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Introduction Peripartum cardiomyopathy is characterized by LV systolic dysfunction in the absence of other existing cardiac disease. It presents with clinical signs of acute heart failure, with ventricular arrhythmias or cardiac arrest in the last stages of pregnancy up to 5–6 months after delivery. The LV may be non–dilated, but EF is usually Conclusion it is a rare disease: 50% of patients improve with standard medical treatment; 25% develop chronic heart failure and the rest die in the course of the disease. The onset is subtle with non–specific signs and symptoms often confused with "inconveniences" related to the pregnancy itself. To limit the diagnostic delay it is necessary to pay attention to the appearance of tachycardia, third heart sound, basal crackling rales and jugular venous turgor, since they are not physiologically present in pregnancy and to carry out a control echocardiogram especially if in old age.

Introduction Prolonged antibiotic therapy and complete hardware removal are recommended in definite cardiac device–related infective endocarditis (CDRIE), as well as in presumably isolated pocket infection, in class I. A tubular mobile mass, known as ghost, that previously surrounded the lead can be detected by ultrasounds, in 8–14% of patients undergoing transvenous lead extraction (TLE). Case presentation: A 72–year–old man with ischemic cardiomyopathy is referred to our center due to a persistent fever. His medical history shows a previous extraction of CRT–D for infection of the left infraclavicular pocket, with a new implantation of CRT–P on the right side of the chest, in consideration of the recovery of the ejection fraction. At the entrance to the ward he has fever and inflammation‘s signs of the pocket of the generator, with positive blood cultures for Staphylococcus Aureus Methicillin resistant. A transesophageal echocardiography (TEE) excludes vegetations of valve systems and electrocatheters. Therefore, the patient begins antibiotic therapy and undergoes full extraction of the device (generator and leads). A post–operative transthoracic echocardiography shows the presence of a linear image of 2.5 cm in the right ventricle, seen as remnants of scar tissue surrounding the lead. ECG monitoring detects phases of BAV 2:1. Considering the high risk of infectious disease, a pacemaker leadless implantation is indicated. The surgery is postposted at the end of the 4 weeks of antibiotic therapy, checking blood cultures before implantation to reduce the residual infectious risk. Discussion The persistence of fibrous residues after TLE has been variously described in recent years, but it is unclear whether these are predictors of increased mortality. The current guidelines on the therapeutic management of patients with infectious endocarditis and pacemaker dependency do not indicated the timing of reimplantation, in a potentially infectious ghost setting. Clinical co–morbidities play a crucial role in the prognosis of patients, especially when combined with systemic infections. Conclusion An echocardiographic follow–up is recommended to detect ghost disappearance in patients undergoing explant due to a related device infection. In fact, a rapid fibrin dissolution process usually takes place when the thrombogenic stimulus is removed.

We present the case of a 75 year–old man, diabetic, dyslipidemic, hypertensive, previous ischemic heart disease, AF, previous hospitalizations for heart failure, who underwent cardiology evaluation for worsening dyspnea (NYHA class II–III), swallen ankles and elevated BNP levels (900 pg/ml). The patient suffered from sensory–motor polyneuropathy diagnosed with EMG and ENG. Echocardiographic evaluation: severe concentric hypertrophy of the left ventricle (SIV 18 mm, PP 17 mm), granular sparkling and EF 50%, left atrium dilatation, light–moderate mitral regurgitation, moderate tricuspid regurgitation with PAPS 40–45 mmHg. Circumferential pericardial effusion (12 mm). Moreover, we noticed a decreased longitudinal contractive function of the left ventricle (TDI e‘, a’, e s’ 12 mm). •Laboratory: (SPIE and UPIE) no monoclonal protein present. •Bone scintigraphy: grade 3 cardiac uptake. •Cardiac MRI: asymmetric hypertrophy of the left ventricle with moderate biventricular systolic dysfunction. Subendocardial late gadolinium enhancement. •Genetic testing: no sarcomeric or TTS gene mutations. All findings were suggestive for senile cardiac amyloidosis (ATTR wt), the patient was discharged from the hospital with optimized medical therapy for heart failure and follow up was prescribed. After 3 months from the first diagnosis we added Tafamidis to the therapy (ESC indications class IB). ATTR–ACT, published on ‘New England Journal of Medicine’ showed that Tafamis is superior to placebo in reducing the combination of all–cause mortality and cardiovascular–related hospitalizations. Tafamidis was also associated with a significant reduction in the decline in functional capacity (as measured by the 6–minute walk test) and the decline in quality of life (as measured by the KCCQ–OS) at month 30, with differences first observed at 6 months. Tafamidis was well–tolerated, with a safety profile comparable to placebo. Follow–up: 6 months later the introduction of Tafamidis, the patient has not needed other hospitalizations for heart failure, well tolerates the drug with a subjective symptom reduction and remarkable improvement in quality of life.

Introduction in most cases mitral valve prolapse is a benign condition, however in 2% of cases it has been associated with the risk of sudden cardiac death (SCD). Basso et al have demonstrated papillary muscle’s and left ventricle’s inferolateral wall fibrosis on cardiac magnetic resonance imaging (MRI), in patients who died from SCD with mitral valve prolapse. Clinical case A 59–year–old patient was admitted to the Cardiology Department of Pertini Hospital (Rome, Italy) for episodes of vertigo and not sustained ventricular tachycardia in two morphologies at 24–hour ECG monitoring. The patient had negative history for cardiovascular risk factors, but an echocardiogram had demonstrated a moderate mitral valve regurgitation, secondary to valve prolapse with mitral annular disjunction (MAD) (Fig.1). Considering patient‘s age associated with low pre–test probability of coronary artery disease, the patient underwent coronary CT that showed a coronary artery tree free from injury. Cardiac MRI showed increased volumes in the left ventricle and slightly reduced systolic function and valve prolapse of both mitral leaflets determining moderate regurgitation. In addition, intra–myocardial Late Gadolinium Enhancement (LGE) showed fibrosis of the inferior and inferolateral wall with extension to the proximal portion of the inferior papillary muscle (Fig.2). Considering such findings, an intracavitary electrophysiological study (EPS) was performed for an evaluation of the arhythmic burden, by administrating the patient a double extra stimulus from the outflow tract of the right ventricle; the treatment induced a polymorphic ventricular tachycardia, starting from the inferior papillary muscle and degenerating into ventricular fibrillation (Fig.3). Discussion considering all the above findings, a mitral valve prolapse at high risk of malignant arrhythmias has been diagnosed and a subcutaneous cardiac defibrillator was implanted. Conclusions in mitral valve prolapse associated with complex ventricular arrhythmias, evaluation with cardiac MRI increasingly plays a crucial role in prognostic stratification for defibrillator implantation in primary prevention.

A 41–year–old woman with history of drug addiction was ammitted at emergency department (ED) with the following symptoms: hyperpyrexia, shaking chills asthenia and anorexia for about 10 days; the hematochemical tests performed in urgency showed an increasing inflammatory markers and severe anemia. On suspicion of infective endocarditis, a transthoracic echocadiogram was performed which revealed a mobile isoechoic mass adhered to the anterior mitral leaflet (LAM), compatible in the first hypothesis with endocardiac vegetation. Hemocultures were drawn and empiric antibiotic therapy was setted. Following clinical conditions’s worsening, the patient underwent contrast–free total body Computed Tomography (CT) with the detection of multiple pulmonary, splenic and renal septic emboli associated with a cerebral hemorrhagic focus. Transesophageal echocardiography (TEE) confirmed the presence of a 29 mm mobile vegetation on the atrial side of the LAM and the LAM’s perforation at the A3 level with associated severe eccentric regurgitation jet. Therefore, during hospitalization, coronary septic embolization was suspected due to the onset of a severe epigastric pain and the electrocardiographic finding of ST–elevation in the inferior leads associated with troponin’s increase. In consideration of the high bleeding risk and the septic state, conservative therapy was indicated. After a month of targeted antibiotic therapy, once clinical stabilization was obtained, a control TEE was performed and showed the disappearance of the endocardial vegetation and the persistence of the valve flap perforation and the eccentric jet. Once the regression of the septic state, a coronarographic study was performed and it showed no significant stenosis. The patient underwent mitral valve plastic surgery with the direct suture of the LAM and ring implantation in mini–thoracotomy. After a short period in intensive care, she continued her hospitalization in cardiac surgery department without complications. Careful clinical management of the acute phase and antibiotic therapy, empirical and targeted, allowed the patient to undergo cardiac surgery in the best possible conditions, reducing the risk of complications.

Anion supply in prepartum rations affects the mineral metabolism in primiparous cows. The objective of this study was to evaluate the effect of calcium chloride and dietary calcium sulfate in prepartum heifers’ rations on the composition of colostrum, fat and protein milk content, and total milk production during 305 days of lactation. Forty five Holstein heifers were assigned to three groups (15 per group) 21 days before calving. The heifers received a partially mixed ration (PMR) plus 2.5 kg/cow/day of wheat middlings (CP= 18.5%, neutral detergent fiber= 36.7%). Mineral salts with a dietary cation-anion difference (DCAD) of +200 mEq/kg of dry matter (DM) were added in the control group (TCon); calcium chloride was added in one of the experimental groups (TCICa), and calcium sulfate was added in the other experimental group (TSoCa), both with DCAD= +30 mEq/kg of DM. After calving, they were fed on commercial feed, corn silage, and alfalfa grazing. The content of fat, protein, calcium, phosphorus, and magnesium in the colostrum was not different among the treatments (p0.05). TClCa cows produced a greater average of milk (kg/day), fat and protein corrected milk (kg/day), fat (kg/day), and net energy of lactation (Mcal/day). The TClCa group had higher milk production, and fat (kg) and protein (kg) content than TCon (p0.05), with intermediate values for TSoCa. The supply of calcium chloride in the prepartum of heifers produced differences in milk production and composition during the 305 days of lactation.

BACKGROUND: Weight telemonitoring may be an effective way to improve patients' ability to manage heart failure and prevent unnecessary utilization of health services. However, the effectiveness of such interventions is dependent upon patient adherence. OBJECTIVE: The purpose of this study was to determine how adherence to weight telemonitoring changes in response to 2 types of events: hospital readmissions and emergency department visits. METHODS: The Better Effectiveness After Transition–Heart Failure trial examined the effectiveness of a remote telemonitoring intervention compared with usual care for patients discharged to home after hospitalization for decompensated heart failure. Participants were followed for 180 days and were instructed to transmit weight readings daily. We used Poisson regression to determine the within-person effects of events on subsequent adherence. RESULTS: A total of 625 events took place during the study period. Most of these events were rehospitalizations (78.7%). After controlling for the number of previous events and discharge to a skilled nursing facility, the rate for adherence decreased by nearly 20% in the 2 weeks after a hospitalization compared with the 2 weeks before (adjusted rate ratio, 0.81; 95% confidence interval: 0.77–0.86; P < .001). CONCLUSIONS: Experiencing a rehospitalization had the effect of diminishing adherence to daily weighing. Providers using telemonitoring to monitor decompensation and manage medications should take advantage of the potential “teachable moment” during hospitalization to reinforce the importance of adherence.

Researchers use risk-adjustment models to account for severity of illness in comparing patient outcomes across hospitals. Researchers specify important features as main effects, but they ignore interaction effects or use stratification methods, to account for effect modification, despite its limitations resulting from the number of potential strata. The Agency for Healthcare Research and Quality Inpatient Quality Indicator (IQI) 11, Abdominal Aortic Aneurysm Repair Mortality, is stratified into four groups based on the type of repair and rupture. IQI 09, Pancreatic Resection Mortality Rate, is stratified into two groups based on the presence of pancreatic cancer. The variable performance of these models motivated design of better models. We used hierarchical group lasso regularisation (HGLR) to identify first-order interactions in patient discharge data used in the development of risk-standardised models. HGLR identified unsuspected but clinically meaningful interactions for IQI 11, which has a heterogeneous population, but not for IQI 09. Synergistic interactions, such as between hypertension and respiratory failure, suggest patients merit special attention in perioperative care. Antagonistic interactions, such as between shock at admission and chronic comorbidities, illustrate that naïve main effects models overpredict risk in key population subsets, leading to miscalibrated models that yield biased estimates of hospital performance. HGLR is a useful and necessary step to identify first-order interactions for the development of robust risk-adjustment models used by agencies and stakeholders to rank hospitals in the US.

Background: To face the health emergency due to the first spread in Italy of COVID- 19, a nationwide lockdown was instituted from 9 March to 3 May 2020. During this period all the hospital outpatient activities were suspended except for urgent cases. Objective: To evaluate the cardiological urgent outpatient examinations done in our hospital during the lockdown in view of the reduced hospitalizations and the increased cardiovascular deaths observed during the COVID-19 outbreak. Methods: The urgent cardiological examinations (requests with priority U and B, i.e., to be done within 3 and 10 days respectively) performed during the 8-week period of lockdown (38 working days) were compared with those performed during the same period in the previous year (37 working days). During the lockdown and the control period, the availability of urgent cardiological visits was the same (2 per day with priority U and 2 per day with priority B). The number of cardiological examinations performed and the main characteristics of the subjects attending the outpatient clinic in the two periods were evaluated, comparing them with the chi-square test and considering as significant p values

Background Postoperative respiratory failure is the most common serious postoperative pulmonary complication, yet little is known about factors that can reduce its incidence. We sought to elucidate modifiable factors associated with respiratory failure that developed within the first 5 d after an elective operation. Materials and Methods Matched case-control study of adults who had an operation at five academic medical centers between October 1, 2012 and September 30, 2015. Cases were identified using administrative data and confirmed via chart review by critical care clinicians. Controls were matched 1:1 to cases based on hospital, age, and surgical procedure. Results Our total sample (n = 638) was 56.4% female, 71.3% white, and had a median age of 62 y (interquartile range 51, 70). Factors associated with early postoperative respiratory failure included male gender (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.12-2.63), American Society of Anesthesiologists class III or greater (OR 2.85, 95% CI 1.74-4.66), greater number of preexisting comorbidities (OR 1.14, 95% CI 1.004-1.30), increased operative duration (OR 1.14, 95% CI 1.06-1.22), increased intraoperative positive end-expiratory pressure (OR 1.23, 95% CI 1.13-1.35) and tidal volume (OR 1.13, 95% CI 1.004-1.27), and greater net fluid balance at 24 h (OR 1.17, 95% CI 1.07-1.28). Conclusions We found greater intraoperative ventilator volume and pressure and 24-h fluid balance to be potentially modifiable factors associated with developing early postoperative respiratory failure. Further studies are warranted to independently verify these risk factors, explore their role in development of early postoperative respiratory failure, and potentially evaluate targeted interventions.

Introduction arrhytmogenic cardiomyopathy (ACM) is a genetic heart muscle disease caracterized by substitution of the ventricular myocardium with fibrofatty tissue. The disease was originally termed “arrhytmogenic right ventricular (dysplasia)/cardiomyopathy” to define a condition which distinctively affected the right ventricle and predisposed to fatal ventricular arrhythmias. New insights led to comprehending that the left ventricle is also frequently affected. Clinical case 62 yo, male, no cardiovascular risk factors, positive history for frequent ventricular premature beats treated with Sotalol 40 mg twice a day. No other previous cardiological events. Accesses the ER with suddenly occured dyspnea for minimal exertion, without palpitation, chest discomfort or loss of consciousness. EKG: synus rhythm, low voltages, negative V4–V6 T waves, fragmented QRS. Blood testing: TnI 0,532 ng/ml (n.v. 0–0.034) NTproBNP 3840. Echocardiography: dilated left ventricle. 20% EF due to infero–lateral wall akynesia. Coronary angiography was performed and showed no coronary stenosis. Considered the frequent NSVTs showed by the telemetry, he was admitted to ICU and treated with Amiodarone, Atenolol 100 mg, Sacubistril/Valsartan 24/26 mg, diuretic therapy showing good control of major arrhytmic events. To evaluate characterize heart tissue, a magnetic resonance was performed, which showed: scalloping of the mid and apical left ventricular lateral wall, with fibrofatty substitution. Subepicardial, mid–wall and transmural LGE of the LV anterior, lateral and inferior walls. No RV abnormalities. Considered the reduced EF and the presence of arrhytmic substratum, an ICD was implanted. Finally, a genetic evaluation was discussed with the patient, but was declined. Discussion in patients presenting with typical LV abnormalities, without RV involvement, the phenotipic Padua criterias are not enough for a certain diagnosis. This is because of the phenotipic overlap between ACM and other diseases, such as dilated cardiomyopathy, myocarditis and cardiac sarcoidosis. In the presence of LV involvement, consistent with ACM, the evidence of a pathogenetic mutation is key for the diagnosis.

Introduction Amyloid AL results from misfolding of immunoglobulin light chain (kappa or lambda) secreted by abnormal plasma cells such as in multiple myeloma. It is a rare, multisystemic disease with an estimated annual incidence rate of 6 to 10 cases per million inhabitans in Western countries. The prognosis of this hematologic neoplasm is guided by the extent of cardiac involvement; if untreated, survival rate is less than 6 months; with early initiation of chemotherapy treatment, median survival can range from 4 to 10 years, except for high–risk cases. Case report: 58–year–old patient presented to emergency department in May 2022 with the first syncopal episode and sphincter release. The patient had no cardiovascular risk factors. Echocardiografy showed markedly hypertrophic left ventricle with hyper–reflective walls with a granular–sparkling appearance. Electromyography revealed sensory–motor polyneuropathy, early–stage autonomic neuropathy and bilateral carpal tunnel syndrome. Implantation of a loop recorder was performed to investigate the cause of syncope. In suspected amyloidosis, the patient underwent electrophoresis, which showed no monoclonal peaks, serum and urine kappa and lambda light chains were negative. Bone scintigraphy showed no osteotropic radiopharmaceutical uptake in the heart. Cardiac magnetic resonance imaging (MRI) revealed biventricular hypertrophic phenocopy (concentric hypertrophy) with diffuse edema–like tissue alterations. The patient was asymptomatic. In August 2022, hematologic evaluation revealed a monoclonal band for lambda light chains in repeated immunofixation and bone marrow biopsy showed 9–10% monoclonal lambda plasma cells. The patient was referred to a specialized center for amyloidosis, where a biopsy of peri–umbilical fat was performed to confirm the diagnosis and initiate therapy. In October 2022, due to recurrent syncope, advanced atrioventricular block and extreme bradycardia at loop recorder, a dual–chamber pacemaker was implanted. A few days after discharge, the patient suffered cardiac arrest at home due to electromechanical dissociation and died, only 5 months after the first symptom. Conclusion AL amyloidosis is an aggressive hematological neoplasm, with cardiac involvement. Early diagnosis is crucial for timely initiation of therapy, which is the only means available to increase patient survival. It is important to maintain a high level of awareness and diagnostic suspicion for this condition.

Background It is known that sodium–glucose cotransporter 2 (SGLT2) inhibitors have been shown to confer important clinical benefits in patients with congestive heart failure (HF). Several evidences show SGLT2 influence the longitudinal systolic function of the left ventricle after medium and long term follow–up (FUP) in patients with HF. The aim of this study is to demonstrate how dapagliflozin can modify the global longitudinal strain (GLS) in a population of patients with systolic congestive heart failure (HFrEF) evaluating possible correlations with the basal functional capacity. Methods Clinical and echocardiographic data were retrospectively analyzed in 60 HFrEF patients treated with dapagliflozin, within a dedicated outpatient HF clinic. Pre–treatment data were correlated with to clinical and instrumental FUP date that was generally performed after two months of treatment. The clinical and instrumental data consisted of the NYHA functional class, the left ventricular ejection fraction (LVEF) and the GLS. Results There was no significant change between baseline and FUP date on LVEF (25.2 ± 9.9% vs 25.6 ± 9.6% p.s.), while GLS showed significant improvement (13.1 ± 3.7% vs 14.3 ± 3.1% p < 0.03). GLS improvement in HFrEF patients with more impaired functional class (NYHA III/IV) was more significant from 10.9 ± 3.4% to 13.1 ± 2.2% (p < 0.01), compared to that in HFeEF patients with less compromised functional class (NYHA I–II) from 13.6 ± 2.4% to 14.1 ± 2.1% (p 0.07). Conclusions Dapagliflozin was associated with short term improvement in longitudinal left ventricular myocardial function in patients with chronic congestive systolic heart failure. This improvement is more evident in patients who start from a more impaired functional capacity than in clinically more stable patients.

During embryological period the blood flows from right to left atrium trought patent interatial septum. Embryon’s interatrial semptum consists on the apposition of Septum Secundum (SS) over Septum Primum (SP) that go to seal each other just afther birth. Sometimes this fusion doesn’t happen or partially happens, leading respectively to patent foramen ovale (PFO) or the less known eventuality of Atrial Septal Pouch (ASP). 48–year–old woman, history of chronic anemia treated with blood transfusions, underwent a routine transthoracic echocardiogram (TTE) as recommended by her transfusion center. The patients is asymptomatic, denies cardiovascular risk factors, denies any signs or symptoms suggestive of recent infectious or inflammatory disease. The TTE documented preserved left ventricular sistolic function, normal sized cardiac chembers, no valvular abnormalities, evidence of linear formation (10 x 5 mm), near foramen ovale, on the left side of interatrial septum, increased in echogenicity. It was performed a transesophageal echocardiogram (TEE) which confirmed the finding at SIA level. It was therefore recommended in depth study with cardiac magnetic resonance (CMR) which described the same mobile formation, characterized by the same signal strength as the atrial walls, both before and afther contrat administration, compatible in the first hypotesis with an embryonic residue (Left Atrial Septal Pouch, LASP). There is still much uncertainty regarding the clinical significance of LASP, however, its large prevalence among general population suggests that its potential embolism requires other predisposing conditions in order to be of real clinical relevance. CMR represents a usefull test for cardiac structures analysis owing its better tissue characterization cormpared to other diagnostic tests. In the event of an occasional finding and in absence of any other indication for anticoagulant therapy, no therapeutic measures are currently indicated. These patients could be followed up in order to promptly identify the onset of prothrombotic conditions likely to expose them to higher risk compared with patients who do not have LASP.

Noninvasive telemonitoring and nurse telephone coaching (NTM-NTC) is a promising post-discharge strategy in heart failure (HF). Comorbid conditions and disease burden influence health outcomes in HF, but how comorbidity burden modulates the effectiveness of NTM-NTC is unknown. This study aims to identify HF patients who may benefit from post-discharge NTM-NTC based on their burden of comorbidity.In the Better Effectiveness After Transition - Heart Failure trial, patients hospitalized for acute decompensated HF were randomized to post-discharge NTM-NTC or usual care. In this secondary analysis of 1,313 patients with complete data, comorbidity burden was assessed by scoring complication/coexisting diagnoses from index admissions. Clinical outcomes included 30-day and 180-day readmissions, mortality, days alive, and combined days alive and out of the hospital.Patients had a mean of 5.7 comorbidities and were stratified into low (0-2), moderate (3-8), and high comorbidity (9+) subgroups. Increased comorbidity burden was associated with worse outcomes. NTM-NTC was not associated with readmission rates in any comorbidity subgroup. Among high comorbidity patients, NTM-NTC was associated with significantly lower mortality at 30 days (hazard ratio (HR): 0.25; 95% confidence interval (CI): 0.07-0.90) and 180 days (HR: 0.51; 95% CI: 0.27-0.98), as well as more days alive (160.1 vs 140.3, p=0.029) and days alive out of the hospital (152.0 vs 133.2; p=0.044) compared to usual care.Post-discharge NTM-NTC improved survival among HF patients with high comorbidity burden. Comorbidity burden may be useful for identifying patients likely to benefit from this management strategy.

To develop and evaluate the psychometric properties of a family caregiver-reported survey that assesses family-centeredness of care in the context of pediatric emergency department (ED) encounters.We created a caregiver-reported scale, incorporated content expert feedback, and iteratively revised it based on cognitive interviews with caregivers. We then field tested the scale in a survey with caregivers. We dichotomized items using top-box scoring and obtained a summary score per respondent. Using a sample of 191 caregivers recruited from 9 EDs, we analyzed internal consistency reliability, dimensionality via item response theory modeling, and convergent validity with the ED Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.Feedback from the 9 experts led us to remove 4 items. We conducted 16 cognitive interviews and revised the survey in 4 rounds. An 11-item survey was field tested. Mean (standard deviation) respondent 11-item summary score was 77.2 (26.6). We removed 2 items given inconsistent response patterns, poor variability, and poor internal consistency, which increased coefficient alpha from 0.85 to 0.88 for the final scale. A multidimensional model fit the data best, but factor scores correlated strongly with summary scores, suggesting the latter are sufficient for quality improvement and future research. Regarding convergent validity, adjusted partial correlation between our scale's 9-item summary score and the ED CAHPS summary score was 0.75 (95% confidence interval 0.67-0.81).Psychometric analyses demonstrated strong item performance, reliability, and convergent validity for the 9-item scale. This survey can be used to assess family-centered care in the ED for research and quality improvement purposes.

The pH of airway surface liquid (ASL) is a key factor that determines respiratory host defense; ASL acidification impairs and alkalinization enhances key defense mechanisms. Under healthy conditions, airway epithelia secrete base ([Formula: see text]) and acid (H+) to control ASL pH (pHASL). Neutrophil-predominant inflammation is a hallmark of several airway diseases, and TNFα and IL-17 are key drivers. However, how these cytokines perturb pHASL regulation is uncertain. In primary cultures of differentiated human airway epithelia, TNFα decreased and IL-17 did not change pHASL. However, the combination (TNFα+IL-17) markedly increased pHASL by increasing [Formula: see text] secretion. TNFα+IL-17 increased expression and function of two apical [Formula: see text] transporters, CFTR anion channels and pendrin Cl−/[Formula: see text] exchangers. Both were required for maximal alkalinization. TNFα+IL-17 induced pendrin expression primarily in secretory cells where it was coexpressed with CFTR. Interestingly, significant pendrin expression was not detected in CFTR-rich ionocytes. These results indicate that TNFα+IL-17 stimulate [Formula: see text] secretion via CFTR and pendrin to alkalinize ASL, which may represent an important defense mechanism in inflamed airways.

Background Administrative data can be used to identify cases of postoperative respiratory failure (PRF). We aimed to determine if recent changes to the Agency for Healthcare Research and Quality Patient Safety Indicator 11 (PSI 11) and adoption of clinical documentation improvement programs have improved the validity of PSI 11. We also analyzed reasons why PSI 11 was falsely triggered. Study design Cross-sectional study of all eligible discharges using health record data from five academic medical centers between October 1, 2012 and September 30, 2015. Results Of 437 flagged records, 434 (99.3%) were accurately coded and 414 (94.7%) represented true clinical PRF. None of the false positive records involved respiratory failure present on admission. Most (78.3%) false positive records required airway protection but did not have respiratory failure. Conclusion The validity of PSI 11 has improved with recent changes to the code criterion and adoption of clinical documentation improvement programs.

In Italy, the National Forestry Strategy (SFN) is being implemented: it is an important operational framework to be sized by Regional Governments to which the administrative competences in the forestry sector are delegated. We focus here on the main problems that have to be solved to promote SFN at the local level.

Abstract. The shooter bias effect reveals that individuals are quicker to “shoot” armed Black (vs. White) men and slower to “not shoot” unarmed Black (vs. White) men in a computer task. In three studies ( N = 386), we examined whether being observed would reduce this effect because of social desirability concerns. Participants completed a “shooting” task with or without a camera/live observer supposedly recording behavior. Cameras were strapped to participants’ heads (Studies 1a/1b) and pointed at them (Study 1b). In Study 2, a researcher observed participants complete the task while “filming” them with a smartphone. We replicated the shooter bias, but observation only reduced the effect in Study 2. These results reveal that being observed can reduce the shooter bias effect.

OBJECTIVE: Differences in the quality of emergency department (ED) care are often attributed to nonclinical factors such as variations in the structure, systems, and processes of care. Few studies have examined these associations among children. We aimed to determine whether process measures of quality of care delivered to patients receiving care in children’s hospital EDs were associated with physician-level or hospital-level factors. METHODS: We included children (

OBJECTIVE The aim of the study was to address the controversy surrounding the effects of duty hour reform on new surgeon performance, we analyzed patients treated by new surgeons following the transition to independent practice. SUMMARY BACKGROUND DATA In 2003, duty hour reform affected all US surgical training programs. Its impact on the performance of new surgeons remains unstudied. METHODS We studied 30-day mortality among 1,483,074 Medicare beneficiaries undergoing general and orthopedic operations between 1999 and 2003 ("traditional" era) and 2009 and 2013 ("modern" era). The operations were performed by 2762 new surgeons trained before the reform, 2119 new surgeons trained following reform and 15,041 experienced surgeons. We used a difference-in-differences analysis comparing outcomes in matched patients treated by new versus experienced surgeons within each era, controlling for the hospital, operation, and patient risk factors. RESULTS Traditional era odds of 30-day mortality among matched patients treated by new versus experienced surgeons were significantly elevated [odds ratio (OR) 1.13; 95% confidence interval (CI) (1.05, 1.22), P < 0.001). The modern era elevated odds of mortality were not significant [OR 1.06; 95% CI (0.97-1.16), P = 0.239]. Relative performance of new and experienced surgeons with respect to 30-day mortality did not appear to change from the traditional era to the modern era [OR 0.93; 95% CI (0.83-1.05), P = 0.233]. There were statistically significant adverse changes over time in relative performance to experienced surgeons in prolonged length of stay [OR 1.08; 95% CI (1.02-1.15), P = 0.015], anesthesia time [9 min; 95% CI (8-10), P < 0.001], and costs [255USD; 95% CI (2-508), P = 0.049]. CONCLUSIONS Duty hour reform showed no significant effect on 30-day mortality achieved by new surgeons compared to their more experienced colleagues. Patients of new surgeons, however, trained after duty hour reform displayed some increases in the resources needed for their care.

Objective Aim of the research was to define the quality of life of Italian neurologists and nurses’ professional caring for multiple sclerosis, to understand their living the clinical practice and identify possible signals of compassion fatigue. Material and methods One hundred five neurologists and nurses from 30 Italian multiple sclerosis centres were involved in an online quali-quantitative survey on the organization of care, combined with the Satisfaction and Compassion Fatigue Test and a collection of narratives. Descriptive statistics of the quantitative data were integrated with the results obtained by the narrative medicine methods of analysis. Results Most of the practitioners were neurologists, 46 average years old, 69% women, 43% part time dedicated to multiple sclerosis. An increased number of patients in the last 3 years were referred in 29 centres. Differences were found between neurologists and nurses. Physicians showed higher risks of burnout, reporting intensive working paces, lack of medical personnel, and anxiety caused by the precarious employment conditions. Nurses appeared more satisfied, although the reference to the lack of spaces, and the cross professional roles risk of compassion fatigue. Both positive and negative relationships of care were depicted as influencing the professional quality of life. Conclusion The interviewed neurological teams need to limit the risk of compassion fatigue, which appeared from the first years of the career. The prevalence of the risk among neurologists suggests more awareness among scientific societies and health care managers on the risk for this category, as first step to prevent it. Electronic supplementary material The online version of this article (10.1007/s10072-020-04301-z) contains supplementary material, which is available to authorized users.

Objective The purpose of this study was to examine risk factor and temporal associations between acute care hospitalization and post-discharge home injury falls in a population-based analysis sample of community dwelling older adults. Methods We applied a unidirectional case-crossover design to a retrospective analysis sample derived from healthcare administrative data from all non-federal licensed hospitals in the State of California. The analysis sample was comprised of California residents age 65 years or older with a record of treatment for injury fall occurring at home from January 1, 2014 to December 31, 2014. A conditional Poisson regression with fixed person effects and a robust estimator of variance was used to calculate the incidence rate ratio of acute care admissions during the 90 day period immediately preceding an injury fall, with the period of 360–271 days prior to index fall as reference. Results The rate of acute care admissions was 121% greater (IRR: 2.21; 95% CI 2.15–2.27) during the 90 days immediately preceding the index injury fall than 181–360 days prior. Period effects on rates of admissions were significantly higher in the acute care treatment subsample (IRR 2.63; 95% CI 2.51–2.76) than the emergency department treatment subsample (IRR 2.00; 95% CI 1.94–2.07). Discharge to post-acute care facilities; discharge to home health and Elixhauser comorbidity index all significantly modified period effects on acute care admissions. Conclusions Older adults have an increased risk of falling at home after being discharged from an acute care hospitalization, with highest risk occurring during the 90-day post-discharge period. Special consideration should be given to assessing hospital-associated changes in fall risk among geriatric patients prior to discharge directly home. Discharge planning should include efforts to reduce home fall risk during the period of transition from hospital care.

PURPOSE: Half of the 21-item Minnesota Living with Heart Failure Questionnaire (MLHFQ) response categories are labeled (0 = No, 1 = Very little, 5 =Very much) and half are not (2, 3, and 4). We hypothesized that the unlabeled response options would not be more likely to be chosen at some place along the scale continuum than other response options and, therefore, not satisfy the monotonicity assumption of simple-summated scoring. METHODS: We performed exploratory and confirmatory factor analyses of the MLHFQ items in a sample of 1437 adults in the Better Effectiveness After Transition--Heart Failure study. We evaluated the unlabeled response options using item characteristic curves from item response theory graded response models for MLHFQ physical and emotional health scales. Then, we examined the impact of collapsing response options on correlations of scale scores with other variables. RESULTS: The sample was 46% female; 71% 65 or older; 11% Hispanic, 22% Black, 54% White, and 12% other. The unlabeled response options were rarely chosen. The standard approach to scoring and scores obtained by collapsing adjacent response categories yielded similar associations with other variables, indicating that the existing response options are problematic. CONCLUSIONS: The unlabeled MLHFQ response options do not meet the assumptions of simple-summated scoring. Further assessment of the performance of the unlabeled response options and evaluation of alternative scoring approaches is recommended. Adding labels for response options in future administrations of the MLHFQ should be considered.

Experimental studies on astrophysical reactions involving radioactive isotopes (RI) often accompany technical challenges. Studies on such nuclear reactions have been conducted at the low-energy RI beam separator CRIB, operated by Center for Nuclear Study, the University of Tokyo. We discuss two cases of astrophysical reaction studies at CRIB; one is for the 7Be+n reactions which may affect the primordial 7Li abundance in the Big-Bang nucleosynthesis, and the other is for the 22Mg(α, p) reaction relevantin X-raybursts.

The abundance of 26Al carries a special role in astrophysics, since it probes active nucleosynthesis in the Milky Way and constrains the Galactic core-collapse supernovae rate. It is estimated through the detection of the 1809 keV γ-line and from the superabundance of 26Mg in comparison with the most abundant Mg isotope (A = 24) in meteorites. For this reason, high precision is necessary also in the investigation of the stable 27Al and 24Mg isotopes. Moreover, these nuclei enter the so-called MgAl cycle, playing an important role in the production of Al and Mg. Recently, high-resolution stellar surveys have shown that the Mg–Al anticorrelation in red-giant stars in globular clusters may hide the existence of multiple stellar populations, and that the relative abundances of Mg isotopes may not be correlated with Al. The common thread running through these astrophysical scenarios is the 27Al(p,α)24Mg reaction, which is the main 27Al destruction channel and directly correlates its abundance with the 24Mg one. Since available reaction rates show large uncertainties owing to the vanishingly small cross section at astrophysical energies, we have applied the Trojan Horse Method to deduce the reaction rate with no need of extrapolation. The indirect measurement made it possible to assess the contribution of the 84 keV resonance and to lower upper limits on the strength of nearby resonances. In intermediate-mass AGB stars experiencing hot bottom burning, a sizeable increase in surface aluminum abundance is observed at the lowest masses, while 24Mg is essentially unaffected by the change in the reaction rate.

Background: ESMO COVID-19 and CAncer REgistry (ESMO-CoCARE) is an international collaborative registry-based, cohort study gathering real-world data from Europe, Asia/Oceania and Africa on the natural history, management and outcomes of patients with cancer infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Patients and methods: ESMO-CoCARE captures information on patients with solid/haematological malignancies, diagnosed with coronavirus disease 2019 (COVID-19). Data collected since June 2020 include demographics, comorbidities, laboratory measurements, cancer characteristics, COVID-19 clinical features, management and outcome. Parameters influencing COVID-19 severity/recovery were investigated as well as factors associated with overall survival (OS) upon SARS-CoV-2 infection. Results: This analysis includes 1626 patients from 20 countries (87% from 24 European, 7% from 5 North African, 6% from 8 Asian/Oceanian centres), with COVID-19 diagnosis from January 2020 to May 2021. Median age was 64 years, with 52% of female, 57% of cancer stage III/IV and 65% receiving active cancer treatment. Nearly 64% patients required hospitalization due to COVID-19 diagnosis, with 11% receiving intensive care. In multivariable analysis, male sex, older age, Eastern Cooperative Oncology Group (ECOG) performance status ≥2, body mass index (BMI)

Although nuanced parameterization of sexual behavior may improve estimates from mathematical models of human immunodeficiency virus and sexually transmitted infection transmission, prospective estimates of the incidence of specific sexual behaviors among men who have sex with men (MSM) are limited. From December 2014 to July 2018, MSM with and without nongonococcal urethritis (NGU) completed weekly diaries over 3-12 weeks. Incidence rates of any sex, receptive anal sex, insertive anal sex, insertive oral sex, receptive rimming, and receptive hand-penile contact were 1.19, 0.28, 0.66, 0.90, 0.24, and 0.85 episodes per person-week, respectively, among 104 MSM with NGU at baseline, and 1.33, 0.54, 0.32, 0.95, 0.44, and 0.88 episodes per person-week, respectively, among 25 MSM without NGU at baseline. Most receptive anal sex (NGU + 83%, NGU - 86%) and insertive anal sex (NGU + 85%, NGU - 76%) episodes were condomless. MSM engaged in sex just over once per week, and condom use was infrequent. Insertive oral sex and receptive hand-penile contact were the most common behaviors.

ObjectivesBacterial vaginosis-associated bacterium 2 (BVAB2),Mageeibacillus indolicusandSneathiaspp are highly predictive of bacterial vaginosis (BV) in cisgender women. They have been associated with non-gonococcal urethritis (NGU) in cisgender men in some but not all populations. We evaluated this association in a cross-sectional study of cisgender men who have sex with women only (MSW).MethodsMSW without gonorrhoea attending a sexual health clinic (SHC) from 2014 to 2018 completed a computer-assisted self-interview, clinical interview and examination. NGU was defined as ≥5 polymorphonuclear leucocytes/high-power field in urethral exudates plus either urethral symptoms or visible discharge. Urine was tested forChlamydia trachomatisandMycoplasma genitaliumusing Aptima (Hologic) and for BVAB2,M. indolicus,Sneathiaspp,Trichomonas vaginalis,Ureaplasma urealyticum,Haemophilus influenzae, herpes simplex virus and adenovirus using quantitative PCR.ResultsOf 317 MSW age 17–71, 67 (21.1%) hadSneathiaspp, 36 (11.4%) had BVAB2, and 17 (5.4%) hadM. indolicusat enrolment. Having ≥3 partners in the past 2 months was the only characteristic that was more common among MSW with than those without these bacteria (BVAB2: 47% vs 23%,M. indolicus: 53% vs 24%,Sneathiaspp: 42% vs 22%; p≤0.03 for all). One-hundred seventeen men (37%) were diagnosed with NGU at enrolment. There was no significant association of BVAB2,M. indolicusorSneathiaspp with NGU (adjusted OR=0.59, 95% CI 0.14 to 2.43; aOR=3.40, 95% CI 0.68 to 17.06; aOR=0.46, 95% CI 0.16 to 1.27). Of 109 MSW with monthly samples, 34 (31.2%) had one of the bacteria at one or more follow-up visits, 22 of which were co-colonised with >1. Median persistence over 6 months did not differ significantly (BVAB2=30.5 days, IQR=28–87;M. indolicus=87 days, IQR=60–126;Sneathiaspp=70 days, IQR=30–135; p≥0.20 for each comparison).ConclusionsNeither BVAB2,M. indolicusnorSneathiaspp were associated with increased risk of prevalent NGU in MSW attending an SHC.