Abstract 16097: Impact of Device Miniaturization on Implantable Loop Recorder Utilization in the Pediatric Population: An Analysis of the Marketscan Database

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Dustin Nash ◽  
Hannah Katcoff ◽  
Jennifer Faerber ◽  
Ramesh Iyer ◽  
Michael L O’Byrne ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Study Cohort ◽  
Administrative Claims ◽  
Group 14 ◽  
Loop Recorder ◽  
Device Infection ◽  
History Of ◽  
Secondary Analyses ◽  
The Impact ◽  
Device Miniaturization

Introduction: Implantable loop recorders (ILRs) are an effective technology in the detection of paroxysmal arrhythmias, but utility in the pediatric population has been limited by device size. In 2014, a miniaturized ILR was introduced with a less invasive implant technique. The impact of this technology on ILR utilization in pediatric patients has not been evaluated. Hypothesis: We hypothesize an increase in annual pediatric ILR implants since 2014 due to device miniaturization. Methods: A retrospective observational study was conducted using administrative claims from Marketscan Medicaid and Commercial insurance claims databases. Utilization of ILR between 1/2013 and 12/2018 was measured (normalized to the total enrolled population ≤18 years) and compared to two balancing measures (Holter ambulatory monitors and encounters with syncope as a diagnosis). Secondary analyses included evaluations of subsequent interventions and complications. Results: The study cohort included 33,532,185 individual subjects, of which 769 underwent ILR implantation. ILR subjects were 52% male, with a median age of 16 years (IQR 10-17 yrs). 71% had a history of syncope, 43% had a history of palpitations, and 28% had a history of congenital heart disease. Utilization of ILR increased in 2014, from 5 procedures per million enrollees in 2013 to 11 per million between 2015-2018, while balancing measures remained static (see Figure).Of 393 subjects with ≥1 year of follow-up post-implant, interventions included catheter ablation in 24 (6%), pacemaker implant in 15 (4%) and ICD implant in 7 (1.8%). Among this group, 14 (3.6%) had a device infection and 5 (1.3%) had an erosion. Conclusions: Following introduction of the miniaturized ILR, pediatric utilization has rapidly increased. The effect of this change on outcomes and value deserves further attention.

scholarly journals The impact of prior urethral sling on artificial urinary sphincter outcomes

2016 ◽  
Vol 10 (11-12) ◽  
pp. 405 ◽  
Author(s):  
Matthew J. Ziegelmann ◽  
Brian J. Linder ◽  
Marcelino E. Rivera ◽  
Boyd R. Viers ◽  
Daniel S. Elliott
Keyword(s):  
Retrospective Chart Review ◽  
Artificial Urinary Sphincter ◽  
Device Failure ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Urinary Sphincter ◽  
Device Infection ◽  
Significant Difference ◽  
History Of ◽  
The Impact

Introduction: We sought to evaluate device outcomes in men who underwent primary artificial urinary sphincter (AUS) placement after failed male urethral sling (MUS).Methods: We performed a retrospective chart review of 990 men who underwent an AUS procedure between 2003 and 2014. Of these, 540 were primary AUS placements, including 30 (5.5%) with a history of MUS. AUS revisions and explantations were compared between men stratified by the presence of prior sling. Hazard ratios (HR) adjusting for competing risks were used to determine the association with prior sling and AUS outcomes (infection/ erosion, urethral atrophy, and mechanical malfunction), while overall device failure was estimated using Kaplan-Meier and Coxregression analysis.Results: There was no significant difference in age, body mass index, prior prostatectomy, or pelvic radiation when stratified by history of MUS. However, patients with a history of MUS were more likely to have undergone prior collagen injection (p=0.01). On univariate and multivariate analysis, prior MUS was not associated with device failure (HR 1.54; p=0.27). Three-year overall device survival did not significantly differ between those with and without prior MUS (70% vs. 85%; p=0.21). Also, there were no significant differences in the incidence of device infection/erosion, mechanical malfunction, and urethral atrophy.Conclusions: AUS remains a viable treatment option for men with persistent or recurrent stress urinary incontinence after MUS. However, while not statistically significant, we identified a trend towards lower three-year device outcomes in patients with prior urethral sling. These findings indicate the need for longer-term studies to determine if slings pose an increased hazard.

Abstract 127: Radiosurgery for Unruptured Intervention-Naïve Pediatric Brain Arteriovenous Malformations

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ching-jen Chen ◽  
Cheng-Chia Lee ◽  
Hideyuki Kano ◽  
Kathryn Kearns ◽  
Dale Ding ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Arteriovenous Malformations ◽  
Pediatric Population ◽  
Study Cohort ◽  
Brain Arteriovenous Malformations ◽  
History Of ◽  
Radiation Induced ◽  
Induced Changes ◽  
Pediatric Brain ◽  
Stroke Death

Background and Purpose: To evaluate, in a multicenter, retrospective cohort study, the outcomes after stereotactic radiosurgery (SRS) for unruptured, intervention-naïve pediatric brain arteriovenous malformations (AVM). Methods: We retrospectively analyzed the International Radiosurgery Research Foundation pediatric AVM database from 1987-2018. Pediatric patients with unruptured, previously untreated AVMs who underwent SRS were included. The primary endpoint was a composite of hemorrhagic stroke, death, or permanently symptomatic radiation-induced changes (RIC). Results: The study cohort comprised 101 patients (mean follow-up 80.8 months). The primary endpoint occurred in 14%, comprising hemorrhage stroke, death, and permanent RIC in 6%, 3%, and 8%, respectively. Estimated probabilities of the primary endpoint were 5.2%, 10.8%, and 23.0% at 2, 5, and 10 years, respectively (Figure 1). Estimated probabilities of AVM obliteration at 5 and 10 years were 64% and 82%, respectively (Figure 2). Single SRS treatment (p=0.007) and higher margin dose (p=0.005) were predictors of obliteration. Subgroup analysis of Spetzler-Martin grade I-III AVMs estimated primary endpoint probabilities of 3.7%, 8.4%, and 18.7% at 2, 5 and 10 years, respectively. Conclusion: Treatment of unruptured, intervention-naïve AVMs in the pediatric population with SRS carries an approximately 2% annual risk of morbidity and mortality, which appears to plateau after 10 years. The poorly described natural history of pediatric AVMs makes any comparison of SRS versus conservative management imperfect. However, due to the young age at diagnosis and excessive cumulative life hemorrhage risk of an untreated AVM in a child, SRS is likely to have a favorable long-term risk-benefit profile for appropriately selected unruptured pediatric AVMs.

Impact of USPSTF recommendations on utilization of PSA screening in Medicare beneficiaries.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 166-166
Author(s):  
Rahul Ramesh Khairnar ◽  
Mark Mishra ◽  
Ebere Onukwugha
Keyword(s):  
Task Force ◽  
Specific Antigen ◽  
Age Groups ◽  
The United States ◽  
Study Cohort ◽  
Administrative Claims ◽  
Medicare Beneficiaries ◽  
Psa Screening ◽  
Medicare Population ◽  
The Impact

166 Background: Previous studies assessing the impact of the United States Preventive Services Task Force (USPSTF) recommendations on utilization of prostate-specific antigen (PSA) screening have not investigated longer-term impacts of the 2008 recommendations nor have they investigated the impact of the 2012 recommendations in the Medicare population. The study aim was to evaluate change in utilization of PSA screening, post USPSTF recommendations of 2008 and 2012, and to assess trends and determinants of receipt of PSA screening in the Medicare population. Methods: This retrospective study of male Medicare beneficiaries utilized Medicare Current Beneficiary Survey (MCBS) data and linked administrative claims from 2006-2013. Beneficiaries aged ≥65 years, with continuous enrollment in Parts A and B for each year they were surveyed were included in the study cohort. Beneficiaries with self-reported or claims-based diagnosis of prostate cancer were excluded. Beneficiaries with Medicare eligibility due to end stage renal disease or disability were also excluded. The primary outcome was receipt of PSA screening. Other measures include age groups (65-74 and ≥75), time periods (pre- and post-2008 and 2012 recommendations), and sociodemographic variables. Results: The study cohort consisted of 11,028 beneficiaries, who were predominantly white (87.56%), married (69.25%), and unemployed (84.4%); 52.21% beneficiaries were aged ≥75. Declining utilization trends for PSA screening were observed only in men aged ≥75 after 2008 recommendations and in both age groups after 2012 recommendations. The odds of receiving PSA screening declined by 17% percent in men aged ≥75 after the 2008 recommendations and by 29% in men aged ≥65 after the 2012 recommendations. Conclusions: The USPSTF recommendations of 2008 and 2012 against PSA screening were associated with declines in utilization of PSA screening during the study period. USPSTF recommendations play a significant role in affecting utilization patterns of health services. Future studies should evaluate if the proposed 2017 update to these recommendations advocating shared decision-making for PSA screening in men aged 55-69 increase utilization in this age-group.

scholarly journals Opportunities for Early Intervention Based on Theory, Basic Neuroscience, and Clinical Science

2010 ◽  
Vol 90 (12) ◽  
pp. 1868-1880 ◽  
Author(s):  
Beverly D. Ulrich
Keyword(s):  
Pediatric Population ◽  
Theoretical Perspective ◽  
Third Party ◽  
Functional Skills ◽  
Science Data ◽  
Aggressive Approach ◽  
Theoretical Concepts ◽  
Neural Organization ◽  
History Of ◽  
The Impact

Therapeutic approaches in the pediatric population have generally been less aggressive than those implemented for younger and older adults. Several factors contribute to this, starting with the challenge of engaging infants in the “goal” of therapy, their resistance to initiating behaviors that are uncomfortable or fatiguing, the desire to make therapy as functionally relevant as possible when many functional skills have yet to emerge, and residual history of outdated theoretical concepts. On the practical side of who will pay for this more aggressive approach, there is limited empirical evidence based on randomized controlled trials to convince third-party payers to fund more extensive services. This article outlines a theoretical perspective prominent in developmental science that argues not only for the importance of frequent bouts of functionally relevant activity on the self-organization of behavioral patterns, but also for the impact that should be expected from the use of rigorous interventions on underlying subsystems, such as neural organization, that support these outcomes. In order to propose some future opportunities for clinical research and application, examples from recent activity-based clinical studies are presented, along with theoretical principles, neuroscience, and other tissue science data concerning mechanisms that contribute to behavioral changes. One such opportunity is to increase the structured engagement of caregivers, guided by therapists, in administering well-defined activity intervention programs focused on the development of specific functional skills. Such an approach may be one of the few financially feasible options for generating sufficient therapy that adheres to principles for optimizing development of neuromotor control.

Investigating the Relationship Between Self-Esteem and Stigma Among Young Adults With History of Suicide Attempts

Crisis ◽  
2016 ◽  
Vol 37 (4) ◽  
pp. 265-270 ◽  
Author(s):  
Meshan Lehmann ◽  
Matthew R. Hilimire ◽  
Lawrence H. Yang ◽  
Bruce G. Link ◽  
Jordan E. DeVylder
Keyword(s):  
Young Adults ◽  
Suicide Attempts ◽  
Self Esteem ◽  
High Risk Population ◽  
High Functioning ◽  
People With Mental Illness ◽  
History Of ◽  
The Individual ◽  
The Impact ◽  
The Relationship

Abstract. Background: Self-esteem is a major contributor to risk for repeated suicide attempts. Prior research has shown that awareness of stigma is associated with reduced self-esteem among people with mental illness. No prior studies have examined the association between self-esteem and stereotype awareness among individuals with past suicide attempts. Aims: To understand the relationship between stereotype awareness and self-esteem among young adults who have and have not attempted suicide. Method: Computerized surveys were administered to college students (N = 637). Linear regression analyses were used to test associations between self-esteem and stereotype awareness, attempt history, and their interaction. Results: There was a significant stereotype awareness by attempt interaction (β = –.74, p = .006) in the regression analysis. The interaction was explained by a stronger negative association between stereotype awareness and self-esteem among individuals with past suicide attempts (β = –.50, p = .013) compared with those without attempts (β = –.09, p = .037). Conclusion: Stigma is associated with lower self-esteem within this high-functioning sample of young adults with histories of suicide attempts. Alleviating the impact of stigma at the individual (clinical) or community (public health) levels may improve self-esteem among this high-risk population, which could potentially influence subsequent suicide risk.

The Film World’s Cooperative Store: Institutions and Films of the 1930s and 1940s

2018 ◽  
Author(s):  
C. Claire Thomson
Keyword(s):  
World War Ii ◽  
Meat Products ◽  
Public Information ◽  
Early History ◽  
World War ◽  
International Context ◽  
German Occupation ◽  
History Of ◽  
The Uk ◽  
The Impact

This chapter traces the early history of state-sponsored informational filmmaking in Denmark, emphasising its organisation as a ‘cooperative’ of organisations and government agencies. After an account of the establishment and early development of the agency Dansk Kulturfilm in the 1930s, the chapter considers two of its earliest productions, both process films documenting the manufacture of bricks and meat products. The broader context of documentary in Denmark is fleshed out with an account of the production and reception of Poul Henningsen’s seminal film Danmark (1935), and the international context is accounted for with an overview of the development of state-supported filmmaking in the UK, Italy and Germany. Developments in the funding and output of Dansk Kulturfilm up to World War II are outlined, followed by an account of the impact of the German Occupation of Denmark on domestic informational film. The establishment of the Danish Government Film Committee or Ministeriernes Filmudvalg kick-started aprofessionalisation of state-sponsored filmmaking, and two wartime public information films are briefly analysed as examples of its early output. The chapter concludes with an account of the relations between the Danish Resistance and an emerging generation of documentarists.

The impact of fluorescein-guided technique in the surgical removal of CNS tumors in a pediatric population: results from a multicentric observational study

2020 ◽  
Vol 63 (6) ◽  
Author(s):  
Camilla de Laurentis ◽  
Julius Höhne ◽  
Claudio Cavallo ◽  
Francesco Restelli ◽  
Jacopo Falco ◽  
...  
Keyword(s):  
Observational Study ◽  
Pediatric Population ◽  
Cns Tumors ◽  
Surgical Removal ◽  
The Impact

A Left History of Liquorice: What It Means to Write "Left" History

2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Bryan D. Palmer
Keyword(s):  
Historical Study ◽  
Right Wing ◽  
Special Edition ◽  
Political Climate ◽  
Historical Approach ◽  
History Of ◽  
The Impact

This article is part of a special Left History series reflecting upon changing currents and boundaries in the practice of left history, and outlining the challenges historians of the left must face in the current tumultuous political climate. This series extends a conversation first convened in a 2006 special edition of Left History (11.1), which asked the question, “what is left history?” In the updated series, contributors were asked a slightly modified question, “what does it mean to write ‘left’ history?” The article charts the impact of major political developments on the field of left history in the last decade, contending that a rising neoliberal and right-wing climate has constructed an environment inhospitable to the discipline’s survival. To remain relevant, Palmer calls for historians of the left to develop a more “open-ended and inclusive” understanding of the left and to push the boundaries of inclusion for a meaningful historical study of the left. To illustrate, Palmer provides a brief materialist history of liquorice to demonstrate the mutability of left history as a historical approach, rather than a set of traditional political concerns.

THEORETICAL AND PRACTICAL BASES OF THE CONCEPT OF SOCIO LINGUISTICS

2020 ◽  
Vol 5 (3) ◽  
pp. 20-24
Author(s):  
Durdona Karimova ◽  
Keyword(s):  
Sociolinguistic Competence ◽  
History Of ◽  
The Impact

This article discusses the theoretical and practical foundations of the concept of sociolinguistics and the importance of this field in the study of the impact of society on language. It also describes the views of linguists in this regard, the history of the origin and development of the filed, its connection with other disciplines, and explains in detail the sociolinguistic issues with practical examples.In addition, the terms as macro-sociolinguistics and micro-sociolinguistics and sociolinguistic competence are explained.

Perkembangan TIK, Globalisasi dan Peranan Guru Pendidikan Kewarganegaraan dalam Pengembangan Pendidikan Karakter

2018 ◽  
Vol 1 ◽  
Author(s):  
Zulpadli Zulpadli
Keyword(s):  
Character Education ◽  
Civic Education ◽  
Moral Values ◽  
Hard Work ◽  
Theoretical Studies ◽  
Paper Briefly ◽  
History Of ◽  
Younger Generation ◽  
The Impact

This paper briefly and through theoretical studies will discuss simply the problems formulated, the impact of globalization on Character education in Indonesia, as well as the paradigm of PKN learning and Character education challenges for the younger generation. It is on the ground by the declining awareness and moral values, as well as to increase the values of the characters seen in the young generations. Civic education in Indonesia has been running throughout the history of Indonesian independence, and has gone through various stages and arms, it certainly demands greater hard work of teachers to be able to increase the values of Pancasila and love of the homeland, and practice the character values which is based on the noble values of Indonesian culture into Indonesian youth.

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