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Health literacy describes the capacity to obtain and process health information to make decisions and comprehend a treatment plan.[1] The 2003 National Assessment of Adult Literacy was the first national assessment in the United States designed to measure health literacy and found that 36% of adults have basic or below basic health care literacy.[2] Reducing gaps in health quality and outcomes continues to be a challenge, and this low health literacy (LHL) rate may be playing an integral part. Thus, it may be beneficial to focus on improving patient comprehension in older patients (>65 years old), while targeting patients based on education level or living environments will be less effective. The lowest level of health literacy was seen in the oldest patients, suggesting that these patients are especially at risk for LHL. [Extracted from the article]

Digital Twin (DT) technology is far from being comprehensive and mature, resulting in their piecemeal implementation in practice where some functions are automated by DTs, and others are still performed by humans. This piecemeal implementation of DTs often leaves practitioners wondering what roles (or functions) to allocate to DTs in a work system, and how might it impact humans. A lack of knowledge about the roles that humans and DTs play in a work system can result in significant costs, misallocation of resources, unrealistic expectations from DTs, and strategic misalignments. To alleviate this challenge, this paper answers the research question: When humans work with DTs, what types of roles can a DT play, and to what extent can those roles be automated? Specifically, we propose a two-dimensional conceptual framework, Levels of Digital Twin (LoDT). The framework is an integration of the types of roles a DT can play, broadly categorized under (1) Observer, (2) Analyst, (3) Decision Maker, and (4) Action Executor, and the extent of automation for each of these roles, divided into five different levels ranging from completely manual to fully automated. A particular DT can play any number of roles at varying levels. The framework can help practitioners systematically plan DT deployments, clearly communicate goals and deliverables, and lay out a strategic vision. A case study illustrates the usefulness of the framework. • Digital Twin human interaction • Digital Twin can play multiple roles in a work system. • Levels of Digital Twin framework provides a common language for understanding. • Digital Twin must be evaluated for each case – a "one size fits all" does not work. [ABSTRACT FROM AUTHOR]

Background: An increasing number of children are requiring circulatory suport. Hospitals offering pediatric Ventricular Assist Device (VAD) should have devices of different sizes available to cover the full range of patient sizes incurring considerable expense. As in adults, post-operative bleeding often complicates VAD implantation. The use of a Levitronix Centrimag centrifugal pump, connected to Berlin Heart Excor cannulae, seems an attractive and logic combination, both in terms of patient safety and of hospital economics. Methods: We describe 3 children with therapy resistant cardiac failure who underwent extracorporeal membrane oxygenation (ECMO) as a rescue before proceeding to placement of the Berlin Heart Excor paracorporeal assist device. The Levitronix Centrimag pump was used as an intermediate device to allow the patients to be stabilised. Therefore, only Berlin Heart cannulae of different sizes have to be readily available; if successful stabilization can be achieved, the Berlin Heart Excor ventricles and the drive unit can then be ordered to replace the Levitronix pump. Results: Two patients were successfully stabilised with the Levitronix pump and were switched to the definitive Berlin Heart Excor ventricles after 6 days of support. The third child succumbed due to intractable pulmonary hemorrhage in severely damaged lungs. No device related complications, especially no thrombo-embolic events, occurred during Levitronix support. Conclusion: The Levitronix Centrimag pump was easy to handle and gave effective circulatory support, the patients were only switched to the Berlin Heart Excor system after stabilization. In patients with a high risk of failure, it is a relatively cheap but safe and effective support system. [Copyright &y& Elsevier]

Abstract: Objective: To determine occurrence, causes and associated mortality of postoperative metabolic alkalosis in pediatric cardiac surgery. Methods: We retrospectively analyzed clinical and biochemical variables of 186 consecutive cardiac operations other than ductal ligations on children less than 2 years old during the years 1999 and 2000. Metabolic alkalosis was defined as a pH>7.48 corrected for PCO2, with a base excess ≥5 on two or more consecutive measurements during an 8h period. Results: Median age was 15 weeks [range 2 days–95 weeks] and median weight 4.5kg [range 2.1–15.7kg]. In 157 cases, cardiopulmonary bypass was used. In 92 [49%] procedures, metabolic alkalosis occurred with the highest corrected pH 24.3h after operation. Multivariate regression analysis associated age [P<0.001], cardiopulmonary bypass [P<0.001] and preoperative ductal dependency [P=0.04] with postoperative metabolic alkalosis. Of the surgical procedures the arterial switch for transposition of the great arteries [n=19] was strongly associated with metabolic alkalosis [100%, P<0.001]. Hemodilution appeared to enhance the development of alkalosis: those who experienced alkalosis had been hemodiluted to a greater extent [P=0.007]. Nearly 95% of patients experienced some increase in bicarbonate, but patients with metabolic alkalosis experienced more than those without [5.9 versus 3.5mmol/l, P<0.001]. There were four postoperative deaths, only one coincidental with metabolic alkalosis. Conclusions: Metabolic alkalosis has a high incidence after pediatric cardiac surgery, strongly associated with younger age, cardiopulmonary bypass, preoperative ductal dependency and perioperative hemodilution. Early recognition allows for timely therapeutic intervention. [Copyright &y& Elsevier]

The article discusses a study that examined the mobilization of patients during venovenous extracorporeal membrane oxygenation (vvECMO). Topics discussed include the use of vvECMO in patients with acute severe respiratory failure, potential side effects of mobilization during ECMO therapy, preventing cannula dislocation during mobilization and reasons for respiratory failure of the patients.

Occupational segregation by race and gender, though less common now than in the past, continues to be the norm rather than the exception in the sport industry. The purpose of this study was twofold. First, occupational segregation on the baseball playing field, often referred to as stacking, was discussed in light of human capital and social closure theories. Second, an attempt was made to replicate and extend a multivariate analysis of stacking by Margolis and Piliavin (1999) that challenges the dominant social science paradigm for explaining stacking. The present study uses more recent data than the Margolis and Piliavin study, as well as multinomial logistic regression analysis. The results reveal that stacking persists in Major League Baseball. They also reveal that the effect of race/ethnicity on assignments to playing positions is reduced when one controls for skills and physical characteristics such as speed and power hitting. The implications of this finding for sport management are examined. [ABSTRACT FROM AUTHOR]

Background: Survival following cardiac arrest (CA) remains poor after conventional cardiopulmonary resuscitation (CCPR) (6–26%), and the outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) are often inconsistent. Poor survival is a consequence of CA, low-flow states during CCPR, multi-organ injury, insufficient monitoring, and delayed treatment of the causative condition. We developed a new strategy to address these issues. Methods: This all-comers, multicenter, prospective observational study (69 patients with in- and out-of-hospital CA (IHCA and OHCA) after prolonged refractory CCPR) focused on extracorporeal cardiopulmonary support, comprehensive monitoring, multi-organ repair, and the potential for out-of-hospital cannulation and treatment. Result: The overall survival rate at hospital discharge was 42.0%, and a favorable neurological outcome (CPC 1+2) at 90 days was achieved for 79.3% of survivors (CPC 1+2 survival 33%). IHCA survival was very favorable (51.7%), as was CPC 1+2 survival at 90 days (41%). Survival of OHCA patients was 35% and CPC 1+2 survival at 90 days was 28%. The subgroup of OHCA patients with pre-hospital cannulation showed a superior survival rate of 57.1%. Conclusions: This new strategy focusing on repairing damage to multiple organs appears to improve outcomes after CA, and these findings should provide a sound basis for further research in this area. [ABSTRACT FROM AUTHOR]

Introduction: In cardiac arrest, cerebral ischemia and reperfusion injury mainly determine the neurological outcome. The aim of this study was to investigate the relation between the course of cerebral oxygenation and regain of consciousness in patients treated with extracorporeal cardiopulmonary resuscitation (ECPR). We hypothesized that rapid cerebral oxygenation increase causes unfavorable outcomes. Methods: This prospective observational study was conducted in three European hospitals. We included adult ECPR patients between October 2018 and March 2020, in whom cerebral regional oxygen saturation (rSO2) measurements were started minutes before ECPR initiation until 3 h after. The primary outcome was regain of consciousness, defined as following commands, analyzed using binary logistic regression. Results: The sample consisted of 26 ECPR patients (23% women, Agemean 46 years). We found no significant differences in rSO2 values at baseline (49.1% versus 49.3% for regain versus no regain of consciousness). Mean cerebral rSO2 values in the first 30 min after ECPR initiation were higher in patients who regained consciousness (38%) than in patients who did not regain consciousness (62%, odds ratio 1.23, 95% confidence interval 1.01–1.50). Conclusion: Higher mean cerebral rSO2 values in the first 30 min after initiation of ECPR were found in patients who regained consciousness. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the frequency of pancreatic duct (PD) variants and their effect on pancreatic exocrine function in a population-based study using non-invasive secretin-stimulated magnetic resonance cholangiopancreatography (sMRCP). Methods: Nine hundred and ninety-five volunteers, 457 women and 538 men, aged 51.9 ± 13.4 years, underwent navigator-triggered, T2-weighted, 3D turbo spin echo MRCP on a 1.5 T system after 1 unit/kg secretin administration. Two readers evaluated images for PD variants. Pancreatic exocrine function and morphological signs of chronic pancreatitis such as abnormalities of the main PD, side branch dilatation, and pancreatic cysts were evaluated and related to PD variants using a Kruskal-Wallis test and post hoc analysis. Results: Of all sMRCP, 93.2 % were of diagnostic quality. Interobserver reliability for detection of PD variants was found to be kappa 0.752 (95 %CI, 0.733 - 0.771). Normal PD variants were observed in 90.4 % (n = 838/927). Variants of pancreas divisum was identified in 9.6 % (n = 89/927). Abnormalities of the main PD, side branch dilatation, and pancreatic cysts were observed in 2.4 %, 16.6 %, and 27.7 %, respectively, and were not significantly different between pancreas divisum and non-divisum group ( P = 0.122; P = 0.152; P = 0.741). There was no association between PD variants and pancreatic exocrine function ( P = 0.367). Conclusion: PD variants including pancreas divisum are not associated with morphological signs of chronic pancreatitis or restriction of pancreatic exocrine function. Key Points: • MRCP allows the evaluation of pancreatic duct variants and morphological change. • Pancreatic duct variants are not associated with morphological signs of chronic pancreatitis. • Pancreas divisum is not accompanied by restriction of pancreatic exocrine function. • Pancreatic duct variants including pancreas divisum are limited in their clinical relevance. [ABSTRACT FROM AUTHOR]

Study Type - Diagnostic (validating cohort) Level of Evidence 1b What's known on the subject? and What does the study add? Nadir Ultrasensitive PSA levels has some value for predicting BCR following RD. AccuPSA assays lower limit of PSA quantification of <0.01 pg/ml greatly enhances sensitivity and specificity of nadir PSA to predict BCR following RP. Our pilot study shows an AccuPSA of 3 pg/ml has a sensitory and specificity of 100% and 75% respectively for predicting 5 year BCR following RP. OBJECTIVES To conduct a proof of concept study to evaluate a novel digital single molecule immunoassay (AccuPSATM) that detects prostate-specific antigen (PSA) a thousandfold more sensitively than current PSA detection methods., To determine the ability of the AccuPSATM assay to predict 5-year biochemical recurrence (BCR)-free survival after radical prostatectomy (RP)., PATIENTS AND METHODS A total of 31 frozen serum specimens were obtained from specimen logs maintained at New York University Langone Medical Center and the Johns Hopkins University School of Medicine on men who had undergone RP. Those men without evidence of BCR had a minimum of 5 years' PSA follow-up., In all cases, preoperative and pathological information were available, as was a serum specimen 3-6 months after RP, with a PSA level of <0.1 ng/mL measured by conventional PSA methods at the time of serum collection., Specimens were tested using the AccuPSATM method., A Cox proportional hazard model and Kaplan-Meier analysis were used to determine whether AccuPSATM predicted the risk of BCR., RESULTS Overall, 11/31 (35.5%) men developed BCR., Mean AccuPSATM nadir levels were significantly different ( P < 0.001) between the non-BCR group (2.27 pg/mL) and the BCR group (46.99 pg/mL)., Using a multivariate Cox proportional hazard model, AccuPSATM nadir level was a significant predictor of BCR-free survival ( P < 0.01)., Kaplan-Meier analysis of up to 5 years follow-up showed that 100% of men with AccuPSATM nadir values <3 pg/mL did not develop BCR, whereas 62.5% of men with values >3 pg/mL developed BCR ( P= 0.00024)., The sensitivity, specificity, positive predictive value and negative predictive value of the AccuPSATM method was 100%, 75%, 69% and 100%, respectively., CONCLUSIONS AccuPSATM assay predicts 5-year BCR- free survival after RP., Identifying a reliable predictor of BCR soon after RP has important implications for frequency of PSA testing, selection of candidates for adjuvant therapy, and reassuring a large subset of men that they are not at risk of recurrence., Larger studies are needed to validate these findings. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To determine whether prostate-specific antigen (PSA) velocity (PSAV), used as a selection criterion for salvage radiotherapy (RT) after radical prostatectomy (RP), predicts the likelihood of response to RT in men with biochemical relapse. Methods: We retrospectively reviewed the records of 48 patients who had undergone salvage RT for biochemical relapse after RP. All men were followed up with serial PSA measurements for a minimum of 6 months from their initial PSA recurrence, and RT was only offered to those patients with a serum PSA level remaining at less than 1.0 ng/mL. The response to RT was defined as maintenance of a PSA level of less than 0.1 ng/mL. The pathologic and clinical parameters, including PSAV, were examined to determine their individual ability to predict the response to RT. Results: Of the 48 patients, 30 had maintained a PSA level of less than 0.1 ng/mL at a median follow-up of 16 months. The PSAV was strongly predictive of the likelihood of a response to salvage RT. The median relapse-free survival time for patients with a PSAV of less than 0.035 ng/mL/mo was 28 months compared with 16 months for patients with a PSAV greater than 0.035 ng/mL/mo. All other parameters tested, including Gleason score, seminal vesicle invasion, extracapsular extension, and margin status, were not predictive of the likelihood of a response to RT. Conclusions: In the present study, PSAV accurately predicted the likelihood of response to salvage RT in men with biochemical relapse after RP. No other pathologic parameters predicted the likelihood of response to RT. Using PSAV as a sole selection criterion for salvage RT after RP may allow improvement in the historically low rates of durable response. [Copyright &y& Elsevier]

Background: Cardiac arrest (CA) due to pulmonary embolism (PE) is associated with low survival rates and poor neurological outcomes. We examined whether Extracorporeal Cardiopulmonary Resuscitation (ECPR) improves the outcomes of patients who suffer from CA due to massive PE.Methods: We retrospectively included 39 CA patients with proven or strongly suspected PE in two hospitals in the Netherlands, in a 'before/after'-design. 20 of these patients were treated with Conventional Cardiopulmonary Resuscitation (CCPR) and 19 patients with ECPR.Results: The main outcomes of this study were ICU survival and favourable neurological outcome, defined as Cerebral Performance Category (CPC) score 1-2. The ICU survival rate in CCPR patients was 5% compared to 26% in ECPR patients (p<0.01). Survival with favourable neurological outcome was present in 0/20 (0%) CCPR patients compared to 4/19 (21%) of the ECPR patients (p<0.05).Conclusion: ECPR seems a promising treatment for cardiac arrest patients due to (suspected) massive pulmonary embolism compared to conventional CPR, though outcomes remain poor. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Bleeding is a common complication following left ventricular assist device (LVAD) implantation. The goal of this study was to investigate the incidence, predictors and clinical outcome of early bleeding events in patients after LVAD implantation. METHODS: A total of 83 patients (age 50 ± 13 years, 76% men) had an LVAD implanted [77% HeartMate II, 19% HeartMate 3 (Abbott, Chicago, IL, USA)] over a period of 11 years. Patients were included consecutively. An early bleeding event was defined as the need for thoracic surgical re-exploration or transfusion with >4 units of packed red blood cells before discharge. RESULTS: Overall, 39 (47%) patients (age 50 ± 14 years, 77% men) experienced an early bleeding event [median time 6 days (interquartile range 1-9 days)]. Furthermore, 10 (26%) of these patients had > _2 bleeding events. Twelve of the 14 (92%) patients with venoarterial extracor- poreal membrane oxygenation (ECMO) support before LVAD implantation experienced an early bleeding event versus 27 of the 69 (39%) patients without ECMO support (P < 0.001). No difference was found in early bleeding rates between HeartMate II and HeartMate 3. Predictors for early bleeding events were lower pre- and postimplant platelet counts and ECMO support preimplantation. After multivariable adjustment, early bleeding events were associated with ECMO support preimplantation (odds ratio 6.3, 95% confidence interval 1.2-32.4; P = 0.03) and thrombocytopenia (<150-109/l) postimplant (odds ratio 5.9, 95% confidence interval 1.9-18.7; P = 0.002). Patients who experienced an early bleeding event had a significantly worse 90-day survival rate compared to patients who did not (79% vs 96%, P = 0.03). CONCLUSIONS: An early bleeding event needing surgical exploration is highly prevalent after LVAD implantation, especially in patients bridged with ECMO and with pre- and postimplant thrombocytopenia. [ABSTRACT FROM AUTHOR]

Over the past decades donor and recipient characteristics and medical management of heart transplantation ( HT) patients have changed markedly. We studied the impact of these changes on long-term clinical outcome. Data of all consecutive HT recipients in our center have been collected prospectively. Cohort A ( n = 353) was defined as the adult pts transplanted between 1984 and 1999 and was compared with cohort B ( n = 227) transplanted between 2000 and 2013. Compared with cohort A, recipients in cohort B had older donors (mean age 29 vs. 43 years, donors aged >50 year: 2% vs. 33%, respectively). Survival at 1 and 10 years in cohort A vs. B was 89% vs. 86% and 53% vs. 68%, respectively ( P = 0.02). Cohort B pts were treated more often with tacrolimus-based immunosuppression (77% vs. 22%; P = <0.0001) and early statins post- HT (88% vs. 18%; P = 0.0001), while renal function was better conserved at 5 and 10 years ( P = 0.001 and 0.02). Multivariate analysis showed significant reduction in 10-year mortality with tacrolimus-based immunosuppression ( HR 0.27 and 95% CI 0.17-0.42), hypertension post-HT ( HR 0.5, 95% CI 0.36-0.72), and revascularization ( HR 0.28, 95% CI 0.15-0.52). In spite of the use of much older donors, the long-term outcome after HT has improved considerably in the last decade, probably due to the introduction of newer treatment modalities. [ABSTRACT FROM AUTHOR]

Background: Evaluate and compare the utility of serum folate receptor alpha (FRA) and megakaryocyte potentiating factor (MPF) determinations relative to serum CA125, mesothelin (MSLN) and HE4 for the diagnosis of epithelial ovarian cancer (EOC). Methods: Electrochemiluminescent assays were developed for FRA, MSLN and MPF and used to assess the levels of these biomarkers in 258 serum samples from ovarian cancer patients. Commercial assays for CA125 and HE4 were run on a subset of 176 of these samples representing the serous histology. Data was analyzed by histotype, stage and grade of disease. A comparison of the levels of the FRA, MSLN and MPF biomarkers in serum, plasma and urine was also performed in a subset of 57 patients. Results: Serum and plasma levels of FRA, MSLN and MPF were shown to be highly correlated between the two matrices. Correlations between all pairs of markers in 318 serum samples were calculated and demonstrated the highest correlation between HE4 and MPF, and the lowest between FRA and MPF. Serum levels of all markers showed a dependence on both stage and grade of disease. A multi-marker logistic regression model was developed resulting in an AUC=0.91 for diagnosis of serous ovarian cancer, a significant improvement over the AUC for any of the individual markers, including CA125 (AUC=0.84). Conclusions: FRA has significant potential as a biomarker for ovarian cancer, both as a stand-alone marker and in combination with other known markers for EOC. The lack of correlation between the various markers analyzed in the present study suggests that a panel of markers can aid in the detection and/or monitoring of this disease. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the time course of perioperative blood glucose levels of children undergoing cardiac surgery for congenital heart disease in relation to endogenous stress hormones, inflammatory mediators, and exogenous factors such as caloric intake and glucocorticoid use. The study prospectively included 49 children undergoing cardiac surgery. Blood glucose levels, hormonal alterations, and inflammatory responses were investigated before and at the end of surgery, then 12 and 24 h afterward. In general, blood glucose levels were highest at the end of surgery. Hyperglycemia, defined as a glucose level higher than 8.3 mmol/l (>150 mg/dl) was present in 52% of the children at the end of surgery. Spontaneous normalization of blood glucose occurred in 94% of the children within 24 h. During surgery, glucocorticoids were administered to 65% of the children, and this was the main factor associated with hyperglycemia at the end of surgery (determined by univariate analysis of variance). Hyperglycemia disappeared spontaneously without insulin therapy after 12-24 h for the majority of the children. Postoperative morbidity was low in the study group, so the presumed positive effects of glucocorticoids seemed to outweigh the adverse effects of iatrogenic hyperglycemia. [ABSTRACT FROM AUTHOR]

Background: Patients with aortic stenosis (AS) should undergo aortic valve replacement (AVR) before irreversible LV dysfunction has developed. Assessment of long-axis left ventricular (LV) function may assist in proper timing of AVR. Objectives: To assess serial changes in long-axis LV function before and after AVR in patients with severe AS and preserved LV ejection fraction. Methods: The study comprised 27 consecutive patients (mean age 64.9 ± 11.7 years, 15 males) with symptomatic severe AS, scheduled for AVR. Seventeen subjects without known cardiac disease, matched for age, gender, LV ejection fraction and cardiovascular risk factors, served as a control group. Long-axis LV function assessment was done with tissue Doppler imaging at 3 weeks, 6 months, and 12 months after AVR. Results: Mean aortic valve area in the AS group was 0.70 ± 0.24 cm. Pre-AVR peak systolic mitral annular velocities were significantly lower compared to controls (6.7 ± 1.5 vs. 8.9 ± 2.0 cm/s, P < 0.05). Post-AVR peak systolic mitral annular velocities improved to 9.1 ± 2.9 at 3 weeks, 8.6 ± 2.7 at 6 months, and 8.1 ± 1.7 cm/s at 12 months (P < 0.05). Improvements were seen over the whole range of pre-AVR peak systolic mitral annular velocities. Patients with improved Sm after AVR (defined as ≥10% compared to baseline values) did not differ in baseline characteristics as compared to those who did not improve. Conclusions: In patients with severe AS and preserved LV ejection fraction, abnormal systolic mitral annular velocities improve after AVR, independent of the pre-AVR value. (Echocardiography 2010;27:1177-1181) [ABSTRACT FROM AUTHOR]

Objectives: This study evaluated the effects of mechanical circulatory support (MCS) on sub-lingual microcirculation as a surrogate for splanchnic microvascular perfusion. Methods: Between May 2008 and April 2009, 10 consecutive patients received an MCS device or extracorporeal membrane oxygenation for end-stage chronic heart failure (n = 6) or cardiogenic shock (n = 4). Microcirculation was investigated using a hand-held Sidestream Dark Field imaging device. Perfused capillary density (PCD) and capillary red blood cell velocity (cRBCv) were assessed before device implantation (T0), immediately after implantation (T1), and 1 day after implantation (T2). Results: Median patient age was 45 years (interquartile range [IQR] 38–52 years) and 70% were men. MCS significantly decreased pulmonary capillary wedge pressure (p = 0.04). Median cardiac power index increased (0.29 [IQR, 0.21–0.34] W/m2 at T0 vs 0.48 [IQR, 0.39–0.54] W/m2 at T1, p = 0.005) as well as median central venous oxygen saturation (54% [IQR, 46%–61%] at T0 vs 78% [IQR, 67%–85%] at T1, p = 0.007). There was a 3-fold increase in tissue perfusion index (sub-lingual PCD × cRBCv) during mechanical circulatory support (573 [IQR, 407–693] at T0 vs 1909 [IQR, 1771–2835] at T1, p = 0.005). Microcirculatory parameters remained improved at T2. Conclusion: Mechanical circulatory support for severe heart failure is associated with a consistent, significant, and sustained improvement in tissue perfusion, as measured at the bedside by a 2-dimensional microcirculation imaging technique. [Copyright &y& Elsevier]

Objective: After cardiac surgery, functional residual capacity (FRC) after extubation is reduced significantly. We hypothesized that ventilation according to the open lung concept (OLC) attenuates FRC reduction after extubation.Design: A prospective, single-center, randomized, controlled clinical study.Setting: Cardiothoracic operating room and intensive care unit of a university hospital.Patients: Sixty-nine patients scheduled for elective coronary artery bypass graft and/or valve surgery with cardiopulmonary bypass.Interventions: Before surgery, patients were randomly assigned to three groups: (1) conventional ventilation (CV); (2) OLC, started after arrival in the intensive care unit (late open lung); and (3) OLC, started directly after intubation (early open lung). In both OLC groups, recruitment maneuvers were applied until Pao2/Fio2 was >375 Torr (50 kPa). No recruitment maneuvers were applied in the CV group.Measurements and Main Results: FRC was measured preoperatively and 1, 3, and 5 days after extubation. Peripheral hemoglobin saturation (Spo2) was measured daily till the third day after extubation while the patient was breathing room air. Hypoxemia was defined by an Spo2 value < or =90%. Averaged over the 5 postoperative days, FRC was significantly higher in the early open lung group and tended to be higher in the late open lung group, in comparison with the CV group (mean +/- sem: CV, 1.8 +/- 0.1; late open lung,1.9 +/- 0.1; and early open lung, 2.2 +/- 0.1l). In the CV group, 37% of the patients were hypoxic on the third day after extubation, compared with none of the patients in both OLC groups.Conclusions: After cardiac surgery, earlier application of OLC resulted in a significantly higher FRC and fewer episodes of hypoxemia than with CV after extubation. [ABSTRACT FROM AUTHOR]

In recent years body composition studies on American Football players have focused on participants at the professional, NCAA Division I and NCAA Division III levels. Recent data utilizing skinfold and hydrostatic weighing to measure the body composition of NCAA Division II football players is currently not available. Purpose: The purpose of the present investigation was to examine the body composition of NCAA Division II football players utilizing both hydrostatic weighing and skinfold measurements. Methods: Sixty-eight NCAA Division II (DII) football players volunteered for this study. Body height (HT), body weight (BW), forced vital capacity and percent body fat were measured. Percent body fat was assessed across all playing positions: offensive line/tightends (OL/TE), defensive line (DL), offensive backs/receivers (OB/WR), defensive backs (DB), linebackers (LB) and quarterbacks/kickers (QB/K) through eight skinfold measurements (chest, abdominal, thigh, calf, subscapular, suprailliac, triceps & biceps) and hydrostatic weighing. Body density was calculated from skinfold measurements utilizing six regression equations with a pooled median value utilized for analysis. Percent body fat was calculated using the Schutte equation for African Americans and the Siri equation for Caucasian athletes. Results: Percent body fat calculated from skinfold measurements: OL/TE = 28.26 ( ± 1.19%) DL = 25.04 ( ± 2.82%) OB/WR = 15.12 ( ± 1.24%) DB = 15.40 ( ± 0.66%) LB = 18.63 ( ± 1.20%) QB/K = 17.86 ( ± 1.70%). Percent body fat calculated from hydrostatic weighing: OL/TE = 25.29 ( ± 1.42%) DL = 22.05 ( ± 3.21%) OB/WR = 11.98 ( ± 1.35%) DB = 12.76 ( ± 1.03%) LB = 14.99 ( ± 1.39%) QB/K = 14.53 ( ± 1.73%). Discussion: Upon inspection, these data show DII football players possessed a higher percentage of body fat when compared to their Division I (DI) counterparts published by Noel, Vanheest, Zaneteas & Rodgers (2003) (See table 1.). Practical Application: These data will allow strength and conditioning professionals and nutritionists to better monitor training and dietary programs of NCAA Division II football players.Table 1. Comparison of percentage of body fat between NCAA Division II football players and NCAA Division I football players. [ABSTRACT FROM AUTHOR]