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Feeding outcomes after paediatric cardiothoracic surgery: a retrospective review
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- Robert Hill, Ching S. Tey, Calvin Jung, Robert Monfort, Brian Pettitt-Schieber, William Vaughn, Campbell Hathaway, Subhadra Shashidharan, William Sharp, Martha Wetzel, Nikhila Raol
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- Journal:
- Cardiology in the Young / Volume 31 / Issue 4 / April 2021
- Published online by Cambridge University Press:
- 07 January 2021, pp. 673-681
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Background:
Feeding difficulty is a known complication of congenital heart surgery. Despite this, there is a relative sparsity in the available data regarding risk factors, incidence, associated symptoms, and outcomes.
Methods:In this retrospective chart review, patients aged 0–18 years who underwent congenital heart surgery at a single institution between January and December, 2017 were reviewed. Patients with feeding difficulties before surgery, multiple surgeries, and potentially abnormal recurrent laryngeal nerve anatomy were excluded. Data collected included patient demographics, feeding outcomes, post-operative symptoms, flexible nasolaryngoscopy findings, and rates of readmission within a 1-year follow-up period. Multivariable regression analyses were performed to evaluate the risk of an alternative feeding plan at discharge and length of stay.
Results:Three-hundred and twenty-six patients met the inclusion criteria for this study. Seventy-two (22.09%) were discharged with a feeding tube and 70 (97.22%) of this subgroup were younger than 12 months at the time of surgery. Variables that increased the risk of being discharged with a feeding tube included patient age, The Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery score, procedure group, aspiration, and reflux. Speech-language pathology was the most frequently utilised consulting service for patients discharged with feeding tubes (90.28%) while other services were not frequently consulted. The median length of stay was increased from 4 to 10 days for patients who required an enteral feeding tube at discharge.
Discussion:Multidisciplinary management protocol and interventions should be developed and standardised to improve feeding outcomes following congenital heart surgery.
Characterizing the inpatient care of young adults experiencing early psychosis
- R. Kamieniecki, B. Vaughn, J. Danielson, K. Bonnie, M. Carter, T. Mihic, S. Williams, J. Puyat
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S380
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Introduction/objectives
The available literature suggests that treatments and health services for psychosis are considered to be poorly organized and highly variable. Little is known, however, about how inpatient care is provided to individuals experiencing early psychosis. To facilitate quality improvement activities, we characterized the care this patient group receives in an inner city hospital.
MethodsWe performed chart reviews of individuals admitted to psychiatric inpatient units at St. Paul's Hospital, Vancouver, British Columbia between 01/04/2014 and 31/03/2016. Those who were 17–25 years of age and hospitalized for psychotic symptoms at the time of admission were included. Demographic and health service use were summarized using descriptive characteristics.
ResultsWe identified 73 inpatients (mean age = 22; males = 78%; Caucasian = 41%) that met study inclusion criteria, having a combined total of 102 care episodes and an average length of stay of 30.7 days (median = 18; min = 3; max = 268). Half of the care episodes were repeat admissions, with up to 30% of the patients readmitted within 28 days of discharge. Physical and mental status examinations (MSE) were performed in virtually all care episodes, although frequency is low (31.4% had daily physical examinations and 18.6% had MSE every nursing shift). In 49% and 50% of care episodes, patients were given oral antipsychotics and discharged on depot medications. Even when indicated, not all care episodes had follow-up appointments (60%) or referrals to income assistance (35%), community mental health teams (61%), and housing support (38%).
ConclusionsSpecific programs are needed to address current gaps in inpatient care for patients with early psychosis.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
2215 The value of storytelling in community stakeholder feedback for clinical and translational research
- Laurie L. Novak, Sheba George, Kenneth Wallston, Yolanda Vaughn, Tiffany Israel, Yvonne Joosten, Neely Williams, Consuelo Wilkins, Al Richmond
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- Journal:
- Journal of Clinical and Translational Science / Volume 2 / Issue S1 / June 2018
- Published online by Cambridge University Press:
- 21 November 2018, p. 75
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OBJECTIVES/SPECIFIC AIMS: Community stakeholder engagement along the translational spectrum of biomedical research has been identified as a potentially crucial factor for encouraging participation among underrepresented groups, improving research relevance, and adoption of evidence into practice. Although we have developed various methods to improve communication between researchers and community stakeholders, we have not focused much attention on the manner by which community stakeholders choose to communicate with researchers in scientific feedback settings. In our PCORI funded study using Community Engagement Studios to elicit feedback on research from community stakeholders, we found that feedback from participants was frequently provided in the form of stories. This presentation aims to describe these narratives, examine their function in the feedback process and consider how a focus on these narratives enhances our understanding of community engagement for clinical and translational research. METHODS/STUDY POPULATION: The present study comes from a larger randomized, controlled methodological study. We randomized 20 investigators seeking input on their research to either a Community Engagement Studio (a panel of community members or patients) or a Translational Studio (a panel of researchers). Any faculty member or research trainee at Vanderbilt University or Meharry Medical College was eligible to participate. Each Studio panel was convened to provide project-specific input. The 153 stakeholders who participated in CE Studios were patients, caregivers, or patient advocates identified by health status, health condition, or demographic variables based on the project-based needs of the 20 researchers randomized in this project. Stakeholders include individuals with diabetes, heart failure, Parkinson’s disease, sickle cell disease, and ICU survivors. All stakeholders had experience as a partner or consultant on a research project or through serving on a research advisory board or committee. All Studios were recorded and transcribed, and experienced qualitative researchers analyzed the data. For this paper, we focus on the narrative feedback in the form of stories elicited in the CE Studios. Using qualitative methods, we coded the transcripts from the 20 CE Studios to identify stories and their functions in the feedback. Stories were defined as narratives with (a) at least one actor (b) action that unfolds over time, and (c) a realization, destination, or conflict resolution (i.e., a point of the story). For example, “I refilled my mother’s pillbox on Sunday and on Friday I found the pillbox still completely full” would be a story, however, “my mother doesn’t take her meds correctly” would not. We coded the stories for how they facilitated communication in the Studio using an open-coding style, that is we did not apply a specific theoretical framework of interaction or communication. It was possible for any given story to have more than one code applied to it; that is they were not classified in a mutually exclusive way. RESULTS/ANTICIPATED RESULTS: We found 5 major functions of stories in the Studios. Basic sender-receiver functions were noted, including responding to queries and seeking mutual understanding. The other functions served to move or add to the conversation, including adding expansion and depth, characterizing abstract concepts, and providing context, with the latter being the most frequent function of stories. Speakers provided context in a wide variety of dimensions, ranging from the context of the body to spatial and institutional contexts. These stories served to help others understand the speakers’ lived experiences. DISCUSSION/SIGNIFICANCE OF IMPACT: We often engage community members in research for their expertise with regards to their lived experiences as patients or community members, and for their experiences of healthcare and social determinants of health in particular community contexts. Yet we may expect them to share their expertise in a manner that is consistent with a scientific, explanatory framing and language. However, we know there is a difference in the way that professional researchers discuss research Versus how community members discuss research. In our PCORI study, we found that our Community Studio participants relied on storytelling as an important means to communicate their lived experiences. Their stories were often key to communicating the complex contexts of their experiences. We focus on examining these narrative practices and their functions in how community members engaged with and provided advice to researchers. This understanding may help us in: (1) Characterizing the contexts, processes, and meanings associated with community stakeholder experiences that are otherwise difficult to access. (2) Identifying community priorities relevant to research that are embedded in community narratives to better align research priorities with community needs and to improve patient outcomes. (3) Collecting insights for improving the design of community engagement activities in research. (4) Harnessing more fully the potential of community engagement in research.
Effects of Trifluralin Metabolites on Goosegrass (Eleusine indica) Root Meristems
- Kevin C. Vaughn, William C. Koskinen
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- Journal:
- Weed Science / Volume 35 / Issue 1 / January 1987
- Published online by Cambridge University Press:
- 12 June 2017, pp. 36-44
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The effects of treatment with twelve metabolites of trifluralin [2,6-dinitro-N,N-dipropyl-4-(trifluoromethyl) benzenamine] on the gross morphology and ultrastructure of trifluralin-susceptible (S) and -resistant (R) biotypes of goosegrass [Eleusine indica (L.) Gaertner. # ELEIN] root meristems were examined. Unlike trifluralin, ten of the twelve metabolites including the major metabolites of trifluralin caused no root tip swelling even at water-saturated concentrations. Two of the minor metabolites, 3-methoxy-2,6-dinitro-N,N-dipropyl-4-(trifluoromethyl)benzenamine (TR-36M) and N-(2,6-dinitro-4-(trifluoromethyl)phenyl)-N-propylpropanamide (TR-40), caused root swelling when applied as a saturated solution. The most effective metabolite, TR-36M, caused root swelling at 10 μM or greater concentrations. Because trifluralin caused swelling of the root tips even at a 0.01 μM concentration, trifluralin is 1000-fold more effective than the most herbicidally active metabolite. Both herbicidally active metabolites are also much less effective than trifluralin at increasing the mitotic index. Structural studies indicate that the two herbicidally active metabolites arrest mitosis at prometaphase due to the loss of spindle microtubules, similar to trifluralin. Cortical microtubules are also affected by the highest concentrations of these two metabolites. A resistant biotype, in which mitosis is unaffected by trifluralin, was unaffected by any of the trifluralin metabolites.
Contributors
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- By Shamsuddin Akhtar, Greg Albert, Sidney Allison, Muhammad Anwar, Haruo Arita, Amanda Barker, Mary Hanna Bekhit, Jeanna Blitz, Tyson Bolinske, David Burbulys, Asokumar Buvanendran, Gregory Cain, Keith A. Candiotti, Daniel B. Carr, Derek Chalmers, John Charney, Rex Cheng, Roger Chou, Keun Sam Chung, Anna Clebone, Frederick Conlin, Susan Dabu-Bondoc, Tiffany Denepitiya-Balicki, Jeanette Derdemezi, Anahat Kaur Dhillon, Ho Dzung, Juan Jose Egas, Stephen M. Eskaros, Zhuang T. Fang, Claudia R. Fernandez Robles, Victor A. Filadora, Ellen Flanagan, Dan Froicu, Allison Gandey, Nehal Gatha, Boris Gelman, Christopher Gharibo, Muhammad K. Ghori, Brian Ginsberg, Michael E. Goldberg, Jeff Gudin, Thomas Halaszynski, Martin Hale, Dorothea Hall, Craig T. Hartrick, Justin Hata, Lars E. Helgeson, Joe C. Hong, Richard W. Hong, Balazs Horvath, Eric S. Hsu, Gabriel Jacobs, Jonathan S. Jahr, Rongjie Jaing, Inderjeet Singh Julka, Zeev N. Kain, Clinton Kakazu, Kianusch Kiai, Mary Keyes, Michael M. Kim, Peter G. Lacouture, Ryan Lanier, Vivian K. Lee, Mark J. Lema, Oscar A. de Leon-Casasola, Imanuel Lerman, Philip Levin, Steven Levin, JinLei Li, Eric C. Lin, Sharon Lin, David A. Lindley, Ana M. Lobo, Marisa Lomanto, Mirjana Lovrincevic, Brenda C. McClain, Tariq Malik, Jure Marijic, Joseph Marino, Laura Mechtler, Alan Miller, Carly Miller, Amit Mirchandani, Sukanya Mitra, Fleurise Montecillo, James M. Moore, Debra E. Morrison, Philip F. Morway, Carsten Nadjat-Haiem, Hamid Nourmand, Dana Oprea, Sunil J. Panchal, Edward J. Park, Kathleen Ji Park, Kellie Park, Parisa Partownavid, Akta Patel, Bijal Patel, Komal D. Patel, Neesa Patel, Swati Patel, Paul M. Peloso, Danielle Perret, Anthony DePlato, Marjorie Podraza Stiegler, Despina Psillides, Mamatha Punjala, Johan Raeder, Siamak Rahman, Aziz M. Razzuk, Maggy G. Riad, Kristin L. Richards, R. Todd Rinnier, Ian W. Rodger, Joseph Rosa, Abraham Rosenbaum, Alireza Sadoughi, Veena Salgar, Leslie Schechter, Michael Seneca, Yasser F. Shaheen, James H. Shull, Elizabeth Sinatra, Raymond S. Sinatra, Neil Singla, Neil Sinha, Denis V. Snegovskikh, Dmitri Souzdalnitski, Julie Sramcik, Zoreh Steffens, Alexander Timchenko, Vadim Tokhner, Marc C. Torjman, Co T. Truong, Nalini Vadivelu, Ashley Vaughn, Anjali Vira, Eugene R. Viscusi, Dajie Wang, Shu-ming Wang, J. Michael Watkins-Pitchford, Steven J. Weisman, Ira Whitten, Bryan S. Williams, Jeremy M. Wong, Thomas Wong, Christopher Wray, Yaw Wu, Anthony T. Yarussi, Laurie Yonemoto, Bita H. Zadeh, Jill Zafar, Martha Zegarra, Keren Ziv
- Edited by Raymond S. Sinatra, Jonathan S. Jahr, University of California, Los Angeles, School of Medicine, J. Michael Watkins-Pitchford
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- Book:
- The Essence of Analgesia and Analgesics
- Published online:
- 06 December 2010
- Print publication:
- 14 October 2010, pp xi-xviii
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- By Hideki Azuma, Susan Mary Benbow, Bettina Heike Bewernick, T. K. Birkenhäger, Hal Blumenfeld, Tom G. Bolwig, Stanley N. Caroff, Sidney S. Chang, Pinhas N. Dannon, Renana Eitan, Alan R. Felthous, Felipe Fregni, Gabor Gazdag, Nataliya Giagou, Mustafa M. Husain, Charles H. Kellner, Barry Alan Kramer, Galit Landshut, James Stuart Lawson, Bernard Lerer, Jerry Lewis, Dongchen Li, Colleen Loo, Michelle Magid, Stephan C. Mann, Limore Maron, W. Vaughn McCall, Shawn M. McClintock, Niall McCrae, Andrew McDonald, Nikolaus Michael, Paul S. Mueller, Alexander I. Nelson, Unnati D. Patel, Kathy Peng, Keith G. Rasmussen, William H. Reid, Joseph M. Rey, Barbara M. Rohland, Marina Odebrecht Rosa, Moacyr Alexandro Rosa, Oded Rosenberg, Peter B. Rosenquist, Thomas E. Schläpfer, Edward Shorter, Pascal Sienaert, Conrad M. Swartz, Kenneth Trevino, Gabor S. Ungvari, Walter W. van den Broek, Garry Walter, Julie A. Williams
- Edited by Conrad M. Swartz
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- Book:
- Electroconvulsive and Neuromodulation Therapies
- Published online:
- 15 July 2009
- Print publication:
- 02 March 2009, pp ix-xiv
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Fluid motion inside a spinning nutating cylinder
- Harold R. Vaughn, William L. Oberkampf, Walter P. Wolfe
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- Journal:
- Journal of Fluid Mechanics / Volume 150 / January 1985
- Published online by Cambridge University Press:
- 20 April 2006, pp. 121-138
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The incompressible three-dimensional Navier–Stokes equations are solved numerically for a fluid-filled cylindrical cannister that is spinning and nutating. The motion of the cannister is characteristic of that experienced by spin-stabilized artillery projectiles. Equations for the internal fluid motion are derived in a non-inertial aeroballistic coordinate system. Steady-state numerical solutions are obtained by an iterative finite-difference procedure. Flow fields and liquid induced moments have been calculated for viscosities in the range of 0.9 × 104−1 × 109 cSt. The nature of the three-dimensional fluid motion inside the cylinder is discussed, and the moments generated by the fluid are explained. The calculated moments generally agree with experimental measurements.