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On February 17, 1996, an earthquake ( M w = 8.2) occurred northeast of Biak Island, Indonesia, and generated a tsunami. Interestingly, the tsunami runup on the southwest side of Biak Island, which did not face the epicenter, was higher than that on the side of the island facing the epicenter. It was earlier suggested that the earthquake triggered submarine landslides. However, this hypothesis remains unexplored and unconfirmed. In this study, tsunami arrival times obtained from eyewitness accounts were used to perform backward tsunami travel time modeling. Based on the backward tsunami travel time results and multibeam bathymetry, five submarine landslide candidates were identified: three located to the southwest of Biak Island and two to the south of the island. Our analysis indicates that tsunamis from a large submarine landslide off the southwest coast of Biak Island (SL 2) and a small submarine landslide off the south side of Biak Island (SL 4) contributed to the 1996 Biak tsunami event and came earlier than the main tsunami from the earthquake fault. Tsunami sources were earlier modeled only by fault parameters without considering submarine landslide sources. As a result, the models could not explain the observed runup and eyewitness tsunami arrival times for the southwest and south of Biak Island. To address this problem, we propose an approach that combines a submarine landslide model with a modified version of a previously proposed fault model. Our combined model explains the observed runup and eyewitness tsunami arrival times well (Aida's index values of the model are K = 1.00 and κ = 1.44). [ABSTRACT FROM AUTHOR]

The 1771 Meiwa tsunami which struck the southern Ryukyu Islands (Sakishima Islands) had greater than 22 m run-up height, leaving about 12,000 casualties in its wake. At many places, the tsunami inundation or lack of inundation is well recorded in historical documents. Several tsunami source models have been proposed for this event using historical records as constraints of tsunami calculations. Nevertheless, the source model remains under discussion. This study re-evaluated the tsunami wave source model of the 1771 Meiwa tsunami using high-resolution (10 m mesh) bathymetric and topographical data for tsunami calculation, the latest historical record dataset, and seismological knowledge. Results demonstrated that a tsunami earthquake along the southern Ryukyu Trench was the likely cause of the 1771 event. However, it is noteworthy that assumption of a large slip with 30 m is necessary for a shallow and narrow region (fault depth = 5 km, fault width = 30 km, Mw = 8.49) of the plate boundary in the Ryukyu Trench, which is far larger than previously thought. This requirement of very large initial water level change at the source might involve not only the fault rupture along the plate boundary but also deformation by splay faults, inelastic deformation of unconsolidated sediments near the trench axis, and/or giant submarine landslides. Results also show that the effects of fault parameters on the run-up were quite different depending on the offshore coral reef width. This phenomenon strongly constrained the fault width to 30 km. Our tsunami ray tracing analysis further revealed the effects of bathymetry on tsunami propagation. It is noteworthy that meter-long huge tsunami boulders tend to be distributed along the specific coasts at which the tsunami was concentrated by bathymetric effects. This finding suggests that past tsunamis, including the 1771 event, might have affected the specific coral reefs on Sakishima Islands repeatedly, which is crucially important for understanding the heterogeneous distribution of tsunami boulders. This feature might also be useful to elucidate the effects of large tsunamis on the corals and reefs because a direct comparison of coral reefs that are damaged and not damaged by tsunami waves is testable in narrow areas in the case of the Sakishima Islands. [ABSTRACT FROM AUTHOR]

Elderly transgender mental health has been a neglected facet of mental health for many years. The current article reviews the global and local challenges faced when catering to elderly transgender mental health. These include trauma and stigma that may be faced when seeking mental health services, in addition to the stigma of belonging to the transgender community. There are many barriers in access to health-care services that have been highlighted, and there are factors such as social discrimination, victimization, hate crime, and domestic violence that add to the barriers. Lack of proper clinics that cater to their needs, improper coverage in health-care insurance, and lack of coverage of sex-change operations also add to the existing burden. Workplace issues and their impact on mental health along with stigma and workplace discrimination are also discussed. The review tries to give an overview of the issues faced, so that clinicians treating these populations are appraised of the same. [ABSTRACT FROM AUTHOR]

The Makran region, which borders southern Iran and Pakistan along the Gulf of Oman, has experienced multiple tsunamis in the last century, with some being triggered by submarine landslides. However, the role played by submarine landslides has been largely neglected in tsunami hazard assessments in the western Makran. In the present study, four different submarine landslide scenarios with volumes of 10–40 km3 are simulated on 25 locations in the western Makran, resulting in 100 different hypothetical scenarios. The results indicate that Oman's coastline, a country in the western part of Makran subduction zone, is more vulnerable to the hazard of landslide-generated waves (maximum average of 3.1 m wave height) compared to Iran (maximum average 0.9 m height). Although Chabahar, Iran, and Muscat, Oman, two major cities in the region, experienced severe waves during some scenarios, it can be implied Muscat is more vulnerable to this kind of tsunami due to the significant gap between the maximum and average wave height for all scenarios. We further discuss that applying hypothetical worst-case scenarios can sometimes lead to an overestimation in tsunami hazard assessment. Therefore, more geological, sedimentological, and geotechnical considerations and studies are required for defining submarine landslide worst-case scenarios. [ABSTRACT FROM AUTHOR]

Objective: Minimally invasive procedures have been developed to reduce surgical trauma after cardiac surgery. Clinical recovery is the main focus of most research. Still, patient-centred outcomes, such as the quality of life, can provide a more comprehensive understanding of the impact of the surgery on the patient's life. This systematic review aims to deliver a detailed summary of all available research investigating the quality of recovery, assessed with quality of life instruments, in adults undergoing minimally invasive cardiac surgery. Methods: All randomised trials, cohort studies, and cross-sectional studies assessing the quality of recovery in patients undergoing minimally invasive cardiac surgery compared to conventional cardiac surgery within the last 20 years were included, and a summary was prepared. Results: The randomised trial observed an overall improved quality of life after both minimally invasive and conventional surgery. The quality of life improvement in the minimally invasive group showed a faster course and evolved to a higher level than the conventional surgery group. These findings align with the results of prospective cohort studies. In the cross-sectional studies, no significant difference in the quality of life was seen except for one that observed a significantly higher quality of life in the minimally invasive group. Conclusions: This systematic review indicates that patients may benefit from minimally invasive and conventional cardiac surgery, but patients undergoing minimally invasive cardiac surgery may recover sooner and to a greater extent. However, no firm conclusion could be drawn due to the limited available studies. Therefore, randomised controlled trials are needed. [ABSTRACT FROM AUTHOR]

Abundant high-quality distant tsunami records from the 2010 Maule (Chile) and 2011 Tohoku-Oki earthquakes have revealed two distinctive features compared to long-wave tsunami simulations. The records show that the traveltime delay of the tsunami increases with distance from the earthquakes, and the initial phase reversal of tsunamis appears and grows systematically. The conventional tsunami theory cannot explain the observed waveforms and traveltimes of distant tsunamis, leading to the need for a new theory to explain and synthesize distant tsunamis. The propagating elevated sea surface of a tsunami compresses seawater and deforms the seafloor and the solid Earth. A propagating tsunami changes the mass distribution of the Earth and results in a spatiotemporal change in gravity, thereby altering the propagating tsunami itself. Incorporating these physics, we developed a new tsunami propagation theory in which a tsunami is naturally treated as a wave in a gravitationally and elastically coupled Earth system composed of solid Earth layers and an ocean layer. Two distinct tsunami simulation techniques based on the new tsunami propagation theory were introduced and confirmed to produce nearly identical tsunami waveforms. One technique treats tsunamis as free waves within a deformable Earth system, while the other treats tsunamis as external pressure and gravitational forces acting on the surface of a deformable Earth system. With the new techniques, the waveform and traveltime differences between the observed and simulated distant tsunamis disappear. Past distant tsunamis recorded by coastal tide gauges, which were not previously studied due to the traveltime and waveform mismatch problems, have become the focus of quantitative tsunami studies analyzing waveforms. New tsunami propagation techniques have been applied to the analysis of distant tsunami waveforms from the past 19 events and have helped to unveil the slip distributions of the past large earthquakes and to determine the earthquake origin time of the trans-Pacific tsunami events recorded by tide gauges since 1854. [ABSTRACT FROM AUTHOR]

Background: The number of citations an article receives is a marker of its scientific influence within a particular specialty. This bibliometric analysis intended to recognise the top 100 cited articles in minimally-invasive cardiac surgery, to determine the fundamental subject areas that have borne considerable influence upon clinical practice and academic knowledge whilst also considering bibliometric scope. This is increasingly relevant in a continually advancing specialty and one where minimally-invasive cardiac procedures have the potential for huge benefits to patient outcomes.Methods: The Web of Science (Clarivate Analytics) data citation index database was searched with the following terms: [Minimal* AND Invasive* AND Card* AND Surg*]. Results were limited to full text English language manuscripts and ranked by citation number. Further analysis of the top 100 cited articles was carried out according to subject, author, publication year, journal, institution and country of origin.Results: A total of 4716 eligible manuscripts were retrieved. Of the top 100 papers, the median (range) citation number was 101 (51-414). The most cited paper by Lichtenstein et al. (Circulation 114(6):591-596, 2006) published in Circulation with 414 citations focused on transapical transcatheter aortic valve implantation as a viable alternative to aortic valve replacement with cardiopulmonary bypass in selected patients with aortic stenosis. The Annals of Thoracic Surgery published the most papers and received the most citations (n = 35; 3036 citations). The United States of America had the most publications and citations (n = 52; 5303 citations), followed by Germany (n = 27; 2598 citations). Harvard Medical School, Boston, Massachusetts, published the most papers of all institutions. Minimally-invasive cardiac surgery pertaining to valve surgery (n = 42) and coronary artery bypass surgery (n = 30) were the two most frequent topics by a large margin.Conclusions: This work establishes a comprehensive and informative analysis of the most influential publications in minimally-invasive cardiac surgery and outlines what constitutes a citable article. Undertaking a quantitative evaluation of the top 100 papers aids in recognising the contributions of key authors and institutions as well as guiding future efforts in this field to continually improve the quality of care offered to complex cardiac patients. [ABSTRACT FROM AUTHOR]

The purpose of this research was to determine Aspergillus fumigatus conidial viability and its biofilm formation upon treatment with triclosan and amphotericin-B loaded liposomes. A. fumigatus was treated with the antimicrobials, triclosan and liposomal amphotericin-B (L-AMB), in single and combined supplementation. To quantify the cells' viability upon treatments, resazurin-based viability assay was performed. Confocal laser scanning microscopy was done by applying FUN-1 stain to screen the role of the agents on extracellular polymeric substances. Total A. fumigatus biomass upon treatments was estimated by using crystal violet-based assay. To study the agents' effect on the conidial viability, flow cytometry analysis was performed. Expression levels of A. fumigatus genes encoding cell wall proteins, α-(1,3)-glucans and galactosaminogalactan were analysed by real-time polymerase chain reaction assay. A synergistic interaction occurred between triclosan and L-AMB when they were added sequentially (triclosan + L-AMB) at their sub-minimum inhibitory concentrations, the triclosan and L-AMB MICs were dropped to 0.6 and 0.2 mg/L, respectively, from 2 to 1 mg/L. Besides, L-AMB and triclosan contributed to the down-regulation of α-(1,3)-glucan and galactosaminogalactan in A. fumigatus conidia and resulted in less conidia aggregation and mycelia adhesion to the biotic/abiotic surfaces; A. fumigatus conidia-became hydrophilic upon treatment, as a result of rodlet layer being masked by a hydrophilic layer or modified by the ionic strength of the rodlet layer. In A. fumigatus, the potential mechanisms of action for L-AMB might be through killing the cells and for triclosan through interrupting the cells' development as a consequence of quorum quenching. [ABSTRACT FROM AUTHOR]

Tsunami coastal hazard is modeled along the US East Coast (USEC), at a coarse regional (450 m) resolution, from coseismic sources located in the Açores Convergence Zone (ACZ) and the Puerto Rico Trench (PRT)/Caribbean Arc areas. While earlier work only considered probable maximum tsunamis, here we parameterize and simulate 18 coseismic sources, with magnitude M8-9 and return periods ∼ 70–2000 year, using seismo-tectonic and historical data. The largest sources in the ACZ are repeats of the 1755 M8.6-9 Lisbon earthquake and tsunami; other sources are hypothetical. In the ACZ, due to the limited data on faults, each source is parameterized with a single fault plane, while in the PRT, coseismic sources are parameterized based on fault segmentation established during a 2019 USGS workshop of experts, using 10–26 SIFT subfault planes (Gica et al. in NOAA Tech. Memo., OAR PMEL-139, 2008). Tsunamis are simulated for each source using the fully nonlinear and dispersive model FUNWAVE-TVD, in two levels of nested grids. At the considered scales, dispersion is shown to affect tsunami propagation. Coastal hazard is quantified by four metrics computed at many save points (∼ 20–30 thousand) defined along the 5-m isobath (due to the coarse resolution), i.e., maximum (1) surface elevation, (2) current, (3) momentum force; and (4) travel time, representing flooding, navigation, structural, and evacuation hazards. Overall, the first three metrics are larger, the larger the source magnitude, and their alongshore variation shows similar patterns of higher/lower values, due to the shelf bathymetric control (refraction). The fourth metric mostly differs between sources from each area, but less so among sources from the same area; its inverse quantifies evacuation hazard. A 1–5 score is given to results for each metric, based on five intensity classes representing low, medium low, medium, high, and highest tsunami hazard. A novel tsunami intensity index is computed as a weighted average of these scores, allowing both a comparison among sources and a quantification of tsunami hazard as a function of their estimated return periods. In the most impacted areas of the USEC, the highest tsunami hazard in the 250–500-year return period range is commensurate with that posed by 100-year category 3–5 tropical cyclones, taking into account the larger current velocities and forces caused by tsunami waves. Results of this work could serve as a basis for a future regional Probabilistic Tsunami Hazard Analysis for the USEC, considering additional source types such as underwater landslides, volcanic flank collapse, and meteotsunamis, that were studied elsewhere. [ABSTRACT FROM AUTHOR]

Objectives: The central aim of the research was to verify and determine the strength of the relationships of therapeutic alliance to wellbeing, life satisfaction, and flourishing in patients attending individual psychotherapy. The relationships were assessed based on different sources of information about the quality of the working alliance: patient's evaluation and patient's and psychotherapist's joint evaluations. Design: The author applied Bordin's pantheoretical model of alliance and two different conceptions of wellbeing, operationalized as hedonistic and eudaimonic. Methods: The 411 participants included 252 patients and 159 psychotherapists. To test the hypotheses, 16 joint and separate models of structural relations were built and analyzed empirically using SEM. Correlations were analyzed between alliance factors and those of wellbeing, satisfaction, and flourishing. Results: The actual impact of working alliance quality on psychological wellbeing proved to be stronger compared to the relations between alliance and satisfaction or flourishing. The results of analyses revealed low, though usually positive and significant, correlations between the dimensions of alliance and those of wellbeing, life satisfaction, and flourishing. Conclusions: The empirical data and the strategy of analyses brought the expected results, confirming that patient's and psychotherapist's perception of a strong therapeutic alliance is crucial for the optimization of patient's functioning and wellbeing. It turns out that the therapeutic alliance is, above all, a factor of wellbeing understood more deeply than merely as current pleasure. The study also showed that no factor isolated from other components of alliance increased the quality of patient's mental functioning more than others. [ABSTRACT FROM AUTHOR]

We describe the development of a time-resolved model for tsunami-induced morphology change, based on an existing Boussinesq model for weakly-dispersive free-surface waves coupled to a depth-integrated model for sediment concentration and an equation for bed level change. The model allows for spatial variability in bottom friction coefficients and accounts for the presence of non-erodible beds or finite depths of available sediment. The model is verified using one laboratory data set and against field observations of morphology change in the Crescent City, CA harbor during the 2011 Tohoku tsunami event. The model is then applied to a hypothetical example illustrating the impact of tsunami inundation on an undeveloped barrier island. [ABSTRACT FROM AUTHOR]

Minimally invasive options for coronary artery bypass graft (CABG) surgery progressed dramatically in the last decades. Minimally invasive CABG surgery is presented trough these forms: minimally invasive direct coronary artery bypass (MIDCAB), endoscopic atraumatic coronary artery bypass (EndoACAB), robot-assisted direct coronary artery bypass (RADCAB), total endoscopic coronary artery bypass (TECAB), and hybrid coronary revascularisation (HCR). Unfortunately, these are still limited only to the specialised centres across the world and have not been accepted by the majority of cardiac surgeons. A surgeon who is starting to practice minimally invasive CABG surgery needs to be ready for long duration of the interventions, higher rate of conversions to sternotomy and significant learning curve. Excellent results that have been published on the subject of minimally invasive revascularisation methods support the potential of these alternative approaches to evolve in the near future. [ABSTRACT FROM AUTHOR]

The massive destruction and loss caused by the 2004 Sumatra–Andaman tsunami were attributed to the lack of knowledge on tsunami and low regional detection and communication systems for early warning in that region. This study aimed to identify locations at risk of impending tsunami from Andaman Sea for the safety of community and proper development planning at the coastal areas by providing an updated and revised inundation maps. The last study on this area was conducted several years ago which open the possibility to new findings. Generated by tsunami simulation models, the maps illustrate the extent and level of inundation to which the coastal community and infrastructure would be subjected. As a result of coastal changes and availability of better topographic data, the existing inundation maps for the coastal areas of northwest Peninsular Malaysia at risk to impending tsunami from the Andaman Sea are revised. This paper documented the computational setup leading to the generation of the revised inundation maps. The tsunami simulation model TUNA was used to simulate the generation, propagation, and subsequent run-up and inundation of tsunamis triggered by earthquakes of moment magnitudes (Mw) 8.5, 9.0, and 9.25 along the Sunda Trench. From the simulations, it was found that at Mw 9.25, Balik Pulau, Pulau Pinang would be subjected to inundation of as far as 3.47 km with 5.40-m-deep inundation at the highest section. [ABSTRACT FROM AUTHOR]

Most tsunamis are generated by earthquakes, but in 1998, a seabed slump offshore of northern Papua New Guinea (PNG) generated a tsunami up to 15 m high that killed more than 2,200 people. The event changed our understanding of tsunami mechanisms and was the forerunner to two decades of major tsunamis that included those in Turkey, the Indian Ocean, Japan, and Sulawesi and Anak Krakatau in Indonesia. PNG provided a context to better understand these tsunamis as well as older submarine landslide events, such as Storegga (8150 BP); Alika 2 in Hawaii (120,000 BP), and Grand Banks, Canada (1929), together with those from dual earthquake/landslide mechanisms, such as Messina (1908), Puerto Rico (1928), and Japan (2011). PNG proved that submarine landslides generate devastating tsunamis from failure mechanisms that can be very different, whether singly or in combination with earthquakes. It demonstrated the critical importance of seabed mapping to identify these mechanisms as well as stimulated the development of new numerical tsunami modeling methodologies. In combination with other recent tsunamis, PNG demonstrated the critical importance of these events in advancing our understanding of tsunami hazard and risk. This review recounts how, since 1998, understanding of the tsunami hazard from submarine landslides has progressed far beyond anything considered possible at that time. For submarine landslide tsunamis, advances in understanding take place incrementally, usually in response to major, sometimes catastrophic, events. The Papua New Guinea tsunami in 1998, when more than 2,200 people perished, was a turning point in first recognizing the significant tsunami hazard from submarine landslides. Over the past 2 to 3 years advances have also been made mainly because of improvements in numerical modeling based on older tsunamis such as Grand Banks in 1929, Messina in 1908, and Storegga at 8150 BP. Two recent tsunamis in late 2018, in Sulawesi and Anak Krakatau, Indonesia, where several hundred people died, were from very unusual landslide mechanisms—dual (strike-slip and landslide) and volcanic collapse—and provide new motivations for understanding these tsunami mechanisms. This is a timely, state of the art review of landslide tsunamis based on recent well-studied events and new research on older ones, which provide an important context for the recent tsunamis in Indonesia in 2018. [ABSTRACT FROM AUTHOR]

Continents grow mainly through magmatism, relamination, accretionary prism development, sediment underplating, tectonic accretion of seamounts, oceanic plateaus and oceanic lithosphere, and collisions of island arcs at convergent margins. The modern Pacific–Rim subduction zone environments present a natural laboratory to examine the nature of these processes. The papers in this special issue focus on the: (1) modern and ancient accretionary margins of Japan; (2) arc–continent collision zone in the Taiwan orogenic belt; (3) accreting versus non-accreting convergent margins of the Americas; and (4) several examples of ancient convergent margins of East Asia. Subduction erosion and sediment underplating are important processes, affecting the melt evolution of arc magmas by giving them special crustal isotopic characteristics. Oblique arc–continent collisions cause strong deformation partitioning that results in orogen-parallel extension, crustal exhumation and wrench faulting in the hinterland, and thrust faulting–folding in the foreland. Trench-parallel widths of subducting slabs exert major control on slab geometries, the degree of coupling–decoupling between the lower and upper plates, and subduction velocity partitioning. An initially large width of the subducting Palaeo-Pacific Plate against East Asia caused flat subduction and resistance to slab rollback during the Triassic Period. These conditions resulted in shortening across SE China. Foundering and delamination of the flat slab during the Early Jurassic Epoch led to slab segmentation and reduced slab widths, followed by slab steepening and rollback. This pull-away tectonics induced lithospheric extension and magmatism in SE China during Late Jurassic – Cretaceous time. Melting of subducted carbonaceous sediments commonly produces networks of silicate veins in CLM that may subsequently undergo partial melting, producing ultrapotassic magmas. [ABSTRACT FROM AUTHOR]

Eighty-six new acoustic survey lines along and across the Japan Trench revealed active sediment creep deformation on a deep-sea terrace at water depths of 400–1200 m in an area of arcuate-shaped depressions that are probably associated with tectonic erosion. The most active region of creep is located on the top at the surface of the depression south of 38° N. The area of creep deformation is characterized by arcuate-shaped topographic lineaments with active folds and active normal faults stepping down trenchward. In contrast to the southern region, normal faults at the top of the depression north of 38° N cut a sedimentary sequence (Unit 1) that is acoustically transparent with continuous weak reflectors, and this is covered by the undeformed layered sediment sequence of Unit 2. Unit 2 corresponds to the period of rising sea level that extended from the latest Pleistocene to the early Holocene (14–6 ka). Thus, creep is ongoing at the top of the depression south of 38° N in the surface layer, whereas it stopped north of the depression between 14 and 6 ka. These observations might indicate that the active region jumped from north to south due to probably retrogressive sliding. [ABSTRACT FROM AUTHOR]

Epilepsy affects 1% of the general population, about one-third of which is pharmacologically resistant. Uncontrolled seizures are associated with an increased risk of traumatic injury and sudden unexpected death of epilepsy. There is a considerable psychological and financial burden on caregivers of patients with epilepsy, particularly among pediatric patients. Epilepsy surgery, when indicated, is the most promising cure for epilepsy. However, when surgery is contraindicated or refused by the patient, neurostimulation is an alternative palliative approach, albeit with a lower chance of entirely curing patients of seizures. There are many options for neurostimulation. The three most commonly used invasive neurostimulation procedures that consistently show evidence of being safe and efficacious are vagal nerve stimulation, responsive neuro stimulation, or anterior thalamic nucleus deep brain stimulation. The goal of this review is to summarize the current evidence supporting the use of these three techniques, which are approved by most regulatory bodies, and discuss different factors that may enable epilepsy surgeons to choose the most appropriate modality for each patient. [ABSTRACT FROM AUTHOR]

The strong ground motions, large crustal deformation, and tsunami generated by the 2011 Tohoku-oki earthquake (Mw 9.1) reveal that a large coseismic slip likely propagated to shallow depth in the Japan Trench. Although data acquired by onshore networks cannot resolve the slip behavior of the updip fault rupture, marine geophysical and geological studies provide direct evidence of coseismic slip to the trench. Differential bathymetry data show ∼50 m of coseismic seafloor displacement extending to the central Japan Trench (38–39.2°N). Seismic data show that coseismic slip ruptured the seafloor within the trench. Pelagic clays may have promoted slip propagation to shallow depths, whereas disturbed/metamorphosed clays may have restricted slip to the main rupture zone. Those observations imply that a smooth, broadly distributed, weak, clay-rich sediment in a shallow part of a subduction zone is a characteristic factor that can foster a large coseismic slip to the trench and, consequently, the generation of a large tsunami. ▪ During the 2011 Tohoku-oki earthquake (Mw 9.1), more than ∼50 m of slip occurred on a fault that ruptured the seafloor in the central Japan Trench. ▪ The fault rupture reaching the seafloor caused a large tsunami. ▪ Marine geophysical explorations revealed that a clay-rich sediment in the subduction zone was one factor fostering the large fault slip. ▪ Understanding of slip behavior in the shallow portion of a subduction zone will help us prepare for future large tsunamis along the Japan-Kuril Trench. [ABSTRACT FROM AUTHOR]

Gigantic submarine landslides pose a significant threat to offshore infrastructures and may be initiated by an inconspicuous weakened zone, followed by catastrophic shear band propagation under the effect of strain softening. Much attention has been paid over the last two decades to unidirectional (parallel to the travel direction of sliding mass) shear band propagation (SBP) related exclusively to an initiation zone that is wide relative to the SBP direction. The paper investigates for the first time the mechanisms of more realistic planar shear band propagation via numerical modelling including finite element and finite difference analyses. Rather than propagating only along the travel direction for a 1D shear band in a plane-strain slope, the multidirectional propagation behaviour of a planar shear band depends significantly on the aspect ratio of the initiation zone. New criteria for catastrophic propagation of a planar shear band are proposed and are shown to be in good agreement with the numerical results. The criteria with respect to the initiation zone area can be incorporated easily within a GIS-based stability analysis of catastrophic submarine landslides, facilitating robust hazard analysis for offshore developments. [ABSTRACT FROM AUTHOR]

Rapid finite fault source determination is critical for reliable and robust tsunami early warnings. Near-field Global Navigation Satellite System (GNSS) observations have shown value to constrain the source inversion, but real-time GNSS stations are sparse along most of the active faults. Here we propose an automatic earthquake finite source inversion (AutoQuake Inversion) algorithm jointly using near-field (epicentral distance < 1000 km) GNSS data and mid-range (epicentral distance from 30° to 45°) teleseismic P displacement waveforms. Neither the near-field GNSS nor the mid-range teleseismic data clip or saturate during large earthquakes, while the fast-traveling P-waves are still essential to constrain the source in regions where very few or no GNSS stations are available. Real-time determination of the fault geometry remains to be the main challenge for rapid finite source inversion. We adopt a strategy to use the pre-defined geometry Slab2 for earthquakes within it or to forecast a focal mechanism based on near-by historical events for earthquakes without Slab2 prior. The algorithm has been implemented successfully in the prototype of JPL's GPS-Aided Tsunami Early-Detection system and tested for many real events recently. This article provides the framework of the algorithm, documents the retrospective and real-time results, and discusses remaining challenges for future improvements. [ABSTRACT FROM AUTHOR]

The Indus Canyon in the northwestern Indian Ocean has been reported to be the site of numerous submarine mass failures in the past. This study is the first to investigate potential tsunami hazards associated with such mass failures in this region. We employed statistical emulation, i.e. surrogate modelling, to efficiently quantify uncertainties associated with slump-generated tsunamis at the slopes of the canyon. We simulated 60 slump scenarios with thickness of 100–300 m, width of 6–10.5 km, travel distances of 500–2000 m and submergence depth of 250–450 m. These scenarios were then used to train the emulator and predict 500,000 trial scenarios in order to study probabilistically the tsunami hazard over the near field. Due to narrow–deep canyon walls and the shallow continental shelf in the adjacent regions ( < 100 m water depth), the tsunami propagation has a unique pattern as an ellipse stretched in the NE–SW direction. The results show that the most likely tsunami amplitudes and velocities are approximately 0.2–1.0 m and 2.5–13 m/s, respectively, which can potentially impact vessels and maritime facilities. We demonstrate that the emulator-based approach is an important tool for probabilistic hazard analysis since it can generate thousands of tsunami scenarios in few seconds, compared to days of computations on High Performance Computing facilities for a single run of the dispersive tsunami solver that we use here. [ABSTRACT FROM AUTHOR]

Numerical simulations of Submarine Mass Failures (SMFs) are performed along the upper US East Coast to assess the effect of slide deformation on predicted tsunami hazard. Tsunami generation is simulated using the three-dimensional non-hydrostatic model NHWAVE. For rigid slumps, the geometry and law of motion are specified as bottom boundary conditions. Deforming slide motion is modeled using a depth-integrated bottom layer of dense Newtonian fluid, fully coupled to the overlying fluid motion. Once the SMFs are no-longer tsunamigenic, tsunami propagation simulations are performed using the Boussinesq wave model FUNWAVE-TVD, using nested grids of increasingly fine resolution towards shore and employing a one-way coupling methodology. Probable maximum tsunamis are simulated for Currituck SMF proxies sited in four areas of the shelf break slope that have enough sediment accumulation to cause large failures. Deforming slides have a slightly larger initial acceleration, but still generate a smaller tsunami than rigid slumps due to their spreading and thinning out during motion, which gradually makes them less tsunamigenic. Comparing the maximum envelope of surface elevations along a 5 m isobath, consistent with earlier work, the bathymetry of the wide shelf is found to strongly control the spatial distribution of tsunami inundation. Overall, tsunamis caused by rigid slumps are worst case scenarios, providing up to 50% more inundation than for deforming slides having a moderate level of viscosity set in the upper range of debris flows. Tsunamis from both types of SMFs are able to cause water withdrawal to the 5 m isobath or deeper. Bottom friction effects are assessed by performing some of the simulations using two different Manning coefficients, one 50% larger than the other. With increased bottom friction, the largest tsunami inundations at the coast are reduced by up to 15%. Selected simulations are rerun by turning off dispersion in the model, which leads to moderate changes in maximum surface elevations nearshore (− 10 to + 5% changes), but to more significant effects in the far field (− 40 to 80% changes). Onshore, dispersion causes the appearance of short period undular bores that eventually break nearshore without significantly affecting inundation at the coast. However, these bores increase wave-induced maximum flow velocity and impulse forces, the latter by up to 40%, which may affect the design of coastal structures. [ABSTRACT FROM AUTHOR]

The French Riviera is a densely populated and touristic coast. It is also one of the most seismically active areas of the Western Mediterranean. This is evidenced by the Mw 6.7–6.9, 1887 earthquake and tsunami, that was triggered nearshore, rupturing the easternmost 40 km of the 80-km-long Ligurian fault system, which runs parallel to and offshore of the Riviera. Here, coastal hazard from co-seismic tsunamis is assessed along the French and part of the Italian Riviera by simulating three Ligurian earthquake scenarios: (1) the 1887 event offshore Genoa, Italy; (2) a similar event transposed to the westernmost 40-km segment of the fault, offshore Nice, France; and (3) the rupture of the entire 80-km fault, which constitutes an extreme case scenario for the region. Simulations of tsunami propagation and coastal impact are performed by one-way coupling with the Boussinesq model FUNWAVE-TVD, in a series of nested grids, using new high-resolution bathymetric and topographic data. Results obtained in 10-m coastal grids provide the highest resolution predictions to date for this section of the French Riviera of co-seismic tsunami coastal hazard, in terms of inundation, runup, and current velocity. In general, the most impacted areas are bays (near Cap d'Antibes and Cap Ferrat), due to wave buildup and shoaling within semi-enclosed shallow areas, enhanced by possible resonances. In contrast to earlier work, which was based on coarser resolution grids, the area of Nice harbor is found to be rather well sheltered. It should be noted that uniform fault slip was used in the ruptures and runup estimates could locally be enhanced in case of more complex ruptures, such as segmented and heterogeneous ruptures. [ABSTRACT FROM AUTHOR]

This paper represents a numerical study on the effects of landslide initial submergence and its geotechnical and rheological properties on the characteristics of landslide-generated waves (LGWs) and landslide deformation. A number of 117 numerical experiments are performed using a two-layer Coulomb Mixture Flow (2LCMFlow) model on a real-sized numerical flume as a simplified cross section of the Maku dam reservoir, located in the Northwest of Iran. Three different initial locations are considered for landslide representing a subaerial (SAL), a semi-submerged (SSL), and a submarine (SML) landslide. Based on the numerical results, the majority of SMLs and in some cases SSLs generate tsunami waves with a larger wave trough than the wave crest. The maximum negative wave amplitudes of LGWs caused by SMLs (SMLGWs) can be up to 55% larger than that for SALs. LGWs caused by SALs (SALGWs) commonly have a higher wave crest than the wave trough. In 70% of cases, the maximum wave crests of SALGWs are larger than that for LGWs caused by SSLs (SSLGWs) and SMLGWs. While, in the rest 30% of simulations, the maximum SSLGW crests are up to 60% larger than SALGWs. Due to the landslide inter-phase interactions in combination with its basal and internal friction resistances, only 10-40% of the SAL initial mass contributes in LGW generation process. Energy transfer from landslide into water is about 0.5-7.5% for SMLs, 6-17.2% for SSLs, and 5-15% for SALs. The final deposit of SMLs generally has a short and thick profile while SALs and SSLs elongate more and travel longer distances. Finally, a Coulomb mixture product parameter, PCM, is defined to relate the maximum LGW heights to the considered landslide properties. [ABSTRACT FROM AUTHOR]

Robot-assisted coronary artery bypass graft [robot-assisted (coronary artery bypass grafting (CABG)] surgery is the latest treatment for coronary artery disease. However, the surgery extensively affects cardiac and pulmonary function, and the risk factors associated with peri-operative morbidity, including prolong mechanical ventilation (PMV), have not been fully examined. In this retrospective cohort study, a total of 382 patients who underwent robot-assisted internal mammary artery harvesting with mini-thoracotomy direct-vision bypass grafting surgery (MIDCABG) from 2005 to 2012 at our tertiary care hospital were included. The definition of PMV was failure to wean from mechanical ventilation more than 48 h after the surgery. Risk factors for PMV, and peri-operative morbidity and mortality were analyzed with a multivariate logistic regression model. Forty-three patients (11.3%) developed PMV after the surgery, and the peri-operative morbidity and mortality rates were 38 and 2.6%, respectively. The risk factors for PMV were age, left ventricular ejection fraction (LVEF), the duration of one-lung ventilation for MIDCABG (beating time), and peak airway pressure at the end of the surgery. Furthermore, age and anesthesia time were found to be independent risk factors for peri-operative morbidity, whereas age, LVEF, and anesthesia time were the risk factors for peri-operative mortality. These findings may help physicians to properly choose patients for this procedure, and provide more attention to patients with higher risk after surgery to achieve better clinical outcomes. [ABSTRACT FROM AUTHOR]

The dominance of cognitive behavioral treatment in social work practice is acknowledged and challenged, not from the usual quarters of pointing out its limitations as a theoretical and conceptual model, but from a fundamental critique of its evidentiary basis and the methodology from which such claims of superiority are pronounced. Significant concerns are raised about the restrictive inclusion criteria, the lack of ethnic and racial diversity, inadequate control groups, and researcher bias in random controlled trials studies. Further concerns are raised from social/cultural/political/professional dynamics that are evident in the delivery of mental health services and function to limit client options for treatment. [ABSTRACT FROM AUTHOR]

The main focus of this paper is to assess the feasibility of utilizing dedicated satellite gravity missions in order to detect large-scale solid mass transfer events (e.g. landslides). Specifically, a sensitivity analysis of Gravity Recovery and Climate Experiment (GRACE) gravity field solutions in conjunction with simulated case studies is employed to predict gravity changes due to past subaerial and submarine mass transfer events, namely the Agulhas slump in southeastern Africa and the Heart Mountain Landslide in northwestern Wyoming. The detectability of these events is evaluated by taking into account the expected noise level in the GRACE gravity field solutions and simulating their impact on the gravity field through forward modelling of the mass transfer. The spectral content of the estimated gravity changes induced by a simulated large-scale landslide event is estimated for the known spatial resolution of the GRACE observations using wavelet multiresolution analysis. The results indicate that both the Agulhas slump and the Heart Mountain Landslide could have been detected by GRACE, resulting in |0.4| and |0.18| mGal change on GRACE solutions, respectively. The suggested methodology is further extended to the case studies of the submarine landslide in Tohoku, Japan, and the Grand Banks landslide in Newfoundland, Canada. The detectability of these events using GRACE solutions is assessed through their impact on the gravity field. [ABSTRACT FROM AUTHOR]

Ray tracing, which has been widely used for seismic waves, was also applied to tsunamis to examine the bathymetry effects during propagation, but it was limited to linear shallow-water waves. Green’s law, which is based on the conservation of energy flux, has been used to estimate tsunami amplitude on ray paths. In this study, we first propose a new ray tracing method extended to dispersive tsunamis. By using an iterative algorithm to map two-dimensional tsunami velocity fields at different frequencies, ray paths at each frequency can be traced. We then show that Green’s law is valid only outside the source region and that extension of Green’s law is needed for source amplitude estimation. As an application example, we analyzed tsunami waves generated by an earthquake that occurred at a submarine volcano, Smith Caldera, near Torishima, Japan, in 2015. The ray-tracing results reveal that the ray paths are very dependent on its frequency, particularly at deep oceans. The validity of our frequency-dependent ray tracing is confirmed by the comparison of arrival angles and travel times with those of observed tsunami waveforms at an array of ocean bottom pressure gauges. The tsunami amplitude at the source is nearly twice or more of that just outside the source estimated from the array tsunami data by Green’s law. [ABSTRACT FROM AUTHOR]

Submarine landslides, also known as submarine mass failures (SMFs), are major natural marine disasters that could critically damage coastal facilities such as nuclear power plants and oil and gas platforms. It is therefore essential to investigate submarine landslides for potential tsunami hazard assessment. Three-dimensional seismic data from offshore Brunei have revealed a giant seabed mass deposited by a previous SMF. The submarine mass extends over 120 km from the continental slope of the Baram Canyon at 200 m water depth to the deep basin floor of the Northwest Borneo Trough. A suite of in-house two-dimensional depth-averaged tsunami simulation model TUNA (Tsunami-tracking Utilities and Application) is developed to assess the vulnerability of coastal communities in Sabah and Sarawak subject to potential SMF tsunami. The submarine slide is modeled as a rigid body moving along a planar slope with the center of mass motion parallel to the planar slope and subject to external forces due to added mass, gravity, and dissipation. The nonlinear shallow water equations are utilized to simulate tsunami propagation from deepwater up to the shallow offshore areas. A wetting-drying algorithm is used when a tsunami wave reaches the shoreline to compute run up of tsunami along the shoreline. Run-up wave height and inundation maps are provided for seven densely populated locations in Sabah and Sarawak to highlight potential risks at each location, subject to two scenarios of slide slopes: 2° and 4°. The first wave may arrive at Kudat as early as 0.4 h after the SMF, giving local communities little time to evacuate. Over a small area, maximum inundated depths reaching 20.3 m at Kudat, 26.1 m at Kota Kinabalu, and 15.5 m at Miri are projected, while the maximum inundation distance of 4.86 km is expected at Miri due to its low-lying coast. In view of the vulnerability of some locations to the SMF tsunami, it is important to develop and implement community resilience program to reduce the potential damage that could be inflicted by SMF tsunamis. [ABSTRACT FROM AUTHOR]

Previously, we reported that GfsA is a novel galactofuranosyltransferase involved in the biosynthesis of O-glycan, the proper maintenance of fungal morphology, the formation of conidia and anti-fungal resistance in Aspergillus nidulans and A. fumigatus (Komachi Y et al., 2013. GfsA encodes a novel galactofuranosyltransferase involved in biosynthesis of galactofuranose antigen of O-glycan in Aspergillus nidulans and Aspergillus fumigatus. Mol. Microbiol. 90:1054-1073). In the present paper, to gain an in depth-understanding of the enzymatic functions of GfsA in A. fumigatus (AfGfsA), we established an in vitro assay to measure galactofuranosyltransferase activity using purified AfGfsA, UDP-α-D-galactofuranose as a sugar donor, and p-nitrophenyl-β-Dgalactofuranoside as an acceptor substrate. LC/MS, 1H-NMR and methylation analyses of the enzymatic products of AfGfsA revealed that this protein has the ability to transfer galactofuranose to the C-5 position of the β-galactofuranose residue via a β-linkage. AfGfsA requires a divalent cation of manganese for maximal activity and consumes UDP-α-D-galactofuranose as a sugar donor. Its optimal pH range is 6.5-7.5 and its optimal temperature range is 20-30°C. 1H-NMR, 13C-NMR and methylation analyses of fungal-type galactomannan extracted from the ΔAfgfsA strain revealed that AfGfsA is responsible for the biosynthesis of β1,5-galactofuranose in the galactofuran side chain of fungal-type galactomannan. Based on these results, we conclude that AfGfsA acts as a UDP-α-D-galactofuranose: β-D-galactofuranoside β1,5-galactofuranosyltransferase in the biosynthetic pathway of galactomannans. [ABSTRACT FROM AUTHOR]

We perform numerical simulations to assess how coastal tsunami hazard from submarine mass failures (SMFs) is affected by slide kinematics and rheology. Two types of two-layer SMF tsunami generation models are used, in which the bottom (slide) layer is depth-integrated and represented by either a dense Newtonian fluid or a granular flow, in which inter-granular stresses are governed by Coulomb friction (Savage and Hutter model). In both cases, the upper (water) layer flow is simulated with the non-hydrostatic 3D σ-layer model NHWAVE. Both models are validated by simulating laboratory experiments for SMFs made of glass beads moving down a steep plane slope. In those, we assess the convergence of results (i.e., SMF motion and surface wave generation) with model parameters and their sensitivity to slide parameters (i.e., viscosity, bottom friction, and initial submergence). The historical Currituck SMF is simulated with the viscous slide model, to estimate relevant parameters for simulating tsunami generation from a possible SMF sited near the Hudson River Canyon. Compared to a rigid slump, we find that deforming SMFs of various rheology, despite having a slightly larger initial acceleration, generate a smaller tsunami due to their spreading and thinning out during motion, which gradually makes them less tsunamigenic; the latter behavior is controlled by slide rheology. Coastal tsunami hazard is finally assessed by performing tsunami simulations with the Boussinesq long wave model FUNWAVE-TVD, initialized by SMF tsunami sources, in nested grids of increasing resolution. While initial tsunami elevations are very large (up to 25 m for the rigid slump), nearshore tsunami elevations are significantly reduced in all cases (to a maximum of 6.5 m). However, at most nearshore locations, surface elevations obtained assuming a rigid slump are up to a factor of 2 larger than those obtained for deforming slides. We conclude that modeling SMFs as rigid slumps provides a conservative estimate of coastal tsunami hazard while using a more realistic rheology, in general, reduces coastal tsunami impact. [ABSTRACT FROM AUTHOR]

Microbial biofilms can colonize medical devices and human tissues, and their role in microbial pathogenesis is now well established. Not only are biofilms ubiquitous in natural and human-made environments, but they are also estimated to be associated with approximately two-thirds of nosocomial infections. This multicellular aggregated form of microbial growth confers a remarkable resistance to killing by antimicrobials and host defenses, leading biofilms to cause a wide range of subacute or chronic infections that are difficult to eradicate. We have gained tremendous knowledge on the molecular, genetic, microbiological, and biophysical processes involved in biofilm formation. These insights now shape our understanding, diagnosis, and management of many infectious diseases and direct the development of novel antimicrobial therapies that target biofilms. Bacterial and fungal biofilms play an important role in a range of diseases in pulmonary and critical care medicine, most importantly catheter-associated infections, ventilator-associated pneumonia, chronic Pseudomonas aeruginosa infections in cystic fibrosis lung disease, and Aspergillus fumigatus pulmonary infections. [ABSTRACT FROM AUTHOR]

Since the devastating earthquake of 2010 in Haiti, significant efforts have been devoted to estimating future seismic and tsunami hazard in Hispaniola. In 2013, following a workshop of experts, UNESCO commissioned an initial modeling study to assess tsunami hazard, essentially from seismic sources, along the North shore of Hispaniola (NSOH), which is shared by the Republic of Haiti (RH) and the Dominican Republic (DR). The scope of this study included detailed tsunami inundation mapping for two selected critical sites, Cap Haitien in RH and Puerto Plata in DR. Results of this effort are reported here, and, although still limited in scope, they are within the framework and contribute to the advancement of the UNESCO IOC Tsunami and other Coastal Hazards Warning System for the Caribbean and Adjacent Regions (CARIBE EWS; von Hillebrandt-Andrade in Science 341:966-968, ). In similar work done for critical areas of the US east coast (under the auspice of the US National Tsunami Hazard Mitigation Program), the authors have modeled the most extreme far-field tsunami sources in the Atlantic Ocean basin, including: (1) a hypothetical $$M_w$$ 9 seismic event in the Puerto Rico Trench (PRT); (2) a repeat of the historical 1755 $$M_w$$ 9 earthquake in the Azores convergence zone (LSB); and (3) a hypothetical extreme $$450\,\hbox {km}^3$$ flank collapse of the Cumbre Vieja Volcano (CVV) in the Canary Archipelago. Here, tsunami hazard assessment is performed along the NSOH for these three sources, plus two additional near-field coseismic tsunami sources: (1) a $$M_w$$ 8 earthquake in the western segments of the nearshore Septentrional fault (SF), as a repeat of the 1842 event; and (2) a $$M_w$$ 8.7 earthquake occurring in selected segments of the North Hispaniola Thrust Fault (NHTF). Initial tsunami elevations are modeled based on each source's parameters and propagated with FUNWAVE-TVD (a nonlinear and dispersive long-wave Boussinesq model) in a series of increasingly fine-resolution nested grids (from 1 arc-min to 205 m) using a one-way coupling methodology. For the two selected sites, coastal inundation is computed with TELEMAC (a Nonlinear Shallow Water wave model), in finer-resolution (12-30 m) unstructured nested grids. While for the EC, PRT is a far-field source, for RH and DR, this would be local source as some of the NSOH would be affected within 1 h or is within 200 km of the PRT. This is per definitions of UNESCO IOC. Regional goes from 200 to 1000 km and within 1 and 3 h, and distant is greater than 3 h and more than 1000 km. We find that among the far-field sources CVV causes the largest impact, with up to 20-m runup at the critical sites while PRT, which is a local source for the NSOH, only causes up to 4-m runup due to its directionality; PRT, however, has both a much shorter return period and would impact the NSOH within 30 min of the earthquake. Among near-field sources, the SF event, as could be expected from a strike-slip fault, only causes a small tsunami, but the NHTF event causes up to 12-m runup in the critical sites, with the tsunami arriving within minutes of the earthquake. Hence, the latter event can be considered as the 'Probable Maximum Tsunami' (PMT; following, e.g., the US Nuclear Regulatory Commission terminology) for the NSOH. Results of detailed coastal modeling for this PMT can be used to develop maps of vulnerability for the critical sites and prepare for mitigating measures and evacuation; a few examples of such maps are given in the paper. Although a number of earlier studies have dealt with each of the far-field tsunami sources, the modeling of their impact on the NSOH and that of the near-field sources, presented here as part of a comprehensive tsunami hazard assessment study, are novel. Future work should model additional coastal sites and may consider effects of tsunamis generated by near-field submarine mass failures. [ABSTRACT FROM AUTHOR]

OBJECTIVES The technical difficulty in the revascularization of the circumflex artery territory with off-pump surgery may compromise the outcome of this method in clinical follow-up. We aimed to evaluate cardiac events in patients with stable coronary artery disease and severe obstruction of the circumflex system, undergoing coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass. METHODS MASS III was a single-centre study that evaluated 308 patients with multivessel coronary artery disease randomized to on-pump (153) or off-pump (155) CABG. Of this total, 260 (84.4%) patients had, on coronary angiography, at least one 70% obstruction in the circumflex territory (141 on-pump and 119 off-pump). The combined outcome was death, myocardial infarction, target vessel revascularization (angioplasty or surgery) or hospitalization for cardiac causes. Variables with possible associations (P < 0.1) were included in the multivariate analysis. RESULTS The two groups were well matched for demographics and clinical and angiographic characteristics. After 5 years of follow-up, off-pump CABG had higher combined events than on-pump had: 25 (21%) vs 17 (12%), hazard ratio 1.88, 95% confidence interval 1.02–3.48, P = 0.041. In the multivariate model with the inclusion of the following variables: age (P = 0.09) and complete revascularization (P = 0.68), off-pump surgery remained as a predictor of combined events in 5 years, P = 0.03. CONCLUSIONS In patients with multivessel coronary artery disease and severe lesions in the circumflex territory, off-pump coronary artery bypass surgery resulted in a higher incidence of cardiac events at 5-year follow-up. Clinical trial registration number ISRCTN59539154 (http://www.controlled-trials.com). [ABSTRACT FROM PUBLISHER]

Background: Coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CBP) is associated with significant morbidity and mortality. In high-risk patients, doomed for reoperation the adverse effects of CBP may be more striking. We evaluated the results of reoperative CABG (redo-CABG) by either off-pump (OPCAB) or on-pump (ONCAB). Clinical endpoints were perioperative myocardial infarction, mortality, survival and as the most striking difference between prior studies the quality of life (QoL). Methods: We performed a prospective, non-randomized assessment for patients who underwent redo-CABG by redo-OPCAB (n = 40) or redo-ONCAB (n = 40) at our institution between January 2007 and December 2010. For evaluation of QoL the SF-36 health survey was used with self-administered assessment. Results: During follow-up 37 of 40 patients were alive in the redo-OPCAB group versus 32 of 40 patients in the redo-ONCAB group (p < 0.05). The shorter operation time, less blood loss, fewer perioperative myocardial infarctions, the higher rate of totally arterial revascularisation and shorter intensive care stay were the significantly beneficial differences for patients in the redo-OPCAB group (p < 0.05). The 3-year survival rate was higher in the redo-OPCAB group with 81 ± 12% versus 63 ± 9%in the redo-ONCAB group. The quality of life survey did not reveal any significant differences between both groups. Conclusion: In conclusion, with our present retrospective study, we could demonstrate the safety and efficacy of the redo-OPCAB technique with even higher 3-year survival rate. Both techniques seem to have similar impact on the outcome of patients. [ABSTRACT FROM AUTHOR]

The article discusses the history of coronary artery bypass graft, as well as techniques involved in the procedure. It states that surgical treatment of coronary artery disease is one of the most studied topics among all medical specialties. Contributions of several notable cardiovascular surgeons are highlighted, including Doctor Christiaan Barnard, Doctor Denton Cooley, and Doctor Norman Shuhmway. Alternative techniques, including the use of laser beams and stem cells, are also described.

Despite many years of clinical and experimental research, the contribution of Cardiopulmonary Bypass (CPB) and cardioplegic arrest to morbidity and mortality following cardiac surgery remains unclear. In the last few years, Off-Pump Coronary Artery Bypass grafting (OPCAB) has gained widespread attention as an alternative technique to conventional On-Pump Coronary Artery Bypass grafting (ONCAB). It has provided an opportunity to compare the operations, in similar patient groups, with or without CPB and cardioplegic arrest. Although initial studies performed on low risk patients preferably with single vessel disease showed favorable outcome, we currently lack larger properly randomized high quality studies which show definite benefit. Proponents of off-pump surgery state that the avoidance of the CPB leads to significantly reduced myocardial ischemia-reperfusion injury, post-operative systemic inflammatory response, postoperative pulmonary complications, hospital stay and cost, a feature that may improve the clinical and economical outcomes. However, perfection in surgical technique, completeness of revascularization and whether the off pump method leads to improved outcome are still burning issues. In this review, OPCAB is found to be significantly better than the ONCAB in reducing cost, hospital stay, blood transfusion requirements, incidence of post-operative pulmonary complications, systemic inflammation and post-operative atrial fibrillations in most of the studies. The comparison show almost equivocal results regarding mortality, survival, quality of life, re-intervention rate, risk of stroke, cognitive decline and GI complication. [ABSTRACT FROM AUTHOR]

Background: In the current scenario the costs of performing minimally invasive cardiac surgery are very high primarily due to the high cost of hardware used, limiting its widespread usage especially in a developing country like ours. The aim of our study was to test the feasibility and safety of performing minimally invasive surgery to repair simple congenital cardiac defects using standard equipment. Methods and materials: From July 2011 to March 2012, 59 patients, weighing between 7 kg to 32 kg underwent closure of their defects via lower ministernotomy. Forty six cases were Ostium Secundum Atrial Septal Defect (OSASD), four cases had OSASD with Valvar Pulmonary Stenosis (PS), five cases of moderate Ventricular Septal Defect (VSD), three cases of Sinus Venosus Atrial Septal Defect (SVASD) and one case of Partial AtrioVentricular Canal Defect (PAVCD). All patients underwent central canulation of aorta and vena cava. Standard cannula and instruments were used during the procedure. Results: The length of the postoperative scar measured ranged from 3.5 to 8 cm. One SVASD was converted to complete sternotomy because of high drainage of the Partial Anomalous Partial Venous Connection (PAPVC). None of the patients had any emergency conversion, re-exploration or neurological side effects. One patient had a tiny residual VSD and another patient had a pericardial effusion that required drainage. Conclusion: Repair of most simple congenital cardiac defects can be safely performed through a lower ministernotomy approach. The procedure resulted in a cosmetically appealing scar and decreased patient morbidity without using any special expensive instruments. [ABSTRACT FROM AUTHOR]

It has been reported that hypoxia-inducible factor 1α (HIF-1α) serves a key role in the protective effect of remote ischemic preconditioning (RIP) in ischemia/reperfusion (I/R)-induced cardiac injury. Moreover, inhibition of prolyl 4-hydroxylase (PHD), an enzyme responsible for HIF-1α degradation, prevents I/R-induced cardiac injury. However, whether their protective effects are synergetic remains to be elucidated. The present study aimed to investigate the protective effect of RIP, PHD inhibition using dimethyloxalylglycine (DMOG) and their combination on I/R-induced cardiac injury. Rabbits were randomly divided into seven groups: i) Sham; ii) I/R; iii) lung RIP + I/R; iv) thigh RIP + I/R; v) DMOG + I/R; vi) DMOG + lung RIP + I/R; and vii) DMOG + thigh RIP + I/R. I/R models were established via 30 min left coronary artery occlusion and 3 h reperfusion. For lung/thigh RIP, rabbits received left pulmonary artery (or left limb) ischemia for 25 min and followed by release for 5 min. Some rabbits were administered 20 mg/kg DMOG. The results demonstrated that both lung/thigh RIP and DMOG significantly decreased myocardial infarct size, creatine kinase activity and myocardial apoptosis in I/R rabbits. Furthermore, the combination of RIP and PHD inhibition exerted synergetic protective effects on these aforementioned changes. The mechanistic study indicated that both treatments increased mRNA and protein expression levels of HIF-1α and its downstream regulators, including vascular endothelial growth factor (VEGF), AKT and endothelial nitric oxide synthase (eNOS). In conclusion, the present study demonstrated that RIP and PHD inhibition exerted synergetic protective effects on cardiac injury via activation of HIF-1α and the downstream VEGF/AKT-eNOS signaling pathway. [ABSTRACT FROM AUTHOR]

Cardiac surgery has been the last of the surgical specialties to embrace the principles of minimal invasiveness. The complexity and invasiveness of the procedures have presented both a problem and an opportunity to make the procedures less invasive. Beginning with initial attempts at coronary artery bypass surgery through limited access with and without robotics, a number of other cardiac procedures currently are being performed by minimally invasive approaches. These include mitral valve repair, transapical aortic valve implant, limited access, and totally endoscopic pulmonary vein isolation for the treatment of atrial fibrillation and the treatment of aortic aneurysmal disease by thoracic endografting. The experience with less invasive surgery in other specialties has served as cross-fertilization for minimally invasive cardiac surgery. [ABSTRACT FROM AUTHOR]

This study examined the prevalence of disordered gambling in substance abuse counselors. Participants (N = 328) completed an anonymous self-report survey assessing lifetime disordered gambling, past two-month gambling behavior, and current mental and physical health. The lifetime prevalence rates of pathological and problem gambling in this sample (11.9% and 6.4%, respectively) were higher than rates reported in general population surveys. Poorer physical health was associated with pathological gambling, but mental health was not. These results suggest that substance abuse counselors may benefit from education, prevention, and intervention efforts for disordered gambling. [ABSTRACT FROM AUTHOR]