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Hybrid formulation chemistry was used to internally control the reaction rate differences between radical and cationic photopolymerizations leading to a tailorable array of polymer morphologies and mechanical properties.

IMPORTANCE: The long-term benefits of off-pump (“beating heart”) vs on-pump coronary artery bypass grafting (CABG) remain controversial. OBJECTIVE: To evaluate the 10-year outcomes and costs of off-pump vs on-pump CABG in the Department of Veterans Affairs (VA) Randomized On/Off Bypass (ROOBY) trial. DESIGN, SETTING, AND PARTICIPANTS: From February 27, 2002, to May 7, 2007, 2203 veterans in the ROOBY trial were randomly assigned to off-pump or on-pump CABG procedures at 18 participating VA medical centers. Per protocol, the veterans were observed for 10 years; the 10-year, post-CABG clinical outcomes and costs were assessed via centralized abstraction of electronic medical records combined with merges to VA and non-VA databases. With the use of an intention-to-treat approach, analyses were performed from May 7, 2017, to December 9, 2021. INTERVENTIONS: On-pump and off-pump CABG procedures. MAIN OUTCOMES AND MEASURES: The 10-year coprimary end points included all-cause death and a composite end point identifying patients who had died or had undergone subsequent revascularization (ie, percutaneous coronary intervention [PCI] or repeated CABG); these 2 end points were measured dichotomously and as time-to-event variables (ie, time to death and time to composite end points). Secondary 10-year end points included PCIs, repeated CABG procedures, changes in cardiac symptoms, and 2018-adjusted VA estimated costs. Changes from baseline to 10 years in post-CABG, clinically relevant cardiac symptoms were evaluated for New York Heart Association functional class, Canadian Cardiovascular Society angina class, and atrial fibrillation. Outcome differences were adjudicated by an end points committee. Given that pre-CABG risks were balanced, the protocol-driven primary and secondary hypotheses directly compared 10-year treatment-related effects. RESULTS: A total of 1104 patients (1097 men [99.4%]; mean [SD] age, 63.0 [8.5] years) were enrolled in the off-pump group, and 1099 patients (1092 men [99.5%]; mean [SD] age, 62.5 [8.5] years) were enrolled in the on-pump group. The 10-year death rates were 34.2% (n = 378) for the off-pump group and 31.1% (n = 342) for the on-pump group (relative risk, 1.05; 95% CI, 0.99-1.11; P = .12). The median time to composite end point for the off-pump group (4.6 years; IQR, 1.4-7.5 years) was approximately 4.3 months shorter than that for the on-pump group (5.0 years; IQR, 1.8-7.9 years; P = .03). No significant 10-year treatment-related differences were documented for any other primary or secondary end points. After the removal of conversions, sensitivity analyses reconfirmed these findings. CONCLUSIONS AND RELEVANCE: No off-pump CABG advantages were found for 10-year death or revascularization end points; the time to composite end point was lower in the off-pump group than in the on-pump group. For veterans, in the absence of on-pump contraindications, a case cannot be made for supplanting the traditional on-pump CABG technique with an off-pump approach. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01924442

This subanalysis of the Randomized On-Off Bypass (ROOBY) trial examined transit time flow measurement (TTFM) use and its impact on graft patency and long-term clinical outcomes after coronary artery bypass graft surgery.Use of TTFM for ROOBY centers and surgeons was assessed. Comparative patient outcomes based on TTFM use included 1-year graft patency and 1-year and 5-year major adverse cardiac events: all-cause mortality, nonfatal myocardial infarction, and revascularization (percutaneous coronary intervention or repeat coronary artery bypass graft surgery).Transit time flow measurement was used in 1067 patients (TTFM group) and not used in 501 patients (non-TTFM group); of the TTFM group, median percentage TTFM use was 79% (interquartile range, 41% to 98%) among 18 Veterans Affairs Medical Centers, and 74% (interquartile range, 13% to 98%) among 48 surgeons. Patients were comparable in age (63 ± 8.5 years TTFM vs 62 ± 8 years non-TTFM, P = .30) and estimated 30-day mortality risk (1.8 ± 1.7 TTFM vs 1.9 non-TTFM, P = .53). One-year FitzGibbon A patency was 83% (1600 of 1988 grafts) for TTFM assessed grafts and 78% (629 of 803) for non-TTFM assessed grafts (P.01). Fewer TTFM patients had an occluded graft (29%, vs 38% non-TTFM; P = .01). Comparing TTFM patients with non-TTFM patients, 5-year major adverse cardiac event rates were 30% vs 25% (P = .06). Individual component rates were 14% vs 11% for death (P = .06), 12% vs 8.8% for myocardial infarction (P = .07), and 13% vs 12% for revascularization (P = .62).The association of TTFM use with graft patency and clinical outcome is uncertain. Future randomized studies that account for patient risk factors and practice variation would help address this knowledge gap.

Background: Poor preoperative health-related quality of life (HRQoL) has been associated with reduced short-term survival after coronary artery bypass graft surgery (CABG); however, it’s impact on long-term mortality is unknown. This study’s objective was to determine if baseline HRQoL status predicts five-year post-CABG mortality. Methods: This pre-specified, Randomized On/Off Bypass Follow-up Study (ROOBY-FS) sub-analysis compared baseline patient characteristics and HRQoL scores, obtained from the Seattle Angina Questionnaire (SAQ) and Veterans Rand Short Form 36 (VR-36), between five-year post-CABG survivors and non-survivors. Standardized sub-scores were calculated for each questionnaire. Multivariable logistic regression assessed whether HRQoL survey sub-components independently predicted five-year mortality (p < 0.05). Results: Of the 2,203 ROOBY-FS enrollees, 2,104 (95.5%) completed baseline surveys. Significant differences between five-years post-CABG deaths (n = 286) and survivors (n = 1818) included age, history of chronic obstructive pulmonary disease, stroke, peripheral vascular disease, renal dysfunction, diabetes, lower left ventricular ejection fraction, atrial fibrillation, depression, non-white race/ethnicity, lower education status, and off-pump CABG. Adjusting for these factors, baseline VR-36 Physical Component Summary score (PCS) [p = 0.01], VR-36 Mental Component Summary score (MCS) (p < 0.001) and SAQ Physical Limitation score (SAQ-PL) (p = 0.003) were all associated with five-year all-cause mortality. Conclusions: Pre-CABG HRQoL scores may provide clinically relevant prognostic information beyond traditional risk models and prove useful for patient-provider shared decision making and enhancing pre-CABG informed consent.

Poor preoperative health-related quality of life (HRQoL) has been associated with reduced short-term survival after coronary artery bypass graft (CABG) surgery; however, its impact on long-term mortality is unknown. This study's objective was to determine if baseline HRQoL status predicts 5-year post-CABG mortality.This prespecified, randomized on/off bypass follow-up study (ROOBY-FS) subanalysis compared baseline patient characteristics and HRQoL scores, obtained from the Seattle Angina Questionnaire (SAQ) and Veterans RAND Short Form-36 (VR-36), between 5-year post-CABG survivors and nonsurvivors. Standardized subscores were calculated for each questionnaire. Multivariable logistic regression assessed whether HRQoL survey subcomponents independently predicted 5-year mortality (p ≤ .05).Of the 2203 ROOBY-FS enrollees, 2104 (95.5%) completed baseline surveys. Significant differences between 5-year post-CABG deaths (n = 286) and survivors (n = 1818) included age, history of chronic obstructive pulmonary disease, stroke, peripheral vascular disease, renal dysfunction, diabetes, lower left ventricular ejection fraction, atrial fibrillation, depression, non-White race/ethnicity, lower education status, and off-pump CABG. Adjusting for these factors, baseline VR-36 physical component summary score (p = .01), VR-36 mental component summary score (p .001), and SAQ physical limitation score (p = .003) were all associated with 5-year all-cause mortality.Pre-CABG HRQoL scores may provide clinically relevant prognostic information beyond traditional risk models and prove useful for patient-provider shared decision-making and enhancing pre-CABG informed consent.

SIGNIFICANCE Planning for the effective delivery of eye care, on all levels, depends on an accurate and detailed knowledge of the optometric workforce and an understanding of demographic/behavioral trends to meet future needs of the public. PURPOSE The purposes of this study were to assess the current and future supply of doctors of optometry and to examine in-depth trends related to (1) demographic shifts, (2) sex-based differences, (3) differences in practice behaviors in between self-employed and employed optometrists, and (4) the concept of additional capacity within the profession. METHODS The 2017 National Optometry Workforce Survey (31 items) was distributed to 4050 optometrists, randomly sampled from a population of 45,033 currently licensed and practicing optometrists listed in the American Optometric Association's Optometry Master Data File. A stratified sampling method was applied to the population of optometrists using primary license state, age, and sex as variables to ensure a representative sample. RESULTS With a response rate of 29% (1158 responses), the sample ensured a 95% confidence interval with a margin of error of

Complete revascularization (CR) at the time of coronary artery bypass graft (CABG) surgery improves long-term cardiac outcomes. No studies have previously reported angiographically confirmed CR rates post-CABG. This study's aim was to assess the impact upon long-term outcomes of CR versus incomplete revascularization (IR), confirmed by coronary angiography 1 year after CABG. Randomized On/Off Bypass Study patients who returned for protocol-specified 1-year post-CABG coronary angiograms were included. Patients with a widely patent graft supplying the major diseased artery within each diseased coronary territory were considered to have CR. Outcomes were all-cause mortality and major adverse cardiovascular events (MACE; all-cause mortality, nonfatal myocardial infarction, repeat revascularization) over the 4 years after angiography. Of the 1,276 patients, 756 (59%) had CR and 520 (41%) had IR. MACE was 13% CR versus 26% IR, p0.001. This difference was driven by fewer repeat revascularizations (5% CR vs 18% IR; p0.001). There were no differences in mortality (7.1% CR vs 8.1% IR, p = 0.13) or myocardial infarction (4% in both). Adjusted multivariable models confirmed CR was associated with reduced MACE (odds ratio 0.44, 95% confidence interval 0.33 to 0.58, p0.01), but had no impact on mortality. In conclusion, CR confirmed by post-CABG angiography was associated with improved MACE but not mortality. Repeat revascularization of patients with IR, driven by knowledge of the research angiography results, may have ameliorated potential mortality differences.

Compared with randomized controlled trials (RCTs) in medical specialties, RCTs in cardiac surgery face specific issues. Individual and collective equipoise, rapid evolution of the surgical techniques, as well as difficulties in obtaining funding, and limited education in clinical epidemiology in the surgical community are among the most important challenges in the design phase of the trial. Use of complex interventions and learning curve effect, differences in individual operators' expertise, difficulties in blinding, and slow recruitment make the successful completion of cardiac surgery RCTs particularly challenging. In fact, over the course of the last 20 years, the number of cardiac surgery RCTs has declined significantly. In this review, a team of surgeons, trialists, and epidemiologists discusses the most important challenges faced by RCTs in cardiac surgery and provides a list of suggestions for the successful design and completion of cardiac surgery RCTs.

Background: Previous research has examined the relation between mental illness (MI) and perceptions of dangerousness, but less research has focused on its relation to perceived risk of criminality. Individuals with MI are perceived to be more dangerous than those without, and individuals with schizophrenia or substance abuse diagnoses are viewed as being more dangerous. Research also supports that race of individuals with MI plays an important role in the conceptualization and experience of stigma. Aims: The current study investigated the relation between MI, perceived criminality and race of diagnosed individuals. Method: Two hundred ninety participants were randomly assigned to read one of the four vignettes and answer a series of questions. The first three vignettes depicted someone with MI (schizophrenia, depression or alcohol dependency), while the fourth vignette served as a control. Participants were asked to indicate likelihood of committing a future crime, severity of the future crime and the person’s potential for rehabilitation. Levels of sympathy and trust, as well as perceived race of the person, were also measured. Results: Presence of MI was a significant predictor where MI elicited higher levels of perceived risk of criminality. The remaining predictor variables (type of MI, familiarity with MI and criminality and perceived race) were not significant predictors. Exploratory analyses revealed the schizophrenia and alcohol dependency conditions elicited higher levels of perceived severity of future crimes. Perceived MI severity and likelihood of rehabilitation were all significantly correlated with perceived risk of criminality. Conclusion: Presence of MI appears to be the most important in influencing participant attitudes about perceived risk of criminality, though type of MI may influence beliefs about severity of future crimes. The impact of race could not be examined but should be examined in future studies.

This paper introduces a new scale to measure cognitive cultural differences, drawing on the theory of analytic versus holistic thought. Examining culture from a cognitive perspective is a challenge to traditional values-based approaches. Existing measures based on this framework are methodologically problematic and warrant renewal. This paper presents development and validation studies for a new instrument that measures analytic versus holistic cognitive tendencies at the individual level. The scale assesses four previously established dimensions: attention, causality, contradiction, and change. The present work follows well-established scale development protocols and the results show that the 16-item Holistic Cognition Scale (HCS) is a valid and reliable measure of analytic versus holistic thought. Three new studies with four unique samples (N = 41; 272; 454; and 454) provide evidence to support the content validity, reliability, and factor structure of the new instrument, as well as its convergent, discriminant, and concurrent validity against comparable constructs. Convergent validity is established against measures of compromise, intuition, complexity, and collectivism; predictive validity is established against Hofstede’s (1980) five cultural value dimensions; and discriminant validity is established using the average variance extracted from a confirmatory factor analysis. The new HCS is an improvement over previous attempts with a balanced number of forward- and reverse-scored items, superior reliability, less redundancy, and stronger factor loadings.

The contemporary culture of harm avoidance sanctifies the role of the victim, which creates a suite of challenges for managers and researchers attempting to address impartially allegations of harmd...

This study examines how individual optimism affects attributions about uncertain phenomena. Using a motivated reasoning lens, we theorize that optimism drives people to overestimate the effectiveness of measures meant to prevent accidents. We tested this theory with two studies. The first study assessed attributions about Malaysian Airlines flight MH370 immediately following its disappearance. Individual optimism positively related to the perceived likelihood of an unpredictable explanation, a mentally unstable pilot, and negatively related to the likelihood of mechanical failure. The second study examined attributions about the causes of a hypothetical car crash, finding optimism positively related to preventable factors under the control of drivers. Optimists overestimate their own agency (in the car crash scenario) for promoting safety and the infallibility of institutional systems (airplane disappearance).

In patients with end-stage renal disease (ESRD), surgical aortic valve replacement is associated with higher early and late mortality, and adverse outcomes compared with patients without renal disease. Transcatheter aortic valve replacement (TAVR) offers another alternative, but there are limited reported outcomes.The purpose of this study was to determine the outcomes of TAVR in patients with ESRD.Among the first 72,631 patients with severe aortic stenosis (AS) treated with TAVR enrolled in the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) TVT (Transcatheter Valve Therapies) registry, 3,053 (4.2%) patients had ESRD and were compared with patients who were not on dialysis for demographics, risk factors, and outcomes.Compared with the nondialysis patients, ESRD patients were younger (76 years vs. 83 years; p 0.01) and had higher rates of comorbidities leading to a higher STS predicted risk of mortality (median 13.5% vs. 6.2%; p 0.01). ESRD patients had a higher in-hospital mortality (5.1% vs. 3.4%; p 0.01), although the observed to expected ratio was lower (0.32 vs. 0.44; p 0.01). ESRD patients also had a similar rate of major vascular complications (4.5% vs. 4.6%; p = 0.86), but a higher rate of major bleeding (1.4% vs. 1.0%; p = 0.03). The 1-year mortality was significantly higher in dialysis patients (36.8% vs. 18.7%; p 0.01).Patients undergoing TAVR with ESRD are at higher risk and had higher in-hospital mortality and bleeding, but similar vascular complications, when compared with those who are not dialysis dependent. The 1-year survival raises concerns regarding diminished benefit in this population. TAVR should be used judiciously after full discussion of the risk-benefit ratio in patients on dialysis.

Background Stroke is a serious complication after transcatheter aortic valve replacement (TAVR), yet predictive models are not available. A new risk model for in-hospital stroke after TAVR was developed and used to estimate site-specific performance. Methods We included 97,600 TAVR procedures from 521 sites in The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry from July 2014 to June 2017. Association between baseline covariates and in-hospital stroke was estimated by logistic regression. Discrimination was evaluated by C-statistic. Calibration was tested internally via cross-validation. Hierarchical modeling was used to estimate risk-adjusted site-specific performance. Results Median age was 82 years, 44,926 (46.0%) were women, and 1,839 (1.9%) had in-hospital stroke. Covariates associated with stroke (odds ratio) included transapical access (1.44), access excluding transapical and transfemoral (1.77), prior stroke (1.57), prior transient ischemic attack (1.50), preprocedural shock, inotropes or mechanical assist device (1.48), smoking (1.28), porcelain aorta (1.23), peripheral arterial disease (1.21), age per 5 years (1.11), glomerular filtration rate per 5 mL/min (0.97), body surface area per m2 (0.55 male; 0.43 female), and prior aortic valve (0.78) and nonaortic valvular (0.42) procedures. The C-statistic was 0.622. Calibration curves demonstrated agreement between observed and expected stroke rates. Hierarchical modeling showed 10 (1.9%) centers with significantly higher odds ratios for in-hospital stroke than their peers. Conclusions A risk model for in-hospital stroke after TAVR was developed from The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry and used to estimate site-specific stroke performance. This model can serve as a valuable resource for quality improvement, clinical decision making, and patient counseling.

Abstract. We propose that two aspects of leadership, perceived respectful leadership and the degree of leaders’ prototypicality, positively affect employee proactivity. A multisource and multilevel field study of 234 employees supervised by 62 leaders shows that respectful leadership relates positively to employee proactivity in terms of personal initiative and that leader group prototypicality diminishes this effect. Moreover, perceived respectful leadership and prototypicality substitute for one another in their relation to follower proactivity. This study contributes to previous research that shows leader–follower relationships enhance proactivity by showing the impact of perceived respectful leadership and leader group prototypicality.

Objective Occurrence of a stroke within 30 days following coronary artery bypass grafting (CABG) is an uncommon, but often devastating, complication. This study aimed to identify factors associated with long-term survival (beyond 30 days) in patients with stroke after CABG. Methods De-identified patients’ records from the Veterans Affairs Surgical Quality Improvement Program database were used to identify risk factors and perioperative complications associated with survival for up to 20 years in patients with post-CABG stroke. The multivariable Cox proportional hazards model was used for analyzing survival. Results The median survival time for patients with stroke (n = 1422) was 6.7 years. The mortality rate for these patients was highest in the first year post-CABG and was significantly elevated compared with non-stroke patients. Survival rates at 1, 5, and 10 years for stroke versus non-stroke patients were 79% vs. 96%, 58% vs. 83%, and 36% vs. 63%, respectively. High preoperative serum creatinine levels, postoperative occurrence of renal failure, prolonged ventilation, coma, and reoperation for bleeding were important predictors of 1-year mortality of patients with post-CABG stroke. Conclusions Veterans with post-CABG stroke have a considerably higher risk for mortality during the first year compared with patients without stroke.

Objective: This study explored the outcome of applying red/near-infrared light therapy using light-emitting diodes (LEDs) pulsed with three different frequencies transcranially to treat traumatic brain injury (TBI) in Veterans. Background: Photobiomodulation therapy (PBMT) using LEDs has been shown to have positive effects on TBI in humans and animal models. Materials and methods: Twelve symptomatic military Veterans diagnosed with chronic TBI >18 months post-trauma received pulsed transcranial PBMT (tPBMT) using two neoprene therapy pads containing 220 infrared and 180 red LEDs, generating a power output of 3.3 W and an average power density of 6.4 mW/cm2 for 20 min, thrice per week over 6 weeks. Outcome measures included standardized neuropsychological test scores and qualitative and quantitative single photon emission computed tomography (SPECT) measures of regional cerebral blood flow (rCBF). Results: Pulsed tPBMT significantly improved neuropsychological scores in 6 of 15 subscales (40.0%; p

Background: Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has been shown to be feasible, yet the safety and efficacy in relation to native valve (NV) TAVR are not known...

Background For advanced coronary disease, coronary artery bypass graft (CABG) surgery generally improves patients' symptoms and long-term survival. Unfortunately, some patients experience worse health-related quality of life (HRQL) after CABG. The objective of this study is to report the frequency and risk factors associated with 1-year post-CABG HRQL deterioration. Methods From 2002 to 2007, 2203 “Randomized On/Off Bypass” (ROOBY) trial patients randomly received either off-pump or on-pump CABG at 18 VA medical centers. Subjects completed both baseline and 1-year Seattle Angina Questionnaire (SAQ) and the Veterans Rand 36 (VR-36) questionnaires to assess HRQL. Using previously published criteria, the rates of clinically significant changes were determined for the SAQ [angina frequency (AF), physical limitation (PL), and quality of life (QoL)] and VR36 [mental component score (MCS) and physical component score (PCS)] subscales. Multivariate regression models were then used to identify pre-CABG patient characteristics associated with worsened 1-year HRQL status for each subscale. Results Over 80% of patients had an improvement or no change in SAQ and VR-36 subscale scores 1 year after CABG. The HRQL scale-specific deterioration rates were 4.5% SAQ-AF, 16.8% SAQ-PL, 4.9% SAQ-QoL, 19.4% VR36-MCS, and 13.5% VR36-PCS. Predictors of 1-year HRQL deterioration were diabetes and smoking for the SAQ-AF; diabetes, chronic obstructive pulmonary disease (COPD), and peripheral vascular disease (PVD) for SAQ-PL; COPD and depression for the SAQ-QoL; diabetes for VR36-PCS, and history of stroke and depression for VR36-MCS. The baseline score was an independent predictor for worsening in all the subscales studied. Conclusions Among VA patients, less than 20% experienced worse HRQL 1 year after CABG. For patients with low symptom burden at baseline, diabetes, smoking, depression, PVD, COPD, and a prior stroke, clinicians should be more cautious in pre-CABG counseling as to their anticipated HRQL improvements.

Optimal antiplatelet therapy after coronary artery bypass graft (CABG) surgery remains controversial. This study evaluated the role of dual antiplatelet therapy using aspirin and clopidogrel (DAPT) versus antiplatelet therapy using aspirin only (ASA) on post-CABG clinical outcomes and costs. In the Department of Veterans Affairs Randomized On/Off Bypass (ROOBY) trial, clopidogrel use after CABG was prospectively collected beginning in year 2 of this study to include 1,525 of the 2,203 original ROOBY patients who received aspirin after CABG. Discretionarily, surgeons after CABG administered either DAPT or ASA treatments. The ROOBY trial's primary 30-day composite (mortality or perioperative morbidity), 1-year composite (all-cause death, repeat revascularization, or nonfatal myocardial infarction), and costs were compared for these 2 strategies. Of the 1,525 subjects, 511 received DAPT and 1,014 received ASA. DAPT subjects, compared with ASA subjects, had lower rates of preoperative left ventricular ejection fraction of ≥45% (78.8% vs 85.7%, p 0.001), on-pump CABG (36.6% vs 57.1%, p = 0.001), and endoscopic vein harvesting (30.0% vs 42.8%, p 0.001). ASA patients were more likely to have earlier aspirin administration and receive 325 versus 81 mg dosages. The 30-day composite outcome rate was significantly lower for DAPT patients compared with ASA patients (3.3% vs 7.1%, p = 0.003), but the 1-year composite outcome was equal between the 2 groups (12.0% vs12.0%, p = 1.0). At 1 year, there were no cost differences between the 2 groups. Propensity analyses did not significantly alter the results. In conclusion, DAPT appeared safe and was associated with fewer 30-day adverse outcomes than aspirin only and with no 1-year outcome or cost differences.

Objectives The aim of this study was to develop and validate a risk adjustment model for 30-day mortality after transcatheter aortic valve replacement (TAVR) that accounted for both standard clinical factors and pre-procedural health status and frailty. Background Assessment of risk for TAVR is important both for patient selection and provider comparisons. Prior efforts for risk adjustment have focused on in-hospital mortality, which is easily obtainable but can be biased because of early discharge of ill patients. Methods Using data from patients who underwent TAVR as part of the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry (June 2013 to May 2016), a hierarchical logistic regression model to estimate risk for 30-day mortality after TAVR based only on pre-procedural factors and access site was developed and internally validated. The model included factors from the original TVT Registry in-hospital mortality model but added the Kansas City Cardiomyopathy Questionnaire (health status) and gait speed (5-m walk test). Results Among 21,661 TAVR patients at 188 sites, 1,025 (4.7%) died within 30 days. Independent predictors of 30-day death included older age, low body weight, worse renal function, peripheral artery disease, home oxygen, prior myocardial infarction, left main coronary artery disease, tricuspid regurgitation, nonfemoral access, worse baseline health status, and inability to walk. The predicted 30-day mortality risk ranged from 1.1% (lowest decile of risk) to 13.8% (highest decile of risk). The model was able to stratify risk on the basis of patient factors with good discrimination (C = 0.71 [derivation], C = 0.70 [split-sample validation]) and excellent calibration, both overall and in key patient subgroups. Conclusions A clinical risk model was developed for 30-day death after TAVR that included clinical data as well as health status and frailty. This model will facilitate tracking outcomes over time as TAVR expands to lower risk patients and to less experienced sites and will allow an objective comparison of short-term mortality rates across centers.

Aim: This Department of Veterans Affairs’ (VA) research project evaluated the impact of postoperative atrial fibrillation (POAF) upon 10-year outcomes for coronary artery bypass grafting (CABG) patients. Methods: Veterans enrolled in the “Randomized On-/Off-pump Bypass” (ROOBY) trial with new-onset POAF post-CABG were compared to those without POAF with respect to 10-year atrial fibrillation (AF) and mortality rates. Multivariable logistic regression examined whether AF was independently associated with 10-year survival after holding other preoperative risk factors constant. Results: Of the 2203 ROOBY veterans enrolled at 18 VA medical centers from 2002 to 2008, 100 patients with preoperative AF (n = 93) or unknown post-CABG POAF status (n = 7) were excluded. The POAF rate was 26.2% (n = 551/2103). The POAF patients were older and had more co-morbidities than the non-POAF patients (n = 1552). The AF rate among 10-year ROOBY POAF survivors was 18.9% (n = 64/338) compared to 5.8% (n = 61/1048) for non-POAF patients; P < 0.001. Compared to non-POAF patients’ 10-year survival of 70%, the ROOBY POAF veterans’ 10-year survival rate was 63%. Baseline risks inversely associated with 10-year survival included age, chronic obstructive pulmonary disease, serum creatinine > 1.5, peripheral vascular disease, and smoking. Holding these factors constant, POAF was not independently associated with 10-year survival. Conclusion: Post-CABG, ROOBY POAF veterans had higher rates of 10-year AF, which was negatively associated with 10-year survival; however, this association was not significant. Given that POAF may adversely impact 10-year AF rates, additional investigation appears warranted to improve future POAF patients’ care.

Postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery, yet there is no consistent cardiothoracic professional society-based definition of new-onset POAF, nor a broadly accepted consensus on how to prevent or treat it. Importantly, there is an ever-growing body of evidence that new-onset POAF is associated with worse patient outcomes. Given the lack of evidence-based guidelines, detection and treatment of POAF, in addition to understanding how POAF is related to these worse outcomes, represents an unaddressed quality of care concern. In the United States, the annual cardiac surgical POAF patient costs are estimated at ~$1 billion. The entire US Medicare annual budget has been reported at ~$141.2 billion for all hospital-related care; thus, the administrative challenges uniquely posed by POAF have been exposed for the first time. Mapping future tactics, this Vessel Plus special atrial fibrillation publication, swings the pendulum from impromptu observations towards action. A new strategic framework is proposed to begin the tedious but necessary task of taking on this elephant in the room. With ideal collaboration between clinical providers, health care systems, professional societies and insurers, a five-step approach is proposed to overcome these POAF patient care challenges.

Aim: In the United States (US), post-operative atrial fibrillation (POAF) is the most common complication following cardiac surgery. In order to understand the opportunities to improve POAF patients’ care, this “30,000 foot” review evaluated the professional society POAF database/registry definitions and guideline recommendations. Methods: All US-based professional society organizations with an interventional cardiac database/registry and/or cardiac care guidelines were identified; from these, the POAF database definitions and guideline recommendations were evaluated using a content analysis approach. Results: The Society of Thoracic Surgeons (STS) POAF definition was the most frequently referenced definition (21% of key references). Only 50% (n = 5/10) US cardiac surgery databases/registries included any POAF definition; compared to STS, the other five definitions required substantially more detailed documentation. Across eight guidelines, three different types of POAF recommendations were found: risk assessment (n = 3); prevention (n =7); and management (n = 8). As a common feature, the risk assessment strategies tended to focus on advanced age (n = 6). Beta-blockers (n = 5) and amiodarone (n = 6) were common prevention approaches. Uniformly, anti-coagulation was the only management strategy (n = 8) recommended, barring any contraindications. Conclusion: Across ten professional societies, 50% had no POAF definition; of the remaining five, no POAF definitional consistency was found. Across the eight US-based professional society POAF-related guidelines, only anticoagulation was uniformly recommended. Given these “big picture” findings, professional societies are urged to work collaboratively to harmonize these divergent POAF definitions and consolidate their evidence-based guideline recommendations to improve future POAF patients’ quality of care.

Purpose The purpose of this paper is to examine the interplay between different streams of trust and leadership and their impact on motivation and performance. The model answers recent calls for a better understanding of underlying mechanisms in these interactions. Design/methodology/approach The authors drew from contemporary leadership and trust theories to develop ten propositions teasing out how specific person- and role-oriented leadership behaviors interact with calculus-, identification-, knowledge-based trust, motivation, and performance. Findings The model accentuates the complexity of the interactions between trust, leadership, and follower outcomes. It guides future empirical research to unravel these intricate relations and accentuates their complexity. Research limitations/implications The ten propositions act as guidelines in mastering the complex art of leadership by understanding how behaviors affect followers. An important limitation originates in the detailed analysis of leadership and trust. Focusing on specific leadership behaviors and trust types leaves further scope for future research into additional behaviors and cofounding variables to arrive at a more holistic picture of the underlying mechanisms that make or break an effective leader. Originality/value Contemporary theories on leadership and trust frequently view the different streams as overall constructs in lieu of multi-faceted phenomena. The model is a first of its kind in that it fuses contemporary leadership and trust theory to develop a set of propositions based on specific interactions between leadership behaviors and different forms of trust.

Background Transcatheter aortic valve replacement (TAVR) has been introduced into U.S. clinical practice with efforts to optimize outcomes and minimize the learning curve. Objectives The goal of this study was to assess the degree to which increasing experience during the introduction of this procedure, separated from other outcome determinants including patient and procedural characteristics, is associated with outcomes. Methods The authors evaluated the association of hospital TAVR volume and patient outcomes for TAVR by using data from 42,988 commercial procedures conducted at 395 hospitals submitting to the Transcatheter Valve Therapy Registry from 2011 through 2015. Outcomes assessed included adjusted and unadjusted in-hospital major adverse events. Results Increasing site volume was associated with lower in-hospital risk-adjusted outcomes, including mortality (p Conclusions The initial adoption of TAVR into practice in the United States showed that increasing experience was associated with better outcomes. This association, whether deemed a prolonged learning curve or a manifestation of a volume–outcome relationship, suggested that concentrating experience in higher volume heart valve centers might be a means of improving outcomes. (STS/ACC Transcatheter Valve Therapy Registry [TVT Registry]; NCT01737528 )

The subfield of organizational justice has entered young adulthood. Its scientific achievements from conception to contemporary applications are represented in The Oxford Handbook of Justice in the Workplace, edited by Russell Cropanzano and Maureen Ambrose. The Handbook highlights advances in the field’s theoretical foundations, measurements, and applications. This Handbook follows a decade on the heels of its predecessor, Handbook of Organizational Justice, edited by Jerald Greenberg and Jason Colquitt. In 2005 the justice field was dominated by developmental debates over esoteric definitions of various facets of organizational justice, whereas the present Handbook reflects construct refinement, orientation to detail, and theoretical nuance that comes with maturation. This timely release therefore offers a fitting opportunity to reflect on key trends over the last 10 years and to consider the future of organizational justice research. This collection of comprehensive chapters meticulously compiled by the luminaries of organizational justice shows that organizational justice is still young, developing, and full of potential to influence the world.

Recent investigation suggests that near infrared (NIR) light may improve symptoms from mild traumatic brain injury. In addition, quantitative electroencephalography (qEEG) has shown measures correlating with concussion: P300, reaction time, and amplitude. The objective of this study was to determine whether NIR light treatment has an acute effect on brain state in healthy patients as measured by EEG.A total of 31 healthy volunteers, between the ages of 14 and 65, underwent qEEG event-related response tests before and after a 20-min NIR light head treatment. The treatment device is composed of 784 NIR GaAIAs LEDs covering 360 cmChange in reaction time significantly differed between treated and control, with a mean of 23.8 msec improvement compared with controls (p = 0.035). Amplitude increased an average of 0.81 μV in treatment versus 0.22 μV in controls and did not reach significance. However, subanalysis of 14 treated subjects and 8 controls displaying initially low amplitude showed a mean increase in amplitude of 1.83 μV (30%) in treated subjects versus 0 μV in controls (p = 0.08). P300 measures did not show significant differences between groups.The data suggest that NIR light may have an acute effect on reaction time and amplitude in certain subject subsets. There were no adverse events registered across the 31 subjects in the treatment group, nor in the 18 evaluable control group subjects.

The current chapter tackles the challenge of defining social skills. Existing definitions of both social skills and social competence are reviewed and synthesized. In addition, prominent models of social skills and competence are presented, and the utility of each perspective is discussed. Finally, the models are distilled to four core target skill areas: communication skills, emotion regulation, cognitive skills, and social problem solving. Each target skill area is defined and linked to adjustment and intervention across the lifespan.

Affective organizational commitment is theorized and empirically tested as a key mediator between authentic leadership and desirable employee outcomes. The results of a two-wave survey of 830 business people in Australia support a serial mediation model of authentic leadership efficacy. Followers' perceptions of authentic leadership behavior influence their personal identification and affect-based trust in the leader, which in turn are mediated by affective organizational commitment to positively influence their work engagement and job satisfaction. These findings reinforce previous work that positions personal identification and affect-based trust as the two primary mediating mechanisms of authentic leadership. This paper extends prior research by demonstrating the important role of followers' affective bonds with their organization in the operation of authentic leadership, moving beyond the dyad in our understanding of follower outcomes.

Objective The impact of new-onset postoperative atrial fibrillation (POAF) following coronary artery bypass grafting (CABG) surgery on long-term clinical outcomes and costs is not known. This subanalysis of the Veterans Affairs “Randomized On/Off Bypass Follow-up Study” compared 5-year outcomes and costs between patients with and without POAF. Methods Of the 2203 veterans in the study, 100 with pre-CABG atrial fibrillation (93) or missing data (7) were excluded (4.8%). Unadjusted and risk-adjusted outcomes were compared between new-onset POAF (n = 551) and patients without POAF (n = 1552). Five-year clinical outcomes included mortality, major adverse cardiovascular events (MACE, comprising mortality, repeat revascularization, and myocardial infarction), MACE subcomponents, stroke, and costs. A stringent P value of ≤.01 was required to identify statistical significance. Results Patients with POAF were older and had more complex comorbidities. Unadjusted 5-year all-cause mortality was 16.3% POAF versus 11.9% no-POAF, P = .008. Unadjusted cardiac-mortality was 7.4% versus 4.8%, P = .022. There were no differences between groups in any other unadjusted outcomes including MACE or stroke. After risk adjustment, there were no significant differences between groups in 5-year all-cause mortality (POAF odds ratio, 1.19; 99% confidence interval, 0.81-1.75) or cardiac mortality (odds ratio, 1.51, 99% confidence interval, 0.88-2.60). Adjusted first-year post-CABG costs were $15,300 greater for patients with POAF, but 2- through 5-year costs were similar. Conclusions No 5-year risk-adjusted outcome differences were found between patients with and without POAF after CABG. Although first-year costs were greater in patients with POAF, this difference did not persist in subsequent years.

This article examines empirical links between a subordinate’s felt recognition respect from his/her supervisor, the subordinate’s appraisal respect for that supervisor, and bullying, work engagement, and organizational citizenship behaviour in Vietnam’s public sector. Data from 274 employees in six branches of a public sector agency were used to test the hypothesized model. Within Vietnam’s public sector, the followers who receive recognition respect from the leaders have greater appraisal respect for their leaders, experience less bullying, and reveal higher work engagement and organizational citizenship behaviour. This article theoretically and empirically contributes to the respect literature developed in the Western context.

Background: Studies of the relationship between patient self-reported angina symptoms using the Seattle Angina Questionnaire (SAQ) and angiographic findings after coronary artery bypass grafting surgery (CABG) are lacking. Nested within a randomized controlled trial, this prospective observational cohort comparison study aimed to assess which clinical characteristics and angiographic findings are associated with self-reported angina 1 year after CABG. Methods and Results: Patients from the ROOBY trial (Randomized On/Off Bypass) with protocol-specified 1-year post-CABG coronary angiography and SAQ assessments were included (n=1258). Patients reporting no angina (62.3%) within 4 weeks before the 1-year post-CABG study visit on the SAQ angina frequency domain were compared with patients reporting angina (37.7%). Multivariable modeling identified clinical variables and angiographic findings associated with angina. Sequential univariate and multivariable modeling found the following demographic and clinical factors were associated with angina after CABG: younger age, worse preoperative SAQ angina frequency score, smoking, diabetes mellitus, and pre-CABG depression. The only 1-year angiographic finding significantly associated with angina was incomplete revascularization of the left anterior descending (LAD) territory. Graft occlusions, incomplete revascularization of non-LAD territories, and ≥70% lesions in nonrevascularized native coronary arteries were not correlated with the presence or absence of angina. Further, only 30.6% of subjects reporting angina at 1 year had a residual major coronary artery stenosis of ≥70%. Conclusions: Self-reported angina 1 year after CABG is associated with younger age, worse baseline SAQ angina frequency score, smoking, diabetes mellitus, and depression. The only angiographic finding associated with angina was a poorly revascularized LAD territory. These results may help guide physicians when counseling patients on expected improvements in angina symptoms and in making decisions regarding the need for coronary angiography after CABG. Whether intensive treatment of these comorbidities improves post-CABG angina symptoms requires further study. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00032630.

International audience; This study examines the conditions under which apologies help to elicit forgiveness and restore trust following trust violations between leaders and followers. The intentionality and severity of violations are examined in a critical incident study and a laboratory study. The results support a model in which forgiveness mediates the relation of apology quality and trust. More importantly, the moderation–mediation model shows that apology quality influenced forgiveness and subsequent trust following violations that were moderate in severity–intentionality combination. The effect of apologizing affects trust directly without forgiveness when the severity–intentionality combination held minor or extreme intensity. The results suggest a range in which apologies are effective and enrich understanding of the conditions under which trust can be recovered through an apology–forgiveness process in leader–follower relationships. The contribution of the study lies in elucidating that the combination of severity and intentionality of leaders’ trust violations has greater importance than either one separately.

The bureaucratic and impersonal nature of public management can fertilize workplace bullying and risks for psychological health and safety. Psychological safety climate (PSC) is an important indica...