Search

BACKGROUND: The use of a Left Ventricular Assist Device (LVAD) in patients with advanced heart failure refractory to optimal medical management has progressed steadily over the past two decades. Data have demonstrated reduced LVAD efficacy, worse clinical outcome, and higher mortality for patients who experience significant ventricular tachyarrhythmia (VTA). We hypothesize that a novel prophylactic intra-operative VTA ablation protocol at the time of LVAD implantation may reduce the recurrent VTA and adverse events postimplant. METHODS: We designed a prospective, multicenter, open-label, randomized-controlled clinical trial enrolling 100 patients who are LVAD candidates with a history of VTA in the previous 5 years. Enrolled patients will be randomized in a 1:1 fashion to intra-operative VTA ablation (n = 50) versus conventional medical management (n = 50) with LVAD implant. Arrhythmia outcomes data will be captured by an implantable cardioverter defibrillator (ICD) to monitor VTA events, with a uniform ICD programming protocol. Patients will be followed prospectively over a mean of 18 months (with a minimum of 9 months) after LVAD implantation to evaluate recurrent VTA, adverse events, and procedural outcomes. Secondary endpoints include right heart function/hemodynamics, healthcare utilization, and quality of life. CONCLUSION: The primary aim of this first-ever randomized trial is to assess the efficacy of intra-operative ablation during LVAD surgery in reducing VTA recurrence and improving clinical outcomes for patients with a history of VTA.

Introduction: Tenofovir diphosphate (TFV-DP) in dried blood spots (DBS), a measure of cumulative antiretroviral therapy (ART) adherence, is associated with viral suppression and predicts future viremia in persons with HIV (PWH). However, its utility to identify those at risk for virologic failure (VF) and drug resistance is unknown. To address this, we aimed to establish the association between this adherence biomarker and VF with drug resistance in a cohort of PWH initiating first-line ART in KwaZulu-Natal, South Africa. Methods: PWH initiating TFV disoproxil fumarate (TDF)-based ART within a parent prospective cohort were evaluated. Using a nested design, DBS for TFV-DP were collected from cases who developed VF (HIV-1 RNA [greater than or equal to]1000 copies/ml) after [greater than or equal to]5 months on ART versus controls, matched 1:2 by site, age, gender, race and ART duration. Cases were categorized as having VF with or without resistance using genotyping. One-way analysis of variance (ANOVA) was used to compare TFV-DP for controls, cases with VF and resistance, and cases with VF without resistance. Data are presented as mean (standard deviation, SD) or geometric mean [95% confidence interval, 95% CI]. Results and discussion: One thousand participants were enrolled in the parent study between 2014 and 2016, of which 288 (29%) had DBS available. Of these, 94 (33%) were cases and 194 (67%) were controls; 59% were women. Mean age of our population was 33 (SD 8) years. Genotyping was available in 50 (53%) of the 94 cases. Geometric mean TFV-DP in DBS from controls was 708 [95% CI; 647-773] fmol/punch, which was higher compared to participants having VF with resistance (n = 36), 386 [95% CI; 241-617] fmol/punch and VF without resistance (n = 14), 61 [95% CI; 22-164] fmol/punch; p Conclusions: TFV-DP in DBS showed a stepwise association with VF and drug resistance in South African PWH. Participants having VF with resistance had mid-range concentrations of TFV-DP, which were higher than those for PWH without resistance. Future research on the clinical utility of TFV-DP concentrations in DBS to predict and prevent the development of VF and drug resistance is needed. Keywords: adherence; dried blood spots; HIV resistance; South Africa; tenofovir diphosphate; viral failure, 1 | INTRODUCTION Although current antiretroviral therapy (ART) is highly effective, durable adherence remains necessary to sustain viral suppression in persons with HIV (PWH). Unfortunately, up to 30-40% of PWH [...]

Political discourses and practices surrounding the current presidential administration are propagating familiar stereotypes of immigrants as "diseases," "criminals," and questionably "American." Emergent research and the news media are also reporting stories of hostility toward immigrants in schools and broader society that has been incited by such rhetoric and practices. This article proposes teacher educators concerned with social justice for immigrant youth should teach meaningfully about the controversial emotions surrounding immigration. More specifically, the authors hypothesize how critical affect literacy may be instructive for helping pre-service teachers address the polarized and controversial emotions swirling around immigration. After providing a brief overview of the current national context of schools, the authors discuss the literature on teacher education for immigration. They then describe critical affect literacy and highlight its promise for helping pre-service teachers understand and counter-act negative emotions directed at immigrant students in schools. The authors also provide examples of instructional activities that might engage critical affect literacy practices in teacher education classrooms. In doing so, the authors hope to advocate the power of emotion in teaching for social justice in an increasingly uncertain and combative political climate.

Social bonds to school (i.e., attachment, commitment, involvement, and belief) can influence educational progress and success for students; however, the children of immigrants' bonding to school remain unclear. This study utilizes data from the Education Longitudinal Study of 2002 and incorporates multilevel analysis to examine straight-line assimilation, segmented assimilation, and immigrant optimism theories in relationship to the children of immigrants' school bonds. Findings suggest that bonds to school are moderated by gender, race, ethnicity, and immigrant generation. The implications of the evident disparities in the children of immigrants' bonds to U.S. public schools are discussed more broadly.

Prescribed burning is the primary method used to reduce wildfire risk in a range of ecosystems globally. Knowledge of how animal populations respond to prescribed burns is essential for designing fuel management plans that are sensitive to ecological values. We conducted a before–after, control‐impact experiment in the temperate jarrah forest ecosystem of south‐western Australia to examine how reptiles respond to season of burning (spring or autumn) and time since burning (0–5 years). Through pitfall trapping at 10 survey grids over 7 years, we captured 1808 reptiles from 22 species. Bayesian mixed effects models revealed that six of the eight species analysed showed either a decrease or increase in capture rate at burnt compared to unburnt sites, and most of these effects only occurred within the first 2 years post fire. Species richness showed a weak negative response to one autumn burn and no relationship with time since fire. Fire effects were more common in autumn compared to spring burns, which is likely a reflection of differing fire severities. These results suggest that prescribed burning can temporarily reduce habitat suitability and abundance for some species, particularly those that rely on leaf litter for shelter and foraging. Our findings emphasise the dynamic nature of reptile responses to prescribed burns and underscore the importance of considering both fire seasonality and recency of burning in wildlife management plans. [ABSTRACT FROM AUTHOR]

Doubly robust (DR) estimators are an important class of statistics derived from a theory of semiparametric efficiency. They have become a popular tool in causal inference, including applications to dynamic treatment regimes. The doubly robust estimators for the mean response to a dynamic treatment regime may be conceived through the augmented inverse probability weighted (AIPW) estimating function, defined as the sum of the inverse probability weighted (IPW) estimating function and an augmentation term. The IPW estimating function of the causal estimand via marginal structural model is defined as the complete-case score function for those subjects whose treatment sequence is consistent with the dynamic regime in question divided by the probability of observing the treatment sequence given the subject's treatment and covariate histories. The augmentation term is derived by projecting the IPW estimating function onto the nuisance tangent space and has mean-zero under the truth. The IPW estimator of the causal estimand is consistent if (i) the treatment assignment mechanism is correctly modeled and the AIPW estimator is consistent if either (i) is true or (ii) nested functions of intermediate and final outcomes are correctly modeled.

Linked foraging and bioenergetics models allow for increased understanding of fish growth potential and behavior by incorporating prey availability coupled to environmental conditions including temperature and prey visibility. To inform our understanding of growth and vertical migration patterns of Chinook salmon (Oncorhynchus tshawytscha) inhabiting lentic ecosystems, we linked foraging and bioenergetics models to create GrowChinook (http://growchinook.fw.oregonstate.edu/). This multimodel design and optimization routine has broad applications in examining growth potential and predicting habitat use in stratified environments. We demonstrate the use of GrowChinook for the spring-summer rearing period in three Willamette River basin reservoirs, Oregon, USA. These reservoirs support juvenile spring Chinook salmon that exhibit a novel reservoir-reared life history that includes larger juvenile fish compared with nearby stream-reared subyearlings. Model outputs of predicted growth and depth use patterns based on observed prey distributions and environmental conditions were corroborated by observed empirical size and growth data from other years. Our simulations support diel vertical migration as a tactic that increases growth potential and contribute to understanding juvenile Chinook salmon growth in stratified systems. Les modeles relies d'approvisionnement et de bioenergetique permettent une meilleure comprehension du potentiel de croissance et des comportements des poissons en integrant la disponibilite de proies jumelee aux conditions ambiantes, notamment la temperature et la visibilite des proies. Pour parfaire la comprehension de la croissance et des motifs de migration verticale des saumons chinooks (Oncorhynchus tshawytscha) dans les ecosystemes lentiques, nous avons relie des modeles d'approvisionnement et de bioenergetique pour creer GrowChinook (http://growchinook.fw.oregonstate.edu/). Son schema multi-modeles et sa routine d'optimisation ont de vastes applications pour l'etude du potentiel de croissance et la prediction de l'utilisation de l'habitat en milieux stratifies. Nous faisons une demonstration de l'utilisation de GrowChinook pour la periode de grossissement duprintemps etde l'ete dans trois reservoirs dubassin versantde la riviere Willamette (Oregon, Etats- Unis). Ces reservoirs supportent des saumons chinooks juveniles du printemps qui presentent un nouveau cycle biologique avec grossissement en reservoir caracterisant des poissons juveniles plus gros que les poissons de moins de landont le grossissement a eu lieu dans des cours d'eau a proximite. Les motifs de croissance et d'utilisation de differentes profondeurs issus du modele et bases sur la repartition des proies et les conditions ambiantes observees sont corrobores par des donnees d'observation empiriques sur la taille et la croissance pour d'autres annees. Nos simulations appuient l'interpretation voulant que la migration verticale nycthemerale constitue une tactique qui accroit le potentiel de croissance, et elles ameliorent la comprehension de la croissance des saumons chinooks juveniles dans les systemes stratifies. [Traduit par la Redaction], Introduction Bioenergetics modelling has improved our understanding of growth and consumption across many fish species (Chipps and Wahl 2008). This is especially important for species of concern because growth and [...]

Objective: To determine the long‐term outcomes, including mortality and recurrent seizures, among children living with HIV (CLWH) who present with new onset seizure. Methods: Zambian CLWH and new onset seizure were enrolled prospectively to determine the risk of and risk factors for recurrent seizures. Demographic data, clinical profiles, index seizure etiology, and 30‐day mortality outcomes were previously reported. After discharge, children were followed quarterly to identify recurrent seizures and death. Given the high risk of early death, risk factors for recurrent seizure were evaluated using a model that adjusted for mortality. Results: Among 73 children enrolled, 28 died (38%), 22 within 30‐days of the index seizure. Median follow‐up was 533 days (IQR 18–957) with 5% (4/73) lost to follow‐up. Seizure recurrence was 19% among the entire cohort. Among children surviving at least 30‐days after the index seizure, 27% had a recurrent seizure. Median time from index seizure to recurrent seizure was 161 days (IQR 86–269). Central nervous system opportunistic infection (CNS OI), as the cause for the index seizure was protective against recurrent seizures and higher functional status was a risk factor for seizure recurrence. Significance: Among CLWH presenting with new onset seizure, mortality risks remain elevated beyond the acute illness period. Recurrent seizures are common and are more likely in children with higher level of functioning even after adjusting for the outcome of death. Newer antiseizure medications appropriate for co‐usage with antiretroviral therapies are needed for the care of these children. CNS OI may represent a potentially reversible provocation for the index seizure, while seizures in high functioning CLWH without a CNS OI may be the result of a prior brain injury or susceptibility to seizures unrelated to HIV and thus represent an ongoing predisposition to seizures. Plain Language Summary: This study followed CLWH who experienced a new onset seizure to find out how many go on to have more seizures and identify any patient characteristics associated with having more seizures. The study found that mortality rates continue to be high beyond the acute clinical presentation with new onset seizure. Children with a CNS OI causing the new onset seizure had a lower risk of later seizures, possibly because the trigger for the seizure can be treated. In contrast, high functioning children without a CNS OI were at higher risk of future seizures. [ABSTRACT FROM AUTHOR]

Academic self-efficacy reflects an adolescent's level of confidence or belief that she or he can successfully accomplish educational assignments and tasks, which are also argued to be a fundamental factor in educational progress and success. Little is known, however, about the academic self-efficacy that the children of immigrants have, which is particularly relevant today in the midst of the current social, political, and economic debate over the influence of immigration in U.S. public schools. Segmented assimilation theory guides this study's understanding of the children of immigrants' academic self-efficacy. Analyses, which draw from the Educational Longitudinal Study of 2002 and multilevel analyses, indeed reveal imperative findings. Most notably, the association between academic self-efficacy and assimilation is moderated by gender, race, and ethnicity. This article also discusses the importance of understanding the schooling of the children of immigrants in the educational system.