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Aims The Society of Thoracic Surgeons (STS) National Database collects detailed clinical information on patients undergoing adult cardiac, paediatric and congenital cardiac, and general thoracic surgical operations. These data are used to support risk-adjusted, nationally benchmarked performance assessment and feedback; voluntary public reporting; quality improvement initiatives; guideline development; appropriateness determination; shared decision making; research using cross-sectional and longitudinal registry linkages; comparative effectiveness studies; government collaborations including postmarket surveillance; regulatory compliance and reimbursement strategies. Interventions All database participants receive feedback reports which they may voluntarily share with their hospitals or payers, or publicly report. STS analyses are regularly used as the basis for local, regional and national quality improvement efforts. Population More than 90% of adult cardiac programmes in the USA participate, as do the majority of paediatric cardiac programmes, and general thoracic participation continues to increase. Since the inception of the Database in 1989, more than 5 million patient records have been submitted. Baseline data Each of the three subspecialty databases includes several hundred variables that characterise patient demographics, diagnosis, medical history, clinical risk factors and urgency of presentation, operative details and postoperative course including adverse outcomes. Data capture Data are entered by trained data abstractors and by the care team, using detailed data specifications for each element. Data quality Quality and consistency checks assure accurate and complete data, missing data are rare, and audits are performed annually of selected participant sites. Endpoints All major outcomes are reported including complications, status at discharge and mortality. Data access Applications for STS Database participants to use aggregate national data for research are available at http://www.sts.org/quality-research-patient-safety/research/publications-and-research/access-data-sts-national-database.

A large PCI registry and a large CABG registry were linked to claims records, with data adjusted for propensity score, to compare clinical outcomes. Patients selected for CABG had a long-term survival advantage over those selected for PCI. The strategies of percutaneous coronary intervention (PCI) and coronary-artery bypass grafting (CABG) for revascularization have been compared in randomized clinical trials. 1 , 2 Although the best way to control for treatment-selection bias is to conduct a randomized trial, such trials often have limited power to evaluate subgroups, and the results may not be generalizable, since patients and centers are often highly selected. Nonrandomized, observational data from clinical databases can complement data from clinical trials, because observational data, if they are from a larger and more representative population, may better reflect real-world practice. The American College of Cardiology Foundation (ACCF) and the . . .

Ralph Lemon (born 1952) is one of the most significant figures to emerge from New Yorks downtown dance and performance world in the past 40 years. A polymath and shape-shifter, Lemon combines dance and theater with drawing, film, writing and ethnography in works presented on the stage, in publications and in museums. He builds his politically resonant and deeply personal projects in collaboration with dance makers and artists from New York, West Africa, South and East Asia, and the American South. Lemon, who was born in Cincinnati and raised in Minneapolis, describes his explorations as a \"search for the forms of formlessness.\" Absorbing and transmuting fractured mythologies, social history and dance techniques from multiple geographies and decades, Lemons genre-transcending works perform an alchemy of past and present, reality and fantasy. This book, the first monograph on the artist, features a wide range of texts by scholars and performers, an original photo essay by Lemon and an extensive chronology.

Heart valve diseases are increasingly prevalent, especially in people older than age seventy. Many of these elderly people have other comorbid conditions, making them poor candidates for surgical treatment of heart valve diseases. Since 2011 such patients have been eligible to receive new nonsurgical heart valve treatments approved by the Food and Drug Administration (FDA) and covered by Medicare. This article examines the Transcatheter Valve Therapy Registry, which captures clinical information on all US patients undergoing new nonsurgical heart valve treatments. The registry has patient-level data from more than 27,000 patients treated with the novel devices. Patient- and procedure-related data are gathered from hospitals, patient-reported outcomes are assessed pre- and postprocedure, and longer-term data on mortality and repeat hospitalization are provided by linking the registry's data to Medicare patient data. The registry is a model of collaboration among professional societies, the FDA, the Centers for Medicare and Medicaid Services, hospitals, patients, and the medical device industry. It has been used to support Medicare coverage decisions, expand device indications, provide comprehensive device surveillance, and establish national quality benchmarks. Beyond having it serve as a collaborative model, future goals for the registry include shortening the FDA-approval timeline for devices, providing data for decision-making tools for patients, and public reporting of hospital performance.

As an intelligence officer during the Vietnam War, Fred L. Edwards, Jr., was instructed to visit every major ground unit in the country to search for intelligence sources—long range patrols, boats, electronic surveillance, and agent operations. “Edwards found time to keep a journal, an extremely well-written, sharply observed report of his adventures. Along with contemporary postscripts and a helpful historical chronology, that journal is a significant improvement on most Vietnam memoirs. It is the record of a Marine’s on-the-job education.”—Proceedings

Seeds of Success (SOS) is a national seed collection program led by the Bureau of Land Management. SOS represents the most comprehensive native seed repository in the United States, supporting native plant restoration, management, and research. Since inception in 2000, SOS has collected seeds from over 24,400 native plant populations from ~5,600 taxa from 43 states. Collections include species important to wildlife, pollinators, and indigenous people, and over 10,000 collections have been shared for restoration and research use. We asked how many SOS sites have burned since collection, and identified 662 fires at 631 sites. If fire continues at the pace observed since 2011, an estimated 14% of collection sites will burn by 2050 and over 24% by 2080, putting genetic diversity at risk in areas where fire is linked with invasion. Analysis of 14 native forb species from the western United States found that many collections were from the warmest and driest portions of their range, areas at the highest risk of wildfire, subsequent invasion, and local extinction. SOS provides an opportunity to understand change in natural populations, and represents a critical repository of native plant genetic resources for conservation and future use.

This review discusses the historical aspects, current state of the art, and potential future advances in the areas of nomenclature and databases for the analysis of outcomes of treatments for patients with congenitally malformed hearts. We will consider the current state of analysis of outcomes, lay out some principles which might make it possible to achieve life-long monitoring and follow-up using our databases, and describe the next steps those involved in the care of these patients need to take in order to achieve these objectives. In order to perform meaningful multi-institutional analyses, we suggest that any database must incorporate the following six essential elements: use of a common language and nomenclature, use of an established uniform core dataset for collection of information, incorporation of a mechanism of evaluating case complexity, availability of a mechanism to assure and verify the completeness and accuracy of the data collected, collaboration between medical and surgical subspecialties, and standardised protocols for life-long follow-up. During the 1990s, both The European Association for Cardio-Thoracic Surgery and The Society of Thoracic Surgeons created databases to assess the outcomes of congenital cardiac surgery. Beginning in 1998, these two organizations collaborated to create the International Congenital Heart Surgery Nomenclature and Database Project. By 2000, a common nomenclature, along with a common core minimal dataset, were adopted by The European Association for Cardio-Thoracic Surgery and The Society of Thoracic Surgeons, and published in the Annals of Thoracic Surgery. In 2000, The International Nomenclature Committee for Pediatric and Congenital Heart Disease was established. This committee eventually evolved into the International Society for Nomenclature of Paediatric and Congenital Heart Disease. The working component of this international nomenclature society has been The International Working Group for Mapping and Coding of Nomenclatures for Paediatric and Congenital Heart Disease, also known as the Nomenclature Working Group. By 2005, the Nomenclature Working Group crossmapped the nomenclature of the International Congenital Heart Surgery Nomenclature and Database Project of The European Association for Cardio-Thoracic Surgery and The Society of Thoracic Surgeons with the European Paediatric Cardiac Code of the Association for European Paediatric Cardiology, and therefore created the International Paediatric and Congenital Cardiac Code, which is available for free download from the internet at [http://www.IPCCC.NET]. This common nomenclature, the International Paediatric and Congenital Cardiac Code, and the common minimum database data set created by the International Congenital Heart Surgery Nomenclature and Database Project, are now utilized by both The European Association for Cardio-Thoracic Surgery and The Society of Thoracic Surgeons. Between 1998 and 2007 inclusive, this nomenclature and database was used by both of these two organizations to analyze outcomes of over 150,000 operations involving patients undergoing surgical treatment for congenital cardiac disease. Two major multi-institutional efforts that have attempted to measure the complexity of congenital heart surgery are the Risk Adjustment in Congenital Heart Surgery-1 system, and the Aristotle Complexity Score. Current efforts to unify the Risk Adjustment in Congenital Heart Surgery-1 system and the Aristotle Complexity Score are in their early stages, but encouraging. Collaborative efforts involving The European Association for Cardio-Thoracic Surgery and The Society of Thoracic Surgeons are under way to develop mechanisms to verify the completeness and accuracy of the data in the databases. Under the leadership of The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease, further collaborative efforts are ongoing between congenital and paediatric cardiac surgeons and other subspecialties, including paediatric cardiac anaesthesiologists, via The Congenital Cardiac Anesthesia Society, paediatric cardiac intensivists, via The Pediatric Cardiac Intensive Care Society, and paediatric cardiologists, via the Joint Council on Congenital Heart Disease and The Association for European Paediatric Cardiology. In finalising our review, we emphasise that analysis of outcomes must move beyond mortality, and encompass longer term follow-up, including cardiac and non cardiac morbidities, and importantly, those morbidities impacting health related quality of life. Methodologies must be implemented in these databases to allow uniform, protocol driven, and meaningful, long term follow-up.