Dr. John H. Gibbon, Jr. and Jefferson\u27s Heart-Lung Machine: Commemoration of the World\u27s First Successful Bypass Surgery

On May 6, 1953 at Jefferson Medical College Hospital, Dr. John Heysham Gibbon, Jr., his staff, and with the help of his latest-designed heart-lung machine, “Model II,” closed a very serious septal defect between the upper chambers of the heart of eighteen-year-old Cecelia Bavolek. This was the first successful intercardiac surgery of its kind performed on a human patient. Ms. Bavolek was connected to the device for three-quarters of an hour and for 26 crucial minutes, the patient totally depended upon the machine’s artificial cardiac and respiratory functions. “Jack” Gibbon did not follow this epoch-making event by holding an international press conference or by swiftly publishing his achievements in a major medical journal. In fact he later recalled that it was the first and only time that he did not write his own operative notes (which were supplied by Dr. Robert K. Finley, Jr.). According to a recent biographical review by C. Rollins Hanlon, “Therein lies a hint of the complex, unassuming personality behind the magnificent technical and surgical achievement of this patrician Philadelphia surgeon.”https://jdc.jefferson.edu/jeffhistoryposters/1000/thumbnail.jp

On a game theoretic cardinality bound

The main purpose of the paper is the proof of a cardinal inequality for a space with points $G_\delta$, obtained with the help of a long version of the Menger game. This result improves a similar one of Scheepers and Tall

Topological games and productively countably tight spaces

The two main results of this work are the following: if a space $X$ is such that player II has a winning strategy in the game \gone(\Omega_x, \Omega_x) for every $x \in X$, then $X$ is productively countably tight. On the other hand, if a space is productively countably tight, then \sone(\Omega_x, \Omega_x) holds for every $x \in X$. With these results, several other results follow, using some characterizations made by Uspenskii and Scheepers

Nonlinear Response of Inertial Tracers in Steady Laminar Flows: Differential and Absolute Negative Mobility

We study the mobility and the diffusion coefficient of an inertial tracer advected by a two-dimensional incompressible laminar flow, in the presence ofthermal noise and under the actionof an external force. We show, with extensive numerical simulations, that the force-velocity rela-tion for the tracer, in the nonlinear regime, displays complex and rich behaviors, including negativedifferential and absolute mobility. These effects rely upon asubtle coupling between inertia andapplied force which induce the tracer to persist in particular regions of phase space with a velocityopposite to the force. The relevance of this coupling is revisited in the framework of non-equilibriumresponse theory, applying a generalized Einstein relationto our system. The possibility of experi-mental observation of these results is also discussed

Tool for reading psychrometric charts

Three-legged, clear plastic tool is designed so that the angles of each leg correspond with the angles of psychometric chart construction for each of the three required scales. The appropriate edges are tapered to the chart surface

Sustainability and Spread of Community-based Initiatives: A case study of Community Cares, a Children’s Hospital’s 16 year effort to serve its community

The sustainability and spread of innovations is often elusive, presenting continuous challenges to clinicians and healthcare leaders. Somewhere between 33 - 70% of all innovations are reportedly not sustained, and even fewer are spread beyond the original team, or to other units within an organization. In plain language, sustainability is defined as locking in progress, while continually building upon that foundation, while spread is the exchange of knowledge and experience to others beyond the original implementing team. The literature supports the concept that sustainability is both multi-dimensional and multi-factorial and has several characteristics and pre-conditions. Tax-exempt, not-for-profit organizations in the USA must provide measurable community benefits to the populations they seek to serve. Many of these community benefits take the form of locating necessary services closer to or directly within the communities being served in order to enhance access. A case study of a 16 year effort to provide a medical home-oriented primary care model to underserved children in Houston, Texas Children’s Pediatrics’ Community Cares, is presented as illustrative of such a community benefit. Many of the characteristics and preconditions essential to a model for sustainability and spread are highlighted and the Community Cares case study is discussed from the standpoint of this framework

Follicular nodules (Thy3) of the thyroid: is total thyroidectomy the best option?

BACKGROUND: Identification of the best management strategy for nodules with Thy3 cytology presents particular problems for clinicians. This study investigates the ability of clinical, cytological and sonographic data to predict malignancy in indeterminate nodules with the scope of determining the need for total thyroidectomy in these patients. METHODS: The study population consisted of 249 cases presenting indeterminate nodules (Thy3): 198 females (79.5%) and 51 males (20.5%) with a mean age of 52.43 ± 13.68 years. All patients underwent total thyroidectomy. RESULTS: Malignancy was diagnosed in 87/249 patients (34.9%); thyroiditis co-existed in 119/249 cases (47.79%) and was associated with cancer in 40 cases (40/87; 45.98%). Of the sonographic characteristics, only echogenicity and the presence of irregular margins were identified as being statistically significant predictors of malignancy. 52/162 benign lesions (32.1%) and 54/87 malignant were hypoechoic (62.07%); irregular margins were present in 13/162 benign lesions (8.02%), and in 60/87 malignant lesions (68.97%). None of the clinical or cytological features, on the other hand, including age, gender, nodule size, the presence of microcalcifications or type 3 vascularization, were significantly associated with malignancy. CONCLUSIONS: The rate of malignancy in cytologically indeterminate lesions was high in the present study sample compared to other reported rates, and in a significant number of cases Hashimoto’s thyroiditis was also detected. Thus, considering the fact that clinical and cytological features were found to be inaccurate predictors of malignancy, it is our opinion that surgery should always be recommended. Moreover, total thyroidectomy is advisable, being the most suitable procedure in cases of multiple lesions, hyperplastic nodular goiter, or thyroiditis; the high incidence of malignancy and the unreliability of intraoperative frozen section examination also support this preference for total over hemi-thyroidectomy