The European Food Safety Authority has suggested that EU countries implement the 2 × 24 h diet recall (2 × 24 h DR) method and physical activity (PA) measurements for national dietary surveys. Since 2000, Denmark has used 7 d food diaries (7 d FD) with PA questionnaires and measurements. The accuracy of the reported energy intakes (EI) from the two diet methods, pedometer-determined step counts and self-reported time spent in moderate-to-vigorous PA (MVPA) were compared with total energy expenditure measured by the doubly labelled water (TEEDLW) technique and with PA energy expenditure (PAEE), respectively. The study involved fifty-two male and sixty-eight female volunteers aged 18–60 years who were randomly assigned to start with either the 24 h DR or the web-based 7 d FD, and wore a pedometer for the first 7 d and filled in a step diary. The mean TEEDLW (11·5 MJ/d) was greater than the mean reported EI for the 7 d FD (9·5 MJ/d (P < 0·01)) but the same as the 2 × 24 h DR (11·5 MJ/d). The proportion of under-reporters was 34 % (7 d FD) and 4 % (2 × 24 h DR). Most participants preferred the 7 d DR as it was more flexible, despite altering their eating habits. Pearson’s correlation between steps corrected for cycling and PAEE was r = 0·44, P < 0·01. Spearman’s correlation for self-reported hours spent in MVPA and PAEE was r = 0·58, P < 0·01. The 2 × 24 h DR performs better than the existing 7 d FD method. Pedometer-determined steps and self-reported MVPA are good predictors of PAEE in adult Danes.

Cave sediments from Stump Cross Cave in northern England contain Pleistocene mammal remains. Uranium-series dating of calcium carbonate deposits closely associated with the fossiliferous horizons has established an absolute age of 83,000 ± 6000 yr B.P. for a faunal assemblage largely comprised of wolverines (Gulo gulo). This date lies firmly within the younger portion of oxygen-isotope stage 5. The occurrence of wolverines in the vicinity of Stump Cross Cave at ca. 83,000 yr B.P. indicates a significant climatic deterioration from ca. 120,000 yr B.P., when an Ipswichian interglacial fauna with hippopotamus was present in this part of northern England.

Herpes zoster, commonly called shingles, is a disease that results from the reactivation of varicella zoster virus. Local trauma has been reported as a precipitant for reactivation, but this condition is rarely seen localized to a fresh surgical incision. We present the case of a patient who developed shingles overlying the incision site of a recently buried central venous access port, illustrating the need to consider this diagnosis as a unique imposter of localized infection or reaction at sites of recent procedural trauma.

Among dialysis facilities participating in a bloodstream infection (BSI) prevention collaborative, access-related BSI incidence rate improvements observed immediately following implementation of a bundle of BSI prevention interventions were sustained for up to 4 years. Overall, BSI incidence remained unchanged from baseline in the current analysis.

Infect Control Hosp Epidemiol 2016;37:863–866

A 44-year-old woman was referred to our centre for interventional cardiac catheterisation. The diagnostic work-up after a preceding ischaemic stroke led to the assumption of a patent foramen ovale due to a positive bubble study. Before the planned percutaneous closure of the patent foramen ovale, we performed a second bubble study, which showed an intact atrial septum. However, after two to three heart cycles bubbles could be detected in the left atrium, assuming a right-to-left shunt of an extracardiac origin most likely in the lung. We therefore performed cardiac catheterisation, yielding a pulmonary arteriovenous malformation in the lower lobe of the right lung. This was successfully closed interventionally by placing a Cook coil, as well as several plugs into the malformation and feeding vessels.

Objectives: We undertook this study to assess the immediate and long-term outcome of balloon angioplasty performed for recurrent or residual coarctation of the aorta, and to assess the changes in the vessel wall caused by this procedure. Methods: Clinical, echocardiographic, angiographic and hemodynamic data from 71 patients who underwent balloon angioplasty for recoarctation between January 1987 and January 1998 were analysed retrospectively. Results: Angioplasty was performed after a median of 82.6 months (range 1.4 mo – 20.9 y, mean 88.5 mo) following surgery for coarctation. Mean systolic pressure gradients were reduced from 27±15 mmHg to 11 ± 11 m m Hg after angioplasty (p< 0.0001). The mean diameter at the site of recoarctation increased from 5.5±2.5 to 7.5±2.7 mm(p< 0.0001). Outpouchings of contrast agents, indicating the disruption of the inner layers of the vessel wall, were defined as extravasations. They were observed in one-quarter of the angiograms performed immediately after the intervention. Immediate success of angioplasty was achieved in 71%, and persisted in 69% of patients during long-term follow up. The main determinant for immediate success was the age at the time of the procedure (p<0.05), while the main determinant for long-term success was the increase achieved in diameter. Extravasations did not progress to aneurysms, neither acutely nor during echocardiographic follow-up studies. For further follow-up, more sensitive imaging techniques will be necessary to delineate the morphology of the site of extravasation observed immediately after angioplasty.

Percutaneous pulmonary valve implantation for conduit dysfunction in the right ventricular outflow tract is a safe and efficient treatment in selected patients. We report on a patient with stenosis and regurgitation of a homograft in the right ventricular outflow tract who developed complete atrioventricular block during percutaneous implantation of a Melody™ valve. This complete atrioventricular block spontaneously reverted to a stable sinus rhythm after 3 weeks.

Behavioural/emotional problems were assessed at least nine years after surgical correction for congenital heart disease (ConHD) in childhood. Parents of 144 10–15-year-old ConHD-children completed the Child Behavior Checklist (CBCL) and 179, 11–17-year-old, ConHD-adolescents completed the Youth Self-Report (YSR). On the CBCL and YSR ConHD-children and adolescents obtained significantly higher problem scores than same-aged peers from normative reference groups. No significant differences were found between problem scores for different cardiac diagnostic groups. A negative correlation was found between CBCL total problem scores and IQ-scores of ConHD-children; for YSR total problem scores no such relationship was found.

Transesophageal echocardiography has gained an established role in the evaluation and management of the adult patient with acquired cardiac disease. Unlike the transthoracic approach, the transesophageal approach provides excellent imaging of posterior cardiac structures in virtually all patients.

BEFORE GOING INTO THE SPECIFIC AREAS OF PEDIATRIC cardiology and pediatric cardiac cardiology and pediatric cardiac surgery, an overview of the general health care organization in the Netherlands might be helpful. The Netherlands, a country with about 15 million inhabitants, spent 47 billion Dutch guilders (US$22 billion) for general health care in 1991. This is about 8.5% of the gross domestic product. Of this, 61% was spent on in-hospital costs, 39% on extramural costs, including the financing of organizations that deal with preventive (primary) medicine, such as clinics for infants and school children which were visited regularly. Almost all inhabitants, 99.6%, are covered for the expenses of health care, 60% through the “Sick Fund,” a state-insurance that is obliged for everyone with a yearly income of less than US$30,000. Employers of these people have to deduct an amount of money from the monthly salary to be paid to the “Sick Fund.” In case of unemployment this money is deducted from the amount paid by the social security office. The remaining 40% has some form of private insurance, that covers health care. Both diagnostic and therapeutic approaches as the timing of these are completely similar and independent from the type of insurance that applies for the individual patient.

Aims: To assess the influence of age at a cardiac procedure of children, who underwent elective cardiac surgery or interventional cardiac catheterisation for treatment of congenital cardiac defects between 3 months and 7 years of age, on the longitudinal development of psychological distress and styles of coping of their parents. Methods: We used the General Health Questionnaire to measure psychological distress, and the Utrecht Coping List to measure styles of coping. Parents completed questionnaires on average respectively 5 weeks prior to, and 18.7 months after, cardiac surgery or catheter intervention for their child. Results: Apart from one exception, no significant influence was found of the age at which children underwent elective cardiac surgery or catheter intervention on the pre- to postprocedural course of psychological distress and the styles of coping of their parents. Across time, parents of children undergoing surgery reported, on average, significantly higher levels of psychological distress than parents of children who underwent catheter intervention. After the procedure, parents of children who underwent either procedure reported significantly lower levels of psychological distress, and showed a weaker tendency to use several styles of coping, than did their reference groups. Conclusion: Age of the children at the time of elective cardiac surgery or catheter intervention did not influence the course of psychological distress of their parents, nor the styles of coping used by the parents. Future research should investigate in what way the age at which these cardiac procedures are performed influences the emotional and cognitive development of the children.

Aims: To assess the cognitive, and behavioural and emotional functioning of children aged 3 months to 7 years shortly before elective cardiac surgery or elective interventional catheterisation. Methods: We used the Bayley Scales of Infant Development, and the McCarthy Scales of Children's Abilities, to measure cognitive functioning. The Child Behavior Checklist was used to assess behavioural and emotional problems. Results: We found no significant differences in mean cognitive scores for children scheduled for cardiac surgery or interventional catheterisation when compared with reference groups. This was also the case for children awaiting cardiac surgery as opposed to those awaiting interventional catheterisation, and for those below as compared to those above the age of 2.5 years. Overall, our results regarding behavioural and emotional functioning were comparable to those of normative reference groups. The only difference found was that the children scheduled for cardiac surgery and aged from 2 to 3 years had significantly higher scores on the Child Behavior Checklist than did peers from normative groups. Conclusion: Cognitive, and behavioural and emotional functioning, both for young children awaiting elective cardiac surgery and interventional catheterisation, can be considered as quite favourable.

A new class of analytic solutions to the problem of two-dimensional potential fnow is presented here. The method of solution has features of both direct and indirect solutions. The bodies about which flow is computed are semi-infinite and have forward regions that either are flat or consist of a circular arc, which may be convex or concave to the flow. Closed-form solutions are obtained for the surface velocity. Afterbody shapes are defined by implicit equations containing a quadrature. Certain analytic properties of the solutions are investigated. An interesting feature of the bodies is the presence of a ‘pseudo corner’ where the slope angle is continuous but the curvature is infinite. The surface velocity becomes logarithmically infinite at these points in contrast to the power-law behaviour at a true corner. One case of the convex circular arc has finite velocity everywhere, and in some sense represents flow over a circular cylinder with a ‘natural’ separation point. This point occurs at 77·45° from the front stagnation point, which is close to the separation point for incompressible laminar boundarylayer flow.