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Recurrent aortic arch obstruction following the Norwood procedure is recognised as an important complication. Balloon arch angioplasty is associated with a high recoarctation rate.
We sought to evaluate the prevalence and outcome of stent implantation for recoarctation in children following Norwood or Damus–Kaye–Stansel procedure over the past decade at a single national cardiology centre.
Of 114 children who underwent Norwood procedure or Damus–Kaye–Stansel procedure between January 2003 and June 2013, 80 patients survived. Of these 15 children underwent stent implantation for recoarctation. Six of these patients had previous balloon angioplasty. The median age at stent implantation was 4.4 months (range 2–82 months). The median peak aortic arch gradient at catheterisation decreased from 26mmHg (range 10–70mmHg) to 2mmHg (range 0–20mmHg). The median luminal diameter increased from 4.7 mm (range 3.2–7.9 mm) to 8.6 mm (range 6.2–10.9 mm). The median coarctation index increased by 0.49 (range = 0.24–0.64). A Valeo stent was employed in 11 children, a Palmaz Genesis stent in 2 patients, a MultiLink stent in 1 child, and a Jomed covered stent in 1 child. Two factors were associated with the need for stent placement: previous arch angioplasty (p valve < 0.001, χ-square 11.5) and borderline left ventricle (p = 0.04, χ-square = 4.1). Stent migration occurred in one child. There were two deaths related to poor right ventricular systolic function and severe tricuspid regurgitation. Six patients underwent redilation of the stent with no complications.
The prevalence of recurrent aortic arch obstruction following Norwood/Damus–Kaye–Stansel procedure was 18%. Stent implantation is safe and reliably eliminates the aortic obstruction. Redilation can be successfully achieved to accommodate somatic growth or development of stent recoarctation.
We describe the case of a newborn infant with transposition of the great vessels and a retroaortic innominate vein. This is a previously undescribed association. The decision was made to incorporate the retroaortic innominate vein into the Lecompte procedure at the time of surgery to avoid the risk of superior caval vein syndrome.
Mental imagery refers to the experience of perception in the absence of external sensory input. Deficits in the ability to generate mental imagery or to distinguish it from actual sensory perception are linked to neurocognitive conditions such as dementia and schizophrenia, respectively. However, the importance of mental imagery to psychiatry extends beyond neurocognitive impairment. Mental imagery has a stronger link to emotion than verbal-linguistic cognition, serving to maintain and amplify emotional states, with downstream impacts on motivation and behavior. As a result, anomalies in the occurrence of emotion-laden mental imagery has transdiagnostic significance for emotion, motivation, and behavioral dysfunction across mental disorders. This review aims to demonstrate the conceptual and clinical significance of mental imagery in psychiatry through examples of mood and anxiety disorders, self-harm and suicidality, and addiction. We contend that focusing on mental imagery assessment in research and clinical practice can increase our understanding of the cognitive basis of psychopathology in mental disorders, with the potential to drive the development of algorithms to aid treatment decision-making and inform transdiagnostic treatment innovation.
We used pollen and high-resolution charcoal analysis of lake sediment to reconstruct a 7600 yr vegetation and fire history from Anthony Lake, located in the Blue Mountains of northeastern Oregon. From 7300 to 6300 cal yr BP, the forest was composed primarily of Populus, and fire was common, indicating warm, dry conditions. From 6300 to 3000 cal yr BP, Populus declined as Pinus and Picea increased in abundance and fire became less frequent, suggesting a shift to cooler, wetter conditions. From 3000 cal yr BP to present, modern-day forests composed of Pinus and Abies developed, and from 1650 cal yr BP to present, fires increased. We utilized the modern climate-analogue approach to explain the potential synoptic climatological processes associated with regional fire. The results indicate that years with high fire occurrence experience positive 500 mb height anomalies centered over the Great Basin, with anomalous southerly component of flow delivering dry air into the region and with associated sinking motions to further suppress precipitation. It is possible that such conditions became more common over the last 1650 cal yr BP, supporting an increase in fire despite the shift to more mesic conditions.
A fine-grained, up to 3-m-thick tephra bed in southwestern Saskatchewan, herein named Duncairn tephra (Dt), is derived from an early Pleistocene eruption in the Jemez Mountains volcanic field of New Mexico, requiring a trajectory of northward tephra dispersal of ~1500 km. An unusually low CaO content in its glass shards denies a source in the closer Yellowstone and Heise volcanic fields, whereas a Pleistocene tephra bed (LSMt) in the La Sal Mountains of Utah has a very similar glass chemistry to that of the Dt, supporting a more southerly source. Comprehensive characterization of these two distal tephra beds along with samples collected near the Valles caldera in New Mexico, including grain size, mineral assemblage, major- and trace-element composition of glass and minerals, paleomagnetism, and fission-track dating, justify this correlation. Two glass populations each exist in the Dt and LSMt. The proximal correlative of Dt1 is the plinian Tsankawi Pumice and co-ignimbritic ash of the first ignimbrite (Qbt1g) of the 1.24 Ma Tshirege Member of the Bandelier Tuff. The correlative of Dt2 and LSMt is the co-ignimbritic ash of Qbt2. Mixing of Dt1 and Dt2 probably occurred during northward transport in a jet stream.
Judicial scholars have often speculated about the impact of elections on the administration of justice in the state courts. Yet relatively little research has concerned itself with public perceptions of state court selection methods. Of particular interest is the concept of legitimacy. Do elections negatively affect public perceptions of judicial legitimacy? Bonneau and Hall (2009) and Gibson (2012) answer this question with an emphatic “No.” Judicial elections, these studies show, are not uniquely troublesome for perceptions of institutional legitimacy. This article aims to extend the findings of Bonneau and Hall and Gibson via a laboratory experiment on the effects of elections on public perceptions of judicial legitimacy. In the end, we find that because elections preempt the use of the other main selection method—appointment—they actually enhance perceptions of judicial legitimacy rather than diminish them.
Global climate change poses significant threats to the Caribbean islands. Yet, little is known about the long-term disturbance regimes in island ecosystems. This research investigates 2000 yr of natural and anthropogenic fire disturbance through the analysis of a latitudinal transect of sediment records from coastal salt ponds in the British Virgin Islands (BVI). The two research objectives in this study are (1) to determine the fire regime history for the BVI over the last 2000 yr and (2) to explore ecological impacts from anthropogenic landscape modification pre- and post-European settlement. The magnitude of anthropogenic landscape modification, including the introduction of agriculture, was investigated through a multiproxy approach using sedimentary records of fossil pollen and charcoal. Our results suggest fire regimes from Belmont Pond, Thatch Island, and Skeleton Pond have been influenced by human activity, particularly during the postsettlement era, from 500 cal yr BP to modern. Our results suggest that fire regimes during the Medieval Climate Anomaly were responding to changes in climate via dominant atmospheric drivers. The presettlement fire regimes from these islands suggest that fires occurred every 90 to 120 yr. This research represents a significant data contribution to a region with little disturbance and vegetation data available.
We examined the radiocarbon (14C) reservoir effect in Lake Kutubu using tephrochronology and terrestrial plant material to deliver a precise age-depth profile and sedimentation rates for this lake. Based on the presence of two tephra horizons (Tibito and Olgaboli), we found a reservoir age offset in sediments of between 1490 and 2280 14C yr using the sediment ages derived from the lead-210 (210Pb) dating method. The live submerged biological samples collected exhibited a higher reservoir age offset than the sediment. This is most likely a result of delayed transport of “bomb” 14C from the atmosphere to aquatic and sedimentary system. The 14C reservoir effect increased with distance from the lake inlet and also decreased with depth. Dissolution of 14C-depleted carbon from surrounding limestone and direct in-wash of old soil or vegetation remnants from the catchment are the most likely causes of the 14C reservoir effect. Based on limestone areas mapped in Papua New Guinea, we indicate lakes which may be subject to a significant 14C reservoir effect. The results of this study demonstrate the magnitude of the 14C reservoir effect in lakes and provide insights to the correct interpretation of past environmental and archaeological events in PNG.