Hybrid Intervention Research Articles

Synchronous hybrid procedure combining interventional radiology and endoscopy for esophagogastric varices with large gastro-renal shunt.

Successful treatment of esophagogastric varices (EGV) with giant portal-systemic shunt is challenging. To explore the feasibility and safety of a novel hybrid procedure involving interventional radiology and endoscopy in the same sitting.Three cases clinically diagnosed to have decompensated cirrhosis and EGV with giant gastrorenal shunt (GRS) on contrast-enhanced computed tomography (CT) were included. The hybrid procedures included: indirect portography, hepatic vein pressure gradient (HVPG) measurement, HVPG-based partial splenic embolization (PSE), retrospective GRS balloon occlusion, endoscopic histoacryl injection (EHI), balloon catheter radiography and withdrawal. All the procedures were done in the same operation room. Main outcomes measurements included operation time, complications, and re-bleeding events.Hybrid interventions were performed successfully in 3 cases with a mean operation time of 63.3 minutes without any major intra- and post-operation complications. No rebleeding occurred at 6-month follow-up.Synchronous hybrid intervention combining radiology and endoscopy is feasible and safe for patients with EGV and giant GRS, preliminary study with limited cases deserves further exploration.

Long-term outcomes of myocardial and cerebral revascularization with combined or staged percutaneous interventions and carotid endarterectomy

Aim To evaluate in-hospital and long-term outcomes of myocardial and cerebral revascularization with combined or staged PCI and carotid endarterectomy.Methods.263 myocardial and cerebral revascularizations with PCI and CEA in patients with combined cerebral and coronary artery lesions in the period from 2011 to 2017 were performed. Patients were divided into two groups depending on the surgical strategy. Patient (n = 133) who underwent a staged intervention (CEA and PCI) were included in Group 1, whereas patients (n = 130) who underwent a hybrid intervention (CEE+PCI CA) were included in Group 2. The mean follow-up was 3.5 years.Results.100% of patients in Group 2 underwent coronary and internal carotid revascularization according to the results of in-hospital and long-term follow-up. 81.35% of patient in Group 1 underwent PCI and CEA, whereas 3.01% of patients underwent only PCI and 6.77% of patients – CEA. 1.5% of patients in Group 1 did not receive any surgical treatment. The most common causes of incomplete revascularization were the subsequent change of the initially defined treatment for myocardial (6.02%) or cerebral revascularization (0.75%). The rest refused the second stage, or it was associated with extremely high risk and the strategy was switched to the conservative therapy.Conclusion.100% of patients received hybrid myocardial and cerebral revascularization during one hospitalization. It allowed reducing mortality from MI and stroke during the waiting period for the next stage of the treatment in Group 1 (almost 5%). Hybrid interventions can be used in patients with high risk for open-heart surgery, severe comorbidities (obesity, diabetes, renal dysfunction), significant coronary and cerebral artery lesions with high risk of MI and stroke. However, hybrid approach was associated with high rate (almost 7%) of non-fatal MI in the long-term follow-up.

Supporting Japanese Mothers of Children at Risk for Attention Deficit Hyperactivity Disorder (ADHD): A Small Scale Randomized Control Trial of Well Parent Japan

ObjectivesGuidelines recommend parent management training in the multi-modal treatment of attention deficit hyperactivity disorder (ADHD). The availability of such interventions in Japan is limited. This study evaluated the effects of Well Parent Japan, a hybrid intervention including a group Japanese language adaptation of the New Forest Parenting Programme for ADHD (NFPP) augmented with strategies to improve parent’s psychological wellbeing and enhance confidence in their ability to implement change.MethodsMothers of children aged 6–12 years displaying marked symptoms of ADHD were randomly assigned to the intervention (n = 28) or a waitlist control condition (n = 24). Measures were completed at baseline and again 14 weeks later. Parenting stress was the primary outcome. Other outcomes included maternal depression, parenting self-efficacy, reported and observed parenting behaviour, and maternal ratings of child ADHD, oppositional defiant disorder (ODD) symptoms, and internalizing problems.ResultsAnalysis of covariance (ANCOVA) compared the groups post intervention. Intervention mothers reported significantly less parenting stress, higher parenting self-esteem and use of more effective parenting strategies compared with controls, including a reduction in observed negative parenting, post intervention. These mothers also reported lower levels of child aggression and internalizing problems post intervention together with a trend (p < 0.05) toward reduced symptoms of inattention.ConclusionsWell Parent Japan is an effective psychosocial intervention for parents of children with ADHD in Japan. The group format and the session content is well tolerated. This is the first randomized control trial (RCT) of a psychosocial intervention targeting ADHD in Japan.

The design and development of a hybrid off-job crafting intervention to enhance needs satisfaction, well-being and performance: a study protocol for a randomized controlled trial

BackgroundEmployees dealing with job demands such as high workload and permeable work-life boundaries could benefit from bottom-up well-being strategies such as off-job crafting. We have developed a hybrid off-job crafting intervention to promote off-job crafting, a proactive pursuit to adjust one’s off-job time activities to satisfy one’s psychological needs. This hybrid intervention contains both on-site (two trainings) and online elements (smartphone app) to enhance employees’ well-being and performance within different life domains.MethodsThe study is designed as a randomized controlled trial with an intervention group and a waitlist control group. The study population will be Finnish knowledge workers. The intervention program focuses on six psychological needs (detachment, relaxation, autonomy, mastery, meaning, and affiliation) proposed by the DRAMMA model. The intervention will consist of the following components: 1) an on-site off-job crafting training, 2) an individual off-job crafting plan for the four-week intervention period, 3) Everydaily smartphone app usage, and 4) a training session for reflection. The study outcomes are assessed with online questionnaires once at baseline, weekly during the intervention period and twice after the intervention (two-week and six-week follow-up). Moreover, during the second training session, participants will participate in a process evaluation to shed light on the mechanisms that can affect the effectiveness of the intervention.DiscussionWe expect that the intervention will stimulate off-job crafting behaviors, which may in turn increase well-being and performance in both non-work and work domains during and after the intervention (compared to baseline and to the control group). The intervention may provide employees with additional resources to deal with various stressors in life. Furthermore, this off-job crafting intervention could also offer performance benefits for the employers such as increased organizational citizenship behaviors among employees.Trial registrationThe Netherlands Trial Register (NTR): NL8219, December 9, 2019. Registered retrospectively. https://www.trialregister.nl/trial/8219

A new viewpoint on endoscopic CABG: technique description and clinical experience

BackgroundThe aim of this paper is to describe a newly developed endoscopic coronary artery bypass graft (Endo-CABG) technique to treat patients with single- and multi-vessel disease and discuss the short-term clinical results in a large patient cohort. This technique avoids a median sternotomy by combining a thoracoscopic technique via three ∼5 mm thoracic ports and a mini-thoracotomy utility 3–4 cm port through the intercostal space. MethodsFrom January 2016 to January 2018, data from consecutive patients undergoing an elective Endo-CABG were prospectively entered into a customized database and retrospectively reviewed. Patients scheduled for a combined hybrid intervention were excluded. Conversion rate to sternotomy, incidence of surgical revision and postoperative graft failure, one-month survival, morbidity, and length of stay (LOS) were investigated. Subgroup analyses were performed. ResultsA total of 342 patients undergoing an Endo-CABG with one (n = 53) or multiple (n = 289) bypasses were included. No conversion to sternotomy occurred and incidence of surgical revision, graft failure, and 30-day mortality was 7.3%, 1.5%, and 1.8%, respectively. Adverse neurological outcomes were rare: cerebrovascular accident, transient ischemic attack, epilepsy, and postoperative delirium were observed in 0.6%, 0.3%, 0.3%, and 5.3% of patients, respectively. Median intensive care unit and hospital LOS were 2.75 (IQR 1.8 to 3.8) and 8.0 days (IQR 7.0 to 10.0), respectively. Thirty-day mortality in obese patients, diabetics, and octogenarians was 0%, 3.6%, and 5.6%, respectively. EuroSCORE II > 5% was associated with a high 30-day mortality (25%). ConclusionsEndo-CABG can be considered a safe and effective procedure to treat single- and multi-vessel coronary artery disease. Individual patient selection seems not necessary to apply this technique.

Anodic and Mechanical Behavior of Carbon Fiber Reinforced Polymer as a Dual-Functional Material in Chloride-Contaminated Concrete.

Carbon fiber reinforced polymer (CFRP) has been used as a dual-functional material in a hybrid intervention system (ICCP-SS) which integrates the impressed current cathodic protection (ICCP) and structural strengthening (SS). The mechanical behavior of CFRP as an anode has been investigated in some solution environments. However, the anodic and mechanical behavior of CFRP bonded to concrete is unclear. This paper focuses on the anodic and mechanical performance of CFRP bonded to the chloride-contaminated concrete by conducting an electrochemical (EC) test. The method of bonding the CFRP to the concrete and the shape of the steel embedded in the concrete were considered. The current densities of 20 mA/m2 and 100 mA/m2 were applied during 120-day and 310-day EC tests. The electrode potentials and driving voltages were recorded, and the bond interfaces of the CFRP were inspected after EC test. The residual tensile strength and failure modes of the CFRP were analyzed after tensile tests. Finally, the long-term performance of CFRP as a dual-functional material in ICCP-SS system was discussed. Results show that the externally bonding CFRP in ICCP-SS system can not only protect the steel in chloride-contaminated concrete effectively but also maintain 70% of the original tensile strength of CFRP at a charge density of 744 A·h/m2. The expected service period of CFRP as a dual-functional material bonded to the chloride-contaminated concrete was determined to be more than 42.5 years.

Вибори як об’єкт та інструмент гібридної війни

The article examines the problem of elections as an object and tool in modern hybrid conflicts. The authors emphasize that in the context of information technology development and globalization, elections are becoming one of the main targets in the implementation of hybrid aggression, due to the relative cheapness and effectiveness of such technology. It is shown that by interfering in the electoral process of democratic countries of the world, the hybrid aggressor promotes the coming to power (or, conversely, defeat) of the necessary political forces and, accordingly, neutralizes its opponents. The main forms of foreign interference in the electoral process are revealed: support of candidates or political parties beneficial to the aggressor state in order to further use them to destabilize the victim country, or to increase influence on the situation in the country that has become the object of a hybrid warfare; influence on certain categories of the population living in the victim state, in order to push them to vote for the politicians needed by the aggressor; information propaganda by the aggressor state aimed at discrediting the institution of elections and its results in a country that has become the object of a hybrid warfare; use of the institution of international election observation to achieve the goals of hybrid warfare; direct cyberattacks on electronic and communication systems used in the victim state to organize elections and count votes. Emphasis is placed on the fact that in the conditions of hybrid Russian aggression, the institution of elections in Ukraine is one of the potential objects of hybrid intervention by Russia. Therefore, an important condition for preserving the democracy of elections, the socio-political system and the sovereignty of our state in general is to ensure reliable protection of the institution of elections from foreign interference.

A case study of short-term exposure to hybrid learning

In this study, we: 1) investigated whether short-term use of online/off-campus learning modules would help instructors and students engage in teaching and learning if class schedules were abruptly switched to online; 2) suggested design improvements for short-term hybrid intervention. We assumed that the supportive features of hybrid learning would benefit students with low motivation and negative feelings prior to short-term online intervention. We used a mixed-methods approach, gathering data from two typical on-campus undergraduate classes. The results show that student emotions significantly differed before and after the short-term online intervention. These findings aligned with comments made by the students. The instructors reported positive effects of the online pedagogy due to the affordances of network technologies. Participant reflections suggested four design improvements: clear goals, cohesive alignment, clear guidance and feedback, and technologies with which students are familiar.

Hacia la transformación de la cultura organizacional de una agencia pública: Un modelo híbrido de intervención

Hacia la transformación de la cultura organizacional de una agencia pública: Un modelo híbrido de intervención&#x0D; Uno de los niveles de intervención de la Psicología Comunitaria (PC) es el nivel organizacional. La intervención descrita es sintónica con los valores y principios de la PC. Los objetivos del proyecto son: aquilatar (assess) los elementos de la cultura organizacional de una dependencia gubernamental en Puerto Rico que constituyen fortalezas y debilidades para el logro de su misión y desarrollar acciones colectivas específicas para motivar y potenciar las capacidades de todos los sectores de la organización para que se involucren en procesos de cambio que aumenten la eficiencia y la efectividad de la agencia, así como la satisfacción individual y colectiva de empleados/as a todos los niveles. El proyecto fue desarrollado en dos fases: una de investigación y otra de intervención. Todos los sectores de la organización participaron en el diseño y ofrecieron sugerencias sobre su alcance e implantación. La fase de intervención sigue un Modelo de Competencias que permite describir el conocimiento, las destrezas y el comportamiento necesario para el desempeño efectivo en una organización. Desarrollamos cinco módulos de capacitación y se administraron pre y post pruebas antes y después de la implantación de los módulos de capacitación. La intervención permitió confirmar la posibilidad de cambio organizacional con implicaciones para el cambio individual.

Dissection Thoracic Aneurysm After Type A Surgical Repair: “Kick-Off registry”

Introduction - The success of aortic dissection surgery depends upon complete resection of the primary intimal tear with attempted obliteration of the false lumen; in this concept the major goal for acute type A aortic dissection (AAAD) after surgical aortic replacement is to have a living patient.” This motto is always the directive for the cardiac-surgeon. However, the extent of the “A” dissection and surgical management could lead to “chronic dissection B”; which may eventually require additional treatments during follow-up. The traditional approach of open distal anastomosis is associated with high rates of persistent false lumen patency which exposes the patient to the formation of complex thoraco-abdominal dissection aneurysms. Kick-Off is a registry which evaluates the results of “cardiac-surgery” performed on patients with AAAD, in acute phase as well as during follow-up (the need of intervention surgery or endovascular aortic repair for dissection thoracic aneurysm > 55 mm). Methods - Between January 2010 and December 2017, in Santa Maria Hospital - Terni data concerning acute type A aortic dissection was collected in a registry: “Kick-Off Registry”. Urgent admissions with the diagnosis of acute A dissection were selected. Surgical outcomes were evaluated in terms of operative mortality and morbidity. Furthermore the development of thoracic dissection aneurysm was analysed, during follow-up. The following anatomic conditions like entry tear (patent / non patent); entry tear localization (inner or external), diameter of entry tear (major or minor 10 mm); initial aortic diameter (major or minor 40 mm), false lumen thrombosis (yes or not), shape of true lumen (elliptical or circular) and type of dissecton (linear or spiral) were taken into consideration. Moreover the type of surgical approach was evaluated. Statistical analyses were carried out using SPSS statistics version 22. Results - 196 patients underwent emergency repair for AAAD using a standard approach. 66% patients required replacement of the dissected ascending aorta, 27% required an emiarch replacement and 7% required total aortic root replacement. The mean age was 65.7 (146 male – 50 female). Median-follow-up was 29 months. Overall operative mortality was 21%. Multivariate analysis revealed that older age, stroke and malperfusion increased the risk of operative death. During follow-up the overall need for any kind of intervention (surgery, TEVAR or Hybrid intervention) was 19%. In multivariate analysis (Cox regression) a patent primary entry tear (P<0.05), initial diameter (superior to 40 mm - P<0.05)were predictors of thoraco-abdominal dissection aneurysm superior to 55 mm. Multivariate analysis showed that the type of required repair (emiarch replacement) was the primary factor associated with the development of dissection aneurysm (P<0.001). Conclusion - The anatomic conditions of AAAD and an unsuitable surgical strategy could bring about the development of thoraco-abdominal dissection aneurysm. The “Kick-Off” registry is helpful to understand the mechanisms that lead to dissection aneurysm; in the future we hope to categorization the risk patients for aneurysm disease. Furthermore, treatment options in acute phase and suggest preventive strategies to reduce the occurrence of this dissection aneurysm to a minimum would be define.

Outcomes Analysis of 677 Cases from the Multicenter Italian Registry on Primary Endovascular Treatment of Iliac and Aorto-Iliac Arteries Obstructive Disease (Iliacs Registry)

Introduction - Endovascular revascularization has become the first-line strategy for iliac obstructive lesions (IOL), and also used increasingly as an alternative to conventional surgery for complex aorto-iliac obstructive disease (AIOD). Owing to the good results resembling those of open surgery, an endovascular-first strategy have been considered for complex AIOD even in the most recent guidelines if done by an experienced team and if it does not compromise subsequent surgical options. The aim of this study was to analyze the results of the endovascular treatment of IOL and AIOD in a multicenter Italian registry. Methods - Over a 3-year period, ending in December 2017, 677 treatments were performed for IOL and AIOD in eleven Italian hospitals and collected into a dedicated registry database. Intermittent claudication was an indication in 376 (55.5%) patients, whereas critical limb threatening ischemia in 298 (44.0%). Postoperative anti-thrombotic therapy was left at center’s discretion: follow-up evaluation was performed at 1, 6 and 12 months after the intervention. Early (<30 days) major end-points were mortality and major complications; late major end-point was freedom from reintervention. Early results were compared with the Chi-square test and the Wilcoxon’s signed rank test; follow-up results were analyzed with Kaplan-Meier survival estimates andcompared with log-rank test. Univariate and multivariate (forward Cox regression) analysis was used to identify potentially significantpredictors of need for reintervention. Results - We treated 511 (75.4%) males. Overall, mean age was 68 ± 10 (range, 22-96; IQR, 62-76). Accordingly to the TASC II classification we treated 98 (14.5%) type A, 163 (24.1%) type B, 164 (24.2%) type C, and 248 (36.6%) type D lesions: stenoses were 370 (56.2%) and occlusions were 288 (43.8%). We used a totally percutaneous approach in 473 (69.9%): hybrid intervention was carried out in 204 (30.1%) patients, mostly with femoral endarterectomy plus patch plasty. A covered stent was implanted in 207 (30.6%) cases. Overall, a kissing-stent configuration was performed in 243 (36.1%) lesions. Primary technical success was obtained in 671 (99.3%) cases: earl mortality occurred in 3 (0.4%) cases, and postoperative complication was observed in 51 (7.5%) patients. Mean ankle-brachial index improved significantly from preoperative to postoperative period (0.5 ± 0.2 vs. 0.9 ± 0.1, P < 0.001). Median hospitalization was 5 days (IQR, 2-7). Early thrombosis, major amputation, and mortality was observed in 10 (1.5%), 3 (0.5%), and 4 (0.6%) cases, respectively. During the follow-up 21 (3.1%) died: the estimated survival was 96.3% at 12 months (95%CI: 93.8-97.8) and 90.2% at 36 months (95%CI: 82.7-94.7). Follow-up thrombosis occurred in 17 (2.5%) cases. Estimated primary patency and freedom from reintervention was 96% (IC95%: 93.3-97.7) and 97.2% (95%CI: 94.5-98.6) at 12 months, and 95% (95%CI: 89.0-97.6) for both outcomes at 36 months. At Cox regression analysis, no pre/intra/or-postoperative parameters independently predicted loss of primary patency and need for reintervention. Conclusion - In this “real world” registry experience, endovascular revascularization showed to be safe and effective. No independent predictors were found to be associated with the need of reintervention thus indicating that endovascular revascularization for IOL and AOID can be an effective and durable first-line alternative even for the treatment of complex AOID.

Amputation-Free Survival in Patients With Diabetes Mellitus and Peripheral Arterial Disease With Diabetic Foot Ulcer: Open Versus Endovascular Surgery

Introduction: The number of people with diabetes mellitus (DM) is increasing worldwide with an estimated number of 422 million adults, according to WHO. The incidence of peripheral arterial disease (PAD) increases with both age and diabetes mellitus which in turn can lead to diabetic foot ulcers (DFU). Comparison of endovascular surgery vs open vascular surgery, in patients with DM, PAD and DFU has not been done in a randomized trial. Large cohort studies are therefore needed to address this issue. Methods: Between the years 1984-2006, 1151 limbs presented with DFU were admitted to a multidisciplinary foot centre. Among 1151 limbs, 478 went through vascular intervention, data on death and amputation was recorded up to 2019-01-01. Patients receiving hybrid intervention were excluded and because of loss of follow up the final study population was comprised to 408 limbs. Among the study population, 40% were women and the median follow up time was 2.7 years. Median time to intervention was 8.3 weeks. Retrospective comparative analysis between endovascular and open vascular surgery was performed. Results: Patients were treated with endovascular surgery first (n=289) or open vascular surgery first (n=119). Major amputation rate at 3 years was 17.0% and 16.8%, respectively (p=0.97) Mortality at 3 years was 42.6% and 46.2%, respectively (p=0.50). Compared to the endovascular group, patients in the open group had a lower ankle-brachial index (ABI) (p< 0.01), and there was a trend for higher HbA1c (p=0.08) and longer time to intervention (p=0.06). In a Cox regression analysis, no difference between endovascular surgery compared to open vascular surgery was found in regard to major amputation (p=0.62), mortality (p=0.23) or amputation-free survival (p=0.21). Longer time to intervention was associated with increased major amputation rate in the cox regression analysis (p=0.03). Conclusion: Endovascular sugary and open vascular surgery achieved similar long-term results in a large cohort of patients undergoing revascularization with foot ulcer, DM and PAD. Disclosure: Nothing to disclose

Underestimated fracture risk in postmenopausal women-application of the hybrid intervention threshold.

To explore the risk of fragility fracture in Taiwanese postmenopausal women with osteopenia using the hybrid intervention threshold (HIT) and Fracture Risk Assessment tool (FRAX). The Taiwan Osteoporosis Association (TOA) conducted a nationwide bone mineral density (BMD) survey between 2008 and 2011 using a bus equipped with a dual-energy X-ray absorptiometry (DXA) machine. All participants completed a structured questionnaire, which included the elements in the FRAX. Based on the results, the group made up of postmenopausal women with osteopenia was identified. In order to explore the risk of fragility fracture by HIT and FRAX among Taiwan postmenopausal women with osteopenia, the 10-year probability of fracture (FRAX score) and individual intervention threshold (IIT) in this group were calculated. If the FRAX score of a participant was higher than or equal to the IIT or fixed intervention threshold (FIT), the participant was considered as above the HIT (HIT could be reached by being over a threshold at either major osteoporotic fracture or hip fracture) and categorized as having a high FRAX fracture risk. A total of 13,068 postmenopausal women were enrolled in the program. A total of 5743 (43.9%) participants had osteopenia, of which 1434 (25.0%) had high FRAX fracture risk. One quarter of Taiwanese postmenopausal women with osteopenia had high fragility fracture risk evaluated by FRAX and HIT. Due to the poor sensitivity of BMD for fragility fracture, we suggest that intervention for fragility fracture for postmenopausal women should also be guided by FRAX and HIT instead of BMD alone.

Psychological Symptoms and Rates of Performance Validity Improve Following Trauma-Focused Treatment in Veterans with PTSD and History of Mild-to-Moderate TBI

Iraq and Afghanistan Veterans with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) history have high rates of performance validity test (PVT) failure. The study aimed to determine whether those with scores in the invalid versus valid range on PVTs show similar benefit from psychotherapy and if psychotherapy improves PVT performance. Veterans (N = 100) with PTSD, mild-to-moderate TBI history, and cognitive complaints underwent neuropsychological testing at baseline, post-treatment, and 3-month post-treatment. Veterans were randomly assigned to cognitive processing therapy (CPT) or a novel hybrid intervention integrating CPT with TBI psychoeducation and cognitive rehabilitation strategies from Cognitive Symptom Management and Rehabilitation Therapy (CogSMART). Performance below standard cutoffs on any PVT trial across three different PVT measures was considered invalid (PVT-Fail), whereas performance above cutoffs on all measures was considered valid (PVT-Pass). Although both PVT groups exhibited clinically significant improvement in PTSD symptoms, the PVT-Pass group demonstrated greater symptom reduction than the PVT-Fail group. Measures of post-concussive and depressive symptoms improved to a similar degree across groups. Treatment condition did not moderate these results. Rate of valid test performance increased from baseline to follow-up across conditions, with a stronger effect in the SMART-CPT compared to CPT condition. Both PVT groups experienced improved psychological symptoms following treatment. Veterans who failed PVTs at baseline demonstrated better test engagement following treatment, resulting in higher rates of valid PVTs at follow-up. Veterans with invalid PVTs should be enrolled in trauma-focused treatment and may benefit from neuropsychological assessment after, rather than before, treatment.

Novel algorithm generating strategy to identify high fracture risk population using a hybrid intervention threshold.

The aim of this study was to develop an algorithm to identify high-risk populations of fragility fractures in Taiwan. A total of 16,539 postmenopausal women and men (age ≥ 50years) were identified from the Taiwan Osteoporosis Survey database. Using the Taiwan FRAX® tool, the 10-year probability of major osteoporotic fracture (MOF) and hip fracture (HF) and the individual intervention threshold (IIT) of each participant were calculated. Subjects with either a probability above the IIT or those with MOF ≥ 20% or HF ≥ 9% were included as group A. Subjects with a bone mineral density (BMD) T-score at femoral neck based on healthy subjects of ≤ -2.5 were included in group B. We tested several cutoff points for MOF and HF so that the number of patients in group A and group B were similar. A novel country-specific hybrid intervention threshold along with an algorithm was generated to identify high fracture risk individuals. 3173 (19.2%) and 3129 (18.9%) participants were categorized to groups A and B, respectively. Participants in group B had a significantly lower BMD (p < 0.001), but clinical characteristics, especially the 10-year probability of MOF (p < 0.001) or HF (p < 0.001), were significantly worse in group A. We found the algorithm generated from the hybrid intervention threshold is practical. The strategy of generating an algorithm for fracture prevention by novel hybrid intervention threshold is more efficient as it identifies patients with a higher risk of fragility fracture and could be a template for other country-specific policies.

A453 Personalized, Multi-Component Interventions for Behavioral Weight Management: Yes, but How? A Hybrid Intervention of Compulsory and Personalized Elements Based in Self-Determination Theory

Bariatric surgery is the most effective treatment for severe obesity. However, with more than 40% of postoperative bariatric patients experiencing excessive weight regain (i.e., 25%+ of total lost weight) and the majority of patients regaining some weight, there is a need for individualized behavioral interventions to promote sustained, lifelong maintenance of surgical weight loss. Given the multifactorial nature of weight regain, interventions must be multicomponent and personalized. This recommendation represents best practice; however, clinicians may lack knowledge or experience for pragmatic implementation. This session will address these issues, highlighting self-determination theory (SDT) as optimal for conceptualizing personalized treatments. Emphasis will be placed on the utility of the three components of SDT – autonomy, competence, and relatedness – to inform personalized, holistic interventions for patients who have lost or are trying to lose weight. SDT-based, personalized behavioral interventions can be tailored for both surgical and non-surgical populations with obesity, and they are ideal for preventing recidivism following weight loss. A brief overview of the BOSS intervention (Bariatric Outcomes: Sustaining Success) will be provided: this is an SDT-based, multicomponent intervention for promoting sustained weight loss and preventing recidivism. Five adult case examples will highlight how the intervention is tailored across SDT domains of autonomy, competence, and relatedness. Preliminary outcome data will also be provided: all patients are actively losing weight or maintaining weight loss. The session will demonstrate the implementation and personalization of evidence-based interventions, emphasizing the need for both compulsory and individualized elements within a multi-component program for lifelong behavioral weight management.

Hybrid Intervention and Open Surgical Reconstruction Carry Comparable Risk in the Treatment of Tandem Carotid Bifurcation and Proximal Disease

Hybrid Intervention and Open Surgical Reconstruction Carry Comparable Risk in the Treatment of Tandem Carotid Bifurcation and Proximal Disease

Staged Biventricular Repair After Hybrid Procedure in High-Risk Neonates and Infants.

Single-stage biventricular repair remains a challenging and difficult decision in high-risk newborns and early infants with the presence of left ventricular outflow tract obstruction (LVOTO) or borderline hypoplasia of the left ventricle (LV). Six high-risk patients underwent the initial hybrid procedure (bilateral pulmonary banding + ductal stenting) for staged biventricular repair. Their median age was 17 days (range: 7-55 days). The diagnosis was interrupted aortic arch (IAA), ventricular septal defect (VSD), and LVOTO (n = 3); IAA and VSD (n = 1); and aortic annular hypoplasia, aortic arch hypoplasia, VSD, and LVOTO (n = 1). The last patient had borderline LV with large atrial septal defect (ASD) and aortic arch hypoplasia. The patient with borderline LV had also ASD closure with small fenestration. One patient died of sepsis after the hybrid procedure. Other patients underwent biventricular repair 8 to 13 months later. Three patients had conventional repair with conal septum resection. The other patient with IAA, in whom LVOTO was considered nonresectable, underwent Yasui operation. The last patient with borderline LV had enough development of left heart structures during follow-up and underwent aortic arch repair. One patient who had conal septum resection died after biventricular repair. One patient needed a tracheostomy; four patients were discharged uneventfully and their clinical conditions were good on postoperative year 1. Staged biventricular repair with the initial hybrid procedure may be a feasible and safe alternative in high-risk neonates and early infants. Hybrid intervention may provide the development of cardiac structures in time and a better evaluation for the possibility of biventricular repair in borderline patients.

The Effect of Blocked Versus Serial Practice in the Treatment of Developmental Motor-Based Articulation Disorder

The application of specific motor learning principles (MLPs) in treatment for developmental motor-based articulation disorder in children has not been reported to date. The aims were to determine treatment effects of a novel hybrid intervention approach for a single participant with motor-based articulation disorder, and to examine the role of specific MLP, namely blocked versus serial practice schedules, in performance, generalization, and maintenance of speech skills. Results suggested that the novel hybrid treatment approach produced measurable gains in most instances. However, there were no systematic differences between the different practice schedules. Possible reasons for these specific treatment and generalization effects were explored.

Five-year results of using the 'frozen elephant trunk' technique for thoracic aortic dissection.

Analysed herein is efficacy of hybrid intervention according to the 'frozen elephant trunk' procedure in the medium-term period of follow-up in patients operated on for aortic dissection. During the period from 2012 to 2018, a total of 44 'frozen elephant trunk' procedures were carried out for Stanford type A and B thoracic aortic dissections. All interventions were performed in conditions of moderate hypothermic circulatory arrest (25-28 °C) with unilateral cerebral perfusion through the brachiocephalic trunk. The mean diameter of the implanted stent grafts amounted to 27.7±2.8 mm (range 24-30 mm). The distal edge of the stent graft was located at the level below the Th9 in more than 65% of cases (range Th7-Th12). The stent grafts were fixed proximally at the levels Z0-Z3, predominantly in the Z3 zone (72.7%). Thirty-day mortality amounted to 6.8%, with in-hospital mortality of 15.9%. Five-year survival in acute and chronic type A aortic dissection (AD) amounted to 100 and 80%, respectively (p=0.175). In acute type B aortic dissection five-year survival amounted to 62.2%, being 25.0% for chronic AD (p=0.057). Freedom from reinterventions for acute and chronic type A aortic dissection amounted to 100 and 66.7%, respectively (p=0.286). Freedom from aortic reinterventions for acute and chronic type B aortic dissection amounted to 100% and 75%, respectively (p=0.123). Reconstructive operations performed according to the 'frozen elephant trunk' technique appear to be effective surgical treatment in patients with thoracic aortic dissection, yielding satisfactory clinical results during a medium-term follow-up period.