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Pulmonary insufficiency requiring reintervention frequently occurs after primary tetralogy of Fallot repair. Repeat interventions present a challenge for both the surgeon and patient. We compare a minimally invasive, 5 cm left anterior mini-incision to redo median sternotomy for pulmonary valve replacement in tetralogy of Fallot patients.
Following Internal Review Board approval, we conducted a single institution retrospective review of patients with tetralogy of Fallot who underwent pulmonary valve replacement via redo median sternotomy or left anterior mini-incision between 13 July, 2016 and 6 March, 2020.
Twenty-three patients underwent pulmonary valve replacement following primary tetralogy of Fallot repair between March 2016 and March 2020. Twelve patients received a redo-median sternotomy from March 2016 to August 2018. Left anterior mini-incision was first offered in August of 2018 and was chosen by all eleven patients thereafter. The two groups had similar baseline characteristics including preoperative pulmonary valve dysfunction. Early trends suggest a longer cardiopulmonary bypass time for patients who received left anterior mini-incisions. Other outcomes were comparable, including operative times, blood product requirements, residual pulmonary valve dysfunction, postoperative pain, narcotic requirements, ICU length of stay, total length of stay, and postoperative complications.
In patients who have previously undergone primary repairs of tetralogy of Fallot, outcomes for pulmonary valve replacement via left anterior mini-incision are comparable to those via redo median sternotomy.
Comorbidity with general medical conditions is common in individuals with eating disorders. Many previous studies do not evaluate types of eating disorder.
To provide relative and absolute risks of bidirectional associations between (a) anorexia nervosa, bulimia nervosa and eating disorders not otherwise specified and (b) 12 general medical conditions.
We included all people born in Denmark between 1977 and 2010. We collected information on eating disorders and considered the risk of subsequent medical conditions, using Cox proportional hazards regression. Absolute risks were calculated using competing risks survival analyses. We also considered risks for prior medical conditions and subsequent eating disorders.
An increased risk was seen for almost all disorder pairs (69 of 70). Hazard ratios for those with a prior eating disorder receiving a subsequent diagnosis of a medical condition ranged from 0.94 (95% CI 0.57−1.55) to 2.05 (95% CI 1.86−2.27). For those with a prior medical condition, hazard ratios for later eating disorders ranged from 1.35 (95% CI 1.26–1.45) to 1.98 (95% CI 1.71–2.28). Absolute risks for most later disorders were increased for persons with prior disorders, compared with reference groups.
This is the largest and most detailed examination of eating disorder–medical condition comorbidity. The findings indicate that medical condition comorbidity is increased among those with eating disorders and vice versa. Although there was some variation in comorbidity observed across eating disorder types, magnitudes of relative risks did not differ greatly.
Research conducted into the demography of the Kingdom of Kongo some forty years ago, employing baptismal statistics left by missionaries, has been in need of revision thanks to challenges by more recent scholarship. This article revises the estimated population of Kongo by addressing these challenges, drawing on newly discovered documentary sources. Using this new evidence, the estimate for the kingdom's population in the mid-seventeenth century has been elevated from 509,000 to around 790,000. The original article's claims about levels of fertility and mortality have been retained. The article also addresses questions concerning the validity of missionary statistics and the impact of the slave trade, which was small before 1700 but then increasingly large thereafter, reaching very high levels by the early nineteenth century. While a quantitative estimate of the later population is not possible given the limitations of sources for this period, it is likely that the population of the kingdom fell as slave exports peaked.
Regionalizing pre-colonial Africa aids in the collection and interpretation of primary sources as data for further analysis. This article includes a map with six broad regions and 34 sub-regions, which form a controlled vocabulary within which researchers may geographically organize and classify disparate pieces of information related to Africa’s past. In computational terms, the proposed African regions serve as data containers in order to consolidate, link, and disseminate research among a growing trend in digital humanities projects related to the history of the African diasporas before c. 1900. Our naming of regions aims to avoid terminologies derived from European slave traders, colonialism, and modern-day countries.
During the Randomized Assessment of Rapid Endovascular Treatment (EVT) of Ischemic Stroke (ESCAPE) trial, patient-level micro-costing data were collected. We report a cost-effectiveness analysis of EVT, using ESCAPE trial data and Markov simulation, from a universal, single-payer system using a societal perspective over a patient’s lifetime.
Primary data collection alongside the ESCAPE trial provided a 3-month trial-specific, non-model, based cost per quality-adjusted life year (QALY). A Markov model utilizing ongoing lifetime costs and life expectancy from the literature was built to simulate the cost per QALY adopting a lifetime horizon. Health states were defined using the modified Rankin Scale (mRS) scores. Uncertainty was explored using scenario analysis and probabilistic sensitivity analysis.
The 3-month trial-based analysis resulted in a cost per QALY of $201,243 of EVT compared to the best standard of care. In the model-based analysis, using a societal perspective and a lifetime horizon, EVT dominated the standard of care; EVT was both more effective and less costly than the standard of care (−$91). When the time horizon was shortened to 1 year, EVT remains cost savings compared to standard of care (∼$15,376 per QALY gained with EVT). However, if the estimate of clinical effectiveness is 4% less than that demonstrated in ESCAPE, EVT is no longer cost savings compared to standard of care.
Results support the adoption of EVT as a treatment option for acute ischemic stroke, as the increase in costs associated with caring for EVT patients was recouped within the first year of stroke, and continued to provide cost savings over a patient’s lifetime.
For the purposes of this study I am defining West Central Africa largely by the watershed of the Congo River. If the region has a hydrographic center, it is the Lunda Plateau in eastern Angola, a relatively flat region at roughly 1,000 meters elevation, origin of many of the largest effluents of the Congo. This highland continues eastward until it reaches the great range of mountains that define the Rift Valley, and separate it from the Nile system. Because human geography is not always identical to natural geography, there are additions to this defined space.
An important addition is the rivers that drain from the low mountains that define the western end of the Congo watershed that flow westward into the Atlantic Ocean which are included in the study because many political units had borders that straddled the two, such as the Kingdoms of Ndongo and Kasanje, which were regularly engaged on both sides of the Kwango watershed, or the Luyana Kingdom, which lay squarely in the Zambezi River watershed but was in substantial communication with the Lunda Empire.
The death of Nawej II in 1852 marks the end of this history. In some ways, this date, like any other, has only limited significance. One might as easily chose the death of Henrique II in Kongo in 1856, or the death of several other powerful or influential rulers, as the region was not so tightly integrated politically as to give precedence to any one or the other.
But the mid-nineteenth century was a signal turning point for West Central Africa. In 1839 steamships from Europe began making regular stops in Africa, and for the first time in history it was possible to ship bulk commodities cheaply. The Industrial Revolution in Europe had reached a point where production of some vital commodities such as metal goods and textiles were sufficient in themselves to clothe and provide equipment for entire world regions, and export them there. The commodity revolution, the mass import of mundane products, began in earnest with that signal change.
Lunda becomes an important kingdom and begins expanding east and west, Matamba and Kasanje struggle over the Kwango Valley, the Portuguese consolidate their control over the colony of Angola, Kongo enters a period of civil war, and Beatriz Kimpa Vita tries to restore it