Prospective Associations Between Infant Sleep at 12 Months and Autism Spectrum Disorder Screening Scores at 24 Months in a Community-Based Birth Cohort.

BACKGROUND: Sleep problems have been associated with autism spectrum disorder (ASD) symptoms and diagnosis. However, past research has studied the simultaneous association of sleep problems with precursor ASD symptoms. Using data from a birth cohort, we estimate prospective associations between infant sleep characteristics at 12 months and later ASD screening scores at 24 months. METHODS: We obtained data from children (N = 1,096) and their mothers as participants in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood longitudinal birth cohort study. Mothers were enrolled between 2006 and 2011, when they were 16-26 weeks pregnant. Using linear regression, we examined the influence of infant sleep characteristics (nighttime and daytime sleep, night wakings, and sleep onset latency) at 12 months on ASD screening scores at 24 months while controlling for other psychosocial characteristics. RESULTS: The number of night wakings was the only sleep characteristic at 12 months to be significantly associated with the development of early ASD symptoms at 24 months (B = 0.097, P = .021; 95% CI, 0.014 to 0.180). However, other competing risks, especially child socioemotional competence at 12 months (B = 0.573, P < .001; 95% CI, 0.361 to 0.785), showed stronger relative contributions in predicting ASD risk. CONCLUSIONS: Infants with more sleep problems by 12 months, especially those waking more often during the night, showed an increased number of early ASD symptoms a year later. This study suggests that infant sleep characteristics could constitute one clinical sign of ASD risk, together with key psychosocial characteristics.

Prospective Associations Between Early Long-Term Household Tobacco Smoke Exposure and Subsequent Indicators of Metabolic Risk at Age 10.

INTRODUCTION: Although there are established risks associated with gestational tobacco smoke exposure, few studies have addressed the metabolic hazards of domestic exposure in early childhood. This study prospectively examines the long-term relationship between early childhood exposure to household smoke and two adiposity-related measures at age 10. METHODS: Participants from the Quebec Longitudinal Study of Child Development birth cohort were categorized into one of three groups of early childhood household exposure to tobacco smoke over four time points (from ages 1 to 7 years): never-exposed; transient exposure; and continuous exposure. Follow-up measures of body mass index and waist circumference were independently assessed at age 10. RESULTS: Compared to being never exposed, transient and continuous household smoke exposure predicted increases of 0.93 cm (95% confidence interval [CI] between 0.05 and 1.82 cm; P = .03) and 1.56 cm (95% CI between 0.07 and 3.05 cm; P = .04) in children's waist circumference, respectively. Children exposed to transient and continuous household smoke, compared to unexposed children, also showed 0.48 and 0.81 point increases in their body mass index, respectively, both Ps = .005. Once adjusted, for confounding variables, only transient household smoke remained associated with 43% greater odds of belonging to the overweight/obese category (95% CI between 1.12 and 1.81 cm; P < .01). CONCLUSIONS: We found significant long-term prospective associations between home-based secondhand smoke exposure and unhealthy body fat distribution. Waist circumference in youth has become an important risk factor for obesity-related diseases in adulthood. Our findings emphasize the importance public health initiatives and parental sensitization aimed at domestic exposure reductions during the critical early childhood years.

Awareness of rabies prevention and control measures among public health workers in Northern Vietnam.

OBJECTIVES: To assess and compare rabies related knowledge and awareness of public health workers at provincial and district levels in the seven provinces with the highest number of deaths from human rabies in northern Vietnam. STUDY DESIGN: A cross-sectional study. METHOD: A survey was administered to a convenience sample of public health workers attending four workshops on rabies disease, control and prevention between 16 October and 21 November, 2012. Total knowledge scores (maximum 38 points) were categorized into: 'high' (>30 points) 'moderate' (21-30) and 'low' (<21). The Chi-square test was used to evaluate the statistical significance of the differences in responses between the respondents. RESULTS: Of the 105 public health workers attending the workshops: 57% were male; 76% worked at the district level compared with 24% who worked at provincial level; and 45% had worked in rabies control for <1 year compared with 11% who had worked in rabies control for >5 years. Overall knowledge was patchy and ranked as 'moderate'. Important gaps in knowledge were identified particularly in relation to indications for rabies vaccine and rabies immunoglobulin, and routes of exposure to rabies virus. One in ten respondents did not know that rabies virus could be transmitted by the bite of an infected animal. When examining the overall mean knowledge scores, marginally significant differences were identified. The average scores for district level health workers (DLHW) and provincial level health workers (PLHW) were 28 ± 3 and 29 ± 3 points respectively (p = 0.098), which fell within the study definition of 'moderate' knowledge. In contrast, when 'high' knowledge scores were compared, a significantly greater proportion of PLHW achieved >30 points compared to DLHW (44.0% vs 22.5%, p = 0.044). CONCLUSIONS: Important gaps in knowledge and awareness of public health workers were identified particularly in relation to routes of exposure to rabies virus and indications for rabies vaccine and rabies immunoglobulin. Overall, comparison of knowledge scores revealed significant differences between district and provincial public health workers. The results obtained suggest that in order for rabies control programmes to succeed public health workers at all levels need to have accurate and evidence-based knowledge. This may be facilitated by improving the quantity and quality of their training and education.

Head Circumference in Canadian Male Adults: Development of a Normalized Chart / Circunferencia Cefálica en Hombres Adultos Canadienses: Desarrollo de una Tabla Normalizada

Macrocephaly has been reported as one of the few physiological markers of several syndromes which are identified during childhood. However, only a limited number of studies have investigated whether macrocephaly persists in adults in these conditions, due to an absence of up-to-date reference charts constructed for typically developing adults. Available adult head circumference reference charts either don't measure individuals beyond 21 years of age, are outdated, mostly use homogeneous samples and most importantly do not account for the individual's height and weight at the same time. Two hundred twenty-one male adults were recruited in a large urban community. For each participant, height, weight and head circumference were measured. A significant positive relationship was found between head circumference and height (r=0.379) as well as between head circumference and weight (r=0.391) and a weaker positive correlation with bodymass index (r=0.213). Charts to determine the level of head circumference abnormalities in adulthood are provided, along with a calculation formula for head circumference based on height and weight. The findings indicate the necessity of taking height and weight into account when measuring head circumference in adults.

La macrocefalia ha sido reportada como uno de los pocos marcadores fisiológicos de varios síndromes que se identifican durante la infancia. Sin embargo, sólo un número limitado de estudios han investigado si la macrocefalia persiste en los adultos con estas condiciones, debido a la ausencia de tablas de referencia actualizadas, construidas para el desarrollo normal de adultos. Las tablas de referencia de circunferencia cefálica disponible para adultos, no miden a los individuos más allá de los 21 años de edad, no están actualizadas, y la mayoría utiliza muestras homogéneas y lo más importante, no toman en cuenta al mismo tiempo la altura y peso del individuo. Fueron reclutados 221 hombres adultos de una comunidad urbana grande. En cada participante se midió la circunferencia cefálica, altura y peso. Se observó una relación significativamente positiva entre la circunferencia cefálica y la altura (r = 0,379), así como entre la circunferencia cefálica y el peso (r = 0,391), mientras la correlación positiva fue débil con el índice de masa corporal (r = 0,213). Se proporcionan tablas para determinar el nivel de anormalidades de la circunferencia cefálica en la edad adulta, junto con una fórmula de cálculo para la circunferencia cefálica basada en la altura y el peso. Los resultados indican la necesidad de tomar en cuenta altura y peso al momento de medir la circunferencia cefálica en adultos.

Perforation of the left atrium by a chest tube in a patient with cardiomegaly: management of a rare, but life-threatening complication.

Perforation of the heart is a rare, but life-threatening complication of chest tube thoracostomy. We report the very unusual case where right-sided insertion of a Matthys catheter (6 F) due to pleural effusion resulted in a left atrium perforation. Heart injury was immediately considered as a continuous flow of bright red blood emerging through the chest drain. Diagnosis was confirmed by computertomography also revealing a massive cardiomegaly due to pre-existing mitral valve regurgitation. In two consecutive thoracotomies, first the Mathys drain was removed and the heart defect closed and then the mitral valve was replaced by a bio prosthesis. The extent of the cardiomegaly and the position of the left atrium were not detected pre-operatively by chest X-ray or ultrasonic device. Despite a nosocomial pneumonia, the patient fully recovered. This case shows that extreme caution is necessary when inserting chest tubes in patients where thorax imaging by X-ray or ultrasonic device does not provide a clear anatomical site. In order to minimise complications, a blunt puncturing procedure or Seldinger technique should be used and assisted by a Doppler ultrasonic device. Also early imaging by CT and Doppler ultrasonic technique should be attempted. This may reduce incidence of severe complications as in this case.

Resonant cooper-pair tunneling: quantum noise and measurement characteristics.

We study the quantum charge noise and measurement properties of the double Cooper-pair resonance point in a superconducting single-electron transistor (SSET) coupled to a Josephson charge qubit. Using a density-matrix approach for the coupled system, we obtain a full description of the measurement backaction; for weak coupling, this is used to extract the quantum charge noise. Unlike the case of a nonsuperconducting SET, the backaction here can induce population inversion in the qubit. We find that the Cooper-pair resonance process allows for a much better measurement than a similar nonsuperconducting SET, and can approach the quantum limit of efficiency.

Non-Gaussian noise in quantum spin glasses and interacting two-level systems.

We study a general model for non-Gaussian 1/f noise based on an infinite range quantum Ising spin system in the paramagnetic state, or, equivalently, interacting two-level classical fluctuators. We identify a dilatation interaction term in the dynamics which survives the thermodynamic limit and circumvents the central limit theorem to produce non-Gaussian noise even when the equilibrium distribution is that of noninteracting spins. The resulting second spectrum ("noise of the noise") itself has a universal 1/f form which we analyze within a dynamical mean-field approximation.

Activity of rifabutin alone or in combination with clofazimine or ethambutol or both against acute and chronic experimental Mycobacterium intracellulare infections.

Rifabutin (ansamycin LM 427) when given alone in doses of 5, 10, or 20 mg/kg showed limited in vivo activity against acute or chronic Mycobacterium intracellulare infections studied in beige C57B1/6, or S/W mice. Prophylactic studies in S/W mice in which chemotherapy was given for 3 wk prior to challenge showed slight improvement. Combination chemotherapy consisting of rifabutin (10 mg/kg) and clofazimine (20 mg/kg) achieved complete sterilization of M. intracellulare infections in spleen and lung when initiated immediately after challenge. Inclusion of ethambutol did not offer additional benefit. If chemotherapy is initiated 3 wk after challenge (established infections), the activity of this double drug combination is less effective.