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Reports of paediatric cardiac neurodevelopmental programmes are predominately limited to high-volume surgical centres. Regional characterisation of neurodevelopmental care practices across multiple centres both with and without cardiac surgery programmes has not yet been described.
Objective:
Assess cardiac neurodevelopmental infrastructure and approach across New England to describe regional support for children with CHD.
Methods:
A 16-item survey assessing inpatient and outpatient neurodevelopmental care practices was sent electronically via REDCap to all member institutions of the New England Congenital Cardiology Association Health Disparities Working Group. Centres were characterised by surgical capability, annual volume, and academic affiliation. Descriptive statistics and Fisher’s exact test were used for comparisons.
Results:
The survey response rate was 90% (9/10). Participating centres included non-surgical academic centres (55%), small surgical centres (22%) and medium-large surgical centres (22%). Surgical centres typically refer their patients to internal neurodevelopmental services (100%) and rely on automatic referral processes (100%). Non-surgical centres predominately refer to the institution where cardiac surgery was performed (80%) compared to engaging local teams (20%) and depend on family or physician-initiated referral (100%) to schedule neurodevelopmental services. While none of the non-surgical centres surveyed have cardiac-specific neurodevelopmental programmes, all have other developmental programmes that accommodate children with CHD.
Conclusions:
Varying neurodevelopmental infrastructure and resources are reported across New England. Academic, non-surgical centres may have infrastructure for neurodevelopmental follow-up despite not having cardiac neurodevelopmental programmes. Collaboration between surgical and non-surgical cardiac centres in New England may be leveraged to promote neurodevelopmental care closer to home.
There are several ways to convert a closure or interior operation to a different operation that has particular desirable properties. In this paper, we axiomatize three ways to do so, drawing on disparate examples from the literature, including tight closure, basically full closure, and various versions of integral closure. In doing so, we explore several such desirable properties, including hereditary, residual, and cofunctorial, and see how they interact with other properties such as the finitistic property.
On 3–4 October 2022, the Memorial Sloan Kettering Cancer Center Supportive Care Service and Department of Psychiatry and Behavioral Sciences hosted the Third Annual United States (US) Celebration of World Hospice and Palliative Care Day (WHPCD). The purpose of this article is to reflect on the event within the broader context of the international WHPCD theme: “healing hearts and communities.” We describe lessons learned in anticipation of the fourth annual conference to be held on 3–4 October 2023.
Methods
Description of the third annual event, conference planning team reflection, and attendee evaluation responses.
Results
The Worldwide Hospice Palliative Care Alliance launched WHPCD in 2005 as an annual unified day of action to celebrate and support hospice and palliative care globally. Since 2020, the conference has attracted an increasing number of attendees from around the world. Two primary aims continue to guide the event: community building and wisdom sharing. Fifty-two interprofessional palliative care experts, advocates, patients, and caregivers provided 13 unique interactive sessions. Four hundred and fifty-eight multidisciplinary registrants from at least 17 countries joined the program. Free registration for colleagues in low- and middle-income countries, students and trainees, and individuals experiencing financial hardship remains a cornerstone of inclusion and equitable access to the event.
Significance of results
The US WHPCD celebration provides a virtual platform that offers opportunities for scientific dissemination and collective reflection on hospice and palliative care delivery amid significant local and global changes in clinical practice, research, policy and advocacy, and population health. We remain committed to ensuring an internationally relevant, culturally diverse, and multidisciplinary agenda that will continue to draw increased participation worldwide during future annual events.
On October 5–6, 2021, the Memorial Sloan Kettering Cancer Center Supportive Care Service and Department of Psychiatry and Behavioral Sciences hosted the 2nd Annual United States (US) Celebration of World Hospice and Palliative Care Day (WHPCD). The purpose of this article is to describe the event within the broader context of the international WHPCD theme: “Leave No One Behind — Equity in Access to Palliative Care.” We reflect on lessons learned in anticipation of the 3rd annual conference to be held October 3–4, 2022.
Methods
Description of the 2nd annual event, conference planning team reflection, and attendee evaluation responses.
Results
The Worldwide Hospice Palliative Care Alliance launched WHPCD in 2005 as an annual unified day of action to celebrate and support hospice and palliative care around the world. The 2021 US-based innovative virtual conference featured 37 interprofessional hospice and palliative care specialists and patient and family caregiver speakers across 11 diverse sessions with a focus on health equity and COVID-19 considerations. Two primary aims continue to guide the event: community building and wisdom sharing at the intersection of art and science. 278 registrants from at least 14 countries and 21 different states across the US joined the program, which served as a global debriefing for hospice and palliative care workers from diverse settings, contexts, and disciplines.
Significance of results
The US WHPCD Celebration creates a virtual coming together for collective reflection on hospice and palliative care delivery amid vast changes in clinical practice, research, and policy, both locally and globally. In addition, our goal to ensure an internationally relevant, culturally inclusive, and multidisciplinary agenda will continue to draw increased participation worldwide during future annual events.
On October 10, 2020, the Memorial Sloan Kettering Cancer Center Supportive Care Service hosted their first-ever United States (US) World Hospice and Palliative Care Day (WHPCD) Celebration. The purpose of this article is to describe the US inaugural event in alignment with the broader goals of WHPCD and provide lessons learned in anticipation of the second annual conference to be held on October 5–6, 2021.
Methods
Description of the inaugural event in the context of COVID-19 and WHPCD, co-planning conference team reflection, and attendee survey responses.
Results
The Worldwide Hospice Palliative Care Alliance initially launched WHPCD in 2005 as an annual unified day of action to celebrate and support hospice and palliative care around the world. The US-based innovative virtual conference featured 23 interprofessional hospice and palliative care specialists and patient and family caregiver speakers across nine diverse sessions addressing priorities at the intersection of COVID-19, social injustice, and the global burden of serious health-related suffering. Two primary aims guided the event: community building and wisdom sharing. Nearly 270 registrants from at least 16 countries and one dozen states across the US joined the free program focused on both personal and professional development.
Significance of results
Unlike many other academic conferences and professional gatherings that were relegated to online forums due to pandemic-related restrictions, the US WHPCD Celebration was intentionally established to create a virtual coming together for collective reflection on the barriers and facilitators of palliative care delivery amid vast societal change. The goal to ensure a globally relevant and culturally inclusive agenda will continue to draw increased participation at an international level during future annual events. Finally, the transparent and respectful sharing of palliative care team experiences in the year preceding the conference established a safe environment for both individual expression and scholarly discussion.
Pollination services are critical for food production. Although domesticated honey bees are important pollinators in agriculture, there is growing interest in supporting naturally occurring wild bees. Diversifying pollination management strategies by encouraging healthy wild bee communities may be especially useful for growers of insect-pollinated crops, such as apples. Although research has identified several land management practices that can enhance local pollinator communities on farms, there are few studies on the factors that influence growers to adopt pollinator-supporting actions on their land. Here, we surveyed 75 Canadian apple growers and used regression models to explore the influence of farm characteristics and perceptions about bees on the likelihood of adopting 15 unique pollinator-supporting practices. We also provide a descriptive analysis of growers' pollination management practices and self-assessed resourcefulness on the ability to improve habitat for wild pollinators on the farm. We found that an increase in three variables: awareness of wild bees, perception of the severity of threats facing wild populations, and the perception of the benefits provided by wild bees is associated with more pollinator-supporting practices on the farm. Overall, growers were less likely to adopt pollinator-friendly practices as the fraction of rented land increased and as the perceived costs of implementing these practices rose. We found ‘low-hanging fruit’ (i.e., pollinator-supporting practices that could be easily and inexpensively implemented) were adopted by less than one-third of growers and that the majority of those surveyed had little to no knowledge on what actions to take if they wanted to improve their farms for wild bees or where to go for that knowledge. Our results suggest that policies and programs that focus on raising grower awareness of wild bees, increasing grower perception of their benefits, and reducing the perceived costs of implementing pollinator-supporting practices may positively affect their uptake. A deeper understanding of grower perceptions will provide essential insight into how growers may contribute to wild pollinator conservation while potentially increasing agricultural production and reducing vulnerability borne of heavy reliance on managed pollinators.
The rocky shores of the north-east Atlantic have been long studied. Our focus is from Gibraltar to Norway plus the Azores and Iceland. Phylogeographic processes shape biogeographic patterns of biodiversity. Long-term and broadscale studies have shown the responses of biota to past climate fluctuations and more recent anthropogenic climate change. Inter- and intra-specific species interactions along sharp local environmental gradients shape distributions and community structure and hence ecosystem functioning. Shifts in domination by fucoids in shelter to barnacles/mussels in exposure are mediated by grazing by patellid limpets. Further south fucoids become increasingly rare, with species disappearing or restricted to estuarine refuges, caused by greater desiccation and grazing pressure. Mesoscale processes influence bottom-up nutrient forcing and larval supply, hence affecting species abundance and distribution, and can be proximate factors setting range edges (e.g., the English Channel, the Iberian Peninsula). Impacts of invasive non-native species are reviewed. Knowledge gaps such as the work on rockpools and host–parasite dynamics are also outlined.
The objective of this study was to determine whether hatha yoga is an efficacious adjunctive intervention for individuals with continued depressive symptoms despite antidepressant treatment.
Method
We conducted a randomized controlled trial of weekly yoga classes (n = 63) v. health education classes (Healthy Living Workshop; HLW; n = 59) in individuals with elevated depression symptoms and antidepressant medication use. HLW served as an attention-control group. The intervention period was 10 weeks, with follow-up assessments 3 and 6 months afterwards. The primary outcome was depression symptom severity assessed by blind rater at 10 weeks. Secondary outcomes included depression symptoms over the entire intervention and follow-up periods, social and role functioning, general health perceptions, pain, and physical functioning.
Results
At 10 weeks, we did not find a statistically significant difference between groups in depression symptoms (b = −0.82, s.e. = 0.88, p = 0.36). However, over the entire intervention and follow-up period, when controlling for baseline, yoga participants showed lower levels of depression than HLW participants (b = −1.38, s.e. = 0.57, p = 0.02). At 6-month follow-up, 51% of yoga participants demonstrated a response (⩾50% reduction in depression symptoms) compared with 31% of HLW participants (odds ratio = 2.31; p = 0.04). Yoga participants showed significantly better social and role functioning and general health perceptions over time.
Conclusions
Although we did not see a difference in depression symptoms at the end of the intervention period, yoga participants showed fewer depression symptoms over the entire follow-up period. Benefits of yoga may accumulate over time.
We assessed the impact of a reflex urine culture protocol, an intervention aimed to reduce unnecessary urine culturing, in intensive care units at a tertiary care hospital. Significant decreases in urine culturing rates and reported rates of catheter-associated urinary tract infection followed implementation of the protocol.
To determine the impact of mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBIs) on central-line–associated bloodstream infection (CLABSI) rates during the first year of MBI-LCBI reporting to the National Healthcare Safety Network (NHSN)
DESIGN
Descriptive analysis of 2013 NHSN data
SETTING
Selected inpatient locations in acute care hospitals
METHODS
A descriptive analysis of MBI-LCBI cases was performed. CLABSI rates per 1,000 central-line days were calculated with and without the inclusion of MBI-LCBIs in the subset of locations reporting ≥1 MBI-LCBI, and in all locations (regardless of MBI-LCBI reporting) to determine rate differences overall and by location type.
RESULTS
From 418 locations in 252 acute care hospitals reporting ≥1 MBI-LCBIs, 3,162 CLABSIs were reported; 1,415 (44.7%) met the MBI-LCBI definition. Among these locations, removing MBI-LCBI from the CLABSI rate determination produced the greatest CLABSI rate decreases in oncology (49%) and ward locations (45%). Among all locations reporting CLABSI data, including those reporting no MBI-LCBIs, removing MBI-LCBI reduced rates by 8%. Here, the greatest decrease was in oncology locations (38% decrease); decreases in other locations ranged from 1.2% to 4.2%.
CONCLUSIONS
An understanding of the potential impact of removing MBI-LCBIs from CLABSI data is needed to accurately interpret CLABSI trends over time and to inform changes to state and federal reporting programs. Whereas the MBI-LCBI definition may have a large impact on CLABSI rates in locations where patients with certain clinical conditions are cared for, the impact of MBI-LCBIs on overall CLABSI rates across inpatient locations appears to be more modest.
A 45-year old man was referred to the Johns Hopkins Hospital with a seven-year history of repeated episodes of light-headedness, increasing irritability and forgetfulness. Examinations revealed a right superior, incongruous quadrantanopsia. EEG showed an abnormality in the left temporal lobe, and a cerebral angiogram outlined an avascular mass in the left cerebral hemisphere. At operation, the patient was found to have a giant dermoid cyst involving the left frontal, temporal and parietal lobes. Over the last 30 years we have encountered only 6 cases of intracranial epidermoids and 3 cases of intracranial dermoids. These cases are cited, and a discussion of the embryology, histology, clinical characteristics, and treatment of these lesions with a review of the literature is undertaken.
We have had experience with diaphragm pacing in 24 patients at the Toronto Western Hospital. Fourteen patients have undergone bilateral implants to treat chronic ventilatory insufficiency (CVI) caused by traumatic tetraplegia at the C1/2 level (eight patients), neurogenic apnea (five) and one case of neonatal apnea. Unilateral stimulators for nocturnal pacing have been implanted in five patients with central alveolar hypoventilation (sleep apnea) and five patients who suffered CVI resulting from various etiologies. Of the patients who were ventilatory dependent, 80% were successfully weaned and in the entire series, 58% of the patients are living. Diaphragm pacing was successful in 67%, partially successful in 8% and ineffective in 25%. The major complications were: death by pneumonia, failure of the radio receivers, and infection. Diaphragm pacing is the treatment of choice for patients who are ventilator dependent and tetraplegic from upper cervical trauma or in some cases of neurogenic apnea; it may be life saving for patients who suffer central alveolar hypoventilation.
Self-emission x-ray shadowgraphy provides a method to measure the ablation-front trajectory and low-mode nonuniformity of a target imploded by directly illuminating a fusion capsule with laser beams. The technique uses time-resolved images of soft x-rays (${>}1$ keV) emitted from the coronal plasma of the target imaged onto an x-ray framing camera to determine the position of the ablation front. Methods used to accurately measure the ablation-front radius (${\it\delta}R=\pm 1.15~{\rm\mu}\text{m}$), image-to-image timing (${\it\delta}({\rm\Delta}t)=\pm 2.5$ ps) and absolute timing (${\it\delta}t=\pm 10$ ps) are presented. Angular averaging of the images provides an average radius measurement of ${\it\delta}(R_{\text{av}})=\pm 0.15~{\rm\mu}\text{m}$ and an error in velocity of ${\it\delta}V/V=\pm 3\%$. This technique was applied on the Omega Laser Facility [Boehly et al., Opt. Commun. 133, 495 (1997)] and the National Ignition Facility [Campbell and Hogan, Plasma Phys. Control. Fusion 41, B39 (1999)].
Proffitt, Stefanucci, Banton, and Epstein (2003) reported a set of studies showing that the perceived distance to a target is influenced by the effort required to walk to its location. Hutchison and Loomis (H&L) reported an experiment that failed to find a significant influence of effort on indices of apparent distance. There were numerous important differences between the design and methods of H&L's study and those of Proffitt et al. Moreover, there are important theoretical reasons to believe that these differences were responsible for the different results. The theoretical motivation of H&L's studies was also brought into question.
While acknowledging that their design and methods were different from the original Proffitt, Stefanucci, Banton, and Epstein (2003) study, Hutchison and Loomis (H&L) continue to argue that their findings qualify our account of energetic influences on distance perception. This reply provides a brief and focused discussion of the methodological differences between their study and ours and why these differences were likely responsible for the different results. It is also argued that the measures employed by H&L are assessments of apparent location, not apparent distance.