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Fixed-dose combination (FDC) therapies (also known as polypills) remain underutilized in clinical practice despite over two decades of evidence from randomized controlled trials demonstrating increased adherence to multidrug therapy, improved cardiovascular disease (CVD) risk factor control, and lower incidence of cardiovascular events. Evidence demonstrates that FDC-based implementation strategies can substantially complement and augment current strategies for CVD risk prevention globally. The next decade is likely to extend the frontier of cardiovascular FDC therapies, particularly given expected advances in FDC manufacturing technology and accessibility. FDC-based anti-hypertensive therapies are emerging as integral components of a pragmatic blood pressure lowering strategy. Cardiovascular FDCs are rapidly approaching its coming of age, transforming from heavily hyped research tools to pragmatic clinical instruments. This review evaluates the current evidence for cardiovascular FDCs, barriers to current use, and potential next generation advances.

Using nationally representative data from 40 low- and middle-income countries, the authors find very low use of important CVD preventive medications, including blood pressure lowering drugs, statins, and aspirin.

COVID-19 was first detected in Wuhan (China), in December 2019. Mode of transmission was by respiratory droplets)or by surface transmission. Changing symptoms, treatment guidelines, and increased transmissibility of the virus were a concern among the healthcare workers. During the pandemic, the anxiety and stress levels were high among HCWs as they were disturbed by the increased caseload with colleagues testing positive. The present study aimed to find a correlation between knowledge and fear among health care workers working in COVID-19 areas of a tertiary care government hospital. This was a hospital-based study conducted at a tertiary care hospital, Rishikesh, Uttarakhand. It was an observational study with a cross-sectional study design. The study was conducted in OPD and IPD of COVID-19 for a period of three months. Study participants were consultants, residents, nurses, hospital attendants, and paramedical staff. Pre-structured questionnaires for knowledgeand fear assessment were utilized. A total of 358 study participants were enrolled. The mean age of study participants was 29± 6.17. The mean knowledge and fear score of all study participants was 9.85 ± 1 and 19.86 ± 5.2 respectively. A negative correlation (r= - 0.04) was found between the knowledge and fear scores. There was a significant difference in knowledge among different groups of HCWs, but the level of fear was not significantly different It was established that the negative correlation between the knowledge and fear score among health care workers working in COVID-19 situation in tertiary health care hospitalRegular training and dissemination of the new updates regarding the pandemic can help in allaying the fear. Making appropriate personal protective equipment available at the healthcare center will boost the confidence of the health workers.

Conventional implants cannot be placed in patients with severe atrophied maxilla resulting in insufficient amount of bone remaining for anchorage. Routinely, grafts were the preferred technique. But the drawbacks associated with this procedure, Branemark proposed surgical /prosthetic rehabilitation with zygomatic implants to overcome them. This review aims to address the criteria for placement, surgical and prosthodontics procedure, outcome evaluation and complications arising with zygomatic implants.

Heart failure affects over 2.6 million women and 3.4 million men in the United States with known sex differences in epidemiology, management, response to treatment, and outcomes across a wide spectrum of cardiomyopathies that include peripartum cardiomyopathy, hypertrophic cardiomyopathy, stress cardiomyopathy, cardiac amyloidosis, and sarcoidosis. Some of these sex-specific considerations are driven by the cellular effects of sex hormones on the renin-angiotensin-aldosterone system, endothelial response to injury, vascular aging, and left ventricular remodeling. Other sex differences are perpetuated by implicit bias leading to undertreatment and underrepresentation in clinical trials. The goal of this narrative review is to comprehensively examine the existing literature over the last decade regarding sex differences in various heart failure syndromes from pathophysiological insights to clinical practice.

Aims: Little information is available on sex differences in coronary microvascular dysfunction (CMD) in heart failure with preserved ejection fraction (HFpEF). We investigated sex-specific proteomic profiles associated with CMD in patients with HFpEF.Methods and results: Using the prospective multinational PROMIS-HFpEF study (Prevalence of Microvascular Dysfunction in HFpEF; n = 182; 54.6% women), we compared clinical and biomarker correlates of CMD (defined as coronary flow reserve [CFR] Conclusion: While the prevalence of CMD among men and women with HFpEF is similar, the drivers of microvascular dysfunction may differ by sex. The current inflammatory paradigm of CMD in HFpEF potentially predominates in men, while derangement in ventricular remodelling and fibrosis may play a more important role in women.

We report preparation and nanoscale photophysical characterization of mixed cation perovskites films of the composition MA1-xFAxPbI3, with x = 0, 0.3 and 0.5. The films with x = 0.5 and...

BACKGROUND South Asian Americans experience disproportionately high burden of cardiovascular diseases. Estimating predicted heart failure (HF) risk distribution may facilitate targeted prevention. We estimated the distribution of 10-year predicted risk of incident HF in South Asian Americans and evaluated the associations with social determinants of health and clinical risk factors. METHODS AND RESULTS In the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study, we calculated 10-year predicted HF risk using the Pooled Cohort Equations to Prevent Heart Failure multivariable model. Distributions of low (

ObjectiveDiuretics reduce congestion in patients with heart failure with preserved ejection fraction (HFpEF). However, comparison of clinical effects across diuretic classes or combinations of diuretics in patients with HFpEF are not well described. Therefore, we sought to conduct a scoping review to map trial data of diuretic efficacy and safety in patients with HFpEF.Review methods and resultsWe searched multiple bibliometric databases for published literature and ClinicalTrials.gov, and hand searched unpublished studies comparing different classes of diuretics to usual care or placebo in patients with HFpEF. We included randomised controlled trials or quasi-experimental studies. Two authors independently screened and extracted key data using a structured form. We identified 13 published studies on diuretics in HFpEF, with 1 evaluating thiazide use, 7 on mineralocorticoid receptor antagonists (MRAs) and 5 on sodium-glucose co-transporter 2 inhibitors (SGLT2i). There remain 17 ongoing trials evaluating loop diuretics (n=1), MRAs (n=5), SGLT2i (n=10) and a polydiuretic (n=1), including 2 well-powered trials of SGLT2i that will be completed in 2021.ConclusionsThe limited number of published trials evaluating different classes of diuretics in patients with HFpEF have been generally small and short term. Ongoing and emerging trials of single or combination diuretics with greater power will be useful to better define their safety and efficacy.Scoping review registrationdoi:10.18131/g3-dejv-tm77.

Background: The novel corona virus disease 2019 has been declared a global public health emergency & is affecting people across the globe. Dental Surgeons are at an invariably high risk of contracting COVID 19. Since all dentists are slowly resuming their full practice they shall be fully prepared. Objective: Aim of the study is to assess the knowledge, attitude & practise of Dental Surgeons regarding the novel Corona Virus Disease 2019 in District, Dehradun. Methods: An online Questionnaire was circulated among dental surgeons in District, Dehradun. The Questionnaire consisted of 5 sections: 1. Consent, 2. Epidemiological Data, 3. Knowledge Based Questions (11 Questions), 4. Attitude Based Questions (8 Questions), 5. Practice Based Questions (11 Questions). Results: 107 responses were collected in total. Most dental surgeons had a degree of MDS (Masters of Dental Science): 60.7%. Good knowledge and practice scores were observed among 92.7% and 79.5% of the dental surgeons. Significant association of good knowledge scores with qualifications (p = 0.04) and years of practice (p = 0.02) was found; while good practice scores were associated with qualifications only (p = 0.03). Conclusion: Dental surgeons in district Dehradun were found to have good knowledge and practice scores, which is important to skirmish COVID-19. They are hence advised to follow the Center of Disease Control and Prevention (CDC) World Health Organization (WHO), Ministry of Health & Family Welfare (MoHFW) guidelines in their clinics and should sensitize their staff as well. So that they themselves, their staff and patients all remain safe. Keywords: Covid 19, Pandemic, Dental surgeons, Dentists, Coronavirus.

This narrative review synthesizes sex differences in guideline-directed medical therapy (GDMT) use and response among female patients with heart failure with reduced ejection fraction (HFrEF), discusses female representation in HFrEF clinical trials, and outlines future areas of investigation to reduce sex disparities in HFrEF care globally. Observational registries suggest sex-specific disparities persist in GDMT rates, and there may be key sex-specific differences in optimal dosing of GDMT in HFrEF patients. Underrepresentation of female patients in HF clinical trials is a key barrier, and sex disparities in HF clinical trial leadership may influence sex-specific knowledge generation of medical management of HFrEF patients. There are important sex-specific differences in GDMT use and response among female HFrEF patients that warrant further study. Increasing female representation in HFrEF clinical trials, diversifying HF trial leadership, and embedding sex-specific approaches in the lifecycle of research from conception to reporting are essential to decreasing sex disparities in clinical care of all HFrEF patients.

Heart failure is prevalent in those with type 2 diabetes and chronic kidney disease, and is associated with significant mortality and morbidity. In the CREDENCE trial, canagliflozin reduced the risk of hospitalization for heart failure (HHF) or cardiovascular (CV) death by 31%. In the current analysis we sought to determine whether the effect of canagliflozin on HHF/CV death differed in subgroups defined by key baseline participant characteristics. Cox regression models were used to estimate hazard ratios and 95% confidence intervals. Canagliflozin was associated with a reduction in the relative risk of HHF/CV death regardless of age, sex, history of heart failure or CV disease, and the use of loop diuretics or glucagon-like peptide-1 receptor agonists (all p(interaction) > .114). The absolute benefit of canagliflozin was greater in those at highest baseline risk, such as those with CV disease (50 fewer events/1000 patients treated over 2.5 years vs. 20 fewer events in those without CV disease) or advanced kidney disease (estimated glomerular filtration rate [eGFR] 30-45 mL/min/1.73m(2): 61 events prevented/1000 patients treated over 2.5 years vs. 23 events in eGFR 60-90 mL/min/1.73m(2)). Canagliflozin consistently reduces the proportional risk of HHF/CV death across a broad range of subgroups with greater absolute benefits in those at highest baseline risk.

The optoelectronic properties of functional π-conjugated organic materials are affected by their ability to self-assemble within thin films of devices. There are limited reports that demonstrate the positive impact of self-assembly on the photovoltaic performance of organic solar cells. Here, we demonstrate that hydrogen-bonded supramolecular arrays of a cyanopyridone-based oligothiophene donor, CP6, show notable improvement in photovoltaic performance upon self-assembly into a nanofibrous network. The honeycomb-like blend network exhibited higher hole mobility, leading to efficient charge generation and transport. The photovoltaic performance of CP6 was superior to that of two structural analogues, CP5 and CP1, and was attributed to the enhanced capability of CP6 to self-assemble into a film morphology favorable for BHJ devices. The BHJ devices comprising CP6 and the conventional fullerene acceptor (PC71BM) exhibited an efficiency of 7.26%, which is greater than that of CP5 (5.19%) and CP1 (3.11%) and is among the best-performing, cyanopyridone-based oligothiophene donors described to date.

Psychosomatic disorder is condition in which psychological stresses adversely affect physiological (somatic) functioning to the point of distress. They can cause disruptions in daily functioning, relationships, work, school, and other important domains. With appropriate diagnosis and treatment, however, people can find relief from their symptoms and discover ways to cope effectively. The MEDLINE/PubMed database was searched using certain combinations of keywords related to the topic. The search revealed that medical and dental practitioners are concerned with the emotional and psychological state of the patient, for it is an essential component of treatment and the success of the treatment often depends on the emotional state of the patient. In the present paper, various psychosomatic disorders, their classification, diagnosis and management has been discussed. Keywords: Psychosomatic disorders, Diagnosis, Management, Dentistry.

Various studies have been conducted so far using oral infection to be a hypothesis saying it to be a cause of Cardiovascular Diseases. Periodontal infections being the leading source but the conflict still continues to linger, that there is dental contribution towards heart problems. It is undetermined, whether this relationship is coincidental or specific. Though most studies have concluded it to be one positive relationship. Keywords: Oral health, Heart health, Periodontal diseases and epidemiology.

Botox i.e botulinum toxin (BTX), is a neurotoxin protein which is produced by the bacteria clostridium botulium and the other bacteria’s of same species. It has been used in various treatment modalities in medical science. Botox has been approved by FDA for its use in medical industry. Apart from medical application it has also been found useful in various dental treatments, which includes treatment for temporo-mandibula disorders, its use in patients with habit of bruxism and clenching. Botox has also been found useful in enhancing facial aesthetic by removing wrinkle line, treating gummy smiles and also in treating black triangles. Botox is becoming a popular noninvasive treatment modality for various aesthetic and functional problems with minimum trauma and discomfort to the patient. Keywords: Black triangles, Botulinum toxin A, Bruxism, Gummy smile.

In India, data from large HF registries has demonstrated significantly lower 5-year mortality rates for patients with HFrEF discharged on guideline-directed medical therapy (GDMT), revealing an important target for intervention to improve clinical outcomes. Hospital-based quality improvement initiatives to increase rates of GDMT at hospital discharge have had limited effect, suggesting additional strategies are needed to improve GDMT rates in HFrEF patients. Polypills for HFrEF have been proposed as an implementation strategy to simplify the current treatment paradigm for undertreated patients with HFrEF. However, the potential effect of HFrEF polypills on increasing GDMT rates in target populations is unknown. The objective of this secondary analysis is to describe eligibility for a potential HFrEF polypill in the context of GDMT prescription rates for South Indian patients with HFrEF. We analyzed data from a prospective, interrupted time series study in 2018 (HFQUIK) that evaluated the effect of a quality improvement intervention on process of care measures and clinical outcomes in patients hospitalized with acute HFrEF in 8 hospitals in South India. The primary outcome was prescription of GDMT defined as an ACE-I or ARB or ARNi, along with a beta-blocker and aldosterone antagonist. Participants were eligible for a HFrEF polypill containing GDMT if LVEF

Cardiovascular diseases (CVD) are the world's leading cause of death. High blood pressure (BP) is the leading global risk factor for all‐cause preventable morbidity and mortality. Globally, only about 14% of patients achieve BP control to systolic BP 60%) require two or more drugs to achieve BP control, yet poor adherence to therapy is a major barrier to achieving this control. Fixed‐dose combinations (FDCs) of BP‐lowering drugs are one means to improve BP control through greater adherence and efficacy, with favorable safety and cost profiles. The authors present a review of the supporting data from a successful application to the World Health Organization (WHO) for the inclusion of FDCs of two BP‐lowering drugs on the 21st WHO Essential Medicines List. The authors discuss the efficacy and safety of FDCs of two BP‐lowering drugs for the management of hypertension in adults, relevant hypertension guideline recommendations, and the estimated cost of such therapies.

The Corona Virus Outbreak has brought the world to a halt. It has caused global panic. Italy, Iran and US happen to be the worst hit countries in addition to China which was the Epicentre. Streets have been talking and the rumour mills are running strenuously. There is a lot of controversy about this corona virus. From it spreading through seafood, or bats or snakes. To it being artificially created and spread through the means. Some netizens said it won’t be as dangerous as SARS, some said its unnecessary panic, to some saying that many Shows, Books & Movies had already predicted this & its preplanned. If it is artificially created & spread out globally it is a “BIOTERRORISM ATTACK” Bioterrorism is the intentional use of microorganisms and toxins to produce disease and death in humans, animals and crops. Terror is derived from a Latin word meaning fright. It is practised and spread by collecting people of different regions, religions and ages with any intention related to politics, society or economy. Terror groups may sometimes stop or pause their activity when their needs are met. These attempts may be done just to spread fear and to gain publicity. In bioterrorism biological agents are used to cause harm. Biological weapons strike in all of a sudden and then linger for a long time. Thus creating a high level of panic, environment contamination and extreme pressures on emergency health services. An accurate and quality information given to the public by credible public health and medical experts can do a lot in controlling fears and encouraging cooperation and participation from masses in a constructive and organized manner. Dental professionals can potentially play a very significant role in the response to the big emergency of a bioterrorism attack. Keywords: Bioterrorism attack.

Background: Sex differences in presentation, management, and outcomes of heart failure (HF) have been observed, but it is uncertain whether these differences exist in South India.Objective: We describe sex differences in presentation, management, and in-hospital outcomes in patients hospitalized with HF in South India and explore sex-based differences in the effect of the quality improvement intervention in a secondary analysis of a prospective, interrupted time series study.Methods: The Heart Failure Quality Improvement in Kerala (HF QUIK) study evaluated the effect of a quality improvement toolkit on process of care measures and clinical outcomes in patients hospitalized with HF in eight hospitals in Kerala using an interrupted time series design from February 2018 to August 2018. The primary outcome was guideline-directed medical therapy (GDMT) at hospital discharge for patients with HF with reduced ejection fraction (HFrEF). We performed sex-stratified analyses using mixed effect logistic regression models.Results: Among 1,400 patients, 536 (38.3%) were female. Female patients were older (69.6 vs. 65 years, p < 0.001), were less likely to have an ischemic etiology of HF (control period: 78.2% vs. 87.5%; intervention period: 83.6% vs. 91.5%; p < 0.05 for both) and were less likely to undergo coronary angiography or percutaneous coronary intervention. The quality improvement intervention had similar effects on the odds of GDMT at discharge in females with HFrEF (adjusted OR 1.79, 95% CI 0.92, 3.47) and males with HFrEF (adjusted OR 1.68, 95% CI 1.07, 2.64, pinteraction = 0.69).Conclusions: We observed sex-specific differences in presentation and procedural management of patients with HF but no differences in the effect of the quality improvement intervention on discharge GDMT rates. Both male and female patients with HFrEF remained undertreated in the study intervention period, demonstrating the need for implementation strategies to close the HFrEF treatment gap in South India.

Through the direct connection of the donor nitrogen atom to oligothiophenes, herein we report three novel, donor materials for evaluation in bulk-heterojunction solar cells. The direct substitution enhances the charge transfer transition, thus improving the light-harvesting ability of the target chromophores. The influence of various terminal acceptor functionalities on the optoelectronic and photovoltaic properties was systematically studied. The target chromophore, T3, bearing oxoindenemalononitrile acceptor unit afforded a power conversion efficiency of 6.12% when paired with the conventional acceptor, PC61BM, a result that is the highest in the current literature for push-pull chromophores .

ObjectiveTo estimate the direction and magnitude of effect and quality of evidence for hospital-based heart failure (HF) quality improvement interventions on process of care measures and clinical outcomes among patients with acute HF.Review methodsWe performed a structured search to identify relevant randomised trials evaluating the effect of in-hospital quality improvement interventions for patients hospitalised with HF through February 2017. Studies were independently reviewed in duplicate for key characteristics, outcomes were summarised and a qualitative synthesis was performed due to substantial heterogeneity.ResultsFrom 3615 records, 14 randomised controlled trials were identified for inclusion with multifaceted interventions. There was a trend towards higher in-hospital use of ACE inhibitors (ACE-I; 57.9%vs40.0%) and beta-blockers (BBs; 46.7%vs10.2%) in the intervention than the comparator in one trial (n=429 participants). Five trials (n=78 727 participants) demonstrated no effect of the intervention on use of ACE-I or angiotensin receptor blocker at discharge. Three trials (n=89 660 participants) reported no effect on use of BB at discharge. Two trials (n=419 participants) demonstrated a trend towards lower hospital readmission up to 90 days after discharge. There was no consistent effect of the quality improvement intervention on 30-day all-cause mortality, hospital length of stay and patient-level health-related quality of life.ConclusionsRandomised trials of hospital-based HF quality improvement interventions do not show a consistent effect on most process of care measures and clinical outcomes. The overall quality of evidence for the prespecified primary and key secondary outcomes was very low to moderate, suggesting that future research will likely influence these estimates.Trial registration numberCRD42016049545.

Aim To assess validity and reliability of Hindi version of Child Oral impact on daily performances (C-OIDP) index among school children in North India. Material and methodology Descriptive cross sectional study was conducted amongst 250, 11–12 year old school children in primary schools of Rishikesh, Uttarakhand, India. The study was done in two phases: first phase included assessment of Psychometric and linguistic properties of hindi version of C-OIDP index which was then pilot tested on study subjects. Phase two comprised of the actual main study which included the re-assessment of Hindi C-OIDP index on the entire study population. The pilot study comprised of 40 school children while the main study was conducted on 250 school children. Results The inter-item correlation coefficient ranged from 0.1 to 0.786 while corrected item total correlation coefficient ranged from 0.176 (smiling) to 0.843 ((cleaning). The standardised Cronbach's Alpha coefficient was 0.88. Moreover, the alpha coefficients didn't increase upon deleting any of the items. Weighted kappa was 0.85 & ICC was 0.9. Children with higher scores were less satisfied with their mouth (p- 0.001) in case of concurrent validity. Conclusion Hindi Child Oral Impact on Daily Performances index can be used as a valid and reliable instrument in measuring OHRQoL. of Paediatric North Indian population.

Background Long-term data on outcomes of participants hospitalized with heart failure (HF) from low- and middle-income countries are limited. Methods and Results In the Trivandrum Heart Failure Registry (THFR) in 2013, 1205 participants from 18 hospitals in Trivandrum, India, were enrolled. Data were collected on demographics, clinical presentation, treatment, and outcomes. We performed survival analyses, compared groups and evaluated the association between heart failure (HF) type and mortality, adjusting for covariates that predicted mortality in a global HF risk score. The mean (standard deviation) age of participants was 61.2 (13.7) years. Ischemic heart disease was the most common cause (72%). The in-hospital mortality rate was higher for participants with HF with reduced ejection fraction (HFrEF; 9.7%) compared with those with HF with preserved ejection fraction (HFpEF; 4.8%; P = .003). After 3 years, 540 (44.8%) participants had died. The all-cause mortality rate was lower for participants with HFpEF (40.8%) compared with HFrEF (46.2%; P = .049). In multivariable models, older age (hazard ratio [HR] 1.24 per decade, 95% confidence interval [CI] 1.15-1.33), New York Heart Association functional class IV symptoms (HR 2.80, 95% CI 1.43-5.48), and higher serum creatinine (HR 1.12 per mg/dL, 95% CI 1.04-1.22) were associated with all-cause mortality. Conclusions Participants with HF in the THFR have high 3-year all-cause mortality. Targeted hospital-based quality improvement initiatives are needed to improve survival during and after hospitalization for HF.

BACKGROUND: Although quality improvement interventions for acute heart failure have been studied in high-income countries, none have been studied in low- or middle-income country settings where quality of care can be lower. We evaluated the effect of a quality improvement toolkit on process of care measures and clinical outcomes in patients hospitalized for acute heart failure in 8 hospitals in Kerala, India utilizing an interrupted time series design from February 2018 to August 2018. METHODS: The quality improvement toolkit included checklists, audit-and-feedback reports, and patient education materials. The primary outcome was rate of discharge guideline-directed medical therapy for patients with heart failure with reduced ejection fraction. We used mixed effect logistic regression and interrupted time series models for analysis. RESULTS: Among 1400 participants, mean (SD) age was 66.6 (12.2) years, and 38% were female. Mean (SD) left ventricular ejection fraction was 35.2% (9.7%). The primary outcome was observed in 41.3% of participants in the intervention period and 28.1% of participants in the control period (difference 13.2%; 95% CI 6.8, 19.0; adjusted OR = 1.70; 95% CI 1.17, 2.48). Interrupted time series model demonstrated highest rate of guideline-directed medical therapy at discharge in the initial weeks following intervention delivery with a concomitant decline over time. Improvements were observed in discharge process of care measures, including diet counseling, weight monitoring instructions, and scheduling of outpatient clinic follow-up but not hospital length of stay nor inpatient mortality. CONCLUSIONS: Higher rates of guideline-directed medical therapy at discharge were observed in Kerala. Broader implementation of this quality improvement intervention may improve heart failure care in low- and middle-income countries. SUMMARY TWEET: QI toolkit in Kerala, India shows improvements in GDMT at discharge for patients with HFrEF. Centre for Chronic Disease Control, Cardiological Society of India, @DukeGHI, @Fogarty_NIH, @NMCardioVasc, @FSMGlobalHealth

Introduction: The Centers for Medicare & Medicaid Services (CMS) is using a new peer group-based payment system to compare hospital performance which classifies hospitals into quintiles based on their share of dual eligible beneficiaries for Medicare and Medicaid. This study evaluated the association of percent dual eligibility for Medicare Medicaid with HF quality of care and outcomes. Methods: This is a retrospective analysis of patients hospitalized for HF using the Get With The Guidelines-HF (GWTG-HF) registry between July, 1 2010 - December 31, 2017. Study endpoints included HF process of care measures, in-hospital mortality, 30-day all-cause or HF readmissions, 30-day all-cause mortality. We included patients aged ≥65 years old with available data on dual eligibility status. Hospitals were divided into quintiles based on their share dual eligible patients. Quality and outcomes were analyzed using unadjusted and adjusted multivariable logistic regression models. Results: A total of 258,995 HF hospitalizations from 455 sites were included in the primary analysis of the study. Hospitals in the highest dual eligibility quintile (Q5) tended to care for patients who were younger, more likely female, belong to racial minority groups, or located in rural areas compared with Q1 sites. After multivariable adjustment, hospitals with the highest quintile of dual eligibility (Q5 sites) were associated with lower rates of key process measures including evidence-based beta blocker prescription (aOR: 0.70, 95% CI [0.52,0.94]), measure of left ventricular function (aOR: 0.39, 95% CI [0.21,0.72]), anticoagulation for atrial fibrillation or atrial flutter (aOR: 0.68, 95% CI [0.51,0.91]). Differences in clinical outcomes were seen with higher 30-day all-cause (aOR: 1.24, 95% CI [1.14,1.35]) and HF (aOR: 1.14, 95% CI [1.03,1.27]) readmissions in higher dual eligible Q5 sites compared to Q1 sites. Risk-adjusted in-hospital and 30-day mortality did not significantly differ in Q1 vs Q5 hospitals. Conclusions: Higher dual eligibility quintile sites were associated with lower rates of key HF quality of care process measures and higher 30-day all-cause or HF readmissions compared to lower dual eligibility quintile sites.

Heart failure (HF) has emerged as an important and increasing disease burden in India. We present the 5-year outcomes of patients hospitalized for HF in India.The Trivandrum Heart Failure Registry (THFR) recruited consecutive patients admitted for acute HF among 16 hospitals in Trivandrum, Kerala in 2013. Guideline-directed medical therapy (GDMT) was defined as the combination of beta-blockers (BB), renin angiotensin system blockers (RAS), and mineralocorticoid receptor antagonists (MRA) in patients with HF with reduced ejection fraction (HFrEF, EF 40%) at discharge. We used Cox proportional hazards models and Kaplan-Meier survival plots for analysis. The MAGGIC risk score variables were included as exposure variables.Among 1205 patients [69% male, mean (SD) age = 61.2 (13.7) years], HFrEF constituted 62% of patients and among them, 25% received GDMT. The 5-year mortality rate was 59% (n = 709 deaths), and median survival was 3.1 years. Sudden cardiac death and pump failure caused 46% and 49% of the deaths, respectively. In the multivariate Cox model, components of GDMT associated with lower 5-year mortality risks were discharge prescription of BB, RAS blocker, and MRA. Older age, lower systolic blood pressure, NYHA class III or IV, and higher serum creatinine were also associated with higher 5-year mortality.Three out of every 5 patients had died during 5-years of follow-up with a median survival of approximately 3 years. Lack of GDMT in patients with HFrEF and frequent readmissions were associated with higher 5-year mortality. Quality improvement programmes with strategies to improve adherence to GDMT and reduction in readmissions may improve HF outcomes in this region.

The positive impact of self-assembly on the photovoltaic properties of a donor-π-acceptor oligothiophene molecule coded as CP3, which contains a barbituric acid as a terminal acceptor unit and triphenylamine as donor, enabling hydrogen-bonded spherulites to assemble in its films is described. The hydrogen-bonded supramolecular array of barbiturated-oligothiophene molecules were directly visualized by scanning electron microscopy. Bulk-heterojunction solar cells comprising CP3 and the fullerene PC61BM show a power conversion efficiency of 6.31%, which is markedly higher than a structural analogue CP4, which comprises a N-ethylrhodanine terminal acceptor unit incapable of participating in the same degree of self-assembly, supporting the impact of self-assembly in BHJ devices.

Age is estimated on basis of chronological age and bone age, dental age, mental age, and others. Dental age is considered to be vital as tooth development shows less variability than other developmental features and also low variability in relation to chronological age so, it is considered to be vital in establishing the age of an individual. Every person of all ages whether they are neonate, adults, or adolescent got right to be identified during death or when they are alive, and with the help of forensic odontology now it has become easier to estimate the age in very less time by various methods. However, different methods are associated with varying degrees of uncertainty and precision. From a statistical-methodological point of view, a combination of different measurement methods and a more conscious use of the relevant statistical methodology may provide more reliable estimates and better quantification. This review will deal with various aspects of age estimation such as morphological, biochemical, and radiographical methods and its scope and limitation.

Through the combination of cheaply synthesized structural fragments, spiro[fluorene-9,9′-xanthene] – otherwise termed low-cost spiro – and cyanopyridone, herein we report a new, three-dimensional, small molecule non-fullerene electron acceptor, (5Z,5′Z,5′′E,5′′′E)-5,5′,5′′,5′′′-((((S)-spiro[fluorene-9,9′-xanthene]-2,2′,7,7′-tetrayl)tetrakis(thiophene-5,2-diyl))tetrakis(methaneylylidene))tetrakis(4-methyl-1-octyl-2,6-dioxo-1,2,5,6-tetrahydropyridine-3-carbonitrile) [A1], which was synthesized for use in solution-processable bulk-heterojunction devices and was fully characterized by proton and carbon NMR spectroscopies together with elemental analysis. A1 was synthesized by a facile synthetic methodology using a Knoevenagel condensation reaction and was found to be highly soluble in a variety of common processing solvents such as chloroform and o-dichlorobenzene. Owing to its envisioned design, A1 displayed promising optoelectronic properties, and energy levels complementing those of the conventional donor polymers poly(3-hexylthiophene) [P3HT] and poly({4,8-bis[(2-ethylhexyl)oxy]benzo[1,2-b:4,5-b′]dithiophene-2,6-diyl}{3-fluoro-2-[(2-ethylhexyl)carbonyl]-thieno[3,4-b]thiophenediyl}) [PTB7]. Given its energy levels, solubility and excellent film forming capability, A1 was used in bulk-heterojunction devices as an n-type semiconducting component. The device performances [D : A 1 : 1.2 = 5.84% (P3HT); 7.21% (PTB7)] validated the design and use of A1 as an efficient non-fullerene acceptor.

Importance The Centers for Medicare & Medicaid Services uses a new peer group–based payment system to compare hospital performance as part of its Hospital Readmissions Reduction Program, which classifies hospitals into quintiles based on their share of dual-eligible beneficiaries for Medicare and Medicaid. However, little is known about the association of a hospital’s share of dual-eligible beneficiaries with the quality of care and outcomes for patients with heart failure (HF). Objective To evaluate the association between a hospital’s proportion of patients with dual eligibility for Medicare and Medicaid and HF quality of care and outcomes. Design, Setting, and Participants This retrospective cohort study evaluated 436 196 patients hospitalized for HF using the Get With The Guidelines–Heart Failure registry from January 1, 2010, to December 31, 2017. The analysis included patients 65 years or older with available data on dual-eligibility status. Hospitals were divided into quintiles based on their share of dual-eligible patients. Quality and outcomes were analyzed using unadjusted and adjusted multivariable logistic regression models. Data analysis was performed from April 1, 2020, to January 1, 2021. Main Outcomes and Measures The primary outcome was 30-day all-cause readmission. The secondary outcomes included in-hospital mortality, 30-day HF readmissions, 30-day all-cause mortality, and HF process of care measures. Results A total of 436 196 hospitalized HF patients 65 years or older from 535 hospital sites were identified, with 258 995 hospitalized patients (median age, 81 years; interquartile range, 74-87 years) at 455 sites meeting the study criteria and included in the primary analysis. A total of 258 995 HF hospitalizations from 455 sites were included in the primary analysis of the study. Hospitals in the highest dual-eligibility quintile (quintile 5) tended to care for patients who were younger, were more likely to be female, belonged to racial minority groups, or were located in rural areas compared with quintile 1 sites. After multivariable adjustment, hospitals with the highest quintile of dual eligibility were associated with lower rates of key process measures, including evidence-based β-blocker prescription, measure of left ventricular function, and anticoagulation for atrial fibrillation or atrial flutter. Differences in clinical outcomes were seen with higher 30-day all-cause (adjusted odds ratio, 1.24; 95% CI, 1.14-1.35) and HF (adjusted odds ratio, 1.14; 95% CI, 1.03-1.27) readmissions in higher dual-eligible quintile 5 sites compared with quintile 1 sites. Risk-adjusted in-hospital and 30-day mortality did not significantly differ in quintile 1 vs quintile 5 hospitals. Conclusions and Relevance In this cohort study, hospitals with a higher share of dual-eligible patients provided care with lower rates of some of the key HF quality of care process measures and with higher 30-day all-cause or HF readmissions compared with lower dual-eligibility quintile hospitals.

Through the molecular engineering of cyanopyrid-2,6-dione functionality, herein we report the design and synthesis of a novel, small molecule electron donor, (Z)-5-((5'-(4-(diphenylamino)phenyl)-[2,2′-bithiophen]-5-yl)methylene)-1-(4-(hexyloxy)phenyl)-4-methyl-2,6-dioxo-1,2,5,6-tetrahydropyridine-3-carbonitrile (coded as CP2), which exhibits improved optoelectronic and photovoltaic properties when compared with its structural analogue (E)-5-((5'-(4-(diphenylamino)phenyl)-[2,2′-bithiophen]-5-yl)methylene)-1-(2-ethylhexyl)-4-methyl-2,6-dioxo-1,2,5,6-tetrahydropyridine-3-carbonitrile (coded as CP1). The molecular engineering helps to achieve more desirable energy levels together with bathochromic shift in the absorption spectrum, which improves the short-circuit current density. A high conversion efficiency of 6.28% was obtained in simple devices (CP2: PC61BM 1: 1) which is one of the best results in the current literature for cyanopyrid-2,6-dione-based small molecule donors.

Background: Quality improvement initiatives have been developed to improve acute coronary syndrome care largely in high-income country settings. We sought to synthesize the effect size and quality of evidence from randomized controlled trials (RCTs) and nonrandomized studies for hospital-based acute coronary syndrome quality improvement interventions on clinical outcomes and process of care measures for their potential implementation in low- and middle-income country settings. Methods and Results: We conducted a bibliometric search of databases and trial registers and a hand search in 2016 and performed an updated search in May 2018 and May 2019. We performed data extraction, risk of bias assessment, and quality of evidence assessments in duplicate. We assessed differences in outcomes by study design comparing RCTs to nonrandomized quasi-experimental studies and by country income status. A meta-analysis was not feasible due to substantial, unexplained heterogeneity among the included studies, and thus, we present a qualitative synthesis. We screened 5858 records and included 32 studies (14 RCTs [n=109 763] and 18 nonrandomized quasi-experimental studies [n=54–423]). In-hospital mortality ranged from 2.1% to 4.8% in the intervention groups versus 3.3% to 5.1% in the control groups in 5 RCTs (n=55 942). Five RCTs (n=64 313) reported 3.0% to 31.0% higher rates of reperfusion for patients with ST-segment–elevation myocardial infarction in the intervention groups. The effect sizes for in-hospital and discharge medical therapies in a majority of RCTs were 3.0% to 10.0% higher in the intervention groups. There was no significant difference in 30-day mortality evaluated by 4 RCTs (n=42 384), which reported 2.5% to 15.0% versus 5.9% to 22% 30-day mortality rates in the intervention versus control groups. In contrast, nonrandomized quasi-experimental studies reported larger effect sizes compared to RCTs. There were no significant consistent differences in outcomes between high-income and middle-income countries. Low-income countries were not represented in any of the included studies. Conclusions: Hospital-based acute coronary syndrome quality improvement interventions have a modest effect on process of care measures but not on clinical outcomes with expected differences by study design. Although quality improvement programs have an ongoing and important role for acute coronary syndrome quality of care in high-income country settings, further research will help to identify key components for contextualizing and implementing such interventions to new settings to achieve their desired effects. Systematic Review Registration: URL: https://www.crd.york.ac.uk/PROSPERO/ . Unique identifier: CRD42016047604.