Mammoth interatrial septal aneurysm in the ICE age

<p>Abstract</p> <p>Background</p> <p>Intracardiac echocardiography (ICE) is a useful imaging modality that is now being used more widely to assist in the percutaneous closure of atrial septal defects (ASD) and patent foramen ovales (PFO).</p> <p>Case presentation</p> <p>A 42 year old lady with a history of transient ischaemic attacks and migraine underwent percutaneous closure of an ASD. Intraprocedural ICE demonstrated a mammoth billowing multiperforated interatrial septal aneurysm in association with a secondum ASD.</p> <p>Conclusion</p> <p>ICE provides excellent adjuvant imaging during percutaneous closure of intracardiac shunts, in this case demonstrating a 'mammoth' interatrial septal aneurysm.</p

Acetabular components in total hip arthroplasty: is there evidence that cementless fixation is better?

BACKGROUND: The use of cementless acetabular components in total hip arthroplasty has gained popularity over the past decade. Most total hip arthroplasties being performed in North America currently use cementless acetabular components. The objective of this systematic review and meta-analysis was to compare the survivorship and revision rate of cemented and cementless acetabular components utilized in total hip arthroplasty. METHODS: A primary literature search in PubMed identified 3488 articles, of which 3407 did not meet the inclusion criteria and were excluded. Only English-language articles on either the survivorship or revision rate of primary total hip arthroplasty at a minimum of ten years of follow-up were included. The present study analyzed forty-five articles reporting the long-term outcome of cementless acetabular components, twenty-nine reporting the outcome of cemented acetabular components, and seven comparing cemented and cementless acetabular components. Meta-analysis (with a random-effects model) was performed on the data from the seven comparative studies, and study-level logistic regression analysis (with a quasibinomial model) was performed on the pooled data on the eighty-one included articles to determine a consensus. The studies were weighted according to the number of total hip arthroplasties performed. RESULTS: The meta-analysis did not reveal any effect of the type of acetabular component fixation on either survivorship or revision rate. The regression analysis revealed the estimated odds ratio for survivorship of a cemented acetabular component to be 1.60 (95% confidence interval, 1.32 to 2.40; p = 0.002) when adjustments for factors including age, sex, and mean duration of follow-up were made. CONCLUSIONS: The preference for cementless acetabular components on the basis of improved survivorship is not supported by the published evidence. Although concerns regarding aseptic loosening of cemented acetabular components may have led North American surgeons toward the nearly exclusive use of cementless acetabular components, the available literature suggests that the fixation of cemented acetabular components is more reliable than that of cementless components beyond the first postoperative decade

How do ecological perspectives help understand schools as sites for teacher learning?

Schools are sites of teachers’ professional learning for both new entrants and experienced practitioners. In this paper, schools are conceptualised as complex, multidimensional ecologies that are constituted by the relations that exist between school leaders, teachers, mentors and all members of the school community. As relational environments, the conditions affecting professional learning – both formal and informal – are constantly dynamic, with multiple and simultaneous interactions taking place between these stakeholders. Interactions are also multi-layered – between the school system, individuals, classrooms, the community and the policy environment. School leaders are a major influence on these dynamics and affect how schools act as sites of professional formation, mediating external policy as well as affecting micro-dynamics within individual school systems. The challenge of realising professional learning within these relational contexts can be viewed as a ‘wicked problem’, a feature of complex systems that resists simplified solutions. In conceptualising a complex ecology at work, we illuminate the relational dynamics with a focus, for all stakeholders within schools, including leaders, on the need to recognise and value the importance of ‘emergence’ in professional learning. This means embracing inevitable uncertainty as a feature of schools as complex systems

Quadricuspid aortic valve by using intraoperative transesophageal echocardiography

Quadricuspid aortic valve is a rare congenital malformation of the aortic valve. Its diagnosis is often missed even with the use of transthoracic echocardiogram. Many of these patients progress to aortic incompetence later in life, hence requiring surgical intervention

Quadricuspid aortic valve not discovered by transthoracic echocardiography

BACKGROUND: Quadricuspid aortic valve is a rare congenital heart defect. Several different anatomical variations of a quadricuspid aortic valve has been described and aortic regurgitation is the predominant valvular dysfunction associated with quadricuspid aortic valve. CASE PRESENTATION: A 68-year-old woman presented with almost a years history of increasing dyspnoea on exertion. The patient have had two previous transthoracic echocardiographic exams in the last six years and they had only documented moderate aortic regurgitation. Transoesophageal echocardiography displayed a rare case of quadricuspid aortic valve with three cusps of equal size and one larger cusp. The malformation was associated with severe aortic regurgitation. CONCLUSION: Liberal use of transoesophageal echocardiography is often warranted if optimal display of valvular morphology is desired

Exploring the role of curriculum materials in teacher professional development

Curriculum materials (schemes of work, lesson plans, etc.) play a complex and pivotal role in school and teacher practices. The adaptation and development of curriculum materials often constitute part of teacher professional development (PD) activities. However, compared with research examining the relationship between PD and teacher professional change, the role of curriculum materials in professional learning remains under-researched and under-theorised. We address this gap by applying a multi-perspectival approach to data from a PD programme in which teachers were supported to develop curriculum materials. We use an interconnected model to analyse the role of curriculum materials in catalysing change in individual teachers’ practice. Our use of Boundary Theory proposes that curriculum material adoption is mediated by the solidity of boundaries between school practice and research findings, and Actor-Network Theory perspectives examine the assemblage of networked relations within and beyond schools that are entangled in curriculum materials. We highlight how combining linear and non-linear perspectives may contribute to improved understanding of the complexity of supporting teachers’ learning and use our analyses to outline implications of using curriculum materials in teacher professional development

Meaningful time for professional growth or a waste of time? A study in five countries on teachers’ experiences within master’s dissertation/thesis work

The relationship between master’s thesis work and teachers’ professional development has rarely been explored empirically, yet. Drawing upon a larger study, this paper investigates how teachers who were studying for or who have recently graduated from Master of Education programmes offered in five countries – Poland, Portugal, England, Latvia, Romania – perceive the usefulness of dissertation/thesis work for their professional development and how they attempt to use their MA research results in their (future) teaching practice. Results suggest that although most respondents recognized their MA dissertation/thesis work as having a positive impact on their professional development by enhancing their professionalism, personal development and growth, and understanding the relationship between research and practice, they were less confident about the use of MA research findings in their (future) workplaces. These results are discussed in the context of current challenges regarding master’s level education for teachers, national governments’ educational policies, and the relationship between research, teachers’ practices and professional development

The relationship between the perception of distributed leadership in secondary schools and teachers' and teacher leaders' job satisfaction and organizational commitment

This study investigates the relation between distributed leadership, the cohesion of the leadership team, participative decision-making, context variables, and the organizational commitment and job satisfaction of teachers and teacher leaders. A questionnaire was administered to teachers and teacher leaders (n=1770) from 46 large secondary schools. Multiple regression analyses and path analyses revealed that the study variables explained significant variance in organizational commitment. The degree of explained variance for job satisfaction was considerably lower compared to organizational commitment. Most striking was that the cohesion of the leadership team and the amount of leadership support was strongly related to organizational commitment, and indirectly to job satisfaction. Decentralization of leadership functions was weakly related to organizational commitment and job satisfaction