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We developed the Long-term Early Development Research (LEADER) project to investigate the development of children with CHD and/or after cardiopulmonary resuscitation. Both populations are at risk for delays in motor, cognitive, and language development. However, few studies to date have investigated the longitudinal development in these children.
To establish a clinical research unit, we planned three studies: a cross-sectional study in children after cardiopulmonary resuscitation (LEADER-REA Pilot Study), a longitudinal study in children after cardiopulmonary resuscitation, with a focus on evaluating various biomarkers as predictors for developmental outcome (LEADER-CPR study), and a longitudinal study in children with ventricular septal defect, tetralogy of Fallot, or transposition of the great arteries after cardiac surgery (LEADER-CHD study).
Implementation of all three LEADER studies was successful and study protocols were conducted as planned. Findings from the LEADER-REA Pilot study have been recently published and data collection for both prospective trials is ongoing. Descriptive analysis of the first 20 assessments of the LEADER-CHD study showed no severe deficits in overall cognitive, motor, and language developments in the children.
Children with CHD and/or after cardiopulmonary resuscitation are at risk for developmental delay. Therefore, a detailed developmental assessment is necessary as a pre-requisite for individual developmental support. Our LEADER project has been shown to be feasible in a clinical setting and is the first step towards the establishment of a clinical research unit in our clinic with a focus on longitudinal research.
With the ongoing expansion of palliative care services throughout the United States, meeting the needs of socioeconomically marginalized populations, as in all domains of healthcare, continues to be a challenge. Our specific aim here was to help meet some of these needs through expanding delivery of pain and palliative care services by establishing a new clinic for underserved patients and collecting descriptive data about its operation.
In November of 2014, the National Institutes of Health Clinical Center's Pain and Palliative Care Service (PPCS) launched a bimonthly offsite pain and palliative care outpatient clinic in collaboration with Mobile Medical Care Inc. (MobileMed), a private not-for-profit primary care provider in Montgomery County, Maryland, serving underserved area residents since 1968. Staffed by NIH hospice and palliative medicine clinical fellows and faculty, the clinic provides specialty pain and palliative care consultation services to patients referred by their primary care healthcare providers. A patient log was maintained, charts reviewed, and referring providers surveyed on their satisfaction with the service.
The clinic had 27 patient encounters with 10 patients (6 males, 4 females, aged 23–67) during its first 7 months of operation. The reason for referral for all but one patient was chronic pain of multiple etiologies. Patients had numerous psychosocial stressors and comorbidities. All primary care providers who returned surveys (n = 4) rated their level of satisfaction with the consultation service as “very satisfied” or “extremely satisfied.”
Significance of Results:
This brief descriptive report outlines the steps taken and logistical issues addressed to launch and continue the clinic, the characteristics of patients treated, and the results of quality-improvement projects. Lessons learned are highlighted and future directions suggested for the clinic and others that may come along like it.
In patients with CHD, cardiac MRI is often indicated for functional and anatomical assessment. With the recent introduction of MRI-conditional pacemaker systems, cardiac MRI has become accessible for patients with pacemakers. The present clinical study aims to evaluate safety, susceptibility artefacts, and image reading of cardiac MRI in patients with CHD and MRI-conditional pacemaker systems.
Material and methods
CHD patients with MRI-conditional pacemaker systems and a clinical need for cardiac MRI were examined with a 1.5-T MRI system. Lead function was tested before and after MRI. Artefacts and image readings were evaluated using a four-point grading scale.
A total of nine patients with CHD (mean age 34.0 years, range 19.5–53.6 years) received a total of 11 cardiac MRI examinations. Owing to clinical indications, seven patients had previously been converted from conventional to MRI-conditional pacemaker systems. All MRI examinations were completed without adverse effects. Device testing immediately after MRI and at follow-up showed no alteration of pacemaker device and lead function. Clinical questions could be addressed and answered in all patients.
Cardiac MRI can be performed safely with high certainty of diagnosis in CHD patients with MRI-conditional pacemaker systems. In case of clinically indicated lead and box changing, CHD patients with non-MRI-conditional pacemaker systems should be considered for complete conversion to MRI-conditional systems.
Objective: Temporary pacing wires play a crucial role in the diagnosis and therapy of post-operative arrhythmia after surgery for congenital heart disease. At present, bipolar pacing wires are used in most institutions. In case of functional failure of these wires, a unipolar mode of stimulation and sensing should be theoretically possible as a rescue procedure. Methods: We tested the feasibility of the customised unipolar mode in 18 post-operative patients with congenital heart disease (age 9.2 ± 13.9 months, weight 6.3 ± 3.8 kg, and cardiopulmonary bypass time 70 ± 29 minutes). As there are two possible unipolar configurations, there are twice the number of testing parameters; of those, we compared sensing (mV) and pacing thresholds (V at 0.5 ms). Results: Atrial sensing was significantly better in the unipolar modes (p < 0.001, p < 0.003). The ventricular unipolar sensing did not differ significantly in the “better” of the two possible configurations from the bipolar values (p = 0.363). For the unipolar pacing thresholds, only the “better” unipolar configuration did not differ significantly from the bipolar measurements (atrial: p = 0.058, ventricular: p = 0.138). There was no exit block or undersensing. Conclusion: The results demonstrate that unipolar stimulation and sensing using bipolar epicardial temporary pacing wires is feasible. In the case of failure of bipolar temporary pacing wires, this modality represents an easy rescue measure that in such cases should always be considered.
Damascening, defined in this context as the inlay of one metal into a different metal base, is a rare decorative technique in the Early Bronze Age, known only from seven bronze artefacts found north of the Alps. This paper reports on the first thorough scientific examination of one such find, the axe from Thun-Renzenbühl grave no. 1. This interdisciplinary project involving several institutions in Germany and Switzerland investigated the axe by means of neutron radiographic imaging and X-ray microprobe methods, supported by microscopic examination. The result is an attempt to reconstruct the fabrication and decoration process and to reconsider the enigmatic question of the origins of the damascene technique north of the Alps.
Quantitative X-ray powder Rietveld refinements for a series of alloys from the solid solution EuyFe4−xNixSb12, synthesized by argon arc-melting followed by long term annealing, established in all cases isotypism with the partially filled skutterudite-type structure, LaFe4P12. The Eucontent of the samples was determined from the combined data obtained results of Rietveld refinements and electron microprobe measurements. These investigations confirmed a systematic trend for the Eu-occupancy y in the parent lattice, revealing a gradual decrease of the maximum Eu-content from practically full occupancy, y = 0.83, in Eu0.83Fe4Sb12 to y ∼ 0.5 for Eu∼0.5Fe2Ni2Sb12. Eu0.83Fe4Sb12 orders magnetically below 84 K and the transition temperature decreases as a function of Fe/Ni substitution. As a further consequence of the Fe/Ni substitution electronic transport crosses over from a hole conductivity regime into electron dominated behaviour. Concomitantly, the transition metal exchange increases the Seebeck coefficient significantly, hence the figure of merit enhances.
In this work, different set-ups as well as different transducer materials have been investigated in order to develop a hydrogen peroxide (H2O2) sensor for the gas phase. The sensor is based on a combined physical/chemical transduction mechanism and should be able to detect high H2O2 concentrations up to 10 Vol.%. Different sensor arrangements are presented that are based on a “three sensor” cell and a diffusion cell. As transducer materials manganese oxide and copper alloys have been investigated. For the reference part of the sensor set-up, Teflon and enamel have been tested as passivating material.
The idea that societies have economic cultures as well as aesthetic, literary, and artistic cultures is well-embedded in a number of major studies attempting to identify the origins of national wealth and progress. From Adam Smith' s recognition of the role of moral sentiments, to the recent acknowledgement by Nobel prize-winning economic historian Douglass North that culture plays a key role in economic progress, there has always been awareness that it needed to be understood more completely. That it still is not speaks more to its complexity as a question than to the efforts devoted to its understanding.
Explanation in this field has to meet the challenge of the great number of factors in the equation, and the parallel challenge that many disciplines find culture hard to handle – too fuzzy, not visible or measurable enough, a residual perhaps after all the other more tangible things have been counted. Our aim here is to place it more centrally, not by further theoretical speculation, but by presenting evidence from several parts of the changing world about how the realm of the spirit affects the economy. The evidence comes from recent studies in Europe, Asia, Africa, Russia, and the US. The book is not entirely without theory, but its main intent is the presentation of new findings from the fields.
The initiative for this collection of work began with a collaboration between the Metanexus Institute, Pennsylvania, and the Institute on Culture, Religion and World Affairs of Boston University.
Explaining the role of religion in societal progress has for long remained a major challenge to thinkers observing the varieties of success and failure in the progress of societies towards wealth and a better life for their people. In the Western world, from the full analysis by Adam Smith two and a half centuries ago, and his insistence on addressing the question of ‘moral sentiments’, to more recent returns to the same issue by writers such as Deidre McCloskey, and Gertrude Himmelfarb, the question of how such influence works remains open to clarification. This is the terrain walked over in this book. In doing so, the walk is taken in the company of scholars who have dedicated years of enquiry into specific countries and religions, and each of them is well recognized in his or her specialism. They have in addition been encouraged to explain not just their theories, but the facts on the ground as they exist in China, India, Russia, Indonesia, South Africa, and Eastern Europe. They do so on the basis of current studies in the environments they observe. An overall guide to world trends is provided at the outset, as is also a statement of the setting of the core question: how does religion sponsor or otherwise a society' progress towards prosperity?