Are Maternal Self-Reports of Social Difficulties Apparent in Interactions with their Children?

To inform parent-mediated intervention models, this study assessed if family affectedness (i.e., elevated autism symptoms in more than one child) was associated with maternal self-reported social difficulties (as indexed by the Social Responsiveness Scale; SRS-2), and social interactions during play. As part of a prospective study, 71 mothers completed the SRS-2 and a play session. Interactions were coded for a range of prosocial behaviors, including gaze, positive affect, and vocalizations. Overall, mothers with multiple children exhibiting autism symptoms self-reported significantly more social difficulties on the SRS-2, when compared to mothers raising only typically developing children, or one child with autism. However, even with elevated SRS-2 scores, mothers with higher family affectedness demonstrated comparable social exchanges with their children during play.

Resolving Magnetopause Shadowing Using Multimission Measurements of Phase Space Density.

Loss mechanisms act independently or in unison to drive rapid loss of electrons in the radiation belts. Electrons may be lost by precipitation into the Earth's atmosphere, or through the magnetopause into interplanetary space-a process known as magnetopause shadowing. While magnetopause shadowing is known to produce dropouts in electron flux, it is unclear if shadowing continues to remove particles in tandem with electron acceleration processes, limiting the overall flux increase. We investigated the contribution of shadowing to overall radiation belt fluxes throughout a geomagnetic storm starting on the 7 September 2017. We use new, multimission phase space density calculations to decipher electron dynamics during each storm phase and identify features of magnetopause shadowing during both the net-loss and the net-acceleration storm phases on sub-hour time scales. We also highlight two distinct types of shadowing; "direct," where electrons are lost as their orbit intersects the magnetopause, and "indirect," where electrons are lost through ULF wave driven radial transport toward the magnetopause boundary.

Transport and Loss of Ring Current Electrons Inside Geosynchronous Orbit During the 17 March 2013 Storm.

Ring current electrons (1-100 keV) have received significant attention in recent decades, but many questions regarding their major transport and loss mechanisms remain open. In this study, we use the four-dimensional Versatile Electron Radiation Belt code to model the enhancement of phase space density that occurred during the 17 March 2013 storm. Our model includes global convection, radial diffusion, and scattering into the Earth's atmosphere driven by whistler-mode hiss and chorus waves. We study the sensitivity of the model to the boundary conditions, global electric field, the electric field associated with subauroral polarization streams, electron loss rates, and radial diffusion coefficients. The results of the code are almost insensitive to the model parameters above 4.5 R E R E, which indicates that the general dynamics of the electrons between 4.5 R E and the geostationary orbit can be explained by global convection. We found that the major discrepancies between the model and data can stem from the inaccurate electric field model and uncertainties in lifetimes. We show that additional mechanisms that are responsible for radial transport are required to explain the dynamics of ≥40-keV electrons, and the inclusion of the radial diffusion rates that are typically assumed in radiation belt studies leads to a better agreement with the data. The overall effect of subauroral polarization streams on the electron phase space density profiles seems to be smaller than the uncertainties in other input parameters. This study is an initial step toward understanding the dynamics of these particles inside the geostationary orbit.

Dyadic interactions in children exhibiting the broader autism phenotype: Is the broader autism phenotype distinguishable from typical development?

In families raising a child with an autism spectrum disorder (ASD), infant siblings are at elevated risk for ASD and other developmental concerns, including elements of the broader autism phenotype (BAP). Typically, the BAP is indexed using standardized developmental assessments; however, these measures do not capture a number of social difficulties commonly associated with the BAP. The present study aims to expand our developmental understanding of the BAP by comparing children exhibiting the BAP to their typically developing peers on, (a) standardized measures of development, and (b) social behaviors exhibited during dyadic play interactions. As part of a prospective study, dyads were recruited from families with at least one older child with ASD (high-risk, n = 36), and families with no history of ASD (low-risk, n = 38). During laboratory visits at 12, 15, 18, and 24 months of age, infants completed a series of standardized assessments and a mother-child play interaction. Dyadic play interactions were micro-analytically coded for gaze, positive affect, and vocalizations to create theory-driven composites to index dyadic synchrony and responsiveness. Videos were also coded with an existing rating scheme for joint engagement and child responsiveness. Multilevel models revealed significant group differences on select constructs within the first 2 years. Language and cognitive differences emerged by 24 months of age, whereas dyadic differences were evident as early as 15 months. Recognizing the increasing demand for elevated-risk interventions, these findings highlight several social constructs through which interventions may identify risk and promote optimal development. Autism Res 2019, 12: 469-481 © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: In families raising children with an autism spectrum disorder (ASD), younger siblings are at an increased risk for social and developmental difficulties that characterize a "broader autism phenotype." The present study explored the emergence of social, language, and cognitive differences in the first 2 years of life. Social differences were evident as early as 15 months of age for several play-based measures, and language and cognitive differences emerged by 24 months of age. For infant siblings of children with ASD, some of the earliest behavioral marks for subclinical features of ASD are evident within the first 2 years of life.

Schistosoma haematobium presenting as an intrinsic conus tumour.

In the small and diverse group of atypical, non-neoplastic intramedullary spinal cord lesions, parasitic infections are rarely considered, especially in Caucasian patients without systemic complaints or eosinophilia. A case of atypical myelopathy caused by Schistosoma haematobium is presented. The clinical, laboratory and imaging features in the MRI era both before and after treatment are discussed.

Osteoid osteomas of the body of the cervical spine. Case report and review of the literature.

A case report of an adult patient with an osteoid osteoma of the body of the 3rd cervical vertebra is presented. The long history of progressively worsening nocturnal cervical pain which was relieved by non-steroidal anti-inflammatory drugs, and an essentially normal clinical examination, are typical of this condition; in which CT is the investigation of choice. Complete relief was obtained following excision of the lesion. The literature is reviewed.

Spontaneous regression of a solitary cerebral metastases in renal carcinoma followed by meningioma development under medroxyprogesterone acetate therapy.

A case of regression of a probable cerebral metastasis of a hypernephroma after nephrectomy and hormone therapy is presented. The patient subsequently developed a meningioma after therapy with medroxyprogesterone acetate. A relationship between meningioma growth and sex hormones has been documented, but little is known about the effect of hormone therapies on tumour growth.

Firearm ownership among female physicians in the United States.

BACKGROUND: Physicians have been called upon to counsel patients about firearm safety, but the personal prevalence of firearm ownership among physicians is poorly established. METHODS: We examined responses to the question "Do you keep a gun/firearm in your home?" from the Women Physicians' Health Study, a nationally representative survey of US female physicians (n = 4,501). RESULTS: Among female physicians, 16.5% reported having a firearm in their homes. Those who were older, married, practicing in a rural region, and residing in the South Central or Mountain states were more likely to report having a firearm in the home. Emergency medicine specialists, Protestants, physicians reporting a history of depression, and those on call more than six times per month were also more likely to report keeping a firearm in their home. Female physicians residing on the East Coast, Hindus, and Jews were least likely to report keeping a firearm in the home. CONCLUSIONS: In the United States, the proportion of female physicians who report having a firearm in the home was about half that reported by other women and one third that reported by men. This observation may have important implications for encouraging female physicians to counsel their patients about firearm ownership and storage.

The impact of nursing home transfer policies at the end of life on a public acute care hospital.

OBJECTIVES: To determine whether nursing homes transferred their terminal care patients to one public hospital, and if so, the impact of these transfers on nursing home and hospital mortality rates. DESIGN: A retrospective cohort study using both Medicare claims and hospital data to construct a mortality prediction model, as well as a cross-sectional descriptive comparison of state nursing home mortality rates. SETTING: A public hospital, one of 32 hospitals designated as overall mortality outliers for each of the first three Medicare mortality reports. PARTICIPANTS: Patients (n = 1235) included in the index hospital's 1988 Medicare mortality report; nursing homes (n = 289) included in state data on 1988 nursing home mortality rates. MEASUREMENTS AND RESULTS: Patients transferred from nursing homes to the index hospital were nearly twice as likely to die as the hospital's other Medicare patients in univariate (P = .0001) as well as multivariate analysis (OR = 1.68, 95% CI = 1.17 - 2.40). Terminal care admissions accounted for 33.9% of deaths from nursing homes but only 16.2% of other deaths (P = .009). The 1988 death/discharge rate at one of two nursing homes responsible for nearly all transfers was 15.2%, less than half the state average. Yet it contributed 59.3% of nursing home deaths and 22.7% of terminal care patients to the hospital. The hospital's 20.0% 1988 Medicare mortality rate was just above the expected range. CONCLUSIONS: Two nursing homes transferred terminal care to a single hospital. This resulted in a lower-than-average mortality rate for one of the nursing homes and a higher-than-expected Medicare mortality for the hospital. Without these end-of-life transfers, the hospital's Medicare mortality rate would have been within the expected range.

Development and isoproterenol-induced regulation of adrenoceptor binding in cultured rat neocortical explants is seen only with the beta-1, not with the beta-2 subtype.

The presence and time-course of beta-adrenoceptor density in cultured explants of neocortex obtained from 6-day-old rat pups were investigated using a [125I]ICYP binding assay. A delayed, but more pronounced, increase in the receptor expression was observed as compared to the situation previously described in vivo. These changes only occurred for the beta 1-subtype of the receptor, whereas the beta 2-subtype binding remained constant up to 3 weeks in vitro. The delay of beta 1-adrenoceptor expression may be due to the incomplete presence of the proper maturational input, and the late enhancement of receptor expression to upregulation related to the absence in vitro of noradrenergic input. Decreased beta-adrenoceptor levels could be induced by chronic treatment of the beta-agonist isoproterenol (1 microM) introduced either for 3 or 13 days. Again, changes in density were found only for the beta 1-adrenoceptor binding sites. There is no reduction of receptor density following return to control conditions for 10 days after a 3-day treatment with isoproterenol, demonstrating the ability of this model to attain its final receptor density notwithstanding the developmental insult.

A public health approach to emergency medicine: preparing for the twenty-first century.

This paper focuses on the implications of an inadequate public health/preventive health care system for emergency medicine (EM), the role that EM providers can play in remedying critical health problems, and the benefits gained from a public health approach to EM. A broad definition of public health is adopted, suggesting shared goals of public health and EM. Critical problems posed for EM include alcohol, tobacco, and other drug abuse; injury; violence; sexually transmitted diseases and human immunodeficiency virus (HIV) infection occupational and environmental exposures; and the unmet health needs of minorities and women. A blueprint for future merging of public health issues with EM is presented that includes the application of public health principles to 1) clinical practice; 2) public education, community involvement, and public policy advocacy; 3) development of medical school and residency public health/prevention curricula and teaching methods; and 4) research opportunities and surveillance. Finally, recommendations are proposed that require restructuring the present health care system to provide resources, incentives, and organizational changes that promote an integration of public health and preventive services in the practice of EM.

Synovial cyst of a lumbar facet joint: a rare cause of back pain and sciatica. Report of two cases.

Intraspinal synovial cysts, sometimes referred to as ganglion cysts, are uncommon lesions which may present as acute or chronic low back pain, with or without radicular symptoms. We present two patients who presented with back pain and radicular symptoms attributable to the unusual pathology of an intraspinal synovial cyst.

Thoracic disc herniation. Analysis of 14 cases and review of the literature.

Fourteen cases of thoracic intervertebral disc prolapse are reported and analysed. Eleven were women, 3 men, and the peak incidence was in the 5th decade. No trauma was reported in our cases. The T8/9 interspace was the most frequently involved. A sensory level was noticed in 6 cases and in four a clear cut sensory level at T10 was observed. Results of surgical treatment show that using microsurgical techniques costotransversectomy and its modifications are equally effective; laminectomy is contraindicated.

Job involvement and job satisfaction of South African nurses compared with other professions.

The study was designed primarily to compare the work outcomes of job satisfaction and job involvement of South African nurses with those of members of 13 other professional groups in South Africa and with American nurses where data was available. Secondary aims included identifying areas where job satisfaction was particularly low and demonstrating the relative independence of the job involvement and job satisfaction constructs. A questionnaire incorporating the Kanungo Job Involvement Scale and the Short Form of the Minnesota Job Satisfaction Questionnaire was mailed to random samples of people between the ages of 29 and 41 drawn from 14 professional registers. There were 114 nurses in the final sample and 1677 members of other professions. Differences among professions were tested for significance using one-way analyses of variance and Bonferroni ranges tests. South African Nurses were shown to have extremely low job satisfaction relative to American nurses and to other professional groups in South-Africa. By contrast their job involvement was moderately high. The implications of these findings for the medical profession as a whole and for nurses in particular are discussed. The fear is expressed that wide spread dissatisfaction may lead to fewer people entering the profession and highly trained people leaving.

Impact of portable pulse oximetry on arterial blood gas test ordering in an urban emergency department.

STUDY OBJECTIVE: To determine the impact of portable pulse oximetry on physician use of arterial blood gas tests (ABGs) in an urban emergency department. DESIGN: Prospective, controlled clinical trial. SETTING: The ED of the Regional Medical Center at Memphis, a publicly subsidized, 450-bed, acute care hospital staffed by residents and faculty of the University of Tennessee, Memphis. TYPE OF PARTICIPANTS: Rotating housestaff treating adult ED patients with a wide variety of medical and surgical problems. INTERVENTION: Introduction of a portable pulse oximeter for noninvasive measurement of blood oxygenation. MEASUREMENTS: Rates of ABG test ordering, housestaff reason(s) for ordering an ABG, and the incidence of adverse clinical outcomes before and after introduction of portable pulse oximetry. MAIN RESULTS: A total of 20,120 patient visits occurred during the four-month study. Before oximeter introduction, emergency physicians ordered 699 ABGs, 63% of which were indicated by explicit criteria. After oximeter introduction, 440 ABGs were ordered (a 37% decrease). Almost all of this decrease was due to fewer ABGs ordered to assess oxygenation (260 before vs 75 after; chi 2, P less than .001). These reductions were not explained by differences in total patient visits or case mix. Physicians decreased ordering of indicated ABGs by almost as great an extent as they reduced ordering of unindicated tests, suggesting they did not consistently distinguish between the two. However, decreased testing did not result in any serious adverse outcomes, defined as unanticipated respiratory or cardiac arrest in the ED, unanticipated arrest on the floor within 24 hours of admission, or death within two days of hospital discharge. CONCLUSION: Portable pulse oximetry can provide a simple, noninvasive way to determine oxygen saturation in the ED. Routine use of portable pulse oximetry may substantially reduce rates of ABG testing and associated patient charges without adversely affecting the quality of emergency care.