Objective: Transient ischemic attacks are common and important harbingers of subsequent stroke. Management varies widely, and most published guidelines have not been updated in several years. We sought to create comprehensive, unbiased, evidencebased guidelines for the management of patients with transient ischemic attacks. Methods: Fifteen expert panelists were selected based on objective criteria, using publication metrics that predicted nomination by practitioners in the field. Prior published guidelines were identified through systematic review, and recommendations derived from them were rated independently for quality by the experts. Highest quality recommendations were selected and subsequently edited by the panelists using a modified Delphi approach with multiple iterations of questionnaires to reach consensus on new changes. Experts were provided systematic reviews of recent clinical studies and were asked to justify wording changes based on new evidence and to rate the final recommendations based on level of evidence and quality. No expert was allowed to contribute to recommendations on a topic for which there could be any perception of a conflict of interest. Results: Of 257 guidelines documents identified by systematic review, 13 documents containing 137 recommendations met all entry criteria. Six iterations of questionnaires were required to reach consensus on wording of 53 final recommendations. Final recommendations covered initial management, evaluation, medical treatment, surgical treatment, and risk factor management. Interpretation: The final recommendations on the care of patients with transient ischemic attacks emphasize the importance of urgent evaluation and treatment. The novel approach used to develop these guidelines is feasible, allows for rapid updating, and may reduce bias. Neurol 2006;60:301-313 A transient ischemic attack (TIA) has been defined classically as "rapidly developed clinical signs of focal or global disturbance of cerebral function lasting fewer than 24 hours, with no apparent non-vascular cause," 1 with a more recent proposal to alter the definition to "a brief episode of neurological dysfunction caused by a focal brain or retinal ischemia, with clinical symptoms typically lasting less than an hour, and without Ann

Introduction: The routine use of outcome measures is essential to the maintained delivery of quality care and the continued commissioning of mental health occupational therapy services. Occupational therapists are required to demonstrate that intervention is successful in an evidence-based, valid and reliable way. Therefore, this critical review aims to address the issue of choosing an appropriate occupational performance outcome measure for use within mental health services. Method: Evidence was critically appraised for the effectiveness of the Assessment of Communication and Interaction Skills (ACIS), Occupational Therapy Task Observation Scale (OTTOS), Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS), all recommended for use by occupational therapists within mental health practice. Findings and discussion: The review identifies that there are a limited number of clinically based studies evidencing the validity and reliability of occupational performance outcome measures. It also identifies a paucity of literature concerning service user experience of outcome measures, bringing into question how client centred and meaningful these tools are.

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Introduction: Infants with staged surgical palliation for congenital heart disease are at high-risk for interstage morbidity and mortality. We have previously described the mediated risk for this patient population through close home monitoring. Given high rates of intercurrent illness, geographic and sociodemographic disparities in access to care, and significant family stressors, we instituted a telecardiology (TC) program in 2019. Methods: All consecutive patients discharged home were monitored from neonatal operation or intervention to subsequent surgical palliation. All had home scales and pulse oximeters. TC visits (TCVs) were held monthly, and increased to bimonthly during the COVID-19 pandemic. TCVs were launched through the electronic medical record (EMR) through a mobile device, with a full-version EMR available for access to full records and efficient documentation. We tracked how TCVs identified clinical concerns, prevented unnecessary emergency room visits (ERV) and expedited in-person assessment. Results: Between 8/2019-5/2020, we conducted 60 TCV for 29 patients (16 had stage 1 palliation, 6 with aortopulmonary shunt or stent and 7 with biventricular physiology with shunt or stents. Initial median weight was 3.4 kg (range 2.3-5.4 kg). Median monitoring time was 199 days (75-264). Median visits per patient were 2 (1-5 V) with average length per visit of 20 minutes. Most scheduled visits were completed (90%); 5% declined, and 5% canceled. Parents reported satisfaction for 97% of visits. In 6 visits (10%) significant clinical findings were identified which avoided ERV or hospital admissions, 4 TCVs (7%) visits led to expedited outpatient assessments, 1 required hospitalization. There were no missed events nor deaths. Additional issues identified included changes to medication (23%), feedings (15%) and equipment malfunction (5%). Frequency of EDV decreased from median 0.4 (0-3.7) V/patient/month the prior year to 0 (0-2.5), p=0.0004]. Conclusions: TC in these high-risk patients is feasible and effective to identify clinical concerns, no missed events and decrease in ERV per patient. TC was particularly effective during the COVID-19 pandemic allowing for easy adaptation of care to ensure patient safety in this fragile cohort.

Organic-rich sediments in estuaries and the coastal ocean are often a product of land clearing, runoff of excess nutrients and other human activities. They can harbor pollutants, oxygen-consuming microbes and toxic hydrogen sulfide (H2S), thereby creating a hostile environment for infauna. In one barrier island lagoon, the Indian River Lagoon (IRL), Florida, layers of organic-rich sediments have increased substantially in thickness and areal extent over the past 60 years. Geochemical properties of these muddy sediments have been described; however, less is known about their habitability. We analyzed infauna and geochemical properties of 102 samples taken during wet and dry seasons at 17 locations spanning 60 km of the lagoon. We quantified infaunal abundance and diversity (Shannon-Wiener, H′) and determined Pearson’s correlation coefficients for effective number of species (ENS = eH′) vs. sediment porosity (ϕ = 0.69–0.95), organic carbon (1–8%), nitrogen (0.1–0.7%), silt + clay (16–99%), porewater H2S (5–3,600 μM), and other environmental variables. Small bivalves accounted for 70% of the organisms collected, followed by gastropods, polychaetes and other biota. The bivalves were predominantly Macoma spp., Mulinia lateralis and Parastarte triquetra with average abundances of 3,896, 2,049, and 926 individuals per m2, respectively. High abundance of some species, such as Macoma, showed that these opportunists had adapted to poor quality sediments. More than two-thirds of the 35 species collected were present at <100 individuals per m2 of sediment. Cluster analysis identified four groups of stations with significantly different geochemical properties. Permutation analyses of variance indicated that the four groups also represented statistically different infaunal communities. Diversity decreased with increasing sediment concentrations of organic carbon, nitrogen and silt + clay; however, community richness at our most prolific station along the perimeter of muddy deposits was ∼7 times lower than found previously in sandy sediments from the IRL. The results identified areas where infaunal communities have experienced the greatest stress due to accumulation of organic-rich sediments. Results from this study help support management plans for remediation of organic-rich mud and improvement of sediment and water quality, especially in areas identified with low ENS.