bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of external repair of HeartMate IITM LVAD percutaneous leads
Authors: Pal Jay D. , Mahr Claudius , Smith Jason W. , Dardas Todd F. , Pinette Jay , Farrar David J. , Mokadam Nahush A.
Published: October 2019

Background

The HeartMate II Left Ventricular Assist Device (LVAD) receives power via a percutaneous lead connected to an external controller and batteries. At times, this lead can be damaged during normal wear, as well as by traumatic fracture, which may jeopardize the functionality of the LVAD. If there is significant internal damage, surgical replacement of the LVAD is required. However it is possible to repair externally damaged leads by replacing the distal portion of the lead to avoid pump replacement. We report the overall experience and outcomes in patients with external lead repairs.

Methods

A procedure for full external lead replacement has been developed and is approved for implementation by the FDA. Pre-procedural steps include examination of high resolution x-rays of the driveline and analysis of pump log files. Efficacy and outcomes of all attempted external lead repairs were evaluated between initiation of repairs in 2008 through 2014.

Results

A total of 321 repairs were attempted in 297 patients with suspected isolated external lead damage after a median of 2.0 yr [range: 7d to 8.7 yr] of support. Of 297 patients, 37 (12.5%) had attempts at external repair that were unsuccessful 

due to concomitant internal lead damage. 31 patients (10.4%) had additional serious malfunctions after lead repair resulting in 17 with repeat repairs and 14 who continued on ungrounded cables, and ultimately 14 of these 31 patients required pump exchanges. 27 of the 297 patients (9.1%) with lead repairs had only minor additional problems, including cuts or abrasion in the insulation which was fixed with tape or external reinforcement. There was one catastrophic failure during attempted lead repair requiring emergent pump exchange, and there were three deaths within 14 days of attempted repair related to continued percutaneous lead damage. One of these patients refused pump exchange, and two were not candidates for other clinical reasons. 202 of the 297 patients (68%) have had no recurrence of lead problems after a median follow-up of 189 days [n=11 over 2 years, longest 5.8 yr].

Conclusions

HeartMate II dysfunction due to percutaneous lead damage is uncommon but is of serious concern due to potential abrupt pump stoppage. Lead repair by replacement of the external distal percutaneous lead can be performed by trained personnel in a standardized fashion and may provide a durable solution in select patients with isolated external lead damage, thus avoiding the need for surgical pump exchange. We provide an algorithm for evaluating potential lead damage.
Adverse Events in Continuous-Flow LVAD Recipients: Gastrointestinal Bleeding is Still Notable?
Authors: Petrovic Marija , Nathan Sriram , Radovancevic Rajko , Rajapreyar Indranee , Dasher Kevin J. , Akay Mehmet H. , Akkanti Bindu , Loyalka Pranav , Kar Biswajit , Gregoric Igor D.
Published: October 2019

Background

The etiology and risk factors associated with gastrointestinal bleeding (GIB) in patients with continuous-flow left ventricular assist devices (CF-LVADs) are currently unknown. Therefore, we sought to assess the risk factors for GIB in these patients.

Design and Methods

This was a retrospective, non-randomized, non-controlled study at a single center. Between 2012 and 2014, 65 men and 6 women (mean age = 55 ± 12 years) underwent CF-LVAD implantation at our institution. Overall, 23.9% of patients (17/71) had at least one GIB episode. Endoscopy confirmed GIB in 13/17. Arteriovenous malformation was the major GIB source in 8/13 (61%). There was no significant difference in incidence of GIB with regard to INTERMACS profile, blood type, or device type—HeartWare vs. HeartMateII. All our patients with GIB were men, most had hyperlipidemia, and most likely had ischemic cardiomyopathy (65%) and peripheral vascular disease (24%). The only significant risk factor for GIB was chronic kidney disease (odds ratio= 3.95; 95% confidence interval of 1.21 to 12.84; p=0.02). At the time of the first GIB, mean hemoglobin was 7.38 ± 1.06 g/dl, international normalized ratio was 2.08 ± 0.69 IU, and mean arterial pressure was 75 ± 12 mmHg. Ten patients (59%) required hospital admission for treatment.

Conclusion

In our patients GIB was often a single event and often occurred within first month after implantation. Prevention strategies should be focused on this vulnerable period, especially in patients with chronic kidney disease
Incidence of Pump Thrombosis in HeartMate II during Destination Therapy
Authors: Samson Rohan , Jaiswal Abhishek , Smart Frank , LeJemtel Thierry H.
Published: October 2019

Pump thrombosis occurs during destination therapy (DT) with HeartMate II, a continuous blood flow left ventricular assist device (St Jude, Pleasanton, CA, USA). With adherence to stringent post-operative and long-term anticoagulation a low incidence of pump thrombosis was initially reported during DT. The increased PT incidence during DT that was reported in early 2013 was attributed to lenient anticoagulation. A wide range of pump thrombosis incidence during DT is being reported since the return to stringent post-operative and long-term anticoagulation. We searched PubMed from January 2008 to February 2016 for reports of pump thrombosis during mechanical circulatory support with HeartMate II and focus on the incidence rate of pump thrombosis from DT approval by the Food and Drug Administration to present. Pump thrombosis which may have been initially underestimated continues to complicate DT with HeartMate II despite stringent post-operative and long-term anticoagulation.
Total Artificial Heart Imaging and Complications: a Pictorial Review
Authors: Gomez Carrie K. , Hobbs Susan
Published: October 2019

Heart failure is a serious cause of morbidity and mortality with many patients ultimately requiring heart transplantation. As the rate of heart failure continues to increase and surpass the number of available donor hearts, the need for cardiac assist devices is rapidly rising. The total artificial heart has emerged as an effective therapeutic option in patients with end-stage biventricular heart failure who are awaiting orthotopic heart transplantation. The TAH replaces the patient’s native ventricle and valves and has one of the highest bridge to transplant rates. Many complications have been associated with the TAH including infections, bleeding, thrombosis, device malfunction, neurological complications among others. CT is the imaging modality of choice that aids in early recognition of TAH complications.

The aim of this review is to illustrate the TAH components and CT based imaging of TAH complications. Recognition of TAH complications can help to plan for early intervention and therefore improve patient’s survival.
Temporary and Durable Mechanical Circulatory Support for Single Ventricular Failure in an Adult
Authors: Hermsen Joshua L. , Smith Jason W. , Pal Jay D. , Rubio Agustin , Masri S. Carolina , Mokadam Nahush A. , Cheng Richard K. , Mahr Claudius
Published: October 2019

Patients palliated with Fontan circulation who require mechanical circulatory support pose anatomic and physiologic challenges. We treated an acutely failed Fontan patient with sequential temporary and durable support devices. Aspects of treatment with each device required modification based on the patient’s anatomy and physiology.
Normal Lactate Dehydrogenase Does Not Exclude Pump Thrombosis in Left Ventricular Assist Devices
Authors: Shelton Julie , George Bennet , Hart Amanda , Guglin Maya
Published: October 2019

Left ventricular assist device (LVAD) pump thrombosis is a well-known complication of LVAD placement. Elevated lactate dehydrogenase (LDH) has classically been the first objective marker of pump thrombosis. In this case, we present a patient found to have normal serum LDH values but was ultimately found to have significant pump thrombosis.
Acute Appendicitis: A Potential Complication of Continuous-Flow Left Ventricular Assist Device Support
Authors: Roark Joshua S. , Abisogun Akinniran A. , Katz Jason N.
Published: October 2019

Acute appendicitis, while common in younger patients, is an unusual cause for hospitalization among older adults. We report a case series of 3 individuals who had been previously implanted with a continuous-flow left ventricular assist device (CF-LVAD) for end-stage heart failure, and who subsequently developed acute appendicitis. Both axial-flow technology and nonpulsatile systemic blood flow have been implicated as potential causes for bleeding and thrombosis in contemporary LVAD populations(1-3). This case series represents the first report of acute appendicitis as an adverse event following LVAD implantation and represents a patient demographic that would historically be at very low-risk for this illness. Our patients, their presentation, and the associated pathologic findings raise the possibility of a unique link between appendiceal inflammation and CF-LVAD support that warrants attention.
CardioMEMSTM in LVAD Patients: A Case Series
Authors: Guglin Maya , George Bennet , Branam Sarah , Hart Amanda
Published: October 2019

Patients with a left ventricular assist device (LVAD) commonly encounter issues with volume status post-implant. Volume overload can result from incomplete compensation of left ventricular failure or from right ventricular failure. The CardioMEMS™ intracardiac hemodynamic monitoring device is an area of growing interest regarding the management of chronic congestive heart failure, however, its utility has not been serially investigated in patients with an LVAD. We present a case series of patients with ventricular assist devices care for at our institution in which the CardioMEMS™ device aided in the management of volume status and pump performance.
The Utility of Perioperative Transesophageal Echocardiography after Left Ventricular Assist Device Implant: A Case Report
Authors: Parks Andrew , George Bennet , Shafii Alexis , Smith Mikel , Guglin Maya
Published: October 2019

Immediate post-operative evaluation of patients who have received a left ventricular assist device (LVAD) can be a daunting task. We present a case of a 51-year-old female who developed ventricular tachycardia soon after returning from the operating theatre and describe the role transesophageal echocardiogram played in helping prompt urgent and definitive treatment.
Fever of Unknown Origin in Patient after Left Ventricular Assist Device Implantation
Authors: Raichlin Eugenia , Varnado Sara , Um John Y. , Moulton Michael J. , Zolty Ronald
Published: October 2019

Mechanical circulatory support (MCS) is a lifesaving procedure in patients with refractory cardiogenic shock. Despite improvement in surgical techniques, ICU care and restored hemodynamics, some patients on MCS remain severely debilitated due to multiple medical problems, including infections, respiratory failure, de-conditioning and nutritional deficits. Here we present a case of a patient with persistent high degree fever, devastating muscle weakness, and elevated lactate dehydrogenase (LDH) level, who dramatically responded to treatment with vitamin B 12.
Common clinical dilemmas in left ventricular assist device therapy: A glimpse into current trends
Authors: Kilic Ahmet , Kiernan Michael S. , Brisco-Bacik Meredith A. , Lee Sangjin , Soleimani Behzad , Bansal Aditya , Gosev Igor , Eckman Peter , Lima Brian , Bethea Brian , Patel Chetan B. , Katz Jason N. , Rich Jonathan D. , Joseph Susan M.
Published: October 2019

Background

Left ventricular assist device (LVAD) therapy has been thrust into the forefront of surgical treatment for advanced heart failure (HF). Despite advancements in survival and quality of life with these devices, the multi-disciplinary care for these patients remains far from standardized across institutions.

Methods

A survey of current practices in LVAD was carried out at the St. Jude Medical User’s meeting representing a variety of caregivers including cardiac surgeons, HF cardiologists, non-HF cardiologists, advanced practice providers and ventricular assist device coordinators, with representation from several continents. Utilizing an audience response system, eleven questions were asked related to the demographics of the audience, left ventricular assist device patient selection and patient management.

Results

A total of 120 audience members representing both transplant and LVAD centers, destination therapy only LVAD centers and non-implanting, shared care centers across a multitude of disciplines responded to the survey. Questions comprised of patient selection (body mass index, pre-existing renal failure, care giver presence and abstinence from substance abuse) and patient management (anticoagulation regimens, first line therapy for hemolysis, implantable cardioverter-defibrillator usage and route of preferred dialysis) issues.

Conclusions

LVAD technology will continue to change and improve with the next generation of pumps on the horizon. Progress cannot be made without pausing to understand the current state of technology, practice patterns and patient determinants of success. This survey underscores the lack of consensus regarding best practice principles and the need for an increased focus on care management for LVAD patients with collaborative, multi-institutional studies.
Left Ventricular Assist Device is a Viable Therapy in End Stage Hypertrophic Cardiomyopathy
Authors: Byku Mirnela , Nassif Michael , Novak Eric , Itoh Aki , Ewald Gregory , Larue Shane
Published: October 2019

Left Ventricular Assist Device (LVAD) therapy use is increasing rapidly in advanced heart failure (HF). Little data exists on the application of this therapy in patients with advanced HF due to hypertrophic cardiomyopathy (HCM). Altered ventricular geometry, thickened septum and reduced LV end-diastolic diameter (LVEDD) in HCM may lead to increased suction events, arrhythmias and inflow cannula malfunction. We hypothesized that patients with end stage HCM benefit from LVAD therapy and have a similar rate of complications to those with ischemic or dilated CM. Between 2009 and 2014, 5 patients with end stage HCM (HCM and EF <50%), were implanted with either a HeartMate II ® (80%) or HVAD® (20%) device, as a bridge-to-transplant (BTT) (80%) or destination therapy (DT) (20%). We compared baseline characteristics, surgical, and long-term clinical outcomes between these patients and those receiving an LVAD for end stage dilated and ischemic CM (n=214) during that time frame. The HCM cohort had a smaller LVEDD (5.2 versus 6.9 cm, p=0.001) and a higher LVEF (28% v 18%, p=0.002). Cardiopulmonary bypass time was similar between the groups (72min vs 69min). Post-operative length of stay was also similar at 21 days. Operative mortality for HCM patients was 0. All 4 BTT patients survived to transplant. LVAD therapy resulted in improved LVEDD (5.2 cm to 3.9 cm), PASP (58.8 mmHg to 30.8 mmHg), and cardiac index (1.5 to 2.82L/min/m2) in patients with HCM, without an increased incidence of postoperative complications. Median duration of LVAD support in the HCM group was 14 months and 10 months for the control.

We conclude that select patients with end stage HCM may benefit from LVAD therapy with a similar rate of complications compared to traditional candidates. Additional study is warranted to further evaluate durable mechanical support in this population.
Anticoagulation Monitoring in Left Ventricular Assist Device (LVAD) Patients
Authors: Sieg Adam C. , Gass Jennifer A. , Weeks Phillip , Rajapreyar Indranee , Gregoric Igor
Published: October 2019

The use of left ventricular assist devices (LVAD) provides a treatment strategy for advanced heart failure patients to prolong life and serve as a mediator (bridge to transplant) until an organ becomes available in patients considered suitable candidates for heart transplantation. The use of LVAD therapy is complicated by the constant risk of bleeding and thrombotic events. We reviewed and analyzed the effectiveness of our current heparin protocol with respect to overall anticoagulation and time in therapeutic range (TTR). Our analysis demonstrated that patients did not achieve therapeutic anticoagulation for at least 24 hours following initiation of heparin and that only 40% of the time patients were considered therapeutic. Even after patients achieved a therapeutic activated plasma thromboplastin time (aPTT) TTR was only approximately 50% with less than 50% of tests resulting within range. Individual centers should perform ongoing assessment of effectiveness of individual heparin protocol for LVAD patients to ensure anticoagulation is optimized in these highly complex patients.
Capsule Endoscopy in Left Ventricular Assist Device Patients: Retrospective Review of Efficacy and Necessity
Authors: Vaidya Gaurang Nandkishor , Dahhan Ali , Krease Michael , Vijayakrishnan Rajakrishnan , Abbel Thomas , Birks Emma , Abramov Dmitry
Published: October 2019

Background

Capsule endoscopy (CE) is mainstream in the evaluation of obscure gastrointestinal bleeding (GIB) in the general population. However, the diagnostic and therapeutic impact of CE in LVAD patients susceptible to transient bleeding remains largely unexplored. This study aimed to assess the benefits of CE in the evaluation of LVAD associated GIB.

Methods

Retrospective review of patients implanted with a continuous flow LVAD who underwent inpatient capsule endoscopy (CE) between January 2014 and May 2017 at our center. Identification of lesions with high bleeding potential or presence of frank blood were considered abnormal findings on CE study.

Results

Twenty-five inpatients who underwent 41 CE were identified. All patients presented with GIB and had preceding negative upper endoscopy and colonoscopy in the past 4 weeks. On the first capsule in each patient, 19 had interpretable images, abnormal findings were detected in 5 patients (high risk lesion in 3, frank blood in 2), four of these underwent an enteroscopy and only 2 (8%) patients had confirmation of the capsule findings with APC treatment (true positive). Excluding patients with malfunction, LVAD interference and poor bowel prep, 14 patients had negative/equivocal CE, of which 4 underwent enteroscopy due to continued bleeding and 2 of these patients had treatable culprit lesions (false negative). A total of 17 (68%) patients were discharged without any therapeutic intervention irrespective of the success or findings on CE due to clinical stabilization. Twenty patients (80%) had recurrence in a mean 154 days. As expected, repeat capsules in the same admission increased the diagnostic yield (p=0.031). Only nine patients (36%) had capsule-image evidence of reaching the cecum while 4 patients (16%) had retention which had to be retrieved without further complication.

Conclusions

This study demonstrated that evaluation of GIB with CE is feasible and safe but was associated with a low diagnostic yield and low conversion to therapeutic intervention. With a true positive yield of 4% in our cohort, the efficacy and cost-effectiveness of CE in the LVAD population is debatable. The role of CE in LVAD patients may need to be reevaluated. An identification of patients who would benefit from a capsule-first approach would allow optimum utilization of resources and reduce healthcare expenditure.
Right ventricle chest compressions: do we need a new paradigm for LVAD patients needing resuscitation? A case report
Authors: Bhimaraj Arvind , Suarez Erik E. , Estep Jerry D.
Published: October 2019

The use of chest compressions in patients with left ventricular assist devices (LVAD) have been viewed to cause a potential damage to the outflow graft and hence have been a topic of controversy. We report a case of a LVAD patient who needed chest compressions during resuscitation for severe right ventricular failure. With the presence of trans-esophageal echocardiogram we noticed that the chest compressions did not need to be full ACLS compressions but modified to gentle right ventricular (RV) compressions in order to move blood into a normally functioning LVAD. We report this as a call for the LVAD medical providers to rethink concepts of standard resuscitation.
Electrocardiographic characteristics, antiarrhythmic utilization, and outcomes in patients with left ventricular assist devices
Authors: Lundgren Scott , Lyden Elizabeth , Stoller Douglas , Hyden Marshall , Burdorf Adam , Zolty Ronald , Um John , Lowes Brian
Published: October 2019

Background

Left ventricular assist devices (LVAD) are an increasingly used therapy for patients with advanced heart failure. Arrhythmias are common complications following LVAD implantation requiring admission, initiation, and escalation of medical therapy. Despite their frequent use in the treatment of arrhythmias, little has been reported regarding electrocardiographic changes, antiarrhythmic utilization, and outcomes post-LVAD.

Methods

A total of 309 patients who received a LVAD underwent retrospective chart review pre- and post-LVAD. Kaplan-Meier curves were calculated and compared using the log-rank test. Cox regression model was used for univariate analysis and those with a p

Results

There was a significant reduction in both the QRS interval (p=0.0001) and QTc interval (p=0.0074) following LVAD implantation. Ventricular tachycardia is common following LVAD implant at 31.1%. Amiodarone use was frequent prior to LVAD (52.1%) and on discharge (68.6%). Amiodarone use (p=0.019, HR 1.7, 95% CI 1.1-2.6), age at implant (p

Conclusion

Amiodarone is a commonly used antiarrhythmic in advanced heart failure and its use prior to LVAD implantation may increase the risk of long-term mortality. Amiodarone's efficacy needs to be weighed against its long-term side effects and implant on clinical outcomes
What Did We Learn about VADs in 2017?
Authors: Guglin Maya
Published: October 2019

The field of mechanical circulatory support is evolving rapidly and new data are published at a rate which can be overwhelming. For the last three years, we published annual reviews of the current literature entitled “What Did We Learn about VADs?” in the past year (1-3). All three papers were well received as the full texts were downloaded 704, 676 and 413 times, respectively, by the readers around the globe. Continuing the tradition, we have written the present review and as with all previous reviews, we summarized some publications from 2017 that we think are of particular importance and interest. There may be some slight overlap with the end of 2016 due to some papers having been published online first.
Hemodynamic, Therapeutic, and Clinical Outcomes of Ambulatory Pressure-Guided Heart Failure Management
Authors: Abraham Jacob , Wang Lian , Lewis Rebecca , Callis Katherine , Remick Joshua , Spinelli Kateri J.
Published: October 2019

Background

Heart failure (HF) management guided by CardioMEMS™ pulmonary artery pressure (PAP) monitoring reduces PAP and HF hospitalizations. The objective of this project was to characterize the relationship between medication adjustments, PAP change, and outcomes for all patients at an advanced HF center.

Methods

We retrospectively analyzed medication changes and hospitalizations for 32 consecutive patients implanted with the CardioMEMS™ sensor at a single HF center and related these outcomes to PAP data from the Merlin.net (Abbott) database. Absolute change in PAP from baseline was estimated using area under the curve normalized to days monitored.

Results

Patients had an average change in mean PAP of -3.9±1.3 mmHg at 6 months and -5.7±2.1 mmHg at 12 months. Compared to the pre-implant time period, hospital days for HF-related hospitalizations decreased by 6.9 (95% CI = 3.3-10.5) days per patient at 6 months (p<0.001) and 7.9 (95% CI = 4.3-11.5) days per patient at 12 months (p<0.001). Over 12 months, patients with baseline PAP 25-35mmHg and >35mmHg experienced a drop in PAP while their number of medication adjustments decreased, and patients with baseline PAP <25mmHg experienced a rise in PAP and an increase in medication adjustments

Conclusions

PAP-guided HF management involved time-varying intensity of medication changes, which correlated with sustained reductions in hospital stay.
Favorable Outcomes with Ventricular Assist Device Exchange
Authors: Carroll Megan , Tooman Meghan , Bochan Markian , Salerno Christopher , Ravichandran Ashwin
Published: October 2019

Left ventricular assist device (LVAD) therapy remains a vital therapeutic option for patients with end-stage heart failure. Unfortunately, adverse events can occur and progress to require consideration for device exchange once the failure of medical management becomes evident, especially when heart transplantation is not possible in a timely manner. The aim of this analysis is to describe the incidence and outcomes of LVAD exchanges at our institution. Between April 2008 and May 2017, 397 patients underwent LVAD implantation, with 32 of those patients subsequently receiving exchange upon the recommendation of our multidisciplinary team due to refractory infection (n=12), device malfunction (n=5), hemolysis (n=9) and pump thrombosis (n=6). The average time from index implant to exchange was 580.6 days, with an average length of stay of 18.2 days. Survival at 3 months was 84.4%, 75.0% at 1 year and median at 8.3 years after exchange. The most common adverse events, occurring in less than 1/3 of the population, included bleeding, infection and stroke. This study suggests that LVAD exchange can be an effective and definitive mechanism for the treatment of otherwise potential fatal pump complications in highly select patients.
The Use of CardioMEMS in Dialysis Patients with Heart Failure
Authors: Viquez Karolina , Hardesty Peggy , Elyamny Mohamed , Fahmy Karim , Elhusseini Amr , Guglin Maya
Published: October 2019

In patients with chronic kidney disease (CKD) and heart failure (HF), volume overload is a major problem. Removal of fluid during the dialysis treatment is the cornerstone management in these conditions, but assessing the amount of volume that should be removed is a challenge since physical exam findings are not accurate. Ambulatory pulmonary artery (PA) pressure measurement is a promising tool in HF that potentially could be used as well in CKD population, monitoring volume status changes and allowing a prompt intervention such as increasing or decreasing the volume of ultrafiltration. We presented two cases of patients with CKD, HF and CardioMEMS.
Refining Auscultation of Left Ventricular Assist Devices: Insights From Phonocardiography
Authors: Araj Faris , Amin Alpesh , Cox Julie , Mammen Pradeep
Published: October 2019

There have been over 15,000 continuous flow left ventricular assist devices (LVADs) implanted in the United States1 . As the care of these patients expands into the general community, it is important for providers at all levels to be familiar with the sound of a normal LVAD. The sound generated is normally described as an “LVAD hum”. That non-descriptive term may be misunderstood as all LVADs or “hums” are the same, when in fact the sound produced is unique to each device. Another common misconception held by some providers, is the absence of heart sounds in a normally functioning LVAD. Using apex phonocardiography we were able to better visualize these unique characteristics (Figures 1-4, phonocardiograms of three United States Food and Drug Administration approved durable LVADs), and suggest a refined description of each device sound. The recordings were made on normal functioning LVADs using the EKO Core stethoscope attachment (EKO, Berkeley, CA).
The Contribution Nonformal Education in Tourism Development Through Empowerment and Training of Street Vendors
Authors: Ariefianto Lutfi , Hilmi Muhammad Irfan
Published: October 2019

Jember Regency has a Malikan White Sand Beach tourist attraction known as "PAPUMA" which is a destination for both local and foreign tourists. Tourists, one of which is a street vendor around tourist attractions has a very important role in the effort to develop tourist attractions so that they become the "icon" of a famous area. The existence of street vendors around the coast of the coast needs to be empowered and fostered so that tourism development business becomes the joint responsibility of coastal communities, tourism actors and tourists. This study aims to determine the contribution of Nonformal Education as an alternative education in empowering and fostering street vendors in coastal communities "PAPUMA" in Jember Regency. This study uses a qualitative approach. Data collection uses in-depth interview techniques, observation and documentation. The results of the study show that Nonformal Education contributes through its excellent programs such as Information (through community awareness movements, social motivation). The outreach agenda that has been given is the launch of awareness of local potential, hygiene and health counseling, counseling about the importance of preserving nature so that nature can protect humans. Institution through training provided to street vendors to provide new skills to them, such as business management skills, business presentations so that their business increases.
Local Potential Development (Local Genius) in Community Empowerment
Authors: Hidayat Dayat , Syahid Ahmad
Published: October 2019

Community entrepreneurship training is one of strategies to improve community economic empowerment. Entrepreneurship training is carried out to improve the ability of the learners to develop their business. This program was carried out because the community's entrepreneurial ability in the CLC Assolahiyah in Karawang regency was still deficient. The aim of this research is to describe the identification of local resources in the development of entrepreneurship for community empowerment through training and mentoring the community entrepreneurship. The approach in this research is qualitative. Research method used is case study to describe local potential development in community empowerment. Data collection techniques used are observation, interview, and documentation study. Data analysis techniques are interactive models, through the stages of data collection, data reduction, display data, conclusions, and verification. The result concludes that the development strategy of community entrepreneurial program begins with the identification of local potential resources, both natural resources and human resources. The results of the entrepreneurship training are the growth and development of productive skills, technical skills, physical skills, social skills, managerial skills, and intellectual skills of the learner’s entrepreneurship. The impact of developing local potentials in implementing entrepreneurship programs is increasing the empowerment of community entrepreneurship. The indicator is the increase of independence, community empowerment and economic income generation.
Whole genome sequencing of apparently mutation-negative MEN1 patients
Authors: Backman Samuel , Bajic Duska , Crona Joakim , Hellman Per , Skogseid Britt , Stålberg Peter
Published: October 2019

Objective

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant syndrome usually caused by loss-of-function mutations in the MEN1 gene. However, a minority of patients who fulfill the criteria for MEN1 are not found to harbor MEN1 mutations. Besides, some of these individuals, present with a subtly different phenotype suggestive of sporadic disease. The aim of the present study was to investigate the genetic architecture of mutation-negative MEN1.

Design

Fourteen patients with a clinical diagnosis (n = 13) or suspicion (n = 1) of MEN1 who had negative genetic screening of the MEN1 gene were included.

Methods

Constitutional DNA from the included patients, as well as tumor DNA from six of the patients, was subjected to whole genome sequencing. Constitutional variants were filtered against population databases and somatic variants were studied under a tumor-suppressor model.

Results

Three patients carried pathogenic variants (two splice-site variants, one missense variant) in MEN1 that had not been detected during routine clinical sequencing, one patient carried a pathogenic variant in CASR and one patient carried a gross deletion on chromosome 1q which included the CDC73 gene. Analysis of matched tumor DNA from six patients without mutations did not detect any recurrent genes fulfilling Knudson’s two-hit model.

Conclusion

These results highlight the possibility of germline mutations being missed in routine screening, the importance of considering phenocopies in atypical or mutation-negative cases. The absence of apparent disease-causing mutations suggests that a fraction of MEN1 mutation-negative MEN1 cases may be due to the chance occurrence of several endocrine tumors in one patient.
Associations of plasma IGF1, IGFBP3 and estradiol with leucocyte telomere length, a marker of biological age, in men
Authors: Yeap Bu B , Hui Jennie , Knuiman Matthew W , S A Paul Chubb , Ken K Y Ho , Flicker Leon , Divitini Mark L , Arscott Gillian M , Twigg Stephen M , Almeida Osvaldo P , Hankey Graeme J , Golledge Jonathan , Beilby John P
Published: October 2019

Objective

Effects of insulin-like growth factor 1 (IGF1) and its binding proteins (IGFBPs) on ageing, and their interaction with sex hormones, remain uncertain. We examined associations of plasma IGF1, IGFBP1, IGFBP3, estradiol and testosterone, with leucocyte telomere length (LTL), a marker of biological age, in 2999 community-dwelling men aged 70–84 years.

Methods

Plasma IGF1, IGFBP1 and IGFBP3 measured using immunoassay, sex hormones using mass spectrometry. LTL measured by PCR, expressed as ratio of telomeric to single-copy control gene DNA (T/S ratio). Linear regression models adjusted for age and cardio-metabolic risk factors, median splits defined low/high groups.

Results

Mean age was 76.7 ± 3.2 years. IGF1 and IGFBP3 showed age-adjusted correlations with LTL (coefficient 0.59, P = 0.001 and 0.45, P = 0.013 respectively), IGFBP1 did not. In multivariable-adjusted models IGF1 and IGFBP3 (but not IGFBP1) were associated with LTL (T/S ratio 0.015 higher per 1 s.d. increase in IGF1, P = 0.007, and 0.011 per 1 s.d. IGFBP3, P = 0.049). IGF1 and estradiol were independently associated with longer telomeres (T/S ratio 0.012 higher per 1 s.d. increase in estradiol, P = 0.027, when included in model with IGF1). Testosterone was not associated with LTL. Men with both high IGF1 (>133 µg/L) and high estradiol (>70 pmol/L) had longer LTL compared to men with lower values (multivariable-adjusted T/S ratio 1.20 vs 1.16, P = 0.018).

Conclusions

Higher IGF1 and IGFBP3 are independently associated with longer telomeres in older men. Additive associations of higher IGF1 and higher estradiol with telomere length are present. Further studies are needed to determine whether these hormonal exposures cooperate to slow biological aging.
Leptin receptor deficiency: a systematic literature review and prevalence estimation based on population genetics
Authors: Kleinendorst Lotte , Abawi Ozair , van der Kamp Hetty J , Alders Mariëlle , Meijers-Heijboer Hanne E J , van Rossum Elisabeth F C , van den Akker Erica L T , van Haelst Mieke M
Published: October 2019

Objective

Leptin receptor (LepR) deficiency is an autosomal-recessive endocrine disorder causing early-onset severe obesity, hyperphagia and pituitary hormone deficiencies. As effective pharmacological treatment has recently been developed, diagnosing LepR deficiency is urgent. However, recognition is challenging and prevalence is unknown. We aim to elucidate the clinical spectrum and to estimate the prevalence of LepR deficiency in Europe.

Design

Comprehensive epidemiologic analysis and systematic literature review.

Methods

We curated a list of LEPR variants described in patients and elaborately evaluated their phenotypes. Subsequently, we extracted allele frequencies from the Genome Aggregation Database (gnomAD), consisting of sequencing data of 77 165 European individuals. We then calculated the number of individuals with biallelic disease-causing LEPR variants.

Results

Worldwide, 86 patients with LepR deficiency are published. We add two new patients, bringing the total of published patients to 88, of which 21 are European. All patients had early-onset obesity; 96% had hyperphagia; 34% had one or more pituitary hormone deficiencies. Our calculation results in 998 predicted patients in Europe, corresponding to a prevalence of 1.34 per 1 million people (95% CI: 0.95–1.72).

Conclusions

This study shows that LepR deficiency is more prevalent in Europe (n = 998 predicted patients) than currently known (n = 21 patients), suggesting that LepR deficiency is underdiagnosed. An important cause for this could be lack of access to genetic testing. Another possible explanation is insufficient recognition, as only one-third of patients has pituitary hormone deficiencies. With novel highly effective treatment emerging, diagnosing LepR deficiency is more important than ever.
La enseñanza de la historia reciente del conflicto armado colombiano desde los textos de las Comisiones para la Paz
Authors: Plazas Díaz Fabián Alfredo
Published: October 2019

Este artículo de reflexión se deriva del proyecto: “Enseñanza de la historia reciente del conflicto armado colombiano en colegios y universidades del país”. Tiene como objetivo analizar el aporte de los textos de las Comisiones de Paz para la enseñanza y comprensión de la historia reciente del conflicto armado en colegios y universidades del país. El enfoque está enmarcado en la investigación documental, que desde una visión hermenéutica busca generar elementos de discusión acerca de las posibilidades de emplear los textos de las Comisiones en la reflexión y enseñanza de un pasado cercano. En ello, la historia reciente –como disciplina de la historia–, aporta elementos teóricos y metodológicos importantes, que ayudan a mejorar la interpretación y uso pedagógico de las contribuciones en escenarios educativos. Los aportes de revisar los textos a partir del entendimiento teórico de la historia reciente y la complejidad del conflicto armado colombiano llevan a replantear la enseñanza de dicha historia, a partir de la renovación, revisión y actualización, de dicho pasado.
Trolling as a new type of virtual communication
Authors: Danko Yurii
Published: October 2019

The article dwells upon the concept of “trolling” as a new network phenomenon of modernity and a new kind of communication practice. Author analyzes the origins and the development of trolling, argues that the emergence of trolling is mainly related to network anonymity.
Also the article proves that this phenomenon can be regarded as an expression of social aggression.
Political and ideological self-identifications of Ukrainian students: dynamics and current status
Authors: Kutyryova Vira
Published: October 2019

The article dwells upon the analysis of political and ideological self-identifications of the Ukrainian students as the subject of politics; the interdependence of these processes and formation of future professionals’ interest in politics; relevant civil position; certain political attitudes and actions. Article is based on the research results conducted among the Ukrainian students by staff of Sociology department of the V.N.Karazin Kharkiv National University in 2001-2002 and 2008-2009.
The analysis of political and ideological self-identifications dynamics of the students suggests that the project of building an independent national state based on democratic principles, actualized in the minds of young people the national-democratic ideological values; at the same time the increasing number of supporters of the left direction can testify about the growth of social discontent and, accordingly, the protest potential of students.
The solution of the problem of the goal-setting when planning social and economic development
Authors: Solomakhin Oleksandr
Published: October 2019

Now, both in Russia and in Ukraine there is an increased interest in the pro-gram-target planning of socio-economic development. In this regard, in an article in the framework of the program-target planning the necessity of solution of the task of goal-setting is presented.
Author offers solution of this problem based on the SWOT analysis method, which provides a definition of the main directions and implementation risks of various foresight projects.
Integration orientations of the population: Autumn of 2013
Authors: Balakireva Olga , Dmytruk Dmytro
Published: October 2019

Based on the results of the monitoring surveys of the population, paper presents the dynamics of public opinion in regard to the two possible directions of Ukrainian integration (Customs Union or EU) depending on the content and objectives of these projects, aiming at the corresponding basic values.
Flavored E-cigarette Use and Progression of Vaping in Adolescents
Authors: Leventhal Adam M. , Goldenson Nicholas I. , Cho Junhan , Kirkpatrick Matthew G. , McConnell Rob S. , Stone Matthew D. , Pang Raina D. , Audrain-McGovern Janet , Barrington-Trimis Jessica L.
Published: October 2019

OBJECTIVES:

Electronic cigarettes (e-cigarettes) are available in nontraditional flavors (eg, fruit and candy) that are banned in combustible cigarettes in the United States. Whether adolescent use of e-cigarettes in nontraditional flavors prospectively predicts continuation of vaping and progression to more frequent vaping is unknown.

METHODS:

High school students in Los Angeles, California, completed 5 semiannual surveys (2014–2017 [10th grade to 12th grade]). Among past-6-month e-cigarette users at survey waves 1 to 4 (N = 478), e-cigarette flavor (or flavors) used was coded into 2 mutually exclusive categories at each wave (use of ≥1 nontraditional flavors [fruit, candy, sweet or dessert, buttery, blends or combinations, and other] versus exclusive use of tobacco, menthol or mint, or flavorless). Flavor used during waves 1 to 4 was modeled as a time-varying, time-lagged regressor of vaping status and frequency outcomes 6 months later at waves 2 to 5.

RESULTS:

Across waves 1 to 4, there were 739 (93.8%) observations of nontraditional-flavor use and 49 (6.2%) observations of exclusive use of tobacco, mint or menthol, or flavorless e-cigarettes. Use of e-cigarettes in nontraditional flavors (versus only tobacco, mint or menthol, or flavorless) was positively associated with vaping continuation (64.3% vs 42.9%; adjusted odds ratio = 3.76 [95% confidence interval 1.20 to 10.31]) and past-30-day number of puffs per nicotine vaping episode (mean: 3.1 [SD 5.5] vs 1.5 [SD 3.8]; adjusted rate ratio = 2.41 [95% confidence interval 1.08 to 5.92]) 6 months later. Flavor used was not associated with the subsequent number of past-30-day vaping days or episodes per day.

CONCLUSIONS:

Adolescents who vaped e-cigarettes in nontraditional flavors, compared with those who exclusively vaped tobacco-flavored, mint- or menthol-flavored, or flavorless e-cigarettes, were more likely to continue vaping and take more puffs per vaping occasion 6 months later.
Re-existencias y lucha política en América Latina: un registro de las temporalidades campesino/indígena desde el Sur Global
Authors: Soto Oscar
Published: October 2019

Este artículo se enfoca en el reconocimiento de alteridades campesinas-indígenas invisibilizadas, que resisten al patrón colonial-patriarcal-capitalista y sus ausencias. Para ello reflexionamos en torno a las prácticas en los territorios campesinos que habitan el mundo rural en la configuración de sus rexistencias, con la perspectiva de incluir allí un espacio conceptual y retórico para la constitución de un “archivo”. Finalmente, a partir de una investigación militante situada desde las epistemologías del sur, se da cuenta de las formas en las que persiste la memoria campesina-indígena de la otredad agraria argentina, contenida particularmente en la lucha de la Unión de Trabajadores Rurales Sin Tierra (UST) de Argentina.
Problemas sociales y políticos en el eslabón primario del sector apícola colombiano
Authors: Rincón Daniel , Téllez Gonzalo
Published: October 2019

Este artículo tiene como objetivo la identificación de problemas en el eslabón primario de la cadena productiva apícola colombiana y su posible inclusión en la formulación de políticas públicas sectoriales. Metodológicamente, el objetivo se desarrolla a partir de una revisión bibliográfica y de la realización de talleres de diagnóstico participativo en seis organizaciones de productores apícolas. A pesar de la existencia de un acervo documental en el sector apícola colombiano, no es posible definir con exactitud a partir del mismo la presencia de problemas sociales o políticos que puedan ser tenidos en cuenta en la formulación de una política pública sectorial. De la totalidad de los problemas identificados en el diagnóstico participativo, cinco podrían ser catalogados como problemas sociales en un eventual proceso de formulación de una política pública sectorial; siempre y cuando la institucionalidad formal del sector inicie el mismo.
Los actores privados en los terrenos de la Inteligencia Gubernamental (IG): una pesquisa breve a su actividad y responsabilidad en Colombia
Authors: Venegas Álvaro
Published: October 2019

Este artículo explora la naturaleza de la actividad de Inteligencia Privada (IP) y la responsabilidad gubernamental en la gestión pública en Colombia. ¿Qué problemas existen como producto de las actividades de la IP?, y, en vista de ellos, ¿existe alguna normatividad y organismo estatal que supervise y regule las actividades de los privados que acrediten experiencia y formación en investigación e inteligencia? Aquí se ofrecen tres estudios de caso que involucran a la IP, una evaluación de algunos indicios de riesgo o amenaza a la seguridad y la privacidad ciudadana, y un andamiaje axiológico para alertar y fortalecer al Estado, que no cuenta con una política para controlar esas actividades. Para alcanzar estas metas, se usa el análisis de Spearin para sugerir la aplicación en Colombia de cuatro formas de rendición de cuentas: Política, Judicial, de Mercadeo y Administrativa. Además, plantea algunas consideraciones en concordancia con el trabajo legítimo de la Inteligencia Gubernamental (IG).
Suzanne Roussi-Césaire: opacidad y camuflaje
Authors: Caicedo Andrés Julián
Published: October 2019

A pesar del amplio reconocimiento que han tenido autores como Aimé Césaire, Frantz Fanon y Édouard Glissant en la configuración de un pensamiento Afrofrancófono y Afrocaribeño en el siglo XX, el reconocimiento de las mujeres no ha tenido el mismo alcance. Este artículo presenta una lectura de la obra de Suzanne Roussi-Césaire (nacida en Martinica, 1915-1966) con el ánimo de visibilizar apuestas políticas, estéticas e intelectuales creadas por mujeres Afrofrancófonas y caribeñas. La exposición se divide en tres apartados. Primero, realizo una breve presentación de la metáfora caníbal durante la conquista europea en el “Nuevo Mundo”, con el ánimo de contextualizar la poesía caníbal propuesta por Roussi- Césaire. Segundo, expongo la crítica que Roussi-Césaire realizó al doudouisme como registro literario y escópico de exotización colonial. Finalmente, presento la propuesta visual que ella diseñó para enfrentar el doudouisme: un caribe opaco, un paisaje camuflado.
Peters, B. G. (2018). Policy Problems and Policy Design. Cheltenham: Edward Elgar, 172 pp.
Authors: Rodrígues de Caires Carlos Miguel
Published: October 2019

B. Guy Peters fue uno de los primeros académicos en incorporar de manera explícita la perspectiva del diseño en los estudios de políticas. En una serie de textos publicados junto a su colega Stephen Linder en la década de los ochenta (Linder y Peters, 1984, 1987, 1988, 1989), Peters constató las limitaciones que confrontaban tanto las macroteorías sociales como el enfoque secuencial de las políticas para proveer orientaciones efectivas a la intervención gubernamental. Los autores subrayaron la necesidad de reevaluar las teorías hasta entonces producidas a la luz de una actitud explícita de diseño, orientada a abordar la complejidad de la acción gubernamental de una manera más inteligente y contingente.