Cost of thoracic endovascular aortic repair versus open repair and implications for the US health care system

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The Ursinus Weekly, November 22, 1965

Who\u27s Who Among Students honors fourteen seniors: Selection based on scholarship, leadership and potential • Dr. Lissfelt addresses PSEA at first meeting • Susan Starr concert Monday, November 29: Program includes Tchaikovsky and Beethoven • Library consultant on campus Dec. 1 • Ursinus receives $1,600 grant from Sears-Roebuck • Mormon speaker scheduled for Wismer forum • 800 enroll in Ursinus College evening school • Dissinger speaks on olfactory experiments • Philadelphia Art Alliance sponsors poetry contest • Editorial: For support and entertainment; A time to give thanks; Harvest dance • New cafeteria-style breakfast revolutionizes UC eating habits • Letters to the editor • Needed: more fun • Thanksgiving meditation • Team prepares for upcoming debating season • Intramural corner • Cross country • College hockey • Ursinus staggers F&M: D\u27Achille, Kamela lead Bears to 35-13 victory • F&M soccer shades Bears • Greek gleaningshttps://digitalcommons.ursinus.edu/weekly/1211/thumbnail.jp

The Ursinus Weekly, December 6, 1965

Weekly announces new staff members • Juniors initiate Prom innovation • Autistic child subject of Psych Club meeting • 28th Messiah performance features soloists Mayes, Valente, Jones and Mayer • Career conference scheduled for Dec. 7, 8 and 9 • Spanish Club offers UNICEF Christmas cards • Senses explored in Moody film • Retzlaff to address MSGA Christmas banquet • Phila. alumni elect regional president • Christmas events • Editorial: The Ursinus story • Theater-in-the-round scores instant success with audience • Klatsch speaker upholds liberal playboy philosophy • Letters to the editor • Mormons amaze UC\u27ers attending YMCA forum • Soccer-Football wrap-up • Kamela named All-American • Sue Day makes All-American hockey team • Cagers win openers: E. Baptist bows to Bears 67-63 • Intramural corner • Basketball-wrestling preview 1965-66 • Greek gleanings • Ursinus band shuns practices yet sounds bigger than life: Unit depends on quality musicians in performances • Moonlight and mistletoe promhttps://digitalcommons.ursinus.edu/weekly/1212/thumbnail.jp

Fate of patients with spinal cord ischemia complicating thoracic endovascular aortic repair

ObjectiveSpinal cord ischemia (SCI) is a potentially devastating complication of thoracic endovascular aortic repair (TEVAR) that can result in varying degrees of short-term and permanent disability. This study was undertaken to describe the clinical outcomes, long-term functional impact, and influence on survival of SCI after TEVAR.MethodsA retrospective review of all TEVAR patients at the University of Florida from 2000 to 2011 was performed to identify individuals experiencing SCI, defined by any new lower extremity neurologic deficit not attributable to another cause. SCI was dichotomized into immediate or delayed onset, with immediate onset defined as SCI noted upon awakening from anesthesia, and delayed characterized as a period of normal function, followed by development of neurologic injury. Ambulatory status was determined using database query, record review, and phone interviews with patients and/or family. Mortality was estimated using life-table analysis.ResultsA total of 607 TEVARs were performed for various indications, with 57 patients (9.4%) noted to have postoperative SCI (4.3% permanent). SCI patients were more likely to be older (63.9 ± 15.6 vs 70.5 ± 11.2 years; P = .002) and have a number of comorbidities, including chronic obstructive pulmonary disease, hypertension, dyslipidemia, and cerebrovascular disease (P < .0001). At some point in their care, a cerebrospinal fluid drain was placed in 54 patients (95%), with 54% placed postoperatively. In-hospital mortality was 8.8% for the entire cohort (SCI vs no SCI; P = .45). SCI developed immediately in 12 patients, delayed onset in 40, and indeterminate in five patients due to indiscriminate timing from postoperative sedation. Three patients (25%) with immediate SCI had measurable functional improvement (FI), whereas 28 (70%) of the delayed-onset patients experienced some degree of neurologic recovery (P = .04). Of the 34 patients with complete data available, 26 (76%) reported quantifiable FI, but only 13 (38%) experienced return to their preoperative baseline. Estimated mean (± standard error) survival for patients with and without SCI was 37.2 ± 4.5 and 71.6 ± 3.9 months (P < .0006), respectively. Patients with FI had a mean survival of 53.9 ± 5.9 months compared with 9.6 ± 3.6 months for those without improvement (P < .0001). Survival and return of neurologic function were not significantly different when patients with preoperative and postoperative cerebrospinal fluid drains were compared.ConclusionsThe minority of patients experience complete return to baseline function after SCI with TEVAR, and outcomes in patients without early functional recovery are particularly dismal. Patients experiencing delayed SCI are more likely to have FI and may anticipate similar life-expectancy with neurologic recovery compared with patients without SCI. Timing of drain placement does not appear to have an impact on postdischarge FI or long-term mortality

A 21 Centimeter Absorber Identified with a Spiral Galaxy: Hubble Space Telescope Faint Object Spectrograph and Wide-Field Camera Observations of 3CR 196

We present imaging and spectroscopy of the quasar 3CR 196 (z(sub e) = 0.871), which has 21 cm and optical absorption at z(sub a) = 0.437. We observed the region of Ly alpha absorption in 3CR 196 at z(sub a) = 0.437 with the Faint Object Spectrograph on the Hubble Space Telescope. This region of the spectrum is complicated because of the presence of a Lyman limit and strong lines from a z(sub a) approx. z(sub e) system. We conclude that there is Ly alpha absorption with an H I column density greater than 2.7 x 10(exp 19) cm(exp -2) and most probably 1.5 x 10(exp 20) cm(exp -2). Based on the existence of the high H I column density along both the optical and radio lines of sight, separated by more than 15 kpc, we conclude that the Ly alpha absorption must arise in a system comparable in size to the gaseous disks of spiral galaxies. A barred spiral galaxy, previously reported as a diffuse object in the recent work of Boisse and Boulade, can be seen near the quasar in an image taken at 0.1 resolution with the Wide Field Planetary Camera 2 on the HST. If this galaxy is at the absorption redshift, the luminosity is approximately L(sub *) and any H I disk should extend in front of the optical quasar and radio lobes of 3CR 196, giving rise to both the Ly alpha and 21 cm absorption. In the z(sub a) approx. z(sub e) system we detect Lyman lines and the Lyman limit, as well as high ion absorption lines of C III, N V, S VI, and O VI. This absorption probably only partially covers the emission-line region. The ionization parameter is approximately 0.1. Conditions in this region may be similar to those in broad absorption line QSOs

Preoperative prediction of spinal cord ischemia after thoracic endovascular aortic repair

ObjectiveSpinal cord ischemia (SCI) is a devastating but potentially preventable complication of thoracic endovascular aortic repair (TEVAR). The purpose of this analysis was to determine what factors predict SCI after TEVAR.MethodsAll TEVAR procedures at a single institution were reviewed for patient characteristics, prior aortic repair history, aortic centerline of flow analysis, and procedural characteristics. SCI was defined as any lower extremity neurologic deficit that was not attributable to an intracranial process or peripheral neuropathy. Forty-three patient and procedural variables were evaluated individually for association with SCI. Those with the strongest relationships to SCI (P < .1) were included in a multivariable logistic regression model, and a stepwise variable elimination algorithm was bootstrapped to derive a best subset of predictors from this model.ResultsFrom 2002 to 2013, 741 patients underwent TEVAR for various indications, and 68 (9.2%) developed SCI (permanent: n = 38; 5.1%). Because of the lack of adequate imaging for centerline analysis, 586 patients (any SCI, n = 43; 7.4%) were subsequently analyzed. Patients experiencing SCI after TEVAR were older (SCI, 72 ± 11 years; no SCI, 65 ± 15 years; P < .0001) and had significantly higher rates of multiple cardiovascular risk factors. The stepwise selection procedure identified five variables as the most important predictors of SCI: age (odds ratio [OR] multiplies by 1.3 per 10 years; 95% confidence interval [CI], 0.9-1.8, P = .06), aortic coverage length (OR multiplies by 1.3 per 5 cm; CI, 1.1-1.6; P = .002), chronic obstructive pulmonary disease (OR, 1.9; CI, 0.9-4.1; P = .1), chronic renal insufficiency (creatinine concentration ≥ 1.6 mg/dL; OR, 1.9; CI, 0.8-4.2; P = .1), and hypertension (defined as chart history or medication; OR, 6.4; CI, 2.6-18; P < .0001). A logistic regression model with just these five covariates had excellent discrimination (area under the receiver operating characteristic curve = .83) and calibration (χ2 = 9.8; P = .28).ConclusionsThis analysis generated a simple model that reliably predicts SCI after TEVAR. This clinical tool can assist decision-making about when to proceed with TEVAR, guide discussions about intervention risk, and help determine when maneuvers to mitigate SCI risk should be implemented

The Ursinus Weekly, January 17, 1966

Y speaker on Vietnam assails US policy • PSEA hears advice from student teachers • Alumni invite U.C. seniors to gala at Bala • Ursinus Plan, part 2: Detailed explanation of new curricular program • U.C. receives $2,500 grant • Lorelei sirens seek out male campus element • Alumni Centennial corner • Editorial: We get letters? Only wish we did! • Letters to the editor • Editors, professor applaud maiden publication of Focus: All cite necessity for participation of student body • Only seven can secure greatest Ursinus honor : Cub and Key to induct at Prom • Intramural corner • Wrestlers strangle H\u27ford, Albright: Shut out Fords 37-0, Drop Albright 20-9 • Troster leads Bears over Dickinson: UC bounces back after losing to H\u27ford • Greek gleanings • Are students destructive? Not often, but accidents happen in dorms, labs: Boys will be boys sometimes, thoughhttps://digitalcommons.ursinus.edu/weekly/1215/thumbnail.jp

On the temperature dependence of organic reactivity, nitrogen oxides, ozone production, and the impact of emission controls in San Joaquin Valley, California

The San Joaquin Valley (SJV) experiences some of the worst ozone air quality in the US, frequently exceeding the California 8 h standard of 70.4 ppb. To improve our understanding of trends in the number of ozone violations in the SJV, we analyze observed relationships between organic reactivity, nitrogen oxides (NO[subscript x]), and daily maximum temperature in the southern SJV using measurements made as part of California at the Nexus of Air Quality and Climate Change in 2010 (CalNex-SJV). We find the daytime speciated organic reactivity with respect to OH during CalNex-SJV has a temperature-independent portion with molecules typically associated with motor vehicles being the major component. At high temperatures, characteristic of days with high ozone, the largest portion of the total organic reactivity increases exponentially with temperature and is dominated by small, oxygenated organics and molecules that are unidentified. We use this simple temperature classification to consider changes in organic emissions over the last and next decade. With the CalNex-SJV observations as constraints, we examine the sensitivity of ozone production (PO[subscript 3]) to future NO[subscript x] and organic reactivity controls. We find that PO[subscript 3] is NO[subscript x]-limited at all temperatures on weekends and on weekdays when daily maximum temperatures are greater than 29 °C. As a consequence, NO[subscript x] reductions are the most effective control option for reducing the frequency of future ozone violations in the southern SJV.California Environmental Protection Agency. Air Resources Board (Contract CARB 08-316)United States. National Aeronautics and Space Administration (Grant NNX10AR36G