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High stakes examinations can have profound implications for how science is taught and learned. Limitations of school science such as the 'cookbook problem' can potentially be addressed if high stakes assessments target learning outcomes that are innovative. For example, less mindless procedural engagement and more thoughtful consideration of practical science can potentially improve science learning. In this paper, we investigate how practical work is represented in the assessment frameworks of several countries that demonstrate above average performance in the latest PISA science assessments. The main motivation is the need to understand if there are aspects of high stakes summative assessments in these countries that can provide insight into how best to structure national examinations. Assessment documents from a set of selected countries have been analysed qualitatively guided by questions such as 'what is the construct of practical science' and 'what is the format of assessment?' The examined jurisdictions used different approaches from traditional external pen-and-paper tests to internal teacher assessments that included different formats (e.g. laboratory report). Innovative approaches to the assessment of practical skills (e.g. PISA computer-based tasks) do not seem to be represented in these high-stakes assessments. Implications for innovative assessments for high-stakes purposes are discussed.

This study examines the major factors that may hinder or enable the adoption of e-learning systems by university students in developing (Qatar) as well as developed (USA) countries. To this end, we used extended Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) with Trust as an external variable. By means of an online survey, data were collected from 833 university students from a university in Qatar and another from USA. Structural equation modelling was employed as the main method of analysis in this study. The results show that performance expectancy, hedonic motivation, habit and trust are significant predictors of behavioural intention (BI) in both samples. However, contrary to our expectation, the relationship between price value and BI is insignificant. Our results also show that effort expectancy and social influence lead to an increase in students' adoption of e-learning systems in developing countries but not in developed countries. Moreover, facilitating conditions increase e-learning adoption in developed countries which is not the case in developing countries. Overall, the proposed model achieves an acceptable fit and explains its variance for 68% of the Qatari sample and 63% of the USA sample. These results and their implications to both theory and practice are described.

Simple Summary: Lung cancer is the worldwide leading cause of cancer-related death among both genders, with about 230,000 patients/year being diagnosed in the US alone. It accounts for about 40% of all brain metastases, which already occur in around 3% of early-stage patients. Nonetheless, current international guidelines do not unanimously recommend brain imaging for use in the early stages of cancer. Some studies have suggested that surgical or radiosurgical treatment of brain metastases may provide better survival, especially in asymptomatic patients. Additionally, advances in genome analysis have identified molecular targets for pharmaceutical agents. These recent advancements in treatment stress the importance of studying incidence as well as patient and tumor characteristics in order to potentially adapt future guidelines and provide the best possible treatment for early-stage lung cancer. This multicentric study analyzed the data of 577 patients diagnosed with early-stage lung cancer who had been submitted for brain imaging at initial tumor staging. Background: Lung cancer is the worldwide leading oncological cause of death in both genders combined and accounts for around 40–50% of brain metastases in general. In early-stage lung cancer, the incidence of brain metastases is around 3%. Since the early detection of asymptomatic cerebral metastases is of prognostic value, the aim of this study was to analyze the incidence of brain metastases in early-stage lung cancer and identify possible risk factors. Methods: We conducted a retrospective multicentric analysis of patients with Stage I (based on T and N stage only) Non-Small Cell Lung Cancer (NSCLC) who had received preoperative cerebral imaging in the form of contrast-enhanced CT or MRI. Patients with a history of NSCLC, synchronous malignancy, or neurological symptoms were excluded from the study. Analyzed variables were gender, age, tumor histology, cerebral imaging findings, smoking history, and tumor size. Results were expressed as mean with standard deviation or median with range. Results: In total, 577 patients were included in our study. Eight (1.4%) patients were found to have brain metastases in preoperative brain imaging. Tumor histology was adenocarcinoma in all eight cases. Patients were treated with radiotherapy (five), surgical resection (two), or both (one) prior to thoracic surgical treatment. Other than tumor histology, no statistically significant characteristics were found to be predictive of brain metastases. Conclusion: Given the low incidence of brain metastases in patients with clinical Stage I NSCLC, brain imaging in this cohort could be avoided. [ABSTRACT FROM AUTHOR]

To systematically review physical activity interventions among culturally and linguistically diverse (CALD) populations and explore the strategies used to recruit CALD populations, the cultural adaptations made in these interventions, and the cultural adaptations used among successful interventions. Four electronic databases (Embase, MEDLINE, CENTRAL, and CINAHL) was searched in March 2017 and re-run in January 2018. Manual screening of the reference lists of the included studies was also conducted. Eligibility criteria for inclusion in the systematic review were: intervention studies (e.g. controlled and non-controlled studies), physical activity as primary outcome and as the only health behaviour targeted, culturally and linguistically diverse population of interest, published in English, and targeted adult populations (i.e. aged ≥18). A total of 19 articles were included in this review, comprising 15 unique studies. Most studies targeted Latino populations, published in the United States, and targeted women. An array of recruitment strategies were used, such as recruiting from religious establishments or religious and cultural events, and community organisations and events. The majority of studies made cultural adaptations to their intervention to suit the CALD population of interest, however, the level of detail of reported adjustments was limited. Successful interventions were those that generally included community consultation to inform their intervention, language adjustments, community health workers/bilingual/bicultural personnel for intervention delivery, recruitment, and data-collection, and using culturally-relevant intervention material. Although many studies included in this review reported increases in physical activity at follow-up, the results need to be interpreted with caution due to the lower level of methodological quality and reporting on study methodology. Future interventions designed for CALD populations should be of greater methodological quality and also provide a greater level of transparency in terms of the cultural adaptations that have been made to the intervention. [ABSTRACT FROM AUTHOR]

Background: When compared to patients with normal renal function, patients with chronic kidney disease develop higher in‐hospital complications post implantable cardioverter‐defibrillator (ICD) therapy. However, real world data on in‐hospital complications post ICD therapy in patients with end stage renal disease (ESRD) is limited. In this study, we aim to explore the procedure‐related complications of ICD therapy in patients with ESRD. Methods: Using the nationwide inpatient sample (NIS) database, we conducted a retrospective analysis on ESRD patients who underwent inpatient ICD placement from 2010 to 2016. Using 1:2 propensity score matching, we compared ESRD patients to those with normal renal function. Outcomes of interest were postoperative hemorrhage and hematoma formation, blood transfusion, pericardial complications, mechanical complications requiring lead revision, vascular injury, in‐hospital mortality, and length of stay. Results: Our sample included 40,075 cases with subsequent propensity score matching between ESRD and normal renal function. Comparatively, patients with ESRD had higher odds of postoperative hemorrhage (Odds ratio [OR] = 1.67, 95% confidence interval [CI] 1.4–1.99, p = <.0001), blood transfusion (OR, 3.88; CI 3.29–4.56; p = <.0001), mechanical complications requiring lead revision (OR, 1.24; CI 1.01–1.51; p =.035), vascular injury (OR, 2.02; CI 1.27–3.24; p =.0027), in‐hospital mortality (OR, 4.56; CI 3.08–6.76; p = <.0001), and longer hospitalization (11 vs. 7 days, p = <.0001), but without significant difference in pericardial complications (OR, 1.9; CI 0.92–1.54; p = <.18). Conclusion: In this large contemporary cohort, patients with ESRD undergoing inpatient ICD therapy are at higher risk of developing postprocedural complications including hemorrhage and hematoma, blood transfusion, mechanical complications requiring lead revision, and in hospital mortality, without increased risk of pericardial complications. [ABSTRACT FROM AUTHOR]

Prisons in the United States have become a hotbed for spreading COVID-19 among incarcerated individuals. COVID-19 cases among prisoners are on the rise, with more than 143,000 confirmed cases to date. However, there is paucity of data addressing clinical outcomes and mortality in prisoners hospitalized with COVID-19. An observational study of all patients hospitalized with COVID-19 between March 10 and May 10, 2020 at two Henry Ford Health System hospitals in Michigan. Clinical outcomes were compared amongst hospitalized prisoners and non-prisoner patients. The primary outcomes were intubation rates, in-hospital mortality, and 30-day mortality. Multivariable logistic regression and Cox-regression models were used to investigate primary outcomes. Of the 706 hospitalized COVID-19 patients (mean age 66.7 ± 16.1 years, 57% males, and 44% black), 108 were prisoners and 598 were non-prisoners. Compared to non-prisoners, prisoners were more likely to present with fever, tachypnea, hypoxemia, and markedly elevated inflammatory markers. Prisoners were more commonly admitted to the intensive care unit (ICU) (26.9% vs. 18.7%), required vasopressors (24.1% vs. 9.9%), and intubated (25.0% vs. 15.2%). Prisoners had higher unadjusted inpatient mortality (29.6% vs. 20.1%) and 30-day mortality (34.3% vs. 24.6%). In the adjusted models, prisoner status was associated with higher in-hospital death (odds ratio, 2.32; 95% confidence interval (CI), 1.33 to 4.05) and 30-day mortality (hazard ratio, 2.00; 95% CI, 1.33 to 3.00). In this cohort of hospitalized COVID-19 patients, prisoner status was associated with more severe clinical presentation, higher rates of ICU admissions, vasopressors requirement, intubation, in-hospital mortality, and 30-day mortality. [ABSTRACT FROM AUTHOR]

Although the dynamic role of the material in migration captivates scholarly imagination, little attention has been given to the ways that objects left behind in the U.S.-Mexico borderlands indicate sexuality and gender. This article brings together queer migration scholarship and new materialist perspectives to examine the rhetoric of images from the photo series "El SueSSL#241;o Americano," which depicts things confiscated from migrants by U.S. Customs and Border Protection. What I call the queer border objects of the series offer up fruitful ground for moving toward a politics that disentangles itself from fixed identities in order to move toward coalitional queerness, the likes of which, as Cathy J. Cohen describes, is built from a shared marginality to power. Whether or not the people who discarded them identify as queer, border objects can be read queerly because they communicate how sexuality and gender, as regimes, shape migration and designate whole groups of people as surplus to the nation. [ABSTRACT FROM AUTHOR]

The article identify laws same-sex domestic violence in post-marriage equality the U.S. Topics discussed include need of violence against LGBT citizens must be understood as hate crimes; elimination of LGBT defenses for reasons relating to homophobic and transphobic juror bias; and institutional failures in protecting and advocating for victims of same-sex domestic violence.

The majority of literature on attitudes toward seeking professional psychological help has focused on Western, predominantly U.S. samples, though attitudes toward counseling differ globally. Due to the paucity of literature with a Muslim sample this study assessed the factor structure of the Attitudes Toward Seeking Professional Psychological Help Scale (ATSPPHS) in Egypt, and its relationship to Islamic beliefs and behaviors. Exploratory factor analysis revealed one factor consistent with the original four-factor instrument, though four factors were found. Reliability analyses supported use of the long version, rather than short version of the instrument. Islamic beliefs were negatively correlated with the ATSPPHS and Islamic behaviors were positively correlated. Implications for ATSPPHS use in Egypt and other Islamic countries are discussed. [ABSTRACT FROM AUTHOR]

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Previous efforts to develop instruments to measure Islamic religiosity have been relatively unsuccessful. These instruments have extended a Christian instrument or Western concepts to study Muslims, and have failed to report acceptable psychometric properties or have included items that are more political in nature. We present a new instrument, the Religiosity of Islam Scale (RoIS), that attempts to remedy these flaws. The RoIS is a 19-item instrument with two subscales: Islamic Beliefs and Islamic Behavioral Practices. Supportive reliability and validity data are reported. A brief discussion of current sociopolitical considerations for conducting research with Muslims in the United States is offered. [ABSTRACT FROM AUTHOR]

This article focuses on the evaluation mechanism of patients with pain following total hip replacement. Annually, more than 168,000 primary and 30,000 revision total hip replacements are performed in the U.S. Unfortunately, a number of patients have persistent or new pain, and some have disability, after the operation, and these problems remain a challenge. The evaluation should, suggestively, be structured in such a way that relevant and timely investigations are undertaken to allow an effective treatment plan to be implemented. The most important feature is determining the nature of the patient's pain, that is, the temporal onset, severity, site, character, and duration. If the patient was never pain-free after the operation, the initial diagnosis might have been incorrect and other local disorders or referred pain might have been the cause of the symptoms.

The Vincent Thomas Bridge in the Los Angeles metropolitan area, is a critical artery for commercial traffic flow in and out of the Los Angeles Harbor, and is at risk in the seismically active Southern California region, particularly because it straddles the Palos Verdes fault zone. A combination of linear and non-linear system identification techniques is employed to obtain a complete reduced-order, multi-input–multi-output (MIMO) dynamic model of the Vincent Thomas Bridge based on the dynamic response of the structure to the 1987 Whittier and 1994 Northridge earthquakes. Starting with the available acceleration measurements (which consists of 15 accelerometers on the bridge structure and 10 accelerometers at various locations on its base), an efficient least-squares-based time-domain identification procedure is applied to the data set to develop a reduced-order, equivalent linear, multi-degree-of-freedom model. Although not the main focus of this study, the linear system identification method is also combined with a non-parametric identification technique, to generate a reduced-order non-linear mathematical model suitable for use in subsequent studies to predict, with good fidelity, the total response of the bridge under arbitrary dynamic environments. Results of this study yield measurements of the equivalent linear modal properties (frequencies, mode shapes and non-proportional damping) as well as quantitative measures of the extent and nature of non-linear interaction forces arising from strong ground shaking. It is shown that, for the particular subset of observations used in the identification procedure, the apparent non-linearities in the system restoring forces are quite significant, and they contribute substantially to the improved fidelity of the model. Also shown is the potential of the identification technique under discussion to detect slight changes in the structure''s influence coefficients, which may be indicators of damage and degradation in the structure being monitored. Difficulties associated with accurately estimating damping for lightly damped long-span structures from their earthquake response are discussed. The technical issues raised in this paper indicate the need for added spatial resolution in sensor instrumentation to obtain identified mathematical models of structural systems with the broadest range of validity. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Zika virus (ZIKV) is an emerging mosquito-borne arbovirus that can produce serious public health consequences. In 2016, ZIKV caused an epidemic in many countries around the world, including the United States. ZIKV surveillance and vector control is essential to combating future epidemics. However, challenges relating to the timely publication of case reports significantly limit the effectiveness of current surveillance methods. In many countries with poor infrastructure, established systems for case reporting often do not exist. Previous studies investigating the H1N1 pandemic, general influenza and the recent Ebola outbreak have demonstrated that time- and geo-tagged Twitter data, which is immediately available, can be utilized to overcome these limitations.Methods: In this study, we employed a recently developed system called Cloudberry to filter a random sample of Twitter data to investigate the feasibility of using such data for ZIKV epidemic tracking on a national and state (Florida) level. Two auto-regressive models were calibrated using weekly ZIKV case counts and zika tweets in order to estimate weekly ZIKV cases 1 week in advance.Results: While models tended to over-predict at low case counts and under-predict at extreme high counts, a comparison of predicted versus observed weekly ZIKV case counts following model calibration demonstrated overall reasonable predictive accuracy, with an R2 of 0.74 for the Florida model and 0.70 for the U.S.Model: Time-series analysis of predicted and observed ZIKV cases following internal cross-validation exhibited very similar patterns, demonstrating reasonable model performance. Spatially, the distribution of cumulative ZIKV case counts (local- & travel-related) and zika tweets across all 50 U.S. states showed a high correlation (r = 0.73) after adjusting for population.Conclusions: This study demonstrates the value of utilizing Twitter data for the purposes of disease surveillance. This is of high value to epidemiologist and public health officials charged with protecting the public during future outbreaks. [ABSTRACT FROM AUTHOR]

Background: Myocardial H2 receptor activation may promote cardiac fibrosis and apoptosis in pre-clinical models and histamine H2 receptor antagonist (H2RA) use may improve symptoms in participants with heart failure (HF); however, relationships between H2RA use, incident HF, and longitudinal change in left ventricular (LV) morphology are not known.Objectives: This study sought to determine whether H2RA use is associated with incident HF and change in LV morphology over time.Methods: We included 6,378 men and women from MESA (Multi-Ethnic Study of Atherosclerosis), a multicenter prospective observational cohort of participants without cardiovascular disease at baseline. Cox proportional hazards were used to estimate the association between H2RA use and incident HF in adjusted models. In participants with cardiac magnetic resonance imaging, associations between H2RA use, baseline LV morphology (n = 4,691), and longitudinal change in the LV (n = 2,806) were estimated using linear regression.Results: H2RAs were used by 313 participants but not by the other 6,065 individuals. During a median follow-up of 11.2 years, 236 participants developed HF. In adjusted models, baseline H2RA use relative to nonuse was associated with 62% lower risk for incident HF (p = 0.02). H2RA use was associated with preserved stroke volume, LV end-diastolic volume, and mass/volume ratio as measured by cardiac magnetic resonance imaging over approximately 10 years (all p < 0.05). There were no associations between H2RA use and LV mass or ejection fraction.Conclusions: H2RA use was associated with reduced risk for incident HF. Left heart morphology over time suggests less age-related change in H2RA users. These associations suggest histamine signaling may be important in the pathogenesis of HF. (Multi-Ethnic Study of Atherosclerosis [MESA]; NCT00005487). [ABSTRACT FROM AUTHOR]

Many current models of ecosystem carbon exchange based on remote sensing, such as the MODIS product termed MOD17, still require considerable input from ground based meteorological measurements and look up tables based on vegetation type. Since these data are often not available at the same spatial scale as the remote sensing imagery, they can introduce substantial errors into the carbon exchange estimates. Here we present further development of a gross primary production (GPP) model based entirely on remote sensing data. In contrast to an earlier model based only on the enhanced vegetation index (EVI), this model, termed the Temperature and Greenness (TG) model, also includes the land surface temperature (LST) product from MODIS. In addition to its obvious relationship to vegetation temperature, LST was correlated with vapor pressure deficit and photosynthetically active radiation. Combination of EVI and LST in the model substantially improved the correlation between predicted and measured GPP at 11 eddy correlation flux towers in a wide range of vegetation types across North America. In many cases, the TG model provided substantially better predictions of GPP than did the MODIS GPP product. However, both models resulted in poor predictions for sparse shrub habitats where solar angle effects on remote sensing indices were large. Although it may be possible to improve the MODIS GPP product through improved parameterization, our results suggest that simpler models based entirely on remote sensing can provide equally good predictions of GPP. [Copyright &y& Elsevier]

Background: Septal myectomy (SM) is offered to symptomatic patients with obstructive hypertrophic cardiomyopathy (oHCM) despite medical therapy. Frequently, patients undergo concomitant planned or ad-hoc mitral valve replacement (MVR), aortic valve replacement (SAVR), or coronary artery bypass grafting (CABG)., Objectives: We sought to assess characteristics and outcomes of patients with oHCM undergoing concomitant surgical interventions at the time of SM., Methods: The National Readmission Databases were used to identify all SM admissions in the United States (2010-2019). Patients undergoing SM were stratified into: isolated SM (±MV repair), SM + CABG only, SM + MVR, SM + SAVR, and SM + MVR + SAVR. Primary outcomes were in-hospital mortality, in-hospital adverse events, and 30-day readmission., Results: 12,063 encounters of patients who underwent SM were included (56.1% isolated SM, 9.0% SM + CABG only, 17.5% SM + MVR, 13.1% SM + SAVR, and 4.3% SM + MVR + SAVR). Patients who underwent isolated SM were younger (54.3 vs. 67.1 years-old, p < 0.01) and had lower overall comorbidity burden. In-hospital mortality was lowest in isolated SM, followed by CABG only, SM + SAVR, SM + MVR, and SM + SAVR+MVR groups (2.3% vs. 3.7% vs. 5.3% vs. 6.7% vs. 13.7%, p < 0.01), respectively. SM with combined surgical interventions was associated with higher adverse in-hospital events (24.3% vs. 11.1%, p < 0.01) and 30-day readmissions (16.9% vs. 10.4%, p < 0.01). MV repair performed concomitantly with SM was not associated with increased in-hospital mortality (3.9% vs. 3.4%, p = 0.72; aOR 0.99; 95% CI: 0.54-1.80, p = 0.97]) or adverse clinical events., Conclusions: In SM for oHCM, patients undergoing concomitant surgical interventions were characteristically distinct. Aside from MV repair, concomitant interventions were associated with worse in-hospital death, adverse in-hospital events, and 30-day readmission., (Copyright © 2024. Published by Elsevier B.V.)

Background Prior national data showed a substantial in-hospital mortality in septal myectomy (SM) with an inverse volume-outcomes relationship. This study sought to assess the contemporary outcomes of septal reduction therapy and volume-outcome relationship in obstructive hypertrophic cardiomyopathy. Methods and Results All septal reduction therapy admissions between 2010 to 2019 in the United States were analyzed using the National Readmission Databases. Hospitals were stratified into tertiles of low-, medium-, and high-volume based on annualized procedural volume of alcohol septal ablation and SM. Of 19 007 patients with obstructive hypertrophic cardiomyopathy who underwent septal reduction therapy, 12 065 (63%) had SM. Two-thirds of hospitals performed ≤5 SM or alcohol septal ablation annually. In all SM encounters, 482 patients (4.0%) died in-hospital post-SM. In-hospital mortality was <1% in 1505 (88.4%) hospitals, 1% to 10% in 30 (1.8%) hospitals, and ≥10% in 167 (9.8%) hospitals. There were 63 (3.7%) hospitals (averaging 2.2 SM cases/year) with 100% in-hospital mortality. Post-SM (in low-, medium-, and high-volume centers, respectively), in-hospital mortality (5.7% versus 3.9% versus 2.4%, P =0.003; adjusted odds ratio [aOR], 2.86 [95% CI, 1.70-4.80], P =0.001), adverse in-hospital events (21.30% versus 18.0% versus 12.6%, P =0.001; aOR, 1.88 [95% CI, 1.45-2.43], P =0.001), and 30-day readmission (17.1% versus 12.9% versus 9.7%, P =0.001; adjusted hazard ratio, 1.53 [95% CI, 1.27-1.96], P =0.001) were significantly higher in low- versus high-volume hospitals. For alcohol septal ablation, the incidence of in-hospital death and all other outcomes did not differ by hospital volume. Conclusions In-hospital SM mortality was 4% with an inverse volume-mortality relationship. Mortality post-alcohol septal ablation was similar across all volume tertiles. Morbidity associated with SM was substantial across all volume tertiles.

Advancement in the diagnosis and treatment of transthyretin amyloid cardiomyopathy has made great strides in recent years. Novel therapeutics for transthyretin amyloidosis such as tafamidis, patisiran, and inotersen have shown significant benefits in a not-so-rare disease but come with high listing price tags ranging from a quarter to more than a half million dollars per year. These costs create significant financial barriers for the majority of patients, especially those with existing Medicare insurance plans. Of 72 patients reviewed, 67% were Medicare beneficiaries. Financial assistance was explored for the majority, and 37 (51%) patients with Medicare Part D received financial assistance that reduced their copayments to $0. Only one-third of our patients were able to afford these medications without any forms of financial assistance. Of these patients, 4 (6%) had the highest copayments ranging from $13 000 to $15 000 per year. To navigate the complexities of prescribing and affordability in amyloidosis, a multidisciplinary team including a dedicated clinical pharmacist is crucial in guaranteeing patients' success to secure these novel therapeutics. In this article, we discuss our experiences with prescribing, acquiring insurance authorizations, and financing these life-saving medications based on patient-specific insurance plans and socioeconomic status.

Objectives: This study sought to evaluate the impact of chronic thrombocytopenia (cTCP) on clinical outcomes after percutaneous coronary intervention (PCI)., Background: The impact of cTCP on clinical outcomes after PCI is not well described. Results from single-center observational studies and subgroup analysis of randomized trials have been conflicting and these patients are either excluded or under-represented in randomized controlled trials., Methods: Using the 2012 to 2014 National (Nationwide) Inpatient Sample database, the study identified patients who underwent PCI with or without cTCP as a chronic condition variable indicator. Propensity score matching was performed using logistic regression to control for differences in baseline characteristics. The primary outcome of interest was in-hospital mortality. Secondary outcomes of interest included in-hospital post-PCI bleeding events, post-PCI blood and platelet transfusion, vascular complications, ischemic cerebrovascular accidents (CVAs), hemorrhagic CVAs, and length of stay., Results: Propensity matching yielded a cohort of 65,130 patients (32,565 with and without cTCP). Compared with those without cTCP, PCI in patients with cTCP was associated with higher risk for bleeding complications (odds ratio [OR]: 2.40; 95% confidence interval [CI]: 2.05 to 2.72; p < 0.0001), requiring blood transfusion (OR: 2.10; 95% CI: 1.80 to 2.24; p < 0.0001), requiring platelet transfusion (OR: 11.70; 95% CI: 6.00 to 22.60; p < 0.0001), higher risk for vascular complications (OR: 1.94; 95% CI: 1.43 to 2.63; p < 0.0001), ischemic CVA (OR: 1.60; 95% CI: 1.20 to 2.10; p = 0.01), and higher in-hospital mortality (OR: 2.30; 95% CI: 1.90 to 2.70; p < 0.0001), but without a significant difference in hemorrhagic CVA (OR: 1.50; 95% CI: 0.70 to 3.10; p = 0.27)., Conclusions: In this large contemporary cohort, patients with cTCP were at higher risk of a multitude of complications, including higher risk of in-hospital mortality., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background Syncope accounts for 0.6% to 1.5% of hospitalizations in the United States. We sought to determine the causes and predictors of 30-day readmission in patients with syncope. Methods and Results We identified 323 250 encounters with a primary diagnosis of syncope/collapse in the 2013-2014 Nationwide Readmissions Database. We excluded patients younger than 18 years, those discharged in December, those who died during hospitalization, hospital transfers, and those whose length of stay was missing. We used multivariable logistic regression analysis to evaluate the association between baseline characteristics and 30-day readmission. A total of 282 311 syncope admissions were included. The median age was 72 years (interquartile range, 58-83), 53.9% were women, and 9.3% had 30-day readmission. The most common cause of 30-day readmissions was syncope/collapse, followed by cardiac, neurological, and infectious causes. Characteristics associated with 30-day readmissions were age 65 years and older (odds ratio [OR], 0.7; 95% confidence interval [ CI ], 0.6-0.7), female sex (OR, 0.9; 95% CI, 0.8-0.9), congestive heart failure (OR, 1.5; 95% CI, 1.2-1.9), atrial fibrillation/flutter (OR, 1.3; 95% CI, 1.3-1.4), diabetes mellitus (OR, 1.2; 95% CI, 1.2-1.3), coronary artery disease (OR, 1.2; 95% CI, 1.2-1.3), anemia (OR, 1.4; 95% CI, 1.4-1.5), chronic obstructive pulmonary disease (OR, 1.4; 95% CI, 1.3-1.4), home with home healthcare disposition (OR, 1.5; 95% CI, 1.5-1.6), leaving against medical advice (OR, 1.7; 95% CI, 1.6-1.9), length of stay of 3 to 5 days (OR, 1.5; 95% CI, 1.4-1.6) or >5 days (OR, 2; 95% CI, 1.8-2), and having private insurance (OR, 0.6; 95% CI, 0.6-0.7). Conclusions The 30-day readmission rate after syncope/collapse was 9.3%. We identified causes and risk factors associated with readmission. Future prospective studies are needed to derive risk-stratification models to reduce the high burden of readmissions.

Objectives: To determine the prevalence and factors associated with persistent pulmonary hypertension (PH) following transcatheter aortic valve replacement (TAVR) and its relationship with long-term mortality., Methods: Consecutive patients who underwent TAVR from July 2011 through January 2016 were studied. The prevalence of baseline PH (mean pulmonary artery pressure ≥25 mm Hg on right heart catheterisation) and the prevalence and the predictors of persistent≥moderate PH (pulmonary artery systolic pressure (PASP)>45 mm Hg on 1 month post-TAVR transthoracic Doppler echocardiography) were collected. Cox models quantified the effect of persistent PH on subsequent mortality while adjusting for confounders., Results: Of the 407 TAVR patients, 273 (67%) had PH at baseline. Of these, 102 (25%) had persistent≥moderate PH. Mortality at 2 years in patients with no baseline PH versus those with PH improvement (follow-up PASP≤45 mm Hg) versus those with persistent≥moderate PH was 15.4%, 16.6% and 31.3%, respectively (p=0.049). After adjusting for Society of Thoracic Surgeons Predicted Risk of Mortality and baseline right ventricular function (using tricuspid annular plane systolic excursion), persistent≥moderate PH remained associated with all-cause mortality (HR=1.82, 95% CI 1.06 to 3.12, p=0.03). Baseline characteristics associated with increased likelihood of persistent≥moderate PH were ≥moderate tricuspid regurgitation, ≥moderate mitral regurgitation, atrial fibrillation/flutter, early (E) to late (A) ventricular filling velocities (E/A ratio) and left atrial volume index., Conclusions: Persistency of even moderate or greater PH at 1 month post-TAVR is common and associated with higher all-cause mortality., Competing Interests: Competing interests: JLC and TGG received investigator-initiated grant support from Medtronic. None of the other coauthors have any conflict of interest relevant to the content of this manuscript., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)