Clinical Outcomes for VA-ECMO Patients Associated with Hyperlipidemia: An Analysis of the National Inpatient Sample

Introduction: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is considered the most advanced temporary life support which provides complete hemodynamic support in addition to gas exchange. There is limited data available on the impact of hyperlipidemia (HLD) on VA-ECMO patients. We sought to examine the national inpatient sample (NIS) database to describe in-hospital outcomes among these patients. Methods: The NIS was searched for hospitalizations of adult VA-ECMO patients with and without a concomitant diagnosis of HLD for the years 2019 and 2020. The primary outcome was inpatient mortality. Results:This study included 3,885 VA-ECMO patients, of which 1,082 (27.8%) patients had HLD. VA-ECMO patients with HLD had higher prevalence of hypertension (57.3% vs. 71.4%, p Conclusion: In this nationally representative population‐based retrospective cohort study, HLD was associated with higher mortality and worse outcomes among VA-ECMO patients

Sex Differences in Outcomes Among Patients Undergoing Thoracic Endovascular Aortic Repair (TEVAR) Procedure: A Retrospective Cohort Study

Introduction: There is limited data about sex differences in patients undergoing a thoracic endovascular aortic repair (TEVAR) procedure. This study sought to examine the national inpatient sample (NIS) database to describe in-hospital outcomes by gender. Methods: The NIS was searched for hospitalizations of adult patients who underwent TEVAR in 2019 and 2020. For this cohort, female patients were identified, and pregnant patients were excluded. The primary outcome was inpatient mortality. Secondary outcomes included hospital length of stay (LOS), and total hospital charges (TOTHCG). Results: This study included 696 patients who underwent TEVAR. 255 (36.6%) females were identified, of which, 7 were pregnant and excluded from the study. Female patients who underwent TEVAR had higher prevalence of obesity (30.6% vs. 24.3%, p \u3c0.001), smoking (28.1% vs. 22.3%, p \u3c0.001), and CKD (5.2% vs. 4.2%, p \u3c0.001). In-hospital mortality was higher among the female cohort (6.1% vs. 4.0%, p \u3c 0.001). On multivariable regression, females who underwent TEVAR were associated with higher odds of inpatient mortality (OR 1.210, 95% CI 1.091-1.342, p \u3c0.001). Additionally, patients who underwent TEVAR and had ventricular arrythmias pay significantly more TOTHCG ($600,004 vs.$462,216, P\u3c0.001) with longer LOS (23.5days vs. 15.7days, p \u3c0.001). On secondary analysis it has shown patients with ventricular arrhythmias who underwent TEVAR had higher odds of having acute kidney injury, developing shock, arrhythmias and congestive heart failure exacerbation. Conclusion: In this nationally representative population‐based retrospective cohort study, female patients were associated with higher mortality and worse outcomes among patients undergoing TEVAR procedure

Outcomes of Thoracic Endovascular Aortic Repair (TEVAR) Procedure in Octogenarians, Nonagenarians and Centenarians: A Population-Based Study

Introduction: Limited data exists for patients undergoing a thoracic endovascular aortic repair (TEVAR) procedure who are older than or equal to 80 years old (YO). This study sought to examine the national inpatient sample (NIS) database to describe in-hospital outcomes among these older patients. Methods: The NIS was searched for hospitalizations of adults who underwent a TEVAR procedure in 2019 and 2020. The study compared those aged 80 YO and over to those younger than 80 YO. The primary outcome was inpatient mortality. Secondary outcomes included hospital length of stay (LOS), and total hospital charges (TOTHCG). Results: This study included 696 patients who underwent TEVAR, of which 35 (5.02%) were 80 years or older. Patients who had a TEVAR and were 80 years and older had higher prevalence of hypertension (57.6% vs. 50.3%, p Conclusion: In this nationally representative population‐based study, aging was associated with higher mortality and worse outcomes among patients undergoing a TEVAR procedure

Adolescent self-control predicts midlife hallucinatory experiences:40-year follow-up of a national birth cohort

Associations between self-control in adolescence and adult mental health are unclear in the general population; to our knowledge, no study has investigated self-control in relation to psychotic-like symptoms

Healthy lifestyles are associated with better vitamin D status in community-dwelling older men: The Health In Men Study (HIMS)

Objective: Older people are more prone to vitamin D deficiency than younger populations. Individual lifestyle factors have been associated with vitamin D status. We examined the influence of a combination of lifestyle factors on vitamin D status in older men. Participants and Measurements: In a population-based cohort study of older men (age ≥65 years), a lifestyle score was calculated from eight prudent health-related behaviours (smoking, exercise, alcohol, fish and meat consumption, adding salt, milk choices and obesity) collected via questionnaire at baseline. Blood samples were collected 5 years afterwards to measure plasma 25-hydroxyvitamin D (25OHD) levels. Associations between lifestyles and the likelihood of having plasma 25OHD levels of ≥75 versus <75 nmol/L and ≥50 versus <50 nmol/L were tested using logistic regression models. Results: Of the 2717 men analysed, mean plasma 25OHD was 69.0 ± 23.5 nmol/L, with 20.7% having plasma 25OHD <50 nmol/L. Men engaging in ≥4 healthy lifestyle behaviours had 20% higher odds of plasma 25OHD ≥75 nmol/L (adjusted OR = 1.20, 95% CI: 1.01−1.45) compared to those with <4 healthy behaviours. No association was found for 25OHD ≥50 nmol/L. Higher physical activity was the only individual component significantly associated with vitamin D sufficiency (highest vs. lowest quintiles of physical activity, adjusted OR = 2.01, 95% CI: 1.47−2.74 for 25OHD ≥50 nmol/L, adjusted OR = 2.35, 95% CI: 1.81−3.06 for 25OHD ≥75 nmol/L). Conclusion: Multiple healthy lifestyle behaviours are associated with better vitamin D status in older men. Further work is needed to determine the effects of promoting healthy lifestyle behaviours, including physical activity, on vitamin D sufficiency

The Early Psychosis Screener (EPS): Quantitative validation against the SIPS using machine learning

Machine learning techniques were used to identify highly informative early psychosis self-report items and to validate an early psychosis screener (EPS) against the Structured Interview for Psychosis-risk Syndromes (SIPS). The Prodromal Questionnaire–Brief Version (PQ-B) and 148 additional items were administered to 229 individuals being screened with the SIPS at 7 North American Prodrome Longitudinal Study sites and at Columbia University. Fifty individuals were found to have SIPS scores of 0, 1, or 2, making them clinically low risk (CLR) controls; 144 were classified as clinically high risk (CHR) (SIPS 3–5) and 35 were found to have first episode psychosis (FEP) (SIPS 6). Spectral clustering analysis, performed on 124 of the items, yielded two cohesive item groups, the first mostly related to psychosis and mania, the second mostly related to depression, anxiety, and social and general work/school functioning. Items within each group were sorted according to their usefulness in distinguishing between CLR and CHR individuals using the Minimum Redundancy Maximum Relevance procedure. A receiver operating characteristic area under the curve (AUC) analysis indicated that maximal differentiation of CLR and CHR participants was achieved with a 26-item solution (AUC = 0.899 ± 0.001). The EPS-26 outperformed the PQ-B (AUC = 0.834 ± 0.001). For screening purposes, the self-report EPS-26 appeared to differentiate individuals who are either CLR or CHR approximately as well as the clinician-administered SIPS. The EPS-26 may prove useful as a self-report screener and may lead to a decrease in the duration of untreated psychosis. A validation of the EPS-26 against actual conversion is underway

Effect of microstructural evolution on magnetic properties of Ni thin films

Copyright © Indian Academy of Sciences.The magnetic properties of Ni thin films, in the range 20–500 nm, at the crystalline-nanocrystalline interface are reported. The effect of thickness, substrate and substrate temperature has been studied. For the films deposited at ambient temperatures on borosilicate glass substrates, the crystallite size, coercive field and magnetization energy density first increase and achieve a maximum at a critical value of thickness and decrease thereafter. At a thickness of 50 nm, the films deposited at ambient temperature onto borosilicate glass, MgO and silicon do not exhibit long-range order but are magnetic as is evident from the non-zero coercive field and magnetization energy. Phase contrast microscopy revealed that the grain sizes increase from a value of 30–50 nm at ambient temperature to 120–150 nm at 503 K and remain approximately constant in this range up to 593 K. The existence of grain boundary walls of width 30–50 nm is demonstrated using phase contrast images. The grain boundary area also stagnates at higher substrate temperature. There is pronounced shape anisotropy as evidenced by the increased aspect ratio of the grains as a function of substrate temperature. Nickel thin films of 50 nm show the absence of long-range crystalline order at ambient temperature growth conditions and a preferred [111] orientation at higher substrate temperatures. Thin films are found to be thermally relaxed at elevated deposition temperature and having large compressive strain at ambient temperature. This transition from nanocrystalline to crystalline order causes a peak in the coercive field in the region of transition as a function of thickness and substrate temperature. The saturation magnetization on the other hand increases with increase in substrate temperature.University Grants Commission for Centre of Advanced Studies in Physic

Acceptability and appropriateness of a clinical pathway for managing anxiety and depression in cancer patients: a mixed methods study of staff perspectives.

BACKGROUND: Clinical pathways (CPs) can improve health outcomes, but to be sustainable, must be deemed acceptable and appropriate by staff. A CP for screening and management of anxiety and depression in cancer patients (the ADAPT CP) was implemented in 12 Australian oncology services for 12 months, within a cluster randomised controlled trial of core versus enhanced implementation strategies. This paper compares staff-perceived acceptability and appropriateness of the ADAPT CP across study arms. METHODS: Multi-disciplinary lead teams at each service tailored, planned, championed and implemented the CP. Staff at participating services, purposively selected for diversity, completed a survey and participated in an interview prior to implementation (T0), and at midpoint (6 months: T1) and end (12 months: T2) of implementation. Interviews were recorded, transcribed and thematically analysed. RESULTS: Seven metropolitan and 5 regional services participated. Questionnaires were completed by 106, 58 and 57 staff at T0, T1 and T2 respectively. Eighty-eight staff consented to be interviewed at T0, with 89 and 76 at T1 and T2 (response rates 70%, 66% and 57%, respectively). Acceptability/appropriateness, on the quantitative measure, was high at T0 (mean of 31/35) and remained at that level throughout the study, with no differences between staff from core versus enhanced services. Perceived burden was relatively low (mean of 11/20) with no change over time. Lowest scores and greatest variability pertained to perceived impact on workload, time and cost. Four major themes were identified: 1) Mental health is an important issue which ADAPT addresses; 2) ADAPT helps staff deliver best care, and reduces staff stress; 3) ADAPT is fit for purpose, for both cancer care services and patients; 4) ADAPT: a catalyst for change. Opposing viewpoints are outlined. CONCLUSIONS: This study demonstrated high staff-perceived acceptability and appropriateness of the ADAPT CP with regards to its focus, evidence-base, utility to staff and patients, and ability to create change. However, concerns remained regarding burden on staff and time commitment. Strategies from a policy and managerial level will likely be required to overcome the latter issues. TRIAL REGISTRATION: The study was registered prospectively with the ANZCTR on 22/3/2017. Trial ID ACTRN12617000411347. https://www.anzctr.org.au/