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• DC versus CO patients had different baseline characteristics and initial injury severity. • Age and initial CT findings were independently associated with surgical approach. • After applying coarsened exact matching to patients who underwent CO and DC, DC remained independently associated with inpatient mortality. • DC was also independently associated with mortality at 90-days and 1-year after surgery. Acute subdural hematoma (aSDH) after traumatic brain injury frequently requires emergent craniotomy (CO) or decompressive craniectomy (DC). We sought to determine the variables associated with either surgical approach and to compare outcomes between matched patients. A multi-center retrospective review was used to identify traumatic aSDH patients who underwent CO or DC. Patient variables independently associated with surgical approach were used for coarsened exact matching. Multivariate logistic regression and multivariate Cox proportional-hazards regression were conducted on matched patients to determine independent predictors of mortality. Seventy-six patients underwent CO and sixty-two underwent DC for aSDH evacuation. DC patients were 21.4 years younger (P < 0.001), more likely to be male (80.6 % vs 60.5 %, P = 0.011), and present with GCS ≤ 8 (64.5 % vs 36.8 %, P = 0.001). Age (P < 0.001), epidural hematoma (P = 0.01), skull fracture (P = 0.001), and cisternal effacement (P = 0.02) were independently associated with surgical approach. After coarsened exact matching, DC (P = 0.008), older age (P = 0.007), male sex (P = 0.04), and intraventricular hemorrhage (P = 0.02), were independently associated with inpatient mortality. Multivariate Cox proportional-hazards regression demonstrated that DC was independently associated with mortality at 90-days (P = 0.001) and 1-year post-operation (P = 0.003). aSDH patients who receive surgical evacuation via DC as opposed to CO are younger, more likely to be male, and have worse clinical exam. After controlling for patient differences via coarsened exact matching, DC is independently associated with mortality. [ABSTRACT FROM AUTHOR]

Specialist palliative care (SPC) is often needed to manage complex or refractory problems in children with life-threatening conditions during end-of-life. This study explores the perceptions of healthcare professionals (HPs) to determine the triggers leading to and experiences with introducing SPC among families of children with life-threatening conditions. A secondary analysis of 13 semi-structured interviews with HPs conducted from September 2019–June 2020 was carried out in a pediatric ward and a neonatal and pediatric intensive care unit in Taiwan. A thematic analysis was conducted. Competence Theory was used to guide the research questions and the interpretive framework. Seven nurses, four pediatricians, one psychologist, and one respiratory therapist were interviewed. The need for shared knowledge regarding wishes for care and end-of-life decision-making were found to be the indicators for introducing SPC, along with having a fear of causing harm to the family-professional relationship and the patient. HPs value harmony in the form of clarifying misconceptions, building trust, and holding the moral bottom line. The theme of 'seeking the competent self' encompasses the values and expectations related to improving skills and creating a sense of fulfillment as HPs achieve good quality care. Discussions about SPC facilitate better communication and decision-making. Careful attention should be paid to the needs related to clarifying misconceptions and protecting the child's right to life when SPC is suggested. Communication, empathy, and conflict resolution training may be helpful with developing HP competencies related to introducing SPC. • Timing of introducing specialist palliative care varies among professionals. • Triggers for referral included the need for shared knowledge regarding care. • It is concerned that inaccurate predictions of life expectancy could cause harm. • Professionals value harmonious relationship with the family and within selves. • Improved skills and sense of fulfillment facilitate professionals' motivation. [ABSTRACT FROM AUTHOR]

• Four TADF materials with carbazole donor, and benzonitrile-substituted pyrimidine or triazine as acceptor core were developed. • OLEDs with m-CzPym, p-CzPym, m-CzTrz, and p-CzTrz as host and 4CzIPN were fabricated. • An impressive external quantum efficiency of 31.5% and a superior power efficiency of 116.5 lm W−1 were achieved. • Impressive efficiency roll-off performance (approximately 90% of EQE max at 5000 cd m−2). Four bipolar molecules, namely m-CzPym , p-CzPym , m-CzTrz , and p-CzTrz , with carbazole (Cz) donor and a benzonitrile-substituted pyrimidine (Pym) or triazine (Trz) acceptor core were synthesized and characterized. The electron deficiency of heteroaryl cores together with the substitution pattern of benzonitrile were employed to tune the energy levels as well as the thermally activated delayed fluorescence (TADF) characteristics. The four molecules exhibited TADF behavior with inferior photoluminescent quantum yields (PLQYs) that limit their applications as emitters. These bipolar molecules were employed as TADF host materials for the benchmark TADF emitter 4CzIPN to achieve high-performing green TADF organic light-emitting diodes (OLEDs). Among the molecules, m-CzPym -hosted TADF-OLEDs achieved a maximum external quantum efficiency (EQE max) of 31.5%, maximum power efficiency (PE max) of 95.6 lm/W, and maximum current efficiency (CE max) of 100.2 cd/A. Notably, p-CzPym -hosted TADF-OLEDs also achieved a PE max of 116.5 lm/W, turn-on voltage of 2.5 V, and impressive low efficiency roll-off performance (>89% of EQE max at 5000 cd/m2), representing one of the highest efficiencies ever reported in 4CzIPN-doped devices. The high device efficiency can be ascribed to the balanced ambipolar carrier-transporting character of the host materials and high PLQY as well as the outstanding light outcoupling efficiency of the emitting layer. [ABSTRACT FROM AUTHOR]

Careful hematologic management is required in surgical patients with traumatic acute subdural hematoma (aSDH) taking antithrombotic medications. We sought to compare outcomes between patients with aSDH taking antithrombotic medications at admission who received antithrombotic reversal with patients with aSDH not taking antithrombotics. Retrospective review identified patients with traumatic aSDH requiring surgical evacuation. The cohort was divided based on antithrombotic use and whether pharmacologic reversal agents or platelet transfusions were administered. A 3-way comparison of outcomes was performed between patients taking anticoagulants who received pharmacologic reversal, patients taking antiplatelets who received platelet transfusion, and patients not taking antithrombotics. Multivariable regressions, adjusted for injury severity, further investigated associations with outcomes. Of 138 patients who met inclusion criteria, 13.0% (n = 18) reported taking anticoagulants, 16.7% (n = 23) reported taking antiplatelets, and 3.6% (n = 5) reported taking both. Patients taking antiplatelets who received platelet transfusion had longer intraoperative times (P = 0.040) and higher rates of palliative care consultations (P = 0.046) compared with patients taking anticoagulants who received pharmacologic reversal and patients not taking antithrombotics. Across groups, no significant differences were found in frequency of in-hospital intracranial hemorrhage and venous thromboembolism, length of hospital stay, rate of inpatient mortality, or follow-up health status. In multivariable analysis, intraoperative time remained longest for the antiplatelets with platelet transfusion group. Other outcomes were not associated with patient group. Among surgical patients with traumatic aSDH, those taking antiplatelet medications who receive platelet transfusions experience longer intraoperative procedure times and higher rates of palliative care consultation. Comparable outcomes were observed between patients receiving antithrombotic reversal and patients not taking antithrombotics. [ABSTRACT FROM AUTHOR]