Utilization of Del Nido Cardioplegia in Adult Coronary Artery Bypass Grafting　- A Retrospective Analysis.

BACKGROUND: Studies assessing the safety and effectiveness of Del Nido cardioplegia for adult cardiac surgery remain limited. We investigated early outcomes after coronary artery bypass grafting (CABG) using single-dose Del Nido cardioplegia vs. conventional multi-dose blood cardioplegia. Methods and Results: The 81 consecutive patients underwent isolated CABG performed by a single surgeon. The initial 27 patients received anterograde blood cardioplegia, while the subsequent 54 patients received anterograde Del Nido cardioplegia. There were no differences in the baseline characteristics of each group nor any differences in the 30-day incidences of myocardial infarction, all-cause death, and readmission following surgery. The use of Del Nido cardioplegia was associated with shorter cardiopulmonary bypass time (98 vs. 115 min, P=0.011), shorter cross-clamp time (74 vs. 87 min, P=0.006), and decreased need for intraoperative defibrillation (13.0% vs. 33.3%, P=0.030) compared with blood cardioplegia. To control for the difference in cross-clamp time, we performed propensity score matching with a logistical treatment model and confirmed that Del Nido cardioplegia provided similar outcomes as blood cardioplegia and also reduced the need for defibrillation independent of cross-clamp time. CONCLUSIONS: Compared with conventional blood cardioplegia, Del Nido cardioplegia provided excellent myocardial protection with reduced need for intraoperative defibrillation, shorter bypass and cross-clamp times, and comparable early clinical outcomes for adult patients undergoing CABG.

Implementers' Perspectives on Fidelity of Implementation.

Fidelity of implementation is an essential factor in realizing outcomes of evidence-based interventions. Yet perspectives vary on the degree to which fidelity is necessary or desirable, implementers may receive limited guidance on fidelity, and research on implementers' understanding and operationalization of fidelity is lacking. We conducted key informant interviews with 20 individuals who implemented an evidence-based teen dating violence prevention curriculum in seven sites. Interviews addressed how implementers defined fidelity and the adaptations they made in implementing the curriculum. Although all implementers reported delivering the curriculum with fidelity, their definitions of fidelity varied. Most defined fidelity in terms of adherence to the published curriculum, although definitions sometimes allowed modifications of pedagogy or adding or subtracting materials. A smaller group of implementers defined fidelity in terms of their perceptions of the curriculum's core messages. All implementers described variations from the published curriculum, which were frequently inconsistent with their own definitions of fidelity. Implementers committed to the value of implementation with fidelity may need support in its definition and application. Developers can support implementers by communicating program theory in terms that implementers will understand, clarifying expectations for fidelity and allowable adaptations, and codifying lessons learned from previous implementation.

Teen Dating Violence, Sexual Harassment, and Bullying Among Middle School Students: Examining Mediation and Moderated Mediation by Gender.

This longitudinal study tested whether sexual harassment perpetration mediates the relationship between bullying perpetration and teen dating violence (TDV) perpetration and tested moderated mediation by assessing whether the developmental pathway varies by gender among middle school-aged youth. Although TDV has been associated with bullying and sexual harassment, the developmental relationship among all three behaviors has rarely been examined, especially by gender. The data were collected from one cohort of seventh grade middle school students (N = 612) from four schools. Students were surveyed every 6 months during seventh and eighth grades for a total of four waves of data collection. Structural equation modeling (SEM) was conducted to address the study aims, consisting of three stages: measurement models, mediation, and moderated mediation (otherwise known as Contrast of Mediated Effects). Results indicate no evidence of mediation. However, in the overall model, bullying and sexual harassment both emerged as significant predictors of TDV at a later time point. Among girls, only bullying significantly predicted TDV at a later time point, and, among boys, only sexual harassment significantly predicted TDV at a later time point. Prevention programs that target bullying and sexual harassment perpetration may reduce later perpetration of TDV. Further research is needed to disentangle the temporal relationships between these aggressive behaviors among youth.

Dating violence, bullying, and sexual harassment: longitudinal profiles and transitions over time.

Although there is growing recognition of the problem of dating violence, little is known about how it unfolds among young adolescents who are just beginning to date. This study examined classes (subgroups) and transitions between classes over three time points based on dating violence, bullying, and sexual harassment perpetration and victimization experienced by youth. The sample was ethnically diverse, consisting of 795 seventh-grade students from schools that were part of a multi-site, longitudinal evaluation of a dating violence initiative (50 % female; 27 % White, 32 % African American, 25 % Latino, 16 % other or multiple races). Results from latent transition analyses revealed five classes of students with distinct behavioral profiles: multi-problem (victimization and perpetration), bullying and sexual harassment (victimization and perpetration), bullying (victimization and perpetration) and sexual harassment (victimization only), bullying (victimization and perpetration), and a least problem group. The majority of classes were characterized by reports of both perpetration and victimization for at least one behavior. Girls were more likely to be in the less problematic classes. Class membership was fairly stable across the three time points. When students transitioned to a different class, the shift was most often from a more problematic to a less problematic class, particularly for girls. The findings support understanding dating violence within a dynamic, developmental process that recognizes related behaviors within and across individuals. Overall, the findings highlight the utility of person-oriented approaches to enhance our understanding of longitudinal profiles and transitions over time for dating violence and related behaviors.

Mindful Coping Power Effects on Children's Autonomic Nervous System Functioning and Long-Term Behavioral Outcomes.

Mindful Coping Power (MCP) was developed to enhance the effects of the Coping Power (CP) preventive intervention on children's reactive aggression by integrating mindfulness training into CP. In prior pre-post analyses in a randomized trial of 102 children, MCP improved children's self-reported anger modulation, self-regulation, and embodied awareness relative to CP but had fewer comparative effects on parent- and teacher-reported observable behavioral outcomes, including reactive aggression. It was hypothesized that MCP-produced improvements in children's internal awareness and self-regulation, if maintained or strengthened over time with ongoing mindfulness practice, would yield improvements in children's observable prosocial and reactive aggressive behavior at later time points. To appraise this hypothesis, the current study examined teacher-reported child behavioral outcomes at a one-year follow-up. In the current subsample of 80 children with one-year follow-up data, MCP produced a significant improvement in children's social skills and a statistical trend for a reduction in reactive aggression compared with CP. Further, MCP produced improvements in children's autonomic nervous system functioning compared with CP from pre- to post-intervention, with a significant effect on children's skin conductance reactivity during an arousal task. Mediation analyses found that MCP-produced improvements in inhibitory control at post-intervention mediated program effects on reactive aggression at the one-year follow-up. Within-person analyses with the full sample (MCP and CP) found that improvements in respiratory sinus arrhythmia reactivity were associated with improvements in reactive aggression at the one-year follow-up. Together, these findings indicate that MCP is an important new preventive tool to improve embodied awareness, self-regulation, stress physiology, and observable long-term behavioral outcomes in at-risk youth. Further, children's inhibitory control and autonomic nervous system functioning emerged as key targets for preventive intervention.

The safety and efficacy of physician assistants as first assistant surgeons in cardiac surgery.

This study is a retrospective review of 956 patients comparing cases first-assisted by physician assistants (PAs) to those first-assisted by surgeons, examining whether PAs can function safely and efficiently in the role of first assistant surgeon for cardiac surgery. No differences were found between the two cohorts.

Longitudinal Patterns of Electronic Teen Dating Violence Among Middle School Students.

We investigated rates and developmental trends of electronic teen dating violence (TDV) perpetration and victimization overall and by gender. Data were collected from a single cohort of seventh-grade students from four schools using paper-and-pencil surveys administered at 6-month intervals (N = 795). Data were analyzed with descriptive statistics and longitudinal growth models to estimate change over time in TDV. Overall, 32% of youth reported electronic TDV perpetration, and 51% reported electronic TDV victimization. Victimization was more prevalent for boys (42%) than for girls (31%) at baseline only (t = 2.55, p < .05). Perpetration did not differ at any wave. Perpetration and victimization each decreased significantly from the beginning of seventh grade to the end of eighth grade, ß = -.129 (.058), p < .05, for perpetration, and ß = -.138 (.048), p < .01, for victimization. Gender moderated the decrease in reported victimization, with simple slopes indicating girls showed almost no change in victimization, ß = .006 (.066), ns, whereas boys decreased significantly over the 2 years, ß = -.292 (.069), p < .001. Although moderation by gender of change in perpetration was not conventionally significant, the simple slopes revealed that girls again showed a nonsignificant change in TDV across seventh and eighth grades, ß = -.067 (.078), ns, whereas boys showed a significant decline in reported electronic TDV perpetration, ß = -.197 (.083), p < .05. The high prevalence of electronic TDV underscore the need for addressing these behaviors within TDV prevention interventions.

Mindful Coping Power: Comparative Effects on Children's Reactive Aggression and Self-Regulation.

Coping Power (CP) is an evidence-based preventive intervention for youth with disruptive behavior problems. This study examined whether Mindful Coping Power (MCP), a novel adaptation which integrates mindfulness into CP, enhances program effects on children's reactive aggression and self-regulation. A pilot randomized design was utilized to estimate the effect sizes for MCP versus CP in a sample of 102 child participants (fifth grade students, predominantly low-middle income, 87% Black). MCP produced significantly greater improvement in children's self-reported dysregulation (emotional, behavioral, cognitive) than CP, including children's perceived anger modulation. Small to moderate effects favoring MCP were also observed for improvements in child-reported inhibitory control and breath awareness and parent-reported child attentional capacity and social skills. MCP did not yield a differential effect on teacher-rated reactive aggression. CP produced a stronger effect than MCP on parent-reported externalizing behavior problems. Although MCP did not enhance program effects on children's reactive aggression as expected, it did have enhancing effects on children's internal, embodied experiences (self-regulation, anger modulation, breath awareness). Future studies are needed to compare MCP and CP in a large scale, controlled efficacy trial and to examine whether MCP-produced improvements in children's internal experiences lead to improvements in their observable behavior over time.

Off-Pump Minithoracotomy Versus Sternotomy for Left Anterior Descending Myocardial Bridge Unroofing.

BACKGROUND: Myocardial bridge (MB) of the left anterior descending (LAD) coronary artery occurs in approximately 25% of the population. When medical therapy fails in patients with a symptomatic, hemodynamically significant MB, MB unroofing represents the optimal surgical management. Here, we evaluated minimally invasive MB unroofing in selected patients compared with sternotomy. METHODS: MB unroofing was performed in 141 adult patients by sternotomy on-pump (ST-on, n = 40), sternotomy off-pump (ST-off, n = 62), or minithoracotomy off-pump (MT, n = 39). Angina symptoms were assessed preoperatively and 6 months postoperatively using the Seattle Angina Questionnaire. Matching included all MT patients and 31 ST-off patients with similar MB characteristics, no previous cardiac operations or coronary interventions, and no concomitant procedures. RESULTS: MT patients tended to have a shorter MB length than ST-on and ST-off patients (2.57 vs 2.93 vs 3.09 cm, P = .166). ST-on patients had a longer hospital stay than ST-off and MT patients (5.0 vs 4.0 vs 3.0 days, P < .001), and more blood transfusions (15.2% vs 0.0% vs 2.6%, P = .002). After matching, MT patients had a shorter hospital stay than ST-off patients (3.0 vs 4.0 days, P = .005). No deaths or major complications occurred in any group. In all groups, MB unroofing yielded significant symptomatic improvement regarding physical limitation, angina stability, angina frequency, treatment satisfaction, and quality of life. CONCLUSIONS: We report our single-center experience of off-pump minimally invasive MB unroofing, which may be safely performed in carefully selected patients, yielding dramatic improvements in angina symptoms at 6 months after the operation.

First lung and kidney multi-organ transplant following COVID-19 Infection.

As the world responds to the global crisis of the COVID-19 pandemic an increasing number of patients are experiencing increased morbidity as a result of multi-organ involvement. Of these, a small proportion will progress to end-stage lung disease, become dialysis dependent, or both. Herein, we describe the first reported case of a successful combined lung and kidney transplantation in a patient with COVID-19. Lung transplantation, isolated or combined with other organs, is feasible and should be considered for select patients impacted by this deadly disease.

Theoretical Model of Mindful Coping Power: Optimizing a Cognitive Behavioral Program for High-Risk Children and Their Parents by Integrating Mindfulness.

This paper describes a theoretical model of Mindful Coping Power, a preventive intervention targeting high-risk children and their parents. Mindful Coping Power integrated mindfulness into Coping Power, an evidence-based cognitive behavioral intervention. Reactive aggression is emotionally driven, impulsive, and often referred to as being "hot-blooded." It has been resistant to change, given the high level of emotional arousal and impulsive angry outbursts. Our premise is that mindfulness impacts the mechanisms of reactive aggression-attentional, cognitive, behavioral, and emotional dysregulation. Also in the model are parents who exhibit emotionally charged interactions with their child. Mindful parenting focuses on parents' own emotional self-regulation and being fully present with their child. Our model sets the stage for incorporating mindfulness into existing interventions, thereby optimizing programs and maximizing effects.

Endoscopic Radial Artery Harvesting During Anesthesia Line Placement Reduces the Time and Cost of Multivessel Coronary Artery Bypass Grafting.

OBJECTIVE: Endoscopic radial artery (RA) harvesting performed concurrently with internal mammary artery (IMA) takedown and endoscopic saphenous vein (SV) harvesting creates a crowded and inefficient operating room environment. We assessed the effect of a presternotomy RA harvest strategy on surgery time and costs. METHODS: A total of 41 patients underwent elective, first-time, isolated multivessel on-pump coronary artery bypass grafting including an IMA, RA, and SV graft. The first 20 patients (Phase I) underwent endoscopic RA harvesting concurrently with IMA takedown and endoscopic SV harvesting after sternotomy, requiring two sets of endoscopic harvesting equipment per case, each used by a separate individual. The final 21 patients (Phase II) underwent endoscopic RA harvesting during anesthesia line placement, completing the procedure before sternotomy, thus requiring only one set of endoscopic harvesting equipment reused by a single individual. RESULTS: There were no differences in baseline patient characteristics, number of bypasses, duration of SV or RA harvest time, or duration of cardiopulmonary bypass or cross-clamp time between the two groups. Total surgery time was reduced by 32 minutes in Phase II (P = 0.044). Relative to a total hospital direct cost of 100.00 units, total surgery costs were reduced from 29.33 units in Phase I to 25.62 units in Phase II (P = 0.001). No anesthesia- or RA harvest-related complications occurred in either group. CONCLUSIONS: Endoscopic RA harvesting can be safely performed during anesthesia line placement prior to sternotomy. Our simple but innovative strategy improves intraoperative workflow, reduces the time and cost of surgery, and advances the delivery of high-quality patient care.

Adapting Mindfulness Training for Military Service Members With Chronic Pain.

INTRODUCTION: Rates of chronic pain in military personnel are disproportionately high. Chronic pain is often associated with mental health and substance use disorders as comorbid conditions, making treatment of chronic pain complex. Mindfulness-based interventions (MBIs) are a promising behavioral approach to managing chronic pain and psychosocial sequelae. The unique nature of the military context may require adaptations to original MBIs for successful delivery in active-duty military populations. This study adapted the mindfulness-based stress reduction (MBSR) program to create a mindfulness training program that was relevant to active-duty Army personnel experiencing chronic pain. This article delineates the adaptation process employed to modify the MBSR program to the military context and discusses the resulting training program. MATERIALS AND METHODS: The adaptation process consisted of three iterative stages: 1) Drafting the preliminary intervention protocol with recommendations from stakeholders, including military healthcare providers; 2) Refining the preliminary protocol after pretesting the sessions with research team members and a military Veteran advisory committee; and 3) Delivering the preliminary protocol to one cohort of active-duty Soldiers with chronic pain, collecting feedback, and further refining the intervention protocol. RESULTS: Military-related adaptations to MBSR addressed three areas: military culture, language and terminology, and practical and logistical factors relevant to implementation in the military setting. This adaptation process resulted in a live, online program with six, weekly, sessions. Feedback from a military Veteran advisory committee resulted in modifications, including increasing military-relevant examples; preliminary testing with the target population resulted in additional modifications, including shortening the sessions to 75 min and structuring discussions more efficiently. CONCLUSIONS: The adaptation process was successful in generating an engaging mindfulness training program that was highly relevant to the military context. Obtaining input from stakeholders, such as military healthcare providers and active-duty soldiers, and iterative feedback and modification, were key to the process. Moreover, the program was designed to maintain the integrity and core elements of MBIs while adapting to military culture. A future randomized controlled trial design will be used to evaluate the effectiveness of the intervention in improving chronic pain in military personnel. This program is responsive to the military's call for nonpharmacologic treatments for chronic pain that are easily accessible. If effective, the mindfulness program has the potential for widespread dissemination to complement standard care for Service Members experiencing chronic pain.

Parent and peer predictors of physical dating violence perpetration in early adolescence: tests of moderation and gender differences.

This study examined parenting and peer predictors of physical dating violence perpetration during early adolescence and tested moderation among these predictors and gender. Participants were 2,824 ethnically diverse sixth-grade students with a recent boyfriend/girlfriend who was part of a multisite, longitudinal investigation of the development and prevention of violence among middle school students. Those students who reported having a boyfriend/girlfriend reported significantly more drug use and delinquent activity and were more likely to be male. Twenty-nine percent of youth with a boyfriend/girlfriend reported perpetrating physical aggression against their boyfriend/girlfriend. Parenting and peer variables were significant predictors of physical dating violence. However, gender moderated the association between parenting practices and physical dating violence, with parental monitoring inversely linked to dating violence for boys and parent support for nonaggression inversely linked to dating violence for girls. Parent support for aggression also moderated the association between peer deviancy and reported perpetration. Finally, gender moderated the interaction between peer deviancy and parent support for nonaggressive solutions.

A dynamic cascade model of the development of substance-use onset.

Although the onset of illicit substance use during adolescence can hit parents abruptly like a raging flood, its origins likely start as a trickle in early childhood. Understanding antecedent factors and how they grow into a stream that leads to adolescent drug use is important for theories of social development as well as policy formulations to prevent onset. Based on a review of the extant literature, we posited a dynamic cascade model of the development of adolescent substance-use onset, specifying that (1) temporally distinct domains of biological factors, social ecology, early parenting, early conduct problems, early peer relations, adolescent parenting, and adolescent peer relations would predict early substance-use onset; (2) each domain would predict the temporally next domain; (3) each domain would mediate the impact of the immediately preceding domain on substance use; and (4) each domain would increment the previous domain in predicting substance use. The model was tested with a longitudinal sample of 585 boys and girls from the Child Development Project, who were followed from prekindergarten through Grade 12. Multiple variables in each of the seven predictor domains were assessed annually through direct observations, testing, peer nominations, school records, and parent-, teacher-, and self-report. Partial least-squares analyses tested hypotheses. Of the sample, 5.2% had engaged in substance use by Grade 7, and 51.3% of the sample had engaged in substance use by Grade 12. Five major empirical findings emerged: (1) Most variables significantly predicted early substance-use onset; (2) predictor variables were significantly related to each other in a web of correlations; (3) variables in each domain were significantly predicted by variables in the temporally prior domain; (4) each domain's variables significantly mediated the impact of the variables in the temporally prior domain on substance-use outcomes; and (5) variables in each domain significantly incremented variables in the previous domain in predicting substance-use onset. A dynamic cascade represented the most parsimonious model of how substance use develops. The findings are consistent with six features of social development theories: (1) multiple modest effects; (2) primacy of early influences; (3) continuity in adaptation; (4) reciprocal transactional development; (5) nonlinear growth in problem behaviors during sensitive periods; and (6) opportunities for change with each new domain. The findings suggest points for interventions, public policies, and economics of substance-use and future inquiry.

Early adolescents' social standing in peer groups: behavioral correlates of stability and change.

Sociometric nominations, social cognitive maps, and self-report questionnaires were completed in consecutive years by 327 students (56% girls) followed longitudinally from grade 7 to grade 8 to examine the stability of social standing in peer groups and correlates of changes in social standing. Social preference, perceived popularity, network centrality, and leadership were moderately stable from grade 7 to grade 8. Alcohol use and relational aggression in grade 7 predicted changes in social preference and centrality, respectively, between grade 7 and grade 8, but these effects were moderated by gender and ethnicity. Changes in social standing from grade 7 to grade 8 were unrelated to grade 8 physical aggression, relational aggression, and alcohol use after controlling for the grade 7 corollaries of these behaviors. Results are discussed in terms of their implications for understanding links between social standing and problem behaviors during adolescence.

Early Adolescent Romantic Partner Status, Peer Standing, and Problem Behaviors.

This study examined associations among early adolescent romantic relationships, peer standing, problem behaviors, and gender as a moderator of these associations, in a sample of 320 seventh-grade students. Popular and controversial status youth were more likely to have a romantic partner, whereas neglected status youth were less likely to have a romantic partner. Similarly, youth perceived as conventional and unconventional leaders were also more likely to have a romantic partner than were non-leaders. Youth who had a romantic partner drank more alcohol and were more aggressive than were youth who did not have a romantic partner. Among those youth who had romantic partners, those who reported having more deviance-prone partners were themselves more likely to use alcohol and to be more aggressive, and those who engaged in deviant behavior with their partners used more alcohol. However, these associations varied somewhat by gender. These findings underscore the salience of early romantic partner relationships in the adjustment of early adolescents.

Development and Initial Validation of the Self-Care Practices Scale.

Self-care is regarded as essential for effective social work practice, offsetting occupational stress and promoting well-being and resiliency among practitioners. However, the literature reveals a notable absence of psychometrically sound instruments to measure self-care. The purpose of the present study was to describe the development, refinement, and construct validity of the Self-Care Practices Scale (SCPS). The piloted version of the SCPS is a 38-item instrument designed to measure frequency of engagement in personal and professional self-care practices. Data were collected through mailed surveys from a random sample of master's-level clinical social workers and members of the National Association of Social Workers (N = 492). Analysis supports the construct validity of an 18-item SCPS with two subscales that demonstrate strong internal validity. The SCPS is useful for social work educators, practitioners, and administrators to ascertain frequency of self-care practice and build a stronger culture of self-care. The role of SCPS in future research is discussed.

Trends in mental health service use by age among adults with serious mental illness.

PURPOSE: This study examines trends in mental health service use among 18- to 64-year-old adults with serious mental illness (SMI). METHODS: Data are from approximately 22,200 adults with SMI who participated in the National Survey on Drug Use and Health, an annual nationally representative survey of the U.S. civilian, noninstitutionalized population. A regression restricted spline modeled the trend in mental health service use by age among adults with SMI. RESULTS: Approximately 20 to 50% of adults with SMI did not receive past-year mental health services. The odds of past-year service use increased by 3% per year until age 52 years. CONCLUSIONS: From age 18 to 52 years, age incrementally increases the likelihood that an adult with SMI makes treatment contact.

Mindfulness and Acceptance as Potential Protective Factors for Mothers of Children With Fragile X Syndrome.

Women with an FMR1 premutation may be at increased genetic risk for stress vulnerability. This increased vulnerability, when combined with stressful parenting that can result from raising children with fragile X syndrome (FXS), may result in negative physical and emotional outcomes. Mindfulness and acceptance have been found to be protective factors for parents of children with similar behavioral challenges, but these traits have not previously been explored among mothers with a child with FXS. This study explored the associations of child disability severity with maternal stress, anxiety, depression, and physical health symptoms in 155 biological mothers of children with FXS. Women completed an online survey using standardized measures of stress, mindfulness, and acceptance. General mindfulness, mindfulness in the parenting role, and general acceptance were explored as potential protective factors between the child disability severity and maternal outcomes. Trait mindfulness and acceptance were significant predictors of lower stress, anxiety, depression, and daily health symptoms, while mindful parenting was associated with lower stress, anxiety, and depression. Acceptance was found to attenuate the effects of child severity on maternal stress and depression. These findings suggest that interventions focused on improving mindfulness and acceptance may promote health and well-being for mothers of children with FXS and have important health implications for all individuals with an FMR1 premutation.