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Outcomes after initial heart failure consultation in Fontan patients
- Sharon Chen, Muhammad F. Shezad, Angela Lorts, Amanda D. McCormick, Chad Y. Mao, Kathleen E. Simpson, Matthew J. O’Connor, Aliessa Barnes, Adam M. Lubert, Chesney Castleberry, Julie Schmidt, Katie Schroeder, Anna Joong, David W. Bearl, Ashwin K. Lal, Deepa Mokshagundam, Jennifer Conway, Ari Cedars, Kurt R. Schumacher
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- Journal:
- Cardiology in the Young , First View
- Published online by Cambridge University Press:
- 28 November 2023, pp. 1-8
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Background:
Patients with Fontan failure are high-risk candidates for heart transplantation and other advanced therapies. Understanding the outcomes following initial heart failure consultation can help define appropriate timing of referral for advanced heart failure care.
Methods:This is a survey study of heart failure providers seeing any Fontan patient for initial heart failure care. Part 1 of the survey captured data on clinical characteristics at the time of heart failure consultation, and Part 2, completed 30 days later, captured outcomes (death, transplant evaluation outcome, and other interventions). Patients were classified as “too late” (death or declined for transplant due to being too sick) and/or “care escalation” (ventricular assist device implanted, inotrope initiated, and/or listed for transplant), within 30 days. “Late referral” was defined as those referred too late and/or had care escalation.
Results:Between 7/2020 and 7/2022, 77 Fontan patients (52% inpatient) had an initial heart failure consultation. Ten per cent were referred too late (6 were too sick for heart transplantation with one subsequent death, and two others died without heart transplantation evaluation, within 30 days), and 36% had care escalation (21 listed ± 5 ventricular assist device implanted ± 6 inotrope initiated). Overall, 42% were late referrals. Heart failure consultation < 1 year after Fontan surgery was strongly associated with late referral (OR 6.2, 95% CI 1.8–21.5, p=0.004).
Conclusions:Over 40% of Fontan patients seen for an initial heart failure consultation were late referrals, with 10% dying or being declined for transplant within a month of consultation. Earlier referral, particularly for those with heart failure soon after Fontan surgery, should be encouraged.
Managing Herbicide Resistance: Listening to the Perspectives of Practitioners. Procedures for Conducting Listening Sessions and an Evaluation of the Process
- Jill Schroeder, Michael Barrett, David R. Shaw, Amy B. Asmus, Harold Coble, David Ervin, Raymond A. Jussaume, Jr., Micheal D. K. Owen, Ian Burke, Cody F. Creech, A. Stanley Culpepper, William S. Curran, Darrin M. Dodds, Todd A. Gaines, Jeffrey L. Gunsolus, Bradley D. Hanson, Prashant Jha, Annie E. Klodd, Andrew R. Kniss, Ramon G. Leon, Sandra McDonald, Don W. Morishita, Brian J. Schutte, Christy L. Sprague, Phillip W. Stahlman, Larry E. Steckel, Mark J. VanGessel
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- Journal:
- Weed Technology / Volume 32 / Issue 4 / August 2018
- Published online by Cambridge University Press:
- 09 August 2018, pp. 489-497
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Seven half-day regional listening sessions were held between December 2016 and April 2017 with groups of diverse stakeholders on the issues and potential solutions for herbicide-resistance management. The objective of the listening sessions was to connect with stakeholders and hear their challenges and recommendations for addressing herbicide resistance. The coordinating team hired Strategic Conservation Solutions, LLC, to facilitate all the sessions. They and the coordinating team used in-person meetings, teleconferences, and email to communicate and coordinate the activities leading up to each regional listening session. The agenda was the same across all sessions and included small-group discussions followed by reporting to the full group for discussion. The planning process was the same across all the sessions, although the selection of venue, time of day, and stakeholder participants differed to accommodate the differences among regions. The listening-session format required a great deal of work and flexibility on the part of the coordinating team and regional coordinators. Overall, the participant evaluations from the sessions were positive, with participants expressing appreciation that they were asked for their thoughts on the subject of herbicide resistance. This paper details the methods and processes used to conduct these regional listening sessions and provides an assessment of the strengths and limitations of those processes.
Managing Wicked Herbicide-Resistance: Lessons from the Field
- Jill Schroeder, Michael Barrett, David R. Shaw, Amy B. Asmus, Harold Coble, David Ervin, Raymond A. Jussaume, Jr., Micheal D. K. Owen, Ian Burke, Cody F. Creech, A. Stanley Culpepper, William S. Curran, Darrin M. Dodds, Todd A. Gaines, Jeffrey L. Gunsolus, Bradley D. Hanson, Prashant Jha, Annie E. Klodd, Andrew R. Kniss, Ramon G. Leon, Sandra McDonald, Don W. Morishita, Brian J. Schutte, Christy L. Sprague, Phillip W. Stahlman, Larry E. Steckel, Mark J. VanGessel
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- Journal:
- Weed Technology / Volume 32 / Issue 4 / August 2018
- Published online by Cambridge University Press:
- 09 August 2018, pp. 475-488
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Herbicide resistance is ‘wicked’ in nature; therefore, results of the many educational efforts to encourage diversification of weed control practices in the United States have been mixed. It is clear that we do not sufficiently understand the totality of the grassroots obstacles, concerns, challenges, and specific solutions needed for varied crop production systems. Weed management issues and solutions vary with such variables as management styles, regions, cropping systems, and available or affordable technologies. Therefore, to help the weed science community better understand the needs and ideas of those directly dealing with herbicide resistance, seven half-day regional listening sessions were held across the United States between December 2016 and April 2017 with groups of diverse stakeholders on the issues and potential solutions for herbicide resistance management. The major goals of the sessions were to gain an understanding of stakeholders and their goals and concerns related to herbicide resistance management, to become familiar with regional differences, and to identify decision maker needs to address herbicide resistance. The messages shared by listening-session participants could be summarized by six themes: we need new herbicides; there is no need for more regulation; there is a need for more education, especially for others who were not present; diversity is hard; the agricultural economy makes it difficult to make changes; and we are aware of herbicide resistance but are managing it. The authors concluded that more work is needed to bring a community-wide, interdisciplinary approach to understanding the complexity of managing weeds within the context of the whole farm operation and for communicating the need to address herbicide resistance.
Contributors
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- By Luis G. Acevedo, Schahram Akbarian, Ioanna Andreou, Krishnarao Appasani, Raghu K. Appasani, Julia Arand, David M. Ashley, Alexander R. Ball, Yehudit Bergman, Marina Bibikova, Angela Bithell, Francesca Bonafè, Eric E. Bouhassira, Victoria L. Boyd, Noel J. Buckley, Lars Olov Bygren, Claudio M. Caldarera, Gemma Carvill, James W. F. Catto, Sarah Derks, Ewa Dudziec, Jeffrey D. Falk, Jian-Bing Fan, Joseph M. Fernandez, David E. Fisher, Emanuela Fiumana, Tamara B. Franklin, Fei Gao, Arkadiusz Gertych, Emanuele Giordano, David Goldman, Markus Grammel, Carlo Guarnieri, Kevin L. Gunderson, Victoria (Fatemeh) G. Haghighi, Xu Han, Yong-Mahn Han, Howard C. Hang, Aditi Hazra, Laura B.K. Herzing, Norbert Hochstein, Robin Holliday, Dorothee Honsel, Mary A. Jelinek, Guanyu Ji, Yan Jiang, Atsushi Kaneda, Richard A. Katz, Hyemin Kim, Richard Kroon, Tapas K. Kundu, Benoit Labonté, Daeyoup Lee, Konstantin Lepikhov, Andrea Linnemann-Florl, Dirk Loeffert, Dylan Maixner, Isabelle M. Mansuy, Andreas Missel, D. V. Mohankrishna, Joana Carvalho Moreira de Mello, Paolo G. Morselli, Rituparna Mukhopadhyay, Claudio Muscari, Takashi Nagano, Frank Narz, Shuji Ogino, Carlo M. Oranges, Shari Orlanski, Alice Pasini, Ralf Peist, Lygia V. Pereira, Andrey Poleshko, Claire Rougeulle, Thea Rütjes, Ana Sanz, Benjamin G. Schroeder, Gerald Schock, Kornel Schuebel, B. Ruthrotha Selvi, Hogyu Seo, Natalia Shalginskikh, Andrew Sharp, Jun S. Song, Lennart Suckau, Azim Surani, Jian Tajbakhsh, Gustavo Turecki, Céline Vallot, Manon van Engeland, Jörn Walter, Nicholas C. Wong, Mark Wossidlo, Honglong Wu, Yurong Xin, Zhixiang Yan, Yu-Ying Yang, Mingzhi Ye, Kyoko Yokomori, Sephorah Zaman, Weihua Zeng, Gerald Zon
- Edited by Krishnarao Appasani
- Foreword by Azim Surani, University of Cambridge
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- Book:
- Epigenomics
- Published online:
- 05 August 2012
- Print publication:
- 02 August 2012, pp x-xxiv
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Wear Evaluation of Ultra High Molecular Weight Polyethylene Using Pin-On-Flat and Hip Simulation Techniques
- David W. Schroeder, Joel C. Higgins
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- Journal:
- MRS Online Proceedings Library Archive / Volume 394 / 1995
- Published online by Cambridge University Press:
- 21 February 2011, 35
- Print publication:
- 1995
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Reduction of wear and wear debris is one of the most important areas of research presently in the field of orthopedic devices. It is speculated that wear debris is one of the contributing factors in the cascade of events that lead to osteolysis. In this regard it is very important to be able to evaluate in vitro the wear of UHMWPE produced by various manufacturing methods. Presently the three most common methods of wear testing are: pin-on-flat, pin-on-disk, and hip simulator.
Wear evaluation was performed on gamma irradiated UHMWPE that was manufactured by three different processes: extrusion, direct compression molding, and isostatic compression molding. The wear evaluation consisted of pin-on-flat and hip simulator testing.
omparison of the results from these two different types of tests show that the two tests would rank the wear resistance of the UHMWPE in the same order. However, there is a variation in the difference of the wear rates between the two tests. The pin-on-flat results show that the direct and isostatic compression molded material had approximately 50% less wear than the extruded material whereas the hip simulator results show that the isostatic compression molded material had 16% less wear than the extruded material. The difference in the results of these two tests are the effects of a combination of factors including the mechanical and material properties of the UHN4WPE, modes of wear that are active, the state of stress (constant vs. cyclic) in the specimens, third body contamination of the lubricant, bacterial degradation of the bovine serum lubricant, etc. Both tests are very important and necessary in the evaluation of wear of orthopedic materials.
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