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1.
J Phys Chem A ; 2019 Dec 02.
Artículo en Inglés | MEDLINE | ID: mdl-31790225

RESUMEN

Carboxylic acids react with sulfur trioxide to form carboxylic sulfuric anhydrides, RCOOSO2OH. In this article, new supersonic jet microwave spectra are presented for the anhydride derived from propiolic acid (HCCCOOH), and recent work on a series of carboxylic sulfuric anhydrides is reviewed. For the propiolic acid derivative, computed minimum-energy structures are reported for both the anhydride (HCCCOOSO2OH) and its precursor complex (HCCCOOH-SO3), and additional CCSD(T)/CBS(D-T)//M06-2X/6-311++G(3df,3pd) calculations indicate that, after zero-point energy corrections, the barrier to anhydride formation is effectively zero. These results are similar to those for other carboxylic sulfuric anhydrides studied and are consistent with their rapid production under supersonic jet conditions. Carboxylic sulfuric anhydrides, as a class, have not been widely characterized in the chemical literature and thus their study represents a new feature of the chemistry of sulfur oxides and oxyacids. As such, structural and energetic features of the carboxylic sulfuric anhydrides derived from formic, acetic, acrylic, trifluoroacetic, propiolic, pinic, and benzoic acids are compared. Computed vibrational frequencies are provided as Supporting Information and should be useful for possible future observation by infrared and/or Raman spectroscopy. Statistical thermodynamics is used to estimate the equilibrium constants for the formation reactions at a series of temperatures, and the results indicate values ranging from ~104 atm-1 for formic acid at 288 K to over 1011 atm-1 for benzoic acid at 217 K. We speculate that carboxylic sulfuric anhydrides could be active species in the Earth's atmosphere and atmospheric concentrations have, therefore, been estimated assuming an equilibrium state. These estimates are subject to significant uncertainties in the atmospheric SO3 and carboxylic acid concentrations, but may be as high as 107 molecules/cm3 in some locations. Related calculations suggest that equilibrium anhydride concentrations may exceed those of the sulfuric acid precursors SO3-H2O and SO3-(H2O)2 by several orders of magnitude. Kinetic modeling will ultimately be necessary to fully assess the role, if any, of carboxylic sulfuric anhydrides in atmospheric processes.

2.
Nature ; 573(7774): 408-411, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31534245

RESUMEN

The combustion of fossil fuels produces emissions of the long-lived greenhouse gas carbon dioxide and of short-lived pollutants, including sulfur dioxide, that contribute to the formation of atmospheric aerosols1. Atmospheric aerosols can cool the climate, masking some of the warming effect that results from the emission of greenhouse gases1. However, aerosol particulates are highly toxic when inhaled, leading to millions of premature deaths per year2,3. The phasing out of unabated fossil-fuel combustion will therefore provide health benefits, but will also reduce the extent to which the warming induced by greenhouse gases is masked by aerosols. Because aerosol levels respond much more rapidly to changes in emissions relative to carbon dioxide, large near-term increases in the magnitude and rate of climate warming are predicted in many idealized studies that typically assume an instantaneous removal of all anthropogenic or fossil-fuel-related emissions1,4-9. Here we show that more realistic modelling scenarios do not produce a substantial near-term increase in either the magnitude or the rate of warming, and in fact can lead to a decrease in warming rates within two decades of the start of the fossil-fuel phase-out. Accounting for the time required to transform power generation, industry and transportation leads to gradually increasing and largely offsetting climate impacts of carbon dioxide and sulfur dioxide, with the rate of warming further slowed by reductions in fossil-methane emissions. Our results indicate that even the most aggressive plausible transition to a clean-energy society provides benefits for climate change mitigation and air quality at essentially all decadal to centennial timescales.

3.
Nature ; 571(7765): 335-342, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31316194

RESUMEN

Research reported during the past decade has shown that global warming is roughly proportional to the total amount of carbon dioxide released into the atmosphere. This makes it possible to estimate the remaining carbon budget: the total amount of anthropogenic carbon dioxide that can still be emitted into the atmosphere while holding the global average temperature increase to the limit set by the Paris Agreement. However, a wide range of estimates for the remaining carbon budget has been reported, reducing the effectiveness of the remaining carbon budget as a means of setting emission reduction targets that are consistent with the Paris Agreement. Here we present a framework that enables us to track estimates of the remaining carbon budget and to understand how these estimates can improve over time as scientific knowledge advances. We propose that application of this framework may help to reconcile differences between estimates of the remaining carbon budget and may provide a basis for reducing uncertainty in the range of future estimates.


Asunto(s)
Atmósfera/química , Dióxido de Carbono/análisis , Calentamiento Global/prevención & control , Calentamiento Global/estadística & datos numéricos , Metas , Modelos Teóricos , Temperatura Ambiental , Política Ambiental/legislación & jurisprudencia , Retroalimentación , Calentamiento Global/legislación & jurisprudencia , Actividades Humanas/legislación & jurisprudencia , Cooperación Internacional/legislación & jurisprudencia , Paris , Reproducibilidad de los Resultados , Factores de Tiempo , Incertidumbre
4.
J Gen Intern Med ; 34(5): 754-757, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30993610

RESUMEN

In the context of internal medicine, "triage" is a newly popularized term that refers to constellation of activities related to determining the most appropriate disposition plans for patients, including assessing patients for admissions into the inpatient medicine service. The physician or "triagist" plays a critical role in the transition of care from the outpatient to the inpatient settings, yet little literature exists addressing this particular transition. The importance of this set of responsibilities has evolved over time as health systems become increasingly complex to navigate for physicians and patients. With the emphasis on hospital efficiency metrics such as emergency department throughput and appropriateness of admissions, this type of systems-based thinking is a necessary skill for practicing contemporary inpatient medicine. We believe that triaging admissions is a critical transition in the care continuum and represents an entrustable professional activity that integrates skills across multiple Accreditation Council for Graduate Medical Education (ACGME) competencies that internal medicine residents must master. Specific curricular competencies that address the domains of provider, system, and patient will deliver a solid foundation to fill a gap in skills and knowledge for the triagist role in IM residency training.

5.
Front Neurosci ; 13: 111, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30872988

RESUMEN

Objective: The Janssen Autism Knowledge Engine (JAKE®) is a clinical research outcomes assessment system developed to more sensitively measure treatment outcomes and identify subpopulations in autism spectrum disorder (ASD). Here we describe JAKE and present results from its digital phenotyping (My JAKE) and biosensor (JAKE Sense) components. Methods: An observational, non-interventional, prospective study of JAKE in children and adults with ASD was conducted at nine sites in the United States. Feedback on JAKE usability was obtained from caregivers. JAKE Sense included electroencephalography, eye tracking, electrocardiography, electrodermal activity, facial affect analysis, and actigraphy. Caregivers of individuals with ASD reported behaviors using My JAKE. Results from My JAKE and JAKE Sense were compared to traditional ASD symptom measures. Results: Individuals with ASD (N = 144) and a cohort of typically developing (TD) individuals (N = 41) participated in JAKE Sense. Most caregivers reported that overall use and utility of My JAKE was "easy" (69%, 74/108) or "very easy" (74%, 80/108). My JAKE could detect differences in ASD symptoms as measured by traditional methods. The majority of biosensors included in JAKE Sense captured sizable amounts of quality data (i.e., 93-100% of eye tracker, facial affect analysis, and electrocardiogram data was of good quality), demonstrated differences between TD and ASD individuals, and correlated with ASD symptom scales. No significant safety events were reported. Conclusions: My JAKE was viewed as easy or very easy to use by caregivers participating in research outside of a clinical study. My JAKE sensitively measured a broad range of ASD symptoms. JAKE Sense biosensors were well-tolerated. JAKE functioned well when used at clinical sites previously inexperienced with some of the technologies. Lessons from the study will optimize JAKE for use in clinical trials to assess ASD interventions. Additionally, because biosensors were able to detect features differentiating TD and ASD individuals, and also were correlated with standardized symptom scales, these measures could be explored as potential biomarkers for ASD and as endpoints in future clinical studies. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02668991 identifier: NCT02668991.

6.
J Autism Dev Disord ; 2019 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-30825083

RESUMEN

Evidence supporting the effectiveness of the PEERS® social skills intervention for adolescents with autism spectrum disorder is relatively strong. Less is known about whether the duration of the program impacts participant outcomes. The current study compared outcomes of participants randomly assigned to participate in an accelerated version of PEERS that met twice weekly for 7 weeks (n = 11) or the traditional PEERS program that met once weekly for 14 weeks (n = 10). The accelerated PEERS group demonstrated improvements consistent with previous research on the program, and treatment response did not differ significantly between the accelerated PEERS and traditional PEERS groups. Together, findings provide preliminary evidence that PEERS is effective when administered as a 7-week program.

7.
PeerJ ; 6: e6002, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30671285

RESUMEN

Soil physical parameter calculation by inverse modelling provides an indirect way of estimating the unsaturated hydraulic properties of soils. However many measurements are needed to provide sufficient data to determine unknown parameters. The objective of this research was to assess the use of unsaturated water flow and solute transport experiments, in horizontal packed soil columns, to estimate the parameters that govern water flow and solute transport. The derived parameters are then used to predict water infiltration and solute migration in a repacked soil wedge. Horizontal columns packed with Red Ferrosol were used in a nitrate diffusion experiment to estimate either three or six parameters of the van Genuchten-Mualem equation while keeping residual and saturated water content, and saturated hydraulic conductivity fixed to independently measured values. These parameters were calculated using the inverse optimisation routines in Hydrus 1D. Nitrate concentrations measured along the horizontal soil columns were used to independently determine the Langmuir adsorption isotherm. The soil hydraulic properties described by the van Genuchten-Mualem equation, and the NO3 - adsorption isotherm, were then used to predict water and NO3 - distributions from a point-source in two 3D flow scenarios. The use of horizontal columns of repacked soil and inverse modelling to quantify the soil water retention curve was found to be a simple and effective method for determining soil hydraulic properties of Red Ferrosols. These generated parameters supported subsequent testing of interactive flow and reactive transport processes under dynamic flow conditions.

8.
Nat Commun ; 10(1): 101, 2019 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-30647408

RESUMEN

Committed warming describes how much future warming can be expected from historical emissions due to inertia in the climate system. It is usually defined in terms of the level of warming above the present for an abrupt halt of emissions. Owing to socioeconomic constraints, this situation is unlikely, so we focus on the committed warming from present-day fossil fuel assets. Here we show that if carbon-intensive infrastructure is phased out at the end of its design lifetime from the end of 2018, there is a 64% chance that peak global mean temperature rise remains below 1.5 °C. Delaying mitigation until 2030 considerably reduces the likelihood that 1.5 °C would be attainable even if the rate of fossil fuel retirement was accelerated. Although the challenges laid out by the Paris Agreement are daunting, we indicate 1.5 °C remains possible and is attainable with ambitious and immediate emission reduction across all sectors.

9.
Autism ; 23(3): 770-782, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29852752

RESUMEN

Despite efforts to detect autism spectrum disorder during toddlerhood, many children with autism spectrum disorder remain undiagnosed until school age. To identify characteristics of children whose autism spectrum disorder might not be diagnosed during toddlerhood, this study used archived Autism Diagnostic Interview-Revised records to examine the historical presentation of autism spectrum disorder symptoms in 48 school-age children with autism spectrum disorder. Children diagnosed after starting school (Late-Diagnosed; n = 24) were compared to age-matched children diagnosed before school age (Early-Diagnosed; n = 24). Symptom presentation was similar between groups, with the Late-Diagnosed group exhibiting only marginally fewer symptoms historically. The most commonly reported historical symptoms were negative symptoms, namely, deficits in social behaviors. Positive symptoms, such as unusual preoccupations, rituals, and mannerisms, were less commonly reported. These findings may aid earlier identification of autism spectrum disorder in children who would likely be diagnosed at school age.

10.
BMC Med Educ ; 18(1): 321, 2018 Dec 27.
Artículo en Inglés | MEDLINE | ID: mdl-30591050

RESUMEN

BACKGROUND: Point-of-care-ultrasound (POCUS) training is expanding in undergraduate and graduate medical education, but lack of trained faculty is a major barrier. Two strategies that may help mitigate this obstacle are interprofessional education (IPE) and near-peer teaching. The objective of this study was to evaluate a POCUS course in which diagnostic medical sonography (DMS) students served as near-peer teachers for internal medicine residents (IMR) learning to perform abdominal sonography. METHODS: Prior to the IPE workshop, DMS students participated in a train-the-trainer session to practice teaching and communication skills via case-based simulation. DMS students then coached first-year IMR to perform POCUS examinations of the kidney, bladder, and gallbladder on live models. A mixed-methods evaluation of the interprofessional workshop included an objective structured clinical exam (OSCE), course evaluation, and qualitative analysis of focus group interviews. RESULTS: Twenty-four of 24 (100%) IMR completed the OSCE, averaging 97.7/107 points (91.3%) (SD 5.2). Course evaluations from IMR and DMS students were globally positive. Twenty three of 24 residents (96%) and 6/6 DMS students (100%) participated in focus group interviews. Qualitative analysis identified themes related to the learning environment, scanning technique, and suggestions for improvement. IMR felt the interprofessional training fostered a positive learning environment and that the experience complimented traditional faculty-led workshops. Both groups noted the importance of establishing mutual understanding of expectations and suggested future workshops have more dedicated time for DMS student demonstration of scanning technique. CONCLUSION: An interprofessional, near-peer workshop was an effective strategy for teaching POCUS to IMR. This approach may allow broader adoption of POCUS in medical education, especially when faculty expertise is limited.


Asunto(s)
Medicina Interna/educación , Sistemas de Atención de Punto , Enseñanza , Ultrasonografía , Abdomen/diagnóstico por imagen , Educación Médica/métodos , Humanos , Grupo Paritario , Estudiantes de Medicina
11.
Crit Ultrasound J ; 10(1): 9, 2018 Apr 24.
Artículo en Inglés | MEDLINE | ID: mdl-29691756

RESUMEN

BACKGROUND: Point-of-care (POCUS) education is rapidly expanding within medical schools and internal medicine residency programs, but lack of trained faculty is a major barrier. While POCUS training can improve short-term outcomes, knowledge and skills rapidly decay without deliberate practice and feedback. The purpose of this study was to evaluate the performance of focused cardiac ultrasound (FCU) by volunteer general internal medicine (GIM) faculty participating in a longitudinal POCUS curriculum. METHODS: Participants: Nine GIM clinician-educators participated in a 6-month POCUS curriculum. Faculty performance was compared to three cardiology fellows. Three diagnostic cardiac sonographers (DCS) were also evaluated and served as the gold standard. EVALUATION: the primary outcome was a FCU efficiency score, calculated by dividing image quality score by exam duration. FCU exams were conducted on three standardized patients after completion of an introductory workshop, at 3 months, and at 6 months. Two blinded cardiologists scored the exams. ANALYSIS: mean efficiency scores were compared using a linear mixed effects model, followed by pairwise comparisons using Tukey's test. RESULTS: GIM faculty's FCU efficiency scores were maintained over the 6-month period (2.2, SE 1.0 vs. 3.8, SE 1.0, p = 0.076). Their scores at each session were similar to cardiology fellows (p > 0.69), but inferior to DCSs (p < 0.0001). CONCLUSION: GIM faculty participating in a POCUS curriculum maintained their FCU performance over 6 months with efficiency scores comparable to experienced cardiology fellows.

12.
13.
Eur J Drug Metab Pharmacokinet ; 43(5): 543-554, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-29520718

RESUMEN

BACKGROUND AND OBJECTIVES: Fullerene-based compounds are a novel class of molecules being developed for a variety of biomedical applications, with nearly 1000 publications in this area in the last 4 years alone. One such compound, the e,e,e-methanofullerene(60)-63-tris malonic acid (designated C3), is a potent catalytic superoxide dismutase mimetic which has shown neuroprotective efficacy in a number of animal models of neurologic disease, including Parkinsonian Macaca fascicularis monkeys. The aim of this study was to characterize its toxicity and pharmacokinetics in mice and monkeys. METHODS: To assess pharmacokinetics in mice, we synthesized and administered 14C-C3 to mice using various routes of delivery, including orally. To assess potential toxicity in primates, serial blood studies and electrocardiograms (ECGs) were obtained from monkeys treated with C3 (3 or 7 mg/kg/day) for 2  months. RESULTS AND CONCLUSIONS: The plasma half-life of C3 was 8.2 ± 0.2 h, and there was wide tissue distribution, including uptake into brain. The compound was cleared by both hepatic and renal excretion. C3 was quite stable, with minimal metabolism of the compound even after 7 days of treatment. The LD50 in mice was 80 mg/kg for a single intraperitoneal injection, and was > 30 mg/kg/day for sustained administration; therapeutic doses are 1-5 mg/kg/day. For primates, no evidence of renal, hepatic, electrolyte, or hematologic abnormalities were noted, and serial ECGs demonstrated no alteration in cardiac electrical activity. Thus, doses of C3 that have therapeutic efficacy appear to be well tolerated after 2 years (mice) or 2 months (non-human primates) of treatment.


Asunto(s)
Fulerenos/farmacocinética , Fulerenos/toxicidad , Infarto de la Arteria Cerebral Media/tratamiento farmacológico , Intoxicación por MPTP/tratamiento farmacológico , Fármacos Neuroprotectores/farmacocinética , Fármacos Neuroprotectores/toxicidad , 1-Metil-4-fenil-1,2,3,6-Tetrahidropiridina , Animales , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a Droga , Fulerenos/administración & dosificación , Fulerenos/sangre , Semivida , Frecuencia Cardíaca/efectos de los fármacos , Eliminación Hepatobiliar , Infarto de la Arteria Cerebral Media/sangre , Dosificación Letal Mediana , Intoxicación por MPTP/sangre , Intoxicación por MPTP/inducido químicamente , Macaca fascicularis , Masculino , Tasa de Depuración Metabólica , Ratones Endogámicos C57BL , Fármacos Neuroprotectores/administración & dosificación , Fármacos Neuroprotectores/sangre , Eliminación Renal , Distribución Tisular
14.
West J Emerg Med ; 19(2): 372-379, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29560068

RESUMEN

Introduction: Miscommunication during inter-unit handoffs between emergency and internal medicine physicians may jeopardize patient safety. Our goal was to evaluate the impact of a structured communication strategy on the quality of admission handoffs. Methods: We conducted a mixed-methods, pre-test/post-test study at a 560-bed academic health center with 60,000 emergency department (ED) patient visits per year. Admission-handoff best practices were integrated into a modified SBAR format, resulting in the Situation, Background, Assessment, Responsibilities & Risk, Discussion & Disposition, Read-back & Record (SBAR-DR) model. Physician handoff conversations were recorded and transcribed for the 60 days before (n=110) and 60 days after (n=110) introduction of the SBAR-DR strategy. Transcriptions were scored by two blinded physicians using a 16-item scoring instrument. The primary outcome was the composite handoff quality score. We assessed physician perceptions via a post-intervention survey. Results: The composite quality score improved in the post-intervention phase (7.57 + 2.42 vs. 8.45 + 2.51, p=.0085). Three of the 16 individual scoring elements also improved, including time for questions (70.6% vs. 82.7%, p=.0344) and confirmation of disposition plan (41.8% vs. 62.7%, p=.0019). The majority of emergency and internal medicine physicians felt that the SBAR-DR model had a positive impact on patient safety and handoff efficiency. Conclusion: Implementation of the SBAR-DR strategy resulted in improved verbal handoff quality. Agreement upon a clear disposition plan was the most improved element, which is of great importance in delineating responsibility of care and streamlining ED throughput. Future efforts should focus on nurturing broader physician buy-in to facilitate institution-wide implementation.


Asunto(s)
Comunicación , Servicio de Urgencia en Hospital/organización & administración , Admisión del Paciente/normas , Pase de Guardia/normas , Mejoramiento de la Calidad , Continuidad de la Atención al Paciente , Humanos , Seguridad del Paciente , Médicos/organización & administración , Encuestas y Cuestionarios
15.
J Autism Dev Disord ; 48(7): 2458-2475, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-29453708

RESUMEN

This study compared immediate and 4-month outcomes among adolescents with autism spectrum disorder randomly assigned to the PEERS curriculum (n = 10), a peer mediated PEERS curriculum (n = 12), or a delayed treatment control group (n = 12). Findings suggest a modest advantage in social skills knowledge and social functioning for participants in the peer-mediated PEERS curriculum relative to Traditional PEERS, and gains in social skills knowledge, social functioning, and reductions in loneliness were maintained in one or both treatment groups at a 4-month follow-up. Typically developing peer mentors (n = 16) showed improvements in social skills knowledge and marginal improvements in autism knowledge and loneliness. Future research with a larger sample and objective outcome measures is needed.


Asunto(s)
Trastorno del Espectro Autista/terapia , Terapia Conductista/métodos , Ajuste Social , Habilidades Sociales , Adolescente , Curriculum , Femenino , Humanos , Soledad , Masculino , Grupo Paritario , Proyectos Piloto
16.
Autism Res ; 10(12): 1945-1959, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28940848

RESUMEN

There is a rapidly growing group of aging adults with autism spectrum disorder (ASD) who may have unique needs, yet cognitive and brain function in older adults with ASD is understudied. We combined functional and structural neuroimaging and neuropsychological tests to examine differences between middle-aged men with ASD and matched neurotypical (NT) men. Participants (ASD, n = 16; NT, n = 17) aged 40-64 years were well-matched according to age, IQ (range: 83-131), and education (range: 9-20 years). Middle-age adults with ASD made more errors on an executive function task (Wisconsin Card Sorting Test) but performed similarly to NT adults on tests of delayed verbal memory (Rey Auditory Verbal Learning Test) and local visual search (Embedded Figures Task). Independent component analysis of a functional MRI working memory task (n-back) completed by most participants (ASD = 14, NT = 17) showed decreased engagement of a cortico-striatal-thalamic-cortical neural network in older adults with ASD. Structurally, older adults with ASD had reduced bilateral hippocampal volumes, as measured by FreeSurfer. Findings expand our understanding of ASD as a lifelong condition with persistent cognitive and functional and structural brain differences evident at middle-age. Autism Res 2017, 10: 1945-1959. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: We compared cognitive abilities and brain measures between 16 middle-age men with high-functioning autism spectrum disorder (ASD) and 17 typical middle-age men to better understand how aging affects an older group of adults with ASD. Men with ASD made more errors on a test involving flexible thinking, had less activity in a flexible thinking brain network, and had smaller volume of a brain structure related to memory than typical men. We will follow these older adults over time to determine if aging changes are greater for individuals with ASD.


Asunto(s)
Trastorno del Espectro Autista/fisiopatología , Encéfalo/fisiopatología , Función Ejecutiva/fisiología , Adulto , Encéfalo/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Memoria a Corto Plazo/fisiología , Persona de Mediana Edad , Pruebas Neuropsicológicas , Tamaño de los Órganos
17.
Autism Res ; 10(12): 2023-2036, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28851095

RESUMEN

Little is known about specific adaptive functioning impairments in intellectually-able individuals with autism spectrum disorder. In adolescents (n = 22) and young adults (n = 22) matched on composite IQ scores, this study examined profiles of cognitive and adaptive functioning, and caregiver responses on individual Vineland-II items. Adaptive functioning standard scores were significantly lower than IQ scores, and the adult group had significantly lower adaptive functioning standard scores than the adolescent group. Examination of caregiver responses to individual Vineland-II items identified more than 100 potential intervention targets. Differences favoring the adult group were observed on only 16 items across all three adaptive functioning domains, suggesting that little skill development is occurring during the transition to adulthood. Future research will examine the relevance of identified intervention targets to optimal outcomes. Autism Res 2017, 10: 2023-2036. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Adolescents and young adults with autism spectrum disorder (ASD) without intellectual disability demonstrated impaired adaptive functioning skills (i.e., age appropriate skills necessary for independent living). Development of adaptive functioning skills appears to slow with age among individuals without intellectual disability. Findings clarify the specific adaptive functioning skills that transition-aged youth with ASD have difficulty completing independently and will inform the development of interventions to increase the likelihood of independent living in adulthood.


Asunto(s)
Actividades Cotidianas/psicología , Adaptación Psicológica , Trastorno del Espectro Autista/psicología , Cuidadores , Adolescente , Adulto , Femenino , Humanos , Inteligencia , Masculino , Encuestas y Cuestionarios , Transición a la Atención de Adultos , Adulto Joven
18.
J Grad Med Educ ; 9(2): 184-189, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28439351

RESUMEN

BACKGROUND: There is an incomplete understanding of the most effective approaches for motivating residents to adopt guideline-recommended practices for hospital discharges. OBJECTIVE: We evaluated internal medicine (IM) residents' exposure to educational experiences focused on facilitating hospital discharges and compared those experiences based on correlations with residents' perceived responsibility for safely transitioning patients from the hospital. METHODS: A cross-sectional, multi-center survey of IM residents at 9 US university- and community-based training programs in 2014-2015 measured exposure to 8 transitional care experiences, their perceived impact on care transitions attitudes, and the correlation between experiences and residents' perceptions of postdischarge responsibility. RESULTS: Of 817 residents surveyed, 469 (57%) responded. Teaching about care transitions on rounds was the most common educational experience reported by residents (74%, 327 of 439). Learning opportunities with postdischarge patient contact were less common (clinic visits: 32%, 142 of 439; telephone calls: 12%, 53 of 439; and home visits: 4%, 18 of 439). On a 1-10 scale (10 = highest impact), residents rated postdischarge clinic as having the highest impact on their motivation to ensure safe transitions of care (mean = 7.61). Prior experiences with a postdischarge clinic visit, home visit, or telephone call were each correlated with increased perceived responsibility for transitional care tasks (correlation coefficients 0.12 [P = .004], 0.1 [P = .012], and 0.13 [P = 001], respectively). CONCLUSIONS: IM residents learn to facilitate hospital discharges most often through direct patient care. Opportunities to interact with patients across the postdischarge continuum are uncommon, despite correlating with increased perceived responsibility for ensuring safe transitions of care.


Asunto(s)
Actitud del Personal de Salud , Medicina Interna/educación , Internado y Residencia , Alta del Paciente , Médicos/psicología , Aprendizaje Basado en Problemas , Atención Ambulatoria , Estudios Transversales , Humanos , Seguridad del Paciente , Encuestas y Cuestionarios
19.
J Autism Dev Disord ; 47(7): 2176-2188, 2017 07.
Artículo en Inglés | MEDLINE | ID: mdl-28447306

RESUMEN

Research suggests that toddlers with no language delay (NLD) should have better outcomes than those with language delay (LD). However, the predictive utility of language milestones relative to co-varying factors such as age at diagnosis, IQ, and ASD symptomatology is unclear. This study compared school-aged children with ASD and NLD (n = 59) to a well-matched group with ASD and LD (n = 59). The LD group was diagnosed at younger ages and their historical ASD symptoms were more severe than the NLD group. The groups were similar in current ASD symptoms and adaptive functioning at school age. Language milestones were correlated with adaptive functioning, but IQ and social symptoms of ASD were stronger predictors of functioning at school age. Therefore, language milestones may not be the best indicators of prognosis for children who are diagnosed after toddlerhood.


Asunto(s)
Trastorno del Espectro Autista/diagnóstico , Desarrollo del Lenguaje , Niño , Preescolar , Femenino , Humanos , Pruebas del Lenguaje/normas , Masculino
20.
J Radiol Case Rep ; 11(5): 27-33, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-29299091

RESUMEN

Renal oncocytoma is a benign renal neoplasm that is often discovered incidentally and closely mimics renal cell carcinoma on common imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI). Due to the inability to reliably distinguish between these benign and malignant lesions with imaging, both are typically treated as if they are malignant. Hypermetabolic activity of renal oncocytomas is not frequently encountered because positron emission tomography (PET) is not a standard modality for imaging primary renal tumors. We present a case of a 65 year-old female with a history of thyroid cancer who had an incidentally discovered hypermetabolic renal mass on surveillance PET-CT imaging. Due to the concern for a primary renal malignancy or metastatic disease, the mass was resected and proven to be an oncocytoma on pathologic review.


Asunto(s)
Adenoma Oxifílico/diagnóstico por imagen , Neoplasias Renales/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Adenoma Oxifílico/metabolismo , Adenoma Oxifílico/patología , Adenoma Oxifílico/cirugía , Anciano , Carcinoma Papilar/diagnóstico por imagen , Carcinoma Papilar/terapia , Diagnóstico Diferencial , Femenino , Fluorodesoxiglucosa F18 , Humanos , Hallazgos Incidentales , Neoplasias Renales/metabolismo , Neoplasias Renales/patología , Neoplasias Renales/cirugía , Laparoscopía , Nefrectomía , Radiofármacos , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/terapia
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