Durability of thoracoabdominal aortic aneurysm repair in patients with connective tissue disorders

AbstractObjective: Thoracoabdominal aortic aneurysm (TAAA) repair is a durable procedure performed with reasonable perioperative mortality and morbidity in patients with atherosclerotic aortic disease. However, the long-term outcome and durability of TAAA repair performed in patients with a connective tissue disorder (CTD) is not well known. Methods: The records of 257 patients who underwent TAAA repair at the Johns Hopkins Hospital between January 1992 and December 2001 were reviewed. Survival analysis was performed with Kaplan-Meier analysis, and subgroups were compared with the log-rank test. Multivariable analysis was performed with the Cox proportional hazards model and logistic regression. Results: Patients with CTD (n = 31) were seen earlier (mean age, 48.6 ± 2.9 years) than patients without CTD (mean age, 69.1 ± 0.6 years; P < .0001, Mann-Whitney U test) and had a greater incidence rate of aortic dissection (52% versus 19%; P < .0001, χ2 test) and extent I or II aneurysm (77% versus 64%; P = .04). The perioperative (30-day) mortality rate was 6.5% in patients with CTD, which was similar to the rest of the cohort (P = .39, Fisher exact test). The incidence rate of paraparesis/paraplegia was 12.9%/6.5% in patients with CTD, and CTD was the only factor predictive of paraparesis (P = .03; odds ratio, 9.3; logistic regression). The cumulative survival rate among the entire cohort was 53.4% ± 4.4% at 5 years (Kaplan-Meier), and no difference was seen among patients with or without CTD (P = .16, log-rank test) or among different Crawford extents (P = .29). Of the two late (>6 months) deaths in patients with CTD, none were from aortic rupture or dissection, compared with two of 31 late deaths in patients without CTD. Multivariable analysis confirmed that postoperative renal failure (P = .03) predicted mortality but neither CTD (P = .93), nor Crawford extent (P = .21, Cox regression) predicted mortality. Among survivors, no mean difference was found in largest aortic diameter on follow-up imaging in patients with or without CTD (4.7 ± 0.3 cm versus 4.4 ± 0.3 cm; P = .47, Mann-Whitney U test). The cumulative graft patency rate, representing long-term graft stability and with death, rupture, dissection, or recurrent aneurysm as endpoints, was 47.5% ± 4.6% at 5 years (Kaplan-Meier) and was similar in patients with or without CTD (P = .10, log-rank test). Conclusion: TAAA repair appears to be a durable operation, with a reasonable 5-year patient survival rate and a low risk of postoperative paraplegia or additional aortic events. Patients with CTD can expect their outcome, including long-term survival and aortic stability, to be similar to patients without CTD. (J Vasc Surg 2002;36:696-703.

Feeding practices of pre-school children and associated factors in Kathmandu, Nepal

Background: In developing countries such as Nepal, many children aged below 3 years do not grow at a sufficiently high rate and are vulnerable to micronutrient deficiencies (e.g. vitamin A). Challenges to child nutrition can result from poverty, unhealthy traditional practices, inadequate caring and feeding practices. The present study aimed to assess the feeding prac- tices of pre-school children and their associated factors. Methods: A cross-sectional study was carried out in pre-schools located in Kathmandu district between February and March 2018. Three levels in terms of price range (lower, medium and higher level) of pre-schools were selected to reach the mothers of children aged ≤3 years. A structured ques- tionnaire was administered to 145 mothers. Descriptive analyses were con- ducted to observe the characteristics of the population. Multinomial logistic regression analyses were performed to identify the association for the factors of mothers’ perception of their current feeding practices. Results: We found that dal-bhat/jaulo was a common complementary food irrespective of socio-economic background. Interestingly, mothers who had received a higher education were significantly less likely to change their feeding practices (odds ratio = 0.118, confidence interval = 0.01–0.94). The mothers that fed a higher quantity porridge to their children showed a high willingness to change the feeding practices. Conclusions: Poor feeding practices are still an important public health problem in Nepal and were observed to be associated with low socio-eco- nomic status, unawareness and a lack of knowledge towards dietary diversity combined with strong beliefs related to social forces and cultures

Testing message framing to increase physical activity among British South Asians

Objective: British South Asians (BSAs) experience a higher incidence of coronary heart disease (CHD) which is not declining in line with the UK national average. Low physical activity levels are likely to contribute to this elevated risk. This study investigated the effectiveness of message framing, cultural sensitivity and their interaction on promoting physical activity among BSAs. Design: One hundred and seventy-nine participants (70 males and 109 females) were randomly allocated to watch one of four films in a 2 (loss vs. gain) × 2 (culturally sensitive vs. non-culturally sensitive) design. Main outcome measures: Measures of self-reported physical activity and behavioural intention were completed at baseline and two-month follow-up. Results: The analysis revealed no main effects for message framing, cultural sensitivity or for the interaction between these factors for self-reported physical activity and behavioural intention. Conclusions: Healthy BSAs appear not to respond to health promotion messages which have been manipulated by message framing or cultural sensitivity. Possible explanations are that despite an increased risk of developing CHD, healthy BSAs may be unwilling to engage in immediate action for a potential future health problem and cultural sensitivity may be irrelevant to a ‘Westernised’ sample. Nevertheless, future research ought to investigate variations of the current intervention by using a larger sample size, targeting a more sedentary population, varying the length and exposure to the intervention in less assimilated groups, clinically symptomatic populations or those at high risk of CHD

Forming Judgments of Attitude Certainty, Intensity, and Importance: The Role of Subjective Experiences

Two studies examined the impact of subjective experiences on reports of attitude certainty, intensity, and importance. In Study 1, participants with moderate or extreme attitudes toward doctor-assisted suicide generated three (easy) or seven (hard) arguments that either supported or countered their opinion toward the issue prior to indicating the strength of their attitude. Participants with moderate attitudes rated their opinions as more intense, personally important, and held with greater certainty when they had generated either a small number of supporting arguments or a large number of opposing arguments. Ratings provided by individuals with extreme attitudes were unaffected by the argument generation task. In Study 2, the impact of ease of recall on strength-related judgments was eliminated when it was rendered nondiagnostic by a misattribution manipulation. Implications of these findings for attitude strength and other judgmental phenomena are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68385/2/10.1177_0146167299025007001.pd

The Aversion to Tampering with Nature (ATN) Scale: Individual Differences in (Dis)comfort with Altering the Natural World

People differ in their comfort with tampering with the natural world. Although some see altering nature as a sign of human progress, others see it as dangerous or hubristic. Across four studies, we investigate discomfort with tampering with the natural world. To do so, we develop the Aversion to Tampering with Nature (ATN) Scale, a short scale that is the first to directly measure this discomfort. We identify six activities that people believe tamper with nature (geoengineering, genetically modified organisms, pesticides, cloning, gene therapy, and nanoparticles) and show that ATN scores are associated with opposition to these activities. Furthermore, the ATN Scale predicts actual behavior: donations to an antiâ tampering cause. We demonstrate that ATN is related to previously identified constructs including trust in technology, naturalness bias, purity values, disgust sensitivity, aversion to playing God, and environmental beliefs and values. By illuminating who is concerned about tampering with nature and what predicts these beliefs, the ATN Scale provides opportunities to better understand public opposition to technological innovations, consumer preferences for â naturalâ products, and strategies for science communication.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154364/1/risa13414_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154364/2/risa13414.pd

A functional-cognitive framework for attitude research

In attitude research, behaviours are often used as proxies for attitudes and attitudinal processes. This practice is problematic because it conflates the behaviours that need to be explained (explanandum) with the mental constructs that are used to explain these behaviours (explanans). In the current chapter we propose a meta-theoretical framework that resolves this problem by distinguishing between two levels of analysis. According to the proposed framework, attitude research can be conceptualised as the scientific study of evaluation. Evaluation is defined not in terms of mental constructs but in terms of elements in the environment, more specifically, as the effect of stimuli on evaluative responses. From this perspective, attitude research provides answers to two questions: (1) Which elements in the environment moderate evaluation? (2) What mental processes and representations mediate evaluation? Research on the first question provides explanations of evaluative responses in terms of elements in the environment (functional level of analysis); research on the second question offers explanations of evaluation in terms of mental processes and representations (cognitive level of analysis). These two levels of analysis are mutually supportive, in that better explanations at one level lead to better explanations at the other level. However, their mutually supportive relation requires a clear distinction between the concepts of their explanans and explanandum, which are conflated if behaviours are treated as proxies for mental constructs. The value of this functional-cognitive framework is illustrated by applying it to four central questions of attitude research

Teaching Engineering Ethics using BLOCKS Game

The aim of this study was to investigate the use of a newly developed design game called BLOCKS to stimulate awareness of ethical responsibilities amongst engineering students. The design game was played by seventeen teams of chemical engineering students, with each team having to arrange pieces of colored paper to produce two letters each. Before the end of the game, additional constraints were introduced to the teams such that they faced similar ambiguity in the technical facts that the engineers involved in the Challenger disaster had faced prior to the space shuttle launch. At this stage, the teams had to decide whether to continue with their original design or to develop alternative solutions. After the teams had made their decisions, a video of the Challenger explosion was shown followed by a post-game discussion. The students’ opinion on five Statements on ethics was tracked via a Five-Item Likert survey which was administered three times, before and after the ethical scenario was introduced, and after the video and post-game discussion. The results from this study indicated that the combination of the game and the real-life incident from the video had generally strengthened the students’ opinions of the Statements