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To compare the results of cardiac output measurements obtained by lithium dilution and transpulmonary thermodilution in paediatric patients. A prospective study. Paediatric intensive care unit in a university teaching hospital. Twenty patients (age 5 days-9 years; weight 2.6-28.2 kg) were studied. Between two and four comparisons of lithium dilution cardiac output (LiDCO) and transpulmonary thermodilution (TPCO) were made in each patient. Results from three patients were excluded: in one patient there was an unsuspected right-to-left shunt, in two patients there was a problem with blood sampling through the lithium sensor. There were 48 comparisons of LiDCO and TPCO in the remaining 17 patients over a range of 0.4-6 l/min. The mean of the differences (LiDCO-TPCO) was -0.1 +/- 0.3 (SD) l/min. Linear regression analysis gave LiDCO = 0.11 + 0.90 x TPCO l/min (r2 = 0.96). There were no adverse effects in any patient. These results suggest that the LiDCO method can be used to provide safe and accurate measurement of cardiac output in paediatric patients. The method is simple and quick to perform, requiring only arterial and venous catheters, which will already have been inserted for other reasons in these patients.

SummaryWe examined individuals’ experiences using an educational booklet developed by the Ontario Osteoporosis Strategy. The booklet appeared to motivate individuals to make changes to their existing management of their bone health and served as a reference tool reaffirming current practices and beliefs for others.IntroductionThe purpose of this study was to examine individuals’ experiences of the educational booklet and explore the influence of the booklet on individuals’ beliefs and actions regarding their bone health.MethodsEligible individuals were those who had been prescribed medication to treat low bone mass. One-on-one telephone interviews were conducted over an 18-month period. Participants were interviewed for approximately 1 hour and asked to provide their feedback on the booklet, and to discuss what they were doing with respect to the recommendations made in the booklet.ResultsWe interviewed 50 participants who ranged in age from 58 to 89. The overall impression of the booklet was positive. Participants described the language in the booklet as clear and easy to understand. Participants stated that they would have appreciated receiving this tool at the onset of their diagnosis. Forty-two participants had already taken action, or expressed an intention to make changes, to their existing routines to improve their bone health. In contrast, eight participants used the booklet to reaffirm current practices and beliefs. For these individuals, the recommendations made in the booklet were consistent with what they had already been doing.ConclusionThe booklet can engage patients in discussions about bone health. The booklet appeared to motivate individuals to make changes to their existing routines in an effort to achieve better health outcomes for their bone health. Providing a tool like this to people recently diagnosed with a bone health issue may prove to be beneficial.

School leaders pour time and energy into others all day, every day. To keep them energized and build their capacity to lead, principals need to connect with others and engage in conversation around effective practices. A new model of professional development known as Edcamp offers a place where school leaders can stay abreast of emerging practices and resources, talk about problems of practice with other leaders, and recharge their batteries for the tireless work they do. This article describes the value of Edcamps for principals and offers suggestions to help school leaders connect with other passionate educators at Edcamp.

Background Catheter ablation is routinely used to treat scar-related atrial tachycardia (s-AT). Conventional ablation often involves creating anatomical “lines” that transect myocardial tissue supporting reentry. This can be extensive, creating iatrogenic scar as a nidus for future reentry, and may account for arrhythmia recurrence. High-density mapping may identify “narrower isthmuses” requiring less ablation, with ripple mapping proven to be an effective approach in identifying. This trial explores whether ablation of narrower isthmuses in s-AT, defined using ripple mapping, results in greater freedom from arrhythmia recurrence compared to conventional ablation. Methods The Ripple-AT-Plus trial (registration ClinicalTrials.gov , NCT03915691) is a prospective, multicentre, single-blinded, randomised controlled trial with 12-month follow-up. Two hundred s-AT patients will be randomised in a 1:1 fashion to either “ripple mapping-guided isthmus ablation” vs conventional ablation on the CARTO3 ConfiDENSE system (Biosense Webster). The primary outcome will compare recurrence of any atrial arrhythmia. Multicentre data will be analysed over a secure web-based cloud-storage and analysis software (CARTONET TM ). Conclusion This is the first trial that considers long-term patient outcomes post s-AT ablation, and whether targeting narrower isthmuses in the era of high density is optimal.

A web-based, collaborative distance-learning system that will allow groups of students to interact with each other remotely and with an intelligent electronic agent that will aid them in their learning has the potential for improving on-line learning. The agent would follow the discussion and interact with the participants when it detects learning trouble of some sort, such as confusion about the problem they are working on or a participant who is dominating the discussion or not interacting with the other participants. In order to recognize problems in the dialogue, we investigated conversational elements that can be utilized as predictors for effective and ineffective interaction between human students. These elements can serve as the basis for student and group models. In this paper, we discuss group interaction during collaborative learning, our representation of participant dialogue, and the statistical models we are using to determine the role being played by a participant at any point in the dialogue and the effectiveness of the group. We also describe student and group models that can be built using conversational elements and discuss one set that we built to illustrate their potential value in collaborative learning. [PUBLICATION ABSTRACT]

BackgroundTo prevent atrial fibrillation (AF) recurrence after catheter ablation, pulmonary venous isolation (PVI) at an antral level is more effective than segmental ostial ablation. Cryoablation around the pulmonary venous (PV) ostia for AF therapy is potentially safer compared to radiofrequency ablation (RFA). The aim of this study was to investigate the efficacy of a strategy using a large cryoablation balloon to perform antral cryoablation with ‘touch-up’ ostial cryoablation for PVI in patients with paroxysmal and persistent AF.MethodsParoxysmal and persistent AF patients undergoing their first left atrial ablation were recruited. After cryoballoon therapy, each PV was assessed for isolation and if necessary, treated with focal ostial cryoablation until PVI was achieved. Follow-up with Holter monitoring was performed. Clinical outcomes of the cryoablation protocol were compared, with consecutive patients undergoing PVI by RFA.Results124 consecutive patients underwent cryoablation. 77% of paroxysmal and 48% of persistent AF subjects were free from AF at 12 months after a single procedure. Over the same time period, 53 consecutive paroxysmal AF subjects underwent PVI with RFA and at 12 months, 72% were free from AF at 12 months (p=NS). There were too few persistent AF subjects (n=8) undergoing solely PVI by RFA as a comparison group. Procedural and fluoroscopic times during cryoablation were significantly shorter than RFA.ConclusionsPV isolation can be achieved in less than 2 h by a simple cryoablation protocol with excellent results after a single intervention, particularly for paroxysmal AF.

Four hundred fifty volunteers participated in a placebo-controlled, double-blind, randomized trial of the prophylactic effects of rimantadine and amantadine during an outbreak of influenza A. The subjects received drugs orally at a dose of 100 mg twice a day for six weeks. Influenza-like illness occurred in 41 per cent of the subjects receiving placebo but in only 14 per cent of those receiving rimantadine and 9 per cent of those receiving amantadine (P<0.001 for either drug vs. placebo). Laboratory-documented influenza occurred in 21 per cent of placebo recipients, 3 per cent of rimantadine recipients, and 2 per cent of amantadine recipients (P<0.001). These findings represent efficacy rates of 85 per cent for rimantadine and 91 per cent for amantadine, as compared with placebo. More recipients of amantadine (13 per cent) than recipients of rimantadine (6 per cent; P<0.05) or placebo (4 per cent; P<0.01) withdrew from the study because of Central-nervous-system side effects. On the basis of this study, rimantadine appears to be the drug of choice for the prophylaxis of influenza A. (N Engl J Med. 1982; 307: 580–4.) AMANTADINE hydrochloride (1-adamantanamine hydrochloride) was licensed in 1966 for the prophylaxis of infections with influenza A viruses of the H2N2 subtype, and it has subsequently been approved for the prophylaxis of infections with all influenza A subtypes. Despite accumulated evidence of the efficacy of amantadine in the prophylaxis of influenza in human beings, 1 2 3 4 5 6 the drug has received relatively little use for this purpose. In part, this has been a result of continued challenges to the evidence of its efficacy by some workers, 7 as well as concern over its reported side effects, which have varied considerably in frequency from study to . . .

Introduction: Conduction system pacing is a novel way for delivering cardiac resynchronisation therapy (CRT). This may deliver more effective ventricular resynchronisation than the gold standard, biventricular pacing (BVP). In BVP scar burden is known to impact response but whether this is true for conduction system pacing is unknown. Methods: Patients with standard CRT indications were recruited. They underwent a pre-procedure cardiac MRI, with late gadolinium enhancement to assess scar. Scar burden was quantified as the percentage of the amount of myocardium for each segment and the whole of the left ventricle (total scar). Conduction system pacing with both His bundle CRT (HB-CRT) and left bundle area CRT (LBA-CRT) was attempted in everyone, and the modality that delivered the narrowest QRS duration was selected. The electrical response was measured using non-invasive mapping (ECGi, CardioInsight, Medtronic). The haemodynamic response was measured with a high precision protocol. We investigated the impact of scar on the electrical and haemodynamic response. Results: A total of 26 patients were recruited, 85% male, mean age 69 ± 10 years, ischaemic cardiomyopathy in 35% and mean QRS duration 160 ± 15. LGE was observed in 96% of cases, mean total scar burden was 13 ± 12% (range 1–39%). We found a significant correlation between amount of scar and both the electrical and acute haemodynamic response (Figure 1). Patients with a lower scar burden obtained a greater improvement in both electrical resynchronisation (R=0.55, 95% CI 0.21–0.77, p<0.01, for reduction in left ventricular activation time [LVAT]), and acute haemodynamic response (R=0.5, 95% CI 0.18–0.76, p=0.005 for increase in acute systolic blood pressure). Conclusion: Conduction system pacing appears to be less effective in patients with a high left ventricular scar burden. We observed a strong correlation between scar burden and both ventricular electrical resynchronisation and acute haemodynamic response. This information may help patient selection for conduction system CRT. Alternative CRT modalities or combinations of modalities warrant further investigation in this challenging group of patients. ❑ [Image Omitted]