School-based assessment of mental health risk in children: the preliminary development of the Child RADAR.

BACKGROUND: Screening young people for risk of mental health difficulties in schools is an effective method to facilitate monitoring and early intervention. This study is a preliminary report on the adaptation of the Youth RADAR screening instrument for primary school children. Specifically designed to be used in schools, the Child RADAR assesses a child's balance of risk and protective factors known to be associated with the development of mental health problems. METHOD: Three hundred and thirty-nine children drawn from six primary schools across NSW, Australia, completed the alpha version of the Child RADAR in addition to an assessment of depression and anxiety symptoms and subjective well-being. RESULTS: Confirmatory factor analysis revealed the Child RADAR to have an acceptable factor structure. Reliability for the Total Child RADAR was satisfactory based on both internal consistency (α = .86) and test-retest reliability (r = .85). Convergent validity was demonstrated through significant associations with symptoms of anxiety and depression. CONCLUSIONS: The Child RADAR shows preliminary promise as a school-based screener of mental health risk. Further evaluation is required to demonstrate the generalizability of the instrument across different populations.

Safety of acoustic separation in plastic devices for extracorporeal blood processing.

BACKGROUND: Acoustic cell separation uses ultrasound waves to separate cells from plasma to perform plasmapheresis. Although the fundamental process has been studied for decades, no acoustic cell separation has been studied in a disposable plastic format suitable for clinical applications. STUDY DESIGN AND METHODS: We developed a disposable, rectangular, polystyrene microchannel acoustic cell-separation system and applied acoustic energy relevant for plasmapheresis. Fresh blood from healthy volunteers was exposed in vitro to acoustic energy in an open microfluidic circuit with and without ultrasound applied. Blood was tested for perturbations in red blood cells, platelets, and coagulation using clinical assays. RESULTS: Red blood cell and platelet size parameters as well as coagulation activation all were within 3% of baseline values. P-selectin expression on platelets increased by an average of 10.9% relative to baseline. Hemolysis increased with flow through the microfluidic channel, but percentage hemolysis remained below 0.3%. CONCLUSION: Blood parameters in a single-pass, microfluidic acoustic cell-separation apparatus remained within normal limits. In vivo animal studies that model continuous separation in a physiologic environment are warranted.

General practitioners and school psychologists: An underused collaboration.

BACKGROUND: General Practitioners (GPs) play a vital role in the management of the social, emotional and behavioural health of children and adolescents. Best practice usually requires collaboration with a broad range of other medical and allied health professionals, to bring about optimal outcomes for patients and their family. OBJECTIVE: This article describes the specific role of a school psychologist and outlines various ways that GPs and school psychologists can collaborate in the assessment and management of school­aged patients. DISCUSSION: Given the importance of school in the social and emotional development of children and adolescents, school psychologists should be considered a valuable partner for GPs when caring for young people.

Comparative local analysis of metabolites, lipids and proteins in intact fish tissues by LAESI mass spectrometry.

Direct mass spectrometric analysis of animal tissues is an emerging field enabled by recent developments in ambient ion sources. Label-free in situ analysis of metabolites, lipids, and peptides/proteins from intact tissues in whole fish specimens of different gender and age were performed by laser ablation electrospray ionization (LAESI) mass spectrometry (MS). Hypertrophied glandular tissue (gill gland) of adult male Aphyocharax anisitsi (bloodfin tetra) was compared with gill tissues in females of the same species. Comparison of a large number of sample-specific ions was aided by a multivariate statistical method based on orthogonal projections to latent structures discriminant analysis. More than 200 different ions were detected in the mass spectra corresponding to primary metabolites, hormones, lipids and peptides/proteins. The gill tissues of the sexually mature males exhibited multiply charged ions in the 6+ to 10+ charge states corresponding to a protein with a molecular weight of 11 380 Da. This protein was present only in the mature male gill glands but absent in the corresponding area of the female and immature male specimens. An additional nine proteins were detected by LAESI-MS in both the male and female gill tissues.

Relationships among major lineages of characid fishes (Teleostei: Ostariophysi: Characiformes), based on molecular sequence data.

The family Characidae is a group of freshwater bony fishes that exhibits high species-level diversity and whose members inhabit parts of Texas, Mexico, and Central and South America. Thus far, morphological data have been of limited use in discerning relationships among subfamilies and incertae sedis genera of the family Characidae. In this study, DNA sequence data from GenBank were combined with new sequences for analyses under Bayesian and parsimony schemes. Sequences fell into four gene partitions, with three genes in the mitochondrial subset (12S, 16S, COI genes) and one gene in the nuclear subset (RAG2 gene). Inferred Bayesian and parsimony-based phylogenies reject the monophyly of certain groups (e.g., Astyanax, Hyphessobrycon, and Bryconamericus), do not reject the monophyly of others (e.g., Cheirodontinae and "clade A" of previous authors), and present new sister-group hypotheses (e.g., Brittanichthys sister to Paracheirodon). Sister to clade A is a lineage referred to herein as "clade B" which includes Exodon and exemplars from Cheirodontinae (the most basal lineage within clade B), Aphyocharacinae, Tetragonopterinae, and Characinae (excluding Gnathocharax). "Clade C" is sister to A+B and contains representatives of large incertae sedis genera (e.g., Hyphessobrycon, Hemigrammus), as well as members of Stethaprioninae. Unless certain other subfamilial names are to be disregarded, the use of Tetragonopterinae should continue to be restricted to species of Tetragonopterus because other genera previously referred to this subfamily grouped in clades A or C, quite distant from Tetragonopterus.

Utilization of Acupuncture Services in the Emergency Department Setting: A Quality Improvement Study.

PURPOSE: Patients often present to the emergency department (ED) for pain. As opioid fatalities rise, alternative treatments are warranted for pain management. Acupuncture, a nonpharmacological treatment involving the insertion of needles into skin or tissue at specific points within the body, may help to decrease acute pain. Our study aimed to assess the utilization and impact of acupuncture in the ED for acute pain management. METHODS: We conducted a retrospective analysis of purposefully collected quality improvement data. Patients who were ≥18 years old and who presented to the ED at an urban medical center in Wisconsin during 2017 were offered acupuncture services based on their emergency severity index (ESI; range: highest severity [1] - lowest severity [5]), reason for visit, and physician approval. Paired t-tests were used to examine mean differences between pre- and post-acupuncture pain, stress, anxiety, and nausea scores (range: none [0] - worst [10]). Multivariable regression models also were constructed. RESULTS: A total of 379 patients received acupuncture. Patients presented predominately with an ESI score of 3 (68.9%) or 4 (24.8%); 46.4% received opioids in the ED. Mean pre- and post-acupuncture pain scores significantly differed (6.5 vs 3.4; P<0.001); receiving opioids during the ED visit was not associated with improved pain scores (P=0.948). Stress (5.7 vs 1.9), anxiety (4.8 vs 1.6), and nausea (1.6 vs 0.6) scores also improved (P<0.001) following acupuncture. CONCLUSIONS: Emergency department acupuncture significantly decreased pain, stress, anxiety, and nausea. Our findings support a larger randomized controlled trial to further assesses the impact of acupuncture for acute pain in other ED settings.

Living renal donor allograft lithiasis: a review of stone related morbidity in donors and recipients.

PURPOSE: The use of screening computerized tomography angiography has resulted in the increased detection of incidental nephrolithiasis in potential living renal donor candidates. We reviewed current acceptance guidelines for donors with stone disease as well as data on stone related outcomes in donors with stone disease and recipients who received a kidney with a stone left in situ. MATERIALS AND METHODS: We performed a medical literature search in English using MEDLINE/PubMed that addressed renal donor allograft lithiasis. We then analyzed the literature with respect to the historical evolution of this concept, current guidelines regarding the acceptance of donors with stones and stone related morbidity in recipients and donors. RESULTS: The prevalence of asymptomatic solitary nephrolithiasis has increased with the widespread use of screening computerized tomography angiography during renal donor evaluation. Few studies have addressed the risk of stone related morbidity in donors and recipients. Short-term studies have shown little stone related morbidity in patients who donate or receive an allograft with a stone left in situ. Consensus statements from transplant societies around the world offer guidance for determining donor eligibility. CONCLUSIONS: The available literature on stone related morbidity in donors and recipients is extremely limited. It would appear that the risk of recurrence and subsequent morbidity in renal donors with a solitary kidney is low but not insignificant. Rare stone related adverse events are reported for recipients of an allograft with a stone left in situ. Renal donors and recipients should be educated regarding their unique risk perspectives. Long-term followup is mandatory.

Sperm ultrastructure in the inseminating Macropsobrycon uruguayanae (Teleostei: Characidae: Cheirodontinae).

Macropsobrycon uruguayanae is a small, inseminating characid (tetra) of the tribe Compsurini. Although spermatozoa can be found within the ovarian cavity close to oocytes, the exact moment of fertilization has not yet been determined. Spermatozoa have moderately elongate nuclei with electron-dense chromatin. During spermiogenesis, nuclear rotation takes place. Elongate mitochondria with lamellar cristae are found posterior to the nucleus. Centrioles are parallel to one another with the proximal centriole slightly anterior to the longer distal one. The anterior tip of the proximal centriole is located within a shallow nuclear fossa. Electron-dense spurs are associated within the anterior and posterior ends of the distal centriole. Striated centriolar rootlets radiate both anteriorly and posteriorly from the distal centriole. Nine longitudinal accessory microtubules surround the axoneme in the proximal flagellum. The flagellum has a typical 9 + 2 axoneme with no intratubular differentiation. Atypical spermatozoa are also found in the testicular lumen. These cells resemble spermatozoa in most aspects, except that their nuclei are variable in shape, with the granular chromatin less electron-dense than that seen in spermatozoa. The origin and function of these cells could not be determined. The specializations seen in the spermatozoa are discussed as possible adaptations related to the habit of insemination.

Practical use of investigations in patients with hematuria.

OBJECTIVE: The majority of patients with microscopic hematuria undergo a complete evaluation resulting in negative findings. The outcome of patients with hematuria was analyzed in an effort to optimize the use of investigations. PATIENTS AND METHODS: The records for 404 patients who presented with hematuria were reviewed. Data were collected on demographics, type of hematuria, investigations, and final diagnosis. RESULTS: The hematuria was microscopic in 140 patients (35%) and gross in 264 patients (65%). In gross hematuria patients, 10% had urinary tract tumors and 12% had calculi. All patients with genitourinary tumors and 87% of patients with calculi had gross hematuria and/or > or =5 RBCs/HPF (red blood cells per high-power microscopic field) on urinalysis. The sensitivity and specificity were 94% and 6% for the dipstick urine test, 37% and 71% for urine cytology, 92% and 93% for computed tomography (CT), 50% and 95% for ultrasound scans, and 38% and 90% for intravenous pyelography, respectively. Logistic regression analysis showed that age and number of RBCs/HPF in the urinalyses were the only significant factors predicting genitourinary cancer. In patients < or =40 years old, there was one patient with malignancy and seven patients with stones. In older patients, there were 31 patients with malignancy and 32 patients with stones. CONCLUSIONS: Patients with <5 RBCs/HPF on three urinalyses are unlikely to have significant pathology and could possibly be followed up conservatively. Patients < or =40 years of age should have a noncontrast CT or ultrasound study if they present with microscopic hematuria, and a cystoscopy should be added if gross hematuria exists. In older patients, a pre- and postcontrast CT and a cystoscopy should be performed.

Transcriptomic analysis of changes in gene expression of immune proteins of gill tissue in response to low environmental temperature in fathead minnows (Pimephales promelas).

In the face of ongoing climate change, it is imperative to understand better the effects of temperature on immune function in freshwater teleosts. It is unclear whether previously observed changes were caused by temperature per se. We studied changes in the gill transcriptome of fathead minnows (Pimephales promelas) at low temperature to understand better the effects of temperature on immune function. De novo assembly of the transcriptome using Trinity software resulted in 73,378 assembled contigs. Annotation using the Trinotate package yielded 58,952 Blastx hits (accessions). Expression of 194 unique mRNA transcripts changed in gill tissue of fathead minnows acclimatized to 5° compared to controls at 22 °C. At 5 °C mRNAs coding for proteins involved in innate immune responses were up-regulated. Those included proteins that block early-stage viral replication and macrophage activation. Expression of mRNAs coding for pro-inflammatory molecules and mucus secretion were also enhanced. Messenger RNAs coding for proteins associated with adaptive immune responses were down-regulated at 5 °C. Those included antigen-presenting proteins and proteins involved in immunoglobin production. Messenger RNAs coding for proteins that stimulate the cell cycle were also down-regulated at 5 °C. Histological comparison revealed that gills of cold acclimated fish had fewer mucus cells but cells contained larger mucus droplets. We conclude that decreased temperature modifies the immune systems of freshwater teleosts, leading to genome-wide upregulation of innate immunity and down regulation of adaptive immunity. Such acclimation likely evolved as an adaptive strategy against seasonal changes in infectious insults.

Reproductive morphology of Brittanichthys axelrodi (Teleostei: Characidae), a miniature inseminating fish from South America.

Light and electron microscopy were used to investigate the morphology of reproductive characters in a characid fish, Brittanichthys axelrodi. Spermatozoa were found in ovaries of females, thereby confirming insemination in this species. Bony hooks can be found on the fourth unbranched ray and branched rays 1-4 of the anal fin and the unique sigmoidally-curved ray of the caudal fin in mature males. Testes have three distinct regions: an anterior spermatogenic region, an aspermatogenic middle region lined with a simple squamous epithelium and used for storage of mature spermatozoa, and a posterior region of coiled chambers lined with a high simple cuboidal epithelium. The most posterior region appears to be instrumental in the formation and storage of spermatozeugmata, unencapsulated sperm packets. Thus far, this tripartite testis morphology is unique among characids. The mature spermatozoon has an elongate nucleus ( approximately 5 microm in length). A striated rootlet originates at the anterior end of the distal centriole and continues to the anterior tip of the cell. The striated rootlet wraps around the entire ventral area of the anterior part of the nucleus and appears to continue around the anterior tip of the nucleus and down the dorsal side as electron-dense material. Several large, spherical mitochondria ( approximately 0.6 microm in diameter) with lamellar cristae overlap the posterior end of the nucleus and continue beyond together with the cytoplasmic collar that contains the flagellum which lacks axonemal fins. Each spermatozeugma is lanceolate in shape when sectioned mid-sagitally, with the core staining positively for mucopolysaccharides. In both sexes, the gonopore opens posterior to the anus, with the urinary pore having a separate opening posterior to the gonopore. Bands of skeletal muscle were found in the area of the male gonopore. These morphological features are likely linked to the reproductive mode of insemination, a trait that is so far as known, relatively rare among teleost fishes, but is proving increasingly frequent among certain groups of characid fishes.

Outcomes for vasovasostomy performed when only sperm parts are present in the vasal fluid.

This article reviews the outcomes for vasovasostomy (VV) when only sperm parts were present in the vasal fluid. Thirtyfour patients who underwent bilateral (31) or unilateral (3) VV had either sperm parts bilaterally or sperm parts on 1 side and intravasal azoospermia on the contralateral side. Two of the procedures (1 unilateral, 1 bilateral) were repeat procedures. Patient and partner age were 42 +/- 1.2 (range: 34-54 and 33 +/- 0.9 (range: 23-42) years, respectively. Follow-up was 10 +/- 1.8 months. The obstructive interval was 10 +/- 0.9 (range: 4-27) years. The patency rate was 76% (26/34). The obstructive interval ranges for patent cases versus not-patent cases were 3 to 21 and 3 to 27 years, respectively. The obstructive interval did not differ between the patent and not-patent groups (9 years vs 11 years, P = 0.3978). The pregnancy rate for those with sufficient follow-up was 35% (7/20). Of the 8 failed cases, 2 had only an occasional sperm head bilaterally and 1 other had an occasional sperm head on 1 side and contralateral intravasal azoospermia. If these 3 cases were excluded, then the patency rate was 84% (26/31). The patency rate for VV performed when only sperm parts were present in the vas fluid was lower than previously reported patency rates with complete sperm but at least as good as most surgeons' experience with vasoepididymostomy. The pregnancy rate was also less than previously reported pregnancy rates with complete sperm. These data suggest that VV is indicated only when sperm parts are noted in the vasal fluid. There does not appear to be a threshold obstructive interval above which VE would be indicated in this setting. If only an occasional sperm head is noted in the vasal fluid, then the surgeon should consider vasoepididymostomy.

Screening for mental health risk in high schools: The development of the Youth RADAR.

Epidemiological studies indicate that as many as 1 in 5 young people will develop a mental health problem in any given year. Early detection and intervention are needed to reduce the impact that these conditions have-both for the young person and for the communities in which they live. This study reports the development of a new instrument aimed at helping identify students at risk of developing mental health difficulties. Rather than asking about the presence of symptoms of mental health conditions, the RADAR screening tool assesses a student's balance of risk and protective factors associated with the development of mental health problems. The RADAR was evaluated with a sample of 838 participants in high school Years 7-12. A robust internal factor structure was revealed using exploratory and confirmatory factor analysis. Internal consistency was satisfactory for each subscale, ranging from .73 to .90 while the reliability for the total scale was .91. Retest stability, measured over a 12 month period, was found to be strong (r = .72). Convergent validity was demonstrated with reference to standard measures of depression and behavioral problems. It is concluded that the RADAR is a promising measure for helping mental health professionals and educators decide which students may be at risk of developing mental health problems. (PsycINFO Database Record

An implantable, designed-for-human-use peripheral nerve stimulation and recording system for advanced prosthetics.

Complex suture prostheses that deliver sensory and position feedback require a more sophisticated integration with the human user. Here a micro-size active implantable system that provides many-degree-of-freedom neural feedback in both sensory stimulation and motor control is shown, as one potential human-use solution in DARPA's HAPTIX program. Various electrical and mechanical challenge and solutions in meeting both sensory /motor performance as well as ISO 14708 FDA-acceptable human use in an aspirin-size active implementation are discussed.

Sperm and spermatozeugma ultrastructure in the inseminating species Tyttocharax cochui, T. tambopatensis, and Scopaeocharax rhinodus (Pisces: Teleostei: Characidae: Glandulocaudinae: Xenurobryconini).

This article presents the scanning and transmission electron microscopy of the spermatozoa and sperm packets of three inseminating species of the glandulocaudine tribe Xenurobryconini. All three species, Scopaeocharax rhinodus, Tyttocharax cochui, and T. tambopatensis produce unencapsulated sperm packets (= spermatozeugmata) of similar morphology. The external anterior surface of each spermatozeugma is comprised of elongate sperm heads arranged in parallel, and the posterior part is made up of tightly packed flagella. The interior of the anterior portion consists of alternating layers of sperm heads and flagella. The remarkable integrity of each packet appears to be maintained through an electron-dense secretion seen among all parts of the cells. Spermatozeugma formation takes place within the spermatocysts at the end of spermiogenesis and at spermiation fully formed packets are released. Morphology of the mature spermatozoa was similar in all three species. Each nucleus is elongate, flattened along most of its length, and tapers at either end. The two centrioles are nearly parallel to one another and are located just anterior to the nucleus. Elongate mitochondria are located along the nucleus. The single flagellum, which lacks axonemal fins, is initially contained within a short cytoplasmic collar. Accessory microtubules run parallel to the long axis of the nucleus just beneath the plasma membrane. During spermiogenesis, no nuclear rotation occurs and the cytoplasmic canal containing the flagellum elongates along with the nucleus. However, prior to spermiation all but the anterior portion of the collar degenerates. The sperm modifications observed in these species are discussed as adaptations to the unique reproductive habit of insemination.

Outcomes for vasovasostomy with bilateral intravasal azoospermia.

We conducted an evaluation of outcomes for microsurgical vasectomy reversal in which sperm are absent from the vas fluid in order to determine a threshold obstructive interval when vasoepididymostomy (VE) may be indicated. Vasectomy reversal was performed for 32 patients with intravasal azoospermia: 25 received bilateral vasovasostomy (VV), 1 had a bilateral VV, 5 underwent VV/VE, and 1 had bilateral VE. Overall, the patency rate was 50% (14 of 28). Five pregnancies (20%) and 3 live births (12%) occurred in 25 patients with sufficient follow-up. One pregnancy was electively terminated and the other is ongoing, for an ongoing or delivered rate of 16%. The patency rate for VV (either bilateral or unilateral) was 55% (12 of 22). Median obstructive interval was 7 years in patent and 15 years in nonpatent cases, respectively, (P =.0027). Sperm were not observed after VV in any case n which the obstructive interval was greater than 11 years. If VV was limited to obstructive intervals of 11 years or less, then the patency rate was 80% (12 of 15) and the pregnancy rate was 38% (5 of 13). The patency rate for bilateral VV was 67% (8 of 12) if clear fluid was observed on at least one side. We conclude that VE is not required in every case of intravasal azoospermia, but it could improve success rates in this setting. Based on our experience, VE may be indicated for intravasal azoospermia if the obstructive interval is more than 11 years.

Gill-derived glands in glandulocaudine fishes (teleostei: Characidae: Glandulocaudinae).

The Glandulocaudinae is a subfamily of neotropical characid fishes from Central and South America. A unifying feature of the subfamily is the caudal gland, found almost exclusively in males. The gland consists of tissue on the base of the caudal fin covered in part by hypertrophied scales. Scale movement as the caudal fin is flexed appears to facilitate the release of chemical compounds from the glandular tissue. We describe here a different structure, found in the gill cavity of mature males in 12 of 17 glandulocaudine genera examined. Termed a gill gland, it develops as a male secondary sex character and appears morphologically suited to release chemical signals. The gland forms by the growth of tissue over and around 4-13 anterior gill filaments on the first gill arch, forming chambers with ventral openings. Within the gland chambers, gill secondary lamellae usually shorten and may disappear. When secondary lamellae persist, simple columnar epithelial cells develop between them. In the absence of secondary lamellae, the gland chambers are lined with a simple cuboidal or columnar epithelium. Gland size and the degree of gill modification vary among species. Gill glands appear absent in five glandulocaudine genera, suggesting character reversals based on current phylogenetic hypotheses and systematic classification. Gill gland morphology suggests that this structure releases chemical compounds into the gill current. The presence of gill glands only in mature males suggests a function in reproduction and/or male aggression. Together with studies of the caudal gland, this research suggests that chemical signals may play important roles in glandulocaudine reproduction.

Predictive factors for percutaneous nephrolithotomy outcomes in neurogenic bladder population.

PURPOSE: To review experience performing percutaneous nephrolithotomy (PCNL) on patients with neurogenic bladder, evaluating predictors for increased length of stay (LOS), intensive care unit (ICU) stay, stone-free rate, and number of procedures and outcomes measures between spinal cord injury (SCI) and spina bifida (SB) patients. PATIENTS AND METHODS: We retrospectively reviewed our PCNLs from January 1, 2002 to December 31, 2009 and identified 47 patients. Data collected included LOS, ICU stay, stone-free rate, complications, and total procedures. RESULTS: A total of 66 PCNLs were performed on 47 patients. The mean LOS was 5.3 days, and nine patients needed ICU stay (mean 13.9 d). Initial stone-free rate was 60.6%, and final stone-free rate was 69.7%. Multiple access was associated with increased LOS (P=0.01), ICU stay (P<0.01), transfusion (P<0.01), and pulmonary complications (P=0.03). Upper-pole access was associated with decreased initial stone-free rate (P=0.04). Midpolar access predicted increased final stone-free rate (P=0.04). Mean stone size was 3.31 cm and was predictive of an increased number of procedures (P=0.04). Larger stone size was also predictive of decreased initial stone-free rate (P=0.03) and final stone-free rate (P=0.05). There were no statistically significant differences between SCI and SB patients in terms of outcomes. CONCLUSIONS: Increasing stone size and multiple access were predictors of adverse outcomes, and location of access affected stone-free status. We found no differences in outcomes between SB and SCI patients. To our knowledge, this is the largest series reported regarding PCNLs in this patient population.

Treatment outcomes for percutaneous nephrolithotomy in renal allografts.

PURPOSE: We reviewed our experience with percutaneous nephrolithotomy (PCNL) in patients with renal allografts over 19 years. MATERIALS AND METHODS: We cross-referenced all renal allograft recipients at our institution with all PCNLs performed. We identified 16 renal allograft recipients who underwent a total of 21 PCNL procedures between 1986 and 2005. These charts were abstracted and the outcomes reviewed. RESULTS: The mean follow-up was 7.2 years. No loss of renal function occurred in the perioperative period. Five patients lost graft function during the follow-up period; however, none of these patients' loss of function was related to the PCNL. No patient had sepsis. Thirteen of the 16 patients were rendered stone free during long-term follow-up. CONCLUSIONS: PCNL is a safe and effective method of treating nephrolithiasis in a transplanted kidney.