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This qualitative study explored the experiences of Latine college students with their high school counselors about community cultural wealth. The study aimed to understand how high school counselors cultivated Latine students' navigational, aspirational, linguistic, familial, social, and resistant capital. Data were collected through semistructured interviews with eight Latine college students attending a Hispanic‐Serving Institution. The findings revealed that high school counselors supported Latine students' navigational and aspirational capital but did not cultivate their linguistic, familial, social, and resistant capital. Implications for practice include the need for culturally appropriate interventions, advocacy for better student–counselor ratios, and using the ASCA National Model and Empowerment Model to design interventions that cultivate Latine students' community cultural wealth. [ABSTRACT FROM AUTHOR]

Introduction: The prediction of ventricular tachyarrhythmias among patients with implantable cardioverter defibrillators is difficult with available clinical tools. We sought to assess whether in patients with heart failure (HF) and reduced ejection fraction with defibrillators, physiological sensor‐based HF status, as summarized by the HeartLogic index, could predict appropriate device therapies. Methods: Five hundred and sixty‐eight consecutive HF patients with defibrillators (n = 158, 28%) or cardiac resynchronization therapy‐defibrillators (n = 410, 72%) were included in this prospective observational multicenter analysis. The association of both HeartLogic index and its physiological components with defibrillator shocks and overall appropriate therapies was assessed in regression and time‐dependent Cox models. Results: Over a follow‐up of 25 (15–35) months, 122 (21%) patients received an appropriate device therapy (shock, n = 74, 13%), while the HeartLogic index crossed the threshold value (alert, HeartLogic ≥ 16) 1200 times (0.71 alerts/patient‐year) in 370 (65%) subjects. The occurrence of ≥1 HeartLogic alert was significantly associated with both appropriate shocks (Hazard ratios [HR]: 2.44, 95% confidence interval [CI]: 1.49–3.97, p =.003), and any appropriate defibrillator therapies. In multivariable time‐dependent Cox models, weekly IN‐alert state was the strongest predictor of appropriate defibrillator shocks (HR: 2.94, 95% CI: 1.73–5.01, p <.001) and overall therapies. Compared with stable patients, patients with appropriate shocks had significantly higher values of HeartLogic index, third heart sound amplitude, and resting heart rate 30–60 days before device therapy. Conclusion: The HeartLogic index is an independent dynamic predictor of appropriate defibrillator therapies. The combined index and its individual physiological components change before the arrhythmic event occurs. [ABSTRACT FROM AUTHOR]

Introduction: In patients with symptomatic permanent atrial fibrillation (PEAF) and narrow QRS, atrio‐ventricular junction ablation (AVJA) plus cardiac resynchronization therapy (CRT) is superior to medical therapy in reducing heart failure (HF) hospitalization and all‐cause mortality. To compare the mortality of a population of patients with HF, reduced EF (rEF), and PEAF treated with AVJA plus CRT with that of a contemporary cohort of patients in sinus rhythm (SR) with similar baseline characteristics. Methods and Results: In this prospective, multicentre, observational study, all‐cause mortality in a group of consecutive patients undergoing AVJA and implantable cardioverter‐defibrillator (ICD) combined with CRT implantation for HFrEF, narrow QRS, and PEAF with uncontrolled ventricular rate was compared with that of a contemporary cohort of patients in SR undergoing ICD implantation (not combined with CRT) for HFrEF and narrow QRS. Individual 1:1 propensity matching of baseline characteristics was performed. A total of 824 patients were enrolled. Propensity matching yielded 107 matched pairs. After a median follow‐up of 52 months, all‐cause mortality was similar in patients treated with AVJA plus CRT and in the control group (p =.434). In AVJA plus CRT patients, mortality was significantly lower than in control group patients with a history of paroxysmal/persistent AF (n = 45, p =.020), and similar to that of patients without a history of AF (n = 62, p =.459). Conclusions: After adjustment for patient characteristics, the long‐term prognosis of patients with HFrEF, narrow QRS, and PEAF who underwent AVJA plus CRT was similar to that of a population of patients in SR with similar characteristics. [ABSTRACT FROM AUTHOR]

Aims: HeartLogic algorithm combines data from multiple implantable defibrillators (ICD)‐based sensors to predict impending heart failure (HF) decompensation. A treatment protocol to manage algorithm alerts is not yet known, although decongestive treatment adjustments are the most frequent alert‐triggered actions reported in clinical practice. We describe the implementation of HeartLogic for remote monitoring of HF patients, and we evaluate the approach to diuretic dosing and timing of the intervention in patients with device alerts. Methods: The algorithm was activated in 229 ICD patients at eight centers. The median follow‐up was 17 months (25th–75th percentile: 11–24). Remote data reviews and patient phone contacts were undertaken at the time of HeartLogic alerts, to assess the patient's status and to prevent HF worsening. We analyzed alert‐triggered augmented HF treatments, consisting of isolated increases in diuretics dosage. Results: We reported 242 alerts (0.8 alerts/patient‐year) in 123 patients, 137 (56%) alerts triggered clinical actions to treat HF. The HeartLogic index decreased after the 56 actions consisting of diuretics increase. Specifically, alerts resolved more quickly when the increases in dosing of diuretics were early rather than late: 28 days versus 62 days, p <.001. The need of hospitalization for further treatments to resolve the alert condition was associated with higher HeartLogic index values on the day of the diuretics increase (odds ratio: 1.11, 95% CI: 1.02–1.20, p =.013) and with late interventions (odds ratio: 5.11, 95% CI: 1.09–24.48, p =.041). No complications were reported after drug adjustments. Conclusions: Decongestive treatment adjustments triggered by alerts seem safe and effective. The early use of decongestive treatment and the use of high doses of diuretics seem to be associated with more favorable outcomes. [ABSTRACT FROM AUTHOR]

Complete atrioventricular block (CAVB) is a total dissociation between the atrial and ventricular activity, in the absence of atrioventricular conduction. Several diseases may result in CAVB in the pediatric and young‐adult population. Permanent right ventricular (RV) pacing is required in permanent CAVB, when the cause is neither transient nor reversible. Continuous RV apical pacing has been associated with unfavorable outcomes in several studies due to the associated ventricular dyssynchrony. This study aims to summarize the current literature regarding CAVB in the pediatric and young adult population and to explore future treatment perspectives. [ABSTRACT FROM AUTHOR]

Aims: Patients with permanently increased risk of sudden cardiac death (SCD) can be protected by implantable cardioverter defibrillators (ICD). If an ICD must be removed due to infection, for example, immediate reimplantation might not be possible or indicated. The wearable cardioverter defibrillator (WCD) is an established, safe and effective solution to protect patients from SCD during this high‐risk bridging period. Very few economic evaluations on WCD use are currently available. Methods: We conducted a systematic review to evaluate the available evidence of WCD in patients undergoing ICD explant/lead extraction. Additionally, a decision model was developed to compare use and costs of the WCD with standard therapy (in‐hospital stay). For this purpose, a cost‐minimization analysis was conducted, and complemented by a one‐way sensitivity analysis. Results: In the base case scenario, the WCD was less expensive compared to standard therapy. The cost‐minimization analysis showed a cost reduction of €1782 per patient using the WCD. If costs of standard care were changed, cost savings associated with the WCD varied from €3500 to €0, assuming costs for standard care of €6800 to €3600. Conclusion: After ICD explantation, patients can be safely and effectively protected from SCD after hospital discharge through WCD utilization. Furthermore, the use of a WCD for this patient group is cost saving when compared to standard therapy. [ABSTRACT FROM AUTHOR]

Aims and methods: In case of cardiacimplantable electronicdevice (CIED)‐related infections, it is mandatory to completely remove the device and administer prolonged antibiotic therapy. The management of patients explanted for an implantable defibrillator (ICD) infection is complex especially in patients needing anti‐bradycardia pacing or tachyarrhythmia protection. We tested the efficacy and safety of a conventional ICD externally connected to a transvenous dual‐coil lead as bridging therapy before the reimplant, comparing outcomes with a historical cohort of patients (N = 113) treated with temporary transvenous pacing. We enrolled 18 patients explanted for ICD infection and needing prolonged antibiotic therapy in three high‐volume Italian centers. They received an external ICD stand‐by for a mean of 16.5 (4–30) days before the reimplant. Results: No patient experienced malfunction of the system, with a significant reduction of this complication versus temporary transfemoral pacing (37%, p =.004). Post‐procedural occurrence of other complications (infection, relevant local bleeding, ventricular tachycardia during insertion of the lead, cardiac perforation, and venous thromboembolism) was low and not different in the two groups. One patient experienced an electrical storm, effectively recognized by the external ICD and treated with anti‐tachycardia pacings (ATPs) and shocks. Conclusions: An approach with an external ICD seems to be a safe and viable option as bridging therapy in patients requiring ICD explant for CIED infection. [ABSTRACT FROM AUTHOR]

Aims: The use of beta‐blocker therapy in cardiac amyloidosis (CA) is debated. We aimed at describing patterns of beta‐blocker prescription through a nationwide survey. Methods and results: From 11 referral centres, we retrospectively collected data of CA patients with a first evaluation after 2016 (n = 642). Clinical characteristics at first and last evaluation were collected, with a focus on medical therapy. For patients in whom beta‐blocker therapy was started, stopped, or continued between first and last evaluation, the main reason for beta‐blocker management was requested. Median age of study population was 77 years; 81% were men. Arterial hypertension was found in 58% of patients, atrial fibrillation (AF) in 57%, and coronary artery disease in 16%. Left ventricular ejection fraction was preserved in 62% of cases, and 74% of patients had advanced diastolic dysfunction. Out of the 250 CA patients on beta‐blockers at last evaluation, 215 (33%) were already taking this therapy at first evaluation, while 35 (5%) were started it, in both cases primarily because of high‐rate AF. One‐hundred‐nineteen patients (19%) who were on beta‐blocker at first evaluation had this therapy withdrawn, mainly because of intolerance in the presence of heart failure with advanced diastolic dysfunction. The remaining 273 patients (43%) had never received beta‐blocker therapy. Beta‐blockers usage was similar between CA aetiologies. Patients taking vs. not taking beta‐blockers differed only for a greater prevalence of arterial hypertension, coronary artery disease, AF, and non‐restrictive filling pattern (P < 0.01 for all) in the former group. Conclusions: Beta‐blockers prescription is not infrequent in CA. Such therapy may be tolerated in the presence of co‐morbidities for which beta‐blockers are routinely used and in the absence of advanced diastolic dysfunction. [ABSTRACT FROM AUTHOR]

Introduction: Comparison data on management of device‐related complications and their impact on patient outcome and healthcare utilization between subcutaneous implantable cardioverter–defibrillator (S‐ICD) and transvenous ICD (TV‐ICD) are lacking. We designed this prospective, multicentre, observational registry to compare the rate, nature, and impact of long‐term device‐related complications requiring surgical revision on patient outcome and healthcare utilization between patients undergoing S‐ICD or TV‐ICD implantation. Methods and Results: A total of 1099 consecutive patients who underwent S‐ICD or TV‐ICD implantation were enrolled. Propensity matching for baseline characteristics yielded 169 matched pairs. Rate, nature, management, and impact on patient outcome of device‐related complications were analyzed and compared between two groups. During a mean follow‐up of 30 months, device‐related complications requiring surgical revision were observed in 20 patients: 3 in S‐ICD group (1.8%) and 17 in TV‐ICD group (10.1%; p =.002). Compared with TV‐ICD patients, S‐ICD patients showed a significantly lower risk of lead‐related complications (0% vs. 5.9%; p =.002) and a similar risk of pocket‐related complications (0.6 vs. 2.4; p =.215) and device infection (0.6% vs. 1.2%; p = 1.000). Complications observed in S‐ICD patients resulted in a significantly lower number of complications‐related rehospitalizations (median 0 vs. 1; p =.013) and additional hospital treatment days (1.0 ± 1.0 vs. 6.5 ± 4.4 days; p =.048) compared with TV‐ICD patients. Conclusions: Compared with TV‐ICD, S‐ICD is associated with a lower risk of complications, mainly due to a lower risk of lead‐related complications. The management of S‐ICD complications requires fewer and shorter rehospitalizations. [ABSTRACT FROM AUTHOR]

Background: Limited data are available on the clinical course of patients with history of atrial fibrillation (AF) when admitted in an intensive care environment. We aimed to describe the occurrence of major adverse events in AF patients admitted to a stepdown care unit (SDU) and to analyse clinical factors associated with outcomes, impact of dicumarolic oral anticoagulant (OAC) therapy impact and performance of clinical risk scores in this setting. Materials and methods: Single‐centre, observational retrospective analysis on a population of subjects with AF history admitted to a SDU. Therapeutic failure (composite of transfer to ICU or death) was considered the main study outcome. Occurrence of stroke and major bleeding (MH) was considered as secondary outcomes. The performance of clinical risk scores was evaluated. Results: A total of 1430 consecutive patients were enrolled. 194 (13.6%) reported the main outcome. Using multivariate logistic regression, age (odds ratio [OR]: 1.03, 95% confidence interval [CI]: 1.01‐1.05), acute coronary syndrome (OR:3.10, 95% CI: 1.88‐5.12), cardiogenic shock (OR:10.06, 95% CI: 5.37‐18.84), septic shock (OR:5.19,95%CI:3.29‐18.84), acute respiratory failure (OR:2.49, 95% CI: 1.67‐3.64) and OAC use (OR: 1.61, 95% CI: 1.02‐2.55) were independently associated with main outcome. OAC prescription was associated with stroke risk reduction and to both MH and main outcome risk increase. CHA2DS2‐VASc (c‐index: 0.545, P =.117 for stroke) and HAS‐BLED (c‐index:0.503, P =.900 for MH) did not significantly predict events occurrence. Conclusions: In critically ill AF patients admitted to a SDU, adverse outcomes are highly prevalent. OAC use is associated to an increased risk of therapeutic failure, clinical scores seem unhelpful in predicting stroke and MH, suggesting a highly individualized approach in AF management in this setting. [ABSTRACT FROM AUTHOR]

The authors conducted a study to examine how the presence of meaning in life, search for meaning in life, hope, family importance, and enculturation influenced Latinx adolescent students' depressive symptoms and life satisfaction. Two regression models revealed there was a statistically significant relationship between predictor variables, life satisfaction, and depression. The article concludes with a discussion regarding the importance of these findings and recommendations for practice and research. Los autores llevaron a cabo un estudio para examinar cómo la presencia de sentido en la vida, la búsqueda de sentido en la vida, la esperanza, la importancia de la familia y la enculturación influyeron en los síntomas depresivos y satisfacción vital de estudiantes adolescentes Latinx. Dos modelos de regresión revelaron que existe una relación estadísticamente significativa entre las variables de predicción, la satisfacción vital y la depresión. Este artículo concluye con una discusión en torno a la importancia de estos hallazgos, así como recomendaciones para la práctica y la investigación. [ABSTRACT FROM AUTHOR]

We would like to thank Dr Imamura for his interest in our paper and we have greatly appreciated his insights on the current perspective related to heart failure (HF) monitoring. Decongestive treatment adjustments in heart failure patients remotely monitored with a multiparametric implantable defibrillators algorithm. [Extracted from the article]

The aim of this study was to examine teachers' knowledge, misconceptions and concerns about students with attention deficit hyperactivity disorder ( ADHD). This mixed methods study involved 173 school teachers from five elementary schools. Knowledge of Attention Deficit Disorders Scale ( KADDS) was used to measure teachers' knowledge and perspectives about ADHD. The data were analysed using descriptive and inferential statistics. Additionally, themes were created based on the responses from open-ended responses. The findings indicate that the majority of the teachers did not have coursework related to students with ADHD in their teacher preparation programme. The teachers indicated inadequate administrative support and access to professional development as primary reasons for their inability to include ASHD in their classrooms. This study concludes that given a rise in the numbers of students with ADHD, it is imperative that teachers receive specific and advanced training related to ADHD signs and symptoms to implement specific teaching strategies. Furthermore, future research should focus on evaluating teacher training programmes to demonstrate how emotional health as a result of ADHD could impact students' performances negatively. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most common type of arrhythmia in adults, accounting for about one third of total arrhythmia-related hospitalizations. AF impact on daily clinical practice is steadily rising, together with population aging and increased survival from underlying conditions closely associated with AF such as coronary heart disease and heart failure. Although antiarrhythmic therapy, oral anticoagulation, implanted device therapy, and ablation techniques are now all common and promptly available strategies in AF management, some of them are burdened by a low efficacy rate, while others are associated with increased proarrhythmic or hemorrhagic risk. Consequently, useful alternatives are being sought. Between those, polyunsaturated fatty acids (n-3 PUFAs) have risen from mere alternative to statins in dyslipidemia management to powerful and well-tolerated antiinflammatory, antithrombotic, and antiarrhythmogenic drugs. From the evidence collected through basic science studies, whether on in vivo myocytes, animal models, or surrogate end points in human, n-3 PUFAs seem to offer innumerable advantages. On the other hand, epidemiological and clinical trials failed to demonstrate a clear efficacy of n-3 PUFAs as antiarrhythmic drugs, although covered by an optimal safety profile. The aim of the present review is to summarize the most important evidences currently available on the role of n-3 PUFA in AF management and therapy. [ABSTRACT FROM AUTHOR]

Background COVID-19 is an infectious illness, featured by an increased risk of thromboembolism. However, no standard antithrombotic therapy is currently recommended for patients hospitalized with COVID-19. The aim of this study was to evaluate safety and efficacy of additional therapy with aspirin over prophylactic anticoagulation (PAC) in patients hospitalized with COVID-19 and its impact on survival. Methods and Results A total of 8168 patients hospitalized for COVID-19 were enrolled in a multicenter-international prospective registry (HOPE COVID-19). Clinical data and in-hospital complications, including mortality, were recorded. Study population included patients treated with PAC or with PAC and aspirin. A comparison of clinical outcomes between patients treated with PAC versus PAC and aspirin was performed using an adjusted analysis with propensity score matching. Of 7824 patients with complete data, 360 (4.6%) received PAC and aspirin and 2949 (37.6%) PAC. Propensity-score matching yielded 298 patients from each group. In the propensity score-matched population, cumulative incidence of in-hospital mortality was lower in patients treated with PAC and aspirin versus PAC (15% versus 21%, Log Rank P =0.01). At multivariable analysis in propensity matched population of patients with COVID-19, including age, sex, hypertension, diabetes, kidney failure, and invasive ventilation, aspirin treatment was associated with lower risk of in-hospital mortality (hazard ratio [HR], 0.62; [95% CI 0.42-0.92], P =0.018). Conclusions Combination PAC and aspirin was associated with lower mortality risk among patients hospitalized with COVID-19 in a propensity score matched population compared to PAC alone.