Cardiac evaluation of young athletes: Time for a risk-based approach?

Pre-participation cardiovascular screening (PPCS) is recommended by several scientific and sporting organizations on the premise that early detection of cardiac disease provides a platform for individualized risk assessment and management; which has been proven to lower mortality rates for certain conditions associated with sudden cardiac arrest (SCA) and sudden cardiac death (SCD). What constitutes the most effective strategy for PPCS of young athletes remains a topic of considerable debate. The addition of the electrocardiogram (ECG) to the medical history and physical examination undoubtedly enhances early detection of disease, which meets the primary objective of PPCS. The benefit of enhanced sensitivity must be carefully balanced against the risk of potential harm through increased false-positive findings, costly downstream investigations, and unnecessary restriction/disqualification from competitive sports. To mitigate this risk, it is essential that ECG-based PPCS programs are implemented by institutions with a strong infrastructure and by physicians appropriately trained in modern ECG standards with adequate cardiology resources to guide downstream investigations. While PPCS is compulsory for most competitive athletes, the current debate surrounding ECG-based programs exists in a binary form; whereby ECG screening is mandated for all competitive athletes or none at all. This polarized approach fails to consider individualized patient risk and the available sports cardiology resources. The limitations of a uniform approach are highlighted by evolving data, which suggest that athletes display a differential risk profile for SCA/SCD, which is influenced by age, sex, ethnicity, sporting discipline, and standard of play. Evaluation of the etiology of SCA/SCD within high-risk populations reveals a disproportionately higher prevalence of ECG-detectable conditions. Selective ECG screening using a risk-based approach may, therefore, offer a more cost-effective and feasible approach to PPCS in the setting of limited sports cardiology resources, although this approach is not without important ethical considerations

All Politics Is Global: Explaining International Regulatory Regimes

Has globalization diluted the power of national governments to regulate their own economies? Are international governmental and nongovernmental organizations weakening the hold of nation-states on global regulatory agendas? Many observers think so. But in All Politics Is Global , Daniel Drezner argues that this view is wrong. Despite globalization, states--especially the great powers--still dominate international regulatory regimes, and the regulatory goals of states are driven by their domestic interests. As Drezner shows, state size still matters. The great powers--the United States and the European Union--remain the key players in writing global regulations, and their power is due to the size of their internal economic markets. If they agree, there will be effective global governance. If they don't agree, governance will be fragmented or ineffective. And, paradoxically, the most powerful sources of great-power preferences are the least globalized elements of their economies. Testing this revisionist model of global regulatory governance on an unusually wide variety of cases, including the Internet, finance, genetically modified organisms, and intellectual property rights, Drezner shows why there is such disparity in the strength of international regulations.globalization, politics, governance, international regulatory regimes, nongovernmental organizations, states, great powers

Abnormal electrocardiographic findings in athletes: Correlation with intensity of sport and level of competition.

INTRODUCTION: Athletes can exhibit abnormal electrocardiogram (ECG) phenotypes that require further evaluation prior to competition. These are apparently more prevalent in high-intensity endurance sports. The purpose of this study was to assess the association between ECG findings in athletes and intensity of sport and level of competition. METHODS: A cohort of 3423 competitive athletes had their ECGs assessed according to the Seattle criteria (SC). The presence of abnormal ECGs was correlated with: (1) intensity of sport (low/moderate vs. at least one high static or dynamic component); (2) competitive level (regional vs. national/international); (3) training volume (≤20 vs. >20 hours/week); (4) type of sport (high dynamic vs. high static component). The same endpoints were studied according to the 'Refined Criteria' (RC). RESULTS: Abnormal ECGs according to the SC were present in 225 (6.6%) athletes, more frequently in those involved in high-intensity sports (8.0% vs. 5.4%; p=0.002), particularly in dynamic sports, and competing at national/international level (7.1% vs. 4.9%; p=0.028). Training volume was not significantly associated with abnormal ECGs. By multivariate analysis, high-intensity sport (OR 1.55, 1.18-2.03; p=0.002) and national/international level (OR 1.50, 95% CI 1.04-2.14; p=0.027) were independent predictors of abnormal ECGs, and these variables, when combined, doubled the prevalence of this finding. According to the RC, abnormal ECGs decreased to 103 (3.0%), but were also more frequent in high-intensity sports (4.2% vs. 2.0%; p<0.001). CONCLUSIONS: There is a positive correlation between higher intensity of sports and increased prevalence of ECG abnormalities. This relationship persists with the use of more restrictive criteria for ECG interpretation, although the number of abnormal ECGs is lower

Directional approach to gradual cover: the continuous case

The objective of the cover location models is covering demand by facilities within a given distance. The gradual (or partial) cover replaces abrupt drop from full cover to no cover by defining gradual decline in cover. In this paper we use a recently proposed rule for calculating the joint cover of a demand point by several facilities termed "directional gradual cover". Contrary to all gradual cover models, the joint cover depends on the facilities' directions. In order to calculate the joint cover, existing models apply the partial cover by each facility disregarding their direction. We develop a genetic algorithm to solve the facilities location problem and also solve the problem for facilities that can be located anywhere in the plane. The proposed modifications were extensively tested on a case study of covering Orange County, California

A modified Kolmogorov-Smirnov test for normality

In this paper we propose an improvement of the Kolmogorov-Smirnov test for normality. In the current implementation of the Kolmogorov-Smirnov test, a sample is compared with a normal distribution where the sample mean and the sample variance are used as parameters of the distribution. We propose to select the mean and variance of the normal distribution that provide the closest fit to the data. This is like shifting and stretching the reference normal distribution so that it fits the data in the best possible way. If this shifting and stretching does not lead to an acceptable fit, the data is probably not normal. We also introduce a fast easily implementable algorithm for the proposed test. A study of the power of the proposed test indicates that the test is able to discriminate between the normal distribution and distributions such as uniform, bi-modal, beta, exponential and log-normal that are different in shape, but has a relatively lower power against the student t-distribution that is similar in shape to the normal distribution. In model settings, the former distinction is typically more important to make than the latter distinction. We demonstrate the practical significance of the proposed test with several simulated examples.Closest fit; Kolmogorov-Smirnov; Normal distribution

The planar multiple obnoxious facilities location problem: A Voronoi based heuristic

Consider the situation where a given number of facilities are to be located in a convex polygon with the objective of maximizing the minimum distance between facilities and a given set of communities with the important additional condition that the facilities have to be farther than a certain distance from one another. This continuous multiple obnoxious facility location problem, which has two variants, is very complex to solve using commercial nonlinear optimizers. We propose a mathematical formulation and a heuristic approach based on Voronoi diagrams and an optimally solved binary linear program. As there are no nonlinear optimization solvers that guarantee optimality, we compare our results with a popular multi-start approach using interior point, genetic algorithm (GA), and sparse non-linear optimizer (SNOPT) solvers in Matlab. These are state of the art solvers for dealing with constrained non linear problems. Each instance is solved using 100 randomly generated starting solutions and the overall best is then selected. It was found that the proposed heuristic results are much better and were obtained in a fraction of the computer time required by the other methods.The multiple obnoxious location problem is a perfect example where all-purpose non-linear non-convex solvers perform poorly and hence the best way forward is to design and analyze heuristics that have the power and the exibility to deal with such a high level of complexity

The Viscosity of Global Governance

Streaming video requires RealPlayer to view.The University Archives has determined that this item is of continuing value to OSU's history.Daniel Drezner is associate professor of international politics at the Fletcher School of Law and Diplomacy at Tufts University. His recent paper suggests that issue linkage and organizational reputation can increase the viscosity of global governance in the short run. The barriers to forum-shopping are not constant over time, however; in the long run, there is little viscosity in global governance structures.Ohio State University. Mershon Center for International Security StudiesEvent webpage, streaming video, photo

Discovering Perceptions about and the Potential Demand for Unique, S.T.E.A.M. Educational Programs for Children in Osijek, Croatia

S.T.E.A.M. (Science, Technology, Engineering, Art and Mathematics) as a topic has been explored in terms of adding the arts as a basis for creativity, creative making, divergent thinking and in relation to innovation (Ghanbari, 2014). In addition, a connection between arts and future leadership might have been made by previous researchers. Moreover, S.T.E.A.M. has been researched in terms of ethical framework and demand related to education. This research paper investigated the perceptions about and the potential demand for unique, S.T.E.A.M. educational programs for children from five to ten years old, in Osijek, Croatia. Past studies regarding the implementation of program, innovation in education and unexplored demand were used to investigate the market potential. A number of factors helped in understanding the demand, but emerging trends within the local community, the uniqueness of the experience itself and innovation on the market played a pivotal role. Although past studies have explored the association between education and future of work, a concrete theoretical framework was now used. Thus, using Constructivist approach, this qualitative study with qualitative design, attempted to discover the preferences and whether the parent’s interest in extracurricular education through play and experiments is becoming a trend. The study was conducted using interviews and focus group. Data was collected from multi-disciplinary innovators and parents of children attending Helen Doron Early English school. Data obtained through a two-phased research was analyzed, coded and grouped according to predetermined themes associated with research questions. However, limitations were identified to be considered by future researchers