Infection Rate and Outcomes of Watchman Devices: Results from a Single-Center 14-Year Experience

The Watchman device (WD) is a commonly used alternative strategy to oral anticoagulation for stroke risk reduction in patients with atrial fibrillation who have an increased bleeding risk. There are rare case reports of WD-related infection. Currently, there is no formal study that has systematically evaluated the incidence and outcomes WD-related infections. The objective of this study was to evaluate the incidence, risk factors, and outcomes for WD-associated infections in a single-center cohort over a 14-year period. All patients who underwent WD implantation over a 14-year study period (July 2004 through December 2018) comprised our cohort. Baseline characteristics, procedural data, and postimplantation events were identified through a retrospective chart review. Primary study outcomes included WD-related infection, other cardiovascular device-related infection, bacteremia, and mortality. A total of 181 patients (119 males; 65.7%) with a mean age of 75 years at implantation were included in the analysis. A total of 534.7 patient years of follow-up was accrued, with an average of 2.9 years per patient. The most common indications for implantation included gastrointestinal bleeding (56 patients; 30.9%) and intracerebral bleeding (51 patients; 28.2%). During the follow-up period, 37 (20.4%) patients died. Six developed evidence of bacteremia. Only 1 developed an implantable cardioverter defibrillator infection that required a complete system extraction. None of the cohort developed a WD-related device infection during the study period. We concluded that there is a low risk of WD-related infection even in the setting of a blood stream infection

Atrioventricular and interventricular delay optimization in cardiac resynchronization therapy: physiological principles and overview of available methods

In this review, the physiological rationale for atrioventricular and interventricular delay optimization of cardiac resynchronization therapy is discussed including the influence of exercise and long-term cardiac resynchronization therapy. The broad spectrum of both invasive and non-invasive optimization methods is reviewed with critical appraisal of the literature. Although the spectrum of both invasive and non-invasive optimization methods is broad, no single method can be recommend for standard practice as large-scale studies using hard endpoints are lacking. Current efforts mainly investigate optimization during resting conditions; however, there is a need to develop automated algorithms to implement dynamic optimization in order to adapt to physiological alterations during exercise and after anatomical remodeling

PEER-EFFECTS IN OBESITY AMONG PUBLIC SCHOOL CHILDREN: A GRADE-LEVEL ANALYSIS

We examine the role of peer effects in childhood obesity outcomes by investigating whether obesity rates among the highest graders in a public school has an effect on obesity rates among younger grades. We use a panel dataset with obesity prevalence measured at the grade level. Our data are from Arkansas public schools. Results provide evidence that changes in the obesity prevalence at the highest grade are associated with changes in obesity prevalence at younger grades. The magnitude of the peer effect depends on the type of school, and we find statistically significant peer effects in both elementary and high schools but not in middle schools. These effects are also larger in high schools than in elementary schools. We use falsification tests to provide evidence that these peer effects are more than just a statistical correlation or an association

Peer-Effects on Childhood Obesity

This study investigates whether peers are a contributing factor in the increase in childhood obesity rates, and whether peer effects vary by race, gender and residential neighborhood. We control for the commercial food environment around schools and residence when estimating peer effects given that the food environment constitutes an important set of factors that have not been adequately measured and accounted for in previous studies. We find that the weight of peers within the same grade in a school significantly impacts body mass index (BMI) z-score of an individual student. A typical student’s BMI z-score increases when facing heavier peers and it decreases when facing lighter peers. The results show differential peer-effects across race and gender, but more so by gender than by race

Peer-Effects on Childhood Obesity: An Instrumental Variables Approach on Exogenously Assigned Peers

This study investigates whether peers are a contributing factor in childhood body-weight outcomes. Using an instrumental variables method on exogenously assigned peers, we find that the weight of peers within the same grade and school significantly impacts body mass index (BMI) z-score of an individual student. A typical student’s BMI z-score increases when facing heavier peers. The size of the peer-effect, however, is very modest. For a percentage point increase in the proportion of obese students in the same grade, a typical student’s BMI z-score increases by only 0.00341 standard deviations