Comparison of Echocardiographically-Calculated Fontan Fenestration Gradient and Catheter-Based Measurement.

BACKGROUND: Patients born with single ventricle anatomy typically undergo surgical palliation in three stages, culminating in the Fontan procedure. Assessment of flow across a Fontan fenestration by Doppler ultrasound theoretically allows for non-invasive estimation of the transpulmonary gradient (TPG). Our objective was to determine the relationship between Doppler-derived mean fenestration gradient (mFG) and direct catheter-based measurements of TPG in patients with fenestrated Fontans. METHODS: We performed a single-center retrospective cohort study of 59 patients with fenestrated Fontans completed between 2000 and 2022. The primary outcome was catheter-based measurement of TPG and the primary predictor was mFG from echo performed within 6 months of the catheterization. Linear regression and R2 were used to determine the relationship between predictors and outcomes. RESULTS: Catheter-based measurements of TPG and mFG were weakly correlated (R2 = 0.382, p < 0.001); the regression coefficient was 0.550, with a standard error of 0.09 for every increase in mFG (Cath TPG = 0.55 [mFG] + 1.92). mFG had a slightly better predictive relationship with cath-derived TPG in patients with systemic left ventricles with R2 of 0.47, p < 0.004. CONCLUSION: mFG accounts for approximately 38% of the variance in catheter-derived TPG. Although mFG is non-invasive and intuitive, mFG in Fontan patients should be interpreted with caution and direct measurement by cardiac catheterization should be considered.

A 12-Year-Old with Sudden Cardiac Arrest.

Sudden Cardiac Arrest in 12-Year-Old BoyA 12-year-old boy suddenly lost consciousness while playing catch in his backyard. He was found pulseless and received cardiopulmonary resuscitation and defibrillation before being transferred to the emergency department. How do you approach the evaluation, and what is the diagnosis?

Comparison of Postoperative, In-Hospital Outcomes After Complete Repair of Tetralogy of Fallot Between 22q11.2 Deletion Syndrome and Trisomy 21.

22q11.2 deletion syndrome (22q11) and trisomy 21 (T21) are frequently associated with tetralogy of Fallot (TOF). We hypothesized that there are differences in postoperative length of stay (LOS) and occurrence of postoperative interventions after complete repair of TOF when comparing children with 22q11 to those with T21. Using the Pediatric Health Information System, we performed a retrospective cohort study of patients who underwent complete repair of TOF from 2004 to 2019. Three groups were identified: 22q11, T21, and controls (those without a coded genetic syndrome). Outcomes were postoperative LOS and composite occurrence (yes/no) of at least one postoperative intervention. Bivariate and multivariate comparisons were made among groups; odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the control group as the comparator. There were 6924 subjects (n = 493 22q11, n = 455 T21, n = 5976 controls). In bivariate analysis, 22q11 was associated with a longer LOS compared to T21 (OR 2.37 [2.16, 2.60] vs. 1.25 [1.12, 1.39], p < 0.001), and 22q11 more often underwent postoperative intervention (OR 3.42 [CI 2.56, 4.57] vs. 1.38 [CI 0.91, 2.11]; p < 0.001). In multivariate analysis, 22q11 was also associated with longer LOS (adjusted OR 1.35 [1.26, 1.44] vs. 1.12 [1.04, 1.20]; p < 0.001), but there was no difference in the adjusted odds of postoperative intervention. Children with 22q11 are more likely to experience adverse outcomes after repair of TOF compared to those with T21; the differences are most pronounced for LOS.

Evidence of selective reporting bias in hematology journals: A systematic review.

INTRODUCTION: Selective reporting bias occurs when chance or selective outcome reporting rather than the intervention contributes to group differences. The prevailing concern about selective reporting bias is the possibility of results being modified towards specific conclusions. In this study, we evaluate randomized controlled trials (RCTs) published in hematology journals, a group in which selective outcome reporting has not yet been explored. METHODS: Our primary goal was to examine discrepancies between the reported primary and secondary outcomes in registered and published RCTs concerning hematological malignancies reported in hematology journals with a high impact factor. The secondary goals were to address whether outcome reporting discrepancies favored statistically significant outcomes, whether a pattern existed between the funding source and likelihood of outcome reporting bias, and whether temporal trends were present in outcome reporting bias. For trials with major outcome discrepancies, we contacted trialists to determine reasons for these discrepancies. Trials published between January 1, 2010 and December 31, 2015 in Blood; British Journal of Haematology; American Journal of Hematology; Leukemia; and Haematologica were included. RESULTS: Of 499 RCTs screened, 109 RCTs were included. Our analysis revealed 118 major discrepancies and 629 total discrepancies. Among the 118 discrepancies, 30 (25.4%) primary outcomes were demoted, 47 (39.8%) primary outcomes were omitted, and 30 (25.4%) primary outcomes were added. Three (2.5%) secondary outcomes were upgraded to a primary outcome. The timing of assessment for a primary outcome changed eight (6.8%) times. Thirty-one major discrepancies were published with a P-value and twenty-five (80.6%) favored statistical significance. A majority of authors whom we contacted cited a pre-planned subgroup analysis as a reason for outcome changes. CONCLUSION: Our results suggest that outcome changes occur frequently in hematology trials. Because RCTs ultimately underpin clinical judgment and guide policy implementation, selective reporting could pose a threat to medical decision making.

XRIndex: a brief screening tool for individual differences in security threat detection in x-ray images.

X-ray imaging is a cost-effective technique at security checkpoints that typically require the presence of human operators. We have previously shown that self-reported attention to detail can predict threat detection performance with small-vehicle x-ray images (Rusconi et al., 2012). Here, we provide evidence for the generality of such a link by having a large sample of naïve participants screen more typical dual-energy x-ray images of hand luggage. The results show that the Attention to Detail score from the autism-spectrum quotient (AQ) questionnaire (Baron-Cohen et al., 2001) is a linear predictor of threat detection accuracy. We then develop and fine-tune a novel self-report scale for security screening: the XRIndex, which improves on the Attention to Detail scale for predictive power and opacity to interpretation. The XRIndex is not redundant with any of the Big Five personality traits. We validate the XRIndex against security x-ray images with an independent sample of untrained participants and suggest that the XRIndex may be a useful aid for the identification of suitable candidates for professional security training with a focus on x-ray threat detection. Further studies are needed to determine whether this can also apply to trained professionals.

The role of expectations, hype and ethics in neuroimaging and neuromodulation futures.

The production of expectations or future-goals for the development of techniques which "read" and modulate brain function, represent an important practical tool for neuroscientists. These visions-of-the-future assist scientists by providing focus for both individual and cross-disciplinary research programs; they encourage the development of new industrial sectors, are used to justify the allocation of government resources and funding, and via the media can help capture the imagination and support of the public. However, such expectations need to be tempered by reality. Over-hyping brain imaging and modulation will lead to disappointment; disappointment that in turn can undermine its potential. Similarly, if neuroscientists focus their attention narrowly on the science without concomitant consideration of its future ethical, legal and social implications, then their expectations may remain unrealized. To develop these arguments herein we introduce the theoretical concept of expectations and the practical consequences of expectations. We contextualize these reflections by referring to brain imaging and modulation studies on deception, which encompass the measurement-suppression-augmentation range.

Prospects of functional magnetic resonance imaging as lie detector.

Following the demise of the polygraph, supporters of assisted scientific lie detection tools have enthusiastically appropriated neuroimaging technologies "as the savior of scientifically verifiable lie detection in the courtroom" (Gerard, 2008: 5). These proponents believe the future impact of neuroscience "will be inevitable, dramatic, and will fundamentally alter the way the law does business" (Erickson, 2010: 29); however, such enthusiasm may prove premature. For in nearly every article published by independent researchers in peer reviewed journals, the respective authors acknowledge that fMRI research, processes, and technology are insufficiently developed and understood for gatekeepers to even consider introducing these neuroimaging measures into criminal courts as they stand today for the purpose of determining the veracity of statements made. Regardless of how favorable their analyses of fMRI or its future potential, they all acknowledge the presence of issues yet to be resolved. Even assuming a future where these issues are resolved and an appropriate fMRI lie-detection process is developed, its integration into criminal trials is not assured for the very success of such a future system may necessitate its exclusion from courtrooms on the basis of existing legal and ethical prohibitions. In this piece, aimed for a multidisciplinary readership, we seek to highlight and bring together the multitude of hurdles which would need to be successfully overcome before fMRI can (if ever) be a viable applied lie detection system. We argue that the current status of fMRI studies on lie detection meets neither basic legal nor scientific standards. We identify four general classes of hurdles (scientific, legal and ethical, operational, and social) and provide an overview on the stages and operations involved in fMRI studies, as well as the difficulties of translating these laboratory protocols into a practical criminal justice environment. It is our overall conclusion that fMRI is unlikely to constitute a viable lie detector for criminal courts.

Addressing social resistance in emerging security technologies.

In their efforts to enhance the safety and security of citizens, governments and law enforcement agencies look to scientists and engineers to produce modern methods for preventing, detecting, and prosecuting criminal activities. Whole body scanners, lie detection technologies, biometrics, etc., are all being developed for incorporation into the criminal justice apparatus. Yet despite their purported security benefits these technologies often evoke social resistance. Concerns over privacy, ethics, and function-creep appear repeatedly in analyses of these technologies. It is argued here that scientists and engineers continue to pay insufficient attention to this resistance; acknowledging the presence of these social concerns yet failing to meaningfully address them. In so doing they place at risk the very technologies and techniques they are seeking to develop, for socially controversial security technologies face restrictions and in some cases outright banning. By identifying sources of potential social resistance early in the research and design process, scientists can both engage with the public in meaningful debate and modify their security technologies before deployment so as to minimize social resistance and enhance uptake.