Abstract WP354: Ten-year Temporal Trends in Medical Complications Following Acute Intracerebral Hemorrhage in the United States

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Fadar O Otite ◽  
Priyank Khandelwal ◽  
Amer M Malik ◽  
Seemant Chaturvedi ◽  
Ralph L Sacco ◽  
...  
Keyword(s):  
United States ◽  
Intracerebral Hemorrhage ◽  
Nationwide Inpatient Sample ◽  
Temporal Trends ◽  
The United States ◽  
Medical Complications ◽  
Innovative Strategies ◽  
The Us ◽  
Acute Intracerebral Hemorrhage ◽  
Over Time

Background: Data on medical complications following intracerebral hemorrhage (ICH) are sparse. We assessed trends in the prevalence of urinary tract infection (UTI), pneumonia, sepsis, deep venous thrombosis (DVT), pulmonary embolism (PE), acute renal failure (ARF) and acute myocardial infarction (AMI) following ICH in the United States and evaluated their association with in-hospital mortality (IM), cost, length-of-stay (LOS) and home disposition (HD). Methods: Adults admitted to US hospitals from 2004-2013 (n=582,736) were identified from the Nationwide Inpatient Sample. Weighted complication risks were computed by sex and by mechanical ventilation (MV) status. Multivariate models were used to evaluate trends in complication and to assess their association with IM, cost, LOS, and HD. Results: Overall risks of UTI, pneumonia, sepsis, DVT, PE, ARF and AMI following ICH were 14.8%, 7.7%, 4.1%, 2.7%, 0.7%, 8.2% and 2.0% respectively. Risks differed by sex (UTI: females (F) 19.8% vs males (M) 9.9%; ARF: M 10.6% vs F 5.9%; sepsis: M 4.8% vs F 3.4%) and by MV status (pneumonia: MV 17.7% vs non-MV 3.9%; DVT: MV 4.3% vs non-MV 3.2%). From 2004 to 2103, odds of DVT and ARF increased while odds of pneumonia, sepsis and mortality declined over time (figure 1). Each complication was associated with > 2.5-day increase in mean LOS, > $8,000 increase in cost and reduced odds of HD. ARF and AMI were associated with increased IM in all patients; sepsis and pneumonia were associated with increased IM only in non-MV patients while UTI and DVT were associated with reduced IM in all patients. Conclusion and Relevance: Despite IM reduction, ARF and DVT risk following ICH in the US have increased while odds of sepsis and pneumonia have declined over time. All complications were associated with increased cost, LOS and reduced odds of HD but their associations with IM were variable, likely due in part to survival bias. Innovative strategies are needed to prevent ICH-associated medical complications.

scholarly journals Ten-Year Temporal Trends in Medical Complications After Acute Intracerebral Hemorrhage in the United States

Stroke ◽  
2017 ◽  
Vol 48 (3) ◽  
pp. 596-603 ◽  
Author(s):  
Fadar Oliver Otite ◽  
Priyank Khandelwal ◽  
Amer M. Malik ◽  
Seemant Chaturvedi ◽  
Ralph L. Sacco ◽  
...  
Keyword(s):  
United States ◽  
Intracerebral Hemorrhage ◽  
Temporal Trends ◽  
The United States ◽  
Medical Complications ◽  
Acute Intracerebral Hemorrhage

Abstract 22: STEMI Trends in the United States 2002-2010: Increasing Use of PCI and Declining Mortality

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Rashmee U Shah ◽  
Stephanie Rutten-Ramos ◽  
Ross Garberich ◽  
Mourad Tighiouart ◽  
Timothy D Henry ◽  
...  
Keyword(s):  
United States ◽  
Temporal Trends ◽  
High Volume ◽  
Coronary Intervention ◽  
The United States ◽  
Absolute Number ◽  
Diagnostic Code ◽  
The Us ◽  
The Absolute ◽  
Over Time

Objective: We sought to quantify changes in STEMI mortality and percutaneous coronary intervention (PCI) use in the United States (US) from 2002 to 2010. Methods: We used the Nationwide Inpatient Sample (NIS), an all-payer discharge database, to create estimates of STEMI, STEMI in-hospital mortality, and PCI use. The NIS includes hospitals selected to approximate 20% of all non-federal US hospitals and includes weights to create national estimates. STEMI cases were identified based on primary diagnostic code. High volume STEMI-PCI centers were defined as >36 cases/year, according to PCI guidelines. Temporal trends were evaluated with logistic regression, adjusted for patient and hospital characteristics. Discharges to other acute care facilities were excluded for outcomes analyses. Results: We identified 1,944,112 STEMI discharges in the US; mean age was 64 years, 34% were women, and 46% were Medicare insured. The absolute number of STEMI discharges declined from 299,441 in 2002 to 167,929 in 2010 (Figure). The number of hospitals performing zero STEMI-related PCIs decreased from 75% (3633/4840) to 68% (3514/5134) between 2002 and 2010. The number of high volume centers increased from 20% (949/4840) to 24% (1235/4840) over the same period. Overall, 64% (1,145,196/1,783,825) of discharges received PCI and 8.5% (151,528/1,783,825) died during hospitalization. PCI use increased and mortality decreased over time (Figure). The adjusted odds of PCI use for STEMI discharges increased over three fold during the study period (OR 3.51 in 2010 versus 2002, 95% CI 3.21 to 3.83). The adjusted odds of death decreased by one fifth (OR 0.81 in 2010 versus 2002, 95% CI 0.75 to 0.87). Inclusion of PCI in the model attenuated the effect of year on death (OR 1.06 in 2010 versus 2002, 95% CI 0.98 to 1.14). Conclusions: In this study we demonstrate favorable trends in STEMI outcomes. Between 2002 and 2010, the absolute number of STEMIs in the US decreased, while more hospitals provided PCI for STEMI. Over time, more discharges were treated with PCI and fewer died during hospitalization.

scholarly journals A cross-sectional study of neurosurgical department chairs in the United States

2018 ◽  
Vol 129 (5) ◽  
pp. 1342-1348 ◽  
Author(s):  
Patrick M. Flanigan ◽  
Arman Jahangiri ◽  
Joshua L. Golubovsky ◽  
Jaret M. Karnuta ◽  
Francis J. May ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
San Francisco ◽  
Residency Program ◽  
Department Chair ◽  
Department Chairs ◽  
Temporal Trends ◽  
The United States ◽  
Advanced Degrees ◽  
Over Time

OBJECTIVEThe position of neurosurgery department chair undergoes constant evolution as the health care landscape changes. The authors’ aim in this paper was to characterize career attributes of neurosurgery department chairs in order to define temporal trends in qualities being sought in neurosurgical leaders. Specifically, they investigated the hypothesis that increased qualifications in the form of additional advanced degrees and research acumen are becoming more common in recently hired chairs, possibly related to the increased complexity of their role.METHODSThe authors performed a retrospective study in which they collected data on 105 neurosurgeons who were neurosurgery department chairs as of December 31, 2016, at accredited academic institutions with a neurosurgery residency program in the United States. Descriptive data on the career of neurosurgery chairs, such as the residency program attended, primary subspecialty focus, and age at which they accepted their position as chair, were collected.RESULTSThe median age and number of years in practice postresidency of neurosurgery chairs on acceptance of the position were 47 years (range 36–63 years) and 14 years (range 6–33 years), respectively, and 87% (n = 91) were first-time chairs. The median duration that chairs had been holding their positions as of December 31, 2016, was 10 years (range 1–34 years). The most common subspecialties were vascular (35%) and tumor/skull base (27%), although the tendency to hire from these specialties diminished over time (p = 0.02). More recently hired chairs were more likely to be older (p = 0.02), have more publications (p = 0.007), and have higher h-indices (p < 0.001) at the time of hire. Prior to being named chair, 13% (n = 14) had a PhD, 4% (n = 4) had an MBA, and 23% (n = 24) were awarded a National Institutes of Health R01 grant, tendencies that were stable over time (p = 0.09–0.23), although when additional degrees were analyzed as a binary variable, chairs hired in 2010 or after were more likely to have an MBA and/or PhD versus those hired before 2010 (26% vs 10%, p = 0.04). The 3 most common residency programs attended by the neurosurgery chairs were Massachusetts General Hospital (n = 8, 8%), University of California, San Francisco (n = 8, 8%), and University of Michigan (n = 6, 6%). Most chairs (n = 63, 61%) attended residency at the institution and/or were staff at the institution before they were named chair, a tendency that persisted over time (p = 0.86).CONCLUSIONSMost neurosurgery department chairs matriculated into the position before the age of 50 years and, despite selection processes usually involving a national search, most chairs had a previous affiliation with the department, a phenomenon that has been relatively stable over time. In recent years, a large increase has occurred in the proportion of chairs with additional advanced degrees and more extensive research experience, underscoring how neurosurgical leadership has come to require scientific skills and the ability to procure grants, as well as the financial skills needed to navigate the ever-changing financial health care landscape.

Abstract WMP60: Temporal Trends in Incidence, Prevalence and Epidemiological Characteristics of Cerebral Venous Thrombosis in the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Fadar Otite ◽  
Smit Patel ◽  
Richa Sharma ◽  
Pushti Khandwala ◽  
Devashish Desai ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Cerebral Venous Thrombosis ◽  
The United States ◽  
P Value ◽  
Joinpoint Regression ◽  
The Us ◽  
Epidemiological Characteristics ◽  
Over Time ◽  
Age And Sex

Background: The primary aim of this study is to describe current trends in racial-, age- and sex-specific incidence, clinical characteristics and burden of cerebral venous thrombosis (CVT) in the United States (US). Methods: Validated International Classification of Disease codes were used to identify all adult new cases of CVT (n=5,567) in the State Inpatients Database of New York and Florida (2006-2016) and all cases of CVT in the entire US from the National Inpatient Sample 2005-2016 (weighted n=57,315). Incident CVT counts were combined with annual US Census data to compute age and sex-specific incidence of CVT. Joinpoint regression was used to evaluate trends in incidence over time. Results: From 2005-2016, 0.47%-0.80% of all strokes in the US were CVTs but this proportion increased by 70.4% over time. Of all CVTs over this period, 66.7% were in females but this proportion declined over time (p<0.001). Pregnancy/puerperium (27.4%) and cancer (11.8%) were the most common risk factors in women, while cancer (19.5%) and central nervous trauma (11.3) were the most common in men. Whereas the prevalence of pregnancy/puerperium declined significantly over time in women, that of cancer, inflammatory conditions and trauma increased over time in both sexes. Annual age and sex-standardized incidence of CVT in cases/million population ranged from 13.9-20.2, but incidence varied significantly by sex (women: 20.3-26.9; men 6.8-16.8) and by age/sex (women 18-44yo: 24.0-32.6%; men: 18-44yo: 5.3-12.8). Age and sex-standardized incidence also differed by race (Blacks:18.6-27.2; whites: 14.3-18.5; Asians: 5.1-13.8). On joinpoint regression, incidence increased across 2006-2016 but most of this increase was driven by increase in all age groups of men (combined annualized percentage change (APC) 9.2%, p-value <0.001), women 45-64 yo (APC 7.8%, p-value <0.001) and women ≥65 yo (APC 7.4%, p-value <0.001). Incidence in women 18-44 yo remained unchanged over time . Conclusion: The epidemiological characteristics of CVT patients in the US is changing. Incidence increased significantly over the last decade. Further studies are needed to determine whether this increase represents a true increase from changing risk factors or artefactual increase from improved detection.

Abstract MP38: Intracerebral Hemorrhage Across the United States: Incidence and Mortality Trends From 1990 to 2017

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Augustin DeLago ◽  
Harpreet Singh ◽  
Arashdeep Rupal ◽  
Chinmay Jani ◽  
Arshi Parvez ◽  
...  
Keyword(s):  
United States ◽  
Intracerebral Hemorrhage ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
The United States ◽  
Mortality Trends ◽  
Reversal Agents ◽  
Incidence And Mortality ◽  
The Us

Background: Intracerebral Hemorrhage (ICH) accounts for 10% of strokes annually in the United States (US). Up-to-date trends in disease burden and regional variation remain unknown; especially after a dramatic increase in the use of direct oral anticoagulants (DOACs) since 2010. Our study reports updated incidence, mortality and mortality to incidence ratio (MIR) data related to ICH across the US. Methods: This observational study utilized the Global Burden of Disease database to determine age-standardized incidence (ASIR), death (ASDR) and MIR rates for ICH overall and for each state in the US from 1990-2017. All analyses were stratified by sex. Trends were analyzed using Joinpoint regression analysis, with presentation of estimated annual percentage changes (EAPCs) in ASIRs, ASDRs and MIRs over the observation period. Results: We observed an overall decrease in ASIRs, ASDRs and MIRs in both genders from 1990-2017, apart from female ASIRs and ASDRs in West Virginia and Kentucky. In 2017, the mean ASIR per 100,000 population for men was 25.67 and 19.17 for women. The 2017 mean ASDRs per 100,000 population for men and women were 13.96 and 11.35, respectively. The District of Columbia had the greatest decreases in ASIR EAPCs for males at -41.25% and females at -40.58%, and the greatest decreases in ASDR EAPCs for both males and females at -55.38% and -48.51%, respectively. The overall MIR during the study period decreased in males by -12.12% and females by -7.43%. However, MIR increased in males from 2014-2017 (EAPC +2.2% [95% CI +0.9%-+3.5%]) and in females from 2011-2017 (EAPC +1.0% [CI +0.7%-+1.4%]). Conclusion: This report reveals overall decreasing trends in incidence, mortality and MIR from 1990-2017. Notably, no significant change in mortality was found in the last 6 years of the study period, and MIR worsened in males from 2014-2017 and in females from 2011-2017, suggesting decreased ICH related survival lately. The substitution of vitamin K antagonists with DOACs is one possible explanation for a downtrend in incidence despite an aging population and increased use of anticoagulants. Limited access to reversal agents for DOACs is a potential reason for increase in MIR, however concrete deductions cannot be made owing to the observational nature of the study.

scholarly journals Temporal and spatial variations in freeze warnings in the conterminous United States: 2005–2018

2019 ◽  
Vol 139 (3-4) ◽  
pp. 1379-1384
Author(s):  
Brandon Lawhorn ◽  
Robert C. Balling
Keyword(s):  
United States ◽  
Temporal Trends ◽  
The United States ◽  
Temporal Variations ◽  
Atmospheric Composition ◽  
Southeastern Us ◽  
The Us ◽  
Temporal And Spatial ◽  
Frost Free Period ◽  
Spatial And Temporal Trends

AbstractIt is well-documented that the United States (US), along with other mid-latitude land locations, has experienced warming in recent decades in response to changes in atmospheric composition. Among other changes, Easterling (2002) reported that the frost-free period is now longer across much of the US with the first frost in fall occurring later and the last freeze in spring occurring earlier. In this investigation, we explore spatial and temporal variations in all freeze warnings issued by the US National Weather Service. Freeze warning counts are highest in the southeastern US peaking overall in the spring and fall months. Freeze warnings tend to occur more toward summer moving northward and westward into more northerly states. Consistent with the warming in recent decades, we find statistically significant northward movements in freeze warning centroids in some months (December, February) across the study period (2005–2018). Detection of spatial and temporal trends in freeze warnings may be of interest to any number of scientists with applied climatological interests.

The Democratic Deficit of United States Federalism? Red State, Blue State, Purple?

2018 ◽  
Vol 46 (4) ◽  
pp. 645-667
Author(s):  
Vicki C Jackson
Keyword(s):  
United States ◽  
State Legislatures ◽  
The United States ◽  
State Legislature ◽  
Democratic Deficit ◽  
The Us ◽  
The 1960S ◽  
Us Senate ◽  
The One ◽  
Over Time

Aspects of an entrenched constitution that were essential parts of founding compromises, and justified as necessary when a constitution was first adopted, may become less justifiable over time. Is this the case with respect to the structure of the United States Senate? The US Senate is hardwired in the Constitution to consist of an equal number of Senators from each state—the smallest of which currently has about 585,000 residents, and the largest of which has about 39.29 million. As this essay explains, over time, as population inequalities among states have grown larger, so too has the disproportionate voting power of smaller-population states in the national Senate. As a result of the ‘one-person, one-vote’ decisions of the 1960s that applied to both houses of state legislatures, each state legislature now is arguably more representative of its state population than the US Congress is of the US population. The ‘democratic deficit’ of the Senate, compared to state legislative bodies, also affects presidential (as compared to gubernatorial) elections. When founding compromises deeply entrenched in a constitution develop harder-to-justify consequences, should constitutional interpretation change responsively? Possible implications of the ‘democratic’ difference between the national and the state legislatures for US federalism doctrine are explored, especially with respect to the ‘pre-emption’ doctrine. Finally, the essay briefly considers the possibilities of federalism for addressing longer term issues of representation, polarisation and sustaining a single nation.

The Adverse Consequences of the Politics of Agency Design for Presidential Management in the United States: The Relative Durability of Insulated Agencies

2004 ◽  
Vol 34 (3) ◽  
pp. 377-404 ◽  
Author(s):  
DAVID E. LEWIS
Keyword(s):  
United States ◽  
Public Policies ◽  
The United States ◽  
Executive Branch ◽  
Us Congress ◽  
The Us ◽  
Presidential Management ◽  
Agency Design ◽  
Over Time ◽  
Expected Duration

The US Congress has often sought to limit presidential influence over certain public policies by designing agencies that are insulated from presidential control. Whether or not insulated agencies persist over time has important consequences for presidential management. If those agencies that persist over time are also those that are the most immune from presidential direction, this has potentially fatal consequences for the president's ability to manage the executive branch. Modern presidents will preside over a less and less manageable bureaucracy over time. This article explains why agencies insulated from presidential control are more durable than other agencies and shows that they have a significantly higher expected duration than other agencies. The conclusion is that modern American presidents preside over a bureaucracy that is increasingly insulated from their control.

Incidence of and Risk Factors for Nosocomial Bloodstream Infections in Adults in the United States, 2003

2009 ◽  
Vol 30 (11) ◽  
pp. 1036-1044 ◽  
Author(s):  
Omar M. AL-Rawajfah ◽  
Frank Stetzer ◽  
Jeanne Beauchamp Hewitt
Keyword(s):  
United States ◽  
Risk Factors ◽  
Case Fatality Rate ◽  
Nationwide Inpatient Sample ◽  
Hospital Admissions ◽  
Case Fatality ◽  
The United States ◽  
Fatality Rate ◽  
The Us ◽  
National Estimates

Background.Although many studies have examined nosocomial bloodstream infection (BSI), US national estimates of incidence and case-fatality rates have seldom been reported.Objective.The purposes of this study were to generate US national estimates of the incidence and severity of nosocomial BSI and to identify risk factors for nosocomial BSI among adults hospitalized in the United States on the basis of a national probability sample.Methods.This cross-sectional study used the US Nationwide Inpatient Sample for the year 2003 to estimate the incidence and case-fatality rate associated with nosocomial BSI in the total US population. Cases of nosocomial BSI were defined by using 1 or more International Classification of Diseases, 9th Revision, Clinical Modification codes in the secondary field(s) that corresponded to BSIs that occurred at least 48 hours after admission. The comparison group consisted of all patients without BSI codes in their NIS records. Weighted data were used to generate US national estimates of nosocomial BSIs. Logistic regression was used to identify independent risk factors for nosocomial BSI.Results.The US national estimated incidence of nosocomial BSI was 21.6 cases per 1,000 admissions, while the estimated case-fatality rate was 20.6%. Seven of the 10 leading causes of hospital admissions associated with nosocomial BSI were infection related. We estimate that 541,081 patients would have acquired a nosocomial BSI in 2003, and of these, 111,427 would have died. The final multivariate model consisted of the following risk factors: central venous catheter use (odds ratio [OR], 4.76), other infections (OR, 4.61), receipt of mechanical ventilation (OR, 4.97), trauma (OR, 1.98), hemodialysis (OR, 4.83), and malnutrition (OR, 2.50). The total maximum rescaled R2 was 0.22.Conclusions.The Nationwide Inpatient Sample was useful for estimating national incidence and case-fatality rates, as well as examining independent predictors of nosocomial BSI.

scholarly journals The Changing Shape of the World Automobile Industry: A Multilayer Network Analysis of International Trade in Components and Parts

2022 ◽  
Author(s):  
Margherita Russo ◽  
◽  
Fabrizio Alboni ◽  
Jorge Carreto Sanginés ◽  
Manlio De Domenico ◽  
...  
Keyword(s):  
United States ◽  
Network Analysis ◽  
Trade Agreement ◽  
The United States ◽  
Trade Network ◽  
Trade Relations ◽  
Automotive Components ◽  
The Us ◽  
The World ◽  
Over Time

In 2018, after 25 years of the North America Trade Agreement (NAFTA), the United States requested new rules which, among other requirements, increased the regional con-tent in the production of automotive components and parts traded between the three part-ner countries, United States, Canada and Mexico. Signed by all three countries, the new trade agreement, USMCA, is to go into force in 2022. Nonetheless, after the 2020 Presi-dential election, the new treaty's future is under discussion, and its impact on the automo-tive industry is not entirely defined. Another significant shift in this industry – the acceler-ated rise of electric vehicles – also occurred in 2020: while the COVID-19 pandemic largely halted most plants in the automotive value chain all over the world, at the reopen-ing, the tide is now running against internal combustion engine vehicles, at least in the an-nouncements and in some large investments planned in Europe, Asia and the US. The definition of the pre-pandemic situation is a very helpful starting point for the analysis of the possible repercussions of the technological and geo-political transition, which has been accelerated by the epidemic, on geographical clusters and sectorial special-isations of the main regions and countries. This paper analyses the trade networks emerg-ing in the past 25 years in a new analytical framework. In the economic literature on inter-national trade, the study of the automotive global value chains has been addressed by us-ing network analysis, focusing on the centrality of geographical regions and countries while largely overlooking the contribution of countries' bilateral trading in components and parts as structuring forces of the subnetwork of countries and their specific position in the overall trade network. The paper focuses on such subnetworks as meso-level structures emerging in trade network over the last 25 years. Using the Infomap multilayer clustering algorithm, we are able to identify clusters of countries and their specific trades in the automotive internation-al trade network and to highlight the relative importance of each cluster, the interconnec-tions between them, and the contribution of countries and of components and parts in the clusters. We draw the data from the UN Comtrade database of directed export and import flows of 30 automotive components and parts among 42 countries (accounting for 98% of world trade flows of those items). The paper highlights the changes that occurred over 25 years in the geography of the trade relations, with particular with regard to denser and more hierarchical network gener-ated by Germany’s trade relations within EU countries and by the US preferential trade agreements with Canada and Mexico, and the upsurge of China. With a similar overall va-riety of traded components and parts within the main clusters (dominated respectively by Germany, US and Japan-China), the Infomap multilayer analysis singles out which com-ponents and parts determined the relative positions of countries in the various clusters and the changes over time in the relative positions of countries and their specialisations in mul-tilateral trades. Connections between clusters increase over time, while the relative im-portance of the main clusters and of some individual countries change significantly. The focus on US and Mexico and on Germany and Central Eastern European countries (Czech Republic, Hungary, Poland, Slovakia) will drive the comparative analysis.

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