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Preoperative transcatheter closure of congenital muscular ventricular septal defects.
BackgroundSurgical repair of muscular ventricular septal defects, particularly those associated with complex heart lesions carries a higher risk of reoperation and death than the repair of membranous defects. Closing a muscular defect through an incision in the systemic ventricle may cause late ventricular dysfunction. In a collaborative approach to this problem, we undertook preoperative transcatheter closure of muscular ventricular septal defects remote from the atrioventricular and semilunar valves, followed by the surgical repair of associated conditions.MethodsIn 12 patients selected jointly by a cardiologist and a cardiac surgeon, we attempted preoperative transcatheter umbrella closure of 21 defects. Half the patients had associated complex heart lesions; the others had had pulmonary-artery banding to reduce the amount of left-to-right shunting. Half had severe ventricular septal deficiency.ResultsAll 21 defects were successfully closed without major complications. Subsequent cardiac surgery for associated conditions in 11 of the 12 patients resulted in a mean pulmonary-to-systemic flow ratio of 1.1, indicating minimal residual left-to-right shunting; 1 patient awaited surgical repair. No deaths, reoperations, or late complications have occurred after a follow-up of 7 to 20 months.ConclusionsA collaborative approach using transcatheter closure followed by the surgical repair of associated cardiac lesions may decrease rates of operative mortality, reoperation, and left ventricular dysfunction in patients with muscular ventricular septal defects
Non-Abelian Magnetized Blackholes and Unstable Attractors
Fluctuations of non-Abelian gauge fields in a background magnetic flux
contain tachyonic modes and hence the background is unstable. We extend these
results to the cases where the background flux is coupled to Einstein gravity
and show that the corresponding spherically symmetric geometries, which in the
absence of a cosmological constant are of the form of Reissner-Nordstrom
blackholes or the AdS_2xS^2, are also unstable. We discuss the relevance of
these instabilities to several places in string theory including various string
compactifications and the attractor mechanism. Our results for the latter imply
that the attractor mechanism shown to work for the extremal Abelian charged
blackholes, cannot be applied in a straightforward way to the extremal
non-Abelian colored blackholes.Comment: 23 pages, 3 .eps figures; v2: Stability of minimal charge blackhole
emphasized, Refs adde
Evidence for maize (Zea mays) in the Late Archaic (3000-1800 B.C.) in the Norte Chico region of Peru
How Schools Affect Student Well-Being: A Cross-Cultural Approach in 35 OECD Countries
A common approach for measuring the effectiveness of an education system or a school
is the estimation of the impact that school interventions have on students’ academic
performance. However, the latest trends aim to extend the focus beyond students’
acquisition of knowledge and skills, and to consider aspects such as well-being in the
academic context. For this reason, the 2015 edition of the international assessment
system Programme for International Student Assessment (PISA) incorporated a new tool
aimed at evaluating the socio-emotional variables related to the well-being of students. It
is based on a definition focused on the five dimensions proposed in the PISA theoretical
framework: cognitive, psychological, social, physical, and material. The main purpose
of this study is to identify the well-being components that significantly affect student
academic performance and to estimate the magnitude of school effects on the wellbeing
of students in OECD countries, the school effect being understood as the ability of
schools to increase subjective student well-being. To achieve this goal, we analyzed the
responses of 248,620 students from 35 OECD countries to PISA 2015 questionnaires.
Specifically, we considered non-cognitive variables in the questionnaires and student
performance in science. The results indicated that the cognitive well-being dimension,
composed of enjoyment of science, self-efficacy, and instrumental motivation, as well as
test anxiety all had a consistent relationship with student performance across countries.
In addition, the school effect, estimated through a two-level hierarchical linear model, in
terms of student well-being was systematically low. While the school effect accounted
for approximately 25% of the variance in the results for the cognitive dimension, only
5–9% of variance in well-being indicators was attributable to it. This suggests that the
influence of school on student welfare is weak, and the effect is similar across countries.
The present study contributes to the general discussion currently underway about the
definition of well-being and the connection between well-being and achievement. The
results highlighted two complementary concerns: there is a clear need to promote socioemotional
education in schools, and it is important to develop a rigorous framework for
well-being assessment. The implications of the results and proposals for future studies
are discussed.Spain Ministry of Science, Innovation and Universities
PSI2017-85724-P2E Estudios, Evaluaciones e Investigacion, S.
Development and Validation of a Modified Multiple Errands Test for Adults with Intellectual Disabilities
Background: The aims of the current study were to adapt a version of the MET for people with intellectual disabilities (IDs) and assess its ecological and construct validity. Material and Methods: Using a correlational design, 40 participants with IDs were invited to complete a battery of neuropsychological assessments and the modified Multiple Errands Test for Intellectual Disabilities (mMET-IDs). Results: The ability to successfully complete tasks on the mMET-IDs correlated significantly with measures of the Supervisory Attentional System, namely, the Tower of London Test and the Six Parts Test. However, performance on the mMET-IDs and the Six Parts Test could be accounted for by Verbal IQ and receptive vocabulary. The mMET-IDs failed to correlate with the DEX-IR. Conclusions: The mMET-IDs can be successfully used to assess some aspects of the Supervisory Attentional System in people with IDs. Further development is needed, however, to improve the ecological validity of the mMET-IDs
HPV transcript expression affects cervical cancer response to chemoradiation
Persistent HPV infection is causative for the majority of cervical cancer cases; however, current guidelines do not require HPV testing for newly diagnosed cervical cancer. Using an institutional cohort of 88 patients with cervical cancer treated uniformly with standard-of-care chemoradiation treatment (CRT) with prospectively collected clinical outcome data, we observed that patients with cervical tumors containing HPV genotypes other than HPV 16 have worse survival outcomes after CRT compared with patients with HPV 16+ tumors, consistent with previously published studies. Using RNA sequencing analysis, we quantified viral transcription efficiency and found higher levels of E6 and the alternative transcript E6*I in cervical tumors with HPV genotypes other than HPV 16. These findings were validated using whole transcriptome data from The Cancer Genome Atlas (n = 304). For the first time to our knowledge, transcript expression level of HPV E6*I was identified as a predictive biomarker of CRT outcome in our complete institutional data set (n = 88) and within the HPV 16+ subset (n = 36). In vitro characterization of HPV E6*I and E6 overexpression revealed that both induce CRT resistance through distinct mechanisms dependent upon p53-p21. Our findings suggest that high expression of E6*I and E6 may represent novel biomarkers of CRT efficacy, and these patients may benefit from alternative treatment strategies
Assessing the Effectiveness of House-to-House Visits on Routine Oral Polio Immunization Completion and Tracking of Defaulters
Strengthening routine immunization is one of the four prongs of the
Global Polio Eradication Initiative. Using data collected through
30-cluster sample household surveys of caretakers of children aged
12-23 months, this paper assessed the effectiveness of house-to-house
visits on routine oral polio immunization completion, using simple
frequency tables, bivariate and multivariate logistic regression
analyses. Logistic regression results demonstrated that children in
households where the caregivers reported receiving a household visit by
health workers were more likely to be fully immunized for polio through
routine immunization than other children, although results were
significant only after correcting for confounders. In Ethiopia and
India, children of caregivers who remembered a house-to-house visit
were significantly and positively associated with routine polio
vaccination completion (OR=2.2 and OR=2.2 respectively). In Angola, the
association was positive, though not significant (OR=1.3). The evidence
suggests that targeting high-risk areas for house-to-house visits
played a role in increasing routine polio vaccination
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