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This paper explores the relative importance of social factors and health measures in predicting educational achievement in early and late adolescence using population-based administrative data. The sample was made up of 41,943 children born in Manitoba, Canada between 1982 and 1989 and remaining in the province until age 18. Multilevel modeling nests each individual (level 1) within a family (level 2) residing within a neighborhood (level 3). Most important in predicting adolescent achievement were a broad socioeconomic status index (and a narrower measure of household income), being on social assistance, mother's age at first birth, gender, residential mobility, the presence of ADHD/Conduct disorders, and measures of family functioning (child taken into care or offered protection services and family structure history). Family size, birth order, and newborn characteristics (birthweight, APGAR, gestational age) were statistically significant but of little importance in explaining the outcomes. Both examining regression coefficients and systematically omitting variables showed social factors (often emphasized by epidemiologists) to have markedly greater effects than the combination of health measures (often stressed by economists) in predicting achievement. However, mental health in childhood is identified as among the important predictors. Record linkage across population datasets from health, education, and family services ministries allowed: tracking health and educational attainment at different times in a child's life, following a large number of cases across childhood, considerable sensitivity testing, controlling for unmeasured family and neighborhood effects, generating an extensive list of predictors, estimating effect sizes, and comparing Manitoba results with those of well-known American studies.

Ex vivo heart perfusion (EVHP) may facilitate resuscitation of discarded donor hearts and expand the donor pool; however, a reliable means of demonstrating organ viability prior to transplantation is required. Therefore, we sought to identify metabolic and functional parameters that predict myocardial performance during EVHP. To evaluate the parameters over a broad spectrum of organ function, we obtained hearts from 9 normal pigs and 37 donation after circulatory death pigs and perfused them ex vivo. Functional parameters obtained from a left ventricular conductance catheter, oxygen consumption, coronary vascular resistance, and lactate concentration were measured, and linear regression analyses were performed to identify which parameters best correlated with myocardial performance (cardiac index: mL x [min.sup.-1] x [g.sup.-1]). Functional parameters exhibited excellent correlation with myocardial performance and demonstrated high sensitivity and specificity for identifying hearts at risk of poor post-transplant function (ejection fraction: [R.sup.2] = 0.80, sensitivity = 1.00, specificity = 0.85; stroke work: [R.sup.2] = 0.76, sensitivity = 1.00, specificity = 0.77; minimum dP/dt: [R.sup.2] = 0.74, sensitivity = 1.00, specificity = 0.54; tau: [R.sup.2] = 0.51, sensitivity = 1.00, specificity = 0.92), whereas metabolic parameters were limited in their ability to predict myocardial performance (oxygen consumption: [R.sup.2] = 0.28; coronary vascular resistance: [R.sup.2] = 0.20; lactate concentration: [R.sup.2] = 0.02). We concluded that evaluation of functional parameters provides the best assessment of myocardial performance during EVHP, which highlights the need for an EVHP device capable of assessing the donor heart in a physiologic working mode. Key words: ex vivo heart perfusion, machine perfusion, heart transplant, organ preservation, organ evaluation, functional assessment, oxygen consumption, lactate metabolism. Resume : La perfusion cardiaque ex vivo pourrait favoriser la reanimation de coeurs de donneurs qui ont ete ecartes et ainsi augmenter le bassin de donneurs, mais des moyens fiables permettant de faire etat de la viabilite d'un organe avant une greffe font defaut. Par consequent, nous avons cherche a identifier les parametres metaboliques et fonctionnels permettant de predire les performances myocardiques pendant la perfusion cardiaque ex vivo. En vue de toucher a un large eventail de fonctions organiques, nous avons perfuse ex vivo 9 coeurs porcins normaux et 37 coeurs de porcs donneurs ayant ete soumis a un arret circulatoire entrainant la mort. Nous avons mesure les parametres fonctionnels obtenus a l'aide d'un catheter de conductance ventriculaire gauche, la consommation d'oxygene, la resistance vasculaire coronaire et la concentration d'acide lactique et nous avons effectue des analyses de regression lineaire en vue d'identifier les parametres qui sont le mieux correles avec la performance myocardique (indice cardiaque en mL x [min.sup.-1] x [g.sup.-1]). Les parametres fonctionnels montraient une excellente correlation avec la performance myocardique, et nous avons pu reperer les coeurs presentant un risque de mauvais fonctionnement post-greffe avec une sensibilite et une specificite elevees (fraction d'ejection : [R.sup.2] = 0,80, sensibilite = 1,00, specificite = 0,85; travail systolique : [R.sup.2] = 0,76, sensibilite = 1,00, specificite = 0,77 ; dP/dt minimale : [R.sup.2] = 0,74, sensibilite = 1,00, specificite = 0,54 ; tau : [R.sup.2] = 0,51, sensibilite = 1,00, specificite = 0,92), alors que notre capacite de predire la performance myocardique au moyen des parametres metaboliques etait limitee (consommation d'oxygene : [R.sup.2] = 0,28 ; resistance vasculaire coronaire : [R.sup.2] = 0,20 ; concentrations d'acide lactique : [R.sup.2] = 0,02). Nous en arrivons a la conclusion que l'etude des parametres fonctionnels est le meilleur moyen d'evaluer la performance myocardique pendant une perfusion ex vivo, ce qui accentue le besoin d'un dispositif de perfusion cardiaque ex vivo permettant d'evaluer les proprietes physiologiques des coeurs de donneurs alors qu'elles sont sollicitees dans de telles conditions. [Traduit par la Redaction] Mots-cles : perfusion cardiaque ex vivo, machine de perfusion, greffe cardiaque, preservation des organes, evaluation des organes, evaluation fonctionnelle, consommation d'oxygene, metabolisme de l'acide lactique., Introduction Cardiac transplantation is the gold-standard treatment for eligible patients with advanced heart failure; however, it is limited by a critical shortage of suitable donor organs (Guglin 2015). A low [...]

Purpose: The novel high-sensitivity troponin T assay (hs-cTnT) has been validated for diagnosing AMI in the emergency room. However its utility in high-risk in-patient populations is unknown. Methods: We retrospectively reviewed admissions to a general cardiology unit that had 2 hs-cTnT measurements in the first 12 h of presentation. We assessed 8 diagnostic algorithms that used hs-cTnT concentration and changes in concentration (including the 99th percentile cut-off of 14 ng/L) for their diagnostic utility in separating AMI patients from cardiac/nonACS and non-cardiac chest- pain patients. UA was excluded. Results: There were 233 patients (mean age 67 years, 153 were males (66%)) admitted over a 2 month period, with AMI diagnosed in 118 of these patients (51%). The recommended 99th percentile cut-off had modest accuracy (65%), good sensitivity (88%), and poor specificity (25%); a higher cut-off of 75 ng/L had a better diagnostic accuracy of 73%, p < 0.05. While some hs-cTnT algorithms were either highly sensitive or specific, none were both. Conclusion: In high-risk cardiology in-patients, no hs-cTnT concentration cut-off or change more accurately diagnosed and excluded AMI, although higher cut-offs had better diagnostic utility. Key words: high sensitivity troponin, acute coronary syndromes, coronary artery disease, myocardial infarction, cardiac biomarkers. Objectif : Le nouvel essai de dosage de la troponine T hypersensible (hs-cTnT) a ete valide aux fins de diagnostic de l'infarctus aigu du myocarde au service des urgences. Cependant, on ne connait pas son utilite chez les patients hospitalises presentant un risque eleve. Methodologie : Nous avons passe en revue de facon retrospective les dossiers des patients admis dans une unite de cardiologie generale chez qui l'essai de dosage de la hs-cTnT a ete utilise a deux reprises au cours des 12 premieres heures de presentation. Nous avons evalue huit algorithmes diagnostiques qui employaient la concentration de hs-cTnT et les variations de concentration--avec une limite de 14 ng/L correspondant au 99e percentile--afin de determiner leur utilite diagnostique pour distinguer les patients presentant un infarctus aigu du myocarde de ceux qui presentaient un syndrome cardiaque aigu non coronarien (sans MCAS) et de ceux qui presentaient une douleur thoracique d'origine autre que cardiaque. Les patients atteints d'angine instable etaient exclus de l'etude. Resultats : Des 233 patients (age moyen de 67 ans, et 153 d'entre eux [66 %] etaient de sexe masculin) admis sur une periode de 2 mois, 118 patients (51 %) ont obtenu un diagnostic d'infarctus aigu du myocarde. La limite correspondant au 99e percentile presentait une exactitude tres moderee (65 %), une bonne sensibilite (88 %) et une faible specificite (25 %). Dans les faits, nous avons observe une meilleure exactitude diagnostique (73 %; p < 0,05) a une limite plus elevee (a 75 ng/L). Meme si certains algorithmes utilisant l'essai de dosage de la hs-cTnT etaient tres sensibles ou tres specifiques, aucun d'entre eux ne presentait les deux caracteristiques a la fois. Conclusion : Chez les patients hospitalises en cardiologie presentant un risque eleve, aucune limite de concentration ou de variation de la concentration mesuree de hs-cTnT n'a permis de poser ni d'invalider adequatement le diagnostic d'infarctus aigu du myocarde, et ce, meme si l'application de limites plus elevees etait plus utile sur le plan diagnostique. [Traduit par la Redaction] Mots-cles : troponine hypersensible, syndromes coronariens aigus, maladie coronarienne, infarctus du myocarde, biomarqueurs cardiaques., Introduction The use of cardiac biomarkers is essential in the assessment and management of patients with suspected ACS in the emergency room (ER), owing to their diagnostic and prognostic properties [...]