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Nearly 1 year into the coronavirus disease 2019 pandemic, the first severe acute respiratory syndrome coronavirus 2 vaccines received emergency use authorisation and vaccination campaigns began. A number of factors can reduce the averted burden of cases and deaths due to vaccination. Here, we use a dynamic model, parametrised with Bayesian inference methods, to assess the effects of non-pharmaceutical interventions (NPIs) (such as social distancing, mask mandates, school and workplace closure), and vaccine administration and uptake rates on infections and deaths averted in the United States. We show that scenarios depicting higher compliance with NPIs avert more than 60% of infections and 70% of deaths during the period of vaccine administration, and that increasing the vaccination rate from 5 to 11 million people per week could increase the averted burden by more than one-third. These findings underscore the importance of maintaining NPIs and increasing vaccine administration rates.

The formation of cardiorenal syndrome (CRS) in patients with chronic heart failure (CHF) is a naturalmanifestation of a functionally interrelated process at the organ level. Moreover, impaired renal function is acommon and independent factor in the progression of the disease, a high incidence of cardiovascular eventsand death in a population of patients with asymptomatic and / or clinically manifested CHF, which is dueto the pathogenetic features of the formation of cattle in patients with CHF of ischemic genesis. The articleprovides an overview of studies on the pathogenesis of kidney damage in CHF, the role of various markersin the early diagnosis of cattle. A decrease in glomerular filtration rate (GFR) and an increase in urinaryalbumin excretion are currently considered as “renal” markers of a poor prognosis within the cardiorenalcontinuum. In this regard, for stratification of patients by stages of chronic kidney disease (CKD) and,consequently, for assessing the risks of increased overall and cardiovascular mortality in patients with CHF,the accuracy of calculating GFR, as the main indicator reflecting the severity of formed kidney damage, is ofgreat importance. Microalbuminuria is one of the early signs of CKD, the main cause of which is glomerularcapillary endothelial dysfunction that occurs in most patients with CHF. The presence and persistence ofsubclinical renal dysfunction during treatment, even with the achievement of risk factors (RF) control andregression of organ lesions, can adversely affect the patient’s prognosis. Assessment of the functional stateof the kidneys is important for early diagnosis, selection of effective preventive measures and treatment. Thetherapeutic strategy in patients with CHF in combination with CKD should be based on the nephroprotectiveeffects of drugs.

The aims of this study were to evaluate health outcomes and the economic burden of hospitalized COVID-19 patients in the United States. Hospitalized patients with a primary or secondary discharge diagnosis code for COVID-19 (ICD-10 code U07.1) from 1 April to 31 October 2020 were identified in the Premier Healthcare COVID-19 Database. Patient demographics, hospitalization characteristics, and concomitant medical conditions were assessed. Hospital length of stay (LOS), in-hospital mortality, hospital charges, and hospital costs were evaluated overall and stratified by age groups, insurance types, and 4 COVID-19 disease progression states based on intensive care unit (ICU) and invasive mechanical ventilation (IMV) usage. Of the 173,942 hospitalized COVID-19 patients, the median age was 63 years, 51.0% were male, and 48.5% were covered by Medicare. The most prevalent concomitant medical conditions were cardiovascular disease (73.5%), hypertension (64.8%), diabetes (40.7%), obesity (27.0%), and chronic kidney disease (24.2%). Approximately one-fifth (21.9%) of the hospitalized COVID-19 patients were admitted to the ICU and 16.9% received IMV; most patients (73.6%) did not require ICU admission or IMV, and 12.4% required both. The median hospital LOS was 5 days, in-hospital mortality was 13.6%, median hospital charges were $43,986, and median hospital costs were $12,046. Hospital LOS and in-hospital mortality increased with ICU and/or IMV usage and age; hospital charges and costs increased with ICU and/or IMV usage. Patients with both ICU and IMV usage had the longest median hospital LOS (15 days), highest in-hospital mortality (53.8%), and highest hospital charges ($198,394) and hospital costs ($54,402). This retrospective administrative database analysis relied on coding accuracy and a subset of admissions with validated/reconciled hospital costs. This study summarizes the severe health outcomes and substantial hospital costs of hospitalized COVID-19 patients in the US. The findings support the urgent need for rapid implementation of effective interventions, including safe and efficacious vaccines.

In this communication we assess the potential benefit of SARS-COV-2 pandemic vaccination in the US and show how continued use of non-pharmaceutical interventions (NPIs) will be crucial during implementation.

A global effort to develop vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began early in 2020. In mid-December, the U.S. Food and Drug Administration approved emergency use authorization for two vaccines that successfully concluded their phase 3 trials ([ 1 ][1]), and vaccine distribution in the United States began shortly afterwards. As vaccinations progress, the public must continue to social distance, limit large gatherings, wear masks, and engage in other non-pharmaceutical interventions (NPIs) to curb the spread of COVID-19. Both the Pfizer/BioNTech and Moderna vaccines use mRNA technology and require two doses administered 3 and 4 weeks apart, respectively, to reach the full 90 to 95% efficacy ([ 2 ][2]). In light of limited supply, the Centers for Disease Control and Prevention has provided preliminary guidance indicating that vaccination should be prioritized first for health care workers and long-term care facility residents, then for other essential workers, and next for people at higher risk for severe illness ([ 3 ][3]). Subsequently, vaccination will reach most sectors of the population, though inoculation of children under 16 has yet to be recommended. Globally, vaccination uptake over the coming year could prevent disease for the sizeable portion of the population that has yet to be infected with SARS-CoV-2 and move the world to a post-pandemic phase; however, this potential benefit of averted infections, hospitalizations, and deaths depends considerably on societal maintenance of NPIs during vaccine deployment. Relaxing NPIs before attaining adequate distribution would enable infection of many more people before their vaccination than would occur if NPIs were to be maintained or increased. Locally, relaxation of NPIs increases the reproduction number, Rt , which enables greater transmission of the virus and a larger overall attack rate. These changes lead to a faster and larger accumulation of infections that could greatly outpace vaccination distribution efforts. Thus, maintaining NPIs throughout the upcoming SARS-CoV-2 vaccination campaign is essential for maximizing the health benefit. In the coming months, public health messaging is critically needed to encourage continued compliance with NPI control measures. 1. [↵][4]U.S. Food and Drug Administration, “COVID-19 vaccines” (2020); [www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines][5]. 2. [↵][6]1. C. Zimmer, 2. J. Corum, 3. S.-L. Wee , “Coronavirus vaccine tracker,” The New York Times (2020). 3. [↵][7]Centers for Disease Control and Prevention, “How CDC is making COVID-19 vaccine recommendations” (2020); [www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations-process.html][8]. Pfizer Inc. reviewed this manuscript and approved the decision to submit the manuscript for publication. F.J.A., A.C., and D.L.S. own Pfizer stock. J.S. and Columbia University disclose partial ownership of SK Analytics. J.S. has done paid consulting work for Business Network International and receives funding from Pfizer Inc., National Science Foundation grant DMS-2027369, and a gift from the Morris-Singer Foundation. [1]: #ref-1 [2]: #ref-2 [3]: #ref-3 [4]: #xref-ref-1-1 "View reference 1 in text" [5]: http://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines [6]: #xref-ref-2-1 "View reference 2 in text" [7]: #xref-ref-3-1 "View reference 3 in text" [8]: http://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations-process.html

Introduction Rising rates of caesarean section (CS) is an issue of particular concern. Recently, there has been research supporting Vaginal Births After Caesarean (VBAC), which is controversial. In Greece, over half of births in the country are by CS, placing Greece among countries with the highest CS rates. The aim of this study was to investigate the prevalence and the factors associated with VBACs and to compare the maternal/neonatal outcomes with a 'non-caesarean' control group. Methods The data were evaluated and retrospectively gathered on archived singleton births, from medical records of a midwifery-led team, between May 2006 and May 2013. The target group of the study included mothers with a previous CS, who had a second birth. The sample consisted of 71 VBAC women and 583 who had normal spontaneous vaginal delivery (NSVD) as the 'non-caesarean' control group. Results The duration of labour was longer for the VBACs compared with first-time mothers who gave birth naturally (for duration 481-720 min, 27% vs 10.3%, respectively), episiotomy was more common for VBAC (20.7% vs 7.9%), and epidural analgesia was more often for VBAC (68.4% vs 10%). The percentage of 1-min Apgar score in the range 0-7 in the VBAC group was 5%, and there was no significant difference in women who had NSVD (3.6%). The Apgar score in the 5th minute was always above 8 for both groups. Conclusions Severe maternal and neonatal complications are infrequent, and therefore the necessity arises for further continuous studies to ascertain the safety of VBAC.

Introduction To evaluate the expected impact of the Algeria national immunization program (NIP) and potential impact for a Tunisia NIP, this study assessed the public health and economic value of vaccination, through a cost-effectiveness analysis, for a PCV13 or PCV10 NIP, compared with no vaccination. Methods A decision-analytic model was programmed in Microsoft Excel™ and adapted to evaluate the clinical and economic outcomes of PCV vaccination. Assuming a steady state, the model estimated invasive pneumococcal disease (IPD; bacteremia and meningitis), all-cause pneumonia (inpatient and outpatient), and all-cause otitis media cases as well as the associated costs from a payer perspective. The base case scenario assumed direct effects for both PCVs and indirect effects (against IPD) for PCV13 only. Results In Algeria, compared with no vaccination program, PCV13 would save 2177 lives and avoid nearly 349,000 cases of IPD, pneumonia, and AOM at a highly cost-effective value of $308 per QALY. In Tunisia, PCV13 would save 308 lives and avoid 1305 cases of IPD, 4833 cases of pneumonia, and 54,957 cases of AOM at a highly cost-effective value of $848 per QALY. PCV10 prevented 1224 deaths and 270,483 cases of disease in Algeria and prevented 172 deaths and 56,610 cases in Tunisia. PCV10 was cost-effective in both Algeria at $731/QALY and in Tunisia at $1366/QALY. Conclusion The ongoing NIP in Algeria is projected to reduce the impact and economic toll of pneumococcal disease in Algeria. If an NIP were also introduced in Tunisia, a commensurate impact would be expected. PCV NIPs are highly cost-effective, highly impactful public health interventions. Funding Pfizer. Electronic supplementary material The online version of this article (10.1007/s40121-018-0226-x) contains supplementary material, which is available to authorized users.

©2016 American Association of Critical-Care Nurses doi: http://dx.doi.org/10.4037/ajcc2016625 Teri M. Kozik is a nurse researcher and George S. Charos is an electrophysiologist and director of Cardiology at St. Joseph’s Medical Center, Stockton, California. Salah S. Al-Zaiti is an assistant professor at the Department of Acute and Tertiary Care Nursing, University of Pittsburgh, Pennsylvania. Mary G. Carey is associate director for clinical nursing research, Strong Memorial Hospital, Rochester, New York and Michele M. Pelter is an assistant professor at the the Department of Physiological Nursing at University of California, San Francisco, California. ECG Puzzler

OBJECTIVES: To evaluate potential costs and savings from implementing an evaluation tool that uses bedside review of antibiotic use and infection management to assess whether patients with infections in acute medical and surgical wards could have their antibiotic regimen changed and be safely managed out of hospital. METHODS: The tool was implemented in 30 acute wards in five UK hospital trusts. Data were collected on demographic variables, diagnosis, social situation, hospital stay and all current antibiotic prescribing for 291 patients. A physician and pharmacist assessed antibiotic therapy and feasibility of discharge. Resource use was measured for each patient, unit costs attached, and mean and total costs of implementing recommendations were calculated. RESULTS: Implementation of these recommendations could reduce total inpatient days by 494 at a saving of £186 731, and save £20 215 from adjustment of antibiotic therapy. Additional costs were associated with implementation of the assessment (£2468), community support (£6227) and outpatient parenteral antimicrobial therapy (£5616). As a result, the net potential savings would be £192 635 in total or £662 (95% CI: £393, £930) for every patient assessed. Excluding eight patients with the highest potentially avoidable inpatient stays (>15 days), mean savings would fall to £363 per patient assessed but remain highly significant (95% CI: £261, £465). CONCLUSIONS: Careful assessment of antibiotic use in acute wards has the potential to reduce the use and cost of antibiotics, and length of stay. Added costs of assessment and out-of-hospital support services would offset a small proportion of these potential savings. Randomized studies are now needed to test these results.

Energy drink consumption has increased significantly over the past decade and is associated with greater than 20,000 emergency department visits per year. Most often these visits are due to cardiovascular complaints ranging from palpitations to cardiac arrest.To determine if energy drinks alter; blood pressure, electrolytes, activated bleeding time (ACT), and/or cardiac responses measured with a 12-lead electrocardiographic (ECG) Holter.Continuous ECG data was collected for five hours (30 minutes baseline and 4 hours post consumption [PC]). Subjects consumed 32 ounces of energy drink within one hour and data (vital signs and blood samples) was collected throughout the study period. Paired students t-test and a corresponding non-parametric test (Wilcoxon signed rank) were used for analysis of the data.Fourteen healthy young subjects were recruited (mean age 28.6 years). Systolic blood pressure (baseline=132, ±7.83; PC=151, ±11.21; P=.001); QTc interval (baseline=423, ±22.74; PC=503, ±24.56; P.001); magnesium level (baseline 2.04, ± 0.09; PC=2.13, ±0.15; P=.05); and calcium level (baseline=9.31, ±.28; PC=9.52, ±.22; P=.018) significantly increased from baseline. While potassium and ACT fluctuated (some subjects increased their levels while others decreased) these changes were not significant. Eight of the fourteen subjects (57%) developed a QTc500 milliseconds PC. Other T-wave changes were noted in 9/14 (64.3%) subjects PC.Energy drinks increased systolic blood pressure, altered electrolytes, and resulted in repolarization abnormalities. These physiological responses can lead to arrhythmias and other abnormal cardiac responses highlighting the importance that emergency room personnel assess for energy drink consumption and potential toxicity.

Introduction: Energy drinks are presumed to enhance energy, physical endurance, mood, and boost metabolism. Serious health risks have been reported with energy drink consumption such as myocardial infarction, cardiac arrest, stroke, seizures, and arrhythmias. More than 20,000 emergency department visits related to energy drink consumption were reported in 2011. Little is known about the possible pathophysiological mechanisms and adverse events associated with energy drinks. Unlike the tobacco and alcohol industry, there are limited restrictions regulating the purchasing and marketing of these drinks. Purpose: To determine if consumption of energy drinks alter; vital signs (blood pressure, temperature), electrolytes (magnesium, potassium, calcium), activated bleeding time (ACT), or cardiac responses measured with a 12-lead electrocardiographic (ECG) Holter. Method: Subjects consumed two-16 ounce cans of an energy drink within one hour and remained in the lab where data was collected at base line (BL) and then during four hours post consumption (PC). Vital signs were taken every 30 minutes; blood samples were collected at BL, one, two and four hours PC and ECG data was collected throughout the entire study period. Paired students t-test and a corresponding non-parametric test (Wilcoxon signed rank) were used for analysis of the data. Results: Fourteen healthy young subjects were recruited (mean age 28.6 years). Systolic blood pressure (BL=132, ±7.83; PC= 151, ±11.21; p=.001); QTc interval (BL=423, ±22.74; PC=503, ±24.56; p500 milliseconds PC. Conclusions: In our sample, consumption of energy drinks increased systolic blood pressure, serum magnesium and calcium, and resulted in repolarization abnormalities. Because these physiological responses can lead to arrhythmias and other abnormal cardiac responses, further study in a larger sample is needed to determine the effects and possible consequences of energy drink consumption.

The efficacy and safety of a new antitachycardia pacing technique, self-adapting decremental overdrive pacing, was assessed in patients with clinical ventricular tachyarrhythmias who underwent programmed ventricular stimulation and serial drug testing. The three phases of this study involved a learning/experience phase, followed by intrapatient comparison of decremental overdrive pacing with conventional antitachycardia pacing modalities of overdrive burst ventricular pacing, and diastolic scanning with single (S2) and double (S2S3) ventricular extrastimuli. The final phase involved an intrapatient comparison of automated decremental overdrive pacing with overdrive burst ventricular pacing in patients with ventricular tachycardia (VT) cycle lengths of 280 msec or greater. Decremental overdrive pacing was superior to overdrive burst pacing and diastolic scanning (S2S3 and S2) (83% vs 38%, 50%, 9%) in patients with VT cycle lengths of 280 msec or greater. Automated decremental overdrive pacing as applied in the final phase was the most efficacious modality, terminating 92% of VT episodes compared with 56% for overdrive burst pacing in the same patients.

Atrial fibrillation (AF) is a difficult arrhythmia to manage with antiarrhythmic agents. Amiodarone is highly effective in restoring and maintaining normal sinus rhythm in patients with AF. However, the mechanism and predictors of efficacy for amiodarone in treating AF have not been adequately addressed. Various measures of success or failure of amiodarone therapy were examined in 68 patients who had paroxysmal or chronic, established AF refractory to conventional antiarrhythmic agents. The patients were 25 to 75 years old (mean 59) and mean follow-up was 21 months (range 3 to 56). Maintenance amiodarone dosages were 200 to 400 mg/day. Overall, amiodarone therapy was effective long term in 54 of the 68 patients (79%). Left atrial diameter, age, gender and origin of AF were not helpful in predicting success or failure of amiodarone therapy. The presence of chronic AF for longer than 1 year was an adverse factor in maintaining normal sinus rhythm (p = 0.007), although the success rate even in this group was relatively high (57%). Thirty-five percent of the patients had adverse effects, which precluded long-term therapy with amiodarone in 10%.