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A growing body of research on character education offers the opportunity to derive lessons on effective practice. While there is little focused research on the effectiveness of specific practices, reviews of effective programs have been mined for well over a decade to reach conclusions about "what works in character education." More recent reviews and meta-analyses offer the opportunity for a review of reviews. This article examines 8 reviews and identifies 42 evidence-based practices. However, such a list can be unwieldy by itself. Hence, a conceptual framework of 6 foundational character educational principles (PRIMED) is presented and used as an organizational structure for the 42 practices. In addition, a comparison is made of practices that have been shown to support academic achievement and those shown to foster character development, showing substantial overlap in effective academic and character practices.

Background Statistically significant decreases in methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infections (HAIs) occurred in Veterans Affairs (VA) hospitals from 2007 to 2019 using a national policy of active surveillance (AS) for facility admissions and contact precautions for MRSA colonized (CPC) or infected (CPI) patients, but the impact of suspending these measures to free up laboratory resources for testing and conserve personal protective equipment for coronavirus disease 2019 (COVID-19) on MRSA HAI rates is not known. Methods From July 2020 to June 2022 all 123 acute care VA hospitals nationwide were given the rolling option to suspend (or re-initiate) any combination of AS, CPC, or CPI each month, and MRSA HAIs in intensive care units (ICUs) and non-ICUs were tracked. Results There were 917 591 admissions, 5 225 174 patient-days, and 568 MRSA HAIs. The MRSA HAI rate/1000 patient-days in ICUs was 0.20 (95% confidence interval [CI],.15–.26) for facilities practicing "AS + CPC + CPI" compared to 0.65 (95% CI,.41–.98; P <.001) for those not practicing any of these strategies, and in non-ICUs was 0.07 (95% CI,.05–.08) and 0.12 (95% CI,.08–.19; P =.01) for the respective policies. Accounting for monthly COVID-19 facility admissions using a negative binomial regression model did not change the relationships between facility policy and MRSA HAI rates. There was no significant difference in monthly facility urinary catheter-associated infection rates, a non-equivalent dependent variable, in the policy categories in either ICUs or non-ICUs. Conclusions Facility removal of MRSA prevention practices was associated with higher rates of MRSA HAIs in ICUs and non-ICUs. [ABSTRACT FROM AUTHOR]

Patients with epilepsy suffer from a higher mortality rate than the general population, a portion of which is not due to epilepsy itself or comorbid conditions. Sudden unexpected death in epilepsy (SUDEP) is a common but poorly understood cause of death in patients with intractable epilepsy and often afflicts younger patients. The pathophysiology of SUDEP is poorly defined but does not appear to be related to prolonged seizure activity or resultant injury. Interestingly, a subset of patients with confirmed long QT syndrome (LQTS) present with a seizure phenotype and may have concurrent epilepsy. In this case, we present a patient who initially presented with a seizure phenotype. Further workup captured PMVT on an outpatient event monitor, and the patient was subsequently diagnosed with LQTS1. A substantial number of patients with LQTS initially present with a seizure phenotype. These patients may represent a subset of SUDEP cases resulting from ventricular arrhythmias. Appropriate suspicion for ventricular arrhythmias is necessary for proper arrhythmia evaluation and management in patients presenting with epilepsy. [ABSTRACT FROM AUTHOR]

New information and communication technologies continue to spread rapidly into the Asian marketplace, which has led to new patterns of leisure consumption, one of the most popular being digital gaming. However, in Vietnam there is limited research on gaming as a leisure activity. The purpose of this study is to explore the phenomenon of digital gaming in Vietnam to better understand how it is practiced in this culture. Semi-structured interviews were conducted with twenty-five gaming industry figures and gamers. Thematic analysis was used to guide data collection and analysis. The findings indicate that glocalisation, socialised gaming practices and competitiveness characterise the Vietnamese gaming experience. The distinct culture of Vietnam combined with globalised gaming consumption habits has created new modes of play culture, and hence leisure experiences that are growing in pervasive and influential ways. [ABSTRACT FROM AUTHOR]

Globally, eSports is growing in influence in media. However, it represents a unique phenomenon in the modern mediascape as it is expanding beyond the online digital world and becoming interwoven in the offline, physical world. Jönköping, a mid-sized Swedish city that hosts the DreamHack winter and summer events, provides the setting for how this offline context is being facilitated and shaped to maximize the benefits of eSports' increasing cultural relevance and value. By conceptualizing the local eSports scene as a market, this article synthesizes 17 interviews with local actors to answer the question: What offline actions do actors engage in to facilitate and shape the local eSports market? This article provides actionable insights from a strategic media management perspective that can enable others to engage with and develop local offline eSports markets to provide a platform for media creation. [ABSTRACT FROM AUTHOR]

Implantable pacemakers stand as a mainstay in our therapeutic arsenal, affording those suffering from advanced cardiac conduction system disease both an improved quality of life and reduced mortality. Annually, over 225,000 new pacemakers are implanted in the United States for bradyarrhythmias and heart block. The first implantable transvenous pacemakers appeared in 1965; they were bulky devices, hobbled by a short battery life and a single pacing mode. Modern transvenous pacemakers have evolved considerably with significant improvements in battery life, pacing options and lead technology but are still subject to a spectrum of complications stemming from either the subcutaneous pocket or the leads, including: hematoma, infection, wound dehiscence, pneumothorax, cardiac tamponade, lead dislodgment, upper extremity deep vein thrombosis, lead failure, venous obstruction, tricuspid valve insufficiency and endocarditis. Single-chamber right ventricular (RV) leadless cardiac pacemakers, a concept from the past, has been revitalized to address these complications. Improvements in battery life, device miniaturization, catheter-based delivery tools, and advanced programming have made leadless cardiac pacemakers a viable option. In this review, we will discuss single-component leadless cardiac pacemaker technology, provide an overview of the two approved devices and discuss their benefits as well as their limitations. [ABSTRACT FROM AUTHOR]

Atrial Fibrillation's (AF) role in the pathogenesis of thromboembolic stroke has been well established, with estimates from trials of approximately 15-20% of all strokes in the U.S. Research shows more than 90% of atrial thrombi originate from the left atrial appendage (LAA). Traditionally, oral anticoagulants (OACs) have been the keystone of management for AF in reducing the risk of thromboembolic stroke. However, OACs also pose a non-negligible risk of bleeding with between 30-50% of eligible patients not receiving OACs due to absolute contraindications or perceived increased bleeding risk. New technologies aimed at isolating the LAA through ligation, exclusion, or occlusion are attempting to mitigate the embolic risk posed by LAA thrombi while simultaneously reducing the bleeding risk associated with OAC. In this review, we discuss the safety, efficacy, and clinical utility of these technologies as alternatives to OACs. [ABSTRACT FROM AUTHOR]

The article discusses potential risk factors for death and intermittent mechanical ventilation (IMV) among a unique hospitalized population with coronavirus disease 2019. It mentions lack of influence that chronic lung disease, immunocompromise, tobacco use, and obesity in either IMV initiation or mortality; and also mentions use of robust random forest models to allow for improved control of confounders.

Identifying reversible renal dysfunction (RD) in the setting of heart failure is challenging. The goal of this study was to evaluate whether elevated admission blood urea nitrogen/creatinine ratio (BUN/Cr) could identify decompensated heart failure patients likely to experience improvement in renal function (IRF) with treatment.Consecutive hospitalizations with a discharge diagnosis of heart failure were reviewed. IRF was defined as ≥20% increase and worsening renal function as ≥20% decrease in estimated glomerular filtration rate. IRF occurred in 31% of the 896 patients meeting eligibility criteria. Higher admission BUN/Cr was associated with in-hospital IRF (odds ratio, 1.5 per 10 increase; 95% confidence interval [CI], 1.3-1.8; P<0.001), an association persisting after adjustment for baseline characteristics (odds ratio, 1.4; 95% CI, 1.1-1.8; P=0.004). However, higher admission BUN/Cr was also associated with post-discharge worsening renal function (odds ratio, 1.4; 95% CI, 1.1-1.8; P=0.011). Notably, in patients with an elevated admission BUN/Cr, the risk of death associated with RD (estimated glomerular filtration rate <45) was substantial (hazard ratio, 2.2; 95% CI, 1.6-3.1; P<0.001). However, in patients with a normal admission BUN/Cr, RD was not associated with increased mortality (hazard ratio, 1.2; 95% CI, 0.67-2.0; P=0.59; p interaction=0.03).An elevated admission BUN/Cr identifies decompensated patients with heart failure likely to experience IRF with treatment, providing proof of concept that reversible RD may be a discernible entity. However, this improvement seems to be largely transient, and RD, in the setting of an elevated BUN/Cr, remains strongly associated with death. Further research is warranted to develop strategies for the optimal detection and treatment of these high-risk patients. [ABSTRACT FROM AUTHOR]

The article presents a study which compares the invasive and noninvasive assessment of aortic stenosis (AS) severity among older patients. The study investigates 55 elderly patients who were referred for cardiac catheterization to examine AS and underwent transthoracic echocardiography. The study concludes that the standard techniques of aortic valve area (AVA) assessment for AS have shown poor correlation among older patients.

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia, with an estimated prevalence in the US of up to 6.1 million people in 2014. The CHA2DS2-VASc score is a widely used tool to help stratify ischemic stroke risk and guide decision-making regarding anticoagulation in AF based on multiple clinical risk factors including a history of hypertension. While the CHA2DS2-VASc score has been validated using the prior definition of hypertension (≥140/≥90 mmHg), the 2017 ACC/AHA guidelines define hypertension as ≥130/≥80 mmHg. It is unclear what clinical impact this change will have on the use and validity of CHA2DS2-VASc scoring and risk/benefit of anticoagulation for prevention of thromboembolic stroke. In order to estimate this impact, we performed a statistical analysis of the NHANES III database. Methods: The Third National Health and Nutrition Examination Survey (NHANES III), a nationwide probability survey of 39,695 persons conducted from 1988-1994, was used as a representative sample of the general US population. AF was defined as the presence of AF on ECG or the presence of an irregular pulse on physical exam along with the absence of documented sinus rhythm on ECG. Results: We identified 278 patients with AF, with a weighted value representing 2.58 million people. Using the prior hypertension guidelines, 181 patients (weighted value 1.07 million) had a CHA2DS2-VASc score of ≥2 and qualified for anticoagulation. With the new hypertension guidelines, 200 patients qualified for anticoagulation (weighted value 1.33 million). This represents a 10.5% increase in the number of patients with atrial fibrillation requiring anticoagulation (weighted value 250,000). Conclusions: Incorporation of the 2017 ACC/AHA hypertension definitions into the CHA2DS2-VASc score results in a 10.5% increase in patients who would require anticoagulation from a representative sample of the US population (NHANES III). Clinical risk/benefit for CHA2DS2-VASc scoring and anticoagulation using this definition for hypertension has not been validated. To avoid potentially unnecessary anticoagulation in AF, clinicians should consider using the ≥140/≥90 mmHg definition for hypertension upon which the CHA2DS2-VASc scoring is validated. [ABSTRACT FROM AUTHOR]

Introduction: Based on the data from CASTLE-AF trial, in patient with Atrial Fibrillation (AF) and heart failure (HF) catheter ablation may offer a significant reduction in both death, and hospitalization, while promoting maintenance of sinus rhythm as well as improvement in left ventricular ejection fraction (LVEF). This multi-center randomized trial is hailed as a paradigm shifting study in catheter ablation, however it is not without fault. One of the critiques of the CASTLE-AF trial was the high frequency of crossover between the treatment arms. To help sort out this potential source of confounding, we performed a systematic meta-analysis of prospective trials for catheter ablation in AF in patients with Class II through IV heart failure. Hypothesis: The reduction in death, and hospitalization, as well as the maintenance in sinus rhythm and improvement in LVEF seen CASTLE-AF trial are support by other similarly designed AF ablation trials. Methods: Using the inclusion/exclusion criteria from the CASTLE-AF trial, we performed a systematic meta-analysis of 28 published studies. Randomized and non-randomized observational studies comparing the impact of catheter ablation of AF in HF. Studies were identified using the Cochrane Library, EMBASE, and PubMed. Results: A total of 29 studies were identified (n =2,339). Mean follow-up was 25 (95% confidence interval, 18-40) months. Efficacy in maintaining sinus rhythm at follow-up end was 60% (43%-76%). Left ventricular ejection fraction improved significantly during follow-up by 15% (P<0.001). Conclusions: Following our meta-analysis, we found data to support the findings of improved LVEF and maintenance of sinus rhythm reported in the CASTLE-AF trial. However, due to differences in study design, we were unable to further validate the reduction in both hospitalization and death seen in CASTLE-AF. We recommend future prospective trials be conducted without cross over to further explore this topic. [ABSTRACT FROM AUTHOR]