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Nonoperative management of acute appendicitis is a safe and effective alternative to appendectomy, though rates of treatment failure and disease recurrence are significant. The purpose of this study was to determine whether COVID-19-positive children with acute appendicitis were more likely to undergo nonoperative management when compared to COVID-19-negative peers and to compare clinical outcomes and healthcare use for these groups.A retrospective cohort study of children18 years with acute appendicitis across 45 US Children's Hospitals during the first 12 months of the COVID-19 pandemic was performed. Operative management was defined as appendectomy or percutaneous drain placement, whereas nonoperative management was defined as admission with antibiotics alone. Multivariable hierarchical logistic regression using an exact matched cohort was used to determine the association between COVID-19 positivity and nonoperative management. The secondary outcomes included intensive care unit admission, mechanical ventilation, length of stay, nonoperative management failure rates, and hospital variation in nonoperative management.Of 17,481 children in the cohort, 581 (3.3%) were positive for COVID-19. The odds of nonoperative management was significantly higher in the COVID-19-positive group (adjusted odds ratio [95% confidence interval]: 13.4 [10.7-16.8], P.001). Patients positive for COVID-19 had increased odds of intensive care unit admission (adjusted odds ratio [95% confidence interval]: 3.78 [2.01-7.12], P.001) and longer length of stay (median 2 days vs 1 day, P.001). Hospital rates of nonoperative management ranged from 0% to 100% for COVID-19-positive patients and 0% to 42% for COVID-19-negative patients.Children with concurrent acute appendicitis and COVID-19 positivity are significantly more likely to undergo nonoperative management. Both groups experience infrequent nonoperative management failure rates and rare intensive care unit admissions. Marked hospital variability in nonoperative management practices was demonstrated.

Children undergoing gastrostomy tube placement often have complex medical conditions that can increase caregiver burden and decrease caregiver health-related quality of life. Our goal was to identify changes in health-related quality of life over a 12-month period in the caregivers of these patients.We performed a prospective cohort study of pediatric patients undergoing gastrostomy tube placement. Using the PedsQL 2.0 Family Impact Module, we surveyed the caregivers of these patients at baseline (prior to gastrostomy tube placement) and 1 month, 3 months, 6 months, and 12 months following gastrostomy tube placement. We administered the same survey, at baseline only, to a control group composed of caregivers of pediatric patients undergoing elective hernia repair.We enrolled 130 patients undergoing gastrostomy tube placement and 35 patients undergoing hernia repair. At baseline, these caregivers had significantly lower total health-related quality of life compared to caregivers of children undergoing hernia repair (47.4 ± 16.1 vs 86.0 ± 15.6, P .001). In the first year after gastrostomy tube placement, caregivers had significant increases in total health-related quality of life (P .01) and the physical functioning (P .05), communication (P .05), worry (P .05), and daily activities (P .001) subdomains. A within-subjects analysis comparing scores at baseline and 12 months revealed a significant increase in the total health-related quality of life score over this 1-year period (60.7 ± 18.9 vs 47.4 ± 16.1, P .01). The total health-related quality of life at 12 months, however, remained significantly lower compared to controls (60.7 ± 18.9 vs 86.0 ± 15.6, P .001).Our findings highlight the ongoing caregiver burden associated with children undergoing gastrostomy tube placement and provide evidence of the need for efforts directed at caregiver support post gastrostomy tube placement.

Introducción: Las anomalías de la forma, en niños y niñas, son en gran medida frecuentes, por ello su estudio es importante para precisar diagnósticos, dado que pueden tener diferentes implicancias odontológicas. A la altura de la cúspide mesiopalatina de los segundos molares superiores temporarios, primeros molares superiores permanentes, y con menor frecuencia en los segundos molares superiores permanentes, es posible reconocer una cúspide accesoria o tubérculo denominada de Carabelli (TC).Objetivos: Determinar la prevalencia del TC en pacientes del Hospital de Odontología Infantil (HOI) “Don Benito Quinquela Martín” de Buenos Aires, Argentina. Asimismo, comprender, con respecto a su etiología, si existe alguna relación con el origen étnico de la familia. Para ello se incorporó la variable nacionalidad de los padres para examinar el posible vínculo entre la presencia del TC y la procedencia étnica del paciente.Materiales y Métodos: Se evaluó una muestra de 363 niños que ingresaron por primera vez al Servicio de Clínica y Orientación del HOI durante el período comprendido entre agosto 2019 y marzo 2020.Resultados: La prevalencia del TC observada fue del 34 %, por lo menos en alguna de las piezas dentarias, con una mayor tendencia en el sexo masculino en un 55%, y un 45% en el sexo femenino.Conclusiones: La hipótesis propuesta fue que la prevalencia del TC en los pacientes que acuden al del HOI es inferior al 50 % y fue validada debido a que el 34% de los pacientes presentan el TC.

This cohort study uses administrative health data to evaluate trends in pediatric firearm injuries before and during the COVID-19 pandemic.

Differential access to specialty surgical care can drive healthcare disparities, and interhospital transfer (IHT) is one mechanism through which access barriers can be realized for vulnerable populations. The association between race/ethnicity and IHT for patients presenting with complex emergency general surgery (EGS) disease is understudied.Using the 2019 Nationwide Emergency Department Sample, we identified patients aged ≥18 years with 1 of 13 complex EGS diseases based on International Classification of Diseases 10th Edition Diagnosis Codes. The primary outcome was IHT. A series of weighted logistic regression models were created to determine the association of race/ethnicity with the primary outcome while controlling for patient and hospital characteristics.Of 387,610 weighted patient encounters from 989 hospitals, 59,395 (15.3%) patients underwent IHT. Compared to Non-Hispanic White (NHW) patients, rates of IHT were significantly lower for Non-Hispanic Black (NHB) (15% vs. 17%, unadjusted odds ratio (uOR) [95% CI]: 0.58 [0.49 - 0.68], p.001), Hispanic/Latinx (HL) (9.0% vs. 17%, uOR [95% CI]: 0.48 [0.43 - 0.54], p.001), Asian/Pacific Islander (Asian/PI) (11% vs. 17%, uOR [95% CI]: 0.84 [0.78 - 0.91], p.001), and other race/ethnicity (12% vs 17%, uOR [95% CI]: 0.68 [0.57 - 0.81], p.001) patients. In multivariable models, the adjusted odds of IHT remained significantly lower for HL (aOR [95% CI]: 0.76 [0.72 - 0.83], p.001) and Asian/PI (aOR [95% CI]: 0.73 [0.62 - 0.86], p.001) patients, but not for NHB and other race/ethnicity patients (p.05).In a nationally representative sample of Emergency Departments across the United States, patients of minority race/ethnicity presenting with complex EGS disease were less likely to undergo IHT when compared to NHW patients. Disparities persisted for HL and Asian/PI patients when controlling for comorbid conditions, hospital and residential geography, neighborhood socioeconomic status, and insurance; these patients may face unique barriers in accessing surgical care.Level III, Prognostic/Epidemiological.

It Comes In Waves is a narrative-based Twine game prototype about being an essential worker during the ongoing pandemic. It takes as its focus the role social class plays in relation to COVID-19 protocols surrounding workplaces and the subsequent effects these have on everyday life. You play as Beattie, a low-paid caregiver at two different long-term care facilities during the first few months of the pandemic, navigating the challenges of trying to stay safe while doing her two jobs and maintaining social contact with her friends and family. There were two central design goals for the game: first to show how social class inflects our daily experiences, including our employment prospects, opportunities in life, living experiences, and hopes for the future; and second to avoid the trap of becoming either an “empathy machine” or a misery simulator.

Class depictions in videogames are prevalent, yet understudied. In this article, we analyse how the working class – particularly working-class men – have been depicted in videogames over the past 30 years. In doing so, we bring together a class- and gender-based analysis to study how narratives, representations, gameplay, and game systems construct the “working-class hero” as a central protagonist. This is done by examining eight paired examples of videogames that feature working-class characters in central roles, including janitor, fire-fighter, taxi driver, and bartender. Our analysis finds that some roles are glorified (such as firefighters), positioning their protagonists in direct conflict with white-collar settings and antagonists. However, many other roles task players with “doing their job” in the face of repetitive (and sometimes outlandish) working conditions. Through these examples, we document the portrayal of working-class videogame heroes, noting how videogames can both reinforce and subvert common media tropes.

Significant racial and ethnic disparities exist for children presenting with acute appendicitis; however, it is unknown if disparities persist after initial management and hospital discharge.We performed a retrospective cohort study of children (aged18 y) who underwent treatment for acute appendicitis in 47 U.S. Children's Hospitals between 2017 and 2019. Primary outcomes were 30-d emergency department (ED) visits and 30-d inpatient readmission. Hierarchical multivariable logistic regression models were developed to determine the association of race and ethnicity on the primary outcomes. Inverse odds-weighted mediation analyses were used to estimate the degree to which complicated disease, insurance status, urbanicity, and residential socioeconomic status- mediated disparate outcomes.A total of 67,303 patients were included. Compared with Non-Hispanic White children, Non-Hispanic Black (NHB) (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.23-1.59) and Hispanic/Latinx (HL) children (OR 1.55, 95% CI 1.44-1.67) had higher odds of ED visits. Only NHB children had higher odds of readmission (OR 1.43, 95% CI 1.30-1.57). On a multivariable analysis, NHB (adjusted OR 1.19, 95% CI 1.04-1.36) and HL (adjusted OR 1.19, 95% CI 1.09-1.31) children had higher odds of ED visits. Insurance, disease severity, socioeconomic status, and urbanicity mediated 61.6% (95% CI 29.7-100%) and 66.3% (95% CI 46.9-89.3%) of disparities for NHB and HL children, respectively.Children of racial and ethnic minorities are more likely to visit the ED after treatment for acute appendicitis, but HL patients did not have a corresponding increase in readmission. These differences were mediated mainly by insurance status and urban residence. A lack of appropriate postdischarge education and follow-up may drive disparities in healthcare utilization after pediatric appendicitis.

El objetivo de este trabajo radicó en investigar el consumo de tabaco en adolescentes de la Ciudad Autónoma de Buenos Aires e indagar acerca de su relación con variables sociodemográficas y la deseabilidad social (DS). Los participantes fueron 302 adolescentes escolarizados de entre 13 y 18 años (M = 15.57, DE = 1.75). El 45.4% eran mujeres. De los análisis se desprende que casi la mitad de los evaluados (41.7%) había probado alguna vez un cigarrillo, y que, de ellos, el 27.2% consumían tabaco actualmente. Los consumidores leves representaron más del 62% de los fumadores, mientras que los consumidores severos representaron menos del 3% de la muestra. La edad de inicio fue de 10 años o menos para el 34.9% y, de entre 11 y 15 años para el 51.6%. El consumo mayoritario de esta muestra podría encuadrarse como recreativo. Además, los adolescentes que consignaron haber consumido cigarrillo, los que consumieron al menos 100 en su vida y los que reportaron no verse molestos por el humo del cigarrillo mostraron valores significativamente superiores de deseabilidad social (DS), en comparación al resto. La cantidad de cigarrillos consumidos diariamente covarió positiva y significativamente con los niveles de DS. Quienes tenían más de la mitad de amigos que fumaban tenían también mayor DS. No se hallaron asociaciones significativas entre DS y la edad del primer cigarrillo, ni tampoco diferencias al comparar los grupos definidos por las variables relativas al motivo por el cual el adolecente comenzó a fumar, su opinión sobre qué es el consumo de tabaco, ni sobre la información recibida sobre el tabaquismo. Se discuten los resultados a la luz de los inconvenientes relacionados con el consumo tabáquico, las necesidades de agradar al otro y comportarse conforme a lo esperado en su contexto, y teorizaciones sobre maduración cognitiva y motivacional, el fenómeno del conformismo grupal y el modelado. Fil: Iantorno, Alejandro. Universidad de Flores; Argentina Fil: de la Iglesia, Guadalupe. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad de Palermo, Universidad de Buenos Aires; Argentina Fil: Cuenya, Lucas. Laboratorio de Psicología Experimental y Aplicada, Instituto de Investigaciones Médicas, IDIM – CONICET, Universidad de Buenos Aires; Argentina

The role of NADPH oxidase subunit, gp91phox (NOX2) in development of oxidative stress and cardiac dysfunction due to iron (Fe)-overload was assessed. Control (C57BL/6J) and gp91phox knockout (KO) mice were treated for up to 8 weeks with Fe (2.5 mg/g/wk, i.p.) or Na-dextran; echocardiography, plasma 8-isoprostane (lipid peroxidation marker), cardiac Fe accumulation (Perl’s staining), and CD11b+ (WBCs) infiltrates were assessed. Fe caused no adverse effects on cardiac function at 3 weeks. At 6 weeks, significant declines in left ventricular (LV) ejection fraction (14.6% lower), and fractional shortening (19.6% lower) occurred in the Fe-treated control, but not in KO. Prolonging Fe treatment (8 weeks) maintained the depressed LV systolic function with a trend towards diastolic dysfunction (15.2% lower mitral valve E/A ratio) in controls but produced no impact on the KO. Fe-treatment (8 weeks) caused comparable cardiac Fe accumulation in both strains, but a 3.3-fold elevated plasma 8-isoprostane, and heightened CD11b+ staining in controls. In KO mice, lipid peroxidation and CD11b+ infiltration were 50% and 68% lower, respectively. Thus, gp91phox KO mice were significantly protected against oxidative stress, and systolic and diastolic dysfunction, supporting an important role of NOX2-mediated oxidative stress in causing cardiac dysfunction during Fe overload.

Patients undergoing percutaneous coronary intervention (PCI) often have high-bleeding-risk (HBR) factors. Dual antiplatelet therapy (DAPT) further increases this risk of bleeding. We sought to compare clinical outcomes according to presence or absence of HBR factors in patients with elevated ischemic risk (DAPT score ≥ 2) undergoing PCI. We evaluated all patients undergoing PCI at MedStar Washington Hospital Center (January 2009 to July 2018) with DAPT score ≥2, which is associated with elevated risk of ischemic events. Patients were categorized as HBR group (HBR score ≥1) or low-bleeding-risk (LBR) group (HBR score = 0). Outcomes included major adverse cardiac events such as target vessel revascularization, stent thrombosis, death, and bleeding events at 30 days, 6 months, 1 year, and 2 years. The final cohort consisted of 7,499 patients: 3,949 patients had LBR features, and 3,550 patients had HBR features. The 2 groups were different at baseline, with HBR patients being older and having a higher prevalence of congestive heart failure and renal dysfunction than the LBR group. The mean DAPT score was 2.96±1.1 for the LBR group and 3.7±1.4 for the HBR group (p0.001). During follow-up at 30 days, 6 months, and 1 and 2 years, the rates of target vessel revascularization and stent thrombosis were not significantly different between the 2 groups. Bleeding events and all-cause mortality were significantly more frequent in the HBR group than in the LBR group. In conclusion, patients undergoing PCI often have pre-existing risk factors that predispose them to ischemic and bleeding complications. Prolonged duration of DAPT to mitigate ischemic events could lead to a disproportionate increase in bleeding events, especially in HBR patients.

Objective To determine if mother’s own milk (MOM) dose after gastroschisis repair is associated with time from feeding initiation to discharge. Secondary outcomes included parenteral nutrition (PN) duration and length of stay (LOS). Study design Retrospective study of 44 infants with gastroschisis examined demographics, gastroschisis type, PN days, timing of nutrition milestones, feeding composition, and LOS. Results MOM dose was significantly associated with shorter time to discharge from feeding initiation (adjusted hazard ratio [HR] for discharge per 10% increase in MOM dose, 1.111; 95% CI, 1.011–1.220, p = 0.029). MOM dose was also significantly associated with shorter LOS (adjusted HR for discharge per 10% increase in MOM dose, 1.130; 95% CI, 1.028–1.242, p = 0.011). Conclusions MOM dose was significantly associated with a decrease in time to discharge from feeding initiation and LOS in a dose-dependent manner. Mothers of gastroschisis patients should receive education and proactive lactation support to optimize MOM volume for feedings.

It is estimated that each year in the United States780,000 persons will experience an acute coronary syndrome. Approximately 70% of these will have non-ST-elevation myocardial infarction (NSTEMI). Optimal timing of angiography in NSTEMI is a matter of debate. The aim of this retrospective analysis was to evaluate whether and how the timing of percutaneous coronary intervention (PCI) affects the 1-year rate of major adverse cardiac events (MACE) in patients presenting with NSTEMI. Within our PCI database, we identified 1550 patients who underwent PCI for NSTEMI. We then divided the population into 3 groups based on door-to-balloon time (D2BT) (group 1 = D2BT90 minutes; group 2 = D2BT90 minutes24 hours; group 3 = D2BT24 hours). Primary outcome was MACE, a composite of MI, death and target vessel revascularization (TVR), or TVR at 1 year. Baseline characteristics were heterogeneous among the 3 groups, with patients who underwent angiograms24 hours from presentation being older with more cardiovascular co-morbidities. Patients with D2BT90 minutes were more likely to present with cardiogenic shock and had higher troponin levels. In-hospital mortality was similar among the 3 groups, but 1-year MACE/TVR was significantly higher in groups 1 and 3, driven by worse mortality. In this large cohort of patients presenting with NSTEMI, patients who underwent PCI between 90 minutes to 24 hours from presentation had better 1-year outcomes but also had fewer co-morbidities and with significantly lower prevalence of cardiogenic shock and high troponin on presentation. Therefore, treatment selection bias makes causal inference concerning rapid revascularization and outcome unreliable. Randomized clinical trials are warranted to assess outcome of rapid revascularization in patients presenting with NSTEMI.

The strict emission standards for port approach and coastal navigation, and the fuel-saving requirements, in the marine sector, are pushing the manufactures to consider more advanced and alternative propulsion systems. In this context, this study deals with the design and management of an innovative hybrid thermal-electric propulsion system. The evaluations are referred to the case study of a leisure boat, which is used for passenger transportation in tourist areas. Experimental tests are carried out on single components, with a particular focus on re-calibration of the thermal engine, for its homologation and optimal use in the proposed hybrid architecture. The identification of proper management strategies is performed on the basis of a boat simulation model, which is set up starting from experimental data and characteristics of components. In this regard, an optimization procedure, based on the use of genetic algorithms, is performed in order to set the parameters of onboard energy management strategies and pursue the double objective of extending battery pack cycling life and reducing exhaust emissions. The obtained simulation results highlight the benefits of the proposed architecture showing sensible improvements in comparison with a traditional ICE based configuration. The methodology proposed in this paper enables reliable evaluations and preliminary optimization of energy management strategies, with a drastic reduction in experimentation time and general costs.

L’internet et les vecteurs de diffusions d’images se sont développés sans un accompagnement à une sensibilisation au sens des représentations visuelles. Sans mode d’emploi cognitif à la production du sens, les lecteurs peuvent être à la merci de toutes les formes de manipulations. Il apparait urgent aujourd’hui de former nos élèves à l’analyse d’images. Une telle éducation à l’image ne peut être, à mon sens, qu’une éducation à la compréhension de l’image par la médiation du récit. Au travers de la création et la mise en oeuvre d’une séquence didactique portant sur un album sans texte, il s’agit de décrire les conditions de production du sens d’un récit, par des élèves, à partir de ses composantes iconographiques. Ainsi, du point de vue didactique, il est question de s’appuyer sur les outils conceptuels pensés pour la compréhension de texte et transposés à une compréhension plus globale qui est celle du récit.

Character backgrounds are one of many elements players use to customize their protagonists in fantasy computer role-playing games. By documenting the narrative trappings, mechanical benefits, and hierarchical availability of character backgrounds in Arcanum: Of Steamworks and Magick Obscura (2001) and Dragon Age: Origins (2009), this paper considers how real-world socioeconomic class markers and racial stereotypes have been repeatedly associated with fictitious races such as orcs, dwarves, and elves. Class is an understudied axis of identity in media studies and this research scrutinizes how developers construct socioeconomic class, particularly through character-creator interfaces. We begin by building a theoretical repertoire for studying identity in digital game interfaces while also scrutinizing long-established discourses of race and gender in the fantasy genre. We then analyze the hierarchies embedded in both games’ character creators, connecting them with broader gameplay and narrative themes and contextualizing them in established media stereotypes and existing scholarship.

Smart grids (SG) have been successfully deployed in several countries. In Brazil, the main agency for the wide(r) SG deployment are the electricity companies that operate under federal or state government concession. This paper presents a framework for sharing the SG communication infrastructure with smart city applications. This sharing would accelerate the development and implementation of new applications, especially in less developed countries or in regions with scarce communication resources. We present preliminary performance results for an existing SG. Our results indicate that, with only the energy metering application, the network operates with a duty cycle of less than 2%. Our work will assess the impact on overall performance of smart city applications sharing the SG.

Percutaneous coronary intervention (PCI) has evolved dramatically, along with patient complexity. We studied trends in in-hospital mortality with changes in patient complexity over the last decade stratified by clinical presentation. The study population included all patients presenting to the cardiac catheterization lab between January 2009 and July 2018. Expected in-hospital mortality was calculated using the National Cardiovascular Data Registry CathPCI risk scoring system. Yearly mean in-hospital mortality rates (%) were plotted and smoothed by weighted least squares regression for each presentation: ST-elevation myocardial infarction (STEMI), non-ST-elevation acute coronary syndrome (NSTE-ACS), and stable ischemic coronary artery disease (SI CAD). The overall cohort included 13,732 patients who underwent PCI during the study period, of whom 2,142 were for STEMI, 2,836 for NSTE-ACS, and 8,754 for SI CAD. Indications for PCI have changed over time, with more PCIs being performed for NSTE-ACS and STEMI than for SI CAD. NSTE-ACS and STEMI patients had a steady decrease in in-hospital mortality over time compared with SI CAD patients. Overall observed mortality continues to decrease in NSTE-ACS patients, with reduction in the observed mortality rate within the STEMI population to below expected since 2013. Patient complexity has not changed significantly. These results may be attributed to improved patient selection coupled with optimal pharmacotherapy with more robust therapies during procedure and hospitalization.

INTRODUCTION The Civil Rights Act prohibits employers from making employment decisions based on sex, race, color, religion, or national origin. Questions regarding these topics during a residency interview are therefore prohibited. METHODS A questionnaire was sent to all female orthopaedic surgeons who had an e-mail address in the American Academy of Orthopaedic Surgeons directory. Participants were asked to describe what, if any, inappropriate questions they were asked during interviews. RESULTS Four hundred eighty-eight of 997 invited female orthopaedic surgeons completed the questionnaire (48.9%). Their residency interviews took place from 1971 to 2015. Overall, 61.7% of participants were asked an inappropriate question during an interview. This proportion neither increased nor decreased from 1971 to 2015 (P = 0.315). The most common themes of questions included "raising children during residency" (37.9%), "marital status" (32.4%), and "pregnancy during residency" (29.7%). Of those who were asked an inappropriate question, only 1.4% reported the inappropriate question to authorities. DISCUSSION The present study suggests that over half of female applicants have been asked inappropriate questions at orthopaedic surgery residency interviews, and that there has been no improvement in that percentage over nearly five decades. It is the responsibility those interviewing to be aware of this issue and to be in compliance with national guidelines. LEVEL OF EVIDENCE Level IV.

Background/purpose Optical coherence tomography (OCT) is a high-resolution intravascular imaging modality used to assess coronary arteries and as an adjunctive tool for optimization of percutaneous coronary interventions. Overall, the rate of complications and adverse events related to intravascular imaging is low. Limited data exist on the most commonly reported complications and modes of failure related to the use of OCT. Therefore, we analyzed the post-marketing surveillance data from the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database to assess the reported complications and failure modes for OCT and reviewed techniques to optimize device use. Methods/materials The MAUDE database was queried for all event reports involving coronary OCT devices. Two independent reviewers identified 49 device reports included in the final analysis. Modes of failure and device-related patient complications were assessed. Results Of the 49 cases with reported device-related issues, 6.1% involved malfunction prior to insertion of the OCT catheter, and 30.6% of reported events did not result in an associated patient-related adverse event. The most commonly reported adverse events included coronary dissection and difficulty removing the catheter within a previously stented segment. No events of contrast-induced nephropathy were reported. Conclusions Findings from the MAUDE database highlight the modes of device-related events associated with OCT. Device issues are uncommon, and as a result, users should be aware of optimal techniques to prevent and minimize adverse events related to device use.

Background/purpose Right ventricular (RV) mechanical circulatory support remains an important adjunctive therapy for RV failure refractory to medical therapy. Impella RP (Abiomed, Danvers, MA) is approved for providing temporary RV support for patients with acute right heart failure or decompensation following left ventricular assist device implantation, myocardial infarction, heart transplant, or open-heart surgery. Robust data on the most commonly reported complications and failure modes for the Impella RP are lacking. We analyzed the post-marketing surveillance data from the Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database to assess these endpoints. Materials/methods The MAUDE database was queried for the time period January 1, 2009, through December 31, 2018, for Impella devices by Searching for the following event types: “injury”, “malfunction”, “death”, and “other”. The search yielded 436 device reports. Impella RP medical device reports were screened, and 35 reports were included for the final analysis. Results In cases of reported complications, Impella RP was placed most commonly for right ventricular failure (RVF) developing in postcardiotomy patients (20%). The most commonly reported complications included bleeding (42.9%) and vascular complications (22.8%). The modes of failure included damage or fracture of the device elements (34.2%); thrombus, or clot in the system (17.1%); and device detachment (8.6%). Conclusions Findings from the MAUDE database highlight the failure modes of the Impella RP device that should be addressed in order to improve the device performance and obtain improved clinical outcomes when utilized for RVF.

On June 12, 2018, the US Food and Drug Administration (FDA) convened a meeting of the Circulatory System Devices Panel to advise on the safety and effectiveness of the INCRAFT® AAA Stent Graft System for the treatment of abdominal aortic aneurysms (AAA) and to consider a premarket approval application sponsored by Cordis, Inc., for Unique identifier: NCT01664078 based on the results of the pivotal INSPIRATION trial (URL: https://clinicaltrials.gov/ct2/show/NCT01664078). The INCRAFT® AAA Stent Graft System is designed for endovascular repair of infrarenal AAAs with complex aortic anatomies. The stent-graft system utilizes nitinol stent and polyester graft technology in an ultra-low profile delivery system, with the goal of isolating the aneurysmal sac and preventing sac rupture. The multicenter, prospective, non-randomized investigation trial met its primary composite safety and effectiveness endpoints but also showed higher-than-anticipated rates of stent fracture and endoleaks. The committee discussion focused on how these events impact the long-term safety and effectiveness, as well as the benefit/risk profile, of the device. While the panel acknowledged the risk of the device, the panel's final vote supported that the benefits of the INCRAFT AAA Stent Graft System outweigh the risks and that a post-marketing study should be mandated. The FDA approved the device for use in complex access anatomies in December 2018.

Percutaneous coronary intervention (PCI) in patients with angiographic evidence of intracoronary thrombus is associated with in-hospital and 30-day adverse clinical outcomes. Cangrelor, a direct, rapid-onset acting intravenous P2Y12 receptor inhibitor, has been proved to be effective by reducing peri-PCI ischemic complications in subjects who underwent PCI. This study aimed to assess the angiographic and in-hospital clinical outcomes in all-comer patients receiving cangrelor immediately before PCI at a tertiary care center. The study analyzed consecutive unselected subjects treated with cangrelor at the time the decision was made to proceed with PCI. At the end of the procedure, all patients were transitioned to oral antiplatelet therapy. The target lesion angiographic assessment of Thrombolysis in myocardial infarction flow grade (TIMI-Flow), TIMI-thrombus grade (TIMI-Thrombus), myocardial blush grade, and TIMI-myocardial perfusion grade (TMPG) was performed before and post-PCI. Clinical events were recorded during the procedure and at discharge. In total, 223 patients (244 lesions) were included in the analysis (106, 97, and 20 patientswith TIMI-Flow 0/1, TIMI-Flow 2/3, and cardiogenic shock, respectively). The overall mean age was 63 ± 12 years, 70% men and 38% with diabetes mellitus. Acute myocardial infarction was the main presentation (72%). The use of cangrelor improved TIMI-Flow, MGB, TMPG, and TIMI-Thrombus in patients with initial TIMI-Flow 0 to 2. Major bleeding rate was 2.0%. In conclusion, cangrelor was effective and safe in restoring TIMI-Flow 3, reducing thrombus burden and improving myocardial blush grade and TMPG when administered to unselected subjects who underwent PCI. Therefore, cangrelor should be considered in patients presenting with intracoronary thrombus before intervention.

BACKGROUND/PURPOSE Appropriate patient selection for mechanical circulatory support following percutaneous coronary intervention (PCI) remains a challenge. This study aims to evaluate the role of coronary perfusion pressure and other left ventricular hemodynamics to predict cardiovascular collapse following PCI. METHODS/MATERIALS We retrospectively analyzed all patients who underwent PCI for acute coronary syndrome (ACS) from 2003 to 2016. Coronary perfusion pressure was calculated for each patient and defined as the difference in mean arterial pressure and left ventricular end diastolic pressure (LVEDP). Logistic regression analysis was performed to determine predictor of composite outcome of in-hospital mortality, myocardial infarction (MI), congestive heart failure (CHF), and cardiogenic shock. RESULTS Nine hundred twenty-two patients were analyzed. Two-hundred twenty-eight (25%) presented with ST-elevation MI (STEMI) while 694 (75%) underwent PCI for unstable angina or non-Q-wave MI. The mean LVEDP was significantly higher in the STEMI patients (24 ± 9 vs. 19 ± 8 mm Hg, p

Established almost 100 years ago, the Toronto Maple Leafs hockey team is known for their large, dedicated fan base called Leafs Nation. I am a devoted member of this nation and, as such, the team’s communication practices speak both to me, and about me. This major research paper (MRP) is an analysis of e-mails sent to a subscriber-only list in the context of marketing. Researching the e-mail communication from the Toronto Maple Leafs to their fan base lends itself to an understanding of the communication that occurs in a professional setting. Not only do the Toronto Maple Leafs communicate directly with their proactive fan base but I argue that the way in which they do this instills a sense of community within Leafs Nation through the use of themes, metaphors and rhetorical tropes. Communicating effectively with a fan base is an essential component in running a sports organization. Texts in the form of words and images do not only assist in getting an organization’s message to the supporters, but their connotative meanings can also contribute to the senses of community and belonging. This paper will examine how the Toronto Maple Leafs employ rhetorical devices in the e-mail newsletters sent out to Leafs Nation, as well as analyzing the rhetorical connotations in these devices. Also, I will be examining the way in which the use of rhetorical devices contributes to the creation of an online ‘imagined community,’ a concept first introduced by Benedict Anderson in 1936 in the context of nations and nationalism. Anderson stated that an imagined community does not conform to traditional ideals of a community and is constructed by those that see themselves as being a part of this community, and I see the Leafs Nation as conforming to the ideals detailed by Anderson. As such, I will be completing a qualitative textual analysis of 43 e-mails that have gone out to the subscriber-only fan list since 2012. By examining these e-mails I will attempt to identify the presence of the rhetorical devices of pathopoeia, scesis onomaton and principle of scarcity and the overall frequency with which they appear. Based on the data that emerges from my research, I will then attempt to draw correlations between the findings and attempt to link the presence of rhetorical devices as a contributing factor to the creation of Leafs Nation as an online imagined community through a qualitative textual analysis.

Objective: Characterization of COVID-19 in the Latinx community is necessary for guiding public health initiatives, health system policy, clinical management practices, and improving outcomes. Our aim was to describe the socioeconomic background and clinical profile of patients with COVID-19 at a large public hospital in Los Angeles to improve health disparities leading to poor outcomes during the pandemic. Design, Setting and Participants: A single center retrospective cross-sectional study of all patients with a positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who presented to Los Angeles County (LAC)+University of Southern California (USC) Medical Center between March 15, 2020 and April 30, 2020. Methods: We describe patient characteristics, socioeconomic factors, laboratory findings, and outcomes of the first 278 patients to present to LAC+USC Medical Center with COVID-19. Results: Patients self-identified as Hispanic (82.4%) or non-Hispanic (17.6%). Hispanic patients presented later from symptom onset (6 days vs 3 days, P = 0.027) and had higher post-intubation mortality (40.9% vs. 33.3%, P = 1), intensive care unit (ICU) mortality (31.1% vs. 22.2%, P = 0.87), and overall mortality (11.1% vs 10.2%, P = 1). However, the difference in admission rates, mechanical ventilation rates, and overall mortality rates were not statistically significant. A majority of patients, 275/278 (98.9%), reported residency ZIP codes in areas of higher population density, higher percentage of Latinx, born outside the United States, lower median income, and lower high school graduation rate when compared to the rest of Los Angeles County. Regression analysis within the Hispanic cohort found that age, history of hypertension, history of diabetes, lactate dehydrogenase (LDH), and C-reactive protein (CRP) were predictors of mechanical ventilation and mortality. Conclusion: We show the Latinx community has been disproportionally affected by the pandemic in Los Angeles and we identified multiple socioeconomic and clinical characteristics that predispose this population to COVID-19 infection. This study highlights the need for change in local and national strategies to protect vulnerable communities during public health outbreaks.

Global growth of distributed generation, especially photovoltaic, has given rise to new markets and new problems: large injection of power at daily intervals without increasing in the level of consumption. This scenario has already created, in certain places, overvoltage problems, harmonic distortion, etc. In Brazil, the standards regulate the connection of photovoltaic inverters, however, the control is not yet subject to standardization. For this reason, this paper presents a proposal of local and central algorithms for this power injection control in accordance with the solutions of problems such as the lack of standardization in the communication protocol of the inverters. The results of the pilot plant application are also presented.

BACKGROUND: The variability of parenteral nutrition (PN) utilization for pediatric inpatients is currently unknown. The purpose of this study is to determine the variability in PN utilization in U.S. children’s hospitals and the association of PN utilization with inpatient healthcare utilization. METHODS: We performed a retrospective cohort study of children who received PN during an inpatient encounter in U.S. children’s hospitals. Hospitals were divided into tertiles based on their rates of PN utilization into low (51.8/1,000 encounters) categories. Multivariable regression models were developed to assess the associations between hospital PN utilization and time to PN initiation, PN duration, and encounter length of stay after adjustment for salient patient characteristics. RESULTS: The cohort included 82,142 patients receiving PN, and rates of hospital PN utilization ranged from 5.9 to 76.7 encounters receiving PN per 1,000 inpatient encounters. After multivariable adjustment, patients treated at high utilization hospitals had a significantly shorter time to initiation of PN compared to low utilization hospitals (incident rate ratio [95% Confidence Interval]: 0.78 [0.69–0.89], p

This article relates to the 2018 CSDH/SCHN conference proceedings. This paper outlines Michael Iantorno’s and Melissa Mony’s experiences with quantitative game analysis by summarizing the first year of development of the prototype ludomusicological database GameSound. To further the discussion, this article also summarizes and analyzes the work of fellow digital humanities scholar Jason Bradshaw, who applied intriguing types of tool-based analysis to 'BioShock Infinite'. To conclude, the paper hypothesizes where this type of research could lead in the future: both for GameSound and for other projects using similar methods and methodologies. Résumé Cet article présente les expériences de Michael Iantorno et de Melissa Mony faites avec des analyses de jeu quantitatives, en résumant la première année de développement de la base de données prototype ludomusicale GameSound. Pour approfondir la discussion, cet article résume et analyse également l’oeuvre de Jason Bradshaw et de Dr. Adrienne Shaw, qui emploient des types intrigants d’analyses de jeu quantitatives et qualitatives dans leurs propres projets, respectivement la 'BioShock Infinite and Feminist Theory : A Technical Approach et The LGBTQ Video Game Archive'. Pour conclure, cet article formule une hypothèse concernant l’avenir de ce genre de recherche : non seulement pour GameSound mais aussi pour d’autres projets qui se servent de méthodes et de méthodologies similaires. Mots-clés: études de jeux; la ludomusicologie; humanités numériques; recherche quantitative; bases de données

El trabajo de investigación aquí desarrollado parte de la comparación de dos autores aparentemente distantes: Gabriel García Márquez, colombiano, de fama mundial, premio Nobel de literatura e 1982 y Sergio Atzeni, un escritor de culto que ha suscitado un interesante debate cultural a escala nacional italiana. En el presente estudio se han comparado dos obras, una de cada uno de ellos, respectivamente: Cien años de soledad y Passavamo sulla terra leggeri Dicha comparación se efectúa porque se cree que existe una evidente influencia del primero sobre el segundo y se quiere resaltar las implicaciones de esta ascendencia sobre la obra del sardo.La metodología utilizada aquí es la propia de la investigación en literatura comparada. La Tesis consta de cuatro capítulos realizados con dicha orientación contrastiva. En el primero se analiza el contexto histórico, político, geográfico, social y cultural en el que vivieron los dos autores. En el segundo y tercer capítulo se han analizado estructuralmente las dos obras. El cuarto capítulo es un análisis comparativo entre las dos obras.

Pietro Castellan,1 Michele Marchioni,2 Roberto Castellucci,1 Piergustavo De Francesco,2 Romina Iantorno,1 Luigi Schips,1,2 Luca Cindolo1 1Department of Urology, ASL02 Abruzzo, Chieti, Italy; 2Department of Urology, University “G. d’Annunzio”, Chieti, Italy Abstract: In recent years, therapeutic advances, together with new medication sequences and combinations, have improved outcomes for prostate cancer. For a long time, androgen deprivation therapy (ADT) has been the standard of care for newly diagnosed, metastatic prostate cancer, first as a standalone therapy and then in combination with taxane-based regimens. More recently, the addition of abiraterone acetate to ADT to achieve complete androgen blockade has proven beneficial for the treatment of metastatic hormone-resistant prostate cancer and metastatic hormone-sensitive prostate cancer (mHSPC). In this review, we summarize recent findings on the early use of abiraterone in mHSPC and discuss survival benefits as reported in clinical trials. On the basis of existing data, abiraterone in combination with ADT could be considered a new standard of care for patients affected by mHSPC. Keywords: prostate cancer, metastatic hormone-sensitive prostate cancer, androgen receptor, hormonal therapy, abiraterone acetate, prostate castration naïve