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The initial classic Fontan utilising a direct right atrial appendage to pulmonary artery anastomosis led to numerous complications. Adults with such complications may benefit from conversion to a total cavo-pulmonary connection, the current standard palliation for children with univentricular hearts.
A single institution, retrospective chart review was conducted for all Fontan conversion procedures performed from July, 1999 through January, 2017. Variables analysed included age, sex, reason for Fontan conversion, age at Fontan conversion, and early mortality or heart transplant within 1 year after Fontan conversion.
A total of 41 Fontan conversion patients were identified. Average age at Fontan conversion was 24.5 ± 9.2 years. Dominant left ventricular physiology was present in 37/41 (90.2%) patients. Right-sided heart failure occurred in 39/41 (95.1%) patients and right atrial dilation was present in 33/41 (80.5%) patients. The most common causes for Fontan conversion included atrial arrhythmia in 37/41 (90.2%), NYHA class II HF or greater in 31/41 (75.6%), ventricular dysfunction in 23/41 (56.1%), and cirrhosis or fibrosis in 7/41 (17.1%) patients. Median post-surgical follow-up was 6.2 ± 4.9 years. Survival rates at 30 days, 1 year, and greater than 1-year post-Fontan conversion were 95.1, 92.7, and 87.8%, respectively. Two patients underwent heart transplant: the first within 1 year of Fontan conversion for heart failure and the second at 5.3 years for liver failure.
Fontan conversion should be considered early when atrial arrhythmias become common rather than waiting for severe heart failure to ensue, and Fontan conversion can be accomplished with an acceptable risk profile.
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
To determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP).
Retrospective observational cohort study.
This study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies.
The study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites.
To determine the incidence and duration of absenteeism in outpatient settings, HCP participating in the Respiratory Protection Effectiveness Clinical Trial at both mandatory and nonmandatory vaccination sites over 3 viral respiratory illness (VRI) seasons (2012–2015) reported their influenza vaccination status and symptomatic days absent from work weekly throughout a 12-week period during the peak VRI season each year. The adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models.
The proportion of participants who received influenza vaccination was lower each year at nonmandatory than at mandatory vaccination sites (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.07–0.11). Among HCP who reported at least 1 sick day, vaccinated HCP had lower symptomatic days absent compared to unvaccinated HCP (OR for 2012–2013 and 2013–2014, 0.82; 95% CI, 0.72–0.93; OR for 2014–2015, 0.81; 95% CI, 0.69–0.95).
These data suggest that mandatory HCP influenza vaccination policies increase influenza vaccination rates and that HCP symptomatic absenteeism diminishes as rates of influenza vaccination increase. These findings should be considered in formulating HCP influenza vaccination policies.
The re-emergence of debates on the decolonisation of knowledge has revived interest in the National Question, which began over a century ago and remains unresolved. Tensions that were suppressed and hidden in the past are now being openly debated. Despite this, the goal of one united nation living prosperously under a constitutional democracy remains elusive. This edited volume examines the way in which various strands of left thought have addressed the National Question, especially during the apartheid years, and goes on to discuss its relevance for South Africa today and in the future. Instead of imposing a particular understanding of the National Question, the editors identified a number of political traditions and allowed contributors the freedom to define the question as they believed appropriate – in other words, to explain what they thought was the Unresolved National Question. This has resulted in a rich tapestry of interweaving perceptions. The volume is structured in two parts. The first examines four foundational traditions: Marxism-Leninism (the Colonialism of a Special Type thesis); the Congress tradition; the Trotskyist tradition; and Africanism. The second part explores the various shifts in the debate from the 1960s onwards, and includes chapters on Afrikaner nationalism, ethnic issues, black consciousness, feminism, workerism and constitutionalism. The editors hope that by revisiting the debates not popularly known among the scholarly mainstream, this volume will become a catalyst for an enriched debate on our identity and our future.
The Taipan galaxy survey (hereafter simply ‘Taipan’) is a multi-object spectroscopic survey starting in 2017 that will cover 2π steradians over the southern sky (δ ≲ 10°, |b| ≳ 10°), and obtain optical spectra for about two million galaxies out to z < 0.4. Taipan will use the newly refurbished 1.2-m UK Schmidt Telescope at Siding Spring Observatory with the new TAIPAN instrument, which includes an innovative ‘Starbugs’ positioning system capable of rapidly and simultaneously deploying up to 150 spectroscopic fibres (and up to 300 with a proposed upgrade) over the 6° diameter focal plane, and a purpose-built spectrograph operating in the range from 370 to 870 nm with resolving power R ≳ 2000. The main scientific goals of Taipan are (i) to measure the distance scale of the Universe (primarily governed by the local expansion rate, H0) to 1% precision, and the growth rate of structure to 5%; (ii) to make the most extensive map yet constructed of the total mass distribution and motions in the local Universe, using peculiar velocities based on improved Fundamental Plane distances, which will enable sensitive tests of gravitational physics; and (iii) to deliver a legacy sample of low-redshift galaxies as a unique laboratory for studying galaxy evolution as a function of dark matter halo and stellar mass and environment. The final survey, which will be completed within 5 yrs, will consist of a complete magnitude-limited sample (i ⩽ 17) of about 1.2 × 106 galaxies supplemented by an extension to higher redshifts and fainter magnitudes (i ⩽ 18.1) of a luminous red galaxy sample of about 0.8 × 106 galaxies. Observations and data processing will be carried out remotely and in a fully automated way, using a purpose-built automated ‘virtual observer’ software and an automated data reduction pipeline. The Taipan survey is deliberately designed to maximise its legacy value by complementing and enhancing current and planned surveys of the southern sky at wavelengths from the optical to the radio; it will become the primary redshift and optical spectroscopic reference catalogue for the local extragalactic Universe in the southern sky for the coming decade.
The wind structure diagnostic possibilities offered by combined study of photo-, spectro-, and polari-metric variability are discussed using data from the Montreal group. These demand the presence in the wind of localised density inhomogeneities and in particular of large ‘blobs’ denser than the ‘mean’ wind and put bounds on the size, mass, and density of individual blobs and their distributions, with implications for theories of blob formation. Blobs responsible for polarimetric variability must be present at the stellar surface rather than forming in the wind, and the relation of this to spectrometric indications that blobs are only detectable at several stellar radii is discussed.
A brief overview is given of some of the current outstanding problems in solar physics with greatest emphasis on high energy phenomena in the atmosphere. The importance of plasma kinetic effects, as well as MHD, in understanding the complex finely structured and dynamic solar atmospheric plasma is stressed. Key results from the RHESSI Mission on energetic flare particle acceleration, propagation, and flare energy budgets are presented as are recent findings concerning the solar and stellar flare Neupert effect and the possible role of energetic particles in micro-events in the ‘non-flaring’ sun. Finally, evidence showing that magnetic fields are also important in hot star phenomena is mentioned.
The possible validity of thermal bremsstrahlung models of flare hard X-ray bursts is investigated quantitatively. In particular, the problem of rapid thermal conduction in ‘multi-temperature’ models is adequately examined for the first time by using a continuous temperature distribution consistent with the observed X-ray spectrum. This distribution is obtained from a general analytic solution for the temperature structure required to mimick any ‘non-thermal’ spectrum, the method being equally applicable to cosmic sources.
It is concluded that the thermal interpretation might extend to X-rays of hundreds of keV, a result with important consequences for flare energetics. The relationship of such a model to observations of X-ray polarization and rapid time variations is also considered.
Merits and limitations are discussed of using an inferential inverse, as opposed to the usual model-fitting, approach to diagnose stellar wind structure. We aspire to encourage the stellar wind community to use inversion rather than forward modelling by making it clear what inversion means, when and why it is valuable, and by giving examples of successful applications.
A sub-discipline of astrophysics advances beyond the discovery era as the quality of data moves from single numbers (flux, colour, size) to well measured functions or data strings g(y) (e.g., light curves or spectra where g is flux and y is time or wavelength). As the precision δg/g and the resolution δy/y improve, we progress from data gathering and qualitative description to quantitative modelling in terms of some relevant source model function f(x), describing source “structure” in some sense. In general g(y) and f(x) do not correspond one-to-one but rather f maps to g in a “convolved” (sometimes complex and non-linear) way through the radiation processes, while f itself may be a combination of important source properties. Here we consider only the simplest situation (though our arguments can be generalised) where the relationship is of the linear integral form
where the operator function K, represents the emission physics which we assume known. The diagnostic problem is to determine as much as possible about f(x) within the noise and resolution limits of the data g(y) and the smearing effect of K(x, y).
On december 14, 1974, the United Nations General Assembly adopted by consensus a draft resolution submitted by its Sixth (legal) Committee known as the Definition of Aggression. Adoption of this definition culminated years of effort, interspersed with numerous wars, by the international community. Here is not the place to enter into an elaborate discussion either of its history or contents. It will suffice to note that its antecedents can be traced back to the 1815 Triple Alliance, the 1907 Hague Conventions, the League of Nations, and the 1945 Inter-American Act of Chapultapec. From 1952 to 1974, however, at least four United Nations special committees grappled with the task of this definition, made more crucial by the growing diversity of techniques of aggression and the restraintson responding to aggression imposed by Article 51 of the Charter.
The vancouver lawyer and financier, A. G. Duncan Crux was arrested in the Bahamas on June 3, 1969, on a provisional warrant issued by the chief magistrate in Nassau, before whom five informations, containing a total of twenty-one charges against Crux, were laid by the government of Canada. Canada sought to have him returned to Canada for trial. The charges were heard before a stipendiary and circuit magistrate and, on December 5, Crux was committed to await return to Canada.
The importance and difficulties of determining the height of hard X-ray sources in the solar atmosphere, in order to distinguish source models, have been discussed by Brown and McClymont (1974) and also in this Symposium (Brown, 1975; Datlowe, 1975). Theoretical predictions of this height, h, range between and 105 km above the photosphere for different models (Brown and McClymont, 1974; McClymont and Brown, 1974). Equally diverse values have been inferred from observations of synchronous chromospheric EUV bursts (Kane and Donnelly, 1971) on the one hand and from apparently behind-the-limb events (e.g. Datlowe, 1975) on the other.