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Advocacy at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery
- Bistra Zheleva, Amy Verstappen, David M. Overman, Farhan Ahmad, Sulafa K.M. Ali, Zohair Y. Al Halees, Joumana Ghandour Atallah, Isabella E. Badhwar, Carissa Baker-Smith, Maria Balestrini, Amy Basken, Jonah S. Bassuk, Lee Benson, Horacio Capelli, Santo Carollo, Devyani Chowdhury, M. Sertaç Çiçek, Mitchell I. Cohen, David S. Cooper, John E. Deanfield, Joseph Dearani, Blanca del Valle, Kathryn M. Dodds, Junbao Du, Frank Edwin, Ekanem Ekure, Nurun Nahar Fatema, Anu Gomanju, Babar Hasan, Lewis Henry, Christopher Hugo-Hamman, Krishna S. Iyer, Marcelo B. Jatene, Kathy J. Jenkins, Tara Karamlou, Tom R. Karl, James K. Kirklin, Christián Kreutzer, Raman Krishna Kumar, Keila N. Lopez, Alexis Palacios Macedo, Bradley S. Marino, Eva M. Marwali, Folkert J. Meijboom, Sandra S. Mattos, Hani Najm, Dan Newlin, William M. Novick, Sir Shakeel A. Qureshi, Budi Rahmat, Robert Raylman, Irfan Levent Saltik, Craig Sable, Nestor Sandoval, Anita Saxena, Emma Scanlan, Gary F. Sholler, Jodi Smith, James D. St Louis, Christo I. Tchervenkov, Koh Ghee Tiong, Vladimiro Vida, Susan Vosloo, Douglas J. “DJ” Weinstein, James L. Wilkinson, Liesl Zuhlke, Jeffrey P. Jacobs
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- Journal:
- Cardiology in the Young / Volume 33 / Issue 8 / August 2023
- Published online by Cambridge University Press:
- 24 August 2023, pp. 1277-1287
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The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS) will be held in Washington DC, USA, from Saturday, 26 August, 2023 to Friday, 1 September, 2023, inclusive. The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery will be the largest and most comprehensive scientific meeting dedicated to paediatric and congenital cardiac care ever held. At the time of the writing of this manuscript, The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery has 5,037 registered attendees (and rising) from 117 countries, a truly diverse and international faculty of over 925 individuals from 89 countries, over 2,000 individual abstracts and poster presenters from 101 countries, and a Best Abstract Competition featuring 153 oral abstracts from 34 countries. For information about the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery, please visit the following website: [www.WCPCCS2023.org]. The purpose of this manuscript is to review the activities related to global health and advocacy that will occur at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery.
Acknowledging the need for urgent change, we wanted to take the opportunity to bring a common voice to the global community and issue the Washington DC WCPCCS Call to Action on Addressing the Global Burden of Pediatric and Congenital Heart Diseases. A copy of this Washington DC WCPCCS Call to Action is provided in the Appendix of this manuscript. This Washington DC WCPCCS Call to Action is an initiative aimed at increasing awareness of the global burden, promoting the development of sustainable care systems, and improving access to high quality and equitable healthcare for children with heart disease as well as adults with congenital heart disease worldwide.
Canadian Stroke Best Practice Recommendations: Secondary Prevention of Stroke Update 2020 – ADDENDUM
- David J. Gladstone, M. Patrice Lindsay, James Douketis, Eric E. Smith, Dar Dowlatshahi, Theodore Wein, Aline Bourgoin, Jafna Cox, John B. Falconer, Brett R. Graham, Marilyn Labrie, Lena McDonald, Jennifer Mandzia, Daniel Ngui, Paul Pageau, Amanda Rodgerson, William Semchuk, Tammy Tebbutt, Carmen Tuchak, Stephen van Gaal, Karina Villaluna, Norine Foley, Shelagh Coutts, Anita Mountain, Gord Gubitz, Jacob A Udell, Rebecca McGuff, Manraj K.S. Heran, Pascale Lavoie, Alexandre Y. Poppe
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 50 / Issue 3 / May 2023
- Published online by Cambridge University Press:
- 03 June 2022, p. 481
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Poor outcomes in both infection and colonization with carbapenem-resistant Enterobacterales
- Jessica R. Howard-Anderson, Michelle Earley, Lauren Komarow, Lilian Abbo, Deverick J. Anderson, Jason C. Gallagher, Matthew Grant, Angela Kim, Robert A. Bonomo, David van Duin, L. Silvia Muñoz-Price, Jesse T. Jacob
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 43 / Issue 12 / December 2022
- Published online by Cambridge University Press:
- 02 February 2022, pp. 1840-1846
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- December 2022
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Objectives:
To describe the epidemiology of patients with nonintestinal carbapenem-resistant Enterobacterales (CRE) colonization and to compare clinical outcomes of these patients to those with CRE infection.
Design:A secondary analysis of Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae 2 (CRACKLE-2), a prospective observational cohort.
Setting:A total of 49 US short-term acute-care hospitals.
Patients:Patients hospitalized with CRE isolated from clinical cultures, April, 30, 2016, through August 31, 2017.
Methods:We described characteristics of patients in CRACKLE-2 with nonintestinal CRE colonization and assessed the impact of site of colonization on clinical outcomes. We then compared outcomes of patients defined as having nonintestinal CRE colonization to all those defined as having infection. The primary outcome was a desirability of outcome ranking (DOOR) at 30 days. Secondary outcomes were 30-day mortality and 90-day readmission.
Results:Of 547 patients with nonintestinal CRE colonization, 275 (50%) were from the urinary tract, 201 (37%) were from the respiratory tract, and 71 (13%) were from a wound. Patients with urinary tract colonization were more likely to have a more desirable clinical outcome at 30 days than those with respiratory tract colonization, with a DOOR probability of better outcome of 61% (95% confidence interval [CI], 53%–71%). When compared to 255 patients with CRE infection, patients with CRE colonization had a similar overall clinical outcome, as well as 30-day mortality and 90-day readmission rates when analyzed in aggregate or by culture site. Sensitivity analyses demonstrated similar results using different definitions of infection.
Conclusions:Patients with nonintestinal CRE colonization had outcomes similar to those with CRE infection. Clinical outcomes may be influenced more by culture site than classification as “colonized” or “infected.”
Canadian Stroke Best Practice Recommendations: Secondary Prevention of Stroke Update 2020
- David J. Gladstone, M. Patrice Lindsay, James Douketis, Eric E. Smith, Dar Dowlatshahi, Theodore Wein, Aline Bourgoin, Jafna Cox, John B. Falconer, Brett R. Graham, Marilyn Labrie, Lena McDonald, Jennifer Mandzia, Daniel Ngui, Paul Pageau, Amanda Rodgerson, William Semchuk, Tammy Tebbutt, Carmen Tuchak, Stephen van Gaal, Karina Villaluna, Norine Foley, Shelagh Coutts, Anita Mountain, Gord Gubitz, Jacob A Udell, Rebecca McGuff, Manraj K.S. Heran, Pascale Lavoie, Alexandre Y. Poppe, , the Canadian Stroke Consortium
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- Canadian Journal of Neurological Sciences / Volume 49 / Issue 3 / May 2022
- Published online by Cambridge University Press:
- 18 June 2021, pp. 315-337
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The 2020 update of the Canadian Stroke Best Practice Recommendations (CSBPR) for the Secondary Prevention of Stroke includes current evidence-based recommendations and expert opinions intended for use by clinicians across a broad range of settings. They provide guidance for the prevention of ischemic stroke recurrence through the identification and management of modifiable vascular risk factors. Recommendations address triage, diagnostic testing, lifestyle behaviors, vaping, hypertension, hyperlipidemia, diabetes, atrial fibrillation, other cardiac conditions, antiplatelet and anticoagulant therapies, and carotid and vertebral artery disease. This update of the previous 2017 guideline contains several new or revised recommendations. Recommendations regarding triage and initial assessment of acute transient ischemic attack (TIA) and minor stroke have been simplified, and selected aspects of the etiological stroke workup are revised. Updated treatment recommendations based on new evidence have been made for dual antiplatelet therapy for TIA and minor stroke; anticoagulant therapy for atrial fibrillation; embolic strokes of undetermined source; low-density lipoprotein lowering; hypertriglyceridemia; diabetes treatment; and patent foramen ovale management. A new section has been added to provide practical guidance regarding temporary interruption of antithrombotic therapy for surgical procedures. Cancer-associated ischemic stroke is addressed. A section on virtual care delivery of secondary stroke prevention services in included to highlight a shifting paradigm of care delivery made more urgent by the global pandemic. In addition, where appropriate, sex differences as they pertain to treatments have been addressed. The CSBPR include supporting materials such as implementation resources to facilitate the adoption of evidence into practice and performance measures to enable monitoring of uptake and effectiveness of recommendations.
The Qualitative Transparency Deliberations: Insights and Implications
- Alan M. Jacobs, Tim Büthe, Ana Arjona, Leonardo R. Arriola, Eva Bellin, Andrew Bennett, Lisa Björkman, Erik Bleich, Zachary Elkins, Tasha Fairfield, Nikhar Gaikwad, Sheena Chestnut Greitens, Mary Hawkesworth, Veronica Herrera, Yoshiko M. Herrera, Kimberley S. Johnson, Ekrem Karakoç, Kendra Koivu, Marcus Kreuzer, Milli Lake, Timothy W. Luke, Lauren M. MacLean, Samantha Majic, Rahsaan Maxwell, Zachariah Mampilly, Robert Mickey, Kimberly J. Morgan, Sarah E. Parkinson, Craig Parsons, Wendy Pearlman, Mark A. Pollack, Elliot Posner, Rachel Beatty Riedl, Edward Schatz, Carsten Q. Schneider, Jillian Schwedler, Anastasia Shesterinina, Erica S. Simmons, Diane Singerman, Hillel David Soifer, Nicholas Rush Smith, Scott Spitzer, Jonas Tallberg, Susan Thomson, Antonio Y. Vázquez-Arroyo, Barbara Vis, Lisa Wedeen, Juliet A. Williams, Elisabeth Jean Wood, Deborah J. Yashar
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- Journal:
- Perspectives on Politics / Volume 19 / Issue 1 / March 2021
- Published online by Cambridge University Press:
- 06 January 2021, pp. 171-208
- Print publication:
- March 2021
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In recent years, a variety of efforts have been made in political science to enable, encourage, or require scholars to be more open and explicit about the bases of their empirical claims and, in turn, make those claims more readily evaluable by others. While qualitative scholars have long taken an interest in making their research open, reflexive, and systematic, the recent push for overarching transparency norms and requirements has provoked serious concern within qualitative research communities and raised fundamental questions about the meaning, value, costs, and intellectual relevance of transparency for qualitative inquiry. In this Perspectives Reflection, we crystallize the central findings of a three-year deliberative process—the Qualitative Transparency Deliberations (QTD)—involving hundreds of political scientists in a broad discussion of these issues. Following an overview of the process and the key insights that emerged, we present summaries of the QTD Working Groups’ final reports. Drawing on a series of public, online conversations that unfolded at www.qualtd.net, the reports unpack transparency’s promise, practicalities, risks, and limitations in relation to different qualitative methodologies, forms of evidence, and research contexts. Taken as a whole, these reports—the full versions of which can be found in the Supplementary Materials—offer practical guidance to scholars designing and implementing qualitative research, and to editors, reviewers, and funders seeking to develop criteria of evaluation that are appropriate—as understood by relevant research communities—to the forms of inquiry being assessed. We dedicate this Reflection to the memory of our coauthor and QTD working group leader Kendra Koivu.1
Compositional turnover in ecto- and endoparasite assemblages of an African bat, Miniopterus natalensis (Chiroptera, Miniopteridae): effects of hierarchical scale and host sex
- Boris R. Krasnov, Kerstin Junker, Simon Wood, Edward A. Ueckermann, Gert J. Venter, Luther van der Mescht, Heloise Heyne, David S. Jacobs
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- Parasitology / Volume 147 / Issue 14 / December 2020
- Published online by Cambridge University Press:
- 01 September 2020, pp. 1728-1742
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We studied the compositional turnover in infracommunities and component communities of ecto- and endoparasites infesting a bat, Miniopterus natalensis (Chiroptera, Miniopteridae), across seven sampling sites using the zeta diversity metric (measuring similarity between multiple communities) and calculating zeta decline and retention rate (both scales) and zeta decay (component communities). We asked whether the patterns of zeta diversity differ between (a) infracommunities and component communities; (b) ecto- and endoparasites and (c) subsets of communities infecting male and female bats. The pattern of compositional turnover differed between infracommunities and component communities in endoparasites only. The shape of zeta decline for infracommunities indicated that there were approximately equal probabilities of ecto- and endoparasitic species to occur on/in any bat individual within a site. The shape of zeta decline for component communities suggested the stochasticity of ectoparasite turnover, whereas the turnover of endoparasites was driven by niche-based processes. Compositional turnover in component communities of ectoparasites was more spatially dependent than that of endoparasites. Spatial independence of compositional turnover in endoparasites was due to subcommunities harboured by female bats. We conclude that the patterns of compositional turnover in infracommunities were similar in ecto- and endoparasites, whereas the patterns of turnover in component communities differed between these groups.
Sustained decrease in urine culture utilization after implementing a reflex urine culture intervention: A multicenter quasi-experimental study
- Jessica R. Howard-Anderson, Shanza Ashraf, Elizabeth C. Overton, Lisa Reif, David J. Murphy, Jesse T. Jacob
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue 3 / March 2020
- Published online by Cambridge University Press:
- 30 January 2020, pp. 369-371
- Print publication:
- March 2020
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Accurately diagnosing urinary tract infections (UTIs) in hospitalized patients remains challenging, requiring correlation of frequently nonspecific symptoms and laboratory findings. Urine cultures (UCs) are often ordered indiscriminately, especially in patients with urinary catheters, despite the Infectious Diseases Society of America guidelines recommending against routine screening for asymptomatic bacteriuria (ASB).1,2 Positive UCs can be difficult for providers to ignore, leading to unnecessary antibiotic treatment of ASB.2,3 Using diagnostic stewardship to limit UCs to situations with a positive urinalysis (UA) can reduce inappropriate UCs since the absence of pyuria suggests the absence of infection.4–6 We assessed the impact of the implementation of a UA with reflex to UC algorithm (“reflex intervention”) on UC ordering practices, diagnostic efficiency, and UTIs using a quasi-experimental design.
Building Partnerships and Bridging Science and Policy to Address the Biological Invasions Crisis
- Jacob N. Barney, Todd Schenk, David C. Haak, Scott Salom, Bryan Brown, Erin R. Hotchkiss
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- Invasive Plant Science and Management / Volume 12 / Issue 1 / March 2019
- Published online by Cambridge University Press:
- 13 February 2019, pp. 74-78
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Biological invasions are one of the grand challenges facing society, as exotic species introductions continue to rise and can result in dramatic changes to native ecosystems and economies. The scale of the “biological invasions crisis” spans from hyperlocal to international, involving a myriad of actors focused on mitigating and preventing biological invasions. However, the level of engagement among stakeholders and opportunities to collaboratively solve invasives issues in transdisciplinary ways is poorly understood. The Biological Invasions: Confronting a Crisis workshop engaged a broad group of actors working on various aspects of biological invasions in Virginia, USA—researchers, Extension personnel, educators, local, state, and federal agencies, nongovernmental organizations, and land managers—to discuss their respective roles and how they interact with other groups. Through a series of activities, it became clear that despite shared goals, most groups are not engaging with one another, and that enhanced communication and collaboration among groups is key to designing effective solutions. There is strong support for a multistakeholder coalition to affect change in policy, public education/engagement, and solution design. Confronting the biological invasions crisis will increasingly require engagement among stakeholders.
Low-carbohydrate diets and prevalence, incidence and progression of coronary artery calcium in the Multi-Ethnic Study of Atherosclerosis (MESA)
- Tian Hu, David R. Jacobs, Jr, Lydia A. Bazzano, Alain G. Bertoni, Lyn M. Steffen
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- Journal:
- British Journal of Nutrition / Volume 121 / Issue 4 / 28 February 2019
- Published online by Cambridge University Press:
- 11 January 2019, pp. 461-468
- Print publication:
- 28 February 2019
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The evidence linking low-carbohydrate diets (LCD) to CVD is controversial, and results from epidemiological studies are inconsistent. We aimed to assess the relationship between LCD patterns and coronary artery Ca (CAC) scores from computed tomography in the Multi-Ethnic Study of Atherosclerosis cohort. Our sample included 5614 men and women free of clinical CVD at baseline (2000–2002), who had a FFQ, a baseline measure and ≥1 measure of CAC during follow-up. We excluded those with implausible energy intake or daily physical activity. The overall, animal-based and plant-based LCD scores were calculated based on intakes of macronutrients. Relative risk regression and robust regression models were used to examine the cross-sectional and longitudinal relationship between LCD score quintile and CAC outcomes, after adjustment for multiple cardiovascular risk factors. The mean age of participants was 63 years. The median intakes of total carbohydrate, fat and protein were 53·7, 30·5 and 15·6 % energy/d, respectively. Among 2892 participants with zero CAC scores at baseline, 264 developed positive scores during 2·4-year follow-up (11–59 months). Among those with positive scores at baseline, the median increase in CAC was 47 units over the course of follow-up. The overall, the animal-based and the plant-based LCD scores were not associated with CAC prevalence, incidence and progression. In conclusion, diets low in carbohydrate and high in fat and/or protein, regardless of the sources of protein and fat, were not associated with higher levels of CAC, a validated predictor of cardiovascular events, in this large multi-ethnic cohort.
Cardiac Networks United: an integrated paediatric and congenital cardiovascular research and improvement network
- Michael Gaies, Jeffrey Anderson, Alaina Kipps, Angela Lorts, Nicolas Madsen, Bradley Marino, John M. Costello, David Brown, Jeffrey P. Jacobs, David Kasnic, Stacey Lihn, Carole Lannon, Peter Margolis, Gail D. Pearson, Jonathan Kaltman, John R. Charpie, Andrew N. Redington, Sara K. Pasquali, on behalf of the Cardiac Networks United Executive Committee and Advisory Board
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- Cardiology in the Young / Volume 29 / Issue 2 / February 2019
- Published online by Cambridge University Press:
- 20 December 2018, pp. 111-118
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Optimising short- and long-term outcomes for children and patients with CHD depends on continued scientific discovery and translation to clinical improvements in a coordinated effort by multiple stakeholders. Several challenges remain for clinicians, researchers, administrators, patients, and families seeking continuous scientific and clinical advancements in the field. We describe a new integrated research and improvement network – Cardiac Networks United – that seeks to build upon the experience and success achieved to-date to create a new infrastructure for research and quality improvement that will serve the needs of the paediatric and congenital heart community in the future. Existing gaps in data integration and barriers to improvement are described, along with the mission and vision, organisational structure, and early objectives of Cardiac Networks United. Finally, representatives of key stakeholder groups – heart centre executives, research leaders, learning health system experts, and parent advocates – offer their perspectives on the need for this new collaborative effort.
Eighteen years of paediatric extracorporeal membrane oxygenation and ventricular assist devices: insight regarding late outcomes
- Shawn M. Shah, David W. Kays, Sharon R. Ghazarian, Tom R. Karl, Plato Alexander, Nathaniel Sznycer-Taub, Jason Parker, Molly Oldeen, Melvin C. Almodovar, Gary Stapleton, James A. Quintessenza, Alfred Asante-Korang, Vyas Kartha, Jade Hanson, Ernest Amankwah, Joeli Roth, Jeffrey P. Jacobs
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- Journal:
- Cardiology in the Young / Volume 28 / Issue 11 / November 2018
- Published online by Cambridge University Press:
- 17 September 2018, pp. 1316-1322
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Background
We reviewed all patients who were supported with extracorporeal membrane oxygenation and/or ventricular assist device at our institution in order to describe diagnostic characteristics and assess mortality.
MethodsA retrospective cohort study was performed including all patients supported with extracorporeal membrane oxygenation and/or ventricular assist device from our first case (8 October, 1998) through 25 July, 2016. The primary outcome of interest was mortality, which was modelled by the Kaplan–Meier method.
ResultsA total of 223 patients underwent 241 extracorporeal membrane oxygenation runs. Median support time was 4.0 days, ranging from 0.04 to 55.8 days, with a mean of 6.4±7.0 days. Mean (±SD) age at initiation was 727.4 days (±146.9 days). Indications for extracorporeal membrane oxygenation were stratified by primary indication: cardiac extracorporeal membrane oxygenation (n=175; 72.6%) or respiratory extracorporeal membrane oxygenation (n=66; 27.4%). The most frequent diagnosis for cardiac extracorporeal membrane oxygenation patients was hypoplastic left heart syndrome or hypoplastic left heart syndrome-related malformation (n=55 patients with HLHS who underwent 64 extracorporeal membrane oxygenation runs). For respiratory extracorporeal membrane oxygenation, the most frequent diagnosis was congenital diaphragmatic hernia (n=22). A total of 24 patients underwent 26 ventricular assist device runs. Median support time was 7 days, ranging from 0 to 75 days, with a mean of 15.3±18.8 days. Mean age at initiation of ventricular assist device was 2530.8±660.2 days (6.93±1.81 years). Cardiomyopathy/myocarditis was the most frequent indication for ventricular assist device placement (n=14; 53.8%). Survival to discharge was 42.2% for extracorporeal membrane oxygenation patients and 54.2% for ventricular assist device patients. Kaplan–Meier 1-year survival was as follows: all patients, 41.0%; extracorporeal membrane oxygenation patients, 41.0%; and ventricular assist device patients, 43.2%. Kaplan–Meier 5-year survival was as follows: all patients, 39.7%; extracorporeal membrane oxygenation patients, 39.7%; and ventricular assist device patients, 43.2%.
ConclusionsThis single-institutional 18-year review documents the differential probability of survival for various sub-groups of patients who require support with extracorporeal membrane oxygenation or ventricular assist device. The indication for mechanical circulatory support, underlying diagnosis, age, and setting in which cannulation occurs may affect survival after extracorporeal membrane oxygenation and ventricular assist device. The Kaplan–Meier analyses in this study demonstrate that patients who survive to hospital discharge have an excellent chance of longer-term survival.
Meta-analysis across Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium provides evidence for an association of serum vitamin D with pulmonary function
- Jiayi Xu, Traci M. Bartz, Geetha Chittoor, Gudny Eiriksdottir, Ani W. Manichaikul, Fangui Sun, Natalie Terzikhan, Xia Zhou, Sarah L. Booth, Guy G. Brusselle, Ian H. de Boer, Myriam Fornage, Alexis C. Frazier-Wood, Mariaelisa Graff, Vilmundur Gudnason, Tamara B. Harris, Albert Hofman, Ruixue Hou, Denise K. Houston, David R. Jacobs, Jr, Stephen B. Kritchevsky, Jeanne Latourelle, Rozenn N. Lemaitre, Pamela L. Lutsey, George O’Connor, Elizabeth C. Oelsner, James S. Pankow, Bruce M. Psaty, Rebecca R. Rohde, Stephen S. Rich, Jerome I. Rotter, Lewis J. Smith, Bruno H. Stricker, V. Saroja Voruganti, Thomas J. Wang, M. Carola Zillikens, R. Graham Barr, Josée Dupuis, Sina A. Gharib, Lies Lahousse, Stephanie J. London, Kari E. North, Albert V. Smith, Lyn M. Steffen, Dana B. Hancock, Patricia A. Cassano
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- Journal:
- British Journal of Nutrition / Volume 120 / Issue 10 / 28 November 2018
- Published online by Cambridge University Press:
- 12 September 2018, pp. 1159-1170
- Print publication:
- 28 November 2018
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The role that vitamin D plays in pulmonary function remains uncertain. Epidemiological studies reported mixed findings for serum 25-hydroxyvitamin D (25(OH)D)–pulmonary function association. We conducted the largest cross-sectional meta-analysis of the 25(OH)D–pulmonary function association to date, based on nine European ancestry (EA) cohorts (n 22 838) and five African ancestry (AA) cohorts (n 4290) in the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium. Data were analysed using linear models by cohort and ancestry. Effect modification by smoking status (current/former/never) was tested. Results were combined using fixed-effects meta-analysis. Mean serum 25(OH)D was 68 (sd 29) nmol/l for EA and 49 (sd 21) nmol/l for AA. For each 1 nmol/l higher 25(OH)D, forced expiratory volume in the 1st second (FEV1) was higher by 1·1 ml in EA (95 % CI 0·9, 1·3; P<0·0001) and 1·8 ml (95 % CI 1·1, 2·5; P<0·0001) in AA (Prace difference=0·06), and forced vital capacity (FVC) was higher by 1·3 ml in EA (95 % CI 1·0, 1·6; P<0·0001) and 1·5 ml (95 % CI 0·8, 2·3; P=0·0001) in AA (Prace difference=0·56). Among EA, the 25(OH)D–FVC association was stronger in smokers: per 1 nmol/l higher 25(OH)D, FVC was higher by 1·7 ml (95 % CI 1·1, 2·3) for current smokers and 1·7 ml (95 % CI 1·2, 2·1) for former smokers, compared with 0·8 ml (95 % CI 0·4, 1·2) for never smokers. In summary, the 25(OH)D associations with FEV1 and FVC were positive in both ancestries. In EA, a stronger association was observed for smokers compared with never smokers, which supports the importance of vitamin D in vulnerable populations.
Correlation of Etch Pits and Dislocations in As-grown and Thermal-Cycle-Annealed HgCdTe(211) Films
- Majid. Vaghayenegar, R. N. Jacobs, J. D. Benson, A. J. Stoltz, L. A. Almeida, David. J. Smith
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- Journal:
- Microscopy and Microanalysis / Volume 23 / Issue S1 / July 2017
- Published online by Cambridge University Press:
- 04 August 2017, pp. 1526-1527
- Print publication:
- July 2017
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Glaciological and oceanographic evidence of high melt rates beneath Pine Island Glacier, West Antarctica
- Adrian Jenkins, David G. Vaughan, Stanley S. Jacobs, Hartmut H. Hellmer, John R. Keys
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- Journal of Glaciology / Volume 43 / Issue 143 / 1997
- Published online by Cambridge University Press:
- 20 January 2017, pp. 114-121
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Satellite imagery indicates that the floating terminus of Pine Island Glacier has changed little in extent over the past two decades. Data on the velocity and thickness of the glacier reveal that calving of 28 ± 4 Gta−1 accounts for only half of the ice input near the grounding line. The apparently steady configuration implies that the remainder of the input is lost by basal melting at a mean rate of 12 ± 3 ma−1. Ocean circulation in Pine Island Bay transports +1°C waters beneath the glacier and temperatures recorded in melt-laden outflows show that heat loss from the ocean is consistent with the requirements of the calculated melt rate. The combination of iceberg calving and basal melting lies at the lower end of estimates for the total accumulation over the catchment basin, drawing into question previous estimates of a significantly positive mass budget for this part of the ice sheet.
Principles of shared decision-making within teams
- Jeffrey P. Jacobs, Gil Wernovsky, David S. Cooper, Tom R. Karl
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- Cardiology in the Young / Volume 25 / Issue 8 / December 2015
- Published online by Cambridge University Press:
- 18 August 2015, pp. 1631-1636
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In the domain of paediatric and congenital cardiac care, the stakes are huge. Likewise, the care of these children assembles a group of “A+ personality” individuals from the domains of cardiac surgery, cardiology, anaesthesiology, critical care, and nursing. This results in an environment that has opportunity for both powerful collaboration and powerful conflict. Providers of healthcare should avoid conflict when it has no bearing on outcome, as it is clearly a squandering of individual and collective political capital.
Outcomes after cardiac surgery are now being reported transparently and publicly. In the present era of transparency, one may wonder how to balance the following potentially competing demands: quality healthcare, transparency and accountability, and teamwork and shared decision-making.
An understanding of transparency and public reporting in the domain of paediatric cardiac surgery facilitates the implementation of a strategy for teamwork and shared decision-making. In January, 2015, the Society of Thoracic Surgeons (STS) began to publicly report outcomes of paediatric and congenital cardiac surgery using the 2014 Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) Mortality Risk Model. The 2014 STS-CHSD Mortality Risk Model facilitates description of Operative Mortality adjusted for procedural and patient-level factors.
The need for transparency in reporting of outcomes can create pressure on healthcare providers to implement strategies of teamwork and shared decision-making to assure outstanding results. A simple strategy of shared decision-making was described by Tom Karl and was implemented in multiple domains by Jeff Jacobs and David Cooper. In a critical-care environment, it is not unusual for healthcare providers to disagree about strategies of management of patients. When two healthcare providers disagree, each provider can classify the disagreement into three levels:
• SDM Level 1 Decision: “We disagree but it really does not matter, so do whatever you desire!”
• SDM Level 2 Decision: “We disagree and I believe it matters, but I am OK if you do whatever you desire!!”
• SDM Level 3 Decision: “We disagree and I must insist (diplomatically and politely) that we follow the strategy that I am proposing!!!!!!”
SDM Level 1 Decisions and SDM Level 2 Decisions typically do not create stress on the team, especially when there is mutual purpose and respect among the members of the team. SDM Level 3 Decisions are the real challenge. Periodically, the healthcare team is faced with such Level 3 Decisions, and teamwork and shared decision-making may be challenged. Teamwork is a learned behaviour, and mentorship is critical to achieve a properly balanced approach. If we agree to leave our egos at the door, then, in the final analysis, the team will benefit and we will set the stage for optimal patient care. In the environment of strong disagreement, true teamwork and shared decision-making are critical to preserve the unity and strength of the multi-disciplinary team and simultaneously provide excellent healthcare.
Hospital Transfer Network Structure as a Risk Factor for Clostridium difficile Infection
- Jacob E. Simmering, Linnea A. Polgreen, David R. Campbell, Joseph E. Cavanaugh, Philip M. Polgreen
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 36 / Issue 9 / September 2015
- Published online by Cambridge University Press:
- 15 June 2015, pp. 1031-1037
- Print publication:
- September 2015
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OBJECTIVE
To determine the effect of interhospital patient sharing via transfers on the rate of Clostridium difficile infections in a hospital.
DESIGNRetrospective cohort.
METHODSUsing data from the Healthcare Cost and Utilization Project California State Inpatient Database, 2005–2011, we identified 2,752,639 transfers. We then constructed a series of networks detailing the connections formed by hospitals. We computed 2 measures of connectivity, indegree and weighted indegree, measuring the number of hospitals from which transfers into a hospital arrive, and the total number of incoming transfers, respectively. Next, we estimated a multivariate model of C. difficile infection cases using the log-transformed network measures as well as covariates for hospital fixed effects, log median length of stay, log fraction of patients aged 65 or older, and quarter and year indicators as predictors.
RESULTSWe found an increase of 1 in the log indegree was associated with a 4.8% increase in incidence of C. difficile infection (95% CI, 2.3%–7.4%) and an increase of 1 in log weighted indegree was associated with a 3.3% increase in C. difficile infection incidence (1.5%–5.2%). Moreover, including measures of connectivity in our models greatly improved their fit.
CONCLUSIONSOur results suggest infection control is not under the exclusive control of a given hospital but is also influenced by the connections and number of connections that hospitals have with other hospitals.
Infect. Control Hosp. Epidemiol. 2015;36(9):1031–1037
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. 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- By Brittany L. Anderson-Montoya, Heather R. Bailey, Carryl L. Baldwin, Daphne Bavelier, Jameson D. Beach, Jeffrey S. Bedwell, Kevin B. Bennett, Richard A. Block, Deborah A. Boehm-Davis, Corey J. Bohil, David B. Boles, Avinoam Borowsky, Jessica Bramlett, Allison A. Brennan, J. Christopher Brill, Matthew S. Cain, Meredith Carroll, Roberto Champney, Kait Clark, Nancy J. Cooke, Lori M. Curtindale, Clare Davies, Patricia R. DeLucia, Andrew E. Deptula, Michael B. Dillard, Colin D. Drury, Christopher Edman, James T. Enns, Sara Irina Fabrikant, Victor S. Finomore, Arthur D. Fisk, John M. Flach, Matthew E. Funke, Andre Garcia, Adam Gazzaley, Douglas J. Gillan, Rebecca A. Grier, Simen Hagen, Kelly Hale, Diane F. Halpern, Peter A. Hancock, Deborah L. Harm, Mary Hegarty, Laurie M. Heller, Nicole D. Helton, William S. Helton, Robert R. Hoffman, Jerred Holt, Xiaogang Hu, Richard J. Jagacinski, Keith S. Jones, Astrid M. L. Kappers, Simon Kemp, Robert C. Kennedy, Robert S. Kennedy, Alan Kingstone, Ioana Koglbauer, Norman E. Lane, Robert D. Latzman, Cynthia Laurie-Rose, Patricia Lee, Richard Lowe, Valerie Lugo, Poornima Madhavan, Leonard S. Mark, Gerald Matthews, Jyoti Mishra, Stephen R. Mitroff, Tracy L. Mitzner, Alexander M. Morison, Taylor Murphy, Takamichi Nakamoto, John G. Neuhoff, Karl M. Newell, Tal Oron-Gilad, Raja Parasuraman, Tiffany A. Pempek, Robert W. Proctor, Katie A. Ragsdale, Anil K. Raj, Millard F. Reschke, Evan F. Risko, Matthew Rizzo, Wendy A. Rogers, Jesse Q. Sargent, Mark W. Scerbo, Natasha B. Schwartz, F. Jacob Seagull, Cory-Ann Smarr, L. James Smart, Kay Stanney, James Staszewski, Clayton L. Stephenson, Mary E. Stuart, Breanna E. Studenka, Joel Suss, Leedjia Svec, James L. Szalma, James Tanaka, James Thompson, Wouter M. Bergmann Tiest, Lauren A. Vassiliades, Michael A. Vidulich, Paul Ward, Joel S. Warm, David A. Washburn, Christopher D. Wickens, Scott J. Wood, David D. Woods, Motonori Yamaguchi, Lin Ye, Jeffrey M. Zacks
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- By Naila A. Ahmad, Dua M. Anderson, Jennifer Aunspaugh, Sabrina T. Bent, Adam Broussard, Staci Cameron, Rahul Dasgupta, Ravinder Devgun, Ofer N. Eytan, Sean H. Flack, Terry G. Fletcher, Charles James Fox, Mary Elise Fox, Scott Friedman, Louise K. Furukawa, Sonja Gennuso, Stanley M. Hall, Hani Hanna, Jacob Hummel, James E. Hunt, Ranu Jain, Joe R. Jansen, Deepa Kattail, Alan David Kaye, David J. Krodel, Gregory J. Latham, Sungeun Lee, Michael G. Levitzky, Alexander Y. Lin, Carl Lo, Hoa N. Luu, Camila Lyon, Kelly A. Machovec, Lizabeth D. Martin, Maria Matuszczak, Patrick S. McCarty, Brenda C. McClain, J. Grant McFadyen, Helen Nazareth, Dolores B. Njoku, Christina M. Pabelick, Shannon M. Peters, Amit Prabhakar, Michael Richards, Kasia Rubin, Joel A. Saltzman, Lisgelia Santana, Gabriel Sarah, Katherine Stammen, John Stork, Kim M. Strupp, Lalitha V. Sundararaman, Rosalie F. Tassone, Douglas R. Thompson, Nicole C. P. Thompson, Paul A. Tripi, Jacqueline L. Tutiven, Navyugjit Virk, Stacey Watt, B. Craig Weldon, Maria Zestus
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A modified Mediterranean diet score is associated with a lower risk of incident metabolic syndrome over 25 years among young adults: the CARDIA (Coronary Artery Risk Development in Young Adults) study
- Lyn M. Steffen, Linda Van Horn, Martha L. Daviglus, Xia Zhou, Jared P. Reis, Catherine M. Loria, David R. Jacobs, Kiyah J. Duffey
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- British Journal of Nutrition / Volume 112 / Issue 10 / 28 November 2014
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- 19 September 2014, pp. 1654-1661
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The Mediterranean diet has been reported to be inversely associated with incident metabolic syndrome (MetSyn) among older adults; however, this association has not been studied in young African American and white adults. The objective of the present study was to evaluate the association of a modified Mediterranean diet (mMedDiet) score with the 25-year incidence of the MetSyn in 4713 African American and white adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. A diet history questionnaire was used to assess dietary intake at baseline, year 7 and year 20 and a mMedDiet score was created. Cardiovascular risk factors were measured at multiple examinations over 25 years. The MetSyn was defined according to the National Cholesterol Education Program Adult Treatment Panel III (ATP III) criteria. Cox proportional-hazards regression analysis was use to evaluate associations for incident MetSyn across the mMedDiet score categories adjusting for demographic characteristics, lifestyle factors and BMI. Higher mMedDiet scores represented adherence to a dietary pattern rich in fruit, vegetables, whole grains, nuts and fish, but poor in red and processed meat and snack foods. The incidence of MetSyn components (abdominal obesity, elevated TAG concentrations and low HDL-cholesterol concentrations) was lower in those with higher mMedDiet scores than in those with lower scores. Furthermore, the incidence of the MetSyn was lower across the five mMedDiet score categories; the hazard ratios and 95 % CI from category 1 to category 5 were 1·0; 0·94 (0·76, 1·15); 0·84 (0·68, 1·04); 0·73 (0·58, 0·92); and 0·72 (0·54, 0·96), respectively (Ptrend= 0·005). These findings suggest that the risk of developing the MetSyn is lower when consuming a diet rich in fruit, vegetables, whole grains, nuts and fish.
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