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Introduction: Extracellular volume (ECV) predicts mortality in hemodialysis patients, but it is difficult to assess clinically. Peridialytic blood pressure (BP) measurements can help ECV assessment. Orthostatic BP is routinely measured clinically, but its association with ECV is unknown. Methods: In a cohort of hypertensive hemodialysis patients, we measured posthemodialysis ECV/weight with bioimpedance spectroscopy and analyzed its association with post‐HD orthostatic BP measurements obtained during routine care. Using linear and logistic regression, the primary outcomes were orthostatic BP change and orthostatic hypotension (OH) defined by systolic BP decrease of at least 20 mmHg or diastolic decrease of at least 10 mmHg. Model 1 controlled for sex, age, and diabetes. Model 2 additionally controlled for ultrafiltration rate and antihypertensive medications. We conducted sensitivity analysis using OH definition of systolic BP decrease of at least 30 mmHg. Findings: Among 57 participants, mean orthostatic systolic BP change was −7.30 (20) mmHg and mean ECV/weight was 0.24 (0.04) L/kg. Post‐HD ECV/weight was not associated with orthostatic systolic BP change (β = 8.2, p = 0.6). There were 16 participants with and 41 participants without OH. The ECV/weight did not differ between these groups (0.22 [0.04] vs. 0.24 [0.05] L/Kg, p = 0.09) and did not predict OH in logistic regression (OR 11, 4.04; 95% CI 0.2–671, 0.03–0.530 in the two models.) In a sensitivity analysis, ECV/weight was lower in the OH group (0.22 [0.03] vs. 0.25 [0.04] L/kg, p = 0.005), but this was accompanied by differences in sex and diabetes. Using logistic regression, there was no independent association between ECV/weight with OH. Discussion: Orthostatic systolic BP change after HD completion is not a reliable indicator of posthemodialysis ECV. When considering other factors associated with orthostatic BP, ECV/weight is not independently associated with OH. Although transient postdialytic differences in intravascular volume may be associated with OH, posthemodialysis OH does not necessarily indicate ECV depletion. [ABSTRACT FROM AUTHOR]

Hypoplastic left heart syndrome is a congenital anomaly that is uniformly fatal in infancy without immediate treatment. The standard treatment consists of an initial Norwood procedure (stage 1) followed some months later by stage 2 palliation (S2P). The ideal timing of the S2P is uncertain. The Single Ventricle Reconstruction Trial (SVRT) randomized the procedure used in the initial Norwood operation, leaving the timing of the S2P to the discretion of the surgical team. To estimate the causal effect of the timing of S2P, we propose to impute the potential post‐S2P survival outcomes using statistical models under the Rubin Causal Model framework. With this approach, it is straightforward to estimate the causal effect of S2P timing on post‐S2P survival by directly comparing the imputed potential outcomes. Specifically, we consider a lognormal model and a restricted cubic spline model, evaluating their performance in Monte Carlo studies. When applied to the SVRT data, the models give somewhat different imputed values, but both support the conclusion that the optimal time for the S2P is at 6 months after the Norwood procedure. [ABSTRACT FROM AUTHOR]

Summary: COVID‐19, caused by SARS‐CoV‐2, is a contagious life‐threatening viral disease that has killed more than three million people worldwide to date. Attempts have been made to identify biomarker(s) to stratify disease severity and improve treatment and resource allocation. Patients with SARS‐COV‐2 infection manifest with a higher inflammatory response and platelet hyperreactivity; this raises the question of the role of thrombopoiesis in COVID‐19 infection. Immature platelet fraction (IPF, %) and immature platelet counts (IPC, ×109/l) can be used to assess thrombopoiesis. This study investigates whether the level of thrombopoiesis correlates with COVID‐19 severity. A large cohort of 678 well‐characterized COVID‐19 patients was analyzed, including 658 (97%) hospitalized and 139 (21%) admitted to the intensive care unit (ICU). Elevated percentage IPF at presentation was predictive of length of hospitalization (P < 0·01) and ICU admission (P < 0·05). Additionally, percentage IPF at the peak was significantly higher among ICU patients than non‐ICU patients (6·9 ± 5·1 vs 5·3 ± 8·4, P < 0·01) and among deceased patients than recovered patients (7·9 ± 6·3 vs 5·4 ± 7·8, P < 0·01). Furthermore, IPC at the peak was significantly higher among ICU patients than non‐ICU patients (18·5 ± 16·2 vs. 13·2 ± 8·3, P < 0·05) and among patients on a ventilator than those not (22·1 ± 20·1 vs.13·4 ± 8·4, P < 0·05). Our study demonstrated that elevated initial and peak values of percentage IPF and IPC might serve as prognostic biomarkers for COVID‐19 progression to severe conditions. [ABSTRACT FROM AUTHOR]

Aims: This study demonstrates that auxiliary and exclusion criteria variables increase the effectiveness of missing imputation in correcting underestimation of physiologic reactivity in relation to post-traumatic stress disorder (PTSD) caused by deleting cases with missing physiologic data. Methods: This study used data from survivors of the 1995 Oklahoma City bombing and imputed missing heart rate data using auxiliary and exclusion criteria variables. Logistic regression was used to examine heart rate reactivity in relation to current PTSD. Results: Of 113 survivors who participated in the bombing study's 7-year follow-up interview, 42 (37%) had missing data on heart rate reactivity due to exclusion criteria (medical illness or use of cardiovascular or psychotropic medications) or non-participation. Logistic regression results based on imputed heart rate data using exclusion criteria and auxiliary (the presence of any current PTSD arousal symptoms) variables showed that survivors with current bombing-related PTSD had significantly higher heart rates at baseline and recovered more slowly back to baseline heart rate during resting periods than survivors without current PTSD, while results based on complete cases failed to show significant correlations between current PTSD and heart rates at any assessment points. Conclusions: Suggested methods yielded an otherwise undetectable link between physiology and current PTSD. [ABSTRACT FROM AUTHOR]

This article reports on the effect of income within race on African Americans' perception of the courts. Our findings are somewhat consistent with the previous research on black middle-class relative dissatisfaction with various American institutions. That is, unlike whites and Latirios in our study, we find that higher-income African Americans are more skeptical of the notion that blacks receive equal treatment in the courts. This same group also reported less confidence in the court's handling of specific types of cases (e.g., civil, criminal and juvenile delinquency cases.) However, better off blacks were more likely than poor blacks to have confidence in the U.S. Supreme Court and community courts. These findings point a more complex account of African American perceptions of the courts, an account that draws a distinction between diffused and specific support of the courts. [ABSTRACT FROM AUTHOR]

Background Atherosclerotic cardiovascular disease (ASCVD) is the third leading cause of death in women service members and veterans. This study assessed 10-year ASCVD risk in women service members and veterans using their own electronic health record data extracted from Veterans Affairs (VA) national Corporate Data Warehouse database. Methods and Results We retrospectively followed 69 574 VA women, aged 30 to 79 years, from 2007 to 2017. Of these, 52% were whites (n=36 172), 42% were blacks (n=29 232), and 6% were Hispanics (n=4171). Risk factors and ASCVD events (nonfatal myocardial infarction, nonfatal stroke, and cardiac deaths) were identified using diagnostic and procedural codes from electronic health records. Then, within the same construct of the current American College of Cardiology/American Heart Association 10-year ASCVD risk assessment models for women, coefficients for risks factors were recalculated using the VA national electronic health record data, stratified by race (hereafter, VA women model). Our study found a curvilinear association of aging with increased risk of 10-year ASCVD event in VA women starting at ages as young as 30 years across all race groups. The VA women model performance in predicting ASCVD events at 10 years was mixed-moderate in discrimination (C statistics, 0.61-0.64) but good in accuracy, as demonstrated by calibration plots approximating a 45° line. Conclusions The study finding, a curvilinear association of aging with increased ASCVD risk in VA women across all races, demonstrates the need for cardiovascular risk screening of younger VA women, aged <45 years.