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The Residual Lesion Score is a novel tool for assessing the achievement of surgical objectives in congenital heart surgery based on widely available clinical and echocardiographic characteristics. This article describes the methodology used to develop the Residual Lesion Score from the previously developed Technical Performance Score for five common congenital cardiac procedures using the RAND Delphi methodology.
Methods:
A panel of 11 experts from the field of paediatric and congenital cardiology and cardiac surgery, 2 co-chairs, and a consultant were assembled to review and comment on validity and feasibility of measuring the sub-components of intraoperative and discharge Residual Lesion Score for five congenital cardiac procedures. In the first email round, the panel reviewed and commented on the Residual Lesion Score and provided validity and feasibility scores for sub-components of each of the five procedures. In the second in-person round, email comments and scores were reviewed and the Residual Lesion Score revised. The modified Residual Lesion Score was scored independently by each panellist for validity and feasibility and used to develop the “final” Residual Lesion Score.
Results:
The Residual Lesion Score sub-components with a median validity score of ≥7 and median feasibility score of ≥4 that were scored without disagreement and with low absolute deviation from the median were included in the “final” Residual Lesion Score.
Conclusion:
Using the RAND Delphi methodology, we were able to develop Residual Lesion Score modules for five important congenital cardiac procedures for the Pediatric Heart Network’s Residual Lesion Score study.
In this paper I examine Brandom's account of Hegel's claim that the content of an intention can only be determined retrospectively. While Brandom's account, given in Chapter 11 of A Spirit of Trust, sets a new standard for thinking about this topic, I argue that it is flawed in three important respects. First, Brandom is not able to make sense of a distinction that is central for Hegel, namely, between the consequences of an action that ought to have been foreseen by an acting agent, given the right of objectivity of the action, and unforeseeable consequences that are completely contingent. Second, Brandom incorrectly conceptualizes the disparity and unity that all actions display as temporally successive features of an action, rather than as speculatively identical features. Third, Brandom's account cannot make sense of cases of retrospective determination that involve self-deception, and this demonstrates that he misses something critical about Hegel's account of action, namely, that action is expressive of the logic of essence.
In recent years, a renascent form of pragmatism has developed which argues that a satisfactory pragmatic position must integrate into itself the concepts of truth and objectivity. This New Pragmatism, as Cheryl Misak calls it, is directed primarily against Rorty's neo-pragmatic dismissal of these concepts. For Rorty, the goal of our epistemic practices should not be to achieve an objective view, one that tries to represent things as they are ‘in themselves,’ but rather to attain a view of things that can gain as much inter-subjective agreement as possible. In Rorty's language, we need to replace the aim of objectivity with that of solidarity. While the New Pragmatists agree with Rorty's ‘humanist’ and ‘anti-authoritarian’ notion that the world by itself cannot dictate to us what we should think about it, they demur from his suggestion that this requires us to give up the notions of truth and objectivity.
While echocardiographic parameters are used to quantify ventricular function in infants with single ventricle physiology, there are few data comparing these to invasive measurements. This study correlates echocardiographic measures of diastolic function with ventricular end-diastolic pressure in infants with single ventricle physiology prior to superior cavopulmonary anastomosis.
Methods:
Data from 173 patients enrolled in the Pediatric Heart Network Infant Single Ventricle enalapril trial were analysed. Those with mixed ventricular types (n = 17) and one outlier (end-diastolic pressure = 32 mmHg) were excluded from the analysis, leaving a total sample size of 155 patients. Echocardiographic measurements were correlated to end-diastolic pressure using Spearman’s test.
Results:
Median age at echocardiogram was 4.6 (range 2.5–7.4) months. Median ventricular end-diastolic pressure was 7 (range 3–19) mmHg. Median time difference between the echocardiogram and catheterisation was 0 days (range −35 to 59 days). Examining the entire cohort of 155 patients, no echocardiographic diastolic function variable correlated with ventricular end-diastolic pressure. When the analysis was limited to the 86 patients who had similar sedation for both studies, the systolic:diastolic duration ratio had a significant but weak negative correlation with end-diastolic pressure (r = −0.3, p = 0.004). The remaining echocardiographic variables did not correlate with ventricular end-diastolic pressure.
Conclusion:
In this cohort of infants with single ventricle physiology prior to superior cavopulmonary anastomosis, most conventional echocardiographic measures of diastolic function did not correlate with ventricular end-diastolic pressure at cardiac catheterisation. These limitations should be factored into the interpretation of quantitative echo data in this patient population.