Delivery of care for adult patients with congenital heart disease in Europe: Results from the Euro Heart Survey

Aims: The increasing number of adults with congenital heart disease (CHD) has prompted the development of recommendations for the management of these patients and for the organization of their healthcare. The aim of this report is to describe the delivery of care in Europe for adults with congenital cardiac anomalies. Methods and results: As part of the Euro Heart Survey on Adult Congenital Heart Disease, we obtained data from 71 voluntarily participating centres that detailed their care practices for these patients. Forty-eight of these centres were specialist centres and 23 were non-specialist centres. We found that only 19% of the specialist centres complied with defined standards for optimal care structure. The criteria that appeared to be most difficult for all centres to achieve were performing 50 congenital heart operations or more per year and involving nurse specialists in the care of these patients. Conclusion: This survey indicated that the provision of care in Europe for adults with congenital

The value of routine chest radiographs after minimally invasive cardiac surgery: an observational cohort study

BACKGROUND: Chest radiographs (CXRs) are obtained frequently in postoperative cardiac surgery patients. The diagnostic and therapeutic efficacy of routine CXRs is known to be low and the discussion regarding the safety of abandoning these CXRs after cardiac surgery is still ongoing. We investigated the value of routine CXRs directly after minimally invasive cardiac surgery. METHODS: We prospectively included all patients who underwent minimally invasive cardiac surgery by port access, ministernotomy or bilateral video-assisted thoracoscopy (VATS) in the year 2012. A direct postoperative CXR was performed on all patients at ICU arrival. All CXR findings were noted, including whether they led to an intervention or not. The results were compared to the postoperative CXR results in patients who underwent conventional cardiac surgery by full median sternotomy over the same period. MAIN RESULTS: A total of 249 consecutive patients were included. Most of these patients underwent valve surgery, rhythm surgery or a combination of both. The diagnostic efficacy for minor findings was highest in the port access and bilateral VATS groups (56% and 63% versus 28% and 45%) (p < 0.005). The diagnostic efficacy for major findings was also higher in these groups (8.9% and 11% versus 4.3% and 3.8%) (p = 0.010). The need for an intervention was most common after minimally invasive surgery by port access, although this difference was not statistically significant (p = 0.056). CONCLUSIONS: The diagnostic efficacy of routine CXRs performed after minimally invasive cardiac surgery by port access or bilateral VATS is higher than the efficacy of CXRs performed after conventional cardiac surgery. A routine CXR after these procedures should still be considered

Serious game-based word-to-text integration intervention effects in English as a second language

Word-to-text integration (WTI) is the ability to integrate words into a mental representation of the text and is important for reading comprehension, but challenging in English as a second language (ESL). However, it remains unclear whether WTI can be trained in seventh grade ESL learners, who often struggle with reading comprehension and display large individual differences. To pay attention to individual differences, the present study examined an adaptive computer game-based WTI-intervention. The intervention, replacing 50 min of ESL classroom instruction, comprized a 12-week program in which students had to complete WTI-based assignments within four serious games, targeting morphosyntactic awareness, translation of words within sentences, recognizing idioms from words in contexts, and a filler game targeting dictation. The intervention group (n = 164) was compared to a control group (n = 166), who only received regular ESL classroom instruction. Both groups completed the following reading measures: decoding, morphological, and syntactic awareness, WTI (argument and anomaly reading speed and processing), and reading comprehension tasks at the beginning (T1) of the school year and at the end (T2) of the school year. Results demonstrated an intervention effect on decoding and anomaly processing as reflected by an interaction between time (T1 vs. T2) and group (intervention vs. control) in a repeated measures MANOVA. Follow-up mediation analyses for the intervention group only - with game performance as mediators between reading measures at T1 and T2 - indicated that students with better T1 scores on reading measures showed more growth in performance within games. More performance growth within the translation game and the idiom recognition game was related to better reading scores at T2. Both high-achieving and low-achieving students displayed performance growth within games, indicating that a WTI intervention yields promising results for a broad variety of ESL readers

Tumor Angiogenesis Phenotyping by Nanoparticle-facilitated Magnetic Resonance and Near-infrared Fluorescence Molecular Imaging

AbstractOne of the challenges of tailored antiangiogenic therapy is the ability to adequately monitor the angiogenic activity of a malignancy in response to treatment. The αvβ3 integrin, highly overexpressed on newly formed tumor vessels, has been successfully used as a target for Arg-Gly-Asp (RGD)-functionalized nanoparticle contrast agents. In the present study, an RGD-functionalized nanocarrier was used to image ongoing angiogenesis in two different xenograft tumor models with varying intensities of angiogenesis (LS174T > EW7). To that end, iron oxide nanocrystals were included in the core of the nanoparticles to provide contrast for T2*-weighted magnetic resonance imaging (MRI), whereas the fluorophore Cy7 was attached to the surface to enable near-infrared fluorescence (NIRF) imaging. The mouse tumor models were used to test the potential of the nanoparticle probe in combination with dual modality imaging for in vivo detection of tumor angiogenesis. Pre-contrast and post-contrast images (4 hours) were acquired at a 9.4-T MRI system and revealed significant differences in the nanoparticle accumulation patterns between the two tumor models. In the case of the highly vascularized LS174T tumors, the accumulation was more confined to the periphery of the tumors, where angiogenesis is predominantly occurring. NIRF imaging revealed significant differences in accumulation kinetics between the models. In conclusion, this technology can serve as an in vivo biomarker for antiangiogenesis treatment and angiogenesis phenotyping

SDSSJ103913.70+533029.7: A Super Star Cluster in the Outskirts of a Galaxy Merger

We describe the serendipitous discovery in the spectroscopic data of the Sloan Digital Sky Survey of a star-like object, SDSSJ103913.70+533029.7, at a heliocentric radial velocity of +1012 km/s. Its proximity in position and velocity to the spiral galaxy NGC 3310 suggests an association with the galaxy. At this distance, SDSSJ103913.70+533029.7 has the luminosity of a super star cluster and a projected distance of 17 kpc from NGC 3310. Its spectroscopic and photometric properties imply a mass of > 10^6 solar masses and an age close to that of the tidal shells seen around NGC 3310, suggesting that it formed in the event which formed the shells.Comment: Accepted by AJ: 4 figures (1 color

Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections

During the past year, a group has argued that unsafe injections are a major if not the main mode of HIV-1 transmission\ud in sub-Saharan Africa. We review the main arguments used to question the epidemiological interpretations on the lead\ud role of unsafe sex in HIV-1 transmission, and conclude there is no compelling evidence that unsafe injections are a\ud predominant mode of HIV-1 transmission in sub-Saharan Africa. Conversely, though there is a clear need to eliminate\ud all unsafe injections, epidemiological evidence indicates that sexual transmission continues to be by far the major\ud mode of spread of HIV-1 in the region. Increased efforts are needed to reduce sexual transmission of HIV-1

Impact of word-to-text integration processes on reading comprehension development in English as a second language

Background: Word-to-text integration (WTI) can be challenging for second-language (L2) learners, although it can positively contribute to reading comprehension. The present study examined the role of WTI, after controlling for decoding, vocabulary and morphosyntactic awareness, in predicting English as an L2 reading comprehension development in 441 Dutch seventh-grade students. Methods: At the beginning (Time 1 [T1]) and the end (Time 2 [T2]) of the school year, students were tested on their English decoding, vocabulary, morphological and syntactic awareness and reading comprehension with paper-and-pencil tasks and on WTI with a self-paced reading task with reading times being compared on passages with unknown versus known words and passages with and without anomalies. Results: Mediation analyses showed small indirect effects of processing argument overlap and anomalies on T2 reading comprehension, via T1 reading comprehension. Conclusions: WTI explained unique variance in reading comprehension at T2 via reading comprehension at T1, suggesting that it moderately impacts initial stages of reading comprehension in English as a second language (ESL)

Enabling high-efficiency InAs/GaAs Quantum Dot Solar Cells by Epitaxial Lift-Off and Light Management

We report thin-film InAs/GaAs QD solar cells fabricated by epitaxial lift-off of 3-inch wafers containing QD epi-structures with high in-plane QD density. External quantum efficiency measurements demonstrate enhanced QD harvesting in the thin-film configuration. Numerical simulations show that remarkably high increase of the QD photocurrent may be achieved by replacing the planar rear mirror with micro-structured photonic gratings. Measurements of diffraction efficiency of grating prototypes realized on GaAs wafers by nanoimprint lithography are presented

Novel subgroups of adult-onset diabetes and their association with outcomes : a data-driven cluster analysis of six variables

Background Diabetes is presently classified into two main forms, type 1 and type 2 diabetes, but type 2 diabetes in particular is highly heterogeneous. A refined classification could provide a powerful tool to individualise treatment regimens and identify individuals with increased risk of complications at diagnosis. Methods We did data-driven cluster analysis (k-means and hierarchical clustering) in patients with newly diagnosed diabetes (n=8980) from the Swedish All New Diabetics in Scania cohort. Clusters were based on six variables (glutamate decarboxylase antibodies, age at diagnosis, BMI, HbA(1c), and homoeostatic model assessment 2 estimates of beta-cell function and insulin resistance), and were related to prospective data from patient records on development of complications and prescription of medication. Replication was done in three independent cohorts: the Scania Diabetes Registry (n=1466), All New Diabetics in Uppsala (n=844), and Diabetes Registry Vaasa (n=3485). Cox regression and logistic regression were used to compare time to medication, time to reaching the treatment goal, and risk of diabetic complications and genetic associations. Findings We identified five replicable clusters of patients with diabetes, which had significantly different patient characteristics and risk of diabetic complications. In particular, individuals in cluster 3 (most resistant to insulin) had significantly higher risk of diabetic kidney disease than individuals in clusters 4 and 5, but had been prescribed similar diabetes treatment. Cluster 2 (insulin deficient) had the highest risk of retinopathy. In support of the clustering, genetic associations in the clusters differed from those seen in traditional type 2 diabetes. Interpretation We stratified patients into five subgroups with differing disease progression and risk of diabetic complications. This new substratification might eventually help to tailor and target early treatment to patients who would benefit most, thereby representing a first step towards precision medicine in diabetes.Peer reviewe