Demographics and Outcomes of Pulmonary Hypertension Patients in United States Emergency Departments

Introduction: Pulmonary hypertension (PH) is a common, yet under-diagnosed, contributor to morbidity and mortality. Our objective was to characterize the prevalence of PH among adult patients presenting to United States (US) emergency departments (ED) and to identify demographic patterns and outcomes of PH patients in the ED.Methods: We analyzed the Nationwide Emergency Department Sample (NEDS) database, with a focus on ED patients aged 18 years and older, with any International Classification of Diseases, Clinical Modification (ICD)-9-CM or ICD-10-CM diagnosis code for PH from 2011 to 2015. The primary outcome was inpatient, all-cause mortality. The secondary outcomes were hospital admission rates and hospital length of stay (LOS).Results: From 2011 to 2015, in a sample of 121,503,743 ED visits, representing a weighted estimate of 545,500,486 US ED visits, patients with a diagnosis of PH accounted for 0.78% (95% confidence interval [CI], 0.75- 0.80%) of all US ED visits. Of the PH visits, 86.9% were admitted to the hospital, compared to 16.3% for all other ED visits (P <0.001). Likewise, hospital LOS and hospital-based mortality were higher in the PH group than for other ED patients (e.g., inpatient mortality 4.5% vs 2.6%, P < 0.001) with an adjusted odds ratio (aOR) of 1.34 (95% CI, 1.31–1.37). Age had the strongest association with mortality, with an aOR of 10.6 for PH patients over 80 years (95% CI, 10.06–11.22), compared to a reference of ages 18 to 30 years.Conclusion: In this nationally representative sample, presentations by patients with PH were relatively common, accounting for nearly 0.8% of US ED visits. Patients with PH were significantly more likely to be admitted to the hospital than all other patients, had longer hospital LOS, and increased risk of inpatient mortality

Reliability of the Cerebral Performance Category to classify neurological status among survivors of ventricular fibrillation arrest: a cohort study

<p>Abstract</p> <p>Background</p> <p>The Cerebral Performance Category (CPC) score is widely used in research and quality assurance to assess neurologic outcome following cardiac arrest. However, little is known about the inter- and intra-reviewer reliability of the CPC.</p> <p>Methods</p> <p>We undertook an investigation to assess the inter-reviewer and source document reliability of the CPC among a cohort of survivors from out-of-hospital ventricular fibrillation cardiac arrest (n = 131) in a large metropolitan area between November 1, 2003 and December 31, 2005. Subjects with a CPC of 1 or 2 were classified as favorable outcome and those with CPC 3 or greater were classified as unfavorable outcome. One abstractor first used the discharge summary alone to determine the CPC. All 3 abstractors independently reviewed the entire hospital record. Reliability was assessed by determining the proportion of determinations that agreed between abstractors and the respective kappa statistics. We also evaluated the implications for determining survival with favorable neurological outcome when survival to hospital discharge was 20% and 30%.</p> <p>Results</p> <p>When the entire hospital record was used to determine CPC, favorable neurologic outcome (CPC 1 or 2) was recorded in 92% by abstractor 1, 89% by abstractor 2, and 74% by abstractor 3. Agreement was 96% (kappa = 0.78) between abstractors 1 and 2, 84% (kappa = 0.49) between abstractors 2 and 3, 82% (kappa = 0.38) between abstractors 1 and 3. The 3-way kappa was 0.50. Agreement was 90% (kappa = 0.71) between the discharge summary alone and the entire hospital record. If the results from review of the entire record are applied to a circumstance where survival to discharge is 20%, favorable neurologic status would occur in 18.4% for abstractor 1, 17.8% for abstractor 2, and 14.8% for abstractor 3. For survival to hospital discharge of 30%, favorable neurologic status would occur in 27.6% for abstractor 1, 26.7% for abstractor 2, and 22.2% for abstractor 3.</p> <p>Conclusions</p> <p>In this cohort study of survivors of out-of-hospital ventricular fibrillation cardiac arrest, the use of the CPC to classify favorable versus unfavorable neurological status at hospital discharge produced variable inter- and intra-reviewer agreement. The findings provide useful context to interpret outcome evaluations that report CPC.</p

“Her bun in my oven”: Motivations and experiences of two-mother families who have used reciprocal IVF

OBJECTIVES: What motivates same-gender female couples to choose reciprocal in vitro fertilization (IVF)? Do their experiences of becoming and being a mother via reciprocal IVF match their pre-parenthood expectations? BACKGROUND: Reciprocal IVF is a treatment route available to cis, same-gender female couples, and other couples in which both partners have a uterus and egg stores. One partner's egg is retrieved, fertilized in vitro with donor sperm, then carried by the other partner. Existing debate has considered the ethical implications of this treatment route. To date, no empirical research has explored the experiences of families who have used reciprocal IVF. METHODS: Semistructured interviews were conducted with genetic and gestational mothers in 14 families headed by cis, same gender female couples who had conceived by reciprocal IVF in the United Kingdom (N = 28 mothers). Data were analyzed according to the principles of reflexive thematic analysis. RESULTS: Four themes were constructed: (a) becoming mums together; (b) legitimacy: “who's the real mum”; (c) choices and constraints; and (d) biological connections strengthen family connections. CONCLUSION: Families had multiple and nuanced motivations for choosing reciprocal IVF, such as the desire to share the journey of motherhood with their partner, to be perceived as legitimate parents, to overcome practical barriers, and to build strong family relationships. Mothers' pre-parenthood expectations often mismatched the reality of becoming and being a mother via reciprocal IVF. Most parents found that the significance of reciprocal IVF diminished as their children grew up. IMPLICATIONS: Findings demonstrate that reciprocal IVF offers a fulfilling route to parenthood. Parents should have access to routes to parenthood that meet their reproductive needs and feel right for them as a coupl

The significance of interfamilial relationships on birth preparedness and complication readiness in Pakistan.

Background: - In the interests of improving maternal health care and survival, the issue of birth preparedness and complication readiness has been much debated and has remained a priority for the international health community. The provision of birth preparedness and complications readiness is determined by a range of different factors. Aim: - The main aim of this study is to identify and measure the influence of husbands and other family relationships on birth preparedness and complications readiness in the Khyber Pakhtunkhwa province of Pakistan. Methods: - This study is a cross-sectional exploratory study. Data was collected through a survey questionnaire. Logistic regression and descriptive analysis was used. Findings: - Analysis indicated that the mother-in-law's role, men's and women's level of education and interfamilial relationships are still the most significant factors influencing birth preparedness and complications readiness. Of the respondents, 86% were receiving antenatal care and 76.5% were planning for the birth to take place in state-run hospitals or private obstetric and gynae clinics. Conclusion: - The tendency to take up antenatal care in Khyber Pakhtunkhwa can mainly be credited to a mutual understanding between husband and wife and a good relationship between the woman and her mother-in-law. Highlighting the significance of these relationships has implications for ensuring birth preparedness and complications readiness

Measuring Transit Signal Recovery in the Kepler Pipeline II: Detection Efficiency as Calculated in One Year of Data

The Kepler planet sample can only be used to reconstruct the underlying planet occurrence rate if the detection efficiency of the Kepler pipeline is known, here we present the results of a second experiment aimed at characterising this detection efficiency. We inject simulated transiting planet signals into the pixel data of ~10,000 targets, spanning one year of observations, and process the pixels as normal. We compare the set of detections made by the pipeline with the expectation from the set of simulated planets, and construct a sensitivity curve of signal recovery as a function of the signal-to-noise of the simulated transit signal train. The sensitivity curve does not meet the hypothetical maximum detection efficiency, however it is not as pessimistic as some of the published estimates of the detection efficiency. For the FGK stars in our sample, the sensitivity curve is well fit by a gamma function with the coefficients a = 4.35 and b = 1.05. We also find that the pipeline algorithms recover the depths and periods of the injected signals with very high fidelity, especially for periods longer than 10 days. We perform a simplified occurrence rate calculation using the measured detection efficiency compared to previous assumptions of the detection efficiency found in the literature to demonstrate the systematic error introduced into the resulting occurrence rates. The discrepancies in the calculated occurrence rates may go some way towards reconciling some of the inconsistencies found in the literature.Comment: 13 pages, 7 figures, 1 electronic table, accepted by Ap

Computational Discovery of Lanthanide Doped and Co-Doped Y₃Al₅O₁₂ for Optoelectronic Applications

We systematically elucidate the optoelectronic properties of rare-earth doped and Ce co-doped yttrium aluminum garnet (YAG) using hybrid exchange-correlation functional based density functional theory. The predicted optical transitions agree with the experimental observations for single doped Ce:YAG, Pr:YAG, and co-doped Er,Ce:YAG. We find that co-doping of Ce-doped YAG with any lanthanide except Eu and Lu lowers the transition energies; we attribute this behavior to the lanthanide-induced change in bonding environment of the dopant atoms. Furthermore, we find infrared transitions only in case of the Er, Tb, and Tm co-doped Ce:YAG and suggest Tm,Ce:YAG and Tb,Ce:YAG as possible functional materials for efficient spectral up-conversion devices

Experiences of UK identity-release egg donors

The objective of this study was to examine the motivations, experiences and future expectations of identity-release egg donors in the UK following the removal of donor anonymity and the increase in financial compensation for egg donation. This exploratory, in-depth qualitative study comprised semi-structured interviews with 11 women who had attended an egg donation screening appointment at a UK clinic during a four-month period in 2014. Interviews were conducted two to six weeks after the woman had donated or had withdrawn/been rejected from the donation process. Participants' primary motivation for donating was to help infertile women have their 'own child', and the recent increase in financial compensation did not seem to play a significant role in their decision. All were happy to be identifiable and contacted by children born as a result of their donation. However, some were hesitant about providing non-identifying information about themselves for these offspring and wished for further information about the recipient(s) of their eggs and the outcome of their donation. Whilst this study was limited due to the small sample size, it is the first study of UK egg donors following the rise in donor compensation and suggests that other strategies may be more effective in increasing donor numbers.The study was funded by a research grant from the London Women’s Clinic.This is the author accepted manuscript. It is currently embargoed pending publication

Measuring Transit Signal Recovery in the Kepler Pipeline. III. Completeness of the Q1-Q17 DR24 Planet Candidate Catalogue, with Important Caveats for Occurrence Rate Calculations

With each new version of the Kepler pipeline and resulting planet candidate catalogue, an updated measurement of the underlying planet population can only be recovered with an corresponding measurement of the Kepler pipeline detection efficiency. Here, we present measurements of the sensitivity of the pipeline (version 9.2) used to generate the Q1-Q17 DR24 planet candidate catalog (Coughlin et al. 2016). We measure this by injecting simulated transiting planets into the pixel-level data of 159,013 targets across the entire Kepler focal plane, and examining the recovery rate. Unlike previous versions of the Kepler pipeline, we find a strong period dependence in the measured detection efficiency, with longer (>40 day) periods having a significantly lower detectability than shorter periods, introduced in part by an incorrectly implemented veto. Consequently, the sensitivity of the 9.2 pipeline cannot be cast as a simple one-dimensional function of the signal strength of the candidate planet signal as was possible for previous versions of the pipeline. We report on the implications for occurrence rate calculations based on the Q1-Q17 DR24 planet candidate catalog and offer important caveats and recommendations for performing such calculations. As before, we make available the entire table of injected planet parameters and whether they were recovered by the pipeline, enabling readers to derive the pipeline detection sensitivity in the planet and/or stellar parameter space of their choice.Comment: 8 pages, 5 figures, full electronic version of Table 1 available at the NASA Exoplanet Archive; accepted by ApJ May 2nd, 201