Anticipatory perioperative management for patent ductus arteriosus surgery: Understanding postligation cardiac syndrome

Ligation of a hemodynamically significant ductus arteriosus results in significant changes in loading conditions which have predictable consequences. Postligation cardiac syndrome, defined as hypotension requiring inotropic support and failure of oxygenation and ventilation, may occur 6‐12 hours following ligation due to left ventricular systolic and diastolic failure, respectively. Afterload is the primary driver of this decompensation. In this review, we describe the pathophysiological changes in loading conditions associated with postligation cardiac syndrome and other contributors to cardiovascular dysfunction following ductal ligation. We present strategies for perioperative optimization and a physiology‐based algorithm for postoperative management guided by targeted neonatal echocardiography. The use of these strategies to reduce the frequency of postligation deterioration may be an avenue to improve outcomes for neonates in this vulnerable patient population.     

REBOA by a non-surgeon as an adjunct during MASCAL

Use of Resuscitative endovascular balloon occlusion of the aorta (REBOA) for control of non-compressible hemorrhage is a re-emerging technology that historically is employed by surgeons. We present a case in which REBOA was successfully placed by an emergency physician in a critical mass casualty patient awaiting transfer to the operating table. This case is an example in which emergency physicians, in collaboration with the surgeon, can utilize REBOA to temporize non-compressible hemorrhage when a surgeon is not immediately available.     

Comparing Agency Leader and Therapist Perspectives on Evidence-Based Practices: Associations with Individual and Organizational Factors in a Mental Health System-Driven Implementation Effort

Agency leaders and therapists are essential stakeholders in implementation of evidence-based practices (EBPs) within publicly-funded mental health services. Little is known about how these stakeholders differ in their perceptions of specific EBPs and which individual and organizational factors differentially influence these perceptions. Within the context of a system-driven implementation of multiple EBPs, survey data from 160 leaders and 720 therapists were examined to assess differences in perceptions of six EBPs. Findings indicated that leaders and therapists have unique perspectives and preferences regarding EBPs that are shaped by distinct sociodemographic and professional characteristics and aspects of organizational functioning.     

Tracking Inner City Substance Users from the Emergency Department: How Many Contacts Does It Take?

Background: Longitudinal studies of substance users report difficulty in locating and completing 12‐month interviews, which may compromise study validity. Objectives: This study examined rates and predictors of contact difficulty and in‐person follow‐up completion among patients presenting with cocaine‐related chest pain to an inner‐city emergency department (ED). The authors hypothesize that less staff effort in contacting patients and lower follow‐up rates would bias subsequent substance use analysis by missing those with heavier substance misuse. Methods: A total of 219 patients aged 19 to 60 years (65% males; 78% African American) with cocaine‐related chest pain were interviewed in the ED and then in person at 3, 6, and 12 months. Demographics, substance use measures, and amount/type of research staff contacts (telephone, letters, home visits, and locating patient during return ED visits) were recorded. Poisson and negative binomial regression analyses were conducted to predict quantity of patient contacts for the 12‐month follow‐up. Results: Interview completion rates at 3, 6, and 12 months were 78, 82, and 80%, respectively. Average contact attempts to obtain each interview were 10 at 3 months (range 3–44), 8 at 6 months (1–31), and 8 at 12 months (1–49); 13% of patients required a home visit to complete the 12‐month interview. Participants requiring more contact attempts by staff were younger and reported more frequent binge drinking at baseline (p < 0.05), but were less likely to meet criteria for substance abuse or dependence (p < 0.5), or to report prior mental health treatment (p < 0.05). Comparisons of parallel regressions predicting contact difficulty based on the entire sample, the low‐effort group, and the difficult‐to‐reach group showed variation in findings. Conclusions: This study demonstrates that substantial staff effort is required to achieve adequate retention over 12 months of patients with substance misuse. Without these extensive efforts at follow‐up, longitudinal analyses may be biased.     

The lighter side of advertising: Investigating posing and lighting biases

People tend to display the left cheek when posing for a portrait; however, this effect does not appear to generalise to advertising. The amount of body visible in the image and the sex of the poser might also contribute to the posing bias. Portraits also exhibit lateral lighting biases, with most images being lit from the left. This effect might also be present in advertisements. A total of 2801 full-page advertisements were sampled and coded for posing direction, lighting direction, sex of model, and amount of body showing. Images of females showed an overall leftward posing bias, but the biases in males depended on the amount of body visible. Males demonstrated rightward posing biases for head-only images. Overall, images tended to be lit from the top left corner. The two factors of posing and lighting biases appear to influence one another. Leftward-lit images had more leftward poses than rightward, while the opposite occurred for rightward-lit images. Collectively, these results demonstrate that the posing biases in advertisements are dependent on the amount of body showing in the image, and that biases in lighting direction interact with these posing biases.