Screening for Both Child Behavior and Social Determinants of Health in Pediatric Primary Care.

OBJECTIVE: To implement comprehensive screening for child behavior and social determinants of health in an urban pediatric practice and explore rates of referrals and follow-up for positive screens. METHOD: Quality improvement methodology was used to implement routine screening using an adapted version of the Survey of Well Being of Young Children, a child behavior and social screen, for all children aged 6 months to 10 years. Rates of screen administration and documentation were assessed for 18 months. Medical records of a convenience sample (N = 349) were reviewed to track referrals and follow-up for positive screens. A secondary analysis explored associations between reported parental concern for their child's behavior and both child behavior symptoms and social stressors. RESULTS: Over 18 months, 2028 screens were administered. Screening rates reached 90% after introducing a tablet for screening. Provider documentation of screens averaged 62%. In the convenience sample, 28% scored positive for a behavioral problem, and 25% reported at least 1 social stressor. Of those with positive child behavior or social stressor screens, approximately 80% followed up with their primary medical doctor, and approximately 50% completed referrals to the clinic social worker. Further analysis indicated that referral and follow-up rates varied depending on whether the family identified child behavior or social issues. Logistic regression revealed that parental concern was independently associated with child behavior symptoms (p = 0.001) and social stressors (p = 0.002). CONCLUSION: Implementing a comprehensive psychosocial screen is feasible in pediatric primary care and may help target referrals to address psychosocial health needs.

[Complications in sutured scleral fixation of artificial lens implantation]. / Komplikationen bei skleranahtfixierter Kunstlinsenimplantation.

BACKGROUND: Sutured scleral fixation of an artificial posterior chamber lens is a frequently used method for the treatment of eyes with poor or absent capsular support; however, the complication profile is often considered unfavorable. OBJECTIVE: To analyze the postoperative complication profile. METHODS: In this monocentric and retrospective analysis of a consecutive case series of patients with standardized sutured scleral fixation of a posterior chamber lens between 2007 and 2017, the documented complications were categorized as a permanent threat to visual acuity, such as endophthalmitis, choroidal hemorrhage, retinal detachment and clinically relevant but without a permanent threat to visual acuity, such as hemorrhage and hypotension. Additionally, the time point when complications first occurred was categorized into the 3 periods 0-3, 4-30 and ≥31 days. RESULTS: This is the largest patient collective of a study with scleral fixation of a posterior chamber lens published so far. A total of 338 eyes from 338 patients were included in the study (women 47%) and the median postoperative follow-up period was 60 days (range 1-5833 days). In 68% of the patients at least 1 complication was documented. Complications with a permanent threat to visual acuity occurred in 3% (n = 10) of the patients. The most frequent clinically relevant complications were intraocular hypotension ≤10 mm Hg (35%; n = 119), pupil decentration (28%; n = 93), hyphema, iris or vitreous hemorrhage (10%; n = 34), secondary glaucoma (9%; n = 32) and iris capture (5%; n = 17). Of the complications 41% occurred within the first 3 days and 70% within the first 30 days. Revision surgery was carried out in 4.5% (n = 15) of the patients. CONCLUSION: Although complications occurred in two thirds of the interventions, the number of permanent complications with a permanent threat to visual acuity was low. Scleral fixation of an artificial posterior chamber lens is still a justifiable intervention.

Author Correction: Repetitive transcranial magnetic stimulation reveals a causal role of the human precuneus in spatial updating.

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Repetitive transcranial magnetic stimulation reveals a causal role of the human precuneus in spatial updating.

As we move through an environment, the positions of surrounding objects relative to our body constantly change, with some objects even leaving our field of view. As a consequence, maintaining orientation requires spatial updating, the continuous monitoring of self-motion cues to update external locations within an egocentric frame of reference. While previous research using functional magnetic resonance imaging has implicated the precuneus in spatial updating, direct evidence for this claim is missing. To address this important question, we applied theta burst repetitive transcranial magnetic stimulation (rTMS) over the precuneus to induce a "virtual lesion". Following stimulation, participants were tested in a large-scale virtual environment in which they had to use visual self-motion information to keep track of the position of virtual objects. Compared to sham stimulation, rTMS affected working memory traces for object locations. Critically, rTMS further impaired the ability to update these locations whenever participants experienced simulated movement. As this effect could not be explained by working memory deficits alone, we conclude that visual spatial updating relies on the construction of updated representations of egocentric object locations within the precuneus. Together, these findings establish the precuneus as performing key computations for the formation of cognitive maps.

Evidence for the Formation of Benzacridine Derivatives in Alkaline-Treated Sunflower Meal and Model Solutions.

Sunflower extraction meal (SEM) is an economically interesting protein source. During alkaline extraction of proteins, the presence of chlorogenic acid (CQA) in the meal gives rise to the formation of o-quinones. Reactions with nucleophiles present in proteins can lead to green discoloration. Although such reactions have been known for a long time, there is a lack of information on the chemical nature of the reaction products. SEM and model systems consisting of amino acids and CQA were subjected to alkaline treatment and, for comparison, to oxidation of CQA by polyphenoloxidase (PPO). Several green trihydroxy benzacridine (TBA) derivatives were tentatively identified in all samples by UHPLC-DAD-MS/MS. Surprisingly, in alkaline-treated samples of particular amino acids as well as in SEM, the same six TBA isomers were detected. In contrast, the enzymatically oxidized samples resulted in only three TBA derivatives. Contrary to previous findings, neither peptide nor amino acid residues were attached to the resultant benzacridine core. The results indicate that the formation of TBA derivatives is caused by the reaction between CQA quinones and free NH2 groups. Further research is necessary to elucidate the structure of the addition products for a comprehensive evaluation of food and feed safety aspects.

Cell line differences in bacterially translocated ExoS ADP-ribosyltransferase substrate specificity.

Exoenzyme S (ExoS) is an ADP-ribosyltransferase (ADPRT) directly translocated into eukaryotic cells by the type III secretory (TTS) process of Pseudomonas aeruginosa. Comparisons of the functional effects of ExoS on human epithelial and murine fibroblastic cells showed that human epithelial cells exhibited an overall increased sensitivity to the effects of bacterially translocated ExoS on cell proliferation, morphology and re-adherence. ExoS was also found to ADP-ribosylate a greater number of low-molecular-mass G (LMMG) proteins in human epithelial cells, as compared to murine fibroblasts. Examination of the cellular mechanism for differences in ExoS ADPRT substrate modification found that the more restricted pattern of substrate modification in murine fibroblasts was not linked to the efficiency of bacterial adherence nor to the efficiency of ExoS internalization by the TTS process. In exploring the cellular nature of patterns of substrate modification, more extensive substrate modification was detected in human and simian cell lines, while rodent cell lines, including rat, mouse and hamster lines, consistently exhibited the more limited pattern of LMMG protein ADP-ribosylation. Patterns of substrate modification were not altered by cellular transformation and occurred independently of cell type. These studies suggest that eukaryotic cell properties, as recognized through studies of cells of different animal origins, affect the substrate targeting of ExoS ADPRT activity, and that this in turn can influence the severity of effects of ExoS on host-cell function.