First Dedicated Minimally Invasive Right Atrial Retractor.

INTRODUCTION: The importance of correcting tricuspid valve insufficiency in patients with left-sided valve disease is clear. In the United States, up to 30% of mitral valve operations are minimally invasive, while the data for isolated tricuspid valve is not known. A minimally invasive approach to the tricuspid valve provides faster recovery with lower transfusion rates and lower length of stay. MATERIALS AND METHODS: There are no dedicated right atrial (RA) retractors for minimally invasive tricuspid valve (TV) operations. TV exposure is different from mitral given the proximity of the tricuspid anterior annulus to the cut edge of the atrium. An RA retractor should be shallow while preventing slippage of the RA roof and should be quick to deploy and remove. We created a dedicated minimally invasive RA retractor to expose the TV and RA structures (fossa ovalis and coronary sinus). The retractor is a fenestrated shallow and wide retractor with bilateral articulating "wings" to expose left and right of the atrium. This retractor is compatible with the left atrial system by USB Medical Limited (Hatboro, Pennsylvania) and has tilting capability. A three-dimensional (3D)-printed prototype was modified after evaluation by two experienced minimally invasive surgeons (MCS and RKV). Once modifications were finalized, the retractor was then deployed in surgery. RESULTS: The RA retractor was used in isolated TV repairs, RA myxoma resection, RA clot removal, removal of RA migrated stents, select mitral valve operations, and closure of atrial septal defects. The retractor proved effective, safe, and fast to deploy and remove and allowed for full visualization of the tricuspid valve, interatrial septum, ostia of both vena cavas, and coronary sinus. The retractor was useful in mitral valve operations with existing aortic valve prosthesis and in the small left atria. CONCLUSION: The minimally invasive RA retractor affords excellent, stable exposure of the right atrial structures with fast deployment and removal.

Is the Scoutreach Initiative of Boy Scouts of America Linked to Character Development among Socioeconomically, Racially, and Ethnically Diverse Youth?: Initial Explorations.

Youth development programs represent key tools in the work of youth-serving practitioners and researchers who strive to promote character development and other attributes of youth thriving, particularly among youth who may confront structural and social challenges related to their racial, ethnic, and/or economic backgrounds. This article conducts secondary analyses of two previously reported studies of a relatively recent innovation in Boy Scouts of America (BSA) developed for youth from low-income communities, Scoutreach. Our goal is to provide descriptive and admittedly preliminary exploratory information about whether these data sets-one involving a sample of 266 youth of color from socioeconomically impoverished communities in Philadelphia (M age = 10.54 years, SD = 1.58 years) and the other involving a pilot investigation of 32 youth of color from similar socioeconomic backgrounds in Boston (M age = 9.97 years, SD = 2.46 years)-provide evidence for a link between program participation and a key indicator of positive development; that is, character development. Across the two data sets, quantitative and qualitative evidence suggested the presence of character development among Scoutreach participants. Limitations of both studies are discussed and implications for future longitudinal research are presented. We suggest that future longitudinal research should test the hypothesis that emotional engagement is key to creating the conditions wherein Scoutreach participation is linked to character development.

Character Development within Youth Development Programs: Exploring Multiple Dimensions of Activity Involvement.

We examined links among three dimensions of youth involvement (intensity, duration, and engagement) in Boy Scouts of America (BSA), an international out-of-school time (OST) youth development program designed to promote moral and performance character in boys. Using data from 737 youth and their parents who participated in one of 40 BSA program sites (commonly referred to as "packs"), we first considered how individual- and pack-level measures of program involvement were differentially linked with character development. Next, we examined whether pack-level involvement characteristics moderate individual-level involvement characteristics, hypothesizing that highly involved packs would serve to further enhance the positive effects of high levels of individual involvement. Results indicated engagement was the strongest, most frequent predictor of increases in both moral and performance character. Although there were no direct effects of pack-level intensity, duration, or engagement, the effects of individual-level engagement were moderated by pack-level engagement, suggesting that the largest increases in moral and performance character occurred among highly engaged youth who were enrolled in highly engaged packs. These results highlight the need to examine multiple dimensions of OST program involvement simultaneously, and suggest that strengthening youth engagement in programming may provide a means for enhancing the positive effects of high-quality youth programming.