This study aimed to evaluate school-age neurodevelopmental outcomes among children with single ventricle heart disease who underwent neonatal Norwood operation with regional cerebral perfusion compared to deep hypothermic circulatory arrest. Additionally, we aimed to identify predictors of school-age development, including early developmental measures.

Patients enrolled in a prospective randomised trial of infants with single ventricle heart disease undergoing the Norwood operation with either regional cerebral perfusion or deep hypothermic circulatory arrest were included. For the same cohort of patients, this study performed neurodevelopmental testing at 5 years and 10 years of age. At 5 years, a comprehensive neuropsychological evaluation was performed. At 10 years, parent report instruments were used to measure participants’ behaviour and executive function.

Forty-one patients at 5 years of age and 33 patients at 10 years of age completed neurodevelopmental evaluation. There were no significant differences in neurodevelopmental scores between the regional cerebral perfusion and deep hypothermic circulatory arrest groups at either 5 or 10 years. At 5 years of age, the average full scale intelligence quotient (IQ) was 93.4 ± SD18.8. The Bayley Scale of Infant Development Psychomotor Developmental Index (r = 0.68, p < .0001) and mental developmental index (r = 0.64, p < .0001) at 1 year positively correlated with the full scale IQ at 5 years.

Neurodevelopment is delayed in patients with single ventricle heart disease. Neurodevelopmental outcomes at school age did not differ based on the perfusion strategy for the Norwood operation. Mental and psychomotor developmental indices at 1 year are predictive of early school-age measures.

Species of the Burkholderia (B.) cepacia complex (Bcc) have been implicated in multiple nosocomial outbreaks linked to contaminated water-based products, including liquid soaps, mouthwash, and other non-alcoholic aqueous solutions.

We describe two substantial healthcare-associated outbreaks of Bcc (B. cepacia and B. contaminans) in the United Kingdom and Ireland associated with contaminated products. We highlight the challenges during investigation and mitigation, and provide recommendations.

A multidisciplinary, multi-stakeholder investigation across both outbreaks was adopted, involving interviews, trawling questionnaires, and targeted product sampling.

There were 153 and 66 confirmed cases in the B. cepacia and B. contaminans outbreaks, respectively. Cases predominantly comprised hospitalized individuals, and 70% of isolates were recovered from an invasive site. The outbreak strain of B. cepacia was isolated from non-sterile ultrasound gel. An analytical study suggested the B. contaminans cluster was also linked to ultrasound gel; however, a disinfectant wipe product was subsequently identified as the source (0–3 single nucleotide polymorphism differences between case and wipe isolates).

The affected disinfectant wipes were withdrawn. The ultrasound gel was not recalled but health system procurement was suspended, rapid clinical guidance was produced and a National Patient Safety Alert was issued. Inter-organizational partnership was required to mitigate risks.

Identifying the source of outbreaks associated with contaminated products can be challenging, requiring complex multi-stakeholder interventions. We recommend a low threshold for investigation of Bcc clusters, adopting a multidisciplinary approach to investigation and mitigation, implementing interventions focusing on practice, and prompt product removal to protect patients.

Describe the hemodynamic implications of anaesthetic choice among children with heart disease undergoing cardiac catheterisation.

Study 1 was a secondary analysis of data obtained during catheterisation-based hemodynamic assessment of infants with hypoplastic left heart syndrome following Stage 1 palliation, randomised in the Single Ventricle Reconstruction trial. Measured and calculated hemodynamics including pulmonary and systemic vascular resistance indexed to body surface area (PVRi and SVRi respectively) and pulmonary/systemic blood flow (Qp/Qs) were analysed with respect to anaesthetic employed during catheterisation, classified as moderate sedation or general anaesthesia. Study 2 consisted of a single centre, prospective analysis of patients requiring percutaneous closure of a patent ductus arteriosus or endomyocardial biopsy after orthotopic heart transplant. Participants underwent hemodynamic assessment first using inhaled volatile anaesthesia (IA), and then transitioned to total intravenous anaesthesia, comparing hemodynamic measures with respect to anaesthetic approach.

In Study 1, independent of shunt type, PVRi, and patient size, moderate sedation was associated with a greater than two-fold odds of a Qp/Qs >1 (OR 2.12, 95%CI 1.18–3.87, p = 0.013). In Study 2, while PVRi was similar, SVRi was significantly higher using total intravenous anaesthesia. Among the patent ductus arteriosus subgroup, Qp/Qs increased significantly with a total intravenous anaesthesia relative to IA (p = 0.003); additionally, among the orthotopic heart transplant subgroup, left ventricular end diastolic pressure increased following a transition to total intravenous anaesthesia (p = 0.002).

Analyses of hemodynamics during catheterisation support a significant impact of anaesthetic type on hemodynamic values including SVRi, left ventricular end diastolic pressure, and Qp/Qs. Anaesthesia choice and intraprocedural management of SVRi are important considerations when making clinical decisions based on hemodynamic data.

The mental health status and capacity to govern of democratically-elected politicians have become significant topics of interest, which have attracted speculation in the media and beyond. In fulfilling demanding and high-stress positions, politicians could encounter distinctive risk factors that may harm their mental wellbeing, yet existing research literature about this topic remains underexplored.

This scoping review aimed to systematically examine the breadth of available evidence on mental health issues and risk factors affecting democratically-elected politicians and to identify future research needs.

Using pre-defined eligibility criteria based on JBI guidelines, a systematic keyword search was conducted in May 2024 of MEDLINE, Scopus, and APA PsycNet, supplemented by snowballing techniques. Only studies reporting primary, empirical evidence on mental ill-health or risk factors with adverse psychological correlates from serving politicians in “Full” or “Flawed” democracies (per the Democracy Index) were included from 1999-2024. Titles and abstracts were screened and the full-text of potentially eligible literature was assessed before data extraction and synthesis.

Eighteen sources met the eligibility criteria, cumulatively encompassing ~3,500 politicians across seven democracies, namely: Australia, Canada, the Netherlands, Norway, New Zealand, the United Kingdom, and the United States. Four sources (22.2%) explored general psychopathology trends, revealing varying but sizeable rates of mental ill-health and high-risk alcohol consumption. The other fourteen studies (77.8%) provided evidence on risk factors; twelve underlined the psychological toll of violence and two investigations highlighted the injurious effects of specific occupational conditions. Notably, exposure to violence often precipitated detrimental mental health outcomes, with certain data indicating a disproportionate impact on female officeholders.

Existing research literature suggests that democratically-elected politicians face considerable mental health challenges, especially from the effects of violence. However, there are notable research gaps with a paucity of reliable prevalence estimates, intervention studies, and work on national leaders. Equally, the underrepresentation of numerous democratic countries accentuates the need for a more diverse evidence-base to better support the mental wellbeing of politicians worldwide.

None Declared

We compared indices for cerebrovascular health (i.e., physiological responses to tilts by measuring regional cerebral oxygenation [rcSO2], cerebrovascular stability, and cerebral fractional tissue oxygen extraction [FTOE]) in infants with congenital heart disease (CHD) versus healthy controls (HC) at neonatal and 3-month ages.

Our cohort study included 101 neonates (52 CHD, 49 HC) and 108 infants at 3-months (45 CHD, 63 HC). We used an innovative and replicable evaluation tool to noninvasively and rapidly measure indices of cerebrovascular health. Changes in near infrared spectroscopy measures of rcSO2 after tilting (from supine to sitting, ∼150 values) assessed cerebrovascular stability. Mixed-effects regression models examined rcSO2 and FTOE differences between groups, and group-by-posture interactions, adjusting for postconceptional age, sex, ethnicity, and preductal systemic oxygenation (SpO2) at both ages.

Infants with CHD had significantly lower rcSO2 (13% at neonatal and 11% at 3-months, both p < 0.001), increased FTOE (∼0.14 points higher at neonatal and ∼ 0.09 points at 3-months, both p < 0.001), and reduced cerebrovascular stability compared with HC at both ages (both p < 0.001).

CHD infants had persistently poorer indices of cerebrovascular health (i.e., lower rcSO2, increased FTOE, and reduced cerebrovascular stability) through the 3-month age compared to controls. Sustained cerebral hypoxia, reduced cerebrovascular stability, and increased FTOE may contribute to neurodevelopmental delays (NDDs) and could serve as early biomarkers for identifying infants at higher risk for NDD.