Comparison of Risk of Recrudescent Fever in Children With Kawasaki Disease Treated With Intravenous Immunoglobulin and Low-Dose vs High-Dose Aspirin

Importance: Timely initiation of intravenous immunoglobulin plus aspirin is necessary for decreasing the risk of recrudescent fever and coronary artery abnormalities in children with Kawasaki disease (KD). The optimal dose of aspirin, however, remains unclear. Objective: To evaluate whether initial treatment with low-dose compared with high-dose aspirin in children with KD is associated with an increase in fever recrudescence. Design, Setting, and Participants: A retrospective cohort study of 260 children with KD at Riley Hospital for Children, Indianapolis, Indiana, between January 1, 2007, and December 31, 2018, was conducted. Children aged 0 to 18 years with a first episode of KD, identified by International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes treated within 10 days of symptom onset with high-dose intravenous immunoglobulin plus aspirin were eligible. Patients who received an alternative diagnosis, experienced a second episode of KD, did not receive intravenous immunoglobulin plus aspirin for initial treatment, were not treated within 10 days of symptoms, or had incomplete records were excluded. Exposures: High-dose (≥10 mg/kg/d) or low-dose (<10 mg/kg/d) aspirin therapy. Main Outcomes and Measures: The primary outcome was recrudescent fever necessitating retreatment of KD. The secondary outcomes were coronary artery abnormalities and hospital length of stay. Results: Among the 260 patients included, the median (interquartile range) age was 2.5 (1.6-4.3) years, 103 (39.6%) were girls, 166 (63.8%) were non-Hispanic white, 57 (21.9%) were African American, 22 (8.5%) were Asian, 11 (4.2%) were Hispanic, and 4 (1.5%) were of unknown race/ethnicity. One hundred-forty-two patients (54.6%) were treated with low-dose aspirin. There was no association between recrudescent fever and aspirin dose, with 39 children (27.5%) having recrudescent fever in the low-dose group compared with 26 children (22.0%) in the high-dose group (odds ratio [OR], 1.34; 95% CI, 0.76-2.37; P = .31), with similar results after adjusting for potential confounding variables (OR, 1.63; 95% CI, 0.89-2.97; P = .11). In a subset analysis of 167 children with complete KD, however, there was nearly a 2-fold difference in the odds of recrudescent fever with low-dose aspirin (OR, 1.87; 95% CI, 0.82-4.23; P = .14), although this difference did not reach statistical significance. In addition, no association was identified between treatment group and coronary artery abnormalities (low-dose, 7.4% vs high-dose, 9.4%; OR, 0.86; 95% CI, 0.48-1.55; P = .62) or median (interquartile range) length of stay (3 [3-5] days for both groups; P = .27). Conclusions and Relevance: In this study, low-dose aspirin for the initial treatment of children with KD was not associated with fever recrudescence or coronary artery abnormalities. Given the potential benefits, further study of low-dose aspirin to detect potentially clinically relevant outcome differences is warranted to inform treatment decisions and guideline development

Cultural Resources Survey: Freeport, Harbor, Texas, (45-Foot) Navigation Improvement Project, Brazoria County, Texas

In October and November of 1980, the Center for Archaeological Research, The University of Texas at San Antonio, conducted an intensive resource survey and limited testing in an area on either side of the mouth of the Brazos River in Brazoria County, Texas. A history was composed of the project area in relation to that of the Republic and State of Texas. A structural history of the town of Velasco was compiled from archival and historical research. Intensive survey and assessment of the project area resulted in the conclusion that, aside from a few possible subsurface indications at or below the water level, Fort Velasco and the townsite of Velasco have been eliminated by the action of successive tropical storms. It is recommended, however, that further intensive testing be carried out if the area within Monument Square of old Velasco is to be seriously impacted by the Freeport Harbor Navigation Improvement Project

Quality and Publication of Emergency Medicine Trials Registered in ClinicalTrials.gov

Introduction: Promoting emergency medicine (EM) clinical trials research remains a priority. To characterize the status of clinical EM research, this study assessed trial quality, funding source, and publication of EM clinical trials and compared EM and non-EM trials on these key metrics. We also examined the volume of EM trials and their subspecialty areas.Methods: We abstracted data from ClinicalTrials.gov (February 2000 - September 2013) and used individual study National Clinical Trial numbers to identify published trials (January 2007 - September 2016). We used descriptive statistics and chi-square tests to examine study characteristics by EM and non-EM status, and Kaplan-Meier curves and log-rank tests to compare time to publication of completed EM and non-EM studies.Results: We found 638 interventional EM trials and 59,512 non-EM interventional trials conducted in the United States between February 2000 and September 2013, registered on ClinicalTrials.gov. EM studies were significantly less likely than non-EM studies to be National Institutes of Health-funded or to evaluate a drug or biologic. However, EM studies had significantly larger sample sizes, and were significantly more likely to use randomization and blinding. Overall, 34.3% of EM and 26.0% of non-EM studies were published in peer-reviewed journals. By subspecialty, more EM trials concerned medical/surgical and psychiatric/neurological conditions than trauma.Conclusion: Although EM studies were less likely to have received federal or industry funding, and the EM portfolio consisted of only 638 trials over the 14-year study period, the quality of EM trials surpassed that of non-EM trials, based on indices such as randomization and blinding. This novel finding bodes well for the future of clinical EM research, as does the higher proportion of published EM than non-EM trials. Our study also revealed that trauma studies were under-represented among EM studies. Periodic assessment of EM trials with the metrics used here could provide an informative and valuable longitudinal view of progress in clinical EM research

Promoting the achievement of looked after children and young people across Cardiff

As of March 2017, there were 5,955 children and young people in care in Wales. Across the Central South Consortium (Bridgend, Cardiff, Merthyr Tydfil, Rhondda Cynonn Taf and Vale of Glamorgan) there were 2,170 children and young people looked after. The majority of these children are in care as a result of birth families being unable to provide a level of care that meets their emotional and well-being needs. Children and young people who are in or have experienced care remain one of the lowest performing groups in terms of educational outcomes. In 2016, eleven per cent of young people in Wales achieved A* to C grade at GCSE. Care leavers can experience poorer employment and health outcomes after leaving school compared to their peers; for example, 45% of young people who were looked after were not engaged in education, training or employment (NEET) or not in touch with their local authority on their 19th birthday in 2015. This compares with around 4.9% of all other children who leave school at the end of Year 13. However, the education and achievement of children and young people in care is currently the focus of renewed policy, research and practice attention across Wales. The Social Services and Wellbeing (Wales) Act 2014 provides the legal framework for improving the well-being of people who need care and support. A national strategic approach to improving outcomes for children looked after is underway with a focus on promoting and improving collaborative working across agencies, identifying and sharing good practice and making improvements where they are needed. The purpose of this report is to share practice in selected in Cardiff schools that is contributing to improved outcomes and school experiences for children and young people in care

Impacts of Bermudagrass on Northern Bobwhite Chicks: Mobility and Heat Exposure

Conservation programs to benefit northern bobwhites (Colinus virginianus) and other agriculturally-related wildlife species often target crop-field margins for management. The Bobwhite Quail Initiative in Georgia is a program where 3- to 18-m strips are disked and left fallow for 3-year cycles. However, several exotic grasses, such as bermudagrass (Cynodon dactylon), encroach in field margins, reducing their usefulness for avian species. We hypothesized that dense mats of bermudagrass would be a physical barrier to bobwhite chicks and also serve as a heat trap reducing habitat quality. We conducted two experiments to assess these factors. First, we used human-imprinted bobwhite chicks, 5 and 10 days of age, to assess mobility through vegetation with 3 levels (none, moderate, and high) of bermudagrass invasion. There was a significant impact of bermudagrass density on mobility of 5-day old chicks (P 1⁄4 0.002), but no effect on 10-day old chicks (P 1⁄4 0.38). Second, we placed temperature recorders at ground level in plots in field margins that had .75% cover of bermudagrass and those with .75% coverage of forbs. The mean temperature of bermudagrass plots was greater than in forb plots (P 1⁄4 0.03). The percentage of time above the 40 8C critical threshold temperature for bobwhites was greatest in bermudagrass plots (P 1⁄4 0.03) and ranged over 33–38% of daytime hours, but only 6-26% for forb plots. Our data suggests that bermudagrass degrades the quality of field margins and control of exotic invasive grasses is warranted to improve their efficacy

Recent Decisions

Comments on recent decisions by Donald L. Very, James Carroll Booth, William E. Coyle, Edward N. Denn, William C. Rindone, Jr., and Karl Jorda

Promoting the achievement of looked after children and young people across the Central South Consortium in Wales

As of March 2017, there were 5,955 children and young people in care in Wales. Across the Central South Consortium (Bridgend, Cardiff, Merthyr Tydfil, Rhondda Cynonn Taf and Vale of Glamorgan) there were 2,170 children and young people looked after. The majority of these children are in care as a result of birth families being unable to provide a level of care that meets their emotional and well-being needs. Children and young people who are in or have experienced care remain one of the lowest performing groups in terms of educational outcomes. In 2016, eleven per cent of young people in Wales achieved A* to C grade at GCSE. Care leavers can experience poorer employment and health outcomes after leaving school compared to their peers; for example, 45% of young people who were looked after were not engaged in education, training or employment (NEET) or not in touch with their local authority on their 19th birthday in 2015. This compares with around 4.9% of all other children who leave school at the end of Year 13. However, the education and achievement of children and young people in care is currently the focus of renewed policy, research and practice attention across Wales. The Social Services and Wellbeing (Wales) Act 2014 provides the legal framework for improving the well-being of people who need care and support. A national strategic approach to improving outcomes for children looked after is underway with a focus on promoting and improving collaborative working across agencies, identifying and sharing good practice and making improvements where they are needed. The purpose of this report is to share practice in selected in Central South Consortium (CSC) schools that is contributing to improved outcomes and school experiences for children and young people in care