Search

Cutaneous immune related adverse events (cirAEs) are a common toxicity due to immune checkpoint inhibitors (ICI) to treat cancer. We provide a case series of 10 patients who presented with low severity cirAEs who had their ICI discontinued against published guidelines and elucidate methods to decrease the risk of this occurrence.

Elastic moduli of {[(TeO2)0.7 (B2O3)0.3]0.8 (SiO2)0.2}1-y (Er2O3 NPs)y glasses with y = 0.01, 0.02, 0.03, 0.04, 0.05 were studied in this work using the theoretical elastic models. The Makishima & Mackenzie, Rocherulle and bond compression models were employed for the study. In the Makishima and Mackenzie model, the packing density was calculated from the bulk glass molar weight and the bulk glass density whereas in Rocherulle model it is determined as the individual oxides. Young, shear and bulk moduli as well as the Poisson ratio were calculated for the glasses in the Makishima and Rocherulle models, while longitudinal, was calculated in addition to young, bulk and shear moduli using the bond compression model. Bond per unit volume number (nb), bulk modulus, bulk modulus ratio (Kbc/Ke), atomic ring size (?) and stretching force constant were also calculated and presented. The values of the Young, bulk and shear moduli obtained from Makishima model increased from 52.854 to 55.335 GPa, 35.754 to 39.862 GPa and 21.080 to 21.809 GPa respectively with Er2O3 NPs composition increase from 1% to 5%.. The Rocherulle model presented increasing values for Young, bulk and shear moduli as 56.910 to 58.432 GPa, 41.452 to 44.450 GPa and 22.385 to 22.809 GPa respectively with Er2O3 NPs composition increase from 1% to 5%. The bond compression model presented much higher values of the elastic moduli compared to the experimentally obtained values and showed an increasing trend as the Er2O3 NPs concentration increases. In the glass network, the atomic ring size value decreased from 0.5698 to 0.5091 nm indicating an increase in the close packing of atoms. Based on the elastic moduli values presented by all the models, Makishima and Mackenzie model presented a more reliable data and hence represents the best model for the studied glass system.

People diagnosed with COVID-19 who require hospitalization are primarily admitted secondary to shortness of breath because of hypoxia but also display difficulties with overall muscle weakness, which could impair gait, activities of daily living, speech, cognitive-linguistics, or swallowing. This article provides a clinical perspective of how a physical therapist, occupational therapist, and speech language pathologist in the US Public Health Service Commissioned Corps were deployed with an augmentation team and how they improved care at a hospital that was overwhelmed with patients diagnosed with COVID-19. The rehabilitation team completed 246 evaluation and treatment encounters in a 12-day period and began seeing patients within 24 hours on-site. After the rehabilitation team arrived, patients were noted to be more mobile, independent in activities of daily living, and able to tolerate the least restrictive diets without signs and symptoms of aspiration. As a result of rehabilitation services, safe discharges were expedited, length of stay was reduced, and the hospitals’ inpatient admission capacity was maximized. The augmentation team learned the importance of including rehabilitation specialties for treating patients with COVID-19. Mobilizing rehabilitation specialties along with medical and nursing staff helps maximize the overall recovery, health, and outcomes for patients. Leadership that is responsible for the development and deployment of future medical teams in military, emergency response, and public health efforts should consider all therapy disciplines as an essential component for each team.

Background and aims Low-density lipoprotein cholesterol (LDL-C) reduction is an essential part of the 2019 ESC/EAS dyslipidemia guidelines [1]. Only 18% of patients achieve 2019 ESC/EAS LDL-C target goal in secondary prevention [2]. “Jena auf Ziel – JaZ” (“Jena on target”) is a prospective study that aims at LDL-C target attainment in all patients with ST-elevation myocardial infarction (STEMI) and determination of reasons for failed target attainment. Methods All STEMI patients were started on atorvastatin 80 mg/ezetimibe 10 mg on admission. LDL-C levels were monitored during the hospital stay and a 12 months follow-up period. Patients were educated about cardiovascular risk factor optimization. Individual patient cards to document LDL-C levels over time were used to enforce LDL-C target attainment. Results In the first 50 consecutive patients, LDL-C levels were 3.39±1.23 mmol/L on admission, 1.84±0.86 mmol/L on discharge and 1.30±0.65 mmol/L during the first follow-up visit (6–8 weeks). On atorvastatin 80 mg/ezetimibe 10 mg 14 out of 50 patients (28%) reached the LDL-C goal on discharge, 36 out of 50 patients (72%) after 6–8 weeks. After addition of bempedoic acid or PCSK9-inhibitors all patients which were followed up in our lipid clinic reach the EAS/ESC-LDL-C target. Only two patients reported myalgias of which one patient refused to continue with lipid-lowering drugs. One patient had elevated liver enzymes, which resolved after switching to a lower statin dose. Conclusions One out three STEMI patients reached the EAS/ESC-LDL-C target during the initial hospital stay on atorvastatin 80 mg/ezetimibe 10 mg. Adding bempedoic acid or PCSK9 inhibitors resulted in LDL-C target attainment of all patients during follow-up. EAS/ESC-LDL-C target attainment is feasible and well-tolerated in empowered, well-educated patients. Funding Acknowledgement Type of funding sources: None.

Background Due to the high volume and broad availability of troponin testing and invasive coronary diagnostic in Germany, the entity of myocardial infarction with non-obstructive coronary arteries (MINOCA) is gaining increasing clinical and economic significance. As a main feature, no detectable obstructive coronary artery can be found upon angiography despite clinical symptoms related to acute coronary syndrome. Our investigation focuses on the procedural and economic impact of MINOCA and related clinical outcomes in a single-center patient collective of a university heart center. Methods All patients who were admitted to our hospital under the suspicion of an acute coronary syndrome within a 12-month period (2017–2018) for further diagnostics and treatment were screened. Included patients showed a pathological troponin elevation and received invasive coronary angiography. Associated costs, procedural and various clinical parameters as well as timelines and parameters of work-flow were obtained. Results 3021 patients were initially screened and 660 were included. Of those, 103 patients were attributed to the MINOCA group. 542 patients presented with a “classical” myocardial infarction, and thus formed the MIOCA (myocardial infarction with obstructive coronary arteries) group. Baseline characteristics were summarized in Table 1. MINOCA patients were less frail, less diabetic, more likely female and showed no relevant difference in age or other selected comorbidities. The emergency department was the primary point of hospital admission for >70% of the patients from both groups. 50% of the patients arrived in the afternoon on a weekday. MINOCA patients were less present during the weekend as MIOCA patients (8.5% vs. 19.7%; p=0.002). With regard to a potential seasonal occurrence, both MINOCA and MIOCA cases show a pattern with two peaks (Figure 1). In-hospital mortality (MIOCA vs. MINOCA: 59 (11.1%) vs. 0 (0%) patients; p Conclusion Despite MINOCA being mostly a benign syndrome with favorable clinical outcome, it still utilizes relevant financial and capacity resources including high care monitoring and an in-hospital treatment of relevant length. Funding Acknowledgement Type of funding sources: None.

Background Cardiac amyloidosis (CA) is a progressive infiltrative cardiomyopathy that leads to severe heart failure and, once clinically relevant, poses a high mortality risk. Epidemiological data for CA are still sparse and heterogeneous, but urgently needed since novel therapies against ATTR-CA are now available. Aim We aimed to assess minimum prevalence rates of CA among cardiac and non-cardiac patients undergoing routine echocardiography in an echo lab of a large university clinic serving all medical specialities in central Germany. Methods We established a retro- and prospective database based on suspicious findings in echocardiography for all echocardiographic exams over an 8.5 year period (03/2013 and 09/2021). During this time, 41,375 patients underwent at least one echo exam. Indication for echos were mixed, and consisted of non-cardiac and cardiac patients with acute and chronic illnesses as well as screening exams (e.g. before major surgery or chemotherapy). Suspicious echocardiography were retrospectively analysed whether they underwent further diagnostic or if it remained an unproven suspicion (figure). All echos of suspicious cases were comprehensively re-analysed regarding novel surrogate parameters and indices for CA. Various clinical and laboratory parameters were collected. Results The mean age of the cohort of 41,375 patients was 65.1±15.8 years for the first or only echo examination with a slightly unbalanced gender distribution (45% female). The age distribution is shown in the table. While 128 patients were suspected, the diagnosis was falsified in 16 patients and proven in 47 patients (light chain n=16, ATTR n=31; figure). A substantial proportion of patients with suspicious echo received no further diagnostic work-up (N=65). Over the given time frame of 101 months, the prevalence of suspicious echocardiograms was 1 per 323 patients (or 31 per 10,000). The proven cases had a prevalence of 1 per 880 patients (or 11.3 per 10,000). Since ATTR-CA is a disease of the elderly, we saw a vanishingly small number of cases in persons younger than 70 years (table), whereas 90% of all CA patients were older than 70 years. At timing of diagnosis, AL-CA patients were almost 10 years younger compared to diagnosis of ATTR-CA (69.1±8.4 years vs. 77.4±8.5 years). In patients older than 80 years, the prevalence rate of ATTR-CA peaked with 22.6 cases per 10.000 patients (0.23%). The prevalence rate of ATTR-CA was roughly twice as high compared to AL-CA. Conclusion For the first time, an estimation of minimum prevalence rates for CA for a defined volume of echocardiograms in an all-comers population is provided. In a mixed population of a hospital of maximum care CA prevalence rate is much higher than expected. Awareness for this “rare” disease is needed, since routine echo exams can prompt suspicion in clinically silent or so far unrecognized CA cases. Funding Acknowledgement Type of funding sources: None.

The most consequential consideration of brands arises during preferential decision-making. This article proposes that as a consequence of the repeated pairing of brands and preferential decisions, exposure to brands initiates a cognitive state of readiness for preferential decisions (which we term decision readiness) that subsequently makes preferential decisions easier. Using both real and fictitious brands across a variety of choice contexts, seven experiments demonstrate that consumers find preferential decision-making easier when it occurs in the presence (vs. absence) of brands. Consistent with the details of our framework, this effect: (i) is explained by the activation of decision readiness, (ii) leads to outcomes such as increased outcome satisfaction and decreased decision delegation, and (iii) is attenuated when exposure is to only one brand. Collectively, these findings demonstrate the importance of exposure to brands for decision-making which, in turn, offers novel insight into existing literatures on brand exposure, decision difficulty, and brand roles.

Although models of political ideology traditionally focus on the motivations that separate conservatives and liberals, a growing body of research is directly exploring the cognitive factors that vary due to political ideology. Consistent with this emerging literature, the present research proposes that conservatives and liberals excel at tasks of distinct working memory processes (i.e., inhibition and updating, respectively). Consistent with this hypothesis, three studies demonstrate that conservatives are more likely to succeed at response inhibition and liberals are more likely to succeed at response updating. Moreover, this effect is rooted in different levels of cognitive flexibility and independent of respondents’ demographics, intelligence, religiosity, and motivation. Collectively, these findings offer an important perspective on the cognitive factors that delineate conservatism and liberalism, the role of cognitive flexibility in specific working memory processes, and the impact of political ideology on a multitude of behaviors linked to inhibition and updating (e.g., creativity, problem-solving, self-control).

ABSTRACT: A series of field-based multi-physics observations were conducted as part of the Brine Availability Test in Salt (BATS) underground at the Waste Isolation Pilot Plant (WIPP), near Carlsbad, NM. Observations were made of brine production, temperature, electrical resistivity, acoustic emissions (AE), and gas/liquid tracer migration through salt around twin heated/unheated borehole arrays. Here, we present AE results from thermal cycling experiments performed May - July 2021, during which the heater was pulsed several times followed by two longer heated periods. Sixteen AE sensors were installed in three parallel observational boreholes surrounding the central heated borehole. Observed AE demonstrate that heating and cooling cycles significantly impact salt behavior. AE rates increased during heating and increased further upon cooling. Average energy and frequency bandwidth also increased during heating and cooling of salt. Similar behavior was observed for each heating/cooling cycle, suggesting that temperature-enhanced salt healing may have eliminated any threshold loading associated with the onset of AE (i.e., the Kaiser effect). Locations of AE events remained centralized around the borehole. These results show that AE provide valuable information about the thermal behavior of salt, particularly that cooling of salt results in the highest AE behavior. 1. INTRODUCTION The Waste Isolation Pilot Plant (WIPP) outside of Carlsbad, NM is the nation’s only active geologic repository for nuclear waste. Currently, WIPP is licensed to dispose of transuranic radioactive waste from defense activities. The US Department of Energy Office of Nuclear Energy’s (DOE-NE) Spent Fuel and Waste Science and Technology program is pursuing generic research into multiple possible disposal media (i.e., salt, argillite, and crystalline rocks) for heat-generating waste from spent nuclear fuel. The DOE Office of Environmental Management (DOE-EM) that manages the WIPP site provides access to the WIPP underground DOE-NE work that is testing the behavior of the generic bedded salt under conditions relevant to spent fuel and high-level waste disposal.

Introduction: The amount and duration of opioids necessary after anterior cruciate ligament reconstruction (ACLR) are inadequately defined. This study sought to prospectively (1) define the amount and duration of opioid consumption, (2) investigate the relationship between preoperative pain expectation and postoperative satisfaction with pain management, and (3) identify risk factors for increased opioid use after ACLR. Methods: One hundred eight patients undergoing primary ACLR with hamstring graft were prospectively analyzed for preoperative pain expectation, using visual analog scale (VAS) rating, and postoperative satisfaction with pain management. Univariate and multivariate analyses were done to identify patient characteristics associated with satisfaction and/or amount and duration of opioid use. Results: Mean duration and cumulative intake of opioid consumption after ACLR were 5.3 days and 15.3 tablets, respectively. Patients expected moderate postoperative pain: mean preoperative VAS = 68.9. The preoperative VAS rating was associated with a significantly greater amount (P = 0.0265) and longer duration (P = 0.0212) of opioid consumption. Baseline opioid users took opioids for twice as long postoperatively (10.0 versus 5.0 days; P = 0.0149) and consumed twice as many tablets (29.3 versus 14.8 tablets; P = 0.0280) compared with opioid-naive patients. Discussion: This study demonstrated on average 15.3 opioid tablets over 5.3 days provided satisfactory pain management after ACLR. Risk factors for increased opioid consumption included preoperative opioid use.

The burden of the COVID-19 pandemic has been mainly carried by health care providers. Technology-Mediated Interventions (TMI) seem to be a feasible alternative to increase access to behavioral health resources in this population. However, scaling-up treatments into TMI requires developing user-friendly, accepted, and accessible formats. A two-stage study was conducted to assess scalability of an Acceptance and Commitment Therapy (ACT) based strategy (named FACE COVID) delivered using technology. First, a mix-method design connected qualitative and quantitative data from health providers and ACT experts by which changes were performed to enhance scalability. Second, a pretest-posttest study was conducted to preliminary evaluate the efficacy of FACE COVID intervention on well-being, psychological distress, and psychological flexibility. Results showed a positive impact on well-being, but not distress and psychological flexibility. While this intervention has promising results, changes in dose intensity, social support, and mental health literacy could improve retention as well as increase opportunities to target distress and psychological flexibility in future studies.

Background Transcatheter tricuspid valve repair (TTVr) is a novel modality for treatment of severe tricuspid regurgitation (TR) in patients at high surgical risk. So far, the most frequently used system is the MitraClip® providing two different clip types (NTR vs XTR). Purpose To compare XTR vs NTR clip systems for TTVr regarding safety, feasibility, and effectiveness. Methods 35 consecutive high-risk patients (78.4±7.9 years, EUROScore II 10.7±10.8%, STS Score 7.9±4.1) with symptomatic TR were treated using the MitraClip® system between 2017–2020. with an NTR (N=18, 51.4%) or XTR (N=17, 48.6%) system. The primary outcome was successful TTVr with TR reduction of ≥1 grade with no mortality, single leaflet device attachment (SLDA), or conversion to surgery until hospital discharge. At 30-day follow-up, TR severity grade and NYHA functional class were assessed. Results We found more severe initial TR grades in the XTR group compared to the NTR group expressed with wider TR V. contracta (14.8±4.3 vs 11.1±3.8 mm, p=0.011), larger EROA (0.99±0.4 vs 0.72±0.3 cm2, p=0.032), wider coaptation depth (9.6±2.8 vs 7.3±0.4 mm, p=0.036) and V. cava inferior (30.7±3.6 vs. 25.8±6.4 mm in NTR, p=0.013). 5 patients (29.4%) in the XTR and 3 patients (16.7%) in the NTR group presented initially with torrential TR. No significant differences were observed for clinical characteristics, comorbidities, co-medication, laboratory parameters or initial NYHA functional class (3.0±0.5 in NTR vs 3.2±0.4 in XTR, p=0.45). TTVr was safe with no intraprocedural deaths, emergency surgery or major vascular complications. Duration of the procedure and fluoroscopy did not differ. Both, NTR and XTR system led to procedural success in 72.2% (N=13) and 76.5% (N=13), respectively. At discharge, a significant reduction of initial TR grade was observed in both groups (2.4±0.9 in NTR and 2.3±0.9 in XTR, p Conclusion MitraClip® NTR and XTR systems for TTVr of severe TR in high-risk patients are safe and effective leading to a significant reduction of TR and clinical improvement. The XTR system seems to allow successful treatment of more severe TR stages compared to NTR. Funding Acknowledgement Type of funding sources: None.

Time-series observations of total CO2 (CT) accumulation in the deep water of the Gotland Basin were initiated in 2003. The measurements were performed four to five times per year and were complemented by the determination of nutrient and O2/H2S concentrations. The major objective of those measurements was to study organic matter (OM) mineralization. This was facilitated during two periods of stagnation, from 2004 to 2006 and from 2007 to 2014, identified on the basis of temperature-salinity diagrams. In a follow-up to our assessment of the data from the first period, we present here an overall picture of CT accumulation in the deep water of the Gotland Basin. CT measurements were performed at five different depths between 150 m and the sediment surface at 235 m. Mineralization rates for three individual sub-layers were obtained from CT mass balances that took into account vertical mixing across the boundaries of the sub-layers. Mixing coefficients were calculated from the mass balances for salinity. The mass balance calculations yielded the source/sink strength of CT, O2, H2S, NO3− and NH4+ for each time interval between measurements. The accumulated release of CT was shown to increase linearly with time and to reflect consistent mean annual mineralization rates of ~2 mol m−2 for both stagnation periods, which indicated the absence of significant decadal variability. A dependency of the mineralization rate on the redox conditions in the overlying water column was not detected. For the first stagnation period, the sequential use of different oxidants, including O2, NO3− and SO42−, was identified. A determination of oxidant consumption with respect to OM mineralization yielded a mean molar ratio of 1.2 oxygen equivalents per carbon atom of OM, a distinct deviation of the OM composition described by classical Redfield stoichiometry.

Emphasizing customer satisfaction as a strategic lever for enhancing business performance is a widespread business practice. However, just over 25 years of empirical studies by academic researchers has produced evidence that is sometimes contradictory. Hence, greater academic clarity and improved managerial understanding could result from a meta-analysis of the customer satisfaction-business performance relationship. To that end, the authors analyzed 251 correlations from 96 studies published between 1991 and 2017. While the satisfaction-performance relationship is positive and statistically significant on average (r = .101), more meaningful insights emerge from the explication of moderating and mediating relationships. Illustrative of these insights is the finding that satisfaction is more appropriately depicted as mediating the effects of selected marketing strategy variables on firm performance outcomes. Moreover, when satisfaction is viewed in the right setting using the right satisfaction and performance measures, a most favorable contingencies (MFC) perspective, the estimated correlation is reasonably strong (r = .349).