Outcomes after transplantation for “failed” Fontan: A single-institution experience

ObjectiveDespite the excellent outcomes in the current era after the Fontan procedure, it continues to have an inherent risk of failure. Cardiac transplantation provides 1 option for treating these patients; however, the indications for, timing of, and outcomes after, transplantation remain undefined. We examined our own institutional experience with transplantation for failed Fontan.MethodsThe records of 155 patients transplanted for congenital heart disease at a single institution from June 1984 to September 2007 were reviewed. Of these patients, 43 had undergone a previous Fontan procedure (25 male, 15 female; median age, 14.5 years; range, 1–47; 23 classic Fontan, 13 lateral tunnel, 4 extracardiac conduit, and 3 revised to shunt). The predictors of short- and long-term survival were evaluated, and the Fontan patients were compared with all other patients with congenital heart disease (n = 129, 78 male, 51 female).ResultsThe most common indications for transplantation included protein-losing enteropathy (PLE) (39.5%), chronic heart failure (41.8%), and acute post-Fontan failure (9.3%). The transplants performed in Fontan patients were more likely to require pulmonary artery reconstruction (85.4% vs 42.9%; P < .0001) and had longer cardiopulmonary bypass times (278 vs 179 minutes; P < .0001). The 90-day mortality rate was greater in the Fontan group (35.0% vs 20.0%; P = .055). No correlation was observed between the interval from Fontan to transplantation and morality; however, renal failure was a strong predictor of early mortality (odds ratio, 10.8; 95% confidence interval, 1.5–75.7).ConclusionsTransplantation is an acceptable treatment for patients with a failed Fontan. Clinical factors (instead of the indication for transplantation) appear to have the greatest correlation with early mortality

Constraints on crustal recycling from boron isotopes in Italian melt inclusions

Boron represents an important tracer of crustal recycling processes in subduction zones, because it is readily mobilised from the subducted lithosphere and different components in the slab are isotopically distinct. Profiles of boron content and isotope ratio across magmatic arcs generally show that B concentrations decrease with increasing slab depth, which implies decreasing amount of slab-derived fluids. To date, however, data on continental-collision zones and post-collisional subduction settings are scarce. This study examines Plio-Quaternary Italian magmatism to quantify crustal recycling in a complex subduction setting. Magmatic products vary from (ultra)potassic along the Tyrrhenian side in the north, to calcalkaline and Na-alkaline in the south. Combined major and trace element and [B] content and δ11B values are reported in 99 Melt Inclusions (MIs), analyses from a wide range of Italian lavas. [B] vary from 4 to 298 µg/g and δ11B from -29.2 to -3.9‰. The B isotopic values are considerably lower than previously reported in arcs and other post-collisional setting magmatism. We infer a role for phengite in the source of all studied Italian magmas (with the exception of Mt. Etna lavas). This white mica is stable to high pressures in subducted sediments of altered oceanic crust and records dehydration and 11B depletion due to dehydration processes. MIs hosted in highly fosteritic olivines (Fo &gt;74; median of 89) from across Italy reveal that primary melts tap heterogeneous mantle including subducted oceanic and continental components that were introduced during the Alpine, and Adriatic and Ionian subduction phases. The combined geochemical data record the involvement of sediments that variably metasomatized the mantle wedge. We propose that slab detachment and consequent heat input from the inflow of hot asthenosphere was responsible for phengite breakdown in subducted sediments and locally produced metasomatism of the mantle wedge, imposing a characteristic B isotope signature to the overlying mantle. Continued heating due to asthenosphere inflow led to melting of the metasomatized mantle wedge and generation of the Italian magmatism. Mt. Etna represents an exception being dominated by asthenosphere upwelling through a slab window with minimal influence from active subduction.</p

A liquid Xenon Positron Emission Tomograph for small animal imaging : first experimental results of a prototype cell

A detector using liquid Xenon (LXe) in the scintillation mode is studied for Positron Emission Tomography (PET) of small animals. Its specific design aims at taking full advantage of the Liquid Xenon scintillation properties. This paper reports on energy, time and spatial resolution capabilities of the first LXe prototype module equipped with a Position Sensitive Photo- Multiplier tube (PSPMT) operating in the VUV range (178 nm) and at 165 K. The experimental results show that such a LXe PET configuration might be a promising solution insensitive to any parallax effect.Comment: 34 pages, 18 pages, to appear in NIM

A comparison between different propagative schemes for the simulation of tapered step index slab waveguides

The performance and accuracy of a number of propagative algorithms are compared for the simulation of tapered high contrast step index slab waveguides. The considered methods include paraxial as well as nonparaxial formulations of optical field propagation. In particular attention is paid to the validity of the paraxial approximation. To test the internal consistency of the various methods the property of reciprocity is verified and it is shown that for the paraxial algorithms the reciprocity can only be fulfilled if the paraxial approximation of the power flux expression using the Poynting vector is considered. Finally, modeling results are compared with measured fiber coupling losses for an experimentally realized taper structure

The mantle source of lamproites from Torre Alfina, Italy: Evidence from melt inclusions in olivine

The complex post-collisional subduction setting of peninsular Italy, in the central-western Mediterranean region, has given rise to an extremely diverse spectrum of potassium-rich volcanic rocks. The most primitive of these products show trace-element and radiogenic isotope signatures that point to melt derivation from upper mantle domains affected by metasomatism associated with sediment recycling. The style and extent of this metasomatism, and the metasomatic agents responsible for this modification, seem to differ significantly throughout the Italian peninsula. The lamproites of the Tuscan magmatic province, central Italy, are a peculiar and rare example of rocks that require extensive source modification that is not yet well-understood. These rocks are ultrapotassic and mafic in composition and have high compatible trace-element contents. Although bulk-rock compositions have been used to interrogate their petrogenesis, bulk lavas do not reflect the full heterogeneity of their mantle source. Here, we study the geochemistry of melt inclusions in forsterite-rich olivine, which in contrast to their host lavas are snapshots of near-primary melts that have bypassed modification on their way to the surface. The olivines (Fo88-93) from the studied lamproites of Torre Alfina host melt inclusions with major- and trace-element compositions that define two distinct groups. The first is marked by lower SiO2 (47–51 vs. 50–60 wt%) and higher K2O (11–17 vs. 8–14 wt%), CaO (3.5–6 vs. 1.5–5 wt%), TiO2 (1.8–2.4 vs. 0.3–1.8 wt%), P2O5 (1.0–1.7 vs. 0.1–0.9 wt%) and different trace-element contents. Group-1 melts are generally similar to other Tuscan lamproites, whereas group-2 melts are, in terms of trace elements, more akin to the Tuscan high-K calc-alkaline mafic rocks. We interpret these two melt types to originate from a sediment-metasomatised mantle source, which is characterised by distinct (vein) lithologies arising from superimposed metasomatic events. The Sr-Nd-Pb isotope compositions of a subset of the studied inclusions, analysed by wet chemistry and TIMS techniques, will be presented to further constrain the mantle source of these unusual and hitherto unreported primitive melt compositions, and ultimately better understand lamproite petrogenesis

An Alphabet

This book was completed for Jan Baker\u27s artists\u27 book class.https://digitalcommons.risd.edu/specialcollections_bookmark_letters/1005/thumbnail.jp

Flat Information Geometries in Black Hole Thermodynamics

The Hessian of either the entropy or the energy function can be regarded as a metric on a Gibbs surface. For two parameter families of asymptotically flat black holes in arbitrary dimension one or the other of these metrics are flat, and the state space is a flat wedge. The mathematical reason for this is traced back to the scale invariance of the Einstein-Maxwell equations. The picture of state space that we obtain makes some properties such as the occurence of divergent specific heats transparent.Comment: 14 pages, one figure. Dedicated to Rafael Sorkin's birthda

The development of a theory-based intervention to promote appropriate disclosure of a diagnosis of dementia

Background: The development and description of interventions to change professional practice are often limited by the lack of an explicit theoretical and empirical basis. We set out to develop an intervention to promote appropriate disclosure of a diagnosis of dementia based on theoretical and empirical work. Methods: We identified three key disclosure behaviours: finding out what the patient already knows or suspects about their diagnosis; using the actual words 'dementia' or 'Alzheimer's disease' when talking to the patient; and exploring what the diagnosis means to the patient. We conducted a questionnaire survey of older peoples' mental health teams (MHTs) based upon theoretical constructs from the Theory of Planned Behaviour (TPB) and Social Cognitive Theory (SCT) and used the findings to identify factors that predicted mental health professionals' intentions to perform each behaviour. We selected behaviour change techniques likely to alter these factors. Results: The change techniques selected were: persuasive communication to target subjective norm; behavioural modelling and graded tasks to target self-efficacy; persuasive communication to target attitude towards the use of explicit terminology when talking to the patient; and behavioural modelling by MHTs to target perceived behavioural control for finding out what the patient already knows or suspects and exploring what the diagnosis means to the patient. We operationalised these behaviour change techniques using an interactive 'pen and paper' intervention designed to increase intentions to perform the three target behaviours. Conclusion : It is feasible to develop an intervention to change professional behaviour based upon theoretical models, empirical data and evidence based behaviour change techniques. The next step is to evaluate the effect of such an intervention on behavioural intention. We argue that this approach to development and reporting of interventions will contribute to the science of implementation by providing replicable interventions that illuminate the principles and processes underlying change.This project is funded by UK Medical Research Council, Grant reference number G0300999. Jeremy Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake. Jill Francis is funded by the Chief Scientist Office of the Scottish Government Health Directorate. The views expressed in this study are those of the authors

Investigating combined arc and OIB signatures at a post-collisional subduction setting by geochemical and boron isotope analyses of melt inclusions from Vulture, Italy

Recent post-collisional magmatism in central-southern Italy is unique as it is strongly influenced by sediment subduction but also has an intra-plate signature. The composition of the potassium-rich magmatic products covers a wide range of compositions, from subalkaline to strongly alkaline, and from mafic to felsic. The Vulture volcanic centre, located east of the main volcanic front, is considered “anomalous” compared to the other major Quaternary volcanoes, as it shows the eruption of silica-rich and carbonatite lavas, and a magma source with both arc- and OIB-type signatures. To investigate the unique nature of this anomalous magmatism, we analysed 107 Vulture melt inclusions (MIs) trapped in high-forsterite olivine (~87-90 mol% Fo) for major and trace element composition. A subset of 27 MIs was selected for boron isotope and concentration analysis. Based on relative major and trace element enrichment we distinguish two groups of inclusions: Group 1: High CaO (10-16wt.%), TiO2 (1-3 wt.%), Na2O (~ 3wt.%), MgO (4-9 wt.%; n = 80), lower HFSE/HREE and lower LILE/LREE (n = 44); Group 2: Low CaO (6-7 wt.%), TiO2 (0.8-1.5 wt.%), high SiO2 (45-48 wt.%), Al2O3 (18-20 wt.%), K2O (5-7 wt.%; n = 27) and higher LILE/HREE and HFSE/LREE (n = 24). Group 1 MIs have more negative δ11B values (δ11Bav = -20 ‰; n = 23) and lower B concentration ([B]av = 20 ppm; n = 23) compared to Group 2 (δ11Bav = -17 ‰; [B]av = 36 ppm; n = 4). The geochemical distinction between the two groups indicates the involvement of two melt sources with diverse mineralogies. Combining major and trace elements with a more negative δ11B signature of Group 1, suggests a possible additional input of marly sediments to this group. Geophysical data confirm the presence of a slab detachment and mantle inflow under the Vulture volcanic centre, likely responsible for the OIB signature. The geochemistry of the MIs indicates that the OIB signature for this volcano is possibly derived from melts formed due to slab detachment that mix with melts from a sediment metasomatised source

Modulation of aggression in male mice: influence of group size and cage size

Aggression in group-housed male mice is known to be influenced by both cage size and group size. However, the interdependency of these two parameters has not been studied yet. In this study, the level of aggression in groups of three, five, or eight male BALB/c mice housed in cages with a floor size of either 80 or 125 cm2/animal was estimated weekly after cage cleaning for a period of 14 weeks. Furthermore, urine corticosterone levels, food and water intake, body weight, and number of wounds were measured weekly. At the end of the experiment, tyrosine hydroxylase (TH) activity, testosterone levels, and weight of spleen, thymus, testes, and seminal vesicles were determined. Results indicate a moderate increase of intermale aggression in larger cages when compared to the smaller cages. Aggression in groups of eight animals was considerably higher than in groups of three animals. The increase of agonistic behavior was observed both in dominant and subordinate animals. Physiological parameters indicate differences in stress levels between dominant and subordinate animals. It is concluded that aggressive behavior in group-housed male BALB/c mice is best prevented by housing the animals in small groups of three to five animals, while decreasing floor size per animal may be used as a temporary solution to decrease high levels of aggression in an existing social group.