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Non-infectious pulmonary complications (NIPC) after allogeneic hematopoietic stem cell transplantation (alloHSCT), including bronchiolitis obliterans syndrome (BOS), cause significant morbidity and mortality, but their impact on healthcare resource utilization (HRU) and costs is unknown. This longitudinal retrospective study quantified the economic burden of NIPC and BOS in alloHSCT patients using commercial claims data from the IQVIA PharMetrics Plus™ database. Study patients were aged 0-64 who underwent alloHSCT between 1/1/2006-9/30/2018 and observable 12 months before and up to 5 years after index alloHSCT. NIPC patients were identified using International Classification of Disease (ICD) diagnosis codes. Outcomes were mean per-patient HRU (inpatient admissions, outpatient office, hospital visits, and prescription medications) and costs paid by insurers in each post-transplant year. Among 2,162 alloHSCT patients, 254 developed NIPCs and 155; 147 were propensity score matched to non-NIPC patients. The The mean age was 43yrs and 46% were female. In the first year following transplantation, NIPC patients had significantly higher inpatient admission rates (3.8 ± 3.2 vs. non-NIPC: 2.6 ±2.4; p

Dicyandiamide (DCD) has been extensively used to retard nitrification process and decrease nitrogen (N) losses. However, its efficacy is variable and inconsistent depending upon the environmental c...

OBJECTIVE We studied the utilization of home health care (HHC) among acute myocardial infarction (AMI) patients, impact of HHC on and predictors of 30-day readmission. METHODS We queried the National Readmission Database (NRD) from 2012 to 2014identify patients with AMI discharged home with (HHC+) and without HHC (HHC-). Linkage provided in the data identified patients who had 30-day readmission, our primary end-point. The probability for each patient to receive HHC was calculated by a multivariable logistic regression. Average treatment of treated weights were derived from propensity scores. Weight-adjusted logistic regression was used to determine impact of HHC on readmission. RESULTS A total of 406 237 patients with AMI were discharged home. Patients in the HHC+ cohort (38 215 patients, 9.4%) were older (mean age 77 vs. 60 years P < 0.001), more likely women (53 vs. 26%, P < 0.001), have heart failure (5 vs. 0.5%, P < 0.001), chronic kidney disease (26 vs. 6%, P < 0.001) and diabetes (35 vs. 26%, P < 0.001). Patients readmitted within 30-days were older with higher rates of diabetes (RR = 1.4, 95% CI: 1.37-1.48) and heart failure (RR = 5.8, 95% CI: 5.5-6.2). Unadjusted 30-day readmission rates were 21 and 8% for HHC+ and HHC- patients, respectively. After adjustment, readmission was lower with HHC (21 vs. 24%, RR = 0.89, 95% CI: 0.82-0.96; P < 0.001). CONCLUSION In the United States, AMI patients receiving HHC are older and have more comorbidities; however, HHC was associated with a lower 30-day readmission rate.

Background This study was conducted to determine the current nationwide trends and outcomes of reoperative surgical aortic valve replacement (SAVR) performed for a degenerated bioprosthesis. Methods Data from The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database were used. All patients who underwent isolated reoperative SAVR for a degenerated aortic bioprosthesis between January 2012 and December 2016 were included. Patients who had other concomitant cardiac surgery procedures or active endocarditis were excluded. Changes during this period were tracked with trend analyses. Results The number of patients undergoing SAVR for bioprosthetic failure increased substantially between 2012 and 2014 (782 in 2012 to 844 in 2013 and to 900 in 2014; relative change, +7.25%); this trend reversed significantly between 2015 and 2016 (decreased to 873 in 2015 and to 840 in 2016; relative change, −3.4%; P = .005). Patients were older in 2012-2014 (65.80 ± 13.52 years) compared with 2015-2016 (64.45 ± 12.91 years; P = .001). Mean STS-predicted mortality risk score decreased from 4.55% in 2012-2014 to 4.25% in 2015-2016 (P = .001). There was no difference in postoperative stroke (1.80% vs 1.80%, P = .87), renal failure requiring dialysis (2.7% vs 2.8%, P = .69), or operative mortality (3.5% vs 4.0%, P = .36) after reoperative SAVR in 2012-2014 and 2015-2016, respectively. Conclusions The number of patients undergoing SAVR for a degenerated bioprosthesis is decreasing in the United States, particularly among older and high-risk patients. These trends may reflect the adoption of valve-in-valve transcatheter aortic valve replacement for a degenerated bioprosthesis after its United States Food and Drug Administration approval in 2015.

Background: Although the survival advantage of bilateral internal thoracic artery grafting (BITA) is well known in patients undergoing coronary artery bypass grafting (CABG), this technique has not been widely adopted. This is mainly because of the increased risk of deep sternal wound infections (DSWI) associated with its use. However, in recent years the overall risk of DSWI has decreased. This is mainly because of strategies that have been adopted to decrease the risk of these infections in patients undergoing CABG. Conclusion: In this review we identified DSWI preventive strategies and described them in detail so that their use by surgeons can be increased. This would minimize the risk of DSWI after BITA grafting and maximize the use of this highly effective surgical technique.

Intensive crop production systems worldwide, particularly in China, rely heavily on nitrogen (N) fertilization, but left more than 50% of fertilizer N in the environment. Nitrogen (over) fertilization and atmospheric N deposition induce soil acidification, which is neutralized by soil inorganic carbon (SIC; carbonates), and carbon dioxide (CO2 ) is released to the atmosphere. For the first time, the loss of SIC stocks in response to N-induced soil acidification was estimated for Chinese croplands from 1980 to 2020 and forecasts were made up to 2100. The SIC stocks in croplands in 1980 were 2.16 Pg C (16.3 Mg C/ha) in the upper 40 cm, 7% (0.15 Pg C; 1.1 Mg C/ha) of which were lost from 1980 to 2020. During these 40 years, 7 million ha of cropland has become carbonate free. Another 37% of the SIC stocks may be lost up to 2100 in China, leaving 30 million ha of cropland (37.8%) without carbonates if N fertilization follows the business-as-usual (BAU) scenario. Compared to the BAU scenario, the reduction in N input by 15%-30% after 2020 (scenarios S1 and S2) will decrease carbonate dissolution by 18%-41%. If N input remains constant as noted in 2020 (S3) or decreases by 1% annually (S4), a reduction of up to 52%-67% in carbonate dissolution is expected compared to the BAU scenario. The presence of CaCO3 in the soil is important for various processes including acidity buffering, aggregate formation and stabilization, organic matter stabilization, microbial and enzyme activities, nutrient cycling and availability, and water permeability and plant productivity. Therefore, optimizing N fertilization and improving N-use efficiency are important for decreasing SIC losses from acidification. N application should be strictly calculated based on crop demand, and any overfertilization should be avoided to prevent environmental problems and soil fertility decline associated with CaCO3 losses.

It is an integral property of sorghum (Sorghum bicolor L.) to extensively release biological nitrification inhibitors (BNIs) under NH4+ nutrition, in comparison to NO3− nutrition. Our previous research indicated that plasma membrane (PM) H+-ATPase activity was stimulated by NH4+ and low rhizosphere pH, which in turn provided the driving force for BNIs release from sorghum roots. However, the regulatory mechanism of PM H+-ATPase itself in this regard is not fully elucidated. The present study thus aims at post-translational regulation of PM H+-ATPase via phosphorylation in response to NH4+ nutrition and its functional link to the release of BNIs from sorghum roots. A hydroponic system is used to grow sorghum with 1 mM NH4+ or NO3− as N source at pH 3.0 or pH 7.0 in root medium for the analysis of PM H+-ATPase and BNIs release. The effect of NH4+ on the regulation of PM H+-ATPase was further evaluated by the treatment of NO3−cultivated sorghum roots with different NH4+ concentrations (0.1~1 mM). In addition, fusicoccin (a stimulator of PM H+-ATPase) and vanadate (an inhibitor of PM H+-ATPase) were added to check the effect of PM H+-ATPase phosphorylation on BNIs release. Further, methionine sulphoximine (MSX), which inhibits glutamine synthetase, is used to analyze the effect of ammonium transport/assimilation process on the PM H+-ATPase and BNIs release. Microsomal membrane protein isolated from these roots was used for the test of PM H+-ATPase phosphorylation level by western blot technique. Meanwhile, the root exudates were collected for the analysis of BNIs. Higher amount of PM H+-ATPase protein with higher phosphorylation level were detected in sorghum roots in response to NH4+ and low rhizosphere pH, as compared to NO3− and high pH. Further, PM H+-ATPase protein amount and phosporylation level were dependent on the local supplement of NH4+ (from 0.1 ~ 1 mM) to roots. Nevertheless, the enhanced posphorylation level under all of these treatments was significantly higher than the enhanced protein level of PM H+ ATPase. Unlike protein level, phosphorylation level is closely correlated to the release of BNIs from sorghum roots. In addition, phosphorylation level of PM H+-ATPase adjusted by fusicoccin or vanadate directly affected the release of BNIs, irrespective of the protein level. In addition, ammonium assimilation inhibitor MSX caused decreased phosphorylation level of PM H+-ATPase without affecting the protein level, meanwhile inhibited the release of BNIs from sorghum roots. Our research suggests that phosphorylation of PM H+-ATPase is one of the important regulation mechanisms involved in the release of BNIs from sorghum roots. NH4+ stimulated PM H+-ATPase phosphorylation via excessive H+ generated by NH4+ assimilation in cytoplasm. The up regulation of PM H+-ATPase at post-translational level thus activated the H+ pumping activity to provide the driving force for BNIs release. A new hypothesis is proposed to elucidate the interplay of these functionally inter-linked processes involving ammonium-uptake, −assimilation, and H+-pumps activation in PM on the release of BNIs from sorghum roots.

Information on paroxysmal supraventricular tachycardia (PSVT) patient characteristics and the associated economic burden of the disease is limited. Therefore, we sought to characterize newly diagnosed PSVT patients and quantify their healthcare resource use and expenditures. We used enrollment, demographic, and claims data from IBM MarketScan Research Database and Medicare Limited Data Set (LDS) to identify patients newly diagnosed with PSVT (ICD-9: 427.0; ICD-10: I47.1) from 10/1/2012 to 9/30/2016. Patients were required to be observable 1-year before and after index diagnosis. Patients were stratified by age (

The trends in human population growth suggest that population will be a primary driver to produce more with limiting resources. Here, we discuss the correlation between population growth and the projected changes in various sectors and the resultant increase in nitrogen (N) use in Pakistan. Main drivers for increasing N use are (i) population; (ii) food and feed production; (iii) livestock population; (iv) land use; (v) dietary patterns; (vi) power generation; (vii) industry; and (viii) transport. As N use increases, it adds into N emissions, impacts biodiversity, and increases air and water pollution and eutrophication, which raise concerns about human health and socioecological sustainability and abatement costs. Given the important role of N in economy, food security, human health, and environment, a detailed discussion on critical N drivers is essential to improve our understanding about N cycling/dynamics. In Pakistan, a steadily increasing N consumption calls for optimizing N demand and use. Development and enforcement of regulatory measures are needed to reduce N footprints both for the industrial and agriculture sector in Pakistan. Recognizing the cross-related sectors and interrelated drivers, a holistic approach is required to be adopted for regular assessment of N dynamics.

Nitrogen (N) has gained significant attention because of its vital role in food and feed production; however, its excessive use is being criticized for environmental pollution. Nitrogen use is highly imbalanced and inefficient worldwide which is having serious repercussions to the environment and the adjacent ecosystems. The gap between N input to cropland and N use by crops has widened globally as well as in Pakistan over the time and has resulted in a huge amount of surplus N being lost to the environment. In this context, it is very important to know the dynamics of N cycle which are driven by the combination of N sources and sinks. In this chapter, we have discussed in detail the historical changes in N sinks in the agro-food system of Pakistan. Nitrogen uptake by crops is the largest N sink which is further subdivided as N use by livestock and humans. Nitrogen losses toward atmosphere, soil, and water resources are important N sinks which are expanding with the time and are exacerbating environmental degradation. Some of the N sinks are beneficial for the environment such as increased N uptake by plants and removal of reactive N from soils to the atmosphere in N2 form. The increasing volume and magnitude of N sinks requires a proper attention and an assessment in order to control the subsequent environmental pollution. A strong collaboration among all sectors and stakeholders is needed to optimize N use and reducing its leakage to the environment.

Objectives: We conducted this study by comparing low dose of atracurium with low dose rocuronium to see their effects on quality of endotracheal intubation and recovery characteristics as these both agents are widely available and practiced in anesthesia. Study Design: This is prospective, randomised, double blind clinical trial. Setting: ENT operating room of King Khalid Hospital, Saudi Arabia. Period: From January 2018 to April 2018. Material & Methods: In this study, 80 elective paediatric patients planned for adenotonsillectomies operations were randomly selected. Anesthesia was induced by using fentanyl 2 mcg/kg, propofol 2 mg/kg. Patients were divided into two groups, group A and group R. Group A received 0.3 mg/kg atracurium and group R received 0.3 mg/kg rocuronium to facilitate endotracheal intubation. Sevoflurane was used for maintenance of anaesthesia in 50 percent oxygen and 50 percent nitrous oxide. Dexamethasone 0.1 mg/kg was administered in all patients to reduce post operative airway oedema and prophylaxis for PONV. Quality of intubation was assessed and graded as; Good: Jaw and vocal cords relaxed and no patient movement/coughing upon laryngoscopy/intubation. HR and BP within 20 percent range. Fair: Jaw and vocal cords relaxed but patient show body movement/coughing upon laryngoscopy/intubation HR and BP within 20 percent range. Poor: Jaw is partially relaxed, vocal cords moving/closed and patient shows body movement/coughing upon laryngoscopy/intubation. HR and BP beyond 20 percent range. Results: There were 40 patients in each group. 37.5 percent were operated for tonsillectomy, 32.6 percent for adenotonsillectomy and 30.1 percent for tonsillectomy and there was no statistically significant difference regarding type of operation (P=0.861). Age (P=0.321), sex (P=0.370) and weight (P=0.243) in both groups. Grades of intubation quality were comparable and same in both groups (P=0.710). Extubation and recovery was also normal and same in both groups. Conclusion: Low doses of atracurium or low dose of rocuronium can be safely used for good quality of endotracheal intubation and smooth recovery in elective paediatric patients coming for short ENT operations.

Re-admission is an important source of patient dissatisfaction and increased hospital costs. A simple calculator to determine the probability of re-admission may help guide patient dismissal planning.Using the national readmissions database (NRD), we identified admissions for isolated primary coronary artery bypass (CABG) and stratified them according to 30-day readmission. Including pre, intra and postoperative variables, we prepared a logistic regression model to determine the probability for re-admission. The model was tested for reliability with boot-strapping and 10-fold cross-validation.From 135,699 procedures, 19,355 were readmitted at least once within 30days of dismissal. Patients who were readmitted were older (67±10 vs 65 ± 10 years, p0.01), females (32% vs 24%; p0.01) and had a higher Elixhauser comorbidity score (1.5±1.4 vs 1.1±1.2; p0.01). Our final model (c- statistic=0.65) consisted of 16 pre and three postoperative factors. End-stage renal disease (OR 1.79 [1.57-2.04]) and length of stay9days (OR 1.60 [1.52-1.68]) were most prominent indicators for readmission. Compared to Medicaid beneficiaries, those with private insurance (OR 0.62 [0.57-0.68]) and Medicare (OR 0.85 [0.79-0.92]) coverage were less likely to be readmitted.Our simple 30-days CABG readmission calculator can be used as a strategic tool to help reduce readmissions after coronary artery bypass surgery.

The long-term stability of soil inorganic carbon (SIC) and its minimum contribution towards global C cycle has been challenged, as recent studies have showed rapid decreases in SIC stocks in intensive agricultural systems. However, the extent of SIC losses and its driving factors remains unclear. Here, we compared changes in SIC density (SICD) in Chinese croplands between the 1980s and 2010s. The SIC contents in 1980s were obtained from second national soil survey (n = 949) and published studies (n = 47). The SIC contents in 2010s were based on resampling of soil profiles from the same locations during 2019 and 2020 (n = 30), as well as data from published studies and national soil survey (n = 903). We found that Chinese croplands have lost 27-38% of SICD from the 0-40 cm soil layer and that the soil pH has decreased by 0.53 units over the past 30 years. These SIC losses increased with the ratio of precipitation (P) to potential evapotranspiration (PET) and most notably with nitrogen (N) fertilization. The SICD decreased greatly in humid and semiarid regions, and these losses were enhanced by high N fertilization rates; however, the SICD increased in very arid regions. This analysis demonstrates that the water balance and N fertilization are major drivers leading to dramatic losses of SICD in croplands and, consequently, to decreases in soil fertility and functions.

It remains uncertain how advances in revascularization techniques, availability of new evidence, and updated guidelines have influenced the annual rates of coronary revascularization in the United States.We used the Nationwide Inpatient Sample data from 2005 to 2014 with appropriate weighting to determine national procedural volumes. To present accurately overall percutaneous coronary intervention (PCI) rates, PCI with same-day discharge numbers per year were estimated from the available literature and added to annual PCI procedures performed.Annual PCI rate declined from 353 per 100,000 adults in 2005 to 277 per 100,000 adults in 2009 (P.001) but remained stable thereafter (P = .50). Annual coronary artery bypass grafting (CABG) rate declined steadily, at a shallower slope than PCI, from 120 per 100,000 in 2005 to 93 per 100,000 in 2009 (P = .02) but remained stable thereafter (P = .60). Similar trends were seen in men and women. Both PCI and CABG rates were lower in women than men over the study period (PCI, 482 to 324/100,000 in men vs 232 to 153/100,000 in women; CABG, 172 to 118/100,000 in men vs 64 to 38/100,000 in women). Annual PCI rates were higher than CABG rates in patients of all age groups including in younger patients (age50) and octogenarians. The proportion of coronary revascularization procedures performed per insurance type remained relatively similar across the study period.Annual rates of coronary revascularization have changed significantly over time, potentially because of advances in revascularization techniques, availability of new evidence, and updated guidelines. Rates of PCI declined more steeply than CABG before plateauing but remained higher than rates of CABG across the study period.

Background Limited data exist studying the outcomes of the 2 minimally invasive aortic valve replacement (AVR) strategies—mini-sternotomy (AVR-st) and right anterior thoracotomy (AVR-th). We conducted an indirect meta-analysis to compare the outcomes of these minimally invasive approaches with each other and with conventional AVR (cAVR). Methods We Searched Medline, PubMed, Embase, and Web of Science in December 2017 for studies comparing AVR-st, AVR-th, and cAVR. Clinical outcomes were compared between cohorts with inverse weighted random effects modeling. Endpoints studied included hospital mortality, stroke, atrial fibrillation, cardiopulmonary bypass (CPB) time, and length of stay. Results A total of 19 studies (>10,000 pooled patients) met the inclusion criteria. Mortality (p = 0.06) and stroke (p = 0.15) were comparable between minimally invasive and conventional AVR. CPB times were longer with AVR-th versus cAVR (12.4 minutes [range, 5 to 19]; p Conclusions Minimally invasive approaches to AVR yield excellent outcomes in high-volume centers. They reduce hospital stay and incidence of postoperative atrial fibrillation, and therefore should be considered in patients undergoing AVR. The operative approach should be selected according to surgeon’s technical expertise and what is best for specific patient profile, however.

We studied the utilization of home health care (HHC) among acute myocardial infarction (AMI) patients, impact of HHC on and predictors of 30-day readmission.We queried the National Readmission Database (NRD) from 2012 to 2014identify patients with AMI discharged home with (HHC+) and without HHC (HHC-). Linkage provided in the data identified patients who had 30-day readmission, our primary end-point. The probability for each patient to receive HHC was calculated by a multivariable logistic regression. Average treatment of treated weights were derived from propensity scores. Weight-adjusted logistic regression was used to determine impact of HHC on readmission.A total of 406 237 patients with AMI were discharged home. Patients in the HHC+ cohort (38 215 patients, 9.4%) were older (mean age 77 vs. 60 years P0.001), more likely women (53 vs. 26%, P0.001), have heart failure (5 vs. 0.5%, P0.001), chronic kidney disease (26 vs. 6%, P0.001) and diabetes (35 vs. 26%, P0.001). Patients readmitted within 30-days were older with higher rates of diabetes (RR = 1.4, 95% CI: 1.37-1.48) and heart failure (RR = 5.8, 95% CI: 5.5-6.2). Unadjusted 30-day readmission rates were 21 and 8% for HHC+ and HHC- patients, respectively. After adjustment, readmission was lower with HHC (21 vs. 24%, RR = 0.89, 95% CI: 0.82-0.96; P0.001).In the United States, AMI patients receiving HHC are older and have more comorbidities; however, HHC was associated with a lower 30-day readmission rate.

Background: In the United States (US), colorectal cancer (CRC) is the second leading cause of cancer-related deaths. With the majority of the US population covered by employer-based health plans, employers can play a critical role in increasing CRC screening adherence, which may help avert CRC-related deaths. Therefore, it is important for self-insured employers to consider the impact of appropriate utilization of CRC screening options. Objective: To evaluate the impact of increasing multitarget stool DNA [mt-sDNA (Cologuard®)] use among CRC screeners from the perspective of a US self-insured employer. Methods:A 5-year Markov model was developed to quantify the budget impact of increasing mt-sDNA from 6% to 15% among average-risk screeners using colonoscopy, fecal immunological test, and mt-sDNA. Data on direct medical costs were obtained from published literature, Medicare CPT codes, and the Healthcare cost and Utilization project. Indirect costs included productivity loss due to workplace absenteeism for CRC screening and treatment. Results: With a hypothetical population of 100,000 employees with screeners aged 50–64 years, compared to status quo, increased mt-sDNA utilization resulted in no differences in the numbers of cancers detected and the overall direct and indirect cost savings were ~$214,000 ($0.04 per-employee-per-month) over 5 years. Most of the savings were due to a reduction in the direct medical expenditure related to CRC screening, adverse events, and productivity loss due to colonoscopy screening. Similar results were observed in the model simulation among screeners aged 45–64 years. Conclusion: Increased utilization of mt-sDNA for CRC screening averts direct and indirect medical costs from a self-insured US employer perspective.

Coronary artery bypass grafting is one of the most commonly performed surgeries in the United States and worldwide. It can be performed with or without the use of cardiopulmonary bypass (referred to as on-pump or off-pump coronary artery bypass grafting, respectively). For most patients undergoing coronary artery bypass grafting, the on-pump approach remains the default option. This chapter describes the technique of aortic cannulation in patients undergoing on-pump coronary artery bypass grafting.

Bronchiolitis obliterans syndrome (BOS) is a major cause of morbidity and mortality in lung transplantation and allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. Clinical guidelines recommend lung function monitoring to aid early identification of BOS, but real-world rates of pulmonary function testing (PFT) have not been studied. The purpose of this study was to quantify PFT rates in lung transplantation and allo-HSCT recipients.This longitudinal retrospective study used US data from the IQVIA PharMetrics Plus commercial claims database (January 1, 2006-September 30, 2018) and the Medicare Limited Data Set (January 1, 2010-December 31, 2018). Study recipients had no evidence of transplantation 12 months before transplantation, which was identified by using diagnosis and procedure codes. PFTs were identified by using procedure codes. Outcomes were percentage of recipients who received ≥1 PFT in each follow-up year, including spirometry, lung diffusion capacity, lung function volume test, and plethysmography, including the average number of total and specific tests per recipient.The study identified 367 commercially insured and 1776 Medicare recipients who underwent lung transplantation; 92% and 86% received ≥1 lung function test in the first year after transplantation, respectively. Among recipients observable 3 years after transplant, 85% and 83% received ≥1 PFT. Among 2187 commercially insured and 1864 Medicare recipients who underwent allo-HSCT, 44% and 36% received ≥1 lung function test in the first posttransplant year. In the third year after transplant, only 31% and 26% of observable allo-HSCT recipients underwent any PFT.Morbidity and mortality from BOS remain high in lung transplant and allo-HSCT recipients, but lung function testing in the first posttransplant year is not universal, with substantially lower rates among allo-HSCT recipients. Furthermore, testing rates in all cohorts declined over time. Increased and sustained monitoring could lead to earlier detection of BOS and earlier intervention and treatment.

This letter explains the processes and mechanisms involved in the nitrogen-induced soil acidification causing substantial carbonate losses and subsequent CO2 emissions from Chinese croplands.

POTS is under diagnosed with an estimated prevalence of 0.2%. North American and Australian researchers, as well as patient groups have called for more research into POTS. However, there has been no comprehensive appraisal of the current POTS evidence base.To map the POTS evidence base.Two reviewers systematically searched 12 databases until July 1st 2019 using the search term "Postural Tachycardia Syndrome" (n = 7280) and categorised the literature. Inclusion criteria included all adult published literature with no language restrictions. 779 papers are analysed and mapped.Seven themes were identified: symptomology and quality of life 16.8% (n = 132), biomedical topics 16.5% (n = 130), co-morbidities 10.3% (n = 81), non-pharmacological management 9.8% (n = 77), aetiologies 6.9% (n = 53), pharmacological management 6.7% (n = 53), and clinical management 6.6% (n = 52). There 45 subthemes. Quality appraisal of the research studies (n = 233) evaluated design, sample size, outcome measures, data analysis and research biases. 74.8% (n = 175) were observational designs and 25.2% (n = 59) were experimental designs (16 using a randomised controlled design, 11 of which had a sample size greater than 21). 47.4% (n = 111) of studies only measured duration of effect for1 day. 11.5% (n = 27) of studies reported outcomes using an unvalidated subjective measurement tool.The volume of adult POTS literature is small and the validity and reliability of the research lacks rigour. The evidence map methodology provides POTS researchers with a benchmark for research thus far. This paper adds an in-depth research appraisal to the broad calls for action, highlighting the pressing need for multicentre, good quality research in POTS, to support guidelines and consensus development in the future.

Background Information on differences in paroxysmal supraventricular tachycardia (PSVT) diagnosis, healthcare resource use, expenditures, and treatment among women versus men is limited. Methods and Results Study participants identified in the IBM MarketScan Commercial Research Databases were aged 18 to 40 years with newly diagnosed PSVT ( International Classification of Diseases, Ninth Revision [ ICD‐9 ]: 427.0; International Classification of Diseases, Tenth Revision [ ICD‐10 ]: I47.1) from October 1, 2012, through September 30, 2016, observable 1 year preindex and postindex diagnosis. Study outcomes were mean annual per‐patient healthcare resource use and expenditures before and after diagnosis. Among 5466 patients newly diagnosed with PSVT, most (66.9%) were women. Compared with men, women with PSVT tended to have higher rates of anxiety (13.9% versus 10.9%; P P P P P P P Conclusions Among patients aged 18 to 40 years, ≈2 of 3 patients diagnosed with PSVT were women. After diagnosis, spending was significantly lower for women, reflecting lower ablation rates and less spending on services with a PSVT diagnosis.

OBJECTIVE To compare post-procedural outcomes of trans-catheter valve replacement (TAVR) among safety-net (SNH) and non-safety net hospitals (non-SNH). BACKGROUND SNH treat a large population of un-insured and low income patients; prior studies report worse outcome at these centers. Results of TAVR at these centers is limited. METHODS Adults undergoing TAVR at hospitals in the US participating in the National In-patient sample (NIS) database from January 2014 to December 2015 were included. A 1:1 propensity-matched cohort of patients operated at SNH and non-SNH institutions was analyzed, on the basis of 16 demographic and clinical co-variates. Main outcome was all-cause post-procedural mortality. Secondary outcomes included stroke, acute kidney injury and length of post-operative stay. RESULTS Between 2014 and 2015, 41,410 patients (mean age 80 ± 0.11 years, 46% female) underwent TAVR at 731 centers; 6,996 (16.80%) procedures were performed at SNH comprising 135/731 (18.4%) of all centers performing TAVR. SNH patients were more likely to be female (49% vs. 46%, p

Introduction: Safety-net hospitals (SNH) treat a large population of un-insured and low income patients; several prior studies report worse outcome at these centers. Trans-catheter valve replacement (TAVR) is emerging as first-line therapy for aortic stenosis irrespective of surgical risk scores. However, results of TAVR performed at these centers is limited. Objective: To determine whether post-procedural outcomes of TAVR are comparable at safety-net (SNH) and non-safety net hospitals (non-SNH). Methods: We conducted a retrospective, cohort study with propensity-matched analysis. Complex survey data from the Agency for Healthcare Quality and Research containing weighted sample of all hospital admissions nationwide was utilized for this study. Adults undergoing TAVR at US hospitals participating in the National In-patient sample (NIS) database from January 2014 - December 2015 were included. A 1:1 propensity-matched cohort of patients operated at safety-net hospitals (SNH) and non-SNH institutions was analyzed. Propensity-matching was performed on the basis of sixteen demographic and clinical confounding co-variates. Main outcome studied was all-cause post-procedural mortality. Secondary outcomes compared were stroke, acute kidney injury and length of post-operative stay. Results: Between 2014 - 2015, 41410 patients (mean age 80 +/- 0.11 years, 46% female) underwent TAVR at 731 centers nationwide; 6996 (16.80 %) procedures were performed at safety net centers. SNH comprised 135/731 (18.4%) of all centers performing TAVR. SNH patients were more likely to be female (49 % vs 46 %, p Conclusion: Post-procedural outcomes after TAVR at SNH are comparable to national outcomes. Our study provides preliminary evidence that wider adoption of TAVR may not adversely influence outcomes at SNH.

Objective: Home health care (HHC) is a support tool to transition patients after discharge and acute myocardial infarction (AMI) is a significant cause of morbidity and mortality in the U.S. However, little is known regarding the impact of HHC on AMI patients. We sought to identify predictors of readmissions among AMI patients, characteristics of those who receive HHC and investigate the association of HHC with readmission. Methods: We queried the National Readmission Database (NRD) (January 2012 - December 2014), to identify patients discharged after AMI and selected patients who were discharged home with (HHC+) and without HHC (HHC-). We reported national estimates with survey methods with weights provided in our data. After univariate exploratory analyses, we developed a regression model to identify the probability of each patient to receive HHC. From the propensity score, we calculated average treatment on the treated (ATT) weights. These ATT weights were included in the logistic regression model to determine the impact of HHC on readmission after adjusting for available clinical confounders. We considered post-weighting standardized differences Results: Between January 2012 to December 2014, 406,237 patients were treated for AMI and discharged home with or without HHC. Among these 9.4% (38,215) received HHC. HHC+ patients were older (mean age 77 ± 11 vs 60 ±12 years p Conclusion: In the United States, a small proportion of patients receive home health care after discharge post-AMI. Older, females and those with diabetes or heart failure are more likely to receive home health care. Use of home health care may be associated with lower 30-day readmission rates after AMI.