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Eddib A.,State University of New York at Buffalo | Danakas A.,State University of New York at Buffalo | Hughes S.,State University of New York at Buffalo | Erk M.,State University of New York at Buffalo | And 4 more authors.
Journal of Gynecologic Surgery | Year: 2014

Objective: The aim of this research was to estimate the impact of body mass index (BMI) on surgical outcomes in patients undergoing robotic-assisted gynecologic surgery. Materials and Methods: This study was a retrospective review of prospectively collected cohort data for a consecutive series of patients undergoing gynecologic robotic surgery in a single institution. BMI, expressed as kg/m2, was abstracted from the medical charts of all patients undergoing robotic hysterectomy. Data on estimated blood loss (EBL), hemoglobin (Hb) drop, procedure time, length of hospital stay, uterine weight, pain-medication use, and complications were also extracted. Results: Two hundred and eighty-one patients underwent robotic operations. Types of procedures were total hysterectomy with or without adnexal excision, and total hysterectomies with lymphadenectomies. Eighty-four patients who were classified as morbidly obese (BMI>35) were compared with 197 patients who had a BMI of<35 (nonmorbidly obese). For patients with BMI<35, and BMI>35, the mean BMI was 27.1 and 42.5 kg/m2 (p<0.05), mean age was 49 and 50 (p=0.45), mean total operative time was 222 and 266 minutes (p<0.05), console time 115 and 142 minutes (p<0.05), closing time (from undocking until port-site fascia closure) was 30 and 41 minutes (p<0.05), EBL was 67 and 79 mL (p=0.27), Hb drop was 1.6 and 1.4 (p=0.28), uterine weight was 196.2 and 227 g (p=0.52), pain-medication use 93.7 and 111 mg of morphine (p=0.46), and mean length of stay was 1.42 and 1.43 days (0.9), all respectively. No statistically significant difference was noted between the 2 groups for EBL, Hb drop, LOS, uterine weight, pain-medication use, or complications. The only statistically significant difference was seen in operating times and included docking, console, closing, and procedure times. There were no perioperative mortalities. Morbidity occurred in 24 patients (8%). In the morbidly obese group, there were 6 complications (7%) and, in the nonmorbidly obese group, there were 18 complications (9%). Conclusions: Morbid obesity does not appear to be associated with an increased risk of morbidity in patients undergoing robotically assisted gynecologic surgery. Morbid obesity is associated with increased procedure time, but otherwise appears to have no difference in outcomes. Robotic surgery offered an ideal approach, allowing minimally invasive surgery in these technically challenging patients, with no significant increase in morbidity. © 2014, Mary Ann Liebert, Inc. Source

News Article
Site: http://www.labdesignnews.com/rss-feeds/all/rss.xml/all

Projections released by the U.S. Department of Education paint a bright future for jobs in the science, technology, engineering and mathematics (STEM) fields. As populations grow, natural resources diminish, disease prevention and treatment become more complex and evolutionary and universal mysteries continue to be explored, science and technology will remain critical to expanding human knowledge and solving challenges of today and for the future. Opportunities abound for STEM graduates today, but preparing enough STEM graduates to drive the scientific breakthroughs and technological innovations of tomorrow will be a daunting task for colleges and universities across the country. The U.S. President’s Council of Advisors on Science and Technology predicts that in the next decade, we will need approximately 1 million more STEM professionals than we will produce at our current rate. Currently, about 300,000 graduates obtain Bachelor and Associate degrees in STEM fields every year. In order to create this new workforce of 1 million additional STEM experts, that number needs to increase by 100,000 annually. The challenge is clear: Universities must attract more students to STEM programs. However, once these students have enrolled, another challenge begins to unfold: Only about 40 percent of students who enroll in STEM programs graduate with STEM degrees. The remaining 60 percent switch to non-STEM fields or drop out of college entirely. To address the challenges of attraction and retention, educational institutions throughout the country are trading in traditional teaching methods for new pedagogical techniques. These new methods move beyond a model where students passively listen to lectures and cram for tests, to methods that engage students in activities, enable collaboration across STEM disciplines and encourage students to use their hands just as much as their heads. With these new approaches to learning and teaching come new approaches to designing learning environments. These new spaces are eliminating the stereotypes associated with traditional STEM classrooms and fostering the type of creative brilliance that can help us educate and prepare one million new STEM graduates. Here are three ideas every university should consider when rethinking their STEM learning spaces to better recruit and retain students for the future. Get out of the basement Traditionally, STEM teaching labs and research spaces were located in building cores or basements. These underground “lairs” were uncomfortable and uninviting to students and faculty using these facilities. They featured little to no windows, no natural light and the overall environment felt more institutional than educational. For students that didn’t have a class assigned to these spaces, the labs were relatively unknown, and were considered untouchable and intimidating. Countless studies show the design of classroom environments influence students’ motivation and learning, and universities are seeing the value in encouraging the student body to observe the scientific process to raise curiosity and interest. From a design perspective, we use the term “putting science on display” pretty regularly. The general idea is to place science classrooms and labs in public, high-traffic areas. Instead of solid walls, expansive floor-to-ceiling windows celebrate the sciences and allow passersby the opportunity to observe research and watch it unfold. This helps make science an approachable, open process, and as an added benefit, it gives universities the chance to show off their cool research equipment. The University of Buffalo has embraced this idea with its Clinical Translational Research Center (CTRC). Embedded in the same building as Kaleida Health’s Gates Vascular Institute, the CTRC uses interior glass throughout the building to show science in an open, transparent process. Embrace startup culture A key component of successful STEM programs is experimentation. For example, if you look at the most successful technology startups over the last 10 years, very few started in a formal academic settings. More often than not, they started in garages or coffee shops—places with more sofas than fixed bench space. There’s a lot STEM learning environments can learn from these spaces, specifically in how they encourage free thinking and experimentation. Taking inspiration from startups, our team at CannonDesign is seeing an increase in makerspace, hackerspace and innovation hubs within STEM buildings. These spaces serve a pretty basic purpose: nurturing creativity, encouraging experimentation and stimulating intellectual inquiry in an informal setting. They don’t act exclusively as labs, garages or workshops, but they do include many of the tools found in these space (3-D printers, welding machines, computers, building materials). The Univ. of Utah sees the value in such spaces with their new Lassonde Studios Entrepreneurial building that features a 20,000-sf making/planning/hacking space to foster interdisciplinary and cross-disciplinary “mash-ups” extending beyond STEM disciplines and including others, such as business majors. Infuse appropriate technology into S&T academic environments Millennials and Generation Z grew up in a digital world and expect to take full advantage of technology in every aspect of life, especially college. However, technology hasn’t revolutionized education the way it has other industries. STEM learning environments can be leading examples for how using technology can enhance learning by making it more engaging and accessible. The flipped classroom is a good example of an effective use of technology for enhanced learning. The flipped classroom is a pedagogical model that has students watch video lectures and complete homework prior to class. Doing this creates richer face-to-face interactions when students are actually in class; instead of listening to a lecture, they spend their time asking questions, participating in hands-on activities and even getting involved in real university research efforts. On the most dramatic end of the spectrum, some universities are using virtual reality, simulation and gaming to inspire and educate future STEM innovators. These tools allow students to quite literally take part in technology. For example, CAVE environments, which are rooms wrapped in screens that project 3D virtual environments, allow students to immerse themselves in a setting and actually interact with what they’re seeing. From an infrastructure design standpoint, these technology-rich spaces require a building that provides enhanced server space, room for complex computing platforms, and the power and cooling sources to keep everything up and running. One interesting trend our team is also seeing related to technology is a decrease in dedicated computer labs. Prior to the days of constant connectivity, computer labs acted as the hub of higher education buildings. But today, 90 percent of students own a laptop, 86 percent of students own a smartphone and 47 percent of students own a tablet. The need to access university-owned equipment is dwindling, and the need to plug in personal devices and work anywhere is the new norm. There’s no denying universities need to prove themselves up to the challenge of attracting and retaining the much needed next generation of STEM professionals. How they choose to design their STEM learning environments can play a big role in helping them meet this challenge and exceed current projections. Stephen Blair leads CannonDesign’s global science and technology practice, focused on helping academic and corporate institutions design solutions that turn challenges into opportunities for success. www.cannondesign.com

Hannan E.L.,Albany State University | Samadashvili Z.,Albany State University | Jordan D.,Columbia Presbyterian Medical Center | Sundt T.M.,Massachusetts General Hospital | And 8 more authors.
Circulation: Cardiovascular Interventions | Year: 2015

Background - Several studies have compared short-term and medium-term mortality rates for patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR), but no studies have compared short-term readmission rates for the 2 procedures. Methods and Results - New York's Cardiac Surgery Reporting System was used to propensity match 617 TAVI and 1981 SAVR patients using numerous patient risk factors contained in the registry. The 389 propensity-matched pairs were then used to analyze differences in readmission rates between the 2 groups. TAVI and SAVR readmission rates were also compared for patients with a history of congestive heart failure and for patients aged ≥80. Also, reasons for readmission for TAVI and SAVR patients were examined and compared. Readmission rates were not statistically different for all propensity-matched TAVI and SAVR patients (respective rates, 18.8% and 19.3%; P=0.86). After further adjustment using a logistic regression model, there was still no significant difference (adjusted odds ratio, 0.97; 95% confidence interval [0.68-1.39]). For patients aged ≥80, the 30-day readmission rates were 19.9% and 22.0% (P=0.59), and when further adjusted using the logistic regression model, adjusted odds ratio=0.89 (0.55-1.45). For patients with a history of congestive heart failure, the respective rates were 22.8% and 20.4% (P=0.56), and with further adjustment, adjusted odds ratio became 1.15 (0.72-1.82). Conclusions - There are no statistically significant differences between TAVI and SAVR patients in short-term readmission rates. © 2015 American Heart Association, Inc. Source

Hannan E.L.,Albany State University | Samadashvili Z.,Albany State University | Stamato N.J.,Campbell County Memorial Hospital | Lahey S.J.,University of Connecticut | And 7 more authors.
JACC: Cardiovascular Interventions | Year: 2016

Objectives The purpose of this study was to investigate changes in the use of transcatheter aortic valve replacement (TAVR) relative to surgical aortic valve replacement (SAVR) and to examine relative 1-year TAVR and SAVR outcomes in 2011 to 2012 in a population-based setting. Background TAVR has become a popular option for patients with severe aortic stenosis, particularly for higher-risk patients. Methods New York's Cardiac Surgery Reporting System was used to identify TAVR and SAVR volumes and to propensity match TAVR and SAVR patients using numerous patient risk factors contained in the registry to compare 1-year mortality rates. Mortality rates were also compared for different levels of patient risk. Results The total number of aortic valve replacement patients increased from 2,291 in 2011 to 2,899 in 2012, an increase of 27%. The volume of SAVR patients increased by 7.1% from 1,994 to 2,135 and the volume of TAVR patients increased 157% from 297 to 764. The percentage of SAVR patients that were at higher risk (≥3% New York State [NYS] score, equivalent to a Society of Thoracic Surgeons score of about 8%) decreased from 27% to 23%, and the percentage of TAVR patients that were at higher risk decreased from 83% to 76%. There was no significant difference in 1-year mortality between TAVR and SAVR patients (15.6% vs. 13.1%; hazard ratio [HR]: 1.30 [95% confidence interval (CI): 0.89 to 1.92]). There were no differences among patients with NYS score <3% (12.5% vs. 10.2%; HR: 1.42 [95% CI: 0.68 to 2.97]) or among patients with NYS score ≥3% (17.1% vs. 14.5%; HR: 1.27 [95% CI: 0.81 to 1.98]). Conclusions TAVR has assumed a much larger share of all aortic valve replacements for severe aortic stenosis, and the average level of pre-procedural risk has decreased substantially. There are no differences between 1-year mortality rates for TAVR and SAVR patients. © 2016 by the American College of Cardiology Foundation. Source

Kireyev D.,State University of New York at Buffalo | Ashraf M.H.,Kaleida Health | Wilson M.F.,Kaleida Health
Cardiovascular Journal of Africa | Year: 2012

Papillary fibroelastoma is the third most common type of primary cardiac tumour. Even though the majority of patients with these tumours are asymptomatic, they may present with embolic phenomena, syncope and death. This report describes a patient with papillary fibroelastomas affecting all three cusps of the aortic valve, with accompanying transoesophageal echocardiography and images of surgical specimens of the tumours. Source

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