Home surveillance program prevents interstage mortality after the Norwood procedure.

OBJECTIVE: To determine whether early identification of physiologic variances associated with interstage death would reduce mortality, we developed a home surveillance program. METHODS: Patients discharged before initiation of home surveillance (group A, n = 63) were compared with patients discharged with an infant scale and pulse oximeter (group B, n = 24). Parents maintained a daily log of weight and arterial oxygen saturation according to pulse oximetry and were instructed to contact their physician in case of an arterial oxygen saturation less than 70% according to pulse oximetry, an acute weight loss of more than 30 g in 24 hours, or failure to gain at least 20 g during a 3-day period. RESULTS: Interstage mortality among infants surviving to discharge was 15.8% (n = 9/57) in group A and 0% (n = 0/24) in group B (P =.039). Surveillance criteria were breached for 13 of 24 group B patients: 12 patients with decreased arterial oxygen saturation according to pulse oximetry with or without poor weight gain and 1 patient with poor weight gain alone. These 13 patients underwent bidirectional superior cavopulmonary connection (stage 2 palliation) at an earlier age, 3.7 +/- 1.1 months of age versus 5.2 +/- 2.0 months for patients with an uncomplicated interstage course (P =.028). A growth curve was generated and showed reduced growth velocity between 4 and 5 months of age, with a plateau in growth beyond 5 months of age. CONCLUSION: Daily home surveillance of arterial oxygen saturation according to pulse oximetry and weight selected patients at increased risk of interstage death, permitting timely intervention, primarily with early stage 2 palliation, and was associated with improved interstage survival. Diminished growth identified 4 to 5 months after the Norwood procedure brings into question the value of delaying stage 2 palliation beyond 5 months of age.

Appearance and self-presentation research in gay consumer cultures: issues and impact.

Individuals present themselves to others through a variety of verbal and non-verbal behaviors. Appearance represents a non-verbal behavior which consumes a significant amount of our time, effort, and thought. We create and monitor our appearances in relation to cultural standards of attractiveness, relying on a wide range of appearance products and services to do so. The purpose of this paper is to examine the impact of appearance and self-presentation among gay consumers, to discuss issues relating to conducting gay consumer research, to discuss implications for marketing strategies, and to suggest recommendations for further research on specific aspects of appearance management as they may affect marketing to gay consumers. Two studies are reported herein. The first study examines differences in perception among homosexual men when viewing a stimulus person dressed in six distinctly different modes of expression. Social impressions of the stimulus person were different on 15 pairs of characteristics, with certain modes of dress resulting in greater consistency of response and others resulting in greater variability of response. The second study explores differences in aesthetic responses between homosexual and heterosexual men with respect to 14 apparel style categories and 3 fragrance categories. It was found that homosexual men had significantly different responses to innovative, trendy variations in 6 categories of dress, while both homosexual and heterosexual men had similar responses for classic, traditional variations in style categories that might constitute a basic college campus wardrobe (jeans, casual shirts, casual pants, underwear, and coats). Scent preferences also differed between the two groups of respondents. Homosexual men preferred floral, sweet fragrance categories and oriental, spicy categories, while heterosexual men preferred woody, green fragrance categories. These studies suggest that different appearance aesthetics may operate for homosexual and heterosexual men, findings that may have implications for marketing strategies and for understanding the importance of appearance in socialization and self-presentation. Issues relating to conducting consumer studies such as these are discussed, including approval from institutional review boards, sample selection and setting, and measurement. Marketing strategies are discussed relative to target market, product, promotion, distribution, and pricing. Finally, recommendations are offered for further research relating to appearance and self-presentation among gay consumers.