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David Gibson’s (2008) examination of research on conversational interaction highlighted methodological and theoretical gaps in current understanding – particularly around the localized construction of interaction and the reproduction of social structures. This paper extends extant formal models used by group process researchers to explain how exogenous status structures shape local interaction by incorporating insights from qualitative work examining the local production of conversational interaction. Relational events serve as a bridge between conversation analytic understandings of the deep structure of conversation and expectation states formal models of permeation. We propose a theoretical integration of the status organizing process (permeation) and local turn-taking rules (deep structure) as a more complete model of conversational behavior in task groups. We test a formalized construction of this preliminary theory by examining turn-taking using data from 55 task groups whose members vary in gender, authority, and legitimacy of that authority. This integrated model offers substantial improvements in prediction accuracy over using status information alone. We then propose ways to expand the integrated theoretical framework to advance current understandings of action and events in conversation. Finally, we offer suggestions for insights from group processes theories that could be incorporated into network models of interaction outside of this theoretical framework.
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.
A 10-year-old boy with polyvalvular dysplasia and severe involvement of both atrioventricular valves presented with palpitations. Concern was raised for atrial tachyarrhythmia due to biatrial enlargement; however, ambulatory monitoring discovered a reentrant mechanism. Electrophysiology study revealed atypical atrioventricular nodal reentrant tachycardia involving two components of the slow pathway, with inputs in the posterior septum around his dysplastic tricuspid valve. He underwent successful modification of the slow pathway using cryoablation.
Objective: The Laboratory Response Network (LRN) is the United States’ laboratory system for detecting, confirming, and reporting potential bioterrorism agents. The first tier—sentinel laboratories—is composed principally of hospital-based laboratories and is tasked with ruling out potential biological threat agents in clinical specimens or the identification of suspicious specimens for further testing in higher tiers of the LRN system. The aim of the present study was to broadly describe preparedness of the first tier of the hospital LRN, the sentinel laboratories, with a specific focus on training, personnel, and communications.
Methods: A semistructured cross-sectional survey of US sentinel laboratories was designed and conducted. Hospitals with greater than 250 beds and an emergency department were considered eligible for inclusion. A geographically weighted sample of 201 hospitals was selected for inclusion. The survey was administered by telephone to the microbiology managers (or designees) at the selected hospitals. The survey contained questions related to drill frequency, proficiency survey participation, personnel training, personnel responsibilities, procedures for biological threat response, and overall confidence in preparedness.
Results: Overall, 179 hospitals (89.1%) identified themselves as sentinel laboratories and participated in the survey; 11.7% reported that they had had an emergency alert within the last 2 years. Although rates of internal drills were low (20.7%), participation in some form of bioterrorism proficiency evaluation was high (79.9%). In all, 83.8% of laboratories reported that they had personnel designated to coordinate response to acts of bioterrorism. More than 73% of respondents indicated that they had sufficient personnel, equipment, and training to respond to a biological terrorism event. By multivariate analysis, sentinel laboratories were 3.4 times more likely to feel confident that they had sufficient personnel, equipment, and training to respond to a biological terrorism event if they had designated personnel for bioterrorism roles.
Conclusions: This pilot study of sentinel laboratory bioterrorism preparedness demonstrated that hospital laboratory personnel, training, and communication preparedness were not universal, despite designation as sentinel laboratories. A need for unified monitoring of sentinel laboratories exists, and efforts should be made to develop standardized metrics for sentinel laboratory preparedness. (Disaster Med Public Health Preparedness. 2009;3(Suppl 1):S17–S23)