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Following stage 1 palliation, delayed sternal closure may be used as a technique to enhance thoracic compliance but may also prolong the length of stay and increase the risk of infection.
We reviewed all neonates undergoing stage 1 palliation at our institution between 2010 and 2017 to describe the effects of delayed sternal closure.
During the study period, 193 patients underwent stage 1 palliation, of whom 12 died before an attempt at sternal closure. Among the 25 patients who underwent primary sternal closure, 4 (16%) had sternal reopening within 24 hours. Among the 156 infants who underwent delayed sternal closure at 4 [3,6] days post-operatively, 11 (7.1%) had one or more failed attempts at sternal closure. Patients undergoing primary sternal closure had a shorter duration of mechanical ventilation and intensive care unit length of stay. Patients who failed delayed sternal closure had a longer aortic cross-clamp time (123±42 versus 99±35 minutes, p=0.029) and circulatory arrest time (39±28 versus 19±17 minutes, p=0.0009) than those who did not fail. Failure of delayed sternal closure was also closely associated with Technical Performance Score: 1.3% of patients with a score of 1 failed sternal closure compared with 18.9% of patients with a score of 3 (p=0.0028). Among the haemodynamic and ventilatory parameters studied, only superior caval vein saturation following sternal closure was different between patients who did and did not fail sternal closure (30±7 versus 42±10%, p=0.002). All patients who failed sternal closure did so within 24 hours owing to hypoxaemia, hypercarbia, or haemodynamic impairment.
When performed according to our current clinical practice, sternal closure causes transient and mild changes in haemodynamic and ventilatory parameters. Monitoring of SvO2 following sternal closure may permit early identification of patients at risk for failure.
Borrowing an approach from the literature on the economics of discrimination, we estimate the impact of nonvoters on the outcome of presidential elections from 1952–2000 using data from the National Election Study (NES). Our estimates indicate that nonvoters are, on average, slightly more likely to support the Democratic Party. Of the 13 presidential elections between 1952 and 2000 we find no change in the eventual outcome of the election with two possible exceptions: 1980 and 2000. Thus our results are not all that dissimilar from other research on participation. Higher turnout in the form of compulsory voting would not radically change the partisan distribution of the vote. When elections are sufficiently close, however, a two percentage point increase may suffice to affect the outcome. Limitations of the NES data we use suggest that our estimates underestimate the impact of nonparticipation. We also compare our method with other econometric techniques. Finally, using our findings we speculate as to why the Democratic Party fails to undertake widespread “get out the vote” or registration drives.
Early exposure of Nanoscale Science, Engineering and Technology (NSET) to undergraduate students is anticipated to play a pivotal role in recruiting highly qualified professionals for industry and in preparing future faculty and researchers for graduate education. Focusing on early undergraduate education in NSET, the newly launched Drexel Nano Engineering Track (DNET) program at Drexel University addresses the urgent need for early NSET education at the University level. The primary objective of the DNET program is to expose freshmen and sophomores in Drexel's College of Engineering to basic concepts in NSET. It is envisioned that the career decisions of a large fraction of students will be directed as they learn the vocabulary of NSET and see potential engineering applications. The current DNET program activities include (1) updating/modifying a series of freshmen/sophomore courses / laboratories to infuse NSET into early undergraduate curriculum. Because of the size of the established tDEC program, this initiative has been able to reach a remarkably large body of students immediately. Over 700 students are enrolled in NSET-revised freshmen courses, and they will progress to NSET-revised sophomore courses the next year. (2) developing a number of modules for NSET education and (3) launching/maintaining a DNET web for information dissemination, performance assessment and outreach activities. The DNET program, together with the existing Nanotechnology Institute and Drexel/Upenn IGERT program that focus on the NSET research and graduate education, offer a stream of NSET education from college to graduate school at Drexel University.