Prevalence of Surgical Flow Disruptions Across Intra-operative High- and Low-Workload Phases in Cardiac Surgery

2021 ◽  
Vol 10 (1) ◽  
pp. 263-266
Author(s):  
Lauren R. Kennedy-Metz ◽  
Roger D. Dias ◽  
Annette M. Phillips ◽  
Alexander Shapeton ◽  
Suzana Zorca ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cognitive Workload ◽  
Surgical Performance ◽  
Cognitive Domains ◽  
Surgical Workflow ◽  
Surgical Errors ◽  
Flow Disruptions ◽  
Auditory Distractions ◽  
Future Work ◽  
The Relationship

While the influence of surgical flow disruptions (SFDs) on surgical performance has been observed in live cardiovascular surgery and their influence on cognitive workload has been evaluated in high-fidelity simulations, the relationship between SFDs and cognitive workload of surgical providers in the live cardiac surgery operating room has yet to be explored. Recent evidence suggests that preventable surgical errors often have a cognitive basis, warranting investigation into the association between SFDs and workload. This study aimed to characterize SFDs according to auditory and cognitive domains and further to compare the frequency and nature of SFDs within periods of high team cognitive workload and low team cognitive workload. Overall, the presence of cognitive distractions was associated more with high team cognitive workload states, while the frequency of auditory distractions was significantly higher during periods of low team cognitive workload states. Future work should consider the types, frequency, and sources of SFDs as well as their impact on surgical procedures and outcomes in order to devise appropriate methods to mitigate or manage potential disruptions to surgical workflow.

Abstract 147: Subtle Degrees of Frailty Result in Adverse Cardiac Surgery Outcomes

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Emma Wilson-Pease ◽  
George Kephart ◽  
Ryan Gainer ◽  
Jahanara Begum ◽  
Greg M Hirsch
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
The Elderly ◽  
Nutritional Deficiencies ◽  
Study Results ◽  
Surgery Outcomes ◽  
Future Work ◽  
The Relationship ◽  
Larger Sample

Background: In North America, octogenarians are the fastest growing demographic. Chronological age of a patient is not always the same as their biological age, and their biological status can vary from robust to frail. Frail patients are predisposed to falls, institutionalization, hospitalization, and mortality. In the realm of cardiac surgery, there is little research examining frailty as a risk factor for cardiac surgical intervention. Purpose: The objective of the current study is to explore the relationship between more subtle degrees of frailty and cardiac surgical outcomes in more detail. Methods: This non-interventional study subjects all consented participants fitting inclusion criteria to the same questionnaires. The assessment is comprised of the Frailty Assessment for Care-Planning Tool (FACT) for both patient and their collateral, and the EQ-5D-3L. A similar interview process is repeated 5-7 months after surgery, with the addition of a qualitative interview. Results: Pilot study results (n=57) show that 52% of the participants were positive for at least one category of frailty at a level of 4/7 (vulnerable). Results also demonstrated that 3.8% of participants who scored zero deficits on the FACT were discharged to an institution for follow up care compared to 19.3% of participants with one or more deficits. Conclusions: Overall, participants were much frailer than expected, with over half being considered vulnerable or worse on the FACT scale. This signifies an increase in frailty in the elderly population, which supplies rationale for the current study. This study will analyze a larger sample of elderly cardiac surgery patients in the Atlantic provinces to more thoroughly investigate this relationship. Implications: This study will assist in educating future heart surgery patients about their possible risks. It is hoped that patients who possess more knowledge about their personal risks will be able to make more informed decisions about their surgery. Strategies to address and reduce frailty by increasing mobility and cognitive function and reducing nutritional deficiencies could use this information to inform future work.

Identifying Physico-Chemical Laws from the Robotically Collected Data

2019 ◽  
Author(s):  
Liwei Cao ◽  
Danilo Russo ◽  
Vassilios S. Vassiliadis ◽  
Alexei Lapkin
Keyword(s):  
Experimental Data ◽  
Numerical Models ◽  
Predictor Variable ◽  
Physical Models ◽  
Training Data ◽  
Mixed Integer ◽  
Physico Chemical ◽  
Data Points ◽  
Future Work ◽  
The Relationship

<p>A mixed-integer nonlinear programming (MINLP) formulation for symbolic regression was proposed to identify physical models from noisy experimental data. The formulation was tested using numerical models and was found to be more efficient than the previous literature example with respect to the number of predictor variables and training data points. The globally optimal search was extended to identify physical models and to cope with noise in the experimental data predictor variable. The methodology was coupled with the collection of experimental data in an automated fashion, and was proven to be successful in identifying the correct physical models describing the relationship between the shear stress and shear rate for both Newtonian and non-Newtonian fluids, and simple kinetic laws of reactions. Future work will focus on addressing the limitations of the formulation presented in this work, by extending it to be able to address larger complex physical models.</p><p><br></p>

Adolescent Language: Models, Assessment, and Links to Reading

2019 ◽  
Author(s):  
Amanda Goodwin ◽  
Yaacov Petscher ◽  
Jamie Tock
Keyword(s):  
Reading Comprehension ◽  
Bifactor Model ◽  
Language Models ◽  
Multiple Group ◽  
Global Factor ◽  
Eighth Grade Students ◽  
Key Aspects ◽  
Future Work ◽  
The Relationship ◽  
Best Fit

Various models have highlighted the complexity of language. Building on foundational ideas regarding three key aspects of language, our study contributes to the literature by 1) exploring broader conceptions of morphology, vocabulary, and syntax, 2) operationalizing this theoretical model into a gamified, standardized, computer-adaptive assessment of language for fifth to eighth grade students entitled Monster, PI, and 3) uncovering further evidence regarding the relationship between language and standardized reading comprehension via this assessment. Multiple-group item response theory (IRT) across grades show that morphology was best fit by a bifactor model of task specific factors along with a global factor related to each skill. Vocabulary was best fit by a bifactor model that identifies performance overall and on specific words. Syntax, though, was best fit by a unidimensional model. Next, Monster, PI produced reliable scores suggesting language can be assessed efficiently and precisely for students via this model. Lastly, performance on Monster, PI explained more than 50% of variance in standardized reading, suggesting operationalizing language via Monster, PI can provide meaningful understandings of the relationship between language and reading comprehension. Specifically, considering just a subset of a construct, like identification of units of meaning, explained significantly less variance in reading comprehension. This highlights the importance of considering these broader constructs. Implications indicate that future work should consider a model of language where component areas are considered broadly and contributions to reading comprehension are explored via general performance on components as well as skill level performance.

Potential Role of Inflammation in Associations between Particulate Matter and Heart Failure

2018 ◽  
Vol 24 (3) ◽  
pp. 341-358 ◽  
Author(s):  
Xiaotong Ji ◽  
Yingying Zhang ◽  
Guangke Li ◽  
Nan Sang
Keyword(s):  
Heart Failure ◽  
Particulate Matter ◽  
Inflammatory Response ◽  
Heart Diseases ◽  
Experimental Studies ◽  
Epidemiological Studies ◽  
Inflammatory Mechanism ◽  
High Concentrations ◽  
Future Work ◽  
The Relationship

Recently, numerous studies have found that particulate matter (PM) exposure is correlated with increased hospitalization and mortality from heart failure (HF). In addition to problems with circulation, HF patients often display high expression of cytokines in the failing heart. Thus, as a recurring heart problem, HF is thought to be a disorder characterized in part by the inflammatory response. In this review, we intend to discuss the relationship between PM exposure and HF that is based on inflammatory mechanism and to provide a comprehensive, updated evaluation of the related studies. Epidemiological studies on PM-induced heart diseases are focused on high concentrations of PM, high pollutant load exposure in winter, or susceptible groups with heart diseases, etc. Furthermore, it appears that the relationship between fine or ultrafine PM and HF is stronger than that between HF and coarse PM. However, fewer studies paid attention to PM components. As for experimental studies, it is worth noting that coarse PM may indirectly promote the inflammatory response in the heart through systematic circulation of cytokines produced primarily in the lungs, while ultrafine PM and its components can enter circulation and further induce inflammation directly in the heart. In terms of PM exposure and enhanced inflammation during the pathogenesis of HF, this article reviews the following mechanisms: hemodynamics, oxidative stress, Toll-like receptors (TLRs) and epigenetic regulation. However, many problems are still unsolved, and future work will be needed to clarify the complex biologic mechanisms and to identify the specific components of PM responsible for adverse effects on heart health.

scholarly journals Analysis of Dynamic Changes in Cognitive Workload During Cardiac Surgery Perfusionists′ Interactions With the Cardiopulmonary Bypass Pump

2020 ◽  
pp. 001872082097629
Author(s):  
Lauren R. Kennedy-Metz ◽  
Roger D. Dias ◽  
Rithy Srey ◽  
Geoffrey C. Rance ◽  
Heather M. Conboy ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Heart Surgery ◽  
Time Windows ◽  
Open Heart Surgery ◽  
Real Life ◽  
Skin Incision ◽  
Cognitive Workload ◽  
Dynamic Changes ◽  
Pump Operation

Objective This novel preliminary study sought to capture dynamic changes in heart rate variability (HRV) as a proxy for cognitive workload among perfusionists while operating the cardiopulmonary bypass (CPB) pump during real-life cardiac surgery. Background Estimations of operators’ cognitive workload states in naturalistic settings have been derived using noninvasive psychophysiological measures. Effective CPB pump operation by perfusionists is critical in maintaining the patient’s homeostasis during open-heart surgery. Investigation into dynamic cognitive workload fluctuations, and their relationship with performance, is lacking in the literature. Method HRV and self-reported cognitive workload were collected from three Board-certified cardiac perfusionists ( N = 23 cases). Five HRV components were analyzed in consecutive nonoverlapping 1-min windows from skin incision through sternal closure. Cases were annotated according to predetermined phases: prebypass, three phases during bypass, and postbypass. Values from all 1min time windows within each phase were averaged. Results Cognitive workload was at its highest during the time between initiating bypass and clamping the aorta (preclamp phase during bypass), and decreased over the course of the bypass period. Conclusion We identified dynamic, temporal fluctuations in HRV among perfusionists during cardiac surgery corresponding to subjective reports of cognitive workload. Not only does cognitive workload differ for perfusionists during bypass compared with pre- and postbypass phases, but differences in HRV were also detected within the three bypass phases. Application These preliminary findings suggest the preclamp phase of CPB pump interaction corresponds to higher cognitive workload, which may point to an area warranting further exploration using passive measurement.

scholarly journals Hsa-miR-494-3p attenuates gene HtrA3 transcription to increase inflammatory response in hypoxia/reoxygenation HK2 Cells

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Qian Gong ◽  
Zhi-ming Shen ◽  
Zhe Sheng ◽  
Shi Jiang ◽  
Sheng-lin Ge
Keyword(s):  
Cardiac Surgery ◽  
Inflammatory Response ◽  
Target Gene ◽  
Kidney Injury ◽  
Human Kidney ◽  
Luciferase Reporter ◽  
The Relationship ◽  
Hk2 Cells ◽  
Dual Luciferase Reporter Assay ◽  
Hypoxia Reoxygenation

AbstractThe occurrence of cardiac surgery-associated acute kidney injury (CSA-AKI) increases hospital stay and mortality. MicroRNAs has a crucial role in AKI. This objective of the current study is to explore the function of hsa-miR-494-3p in inflammatory response in human kidney tubular epithelial (HK2) cells with hypoxia/reoxygenation. According to KDIGO standard, patients after cardiac surgery with cardiopulmonary bypass were divided into two groups: AKI (n = 10) and non-AKI patients (n = 8). HK2 were raised in the normal and hypoxia/reoxygenation circumstances and mainly treated by overexpression ofmiR-494-3p and HtrA3. The relationship between miR-494-3p and HtrA3 was determined by dual-luciferase reporter assay. Our result showed that Hsa-miR-494-3p was elevated in the serum of patients with CSA-AKI, and also induced in hypoxic reoxygenated HK2 cells. Hsa-miR-494-3p also increased a hypoxia-reoxygenation induced inflammatory response in HK2 cells. Moreover, as a target gene of miR-494-3p, overexpression of HtrA3 downregulated the hypoxia-reoxygenation induced inflammatory response in HK2 cells. Overexpression of hsa-miR-494-3p-induced inflammatory response was inhibited by overexpression of HtrA3. Collectively, we identified that hsa-miR-494-3p, a miRNA induced in both circulation of AKI patients and hypoxia-reoxygenation-treated HK2 cells, enhanced renal inflammation by targeting HtrA3, which may suggest a possible role as a new therapeutic target for CSA-AKI.

scholarly journals Cognitive Assessments in Hydration Research Involving Children: Methods and Considerations

2019 ◽  
Vol 74 (Suppl. 3) ◽  
pp. 19-24 ◽  
Author(s):  
Daniel R. Westfall ◽  
Nicole E. Logan ◽  
Naiman A. Khan ◽  
Charles H. Hillman
Keyword(s):  
Academic Achievement ◽  
Human Health ◽  
Research Interest ◽  
Future Research ◽  
Cognitive Assessments ◽  
Cognitive Domains ◽  
Essential Nutrient ◽  
Definition Of ◽  
The Relationship

The effects of optimal and insufficient hydration on human health have received increasing investigation in recent years. Specifically, water is an essential nutrient for human health, and the importance of hydration on cognition has continued to attract research interest over the last decade. Despite this focus, children remain a relatively understudied population relative to the effects of hydration on cognition. Of those studies investigating children, findings have been inconsistent, resulting from utilizing a wide variety of cognitive domains and cognitive assessments, as well as varied hydration protocols. Here, our aim is to create a primer for assessing cognition during hydration research in children. Specifically, we review the definition of cognition and the domains of which it is composed, how cognition has been measured in both field- and laboratory-based assessments, results from neuroimaging methods, and the relationship between hydration and academic achievement in children. Lastly, future research considerations are discussed.

scholarly journals Preoperative endothelial dysfunction in cutaneous microcirculation is associated with postoperative organ injury after cardiac surgery using extracorporeal circulation: a prospective cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Stanislas Abrard ◽  
Olivier Fouquet ◽  
Jérémie Riou ◽  
Emmanuel Rineau ◽  
Pierre Abraham ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cohort Study ◽  
Endothelial Dysfunction ◽  
Postoperative Complications ◽  
Sofa Score ◽  
Primary Objective ◽  
Laser Speckle ◽  
Organ Injury ◽  
Contrast Imaging ◽  
The Relationship

Abstract Background Cardiac surgery is known to induce acute endothelial dysfunction, which may be central to the pathophysiology of postoperative complications. Preoperative endothelial dysfunction could also be implicated in the pathophysiology of postoperative complications after cardiac surgery. However, the relationship between preoperative endothelial function and postoperative outcomes remains unknown. The primary objective was to describe the relationship between a preoperative microcirculatory dysfunction identified by iontophoresis of acetylcholine (ACh), and postoperative organ injury in patients scheduled for cardiac surgery using cardiopulmonary bypass (CPB). Methods Sixty patients undergoing elective cardiac surgery using CPB were included in the analysis of a prospective, observational, single-center cohort study conducted from January to April 2019. Preoperative microcirculation was assessed with reactivity tests on the forearm (iontophoresis of ACh and nitroprusside). Skin blood flow was measured by laser speckle contrast imaging. Postoperative organ injury, the primary outcome, was defined as a Sequential Organ Failure Assessment score (SOFA) 48 h after surgery greater than 3. Results Organ injury at 48 h occurred in 29 cases (48.3%). Patients with postoperative organ injury (SOFA score > 3 at 48 h) had a longer time to reach the peak of preoperative iontophoresis of acetylcholine (133 s [104–156] vs 98 s [76–139] than patients without, P = 0.016), whereas endothelium-independent vasodilation to nitroprusside was similar in both groups. Beyond the proposed threshold of 105 s for time to reach the peak of preoperative endothelium-dependent vasodilation, three times more patients presented organ dysfunction at 48 h (76% vs 24% below or equal 105 s). In multivariable model, the time to reach the peak during iontophoresis of acetylcholine was an independent predictor of postoperative organ injury (odds ratio = 4.81, 95% confidence interval [1.16–19.94]; P = 0.030). Conclusions Patients who postoperatively developed organ injury (SOFA score > 3 at 48 h) had preoperatively a longer time to reach the peak of endothelium-dependent vasodilation. Trial registration Clinical-Trials.gov, NCT03631797. Registered 15 August 2018, https://clinicaltrials.gov/ct2/show/NCT03631797

scholarly journals Analysis of the Relationship between the Psychological Well-Being, Emotional Intelligence, Willpower, and Job-Efficacy of Clinical Nurses: A Structural Model Application

2021 ◽  
Vol 18 (11) ◽  
pp. 5582
Author(s):  
Jin-Hwa Lee ◽  
In-Ok Sim
Keyword(s):  
Emotional Intelligence ◽  
Nursing Students ◽  
Structural Model ◽  
Well Being ◽  
Psychological Well Being ◽  
Clinical Nurses ◽  
Professional Nurses ◽  
Mediating Factor ◽  
Future Work ◽  
The Relationship

The aim of this study to discover the relationship between psychological well-being, emotional intelligence, willpower, and job-efficacy. The data were collected from 26 May to 30 May 2020 by distributing a questionnaire to 317 clinical nurses with six months of experience in a general hospital located in Seoul. Three hundred copies were collected and used for final data analysis. The results of the study verified that the direct factors of psychological well-being, emotional intelligence, and willpower affect the job-efficacy of clinical nurses and confirmed that emotional intelligence is a mediating factor between psychological well-being and job-efficacy. This study is meaningful in that it proves the necessity of establishing various curriculums focusing on these factors so that nursing students can best perform their duties as professional nurses. In particular, it is suggested that an educational program and curriculum be established that can strengthen the psychological well-being and enhance the emotional intelligence of nursing students. It is expected that such training will equip professional clinical nurses to effectively handle future work in their stress-filled field.

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