The European Registry for Patients with Mechanical Circulatory Support (EUROMACS)

OBJECTIVES: A second paediatric report has been generated from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). The purpose of EUROMACS, which is operated by the European Association for Cardio-Thoracic Surgery, is to gather data related to durable mechanical circulatory support for scientific purposes and to publish reports with respect to the course of mechanical circulatory support therapy. Since the first report issued, efforts to increase compliance and participation have been extended. Additionally, the data provided the opportunity to analyse patients of younger age and lower weight. METHODS: Participating hospitals contributed pre-, peri- and long-term postoperative data on mechanical circulatory support implants to the registry. Data for all implants in paediatric patients (≤19 years of age) performed from 1 January 2000 to 1 July 2019 were analysed. This report includes updates of patient characteristics, implant frequency, outcome (including mortality rates, transplants and recovery rates) as well as adverse events including neurological dysfunction, device malfunction, major infection and bleeding. RESULTS: Twenty-nine hospitals contributed 398 registered implants in 353 patients (150 female, 203 male) to the registry. The most frequent aetiology of heart failure was any form of cardiomyopathy (61%), followed by congenital heart disease and myocarditis (16.4% and 16.1%, respectively). Competing outcomes analysis revealed that a total of 80% survived to transplant or recovery or are ongoing; at the 2-year follow-up examination, 20% died while on support. At 12 months, 46.7% received transplants, 8.7% were weaned from their device and 18.5% died. The 3-month adverse events rate was 1.69 per patient-year for device malfunction including pump exchange, 0.48 for major bleeding, 0.64 for major infection and 0.78 for neurological events. CONCLUSIONS: The overall survival rate was 81.5% at 12 months following ventricular assist device implant. The comparison of survival rates of the early and later eras shows no significant difference. A focus on specific subgroups showed that survival was less in patients of younger age (<1 year of age) (P = 0.01) and lower weight (<20 kg) (P = 0.015). Transplant rates at 6 months contin

Particle growth in urban and industrial plumes in Texas

Particle size distributions and gas-phase particle precursors and tracer species were measured aboard an aircraft in the plumes downwind from industrial and urban sources in the vicinity of Houston, TX during the daytime in late August and early September 2000. Plumes originating from the Parish gas-fired and coal-fired power plant, petrochemical industries along the Houston ship channel, the petrochemical facilities near the Gulf coast, and the urban center of Houston were studied. Most of the particle mass flux advected downwind of Houston came from the industries and electrical utilities at the periphery of the city rather than from sources in the urban core. In SO2-rich plumes that did not contain elevated concentrations of volatile organic compounds (VOCs), particle volume increased with increasing plume oxidation (age) at a rate consistent with condensation and neutralization of the gas-phase oxidation products Of SO2. In plumes that were rich in both SO2 and VOCs, observed particle growth greatly exceeded that expected from SO2 oxidation, indicating the formation of organic particulate mass. In plumes that were enhanced in VOCs but not in SO2, and in the plume of the Houston urban center, no particle volume growth with increasing plume oxidation was detected. Since substantial particle volume growth was associated only with SO2-rich plumes, these results suggest that photochemical oxidation of SO2 is the key process regulating particle mass growth in all the studied plumes in this region. However, uptake of organic matter probably contributes substantially to particle mass in petrochemical plumes rich in both SO2 and VOCs. Quantitative studies of particle formation and growth in photochemical systems containing nitrogen oxides (NOx = NO + NO2 ), VOCs, and SO2 are recommended to extend those previously made in NOx-VOC systems

Ten millennia of hepatitis B virus evolution

Hepatitis B virus (HBV) has been infecting humans for millennia and remains a global health problem, but its past diversity and dispersal routes are largely unknown. We generated HBV genomic data from 137 Eurasians and Native Americans dated between ~10,500 and ~400 years ago. We date the most recent common ancestor of all HBV lineages to between ~20,000 and 12,000 years ago, with the virus present in European and South American hunter-gatherers during the early Holocene. After the European Neolithic transition, Mesolithic HBV strains were replaced by a lineage likely disseminated by early farmers that prevailed throughout western Eurasia for ~4000 years, declining around the end of the 2nd millennium BCE. The only remnant of this prehistoric HBV diversity is the rare genotype G, which appears to have reemerged during the HIV pandemic

The effectiveness of qualification measures for employed workers - an evaluation study for Saxony

This article investigates whether and to what extent employment policy measures (co-) financed by the European Social Fund in Germany meet their objective. Specifically, it is analysed whether qualification programs for employed workers in the German state of Saxony were effective in terms of employment protection. To this end, a control function approach is implemented which utilizes a unique firm-level dataset. This model explicitly accounts for unobserved heterogeneity between participating and nonparticipating companies by modelling the participation decision process. Our results suggest a positive effect of program participation. However, this positive treatment effect varies considerably across different sub-groups of the treatment as well as the comparison group.

Rational application of antibiotics—The influence of anaesthetists’ gender on self‐confidence and knowledge

Background High rates of multiresistant pathogens require detailed knowledge about rational utilization of antibiotics. Many physicians consider themselves uncertain about the interpretation of microbiological diagnostics. We examined whether self-confidence, self-rated knowledge, and objective knowledge regarding the use of antibiotics are associated with gender. Methods For this survey study, in 2017, anaesthesiologists and residents of 16 anaesthetic departments in Germany were asked to complete the Multiinstitutional Reconnaissance of practice with Multiresistant bacteria (MR2) survey. It consists of 55 items evaluating self-confidence regarding the practical use of antibiotics (n = 6), self-rated theoretical knowledge (n = 16), and objective knowledge (n = 5). Their answers to these items in relation to their gender were analysed using Chi-square, Kruskal-Wallis-H-Tests, and unadjusted as well as adjusted logistic regression models. Results Six hundred eighty-four (response rate: 53.9 %) questionnaires were returned and were available for analysis. Female doctors (35.5 %) felt less self-confident (P < 0.001). Self-rated knowledge differed in overall mean (P = 0.014) and the unadjusted (odds ratio [OR]: 0.55; P = 0.013) but not in the adjusted logistic regression (OR: 0.84; P = 0.525). Objective knowledge differed after pooling questions (61.2% correct answers vs 65.4%, P = 0.01) but not with respect to single items and the adjusted logistic regression (OR: 0.83, P = 0.356). Conclusion Less self-confidence and a lower self-rated knowledge were found in female anaesthetists; this is consistent to the gender phenomena observed by other researchers. Nevertheless, between the 2 groups objective knowledge did not differ significantly in any item

The European Registry for Patients with Mechanical Circulatory Support (EUROMACS): first EUROMACS Paediatric (Paedi-EUROMACS) report

OBJECTIVES EUROMACS is a registry of the European Association for Cardio-Thoracic Surgery (EACTS) whose purpose is to gather clinical data related to durable mechanical circulatory support for scientific purposes and to publish annual reports. Because the treatment of children with end-stage heart failure has several significantly different characteristics than the treatment of adults, data and outcomes of interventions are analysed in this dedicated paediatric report. METHODS Participating hospitals contributed pre-, peri- and long-term postoperative data on mechanical circulatory support implants to the registry. Data for all implants in paediatric patients (≤19 years of age) performed from 1 January 2000 to 31 December 2017 were analysed. This report includes updates of patient characteristics, implant frequency, outcome (including mortality rates, transplants and recovery rates) as well as adverse events. RESULTS Twenty-five hospitals contributed 237 registered implants in 210 patients (81 ♀, 129 ♂) to the registry. The most frequent diagnosis was any form of cardiomyopathy (71.4%) followed by congenital heart disease (18.6%). Overall mean support time on a device was 11.6 months (±16.5 standard deviation). A total of 173 children (82.4%) survived to transplant, recovery or are ongoing; 37 patients (17.6%) died while on support within the observed follow-up time. At 12 months 38% of patients received transplants, 7% were weaned from their device and 15% died. At 24 months, 51% of patients received transplants, 17% died while on support, 22% were on a device and 9% were explanted due to myocardial recovery. The adverse events rate per 100 patient-months was 0.2 for device malfunction, 0.05 for major bleeding, 0.06 for major infection and 0.03 for neurological events within the first 3 months after implantation. CONCLUSIONS The first paediatric EUROMACS report reveals a low transplant rate in European countries within the first 2 years of implantation compared to US data. The 1-year survival rate seems to be satisfactory. Device malfunction including pump chamber changes due to thrombosis was the most frequent adverse event

Cerebral strokes in children on intracorporeal ventricular assist devices: analysis of the EUROMACS Registry

OBJECTIVES: Little is known about cerebral strokes in paediatric patients supported by intracorporeal continuous-flow ventricular assist devices. METHODS: We retrospectively investigated patients younger than 19 years of age who were treated with an intracorporeal continuous-flow ventricular assist device in the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) database. The patients were stratified by body surface area in Group 1 [<1.2 m2 (n = 13)] and Group 2 [≥1.2 m2 (n = 38)]. Cerebral strokes, both ischaemic and haemorrhagic, were studied. RESULTS: Of the 2941 patients with ventricular assist device (VAD) implants listed in the database, 124 (4%) patients were less than 19 years of age. Fifty-one of them (2%) were supported with a continuous-flow ventricular assist device. Group 1 (6 female and 7 male) had a mean age (±SD) of 9 ± 2.3 years compared with 15.6 ± 1.8 years in Group 2 (21 female and 17 male). Three (23%) patients died in Group 1 on VAD support, whereas 5 (13%) patients died in Group 2 (P = 0.21; log-rank test). Seven (54%) patients with a VAD in Group 1 and 17 (45%) patients in Group 2 underwent transplantation (P = 0.29); of these, 1 (8%) patient recovered (Group 1) with subsequent device explantation. The other patients, 2 in Group 1 and 16 in Group 2, were still on device support at the time of the analysis. There were no cerebral strokes in Group 1, but 4 cerebral strokes (11% of Group 2, 8% of a total of 51 patients in Groups 1 and 2 combined) occurred in Group 2 (3 patients died; P = 0.26; log-rank test). Taken together, the incidence of cerebral strokes in this paediatric cohort of patients with an intracorporeal VAD was 0.1 per patient-year. CONCLUSIONS: The incidence of cerebral strokes in children with intracorporeal VADs (0.1 per patient-year) seems to be low irrespective of the body surface area