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In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
Optical tracking systems typically trade off between astrometric precision and field of view. In this work, we showcase a networked approach to optical tracking using very wide field-of-view imagers that have relatively low astrometric precision on the scheduled OSIRIS-REx slingshot manoeuvre around Earth on 22 Sep 2017. As part of a trajectory designed to get OSIRIS-REx to NEO 101955 Bennu, this flyby event was viewed from 13 remote sensors spread across Australia and New Zealand to promote triangulatable observations. Each observatory in this portable network was constructed to be as lightweight and portable as possible, with hardware based off the successful design of the Desert Fireball Network. Over a 4-h collection window, we gathered 15 439 images of the night sky in the predicted direction of the OSIRIS-REx spacecraft. Using a specially developed streak detection and orbit determination data pipeline, we detected 2 090 line-of-sight observations. Our fitted orbit was determined to be within about 10 km of orbital telemetry along the observed 109 262 km length of OSIRIS-REx trajectory, and thus demonstrating the impressive capability of a networked approach to Space Surveillance and Tracking.
To outline features of the neurologic examination that can be performed virtually through telemedicine platforms (the virtual neurological examination [VNE]), and provide guidance for rapidly pivoting in-person clinical assessments to virtual visits during the COVID-19 pandemic and beyond.
The full neurologic examination is described with attention to components that can be performed virtually.
A screening VNE is outlined that can be performed on a wide variety of patients, along with detailed descriptions of virtual examination maneuvers for specific scenarios (cognitive testing, neuromuscular and movement disorder examinations).
During the COVID-19 pandemic, rapid adoption of virtual medicine will be critical to provide ongoing and timely neurological care. Familiarity and mastery of a VNE will be critical for neurologists, and this article outlines a practical approach to implementation.
Twenty-four new optically stimulated luminescence (OSL) and radiocarbon ages from sediment cores in nine lakes associated with the Shipshewana and Sturgis moraines in northern Indiana and southern Michigan estimate when recession of the Saginaw Lobe of the Laurentide Ice Sheet was underway in the southern Great Lakes region, USA. Average OSL ages of 23.4 ± 2.2 ka for the Shipshewana Moraine and 19.7 ± 2.2 ka for the Sturgis Moraine are considered minimum limiting deglacial ages for these recessional moraines. The much younger radiocarbon ages are consistent with other regional radiocarbon ages from lakes, and record climate amelioration around ~16.5 cal ka BP. Early recession of the interlobate Saginaw Lobe was well underway by 23.4 ± 2.2 ka, when the adjacent Lake Michigan and Huron-Erie lobes were a few hundred kilometers farther south and near their maximum southerly limits. The results provide the first time constraints when sediment from the Lake Michigan and Huron-Erie lobes began filling the accommodation space left by the Saginaw Lobe. The difference between the oldest radiocarbon and OSL age is 7400 yr for the Shipshewana Moraine and 3400 yr for the Sturgis Moraine.
Reducing the incidence and negative consequences of concussion among youth athletes is a public health priority. In 2010, Massachusetts passed legislation aimed at addressing the issue of concussions in school athletics. We sought to understand local-level implementation decisions of the Massachusetts concussion law.
A qualitative multiple-case study approach was utilized. Semi-structured interviews with school-employed actors associated with the law's implementation were used for analysis. Interview data were subjected to a conventional content analysis.
A total of 19 participants from 5 schools were interviewed. Schools were purposefully selected from communities varying in socioeconomic status and population. Participants included 5 athletic directors, 5 coaches, 4 athletic trainers, 4 school nurses, and 1 health and wellness coordinator. Eight themes emerged regarding specific ways schools have implemented the law. Six themes emerged regarding factors influencing implementation.
All cases employ neurocognitive testing as a means to assess concussions, place decision-making authority in athletic trainers' hands, and use a 30-minute online video to disseminate concussion education. Employing athletic trainers could pose challenges to school districts with limited financial capacity, as financial assistance from the state is not provided under the law. The validity of neurocognitive testing and the effectiveness of online concussion training need further study. Cooperation from student athletes, their parents, and physicians is necessary for full implementation of the law.
The research aim was to discover the circumstances, if any, in which contact with the parent who had abused them, could help survivors of intrafamilial child sexual abuse (ICSA) to recover from the inherent relational trauma. Thirty-five (31 female and 4 male) participants were recruited from across Australia and New Zealand to speak about their experience of post-abuse contact. The research methodology was primarily qualitative, and analysed in a contextual framework. In the Pre-Contact stage, themes such as the need for empowerment versus the fear of the response, linked to motivations for and against contact. Emotional reactions, and issues of acknowledgment and apology were core themes in the Contact stage. Post-contact themes related to evaluation of the overall experience. The majority of participants believed that their contact experience had helped more than hindered their recovery. Participants articulated the need for more public education about the complexity of ICSA, more options for dealing with the crime, and access to non-judgmental professional help for all the family at disclosure. The emergent themes provide a valuable guide for future research, policy and practice and perhaps most importantly, insight into the needs of victims and their recovery processes.
A bimodal mixture of silver nanoparticles consisting of spheres and triangular nanoplates was synthesized from silver nitrate (AgNO3) and polyvinylpyrrolidone with the aid of a microwave reactor system, reducing total reaction time from days to minutes; a specific shape-directing reagent was not used. It is known that freshly prepared solutions of AgNO3 contain a high population of Ag3+, while aged solutions contain fewer trimers. We propose that the product ratios of spheroidal to triangular particles are proportional to the relative population of trimers in solution prior to initiation of the microwave reaction.
Resilience is often associated with extreme trauma or overcoming extraordinary odds. This way of thinking about resilience leaves most of the ontogenetic picture a mystery. In the following review we put forth the Everyday Stress Resilience Hypothesis, in which resilience is analysed from a systems perspective and seen as a process of regulating everyday life stressors. Successful regulation accumulates into regulatory resilience, which emerges during early development from successful coping with the inherent stress in typical interactions. These quotidian stressful events lead to activation of behavioural and physiological systems. Stress that is effectively resolved in the short run and with reiteration over the long term increases children’s, as well as adults’, capacity to cope with more intense stressors. Infants, however, lack the regulatory capacities to take on this task by themselves. Therefore, through communicative and regulatory processes during infant–adult interactions, we demonstrate that the roots of regulatory resilience originate in infants’ relationships with their care givers and that maternal sensitivity can help or hinder the growth of resilience.
We present the results of an approximately 6 100 deg2 104–196 MHz radio sky survey performed with the Murchison Widefield Array during instrument commissioning between 2012 September and 2012 December: the MWACS. The data were taken as meridian drift scans with two different 32-antenna sub-arrays that were available during the commissioning period. The survey covers approximately 20.5 h < RA < 8.5 h, − 58° < Dec < −14°over three frequency bands centred on 119, 150 and 180 MHz, with image resolutions of 6–3 arcmin. The catalogue has 3 arcmin angular resolution and a typical noise level of 40 mJy beam− 1, with reduced sensitivity near the field boundaries and bright sources. We describe the data reduction strategy, based upon mosaicked snapshots, flux density calibration, and source-finding method. We present a catalogue of flux density and spectral index measurements for 14 110 sources, extracted from the mosaic, 1 247 of which are sub-components of complexes of sources.
Emergency physicians are expected to rule out clinically important cervical spine injuries using clinical skills and imaging. Our objective was to determine whether emergency physicians could accurately rule out clinically important cervical spine injuries using computed tomographic (CT) imaging of the cervical spine.
Fifteen emergency physicians were enrolled to interpret a sample of 50 cervical spine CT scans in a nonclinical setting. The sample contained a 30% incidence of cervical spine injury. After a 2-hour review session, the participants interpreted the CT scans and categorized them into either a suspected cervical spine injury or no cervical spine injury. Participants were asked to specify the location and type of injury. The gold standard interpretation was the combined opinion of two staff radiologists.
Emergency physicians correctly identified 182 of the 210 abnormal cases with cervical spine injury. The sensitivity of emergency physicians was 87% (95% confidence interval [CI] 82–91), and the specificity was 76% (95% CI 74–77). The negative likelihood ratio was 0.18 (95% CI 0.12–0.25).
Experienced emergency physicians successfully identified a large proportion of cervical spine injuries on CT; however, they were not sufficiently sensitive to accurately exclude clinically important injuries. Emergency physicians should rely on a radiologist review of cervical spine CT scans prior to discontinuing cervical spine precautions.
We present first imaging results from the PALM-3000 adaptive optics system and PHARO camera on the Hale 5 m telescope. Observations using a vector vortex coronagraph have given us direct detections of the two-ring dusty debris system around the star HD 141569. Our observations reveal the inner clearing in the disk to unprecedentedly small angular separations, and are the most sensitive yet at the H and K bands. We are for the first time able to measure and compare the colors of the scattered light in the inner and outer dust rings, and find that the outer ring is significantly bluer than the inner ring.
As invasive species become increasingly abundant in forests, their presence may influence a number of key nutrient cycling processes. For example, Chinese privet has become well established in southeastern forests and continues to spread. Two studies, a multisite field investigation and a controlled approach on a single site, were conducted to examine the role of Chinese privet (Ligustrum sinense) on decomposition within riparian forests of the Georgia Piedmont. The field study also investigated the effects of privet presence on soil nitrogen (N) mineralization and microbial carbon and N immobilization. Both studies utilized a litterbag approach to examine how increasing proportions of privet in foliar litter influenced mass loss rates and nutrient dynamics. The field investigation included litterbags with representative proportions of the five dominant species from 16 sites. Litterbags in the controlled study were composed of specific levels of privet litter within bags (0, 10, 20, 30, 40, and 50% Chinese privet) as treatments. The litter quality of four native species was compared to Chinese privet in the controlled study. Both studies showed significant positive relationships between percentage of Chinese privet in litterbags and decomposition rates (2.6-fold rate increase with 30% privet in litterfall). Chinese privet leaf litter had lower lignin and cellulose concentrations, higher N concentrations, lower lignin : N ratios, and narrower C : N ratios than the native species. The positive relationship between mass loss rates and the proportion of Chinese privet in litter indicates that Chinese privet enhances decomposition rates as it becomes more abundant. During summer, N mineralization showed approximately a fivefold increase; during winter, microbial biomass N increased by approximately 30% on sites with the highest levels of privet in the understory. Consequently, C and N dynamics in Piedmont riparian forests were significantly influenced in direct proportion to the amount of privet present in the understory.
Recent studies show that adverse life events have a significantly greater impact on depression onset for those with the s/s allele of the genotype for the 5-HT gene-linked promoter region. Research in genes related to risk of depression leads to the question of how this information is received by individuals.
To investigate factors related to the response to receiving one's own serotonin transporter genotype results.
Predictors of the impact of receiving individual genotype data were assessed in 128 participants in a study of gene–environment interaction in depression onset.
Two-thirds decided to learn their individual genotype results (receivers) and prior to disclosure this decision was associated with a perception of greater benefit from receipt of the information (P=0.001). Receivers completing the 2-week (n=76) and 3-month follow-up (n=78) generally reported feeling pleased with the information and having had a more positive experience than distress. However, distress was related to genotype, with those with the s/s allele being most affected.
There was high interest in, and satisfaction with, learning about one's serotonin transporter genotype. Participants appeared to understand that the gene conferred susceptibility to depression rather than a direct causal effect.
The Teaching Research Methods Track at the third annual APSA Teaching
and Learning Conference included 26 participants from schools ranging from
small colleges to major research universities. The program included
presentations on the state of the undergraduate research methods field,
information literacy, and a variety of teaching innovations, culminating
in a large group discussion where we agreed upon a common set of
strengths, opportunities, and challenges to teaching research methods, as
well as a set of recommendations for a future Conference track.