Shalini Sahoo

BACKGROUND Transcarotid artery revascularization (TCAR) is a hybrid approach to carotid revascularization. There is limited information on differences in periprocedural complications and performance measures of TCAR in men compared to women, and in older compared to younger adults. METHODS Patient, lesion, and physician characteristics were collected on all TCAR procedures performed by each physician worldwide in an international Quality Assurance database between March 3, 2009 and May 7, 2020. Clinical composite (death, stroke, transient ischemic attack, myocardial infarction) and technical composite adverse events (aborted procedure, conversion to surgery, bleeding, dissection, cranial-nerve injury, device failure) within 24 hours of the procedure were recorded. Four performance measures were recorded: flow-reversal time, fluoroscopy time, contrast volume, and skin-to-skin time. Poisson regressions were used to assess the impact of age and sex on clinical and technical composite adverse events. Linear regressions were used to compare the four performance measures. RESULTS 18,240 TCARs were performed by 1,273 physicians; 34.9% of patients were women and 37.5% were symptomatic. Overall clinical and technical composite adverse events were low. Adjusted rates of clinical (1.62% [95% confidence intervals 1.17, 2.23] vs 1.35% [1.01,1.79], p=0.22) and technical (7.84% [6.85, 8.97] vs 7.80% [6.94, 8.77], p=0.93) composite adverse event rates did not vary for women vs men. Adjusted clinical (p=0.65) and technical (p=0.55) composite adverse event rates also did not vary by age. Adjusted skin-to-skin time was shorter in females (76.6 minutes [74.6, 78.6]) vs males (77.7 minutes [75.7,79.6], p=0.002). There were significant differences by age-group for fluoroscopy time, flow-reversal time, and skin-to-skin time, though the magnitude of these differences were small (<1 minute for each). CONCLUSIONS Clinical and technical outcomes of TCAR are not impacted by age or sex. There are clinically minor differences in procedural performance measures by age and sex. In addition to being safe in younger individuals, it may also be a preferred method of performing carotid stenting in women and in older patients, and particularly in older women.

Education and training over the life course or lifelong learning has become critical in the fast-changing U.S. society. Foundation skills (e.g., literacy), motivation, curiosity, as well as access to learning opportunities are essential to promote lifelong learning. Despite the importance of these promoting factors, empirical research focusing on complex relationships between literacy skills, immigration and motivation to learn (MtL) among middle-aged and older adults is scarce. The objective of this study is to examine how literacy skills and immigration (vs. U.S. born) are associated with MtL among middle-aged and older adults in the U.S. Nationally representative data (n = 8,670) of adults aged 45 years and older were obtained from the 2012/2014 Program for International Assessment of Adult Competencies (PIAAC). Structural equation models were constructed to examine the formerly tested and validated latent MtL construct based on four 5-point Likert-type scale items among the sub-...

This study highlighted how particular intersections of personal characteristics were related to Motivation to Learn (MtL) among adults. MtL is a prerequisite for adult education and training participation. However, little is known about MtL across subpopulations due to several methodological limitations. This study developed a national profile of MtL by key subpopulations that are defined by combinations of age, gender, education level, and literacy proficiency in the United States. Data were obtained from 2012/2014/2017 Program for International Assessment of Adult Competencies (PIAAC) restricted use file (N = 8400). The alignment optimization (AO) method was employed to estimate subpopulation means of a PIAAC-based latent MtL construct. Subpopulations with younger age, greater educational attainment, and higher literacy proficiency showed significantly greater MtL.

When introduced to a new procedure, physicians improve their performance and reduce their procedural adverse event rates rapidly during initial cases and then improvement slows, signaling that proficiency has been achieved. Determining when they have acquired proficiency has important implications for procedural innovation, education, credentialing, and patient safety. We analyzed the worldwide experience with transcarotid artery revascularization (TCAR), a hybrid approach to carotid revascularization, to identify 1) procedural performance measures that are associated with clinical and technical adverse events, 2) target levels of performance measures that minimize adverse event rates, and 3) number of TCAR cases needed to achieve the target levels of performance measures. Patient, lesion, and physician characteristics were collected on each TCAR procedure performed by each physician worldwide in an international Quality Assurance database. Four procedural performance measures were recorded for each procedure: flow-reversal time, fluoroscopy time, contrast volume, and total skin-to-skin time. Composite clinical adverse events (transient ischemic attack, stroke, myocardial infarction, or death) and composite technical adverse events (aborted procedure, conversion to surgery, bleeding, dissection, cranial-nerve injury, or device failure), occurring within 24 hours were recorded. Correlations between each performance measure, and clinical and technical adverse event rates, were computed. The inflection points in performance measures were identified, below which there was no further improvement in adverse event rates. The minimum number of TCAR cases required to achieve the target performance measure levels was computed. A total of 18,240 procedures performed by 1,273 physicians were analyzed; 34.9% were women and 62.5% were asymptomatic. Flow-reversal time correlated with clinical adverse events adjusted for age, sex, and symptomatic status (R2=0.91, p<0.0001) and adjusted technical adverse events (R2=0.86, p<0.0001). Skin-to-skin time correlated with adjusted technical adverse events (R2=0.92, p<0.0001). A reduction in flow-reversal times below 13.1 minutes and in skin-to-skin time below 81 minutes did not translate into further improvements in adverse event rates. A minimum of 26 TCAR cases was observed to achieve the target flow-reversal time and a minimum of 15 cases was observed to achieve the target skin-to-skin time. Flow-reversal time and skin-to-skin time are appropriate performance measures for establishing the level of expertise of physicians as they acquire skills to perform TCAR. A target time of ≤13.1 minutes for flow-reversal and 81 minutes for skin-to-skin time minimize adverse event rates. Familiarity with the steps involved in performing TCAR was achieved after performing ≥15 cases, while minimizing clinical adverse events occurred after the performance of ≥26 cases.

Lifelong learning or continuing education over the life course has become necessary to navigate a rapidly changing technological landscape. Motivation to learn (MtL) is essential for facilitating lifelong learning. In the U.S., most of the educational opportunities are available in English. Moreover, little is known about associations between being multilingual and MtL across the life stages. This study analyzed nationally representative data from the 2012/2014/2017 Program for International Assessment of Adult Competencies (PIAAC) restricted use file (RUF). Using a previously established latent MtL construct, structural equation models were estimated by four age groups --- 25-34 (n = 2,310); 35-44 (n = 1,610); 45-54 (n = 1,670); and 55 and older (n = 2,620). Results showed that being multilingual was associated with greater MtL among younger age groups, including age 25-34 (b = 0.20, p = 0.01) and 35-44 (b = 0.28, p < 0.001), after adjusting for the demographic, socioeconomic an...

Continuing adult education and training, or lifelong learning, has become increasingly important to fully engage in rapidly changing technology and information-rich societies. However, without motivation to learn (MtL), lifelong learning participation is unlikely to occur. Although previous research has identified lifelong learning gaps by various demographic characteristics, including age, gender, and race/ethnicity, little is known about the intersectionality or differences in MtL across specific sub-groups (e.g., older Black women vs. older Black men) at the national level. The current study analyzed U.S. data from the 2012/2014/2017 Program for International Assessment of Adult Competencies (PIAAC) to examine MtL at the intersections of age (five 10-year age groups), gender (women vs. men), and race (White vs. Black). The previously established 4-item latent MtL construct was evaluated for twenty sub-groups using the alignment optimization method, which is a machine learning alg...

Literacy skills use in everyday life is associated with social (e.g., civic participation) and economic (e.g., higher wages) benefits throughout the life course. Yet, the use of literacy skills may be lower among immigrants and those with limited language proficiency. No prior research examined associations between bilingualism in early life — a critical period for language acquisition — English literacy skills, and the use of literacy skills in later life of Hispanic adults. The objective of this study is to determine whether lifelong bilingualism (i.e., learning a second language in childhood and still understanding today) is associated with Hispanics’ everyday use of literacy skills later in life. Nationally representative data (n = 412) of Hispanics 35 years and older were obtained from the 2012/2014 Program for International Assessment of Adult Competencies (PIAAC). A series of logistic regression models were used to examine the associations between lifelong bilingualism and se...

Research on factors associated with motivation to learn (MtL) is limited, particularly among middle-aged adults and immigrants. This study examines educational attainment, literacy skills, and nativity (foreign-born vs. native-born) as predictors of MtL in middle-aged adults living in the United States. Nationally representative data of middle-aged adults between the ages of 40 and 65 years were obtained from the 2012/2014 Program for International Assessment of Adult Competencies (PIAAC). Structural equation models were used to assess the validity of the latent MtL construct and to examine the associations with the selected determinants in middle-aged adults. Postsecondary education degrees and higher literacy skills were linked with greater MtL. However, foreign-born individuals had lower MtL than their US-born counterparts. Educators and researchers should be aware of lower educational attainment, limited literacy skills, and being an immigrant as possible demoting factors of MtL...

Email is one of the most common and useful online communication tools. However, older adults tend to have difficulties fully taking advantage of email. Organizing the information in the email software environment and sending a message to selected recipients are examples of common email-related problem-solving. To date, little data are available to understand the email-related problem-solving behaviors of older adults. Nationally representative survey data and log-file data of the U.S. adults (n = 1,341) are derived from the 2012 Program for International Assessment of Adult Competencies (PIAAC), which provides computer-based assessment data on problem-solving skills. The PIAAC respondents used the computer device and solved the problems in the simulated email environment. Descriptive summary showed that those 55 years and older took longer (169 seconds), referred to the help menu (15%) and used the cancel button (26%) more often than younger age groups (e.g., age 25-34; 103 seconds,...

Middle-aged and older men are less likely than women to participate in adult education and training (AET) outside of their work. AET is known to provide psychological, social and economic (e.g., job-related skills) benefits throughout the life course. Research has shown that motivation to learn (MtL) is the key to promoting AET. The objective of this study is to identify MtL predictors among middle-aged and older men in the U.S. Nationally representative data (n = 1,450) of men aged 45 years and older were obtained from the 2012/2014 Program for International Assessment of Adult Competencies (PIAAC). Structural equation models were constructed to examine how a latent MtL construct measured by four 5-point Likert-type itemsMtL might be predicted by participant characteristics. Results showed that having a postsecondary degree (vs. high school or less; b = 0.19, p < 0.05), higher literacy skills (0-500 points; b = 0.01, p < 0.05), at least one parent/guardian with a postsecondar...

Online platforms, which are often in English, have become a common source of health information. Accordingly, language skills have been shown to be important for health information-seeking. In the United States, the use of online health information is generally low among Hispanics, particularly those with limited English proficiency. What is less clear, however, is how different measures of English proficiency may be linked to online health information seeking in later life. This study examines the associations between language spoken at home, literacy skills, and online health information seeking among middle age and older Hispanics in the U.S. Data of Hispanic adults aged 40 years and older (n = 315) come from the 2012/2014 Program for International Assessment of Adult Competencies (PIAAC). We used binary logistic regression models with complex sampling weights to examine online health information seeking as a function of primary language use at home (Spanish vs. English) and lite...

Health information plays a critical role for health promotion and maintenance in later life. While health information seeking is primarily driven by need (e.g., health), significantly less is known about the roles of education and health-literacy. Thus, we examine complex pathways that link health information seeking behaviors with education and health literacy (decomposed into general literacy and numeracy), and how these pathways differ by health status among a nationally representative sample of Americans age 50 and older (n = 2,750). Data come from the 2012/2014 Program for International Assessment of Adult Competencies. Multi-group structural equation models were used to examine the use of eight health information sources (newspapers, magazines, internet, radio, TV, books, friends/family, and health professionals) by health status (good vs. poor). Findings showed that literacy and numeracy are significant mediators of the relationship between education and health professional a...

The objective of this study is to examine the associations between the motivation to learn, basic skills (i.e., literacy and numeracy), and organized formal and non-formal adult education and training (AET) participation among middle-aged and older adults in the U.S. Rapid technological advancement and globalization requires that adults engage in lifelong learning to actively participate in society. However, little is known about the roles of motivation to learn and basic skills in AET participation among aging adults in the U.S. We obtained restricted data from the 2012/2014 Program for International Assessment of Adult Competencies, and included adults aged 50 years and older (n = 2,580) in the analysis. Structural equation models were used to examine (1) any AET, (2) formal AET and (3) non-formal AET participation as a function of the latent construct of motivation to learn, literacy and numeracy scores (0 – 500), and covariates. Per the confirmatory factor analysis, the motivati...

Routine cancer screening is widely recognized as an effective strategy for reducing cancer mortality – the second leading cause of death in the U.S. Research shows cancer screening rates need to be improved, and men are less likely to uptake recommended screening than women. Cancer screening requires an array of tasks such as seeking up-to-date guidelines, making appointments, planning a hospital visit, and communicating with health care professionals in the complex health care systems. Importantly, modern health care systems are rapidly adopting technology such as web-based applications for information dissemination and communication with patients. This current study is designed to better understand the roles of problem-solving skills in the technology-rich environment (PSTRE) in two selected cancer screening behaviors among middle-aged and older men. We obtained nationally representative data with a sophisticated PSTRE assessment from the 2012/2014 Program for the International As...

Automation and advanced technologies have increased the need for a better understanding of the skills necessary to have a globally competitive workforce. This study used data from the Program for the International Assessment of Adult Competencies to compare problem-solving skills in technology-rich environments among adults in South Korea, Germany, Singapore, Japan, Canada, Estonia, the United Kingdom, the United States, and Australia. Overall, the United States had the lowest scores among all countries, and in all countries scores declined with age. The United States had higher proportions of survey participants in the lowest skill category and lower proportions in the top-skill categories. The results of this study suggest changes in the U.S. educational and lifelong learning systems, and policies may be necessary to ensure all adults have the necessary skills in a competitive workforce.