Epicardial Electrical Activation During Atrial Fibrillation: Looking at the Other Side of the Coin.

High-definition mapping of atrial fibrillation is most commonly performed from the endocardial surface. This report describes an example of a case in which combined mapping of the endocardium and epicardium of the left atrium demonstrated electrical dissociation between the 2 surfaces and implies that endocardial mapping alone may not provide sufficient information. ().

Hybrid ablation under intraoperative 3D voltage mapping guidance.

Long-standing persistent atrial fibrillation remains a significant therapeutic challenge, often proving to be resistant to treatment with antiarrhythmic medications and transcatheter ablation. Hybrid ablation, which combines a minimally invasive surgical and transcatheter approach, is emerging as a promising treatment option. In this video tutorial, we demonstrate our method of hybrid ablation for long-standing persistent atrial fibrillation using advanced 3D electro-anatomical voltage mapping to guide the ablation process and thereby improve the ultimate effectiveness of the procedure.

Autonomy and Firefighting: Perceived Competence and Stress.

Objective: In workplace settings, autonomy is implicated in employee motivation as well as supervisor autonomy support. As a profession of risk, firefighters may experience greater levels of stress.

Methods: A self-determination paradigm was applied to the firefighter workplace.

The Impact of the Proposed Changes for the DSM-5 on Diagnoses of First-time DUI/DWI Offenders.

Driving while impaired (DWI) is a frequently committed crime with enormous individual and social costs. The type of disposition and/or treatment appropriate for an individual offender is often determined, in part, by diagnostic criteria based on the American Psychiatric Association's Diagnostic and Statistics Manual. The DSM-5 significantly modified these criteria by eliminating legal problems as a criterion and dropping the categories of abuse and dependence.

Skin-to-Skin Care for Term and Preterm Infants in the Neonatal ICU.

“Kangaroo mother care” was first described as an alternative method of caring for low birth weight infants in resource-limited countries, where neonatal mortality and infection rates are high because of overcrowded nurseries, inadequate staffing, and lack of equipment. Intermittent skin-to-skin care (SSC), a modified version of kangaroo mother care, is now being offered in resource-rich countries to infants needing neonatal intensive care, including those who require ventilator support or are extremely premature. SSC significantly improves milk production by the mother and is associated with a longer duration of breastfeeding.

Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis.

This guideline is a revision of the clinical practice guideline, "Diagnosis and Management of Bronchiolitis," published by the American Academy of Pediatrics in 2006. The guideline applies to children from 1 through 23 months of age. Other exclusions are noted.

Hypothermia and neonatal encephalopathy.

Data from large randomized clinical trials indicate that therapeutic hypothermia, using either selective head cooling or systemic cooling, is an effective therapy for neonatal encephalopathy. Infants selected for cooling must meet the criteria outlined in published clinical trials. The implementation of cooling needs to be performed at centers that have the capability to manage medically complex infants.

Guidance on management of asymptomatic neonates born to women with active genital herpes lesions.

Herpes simplex virus (HSV) infection of the neonate is uncommon, but genital herpes infections in adults are very common. Thus, although treating an infant with neonatal herpes is a relatively rare occurrence, managing infants potentially exposed to HSV at the time of delivery occurs more frequently. The risk of transmitting HSV to an infant during delivery is determined in part by the mother's previous immunity to HSV.

MicroRNAs and ovarian function.

MicroRNAs (miRNAs) are a class of small non-coding RNAs which function in gene regulation with an important role in cell proliferation, maturation, and activity. The regulatory role of these small RNA molecules has recently begun to be explored in ovarian cells, uncovering their influence on gonadal development, steroidogenesis, apoptosis, ovulation, and corpus luteum development. This emerging area of research has extended and reshaped our understanding on how ovarian function is regulated.

Longitudinal predictors of maternal stress and coping after very low-birth-weight birth.

Objective: To determine longitudinal outcomes and contributors to parental stress and coping in mothers of very low-birth-weight (VLBW) children.

Design: Prospective cohort follow-up of high-risk VLBW children (n = 113), low-risk VLBW children (n = 80), and term children (n = 122) and their mothers from birth to 14 years.

Setting: Recruitment from level III neonatal intensive care and term nurseries in a large Midwestern region with follow-up at an academic medical center.

Elevated iron indices in preterm infants: association with male gender.

Elevated iron indices may be underrecognized in preterm infants. Sixty growing, stable preterm infants < 1500 g studied had elevated iron indices, which was especially elevated in male infants. Careful evaluation of iron indices is essential to prevent potential organ injury and unnecessary iron supplementation.

Long-term sequelae of postnatal surfactant and corticosteroid therapies for BPD.

Objective: This retrospective analysis assessed the relationship between medical treatment (postnatal steroids, surfactant) received neonatally and outcomes at 3 and 8 years using a longitudinal sample of children with bronchopulmonary dysplasia (BPD).

Study Design: Four groups were formed retrospectively based on the type of neonatal medical treatment received: no drug intervention (n=37), surfactant only (n=29), postnatal steroids only (n=13) and combined surfactant and postnatal steroids (n=16). Groups were compared on neurological and medical outcomes.

Developmental sequelae in preterm infants having a diagnosis of bronchopulmonary dysplasia: analysis using a severity-based classification system.

Objective: To investigate the relationship between the severity-based definition of bronchopulmonary dysplasia (BPD), choice of treatment, and neurocognitive outcomes at age 3 and 8 years.

Design: This is a secondary analysis of data collected from a prospective, longitudinal sample of 99 children with a history of BPD.

Setting: Children born with BPD admitted to 3 hospitals from February 1, 1989, to November 31, 1991.

Parenting very low birth weight children at school age: maternal stress and coping.

Objective: To compare severity and determinants of stress and coping in mothers of 8-year-old very low birth weight (VLBW) and term children varying in medical and developmental risk.

Study Design: Three groups of mothers/infants were prospectively compared in a longitudinal study from birth to 8 years (110 high-risk VLBW, 80 low-risk VLBW, and 112 term). Maternal psychological distress, coping, parenting/marital stress, child health, and family impact were measured in the children at age 8 years.

Neonatal candidiasis: ophthalmologic infection.

Endophthalmitis results from hematogenous seeding of the eye in preterm infants with candidiasis. Early systemic therapy decreases the frequency of eye involvement, now only about 6% in infants with systemic candidiasis. Eye disease can occur on the first day, but is more likely with prolonged candidemia.

Cognitive and academic consequences of bronchopulmonary dysplasia and very low birth weight: 8-year-old outcomes.

Objective: To examine the effects of bronchopulmonary dysplasia (BPD) and very low birth weight (VLBW) on the cognitive and academic achievement of a large sample of 8-year-old children.

Methods: Infants who were VLBW and had BPD (n = 98) or did not have BPD (n = 75) and term infants (n = 99) were followed prospectively to age 8. Groups were compared on measures assessing 4 broad areas of functioning: intelligence, achievement, gross motor, and attentional skills.

Effects of infant risk status and maternal psychological distress on maternal-infant interactions during the first year of life.

The associations of infant medical risk, prematurity, and maternal psychological distress with the quality of maternal-infant interactions during the first year of life were evaluated in a prospective, longitudinal follow-up from birth. A total of 103 high-risk very low birth weight (VLBW) infants with bronchopulmonary dysplasia, 68 low-risk VLBW infants without bronchopulmonary dysplasia, and 117 healthy term infants were seen at 1, 8, and 12 months of age. Videotaped feedings at each age were rated using the Nursing Child Assessment Feeding Scale, and mothers completed the Brief Symptom Inventory as a measure of psychological distress.

Coping and Psychological Distress in Mothers of Very Low Birth Weight Young Children.

Objective: This study sought to increase understanding of relations among coping strategies, sociodemographic variables, and psychological distress in mothers of high-risk (HR) and low-risk (LR) very low birth weight (VLBW; < 1,500g) infants.

Design: The sample ( = 199) consisted of 77 mothers of HR VLBW infants, 43 mothers of LR VLBW infants, and a control group of 79 mothers of healthy, term infants. Data were collected with self-report questionnaires at birth and at 24 months postpartum.

Speech and language outcomes of children with bronchopulmonary dysplasia.

Unlabelled: A prospective follow-up of very low birth weight infants (VLBW) with (n = 89) and without (n = 71) bronchopulmonary dysplasia (BPD) and Term control children (n = 93) was conducted at 8 years of age. Groups were compared on measures of articulation, receptive and expressive language, verbal and performance IQ, oral motor skills and gross and fine motor skills. The BPD group demonstrated reduced articulation, receptive language skills, performance IQ, and overall gross and fine motor skills when compared to VLBW and Term groups.

Developmental outcomes and environmental correlates of very low birthweight, cocaine-exposed infants.

Fetal cocaine exposure may have differentially adverse effects on developmental outcomes of very low birthweight (VLBW) infants. As part of a longitudinal study, 31 cocaine-positive very low birthweight infants, and age, race and socioeconomic status matched VLBW controls enrolled at birth were followed. Neonatal maternal-child interactions, concurrent maternal psychological characteristics and environmental factors conceptualized as important for child outcome were assessed as well as standard developmental outcomes at 3 years.

Preschool language outcomes of children with history of bronchopulmonary dysplasia and very low birth weight.

A prospective follow-up of very low birth weight (VLBW) infants with and without bronchopulmonary dysplasia (BPD) and term control infants was conducted. The effects of BPD and VLBW on speech-language development and specific language impairment at 3 years of age were investigated, controlling for the effects of sociodemographic and other medical risk factors. Groups were compared on cognitive and speech-language outcomes using the Battelle Language and Bayley Mental Scales of Infant Development.