Suicidality in autistic youth: A systematic review and meta-analysis.

Suicidality in autistic youth is a major public health issue. This study aimed to determine global prevalence of, and risk/protective factors for suicidality in autistic youth via systematic review and meta-analysis. We systematically searched Embase, PubMed, PsycINFO, Web of Science, and the Cochrane library for studies from inception to November 22nd, 2021. We selected empirical studies reporting on suicide outcomes (i.e., ideation, behaviors, attempts and deaths) in autistic youth (≤25 years). Random effects models were used to estimate the pooled prevalence of suicide outcomes with 95% confidence interval (CI). Heterogeneity was investigated with potential moderators using meta-regression analyses. The final selection included 47 papers, 29 of which were included in meta-analyses and 37 were narratively synthesized (sociodemographic, psychiatric, psychological, other factors, and interventions). The pooled prevalence of suicidal ideation was 25.2% (95% CI 18.2-33.8; i.e., one in four), suicide attempts 8.3% (3.6-18.2), and suicide deaths 0.2% (0.05-0.52). Estimates in self-reports were higher than in parent-reports. Age was a significant but inconsistent moderator on suicide outcomes, but substantial heterogeneity remained. Adverse childhood experiences were strong risk factors for suicidality, while resilience was protective. Participatory suicide risk-assessment, early intervention, and resilience promotion should be primary clinical/research goals.

Brain event-related potentials predict individual differences in inhibitory control.

Stop-signal reaction time (SSRT), the time needed to cancel an already-initiated motor response, quantifies individual differences in inhibitory control. Electrophysiological correlates of SSRT have primarily focused on late event-related potential (ERP) components over midline scalp regions from successfully inhibited stop trials. SSRT is robustly associated with the P300, there is mixed evidence for N200 involvement, and there is little information on the role of early ERP components. Here, machine learning was first used to interrogate ERPs during both successful and failed stop trials from 64 scalp electrodes at 4 ms resolution (n = 148). The most predictive model included data from both successful and failed stop trials, with a cross-validated Pearson's r of 0.32 between measured and predicted SSRT, significantly higher than null models. From successful stop trials, spatio-temporal features overlapping the N200 in right frontal areas and the P300 in frontocentral areas predicted SSRT, as did early ERP activity (<200 ms). As a demonstration of the reproducibility of these findings, the application of this model to a separate dataset of 97 participants was also significant (r = 0.29). These results show that ERPs during failed stops are relevant to SSRT, and that both early and late ERP activity contribute to individual differences in SSRT. Notably, the right lateralized N200, which predicted SSRT here, is not often observed in neurotypical adults. Both the ascending slope and peak of the P300 component predicted SSRT. These results were replicable, both within the training sample and when applied to ERPs from a separate dataset.

Piloting an integrated approach for estimation of environmental risk of Schistosoma haematobium infections in pre-school-aged children and their mothers at Barombi Kotto, Cameroon.

Within schistosomiasis control, assessing environmental risk of currently non-treated demographic groups e.g. pre-school-aged children (PSAC) and their mothers is important. We conducted a pilot micro-epidemiological assessment at the crater lake of Barombi Kotto, Cameroon with GPS tracking and infection data from 12 PSAC-mother pairs (n = 24) overlaid against environmental sampling inclusive of snail, parasite and water-use information. Several high-risk locations or 'hotspots' with elevated water contact, increased intermediate snail host densities and detectable schistosome environmental DNA (eDNA) were identified. Exposure between PSAC and mother pairs was temporally and spatially associated, suggesting interventions which can benefit both groups simultaneously might be feasible. When attempting to interrupt parasite transmission in future, overlaid maps of snail, parasite and water contact data can guide fine-scale spatial targeting of environmental interventions.

Time to oxygenation for cannula- and scalpel-based techniques for emergency front-of-neck access: a wet lab simulation using an ovine model.

Emergency front-of-neck access to achieve a percutaneous airway can be a life-saving intervention, but there is debate about the preferred technique. This prospective, observational study was designed to compare the two most common emergency surgical airway techniques in a wet lab simulation using an ovine model. Forty-three doctors participated. After providing standardised reading, a lecture and dry lab benchtop training, participants progressed to a high-fidelity wet lab simulation. Participants entered an operating theatre where a 'cannot intubate, cannot oxygenate' situation had been declared and were directed to perform emergency front-of-neck access: first with a cannula technique (14-gauge cannula insertion with ventilation using a Rapid-O2® cricothyroidotomy insufflation device); and subsequently, a scalpel-bougie technique (surgical incision, bougie insertion into trachea and then tracheal tube passed over bougie, with ventilation using a self-inflating bag). The primary end-point was time from declaration of 'cannot intubate, cannot oxygenate' to delivery of oxygen via a correctly placed percutaneous device. If a cannula or tracheal tube was not placed within 240 s, the attempt was marked as a failure. There was one failure for the cannula approach and 15 for the scalpel-bougie technique (OR 0.07 (95%CI 0.00-0.43); p <0.001). Median (IQR [range]) time to oxygenation, if successful, was 65 (57-78 [28-160]) s for the cannula approach and 90 (74-115 [40-265]) s for the scalpel-bougie technique (p=0.005). In this ovine model, emergency front-of-neck access using a cannula had a lower chance of failure and (when successful) shorter time to first oxygen delivery compared with a scalpel-bougie technique.

Readmission rates among cardiology inpatients with echocardiography abnormalities associated with heart failure.

BACKGROUND: Heart failure is a condition associated with significant morbidity. It is caused by structural or functional abnormalities of the heart. Many of these abnormalities if detected and managed early would prevent the onset of heart failure. AIMS: The aim of this study was to to determine the usefulness of echocardiography as a means of predicting readmission rates. A secondary aim was to profile patients with echocardiography abnormalities. METHODS: This was a prospective cohort study that followed patients over 36 months. Data were abstracted from the medical records of 76 cardiology patients in a large urban teaching hospital between 1.6.11 and 31.8.14. The outcome of interest was the number of readmissions occurring up to 48 months after discharge. We also aimed to profile these patients in terms of their co-morbidities and their medication history. RESULTS: Of those patients who had echocardiography (n = 447), 76 were considered to have a cardiac disorder (HHD, VHD, or LVSD) (n = 29). The mean readmission rate for HHD was 0.82, LVSD 0.62, and HHD 0.98. Patients with HHD were associated with a higher readmission rate of 1.8980 and for LVSD-1.24 times more likely. Those with a cardiac disorder were 13 % more likely to have a readmission within the next 36 months than those without a cardiac disorder. CONCLUSIONS: A significant proportion of patients were found to have a cardiac disorder related to HF. Echocardiographic abnormalities were shown to be an independent risk factor for readmission.

Two-photon photodetector in a multiquantum well GaAs laser structure at 1.55 microm.

We report two-photon photocurrent in a GaAs/AlGaAs multiple quantum well laser at 1.55 microm. Using 1ps pulses, a purely quadratic photocurrent is observed. We measure the device efficiency, sensitivity, as well as the two-photon absorption coefficient. The results show that the device has potential for signal processing, autocorrelation and possibly two-photon source applications at sub-Watt power levels.

The experience of empowerment in in-home services delivery.

In-home health services strive for client-centredness, involvement, and ultimately, empowerment, but economic constraint may undermine these aims. The purpose of this study was to explore the everyday experience of in-home care, with particular attention to the enactment of empowerment in the care partnership. In-depth interviews with a maximally varied sample of clients, informal caregivers, and providers uncovered relationships largely reflecting the traditional expert model of care. Findings afford insights into the unrecognized and undervalued personal knowledge of clients, caregivers, and in-home service providers, the professional and structural hegemony and consequent disempowered group behaviour of those who share the experience of care, and the hesitance of clients to engage as equitable partners in care. Strategies to achieve empowerment approaches to in-home health services are identified.

Bilateral epicondylitis in a karate instructor.

Epicondylitis can be a debilitating condition that restricts activity and causes pain. Severe cases can require surgical repair. Early and thorough assessment and instituting treatment expeditiously will help prevent lengthy rehabilitation. It is well documented that sports requiring repetitive wrist movements or tension overloading of wrist extensors, such as racquet sports and bowling, are associated with the development of epicondylitis. In this case study, the sport of karate precipitated this condition in a 38-year-old instructor. The significance of karate as a possible risk factor in epicondylitis is important given the proliferation of karate schools, especially those for children.

A comparison of two methods of teaching. Computer managed instruction and keypad questions versus traditional classroom lecture.

Computers increasingly are being integrated into nursing education. One method of integration is through computer managed instruction (CMI). Recently, technology has become available that allows the integration of keypad questions into CMI. This brings a new type of interactivity between students and teachers into the classroom. The purpose of this study was to evaluate differences in achievement between a control group taught by traditional classroom lecture (TCL) and an experimental group taught using CMI and keypad questions. Both control and experimental groups consisted of convenience samples of junior nursing students in a baccalaureate program taking a medical/surgical nursing course. Achievement was measured by three instructor-developed multiple choice examinations. Findings demonstrated that although the experimental group demonstrated increasingly higher test scores as the semester progressed, no statistical difference was found in achievement between the two groups. One reason for this may be phenomenon of vampire video. Initially, the method of presentation overshadowed the content. As students became desensitized to the method, they were able to focus and absorb more content. This study suggests that CMI and keypads are a viable teaching option for nursing education. It is equal to TCL in student achievement and provides a new level of interaction in the classroom setting.

Amyloidosis of the larynx in a child.

Localized laryngeal amyloidosis is a rare and benign process. Only three cases have been reported in children. We present the case of a 9-year-old girl with localized laryngeal amyloidosis that was excised via laryngofissure. The patient presented with a 3- to 4-week history of progressive hoarseness. Direct laryngoscopy revealed a smooth, firm, submucosal mass extending from the anterior aspect of the left false vocal cord to the vocal process. Biopsy of the mass revealed findings consistent with amyloidosis. The mass was approached via laryngofissure and excised with the thyroid cartilage and left true vocal cord left intact. An extensive workup for systemic amyloidosis was negative, including bone marrow biopsy. The postoperative recovery was uneventful, with good vocal quality and a sluggish but mobile left true vocal cord. This case is significant because of the young age of the child, the extent of disease, and the use of laryngofissure for excision.

A research nurse: enhancing participation in clinical trials.

The Fargo CCOP believes that a Research Nurse enhances their participation in clinical trials. Although it is early in our evaluation, the CCOP has maintained a stable accrual level despite the loss of a Medical Oncologist that historically led our research accrual totals. It may also be noted that enhancing treatment protocol participation increases cancer control participation as illustrated in the figure below. Cancer Control accrual is very respectable and positions the Fargo CCOP among the leaders in the North Central Cancer Treatment Group. The Cancer Control protocols are very time intensive. It would have been extremely difficult for the Medical Oncology Nursing staff to add cancer control research responsibilities to an already busy work day. Although subjective, communication between nurses, physicians, and data managers has been enhanced. Medical Oncology nurses have also begun to do more extensive telephone follow up with non-study patients. Minor violations appear to be decreasing. In summary, the Fargo CCOP plans to continue support of the Research Nurse role. Centralizing the accountabilities identified with one individual provides a mechanism for better communication, patient compliance, and higher patient accrual to cancer treatment and cancer control protocols. This approach may be helpful to other community cancer programs that wish to enhance their participation in clinical trials and the NCI's effort to increase patient accrual to high priority protocols.

Reconstruction of the bile duct with transanastomotic U tubes.

Thirty-one adult patients have undergone reconstruction of the bile duct using a transanastomotic U tube to stent biliary-enteric anastomoses. The U tube is brought through the substance of the liver into the proximal part of the bile duct, threaded through the anastomosis, usually to a Roux-en-Y limb of jejunum and then withdrawn from the jejunum through a separate enterotomy. Both ends of the Silastic (silicone rubber) catheter are then brought out the abdominal wall through separate stab incisions and secured to the abdominal wall. In 21 patients, the procedure was performed for benign disease. There were no operative deaths. Recurrent strictures developed in two patients (9.5 per cent). There were seven infectious complications, none of which were life-threatening. Preoperative bilirubin levels averaged 9.5 milligrams per cent; postoperative bilirubin levels averaged 2.6 milligrams per cent. Recurrent stricture developed in two patients at 20 and 19 months after removal of the U tubes. In ten patients, the obstruction of the biliary tract was secondary to malignant disease--seven primary tumors of the biliary tract and three metastatic tumors. Operative mortality was 20 per cent. Among the patients who survived the operation, the average bilirubin level was 6.6 milligrams per cent as compared with the average preoperative level of 14.4 milligrams per cent.