Contrasting effect of different cardiothoracic operations on echocardiographic right ventricular long axis velocities, and implications for interpretation of post-operative values

AbstractBackgroundPatients undergoing coronary artery bypass grafting (CABG) experience a reduction in right ventricular long axis velocities post surgery.ObjectivesWe tested whether the phenomenon of right ventricular (RV) long axis velocity decline depends on the chest being opened fully by mid-line sternotomy, pericardial incision, or on the type of operation performed.MethodBy intraoperative transoesophageal echocardiography (TEE) we recorded serial right ventricular (RV) systolic pulse-wave tissue Doppler velocities during 6 types of elective procedure: 53 CABG surgery, 15 robotic-assisted minimally-invasive CABG (RCABG), 28 aortic valve replacement (AVR), 8 minimally-invasive aortic valve replacement (mini-AVR), 5 mediastinal mass excision, and 1 left atrial myxoma excision. Pre and post operative transthoracic echocardiography (TTE) were also conducted.ResultsSurgery without substantial opening of the pericardium did not significantly reduce RV systolic velocities (RCABG 13±1.8 versus 12.4±2.7cm/s post; mini-AVR 11.9±2.3 versus 11.1±2.3cm/s; mediastinal mass excision 13.9±3.1 versus 13.8±4cm/s). In contrast, within 5min of pericardial incision those whose surgery involved full opening of the pericardium had large reductions in RV velocities: 54±11% decline with CABG (11.3±1.9 to 5.1±1.6cm/s, p<0.0001), 54±5% with AVR (12.6±1.4 to 5.7±0.6cm/s, p<0.001) and 49% with left atrial myxoma excision (11.3 to 15.8cm/s). This persisted immediately after pericardial opening to the end of surgery (61±11%, p<0.0001; 58±7%, p<0.0001; 59% respectively).ConclusionsIt is full opening of the pericardium, and not cardiac surgery in general, which causes RV long axis decline following cardiac surgery. The impact is immediate (within 5min) and persistent

Workset Creation for Scholarly Analysis and Data Capsules (WCSA+DC): Laying the foundations for secure computation with copyrighted data in the HathiTrust Research Center, Phase I

The primary objective of the WCSA+DC project is the seamless integration of the workset model and tools with the Data Capsule framework to provide non-consumptive research access HathiTrust’s massive corpus of data objects, securely and at scale, regardless of copyright status. That is, we plan to surmount the copyright wall on behalf of scholars and their students. Notwithstanding the substantial preliminary work that has been done on both the WCSA and DC fronts, they are both still best characterized as being in the prototyping stages. It is our intention to that this proposed Phase I of the project devote an intense two-year burst of effort to move the suite of WCSA and DC prototypes from the realm of proof-of-concept to that of a firmly integrated at-scale deployment. We plan to concentrate our requested resources on making sure our systems are as secure and robust at scale as possible. Phase I will engage four external research partners. Two of the external partners, Kevin Page (Oxford) and Annika Hinze (Waikato) were recipients of WCSA prototyping sub-awards. We are very glad to propose extending and refining aspects of their prototyping work in the context of WCSA+DC. Two other scholars, Ted Underwood (Illinois) and James Pustejovsky (Brandeis) will play critical roles in Phase I as active participants in the development and refinement of the tools and systems from their particular user-scholar perspectives: Underwood, Digital Humanities (DH); Pustejovsky, Computational Linguistics (CL). The four key outcomes and benefits of the WCSA+DC, Phase I project are: 1. The deployment of a new Workset Builder tool that enhances search and discovery across the entire HTDL by complementing traditional volume-level bibliographic metadata with new metadata derived from a variety of sources at various levels granularity. 2. The creation of Linked Open Data resources to help scholars find, select, integrate and disseminate a wider range of data as part of their scholarly analysis life-cycle. 3. A new Data Capsule framework that integrates worksets, runs at scale, and does both in a secure, non-consumptive, manner. 4. A set of exemplar pre-built Data Capsules that incorporate tools commonly used by both the DH and CL communities that scholars can then customize to their specific needs.Andrew W. Mellon Foundation, grant no. 41500672Ope

Effectiveness of moorings constructed from rope in reducing impacts to seagrass

Seagrass meadows commonly reside in shallow sheltered coastal environments which are typically safe havens for mooring boats. There is evidence from around the globe that the use of common swinging chain moorings leads to halos of bare sediment in otherwise productive seagrass. These halos reduce animal abundance and diversity and lead to a loss of the carbon stored within sediments. To protect and enhance seagrass ecosystem services, low-cost simple solutions are required that can solve the problems of boating-based disturbance. In the present novel study, we provide evidence that the simple replacement of mooring chains with rope can significantly reduce damage to sensitive benthic habitats such as seagrass. At three locations across a range of environmental conditions, we provide evidence that well-established moorings constructed from rope do not damage seagrass. Overall, there was a significant effect (F1,756 = 299.46, p 0.001) of the mooring type and distance from the mooring base. This equates to a 44% increase in seagrass cover within areas around a rope mooring relative to a chain one. Most small boat mooring activity happens within the summer months, therefore large heavy-duty winter mooring systems are not required in many situations, opening opportunities for adapted systems that have a reduced environmental impact. The present study suggests that there is a ready-made, low-technology, low-cost solution already in existence for halting the widespread loss of seagrass from small boat mooring damage and allowing recovery and opportunity for restoration

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

ECHO DEPository Technical Architecture Phase 1 Final Report

The ECHO DEPository (Phase 1) is an NDIIPP-partner research and development project at the University of Illinois at Urbana-Champaign (UIUC) in partnership with OCLC, the National Center for Supercomputing Applications); the Michigan State University Library; and an alliance of state libraries from Arizona, Connecticut, Illinois, North Carolina and Wisconsin. Our aim is to support the digital preservation efforts of the Library of Congress by addressing issues of how we collect, manage, preserve, and make useful the enormous amount of digital information our culture is now producing. Phase 1 project activities (Fall 2004 through 2007) included developing web archiving tools, evaluating existing repository software, developing an architecture to enhance existing repositories??? interoperability and preservation features, and modeling next-generation repositories for supporting long-term preservation. This narrative report describes project activities and deliverables during ECHO DEP 1.unpublishednot peer reviewe

ECHO DEPository - Phase 2: 2008-2010 Final Report of Project Activities

This narrative report provides an overview of ECHO DEP Phase 2 activities and accomplishments. Accompanying appendices and referenced download facilities make available specific additional project deliverables (e.g., EMP’s evaluation of existing NER tools and the ontology developed by the Semantic Archive project). Many of these materials, as well as this report itself, are archived in IDEALS1, the institutional repository at the University of Illinois, and thus available for future public access. A note about nomenclature: to reduce confusion about phases (e.g., there is a Phase 2 of ECHO DEP, but there are also phases of development within a discrete project), the second phase of ECHO DEP will herein be termed “ECHO DEP 2.” (Accordingly, “ECHO DEP 1” denotes the first phase of ECHO DEP.)unpublishednot peer reviewe

Reduced Confounding by Impaired Ventilatory Function With Oxygen Uptake Efficiency Slope and VE/VCO2 Slope Rather Than Peak Oxygen Consumption to Assess Exercise Physiology in Suspected Heart Failure

Heart failure and ventilatory disease often coexist; both create abnormalities in cardiopulmonary exercise test measurements. The authors evaluated the relative dependency of a well-recognized index of heart failure, peak oxygen consumption (VO(2)), and 2 newer indices, the minute ventilation (VE)/carbon dioxide production (VCO(2)) slope and oxygen uptake efficiency slope (OUES), on standard markers of impaired cardiac and ventilatory function. One hundred twenty-four patients (median age, 65.8; range, 22.6-84.9), with functional limitation from clinical heart failure were exercised. Peak VO(2) was 17.14 ± 7.58 mL/kg/min, VE/VCO(2) slope 50.1 ± 20.1, OUES 1.46 ± 0.68 L/min, and forced expiratory volume in 1 second (FEV(1) ) 1.88 ± 0.75 L. Peak VO(2) is substantially more sensitive to FEV(1) than ejection fraction (4.0 mL/kg/min difference between above- and below-median FEV(1) and 1.5 mL/kg/min between above- and below-median ejection fraction). OUES does not share this peculiar excess sensitivity to FEV(1) (0.12 L/min difference between above- and below-median FEV(1) and 0.01 L/min between above- and below-median ejection fraction). VE/VCO(2) slope has a borderline effect by FEV(1) (7.07 difference between above- and below-median FEV(1) and 2.07 between above- and below-median ejection fraction). Although widely used as a marker of heart failure severity, peak VO(2) is very sensitive to spirometry status and is indeed more affected by FEV(1) than by ejection fraction. OUES in contrast does not show this preferential sensitivity to impaired FEV(1)