The relationship between maximal left ventricular wall thickness and sudden cardiac death in childhood onset hypertrophic cardiomyopathy

Background: Maximal left ventricular wall thickness (MLVWT) is a risk factor for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). In adults, the severity of left ventricular hypertrophy has a nonlinear relationship with SCD, but it is not known whether the same complex relationship is seen in childhood. The aim of this study was to describe the relationship between left ventricular hypertrophy and SCD risk in a large international pediatric HCM cohort. Methods: The study cohort comprised 1075 children (mean age, 10.2 years [±4.4]) diagnosed with HCM (1–16 years) from the International Paediatric Hypertrophic Cardiomyopathy Consortium. Anonymized, noninvasive clinical data were collected from baseline evaluation and follow-up, and 5-year estimated SCD risk was calculated (HCM Risk-Kids). Results: MLVWT Z score was <10 in 598 (58.1%), ≥10 to <20 in 334 (31.1%), and ≥20 in 143 (13.3%). Higher MLVWT Z scores were associated with heart failure symptoms, unexplained syncope, left ventricular outflow tract obstruction, left atrial dilatation, and nonsustained ventricular tachycardia. One hundred twenty-two patients (71.3%) with MLVWT Z score ≥20 had coexisting risk factors for SCD. Over a median follow-up of 4.9 years (interquartile range, 2.3–9.3), 115 (10.7%) had an SCD event. Freedom from SCD event at 5 years for those with MLVWT Z scores <10, ≥10 to <20, and ≥20 was 95.6%, 87.4%, and 86.0, respectively. The estimated SCD risk at 5 years had a nonlinear, inverted U-shaped relationship with MLVWT Z score, peaking at Z score +23. The presence of coexisting risk factors had a summative effect on risk. Conclusions: In children with HCM, an inverted U-shaped relationship exists between left ventricular hypertrophy and estimated SCD risk. The presence of additional risk factors has a summative effect on risk. While MLVWT is important for risk stratification, it should not be used either as a binary variable or in isolation to guide implantable cardioverter defibrillator implantation decisions in children with HCM

An evaluation of the effectiveness of online clinical quandaries in increasing trainee clinical psychology knowledge

Game informed learning principles are increasingly being applied to both the wider educational context and specifically to allow the learner to role play a profession in a safe context prior to entering real practice. This questionnaire based study aimed to examine the impact of an online clinical quandary on the knowledge of trainee clinical psychologists in relation to challenging behaviour in people with a learning disability. Trainee knowledge in relation to key concepts required for successful assessment, intervention and evaluation of challenging behaviour was measured before and after using the clinical quandary, prior to any formal clinical psychology training (n=62). Trainee views on the use of the clinical quandary were also gathered. A significant increase in scores was found after using the clinical quandary, for the following factors: dealing with the initial referral; recording and overall total scores. Trainees evaluated the quandary as interesting, challenging, stimulating and helpful as a study aid. The results suggest that online clinical quandaries may offer a useful learning tool for increasing trainee knowledge and allowing them to rehearse skills in an environment where mistakes do not impact on patients

Tennessee Branded Beef Program: The Producers' Perspective and Willingness to Participate

Beef cattle are the predominant livestock industry in Tennessee. Most beef cattle producers in the state manage cow-calf operations, while a smaller number of producers participate in the stocker, backgrounding and finishing phases of production. Although production in Tennessee is primarily composed of cow-calf producers, marketing and management practices vary across individual producers. Many producers market calves at weaning, while other producers precondition or background calves prior to marketing them to feedlots in the Midwest or Great Plains. Other producers in Tennessee retain ownership of cattle through the finishing phase and largely finish cattle in feedlots in the Midwest and Great Plains before marketing cattle to a beef packing facility. Consumer interest in local foods continues to grow, and consumers want to know more about how their food was produced. Though finishing cattle in Tennessee is not widely practiced, the shift by consumers to desiring local foods has created an increased interest from Tennessee beef cattle farmers to finish cattle on farm and market local beef. At the time of this writing, most local beef production in Tennessee was performed by small-scale producers managing all aspects of cattle production, animal harvest/slaughter and beef marketing. As more consumers demand locally produced beef and as cattle producers in Tennessee evaluate finishing cattle in-state, it becomes increasingly important to evaluate marketing opportunities for producers. One conceivable opportunity is a state sourcing and marketing program of Tennessee Branded Beef (TBB). Thus, the purpose of this publication is to report results from a producer survey concerning Tennessee beef cattle producer interest in a TBB program (TBBP), attitudes and perceptions toward a TBBP, and the potential number of cattle supplied to a TBBP