Pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. Obstructive sleep apnea (OSA) is increasingly recognized in the ageing population, especially with the rising obesity epidemic. The impact of OSA on inpatient mortality in PE is not well understood. We used the Nationwide Inpatient Sample databases from 2005 to 2016 to identify 755,532 acute PE patients (age18 years). Among these 61,050 (8.1%) were OSA+. Temporal trends in length of stay (LOS), inpatient mortality and its association with OSA in PE patients were analyzed. The proportion of PE patients who were OSA+ increased from 2005 to 2016. OSA+ PE patients were younger and predominantly men. Despite a higher prevalence of traditional risk factors for inpatient mortality in OSA+ patients, OSA was associated with a lower risk of mortality in PE patients (OR, 95% CI; p: unadjusted 0.56, 0.53-0.58; p<0.0001 and adjusted 0.55, 0.52-0.58; p<0.0001). Overall mortality and LOS in PE patients decreased over time. Relative to OSA- patients, there was a slight increase in mortality among OSA+ PE patients over time, although the LOS remained unchanged between the 2 groups. In conclusion, OSA+ PE patients had a lower inpatient mortality compared to OSA- patients despite a higher prevalence of traditional mortality risk factors. Secondary pulmonary hypertension related to OSA with pre-conditioning of the right ventricle to elevated afterload may potentially explain the protective effect of OSA on mortality in PE. However, mechanistic studies need to further elucidate the links behind this association.

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Racial disparities in management and outcomes of out-of-hospital cardiac arrest complicating myocardial infarction; a national study from England and Wales

Parametric analyses were performed to determine the optimum heat source configuration relative to previously determined selection criteria. Heat source sizes, weights, volumes, material interaction depths, and thermal expansion differentials between the various components were calculated for all candidate designs. These analyses included single-layer, two-layer, and three-layer designs of flat-ended and hemispherically-ended configurations of all material combinations under consideration. Selective and nonselective vent systems were designed to vent the fuel-generated helium from the heat source to retain and/or decay the Radon-220 to levels below the maximum allowable body burdens. The capsule wall thickness required to survive bullet impact, granite impact, and crushing was determined for the various configurations, and the thickness of a selectively-vented capsule required to survive creep due to the internal helium pressure was also determined. Based on these analyses, minimum required wall thicknesses were determined and an optimum design of each material configuration was generated. Forty-three candidate designs were scored against the selection criteria. The recommended system, which is currently being fabricated, is a rightcircular cylinder consisting of a Pt-20Rh liner, a T-111 strength member, a Pt-20Rh clad and a nonselective pressure relief device/capillary tube assembly. The liner and clad are interconnected to seal off the strength member from external contamination.