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Background: Older populations have suffered the highest rates of SARS‐CoV‐2 infection and associated complications, including Post‐Acute Sequelae of SARS‐CoV‐2 infection (PASC). Frailty is a geriatric syndrome that often coexists with COVID‐19 infection. The vulnerability to stressors caused by multisystemic dysfunction that characterizes frailty may predispose older adults to develop PASC. Methods: Retrospective cohort study using the VA COVID‐19 Shared Data Resource to identify US veterans testing positive for SARS‐CoV‐2 between July 2021 and February 2022, without prior positive tests and who were alive 30 days after infection. Frailty was calculated using a 31‐item VA Frailty Index generated from electronic health records. We categorized Veterans into robust (FI ≤ 0.10), prefrail (FI: >0.10‐ < 0.21), and frail (FI ≥ 0.21). We assessed the association between frailty and PASC and vaccination and PASC using Cox survival model, adjusting for covariates. Results: We identified 245,857 COVID‐19‐positive veterans surviving 30 days after infection. The mean age was 57.5 ± 16.5 years; 87.2% were males, 68.1% were white, and 9.0% were Hispanic. Almost half of the sample (48.9%) were classified as robust, while 28.3% were pre‐frail and 22.7% were frail; 99,886 (40.6%) were fully vaccinated, and 33,516 (13.6%) received booster doses. Over a median follow‐up of 143 days (IQR = 101), 23,890 (9.7%) patients developed PASC. Within 6 months after infection, frailty and pre‐frailty were associated with a 41% (adjusted HR [aHR]:1.40 (95% CI: 1.35–1.47) and 15% (aHR: 1.17 (95% CI: 1.11–1.19) increase in the risk of PASC compared with the robust, respectively. Vaccination and booster doses before infection were associated with a 27% (aHR: 0.73 (95% CI: 0.71–0.75) and 33% (aHR: 0.66 (95% CI: 0.63–0.69) reduction in the risk of developing PASC, respectively. Conclusions: Frailty was associated with an increased risk of developing PASC. Vaccination was associated with a decreased risk of PASC, further reduced by booster doses. Early recognition of frailty in patients with COVID‐19 may assist in the early identification and management of PASC. [ABSTRACT FROM AUTHOR]

The article presents news briefs related to the Music Teachers National Association (MTNA). The 2011 MTNA Achievement Award has been presented to Warren Jones, a member of the faculty at the Manhattan School of Music. Grants from the MTNA Foundation Fund have been received by sixteen teachers, including Laura Mason, and Marti Garrett. MTNA's biennium officers for 2011-13, include Ben Caton, Rebecca Grooms, and Ann Gipson.

Abstract: Study Objective: To determine the current trends in airway education in academic programs. Design: Survey instrument. Setting: American academic medical center. Subjects: 147 directors of American and Canadian anesthesiology residency programs. Measurements: An invitation to complete an online questionnaire was sent. Non-responding institutions were contacted repeatedly by email and telephone to ensure a reasonable response rate. Main Results: 88 of the 147 (60%) programs completed the survey. Forty-three respondents (49%) reported that they had formal airway rotations, and 39 respondents said that a designated titled faculty member was responsible for airway training. Didactic lecture and manikin instruction were used by more than two thirds of the programs. Documentation of supervised airway experience was recorded in 71 (82%) programs. The majority of the programs (81%) had videolaryngoscopes. A fiberoptic bronchoscope was nearly universally available, and approximately one third (34%) of graduating residents were estimated to have performed more than 25 awake fiberoptic intubations. For most techniques, the estimates of the required number of procedures to ensure competence varied widely. Conclusions: The number of programs with a formal airway management program continues to increase, and programs are incorporating newer intubation techniques. The criteria for competence have not been established. [Copyright &y& Elsevier]

The commentators are unanimous in their support for our general orientation to culture and development, and for the pathways we have identified, and they suggest ways to enrich our approach to theory, methods, and values. We view their main suggestions as relating to trade-offs: between theories that highlight generalizations or exceptions; between methods that rely on one-, two-, or multiculture studies; and between values involving individuation or accommodation. Here, we describe ways to find an optimal balance in each instance. [ABSTRACT FROM AUTHOR]

Background Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS. Methods and Results Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating centers in Europe and the United States. Patients were dichotomized according to the presence or absence of AF at the time of admission. Of 1584 patients with TTS, 112 (7.1%) had AF. The mean age was higher ( P <0.001), and there were fewer women ( P =0.046) in the AF than in the non-AF group. Left ventricular ejection fraction was significantly lower ( P =0.001), and cardiogenic shock was more often observed ( P <0.001) in the AF group. Both in-hospital ( P <0.001) and long-term mortality ( P <0.001) were higher in the AF group. Multivariable Cox regression analysis revealed that AF was independently associated with higher long-term mortality (hazard ratio, 2.31; 95% CI, 1.50-3.55; P <0.001). Among patients with AF on admission, 42% had no known history of AF before the acute TTS event, and such patients had comparable in-hospital and long-term outcomes compared with those with a history of AF. Conclusions In patients presenting with TTS, AF on admission is significantly associated with increased in-hospital and long-term mortality rates. Whether antiarrhythmics and/or cardioversion are beneficial in TTS with AF should thus be tested in a future trial. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01947621.

Objective: Takotsubo syndrome (TTS) is characterized by acute left ventricular dysfunction, which can contribute to intraventricular thrombus and embolism. Still, prevalence and clinical impact of thrombus formation and embolic events on outcome of TTS patients remain unclear. This study aimed to investigate clinical features and outcomes of patients with and without intraventricular thrombus or embolism. Additionally, factors associated with thrombus formation or embolism, as well as predictors for mortality, were identified. Approach and Results: TTS patients enrolled in the International Takotsubo Registry at 28 centers in Australia, Europe, and the United States were dichotomized according to the occurrence/absence of intraventricular thrombus or embolism. Patients with intraventricular thrombus or embolism were defined as the ThrombEmb group. Of 1676 TTS patients, 56 (3.3%) patients developed intraventricular thrombus and/or embolism following TTS diagnosis (median time interval, 2.0 days [range, 0-38 days]). Patients in the ThrombEmb group had a different clinical profile including lower left ventricular ejection fraction, higher prevalence of the apical type, elevated levels of troponin and inflammatory markers, and higher prevalence of vascular disease. In a Firth bias-reduced penalized-likelihood logistic regression model apical type, left ventricular ejection fraction ≤30%, previous vascular disease, and a white blood cell count on admission >10×10 3 cells/μL emerged as independent predictors for thrombus formation or embolism., Conclusions: Intraventricular thrombus or embolism occur in 3.3% of patients in the acute phase of TTS. A simple risk score including clinical parameters associated with intraventricular thrombus formation or embolism identifies patients at increased risk., Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01947621.