This large-scale cross-sectional study had the aim to investigate whether adolescent males and females differ in self-perceived self-regulation. The large sample size allowed us to investigate sex ...differences in three age-groups of young (n = 161), middle (n = 133) and late (n = 159) adolescents. Self-regulation was evaluated with a self-report questionnaire, the Amsterdam Executive Functioning Inventory (AEFI). This questionnaire gives a proxi for three executive functions that are important for proper self-regulation: (1) self-control & self-monitoring, (2) attention, and (3) planning & initiative taking. Results revealed clear sex differences in the self-regulation as perceived by mid-adolescents (i.e., 13-16 years). In this age period, females evaluated their attention higher than males, and they reported higher levels of self-control & self-monitoring. Our findings offer important new insights with respect to the decision making, academic achievements and behaviour of 13-16-year olds. Self-regulation is known to have a central role in academic achievement and in behavioural organisation. The sex differences in self-regulation in mid-adolescence may therefore explain part of the difference which males and females in this age-group exhibit in academic achievements and behavioural organisations. The results imply that self-regulation may be a relevant intervention target: rather than focussing on changing behaviour, interventions may focus more on self-insights and thereby changing the adolescent's perceptions about their behaviour. Increased self-insight may have the potency to actually change behaviour, which might be an interesting target for future investigation.
Understanding the links between sleep and brain development is important, as rapid eye movement (REM) sleep and non‐REM (NREM) sleep seem to contribute to different aspects of brain maturation. If ...children have sleep problems, REM sleep and NREM sleep are likely to have different consequences for their developing brain, depending on their age. We highlight important discoveries from human and animal research on the role sleep plays in brain development. A hypothetical model is presented to explain the dynamic relationship of REM sleep and NREM sleep with different processes of brain maturation, with implications for current neonatal care and future research.
Subcutaneous or Transvenous Defibrillator Therapy Knops, Reinoud E; Olde Nordkamp, Louise R A; Delnoy, Peter-Paul H M ...
The New England journal of medicine,
08/2020, Letnik:
383, Številka:
6
Journal Article
Recenzirano
Odprti dostop
The subcutaneous implantable cardioverter-defibrillator (ICD) was designed to avoid complications related to the transvenous ICD lead by using an entirely extrathoracic placement. Evidence comparing ...these systems has been based primarily on observational studies.
We conducted a noninferiority trial in which patients with an indication for an ICD but no indication for pacing were assigned to receive a subcutaneous ICD or transvenous ICD. The primary end point was the composite of device-related complications and inappropriate shocks; the noninferiority margin for the upper boundary of the 95% confidence interval for the hazard ratio (subcutaneous ICD vs. transvenous ICD) was 1.45. A superiority analysis was prespecified if noninferiority was established. Secondary end points included death and appropriate shocks.
A total of 849 patients (426 in the subcutaneous ICD group and 423 in the transvenous ICD group) were included in the analyses. At a median follow-up of 49.1 months, a primary end-point event occurred in 68 patients in the subcutaneous ICD group and in 68 patients in the transvenous ICD group (48-month Kaplan-Meier estimated cumulative incidence, 15.1% and 15.7%, respectively; hazard ratio, 0.99; 95% confidence interval CI, 0.71 to 1.39; P = 0.01 for noninferiority; P = 0.95 for superiority). Device-related complications occurred in 31 patients in the subcutaneous ICD group and in 44 in the transvenous ICD group (hazard ratio, 0.69; 95% CI, 0.44 to 1.09); inappropriate shocks occurred in 41 and 29 patients, respectively (hazard ratio, 1.43; 95% CI, 0.89 to 2.30). Death occurred in 83 patients in the subcutaneous ICD group and in 68 in the transvenous ICD group (hazard ratio, 1.23; 95% CI, 0.89 to 1.70); appropriate shocks occurred in 83 and 57 patients, respectively (hazard ratio, 1.52; 95% CI, 1.08 to 2.12).
In patients with an indication for an ICD but no indication for pacing, the subcutaneous ICD was noninferior to the transvenous ICD with respect to device-related complications and inappropriate shocks. (Funded by Boston Scientific; PRAETORIAN ClinicalTrials.gov number, NCT01296022.).
In many countries around the world impacts of climate change are assessed and adaptation options identified. We describe an approach for a qualitative and quantitative assessment of adaptation ...options to respond to climate change in the Netherlands. The study introduces an inventory and ranking of adaptation options based on stakeholder analysis and expert judgement, and presents some estimates of incremental costs and benefits. The qualitative assessment focuses on ranking and prioritisation of adaptation options. Options are selected and identified and discussed by stakeholders on the basis of a sectoral approach, and assessed with respect to their importance, urgency and other characteristics by experts. The preliminary quantitative assessment identifies incremental costs and benefits of adaptation options. Priority ranking based on a weighted sum of criteria reveals that in the Netherlands integrated nature and water management and risk based policies rank high, followed by policies aiming at 'climate proof' housing and infrastructure.
•Cities are a centers of demand for ecosystem services and with projected doubling of urban populations there will be an accelerating demand of these services.•Rapid expansion of urban areas present ...fundamental challenges but there are also opportunities to restore ecological functions to design more liveable, healthy and resilient cities.•We present estimates of benefits from urban ecosystem services based on comparison of 25 urban areas in USA, China and Canada.•Our results show that across these 25 urban areas, investing in urban ecological infrastructure may often be economically advantageous.
Cities are a key nexus of the relationship between people and nature and are huge centers of demand for ecosystem services and also generate extremely large environmental impacts. Current projections of rapid expansion of urban areas present fundamental challenges and also opportunities to design more livable, healthy and resilient cities (e.g. adaptation to climate change effects). We present the results of an analysis of benefits of ecosystem services in urban areas. Empirical analyses included estimates of monetary benefits from urban ecosystem services based on data from 25 urban areas in the USA, Canada, and China. Our results show that investing in ecological infrastructure in cities, and the ecological restoration and rehabilitation of ecosystems such as rivers, lakes, and woodlands occurring in urban areas, may not only be ecologically and socially desirable, but also quite often, economically advantageous, even based on the most traditional economic approaches.
Glial fibrillary acidic protein (GFAP) is the main astrocytic intermediate filament (IF). GFAP splice isoforms show differential expression patterns in the human brain. GFAPδ is preferentially ...expressed by neurogenic astrocytes in the subventricular zone (SVZ), whereas GFAP(+1) is found in a subset of astrocytes throughout the brain. In addition, the expression of these isoforms in human brain material of epilepsy, Alzheimer and glioma patients has been reported. Here, for the first time, we present a comprehensive study of GFAP isoform expression in both wild-type and Alzheimer Disease (AD) mouse models. In cortex, cerebellum, and striatum of wild-type mice, transcripts for Gfap-α, Gfap-β, Gfap-γ, Gfap-δ, Gfap-κ, and a newly identified isoform Gfap-ζ, were detected. Their relative expression levels were similar in all regions studied. GFAPα showed a widespread expression whilst GFAPδ distribution was prominent in the SVZ, rostral migratory stream (RMS), neurogenic astrocytes of the subgranular zone (SGZ), and subpial astrocytes. In contrast to the human SVZ, we could not establish an unambiguous GFAPδ localization in proliferating cells of the mouse SVZ. In APPswePS1dE9 and 3xTgAD mice, plaque-associated reactive astrocytes had increased transcript levels of all detectable GFAP isoforms and low levels of a new GFAP isoform, Gfap-ΔEx7. Reactive astrocytes in AD mice showed enhanced GFAPα and GFAPδ immunolabeling, less frequently increased vimentin and nestin, but no GFAPκ or GFAP(+1) staining. In conclusion, GFAPδ protein is present in SVZ, RMS, and neurogenic astrocytes of the SGZ, but also outside neurogenic niches. Furthermore, differential GFAP isoform expression is not linked with aging or reactive gliosis. This evidence points to the conclusion that differential regulation of GFAP isoforms is not involved in the reorganization of the IF network in reactive gliosis or in neurogenesis in the mouse brain.
Implantable cardioverter-defibrillators (ICDs) are implanted with the intention to prolong life in selected patients with inherited arrhythmia syndromes, but ICD implantation is also associated with ...inappropriate shocks and complications.
We aimed to quantify the rate of inappropriate shocks and other ICD-related complications to be able to weigh benefit and harm in these patients.
We performed a systematic review and meta-analysis of inappropriate shock and/or other ICD-related complication rates, including ICD-related mortality, in patients with inherited arrhythmia syndromes, that is, arrhythmogenic right ventricular cardiomyopathy/dysplasia, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, hypertrophic cardiomyopathy, dilated cardiomyopathy due to a mutation in the lamin A/C gene, long QT syndrome, and short QT syndrome. We searched MEDLINE and EMBASE from inception to May 30, 2014.
Of 2471 unique citations, 63 studies comprising 4916 patients with inherited arrhythmia syndromes (mean age of 39 ± 15 years) were included. Inappropriate shocks occurred in 20% of patients (crude annual rate of 4.7% per year), with a significantly higher rate in studies published before 2008 (6.1% per year vs 4.1% per year). Moreover, 22% experienced ICD-related complications (4.4% per year) and there was a 0.5% ICD-related mortality (0.08% per year).
ICD implantation carries a significant risk of inappropriate shocks and inhospital and postdischarge complications in relatively young patients with inherited arrhythmia syndromes. These data can be used to better inform patients and physicians about the expected risk of adverse ICD events and thereby facilitate shared decision making.
Respiratory viral infections follow an unpredictable clinical course in young children ranging from a common cold to respiratory failure. The transition from mild to severe disease occurs rapidly and ...is difficult to predict. The pathophysiology underlying disease severity has remained elusive. There is an urgent need to better understand the immune response in this disease to come up with biomarkers that may aid clinical decision making.
In a prospective study, flow cytometric and genome-wide gene expression analyses were performed on blood samples of 26 children with a diagnosis of severe, moderate or mild Respiratory Syncytial Virus (RSV) infection. Differentially expressed genes were validated using Q-PCR in a second cohort of 80 children during three consecutive winter seasons. FACS analyses were also performed in the second cohort and on recovery samples of severe cases in the first cohort.
Severe RSV infection was associated with a transient but marked decrease in CD4+ T, CD8+ T, and NK cells in peripheral blood. Gene expression analyses in both cohorts identified Olfactomedin4 (OLFM4) as a fully discriminative marker between children with mild and severe RSV infection, giving a PAM cross-validation error of 0%. Patients with an OLFM4 gene expression level above -7.5 were 6 times more likely to develop severe disease, after correction for age at hospitalization and gestational age.
By combining genome-wide expression profiling of blood cell subsets with clinically well-annotated samples, OLFM4 was identified as a biomarker for severity of pediatric RSV infection.
Three incisions in the chest are necessary for implantation of the entirely subcutaneous implantable cardioverter-defibrillator (S-ICD). The superior parasternal incision is a possible risk for ...infection and a potential source of discomfort. A less invasive alternative technique of implanting the S-ICD electrode--the two-incision technique--avoids the superior parasternal incision.
The purpose of this prospective cohort study was to evaluate the safety and efficacy of the two-incision technique for implantation of the S-ICD.
Consecutive patients who received an S-ICD between October 2010 and December 2011 were implanted using the two-incision technique, which positions the parasternal part of the S-ICD electrode using a standard 11Fr peel-away sheath. All patients were routinely evaluated for at least 1 year for complications and device interrogation at the outpatient clinic.
Thirty-nine patients (46% male, mean age 44 ± 15 years) were implanted with a S-ICD using the two-incision technique. During mean follow-up of 18 months (range 14-27 months) no dislocations were observed, and there was no need for repositioning of either the ICD or the electrode. No serious infections occurred during follow-up except for 2 superficial wound infections of the pocket incision site. Device function was normal in all patients, and no inappropriate sensing occurred related to the implantation technique.
The two-incision technique is a safe and efficacious alternative for S-ICD implantations and may help to reduce complications. The two-incision technique offers physicians a less invasive and simplified implantation procedure of the S-ICD.
T‐Wave Analysis for the Subcutaneous ICD
Background
The subcutaneous cardioverter‐defibrillator (S‐ICD) relies on a pre‐implantation QRS‐T morphology screening (TMS) of the ECG to assure that it ...reliably detects the QRS complexes and T waves. The prevalence and clinical characteristics of the patients who fail this TMS is unknown.
Methods and Results
QRS‐TMS was done in 230 consecutive ICD outpatients (75% male, age 57 ± 15 years) without an indication for cardiac pacing, using an ECG simulating the 3 sensing vectors of the S‐ICD (TMS‐ECG). Patients were defined suitable when at least 1 sensing vector was considered appropriate in both supine and standing position. In total, 7.4% of patients, who were all male, were considered not suitable for a S‐ICD according to the TMS‐ECG. Independent predictors for TMS failure were hypertrophic cardiomyopathy (HCM; odds ratio OR 12.6), a heavy weight (OR 1.5), a prolonged QRS duration (OR 1.5) and a R:T ratio <3 in the lead with the largest T wave on a standard 12‐lead surface ECG (OR 14.6).
Conclusion
In patients without an indication for pacing, 7.4% would have been not suitable for a S‐ICD according to the TMS. HCM, a heavy weight, a prolonged QRS duration and a R:T ratio <3 in the ECG lead with the largest T wave were independently associated with TMS failure. These data might alert physicians that selection of patients for a S‐ICD should be considered with special caution in certain patient groups, because they may not satisfy ECG criteria for adequate sensing.
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