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Impact of obesity on post-operative arrhythmias after congenital heart surgery in children and young adults
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- Andrew E. Radbill, Andrew H. Smith, Sara L. Van Driest, Frank A. Fish, David P. Bichell, Bret A. Mettler, Karla G. Christian, Todd L. Edwards, Prince J. Kannankeril
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- Journal:
- Cardiology in the Young / Volume 32 / Issue 11 / November 2022
- Published online by Cambridge University Press:
- 06 January 2022, pp. 1820-1825
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Background:
Obesity increases the risk of post-operative arrhythmias in adults undergoing cardiac surgery, but little is known regarding the impact of obesity on post-operative arrhythmias after CHD surgery.
Methods:Patients undergoing CHD surgery from 2007 to 2019 were prospectively enrolled in the parent study. Telemetry was assessed daily, with documentation of all arrhythmias. Patients aged 2–20 years were categorised by body mass index percentile for age and sex (underweight <5, normal 5–85, overweight 85–95, and obese >95). Patients aged >20 years were categorised using absolute body mass index. We investigated the impact of body mass index category on arrhythmias using univariate and multivariate analysis.
Results:There were 1250 operative cases: 12% underweight, 65% normal weight, 12% overweight, and 11% obese. Post-operative arrhythmias were observed in 38%. Body mass index was significantly higher in those with arrhythmias (18.8 versus 17.8, p = 0.003). There was a linear relationship between body mass index category and incidence of arrhythmias: underweight 33%, normal 38%, overweight 42%, and obese 45% (p = 0.017 for trend). In multivariate analysis, body mass index category was independently associated with post-operative arrhythmias (p = 0.021), with odds ratio 1.64 in obese patients as compared to normal-weight patients (p = 0.036). In addition, aortic cross-clamp time (OR 1.007, p = 0.002) and maximal vasoactive–inotropic score in the first 48 hours (OR 1.03, p = 0.04) were associated with post-operative arrhythmias.
Conclusion:Body mass index is independently associated with incidence of post-operative arrhythmias in children after CHD surgery.
3292 Duke Integrated Physician-Scientist Development
- Stephanie A. Freel, Michael Gunn, Andrew Alspaugh, Gowthami Arepally, Gerard Blobe, Jillian Hurst, Maria Price-Rapoza, Ashley Grantham, Laura J. Fish, Rasheed Gbadagesin, Sallie Permar
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- Journal:
- Journal of Clinical and Translational Science / Volume 3 / Issue s1 / March 2019
- Published online by Cambridge University Press:
- 26 March 2019, pp. 67-68
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OBJECTIVES/SPECIFIC AIMS: 1.Identify barriers to pursuing research for physician trainees 2.Develop a sustainable pipeline of physician-scientists at Duke 3.Coordinate physician-scientist development programs across the School of Medicine under one central Office 4.Provide infrastructure and resources for all physician-scientists 5.Increase the number of MDs and MD/PhDs who pursue, succeed, and are retained in research METHODS/STUDY POPULATION: To establish a baseline understanding of the needs and concerns of physician-scientist trainees at Duke, we conducted focus groups using a standardized interview guide and thematic analysis. Findings from these focus groups were used to develop a framework for support, leading to the creation of the Office of Physician-Scientist Development (OPSD) housed centrally within the Duke School of Medicine. The OPSD integrates programs and resources for multiple populations including medical students, residents, fellows, junior faculty, and faculty mentors. Pipeline programs will also be developed to enhance research engagement in targeted student populations prior to medical school. RESULTS/ANTICIPATED RESULTS: A total of 45 students and faculty participated in the focus groups and structured interviews (1st year medical student, n=11; 4th year medical students, n=11; residents/fellows, n=13; junior faculty, n=11). While participants raised a number of specific issues, one key message emerged: non-PhD MDs in basic research felt they lacked opportunities for directed training. Moreover, they felt the need to teach themselves many critical skills through trial and error. This has led to perceptions that they cannot compete effectively with PhDs and MD-PhD scientists for research funding and positions. Consensus recommendations included: better guidance in choosing mentors, labs, and projects; central resource for information relevant to physician scientists; training specifically tailored to physician scientists conducting laboratory-based research; improved infrastructure and well-defined training pathways; and assistance with grant preparation. To-date, over 90 students, residents, and fellows have been identified who identify as laboratory-based physician scientists. Additional efforts are underway to identify and characterize the broader range of physician-scientist students and trainees at Duke. DISCUSSION/SIGNIFICANCE OF IMPACT: Our planning study revealed specific steps forward toward developing a robust community of physician-scientists at Duke. As a first step, the Dean of the School of Medicine has appointed an Associate Dean of Physician-Scientist Development to oversee a new Office of Physician-Scientist Development (OPSD) being launched in December of 2018. The OPSD will offer four primary programs. 1) A concierge mentoring program will assist new trainees in identifying research areas of interest and mentors. Trainees will receive periodic contact to provide additional support as needed and promote success. 2) A physician-scientist training program is being created to provide training specific to laboratory research skills as well as career and professional development training to complement existing clinical and translational research programs. 3) Integrated training pathways will provide additional mentored research training for those pursuing research careers. Pathways will capitalize on existing resources from R38 programs, while pursuing additional R38 and R25 support. 4) An MD-Scientist funding program has been developed to provide additional research funding and protected time for students pursuing a second research year. Through the support and programming offered by the OPSD, we anticipate decreased perceptions of barriers to pursuing a physician-scientist career and increased satisfaction with training opportunities. Over time, we expect such support to increase the number of MD students pursuing research as a career and the number of residents, fellows, and MD junior faculty remaining in research careers.
17 - Cultural ecosystem services, water, and aquatic environments
- from Part IV - Broadening the perspective
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- By Andrew Church, University of Brighton, Rob Fish, University of Kent, Neil Ravenscroft, University of Brighton, Lee Stapleton, University of Sussex
- Edited by Julia Martin-Ortega, Robert C. Ferrier, Iain J. Gordon, Shahbaz Khan, United Nations Educational, Scientific and Cultural Organization (UNESCO), France
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- Book:
- Water Ecosystem Services
- Published online:
- 05 May 2015
- Print publication:
- 26 March 2015, pp 148-155
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Summary
17.1 INTRODUCTION
Cultural ecosystem services have proved a highly challenging area for undertaking ecosystem assessments and developing ecosystem services-based approaches that can be incorporated within decision-making. Cultural ecosystem services are clearly core to understanding how ecosystems relate to human well-being since they focus on the cultural and social processes by which humans and the non-human interact. This involves activities, such as recreation, and spaces, such as parks and gardens, that are at the centre of everyday life. The problematic dimension of cultural ecosystem services is that it brings the longstanding philosophical and social theory debates over the meaning of culture into an approach to understanding the natural environment that has largely emerged out of natural science and economics. Ecosystem services-based approaches encourage classification and measurement which is often highly problematic when considering cultural entities and practices that resist simple definitions. Furthermore, the cultural aspects of ecosystems are not just confined to cultural ecosystem services. For example, Holmlund and Hammer (1999) discuss food production as a cultural service, whereas the Millennium Ecosystem Assessment (2005) would define food as a provisioning service. As Fish (2011, pp.674–675) notes, it ‘is probably more accurate to think of “culture” less as a separate “box” within the services typology […]. In what sense, for instance, is the provision of “food” not also a cultural ecosystem service?’
The same arguments can be applied to water in that how water is treated and ‘mis-treated’ in any society will to a significant degree be influenced by cultural attitudes. There is a large literature on the cultural significance of water which highlights how different societies currently and historically have understood the significance of water and attached distinct political, cultural, and social meanings to water (Toussaint 2006). Strang (2006) argues that it is also important to recognise the crosscultural ‘flows’ relating to water and points out that in Western society and for some Australian Aboriginal peoples immersion in water can be a highly significant spiritual act.
Contributors
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- By Iftikhar Ahmed, Chris Allen, Sani H. Aliyu, Pawel Bogucki, Darshan H. Brahmbhatt, Ewen Cameron, Peter M. F. Campbell, Jane Chalmers, Wendy Chamberlain, Tony Coll, Gareth Corbett, Julia Czuprynska, Carla Davies, Mark Dayer, Edward Fathers, Mark Fish MD MRCP, Zoë Fritz MA MRCP, Jonathan Fuld, Luke Gompels, Daniel E. Greaves, Emma Greig, Stephen Haydock, Matthew R. Hayman, Jonathan Hills, John Kalk, Catherine Laversuch, Cliff Mann, Deepak Mannari, Rudi Matull, Marko Nikolić, Marguerite Paffard, Kate R. Petheram, Lucy Pollock, Kobus Preller, Christopher J. S. Price, Peter J. Pugh, Charlotte Rutter, Gillian Sims, Robert A. Stone, David Tate, Paul D. Thomas, Satish Thomas William, Andrew Thompson, Marianne Tinkler, Gareth Walker, Stuart Walker, Nic Wenninke, Christopher Westall, Duncan Whitehead, Rob Whiting, Penny Williams, Cally Williamson, Mohamed Yousuf
- Edited by Stephen Haydock, Duncan Whitehead, Zoë Fritz
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- Book:
- Acute Medicine
- Published online:
- 05 November 2014
- Print publication:
- 30 October 2014, pp viii-x
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Equivalences in Euler-based diagram systems through normal forms
- Part of
- Andrew Fish, John Taylor
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- Journal:
- LMS Journal of Computation and Mathematics / Volume 17 / Issue 1 / 2014
- Published online by Cambridge University Press:
- 01 September 2014, pp. 431-484
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The form of information presented can influence its utility for the conveying of knowledge by affecting an interpreter’s ability to reason with the information. There are distinct types of representational systems (for example, symbolic versus diagrammatic logics), various sub-systems (for example, propositional versus predicate logics), and even within a single representational system there may be different means of expressing the same piece of information content. Thus, to display information, choices must be made between its different representations, depending upon many factors such as: the context, the reasoning tasks to be considered, user preferences or desires (for example, for short symbolic sentences or minimal clutter within diagrammatic systems). The identification of all equivalent representations with the same information content is a sensible precursor to attempts to minimise a metric over this class. We posit that defining notions of semantic redundancy and identifying the syntactic properties that encapsulate redundancy can help in achieving the goal of completely identifying equivalences within a single notational system or across multiple systems, but that care must be taken when extending systems, since refinements of redundancy conditions may be necessary even for conservative system extensions. We demonstrate this theory within two diagrammatic systems, which are Euler-diagram-based notations. Such notations can be used to represent logical information and have applications including visualisation of database queries, social network visualisation, statistical data visualisation, and as the basis of more expressive diagrammatic logics such as constraint languages used in software specification and reasoning. The development of the new associated machinery and concepts required is important in its own right since it increases the growing body of knowledge on diagrammatic logics. In particular, we consider Euler diagrams with shading, and then we conservatively extend the system to include projections, which allow for a much greater degree of flexibility of representation. We give syntactic properties that encapsulate semantic equivalence in both systems, whilst observing that the same semantic concept of redundancy is significantly more difficult to realise as syntactic properties in the extended system with projections.
An Outbreak Due to Multiresistant Acinetobacter baumannii in a Burn Unit: Risk Factors for Acquisition and Management
- Andrew E. Simor, Mark Lee, Mary Vearncombe, Linda Jones-Paul, Clare Barry, Manuel Gomez, Joel S. Fish, Robert C. Cartotto, Robert Palmer, Marie Louie
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 23 / Issue 5 / May 2002
- Published online by Cambridge University Press:
- 02 January 2015, pp. 261-267
- Print publication:
- May 2002
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Objectives:
To describe the investigation and management of an outbreak due to multiresistant Acinetobacter baumannii and to determine risk factors for acquisition of the organism.
Setting:A 14-bed regional burn unit in a Canadian tertiary-care teaching hospital.
Design:Case-control study with multivariate analysis of potential risk factors using logistic regression analysis. Surveillance cultures were obtained from the hospital environment, from noninfected patients, and from healthcare providers.
Results:A total of 31 (13%) of 247 patients with acute burn injuries acquired multiresistant A. baumannii between December 1998 and March 2000; 18 (58%) of the patients were infected. The organism was recovered from the hospital environment and the hands of healthcare providers. Significant risk factors for acquisition of multiresistant A. baumannii were receipt of blood products (odds ratio [OR], 10.8; 95% confidence interval [CI95], 3.4 to 34.4; P < .001); procedures performed in the hydrotherapy room (OR, 4.1; CI95, 1.3 to 13.1; P = .02); and increased duration of mechanical ventilation (OR, 1.1 per day; CI95, 1.0 to 1.1; P=. 02).
Interventions:Improved compliance with hand hygiene, strict patient isolation, meticulous environmental cleaning, and temporary closure of the unit to new admissions.
Conclusions:Acquisition of multiresistant A. baumannii was likely multifactorial, related to environmental contamination and contact with transiently colonized healthcare providers. Control measures addressing these potential sources of multiresistant A. baumannii were successful in terminating the outbreak. Ongoing surveillance and continued attention to hand hygiene and adequate environmental cleaning are essential to prevent recurrent outbreaks due to antibiotic-resistant bacteria in burn units.