Superficial femoral artery eversion endarterectomy: A useful adjunct for infrainguinal bypass in the presence of limited autogenous vein

AbstractPurpose: To evaluate, in a group of technically high-risk patients, the results of infrainguinal revascularization using a conduit constructed with endarterectomized superficial femoral artery (SFA) and available arm or saphenous vein.Methods: Of 237 consecutive lower extremity vein graft bypass procedures performed in 195 patients from July 1992 through August 1996, 15 SFA eversion endarterectomies (in 10 men and five women; median age, 70 years) were performed and used as a composite bypass conduit with available autogenous vein for the treatment of limb-threatening ischemia. In each case, an occluded SFA was divided 8 to 15 cm distal to its origin, proximally endarterectomized, and sewn end-to-end to a segment of vein to provide adequate conduit length for bypass grafting. Indications for this technique were unavailability of vein as a result of failed previous bypass grafting (n = 10) or previous coronary artery bypass grafting (n = 5). Veins were sewn distally to a below-knee popliteal artery (n = 4; 27%) or tibial artery (n = 11; 73%).Results: Primary patency, secondary patency, and limb salvage rates at 36 months by life table analyses for the 237 grafts were 62.3%, 81.0%, and 77.2%, respectively. The 15 composite SFA-vein bypass grafts had 36-month primary patency, secondary patency, and limb salvage rates of 60.0%, 72.0%, and 65.9%, respectively (mean follow-up, 15 months). Currently, eight of these patients (53%) have patent bypass grafts; two (13%) died at 4 and 18 months after the operation with patent grafts; two (13%) underwent amputations for progressive foot gangrene despite a patent bypass graft; and three (20%) had grafts that thrombosed at 4, 5, and 10 months. Typical hyperplastic intrinsic graft-threatening stenoses developed in two patients (13%) in the SFA segment at 4 and 8 months; they were discovered by routine duplex scan surveillance.Conclusion: Composite SFA eversion endarterectomy/vein graft conduits yield acceptable results, behave similarly to other autogenous conduits used for technically high-risk infrainguinal revascularization, and are beneficial when autogenous vein is limited

Measuring life events and their association with clinical disorder: a protocol for development of an online approach

Background: Severe life events are acknowledged as important aetiological factors in the development of clinical disorders, including major depression. Interview methods capable of assessing context and meaning of events have demonstrated superior validity compared to checklist questionnaire methods and arguments for interview approaches have resurfaced as choice of assessment tool has been implicated in gene-environment interactions in depression. Such approaches also have greater potential for understanding and treating clinical cases or for use in interventions. Objectives: (i) To argue that life events need sophisticated measurement not satisfactorily captured in checklist approaches. (ii) To review life events measures and key findings related to disorder, exemplifying depression. (iii) To describe an ongoing study with a new online measure, to assess its psychometric properties and the association of life events in relation to disorder and educational outcomes. Methods: The Computerised Life Events Assessment Record (CLEAR) is under development as a tool for online assessment of adult life events. Based on the Life Events and Difficulties Schedule (LEDS) interview, CLEAR seeks to assess life events to self and close others, link these to other events and difficulties and utilise calendar-based timing, to improve upon checklist approaches. The phases of the study are outlined in terms of its samples of midlife cases with depression, unaffected controls and students, testing of the psychometric properties of CLEAR, as well as proposed investigations of its association with disorder and educational outcomes. Conclusions: There is currently no sophisticated technological application of social risk factor assessment, such as life events and difficulties. CLEAR is designed to gather reliable and valid life event data whilst combatting the limitations of interviews (e.g. time consuming and costly) and life event checklists (e.g. inability to accurately measure severity and independence of life events). The advantages of using such innovative methodology for research, clinical practice and interventions are discussed

Web-based measure of life events using computerized life events and assessment record (CLEAR): preliminary cross-sectional study of reliability, validity, and association with depression

Background: Given the criticisms of life event checklists and the costs associated with interviews, life event research requires a sophisticated but easy-to-use measure for research and clinical practice. Therefore, the Computerised Life Events and Assessment Record (CLEAR), based on the Life Events and Difficulties Schedule (LEDS), was developed. Objectives: To test CLEAR’s reliability, validity, and association with depression. Methods: CLEAR, the General Health Questionnaire, and the List of Threatening Experiences Questionnaire (LTE-Q) were completed by 328 participants (126 students; 202 matched midlife sample: 127 unaffected controls, 75 recurrent depression cases). Test-retest reliability over 3-4 weeks was examined, and validity determined by comparing CLEAR with LEDS and LTE-Q. Both CLEAR and LTE-Q were examined in relation to depression. Results: CLEAR demonstrated good test-retest reliability for overall number of life events (.89) and severe life events (.60). Long-term problems showed similar findings. In terms of validity, CLEAR severe life events had moderate sensitivity (59.1%) and specificity (65.4%) when compared to LEDS. CLEAR demonstrated moderate sensitivity (43.1%) and specificity (78.6%) when compared to LTE-Q. CLEAR severe life events and long term problems were significantly associated with depression (OR = 3.50, 95% CI: 2.10-5.85, P < .001; OR = 3.38, 95% CI: 2.02-5.67, P < .001, respectively) whereas LTE-Q events were not (OR=1.06, 95% CI: .43-2.60, P =.90). Conclusions: CLEAR has acceptable reliability and validity and predicts depression. It therefore has great potential for effective use in research and clinical practice identifying stress-related factors for the onset and maintenance of depression and related disorders

Characteristics of severe life events, attachment style, and depression – Using a new online approach

Objectives Severe life events are established as provoking agents for depression in combination with vulnerability factors. Identifying features of severe events improves the prediction of disorder but are rarely utilized, mainly because life event research is increasingly dominated by self‐report checklists with no capacity for inferring such characteristics. This paper investigates the association of severe life events’ features with depression and insecure attachment styles using a new online measure of life events in a clinical and control sample. Methods A total of 202 participants (75 clinical and 127 matched control participants), taken from an earlier national Depression Case Control genetic study and followed up after 12 years, completed the Computerised Life Events Assessment Record to assess characteristics of life events, the Vulnerable Attachment Style Questionnaire to measure attachment insecurity, and the General Health Questionnaire to measure depression. Results The clinical group had higher self‐reported depression, severe life events, and insecure attachment style. They also reported more loss, danger, humiliation, and trauma severe events. Intra‐respondent analysis showed individuals experiencing these types of events were more likely to report depression. Insecure attachment style and severe life events were both significantly related to recent depression and history of depressive disorder. Anxious attachment style was significantly related to relationship events and bereavements, as well as severe loss or humiliation events, whereas avoidant style was not. Conclusions Identifying salient features of severe life events improves associations with depression and insecure attachment style. Utilizing a new online approach can aid research and clinical approaches for depression at low cost. Practitioner points Salient features of severe life events (e.g., loss, humiliation) give insight into the potential impact on attachment vulnerability and depression. Clinicians and researchers can use online methods to economically gain detailed life event information needed for clinical formulation and valid data on stressors. The self‐reported scale for recent depression is only a proxy measure of clinical disorder, but the clinical group selection is a more robust criterion for depression history

Scenarios for the development of smart grids in the UK : literature review

No abstractUK Energy Research Centr

Prosthetic thigh arteriovenous access: outcome with SVS/AAVS reporting standards

AbstractPurposeDifferences in the reporting methods of results for arteriovenous (AV) access can dramatically affect apparent outcome. To enable meaningful comparisons in the literature, the Society for Vascular Surgery and the American Association for Vascular Surgery (SVS/AAVS) recently published reporting standards for dialysis access. The purpose of the present study was to determine infection rates, patency rates, and possible predictive factors for prosthetic thigh AV access outcomes with the reporting standards of the SVS/AAVS.MethodsA retrospective analysis was performed of all patients who underwent placement of thigh AV access by the Surgical Teaching Service at Greenville Memorial Hospital between 1989 and 2001. Outcomes were determined based on SVS/AAVS Standards for Reports Dealing with AV Accesses. The rate of revision per year of access patency was also determined; this end point more accurately reflects the true cost and morbidity associated with AV access than do patency or infection rates alone.ResultsOne hundred twenty-five polytetrafluoroethylene thigh AV accesses were placed in 100 patients. Nine accesses were excluded from the study, six because there was no patient follow-up and 3 as a result of deaths unrelated to the access procedure and which occurred less than 30 days after access placement. There were six (4%) late access-related deaths. There were 18 (15%) early access failures, related to infection in 14 cases (12%), thrombosis in three cases (2%), and steal in one case (1%). Early failure was more common in patients with diabetes mellitus (P = .036). The primary and secondary functional patency rates were 19% and 54%, respectively, at 2 years. Infection occurred in 48 (41%) accesses. The patency and infection rates were not influenced by patient age, gender, body mass index, or diabetes mellitus. The median number of interventions per year of access patency was 1.68, and this outcome was positively correlated with body mass index (P < .001).ConclusionsProsthetic AV access in the thigh is associated with higher morbidity compared with that reported for the upper extremity, and should be considered only if no upper extremity AV access option is available. Early access failure and the requirement for an increased number of interventions to reestablish and maintain access patency are more common in patients with diabetes mellitus and obesity. The number of interventions per year of access patency is a valuable end point when assessing the outcome of AV access procedures

Scenarios for the development of smart grids in the UK: synthesis report

No abstractUK Energy Research Centr

Impact of age norms and stereotypes on managers' hiring decisions of retirees

Purpose -Our study investigates the role of managers in the re-employment of early retirees and asks what the effect is of managers’ age norms and stereotypes on managers’ employment decisions. Design/methodology/approach- A combination of a factorial study and a survey was conducted. First, information on the age norms and stereotypes was collected. Secondly, profiles of hypothetical retired job applicants were presented to the employers, who were asked to make a specific hiring decision. The information collected during both studies was combined in the analysis and multilevel models were estimated. Findings -The results indicate that higher age norms result in a higher propensity to hire an early retiree. Stereotypes, by contrast, do not influence managers’ decisions. Early retirees’ chances for re-employment are also related to their own circumstances (physical appearance and relevant experience) and organisational forces, as they are hired when organisations face labour force shortages. Research limitation / implications – with the use of vignettes study we deal with hypothetical hiring situation. Originality value- Although the effect of age norms and age stereotypes has been often suggested, not much empirical evidence was presented to support this notion. Our study estimates the effect of age norms and stereotypes on hiring decision. key words: bridge employment; early retirees; age norms; age stereotypes; multilevel models.

The Effects of Sex-Role Attitudes and Group Composition on Men and Women in Groups

The dual impact of group gender composition and sex-role attitudes on self-perceptions and social behavior was explored. Androgynous and stereotyped men and women were placed in groups of skewed sex composition. Subjects\u27 self-descriptions of masculine attributes shifted significantly in the group environment. In some instances, sex role-stereotyped subjects responded most stereotypically when their gender was in the minority in the group. Differences between men and women and between androgynous and stereotyped subjects in sex role-related preferences for group roles and discussion topics were also found