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Based on dual-pathway models of collective action, this research examines how social movements’ proximity to their stated goal affects potential supporters’ willingness and motivations to engage. Across three experimental studies in two different contexts, and for members of both the disadvantaged ingroups and advantaged outgroups (total N = 1,102), we find consistent support for two counteracting indirect effects of goal distance on collective action. When movements are closer to their goals, potential supporters perceive less injustice, which reduces their willingness to engage in collective action for the movements’ cause via the emotion-focused pathway. At the same time, perceptions of political efficacy increase, bolstering engagement via the problem-focused pathway. We conclude that while goal proximity does not seem to affect overall intentions to engage in collective action, it does affect the motivational paths to it, which makes it a relevant factor to consider in both research and social justice contexts.

Aims To provide population-based data on the prevalence and clinical significance of immune deficiency syndromes (IDS) associated with congenital heart disease (CHD). Methods and results Utilizing administrative German Health System data the prevalence of increased susceptibility to infection (ISI) or confirmed IDS was assessed in CHD patients and compared with an age-matched non-congenital control group. Furthermore, the prognostic significance of IDS was assessed using all-cause mortality and freedom from emergency hospital admission. A total of 54 449 CHD patients were included. Of these 14 998 (27.5%) had ISI and 3034 (5.6%) had a documented IDS (compared with 2.9% of the age-matched general population). During an observation period of 394 289 patient-years, 3824 CHD patients died, and 31 017 patients experienced a combined event of all-cause mortality or emergency admission. On multivariable Cox proportional-hazard analysis, the presence of ISI [hazard ratio (HR): 2.14, P < 0.001] or documented IDS (HR: 1.77, P = 0.035) emerged as independent predictors of all-cause mortality. In addition, ISI and confirmed IDS were associated with a significantly higher risk of emergency hospital admission (P = 0.01 for both on competing risk analysis) during follow-up. Conclusion Limited immune competence is common in CHD patients and associated with an increased risk of morbidity and mortality. This highlights the need for structured IDS screening and collaboration with immunology specialists as immunodeficiency may be amenable to specific therapy. Furthermore, studies are required to assess whether IDS patients might benefit from intensified antibiotic shielding or tailored prophylaxis.

Adding rainbow filters in support of LGBTQ+ movements or changing profile pictures to black squares to show support for the BlackLivesMatter movement have become common contemporary expressions of solidarity. However, these actions are often criticized as being ‘performative’ and falling short of genuine social change. Despite its popular-ity, little is known about what performative allyship is and what its pitfalls or potential benefits may be. We review the existing psychological literature on intergroup relations and allyship to provide a definition and framework for stud-ying performative allyship and its consequences for social change. We propose that the term performative allyship refers to easy and costless actions that often do not chal-lenge the status quo and are motivated primarily by the desire to accrue personal benefits. The literature suggests that engaging in performative allyship may have a negative impact on the physical and mental well-being of disadvan-taged groups, but also on allies. We discuss negative and some positive consequences of engagement in performative allyship on disadvantaged groups, allies and society at large and provide directions for future research.

Rural communities are a vital segment of the US population; however, these communities are shrinking, and their population is aging. Rural women experience health disparities including increased risk of maternal morbidity and mortality. In this article, we will explore these trends and their determinants both within and external to the health care system. Health care providers, public health professionals, and policymakers should be aware of these social and structural factors that influence health outcomes and take action to reduce generational cycles of health disparity. Opportunities to improve the health and pregnancy outcomes for rural women and rural populations are highlighted.

ObjectivesData on the clinical outcome of patients with congenital heart disease (CHD) affected by severe viral pneumonia are limited. We analysed morbidity and mortality of viral pneumonia and evaluated the association between medical conditions, medication, vaccination and outcome specifically in patients with CHD requiring hospitalisation for viral pneumonia.MethodsBased on data from one of Germany’s largest health insurers, all cases of viral pneumonia requiring hospital admission (2005–2018) were studied. Mortality, and composites of death, transplantation, mechanical circulatory support, ventilation or extracorporeal lung support served as endpoints.ResultsOverall, 26 262 viral pneumonia cases occurred in 24 980 patients. Of these, 1180 cases occurred in patients with CHD. Compared with patients without CHD, mortality rate was elevated in patients with CHD. As a group, patients with CHD aged 20–59 years even exceeded mortality rates in patients without CHD aged >60 years. No mortality was observed in patients with CHD with simple defects ConclusionsWe present timely data on morbidity and mortality of severe viral pneumonia requiring hospital admission in patients with CHD. Need for mechanical ventilation and risk of death in CHD increase early in life, reaching a level equivalent to non-CHD individuals >60 years of age. Our data suggest that except for patients with isolated simple defects, patients with CHD should be considered higher-risk individuals when faced with severe viral pneumonia.

The introduction to the EJSP special issue brings together recent literature on allyship. We present and discuss different definitions of allyship and highlight a multiple perspectives approach to understanding the predictors and consequences of allyship. This approach suggests that engagement in allyship can be driven by egalitarian and non-egalitarian motivations and that the behaviours identified as allyship can have different meanings, causes and consequences depending on whether researchers take into account the allies’ perspective or the disadvantaged groups’ perspective. We use this approach as an organizing principle to identify themes that emerge in the papers included in this special issue. We start with four papers that consider the perspective of the advantaged group, followed by two papers that consider the perspective of the disadvantaged group. Finally, we introduce two theoretical papers that examine the relations between disadvantaged groups and allies, and we set out directions for future research.

The current study explores associations among sexism, gender, and support for two approaches to reduce men’s violence toward women targeting (a) men’s behavior to reduce male violence toward women and (b) women’s behavior so that they can avoid male violence. The associations between sexism and support for these two interventions were examined in 21,937 participants in the New Zealand Attitudes and Values Survey. For both women and men, hostility toward nontraditional women (hostile sexism) was associated with lower support for targeting men to reduce men’s violence against women. To a lesser degree, stronger attitudes that women who adhere to traditional feminine roles should be rewarded (benevolent sexism) were associated with greater support for targeting men to reduce men’s violence. In contrast, both hostile and benevolent sexism were positively associated with support for targeting women to avoid men’s violence. These complex and nuanced relationships could suggest that sexism perpetuates the idea that women are responsible for keeping themselves safe from men’s violence while excusing men from accountability. This possibility has implications for addressing how society can be best engaged in the campaign against men’s violence toward women.

Background: Manufacturing companies nowadays have to cope with ever-increasing speed and complexity to manage their global supply chain. Information flow manage the supply chain needs to be more accurate and real-time than ever before. Item master data management is no exception as well. This research demonstrates the potential benefits of applying robotic process automation (RPA) technology in master data management based on two companies in the manufacturing industry. Methods: The method approached by the research was a qualitative method, utilizing interpretation of data extracted from literature and semi-constructed interviews. Results: The article proposes a framework for RPA implementation in the master data managing process. Automation with software robots can greatly benefit the organization, namely: lower processing time, reduce human errors, lower operations cost, improved compliance level and higher data accuracy. Conclusions: With the objective to examine the benefits of RPA in master data management, the researchers have investigated 2 companies in the manufacturing industry to understand how they have benefited from RPA for item master data management processes. The result showed that RPA is affirmed to bring about many benefits for the organizations through structured automation. The researchers have proposed a framework for implementing RPA to capture item master data based on the change management model and the framework is separated in 3 phases involving important tasks in each phase. Future researches might use this study as a stepping stone for further studies in cognitive RPA, utilizing cognitive technology in combination with RPA technology with the mean to achieve a higher level of automation.

Purpose: To directly compare an algorithmic external levator resection technique with the choice of intraoperative adjustment to the same technique without intraoperative adjustments. Methods: A sequential controlled prospective comparative cohort study. Two cohorts were compared: a historical control adjustment, and an experimental non-adjustment group. Fourteen patients, 25 eyelids, were in the historical cohort; and 15 patients, 23 eyelids, were in the non-adjustment cohort. Primary acquired ptosis patients who met inclusion criteria were considered. All patients underwent a standardized external levator resection technique. Intraoperative adjustments were performed only in the historical cohort. Age, follow-up time, surgical time, and marginal reflex distance 1 (MRD1) were collected. Statistical analysis was performed using the Mann-Whitney U test. Statistical significance was p < 0.05. Primary and secondary outcome measures were postoperative MRD1 minus goal MRD1, and surgical time, respectively. Results: Twenty-five historical eyelids were compared with 23 non-adjusted eyelids. The average patient age was 68.4 years (range 19-84) and 59.3 years (range 24-83) for the adjusted and non-adjusted groups. Six-month postoperative (postoperative minus goal) MRD1 was -0.1 mm (95% CI -0.3-0.1) and -0.2 mm (95% -0.5-0.0) (p = 0.33), and surgical time was 13.8 min (95% CI 12.6-15.1) and 9.5 min (95% CI 9.0-10.1) (p < 0.001) for the adjusted and non-adjusted cohort, respectively. Conclusions: The external levator resection, utilizing a standardized algorithm approach, is an efficacious technique for involutional eyelid ptosis. With sound technique, this method can be performed without the need for intraoperative adjustment, thereby saving operative time and achieving similar results.

Mobilizing public support is key to a movement's success. Little is known, however, about how movements can achieve this goal and whether involving advantaged group members is beneficial for a movement's cause. In a set of five experiments with convenience samples collected in the United States and Germany (total N = 1,625), we examined whether protests (e.g., against racism and sexism) with and without advantaged group members affect politicized identification among observers. We expected that the presence (vs. absence) of advantaged group members at a protest will increase politicized identification among advantaged group observers, which was confirmed in Studies 1A–1C. In contrast, we expected that the disadvantaged group observers will increase or decrease their politicized identification depending on the role advantaged group members have at a protest (i.e., supportive vs. leadership role). Studies 2A–2B revealed that when advantaged group members had a supportive role, disadvantaged and advantaged group observers increased their politicized identification, but this effect was absent when they had a leadership role. Moreover, including advantaged group members in a protest increased the belief that solidarity is a normative behavior and the expectations that a protest will be peaceful among observers. Implications for research on allyship are discussed.

Introduction: Transesophageal echocardiography (TEE) is routinely performed before catheter ablation of atrial tachyarrhythmias to rule out the presence of left atrial thrombi. However, data to support this practice are inconsistent. Methods: We analyzed consecutive pre-procedural TEE in a high-volume electrophysiology center for the presence of left atrial thrombi and a relevant flow reduction in the left atrial appendage (LAA) defined as LAA sludge or LAA emptying velocity (LAAEV) < 20 cm/s. The possible predictors of reduced flow were recorded and compared in a multivariate logistic regression analysis. Results: 1676 TEE were included (1122 before pulmonary vein isolation, 436 before atrial flutter ablation, 166 before other ablations). 543 patients (32%) were female and 991 (59%) were on DOAC. Nine patients (0.5%) had an LAA thrombus on pre-procedural TEE. Ninety-five further patients (5.7%) had a relevant reduction in LAA flow. The underlying rhythm showed a significant association with the presence of LAA thrombus or reduced LAA flow (p = 0.003). Patients in sinus rhythm and cavotricuspid isthmus-dependent atrial flutter exhibited the lowest risk. Additionally, reduced kidney function was associated with a reduction in LAA flow velocities (p = 0.04). Of note, two LAA thrombi occurred in patients in sinus rhythm and six out of nine patients with an LAA thrombus were on vitamin-K antagonists. Conclusions: LAA thrombus is a rare occurrence before an elective catheter ablation. The underlying rhythm and kidney function may serve as markers of a higher likelihood of significantly reduced LAAEV and LAA thrombus.

Introduction: Automated echocardiography image interpretation has the potential to transform clinical practice. However, neural networks developed in general cohorts may underperform in the setting of altered cardiac anatomy. Methods: Consecutive echocardiographic studies of patients with congenital or structural heart disease (C/SHD) were used to validate an existing convolutional neural network trained on 14,035 echocardiograms for automated view classification. In addition, a new convolutional neural network for view classification was trained and tested specifically in patients with C/SHD. Results: Overall, 9793 imaging files from 262 patients with C/SHD (mean age 49 years, 60% male) and 62 normal controls (mean age 45 years, 50.0% male) were included. Congenital diagnoses included among others, tetralogy of Fallot (30), Ebstein anomaly (18) and transposition of the great arteries (TGA, 48). Assessing correct view classification based on 284,250 individual frames revealed that the non-congenital model had an overall accuracy of 48.3% for correct view classification in patients with C/SHD compared to 66.7% in patients without cardiac disease. Our newly trained convolutional network for echocardiographic view detection based on over 139,910 frames and tested on 35,614 frames from C/SHD patients achieved an accuracy of 76.1% in detecting the correct echocardiographic view. Conclusions: The current study is the first to validate view classification by neural networks in C/SHD patients. While generic models have acceptable accuracy in general cardiology patients, the quality of image classification is only modest in patients with C/SHD. In contrast, our model trained in C/SHD achieved a considerably increased accuracy in this particular cohort.

Introduction Guidelines recommend transoesophageal echocardiography (TOE) before cardioversion in thrombogenic arrhythmias when the requirement of ≥3 weeks of anticoagulation is not met. Current data to support this approach, especially with direct oral anticoagulants (DOAC), are scarce. Methods We analysed consecutive elective pre-cardioversion TOE in a high-volume electrophysiology centre for the occurrence of LAA thrombi or reduced LAA flow velocity. Possible predictors were recorded and compared in a multivariate logistic regression analysis. Results Consecutive pre-cardioversion TOE in 512 patients (148 female, median age 69 years) were included. In all patients, indication for TOE was either intake of anticoagulation Conclusion The presence of LAA thrombus before an elective cardioversion is a rare event in the age of direct oral anticoagulants. However, LAA thrombi occurred even in supposed low-risk individuals according to the CHA2DS2-VaSc score. QRS width may aid in identifying patients at a high risk of a reduced LAA flow velocity. Funding Acknowledgement Type of funding sources: None. Figure 1. Representative images of a solid LAA thrombus (panel A), LAA sludge (panel B, not containing a solid thrombus on i.v. contrast imaging), and a LAA free of thrombus or sludge (panel C). Panel D shows the PW Doppler signal in a patient with LAA emptying velocity reduced ≤20cm/s while panel E shows a LAA with normal flow characteristics.

Introduction Transoesophageal echocardiography (TOE) is routinely performed before catheter ablation of atrial tachyarrhythmias to rule out the presence of possible left atrial thrombi. However, data to support this practice are scarce. Methods We analysed consecutive pre-procedural TOE in a high-volume electrophysiology centre for the presence of left atrial thrombi and a relevant flow reduction in the left atrial appendage (LAA) defined as LAA sludge or pronounced spontaneous echo contrast. Possible predictors of reduced flow were recorded and compared in a multivariate logistic regression analysis. Results 1676 consecutive TOE were included (1122 before pulmonary vein isolation (PVI), 436 before atrial flutter ablation, 166 before other EP studies in patients with a history of atrial tachyarrhythmias). 543 patients (32%) were female, mean age was 63±12 years and BMI was 27±5 kg/m2. Nine patients (0.5%) had an LAA thrombus on pre-procedural TOE. Ninety-five further patients (5.7%) had a relevant reduction in LAA flow as characterized by LAA sludge or spontaneous echo contrast. Further patient characteristics by LAA flow state are shown in the table. While a higher CHA2DS2-VaSc-Score was associated with the presence of LAA sludge and LAA thrombus (p=0.01), no further clinical parameters such as choice of oral anticoagulation agent were independently predictive of reduced flow velocities or thrombus in a logistic regression model (see table). Importantly, LAA thrombi also occurred in patients with a CHA2DS2-VaSc-Score ≤1 (n=1) or in sinus rhythm (n=2). Of note, 6 out of 9 patients with a LAA thrombus were anticoagulated with phenprocoumon. Conclusion LAA thrombus is a rare occurrence before an elective catheter ablation. In patients with CHA2DS2-VaSc-Score ≤1 the likelihood of LAA thrombus is so low (0.2%) that it may be considered to give up routine TOE before an EP study/ablation. Funding Acknowledgement Type of funding sources: None.

Maternal hemorrhage is a major cause of maternal morbidity and mortality in the United States and efforts are in place to eliminate preventable harm. Accurate assessment of blood lost around the time of birth is essential for timely recognition and intervention. As part of the Alliance for Innovation on Maternal Health (AIM) Obstetrical Hemorrhage Patient Safety Bundle at our institution a quantitative blood loss (QBL) calculator was created within the electronic medical record. This process allows for real-time tracking of cumulative blood loss measurements and is built with triggers to alert the care team when criteria for various hemorrhage stages are achieved along with suggested interventions and assessments. The consistency of implementation and efficacy of the QBL calculator was evaluated by following both utilization of the calculator flowsheet as well as tracking of rates of erroneous QBL values, defined by negative values and cesarean deliveries with QBL2019, 14 months after implementation and post three system-based improvements. By the end of this implementation review the calculator was in use consistently at all cesarean deliveries with improved confidence in the process by providers.

In the present research, we applied the dual process model of ideology and prejudice to beliefs and behavioral intentions toward animals. In Study 1 ( N = 126), we demonstrate in a community sample that right-wing authoritarianism (RWA) predicts support for restricting the distribution of wolves and bears in the wild mediated by perceived threat elicited from the animal outgroups. In contrast, social dominance orientation (SDO) had an indirect effect on the legitimization of meat consumption via endorsement of human supremacy beliefs. In Study 2 ( N = 223), we examined the causal direction of the dual process model using an experimental approach. Results show that RWA predicts support for restricting the free movement of a new animal species in the wild only when it is perceived to be threatening for humans. However, SDO predicted perceived legitimacy of meat consumption, regardless of whether the new animal species was characterized as lower or higher in status compared to other animals. Implications of these findings are discussed.

Deep learning (DL) algorithms are increasingly used in cardiac imaging. We aimed to investigate the utility of DL algorithms in de-noising transthoracic echocardiographic images and removing acoustic shadowing artefacts specifically in patients with congenital heart disease (CHD). In addition, the performance of DL algorithms trained on CHD samples was compared to models trained entirely on structurally normal hearts. Deep neural network based autoencoders were built for denoising and removal of acoustic shadowing artefacts based on routine echocardiographic apical 4-chamber views and performance was assessed by visual assessment and quantifying cross entropy. 267 subjects (94 TGA and atrial switch and 39 with ccTGA, 10 Ebstein anomaly, 9 with uncorrected AVSD and 115 normal controls; 56.9% male, age 38.9 ± 15.6 years) with routine transthoracic examinations were included. The autoencoders significantly enhanced image quality across diagnostic subgroups (p

Purpose: To describe the demographic and clinical characteristics of patients with thyroid eye disease (TED) who present with predominate superior rectus/levator complex involvement.Methods...

Aggressive periodontitis (AgP) comprises a group of rare, often severe, rapidly progressive forms of periodontitis which is characterized by an early age of clinical manifestations. It usually affects people under 30 years of age. Microbiota associated are Aggregatibacter, Actinomycetemcomitans and Porphyromonasgingivalis. The presence of highly pathogenic bacteria, severe periodontal bone destruction and the refractory nature of this disease tends to deter the clinician from placing implants in these patients. This article represents case series of patients with generalized aggressive periodontitits (GAP) rehabilitated prosthetically with successful 2 years follow-up. Key Words : Aggressive periodontitis, preservation, cast partial denture

Limited research has examined disadvantaged group members’ evaluations and support for allies who engage in collective action on their behalf. Across two studies (Study 1 N = 264 women; Study 2 N = 347 Black Americans) we manipulated an ally’s communication style and group membership to investigate whether these factors play a role in how allies are perceived and received. We found that participants evaluated allies less positively and were less willing to support them when they communicated their support in a dominant compared to a neutral way. Heightened perceptions that the ally was trying to take over the movement and make themselves the center of attention explained these results. However, we found no effect of whether the ally belonged to another disadvantaged group or not. Our findings contribute to the growing literature which seeks to understand the complexities associated with involving allies in collective action.

Aims The aim of this study was to provide population-based data on maternal and neonatal complications and outcome in the pregnancies of women with congenital heart disease (CHD). Methods and results Based on administrative data from one of the largest German Health Insurance Companies (BARMER GEK, ∼9 million members representative for Germany), all pregnancies in women with CHD between 2005 and 2018 were analysed. In addition, an age-matched non-CHD control group was included for comparison and the association between adult CHD (ACHD) and maternal or neonatal outcomes investigated. Overall, 7512 pregnancies occurred in 4015 women with CHD. The matched non-CHD control group included 6502 women with 11 225 pregnancies. Caesarean deliveries were more common in CHD patients (40.5% vs. 31.5% in the control group; P Conclusions This population-based study illustrates a reassuringly low maternal mortality rate in a highly developed healthcare system. Nevertheless, maternal morbidity and neonatal morbidity/mortality were significantly increased in women with ACHD and their offspring compared to non-ACHD controls highlighting the need of specialized care and pre-pregnancy counselling.

Aims The aim of this study was to provide population-based data on the healthcare provision for adults with congenital heart disease (ACHD) and the impact of cardiology care on morbidity and mortality in this vulnerable population. Methods and results Based on administrative data from one of the largest German Health Insurance Companies, all insured ACHD patients ( Conclusion Cardiology care compared with primary care is associated with superior survival and lower rates of major complications in ACHD. It is alarming that even in a high resource setting with well-established specialist ACHD care approximately 50% of contemporary ACHD patients are still not linked to regular cardiac care. Almost all patients had at least one contact with a PCP during the study period, suggesting that opportunities to refer patients to cardiac specialists were missed at PCP level. More efforts are required to alert PCPs and patients to appropriate ACHD care.

White Americans who participate in the Black Lives Matter movement, men who attended the Women’s March, and people from the Global North who work to reduce poverty in the Global South—advantaged group members (sometimes referred to as allies) often engage in action for disadvantaged groups. Tensions can arise, however, over the inclusion of advantaged group members in these movements, which we argue can partly be explained by their motivations to participate. We propose that advantaged group members can be motivated to participate in these movements (a) to improve the status of the disadvantaged group, (b) on the condition that the status of their own group is maintained, (c) to meet their own personal needs, and (d) because this behavior aligns with their moral beliefs. We identify potential antecedents and behavioral outcomes associated with these motivations before describing the theoretical contribution our article makes to the psychological literature.

Background Patients with coarctation of the aorta (CoA) are at increased risk of periprocedural and late neurological complications. Based on a nationwide inpatient dataset, we assessed the prevalence and risk factors for neurological complications in this cohort. Method and Results We included all CoA patients hospitalized in England between 1997 and 2015. The risk for procedural complications, subarachnoid bleeding and ischemic stroke were quantified, and risk factors investigated. Overall, 11,907 patients (60% male) with CoA were identified. The median age at first presentation was 0.6 years with a median follow-up period of 14.4 years. Throughout the study period, 8456 surgical or interventional procedures were performed in 6796 patients. The neurological complication rate for primary surgical or interventional repair in patients born after 1997 was 0.05% and 0.2%, respectively. During a total follow-up period of 146,295 patient-years, late neurological complications such as subarachnoid bleeding and cerebral infarction occurred in 225 patients (0.15%/patient-year). The median age for subarachnoid bleeding was 29 years and 57 years for ischemic stroke. While, arterial hypertension (p = .0014), current smoking (p = .02), dyslipidaemia (p = .007) and diabetes (p = .037) were significantly related to the risk of ischemic stroke, only arterial hypertension emerged as significant risk factor for subarachnoid bleeding. Conclusions Neurological complication during primary CoA repair are extremely rare in the current era. In contrast, many CoA patients are afflicted by late complications such as subarachnoid bleeding and ischemic stroke at a relatively young age, emphasizing the need for meticulous and pro-active blood pressure control and reduction of cardiovascular risk factors.

Objectives To analyze the timing of appearance of conduction abnormalities (CAs) after transcatheter aortic valve implantation (TAVI), to identify predictors of delayed CAs requiring pacemaker (PM) implantation and to provide guidance regarding the duration of telemetry monitoring. Background How long patients remain at risk of development of CAs requiring PM implantation after TAVI and for how long they should be monitored remains unclear but is crucial when considering early discharge. Methods Development of CAs was studied in 701 consecutive patients treated with Edwards Sapien 3 valves and monitored with telemetry for 7 days in a single center. After excluding valve-in-valve procedures and patients with previous PM, 606 patients remained for analysis. Predictors of CAs requiring PM and the time of onset of CAs were analyzed. Results Of 606 patients 76 (12.5%) required a PM after TAVI. CAs requiring PM implantation occurred after 48 h in 22.4% (17 patients) and in 10.5% (8 patients) even after 5 days. Of the patients who developed high grade CAs requiring PM after 48 h, 47.1% had no CAs prior to TAVI, and 23.5% had neither pre-existing CAs nor new-developed CAs within the first 48 h after TAVI. Conclusion After TAVI using a new-generation balloon-expandable valve, delayed development of CAs requiring PM implantation is not uncommon, even after 5 days. More importantly, 23.5% of patients eventually requiring a delayed PM implantation had still no CAs at 48 h after TAVI in this study. These results question the safety of early discharge and support ECG monitoring for a longer time period. The most optimal way to monitor these patients is yet to be determined.

Introduction Trans-lamina cribrosa pressure has been postulated to be a contributor in the development of a glaucomatous optic nerve versus optic nerve edema, depending on the pressure gradient. Uncertainty remains in the therapeutic outcome of adjusting this gradient. Case report We discuss a unique case of idiopathic intracranial hypertension presenting as asymmetric optic disc edema following trabeculectomy. It was treated via optic nerve fenestration due to the patient remaining symptomatic on maximum tolerated acetazolamide. Intraocular pressure stabilized into target range and the optic nerve edema resolved. Conclusions Rarely, intraocular pressure reduction can unmask elevated intracranial pressure, leading to optic nerve edema. Optic nerve sheath fenestration is a practical therapeutic modality to consider when treating this occurrence.

Background In patients with repaired Tetralogy of Fallot (ToF), implantable cardioverter defibrillators (ICD) are considered reasonable in selected adults with multiple risk factors for sudden cardiac death. Patients and methods We performed a retrospective cohort study of all 174 patients with repaired ToF who are followed at the University Hospital of Muenster. We analyzed data according to the risk score previously proposed by Khairy and coworkers and patient outcome. We analyzed data separately for patients without previous sustained ventricular tachycardia (VT) (risk stratification group, n = 157) and patients with VT/secondary prevention ICD (n = 17). Results In the risk stratification group, a mean of 4 ± 1 risk score parameters were available. All six risk parameters were known in 10%, five in 14%. Risk score increased with availability of parameters. 15 patients with secondary prevention ICD had a mean risk score of 6.3 ± 2.2 (range 2–10). 11 patients of the risk stratification group with primary prevention ICD had a mean risk score 5.8 ± 2.4 (range 3–8). During follow-up of up to 14 years, five patients died (3%): at age 58, two at 69 and two at 76 years. Conclusion In the majority of patients risk score variables were incomplete, severely limiting its applicability because the true score cannot be calculated. Risk scores were not different between patients with secondary prevention ICD and patients with ICD for primary prevention based on current guidelines. Standardization of follow-up and prospective evaluation of these standards in large prospective patient cohorts is desirable to improve risk stratification in patients with ToF.

Wenn die Milch der eigenen Mutter nicht oder nicht ausreichend zur Verfugung steht, wird bei der Ernahrung von Fruhgeborenen und kranken Neugeborenen die Gabe von qualitatskontrollierter Spenderinnenmilch empfohlen. In diesem Kontext erfullen Frauenmilchbanken eine wichtige Funktion, um sicherzustellen, dass Fruhgeborene und kranke Neugeborene mit der fur sie wertvollen Spenderinnenmilch versorgt werden konnen. Das Bewusstsein bezuglich der Vorteile der Ernahrung mit Muttermilch soll gestarkt und den Kliniken sollen die ersten Schritte bei der Errichtung und der Organisation von Frauenmilchbanken erleichtert werden. Daruber hinaus dient das Positionspapier als Anregung fur die Erstellung einer Leitlinie durch die nationalen Fachgesellschaften. Fachexperten aus Deutschland, Osterreich und der Schweiz (D-A-CH), die teilweise selbst Frauenmilchbanken betreuen, haben ihre Erfahrungen und ihr Wissen eingebracht und aktuelle Richtlinien aus verschiedenen europaischen Landern verglichen. Basierend auf den gangigen Vorgehensweisen in den bestehenden Frauenmilchbanken wurden Empfehlungen zur Forderung von Frauenmilchbanken im Expertenbeirat abgestimmt, die auf der aktuellen wissenschaftlichen Datenlage aufbauen und die Umsetzbarkeit in den Alltag berucksichtigen. Im D‑A-CH-Raum ist derzeit keine einheitliche Empfehlung, Leit- oder Richtlinie fur die Errichtung und Organisation von Frauenmilchbanken vorhanden. Der Expertenbeirat fordert, dass der Aufbau von weiteren Frauenmilchbanken forciert wird, einheitliche Empfehlungen zu Errichtung und Organisation etabliert werden, mehr Mutter als Spenderinnen gewonnen werden und das offentliche Gesundheitssystem der jeweiligen Lander dabei unterstutzend einwirkt.

Objectives: The aim of this study was to assess growth and nutritional biomarkers of preterm infants fed human milk (HM) supplemented with a new powdered HM fortifier (nHMF) or a control HM fortifier (cHMF). The nHMF provides similar energy content, 16% more protein (partially hydrolyzed whey), and higher micronutrient levels than the cHMF, along with medium-chain triglycerides and docosahexaenoic acid. Methods: In this controlled, multicenter, double-blind study, a sample of preterm infants ≤32 weeks or ≤1500 g were randomized to receive nHMF (n = 77) or cHMF (n = 76) for a minimum of 21 days. Weight gain was evaluated for noninferiority (margin = –1 g/day) and superiority (margin = 0 g/day). Nutritional status and gut inflammation were assessed by blood, urine, and fecal biochemistries. Adverse events were monitored. Results: Adjusted mean weight gain (analysis of covariance) was 2.3 g/day greater in nHMF versus cHMF; the lower limit of the 95% CI (0.4 g/day) exceeded both noninferiority (P

The objective of this study was to observe the effect of medical cannabis in benign essential blepharospasm (BEB) as an adjunct to botulinum toxin. A retrospective chart review was performed on patients certified for medical cannabis use for BEB from September 2015 to May 2016. Patient demographics and responses, cannabis history, and severity indices were collected. Ten patients were certified for medical cannabis use. Five met the inclusion criteria, which was any patient with a diagnosis of BEB receiving standard botulinum toxin treatment who had started medical cannabis treatment by a registered distributor within the state, and was contactable by phone. Four patients discontinued use. Three out of four patients (75%) reported symptomatic improvement. Medical cannabis is an accepted therapy for muscle spastic disorders. Its potential as an adjunctive therapy for BEB remains unknown, and further investigations would be of benefit.

Contains fulltext : 225292.pdf (Publisher’s version ) (Open Access) Adults with congenital heart disease (ACHD) may be at high risk in the case of COVID-19. Due to the heterogeneity of ACHD and secondary complications, risk profiles are, however, not uniform. This document aims to give an overview of relevant data and outline our pragmatic approach to disease prevention and management. Based on anatomy and additional physiological factors including symptoms, exercise capacity, heart failure, pulmonary hypertension and cyanosis, we propose a pragmatic approach to categorising patients into low-risk, intermediate-risk and high-risk groups. We regard especially patients with complex cyanotic conditions, those with palliated univentricular hearts, heart failure, severe valvular disease or pulmonary hypertension as high-risk patients. To avoid infection, we recommend self-isolation and exemption from work for these cohorts. Infected ACHD patients with low or moderate risk and without signs of deterioration may be remotely followed and cared for at home while in self isolation. High-risk patients or those with signs of respiratory or cardiovascular impairment require admission ideally at a tertiary ACHD centre. Especially patients with complex, cyanotic disease, heart failure and arrhythmias require particular attention. Treatment in patients with cyanotic heart disease should be guided by the relative degree of desaturation compared with baseline and lactate levels rather than absolute oxygen saturation levels. Patients with right heart dilatation or dysfunction are potentially at increased risk of right heart failure as mechanical ventilation and acute respiratory distress syndrome can lead to increase in pulmonary arterial pressures.

A 6-year-old girl had reduced fetal movements, numerous apneic spells, muscle hypotonia, and developmental motor delay. Her muscle biopsy tissue showed variation in myofiber diameters, small minicores by electron microscopy, and near-uniformity of type I fibers. Although no mutations were detected in RYR1, SEPN1, and DMPK genes, the RAPSN gene revealed one known mutation, p.Asn88Lys, from the mother, and one novel mutation, p.Cys366Gly, from the father. Life-saving pyridostigmine treatment suppressed her apneic spells and improved her motor development.

Operating manufacturing systems in today's markets profitably is challenging for make-to-order and make-to-stock production. Market demand is volatile, product variants are manifold and customers expect fast delivery, while production systems have to constantly adjust the trade-off between high utilization, high throughput and high responsiveness. Reconfigurable manufacturing systems promise the flexibility to dynamically adjust in this environment, however the achievements of higher computational power, cheaper data storage and faster data transfers have not yet enabled a matching production planning and controlling. Production planning and control systems are not used to their full potential due to low crosslinking under the partners, decision quality is in doubt and available data is not used continuously. Improving this situation through production planning and control as a service by specialized agents promises to be a solution however it isn't widely contracted. In this paper, we shall discuss the expected benefits and tangible challenges for production planning and control as a service to open a path for innovative companies to become client or contractor in a service platform, and offer industry cases of production planning and control as a service engagements.

Background Ebstein anomaly (EA) is a rare congenital heart disease characterized by an apically displaced tricuspid valve. It is associated with tricuspid valve regurgitation and right heart dilatation leading to significant morbidity. While echocardiography remains the mainstay of routine outpatient cardiac imaging, assessment of right ventricular (RV) anatomy and function is still challenging. Cardiovascular magnetic resonance imaging (CMR) has been shown to be of advantage in these patients being free from acoustic window limitations and offering superior volume quantification. In the present study, parameters obtained from cardiopulmonary exercise testing (CPET) were compared to conventional and novel CMR parameters in patients with EA. Methods In this prospective single centre study, N=17 patients with EA (mean age = 33.8±12.7yrs; N=10 females) underwent clinical assessment, CPET and multi-parametric CMR. Maximal work load (maxWL) and peak oxygen uptake (maxO2) were derived from CPET. CMR studies were performed on a 1.5-T Philips scanner and respective CMR parameters comprised a) anatomical, b) functional and c) myocardial deformation values of both ventricles. Results The majority of patients presented in NYHA class I or II (mean NYHA = 1.6±0.7) and with normal or mildly elevated NT-proBNP values (mean NT-proBNP = 189±158pg/ml). CPET-based maxWL was 147.14±55 watts and maxO2 19.32±5 ml/kg/min. CMR-based mean LVEF was 57.1±6.4% and RVEF was 46.5±11.1%, respectively. Deformation imaging revealed (amongst others) a LV global longitudinal strain (LV-gLS) of −13.7±3.0 and a RV global longitudinal strain (RV-gLS) of −14.7±5.0. Non-ischemic presence of late-gadolinium-enhancement was documented in 36% of our patients. Comprehensive correlation analysis revealed a substantial correlation a) between LV-gLS and NYHA class (r=0.64, p=0.01), but not between RV-gLS and NYHA class (r=0.19, p=0.46), b) between serum NT-proBNP levels and maxO2 (r=−0.53, p=0.03) as well as maxWL (r=−0.63, p=0.02), and c) between LV-EF and LV-gLS (r=−0.64, p=0.01). Conclusion Our preliminary data suggest that serum markers such as NT-proBNP and novel CMR parameters such as LV-gLS – but not RV-gLS - correlate with CPET-derived exercise parameters in patients with EA. The predictive value of these parameters regarding cardiac disease progression in EA has to be evaluated in future follow-up studies.