The effect of late preterm birth on mortality of infants with major congenital heart defects.

OBJECTIVE: We evaluated the effect of late preterm delivery (34 to 36 weeks) on hospital mortality of infants with congenital heart defects (CHDs). STUDY DESIGN: Retrospective record review of infants with major CHD born at or after to 34 weeks, cared for in a single tertiary perinatal center between 2002 and 2009. Factors associated with death before discharge from the hospital were ascertained using univariate and multivariate analyses. RESULT: Of the 753 infants with CHD, 117 were born at late preterm. Using logistic regression analysis, white race (OR; 95% CI) (0.60; 0.39 to 0.95), late preterm delivery (2.70; 1.69 to 4.33), and need for intubation in the delivery room (3.15; 1.92 to 5.17) were independently associated with hospital death. CONCLUSION: Late preterm birth of infants with major CHDs was independently associated with increased risk of hospital death compared with delivery at more mature gestational ages.

Paroxysmal sneezing at the onset of lateral medullary syndrome: cause or consequence?

Sneezing is known to precede lateral medullary syndrome (LMS). It is usually interpreted as the precipitating cause for a vertebral artery dissection that subsequently causes LMS. Through two case reports and a literature review, we aim to challenge the concept that sneezing at the onset of LMS implies that a dissection is the underlying cause. An 82-year-old man and a 54-year-old man both reported unprovoked explosive pathological sneezing at the onset of the LMS without any delay between sneezing and the other LMS symptoms. Both denied neck trauma or neck pain. There was no conclusive evidence for vertebral artery dissection in either case. Paroxysmal sneezing can be an initial manifestation of lateral medullary ischemia and may not necessarily indicate an underlying vertebral artery dissection as the cause.

A combination of caffeine and taurine has no effect on short term memory but induces changes in heart rate and mean arterial blood pressure.

Red Bull energy drink has become extraordinarily popular amongst college students for use as a study aid. We investigated the combined effects of Red Bull's two active ingredients, caffeine and taurine, on short term memory. Studies on the effects of these two neuromodulators on memory have yielded mixed results, and their combined actions have not yet been investigated. In this double-blind study, college student subjects consumed either caffeine and taurine pills or a placebo and then completed a memory assessment. Heart rate and blood pressure were monitored throughout the testing period. The combination of caffeine and taurine had no effect on short term memory, but did cause a significant decline in heart rate and an increase in mean arterial blood pressure. The heart rate decline may have been caused by pressure-induced bradycardia that was triggered by caffeine ingestion and perhaps enhanced by the actions of taurine.

Electronic imaging impact on image and report turnaround times.

We prospectively compared image and report delivery times in our Urgent Care Center (UCC) during a film-based practice (1995) and after complete implementation of an electronic imaging practice in 1997. Before switching to a totally electronic and filmless practice, multiple time periods were consistently measured during a 1-week period in May 1995 and then again in a similar week in May 1997 after implementation of electronic imaging. All practice patterns were the same except for a film-based practice in 1995 versus a filmless practice in 1997. The following times were measured: (1) waiting room time, (2) technologist's time of examination, (3) time to quality control, (4) radiology interpretation times, (5) radiology image and report delivery time, (6) total radiology turn-around time, (7) time to room the patient back in the UCC, and (8) time until the ordering physician views the film. Waiting room time was longer in 1997 (average time, 26:47) versus 1995 (average time, 15:54). The technologist's examination completion time was approximately the same (1995 average time, 06:12; 1997 average time, 05:41). There was also a slight increase in the time of the technologist's electronic verification or quality control in 1997 (average time, 7:17) versus the film-based practice in 1995 (average time, 2:35). However, radiology interpretation times dramatically improved (average time, 49:38 in 1995 versus average time 13:50 in 1997). There was also a decrease in image delivery times to the clinicians in 1997 (median, 53 minutes) versus the film based practice of 1995 (1 hour and 40 minutes). Reports were available with the images immediately upon completion by the radiologist in 1997, compared with a median time of 27 minutes in 1995. Importantly, patients were roomed back into the UCC examination rooms faster after the radiologic procedure in 1997 (average time, 13:36) than they were in 1995 (29:38). Finally, the ordering physicians viewed the diagnostic images and reports in dramatically less time in 1997 (median, 26 minutes) versus 1995 (median, 1 hour and 5 minutes). In conclusion, a filmless electronic imaging practice within our UCC greatly improved radiology image and report delivery times, as well as improved clinical efficiency.

Picture archive and communication systems implementation in a community medicine practice.

In order to gain experience with vendor-supplied picture archive and communication system (PACS) products, a Vantage PACS from Lockheed-Martin was installed in a Mayo community medicine practice in Rochester. This practice produces about 45,000 radiology examinations annually. The PACS includes central long- and short-term storage devices, 10 image display workstations, and a dedicated high-speed image distribution network. Digital images are produced using two Fuji computed radiography readers. Custom worklists were created to facilitate efficient system usage. Currently, all radiographic examinations for this practice are acquired digitally, and interpreted and distributed using the PACS. Remote softcopy interpretation via PACS has decreased the turnaround time for both routine and urgent examinations, and has allowed subspecialty interpretation or consultation for pediatric examinations. These results have significantly improved the radiology component of this community medicine practice.

Accelerating language acquisition.

How much can the development of language and other skills be accelerated in the general population? High correlations between early verbal and mental competencies and parent and teacher language socialization practices suggest enormous potential for widespread improvement. Here we report follow-up research in progress in studies of late adolescent children from diverse ethnic and educational backgrounds who participated in a language enrichment programme during infancy in the home or day-care. In 39 of 44 home-stimulated children located to date (nearly all from college-educated families) 62-93% were: in gifted or advanced programmes, obtaining high grades, avid readers and skilled in writing (over half read before school and wrote creative material independently) and generally highly skilled in verbal, mathematical and other academic domains. They also excelled socially and in sports, and showed intellectual independence. Additional subjects and data (on competence, later experiences and Scholastic Aptitude Test [SAT] scores) are currently being collected. Preliminary data analyses suggest that although early language enrichment can in the short term easily increase competence in all groups well beyond norms generated by current socialization practices, long-term outcomes are a complex function of developmental dynamics between the early, complex, foundation of high skills and motivation for learning, and the interaction with facilitative parental resources.

Rooming-in at night in the postpartum ward.

Since the early 1970s it has been common practice for 'rooming-in' to take place during the day in Swedish maternity wards. At night newborn babies are usually looked after by nursing staff in special nurseries. One reason for this is to avoid disturbing the mothers' sleep at night. To promote mother-infant adaptation, we undertook a programme intended to encourage night-time rooming-in. Evaluation of the programme was carried out as a quasi-experiment, divided into a pretest period (I), a 6-month implementation period, and a post-test period (II). Breast feeding and maternal sleep were studied during the first 3 postpartum days by means of self-report by 104 mothers in Period I and 111 mothers in Period II. The number of hours that the babies spent in the nursery decreased from Period I to Period II, a difference that was most obvious during the second and third postpartum nights. No difference was found in the number of breast feeds in Periods I and II, except during the third night, when Period II mothers breast fed more often. In spite of increased rooming-in in Period II, these mothers slept the same number of hours and felt equally alert as Period I mothers.

Systemic sclerosis associated with cutaneous exposure to solvent: case report and review of the literature.

Sclerodermatous skin changes and systemic sclerosis have been reported to occur as a result of contact with several different organic solvents. We describe a 41-year-old man who developed systemic sclerosis after working for 15 years in a foundry, where he had extensive cutaneous contact with multiple organic solvents (trichloroethane, xylene, trimethylbenzene, and naphthalene). Cutaneous exposure to organic solvents may be a factor in the etiology of some cases of systemic sclerosis.

A validation of two motion sensors in the prediction of child and adult physical activity levels.

The authors sought to assess the reliability and validity of two motion activity sensors in the prediction of observed physical activity levels in adults and children by means of two studies at North Dakota State University in Fargo, North Dakota. In study 1, 50 adults were observed in fall 1984 for one hour of recreational activity while they simultaneously wore two motion sensors: an activity counter (i.e., LSI Moving Activity Monitor (GMM Electronics Inc., Verona, PA)) and an electronic accelerometer (i.e., Caltrac Personal Activity Computer (Hemokinetics, Inc., Vienna, VA)). The results indicated that both the activity counter (r = 0.65) and the accelerometer (r = 0.69) strongly correlated to observed physical activity levels. The two motion sensors also were highly correlated to each other (r = 0.83). A correlation of self-reports of time spent in various types of physical activity to observed physical activity ranged from 0.21 to 0.88 (mean = 0.60). Study 2 evaluated these same two sensors in winter 1984 in 30 preschool children observed in a freeplay situation. Results of this study indicated very modest relationships between observed physical activity levels and accelerometer readings (r = 0.35) and activity counter readings (r = 0.40). The two motion sensors intercorrelated at very modest levels (r = 0.42). The results indicate that while both motion sensors closely corresponded to observed levels of physical activity in adults, neither sensor correlated substantively to observed levels of physical activity in children. Implications for validating and utilizing these sensors in epidemiologic research are discussed.

Symptoms and lung function in low-exposure to TDI by polyurethane foam manufacturing.

A cross-sectional investigation was performed in seven polyurethane foam manufacturing factories. Lung function tests were performed at the factories by spirometric and nitrogen wash-out methods. Sixty-seven persons were investigated before and after the work shift, and exposure to toluene diisocyanate (TDI) was evaluated by subject-carried sampling equipment on the same day. The day mean exposure to TDI was 0.008 mg/m3 (0.001 ppm). In the non-smokers there was an increased frequency of symptoms from the airways reported in the exposed subjects as compared to the unexposed controls. There were, however, no signs of acute or chronic effects on the lung function measured by spirometric and nitrogen wash-out methods, which could not be explained by smoking.