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Objectives: To identify possible etiology-specific differences in preoperative risk factors for major adverse events during Impella 5.5 support in patients with ischemic (ICM) and nonischemic cardiomyopathy (NICM). Methods: From October 2019 to January 2023, 228 Impella 5.5 devices were inserted at our institution. Patients were stratified into ICM (n = 124) and NICM (n = 104) cohorts. The primary outcome was a composite of death/stroke/new-onset dialysis while actively receiving Impella 5.5 support. Random forests identified preoperative factors predictive of the primary outcome separately for each cohort, with ranking by variable importance. Results: The primary outcome occurred in 42 (34%) patients with ICM and 35 (34%) patients with NICM. Twenty-one (17%) patients with ICM and 21 (20%) patients with NICM died on Impella 5.5; stroke occurred in 12 (9.7%) patients with ICM and 3 (2.9%) patients with NICM, and new-onset dialysis was initiated in 23 (19%) patients with ICM and 24 (23%) patients with NICM while actively receiving Impella 5.5 support. Risk factors reflecting systemic and myocardial cellular injury, end-organ and cardiopulmonary failure, right ventricular dysfunction, and smaller left ventricular dimensions were most predictive of adverse outcomes in both cohorts. Indications for Impella 5.5 and device strategy (bridge to recovery, advanced therapies, or decision) were not top risk factors in either cohort. Conclusions: Risk factors related to preoperative stability, right ventricular dysfunction, and left ventricular size were more predictive of adverse outcomes while actively receiving Impella 5.5 support than indication or device strategy. These factors could help identify high-risk patients who may benefit from additional tailored management to reduce their risk for these impactful adverse outcomes while on Impella 5.5 support.

Background: The clinical characteristics and outcomes of patients who develop cardiogenic shock (CS) secondary to primary valvular dysfunction (valvular cardiogenic shock [VCS]) remain unclear. Objectives: The purpose of this study was to describe the cohort of patients with VCS and understand their outcomes compared to other forms of CS. Methods: All patients admitted to Cleveland Clinic cardiac intensive care unit between January 1, 2010, and December 31, 2021, with a diagnosis of CS were retrospectively identified. Characteristics and outcomes for shock patients with VCS were compared to those without VCS. Results: A total of 2,754 patients were admitted to our cardiac intensive care unit with CS, of which 442 (16%) had VCS. The median age of patients with VCS was higher than those with non-VCS (70 years vs 64 years, P

The diagnosis and treatment of new-onset systolic dysfunction can be challenging, particularly in patients presenting with cardiogenic shock. We present a case of a young African-American male who was admitted for cardiogenic shock following an admission a month earlier for treatmentresistant psychosis. He was diagnosed with medication-induced cardiomyopathy, which resolved with a remarkable recovery of his systolic function after discontinuation of the culprit medication, clozapine.

Nepravde iskovane nejednakim pristupom pravnom sistemu predstavljaju direktnu prijetnju vladavini prava, ipak, takve nepravde su široko rasprostranjene u Engleskoj i drugdje. Advokati redovno kritikuju vlade zbog nedostatka sredstava za pravni sistem, ali privatno tržište za pružanje pravnih usluga dobija mnogo manje pažnje. Privatno tržište pravnih resursa je suprotno jednakoj pravdi jer dovodi do toga da se ishod predmeta okreće proizvoljnim faktorima kao što je bogatstvo. Rješenje jeste, prema Wilmot-Smithu u njegovoj knjizi Jednaka pravda, da se raspodjela pravnih usluga socijalizuje tako da bogati ne mogu kupiti najbolje advokate, i spriječiti ih da izađu iz ovog javnog sistema tako što će privatne arbitraže učiniti neprovedivim. Ovaj pregledni članak tvrdi da je Wilmot-Smithova teza uvjerljiva, ali mogu postojati i druga po redu najbolja rješenja koja bi mogla donijeti veću pravnu jednakost po nižoj cijeni.

Facial artery pseudoaneurysms are exceedingly rare events that can occur as a complication of oral maxillofacial surgery or facial trauma. The management of such pseudoaneurysms following buccal mucosa graft harvest for urinary reconstructive indications has not previously been described. Here, we describe a facial artery pseudoaneurysm that presented as repeated, episodic facial bleeding episodes following buccal mucosal harvest for a patient undergoing urethroplasty.

Abstract Background Zygomaticomaxillary complex (ZMC) and zygomatic arch (ZA) fractures are common injuries resulting from facial trauma and frequently require surgical management (Huang et al., Craniomaxillofac Trauma Reconstr 8(4):271-6, 2015). A substantial number of post-operative functional and cosmetic complications can arise from the surgical management of these fractures. These include scarring, inadequate facial profile restoration, facial asymmetries and diplopia (Ellis et al. J Oral Maxillofac Surg 54(4):386-400, 1996; Yang et al. Oral Maxillofac Surg Clin North Am 23(1):31-45, 2011; Kloss et al. Int J Oral Maxillofac Surg 40(1):33-7, 2011). Intuitively, most of these aforementioned complications arise as a result of inadequate fracture reduction; however, current standard practice is to assess reduction post-operatively through plain radiographs or computed tomography (CT) scans. The role of intra-operative CT scanning to assess the reduction of ZMC/ZA fractures and the potential impact on complications, has thus far not been established. Methods This is a prospective randomised controlled trial currently being undertaken at the Royal Brisbane and Women’s Hospital. All patients who require operative management of their ZMC or ZA fractures are offered enrollment in the trial. The patients are randomised into two groups: interventional (intra-operative CT) and control (no intra-operative CT). All patients in each group will have post-operative radiographs taken. From these radiographs, the reduction of the ZMC and/or ZA fracture is graded by a blinded assessor. Patients will be reviewed in clinic at 1 week and 6 weeks post-surgery. During these consultations, all patients will be assessed for scarring, diplopia, facial profile restoration and need for revision surgery. Discussion Many complications associated with surgical management of ZMC and ZA fractures involve poor aesthetic results as a direct consequence of inadequate fracture reduction. Inadequate fracture reduction is predictable given that small incisions are used and only limited visualisation of the fractures is possible during the procedure. This is due to a desire to limit scarring and reduce the risk of damage to vital structures in an aesthetically sensitive region of the body. It follows that an intraoperative adjunctive tool such as a CT scan, which can assist in visualisation of the fractures and the subsequent reduction, could potentially improve reduction and reduce complications. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12616000693426. Registered on 26 May 2016.

The purpose of this article is to illuminate some of the difficulties experienced by distance educators in the philosophical sense. It will show distance learning practice is still a highly pragmatic enterprise that is academically successful. Despite its academic success distance learning is not accepted by the education profession generally because it challenges the most fundamental paradigm of western education, namely, the co-location in time and space of teachers, students and resources. Distance learning challenges the need for a place or institution for study, for example, a school. This appears to disrupt the social and economic imperatives of having a place to work. Finally, distance learning challenges the socialisation purposes used by society through schools to enculture young people.

This invited article comprises three parts that document the history of distance and flexible learning in New Zealand and the professional association DEANZ/FLANZ (Distance Education Association of New Zealand, later known as the Flexible Learning Association of New Zealand), which serves this community. The first part was originally published in the "DEANZ Magazine" in July 2015 as "DEANZ: A Brief History". The second part was originally published in the "FLANZ Magazine" in July 2016 as "DEANZ Foundation". The third, newly written, part brings the history of DEANZ/FLANZ up to date, and is published for the first time here. FLANZ (formerly DEANZ) is a professional association. The "Journal of Open, Flexible and Distance Learning" is the Association's flagship journal.

Concurrent primary carcinoid tumor and primary mucinous adenocarcinoma arising within a mature cystic teratoma of a horseshoe kidney is a rare event and has been reported once in the literature. We present the first case where this tumor subtype has metastasized to lymph nodes. Treatment included open partial nephrectomy, lymph node dissection, and adjuvant chemotherapy with temozolomide and capecitabine. Due to the rare combination of tumor histologies, it is unlikely that this cohort will ever be able to be adequately studied to determine a standard of care. Thus extrapolation of treatment methods of similar tumors will continue to guide treatment.

Aerococcus urinae is a rare organism isolated from urine cultures. We present a case of an 80 year-old male with bladder cancer and multimorbidity who developed A. urinae infection. A. urinae may cause simple and complicated UTIs, bacteremia, and endocarditis in older adults with multimorbidity, chronic urinary retention, or indwelling catheters. A. urinae treatment should employ penicillin, amoxicillin, and nitrofurantoin. Due to increasing antibiotic resistance, urine culture should include antibiotic susceptibility testing. Prompt and culture-specific treatment is critical to avoid clinical progression of the infection.

This research aimed to inform institutional leaders by producing and disseminating a system wide view of what tertiary education might look like in Aotearoa New Zealand, five years into the future. The researchers were responding to a challenge in a speech at the DEANZ 2010 conference by a highly respected national leader (Dr Peter Coolbear). The outcome became known as the DEANZ2016 scenario set. Using JISC scenario planning methodologies, including interviews of 16 national and international education leaders, the scenario set was developed on an X axis depicting the tension between facing the academy vs facing New Zealand employers, professions and iwi, and a Y axis depicting the tension between standardized education vs customization to personalise learning. Each of the four quadrants aimed to expose and contrast potential future scenarios. These were entitled: Articulation, The 'Supermarket', Quality Branded Consortia, and Self Determination. Innovatively disseminated via the web, the DEANZ2016 website became the most popular section of the larger Ako Aotearoa website, which stimulated further research into uptake and impact of the project.

The purpose of this report is to examine the adoption and implementation of flexible learning initiatives at the University of Otago. Altogether there have been 169 projects of varying size incorporating technologies in teaching. Twenty-eight of these have been designated specifically as flexible learning projects. The report discusses definitions surrounding the term 'flexible learning', the role it plays in helping change teaching strategies and presents five brief case studies which describe the implementation and outcomes of some flexible learning projects.

This paper uses the origins of and subsequent changes to correspondence education in Queensland and New Zealand to highlight how open and flexible learning practices are influencing the normal paradigm of educational teaching, learning and service delivery.

Reviews Mason, R. (1998). Globalising education- Trends and Applications. London: Routledge and Scott, G. ( 1999). Change matters: Making a difference in education and training. Sydney: Allen and Unwin.

Reviews of Brabazon, T. (2002). Digital hemlock: Internet education and the poisoning of teaching. Sydney, Australia: University of New South Wales Press Paechter, C., Edwards, R., Harrison, R., & Twining, P. (Eds.) (2001). Learning, space, and identity. London: Paul Chapman Publishing, in association with The Open University Perraton, H., & Lentell, H. (Eds.) (2004). Policy for open and distance learning. London: RoutledgeFalmer/ Commonwealth of Learning

This paper describes the conversion of a first year History paper at the University of Otago into a flexible learning paper. The work involved using distance learning techniques to generate a paper that went some way to achieving flexibility of time, place and pace of student learning.

This article reports on the views of both staff and students at AUT University after having had three years’ experience using the BlackBoard learning management system, locally renamed AUTonline. The university sought the assistance of its Institutional Research Unit (IRU) to conduct two surveys, one of staff opinions and one from students. There were 210 out of 400 identified regular staff users responding to the questionnaire. The IRU identified 8,000 regular student users of the system, randomly selecting 1,500 and receiving a response from 499 students. The survey found that both staff and students were about 80 percent satisfied with their experiences with the learning management system in general; no category of issues in the survey fell into the less-than-satisfactory bandwidth. No similar institutional surveys have been conducted by universities in New Zealand, so the outcomes of the survey have been located more in the Australasian context.