Improved reading comprehension: Making the regular education initiative work in secondary settings

The Regular Education Initiative, which calls for the abandoning or radical restructuring of special education has triggered the most intense and controversial debate in the professional literature at the present. This article provides a brief overview of instructional approaches for improving reading comprehension as a means of keeping mildly handicapped students in their regular classroom setting or of reintegrating those placed in separate programs. The authors suggest that an integrated system is not only desirable but possible.     

Sepsis severity is the major determinant of circulating thrombopoietin levels in septic patients

OBJECTIVE: To measure serum thrombopoietin levels and to investigate their relationship with platelet counts and other potential determinants in septic patients. DESIGN: Prospective study comparing septic patients and healthy volunteers. SETTING: General intensive care units in two tertiary university hospitals. PATIENTS: A total of 152 consecutive septic patients (69 with sepsis, 24 with severe sepsis, and 59 with septic shock). Twenty-two healthy volunteers served as control subjects. Sepsis severity was determined by grading septic patients in those having sepsis, severe sepsis, and septic shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: After blood sampling, platelet counts, and serum thrombopoietin, interleukin-6 and C-reactive protein levels were measured. Platelets did not decrease in patients with sepsis, but they significantly decreased in patients with severe sepsis and septic shock (p <.01 vs. controls and sepsis). In contrast, thrombopoietin levels (median [range]) increased in patients with sepsis (159 [34-1272] pg/mL) compared with controls (57 [33-333] pg/mL, p <.001), exhibiting further significant increase in patients with severe sepsis and septic shock (461 [73-1550] and 522 [45-2313] pg/mL, respectively, p <.001 vs. sepsis). In multiple regression analysis, thrombopoietin levels were independently related only to sepsis severity (higher in patients with increased sepsis severity, p <.001) and platelet counts (higher in patients with lower platelet counts, p =.004). Sepsis severity accounted for most of the variance explained by the model. Thrombopoietin was significantly related to interleukin-6 (r =.26) and C-reactive protein (r =.37, p <.001 for both). In serial measurements, interleukin-6 peak values constantly preceded those of thrombopoietin, whereas peaks in thrombopoietin levels coincided with clinical episodes of septic shock. CONCLUSIONS: Sepsis severity is the major determinant of elevated thrombopoietin levels in septic patients, whereas platelet count is a secondary determinant. Thrombopoietin represents a potential marker of sepsis severity.     

Long‐term outcomes for different surgical strategies to treat left ventricular outflow tract obstruction in hypertrophic cardiomyopathy

Aims

Surgical intervention is used to treat dynamic left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy. This study assesses the effect of different surgical strategies on long‐term mortality and morbidity.

Methods and results

In total, 347 patients underwent surgical intervention for LVOTO (1988–2015). Group A (n = 272) underwent septal myectomy; Group B (n = 33), septal myectomy and mitral valve (MV) repair; Group C (n = 22), myectomy and MV replacement; and Group D (n = 20), MV replacement alone. Median follow‐up was 5.2 years (interquartile range 1.9–7.9). The mean resting LVOT gradient improved post‐operatively from 71.9 ± 39.6 mmHg to 13.4 ± 18.5 mmHg (P < 0.05). Overall, 72.4% of patients improved by >1 New York Heart Association (NYHA) class; 58.9% of patients undergoing MV replacement alone did not improve their NYHA class. There were 5 perioperative deaths and 20 late deaths (>30 days). Survival rates at 1, 5 and 10 years respectively were 98.4, 96.9, 91.9% in Group A; 97.0, 92.4, 61.6% in Group B; 100.0, 100.0, 55.6% in Group C; and 94.7, 85.3, 85.3% in Group D (log‐rank, P < 0.05). Long‐term (>30 days) complications included atrial fibrillation (29.6%), transient ischaemic attack/stroke (2.4%) and heart failure hospitalisation (3.2%). There were 16 repeat surgical interventions at 3.0 years.

Conclusion

Septal myectomy is a safe procedure resulting in symptomatic improvement in the majority of patients. The annual incidence of non‐fatal disease‐related complications after surgical treatment of LVOTO is relatively high. Patients who underwent MV replacements had poorer outcomes with less symptomatic benefit in spite of a similar reduction in LVOT gradients.

     

Autonomic responses to single- and dual-chamber pacing

We investigated the autonomic effects of short-term, single- and dual-chamber pacing by evaluating frequency-domain indexes of heart rate variability (HRV). The study group comprised 25 patients (mean age 62 +/- 7 years) without organic heart disease and with normal sinus node function who were implanted with a permanent dual-chamber DDD (n = 16) or VDD (n = 9) pacing system for transient high-degree atrioventricular block. Continuous overdrive pacing for 15 minutes slightly above the intrinsic rhythm was programmed to ensure complete capture in AAI, DDD, and VVI modes, and the atrioventricular delays were set to ensure permanent ventricular pacing in DDD and VDD modes. Components of frequency-domain measures of HRV (low frequency [LF], high-frequency [HF], and LF/HF ratio) were calculated in 5-minute intervals over a 30-minute period after cessation of each pacing mode. AAI pacing did not significantly affect LF and LF/HF measures, and presented the highest HF power. DDD and VDD modes led to similar responses with slightly increased fluctuations of LF and LF/HF power. VVI pacing triggered an acceleration in heart rate (p <0.05), the most significant increases in LF power and in the LF/HF ratio, and the lowest HF power. Autonomic effects of pacing did not resolve with cessation of pacing. Atrial AAI pacing appears to have lesser effect on sympathovagal balance. Synchronous VDD and DDD stimulation favor a shift in autonomic balance toward sympathetic predominance. Asynchronous VVI pacing triggers both sympathetic overactivity and vagal withdrawal.     

Acute effects of ozone on mortality from the "air pollution and health: a European approach" project

In the Air Pollution and Health: A European Approach (APHEA2) project, the effects of ambient ozone concentrations on mortality were investigated. Data were collected on daily ozone concentrations, the daily number of deaths, confounders, and potential effect modifiers from 23 cities/areas for at least 3 years since 1990. Effect estimates were obtained for each city with city-specific models and were combined using second-stage regression models. No significant effects were observed during the cold half of the year. For the warm season, an increase in the 1-hour ozone concentration by 10 mug/m3 was associated with a 0.33% (95% confidence interval [CI], 0.17-0.52) increase in the total daily number of deaths, 0.45% (95% CI, 0.22-0.69) in the number of cardiovascular deaths, and 1.13% (95% CI, 0.62-1.48) in the number of respiratory deaths. The corresponding figures for the 8-hour ozone were similar. The associations with total mortality were independent of SO2 and particulate matter with aerodynamic diameter less than 10 mum (PM10) but were somewhat confounded by NO2 and CO. Individual city estimates were heterogeneous for total (a higher standardized mortality rate was associated with larger effects) and cardiovascular mortality (larger effects were observed in southern cities). The dose-response curve of ozone effects on total mortality during the summer did not deviate significantly from linearity.     

The lameness of King Philip II and Royal Tomb I at Vergina,Macedonia

King Philip II was the father of Alexander the Great. He suffered a notorious penetrating wound by a lance through his leg that was nearly fatal and left him lame in 339 B.C.E. (i.e., 3 y before his assassination in 336 B.C.E.). In 1977 and 1978 two male skeletons were excavated in the Royal Tombs II and I of Vergina, Greece, respectively. Tomb I also contained another adult (likely a female) and a newborn skeleton. The current view is that Philip II was buried in Tomb II. However, the male skeleton of Tomb II bears no lesions to his legs that would indicate lameness. We investigated the skeletal material of Tomb I with modern forensic techniques. The male individual in Tomb I displays a conspicuous case of knee ankylosis that is conclusive evidence of lameness. Right through the overgrowth of the knee, there is a hole. There are no obvious signs that are characteristic of infection and osteomyelitis. This evidence indicates that the injury was likely caused by a severe penetrating wound to the knee, which resulted in an active inflammatory process that stopped years before death. Standard anthropological age-estimation techniques based on dry bone, epiphyseal lines, and tooth analysis gave very wide age ranges for the male, centered around 45 y. The female would be around 18-y-old and the infant would be a newborn. It is concluded that King Philip II, his wife Cleopatra, and their newborn child are the occupants of Tomb I.The Great Tumulus in Vergina contains three Royal Tombs (I, II, and III) and one “Heroon” (shrine dedicated to a hero) next to Tomb I. Tomb I was built with the same big porous ashlar blocks as the Heroon, for which there is unanimous agreement by scholars that it belongs to Philip II (from now on called Philip) (1). There is also unanimous agreement that Tomb III, which has a façade strikingly similar to that of Tomb II (with nine bluish triglyphs each), belongs to Alexander the Great’s son, Alexander IV (1). Tomb I is a cist tomb dated earlier than Tomb II (2, 3). Tomb I contains stunning wall paintings in its interior, the most important of which depicts “The rape of Persephone,” after which Tomb I was named. It also contained the bones of a male, a female, and a newborn (4). The Royal Tomb II was discovered unplundered in 1977, containing a rich array of grave goods, such as two golden larnakes (each with cremated human remains inside) and an armor consisting of items such as a cuirass, a helmet, and a shield. It was named “The Tomb of Philip,” which is a misnomer as we show here. Despite anthropological and archaeological evidence that the tomb belongs to King Arrhidaeus and his wife Eurydice (3, 5), the archaeological establishment still maintains that Tomb II belongs to Philip II (2, 6).Tomb I contained the inhumed, unburnt, and incomplete remains of a man, a woman, and a full-term fetus or neonate (4, 7); they were the result of inhumation, not cremation (8). We aimed to study the lesions and estimate the ages of the three individuals in Tomb I and then compare them with those known from the ancient literary sources to identify the occupant of Royal Tomb I in Vergina. Most of the bones of these individuals have never been presented before. Only a brief mention was made of few of them in a couple of lines (4, 7), and certainly nothing was reported on their lesions.     

Efficacy of three candidate Rift Valley fever vaccines in sheep

Rift Valley fever virus (RVFV) is a mosquito-transmitted Bunyavirus that causes high morbidity and mortality among ruminants and humans. The virus is endemic to the African continent and the Arabian Peninsula and continues to spread into new areas. The explosive nature of RVF outbreaks requires that vaccines provide swift protection after a single vaccination. We recently developed several candidate vaccines and here report their efficacy in lambs within three weeks after a single vaccination. The first vaccine comprises the purified ectodomain of the Gn structural glycoprotein formulated in a water-in-oil adjuvant. The second vaccine is based on a Newcastle disease virus-based vector that produces both RVFV structural glycoproteins Gn and Gc. The third vaccine comprises a recently developed nonspreading RVFV. The latter two vaccines were administered without adjuvant. The inactivated whole virus-based vaccine produced by Onderstepoort Biological Products was used as a positive control. Five out of six mock-vaccinated lambs developed high viremia and fever and one lamb succumbed to the challenge infection. A single vaccination with each vaccine resulted in a neutralizing antibody response within three weeks after vaccination and protected lambs from viremia, pyrexia and mortality.