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25 (95% CI 1.22-1.29, p<0.001), myocardial infarction [a-OR 1.10 (95% CI 1.07-1.13, p<0.001)], pericardiocentesis [a-OR 1.16 (95% CI 1.12-1.20, p<0.001)], pacemaker insertion [a-OR 1.06 (95% CI 1.04-1.08, p<0.001)], blood transfusion [a-OR 1.14 (95% CI 1.11-1.16, p<0.001)], vascular complications [a-OR 1.05 (95% CI 1.00-1.09, p=0.03)], longer length of stay [a-MR 1.10 (95% CI 1.10-1.11, p<0.001)] and higher cost [a-MR 1.04 (95% CI 1.03-1.04, p<0.001)].

The HFRS can be utilized in the risk stratification of older patients undergoing TAVR.

The HFRS can be utilized in the risk stratification of older patients undergoing TAVR.

Operating room (OR) extubation has been reported after lung transplantation (LT) in small cohorts. This study aimed to evaluate the prognosis of OR-extubated patients. The secondary objectives were to evaluate the safety of this approach and to identify its predictive factors.

This retrospective single-center cohort study included patients undergoing double lung transplantation (DLT) from January 2012 to June 2019. Patients undergoing multiorgan transplantation, repeat transplantation, or cardiopulmonary bypass during the study period were excluded. OR-extubated patients were compared with intensive care unit (ICU)-extubated patients.

Among the 450 patients included in the analysis, 161 (35.8%) were extubated in the OR, and 4 were reintubated within 24 hours. Predictive factors for OR extubation were chronic obstructive pulmonary disease (COPD)/emphysema (p = .002) and cystic fibrosis (p = .005), recipient body mass index (p = .048), and the PaO

/FiO

ratio 10 minutes after second graft implantation (p < .001). OR-extubated patients had a lower prevalence of grade 3 primary graft dysfunction at day 3 (p < .001). Eight (5.0%) patients died within the first year after OR extubation, and 49 (13.5%) patients died after ICU extubation (log-rank test; p = .005). After adjustment for OR extubation predictive factors, the multivariate Cox regression model showed that OR extubation was associated with greater one-year survival (adjusted hazard ratio = 0.40 [0.16-0.91], p = .028).

OR extubation was associated with a favorable prognosis after DLT, but the association should not be interpreted as causality. This fast-track protocol was made possible by a team committed to developing a comprehensive strategy to enhance recovery.

OR extubation was associated with a favorable prognosis after DLT, but the association should not be interpreted as causality. This fast-track protocol was made possible by a team committed to developing a comprehensive strategy to enhance recovery.

In this study the authors hypothesized that "Lean management" within a dedicated ablation protocol could standardize the pulmonary vein isolation (PVI) procedure and improve quality.

There is a large variability in safety, effectiveness, and efficiency of PVI.

This was a single-center prospective study with inclusion of all consecutive PVI procedures from 2017 to2019. A 3-step intervention was introduced based on Lean management step 1) simplification (CLOSE protocol); step2) waste elimination (higher power shorter duration); and step 3) improved standardization (Lab Optimization Tool [LOT]). PVI was divided into steps that were tracked (in minutes) using LOT. Parameters were compared in 6-month intervals.

Overall, 295 patients (146 patients with LOT) were analyzed. Step 1 reduced skin-to-skin procedure duration (2017 119 ± 21min vs. 2018 77 ± 15min; p<0.001) and variance (from 2018 to 2019p=0.024). Step 2 reduced the radiofrequency time (2017 38 ± 6min vs. 2018 20 ± 3min; p<0.001) and variance mprove health care utilization, increased efficiency should become an accepted goal in addition to procedural safety and effectiveness.Schizophrenia is a complex brain disorder with genetic and environmental factors contributing to its etiology. Complement C4 genes are schizophrenia susceptibility loci and are activated in response to infections and gut microbiome imbalances. learn more We hypothesize that C4 genetic susceptibility predisposes individuals to neuropathological effects from pathogen exposures or a microbiome in dysbiosis. In 214 individuals with schizophrenia and 123 non-psychiatric controls, we examined C4 gene copy number and haplotype groups for associations with schizophrenia and microbial plasma biomarkers. C4A copy number and haplotypes containing HERV-K insertions (C4A-long; C4AL-C4AL) conferred elevated odds ratios for schizophrenia diagnoses (OR 1.58-2.56, p less then 0.0001), while C4B-short (C4BS) haplogroups conferred decreased odds (OR 0.43, p less then 0.0001). Haplogroup-microbe combinations showed extensive associations with schizophrenia including C4AL with Candida albicans IgG (OR 2.16, p less then 0.0005), C4AL-C4BL with cytomegalovirus (CMV) IgG (OR 1.79, p less then 0.008), C4BS with lipopolysaccharide-binding protein (LBP) (OR 1.18, p less then 0.0001), and C4AL-C4AL with Toxoplasma gondii IgG (OR = 17.67, p less then 0.0001). In controls, only one haplogroup-microbe combination was significant C4BS with CMV IgG (OR 0.52, p less then 0.02). In schizophrenia only, LBP and CMV IgG levels were inversely correlated with C4A and C4S copy numbers, respectively (R2 = 0.13-0.16, p less then 0.0001). C4 haplogroups were associated with altered scores of cognitive functioning in both cases and controls and with psychiatric symptom scores in schizophrenia. Our findings link complement C4 genes with a susceptibility to infections and a dysbiotic microbiome in schizophrenia. These results support immune system mechanisms by which gene-environmental interactions may be operative in schizophrenia.

Is the level of shared decision-making (SDM) higher after introduction of a SDM package (including encounter decision aids on treatment options for heavy menstrual bleeding and training for clinicians) than before?.

This before-after study, performed in OB-GYN practice, compared consultations before and after introduction of a SDM package. The target sample size was 25 patients per group. Women seeking treatment for heavy menstrual bleeding were eligible. After their appointments, patients filled out a three-item patient-reported SDM measure. Treatment discussions were audio-recorded and rated for SDM using Observer OPTION

. Consultation transcripts in the 'after' group were checked for adherence to the steps required for intended use of decision aids.

16 gynaecologists participated. 25 patients participated before introduction of the decision aids and 28 after. The proportion of women reporting optimal SDM was higher after introduction (75 %) than before (50 %;p < 0.001). The mean observer-rated level of SDM was also significantly higher after than before (MD = 12.50,95 % CI 5.53-19.47).

The level of SDM was higher after the introduction of the package than before.

This study was conducted in a real-life setting in three clinics, both large academic and small rural, offering opportunities for implementation in different type of organizations.

This study was conducted in a real-life setting in three clinics, both large academic and small rural, offering opportunities for implementation in different type of organizations.

Integrating constructs from three prominent health behavior theories including the extended parallel process model, the health belief model, and the theory of planned behavior, this study seeks to identify sociopsychological factors that influenced American's intention to receive a COVID-19 vaccine.

An online survey was delivered to a U.S. sample (N = 934), assessing the influences of risk perception and fear associated with COVID-19, beliefs about and attitudes toward COVID-19 vaccines, self-efficacy, social and psychological contexts, and demographic characteristics on people's intention to get COVID-19 vaccines.

Most respondents intended to get vaccinated. However, they tended to underestimate their risks of contracting COVID-19. Disease exposure led to higher uptake intent via the mediation of fear. Safety concerns negatively influenced vaccination intention, while perceived community benefits were positively associated with vaccination intention. Positive attitudes toward vaccines and recent vaccine history were positively linked to vaccination intent.

This study attests the effectiveness of HBT constructs in predicting people's intention to receive a COVID-19 vaccine.

The results point to the importance of fostering confidence in vaccine safety and countering overoptimism of individual susceptibility to the disease in interventions promoting COVID-19 vaccines uptake.

The results point to the importance of fostering confidence in vaccine safety and countering overoptimism of individual susceptibility to the disease in interventions promoting COVID-19 vaccines uptake.Elderly patients represent a growing proportion of the acute coronary syndrome population in Western countries. However, their frequent atypical symptoms at presentation often lead to delays in management and to misdiagnosis. Furthermore, their prognosis is poorer than that of younger patients because of physiological changes in platelet function, haemostasis and fibrinolysis, but also a higher proportion of comorbidities and frailty, both of which increase the risk of recurrent thrombotic and bleeding events. This complex situation, with ischaemic and haemorrhagic risk factors often being intertwined, may lead to confusion about the required treatment strategy, sometimes resulting in inadequate management or even to therapeutic nihilism. It is therefore critical to provide a comprehensive overview of our understanding of the pathophysiological processes underlying acute coronary syndrome in elderly patients, and to summarise the results from the latest clinical trials to help decision making for these high-risk patients.

Properly planned single isocenter volumetric modulated arc therapy (VMAT) radiosurgery plans exhibit high quality and efficiency. We report here the largest clinical experience to date, to our knowledge, comparing manual planning with a new automated platform designed to standardize and simplify radiosurgery planning and delivery processes.

We treated 693 patients with single isocenter VMAT radiosurgical plans generated by either our conventional manual (mVMAT) or a recently implemented automated (HyperArc

) technique. All plans targeted the gross tumor volume without margin. Radiochromic film was used for patient-specific quality assurance (PSQA). We evaluated local control and toxicity data for a subgroup of 107 patients having 377 metastatic tumors that were treated with HyperArc.

The median Radiation Therapy Oncology Group (RTOG) conformity index was 1.14 and was not different between the 2 techniques. The median Paddick gradient index was 5.42 for HyperArc versus 7.09 for mVMAT (P < .001). The ocal control for treated targets remained congruent with historical series.

HyperArc produces high-quality radiosurgical plans that are at least as good as mVMAT plans created by an expert manual planner with easier planning and more efficient delivery workflow. A less experienced planner can produce very high-quality radiosurgical plans even for patients with more than 10 targets. The use of a single-isocenter technique for multiple targets with no PTV margin did not compromise clinical outcomes, and 1-year local control for treated targets remained congruent with historical series.