Should All Patients With Pulmonary Hypertension Undergoing Non-Cardiac Surgery Be Managed by Cardiothoracic Fellowship-Trained Anesthesiologists?

OBJECTIVES: To identify differences in practice patterns and outcomes related to the induction of general anesthesia for patients with pulmonary hypertension (PH) performed by anesthesiologists who have completed a cardiothoracic fellowship (CTA group) vs those who have not (non-CTA group). DESIGN: Retrospective study with propensity score matching. SETTING: Operating room. PARTICIPANTS: All adult patients with PH undergoing general anesthesia requiring intubation at a single academic center over 5 years. INTERVENTIONS: Patient baseline characteristics, peri-induction management variables, post-induction mean arterial pressure (MAP), and other outcomes were compared between CTA and non-CTA groups. METHODS AND MAIN RESULTS: Following propensity scoring matching, 402 patients were included in the final model, 100 in the CTA group and 302 in the non-CTA group. Also following matching, only cases of mild to moderate PH without right ventricular dysfunction remained in the analysis. Matched groups were overall statistically similar with respect to baseline characteristics; however, there was a greater incidence of higher ASA class (P = .025) and cardiology and thoracic procedures (P < .001) being managed by the CTA group. No statistical differences were identified in practice patterns or outcomes related to the induction of anesthesia between groups, except for longer hospital length of stay in the CTA group (P = .008). CONCLUSIONS: These results provide early evidence to suggest the induction of general anesthesia of patients with non-severe PH disease can be comparably managed by either anesthesiologists with or without a cardiothoracic fellowship. However, these findings should be confirmed in a prospective study.

Costs associated with the use of multigene panel tests in three solid tumor types and the impact on insurance premiums.

Aim: This study assessed the costs associated with multigene panel tests (MGPTs) in the USA and the impact of coverage on insurance premiums. Materials & methods: We conducted a retrospective claims analysis to estimate total patient costs associated with MGPT use in three solid tumors: advanced non-small-cell lung cancer, advanced melanoma and metastatic colorectal cancer. A decision analytic model was constructed to estimate the premium impact of a 1 million member commercial health plan. Results: In all three tumor types, mean total costs for patients receiving or not receiving MGPTs were not significantly different (p > 0.05). The estimated change in premiums per enrollee per month was estimated to be US$0.040. Conclusion: MGPTs were not associated with higher costs and coverage is expected to have minimal impact on insurance premiums.

Costs & premiums for tests of biomarkers We examined whether using tests for many biomarkers at once in three cancer types would lead to higher costs and increase insurance premiums for patients with private insurance. Using real-world data, we found that use of these tests was not linked to higher costs. Furthermore, we estimated that insurance coverage of these tests would result in small changes to insurance premiums.

Place-Based Policies and Carbon Emission Efficiency: Quasi-Experiment in China's Old Revolutionary Base Areas.

Regional imbalance is a typical feature of economic and social development in China, and place-based policies aimed at promoting balanced regional development may bring challenges to low-carbon goals. This study uses the panel data of China's prefecture-level cities from 2003 to 2019 to investigate the impact of place-based policies on carbon emission efficiency using a quasi-experimental method. Results indicate that place-based policies significantly reduce the regional total-factor carbon emission efficiency. The difference-in-differences method based on propensity score matching and entropy balancing matching consistently supports the finding that carbon emission efficiency decreases after policy intervention. Place-based policies lead to a significant decline in capital allocation efficiency but have an insignificant impact on labor allocation efficiency. Moreover, place-based policies result in the expansion of carbon-intensive industries but hinder the progress of the financial technology of financial institutions. Nevertheless, place-based policies do not lead to the deterioration of environmental quality. Among the advantages of these policies are the significant promotion of regional digitization and increased fiscal expenditure on science and technology. Political promotion, carbon regulation, trade policies, and other conditional factors may be optimally designed to promote low-carbon development in the old revolutionary areas.

Comparative study on life cycle assessment of gasoline with methyl tertiary-butyl ether and ethanol as additives.

China has proposed to use ethanol instead of methyl tert-butyl ether (MTBE) as a gasoline additive, with full compliance planned for 2020. At present, previous studies on gasoline additive focus almost exclusively on effects of fuel performance and engine, however, the environmental impact production and use of additives cannot be ignored. Herein, we use the life cycle assessment (LCA) method, the environmental effects of E10 (10% maize ethanol and 90% gasoline, v/v) and M10 (10% MTBE and 90% gasoline, v/v) were evaluated and compared. Quantifying the net environmental benefits of implementing this national policy from a life cycle perspective. The results showed that the environmental impact of E10 was 15.4% lower than that of M10. Thus, replacing MTBE with ethanol reduces the total environmental impact. However, there were some negative environmental impacts such as waste solids and water use. Finally, we propose further improvements to make E10 more environmentally friendly.

The effects of different mesh generation methods on computational fluid dynamic analysis and power loss assessment in total cavopulmonary connection.

The flow field and energetic efficiency of total cavopulmonary connection (TCPC) models have been studied by both in vitro experiment and computational fluid dynamics (CFD). All the previous CFD studies have employed the structured mesh generation method to create the TCPC simulation model. In this study, a realistic TCPC model with complete anatomical features was numerically simulated using both structured and unstructured mesh generation methods. The flow fields and energy losses were compared in these two meshes. Two different energy loss calculation methods, the control volume and viscous dissipation methods, were investigated. The energy losses were also compared to the in vitro experimental results. The results demonstrated that: (1) the flow fields in the structured model were qualitatively similar to the unstructured model; (2) more vortices were present in the structured model than in the unstructured model; (3) both models had the least energy loss when flow was equally distributed to the left and right pulmonary arteries, while high losses occurred for extreme pulmonary arterial flow splits; (4) the energy loss results calculated using the same method were significantly different for different meshes; and (5) the energy loss results calculated using different methods were significantly different for the same mesh.