First-year follow-up costs of myocardial infarction management in Poland from the payer's perspective.

BACKGROUND: Myocardial infarction (MI) remains a major burden for healthcare systems. Therefore, we intended to analyze the determinants of cost management of patients hospitalized for MI in Poland. METHODS: Data on patients hospitalized and discharged with the diagnosis of acute MI were derived from the public payer claims database. Adult patients, reported between October 1, 2017 and December 31, 2019, were included. Costs of hospitalization for acute MI and cumulative one-year follow-up were analyzed. RESULTS: The median (IQR) of the total direct cost was €3804.7 (2674.1-5712.7) per patient and 29% (€1113.6 [380.5-2490.4]) of these were costs related to the use of post-hospitalization healthcare resources. The median cost of cardiovascular disease management was €3624.7 (2582.1-5258.5), and 26% of this sum were follow-up costs. The analysis of the total cost for individual years showed a slight increase in median costs in subsequent years: €3450.7 (2407.8-5205.2) in 2017, €3753.8 (2642.6-5681.9) in 2018, and €3944.9 (2794.8-5844.4) in 2019. Male sex, heart failure, atrial fibrillation, diabetes, kidney disease, chronic obstructive pulmonary disease, and history of stroke in addition to hospitalization in a department other than cardiology or internal disease were independently related to the cost of MI patient management. CONCLUSIONS: The high cost of management of MI patients was independently related to sex, heart failure, atrial fibrillation, diabetes, kidney disease, chronic obstructive pulmonary disease, and history of stroke as well as hospitalization in other than cardiology or internal disease department.

High in-hospital mortality and prevalence of cardiogenic shock in patients with ST-segment elevation myocardial infarction and concomitant COVID-19.

Introduction: Published data suggest worse outcomes in acute coronary syndrome (ACS) patients with concomitant coronavirus disease (COVID-19) due to delays in standard management caused by burdened healthcare. Aim: To report the demographics, angiographic findings, and in-hospital outcomes of COVID-19 ST-elevation myocardial infarction (STEMI) patients and to compare these with the non-COVID-19 cohort hospitalized during the same period with the same access to medical care. Material and methods: From October 23rd, 2020 to April 23rd, 2021 (exactly 6 months) data were collected into a prospective ACS Registry. STEMI patients underwent invasive coronary angiography and were tested for COVID-19. Outcomes were in-hospital mortality and prevalence of cardiogenic shock. Results: 125 patients, of whom 25 were COVID-19 positive, were admitted to the cardiology ward, and completed their hospital stay (i.e. discharge or death). There were no differences with regard to the time from symptom onset to reperfusion (median (Q1-Q3); 165 (130-202) vs. 170 (123-210), p = 0.86) and door-to-balloon time between the compared groups (25 (21-35) vs. 29 (21-59), p = 0.26). There was a higher GRACE risk score and mortality in the COVID-19 positive patients (180 (154-226) vs. 155 (132-181) and 48% vs. 10%, respectively, both p < 0.0001). Cardiogenic shock occurred more often in this group (32% vs. 13%; p = 0.035). COVID-19 positive patients had elevated high-sensitivity C-reactive protein (hsCRP) (p < 0.0001) and D-dimer (p = 0.003) and reduced left ventricular ejection fraction (p = 0.037). Postprocedural TIMI 3 flow grade was observed less frequently in this group (p = 0.044). Conclusions: High in-hospital mortality in patients with STEMI and COVID-19 did not result from delays in standard management, and could be related to increased thrombogenicity.

Analysis of the Territorial Vocalization of the Pheasants Phasianus colchicus.

The aim of the study was to assess the impact of the duration of the mating season and the time of day on the parameters of the vocalization pheasants (duration of vocalization, frequency of the sound wave, intervals between vocalizations). In the study, pheasant vocalization recorded in the morning (600-800) and in the afternoon (1600-1800) between April and June 2020 was analyzed. In total, the research material consisted of 258 separate vocalizations. After recognition of the individual songs of each bird, frequency-time indicators were collected from the samples to perform statistical analysis of the recorded sounds. The duration of the first syllable [s], the duration of the second syllable [s], the duration of the pause between the syllables [s], the intervals between successive vocalizations [min], and the peak frequency of the syllables I and II [Hz] were specified for each song. The duration of the syllables and the pauses between the syllables and vocalizations were determined through evaluation of spectrograms. The peak amplitude frequencies of the syllables were determined via time-frequency STFT analysis. Statistically significant differences in the distributions of the values of all variables between the analyzed months were demonstrated. The longest duration of total vocalization and the shortest time between vocalizations were recorded in May. Therefore, this month is characterized by the highest frequency and longest duration of vocalization, which is related to the peak of the reproductive period. The time of day was found to exert a significant effect on all variables except the duration of syllable II. The duration of vocalization was significantly shorter in the morning, which indicates that the cooks are more active at this time of day in the study area. The highest peak amplitude frequencies of both syllables were recorded in April, but they decreased in the subsequent months of observation. The time of day was also shown to have an impact on the peak amplitude frequencies, which had the highest values in the morning.

The GRACE risk score in patients with ST-segment elevation myocardial infarction and concomitant COVID-19.

Introduction: Acute coronary syndrome represents a major cause of mortality throughout the world. To date, there are only a few reports of ST-segment elevation type 1 myocardial infarction in patients with COVID-19. The aim of this study was to describe the clinical and angiographic characteristics alongside the prediction of in-hospital mortality using the GRACE risk score in this group. Material and methods: This was a single-center, retrospective study of consecutive patients admitted to a multi-specialist hospital with confirmed ST-segment elevation myocardial infarction (STEMI) and treated with primary percutaneous coronary intervention. Demographic, clinical and angiographic characteristics were compared between survivors and non-survivors. Results: Twenty-five patients, of whom 23 (92%) were men, with confirmed STEMI and COVID-19, with a median age of 70 years and high comorbidity burden, were included in this study. They were treated with percutaneous coronary intervention and 12 (48%) of them died. Non-survivors had elevated high-sensitivity C-reactive protein (hsCRP) (p = 0.026) and D-dimer (p = 0.042) and reduced left ventricular ejection fraction (30 ±9 vs. 41 ±7; p = 0.003). Postprocedural TIMI 3 flow grade was less frequently observed in this group (p = 0.039). There was a higher GRACE score in the non-survivor group (mean ± SD; 210 ±35 vs. 169 ±42, p = 0.014). In ROC analysis, GRACE score predicted in-hospital death with an AUC of 0.788 (95% CI: 0.6-0.98, p = 0.014). A score of 176 was identified as the optimal cut-off with a sensitivity of 92% and specificity of 69%. Conclusions: The GRACE risk score is a good predictor of in-hospital mortality in patients presenting with STEMI with concomitant COVID-19.

Prothrombotic fibrin clot properties are associated with post-discharge venous thromboembolism in acutely ill medical patients.

INTRODUCTION: Reduced clot permeability and lysability have been reported in patients who experienced venous thromboembolism (VTE) following lower limb injury despite pharmacological thromboprophylaxis. We hypothesized that similarly altered fibrin clot properties characterize patients with post-discharge VTE despite thromboprophylaxis during prior hospitalization due to acute medical illnesses. METHODS: In a case-control study, we assessed 48 patients who developed VTE within 4 weeks post-discharge despite pharmacological thromboprophylaxis during hospitalization (the thromboprophylaxis group) and three age- and sex-matched control groups (n = 48 each): (1) patients who developed VTE following hospitalization without pharmacological thromboprophylaxis (the no-thromboprophylaxis group), (2) patients with unprovoked VTE and (3) individuals without history of VTE (the no-VTE group). Blood samples were obtained following ≥3 months of anticoagulation in VTE patients. Fibrin clot properties, thrombin generation and fibrinolysis activators and inhibitors were assessed. RESULTS: Compared with the no-VTE group, the thromboprophylaxis group formed denser fibrin networks reflected by lower clot permeability (Ks, -13%) and impaired fibrinolysis, as evidenced by prolonged clot lysis time (CLT, +14%) and lower rate of D-dimer release from clots (D-Drate, -9%) accompanied by elevated high-sensitivity C-reactive protein (hsCRP, +79%), peak thrombin generation (+55%) and α2-antiplasmin (+10%, all p < 0.05). Similar fibrin clot features were observed following unprovoked VTE. The thromboprophylaxis group had also lower Ks (-13%), elevated α2-antiplasmin (+18%) and higher peak thrombin generation (+25%, all p < 0.05) as compared with the no-thromboprophylaxis group. CONCLUSIONS: Unfavorably altered plasma clot properties and increased thrombin generation characterize medical patients with post-discharge VTE despite receiving pharmacological thromboprophylaxis during hospitalization for acute conditions.

Energy-Gap Law for Photocurrent Generation in Fullerene-Based Organic Solar Cells: The Case of Low-Donor-Content Blends.

The involvement of charge-transfer (CT) states in the photogeneration and recombination of charge carriers has been an important focus of study within the organic photovoltaic community. In this work, we investigate the molecular factors determining the mechanism of photocurrent generation in low-donor-content organic solar cells, where the active layer is composed of vacuum-deposited C60 and small amounts of organic donor molecules. We find a pronounced decline of all photovoltaic parameters with decreasing CT state energy. Using a combination of steady-state photocurrent measurements and time-delayed collection field experiments, we demonstrate that the power conversion efficiency, and more specifically, the fill factor of these devices, is mainly determined by the bias dependence of photocurrent generation. By combining these findings with the results from ultrafast transient absorption spectroscopy, we show that blends with small CT energies perform poorly because of an increased nonradiative CT state decay rate and that this decay obeys an energy-gap law. Our work challenges the common view that a large energy offset at the heterojunction and/or the presence of fullerene clusters guarantee efficient CT dissociation and rather indicates that charge generation benefits from high CT state energies through a slower decay to the ground state.

Geminate electron-hole recombination in organic photovoltaic cells. A semi-empirical theory.

We propose a semi-empirical theory which describes the geminate electron-hole separation probability in both homogeneous systems and donor-acceptor heterojunction systems applicable in organic photovoltaics. The theory is based on the results of extensive simulation calculations, which were carried out using various lattice models of the medium and different charge-carrier hopping mechanisms, over the parameter ranges typical for organic solar cells. It is found that the electron-hole separation probability can be conveniently described in terms of measurable parameters by a formula whose functional form is derived from the existing recombination theories, and which contains only one empirical parameter. For homogeneous systems, this parameter is determined by the structure of the medium and only weakly depends on the charge-carrier hopping mechanism. In the case of donor-acceptor heterojunction systems, this empirical parameter shows a simple power-law dependence on the product of the dielectric constant and inter-molecular contact distance. We also study the effect of heterojunction structure on the electron-hole separation probability and show that this probability decreases with increasing roughness of the heterojunction. By analyzing the simulation results obtained for systems under the influence of an external electric field, we find that the field effect on the electron-hole separation probability in donor-acceptor heterojunction systems is weaker than in homogeneous systems. We also describe this field effect by a convenient empirical formula.

Temperature scaling of effective polaron mobility in energetically disordered media.

We study effective mobility in 2 dimensional (2D) and 3 dimensional (3D) systems, where hopping transitions of carriers are described by the Marcus equation under a Gaussian density of states in the dilute limit. Using an effective medium approximation (EMA), we determined the coefficient Cd for the effective mobility expressed by µeff∝exp-λ/4kBT-Cdσ(2)/kBT(2)/λ(kBT)(3/2), where λ is the reorganization energy, σ is the standard deviation of the Gaussian density of states, and kBT takes its usual meaning. We found Cd = 1/2 for both 2D and 3D. While various estimates of the coefficient Cd for 3D systems are available in the literature, we provide for the first time the expected Cd value for a 2D system. By means of kinetic Monte-Carlo simulations, we show that the effective mobility is well described by the equation shown above under certain conditions on λ. We also give examples of analysis of experimental data for 2D and 3D systems based on our theoretical results.

Aerobic bacterial microbiota isolated from the cloaca of the European pond turtle (Emys orbicularis) in Poland.

We conducted a comparative analysis of the aerobic cloacal bacteria of European pond turtles (Emys orbicularis) living in their natural environment and juvenile turtles reared under controlled conditions in a breeding center. We included 130 turtles in the study. The aerobic bacteria isolated from the cloaca of the juvenile turtles were less diverse and more prevalent than the bacteria isolated from free-living adults. We isolated 17 bacterial species from juvenile captive turtles, among which the dominant species were Cellulomonas flavigena (77/96), Enterococcus faecalis (96/96), Escherichia coli (58/96), and Proteus mirabilis (41/96). From the adult, free-living turtles, we isolated 36 bacterial species, some of which are a potential threat to public health (e.g., Salmonella enterica serovars Newport, Daytona, and Braenderup; Listeria monocytogenes; Yersinia enterocolitica; Yersinia ruckeri; Klebsiella pneumoniae; Vibrio fluvialis; and Serratia marcescens), and pathogens that are etiologic agents of diseases of ectothermic animals (e.g., Aeromonas sobria, Aeromonas caviae, Hafnia alvei, Edwardsiella tarda, and Citrobacter braakii; the last two species were isolated from both groups of animals). The cloacal bacterial biota of the European pond turtle was characterized by numerous species of bacteria, and its composition varied with turtle age and environmental conditions. The small number of isolated bacteria that are potential human pathogens may indicate that the European pond turtle is of relatively minor importance as a threat to public health.

Diffusion-mediated geminate reactions under excluded volume interactions.

In this paper, influence of crowding by inert particles on the geminate reaction kinetics is theoretically investigated. Time evolution equations for the survival probability of a geminate pair are derived from the master equation taking into account the correlation among all diffusing particles, and the results are compared with those obtained by Monte Carlo simulations. In general, excluded volume interactions by the inert particles slow down the diffusive motion of reactants. However, when the initial concentration of the inert particles is uniform and high, we show that additional influence of interference between reaction and correlated diffusion accelerates the transient decay of the survival probability in the diffusion-controlled limit. We also study the escape probability for a nonuniform initial distribution of the inert particles by taking the continuous limit in space. We show that reaction yield is increased when the reaction proceeds in the presence of a positive density gradient of the inert particles which inhibits the escape of reactants. The effect can be interpreted as a cage effect.

Electron recombination in ionized liquid argon: a computational approach based on realistic models of electron transport and reactions.

In this work, we propose a new theoretical approach to modeling the electron-ion recombination processes in ionization tracks in liquid argon at 87 K. We developed a computer simulation method using realistic models of charge transport and electron-ion reactions. By introducing the concept of one-dimensional periodicity in the track, we are able to model very large cylindrical structures of charged particles. We apply our simulation method to calculate the electron escape probability as a function of the initial ionization density in the track. The results are in quantitative agreement with experiment for radiation tracks of relatively high ionization density. At low ionization densities, the simulation results slightly overestimate the experimental data. We discuss possible reasons for this disagreement and conclude that it can be explained by the role of δ tracks (short tracks of secondary electrons) in electron-ion recombination processes. We introduce an approximate model that takes into account the presence of δ tracks and allows the experimental data obtained from a liquid-argon ionization detector to be reproduced over a wide range of ionization density.

Effects of excluded volume interaction and dimensionality on diffusion-mediated reactions.

The kinetic problem of a diffusion-mediated reaction, in which minority reactants are immobile and majority reactants are mobile, is known as the target problem. The standard theory of the target problem ignores the excluded volume interaction between the mobile reactants. Recently, a new theory of the target problem was proposed where the effect of excluded volume interaction was analytically investigated using a lattice model with prohibited double occupancy of the lattice sites. The results of that theory are approximate and need verification. In this work, we perform Monte Carlo simulations on lattices and use their results to assess the accuracy of the analytical theory. We also generalize our theory to the case of different dimensionality and perform calculations for lattices in one- and two-dimensional systems. The analytical results accurately reproduce the simulation results except in the dilute limit in one dimension. For any dimensions, the decay of the target survival probability is accelerated by the presence of excluded volume interaction.

Accuracies of the empirical theories of the escape probability based on Eigen model and Braun model compared with the exact extension of Onsager theory.

This paper deals with the exact extension of the original Onsager theory of the escape probability to the case of finite recombination rate at nonzero reaction radius. The empirical theories based on the Eigen model and the Braun model, which are applicable in the absence and presence of an external electric field, respectively, are based on a wrong assumption that both recombination and separation processes in geminate recombination follow exponential kinetics. The accuracies of the empirical theories are examined against the exact extension of the Onsager theory. The Eigen model gives the escape probability in the absence of an electric field, which is different by a factor of 3 from the exact one. We have shown that this difference can be removed by operationally redefining the volume occupied by the dissociating partner before dissociation, which appears in the Eigen model as a parameter. The Braun model gives the escape probability in the presence of an electric field, which is significantly different from the exact one over the whole range of electric fields. Appropriate modification of the original Braun model removes the discrepancy at zero or low electric fields, but it does not affect the discrepancy at high electric fields. In all the above theories it is assumed that recombination takes place only at the reaction radius. The escape probability in the case when recombination takes place over a range of distances is also calculated and compared with that in the case of recombination only at the reaction radius.

Dispersive-diffusion-controlled distance-dependent recombination in amorphous semiconductors.

The photoluminescence in amorphous semiconductors decays according to the power law t(-delta) at long times. The photoluminescence is controlled by dispersive transport of electrons. The latter is usually characterized by the power alpha of the transient current observed in the time-of-flight experiments. Geminate recombination occurs by radiative tunneling which has a distance dependence. In this paper, we formulate ways to calculate reaction rates and survival probabilities in the case carriers execute dispersive diffusion with long-range reactivity. The method is applied to obtain tunneling recombination rates under dispersive diffusion. The theoretical condition of observing the relation delta=alpha/2+1 is obtained and theoretical recombination rates are compared to the kinetics of observed photoluminescence decay in the whole time range measured.