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We present a case of a 17-year-old White male high school American football player who was diagnosed with an anomalous left coronary artery arising from the right coronary sinus after experiencing dizziness, near-syncope, and altered mental status during a football practice. The symptoms were recognized by an on-site certified athletic trainer who activated emergency medical response. After unremarkable initial emergency evaluation, referral to a sports cardiologist unveiled an anomalous left coronary artery arising from the right coronary sinus on echocardiogram. After surgical correction and rehabilitation, the patient was able to return to exercise activity. Anomalous coronary arteries are the second most common cause of autopsy-positive episodes of sudden cardiac death among athletes and are rarely recognized with abnormal electrocardiogram (EKG) findings prior to events. This case highlights the importance of prompt recognition, evaluation, and treatment of athletes with cardiac symptoms, and contributes to an ongoing discussion on whether echocardiograms should be considered in preparticipation evaluations.

IntroductionTwice-daily caregiver-supervised toothbrushing with fluoridated toothpaste is an effective and widely recommended strategy to prevent tooth decay in children. Qualitative research suggests that low-income caregivers know the recommendation but would benefit from toothbrushing supplies and advice about how to introduce this health behavior especially as the child becomes older and asserts autonomy to do it “myself.” Our objective is to assess consumer satisfaction with the evidence-based theory-informed campaign and usefulness of materials that were home delivered. The focus of the evaluation was families with children

Introduction LEANBH (Learning to Evaluate and manage ANtenatal Blood pressure at Home) is a prospective, observational, non-interventional cohort, pilot study of a novel connected health solution aimed at empowering women to self-manage blood pressure (BP) monitoring in pregnancy. Hypertension in pregnancy affects around 5–8% of all pregnancies and misdiagnosis or poorly managed BP in pregnancy negatively affects maternal and neonatal outcomes. Objectives The primary objective of this study was to assess the feasibility and acceptability of home blood pressure monitoring (HBPM) and to compare these BP readings taken at home using the LEANBH architecture to those taken in healthcare settings (hospital and general practice). Patients, materials and methods Healthy primigravida with low risk singleton pregnancies were recruited from Cork University Maternity Hospital, Ireland. Women were equipped with a Microlife WatchBP Home Monitor, an Urisys 1100® Urine Analyzer and the mobile app developed for use throughout pregnancy as part of the Leanbh project. Participants were encouraged to submit BP and urine readings from home as frequently as possible and especially prior to an antenatal visit. All women attended their planned healthcare visits as usual. Mean arterial pressure (MAP) was calculated from the BP readings uploaded to a LEANBH platform throughout pregnancy and analysed using SPSS version 2.0 Mann-Whitney test. Results 51 women volunteered with 46 of them completing the study. 27 women were equipped with the devices with 5 subsequently withdrawing from this group while 24 women were recruited into the control group. A total of 1381 home BP readings and 983 healthcare setting BP readings were recorded with 972 paired (home vs healthcare setting) MAP available for analysis (Figure 1:). The Mann-Whitney test performed showed a significant difference between the home vs healthcare setting MAP with a P value A user error rate of 3.8% was noted among the HBPM group. Conclusion BP taken at home was significantly lower than that taken in a health care setting, suggesting that the incidence of white coat hypertension in this cohort is under reported. The low error rate suggests that HPBM is easy to use. A large randomized control trial is planned to fully evaluate the utility of this technology solution.

It has become almost a truism to describe the interaction between research ethics committees and researchers as being marred by distrust and conflict. The ethical conduct of researchers is increasingly a matter of institutional concern because of the degree to which non-compliance with national standards can expose the entire institution to risk. This has transformed research ethics into what some have described as a research ethics industry. In an operational sense, there is considerable focus on modifying research behaviour through a combination of education and sanctions. The assessment of whether a researcher is ‘ethical’ is too often based on whether they submit their work for review by an ethics committee. However, is such an approach making a useful contribution to the actual ethical conduct of research and the protection of the interests of participants? Does a focus on ethical review minimise institutional risk? Instead it has been suggested that ethics committees may be distorting or frustrating useful research and are promoting a culture of either mindless rule following or frustrated resistance. An alternative governance approach is required. There is a need for a strong institutional focus on promoting and supporting the reflective practice of researchers through every stage of their work. By situating research ethics within the broader framework of institutional governance, this paper suggests it is possible to establish arrangements that actually facilitate excellent and ethical research.

To improve the oral health of low-income children, innovations in dental delivery systems are needed, including community-based care, the use of expanded duty auxiliary dental personnel, capitation payments, and global budgets. This paper describes the protocol for PREDICT (Population-centered Risk- and Evidence-based Dental Interprofessional Care Team), an evaluation project to test the effectiveness of new delivery and payment systems for improving dental care and oral health. This is a parallel-group cluster randomized controlled trial. Fourteen rural Oregon counties with a publicly insured (Medicaid) population of 82,000 children (0 to 21 years old) and pregnant women served by a managed dental care organization are randomized into test and control counties. In the test intervention (PREDICT), allied dental personnel provide screening and preventive services in community settings and case managers serve as patient navigators to arrange referrals of children who need dentist services. The delivery system intervention is paired with a compensation system for high performance (pay-for-performance) with efficient performance monitoring. PREDICT focuses on the following: 1) identifying eligible children and gaining caregiver consent for services in community settings (for example, schools); 2) providing risk-based preventive and caries stabilization services efficiently at these settings; 3) providing curative care in dental clinics; and 4) incentivizing local delivery teams to meet performance benchmarks. In the control intervention, care is delivered in dental offices without performance incentives. The primary outcome is the prevalence of untreated dental caries. Other outcomes are related to process, structure and cost. Data are collected through patient and staff surveys, clinical examinations, and the review of health and administrative records. If effective, PREDICT is expected to substantially reduce disparities in dental care and oral health. PREDICT can be disseminated to other care organizations as publicly insured clients are increasingly served by large practice organizations. ClinicalTrials.gov NCT02312921 6 December 2014. The Robert Wood Johnson Foundation and Advantage Dental Services, LLC, are supporting the evaluation.

The major objective of this study was to identify predictors of the duration of homeless spells among persons with severe mental illness (SMI). This was the first study to incorporate time-varying covariates into the survival analysis model predicting the length of homeless spells. The sample consisted of 215 individuals who had participated in two experiments evaluating the effectiveness of various treatment programs for homeless individuals. Persons who received assertive community treatment exited homelessness sooner than individuals who received brokered case management, outpatient treatment, or services from a drop-in center. More assistance in finding and maintaining housing were especially predictive of shorter homeless spells. Inclusion of variables which varied over time in the model (e.g., income and frequency of service contacts) reduced the impact of many of the demographic variables in the model. This survival analysis demonstrated that the efforts of human service agencies to assist homeless mentally ill individuals do make a difference. In general, persons who received more services exited homelessness sooner. © 1998 John Wiley & Sons, Inc.

Using a sample of homeless mentally ill clients, this study examined the reliability and validity of the Satisfaction with Life Domains Scale (SLDS), a measure of subjective quality of life (QOL). The SLDS exhibited good internal consistency and test-retest reliability. The SLDS was also correlated with psychopathology and self-esteem, providing some evidence for the concurrent validity of the SLDS. However, subjective QOL, as measured by the SLDS, did not correlate with comparable objective QOL measures (e.g. days stably housed, income, total service utilization), raising doubts about the validity of the SLDS and other subjective QOL measures for this population.

The present study tested a model predicting depression of caregivers of dementia patients. Consistent with previous research, the patient's level of impairment, the relationship of the caregiver to the patient, and the duration of caregiving had an impact on caregiver depression. The caregiver's appraisal of the degree of upset caused by the patient's level of impairment proved to be the most important variable in predicting caregiver depression. Social support variables were somewhat related to caregiver depression, but in a manner contrary to what was predicted, i.e., caregivers who received the most support were the most depressed.

This process evaluation study examined what variables moderate and mediate treatment effects on days in stable housing and client satisfaction for homeless mentally ill clients. In general, demographic characteristics did not moderate either outcome variable. Housing contacts, entitlement contacts, mental health contacts, and supportive services were significant mediators of the treatment effect on days in stable housing. Program contacts, mental health contacts, and supportive services were significant mediators of client satisfaction.

The effects of self-determination vs. teacher-determination of timeout duration on disruptive behavior were investigated in a group of 15 students in a special classroom who had learning disabilities and/or behavior problems. There were five phases to the study: In a repeated measures design each subject received timeout for 5 minutes, no timeout, 5 minutes timeout, selfdetermined timeout duration, and student = teacher-determined timeout duration. The overall effect of timeout was to reduce significantly the rate of disruptive behavior. The effects of various timeout conditions did not differ, indicating self-management of timeout duration was just as effective as when the teacher set the timeout duration.

This study examined the impact of eating during simulated night shift on performance and subjective complaints. Subjects were randomized to eating at night (n=5; 23.2 ± 5.5 y) or not eating at night (n=5; 26.2 ± 6.4 y). All participants were given one sleep opportunity of 8 h (22:00 h-06:00 h) before transitioning to the night shift protocol. During the four days of simulated night shift participants were awake from 16:00 h-10:00 h with a daytime sleep of 6 h (10:00 h-16:00 h). In the simulated night shift protocol, meals were provided at ≈0700 h, 1900 h and 0130 h (eating at night); or ≈0700 h, 0930 h, 1410 h and 1900 h (not eating at night). Subjects completed sleepiness, hunger and gastric complaint scales, a Digit Symbol Substitution Task and a 10-min Psychomotor Vigilance Task. Increased sleepiness and performance impairment was evident in both conditions at 0400 h (p < 0.05). Performance impairment at 0400 h was exacerbated when eating at night. Not eating at night was associated with elevated hunger and a small but significant elevation in stomach upset across the night (p < 0.026). Eating at night was associated with elevated bloating on night one, which decreased across the protocol. Restricting food intake may limit performance impairments at night. Dietary recommendations to improve night-shift performance must also consider worker comfort. Refereed/Peer-reviewed