Relationship Between Operator Volume and Adverse Outcome in Contemporary Percutaneous Coronary Intervention Practice An Analysis of a Quality-Controlled Multicenter Percutaneous Coronary Intervention Clinical Database

ObjectivesThe aim of our study was to evaluate the volume-outcome relationship in a large, quality-controlled, contemporary percutaneous coronary interventions (PCI) database.BackgroundWhether the relationship between physician volume of PCI and outcomes still exists in the era of coronary stents is unclear.MethodsData on 18,504 consecutive PCIs performed by 165 operators in calendar year 2002 were prospectively collected in a regional consortium. Operators' volume was divided into quintiles (1 to 33, 34 to 89, 90 to 139, 140 to 206, and 207 to 582 procedures/year). The primary end point was a composite of major adverse cardiovascular events (MACE) including death, coronary artery bypass grafting, stroke or transient ischemic attack, myocardial infarction, and repeat PCI at the same site during the index hospital stay.ResultsThe unadjusted MACE rate was significantly higher in quintiles one and two of operator volume when compared with quintile five (7.38% and 6.13% vs. 4.15%, p = 0.002 and p = 0.0001, respectively). A similar trend was observed for in-hospital death. After adjustment for comorbidities, patients treated by low volume operators had a 63% increased odds of MACE (adjusted odds ratio [OR] 1.63, 95% confidence interval [CI] 1.29 to 2.06, p < 0.0001 for quintile [Q]1; adjusted OR 1.63, 95% CI 1.34 to 1.90, p < 0.0001 for Q2 vs. Q5), but not of in-hospital death. Overall, high volume operators had better outcomes than low volume operators in low-risk and high-risk patients.ConclusionsAlthough the relationship between operator volume and in-hospital mortality is no longer significant, the relationship between volume and any adverse outcome is still present. Technological advancements have not yet completely offset the influence of procedural volume on proficiency of PCIs

Evaluation of expressive writing for postpartum health: A randomized controlled trial

Pregnancy, birth and adjusting to a new baby is a potentially stressful time that can negatively affect the health of women. There is some evidence that expressive writing can have positive effects on psychological and physical health, particularly during stressful periods. The current study aimed to evaluate whether expressive writing would improve women’s postpartum health. A randomized controlled trial was conducted with three conditions: expressive writing (n=188), a control writing task (n=213), or normal care (n=163). Measures of psychological health, physical health and quality of life were measured at baseline (6-12 weeks postpartum), 1 month and 6 months later. Ratings of stress were taken before and after the expressive writing task. Intent-to-treat analyses showed no significant differences between women in the expressive writing, control writing and normal care groups on measures of physical health, anxiety, depression, mood or quality of life at 1 and 6 months. Uptake and adherence to the writing tasks was low. However, women in the expressive writing group rated their stress as significantly reduced after completing the task. Cost analysis suggest women who did expressive writing had the lowest costs in terms of healthcare service use and lowest cost per unit of improvement in quality of life. Results suggest expressive writing is not effective as a universal intervention for all women 6-12 weeks postpartum. Future research should examine expressive writing as a targeted intervention for women in high-risk groups, such as those with mild or moderate depression, and further examine cost-effectiveness

Exosomal transport of hepatocyte-derived drug-modified proteins to the immune system.

Idiosyncratic drug-induced liver injury (DILI) is a rare, often difficult to predict adverse reaction with complex pathomechanisms. However, it is now evident that certain forms of DILI are immune-mediated and may involve the activation of drug-specific T-cells. Exosomes are cell-derived vesicles that carry RNA, lipids and protein cargo from their cell of origin to distant cells, and may play a role in immune activation. Herein, primary human hepatocytes were treated with drugs associated with a high incidence of DILI (flucloxacillin, amoxicillin, isoniazid and nitroso-sulfamethoxazole) to characterize the proteins packaged within exosomes that are subsequently transported to dendritic cells for processing. Exosomes measured between 50-100 nm and expressed enriched CD63. LC-MS/MS identified 2109 proteins, with 608 proteins being quantified across all exosome samples. Data are available via ProteomeXchange with identifier PXD010760. Analysis of gene ontologies revealed that exosomes mirrored whole human liver tissue in terms of the families of proteins present, regardless of drug treatment. However, exosomes from nitroso-sulfamethoxazole-treated hepatocytes selectively packaged a specific subset of proteins. LC-MS also revealed the presence of hepatocyte-derived exosomal proteins covalently modified with amoxicillin, flucloxacillin and nitroso-sulfamethoxazole. Uptake of exosomes by monocyte-derived dendritic cells occurred silently, mainly via phagocytosis, and was inhibited by latrunculin A. An, amoxicillin-modified 9-mer peptide derived from the exosomal transcription factor protein SOX30 activated naïve T-cells from HLA-A*02:01 positive human donors. Conclusion. This study shows that exosomes have the potential to transmit drug-specific hepatocyte-derived signals to the immune system and provides a pathway for the induction of drug hapten-specific T-cell responses. This article is protected by copyright. All rights reserved

The role of administrative data in the big data revolution in social science research

The term big data is currently a buzzword in social science, however its precise meaning is ambiguous. In this paper we focus on administrative data which is a distinctive form of big data. Exciting new opportunities for social science research will be afforded by new administrative data resources, but these are currently under appreciated by the research community. The central aim of this paper is to discuss the challenges associated with administrative data. We emphasise that it is critical for researchers to carefully consider how administrative data has been produced. We conclude that administrative datasets have the potential to contribute to the development of high-quality and impactful social science research, and should not be overlooked in the emerging field of big data

An Introduction to Quality Assurance with an Application for Perfusionists

Cardiovascular perfusionists have always been interested in quality assurance (QA), most often in the form of equipment maintenance and record keeping. However, these activities have tended to be fragmented. In an attempt to define a more global approach to QA, basic concepts are identified and the steps used to start a formal QA program are illustrated. In the usual approach to QA, three areas are commonly assessed: Structure, Process, and Outcome. Structure evaluates the adequacy of facilities and personnel. Process involves review of the activities concerned with the management of patients. Outcome represents evaluation of the end points of care. In starting our formal QA program, five steps were delineated. These were planning the program, setting up an administration, assessing preexisting activities, initiating the program, and finally evaluating results. A QA specialist helped to define a number of concerns about perfusion from perfusionists, surgeons, anesthesiologists, and nurses. Using a standard approach to QA, these areas were defined according to Structure, Process, and Outcome

Long-term studies find benefits, challenges in alternative rice straw management

California state legislation passed in 1991 mandated a phased reduction of rice straw burning in the Central Valley, to reduce air pollution. In 1993, UC Davis scientists launched an 8-year research project on the long-term effects of various alternative means of managing rice straw. Burning, incorporation into the soil, rolling, and baling and removing the straw were compared, with and without winter flooding. None of the various practices reduced grain yields on our experimental plots, but there was an increase in weeds when straw was incorporated, and in particular when the fields were not winter flooded. However, when straw is incorporated, nutrients are returned to the soil and less nitrogen fertilizer can be applied, resulting in lower production costs and less potential for water pollution. In addition, waterfowl on the Pacific Flyway benefit significantly from the wetlands created when fields are flooded during the winter