The use of extracorporeal membrane oxygenation (ECMO) in patients who are awake and spontaneously breathing may represent a novel bridging strategy toward lung transplantation (LuTx).
To evaluate the ...outcomes of patients treated with the "awake ECMO" concept as bridge to transplantation.
We performed a retrospective, single-center, intention-to-treat analysis of consecutive LuTx candidates with terminal respiratory or cardiopulmonary failure receiving awake ECMO support. The outcomes were compared with a historical control group of patients treated with conventional mechanical ventilation (MV group) as bridge to transplant.
Twenty-six patients (58% female; median age, 44 yr; range, 23-62) were included in the awake ECMO group and 34 patients (59% female; median age, 36 yr; range, 18-59) in the MV group. The duration of ECMO support or MV, respectively, was comparable in both groups (awake ECMO: median, 9 d; range, 1-45. MV: median, 15 d; range, 1-71; P = 0.25). Six (23%) of 26 patients in the awake ECMO group and 10 (29%) of 34 patients in the MV group died before a donor organ was available (P = 0.20). Survival at 6 months after LuTx was 80% in the awake ECMO group versus 50% in the MV group (P = 0.02). Patients in the awake ECMO group required shorter postoperative MV (P = 0.04) and showed a trend toward a shorter postoperative hospital stay (P = 0.06).
ECMO support in patients who are awake and nonintubated represents a promising bridging strategy, which should be further evaluated to determine its role in patients with end-stage lung disease awaiting LuTx.
OPTN/SRTR 2021 Annual Data Report: Lung Valapour, Maryam; Lehr, Carli J.; Schladt, David P. ...
American journal of transplantation,
February 2023, 2023-02-00, 20230201, Volume:
23, Issue:
2
Journal Article
Peer reviewed
Open access
The number of lung transplants has continued to decline since 2020, a period that coincides with the onset of the COVID-19 pandemic. Lung allocation policy continues to undergo considerable change in ...preparation for adoption of the Composite Allocation Score system in 2023, beginning with multiple adaptations to the calculation of the Lung Allocation Score that occurred in 2021. The number of candidates added to the waiting list increased after a decline in 2020, while waitlist mortality has increased slightly with a decreased number of transplants. Time to transplant continues to improve, with 38.0% of candidates waiting fewer than 90 days for a transplant. Posttransplant survival remains stable, with 85.3% of transplant recipients surviving to 1 year; 67%, to 3 years; and 54.3%, to 5 years.
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New faces, new voices Abrajano, Marisa A
2010., 20100322, 2010, 2010-03-22, 20100101
eBook
Making up 14.2 percent of the American population, Hispanics are now the largest minority group in the United States. Clearly, securing the Hispanic vote is more important to political parties than ...ever before. Yet, despite the current size of the Hispanic population, is there a clear Hispanic politics? Who are Hispanic voters? What are their political preferences and attitudes, and why? The first comprehensive study of Hispanic voters in the United States,New Faces, New Voicespaints a complex portrait of this diverse and growing population.
Examining race, politics, and comparative political behavior, Marisa Abrajano and R. Michael Alvarez counter the preconceived notion of Hispanic voters as one homogenous group. The authors discuss the concept of Hispanic political identity, taking into account the ethnic, generational, and linguistic distinctions within the Hispanic population. They compare Hispanic registration, turnout, and participation to those of non-Hispanics, consider the socioeconomic factors contributing to Hispanics' levels of political knowledge, determine what segment of the Hispanic population votes in federal elections, and explore the prospects for political relationships among Hispanics and non-Hispanics. Finally, the authors look at Hispanic opinions on social and economic issues, factoring in whether these attitudes are affected by generational status and ethnicity.
A unique and nuanced perspective on the Hispanic electoral population,New Faces, New Voicesis essential for understanding the political characteristics of the largest and fastest growing group of minority voters in the United States.
The pervasiveness of wireless technology has indeed created massive opportunity to integrate almost everything into the Internet fabric. This can be seen with the advent of Internet of Things and ...Cyber Physical Systems, which involves cooperation of massive number of intelligent devices to provide intelligent services. Fairness amongst these devices is an important issue that can be analysed from several dimensions, e.g., energy usage, achieving required quality of services, spectrum sharing, and so on. This article focusses on these viewpoints while looking at fairness research. To generalize, mainly wireless networks are considered. First, we present a general view of fairness studies, and pose three core questions that help us delineate the nuances in defining fairness. Then, the existing fairness models are summarized and compared. We also look into the major fairness research domains in wireless networks such as fair energy consumption control, power control, topology control, link and flow scheduling, channel assignment, rate allocation, congestion control and routing protocols. We make a distinction amongst fairness, utility and resource allocation to begin with. Later, we present their inter-relation. At the end of this article, we list the common properties of fairness and give an example of fairness management. Several open research challenges that point to further work on fairness in wireless networks are also discussed. Indeed, the research on fairness is entangled with many other aspects such as performance, utility, optimization and throughput at the network and node levels. While consolidating the contributions in the literature, this article tries to explain the niceties of all these aspects in the domain of wireless networking.
Species lists are widely used in legislation and regulation to manage and conserve biodiversity. In this paper, we explore the issues caused by the lack of an adequately governed and universally ...accepted list of the world’s species. These include lack of quality control, duplicated effort, conflicts of interest, lack of currency, and confusion in the scientific use of taxonomic information. If species lists are to fulfill their role efficiently, then the governance systems underlying their creation must keep pace. Fortunately, modernization of species list governance is now possible as a result of advances in biodiversity informatics and two decades of experience working to create the backbone of a global species list.
Clinical quality registries (CQRs) are playing an increasingly important role in improving health outcomes and reducing health care costs. CQRs are established with the purpose of monitoring quality ...of care, providing feedback, benchmarking performance, describing pattern of treatment, reducing variation and as a tool for conducting research.
To synthesise the impact of clinical quality registries (CQRs) as an 'intervention' on (I) mortality/survival; (II) measures of outcome that reflect a process or outcome of health care; (III) health care utilisation; and (IV) healthcare-related costs.
The following electronic databases were searched: MEDLINE, EMBASE, CENTRAL, CINAHL and Google Scholar. In addition, a review of the grey literature and a reference check of citations and reference lists within articles was undertaken to identify relevant studies in English covering the period January 1980 to December 2016. The PRISMA-P methodology, checklist and standard search strategy using pre-defined inclusion and exclusion criteria and structured data extraction tools were used. Data on study design and methods, participant characteristics attributes of included registries and impact of the registry on outcome measures and/or processes of care were extracted.
We identified 30102 abstracts from which 75 full text articles were assessed and finally 17 articles were selected for synthesis. Out of 17 studies, six focused on diabetes care, two on cardiac diseases, two on lung diseases and others on organ transplantations, rheumatoid arthritis, ulcer healing, surgical complications and kidney disease. The majority of studies were "before after" design (#11) followed by cohort design (#2), randomised controlled trial (#2), experimental non randomised study and one cross sectional comparison. The measures of impact of registries were multifarious and included change in processes of care, quality of care, treatment outcomes, adherence to guidelines and survival. Sixteen of 17 studies demonstrated positive findings in their outcomes after implementation of the registry.
Despite the large number of published articles using data derived from CQRs, few have rigorously evaluated the impact of the registry as an intervention on improving health outcomes. Those that have evaluated this impact have mostly found a positive impact on healthcare processes and outcomes.
PROSPERO CRD42015017319.
Many decisions of individuals involve a combination of internal preferences and mental processes related to cognitive ability. As Frederick (2005) argued in this journal, "there is no good reason for ...ignoring the possibility that general intelligence or various more specific cognitive abilities are important causal determinants of decision making." Since then, a number of empirical studies have focused on the relationship between cognitive ability and decision-making in different contexts. This paper will focus on the relationship between cognitive ability and decision-making under risk and uncertainty. Taken as a whole, this research indicates that cognitive ability is associated with risk-taking behavior in various contexts and life domains, including incentivized choices between lotteries in controlled environments, behavior in nonexperimental settings, and self-reported tendency to take risks. We begin by clarifying some important distinctions between concepts and measurement of risk preference and cognitive ability. In particular, complexity and possible confusions arise because observed measures of risk preference and cognitive ability are used to represent the latent characteristics of these concepts. We discuss the substantial (and somewhat implausible) range of assumptions that need to be satisfied in order to be able to interpret a correlation between measures of risk preference and cognitive ability as a relationship between latent risk preference and latent cognitive ability. Drawing causal inferences from such relationships raises additional challenges. We go on to argue that it is nevertheless important and valuable to study whether cognitive ability is related to measured risk preference (see also Dohmen, Falk, Huffman, and Sunde 2010). Risk preference is typically measured by risky behavior (actual or self-reported). If risky behavior varies systematically with cognitive ability, this may reinforce or counteract the impact of cognitive ability on life outcomes, depending on the nature of the correlation. If there is a relationship, it also becomes important to control for cognitive ability when relating life outcomes to standard revealed preference measures of risk preference. If cognitive ability has a causal impact on measured risk preference, it is important to understand the mechanism, and some intriguing policy implications arise. We then take stock of what is known empirically on the connections between cognitive ability and measured risk preferences, looking at studies using real-world risky behavior, experimental measures of risky choice, and self-reported measures of willingness to take risks. One pattern that emerges frequently in these studies is that cognitive ability tends to be positively correlated with avoidance of harmful risky situations, but it tends to be negatively correlated with risk aversion in advantageous situations. This suggests that the relationship between cognitive ability and risk taking has a reinforcing effect on economic outcomes. There is also intriguing emerging evidence that measured risk preference is particularly strongly related to certain facets of cognitive ability, those that facilitate quantitative problem solving, with implications for understanding mechanisms and possibly for better targeting policy interventions. We conclude by discussing perspectives for future research, in particular the scope for the development of richer sets of elicitation instruments and measurement across a wider range of concepts. We also consider progress in neuroscience, but conclude that at present that field still seems relatively far from allowing definitive conclusions about latent risk preference and cognitive ability. Nevertheless, the existing empirical evidence suggests that interventions to influence cognitive ability, should they be possible, might have spillovers on risky choice.
This field note presents initial research findings on the Jadwal ash-Shāsh wa ash-Shāmī (“ Shāsh wa ash-Shāmī List”), an Arabic text written around the mid-twentieth century by a scholar from Harar ...(eastern Ethiopia) named Ahmed Shamie. I was able to see the manuscript in which this text is found in Addis Ababa, in the spring of 2021, thanks in part to financial support from the CFEE. This article, drawing on ongoing research, shows that the Jadwal ash-Shāsh wa ash-Shāmī is a late historiographical construction that compiled numerous sources from different historiographical regimes. There is a great deal of continuity between this text and lists of emirs, the historiographical genre that dominated in Harar during the 17th to early 20th centuries. However, the writing of this text marked a turning point in the historiography of Harar : whereas previous lists only began in the seventeenth century, the Jadwal enforced a “ metanarrative” that gave the city a linear, exhaustive, and over-ten-centuries-long past.
Cette note de terrain présente des premiers résultats d’enquête concernant le Jadwal ash-Shāsh wa ash-Shāmī («Répertoire de Shāsh et de Shāmī » ), un texte en arabe écrit vers la mi-XXe siècle par un lettré de Harar (Éthiopie orientale) nommé Ahmed Shamie. Le manuscrit dans lequel figure ce texte a pu être consulté à Addis Abeba au printemps 2021, grâce notamment au soutien financier du CFEE. Cet article, s’appuyant sur des recherches en cours, montre que le Jadwal ash-Shāsh wa ash-Shāmī wa ash-Shāmī est une construction historiographique tardive qui compile des sources nombreuses et issues de régimes historiographiques différents. Il s’inscrit dans la continuité d’un genre historiographique qui domine à Harar au cours de la période moderne : les listes d’émirs. Mais la composition puis la diffusion de ce texte entérine un tournant dans l’historiographie de Harar : alors que les listes antérieures ne débutaient qu’au XVIIe siècle, avec le Jadwal, un «métarécit » s’impose qui dote la ville d’un passé linéaire, exhaustif et long de plus de dix siècles.
Evidence from observational studies that the use of surgical safety checklists results in striking improvements in surgical outcomes led to the rapid adoption of such checklists worldwide. However, ...the effect of mandatory adoption of surgical safety checklists is unclear. A policy encouraging the universal adoption of checklists by hospitals in Ontario, Canada, provided a natural experiment to assess the effectiveness of checklists in typical practice settings.
We surveyed all acute care hospitals in Ontario to determine when surgical safety checklists were adopted. Using administrative health data, we compared operative mortality, rate of surgical complications, length of hospital stay, and rates of hospital readmission and emergency department visits within 30 days after discharge among patients undergoing a variety of surgical procedures before and after adoption of a checklist.
During 3-month periods before and after adoption of a surgical safety checklist, a total of 101 hospitals performed 109,341 and 106,370 procedures, respectively. The adjusted risk of death during a hospital stay or within 30 days after surgery was 0.71% (95% confidence interval CI, 0.66 to 0.76) before implementation of a surgical checklist and 0.65% (95% CI, 0.60 to 0.70) afterward (odds ratio, 0.91; 95% CI, 0.80 to 1.03; P=0.13). The adjusted risk of surgical complications was 3.86% (95% CI, 3.76 to 3.96) before implementation and 3.82% (95% CI, 3.71 to 3.92) afterward (odds ratio, 0.97; 95% CI, 0.90 to 1.03; P=0.29).
Implementation of surgical safety checklists in Ontario, Canada, was not associated with significant reductions in operative mortality or complications. (Funded by the Canadian Institutes of Health Research.).
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