Analysis of Hungarian Students’ College Choices

AbstractThe present work is the second in aseries of studies in which we are going to present an unbiased picture on the attractivity of universities. In doing so we confined our study to Hungary, where we have access to all annual application data of students to universities and colleges. Our first study presented an unbiased one-dimensional preference list of higher educational institutions, schools and study programs alongside a bunch of methods to produce such preference lists. In the present work we report on the first results of the second stage of our project in which we investigate students’ choice of further studies. Our database contains more than a million application entries, covers student scores, place of residence, and GDP per capita and employment data of their regions of residence. Similar economic data have been collected about the institutions as well as their indicators of academic excellence. We incorporated into the database the distance between students’ places of residence and colleges as well. Classical and novel econometric methods are used from logistic regression and gravity models to neural networks. The study reveals some common patterns of students’ choices and striking differences between different fields of studies. Among other results it has beenfound that the most preferred place of study is selected with much care while descending on the preference list the choice is less and less sophisticated. To the best of our knowledge this article is one of the few attempts to analyse the behaviour of student mobility: an estimation of the quantitative direct impact of several determinants for student flows

Lung Transplant Rehabilitation—A Review

Background: Both lung transplant recipients and candidates are characterised by reduced training capacity and low average quality of life (QoL). This review investigates the impact of training on exercise ability and QoL in patients before and after lung transplant. Methods: Searches were conducted from the beginning to 7 March 2022 using the terms “exercise,” “rehabilitation,” “lung transplant,” “exercise ability,” “survival,” “quality of life” and “telerehabilitation” in six databases, including Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, CINAHL, Nursing and Allied Health, and Scopus. The inclusion criteria were studies evaluating the effects of an exercise training programme concurrent with lung transplantation as well as patients and candidates (&gt;18 years old) through any lung diseases. The term “lung transplant rehabilitation” was used to refer to all carefully thought-out physical activities with the ultimate or intermediate objective of improving or maintaining physical health. Results: Out of 1422 articles, 10 clinical- and 3 telerehabilitation studies, candidates (n = 420) and recipients (n = 116) were related to the criteria and included in this review. The main outcome significantly improved in all studies. The 6-min walk distance, maximum exercise capacity, peak oxygen uptake, or endurance for constant load rate cycling improved measuring physical activity [aerobic exercises, breathing training, and aerobic and inspiratory muscle training sessions (IMT)]. Overall scores for dyspnoea improved after exercise training. Furthermore, health-related quality of life (HRQOL) also improved after aerobic exercise training, which was performed unsupervised or accompanied by breathing sessions. Aerobic training alone rather than combined with inspiratory muscle- (IMT) or breathing training enhanced exercise capacity. Conclusion: In conclusion, rehabilitation programmes seem to be beneficial to patients both preceding and following lung transplantation. More studies are required to determine the best training settings in terms of time scale, frequency, and work intensity in terms of improving exercise ability, dyspnoea, and HRQOL.</jats:p

Lung Transplant Rehabilitation—A Review

Background: Both lung transplant recipients and candidates are characterised by reduced training capacity and low average quality of life (QoL). This review investigates the impact of training on exercise ability and QoL in patients before and after lung transplant. Methods: Searches were conducted from the beginning to 7 March 2022 using the terms “exercise,” “rehabilitation,” “lung transplant,” “exercise ability,” “survival,” “quality of life” and “telerehabilitation” in six databases, including Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, CINAHL, Nursing and Allied Health, and Scopus. The inclusion criteria were studies evaluating the effects of an exercise training programme concurrent with lung transplantation as well as patients and candidates (>18 years old) through any lung diseases. The term “lung transplant rehabilitation” was used to refer to all carefully thought-out physical activities with the ultimate or intermediate objective of improving or maintaining physical health. Results: Out of 1422 articles, 10 clinical- and 3 telerehabilitation studies, candidates (n = 420) and recipients (n = 116) were related to the criteria and included in this review. The main outcome significantly improved in all studies. The 6-min walk distance, maximum exercise capacity, peak oxygen uptake, or endurance for constant load rate cycling improved measuring physical activity [aerobic exercises, breathing training, and aerobic and inspiratory muscle training sessions (IMT)]. Overall scores for dyspnoea improved after exercise training. Furthermore, health-related quality of life (HRQOL) also improved after aerobic exercise training, which was performed unsupervised or accompanied by breathing sessions. Aerobic training alone rather than combined with inspiratory muscle- (IMT) or breathing training enhanced exercise capacity. Conclusion: In conclusion, rehabilitation programmes seem to be beneficial to patients both preceding and following lung transplantation. More studies are required to determine the best training settings in terms of time scale, frequency, and work intensity in terms of improving exercise ability, dyspnoea, and HRQOL

Abstract W P190: Contrast Transcranial Doppler Detects More Intra and Extra-Cardiac Right-to-Left Shunts than Trans-Esophageal Echocardiogram

INTRODUCTION/OBJECTIVES: Paradoxical embolism is initially evaluated with a contrast trans-thoracic echocardiogram (cTTE), since the more sensitive method of contrast trans-esophageal echocardiogram (cTEE) is also more invasive. An adequate valsalva is essential to raise intra-thoracic pressures, but since the patient is sedated for the procedure, it is not always possible with cTEE. The amount of RLS through a PFO depends on strain rate and duration of the Valsalva maneuver. CTCD is a non-invasive method of detecting RLS that has been shown to be as good as cTEE. The goal of this study was to evaluate whether or not cTCD could be more effective at detecting RLS. MATERIALS AND METHODS: A review and evaluation of medical records and imaging was done on patients with embolic stroke from 2012-2013 at a university affiliated comprehensive stroke center. Patients had embolic stroke and a cTCD to be included. A subgroup of patients who had cTCD also had a cTEE. Patients who were positive for RLS on cTCD were compared with those who had RLS on cTEE. Statistical analysis was performed to determine significance and potential for future complications. RESULTS: A total of 1,033 patient records were reviewed and of those 130 patients (55% women) had embolic stroke and a cTCD, 35 were positive for a RLS based on the presence of microbubbles in the cerebral circulation, and 95 were negative. Of the 35 patients with positive cTCD, 45% (n=16) also underwent cTEE; however, only 44% (n=7) of those had positive results for RLS. Conversely, 56% (n=9) of the patients who were shown to have RLS on cTCD were missed on cTEE (without cardiac septal defects). Of the 95 patients who had negative cTCD, 19 of them also underwent cTEE and all were negative on cTEE. CONCLUSION: Using cTCD to detect microbubbles in cerebral arteries appears to be more reliable and accurate for discovering RLS of intra or extra-cardiac origin. For embolic ischemic strokes, we recommend using cTCD as a first-line study and suggest it should be the new “gold standard”. Randomized, prospective studies should be conducted to further validate this data. </jats:p

Abstract W P53: Hydration After IV tPA Predicts Outcome for Acute Ischemic Stroke: A Substudy of THIRST-O

Background and Objective: Dehydration is potentially a precipitating factor in patients at risk for stroke. Patients who suffer from acute ischemic attacks are warned not to become dehydrated. Early animal models and studies on dehydration were linked to the development of hypercoagulation and thrombus formation. Previous studies have looked deeper into the enzymatic reactions occurring in the coagulation cascade and discovered the role of dehydration in catalyzing thrombus formation. Our objective was to study the effect hydration has on outcomes after IV tPA as a sub-study of our previous work on the Hydration Influence on the Risk of Stroke Outcome (THIRST-O) study. Methods: We reviewed the laboratory findings, clinical exam and overall hydration status of all patients who received IV tPA for the treatment of acute ischemic stroke from 2011-2013 at a university affiliated comprehensive stroke center. SPSS Software Version 22 was used to obtain descriptive statistics with frequencies, and the Spearman’s rho correlation coefficients were determined. Higher BUN/Creatinine ratio and serum osmolarity were used as markers for dehydration and were compared with the NIH Stroke Scale at admission, at 24-hours and discharge. Modified Rankin Scale at discharge (DCmRS) was recorded Results: Of the 1,565 ischemic stroke patients evaluated, 188 received IV tPA, and 162 met study criteria. Patients were mostly female [n=85, 52.7%), with the mean age of 73.4 (SD= 13.6). Patients with higher initial and later serum osmolarity had higher initial, 24-hour and DCNIHSS as well as higher DCmRS (r=.196, r=.207, r=.247, r=.411; p&lt;.01). The initial BUN/Creatinine ratio correlated well with the ratio before discharge (r=.450; p=.0001). Patients with elevated BUN/Creatinine ratios were significantly more likely to have higher initial NIHSS, 24-hour NIHSS, DCNIHSS and DCmRS (r= 235, .216, .324, .431; p&lt;.01). Conclusion: Dehydrated patients with acute ischemic stroke who received IV tPA had significantly worse clinical presentations and outcome. Our study suggests patients who receive IV tPA should be well hydrated for a better outcome. Our data needs to be validated in larger, prospective trials. </jats:p

Abstract W P151: Time is More Brain in Patients with Higher Hemoglobin A1C

Objective: The aim of our study was to determine if chronic hyperglycemia, demonstrated by elevated hemoglobin A1C (HbA1C), had an effect on outcome after IV tPA infusion for acute ischemic stroke. Materials: A comprehensive record review of diabetic patients who received IV tPA with ischemic stroke who presented to a community comprehensive stroke center during a 3-year period (2010-2013) was done. Two groups were made: HbA1C &gt;6% and &lt;6% (Group A &amp; Group B). Each group subdivided into 3 groups based on times from symptom onset to IV tPA: 180 mins. The groups were then compared to establish the number needed to harm (NNH) for IV tPA at different time periods. Harm was considered a worsening in the NIHSS of 3 or more. Mean initial NIH Stroke Scale (INIHSS) and discharge NIHSS (DNIHSS) were determined and 2-tailed t-tests were performed for the outer groups with SPSS V22. Results: A total of 1,565 patients with ischemic stroke were evaluated. Of those, 166 patients met study criteria. There were 100 patients with HbA1C over 6% (mean age 73.4, 55% female). Group A had a mean INIHSS/DNIHSS of 24.5/7.8, 13.3/10.6 and 8.65/8.23 at 180 mins, respectively. The mean change in INIHSS to DNIHSS between the 180 group with Group A was Patients with Group B had mean INIHSS/DNIHSS of 16.5/6.5, 13.23/7.6 and 11.6/6.5. The mean differences between INIHSS and DNIHSS in Group A patients in the 180 min time was 13.2 (95% CI 3.8-22.5, p=.01). The NNH for giving IV tPA to patients with HbA1C &gt;6% versus &lt;6% at different times was: 180= 4.8. For every 10 patients with HBA1C &gt;6% treated with IVtPA, one is harmed. This doubled when IVtPA is given after 180 mins. Conclusion: Compared with patients with HbA1C &lt;6%, patients with HbA1c &gt;6% have a significantly greater chance of suffering a bad outcome and incurring harm. More data needs to be collected with a larger prospective study to draw better conclusions. </jats:p

The RAPID Consortium: A Platform for Clinical and Translational Pituitary Tumor Research.

Objectives  Pituitary tumor treatment is hampered by the relative rarity of the disease, absence of a multicenter collaborative platform, and limited translational-clinical research partnerships. Prior studies offer limited insight into the formation of a multicenter consortium. Design  The authors describe the establishment of a multicenter research initiative, Registry of Adenomas of the Pituitary and Related Disorders (RAPID), to encourage quality improvement and research, promote scholarship, and apply innovative solutions in outcomes research. Methods  The challenges encountered during the formation of other research registries were reviewed with those lessons applied to the development of RAPID. Setting/Participants  RAPID was formed by 11 academic U.S. pituitary centers. Results  A Steering Committee, bylaws, data coordination center, and leadership team have been established. Clinical modules with standardized data fields for nonfunctioning adenoma, prolactinoma, acromegaly, Cushings disease, craniopharyngioma, and Rathkes cleft cyst were created using a Health Insurance Portability and Accountability Act-compliant cloud-based platform. Currently, RAPID has received institutional review board approval at all centers, compiled retrospective data and agreements from most centers, and begun prospective data collection at one site. Existing institutional databases are being mapped to one central repository. Conclusion  The RAPID consortium has laid the foundation for a multicenter collaboration to facilitate pituitary tumor and surgical research. We sought to share our experiences so that other groups also contemplating this approach may benefit. Future studies may include outcomes benchmarking, clinically annotated biobank tissue, multicenter outcomes studies, prospective intervention studies, translational research, and health economics studies focused on value-based care questions