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IMPORTANCE: Ventricular tachycardia (VT) is associated with high mortality in patients with cardiac sarcoidosis (CS), and medical management of CS-associated VT is limited by high failure rates. The role of catheter ablation has been investigated in small, single-center studies. OBJECTIVE: To investigate outcomes associated with VT ablation in patients with CS. DESIGN, SETTING, AND PARTICIPANTS: This cohort study from the Cardiac Sarcoidosis Consortium registry (2003-2019) included 16 tertiary referral centers in the US, Europe, and Asia. A total of 158 consecutive patients with CS and VT were included (33% female; mean [SD] age, 52 [11] years; 53% with ejection fraction [EF] <50%). EXPOSURES: Catheter ablation of CS-associated VT and, as appropriate, medical treatment. MAIN OUTCOMES AND MEASURES: Immediate and short-term outcomes included procedural success, elimination of VT storm, and reduction in defibrillator shocks. The primary long-term outcome was the composite of VT recurrence, heart transplant (HT), or death. RESULTS: Complete procedural success (no inducible VT postablation) was achieved in 85 patients (54%). Sixty-five patients (41%) had preablation VT storm that did not recur postablation in 53 (82%). Defibrillator shocks were significantly reduced from a median (IQR) of 2 (1-5) to 0 (0-0) in the 30 days before and after ablation (P < .001). During median (IQR) follow-up of 2.5 (1.1-4.9) years, 73 patients (46%) experienced VT recurrence and 81 (51%) experienced the composite primary outcome. One- and 2-year rates of survival free of VT recurrence, HT, or death were 60% and 52%, respectively. EF less than 50% and myocardial inflammation on preprocedural 18F-fluorodeoxyglucose positron emission tomography were significantly associated with adverse prognosis in multivariable analysis for the primary outcome (HR, 2.24; 95% CI, 1.37-3.64; P = .001 and HR, 2.93; 95% CI, 1.31-6.55; P = .009, respectively). History of hypertension was associated with a favorable long-term outcome (adjusted HR, 0.51; 95% CI, 0.28-0.92; P = .02). CONCLUSIONS AND RELEVANCE: In this observational study of selected patients with CS and VT, catheter ablation was associated with reductions in defibrillator shocks and recurrent VT storm. Preablation LV dysfunction and myocardial inflammation were associated with adverse long-term prognosis. These data support the role of catheter ablation in conjunction with medical therapy in the management of CS-associated VT.

Popular entertainment often involves political messages, and entertainment elements are now commonly used in politics coverage. This study examines how suspense drives impacts of political entertainment media content on attitudes, building on the “affective news” extended model. Hypotheses were tested with four texts on controversial political issues (within-subjects), presented in a linearor inverted-pyramidstructure and either as newsor fiction. The resulting 2 × 2 × 3 × 4 online experiment (N= 227) showed that linear texts produced greater suspense and attitude change than inverted-pyramid texts. Suspense mediated attitude impacts. Both news and fiction versions influenced attitudes, with impacts still detectable 1 day after exposure.

Lamkang is a Trans-Himalayan language spoken in the Chandel District of Manipur, India by under 10,000 ethnically Naga people. Due to a complex person indexation system in Lamkang clauses, multiple prefixes with the shape C- are attached to a verb stem creating lexemes with the shape CCCCVC. To make such forms pronounceable, speakers insert super-short vowel-like segments between the C- prefixes. Combining acoustic analysis with speakers’ intuitions about syllable structure, we examine the nature of these segments, arguing that an accurate phonetic description of Lamkang vowels must include these super-short vowels, as well as long and short vowels, which are phonemically distinct. We call these super-short vowels excrescent, following the terminology discussed in Hall (2011. Vowel epenthesis. In Marc van Oostendorp, Colin J. Ewen, Elizabeth V. Hume & Keren Rice (eds.), The blackwell companion to phonology, 1576–1596. Oxford: Blackwell. doi: 10.1002/9781444335262.wbctp0067: 1584). The excrescent vowel is a type of epenthetic vowel, sometimes also called “intrusive”, and is typified by its short duration and centralized quality distinct from lexical vowels. It is unstressed and has the phonetic effect of helping to transition between consonants. We show that the excrescent vowels in Lamkang have formant structures that barely resemble the characteristic formant profiles of the short and long vowels. While excrescent vowels are not contrastive, they are phonologically relevant because they have just enough sonority to form nuclei of CiVCiisyllables where Ciiis often ambisyllabic with the following syllable. The Lamkang data show that while any language-specific phonotactic constraints must reference the syllable, what constitutes a syllable must include the possibility of excrescent vowels as nuclei.

Low-caliber gunshot wounds (GSW) to the hand are common and their incidence is increasing. Most low-caliber GSW’s are treated in the emergency department (ED) with washout, intravenous antibiotics and any further follow-up treatment usually performed in an outpatient capacity. Treatment of these injuries specifically to the hand may be controversial in terms of timing and extent of washout, debridement, and fixation. Currently, the literature lacks a concise treatment algorithm, and this report aims to provide clinical scenarios that may educate management decision-making for patients with these injuries.

This study examined the effects of reading modality (oral vs. silent) on comprehension in elementary school students with a specific learning disability in reading (N= 77). A 2 (development-level) × 2 (reading modality) × 2 (time) mixed factorial analysis of variance (ANOVA) was conducted to determine the influence of these variables on comprehension. Significant main effects were found for reading modality and time on comprehension, but the main effect for developmental level was not significant. Students understood more of what was read orally than silently and showed improved comprehension across the year. The development-level by modality interaction was significant. Early elementary students benefited from oral reading in terms of comprehension, whereas equivalent comprehension was observed for late elementary students across modalities. No other two- or three-way interactions were significant. Results from this study suggest that reading modality is an important variable to consider for researchers and educators who are interested in the construct of reading comprehension.

Anecdotal reports have suggested that transplantation of hepatitis C virus (HCV) antibody positive (Ab+)/nucleic acid test negative (NAT−) donor kidneys into HCV negative recipients is not associated with HCV transmission. We reviewed our center’s outcomes of 32 HCV negative patients who received kidney allografts from 25 donors who were HCV Ab+/NAT−. The mean recipient age was 56.9 ± 12.1 years and the mean donor age was 41.5 ± 14 years, with a median Kidney Donor Profile Index (KDPI) of 68%. Twelve donors (48%) met Public Health Service (PHS) increased risk status. All patients received antithymocyte globulin induction followed by tacrolimus, mycophenolate mofetil, and steroid maintenance immunosuppression. With a mean follow-up posttransplant of 10 ± 2.7 months, 1- and 3- month serum creatinine levels were 1.7 ± 0.8 and 1.3 ± 0.4, respectively, and patient and graft survival rates were 100% and 97%, respectively. Fourteen patients (44%) seroconverted and became HCV Ab+ posttransplant. However, all 32 patients were HCV RNA negative at 1- and 3- months posttransplant, and 27 and 8 patients tested at 6- and 12-months posttransplant, respectively, remain HCV RNA negative. In conclusion, transplantation of HCV Ab+/NAT− kidneys to HCV negative recipients frequently causes HCV Ab seroconversion but not HCV viremia.

Anecdotal reports have suggested that transplantation of hepatitis C virus (HCV) antibody positive (Ab+)/nucleic acid test negative (NAT−) donor kidneys into HCV negative recipients is not associated with HCV transmission. We reviewed our center's outcomes of 32 HCV negative patients who received kidney allografts from 25 donors who were HCV Ab+/NAT−. The mean recipient age was 56.9 ± 12.1 years and the mean donor age was 41.5 ± 14 years, with a median Kidney Donor Profile Index (KDPI) of 68%. Twelve donors (48%) met Public Health Service (PHS) increased risk status. All patients received antithymocyte globulin induction followed by tacrolimus, mycophenolate mofetil, and steroid maintenance immunosuppression. With a mean follow‐up posttransplant of 10 ± 2.7 months, 1‐ and 3‐ month serum creatinine levels were 1.7 ± 0.8 and 1.3 ± 0.4, respectively, and patient and graft survival rates were 100% and 97%, respectively. Fourteen patients (44%) seroconverted and became HCV Ab+ posttransplant. However, all 32 patients were HCV RNA negative at 1‐ and 3‐ months posttransplant, and 27 and 8 patients tested at 6‐ and 12‐months posttransplant, respectively, remain HCV RNA negative. In conclusion, transplantation of HCV Ab+/NAT− kidneys to HCV negative recipients frequently causes HCV Ab seroconversion but not HCV viremia. This single‐center study demonstrates the absence of HCV transmission when transplanting kidneys from HCV antibody positive/nucleic acid testing negative donors. See Goldberg and Wolfe's editorial on page 2380.

Baked egg and baked milk are tolerated by most children who are allergic to hen’s egg and cow’s milk. Incorporating baked goods into the diets of allergic children may help them outgrow their primary allergy more quickly, with changes observed akin to immunotherapy. Benefits may also include increased quality of life and improved nutritional status. The search for a reliable biomarker to predict tolerance to baked goods is ongoing. Most children with a milk or egg allergy who are not previously tolerating egg or milk in baked goods should be offered an observed oral food challenge.

In lung cancer, targetable activating alterations in cancer genes, such as EGFR, ALK, RET, ROS1and MET, are usually mutually exclusive. Rare lung cancer cases with coexistent alterations of EGFRand ALKor EGFRmutations with RETor ROS1rearrangements have been reported. In this study, we report 15 patients (3 men and 12 women; 14 Caucasians and 1 African American) with ages ranging from 43 to 81 years (median 60 years) with lung adenocarcinoma in which coexistent alterations of two cancer-associated genes, including ALK, ROS1,or RETrearrangement or METamplification were present. The combination of alterations detected by fluorescence in situhybridization included ALKcombined with ROS1(n=4), ALKwith MET(n=3), ALKwith RET(n=1); RETwith MET(n=4), RETwith ROS1(n=2), and ROS1 combined with MET(n=1). The frequencies of involvement were similar for all 4 genes, 53% for both ALKand MET(n=8), 47% for both RETand ROS1(n=7). Activating gene mutations were also detected by next-generation sequencing for TP53(n=6), EGFR(n=5), KRAS(n=3) and STK11(n=2). Nine patients reported a smoking history (8 heavy and 1 light) and 6 patients were non-smokers. These findings suggest the need for assessing a panel of genes in lung cancer. Since targetable agents are available for each of these activating alterations, treatment with more than one targeted agent may be beneficial for this rare group of patients.

In lung cancer, targetable activating alterations in cancer genes, such as EGFR, ALK, RET, ROS1 and MET, are usually mutually exclusive. Rare lung cancer cases with coexistent alterations of EGFR and ALK or EGFR mutations with RET or ROS1 rearrangements have been reported. In this study, we report 15 patients (3 men and 12 women; 14 Caucasians and 1 African American) with ages ranging from 43 to 81 years (median 60 years) with lung adenocarcinoma in which coexistent alterations of two cancer-associated genes, including ALK, ROS1, or RET rearrangement or MET amplification were present. The combination of alterations detected by fluorescence in situ hybridization included ALK combined with ROS1 (n=4), ALK with MET (n=3), ALK with RET (n=1); RET with MET (n=4), RET with ROS1 (n=2), and ROS1 combined with MET (n=1). The frequencies of involvement were similar for all 4 genes, 53% for both ALK and MET (n=8), 47% for both RET and ROS1 (n=7). Activating gene mutations were also detected by next-generation sequencing for TP53 (n=6), EGFR (n=5), KRAS (n=3) and STK11 (n=2). Nine patients reported a smoking history (8 heavy and 1 light) and 6 patients were non-smokers. These findings suggest the need for assessing a panel of genes in lung cancer. Since targetable agents are available for each of these activating alterations, treatment with more than one targeted agent may be beneficial for this rare group of patients.

Epinephrine is the first-line treatment for anaphylaxis but may be underused by patients and medical personnel.

Arrhythmia and sudden cardiac death remain common in repaired tetralogy of Fallot and affect even those with excellent anatomic repairs. Atrial arrhythmia often has mechanisms different from those in acquired heart disease. Ventricular arrhythmia remains a major source of mortality in repaired tetralogy of Fallot. Noninvasive risk stratification is important to identify patients who may benefit from ablation or primary prevention implantable cardioverter defibrillators. Multiple noninvasive risk factors are associated with ventricular arrhythmia, but no universally accepted risk stratification algorithm exists. The mechanism of ventricular arrhythmia is usually attributable to a consistent and discrete set of slowly conducting anatomic isthmuses related to both the native anatomy and the consequences of the surgical repair, which interact with ventricular remodeling to provide arrhythmic substrate. This substrate can be identified during electroanatomic mapping and prophylactically ablated in appropriate patients. This scientific statement discusses the mechanisms and treatment of arrhythmia in repaired tetralogy of Fallot.

There has been increasing interest at health science centers in improving the education of health professionals by offering faculty development activities. In 2007–08, as part of an effort to expand education‐related faculty development offerings on campus, the University of Tennessee Health Science Center surveyed faculty members in an effort to identify faculty development activities that would be of interest. Factor analysis of survey data indicated that faculty interests in the areas of teaching and learning can be grouped into six dimensions: development of educational goals and objectives, the use of innovative teaching techniques, clinical teaching, improving traditional teaching skills, addressing teaching challenges, and facilitating participation. There were significant differences in the level of interest in education‐related faculty development activities by academic rank and by the college of appointment. Full professors expressed somewhat less interest in faculty development activities than faculty members of lower ranks. Faculty members in the Colleges of Medicine and Dentistry expressed somewhat greater interest in faculty development to improve traditional teaching skills. The policy implications of the survey results are discussed, including the need for faculty development activities that target the needs of specific faculty groups.

Congenital obstructive nephropathy (CON) is the most common cause of chronic renal failure in children often leading to end-stage renal disease. The megabladder (mgb) mouse exhibits signs of urinary tract obstruction in utero resulting in the development of hydroureteronephrosis and progressive renal failure after birth. This study examined the development of progressive renal injury in homozygous mgb mice (mgb-/-). Renal ultrasound was used to stratify the disease state of mgb-/- mice, whereas surgical rescue was performed using vesicostomy. The progression of renal injury was characterized using a series of pathogenic markers including alpha smooth muscle isoactin (a-SMA), TGF-ß1, connective tissue growth factor (CTGF), E-cadherin, F4/80, Wilm's tumor (WT)-1, and paired box gene (Pax) 2. This analysis indicated that mgb-/- mice are born with pathologic changes in kidney development that progressively worsen in direct correlation with the severity of hydronephrosis. The initiation and pattern of fibrotic development observed in mgb-/- kidneys appeared distinctive from previous animal models of obstruction. These observations suggest that the mgb mouse represents a unique small animal model for the study of CON.

Congenital obstructive nephropathy (CON) is the most common cause of chronic renal failure in children often leading to end-stage renal disease. The megabladder (mgb) mouse exhibits signs of urinary tract obstruction in uteroresulting in the development of hydroureteronephrosis and progressive renal failure after birth. This study examined the development of progressive renal injury in homozygous mgbmice (mgb−/−). Renal ultrasound was used to stratify the disease state of mgb−/−mice, whereas surgical rescue was performed using vesicostomy. The progression of renal injury was characterized using a series of pathogenic markers including alpha smooth muscle isoactin (-SMA), TGF-1, connective tissue growth factor (CTGF), E-cadherin, F4/80, Wilm's tumor (WT)-1, and paired box gene (Pax) 2. This analysis indicated that mgb−/−mice are born with pathologic changes in kidney development that progressively worsen in direct correlation with the severity of hydronephrosis. The initiation and pattern of fibrotic development observed in mgb−/−kidneys appeared distinctive from previous animal models of obstruction. These observations suggest that the mgbmouse represents a unique small animal model for the study of CON.

Critically ill patients often require invasive monitoring to evaluate and optimize cardiac function and preload. With questionable outcomes associated with pulmonary artery catheters (PACs), some have evaluated the role of less invasive monitors. We hypothesized that the Bedside Echocardiographic Assessment in Trauma (BEAT) examination would generate cardiac index (CI) and central venous pressure (CVP) estimates that correlate with that of a PAC.

The corrected QT interval (QTc) is a measure of ventricular repolarization time, and a prolonged QTc increases risk for malignant ventricular arrhythmias. Pulmonary vein isolation (PVI) may increase QTc but its effects have not been well studied.

Plant response to ethephon treatment was tested on 27 cultivars of vegetative annuals that have spreading and trailing growth habits. A control treatment was compared to 500 and 1000 mg·L-1(ppm) foliar spray treatments of ethephon. Plant height and/or width index were significantly reduced for 81% of the cultivars tested. Responsive cultivars were alternanthera (Alternanthera dentata), brachyscome (Brachyscome iberidifolia) 'Toucan Tango'; calibrachoa (Calibrachoa hybrids) 'Colorburst Red', 'Million Bells Cherry Pink', and 'Trailing Pink'; diascia (Diascia xhybrida) 'Sunchimes Rose' and 'Red Ace'; double impatiens (Impatiens wallerana) 'Tioga Red' and 'Tioga White'; sweetpotato vine (Ipomoea batatas) 'Sweet Caroline Bronze'; lantana ( Lantana camara) 'Patriot Cherry' and 'Samantha'; nemesia (Nemesia x hybrida) 'Aromatica Dark Lavender', 'Blue Bird', and 'Blueberry Sachet'; nolana (Nolana paradoxa) 'Blue Eyes'; ivy geranium (Pelargonium hybrida) 'King of Balcon'; petunia (Petunia xhybrida) 'Cascadia Pink', 'Mini Bright Pink', and 'Supertunia Mini Purple'; bacopa (Sutera cordata) 'Bridal Showers'; and vinca vine (Vinca minor) 'Illumination'. Ethephon was not effective on monopsis (Monopsis unidentata) 'Royal Flush', persicaria (Persicaria microcephala) 'Red Dragon', or calibrachoa 'Liricashower Rose'. Different cultivars of petunia showed varied responses to ethephon treatments as did trailing snapdragon ( Antirrhinum majus) 'Chandelier Yellow' and 'Luminaire Yellow'. Flower number was reduced in 55% of the cultivars due to a delay in flowering. The experiment finds efficacy of ethephon for most cultivars treated at rates greater than or equal to that used commercially, however more research is needed to determine optimum concentrations for the specific cultivars. Chemical name used: ethephon [(2-chloroethyl) phosphonic acid]. [ABSTRACT FROM AUTHOR]

Reports that the Center for Strategic and Budgetary Assessments has concluded that the US Navy should reduce its fleet of aircraft carriers and develop a network of ships and weapons capable of long-range strikes. Greater military effectiveness and flexibility within budgetary limits; Increased vulnerability of aircraft carriers; Long-range precision-guided munitions as weapons of choice.

Reports on US Energy Secretary Hazel O'Leary's consideration of ways to prevent price increases in home heating oil for the 1996 winter. Options to be reviewed by the Department of Energy.