211 research outputs found
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
gravity constrained by PPN parameters and stochastic background of gravitational waves
We analyze seven different viable -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 -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
. The optical detection of H and CO molecules with large
ground-based telescopes (as the ESO-VLT and the Keck telescopes), as well as
the detection of H 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
(ammonia) and CHOH (methanol) can be used, which are much more sensitive to
a varying than diatomic molecules. Current constraints are
for redshift , corresponding to
look-back times of 10-12.5 Gyrs, and for
, corresponding to half the age of the Universe (both at 3
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
and place constraints on the strength of nonminimal couplings using a
compilation of latest observational data. In the case of the quadratic
potential (), the nonminimal coupling is constrained to be for negative from the observational contour
bound. Although the quartic potential () is under a strong observational
pressure for , this property is relaxed by taking into account negative
nonminimal couplings. We find that inflationary observables are within the
contour bound as long as . We also show that
the 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
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