Prediction of Intellectual Deficits in Children with Acute Lymphocytic Leukemia

Possible predictors of reported lower cognitive functioning in irradiated children with acute lymphoblastic leukemia (ALL) were investigated. Thirty-four subjects, 5-14 years old, with ALL in continuous complete remission and without evidence of current or past central nervous system disease, were examined 9-110 months after diagnosis, using standard measures of intelligence and academic achievement. Subjects with a history of post-irradiation somnolence syndrome were significantly older at diagnosis than nonsomnolent subjects. Intelligence (IQ) was found to be unrelated to history of somnolence syndrome. IQ and achievement were unrelated to age at irradiation, irradiation-examination interval, and radiation dosages. The strongest predictor of IQ by far is parental social class. The importance of controlling for social class differences when searching for treatment effects on IQ and achievement is stressed

Authigenic carbonates from the Cascadia subduction zone and their relation to gas hydrate stability

Authigenic carbonates are intercalated with massive gas hydrates in sediments of the Cascadia margin. The deposits were recovered from the uppermost 50 cm of sediments on the southern summit of the Hydrate Ridge during the RV Sonne cruise SO110. Two carbonate lithologies that differ in chemistry, mineralogy, and fabric make up these deposits. Microcrystalline high-magnesium calcite (14 to 19 mol% MgCO3) and aragonite are present in both semiconsolidated sediments and carbonate-cemented clasts. Aragonite occurs also as a pure phase without sediment impurities. It is formed by precipitation in cavities as botryoidal and isopachous aggregates within pure white, massive gas hydrate. Variations in oxygen isotope values of the carbonates reflect the mineralogical composition and define two end members: a Mg-calcite with δ18O =4.86‰ PDB and an aragonite with δ18O =3.68‰ PDB. On the basis of the ambient bottom-water temperature and accepted equations for oxygen isotope fractionation, we show that the aragonite phase formed in equilibrium with its pore-water environment, and that the Mg-calcite appears to have precipitated from pore fluids enriched in 18O. Oxygen isotope enrichment probably originates from hydrate water released during gas-hydrate destabilization

The intranasal dexmedetomidine plus ketamine for procedural sedation in children, adaptive randomized controlled non-inferiority multicenter trial (Ketodex): a statistical analysis plan

Background: Procedural sedation and analgesia (PSA) is frequently required to perform closed reductions for fractures and dislocations in children. Intravenous (IV) ketamine is the most commonly used sedative agent for closed reductions. However, as children find IV insertion a distressing and painful procedure, there is need to identify a feasible alternative route of administration. There is evidence that a combination of dexmedetomidine and ketamine (ketodex), administered intranasally (IN), could provide adequate sedation for closed reductions while avoiding the need for IV insertion. However, there is uncertainty about the optimal combination dose for the two agents and whether it can provide adequate sedation for closed reductions. The Intranasal Dexmedetomidine Plus Ketamine for Procedural Sedation (Ketodex) study is a Bayesian phase II/III, non-inferiority trial in children undergoing PSA for closed reductions that aims to address both these research questions. This article presents in detail the statistical analysis plan for the Ketodex trial and was submitted before the outcomes of the trial were available for analysis. Methods/design: The Ketodex trial is a multicenter, four-armed, randomized, double-dummy controlled, Bayesian response adaptive dose finding, non-inferiority, phase II/III trial designed to determine (i) whether IN ketodex is non-inferior to IV ketamine for adequate sedation in children undergoing a closed reduction of a fracture or dislocation in a pediatric emergency department and (ii) the combination dose for IN ketodex that provides optimal sedation. Adequate sedation will be primarily measured using the Pediatric Sedation State Scale. As secondary outcomes, the Ketodex trial will compare the length of stay in the emergency department, time to wakening, and adverse events between study arms. Discussion: The Ketodex trial will provide evidence on the optimal dose for, and effectiveness of, IN ketodex as an alternative to IV ketamine providing sedation for patients undergoing a closed reduction. The data from the Ketodex trial will be analyzed from a Bayesian perspective according to this statistical analysis plan. This will reduce the risk of producing data-driven results introducing bias in our reported outcomes. Trial registration: ClinicalTrials.gov NCT04195256. Registered on December 11, 2019

Consolidation patterns during initiation and evolution of a plate-boundary decollement zone: Northern Barbados accretionary prism

Borehole logs from the northern Barbados accretionary prism show that the plate-boundary decollement initiates in a low-density radiolarian claystone. With continued thrusting, the decollement zone consolidates, but in a patchy manner. The logs calibrate a three-dimensional seismic reflection image of the decollement zone and indicate which portions are of low density and enriched in fluid, and which portions have consolidated. The seismic image demonstrates that an underconsolidated patch of the decollement zone connects to a fluid-rich conduit extending down the decollement surface. Fluid migration up this conduit probably supports the open pore structure in the underconsolidated patch