Feasibility of a healthcare system-based tetralogy of Fallot patient registry

Background Patient-reported outcomes and epidemiological studies in adults with tetralogy of Fallot are lacking. Recruitment and longitudinal follow-up investigation across institutions is particularly challenging. Objectives of this study were to assess the feasibility of recruiting adult patients with tetralogy of Fallot for a patient-reported outcomes study, describe challenges for recruitment, and create an interactive, online tetralogy of Fallot registry. Methods Adult patients living with tetralogy of Fallot, aged 18-58 years, at the University of North Carolina were identified using diagnosis code query. A survey was designed to collect demographics, symptoms, history, and birth mother information. Recruitment was attempted by phone (Part I, n=20) or by email (Part II, n=20). Data analysis included thematic grouping of recruitment challenges and descriptive statistics. Feasibility threshold was 75% for recruitment and for data fields completed per patient. Results In Part I, 60% (12/20) were successfully contacted and eight (40%) were enrolled. Demographics and birth mother information were obtained for all enrolled patients. In Part II, 70% (14/20) were successfully contacted; 30% (6/20) enrolled and completed all data fields linked to REDCap database; the median time for survey completion was 8 minutes. Half of the patients had cardiac operations/procedures performed at more than one hospital. Automatic electronic data entry from the online survey was uncomplicated. Conclusions Although recruitment (54%) fell below our feasibility threshold, enrolled individuals were willing to complete phone or online surveys. Incorrect contact information, privacy concerns, and patient-reported time constraints were challenges for recruitment. Creating an online survey and linked database is technically feasible and efficient for patient-reported outcomes research

Adiabatic and Isocurvature Perturbations for Multifield Generalized Einstein Models

Low energy effective field theories motivated by string theory will likely contain several scalar moduli fields which will be relevant to early Universe cosmology. Some of these fields are expected to couple with non-standard kinetic terms to gravity. In this paper, we study the splitting into adiabatic and isocurvature perturbations for a model with two scalar fields, one of which has a non-standard kinetic term in the Einstein-frame action. Such actions can arise, e.g., in the Pre-Big-Bang and Ekpyrotic scenarios. The presence of a non-standard kinetic term induces a new coupling between adiabatic and isocurvature perturbations which is non-vanishing when the potential for the matter fields is nonzero. This coupling is un-suppressed in the long wavelength limit and thus can lead to an important transfer of power from the entropy to the adiabatic mode on super-Hubble scales. We apply the formalism to the case of a previously found exact solution with an exponential potential and study the resulting mixing of adiabatic and isocurvature fluctuations in this example. We also discuss the possible relevance of the extra coupling in the perturbation equations for the process of generating an adiabatic component of the fluctuations spectrum from isocurvature perturbations without considering a later decay of the isocurvature component.Comment: 11 pages, 3 figures, one equation corrected, typos fixed, conclusions unchange

Thoracic Enhanced Recovery After Surgery: Single Academic Center Observations After Implementation

Background: Enhanced recovery after surgery (ERAS) is an evidence-based, multidisciplinary perioperative care model shown to reduce complications and hospital length of stay (LOS). While some thoracic ERAS studies were inconclusive, others demonstrated that ERAS improves patient outcomes after lung resections and provides more cost-effective care. We aimed to investigate the effects of preliminary implementation of an ERAS protocol, in comparison with conventional care, on lung resection outcomes at a single academic institution. Methods: In this observational study, adult patients undergoing lung resections during the pre-ERAS (April 2014 to September 2015) and post-ERAS (January 2016 to May 2017) periods were identified. Relevant demographic, preoperative, anesthesia, and surgical variables were collected. Pre-ERAS and post-ERAS cohorts were compared in terms of hospital LOS, postoperative complications, and 30-day outcomes. Results: We identified 264 patients, half in each cohort. Pre-ERAS and post-ERAS groups were similar with respect to age, race, and comorbidities. There were no significant differences in LOS, complications, 30-day readmission and mortality rates, or patient-reported outcomes. Of the patients with prolonged LOS, 31% had pulmonary complications, almost half of which were prolonged air leaks. ERAS adherence rate was approximately 60%. Conclusions: In the first year of implementation, median LOS, complications, and 30-day outcomes did not differ significantly between the pre-ERAS and post-ERAS groups. Prolonged air leaks commonly led to prolonged LOS; therefore, thoracic ERAS protocols could include interventions to reduce air leak and consideration for discharging patients with chest tubes placed to Heimlich valves. Buy-in and adherence to a new protocol are necessary for implementation to be effective

A noninvasive hemoglobin monitor in the pediatric intensive care unit

Background Critically ill pediatric patients frequently require hemoglobin monitoring. Accurate noninvasive Hb (SpHb) would allow practitioners to decrease anemia from repeated blood draws, traumatic blood draws, and a decreased number of laboratory Hb (LabHb) medical tests. The Food and Drug Administration has approved the Masimo Pronto SpHb and associated Rainbow probes; however, its use in the pediatric intensive care unit (PICU) is controversial. In this study, we define the degree of agreement between LabHb and SpHb using the Masimo Pronto SpHb Monitor and identify clinical and demographic conditions associated with decreased accuracy. Materials and methods We performed a prospective, observational study in a large PICU at an academic medical center. Fifty-three pediatric patients (30-d and 18-y-old), weighing >3 kg, admitted to the PICU from January-April 2013 were examined. SpHb levels measured at the time of LabHb blood draw were compared and analyzed. Results Only 83 SpHb readings were obtained in 118 attempts (70.3%) and 35 readings provided a result of "unable to obtain." The mean LabHb and SpHb were 11.1 g/dL and 11.2 g/dL, respectively. Bland-Altman analysis showed a mean difference of 0.07 g/dL with a standard deviation of ±2.59 g/dL. Pearson correlation is 0.55, with a 95% confidence interval between 0.38 and 0.68. Logistic regression showed that extreme LabHb values, increasing skin pigmentation, and increasing body mass index were predictors of poor agreement between SpHb and LabHb (P < 0.05). Separately, increasing body mass index, hypoxia, and hypothermia were predictors for undetectable readings (P < 0.05). Conclusions The Masimo Pronto SpHb Monitor provides adequate agreement for the trending of hemoglobin levels in critically ill pediatric patients. However, the degree of agreement is insufficient to be used as the sole indicator for transfusion decisions and should be used in context of other clinical parameters to determine the need for LabHb in critically ill pediatric patients

f(R)f(R) gravity constrained by PPN parameters and stochastic background of gravitational waves

We analyze seven different viable $f(R)$-gravities towards the Solar System tests and stochastic gravitational waves background. The aim is to achieve experimental bounds for the theory at local and cosmological scales in order to select models capable of addressing the accelerating cosmological expansion without cosmological constant but evading the weak field constraints. Beside large scale structure and galactic dynamics, these bounds can be considered complimentary in order to select self-consistent theories of gravity working at the infrared limit. It is demonstrated that seven viable $f(R)$-gravities under consideration not only satisfy the local tests, but additionally, pass the above PPN-and stochastic gravitational waves bounds for large classes of parameters.Comment: 23 pages, 8 figure

Enhanced recovery after thoracic surgery: Systematic review and meta-analysis

The enhanced recovery after thoracic surgery (ERATS) protocol has been shown to reduce complications and hospital length of stay (LOS). In thoracic surgery, the prototypical ERATS pathway involves a preoperative phase, which focuses on patient education and smoking cessation; the intraoperative phase incorporates multimodal anesthesia along with minimally invasive surgery (video-assisted thoracoscopic surgery [VATS]); and the postoperative phase emphasizes the use of incentive spirometry, early mobilization, early chest tube and urinary catheter removal. Goal-directed fluid therapy and minimization of opioids is encouraged

Search for varying constants of nature from astronomical observation of molecules

The status of searches for possible variation in the constants of nature from astronomical observation of molecules is reviewed, focusing on the dimensionless constant representing the proton-electron mass ratio $\mu=m_p/m_e$. The optical detection of H$_2$ and CO molecules with large ground-based telescopes (as the ESO-VLT and the Keck telescopes), as well as the detection of H$_2$ with the Cosmic Origins Spectrograph aboard the Hubble Space Telescope is discussed in the context of varying constants, and in connection to different theoretical scenarios. Radio astronomy provides an alternative search strategy bearing the advantage that molecules as NH$_3$ (ammonia) and CH$_3$OH (methanol) can be used, which are much more sensitive to a varying $\mu$ than diatomic molecules. Current constraints are $|\Delta\mu/\mu| < 5 \times 10^{-6}$ for redshift $z=2.0-4.2$, corresponding to look-back times of 10-12.5 Gyrs, and $|\Delta\mu/\mu| < 1.5 \times 10^{-7}$ for $z=0.88$, corresponding to half the age of the Universe (both at 3$\sigma$ statistical significance). Existing bottlenecks and prospects for future improvement with novel instrumentation are discussed.Comment: Contribution to Workshop "High Performance Clocks in Space" at the International Space Science Institute, Bern 201

Density perturbations in generalized Einstein scenarios and constraints on nonminimal couplings from the Cosmic Microwave Background

We study cosmological perturbations in generalized Einstein scenarios and show the equivalence of inflationary observables both in the Jordan frame and the Einstein frame. In particular the consistency relation relating the tensor-to-scalar ratio with the spectral index of tensor perturbations coincides with the one in Einstein gravity, which leads to the same likelihood results in terms of inflationary observables. We apply this formalism to nonminimally coupled chaotic inflationary scenarios with potential $V=c\phi^p$ and place constraints on the strength of nonminimal couplings using a compilation of latest observational data. In the case of the quadratic potential ($p=2$), the nonminimal coupling is constrained to be $\xi>-7.0 \times 10^{-3}$ for negative $\xi$ from the $1\sigma$ observational contour bound. Although the quartic potential ($p=4$) is under a strong observational pressure for $\xi=0$, this property is relaxed by taking into account negative nonminimal couplings. We find that inflationary observables are within the $1\sigma$ contour bound as long as $\xi<-1.7 \times 10^{-3}$. We also show that the $p \ge 6$ cases are disfavoured even in the presence of nonminimal couplings.Comment: 16 pages, 4 eps figure

Static Spherically Symmetric Solution of (R +- {\mu}^4/R) Gravity

The static spherically symmetric solution for (R +- {\mu}^4/R) model of f(R)gravity is investigated. We obtain the metric for space-time in the solar system that reduces to the Schwarzschild metric, when {\mu} tends to zero. For the obtained metric, the deviation from Einstein gravity is very small. This result is different from the other results have been obtained by equivalence between f(R) gravity and scalar tensor theory. Also it is shown that the vacuum solution in the solar system depends on the shape of matter distribution which differ from the Einstein's gravity