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To evaluate the motor proficiency, identify risk factors for abnormal motor scores, and examine the relationship between motor proficiency and health-related quality of life in school-aged patients with CHD.
Study design:
Patients ≥ 4 years old referred to the cardiac neurodevelopmental program between June 2017 and April 2020 were included. Motor skills were evaluated by therapist-administered Bruininks-Oseretsky Test of Motor Proficiency Second-Edition Short Form and parent-reported Adaptive Behavior Assessment System and Patient-Reported Outcomes Measurement Inventory System Physical Functioning questionnaires. Neuropsychological status and health-related quality of life were assessed using a battery of validated questionnaires. Demographic, clinical, and educational variables were collected from electronic medical records. General linear modelling was used for multivariable analysis.
Results:
The median motor proficiency score was the 10th percentile, and the cohort (n = 272; mean age: 9.1 years) scored well below normative values on all administered neuropsychological questionnaires. In the final multivariable model, worse motor proficiency score was associated with family income, presence of a genetic syndrome, developmental delay recognised in infancy, abnormal neuroimaging, history of heart transplant, and executive dysfunction, and presence of an individualised education plan (p < 0.03 for all predictors). Worse motor proficiency correlated with reduced health-related quality of life. Parent-reported adaptive behaviour (p < 0.001) and physical functioning (p < 0.001) had a strong association with motor proficiency scores.
Conclusion:
This study highlights the need for continued motor screening for school-aged patients with CHD. Clinical factors, neuropsychological screening results, and health-related quality of life were associated with worse motor proficiency.
Opportunities exist to leverage mobile phones to replace or supplement in-person supervision of lay counselors. However, contextual variables, such as network connectivity and provider preferences, must be considered. Using an iterative and mixed methods approach, we co-developed implementation guidelines to support the implementation of mobile phone supervision with lay counselors and supervisors delivering a culturally adapted trauma-focused cognitive behavioral therapy in Western Kenya. Guidelines were shared and discussed with lay counselors in educational outreach visits led by supervisors. We evaluated the impact of guidelines and outreach on the acceptability, feasibility, and usability of mobile phone supervision. Guidelines were associated with significant improvements in acceptability and usability of mobile phone supervision. There was no evidence of a significant difference in feasibility. Qualitative interviews with lay counselors and supervisors contextualized how guidelines impacted acceptability and feasibility – by setting expectations for mobile phone supervision, emphasizing importance, increasing comfort, and sharing strategies to improve mobile phone supervision. Introducing and discussing co-developed implementation guidelines significantly improved the acceptability and usability of mobile phone supervision. This approach may provide a flexible and scalable model to address challenges with implementing evidence-based practices and implementation strategies in lower-resourced areas.
Despite improvements in the medical and surgical management of infants with CHD, growth failure before surgery in many infants continues to be a significant concern. A nutritional pathway was developed, the aim of which was to provide a structured approach to nutritional care for infants with CHD awaiting surgery.
Materials and methods
The modified Delphi process was development of a nutritional pathway; initial stakeholder meeting to finalise draft guidelines and develop questions; round 1 anonymous online survey; round 2 online survey; regional cardiac conference and pathway revision; and final expert meeting and pathway finalisation.
Results
Paediatric Dietitians from all 11 of the paediatric cardiology surgical centres in the United Kingdom contributed to the guideline development. In all, 33% of participants had 9 or more years of experience working with infants with CHD. By the end of rounds 1 and 2, 76 and 96% of participants, respectively, were in agreement with the statements. Three statements where consensus was not achieved by the end of round 2 were discussed and agreed at the final expert group meeting.
Conclusions
Nutrition guidelines were developed for infants with CHD awaiting surgery, using a modified Delphi process, incorporating the best available evidence and expert opinion with regard to nutritional support in this group.
The legend of Tristan and Isolde -- the archetypal narrative about the turbulent effects of all-consuming, passionate love -- achieved its most complete and profound rendering in the German poet Gottfried von Strassburg's verse romance Tristan (ca. 1200-1210). Along with his great literary rival Wolfram von Eschenbach and his versatile predecessor Hartmann von Aue, Gottfried is considered one of three greatest poets produced by medieval Germany, and over the centuries his Tristan has lost none of its ability to attract with the beauty of its poetry and to challenge -- if not provoke -- with its sympathetic depiction of adulterous love. The essays, written by a dozen leading Gottfried specialists in Europe and North America, provide definitive treatments of significant aspectsof this most important and challenging high medieval version of the Tristan legend. They examine aspects of Gottfried's unparalleled narrative artistry; the important connections between Gottfried'sTristan and the socio-cultural situation in which it was composed; and the reception of Gottfried's challenging romance both by later poets in the Middle Ages and by nineteenth- and twentieth-century authors, composers, and artists -- particularly Richard Wagner. The volume also contains new interpretations of significant figures, episodes, and elements (Riwalin and Blanscheflur, Isolde ofthe White Hands, the Love Potion, the performance of love, the female figures) in Gottfried's revolutionary romance, which provocatively elevates a sexual, human love to a summum bonum.
Will Hasty is Professor of German at the University of Florida. He is the editor of Companion to Wolfram's "Parzival," (Camden House, 1999).
An excellent collection... breaks new ground in many areas. Should make a substantial impact on the discussion of the contemporary influence of Anglo-Saxon Culture. Conor McCarthy, author of Seamus Heaney and the Medieval Imagination
Britain's pre-Conquest past and its culture continues to fascinate modern writers and artists. From Henry Sweet's Anglo-Saxon Reader to Seamus Heaney's Beowulf, and from high modernism to the musclebound heroes of comic book and Hollywood, Anglo-Saxon England has been a powerful and often unexpected source of inspiration, antagonism, and reflection. The essays here engage with the ways in which the Anglo-Saxons and their literature have been received, confronted, and re-envisioned in the modern imagination. They offer fresh insights on established figures, such as W.H. Auden, J.R.R. Tolkien, and David Jones, and on contemporary writers such as Geoffrey Hill, Peter Reading, P.D. James, and Heaney. They explore the interaction between text, image and landscape in medieval and modern books, the recasting of mythic figures such as Wayland Smith, and the metamorphosis of Beowulf into Grendel - as a novel and as grand opera. The early medieval emerges not simply as a site of nostalgia or anxiety in modern revisions, but instead provides a vital arena for creativity, pleasure, and artistic experiment.
Contributors: Bernard O'Donoghue, Chris Jones, Mark Atherton, Maria Artamonova, Anna Johnson, Clare A. Lees, Sian Echard, Catherine A.M. Clarke, Maria Sachiko Cecire, Allen J. Frantzen, John Halbrooks, Hannah J. Crawforth, Joshua Davies, Rebecca Anne Barr
To determine whether antimicrobial (AM) courses ordered with an antimicrobial computer decision support system (CDSS) were more likely to be appropriate than courses ordered without the CDSS.
Design.
Retrospective cohort study. Blinded expert reviewers judged whether AM courses were appropriate, considering drug selection, route, dose, and duration.
Setting.
A 279-bed university-affiliated Department of Veterans Affairs (VA) hospital.
Patients.
A 500-patient random sample of inpatients who received a therapeutic AM course between October 2007 and September 2008.
Intervention.
An optional CDSS, available at the point of order entry in the VA computerized patient record system.
Results.
CDSS courses were significantly more likely to be appropriate (111/254, 44%) compared with non-CDSS courses (81/246, 33%, P = .013). Courses were more likely to be appropriate when the initial provider diagnosis of the condition being treated was correct (168/273, 62%) than when it was incorrect, uncertain, or a sign or symptom rather than a disease (24/227, 11%, P< .001). In multivariable analysis, CDSS-ordered courses were more likely to be appropriate than non-CDSS-ordered courses (odds ratio [OR], 1.83; 95% confidence interval [CI], 1.13–2.98). Courses were also more likely to be judged appropriate when the initial provider diagnosis of the condition being treated was correct than when it was incorrect, uncertain, or a sign or symptom rather than a disease (OR, 3.56; 95% CI, 1.4-9.0).
Conclusions.
Use of the CDSS was associated with more appropriate AM use. To achieve greater improvements, strategies are needed to improve provider diagnoses of syndromes that are infectious or possibly infectious.
Statistical analyses of occurrence data based on collections made from scattered Caribbean sections over the past 20 years indicate that turnover occurred in the Caribbean reef coral fauna between the late Miocene and early Pleistocene. The collections have been identified using standardized procedures, and age-dates assigned using high-resolution chronostratigraphic methods. During turnover, ~80% of the > 100 species and 17 of the 41 genera that were living in the Caribbean during the early Pliocene became extinct, and > 60% of the species now living in the Caribbean originated. Turnover involved increased speciation beginning in the late Miocene and ended with a pulse of extinction in Plio-Pleistocene time. Turnover was preceded by faunal collapse during the late Oligocene to early Miocene, and it was followed by stasis during the late Pleistocene to Recent. During these preceding and succeeding intervals, reef development was at a maximum, although reef coral diversity was relatively low. As a consequence of origination preceding extinction during turnover, most modern Caribbean reef coral species originated before the Plio-Pleistocene peak of extinction, under quite different ecological conditions from those in which they have lived over the past million years. The unusual relationship between origination and extinction may have been caused by changes in productivity associated with emergence of the Central American Isthmus, followed by the onset of Northern Hemisphere glaciation.
During turnover, faunal change was stepwise or gradual. Local assemblages consisted of a mix of extinct and living species, which varied in composition but not in richness. Important reef dominants such as Acropora palmata and A. cervicornis arose in the southern Caribbean and appear to have migrated northward. Faunal change took place in shallow exposed environments, before it occurred in deep protected environments that served as refuges. Plio-Pleistocene extinction was selective for corals with small colonies, and resulted in a faunal shift to the large, fast-growing species that dominate Caribbean reefs today.
Edited by
David Clark, University Lecturer, School of English, University of Leicester,Nicholas Perkins, Associate Professor and Tutor in English, St Hugh's College, University of Oxford
Edited by
David Clark, University Lecturer, School of English, University of Leicester,Nicholas Perkins, Associate Professor and Tutor in English, St Hugh's College, University of Oxford
Edited by
David Clark, University Lecturer, School of English, University of Leicester,Nicholas Perkins, Associate Professor and Tutor in English, St Hugh's College, University of Oxford
Edited by
David Clark, University Lecturer, School of English, University of Leicester,Nicholas Perkins, Associate Professor and Tutor in English, St Hugh's College, University of Oxford
Edited by
David Clark, University Lecturer, School of English, University of Leicester,Nicholas Perkins, Associate Professor and Tutor in English, St Hugh's College, University of Oxford
Edited by
David Clark, University Lecturer, School of English, University of Leicester,Nicholas Perkins, Associate Professor and Tutor in English, St Hugh's College, University of Oxford
Edited by
David Clark, University Lecturer, School of English, University of Leicester,Nicholas Perkins, Associate Professor and Tutor in English, St Hugh's College, University of Oxford