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Introduction Providers will encounter transgender individuals in their practice, and it is important that they understand the unique challenges that these individuals face. Objective We sought to characterize the challenges transfeminine individuals face in seeking urological care through a developed questionnaire. Methods IRB approval was obtained to develop (with transgender community feedback) and administer a 58-item questionnaire assessing urinary and sexual health. Participants were recruited from the local community and the Philadelphia Trans Wellness Conference. We assessed the urologic care experiences of participants while comparing vaginoplasty (VP) and non-vaginoplasty (NVP) respondents. Results A total 32% of participants (n=17) sought care from a medical provider for GU/sexual symptoms in the past year. 41% of respondents (n=7) who sought medical care saw a urologist, with the majority having seen a urologist based on a referral or recommendation from another physician (n=5, 71%). Among all participants who had been to a urology practice in the past, 57% reported that they experienced a lack of knowledge about transgender health needs from a provider and/or office staff. 14 (26%) participants reported choosing not to see a urologist for one or more of the following reasons: 12 (85.7%) due to fear of being mistreated, disrespected, and/or misgendered, 10 (71.4%) due to discomfort around discussing urinary or sexual function issues as a transgender or gender nonconforming, 3 (21.4%) due to issues with insurance coverage, 3 (21.4%) due to issues with transportation or missing work, and 1 (7.14%) indicated “Other”. With respect to specific patterns of care between VP and NVP participants, we noted that NVP individuals were more likely to seek care for genitourinary issues (p=0.02) than NVP individuals. We also found that a higher proportion of VP compared to NVP individuals (45.5% vs 28.6%) sought general urologic care. Conclusions Transfeminine individuals experience a range of socio-economic barriers to urologic care. Participants indicated a reluctance to seek care because of discomfort and fear, and most reported inexperience from staff regarding transgender care. We noted that VP individuals were more likely to seek care from a urologist than NVP individuals, which may reflect a greater familiarity with the medical system. It is important for providers to be aware with these issues and communicate in a compassionate and affirming manner with their transgender patients. Disclosure No

Introduction Providers may be unfamiliar with the sexual health needs of transgender patients. This hinders chances to provide comprehensive care, as many patients require prompting to discuss sensitive sexual issues. To increase awareness of these issues, we developed a questionnaire which assessed the sexual health of transfeminine individuals. Objective We sought to describe the sexual experiences and preferences of transfeminine individuals, and to categorize sexual health needs in this population. Methods IRB approval was obtained to develop (with transgender community feedback) a questionnaire assessing urinary and sexual health. Sexual preferences, symptoms, and quality of life (QOL) responses were compared among vaginoplasty (VP) and non-vaginoplasty (NVP) groups. NVP respondents were evaluated based on the International Index of Erectile Function (IIEF) categories: erectile function (EF), orgasmic function (OF), and sexual desire (SD). Results 53 transfeminine individuals (11 vaginoplasty, 10 orchiectomy, 32 no procedure) with mean age of 40 years (range 21-80) participated. Sexual QOL was similar for both groups (Table 1). There was an association between self-reported sexual activity and VP/NVP status, where a higher proportion of NVP respondents reported sexual activity with others and penetrative anal sex (p Conclusions When comparing VP and NVP respondents, we found similarities in sexual QOL while noticing differences in sexual preference, highlighting the diversity of this population. While many NVP respondents reported importance of penile function and presence of erectile dysfunction, only a minority were on treatment. This highlights an opportunity for providers to discuss sexual health with transfeminine patients and offer appropriate treatments. Disclosure No

Importance The benefit of an electronic support system for the prescription and adherence to oral anticoagulation therapy among patients with atrial fibrillation (AF) and atrial flutter at heightened risk for of stroke and systemic thromboembolism is unclear. Objective To evaluate the effect of a combined alert intervention and shared decision-making tool to improve prescription rates of oral anticoagulation therapy and adherence. Design, Setting, and Participants A prospective single arm study of 939 consecutive patients treated at a large tertiary healthcare system. Exposures An electronic support system comprising 1) an electronic alert to identify patients with AF or atrial flutter, a CHA2DS2-VASc score ≥ 2, and not on oral anticoagulation and 2) electronic shared decision-making tool to promote discussions between providers and patients regarding therapy. Main Outcomes and Measures The primary endpoint was prescription rate of anticoagulation therapy. The secondary endpoint was adherence to anticoagulation therapy defined as medication possession ratio ≥ 80% during the 12 months of follow-up. Results Between June 13, 2018 and August 31, 2018, the automated intervention identified and triggered a unique alert for 939 consecutive patients with AF or atrial flutter, a CHA2DS2-VASc score ≥2 who were not on oral anticoagulation. The median CHA2DS2-VASc score among all patients identified by the alert was 2 and the median untreated duration prior to the alert was 495 days (interquartile range 123-1,831 days). Of the patients identified by the alert, 345 (36.7%) initiated anticoagulation therapy and 594 (63.3%) did not: 68.7% were treated with a non-Vitamin K antagonist oral anticoagulant (NOAC), 22.0% with warfarin, and 9.3 % combination of NOAC and warfarin. Compared with historical anticoagulation rates, the electronic alert was associated with a 23.6% increase in anticoagulation prescriptions. The overall 1-year rate of adherence to anticoagulant therapy was 75.4% (260/345). Conclusion and Relevance An electronic automated alert can successfully identify patients with AF and atrial flutter at high risk for stroke, increase oral anticoagulation prescription, and support high rates of adherence.

Background Clinical characteristics and outcomes in people living with HIV (PLWH) undergoing percutaneous coronary intervention (PCI) remain poorly described. We sought to compare real‐world treatment of coronary artery disease, as well as patient and procedural factors and outcomes after PCI between PLWH and uninfected controls. Methods and Results We utilized procedural registry data from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program between January 1, 2009 and December 31, 2019 to analyze patients with obstructive coronary artery disease on angiography. In the PCI subgroup, we used inverse probability of treatment weighting and applied Cox proportional hazards to evaluate the association of HIV serostatus with outcomes, including all‐cause mortality at 5 years. Among 184 310 patients with obstructive coronary artery disease, treatment strategy was similar between PLWH and controls—35.7% versus 34.2% PCI, 13.6% versus 15% coronary artery bypass grafting, and 50.7% versus 50.8% medical therapy. The PCI cohort consisted of 546 (0.9%) PLWH and 56 811 (99.1%) controls. PLWH undergoing PCI had well‐controlled HIV disease, and compared with controls, were younger, more likely to be Black, had fewer traditional risk factors, more acute coronary syndrome, less extensive coronary artery disease, and similar types of stents and P2Y12 therapy. However, PLWH experienced worse survival as early as 6 months post‐PCI, which persisted over time and amounted to a 21% increased mortality risk by 5 years (hazard ratio, 1.21 [95% CI, 1.03–1.42; P =0.02]). Conclusions Despite well‐controlled HIV disease, a more favorable overall cardiovascular risk profile, and similar PCI procedural metrics, PLWH still have significantly worse long‐term survival following PCI than controls.

With solar photovoltaic (PV)-based power generation becoming popular, research is being carried out in multiple facets of the PV system. The electrical aspect is one such area where objectives are extracting maximum power, developing power management strategies, etc. Hence, while experimenting with new strategies it is desirable to have controllable irradiation and temperature conditions. This ensures that external factors are constant for comparing the effectiveness of different strategies. Thus, PV emulators are a suitable solution to this. A deep learning-based PV emulator is proposed where the proposed PV emulator is capable of emulating a PV panel under uniform and non-uniform irradiance conditions. A deep learning network is modeled with irradiance, temperature, ratio of partial shading, PV current as inputs, & PV voltage as output. Then, a buck converter is controlled to follow the reference voltage, thereby mimicking the desired I-V characteristics. The deep learning model was trained and built in Python, and simulations to validate the performance were carried out in Simulink.

The objective of the review is to present the contemporary approaches involved in colonic drug targeting for the therapy of inflammatory bowel disease (IBD). The adverse reactions and side-effects of the conventional drug delivery systems are largely on account of the systemic absorption of the drugs from the small intestine. Moreover, in current drug delivery systems, the drug has to be frequently administered and also in larger doses which greatly reduces patient compliance. Various approaches which are being described here mainly target the colonic region specifically for improved therapy of IBD, by increasing localization and accessibility of the drug to the target site. Also, these approaches will result in the reduction of dose and minimization of adverse effects combined with the use of conventional drug delivery systems.

The current document commissioned by the Society for Cardiovascular Angiography and Interventions (SCAI) and endorsed by the American College of Cardiology, the American Heart Association, and Heart Rhythm Society represents a comprehensive update to the 2012 and 2016 consensus documents on patient-centered best practices in the cardiac catheterization laboratory. Comprising updates to staffing and credentialing, as well as evidence-based updates to the pre-, intra-, and post-procedural logistics, clinical standards and patient flow, the document also includes an expanded section on CCL governance, administration, and approach to quality metrics. This update also acknowledges the collaboration with various specialties, including discussion of the heart team approach to management, and working with electrophysiology colleagues in particular. It is hoped that this document will be utilized by hospitals, health systems, as well as regulatory bodies involved in assuring and maintaining quality, safety, efficiency, and cost-effectiveness of patient throughput in this high volume area.

Let G be a simple graph. Let k be a positive integer. G is said to be k- extendable if every independent set of cardinality k is contained in a maximum independent set of G. A graph is weakly k- extendable if any non-maximal independent set of cardinality k is contained in a maximal independent set of G. Every k- extendable is weakly k- extendable but not the converse. Thus weakly k- extendable graph is a class of graphs wider than the class of k-extendable graphs. k-extendable and weakly k- extendable have been studied in [1, 2,3,4,6]. Characterization of graphs with β0 (G) = (n - 3), β0 (G) = (n - 2), and which is trivially extendable has been done in [5]. In this paper, we derive the some results on k-extensibility and weakly k-extensibility in generalized Petersen graphs. “Detection of emerging communities in a social network proves helpful to trace the growth of certain interests or interest groups. There are many community detection algorithms in the literature. However, they have the limitations of being too loose or they are not scalable – i.e., inextensible to large social networks. In this paper, we define a new property for the generalized Petersen Graphs namely k-Extensibility, which helps to find and visualize such communities.”

The aims of this study were to examine rates of radial artery access in post-coronary artery bypass grafting (CABG) patients undergoing diagnostic catherization and/or percutaneous coronary intervention (PCI), whether operators with higher procedural volumes and higher percentage radial use were more likely to perform diagnostic catherization and/or PCI via the radial approach in post-CABG patients, and clinical and procedural outcomes in post-CABG patients who undergo diagnostic catherization and/or PCI via the radial or femoral approach.There are limited data comparing outcomes of patients with prior CABG undergoing transradial or transfemoral diagnostic catheterization and/or PCI.Using the National Cardiovascular Data Registry CathPCI Registry, all diagnostic catheterizations and PCIs performed in patients with prior CABG from July 1, 2009, to March 31, 2018 (n = 1,279,058, 1,173 sites) were evaluated. Temporal trends in transradial access were examined, and mortality, bleeding, vascular complications, and procedural metrics were compared between transradial and transfemoral access.The rate of transradial access increased from 1.4% to 18.7% over the study period. Transradial access was associated with decreased mortality (adjusted odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.75 to 0.91), decreased bleeding (OR: 0.57; 95% CI: 0.51 to 0.63), decreased vascular complications (OR: 0.38; 95% CI: 0.30 to 0.47), increased PCI procedural success (OR: 1.11; 95% CI: 1.06 to 1.16; p 0.0001), and significantly decreased contrast volume across all procedure types. Transradial access was associated with shorter fluoroscopy time for PCI-only procedures but longer fluoroscopy time for diagnostic procedures plus ad hoc PCI and diagnostic procedures only. Operators with a higher rate of transradial access in non-CABG patients were more likely to perform transradial access in patients with prior CABG.The rate of transradial artery access in patients with prior CABG undergoing diagnostic catheterization and/or PCI has increased over the past decade in the United States, and it was more often performed by operators using a transradial approach in non-CABG patients. Compared with transfemoral access, transradial access was associated with improved clinical outcomes in patients with prior CABG.

In secure domination [A. P. Burger, M. A. Henning and J. H. Van Vuuren, Vertex covers and secure domination in graphs, Quaest Math. 31 (2008) 163–171; E. J. Cockayne, Irredundance, secure domination and maximum degree in trees, Discrete Math. 307(1) (2007) 12–17; E. J. Cockayne, O. Favaron and C. M. Mynhardt, Secure domination, weak Roman domination and forbidden subgraph, Bull. Inst. Combin. Appl. 39 (2003) 87–100; C. M. Mynhardt, H. C. Swart and E. Ungerer, Excellent trees and secure domination, Util. Math. 67 (2005) 255–267], a vertex outside has the chance of coming inside the dominating set by replacing an element of the set without affecting domination. This idea is combined with equitability. Secure equitable dominating set is introduced and studied. Other concepts like independence and rigid security are also studied in this paper.

A trial was conducted to assess the physiological and biochemical changes in M. oleifera (L.) Millsp.cv. PKM 1 induced by heading back and pinching treatments. Chlorophyll content, nitrate reductase content, soluble protein content and total phenol content were assessed after the new shoot initiated from heading back and pruning treatments before the flower initiation. Height and stage at which the apical growth was arrested significantly influenced chlorophyll, nitrate reductase, protein and phenol content in leaves. Heading back at 70 cm combined with pinching 100 days after heading back greatly influenced the physiological and biochemical factors except for soluble protein as it was increased by heading back at 30 cm.

The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is highly infectious, carries significant morbidity and mortality, and has rapidly resulted in strained health care system and hospital resources. In addition to patient-related care concerns in infected individuals, focus must also relate to diminishing community spread, protection of staff, case selection, and concentration of resources. The current document based on available data and consensus opinion addresses appropriate catheterization laboratory preparedness for treating these patients, including procedure-room readiness to minimize external contamination, safe donning and doffing of personal protective equipment (PPE) to eliminate risk to staff, and staffing algorithms to minimize exposure and maximize team availability. Case selection and management of both emergent and urgent procedures are discussed in detail, including procedures that may be safely deferred or performed bedside.