Core components of a rehabilitation program in pediatric cardiac disease.

There is increasing effort in both the inpatient and outpatient setting to improve care, function, and quality of life for children with congenital heart disease, and to decrease complications. As the mortality rates of surgical procedures for congenital heart disease decrease, improvement in perioperative morbidity and quality of life have become key metrics of quality of care. Quality of life and function in patients with congenital heart disease can be affected by multiple factors: the underlying heart condition, cardiac surgery, complications, and medical treatment. Some of the functional areas affected are motor abilities, exercise capacity, feeding, speech, cognition, and psychosocial adjustment. Rehabilitation interventions aim to enhance and restore functional ability and quality of life for those with physical impairments or disabilities. Interventions such as exercise training have been extensively evaluated in adults with acquired heart disease, and rehabilitation interventions for pediatric patients with congenital heart disease have similar potential to improve perioperative morbidity and quality of life. However, literature regarding the pediatric population is limited. We have gathered a multidisciplinary team of experts from major institutions to create evidence- and practice-based guidelines for pediatric cardiac rehabilitation programs in both inpatient and outpatient settings. To improve the quality of life of pediatric patients with congenital heart disease, we propose the use of individualized multidisciplinary rehabilitation programs that include: medical management; neuropsychology; nursing care; rehabilitation equipment; physical, occupational, speech, and feeding therapies; and exercise training.

Esophageal Lesion Reveals an Aortic Pseudoaneurysm in the Setting of Actinomyces odontolyticus Bacteremia.

A toddler presented with hematemesis a few weeks after ingesting a penny. Workup revealed an esophageal lesion communicating with an aortic pseudoaneurysm in the setting of Actinomyces odontolyticus bacteremia. A. odontolytica is an oropharyngeal bacteria known to cause fistulas when introduced into tissue planes. (Level of Difficulty: Intermediate.).

Pre-Fontan Assessment Utilizing Combined Cardiac Catheterization and Cardiac MRI: Comparison to the Pre-Fontan Catheterization.

Single ventricle patients eligible for Fontan completion undergo pre-Fontan catheterization for hemodynamic and anatomic assessment prior to surgery. Cardiac magnetic resonance imaging may be used to evaluate pre-Fontan anatomy, physiology, and collateral burden. We describe our center's outcomes in patients undergoing pre-Fontan catheterization combined with cardiac magnetic resonance imaging. A retrospective review of patients undergoing pre-Fontan catheterization from 10/2018 to 04/2022 at Texas Children's Hospital was performed. Patients were divided into 2 groups: combined cardiac magnetic resonance imaging and catheterization (combined group) and those who underwent catheterization only (catheterization only group). There were 37 patients in the combined group and 40 in the catheterization only group. Both groups were similar in age and weight. Patients undergoing combined procedures received less contrast, and experienced less in-lab time, fluoroscopy time and catheterization procedure time. Median radiation exposure was lower in the combined procedure group but was not statistically significant. Intubation and total anesthesia times were higher in the combined procedure group. Patients undergoing a combined procedure were less likely to have collateral occlusion performed than in the catheterization only group. Bypass time, intensive care unit length of stay, and chest tube duration were similar in both groups at the time of Fontan completion. Combined pre-Fontan assessment decreases catheterization procedure and fluoroscopy time associated with cardiac catheterization at the expense of longer anesthetic times, and results in similar Fontan outcomes compared to when cardiac catheterization alone is utilized.

Multiple Shape Coexistence in

From detailed spectroscopy of ^{110}Cd and ^{112}Cd following the ß^{+}/electron-capture decay of ^{110,112}In and the ß^{-} decay of ^{112}Ag, very weak decay branches from nonyrast states are observed. The transition rates determined from the measured branching ratios and level lifetimes obtained with the Doppler-shift attenuation method following inelastic neutron scattering reveal collective enhancements that are suggestive of a series of rotational bands. In ^{110}Cd, a γ band built on the shape-coexisting intruder configuration is suggested. For ^{112}Cd, the 2^{+} and 3^{+} intruder γ-band members are suggested, the 0_{3}^{+} band is extended to spin 4^{+}, and the 0_{4}^{+} band is identified. The results are interpreted using beyond-mean-field calculations employing the symmetry conserving configuration mixing method with the Gogny D1S energy density functional and with the suggestion that the Cd isotopes exhibit multiple shape coexistence.

Isospin character of low-lying pygmy dipole states in 208Pb via inelastic scattering of 17O ions.

The properties of pygmy dipole states in 208Pb were investigated using the 208Pb(17O, 17O'γ) reaction at 340 MeV and measuring the γ decay with high resolution with the AGATA demonstrator array. Cross sections and angular distributions of the emitted γ rays and of the scattered particles were measured. The results are compared with (γ, γ') and (p, p') data. The data analysis with the distorted wave Born approximation approach gives a good description of the elastic scattering and of the inelastic excitation of the 2+ and 3- states. For the dipole transitions a form factor obtained by folding a microscopically calculated transition density was used for the first time. This has allowed us to extract the isoscalar component of the 1- excited states from 4 to 8 MeV.

Coulomb excitation of 104Sn and the strength of the 100Sn shell closure.

A measurement of the reduced transition probability for the excitation of the ground state to the first 2+ state in 104Sn has been performed using relativistic Coulomb excitation at GSI. 104Sn is the lightest isotope in the Sn chain for which this quantity has been measured. The result is a key point in the discussion of the evolution of nuclear structure in the proximity of the doubly magic nucleus 100Sn. The value B(E2; 0+ → 2+) = 0.10(4) e2b2 is significantly lower than earlier results for 106Sn and heavier isotopes. The result is well reproduced by shell model predictions and therefore indicates a robust N = Z = 50 shell closure.

Evidence for a smooth onset of deformation in the neutron-rich Kr isotopes.

The neutron-rich nuclei 94,96Kr were studied via projectile Coulomb excitation at the REX-ISOLDE facility at CERN. Level energies of the first excited 2(+) states and their absolute E2 transition strengths to the ground state are determined and discussed in the context of the E(2(1)(+)) and B(E2;2(1)(+)→0(1)(+)) systematics of the krypton chain. Contrary to previously published results no sudden onset of deformation is observed. This experimental result is supported by a new proton-neutron interacting boson model calculation based on the constrained Hartree-Fock-Bogoliubov approach using the microscopic Gogny-D1M energy density functional.

16+ spin-gap isomer in 96Cd.

A ß-decaying high-spin isomer in (96)Cd, with a half-life T(1/2)=0.29(-0.10)(+0.11) s, has been established in a stopped beam rare isotope spectroscopic investigations at GSI (RISING) experiment. The nuclei were produced using the fragmentation of a primary beam of (124)Xe on a (9)Be target. From the half-life and the observed γ decays in the daughter nucleus, (96)Ag, we conclude that the ß-decaying state is the long predicted 16(+) "spin-gap" isomer. Shell-model calculations, using the Gross-Frenkel interaction and the πν(p(1/2),g(9/2)) model space, show that the isoscalar component of the neutron-proton interaction is essential to explain the origin of the isomer. Core excitations across the N=Z=50 gaps and the Gamow-Teller strength, B(GT) distributions have been studied via large-scale shell-model calculations using the πν(g,d,s) model space to compare with the experimental B(GT) value obtained from the half-life of the isomer.

Enhanced quadrupole collectivity at N = 40: the case of neutron-rich Fe isotopes.

The transition rates for the 2(1)+ states in (62,64,66)Fe were studied using the recoil distance Doppler-shift technique applied to projectile Coulomb excitation reactions. The deduced E2 strengths illustrate the enhanced collectivity of the neutron-rich Fe isotopes up to N = 40. The results are interpreted using the generalized concept of valence proton symmetry which describes the evolution of nuclear structure around N = 40 as governed by the number of valence protons with respect to Z ≈ 30. The trend of collectivity suggested by the experimental data is described by state-of-the-art shell-model calculations with a new effective interaction developed for the fpgd valence space.

Improvement of the intrinsic time resolving power of the Cologne iron-free orange type electron spectrometers.

Conversion electron spectroscopy represents an important tool for nuclear structure analysis of medium and heavy nuclei. Two iron-free magnetic electron spectrometers of the orange type have been installed at the Institute for Nuclear Physics of the University of Cologne. The very large transmission of 15% and the very good energy resolution of 1% makes the iron-free orange spectrometer a powerful instrument. By means of fast timing techniques, lifetimes of nuclear excited states can be measured with an accuracy better than 20 ps. For the first time, the energy dependent centroid position of prompt events yielding the time-walk characteristics (the prompt curve) of the orange spectrometer fast timing setup has been measured using prompt secondary δ-electrons generated in a pulsed beam experiment. The prompt curve calibrated as a function of energy allows precise lifetime determination down to a few tens of picoseconds by the use of the centroid shift method.

Psychological determinants of health-related quality of life in patients with chronic liver disease.

BACKGROUND: The negative impact of chronic liver disease on health-related quality of life (HRQoL) of patients with chronic liver disease (CLD) has long been established, and treatable physiological or psychological factors may potentially influence HRQoL. OBJECTIVE: The authors assessed the interrelationships of multiple psychological factors and HRQoL in patients with CLD. METHOD: Both direct and indirect relationships among HRQoL, depression, anxiety, coping, and self-efficacy in 164 patients with CLD were assessed. RESULTS: Depression, largely determined by low self-efficacy and, possibly, by use of maladaptive coping strategies, influenced HRQoL in three groups of liver patients. CONCLUSION: HRQoL in CLD patients may be positively affected by enhancing coping and self-efficacy skills, thus improving levels of depression.

Low-lying neutron intruder state in 13B and the fading of the N = 8 shell closure.

A lifetime measurement of the excited states in the neutron-rich isotope (13)B has been performed using the (7)Li((7)Li,p)(13)B reaction. An anomalously long mean lifetime of 1.3(3) ps was found for the excited state at 3.53 MeV, giving the upper limits of the transition strengths to the ground state: B(M1) = 7.2 x 10;{-4} Weisskopf unit (W.u.) and B(E2) = 0.81 W.u.. The hindered transition strengths indicate significant intruder configurations for the excited state, coexisting with the normal ground state. The data are well explained by recent shell-model calculations, which suggest J;{pi} = 3/2;{-} for the 3.53-MeV state with the dominant intruder (nu2p2h) configuration.

Search for the pygmy dipole resonance in 68Ni at 600 MeV/nucleon.

The gamma decay from Coulomb excitation of 68Ni at 600 MeV/nucleon on a Au target was measured using the RISING setup at the fragment separator of GSI. The 68Ni beam was produced by a fragmentation reaction of 86Kr at 900 MeV/nucleon on a 9Be target and selected by the fragment separator. The gamma rays produced at the Au target were measured with HPGe detectors at forward angles and with BaF2 scintillators at backward angles. The measured spectra show a peak centered at approximately 11 MeV, whose intensity can be explained in terms of an enhanced strength of the dipole response function (pygmy resonance). Such pygmy structure has been predicted in this unstable neutron-rich nucleus by theory.

Logistic feasibility of health related quality of life measurement in clinical practice: results of a prospective study in a large population of chronic liver patients.

BACKGROUND: The objective of the present study was to provide a complete and detailed report of technical and logistical feasibility problems with the implementation of routine computerized HRQoL measurement at a busy outpatient department of Hepatology that can serve as a tool for future researchers interested in the procedure. METHODS: Practical feasibility was assessed by observing problems encountered during the development of the computer program, observing patients' ability to complete the HRQoL questionnaires, monitoring the number of times that patients completed the HRQoL questionnaires and observing logistics at the outpatient department. Patients' reasons for not completing the HRQoL questionnaires were assessed retrospectively by means of a mailed questionnaire. Physicians' attitudes towards the availability of computerized HRQoL information about their patients were assessed by means semi-structured interviews and by means of checklists administered after each consultation with s study participant. RESULTS: All physicians (n = 11) and 587 patients agreed to participate in the study. Practical feasibility problems concerned complicated technical aspects of developing a user-friendly computer program and safe data transmission over the Internet, patients' lack of basic computer skills and patients' lack of compliance (completion of questionnaires on only 43% of the occasions). The main reason given for non-compliance was simply forgetting, which seemed to be related to reception employees' passive attitude towards sending patients to the computer. Physicians were generally positive about the instant computerized availability of HRQoL information. They requested the information in 92% of the consultations and found the information useful in 45% of the consultations, especially when it provided them with new information. CONCLUSION: This study was among the first to implement the complete procedure of routine computerized HRQoL measurements in clinical practice and to subsequently describe the feasibility issues encountered. It was shown that the attitudes of physicians were generally positive. Several barriers towards successful implementation of such a procedure were encountered, and subsequently solutions were provided. Most importantly, when implementing routine computerized HRQoL measurements in clinical practice, assistance of an IT professional for the development of a tailor-made computer program, availability of questionnaires in multiple languages and the use of touch-screen computers to optimise patient participation are essential. Also, all staff of the department concerned should approve of the intervention and consider it as part of standard clinical routine if successful implementation is to be obtained.

Quality of health care and patient satisfaction in liver disease: the development and preliminary results of the QUOTE-Liver questionnaire.

BACKGROUND: Consensus on how to adequately measure patient satisfaction with health care is limited, and has led to the development of many questionnaires with various methodological problems. The objective of this study was to develop a liver disease- and care-specific patient satisfaction instrument on the basis of previously tested methodology in patient satisfaction measurement, the so called QUOTE- series: Quality Of health care services Through the patients' Eyes. QUOTE methodology aims to standardise the measurement of satisfaction as the discrepancy between patients' needs, and the extent to which these needs are being met. METHODS: As part of the QUOTE methodology routine, 11 Patients with chronic liver disease from the Erasmus MC (Rotterdam, the Netherlands) participated in focus-group meetings on patient satisfaction with the provided service at the outpatient hepatology clinic. Twenty-eight other patients were invited to rank the items generated during the focus-group meetings according to importance. With this information, the QUOTE-Liver was constructed. Face validity, construct validity, content validity, and reliability of the newly developed questionnaire were assessed in a test sample of 152 patients with chronic liver disease. RESULTS: Two liver-disease specific, and the 18 items ranked as most important were included in the QUOTE-Liver. Face validity and content validity were acceptable: neither patients (n = 152) nor psychologists (n = 3) or a hepatologist suggested any extra items to be included. Construct validity was good: the overall score correlated significantly with the Visual Analogue Scale (VAS) measuring overall satisfaction (r = 0.69, p < 0.01). The reliability of the QUOTE-Liver was excellent (alpha = 0.90). CONCLUSION: The QUOTE-Liver is an easy to complete instrument based on standardized state-of-the-art satisfaction measurement methodology. Preliminary evidence for its validity and reliability was demonstrated. The QUOTE-liver covers those aspects of satisfaction that CLD patients consider to be important when visiting the outpatient department of hepatology. Even though further substantiating of the favourable psychometric findings is desirable, it seems to be a useful instrument that can be used to identify those aspects of care that need improvement in order to optimise the provision of health care for patients with chronic liver disease.

Interplay between single-particle and collective effects in the odd-A Cu isotopes beyond N=40.

Collective properties of the low-lying levels in the odd-A 67-73Cu were investigated by Coulomb excitation with radioactive beams. The beams were produced at ISOLDE and postaccelerated by REX-ISOLDE up to 2.99 MeV/u. In 67,69Cu, low-lying 1/2(-), 5/2(-), and 7/2(-) states were populated. In 71,73Cu, besides the known transitions deexciting the single-particle-like 5/2(-) and core-coupled 7/2(-) levels, gamma rays of 454 and 135 keV, respectively, were observed for the first time. Based on a reanalysis of beta-decay work and comparison with the systematics, a spin 1/2(-) is suggested for these excited states. Three B(E2) values were determined in each of the four isotopes. The results indicate a significant change in the structure of the odd-A Cu isotopes beyond N=40 where single-particle-like and collective levels are suggested to coexist at very low excitation energies.

Effectiveness of health-related quality-of-life measurement in clinical practice: a prospective, randomized controlled trial in patients with chronic liver disease and their physicians.

BACKGROUND: This study assessed the effectiveness of computerized measurement and feedback of health-related quality of life (HRQoL) in daily clinical practice in patients with chronic liver disease. METHODS: One hundred and sixty-two patients (61% men; mean age 47.5 years) regularly completed computerized HRQoL questionnaires before each consultation for the duration of 1 year. Six physicians were randomly assigned to the experimental group and received an instant online graphical output of data. Five other physicians were randomly assigned to the control group and conducted their consultations as usual. Differences between groups on generic- and disease-specific HRQoL, patient management, and patient satisfaction with the consultation were assessed, as were physicians' experiences with HRQoL data and effects on their consultations. RESULTS: No direct effect of the experimental condition on patients' HRQoL was found. However, an interaction effect of the experimental condition and age was found: older patients in the experimental group had significantly better disease-specific HRQoL (F = 4.16; P = 0.04) and generic mental HRQoL (F = 4.62; P = 0.03) than patients in the control group. Also, male patients in the experimental group had better generic mental HRQoL than patients in the control group (F = 6.10; P = 0.02). Physicians in the experimental group altered their treatment policy significantly more often than did physicians in the control group (z = -3.73, P = 0.00), and their experiences with the availability of HRQoL information were generally positive. The scores on patient satisfaction with the consultation did not differ significantly between the experimental and control groups (z = -1.20, P = 0.23). CONCLUSIONS: Computerized measurement and feedback of HRQoL in a daily clinical practice of an outpatient department of hepatology did not improve HRQoL for the entire group of chronic liver patients but, rather, improved disease-specific HRQoL of older patients with chronic liver disease and mental HRQoL of older patients and male patients with chronic liver disease. It also had an effect on patient management.

Observation of isomeric decays in the r-process waiting-point nucleus 130Cd82.

The gamma decay of excited states in the waiting-point nucleus (130)Cd(82) has been observed for the first time. An 8(+) two-quasiparticle isomer has been populated both in the fragmentation of a (136)Xe beam as well as in projectile fission of 238U, making (130)Cd the most neutron-rich N = 82 isotone for which information about excited states is available. The results, interpreted using state-of-the-art nuclear shell-model calculations, show no evidence of an N = 82 shell quenching at Z = 48. They allow us to follow nuclear isomerism throughout a full major neutron shell from (98)Cd(50) to (130)Cd(82) and reveal, in comparison with (76)Ni(48) one major proton shell below, an apparently abnormal scaling of nuclear two-body interactions.

Coulomb excitation of neutron-rich Zn isotopes: first observation of the 2(1)+ state in 80Zn.

Neutron-rich, radioactive Zn isotopes were investigated at the Radioactive Ion Beam facility REX-ISOLDE (CERN) using low-energy Coulomb excitation. The energy of the 2(1)+ state in 78Zn could be firmly established and for the first time the 2+ --> 0(1)+ transition in 80Zn was observed at 1492(1) keV. B(E2,2(1)+ --> 0(1)+) values were extracted for (74,76,78,80)Zn and compared to large scale shell model calculations. With only two protons outside the Z=28 proton core, 80Zn is the lightest N=50 isotone for which spectroscopic information has been obtained to date. Two sets of advanced shell model calculations reproduce the observed B(E2) systematics. The results for N=50 isotones indicate a good N=50 shell closure and a strong Z=28 proton core polarization. The new results serve as benchmarks to establish theoretical models, predicting the nuclear properties of the doubly magic nucleus 78Ni.