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ABSTRACT: OBJECTIVE: To examine the occurrence of internalizing symptoms and functional disability in children with noncardiac chest pain (NCCP) compared with children with innocent heart murmurs (IHMs). METHOD: 67 children with NCCP (M [SD] age = 12.61 [2.63]; 68.7% Caucasian) and 62 children with IHM (M [SD] age = 12.67 [2.62]; 50% Caucasian) were recruited from pediatric cardiology offices. Children and parents completed measures of psychological functioning and functional disability during a first visit to the cardiologist before diagnosis. RESULTS: Children with NCCP reported greater levels of anxiety, depression, and anxiety sensitivity than children with IHM. Children with NCCP and their parents reported greater levels of functional disability and somatization than children with IHM and their parents. CONCLUSION: Children with NCCP experience greater levels of psychosocial distress and impairment than similarly physically healthy children with IHM. Consideration of psychosocial influences on NCCP would likely be beneficial in aiding assessment and treatment.
Journal of Pediatric Psychology 11/2012; · 2.91 Impact Factor
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ABSTRACT: Objective: This study investigated factors related to health care utilization (HCU) among patients presenting to pediatric cardiologists with symptoms of chest pain later diagnosed as noncardiac chest pain (NCCP). Methods: Participants included 67 children and adolescents diagnosed with NCCP and their parent. Measures of HCU, pain severity, and child self-report and parent self-report of anxiety and depression were collected at the cardiologist's office. The child's sex was examined as a moderator of HCU. Results: Pain severity and maternal and child depression were significant contributors to the variance in child HCU. The relationship between depression and HCU was moderated by the child's sex, with boys higher in levels of maternal or child depression reporting greater HCU. Conclusions: Psychological factors are related to HCU for children with NCCP, with depression positively associated with HCU. The child's sex plays an important role in depression and HCU. Family-focused psychological screening of pediatric patients with NCCP may aid in identifying families who may benefit from referrals for psychological assessment and treatment. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Health Psychology 04/2012; · 3.87 Impact Factor
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ABSTRACT: There is currently no central mandatory pediatric sudden cardiac arrest (SCA) registry in the United States. Perhaps the time is right to actively endorse and develop a pediatric SCD registry, in collaboration with other agencies, advocacy groups, and organizations. This registry, if well constructed, thorough, and validated, would serve not only important SCD epidemiologic purposes but also provide the seed bed for closer collaboration with medical examiners and coroners and enhance critical cascade testing for identification of genotypically and/or phenotypically affected family members.
Pediatric Cardiology 08/2011; 33(3):471-3. · 1.30 Impact Factor
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ABSTRACT: Atrial fibrillation is rarely encountered in children and adolescents, and these cases are usually secondary to myocardial diseases, electrical abnormalities, or scar related in postoperative congenital heart disease patients. Untreated sustained atrial fibrillation may lead to tachycardia-induced cardiomyopathy and/or systemic thromboembolization.
The objective here is to describe our findings in four adolescent patients presenting with recurrent atrial fibrillation.
We report here the results of the findings in four patients who presented with recurrent clinical atrial fibrillation.
Each of the four underwent electrophysiologic study that revealed a primary reentry or automatic supraventricular tachycardia (SVT) substrate, which was able to be treated with radiofrequency ablation. In three of the four cases, elimination of the primary substrate prevented subsequent recurrence of SVT symptoms or documented SVT and/or atrial fibrillation.
Children and adolescents presenting with atrial fibrillation warrant an exhaustive search for a treatable primary cause of myocardial or electrical disease. If present, a primary SVT substrate may be successfully ablated to prevent recurrence of atrial fibrillation and any associated complications. Pulmonary vein isolation is rarely indicated in adolescents and should be avoided.
Congenital Heart Disease 09/2010; 5(5):465-9. · 0.90 Impact Factor
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Pacing and Clinical Electrophysiology 07/2009; 32 Suppl 2:S2-5. · 1.35 Impact Factor
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Robert M Campbell
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ABSTRACT: Published literature supports the fact that many pediatric patients at risk for sudden cardiac death (SCD) will exhibit warning signs and symptoms. The use of comprehensive cardiovascular screening questionnaires and physical examination should help identify these patients at risk. Recognizing that many of the cardiac disorders predisposing to SCD are genetic, the role of careful and extensive family history cannot be overemphasized. While preparticipation screening is primarily directed toward high school and college athletes, the use of cardiovascular screening should also be considered for children of all ages.
Pacing and Clinical Electrophysiology 07/2009; 32 Suppl 2:S15-8. · 1.35 Impact Factor
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ABSTRACT: To investigate the associations between children's perceived chest pain severity, somatization symptoms, depressive symptoms, anxiety sensitivity, and maternal somatization symptoms in children and adolescents with noncardiac chest pain (NCCP).
Measures of chest pain and psychosocial functioning were collected from 35 participants (M age = 12.5 years, 54% female) with NCCP and their parents during evaluation at cardiology clinics.
Among children presenting for cardiac evaluations, wide variation in ranges of pain severity, episode frequency, and history were observed. Children's somatic symptoms and fear of physiological arousal predicted significant variance in children's chest pain severity. Additionally, children's depressive symptoms and maternal somatization were both significant predictors of children's somatic symptoms.
These results suggest NCCP may be part of a broader pattern of somatic responding and sensitivity to physiological arousal. This pattern is associated with both child and maternal functioning. Suggestions for future research are provided.
Journal of Pediatric Psychology 04/2009; 34(10):1170-4. · 2.91 Impact Factor
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ABSTRACT: Children undergoing radiofrequency ablation (RFA) are believed to be at increased risk of developing malignancy caused by radiation, although the magnitude of this risk is incompletely understood. We previously reported a strategy to reduce radiation exposure during pediatric RFA. In a cohort of 15 subjects (median age 12 years, range 9 to 17), radiation was measured using dosimeters at 5 sites. The risk of malignancy using measured radiation absorbed dose was calculated. International Council for Radiation Protection 60 risk estimates were applied to calculate absorbed organ doses. Median duration of combined biplane fluoroscopy was 14.4 minutes. Of the 5 dosimeter locations, the right scapular location had the highest median radiation exposure (43 mGy). Incorporating data from the 5 dosimeters, the risk model calculated that the organ with the greatest absorbed dose and at greatest risk of malignancy was the lung, followed by bone marrow, then breast. Thyroid and ovary exposures were negligible. The increased lifetime risk of fatal malignancy was 0.02% per single RFA procedure. In conclusion, with appropriate measures to reduce radiation exposure, the increased risk of malignancy after a single RFA procedure in children is low. These data should be of help counseling families and will contribute to analysis of the relative risk reduction benefits of such novel imaging approaches as a magnetic resonance imaging-based catheterization laboratory.
The American Journal of Cardiology 11/2008; 102(7):913-5. · 3.37 Impact Factor
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ABSTRACT: Healthcare providers have become more aware of and concerned about paediatric sudden cardiac arrest. The diseases predisposing a patient to sudden cardiac arrest are all infrequently encountered. However, a detailed and comprehensive patient and family history may reveal warning signs and symptoms that identify a patient at higher risk for sudden cardiac arrest. Since many of these diseases are genetic, extensive family evaluation may uncover a previously undetected cardiac disease process and as well direct the development of a complete family evaluation and treatment plan. Published data document that in many cases preceding warning symptoms and signs are present, but may be misinterpreted or disregarded by medical staff. Attention to the details of patient history, family history and physical exam is critical to the success of any detection strategy, which can and should be widely applied.
British journal of sports medicine 09/2008; 43(5):336-41. · 2.55 Impact Factor
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ABSTRACT: Patients with heart block have conventionally received a pacemaker that stimulates the right ventricular apex (RVA) to restore heart rate control. While RVA pacing has been shown to create systolic dyssynchrony acutely, dyssynchrony can also occur in diastole. The effects of acute RVA pacing on diastolic synchrony have not been investigated. RVA pacing acutely impairs diastolic function by increasing the time constant of relaxation, decreasing the peak lengthening rate and decreasing peak negative dP/dt. We therefore hypothesized that acute RVA pacing would cause diastolic dyssynchrony in addition to creating systolic dyssynchrony.
Fourteen patients (13 +/- 4 years old) with non-preexcited supraventricular tachycardia underwent ablation therapy with subsequent testing to confirm elimination of the tachycardia substrate. Normal cardiac structure and function were then documented on two-dimensional echocardiography and 12-lead electrocardiography prior to enrollment. Tissue Doppler images were collected during normal sinus rhythm (NSR), right atrial appendage pacing (AAI), and VVI-RVA pacing during the postablation waiting interval. Systolic and diastolic dyssynchrony were quantified using cross-correlation analysis of tissue Doppler velocity curves. Systolic dyssynchrony increased 81% during RVA pacing relative to AAI and NSR (P < 0.01). Diastolic synchrony was not affected by the different pacing modes (P = 0.375).
Acute dyssynchronous activation of the LV created by RVA pacing resulted in systolic dyssynchrony with preserved diastolic synchrony in pediatric patients following catheter ablation for treatment of supraventricular tachycardia. Our results suggest that systolic and diastolic dyssynchrony are not tightly coupled and may develop through separate mechanisms.
Journal of Cardiovascular Electrophysiology 06/2008; 19(5):483-8. · 3.06 Impact Factor
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ABSTRACT: Ectopic atrial tachycardia (EAT) is often resistant to medical therapy, with radiofrequency ablation (RFA) being a preferred treatment option. Three-dimensional (3-D) electroanatomic mapping was introduced as a tool for improved substrate localization, although there are no published data with this technology in pediatric patients with EAT. The objective of this study was to examine our experience with 3-D mapping and standard mapping in this patient population. We used retrospective chart review of pediatric patients with EAT requiring RFA from 1993 to 2004. We analyzed the method of ablation, acute success and recurrence rates, procedure and fluoroscopy times, and cardiac function. Twenty-five patients underwent 31 RFA procedures. All patients had been followed for >6 months (6 months to 7 years). Standard mapping (Group 1) was used in 11 patients (5F/6M, 1.4-11.8 years) who underwent 13 RFA procedures; 3-D mapping (Group 2, October 2000-2004) was used in 16 patients (8 F/8M, 2.7-17 years) who underwent 18 RFA procedures. Left-sided focus was present in 6/13 in Group 1 and 7/18 in Group 2 (all transeptal, NS). There was a trend toward fewer lesions with 3-D mapping (15 +/- 14, median 9.5 in Group 1; 8 +/- 6, median 6.5 in Group 2, NS). Acute success was more likely for patients in which 3-D mapping was utilized (10/13 Group 1 vs. 18/18 Group 2, p < 0.04). Recurrence or persistence of tachycardia at follow-up (2 weeks to 1 year) was documented in 7/13 cases in Group 1, compared to only 2/18 cases in Group 2 (p = 0.01). Six patients underwent repeat RFA: two patients using standard mapping (one failure, one success) and four patients using 3-D mapping [all acute and long-term (>1 year) success]. Procedure times (232 +/- 84 vs. 268 +/- 72 min, skin-to-skin) and fluoroscopy times (47 +/- 24 vs. 40 +/- 20 min) were similar (NS). Of the 25 pts, 17 (7 in Group 1, 10 in Group 2, NS) presented with cardiomyopathy [Ejection fraction (EF), 38.6 +/- 12.1%]. Successful RFA resulted in improved EF (61.1 +/- 11.6%, p < 0.0001) in the 14 patients in whom pre-RFA and post-RFA echocardiograms were available. Compared to standard techniques, 3-D electroanatomic mapping has resulted in no acute failures, statistically reduced recurrence rates, and improved overall success in the management of EAT.
Pediatric Cardiology 03/2008; 29(2):393-7. · 1.30 Impact Factor
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ABSTRACT: To determine the incidence, characteristics, and outcomes for adolescents diagnosed with acute myocardial infarction (AMI).
We analyzed data from the Nationwide Inpatient Sample to determine the incidence of AMI in adolescents (age 13 to 18 years). Data from 1998 to 2001 were analyzed. Patients with primary cardiomyopathies, congenital heart lesions, and previous heart transplantation were excluded.
The estimated incidence of AMI admissions of adolescents in the United States is 157 per year, or 6.6 events per 1 million patient-years. AMI occurs predominantly in males (80%). Reported incidences of substance abuse and smoking are significantly higher in the adolescents with AMI than in adolescents admitted to the hospital for other conditions (P < .001 for both). Of the 123 subjects with AMI that we studied, 36 underwent coronary angiography (29%) and 2 underwent coronary artery bypass graft surgery (1%). The hospital mortality rate was 0.8%.
AMI is extremely rare in adolescents. Patient characteristics associated with AMI include substance abuse, tobacco use, and male sex. The hospital survival for AMI in adolescents is excellent, and the need for catheter or surgical coronary artery intervention is uncommon.
The Journal of pediatrics 09/2007; 151(2):150-4. · 4.02 Impact Factor
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ABSTRACT: Complete heart block, either congenital or acquired, in children and patients with congenital heart disease is a relatively frequent occurrence requiring therapy. The natural history of this condition has been distorted by the advent of new diagnostic and therapeutic modalities. The therapy of complete heart block is evolving with new data suggesting that traditional treatment strategies utilizing right ventricular apical pacing may have inadvertent deleterious effects on cardiac function. In the following manuscript, the natural history of complete heart block is reviewed and the current therapy examined.
Congenital Heart Disease 08/2007; 2(4):224-34. · 0.90 Impact Factor
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PEDIATRICS 09/2006; 118(2):802-4. · 4.47 Impact Factor
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ABSTRACT: Single-site ventricular pacing results in dyssynchronous ventricular activation and may contribute to ventricular dysfunction. We evaluated epicardial biventricular (BiV) pacing as a means of maintaining synchronous ventricular activation in an acute piglet model of AV block with normal ventricular anatomy and function.
We used left ventricular (LV) impedance catheters and tissue Doppler imaging to assess the cardiodynamics of immature piglets (n = 6, 33-78 days, 9.35 +/- 0.85 kg). Following catheter ablation of the AV node, a pacemaker was programmed 20 beats per minute above the intrinsic atrial rate. The animals were paced at 5-minute intervals via the following AV sequential configurations: Right atrial appendage (RA)-RV apex (RVA), RA-LV apex (LVA), and RA-biventricular (RVA/LVA). RA-RVA was the experimental control. LV systolic mechanics, measured by the slope of the end-systolic pressure-volume relationship (E(es)), increased with BiV pacing (12.8 +/- 3.4 mmHg/mL, P < 0.02) or single-site LVA pacing (10.6 +/- 3.4 mmHg/mL, P < 0.05) compared with single-site RVA pacing (8.3 +/- 1.4 mmHg/mL). QRS duration lengthened compared with sinus rhythm (42 +/- 8 msec) with either RVA (56 +/- 9 msec, P < 0.02) or LVA (54 +/- 7 msec, P < 0.03), but not with BiV (48 +/- 7 msec, P = 0.08) pacing. Tissue Doppler imaging showed LV dyssynchrony with RVA (septal-to-lateral delay 46.0 +/- 51.7 msec), with return toward normal with LVA (-9.6 +/- 33.6 msec, P < 0.04) or BiV (-4.1 +/- 33.8 msec, P < 0.04) pacing.
In this acute immature piglet model of AV block, LV performance improved with single-site pacing from the LVA and BiV pacing (RVA/LVA), as compared with single-site pacing from the RVA. These changes correlated with tissue Doppler indices of mechanical synchrony, though not necessarily with QRS duration.
Journal of Cardiovascular Electrophysiology 08/2006; 17(8):884-9. · 3.06 Impact Factor
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ABSTRACT: AV Node Reentry Tachycardia (AVNRT) is the second most common supraventricular tachycardia (SVT) undergoing pediatric radiofrequency ablation behind accessory pathway reentry tachycardias. AVNRT can be difficult to induce during electrophysiology study (EPS) and dual atrioventricular nodal (AVN) pathways physiology may not be demonstrated in young patients.
This report is the largest single center long term pediatric experience of radiofrequency modification of slow AVN input fibers for inducible or suspected (non-inducible) AVNRT.
One hundred thirty-two patients underwent slow input AVN modification from 1993 to 2002. The mean patient age was 13.7 years (4-20 yrs) with 62M/70F. Outpatient tachycardia was documented by ambulatory monitoring in all patients. AVNRT was induced in 98/132 patients during EPS (group A) with mean SVT cycle length of 324 msec (230-570 msec). Initial AVN modification (group A) was successful in 97/98 patients (99%). During 34/132 EPS, AVNRT was non-inducible; dual AVN physiology was present in 19/34 (group B), and 15/34 did not show evidence for dual AVN physiology (group C). These 34 patients underwent empiric AVN modification following discussion with patients' families. Freedom of recurrence from SVT at 1 year was 96% for group A (94/98), 89% (17/19) for group B and 93% (14/15) for group C. 1 major and 6 minor complications occurred.
AVN modification for AVNRT can be performed safely and effectively in pediatric patients with good long-term results. Empiric slow pathway AVN modification for non-inducible SVT results in a high rate of freedom from recurrence of tachycardia.
Journal of Interventional Cardiac Electrophysiology 08/2005; 13(2):139-43. · 1.17 Impact Factor
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ABSTRACT: The authors examined associations among parental and child adjustment, child syncope, somatic, and school problems. Participants were children (N = 56) ages 7-18 years with syncope. Measures included syncope severity, parental distress, and children's internalizing symptoms. For children diagnosed negative for neurocardiogenic syncope (NCS), their fathers' and their own psychological symptoms were positively associated with the severity of syncope, whereas their mothers' functioning was negatively associated with the severity of syncope. Also, for the negative NCS group, fathers' psychological functioning was associated with children's nonsyncope somatic complaints but not with their school problems. For the positive NCS group, few significant father-child associations were found, but several significant positive associations were revealed between mothers' psychological symptoms and their children's syncope as well as somatic and school problems.
Journal of Consulting and Clinical Psychology 09/2004; 72(4):597-604. · 4.85 Impact Factor
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ABSTRACT: The 22q11.2 deletion (del22q) is present in many patients with conotruncal abnormalities including pulmonary atresia with ventricular septal defect (PA/VSD). We sought to determine the impact of the del22q on outcome in subjects with PA/VSD.
We reviewed the experience for all patients with PA/VSD who were born between January 1993 and April 2002 and presented to our institution. Patients with conotruncal defects were routinely evaluated for genetic disorders including del22q. Fluorescence in situ hybridization was used to test for del22q.
There were 67 subjects with PA/VSD who presented during that time period; testing for del22q was performed in 58 of 67 (87%) and these 58 patients comprised the study population. The 22q11.2 deletion was present in 20 of 58 (34%) patients tested. Major aortopulmonary collaterals were defined by angiography and were present in 27 (47%). These collaterals were significantly more common among subjects with del22q (13 of 20, 65%; p = 0.04). The median cross sectional area of the pulmonary arteries, the Nakata index, was significantly less for patients with del22q (41 versus 142 mm(2)/m(2); p = 0.006). There were 3 subjects, all of whom had del22q, who did not undergo surgery owing to markedly hypoplastic pulmonary arteries. Of the remaining 55 patients, 53 had arteriopulmonary shunt with or without unifocalization as the initial procedure and 35 patients have undergone complete repair. There were 8 operative deaths and 1 nonoperative death. The 5-year survival was 36% for patients with del22q versus 90% for patients without del22q. The 22q11.2 deletion was a significant risk factor for death, even after adjusting for the presence of major aortopulmonary collaterals (p = 0.004). There was no significant difference between the two groups with respect to the incidence of serious viral, bacterial, or fungal infections in the perioperative period.
Patients with del22q and PA/VSD are at increased risk for death owing to a variety of factors including less favorable pulmonary artery anatomy. A better understanding of del22q, pulmonary artery anatomy, and outcome is required.
The Annals of Thoracic Surgery 09/2003; 76(2):567-71. · 3.74 Impact Factor
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ABSTRACT: The aim of this study was to evaluate epicardial biventricular pacing as a means of maintaining synchronous ventricular activation in an acute canine model of AV block with normal ventricular anatomy and function. Chronic single-site ventricular pacing results in dyssynchronous ventricular activation and may contribute to ventricular dysfunction. Biventricular pacing has been used successfully in adult patients with congestive heart failure.
This was an acute study of open chest mongrel dogs (n = 13). ECG, left ventricular (LV), aortic, and pulmonary arterial pressures were measured. LV impedance catheters were used to assess cardiodynamics using instantaneous LV pressure-volume relations (PVR). Following radiofrequency ablation of the AV node, a temporary pacemaker was programmed 10 beats/min above the intrinsic atrial rate, with an AV interval similar to the baseline intrinsic PR interval. The pacing protocol consisted of 5-minute intervals with the following lead configurations: right atrium-right ventricular apex (RA-RVA), RA-LV apex (LVA), and RA-biventricular using combinations of four ventricular sites (RVA, RV outflow tract [RVOT], LVA, LV base [LVB]). RA-RVA was used as the experimental control. LV systolic mechanics, as measured by the slope of the end-systolic (Ees) PVR (ESPVR, mmHg/cc), was statistically greater (P < 0.05) with all modes of biventricular pacing (RA-RVA/LVA 20.0 +/- 2.9, RA-RVA/LVB 18.4 +/- 2.9, RA-RVOT/LVA 15.1 +/- 1.8, RA-RVOT/LVB 17.6 +/- 2.9) compared to single-site ventricular pacing (RA-RVA 12.8 +/- 1.6). Concurrent with this improvement in myocardial performance was a shortening of the QRS duration (RA-RVA 97.7 +/- 2.9 vs RA-RVA/LVA 75.7 +/- 4.9, RA-RVA/LVB 70.3 +/- 4.9, RA-RVOT/LVA 65.3 +/- 4.4, and RA-RVOT/LVB 76.7 +/- 5.9, P < 0.05).
In this acute canine model of AV block, QRS duration shortened and LV performance improved with epicardial biventricular pacing compared to standard single-site ventricular pacing.
Journal of Cardiovascular Electrophysiology 09/2003; 14(9):996-1000. · 3.06 Impact Factor
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Lorenzo D Botto,
Kristin May,
Paul M Fernhoff,
Adolfo Correa,
Karlene Coleman,
Sonja A Rasmussen,
Robert K Merritt,
Leslie A O'Leary,
Lee-Yang Wong,
E Marsha Elixson,
William T Mahle, Robert M Campbell
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ABSTRACT: Although several studies describe the 22q11.2 deletion, population-based data are scant. Such data are needed to evaluate properly the impact, distribution, and clinical presentation of the deletion in the population. Our goals were to assess the population-based birth prevalence of the 22q11.2 deletion and its associated phenotype and its impact on the occurrence of heart defects.
We evaluated data on infants who were born from 1994 through 1999 to women who resided in metropolitan Atlanta. We matched records from the Metropolitan Atlanta Congenital Defects Program (a population-based registry with active case ascertainment), the Sibley Heart Center at Children's Healthcare of Atlanta, and the Division of Medical Genetics at Emory University. We used birth certificate data for the denominators of the rates.
We identified 43 children with laboratory-confirmed 22q11.2 deletion among 255 849 births. The overall prevalence was 1 in 5950 births (95% confidence interval: 1 in 4417 to 1 in 8224 births). The prevalence was between 1 in 6000 and 1 in 6500 among whites, blacks, and Asians and 1 in 3800 among Hispanics. Most affected children (81%) had a heart defect, and many (1 in 3) had major extracardiac defects (other than velopalatal anomalies), including anomalies of the central nervous system. Overall, the deletion contributed to at least 1 of every 68 cases of major heart defects identified in the total birth cohort and, in particular, to 1 of every 2 cases diagnosed with interrupted aortic arch type B, 1 of every 5 with truncus arteriosus, and 1 of every 8 with tetralogy of Fallot.
The 22q11.2 deletion was common in this birth population. The clinical phenotype included a wide and variable spectrum of major cardiac and extracardiac anomalies. From these population-based data, one can estimate that at least 700 affected infants are born annually in the United States. Population-based estimates such as these should be useful to medical professionals and policy makers in planning for the optimal care of people with the 22q11.2 deletion.
PEDIATRICS 08/2003; 112(1 Pt 1):101-7. · 4.47 Impact Factor
