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Background and objectivesPrior regional or single-center studies have noted that 4% to 7% of eligible patients with acute ischemic stroke (AIS) decline IV tissue plasminogen activator (tPA). We sought to determine the prevalence of tPA declination in a nationwide registry of patients with AIS and to investigate differences in declination by race/ethnicity.MethodsWe used the Get With The Guidelines-Stroke registry to identify patients with AIS eligible for tPA and admitted to participating hospitals between January 1, 2016, and March 28, 2019. We compared patient demographics and admitting hospital characteristics between tPA-eligible patients who received and those who declined tPA. Using multivariable logistic regression, we determined patient and hospital factors associated with tPA declination.ResultsAmong 177,115 tPA-eligible patients with AIS at 1,976 sites, 6,545 patients (3.7%) had tPA declination as the sole documented reason for not receiving tPA. Patients declining treatment were slightly older, were more likely to be female, arrived more often at off-hours and earlier after symptom onset, and were more likely to present to Primary Stroke Centers. Compared with non-Hispanic White, non-Hispanic Black race/ethnicity was independently associated with increased (adjusted odds ratio [aOR] 1.21, 95% CI 1.11-1.31), Asian race/ethnicity with decreased (aOR 0.72, 95% CI 0.58-0.88), and Hispanic ethnicity (any race) with similar odds of tPA declination (OR 0.98, 95% CI 0.86-1.13) in multivariable analysis.DiscussionAlthough the overall prevalence of tPA declination is low, eligible non-Hispanic Black patients are more likely and Asian patients less likely to decline tPA than non-Hispanic White patients. Reducing rates of tPA declinations among non-Hispanic Black patients may be an opportunity to address disparities in stroke care.

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BackgroundThe safety and effectiveness of oral anticoagulation (OAC) after an ischemic stroke in older patients with heart failure (HF) without atrial fibrillation remains uncertain.MethodsUtilizing Get With The Guidelines Stroke national clinical registry data linked to Medicare claims from 2009-2014, we assessed the outcomes of eligible patients with a history of HF who were initiated on OAC during a hospitalization for an acute ischemic stroke. The cumulative incidences of adverse events were calculated using Kaplan-Meier curves and adjusted Cox proportional hazard ratios were compared between patients discharged on or off OAC.ResultsA total of 8,261 patients from 1,370 sites were discharged alive after an acute ischemic stroke and met eligibility criteria. Of those, 747 (9.0%) were initiated on OAC.  Patients on OAC were younger (77.2±8.0 vs. 80.5±8.9 years, p

BackgroundFew contemporary data exist evaluating care patterns and outcomes in heart failure (HF) across the spectrum of kidney function.ObjectivesThis study sought to characterize differences in quality of care and outcomes in patients hospitalized for HF by degree of kidney dysfunction.MethodsGuideline-directed medical therapies were evaluated among patients hospitalized with HF at 418 sites in the GWTG-HF (Get With The Guidelines-Heart Failure) registry from 2014 to 2019 by discharge CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)-derived estimated glomerular filtration rate (eGFR). We additionally evaluated the risk-adjusted association of admission eGFR with in-hospital mortality.ResultsAmong 365,494 hospitalizations (age 72 ± 15 years, left ventricular ejection fraction [EF]: 43 ± 17%), median discharge eGFR was 51 ml/min/1.73 m2 (interquartile range: 34 to 72 ml/min/1.73 m2), 234,332 (64%) had eGFR

The establishment of heavy metal pollution grade standards based on the magnetic susceptibility of surface dust can provide a simpler magnetic method for the evaluation of heavy metal pollution of surface dust. A total of 251 urban soil surface samples were collected in Xining City, and As, Cd, Cr, Cu, Ni, and Pb were determined V and Zn contents, as well as low-frequency magnetic susceptibility (χLF) and high-frequency magnetic susceptibility (χHF). The common Kriging interpolation method was used to explore the spatial distribution of χLF, and the pollution load index (PLI) was used to evaluate the degree of soil heavy metal pollution, and the correlation analysis between PLI and χLF was established。 The results showed that the average PLI of the seven heavy metals in the urban soil samples of Xining City was 2 34. Moderate pollution, Zn is the most important pollution factor. The average value of soil χLF was 125. 7 × 10-8m3 kg-1, which decreased from “northwest-southeast”, and the high-value area appeared in the northwest near Xining Special Steel along the line. The regression equation between soil heavy metal PLI and χLF was y=3.36E-06x2+0.01x+0.9092, showing a significant positive correlation (p 652.02 × 10-8m3 kg-1, it is an intensity pollution.

ObjectiveTo compare short-term health-related quality of life (HRQOL) 6-12 weeks after hysterectomy or myomectomy for the treatment of symptomatic leiomyomas.MethodsWe conducted a prospective comparative effectiveness analysis of data. In an existing multisite registry, we compared 6-12-week postsurgical HRQOL using the disease-specific Uterine Fibroid Symptom Quality of Life and the generic EuroQoL 5-Dimension Health Questionnaire, in women from the ages of 18-54 years with documented leiomyomas undergoing hysterectomy or myomectomy. Propensity score weighting was used to adjust for confounding, and analyses were also stratified by route of surgery.ResultsA total of 1,295 patients (727 with hysterectomy and 568 with myomectomy) enrolled from registry initiation in November 2015 until June 2018 met inclusion criteria. At baseline, leiomyoma-specific HRQOL (44.0±25.4 and 50.2±25.3, P

Alluvial parent material soil is an important soil type found on the Qinghai–Tibet Plateau (QTP) in China. However, due to the limited age data for alluvial soils, the relationship between alluvial geomorphological processes and soil pedogenic processes remains unclear. In this study, three representative alluvial parent material profiles on the Buha River alluvial plain in the Qinghai Lake Basin, northeast QTP, were analyzed using the optical luminescence (OSL) dating method. Combined with physical and chemical analyses of the soil, we further analyzed the pedogenic process of alluvial soil. The alluvial parent material of the Buha alluvial plain predominately yielded ages between 11.9 and 9.1 ka, indicating that the alluvial soil began to form during the early Holocene. The development of the alluvial soil on the first-order terrace presents characteristics of entisol with multiple burial episodes, mainly between 8.5 and 4.0 ka, responding to the warm and humid middle Holocene and high lake levels. [ABSTRACT FROM AUTHOR]

The effect of thermal load in the creep feed grinding have important effect on the surface quality for machining the tenon teeth of turbine blade.In this paper,the effects of grinding parameters on grinding forces and temperature in grinding DD5 single crystal alloy are investigated by experiments.The influences and formation mecha-nism of DD5 creep-feed grinding forces and temperatures are analyzed,and a mapping model between thermody-namic effect and grinding parameters is established and verified.The experimental results show that the grinding depth has the greatest influence on the DD5 creep-feed grinding force and temperature,following by the grinding wheel speed,and the feed velocity of work-piece has less influence on the grinding forces and temperature.With the increase of the grinding wheel speed,the grinding force is decreasing,and the grinding temperature has an increasing trend.With the increase of feed velocity and grinding depth,both the grinding force and temperature are of increasing trends.Increasing the feed velocity and reducing the grinding depth on the premise of satisfying the material removal rate can avoid the larger grinding thermodynamic coupling layer on the DD5 grinding surface.

The stable carbon isotope composition of total organic matter (δ13Corg) has been utilized in aeolian sediments, serving as an indicator for reconstructing terrestrial paleoenvironments. The Qinghai Lake (QHL) Basin is a climate-sensitive region of significant importance in paleoclimatic reconstruction. However, the reconstructed climatic variations based on δ13Corg in aeolian sediments in the QHL Basin in the northeastern Qinghai-Tibet Plateau (QTP) are lacking, and their paleoclimatic significance remains poorly understood. By conducting δ13Corg measurements on the Niaodao (ND) aeolian profile near QHL, we reconstructed the paleoclimate changes of 11 ka–present. The variation range of the δ13Corg values in the ND profile indicated the terrestrial ecosystems were not the sole contributor to lacustrine organic matter. The δ13Corg values are an indicator of historical temperature changes in the study area, exhibiting similar trends with the reconstruction of Chinese summer temperatures, East Asian air temperature, global temperature, and Northern Hemisphere summer insolation at 37° N. The temperature increased with high frequency and amplitude oscillations, with strong aeolian activity and low total organic carbon accumulation during the Early Holocene. The temperature was maintained at a high and stable level, with the weakest aeolian activity and intensified pedogenesis during the Middle Holocene. The temperature decreased at a high rate, with renewed aeolian activity and weak pedogenesis during the Late Holocene. [ABSTRACT FROM AUTHOR]

Background: Given the rarity of tracheobronchopathia osteochondroplastica (TO), many young doctors in primary hospitals are unable to identify TO based on bronchoscopy findings. Objectives: To build an artificial intelligence (AI) model for differentiating TO from other multinodular airway diseases by using bronchoscopic images. Design: We designed the study by comparing the imaging data of patients undergoing bronchoscopy from January 2010 to October 2022 by using EfficientNet. Bronchoscopic images of 21 patients with TO at Anhui Chest Hospital from October 2019 to October 2022 were collected for external validation. Methods: Bronchoscopic images of patients with multinodular airway lesions (including TO, amyloidosis, tumors, and inflammation) and without airway lesions in the First Affiliated Hospital of Guangzhou Medical University were collected. The images were randomized (4:1) into training and validation groups based on different diseases and utilized for deep learning by convolutional neural networks (CNNs). Results: We enrolled 201 patients with multinodular airway disease (38, 15, 75, and 73 patients with TO, amyloidosis, tumors, and inflammation, respectively) and 213 without any airway lesions. To find multinodular lesion images for deep learning, we utilized 2183 bronchoscopic images of multinodular lesions (including TO, amyloidosis, tumor, and inflammation) and compared them with images without any airway lesions (1733). The accuracy of multinodular lesion identification was 98.9%. Further, the accuracy of TO detection based on the bronchoscopic images of multinodular lesions was 89.2%. Regarding external validation (using images from 21 patients with TO), all patients could be diagnosed with TO; the accuracy was 89.8%. Conclusion: We built an AI model that could differentiate TO from other multinodular airway diseases (mainly amyloidosis, tumors, and inflammation) by using bronchoscopic images. The model could help young physicians identify this rare airway disease. [ABSTRACT FROM AUTHOR]

The microstructure of DZ8 after solid solution treatment at 1260 ℃ and 1240 ℃ was observed, and the tensile and stress rupture properties were compared. The results show that less than 1% γ+γ' eutectic remains in the microstructure of DZ8 after solid solution treatment at 1260 ℃, while incipient melting takes place in the Hf-rich phase; about 12% γ+γ' eutectic exists in the microstructure of DZ8 after solid solution treatment at 1240 ℃, but no incipient melting phase is discovered. After solid solution treatment at 1260 ℃, the stress rupture property of DZ8 in 980 ℃/725 MPa and the tensil property of DZ8 at room temperature, 700 ℃ and 980 ℃ show little different compared with those treated at 1240 ℃, but the stress rupture property in 760 ℃/725 MPa decreases to some extent.