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Hospital readmission is an important driver of costs among patients with CHD. We assessed predictors of 30-day rehospitalisation following cardiac surgery in CHD patients across the lifespan.
This was a retrospective analysis of 981 patients with CHD who had cardiac surgery between January 2011 and December 2012. A multivariate logistic regression model was used to identify demographic, clinical, and surgical predictors of 30-day readmission. Receiver operating curves derived from multivariate logistic modelling were utilised to discriminate between patients who were readmitted and not-readmitted at 30 days. Model goodness of fit was assessed using the Hosmer–Lemeshow test statistic.
Readmission in the 30 days following congenital heart surgery is common (14.0%). Among 981 patients risk factors associated with increased odds of 30-day readmission after congenital heart surgery through multivariate analysis included a history of previous cardiac surgery (p < 0.001), longer post-operative length of stay (p < 0.001), as well as nutritional (p < 0.001), haematologic (p < 0.02), and endocrine (p = 0.04) co-morbidities. Patients who underwent septal defect repair had reduced odds of readmission (p < 0.001), as did children (p = 0.04) and adult (p = 0.005) patients relative to neonates.
Risk factors for readmission include a history of cardiac surgery, longer length of stay, and co-morbid conditions. This information may serve to guide efforts to prevent readmission and inform resource allocation in the transition of care to the outpatient setting. This study also demonstrated the feasibility of linking a national subspecialty registry to a clinical and administrative data repository to follow longitudinal outcomes of interest.
Body dysmorphic disorder (BDD) is characterized by a preoccupation with misperceived defects in appearance. Neuropsychological studies and neuroimaging studies of face perception suggests visual processing abnormalities in individuals with BDD, which may involve focus on details at the expense of configural elements.
The objective of the current functional magnetic resonance imaging (fMRI) study was to determine whether individuals with BDD have abnormal patterns of brain activation when visually processing non-face objects (houses).
Fourteen medication-free subjects with BDD and fourteen matched healthy controls engaged in a matching task of photographs of houses that were
b) high spatial frequency (high detail elements only), or
c) low spatial frequency (low detail elements only).
The main outcome measure was group differences in blood oxygen level-dependent fMRI signal changes.
BDD subjects demonstrated lesser activity relative to controls in left parahippocampal gyrus, left lingual gyrus, and bilateral precuneus for low spatial frequency images and relatively greater activity in the frontal pole, left superior frontal gyrus, bilateral anterior cingulate gyrus, and bilateral paracingulate gyrus for high spatial frequency images (Figure 1).
Individuals with BDD have abnormal brain activation patterns when viewing houses for both detailed and configural/holistic visual elements. These results suggest general abnormalities in higher- and lower-order visual processing in individuals with BDD, beyond that for appearance-related stimuli.
Attention, working memory (WM), information processing and memory deficits are important features of schizophrenia. WM functions appear to be mediated by the dorsolateral prefrontal cortex (DLPFC). Functional imaging studies have shown a failure to activate the DLPFC during working memory tasks in patients with chronic schizophrenia. The primary aim of this study is to determine whether there are brain activation changes in the dorso-lateral prefrontal cortex (DLPFC) as a result of engaging in a randomized, controlled 12 week course of cognitive remediation therapy (CRT) in inpatients with chronic schizophrenia.
Patients with DSM IV schizophrenia are randomized to a 12 week trial of Cognitive Remediation (CR) using a Computerized CR program (COGPACK) or to a 12-week control condition. Patients receive at baseline and endpoint an fMRI scan with a cognitive task (N-back task), a neuropsychological test battery (MATRICS), functional and symptom assessments.
Preliminary results of this ongoing study show that patients after 12 weeks of CR showed (1) significantly more improvement in WM functions than patients who participated in the control group and (2) improvement in accuracy on the verbal letter 2-back task during the fMRI scan. Signal difference between 2-back and 0-back was not present or only present minimally at baseline (Pre-CR); however, at endpoint (Post-CR) there was signal difference present, which corresponds to an increase in activation in the areas of the DLPFC. This increase in activation pattern may be reflective of the effects of the exposure to the CR intervention.
Immunocastration provides a less invasive means of castrating lambs. Considering increasing consumer awareness, the efficacy of this technique on commercial slaughter lambs needs to be further investigated and its effects on growth and stress responses need to be established. This study compared the growth rate, testes size and stress responses of immunocastrated lambs with that of lambs physically castrated with a Burdizzo clamp, as well as intact rams. A total of 40 Dohne Merino ram lambs (average live weight = 45.4±3.68 kg) were randomly allocated to the following four treatment groups: control (intact; R), Burdizzo-castrated (on day 2; B), immunocastrated with a 4-week (ICS4), or a 6-week (ICS6) interval between the second immunocastration vaccination and slaughter. Within the immunocastration treatments, the reaction to vaccination was assessed through injection site scoring, recording the local injection site surface temperature and assigning a walking score. The response to Burdizzo castration was assessed by scoring the reaction during the procedure, testes palpation reaction, walking gait and measuring testis temperature. Additional parameters recorded included BW, serum cortisol concentration, scrotal circumference and rectal temperature. Pain behaviours were described for the short-, medium- and long-term effects after the two methods of castration. Predominantly, tissue-hardening and bruising occurred at the injection sites of immunocastrates, but little effect was observed on walking comfort and no effect on injection site temperature or rectal temperatures. After Burdizzo castration, lambs spent more time in abnormal postures, and from day 3 (D3) to D8 of the trial, discomfort was observed during testes palpation and walking in B lambs. Serum cortisol concentrations were elevated in B lambs on D3 and D15, indicating physiological stress. Thus, immunocastration improved the welfare of castrated lambs as assessed by cortisol secretion, scrotal swelling and pain behaviours, without influencing growth rate.
Immunocastration improves the welfare of castrated commercial slaughter lambs; however, the time-point at which this technique influences semen quality and sperm production has not yet been established for various vaccination schedules. Furthermore, the effect of extended intervals between second vaccination and slaughter needs to be investigated regarding continued testosterone suppression in immunocastrated lambs. The effect of extending the interval between second immunocastration vaccination and slaughter from four to six weeks on the reproductive capacity of Dohne Merino lambs was examined. A total of 40 Dohne Merino lambs were stratified according to initial weight (45.4±3.68 kg) and randomly assigned to four treatments that included intact control rams (R), Burdizzo-castrated lambs (B) and lambs immunocastrated with either four (ICS4) or six (ICS6) weeks between second vaccination and slaughter. Blood and semen samples were collected throughout the study period to determine serum testosterone concentrations, evaluate semen quality and assess sperm viability. Semen samples from R showed improvement over the trial. Throughout the collection period, B lambs had low serum testosterone concentrations, poor sperm motility and sperm viability, as expected. However, a slight increase in the percentage of live sperm in semen samples from B lambs towards the end of the collection period indicated poor success rates of the technique in some lambs. Burdizzo-castration also caused testes tissue necrosis and abscessing, indicating physiological stress. Semen appearance scores varied for both immunocastrated treatments, but the mass motility scores decreased over time. The ICS6 lambs showed a consistent and continuous decline in serum testosterone concentrations and sperm viability, with an increased percentage of dead abnormal sperm in the semen samples at the end of the study. The ICS4 treatment was successful in interrupting serum testosterone production and reducing semen quality; however, not as consistently as the ICS6 treatment. Primary immunocastration vaccination influenced serum testosterone concentrations but consistently low levels were only realised for both treatments after secondary vaccination. Although all castration treatments influenced testes size and colour, the six-week vaccination-to-slaughter interval caused a greater decrease in testes cut surface L* (lightness) colour values and in seminiferous tubule circumference. Extending the interval between second immunocastration vaccination and slaughter resulted in a more consistent and reliable influence on reproductive capacity of immunocastrated lambs. Thus, immunocastration is a suitable alternative to Burdizzo-castration regarding the interruption of testosterone production and testis functioning.
BACKGROUND: IGTS is a rare phenomenon of paradoxical germ cell tumor (GCT) growth during or following treatment despite normalization of tumor markers. We sought to evaluate the frequency, clinical characteristics and outcome of IGTS in patients in 21 North-American and Australian institutions. METHODS: Patients with IGTS diagnosed from 2000-2017 were retrospectively evaluated. RESULTS: Out of 739 GCT diagnoses, IGTS was identified in 33 patients (4.5%). IGTS occurred in 9/191 (4.7%) mixed-malignant GCTs, 4/22 (18.2%) immature teratomas (ITs), 3/472 (0.6%) germinomas/germinomas with mature teratoma, and in 17 secreting non-biopsied tumours. Median age at GCT diagnosis was 10.9 years (range 1.8-19.4). Male gender (84%) and pineal location (88%) predominated. Of 27 patients with elevated markers, median serum AFP and Beta-HCG were 70 ng/mL (range 9.2-932) and 44 IU/L (range 4.2-493), respectively. IGTS occurred at a median time of 2 months (range 0.5-32) from diagnosis, during chemotherapy in 85%, radiation in 3%, and after treatment completion in 12%. Surgical resection was attempted in all, leading to gross total resection in 76%. Most patients (79%) resumed GCT chemotherapy/radiation after surgery. At a median follow-up of 5.3 years (range 0.3-12), all but 2 patients are alive (1 succumbed to progressive disease, 1 to malignant transformation of GCT). CONCLUSION: IGTS occurred in less than 5% of patients with GCT and most commonly after initiation of chemotherapy. IGTS was more common in patients with IT-only on biopsy than with mixed-malignant GCT. Surgical resection is a principal treatment modality. Survival outcomes for patients who developed IGTS are favourable.
Coinfection with human immunodeficiency virus (HIV) and viral hepatitis is associated with high morbidity and mortality in the absence of clinical management, making identification of these cases crucial. We examined characteristics of HIV and viral hepatitis coinfections by using surveillance data from 15 US states and two cities. Each jurisdiction used an automated deterministic matching method to link surveillance data for persons with reported acute and chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections, to persons reported with HIV infection. Of the 504 398 persons living with diagnosed HIV infection at the end of 2014, 2.0% were coinfected with HBV and 6.7% were coinfected with HCV. Of the 269 884 persons ever reported with HBV, 5.2% were reported with HIV. Of the 1 093 050 persons ever reported with HCV, 4.3% were reported with HIV. A greater proportion of persons coinfected with HIV and HBV were males and blacks/African Americans, compared with those with HIV monoinfection. Persons who inject drugs represented a greater proportion of those coinfected with HIV and HCV, compared with those with HIV monoinfection. Matching HIV and viral hepatitis surveillance data highlights epidemiological characteristics of persons coinfected and can be used to routinely monitor health status and guide state and national public health interventions.
OBJECTIVES/SPECIFIC AIMS: The 2 primary objectives were to (i) insure that Scholars can effectively communicate the translational impact of their research to a lay audience and (ii) assess the benefits and efficacy of having community, as well as faculty members, judge the translational impact of KL2 Scholar’s poster presentations. An explicit secondary goal was to further the engagement of community members in CTSI-sponsored translational research. METHODS/STUDY POPULATION: CTSI’s Education, Community Engagement, Discovery and Translation, and Translational Workforce Development Cores created the translational impact questions and evaluation sheets. The Community Engagement and Office of Discovery and Translation recruited community judges from their respective networks and they were assigned to relevant studies. Scholars were provided with the judges scoring template in advance. After the Research Poster Session, the KL2 Scholars evaluated the quality of their presentations and the impact of having feedback from Community Judges. The Community Judges evaluated their perceived “added value” to the research presentations and their interactions with the Scholars. Both Scholars and judges completed evaluations of the poster presentation and judging process, performed on a 5-point Likert scale. RESULTS/ANTICIPATED RESULTS: KL2 Scholars felt that the community impact judges provided valuable feedback on their research (3.8/5) and were satisfied overall with the poster session (3.4/5). In evaluating their own presentations, Scholars tended to rate themselves higher (4.2–4.6/5) on the clarity of their translational impact presentations than the community judges rated the Scholars (4.1–4.2/5). Scholars also rated themselves somewhat higher in the quality of their dealing with any ethical issues and their dissemination plan (4.0/5) than the community judges (3.8/5). Judges were very positive and felt they brought value to the experience (4.2–4.4/5). DISCUSSION/SIGNIFICANCE OF IMPACT: Community judges added qualitative value to the Scholar presentations based on the Scholar and community judge evaluations and based on comparison based on prior year poster sessions. Documenting the degree of impact of the combination of this proscribed poster format and community-judging process awaits future assessment of Scholar presentations before and after the next annual poster presentation.
Voters and political candidates increasingly use social networking sites (SNSs) such as Facebook. This study uses data from an online posttest-only experiment (N = 183) in analyzing how exposure to supportive or challenging user comments on a fictional candidate's Facebook page influenced participants’ perceptions of and willingness to vote for the candidate, as well as whether candidate replies to each type of user comments affected these outcomes. Participants who viewed a page with supportive comments and “likes” reported more favorable perceptions of and greater support for the candidate, relative to participants who viewed a page with challenging comments. Thus, the appearance of interactivity between a candidate and other users on the candidate's Facebook page can shape the responses of those viewing the page. However, exposure to candidate replies to either supportive or challenging comments did not lead to significantly more favorable perceptions or a greater likelihood of voting for the candidate.
To highlight the value of sialendoscopy during transoral resection of the sublingual gland for a plunging ranula to prevent iatrogenic injury to the submandibular duct.
Method and results:
The clinical course of a 20-year-old male with a plunging ranula was analysed. The patient underwent transoral resection of the affected sublingual gland and pseudocyst. Sialendoscopy was used to confirm patency of the submandibular duct with placement of a Marchal dilator to aid in preservation of the duct during sublingual gland dissection. The sublingual gland was successfully removed, with no injury to the submandibular duct or lingual nerve. During follow up, the patient had slight numbness to the tip of the tongue, which resolved after 2–3 days. Post-operative examination showed the submandibular duct to be intact and there was no swelling of the submandibular area.
Sialendoscopy-assisted transoral sublingual gland resection for a plunging ranula is a safe and effective technique. Sialendoscopy aids in skeletonisation and preservation of the submandibular duct.
Ediacara-type fossils are found in a diverse array of preservational styles, implying that multiple taphonomic mechanisms might have been responsible for their preservational expression. For many Ediacara fossils, the “death mask” model has been invoked as the primary taphonomic pathway. The key to this preservational regime is the replication or sealing of sediments around the degrading organisms by microbially induced precipitation of authigenic pyrite, leading toward fossil preservation along bedding planes. Nama-style preservation, on the other hand, captures Ediacaran organisms as molds and three-dimensional casts within coarse-grained mass flow beds, and has been previously regarded as showing little or no evidence of a microbial preservational influence. To further understand these two seemingly distinct taphonomic pathways, we investigated the three-dimensionally preserved Ediacaran fossil Pteridinium simplex from mass flow deposits of the upper Kliphoek Member, Dabis Formation, Kuibis Subgroup, southern Namibia. Our analysis, using a combination of petrographic and micro-analytical methods, shows that Pteridinium simplex vanes are replicated with minor pyrite, but are most often represented by open voids that can be filled with secondary carbonate material; clay minerals are also found in association with the vanes, but their origin remains unresolved. The scarcity of pyrite and the development of voids are likely related to oxidative weathering and it is possible that microbial activities and authigenic pyrite may have contributed to the preservation of Pteridinium simplex; however, any microbes growing on P. simplex vanes within mass flow deposits were unlikely to have formed thick mats as envisioned in the death mask model. Differential weathering of replicating minerals and precipitation of secondary minerals greatly facilitate fossil collection and morphological characterization by allowing Pteridinium simplex vanes to be parted from the massive hosting sandstone.
We document changes for Mittivakkat Gletscher, the peripheral glacier in Greenland with the longest field-based observed mass-balance and surface velocity time series. Between 1986 and 2011, this glacier changed by −15% in mean ice thickness and −30% in volume. We attribute these changes to summer warming and lower winter snow accumulation. Vertical strain compensated for ∼60% of the elevation change due to surface mass balance (SMB) in the lower part, and ∼25% in the upper part. The annual mean ice surface velocity changed by −30%, which can be fully explained by the dynamic effect of ice thinning, within uncertainty. Mittivakkat Gletscher summer surface velocities were on average 50–60% above winter background values, and up to 160% higher during peak velocity events. Peak velocity events were accompanied by uplift of a few centimeters.
The current status of the Watcher robotic telescope is presented in the light of a recent
hardware and software upgrade. The latest gamma-ray burst rapid follow-up observations are
discussed, with particular reference to GRB 120711A.
Pollen and conifer stomata analyses of lake sediments from Hippa Island on the north coast of British Columbia were used to reconstruct the vegetation history of this small hypermaritime island. Between 14,000 and 13,230 cal yr BP, the island supported diverse herb–shrub communities dominated by Cyperaceae, Artemisia and Salix. Pinus contorta and Picea sitchensis stomata indicate that these conifers were present among the herb–shrub communities, likely as scattered individuals. Transition to open P. contorta woodland by 13,000 cal yr BP was followed by increases in Alnus viridis, Alnus rubra and P. sitchensis. After 12,000 cal yr BP, Pinus-dominated communities were replaced by dense P. sitchensis and Tsuga heterophylla forest with Lysichiton americanus and fern understory. Thuja plicata stomata indicate that this species was present by 8700 cal yr BP, but the pollen record suggests that its populations did not expand to dominate regional rainforests, along with Tsuga and Picea, until after 6600 cal yr BP. Conifer stomata indicate that species may be locally present for hundreds to thousands of years before pollen exceed thresholds routinely used to infer local species arrival. When combined, pollen and conifer stomata can provide a more accurate record of paleovegetation than either when used alone.