Mentor teachers of student teachers play an important role in novice teacher development, yet rarely receive training or support. This study investigates five mentor teachers during the 2021-2022 ...school year as they participated in monthly mentor professional development meetings. It asks the question 'How can recordings of mentor/mentee conversations be used within mentor professional development to support the development of educative mentors?' This qualitative analysis used interviews and video recordings of meetings to understand the mentor teacher experiences. It finds that audio clips in mentor meetings worked to support mentor teachers' learning as mentors and teachers and worked to deprivatize the work of mentoring. Findings from this study can help inform mentor professional development facilitation and can help inform decisions regarding how to prepare and support mentor teachers.
The aim of this study was to assess the effect of diabetes mellitus (DM) and glycosylated hemoglobin (HbA1c ) on the progression of atherosclerosis in postmenopausal women. A retrospective analysis ...of the Women’s Angiographic and Vitamin and Estrogen (WAVE) trial, a multicenter randomized trial on progression of atherosclerosis in postmenopausal women, was performed. Baseline and follow-up angiography was performed in 320 women. Minimum luminal diameter and average luminal diameter at baseline and follow-up were measured in 1,735 coronary segments. Measurements and adverse events were grouped on the basis of history of DM and HbA1c . DM was associated with more total cardiac events but with similar rates of death or myocardial infarction. There were greater reductions in minimum luminal diameter and average luminal diameter in segments from patients with known DM (p <0.001) and with a baseline HbA1c ≥6.5% (p = 0.002 and p = 0.004, respectively). The greater reductions in minimum luminal diameter and average luminal diameter in the higher HbA1c strata were only in patients with known DM. More new lesions, however, appeared with baseline HbA1c ≥5.7%, irrespective of a history of DM. In conclusion, the relation between DM and the progression of coronary narrowing in postmenopausal women is complex. Clinically apparent DM, not elevated HbA1c alone, appears to promote the progression of established coronary lesions even in HbA1c ranges diagnostic of pre-DM and DM. This raises the possibility that coronary narrowing of existing stenosis in women with DM may be due to negative remodeling, a complex process that might be less dependent on hyperglycemia than new lesion formation.
This study investigates the role of educative mentors as two novices learn to teach, following them from their yearlong student teaching (2015-2016) through their first-year teaching (2016-2017). ...During student teaching, each novice was paired with a mentor teacher who received preparation and support to engage in educative mentoring practices. This study analyzes evidence from multiple data sources collected over 2 years to understand what novices take up from their student-teaching mentors and take with them into their first-year teaching. Findings illustrate that the activities of mentoring matter in the learning to teach process of novices, particularly related to the way novices are able to focus their planning, instruction, and reflection around pupil thinking and understanding.
Patients with severe aortic stenosis and no obstructed coronary arteries are reported to have reduced coronary flow. Doppler evaluation of proximal coronary flow is feasible using transesophageal ...echocardiography. The present study aimed to assess the change in coronary flow in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). The left main coronary artery was visualized using transesophageal echocardiography in 90 patients undergoing TAVI using the Edwards SAPIEN valve. The peak systolic and diastolic velocities of the coronary flow and the time-velocity integral were obtained before and after TAVI using pulse-wave Doppler. Mean aortic gradients decreased from 47.1 ± 15.7 mm Hg before TAVI to 3.6 ± 2.6 mm Hg after TAVI (p <0.001). The aortic valve area increased from 0.58 ± 0.17 to 1.99 ± 0.35 cm2 (p <0.001). The cardiac output increased from 3.4 ± 1.1 to 3.8 ± 1.0 L/min (p <0.001). Left ventricular end-diastolic pressure (LVEDP) decreased from 19.8 ± 5.4 to 17.3 ± 4.1 mm Hg (p <0.001). The following coronary flow parameters increased significantly after TAVI: peak systolic velocity 24.2 ± 9.3 to 30.5 ± 14.9 cm/s (p <0.001), peak diastolic velocity 49.8 ± 16.9 to 53.7 ± 22.3 cm/s (p = 0.04), total velocity-time integral 26.7 ± 10.5 to 29.7 ± 14.1 cm (p = 0.002), and systolic velocity-time integral 6.1 ± 3.7 to 7.7 ± 5.0 cm (p = 0.001). Diastolic time-velocity integral increased from 20.6 ± 8.7 to 22.0 ± 10.1 cm (p = 0.04). Total velocity-time integral increased >10% in 43 patients (47.2%). Pearson's correlation coefficient revealed the change in LVEDP as the best correlate of change in coronary flow (R = −0.41, p = 0.003). In conclusion, TAVI resulted in a significant increase in coronary flow. The change in coronary flow was associated mostly with a decrease in LVEDP.
Stent thrombosis (ST) is a major safety concern after drug-eluting stent (DES) deployment, resulting in significant morbidity and mortality. The goal of this study was to examine the incidence, ...timing, clinical correlates, and outcomes after DES thrombosis in a real-world population. A retrospective analysis of 8,402 patients who underwent percutaneous coronary intervention and received a DES was performed. After DES implantation, 84 definite (DST) and 127 probable ST events occurred. The incidence of early DST was 0.8%, late DST was 0.4%, and very late DST was 0.4%. Multivariate analysis showed that a history of diabetes mellitus, myocardial infarction during admission, number of stents, and DES placement in a restenotic lesion were independently associated with DST. The incidence of early definite or probable ST (DPST) was 1.9%, late DPST was 1.4%, and very late DPST was 0.7%. Multivariate analysis showed that a history of diabetes, myocardial infarction during admission, cardiogenic shock, number of stents, and DES use in a restenotic lesion were independently associated with DPST. Both types of ST were associated with significantly higher rates of all-cause death, Q-wave myocardial infarction, and revascularization up to 24 months after DES implantation. In conclusion, ST after DES implantation in contemporary practice continues to occur from 30 days to 2 years at a rate ≥0.36%/year and is associated with high rates of morbidity and mortality. Diabetes mellitus, myocardial infarction, and DES use in a restenotic lesion were strongly associated with DST; therefore, careful consideration should apply when deploying a DES in these populations.
We have analyzed the incidence, management, and outcome of 84 cases of coronary artery perforation in patients who underwent percutaneous coronary intervention at our institution. This complication ...was more frequent in female patients and in patients who underwent lesion modification with atheroablative devices. A total of 8 patients (9.5%) died after the procedure. They were usually older and had a higher incidence of cardiac tamponade; a larger percentage of these patients underwent emergency surgery than those who survived.
Postoperative atrial fibrillation (AF) frequently complicates coronary artery bypass grafting (CABG) operations. As the frequency of obesity has increased in the United States, the number of obese ...patients undergoing CABG has kept pace. This study sought to define the association between body mass index (BMI) and postoperative AF.
We studied 12,367 consecutive patients with no history of AF who underwent isolated CABG operations. BMI was stratified according to Centers for Disease Control and Prevention criteria, and differences in baseline clinical and operative characteristics were adjusted through multivariate logistic regression models.
The unadjusted incidence of new-onset postoperative AF demonstrated a U-shape with regard to BMI. The highest incidence (34%) was found in the "lean" stratum (BMI<18.5 kg/m2), followed by 32% in the "severely obese" (BMI≥40 kg/m2) stratum. Lower incidences were found in the "normal" stratum (30%), in the "obese" stratum (28%), and the lowest incidence (26%) was in the overweight stratum. Observed incidence was 50% greater than the expected incidence in the "severely obese" stratum (32% vs 21%). In multivariate regression analysis adjusted for age and other covariates, BMI remains a strong risk factor for new-onset postoperative AF. Compared with normal BMI, obesity (odds ratio, 1.24; 95% confidence interval, 1.08 to 1.42) and severe obesity (odds ratio, 2.00; 95% confidence interval, 1.54 to 2.57) both emerged as strong risk factors for postoperative AF. No association was found between a lean BMI and postoperative AF (odds ratio, 1.14; 95% confidence interval, 0.66 to 1.98).
After adjusting for potential confounders, obesity, as reflected by the body mass index, remains an independent predictor of postoperative AF.
Left ventricular systolic dysfunction in patients with severe aortic stenosis (AS) is associated with poor outcome. This analysis was designed primarily to describe the clinical course of a large ...series of consecutive patients with severe AS and low ejection fraction (EF) (<40%) who, because of high surgical risk, were referred for transcatheter aortic valve implantation consideration. A cohort of 270 patients with severe AS and low EF (<40%) who were referred to participate in a clinical trial of transcatheter aortic valve implantation was studied. Clinical, hemodynamic, and periprocedural complications and follow-up mortality data were collected and compared between patients with low mean transvalvular gradients (≤40 mm Hg, n = 170 63%) and high transvalvular gradients (>40 mm Hg, n = 100 37%). Patients with low gradients were younger (mean age 79.8 ± 9.1 vs 83.8 ± 7.7 years, p <0.001) and had higher incidences of coronary artery disease and renal failure. Mean aortic valve area was larger (0.73 ± 0.23 vs 0.53 ± 0.18 cm2 , p <0.001), while mean EF (26.4 ± 6.9% vs 30.5% ± 6.6%, p <0.001), cardiac output (3.7 ± 1.1 vs 4.1 ± 1.3 L/min, p = 0.04), and cardiac index (1.9 ± 0.5 vs 2.1 ± 0.6 L/min/m2 , p = 0.04) were lower in patients with lower gradients compared to those with higher gradients, respectively. Mortality was higher in patients with low gradients (53.8%) at a mean follow-up of 151 days compared to those with high gradients (41%) at a mean follow-up of 256 days (p = 0.01). In conclusion, patients with severe AS and low EF with low transvalvular gradients are at higher risk for worse outcomes compared to patients with high transvalvular gradients. Surgery or transcatheter aortic valve implantation treatment and high baseline transvalvular gradient are associated with EF improvement.
Performance of percutaneous coronary intervention (PCI) at centers without cardiothoracic surgery is a contentious issue. Although this practice allows greater access to care, there are safety ...concerns. The aim was to assess the requirement for emergent coronary artery bypass grafting (CABG) after PCI and characterize patients at highest risk using independent predictors. The study population consisted of 21,957 unselected patients who underwent PCI from August 1994 (Food and Drug Administration stent approval) to January 2008 at a single medical center. Patients requiring emergent CABG (defined as within 24 hours of the index procedure) were identified. Logistic regression analysis was performed to assess for independent correlates of emergent CABG. Emergent CABG was required in 90 patients (cumulative incidence 0.41%). Indications for CABG included triple-vessel disease, dissection, acute closure, perforation, and failure to cross. These patients had significantly higher in-hospital cardiac death rates (7.8% vs 0.7%; p <0.01) and higher rates of Q-wave myocardial infarction, neurologic events, and renal insufficiency. Independent correlates of emergent CABG after PCI were acute ST-segment elevation myocardial infarction presentation, cardiogenic shock, triple-vessel disease, and type C lesion. Risk assessment based on these predictors identified 0.3% of the patient population to have a 9.3% cumulative incidence of emergent CABG. In conclusion, the need for emergent CABG after PCI in the stent era was low and was associated with poor in-hospital outcomes. Risk was nonuniform, with 0.3% of the study population, characterized by acute presentation and complex coronary disease, at heightened risk of emergent surgery.
