OBJECTIVES: To develop predictive models for death or neurodevelopmental impairment (NDI) after neonatal hypoxic-ischemic encephalopathy (HIE) from data readily available at the time of NICU admission (“early”) or discharge (“cumulative”). METHODS: In this retrospective cohort analysis, we used data from the Children’s Hospitals Neonatal Consortium Database (2010–2016). Infants born at ≥35 weeks’ gestation and treated with therapeutic hypothermia for HIE at 11 participating sites were included; infants without Bayley Scales of Infant Development scores documented after 11 months of age were excluded. The primary outcome was death or NDI. Multivariable models were generated with 80% of the cohort; validation was performed in the remaining 20%. RESULTS: The primary outcome occurred in 242 of 486 infants; 180 died and 62 infants surviving to follow-up had NDI. HIE severity, epinephrine administration in the delivery room, and respiratory support and fraction of inspired oxygen of 0.21 at admission were significant in the early model. Severity of EEG findings was combined with HIE severity for the cumulative model, and additional significant variables included the use of steroids for blood pressure management and significant brain injury on MRI. Discovery models revealed areas under the curve of 0.852 for the early model and of 0.861 for the cumulative model, and both models performed well in the validation cohort (goodness-of-fit χ2: P = .24 and .06, respectively). CONCLUSIONS: Establishing reliable predictive models will enable clinicians to more accurately evaluate HIE severity and may allow for more targeted early therapies for those at highest risk of death or NDI.

African American and Hispanic students receive more punitive school discipline than White students even when students of color commit similar infractions as Whites. Similarly, students with a disability status are more likely to experience harsher discipline in schools compared to their counterparts without a disability label. This study examines whether these discrepancies are a result of a difference in the number of infractions students of different racial/ethnic groups and disability categories commit. Using secondary educational data from a state educational agency in the United States, we demonstrate that African American and Hispanic students and students with an emotional behavioral disorder status receive more severe sanctions than White students and students without a disability label at their first discipline encounter. This racial disparity in discipline severity continues through six sanctions and is eliminated at the 13th sanction. The disability disparity in discipline severity dissipates after 10 sanctions for students with emotional behavioral disorder and intellectual disability. Implications for school personnel and future directions are discussed.

Girls are increasingly becoming involved with the juvenile justice system; however, what brings girls to engage in delinquency or what obstacles these girls face later in life resulting from adolescent criminal behavior is understudied. In the present study, we used latent class analysis to identify subtypes of risks among adolescent girls ( N = 1,174) who have engaged in delinquent behaviors and mixture modeling to determine what distal psychological, social, educational, and economic outcomes in young adulthood are associated with each subtype. Four adolescent subtypes were identified, which were distinguished primarily based on the severity of their self-reported victimization experiences and mental health concerns. Classes with higher levels of victimization experiences tended to report more engagement with delinquent behavior in adolescence and had a larger proportion of Black and Hispanic girls than lower-victimization classes. Identified classes differed from each other on distal (i.e., young adulthood) measures of economic instability, educational attainment, drug use, depression, and adult arrests. Generally, latent classes which were characterized by higher rates of victimization and mental health concerns and lower educational performance in adolescence fared worse in young adulthood. Implications for those who care for girls who engage in delinquency, including suggestions for using trauma and culture informed screening, prevention, and intervention services, and directions for future research are discussed. Additional online materials for this article are available on PWQ’s website at http://journals.sagepub.com/doi/suppl/0361684320918243 .

There is extensive evidence suggesting that school suspension is correlated with poor academic performance. However, many studies examining the association between school suspension and achievement focus on the effects of out-of-school suspension specifically. While in-school suspension is offered as a less harmful alternative consequence to out-of-school suspension, the effects of in-school suspension on academic achievement are largely unknown. This article examines the association between in-school suspensions and academic failure on standardized achievement tests. The study utilized secondary data from two cohorts of 380,826 ninth-grade students enrolled in Texas public schools to investigate how many in-school suspensions result in failure on a state standardized achievement test. Our results show that a single in-school suspension is predictive of significant risk for academic failure (greater than 25% chance of failure) on a state-wide standardized test controlling for a host of individual and school characteristics. We also find that this relationship between discipline and risk for standardized test failure is more pronounced for students of color. The implications for school psychologists in terms of curtailing the potential negative impact of in-school suspension on student achievement are discussed.

IMPORTANCE:The novel coronavirus 2019 (SARS-CoV-2) has been well described in adults. Further, the impact on older children and during the perinatal time is becoming better studied. As community spread increases, it is important to recognize that neonates are vulnerable to community spread as well. The impact that community-acquired SARS-CoV-2 has in the neonatal time period is unclear, as this population has unique immunity considerations.OBJECTIVE:To report on a case series of SARS-CoV-2 in neonates through community acquisition in the USA.DESIGN:This is an early retrospective study of patients admitted to the Neonatal Intensive Care Unit (NICU) identified as having SAR-CoV-2 through positive real-time polymerase chain reaction assay of nasopharyngeal swabs.FINDINGS:Three patients who required admission to the NICU between the ages of 17 and 33 days old were identified. All 3 had ill contacts in the home or had been to the pediatrician and presented with mild to moderate symptoms including fever, rhinorrhea, and hypoxia, requiring supplemental oxygen during their hospital stay. One patient was admitted with neutropenia, and the other 2 patients became neutropenic during hospitalization. None of the patients had meningitis or multiorgan failure.CONCLUSIONS AND RELEVANCE:Infants with community-acquired SARS-CoV-2 may require hospitalization due to rule-out sepsis guidelines if found to have fever and/or hypoxia. Caregivers of neonates should exercise recommended guidelines before contact with neonates to limit community spread of SARS-CoV-2 to this potentially vulnerable population, including isolation, particularly as asymptomatic cases become prevalent.

Objective: Transcatheter aortic valve replacement is a safe, minimally invasive treatment for severe aortic stenosis in patients with moderate-to-high surgical risk. Monitored anesthesia is administered by an anesthesiologist.This study compares transcatheter aortic valve outcomes under monitored anesthesia vs general anesthesia. Methods: Data were prospectively collected for 286 patients undergoing transcatheter aortic valve replacement at a single academic hospital from March 2012 to August 2016. The patients were grouped by type of anesthesia: monitored vs general. A propensity score match was performed to compare intraoperative and post-operative outcomes between groups. Results: General anesthesia was used in 102 patients and moderate sedation in 184. Propensity score matching produced 80 pairs. Compared to procedures under general anesthesia, patients receiving monitored anesthesia had shorter procedure (1.6 [1.4, 2.0] vs 2.0 [1.6, 2.5] hours; P < 0.001) and fluoroscopy times (17 [14.5, 22.5] vs 25 [17.9, 30.3] minutes; P < 0.001) and shorter hospital length-of-stay (3 [2.0, 4.0] vs 5 [3.0, 7.0] days; P < 0.001) but no difference in intensive care unit length-of-stay. Blood transfusion was more common in patients undergoing general anesthesia, but there was no difference in stroke, renal failure, postoperative atrial fibrillation, or need for permanent pacemaker. More patients were discharged to home after monitored anesthesia (90% vs 64%; P < 0.001).There was no difference in 30-day mortality (0% vs 3%; P = 0.15). Conclusions: Transcatheter aortic valve replacement under monitored anesthesia provides the safety of anesthesia-led sedation without intubation and general anesthetic.We found no compromise in patient safety or clinical outcomes.

While intercenter variation (ICV) in anti-epileptic drug (AED) use in neonates with seizures has been previously reported, variation in AED practices across regional NICUs has not been specifically and systematically evaluated. This is important as these centers typically have multidisciplinary neonatal neurocritical care teams and protocolized approaches to treating conditions such as hypoxic ischemic encephalopathy (HIE), a population at high risk for neonatal seizures. To identify opportunities for quality improvement (QI), we evaluated ICV in AED utilization for neonates with HIE treated with therapeutic hypothermia (TH) across regional NICUs in the US. Children’s Hospital Neonatal Database and Pediatric Health Information Systems data were linked for 1658 neonates ≥36 weeks’ gestation, > 1800 g birthweight, with HIE treated with TH, from 20 NICUs, between 2010 and 2016. ICV in AED use was evaluated using a mixed-effect regression model. Rates of AED exposure, duration, prescription at discharge and standardized AED costs per patient were calculated as different measures of utilization. Ninety-five percent (range: 83–100%) of patients with electrographic seizures, and 26% (0–81%) without electrographic seizures, received AEDs. Phenobarbital was most frequently used (97.6%), followed by levetiracetam (16.9%), phenytoin/fosphenytoin (15.6%) and others (2.4%; oxcarbazepine, topiramate and valproate). There was significant ICV in all measures of AED utilization. Median cost of AEDs per patient was $89.90 (IQR $24.52,$258.58). Amongst Children’s Hospitals, there is marked ICV in AED utilization for neonatal HIE. Variation was particularly notable for HIE patients without electrographic seizures, indicating that this population may be an appropriate target for QI processes to harmonize neuromonitoring and AED practices across centers.

Transcatheter aortic valve replacement (TAVR) can be performed under general anesthesia (GA), during monitored anesthesia care (MAC) with an anesthesiologist present, or using the “minimalist approach” with no anesthesiologist present. This study compared the outcomes of performing TAVR using

Background. Septal myectomy has been the mainstay of the surgical treatment of obstructive hypertrophic cardiomyopathy (HCM); however, recently there is growing appreciation for associated mitral valve abnormalities that contribute to left ventricular outflow tract (LVOT) obstruction. In this study, we describe our experience with combined papillary muscle realignment (PMR) and septal myectomy for the treatment of obstructive HCM. Methods. We identified 44 patients undergoing surgery for obstructive HCM whose anatomy was amenable to combined PMR and septal myectomy at our institution over a 20-month period. All patients underwent resting and stress echocardiography preoperatively and post-operatively. Demographic, clinical, and imaging data were prospectively collected in a cardiac surgery database. Results. Patient age ranged broadly, with mean age of 54 (range, 18 to 76) years. Preoperatively, 70% of patients were New York Heart Association functional class III or IV, the mean stress LVOT gradient was 144 mm Hg, and severe mitral regurgitation (MR) with stress was seen in 81%. Additional procedures included division of myocardial bands (50%) and chordae (43%) and resection of accessory papillary muscles (25%). Following the procedure, mean resting and stress gradients were reduced to normal (12 and 27 mm Hg, respectively; p < 0.0001). No patient had severe MR and only 3 (6.8%) had moderate MR (p < 0.0001). Mean length of stay was 6 days and there were no mortalities. Conclusions. Septal myectomy combined with PMR is a safe, highly effective, and reproducible procedure that reliably relieves LVOT obstruction and corrects MR without the need for mitral valve repair or replacement. (C) 2018 by The Society of Thoracic Surgeons

The prevalence of child maltreatment and its association with future violence makes identifying ways to intervene with victims and prevent subsequent violence increasingly important. Child maltreatment is any form of child abuse or child neglect resulting in actual or potential harm to a child's health, survival, development or dignity. Self-reported data from the National Longitudinal Study of Adolescent Health were used to further understanding of a commonly described cycle of interpersonal violence where the experience of childhood maltreatment predicts victimization and perpetration of youth violence in adolescence and intimate partner violence in adulthood. Using a nationally representative sample, we examine how both gender and the experience of caring relationships with teachers could affect the cycle. Physical abuse was associated with youth violence victimization and perpetration, and neglect was associated with youth violence victimization. Youth violence victimization was related to IPV perpetration and victimization. For males, youth violence perpetration was associated with only IPV victimization, while for females, youth violence perpetration was associated with IPV perpetration and victimization. For males with low perceptions of having a caring teacher, youth violence victimization and perpetration were strongly correlated. Implications are discussed.

To evaluate the patterns of care and clinical outcomes of irradiated oligodendroglioma patients using a pooled analysis of a multi-institutional cohort. Oligodendroglioma patients with confirmed 1p/19q co-deletion who were treated with radiation therapy (RT) with or without chemotherapy from 2000-2017 at four tertiary academic cancer centers were retrospectively reviewed. PFS and OS rates were determined with Kaplan-Meier analyses. Logistic regression analysis was used to identify factors associated with delayed use of RT. Cox regression analysis was used to identify factors associated with worse progression free survival (PFS) and overall survival (OS). Progression was defined as progression after RT, whether RT was delivered adjuvantly or in a delayed fashion. All times to progression or death were determined from the time of initial surgery. One hundred eighty-eight patients were identified: 122 (65%) received early RT (within 6 months of surgery, median: 1.2 months, range: 0.03-5.6 months), and 67 (35%) received delayed RT (more than 6 months from surgery, median: 50 months, range: 6.3-213 months). Most patients were treated with intensity-modulated RT (65%) followed by 3D conformal RT (23%) and proton therapy (12%). Median age and follow up was 43 years (range 20-80) and 69 months (range 2-242), respectively. For patients who were treated with early RT, 70% were treated with RT and temozolomide (TMZ), and 15% were treated with RT and procarbazine/lomustine/vincristine (PCV), and 15% were treated with RT alone. For patients who were treated with delayed RT, 36% patient were treated with initial chemotherapy and then salvage RT later, 46% were treated with RT +TMZ, 13% were treated with RT+PCV, and 5% were treated with RT alone. Ten-year PFS for early RT and delayed RT were 63% vs. 74%, respectively (P=0.02); ten-year OS for early RT and delayed RT were 67% vs. 91%, respectively (P=0.02). Younger age (OR = 1.04, 95% CI 1.02-1.07) and grade 2 histology (OR = 7.0, 95% CI 3.4 -14.2) were associated with delayed RT. Gliomatosis (HR = 46, 95% CI 5.1-422) and grade 3 histology (HR = 2.2, 95% CI 1.3-3.9) were significantly associated with worse PFS after RT. Older age (HR = 1.06, 95% CI 1.03-1.09), lower performance status (HR = 1.04, 95% CI 1.01-1.08), gliomatosis (HR = 42.7, 95% CI 4.5-401), and early RT (HR = 2.4, 95% CI 1.03-5.6) were associated with worse OS. In this large multi-institutional cohort with treatment spanning over two decades, oligodendroglioma patients had favorable prognosis regardless whether treated with early or delayed RT. Young age and grade 2 histology were more likely to receive delayed RT, which was not associated with significantly worse PFS or OS. Among this molecularly homogenous oligodendroglioma population with 1p/19q co-deletion, grade 3 histology was prognostic for PFS after RT but not OS. When chemotherapy was chosen to combine with either early or delayed RT, TMZ was preferentially chosen over PCV.

PURPOSE: We describe the frequency and timing of withdrawal of life-support (WLS) in moderate or severe hypoxic-ischemic encephalopathy (HIE) and examine its associations with medical and sociodemographic factors. PROCEDURES: We undertook a secondary data analysis of a prospective multicenter data registry of regional level IV Neonatal Intensive Care Units participating in the Children's Hospitals Neonatal Database. Infants >= 36 weeks gestational age with HIE admitted to a Children's Hospitals Neonatal Database Neonatal Intensive Care Unit between 2010 and 2016, who underwent therapeutic hypothermia were categorized as (1) infants who died following WLST and (2) survivors with severe HIE (requiring tube feedings at discharge). RESULTS: Death occurred in 267/1,925 (14%) infants with HIE, 87.6% following WLS. Compared to infants with WLS (n = 234), the survived severe group (n = 74) had more public insurance (73% vs 39.3%, P=0.00001), lower household income ($37,020 vs $41,733, P=0.006) and fewer [20.3% vs 35.0%, P=0.0212] were from the South. Among infants with WLS, electroencephalogram was performed within 24 hours in 75% and was severely abnormal in 64% cases; corresponding rates for MRI were 43% and 17%, respectively. Private insurance was independently associated with WLS, after adjustment for HIE severity and center. CONCLUSIONS: In a multicenter cohort of infants with HIE, WLS occurred frequently and was associated with sociodemographic factors. The rationale for decision-making for WLS in HIE require further exploration. (C) 2018 Elsevier Inc. All rights reserved.

The adaptive and innate immune system play a critical role in tumor control. Methods to improve the anti-tumor immune response through T-cell-specific therapies is the current focus of Immuno-Oncology. Our group and others have demonstrated that treatment-induced lymphopenia correlates with poorer prognosis in newly diagnosed glioblastoma (GBM) patients. We hypothesized that granulocytes, including neutrophils and eosinophils, influence the immunologic response to chemoradiation therapy (CRT) and patient outcomes. We conducted a single-institution, retrospective analysis of 94 patients diagnosed with WHO Grade IV GBM between 2011-2016 treated with surgery followed by CRT (60Gy in 30 fractions, temozolomide 75mg/m2/day) and adjuvant temozolomide. We evaluated the immunologic response to therapy through monthly complete blood count with differential for up to 3 months after CRT. On univariate analysis, the use of immunosuppressive steroids negatively correlated with overall survival (Pearson’s r = -0.382, p<0.01). White blood cell (WBC) count and absolute neutrophil count (ANC) measured at the end, 1 and 2 months after CRT also negatively correlated (r = -0.226 to -0.342, p<0.05) with overall survival. Whereas, eosinophil count measured at the end, 1, 2 and 3 months after CRT (r = 0.227 to 0.366, p<0.05) and absolute lymphocyte count (ALC) measured 3 months after CRT (r = 0.268, p<0.05) positively correlated with overall survival. On partial least squared regression, steroid use and eosinophil count 3 months after CRT were the 1st and 2nd variables of importance in the projection (VIP). In a multivariate analysis, steroid use and eosinophil count 3 months after CRT remained statistically significant (F=5.4, F=6.8, p<0.05). Kaplan-Meier analysis demonstrated that patients with a persistently increased eosinophil count (> 150 cells/uL) 3 months after CRT lived 45% longer than patients with lower (<150 cells/uL) eosinophil count (1165 (CI 663-942) vs. 802 (CI 973-1356) days, p=0.05). Cox regression analysis of patients treated with steroids > or < 59 days confirmed that increased steroid use correlated a 35% decrease in overall survival (639 (CI 513-759) vs. 988 (856-1121) days, p<0.01), independent of initial performance status. We demonstrate that treatment-induced increase in eosinophil count is the strongest hematologic predictor of overall survival in newly diagnosed GBM. Eosinophil count may serve as a proxy for immunologic response to therapy and thus yield more prognostic insight than ALC. We also demonstrate that independent of initial performance status, steroid use was associated with a decrease in overall survival. Though prospective studies are needed, these data suggest that use of immunosuppressive steroids should thus be used judiciously and discontinued when clinically possible.

Background & aims: Objective evidence about the risks associated with anorexia nervosa and how to manage them, is limited. The aim of this study is to describe the medical risk profile, management and outcomes of a cohort of patients with severe anorexia nervosa (sAN) during medical stabilisation treatment.Methods: Retrospective analysis of case records gathered medical risk data for a 90 day high risk period, on 65 patients with sAN admitted to two specialist services. Prospectively established definitions of medical risk variables and significant complications were applied to the data to describe the risk profiles and outcomes.Results: Amongst this population with an average initial BMI of 12.8 kg/m(2), 74% developed no significant medical complications. Oral re-feeding over 60 days achieved an increase in mean BMI to 14.4 kg/m(2) and mean weight gain of 4 kg. No patients developed severe hypophosphatemia (<0.45 mmol/L) or any other indicators of a re-feeding syndrome. All the medical complications that arose were temporary.Conclusions: Initial re-feeding and medical stabilisation of patients with severe AN can be managed safely in specialist inpatient and community settings with slow re-feeding. Although the prevalence of complications was shown to be low, slight worsening of medical risk markers and increased incidence of complications did occur during initial re-feeding. The limited comparable published data appears to support slower rates of re-feeding, showing fewer abnormal results and complications. There is however a need for a definitive prospective multi-centre observational cohort study to investigate risks factors, and the effects of treatment on medical outcomes, in a large sample with varied rates of re-feeding. (c) 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Objective To quantify intercenter cost variation for perinatal hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia across children's hospitals.Study design Prospectively collected data from the Children's Hospitals Neonatal Database and Pediatric Health Information Systems were linked to evaluate intercenter cost variation in total hospitalization costs after adjusting for HIE severity, mortality, length of stay, use of extracorporeal support or nitric oxide, and ventilator days. Secondarily, costs for intensive care unit bed, electroencephalography (EEG), and laboratory and neuroimaging testing were also evaluated. Costs were contextualized by frequency of favorable (survival with normal magnetic resonance imaging) and adverse (death or need for gastric tube feedings at discharge) outcomes to identify centers with relative low costs and favorable outcomes.Results Of the 822 infants with HIE treated with therapeutic hypothermia at 19 regional neonatal intensive care units, 704 (86%) survived to discharge. The median cost/case for survivors was $58 552 (IQR $32 476-$130 203) and nonsurvivors $29 760 (IQR $16 897-$61 399). Adjusting for illness severity and select interventions, intercenter differences explained 29% of the variation in total hospitalization costs. The widest cost variability across centers was EEG use, although low cost and favorable outcome centers ranked higher with regards to EEG costs.Conclusions There is marked intercenter cost variation associated with treating HIE across regional children's hospitals. Our investigation may help establish references for cost and enhance quality improvement and resource utilization projects related to HIE.

Figure 1. Preoperative chest computed tomography revealing the central left upper lobe tumor. The tumor invaded the left pulmonary artery and the left lower lobe bronchus as shown in the crosssectional (A) and coronal (B) images. A 65-year-old woman underwent left pneumonectomy for T2aN1 squamous cell carcinoma (Figures 1A and 1B). She was discharged on postoperative Day 4, breathing room air. The left pleural space demonstrated the expected fluid increase (Figures 2A and 2B). However, after 3 weeks, chest radiography revealed decreased pleural fluid. Chest tomography 1 week later showed complete absence of fluid (Figures 2C and 2D). She remained without cough, fevers, or symptoms suggestive of bronchopleural fistula (1–4). The complete blood cell count and biochemical panel were normal. Thoracotomy and chest tube incisions were well healed. Bronchoscopy (Figure 3A), bronchogram, ventilation scan (Figure 3B), esophagram, and chest and/or abdominal imaging were also normal and revealed no ascites or seroma. She received systemic chemotherapy, but during the 16th week she died of cardiac arrest. Autopsy showed a massive pulmonary embolism. The left bronchial stump was intact, and the pleural space was empty, with negative microbial cultures. There were no diaphragmatic fenestrations. Hence, we determined this was benign evacuation of the pneumonectomy space. We propose that bronchoscopy and ventilation scan should be performed to confirm benign evacuation of the pneumonectomy space. If negative, the patient should undergo surveillance with repeat bronchoscopy because some of these patients might have microscopic bronchopleural fistula (5). However, pleural instrumentation, with thoracentesis or thoracoscopy, should not be performed, to avoid seeding infection. n

Background. With increased time and quality pressures, it may be more difficult for residents in cardiothoracic surgery residency programs to get independent operative experience. That may lead residents to inaccurately report their role as "surgeon" to meet American Board of Thoracic Surgery (ABTS) case requirements.Methods. The 2013 In-Training Examination surveyed 312 cardiothoracic surgery residents and was used to contrast residents in traditional 2-year and 3-year cardiothoracic surgery residencies (traditional, n = 216) with those in 6-year integrated or 3+4-year programs (integrated, n = 96).Results. Traditional program residents reported a higher percentage of cases that met the ABTS criteria of surgeon than did integrated program residents (p = 0.05) but were less likely to meet requirements if all cases were logged accurately (p = 0.03). The majority of residents in each program believed that their case log accurately reflected their experience as "surgeon." Residents who tended to log cases incorrectly had lower self-reported 2012 In-Training Examination percentiles, were less likely to meet case requirements if logged properly, and felt less prepared for board examinations and eventual practice compared with residents who logged cases correctly (all p < 0.001). Residents who believed they would not meet case requirements if logged correctly cited limited surgical opportunities, poor case diversity, and a compromised training environment but not the 80-hour work week, excessive simulation, or disproportionate number of complex cases as causes.Conclusions. Overall cardiothoracic surgery residents appear to be satisfied with their training. There were specific subsets of trainees in both traditional and Integrated programs that are misrepresenting their role on cases because they otherwise may not meet the requirements. (C) 2016 by The Society of Thoracic Surgeons

AIMS Bicuspid aortic valve (BAV) is known to exhibit familial inheritance and is associated with aortopathy and altered aortic haemodynamics. However, it remains unclear whether BAV-related aortopathy can be inherited independently of valve morphology. METHODS AND RESULTS Four-dimensional flow magnetic resonance imaging for the in vivo assessment of thoracic aortic 3D blood flow was performed in 24 BAV relatives with trileaflet aortic valves (age = 40 ± 14 years) and 15 healthy controls (age = 37 ± 10 years). Data analysis included aortic dimensions, shape (round/gothic/cubic), and 3D blood flow characteristics (semi-quantitative vortex/helix grading and peak velocities). Cubic and gothic aortic shapes were markedly more prevalent in BAV relatives compared with controls (38 vs. 7%). Ascending aorta (AAo) vortex flow in BAV relatives was significantly increased compared with controls (grading = 1.5 ± 1.0 vs. 0.6 ± 0.9, P = 0.015). Aortic haemodynamics were influenced by aortic shape: peak velocities were reduced for gothic aortas vs. round aortas (P = 0.003); vortex flow was increased for cubic aortas in the AAo (P < 0.001) and aortic arch (P = 0.004); vortex and helix flows were elevated for gothic aortas in the AAo and descending aorta (P = 0.003, P = 0.029). Logistic regression demonstrated significant associations of shape with severity of vortex flow in AAo (P < 0.001) and aortic arch (P = 0.016) in BAV relatives. CONCLUSION BAV relatives expressed altered aortic shape and increased vortex flow despite the absence of valvular disease or aortic dilatation. These data suggest a heritable component of BAV-related aortopathy affecting aortic shape and aberrant blood flow, independent of valve morphology.

The current study examined observer’s attributions about the victim and perpetrator of an alleged acquaintance rape. Participants included 504 college students from a public university in the northeastern United States who read a brief crime report and completed a series of questionnaires for course credit. While men tended to attribute more blame to the victim than women, gender ideology emerged as a stronger predictor of rape attributions, and some types of sexist beliefs were associated with greater victim blaming and others with less victim blaming. Endorsement of hostile sexism, rape myths, and heterosexual intimacy was generally associated with the attribution of greater victim culpability, as well as less perpetrator culpability, perpetrator criminality, and victim credibility. However, complementary gender differentiation was associated with greater perpetrator culpability and criminality, while protective paternalism was associated with greater victim credibility. Observers attributed lower victim culpability and greater perpetrator criminality when the victim’s drink was spiked, and attributed greater perpetrator culpability when the victim verbally resisted the perpetrator’s advances. Given the implications that observer attitudes can have on professional and personal support for survivors, as well as juror decision making, the ongoing examination of the complex interplay between the person and situational factors affecting attributions of rape is essential. Sexual assault prevention programs may also benefit from a psychoeducational component that targets reducing traditional gender ideology.