycle sales increased 63 percent over the same period in 2019, the market research firm NPD gGroup, Inc. reported.*
These findings may help clinicians and policy makers to better prepare if pandemic-related restrictions are necessary in the future, Dr. Barrios said.
“We did this research to shed light on what to expect during any possible next lockdown for a pandemic and where to potentially put resources for clinicians in terms of what types of injuries might present and that might increase or decrease,” he said. “Tailoring resources was one point.”
One of the take-home findings, Dr. Barrios noted, was that more resources should be applied to addressing issues of wellness, namely stress reduction and mental health. “That might be why people were using bicycles more; to get out and get exercise and reduce their stress,” he said.
Mr. Alaniz added, “Another big contributor would be to have more green spaces in these communities—spaces where people can go out and exercise in a safe environment. That would also play a huge role in preserving the mental health of our communities.”
Study coauthors are Juan P. Hoyos and Erika Tay Lasso, MD, of the UC Irvine Department of Surgery; Shevonne Satahoo, MD, of Jackson Memorial Miller School of Medicine, Miami; Gajal Kumar, MD, FACS, of Ascension Medical Group St. John Medical Center, Tulsa; and Megan Lundeberg, MD, of Legacy Emanuel Hospital and Health Center, Portland.
“FACS” designates that a surgeon is a Fellow of the American College of Surgeons.
The study authors have no relevant financial relationships to disclose.
Citation: Alaniz L, et al. The Effect of Coronavirus Shutdowns on Nationwide Trauma Patterns. Scientific Forum Presentation. American College of Surgeons Clinical Congress. 2021. ________________________ *Schwinn shifts marketing gears as bike riding surges during the coronavirus crisis. CNBC. Available at: https://www.cnbc.com/2020/08/29/coronavirus-bike-sales-surge-schwinn-pivots-marketing-plan.html (.) Accessed September 30, 2021.
# # #
About the American College of Surgeons The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.
USA; FOR PROFIT HEALTHCARE
Hospitals sustained huge financial losses from lost revenues during COVID-19 pandemic as patients lost timely access to surgical services
Researchers provide lessons learned after nationwide pause of most elective operations during 2020
IMAGE: THE FINANCIAL IMPACT OF COVID-19 ON A SURGICAL DEPARTMENT: THE EFFECTS OF SURGICAL SHUTDOWNS AND THE IMPACT ON A HEALTH SYSTEM.view more
CREDIT: AMERICAN COLLEGE OF SURGEONS
Key takeaways
Curtailing surgical services for even a short time can seriously impact a hospital’s financial security
Maintaining access to surgical care is not all about revenue; it’s about how to efficiently manage surgical patients’ needs
Health care systems should make long-term preparations so they can safely provide elective surgical care during future peaks in COVID-19 caseloads
CHICAGO: Postponement of nonessential surgical procedures early in the coronavirus pandemic not only disrupted surgical care at U.S. hospitals, but also took away a large portion of hospitals’ total income, results from two studies reveal. These findings (from the two studies, which took place at the University of Pennsylvania, Philadelphia, and Children’s Hospital of Philadelphia) were presented at the virtual American College of Surgeons (ACS) Clinical Congress 2021.
Surgical services are typically an important financial engine for hospitals, and the new study findings showed that curtailing surgical procedures for even two months can seriously impact a hospital’s financial security. Most elective, nonurgent operations in the country stopped from mid-March to early May 2020, to conserve resources for patients with coronavirus disease 2019 (COVID-19). Results of one study found that this two-month suspension cost a single university health care system 42 percent of its net revenue for five months.
Nationwide, hospitals lost $1.53 billion from missed elective pediatric procedures alone, the other study investigators estimated as part of their study, for approximately the same period, March to May 2020. Hospitals were slow to make up the surgical backlog and the lost income from children’s operations, with a median, or middle, time to recovery of one year, the investigators estimated.
As COVID-19 cases reportedly continue to remain high in many states, some hospitals are again triaging cases and delaying selected operations.1,2 Consequently, the researchers said their findings demonstrate the need for better long-term planning by hospitals to prevent further shutdowns to ensure patients have access to the surgical services that they need.
CAPTION
Hospital Financial Risk Due to Procedural Cancellations During the Covid-19 Pandemic.
CREDIT
American College of Surgeons
USAGE RESTRICTIONS
Reasons for not delaying surgical care
“Whenever possible, we should not delay surgical care for our patients,” said the first study’s lead investigator, Daniel M. Mazzaferro, MD, MBA, a plastic surgery resident at the Perelman School of Medicine at the University of Pennsylvania. “Surgery is a critical asset to the survivability of a health care system.”
Moreover, delays in surgical care also can lead to patients’ medical conditions worsening, affecting their quality of life, or sometimes even shortening it. Another result is patients may require more treatments, raising health care costs down the line, Dr. Mazzaferro noted.
The pandemic resulted in an unprecedented temporary postponement of many elective operations across the country, as recommended by the American College of Surgeons (ACS) and other organizations in March 2020 to free hospital beds and other resources for COVID-19 patients.3 The ACS provided guidance for how hospitals could triage surgical cases—that is, select which operations to prioritize and which to defer until after COVID-19 caseloads decreased.4
Financial impact
Dr. Mazzaferro and his coworkers calculated the net revenues of three hospitals in their health care system during the first surge, or “wave,” of COVID-19 cases from March to July 2020, compared with the same period in 2019. A total of more than $99 million of net revenue was lost from all surgical departments and $58 million from the department of surgery in the first wave. The researchers reported a median net revenue loss of $636,952 per month per division for the department of surgery in the first wave, using updated data presented during the virtual Clinical Congress. However, the system lost significantly less money—$274,626 each month for each division—during a second COVID wave between October 1, 2020, and February 29, 2021.
The surgical department did not suspend elective operations during the second surge, said Liza Wu, MD, FACS, senior investigator of this study and professor of surgery at the Perelman School of Medicine.
“We were in a better position than the first time around to continue with elective surgery,” Dr. Wu said. “We had more personal protective equipment or PPE, better COVID-19 therapies, and a better understanding of the virus, and we probably were able to get COVID patients out of the hospital faster.”
Their surgical department, she added, also began triaging elective surgical patients using a new scoring system called the Medically Necessary, Time-sensitive Scoring, or MeNTS, which University of Chicago physicians described in the Journal of the American College of Surgeons.5
After elective operations resumed in June 2020, surgeons quickly regained their productivity, Dr. Mazzaferro reported. He made this conclusion based on a measure of surgeon productivity that insurance payers use for reimbursement, called work relative value units (RVUs). Work RVUs decreased significantly less in the second COVID-19 wave than the first: 7.8 versus 13.2 percent.
For the second study, researchers led by Sourav Bose, MD, MBA, MSc, then a postdoctoral research fellow at Children’s Hospital of Philadelphia, assessed the financial impact of COVID-related pediatric procedural cancellations. To project lost surgical revenues, they used the 2016 Kids’ Inpatient Database, which represents approximately 80 percent of pediatric hospital admissions nationally.
Dr. Bose, a general surgery resident at Brigham and Women’s Hospital in Boston, said the nation’s children’s hospitals delayed or canceled an estimated more than 51,000 elective procedures from March to May 2020.
Lessons learned
“Our message isn’t all about revenue. It’s about how to efficiently manage surgical patients’ needs,” Dr. Bose said. “Hospital systems must assess their operations management strategies to optimize the availability of surgical resources for patients with the greatest need.”
He proposed that hospitals optimize any excess resource capacity that existed before the pandemic or increase their capacity for performing procedures based on their resources, such as expanding hours for operations.
Dr. Mazzaferro also recommended that health care systems make long-term preparations so they can safely provide elective surgical care during future peaks in COVID-19 caseloads. He suggested the following:
Increase hospital bed and resource capacity through alternate solutions, such as sending an overflow of surgical patients to other patient care units or facilities that can accommodate them.
Appropriately triage elective operations following ACS guidelines4 and other published surgical triage tools.
Ensure sufficient PPE for health care workers and patients.
Help keep staff healthy by mandating COVID-19 vaccines or frequently testing them against the virus.
Dr. Mazzaferro and Dr. Wu’s fellow University of Pennsylvania researchers were Viren Patel, Nelson Asport, MSHI, CPC, Robert L. Stetson, MHA, David Okawa, MBA, Deborah Rose, MBA, Natalie M. Plana, MD, Joseph M. Serletti, MD, FACS, and Ronald DeMatteo, MD.
Citation: Mazzaferro, DM, et al. The Financial Impact of Covid-19 on a Surgical Department: the Effects of Surgical Shutdowns and the Impact on a Health System. Scientific Forum Presentation. American College of Surgeons Clinical Congress 2021.
Dr. Bose’s co-investigators were Serena Dasani, MD, MBA, Brandon White, MSE, Nick S. Adzick, MD, FACS, and William H. Peranteau, MD, FACS, all with Children’s Hospital of Philadelphia.
Citation: Sourav B, et al. Hospital Financial Risk Due to Procedural Cancellations During the Covid-19 Pandemic. Scientific Forum Presentation. American College of Surgeons Clinical Congress 2021.
“FACS” designates that a surgeon is a Fellow of the American College of Surgeons.
The authors report no relevant disclosures.
________________________
1 Advisory Board. Hospitals Are Delaying Elective Surgeries Again. But This Time, They're Doing It Differently. Daily Briefing. https://www.advisory.com/daily-briefing/2021/08/18/elective-surgeries. August 18, 2021. Accessed September 29, 2021.
2 Paavola A. 106 Hospitals Postponing Elective Procedures Amid the COVID-19 Resurgence. Beckers Hosp Rev. June 1, 2021. Accessed September 29, 2021.
5 Prachand VN, Milner R, Angelos P, et al. Medically Necessary, Time-Sensitive Procedures: Scoring System to Ethically and Efficiently Manage Resource Scarcity and Provider Risk During the COVID-19 Pandemic. J Coll Am Surg. 2020;231(2):281-288.
# # #
About the American College of Surgeons The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.
‘Powerful new model’ to engage underserved patients
Researchers propose ‘community-engaged health care’ model to improve service delivery
Poverty, mental health and the fragmented structure of health care systems are some factors keeping many Americans from receiving appropriate health care, resulting in significant health disparities that increase costs for everyone. Efforts to better engage with this currently underserved population have been ineffective, but researchers are now challenging providers to integrate a community-engaged health care model to more effectively treat those with chronic diseases and health issues created by social circumstances, such as homelessness.
The community-engaged health care (CEH) model transfers power over health decision-making processes to patients to advocate for their own health or social solutions, and enables them to design their own interventions with support from health providers rather than expert directives. The conceptual framework developed by researchers at the University of Houston and University of Southampton is detailed in a research review published in the journal SSM – Population Health.
Dr. David Buck, senior author of the study and associate dean for community health at the UH College of Medicine, said this “powerful new model” may be radical, but necessary to improve service delivery, leadership and governance.
“In emergency situations when lives are on the line, of course you still need an expert doctor or captain of the ship to make the best quick decisions for patients. But that model doesn’t work for improving chronic diseases. You can’t just give a vaccine to change behavior, which is what’s really needed,” said Buck. “So rather than an expert model, we need a partnership model where patients are empowered to have a stronger voice in their care. If we don’t listen to what matters most to them, they’re not even going to come to the table.”
Traditional health care assumes that the physician is the most important person in the relationship and the doctor alone determines the best treatment path. After all, they’re the medical expert, right? While effective in many circumstances, this strategy is inefficient when dealing with chronic and/or socially determined health, according to the researchers.
In the United States, 5% of the population are responsible for half of health care spending, of which 47% are underserved patients. These patients frequently lack services beyond expensive and episodic emergency and hospital care that fail to address underlying illness and barriers, or the societal factors that contribute to poor health – housing, employment, food insecurity and the environment.
Joining Buck, a medical doctor, on the study are co-authors Stephanie Barker and Nick Maguire, University of Southampton School of Psychology; Robin Gearing, Monit Cheung and Sarah Narendorf, UH Graduate College of Social Work; and Dan Price, UH Honors College.
“Any community-engaged health model needs to account for the shift in power from the medical establishment within the community being served. This is no less than a revolutionary step, as medicine and medical services have set themselves up as the agents of change related to health. The CEH proposition is that the agents of change are members of the community themselves, engaging medicine only when they deem it necessary,” the researchers wrote.
Buck contends this research analysis serves as an evidence-based “playbook” of sorts for the new University of Houston College of Medicine, founded last year on a social mission to improve health in underserved communities in Houston and across Texas.
“We have established a mission at the medical school to address the needs of the underserved and to partner with communities, so it’s important that we share with the broader health care system why that’s important and what works best. The current health care model is very outdated, but we’re working to make it more efficient,” he said.
Community-engaged healthcare model for currently under-served individuals involved in the healthcare system
ARTICLE PUBLICATION DATE
10-Sep-2021
“Alternative”: An experimental model to study the effects of pollutants on cardiac tissue
A collaborative project, coordinated by Politecnico di Torino in the framework of the “European Green Deal”, will realise an in vitro model of the cardiac tissue to monitor the toxicity of chemical substances and drugs, in particular on elderly patients,
People are continuously exposed to a huge amount and variety of potentially toxic chemicals present in the surrounding environment, such as pesticides or drugs traces in water, soil, air and living organisms. The combined action of pollutants can increase the risk of toxic effects. At the same time, a growing occurrence of cardiovascular diseases has been observed. These diseases have been among the top-ranked causes of death in mature and aged populations for the last 30 years. Scientists think that this increase may be related to the environmental exposure to exogenous toxic chemicals.
ALTERNATIVE (environmentAL Toxicity chEmical mixtuRes through aN innovative platform based on aged cardiac tissue model) project, coordinated by Prof. Gianluca Ciardelli with the Biomedical Lab team (Susanna Sartori, Monica Boffito) from DIMEAS-Department of Mechanical and Aerospace Engineering of Politecnico, will produce an innovative in vitro platform able to evaluate the cardiotoxicity of single chemicals or a mixture of chemical components. The platform is made by a tri-dimensional model of bioengineered human functional cardiac tissue cultured in a bioreactor, together with a system allowing “omic” analysisto understand the response of the model to different substances. Artificial Intelligence algorithms will be implemented to estimate the risk. Additionally, the project will develop a model of aged cardiac tissue to evaluate the impact of toxics on the fragile population.
The model will be initially validated on existing toxicity data and after it will be used to make predictions on chemical and pharmaceutical substances.
This project aims at finding impact also at regulatory level. The European bodies responsible for regulating chemicals such as fertilizers or detergents, industrial chemicals or pharmaceutical products are seeking an exhaustive evaluation of the toxicity of single substances or mixtures. ALTERNATIVE proposes a new method to make this information available for what concerns cardiotoxicity, allowing to obtain more reliable results with a viable technology which willhave a lower impact on the environment and minimize ethical concerns through the reduction of animal testing,
This project has been financed in the framework of the European Green Deal Actions and put together different expertise (in silico systems, machine learning algorithms, toxicology, epidemiology, regulatory affairs) to deliver, in the end, increased awareness of cardiovascular risks related to pollutants (a poorly investigated field so far). A significant support to the regulatory framework for the management of the production and disposal of chemicals and pharmaceuticals is also expected.
“With colleagues at Politecnico di Torino, I am thrilled to start this exciting interdisciplinary research, hoping to contribute with the development of new biomedical technologies to solve problems which are currently impacting the population significantly – says professor Gianluca Ciardelli - The project aims are challenging, but achievable, having put together, with the unvaluable help of Dr. Federico Vozzi (CNR, Pisa), a well-composed international consortium with all the required competencies. In the end, we envisage a significant contribution for making our Technosphere greener and increasingly sustainable.”
ALTERNATIVE project will be developed by an international consortium with complementary capabilities:
Numerous studies have examined the coercive nature of prisons, but few have considered the role of in-prison experiences (e.g., confinement in restrictive housing) and time served in prison in incarcerated people’s perceptions of corrections officers’ fairness. A new study examined whether in-prison experiences among a nationally representative sample of inmates varied in their effect across different lengths of time served on incarcerated people’s perceptions of procedural justice. The study found that most incarcerated individuals’ in-prison experiences lessened their perceptions of procedural justice and fairness.
The study, by researchers at Iowa State University and Kent State University, appears in Justice Quarterly, a publication of the Academy of Criminal Justice Sciences.
“Past research has not evaluatedwhether the in-prison experiences and attitudes associated with perceptions of treatment by correctional staff vary by the amount of time served in prison,” explains Daniel Butler, assistant professor of sociology in criminal justice studies at Iowa State University, who led the study. “Such an investigation is essential as policymakers and researchers question how managerial strategies and policies in correctional settings influence the well-being of incarcerated people.”
One way to measure correctional inmates’ perceptions of corrections staff is to examine whether their behaviors are perceived by incarcerated people to be procedurally just. Corrections officers and others in criminal justice who treat individuals with dignity and respect, make decisions based on facts, and allow inmates opportunities to express themselves are more likely to be perceived as procedurally just.
Using the National Inmate Survey (NIS), 2011-2012, a nationally representative sample of incarcerated individuals who self-report on pre- and in-prison experiences, researchers examined more than 31,000 adults incarcerated at almost 200 state confinement facilities across different categories of time served in a facility.
Researchers measured the effects of a variety of in-prison experiences—including confinement to restrictive housing (e.g., solitary confinement), institutionalized resistance (i.e., filing a complaint), incidences of assault by staff and fellow inmates, perceived crowding, and family visits—on incarcerated individuals’ perceptions of staff members’ procedural justice. They also considered the effect of inmates’ experiences of staff support, inmate support, and mental health.
Procedural justice was defined by looking at eight measures, including staff fairness, staff treatment of inmates with respect, and staff members’ attempts to meet the needs of inmates. The study gauged how inmates’ perceptions varied based on the length of time incarcerated, categorizing time in prison as less than one year, between one and five years, and more than five years.
The study found that most of inmates’ in-prison experiences reduced their perceptions of staff members’ procedural justice, regardless of how much time they had served. This finding contradicts past study results, perhaps because the experiences measured in this study differ from those measured in other research.
Specifically, the study found that:
Decreased perceptions of staff members’ procedural justice were highest among inmates who had been incarcerated for less than a year.
Confinement in restrictive housing (up to 13 percent of the study’s participants served more than 30 days in restrictive housing) significantly decreased inmates’ perceptions of procedural justice for those who had served less than five years in prison.
Inmates who had served more than five years perceived prison to be more dangerous than other inmates, and this decreased their perceptions of staff members’ procedural justice. In addition, inmates who had served more than five years who reported having mental health problems were more likely to perceive staff as less procedurally just.
Inmates’ race and ethnicity influenced their perceptions of procedural justice across each category of time serve: Black and Hispanic inmates perceived correctional staff as less procedurally just than White inmates.
Inmates who filed a grievance, received support from other inmates, and were younger also perceived correctional staff as less procedurally just.
Inmates who had served between one and five years and who perceived the facility as crowded had more negative perceptions of staff procedural justice than did inmates who had served less than a year.
Among the study’s limitations, the authors note that they did not examine characteristics of the facilities or staff that prior research had identified as important predictors of correctional officers’ legitimacy and fairness. In addition, the NIS data included information on experiences within the past 12 months of confinement or since admission to the current facility, which excluded some in-prison experiences.
“The discretion and power afforded to correctional staff creates an imbalance,” notes Starr Solomon, assistant professor of sociology at Kent State University, who coauthored the study. “As correctional agencies develop strategies to help incarcerated people adjust to prison, it is important to recognize that the coercive nature of prisons makes it difficult for individuals to perceive treatment by staff as procedurally just.”
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The research was funded by the Sam Houston State External Grant Application Development System.
