scholarly journals Volumes, outcomes, and complications after surgical versus endovascular treatment of aneurysms in the United States (1993–2015): continued evolution versus steady-state after more than 2 decades of practice

2020 ◽  
pp. 1-14 ◽  
Author(s):  
Pedram Golnari ◽  
Pouya Nazari ◽  
Roxanna M. Garcia ◽  
Hannah Weiss ◽  
Ali Shaibani ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Fold Increase ◽  
The United States ◽  
Diagnosis And Treatment ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
The Past ◽  
The Us ◽  
Risk Ratios ◽  
Over Time

OBJECTIVEAdoption of endovascular treatment (EVT) and other advances in aneurysm care have shifted practice patterns of cerebral aneurysm treatment over the past 2 decades in the US. The objective of this study was to determine whether resulting trends in volumes, outcomes, and complications have matured in general practice or continue to evolve.METHODSData were obtained from the National Inpatient Sample from 1993 to 2015. ICD-9 codes were used to estimate annual volumes, outcomes, and complications following treatment of ruptured and unruptured aneurysms. Univariate and multivariate analyses were used to estimate risk ratios for complications and outcomes. Trends in time were assessed utilizing annual percentage change (APC).RESULTSThe authors found a nearly 5-fold increase in annual admissions with diagnoses of unruptured aneurysms, whereas SAH volume increased less than 50%. Clipping ruptured aneurysms steadily declined (APC −0.86%, p = 0.69 until 1999, then −6.22%, p < 0.001 thereafter), whereas clipping unruptured aneurysms slightly increased (APC 2.02%, p < 0.001). EVT tripled in 2002–2004 and steadily increased thereafter (APC 7.22%, p < 0.001 and 5.85%, p = 0.01 for unruptured and ruptured aneurysms, respectively). Despite a 3-fold increase in both diagnosis and treatment of unruptured aneurysms, the incidence of SAH remained steady at 12 per 100,000 persons per year (APC 0.04%, p = 0.83). In contrast, SAH severity increased over time, as did patient age and comorbidities (all p < 0.001). SAH led to nonroutine discharge more frequently over time after both EVT and clipping (APC 1.24% and 1.10%, respectively), although mortality decreased during the same time (APC −2.48% and −1.44%, respectively). Complications were more frequent after clipping than EVT, but this differential risk diminished during the study period and was less perceptible in ruptured aneurysms. The proportion of patients discharged home after treatment of unruptured aneurysms was significantly lower (p < 0.001) after clipping (69.3%–79.5%) than EVT (88.3%–93.3%); both proportions changed minimally since 1998 (APC −0.39%, p = 0.02, and APC −0.11%, p = 0.14, respectively).CONCLUSIONSEVT volume markedly increased for ruptured and unruptured aneurysms from 1993 to 2015, whereas clipping decreased for ruptured and slightly increased for unruptured aneurysms. The incidence of SAH remained unchanged despite increased diagnosis and treatment of unruptured aneurysms. In ruptured aneurysms, SAH severity has increased over time, as have age, comorbidities, and nonroutine discharges. In contrast, routine discharge after treatment of unruptured aneurysms remains largely unchanged since 1998 and remains lower with clipping.

Removals for Cause: A 35-Year Assessment of LM2500 Engine Removals by the United States Navy

2011 ◽  
Author(s):  
Matthew J. Driscoll ◽  
Eric M. McFetridge ◽  
Jeffrey S. Patterson ◽  
Craig A. See
Keyword(s):  
United States ◽  
Service Life ◽  
Gas Turbine ◽  
United States Navy ◽  
The United States ◽  
General Electric ◽  
The Past ◽  
The Us ◽  
Us Navy ◽  
Over Time

The United States (US) Navy has operated the General Electric LM2500 gas turbine on all its surface combatants for the past 35 years. The LM2500 is utilized as the propulsion engine aboard the US Navy’s newest surface combatants including the FFG 7, CG 47 and DDG 51 Class ships. The US Navy owns and operates 400 LM2500 engines. An on-condition maintenance philosophy is employed whereby engines are run-to-failure rather than removed from service upon achieving some operating milestone. This paper assesses the reasons for the removal of the US Navy’s LM2500s over their entire service life with a focus on how fleet maintenance capabilities have impacted and affected the cause for engine replacements over time.

scholarly journals The Politics of Skilled Immigration: Explaining the Ups and Downs of the US H-1B Visa Program

2018 ◽  
Vol 53 (2) ◽  
pp. 346-370 ◽  
Author(s):  
Andrew Kennedy
Keyword(s):  
United States ◽  
Recent Work ◽  
Immigration Policy ◽  
The United States ◽  
Skilled Immigrants ◽  
The Past ◽  
The Us ◽  
Skilled Immigration ◽  
Over Time ◽  
Us Immigration

The United States has long been a magnet for skilled immigrants, but its openness to these immigrants has varied considerably over time. Focusing on the H-1B visa program, this article explains why the program’s annual cap has risen and fallen from the mid-1990s to the present. Whereas recent studies of skilled immigration policy have focused on struggles between capital and labor, this article contends that US policy also reflects a struggle between capital and citizen groups — one that has changed considerably over the past two decades. The findings challenge recent work on skilled immigration and US immigration policy.

EARLY HISTORY OF AL-QA'IDA

2008 ◽  
Vol 51 (4) ◽  
pp. 1047-1067 ◽  
Author(s):  
R. KIM CRAGIN
Keyword(s):  
United States ◽  
The United States ◽  
Early History ◽  
The Past ◽  
Us Military ◽  
The Us ◽  
History Of ◽  
Autobiographical Accounts ◽  
Development And Evolution ◽  
Over Time

ABSTRACTAlthough the broad outlines of al-Qa'ida's story are well known, less attention has been paid to its early development and evolution. How and why did al-Qa'ida leaders latch on to the United States as a primary adversary? What motivated Usama bin Laden to form al-Qa'ida in the first place? Did this motivation change over time? This article utilizes a series of recently discovered al-Qa'ida documents – such as al-Jihad magazine financed by Usama bin Laden during the 1980s, internal memos written in the early 1990s and captured by the US military in Afghanistan, and autobiographical accounts written since 2001 by former Afghan Arab fighters – to deepen our understanding of a clandestine organization that has caused havoc for the past two decades.

The Riddle of a Common History

2009 ◽  
Vol 1 (1) ◽  
pp. 93-116 ◽  
Author(s):  
Mauricio Tenorio-Trillo
Keyword(s):  
United States ◽  
Common Ground ◽  
The United States ◽  
History Textbooks ◽  
Recent History ◽  
History Textbook ◽  
The Past ◽  
The Us ◽  
Constant Part ◽  
Intrinsic Component

By identifying two general issues in recent history textbook controversies worldwide (oblivion and inclusion), this article examines understandings of the United States in Mexico's history textbooks (especially those of 1992) as a means to test the limits of historical imagining between U. S. and Mexican historiographies. Drawing lessons from recent European and Indian historiographical debates, the article argues that many of the historical clashes between the nationalist historiographies of Mexico and the United States could be taught as series of unsolved enigmas, ironies, and contradictions in the midst of a central enigma: the persistence of two nationalist historiographies incapable of contemplating their common ground. The article maintains that lo mexicano has been a constant part of the past and present of the US, and lo gringo an intrinsic component of Mexico's history. The di erences in their historical tracks have been made into monumental ontological oppositions, which are in fact two tracks—often overlapping—of the same and shared con ictual and complex experience.

scholarly journals Trends in Disability Among Adults 55-64 in the United States and England From 2002 to 2016

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 303-303
Author(s):  
HwaJung Choi ◽  
Robert Schoeni ◽  
Tsai-Chin Cho ◽  
Kenneth Langa
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Income Group ◽  
The United States ◽  
Annual Change ◽  
Individual Level ◽  
Income Groups ◽  
The Us ◽  
Disability Prevalence ◽  
Over Time

Abstract The paper’s goal is to assess whether and, if so, the extent to which prevalence in disability of adults near retirement ages in the US increased over time compared to their peers in England and examine income group differences in the relative trends. This study uses 2002-2016 Health and Retirement Study (HRS) and English Longitudinal Study of Ageing (ELSA) focusing on adults aged 55-64. Annual percent changes over the period of 2002-2016 for limitations in instrumental activities of daily living (IADL) and activities of daily living (ADL) are estimated for each survey (HRS and ELSA) using multivariable logistic regressions to adjust for individual-level characteristics While disability prevalence of adults ages 55-64 in England improved over the years of 2002-2016 (annual % change= -2.01 for IADL; - 2.53 for ADL), disability prevalence of US adults has not improved and in fact even worsened in terms of IADL (annual % change= +1.35). There are substantial variations in the IADL/ADL trends by income groups. In the US, the adverse trends in disability were more pronounced among the lowest income groups (annual % change in IADL=1.76 for bottom 20% vs. -2.08 for top 20%; annual % change in ADL=1.08 for bottom 20% vs. -2.08 for top 20%). In England, the disability status improved over time for all but the lowest income group. We will examine further to identify specific factors contributing to divergent/convergent trends in disability between the US and England.

scholarly journals Long-Term Follow-up Study of Endovascularly Treated Intracranial Aneurysms

2010 ◽  
Vol 16 (3) ◽  
pp. 231-239 ◽  
Author(s):  
L.M. Pyysalo ◽  
L.H. Keski-Nisula ◽  
T.T. Niskakangas ◽  
V.J. Kähärä ◽  
J.E. Öhman
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Bleeding Rate ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Follow Up Study ◽  
Long Term Follow Up ◽  
Rebleeding Rate

Long-term follow-up studies after endovascular treatment for intracranial aneurysm are still rare and inconclusive. The aim of this study was to assess the long-term clinical and angiographic outcome of patients with endovascularly treated aneurysms. The clinical outcome of all 185 patients with endovascularly treated aneurysms were analyzed and 77 out of 122 surviving patients were examined with MRI and MRA nine to 16 years (mean 11 years) after the initial endovascular treatment. Sixty-three patients were deceased at the time of follow-up. The cause of death was aneurysm-related in 34 (54%) patients. The annual rebleeding rate from the treated aneurysms was 1.3% in the ruptured group and 0.1% in the unruptured group. In long-term follow-up MRA 18 aneurysms (53%) were graded as complete, 11 aneurysms (32%) had neck remnants and five aneurysms (15%) were incompletely occluded in the ruptured group. The occlusion grade was lower in the unruptured group with 20 aneurysms (41%) graded as complete, 11 (22%) had neck remnants and 18 (37%) were incomplete. However, only three aneurysms were unstable during the follow-up period and needed retreatment. Endovascular treatment of unruptured aneurysms showed incomplete angiographic outcome in 37% of cases. However, the annual bleeding rate was as low as 0.1%. Endovascular treatment of ruptured aneurysms showed incomplete angiographic outcome in 15% of cases and the annual rebleeding rate was 1,3%.

Abstract P183: 20-year Secular Trend of Cardiovascular Disease Comorbidities in the United States, 1997-2016

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Dianjianyi Sun ◽  
Tao Zhou ◽  
Xiang Li ◽  
Yoriko Heianza ◽  
Xiaoyun Shang ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Secular Trend ◽  
Adult Population ◽  
The United States ◽  
The Past ◽  
The Us ◽  
Metabolic Conditions ◽  
Respiratory Conditions ◽  
The U.S ◽  
Chronic Comorbidities

Background: Cardiovascular disease (CVD) has been the number one cause of death and disability in the US and globally for decades, and its comorbidity complicates the management of CVD. However, little is known about the secular trend of CVD comorbidities in national representative populations in the last 20 years. Methods: Prevalence of CVD and nine major chronic comorbidities was estimated using data from 1,324,214 adults aged 18 years and older in the National Health Interview Survey (NHIS) from 1997 through 2016, with age-standardized to the U.S. population in the year 2000. Results: CVD prevalence in the US adult population significantly declined in the past twenty years (from 6.6% in 1997 to 5.9% in 2016, P trend <0.01in Figure a). And such trend was shown in women and whites (P trend <0.01), but not in men and blacks (P trend >0.05). We ranked the nine major chronic comorbidities (high to low) in the CVD patients (Figure b.), including (1) hypertension, (2) respiratory conditions, (3) nervous system conditions, (4) digestive conditions, (5) diabetes, (6) cancer, (7) genitourinary conditions, (8) circulatory conditions, and (9) endocrine/nutritional/metabolic conditions. From 1997 to 2016, the prevalence of CVD comorbidities including hypertension (38.8% to 50.2%), digestive conditions (17.0% to 27.1%), diabetes (10.0% to 19.2%), cancer (9.4% to 12.8%), and genitourinary conditions (4.1% to 5.2%) continuingly increased (all P trend <0.01), while respiratory conditions declined (35.9% to 27.6%, P trend <0.01). Similar trends of CVD comorbidities were observed among subgroups stratified by gender or by race. Conclusions: CVD prevalence in the U.S. adults have declined significantly in the past two decades, but rates of CVD comorbidities including hypertension, digestive conditions, diabetes, cancer, and genitourinary conditions increased substantially.

Before American History: Nationalist Mythmaking and Indigenous Dispossession

2021 ◽  
Author(s):  
Christen Mucher
Keyword(s):  
Knowledge Production ◽  
American History ◽  
New Spain ◽  
The United States ◽  
Material Base ◽  
Historical Knowledge ◽  
The Past ◽  
British America ◽  
The Us ◽  
Ruling Elites

Before American History examines the project of settler nationalism from the 1780s to the 1840s in two of North America’s republics—the US and Mexico—through an analysis of historical knowledge production. As the US and Mexico transformed from European colonies into independent republics—and before war scarred them both—antiquarians and historians compiled and interpreted archives meant to document America’s Indigenous pasts. Before American History approaches two iconic imaginings of the past—the carved Sun Stone and the mounded earthwork—as archives of nationalist power and Indigenous dispossession as well as objects that are, at their material base, Indigenously-produced but settler-controlled and settler-interpreted. In making the connection between earthworks built by an allegedly vanished people merely peripheral to US citizens and the literal touchstone of Mexicans’ history, Before American History details how Mexican and US nationalists created national histories out of Indigenous pasts and thereby wrote Indigenous pasts out of their national histories and out of national lands. It uncovers how the manipulation of Indigenous pasts and (mis)interpretations of “American Antiquities”—Indigenous documents, objects and monuments—served the purposes of a trans-imperial/transnational network of creole ruling elites, first in New Spain and British America, and later in Mexico and the United States, as they struggled to construct new political, geographic, and historical orders.

History and Current Trends in the Electronic Cigarette Retail Marketplace in the United States: 2010–2016

2018 ◽  
Vol 22 (5) ◽  
pp. 843-847 ◽  
Author(s):  
Jennifer Cantrell ◽  
Jidong Huang ◽  
Marisa Greenberg ◽  
Jeffrey Willett ◽  
Elizabeth Hair ◽  
...  
Keyword(s):  
Tobacco Industry ◽  
The United States ◽  
Retail Market ◽  
Current Trends ◽  
Published Evidence ◽  
The Us ◽  
Industry Response ◽  
Market Trends ◽  
The Impact ◽  
Over Time

Abstract Introduction The US market for electronic nicotine delivery systems (ENDS) has grown rapidly in the last decade. There is limited published evidence examining changes in the ENDS marketplace prior to the US Food and Drug Administration’s (FDA) deeming rule in 2016. This study describes US ENDS retail market trends from 2010 to 2016. Methods National data were obtained from Nielsen retail scanners for five product types: (1) disposables, (2) rechargeables, (3) cartridge replacements, (4) e-liquid bottle refills, and (5) specialty vapor products. We examined dollar sales, volume, price, brand, and flavor. Results Adjusted national sales increased from $11.6 million in 2010 to $751.2 million in 2016. The annual rate of sales growth rapidly increased before slowing through 2015. The rate of growth spiked in 2016. Market share for menthol products and other assorted flavors increased from 20% in 2010 to 52.1% by 2016. NJOY’s early market dominance shifted as tobacco industry brands entered the market and eventually captured 87.8% of share by 2016. Rechargeables and accompanying products comprised an increased proportion of total volume sold over time while disposable volume declined. Specialty vapor products appeared at retail in 2015. Conclusions Findings show strong early growth in the ENDS retail market followed by considerable slowing over time, despite a slight uptick in 2016. Trends reflect shifts to flavored products, newer generation “open-system” devices, lower prices, and tobacco industry brands. This study provides a baseline against which to compare the impact of FDA’s 2016 deeming rule and future actions on the ENDS marketplace. Implications This study uses market scanner data from US retail outlets to describe trends in the ENDS retail market from 2010 to 2016, providing a baseline against which to compare the impact of FDA’s 2016 deeming rule and future actions on the ENDS marketplace. Understanding historical market trends is valuable in assessing how future regulatory efforts and advances in ENDS technology may impact industry response and consumer uptake and use.

scholarly journals Fungicide Sensitivity of U.S. Genotypes of Phytophthora infestans to Six Oomycete-Targeted Compounds

Plant Disease ◽  
2015 ◽  
Vol 99 (5) ◽  
pp. 659-666 ◽  
Author(s):  
Amanda Saville ◽  
Kim Graham ◽  
Niklaus J. Grünwald ◽  
Kevin Myers ◽  
William E. Fry ◽  
...  
Keyword(s):  
United States ◽  
Phytophthora Infestans ◽  
The United States ◽  
Effective Concentration ◽  
Response Curves ◽  
Baseline Sensitivity ◽  
Fungicide Sensitivity ◽  
The Past ◽  
The Us

Phytophthora infestans causes potato late blight, an important and costly disease of potato and tomato crops. Seven clonal lineages of P. infestans identified recently in the United States were tested for baseline sensitivity to six oomycete-targeted fungicides. A subset of the dominant lineages (n = 45) collected between 2004 and 2012 was tested in vitro on media amended with a range of concentrations of either azoxystrobin, cyazofamid, cymoxanil, fluopicolide, mandipropamid, or mefenoxam. Dose-response curves and values for the effective concentration at which 50% of growth was suppressed were calculated for each isolate. The US-8 and US-11 clonal lineages were insensitive to mefenoxam while the US-20, US-21, US-22, US-23, and US-24 clonal lineages were sensitive to mefenoxam. Insensitivity to azoxystrobin, cyazofamid, cymoxanil, fluopicolide, or mandipropamid was not detected within any lineage. Thus, current U.S. populations of P. infestans remained sensitive to mefenoxam during the displacement of the US-22 lineage by US-23 over the past 5 years.

Sign in / Sign up

Export Citation Format

Share Document