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Introduction: Management of transvenous leads in patients with congenital heart disease (CHD) can be complicated by venous obstructions and residual shunts. We present our experience performing concurrent lead extraction and dilation/stenting of venous pathways, including patients with complete venous obstruction. Methods: All cases of concurrent lead extraction and recanalization of vena cavae/baffles between 2017 and 2021 at Boston Children's Hospital were retrospectively included and reviewed for safety and efficacy. Results: Eight patients, 4 female, median 38.5 years of age (range 16.7−49 years) and 81.6 kg weight (range 41.3−97.8 kg) at time of procedure were included. All patients had CHD, a majority (n = 7) having transposition of the great arteries palliated via atrial switch. All leads were removed in their entirety, with most patients having two leads extracted (n = 7). Median lead dwell time was 13.8 years (range 3.6−35.3 years). Three patients had complete obstructions, three required stenting of their innominate veins and three required recanalization of their femoral vessels. Median procedure time was 9.8 h (range 5.4−12.8 h). Complications included blood transfusion (n = 2), arrhythmia (n = 3), pleural effusion (n = 1), and pressure ulcer (n = 1). There were no cardiac perforations, venous tears, or deaths. Conclusion: Lead extraction along with dilation and stenting of venous anomalies, though long in duration, proved effective with minimal complications. This combined procedure can safely and effectively resolve complete obstructions secondary to transvenous leads. [ABSTRACT FROM AUTHOR]

Background: Arkansas is a rural state of 3 million people. It is ranked fifth for poverty nationally. The first case of coronavirus disease 2019 (COVID-19) in Arkansas occurred on 11 March 2020. Since then, approximately 8% of all Arkansans have tested positive. Given the resource limitations of Arkansas, COVID-19 convalescent plasma (CCP) was explored as a potentially lifesaving, therapeutic option. Therefore, the Arkansas Initiative for Convalescent Plasma was developed to ensure that every Arkansan has access to this therapy.Study Design and Method: This brief report describes the statewide collaborative response from hospitals, blood collectors, and the Arkansas Department of Health (ADH) to ensure that CCP was available in a resource-limited state.Results: Early contact tracing by ADH identified individuals who had come into contact with "patient zero" in early March. Within the first week, 32 patients tested positive for COVID-19. The first set of CCP collections occurred on 9 April 2020. Donors had to be triaged carefully in the initial period, as many had recently resolved their symptoms. From our first collections, with appropriate resource and inventory management, we collected sufficient CCP to provide the requested number of units for every patient treated with CCP in Arkansas.Conclusions: The Arkansas Initiative, a statewide effort to ensure CCP for every patient in a resource-limited state, required careful coordination among key players. Collaboration and resource management was crucial to meet the demand of CCP products and potentially save lives. [ABSTRACT FROM AUTHOR]

The workload for shielding purposes of modern linear accelerators (linacs) consists of primary and scatter radiation which depends on the dose delivered to isocenter (cGy) and leakage radiation which depends on the monitor units (MUs). In this study, we report on the workload for 10 treatment vaults in terms of dose to isocenter (cGy), monitor units delivered (MUs), number of treatment sessions (Txs), as well as, use factors (U) and modulation factors (CI) for different treatment techniques. The survey was performed for the years between 2006 and 2015 and included 16 treatment machines which represent different generations of Varian linear accelerators (6EX, 600C, 2100C, 2100EX, and TrueBeam) operating at different electron and x-ray energies (6, 9, 12, 16 and 20 MeV electrons and, 6 and 15 MV x-rays). An institutional review board (IRB) approval was acquired to perform this study. Data regarding patient workload, dose to isocenter, number of monitor units delivered, beam energies, gantry angles, and treatment techniques were exported from an ARIA treatment management system (Varian Medical Systems, Palo Alto, Ca.) into Excel spreadsheets and data analysis was performed in Matlab. The average (± std-dev) number of treatment sessions, dose to isocenter, and number of monitor units delivered per week per machine in 2006 was 119 ± 39 Txs, (300 ± 116)×102 cGys, and (78 ± 28)×103 MUs respectively. In contrast, the workload in 2015 was 112 ± 40 Txs, (337 ± 124) × 102 cGys, and (111 ± 46) × 103 MUs. 60% of the workload (cGy) was delivered using 6 MV and 30% using 15 MV while the remaining 10% was delivered using electron beams. The modulation factors (MU/cGy) for IMRT and VMAT were 5.0 (± 3.4) and 4.6 (± 1.6) respectively. Use factors using 90° gantry angle intervals were equally distributed (~0.25) but varied considerably among different treatment techniques. The workload, in terms of dose to isocenter (cGy) and subsequently monitor units (MUs), has been steadily increasing over the past decade. This increase can be attributed to increased use of high dose hypo-fractionated regimens (SBRT, SRS) and the increase in use of IMRT and VMAT, which require higher MUs per cGy as compared to more conventional treatment (3DCRT). Meanwhile, the patient workload in terms of treatment sessions per week remained relatively constant. The findings of this report show that variables used for shielding purposes still fall within the recommendation of NCRP Report 151. [ABSTRACT FROM AUTHOR]

Human pharmaceuticals (e.g. the lipid regulator gemfibrozil and the non-steroidal anti-inflammatory drug diclofenac) are an emerging environmental threat in the aquatic environment. This study aimed to evaluate sublethal effects of these two commonly found pharmaceuticals on the protein profiles of marine mussels ( Mytilus spp.). Mytilus spp. was exposed to environmentally relevant and elevated concentrations (1 and 1000 µg/l respectively) of both drugs for 14 days. In addition, mussels were maintained for seven days post treatment to examine the potential of blue mussels to recover from such an exposure. Differential protein expression signatures (PES) in the digestive gland of mussels were obtained using two-dimensional gel electrophoresis after 7, 14, and 21 days of exposure. Twelve spots were significantly increased or decreased by gemfibrozil and/or diclofenac, seven of which were successfully identified by liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis. These proteins were involved in energy metabolism, oxidative stress response, protein folding, and immune responses. Changes in the PES over time suggested that mussels were still experiencing oxidative stress for up to seven days post exposure. In addition, a suite of biomarkers comprising glutathione transferase, lipid peroxidation, and DNA damage were studied. An oxidative stress response was confirmed by biomarker responses. To our knowledge, this is the first investigation using proteomics to assess the potential effects of human pharmaceuticals on a non-target species in an environmentally-relevant model. The successful application of this proteomic approach supports its potential use in pollution biomonitoring and highlights its ability to aid in the discovery of new biomarkers. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Adherence to microbicide gel use is critical to optimizing effectiveness in preventing human immunodeficiency virus transmission. The authors hypothesized that ester taggants added to vaginal gels would generate exhaled alcohol and ketone metabolites and provide a 'breath test' for vaginal gel use. This 2-arm (vaginal and dermal), randomized, participant-blinded, pilot study tested this hypothesis. On 8 visits, healthy women (n = 8) received intravaginal taggant (2-butyl acetate, 2-pentyl acetate, isopropyl butyrate, or 2-pentyl butyrate; 30 mg) formulated in hydroxyethylcellulose or tenofovir placebo gel. A second group (n = 4) of women received the same formulations administered dermally on the forearm to determine if skin administration might confound the system. Breath samples were collected using bags before and after taggant administration for 1 hour. Samples were measured using a miniature gas chromatograph and/or gas chromatography-mass spectroscopy for ester taggant, alcohol, and ketone concentrations. After vaginal administration, 2-butyl acetate, 2-pentyl acetate, and metabolites were observed in breath, whereas isopropyl butyrate, 2-pentyl butyrate, and metabolites were not. Some women reported self-resolving, mild burning (24/64 visits) with vaginal administration or a 'bubblegum' taste (7/64 visits). No taggants or metabolites were detected following dermal application. A 'breath test' for adherence to antiretroviral vaginal gel application appears physiologically and technically feasible. [ABSTRACT FROM AUTHOR]

Purpose: Patient exposure rate measurements verify published patient dose rate data and characterize dose rates near 2-18-fluorodeoxyglucose (18F-FDG) patients. A specific dose rate constant based on patient exposure rate measurements is a convenient quantity that can be applied to the desired distance, injection activity, and time postinjection to obtain an accurate calculation of cumulative external radiation dose. This study reports exposure rates measured at various locations near positron emission tomography (PET) 18F-FDG patients prior to PET scanning. These measurements are normalized for the amount of administered activity, measurement distance, and time postinjection and are compared with other published data. Methods: Exposure rates were measured using a calibrated ionization chamber at various body locations from 152 adult oncology patients postvoid after a mean uptake time of 76 min following injection with a mean activity of 490 MBq 18F-FDG. Data were obtained at nine measurement locations for each patient: three near the head, four near the chest, and two near the feet. Results: On contact with, 30 cm superior to and 30 cm lateral to the head, the mean (75th percentile) dose rates per unit injected activity at 60 min postinjection were 0.482 (0.511), 0.135 (0.155), and 0.193 (0.223) μSv/MBq h, respectively. On contact with, 30 cm anterior to, 30 cm lateral to and 1 m anterior to the chest, the mean (75th percentile) dose rates per unit injected activity at 60 min postinjection were 0.623 (0.709), 0.254 (0.283), 0.190 (0.218), and 0.067 (0.081) μSv/MBq h respectively. 30 cm inferior and 30 cm lateral to the feet, the mean (75th percentile) dose rates per unit injected activity at 60 min postinjection were 0.024 (0.022) and 0.039 (0.044) μSv/MBq h, respectively. Conclusions: The measurements for this study support the use of 0.092 μSv m2/MBq h as a reasonable representation of the dose rate anterior from the chest of patients immediately following injection. This value can then be reliably scaled to the desired time and distance for planning and staff dose evaluation purposes. At distances closer than 1 m, a distance-specific dose rate constant of 0.367 μSv/MBq h at 30 cm is recommended for accurate calculations. An accurate patient-specific dose rate constant that accounts for patient-specific variables (e.g., distribution and attenuation) will allow an accurate evaluation of the dose rate from a patient injected with an isotope rather than simply utilizing a physical constant. [ABSTRACT FROM AUTHOR]

Purpose: Effective dose (E) is useful as a dose index for patient exposures in interventional radiology; therefore, the authors estimated E from the kerma-area product (PKA) utilized during hepatic embolization interventional radiology cases performed at a cancer center and determined the variation of such doses over a representative patient population. Methods: A single-center, IRB-approved retrospective study was performed to estimate doses from consecutive hepatic embolization procedures performed during 2006. Organ doses E and E/PKA were determined from patient height, weight, PKA, procedure geometry factors, beam quality, the PCXMC Monte Carlo model, and the International Commission on Radiological Protection organ weighting factors. Results: One hundred thirteen patients were included in the study population, 72 males and 41 females, with a median age of 63 yr (29-89 yr), weight of 79 kg (42-111 kg), height of 170 cm (147-188 cm), and PKA of 233 Gy cm2 (9-1020 Gy cm2). E was directly correlated with PKA r2=0.8 (p<0.01), with a median E/PKA of 0.18 mSv Gy-1 cm-2 (0.12-0.33 mSv Gy-1 cm-2). The E/PKA ratio was inversely and exponentially correlated with weight r2=0.9 (p<0.001). The median E (mSv) for the study patient population was 44 mSv (2.0-255 mSv). Conclusions: Values of E can be estimated utilizing patient-specific and procedure-specific parameters. The strong inverse correlation of E/PKA with patient weight allows simple estimation of E from PKA and patient weight. There is a wide variation in effective dose in oncologic hepatic embolizations with doses up to an order of magnitude higher than diagnostic imaging of the abdomen by CT radiology. Variation is likely due to patient geometry, clinical technique factors, and procedure complexity. [ABSTRACT FROM AUTHOR]

Early adversity, for example poor caregiving, can have profound effects on emotional development. Orphanage rearing, even in the best circumstances, lies outside of the bounds of a species-typical caregiving environment. The long-term effects of this early adversity on the neurobiological development associated with socio-emotional behaviors are not well understood. Seventy-eight children, who include those who have experienced orphanage care and a comparison group, were assessed. Magnetic resonance imaging (MRI) was used to measure volumes of whole brain and limbic structures (e.g. amygdala, hippocampus). Emotion regulation was assessed with an emotional go-nogo paradigm, and anxiety and internalizing behaviors were assessed using the Screen for Child Anxiety Related Emotional Disorders, the Child Behavior Checklist, and a structured clinical interview. Late adoption was associated with larger corrected amygdala volumes, poorer emotion regulation, and increased anxiety. Although more than 50% of the children who experienced orphanage rearing met criteria for a psychiatric disorder, with a third having an anxiety disorder, the group differences observed in amygdala volume were not driven by the presence of an anxiety disorder. The findings are consistent with previous reports describing negative effects of prolonged orphanage care on emotional behavior and with animal models that show long-term changes in the amygdala and emotional behavior following early postnatal stress. These changes in limbic circuitry may underlie residual emotional and social problems experienced by children who have been internationally adopted. [ABSTRACT FROM AUTHOR]

Objective. To introduce the American Community Survey (ACS) and its measure of health insurance coverage to researchers and policy makers. Data Sources/Study Setting. We compare the survey designs for the ACS and Current Population Survey (CPS) that measure insurance coverage. Study Design. We describe the ACS and how it will be useful to health policy researchers. Principal Findings. Relative to the CPS, the ACS will provide more precise state and substate estimates of health insurance coverage at a point-in-time. Yet the ACS lacks the historical data and detailed state-specific coverage categories seen in the CPS. Conclusions. The ACS will be a critical new resource for researchers. To use the new data to the best advantage, careful research will be needed to understand its strengths and weaknesses. [ABSTRACT FROM AUTHOR]

Objective. To test the hypothesis that high community-level unemployment is associated with reduced use of preventive dental care services by a dentally insured population. Data. The study uses monthly data on population dental visits and unemployment in the Seattle and Spokane areas from 1995 to 2004. Utilization data come from Washington Dental Services. Unemployment data were obtained from the Bureau of Labor Statistics and Washington's Employment Security Department. Study Design. The study uses a Box–Jenkins Autoregressive Integrated Moving Average (ARIMA) method to measure the association between the variables over time. The approach controls for the effects of autocorrelation, seasonality, and confounding variables. Findings. In the Seattle area, an unexpected 10,000 unit increase in the number of unemployed individuals is associated with a 1.24 percent decrease in preventive visits during the month ( p=.0043). In the Spokane area, a similar increase in unemployment is associated with a 5.95 percent decrease in preventive visits ( p=.0326). The findings persist when the independent variable is the number of initial unemployment insurance claims. Conclusions. The analysis suggests that utilization of preventive dental care declines during periods of high community-level unemployment. Community-level unemployment may impede or distract populations from utilizing preventive dental services. The study's findings have implications for insurers, dentists, policy makers, and researchers. [ABSTRACT FROM AUTHOR]

The author looks at how regulatory decisions are taken, and implemented, at national as well as international level and discusses issues such as independence of regulatory and supervisory authorities, regulatory capture and the rivalry in decision taking between Basel, Brussels and Washington. [ABSTRACT FROM AUTHOR]

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Objective. To propose and test a method that produces an unbiased estimate of the average effect of smoking cessation on weight gain. Previous estimates may be biased due to unobservable differences in attributes of quitters and continuing smokers. An accurate estimate of weight gain due to cessation is important for policymakers, health managers, clinicians, consumers, and developers of smoking cessation aids. Study Setting. Our analysis consisted of an instrumental variables (IVs) approach in which treatment assignment in randomized smoking cessation trials served as a random source of variation in probability of quitting. Data Collection. We searched the medical literature for previously conducted smoking cessation trials that contained data suitable for our reanalysis. Principal Findings. We identified one trial for our reanalysis, the Lung Health Study, a randomized smoking cessation trial with 5,887 smokers aged 35–60 from 1986 to 1994 in several sites across the United States. In our IV reanalysis, we estimated a 9.7 kg weight gain over 5 years due to cessation, as compared with the conventional estimate of 5.3 kg. Conclusions. The true effect of smoking cessation on weight gain may be larger than previously estimated. This result indicates the importance of fully understanding the possible weight effects of cessation and underscores the need to accompany cessation programs with weight management interventions. The result, however, does not overturn the conclusion that the net health benefits of quitting are positive and very large. The application of the IV technique we propose is likely to be useful in a variety of contexts in which one is interested in the effect of one health condition on another. [ABSTRACT FROM AUTHOR]

Objective. To assess the impact of changes in relative health maintenance organization (HMO) penetration on changes in the physician-to-population ratio in California counties when changes in the economic conditions in California counties relative to the U.S. average are taken into account. Data Sources. Data on physicians who practiced in California at any time from 1988 to 1998 were obtained from the AMA Masterfile. The analysis was restricted to active, patient care physicians, excluding medical residents. Data on other covariates in the model were obtained from the Bureau of Economic Analysis, InterStudy, the Area Resource File, and the California state government. Data were merged using county FIPS codes. Study Design. Changes in the physician-to-population ratio in California counties include the effects of both intrastate migration and interstate migration. A reduced-form model was estimated using the Arellano–Bond dynamic panel estimator. Economic conditions in California relative to the U.S. were measured as the ratio of county-level real per capita income to national-level real per capita income. Relative HMO penetration in California was measured as the ratio of county-level HMO penetration to HMO penetration in the U.S. relative HMO penetration was instrumented using five identifying variables to address potential endogeneity. Omitted-variable bias was controlled for by first differencing the model. The model also incorporated eight other covariates that may be associated with the demand for physicians: the percentage of the population enrolled in Medicaid, beds in short-term hospitals per 100,000 population, the percentage of the population that is black, the percentage of the population that is Hispanic, the percentage of the population that is Asian, the percentage of the population that is below age 18, the percentage of the population that is aged 65 and older, and the percentage of the population that are new legal immigrants in a given year. All of the above variables were lagged one period. The lagged physician-to-population ratio was also included to control for the supply of physicians. Separate equations were estimated for primary care physicians and specialist physicians. Principal Findings. Changes in lagged relative HMO penetration are negatively associated with changes in specialist physicians per 100,000 population. However, this effect of HMO penetration is attenuated and at times reversed in areas where the magnitude of the difference in relative economic conditions is sufficiently large. We did not find any statistically significant effects for primary care physicians. Conclusions. Consistent with prior studies, we find that changes in physician supply are associated with changes in relative HMO penetration. Relative economic conditions are an important moderator of the effect of changes in relative HMO penetration on physician migration. [ABSTRACT FROM AUTHOR]

Water samples were collected on three dates at 24 sites influenced by effluent from Georgia-Pacific's Palatka Pulp and Paper Mill Operation, a bleached and unbleached kraft mill near Palatka, Florida, USA. The sampling sites were located within the mill retention ponds, Rice Creek, and the St. John's River. Samples were analyzed by gas chromatography--mass spectrometry for abietic, dehydroabietic, and isopimaric acids, all of which are potentially toxic by-products of pulp production. Isopimaric acid concentrations greater than 12 mg/L were measured at the mill's effluent outfall but were less than 20 µg/L at the end of Rice Creek. This result indicates that the waters of Rice Creek provide dilution or conditions conducive for degradation or sorption of these compounds. Large differences in resin acid concentrations were observed between sampling events. In two sampling events, the maximum observed concentrations were less than 2 mg/L for each analyte. In a third sampling event, all of the compounds were detected at concentrations greater than 10 mg/L. Data from the three sample dates showed that resin acid concentrations were below 20 µg/L before the confluence of Rice Creek and the St. John's River in all cases. [ABSTRACT FROM AUTHOR]

This study evaluated the effects of bleached and unbleached kraft mill effluent on reproductive success of largemouth bass (Micropterus salmoides). Bass were exposed to effluent concentrations (0, 10, 20, 40, or 80%) for 28 and 56 d. Parameters measured included hepatosomatic index (HSI) and gonadosomatic index (GSI) and plasma concentrations of 17β-estradiol (E2), 11-ketotestosterone (11-KT), and vitellogenin (VTG). At the end of the 56-d period, bass were moved to hatchery ponds to evaluate spawning success. Spawning mats with eggs either were brought indoors for evaluation of fecundities, hatchabilities, and egg and fry size (measured at age 3 d), or were left in ponds and fry number and size recorded (average age of 14 d). Effluent exposure was verified by measuring resin acids (isopimaric, abietic, and dehydroabietic acids) in bile. Compared to controls, exposed bass had greater concentrations of resin acids in bile. In general, exposed females had lower concentrations of E2 and VTG (≥20% effluent), whereas males had lower concentrations of 11-KT (≥20% effluent) and increased E2 (≥20% effluent). The HSI values increased in females (≥10% effluent), and GSI values decreased in both sexes (≥40% effluent). Fecundity, egg size, and hatchability did not differ across treatments, but an increase in the frequency of fry abnormalities and a decrease in fry weights was observed at effluent exposures of 40% and higher. However, results from the pond study, revealed a significant reduction in fry growth and survival ($10%). This decline may have been caused by an increased frequency of deformities, in conjunction with alterations of growth. These changes could have resulted from alterations in egg quality because of failure of parental reproductive systems, from acute embryo toxicity after translocation of contaminants from the mother to the developing embryo, or from both. [ABSTRACT FROM AUTHOR]

Explores the relationship between management strategy, technological change and collective bargaining in the commercial television industry in Great Britain during 1979 to 1998. Termination of the national collective bargaining that had regulated minimum crewing levels; Achievements of British broadcasting; Benefits of digital production technologies.

Background Nodular fasciitis is a fibroblastic proliferation in which nodules, most commonly appearing on the extremities, develop suddenly and rapidly Although excisional biopsy is curative, the nodules will often resolve spontaneously, however, the histologic appearance of a pleomorphic spindle cell neoplasm with frequent mitotic figures may raise concern of a more malignant neoplasm and lead to unnecessary and overly aggressive therapy Methods A case of nodular fasciitis presenting in an unusual location, intradermally at the lateral canthus, is discussed Results Review of the recent literature from other disciplines reveals new insights into the etiology and diagnostic options (fine needle aspiration, tomography, other imaging techniques) for this puzzling disease Conclusions. When nodular fasciitis occurs in an unusal location, such as on the head and neck or at an intradermal location, it will not present as the deep, mobile, nontender nodule described in the dermatologic literature, Fine-needle aspiration and modern imaging techniques may help in the diagnosis and prevent unnecessary surgery for a self-limited condition. [ABSTRACT FROM AUTHOR]

The paper was based on extensive interviewing of executives around Europe. At that time was noted that an aggressive bank, trying to break into the M & A advisory business, might use such stratagems to 'try to open a commercial relationship' with a potential client. In the case of Swiss Bank, the press comment in January 1995 suggested that this may indeed have been a factor behind the use of the equity swap technique in this particular case. The development of equity derivative markets alongside a relatively highly regulated cash market for equities poses a number of regulatory issues. The most important problem is, in fact, a general issue in the context of the interrelationships of derivatives and securities markets. In the past, cash market equity transactions would all be reported to stock exchange authorities. Now, where OTC equity derivatives trading is taking place, they are more often reported to the banking authorities. This is because a high proportion of large, medium-term OTC derivatives are traded by banks which have the balance sheet capacity for them rather than by securities houses. The data reported to the banking authorities are aggregated and the banking supervisors. [ABSTRACT FROM AUTHOR]

The author reflects on the state-level research on innovation with Medicaid and Children's Health Insurance Program. He states that to evaluate the impact of Affordable Care Act (ACA), special attention is paid to the research, because the evidences with coverage and delivery system reforms, made way for the act, and the need for the policy will grow. He mentions that the project will provide information to researchers and policy makers, about increasing health insurance coverage.

The author reflects on the need for research and evaluation of state health reforms. He cites the enactment of Massachusetts of near universal health insurance coverage in 2006. The author suggests that increase activity around state-level health care reform provides a set of challenges for different sectors of the health services research community.

Background Advancements in the field, including novel procedures and multiple interventions, require an updated approach to accurately assess patient risk. This study aims to modernize patient hemodynamic and procedural risk classification through the creation of risk assessment tools to be used in congenital cardiac catheterization. Methods and Results Data were collected for all cases performed at sites participating in the C3PO (Congenital Cardiac Catheterization Project on Outcomes) multicenter registry. Between January 2014 and December 2017, 23 119 cases were recorded in 13 participating institutions, of which 88% of patients were <18 years of age and 25% <1 year of age; a high-severity adverse event occurred in 1193 (5.2%). Case types were defined by procedure(s) performed and grouped on the basis of association with the outcome, high-severity adverse event. Thirty-four unique case types were determined and stratified into 6 risk categories. Six hemodynamic indicator variables were empirically assessed, and a novel hemodynamic vulnerability score was determined by the frequency of high-severity adverse events. In a multivariable model, case-type risk category (odds ratios for category: 0=0.46, 1=1.00, 2=1.40, 3=2.68, 4=3.64, and 5=5.25; all P ≤0.005) and hemodynamic vulnerability score (odds ratio for score: 0=1.00, 1=1.27, 2=1.89, and ≥3=2.03; all P ≤0.006) remained independent predictors of patient risk. Conclusions These case-type risk categories and the weighted hemodynamic vulnerability score both serve as independent predictors of patient risk for high-severity adverse events. This contemporary procedure-type risk metric and weighted hemodynamic vulnerability score will improve our understanding of patient and procedural outcomes.