Cognitive dysfunction is common in adult patients of all ages at hospital discharge after major noncardiac surgery, but only the elderly (aged 60 yr or older) are at significant risk for long-term cognitive problems. Patients with POCD are at an increased risk of death in the first year after surgery.

The relative effectiveness of 3 instructional approaches for the prevention of reading disabilities in young children with weak phonological skills was examined. Two programs varying in the intensity of instruction in phonemic decoding were contrasted with each other and with a 3rd approach that supported the children's regular classroom reading program. The children were provided with 88 hr of one-to-one instruction beginning the second semester of kindergarten and extending through 2nd grade. The most phonemically explicit condition produced the strongest growth in word level reading skills, but there were no differences between groups in reading comprehension. Word level skills of children in the strongest group were in the middle of the average range. Growth curve analyses showed that beginning phonological skills, home background, and ratings of classroom behavior all predicted unique variance in growth of word level skills.This study was designed to contribute to our understanding of the instructional conditions that need to be in place to prevent reading disabilities in young children. Both the specific design of the study and the questions it addressed were derived from previous research and theory in two areas. The broadest context of the study is the new understanding of reading and reading disabilities we have acquired from research over the past 20 years (Adams, 1990;Metsala & Ehri, 1998), and the more focused context is previous research on instructional methods that accelerate reading development in young children who are either experiencing or are at risk for reading failure (Foorman,

Acute kidney injury as defined according to the RIFLE classification is a risk factor for mortality and will be useful in future studies of renal dysfunction in thoracic aortic surgery.

No abstract

No abstract

We retrospectively compared anticoagulation with heparin and bivalirudin for 32 consecutive children under 18 years old during extracorporeal membrane oxygenation (ECMO) in our pediatric cardiac intensive care unit (PCICU). Between September 2015 and January 2018, 14 patients received heparin, 13 venoarterial (VA), and 1 venovenous (VV). From February 2018 to September 2019, 18 received bivalirudin (all VA). The mean (standard deviation [SD]) percentage of time with therapeutic activated partial thromboplastin time and activated clotting time was bivalirudin 54 (14%) and heparin 57 (11%), p = 0.4647, and percentage of time supratherapeutic was bivalirudin 18 (10%) and heparin 27 (12%), p = 0.0238. Phlebotomy-associated blood loss per hour of ECMO was double in the heparin compared with bivalirudin group 1.08 ml/h (0.20 ml/h), compared with 0.51 ml/h (0.07 ml/h), p = 0.0003, as well as interventions to control bleeding. Packed red blood cell (PRBC) transfusions significantly correlated with higher blood loss in the heparin group (Pearson correlation coefficient = 0.49, p = 0.0047). Overall amount of blood product utilization was not different between the groups. Survival to ECMO decannulation was 89% for bivalirudin and 57% for heparin, p = 0.0396, although 6 month survival was not significantly different (67% versus 57%, p = 0.5809). Heparin may increase the need for PRBC transfusions and strategies to attenuate bleeding when compared with bivalirudin for children receiving ECMO in PCICU.

Fox EJ, Tester NJ, Kautz SA, Howland DR, Clark DJ, Garvan C, Behrman AL. Modular control of varied locomotor tasks in children with incomplete spinal cord injuries.

Background: To examine the efficacy of sequential sertraline and cognitive-behavioral therapy (CBT) treatment relative to CBT with pill placebo over 18 weeks in children and adolescents with obsessive-compulsive disorder (OCD). Methods: Forty-seven children and adolescents with OCD (Range=7-17 years) were randomized to 18-weeks of treatment in one of three arms: 1) sertraline at standard dosing + CBT (RegSert+CBT); 2) sertraline titrated slowly but achieving at least 8 weeks on the maximally tolerated daily dose + CBT (SloSert+CBT); or 3) pill placebo + CBT (PBO+CBT). Assessments were conducted at screening, baseline, weeks 1-9, 13, and 17, and post- treatment. Raters and clinicians were blinded to sertraline (but not CBT) randomization status. Primary outcomes included the Children’s Yale-Brown Obsessive-Compulsive Scale, and response and remission status. Secondary outcomes included the Child Obsessive Compulsive Impact Scale–Parent/Child, Children’s Depression Rating Scale-Revised, Multidimensional Anxiety Scale for Children, and Clinical-Global Impressions-Severity. Results: All groups exhibited large within-group effects across outcomes. There was no group by time interaction across all outcomes suggesting that group changes over time were comparable. Conclusions: Among youth with OCD, there was no evidence that sequentially provided sertraline with CBT differed from those receiving placebo with CBT.