Withdrawal Of Support Research Articles

Tetrabenazine in Delayed Post Hypoxic Choreoathetosis after Resuscitation from Cardiac Arrest

Background: After cardiac arrest (CA), global cerebral ischemia results in brain tissue damage, inducing post-anoxic movement disorders (PMD) in some survivors. There are no current consensus recommendations to treat refractory PMD. Case Report: A 72-year-old male, smoker, presented with confusion, fever, and dyspnea. Progressive respiratory failure led to hemodynamic compromise and subsequent CA. He was resuscitated for 15 minutes but remained in a vegetative state. Magnetic resonance imaging (MRI) was normal and serial electroencephalograms were uncontributive. Median nerve somatosensory evoked potentials showed normal N20 waves. Six weeks after CA, while in a persistent vegetative state, the patient developed myoclonus and choreoathetosis requiring the resumption of sedatives to avoid ventilator asynchronies. A significant reduction in PMD was obtained with tetrabenazine, allowing withdrawal of the sedatives. Conclusion: In our case, tetrabenazine seemed to provide a better effect than other current medications (including levomepromazine) in PMD, allowing sedation and respiratory support withdrawal.

Modeling the Country’s Participation in Armed Conflict Resolution: Case of Germany’s Activity in Mali

In the early 2020s, the challenges of maintaining a Western presence in the zones of armed conflicts in Asia and Africa increased dramatically. This was most evident in Afghanistan, while notable difficulties were also observed in the Sahara-Sahel region. In trying to understand the reasons for this, the author turned to the situation in Mali, trying to correlate the Germany’s actions in Mali with the author’s theoretical-practical scheme of participation of an outside actor in the resolution of an armed conflict. Reaching the position of a full-fledged global actor, Germany is especially interested in creating a strategic presence in the instability zones and is sensitive to its loss. At the first stage of the resolution, the key tasks are the bracketing of radical forces, especially terrorist groups, and the reconciliation of the moderate ones, which are interested in preserving the institution of the state as such. The second stage is the time for full-scale international peacekeeping. The third stage is the nationalization of the resolution, i.e. the transfer of control over the process to the authorities and security forces in the country of conflict’s origin. The study explores the forms, scale, and geographical features of Germany’s use of military tools and diplomatic capabilities in the first two stages of the 2013-2019 resolution. The main “bottlenecks” of the approach are identified, including the persistent delay in applying sufficient efforts and the determinism of this trend. For 2020-2021, two contradictory paths are shown against the background of a new wave of activation of terrorist groups in the south of Mali: an accelerated transition to nationalization with a possible withdrawal of German and French support, and a postponement of the third stage, linked to the preparations for the continued presence of Western countries in Mali.

JOSS IS (NO LONGER?) BOSS: FANS’ NEGOTIATIONS AROUND THE “CANCELLING” OF JOSS WHEDON

The case of Joss Whedon, who has been subject to calls for “cancelling” in light of allegations around misconduct and abuse, is at the heart of a major cultural debate. The term ‘cancel culture’ that entered the public sphere alongside the #MeToo movement has quickly earned a contested status. The Whedon fan community has been a key site within this broader controversy, as withdrawal of support for the prominent creator began gradually in 2017 and intensified in 2021, after several allegations of harassment and abuse have been made public. This study will examine how fans perceive these allegations, how they see the status of creators and their contents in light of them, and how they navigate the ambivalences inherent in “cancelling” a previously-valued creator. This case is particularly enlightening given the fact that Whedon was celebrated for advancing feminist agendas in popular culture. In order to understand how Whedon fans perceive, evaluate and employ “cancelling,” this study will employ qualitative analysis of 20 in-depth interviews with Whedon fans and former fans, sampled from the fan community on Twitter. Through an in-depth examination of how fans understand Whedon and his works in light of the recent allegations, this study will shed light on “cancelling” as a political-ideological tool and the ways in which popular culture serves as a key arena in today’s “culture wars.”

The Future Is Now: OrganEx Technology and Its Implications for Transplant Medicine.

The Future Is Now: OrganEx Technology and Its Implications for Transplant Medicine.

Forced Organ Harvesting

Forced Organ Harvesting

The impact of sustained malaria control in the Loreto region of Peru: a retrospective, observational, spatially-varying interrupted time series analysis of the PAMAFRO program

Although malaria control investments worldwide have resulted in dramatic declines in transmission since 2000, progress has stalled. In the Amazon, malaria resurgence has followed withdrawal of Global Fund support of the Project for Malaria Control in Andean Border Areas (PAMAFRO). We estimate intervention-specific and spatially-explicit effects of the PAMAFRO program on malaria incidence across the Loreto region of Peru, and consider the influence of the environmental risk factors in the presence of interventions. We conducted a retrospective, observational, spatial interrupted time series analysis of malaria incidence rates among people reporting to health posts across Loreto, Peru between the first epidemiological week of January 2001 and the last epidemiological week of December 2016. Model inference is at the smallest administrative unit (district), where the weekly number of diagnosed cases of Plasmodium vivax and Plasmodium falciparum were determined by microscopy. Census data provided population at risk. We include as covariates weekly estimates of minimum temperature and cumulative precipitation in each district, as well as spatially- and temporally-lagged malaria incidence rates. Environmental data were derived from a hydrometeorological model designed for the Amazon. We used Bayesian spatiotemporal modeling techniques to estimate the impact of the PAMAFRO program, variability in environmental effects, and the role of climate anomalies on transmission after PAMAFRO withdrawal. During the PAMAFRO program, incidence of P.vivax declined from 42.8 to 10.1 cases/1000 people/year. Incidence for P.falciparum declined from 14.3 to 2.5 cases/1000 people/year over this same period. The effects of PAMAFRO-supported interventions varied both by geography and species of malaria. Interventions were only effective in districts where interventions were also deployed in surrounding districts. Further, interventions diminished the effects of other prevailing demographic and environmental risk factors. Withdrawal of the program led to a resurgence in transmission. Increasing minimum temperatures and variability and intensity of rainfall events from 2011 onward and accompanying population displacements contributed to this resurgence. Malaria control programs must consider the climate and environmental scope of interventions to maximize effectiveness. They must also ensure financial sustainability to maintain local progress and commitment to malaria prevention and elimination efforts, as well as to offset the effects of environmental change that increase transmission risk. National Aeronautics and Space Administration, National Institutes of Health, Bill and Melinda Gates Foundation.

Trajectories of systolic blood pressure decline in kidney transplant donors prior to circulatory death and delayed graft function.

Kidneys donated after circulatory death suffer a period of functional warm ischaemia before death, which may lead to early ischaemic injury. Effects of haemodynamic trajectories during the agonal phase on delayed graft function (DGF) is unknown. We aimed to predict the risk of DGF using patterns of trajectories of systolic blood pressure (SBP) declines in Maastricht category 3 kidney donors. We conducted a cohort study of all kidney transplant recipients in Australia who received kidneys from donation after circulatory death donors, divided into a derivation cohort (transplants between 9 April 2014 and 2 January 2018 [462 donors]) and a validation cohort (transplants between 6 January 2018 and 24 December 2019 [324 donors]). Patterns of SBP decline using latent class models were evaluated against the odds of DGF using a two-stage linear mixed effects model. In the derivation cohort, 462 donors were included in the latent class analyses and 379 donors in the mixed effects model. Of the 696 eligible transplant recipients, 380 (54.6%) experienced DGF. Ten different trajectories, with distinct patterns of SBP decline were identified. Compared with recipients from donors with the slowest decline in SBP after withdrawal of cardiorespiratory support, the adjusted odds ratio (aOR) for DGF was 5.5 [95% confidence interval (CI) 1.38-28.0] for recipients from donors with a steeper decline and lowest SBP [mean 49.5mmHg (standard deviation 12.5)] at the time of withdrawal. For every 1mmHg/min reduction in the rate of decline of SBP, the respective aORs for DGF were 0.95 (95% CI 0.91-0.99) and 0.98 (95% CI 0.93-1.0) in the random forest and least absolute shrinkage and selection operator models. In the validation cohort, the respective aORs were 0.95 (95% CI 0.91-1.0) and 0.99 (95% CI 0.94-1.0). Trajectories of SBP decline and their determinants are predictive of DGF. These results support a trajectory-based assessment of haemodynamic changes in donors after circulatory death during the agonal phase for donor suitability and post-transplant outcomes.

The selflessness of an 8-year-old.

This short 55-word story highlights an Internal Medicine resident's experience talking to the family of a patient dying while on life support in the ICU, and the family dynamic while the resident discusses end of life care and withdrawal of life support. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A phase I trial of androgen deprivation, darolutamide, and ipatasertib in a safety cohort with castration-resistant prostate cancer (ADDITION).

174 Background: Alterations activating the PI3K-AKT pathway are found in 40-50% of patients with aggressive prostate cancer. This leads to an abrogated response to therapy with androgen-receptor (AR) pathway inhibitors (ARPIs) and is associated with poor outcomes. Preclinical in vivo models suggest there is synergy between ARPIs and AKT inhibitors. Methods: This is a single-arm study of the AR inhibitor darolutamide, the AKT inhibitor ipatasertib, and androgen deprivation therapy (ADT). The phase I safety cohort included patients with castration-resistant prostate cancer (CRPC). ADT was administered per institutional standards. Patients started with a lead-in of ipatasertib for 7 days, followed by ipatasertib combined with darolutamide 600 mg BID. The starting dose of ipatasertib was 400 mg daily with plans to de-escalate if ≥ 2 dose-limiting toxicities (DLTs) were identified in the first six patients. The DLT period was the first 4 weeks of combination therapy. The primary endpoint was to identify the recommended phase II dose (RP2D) of ipatasertib. A phase II biomarker-selected cohort was planned to receive the combination neoadjuvantly. That portion of the study was terminated prior to patient enrollment due to the withdrawal of industry support. Results: Six patients with metastatic CRPC were enrolled in the phase I cohort. They had received a median of 3 prior systemic therapies in addition to ADT (range 1-6). All patients completed the DLT period, and no DLTs were observed. The RP2D of ipatasertib, when given with darolutamide, is 400mg daily. Two patients (33%) had serious adverse events (SAEs) (diarrhea; grade 3) related to ipatasertib outside the DLT period. Two patients (33%) had SAEs unrelated to study drugs; pyelonephritis (one patient; grade 3) secondary to obstruction, and respiratory failure (one patient; grade 5) attributed to disease progression. Two (33%) patients had at least a 50% decline in PSA as the best PSA response, including 2 of 3 patients with known PI3K pathway alterations. Median PSA progression free survival (PFS) was 3.35 months (95% CI 3.06-NA). Median radiographic PFS was 2.91 months (95% CI 2.79-NA). Conclusions: Combination therapy with darolutamide and ipatasertib in CRPC is safe and a RP2D of ipatasertib was established. Toxicity was similar to the therapies given alone, and the most common treatment-related SAE was diarrhea. Partial response to combination therapy was seen in men with CRPC and known PI3K alterations. Clinical trial information: NCT04737109 .

The mediating role of self-efficacy in the relationship between social support and work withdrawal behavior: A cross-sectional study among young lung cancer survivors

ObjectiveThe study aimed to explore the predictors of work withdrawal behavior among young lung cancer survivors and examine the mediating role of self-efficacy in the relationship between social support and work withdrawal behavior. MethodsThis cross-sectional study was conducted in a cancer center in southern China. A total of 215 young lung cancer survivors were recruited from January 2021 to July 2021 and investigated by a demographic and disease-related questionnaire, the Work Withdrawal Behavior Scale, Social Support Rating Scale, and General Self-efficacy Scale. Data analysis was performed ​using ​IBM SPSS 25.0 (IBM Corp., Armonk, NY, USA) and PROCESS macro version 3.3 for SPSS developed by Preacher and Hayes. ResultsThe mean score of work withdrawal behavior was 3.02 (±0.70). Existing symptoms, income, residence, the duration of postoperative rest time, social support, and self-efficacy were the predictors and explained 70.2% of the variance of work withdrawal behavior. The mediating effect of self-efficacy was identified between social support and work withdrawal behavior (indirect effect ​= ​0.36, bias-corrected 95% confidence interval [−0.542 to −0.197]). ConclusionsWork withdrawal behavior was prevalent among young lung cancer survivors. Social support and self-efficacy were significantly associated with work withdrawal behavior, and self-efficacy was identified as a mediator between social support and work withdrawal behavior among this group. Health professionals could help them return and adapt to work by relieving their symptoms, providing social support, and enhancing their self-efficacy.

Identity management in the face of HIV and intersecting stigmas: A metasynthesis of qualitative reports from sub-Saharan Africa.

While stigma experienced by people living with HIV (PLWH) is well documented, intersectional stigma and additional stigmatized identities have not received similar attention. The purpose of this metasynthesis is to identify salient stigmatized intersections and their impact on health outcomes in PLWH in sub-Saharan Africa. Using Sandelowski and Barroso's metasynthesis method, we searched four databases for peer-reviewed qualitative literature. Included studies (1) explored personal experiences with intersecting stigmas, (2) included ≥1 element of infectious disease stigma, and (3) were conducted in sub-Saharan Africa. Our multinational team extracted, aggregated, interpreted, and synthesized the findings. From 454 screened abstracts, the 34 studies included in this metasynthesis reported perspectives of at least 1258 participants (282 men, 557 women, and 109 unspecified gender) and key informants. From these studies, gender and HIV was the most salient stigmatized intersection, with HIV testing avoidance and HIV-status denial seemingly more common among men to preserve traditional masculine identity. HIV did not threaten female identity in the same way with women more willing to test for HIV, but at the risk of abandonment and withdrawal of financial support. To guard against status loss, men and women used performative behaviors to highlight positive qualities or minimize perceived negative attributes. These identity management practices ultimately shaped health behaviors and outcomes. From this metasynthesis, the Stigma Identity Framework was devised for framing identity and stigma management, focusing on role expectation and fulfillment. This framework illustrates how PLWH create, minimize, or emphasize other identity traits to safeguard against status loss and discrimination. Providers must acknowledge how stigmatization disrupts PLWH's ability to fit into social schemas and tailor care to individuals' unique intersecting identities. Economic security and safety should be considered in women's HIV care, while highlighting antiretrovirals' role in preserving strength and virility may improve care engagement among men.

Alone (together): becoming a parent in the pandemic

ABSTRACT This paper draws on the author’s own experience of becoming a parent during the Covid-19 pandemic as a starting point from which to explore, and consider, how the experience of new parenthood was profoundly affected by the unusual and challenging circumstances created by the pandemic. Using a psychoanalytic lens, the author considers the legacy effects of Covid-19 restrictions and the atmosphere of heightened anxiety and danger, on the families who welcomed their first child in 2020 or 2021. The paper brings into focus the simultaneous experience of increased isolation and the withdrawal of support that would ordinarily be offered to new parents, along with the increased opportunities for closeness and early bonding this might bring, and considers how these factors might interrelate. It considers the changes to fatherhood that the pandemic created, and examines the benefits as well as pitfalls of the unusual circumstances brought about by successive lockdowns in the UK. The paper also explores the role that child psychotherapy has, as a profession, to examine and understand this experience for new parents and children born in the pandemic.

Pakistan's Foreign Policy in the Context of Z.A Bhutto: Towards Nonalignment

US withdrawal of military support during 1965, 1971, and 1975 led to a widespread perception in Pakistan that the US was an unreliable ally and had betrayed Pakistan. Initially, their relations were cordial but later on, this alliance became weaker especially during Zulfiqar Ali Bhutto's government. Bhutto after taking charge of the government reshaped Pakistan's internal and external politics. He adopted new dimensions regarding Pakistan's Foreign policy goals. He tried to free Pakistan from US influence and dependence and desired Pakistan to acquire nuclear capabilities. The paper aims to throw light on the factors that led to the drift in Pak-US relations. The findings of the study concluded that Bhutto adopted socialist policies and promoted friendly relations with socialist countries like the Soviet Union and the Peoples' Republic of China. All these steps were against the US interests. Pakistan also abandoned SEATO and CENTO pacts during this phase.

‘The Fall of Afghanistan: An American Tragedy’

ABSTRACT The conventional view has been that Trump and Biden made the correct decision to withdraw the US from Afghanistan, but the actual departure was flawed. On the contrary, the US should not have withdrawn and the actual departure was not a failure. The withdrawal was against the US’ larger strategic interests beyond counterterrorism. If it withdrew, it should not have done so unconditionally, for both its interests (including humanitarian) and assets were substantial. The US should not have negotiated with the Taliban absent the Afghan government, thereby undermining the government’s and its security forces’ will to fight. Thus, the success of the Taliban’s revolution owed more to the Afghan government’s collapse than its revolutionary mobilization. In withdrawing from Afghanistan, the US showed that it failed to learn lessons from its withdrawal from Iraq in 2011, which led to internal political decay in Iraq, the re-emergence of terrorism, and larger strategic setbacks for Washington. More broadly, the US failed to appreciate how its withdrawal of support for regimes dependent on it often facilitates the coming to power of hostile revolutionary movements.

280: TRANSPORT OF THE CRITICAL CARE PATIENT FOR WITHDRAWAL OF CARE IN THE HOME: A SCOPING REVIEW

Introduction: While most people state they want to die at home, evidence shows that many die in an institutional setting. Deaths in the intensive care unit contribute to family distress, moral distress of staff, and organizational strain. Transport of the critical care patient to their home for withdrawal of care and death is a possible, understudied, underutilized option. The authors performed a search and scoping review to determine the current practice and trends globally. Methods: Search terms discharge of ICU patients for home hospice were searched among the databases PubMed, CINAHL, Embase, Cochrane, Web of Science and Scopus. Results were filtered to the last ten years and in the English language, which yielded 312 articles. Article abstracts were independently reviewed by two authors for the appropriate intervention: Transport of the ICU patient to home for withdrawal of care, yielding 19 articles. The authors added 6 articles via hand-searching which yielded 25 total articles for review. Results: 25 articles were reviewed published between the years 2011-2021. Most articles were case studies or retrospective chart reviews. Qualitative studies were beneficial to explore the healthcare provider perspective as well as that of the family. Most articles came from the United States and United Kingdom, with some from Australia, New Zealand, Canada and Singapore. The practice was most commonly discussed within the pediatric population, though some centers were offering the intervention to adults. Benefits discussed included: Increased ease in end-of-life discussions when the family saw the opportunity for a “better” death, enhanced family bereavement, privacy and memory making during the dying process in the home, and decreased moral distress in staff. Barriers identified include the complex interdisciplinary teamwork necessary for implementation, the varying scope of EMS across states and countries, perceived medical complexity of the patient, and caregiver support once the patient returns home. Conclusions: Critical care transport to home for the aim of withdrawal of life support and death is a safe, feasible, compassionate option for patients and their families. If this option is pursued, it involves complex multidisciplinary planning and contingency planning to mitigate challenges and maintain safety.

How China Achieves the Delicate Balance in Ecological Poverty Alleviation: A Systems Thinking Perspective

Ecological poverty alleviation (EPA) is a syngenetic approach to tackling challenges in alleviating extreme poverty and ecological protection. Such an approach is crucial to help countries facing these two challenges to accelerate their progression towards meeting the United Nations Sustainable Development Goals in 2030. Prior research on EPA was focusing on understanding EPA from a national perspective and limited consideration was given to regional pertinence. This study uses systems thinking to construct causal loop diagrams (CLDs) and analyzes the mechanisms of EPA in Lanping County, Yunnan Province based on qualitative material. It reveals that the dynamics mechanism of EPA in Lanping County consists of seven reinforcing feedback loops and ten balancing feedback loops. Results indicate that external support, funding resources, employment, and endogenous-driven industrial development are the key drivers to successful EPA. Policies should be taken to avoid the risk of returning to poverty caused by the withdrawal of external support. This study proposes an effective tool with system foresight for exploring the mechanism of EPA and provides reference suggestions for poverty alleviation and development worldwide.

Are we waiting for the sky to fall? Predictors of withdrawal of life-sustaining support in older trauma patients: A retrospective analysis.

Limited data exist regarding the impact of advanced care planning for injured geriatric patients. We hypothesized that patients with advance directives limiting care (ADLC) compared with those without ADLC are more likely to undergo withdrawal of life-sustaining support (WLSS). This is a propensity-matched analysis utilizing American College of Surgeons Trauma Quality Improvement Program patients 65 years or older who presented between 2017 and 2018. Patients with and without ADLC on admission were compared. The primary outcome was WLSS and days prior to WLSS. Additional factors examined included hospital length of stay (LOS), unplanned operations, unplanned intensive care unit admissions, and in-hospital cardiac arrests. Prior to matching, logistic regression model assessed factors associated with WLSS. Patients with and without ADLC were matched 1:1 via a propensity score using patient and injury factors as covariates, and matched pair analysis compared differences in WLSS between patients with and without ADLC. There were 597,840 patients included: 44,001 patients with an ADLC (7.36%) compared with 553,839 with no ADLC (92.64%). Patients with an ADLC underwent WLSS more often than those with no ADLC (7.68% vs. 2.48%, p < 0.001). In a 1:1 propensity-matched analysis, patients with ADLC were more likely to undergo WLSS (odds ratio [OR], 2.38' 95% confidence interval [CI], 2.22-2.55), although stronger predictors of WLSS included severity of injury (Injury Severity Score, 25+; OR, 23.84; 95% CI, 21.55-26.36), unplanned intensive care unit admissions (OR, 3.30; 95% CI, 2.89-3.75), and in-hospital cardiac arrests (OR, 4.97; 95% CI, 4.02-6.15). A small proportion of the geriatric trauma population had ADLC on admission. While ADLC was predictive of WLSS, adverse events were more strongly associated with WLSS. To ensure patient-centered care and reduce futile interventions, surgeons should delineate goals of care early regardless of ADLC. Therapeutic/Care Management; Level III.

Contribuciones a una seguridad alimentaria desde los saberes locales. La producción de maíz nativo por el Consejo Poblano de Agricultura de Conservación

In Mexico, neoliberal policies have adverse effects on the agricultural sector: the withdrawal of direct government support for production and the policy of promoting agriculture based on agribusiness, leads to thousands of producers and peasants facing the possibility of abandoning their lands. and stop growing their corn, which represent an indispensable part of the basic diet of millions of families; but they also form an element of their culture and identity, which reflects a conception of life associated with the land. In the national territory, there are various organized social actors that seek to break with the paradigm of the development mo­del, with which the present work has the objective of analyzing the experience of the Poblano Council of Conservation Agriculture (Copac), in the state of Puebla, who a Over ten years it has contributed to food security from local knowledge in the production of native corn.

다문화 청소년의 성취동기와 진로장벽 인식

Objectives The purpose of this study is to identify the mediating effect of parental support and social withdrawal on the relationship between achievement motivation and perceived career barriers of multi-cultural adolescents. Methods For this purpose, this study used data of 1,197 multi-cultural adolescents who participated in the 8th year of the “Multicultural Adolescent Panel Survey(MAPS)” established by the National Youth Policy Institute (NYPI) and analyzed using SPSS 25.0 and PROCESS Macro 3.1. Results The results are as follows. First, multi-cultural adolescents' achievement motivation had a significant effect on perceived career barriers. Second, multi-cultural adolescents' parental support significantly mediated the relationship between achievement motivation and perceived career barriers. Third, there was a significant mediation effect of multi-cultural adolescents' social withdrawal on the relationship between achievement motivation and perceived career barriers. Fourth, multi-cultural adolescents' parental support and social withdrawal sequentially mediated the relation between achievement motivation and percieved career barriers. Conclusions Multi-cultural adolescents' parental support and social withdrawal partially mediate the relationship between achievement motivation and perceived career barriers. This study implies that when developing the counseling program to reduce multicultural adolescents’ perceived career barriers, researchers should give greater weight to achievement motivation and, at the same time, actively consider parental support and social withdrawal.

Prediction of Death after Terminal Extubation, the Machine Learning Way

Introduction: Terminal Extubation (TE), as hospital End of Life (EOL) policies is the withdrawal of ventilatory support from terminally ill patients. Although TE and its natural progression to death provides closure to the suffering for patient and the family, we lack the tools to serve that purpose. This inability also negatively affects Donation after Cardiac Death organ donation efforts and making death vigil more grueling than comforting. We developed an advanced machine learning model, long-short term memory (LSTM) to accurately predict death within 2 hours post-TE and compare to the standard regression model on priori list of clinical variables. Methods: Clinical, laboratory, demographic data from 1,965 patients were extracted 24 hours before TE. Validation set (1,645 patients at Yale New-Haven Hospital) and external validation set(320 patients at Bridgeport-hospital). Outcome of interest was death within 2 hours of TE. LSTM model was trained on different versions of time-updating data, including carryforward and zero imputation after data transformation. LSTM model was compared with clinical prediction score. Results: LSTM model outperformed clinical prediction score (AUC 0.66 vs 0.51, P = 0.001) in predicting post-extubation death within 2 hours on external validation. At matched sensitivity threshold of 94%(with clinical prediction score of ≥2), LSTM model outperformed clinical prediction score(specificity 28.8% vs 11.1%). Conclusion: We were able to accurately predict progression to natural death within 2 hours after TE and our LSTM model was superior to clinical prediction score. This information will critically help intensivists facilitate EOL discussions, improve organ donation rates and help in operationalizing allocation of ICU resources efficiently.