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Background Prior research has established some risk factors for an increased risk of severe disease and mortality from coronavirus disease 2019 (COVID-19). However, the impact of HIV infection on SARS-CoV-2 susceptibility and severity is a significant gap in the literature. In the same way, not many studies across the globe have analyzed the degree of vaccination willingness among people living with HIV/AIDS (PLWHA) and considerations regarding prioritizing this population during vaccination plans, particularly in developing countries. Methods A descriptive-analytical cross-sectional study was conducted. Self-completed electronic surveys directed to PLWHA were performed via Twitter in February 2021, using accounts of HIV activists. Results 460 (87.1%) participants were willing to be vaccinated with any COVID-19 vaccine. The reasons for that were listed as 1) the belief that vaccination prevents both the COVID-19 infection (81.3%) as well as being a spreader (52.2%); 2) having a high occupational risk of becoming infected with COVID-19 (22%); and 3) the belief that they would be at high risk of death because of COVID-19 (21.3%). Only 56 (10.6%) participants expressed hesitancy toward vaccination, and 12 (2.2%) stated they did not want to get vaccinated. Conclusions Our results may support the prioritization of people living with HIV during the implementation of vaccination plans in developing countries. New strategies should be adopted to overcome the hesitancy and unwillingness toward the COVID-19 vaccination, especially in populations with risk factors for severe disease.

Ongoing inputs, in the form of sediment deposition along with associated dissolved contaminants, have challenged the assessment of cap performance at contaminated sediment sites. To address this issue, thin 2–3 cm layer sand caps amended with activated carbon (AC) were investigated for the remediation of polychlorinated biphenyl (PCB) contaminated marine sediments using 90-day mesocosms. All treatments were challenged with (1) ongoing clean or marker-PCB-spiked sediment inputs and (2) bioturbation. Bioaccumulation in hard clams (filter feeding near the cap-water interface) was evaluated to best understand cap effectiveness, relative to sheepshead minnows (confined to the surface water) and sandworms (which burrowed through the caps). All caps (sand and AC amended sand) provided isolation of native bedded PCBs (i.e., PCBs sourced from the bed), reducing uptake in organisms. Total PCB bioaccumulation in clams indicated that AC addition to the cap provided no benefit with spiked influx, or some benefit (56% reduction) with clean influx. Spiked input PCBs, when added to the depositional input sediment, were consistently detected in clams and passive samplers, with and without AC in the cap. PCB uptake by passive samplers located in the caps did not reflect the performance of the remedy, as defined by clam bioaccumulation. However, PCB uptake by passive samplers in the overlying water reasonably represented clam bioaccumulation results.

Background & aims. Frailty syndrome, characterized by loss of functional reserves and vulnerability to acute stressors, conditionate a higher risk of adverse outcomes and mortality. Its prevalence is mainly high (65%) in patients with End Stage Kidney Disease, receiving renal replacement therapy. Methods. Cross-sectional study with a non-probabilistic sampling of adult patients with chronic kidney disease stage 5 that initiated renal replacement therapy at a dialysis centre from Santander, Colombia. The main objective was to estimate the prevalence of frailty syndrome and to describe the clinical and functional characteristics of the studied population. The frailty syndrome was defined through the FRAIL Questionnaire. Results. Sixty-six subjects were included. The median age was 65 years (IQR 58-69). 54.55% were frail. The median age in frail patients was higher than the one in non-frail (p = 0.019). The prevalence of frailty syndrome was higher in women than in men (p = 0.045). Frail patients had a higher Charlson comorbidity index (p =< 0.01). The mean serum creatinine, parathyroid hormone (PTH), and albumin were lower in frail patients, with statistically significant differences. Conclusions. The prevalence of frailty in patients that initiate renal replacement therapy in Santander, Colombia, is similar to that reported in other latitudes. Although the FRAIL Scale is based on the self-report, it counts with studies that endorse its reproductivity. Albumin and creatinine serum levels are decreased in subjects with frailty syndrome, behaving as frailty biomarkers in our research.

Much management and leadership development provision for healthcare professionals has been the subject of considerable criticism, and there have been numerous calls for training programmes explicitly focused on the specific managerial (manager/leader) behaviours healthcare managers, physician leaders and nurse managers need to exhibit to be perceived effective. The aim of our multiple cross-case/cross-nation comparative study has been to: i) identify similarities and differences between the findings of published qualitative critical incident studies of effective and ineffective managerial behaviour observed within British, Egyptian, Mexican and Romanian public hospitals, respectively, and ii) if possible, deduce from the identified commonalities a healthcare-related behavioural model of perceived managerial and leadership effectiveness. Adopting a philosophical stance informed by pragmatism, epistemological instrumentalism and abduction, we used realist qualitative analytic methods to code and classify into a maximum number of discrete behavioural categories empirical source data obtained from five previous studies. We found high degrees of empirical generalization which resulted in the identification of five positive ( effective) and four negative ( ineffective) behavioural dimensions (BDs) derived, respectively, from 14 positive and 9 negative deduced behavioural categories (BCs). These BDs and underpinning BCs are expressed in the form of an emergent two-factor universalistic behavioural model of perceived managerial and leadership effectiveness. We suggest the model could be used to critically evaluate the relevance and appropriateness of existing training provision for physician leaders, nurse managers and other healthcare managers/leaders in public hospitals or to design new explicit training programmes informed and shaped by healthcare-specific management research, as called for in the literature.

Accepted version

Transcatheter therapies to treat tricuspid regurgitation are being developed, but few have attempted the gold standard of surgical repair: ring annuloplasty. We describe the first-ever fully percutaneous implantation of a circumferential, semirigid annuloplasty ring to treat massive secondary tricuspid regurgitation. (Level of Difficulty: Advanced.), Central Illustration

A virtual aortic annular plane that is built using the three hinge points, known as the hinge point-based annular plane (HPAP), is routinely used during transcatheter aortic valve replacement (TAVR). Abnormal aortic cusps (AAC) with unequal length and size influence the relationship of the HPAP to the aortic root axis significantly and pose challenges to valve deployment, leading to paravalvular leak and valve embolisation. Obtaining a centreline-based aortic annular plane in addition may help to understand valve deployment behaviour in AAC better.

Summary Background Randomised trial data assessing the safety and efficacy of the self-expanding intra-annular Portico transcatheter aortic valve system (Abbott Structural Heart, St Paul, MN, USA) compared with any commercially available valves are needed to compare performance among designs. Methods In this prospective, multicentre, non-inferiority, randomised controlled trial (the Portico Re-sheathable Transcatheter Aortic Valve System US Investigational Device Exemption trial [PORTICO IDE]), high and extreme risk patients with severe symptomatic aortic stenosis were recruited from 52 medical centres experienced in performing transcatheter aortic valve replacement in the USA and Australia. Patients were eligible if they were aged 21 years or older, in New York Heart Association functional class II or higher, and had severe native aortic stenosis. Eligible patients were randomly assigned (1:1) using permuted block randomisation (block sizes of 2 and 4) and stratified by clinical investigational site, surgical risk cohort, and vascular access method, to transcatheter aortic valve replacement with the first generation Portico valve and delivery system or a commercially available valve (either an intra-annular balloon-expandable Edwards-SAPIEN, SAPIEN XT, or SAPIEN 3 valve [Edwards LifeSciences, Irvine, CA, USA]; or a supra-annular self-expanding CoreValve, Evolut-R, or Evolut-PRO valve [Medtronic, Minneapolis, MN, USA]). Investigational site staff, implanting physician, and study participant were unmasked to treatment assignment. Core laboratories and clinical event assessors were masked to treatment allocation. The primary safety endpoint was a composite of all-cause mortality, disabling stroke, life-threatening bleeding requiring transfusion, acute kidney injury requiring dialysis, or major vascular complication at 30 days. The primary efficacy endpoint was all-cause mortality or disabling stroke at 1 year. Clinical outcomes and valve performance were assessed up to 2 years after the procedure. Primary analyses were by intention to treat and the Kaplan-Meier method to estimate event rates. The non-inferiority margin was 8·5% for primary safety and 8·0% for primary efficacy endpoints. This study is registered with ClinicalTrials.gov, NCT02000115, and is ongoing. Findings Between May 30 and Sept 12, 2014, and between Aug 21, 2015, and Oct 10, 2017, with recruitment paused for 11 months by the funder, we recruited 1034 patients, of whom 750 were eligible and randomly assigned to the Portico valve group (n=381) or commercially available valve group (n=369). Mean age was 83 years (SD 7) and 395 (52·7%) patients were female. For the primary safety endpoint at 30 days, the event rate was higher in the Portico valve group than in the commercial valve group (52 [13·8%] vs 35 [9·6%]; absolute difference 4·2, 95% CI −0·4 to 8·8 [upper confidence bound {UCB} 8·1%]; pnon-inferiority=0·034, psuperiority=0·071). At 1 year, the rates of the primary efficacy endpoint were similar between the groups (55 [14·8%] in the Portico group vs 48 [13·4%] in the commercial valve group; difference 1·5%, 95% CI −3·6 to 6·5 [UCB 5·7%]; pnon-inferiority=0·0058, psuperiority=0·50). At 2 years, rates of death (80 [22·3%] vs 70 [20·2%]; p=0·40) or disabling stroke (10 [3·1%] vs 16 [5·0%]; p=0·23) were similar between groups. Interpretation The Portico valve was associated with similar rates of death or disabling stroke at 2 years compared with commercial valves, but was associated with higher rates of the primary composite safety endpoint including death at 30 days. The first-generation Portico valve and delivery system did not offer advantages over other commercially available valves. Funding Abbott.

Graphical abstract, Highlights • Echo fusion overlays echocardiographic cardiac structures over fluoroscopy. • Echo fusion provides “real-time” feedback during complicated percutaneous procedures. • Echo fusion and 3D TEE imaging can be used to localize PVLs and guide intervention.

Background The Harmonization By Doing (HBD) program was established in 2003 as a partnership among stakeholders of academia, industry and regulatory agencies in Japan and the United States, with a primary focus on streamlining processes of global medical device development for cardiovascular medical devices. While HBD has traditionally focused on development of devices intended to treat conditions prevalent in adults, in 2016, HBD established the "HBD-for-Children" program, which focuses on the development of pediatric devices as the development of medical devices for pediatric use lags behind that of medical devices for adults in both countries.Methods and Results:Activities of the program have included: (1) conducting a survey with industry to better understand the challenges that constrain the development of pediatric medical devices; (2) categorizing pediatric medical devices into five categories based on global availability and exploring concrete solutions for the early application and regulatory approval in both geographies; and (3) facilitating global clinical trials of pediatric medical devices in both countries. Conclusions The establishment of the HBD-for-Children program is significant because it represents a global initiative for the introduction of pediatric medical devices for patients in a timely manner. Through the program, academia, industry and regulatory agencies can work together to facilitate innovative pediatric device development from a multi-stakeholder perspective. This activity could also encourage industry partners to pursue the development of pediatric medical devices.

The association between leadership effectiveness and successful marketing efforts has been a somewhat popular area of research in business. Some studies have also investigated if those relationships hold in different regions across the world. This manuscript proposes an empirical study of the relationship between leadership effectiveness and marketing in Latin America, a region that lacks strong academic business research.

A 72 year old female with a past medical history of bicuspid aortic valve with severe aortic regurgitation status post placement of a 21 mm Magna Ease aortic valve replacement on 6/1/16, chronic atrial fibrillation, diabetes mellitus, and severe mitral regurgitation presented with symptoms of dyspnea upon exertion. Transesophageal echocardiogram (TEE) showed normal left ventricular function with severe mitral regurgitation, severe tricuspid regurgitation and severe pulmonary hypertension. Upon close interrogation of the tricuspid valve, there was evidence of fusion with a raphe present between the septal and anterior leaflets ("a bicuspid" tricuspid valve). The patient was referred for surgical evaluation where she was deemed to be at increased surgical risk and referred for percutaneous treatment for both severe mitral and severe tricuspid regurgitation. After an uncomplicated transseptal puncture, she underwent a placement of a single MitraClip XT clip to the A2/P2 portions of the mitral valve leaflets leaving mild residual mitral regurgitation by color Doppler. Attention was then taken towards the tricuspid valve where using TEE guidance, a MitraClip XT was positioned over the central aspect of the "bicuspid" tricuspid valve with the opened clip arms perpendicular leaflet coaptation. The MitraClip XT was advanced into the right ventricle and slowly retracted to grab both TV leaflets. There was mild, residual tricuspid regurgitation by color Doppler. The mean gradient across the tricuspid valve was 1 mmHg obtained at a heart rate of 52 bpm. This case describes the first known percutaneous treatment of severe tricuspid regurgitation from a "bicuspid" tricuspid valve with a MitraClip device. Abstract 1637 Figure.

The VARC (Valve Academic Research Consortium) for transcatheter aortic valve replacement set the standard for selecting appropriate clinical endpoints reflecting safety and effectiveness of transcatheter devices, and defining single and composite clinical endpoints for clinical trials. No such standardization exists for circumferentially sutured surgical valve paravalvular leak (PVL) closure. This document seeks to provide core principles, appropriate clinical endpoints, and endpoint definitions to be used in clinical trials of PVL closure devices. The PVL Academic Research Consortium met to review evidence and make recommendations for assessment of disease severity, data collection, and updated endpoint definitions. A 5-class grading scheme to evaluate PVL was developed in concordance with VARC recommendations. Unresolved issues in the field are outlined. The current PVL Academic Research Consortium provides recommendations for assessment of disease severity, data collection, and endpoint definitions. Future research in the field is warranted.

Subclinical leaflet thrombosis was recently described in a randomized trial of transcatheter aortic valve replacement. It was subsequently demonstrated in a series of registries that this was a commonly observed imaging finding seen in all transcatheter and surgical bioprostheses. The phenomenon has aroused considerable interest due to the as-yet-undefined risk for later clinical events and the possibility of pharmacological intervention with anticoagulation. Subclinical leaflet thrombosis is easily detected noninvasively by technically suitable computed tomography (CT) with a high degree of concordance to transesophageal echocardiography findings. The CT hallmarks were noted to be hypoattenuated leaflet thickening (HALT) associated with reduced leaflet motion (RELM). The combination of HALT and RELM signified hypoattenuation affecting motion, the standardized imaging endpoint used. This paper describes the systematic CT evaluation methodology that was devised during the Portico trial investigation and U.S. Food and Drug Administration submission; it also highlights the need for an ongoing discussion among experts to enable, with the help of the Valve Academic Research Consortium, standardization of reporting of this imaging finding to cater to the present and future needs of clinical trials.

OBJECTIVES To describe the feasibility and safety of the Hopscotch Technique, a novel method to close paravalvular leaks. BACKGROUND Successful closure of paravalvular leaks requires the complete seal of irregular defects, frequently interrupted by remaining sutures or tissue that converts a large defect into a complex series of contiguous smaller defects. Successful treatment with devices placed in a single space is impossible with constrained appearance and significant residual leak; therefore, new techniques to deploy smaller devices in the correct location are needed. METHODS We retrospective analyzed all the patients with mitral PVLs undergoing percutaneous closure with the Hopscotch technique from November 2011 to January 2016. RESULTS Sixteen procedures were performed in 15 patients (median age 66-year-old, 67% male, STS 3.9%), most of them with biological prostheses (73%). Mean PVL size was 12.5 mm located in the lateral position. Percutaneous transapical access was the final approach in nine procedures and success of the procedure was achieved in 12. Usually, the technique was performed by 1 Hopscotch crossing/jump; however, complex procedures requiring 2 or 3 crossings were utilized in 4 patients, even possible between aortic and mitral leaks along the aortic-mitral continuity. Residual mitral paravalvular regurgitation of ≤mild was achieved in 93% of procedures. CONCLUSIONS The Hopscotch technique is feasible and safety for patients with mitral paravalvular leak when boundaries prevent full device expansion. © 2017 Wiley Periodicals, Inc.

Acute circulatory collapse may rarely occur during transcatheter aortic valve implantation (TAVI). In such cases, immediate mechanical circulatory support (MCS) as a bridge to remedial interventions may be required. To define the rate of MCS utilization in TAVI patients and identify the predictors of MCS utilization in a cohort of TAVI patients. TAVI patients between January 2012 and September 2015 were identified in the National Inpatient Sample (NIS) by using the International Classification of Diseases, 9th Revision. Trend weights were used to generate the national estimates of MCS rate in TAVI. Multivariate regression analysis was done to identify predictors of MCS use. A total 60,985 patients underwent TAVI with 1,695 patients receiving MCS (2.8%) during index hospitalization. The most common type of MCS was intra-aortic balloon pump in 52%, followed by extra corporeal membrane oxygenator in 34%, then percutaneous ventricular assist device in 7.4%. Rate of MCS use declined over the study period from 3% in 2012 (Q1) to 1.8% in 2015 (Q3). The use of MCS during TAVI was associated with 10-fold increase in-hospital mortality (27.1% vs 2.8%, p0.001). Predictors of MCS were congestive heart failure (OR = 2.58, p0.001), transapical access (OR = 1.92, p0.001), respiratory complication (OR = 5.19, p0.001), acute myocardial infarction (OR = 4.21, p0.001), cardiac arrest (OR = 10.65, p0.001), and cardiogenic shock (OR = 19.09, p0.001). In conclusion, the rate of MCS during TAVI hospitalization in the United States declined between 2012 and 2015. MCS during TAVI was associated with a 10-fold increase in in-hospital mortality.

During the introduction of transcatheter aortic-valve replacement (TAVR) in the United States, requirements regarding procedural volume were mandated by the Centers for Medicare and Medicaid Services as a condition of reimbursement. A better understanding of the relationship between hospital volume of TAVR procedures and patient outcomes could inform policy decisions.We analyzed data from the Transcatheter Valve Therapy Registry regarding procedural volumes and outcomes from 2015 through 2017. The primary analyses examined the association between hospital procedural volume as a continuous variable and risk-adjusted mortality at 30 days after transfemoral TAVR. Secondary analysis included risk-adjusted mortality according to quartile of hospital procedural volume. A sensitivity analysis was performed after exclusion of the first 12 months of transfemoral TAVR procedures at each hospital.Of 113,662 TAVR procedures performed at 555 hospitals by 2960 operators, 96,256 (84.7%) involved a transfemoral approach. There was a significant inverse association between annualized volume of transfemoral TAVR procedures and mortality. Adjusted 30-day mortality was higher and more variable at hospitals in the lowest-volume quartile (3.19%; 95% confidence interval [CI], 2.78 to 3.67) than at hospitals in the highest-volume quartile (2.66%; 95% CI, 2.48 to 2.85) (odds ratio, 1.21; P = 0.02). The difference in adjusted mortality between a mean annualized volume of 27 procedures in the lowest-volume quartile and 143 procedures in the highest-volume quartile was a relative reduction of 19.45% (95% CI, 8.63 to 30.26). After the exclusion of the first 12 months of TAVR procedures at each hospital, 30-day mortality remained higher in the lowest-volume quartile than in the highest-volume quartile (3.10% vs. 2.61%; odds ratio, 1.19; 95% CI, 1.01 to 1.40).An inverse volume-mortality association was observed for transfemoral TAVR procedures from 2015 through 2017. Mortality at 30 days was higher and more variable at hospitals with a low procedural volume than at hospitals with a high procedural volume. (Funded by the American College of Cardiology Foundation National Cardiovascular Data Registry and the Society of Thoracic Surgeons.).

Transcatheter interventions for congenital heart disease can be challenging and require not only the understanding of anatomy but a working knowledge of modern imaging modalities. Fluoroscopy has poor characterization of non-radiopaque structures and has limitations in providing three-dimensional (3D) spatial information. Similarly, echocardiography by itself has limitations in detecting the position of the catheters and wires. Additionally, the orientation of the images from various imaging modalities can be different which poses an added challenge to the operator. A real-time integration of the imaging modalities with 3D information and live fluoroscopy provides a rapid recognition and orientation of the cardiac structures during percutaneous interventions. It can also improve the communication between various members for the team while performing the procedure.

The purpose of this empirical study was to explore the perceptions of Argentinean managers and non-managerial employees about managerial and leadership effectiveness, and the extent to which the findings are generalized to other countries. The central research question addressed was as follows: How do people employed in Argentinean companies behaviourally distinguish effective managers from ineffective managers, and to what extent are the findings culture-specific or context-general? A total of 42 employees from private and public sector organizations in Cordoba, Argentina, were interviewed using critical incident technique. The interviews generated 302 critical incidents of which 155 were examples of positive (effective) managerial behaviour, and 147 of negative (ineffective) managerial behaviour. The findings suggest that Argentineans perceive as effective those managers who are supportive, considerate, motivating, caring, good decision makers, approachable, participative, fair-minded, communicative, ac...

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 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.

We describe a novel robotically assisted minimally invasive surgical technique for repair of partial anomalous pulmonary vein connection (PAPVC). Partial anomalous pulmonary vein connection is a rare congenital anomaly that consists in drainage of one or more pulmonary veins into the systemic venous system. Traditionally, large thoracotomy incision and sometimes establishment of cardiopulmonary bypass are needed to redirect the abnormal pulmonary vein to the left-sided reservoir. We describe a robotically assisted, minimally invasive, off-pump technique for the treatment of the left PAPVC in a 57-year-old patient with signs of progressive right ventricular dilatation. The Da Vinci robot was used for mediastinal dissection and isolation of the distal aspect of the left superior anomalous pulmonary vein from the brachiocephalic vein. Through a left minithoracotomy, under direct vision, the pulmonary vein was reanastomosed to the left atrial appendage, thus reconstituting a normal venous return pattern. The use of the da Vinci robot is a valid adjunct for correction of the left PAPVC. It helps mediastinal dissection and allows reconnection of the pulmonary vein to the left venous system via a small thoracotomic incision and without the use of cardiopulmonary bypass.

An 86-year-old woman presented with New York Heart Association functional class III symptoms and a large mitral valve prolapse involving the P2 and P3 segments (white arrows, [Figure 1A][1]) with severe mitral regurgitation. A MitraClip (Abbott Vascular, Santa Clara, California) was placed at the

BackgroundA finding of reduced aortic-valve leaflet motion was noted on computed tomography (CT) in a patient who had a stroke after transcatheter aortic-valve replacement (TAVR) during an ongoing clinical trial. This finding raised a concern about possible subclinical leaflet thrombosis and prompted further investigation. MethodsWe analyzed data obtained from 55 patients in a clinical trial of TAVR and from two single-center registries that included 132 patients who were undergoing either TAVR or surgical aortic-valve bioprosthesis implantation. We obtained four-dimensional, volume-rendered CT scans along with data on anticoagulation and clinical outcomes (including strokes and transient ischemic attacks [TIAs]). ResultsReduced leaflet motion was noted on CT in 22 of 55 patients (40%) in the clinical trial and in 17 of 132 patients (13%) in the two registries. Reduced leaflet motion was detected among patients with multiple bioprosthesis types, including transcatheter and surgical bioprostheses. Therapeu...

Omentin-1 is an adipocytokine with anti-inflammatory activity that has been associated with different metabolic disorders. The aim of this study is to investigate the serum profiles of omentin-1 throughout human and rat pregnancy. Serum omentin-1 levels were determined by ELISA in a prospective cohort study of healthy pregnant women (n=40) during the three trimesters of pregnancy and in twenty healthy non-pregnant women during the follicular and luteal phase of the menstrual cycle. In addition, serum omentin-1 levels were measured in rats during different periods of pregnancy (gestational days 8, 12, 16, 19, and 21) and in an age-matched control (virgin) group of rats (n=12rats/group). Finally, immunohistochemistry was used to demonstrate the presence of omentin-1 protein in human and rat placenta. Omentin-1 immunoreactivity was detected in cytotrophoblasts, syncytiotrophoblasts, sparse Hofbauer cells, and endothelial cells of the stem villi of human placenta. Additionally, it was detected in the labyrinthine trophoblast and yolk sac layer of the rat placenta. Human and rat serum omentin-1 levels were significantly lower in the late gestational period when compared with the non-pregnant women and virgin rats (p0.05). Serum omentin-1 changes were not significant throughout the gestation in both species (p0.05). Human serum omentin-1 levels have an inverse relationship with triglyceride levels during pregnancy. Our findings have not determined the exact role of omentin-1 during pregnancy, concerning the metabolic control of triglycerides and other energy sources. Whether omentin-1 decrease implies a regulatory function is still not clear. Further studies are needed to address this issue and determine the role of omentin-1 in metabolic adaptations during normal human and rat pregnancy.

Purpose – The purpose of this study was to identify what Colombians perceive as effective and least effective/ineffective managerial behavior. Design/methodology/approach – This study was conducted following a qualitative methodology based on the philosophical assumptions of pragmatism and the “pragmatic approach” (Morgan, 2007). The critical incident technique was used to generate data from a purposive sample of 27 managers and non-managerial employees located in Medellin and Bogota, Colombia. Findings – The results of this study suggest that effective managers in Colombia are those who are supportive, caring, considerate, participative, understanding, communicative and flexible, and are also good problem solvers. Research limitations/implications – This study focused on the perceptions of Colombian managers and non-managerial employees only. Therefore, the description of effective and least effective/ineffective managers in Colombia could be highly value-laden from the national cultural perspective. Hence, it is recommended that further research should be carried out to explore the perceptions of international managers who have frequently interacted or worked with Colombian managers. Originality/value – The results of this study have practical implications for Colombian managers and international managers who manage the Colombian workforce. For Colombian managers, this study provides insight into what is considered effective or least effective/ineffective managerial and leadership behavior. The findings provide useful information on foreign multinational corporations (MNCs) that have operations in Colombia. MNCs can use the results of this study to create effective management development models for their expatriates in Colombia.

Background Significant paravalvular leak (PVL) after surgical valve replacement can result in intractable congestive heart failure and hemolytic anemia. Because repeat surgery is performed in only few patients, transcatheter reduction of PVL is emerging as an alternative option, but its safety and efficacy remain uncertain. In this study we sought to assess whether a successful transcatheter PVL reduction is associated with an improvement in clinical outcomes. Methods We identified 12 clinical studies that compared successful and failed transcatheter PVL reductions in a total of 362 patients. A Bayesian hierarchical meta-analysis was performed using cardiac mortality as a primary end point. The combined occurrence of improvement in New York Heart Association functional class or hemolytic anemia and the need for repeat surgery, were used as secondary end points. Results A successful transcatheter PVL reduction was associated with a lower cardiac mortality rate (odds ratio [OR], 0.08; 95% credible interval [CrI], 0.01-0.90) and with a superior improvement in functional class or hemolytic anemia, compared with a failed intervention (OR, 9.95; 95% CrI, 2.10-66.73). Fewer repeat surgeries were also observed after successful procedures (OR, 0.08; 95% CrI, 0.01-0.40). Conclusions A successful transcatheter PVL reduction is associated with reduced all-cause mortality and improved functional class in patients deemed unsuitable for surgical correction.

THE FOLLOWING iFORUM DEBATE FEATURES 3 VIEWPOINTS related to the most practical and effective imaging strategy for guiding transcatheter aortic valve replacement (TAVR). Kronzon, et al. provide evidence that enhanced analysis of abrtic valve anatomy and improved appreciation of complications mandate the use of transesophageal echocardiography as front-Line imaging modality for ALL patients undergoing TAVR. On the other hand, Saric and colleagues compare and contrast the approach of performing TAVR under transthoracic guidance. Lastly, Kasel and co-workers provide preliminary evidence that TAVR could be performed under fluoroscopic guidance without the need for additional imaging technique. Although the use of Less-intensive sedation or anesthesia might reduce the procedural time, we need more randomized data to establish the most cost-effective approach in guiding TAVR.