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Online learning has become an increasingly expected and popular component for education of the modern-day adult learner, including the medical provider. In light of the recent coronavirus pandemic, there has never been more urgency to establish opportunities for supplemental online learning. Heart University aims to be “the go-to online resource” for e-learning in CHD and paediatric-acquired heart disease. It is a carefully curated open access library of paedagogical material for all providers of care to children and adults with CHD or children with acquired heart disease, whether a trainee or a practising provider. In this manuscript, we review the aims, development, current offerings and standing, and future goals of Heart University.
Scholars have recently investigated the efficacy of applying globalisation models to ancient cultures such as the fourth-millennium BC Mesopotamian Uruk system. Embedded within globalisation models is the ‘complex connectivity‘ that brings disparate regions together into a singular world. In the fourth millennium BC, the site of Çadır Höyük on the north-central Anatolian plateau experienced dramatic changes in its material culture and architectural assemblages, which in turn reflect new socio-economic, sociopolitical and ritual patterns at this rural agro-pastoral settlement. This study examines the complex connectivities of the ancient Uruk system, encompassing settlements in more consistent contact with the Uruk system such as Arslantepe in southeastern Anatolia, and how these may have fostered exchange networks that reached far beyond the Uruk ‘global world‘ and onto the Anatolian plateau.
To date, Ireland has been a leading light in the provision of youth mental health services. However, cognisant of the efforts of governmental and non-governmental agencies working in youth mental health, there is much to be done. Barriers into care as well as discontinuity of care across the spectrum of services remain key challenges. This editorial provides guidance for the next stage of development in youth mental care and support that will require significant national engagement and resource investment.
The unique phenotypic and genetic aspects of obsessive-compulsive (OCD) and attention-deficit/hyperactivity disorder (ADHD) among individuals with Tourette syndrome (TS) are not well characterized. Here, we examine symptom patterns and heritability of OCD and ADHD in TS families.
OCD and ADHD symptom patterns were examined in TS patients and their family members (N = 3494) using exploratory factor analyses (EFA) for OCD and ADHD symptoms separately, followed by latent class analyses (LCA) of the resulting OCD and ADHD factor sum scores jointly; heritability and clinical relevance of the resulting factors and classes were assessed.
EFA yielded a 2-factor model for ADHD and an 8-factor model for OCD. Both ADHD factors (inattentive and hyperactive/impulsive symptoms) were genetically related to TS, ADHD, and OCD. The doubts, contamination, need for sameness, and superstitions factors were genetically related to OCD, but not ADHD or TS; symmetry/exactness and fear-of-harm were associated with TS and OCD while hoarding was associated with ADHD and OCD. In contrast, aggressive urges were genetically associated with TS, OCD, and ADHD. LCA revealed a three-class solution: few OCD/ADHD symptoms (LC1), OCD & ADHD symptoms (LC2), and symmetry/exactness, hoarding, and ADHD symptoms (LC3). LC2 had the highest psychiatric comorbidity rates (⩾50% for all disorders).
Symmetry/exactness, aggressive urges, fear-of-harm, and hoarding show complex genetic relationships with TS, OCD, and ADHD, and, rather than being specific subtypes of OCD, transcend traditional diagnostic boundaries, perhaps representing an underlying vulnerability (e.g. failure of top-down cognitive control) common to all three disorders.
Many medications administered to patients with schizophrenia possess anticholinergic properties. When aggregated, pharmacological treatments may result in a considerable anticholinergic burden. The extent to which anticholinergic burden has a deleterious effect on cognition and impairs ability to participate in and benefit from psychosocial treatments is unknown.
Seventy patients were followed for approximately 3 years. The MATRICS consensus cognitive battery (MCCB) was administered at baseline. Anticholinergic burden was measured with the Anticholinergic Cognitive Burden (ACB) scale. Ability to benefit from psychosocial programmes was measured using the DUNDRUM-3 Programme Completion Scale (D-3) at baseline and follow-up. Psychiatric symptoms were measured using the PANSS. Total antipsychotic dose was measured using chlorpromazine equivalents. Functioning was measured using the Social and Occupational Functioning Assessment Scale (SOFAS).
Mediation analysis found that the influence of anticholinergic burden on ability to participate and benefit from psychosocial programmes was completely mediated by the MCCB. For every 1-unit increase on the ACB scale, change scores for DUNDRUM-3 decreased by −0.27 points. This relationship appears specific to anticholinergic burden and not total antipsychotic dose. Moreover, mediation appears to be specific to cognition and not psychopathology. Baseline functioning also acted as mediator but only when MCCB was not controlled for.
Anticholinergic burden has a significant impact on patients’ ability to participate in and benefit from psychosocial treatment programmes. Physicians need to be mindful of the cumulative effect that medications can have on patient cognition, functional capacity and ability to benefit from psychosocial treatments.
Many youth participate in extracurricular activities, and research has linked activity participation with school engagement and academic success. Social-ecological theory suggests that the social contexts of different types of extracurricular activities may differentially affect student outcomes. Yet, there is scant research examining the relation between various extracurricular activities and student outcomes. The current study seeks to address this gap by exploring how participation in three activities (sports, clubs, and arts), and combinations of these activities are associated with perceptions of school climate, using multilevel modelling. Participants included 15,004 high school students from 28 schools across 11 states in the United States. Findings suggest that students involved in extracurricular activities have more favourable perceptions of social-emotional security, adult support, student support, and school connectedness. However, these perceptions vary by activity type and combination, and do not appear to have a stacked effect in which involvement in more activities yields more favourable outcomes. We conclude that extracurricular activity participation may serve as a mechanism to promote a positive school climate. Implications for research and practice are discussed.
The multi-object spectroscopic facility FOCAP at the Anglo-Australian Telescope has been used to obtain spectra centred at the Ca II IR triplet of 14 stars in the field of the Sextans dwarf spheroidal (dSph) galaxy. This satellite of our own Galaxy was recently discovered by Irwin et al. (1990) from APM measures of UK Schmidt Telescope photographic plates.
We describe the cases of two children who both presented in infancy with recurrent severe pulmonary hypertensive crises. Exhaustive clinical work-up failed to identify an underlying aetiology. The patients had no clinical response to steroids, immunoglobulins, or pulmonary vasodilators. Post-mortem examination revealed extensive invasive pulmonary capillary haemangiomatosis. There was no evidence of pulmonary venous occlusive disease. Given the lethal nature of this condition, early consideration of referral to a lung transplant centre should be considered in selected patients.
Helicobacter pylori infection is a major cause of peptic ulcer and is also associated with chronic gastritis, mucosa-associated lymphoid tissue (MALT) lymphoma, and adenocarcinoma of the stomach. Guidelines have been developed in the United States and Europe (areas with low prevalence) for the diagnosis and management of this infection, including the recommendation to ‘test and treat’ those with dyspepsia. A group of international experts performed a targeted literature review and formulated an expert opinion for evidenced-based benefits and harms for screening and treatment of H. pylori in high-prevalence countries. They concluded that in Arctic countries where H. pylori prevalence exceeds 60%, treatment of persons with H. pylori infection should be limited only to instances where there is strong evidence of direct benefit in reduction of morbidity and mortality, associated peptic ulcer disease and MALT lymphoma and that the test-and-treat strategy may not be beneficial for those with dyspepsia.
We performed a study to determine rates of reinfection in three groups followed for 2 years after successful treatment: American Indian/Alaska Native (AI/AN) persons living in urban (group 1) and rural (group 2) communities, and urban Alaska non-Native persons (group 3). We enrolled adults diagnosed with H. pylori infection based on a positive urea breath test (13C-UBT). After successful treatment was documented at 2 months, we tested each patient by 13C-UBT at 4, 6, 12 and 24 months. At each visit, participants were asked about medication use, illnesses and risk factors for reinfection. We followed 229 persons for 2 years or until they became reinfected. H. pylori reinfection occurred in 36 persons; cumulative reinfection rates were 14·5%, 22·1%, and 12·0% for groups 1, 2, and 3, respectively. Study participants who became reinfected were more likely to have peptic ulcer disease (P = 0·02), low education level (P = 0·04), or have a higher proportion of household members infected with H. pylori compared to participants who did not become reinfected (P = 0·03). Among all three groups, reinfection occurred at rates higher than those reported for other US populations (<5% at 2 years); rural AI/AN individuals appear to be at highest risk for reinfection.
OVERVIEW. One of the most important challenges facing the career counseling profession is developing effective strategies to counsel racially diverse individuals. Understanding the role of racial factors in career counseling requires an understanding of the impact of race on the development and identification of career concerns (Leong & Hartung, 1997). This chapter invites an understanding of career counseling with a focus on people of African ancestry. There is scant literature on the career development and career counseling of people of African ancestry including African Americans. This paucity of literature is explained, in part, by the fact that people of African ancestry have unique histories of being excluded from a broad range of human services, including career counseling.
This chapter considers career counseling with people of African ancestry. First, the chapter explores how the African cultural belief of Ubuntu may influence individuals and then considers its possible influence on career counseling. Second, the chapter considers how cultural contexts may impact the career counseling of individuals of African ancestry, specifically African Americans and African immigrants. Finally, social justice and narrative approaches to career counseling are examined as a means to address the needs of people of African ancestry in a range of cultural settings.
By the end of the chapter, the reader should be able to:
Demonstrate an understanding of the evolving nature of career counseling and of the culture of people of African ancestry.
The Hague, Netherlands, 1690. Christiaan Huygens and Sir Isaac Newton, at odds with their competing wave/particle theories of light, today reached a compromise with their unveiling of a new multibeam SEM/FIB instrument featuring an SEM column designed by Huygens that uses electromagnetic lenses to focus the beam of electrons and a FIB column employing electrostatic lenses to focus the beam of ions devised by Newton. Onlookers were dazzled by its extensive capabilities and range of applications.
Sheep, after infection with louping ill virus and after re-infection with the same strain of virus 19–21 months later, were bled at intervals and their sera examined for neutralizing and haemagglutinin-inhibiting antibodies. Each antibody type was measured by the constant serum/variable virus and constant virus/variable serum methods. The persistence of each type of antibody and its significance in epidemiological studies is discussed. The relationship of antibody levels in ewes and their lambs was also examined.
In 1990, Fontan, Kirklin, and colleagues published equations for survival after the so-called “Perfect Fontan” operation. After 1988, we evolved a protocol using an internal or external polytetraflouroethylene tube of 16 to 19 millimetres diameter placed from the inferior caval vein to either the right or left pulmonary artery along with a bidirectional cava-pulmonary connection. The objective of this study was to test the hypothesis that a “perfect” outcome is routinely achievable in the current era when using a standardized surgical procedure.
Between 1 January, 1988, and 12 December, 2005, 112 patients underwent the Fontan procedure using an internal or external polytetraflouroethylene tube plus a bidirectional cava-pulmonary connection, the latter usually having been constructed as a previous procedure. This constituted 45% of our overall experience in constructing the Fontan circulation between 1988 and 1996, and 96% of the experience between 1996 and 2005. Among all surviving patients, the median follow-up was 7.3 years. We calculated the expected survival for an optimal candidate, given from the initial equations, and compared this to our entire experience in constructing the Fontan circulation.
An internal tube was utilized in 61 patients, 97% of whom were operated prior to 1998, and an external tube in 51 patients, the latter accounting for 95% of all operations since 1999. At 1, 5, 10 and 15 years, survival of the entire cohort receiving polytetraflouroethylene tubes is superimposable on the curve calculated for a “perfect” outcome. Freedom from replacement or revision of the tube was 97% at 10 years.
Using a standardized operative procedure, combining a bidirectional cavopulmonary connection with a polytetraflouroethylene tube placed from the inferior caval vein to the pulmonary arteries for nearly all patients with functionally univentricular hearts, early and late survival within the “perfect” outcome as predicted by the initial equations of Fontan and Kirklin is routinely achievable in the current era. The need for late revision or replacement of the tube is rare.