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Catheter ablation is a safe and effective therapy for the treatment of supraventricular tachycardia in children. Current improvements in technology have allowed progressive reduction in radiation exposure associated with the procedure. To assess the impact of three-dimensional mapping, we compared acute procedural results collected from the Catheter Ablation with Reduction or Elimination of Fluoroscopy registry to published results from the Prospective Assessment after Pediatric Cardiac Ablation study.
Inclusion and exclusion criteria from the Prospective Assessment after Pediatric Cardiac Ablation study were used as guidelines to select patient data from the Catheter Ablation with Reduction or Elimination of Fluoroscopy registry to compare acute procedural outcomes between cohorts. Outcomes assessed include procedural and fluoroscopy exposure times, success rates of procedure, and complications.
In 786 ablation procedures, targeting 498 accessory pathways and 288 atrioventricular nodal reentrant tachycardia substrates, average procedural time (156.5 versus 206.7 minutes, p < 0.01), and fluoroscopy time (1.2 versus 38.3 minutes, p < 0.01) were significantly shorter in the study group. Success rates for the various substrates were similar except for manifest accessory pathways which had a significantly higher success rate in the study group (96.4% versus 93.0%, p < 0.01). Major complication rates were significantly lower in the study group (0.3% versus 1.6%, p < 0.01).
In a large, multicentre study, three-dimensional systems show favourable improvements in clinical outcomes in children undergoing catheter ablation of supraventricular tachycardia compared to the traditional fluoroscopic approach. Further improvements are anticipated as technology advances.
‘Dementia-friendly communities’ herald a shift toward the neighbourhood as a locus for the care and support of people with dementia, sparking growing interest in the geographies of dementia care and raising questions over the shifting spatial and social experience of the condition. Existing research claims that many people with dementia experience a ‘shrinking world’ whereby the boundaries to their social and physical worlds gradually constrict over time, leading to a loss of control and independence. This paper reports a five-year, international study that investigated the neighbourhood experience of people with dementia and those who care for and support them. We interrogate the notion of a shrinking world and in so doing highlight an absence of attention paid to the agency and actions of people with dementia themselves. The paper draws together a socio-relational and embodied-material approach to question the adequacy of the shrinking world concept as an explanatory framework and to challenge reliance within policy and practice upon notions of place as fixed or stable. We argue instead for the importance of foregrounding ‘lived place’ and attending to social practices and the networks in which such practices evolve. Our findings have implications for policy and practice, emphasising the need to bolster the agency of people living with dementia as a route to fostering accessible and inclusive neighbourhoods.
The Promontory caves (Utah) and Franktown Cave (Colorado) contain high-fidelity records of short-term occupations by groups with material culture connections to the Subarctic/Northern Plains. This research uses Promontory and Franktown bison dung, hair, hide, and bone collagen to establish local baseline carbon isotopic variability and identify leather from a distant source. The ankle wrap of one Promontory Cave 1 moccasin had a δ13C value that indicates a substantial C4 component to the animal's diet, unlike the C3 diets inferred from 171 other Promontory and northern Utah bison samples. We draw on a unique combination of multitissue isotopic analysis, carbon isoscapes, ancient DNA (species and sex identification), tissue turnover rates, archaeological contexts, and bison ecology to show that the high δ13C value was not likely a result of local plant consumption, bison mobility, or trade. Instead, the bison hide was likely acquired via long-distance travel to/from an area of abundant C4 grasses far to the south or east. Expansive landscape knowledge gained through long-distance associations would have allowed Promontory caves inhabitants to make well-informed decisions about directions and routes of movement for a territorial shift, which seems to have occurred in the late thirteenth century.
There is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness.
This study seeks to describe patterns of service use, continuity of care, health risks, physical healthcare monitoring and the balance between primary and secondary mental healthcare for people with severe mental illness in receipt of secondary mental healthcare in the UK.
We conducted an epidemiological medical records review in three UK sites. We identified 297 cases randomly selected from the three participating mental health services. Data were manually extracted from electronic patient medical records from both secondary and primary care, for a 2-year period (2012–2014). Continuous data were summarised by mean and s.d. or median and interquartile range (IQR). Categorical data were summarised as percentages.
The majority of care was from secondary care practitioners: of the 18 210 direct contacts recorded, 76% were from secondary care (median, 36.5; IQR, 14–68) and 24% were from primary care (median, 10; IQR, 5–20). There was evidence of poor longitudinal continuity: in primary care, 31% of people had poor longitudinal continuity (Modified Modified Continuity Index ≤0.5), and 43% had a single named care coordinator in secondary care services over the 2 years.
The study indicates scope for improvement in supporting mental health service delivery in primary care. Greater knowledge of how care is organised presents an opportunity to ensure some rebalancing of the care that all people with severe mental illness receive, when they need it. A future publication will examine differences between the three sites that participated in this study.
Health reform debate understandably focuses on large system design. We should not omit attention to the “last mile” problem of physician payment theory. Achieving fundamental goals of integrative, patient-centered primary care depends on thoughtful financial support. This commentary describes the nature and importance of innovative primary care payment programs.
This article draws upon six social research studies completed by members of the Dementia and Ageing Research Team at The University of Manchester and their associated networks over an eight-year period (2011–2019) with the aim of constructing a definition of ‘being in the moment’ and situating it within a continuum of moments that could be used to contextualise and frame the lived experience of dementia. Using the approach formulated by Pound et al. (2005) in synthesising qualitative studies, we identified this continuum of moments as comprising four sequential and interlinked steps: (a) ‘creating the moment’, defined as the processes and procedures necessary to enable being in the moment to take place – the time necessary for this to occur can range from fleeting to prolonged; (b) ‘being in the moment’, which refers to the multi-sensory processes involved in a personal or relational interaction and embodied engagement – being in the moment can be sustained through creativity and flow; (c) ‘ending the moment’, defined as when a specific moment is disengaged – this can be triggered by the person(s) involved consciously or subconsciously, or caused by a distraction in the environment or suchlike; and (d) ‘reliving the moment’, which refers to the opportunity for the experience(s) involved in ‘being in the moment’ to be later remembered and shared, however fragmentary, supported or full the recall.
Although there is some evidence that duration of untreated psychosis (DUP) is geographically stable, few have examined whether the phenomenon is temporally stable. We examined DUP in two cohorts within two discrete time periods (1995–1999 and 2003–2005) spanning a decade in the same geographically defined community psychiatric service with no early intervention programme. Patients were diagnosed by Structured Clinical Interview for DSM (SCID) and we determined the DUP using the Beiser Scale. The DUP of the 240 participants did not differ significantly between study periods.
The increased uptake of evidence from systematic reviews is advocated because of their potential to improve the quality of patient care. However, research suggests that evidence from systematic reviews has not been widely adopted. Little is known about the factors that impact on systematic review uptake.
To identify how uptake of evidence from systematic reviews can be enhanced.
We searched 19 databases covering the full range of publication years, utilizing three search engines. Study selection Reports of strategies improving systematic review uptake were selected and evaluated according to the Effective Practice and Organisation of Care criteria.
Two reviewers independently assessed quality and extracted data from each outcome study.
Ten publications addressing interventions met inclusion criteria. Following a systematic review of these studies, a further broader synthesis of findings was carried out to determine the extent to which the identified interventions overcame already identified barriers and built on perceived facilitators.
Strategies such as targeted messaging, educational visits, and summaries, addressed a range of barriers and facilitators and are recommended to enhance uptake of systematic reviews and meta-analyses. Promising approaches such as inactive workshops, e-learning programmes and computer-based approaches need to be developed further. New strategies need to be designed that address a number of identified but neglected barriers and facilitators. This review has added value. It addressed not just effectiveness but also appropriateness of knowledge uptake strategies. It allowed the development of an intervention to enhance evidence uptake in psychiatry.
Previous research in clinical, community, and school settings has demonstrated positive outcomes for the Secret Agent Society (SAS) social skills training program. This is designed to help children on the autism spectrum become more aware of emotions in themselves and others and to ‘problem-solve’ complex social scenarios. Parents play a key role in the implementation of the SAS program, attending information and support sessions with other parents and providing supervision, rewards, and feedback as their children complete weekly ‘home mission’ assignments. Drawing on data from a school-based evaluation of the SAS program, we examined whether parents’ engagement with these elements of the intervention was linked to the quality of their children’s participation and performance. Sixty-eight 8–14-year-olds (M age = 10.7) with a diagnosis of autism participated in the program. The findings indicated that ratings of parental engagement were positively correlated with children’s competence in completing home missions and with the quality of their contribution during group teaching sessions. However, there was a less consistent relationship between parental engagement and measures of children’s social and emotional skill gains over the course of the program.
May faced a choice between a fantasy Brexit, designed only to gratify a minority who are immune to gratification, and real Brexits that require compromise on every side. It wasn't an appealing decision, but nor was it a hard one. (Behr, 2018)
There has been an outpouring of journalistic and academic writing that has used the idea of fantasy to describe and critique Brexit (see, for example, Gearty, 2016; Nawratek, 2017; Newbigin, 2017; Eaglestone, 2018; Shariatmardi, 2018). It has been one widely used figure through which to address both the political leadership (of the campaign to leave and of the Conservative Party in government) and the popular support for Leave. Much of the time, ‘fantasy’ has been deployed as an image driven by liberal scepticism – denoting the apparently illinformed, misguided and potentially disastrous project of leaving the EU. It has been frequently expressed in the image of searching for ‘unicorns’ as a way of registering the triumph of fantasy and desire over rationality (for example, Rigby, 2019). It is not the aim here to treat fantasy in these terms, as marking a politics that is explicitly or implicitly contrasted with hard-headed realism or rational political decision-making. Too much of the debate around Brexit has found it convenient to dismiss the vote to leave in such terms. However, this does not mean abandoning the idea of fantasy: this chapter is more interested in how fantasy may be a productive way of thinking about processes of political articulation and mobilization – offering a means of addressing projections and promises that find political purchase. The chapter certainly does not assume that only the Leave campaign traded in affective politics that involved the use of collective fantasies: the campaign to remain was dubbed ‘Project Fear’ by the Leave campaign for good reason, and contrasted the projected economic misery outside the EU with images of other empowered (largely consumerist) futures for UK citizens should they make the ‘reasonable’ choice.
In the context of Brexit, then, one might pay attention to specific aspects of political-cultural fantasy work that project a double dynamic of loss and restoration; examples of what Paul Gilroy has described as melancholia, borrowing and adapting the term from Freud to explore the postcolonial condition in Britain.
Studies suggest that alcohol consumption and alcohol use disorders have distinct genetic backgrounds.
We examined whether polygenic risk scores (PRS) for consumption and problem subscales of the Alcohol Use Disorders Identification Test (AUDIT-C, AUDIT-P) in the UK Biobank (UKB; N = 121 630) correlate with alcohol outcomes in four independent samples: an ascertained cohort, the Collaborative Study on the Genetics of Alcoholism (COGA; N = 6850), and population-based cohorts: Avon Longitudinal Study of Parents and Children (ALSPAC; N = 5911), Generation Scotland (GS; N = 17 461), and an independent subset of UKB (N = 245 947). Regression models and survival analyses tested whether the PRS were associated with the alcohol-related outcomes.
In COGA, AUDIT-P PRS was associated with alcohol dependence, AUD symptom count, maximum drinks (R2 = 0.47–0.68%, p = 2.0 × 10−8–1.0 × 10−10), and increased likelihood of onset of alcohol dependence (hazard ratio = 1.15, p = 4.7 × 10−8); AUDIT-C PRS was not an independent predictor of any phenotype. In ALSPAC, the AUDIT-C PRS was associated with alcohol dependence (R2 = 0.96%, p = 4.8 × 10−6). In GS, AUDIT-C PRS was a better predictor of weekly alcohol use (R2 = 0.27%, p = 5.5 × 10−11), while AUDIT-P PRS was more associated with problem drinking (R2 = 0.40%, p = 9.0 × 10−7). Lastly, AUDIT-P PRS was associated with ICD-based alcohol-related disorders in the UKB subset (R2 = 0.18%, p < 2.0 × 10−16).
AUDIT-P PRS was associated with a range of alcohol-related phenotypes across population-based and ascertained cohorts, while AUDIT-C PRS showed less utility in the ascertained cohort. We show that AUDIT-P is genetically correlated with both use and misuse and demonstrate the influence of ascertainment schemes on PRS analyses.
In the spectrum of the cities buried by Vesuvius, studies of humble dwellings have suffered from poor preservation, a lack of documentation and a general disinterest. Small commercial spaces frequented by non-élites, such as tabernae, thermopolia, cauponae, popinae and cenacula, remain difficult to identify as they often doubled as domestic spaces and Latin terminology does not always match the architectural remains. A few studies have focused on the place of such spaces within Roman architecture as well as on the economic rôles of tabernae and/or rental accommodations.1 This paper expands on these approaches by offering the preliminary results of research at Oplontis B (Torre Annunziata) by the Oplontis Project, one of the few sites where a series of row houses sheds light on the domestic aspects of tabernae and their rôle in urban development along the Bay of Naples.2
We report on the successful demonstration of a 150 J nanosecond pulsed cryogenic gas cooled, diode-pumped multi-slab Yb:YAG laser operating at 1 Hz. To the best of our knowledge, this is the highest energy ever recorded for a diode-pumped laser system.
Relapse prevention strategies based on monitoring of early warning signs (EWS) are advocated for the management of psychosis. However, there has been a lack of research exploring how staff, carers and patients make sense of the utility of EWS, or how these are implemented in context.
To develop a multiperspective theory of how EWS are understood and used, which is grounded in the experiences of mental health staff, carers and patients.
Twenty-five focus groups were held across Glasgow and Melbourne (EMPOWER Trial, ISRCTN: 99559262). Participants comprised 88 mental health staff, 21 patients and 40 carers from UK and Australia (total n = 149). Data were analysed using constructivist grounded theory.
All participants appeared to recognise EWS and acknowledged the importance of responding to EWS to support relapse prevention. However, recognition of and acting on EWS were constructed in a context of uncertainty, which appeared linked to risk appraisals that were dependent on distinct stakeholder roles and experiences. Within current relapse management, a process of weighted decision-making (where one factor was seen as more important than others) described how stakeholders weighed up the risks and consequences of relapse alongside the risks and consequences of intervention and help-seeking.
Mental health staff, carers and patients speak about using EWS within a weighted decision-making process, which is acted out in the context of relationships that exist in current relapse management, rather than an objective response to specific signs and symptoms.
This book brings about a long overdue, and much needed, encounter between social policy and geography. Now that it has finally arrived, we can see some of the possibilities and problems that might be at stake in developing the encounter into a more long-running dialogue. Here my aim is to reflect back on some of the issues and arguments that emerged in the preceding chapters and their implications for the study of social policy. Later, I try to pick out two or three themes that might add to the potential conversation between geography and social policy by thinking a little further about ways in which space, place and policy are entangled. The chapter is written from the perspective of an occasionally disaffected social policy scholar who had the good fortune to mix with geographers who taught him the benefits of ‘taking geography seriously’ (Massey and Allen, 1984).
One of the conditions underlying my social policy disaffection is shared with many of the authors in this collection, and with the position that underpins it. The book is inspired by a deafening silence about place and space in social policy, characterised by the assumption that place is a self-evident and unquestioned terrain where policy and its practices happen. It is treated as a backdrop, location or passive context rather than an active force in the organisation of social life. Whether analysis is directed to the nation state or the neighbourhood, social policy is shot through with geographical reference points that are rarely questioned. For me, the assumptions about the nation (and its accompanying state) have always been a stumbling block, with national borders taken for granted as the framework within which analysis could be conducted – or between which comparisons could be safely made. The presumption of what we might call spatial tidiness, the belief that there is a stable entity bounded by fixed borders, in which the people, the policy and culture form a coherent and harmonious whole, has dominated much of social policy – with unfortunate consequences.