Supplementary Material for: In-Hospital Mortality and Major Adverse Cardiovascular Events after Kidney Transplantation in the United States

Background: Kidney transplantation (KT) is the treatment of choice for end-stage kidney disease. Cardiovascular disease is a major determinant of morbidity and mortality in patients with KT. Temporal trends in perioperative cardiovascular outcomes after KT are understudied, especially in light of an aging KT waitlist population. Methods: We performed a retrospective observational cohort study using the National Inpatient Sample for the years 2004–2013. All adult patients undergoing KT were identified using the appropriate International Classification of Diseases, 9th Revision, Clinical Modification codes. Demographic and hospital characteristics, discharge disposition, payer status, and major adverse cardiovascular events (MACEs) were summarized using summary statistics. Multivariate logistic regression was used to identify predictors of MACEs in the perioperative period of KT. Results: A total of 147,431 KTs were performed between 2004 and 2013. The mean age at KT went up from 48.1 to 51.8 years from 2004 to 2013. Medicare was the primary payer for 59.6% of the KTs. Overall average perioperative mortality was 0.5%, median length of stay was 5 days, and 6.5% of patients experienced an MACE, 78% of which were heart failures (HFs). Important predictors of perioperative MACEs were age ≥65 years (OR = 2.14), Medicare as primary payer (OR = 1.51), diabetes (OR = 1.46), recreational drug use (OR = 1.72), pulmonary circulation disorders (OR = 3.28), and malnutrition (OR = 1.91). Conclusion: Despite increases in age at the time of KT, the absolute risk of perioperative MACEs has remained stable from 2004 to 2013. HF is a major component of postoperative MACEs in KT. Malnutrition and pulmonary hypertension are major nontraditional predictors of perioperative MACE outcomes

Inclusive Futures: Harnessing Virtual Reality for Dementia Care

Dementia care, on both national and global scales, faces mounting pressures as incidence increases, effective treatments remain elusive, and existing support systems struggle to provide personalised, enriching experiences for those in moderate-to-advanced stages of the condition. Simultaneously, virtual reality (VR) technology has advanced rapidly in both capability and accessibility, offering potentially new ways to deliver immersive experiences to spark reminiscence, social connection, and improve emotional wellbeing. In this report, we explore how these two trajectories—heightened demand for person-centred dementia care and the maturation of immersive technologies—could converge to shape a more inclusive future for people living with dementia. Through four complementary streams of inquiry, we explore the depth and breadth of VR’s potential in dementia support. We report on two studies led by the Centre for Immersive Technologies: (i) surveying experts working in healthcare and/or with XR technologies; and (ii) a focus group with the underserved South Asian community. The results of this work show that interventions must reflect personal histories and linguistic preferences if they are to be truly meaningful. We highlight the results of a Yorkshire-based VR company, Recreo VR, who conducted a feasibility trial with 101 participants in community and care-home settings. Their personalised, low-flow 360° videos successfully engaged up to 97% of users, eliciting recollections of treasured life events and facilitating valuable conversations that might otherwise have remained dormant. Finally, a pilot project at Bradford District Care Trust demonstrated that even in the most challenging environment of inpatient wards, VR shows potential for reducing agitation, promoting calmness, and allowing patients who cannot leave the ward to access virtual nature or travel scenes. Collectively, these studies demonstrate the significant potential for VR interventions to be integrated into diverse care pathways, whether as reminiscence sessions in care homes, family-oriented activities in community centres, or therapeutic tools in acute hospital settings. They also underscore that a one-size-fits-all approach will not suffice: content must be culturally relevant, co-designed with people who have dementia, and supported by clear training and guidelines for caregivers. Larger-scale trials, rigorous evaluation of clinical outcomes, and engagement with policy makers will be critical in transforming these promising pilots into standard practice. By bridging empathy, technological innovation, and cultural awareness, VR may be able to offer deeply personal, uplifting moments for people with dementia, pointing toward a future where immersive care is as inclusive as it is transformative

Supplementary Material for: Patterns of Use and Clinical Outcomes with Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Acute Heart Failure and Changes in Kidney Function: An Analysis of the Veterans’ Health Administrative Database

Objective: The aim of the study was to determine patterns and predictors of utilization of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) in patients with acute heart failure (AHF) and changes in kidney function at admission, hospitalization, and discharge in relation to clinical outcomes. Methods: This retrospective analysis of the Veterans’ Health Administration data (2016) included patients with heart failure (HF) with reduced ejection fraction who were hospitalized. Patients with an estimated glomerular filtration 3/min/1.73 m2 and those on dialysis were excluded. Patients were categorized based on the use of ACEI/ARB as continued, initiated, discontinued, or no therapy. Multivariable logistic regression evaluated predictors of being discharged home on an ACEI/ARB. Cox regression analysis evaluated outcomes (30 and 180-day mortality/HF readmissions). Results: 3,652 patients were included, of which 37% of patients hospitalized for AHF had ACEI/ARB discontinued on admission, or not initiated. After adjusting for age, blood pressure, and serum potassium, a per-unit increase in admission serum creatinine (SCr) was independently associated with lower rates of continuation or initiation of ACEI/ARB odds ratio 0.51 95% confidence interval (CI) (0.46–0.57). Discharge on ACEI/ARB was independently associated with lower odds of 30- and 180-day mortality hazard ratio (HR) 0.36 95% CI (0.25–0.52), and HR 0.23 95% CI (0.19–0.27), respectively. Conclusion: Higher SCr at admission is an important determinant of ACEI/ARB being discontinued or withheld in patients admitted with AHF. ACEI/ARB at discharge was associated with lower mortality in patients with AHF