MRI-based multiparametric strain analysis predicts contractile recovery after aortic valve replacement for aortic insufficiency.

BACKGROUND: Guidelines for referral of chronic aortic insufficiency (AI) patients for aortic valve replacement (AVR) suggest that surgery can be delayed until symptoms or reduction in left ventricular (LV) contractile function occur. The frequent occurrence of reduced LV contractile function after AVR for chronic AI suggests that new contractile metrics for surgical referral are needed. METHODS: In 16 chronic AI patients, cardiac MRI tagged images were analyzed before and 21.5 ± 13.8 months after AVR to calculate LV systolic strain. Average measurements of three strain parameters were obtained for each of 72 LV regions, normalized using a normal human strain database (n = 63), and combined into a composite index (multiparametric strain z score [MSZ]) representing standard deviation from the normal regional average. RESULTS: Preoperative global MSZ (72-region average) correlated with post-AVR global MSZ (R(2) = 0.825, p < 0.001). Preoperative global MSZ also predicts improvement of impaired regions (N = 271 regions from 14 AI patients, R(2) = 0.392, p < 0.001). Preoperative MRI-based LV ejection fraction (LVEF) is also predictive (r = 0.410, p < 0.001). Although global preoperative MSZ had a significantly higher correlation than preoperative LVEF with improvement of injured regions (p < 0.001), both measures convey the same phenomenon. CONCLUSIONS: Global preoperative MRI-based multiparametric strain predicts global strain postoperatively, as well as improvement of regions (n = 72 per LV) with impaired contractile function. Global contractile function is an important correlate with improvement in regionally impaired contractile function, perhaps reflecting total AI volume-overload burden (severity/duration of AI).

Behavioral Training and Performance Management of Human Services Organization Care Providers During the COVID-19 Pandemic.

Objectives: This report describes a model of training and performance management that was designed for and implemented with care providers at a residential school for children with neurodevelopmental and intellectual disabilities in response to the COVID-19 pandemic. The model focused on health and safety concerns, risk mitigation, and intervention integrity. Methods: Procedures followed an applied behavior analysis (ABA) and organizational behavior management (OBM) framework. Action plans addressed (a) critical COVID-19 protocols, (b) behavior-specific implementation guidelines, (c) remote and in-person training formats, (d) in vivo supervision, and (e) knowledge and performance assessments. Results: A competency evaluation (field study) revealed that participant care providers (N = 25) acquired and maintained COVID-19 protocols at near 100% proficiency immediately following and 1-month post-training. Supervisors had uniformly positive approval and acceptance ratings of school responsiveness to the COVID-19 pandemic. Conclusions: Integrated and evidence-based care provider training and supervisory practices can promote risk mitigation and performance effectiveness during health crises such as the COVID-19 pandemic. More controlled research that includes multiple dependent measures is needed to replicate and extend our findings to similar human services settings.

Extent of Aortic Replacement in Type A Dissection: Current Answers for an Endless Debate.

BACKGROUND: The proximal and distal extent of surgery for type A dissection is the subject of this review article. METHODS: In this review, we summarize select series that illumine the issue at hand and provide insight into the surgical approach at our institution to DeBakey type I aortic dissections. RESULTS: For proximal extent, we discuss preservation of the aortic valve in the presence of aortic insufficiency and management of the aortic root in the setting of root dilation. Distal extent of surgery for type A dissection has been a much more controversial topic. At our institution, we subscribe to the philosophy of ascending or hemiarch replacement alone for dissection under most circumstances. We describe when we believe a more aggressive arch replacement for type A dissection may be considered and detail the reports of other groups that have performed this operation more routinely. We also touch on the frozen elephant trunk operation and its role in type A dissection, although we believe it should be reserved for high-volume dedicated aortic centers. Finally, we conclude by discussing the role of experience in choosing aortic operations for type A dissection. CONCLUSIONS: In our opinion, there is no single correct operation for a patient with type A dissection, but there is a correct operation for each surgeon and clinical scenario.

Assessing the safety and effectiveness of hip protectors.

Hip protectors are used in the preventive management of older people who are at risk of fracturing their hip after a fall. However, nurses have little guidance about which type is the most appropriate for particular patients. This article highlights the different designs available and their mechanical performance was assessed by the authors using a purpose-built impact rig. Problems with compliance and issues about tissue viability are discussed and the article also contains a risk assessment tool to help nurses decide on which is the most suitable type of hip protector to use.

Intensive positive behavior supports for adolescents with acquired brain injury: long-term outcomes in community settings.

BACKGROUND: Based on the technologies of applied behavior analysis and person-centered planning, positive behavior support is a process for designing and implementing proactive behavioral interventions with the goal of positive lifestyle changes. PARTICIPANTS: The two adolescents who received the intensive, longitudinal, multicomponent intervention had experienced escalating behavior challenges over several years after brain injury in early childhood. MAIN OUTCOME MEASURES: Quantitative data included episodes of aggression and property destruction. Qualitative data included intensity of supports, family involvement, peer relationships, medication regime, vocational status, educational status, community access, and self-help skills. RESEARCH DESIGN: A long-term, natural-environment, case-study method was used. RESULTS: The targeted challenging behaviors were reduced to zero. In addition, the participants' domains of activity increased and self-management improved even as supports were systematically withdrawn. CONCLUSIONS: These results illustrate the potential for successfully treating extreme chronic behavior disorders after childhood brain injury.

Accessibility, sustainability, excellence: how to expand access to research publications. Executive summary

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