Early, concurrent, and consistent hand preferences predict stacking in toddlerhood.

Stacking is a hallmark of fine motor skill development and requires skilled hand use. One mechanism for children to gain manual proficiency involves establishing a hand preference that creates practice differences between the hands as the preferred hand is used more often and in different ways than the other. Prior work found that stacking skill emerged earlier for infants with an identifiable hand preference. However, it is not known how hand preference relates to later toddler stacking performance. This study examined the effects of early hand preference (infant pattern), concurrent hand preference (toddler pattern), and consistent hand preference (infant to toddler pattern) on toddler stacking skills. Sixty-one toddlers, whose hand preferences as infants were known, were assessed for their toddler hand preference and their stacking skill across 7 monthly visits from 18 to 24 months of age. Using multilevel Poisson longitudinal analysis, children with hand preferences that were consistent across both infancy and toddlerhood were more successful at stacking, compared to those with inconsistent preferences across the infant and toddler periods. Thus, consistency of hand preferences during the first 2 years likely contributes toward individual differences in the development of fine motor skills.

The Incidence of Alcohol Use Disorders during the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has introduced a myriad of challenges to healthcare systems and public health policies across the globe. Individuals with alcohol use disorders are at peaked risk due to mental, socio-demographic, and economic factors leading to hindered mental health service access, misinformation and adherence. METHODS: Keywords including "alcohol use", "death", "hand sanitizer", "overdose" and "COVID-19" were used to obtain 8 media reports for case analysis. A review of 34 manually extracted records were also conducted using PubMed, MEDLINE, Scopus, and the Embase database with no time and language restrictions. RESULTS: A total of 2,517 individuals with alcohol overdose across the United States, India, Canada, and Iran were presented. The majority of cases were male, ages 21-65. Common contributors were linked to socio-economic changes, disruption to mental health services, and physical isolation. CONCLUSION: While original studies are essential to evaluate the etiologies of alcohol use and misuse during pandemics, the dissemination of misinformation must be curbed by directing vulnerable individuals towards accurate information and access to mental health services.

Preference phenotypes to facilitate shared decision-making in rheumatoid arthritis.

OBJECTIVE: Implementing treat-to-target (TTT) strategies requires that patients with rheumatoid arthritis (RA) and their rheumatologists decide on how best to escalate care when indicated. The objective of this study was to develop preference phenotypes to facilitate shared decision-making at the point of care for patients failing methotrexate monotherapy. METHODS: We developed a conjoint analysis survey to measure the preferences of patient with RA for triple therapy, biologics and Janus kinase (JAK) inhibitors. The survey included seven attributes: administration, onset, bothersome side effects, serious infection, very rare side effects, amount of information and cost. Each choice set (n=12) included three hypothetical profiles. Preference phenotypes were identified by applying latent class analysis to the conjoint data. RESULTS: 1273 participants completed the survey. A five-group solution was chosen based on progressively lower values of the Akaike and Bayesian information criteria. Members of the largest group (group 3: 38.4%) were most strongly impacted by the cost of the medication. The next largest group (group 1: 25.8%) was most strongly influenced by the risk of bothersome side effects. Members of group 2 (11.2%) were also risk averse, but were most concerned with the risk of very rare side effects. Group 4 (6.6%) strongly preferred oral over parenteral medications. Members of group 5 (18.0%) were most strongly and equally influenced by onset of action and the risk of serious infections. CONCLUSIONS: Treatment preferences of patients with RA can be measured and represented by distinct phenotypes. Our results underscore the variability in patients' values and the importance of using a shared decision-making approach to implement TTT.

The development of neuromotor skills and hand preference during infancy.

Assessing infant handedness has been controversial. Different assessment techniques and theoretical approaches produce different results. Evidence from a dynamic systems perspective showed that the development of postural control during infancy affects the expression of an infant's handedness. However, others found that developmental changes in postural control influenced the amount of symmetrical (bimanual) reaching during infancy, but not hand preference. Since most studies of infant handedness use age to assess development, perhaps measures of an infant's developing neuromotor control, irrespective of age, would better predict changes in an infant's hand preference. To assess neuromotor development, items from [Touwen's (1976) Neurological development in infancy. Lavenham, Suffolk: The Lavenham Press, LTD]. "Group III" indices were used. These items assess developmental changes in neuromotor abilities throughout the 6-14-month age period. Hand preference for acquiring objects was measured during these same months. Group Based Trajectory Models (GBTM) of 380 infants identified four different groups of infants according to the trajectory of the development of their hand preferences (32% Early Right, 12% Early Left, 25% Late Right, 30% No Preference). A multilevel model was used to compare these four developmental trajectories according to age and neuromotor development. Age, not neuromotor development, is a better predictor of differences in developmental trajectories of the four hand preference groups. However, Late Right infants are significantly less developed at 6 months than No Preference, Early Right and Left infants and both Early Right and Left infants are most advanced at 6 months. All groups exhibit similar rates of neuromotor development indicating no "catch-up" by the Late Right infants. Thus, any assessment of infant handedness will incorporate necessarily four groups of infants with differently developing hand preferences and neuromotor abilities.

Toddler hand preference trajectories predict 3-year language outcome.

A growing body of work suggests that early motor experience affects development in unexpected domains. In the current study, children's hand preference for role-differentiated bimanual manipulation (RDBM) was measured at monthly intervals from 18 to 24 months of age (N = 90). At 3 years of age, children's language ability was assessed using the Preschool Language Scales 5th edition (PLS™-5). Three distinct RDBM hand preference trajectories were identified using latent class growth analysis: (1) children with a left hand preference but a moderate amount of right hand use; (2) children with a right hand preference but a moderate amount of left hand use; and (3) children with a right hand preference and only a mild amount of left hand use. Stability over time within all three trajectories indicated that children did not change hand use patterns from 18 to 24 months. Children with the greatest amount of preferred (i.e., right) hand use demonstrated higher expressive language scores compared to children in both trajectories with moderate levels of non-preferred hand use. Children with the greatest amount of right hand use also had higher scores for receptive language compared to children with a right hand preference but moderate left hand use. Results support that consistency in handedness as measured by the amount of preferred hand use is related to distal language outcomes in development.

Development of role-differentiated bimanual manipulation in infancy: Part 1. The emergence of the skill.

This is the first paper in a series of three discussing different aspects of the development of role-differentiated bimanual manipulation (RDBM-two hands performing different but complementary actions on an object). Emergence of RDBM is an important shift in the development of infant manual skills. Trajectories of monthly changes in the number of RDBMs and RDBM hand preference were explored in a sample of 90 (57 males) normally developing infants (30 with a right preference for acquiring objects, 30 with a left preference, 30 with no preference) during the 9-14 month period. Multilevel analysis revealed that infants performed more RDBMs with age, with similar patterns of change in all hand preference groups. A hand-use preference for RDBM became more prominent with age with most right-preferring infants and those without a preference for object acquisition developing right-hand preference for RDBM. Left-preferring infants exhibited more heterogeneity in their hand-use for RDBM.

Development of role-differentiated bimanual manipulation in infancy: Part 2. Hand preferences for object acquisition and RDBM--continuity or discontinuity?

This second paper in a series of three investigated the development of hand preference for role-differentiated bimanual manipulation (RDBM) relative to the infant's hand preference for object acquisition and to the infant's hand-use for acquiring the objects used to assess RDBM. The same 90 infants (30 with a right preference, 30 with a left preference, and 30 with no preference to acquire objects) from the first paper were tested from 9 to 14 months for hand preference for acquiring those objects used to assess RDBM and for a hand preference for RDBM. Multilevel analysis revealed that infants with a hand preference for acquiring objects decreased in their use of the preferred hand for object acquisition during the 11 to 14 month interval, which coincided with the development of a hand preference for RDBM. These results are discussed in relation to the cascade theory of hand preference development.

Development of role-differentiated bimanual manipulation in infancy: Part 3. Its relation to the development of bimanual object acquisition and bimanual non-differentiated manipulation.

This third paper in a series of three related developmental trajectories of bimanual object acquisition and non-differentiated bimanual manipulation (NDBM) to patterns of role-differentiated bimanual manipulation (RDBM) development to help identify the sequence of events that might predict (and potentially facilitate) the development of RDBM skill. Ninety infants were tested monthly from 6 to 14 months of age for object acquisition, and from 9 to 14 months for NDBM and RDBM. The results did not support the hypothesis proposing that the onset of RDBM would require decoupling of the hands in unimanual acquisition, but supported the prediction that coupling of the hands in bimanual acquisition would predict increasing expertise in the RDBM skill. The relation between the bimanual object acquisition and RDBM was found to be mediated by NDBM, which prompts the hypothesis that bimanual acquisition of objects facilitates the development of NDBM, which, in its turn, facilitates the development of the RDBM skill.

Do hand preferences predict stacking skill during infancy?

The cascade theory of handedness suggests that hand preferences develop from a history of cascading and sequentially developing manual asymmetries for a variety of actions. Infants who consistently use their preferred hand for a variety of actions likely would gain proficiency using that preferred hand and, consequently, perform more proficiently on other challenging manual tasks. One such task is object stacking, which has been linked with a number of cognitive abilities. If infant hand preference facilitates the development of stacking skill, then this could provide a link by which early hand preference might affect the development of cognition. From a sample of 380 infants assessed for an acquisition hand preference across 6-14 months, 131 infants were assessed for stacking skill from 10 to 14 months at monthly visits. Four unique handedness sub-groups were identified from the 380-infant sample: left, trending right, stable right, or no hand preference. Each of the four hand preference groups exhibited different trajectories in the development of their stacking skills. Left- and stable right-handers stacked more items than infants with no preference by 14 months, whereas infants with a trending right preference did not. The proportion of preferred hand use (right and left) from 6 to 9 months also predicted an earlier initial onset of stacking skill, whereas the proportion of only right hand use did not. Thus, the development of a hand preference predicts an earlier emergence of stacking skill and may have implications for other domains of infant cognitive development.

Postural influences on the development of infant lateralized and symmetric hand-use.

Within-individual variability is such an apparent characteristic of infant handedness that handedness is believed to consolidate only in childhood. Research showed that manifest handedness is influenced by emerging postural skills (sitting, crawling, and walking). In this investigation, it was proposed that symmetric hand-use (tendency to acquire objects bimanually), rather than lateralized hand-use (the use of one hand more than the other), may be influenced by postural changes. Trajectories of lateralized and symmetric hand-use for object acquisition were examined in 275 infants tested monthly from 6 to 14 months. Multilevel modeling revealed that change in lateralized hand-use is unrelated to developmental transitions in infant posture, whereas the trajectory of symmetric hand-use changes significantly with the development of postural skills.

Left Renal Artery Chronic Occlusion in the Setting of Extensive Intraprosthetic Mural Thrombus in an Abdominal Aortic Endograft.

Thrombotic deposits within aortic endograft post-endovascular aortic aneurysm repair (EVAR) is a fairly well-recognized complication, yet their clinical significance remains inadequately understood. We present a rare case of extensive mural thrombus formation in an oncologic patient with a history of EVAR, emphasizing the importance of lifelong surveillance in abdominal aortic aneurysm (AAA)-EVAR patients. A 75-year-old female was admitted with refractory hypertension secondary to a medium-sized AAA, which exhibited an extensive mural thrombus, contributing to atrophic changes in the left kidney and likely chronic occlusion of the left renal artery. Factors contributing to thrombus formation generally include endograft configuration, aneurysm diameter, and patient-specific characteristics, such as a pro-thrombotic status conferred by metastatic lung cancer. This case underscores the necessity for comprehensive surveillance strategies post-EVAR. Recommendations advocate for a 30-day follow-up and lifelong annual surveillance, employing modalities such as color duplex ultrasound for detection of endoleaks and sac enlargement, with selective use of CT imaging. This case underscores the importance of continued vigilance and surveillance in patients undergoing EVAR, particularly those with complex medical histories, to mitigate potential long-term complications and optimize patient outcomes.

Increased anxiety and emotional lability in a patient with SDHB gene mutation paraganglioma: a call to multidisciplinary approach.

Paragangliomas are neuroendocrine tumors that have the potential to secrete catecholamines. They have been linked to genetic mutations in the mitochondrial succinate dehydrogenase (SDH) complex. Patients can experience both physical symptoms and psychiatric symptoms like anxiety, depression, and psychosis. These symptoms can occur as paroxysmal episodes with periods of increased catecholamine secretion. We describe a patient with SDHB gene mutation, who has been diagnosed with a jugular paraganglioma, and was brought to the hospital under Baker Act for threats made online. Since diagnosis this patient has been experiencing both anxiety and post-traumatic stress disorder (PTSD). The patient and a family member report increased emotional lability, and the patient reports multiple daily episodes of anxiousness. This case outlines the connection between paragangliomas and psychiatric symptoms, the impact they can have on patients' daily lives, and the importance of addressing the possibility of these symptoms and establishing a multispecialty healthcare team at the time of diagnosis.

Global Perspective on COVID-19 Therapies, Cardiovascular Outcomes, and Implications for Long COVID: A State-of-the-Art Review.

The COVID-19 pandemic has resulted in many therapies, of which many are repurposed and used for other diseases in the last decade such in Influenza and Ebola. We intend to provide a robust foundation for cardiovascular outcomes of the therapies to better understand the rationale for the clinical trials that were conducted during the COVID-19 pandemic, and to gain more clarity on the steps moving forward should the repurposing provide clinical benefit in pandemic situations. With this state-of-the-art review, we aim to improve the understanding of the cardiovascular involvement of the therapies prior to, during, and after the COVID-19 pandemic to provide meaningful findings to the cardiovascular specialists and clinical trials for therapies, moving on from the period of pandemic urgency.

The concept of homology in the development of handedness.

The construct of homology in the development of behavior is examined using human handedness. Research on the development of hand-use preferences in infants provides some evidence that it may be homologous with adult handedness. Nevertheless, I propose that the construct of homology may not be relevant to the study of human behavioral development. However, other constructs from developmental biology may prove useful in improving developmental psychological research.

How the development of handedness could contribute to the development of language.

We propose a developmental process which may link the development of handedness with the development of hemispheric specialization for speech processing. Using Arbib's proposed sequence of sensorimotor development of manual skills and gestures (that he considers to be the basis of speech gestures and proto-language), we show how the development of hand-use preferences in proto-reaching skills concatenate into object acquisition skills and eventually into role-differentiated bimanual manipulation skills (that reflect interhemispheric communication and coordination). These latter sensorimotor skills might facilitate the development of speech processing via their influence on the development of tool-using and object management abilities.

Waste Plastic Nanomagnetite Pour Point Depressants for Heavy and Light Egyptian Crude Oil.

One of the most widely used plastics in the world's rapidly urbanizing population is polyethylene (PE). Globally, there is a growing demand for plastics. Polyethylene plastics do pollute and harm the environment. Although polyethylene is said to be nonbiodegradable, any chemical deterioration can take hundreds of years. This study intends to improve the crude oil property, precisely its pour point, by using polyethylene derived from waste products with magnetic nanoparticles (MNPs) and applying it to heavy and light crude oils. Forty crude oil samples were prepared by changing the PE additive concentration from 0.25 to 2% with 0-2.0% MNP concentration. Dynamic light scattering (DLS), gas chromatography, and photomicrographic techniques were employed during the study. DLS results revealed that nanoparticles of heavy (B) crude oil have bigger particle sizes than light (A) crude oil samples, and the overall distribution of the added nanoparticles was much better in light crude oil than in heavy crude oil. The photomicrographic results revealed that the treated samples using additives provided a significant wax crystal reduction compatible with the provided pour point results. The prepared sample of the treated light (A) crude oil provided a more extraordinary rheology performance than the heavy (B) crude oil. Moreover, prepared crude oil samples with PE additives and MNPs are effective as pour point depressants.

Krokodil-Associated Cutaneous Ulceration, Cardiac Arrhythmia and Thrombi.

Krokodil, the street name for desomorphine, has emerged as a deadly and alarming drug phenomenon in recent years. This report delves into the intricate relationship between krokodil abuse, its adverse effects on the skin and its profound impact on cardiovascular events. Our patient developed a non-healing cutaneous ulceration associated with an acute onset of cardiac arrhythmia, as well as bilateral upper extremity acute deep-vein thrombosis. LEARNING POINTS: The use of Krokodil can lead to chronic non-healing ulcerations.It is important to be aware that new cardiac arrhythmias can arise in individuals using krokodil.Acute bilateral upper extremity thrombosis can occur as a complication in patients using krokodil.

Diagnosis and Management of Marchiafava-Bignami Disease, a Rare Neurological Complication of Long-term Alcohol Abuse.

Marchiafava Bignami disease (MBD) is a neurological disorder characterized by myelin degeneration and tissue necrosis within the central nervous system. This condition predominantly afflicts individuals with chronic alcohol abuse and malnutrition. The most distinctive pathological feature of MBD is the necrotic degeneration specifically observed in the corpus callosum; however, emerging evidence also indicates the potential involvement of other brain regions. The main pathophysiological mechanisms involve alcohol consumption, which leads to thiamine depletion and disrupts various metabolic pathways. This, in turn, hinders myelin synthesis and impairs signal transmission, resulting in a wide range of symptoms and signs. MBD can manifest in different stages, including acute, subacute, and chronic, each with varying severity. Diagnosing MBD can be challenging due to its presenting symptoms being nonspecific. In the era preceding the development of sophisticated imaging methodologies, the diagnosis of MBD was primarily established through postmortem examination conducted during autopsies. However, with a detailed medical history and imaging modalities such as magnetic resonance imaging (MRI) and computed tomography (CT), it is now possible to diagnose MBD and differentiate it from other diseases with similar clinical presentations. MRI is considered the gold standard for visualizing lesions in the corpus callosum and other affected areas. Also, positron emission tomography (PET), single photon emission computed tomography (SPECT), and magnetic resonance spectroscopy (MRS) could show brain damage in the corpus callosum associated with MBD. MRI-diffusion-weighted imaging (DWI) detects early lesions, while diffusion tensor imaging (DTI) investigates clinical manifestations and recovery. Poor prognostic indicators for MBD include extensive cerebral cortex involvement and severe disturbances in consciousness. Differential diagnosis involves ruling out other alcohol-related disorders, such as neoplastic conditions, Wernicke's encephalopathy, and multiple sclerosis, among others, through careful evaluation. The therapeutic strategies for the management of MBD are currently lacking definitive establishment; however, available evidence indicates that targeted interventions have the potential to induce amelioration. Corticosteroids offer prospective advantages in addressing brain edema, demyelination, and inflammation; research findings present a heterogeneous outcome pattern. Notably, thiamine treatment reduces the likelihood of unfavorable consequences, particularly when administered promptly, and thus is endorsed as the primary therapeutic approach for MBD. This review will highlight this rare disease that many healthcare providers might not be familiar with. By understanding its clinical presentation, differential diagnosis, imaging, and management, medical providers might better identify and diagnose MBD. Raising awareness about this condition can lead to better prevention, early detection, and timely intervention.

Fibrin Sheath Catheter-Related Endovascular Right-Sided Heart Infection in Heart Failure With Reduced Ejection Fraction: A Case Report.

Patients with end-stage renal disease (ESRD) receive dialysis through either hemodialysis (HD) or peritoneal dialysis (PD). HD has challenges associated with vascular access and catheter-associated complications. The development of a fibrin sheath is a common complication with tunneled catheters. However, infection of the fibrin sheath is not usually encountered. We discuss the case of a 60-year-old female with ESRD and heart failure with reduced ejection fraction (HFrEF) receiving HD via tunneled right internal jugular (RIJ) Permcath who was diagnosed with an infected fibrin sheath located in the cavoatrial junction via a transesophageal echocardiogram (TEE). Compared to a transthoracic echocardiogram (TTE), a transesophageal echocardiogram provides a much more accurate diagnosis of this rare condition. Treatment primarily involves administering antibiotics based on sensitivity cultures and closely monitoring for any potential complications.

A Complex Presentation of Acute Postoperative Negative-Pressure Pulmonary Edema: A Case Report and Review of Literature.

Negative-pressure pulmonary edema (NPPE) is an uncommon diagnosis that requires a high clinical suspicion to recognize and manage and has high morbidity and mortality. It usually results secondary to markedly negative intrapleural pressure due to the forceful inspiration against the obstructed airway from upper airway infection, tumor, or laryngospasm. We present a case of a 27-year-old female with morbid obesity who underwent sleeve gastrectomy and developed NPPE upon emergence from anesthesia. The focus of supportive care should be on addressing the obstruction in the upper airway through either endotracheal intubation or cricothyroidotomy. Additionally, it is important to initiate lung-protective positive-pressure ventilation and promote diuresis, unless the patient is in a state of shock. The resolution of pulmonary edema is typically swift, partially due to the preservation of alveolar fluid clearance mechanisms. In the literature review, we delve into the clinical presentation, pathophysiology, and management of NPPE or post-obstructive pulmonary edema.