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IMPORTANCE Randomized clinical trials have demonstrated that patients with asymptomatic carotid stenosis are eligible for carotid endarterectomy (CEA) if the 30-day surgical complication rate is less than 3% and the patient’s life expectancy is at least 5 years. OBJECTIVE To develop a risk prediction tool to improve patient selection for CEA among patients with asymptomatic carotid stenosis. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, veterans 65 years and older who received both carotid imaging and CEA in the Veterans Administration between January 1, 2005, and December 31, 2009 (n = 2325) were followed up for 5 years. Data were analyzed from January 2005 to December 2015. A risk prediction tool (the Carotid Mortality Index [CMI]) based on 23 candidate variables identified in the literature was developed using Veterans Administration and Medicare data. A simpler model based on the number of 4 key comorbidities that were prevalent and strongly associated with 5-year mortality was also developed (any cancer in the past 5 years, chronic obstructive pulmonary disease, congestive heart failure, and chronic kidney disease [the 4C model]). Model performance was assessed using measures of discrimination (eg, area under the curve [AUC])and calibration. Internal validation was performed by correcting for optimism using 500 bootstrapped samples. MAIN OUTCOME AND MEASURE Five-year mortality. RESULTS Among 2325 veterans, the mean (SD) age was 73.74 (5.92) years. The cohort was predominantly male (98.8%) and of white race/ethnicity (94.4%). Overall, 29.5% (n = 687) of patients died within 5 years of CEA. On the basis of a backward selection algorithm, 9 patient characteristics were selected (age, chronic kidney disease, diabetes, chronic obstructive pulmonary disease, any cancer diagnosis in the past 5 years, congestive heart failure, atrial fibrillation, remote stroke or transient ischemic attack, and body mass index) for the final logistic model, which yielded an optimism-corrected AUC of 0.687 for the CMI. The 4C model had slightly worse discrimination (AUC, 0.657) compared with the CMI model; however, the calibration curve was similar to the full model in most of the range of predicted probabilities. CONCLUSIONS AND RELEVANCE According to results of this study, use of the CMI or the simpler 4C model may improve patient selection for CEA among patients with asymptomatic carotid stenosis.

BACKGROUND: Marijuana is currently legal for recreational use in 10 states and Washington DC while a total of 34 states have implemented varying degrees of medical marijuana. The commercialization of marijuana has been accompanied by a proliferation of false claims regarding the therapeutic potential of marijuana, which are popularized by several different information sources. To date, no study has examined where US adults get their information regarding marijuana. OBJECTIVE: To determine the sources of information associated with believing unsupported claims about marijuana. DESIGN: Probability-based online survey PARTICIPANTS: 16,820 adults, with a response rate of about 55% (N = 9003) MAIN MEASURES: Most influential sources of information about marijuana and belief of statements consistent with misinformation, for example, smoking marijuana has preventative health benefits, secondhand marijuana smoke or use during pregnancy is completely or somewhat safe, and marijuana is not at all addictive. KEY RESULTS: There were 9003 respondents (response rate 55%). Forty-three percent believed unsupported claims about marijuana. The most influential sources of information were health professionals, traditional media, friends/relatives, and social media/internet. Individuals reporting social media or the Internet (1.46 CI [1.30, 1.64]), the marijuana industry (e.g., advertisements, dispensaries) (2.88 CI [2.15, 3.88]), and friends or relatives (1.41 CI[1.26, 1.58]) as the most influential source of information about marijuana were more likely to believe any statement consistent with misinformation about marijuana in comparison with those who reported other sources as most influential. CONCLUSIONS: Individuals reporting the most significant source of information regarding marijuana was from social media or the Internet, the marijuana industry, or friends or relatives were more likely to believe unsupported claims about marijuana. Public health campaigns to counter the misinformation about marijuana to the public are needed.

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