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The long-term academic outcomes for many students with attention-deficit/hyperactivity disorder (ADHD) are strikingly poor. It has been decades since students with ADHD were specifically recognized as eligible for special education through the Other Health Impaired category under the Education for all Handicapped Children Act of 1975, and similarly, eligible for academic accommodations through Section 504 of the 1973 Rehabilitation Act. It is time to acknowledge that these school-policies have been insufficient for supporting the academic, social, and behavioral outcomes for students with ADHD. Numerous reasons for the unsuccessful outcomes include a lack of evidence-based interventions embedded into school approaches, minimizing the importance of the general education setting for promoting effective behavioral supports, and an over-reliance on assessment and classification at the expense of intervention. Contemporary behavioral support approaches in schools are situated in multi-tiered systems of support (MTSS); within this article we argue that forward-looking school policies should situate ADHD screening, intervention, and maintenance of interventions within MTSS in general education settings and reserve special education eligibility solely for students who require more intensive intervention. An initial model of intervention is presented for addressing ADHD within schools in a manner that should provide stronger interventions, more quickly, and therefore more effectively.
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Transtorno do Deficit de Atenção com Hiperatividade , Instituições Acadêmicas , Estudantes , Humanos , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Criança , Estudantes/psicologia , Educação Inclusiva/métodos , AdolescenteRESUMO
The Inventory of Callous-Unemotional Traits (ICU) is a widely used measure of callous-unemotional (CU) traits that may aid in the assessment of the diagnostic specifier "with limited prosocial emotions," which has been added to diagnostic criteria for conduct disorder. Though there is substantial support for use of the ICU total score, the scale's factor structure has been highly debated. Inconsistencies in past factor analyses may be largely attributed to failure to control for method variance due to item wording (i.e., half of the items being worded in the callous direction and half worded in the prosocial direction). Thus, the present study used a multitrait-multimethod confirmatory factor analytic approach that models both trait and method variance to test the factor structure of the ICU self-report in a clinically relevant, high-risk sample of justice-involved male adolescents (N = 1,216). When comparing the fit of empirical and theoretical models, goodness of fit indices (χ² = 1105.877, df = 190, root-mean-square error of approximation = .063, comparative fit index = .916, Tucker-Lewis index = .878, standardized root-mean-square residual = .051) provided support for a hierarchical four-factor model (i.e., one overarching callous-unemotional factor, four latent trait factors) when accounting for method variance (i.e., covarying positively worded items). This factor structure is consistent with the way the ICU was constructed and with criteria for the limited prosocial emotions specifier. In addition, measurement invariance of this factor structure across age, race, and ethnicity was supported, and the predictive validity of the ICU was supported across these demographic groups in predicting self-reported antisocial behavior and rearrests over a 5-year period following an adolescent's first arrest. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Demographic data from nearly 50 years of treatment research for children and adolescents with attention-deficit/hyperactivity disorder (ADHD) are synthesized. Comprehensive search identified ADHD treatment studies that were between-group designs, included a psychosocial, evidence-based treatment, and were conducted in the United States. One hundred and twenty-six studies that included 10,604 youth were examined. Reporting of demographics varied with 48% of studies (k = 61) reporting ethnicity, 73% (k = 92) reporting race, 80% (k = 101) reporting age (M age = 8.81, SD = 2.82), and 88% (k = 111) reporting gender. Most participants identified as non-Hispanic/Latine (15.99% Hispanic/Latine), White (62.54%), and boys (74.39%; 24.47% girls). Since the 1970s, zero youth in ADHD treatment studies identified as Middle Eastern/North African, 0.1% were American Indian/Alaskan Native or Native Hawaiian Pacific Islander, 1.77% were Asian, 15.10% were Black, and 3.14% were Multiracial. Based on publication year, the proportions of girls, racially minoritized youth, and Hispanic/Latine youth included in ADHD treatment research have increased over time. Girls, non-binary and non-cisgender youth, young children, adolescents, Hispanic/Latine youth, and youth from all racial groups other than White are underrepresented in ADHD treatment research. Research gaps are discussed, and recommendations for comprehensive demographic reporting in child and adolescent psychological research are provided.
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Previous research indicates that youth exhibiting antisocial behavior are at risk for utilizing a disproportionate amount of health services compared to youth without these problems. The present study investigates whether being processed by the juvenile justice system and showing callous-unemotional (CU) traits independently predict health service utilization (medical and mental health service use and out-of-home placement) over and above the severity of antisocial behavior across adolescence. A total of 766 participants who had been arrested for the first time in adolescence provided data at ten appointments over a period of seven years. Results showed that self-reported antisocial behavior at the time of arrest predicted increased use of most health service use types over the next seven years (i.e. medicine prescriptions, tests for sexually transmitted infections, mental health service appointments, and out-of-home placements). All except prescription medication use remained significant when controlling for justice system processing and CU traits. Further, justice system processing added significantly to the prediction of medical service appointments. Whereas CU traits were associated with mental health service appointments and out-of-home placements, these did not remain significant when controlling for severity of antisocial behavior. These findings are consistent with prior research documenting the health care costs of antisocial behavior.
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Delinquência Juvenil , Serviços de Saúde Mental , Humanos , Adolescente , Masculino , Feminino , Delinquência Juvenil/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Transtorno da Personalidade Antissocial , Emoções , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricosRESUMO
Transforming acidic acid coiled-coil protein 3 (TACC3) and cytoskeleton associated protein 5 (cKAP5; or colonic hepatic tumor overexpressed gene, chTOG) are vital for spindle assembly and stabilization initiated through TACC3 Aurora-A kinase interaction. Here, TACC3 and cKAP5/chTOG localization with monospecific antibodies is investigated in eGFP-centrin-2- expressing mouse meiotic spermatocytes. Both proteins bind spermatocyte spindle poles but neither kinetochore nor interpolar microtubules, unlike in mitotic mouse fibroblasts or female meiotic oocyte spindles. Spermatocytes do not display a liquid-like spindle domain (LISD), although fusing them into maturing oocytes generates LISD-like TACC3 condensates around sperm chromatin but sparse microtubule assembly. Microtubule inhibitors do not reduce TACC3 and cKAP5/chTOG spindle pole binding. MLN 8237 Aurora-A kinase inhibitor removes TACC3, not cKAP5/chTOG, disrupting spindle organization, chromosome alignment, and impacting spindle pole γ-tubulin intensity. The LISD disruptor 1,6-hexanediol abolished TACC3 in spermatocytes, impacting spindle bipolarity and chromosome organization. Cold microtubule disassembly and rescue experiments in the presence of 1,6-hexanediol reinforce the concept that spermatocyte TACC3 spindle pole presence is not required for spindle pole microtubule assembly. Collectively, meiotic spermatocytes without a LISD localize TACC3 and cKAP5/chTOG exclusively at spindle poles to support meiotic spindle pole stabilization during male meiosis, different from either female meiosis or mitosis.
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Aurora Quinase A , Glicóis , Proteínas Associadas aos Microtúbulos , Animais , Feminino , Masculino , Camundongos , Aurora Quinase A/genética , Aurora Quinase A/metabolismo , Proteínas de Ciclo Celular/metabolismo , Meiose , Proteínas Associadas aos Microtúbulos/genética , Proteínas Associadas aos Microtúbulos/metabolismo , Microtúbulos/metabolismo , Oócitos/metabolismo , Sêmen/metabolismo , Fuso Acromático/metabolismo , Polos do Fuso/metabolismoRESUMO
In this study, the use of self-consistent field quasi-diabats is investigated for calculation of triplet energy transfer diabatic coupling elements. It is proposed that self-consistent field quasi-diabats are particularly useful for studying energy transfer (EnT) processes because orbital relaxation in response to changes in electron configuration is implicitly built into the model. The conceptual model that is developed allows for the simultaneous evaluation of direct and charge-transfer mechanisms to establish the importance of the different possible EnT mechanisms. The method's performance is evaluated using two model systems: the ethylene dimer and ethylene with the methaniminium cation. While states that mediate the charge-transfer mechanism were found to be higher in energy than the states involved in the direct mechanism, the coupling elements that control the kinetics were found to be significantly larger in the charge-transfer mechanism. Subsequently, we discuss the advantage of the approach in the context of practical difficulties with the use of established approaches.
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Background: In clinical settings, there is significant need for brief, easily-administered assessment tools for adolescent depression that can be used by mental health clinicians from a variety of training backgrounds. Existing depression screening tools do not assess for duration and consistency of symptoms, two key indicators of pathological depression. Objective: The Brief Adolescent Depression Screen (BADS) was developed to screen for major and persistent depressive disorders in adolescents in order to meet the assessment needs in an inpatient setting, and the validity of this tool was tested. Method: The current study used a sample of 396 inpatient adolescents to assess the screening utility of the BADS for detecting whether the adolescent meets criteria for a depressive diagnosis according to a well-validated semi-structured interview, as well as detecting a positive history of suicidal behavior. Further, the screening utility of this measure was compared to the utility of an established depression rating scale. Results: Analyses first determined the duration of depressive symptoms on the BADS that optimally screened for the presence of Major Depressive Disorder and Persistent Depressive Disorder. Findings indicated that, using these optimal screening cut-offs, the BADS showed a strong screening utility, resulting in a sensitivity and specificity for identifying full depressive diagnoses and a positive history of suicidal behavior with similar or greater accuracy than an established rating scale. Conclusions: These findings provide initial evidence to suggest that the BADS may be a helpful screening tool for adolescent depressive disorders in inpatient settings.
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Research on proactive and reactive aggression has identified covariates unique to each function of aggression, but hypothesized correlates have often not been tested with consideration of developmental changes in or the overlap between the types of aggression. The present study examines the unique developmental trajectories of proactive and reactive aggression over adolescence and young adulthood and tests these trajectories' associations with key covariates: callous-unemotional (CU) traits, impulsivity, and internalizing emotions. In a sample of 1,211 justice-involved males (ages 15-22), quadratic growth models (i.e., intercepts, linear slopes, and quadratic slopes) of each type of aggression were regressed onto quadratic growth models of the covariates while controlling for the other type of aggression. After accounting for the level of reactive aggression, the level of proactive aggression was predicted by the level of CU traits. However, change in proactive aggression over time was not related to the change in any covariates. After accounting for proactive aggression, reactive aggression was predicted by impulsivity, both at the initial level and in change over time. Results support that proactive and reactive aggression are unique constructs with separate developmental trajectories and distinct covariates.
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The association of anxiety and trauma with antisocial behavior in children and adolescents has long been the focus of research, and more recently this area of research has become critical to theories of the development of callous-unemotional (CU) traits. Research suggests those with elevated CU traits and anxiety (i.e., secondary CU variant) seem to show more severe externalizing behaviors and are more likely to show histories of trauma, compared to those with elevated CU and low anxiety (i.e., primary CU variant). These findings have typically been interpreted as being indicative of distinct etiological pathways to the development of CU traits. We test an alternative explanation that the higher rates of anxiety and trauma exposure in some youth with elevated CU traits are largely a consequence of their higher levels of antisocial behavior. The current study recruited a sample of 1,216 justice-involved adolescents (Mage = 15.28, SD = 1.28) from three distinct regions of the United States, who were assessed at 6, 12, 18, 24, 30, 36, 48, and 60 months following their first arrest. Using random-intercept cross-lagged models, both antisocial behavior and CU traits predicted changes in future anxiety and CU traits predicted increases in future victimization. Further, using longitudinal parallel mediation models, antisocial and aggressive behavior largely accounted for the predictive association between CU traits and anxiety and CU traits and victimization. These results support a model in which anxiety and trauma histories may be a marker of the severity of antisocial behavior displayed by youth with elevated CU traits. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Transtorno da Personalidade Antissocial , Transtorno da Conduta , Adolescente , Criança , Humanos , Agressão/psicologia , Transtorno da Personalidade Antissocial/epidemiologia , Transtorno da Personalidade Antissocial/psicologia , Ansiedade/epidemiologia , Ansiedade/psicologia , Transtorno da Conduta/epidemiologiaRESUMO
Scanning tunneling microscopy tip-induced deprotonation has been demonstrated experimentally and can be used as an additional control mechanism in electric-field induced molecular switching. The goal of the current work is to establish whether (de)protonation can be used to inhibit or enhance the electric field controlled thermal and photoisomerization processes. Dihydroxyazobenzene is used as a model system, where protonation/deprotonation of the free hydroxyl moiety changes the azo bond order, and so modifies the rate of electric field induced isomerization. Through the combined action of deprotonation and applied field, it was found that the cis-to-trans thermal isomerization barrier could be completely removed, changing the isomerization half-life from the order of several months. In addition, due to the presence of multiple isomerization mechanisms, electric fields could modify the isomerization kinetics by increasing the number of energetically viable isomerization pathways, rather than reducing the activation barrier of the lowest energy pathway. Excited state calculations indicated that the protonation state and electric field could be used together to control the presence of electronic degeneracies along the rotation pathway between S0/S1, and along all three pathways between S1/S2. This work provides insight into the mechanisms that enable the use of protonation state, light, and electric fields in concert to control molecular switches.
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Due to the significant impairment associated with subthreshold bipolar symptomatology and the harmful effects of delayed diagnosis, there is a great need for diagnostic tools that can facilitate early identification of bipolar spectrum disorders. The Mood Disorder Assessment Schedule (MDAS) is a newly developed measure that focuses on autonomous changes in mood and energy, a key indicator of bipolar spectrum problems which is not included in current diagnostic tools for bipolar disorders. The current study tested the ability of the MDAS to identify individuals at risk for bipolar spectrum disorders. In a cross-sectional sample of 396 inpatient adolescents, the MDAS identified a group of individuals with several bipolar spectrum disorder (BSD) indicators, including greater manic and depressive symptoms, affective lability, suicidal behavior, adverse reactions to antidepressants, and a family history of bipolar disorder and suicidal behavior. When compared to a standard diagnostic interview for bipolar disorders (i.e., Kiddie Schedule for Affective Disorders and Schizophrenia [KSADS]), the MDAS yielded stronger clinical utility in its ability to identify individuals with BSD indicators. Therefore, the MDAS appears to be a promising diagnostic tool for identifying adolescents at risk for BSDs and may help facilitate earlier diagnosis and prevent harmful effects of improper treatment.
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Transtorno Bipolar , Humanos , Adolescente , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Estudos Transversais , Pacientes Internados , Transtornos do Humor/diagnóstico , Escalas de Graduação PsiquiátricaRESUMO
Objective: The recent addition of the callous-unemotional (CU) traits specifier, "with Limited Prosocial Emotions (LPE)," to major classification systems has prompted the need for assessment tools that aid in the identification of elevations on these traits for diagnostic purposes. The goal of the current study was to use and evaluate multiple methods for establishing cutoff scores for the multi-informant questionnaire, the Inventory of Callous-Unemotional Traits (ICU).Method: The present study compared the clinical utility of various proposed cutoff methods and scores (i.e., empirically derived cutoffs using receiver operating characteristic (ROC), normative cutoffs, and rational scoring approximations of LPE criteria) in both a longitudinal sample of justice-involved male adolescents (N = 1,216; Mage = 15.29, SD = 1.29) and a cross-sectional sample of school children (N = 289; Mage = 11.47 years; SD = 2.26).Results: Methods resulted in a range of cutoff scores with substantial diagnostic overlap and validity. Specifically, they designated justice-involved adolescents at risk for later delinquency, aggression, and rearrests, and they designated school children more likely to be rated by parents and teacher as having conduct problems and rated by peers as being rejected and mean.Conclusions: The results lead to ranges of ICU scores that have support for their validity and can help to guide clinical decisions about children and adolescents who may be elevated on CU traits.
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Transtorno da Conduta , Criança , Adolescente , Humanos , Masculino , Transtorno da Conduta/diagnóstico , Transtorno da Conduta/psicologia , Estudos Transversais , Inventário de Personalidade , Agressão/psicologia , Emoções , Unidades de Terapia Intensiva , Transtorno da Personalidade Antissocial/psicologiaRESUMO
BACKGROUND: Neonates born in low- and middle-income countries (LMICs) with esophageal atresia (EA) and tracheoesophageal fistula (TEF) often do not have access to adequate surgical care. We have partnered with the non-profit organization World Pediatric Project (WPP) to facilitate care for such patients. METHODS: Our protocol included placement of a gastrostomy tube by local surgeons before definitive repair at the Children's Hospital of Richmond at VCU (CHoR). The outcomes of WPP-sponsored patients with EA and TEF in this program (n = 9) were compared to patients born in the U.S. with the same condition at CHoR (n = 9). RESULTS: The baseline characteristics of the groups aside from the age at admission to CHoR and at day of surgery were comparable (0.5 ± 1.3 days vs. 15.3 ± 11.1 days, p < 0.0001; 1.1 ± 3.9 days vs. 37.3 ± 8.3 days, p < 0.0001, respectively). All patients received definitive repair without mortality; the average length of stay after surgery was lower in the WPP group. There were 4 surgical complications in the U.S. group and 1 in WPP group. All patients were weaned off of TPN and all WPP patients are now on a regular PO diet. Every WPP patient has been seen in follow-up in the U.S. and in their home country. CONCLUSION: We provided successful multidisciplinary care for neonates with EA and TEF from LMICs with outcomes similar to the neonates with the same abnormality in the U.S. The partnership with WPP has been invaluable as it has provided essential support to identify and manage these patients. LEVEL OF EVIDENCE: IV.
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Atresia Esofágica , Fístula Traqueoesofágica , Recém-Nascido , Humanos , Criança , Fístula Traqueoesofágica/complicações , Países em Desenvolvimento , Complicações Pós-Operatórias/etiologia , Gastrostomia/efeitos adversos , Estudos RetrospectivosRESUMO
The nonorthogonal active space decomposition (NO-ASD) methodology is proposed for describing systems containing multiple correlation mechanisms. NO-ASD partitions the wave function by a correlation mechanism, such that the interactions between different correlation mechanisms are treated with an effective Hamiltonian approach, while interactions between correlated orbitals in the same correlation mechanism are treated explicitly. As a result, the determinant expansion scales polynomially with the number of correlation mechanisms rather than exponentially, which significantly reduces the factorial scaling associated with the size of the correlated orbital space. Despite the nonorthogonal framework of NO-ASD, the approach can take advantage of computational efficient matrix element evaluation when performing nonorthogonal coupling of orthogonal determinant expansions. In this work, we introduce and examine the NO-ASD approach in comparison to complete active space methods to establish how the NO-ASD approach reduces the problem dimensionality and the extent to which it affects the amount of correlation energy recovered. Calculations are performed on ozone, nickel-acetylene, and isomers of µ-oxo dicopper ammonia.
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OBJECTIVE: The Inventory of Callous-Unemotional Traits (ICU) is a widely used, comprehensive measure of callous-unemotional (CU) traits. While the ICU total score is used frequently in research, the scale's factor structure remains highly debated. Inconsistencies in past factor structure research appear to be largely due to the use of small non-representative samples and failure to control for method variance (i.e., item wording direction). METHOD: The current study used a multitrait-multimethod (MTMM) confirmatory factor analysis (CFA) approach that considers both trait and method variance to test the factor structure of a 22-item version of the self-report ICU in a multinational community sample of 4,683 adolescents (ages 11-17). RESULTS: Results showed that a hierarchical four-factor model (i.e., one overarching CU factor, four latent trait factors) that controlled for method variance (i.e., by allowing residuals from positively worded items to covary) provided the best fit (χ2 = 2797.307, df = 160, RMSEA=.059, CFI=.922, TLI=.888, SRMR=.045). CONCLUSIONS: After controlling for method variance, the best-fitting factor structure is consistent with how the ICU was developed and corresponds to the four symptoms of Limited Prosocial Emotions (LPE) specifier in the DSM-5 criteria for Conduct Disorder (CD). In addition, measurement invariance of this factor structure across age (i.e., younger versus older adolescents) and sex was supported. As a result, mean differences in ICU total score across age and sex can be interpreted as reflecting true variations in these traits. Further, we documented that boys generally scored higher than girls on the ICU, and this sex difference was larger in later adolescence.
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Difference approaches to the study of excited states have undergone a renaissance in recent years, with the development of a plethora of algorithms for locating self-consistent field approximations to excited states. Density functional theory is likely to offer the best balance of cost and accuracy for difference approaches, and yet there has been little investigation of how the parametrization of density functional approximations affects performance. In this work, we aim to explore the role of the global Hartree-Fock exchange parameter in tuning accuracy of different excitation types within the framework of the recently introduced difference projected double-hybrid density functional theory approach and contrast the performance with conventional time-dependent double-hybrid density functional theory. Difference projected double-hybrid density functional theory was demonstrated to give vertical excitation energies with average error and standard deviation with respect to multireference perturbation theory comparable to more expensive linear-response coupled cluster approaches ( J. Chem. Phys.2020, 153, 074103). However, despite benchmarking of local excitations, there has been no investigation of the methods performance for charge transfer or Rydberg excitations. In this work we report a new benchmark of charge transfer, Rydberg, and local excited state vertical excitation energies and examine how the exact Hartree-Fock exchange affects the benchmark performance to provide a deeper understanding of how projection and nonlocal correlation balance differing sources of error in the ground and excited states.
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INTRODUCTION: Poor parental monitoring has been theorized as a key risk factor for an adolescent's association with deviant peers. However, measurements of parental monitoring often only measure parental knowledge rather than parental monitoring actions, leaving the true longitudinal associations between parental monitoring and peer delinquency unclear. METHODS: The current sample consisted of 1095 male justice-involved adolescents (13-17 years old at baseline collected between 2011 and 2013) from across the United States who provided survey data every 6 months for 3 years. Longitudinal associations between parental monitoring constructs (i.e., parental solicitation and monitoring rules) and peer delinquency were tested using random intercept cross-lagged panel models to investigate both between-individual associations and within-individual bidirectional effects. RESULTS: Although parental monitoring and peer delinquency were negatively related at a between-individual level, very few within-individual directional effects were found. The few within-individual effects present indicated that parental solicitation predicted greater peer delinquency and peer delinquency predicted fewer parental monitoring rules over time. CONCLUSIONS: Current findings indicate that, while greater overall parental monitoring is associated with less peer delinquency, there is little evidence that changes in parental monitoring lead to reductions in peer delinquency over time. Results support previous findings suggesting parental monitoring should not be the sole target of intervention for reducing peer delinquency.
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Comportamento do Adolescente , Delinquência Juvenil , Adolescente , Humanos , Estudos Longitudinais , Masculino , Pais , Grupo Associado , Inquéritos e QuestionáriosRESUMO
Disparities in care for low-income children of color call for innovative culturally and linguistically responsive solutions to better engage marginalized populations in evidence-based interventions. In partnership with a community organization, the addition of natural helper support as an adjunct to Parent-Child Interaction Therapy (PCIT+NH) was examined as a strategy to increase recruitment, engagement, and retention in PCIT for families historically unreached by a university-based clinic. Natural helpers provided home-based skills practice and support for forty-two families whose parents were more racially and linguistically diverse and had lower income and lower caregiver education than the typical population served by the same program (i.e., program population). Families who received PCIT+NH had comparable or higher rates of engagement and improvements in clinical outcomes (i.e., decreased child externalizing and internalizing behaviors, increased child compliance, decreased caregiver stress, increased caregiver parenting skills) relative to the program population. Furthermore, higher doses of natural helper support were associated with higher rates on most measures of treatment engagement (i.e., treatment completion, completion of the Child Directed Interaction phase of treatment, PCIT sessions, homework in the Parent Directed Interaction phase of treatment), with the exception of homework in the Child Directed Interaction phase of treatment and overall session attendance rate. Next steps for testing the treatment engagement and clinical outcome effects of the PCIT+NH model are discussed.
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HYPOTHESIS: We hypothesize that varying the chemical structure of the monomeric unit in a polymer will affect the surface structure and interfacial molecular group orientations of the polymer film leveraging its response to solvents of different chemical affinities. EXPERIMENTS: Poly (2-methoxy ethyl methacrylate) and poly (2-tertbutoxy ethyl methacrylate) thin films exposed to either deuterated water (D2O) or deuterated chloroform (CDCl3) were studied by sum frequency generation (SFG) spectroscopy, contact angle goniometry, and atomic force microscopy (AFM) at the polymer-solvent interface, supported with molecular simulation studies. FINDINGS: SFG spectral analysis of the polymer thin films corroborated molecular re-organization at the surface when exposed to different chemical environments. The AFM height images of the polymer surfaces were homogeneously flat under CDCl3 and showed swollen regions under D2O. Following the removal of D2O, the exposed areas have imprinted, recessed locations and exposure to CDCl3 resulted in the formation of aggregates. The chemical affinity and characteristics of the solvents played a role in conformational change at the polymer surface. It had direct implications to interfacial processes involving adsorption, permeation which eventually leads to swelling, deformation or aggregation, and possibly dissolution.
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Metacrilatos , Polímeros , Metacrilatos/química , Microscopia de Força Atômica , Polímeros/química , Solventes/química , Propriedades de SuperfícieRESUMO
PURPOSE: The burden of surgical disease in children from low and middle-income countries (LMICs) is becoming more recognized as significant and undertreated. We recently reviewed our health system's experience with providing quaternary-level surgical care to children from LMICs through a partnership with World Pediatric Project (WPP), a not-for-profit organization. METHODS: A retrospective review was performed of all WPP-sponsored patients who received surgical care at our children's hospital from LMICs in the Caribbean and Central America from July 2000 to August 2018. RESULTS: Two hundred and fifty-five patients (average age: 5.9 ± 5.3 years; range: <1-18 years) from 14 countries received a total of 371 moderately to significantly complex operations from 10 pediatric surgical subspecialties, with cardiac, neurosurgery, craniofacial and general/thoracic surgical subspecialties being the most common. The average length of hospital stay was 10.7 ± 18.9 days. All patients had the opportunity to follow-up with local providers and/or visiting WPP-sponsored surgical teams. 227 patients (93.8%) were seen by WPP providers or released to an in-country physician partnering with WPP. There were 21 (8.2%) total, minor and major, postoperative complications. Five deaths (2.0%) occurred at our institution and 7 from disease progression, after returning to their home country. CONCLUSIONS: Providing complex surgical care to LMIC children in the US may help address a significant global burden. This care can be provided by multiple subspecialists with excellent outcomes, good follow-up, and low complication and mortality rates. Having a supportive health care system, volunteer surgeons, and an organization that manages logistics and provides financial support is essential. TYPE OF STUDY: Clinical research, retrospective review LEVEL OF EVIDENCE: Level IV.