Development of quality metrics for ambulatory pediatric cardiology: Transposition of the great arteries after arterial switch operation

ObjectiveTo develop quality metrics (QMs) for the ambulatory care of patients with transposition of the great arteries following arterial switch operation (TGA/ASO).DesignUnder the auspices of the American College of Cardiology Adult Congenital and Pediatric Cardiology (ACPC) Steering committee, the TGA/ASO team generated candidate QMs related to TGA/ASO ambulatory care. Candidate QMs were submitted to the ACPC Steering Committee and were reviewed for validity and feasibility using individual expert panel member scoring according to the RANDâ UCLA methodology. QMs were then made available for review by the entire ACC ACPC during an â open comment period.â Final approval of each QM was provided by a vote of the ACC ACPC Council.PatientsPatients with TGA who had undergone an ASO were included. Patients with complex transposition were excluded.ResultsTwelve candidate QMs were generated. Seven metrics passed the RANDâ UCLA process. Four passed the â open comment periodâ and were ultimately approved by the Council. These included: (1) at least 1 echocardiogram performed during the first year of life reporting on the function, aortic dimension, degree of neoaortic valve insufficiency, the patency of the systemic and pulmonary outflows, the patency of the branch pulmonary arteries and coronary arteries, (2) neurodevelopmental (ND) assessment after ASO; (3) lipid profile by age 11 years; and (4) documentation of a transition of care plan to an adult congenital heart disease (CHD) provider by 18 years of age.ConclusionsApplication of the RANDâ UCLA methodology and linkage of this methodology to the ACPC approval process led to successful generation of 4 QMs relevant to the care of TGA/ASO pediatric patients in the ambulatory setting. These metrics have now been incorporated into the ACPC Quality Network providing guidance for the care of TGA/ASO patients across 30 CHD centers.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142334/1/chd12540_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142334/2/chd12540.pd

Challenges in optics for Extremely Large Telescope instrumentation

We describe and summarize the optical challenges for future instrumentation for Extremely Large Telescopes (ELTs). Knowing the complex instrumental requirements is crucial for the successful design of 30-60m aperture telescopes. After all, the success of ELTs will heavily rely on its instrumentation and this, in turn, will depend on the ability to produce large and ultra-precise optical components like light-weight mirrors, aspheric lenses, segmented filters, and large gratings. New materials and manufacturing processes are currently under study, both at research institutes and in industry. In the present paper, we report on its progress with particular emphasize on volume-phase-holographic gratings, photochromic materials, sintered silicon-carbide mirrors, ion-beam figuring, ultra-precision surfaces, and free-form optics. All are promising technologies opening new degrees of freedom to optical designers. New optronic-mechanical systems will enable efficient use of the very large focal planes. We also provide exploratory descriptions of "old" and "new" optical technologies together with suggestions to instrument designers to overcome some of the challenges placed by ELT instrumentation.Comment: (Proc. OPTICON Key Technology Network Workshop, Rome 20-21 October 2005

MOONS: a Multi-Object Optical and Near-infrared Spectrograph for the VLT

MOONS is a new conceptual design for a Multi-Object Optical and Near-infrared Spectrograph for the Very Large Telescope (VLT), selected by ESO for a Phase A study. The baseline design consists of 1000 fibers deployable over a field of view of 500 square arcmin, the largest patrol field offered by the Nasmyth focus at the VLT. The total wavelength coverage is 0.8um-1.8um and two resolution modes: medium resolution and high resolution. In the medium resolution mode (R=4,000-6,000) the entire wavelength range 0.8um-1.8um is observed simultaneously, while the high resolution mode covers simultaneously three selected spectral regions: one around the CaII triplet (at R=8,000) to measure radial velocities, and two regions at R=20,000 one in the J-band and one in the H-band, for detailed measurements of chemical abundances. The grasp of the 8.2m Very Large Telescope (VLT) combined with the large multiplex and wavelength coverage of MOONS - extending into the near-IR - will provide the observational power necessary to study galaxy formation and evolution over the entire history of the Universe, from our Milky Way, through the redshift desert and up to the epoch of re-ionization at z>8-9. At the same time, the high spectral resolution mode will allow astronomers to study chemical abundances of stars in our Galaxy, in particular in the highly obscured regions of the Bulge, and provide the necessary follow-up of the Gaia mission. Such characteristics and versatility make MOONS the long-awaited workhorse near-IR MOS for the VLT, which will perfectly complement optical spectroscopy performed by FLAMES and VIMOS.Comment: 9 pages, 5 figures. To appear in the proceedings of the SPIE Astronomical Instrumentation + Telescopes conference, Amsterdam, 201

Single Molecule Discrimination of Heteropolytungstates and Their Isomers in Solution with a Nanometer-Scale Pore

We report a new method to identify metallic nanoclusters (polyoxometalate structures) in solution at the single molecule limit using a nanometer-scale pore. The technique allows the measurement of polyoxometalates with over 2 orders of magnitude lower analyte concentration than conventional analytical chemistry tools. Furthermore, pH-dependent structural changes in phosphotungstic acid are measured with protein nanopores and validated with NMR. We further demonstrate that the method can also discriminate [PW₉O₃₄]^9– structural isomers. The results suggest this technique can serve as a complementary approach to traditional methods

A comparison of ion channel current blockades caused by individual poly(ethylene glycol) molecules and polyoxometalate nanoclusters

Proteinaceous nanometer-scale pores have been used to detect and physically characterize many different types of analytes at the single-molecule limit. The method is based on the ability to measure the transient reduction in the ionic channel conductance caused by molecules that partition into the pore. The distribution of blockade depth amplitudes and residence times of the analytes in the pore are used to physically and chemically characterize them. Here we compare the current blockade events caused by flexible linear polymers of ethylene glycol (PEGs) and structurally well-defined tungsten polyoxymetallate nanoparticles in the nanopores formed by Staphylococcus aureus $\alpha$-hemolysin and Aeromonas hydrophila aerolysin. Surprisingly, the variance in the ionic current blockade depth values for the relatively rigid metallic nanoparticles is much greater than that for the flexible PEGs, possibly because of multiple charged states of the polyoxymetallate clusters

Pulmonary artery growth fails to match the increase in body surface area after the Fontan operation

OBJECTIVE: To evaluate the growth of the pulmonary arteries after a Fontan procedure. DESIGN: Retrospective review. SETTING: Two paediatric cardiology tertiary care centres. PATIENTS: 61 children who underwent a modified Fontan operation and had angiography suitable for assessment of pulmonary artery size before the Fontan procedure and during long term follow up. An atriopulmonary connection (APC) was present in 23 patients (37.7%) and a total cavopulmonary connection (TCPC) was present in 38 (62.3%). Postoperative angiograms were performed 0.5–121 months (median 19 months) after the Fontan operation. MAIN OUTCOME MEASURE: Growth of each pulmonary artery measured just before the first branching point. The diameter was expressed as a z score with established nomograms used to standardise for body surface area. RESULTS: The mean change in the preoperative to postoperative z scores of the right pulmonary artery was −1.06 (p  =  0.004). The mean change in the preoperative to postoperative z scores of the left pulmonary artery was −0.88 (p  =  0.003). Changes in the preoperative to postoperative z scores were more pronounced in the patients undergoing APC than TCPC, especially for the right pulmonary artery. CONCLUSION: After the Fontan operation, growth of the pulmonary arteries often fails to match the increase in body surface area