Following a methodical procedure development phase, ESG demonstrated safety and short-term efficacy in this trial. The procedure also achieved meaningful weight loss during the follow-up period.
Shark nurseries are essential habitats for shark survival. Notwithstanding the rich fossil record of the modern great white shark (Carcharodon carcharias, GWS), its use of nursery areas in the fossil record has never been assessed before. Here, we analysed the fossil record of the GWS from three South American Pliocene localities, assessed body size distributions and applied previously established criteria to identify palaeo-nurseries. We found that juveniles dominate the Coquimbo locality (Chile), whereas subadults and adults characterize Pisco (Peru) and Caldera (Chile), respectively. These results, summed to the paleontological and paleoenvironmental record of the region, suggest that Coquimbo represents the first nursery area for the GWS in the fossil record. Our findings demonstrate that one of the top predators in today's oceans has used nursery areas for millions of years, highlighting their importance as essential habitats for shark survival in deep time.
Background:
The hospitalization rates of patients with pulmonary embolism (PE) has been on the rise. However, there is limited data recognizing the etiologies and predictors of early readmission rate in this patient population.
Methods:
We utilized the National Readmission Database (NRD) 2013, subset of the Healthcare Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality (AHRQ). PE was identified using ICD 9 code (415.1X) as primary diagnosis. Co-morbidities identified by “CM_” variables provided by NRD. Primary outcome was identified as predictors of 30-day readmission rates and secondary outcomes as the leading etiologies and trends of readmission rate. To identify predictors of outcome, a two level hierarchical logistical model was used.
Results:
We analyzed 76,994 patients with primary diagnosis of PE. Total of 11.6% (8,934) patients were readmitted within 30 days of index hospitalization. Significant predictors of readmission were associated with end stage renal disease, drug abuse, chronic lung disease, congestive heart failure, and gastrointestinal bleed during primary admission. In addition, female gender, those admitted to teaching hospital and with longer length of stay (LOS) had higher 30-day readmission rate. Remarkably, elderly age (age>75 years) was not associated with increase in readmission rates. The leading etiologies besides DVT/PE for readmission were sepsis/septic shock, cancer, heart failure and pneumonia.
Conclusion:
The rising hospitalization rate of patients with pulmonary embolism, imposes a higher burden on the cost of health care. We identified important predictors and etiologies of 30-day readmission rate. These findings may help in prevention of hospital readmissions and may decrease the cost of care.
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