bluuebunny/crossref_metadata_2025 huggingface dataset:
Multi-disciplinary palliative care is effective in people with symptomatic heart failure: A systematic review and narrative synthesis
Authors: Datla Sushma , Verberkt Cornelia Antonia , Hoye Angela , Janssen Daisy J.A. , Johnson Miriam J
Published: July 2019

Background:

Despite recommendations, people with heart failure have poor access to palliative care.

Aim:

To identify the evidence in relation to palliative care for people with symptomatic heart failure.

Design:

Systematic review and narrative synthesis. (PROSPERO CRD42016029911)

Data sources:

Databases (Medline, Cochrane database, CINAHL, PsycINFO, HMIC, CareSearch Grey Literature), reference lists and citations were searched and experts contacted. Two independent reviewers screened titles and abstracts and retrieved papers against inclusion criteria. Data were extracted from included papers and studies were critically assessed using a risk of bias tool according to design.

Results:

Thirteen interventional and 10 observational studies were included. Studies were heterogeneous in terms of population, intervention, comparator, outcomes and design rendering combination inappropriate. The evaluation phase studies, with lower risk of bias, using a multi-disciplinary specialist palliative care intervention showed statistically significant benefit for patient-reported outcomes (symptom burden, depression, functional status, quality of life), resource use and costs of care. Benefit was not seen in studies with a single component/discipline intervention or with higher risk of bias. Possible contamination in some studies may have caused under-estimation of effect and missing data may have introduced bias. There was no apparent effect on survival.

Conclusion:

Overall, the results support the use of multi-disciplinary palliative care in people with advanced heart failure but trials do not identify who would benefit most from specialist palliative referral. There are no sufficiently robust multi-centre evaluation phase trials to provide generalisable findings. Use of common population, intervention and outcomes in future research would allow meta-analysis.
Changes in volumetric and metabolic parameters relate to differences in exposure to sub-concussive head impacts
Authors: Champagne Allen A , Coverdale Nicole S , Germuska Mike , Bhogal Alex A , Cook Douglas J
Published: July 2019

Structural and calibrated magnetic resonance imaging data were acquired on 44 collegiate football players prior to the season ( PRE), following the first four weeks in-season ( PTC) and one month after the last game ( POST). Exposure data collected from g-Force accelerometers mounted to the helmet of each player were used to split participants into HIGH ( N = 22) and LOW ( N = 22) exposure groups, based on the frequency of impacts sustained by each athlete. Significant decreases in grey-matter volume specific to the HIGH group were documented at POST ( P = 0.009), compared to baseline. Changes in resting cerebral blood flow (CBF0), corrected for partial volume effects, were observed within the HIGH group, throughout the season ( P < 0.0001), suggesting that alterations in perfusion may follow exposure to sub-concussive collisions. Co-localized significant increases in cerebral metabolic rate of oxygen consumption (CMRO2|0) mid-season were also documented in the HIGH group, with respect to both PRE- and POST values. No physiological changes were observed in the LOW group. Therefore, cerebral metabolic demand may be elevated in players with greater exposure to head impacts. These results provide novel insight into the effects of sub-concussive collisions on brain structure and cerebrovascular physiology and emphasize the importance of multi-modal imaging for a complete characterization of cerebral health.
Percutaneous antegrade nailing with reductor-T tape pin is effective and well tolerated in patients with ipsilateral multisegmental femoral shaft fractures
Authors: Wang Wei , Liu Jianning , Li Zhiyong , Xu Guohui , Wei Rongling , Li Xu , Qi Xiangbei
Published: July 2019

Objective

This study was performed to investigate the efficacy and safety of percutaneous antegrade nailing with a reductor-T tape pin in the treatment of ipsilateral multisegmental femoral shaft fractures (IMFSFs).

Methods

Nineteen patients with IMFSFs underwent antegrade nailing with a reductor-T tape pin by percutaneous techniques. The operation time, reduction time, fluoroscopy time, blood loss, fracture union time, and complications were recorded.

Results

All 19 patients (100%) achieved technical success. The mean and median operation time were 62.42±16.27 and 60 (range, 40–105) minutes, respectively; the mean and median reduction time were 11.47±3.78 and 10 (range, 8–22) minutes, respectively; the mean and median fluoroscopy time were 16.63±6.10 and 15 (range, 10–35) s, respectively; and the mean and median blood loss were 185.26±62.75 and 180 (range, 110–350) mL, respectively. Additionally, all 19 patients (100%) achieved fracture union within a mean and median time of 3.95±1.75 and 3 (range, 3–9) months, respectively; most patients [n=14 (73.7%)] achieved fracture union within 3 months. No obvious complications occurred during the study.

Conclusion

Antegrade nailing with a reductor-T tape pin by a percutaneous technique is effective and well tolerated in patients with IMFSFs.
Stroke knowledge among middle and high school students
Authors: Umar Abdullah B. , Koehler Tracy J. , Zhang Reian , Gilbert Veronica , Farooq Muhammad U. , Davis Alan T. , Nyenhuis David , Gorelick Philip B.
Published: July 2019

Objective

To determine the awareness of stroke symptoms and risk factors in middle and high school students at a single institution.

Methods

An 11-question multiple-choice stroke awareness survey was administered to students in grades 7 to 12 at City High Middle School in Grand Rapids, Michigan, United States. Summary statistics were calculated.

Results

A total of 603/608 surveys were analyzed. Only 8% of respondents correctly identified stroke as the fifth leading cause of death in the United States. Half (50.1%) recognized that a stroke occurred in the brain. Sixty-seven students (11.1%) correctly identified all 11 stroke risk factors. Only 5.1% correctly selected all four correct stroke symptoms. Two-thirds (64.5%) recognized stroke as an immediate medical emergency. Slightly more than half (55.9%) knew the acronym FAST (face, arms, speech, time).

Conclusions

Most students in our study were unaware of all the risk factors and symptoms related to stroke. Although this study was limited because data were collected from only one school, the findings suggest a need to educate middle and high school students about stroke risk factors, symptoms and acute interventions.
Evaluating the HERO Ramp-Metering Algorithm with San Diego’s Integrated Corridor Management System Model
Authors: Bélisle François , Torres Laura , Volet Pascal , Hale David K. , Avr Anjana
Published: July 2019

The FHWA project “Alternative Designs to Alleviate Freeway Bottlenecks at Merge/Diverge and Weaving Areas” aims at evaluating six different methods to mitigate merge impacts. In this paper, the following ramp-metering algorithms were tested: HEuristic Ramp metering coOrdination (HERO), Asservissement Linéaire d’entrée sur Autoroute (ALINEA), and San Diego Ramp Meter System (SDRMS). These were compared with a “do-nothing” base scenario. The algorithms were tested during a 5 h morning peak period simulation using the integrated corridor management system (ICMS) Aimsun network, a complete and wide-ranging network covering San Diego’s I-15 mainline corridor, on-off ramps and arterial roads. Whereas ALINEA is already included in the base distribution of Aimsun, a new implementation of HERO was programmed from algorithms found in the literature and adapted for use on such a network. Different measures of performance (MOP) were used to assess the efficiency of each algorithm and HERO was found to outperform all the other algorithms: gains of 1.5% over ALINEA and 4% over do-nothing on the mainline average travel time, and gains of 0.5% over ALINEA and 1.5% over do-nothing for the average weighted harmonic speed on all mainline and ramp sections. However, although tests showed that better results can be obtained on the mainline, careful calibration was needed to attain overall positive MOP and not penalize vehicles entering on ramps. The paper concludes with proposed improvements to the original algorithm.
Solving the conjugate tooth profile of screw compressor rotors using edge detection method based on Alpha Shape algorithm
Authors: Yang Jian , Sun Fang-Hong , Lu Zheng
Published: July 2019

While designing a screw compressor, the design of the rotor profiles is the most important because rotor profiles essentially determine the overall performance of the screw compressor. In the field of rotor design, the mutual solution of male and female rotors is characterized by shortcomings such as complex and error-prone calculation, and unsolvable interference. In this study, an edge detection method based on the Alpha Shape algorithm was proposed to avoid the complex calculation process in the traditional planar meshing theory and quickly obtain the point cloud data with singularity points removed. The results show that, with relatively high accuracy and fast processing speed, this algorithm can extract comparatively desirable edges so as to obtain data of the female (male) rotor profile based on the conjugate male (female) rotor profile. The analytical method and the experimental method were used to compare the data of the conjugate rotors, verifying the correctness of the design, which efficiently and highly accurately overcame the problems in mutual solution of male and female rotors. This method can also be applied to design similar conjugate products such as gears, worms, and milling cutters.
Using infrared imaging for assessment of muscular activity in the forearm of surgeons in the performance of laparoscopic tasks
Authors: Sancibrian Ramon , Gutierrez-Diez Maria C , Redondo-Figuero Carlos , Llata Jose R , Manuel-Palazuelos Jose C
Published: July 2019

Surgeons working in laparoscopic surgery are subjected to hard working conditions because of the poor ergonomic characteristics of the workplace. The improvement in the working conditions requires the use of reliable techniques for the assessment of muscular activity. In this article infrared imaging is used and compared with electromyography for the evaluation of muscle activity in the performance of laparoscopic surgical tasks. Electromyography has been widely used for the evaluation of the electrical activity produced by the muscles in the performance of surgery. On the contrary, infrared imaging is an innovative technique that has not been sufficiently explored. An experimental evaluation was carried out using a thermography camera and recording the infrared images from volunteers in different tests. Pearson’s correlation was obtained between the electromyography and thermographic measurements in two stages: Endurance Stage (best value: ρ = 0.8401 with p < 0.01) and Surgical Task (best value: ρ  = 0.8309 with p < 0.01). The article demonstrates that infrared imaging is a valuable technique for the evaluation of muscle activity in laparoscopic surgery, and it can be compared with electromyography. The main advantages of infrared imaging are that it allows remote measurement and provides activity information in the whole area of interest. However, drawbacks such as delayed response of the infrared imaging due to thermal conductivity of the skin should be considered. Electromyography only provides information in the location of the electrodes, but it is a real-time response. For these reasons, the techniques complement each other.
Opinion: psychiatry formal education courses have been lost in transition
Authors: McKay Roderick
Published: July 2019

Objective:

With reference to relevant literature, this article explores the impact of moving to a competency-based training programme upon psychiatry formal education courses (FECs).

Conclusions:

In the context of major changes in psychiatry training, FECs have lost clarity of role, alignment and governance. Strategic decisions made with key stakeholders are required to continue to train psychiatrists best able to meet future community needs.
Symptoms in Children Receiving Treatment for Cancer—Part I: Fatigue, Sleep Disturbance, and Nausea/Vomiting
Authors: Hooke Mary C. , Linder Lauri A.
Published: July 2019

Children and adolescents with cancer often undergo intensive chemotherapy treatment to obtain remission and long-term survival. The pursuit of successful treatment outcomes may lead to high levels of symptom distress related to treatment side effects and toxicities. The Children’s Oncology Group Nursing Discipline held a State of the Science Symposium “Symptom Assessment During Childhood Cancer Treatment” in 2018 that included reviews of evidence regarding key symptoms. The purpose of this review is to summarize and synthesize the evidence presented about the prevalence, relationships, trajectories, and associated biomarkers of selected symptoms experienced by children and adolescents during cancer treatment. Five symptoms were selected, with the focus on fatigue, sleep disturbance, and nausea/vomiting and included in Part I of the review. Using Ovid-Medline, studies published between 2008 and 2018 that focused on these specific symptoms during active chemotherapy treatment were selected. Fatigue interferes with normal developmental activities and is associated with sleep disturbances, and its pattern changes within a cycle of chemotherapy as well as across the treatment trajectory. Sleep is disrupted by the hospital environment, treatment medications, and changes in normal childhood and schedules. Disturbances of sleep persist during treatment, preventing recovery from poor quality sleep. Although pharmacologic interventions have advanced for treatment of nausea and vomiting, children and adolescents continue to struggle with this symptom. Its trajectory changes with the intensity of treatment, and over half of the patients report that they experience nausea and/or vomiting. Future research is needed to advance identification of biologic risk factors for symptoms and test effectiveness of symptom-related interventions.
Evaluating Cultural Transmission in Bronze Age burial rites of Central, Northern and Northwestern Europe using radiocarbon data
Authors: Schmid Clemens
Published: July 2019

European Bronze Age archaeology traditionally focusses on two major dimensions to categorise burials – although there is an immense variability of attendant phenomena within this spectrum – flat graves versus burial mounds and cremation versus inhumation. These traits are an indispensable ingredient for common archaeological narratives of sociocultural interaction and cultural evolution. This article presents a quantitative reconstruction of the general trends in the distribution of Bronze Age burial traditions based on bulk radiocarbon data and employs the resulting time series for the estimation of macro-regional cultural distance. Despite the relatively small amount of input data, the trend reconstruction fits to established archaeological observations for prehistoric Europe. The comparison of cultural and spatial distance leads to the remarkable result of no significant permanent correlation, which indicates that the spread of the relevant aspects of burial traditions cannot be explained with simple diffusion models. Instead, a more complex process of cultural transmission has to be considered.
Children’s Plans for Writing: Characteristics and Impact on Writing Performance
Authors: Llaurado Anna , Dockrell Julie E.
Published: July 2019

Planning plays an important role in the production of written texts. Little is known about why children plan and the plans they create when they are not explicitly instructed. This study explores the plans that elementary school children in Years 1, 3, and 5 create before writing a text. We compared performance of children educated in Catalan and in English (the United Kingdom) and examined whether the plans were related to their language and literacy skills. Children of all ages produced plans before writing either by producing a draft or an organizer. The types of plan changed with age and were influenced by the educational context. Plans were not associated with either the text length or the text quality. Nor were language, literacy, and transcription skills associated with the plans. School instruction is important for producing plans but, at this stage, children’s self-generated plans do not impact on the texts produced.
Political Economy of the Parcel Tax in California School Districts
Authors: Lee Soomi
Published: July 2019

This article examines the effect of home price distribution on the likelihood of parcel tax adoption in California school districts. A parcel tax is a regressive tax imposed as the same amount per unit of property regardless of property values and requires a two-thirds supermajority vote to be adopted. Despite the growing role that local parcel taxes have in funding public education, it has not been fully understood how their regressive nature influences adoption. I argue that because the regressive tax imposes different marginal property tax rates for voters, the distribution of home prices within a district determines the likelihood of parcel tax adoption. Using the Heckman selection models with California school district–level data, I find that a large gap in home values within a district significantly lowers the likelihood of parcel tax adoption.
On the Bias of Precision Estimation Under Separate Sampling
Authors: Xie Shuilian , Braga-Neto Ulisses M
Published: July 2019

Observational case-control studies for biomarker discovery in cancer studies often collect data that are sampled separately from the case and control populations. We present an analysis of the bias in the estimation of the precision of classifiers designed on separately sampled data. The analysis consists of both theoretical and numerical results, which show that classifier precision estimates can display strong bias under separating sampling, with the bias magnitude depending on the difference between the true case prevalence in the population and the sample prevalence in the data. We show that this bias is systematic in the sense that it cannot be reduced by increasing sample size. If information about the true case prevalence is available from public health records, then a modified precision estimator that uses the known prevalence displays smaller bias, which can in fact be reduced to zero as sample size increases under regularity conditions on the classification algorithm. The accuracy of the theoretical analysis and the performance of the precision estimators under separate sampling are confirmed by numerical experiments using synthetic and real data from published observational case-control studies. The results with real data confirmed that under separately sampled data, the usual estimator produces larger, ie, more optimistic, precision estimates than the estimator using the true prevalence value.
Communities of practice in landscapes of practice
Authors: Pyrko Igor , Dörfler Viktor , Eden Colin
Published: July 2019

The original formulation of communities of practice primarily focused on describing how learning, meaning, and identity within a community can translate into a sustained practice. Wenger-Trayner et al. elaborated the concept of landscapes of practice to describe how different communities of practice may interact, and belong to broader landscapes of practice, rather than rely exclusively on their own local situated practices. In this conceptual article, we apply the perspective of landscapes of practice to organizations. The first part of our argument is descriptive, and is aimed at developing a model of landscapes of practice in organizations. With regard to this model, we propose that practices can be seen as multilevel, including local situated practices, generic practices, and cultural fields. This, in turn, helps to clarify and organize a number of central concepts within the practice literature. The second part of our argument is prescriptive, as we suggest that landscapes of practice call for triple-legitimization of situated learning, meaning that legitimization is not only needed at the level of community and organization, but also by attending to the dynamically changing epistemic texture of the landscapes.
Vibration-response-only statistical time series structural health monitoring methods: A comprehensive assessment via a scale jacket structure
Authors: Spanos Nikos A , Sakellariou John S , Fassois Spilios D
Published: July 2019

Random-vibration-based statistical time series structural health monitoring methods utilize small-scale, compact, and data-based, time series stochastic representations of the structural dynamics for damage diagnosis. In this study, a comprehensive and critical assessment of the diagnostic performance of five prominent response-only methods is presented based on incipient, ‘minor’ to ‘mild’, damages on a lab-scale wind turbine jacket structure. Statistically reliable damage detection and identification results are obtained via a ‘rotation’ procedure resulting into thousands of test cases, with the performance analysed in terms of receiver operating characteristic curves and confusion matrices. The results indicate not only challenging of the methods’ capabilities, but also the achievement of good to excellent performance for the ‘minor’ to ‘mild’ damages, respectively, with the model parameter–based method offering the best performance. In addition, the use of a vibration signal measured via a laser vibrometer leads to slightly improved detection performance over that obtained via a classical accelerometer.
“My greatest challenge happens to be my greatest success”: Overcoming barriers during an early preservice teacher practicum with a high percentage of dual language learners
Authors: Durham Sean , Harrison Jamie , Barry Nancy H
Published: July 2019

This qualitative study investigated preservice teachers’ experiences working with dual language learners within an early university-based practicum with young children. Our data were multiple reflective journal entries that each preservice teacher composed during the practicum. Our initial analysis revealed a subset of preservice teachers who described major challenges in their initial work with dual language learners but ultimately formed more professional dispositions toward working with this population. A constructivist paradigm guided our further collaborative, iterative coding process that yielded three principal themes: (1) struggling to connect with dual language learners, (2) trying out “child-centered” approaches, and (3) articulating a sense of professional empowerment. Additional research is needed to support teacher educators in their mission to empower all early childhood teachers to work effectively with dual language learners.
Pushing the Next Level: Investigating Digital Content Creation in India
Authors: Mehta Smith , Kaye D. Bondy Valdovinos
Published: July 2019

Film, television, and music form a major domestic and export product in India. Whereas, in the past, content production has been restricted to professional producers, digital media platforms have drastically altered the landscape of content production in India. Through in-depth interviews of ten online content creators, the article describes motivations of online content creation in India. Discussion themes include professional activities, identity construction of creators, and quasi-corporate structures that are taking root in the democratized digital spaces in India. In doing so, the article challenges the notion of creators on social media as mere “amateurs” or “UGC” (user-generated content). Conclusions from this study suggest future research should take a more holistic approach to studying online content creators rather than classifying creators on the basis of platform affordances.
Dietary protein and exercise for preservation of lean mass and perspectives on type 2 diabetes prevention
Authors: de Sousa Maysa Vieira , da Silva Soares Diana Bento , Caraça Elaine Reis , Cardoso Ronaldo
Published: July 2019

Sedentary lifestyle and aging favor the increasing prevalence of obesity and type 2 diabetes and their comorbidities. The loss of lean body mass reduces muscle strength, resulting in impaired functional capacity and leading to increased risks of chronic diseases with advancing age. Besides aging, conditions such as inappetence, social isolation, and inadequate dietary intake cause the loss of lean body mass and increased abdominal fatty mass, resulting in sarcopenic obesity and predisposition to type 2 diabetes. Compared to younger people, this condition is more common in the elderly owing to natural changes in body composition associated with aging. Lifestyle changes such as increased physical activity and improved dietary behaviors are effective for preventing the occurrence of comorbidities. Regarding muscle nutrition, besides caloric adequacy, meeting the requirements for the consumption of dietary amino acids and proteins is important for treating sarcopenia and sarcopenic obesity because muscle tissue mainly consists of proteins and is, therefore, the largest reservoir of amino acids in the body. Thus, this review discusses the effects of dietary protein on the preservation of lean body mass, improvements in the functional capacity of muscle tissue, and prevention of chronic diseases such as type 2 diabetes. In addition, we address the effects of regular physical training associated with dietary protein strategies on lean body mass, body fat loss, and muscle strength in the elderly at a risk for type 2 diabetes development.

Impact statement

Diabetes mellitus is a worldwide health problem associated with obesity and sedentary lifestyle, which predisposes affected individuals to mortality and morbidity. Additionally, aging and unhealthy lifestyle behaviors increase inflammation and insulin resistance, contributing to the reduction of cytokines related to muscle nutrition and the suppression of lipogenesis, resulting in the development of sarcopenic obesity. One strategy for the prevention of T2D is the avoidance of secondary aging by participating in healthy action programs, including exercise and nutritional interventions. This minireview of several studies demonstrates the impact of physical activity and nutritional interventions on gaining or preserving muscle mass and on the functional aspects of muscles with aging. It provides information on the effect of protein, leucine, β-hydroxy-β-methylbutyrate (HMB), and creatine supplementation on muscle mass, strength, and volume gain and on the prevention of the progressive decrease in muscle mass with aging in combination with maintaining regular physical activity.
Double D Technique: An Innovative Modified Bifurcated Stent Graft Deployment Strategy for an Isolated Common Iliac Artery Aneurysm With a Challenging Renal Artery Anatomy
Authors: Date Yusuke , Takano Tamaki , Fujii Taishi , Terasaki Takamitsu , Sakaguchi Masayuk
Published: July 2019

Purpose:

Endovascular aneurysm repair (EVAR) for an isolated common iliac artery aneurysm (iCIAA) sometimes requires a bifurcated stent graft (SG). In EVAR, it is essential to preserve the renal artery (RA). However, this is challenging in cases of anatomical variation. The double D technique (DDT) can be used in anatomically inadequate cases with a commercially approved bifurcated SG. Here, we report the repair of iCIAA in the presence of a challenging RA anatomy, through EVAR using the DDT.

Case Report:

An 84-year-old woman was diagnosed with a maximal 35-mm diameter left iCIAA and a nonaneurysmal aorta by computed tomography (CT), which also showed that the right RA arose 50-mm above the aortic bifurcation. The DDT was chosen because commercially approved bifurcated SGs typically require a distance of >70 mm from the proximal position to the aortic bifurcation. Postoperative CT showed excellent results with no endoleaks or SG kinking and occlusion, as well as preservation of robust blood flow to the right RA.

Conclusion:

Endovascular aneurysm repair using the DDT can be an alternative option for treatment of iCIAA with a challenging RA anatomy.
Performance of relaxed iterative methods for image deblurring problems
Authors: Yun Jae H
Published: July 2019

In this paper, we consider performance of relaxation iterative methods for four types of image deblurring problems with different regularization terms. We first study how to apply relaxation iterative methods efficiently to the Tikhonov regularization problems, and then we propose how to find good preconditioners and near optimal relaxation parameters which are essential factors for fast convergence rate and computational efficiency of relaxation iterative methods. We next study efficient applications of relaxation iterative methods to Split Bregman method and the fixed point method for solving the L1-norm or total variation regularization problems. Lastly, we provide numerical experiments for four types of image deblurring problems to evaluate the efficiency of relaxation iterative methods by comparing their performances with those of Krylov subspace iterative methods. Numerical experiments show that the proposed techniques for finding preconditioners and near optimal relaxation parameters of relaxation iterative methods work well for image deblurring problems. For the L1-norm and total variation regularization problems, Split Bregman and fixed point methods using relaxation iterative methods perform quite well in terms of both peak signal to noise ratio values and execution time as compared with those using Krylov subspace methods.
The transnational mythscape of the Second World War
Authors: Galai Yoav
Published: July 2019

Since the early 2000s, the study of European Memory politics has proliferated, but has come to mean different things. It focuses either on the emergence of Holocaust remembrance as a shared cultural memory, disputes within European Union institutions over what the European collective memory should be, or diplomatic standoffs between Russia and its former satellites. I argue that while such complex multi-level memory politics defy an overarching theoretical categorisation, they can be understood through a comprehensive approach, which is achieved by considering the different narratives of the past to be interpretations of a common historical occurrence. This article argues that European Memory Politics as a whole occurs within a transnational mythscape of the Second World War, in which international actors promote their interpretations as simplified myths while warding off competing myths that negatively depict their mythical selves. An emergent narrative alliance between Russia and Israel, made in response to European memory politics, is used to illustrate the utility of the transnational mythscape framework for understanding memory politics beyond the national sphere.
The Association Between Cardiac Biomarker NT-proBNP and 30-Day Readmission or Mortality After Pediatric Congenital Heart Surgery
Authors: Parker Devin M. , Everett Allen D. , Stabler Meagan E. , Leyenaar JoAnna , Vricella Luca , Jacobs Jeffrey P. , Thiessen-Philbrook Heather , Parikh Chirag , Greenberg Jason , PhD Jeremiah R. Brown
Published: July 2019

Background:

Very little is known about clinical and biomarker predictors of readmissions following pediatric congenital heart surgery. The cardiac biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) can help predict readmission in adult populations, but the estimated utility in predicting risk of readmission or mortality after pediatric congenital heart surgery has not previously been studied. Our objective was to evaluate the association between pre- and postoperative serum biomarker levels and 30-day readmission or mortality for pediatric patients undergoing congenital heart surgery.

Methods:

We measured pre- and postoperative NT-proBNP levels in two prospective cohorts of 522 pediatric patients <18 years of age who underwent at least one congenital heart operation from 2010 to 2014. Blood samples were collected before and after surgery. We evaluated the association between pre- and postoperative NT-proBNP with readmission or mortality within 30 days of discharge, using multivariate logistic regression, adjusting for covariates based on the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Mortality Risk Model.

Results:

The Johns Hopkins Children's Center cohort and the Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury (TRIBE-AKI) cohort demonstrate event rates of 12.9% and 9.4%, respectively, for the composite end point. After adjustment for covariates in the STS congenital risk model, we did not find an association between elevated levels of NT-proBNP and increased risk of readmission or mortality following congenital heart surgery for either cohort.

Conclusions:

In our two cohorts, preoperative and postoperative values of NT-proBNP were not significantly associated with readmission or mortality following pediatric congenital heart surgery. These findings will inform future studies evaluating multimarker risk assessment models in the pediatric population.
Aortic or Pulmonary Valved Homograft Right Ventricle to Pulmonary Artery Conduit in the Norwood Procedure
Authors: Nasirov Teimour , Maeda Katsuhide , Reinhartz Olaf
Published: July 2019

Background:

Several modifications of the Norwood procedure utilizing valved right ventricle to pulmonary artery conduits have recently been reported. Our group has been using aortic or pulmonary valved homografts combined with PTFE tube grafts for now 16 years.

Methods:

In this report, we review our technique in detail and describe any changes that have occurred over the years. We provide detailed illustrations of our preferred surgical technique, report outcome data, and compare it to the other conduit options available.

Results:

Between 2006 and 2015, 130 stage I Norwood procedures were performed at our institution, 100 of them using valved conduits. Our technique is described and illustrated in detail. Early mortality was 15%. Postoperative percutaneous intervention on the conduit was required in 29% of cases.

Conclusions:

While a randomized trial comparing different valved conduits is lacking, we believe a composite conduit made from homograft aortic or pulmonary valves and PTFE tube grafts is an excellent choice in stage I Norwood procedure.
Staged Biventricular Repair After Hybrid Procedure in High-Risk Neonates and Infants
Authors: Erek Ersin , Suzan Dilek , Aydin Selim , Temur Bahar , Demir Ibrahim Halil , Odemis Ender
Published: July 2019

Background:

Single-stage biventricular repair remains a challenging and difficult decision in high-risk newborns and early infants with the presence of left ventricular outflow tract obstruction (LVOTO) or borderline hypoplasia of the left ventricle (LV).

Methods:

Six high-risk patients underwent the initial hybrid procedure (bilateral pulmonary banding + ductal stenting) for staged biventricular repair. Their median age was 17 days (range: 7-55 days). The diagnosis was interrupted aortic arch (IAA), ventricular septal defect (VSD), and LVOTO (n = 3); IAA and VSD (n = 1); and aortic annular hypoplasia, aortic arch hypoplasia, VSD, and LVOTO (n = 1). The last patient had borderline LV with large atrial septal defect (ASD) and aortic arch hypoplasia. The patient with borderline LV had also ASD closure with small fenestration.

Results:

One patient died of sepsis after the hybrid procedure. Other patients underwent biventricular repair 8 to 13 months later. Three patients had conventional repair with conal septum resection. The other patient with IAA, in whom LVOTO was considered nonresectable, underwent Yasui operation. The last patient with borderline LV had enough development of left heart structures during follow-up and underwent aortic arch repair. One patient who had conal septum resection died after biventricular repair. One patient needed a tracheostomy; four patients were discharged uneventfully and their clinical conditions were good on postoperative year 1.

Conclusion:

Staged biventricular repair with the initial hybrid procedure may be a feasible and safe alternative in high-risk neonates and early infants. Hybrid intervention may provide the development of cardiac structures in time and a better evaluation for the possibility of biventricular repair in borderline patients.
Proceedings From the 3rd Symposium of the World Database for Pediatric and Congenital Heart Surgery
Authors: St. Louis James D. , Tchervenkov Christo I. , Jonas Richard A. , Sandoval Nestor , Zhang Hao , Jacobs Jeffrey P. , Talwar Sachin , Halees Zohair Al , Finucane Kirsten , Kirklin James K.
Published: July 2019

The World Database for Pediatric and Congenital Heart Surgery was created to provide a resource for centers to be able to perform complex outcomes analyses of children undergoing repair of a congenital heart defect. In just under two years, the World Society for Pediatric and Congenital Heart Surgery (WSPCHS) has amassed over 13,000 procedures from 55 centers into the database. This Proceedings of the 3rd World Database Symposium held at the 6th Scientific Meeting of the WSPCHS summarizes the presentations of international experts in the fields of outcomes analysis and care of children with congenital heart surgery.
Development of an Innovative Career Development Program for Early-Career Women Faculty
Authors: Danhauer Suzanne C , Tooze Janet A , Barrett Natalie AM , Blalock Jamie S , Shively Carol A , Voytko Mary Lou , Crandall Sonia J
Published: July 2019

Objective

Our institutional Women in Medicine & Science Program (formerly the Office of Women in Medicine and Science) developed the Early Career Development Program for Women to promote the careers of women faculty. At 6 monthly sessions, participants learn relevant content (imposter syndrome, strengths, change style, career management, assertive communication, feedback, personal influence, conflict management, negotiation, importance of mentors, resilience, and self-care); exchange ideas; and expand their professional networks. Here, we report changes in participants’ career skills/knowledge, confidence, and perceptions of the current environment after attending the program.

Method

Between 2014 and 2017, participants (N = 65) completed pre- and post-program surveys that assessed career knowledge and skills, confidence, and perceptions of the current environment and provided program feedback.

Results

Most skills showed pre–post significant improvement. The greatest increases occurred in knowing paths to promotion, tailoring communication style, ability to manage conflict, and ability to handle personal–professional role balance. Women reported a significant increase for all items measuring confidence. Among these items, establishing networks, understanding institutional culture, providing feedback, motivating others, strategic planning, delegating, and conflict management had the largest increases. Overall, 89.3% of respondents rated the program impact as very strong/profound, 98.5% rated the concepts as essential, 95.2% rated the skills as essential, and 90.8% rated the sense of community with women in their class as very/extremely close.

Conclusions

Work-related skills/knowledge, confidence, and perceptions of the current environment increased significantly among program participants. These early-career women faculty indicated that the program augmented the skills needed to develop their careers in an academic medical center.
Assessing spontaneous passage of prophylactic pancreatic duct stents by X-ray: is a radiology report adequate?
Authors: Loloi Justin , Lipkin Jacob S. , Gagliardi Eileen M. , Levenick John M.
Published: July 2019

Background:

Pancreatic duct stents are frequently placed for prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis. Because of concern for possible secondary ductal changes from a retained stent, these stents need to be monitored and removed if retained. Usually an abdominal X-ray is performed to assess retained stent, and if present, an esophagogastroduodenoscopy is performed to remove the stent. Limited data is published on false-negative radiology reports for spontaneous passage of stents.

Methods:

Using an Institutional Review Board–approved stent log, a retrospective chart review of all pancreatic duct stents placed at our institution from 2008 to 2014 was performed.

Results:

A total of 856 pancreatic duct stents were placed during the study period. Of these, 435 (50.8%) were prophylactic stents and 421 (49.2%) were therapeutic. Complete follow-up data were available in 426 (97.9%) patients with prophylactic stents. Six patients (1.4%) were lost to follow up and three (0.7%) expired prior to removal. In all, 283 (66%) had follow-up imaging, with 167 (39.2%) having the official radiology read with no retained pancreatic duct stent in place. Eight of these cases were “false-negative” radiology interpretation (4.8% of cases read as “no stent,” NNH = 20). The stent was found either by review of image by an endoscopist or incidental stent discovery during a follow-up procedure.

Conclusion:

Radiologist interpretation of abdominal X-rays to assess spontaneous passage of prophylactic pancreatic ducts stents resulted in a false-negative interpretation in approximately 5% of cases. Independent review of the images by the endoscopist may be beneficial given unfamiliarity of these stents by radiologists.
Genetic defects in hematopoietic transcription factors and predisposition to acute lymphoblastic leukemia
Authors: Gocho Yoshihiro , Yang Jun J.
Published: July 2019

Recent genome-wide studies have revealed a plethora of germline variants that significantly influence the susceptibility to acute lymphoblastic leukemia (ALL), thus providing compelling evidence for genetic inheritance of this blood cancer. In particular, hematopoietic transcription factors (eg, ETV6, PAX5, IKZF1) are most frequently implicated in familial ALL, and germline variants in these genes confer strong predisposition (albeit with incomplete penetrance). Studies of germline risk factors for ALL provide unique insights into the molecular etiology of this leukemia.
Jan Steen’s ground layers analysed with Principal Component Analysis
Authors: Albrecht Marya , de Noord Onno , Meloni Sabrina , van Loon Annelies , Haswell Ralph
Published: July 2019

In-depth technical and art historical research into Jan Steen’s (ca. 1626–1679) oeuvre has been a focus at the Mauritshuis since 2012, as part of the Partners in Science collaboration with Shell. The aim of this project is to shed light on the chronology of Steen’s oeuvre based on the materials he used, since only 10% of his circa 450 works are dated. Steen worked in different cities within the Netherlands (Haarlem, The Hague, Delft, Leiden and Warmond), each with a distinct artistic community. So far 39 paintings from the Mauritshuis and many other collections in and outside the Netherlands have been analysed. This paper focuses on the ground layers in Steen’s paintings. Cross sections were taken of each painting and analysed using SEM-EDX. Principal Component Analysis (PCA) on the resulting dataset was used to find correlations between variables and clustering of samples. Special versions of PCA were explored to analyse pigment identifications and to allow data fusion of this binary data with the quantitative elemental analyses, which is not trivial with normal PCA. The statistical analyses allowed us to group paintings linking them to the different cities where Steen worked and to see outliers in terms of the ground layer composition. Interestingly, the present survey also revealed that apart from commercially prepared grounds, Steen also used grounds prepared in his own studio.
A Cohort Analysis of Clinical and Ultrasound Variables Predicting Cancer Risk in 20,001 Consecutive Thyroid Nodules
Authors: Angell Trevor E , Maurer Rie , Wang Zhihong , Kim Matthew I , Alexander Caroline A , Barletta Justine A , Benson Carol B , Cibas Edmund S , Cho Nancy L , Doherty Gerard M , Doubilet Peter M , Frates Mary C , Gawande Atul A , Krane Jeff F , Marqusee Ellen , Moore Francis D , Nehs Matthew A , Larsen P Reed , Alexander Erik K
Published: July 2019

Context

Assessing thyroid nodules for malignancy is complex. The impact of patient and nodule factors on cancer evaluation is uncertain.

Objectives

To determine precise estimates of cancer risk associated with clinical and sonographic variables obtained during thyroid nodule assessment.

Design

Analysis of consecutive adult patients evaluated with ultrasound-guided fine-needle aspiration for a thyroid nodule ≥1 cm between 1995 and 2017. Demographics, nodule sonographic appearance, and pathologic findings were collected.

Main Outcome Measures

Estimated risk for thyroid nodule malignancy for patient and sonographic variables using mixed-effect logistic regression.

Results

In 9967 patients [84% women, median age 53 years (range 18 to 95)], thyroid cancer was confirmed in 1974 of 20,001 thyroid nodules (9.9%). Significant ORs for malignancy were demonstrated for patient age <52 years [OR: 1.82, 95% CI (1.63 to 2.05), P < 0.0001], male sex [OR: 1.68 (1.45 to 1.93), P < 0.0001], nodule size [OR: 1.30 (1.14 to 1.49) for 20 to 19 mm, OR: 1.59 (1.34 to 1.88) for 30 to 39 mm, and OR: 1.71 (1.43 to 2.04) for ≥40 mm compared with 10 to 19 mm, P < 0.0001 for all], cystic content [OR: 0.43 (0.37 to 0.50) for 25% to 75% cystic and OR: 0.21 (0.15 to 0.28) for >75% compared with predominantly solid, P < 0.0001 for both], and the presence of additional nodules ≥1 cm [OR: 0.69 (0.60 to 0.79) for two nodules, OR: 0.41 (0.34 to 0.49) for three nodules, and OR: 0.19 (0.16 to 0.22) for greater than or equal to four nodules compared with one nodule, P < 0.0001 for all]. A free online calculator was constructed to provide malignancy-risk estimates based on these variables.

Conclusions

Patient and nodule characteristics enable more precise thyroid nodule risk assessment. These variables are obtained during routine initial thyroid nodule evaluation and provide new insights into individualized thyroid nodule care.
Indigenous Technologies in the 1577 Relaciones geográficas of New Spain: Collective Land Memory, Natural Resources, and Herbal Medicine
Authors: McDonough Kelly S.
Published: July 2019

This essay applies the analytic category of technologies proposed by historian Marcy Norton as complex systems of knowledges, practices, and products generated in specific social contexts to a study of the sixteenth-century bureaucratic surveys known as the Relaciones geográficas (RG) manuscripts. As a methodological intervention, the principal aim is to draw out the relatively understudied Indigenous knowledges and practices found throughout the corpus. The first section of the essay outlines the conceptual framework of technologies and contextualizes the RG survey and response processes. The remainder of the essay discusses Indigenous technologies including collective land memory, natural resources, and herbal medicines recorded in the Archdiocese of Mexico corpus of RGs (appendix), thirty-one manuscripts in total.