Search

This paper introduces a new scale to measure cognitive cultural differences, drawing on the theory of analytic versus holistic thought. Examining culture from a cognitive perspective is a challenge to traditional values-based approaches. Existing measures based on this framework are methodologically problematic and warrant renewal. This paper presents development and validation studies for a new instrument that measures analytic versus holistic cognitive tendencies at the individual level. The scale assesses four previously established dimensions: attention, causality, contradiction, and change. The present work follows well-established scale development protocols and the results show that the 16-item Holistic Cognition Scale (HCS) is a valid and reliable measure of analytic versus holistic thought. Three new studies with four unique samples (N = 41; 272; 454; and 454) provide evidence to support the content validity, reliability, and factor structure of the new instrument, as well as its convergent, discriminant, and concurrent validity against comparable constructs. Convergent validity is established against measures of compromise, intuition, complexity, and collectivism; predictive validity is established against Hofstede’s (1980) five cultural value dimensions; and discriminant validity is established using the average variance extracted from a confirmatory factor analysis. The new HCS is an improvement over previous attempts with a balanced number of forward- and reverse-scored items, superior reliability, less redundancy, and stronger factor loadings.

Abstract. We propose that two aspects of leadership, perceived respectful leadership and the degree of leaders’ prototypicality, positively affect employee proactivity. A multisource and multilevel field study of 234 employees supervised by 62 leaders shows that respectful leadership relates positively to employee proactivity in terms of personal initiative and that leader group prototypicality diminishes this effect. Moreover, perceived respectful leadership and prototypicality substitute for one another in their relation to follower proactivity. This study contributes to previous research that shows leader–follower relationships enhance proactivity by showing the impact of perceived respectful leadership and leader group prototypicality.

Objective: This study explored the outcome of applying red/near-infrared light therapy using light-emitting diodes (LEDs) pulsed with three different frequencies transcranially to treat traumatic brain injury (TBI) in Veterans. Background: Photobiomodulation therapy (PBMT) using LEDs has been shown to have positive effects on TBI in humans and animal models. Materials and methods: Twelve symptomatic military Veterans diagnosed with chronic TBI >18 months post-trauma received pulsed transcranial PBMT (tPBMT) using two neoprene therapy pads containing 220 infrared and 180 red LEDs, generating a power output of 3.3 W and an average power density of 6.4 mW/cm2 for 20 min, thrice per week over 6 weeks. Outcome measures included standardized neuropsychological test scores and qualitative and quantitative single photon emission computed tomography (SPECT) measures of regional cerebral blood flow (rCBF). Results: Pulsed tPBMT significantly improved neuropsychological scores in 6 of 15 subscales (40.0%; p

Affective organizational commitment is theorized and empirically tested as a key mediator between authentic leadership and desirable employee outcomes. The results of a two-wave survey of 830 business people in Australia support a serial mediation model of authentic leadership efficacy. Followers' perceptions of authentic leadership behavior influence their personal identification and affect-based trust in the leader, which in turn are mediated by affective organizational commitment to positively influence their work engagement and job satisfaction. These findings reinforce previous work that positions personal identification and affect-based trust as the two primary mediating mechanisms of authentic leadership. This paper extends prior research by demonstrating the important role of followers' affective bonds with their organization in the operation of authentic leadership, moving beyond the dyad in our understanding of follower outcomes.

This article examines empirical links between a subordinate’s felt recognition respect from his/her supervisor, the subordinate’s appraisal respect for that supervisor, and bullying, work engagement, and organizational citizenship behaviour in Vietnam’s public sector. Data from 274 employees in six branches of a public sector agency were used to test the hypothesized model. Within Vietnam’s public sector, the followers who receive recognition respect from the leaders have greater appraisal respect for their leaders, experience less bullying, and reveal higher work engagement and organizational citizenship behaviour. This article theoretically and empirically contributes to the respect literature developed in the Western context.

International audience; This study examines the conditions under which apologies help to elicit forgiveness and restore trust following trust violations between leaders and followers. The intentionality and severity of violations are examined in a critical incident study and a laboratory study. The results support a model in which forgiveness mediates the relation of apology quality and trust. More importantly, the moderation–mediation model shows that apology quality influenced forgiveness and subsequent trust following violations that were moderate in severity–intentionality combination. The effect of apologizing affects trust directly without forgiveness when the severity–intentionality combination held minor or extreme intensity. The results suggest a range in which apologies are effective and enrich understanding of the conditions under which trust can be recovered through an apology–forgiveness process in leader–follower relationships. The contribution of the study lies in elucidating that the combination of severity and intentionality of leaders’ trust violations has greater importance than either one separately.

The aim of this study was to develop and validate a risk adjustment model for 30-day mortality after transcatheter aortic valve replacement (TAVR) that accounted for both standard clinical factors and pre-procedural health status and frailty.Assessment of risk for TAVR is important both for patient selection and provider comparisons. Prior efforts for risk adjustment have focused on in-hospital mortality, which is easily obtainable but can be biased because of early discharge of ill patients.Using data from patients who underwent TAVR as part of the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry (June 2013 to May 2016), a hierarchical logistic regression model to estimate risk for 30-day mortality after TAVR based only on pre-procedural factors and access site was developed and internally validated. The model included factors from the original TVT Registry in-hospital mortality model but added the Kansas City Cardiomyopathy Questionnaire (health status) and gait speed (5-m walk test).Among 21,661 TAVR patients at 188 sites, 1,025 (4.7%) died within 30 days. Independent predictors of 30-day death included older age, low body weight, worse renal function, peripheral artery disease, home oxygen, prior myocardial infarction, left main coronary artery disease, tricuspid regurgitation, nonfemoral access, worse baseline health status, and inability to walk. The predicted 30-day mortality risk ranged from 1.1% (lowest decile of risk) to 13.8% (highest decile of risk). The model was able to stratify risk on the basis of patient factors with good discrimination (C = 0.71 [derivation], C = 0.70 [split-sample validation]) and excellent calibration, both overall and in key patient subgroups.A clinical risk model was developed for 30-day death after TAVR that included clinical data as well as health status and frailty. This model will facilitate tracking outcomes over time as TAVR expands to lower risk patients and to less experienced sites and will allow an objective comparison of short-term mortality rates across centers.

Aim To develop a management strategy (rehabilitation programme) for erectile dysfunction (ED) after radiotherapy (RT) or androgen deprivation therapy (ADT) for prostate cancer that is suitable for use in a UK NHS healthcare context. Methods PubMed literature searches of ED management in this patient group together with a survey of 28 experts in the management of treatment-induced ED from across the UK were conducted. Results Data from 19 articles and completed questionnaires were collated. The findings discussed in this article confirm that RT/ADT for prostate cancer can significantly impair erectile function. While many men achieve erections through PDE5-I use, others need combined management incorporating exercise and lifestyle modifications, psychosexual counselling and other erectile aids. This article offers a comprehensive treatment algorithm to manage patients with ED associated with RT/ADT. Conclusion Based on published research literature and survey analysis, recommendations are proposed for the standardisation of management strategies employed for ED after RT/ADT. In addition to implementing the algorithm, understanding the rationale for the type and timing of ED management strategies is crucial for clinicians, men and their partners.

Aim To develop a management strategy (rehabilitation programme) for postsurgical erectile dysfunction (ED) among men experiencing ED associated with treatment of prostate, bladder or rectal cancer that is suitable for use in a UK NHS healthcare context. Methods PubMed literature searches of ED management together with a survey of 13 experts in the management of ED from across the UK were conducted. Results Data from 37 articles and completed questionnaires were collated. The results discussed in this study demonstrate improved objective and subjective clinical outcomes for physical parameters, sexual satisfaction, and rates of both spontaneous erections and those associated with ED treatment strategies. Conclusion Based on the literature and survey analysis, recommendations are proposed for the standardisation of management strategies employed for postsurgical ED.

Background Excessive wear of the polyethylene bearing surfaces of tibial components has become an important factor in early failure of total knee arthroplasty. Inadequate thickness of the polyethylene insert is one cause of excessive wear, and various minimum thicknesses have been recommended in order to reduce contact stresses within the polyethylene. However, the true thicknesses of modular polyethylene tibial inserts typically are not stated accurately by the manufacturers in their product information. The purpose of this study was to determine whether the information about the thickness of tibial inserts supplied by the manufacturers is adequate. Methods Five of the thinnest available polyethylene tibial inserts from five different manufacturers were selected. The minimum thickness of each was measured with use of a Sigma electronic micrometer comparator to an accuracy of +/-0.005 mm. Results The stated thicknesses of the polyethylene tibial inserts were 8, 9, and 10 mm, values that differed markedly from the actual minimum thicknesses, which ranged from 5.5722 to 6.2048 mm (mean values). Conclusion The thickness of polyethylene tibial inserts has been implicated as a potential cause of excessive wear and early failure of total knee replacements. This paper highlights the fact that the information supplied by the manufacturers is inaccurate and potentially misleading; in one case, the true thickness was much less than the recommended minimum thickness. We recommend that the minimum thickness of the tibial components as well as the combined thickness of the polyethylene insert and the metal tibial tray be specified in the product information and on the packaged insert.

Recent corporate scandals, including the mortgage situation precipitating the global financial crisis in 2008, have led many people to question the role of un/ethical leadership in corporate misbeh...

International audience; The present paper explores how trust is violated and restored in the leader-follower relationship using a systematic grounded theory approach to discover and categorize the types of trust violations that occur and develops theory about how these different types of violations are processed by followers. The data are based on 38 in-depth interviews conducted in New Zealand and France. The conclusion is that there are two main types of trust violations: 1) dashed expectations in which the leader demonstrates incompetence and 2) power abuse. The former builds up over time and provides the opportunity for restoration whereas the latter is more likely to be a single event and create barriers to ever creating trust again

Background— The purpose of this study was to develop a long-term model to predict mortality after percutaneous coronary intervention in both patients with ST-segment elevation myocardial infarction and those with more stable coronary disease. Methods and Results— The American College of Cardiology Foundation CathPCI Registry data were linked to the Centers for Medicare and Medicaid Services 100% denominator file by probabilistic matching. Preprocedure demographic and clinical variables from the CathPCI Registry were used to predict the probability of death over 3 years as recorded in the Centers for Medicare and Medicaid Services database. Between 2004 and 2007, 343 466 patients (66%) of 518 195 patients aged ≥65 years undergoing first percutaneous coronary intervention in the CathPCI Registry were successfully linked to Centers for Medicare and Medicaid Services data. This study population was randomly divided into 60% derivation and 40% validation cohorts. Median follow-up was 15 months, with mortality of 3.0% at 30 days and 8.7%, 13.4%, and 18.7% at 1, 2, and 3 years, respectively. Twenty-four characteristics related to demographics, clinical comorbidity, prior history of disease, and indices of disease severity and acuity were identified as being associated with mortality. The C indices in the validation cohorts for patients with and without ST-segment elevation myocardial infarction were 0.79 and 0.78. The model calibrated well across a wide range of predicted probabilities. Conclusions— On the basis of the large and nationally representative CathPCI Registry, we have developed a model that has excellent discrimination, calibration, and validation to predict survival up to 3 years after percutaneous coronary intervention.

This study examined the concurrent and long-term psychosocial outcomes associated with anxiety symptoms among a community sample of predominately low-income African Americans (N = 149; 72 females). We classified first graders as high or low anxious using child, parent, and teacher reports. Academic, social, and psychological outcomes were assessed in the first and eighth grades. Logistic regressions with concurrent data revealed that highly anxious children were significantly more likely to score lower on measures of academic achievement and peer acceptance, but higher on measures of depression and aggression compared to their low-anxious peers. Longitudinal analyses revealed that high-anxious first graders, compared to their low-anxious peers, scored significantly lower on measures of academic achievement, aggression, and peer acceptance; and higher on measures of anxiety and depression in the eighth grade. Importantly, outcomes varied depending on informant. Findings suggest that, similar to European American youth, early-onset anxious symptoms in African American children are associated with both concurrent and long-term academic, social, and psychological difficulties.

To examine, in the Veterans Health Administration (VHA), the relation between surgical volume and outcome in eight commonly performed operations of intermediate complexity.In multihospital health care systems such as VHA, consideration is often given to closing low-volume surgical services, with the assumption that better surgical outcomes are achieved in hospitals with larger surgical volumes. Literature data to support this assumption in intermediate-complexity operations are either limited or controversial.The VHA National Surgical Quality Improvement Program data on nonruptured abdominal aortic aneurysmectomy, vascular infrainguinal reconstruction, carotid endarterectomy (CEA), lung lobectomy/pneumonectomy, open and laparoscopic cholecystectomy, partial colectomy, and total hip arthroplasty were used. Pearson correlation, analysis of variance, mixed effects hierarchical logistic regression, and automatic interaction detection analysis were used to assess the association of annual procedure/specialty volume with risk-adjusted 30-day death (and stroke in CEA).Eight major surgical procedures (68,631 operations) were analyzed. No statistically significant associations between procedure or specialty volume and 30-day mortality rate (or 30-day stroke rate in CEA) were found.In VHA hospitals, the procedure and surgical specialty volume in eight prevalent operations of intermediate complexity are not associated with risk-adjusted 30-day mortality rate from these operations, or with the risk-adjusted 30-day stroke rate from CEA. Volume of surgery in these operations should not be used as a surrogate for quality of surgical care.

OBJECTIVE: The purpose of the study was to investigate the incidence, predictors, morbidity, and mortality associated with postoperative atrial fibrillation (AF) and its impact on intensive care unit (ICU) and postoperative hospital stay in patients undergoing cardiac surgery in the Department of Veterans Affairs (VA). SUMMARY BACKGROUND DATA: Postoperative AF after open cardiac surgery is rather common. The etiology of this arrhythmia and factors responsible for its genesis are unclear, and its impact on postoperative surgical outcomes remains controversial. The purpose of this special substudy was to elucidate the incidence of postoperative AF and the factors associated with its development, as well as the impact of AF on surgical outcome. METHODS: The study population consisted of 3855 patients who underwent open cardiac surgery between September 1993 and December 1996 at 14 VA Medical Centers. Three hundred twenty-nine additional patients were excluded because of lack of complete data or presence of AF before surgery, and 3794 (98.4%) were male with a mean age of 63.7+/-9.6 years. Operations included coronary artery bypass grafting (CABG) (3126, 81%), CABG + AVR (aortic valve replacement) (228, 5.9%), CABG + MVR (mitral valve replacement) (35, 0.9%), AVR (231, 6%), MVR (41, 1.06%), CABG + others (95, 2.46%), and others (99, 2.5%). The incidence of postoperative AF was 29.6%. Multivariate logistic regression analysis of factors found significant on univariate analysis showed the following predictors of postoperative AF: preoperative patient risk predictors: advancing age (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.48-1.75, p < 0.001), chronic obstructive pulmonary disease (OR 1.37, 95% CI 1.12-1.66, p < 0.001), use of digoxin within 2 weeks before surgery (OR 1.37, 95% CI 1.10-1.70, p < 0.003), low resting pulse rate 120 (OR 1.19, 95% CI 1.02-1.40, p < 0.026), intraoperative process of care predictors: cardiac venting via right superior pulmonary vein (OR 1.42, 95% CI 1.21-1.67, p < 0.0001), mitral valve repair (OR 2.86, 95% CI 1.72-4.73, p < 0.0001) and replacement (OR 2.33, 95% CI 1.55-3.55, p < 0.0001), no use of topical ice slush (OR 1.29, 95% CI 1.10-1.49, p < 0.0009), and use of inotropic agents for greater than 30 minutes after termination of cardiopulmonary bypass (OR 1.36, 95% CI 1.16-1.59, p < 0.0001). Postoperative median ICU stay (3.6 days AF vs. 2 days no AF, p < 0.001) and hospital stay (10 days AF vs. 7 days no AF, p < 0.001) were higher in AF. Morbid events, hospital mortality, and 6-month mortality were significantly higher in AF (p < 0.001): ICU readmission 13% AF vs. 3.9% no AF, perioperative myocardial infarction 7.41 % AF vs. 3.36% no AF, persistent congestive heart failure 4.57% AF vs. 1.4% no AF, reintubation 10.59% AF vs. 2.47% no AF, stroke 5.26% AF vs. 2.44% no AF, hospital mortality 5.95% AF vs. 2.95% no AF, 6-month mortality 9.36% AF vs. 4.17% no AF. CONCLUSIONS: Atrial fibrillation after cardiac surgery occurs in approximately one third of patients and is associated with an increase in adverse events in all measurable outcomes of care and increases the use of hospital resources and, therefore, the cost of care. Strategies to reduce the incidence of AF after cardiac surgery should favorably affect surgical outcomes and reduce utilization of resources and thus lower cost of care.

Benz(a)anthracene injected subcutaneously during the first 3 days of life caused a dose related increase in the incidence of liver and lung tumours in Swiss mice but over a similar dose range, the K region epoxide of benz(a)anthracene was less effective. Neonatally injected 7-methylbenz(a) was considerably more active than its K region epoxide in increasing the incidence of liver tumours in males. Both the parent compound and the epoxide slightly raised the incidence of lung tumours. Both chrysene and its K region epoxide increased liver tumour incidence but not lung tumour incidence. The K region epoxides of dibenz(a,h)-anthracene and 3-methylcholanthrene were without apparent effect on the incidence of liver, lung or other tumours despite indications from previously reported studies that the parent hydrocarbons are active at the same dose levels. The K region epoxide of phenanthrene had no effect on the incidence of any kind of neoplasm.

Five dihydrodiols derived from benz[a]anthracene (BA) and 4 dihydrodiols derived from 7,12-dimethylbenz[a]anthracene (DMBA) have been tested, together with the parent hydrocarbons, for their abilities to induce mutations to 8-azaguanine resistance in V79 (Chinese hamster cells and malignant transformation in M2 mouse fibroblasts. The syn- and anti-isomers of benz[a]anthracene 8,9-diol 10,11-oxide were also tested for biological activity in these two systems. The non-K-region 1,2- and 3,4-dihydrodiols of BA induced mutations but the non-K-region 8,9-dihydrodiol and the K-region 5,6-dihydrodiol were inactive as mutagens; none of these BA diols transformed M2 mouse fibroblasts. The 3,4- and the 8,9-dihydrodiols derived from 7,12-dimethylbenz[a]anthracene induced mutations in V79 cells and malignant transformation in M2 mouse fibroblasts and both were more active than the hydrocarbon itself. The K-region 5,6-dihydrodiol and the non-K-region 10,11-dihydrodiol of DMBA were inactive in both test systems. The results are not inconsistent with other data suggesting that the metabolic activation of both BA and DMBA occurs through conversion of the respective 3,4-dihydrodiols into the related vicinal diol-epoxides, although other dihydrodiols may also be involved in vivo. Both the BA diol-epoxides tested were mutagenic, but although the anti-isomer transformed M2 fibroblasts, the syn-isomer was inactive.

Comparisons have been made between (a) the initiation of tumours in mouse skin, (b) the induction of hyperplasia and the suppression of sebaceous glands in mouse skin and (c) the induction of s.c. tumours in rats, by either benzo[a]pyrene or 7-methylbenz[a]anthracene and their related K-region and non-K-region dihydrodiols. Whilst the 3,4-dihydrodiol derived from 7-methylbenz[a]anthracene is more active than the hydrocarbon in initiating tumours in mouse skin (subsequently promoted by a phorbol ester) the 7,8-dihydrodiol of benzo[a]pyrene is very much less active than benzo[a]pyrene itself in the induction of hyperplasia or the suppression of sebaceous glands in mouse skin or in the induction of s.c. sarcomas in rats. Since much other evidence suggests that the 3,4-dihydrodiol of 7-methylbenz[a]anthracene and the 7,8-dihydrodiol of benzo[a]pyrene are the dihydrodiols involved, via the related vicinal diol-epoxides, in the metabolic activation of these hydrocarbons, mouse skin initiation-promotion experiments may be more useful for the identification of such diols than the other two in vivo tests for biological activity used here.

Objective Single-lung transplantation is an accepted treatment for end-stage lung disease caused by chronic obstructive pulmonary disease. A complication unique to single-lung transplantation for chronic obstructive pulmonary disease is graft dysfunction due to compression caused by native lung hyperinflation. We hypothesized that patients with functional compromise from native lung hyperinflation would benefit from native lung volume reduction surgery. Methods The charts of all patients undergoing single-lung transplantation for chronic obstructive pulmonary disease were reviewed for lung volume reduction surgery of their native lung. Data regarding length of stay, surgical morbidity and mortality, overall survival, type of lung volume reduction surgery, and pulmonary function were recorded to evaluate the effect of lung volume reduction surgery. Results Between February 1992 and May 2007, 206 single-lung transplantations were performed for chronic obstructive pulmonary disease. Ten (5%) patients had clinically significant graft compression from native lung hyperinflation. After excluding other causes for functional decline, these patients underwent a modified lung volume reduction surgery between 12 and 142 months after single-lung transplantation (mean, 50 months). Lung volume reduction surgery consisted of anatomic resection. Two (20%) of 10 patients died during their hospitalization. Of the remaining 8 patients, 7 (87.5%) have demonstrated functional improvement on the basis of forced expiratory volume in 1 second improving from 12% to 200% (mean improvement, 57%). Within 6 months of lung volume reduction surgery, mean 6-minute walk values improved significantly (866 to 1055 feet), whereas desaturation with exertion decreased significantly. Conclusions Lung volume reduction surgery by means of formal lobectomy in patients with native lung hyperinflation undergoing single-lung transplantation and significant graft compression appears feasible. Additionally, improvements in forced expiratory volume in 1 second can be accomplished in nearly all properly selected patients. Lung volume reduction surgery should be considered in patients with decreasing graft function caused by graft compression from native lung hyperinflation.

Methods. We analyzed a Veterans Affairs database obtained The presence of impaired renal function potentially prospectively from 1992 through 1996 at 14 of 43 centers per- results in several physiologic abnormalities that could forming heart surgery. We compared the outcome after CABG contribute to adverse operative outcome. Indeed, the in patients with a baseline serum creatinine of less than 1.5 mg/dl (median 1.1 mg/dl, N 5 3271) to patients with a baseline absence of renal function has been well documented to serum creatinine of 1.5 to 3.0 mg/dl (median 1.7, N 5 631). be associated with relatively high morbidity and mortalResults. Univariate analysis revealed that patients with a ity after surgery, including cardiac surgery, despite renal serum creatinine of 1.5 to 3.0 mg/dl had a higher 30-day mortal- replacement therapy [13‐15]. There is, however, limited ity (7% vs. 3%, P , 0.001) requirement for prolonged mechanical ventilation (15% vs. 8%, P 5 0.001), stroke (7% vs. 2%, information on the effects of lesser degrees of renal failP , 0.001), renal failure requiring dialysis at discharge (3% ure on CABG outcome [1, 4, 5, 11, 12]. vs. 1%, P , 0.001), and bleeding complications (8% vs. 3%, This study was therefore undertaken to test the hyP , 0.001) than patients with a baseline serum creatinine of pothesis that mild-to-moderate renal failure (defined as less than 1.5 mg/dl. Multiple logistic regression analyses found a serum creatinine concentration of 1.5 to 3.0 mg/dl) is that patients with a baseline serum creatinine of less than 1.5 mg/dl had significantly lower (P , 0.02) 30-day mortality and an independent risk factor for adverse outcome after postoperative bleeding and ventilatory complications than pa- CABG. To test this hypothesis, we used a large Veterans tients with a serum creatinine of 1.5 to 3.0 mg/dl when control- Affairs (VA) database. This database contained extenling for all other variables. sive data on comorbid conditions, preoperative status, Conclusion. These results demonstrate that mild renal failure and post-CABG complications collected on more than is an independent risk factor for adverse outcome after CABG. 3900 patients. Our multivariate analysis results demonstrate that mild-to-moderate renal failure is an independent risk factor for adverse outcome after CABG when More than 600,000 patients undergo coronary artery all other risk factors are held constant. Our results also bypass grafting (CABG) annually in the United States. delineate some of the specific post-CABG complications Many of these patients have comorbid conditions, such associated with mild-to-moderate renal failure.

Although the structure of the hammerhead ribozyme is well characterized, many questions remain about its catalytic mechanism. Extensive evidence suggests the necessity of a conformational change en route to the transition state. We report a steric interference modification approach for investigating this change. By placing large 2′ modifications at residues insensitive to structurally conservative 2′-deoxy modifications, we hoped to discover structural effects distal to the site of modification. Of twenty residues tested, six were identified where the addition of 2′ bulk inhibits cleavage, even though these bulky modifications could be accommodated in the crystal structure without steric clash. It is proposed that these 2′-modifications inhibit cleavage by preventing formation of the alternate, active conformation. Since these 2′ effects are present in both domain I and domain II of the hammerhead, the entire catalytic core must undergo conformational changes during catalysis.

Preamble....... 831 The American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Clinical Data Standards has undertaken the task to develop and publish clinical data standards—data elements and corresponding definitions that can be used in the measurement of patient

Objectives The Society of Thoracic Surgeons Adult Cardiac Surgery Database has been linked to the Social Security Death Master File to verify "life status" and evaluate long-term surgical outcomes. The objective of this study is explore practical applications of the linkage of the Society of Thoracic Surgeons Adult Cardiac Surgery Database to Social Securtiy Death Master File, including the use of the Social Securtiy Death Master File to examine the accuracy of the Society of Thoracic Surgeons 30-day mortality data. Methods On January 1, 2008, the Society of Thoracic Surgeons Adult Cardiac Surgery Database began collecting Social Security numbers in its new version 2.61. This study includes all Society of Thoracic Surgeons Adult Cardiac Surgery Database records for operations with nonmissing Social Security numbers between January 1, 2008, and December 31, 2010, inclusive. To match records between the Society of Thoracic Surgeons Adult Cardiac Surgery Database and the Social Security Death Master File, we used a combined probabilistic and deterministic matching rule with reported high sensitivity and nearly perfect specificity. Results Between January 1, 2008, and December 31, 2010, the Society of Thoracic Surgeons Adult Cardiac Surgery Database collected data for 870,406 operations. Social Security numbers were available for 541,953 operations and unavailable for 328,453 operations. According to the Society of Thoracic Surgeons Adult Cardiac Surgery Database, the 30-day mortality rate was 17,757/541,953 = 3.3%. Linkage to the Social Security Death Master File identified 16,565 cases of suspected 30-day deaths (3.1%). Of these, 14,983 were recorded as 30-day deaths in the Society of Thoracic Surgeons database (relative sensitivity = 90.4%). Relative sensitivity was 98.8% (12,863/13,014) for suspected 30-day deaths occurring before discharge and 59.7% (2120/3551) for suspected 30-day deaths occurring after discharge. Conclusions Linkage to the Social Security Death Master File confirms the accuracy of data describing "mortality within 30 days of surgery" in the Society of Thoracic Surgeons Adult Cardiac Surgery Database. The Society of Thoracic Surgeons and Social Security Death Master File link reveals that capture of 30-day deaths occurring before discharge is highly accurate, and that these in-hospital deaths represent the majority (79% [13,014/16,565]) of all 30-day deaths. Capture of the remaining 30-day deaths occurring after discharge is less complete and needs improvement. Efforts continue to encourage Society of Thoracic Surgeons Database participants to submit Social Security numbers to the Database, thereby enhancing accurate determination of 30-day life status. The Society of Thoracic Surgeons and Social Security Death Master File linkage can facilitate ongoing refinement of mortality reporting.

OBJECTIVES We sought to develop national benchmarks for valve replacement surgery by developing statistical risk models of operative mortality. BACKGROUND National risk models for coronary artery bypass graft surgery (CABG) have gained widespread acceptance, but there are no similar models for valve replacement surgery. METHODS The Society of Thoracic Surgeons National Cardiac Surgery Database was used to identify risk factors associated with valve surgery from 1994 through 1997. The population was drawn from 49,073 patients undergoing isolated aortic valve replacement (AVR) or mitral valve replacement (MVR) and from 43,463 patients undergoing CABG combined with AVR or MVR. Two multivariable risk models were developed: one for isolated AVR or MVR and one for CABG plus AVR or CABG plus MVR. RESULTS Operative mortality rates for AVR, MVR, combined CABG/AVR and combined CABG/MVR were 4.00%, 6.04%, 6.80% and 13.29%, respectively. The strongest independent risk factors were emergency/salvage procedures, recent infarction, reoperations and renal failure. The c-indexes were 0.77 and 0.74 for the isolated valve replacement and combined CABG/valve replacement models, respectively. These models retained their predictive accuracy when applied to a prospective patient population undergoing operation from 1998 to 1999. The Hosmer-Lemeshow goodness-of-fit statistic was 10.6 (p = 0.225) for the isolated valve replacement model and 12.2 (p = 0.141) for the CABG/valve replacement model. CONCLUSIONS Statistical models have been developed to accurately predict operative mortality after valve replacement surgery. These models can be used to enhance quality by providing a national benchmark for valve replacement surgery.

Objectives. We attempted to answer the question, Is balloon angioplasty a reasonable alternative to repeat coronary artery bypass graft surgery in patients with previous coronary bypass graft surgery, medically refractory unstable angina and vein graft lesions?Background. Patients with medically refractory unstable angina need revascularization. Patients with previous coronary artery bypass graft surgery and medically refractory angina are at “high risk” for adverse outcomes with repeat coronary bypass graft surgery. Conversely, patients with angioplasty of old vein grafts are also at “high risk” for adverse outcomes.Methods. Balloon angioplasty of 89 lesions in saphenous vein grafts was performed in 75 consecutive patients with medically refractory unstable angina. Of these 75 patients, 24 (32%) had myocardial infarct within 30 days, 23 (31%) had left ventricular ejection fraction

Initiated in 1989, the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) includes more than 1085 participating centers, representing 90%-95% of current US-based adult cardiac surgery hospitals. Since its inception, the primary goal of the STS ACSD has been to use clinical data to track and improve cardiac surgical outcomes. Patients' preoperative risk characteristics, procedure-related processes of care, and clinical outcomes data have been captured and analyzed, with timely risk-adjusted feedback reports to participating providers. In 2006, STS initiated an external audit process to evaluate STS ACSD completeness and accuracy. Given the extremely high inter-rater reliability and completeness rates of STS ACSD, it is widely regarded as the "gold standard" for benchmarking cardiac surgery risk-adjusted outcomes. Over time, STS ACSD has expanded its quality horizons beyond the traditional focus on isolated, risk-adjusted short-term outcomes such as perioperative morbidity and mortality. New quality indicators have evolved including composite measures of key processes of care and outcomes (risk-adjusted morbidity and risk-adjusted mortality), longer-term outcomes, and readmissions. Resource use and patient-reported outcomes would be added in the future. These additional metrics provide a more comprehensive perspective on quality as well as additional end points. Widespread acceptance and use of STS ACSD has led to a cultural transformation within cardiac surgery by providing nationally benchmarked data for internal quality assessment, aiding data-driven quality improvement activities, serving as the basis for a voluntary public reporting program, advancing cardiac surgery care through STS ACSD-based research, and facilitating data-driven informed consent dialogues and alternative treatment-related discussions.

Department of Chemistry, Panjab University, Chandigarh Manuscript 23 March 1978, accepted 6 October 1979 Heats of solution of Eluorosulphuric, pyrosulphuric and sulphuric acids in acetic anhydride have been determined and their relative strengths compared. Studies on the heats of neutralization of these protonic acids with bases like pyridine, piperidine \(\alpha\)-pico­line and potassium acetate have also been carried out with a view to comparing the relative strength of the bases and to explain the nature of the solvent.

The cytotoxicity and mutagenicity of several polycyclic hydrocarbons and their K-region derivatives were tested in a clone of Chinese hamster cells; the production of clones resistant to 8-azaguanine was used as the marker for mutagenesis. In the series related to benz(a)anthracene, the K-region epoxide was highly mutagenic, and the phenol was less mutagenic; the hydrocarbon and cis and trans -dihydrodiols were not mutagenic. Seven resistant clones were isolated and retained their drug-resistance; three of these could be reverted to the wild type. There was no difference in the chromosome numbers among the parent and mutant clones. The results in the methylcholanthrene series were similar to those for benz(a)anthracene. However, in the dibenz(a,h)anthracene series, the phenol was more mutagenic than the epoxide. 7-Methylbenz(a)anthracene epoxide and 7-bromomethylbenz(a)anthracene were highly mutagenic, 7-bromomethyl-12-methylbenz(a)anthracene was less mutagenic, and the parent hydrocarbons were inactive. These results demonstrate that metabolic activation of polycyclic hydrocarbon is required for mutagenic activity in mammalian cells.

Hydrocarbon-deoxyribonucleoside products formed by the binding of derivatives of 7-methylbenz(A)anthracene to DNA

Objectives Recent national trends in off-pump versus on-pump coronary artery bypass grafting have not been reported. Methods We analyzed data from the Society of Thoracic Surgeons Adult Cardiac Surgery Database regarding isolated primary coronary artery bypass grafting operations (N = 2,137,841; 1997-2012). The off-pump percentages were calculated in aggregate, by center, and by surgeon. On the basis of the 2007/2008 yearly off-pump volume, the analysis subgroups were "high" (center n > 200, surgeon n > 100), "intermediate" (center n = 50-200, surgeon n = 20-100), and "low" (center n = 1-49, surgeon n = 1-19). Results The use of off-pump procedures peaked in 2002 (23%) and again in 2008 (21%), followed by a progressive decline in off-pump frequency to 17% by 2012. After 2008, off-pump rates declined among both high-volume and intermediate-volume centers and surgeons; little change was observed for low-volume centers or surgeons (off-pump rates = 10% since 2008). By the end of the study period, 84% of centers performed fewer than 50 off-pump cases per year, 34% of surgeons performed no off-pump operations, and 86% of surgeons performed fewer than 20 off-pump cases per year. Except for a higher (7.8%) conversion rate in 2003, the rate for conversions fluctuated approximately 6%. Conclusions Enthusiasm for off-pump coronary artery bypass grafting has been tempered. The percentage of coronary artery bypass grafting operations performed off-pump has steadily declined over the last 5 years, and currently this technique is used in fewer than 1 in 5 patients who undergo surgical coronary revascularization. A minority of surgeons and centers continue to perform off-pump coronary artery bypass grafting in most of their patients.

[This corrects the article DOI: 10.1016/j.isci.2021.103262.]., (© 2023 The Author(s).)