Increased Risk of Infection and Mortality in Women after Cardiac Surgery Related to Allogeneic Blood Transfusion

Background: Infection and mortality rates are greater in women than in men after cardiac surgery. This study was conducted to assess whether allogeneic blood transfusion could partially account for this gender difference, as transfusion has been associated with immunomodulation. Methods: A cohort study was conducted in 380 patients at the University of Rochester Medical Center. Subjects were adult patients who underwent primary coronary artery bypass graft (CABG) surgery, primary valve replacement surgery, or both. Information was collected about blood components transfused, as well as postoperative infection, pulmonary dysfunction, and in-hospital mortality. Results: Women were more likely to receive allogeneic red blood cells (RBCs) or platelets than men (odds ratio [OR] 21.6, 95% CI 3.8, 124.2) and a greater quantity of blood than men. Patients who received allogeneic blood were 4.4 times more likely to develop an infection than those who did not (95% CI 1.5, 13.2). There was a positive linear correlation between number of units of blood received and number of days with fever (p < 0.001) and hospital length of stay (p < 0.001). This was particularly evident in patients who received four or more units of nonleukoreduced blood components. Women had a greater risk of infection (p = 0.005), pulmonary dysfunction (p = 0.005), and mortality (p = 0.007) than men during hospitalization. Conclusions: One reason for the greater mortality in women after cardiac surgery may be the increased likelihood of receiving nonleukoreduced allogeneic RBCs and platelets. Transfusion increased the risk of infection; infection, then, increased the likelihood of pulmonary dysfunction and mortality.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63383/1/jwh.2007.0397.pd

Proposal to study the k+- charge exchange reactions at high energies

An experiment is proposed for measurement of the K{sup {+-}} {yields} K-Long charge-exchange reactions using unseparated beams; useful rates are obtained for p{sub inc}{le}100 GeV/c and -t {le} 1 (GeV/c){sup 2}. A V-spectrometer with resolution {+-}1% is used downstream of the target for detection of the decays K-long {yields} {pi}{sup +}{pi}{sup -}. Using hydrogen and deuterium targets, the detection system is designed to measure: (1) d{sigma}/dt for K{sup -}p {yields} {bar K}{sup 0}n. The reaction will be distinguished from background processes involving N* and K* production by kinematics and supplementary detectors surrounding the target. (2) d{sup 2}{sigma}/dpdt for K{sup -}d {yields} {bar K}{sup 0}nn. This final state will be distinguished from those involving production of {pi}{sup 0}'s or charged particles primarily by the supplementary target veto array. Use of a deuterium target will provide partial clarification of the problems to be encountered in achieving part 3. In principle, some information on the relative sizes of the spin-flip and non-spin-flip amplitudes will be obtained. (3) d{sup 2}{sigma}/dpdt for K{sup +}d {yields} K{sup 0}pp. Since charged particles are produced at the interaction vortex, this final state can be reliably extracted only with the insight gained in parts (1) and (2) and a detailed study of the distributions in the target veto counter array

A Medium-Resolution Near-Infrared Spectral Library of Late Type Stars: I

We present an empirical infrared spectral library of medium resolution (R~2000-3000) H (1.6 micron) and K (2.2 micron) band spectra of 218 red stars, spanning a range of [Fe/H] from ~-2.2 to ~+0.3. The sample includes Galactic disk stars, bulge stars from Baade's window, and red giants from Galactic globular clusters. We report the values of 19 indices covering 12 spectral features measured from the spectra in the library. Finally, we derive calibrations to estimate the effective temperature, and diagnostic relationships to determine the luminosity classes of individual stars from near-infrared spectra. This paper is part of a larger effort aimed at building a near-IR spectral library to be incorporated in population synthesis models, as well as, at testing synthetic stellar spectra.Comment: 34 pages, 12 figures; accepted for publication at ApJS; the spectra are available from the authors upon reques

Targeted surveillance strategies for efficient detection of novel antibiotic resistance variants.

Genotype-based diagnostics for antibiotic resistance represent a promising alternative to empiric therapy, reducing inappropriate antibiotic use. However, because such assays infer resistance based on known genetic markers, their utility will wane with the emergence of novel resistance. Maintenance of these diagnostics will therefore require surveillance to ensure early detection of novel resistance variants, but efficient strategies to do so remain undefined. We evaluate the efficiency of targeted sampling approaches informed by patient and pathogen characteristics in detecting antibiotic resistance and diagnostic escape variants in Neisseria gonorrhoeae, a pathogen associated with a high burden of disease and antibiotic resistance and the development of genotype-based diagnostics. We show that patient characteristic-informed sampling is not a reliable strategy for efficient variant detection. In contrast, sampling informed by pathogen characteristics, such as genomic diversity and genomic background, is significantly more efficient than random sampling in identifying genetic variants associated with resistance and diagnostic escape

PTEN protein loss by immunostaining: Analytic validation and prognostic indicator for a high risk surgical cohort of prostate cancer patients

PURPOSE: Analytically validated assays to interrogate biomarker status in clinical samples are crucial for personalized medicine. PTEN is a tumor suppressor commonly inactivated in prostate cancer that has been mechanistically linked to disease aggressiveness. Though deletion of PTEN, as detected by cumbersome fluorescence in situ hybridization (FISH) spot counting assays, is associated with poor prognosis, few studies have validated immunohistochemical (IHC) assays to determine whether loss of PTEN protein is associated with unfavorable disease. EXPERIMENTAL DESIGN: PTEN IHC was validated by employing formalin fixed and paraffin embedded isogenic human cell lines containing or lacking intact PTEN alleles. PTEN IHC was 100% sensitive and 97.8% specific for detecting genomic alterations in 58 additional cell lines. PTEN protein loss was then assessed on 376 prostate tumor samples, and PTEN FISH or high resolution SNP microarray analysis was performed on a subset of these cases. RESULTS: PTEN protein loss, as assessed as a dichotomous IHC variable, was highly reproducible, correlated strongly with adverse pathologic features (e.g. Gleason score and pathological stage), detected between 75% and 86% of cases with PTEN genomic loss, and was found at times in the absence of apparent genomic loss. In a cohort of 217 high risk surgically treated patients, PTEN protein loss was associated with decreased time to metastasis. CONCLUSIONS: These studies validate a simple method to interrogate PTEN status in clinical specimens and support the utility of this test in future multi-center studies, clinical trials and ultimately perhaps for routine clinical care

Hip-Hop Development™ Bridging the Generational Divide for Youth Development

Hip-Hop culture in the lives of youth can not be ignored. This research is based on the premise that youth workers who expect ongoing successes must increase their Hip-Hop culture competence. The study examined the knowledge of and attitude towards Hip-Hop by educators who participated in a Hip-Hop 101 workshop. Their perceptions relevant to the importance of Hip-Hop awareness and application for positively influencing youth behaviors were also explored. Results revealed that workshop participants significantly increased their Hip-Hop knowledge. They also demonstrated significantly more favorable attitudes toward Hip-Hop and its use for youth development. Findings suggest that the workshop promoted an environment conducive to bridging the generation gap between youth who embrace Hip-Hop, and educators who have a less favorable view. This research provides insight into Hip-Hop Developmenttm as a core component for establishing the kinds of youth-adult partnerships necessary for today’s Hip-Hop generation’s self-growth, skill enhancement, and leadership development

Hip-Hop Development™ Bridging the Generational Divide for Youth Development

Hip-Hop culture in the lives of youth can not be ignored. This research is based on the premise that youth workers who expect ongoing successes must increase their Hip-Hop culture competence. The study examined the knowledge of and attitude towards Hip-Hop by educators who participated in a Hip-Hop 101 workshop. Their perceptions relevant to the importance of Hip-Hop awareness and application for positively influencing youth behaviors were also explored. Results revealed that workshop participants significantly increased their Hip-Hop knowledge. They also demonstrated significantly more favorable attitudes toward Hip-Hop and its use for youth development. Findings suggest that the workshop promoted an environment conducive to bridging the generation gap between youth who embrace Hip-Hop, and educators who have a less favorable view. This research provides insight into Hip-Hop Developmenttm as a core component for establishing the kinds of youth-adult partnerships necessary for today’s Hip-Hop generation’s self-growth, skill enhancement, and leadership development

A mediation approach to understanding socio-economic inequalities in maternal health-seeking behaviours in Egypt.

BACKGROUND: The levels and origins of socio-economic inequalities in health-seeking behaviours in Egypt are poorly understood. This paper assesses the levels of health-seeking behaviours related to maternal care (antenatal care [ANC] and facility delivery) and their accumulation during pregnancy and childbirth. Secondly, it explores the mechanisms underlying the association between socio-economic position (SEP) and maternal health-seeking behaviours. Thirdly, it examines the effectiveness of targeting of free public ANC and delivery care. METHODS: Data from the 2008 Demographic and Health Survey were used to capture two latent constructs of SEP: individual socio-cultural capital and household-level economic capital. These variables were entered into an adjusted mediation model, predicting twelve dimensions of maternal health-seeking; including any ANC, private ANC, first ANC visit in first trimester, regular ANC (four or more visits during pregnancy), facility delivery, and private delivery. ANC and delivery care costs were examined separately by provider type (public or private). RESULTS: While 74.2% of women with a birth in the 5-year recall period obtained any ANC and 72.4% delivered in a facility, only 48.8% obtained the complete maternal care package (timely and regular facility-based ANC as well as facility delivery) for their most recent live birth. Both socio-cultural capital and economic capital were independently positively associated with receiving any ANC and delivering in a facility. The strongest direct effect of socio-cultural capital was seen in models predicting private provider use of both ANC and delivery. Despite substantial proportions of women using public providers reporting receipt of free care (ANC: 38%, delivery: 24%), this free-of-charge public care was not effectively targeted to women with lowest economic resources. CONCLUSIONS: Socio-cultural capital is the primary mechanism leading to inequalities in maternal health-seeking in Egypt. Future studies should therefore examine the objective and perceived quality of care from different types of providers. Improvements in the targeting of free public care could help reduce the existing SEP-based inequalities in maternal care coverage in the short term

Training less-experienced faculty improves reliability of skills assessment in cardiac surgery

OBJECTIVE: Previous work has demonstrated high inter-rater reliability in the objective assessment of simulated anastomoses among experienced educators. We evaluated the inter-rater reliability of less-experienced educators and the impact of focused training with a video-embedded coronary anastomosis assessment tool. METHODS: Nine less-experienced cardiothoracic surgery faculty members from different institutions evaluated 2 videos of simulated coronary anastomoses (1 by a medical student and 1 by a resident) at the Thoracic Surgery Directors Association Boot Camp. They then underwent a 30-minute training session using an assessment tool with embedded videos to anchor rating scores for 10 components of coronary artery anastomosis. Afterward, they evaluated 2 videos of a different student and resident performing the task. Components were scored on a 1 to 5 Likert scale, yielding an average composite score. Inter-rater reliabilities of component and composite scores were assessed using intraclass correlation coefficients (ICCs) and overall pass/fail ratings with kappa. RESULTS: All components of the assessment tool exhibited improvement in reliability, with 4 (bite, needle holder use, needle angles, and hand mechanics) improving the most from poor (ICC range, 0.09-0.48) to strong (ICC range, 0.80-0.90) agreement. After training, inter-rater reliabilities for composite scores improved from moderate (ICC, 0.76) to strong (ICC, 0.90) agreement, and for overall pass/fail ratings, from poor (kappa = 0.20) to moderate (kappa = 0.78) agreement. CONCLUSIONS: Focused, video-based anchor training facilitates greater inter-rater reliability in the objective assessment of simulated coronary anastomoses. Among raters with less teaching experience, such training may be needed before objective evaluation of technical skills

Evaluation of simulation training in cardiothoracic surgery: The Senior Tour perspective

OBJECTIVE: The study objective was to introduce senior surgeons, referred to as members of the "Senior Tour," to simulation-based learning and evaluate ongoing simulation efforts in cardiothoracic surgery. METHODS: Thirteen senior cardiothoracic surgeons participated in a 2½-day Senior Tour Meeting. Of 12 simulators, each participant focused on 6 cardiac (small vessel anastomosis, aortic cannulation, cardiopulmonary bypass, aortic valve replacement, mitral valve repair, and aortic root replacement) or 6 thoracic surgical simulators (hilar dissection, esophageal anastomosis, rigid bronchoscopy, video-assisted thoracoscopic surgery lobectomy, tracheal resection, and sleeve resection). The participants provided critical feedback regarding the realism and utility of the simulators, which served as the basis for a composite assessment of the simulators. RESULTS: All participants acknowledged that simulation may not provide a wholly immersive experience. For small vessel anastomosis, the portable chest model is less realistic compared with the porcine model, but is valuable in teaching anastomosis mechanics. The aortic cannulation model allows multiple cannulations and can serve as a thoracic aortic surgery model. The cardiopulmonary bypass simulator provides crisis management experience. The porcine aortic valve replacement, mitral valve annuloplasty, and aortic root models are realistic and permit standardized training. The hilar dissection model is subject to variability of porcine anatomy and fragility of the vascular structures. The realistic esophageal anastomosis simulator presents various approaches to esophageal anastomosis. The exercise associated with the rigid bronchoscopy model is brief, and adding additional procedures should be considered. The tracheal resection, sleeve resection, and video-assisted thoracoscopic surgery lobectomy models are highly realistic and simulate advanced maneuvers. CONCLUSIONS: By providing the necessary tools, such as task trainers and assessment instruments, the Senior Tour may be one means to enhance simulation-based learning in cardiothoracic surgery. The Senior Tour members can provide regular programmatic evaluation and critical analyses to ensure that proposed simulators are of educational value