Search

We study the homogeneous Dirichlet problem for the parabolic equations ut−div(A(z,∣∇u∣)∇u)=F(z,u,∇u),z=(x,t)∈Ω×(0,T),{u}_{t}-{\rm{div}}\left({\mathcal{A}}\left(z,| \nabla u| )\nabla u)=F\left(z,u,\nabla u),\hspace{1.0em}z=\left(x,t)\in \Omega \times \left(0,T), with the double phase flux A(z,∣∇u∣)∇u=(∣∇u∣p(z)−2+a(z)∣∇u∣q(z)−2)∇u{\mathcal{A}}\left(z,| \nabla u| )\nabla u=(| \nabla u{| }^{p\left(z)-2}+a\left(z)| \nabla u{| }^{q\left(z)-2})\nabla u and the nonlinear source FF. The initial function belongs to a Musielak-Orlicz space defined by the flux. The functions aa, pp, and qq are Lipschitz-continuous, a(z)a\left(z) is nonnegative, and may vanish on a set of nonzero measure. The exponents pp, and qq satisfy the balance conditions 2NN+20\varepsilon \gt 0.

Objective: To analyze the clinical and cost outcomes of transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) in heart failure (HF) patients. Methods: All 162 HF patients undergoing TEER for MR between January 2019 and March 2023 were included. A propensity-adjusted analysis was used to compare 32 systolic vs. 97 diastolic vs. 33 mixed (systolic + diastolic) HF patients. Systolic, diastolic, and mixed HF patients were defined according to AHA guidelines. The primary outcome was the long-term incidence of all-cause death and major adverse cardiovascular and cerebrovascular events (MACCEs, all-cause mortality + stroke + myocardial infarction + repeat intervention). Results: The mean age was 76.3 vs. 80.9 vs. 76 years old, and the mean ejection fraction (EF) was 39.5% vs. 59.8% vs. 39.7% in systolic vs. diastolic vs. mixed HF, respectively. Postoperatively, the diastolic vs. systolic HF group had a higher intensive care unit stay (21 vs. 0 h; HR 67.5 (23.7, 111.4)]; lower ventilation time [2 vs. 2.3 h; HR 49.4 (8.6, 90.2)]; lower EF [38% vs. 58.5%; HR 9.9 (3.7, 16.1)]. In addition, the diastolic vs. mixed HF groups had a lower incidence of EF < 50% (11 vs. 27 patients; HR 6.6 (1.6, 27.3) and a lower use of dialysis (one vs. three patients; HR 18.1 (1.1, 287.3), respectively. At a mean 1.6 years follow-up, all-cause death [HR 39.8 (26.2, 60.5)], MACCEs [HR 50.3 (33.7–75.1)], and new pacemaker implantations [HR 17.3 (8.7, 34.6)] were higher in the mixed group. There was no significant total hospital cost difference among the systolic (USD 106,859) vs. diastolic (USD 91,731) vs. mixed (USD 120,522) HF groups (p = 0.08). Conclusions: TEER for MR evidenced the worst postoperative and follow-up clinical outcomes in the mixed HF group compared to diastolic and systolic HF groups. No total hospital cost differences were observed. [ABSTRACT FROM AUTHOR]

One and a half million cardiac surgeries are completed worldwide each year where undertreated postoperative pain increases the risk of patient morbidity and mortality. Patient-centered pain management is recommended to improve patient outcomes but there is insufficient information regarding how the patient views their role. The objective of this study is to explore cardiac surgery patients' perspectives on their role in postoperative pain management. This study used an interpretive phenomenological design and convenience sampling. Six participants who had undergone cardiac surgery were recruited from a cardiac rehabilitation program in Western Canada. The first author conducted semi-structured digitally recorded interviews. Sociodemographic characteristics and measures of anxiety and depression were also collected. Emergent thematic analysis of the qualitative data generated three themes: attitude, coping and care, and communication. The findings of this study address a gap in the literature with regard to patients' perceived roles in pain management. There is a complex relationship between patient attitude, coping and care, and communication which, in turn, influences how patients view their role within the pain management continuum. These themes contribute to the development of the patient role within the pain management continuum and form an integrated feedback loop. The patient's attitude contributes to their ability to cope with pain and participate in pain assessment and management. Furthermore, their ability to cope and desire to participate influences the development of their attitude. These findings may enhance providers' understanding of the patient's perspective and improve pain management outcomes. [ABSTRACT FROM AUTHOR]

• Global income inequality and disparities of healthcare resources have been exacerbated by the pandemic. • Coronavirus disease-2019 (COVID-19) causes severe respiratory distress as well as a slew of additional systemic consequences that affect several organ systems, including neurological complications. Ischemic stroke represents the most common neurological complication of respiratory failure due to COVID-19. • Stroke incidence per admitted days in patients with respiratory failure due to COVID-19 was low in high income countries (HICs) and low-middle income countries (LMICs) although the stroke risk was higher in LMICs. • Both LMIC status and stroke increased the risk of death in patients with respiratory failure due to COVID-19. We aimed to compare the incidence of stroke in low-and middle-income countries (LMICs) versus high-income countries (HICs) in critically ill patients with COVID-19 and its impact on in-hospital mortality. International observational study conducted in 43 countries. Stroke and mortality incidence rates and rate ratios (IRR) were calculated per admitted days using Poisson regression. Inverse probability weighting (IPW) was used to address the HICs vs. LMICs imbalance for confounders. 23,738 patients [20,511(86.4 %) HICs vs. 3,227(13.6 %) LMICs] were included. The incidence stroke/1000 admitted-days was 35.7 (95 %CI = 28.4–44.9) LMICs and 17.6 (95 %CI = 15.8–19.7) HICs; ischemic 9.47 (95 %CI = 6.57–13.7) LMICs, 1.97 (95 %CI = 1.53, 2.55) HICs; hemorrhagic, 7.18 (95 %CI = 4.73–10.9) LMICs, and 2.52 (95 %CI = 2.00–3.16) HICs; unspecified stroke type 11.6 (95 %CI = 7.75–17.3) LMICs, 8.99 (95 %CI = 7.70–10.5) HICs. In regression with IPW, LMICs vs. HICs had IRR = 1.78 (95 %CI = 1.31–2.42, p < 0.001). Patients from LMICs were more likely to die than those from HICs [43.6% vs 29.2 %; Relative Risk (RR) = 2.59 (95 %CI = 2.29–2.93), p < 0.001)]. Patients with stroke were more likely to die than those without stroke [RR = 1.43 (95 %CI = 1.19–1.72), p < 0.001)]. Stroke incidence was low in HICs and LMICs although the stroke risk was higher in LMICs. Both LMIC status and stroke increased the risk of death. Improving early diagnosis of stroke and redistribution of healthcare resources should be a priority. ACTRN12620000421932 registered on 30/03/2020. [ABSTRACT FROM AUTHOR]

Introduction: Obesity is associated with a worse prognosis in COVID-19 patients with acute respiratory distress syndrome (ARDS). Veno-venous (V-V) Extracorporeal Membrane Oxygenation (ECMO) can be a rescue option, however, the direct impact of morbid obesity in this select group of patients remains unclear. Methods: This is an observational study of critically ill adults with COVID-19 and ARDS supported by V-V ECMO. Data are from 82 institutions participating in the COVID-19 Critical Care Consortium international registry. Patients were admitted between 12 January 2020 to 27 April 2021. They were stratified based on Body Mass Index (BMI) at 40 kg/m2. The endpoint was survival to hospital discharge. Results: Complete data available on 354 of 401 patients supported on V-V ECMO. The characteristics of the high BMI (>40 kg/m2) and lower BMI (≤40 kg/m2) groups were statistically similar. However, the 'high BMI' group were comparatively younger and had a lower APACHE II score. Using survival analysis, older age (Hazard Ratio, HR 1.49 per-10-years, CI 1.25–1.79) and higher BMI (HR 1.15 per-5 kg/m2 increase, CI 1.03 – 1.28) were associated with a decreased patient survival. A safe BMI threshold above which V-V ECMO would be prohibitive was not apparent and instead, the risk of an adverse outcome increased linearly with BMI. Conclusion : In COVID-19 patients with severe ARDS who require V-V ECMO, there is an increased risk of death associated with age and BMI. The risk is linear and there is no BMI threshold beyond which the risk for death greatly increases. [ABSTRACT FROM AUTHOR]

In this article, we study the symmetry of positive solutions to a class of singular semilinear elliptic equations whose prototype is \begin{align*} (P) \quad \left\lbrace \begin{array}{ll} (-\Delta )^{s}u = \frac{1}{u^\delta } + f(u), \; u>0\quad & \text{ in }\Omega ; \\ u=0 & \text{ in } \mathbb{R}^n\setminus \Omega ,\\ \end{array} \right. \end{align*} where $0, $n\ge 2s$, $\Omega = B_r(0) \subset \mathbb{R}^n, \; \delta >0$, $f(u)$ is a locally Lipschitz function. We prove that classical solutions are radial and radially decreasing (see Theorem 1). The proof uses the moving plane method adapted to the non local setting. We then give two applications of this main result: Theorem 2 establishes the uniform apriori bound for classical solutions in case of polynomial growth nonlinearities whereas Theorem 3 ensures in case of exponential growth nonlinearities the convergence of large solutions with unbounded energy to a singular solution.