Experience using the new GORE Septal Occluder at the margins.

Complex atrial anatomy continues to challenge transcatheter device closure of septal defects. Devices and technology continue to evolve. We report three cases from our institution where the new Gore Septal Occluder was utilized for the closure of a lateral tunnel fenestration, a moderate-sized secundum atrial septal defect and a long tunnel patent foramen ovale.

Bridging the gap: innovative approaches to continuing education in rural, remote, and isolated first nation communities.

Access to education, communication, and support is essential for achieving and maintaining a skilled healthcare workforce. Delivering affordable and accessible continuing education for healthcare providers in rural, remote, and isolated First Nation communities is challenging due to barriers such as geography, isolation, costs, and staff shortages. The innovative use of technology, such as on-line courses and webinars, will be presented as a highly effective approach to increase access to continuing education for healthcare providers in these settings.

Mortality, hepatopathy and liver copper concentrations in artificially reared Jersey calves before and after reductions in copper supplementation.

High winter mortality (28 per cent) in female Jersey calves ( View Article and Find Full Text PDF

Evaluation of clinical and safety outcomes associated with conversion from brand-name to generic tacrolimus in transplant recipients enrolled in an integrated health care system.

Study Objective: To evaluate clinical and safety outcomes among transplant recipients whose tacrolimus was converted from the brand-name formulation to a generic formulation.

Design: Retrospective analysis.

Data Source: Clinical databases and electronic records from a large, integrated health care system in California.

Predictors of body mass index in female parents whose children participate in a competitive, creative, problem-solving program.

Background: Recent findings from our research indicate that children participating in a creative afterschool program exhibit overall healthier lifestyle practices compared to the average US pediatric population. This observation led us to investigate the prevalence of overweight/obesity and lifestyle practices of their parents.

Objective: To determine the strongest predictors of weight status for female parents whose children were participating in such creative afterschool program.

A pressing matter--mediastinal fibrosis with near obliteration of the pulmonary arteries.

Idiopathic mediastinal fibrosis is a rare, histologically benign condition which often presents with symptoms attributable to compression of vital mediastinal structures. Diagnosis can be difficult and individualized treatments are required for patients, with possible intervention including pharmacotherapy, surgery, and percutaneous stenting. We present a case of idiopathic mediastinal fibrosis present in a 50-year-old woman as compression and near obliteration of the pulmonary arteries.

Genotypic and phenotypic analysis of 396 individuals with mutations in Sonic Hedgehog.

Background: Holoprosencephaly (HPE), the most common malformation of the human forebrain, may result from mutations in over 12 genes. Sonic Hedgehog (SHH) was the first such gene discovered; mutations in SHH remain the most common cause of non-chromosomal HPE. The severity spectrum is wide, ranging from incompatibility with extrauterine life to isolated midline facial differences.

Standalone balloon aortic valvuloplasty: indications and outcomes from the UK in the transcatheter valve era.

Objectives: We sought to characterize UK-wide balloon aortic valvuloplasty (BAV) experience in the TAVI era.

Background: BAV for acquired calcific aortic stenosis is in a phase of renaissance, largely due to the development of transcatheter aortic valve implantation (TAVI).

Methods: Data from 423 patients at 14 centers across the UK were analyzed.

The effects of an energy density prescription on diet quality and weight loss: a pilot randomized controlled trial.

Dietary goals specific for lowering energy density (ED) may promote a nutrient-dense diet and weight loss. This pilot study examined the effects of ED-based diet prescriptions on diet quality and weight loss during a 3-month behavior-based obesity intervention conducted in a research setting. Forty-four adults with overweight/obesity (age 52.

Problem gambling among international and domestic university students in Australia: who is at risk?

Young people are a high risk group for gambling problems and university (college) students fall into that category. Given the high accessibility of gambling in Australia and its association with entertainment, students from overseas countries, particularly those where gambling is restricted or illegal, may be particularly vulnerable. This study examines problem gambling and its correlates among international and domestic university students using a sample of 836 domestic students (286 males; 546 females); and 764 international students (369 males; 396 females) at three Australian universities.

Mitochondrial and ion channel gene alterations in autism.

To evaluate the potential importance in autistic subjects of copy number variants (CNVs) that alter genes of relevance to bioenergetics, ionic metabolism, and synaptic function, we conducted a detailed microarray analysis of 69 autism probands and 35 parents, compared to 89 CEU HapMap controls. This revealed that the frequency CNVs of≥100kb and CNVs of≥10 Kb were markedly increased in probands over parents and in probands and parents over controls. Evaluation of CNVs≥1Mb by chromosomal FISH confirmed the molecular identity of a subset of the CNVs, some of which were associated with chromosomal rearrangements.

Evaluation of a DVD for women with diabetes: impact on knowledge and attitudes to preconception care.

Aims: To determine if an educational DVD increases knowledge and changes attitudes of women with diabetes towards preconception care.

Methods: Ninety-seven women with diabetes (Type 1, n = 89; Type 2, n = 8), aged 18-40 years, completed a pre-DVD and post-DVD intervention study by postal questionnaire. Beliefs and attitudes associated with preventing an unplanned pregnancy and seeking preconception care were assessed using a validated questionnaire; scales included benefits, barriers, personal attitudes and self-efficacy.

Does a diet high or low in fat influence the oxidation potential of VLDL, LDL and HDL subfractions?

Background And Aims: High-fat diets have become increasingly popular for weight-loss, but their effect on the oxidation potential of lipoprotein subfractions has not been studied. Therefore, this study compared the effects of high-fat vs. low-fat weight reduction diets on this parameter.

Incorporating the life course model into MCH nutrition leadership education and training programs.

Life course perspective, social determinants of health, and health equity have been combined into one comprehensive model, the life course model (LCM), for strategic planning by US Health Resources and Services Administration's Maternal and Child Health Bureau. The purpose of this project was to describe a faculty development process; identify strategies for incorporation of the LCM into nutrition leadership education and training at the graduate and professional levels; and suggest broader implications for training, research, and practice. Nineteen representatives from 6 MCHB-funded nutrition leadership education and training programs and 10 federal partners participated in a one-day session that began with an overview of the models and concluded with guided small group discussions on how to incorporate them into maternal and child health (MCH) leadership training using obesity as an example.

Remote lactation consultation: a qualitative study of maternal response to experience and recommendations for survey development.

Background: Use of videoconferencing technology for healthcare intervention and support is an area of tremendous potential, especially in regard to application in rural or underserved communities. Potential for cost-savings, time-savings, and increased access to care are the ultimate driving force behind use of this technology, for both providers and recipients of healthcare services. Recently, the Federal Government has initiated rulings to support the increased use of computer technology in underserved areas.

Short-term efficacy of palliative balloon aortic valvuloplasty in selected patients with high operative risk.

Unlabelled: With the introduction of transcatheter aortic valve implantation (TAVI), the precise role of balloon aortic valvuloplasty (BAV) remains to be established.

Methods: Between August 2008 and November 2010, consecutive patients undergoing BAV for severe aortic stenosis (AS) in our center were enrolled. The primary endpoint was survival to hospital discharge.

Does theory of mind performance differ in children with early-onset and regressive autism?

A deficit in theory of mind (ToM), or the ability to infer the mental states of others, has been implicated as one of the major characteristics of Autism Spectrum Disorder (ASD); however, little attention has been devoted to possible differences in ToM ability within ASD. The current study examined ToM performance in children with early-onset autism and regressive autism in comparison to typically developing children. Results indicated that children in the regressive autism group performed significantly better than the early-onset autism group on the non-verbal appearance-reality task.

A generic bioanalytical method development strategy and fit-for-purpose qualification to support hERG in vitro sample analysis.

Background: The amount of method development and assay validation required to support analysis of solutions from in vitro systems is a consideration of analytical laboratories performing this type of analysis. As there is little information from regulatory bodies as to how much assay development and validation is required, analytical laboratories need to decide on the best approach for this type of work. In this paper, we describe an efficient 'fit-for-purpose' approach that has been developed to support buffer sample analysis from Safety Pharmacology hERG studies.

Contact precautions for methicillin-resistant Staphylococcus aureus colonization: costly and unnecessary?

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is frequently encountered in health care facilities. Many hospitals have established screening programs to identify individuals harboring the organism. Patients identified as carrying MRSA are frequently placed in Contact Precautions at time of admission.

Evaluation of a pharmacist-managed amiodarone monitoring program.

Background: Because of the potential for serious adverse effects, patients treated with amiodarone must be carefully screened and routinely monitored for potential liver, thyroid, and pulmonary toxicity. However, laboratory and pulmonary monitoring rates have been found to be substantially lower than recommended in guidelines, including those of the North American Society of Pacing and Electrophysiology (NASPE, 2007).

Objective: To (a) assess rates of laboratory monitoring of liver, thyroid, and pulmonary function and adverse events in a pharmacist-managed amiodarone monitoring program compared with usual care in an integrated health care system and (b) estimate return on investment (ROI) from this intervention.

Guideliner catheter--friend or foe?

Performing percutaneous coronary intervention (PCI) in arteries with complex anatomy remains a clinical problem. In particular tortuosity within a coronary vessel is frequently encountered and can hamper delivery of balloons or stents to coronary stenoses. This has led to the development of a number of adjuvant devices to assist stent delivery in difficult cases.

How should I treat a patient to remove a fractured jailed side branch wire?

Background: A 53-year-old female was sent for diagnostic angiography after successful reperfusion therapy for an anterior ST-elevation myocardial infarct. The culprit lesion was a LAD/D1 bifurcation stenosis.

Investigations: Coronary angiography, intravascular ultrasound.

Youth Can! results of a pilot trial to improve the school food environment.

Objective: This study evaluated the potential of youth partnerships to improve the school environment and child nutrition.

Methods: A quasi-experimental trial was conducted with 2 intervention and 3 control schools. Intervention schools selected student leaders to participate in youth-led interventions in their schools.

The interrelationship of isolation precautions and adverse events in an acute care facility.

It has been well documented that patients placed in isolation precautions are at an increased risk of experiencing adverse events. Medically relevant incident reports are one way to determine whether an adverse event has occurred. We compared these reports in isolated and nonisolated patients.