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Rachel Harvey,1 Maryan Hermez,1 Luke Schanz,2 Patrick Karabon,3 Tracy Wunderlich-Barillas,3 Alexandra Halalau1,2 1Oakland University William Beaumont School of Medicine, Rochester, MI, USA; 2Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA; 3Office of Research, Oakland University William Beaumont School of Medicine, Rochester, MI, USACorrespondence: Alexandra HalalauBeaumont Health, 3601 W 13 Mile Road, Royal Oak, MI, 48073, USAEmail alexandra.halalau@beaumont.eduIntroduction: Increasing age, male gender, African American race, and medical comorbidities have been reported as risk factors for COVID-19 mortality. We aimed to identify health-care disparities associated with increased mortality in COVID-19 patients.Methods: We performed an observational study of all hospitalized patients with SARS-CoV2 infection from within the largest multicenter healthcare system in Southeast Michigan, from February to December, 2020.Results: From 11,304 hospitalized patients, 1295 died, representing an in-hospital mortality rate of 11.5%. The mean age of hospitalized patients was 63.77 years-old, with 49.96% being males. Older age (AOR = 1.05, p < 0.0001), male gender (AOR = 1.43, p < 0.0001), divorced status (AOR = 1.25, p = 0.0256), disabled status (AOR = 1.42, p = 0.0091), and homemakers (AOR = 1.96, p = 0.0216) were significantly associated with in-hospital mortality.Conclusion: Older age, male gender, divorced and disabled status and homemakers were significantly associated with in-hospital mortality if they developed COVID-19. Further research should aim to identify the underlying factors driving these disparities in COVID-19 in-hospital mortality.Keywords: disparities, COVID-19, mortality, race, disability

Since the term globalization erupted in public and academic discourses in the late-1980s, the hyperglobal perspective has been a prominent framing offered to understand global phenomena. Despite important challenges, it has remained extremely popular with its rhetoric exerting a powerful influence across the political spectrum, and in business and policy circles. This article argues that one reason for this durability is its inadvertent reproduction by the traditional understandings of “local” and “global” utilized in frameworks critiquing the hyperglobal perspective. More specifically, as scholars have noted, the global-local tends to be marked by dichotomous binaries and placed in a scalar hierarchy where the global overpowers the local. To side-step the issues emerging from the global-local approach, a conceptual rubric focusing on the “global-particular” relationship is offered as an alternative. This orientation helps prevent the importation of the dichotomous binaries and scalar hierarchies that reproduce hyperglobal imaginaries. As a result, it is easier to retain the complexity and contingency of global dynamics, and by extension, challenge hyperglobal framings. A case study of the global foreign exchange market is used to elaborate on the framework and to show why it provides a stronger point of departure for researching and theorizing globalization.

P78 Figure 1ConclusionThis electronic system re-vitalised the use of PEF in our asthma clinic;it is paper-light, patient-friendly and has increased our PEF diary responses, without additional cost or the requirement of a smart-phone. An average daily diurnal PEF variability >10% is valuable for the diagnosis of asthma and to assess asthma control. We continue to utilise PEF and have shared this resource across our local asthma networks. This is also likely to be beneficial in primary care to support annual asthma reviews and the requirement for at least two confirmatory diagnostic tests in the 2020/2021 NHS Quality and Outcomes Framework.

Cardiomyocytes (CMs) derived from induced pluripotent stem cells (iPSCs) provide an in vitro model of the human myocardium. Complex 3D scaffolded culture methods improve the phenotypical maturity of iPSC-CMs, although typically at the expense of throughput. We have developed a novel, scalable approach that enables the use of iPSC-CM 3D spheroid models in a label-free readout system in a standard 96-well plate-based format. Spheroids were accurately positioned onto recording electrodes using a magnetic gold-iron oxide nanoparticle approach. Remarkably, both contractility (impedance) and extracellular field potentials (EFPs) could be detected from the actively beating spheroids over long durations and after automated dosing with pharmacological agents. The effects on these parameters of factors, such as co-culture (including human primary cardiac fibroblasts), extracellular buffer composition, and electrical pacing, were investigated. Beat amplitudes were increased greater than 15-fold by co-culture with fibroblasts. Optimization of extracellular Ca2+ fluxes and electrical pacing promoted the proper physiological response to positive inotropic agonists of increased beat amplitude (force) rather than the increased beat rate often observed in iPSC-CM studies. Mechanistically divergent repolarizations in different spheroid models were indicated by their responses to BaCl2 compared with E-4031. These studies demonstrate a new method that enables the pharmacological responses of 3D iPSC-CM spheroids to be determined in a label-free, standardized, 96-well plate-based system. This approach could have discovery applications across cardiovascular efficacy and safety, where parameters typically sought as readouts of iPSC-CM maturity or physiological relevance have the potential to improve assay predictivity.

Introduction: The Portsmouth Asthma Service serves a population of over 675,000 people. We regularly identify patients who do not understand their asthma; as a result they lack confidence to seek advice or ask questions about their condition, resulting in a reliance on healthcare providers to manage symptoms and subsequent poor asthma control. Poorly controlled disease can lead to frequent exacerbations, impairing the patient’s quality of life and increasing their risk of premature death. Method: We undertook an appreciative exercise to identify the main gaps in our patient’s understanding of their asthma. We held focus groups with clinic patients to explore their understanding of asthma and to identify potential educational interventions to improve their confidence to manage their symptoms. Results: The majority of patients were unable to define asthma as a condition and responses included “terrifying and life-threatening” and “frustrating and depressing”. Patients felt that there was a lack of educational resources available in the clinic, they did not know where to seek advice and suggested that written information to share with family would be beneficial. They identified that a poor understanding of their condition prevented them from being able to make decisions about their asthma management. In collaboration with patients, we designed asthma information leaflets and a poster to display in the waiting room. Conclusion: Feedback was overwhelmingly positive. As a result of their improved understanding, patients felt empowered to ask questions about their diagnosis and management and felt confident to self-manage symptoms. We will ensure that asthma education remains a prominent and sustainable aspect of the care we provide our patients.

Background Addressing themes raised by the Royal College of Anaesthetists National Audit Project 4, we introduced new training programmes to improve the knowledge and skills necessary for the management of airway crises. A further large-scale multimodal training programme was introduced to implement guidelines published in 2015 by the Difficult Airway Society (DAS). Methods In 2014, questionnaires were used to assess the knowledge necessary to manage the unanticipated difficult airway before and after high-fidelity simulation sessions. In 2016, surveys assessed knowledge of new DAS guidelines before and 5 months after the implementation of a large-scale targeted teaching programme to educate staff. Results In 2014, 20 anaesthetic teams (75 delegates) attended high-fidelity simulations and demonstrated a significant immediate improvement in knowledge. In 2016, 185 participants attended a targeted teaching programme. Although after the teaching programme an increased number of anaesthetists reported having accessed training, there was a persistent knowledge gap, with some details retained by as few as 15% of participants. Discussion Whereas the knowledge of these important guidelines was improved in the immediate aftermath of high-fidelity simulation training, the knowledge retention was disappointing, raising questions as to why knowledge of highly important techniques used in crises was so poor. We ask whether training should be compulsory and how knowledge retention might be improved across all health care disciplines that rely on guidelines for the effective management of rarely occurring but safety-critical events.

National attention on whole-of-school approaches to decrease children’s sedentary behavior and increase physical activity includes movement integration (MI) in classrooms. The purpose of this study was to describe instrument development, reliability, and validity of the System for Observing Student Movement in Academic Routines and Transitions (SOSMART), designed to assess MI in elementary classrooms. An a priori conceptual framework was developed based on existing literature. The framework was expanded/refined using videos from elementary classrooms and a Delphi survey. The survey, sent to 85 experts, yielded a 38% response rate. The final system includes 11 MI variables (three categories of teacher variables, two categories of student variables) and uses a 20-second continuous interval recording format. Reliability and validity data were collected in 12 classrooms across four elementary schools. Instrument reliability was tested using interval-by-interval percentage agreement for each category. Construct validity was tested by estimating multilevel random effects logistic regression models comparing student accelerometer derived activity with the presence/absence of each MI variable. Intraobserver reliability resulted in 97.5% agreement and exceeded 80% on all variables. Construct validity was supported for 8 out of 11 MI variables. SOSMART can provide valid, reliable, and objective data about MI in elementary schools.

The trans-disciplinary New Institutional framework identifies the importance of incentive structures in preventing opportunism in market making. In recent decades this theoretical tradition has increasingly shifted its attention from formal institutions to identify the significance of cultural processes in countering uncertainty, bounded rationality, and information asymmetries. More specifically the New Institutional perspective tends to focus on the formal mechanisms producing and reproducing culture, as opposed to an examination of specific cultural content. This attention to formal mechanisms means that value-rational action and commitments in market making receive insufficient attention. In order to examine the problems entailed in this trend, the case study of a financial market in which market making was constituted by the values of loyalty, duty, and honor of traders is used.

Initial analyses of financial globalization argued that increasing interdependence severely curtailed state authority and policy autonomy. While subsequent research countered such claims, the foreign exchange market, which underpins all cross-border transactions, continued to be characterized largely as operating outside the governance frontier of states. At one level, the qualities of the market lent themselves to such conclusions. Yet, through an analysis of the historical trajectory of two legal instruments, the Treasury Amendment and master netting agreements, the central importance of binding state-enforced explicit and implicit codes, or law, in the foreign exchange market is revealed. Far from operating beyond the reach of states, even this most globalized market is legally constructed.

PurposeThe purpose of this paper is to compare and contrast traditional data collection methodologies employed in health care with more practical observational methods which are closely aligned with Lean thinking. When combined with problem solving, observational approaches achieve demonstrable improvements in clinical outcomes, productivity and efficiency. The paper aims to describe the changes in mindset and behaviour that are required to adopt the observational methods.Design/methodology/approachThe approach is to describe and evaluate case study examples on the use of observational data in the National Health Service in the UK. This is then used to derive generic principles about the wider application of observational data in health care.FindingsTraditional data collection methodologies are often insufficient to expose the root cause of a problem and therefore may result in little or no action. The observational methods identify the root cause and as such offer a much more practical and real‐time way of solving process‐related problems.Practical implicationsThe observational methods of collecting data described here offer staff at all levels of the organisation practical approaches to preventing mistakes and errors in health care processes.Originality/valueThe case studies described here support the reintroduction of observational techniques used by the early pioneers of productivity. The originality of the paper is in the use of these observational methods in a wide range of clinical settings to provoke changes in working practices.

Summary Background Conducting clinical ‘rounds’ is one of the most onerous and important duties that every junior doctor is expected to perform. There is evidence that newly qualified doctors are not adequately prepared by their undergraduate experiences for this task. The aim of this study was to analyse the challenges pertaining to non-technical skills that students would face during ward rounds, and to create a model that facilitates the transition from medical student to doctor. Methods A total of 217 final-year medical students completed a simulated ward round. Free-text responses were analysed using template analysis applying an a priori template developed from the literature by the research team. This drew on the generic categories of non-technical skills suggested by Flin et al. Results Ninety-seven per cent of students agreed or strongly agreed that the simulated ward round improved their insight into the challenges of ward rounds and their perceived ability to work efficiently as an active member of the ward round. The responding students (206) submitted written feedback describing the learning that they planned to use: 800 learning points were recorded, and all could be categorised into one of seven non-technical skills. Conducting clinical 'rounds' is one of the most onerous and important duties that every junior doctor is expected to perform Discussion We believe that improved task efficiency and insight into the challenges of the ward round gained by medical students will lead to an enhancement in performance during clinical rounds, and will have a positive impact on patient safety. We would suggest that undergraduate medical schools consider this model in the preparation for the clinical practice element of the curriculum.

Because of market failures, domestic investment resources are often insufficient to fully finance the public and private capital formation critical to global wealth preservation and growth. It is thus important to understand the factors that drive cross-border investments, including the potential fit between the objectives of international long-term investors and public policy objectives. This article reports the results of a survey of such investors. This research revealed that foreign policy factors were most likely to affect cross-border investment decisions; other influential factors included organizational issues. The survey also found a surprising gap between the responding funds’ aspiration to be long-term investors and their apparent willingness and/or ability to implement long-term investment strategies. These findings highlight the importance of a facilitative policy environment for understanding the benefits of, and implementing, long-horizon cross-border investments.

Five men met this morning for 27 minutes and told the world the price of gold here. They’ve been doing it for years, they said. And it didn’t matter that the world gold market was in a state of flux, rising from the United States peg — $35 an ounce — all the way to $41 an ounce in yesterday’s feverish trading. The five men, impeccably attired in dull gray and black, assembled at Rothschild’s, around an austere table in the financial district.

Overseas manufacturers and healthcare providers can provide valuable lessons to the NHS in embedding a culture of service improvement. A key lesson is that empowering staff unleashes an organisation's most powerful asset. Service improvement has been proven to enhance a organisation's year-on-year fianancial position.