Decision-Making Competence in Older Adults: A Rosy View From a Longitudinal Investigation

Cross-sectional studies have suggested age-related differences in decision-making competence, but these differences may also reflect cohort-related effects. We present a longitudinal study of age-related changes over 5 years in older adults (aged 60-85) for 3 important aspects of decision-making competence: resistance to framing, applying decision rules, and resistance to sunk costs. The findings show small age-related longitudinal declines in resistance to framing but no decline in applying decision rules or resistance to sunk costs. The results also indicate that individuals' decision-making competence after 5 years is significantly related to their initial decision-making competence assessment and that the contribution of crystallized abilities to decision making in older adults is greater than previously thought

Chytrid epidemics may increase genetic diversity of a diatom spring-bloom

Contrary to expectation, populations of clonal organisms are often genetically highly diverse. In phytoplankton, this diversity is maintained throughout periods of high population growth (that is, blooms), even though competitive exclusion among genotypes should hypothetically lead to the dominance of a few superior genotypes. Genotype-specific parasitism may be one mechanism that helps maintain such high-genotypic diversity of clonal organisms. Here, we present a comparison of population genetic similarity by estimating the beta-dispersion among genotypes of early and peak bloom populations of the diatom Asterionella formosa for three spring-blooms under high or low parasite pressure. The Asterionella population showed greater beta-dispersion at peak bloom than early bloom in the 2 years with high parasite pressure, whereas the within group dispersion did not change under low parasite pressure. Our findings support that high prevalence parasitism can promote genetic diversification of natural populations of clonal hosts

Pre-operative Planning and Intra-operative Guidance for Shoulder Replacement Surgery

Shoulder joint replacement, or arthroplasty, is indicated in cases where arthritis or trauma has resulted in severe joint damage that in turn causes increased pain and decreased function. However, shoulder arthroplasty is less successful than hip and knee replacement, mostly due to the complexity of the shoulder joint and the resultant complexity of the replacement operation. In this paper we present a complete visualization-oriented pre-operative planning and intra-operative guidance approach for shoulder joint replacement. Our system assists the surgeon by allowing a virtual arthroplasty procedure whilst giving feedback, primarily via patient- and procedure-specific joint range of motion (ROM) simulation and visualization. After a successful planning, our system automatically generates a 3D model of a patient-specific mechanical guidance device that is then produced by a rapid prototyping machine and can be used during the operation. In this way, a computer-based guidance system is not required in the operating room

Transfusion practice in the bleeding critically ill:An international online survey-The TRACE-2 survey

Background: Transfusion is very common in the intensive care unit (ICU), but practice is highly variable, as has recently been shown in non-bleeding critically ill patients practices survey. Bleeding patients in ICU require different blood products across a range of specific patient categories. We hypothesize that a large variety in transfusion practice exists in bleeding patients. Study design and methods: An international online survey was performed among physicians working in the ICU. Transfusion practice in massively and non-massively bleeding patients was examined, including transfusion ratios, thresholds, and the presence of transfusion guidelines. Results: Six hundred eleven respondents filled in the survey of which 401 could be analyzed, representing 64 countries. Among the respondents, 52% had a massive transfusion protocol (MTP) available at their ICU. In massively bleeding patients, 46% of the respondents used fixed transfusion component ratios. Of those who used fixed blood ratios, the 1:1:1 ratio (red blood cell [RBC] concentrates: plasma: platelet concentrates) was most commonly used (33%). The presence of an MTP was associated with a more frequent use of fixed ratios (p <.001). For RBC transfusion in the general non-massively bleeding ICU population, a hemoglobin (Hb) threshold of 7.0[7.0–7.3] g/dl was reported. In the general ICU population, a platelet count threshold of 50[26–50] × 109/L was applied. Discussion: Half of the centers had no massive transfusion protocol available. Transfusion practice in massively bleeding critically ill patients is highly variable and driven by the presence of an MTP. In the general non-massively bleeding ICU population restrictive transfusion triggers were chosen

Outcomes after endovascular mechanical thrombectomy in occluded vascular access used for dialysis purposes

PURPOSE: Endovascular mechanical thrombectomy using the AngioJet™ system can be considered to reestablish patency in occluded vascular access. The aim of this study was to review our results for endovascular mechanical thrombectomy using the AngioJet™ system in patients with arteriovenous fistulae (AVF) and arteriovenous grafts (AVG). METHODS: Data collected in a database of patients requiring hemodialysis for renal failure were analyzed. Patients who underwent endovascular mechanical thrombectomy procedures with the AngioJet™ system for occlusion of vascular access were included. Clinical and technical success rates and patency rates were calculated. Multivariate analysis was used to identify factors of influence. RESULTS: A total of 92 AngioJet™ procedures in 60 patients with thrombosed vascular access were reviewed during a mean follow-up period of 21.5 months in patients with an AVF and 11.9 months in patients with an AVG. Technical and clinical success was achieved in 92.6% of AVF cases and 92.0 and 90.8% of AVG cases with an AVG, respectively. Significantly higher primary and primary-assisted patency rates were observed in the AVF group. Multivariate regression analysis indicated that left-sided vascular access and female sex were independent predictors for failure regarding primary patency in AVG patients. Immunosuppressive drugs and older age were negative predictors for secondary patency in AVG patients. CONCLUSIONS: The AngioJet™ system can be deemed an effective technique to reestablish patency in occluded vascular access with minimal use of central venous catheters for dialysis. Good technical and clinical success rates were achieved with acceptable patency rates, especially in AVF patients

Vascular access creation in octogenarians:The effect of age on outcomes

Background: The prevalence of end-stage renal disease is accelerating among older age groups. Patient-specific factors in the elderly patient group might advocate for a different vascular access creation approach, in which patency, risk of nonmaturation, and time to cannulation with accompanied prolonged catheter use should be of primary importance. The aim of this study was to determine which vascular access has the best outcomes and to determine whether age is associated with different outcomes after vascular access surgery. Methods: Data were obtained from a prospectively maintained database of patients treated between November 2004 and December 2017. Two different patient groups were identified: the octogenarian group, consisting of patients aged >= 80 years; and the control group, consisting of all the other patients. A total of 694 vascular access procedures were included in this study, 65 in the octogenarian group and 629 in the control group. Primary, primary assisted, and secondary patency rates were calculated and compared between groups and vascular accesses. Multivariable analysis was used to determine whether age is an effect modifier in the association between type of vascular access and different patency outcomes. Results: Mean follow-up was 23.2 months in the octogenarian group and 21.2 months in the control group (P = .210). No significant differences were found in patient survival, with a 5-year survival rate of 63.8% (+/- 5.9%) in the octogenarian group and 57.2% (+/- 2.2%) in the control group (P = .866). Within the octogenarian group, primary failure rate was highest in the radiocephalic arteriovenous fistula (AVF) patients, 42.1% (P = .006). Brachiocephalic AVF had significantly improved assisted patency compared with the other vascular accesses among the octogenarians (P = .016). Age was not an effect modifier in the association between type of vascular access and different patency outcomes. The adjusted analysis, corrected for octogenarian age, diabetes mellitus, hypertension, and sex, showed that brachiocephalic AVF was significantly associated with an increase in primary patency (hazard ratio, 0.70; 95% confidence interval, 0.54-0.90; P = .006) and primary assisted patency (hazard ratio, 0.58; 95% confidence interval, 0.39-0.86; P = .006) compared with other vascular accesses. Conclusions: The results of our study support primary placement of a brachiocephalic AVF in the octogenarian patient. A low primary failure rate was achieved with significant improved patency rates compared with the other vascular accesses