Abstract 14091: Outcomes of Patients With Recalled Defibrillator Leads: Results From the NCDR-ICD Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Emily P Zeitler ◽  
Yongfei Wang ◽  
Jeptha P Curtis ◽  
Jordan M PRUTKIN
Keyword(s):  
Management Strategies ◽  
Significant Risk ◽  
Hospital Death ◽  
Icd Leads ◽  
Sprint Fidelis ◽  
Medicare Patients ◽  
Lead Management ◽  
Future Work ◽  
Generator Replacement

Introduction: Whether to reuse, abandon, or extract functioning, recalled ICD leads at the time of generator replacement is an area of uncertainty as lead failure is more common following generator replacement, and long term failure rates of recalled ICD leads are unknown. We sought to evaluate outcomes following various lead management strategies at the time of generator replacement. Hypothesis: Functional St. Jude Riata and Medtronic Sprint Fidelis leads at the time of elective generator replacement are more frequently reused than replaced, and extracting them poses significant procedural risk. Methods: We queried the NCDR ICD Registry for Medicare patients undergoing elective generator replacement with a normal Fidelis or Riata lead from 2010-2016 and categorized patients based on the fate of the recalled lead: reused, abandoned, or extracted. We report pre-discharge complications by group. Results: There were 9937 generator replacement patients between 2010-2016 with a functioning Riata or Fidelis lead in which lead management was reported. The lead was reused in 9806 (98%) patients, extracted in 55 (0.6%), and abandoned in 76 (0.8%). Compared with the reused group, extracted patients were >10 years younger, had less heart failure and fewer comorbidities. In-hospital death occurred in 4 (7.3%) patients in the extracted group and 7 (0.07%) in the reused group (P<0.0001). The combination of death or any pre-discharge event occurred in 11% of extracted patients compared with 0.3% and 0% in the reused and abandoned groups, respectively.(Table) Conclusions: At the time of generator replacement, a small percentage of functional Riata and Fidelis leads were extracted. Even in this highly selected extraction population, extraction posed significant risk of in-hospital mortality and severe complications. Future work will help clarify whether these peri-procedural risks may be justified by improved medium and long term outcomes.

Customer Acquisition Management Strategies

2015 ◽  
pp. 219-243
Keyword(s):  
Management Strategies ◽  
Customer Retention ◽  
Customer Acquisition ◽  
Management Process ◽  
Customer Base ◽  
Process Understanding ◽  
Lead Management ◽  
Acquisition Management ◽  
Lead Nurturing

Achieving customer retention and loyalty is vital for the success of the company; however, acquiring new customers has to be considered equally significant to the customer retention process. Since the company's ability to grow its customer base determines the long-term success of the company, companies need to consider customer acquisition as an ongoing process. Customer acquisition management process involves identifying, attracting, and retaining potentially profitable customers. This chapter starts with examining the phases of the lead management process. Understanding customers is seen as important for effective lead management. After explaining the lead generation and lead nurturing within the context of lead management, this chapter ends up with underlining the importance of lead management automation for customer acquisition.

Connecting Crop Nutrient Use Efficiency to Future Soil Productivity

2018 ◽  
Vol 102 (4) ◽  
pp. 8-10
Author(s):  
Fernando García ◽  
Andrés Grasso ◽  
María González Sanjuan ◽  
Adrián Correndo ◽  
Fernando Salvagiotti
Keyword(s):  
Nutrient Management ◽  
Nutrient Use Efficiency ◽  
Management Strategies ◽  
Crop Productivity ◽  
Soil Productivity ◽  
Nutrient Use ◽  
Grain Crop ◽  
Wide Scale ◽  
Use Efficiency

Trends over the past 25 years indicate that Argentina’s growth in its grain crop productivity has largely been supported by the depletion of the extensive fertility of its Pampean soils. Long-term research provides insight into sustainable nutrient management strategies ready for wide-scale adoption.

Petroclival meningiomas: long-term outcomes of multimodal treatments and management strategies based on 30 years of experience at a single institution

2020 ◽  
Vol 132 (6) ◽  
pp. 1675-1682 ◽  
Author(s):  
Jin Wook Kim ◽  
Hee-Won Jung ◽  
Yong Hwy Kim ◽  
Chul-Kee Park ◽  
Hyun-Tai Chung ◽  
...  
Keyword(s):  
Adjuvant Treatment ◽  
Management Strategies ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Years Of Experience ◽  
Local Tumor ◽  
Long Term Outcomes ◽  
Single Institution ◽  
Petroclival Meningiomas

OBJECTIVEA thorough investigation of the long-term outcomes and chronological changes of multimodal treatments for petroclival meningiomas is required to establish optimal management strategies. The authors retrospectively reviewed the long-term clinical outcomes of patients with petroclival meningioma according to various treatments, including various surgical approaches, and they suggest treatment strategies based on 30 years of experience at a single institution.METHODSNinety-two patients with petroclival meningiomas were treated surgically at the authors’ institution from 1986 to 2015. Patient demographics, overall survival, local tumor control rates, and functional outcomes according to multimodal treatments, as well as chronological change in management strategies, were evaluated. The mean clinical and radiological follow-up periods were 121 months (range 1–368 months) and 105 months (range 1–348 months), respectively.RESULTSA posterior transpetrosal approach was most frequently selected and was followed in 44 patients (48%); a simple retrosigmoid approach, undertaken in 30 patients, was the second most common. The initial extent of resection and following adjuvant treatment modality were classified into 3 subgroups: gross-total resection (GTR) only in 13 patients; non-GTR treatment followed by adjuvant radiosurgery or radiation therapy (non-GTR+RS/RT) in 56 patients; and non-GTR without adjuvant treatment (non-GTR only) in 23 patients. The overall progression-free survival rate was 85.8% at 5 years and 81.2% at 10 years. Progression or recurrence rates according to each subgroup were 7.7%, 12.5%, and 30.4%, respectively.CONCLUSIONSThe authors’ preferred multimodal treatment strategy, that of planned incomplete resection and subsequent adjuvant radiosurgery, is a feasible option for the management of patients with large petroclival meningiomas, considering both local tumor control and postoperative quality of life.

The effects of long-term vigorous endurance exercise on the coronary arteries

2019 ◽  
Vol 67 (2) ◽  
Keyword(s):  
Endurance Training ◽  
Coronary Atherosclerosis ◽  
Calcium Score ◽  
The Other ◽  
Disease Phenotype ◽  
Male Athletes ◽  
Artery Disease ◽  
Future Work ◽  
Summary Data

Moderate endurance training is known to improve cardiovascular risk factors, and prolongs life expectancy. On the other hand, there has been some discussion whether “too much” exercise might have a contrarious effect by accelerating coronary atherosclerosis. The goal of this review was to evaluate the current literature on the effects of long-term vigorous endurance training on the coronary vasculature. In summary, data point to an increased calcium score, and a higher burden of atherosclerotic plaque in male athletes compared to sedentary controls. However, the plaques found in athletes were more prone to be calcified. The pathogenesis and clinical relevance of this athlete coronary artery disease phenotype remains incompletely understood and represents an area of important future work.

The effects of long-term vigorous endurance exercise on the coronary arteries

2019 ◽  
Vol 67 (2) ◽  
Keyword(s):  
Endurance Training ◽  
Coronary Atherosclerosis ◽  
Calcium Score ◽  
The Other ◽  
Disease Phenotype ◽  
Male Athletes ◽  
Artery Disease ◽  
Future Work ◽  
Summary Data

Moderate endurance training is known to improve cardiovascular risk factors, and prolongs life expectancy. On the other hand, there has been some discussion whether “too much” exercise might have a contrarious effect by accelerating coronary atherosclerosis. The goal of this review was to evaluate the current literature on the effects of long-term vigorous endurance training on the coronary vasculature. In summary, data point to an increased calcium score, and a higher burden of atherosclerotic plaque in male athletes compared to sedentary controls. However, the plaques found in athletes were more prone to be calcified. The pathogenesis and clinical relevance of this athlete coronary artery disease phenotype remains incompletely understood and represents an area of important future work.

Investigation of a New Approach to Predict Water Quality Extremes with a Case Study of Chemical Determinands in Stream Water

1991 ◽  
Vol 24 (6) ◽  
pp. 25-33
Author(s):  
A. J. Jakeman ◽  
P. G. Whitehead ◽  
A. Robson ◽  
J. A. Taylor ◽  
J. Bai
Keyword(s):  
Water Quality ◽  
Stream Water ◽  
Probability Distributions ◽  
Management Strategies ◽  
Hybrid Modelling ◽  
Trend Model ◽  
Environmental Extremes ◽  
Modelling Approach

The paper illustrates analysis of the assumptions of the statistical component of a hybrid modelling approach for predicting environmental extremes. This shows how to assess the applicability of the approach to water quality problems. The analysis involves data on stream acidity from the Birkenes catchment in Norway. The modelling approach is hybrid in that it uses: (1) a deterministic or process-based description to simulate (non-stationary) long term trend values of environmental variables, and (2) probability distributions which are superimposed on the trend values to characterise the frequency of shorter term concentrations. This permits assessment of management strategies and of sensitivity to climate variables by adjusting the values of major forcing variables in the trend model. Knowledge of the variability about the trend is provided by: (a) identification of an appropriate parametric form of the probability density function (pdf) of the environmental attribute (e.g. stream acidity variables) whose extremes are of interest, and (b) estimation of pdf parameters using the output of the trend model.

Positive Emotion in Generalized Anxiety Disorder

2019 ◽  
pp. 297-311
Author(s):  
Ilana Seager ◽  
Douglas S. Mennin ◽  
Amelia Aldao
Keyword(s):  
Anxiety Disorder ◽  
Positive Affect ◽  
Generalized Anxiety Disorder ◽  
Positive Emotion ◽  
Behavioral Therapy ◽  
Generalized Anxiety ◽  
Emotional Dysfunction ◽  
Wide Range ◽  
Future Work

Generalized anxiety disorder (GAD) is a debilitating condition characterized by excessive, pervasive, uncontrollable, and paralyzing worries about a wide range of future situations. Individuals with this condition frequently find themselves stuck in worry and tension cycles in futile attempts at reducing uncertainty and increasing control. GAD has been associated with substantial impairments in functioning and reduced quality of life. GAD remains poorly understood, and the long-term efficacy and end-state functioning resulting from treatment are weaker compared to other anxiety disorders. Some treatments (e.g., emotion regulation therapy, acceptance-based behavioral therapy) have improved efficacy, partly by targeting emotional dysfunction. Basic psychopathology research has focused on identifying the role of negative affect in GAD, so little is known about how positive affect is experienced and regulated in this disorder. This is particularly important in light of the overlap of this condition with major depressive disorder, which is characterized by low or suppressed positive emotion. Developing such an understanding is essential to further improve the efficacy of emotion-based treatments. This chapter reviews current and future directions in the study of positive affect in GAD. The chapter reviews the nascent research on positive affect and GAD, then illustrates dimensions of future work.

scholarly journals Contributions to Management Strategies in the NE Atlantic Regarding the Life History and Population Structure of a Key Deep-Sea Fish (Mora moro)

Biology ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 522
Author(s):  
Régis Santos ◽  
Wendell Medeiros-Leal ◽  
Osman Crespo ◽  
Ana Novoa-Pabon ◽  
Mário Pinho
Keyword(s):  
Population Structure ◽  
Life History ◽  
Deep Sea ◽  
Management Strategies ◽  
Size Composition ◽  
Large Size ◽  
The Common ◽  
Fishing Impacts ◽  
Sea Fish

With the commercial fishery expansion to deeper waters, some vulnerable deep-sea species have been increasingly captured. To reduce the fishing impacts on these species, exploitation and management must be based on detailed and precise information about their biology. The common mora Mora moro has become the main deep-sea species caught by longliners in the Northeast Atlantic at depths between 600 and 1200 m. In the Azores, landings have more than doubled from the early 2000s to recent years. Despite its growing importance, its life history and population structure are poorly understood, and the current stock status has not been assessed. To better determine its distribution, biology, and long-term changes in abundance and size composition, this study analyzed a fishery-dependent and survey time series from the Azores. M. moro was found on mud and rock bottoms at depths below 300 m. A larger–deeper trend was observed, and females were larger and more abundant than males. The reproductive season took place from August to February. Abundance indices and mean sizes in the catch were marked by changes in fishing fleet operational behavior. M. moro is considered vulnerable to overfishing because it exhibits a long life span, a large size, slow growth, and a low natural mortality.

scholarly journals Coronary artery aneurysms: outcomes following medical, percutaneous interventional and surgical management

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001440
Author(s):  
Shameer Khubber ◽  
Rajdeep Chana ◽  
Chandramohan Meenakshisundaram ◽  
Kamal Dhaliwal ◽  
Mohomed Gad ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Surgical Management ◽  
Medical Management ◽  
Cox Regression ◽  
Artery Bypass ◽  
Management Strategies ◽  
Coronary Artery Aneurysms ◽  
Kaplan Meier

BackgroundCoronary artery aneurysms (CAAs) are increasingly diagnosed on coronary angiography; however, controversies persist regarding their optimal management. In the present study, we analysed the long-term outcomes of patients with CAAs following three different management strategies.MethodsWe performed a retrospective review of patient records with documented CAA diagnosis between 2000 and 2005. Patients were divided into three groups: medical management versus percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG). We analysed the rate of major cardiovascular and cerebrovascular events (MACCEs) over a period of 10 years.ResultsWe identified 458 patients with CAAs (mean age 78±10.5 years, 74.5% men) who received medical therapy (N=230) or underwent PCI (N=52) or CABG (N=176). The incidence of CAAs was 0.7% of the total catheterisation reports. The left anterior descending was the most common coronary artery involved (38%). The median follow-up time was 62 months. The total number of MACCE during follow-up was 155 (33.8%); 91 (39.6%) in the medical management group vs 46 (26.1%) in the CABG group vs 18 (34.6%) in the PCI group (p=0.02). Kaplan-Meier survival analysis showed that CABG was associated with better MACCE-free survival (p log-rank=0.03) than medical management. These results were confirmed on univariate Cox regression, but not multivariate regression (OR 0.773 (0.526 to 1.136); p=0.19). Both Kaplan-Meier survival and regression analyses showed that dual antiplatelet therapy (DAPT) and anticoagulation were not associated with significant improvement in MACCE rates.ConclusionOur analysis showed similar long-term MACCE risks in patients with CAA undergoing medical, percutaneous and surgical management. Further, DAPT and anticoagulation were not associated with significant benefits in terms of MACCE rates. These results should be interpreted with caution considering the small size and potential for selection bias and should be confirmed in large, randomised trials.

scholarly journals Tracking Changes on Soil Structure and Organic Carbon Sequestration after 30 Years of Different Tillage and Management Practices

Agronomy ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 291
Author(s):  
Ramón Bienes ◽  
Maria Jose Marques ◽  
Blanca Sastre ◽  
Andrés García-Díaz ◽  
Iris Esparza ◽  
...  
Keyword(s):  
Triticum Aestivum ◽  
Organic Carbon ◽  
Management Practices ◽  
Management Strategies ◽  
Triticum Aestivum L ◽  
Field Trials ◽  
Conventional Tillage ◽  
Soil Parameters ◽  
Wilting Point

Long-term field trials are essential for monitoring the effects of sustainable land management strategies for adaptation and mitigation to climate change. The influence of more than thirty years of different management is analyzed on extensive crops under three tillage systems, conventional tillage (CT), minimum tillage (MT), and no-tillage (NT), and with two crop rotations, monoculture winter-wheat (Triticum aestivum L.) and wheat-vetch (Triticum aestivum L.-Vicia sativa L.), widely present in the center of Spain. The soil under NT experienced the largest change in organic carbon (SOC) sequestration, macroaggregate stability, and bulk density. In the MT and NT treatments, SOC content was still increasing after 32 years, being 26.5 and 32.2 Mg ha−1, respectively, compared to 20.8 Mg ha−1 in CT. The SOC stratification (ratio of SOC at the topsoil/SOC at the layer underneath), an indicator of soil conservation, increased with decreasing tillage intensity (2.32, 1.36, and 1.01 for NT, MT, and CT respectively). Tillage intensity affected the majority of soil parameters, except the water stable aggregates, infiltration, and porosity. The NT treatment increased available water, but only in monocropping. More water was retained at the permanent wilting point in NT treatments, which can be a disadvantage in dry periods of these edaphoclimatic conditions.

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