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Objective: To assess whether older adults who develop geriatric syndromes following elective gastrointestinal surgery have poorer 1-year outcomes. Background: Within 10 years, 70% of all cancers will occur in older adults ≥65 years old. The rise in older adults requiring major surgery has brought attention to age-related complications termed geriatric syndromes. However, whether postoperative geriatric syndromes are associated with long-term outcomes is unclear. Methods: A population-based retrospective cohort study using the New York State Cancer Registry and the Statewide Planning and Research Cooperative System was performed including patients >55 years with pathologic stage I-III esophageal, gastric, pancreatic, colon, or rectal cancer who underwent elective resection between 2004 and 2018. Those aged 55 to 64 served as the reference group. The exposure of interest was a geriatric syndrome [fracture, fall, delirium, pressure ulcer, depression, malnutrition, failure to thrive, dehydration, or incontinence (urinary/fecal)] during the surgical admission. Patients with any geriatric syndrome within 1 year of surgery were excluded. Outcomes included incident geriatric syndrome, 1-year days alive and out of the hospital, and 1-year all-cause mortality. Results: In this study, 37,998 patients with a median age of 71 years without a prior geriatric syndrome were included. Of those 65 years or more, 6.4% developed a geriatric syndrome. Factors associated with an incident geriatric syndrome were age, alcohol/tobacco use, comorbidities, neoadjuvant therapy, ostomies, open surgery, and upper gastrointestinal cancers. An incident geriatric syndrome was associated with a 43% higher risk of 1-year mortality (hazard ratio, 1.43; 95% confidence interval, 1.27–1.60). For those aged 65+ discharged alive and not to hospice, a geriatric syndrome was associated with significantly fewer days alive and out of hospital (322 vs 346 days, P < 0.0001). There was an indirect relationship between the number of geriatric syndromes and 1-year mortality and days alive and out of the hospital after adjusting for surgical complications. Conclusions: Given the increase in older adults requiring major surgical intervention, and the establishment of geriatric surgery accreditation programs, these data suggest that morbidity and mortality metrics should be adjusted to accommodate the independent relationship between geriatric syndromes and long-term outcomes. [ABSTRACT FROM AUTHOR]

Reviews the Lakoff and Nunez's book, "Where Mathematics Comes From: How the Embodied Mind Brings Mathematics into Being (2000)," which provided many mathematics education researchers with a novel and startling perspective on mathematical thinking. Suggests that several of the book's flaws can be addressed through a more rigorous establishment of conceptual distinctions as well as appropriate methodological approaches. (Author/KHR)

In choosing a title for what might well be his least successful long poem, W. H. Auden nonetheless succeeded brilliantly in the far more ambitious task of naming an age. Set in his version of the urban Waste Land, a New York bar, "The Age of Anxiety" probes the dislocations of the modern consciousness as its four principal characters move uneasily toward an understanding of their own and their time's condition. If the poem is ultimately about that particular form of anxious dread to be found at the core of Soren Kierkegaard or Reinhold Niebuhr, or that most modern form of spiritual angst presented so viscerally in Franz Kafka, the anxiety of the poem's title also quite centrally refers specifically to those psychological and emotional displacements that acutely characterize the feeling lives of large numbers of artists and intellectuals during the broad middle years of the last century. The origins of these anxieties, what might be called the anxieties of modernism, may plausibly be traced to the vast array of social and cultural upheavals that occurred in the latter half of the nineteenth century. In the first part of this essay, the author discusses how the anxieties of the modern were located in the intellectual repositioning of both religion and science. He then goes on to describe the postmodern reaction as a representation of a repositioning of science on less secure and more problematic foundations. He contends that the postmodern intellectual simply rejects the pseudoscientific ambitions of social and cultural theory, while the postmodern artist's impulse is to display and probe the ambivalences and indeterminacies attendant upon the new pandemic uncertainty. (Contains 34 notes.)

Suggests that the aesthetic positions James Joyce expresses in his work have an independent intellectual value in understanding gifted childrens' aesthetic development. Discusses and critiques Joyce's theory on the psychology and philosophy of the artist. (KM)

Evaluates the report "The Quiet Evolution: Changing the Face of Arts Education," which documents the results from the evaluation of the Regional Institute Grants. Examines the evaluation protocol. Asserts that the report should have addressed forward-looking reappraisals. Addresses the influence on arts education of emergent models of cultural and aesthetic change. (CMK)

Background: Right ventricular (RV) failure after the insertion of a left ventricular assist device (LVAD) historically results in poor outcomes. Patients requiring temporary RV support after LVAD insertion are a heterogeneous group of patients consisting of those in cardiogenic shock after myocardial infarction, to those with chronic decompensated heart failure. For patients requiring biventricular support, we have used a hybrid system consisting of a HeartMate II LVAD and CentriMag right ventricular assist device (RVAD). The purpose of this study was to determine the 1-year survival in patients requiring isolated LVAD and patients requiring biventricular support. Methods: All patients who underwent HeartMate II LVAD alone or in conjunction with a temporary CentriMag RVAD were examined from 2006 to 2011. Preoperative demographics, operative outcomes, and survival were analyzed. Results: A total of 139 patients required HeartMate II insertion; 34 (24%) required biventricular support at the time of HeartMate II implantation. The mean duration of biventricular support was 17 ± 11.9 days (range, 6 to 56 days) with 91.8% (n = 31) of RVADs successfully explanted. Survival to hospital discharge was not different between groups (95.2 versus 88.2%; p = 0.2). However, 1-year survival was significantly greater in patients who required isolated HeartMate II LVAD (87% versus 77%; p = 0.03). Conclusions: Biventricular support using a HeartMate II LVAD and CentriMag RVAD resulted in limited mortality at hospital discharge. However biventricular dysfunction does not have a favorable outcome at 1 year when compared with patients requiring isolated HeartMate II. [Copyright &y& Elsevier]

Neonatal surgical repair for truncus arteriosus historically involves removing the pulmonary arteries from the truncal root, closing the ventricular septal defect, and creating right ventricular to pulmonary artery continuity. Unfortunately, early reintervention is frequently required for conduit failure and proximal branch pulmonary artery stenosis. We present a technique that preserves the pulmonary artery architecture, keeping the pulmonary arteries in their native position. This technique has been applied to 16 patients and appears to decrease proximal branch pulmonary artery stenosis, thereby extending conduit longevity and increasing the freedom from early reintervention. [ABSTRACT FROM AUTHOR]

The importance of surgical simulation has grown in the quickly changing climate of modern surgical training. As the expectation of basic skills acquisition has shifted to forums outside the operating room, residency programs have struggled to provide realistic teaching simulations for their trainees. We have developed and tested a realistic and low-cost porcine cannulation model. This model provided a platform for both technical and cognitive skills acquisition at the first session of the cardiothoracic or “CT Surgery Boot Camp” during the summer of 2008. [Copyright &y& Elsevier]

Objective: To present the results of a nationwide survey among urological patients to evaluate their perception of the quality of care provided by residents., Methods: An anonymous survey was distributed to patients who were referred to 22 Italian academic institutions. The survey aimed to investigate the professional figure of the urology resident as perceived by the patient., Results: A total of 2587 patients were enrolled in this study. In all, 51.6% of patients were able to correctly identify a urology resident; however, almost 40% of respondents discriminated residents from fully trained urologists based exclusively on their young age. Overall, 98.2% patients rated the service provided by the resident as at least sufficient. Urology trainees were considered by more than 50% of the patients interviewed to have good communication skills, expertise and willingness. Overall, patients showed an excellent willingness to be managed by urology residents. The percentage of patients not available for this purpose showed an increasing trend that directly correlated with the difficulty of the procedure. Approximately 5-10% of patients were not willing to be managed by residents for simple procedures such as clinical visits, cystoscopy or sonography, and up to a third of patients were not prepared to undergo any surgical procedure performed by residents during steps in major surgery, even if the residents were adequately tutored., Conclusions: Our data showed that patients have a good willingness to be managed by residents during their training, especially for medium- to low-difficulty procedures. Furthermore, the majority of patients interviewed rated the residents' care delivery as sufficient. Urology trainees were considered to have good communication skills, expertise and willingness., (© 2022 The Authors. BJU International published by John Wiley & Sons Ltd on behalf of BJU International.)