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Daily home surveillance of arterial oxygen saturation according to pulse oximetry and weight selected patients at increased risk of interstage death, permitting timely intervention, primarily with early stage 2 palliation, and was associated with improved interstage survival. Diminished growth identified 4 to 5 months after the Norwood procedure brings into question the value of delaying stage 2 palliation beyond 5 months of age.

In the recent era, no congenital heart defect has undergone a more dramatic change in diagnostic approach, management, and outcomes than hypoplastic left heart syndrome (HLHS). During this time, survival to the age of 5 years (including Fontan) has ranged from 50% to 69%, but current expectations are that 70% of newborns born today with HLHS may reach adulthood. Although the 3-stage treatment approach to HLHS is now well founded, there is significant variation among centers. In this white paper, we present the current state of the art in our understanding and treatment of HLHS during the stages of care: 1) pre-Stage I: fetal and neonatal assessment and management; 2) Stage I: perioperative care, interstage monitoring, and management strategies; 3) Stage II: surgeries; 4) Stage III: Fontan surgery; and 5) long-term follow-up. Issues surrounding the genetics of HLHS, developmental outcomes, and quality of life are addressed in addition to the many other considerations for caring for this group of complex patients.

The contemporary ideal standard offemale beauty in the Western world is based on thinness, attractiveness, and fitness. Women are enculturated to monitor these personal characteristics, and to construct their appearances to meet these normative expectations. Because most body image research to date has focused on quantitative methods of assessing the complex interrelationships among variables, women's "lived experiences" were examined through a qualitative study of 95 college women to explore the subjective nature of body satisfaction, the extent to which agency and control influence the construction of appearance, and what appearance-management behaviors are typically practiced andlor advisable. Nine themes emerged from the written essays. The most common theme was risky appearance-management behaviors that were practiced in response to gendered social norms, indicating the prevalent feeling that the body is malleable and considered to be under individual control. Common socio-cultural constructs were social comparison, world view, and influence of others. Essays attested to the centrality of body image in the lives of college women, and provide evidence that social comparison and ensuing appearancemanagement behaviors were ways in which young women exhibit agency or control over their lives.

After stage 1 palliation (S1P) with a Norwood operation, infants commonly experience growth failure during the initial interstage period. Growth failure during this high-risk period is associated with worse outcomes. This study evaluated the growth patterns of patients enrolled in the authors’ interstage home-monitoring program (HMP), which uses a multidisciplinary team approach to nutrition management. From 2000 to 2009, 148 infants were enrolled in the HMP after S1P. Families recorded daily weights during the interstage period and alerted the interstage monitoring team about protocol violations of nutritional goals. Interstage monitoring and inpatient data from the S1P hospitalization were reviewed to identify risk factors for poor growth. Growth outcomes were compared with published norms from the Centers for Disease Control. Interstage survival for patients in the HMP was 98 % (145/148). Growth velocity during the interstage period was 26 ± 8 g/day. The weight-for-age z-scores decreased from birth to discharge after S1P (−0.4 ± 0.9 to −1.3 ± 0.9; p < 0.001) but then increased during the interstage period to the time of S2P (−0.9 ± 1; p < 0.001). The factors associated with improved growth during the interstage period included male gender, greater birth weight, full oral feeding at S1P discharge, and a later birth era. After S1P, infants enrolled in an HMP experienced normal growth velocity during the interstage period. Daily observation of oxygen saturation, weight change, and enteral intake together with implementation of a multidisciplinary feeding protocol is associated with excellent interstage growth and survival.

This study examines the relationship between physical and psychosocial attributes of the body, and aesthetic attribute preferences in clothing. Building upon a clothing comfort model, the purpose is to determine whether women's aesthetic response to apparel is related to their body size, body cathexis and body image and if so, to provide insight into underlying patterns of similarity in their response. An Internet survey was administered to a random sample of 199 female undergraduate students. The results indicated that body image and body cathexis had a negative linear relationship with aesthetic preference in styling, implying that lower body image and body cathexis correlate with preference for greater body coverage through clothing and vice versa. Body size showed a positive linear association with styling preferences, implying that increase in body size correlates with preference for greater body coverage in clothing and vice versa. Theoretical, methodological and practical implications are discussed.

Home monitoring after S1P is associated with excellent interstage survival. Although a breach of monitoring criteria occurred in more than half of patients, our analysis failed to identify independent predictors of interstage events. Analysis of variables predicting mortality could not be assessed due to the low frequency of death in this cohort. Failure to identify specific variables for interstage events suggests that home monitoring, as part of an interstage surveillance program, should be applied to all S1P hospital survivors.

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