Background: There is a paucity of literature regarding systemic semilunar valve (SSLV) dysfunction in patients with Fontan circulation. We sought to describe our center's 47-year experience with ...systemic semilunar valve replacement or repair (SSLVR) in patients with Fontan circulation. Methods: The Mayo Clinic Fontan Database is a comprehensive institutional database that stores clinical information of 1176 patients from 1973 to 2021. It was reviewed to identify patients who had a SSLV intervention at the time of or after Fontan. A cohort of 15 patients was identified and a retrospective review of their records was performed. Results: Fourteen patients had SSLV replacement (all mechanical) and one had a repair. SSLVR occurred up to 29 years following the Fontan (mean 11.3 ± 9 years, median 14 years). Thirteen of 14 with SSLVR were performed after Fontan and one was done at the time of initial Fontan. This was an older cohort and mean age at the time of Fontan was 8.7 ± 9.4 years (median 4 years). Indication for the operation was > moderate SSLV regurgitation in all patients. Six patients had decreased ventricular function (EF < 50%) prior to SSLVR and 8 had reduced function after SSLVR. Conclusion: Fortunately, the need for SSLV intervention after Fontan was rare, as evidenced by our small cohort extracted from a large single-institution database spanning a 47-year time period. Reduced preoperative and postoperative ejection fraction was common but did not seem to impact the outcome. Optimal timing for SSLV intervention after Fontan remains unclear.
One third of older adults fall each year, placing them at risk for serious injury, functional decline, and health care utilization. Despite the availability of effective preventive approaches, policy ...and clinical efforts at preventing falls among older adults have been limited. In this article we present the burden of falls, review evidence concerning the effectiveness of fall-prevention services, describe barriers for clinicians and for payers in promoting these services, and suggest strategies to encourage greater use of these services. The challenges are substantial, but strategies for incremental change are available while more broad-based changes in health care financing and clinical practice evolve to better manage the multiple chronic health conditions, including falls, experienced by older Americans.
Introduction
Outcomes after frontline treatment of Burkitt lymphoma (BL) have improved with the introduction of dose‐intense chemotherapy regimens, such as CODOX‐M/IVAC. While rituximab has increased ...survival rates for most forms of high‐grade B‐cell lymphoma, there has previously been hesitancy about incorporating it into BL treatment, partly due to concerns about increased toxicity. Prospective data using the standard dose CODOX‐M/IVAC regimen in combination with rituximab are lacking. We conducted a single‐arm phase 2 trial to assess the efficacy and toxicity of R‐CODOX‐M/R‐IVAC.
Methods
Eligible patients were aged 18–65 years, with newly diagnosed BL with MYC rearrangement as the sole cytogenetic abnormality, and high‐risk disease, defined by an International Prognostic Index (IPI) score of 3‐5. Patients received two cycles of R‐CODOX‐M chemotherapy alternating with two cycles of R‐IVAC, followed by two further cycles of rituximab alone. The primary endpoint was 2‐year progression‐free survival.
Results
Thirty‐eight patients were registered but after central pathology review, 27 patients had confirmed BL and commenced study treatment. Median age was 35 years, 14.8% patients had central nervous system involvement and 18.5% were HIV positive. Twenty‐two (81.4%) patients completed four cycles of chemotherapy. There were two treatment‐related deaths (7.4%). Two‐year progression‐free and overall survival rates were 77.2% (90% confidence interval CI: 56.0‐89.0) and 80.7% (90% CI: 59.6‐91.5), respectively.
Conclusions
This prospective trial demonstrates excellent survival rates with R‐CODOX‐M/R‐IVAC in a high‐risk BL cohort. It provides reassuring evidence regarding the feasibility of this regimen and also provides a benchmark for future studies.
Body dysmorphic disorder (BDD) is a relatively common and often severe disorder. Although individuals with BDD have markedly poor psychosocial functioning, the nature of interpersonal problems has ...been only minimally investigated. This study examined the severity, domains, and correlates of interpersonal problems in 51 individuals with BDD using the Inventory of Interpersonal Problems-64 (IIP-64) and other reliable and valid measures. Compared to norms for a U.S. community sample, individuals with DSM-IV BDD reported greater severity of interpersonal problems across most IIP-64 domains. BDD subjects' scores were most elevated on the Socially Inhibited and Nonassertive subscales. More severe BDD symptoms were significantly correlated with higher scores on the Socially Inhibited, Nonassertive, and Vindictive/Self-Centered subscales and with IIP-64 total score. In a logistic regression analysis, BDD severity and a personality disorder were independently associated with severity of interpersonal problems. These findings suggest that individuals with BDD have significant problems with interpersonal relationships, particularly in the areas of social inhibition and nonassertiveness.
•Baseline maximum tumor diameter is an important predictor of relapse for patients with ES-HL achieving complete metabolic remission.•Patients with baseline tumor size ≥5 cm have worse outcomes with ...ABVD alone and are likely to benefit from consolidation radiotherapy.
Purpose: This study was a pilot of a brief psychological capital (PsyCap) intervention with a sample of transition age youth with disabilities (N = 24) in a school setting. Substantial evidence ...supports the relationship between PsyCap and employment outcomes. Transition age youth with disabilities are an important target for pre-employment counseling interventions due to a lack of parity in postsecondary outcomes. Researchers have successfully boosted PsyCap in adult samples using brief interventions. Methods: PsyCap and vocational outcome expectancy (VOE) were compared in a repeated measures design. Results: PsyCap and VOE, and PsyCap and school performance were significantly correlated in our sample, but no differences were observed in PsyCap or VOE postintervention. Conclusion: As the first known effort to develop a PsyCap driven pre-employment intervention for transition age youth with disabilities, our experience and findings provide several implications for practice and future research. Aspects of the intervention to be modified for future efforts are presented.
Australia-wide consensus was reached on seven core concepts of physiology, which included homeostasis, a fundamental concept for students to understand as they develop their basic knowledge of ...physiological regulatory mechanisms. The term homeostasis is most commonly used to describe how the internal environment of mammalian systems maintains relative constancy. The descriptor "the internal environment of the organism is actively regulated by the responses of cells, tissues, and organs through feedback systems" was unpacked by a team of three Australian Physiology educators into 5 themes and 18 subthemes arranged in a hierarchy. Using a five-point Likert scale, the unpacked concept was rated by 24 physiology educators from 24 Australian Universities for level of importance and level of difficulty for students. Survey data were analyzed using a one-way ANOVA to compare between and within concept themes and subthemes. There were no differences in main themes for level of importance, with all ratings between essential or important.
was almost unanimously rated as essential. Difficulty ratings for unpacked concept themes averaged between slightly difficult and moderately difficult. The Australian team concurred with published literature that there are inconsistencies in the way the critical components of homeostatic systems are represented and interpreted. We aimed to simplify the components of the concept so that undergraduates would be able to easily identify the language used and build on their knowledge.
The homeostasis core concept of physiology was defined and unpacked by an Australian team with the goal of constructing a resource that will improve learning and teaching of this core physiology concept in an Australian Higher Education context.
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