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The ventricular assist device is being increasingly used as a “bridge-to-transplant” option in children with heart failure who have failed medical management. Care for this medically complex population must be optimised, including through concomitant pharmacotherapy. Pharmacokinetic/pharmacodynamic alterations affecting pharmacotherapy are increasingly discovered in children supported with extracorporeal membrane oxygenation, another form of mechanical circulatory support. Similarities between extracorporeal membrane oxygenation and ventricular assist devices support the hypothesis that similar alterations may exist in ventricular assist device-supported patients. We conducted a literature review to assess the current data available on pharmacokinetics/pharmacodynamics in children with ventricular assist devices. We found two adult and no paediatric pharmacokinetic/pharmacodynamic studies in ventricular assist device-supported patients. While mechanisms may be partially extrapolated from children supported with extracorporeal membrane oxygenation, dedicated investigation of the paediatric ventricular assist device population is crucial given the inherent differences between the two forms of mechanical circulatory support, and pathophysiology that is unique to these patients. Commonly used drugs such as anticoagulants and antibiotics have narrow therapeutic windows with devastating consequences if under-dosed or over-dosed. Clinical studies are urgently needed to improve outcomes and maximise the potential of ventricular assist devices in this vulnerable population.
To investigate the importance of anatomical variation in acquiring skills in virtual reality cochlear implant surgery.
Eleven otolaryngology residents participated in this study. They were randomly allocated to practice cochlear implant surgery on the same specimen or on different specimens for four weeks. They were then tested on two new specimens, one standard and one challenging. Videos of their performance were de-identified and reviewed independently, by two blinded consultant otolaryngologists, using a validated assessment scale. The scores were compared between groups.
On the standard specimen, the round window preparation score was 2.7 ± 0.4 for the experimental group and 1.7 ± 0.6 for the control group (p = 0.01). On the challenging specimen, instrument handling and facial nerve preservation scores of the experimental group were 3.0 ± 0.4 and 3.5 ± 0.7 respectively, while the control group received scores of 2.1 ± 0.8 and 2.4 ± 0.9 respectively (p < 0.05).
Training on temporal bones with differing anatomies is beneficial in the development of expertise.
We present an interesting and rare case of traumatic Gerbode ventricular septal defect and complete heart block. The multimodality images illustrate the diagnosis well. This case is an excellent demonstration of the diagnostic utility of multimodality imaging.
Although the spectrum of physiology seen in infants and children with double-outlet right ventricle is broad, this anatomy in combination with an aortopulmonary window is extremely rare. We present an interesting case of an infant prenatally diagnosed with this rare CHD. To our knowledge, this is the first report of complete repair in the neonatal period for such a combination of defects.
We report a case of endocarditis of a transcatheter pulmonary valve-in-valve in a 14-year-old boy with tetralogy of Fallot. He presented with recurrent low-grade fevers, lethargy, and anorexia. Multiple blood cultures grew a gram-positive rod, Corynebacterium pseudodiphtheriticum. He was taken to the operating room for removal of the vegetative endocarditis and pulmonary valve replacement.
A 7-year-old child was noted to have dextrojuxtaposition of the left atrial appendage at the time of surgical atrial septal defect repair. Given the favourable anatomic location and size of the atrial appendage, it was inverted and used to close the atrial defect. This is the first report of atrial septal defect repair using a juxtaposed atrial appendage. The cardiac anatomy and theoretical benefits of this repair are discussed.
Cyber-bullying has emerged as the latest Permutation of school bullying. The growing number and the level of severity of cyber-bullying call for our educators, researchers, administrators, and authorities to take action. But before we can tackle this problem, a better understanding of the issue and how we can best support students is necessary. This study of 652 young people aged 11–17 years from Melbourne independent and state government schools, provides data on bullying that uses information and communication technologies (cyber-bullying), general bullying, and overall patterns of coping. Results revealed significant gender and school differences – with girls from independent schools reporting more cyber-bullying problems. These findings contrast with those of ‘real-world’(general) school bullying. Further analyses suggest that young people who are persistently victimised have most likely exhausted their strategies for responding. Of note, apprehensive and avoidant coping profiles exemplified girls reporting greater levels of cyber-bullying while boys reporting cyber-bullying problems were characterized by apprehensive, but active coping actions. The findings offer clear avenues of support for school practitioners and may also facilitate the identification of young people who are at high risk for negative outcomes.
The function of the mental health review tribunal is defined in Part V of the Mental Health Act 1983. Together with statute and Common Law, it provides safeguards to those detained under the Act. The provisions of the Human Rights Act 1998 have strengthened these safeguards. The key articles in Schedule 1 of the Human Rights Act are 5(1)(e), relating to the lawful detention of persons of unsound mind; 5(4), providing that the lawfulness of such detention shall be decided speedily by a court; 6, providing for a fair and public hearing within a reasonable time by an independent and impartial tribunal established by law; and 8, establishing the right to respect for a private and family life. The latter is relevant to disclosure, nearest relatives' rights, and treatment.
Few topics in ecology are as intriguing or bedeviling as
comparative studies of different types of mycorrhizas
formed in the same plant species. Attempts to determine
the relative benefits from each fungal type to the host plant
are fraught with difficulties (Jones et al., 1998), and for this
reason plants that form tripartite associations with arbuscular
and ectomycorrhizal fungi make ideal experimental
systems. Just such a tripartite system is explored in a
report in this issue by Chen et al. (pp. 545–556).
Why compare mycorrhizas? Although both ecto- and
arbuscular mycorrhizas are generally known to increase
the uptake of nutrients such as phosphorus and nitrogen in
infertile soils, their functions and the benefits they provide
to their host plants may not be equivalent (Jones et al.,
1998). Hence the ecological benefits of the two types of
symbiosis are of great interest to plant community
ecologists and researchers studying nutrient cycling.
Arbuscular mycorrhizas are formed as a symbiosis of plant
roots with primitive fungi of the order Glomales (Zygomycetes),
while ectomycorrhizas are formed with higher
basidiomycetes and a few ascomycetes. Only a few plant
genera and species are capable of forming both types of
association, sometimes on the same root tip (Fig. 1), but
it is these that are so useful in comparative studies.
All British mental health professionals will be aware of several highly publicised deaths at the hands of mentally ill people and will have seen the conclusions of inquiries and government reactions. To reduce the risk of future tragedies effective methods of risk assessment and prediction are needed.