Lead aVL P‐Wave Polarity: Insight from Mapping and Ablation of Atrial Arrhythmia Initiated from Superior Vena Cava

We report a case of focal atrial tachycardia (AT) originating from prior superior vena cava isolation line. The P‐wave morphology in lead aVL during the AT differed from that during sinus rhythm although their foci were in close proximity to each other. We discuss the mechanism based on the activation maps of the right atrium. (PACE 2010; 33:e100–e101)     

Reliability and Validity of the Child and Adolescent Trial for Cardiovascular Health (CATCH) Food Checklist: A Self-report Instrument to Measure Fat and Sodium Intake by Middle School Students

OBJECTIVE: To develop a scoring algorithm and evaluate the reliability and validity of scores from the Child and Adolescent Trial for Cardiovascular Health (CATCH) Food Checklist (CFC) as measures of total fat, saturated fat, and sodium intake in middle school students. DESIGN: Randomized, controlled trial in which participants were assigned to 1 of 3 study protocols that varied the order of CFC and 24-hour dietary recall administration. Criterion outcomes were percent energy from total fat, percent energy from saturated fat, and sodium intake in milligrams. SUBJECTS/SETTING: A multiethnic sample (33% ethnic and racial minorities) of 365 seventh-grade students from 8 schools in 4 states. STATISTICAL ANALYSES: Multivariable regression models were used to calibrate the effects of individual food checklist items; bootstrap estimates were used for cross-validation; and kappa statistics, Pearson correlations, t tests, and effect sizes were employed to assess reliability and validity. RESULTS: The median same-day test-retest reliability kappa for the 40 individual CFC food items was 0.85. With respect to item validity, the median kappa statistic comparing student choices to those identified by staff dietitians was 0.54. Test-retest reliability coefficients ranged from 0.84 to 0.89 for CFC total nutrient scores. Correlations between CFC scores and 24-hour recall values were 0.36 for total fat, 0.36 for saturated fat, and 0.34 for sodium; CFC scores were consistent with hypothesized gender differences in nutrient intake. APPLICATIONS/CONCLUSIONS: The CFC is a reliable and valid tool for measuring fat, saturated fat, and sodium intake in middle school students. Its brevity and ease of administration make the CFC a cost-effective way to measure middle school students' previous day's intake of selected nutrients in school surveys and intervention studies.     

Malfunction of Subpectorally Implanted Cardiac Resynchronization Therapy Defibrillators Due to Weakened Header Bond

Malfunction of Subpectorally Implanted Cardiac Resynchronization Therapy . Background: Implantable cardioverter defibrillator (ICD) implantation has increased significantly over the last 10 years. Concerns about the safety and reliability of ICD systems have been raised, with premature lead failure and battery malfunctions accounting for the majority of reported adverse events. We describe the unique mode of presentation, diagnosis, and management of cardiac resynchronization therapy defibrillators (CRT‐D) malfunctions that were caused by weakened bonding between the generator and header. Methods and Results: Between June 2008 and December 2009, 22 Teligen? ICDs and 24 Cognis? CRT‐Ds were implanted subpectorally at our institution, until a product advisory was issued. Of 24 Cognis? CRT‐D implants, 3 patients presented with CRT‐D malfunctions. All our cases presented with initially intermittent and then persisting increases in shock lead impedance, associated with nonphysiological noise in the shock electrogram channels. These issues were rectified by generator change. Postexplant laboratory analysis confirmed inadequate bonding between device header and titanium casing in all cases, resulting in loosening and rocking of the header followed by fatigue‐induced fracture of the shock circuitry. Conclusion: Weakened bonding between the header and generator casing of subpectorally implanted CRT‐Ds can result in fractures and malfunction of the HV circuit. Physicians monitoring patients with devices affected by the product advisory should remain vigilant in order to diagnose and manage similar device malfunction expediently. (J Cardiovasc Electrophysiol, Vol. 24, pp. 351‐355, March 2013)     

Pityriasis rubra pilaris in the setting of HIV infection: clinical behaviour and association with explosive cystic acne

The development of pityriasis rubra pilaris (PRP) in three patients with human immunodeficiency virus (HIV) infection is described. Two of the patients had onset of severe generalized cystic acne concomitant with their development of PRP. PRP and acne conglobata should be added to the group of cutaneous disorders that can present in a more virulent manner in the setting of HIV infection. The association of cystic acne with PRP and their response to treatment are discussed.     

Developing methodologies for evaluating community-wide health promotion

There has been growing recognition that health promotion programswhich target whole communities are more likely to be effectivein changing health behaviour. However, studies evaluating theimpact of community-wide health promotion programs rarely useadequate methodology. Randomised control trials where multiplewhole communities are randomly assigned to control and interventiongroups are optimum if evaluators hope to validly attribute changesin health behaviour to the intervention. However, such trialspresent a number of difficulties including cost and feasibilitylimitations and the evolving nature of statistical techniques.This paper proposes applying a fairly well-accepted phased evaluationapproach to the evaluation of community participation programs,using three defined phases. Phase 1 consists of small-scalestudies to develop the measures and assess acceptability andfeasibility of the intervention; Phase 2 consists of studiesin a small number of communities designed to trial the interventionin the real world; Phase 3 studies use an appropriate numberof entire communities to provide valid evidence of efficacyof the intervention. It is suggested that criteria be resolvedto identify adequate studies at each stage and that advantagesand limitations of Phase 1 and 2 studies be clearly identified.The paper describes the major design, sampling and analysisconsiderations for a Phase 3 study.     

Maternal perceptions of child behavior: handicappec versus nonhandicapped

This study compares the ratings of child behavior in short stories by mothers of children with handicapping conditions versus those whose children had no handicapping conditions. Each of the mothers rated 12 short stories or vignettes and indicated their self-perceived level of stress. The results showed that the mothers of children with handicapping conditions expressed significantly greater stress levels and rated inappropriate child behavior in a more tolerant fashion than the mothers of children without handicapping conditions. This information may be of value to the dentist who treats patients with handicapping conditions, and it provides a greater understanding of the mothers' concerns and daily life stresses.