Project SAM: Developing an app to provide self-help for anxiety

An interdisciplinary team at the University of the West of England (UWE) was commissioned and funded to develop a mobile phone app which would provide self-help options for the management of mild to moderate anxiety. The completed app would extend the range and availability of psychological support for student well-being at UWE and other higher education institutions.The project team consisted of two computer scientists and one psychologist who were responsible for the technical, functional and clinical specification of the app. A local mobile app development company was appointed and the teams collaborated on the design, build and evaluation of the app. The self-help structure and components were developed in consultation with therapeutic practitioners, in and out of UWE. The developer team advised on and constructed multi-media features to realise the self-help aims of the app.The UWE project team promoted an iterative approach to development, evaluating each stage of development through trials with expert users, practitioners and students. The app, named SAM (Self-help for Anxiety Management), was developed for Apple and Android operating systems, to be usable on smartphones and tablets. SAM was launched in the app stores in July 2013, globally available and free to download for the first year of operation. It was promoted to students, educational institutions, mental health organisations and charities as well as a range of professional and informal contacts. A UWE-based Advisory Board was convened to oversee the maintenance and development of the university’s investment in SAM. Members include the project team, researchers, therapists and other staff with an interest in its use to support student well-being. Three key tasks of the Board are to ensure SAM’s financial sustainability, to oversee developments in its usability and self-help components, and to obtain funding for the evaluation of its therapeutic impact

Severe re‐expansion pulmonary edema after conventional cardiac surgery: Identification and management

Re‐expansion Pulmonary Edema (REPE) is a recognized but rare complication of lung re‐inflation after pathologic collapse or intentional deflation. The presentation of REPE may be highly variable, ranging from a clinically asymptomatic, incidental radiologic finding to acute respiratory failure accompanied by severe, life‐threatening hypoxemia. With the current report, we present a patient with severe aortic insufficiency, severe mitral regurgitation, coronary artery disease, pulmonary hypertension, who underwent aortic valve replacement, mitral valvuloplasty, coronary artery bypass grafting, and developed at the immediate post‐ operative period severe respiratory failure due to REPE, requiring venous‐venous Extracorporeal Membrane Oxygenation (VV‐ECMO).Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149568/1/jocs14057.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149568/2/jocs14057_am.pd

Impact of time between diagnosis to treatment in Acute Type A Aortic Dissection

There is a paucity of data describing the effect of time interval between diagnosis and surgery for Acute Type A Aortic Dissection. We describe our 8-year experience and investigate the impact of time interval between symptom onset, diagnosis and surgery on outcomes. Retrospective single-center study utilizing our Society of Thoracic Surgeons registry and patient records. Subjects were grouped by time interval between radiographic diagnosis and surgical treatment: Group A (0–4 h), Group B (4.1–8 h), Group C (8.1–12 h), and Group D (12.1 + h). Data were analyzed to identify factors associated with mortality and outcomes. 164 patients were included. Overall mortality was 21.3%. Group C had the greatest intervals between symptom onset to diagnosis to surgery, and also the highest mortality (66.7%). Preoperative tamponade, cardiac arrest, malperfusion, elevated creatinine, cardiopulmonary bypass time, and blood transfusions were associated with increased mortality, while distance of referring hospital was not. Time intervals between symptom onset, diagnosis and surgery have a significant effect on mortality. Surgery performed 8–12 h after diagnosis carries the highest mortality, which may be exacerbated by longer interval since symptom onset. Time-dependent effects should be considered when determining optimal strategy especially if inter-facility transfer is necessary

Infective Endocarditis: A Review of the Past and Present, and a Look into the Future

Infective endocarditis is a lethal and challenging multifaceted disease that can involve any vascularized system. We believe that multimodality imaging is invaluable to provide a comprehensive diagnosis. Our management approach to infective endocarditis adheres to a combination of the AHA, ACC, STS, and ESC guidelines. With the rapidly increasing transcatheter valve population, we expect an increased caseload of infective endocarditis. Beyond patients with hemorrhagic strokes, we advocate for early surgery if medical management has failed. Furthermore, a multidisciplinary team approach is imperative in infective endocarditis, and clear communication reduces the time to diagnosis and definitive treatment for this patient population

Preoperative stroke before cardiac surgery does not increase risk of postoperative stroke

The optimal time when surgery can be safely performed after stroke is unknown. The purpose of this study was to investigate how cardiac surgery timing after stroke impacts postoperative outcomes between 2011–2017 were reviewed. Variables were extracted from the institutional Society of Thoracic Surgeons database, statewide patient registry, and medical records. Subjects were classified based upon presence of endocarditis and further grouped by timing of preoperative stroke relative to cardiac surgery: Recent (stroke within two weeks before surgery), Intermediate (between two and six weeks before), and Remote (greater than six weeks before). Postoperative outcomes were compared amongst groups. 157 patients were included: 54 in endocarditis and 103 in non-endocarditis, with 47 in Recent, 26 in Intermediate, and 84 in Remote. 30-day mortality and postoperative stroke rate were similar across the three subgroups for both endocarditis and non-endocarditis. Of patients with postoperative stroke, mortality was 30% (95% CI 4.6–66). Timing of cardiac surgery after stroke occurrence does not seem to affect postoperative stroke or mortality. If postoperative stroke does occur, subsequent stroke-related mortality is high

The Influence of Airway Closure Technique for Right Pneumonectomy on Wall Tension During Positive Pressure Ventilation: An Experimental Study

Bronchopleural fistula (BPF) remains a significant source of morbidity and mortality after right pneumonectomy (RPN). Postoperative mechanical ventilation represents a primary risk factor for BPF. We undertook an experiment to determine the influence of airway diameter on suture line tension during mechanical ventilation after RPN. RPN was performed in 6 fresh human adult cadavers. After initial standard bronchial stump closure (BSC), the airway suture lines were subjected to 5 cm H2O incremental increases in airway pressures beginning at 5–40 cm H2O. To minimize airway diameter, a carinal resection was then performed with trachea to left main bronchial anastomosis and the airway suture lines subjected to similar incremental airway pressures. Wall tension (N/m) at the suture lines was measured using piezoresistive sensors at each pressure point. As delivered airway pressure increased, there was a concomitant increase in wall tension after BSC and carinal resection. At every point of incremental positive pressure, wall tension was however significantly lower after carinal resection when compared to BSC (P < 0.05). Additionally the differences in airway tension became even more significant with higher delivered airway pressure (P < 0.001). Airway diverticulum after BSC leads to significantly increased tension on the bronchial closure with positive airway pressure as compared to a closure which minimize airway diameter after RPN. This supports the role of Laplacian Law where small increases in airway diameter result in significant increases on closure site tension. Techniques which reduce airway diameter at the airway closure will more reliably reduce the incidence of BPF following RPN

Outcomes of surgical coronary revascularization performed pre-solid abdominal organ transplant

Background Cardiac risk stratification and coronary angiography are routinely performed as part of kidney and liver transplant candidacy evaluation. There are limited data on the outcomes of surgical coronary revascularization in this patient population. We investigated outcomes in patients with end stage renal or hepatic disease undergoing coronary artery bypass grafting (CABG) to attain kidney or liver transplant candidacy. Methods Retrospective analysis of all patients who underwent isolated CABG at our institution between 2010 and 2016. Patients were divided into two cohorts: Pre-transplant (those undergoing surgery to attain renal or hepatic transplant candidacy) and Non-transplant (all others). Baseline characteristics and postoperative outcomes were compared between groups. Results A total of 1801 patients were included: 28 in Pre-transplant (n=22 kidney, n=7 liver) and 1773 in Non-transplant. Major adverse postoperative outcomes were significantly greater in Pre-transplant compared to Non-transplant: 30-day mortality (14.3% vs. 2.8%, p=0.009), neurologic events (17.9% vs. 4.8%, p=0.011), re-intubation (21.4% vs. 5.8%, p=0.005) and total postoperative ventilation (5.2 vs. 5.0 hours, p=0.0124). One- and five-year mortality in Pre-transplant was 17.9% and 53.6%, respectively. Of the Pre-transplant cohort, three patients (10.7%) underwent organ transplantation (all kidneys) at a mean 436 days after CABG. No patients received liver transplantation. Conclusions Outcomes following CABG in the pre-kidney and pre-liver transplant population are poor. Despite surgical revascularization, the vast majority of patients do not ultimately undergo transplantation. Revascularization strategies and optimal management in this high-risk population warrants further study

HIV Prevention and Care Among Black Cisgender Sexual Minority Men and Transgender Women: Protocol for an HIV Status–Neutral Cohort Study Using an Observational-Implementation Hybrid Approach

Background: Black cisgender gay, bisexual, and other sexual minority men (SMM) and transgender women (TW) continue to be heavily affected by HIV. Further research is needed to better understand HIV prevention and care outcomes in this population. In particular, there is a need for research examining the impact of substance use and sleep health on HIV prevention and treatment outcomes among Black SMM and TW. Objective: This paper outlines the study methods being used in the recently launched follow-up study to the Neighborhoods and Networks (N2) study, which we refer to as N2 Part 2 (N2P2). N2P2 aims to address this gap in the literature, build off the findings of the original N2 study, and identify socioenvironmental determinants of health, including whether neighborhood and network factors mediate and moderate these relationships. Methods: Building on the N2 cohort study in Chicago from 2018 to 2022, N2P2 used a prospective longitudinal cohort design and an observational-implementation hybrid approach. With sustained high levels of community engagement, we aim to recruit a new sample of 600 Black SMM and TW participants residing in the Chicago metropolitan statistical area. Participants are asked to participate in 3 study visits across an 18-month study period (1 visit every 9 months). Four different forms of data are collected per wave: (1) an in-person survey, (2) biological specimen collection, (3) a daily remote ecological momentary assessment for 14 days after each study visit, and (4) data from electronic health records. These forms of data collection continue to assess neighborhood and network factors and specifically explore substance use, sleep, immune function, obesity, and the implementation of potential interventions that address relevant constructs (eg, alcohol use and pre-exposure prophylaxis adherence). Results: The N2P2 study was funded in August 2021 by the National Institute of Drug Abuse (R01DA054553 and R21DA053156) and National Heart, Lung, and Blood Institute (R01HL160325). This study was launched in November 2022. Recruitment and enrollment for the first wave of data collection are currently ongoing. Conclusions: The N2P2 study is applying innovative methods to comprehensively explore the impacts of substance use and sleep health on HIV-related outcomes among an HIV status-neutral cohort of Black SMM and TW in Chicago. This study is applying an observational-implementation hybrid design to help us achieve findings that support rapid translation, a critical priority among populations such as Black SMM and TW that experience long-standing inequities with regard to HIV and other health-related outcomes. N2P2 will directly build off the findings that have resulted from the original N2 study among Black SMM and TW in Chicago. These findings provide a better understanding of multilevel (eg, individual, network, and neighborhood) factors that contribute to HIV-related outcomes and viral suppression among Black SMM and TW. International registered report identifier (irrid): DERR1-10.2196/48548.</p

System Engineering Paper

The Iowa State University team, Team LunaCY, is composed of the following sub-teams: the main student organization, the Lunabotics Club; a senior mechanical engineering design course, ME 415; a senior multidisciplinary design course, ENGR 466; and a senior design course from Wartburg College in Waverly, Iowa. Team LunaCY designed and fabricated ART-E III, Astra Robotic Tractor- Excavator the Third, for the team's third appearance in the NASA Lunabotic Mining competition. While designing ART-E III, the team had four main goals for this year's competition:to reduce the total weight of the robot, to increase the amount of regolith simulant mined, to reduce dust, and to make ART-E III autonomous. After many designs and research, a final robot design was chosen that obtained all four goals of Team LunaCY. A few changes Team LunaCY made this year was to go to the electrical, computer, and software engineering club fest at Iowa State University to recruit engineering students to accomplish the task of making ART-E III autonomous. Team LunaCY chose to use LabView to program the robot and various sensors were installed to measure the distance between the robot and the surroundings to allow ART-E III to maneuver autonomously. Team LunaCY also built a testing arena to test prototypes and ART-E III in. To best replicate the competition arena at the Kennedy Space Center, a regolith simulant was made from sand, QuickCrete, and fly ash to cover the floor of the arena. Team LunaCY also installed fans to allow ventilation in the arena and used proper safety attire when working in the arena . With the additional practice in the testing arena and innovative robot design, Team LunaCY expects to make a strong appearance at the 2012 NASA Lunabotic Mining Competition.

A single nuclear transcriptomic characterisation of mechanisms responsible for impaired angiogenesis and blood-brain barrier function in Alzheimer's disease

Brain perfusion and blood-brain barrier (BBB) integrity are reduced early in Alzheimer's disease (AD). We performed single nucleus RNA sequencing of vascular cells isolated from AD and non-diseased control brains to characterise pathological transcriptional signatures responsible for this. We show that endothelial cells (EC) are enriched for expression of genes associated with susceptibility to AD. Increased β-amyloid is associated with BBB impairment and a dysfunctional angiogenic response related to a failure of increased pro-angiogenic HIF1A to increased VEGFA signalling to EC. This is associated with vascular inflammatory activation, EC senescence and apoptosis. Our genomic dissection of vascular cell risk gene enrichment provides evidence for a role of EC pathology in AD and suggests that reducing vascular inflammatory activation and restoring effective angiogenesis could reduce vascular dysfunction contributing to the genesis or progression of early AD.</p