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The Affordable Care Act established the Hospital Readmissions Reduction Program (HRRP) to reduce payments to hospitals with excessive readmissions in an effort to link payment to the quality of hospital care. Prior studies demonstrating an association of HRRP implementation with increased mortality after heart failure discharges have prompted concern for potential unintended adverse consequences of the HRRP. We examined the impact of these policies on coronary artery bypass graft (CABG) surgery outcomes using the Nationwide Readmissions Database and found that, in line with previously observed readmission trends for CABG, readmission rates continued to decline in the era of the HRRP, but that this did not come at the expense of increased mortality. These results suggest that inclusion of surgical procedures, such as CABG in the HRRP might be an effective cost-reducing measure that does not adversely affect quality of hospital care.

To further improve the quality of head and neck cancer (HNC) care, we developed a composite measure defined as "textbook outcome" (TO).

We analyzed a retrospective cohort of patients after curvative-intent primary surgery, radiotherapy (RT), or chemoradiation (CRT) for HNC between 2015 and 2018 at the Netherlands Cancer Institute. TO was defined as 1) the start of treatment within 30 days, 2a) satisfactory pathologic outcomes, without 30-day postoperative complications, for the surgically treated group, and 2b), for RT and CRT patients, no unexpected or prolonged hospitalization and toxicity after the completion of treatment as planned.

In total, 392 patients with HNC were included. An overall TO was achieved in 9.6% of patients after surgery, 20.6% after RT, and 2.2% after CRT. Two indicators (margins >5 mm and start treatment <30 days) reduced TO radically for both groups.

TO can aid the evaluation of the quality of care for HNC patients and guide improvement processes.

3 Laryngoscope, 2021.

3 Laryngoscope, 2021.Water is crucial for enhancing the yield of agricultural land to meet the growing demand. Forward osmosis (FO) is a developing technology that utilizes the natural osmotic gradient of solutions. In this study, fertilizer drawn FO setup was considered by using potassium chloride (KCl) as the draw solution (DS) for treating textile wastewater as the feed solution (FS). This study investigated the effects of FS temperature, pH, and FS and DS concentrations. The performance investigation involved the study in terms of water flux, reverse salt flux, and specific reverse salt flux. DS and FS properties, osmotic potential, and temperature played a vital role in the performance. At 30°C FS temperature, the highest water flux (5.5 LMH) was observed. Reverse salt flux increased due to the increase in solute diffusivity. The highest value of water flux was obtained at a DS of 1.150 M and FS of 1000 mg/L. The permeation of water improved due to the difference in DS and FS concentrations at pH values above 7. PF-06873600 nmr The results of this study suggest that KCl as DS has a higher potential for the treatment of textile wastewater at a temperature of 30°C. Additionally, the functional groups attached to the FO membrane were identified through Fourier-transform infrared (FTIR) spectroscopic study.

In vivo measures of myeloid activity are promising biomarkers in multiple sclerosis. We previously demonstrated that cerebrospinal fluid (CSF) myeloid microvesicles are markers of microglial/macrophage activity and neuroinflammation in multiple sclerosis. Here, we aimed at investigating the diagnostic and prognostic value of myeloid microvesicles in a clinical setting.

Six hundred one patients discharged with a diagnosis of neuroinflammatory, neurodegenerative, or no neurological disease were enrolled. Myeloid microvesicles were measured with flow cytometry as isolectin B4-positive events in fresh CSF. Clinical, demographical, and magnetic resonance imaging (MRI) data were collected at diagnosis (all patients) and during follow-up (n=176).

CSF myeloid microvesicles were elevated in neuroinflammatory patients compared to the neurodegenerative and control groups. In multiple sclerosis, microvesicles were higher in patients with MRI disease activity and their concentration increased along with the number oker of neuroinflammation and microglial/macrophage activity in vivo. These findings may support a possible use in clinical practice during diagnostic workup and prognostic assessment. ANN NEUROL 2021;90253-265.

Our results confirm that CSF myeloid microvesicles are a clinically meaningful biomarker of neuroinflammation and microglial/macrophage activity in vivo. These findings may support a possible use in clinical practice during diagnostic workup and prognostic assessment. ANN NEUROL 2021;90253-265.

Mechanical thrombectomy (MT) is not recommended for acute stroke with large vessel occlusion (LVO) and a large volume of irreversibly injured tissue ("core"). Perfusion imaging may identify a subset of patients with large core who benefit from MT.

We compared two cohorts of LVO-related patients with large core (>50 ml on diffusion-weighted-imaging or CT-perfusion using RAPID), available perfusion imaging, and treated within 6 hours from onset by either MT + Best Medical Management (BMM) in one prospective study, or BMM alone in the pre-MT era from a prospective registry. Primary outcome was 90-day modified Rankin Scale ≤2. We searched for an interaction between treatment group and amount of penumbra as estimated by the mismatch ratio (MMRatio=critical hypoperfusion/core volume).

Overall, 107 patients were included (56 MT + BMM and 51 BMM) Mean age was 68 ± 15 years, median core volume 99 ml (IQR 72-131) and MMRatio 1.4 (IQR 1.0-1.9). Baseline clinical and radiological variables were similar between the two groups, except for a higher intravenous thrombolysis rate in the BMM group. The MMRatio strongly modified the clinical outcome following MT (p

 < 0.001 for continuous MMRatio); MT was associated with a higher rate of good outcome in patients with, but not in those without, MMRatio>1.2 (adjusted OR [95% CI]=6.8 [1.7-27.0] vs 0.7 [0.1-6.2], respectively). Similar findings were present for MMRatio ≥1.8 in the subgroup with core ≥70 ml. Parenchymal hemorrhage on follow-up imaging was more frequent in the MT + BMM group regardless of the MMRatio.

Perfusion imaging may help select which patients with large core should be considered for MT. Randomized studies are warranted. ANN NEUROL 2021.

Perfusion imaging may help select which patients with large core should be considered for MT. Randomized studies are warranted. ANN NEUROL 2021.We analyzed the efficacy and safety of an everolimus with reduced-exposure calcineurin inhibitor (EVR+rCNI) versus mycophenolic acid with standard-exposure CNI (MPA+sCNI) regimen in Asian patients from the TRANSFORM study. In this 24-month, open-label study, de novo kidney transplant recipients (KTxRs) were randomized (11) to receive EVR+rCNI or MPA+sCNI, along with induction therapy and corticosteroids. Of the 2037 patients randomized in the TRANSFORM study, 293 were Asian (EVR+rCNI, N = 136; MPA+sCNI, N = 157). At Month 24, EVR+rCNI was noninferior to MPA+sCNI for the binary endpoint of estimated glomerular filtration rate (eGFR) less then 50 mL/min/1.73 m2 or treated biopsy-proven acute rejection (27.0% vs 29.2%, P = 0.011 for a noninferiority margin of 10%). Graft loss and death were reported for one patient each in both arms. Mean eGFR was higher in EVR+rCNI versus MPA+sCNI (72.2 vs 66.3 mL/min/1.73 m2 , P = 0.0414) even after adjusting for donor type and donor age (64.3 vs 59.3 mL/min/1.73 m2 , P = 0.0582). Overall incidence of adverse events was comparable. BK virus (4.4% vs 12.1%) and cytomegalovirus (4.4% vs 13.4%) infections were significantly lower in the EVR+rCNI arm This subgroup analysis in Asian de novo KTxRs demonstrated that the EVR+rCNI versus MPA+sCNI regimen provides comparable antirejection efficacy, better renal function and reduced viral infections. (NCT01950819) This article is protected by copyright. All rights reserved.

Paternal depression and inadequate attachment experienced in the postpartum period may be associated with future emotional and behavioural problems of children. This study aimed to investigate the paternal depression and attachment levels of first-time fathers.

The sample of this descriptive study consisted of 175 fathers with 3-6 months old babies whose wives applied to the polyclinic for check-up.

When the cut-off point of the scale was evaluated at 13 and above in this study, the risk of depression was found to be 14.2%. The level of attachment decreases as fathers' risk of depression increases (p < 0.05).

There is a risk of depression in fathers in the postpartum period. The level of attachment decreases as fathers' risk of depression increases.

There is a risk of depression in fathers in the postpartum period. The level of attachment decreases as fathers' risk of depression increases.We present here a case of a symptomatic chest injury with a nail gun causing a delayed occurrence of coronary artery fistula to the left pulmonary artery presenting with unstable angina 4 years after the initial injury, three of which were symptom-free. The patient underwent successful surgical closure of the fistula and removal of the foreign body.

Subjective cognitive complaints (SCCs) are a risk factor for dementia; however, little is known about their trajectories.

Participants were 873 older adults (mage=78.65 years; 55% females) from the Sydney Memory and Ageing Study that were followed-up biennially. SCCs were measured using the six-item Memory Complaint Questionnaire. Associations between initial level of SCC reporting, linear change in SCC reporting, and change in global cognition over 6years was examined using latent growth curve analysis. Risk of dementia was examined over 10years using Cox regression.

After controlling for demographics, mood and personality, results revealed a negative longitudinal association between the slope of SCCs and the slope of global cognition scores (b=-0.01, p=0.005, β=-0.44), such that participants who reported increasing SCCs showed a steeper rate of decline in global cognition over 6years. Cox regression also revealed participants who reported increasing SCCs had a nearly fourfold increased risk of developing dementia over 10years (hazard ratio 3.70, 1.24-11.01).

This study explored whether initial levels of, and change in, SCCs over time are associated with both cognitive decline and risk of dementia. These findings are clinically relevant as GPs should note patients reporting increasing SCCs as they may be at greater risk of cognitive decline and incident dementia.

This study explored whether initial levels of, and change in, SCCs over time are associated with both cognitive decline and risk of dementia. These findings are clinically relevant as GPs should note patients reporting increasing SCCs as they may be at greater risk of cognitive decline and incident dementia.Chiral compounds commonly exist in traditional Chinese medicine (TCM), but little research on the quality control of TCM has been conducted. In this study, a new strategy is proposed, taking Yuanhuzhitong tablet [YHZT, consisting of Radix Angelicae Dahuricae and Rhizoma Corydalis (Yan Hu Suo, YHS)] for example, which is based on chiral isomer ratio analysis to monitor the production process of Chinese patent medicine companies. In the process of content determination for tetrahydropalmatine (THP) in YHZT from different companies, noticeable differences were observed in their chromatographic behaviors. It is known that THP has two enantiomers, naturally coexisting in YHS as a racemic mixture, so we prepared THP twice and subsequently performed chiral separation analysis using supercritical fluid chromatography. As a result, the peak area ratios of two enantiomers from different companies varied remarkably, demonstrating that some companies did not probably manufacture YHZT products in accordance with the prescription proportion, used inferior or extracted YSH crude materials in the production process, and added raw chemical medicine in the production to reach the standard and lower the costs.