5,369 research outputs found
How Do Interventional Cardiologists Make Decisions? Implications for Practice and Reimbursement
Evaluating the Likelihood of Tree Failure in Naples, Florida (United States) Following Hurricane Irma
Trees in residential landscapes provide many benefits, but can injure persons and damage property when they fail. In hurricane-prone regions like Florida, USA, the regular occurrence of hurricanes has provided an opportunity to assess factors that influence the likelihood of wind-induced tree failure and develop species failure profiles. We assessed open-grown trees in Naples, Florida, following the passage of Hurricane Irma in September 2017 to determine the effect of relevant factors on the degree of damage sustained by individual trees. Of 4034 assessed individuals (n = 15 species), 74% sustained no damage, 4% sustained only minor damage (i.e., minimal corrective pruning needed), 6% sustained significant damage (i.e., major corrective pruning needed), and 15% were whole-tree failures (i.e., overturned trees or trees requiring removal). The proportion of individuals in each damage category varied among species, stem diameter at 1.4 m above ground, and the presence of utility lines, which was a proxy for maintenance. We compared our results with the findings of seven previous hurricanes in the region to explore speciesâ resilience in hurricanes
Modified CHA2DS2-VASc score predicts in-hospital mortality and procedural complications in acute coronary syndrome treated with percutaneous coronary intervention
Background: Current risk prediction models in acute coronary syndrome (ACS) patients undergoing PCI are mathematically complex. This study was undertaken to assess the accuracy of a modified CHA2DS2-VASc score, comprised of easily accessible clinical factors in predicting adverse events.
Methods: The National Inpatient Sample (NIS) was queried for ACS patients who underwent PCI between 2010 and 2014. We developed a modified CHA2DS2-VASc score for risk prediction in ACS patients. Multivariate mixed effect logistic regression was utilized to study the adjusted risk for adverse outcomes based on the score. The primary outcome evaluated was in-hospital mortality. Secondary outcomes assessed were stroke, respiratory failure, acute kidney injury, all-cause bleeding, pacemaker insertion, vascular complications, length of stay and cost.
Results: There were 252,443 patients admitted with ACS included. Mean age was 62 +/- 12 years. The mean CH3A2DS-VASc score was 1.6 +/- 1.6. The in-hospital mortality rate was 2.5%. CH3A2DS-VASc score was highly correlated with increased rate of mortality and all secondary outcomes. ROC curve analysis for association of CH3A2DS-VASc score with mortality demonstrates that area under the curve (AUC) = 0.83 (95%C: 0.82-0.84). Stepwise increases in CH3A2DS-VASc score correlated with incremental risk, and total score was an independent predictor of mortality (adjusted OR: 1.99 (95%CI: 1.96-2.03) p \u3c 0.001) and all secondary outcomes.
Conclusion: This study supports the applicability of the CH3A2DS-VASc score as an accurate risk prediction model for ACS patients undergoing PCI and could supplant more complicated models for quality assurance
Percutaneous coronary interventions in octogenarians in the American College of CardiologyâNational Cardiovascular Data Registry Development of a nomogram predictive of in-hospital mortality
AbstractObjectivesWe sought to evaluate the results of percutaneous coronary intervention (PCI) in elderly patients in contemporary practice.BackgroundPrior studies of PCI in the elderly population demonstrate increased in-hospital mortality, but these studies are limited by small population size.MethodsUsing the American College of CardiologyâNational Cardiovascular Data Registry (ACCâNCDR) of 100,253 patients, the in-hospital outcomes in all 8,828 PCI procedures performed on octogenarians were evaluated. Patients underwent PCI between 1998 and 2000 at over 145 participating centers.ResultsThe mean age was 83.72 ± 3.02 years, with female preponderance (53%). The PCI was considered angiographically successful in 93%, stents were placed in 75%, and the post-PCI length of stay was 3.3 ± 5.1 days. Overall in-hospital mortality was 3.77% but was only 1.35% in PCI without recent myocardial infarction (MI) within one week (p < 0.0001). Patients having PCI within 6 h of the onset of their MI had an increase in mortality tenfold (13.79%) compared with patients without a recent MI (p < 0.0001). All groups that were defined based on time of PCI after MI onset up to seven days had increased mortality (all p < 0.0001). Older age (odds ratio [OR] of 1.03 per incremental year), depressed ejection fraction (EF) (OR 0.69 per 10 points for EF <60%), and time of PCI after MI onset (<6 h, OR 6.87; 6 to 24 h, OR 5.66; 24 h to one week, OR 2.93) were most strongly predictive of outcome by multivariate analysis. The predicted mortality from the multivariate model correlated well with the observed in-hospital mortality up to 20% mortality. A 254-point nomogram was constructed employing the logistic model using a weighted point system.ConclusionsIn patients â„80 years old, PCI has good success and acceptable mortality. The presence of an acute or recent MI substantially increases the risk of in-hospital death
3-dimensional intravascular ultrasound imaging of human coronary arteries after percutaneous revascularization
Seismicity and Pn Velocity Structure of Central West Antarctica
We have located 117 previously undetected seismic events mainly occurring between 2015 and 2017 that originated from glacial, tectonic, and volcanic processes in central West Antarctica using data recorded on Polar Earth Observing Network (POLENET/ANET) and UK Antarctic Network (UKANET) seismic stations. The seismic events, with local magnitudes (ML) ranging from 1.1 to 3.5, are predominantly clustered in four geographic regions; the Ellsworth Mountains, Thwaites Glacier, Pine Island Glacier, and Mount Takahe. Eighteen of the events are in the Ellsworth Mountains and can be attributed to a mixture of glacial and tectonic processes. The largest event noted in this study was a midâcrustal (âŒ19 km focal depth; ML 3.5) normal mechanism earthquake beneath Thwaites Glacier. We also located 91 glacial events near the grounding zones of Thwaites Glacier and Pine Island Glacier that are predominantly associated with time periods of significant calving activity. Eight events, likely arising from volcanoâtectonic processes, occurred beneath Mount Takahe. Using Pn travel times from the seismic events, we find laterally variable uppermost mantle structure in central West Antarctica. On average, the Ellsworth Mountains are underlain by a faster mantle lid (VPn = âŒ8.4 km/s) compared to the Amundsen Sea Embayment region (VPn = âŒ8.1 km/s). Within the Amundsen Sea Embayment itself, we find mantle lid velocities ranging from âŒ8.05 to 8.18 km/s. Laterally heterogeneous uppermost mantle structure, indicative of variable thermal and rheological structure, likely influences both geothermal heat flux and glacial isostatic adjustment spatial patterns and rates within central West Antarctica
Development of a risk adjustment mortality model using the American College of CardiologyâNational Cardiovascular Data Registry (ACCâNCDR) experience: 1998â2000
AbstractObjectivesWe sought to develop and evaluate a risk adjustment model for in-hospital mortality following percutaneous coronary intervention (PCI) procedures using data from a large, multi-center registry.BackgroundThe 1998â2000 American College of CardiologyâNational Cardiovascular Data Registry (ACCâNCDR) dataset was used to overcome limitations of prior risk-adjustment analyses.MethodsData on 100,253 PCI procedures collected at the ACCâNCDR between January 1, 1998, and September 30, 2000, were analyzed. A training set/test set approach was used. Separate models were developed for presentation with and without acute myocardial infarction (MI) within 24 h.ResultsFactors associated with increased risk of PCI mortality (with odds ratios in parentheses) included cardiogenic shock (8.49), increasing age (2.61 to 11.25), salvage (13.38) urgent (1.78) or emergent PCI (5.75), pre-procedure intra-aortic balloon pump insertion (1.68), decreasing left ventricular ejection fraction (0.87 to 3.93), presentation with acute MI (1.31), diabetes (1.41), renal failure (3.04), chronic lung disease (1.33); treatment approaches including thrombolytic therapy (1.39) and non-stent devices (1.64); and lesion characteristics including left main (2.04), proximal left anterior descending disease (1.97) and Society for Cardiac Angiography and Interventions lesion classification (1.64 to 2.11). Overall, excellent discrimination was achieved (C-index = 0.89) and application of the model to high-risk patient groups demonstrated C-indexes exceeding 0.80. Patient factors were more predictive in the MI model, while lesion and procedural factors were more predictive in the analysis of non-MI patients.ConclusionsA risk adjustment model for in-hospital mortality after PCI was successfully developed using a contemporary multi-center registry. This model is an important tool for valid comparison of in-hospital mortality after PCI
Education, income, and incident heart failure in post-menopausal women: the Women\u27s Health Initiative Hormone Therapy Trials
OBJECTIVES: The purpose of this study is to estimate the effect of education and income on incident heart failure (HF) hospitalization among post-menopausal women.
BACKGROUND: Investigations of socioeconomic status have focused on outcomes after HF diagnosis, not associations with incident HF. We used data from the Women\u27s Health Initiative Hormone Trials to examine the association between socioeconomic status levels and incident HF hospitalization.
METHODS: We included 26,160 healthy, post-menopausal women. Education and income were self-reported. Analysis of variance, chi-square tests, and proportional hazards models were used for statistical analysis, with adjustment for demographics, comorbid conditions, behavioral factors, and hormone and dietary modification assignments.
RESULTS: Women with household incomes $50,000 a year (16.7/10,000 person-years; p \u3c 0.01). Women with less than a high school education had higher HF hospitalization incidence (51.2/10,000 person-years) than college graduates and above (25.5/10,000 person-years; p \u3c 0.01). In multivariable analyses, women with the lowest income levels had 56% higher risk (hazard ratio: 1.56, 95% confidence interval: 1.19 to 2.04) than the highest income women; women with the least amount of education had 21% higher risk for incident HF hospitalization (hazard ratio: 1.21, 95% confidence interval: 0.90 to 1.62) than the most educated women.
CONCLUSIONS: Lower income is associated with an increased incidence of HF hospitalization among healthy, post-menopausal women, whereas multivariable adjustment attenuated the association of education with incident HF. Elsevier Inc. All rights reserved
Transaction processing in consistency-aware userâs applications deployed on NoSQL databases
Quantum chaos, random matrix theory, and statistical mechanics in two dimensions - a unified approach
We present a theory where the statistical mechanics for dilute ideal gases
can be derived from random matrix approach. We show the connection of this
approach with Srednicki approach which connects Berry conjecture with
statistical mechanics. We further establish a link between Berry conjecture and
random matrix theory, thus providing a unified edifice for quantum chaos,
random matrix theory, and statistical mechanics. In the course of arguing for
these connections, we observe sum rules associated with the outstanding
counting problem in the theory of braid groups. We are able to show that the
presented approach leads to the second law of thermodynamics.Comment: 23 pages, TeX typ
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