Effect of managed transition on mental health outcomes for young people at the child-adult mental health service boundary: a randomised clinical trial.

BACKGROUND: Poor transition planning contributes to discontinuity of care at the child-adult mental health service boundary (SB), adversely affecting mental health outcomes in young people (YP). The aim of the study was to determine whether managed transition (MT) improves mental health outcomes of YP reaching the child/adolescent mental health service (CAMHS) boundary compared with usual care (UC). METHODS: A two-arm cluster-randomised trial (ISRCTN83240263 and NCT03013595) with clusters allocated 1:2 between MT and UC. Recruitment took place in 40 CAMHS (eight European countries) between October 2015 and December 2016. Eligible participants were CAMHS service users who were receiving treatment or had a diagnosed mental disorder, had an IQ ⩾ 70 and were within 1 year of reaching the SB. MT was a multi-component intervention that included CAMHS training, systematic identification of YP approaching SB, a structured assessment (Transition Readiness and Appropriateness Measure) and sharing of information between CAMHS and adult mental health services. The primary outcome was HoNOSCA (Health of the Nation Outcome Scale for Children and Adolescents) score 15-months post-entry to the trial. RESULTS: The mean difference in HoNOSCA scores between the MT and UC arms at 15 months was -1.11 points (95% confidence interval -2.07 to -0.14, p = 0.03). The cost of delivering the intervention was relatively modest (€17-€65 per service user). CONCLUSIONS: MT led to improved mental health of YP after the SB but the magnitude of the effect was small. The intervention can be implemented at low cost and form part of planned and purposeful transitional care.

Evolution of active catalysts for the selective oxidative dehydrogenation of methanol on Fe2O3 surface doped with Mo oxide.

Iron molybdate catalysts are used for the selective oxidation of methanol to formaldehyde. In this paper we have attempted to understand what determines high selectivity in this reaction system by doping haematite with surface layers of Mo by incipient wetness impregnation. This works well and the Mo appears to form finely dispersed layers. Even very low loadings of Mo have a marked effect on improving the selectivity to formaldehyde. Haematite itself is a very poor catalyst with high selectivity to combustion products, whereas, when only 0.25 monolayers of Mo are deposited on the surface, formaldehyde and CO selectivities are greatly enhanced and CO2 production is greatly diminished. However, even with as much as seven monolayers of Mo dosed on to the surface, these materials achieve much less selectivity to formaldehyde at high conversion than do the industrial catalysts. The reason for this is that the Mo forms a 'skin' of ferric molybdate on a core of iron oxide, but does not produce a pure Mo oxide monolayer on the surface, a situation which is essential for very high yields of formaldehyde.

A teratologic suppressor role for p53 in benzo[a]pyrene-treated transgenic p53-deficient mice.

DNA damage may mediate birth defects caused by many drugs and environmental chemicals, therefore p53, a tumour suppressor gene that facilitates DNA repair, may be critically embryoprotective. We have studied the effects of the environmental teratogen, benzo[a]pyrene, on pregnant heterozygous p53-deficient mice. Such mice exhibited between 2- to 4-fold higher embryotoxicity and teratogenicity than normal p53-controls. Fetal resorptions reflecting in utero death were genotyped using the polymerase chain reaction and found to be increased 2.6-fold and 3.6-fold respectively with heterozygous and homozygous p53-deficient embryos. These results provide the first direct evidence that p53 may be an important teratological suppressor gene which protects the embryo from DNA-damaging chemicals and developmental oxidative stress.

Host Genotype Links to Salivary and Gut Microbiota by Periodontal Status.

Limited evidence describing how host genetic variants affect the composition of the microbiota is currently available. The aim of this study was to assess the associations between a set of candidate host genetic variants and microbial composition in both saliva and gut in the TwinsUK registry. A total of 1,746 participants were included in this study and provided stool samples. A subset of 1,018 participants also provided self-reported periodontal data, and 396 of those participants provided a saliva sample. Host DNA was extracted from whole-blood samples and processed for Infinium Global screening array, focusing on 37 selected single-nucleotide polymorphisms (SNPs) previously associated with periodontitis. The gut and salivary microbiota of participants were profiled using 16S ribosomal RNA amplicon sequencing. Associations between genotype on the selected SNPs and microbial outcomes, including α diversity, ß diversity, and amplicon sequence variants (ASVs), were investigated in a multivariate mixed model. Self-reported periodontal status was also compared with microbial outcomes. Downstream analyses in gut microbiota and salivary microbiota were carried out separately. IL10 rs6667202 and VDR 2228570 SNPs were associated with salivary α diversity, and SNPs in IL10, HSA21, UHRF2, and Fc-γR genes were associated with dissimilarity matrix generated from salivary ß diversity. The SNP that was associated with the greatest number of salivary ASVs was VDR 2228570 followed by IL10 rs6667202, and that of gut ASVs was NPY rs2521364. There were 77 salivary ASVs and 39 gut ASVs differentially abundant in self-reported periodontal disease versus periodontal health. The dissimilarity between saliva and gut microbiota within individuals appeared significantly greater in self-reported periodontal cases compared to periodontal health. IL10 and VDR gene variants may affect salivary microbiota composition. Periodontal status may drive variations in the salivary microbiota and possibly, to a lesser extent, in the gut microbiota.

Free radical-mediated oxidative DNA damage in the mechanism of thalidomide teratogenicity.

The sedative drug thalidomide ([+]-alpha-phthalimidoglutarimide), once abandoned for causing birth defects in humans, has found new therapeutic license in leprosy and other diseases, with renewed teratological consequences. Although the mechanism of teratogenesis and determinants of risk remain unclear, related teratogenic xenobiotics are bioactivated by embryonic prostaglandin H synthase (PHS) to a free-radical intermediates that produce reactive oxygen species (ROS), which cause oxidative damage to DNA and other cellular macromolecules. Similarly, thalidomide is bioactivated by horseradish peroxidase, and oxidizes DNA and glutathione, indicating free radical-mediated oxidative stress. Furthermore, thalidomide teratogenicity in rabbits is reduced by the PHS inhibitor acetylsalicylic acid, indicating PHS-catalyzed bioactivation. Here, we show in rabbits that thalidomide initiates embryonic DNA oxidation and teratogenicity, both of which are abolished by pre-treatment with the free radical spin trapping agent alpha-phenyl-N-t-butylnitrone (PBN). In contrast, in mice, a species resistant to thalidomide teratogenicity, thalidomide does not enhance DNA oxidation, even at a dose 300% higher than that used in rabbits, providing insight into an embryonic determinant of species-dependent susceptibility. In addition to their therapeutic implications, these results constitute direct evidence that the teratogenicity of thalidomide may involve free radical-mediated oxidative damage to embryonic cellular macromolecules.

Prescribing patterns and outcomes of venous thromboembolism prophylaxis in hospitalized medical and cancer patients: Observations from the Ottawa Hospital.

Guidelines suggest broad use of pharmacologic prophylaxis to prevent venous thromboembolism (VTE) in hospitalized medical patients, however little 'real-world' data exists to support this. Our goal was to describe the use of thromboprophylaxis among general medical and cancer patients admitted to hospital, compare VTE and bleeding outcomes according to use of thromboprophylaxis, and to determine what variables influence prescribing patterns and outcomes. Patients admitted to the general medical and oncology services at The Ottawa Hospital between 2010 and 2015 were retrospectively reviewed and classified according to whether they received initial, delayed, or no pharmacologic thromboprophylaxis during their first hospitalization. Patients with an alternate indication for anticoagulation or those admitted with a bleeding event were excluded from analysis. The primary efficacy outcome was any symptomatic VTE during index hospitalization or within 90 days of discharge, and the primary safety outcome was clinically relevant bleeding during the index hospitalization. 17,262 patients were included in our final analysis. General medical patients selected to receive no, initial, or delayed thromboprophylaxis had 0.4%, 0.7%, and 2.4% rates of VTE; and 0.2%, 0.7%, and 1.5% rates of clinically relevant bleeding complications, respectively. Cancer patients had significantly higher rates of VTE: 3.3%, 3.9%, and 5.0%; and 0.9%, 0.7%, and 3.0% rates of clinically relevant bleeding among those selected to receive no, initial, or delayed thromboprophylaxis, respectively. Overall, our study suggests that broad use of pharmacologic thromboprophylaxis may be unnecessary in select low-risk general medical patients and may be less effective in cancer patients in whom new studies are indicated.

The Urinary Tract Microbiome in Older Women Exhibits Host Genetic and Environmental Influences.

The urinary microbiome is a relatively unexplored niche that varies with gender. Urinary microbes, especially in aging populations, are associated with morbidity. We present a large-scale study exploring factors defining urinary microbiome composition in community-dwelling older adult women without clinically active infection. Using 1,600 twins, we estimate the contribution of genetic and environmental factors to microbiome variation. The urinary microbiome is distinct from nearby sites and unrelated to stool microbiome with more Actinobacteria, Fusobacteria and Proteobacteria, but fewer Bacteroidetes, Firmicutes and Verrumicrobia. A quarter of variants had heritability estimates greater than 10% with most heritable microbes having potential clinical relevance, including Escherichia-Shigella linked to urinary tract infections. Age, menopausal status, prior UTI, and host genetics were top factors defining the urobiome with increased microbial diversity tending to associate with older age. These findings highlight the distinct composition of the urinary microbiome and significant contributions of host genetics.

Late pleistocene vegetation and degree of pluvial climatic change in the chihuahuan desert.

Eight Pleistocene wood rat middens at elevations of 1200, 880, and 600 meters in the Chihuahuan Desert contain abundant macrofossils of pinyon pine, juniper, shrubby liveoak, and Opuntia, together with smaller quantities of Agave lecheguilla and other xerophytes of existing desert vegetation, which in dicate a xerophilous woodland vegetation in the lowlands, as much as 800 meters below existing woodland, during the Wisconsin pluvial. Ten radiocarbon dates show ages that range from 11,560 to 14,800 and 16,250 to 20,000 years, and to more than 40,000 years. Absence of most mesophytic montane species in deposits as high as 1200 meters indicates a lack of equivalent downward dis placement for the ponderosa pine zone or other zones of montane vegetation. Uneven stocking of isolated peaks in the Chihuahuan Desert province with montane species suggests that long-distance transport of propagules, rather than former continuity, may account for the disjunct distributions of many species.

Late pleistocene history of coniferous woodland in the mohave desert.

Seventeen ancient wood-rat middens, ranging in radiocarbon age from 7400 to 19,500 years and to older than 40,000 years, have been uncovered in the northeastern, north-central, southeastern, and southwestern sectors of the Mohave Desert. Excellent preservation of macroscopic plant materials (including stems, buds, leaves, fruits, and seeds) enables identification of many plant species growing within the limited foraging range of the sedentary wood rat. An approximately synchronous zonal differentiation of vegetation in response to a gradient of elevation on limestone in the northeastern Mohave Desert is apparent from the macrofossil evidence, preserved in wood-rat middens and ground-sloth coprolites, covering a time span bracketed by radiocarbon ages of about 9000 and 10,000 years. XerophilQus juniper woodlands descended to an elevation of 1100 meters, some 600 meters below the present lower limit of woodland (1700 meters) in the latitude of Frenchman Flat. But desert or semidesert shrubs coexisted with the woodland trees throughout much of the span of elevation corresponding to the pluvial lowering of the woodland zone, and the more mesophytic phase of pinyonjuniper woodland was evidently confined to montane habitats at elevations above 1500 meters. Joshua trees, accompanied by desert shrubs, prevailed down to about 600 meters at Gypsum Cave, Nevada, but only the shrubs of the existing warm-desert vegetation occurred at 530 meters near Rampart Cave, Arizona. Pleistocene middens from the southeastern Mohave Desert record a relatively large downward shift of the pinyon-juniper woodland zone, paralleling the remarkably low minimum elevation of the existing woodland zone in that area. The macrofossil evidence speaks for former continuity of the many disjunct stands of woodland vegetation in the Mohave Desert region, at least along the higher divides connecting most of the ranges. However, there is no macrofossil evidence of pluvial continuity of range for the more mesophytic, montane, coniferous-forest zone of ponderosa pine or white fir now occupying islands of relatively mesic environment on the highest mountains of the region. On the contrary, the uneven stocking of the lofty mountains of the Mohave Desert with mesephytic or boreal species and the trend toward endemism suggest a long history of isolation.

Photosynthetic Mechanisms and Paleoecology from Carbon Isotope Ratios in Ancient Specimens of C4 and CAM Plants.

Carbon istotope ratios of modern, 10,000-year-old, and more than 40,000-year-old Atriplex confertifolia (C(4)) material from Nevada caves indicate that the C(4) photosynthetic pathway was operating in these plants over that period. Samples of a plant with crassulacean acid metabolism, Opuntia polyacantha, were also measured, and a shift in the 8(13)C value from -21.9 per mil (more than 40,000 years ago) to -13.9 per mil (10,000 years ago) was observed. This provides unique physiological evidence to support the hypothesis that the late Pleistocene pluvial climate in the region already had become drier about 10,000 years ago.

Honey bee recruitment to food sources: olfaction or language?

Honey bee recruits locate food sources by olfaction and not by use of distance and direction information contained in the recruitment dance. Recruitment efficiency increases as odor of the food source accumulates in the hive, from hour to hour and from day to day. Flight patterns, landing patterns, bee odor, and Nassanoff secretion apparently do not aid in recruitment of bees.

Flight periodicity and the vertical distribution of high-altitude moth migration over southern Britain.

The continuous operation of insect-monitoring radars in the UK has permitted, for the first time, the characterization of various phenomena associated with high-altitude migration of large insects over this part of northern Europe. Previous studies have taken a case-study approach, concentrating on a small number of nights of particular interest. Here, combining data from two radars, and from an extensive suction- and light-trapping network, we have undertaken a more systematic, longer-term study of diel flight periodicity and vertical distribution of macro-insects in the atmosphere. Firstly, we identify general features of insect abundance and stratification, occurring during the 24-hour cycle, which emerge from four years' aggregated radar data for the summer months in southern Britain. These features include mass emigrations at dusk and, to a lesser extent, at dawn and daytime concentrations associated with thermal convection. We then focus our attention on the well-defined layers of large nocturnal migrants that form in the early evening, usually at heights of 200-500 m above ground. We present evidence from both radar and trap data that these nocturnal layers are composed mainly of noctuid moths, with species such as Noctua pronuba, Autographa gamma, Agrotis exclamationis, A. segetum, Xestia c-nigrum and Phlogophora meticulosa predominating.

On the Elevated Temperature Thermal Stability of Nanoscale Mn-Ni-Si Precipitates Formed at Lower Temperature in Highly Irradiated Reactor Pressure Vessel Steels.

Atom probe tomography (APT) and scanning transmission electron microscopy (STEM) techniques were used to probe the long-time thermal stability of nm-scale Mn-Ni-Si precipitates (MNSPs) formed in intermediate and high Ni reactor pressure vessel steels under high fluence neutron irradiation at ≈320 °C. Post irradiation annealing (PIA) at 425 °C for up to 57 weeks was used to determine if the MNSPs are: (a) non-equilibrium solute clusters formed and sustained by radiation induced segregation (RIS); or, (b) equilibrium G or Γ2 phases, that precipitate at accelerated rates due to radiation enhanced diffusion (RED). Note the latter is consistent with both thermodynamic models and x-ray diffraction (XRD) measurements. Both the experimental and an independently calibrated cluster dynamics (CD) model results show that the stability of the MNSPs is very sensitive to the alloy Ni and, to a lesser extent, Mn content. Thus, a small fraction of the largest MNSPs in the high Ni steel persist, and begin to coarsen at long times. These results suggest that the MNSPs remain a stable phase, even at 105 °C higher than they formed at, thus are most certainly equilibrium phases at much lower service relevant temperatures of ≈290 °C.

Cognitive and behavioural effects of genetic testing for thrombophilia.

Very few studies have examined the impact of genetic testing for thrombophilia on health behaviours, perceptions of control over risk factors for venous thromboembolism, or health services utilization. Through a postal questionnaire we compared first degree relatives with thrombophilia (carriers) most of whom had received counseling, to those without (non-carriers) with respect to: (a) perceived causes of venous thromboembolism; (b) perceived control; (c) health behaviour changes; and (d) use of health care services. 44/51 for carriers and 26/47 for non-carriers completed questionnaires. Carriers were more likely to believe their risk of venous thromboembolism 'is a little higher' or 'much higher' than average (p < 0.001) but some continued to believe their risk 'is the same as' or 'lower than' average. 16%-32% of carriers did not recognize major risk factors. Stress, worry, or depression, negative attitude, and over-exertion were over-interpreted as risks. 37.2% did not appreciate that thrombophilia increases risk. Behaviour changes were uncommon. There is a need for research on education and strategies to improve knowledge in thrombophilia carriers.

A theoretically-motivated biaxial tissue culture system with intravital microscopy.

Many cell types produce, remodel, and degrade extracellular matrix in response to diverse stimuli, including mechanical loads. Much is known about the molecular biology and biochemistry of the deposition and degradation of collagen, the primary structural constituent of the extracellular matrix in many tissues, yet there has been little modeling of the associated mechanobiology. For example, we do not have quantitative descriptions, or rules, for the kinetics of collagen turnover as a function of altered mechanical loading and we do not know what governs the orientation and pre-stretch at which new fibers are incorporated within extant tissue. In this paper, we use a constrained mixture theory for growth and remodeling of planar soft tissues to motivate a new experimental approach for investigating competing hypotheses on, for example, how new collagen is aligned by synthetic cells. In particular, because stress and strain fields can be homogeneous in a central region of a biaxially tested tissue, and because biaxial testing admits diverse protocols wherein equal stresses can be imposed in the presence of unequal strains or stresses can be maintained in the absence of strain, we report simulations that illustrate the potential utility of biaxial culture studies. Finally, we describe the associated design of a computer-controlled system that allows intravital microscopic quantification of collagen density, orientation, and cross-linking at various stages during the adaptation of a native tissue or the development of a tissue engineered equivalent, each subjected to well controlled biaxial loads.

Ruling out pulmonary embolism across different subgroups of patients and healthcare settings: protocol for a systematic review and individual patient data meta-analysis (IPDMA).

BACKGROUND: Diagnosing pulmonary embolism in suspected patients is notoriously difficult as signs and symptoms are non-specific. Different diagnostic strategies have been developed, usually combining clinical probability assessment with D-dimer testing. However, their predictive performance differs across different healthcare settings, patient subgroups, and clinical presentation, which are currently not accounted for in the available diagnostic approaches. METHODS: This is a protocol for a large diagnostic individual patient data meta-analysis (IPDMA) of currently available diagnostic studies in the field of pulmonary embolism. We searched MEDLINE (search date January 1, 1995, till August 25, 2016) to retrieve all primary diagnostic studies that had evaluated diagnostic strategies for pulmonary embolism. Two authors independently screened titles, abstracts, and subsequently full-text articles for eligibility from 3145 individual studies. A total of 40 studies were deemed eligible for inclusion into our IPDMA set, and principal investigators from these studies were invited to participate in a meeting at the 2017 conference from the International Society on Thrombosis and Haemostasis. All authors agreed on data sharing and participation into this project. The process of data collection of available datasets as well as potential identification of additional new datasets based upon personal contacts and an updated search will be finalized early 2018. The aim is to evaluate diagnostic strategies across three research domains: (i) the optimal diagnostic approach for different healthcare settings, (ii) influence of comorbidity on the predictive performance of each diagnostic strategy, and (iii) optimize and tailor the efficiency and safety of ruling out PE across a broad spectrum of patients with a new, patient-tailored clinical decision model that combines clinical items with quantitative D-dimer testing. DISCUSSION: This pre-planned individual patient data meta-analysis aims to contribute in resolving remaining diagnostic challenges of time-efficient diagnosis of pulmonary embolism by tailoring available diagnostic strategies for different healthcare settings and comorbidity. SYSTEMATIC REVIEW REGISTRATION: Prospero trial registration: ID 89366.

Integrated strategies for the diagnosis of venous thromboembolism.

Diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) is an important medical problem because of the high fatality rate from PE and the large number of cases not diagnosed before causing death. Over the last decade, there has been considerable research into the diagnostic process. It is widely accepted that venous ultrasound imaging is an accurate test for the diagnosis of DVT and is the imaging test of choice. For PE, computer tomographic pulmonary angiography (CTPA) is replacing ventilation perfusion lung scanning. Technology for CTPA is rapidly evolving and multi-row detector scans have quite reasonable sensitivity and specificity. Despite the accuracy of imaging tests, the post-test probability of disease is highly dependent on pretest probability. Clinical evaluation tools have developed that enable us to accurately categorize patients' risk prior to diagnostic imaging. One advantage of this characterization is an ability to exclude the diagnosis of DVT or PE if clinical probability is sufficiently low and when the D-dimer is negative. There are now a number of D-dimer assays that have well-defined specificities and sensitivities, which enable use in conjunction with clinical probability. A careful combination of clinical assessment, D-dimer and imaging enables safe PE rule out protocols without imaging, an ability to suspect false positive imaging results, and more accurate determination of true positive imaging. These integration strategies result in safer, more convenient and cost-effective care for patients.

A pilot study of central venous catheter survival in cancer patients using low-molecular-weight heparin (dalteparin) and warfarin without catheter removal for the treatment of upper extremity deep vein thrombosis (The Catheter Study).

BACKGROUND: Central venous catheters in patients with cancer are associated with development of deep vein thrombosis (DVT); however, there is no accepted standard treatment. OBJECTIVES: To assess the safety and effectiveness of a management strategy for central venous catheter-related DVT in cancer patients consisting of dalteparin and warfarin without the need for line removal. PATIENTS/METHODS: Patients older than 18 years of age with an active malignancy and who had symptomatic, acute, objectively documented UEDVT were eligible. Patients were treated with dalteparin 200 IU kg(-1) per day for 5-7 days and warfarin with a target International Normalized Ratio of 2.0-3.0. Patients were followed for 3 months for recurrent venous thromboembolism, major hemorrhage and survival of the central venous catheter. RESULTS: There were 74 patients (48 males). The average age was 58 years. There were no episodes of recurrent venous thromboembolism and three (4%) major bleeds. No lines were removed because of infusion failure or recurrence/extension of DVT. CONCLUSION: Treatment of UEDVTs secondary to central catheters in cancer patients with standard dalteparin/warfarin can allow the central line to remain in situ with little risk of line failure or recurrence/extension of the DVT.

The use and reliability of Tait video analysis in assessing preverbal language skills in profoundly deaf and normally hearing children under 12 months of age.

BACKGROUND: Assessment measures in evaluating preverbal skills and their progress in very young deaf children are lacking. However, their importance is highlighted by the recent trend of implanting children under 1 year of age. Tait video analysis is a technique for assessing preverbal communication behaviours in very young children with hearing impairment and has been found to be strongly related to speech discrimination and intelligibility outcomes post-implantation. AIM: To assess feasibility and inter-user reliability of Tait video analysis in assessing preverbal communication skills in children under 1 year of age. MATERIAL AND METHODS: Ten children (five profoundly deaf and five normally hearing) under 1 year of age were assessed by Tait video analysis. Three observers analysed the samples independently, according to the established protocol. RESULTS: There was complete agreement on 305 judgements and 8 discrepancies between observers over all the measures. Four of the discrepancies occurred in the samples of deaf children and four in the normally hearing samples. Statistical analysis revealed that the correlation coefficients between the different observers were extremely high ranging from 0.94 to 1 (perfect agreement). All of them were found to be statistically significant (p<0.01). CONCLUSION: The very high rate of inter-observer reliability suggests that the video recordings of children under 12 months can be scored consistently, and Tait video analysis is therefore a valid method of monitoring the development of vocal and auditory preverbal skills in very young deaf children, either following cochlear implantation or using acoustic hearing aids.

Net clinical benefit of hospitalization versus outpatient management of patients with acute pulmonary embolism.

Essentials Clinical benefit of hospitalization vs. outpatient treatment in pulmonary embolism (PE) is unknown. We performed a propensity matched cohort study of hemodynamically stable PE patients. Regardless of the risk assessment, hospitalized patients had the highest rate of adverse event. If confirmed, ambulatory care of normotensive PE patients may be preferred whenever possible. SUMMARY: Background The decision to hospitalize or not patients with acute pulmonary embolism (PE) is controversial. Despite the advantages of close monitoring, hospitalization by itself may lead to in-hospital complications and potentially worsen the prognosis of PE patients. Objectives To determine the net clinical benefit of hospitalization vs. outpatient management of normotensive patients with acute pulmonary embolism (PE). Methods Retrospective cohort propensity score analysis (radius marching with replacement). Hemodynamically stable PE patients treated as outpatients or inpatients were matched to balance out differences for 28 patient characteristics and known risk factors for adverse events. The primary outcome was the rate of adverse events at 14 days, including recurrent venous thromboembolism, major bleeding or death. Results Among 1127 eligible patients, 1081 were included in the matched cohort, 576 treated as inpatients and 505 as outpatients. The 14-day rate of adverse events was 13.0% for inpatients and 3.3% for outpatients (adjusted OR, 5.07; 95% CI, 1.68-15.28). The 3-month rate was 21.7% for inpatients and 6.9% for outpatients (OR, 4.90; 95% CI, 2.62-9.17). In the high-risk subgroup (Pulmonary Embolism Severity Index class III-V; n = 597), the 14-day rate of adverse events was 16.5% for hospitalized patients vs. 4.5% for outpatients (OR, 4.16; 95% CI, 1.2-14.35). Conclusion Outpatient treatment of hemodynamically stable PE patients seems to be associated with a lower rate of adverse events than hospitalization and, if confirmed, may be considered as first-line management in patients not requiring specific in-hospital care, regardless of their initial risk stratification, if proper outpatient care can be provided.