Should We Mend Their Broken Hearts? The History of Cardiac Repairs in Children With Down Syndrome
Bibliographic record
Abstract
* Abbreviation: AVSD — : atrioventricular septal defect In May 2014, Evans et al1 reported that children with Down syndrome had lower rates of in-hospital death after cardiac surgery, compared with children without Down syndrome. Forty years ago, these results would have been unthinkable, as heart defects were not repaired in the majority of children with Down syndrome. However, as the field of cardiac surgery evolved, equal postoperative outcomes were reported between children with Down syndrome and those without. The historical question of whether we ought to offer cardiac repairs to infants with Down syndrome was influenced by a complex web of ethical, social, and legal considerations that changed over time, resulting in the current standard of care in which children with and without Down syndrome have the same opportunity for cardiac repair. Complex intracardiac surgery in infants was not routinely performed until the early 1970s, and Pediatrics published the first report on cardiac repairs in infants with Down syndrome in 1976.2 The authors concluded that overall surgical mortality in Down syndrome was high, especially in atrioventricular septal defects (AVSD), the most common heart defect associated with Down syndrome. Critical appraisal reveals only a minority of the children in the cohort received cardiac repairs, and of those, many were not suitable for full repairs because they had developed pulmonary hypertension by the time of surgery. In a 1978 Letter to the Editor,3 Feingold suggested that children with Down syndrome did poorly because they did not receive prompt surgical repairs, and not because of their Down syndrome. Over the following years, cardiac surgical techniques in infants developed rapidly, with improved outcomes in all children. The advent of … Address correspondence to: Chantelle R. Champagne, BMSc, MD, Department of General Pediatrics, 3rd Floor, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Ave NW, Edmonton, AB, Canada T6G 2J3. E-mail: cchampag{at}ualberta.ca
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.035 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.006 | 0.009 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".