Transcatheter closure of a large patent ductus arteriosus with the clamshell septal umbrella

AbstractIn 14 patients undergoing transcatheter closure of a large (>4 mm diameter) patent ductus arteriosus, occlusion was attempted with use of the Bard Clamshell septal umbrella. Patient age ranged from 0.7 to 30.4 years. Isolated patent ductus arteriosus was present in 11 patients; 3 had additional congenital heart lesions. Moderate or severe pulmonary hypertension was present in four patients. The diameter of the patent ductus arteriosus ranged from 4.5 to 14 mm, as determined by contrast injection through an 11F sheath or by balloon sizing; it appeared larger by this method than by the standard angiographic method.All 14 patent ductus arteriosi were successfully closed. Prior embolization of a Rashkind umbrella was the reason for using a Clamshell device in three patients; one additional embolization of a Clamshell device occurred. All errant devices were retrieved at cardiac catheterization, without associated hemodynamic instability. No other complications occurred. Among the 14 patients, 11 had complete ductal closure by Doppler color flow mapping at last follow-up and 3 had trivial residual Row. All four patients having associated complex lesions or pulmonary hypertension, or both, had symptomatic improvement after the procedure, although one child (with Shone's anomaly) died 3 months later.The Clamshell device provides stable and effective closure of a large patent ductus arteriosus, and allows transcatheter closure to be offered to some patients who were previously considered unsuitable for this procedure

Teaching the Three E’s of Sustainability Through Service‐Learning in a Professional Program

Using seven established course design principles for effective service‐learning, this chapter discusses the lessons learned in teaching the three E’s of sustainability: environmental; economic; and (social) equity, in a professional program at an American Midwestern public university.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154652/1/tl20374_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154652/2/tl20374.pd

Distributed situation awareness in dynamic systems: Theoretical development and application of an ergonomics methodology

The purpose of this paper is to propose foundations for a theory of situation awareness based on the analysis of interactions between agents (i.e., both human and non-human) in subsystems. This approach may help promote a better understanding of technology-mediated interaction in systems, as well as helping in the formulation of hypotheses and predictions concerning distributed situation awareness. It is proposed that agents within a system each hold their own situation awareness which may be very different from (although compatible with) other agents. It is argued that we should not always hope for, or indeed want, sharing of this awareness, as different system agents have different purposes. This view marks situation awareness as a 1 dynamic and collaborative process that binds agents together on tasks on a moment-by-moment basis. Implications of this viewpoint for development of a new theory of, and accompanying methodology for, distributed situation awareness are offered

Surgical management of life threatening events caused by intermittent aortic insufficiency in a native valve: case report

We describe a case of a patient admitted with apparent life threatening events characterized by hypotension and bradycardia. The patient was ultimately found to have intermittent severe aortic insufficiency. Upon surgical exploration, abnormalities were discovered in the aortic valve, which had a small left coronary cusp with absence of the nodulus of Arantius. Following surgical repair of the valve, aimed at preventing the small cusp from becoming stuck in the open position, the patient has remained episode free for over one year

People, technology, and complex work in healthcare

Motivation - Healthcare are rapidly replacing manual with computerized artefacts for many reasons, but the impact on users of the technology is often assumed to be neutral. Approach-Three presentations of the increasingly more intensive use of computer technology in healthcare will be discussed by panelists and audience to explore the problem space. A closing presentation will highlight issues in designing technology that is both usable and useful to frontline workers. Originality/Value-There is great pressure to speed up the introduction of technology in healthcare, but a "rush to implementation" risks serious design problems. Take away message-Technological artefacts are introduced to meet many needs, but if users' needs are not taken into account, the technology may founder or be subverted