In this warm, deeply-personal, and often humorous book, Nancy McCabe re-examines and gains new understanding of her early life and her ill-advised marriage. Borrowing from Bosch’s Garden of Earthly ...Delights and Kafka’s “Metamorphosis,” how-to essays and before-and-after weight loss ads, a curriculum guide, Bible study notes, an obsession with Tom Swiftie jokes, and women’s magazine columns and quizzes that oversimplified women’s lives and choices, McCabe examines the many influences that led to her youthful marriage—and out of it, into finally taking control of her life.
Fontan failure can occur even with normal systolic ventricular function and often in the context of significant liver disease. We hypothesized that Fontan failure is hemodynamically distinct from ...traditional heart failure and characterized by low systemic vascular resistance (SVR) index and preserved cardiac index. Twenty-seven symptomatic adult Fontan (SAF) patients who underwent catheterization from 2001 to 2011 constituted our study group. Fifty-four predominantly asymptomatic pediatric Fontan (PF) patients who underwent catheterization during the same period were randomly selected to perform a control:case cohort analysis. Clinical comparisons were made between the 2 groups. The adults were more symptomatic than the PF cohort (New York Heart Association classes I and II or III and IV: 48% or 52% SAF vs 94% or 6% PF, respectively, p <0.01). SAF versus PF mean catheterization findings were central venous pressure 18 ± 6 versus 14 ± 3 mm Hg (p <0.01), SVR index 1,680 ± 368 versus 1,960 ± 550 dyn s/cm5 /m2 (p = 0.02), and cardiac index 2.7 ± 0.8 versus 2.8 ± 0.7 L/min/m2 (p = 0.25). By imaging, the SAF cohort demonstrated a greater incidence of abnormal liver texture changes (96% vs 75%, p = 0.04) and nodularity (77% vs 42%, p = 0.02). In conclusion, adult patients with failing Fontan circulation had a lower SVR index and similar cardiac index compared with the pediatric cohort. Liver disease in the adults was more advanced. Our data suggest that Fontan failure is a distinct circulatory derangement with hemodynamic features similar to portal hypertension, albeit with limited ability to augment cardiac output.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract Background Chronic congestive hepatopathy is known to cause hepatic fibrosis and portal hypertension in patients post-Fontan operation for single ventricle palliation. The clinical ...significance of these findings is not clear. We hypothesized that features of portal hypertension would be significantly related to major adverse events. Methods A retrospective review of 73 adult and pediatric post-Fontan patients referred for a liver evaluation from 2001 to 2011 was performed. The relationship between features of portal hypertension (VAST score ≥ 2, 1 point each for V arices, A scites, S plenomegaly or T hrombocytopenia) and a major adverse event (death, need for transplant, or hepatocellular carcinoma) was examined using logistic regression. Results 73 post-Fontan patients (30% female, 73% Caucasian, 66% systemic left ventricle (SLV), mean age 24 ± 11 years, mean interval from Fontan 17 ± 6 years) were included in analysis. Features of portal hypertension (VAST score ≥ 2) were present in 26 (36%), and there were 19 major adverse events: death (n = 12), transplant (n = 6), and HCC (n = 1). A significant relationship was found between VAST score ≥ 2 and major adverse events (OR = 9.8, 95% CI 2.9–32.7). After adjusting for time since Fontan, SLV, age, hemoglobin and type of failure, VAST score ≥ 2 remained significant (OR = 9.1, 95% CI 1.4–57.6). Conclusion Fontan patients with features of portal hypertension have a 9-fold increased risk for a major adverse event. Therapies targeted to manage clinical manifestations of portal hypertension, and early referral to heart transplant may help delay major adverse events. Future prospective studies are needed to confirm these findings.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
The burden of cardiovascular disease as a chronic illness increasingly requires patients to assume more responsibility for their self-management. Patient education is believed to be an essential ...component of cardiovascular care; however, there is limited evidence about specific therapeutic patient education approaches used and the impact on patient self-management outcomes.
An integrative review of the literature was conducted to critically analyze published research studies of therapeutic patient education for self-management in selected cardiovascular conditions. There was variability in methodological approaches across settings and disease conditions. The most effective interventions were tailored to individual patient needs, used multiple components to improve self-management outcomes, and often used multidisciplinary approaches.
This synthesis of evidence expands the base of knowledge related to the development of patient self-management skills and provides direction for more rigorous research. Recommendations are provided to guide the implementation of therapeutic patient education in clinical practice and the design of comprehensive self-management interventions to improve outcomes for cardiovascular patients.
A typical travel book takes readers along on a trip with the author, but a great travel book does much more than that, inviting readers along on a mental and spiritual journey as well. This ...distinction is what separates Nancy McCabe’s From Little Houses to Little Women from the typical and allows it to take its place not only as a great travel book but also as a memoir about the children’s books that have shaped all of our imaginations.
McCabe, who grew up in Kansas just a few hours from the Ingalls family’s home in Little House on the Prairie , always felt a deep connection with Laura Ingalls Wilder, author of the Little House series. McCabe read Little House on the Prairie during her childhood and visited Wilder sites around the Midwest with her aunt when she was thirteen. But then she didn’t read the series again until she decided to revisit in adulthood the books that had so influenced her childhood. It was this decision that ultimately sparked her desire to visit the places that inspired many of her childhood favorites, taking her on a journey that included stops in the Missouri of Laura Ingalls Wilder, the Minnesota of Maud Hart Lovelace, the Massachusetts of Louisa May Alcott, and even the Canada of Lucy Maud Montgomery.
From Little Houses to Little Women reveals McCabe’s powerful connection to the characters and authors who inspired many generations of readers. Traveling with McCabe as she rediscovers the books that shaped her and ultimately helped her to forge her own path, readers will enjoy revisiting their own childhood favorites as well.
Abstract Objectives To determine the relationship between 6-min walk test distance (6MWD) and 30-day readmission in hospitalized heart failure (HF) patients. Background 6MWD is known to predict ...hospitalizations in outpatients with HF, but its ability to predict recidivism in hospitalized HF patients is relatively unknown. Methods Seventy-one hospitalized HF patients with NYHA Class II/III (mean age 52.6 ± 12.3 years, 42.3% female, 73.2% African American) performed 6MWD prior to discharge. Logistic regression was used to determine relationships between 6MWD and 30-day readmission. Results 30-day readmission occurred in 14 (19.7%) patients. Average 6MWD was 756.4 ± 403.2 feet. Higher 6MWD significantly decreased risk of 30-day readmission, even after adjusting for sociodemographic and clinical characteristics (OR = .84, 95% CI .71, .99). For each additional 100 feet walked, odds of a 30-day readmission decreased by 16%. Conclusions 6MWD predicted 30-day readmission in this study, warranting further investigation to understand how the 6MWD may predict readmissions and guide treatment in hospitalized HF patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Risk factors for major adverse events late after Fontan palliation are unknown. Prior studies have suggested ventricular function and morphology as important risk factors. The aim of this study is to ...(1) characterize the late major adverse event profile in adult Fontan patients and (2) identify additional risk factors that may contribute to adverse outcomes.
A retrospective review of all adult patients >15 years post-Fontan seen at a tertiary academic center was conducted. Clinical, laboratory, cardiac data, and abdominal imaging were collected via chart review. Major adverse events (death, cardiac transplantation, or listing) were identified, and timing of events was plotted using Kaplan-Meier methods. Univariate and multivariate logistic regression was used to determine independent predictors of late-term events.
A total of 123 adult Fontan patients were identified (mean time post-Fontan 22.4 years ±4.4). Major adverse events occurred in 19/123 patients (15%). In this 15-year survivor cohort, transplant-free survival rates were 94.6%, 82.9%, and 59.8% at 20, 25, and 30 years postoperation, respectively. Modes of death were Fontan failure with preserved function (4), congestive heart failure with decreased function (2), sudden death (2), thromboembolic event (1), post-Fontan conversion (2), and posttransplant (2). No differences in adverse outcomes were found based on morphology of the systemic ventricle, Fontan type, or systolic ventricular function. On the other hand, features of portal hypertension (OR 19.0, CI 4.7-77.3, P < .0001), presence of a pacemaker (OR 13.4, CI 2.6-69.8, P = .002), and systemic oxygen desaturation (OR 0.86, CI 0.75-0.98, P = .02) were risk factors for major adverse events in the multivariate analysis.
In adult Fontan patients surviving >15 years post-Fontan, portal hypertension, oxygen desaturation, and need for pacemaker were predictive of adverse events. Traditional measures may not predict late-term outcomes in adult survivors; further study of the liver's role in late outcomes is warranted.
Thymectomy is performed routinely in infants undergoing cardiothoracic surgery. Children post-sternotomy have decreased numbers of T lymphocytes, although the mechanisms involved and long-term ...consequences of this have not been defined. We hypothesized that lymphopenia in patients with adult congenital heart disease (ACHD) would be reflective of premature T cell maturation and exhaustion. Adults with ACHD who had sternotomy to repair congenital heart disease as infants (<1 year) and age-matched ACHD patients without prior sternotomy were studied using polychromatic flow cytometry interrogating markers of lymphocyte maturation, exhaustion and senescence. Group differences were analyzed using Mann–Whitney U and Fisher’s exact tests. Eighteen ACHD patients aged 21–40 years participated: 10 cases and 8 controls. Median age at sternotomy for cases was 52 days. Cases and controls were matched for age (28.9 vs. 29.1 years;
p
= 0.83), gender (
p
= 0.15) and race (
p
= 0.62) and had similar case complexity. Cases had a lower mean percentage of cytotoxic CD8 lymphocytes compared to controls (26.8 vs. 33.9 %;
p
= 0.016), with fewer naive, undifferentiated CD8 T cells (31.0 vs. 53.6 %;
p
= 0.027). CD8 cells expressing PD1, a marker of immune exhaustion, trended higher in cases versus controls (25.6 vs. 19.0 %;
p
= 0.083). Mean percentage of CD4 cells was higher in cases versus controls (65.6 vs. 59.6 %;
p
= 0.027), without differences in CD4 T cell maturation subtype. In summary, ACHD patients who undergo sternotomy as infants exhibit differences in T lymphocyte composition compared to ACHD controls, suggesting accelerated immunologic exhaustion. Investigation is warranted to assess the progressive nature and clinical impact of this immune phenotypic change.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
  Even before Nancy McCabe and her daughter, Sophie, left for China, it was clear that, as the mother of an adopted child from China, McCabe would be seeing the country as a tourist while her ...daughter, who was seeing the place for the first time in her memory, was “going home.” Part travelogue, part memoir, Crossing the Blue Willow Bridge immerses readers in an absorbing and intimate exploration of place and its influence on the meaning of family.   A sequel to Meeting Sophie , which tells McCabe’s story of adopting Sophie as a single woman, Crossing the Blue Willow Bridge picks up a decade later with a much different Sophie—a ten-year-old with braces who wears black nail polish, sneaks eyeliner, wears clothing decorated with skulls, and has mixed feelings about being one of the few non-white children in the little Pennsylvania town where they live. Since she was young, Sophie had felt a closeness to the country of her birth and held it in an idealized light. At ten, she began referring to herself as Asian instead of Asian-American. It was McCabe’s hope that visiting China would “help her become comfortable with both sides of the hyphen, figure out how to be both Chinese and American, together.”   As an adoptive parent of a foreign-born child, McCabe knows that homeland visits are an important rite of passage to help children make sense of the multiple strands of their heritage, create their own hybrid traditions, and find their particular place in the world. Yet McCabe, still reeling from her mother’s recent death, wonders how she can give any part of Sophie back to her homeland. She hopes that Sophie will find affirmation and connection in China, even as she sees firsthand some of the realities of China—overpopulation, pollution, and an oppressive government—but also worries about what that will mean for their relationship.   Throughout their journey on a tour for adopted children, mother and daughter experience China very differently. New tensions and challenges emerge, illuminating how closely intertwined place is with sense of self. As the pair learn to understand each other, they lay the groundwork for visiting Sophie’s orphanage and birth village, life-changing experiences for them both.
While she's still unconscious, the doctor calls me into a room and lays photographs before me of esophageal and duodenal openings, slimy red-brown circles, whirlpools twirling into the depths of ...tubes and tunnels. Caves in Literature Caves and other dark, enclosed spaces serve multiple functions: as setting, metaphor, plot device, and means of characterization, echoing the emotional states of protagonists. In the exam room, with the usual charts on the wall and paper-covered examining table, we sit in the usual plastic chairs while the nurse taps on her computer, reviewing information. Audience members in an opera box stare at us: were the actors, traipsing across a stone path, the focus of millions of years of configurations sculpted by water, dripping through the earth's cavities.
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