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This article updates Karen May’s earlier 2012 hypothesis (Could Captain Scott have been saved? Revisiting Scott’s last expedition). In this revised hypothesis, Cecil Meares, not Surgeon E. L. Atkinson, originated the unsubstantiated statement that “Strict injunctions had been given by Scott that the dogs should not be risked in any way.” This hypothesis incorporates new information uncovered since 2012, specifically Meares’ misrepresentations during the Terra Nova expedition; Atkinson’s 1911 journal entries; Atkinson’s 1919 allegation that Meares had “disobeyed orders”; and Tryggve Gran’s “The Race for the South Pole between Scott and Amundsen”, a 1945/post-1945 document that appears to have been Roland Huntford’s source for anecdotes in Huntford’s 1979 Scott–Amundsen biography. The article gives a proposed chronology for how Meares’ early misrepresentations and Gran’s later misunderstandings influenced the decisions, and later presentations, of the Terra Nova expedition.
Point-of-care ultrasound (POCUS) is used increasingly during resuscitation. The aim of this study was to assess whether combining POCUS and electrocardiogram (ECG) rhythm findings better predicts outcomes during cardiopulmonary resuscitation in the emergency department (ED).
We completed a health records review on ED cardiac arrest patients who underwent POCUS. Primary outcome measurements included return of spontaneous circulation (ROSC), survival to hospital admission, and survival to hospital discharge.
POCUS was performed on 180 patients; 45 patients (25.0%; 19.2%–31.8%) demonstrated cardiac activity on initial ECG, and 21 (11.7%; 7.7%–17.2%) had cardiac activity on initial POCUS; 47 patients (26.1%; 20.2%–33.0%) achieved ROSC, 18 (10.0%; 6.3%–15.3%) survived to admission, and 3 (1.7%; 0.3%–5.0%) survived to hospital discharge. As a predictor of failure to achieve ROSC, ECG had a sensitivity of 82.7% (95% CI 75.2%–88.7%) and a specificity of 46.8% (32.1%–61.9%). Overall, POCUS had a higher sensitivity of 96.2% (91.4%–98.8%) but a similar specificity of 34.0% (20.9%–49.3%). In patients with ECG-asystole, POCUS had a sensitivity of 98.18% (93.59%–99.78%) and a specificity of 16.00% (4.54%–36.08%). In patients with pulseless electrical activity, POCUS had a sensitivity of 86.96% (66.41%–97.22%) and a specificity of 54.55% (32.21%–75.61%). Similar patterns were seen for survival to admission and discharge. Only 0.8% (0.0–4.7%) of patients with ECG-asystole and standstill on POCUS survived to hospital discharge.
The absence of cardiac activity on POCUS, or on both ECG and POCUS together, better predicts negative outcomes in cardiac arrest than ECG alone. No test reliably predicted survival.
Cognitive ability and problem behaviour (externalising and internalising problems) are variable and inter-related in children. However, it is not known if they mutually influence one another, if difficulties in one cause difficulties in the other, or if they are related only because they share causes.
Random-intercept cross-lagged models adjusted for confounding were fitted to explore this in 17,318 (51% male) children of the UK’s Millennium Cohort Study at ages 3, 5, 7, 11 and 14 years. Externalising and internalising problems were assessed using the parent-reported Strengths and Difficulties Questionnaire. Cognitive ability was measured using standardised scores of age-appropriate validated cognitive ability assessments. Where multiple cognitive assessments were available a single score was derived using principal components analysis.
There was much evidence for cross-domain longitudinal effects in childhood, especially for cognitive ability (on both internalising and externalising problems and in both males and females) and externalising problems (on internalising problems in both genders and cognitive ability in males). Bidirectional effects were childhood-limited, gender-specific and less consistent. The consistent bidirectional associations were, in males, between externalising problems and cognitive ability, and, in females, between externalising and internalising problems (although the effects of internalising problems were weak). In adolescence, only externalising problems had cross-domain effects such that, in both genders, they were associated with lower cognitive ability in subsequent measurements and increased levels of internalising problems.
In either childhood or adolescence, reducing behavioural problems could have both emotional and cognitive benefits. In childhood, improving cognitive skills could reduce both emotional and behavioural problems.
The role that vitamin D plays in pulmonary function remains uncertain. Epidemiological studies reported mixed findings for serum 25-hydroxyvitamin D (25(OH)D)–pulmonary function association. We conducted the largest cross-sectional meta-analysis of the 25(OH)D–pulmonary function association to date, based on nine European ancestry (EA) cohorts (n 22 838) and five African ancestry (AA) cohorts (n 4290) in the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium. Data were analysed using linear models by cohort and ancestry. Effect modification by smoking status (current/former/never) was tested. Results were combined using fixed-effects meta-analysis. Mean serum 25(OH)D was 68 (sd 29) nmol/l for EA and 49 (sd 21) nmol/l for AA. For each 1 nmol/l higher 25(OH)D, forced expiratory volume in the 1st second (FEV1) was higher by 1·1 ml in EA (95 % CI 0·9, 1·3; P<0·0001) and 1·8 ml (95 % CI 1·1, 2·5; P<0·0001) in AA (Prace difference=0·06), and forced vital capacity (FVC) was higher by 1·3 ml in EA (95 % CI 1·0, 1·6; P<0·0001) and 1·5 ml (95 % CI 0·8, 2·3; P=0·0001) in AA (Prace difference=0·56). Among EA, the 25(OH)D–FVC association was stronger in smokers: per 1 nmol/l higher 25(OH)D, FVC was higher by 1·7 ml (95 % CI 1·1, 2·3) for current smokers and 1·7 ml (95 % CI 1·2, 2·1) for former smokers, compared with 0·8 ml (95 % CI 0·4, 1·2) for never smokers. In summary, the 25(OH)D associations with FEV1 and FVC were positive in both ancestries. In EA, a stronger association was observed for smokers compared with never smokers, which supports the importance of vitamin D in vulnerable populations.
BACKGROUND: The use of high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplant (HSCT) has been used in certain pediatric patients with brain tumours to delay/spare radiotherapy. We aimed to study factors predicting a successful stem cell collection (SCC) and correlate stem cell dose infused with HSCT outcomes. METHODS: A retrospective chart review was undertaken for pediatric patients with brain tumours treated at our centre with HDC/HSCT between 2004-2016. RESULTS: Fifty-five patients were identified (32 male) with median age of 6.3 years at time of SCC (range 0.4-18.7). Patients' diagnoses were medulloblastoma (62%), ATRT (20%), and PNET (18%). Most patients (82%) underwent a single/1-day SCC, while the remaining required 2 SCC procedures. Peripheral blood stem cells were the source in most collections (95%). Successful SCC (CD34 collected greater-than-or-equal-to 2 x10^6/kg/transplant) and ideal SCC (greater-than-or-equal-to 5 x10^6/kg/transplant) was achieved in 85% and 45% of patients, respectively. Use of mobilizing chemotherapy with G-CSF was the only factor associated with achieving an ideal collection, while gender, age, stem cell source, and pre-apheresis peripheral blood CD34 count were not significant. Higher CD34/kg infused was associated with faster neutrophil engraftment in the first 3 courses of HDC/HSCT and platelet engraftment in the first course. CONCLUSIONS: The majority of SCC for autologous HSCT can be successfully completed with a single apheresis session. Mobilization with both chemotherapy and G-CSF yields higher CD34 compared to G-CSF alone. Higher dose of CD34/kg infused was associated with faster neutrophil and to a more limited scale platelet recovery post-HSCT.
Dyspnea is a common presenting problem that creates a diagnostic challenge for physicians in the emergency department (ED). While the differential diagnosis is broad, acute decompensated heart failure (ADHF) is a frequent cause that can be challenging to differentiate from other etiologies. Recent studies have suggested a potential diagnostic role for emergency lung ultrasound (US). The objective of this systematic review was to assess the accuracy of early bedside lung US in patients presenting to the ED with dyspnea.
A systematic search of EMBASE, PubMed, and the Cochrane Library was performed in addition to a grey literature search. We selected prospective studies that reported on the sensitivity and specificity of B-lines from early lung ultrasound in dyspneic patients presenting to the ED. Selected studies underwent quality assessment using the Critical Appraisal and Skills Program (CASP) questionnaire.
Data Extraction and Synthesis
The search yielded 3674 articles; seven studies met inclusion criteria and fulfilled CASP requirements for a total of 1861 patients. Summary statistics from the meta-analysis showed that as a diagnostic test for ADHF, bedside lung US had a pooled sensitivity of 82.5% (95% confidence interval [CI]=66.4% to 91.8%) and a pooled specificity of 83.6% (95% CI=72.4% to 90.8%).
Our results suggest that in patients presenting to the ED with undifferentiated dyspnea, B-lines from early bedside lung US may be reliably used as an adjunct to current diagnostic methods. The incorporation of lung US may lead to more appropriate and timely diagnosis of patients with undifferentiated ADHF.
Observational studies report associations between early menarche and higher levels of depressive symptoms and depression. However, no studies have investigated whether this association is causal.
To determine whether earlier menarche is a causal risk factor for depressive symptoms and depression in adolescence.
The associations between a genetic score for age at menarche and depressive symptoms at 14, 17 and 19 years, and depression at 18 years, were examined using Mendelian randomisation analysis techniques.
Using a genetic risk score to indicate earlier timing of menarche, we found that early menarche is associated with higher levels of depressive symptoms at 14 years (odds ratio per risk allele 1.02, 95% CI 1.005–1.04, n=2404). We did not find an association between the early menarche risk score and depressive symptoms or depression after age 14.
Our results provide evidence for a causal effect of age at menarche on depressive symptoms at age 14.
Objective: Patients with Parkinson’s disease (PD) can show impaired self-awareness of motor deficits (ISAm). We developed a new scale that measures ISAm severity of hyper- and hypokinetic movements in PD during medication on state and defined its psychometric criteria. Method: Included were 104 right-handed, non-depressed, non-demented patients. Concerning ISAm, 38 motor symptoms were assessed using seven tasks, which were performed and self-rated concerning presence of deficit (yes/no) by all patients. The whole procedure was videotaped. Motor symptoms were then evaluated by two independent experts, blinded for patient’s ratings, concerning presence, awareness of deficit, and severity. Exploratory principal component analysis (promax rotation) was applied to reduce items. Principal axis factoring was conducted to extract factors. Reliability was examined regarding internal consistency, split-half reliability, and interrater reliability. Validity was verified by applying two additional measures of ISAm. Results: Of the initial 38 symptoms, 15 remained, assessed in five motor tasks and merged to a total severity score. Factor analysis resulted in a four factor solution (dyskinesia, resting tremor right hand, resting tremor left hand, bradykinesia). For all subscales and the total score, measures of reliability (values 0.64–0.89) and validity (effect sizes>0.3) were satisfactory. Descriptive results showed that 66% of patients had signs of ISAm (median 2, range 0–15), with ISAm being most distinct for dyskinesia. Conclusions: We provide the first validation of a test for ISAm in PD. Using this instrument, future studies can further analyze the pathophysiology of ISAm, the psychosocial sequelae, therapeutic strategies and compliance with therapy. (JINS, 2015, 21, 1–10)
Captain Robert Falcon Scott has been attacked in recent decades because his Terra Nova expedition (1910–1913) had to rely on substandard Siberian ponies. Certain commentators have argued that this was Scott's fault, but the available evidence indicates that blame should rest with the buyer Cecil Meares. Additionally, archive evidence indicates that Scott specifically requested Captain Lawrence Oates to travel to Siberia to assist Meares in 1910, and that Oates refused Scott's request.
An opinion piece by Ben Macintyre entitled ‘Sorry, Scott fans: noble death is so last century’ appeared in The Times (London) on 20 September 2013. In this, Macintyre argued not only that Ernest Shackleton should be explicitly contrasted against his contemporary and rival Robert Falcon Scott, but that Shackleton should be found superior to Scott in virtually every way. It was a dispiriting piece, strongly suggesting that that the media's understanding of Scott has not greatly advanced since the savage, cod-psychological and often unsubstantiated attacks upon Scott's character and reputation in the 1970s–1990s. Sadly, all too often polar history is reduced to a zero-sum game where praise for Shackleton is directly proportional to insults directed at Scott.
In his book Scott and Amundsen (1979) Roland Huntford described Captain Robert Falcon Scott R.N. as ‘not well thought of in the Service’ and ‘an obscure, rather dull torpedo lieutenant with mediocre prospects’. A myth has subsequently arisen that Scott was forced into Antarctic exploration as his only route to naval promotion. In reality, Scott was an extremely able officer held in high regard by his naval contemporaries; he was on course for promotion to flag rank (rear-admiral and above) had he not taken up polar exploration; and his primary motivation for polar work was financial support for his family. In addition to a chronological account of Scott's career, this article will present his Admirals’ reports in full.
On 1 June 1965, the House Un-American Activities Committee (HUAC) announced that it would hold hearings into the Ku Klux Klan, fifty years after the organization had appeared before the House Rules Committee. Whereas the 1925 investigation allowed the Klan to continue to claim a “100% Americanism,” HUAC unequivocally declared the Klan of the 1960s to be entirely un-American. This essay seeks to explain that turnaround in the understanding of the Klan and its activities, on the one hand, and the contested ideas of un-Americanism and Americanism on the other. It is only within the context of that struggle over un-Americanism's evolving definition, it is argued, that the official decision of civil rights organizations such as COFO and SCLC – whose members had suffered personally from Klan violence – to oppose the proposed HUAC investigation of the Klan can be understood. Similarly, that ongoing contest explains how it was that, after almost three decades of investigating left-wing organizations that often included those fighting for greater civil rights, HUAC was finally moved to turn its attention to the right. Finally, this essay seeks to determine what it was, precisely, about the Klan in 1965 that was deemed “un-American” rather than simply criminal.
On 18 June 1928, Roald Amundsen and a team of five men (René Guilbaud, Leif Dietrichson, Albert Cavelier de Cuverville, Gilbert Brazy and Emile Valette) flew in a French Latham 47 prototype aeroplane from Tromsø, Norway, to aid in the rescue of survivors of the crashed airship Italia. The party disappeared nearly without trace into the Barents Sea. We shall examine Amundsen's last years, the decision to employ for an Arctic relief mission a prototype aeroplane which had not completed its flight tests, and the evidence that, in deciding to disregard warnings and fly this aeroplane unaccompanied over the Barents Sea, Amundsen took a significant risk that led to his death and those of his crew.