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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.
OBJECTIVES/SPECIFIC AIMS: Engaging patients and consumers in research is a complex process where innovative strategies are needed to effectively translate scientific discoveries into improvements in the public’s health (Wilkins et. al., 2013; Terry et. al., 2013). The Clinical Translational Science Awards (CTSA)—supported by the National Institute of Health (NIH) under the auspices of the National Center for Advancing Translational Sciences (NCATS)—aim to provide resources and support needed to strengthen our nation’s clinical and translational research (CTR) enterprise. In 2008, Stanford University was awarded a CTSA from the NIH, establishing Spectrum (Stanford Center for Clinical and Translational Research and Education) and its Community Engagement (CE) Program aimed at building long-standing community-academic research partnerships for translational research in the local area surrounding Stanford University. To date, the CE Pilot Program has funded 38 pilot projects from the 2009-2017 calendar year. The purpose of this study was to understand, through a unique pilot program, the barriers, challenges, and facilitators to community-engaged research targeting health disparities as well as community-academic partnerships. METHODS/STUDY POPULATION: Investigators conducted a qualitative study of the community engagement pilot program. Previous pilot awardees were recruited via email and phone to participate in a one-hour focus group to discuss their pilot project experience—describing any barriers, challenges, and facilitators to implementing their pilot project. RESULTS/ANTICIPATED RESULTS: The focus group revealed that community engage research through the pilot program was not only appreciated by faculty, but projects were successful, and partnerships developed were sustained after funding. Specifically, the pilot program has seen success in both traditional and capacity building metrics: the initial investment of $652,250.00 to fund 38 projects has led to over $11 million dollars in additional grant funding. In addition, pilot funding has led to peer-reviewed publications, data resources for theses and dissertations, local and national presentations/news articles, programmatic innovation, and community-level impact. Challenges and barriers were mainly related to timing, grant constraints, and university administrative processes. DISCUSSION/SIGNIFICANCE OF IMPACT: The Community Engagement Pilot Program demonstrates an innovative collaborative approach to support community-academic partnerships. This assessment highlights the value and importance of pilot program to increase community engaged research targeting health disparities. Challenges are mainly administrative in nature: pilot awardees mentioned difficulties working on university quarterly timelines, challenges of subcontracting or sharing money with community partners, onerous NIH prior approval process, and limitations to carryover funding. However, pilot grants administered through the program strengthen the capacity to develop larger scale community-based research initiatives.
Stone tool producers in the Maya Lowlands had several types of raw materials from which to choose. Limestone, chert, and obsidian are the most naturally abundant, whereas chert and obsidian outnumber limestone in archaeological contexts. The presence of flaked-stone tools made of limestone is typically attributed to the scarcity of more suitable raw materials. Nevertheless, in chert-rich areas, such as the upper Belize River valley, limestone bifaces and production debitage are present. To understand their presence, we examine limestone biface production and use at Buenavista del Cayo.
Forty years ago, E. P. Thompson praised the English rule of law forged during the bloody and fractious eighteenth century, calling it not only “an unqualified human good,” but also a “cultural achievement of universal significance.” This article examines colonial rule-of-law development as another example of law and state building. Both have relevance for contemporary rule-of-law programming in the Global South where Thompson's “cultural achievement” has resisted fabrication by legal technicians. The problems faced today are not new, for colonial rulers also engaged with complex indigenous norms and forms and sought to balance universal principles with political control imperatives. Contra arguments about colonial “lawfare,” colonial rule of law often frustrated authoritarian tendencies while developing new forms of legal subjectivity and avenues for redress of grievances. Using data from the Indian province of Punjab, the article illustrates how historical case studies might aid contemporary rule-of-law programming in the Global South.
The biological domain has the potential to offer a rich source of analogies to solve engineering design problems. However, due to the complexity embedded in biological systems, adding to the lack of structured, detailed, and searchable knowledge bases, engineering designers find it hard to access the knowledge in the biological domain, which therefore poses challenges in understanding the biological concepts in order to apply these concepts to engineering design problems. In order to assist the engineering designers in problem-solving, we report, in this paper, a web-based tool called Idea-Inspire 4.0 that supports analogical design using two broad features. First, the tool provides access to a number of biological systems using a searchable knowledge base. Second, it explains each one of these biological systems using a multi-modal representation: that is, using function decomposition model, text, function model, image, video, and audio. In this paper, we report two experiments that test how well the multi-modal representation in Idea-Inspire 4.0 supports understanding and application of biological concepts in engineering design problems. In one experiment, we use Bloom's method to test “analysis” and “synthesis” levels of understanding of a biological system. In the next experiment, we provide an engineering design problem along with a biological-analogous system and examine the novelty and requirement-satisfaction (two major indicators of creativity) of resulting design solutions. In both the experiments, the biological system (analogue) was provided using Idea-Inspire 4.0 as well as using a conventional text-image representation so that the efficacy of Idea-Inspire 4.0 is tested using a benchmark.
In the product design realm, designers often use presentations to convey certain ideas about a product or a specific stage of the design process. The popular forms of presentation include verbal pitching, two-dimensional drawing, and prototyping. The clients, investigators, and other audiences rely on such presentations to evaluate an idea. Popular idea evaluation assessment tools, such as the consensual assessment technique, utilize such interactions. On the other hand, numerous pieces of literature state that the audiences are heavily influenced by the quality of presentation when evaluating the worth of the product being presented. In this study, we examine if the audience is able to discriminate between the quality of the presentation and the quality of the idea being presented. A total of 613 ideas were evaluated over a 4-year period during a specific product design class at different phases in the design process. The result shows that no matter the kind of presentation tool used, the presentation quality ratings and the idea value ratings had a very strong positive correlation despite the explicit instructions to reviewers to separate presentation quality from concept quality. Our additional analysis shows that such a pattern did not change during the different phases of the design process.
It is well-known that creativity is crucial for sustaining a product against competition. Many factors have been proposed in the literature as indicators of creativity, among which outcome-characteristics-based factors are considered the most reliable; among these, the creativity of an outcome is often indicated by two major factors: novelty and usefulness. Only a few studies address as to how creativity assessment methods and their results can be used during the design process. To systematically address the issue of how to influence creativity of design solutions, the following questions have been framed. (1) Which factors should be used as indicators of creativity consistently across different phases of the engineering design process? (2) How can creativity be assessed in terms of these factors during the engineering design process? In this work, we consider novelty and usefulness as the necessary factors for creativity. It is found, however, that it is not possible to directly assess the usefulness of outcomes during the design process. Therefore, requirement satisfaction is used as a proxy for usefulness. We propose a creativity assessment method that uses novelty and requirement satisfaction as indicators for creativity; the method can be used for assessing not only complete products but also ideas or concepts, as they evolve through the phases of the design process. The application of the method in design is explained using a detailed example from a case study.
Analogy is a core cognition process used to produce inferences as well as new ideas using previous knowledge and experience. Ontology is a formal representation of a set of domain concepts and their relationships. The use of analogy and ontology in design activities to support design creativity have previously been explored. This paper explores an approach to construct ontologies with sufficient richness and coverage to support reasoning over real-world datasets for prompting creative idea generation. This approach has been implemented into a computational tool for assisting designers in generating creative ideas during the early stages of design. The tool, called “the Retriever”, has been developed based on ontology by embracing the aspects of analogical reasoning. A case study has indicated that the tool can be effective and useful for idea generation. The results have indicated that the tool, in its current formulation, can significantly improve the fluency and flexibility of idea generation and the usefulness of ideas, as well as slightly increase the originality of ideas, for the case study concerned.
Traditionally, design opportunities and directions are conceived based on expertise, intuition, or time-consuming user studies and marketing research at the fuzzy front end of the design process. Herein, we propose the use of the total technology space map (TSM) as a visual ideation aid for rapidly conceiving high-level design opportunities. The map is comprised of various technology domains positioned according to knowledge proximity, which is measured based on a large quantity of patent data. It provides a systematic picture of the total technology space to enable stimulated ideation beyond the designer's knowledge. Designers can browse the map and navigate various technologies to conceive new design opportunities that relate different technologies across the space. We demonstrate the process of using TSM as a rapid ideation aid and then analyze its applications in two experiments to show its effectiveness and limitations. Furthermore, we have developed a cloud-based system for computer-aided ideation, that is, InnoGPS, to integrate interactive map browsing for conceiving high-level design opportunities with domain-specific patent retrieval for stimulating concrete technical concepts, and to potentially embed machine-learning and artificial intelligence in the map-aided ideation process.
Design problems are often presented as structured briefs with detailed constraints and requirements, suggesting a fixed definition. However, past studies have identified the importance of exploring design problems for creative design outcomes. Previous protocol studies of designers has shown that problems can “co-evolve” with the development of solutions during the design process. But to date, little evidence has been provided about how designers systematically explore presented problems to create better solutions. In this study, we conducted a qualitative analysis of 252 design problems collected from publically available sources, including award-winning product designs and open-source design competitions. This database offers an independent sample of presented problems, designers’ alternative problem descriptions, and innovative solutions. We report the results of this large-scale qualitative analysis aimed at characterizing changes to problems during the design process. Inductive coding was used to identify content patterns in “discovered” problem descriptions, with qualitative codes reliably scored by two independent coders. A total of 32 distinct patterns of problem exploration were identified across designers and presented problems. Each pattern is described in the form of a generalized strategy to guide designers as they explore problem spaces. The exploration patterns identified in this study are the first empirical evidence of problem exploration in independent design problems. Further, the presence of exploration patterns in discovered problems is associated with the selection of the corresponding solution as a challenge finalist. These empirically identified strategies for problem exploration may be useful for computational tools supporting designers.
The goal of this paper is to examine meaning as a component of creativity. We take a demand-based approach for conceptualizing meaning, and propose that it emerges from user needs instead of emerging from already existing creative solutions. Meaning is proposed as a third component of creativity, alongside novelty and usefulness. We test this proposition in a pre-study, and two empirical studies. In the pre-study, designers define creativity and provide examples of solutions that they deem creative. The results of the pre-study yield a 24-item scale for assessing creativity. Then, we conduct two empirical studies, in which we utilize the created scale for measuring creativity, and for examining the components arising thereof. In the first study, we ask creators (design engineering students) to generate ideas for one of two design briefs. Afterwards, creators were asked to rate their own creations, on the 24-item creativity scale. Here, we find a four-factor solution for creative outcomes, consisting of the dimensions novelty, usefulness, cleverness, and meaning. In the second study, we ask independent evaluators (individuals with related and relevant degrees) to assess the creators’ work on the creativity scale. Here, we find a three-factor solution for creative outcomes, consisting of the dimensions novelty, usefulness, and meaning. In both studies, meaning emerged as a separate component of creativity. Additionally, in both studies, it accounted for variance that was unaccounted for by novelty and usefulness, thereby increasing the overall explanatory power of creative solutions. These findings strongly speak of meaning as a third component of creativity.
To determine whether patients using the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website (http://medicare.gov/hospitalcompare) can use nationally reported healthcare-associated infection (HAI) data to differentiate hospitals.
Secondary analysis of publicly available HAI data for calendar year 2013.
We assessed the availability of HAI data for geographically proximate hospitals (ie, hospitals within the same referral region) and then analyzed these data to determine whether they are useful to differentiate hospitals. We assessed data for the 6 HAIs reported by hospitals to the Centers for Disease Control and Prevention (CDC).
Data were analyzed for 4,561 hospitals representing 88% of registered community and federal government hospitals in the United States. Healthcare-associated infection data are only useful for comparing hospitals if they are available for multiple hospitals within a geographic region. We found that data availability differed by HAI. Clostridium difficile infections (CDI) data were most available, with 82% of geographic regions (ie, hospital referral regions) having >50% of hospitals reporting them. In contrast, 4% of geographic regions had >50% of member hospitals reporting surgical site infections (SSI) for hysterectomies, which had the lowest availability. The ability of HAI data to differentiate hospitals differed by HAI: 72% of hospital referral regions had at least 1 pair of hospitals with statistically different risk-adjusted CDI rates (SIRs), compared to 9% for SSI (hysterectomy).
HAI data generally are reported by enough hospitals to meet minimal criteria for useful comparisons in many geographic locations, though this varies by type of HAI. CDI and catheter-associated urinary tract infection (CAUTI) are more likely to differentiate hospitals than the other publicly reported HAIs.