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Targeted drug development efforts in patients with CHD are needed to standardise care, improve outcomes, and limit adverse events in the post-operative period. To identify major gaps in knowledge that can be addressed by drug development efforts and provide a rationale for current clinical practice, this review evaluates the evidence behind the most common medication classes used in the post-operative care of children with CHD undergoing cardiac surgery with cardiopulmonary bypass.
We systematically searched PubMed and EMBASE from 2000 to 2019 using a controlled vocabulary and keywords related to diuretics, vasoactives, sedatives, analgesics, pulmonary vasodilators, coagulation system medications, antiarrhythmics, steroids, and other endocrine drugs. We included studies of drugs given post-operatively to children with CHD undergoing repair or palliation with cardiopulmonary bypass.
We identified a total of 127 studies with 51,573 total children across medication classes. Most studies were retrospective cohorts at single centres. There is significant age- and disease-related variability in drug disposition, efficacy, and safety.
In this study, we discovered major gaps in knowledge for each medication class and identified areas for future research. Advances in data collection through electronic health records, novel trial methods, and collaboration can aid drug development efforts in standardising care, improving outcomes, and limiting adverse events in the post-operative period.
We examined whether Research Domain Criteria (RDoC)-informed measures of prenatal stress predicted newborn neurobehavior and whether these effects differed by newborn sex. Multilevel, prenatal markers of prenatal stress were obtained from 162 pregnant women. Markers of the Negative Valence System included physiological functioning (respiratory sinus arrhythmia [RSA] and electrodermal [EDA] reactivity to a speech task, hair cortisol), self-reported stress (state anxiety, pregnancy-specific anxiety, daily stress, childhood trauma, economic hardship, and family resources), and interviewer-rated stress (episodic stress, chronic stress). Markers of the Arousal/Regulatory System included physiological functioning (baseline RSA, RSA, and EDA responses to infant cries) and self-reported affect intensity, urgency, emotion regulation strategies, and dispositional mindfulness. Newborns’ arousal and attention were assessed via the Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale. Path analyses showed that high maternal episodic and daily stress, low economic hardship, few emotion regulation strategies, and high baseline RSA predicted female newborns’ low attention; maternal mindfulness predicted female newborns’ high arousal. As for male newborns, high episodic stress predicted low arousal, and high pregnancy-specific anxiety predicted high attention. Findings suggest that RDoC-informed markers of prenatal stress could aid detection of variance in newborn neurobehavioral outcomes within hours after birth. Implications for intergenerational transmission of risk for psychopathology are discussed.
To describe a pilot project infection prevention and control (IPC) assessment conducted in skilled nursing facilities (SNFs) in New York State (NYS) during a pivotal 2-week period when the region became the nation’s epicenter for coronavirus disease 2019 (COVID-19).
A telephone and video assessment of IPC measures in SNFs at high risk or experiencing COVID-19 activity.
SNFs in 14 New York counties, including New York City.
A 3-component remote IPC assessment: (1) screening tool; (2) telephone IPC checklist; and (3) COVID-19 video IPC assessment (ie, “COVIDeo”).
In total, 92 SNFs completed the IPC screening tool and checklist: 52 (57%) were conducted as part COVID-19 investigations, and 40 (43%) were proactive prevention-based assessments. Among the 40 proactive assessments, 14 (35%) identified suspected or confirmed COVID-19 cases. COVIDeo was performed in 26 (28%) of 92 assessments and provided observations that other tools would have missed: personal protective equipment (PPE) that was not easily accessible, redundant, or improperly donned, doffed, or stored and specific challenges implementing IPC in specialty populations. The IPC assessments took ∼1 hour each and reached an estimated 4 times as many SNFs as on-site visits in a similar time frame.
Remote IPC assessments by telephone and video were timely and feasible methods of assessing the extent to which IPC interventions had been implemented in a vulnerable setting and to disseminate real-time recommendations. Remote assessments are now being implemented across New York State and in various healthcare facility types. Similar methods have been adapted nationally by the Centers for Disease Control and Prevention.
A new wave of scholarship has made major advances in how we understand the politics of civilizational identity by drawing powerfully from conceptual tools developed over the years to study other forms of identity. What unites this wave is treating civilizations not as distinctive “things” that might “clash” but as meaningful social imaginings. This growing body of work is far from monolithic, generating alternative theories that should structure scholarly debate going forward. Central issues include whether civilizational identity is primarily elite led or mass driven, whether it inherently involves conflictual human impulses, what the role of religion and values are in driving it, what its relationship is to nationalism, and how similarly we can expect the countries and people who share civilizational identity to behave. We also find emerging debates on what this newly conceptualized civilizational identity explains in contemporary world politics. Social scientists are now only beginning to apply important tools of social science to this question, with even public opinion research in its infancy. Early findings suggest civilizational identity may be shaping not only elite foreign policy making but also patterns of domestic politics, including the recent rise of populism and levels of democracy and authoritarianism more generally.
Agitated patients constitute 10% of all emergency psychiatric treatment. Management guidelines, the preferred treatment of clinicians differ in opinion and practice. In Lebanon, the use of the triple therapy haloperidol plus promethazine plus chlorpromazine (HPC) is frequently used but no studies involving this combination exists.
A pragmatic randomised open trial (September 2018–July 2019) in the Lebanese Psychiatric Hospital of the Cross in Beirut Lebanon involving 100 people requiring urgent intramuscular sedation due to aggressive behaviour were given intramuscular chlorpromazine 100 mg plus haloperidol 5 mg plus promethazine 25 mg (HPC) or intramuscular haloperidol 5 mg plus promethazine 25 mg
Primary outcome data were available for 94 (94%) people. People allocated to the haloperidol plus promethazine (HP) group showed no clear difference at 20 min compared with patients allocated to the HPC group [relative risk (RR) 0.84, 95% confidence interval (CI) 0.47–1.50].
Neither intervention consistently impacted the outcome of ‘calm’, or ‘asleep’ and had no discernible effect on the use of restraints, use of additional drugs or recurrence. If clinicians are faced with uncertainty on which of the two intervention combinations to use, the simpler HP is much more widely tested and the addition of chlorpromazine adds no clear benefit with a risk of additional adverse effects.
Infants with moderate-to-severe CHD frequently undergo cardiopulmonary bypass surgery in childhood. Morbidity and mortality are highest in those who develop post-operative low cardiac output syndrome. Vasoactive and inotropic medications are mainstays of treatment for these children, despite limited evidence supporting their use.
To help inform clinical practice, as well as the conduct of future trials, we performed a systematic review of existing literature on inotropes and vasoactives in children after cardiac surgery using the PubMed and EMBASE databases. We included studies from 2000 to 2020, and the patient population was defined as birth – 18 years of age. Two reviewers independently reviewed studies to determine final eligibility.
The final analysis included 37 papers. Collectively, selected studies reported on 12 different vasoactive and inotropic medications in 2856 children. Overall evidence supporting the use of these drugs in children after cardiopulmonary bypass was limited. The majority of studies were small with 30/37 (81%) enrolling less than 100 patients, 29/37 (78%) were not randomised, and safety and efficacy endpoints differed widely, limiting the ability to combine data for meta-analyses.
Vasoactive and inotropic support remain critical parts of post-operative care for children after cardiopulmonary bypass surgery. There is a paucity of data for the selection and dosing of vasoactives and inotropes for these patients. Despite the knowledge gaps that remain, numerous recent innovations create opportunities to rethink the conduct of clinical trials in this high-risk population.
The manuscript known today as Munich, Bayerische Staatsbibliothek, Codex Latinus Monacensis (clm) 4660 was transferred from the Benedictine abbey of Benediktbeuern to its present home in 1803. It is unknown in which circumstances and at which juncture the manuscript came to Benediktbeuern. The codex nevertheless takes its name from the abbey in which it was rediscovered and is referred to as the Codex Buranus (‘the manuscript from Benediktbeuern’). The manuscript is frequently and erroneously called the Carmina Burana (‘songs from Benediktbeuern’), a term which properly denotes the lyric contents, not the codex itself. The present volume considers the manuscript as a whole, and thus uses the less common, but apposite term Codex Buranus throughout. The manuscript dates from around 1230 and is, in all likelihood, of South Tyrolian origin. The codex contains more than two hundred Latin texts, of which a handful contain parts in Romance languages and more than fifty have sections in Middle High German; it includes lyric songs, sententious uersus, and religious plays, the majority of which are preserved uniquely in the Codex Buranus. Fifty-one items feature notation (including the material in the Fragmenta Burana manuscript), and there are eight figural images in the codex as it survives. This volume contains a tabulation of the manuscript's textual contents, giving an immediate sense of the codex's breadth and its engagement with several contemporary cultural milieux, as well as its striking independence (see Illustrations 0.1 and 0.2). All manuscripts are, by their very nature, unique, but some, like the Codex Buranus, are much more unique than others.
Whilst a handful of medieval manuscripts have achieved a fleeting impact on the public imagination, the Codex Buranus has attained an extraordinary presence in the cultural imagination of many in the Western world through Carl Orff 's setting of parts of more than twenty of its songs. His Carmina Burana, first performed in 1937, conjured a colourful and daring portrayal of the lives of clerics in the High Middle Ages, and brought this monumental manuscript, its songs, and its images to a much wider audience than even the extensive scholarship on the codex might suggest it had reached.
The Codex Buranus, compiled, in all likelihood, in South Tyrol in the first half of the thirteenth century, has fascinated modern scholars and performers ever since its rediscovery in 1803. Its diverse range of texts (some famously featuring in Carl Orff's Carmina Burana and music gives testimony to the intensely vibrant, plurilingual, and multicultural milieu in which the Codex Buranus was compiled, but poses a challenge to modern users. Perhaps more so than many other medieval manuscripts, it is an artefact which demands, and benefits from, an interdisciplinary approach. The chapters here, from scholars in a variety of fields, enable the less well-known aspects of the Codex Buranus - textual, musical, and artistic - to receive greater scrutiny, and bring new perspectives to bear on the more thoroughly explored parts of the manuscript. Making accessible existing discourse and encouraging fresh debates on the codex, the essays advocate fresh modes of engagement with its contents, contexts, and composition. They also examine questions of its reception history and audience. TRISTAN E. FRANKLINOS is a British Academy Postdoctoral Fellow at the University of Oxford, and a Junior Research Fellow of Trinity College, Oxford. HENRY HOPE has taught at the universities of Oxford and Bern; his research centres on the musical aspects of Minnesang. Contributors: Gundela Bobeth, Charles E. Brewer, Carmen Cardelle de Hartmann, Albrecht Classen, Johann Drumbl, Tristan E. Franklinos, Peter Godman, Henry Hope, Racha Kirakosian, Heike Sigrid Lammers-Harlander, Jonathan Seelye Martin, Micha