Thoracic Surgery Workforce: Report of STS/AATS Thoracic Surgery Practice and Access Task Force—Snapshot 2010

BackgroundThe Society of Thoracic Surgeons (STS) and the American Association for Thoracic Surgery (AATS) have intermittently surveyed their combined membership. These manpower surveys have provided snapshots of thoracic surgery, documenting practice changes over time. At this critical time in US health care reform the physician workforce is of critical importance. This survey updates the data obtained from the 2000 and 2005 surveys.MethodsThe survey instrument was updated from the 2005 survey. It was received by 5265 surgeon members of the STS/AATS during November and December 2009. There was a superb 50% return rate. The data were entered into a comprehensive database. Perception Solutions, Inc, independently performed the analysis.ResultsThe median age of the active US thoracic surgeons is 52.9 years. Women comprise 3.4% of adult cardiac, 5.2% of congenital heart, and 7.9% of general thoracic surgeons. The decision to pursue a career in thoracic surgery was made before or in medical school by 45.3% of surgeons. The majority of survey respondents had a mean of 8.7 years of residency training after medical school graduation. The cumulative average educational debt was $56,000. Overall career satisfaction was 46$55,947 to $59,673. The number of additional years the currently active US cardiothoracic surgeon plans to practice is 12.6 years. Therefore, the projected retirement age of the thoracic surgery workforce will be 65. This is consistent among all surgeons: adult cardiac, 66 years; congenital heart, 65 years; and general thoracic, 67 years.ConclusionsThese data give a clear profile of the specialty at this time. The major challenges remain length of training and educational debt of the thoracic surgeon. Case volume, scope of practice, malpractice costs, and career satisfaction remain major elements to provide a positive environment to recruit new surgeons in to the specialty. The resident pool has contracted while the workforce ages and retirement looms. Significant shortages may develop as the US population ages in the environment of health care reform

Comparison of David V valve-sparing root replacement and bioprosthetic valve conduit for aortic root aneurysm

ObjectiveValve sparing root replacement (VSRR) is an attractive option for the management of aortic root aneurysms with a normal native aortic valve. Therefore, we reviewed our experience with a modification of the David V VSRR and compared it with stented pericardial bioprosthetic valve conduit (BVC) root replacement in an age-matched cohort of older patients.MethodsA total of 48 VSRRs were performed at our institution, excluding those on bicuspid aortic valves. We compared these cases with 15 aortic root replacements performed using a BVC during the same period. Subgroup analysis was performed comparing 16 VSRR cases and 15 age-matched BVC cases.ResultsThe greatest disparity between the VSRR and BVC groups was age (53 vs 69 years, respectively; P < .0005). The matched patients were similar in terms of baseline demographics and differed only in concomitant coronary artery bypass grafting (2 VSRR vs 7 BVC patients; P = .036). None of the VSRR and 3 of the BVC procedures were performed for associated dissection (P = .101). Postoperative aortic insufficiency grade was significantly different between the 2 groups (P = .004). The cardiopulmonary bypass, crossclamp, and circulatory arrest times were not different between the VSRR and BVC groups (174 vs 187 minutes, P = .205; 128 vs 133 minutes, P = .376; and 10 vs 13 minutes, respectively; P = .175). No differences were found between the 2 groups with respect to postoperative complications. One postoperative death occurred in the BVC group and none in the VSRR group. The postoperative length of stay and aortic valve gradients were less in the VSRR group (6 vs 8 days, P = .038; 6 vs 11.4 mm Hg, P = .001). The intensive care unit length of stay was significantly less in the VSRR group (54 vs 110 hours, P = .001).ConclusionsVSRR is an effective alternative to the BVC for aortic root aneurysm

1119-99 Immunoglobulin A anticardiolipin antibodies are markers of the extent of daily life ischemia in patients with stable angina

Rising population numbers place ever increasing demands on energy resources. A large percentage of the worldwide energy production is reserved for the generation of electricity and a significant portion of the electrical energy generation is used for illumination purposes. At the same time, people demand brighter light sources that provide better light quality. The luminaire of today is not just a simple lamp, but a complex, intelligent piece of technology designed for a specific purpose. This doctoral dissertation aims to provide a link between the theoretical universe surrounding the physics of electromagnetic radiation and the practical illumination world. A theoretical framework presents the physical properties of light and connects, through the human visual system, to a number of perceptual models. Based on these perceptual models, the colourimetric qualities of an illumination spectrum are analysed and a theoretical framework that aims to optimise the balance between colour fidelity and energy efficiency is proposed. The result of this optimisation is a spectrum that needs to be implemented into a light source. Recent advancements in semiconductor technology led to the development of highly efficient light emitting diodes. The monochromatic nature of these light sources offers the possibility of creating a spectrally tuneable luminaire that is able to reproduce these optimised illumination spectra. A fully integrated spectrally tuneable light engine combines knowledge on characterising and driving LEDs, optical design and thermal management. Each group of monochromatic LEDs needs a variable current source that ensures predictable behaviour regardless of their dimming level or temperature. An advanced optical solution enables efficient light extraction from the LEDs, provides excellent luminance and chroma homogenisation and, finally, delivers a suitable beam pattern for the intended illumination application. Proper thermal management establishes sufficient heat extraction to guarantee low semiconductor temperatures. Finally, the LED light engines created during this doctoral research are incorporated into three spectrally tuneable illumination devices, each designed for a specific purpose. A set of spectrally tuneable downlights installed in the laboratories of the lighting group of the Catalonia Institute for Energy Research (IREC) in Barcelona, Spain and the department of neuroscience of the University of Newcastle in the United Kingdom serves as a valuable tool for experiments that evaluate both physical and psychovisual properties of selected illumination spectra. A compact spotlight, used during the "Making Colour" exhibition of the National Gallery in London, is optimised to provide a set of specific illumination spectra to illuminate art reproductions. Lastly, a high power luminaire was designed to generate specialised spectra to irradiate greenhouse plants, steering their morphology and the production of plant-specific compounds.El incremento de población mundial en los últimos años implica necesariamente un incremento en la demanda energética global. Un alto porcentaje de la energía producida globalmente es utilizada para iluminar los diferentes espacios. Al mismo tiempo, los usuarios reclaman cada vez fuentes de luz más potentes y entornos más iluminados y con mayor calidad de luz. Las luminarias actuales no son simplemente lámparas, sino sistemas complejos e inteligentes diseñados con propósitos específicos. Esta tesis doctoral pretende unir dos espacios que normalmente son abordados de manera separada: por un lado, el entorno teórico de la radiación visible y sus propiedades colorimétricas, y por otro lado la luminotecnia aplicada. En el ámbito teórico, se han tratado con las propiedades físicas de la luz, estableciendo un puente a través de la visión humana con diferentes modelos de percepción visual. En base a estos modelos, se han analizado las propiedades colorimétricas de los espectros de iluminación estudiados y se propone un marco teórico de optimización entre fidelidad de color y eficiencia energética. Los resultados de esta optimización se han implementado también en una fuente de luz de espectro modulable real. Recientemente, el mercado LED está alcanzando valores altísimos en cuanto a eficacias lumínicas. Sin embargo, el crecimiento del mercado pasa por mejorar otros aspectos que garanticen el progreso de la tecnología. La naturaleza esencialmente monocromática de los LEDs de estado sólido ofrece la posibilidad de crear fuentes de luz de espectro sintonizable mediante la composición espectral o adición cromática de varios tipos diferentes de LED. Para el diseño de una de estas fuentes de luz se requieren conocimientos en cuanto a la caracterización y energizado de los LEDs, diseño óptico y diseño térmico. Cada clúster de LEDs de características espectrales similares necesita una fuente de corriente variable que garantice unos valores estables y que no dependan de otros parámetros como la potencia de entrada o la temperatura. Se necesitan también soluciones ópticas avanzadas para conseguir no solo una alta eficiencia de extracción de la radiación sino también una mezcla homogénea de los colores a la salida así como una distribución angular específicamente diseñada para cada aplicación. Por otro lado, se precisa de un manejo térmico óptimo que permita la extracción de calor hacia elementos activos o pasivos para que así la temperatura de la unión de los LEDs sea óptima. Finalmente, los módulos LED creados durante esta tesis doctoral se han incorporado en tres luminarias distintas representativas de tres campos de aplicación independientes. La primera aplicación implicó el diseño y la incorporación de los módulos LED a un grupo de downlights que se instalaron en una habitación del Instituto de Investigación en Energía de Cataluña y en el Instituto de Neurociencia de la Universidad de Newcastle (UK), constituyendo dos instalaciones únicas para la investigación de los aspectos físicos y físico-visuales de diferentes espectros de iluminación. Para la segunda aplicación, se diseñaron un conjunto de luminarias tipo spotlight que fueron instaladas y demostradas en la exhibición "Making Colour" que tuvo lugar en la National Gallery (Londres). En la misma, se mostraron las propiedades de distintos espectros de iluminación. Finalmente, se ha realizado también una luminaria de alta potencia optimizada para la generación de espectros de interés en horticultura, habiéndose demostrado que es posible cambiar la morfología de los cultivos estudiados e incentivar la producción de ciertas vitaminas y compuesto

New Directions in Diagnostics for Aortic Aneurysms: Biomarkers and Machine Learning

This review article presents an appraisal of pioneering technologies poised to revolutionize the diagnosis and management of aortic aneurysm disease, with a primary focus on the thoracic aorta while encompassing insights into abdominal manifestations. Our comprehensive analysis is rooted in an exhaustive survey of contemporary and historical research, delving into the realms of machine learning (ML) and computer-assisted diagnostics. This overview draws heavily upon relevant studies, including Siemens’ published field report and many peer-reviewed publications. At the core of our survey lies an in-depth examination of ML-driven diagnostic advancements, dissecting an array of algorithmic suites to unveil the foundational concepts anchoring computer-assisted diagnostics and medical image processing. Our review extends to a discussion of circulating biomarkers, synthesizing insights gleaned from our prior research endeavors alongside contemporary studies gathered from the PubMed Central database. We elucidate the prevalent challenges and envisage the potential fusion of AI-guided aortic measurements and sophisticated ML frameworks with the computational analyses of pertinent biomarkers. By framing current scientific insights, we contemplate the transformative prospect of translating fundamental research into practical diagnostic tools. This narrative not only illuminates present strides, but also forecasts promising trajectories in the clinical evaluation and therapeutic management of aortic aneurysm disease

Inotropes in Acute Heart Failure: From Guidelines to Practical Use: Therapeutic Options and Clinical Practice

Inotropes are pharmacological agents that are indicated for the treatment of patients presenting with acute heart failure (AHF) with concomitant hypoperfusion due to decreased cardiac output. They are usually administered for a short period during the initial management of AHF until haemodynamic stabilisation and restoration of peripheral perfusion occur. They can be used for longer periods to support patients as a bridge to a more definite treatment, such as transplant of left ventricular assist devices, or as part of a palliative care regimen. The currently available inotropic agents in clinical practice fall into three main categories: beta-agonists, phosphodiesterase III inhibitors and calcium sensitisers. However, due to the well-documented potential for adverse events and their association with increased long-term mortality, physicians should be aware of the indications and dosing strategies suitable for different types of patients. Novel inotropes that use alternative intracellular pathways are under investigation, in an effort to minimise the drawbacks that conventional inotropes exhibit

Interrelated modulation of endothelial function in Behcet's disease by clinical activity and corticosteroid treatment

Corticosteroids are commonly used in empirical treatment of Behçet's disease (BD), a systemic inflammatory condition associated with reversible endothelial dysfunction. In the present study we aimed to dissect the effects of clinical disease activity and chronic or short-term corticosteroid treatment on endothelial function in patients with BD. In a case-control, cross-sectional study, we assessed endothelial function by endothelium dependent flow mediated dilatation (FMD) at the brachial artery of 87 patients, who either were or were not receiving chronic corticosteroid treatment, and exhibiting variable clinical disease activity. Healthy individuals matched for age and sex served as controls. Endothelial function was also assessed in a prospective study of 11 patients before and after 7 days of treatment with prednisolone given at disease relapse (20 mg/day). In the cross-sectional component of the study, FMD was lower in patients than in control individuals (mean ± standard error: 4.1 ± 0.4% versus 5.7 ± 0.2%, P = 0.003), whereas there was a significant interaction between the effects of corticosteroids and disease activity on endothelial function (P = 0.014, two-factor analysis of variance). Among patients with inactive BD, those who were not treated with corticosteroids (n = 33) had FMD comparable to that in healthy control individuals, whereas those treated with corticosteroids (n = 15) had impaired endothelial function (P = 0.023 versus the respective control subgroup). In contrast, among patients with active BD, those who were not treated with corticosteroids (n = 20) had lower FMD than control individuals (P = 0.007), but in those who were receiving corticosteroids (n = 19) the FMD values were comparable to those in control individuals. Moreover, FMD was significantly improved after 7 days of prednisolone administration (3.7 ± 0.9% versus 7.6 ± 1.4%, P = 0.027). Taken together, these results imply that although corticosteroid treatment may impair endothelial function per se during the remission phase of the inflammatory process, it restores endothelial dysfunction during active BD by counteracting the harmful effects of relapsing inflammation