Efficacy and safety of linaclotide in treating functional constipation in paediatric patients: a randomised, double-blind, placebo-controlled, multicentre, phase 3 trial.

Background: Linaclotide, a guanylate cyclase C agonist, has been approved in the USA for the treatment of chronic idiopathic constipation and irritable bowel syndrome with predominant constipation in adults. We aimed to assess the efficacy and safety of linaclotide in paediatric patients aged 6-17 years with functional constipation.

Methods: This randomised, double-blind, placebo-controlled, multicentre, phase 3 study was done at 64 clinic or hospital sites in seven countries (USA, Canada, Israel, Italy, the Netherlands, Ukraine, and Estonia).

Role of ephaptic coupling in discordant alternans domain sizes and action potential propagation in the heart.

Discordant alternans, the spatially out-of-phase alternation of the durations of propagating action potentials in the heart, has been linked to the onset of fibrillation, a major cardiac rhythm disorder. The sizes of the regions, or domains, within which these alternations are synchronized are critical in this link. However, computer models employing standard gap junction-based coupling between cells have been unable to reproduce simultaneously the small domain sizes and rapid action potential propagation speeds seen in experiments.

Ephaptic Coupling as a Resolution to the Paradox of Action Potential Wave Speed and Discordant Alternans Spatial Scales in the Heart.

Previous computer simulations have suggested that existing models of action potential wave propagation in the heart are not consistent with observed wave propagation behavior. Specifically, computer models cannot simultaneously reproduce the rapid wave speeds and small spatial scales of discordant alternans patterns measured experimentally in the same simulation. The discrepancy is important, because discordant alternans can be a key precursor to the development of abnormal and dangerous rapid rhythms in the heart.

Standardised neonatal parenteral nutrition formulations - Australasian neonatal parenteral nutrition consensus update 2017.

Background: The first consensus standardised neonatal parenteral nutrition formulations were implemented in many neonatal units in Australia in 2012. The current update involving 49 units from Australia, New Zealand, Singapore, Malaysia and India was conducted between September 2015 and December 2017 with the aim to review and update the 2012 formulations and guidelines.

Methods: A systematic review of available evidence for each parenteral nutrient was undertaken and new standardised formulations and guidelines were developed.

Plasma ammonia concentrations in extremely low birthweight infants in the first week after birth: secondary analysis from the ProVIDe randomized clinical trial.

Background: Little is known about normative ammonia concentrations in extremely low birthweight (ELBW) babies and whether these vary with birth characteristics. We aimed to determine ammonia concentrations in ELBW babies in the first week after birth and relationships with neonatal characteristics and protein intake.

Methods: Arterial blood samples for the measurement of plasma ammonia concentration were collected within 7 days of birth from ProVIDe trial participants in six New Zealand neonatal intensive care units.

Life History Theory and economic modernity.

Baumard's new explanation of the Industrial Revolution shows that Life History Theory holds great potential. Here, I suggest two related hypotheses for examination. One is that there are long-term roots of slow life traits and preferences.

Long-term nitrogen dioxide exposure assessment using back-extrapolation of satellite-based land-use regression models for Australia.

Assessing historical exposure to air pollution in epidemiological studies is often problematic because of limited spatial and temporal measurement coverage. Several methods for modelling historical exposures have been described, including land-use regression (LUR). Satellite-based LUR is a recent technique that seeks to improve predictive ability and spatial coverage of traditional LUR models by using satellite observations of pollutants as inputs to LUR.

The effects of routine administration of probiotics on the length of central venous line usage in extremely premature infants.

Rajput N, Filipovska J, Hewson M. The effects of routine administration of probiotics on the length of central venous line usage in extremely premature infants. Turk J Pediatr 2017; 59: 20-27.

Independent Validation of National Satellite-Based Land-Use Regression Models for Nitrogen Dioxide Using Passive Samplers.

Including satellite observations of nitrogen dioxide (NO) in land-use regression (LUR) models can improve their predictive ability, but requires rigorous evaluation. We used 123 passive NO samplers sited to capture within-city and near-road variability in two Australian cities (Sydney and Perth) to assess the validity of annual mean NO estimates from existing national satellite-based LUR models (developed with 68 regulatory monitors). The samplers spanned roadside, urban near traffic (≤100 m to a major road), and urban background (>100 m to a major road) locations.

A national satellite-based land-use regression model for air pollution exposure assessment in Australia.

Land-use regression (LUR) is a technique that can improve the accuracy of air pollution exposure assessment in epidemiological studies. Most LUR models are developed for single cities, which places limitations on their applicability to other locations. We sought to develop a model to predict nitrogen dioxide (NO2) concentrations with national coverage of Australia by using satellite observations of tropospheric NO2 columns combined with other predictor variables.

Randomized controlled trial of oxygen saturation targets in very preterm infants: two year outcomes.

Objective: To assess whether an oxygen saturation (Spo2) target of 85%-89% compared with 91%-95% reduced the incidence of the composite outcome of death or major disability at 2 years of age in infants born at <28 weeks' gestation.

Study Design: A total 340 infants were randomized to a lower or higher target from <24 hours of age until 36 weeks' gestational age. Blinding was achieved by targeting a displayed Spo2 of 88%-92% using a saturation monitor offset by ±3% within the range 85%-95%.

Oxygen saturation and outcomes in preterm infants.

Background: The clinically appropriate range for oxygen saturation in preterm infants is unknown. Previous studies have shown that infants had reduced rates of retinopathy of prematurity when lower targets of oxygen saturation were used.

Methods: In three international randomized, controlled trials, we evaluated the effects of targeting an oxygen saturation of 85 to 89%, as compared with a range of 91 to 95%, on disability-free survival at 2 years in infants born before 28 weeks' gestation.

A randomised, controlled trial of heparin in total parenteral nutrition to prevent sepsis associated with neonatal long lines: the Heparin in Long Line Total Parenteral Nutrition (HILLTOP) trial.

Background: Infections are common complications of neonatal long lines. Heparin has been shown to prolong the effective duration of neonatal long lines and to reduce the ability of bacteria to adhere to foreign surfaces, but the effect of heparin on rates of infection is uncertain.

Objective: The goal of this study was to evaluate the effect of heparin on the frequency of episodes of catheter-related sepsis (CRS) in infants receiving total parenteral nutrition (TPN) through a neonatal long line.

Teaching the medical interview: methods and key learning issues in a faculty development course.

Objective: To describe the American Academy on Communication in Healthcare's (AACH) Faculty Development Course on Teaching the Medical Interview and report a single year's outcomes.

Design: We delivered a Faculty Development course on Teaching the Medical Interview whose theme was relationship-centered care to a national and international audience in 1999. Participants completed a retrospective pre-post assessment of their perceived confidence in performing interview, clinical, teaching, and self-awareness skills.

Integrative medicine: implementation and evaluation of a professional development program using experiential learning and conceptual change teaching approaches.

Objective: To meet the increasing patient interest in complementary and alternative medicine (CAM), conventional physicians need to understand CAM, be willing to talk with their patients about CAM, and be open to recommending selected patients to appropriate CAM modalities. We aimed to raise physicians' awareness of, and initiate attitudinal changes towards CAM in the context of integrative medical practice. We developed and implemented a professional development program involving experiential learning and conceptual change teaching approaches.

RADPED: an approach to teaching communication skills to radiology residents.

Background: The Accreditation Council for Graduate Medical Education mandates that radiology residency programs teach communication skills to residents.

Objective: The purpose of this paper is to present a mnemonic, RADPED, that can be used to enhance communication in the radiology setting. It reminds the resident of the salient points to address during an imaging encounter with pediatric patients and their families for the purpose of enhancing communication.

Assessing residents' competency in care management: report of a consensus conference.

Background: Residency programs must prepare physicians to practice in the current health care environment. This mandate is reflected in 3 of the 6 competency domains now required by the Accreditation Council for Graduate Medical Education: systems-based practice, interpersonal skills and communication, and practice-based learning and improvement.

Summary: An invitational conference was convened, with experts in clinical practice, managed care administration, and education to identify and recommend optimal and promising assessment methods for 4 target areas: physician-patient communication, ethics, teamwork and collaboration, and practice management.

Creating an international comprehensive web-based curriculum in pediatric radiology.

Objective: This article describes the creation of a standardized comprehensive resident curriculum in pediatric radiology that uses adult learning principles authored by international experts and addresses the six general competencies required by the Accreditation Council for Graduate Medical Education.

Conclusion: Web-based learning with an online curriculum has the potential to become an integral component of residency training. The use of radiology experts as authors allows compilation of an authoritative, comprehensive, and current body of knowledge that enhances the current teaching file approach to Web-based instruction in radiology.

Congenital malaria in a preterm infant.

A case of congenital malaria in a preterm newborn infant is presented. The case illustrates the difficulty of early diagnosis, and the atypical nature of presentation in a preterm infant.

Severe congenital Factor VII deficiency associated with the 13q deletion syndrome.

The first reported case of clinically significant congenital Factor VII deficiency in association with the 13q deletion syndrome is presented. It illustrates the importance of knowledge of the specific genes involved in gross deletion syndromes and adds to the current clinical experience of this rare disease.

Reflections on integrating theories of adult education into a medical school faculty development course.

The purpose of this study was to test a three-day course model for medical school faculty designed to promote self-directed learning, teaching skills, personal awareness and interdisciplinary collegiality. The training program described was conducted three times in our medical school. Fifty-eight faculty from 11 clinical departments have participated in this intensive experience of learning how to teach, based on principles of learner-centered learning and adult education theory.

What's the use of faculty development? Program evaluation using retrospective self-assessments and independent performance ratings.

Background: The assessment of the effectiveness of faculty development programs is increasingly important in medical schools and academic medical centers but is difficult to accomplish.

Purpose: We investigated the usefulness of retrospective self-assessments by program participants in combination with independent ratings of teaching performance by their trainees.

Methods: We used a single sample, prepost intervention design using multiple measures.

Successful lecturing: a prospective study to validate attributes of the effective medical lecture.

Objective: In a study conducted over 3 large symposia on intensive review of internal medicine, we previously assessed the features that were most important to course participants in evaluating the quality of a lecture. In this study, we attempt to validate these observations by assessing prospectively the extent to which ratings of specific lecture features would predict the overall evaluation of lectures.

Measurements And Main Results: After each lecture, 143 to 355 course participants rated the overall lecture quality of 69 speakers involved in a large symposium on intensive review of internal medicine.

Insulin infusions in the neonatal unit: delivery variation due to adsorption.

Objective: To assess the extent of the variability in insulin delivery over time, under conditions used in Australian neonatal units, studying the following variables: diluent, preconditioning, flushing, sequential preconditioning and flushing, insulin concentration, flow rate, catheter type, and addition of albumin.

Methodology: A range of simulated insulin infusions was studied. Infusions were run over 22 h, with aliquots of infusate collected at baseline and after 15 min, 30 min, 1 h, 2 h, 6 h and 22 h.