Payments For Acute Myocardial Infarction Episodes Of Care By Hospital Interventional Capability

It is not known whether hospitals with percutaneous coronary intervention (PCI) capability provide more costly care than hospitals without PCI capability for patients admitted for acute myocardial infarction (AMI). The growing number of PCI-capable hospitals and higher rate of PCI use at technologically advanced hospitals may result in higher costs for episodes of care initiated at PCI hospitals. However, higher rates of transfers and post-acute care procedures may result in higher costs for episodes of care initiated at non-PCI hospitals. We identified all AMI admissions in 2008 among Medicare fee-for-service beneficiaries and classified hospitals as PCI- or non-PCI-capable based on hospitals\u27 2007 PCI performance. We added all payments from the time of admission through 30 days post-admission, including payments to hospitals other than the admitting hospital. We calculated and compared risk- standardized payment for PCI and non-PCI hospitals using 2-level hierarchical generalized linear models that adjust for patient demographics and clinical characteristics. PCI hospitals had a slightly higher mean 30-day risk-standardized payment than non-PCI hospitals ($20,340 v.$19,713, P\u3c0.001). Patients presenting to PCI hospitals had higher PCI rates (39.2% v. 13.2%, P\u3c0.001) and higher coronary artery bypass graft (CABG) rates (9.5% v. 4.4%, P\u3c0.001) during index AMI admissions, lower transfer rates (2.2% v. 25.4%, P\u3c0.001), and lower revascularization rates within 30 days (0.15% v. 0.27%, P\u3c0.0001) than those presenting to non- PCI hospitals. Despite higher PCI and CABG rates for patients who began their 30-day episode of care at PCI hospitals, PCI hospitals were only $627 more costly than non-PCI hospitals for the treatment of patients with AMI

SIRT1 promotes the central adaptive response to diet restriction through activation of the dorsomedial and lateral nuclei of the hypothalamus

Diet restriction retards aging and extends life span by triggering adaptive mechanisms that alter behavioral, physiological, and biochemical responses in mammals. Little is known about the molecular pathways evoking the corresponding central response. One factor that mediates the effects of diet restriction is the mammalian nicotinamide adenine dinucleotide (NAD)-dependent deacetylase SIRT1. Here we demonstrate that diet restriction significantly increases SIRT1 protein levels and induces neural activation in the dorsomedial and lateral hypothalamic nuclei. Increasing SIRT1 in the brain of transgenic (BRASTO) mice enhances neural activity specifically in these hypothalamic nuclei, maintains a higher range of body temperature, and promotes physical activity in response to different diet-restricting paradigms. These responses are all abrogated in Sirt1-deficient mice. SIRT1 up-regulates expression of the orexin type 2 receptor specifically in these hypothalamic nuclei in response to diet-restricting conditions, augmenting response to ghrelin, a gut hormone whose levels increase in these conditions. Our results suggest that in the hypothalamus, SIRT1 functions as a key mediator of the central response to low nutritional availability, providing insight into the role of the hypothalamus in the regulation of metabolism and aging in mammals

withdrawn 2017 hrs ehra ecas aphrs solaece expert consensus statement on catheter and surgical ablation of atrial fibrillation

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Daily Rhythms in Olfactory Sensitivity

Mentor: Erik Herzog From the Washington University Undergraduate Research Digest: WUURD, Volume 4, Issue 1, Fall 2008. Published by the Office of Undergraduate Research. Henry Biggs, Director of Undergraduate Research and Associate Dean in the College of Arts & Sciences; Joy Zalis Kiefer, Undergraduate Research Coordinator, Co-editor, and Assistant Dean in the College of Arts & Sciences; Kristin Sobotka, Editor

Daily Rhythms in Olfactory Sensitivity

Mentor: Erik D. Herzog From the Washington University Undergraduate Research Digest: WUURD, Volume 3, Issue 2, Spring 2008. Published by the Office of Undergraduate Research. Henry Biggs, Director of Undergraduate Research and Associate Dean in the College of Arts & Sciences; Joy Zalis Kiefer, Undergraduate Research Coordinator, Co-editor, and Assistant Dean in the College of Arts & Sciences; Kristin Sobotka, Editor

Daily Rhythms in Olfactory Sensitivity

Mentor: Erik Herzog From the Washington University Undergraduate Research Digest: WUURD, Volume 4, Issue 2, Spring 2009. Published by the Office of Undergraduate Research. Henry Biggs, Director of Undergraduate Research and Associate Dean in the College of Arts & Sciences; Joy Zalis Kiefer, Undergraduate Research Coordinator, Co-editor, and Assistant Dean in the College of Arts & Sciences; Kristin Sobotka, Editor

LPS-binding protein mediates LPS-induced liver injury and mortality in the setting of biliary obstruction

It is generally accepted that low levels of lipopolysaccharide (LPS)-binding protein (LBP) augment the cell's response to LPS, whereas high levels of LBP have been shown to inhibit cell responses to LPS. Clinical studies and in vitro work by our group have demonstrated that, in the setting of liver disease, increased or acute-phase levels of LBP may actually potentiate rather than inhibit an overwhelming proinflammatory response. Therefore, in the present studies we sought to determine the role of acute-phase LBP in mediating morbidity and mortality in animals challenged with LPS in the setting of biliary obstruction. Using LBP-deficient mice and LBP blockade in wild-type mice, we demonstrate that high levels of LBP are deleterious in the setting of cholestasis. Following biliary obstruction and intraperitoneal LPS challenge, hepatic injury, hepatic neutrophil infiltration, and mortality were significantly increased in animals with an intact LBP acute-phase response. Kupffer cell responses from these animals demonstrated a significant increase in several inflammatory mediators, and Kupffer cell-associated LBP appears to be responsible for these differences, at least in part. Our results indicate that the role of LBP signaling in inflammatory conditions is complex and heterogeneous, and elevated levels of LBP are not always protective. Increased LBP production in the setting of cholestatic liver disease appears to be deleterious and may represent a potential therapeutic target for preventing overwhelming inflammatory responses to LPS in this setting

Prevention and rehabilitation after heart transplantation: A clinical consensus statement of the European Association of Preventive Cardiology, Heart Failure Association of the ESC, and the European Cardio Thoracic Transplant Association, a section of ESOT

Little is known either about either physical activity patterns, or other lifestyle‐related prevention measures in heart transplantation (HTx) recipients. The history of HTx started more than 50 years ago but there are still no guidelines or position papers highlighting the features of prevention and rehabilitation after HTx. The aims of this scientific statement are (i) to explain the importance of prevention and rehabilitation after HTx, and (ii) to promote the factors (modifiable/non‐modifiable) that should be addressed after HTx to improve patients' physical capacity, quality of life and survival. All HTx team members have their role to play in the care of these patients and multidisciplinary prevention and rehabilitation programmes designed for transplant recipients. HTx recipients are clearly not healthy disease‐free subjects yet they also significantly differ from heart failure patients or those who are supported with mechanical circulatory support. Therefore, prevention and rehabilitation after HTx both need to be specifically tailored to this patient population and be multidisciplinary in nature. Prevention and rehabilitation programmes should be initiated early after HTx and continued during the entire post‐transplant journey. This clinical consensus statement focuses on the importance and the characteristics of prevention and rehabilitation designed for HTx recipients