Significant Differences In Trends Research Articles

Multiple growth periods predict unfavourable pathology in patients with small renal masses.

To use the number of positive growth periods as a characterization of the growth of small renal masses in order to determine potential predictors of malignancy. Patients who underwent axial imaging at multiple time points prior to surgical resection for a small renal mass were queried. Patients were categorized based on their pathological tumour grade and stage: favourable (benign, chromophobe and low-grade pT1-2 renal cell carcinoma [RCC]) vs unfavourable (high-grade of any stage and low-grade pT3-4 RCC). A positive growth period was counted each time the difference in greatest tumour diameters between two images was positive. The Cochran-Armitage trend test and Somers' D association were used to determine if the number of positive growth periods was correlated with unfavourable pathology. Of the 124 patients, 86 (69.4%) had favourable pathology and 38 (30.6%) had unfavourable pathology. Those who had favourable pathology were younger than those who had unfavourable pathology: median (interquartile range [IQR]) 61.0 (52.2-66.0) vs 68.5 (61.5-77.0); P < 0.001. The overall growth rate was higher in the unfavourable group, but was not statistically significant: mean (sd) 0.7 (1.7) vs 1.6 (2.8) cm/year; P = 0.07. There was a significant trend difference in the number of positive growth periods between favourability groups (P = 0.02). An association between increased number of positive growth periods and unfavourable pathology was observed: 0.15 (95% confidence interval 0.02, 0.29). The ratios of favourable to unfavourable pathology were 1.8, 1.0, 0.66, 0.59 and 0 as the number of positive growth periods increased from 0 to 4, respectively. While overall growth rate was not predictive of pathology favourability, there was a positive association between the number of positive growth periods and unfavourable pathology. The number of positive growth periods may be a potential parameter for malignant potential in patients undergoing active surveillance for small renal masses.

Trends in prescribing rate of statins at discharge and modifiable factors in patients with atherosclerotic cardiovascular disease.

Tremendous effort has been invested in reducing the prevalence of atherosclerotic cardiovascular disease (ASCVD) in China. Meanwhile, accumulating evidence has emerged to show the benefits of statins in the prevention of cardiovascular disease. The present study investigated the change trends of statins prescription at discharge among patients with ASCVD in recent years, differences across subtypes of ASCVD, and associated factors. The study included 51,972 patients with a discharge diagnosis of ASCVD who were hospitalized in West China Hospital from 2008 to 2014. Trends of statins prescription rates between subtypes of ASCVD were compared and potential influential factors were explored. The overall statins prescription rate in patients with ASCVD was 58.8%. Adjusted odds ratios (ORs) of increase in prescription rate per year were 1.15 (95% CI 1.13-1.17, p<0.001), 1.14 (95% CI 1.10-1.17, p<0.001), 1.19 (95% CI 1.16-1.23; p<0.001), 1.14 (95% CI 1.09-1.19; p<0.001), and 1.13 (95% CI 1.09-1.17; p<0.001) for ASCVD, coronary artery disease, cerebrovascular disease, peripheral arterial disease (PAD), and polyvascular disease, respectively; no significant differences in trends were detected among ASCVD subtypes. However, statins prescription rates were persistently lower in cerebrovascular disease and PAD than the other two subtypes. Discharge departments, together with other physician-related and patient-related characteristics were associated with statins utilization. In conclusion, between 2008 and 2014, statins prescription rate in patients with ASCVD was not optimal. The increasing trends in statins prescription among patients with ASCVD subtypes were similar but the differences did not decrease. Consciousness of integrated and successive medical care should be strengthened in China.

No significant gender difference in hospitalizations for acute coronary syndrome in Switzerland over the time period of 2001 to 2010

BackgroundMorbidity and mortality from cardiovascular diseases have decreased since the 1970s in most Western societies. However, it is unclear if this positive trend can also be found in younger women suffering from acute coronary syndrome (ACS). MethodsThis is a prospective single center registry study including 11.015 women and men hospitalized for a first ACS between the years 2001 and 2010. We analyzed ACS rates according to sex and age group using Poisson regression in order to assess temporal trends. ResultsOverall ACS hospitalization rates per 100.000 inhabitants increased by 31% between 2001 and 2010 (Rate Ratio (RR) of 1.31, 95% CI 1.20–1.43; p<0.001) with a similar increase in men (RR 1.29, p<0.00001) and women (RR 1.35, p<0.0001). Analyses of age-specific ACS rates showed a significant increase in ACS hospitalization rates only for the age groups 70–79years (p=0.003) and 80+ years (p<0.00001). None of the age matched subgroups showed a sex related significant difference in trend for ACS hospitalization rates. Temporal trends for recorded risk factors showed a significant increase in smoking (p=0.03), and a trend to increased obesity prevalence (p=0.06) in females in the age group 60–69years. ConclusionsIn contrast to other studies, we found no evidence for a particular increase in the number of younger women referred for a first ACS during the years 2001 and 2010. Potential negative effects of smoking and obesity on ACS incidence may be delayed to women older than 70years.

Adoption of the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guideline in Cardiology Practices Nationwide

The 2013 American College of Cardiology/American Heart Association (ACC/AHA) Cholesterol Management Guideline recommends moderate-intensity to high-intensity statin therapy in eligible patients. To examine adoption of the 2013 ACC/AHA guideline in US cardiology practices. Among 161 cardiology practices, trends in the use of moderate-intensity to high-intensity statin and nonstatin lipid-lowering therapy (LLT) were analyzed before (September 1, 2012, to November 1, 2013) and after (February 1, 2014, to April 1, 2015) publication of the 2013 ACC/AHA guideline among 4 mutually exclusive risk groups within the ACC Practice Innovation and Clinical Excellence Registry. Interrupted time series analysis was used to evaluate for differences in trend in use of moderate-intensity to high-intensity statin and nonstatin LLT use in hierarchical logistic regression models. Participants were a population-based sample of 1 105 356 preguideline patients (2 431 192 patient encounters) and 1 116 472 postguideline patients (2 377 219 patient encounters). Approximately 97% of patients had atherosclerotic cardiovascular disease (ASCVD). Moderate-intensity to high-intensity statin and nonstatin LLT use before and after publication of the 2013 ACC/AHA guideline. Time trend in the use of moderate-intensity to high-intensity statin and nonstatin LLT. In the study cohort, the mean (SD) age was 69.6 (12.1) years among 1 105 356 patients (40.2% female) before publication of the guideline and 70.0 (11.9) years among 1 116 472 patients (39.8% female) after publication of the guideline. Although there was a trend toward increasing use of moderate-intensity to high-intensity statins overall and in the ASCVD cohort, such a trend was already present before publication of the guideline. No significant difference in trend in the use of moderate-intensity to high-intensity statins was observed in other groups. The use of moderate-intensity to high-intensity statin therapy was 62.1% (before publication of the guideline) and 66.6% (after publication of the guideline) in the overall cohort, 62.7% (before publication) and 67.0% (after publication) in the ASCVD cohort, 50.6% (before publication) and 52.3% (after publication) in the cohort with elevated low-density lipoprotein cholesterol levels (ie, ≥190 mg/dL), 52.4% (before publication) and 55.2% (after publication) in the diabetes cohort, and 41.9% (before publication) and 46.9% (after publication) in the remaining group with 10-year ASCVD risk of 7.5% or higher. In hierarchical logistic regression models, there was a significant increase in the use of moderate-intensity to high-intensity statins in the overall cohort (4.8%) and in the ASCVD cohort (4.3%) (P < .01 for slope for both). There was no significant change for other risk cohorts. Nonstatin LLT use remained unchanged in the preguideline and postguideline periods in the hierarchical logistic regression models for all of the risk groups. Adoption of the 2013 ACC/AHA Cholesterol Management Guideline in cardiology practices was modest. Timely interventions are needed to improve guideline-concordant practice to reduce the burden of ASCVD.

Study of the effect of Memantine therapy on the treatment of dyslexia in children.

Background:Reading disorder (RD) is one of the important complaints in children with learning disorders (LD) that is prevalent in 4% of children in the United States. Treating this disorder includes education of reading practices and treating psychological disorders, and there are no exact medications prescribed in these children. Memantine has been effective in treating memory problems in Alzheimer Dementia, obsessive–compulsive disorder, autism disorder, and other psychological diseases. The aim of this study is to evaluate the effect of memantine in improving RD in children.Materials and Methods:In this randomized clinical trial, 62 children, with RD in Pediatric Psychiatry Clinics of Noor and Ali-Asghar Hospital in Isfahan from 2015 to 2016, were participated. They were randomly assigned to two groups of equal number, one receiving education plus memantine and the other education plus placebo. RD was evaluated at the beginning, 1 and 3 months after intervention by Iranian standard reading and dyslexia test (Nama).Results:Mean (standard deviation) age of participants was 7.55 (0.60) years. Most of the participants were boy (55%), most having parents in 36–45-year-old age group (52% and 48% for fathers and mothers, respectively), and also most parents in diploma and bachelor educational group (61% and 60% for fathers and mothers, respectively). There were statistical significant difference in trend of total score (P = 0.034), word chain (P < 0.001), rhyming (P < 0.001), text comprehension (P < 0.001), and letter fluency (P = 0.002), subscale between two groups. However, the difference of time trend between two groups was not significant in word reading (P = 0.14), word comprehension (P = 0.06), phoneme deletion (P = 0.12), reading nonwords (P = 0.32), and category fluency (P = 0.06).Conclusion:Adding memantine to educational practices is effective in improving RD in school-age children with LD.

Post universal health coverage trend and geographical inequalities of mortality in Thailand.

BackgroundThailand has achieved remarkable improvement in health status since the achievement of universal health coverage in 2002. Health equity has improved significantly. However, challenges on health inequity still remain.This study aimed to determine the trends of geographical inequalities in disease specific mortality in Thailand after the country achieved universal health coverage.MethodsNational vital registration data from 2001 to 2014 were used to calculate age-adjusted mortality rate and standardized mortality ratio (SMR). To minimize large variations in mortality across administrative districts, the adjacent districts were systematically grouped into “super-districts” by taking into account the population size and proximity. Geographical mortality inequality among super-districts was measured by the coefficient of variation. Mixed effects modeling was used to test the difference in trends between super-districts.ResultsThe overall SMR steadily declined from 1.2 in 2001 to 0.9 in 2014. The upper north and upper northeast regions had higher SMR whereas Greater Bangkok achieved the lowest SMR. Decreases in SMR were mostly seen in Greater Bangkok and the upper northern region. Coefficient of variation of SMR rapidly decreased from 20.0 in 2001 to 12.5 in 2007 and remained close to this value until 2014. The mixed effects modelling revealed significant differences in trends of SMR across super-districts. Inequality in mortality declined among adults (≥15 years old) but increased in children (0–14 years old). A declining trend in inequality of mortality was seen in almost all regions except Greater Bangkok where the inequality in SMR remained high throughout the study period.ConclusionsA decline in the adult mortality inequality across almost all regions of Thailand followed universal health coverage. Inequalities in child mortality rates and among residents of Greater Bangkok need further exploration.

Acute ivabradine treatment reduces heart rate without increasing atrial fibrillation inducibility irrespective of underlying vagal activity in dogs.

Ivabradine, a bradycardic agent, has been shown to stably reduce patient's heart rate (HR) in the setting of acute cardiac care. However, an association between atrial fibrillation (AF) risk and acute ivabradine treatment remains a controversial clinical issue, and has not been thoroughly investigated. Bradycardia and abnormal atrial refractoriness induced by ivabradine treatment may enhance vulnerability to AF induction, especially when vagal nerve is concurrently activated. We aimed to experimentally investigate the effects of acute ivabradine treatment with/without concurrent vagal activation on AF inducibility. In 16 anesthetized dogs, cervical vagal nerves were prepared for electrical stimulation (VS). AF induction rate (AFIR) was determined by atrial burst pacing. HR, atrial action potential duration (APD), atrial effective refractory period (ERP), and AFIR were obtained consecutively at baseline, during delivery of VS (VS alone), after intravenous injection of ivabradine 0.5mg/kg (n=8, ivabradine group) or saline (n=8, saline group), and again during VS delivery (drug+VS). In the ivabradine group, ivabradine alone significantly lowered HR compared to baseline, while ivabradine+VS significantly lowered HR compared to VS alone. Contrary to expectations, there were no significant differences in trends of APD, temporal dispersion of APD, ERP, and AFIR between ivabradine and saline groups. Irrespective of whether ivabradine or saline was injected, VS significantly shortened APD and ERP, and increased AFIR. Interestingly, although bradycardia in response to ivabradine injection was more intense than that to VS alone, AFIR was significantly lower after ivabradine injection than during VS alone. We conclude that, despite its intense bradycardic effect, acute ivabradine treatment does not increase AF inducibility irrespective of underlying vagal activity. This study may constitute support for the safety of using ivabradine in the setting of acute cardiac care.

Geographic Variation in Trends and Disparities in Acute Myocardial Infarction Hospitalization and Mortality by Income Levels, 1999-2013.

During the past decade, the incidence and mortality associated with acute myocardial infarction (AMI) in the United States have decreased substantially. However, it is unknown whether these improvements were consistent across communities of different economic status and geographic regions since efforts to improve cardiovascular disease prevention and management may have had variable impact. To determine whether trends in US county-level, risk-standardized AMI hospitalization and mortality rates varied by county-based median income level. In this observational study, county-level risk-standardized (age, sex, and race) hospitalization and 1-year mortality rates for AMI from January 1, 1999, to December 31, 2013, were measured for Medicare beneficiaries 65 years or older. Data analysis was performed from June 2 through December 1, 2015. Counties were stratified by median income percentile using 1999 US Census Bureau data adjusted for inflation: low- (<25th), average- (25th-75th), or high- (>75th) income groups. The effect of income on the slope of AMI hospitalizations and mortality, measured as differences in the rate of change in AMI hospitalizations and mortality by county income and by the 4 US geographic regions, and a possible lag effect among low-income counties. In the 15-year study period, AMI risk-standardized hospitalization and mortality rates decreased significantly for all 3 county income groups. Mean hospitalization rates were significantly higher among low-income counties compared with high-income counties in 1999 (1353 vs 1123 per 100 000 person-years, respectively) and in 2013 (853 vs 648 per 100 000 person-years, respectively). One-year mortality rates after hospitalization for AMI were similar across county income groups, decreasing from 1999 (31.5%, 31.4%, and 31.1%, for high-, average-, and low-income counties, respectively) to 2013 (26.2%, 26.1%, and 25.4%, respectively). Income was associated with county-level, risk-standardized AMI hospitalization rates but not mortality rates. Increasing 1 interquartile range of median county consumer price index-adjusted income ($12 000) was associated with a decline in 46 and 37 hospitalizations per 100 000 person-years for 1999 and 2013, respectively; interaction between income and time was 0.56. The rate of decline in AMI hospitalizations was similar for all county income groups; however, low-income counties lagged behind high-income counties by 4.3 (95% CI, 3.1-5.9) years. There were no significant differences in trends across geographic regions. Hospitalization and mortality rates of AMI declined among counties of all income levels, although hospitalization rates among low-income counties lag behind those of the higher income groups. These findings lend support for a more targeted, community-based approach to AMI prevention.

Outcomes of ring versus suture annuloplasty for tricuspid valve repair in patients undergoing mitral valve surgery

ObjectiveThere is controversy regarding the comparative effectiveness of methods of tricuspid valve (TV) repair—prosthetic ring versus suture annuloplasty—in patients undergoing operation for primary mitral valve (MV) disease. In this study, we analyzed factors associated with patient survival and recurrent tricuspid regurgitation (TR) following TV repair and focused on results stratified by method of tricuspid valve repair. MethodsWe reviewed patients who underwent TV repair with suture (De Vega) or flexible ring annuloplasties at the time of MV surgery from 1995 to 2010. Patients with prior cardiac or concomitant aortic valve operations were excluded. Propensity matching was performed to account for potential differences in baseline characteristics between the groups. Primary outcomes were long-term mortality and postoperative TR grade. ResultsIn the overall study, there were 415 patients with median age 72 years (range, 63-78 years), from which 148 matched pairs were identified by propensity score analysis. In the overall cohort, patients in the ring annuloplasty group more often had preoperative transvenous pacemakers (P = .05), lower ejection fractions (P = .028), and more recent years of operation (P < .001). For patients who had De Vega suture annuloplasty, long-term mortality was not different from that of patients who had ring annuloplasty (hazard ratio, 0.93; 95% confidence interval, 0.67-1.30). Older age, preoperative diabetes, and preoperative right ventricular dysfunction were predictors for long-term mortality. Durability of the annuloplasty methods was similar with no significant difference in trend of recurrent TR grades over follow-up (P = .807). Etiology of mitral regurgitation was not associated with recurrent TR during follow-up (P = .857). ConclusionsLate survival and TV durability following concomitant TV repair during MV surgery did not differ with respect to TV repair technique. In this series of patients with repaired tricuspid valves, etiology of MV disease did not influence postoperative changes in TR.

Mind the gap: TB trends in the USA and the UK, 2000–2011

BackgroundTB remains a major public health concern, even in low-incidence countries like the USA and the UK. Over the last two decades, cases of TB reported in the USA have...

Has Choosing Wisely® affected rates of dual-energy X-ray absorptiometry use?

Reducing overuse of tests such as dual-energy X-ray absorptiometry (DXA) scans in younger women is an important quality issue. We evaluated trends in DXA ordering before and after Choosing Wisely recommendations were released. We found no significant difference in ordering trends suggesting that other initiatives are needed to change behavior. Reducing overuse of tests such as dual-energy X-ray absorptiometry (DXA) scans in younger women is an important quality issue, but trends in care are difficult to change. We evaluated (1) trends in DXA ordering before and after the Choosing Wisely recommendation release and (2) patterns of key characteristics that indicate a potentially appropriate DXA scan order. We performed a retrospective longitudinal analysis of electronic health record data at a multi-specialty, ambulatory care network of 34 practices across Maryland and Washington, DC. Since the Choosing Wisely DXA recommendation was released April 2012, the study periods were April-December 2011 (pre-initiative) and April-December 2012 (post-initiative). Women between 50 and 64years with primary care encounters, and primary care providers who saw ten or more women in the study population in both pre and post periods were included. For 42,320 eligible patients, the mean provider ordering rate was 2.6 % pre-initiative and 2.0 % post-initiative; there was no significant difference in trend over time. Over 70 % of the population had no characteristics associated with potentially appropriate DXA ordering. Low body mass index, current smoker status, and osteopenia were the most common characteristics indicating potentially appropriate DXA orders. Patients with any of these three characteristics had DXA ordering rates between 3-20 %. The trend in provider ordering rates of DXA scans did not decrease after the release of the DXA Choosing Wisely recommendation. Targeted initiatives addressing providers with high ordering rates will be needed to change behavior.

Trends in etnocentrische reacties onder de Nederlandse bevolking, 1979-2012

Summary Trends in ethnocentric reactions among the Dutch population, 1979-2012Based upon predictions from 1996 about future trends in ethnocentric reactions in the Netherlands, we investigate the trends in ethnocentric reactions among the general public from 1979 to 2012. We distinguish two forms of ethnocentric reactions: negative attitudes towards ethnic minorities and public support for ethnic discrimination. In line with one of the predictions from 1996, we find an increase in negative attitudes towards ethnic minorities. Although this relates to increasing levels of diversity in the Netherlands, this finding may also reflect a decrease in the social norm that prohibits overt negative stances towards ethnic minorities. With regard to public support for ethnic discrimination, we find no clear upward or downward trend since the mid-nineties. Lower educated and older birth cohorts show stronger ethnocentric reactions. Although there are some indications that those with secondary educational levels and the youngest birth cohorts show stronger ethnocentric reactions over time, there are no significant differences in trends across educational levels and birth cohorts. Changes in ethnocentric reactions are rather robust across different social categories.

Debunking the climate hiatus

The reported “hiatus” in the warming of the global climate system during this century has been the subject of intense scientific and public debate, with implications ranging from scientific understanding of the global climate sensitivity to the rate in which greenhouse gas emissions would need to be curbed in order to meet the United Nations global warming target. A number of scientific hypotheses have been put forward to explain the hiatus, including both physical climate processes and data artifacts. However, despite the intense focus on the hiatus in both the scientific and public arenas, rigorous statistical assessment of the uniqueness of the recent temperature time-series within the context of the long-term record has been limited. We apply a rigorous, comprehensive statistical analysis of global temperature data that goes beyond simple linear models to account for temporal dependence and selection effects. We use this framework to test whether the recent period has demonstrated i) a hiatus in the trend in global temperatures, ii) a temperature trend that is statistically distinct from trends prior to the hiatus period, iii) a “stalling” of the global mean temperature, and iv) a change in the distribution of the year-to-year temperature increases. We find compelling evidence that recent claims of a “hiatus” in global warming lack sound scientific basis. Our analysis reveals that there is no hiatus in the increase in the global mean temperature, no statistically significant difference in trends, no stalling of the global mean temperature, and no change in year-to-year temperature increases.

The rise of digital direct-to-consumer advertising?: Comparison of direct-to-consumer advertising expenditure trends from publicly available data sources and global policy implications

BackgroundPharmaceutical marketing is undergoing a major shift in the United States, in part due to new transparency regulations under the healthcare reform act. Changes in pharmaceutical marketing practices include a possible shift from more traditional forms of direct-to-consumer advertising towards emerging use of Internet-based DTCA (“eDTCA”) given the growing importance of digital health or “eHealth.” Though legally allowed only in the U.S. and New Zealand, eDTCA poses novel regulatory challenges, as it can cross geopolitical boundaries and impact health systems and populations outside of these countries.MethodsWe wished to assess whether changes in DTCA and eDTCA expenditure trends was occurring using publicly available pharmaceutical marketing data. DTCA data was analyzed to compare trends in aggregate marketing expenditures and to assess if there were statistically significant differences in trends and magnitudes for data sources and DTCA sub-categories (including eDTCA). This was accomplished using regression lines of DTCA trend data and conducting pairwise comparisons of regression coefficients using t-tests. Means testing was utilized for comparing magnitude of DTCA expenditure.ResultsData from multiple data sources indicate that aggregate DTCA expenditures have slightly declined during the period from 2005–2009 and are consistent with results from other studies. For DTCA sub-categories, television remained the most utilized form of DTCA, though experienced trends of declining expenditures (−13.2 %) similar to other traditional media platforms such as radio (−30.7 %) and outdoor ads (−12.1 %). The only DTCA sub-category that experienced substantial increased expenditures was eDTCA (+109.0 %) and it was the only medium that had statistically significant differences in its marketing expenditure trends compared to other DTCA sub-categories.ConclusionsOur study indicates that traditional DTCA marketing may be on the decline. Conversely, the only DTCA sub-category that experienced significant increases was eDTCA. However, to fully understand this possible shift to “digital” DTCA, improvements in publicly available DTCA data sources are necessary to confirm changing trends and validate existing data. Hence, utilizing the newly implemented U.S. physician-payment expenditure transparency requirements, we advocate for the mandatory disclosure of DTCA/eDTCA in order to inform future domestic and international health policy efforts regarding appropriate regulation of pharmaceutical promotion.

The Changing Bariatric Surgery Landscape in the USA.

The growth of bariatric surgery in the USA followed the adoption of gastric bypass (RYGB). The recent introduction of sleeve gastrectomy (SG) has been met with wide adoption. A single state report suggests that the popularity of SG has surpassed that of RYGB. Our study aimed to assess the nationwide changes in trend of bariatric procedures performed, using data from the National Surgical Quality Improvement Program from 2010 to 2013. In this cohort of 74,790 bariatric patients, there was a significant difference in trend between laparoscopic RYGB and SG. By 2013, SG was the most common bariatric procedure performed (49.4 %). This report underlines the exponential adoption of SG and aims to alert patients, physicians, and funding agencies of the need for longitudinal prospective long-term data.

Analysis of combined data sets yields trend estimates for vulnerable spruce-fir birds in northern United States

Continental-scale monitoring programs with standardized survey protocols play an important role in conservation science by identifying species in decline and prioritizing conservation action. However, rare, inaccessible, or spatially fragmented communities may be underrepresented in continental-scale surveys. Data on these communities often come from decentralized, local monitoring efforts that differ in their goals and survey protocols. We combine 16 point count datasets, controlling for differences in protocol and detection probabilities to estimate regional trends for 14 spruce-fir forest bird species across Northeastern and Midwestern United States, a vulnerable community threatened by numerous anthropogenic stressors and widely considered a priority for conservation. Our analyses indicated that four species considered as ecological indicators for this community, Bicknell’s Thrush (Catharus bicknelli), Magnolia Warbler (Setophaga magnolia), Blackpoll Warbler (Setophaga striata) and Yellow-bellied Flycatcher (Empidonax flaviventris), each exhibited significant declines. Olive-sided Flycatcher (Contopus cooperi), a species of concern in parts of its range, and two additional species for which no previous concern existed, the Evening Grosbeak (Coccothruastes vespertinus) and the Gray Jay (Perisoreus canadensis), each also showed significant overall declines. Five out of nine species with sufficient data for analyses from Northeastern and Midwestern surveys showed significant differences in trends between these regions. Spruce-fir obligate species were more likely to decline significantly than species that use spruce-fir in addition to other habitat types. These results demonstrate the value of combining disparate data sources for analyzing regional patterns of population trends to confirm and extend conservation concern for some species and identify others for which additional attention may be needed.

Abstract P306: Increase of the Inflammatory Burden at a Young Age in Patients with Coronary Artery Disease

Introduction: Age and inflammation both are considered risk factors for coronary artery disease (CAD) and the levels of inflammatory markers increase with aging. However, the role of age-induced inflammatory burden in CAD development is not fully understood. We investigated the trajectories of inflammatory markers with increasing age in subjects with or without CAD. Hypothesis: We hypothesized that the rate of increase in inflammatory markers as a function of age would depend on the presence of CAD and differ between subjects with and without CAD. Methods: Systemic inflammatory burden was assessed by levels of C-reactive protein (CRP), serum amyloid A (SAA) and fibrinogen in Caucasians (n=184) and African-Americans (n=154) (age range: 20-60 years). The presence of CAD was defined as the presence of ≥50% stenosis in any one of 15 coronary artery segments. Results: The prevalence of CAD was 46% (85 of 184) and 38% (58 of 154) in Caucasians and African-Americans, respectively. In both ethnic groups, subjects with CAD were older and had an atherogenic lipid profile compared to subjects without CAD. For both subjects with and without CAD, HDL cholesterol level was significantly higher and triglyceride level was significantly lower in African-Americans compared to Caucasians. The pattern of inflammatory burden over age differed across CAD status and ethnicity. Among Caucasians, the trend patterns of CRP (p&lt;0.05), SAA (p&lt;0.01) and fibrinogen (p&lt;0.001) over age differed significantly between subjects with and without CAD. Levels of all three markers were elevated already at young ages and remained relatively constant over age in Caucasians with CAD. In contrast, in Caucasians without CAD, the levels of these markers were lower at young ages with a gradual increase over age. The findings for African-Americans differed from that of Caucasians. The levels of inflammatory markers increased with age with no significant differences in trends between subjects with and without CAD. In multivariate analyses adjusting for covariates, the trend pattern of fibrinogen over age differed significantly between Caucasians with and without CAD. Conclusions: There was a diverging pattern in age-induced inflammatory burden associated with CAD, with an early start and faster rate of increase in Caucasian patients with CAD. The findings suggest an accelerated inflammation over age in individuals with CAD with a possible modulatory role of ethnicity/race.

Trends in U.S. Extracorporeal Membrane Oxygenation Use and Outcomes: 2002-2012

This study evaluates contemporary trends in the use and outcomes of adult patients undergoing extracorporeal membrane oxygenation (ECMO) in U.S. hospitals. All adult discharges in the Nationwide Inpatient Sample database during the years 2002-2012 that included ECMO were used to estimate the total number of U.S. ECMO hospitalizations (n = 12,407). Diagnostic codes were used to group patients by indication for ECMO use into postcardiotomy, heart transplant, lung transplant, cardiogenic shock, respiratory failure, and cardiopulmonary failure. A Mann-Kendall test was used to examine trends over time using standard statistical techniques for survey data. We found that ECMO use increased significantly from 2002-2012 (P = 0.003), whereas in-hospital mortality rate fluctuated without a significant difference in trend over time. No significant trend was observed in overall ECMO use from 2002-2007, but the use did demonstrate a statistically significant increase from 2007-2012 (P = 0.0028). The highest in-hospital mortality rates were found in the postcardiotomy (57.2%) and respiratory failure (59.2%) groups. Lung and heart transplant groups had the lowest in-hospital mortality rates (44.10% and 45.31%, respectively). The proportion of ECMO use for postcardiotomy decreased from 56.9% in 2002 to 37.9% in 2012 (P = 0.026) and increased for cardiopulmonary failure from 3.9% to 11.1% (P = 0.026). We concluded that ECMO use in the United States increased between 2002 and 2012, driven primarily by increase in national ECMO use beginning in 2007. Mortality rates remained high but stable during this time period. Though there were shifts in relative ECMO use among patient groups, absolute ECMO use increased for all indications over the study period.

Recent Trends in Human Resources Management in Selected Industry in Slovakia and the Czech Republic

Abstract The main goal of the paper is to evaluate trends in human resources management in the international environment on a selected sample of HR managers and their employees. The paper is based on extensive theoretical research and on a study of previous similar research. In order to achieve a more detailed analysis, there has been a research conducted. The research investigates the relation between the trends and gained benefits and the origin of the respondents – from Slovakia and the Czech Republic. According to the results, there exists a statistically significant difference in a small group of trends/benefits. In the rest of the benefits the results show there is no statistically significant difference in trends and benefits between employees who come from Slovakia or the Czech Republic.

The volume-quality relationship in antibiotic prescribing: when more isn't better.

For many surgeries and high-risk medical conditions, higher volume providers provide higher quality care. The impact of volume on more common medical conditions such as acute respiratory infections (ARIs) has not been examined. Using electronic health record data for adult ambulatory ARI visits, we divided primary care physicians into ARI volume quintiles. We fitted a linear regression model of antibiotic prescribing rates across quintiles to assess for a significant difference in trend. Higher ARI volume physicians had lower quality across a number of domains, including higher antibiotic prescribing rates, higher broad-spectrum antibiotic prescribing, and lower guideline concordance. Physicians with a higher volume of cases manage ARI very differently and are more likely to prescribe antibiotics. When they prescribe an antibiotic for a diagnosis for which an antibiotic may be indicated, they are less likely to prescribe guideline-concordant antibiotics. Given that high-volume physicians account for the bulk of ARI visits, efforts targeting this group are likely to yield important population effects in improving quality.