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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 consenus 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 follow-up in pediatric patients.
In 2018, the Neurodevelopmental and Psychosocial Interventions Working Group of the Cardiac Neurodevelopmental Outcome Collaborative convened through support from an R13 grant from the National Heart, Lung, and Blood Institute to survey the state of neurodevelopmental and psychosocial intervention research in CHD and to propose a slate of critical questions and investigations required to improve outcomes for this growing population of survivors and their families. Prior research, although limited, suggests that individualised developmental care interventions delivered early in life are beneficial for improving a range of outcomes including feeding, motor and cognitive development, and physiological regulation. Interventions to address self-regulatory, cognitive, and social-emotional challenges have shown promise in other medical populations, yet their applicability and effectiveness for use in individuals with CHD have not been examined. To move this field of research forward, we must strive to better understand the impact of neurodevelopmental and psychosocial intervention within the CHD population including adapting existing interventions for individuals with CHD. We must examine the ways in which dedicated cardiac neurodevelopmental follow-up programmes bolster resilience and support children and families through the myriad transitions inherent to the experience of living with CHD. And, we must ensure that interventions are person-/family-centred, inclusive of individuals from diverse cultural backgrounds as well as those with genetic/medical comorbidities, and proactive in their efforts to include individuals who are at highest risk but who may be traditionally less likely to participate in intervention trials.
A recent genome-wide association study (GWAS) identified 12 independent loci significantly associated with attention-deficit/hyperactivity disorder (ADHD). Polygenic risk scores (PRS), derived from the GWAS, can be used to assess genetic overlap between ADHD and other traits. Using ADHD samples from several international sites, we derived PRS for ADHD from the recent GWAS to test whether genetic variants that contribute to ADHD also influence two cognitive functions that show strong association with ADHD: attention regulation and response inhibition, captured by reaction time variability (RTV) and commission errors (CE).
The discovery GWAS included 19 099 ADHD cases and 34 194 control participants. The combined target sample included 845 people with ADHD (age: 8–40 years). RTV and CE were available from reaction time and response inhibition tasks. ADHD PRS were calculated from the GWAS using a leave-one-study-out approach. Regression analyses were run to investigate whether ADHD PRS were associated with CE and RTV. Results across sites were combined via random effect meta-analyses.
When combining the studies in meta-analyses, results were significant for RTV (R2 = 0.011, β = 0.088, p = 0.02) but not for CE (R2 = 0.011, β = 0.013, p = 0.732). No significant association was found between ADHD PRS and RTV or CE in any sample individually (p > 0.10).
We detected a significant association between PRS for ADHD and RTV (but not CE) in individuals with ADHD, suggesting that common genetic risk variants for ADHD influence attention regulation.
Clinical trials are a fundamental tool in evaluating the safety and efficacy of new drugs, medical devices, and health system interventions. Clinical trial visits generally involve eligibility assessment, enrollment, intervention administration, data collection, and follow-up, with many of these steps performed during face-to-face visits between participants and the investigative team. Social distancing, which emerged as one of the mainstay strategies for reducing the spread of SARS-CoV-2, has presented a challenge to the traditional model of clinical trial conduct, causing many research teams to halt all in-person contacts except for life-saving research. Nonetheless, clinical research has continued during the pandemic because study teams adapted quickly, turning to virtual visits and other similar methods to complete critical research activities. The purpose of this special communication is to document this rapid transition to virtual methodologies at Clinical and Translational Science Awards hubs and highlight important considerations for future development. Looking beyond the pandemic, we envision that a hybrid approach, which implements remote activities when feasible but also maintains in-person activities as necessary, will be adopted more widely for clinical trials. There will always be a need for in-person aspects of clinical research, but future study designs will need to incorporate remote capabilities.
This paper proposes that the United Nation's sustainable development goals (SDGs) and associated targets form an effective framework for determining real-world research impact. Existing bibliometrics that assess the quality of academic work are usually quantitative and self-referential, reducing the focus on real-world issues. The same measurements are often adopted by funding bodies, pressuring researchers to increase compliance, and further reducing integrity and real-world impact. A series of world cafés were conducted, collecting data on how researchers, their institutions, and network organisations can contribute to, and measure research aligned with the SDGs and targets. The results showed that participants were generally positive towards using the SDGs and targets to measure impact and quality of academic research. Suggestions to assist greater adoption of the SDGs and targets as a measure of impact included: aligning governmental and institutional funding; changing key performance indicators; increasing cross-disciplinary work; aligning mission/vision statements; and legitimising SDG-focused projects at conferences.
This article aims to temper the fetishization of the events of 1989–1990. It explores how the historical framing of the Federal Republic transforms when 1989–1990 becomes peripheral, and argues that the force of 1989–1990 as a mythic ending relies on two interpretive paradigms: on a temporal sensibility based on a belief in the progressive development of politics and society, and on a conception of identity and difference understood in terms of a Cold War global order. The article highlights how these twentieth-century paradigms guided the historiography that made 1989–1990 the climax of the history of the Federal Republic. The precondition of any new master narrative for the Federal Republic is the recognition that these paradigms have lost their purchase. Viewed instead through the new temporal sensibility of presentism and the lateral power politics of globalization, 1989–1990 assumes a new position amid longer arcs of historical change that do not hinge on the fate of the Berlin Wall.
Dieser Aufsatz zielt darauf ab die Fetischisierung der Ereignisse von 1989–1990 abzuschwächen. In diesem Sinne wird untersucht, wie sich der historische Rahmen der Bundesrepublik verändert, wenn 1989–1990 an die Peripherie gerückt wird; dabei wird argumentiert, dass die Kraft von 1989–1990 als ein mythisches Ende auf zwei interpretativen Paradigmen beruht, nämlich zum ersten auf einer temporalen Sensibilität, die auf einem Glauben an eine fortschrittliche Entwicklung von Politik und Gesellschaft beruht, und zum zweiten auf einem Konzept von Identität und Unterschiedlichkeit, das auf der globalen Ordnung des Kalten Krieges fußt. Der Aufsatz hebt hervor, wie diese Paradigmen des 20. Jahrhunderts die Historiographie bestimmten, die 1989–1990 zum Höhepunkt der Geschichte der Bundesrepublik gestaltete. Die Vorbedingung eines jeden neuen Masternarrativs für die Bundesrepublik ist somit die Erkenntnis, dass diese Paradigmen ihre Kraft verloren haben. Wenn man 1989–1990 dagegen vom Blickwinkel der neuen temporalen Sensibilität des Presentismus und der lateralen Machtpolitik der Globalisierung betrachtet, nimmt es eine neue Position ein: eine Position inmitten längerer historischer Veränderungsprozessen, die nicht vom Schicksal der Berliner Mauer abhängen.
Atomic layer deposition (ALD) of air stable cobalt and nickel complexes based on tridentate enaminones N,N-(4,4,4-trifluorobut-1-en-3-on)-dimethylethyldiamine (Htfb-dmeda) and N,N-(4,4,4-trifluorobut-1-en-3-on)-dimethylpropyldiamine (Htfb-dmpda) successfully produced metallic cobalt and nickel thin films. Detailed X-ray photoelectron spectroscopy (XPS) studies on the binding interaction of the first precursor monolayer with the surface functional groups elucidated the chemisorption behavior of the new precursor systems. A reactive remote hydrogen plasma was used as the co-reactant to activate the precursor decomposition yielding metal hydroxide intermediates. Subsequent hydrogen plasma etching of as-deposited films resulted in phase-pure metallic films through a recrystallization process, verified by surface and sub-surface XPS. Scanning electron microscopy (SEM) and atomic force microscopy (AFM) analyses revealed pinhole-free films, with low surface roughness (0.2 ± 0.06 nm root mean square, RMS) for both, cobalt and nickel thin films. Herein, the competitive role of hydrogen as etchant and reactant was demonstrated as prolonged plasma exposure time periods resulted in the formation of metal hydrides. This is mostly due to the catalytic dissociation of molecular hydrogen on transition metal surfaces, which already occurs upon low energy input.
This study uses simulation over real and artificial networks to compare the eventual adoption outcomes of network interventions, operationalized as idealized contagion processes with different sets of seeds. While the performance depends on the details of both the network and behaviour adoption mechanisms, interventions with seeds that are central to the network are more effective than random selection in the majority of simulations, with faster or more complete adoption throughout the network. These results provide additional theoretical justification for utilizing relevant network information in the design of public health behavior interventions.
The current project seeks to integrate literatures on personality risk for antisocial behavior (ASB) by examining how callous–unemotional traits relate to (a) the development of disinhibited traits and (b) the association between disinhibited traits and ASB. In Study 1, using a nationally representative sample of youth (N > 7,000), we examined whether conduct problems and lack of guilt assessed during ages 4–10 years predicted levels of and changes in disinhibited traits over the course of adolescence, and moderated associations between these traits and ASB. High levels of childhood conduct problems were associated with higher levels of impulsivity, sensation seeking, and ASB in early adolescence, whereas lack of guilt was associated with lower levels of sensation seeking. Neither conduct problems nor lack of guilt significantly predicted changes in impulsivity or sensation seeking, and associations among changes in sensation seeking, impulsivity, and ASB were also consistent across levels of conduct problems and lack of guilt. In Study 2, using a cross-sectional sample of adolescents (N = 970), we tested whether callous–unemotional traits moderated associations between disinhibited traits and ASB. Consistent with the results of Study 1, associations between disinhibited personality and ASB were consistent across a continuous range of callous–unemotional traits.
To develop consensus recommendations for training future clinician educators (CEs) in emergency medicine (EM).
A panel of EM education leaders was assembled from across Canada and met regularly by teleconference over the course of 1 year. Recommendations for CE training were drafted based on the panel’s experience, a literature review, and a survey of current and past EM education leaders in Canada. Feedback was sought from attendees at the Canadian Association of Emergency Physicians (CAEP) annual academic symposium. Recommendations were distributed to the society’s Academic Section for further feedback and updated by a consensus of the expert panel.
Recommendations were categorized for one of three audiences: 1) Future CEs; 2) Academic departments and divisions (AD&D) that support training to fulfill their education leadership goals; and 3) The CAEP Academic Section. Advanced medical education training is recommended for any emergency physician or resident who pursues an education leadership role. Individuals should seek out mentorship in making decisions about career opportunities and training options. AD&D should regularly perform a needs assessment of their future CE needs and identify and encourage potential individuals who fulfill education leadership roles. AD&D should develop training opportunities at their institution, provide support to complete this training, and advocate for the recognition of education scholarship in their institutional promotions process. The CAEP Academic Section should support mentorship of future CEs on a national scale.
These recommendations serve as a framework for training and supporting the next generation of Canadian EM medical educators.
We analyzed birth order differences in means and variances of height and body mass index (BMI) in monozygotic (MZ) and dizygotic (DZ) twins from infancy to old age. The data were derived from the international CODATwins database. The total number of height and BMI measures from 0.5 to 79.5 years of age was 397,466. As expected, first-born twins had greater birth weight than second-born twins. With respect to height, first-born twins were slightly taller than second-born twins in childhood. After adjusting the results for birth weight, the birth order differences decreased and were no longer statistically significant. First-born twins had greater BMI than the second-born twins over childhood and adolescence. After adjusting the results for birth weight, birth order was still associated with BMI until 12 years of age. No interaction effect between birth order and zygosity was found. Only limited evidence was found that birth order influenced variances of height or BMI. The results were similar among boys and girls and also in MZ and DZ twins. Overall, the differences in height and BMI between first- and second-born twins were modest even in early childhood, while adjustment for birth weight reduced the birth order differences but did not remove them for BMI.
Records at the Endulen Hospital in the Ngorongoro Conservation Area (NCA), Tanzania, reveal that soil-transmitted helminth infections and protozoa are consistently in the top ten diagnoses for Maasai pastoralists, indicating a significant public health concern. Nevertheless, Maasai pastoralist adaptations to life in close proximity to livestock and to unreliable access to water raise important questions about experiences of, and resiliency to, parasitic infections. Though these infections are particularly prevalent among youth in low- and middle-income countries (LMIC), a focus on resiliency highlights local capacity to recover from and prevent illness. For instance, how is human parasitism perceived and experienced among communities displaying behaviours that studies have associated with transmission of diarrhoeal diseases, such as open defecation? Among these communities, how is parasitism seen to impact the health and development of children? And, what resources are available to endure or mitigate this heavy disease burden among affected communities? This study draws on formative research carried out in May 2014 in anticipation of an innovative school-based and youth-driven water, sanitation and hygiene education intervention rolled out in two boarding schools in the NCA in subsequent months. The initiative is grounded in a One Health approach to health promotion, drawing on partnerships in medicine, public health and veterinary medicine to appreciate the unique interactions between humans, animals and the environment that shape well-being among pastoralist communities. Qualitative data generated through group discussions with secondary school youth (n=60), Maasai teachers (n=6) and a women’s group (n=8) in the NCA convey existing knowledge of the prevalence, prevention and treatment of human parasitism. An underlying principle of the larger initiative is to engage youth as creative agents of change in developing and sustaining locally relevant health promotion strategies. Findings highlight practical knowledge around certain ‘neglected tropical diseases’, namely helminths, among pastoralist communities in the NCA, in turn feeding into the development of the science fair and related interventions.
To characterize the current state of Canadian emergency medicine (EM) resident research and develop recommendations to promote excellence in this area.
We performed a systematic review of MEDLINE, Embase, and ERIC using search terms relevant to EM resident research. We conducted an online survey of EM residency program directors from the Royal College of Physicians and Surgeons of Canada (RCPSC) and College of Family Physicians of Canada (CFPC). An expert panel reviewed these data, presented recommendations at the Canadian Association of Emergency Physicians 2014 Academic Symposium, and refined them based on feedback received.
Of 654 potentially relevant citations, 35 articles were included. These were categorized into four themes: 1) expectations and requirements, 2) training and assessment, 3) infrastructure and support, and 4) dissemination. We received 31 responses from all 31 RCPSC-EM and CFPC-EM programs. The majority of EM programs reported requiring a resident scholarly project; however, we found wide-ranging expectations for the type of resident research performed and how results were disseminated, as well as the degree of completion expected. Although 93% of RCPSC-EM programs reported providing formal training on how to conduct research, only 53% of CFPC-EM programs reported doing so. Almost all programs (94%) reported having infrastructure in place to support resident research, but the nature of support was highly variable. Finally, there was marked variability regarding the number of resident-published abstracts and manuscripts.
Based on the literature, our national survey, and discussions with stakeholders, we offer 14 recommendations encompassing goals, expectations, training, assessment, infrastructure, and dissemination in order to improve Canadian EM resident research.