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Traditional ambulatory rhythm monitoring in children can have limitations, including cumbersome leads and limited monitoring duration. The ZioTM patch ambulatory monitor is a small, adhesive, single-channel rhythm monitor that can be worn up to 2 weeks. In this study, we present a retrospective cross-sectional analysis of the ZioTM monitor’s impact in clinical practice. Patients aged 0–18 years were included in the study. A total of 373 studies were reviewed in 332 patients. In all, 28.4% had structural heart disease, and 16.9% had a prior surgical, catheterisation, or electrophysiology procedure. The most common indication for monitoring was tachypalpitations (41%); 93.5% of these patients had their symptoms captured during the study window. The median duration of monitoring was 5 days. Overall, 5.1% of ZioTM monitoring identified arrhythmias requiring new intervention or increased medical management; 4.0% identified arrhythmias requiring increased clinical surveillance. The remainder had either normal-variant rhythm or minor rhythm findings requiring no change in management. For patients with tachypalpitations and no structural heart disease, 13.2% had pathological arrhythmias, but 72.9% had normal-variant rhythm during symptoms, allowing discharge from cardiology care. Notably, for patients with findings requiring intervention or increased surveillance, 56% had findings first identified beyond 24 hours, and only 62% were patient-triggered findings. Seven studies (1.9%) were associated with complications or patient intolerance. The ZioTM is a well-tolerated device that may improve what traditional Holter and event monitoring would detect in paediatric cardiology patients. This study shows a positive clinical impact on the management of patients within a paediatric cardiology practice.
It is increasingly essential for medical researchers to be literate in statistics, but the requisite degree of literacy is not the same for every statistical competency in translational research. Statistical competency can range from ‘fundamental’ (necessary for all) to ‘specialized’ (necessary for only some). In this study, we determine the degree to which each competency is fundamental or specialized.
We surveyed members of 4 professional organizations, targeting doctorally trained biostatisticians and epidemiologists who taught statistics to medical research learners in the past 5 years. Respondents rated 24 educational competencies on a 5-point Likert scale anchored by ‘fundamental’ and ‘specialized.’
There were 112 responses. Nineteen of 24 competencies were fundamental. The competencies considered most fundamental were assessing sources of bias and variation (95%), recognizing one’s own limits with regard to statistics (93%), identifying the strengths, and limitations of study designs (93%). The least endorsed items were meta-analysis (34%) and stopping rules (18%).
We have identified the statistical competencies needed by all medical researchers. These competencies should be considered when designing statistical curricula for medical researchers and should inform which topics are taught in graduate programs and evidence-based medicine courses where learners need to read and understand the medical research literature.
Mass-casualty (MASCAL) events are known to occur in the combat setting. There are very limited data at this time from the Joint Theater (Iraq and Afghanistan) wars specific to MASCAL events. The purpose of this report was to provide preliminary data for the development of prehospital planning and guidelines.
Cases were identified using the Department of Defense (DoD; Virginia USA) Trauma Registry (DoDTR) and the Prehospital Trauma Registry (PHTR). These cases were identified as part of a research study evaluating Tactical Combat Casualty Care (TCCC) guidelines. Cases that were designated as or associated with denoted MASCAL events were included.
Fifty subjects were identified during the course of this project. Explosives were the most common cause of injuries. There was a wide range of vital signs. Tourniquet placement and pressure dressings were the most common interventions, followed by analgesia administration. Oral transmucosal fentanyl citrate (OTFC) was the most common parenteral analgesic drug administered. Most were evacuated as “routine.” Follow-up data were available for 36 of the subjects and 97% were discharged alive.
The most common prehospital interventions were tourniquet and pressure dressing hemorrhage control, along with pain medication administration. Larger data sets are needed to guide development of MASCAL in-theater clinical practice guidelines.
SchauerSG, AprilMD, SimonE, MaddryJK, CarterR III, DelorenzoRA. Prehospital Interventions During Mass-Casualty Events in Afghanistan: A Case Analysis. Prehosp Disaster Med. 2017;32(4):465–468.
The authors study the influence of domestic political dissent and violence on incumbent dictators and their regimes. They argue that elite with an interest in preserving the regime hold dictators accountable when there is a significant increase in terrorism. To pinpoint the accountability of dictators to elite who are strongly invested in the current regime, the authors make a novel theoretical distinction between reshuffling coups that change the leader but leave the regime intact and regime-change coups that completely change the set of elites atop the regime. Using a new data set that distinguishes between these two coup types, the authors provide robust evidence that terrorism is a consistent predictor of reshuffling coups, whereas forms of dissent that require broader public participation and support, such as protests and insurgencies, are associated with regime-change coup attempts. This article is the first to show that incumbent dictators are held accountable for terrorist campaigns that occur on their watch.
We previously documented that cigarette smoking is a risk factor for
subsequent alcohol and drug misuse and dependence in adolescent girls
with attention-deficit hyperactivity disorder (ADHD).
To revisit this hypothesis with a large longitudinal sample of both
genders followed up for 10 years into young adulthood.
We used data from two identically designed, longitudinal, case–control
family studies of boys and girls with and without ADHD ascertained from
psychiatric and paediatric sources. We studied 165 individuals with ADHD
and 374 controls followed up longitudinally and masked for 10 years. We
assessed ADHD, smoking and substance use status using structured
diagnostic interviews. We tested the association between cigarette
smoking and subsequent substance use outcomes using Cox proportional
hazard regression models.
Youth with ADHD who smoked cigarettes (n = 27) were
significantly more likely to subsequently develop drug misuse and
dependence compared with youth with ADHD who did not smoke
(n = 138, P<0.05).
These results confirm that cigarette smoking increases the risk for
subsequent drug and alcohol use disorders among individuals with ADHD.
These findings have important public health implications, and underscore
the already pressing need to prevent smoking in children with ADHD.
New shell microstructure data for the Triassic pectinid Pleuronectites reinforce shell morphological data suggesting that its family Pectinidae was derived from the superfamily Aviculopectinoidea and not from the Pernopectinidae-Entolioidesidae-Entoliidae clade. This would make the superfamily Pectinoidea, as defined by recent authors, polyphyletic. This would also imply that alivincular-alate ligaments evolved independently in the Pernopectinidae-Entolioidesidae-Entolidae and Pectinidae clades.
The specimens of Gastrochaena cuneiformis Spengler, 1783, with Spengler-written labels at the Zoologisk Museum, Copenhagen, did not come from Spengler's type locality in the Nicobar Islands, and may instead be syntypes of Chemnitz's (1788) West Indies “Pholas hians”. the identity of Gastrochaena cuneiformis as a senior synonym of Gastrochaena gigantea (Deshayes, 1830) is established on the basis of Spengler's original descriptions and illustrations, and by examination of specimens from the type locality. A neotype for G. cuneiformis is designated and illustrated, and its genus is revised to exclude Rocellaria Blainville, 1829, and Lamychaena Freneix in Freneix and Roman, 1979. Gastrochaena Spengler, 1783 is the most plesiomorphic of these three genera, as shown by its simple boring, short siphons, and diffuse, poorly differentiated anterior pedal muscles. Rocellaria evolved from a close common ancestor with Gastrochaena, and is characterized by a ventral shift and fusion of the posteroventral pallial sinus with the posteroventral pallial band, low, irregular posterior commarginal lamellae, and well defined anterior pedal retractor muscles generally supported by myophores. Lamychaena evolved from Rocellaria during the Oligocene, extending its ctenidia far posterior into the siphonal part of the boring, and, in some species, uniting its anterior pedal retractor and protractor muscles as they approach the byssus apparatus.
Background. To evaluate the longitudinal course of psychiatric disorders in children of parents with panic disorder (PD) and major depression (MD) as they transition through the period of risk from childhood into adolescence.
Method. Over a 5-year follow-up, we compared psychiatric disorders in four groups of children: (1) offspring of parents with PD plus MD (n=136); (2) offspring of parents with PD without MD (n=27); (3) offspring of parents with MD but without PD (n=53); and (4) offspring of non-PD non-MD parents (n=103).
Results. Parental PD was significantly associated with increased risk for anxiety disorders, irrespective of parental MD. Parental MD was associated with increased risk for MD, disruptive behavior disorders, and deficits in psychosocial functioning, irrespective of parental PD.
Conclusions. These longitudinal findings confirm and extend previous cross-sectional results documenting significant associations between PD and MD in parents and patterns of psychopathology and dysfunction in their offspring.
We describe surface preparation and epilayer growth techniques that readily reduce the density of Vf drift inducing basal plane dislocations in epilayers to less than 10 cm-2 and permit the fabrication of bipolar SiC devices with very good Vf stability. The optimal process route requires etching the substrate surface prior to epilayer growth to enhance the natural conversion of basal plane dislocations into threading edge dislocations during epilayer growth. The surface of this relatively rough “conversion” epilayer is subsequently repolished prior to growing the device structure. We provide details on processing parameters and potential problems as well as describe devices produced using this low basal plane dislocation growth processes.
Language disorders have been reported after severe falciparum malaria but the deficits have not been described in detail. We assessed language outcome in three groups of children aged 6 to 9 years (n=487): those previously admitted to Kilifi District Hospital, Kenya, with cerebral malaria (CM; n=152; mean age 7y 4 mo [SD 1y 1mo]; 77 males, 75 females); or those with malaria and complicated seizures (M/S; n=156; mean age 7y 4mo [SD 1y 2mo]; 72 males, 84 females); and those unexposed to either condition (n=179; mean age 7y 6mo [SD 1y 1mo]; 93 males, 86 females). Median age at hospital admission was 28 months (interquartile range [IQR] 19 to 44 mo) among children with a history of CM and 23 months (IQR 12 to 35mo) among children with a history of M/S. A battery of eight assessments covering the major facets of speech and language was used to measure language performance. Cognitive performance, neurological/motor skills, behaviour, hearing, and vision were also measured. Eighteen (11.8%) of the CM group, 14 (9%) of the M/S group, and four (2.2%) of the unexposed group were found to have a language impairment. CM (odds ratio 3.68, 95% confidence interval 1.09 to 12.4, p=0.04) was associated with significantly increased odds of an impairment-level score relative to the unexposed group. The results suggest that falciparum malaria is one of the most common causes of acquired language disorders in the tropics.
The grey wolf (Canis lupus) is the most widely distributed large carnivore in the northern hemisphere (Nowak 1995) and has a reputation for killing livestock and competing with human hunters for wild ungulates (Young 1944; Fritts et al. 2003). Wolves rarely threaten human safety, but many people still fear them. In the western USA, widespread extirpation of ungulates by colonizing settlers, wolf depredation on livestock and negative public attitudes towards wolves resulted in extirpation of wolf populations by 1930 (Mech 1970; McIntyre 1995). By 1970, mule deer (Odocoileus hemionus), white-tailed deer (O. virginianus), elk (Cervus elaphus), moose (Alces alces) and bighorn sheep (Ovis canadensis) populations had been restored throughout the western USA while bison (Bison bison) were recovered only in Yellowstone National Park. However, grey wolves were still persecuted. In 1974, grey wolves were protected and managed by the US Fish and Wildlife Service under the federal Endangered Species Act of 1973.
In 1986, the first recorded den in the western USA in over 50 years was established in Glacier National Park by wolves that naturally dispersed from Canada (Ream et al. 1989). Restoration of wolves in that region emphasized legal protection and building local public tolerance. Wolves from Canada were reintroduced to central Idaho and Yellowstone National Park in 1995 and 1996 to accelerate restoration (Bangs and Fritts 1996; Fritts et al. 1997). The Northern Rocky Mountains wolf population grew from 10 wolves in 1987 to 663 wolves by 2003 (US Fish and Wildlife Service et al. 2003) (Fig. 21.1, Table 21.1).