Background. We examined the effect of cold ischemic interval on modern outcomes to determine whether advances in patient management have made an impact.Methods. Using the United Network of Organ Sharing database, we reviewed adult heart transplants between January 2000 and March 2016. We divided donor age into terciles: younger than 18 years, 18 to 33 years, and 34 years and older. Within each tercile, transplants were divided by cold ischemic interval of less than 4 hours, 4 to 6 hours, and more than 6 hours. Survival curves were compared between cold ischemic interval categories within each tercile. Covariate-adjusted and donor age-stratified Cox proportional hazards regression models were used to estimate overall mortality and graft failure hazards ratios.Results. Of 29,192 transplants, no significant differences between cold ischemic interval groups in survival or graft failure were apparent in the group aged younger than 18. For donors older than 18, significant differences were found for survival and graft failure with cold

IMPORTANCE A high cesarean delivery rate in US hospitals indicates the potential overuse of this procedure; however, underlying causes of the excessive use of cesarean procedures in the US have not been fully understood. OBJECTIVE To investigate the association between the probability of cesarean delivery at the patient-level and profit per procedure from cesarean deliveries. DESIGN, SETTING, AND PARTICIPANTS This observational, cross-sectional study used a nationally representative sample of hospital discharge data from women at low risk for cesarean birth who delivered newborns between 2010 and 2014 in the US. Data were gathered from the Nationwide Readmissions Database from the Healthcare Cost and Utilization Project, compiled by the Agency for Healthcare Research and Quality. Data cleaning and analyses were conducted between August 2019 and May 2020. EXPOSURES Hospital-level median value of profits from cesarean deliveries, defined as the difference between the charge and the cost for cesarean delivery calculated for each hospital. MAIN OUTCOMES AND MEASURES Our primary outcome was the individual-level probability of undergoing a cesarean delivery. We examined the association with the hospital-level median value of profits per procedure for cesarean delivery (defined as the difference between the charge and the cost for cesarean delivery) using hierarchical regression models adjusted for patient and hospital characteristics and year-fixed effects. RESULTS A total of 13 215 853 deliveries were included in our analyses (mean [SE] age, 27.4 [0] years), of which 2 202 632 (16.7%) were cesarean deliveries. After adjusting for potential confounders, pregnant women were more likely to have a cesarean birth when they delivered at hospitals with higher profits per procedure from cesarean deliveries. Women cared for at hospitals with the highest (adjusted odds ratio, 1.08; 95% CI, 1.02-1.14; P = .005) and second-highest profit quartiles (adjusted odds ratio, 1.07; 95% CI, 1.02-1.13; P = .007) had higher probabilities of a cesarean delivery compared with those cared for at hospitals in the lowest profit quartile. CONCLUSIONS AND RELEVANCE In this cross-sectional study of US nationally representative hospital discharge data, hospitals with higher profits per cesarean procedure were associated with an increased probability of delivering newborns through cesarean birth. These findings highlight the potential influence financial incentives play in determining a high cesarean delivery rate in the US.

Purpose: To characterize plant-based dietary practices and examine their relationship with body mass index (BMI) in Hispanic/Latino Seventh-day Adventists (SDA). Design: Cross-sectional analyses of data among Hispanics/Latinos in the Adventist Health Study-2 (AHS-2). Setting: The AHS-2 is a cohort of SDA adults (n = 96 592) in North America. Participants: A total of 3475 Hispanics/Latinos who provided demographic, dietary, anthropometric, and lifestyle data at enrollment. Measures: Plant-based dietary practices were determined from food frequency questionnaire; BMI, demographic, and lifestyle data were assessed by questionnaire. Analysis: In linear regression analysis, plant-based diets were modeled as dummy variables with nonvegetarian as the referent group and log(BMI) as the outcome adjusted for age, sex, education, exercise, nativity, alcohol use, smoking, and energy intake. Results: We identified 202 vegans, 664 vegetarians, 409 pesco-vegetarians, 227 semi-vegetarians, and 1973 nonvegetarians. Compared to the nonvegetarian referent (BMI = 27.50), estimated BMI were lower among vegans (23.58, P < .0001), vegetarians (25.24, P < .0001), pesco-vegetarians (26.36, P = .0002), and semi-vegetarians (26.69, P = .130). Other factors associated with lower BMI were being female ( P = .001), nativity (Mexico, P = .002; South America, P < .0001; Caribbean, P = .004), having a college degree or higher ( P = .01), exercise ( P < .0001), and never smoked ( P = .0006). Conclusion: Hispanic/Latino SDAs who consumed plant-based diets had lower BMI than nonvegetarians. The application of a plant-based diet as practiced by the Hispanic/Latino Adventists in this population may have public health impact on US Hispanic/Latinos.

INTRODUCTION Systematic analyses of workplace smoking cessation programs indicate that efficacy can be enhanced by using incentives. There is variation in the type of incentives used and their effect on participation and efficacy. The aim of our study was to examine whether lowering employee health plan costs (employee contributions, co-pays) encourage employee smokers to participate in workplace smoking cessation. METHODS We conducted a 2014-2015 prospective cohort study of 415 employee smokers of Loma Linda University Health (LLUH). The employees were offered participation in a workplace smoking cessation program (LLUH BREATHE Initiative) with the incentive of enrollment in an employer-provided health plan that had a 50% lower employee monthly contribution and co-payment relative to the employer-provided health plan for non-participants. Participation rates and variables associated with participation were analyzed. RESULTS In the LLUH BREATHE cohort, we found a very high rate of participation (72.7%; 95% CI: 69-77%) in workplace smoking cessation that was encouraged by a lower out-of-pocket health plan cost for the participating employee and/or spouse. Participation did, however, vary by gender and spouse, whereby female employee households with a qualifying smoker were more than two times more likely (employee: OR=2.89, 95% CI: 1.59-5.24; or spouse: OR=2.71, 95% CI: 1.47-5.00) to participate in smoking cessation than male employee households. The point prevalence, at four months, of abstinence from smoking among the participants was 48% (95% CI: 42-54%). CONCLUSIONS Our findings indicate that a workplace smoking cessation program that uses a novel reward-based incentive of lower out-of-pocket health plan costs results in a participation rate that is much higher than US norms.