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The International Federation for Emergency Medicine (IFEM) Ultrasound Special Interest Group (USIG) was tasked with development of a hierarchical consensus approach to the use of point of care ultrasound (PoCUS) in patients with hypotension and cardiac arrest.
The IFEM USIG invited 24 recognized international leaders in PoCUS from emergency medicine and critical care to form an expert panel to develop the sonography in hypotension and cardiac arrest (SHoC) protocol. The panel was provided with reported disease incidence, along with a list of recommended PoCUS views from previously published protocols and guidelines. Using a modified Delphi methodology the panel was tasked with integrating the disease incidence, their clinical experience and their knowledge of the medical literature to evaluate what role each view should play in the proposed SHoC protocol.
Consensus on the SHoC protocols for hypotension and cardiac arrest was reached after three rounds of the modified Delphi process. The final SHoC protocol and operator checklist received over 80% consensus approval. The IFEM-approved final protocol, recommend Core, Supplementary, and Additional PoCUS views. SHoC-hypotension core views consist of cardiac, lung, and inferior vena vaca (IVC) views, with supplementary cardiac views, and additional views when clinically indicated. Subxiphoid or parasternal cardiac views, minimizing pauses in chest compressions, are recommended as core views for SHoC-cardiac arrest; supplementary views are lung and IVC, with additional views when clinically indicated. Both protocols recommend use of the “4 F” approach: fluid, form, function, filling.
An international consensus on sonography in hypotension and cardiac arrest is presented. Future prospective validation is required.
Short-term randomised, controlled trials have found that dietary protein relative to carbohydrate can reduce blood pressure. Our objective was to investigate the effects on blood pressure of an increase in protein intake from whey over 2 years in women aged over 70 years. From the general population, 219 women aged between 70 and 80 years were recruited to a 2-year randomised, double-blind, placebo-controlled parallel-design trial: 181 women completed the trial to the end of year 2. Participants were randomly assigned to consume a daily whey protein-based beverage (protein) or an energy-matched low-protein high-carbohydrate beverage (control). Blood pressure measurements were performed at baseline, year 1 and year 2. For protein relative to control, the estimated mean net differences in protein and carbohydrate intakes were 18 (95 % CI 13, 23) and − 22 (95 % CI − 9, − 35) g/d at year 1, and 22 (95 % CI 17, 28) and − 18 (95 % CI − 6, − 31) g/d at year 2. Intention-to-treat analysis found no overall differences between groups in blood pressure (P>0·5). Net differences in systolic and diastolic blood pressure were − 2·3 (95 % CI − 5·3, 0·7) and − 1·5 (95 % CI − 3·6, 0·6) mmHg at year 1, and 1·6 (95 % CI − 1·5, 4·7) and 0·3 (95 % CI − 1·9, 2·4) mmHg at year 2. Similar differences in systolic and diastolic blood pressure at years 1 and 2 were observed with per-protocol analysis. Therefore, the present study did not provide evidence that a higher whey protein intake in older women can have prolonged effects on blood pressure.
It is well established that people with autism have impaired face processing, but much less is
known about voice processing in autism. Four experiments were therefore carried out to
assess (1) familiar voice-face and sound-object matching; (2) familiar voice recognition; (3)
unfamiliar voice discrimination; and (4) vocal affect naming and vocal-facial affect matching.
In Experiments 1 and 2 language-matched children with specific language impairment (SLI)
were the controls. In Experiments 3 and 4 language-matched children with SLI and young
mainstream children were the controls. The results were unexpected: the children with
autism were not impaired relative to controls on Experiments 1, 2 and 3, and were superior
to the children with SLI on both parts of Experiment 4, although impaired on affect
matching relative to the mainstream children. These results are interpreted in terms of an
unexpected impairment of voice processing in the children with SLI associated partly, but
not wholly, with an impairment of cross-modal processing. Performance on the experimental
tasks was not associated with verbal or nonverbal ability in either of the clinical groups. The
implications of these findings for understanding autism and SLI are discussed.
Children's narratives consist of event clauses and contextualizing or
‘evaluative’ clauses. Bamberg & Damrad-Frye (1991) and Bamberg
(1994) claimed that young children make limited use of evaluative
clauses because they are less able to adopt a global perspective on the
narrative. In an earlier study, Karmiloff-Smith (1985) demonstrated
that the narratives of younger children have coherence only at a local
level. However, Wellman & Bartsch (1988) showed that young children
could produce evaluative-like causal explanations if given a specific
prompt. The present study on 160 young children aged five, seven, nine
and eleven years examined their production of evaluatives in narratives
of a story presented as a video sequence with no spoken dialogue, to
ensure that the children's production was not simply a re-working of
verbal input. Results indicated that prompts greatly facilitated children's
production of evaluatives and that they could adopt a global perspective
on the story when formulating evaluatives.
These results indicate that limitations in the narratives of young
children are more plausibly explained by contextual factors influencing
language production and by constraints on working memory than by
children's presumed lack of understanding of the structure of events or
their inferences about the minds of the characters.
Relatively able children with autism were compared
with age- and language-matched
controls on assessments of (1) familiar voice–face
identity matching, (2) familiar face
recognition, and (3) familiar voice recognition. The faces
and voices of individuals at the
children's schools were used as stimuli. The experimental
group were impaired relative to the
controls on all three tasks. Face recognition and voice
recognition correlated significantly
with voice–face identity matching, but not with each
other, suggesting that the recognition
impairments jointly cause the matching impairment. Neither
chronological age nor verbal
mental age were consistently related to the recognition and
Abbreviations: APT-I: Action Picture Test
Information Scale; CA: chronological age;
MLD: moderate learning disability; SLI: specific language
Investigation of children's understanding of the cognitive
verb forget has
shown that young children do not consider the role of prior knowledge
when using this verb. Thus, someone may be said to have forgotten a
fact despite not ever having previously known it. However, forget
also be used to refer to a failure to recall a prior intention. Three
experiments examined the role of prior intention as well as prior
knowledge in the comprehension of forget by 160 young children
four to eight years. The results showed that children initially have two
interpretations of forget: as an unfulfilled desire
rather than a failure to
recall a prior intention, and as a state of not knowing rather than a failure
to recall prior knowledge. Explanations for the late comprehension of
forget are discussed in terms of representation of knowledge and
intention, processing capacity and exposure to pragmatic usages.
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