Association of Hospital Racial Composition and Payer Mix With Mortality in Acute Coronary Syndrome.

Background Patient characteristics insufficiently explain disparities in cardiovascular outcomes among hospitalized patients, suggesting a role for community or hospital-level factors. Here, we evaluate the association of hospital racial composition and payer mix with all-cause inpatient mortality for patients hospitalized with acute coronary syndrome (ACS). Methods and Results Using the National Inpatient Sample, we identified adult hospitalizations from 2014 with a primary diagnosis of ACS (n=550 005). We divided National Inpatient Sample hospitals into quartiles based on percent of minority (black, Hispanic, Asian or Pacific Islander, Native American race/ethnicity) and low-income payer (Medicaid or uninsured) discharges in 2014. We utilized logistic regression to determine whether hospital minority or low-income payer makeup associated with all-cause inpatient mortality among those admitted for ACS . In adjusted models, ACS patients admitted to hospitals with >12.4% to 25.4% (Quartile 2), >25.4% to 44.3% (Q3), and >44.3% (Q4) minority discharges experienced a 14% (OR 1.14, 95% CI 1.06-1.23), 13% (OR 1.13, 95% CI 1.04-1.23), and 15% (OR 1.15, 95% CI 1.04-1.26) increased odds of all-cause inpatient mortality compared with hospitals with ≤12.4% (Q1) minority discharges. ACS patients admitted to hospitals with >18.7% to 25.7% (Q2) and >34.0% (Q4) low-income payer discharges experienced a 9% (OR 1.09, 1.01-1.17) and 9% (OR 1.09, 1.00-1.19) increased odds of all-cause inpatient mortality when compared with hospitals with ≤18.7% (Q1) low-income payer discharges. Conclusions Hospital minority and low-income payer makeup positively associate with odds of all-cause inpatient mortality among patients admitted for acute coronary syndrome

Morphologische und funktionelle Charakterisierung von differenzierenden enterischen Nervenzellen in Kultur und in neuro-muskulären Aggregaten

In der vorliegenden Arbeit wurden mithilfe der Whole-cell-Konfiguration der Patch-Clamp-Technik zum einen die Membranströme der enterischen Nervenzelle während ihrer Entwicklung gemessen und ausgewertet und zum anderen das Verhalten spontan aktiver neuromuskulärer Zellaggregate analysiert

Identification and measurement of fatty acids, amino acids in roe of tuna fish (Thunnus tonggol) and its TVB and peroxide value during cold storage

The first aim of this research was to identify fatty acids, amino acids composition of Thunnus tonggol roe and their changes during cold storage (-18'C). The second aim was to determine the changes of moisture, protein, fat and ash contents of the roe during one year cold storage (-18'C). 60 samples of longtail tuna (Thunnus tonggol) ovaries were randomly collected form Bandar-e-Abbas landings. The samples were frozen at-30'C and kept in cold store at -18'C for one year. According to a time table, the samples were examined for identification of fatty acids, amino acids, moisture, protein, fat, ash, peroxide and T.V.N. and their changes were evaluated during this time. The results showed that 26 fatty acids were identified. The unsaturated fatty acids (UFA) and saturated fatty acids (SFA) were 62.33 and 37.6%, respectively, in fresh roe. So that, DHA (C22:6) and oleic acid (C18:1) had high amounts (24.79 and 21.88%) among the UFA and palmitic acid (C16:0) was the most content (22.75%) among the SFA. The PUFA/SFA was 0.91. Also, 17 amino acids were identified that essential amino acids (EAA) and nonessential amino acids (NE) were 10478 and 7562 mg/100g, respectively, and E/NE was 1.38. Among the EAA and NE, lysine (2110mg/100g) and aspartic acid (1924 mg/100g) were the most contents. Also, results showed that moisture, ash, protein and fat contents were 72.74, 1.8, 19.88 and 4.53%, respectively, in fresh roe. The effects of freezing and cold storage on the roes showed that UFA and SFA contents have reached to 49.83 and 48.07%, respectively, at the end of cold storage. It indicated that these compounds change to each other during frozen storage. Also, n-3 and n-6 series of fatty acids were 32.75 and 1.61% in fresh roe. But their contents decreased to 22.96 and 1.25% at the end of period. Among the fatty acids, 22:6 and C16:0 had the most changes. The changes of fatty acids were significantly at 95% level except for C15:1, C18:3(n-3) and C20:4(n-6). All of the amino acids decreased in frozen storage and their changes were significantly (P<0.05). EAA was 7818 mg/100g and E/NE was 1.27 at the end of storage period. Among the amino acids, leucine and lysine had the most changes. Moisture, ash, protein and fat contents were 70.13, 1.82, 19.4 and 6.51%, respectively, at the end of storage period. The peroxide value and T.V.N. increased during storage. So that, their contents have reached to 5.86 mg/kg and 26.37 mg/100 g, respectively, at the end of frozen storage. The best shelf life of Thunnus tonggol roe was 6 or 7 months, because of lipid oxidation and increasing of peroxide

Technological innovation at PC sector during Covid-crisis

PURPOSE: The article's primary goal is to assess the current impact of the coronavirus pandemic on the innovative activity of computer hardware manufacturers. It is imperative to assess whether the impact of a pandemic is negative.DESIGN/APPROACH/METHODOLOGY: For the set goals, the authors analyzed the literature on innovation. The analysis of the case study referred to the segment of graphics card manufacturers. Graphics cards were assessed based on selected criteria. These criteria are the technological process of producing graphics processors (photolithography), and the second element in the evaluation of graphics cards were the results of selected card models in a representative program for computer graphics performance tests.FINDINGS: Thanks to this approach, it was possible to identify trends in graphics card performance in the pre-pandemic and pandemic period. The increase in graphics card performance is the result of the implementation of technological innovations. So far, the coronavirus pandemic has not significantly affected the development of the graphics card segment.PRACTICAL IMPLICATIONS: The presented approach and results of analyses may constitute the basis for creating an advanced methodology for determining trends in the development of graphics processor performance.ORIGINALITY/VALUE: Research results confirmed the adopted assumptions that so far, the pandemic has not a negative impact on innovation in the computer hardware industry.peer-reviewe

Mechanical circulatory support in acute myocardial infarction and cardiogenic shock: Challenges and importance of randomized control trials

BACKGROUND: Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is associated with significant morbidity and mortality. METHODS: We provide an overview of previously conducted studies on the use of mechanical circulatory support (MCS) devices in the treatment of AMI-CS and difficulties which may be encountered in conducting such trials in the United States. RESULTS: Well powered randomized control trials are difficult to conduct in a critically ill patient population due to physician preferences, perceived lack of equipoise and challenges obtaining informed consent. CONCLUSIONS: With growth in utilization of MCS devices in patients with AMI-CS, efforts to perform well-powered, randomized control trials must be undertaken

The Gap to Fill: Rationale for Rapid Initiation and Optimal Titration of Comprehensive Disease-modifying Medical Therapy for Heart Failure with Reduced Ejection Fraction

There are gaps in the use of therapies that save lives and improve quality of life for patients with heart failure with reduced ejection fraction, both in the US and abroad. The evidence is clear that initiation and titration of guideline-directed medical therapy (GDMT) and comprehensive disease-modifying medical therapy (CDMMT) to maximally tolerated doses improves patient-focused outcomes, yet observational data suggest this does not happen. The purpose of this review is to describe the gap in the use of optimal treatment worldwide and discuss the benefits of newer heart failure therapies including angiotensin receptor-neprilysin inhibitors and sodium-glucose cotransporter 2 inhibitors. It will also cover the efficacy and safety of such treatments and provide potential pathways for the initiation and rapid titration of GDMT/CDMMT

Optimizing Guideline-directed Medical Therapies for Heart Failure with Reduced Ejection Fraction During Hospitalization

Heart failure remains a huge societal concern despite medical advancement, with an annual direct cost of over $30 billion. While guideline-directed medical therapy (GDMT) is proven to reduce morbidity and mortality, many eligible patients with heart failure with reduced ejection fraction (HFrEF) are not receiving one or more of the recommended medications, often due to suboptimal initiation and titration in the outpatient setting. Hospitalization serves as a key point to initiate and titrate GDMT. Four evidence-based therapies have clinical benefit within 30 days of initiation and form a crucial foundation for HFrEF therapy: renin-angiotensin-aldosterone system inhibitors with or without a neprilysin inhibitor, β-blockers, mineralocorticoid-receptor-antagonists, and sodium-glucose cotransporter-2 inhibitors. The authors present a practical guide for the implementation of these four pillars of GDMT during a hospitalization for acute heart failure

Exercise-Based Rehabilitation for Heart Failure:Cochrane Systematic Review, MetaAnalysis, and Trial Sequential Analysis

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record Objectives: This study performed a contemporary systematic review and meta-analysis of exercise-based cardiac rehabilitation (ExCR) for heart failure (HF). Background: There is an increasing call for trials of models of ExCR for patients with HF that provide alternatives to conventional center-based provision and recruitment of patients that reflect a broader HF population. Methods: The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, and PsycINFO databases were searched between January 2013 and January 2018. Randomized trials comparing patients undergoing ExCR to control patients not undergoing exercise were included. Study outcomes were pooled using meta-analysis. Metaregression examined potential effect modification according to ExCR program characteristics, and risk of bias, trial sequential analysis (TSA), and Grading of Recommendations Assessment Development and Evaluation (GRADE) were applied. Results: Across 44 trials (n = 5,783; median follow-up of 6 months), compared with control subjects, ExCR did not reduce the risk of all-cause mortality (relative risk [RR]: 0.89; 95% confidence interval [CI]: 0.66 to 1.21; TSA-adjusted CI: 0.26 to 3.10) but did reduce all-cause hospitalization (RR: 0.70; 95% CI: 0.60 to 0.83; TSA-adjusted CI: 0.54 to 0.92) and HF-specific hospitalization (RR: 0.59; 95% CI: 0.42 to 0.84; TSA-adjusted CI: 0.14 for 2.46), and patients reported improved Minnesota Living with Heart Failure questionnaire overall scores (mean difference: −7.1; 95% CI: −10.5 to −3.7; TSA-adjusted CI: −13.2 to −1.0). No evidence of differential effects across different models of delivery, including center- versus home-based programs, were found. Conclusions: This review supports the beneficial effects of ExCR on patient outcomes. These benefits appear to be consistent across ExCR program characteristics. GRADE and TSA assessments indicated that further high-quality randomized trials are needed

Patients' satisfaction with information at discharge

Background: Adequate patient knowledge and engagement with their condition and its management can reduce re-hospitalisations and improve outcomes after acute admission for circulatory system disease. Aim: To evaluate the perceptions of cardio- or cerebrovascular patients of their satisfaction with discharge processes and to determine if this differs by demographic groups. Methods: A sample of 536 eligible public hospital inpatients was extracted from a consumer experience surveillance system. Questions relating to the discharge process were analysed using descriptive statistics to compare patient satisfaction levels against demographic variables. Results: Dissatisfaction rates were highest within the ‘Written information provided’ (37.8%) and ‘Danger signals communicated’ (34.7%) categories. Women and people aged ≥80 were more likely to express dissatisfaction. Conclusion: Although respondents were largely satisfied, there are important differences in the characteristics of those that were dissatisfied. The communication of important discharge information to older people and women was less likely to meet their perceived needs