ABSTRACT
Real-time captions appear to be an effective tool in assisting deaf and hard of hearing (DHH) college students' access information and communication in certain classroom settings. However, there is limited knowledge of DHH students' direct experiences with real-time captioning services. In this study, we gathered narratives from 15 DHH college students across the United States about their experiences with real-time captioning services in college. We analyzed the stories using thematic narrative analysis and uncovered 4 types that students told about their experiences. The story types were (a) stories of overcoming obstacles, (b) stories of resignation, (c) pragmatic stories, and (d) stories of personal connection. These story types reveal that although many students eventually experience effective communication access through real-time captioning services, they can initially struggle to overcome barriers to using the services successfully. Making time and space to listen to DHH students' narratives can teach educators and professionals how to support these students and resolve barriers before they arise.
Subject(s)
Aminophylline , Myocardial Perfusion Imaging , Caffeine , Exercise Test , Purines , Pyrazoles , Vasodilator AgentsABSTRACT
OBJECTIVE: To compare same-day (SD) vs. delayed hospital discharge (DD) after single and multivessel coronary stenting facilitated by femoral closure device in patients with stable angina and low-risk acute coronary syndrome (ACS). METHODS: University of Southern California patients were screened and coronary stenting was performed in 2480 patients. Four hundred ninety-three patients met screening criteria and consented. Four hours after percutaneous coronary intervention, 100 were randomized to SD (n=50) or DD (n=50). Patients were followed for one year; outcomes-, patient satisfaction-, and cost analyses were performed. RESULTS: Groups were well distributed, with similar baseline demographic and angiographic characteristics. Mean age was 58.1±8.8years and 86% were male. Non-ST-elevation myocardial infarction and unstable angina were the clinical presentations in 30% and 44% of the SD and DD groups, respectively (p=0.2). Multivessel stenting was performed in 36% and 30% of SD and DD groups, respectively (p=0.14). At one year, two patients from each group (4%) required unplanned revascularization and one patient in the SD group had a gastrointestinal bleed that required a blood transfusion. Six SD and four DD patients required repeat hospitalization (p=0.74). There were no femoral artery vascular complications in either group. Patient satisfaction scores were equivalent. SD discharge was associated with $1200 savings per patient. CONCLUSIONS: SD discharge after uncomplicated single and multivessel coronary stenting of patients with stable, low-risk ACS, via the femoral approach facilitated by a closure device, is associated with similar clinical outcomes, patient satisfaction, and cost savings compared to overnight (DD) hospital stay.
Subject(s)
Acute Coronary Syndrome/therapy , Angina, Stable/therapy , Catheterization, Peripheral , Femoral Artery , Hemorrhage/prevention & control , Hemostatic Techniques/instrumentation , Length of Stay , Patient Discharge , Percutaneous Coronary Intervention/instrumentation , Stents , Vascular Closure Devices , Acute Coronary Syndrome/diagnostic imaging , Acute Coronary Syndrome/economics , Aged , Angina, Stable/diagnostic imaging , Angina, Stable/economics , Catheterization, Peripheral/adverse effects , Catheterization, Peripheral/economics , Coronary Angiography , Cost Savings , Cost-Benefit Analysis , Equipment Design , Female , Femoral Artery/diagnostic imaging , Hemorrhage/economics , Hemorrhage/etiology , Hemostatic Techniques/adverse effects , Hemostatic Techniques/economics , Hospital Costs , Humans , Length of Stay/economics , Los Angeles , Male , Middle Aged , Patient Discharge/economics , Patient Readmission , Patient Satisfaction , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/economics , Prospective Studies , Punctures , Risk Factors , Stents/economics , Surveys and Questionnaires , Time Factors , Treatment Outcome , Vascular Closure Devices/economicsABSTRACT
INTRODUCTION: Ultrasound guidance is widely recommended to reduce the risk of complications during central venous catheter placement. However, ultrasound guidance is not commonly utilized for implanting leads for cardiac rhythm management devices. METHODS AND RESULTS: We describe our technique of ultrasound-guided pacemaker implantation, including a novel pull-through technique that allows percutaneous guidewire insertion prior to the first incision. We review the literature and recent advances in ultrasound imaging technology that may facilitate the adoption of ultrasound guidance. CONCLUSIONS: Ultrasound guidance provides a safe and rapid technique for extrathoracic subclavian or axillary venous lead placement.
Subject(s)
Axillary Vein/diagnostic imaging , Cardiac Pacing, Artificial , Catheterization, Central Venous/methods , Defibrillators, Implantable , Electric Countershock/instrumentation , Pacemaker, Artificial , Prosthesis Implantation/methods , Subclavian Vein/diagnostic imaging , Ultrasonography, Interventional , Humans , PuncturesABSTRACT
mahoganoid is a mouse coat-color mutation whose pigmentary phenotype and genetic interactions resemble those of Attractin (Atrn). Atrn mutations also cause spongiform neurodegeneration. Here, we show that a null mutation for mahoganoid causes a similar age-dependent neuropathology that includes many features of prion diseases but without accumulation of protease-resistant prion protein. The gene mutated in mahoganoid encodes a RING-containing protein with E3 ubiquitin ligase activity in vitro. Similarities in phenotype, expression, and genetic interactions suggest that mahoganoid and Atrn genes are part of a conserved pathway for regulated protein turnover whose function is essential for neuronal viability.
