bluuebunny/crossref_metadata_2025 huggingface dataset:
Paclitaxel-Coated Balloon vs Uncoated Balloon Angioplasty for Treatment of In-Stent Restenosis in the Superficial Femoral and Popliteal Arteries: The COPA CABANA Trial
Authors: Tepe Gunnar , Schroeder Henrik , Albrecht Thomas , Reimer Peter , Diehm Nicolas , Baeriswyl Jean-Luc , Brechtel Klaus , Speck Ulrich , Zeller Thomas
Published: February 2020

Purpose: To investigate the efficacy and sustainability of drug-coated balloon (DCB) treatment of femoropopliteal in-stent restenosis (ISR). Materials and Methods: An investigator-initiated, prospective, multicenter, 1:1 randomized study enrolled 88 patients for treatment of ISR with DCB (n=47; mean age 68.3±9.6 years; 26 men) or uncoated balloon (n=41; mean age 67.6±10.2 years; 26 men) angioplasty ( ClinicalTrials.gov identifier NCT01594684). Additionally, the protocol provided for an observational arm composed of patients from either randomized arm who experienced recurrent ISR ≥30 days after the index treatment. Redo treatment consisted of 2 DCBs sequentially inflated at the same location (double dose therapy). The majority of patients (66, 78%) had Rutherford category 3 ischemia. The mean lesion length was 140 mm; a third (27, 31%) were total occlusions. The primary endpoint was angiographic late lumen loss (LLL) at 6 months evaluated by an independent core laboratory. Results: Twenty-two patients (7 DCB +15 uncoated) were treated for recurrence with fully overlapping double DCB angioplasty. Six-month LLL was lower after DCB (0.34±1.12 mm) treatment than after angioplasty with an uncoated balloon (1.58±1.10 mm, p<0.001). At the 12-month follow-up, target lesion revascularization (TLR) was performed in 18 (49%) of 37 patients in the uncoated group, 6 (14%) of 43 patients in the single-dose DCB group (p=0.001), and no patients from the recurrent ISR group. At ~2 years after treatment, a remarkable number (14/27, 52%) of TLRs were recorded in the single-dose DCB group. Conclusion: Treatment with DCBs resulted in significantly less 6-month LLL and fewer TLRs up to 24 months than treatment with uncoated balloons. The double dose for treating recurrent ISR did not cause recognizable adverse events or require TLR up to 24 months.
Comparison of the Biomechanical Properties of the Advanta V12/iCast and Viabahn Stent-Grafts as Bridging Devices in Fenestrated Endografts: An In Vitro Study
Authors: Torsello Giovanni Federico , Herten Monika , Müller Markus , Frank André , Torsello Giovanni B. , Austermann Martin
Published: February 2020

Purpose: To compare experimentally the biomechanical properties of the Viabahn Balloon-Expandable Stent Graft (VBX) with the widely used Advanta V12/iCast in the role of bridging stent-grafts for fenestrated endovascular aortic repair. Materials and Methods: Test sheets made of polyester having 2 rows of 5 fenestrations in 6-mm and 8-mm diameters were used to simulate a commercially made fenestrated aortic endograft. In total, 40 stent-grafts measuring 6×39 mm and 8×39 mm (10 of each size for each stent-graft) were implanted in fenestration sheets immersed in a 37°C water bath. After flaring, all stent-grafts were evaluated using microscopy and radiography. Biomechanical evaluation included pullout and the shear stress force testing; results are reported in Newtons (N) as the median (minimum–maximum). Results: After flaring, no damage or fracture to the stent-graft structures were detected. Pullout forces for the 6-mm stent-grafts were 27.1 N (20.0–28.9) for the VBX and 16.6 N (14.7–19.2) for the Advanta (p=0.008). Pullout forces for the 8-mm stent-grafts were 20.1 N (14.8–21.5) for the VBX and 15.8 N (12.4–17.5) for the Advanta (p=0.095). The shear stress forces necessary to dislocate the device at 150% stent diameter displacement was 12.5 N (VBX) vs 14.7 N (Advanta) for the 6-mm devices and 23.3 N (VBX) vs 20.2 N (Advanta) for the 8-mm stents (p>0.99 and p=0.222, respectively). Conclusion: In vitro tests simulating external pull and shear forces on bridging stent-grafts implanted in fenestrations showed that the VBX had resistance to dislocation equivalent to a well-known control device.
Primary Progressive Aphasia Education and Support Groups: A Clinical Evaluation
Authors: Taylor-Rubin Cathleen , Azizi Lisa , Croot Karen , Nickels Lyndsey
Published: February 2020

Objectives:

To evaluate the benefits of a primary progressive aphasia (PPA) education and support session for people with PPA (pwPPA) and their caregivers.

Method:

Thirty-eight individuals (20 pwPPA, 18 caregivers) were invited to participate in the study. Twenty-five individuals (12 pwPPA, 13 caregivers) completed questionnaires before and after an education and support group session provided by a speech pathologist and a clinical psychologist. Seven individuals (2 pwPPA, 5 caregivers) participated in follow-up interviews.

Results:

After one attendance, caregivers reported significant improvement in knowledge of PPA, strategies to manage worry and low mood, and opportunities to meet peers. Themes at interview were reduced feelings of isolation, increased feelings of support, increased knowledge of coping strategies, and improved understanding of PPA. Caregivers who had attended previous sessions reported increased feelings of well-being and support.

Implications:

Primary progressive aphasia education and support group sessions in the postdiagnostic period constitute a valuable component of comprehensive care for PPA.
Conserving Authenticity: Artifact Treatment Choices in Creating the Authentic Environment
Authors: Bryk Nancy E. V.
Published: February 2020

Historic house curators have great responsibility and discretion to create what is perceived as an authentic interior. The curator creates the authentic environment based on a variety of factors including research, messaging, and the creation of a visitor experience. However, there are also choices to be made in conserving artifacts as their appearance affects perceptions of authenticity. This article discusses some case studies in which museum staff wrestled with conservation of original objects, trying to find the right balance between constructing the authentic image, maintaining the integrity of the artifact, supporting the message and meaning of the site, and providing a compelling visitor experience.
Constructions of Authenticity at Scottish Historic House Museums
Authors: Venturini Anna
Published: February 2020

This study investigates how authenticity is perceived and negotiated by curators at a selection of Scottish historic house museums (HHMs). Many HHMs are preserved so as to recreate the dwellings of remarkable historical personalities, thus showcasing a unique blend of period artifacts, replicas, and original objects once in the possession of their inhabitants. Focusing on three different case studies, this research investigates how these authentic museum objects are displayed to and interpreted for the public; how relevant their authenticity is from a curatorial perspective; what are the factors influencing curatorial perceptions of authenticity; and how (or, if) HHMs help visitors negotiating the inauthenticity of replicas and period objects displayed onsite. While most studies have examined constructions of authenticity at tourism sites and in terms of their impact on consumers’ behavior, this work aims to shed light on how museum professionals conceive of authenticity within the under-researched context of HHMs, by discussing the outcomes of interviews with curators at the Robert Burns Birthplace Museum and Cottage (Alloway), Broughton House (Kirkcudbright), and Ellisland Farm (Auldgirth).
Borrowed Notion of Authenticity: Viewing Authenticity of Historic Houses in India using a Western Lens
Authors: Vandrewala Sanaeya
Published: February 2020

Authenticity is considered by UNESCO (The United Nations Educational, Scientific and Cultural Organization) as the link between attributes and Outstanding Universal Value (OUV). It is the ability of a property to truthfully, credibly, and genuinely convey its OUV through the attributes. However, these attributes or values are dependent on the site’s cultural associations and context. Therefore, the concept of authenticity is vague and may be subject to different cultural and social interpretations. Since authenticity is measured in time, there are multiple layers of authenticity which can be interpreted differently with diverse value systems. Since the notion of conservation is European in origin, so is the understanding of authenticity. In the Indian context due to a colonial past, the understanding of heritage protection and conservation with all the associated concepts are a borrowed notion from the Western world. This leads to the dilemma where a Western methodology for values and attributes is applied to assess the authenticity of the historic houses in India, based on which the authenticity of Indian historic houses becomes questionable when compared with international standards.
Telling the Truth in Historic Houses: How Substitutes Can Be Authentic
Authors: Brown Pete
Published: February 2020

Many historic house museums are a hotchpotch of architectural styles, furnishing, and fittings, reflecting the tastes and financial situations of generations of owners, and therefore rarely entirely “genuine” or complete. A few examples have been “frozen” at a point in time and remain an unchanging representation of the lives of the last owners, while others are carefully constructed art installations or pieces of theater. And yet, over centuries, museums have cultivated an aura of authenticity which leads visitors to assume that what we show them is “the real thing,” even if the evidence in front of them suggests the opposite. This case study explores two questions: by allowing historic house visitors to believe that what they are seeing is original (when it is not), are we jeopardizing a relationship based on trust? And conversely, will revealing the truth destroy the aura of realism that attracts our audiences in the first place?
Nursing-led ultrasound to aid in trans-radial access in cardiac catheterisation: a feasibility study
Authors: Williams Trent , Condon Jeremy , Davies Allan , Brown Jennifer , Matheson Lucinda , Warner Thomas , Savage Lindsay , Boyle Andrew , Collins Nicholas , Inder Kerry
Published: February 2020

Background

Trans-radial access is increasingly common for cardiac catheterisation. Benefits include reduced bleeding complications, length of hospital stay and costs.

Aims

To determine the feasibility of implementing a nurse-led ultrasound programme to measure radial artery diameter before and after cardiac catheterisation; to determine radial artery occlusion (RAO) rates, risk factors for RAO and predictors of radial artery (RA) diameter.

Method

A prospective observational cohort study design for 100 consecutive patients undergoing cardiac catheterisation, using RA access. Pre- and post-procedural RA diameter were measured using ultrasound, by specialist nurses trained to do so. Logistic regression analyses were performed to determine risk factors for RAO and predictors of RA diameter with results reported as odds ratios (OR) and 95% confidence intervals (CI).

Results

There were no adverse events, supporting the feasibility of nurse led ultrasound programmes. A 4% ( n = 4) rate of occlusion was observed. Haemostasis device application time of greater than 190 min was a predictor of RAO (OR 3.12, 95% CI 0.31–31). Male gender and height were predictors for a RA diameter of >2.2 mm.

Conclusions

Nurses can lead the assessment of RA occlusion using ultrasound to enhance planning and care, including monitoring compression times to reduce RAO.
Health in the United States: Are Appeals to Choice and Personal Responsibility Making Americans Sick?
Authors: Hook Cayce J. , Rose Markus Hazel
Published: February 2020

The United States suffers high rates of preventable lifestyle disease despite widespread calls for people to take responsibility for their health. The United States also stands out in its rejection of government action to guide industry practices and consumer choices. Why? We examine how deeply rooted cultural narratives about “free choice” and “personal responsibility” infuse policymaking, advertising, media, social norms, and individual attitudes about health in the United States. We argue that these narratives contribute to ill health in the United States: They encourage stress and worry over health, blame and stigmatization of the unhealthy, widened health disparities, and the failure to adopt policies that could save lives. Psychologists can play a major role in expanding narratives about health so that they include the role of personal choice and responsibility but also reflect current science about the physical, social, and cultural drivers of health. These broader narratives can be used to promote a more comprehensive understanding of health and to better inform the design, communication, and implementation of effective health-supportive policies.
Changing faces within the perioperative workforce: New, advanced and extended roles
Authors: Abraham Jenny
Published: February 2020

The operating department like many other areas within healthcare is diversifying its workforce. Several new, advanced and extended roles have been integrated within the team. This article briefly outlines historical and current developments which have influenced the operating department workforce. It focuses on the following: Surgical Care Practitioner, Physician Associate, Anaesthesia Associates formerly known as Physician Assistant in Anaesthesia, Surgical First Assistant, Assistant Theatre Practitioner and Nursing Associates, highlighting the professional regulators, education and training, qualification and continuing professional development requirements.
Respiratory function following major emergency abdominal surgery
Authors: Burcharth Jakob , Ohm Oreskov Jakob , Falkenberg Andreas , Schack Anders , Ekeloef Sarah , Gögenur Ismail
Published: February 2020

The purpose of this study was to evaluate the timewise postoperative respiratory function measured by spirometry and peak flow during the first postoperative week after major emergency abdominal surgery. Patients were tested daily with forced expiratory volume (FEV) and peak flow (PEF) from postoperative day (POD) 1 through to POD7. FEV1, FEV6, FEV1/FEV6 ratio and PEF were analysed by unadjusted linear regression with 95% confidence interval (CI) on mean values for each postoperative day. A total of 35 consecutive patients were included in the study. The FEV at 1 second was 51% of predicted at POD1, which increased to 67% at POD7 (p = 0.005), whereas FEV6 was 55% of predicted at POD1, which increased to 70% at POD7 (p = .008). Respiratory function was not significantly correlated to synchronous pain scores. In conclusion, respiratory function following major emergency abdominal surgery was reduced throughout the first postoperative week irrespective of pain scores.
Fostering patient safety through health policy innovation: A case study of implementation of the WHO Surgical Checklist in the UK
Authors: Shah Reena , Barksfield Richard
Published: February 2020

The need to seek innovative solutions to the delivery of safe, cost effective healthcare has never been so pressing. Against a backdrop of austere financial circumstances, the focus must be on reducing unnecessary expenditure on patients that come to harm during the course of their treatment. This article uses the World Health Organization (WHO) Surgical Safety Checklist and its implementation as an example of effecting cultural change within an established western healthcare system. By embedding a safety culture within the perioperative management of surgical patients the incidence of adverse outcomes and harm can be reduced, rationalising the cost of delivering healthcare and improving the efficiency of healthcare systems. An understanding of health policy as a vehicle to induce cultural change throughout a healthcare organisation is essential if new safety innovations are to be effectively implemented.
Does perioperative use of tranexamic acid in hip fracture patients increase the risk of venous thromboembolism and reduce the need for postoperative transfusions?
Authors: Geddes James , McConaghie Greg
Published: February 2020

Perioperative tranexamic acid use is a popular choice among many surgeons for reducing surgical blood loss and its sequelae. While there is evidence in the literature that tranexamic acid use is effective in reducing blood loss in surgery for patients with hip fractures, there is less information on whether it leads to thromboembolic complications. We undertook a retrospective study in patients with hip fractures at two local hospitals to investigate if there was an increased risk of venous thromboembolism in patients who received tranexamic acid, and whether it reduced perioperative blood loss and the need for transfusion. We found that tranexamic acid used in patients undergoing hip fracture surgery reduced the drop in postoperative haemoglobin and the need for postoperative blood transfusion but was not associated with an increased risk of venous thromboembolism.
Educational data mining using cluster analysis and decision tree technique: A case study
Authors: Križanić Snježana
Published: February 2020

Data mining refers to the application of data analysis techniques with the aim of extracting hidden knowledge from data by performing the tasks of pattern recognition and predictive modeling. This article describes the application of data mining techniques on educational data of a higher education institution in Croatia. Data used for the analysis are event logs downloaded from an e-learning environment of a real e-course. Data mining techniques applied for the research are cluster analysis and decision tree. The cluster analysis was performed by organizing collections of patterns into groups based on student behavior similarity in using course materials. Decision tree was the method of interest for generating a representation of decision-making that allowed defining classes of objects for the purpose of deeper analysis about how students learned.
Diterpenes From the Marine Brown Algae of the Genus Dilophus
Authors: Xia Xue , Li Bo , Hou Yuqin , Zhang Jinrong , Yan Xiaojun
Published: February 2020

Brown algae of the genus Dilophus contain plenty of biologically active secondary metabolites with diverse structures. Excellent progress has been made in the discovery of diterpenes with extensive chemical defense activity from this genus. Most of these diterpenes exhibit significant biological activities, such as antifungal, cytotoxic, and feeding-deterrent activities. In the present review, we summarized diterpenes isolated from the brown algae of the genus Dilophus.
Cross-border social dialogue from the perspective of employers
Authors: Hornung-Draus Renate
Published: February 2020

Social dialogue practices across the world are deeply embedded in the different national socio-economic traditions and legal systems and therefore characterised by great heterogeneity. Cross-border social dialogue has developed mainly in the context of supra-national policy frameworks, which are compatible with the different national traditions and practices and accepted by the relevant actors. Since such frameworks have so far only developed as governmental institutions for social standard-setting, e.g. the International Labour Organisation at a global level and the European Union at a regional level, cross-border social dialogue takes place mainly as cooperation with, and consultation of, social partner organisations with a view to shaping social policy. The central element of social dialogue in the national context - collective bargaining on wages and working conditions - has not been successfully elevated to the cross-national level, because the heterogeneity of national settings has not allowed for the creation of a suitable and universally accepted supra-national framework. Given the increasing importance of social policy at the transnational and global levels and the potential of cross-border social dialogue to improve its quality and acceptance in practice, representative social partner organisations should be given an institutionalised role in all the relevant organisations well beyond the ILO or the EU.
The Fate of Homograft Versus Polytetrafluoroethylene Conduits After Neonatal Truncus Arteriosus Repair
Authors: Seese Laura M. , Turbendian Harma K. , Castrillon Carlos E. Diaz , Morell Victor O.
Published: February 2020

Background:

Despite significant improvement in outcomes with truncus arteriosus (TA) repair, right ventricular outflow tract (RVOT) reconstruction with a right ventricular to pulmonary artery (RV-to-PA) conduit remains a source of long-term reintervention and reoperation. This study evaluated our experience with reintervention in homograft and polytetrafluoroethylene (PTFE) RV-to-PA conduits in neonates.

Methods:

Primary TA repairs from 2004 to 2016 at a single institution were included. Stratification was based on RVOT reconstruction with PTFE or homograft conduit. Primary outcome was operative conduit replacement. Secondary outcomes included the rates and types of catheter-based conduit interventions.

Results:

Twenty-eight patients underwent primary TA repair and 89.3% (n = 25) of them had RVOT reconstruction with a homograft (28.0%, n = 7) or PTFE (72.0%, n = 18) conduit. Rates of reoperation for conduit replacement and catheter-based interventions were similar between those with PTFE and homograft conduits (85.7% vs 72.2%, P = .49 and 57.1% vs 83.3%, P = .11, respectively). Additionally, the median time to conduit replacement and catheter-based conduit interventions were comparable. In multivariable analysis, conduit size, but not conduit type, was a predictor of conduit revision (hazard ratio: 1.66, 95% confidence interval: 1.11-2.49, P = .02). At five-year and ten-year follow-up, patients with PTFE conduits had better survival than those with homograft conduits (100.0% vs 71.4%, P = .02); however, no mortalities were associated with conduit reoperations or catheter-based reinterventions.

Conclusions:

Polytetrafluoroethylene and homograft RVOT reconstruction in neonatal TA repair demonstrate similar durability as defined by reoperation and reintervention rates. The validation of the durability of PTFE conduits in neonatal TA repair requires confirmatory studies in larger cohorts.
Modified Damus-Kaye-Stansel Connection for Systemic Outflow Tract Obstruction After Fontan Operation
Authors: Sinha Lok , Klein Katherine , Ramakrishnan Karthik , Jonas Richard
Published: February 2020

Late systemic outflow tract obstruction following completion of the Fontan palliation is rarely seen and is a difficult problem to treat. Absence of the main pulmonary trunk and pulmonary valve at this stage makes a conventional Damus-Kaye-Stansel connection difficult to achieve. We report the case of a 37-year-old female who underwent Fontan completion as an adult and subsequently presented with systemic outflow tract obstruction. A valved conduit was interposed between the native pulmonary annulus and the ascending aorta to create a modified Damus-Kaye-Stansel type connection.
Passive Peritoneal Drainage Impact on Fluid Balance and Inflammatory Mediators: A Randomized Pilot Study
Authors: Pourmoghadam Kamal K. , Kubovec Stacey , DeCampli William M. , Khallouq Bertha Ben , Piggott Kurt , Blanco Carlos , Fakioglu Harun , Kube Alicia , Narasimhulu Sukumar Suguna
Published: February 2020

Background:

Infants after cardiopulmonary bypass are exposed to increasing inflammatory mediator release and are at risk of developing fluid overload. The aim of this pilot study was to evaluate the impact of passive peritoneal drainage on achieving negative fluid balance and its ability to dispose of inflammatory cytokines.

Methods:

From September 2014 to November 2016, infants undergoing STAT category 3, 4, and 5 operations were randomized to receive or not receive intraoperative prophylactic peritoneal drain. We analyzed time to negative fluid balance and perioperative variables for each group. Pro- and anti-inflammatory cytokines were measured from serum and peritoneal fluid in the passive peritoneal drainage group and serum in the control group postoperatively.

Results:

Infants were randomized to prophylactic passive peritoneal drain group (n = 13) and control (n = 12). The groups were not significantly different in pre- and postoperative peak lactate levels, postoperative length of stay, and mortality. Peritoneal drain patients reached time to negative fluid balance at a median of 1.42 days (interquartile range [IQR]: 1.00-2.91), whereas the control at 3.08 (IQR: 1.67-3.88; P = .043). Peritoneal drain patients had lower diuretic index at 72 hours, median of 2.86 (IQR: 1.21-4.94) versus 6.27 (IQR: 4.75-11.11; P = .006). Consistently, tumor necrosis factor-α, interleukin (IL)-4, IL-6, IL-8, IL-10, and interferon-γ were present at higher levels in peritoneal fluid than serum at 24 and 72 hours. However, serum cytokine levels in peritoneal drain and control group, at 24 and 72 hours postoperatively, did not differ significantly.

Conclusions:

The prophylactic passive peritoneal drain patients reached negative fluid balance earlier and used less diuretic in early postoperative period. The serum cytokine levels did not differ significantly between groups at 24 and 72 hours postoperatively. However, there was no significant difference in mortality and postoperative length of stay.
Atrioventricular Valve Function Predicts Reintervention in Complete Atrioventricular Septal Defect
Authors: Ijsselhof Rinske , Gauvreau Kimberlee , Nido Pedro del , Nathan Meena
Published: February 2020

Objective:

Technical performance score (TPS) has been associated with both early and late outcomes across a wide range of congenital cardiac procedures. A previous study has shown that the presence of residual lesions before discharge, as measured by TPS, is accurately able to identify patients who required postdischarge reinterventions after complete atrioventricular septal defect (CAVSD) repair. The aim of this study is to determine which subcomponents of TPS best predict postdischarge reinterventions after CAVSD repair.

Methods:

This was a single-center retrospective review of patients with CAVSD after repair between January 2000 and March 2016. We assigned TPS (class 1, no residua; class 2, minor residua; class 3, major residua or reintervention before discharge for residua) based on subcomponent scores from discharge echocardiograms. Outcome of interest was postdischarge reintervention.

Results:

Among 344 patients, median age was 3.2 months (interquartile range [IQR], 2.4-4.2). There were 34 (10%) postdischarge reinterventions. Median follow-up was 2.6 years (IQR, 0.09-7.9). Trisomy 21 and concomitant procedure were associated with postdischarge reinterventions. After adjusting for these factors, among the subcomponents, left atrioventricular valve stenosis and regurgitation, right atrioventricular valve regurgitation, residual ventricular septal defect, and abnormal conduction at discharge were significantly associated with postdischarge reinterventions.

Conclusions:

We demonstrated the ability of TPS to predict postdischarge reinterventions in patients who underwent CAVSD repair. Residual left and right atrioventricular valve regurgitation and abnormal conduction at discharge were among the subcomponents strongly associated with postdischarge reinterventions. Thus, TPS may aid clinicians in identifying children at higher risk for reintervention.
Surgical Management of Heterotaxy Syndrome: Current Challenges and Opportunities
Authors: Alongi Ashlyn M. , Kirklin James K. , Deng Luqin , Padilla Luz , Pavnica Jozef , Romp Robb L. , Mauchley David C. , Cleveland David C. , Dabal Robert J.
Published: February 2020

Introduction:

Heterotaxy syndrome presents a unique challenge in surgical management, even in the current era. We hypothesized that certain anatomic subsets merit novel strategies.

Methods:

We analyzed morphologic details, surgeries, comorbidities, subsequent admissions, and survival using Kaplan-Meier methods and multivariable risk models from a single-institution experience of 103 consecutive patients with heterotaxy who underwent cardiac surgery between January 1, 1990, and May 31, 2016.

Results:

Of the 103 patients (50 males and 53 females), 31 had left atrial isomerism, 64 had right atrial isomerism (RAI), and 8 patients’ isomerism was indeterminate (IND), with first cardiac operation at a mean 1.0 year (standard deviation ±3.0 years) of age. Kaplan-Meier overall survival estimate was 83.1% at six months, 77.8% at one year, 65.9% at five years, and 52.1% at ten years. Survival was particularly low among RAI following repair of total anomalous pulmonary venous connection (TAPVC) at first operation, with one- and five-year survival of 57% and 46%, respectively. By multivariable analysis, the only risk factor for death during the early phase (hazard model) was repair of TAPVC at the first cardiac operation (hazard ratio [HR]: 4.4, P = .01), and risk factors during the longer term constant phase were atrioventricular valve (AVV) regurgitation (HR: 4.2, P < .01), male gender (HR: 3.7, P < .01), and two-ventricle repair (HR: 3.0, P = .02). Patients with heterotaxy undergoing the Fontan procedure had excellent subsequent survival (85% at ten years).

Conclusions:

This analysis of over 100 patients with heterotaxy identified TAPVC requiring initial repair as the major risk factor for early death and important AVV regurgitation as the major risk factor in the longer term. Survival with RAI and early repair of TAPVC were poor, with one-year mortality exceeding 40%. Patients with single ventricle completing the Fontan operation enjoyed outstanding ten-year survival (85%). Initial management of RAI requiring early repair of TAPVC remains challenging. For this high-risk subset, alternative strategies such as early referral for cardiac transplantation evaluation warrant consideration.
Beyond 30 Days: Analysis of Unplanned Readmissions During the First Year Following Congenital Heart Surgery
Authors: Lushaj Entela B. , Hermsen Joshua , Leverson Glen , MacLellan-Tobert Susan G. , Nelson Kari , Amond Kate , Anagnostopoulos Petros V.
Published: February 2020

Objective:

We investigated the incidence and etiologies for unplanned hospital readmissions during the first year following congenital heart surgery (CHS) at our institution and the potential association of readmissions with longer term survival.

Methods:

We retrospectively reviewed 263 patients undergoing CHS at our institution from August 2011 to June 2015. Scheduled readmissions were excluded.

Results:

Seventy patients accrued a total of 120 readmissions (1.7 readmission/patient) within one year after surgery. The first readmission for 57% of the patients was within 30 days postdischarge. Twenty-two patients were first readmitted between 31 and 90 days postdischarge. Eight patients were first readmitted between 90 days and 1 year postdischarge. Median time-to-first readmission was 21 days. Median hospital length of stay at readmission was two days. Causes of 30-day readmissions included viral illness (25%), wound infections (15%), and cardiac causes (15%). Readmissions between 30 and 90 days included viral illness (27%), gastrointestinal (27%), and cardiac causes (9%). Age, STAT category, length of surgery, intubation, intensive care unit, and hospital stay were risk factors associated with readmissions based on logistic regression. Distance to hospital had a significant effect on readmissions ( P < .001). Patients with higher family income were less likely to be readmitted ( P < .001). There was no difference in survival between readmitted and non-readmitted patients ( P = .68).

Conclusions:

The first 90 days is a high-risk period for unplanned hospital readmissions after CHS. Complicated postoperative course, higher surgical complexity, and lower socioeconomic status are risk factors for unplanned readmissions the first 90 days after surgery. Efforts to improve the incidence or readmission after CHS should extend to the first 3 months after surgery and target these high-risk patient populations.
Pulmonary Valve Endocarditis: The Potential Utility of Multimodal Imaging Prior to Surgery
Authors: Corey Kristin M. , Campbell Michael Jay , Hill Kevin D. , Hornik Christoph P. , Krasuski Richard , Barker Piers C. , Jaquiss Robert D. B. , Li Jennifer S.
Published: February 2020

Background:

The presence of echocardiographic (echo) evidence is a major criterion for the diagnosis of infective endocarditis (IE) by modified Duke criteria. Pulmonary valve (PV) IE, however, can be challenging to identify by echo. We sought to evaluate the added utility of multimodal imaging in PV IE.

Methods:

This is a single-center case series. We retrospectively analyzed demographic, laboratory, imaging, clinical, and surgical data from patients diagnosed with PV IE from 2008 to 2018.

Results:

A total of 23 patients were identified with definite PV IE by Duke criteria (83% male and ages 2 months to 70 years). Twenty-two patients had congenital heart disease, with 21 involving the right ventricular outflow tract (including three with transcatheter PV implant). Overall, 20 (87%) of 23 had positive blood cultures. A total of 17 (74%) of 23 patients demonstrated echo evidence of PV IE. In three cases, echo was negative (did not show vegetations) but showed new PV obstruction. In four cases with negative transthoracic echocardiogram and transesophageal echocardiogram, evidence of PV IE was subsequently seen by positron emission tomography/computed tomography (n = 2) or cardiac magnetic resonance imaging (n = 2). Pulmonary valve IE was confirmed at surgery by evaluation of pathologic samples in 20 cases.

Conclusions:

Multimodal imaging improves the ability to preoperatively identify endocardial involvement in PV IE in cases where echo is negative. Consideration should be given to revise Duke criteria to include new obstruction and endocardial involvement by multimodal imaging for PV IE.
Postoperative Complication Burden, Revision Risk, and Health Care Use in Obese Patients Undergoing Primary Adult Thoracolumbar Deformity Surgery
Authors: Varshneya Kunal , Pangal Dhiraj J. , Stienen Martin N. , Ho Allen L. , Fatemi Parastou , Medress Zachary A. , Herrick Daniel B. , Desai Atman , Ratliff John K. , Veeravagu Anand
Published: February 2020

Study Design:

This is a retrospective cohort study using a nationally representative administrative database.

Objective:

To identify the impact of obesity on postoperative outcomes in patients undergoing thoracolumbar adult spinal deformity (ASD) surgery.

Background:

The obesity rate in the United States remains staggering, with approximately one-third of all Americans being overweight or obese. However, the impact of elevated body mass index on spine surgery outcomes remains unclear.

Methods:

We queried the MarketScan database to identify patients who were diagnosed with a spinal deformity and underwent ASD surgery from 2007 to 2016. Patients were then stratified by whether or not they were diagnosed as obese at index surgical admission. Propensity score matching (PSM) was then utilized to mitigate intergroup differences between obese and nonobese patients. Patients <18 years and those with any prior history of trauma or tumor were excluded from this study. Baseline demographics and comorbidities, postoperative complication rates, and short- and long-term reoperation rates were determined.

Results:

A total of 7423 patients met the inclusion criteria of this study, of whom 597 (8.0%) were obese. Initially, patients with obesity had a higher 90-day postoperative complication rate than nonobese patients (46.1% vs 40.8%, P < .05); however, this difference did not remain after PSM. Revision surgery rates after 2 years were similar across the 2 groups following primary surgery (obese, 21.4%, vs nonobese, 22.0%; P = .7588). Health care use occurred at a higher rate among obese patients through 2 years of long-term follow-up (obese, $152 930, vs nonobese, $140 550; P < .05).

Conclusion:

Patients diagnosed with obesity who underwent ASD surgery did not demonstrate increased rates of complications, reoperations, or readmissions. However, overall health care use through 2 years of follow-up after index surgery was higher in the obesity cohort.
Biomechanical Evaluation of a Novel Loop Retention Mechanism for Cortical Graft Fixation in ACL Reconstruction
Authors: Götschi Tobias , Rosenberg George , Li Xiang , Zhang Chen , Bachmann Elias , Snedeker Jess G. , Fucentese Sandro F.
Published: February 2020

Background:

Implant fixation by means of a cortical fixation device (CFD) has become a routine procedure in anterior cruciate ligament reconstruction. There is no clear consensus whether adjustable-length CFDs are more susceptible to loop lengthening when compared with pretied fixed-length CFDs.

Purpose:

To assess biomechanical performance measures of 3 types of CFDs when subjected to various loading protocols.

Study Design:

Controlled laboratory study.

Methods:

Three types of CFDs underwent biomechanical testing: 1 fixed length and 2 adjustable length. One of the adjustable-length devices is based on the so-called finger trap mechanism, and the other is based on a modified sling lock mechanism. A device-only test of 5000 cycles (n = 8 per group) and a tendon-device test of 1000 cycles (n = 8 per group) with lower and upper force limits of 50 and 250 N, respectively, were applied, followed by ramp-to-failure testing. Adjustable-length devices then underwent further cyclic testing with complete loop unloading (n = 5 per group) at each cycle, as well as fatigue testing (n = 3 per group) over a total of 1 million cycles. Derived mechanical parameters were compared among the devices for statistical significance using Kruskal-Wallis analysis of variance followed by post hoc Mann-Whitney U testing with Bonferroni correction.

Results:

All CFDs showed elongation <2 mm after 5000 cycles when tested in an isolated manner and withstood ultimate tensile forces in excess of estimated peak in vivo forces. In both device-only and tendon-device tests, differences in cyclic performance were found among the devices, favoring adjustable-length fixation devices over the fixed-length device. Completely unloading the suspension loops, however, led to excessive loop lengthening of the finger trap device, whereas the modified sling lock device remained stable throughout the test. The fixed-length device displayed superior ultimate strength over both adjustable-length devices. Both adjustable-length devices showed adequate fatigue behavior during high-cyclic testing.

Conclusion:

All tested devices successfully prevented critical construct elongation when tested with constant tension and withstood ultimate loads in excess of estimated in vivo forces during the rehabilitation phase. The finger trap device gradually lengthened excessively when completely unloaded during cyclic testing.

Clinical Relevance:

Critical loop lengthening may occur if adjustable-length devices based on the finger trap mechanism are repeatedly unloaded in situ.
Metascience on Peer Review: Testing the Effects of a Study’s Originality and Statistical Significance in a Field Experiment
Authors: Elson Malte , Huff Markus , Utz Sonja
Published: February 2020

Peer review has become the gold standard in scientific publishing as a selection method and a refinement scheme for research reports. However, despite its pervasiveness and conferred importance, relatively little empirical research has been conducted to document its effectiveness. Further, there is evidence that factors other than a submission’s merits can substantially influence peer reviewers’ evaluations. We report the results of a metascientific field experiment on the effect of the originality of a study and the statistical significance of its primary outcome on reviewers’ evaluations. The general aim of this experiment, which was carried out in the peer-review process for a conference, was to demonstrate the feasibility and value of metascientific experiments on the peer-review process and thereby encourage research that will lead to understanding its mechanisms and determinants, effectively contextualizing it in psychological theories of various biases, and developing practical procedures to increase its utility.
The 2018 national seismic hazard assessment of Australia: Quantifying hazard changes and model uncertainties
Authors: Allen Trevor I , Griffin Jonathan D , Leonard Mark , Clark Dan J , Ghasemi Hadi
Published: February 2020

Seismic hazard assessments in stable continental regions such as Australia face considerable challenges compared with active tectonic regions. Long earthquake recurrence intervals relative to historical records make forecasting the magnitude, rates, and locations of future earthquakes difficult. Similarly, there are few recordings of strong ground motions from moderate-to-large earthquakes to inform development and selection of appropriate ground-motion models (GMMs). Through thorough treatment of these epistemic uncertainties, combined with major improvements to the earthquake catalog, a 2018 National Seismic Hazard Assessment (NSHA18) of Australia has been undertaken. The resulting hazard levels at the 10% in 50-year probability of exceedance level are in general significantly lower than previous assessments, including hazard factors used in the Australian earthquake loading standard ( AS 1170.4–2007 (R2018)), demonstrating our evolving understanding of seismic hazard in Australia. The key reasons for the decrease in seismic hazard factors are adjustments to catalog magnitudes for earthquakes in the early instrumental period, and the use of modern ground-motion attenuation models. This article summarizes the development of the NSHA18 explores uncertainties associated with the hazard model, and identifies the dominant factors driving the resulting changes in hazard compared with previous assessments.
Forensic PSHA: Benchmarking Canada’s Fifth Generation seismic hazard model using the OpenQuake-engine
Authors: Allen Trevor I , Halchuk Stephen , Adams John , Weatherill Graeme A
Published: February 2020

This article explores the implementation of the Natural Resources Canada’s Fifth Generation national seismic hazard model as developed for the National Building Code of Canada (NBCC), within the OpenQuake-engine. It also describes the reconciliation of the differences in hazard estimates relative to the published NBCC values, calculated using GSCFRISK. Source and ground-motion input models developed for the GSCFRISK software were translated to the OpenQuake-engine format for the hazard comparison. In order to successfully undertake this process, several adjustments to the OpenQuake code were needed to mimic the behavior of GSCFRISK. This required the development of new functions for earthquake-rupture scaling and ground-motion interpolation. Hazard values estimated using the OpenQuake-engine are generally in good agreement with the 2015 NBCC national-scale hazard values, with differences less than 2%–3% typically achieved. Where larger differences arise, they can be rationalized in terms of differences between the behaviors of the two software engines with respect to earthquake-rupture length uncertainty and maximum ground-motion integration distance.
Impact of gender and caregiving responsibilities on academic success in hematology
Authors: King Allison A. , Vesely Sara K. , Vettese Emily , Cook Sadie , Cuker Adam , Stock Wendy , Homer Morgan , Fritz Josel , Sung Lillian
Published: February 2020

We previously identified gender disparities in academic success during evaluation of the American Society of Hematology (ASH) Clinical Research Training Institute (CRTI) and hypothesized that it may be related to caregiving. The objective was to evaluate the impact of gender and caregiving responsibilities on academic success. A cross-sectional survey that included a question about caregiving responsibilities was distributed to alumni who participated in CRTI from 2003 to 2016 and asked about academic productivity in the previous 3 years. Publications and grants were abstracted from submitted curriculum vitae. Academic success was defined as number of first- or senior-author publications, total publications, grants, and percent effort in research. Of 280 potential respondents, 258 responded (92% response rate), 169 (66%) had caregiving responsibilities, and 110 (43%) were men. Respondents with caregiving responsibilities had fewer first- or senior-author publications (median, 3 vs 5; P = .003) and less percent effort in research (median, 40% vs 50%; P = .006). Men had more first- or senior-author publications (median, 4 vs 3; P = .002) and more total publications (median, 12 vs 6.5; P = .0002) than women. When stratified by those without (P = .0001) or with (P = .042) caregiving responsibilities, men had more publications than women. Among men, caregiving responsibilities significantly reduced all outcomes. However, among women, caregiving did not have an impact. In conclusion, men had more publications than women whether or not they had caregiving responsibilities. However, among men, caregiving reduced academic productivity whereas among women, caregiving did not have impact. The scientific community will need to continue to identify the reasons for disparities and implement changes to address them.
Metabolically healthy obese and metabolic syndrome of the lean: the importance of diet quality. Analysis of MAGNETIC cohort
Authors: Osadnik Kamila , Osadnik Tadeusz , Lonnie Marta , Lejawa Mateusz , Reguła Rafał , Fronczek Martyna , Gawlita Marcin , Wądołowska Lidia , Gąsior Mariusz , Pawlas Natalia
Published: February 2020

Background

Obesity is considered as an indispensable component of metabolic health assessment and metabolic syndrome diagnosis. The associations between diet quality and metabolic health in lean, young adults have not been yet established whilst data addressing this issue in overweight and obese subjects is scarce. Our analysis aimed to establish the link between diet quality (measured with data-driven dietary patterns and diet quality scores) and metabolic syndrome (MS) in young adults, regardless of their adiposity status.

Methods

A total of 797 participants aged 18–35 years old were included in the study. Participants were assigned into metabolic syndrome (MS) group if at least two abnormalities within the following parameters were present: blood pressure, triglycerides, total cholesterol, HDL cholesterol, blood glucose. Participants with one or none abnormalities were considered as metabolically healthy subjects (MH), Diet quality was assessed with two approaches: 1) a posteriori by drawing dietary patterns (DPs) with principal component analysis (PCA) and 2) a priori by establishing diet quality scores and the adherence to pro-Healthy-Diet-Index (pHDI) and non-Healthy-Diet-Index (nHDI). Logistic regression with backward selection based on Akaike information criterion was carried out, to identify factors independently associated with metabolic health.

Results

Within the MS group, 31% were of normal weight. Three PCA-driven DPs were identified, in total explaining 30.0% of the variance: “Western” (11.8%), “Prudent” (11.2%) and “Dairy, breakfast cereals & treats” (7.0%). In the multivariate models which included PCA-driven DPs, higher adherence to middle and upper tertiles of “Western” DP (Odds Ratios [OR] and 95% Confidence Intervals [95% CI]: 1.72, 1.07–2.79 and 1.74, 1.07–2.84, respectively), was associated with MS independently of clinical characteristics including BMI and waist-hip ratio (WHR). Similar results were obtained in the multivariate model with diet quality scores - MS was independently associated with higher scores within nHDI (2.2, 0.92–5.28).

Conclusions

Individuals with MS were more likely to adhere to the western dietary pattern and have a poor diet quality in comparison to metabolically healthy peers, independently of BMI and WHR. It may imply that diet composition, as independent factor, plays a pivotal role in increasing metabolic risk. Professional dietary advice should be offered to all metabolically unhealthy patients, regardless of their body mass status.