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Context: Left atrial appendage closure (LAAC) was developed as a novel stroke prevention alternative for patients with atrial fibrillation, particularly for those not suitable for long-term oral anticoagulant therapy. Traditionally, general anesthesia (GA) has been more commonly used primarily due to the necessity of transesophageal echocardiography. Aims: Compare trends of monitored anesthesia care (MAC) versus GA for percutaneous transcatheter LAAC with endocardial implant and assess for independent variables associated with primary anesthetic choice. Settings and Design: Multi-institutional data collected from across the United States using the National Anesthesia Clinical Outcomes Registry. Material and Methods: Retrospective data analysis from 2017–2021. Statistical Analysis Used: Independent-sample t tests or Mann–Whitney U tests were used for continuous variables and Chi-square tests or Fisher’s exact test for categorical variables. Multivariate logistic regression was used to assess patient and hospital characteristics. Results: A total of 19,395 patients underwent the procedure, and 352 patients (1.8%) received MAC. MAC usage trended upward from 2017–2021 (P < 0.0001). MAC patients were more likely to have an American Society of Anesthesiologists (ASA) physical status of≥ 4 (33.6% vs 22.89%) and to have been treated at centers in the South (67.7% vs 44.2%), in rural locations (71% vs 39.5%), and with lower median annual percutaneous transcatheter LAAC volume (102 vs 153 procedures) (all P < 0.0001). In multivariate analysis, patients treated in the West had 85% lower odds of receiving MAC compared to those in the Northeast (AOR: 0.15; 95% CI 0.03–0.80, P = 0.0261). Conclusions: While GA is the most common anesthetic technique for percutaneous transcatheter closure of the left atrial appendage, a small, statistically significant increase in MAC occurred from 2017–2021. Anesthetic management for LAAC varies with geographic location.

Neurogenin3(+) (Ngn3(+)) progenitor cells in the developing pancreas give rise to five endocrine cell types secreting insulin, glucagon, somatostatin, pancreatic polypeptide and ghrelin. Gastrin is a hormone produced primarily by G-cells in the stomach, where it functions to stimulate acid secretion by gastric parietal cells. Gastrin is expressed in the embryonic pancreas and is common in islet cell tumors, but the lineage and regulators of pancreatic gastrin(+) cells are not known. We report that gastrin is abundantly expressed in the embryonic pancreas and disappears soon after birth. Some gastrin(+) cells in the developing pancreas co-express glucagon, ghrelin or pancreatic polypeptide, but many gastrin(+) cells do not express any other islet hormone. Pancreatic gastrin(+) cells express the transcription factors Nkx6.1, Nkx2.2 and low levels of Pdx1, and derive from Ngn3(+) endocrine progenitor cells as shown by genetic lineage tracing. Using mice deficient for key transcription factors we show that gastrin expression depends on Ngn3, Nkx2.2, NeuroD1 and Arx, but not Pax4 or Pax6. Finally, gastrin expression is induced upon differentiation of human embryonic stem cells to pancreatic endocrine cells expressing insulin. Thus, gastrin(+) cells are a distinct endocrine cell type in the pancreas and an alternative fate of Ngn3+ cells.

The need to build an evidence base for reflective supervision (RS) is threefold: (1) to determine the elements of a supervision session that make it reflective, (2) to demonstrate that change occurs within the supervisee, and (3) to demonstrate that having staff members participate in RS enhances positive program (or client) outcomes. This article introduces a new measure, the Provider Reflective Process Assessment Scale, created to assess change in reflective capacity in early childhood providers and practitioners after participating in RS or training. The authors discuss the creation of the measure, the coding system, the administration, and how it is currently being used. [ABSTRACT FROM AUTHOR]

This issue of the ZERO TO THREE journal provides a snapshot of the current state of measurement of reflective supervision within the infant-family field. In this article, the authors introduce the issue by providing a brief history of the development of reflective supervision in the field of infant mental health, with a specific focus on research regarding reflective supervision. They highlight why research on reflective supervision is vital to the field and provide an overview of current research methods. The emerging research methods and implications are discussed in more detail in the other articles in this issue. [ABSTRACT FROM AUTHOR]

Erikson Institute Fussy Baby Network® (FBN) leaders from around the country have been considering the importance of building trauma-informed service programs. In this article, they discuss ways that the Facilitating Attuned Interaction (FAN) approach and the core processes used by the FAN can be helpful both when trauma is an unexpected presence in a family and when a provider has foreknowledge of serious concerns. The authors present the FAN's theory of change, the FAN "ARC of Engagement," and FAN Core Processes as a framework to assist providers in staying present and attuned in situations where trauma and high risk exist. In addition, they describe the role of the FAN in supporting trauma-informed practice in relationship-based infant/parent programs and in programs that specifically provide trauma treatment. [ABSTRACT FROM AUTHOR]

This article describes the components of the FAN model used in the Fussy Baby Network® intervention. Careful attunement and matching to the parents' experience help stressed parents feel understood and not alone and foster a sense of coherence during this difficult time. It is this attention to the parent's experience that allows flexibility in the model so that it can be successfully used to support families from a disaster impacted region, such as South Louisiana, that is rich in multiple cultures, diverse communities, and various socioeconomic status levels. Case vignettes are used to highlight the 5 components of this model. The vignettes selected reflect the diversity of families served by this site. [ABSTRACT FROM AUTHOR]

The best means for the diagnosis and treatment of reactive attachment disorder of infancy and early childhood have not been established. Though some longitudinal data on institutionalized children is available, reports of maltreated young children who are followed over time and assessed with measures of attachment are lacking. This paper presents the clinical course of a set of maltreated fraternal twins who were assessed and treated from 19 months to 30 months of age and then seen in follow-up at 3 and 8 years of age. A summary of the early assessment and course is provided and findings from follow-up assessments of the cognitive, behavioral, and interpersonal functioning of each child is analysed. Follow-up measures, chosen to capture social-cognitive processing of these children from an attachment perspective, are highlighted. Finally, findings from the case are discussed from nosological and theoretical perspectives. [ABSTRACT FROM AUTHOR]

We have performed a high-capacity, semiquantitative, reverse transcriptase-polymerase chain reaction screen for expression of fibroblast growth factor (FGF) and transforming growth factor beta (TGFbeta) family genes as well as their cognate receptors. By using cDNA prepared from embryonic day 12 to postnatal day 0 embryonic mouse pancreas, we have identified several factors potentially involved in the development of the endocrine pancreas. We find high-level early expression of TGFbeta-1 and -2, and constitutive expression of TGFbeta-3 and their receptors. Of the Inhibin/Activin members, we found exclusively Inhibin-alpha and Activin-betaB to be expressed, and the BMP family was represented by BMP4, BMP5, and BMP7. The predominant forms of the BMP and Activin type II receptors were ActR-IIB and BMPR-II and of the type I receptors, BMPR-1A and -1B were the highest expressed. FGF1, FGF7, FGF9, FGF10, FGF11, and FGF18 were also expressed in the pancreas at varying time points and levels, as well as FGF receptor forms FGFR1b, FGFR1c, FGFR2b, FGFR2c, FGFR3b, and FGFR4. To gain insight into the biological function, we misexpressed members of these families in the pancreas by using the early pancreas promoter Pdx1. Misexpression of FGF4 results in disruption of the pancreas morphology with epithelial structures interspersed in stroma tissue. The endocrine compartment was reduced to scattered single cells, and the exocrine consisted of unbranched ductal epithelia with acinar structures budding off. In contrast, misexpression of BMP-6 resulted in complete agenesis of the pancreas and reduced the size of the stomach and spleen dramatically and caused fusion of the liver and duodenum., (Copyright 2003 Wiley-Liss, Inc.)