Are there gender-based variations in the presentation of Autism amongst female and male children?

The Questionnaire for Autism Spectrum Conditions (Q-ASC; Attwood, Garnett & Rynkiewicz, 2011) is one of the few screening instruments that includes items designed to assess female-specific ASD-Level 1 traits. This study examined the ability of a modified version of the Q-ASC (Q-ASC-M; Ormond et al., 2018) to differentiate children with and without ASD-Level 1. Participants included 111 parents of autistic children and 212 parents of neurotypical children (5-12 years). Results suggested that the gendered behaviour, sensory sensitivity, compliant behaviours, imagination, and imitation subscales differentiated autistic females from neurotypical females. Compared to autistic males, autistic females had higher scores on gendered behaviour, sensory sensitivity, social masking, and imitation. Results are discussed in relation to early detection of autistic female children.

Paediatric post-discharge pain and parent perceptions of support from an Australian nurse practitioner led acute pain service.

Poorly managed post-operative pain remains an issue for paediatric patients. Post-discharge telephone follow-up is used by an Australian Nurse Practitioner Acute Pain Service (NpAPS) to provide access to effective pain management post-discharge from hospital. This cross-sectional survey design study aimed to determine the pain levels of children following discharge and parent views on participation in their child's pain management and perceptions of support from the NpAPS. Parents completed the Parents' Postoperative Pain Measure-Short Form (PPPM-SF) and factors affecting parents' participation in children's pain management questionnaire (FPMQ). Results indicated that pain score was high, especially on the day of discharge and 24 hours post-discharge. Parents, despite feeling supported by the NpAPS, experienced uncertainty, emotional responses and expressed concerns about communication and coordination of care. The clinically significant pain levels of the majority of children on the day of discharge and day post-discharge from hospital are a concern. Worry and uncertainty among parents, particularly on the day and first night of discharge, suggest this transition period where responsibility of clinical management of pain is handed over to parents may require greater focus for parental support.

Evaluating the effects of a yoga-based program integrated with third-wave cognitive behavioral therapy components on self-regulation in children on the autism spectrum: A pilot randomized controlled trial.

LAY ABSTRACT: Children on the autism spectrum may experience difficulties with the regulation of attention, thoughts, emotions, and behavior, understanding, and expressing their emotions appropriately, as well as anxiety, and sleep. In autism research, contemplative practices that work through both body and mind have shown tentatively promising results. However, there are limited studies on this topic, and the use of yoga to facilitate executive control has not been researched yet. The Incredible Explorers (6-week program), a yoga-informed intervention program for children (8-12 years), was developed to understand whether, for children on the autism spectrum, the training could improve the ability to self-regulate, reduce anxiety and sleep problems, and increase awareness of emotions. In our sample, 61 children with one of their parents completed the program. Half of the group received the intervention, and the other half had to wait until the yoga group completed their trial. The participants were asked to give their feedback immediately after program completion and at 6-week follow-up. Compared to the group that was waiting to receive the intervention, parents in the yoga group reported significant gains for their children in regulating their overall executive control immediately after the session and again at follow-up. The parents reported a reduction in some of the sleep problems post-treatment. Children indicated an improved ability to communicate their feelings and willingness to analyze their emotions post-intervention. However, the study had several shortcomings and given that this was the first trial of the program, the results need to be interpreted with caution. Further research is recommended.

Lumbo-sacral radiculopathy referral decision-making and primary care management. A case report.

Low back pain guideline recommendations can inform a decision in primary care to refer for surgical assessment. The purpose of this report is to present a patient with clinical signs and symptoms of lumbo-sacral radiculopathy who experienced pain of high intensity, severe paresis and depression. The guideline informed decision-making process resulted in a decision not to refer. This case report aims to increase awareness of referral guidelines and to demonstrate radicular pain and weakness, disability and depression outcomes subsequent to primary care management.

Clinical decision rules for identification of low back pain patients with neurologic involvement in primary care.

STUDY DESIGN: Descriptive study. OBJECTIVE: To compare clinical decision rules in low back pain guidelines for identification of neurologic involvement. SUMMARY OF BACKGROUND DATA: Low back pain guidelines have been developed in a number of countries. Guideline recommendations for assessment of patients with low back pain in primary care include clinical decision rules for identification of neurologic involvement. Broad variation in recommended clinical assessments has previously been identified. More specific investigation of these clinical assessments seems warranted given that guidelines have an important role in facilitating accurate and timely identification of neurologic involvement in patients with low back pain presenting in primary care. METHODS: Guidelines were included that met the following criteria: the guideline included clinical decision rules for low back pain assessments; recommendations were for clinical management of low back pain in primary care; and the guideline was available in English. RESULTS: Three categories of neurologic involvement were identified in the guidelines: cauda equina syndrome; nerve root syndrome; and spinal stenosis. However, only cauda equina syndrome was included in all guidelines. Spinal stenosis or both nerve root syndrome and spinal stenosis categories were omitted from some guidelines. Decision factors for assignment to categories were: generally consistent for cauda equina syndrome; agreed to be conduction block in sensory and motor nerves and pain on straight leg raise for nerve root syndrome; and agreed to be reduced walking distance resulting from pseudoclaudication for spinal stenosis. Disagreement related to postural factors for nerve root syndrome and spinal stenosis categories. CONCLUSION: This study has identified differences between the guidelines in the clinical decision rules for identification of neurologic involvement including omission of categories. Decision-making that employs all 3 categories of neurologic involvement will arguably facilitate accurate and timely identification of patients with low back pain so affected in primary care.

AngioCT in the management of neurointerventional patients: a prospective, consecutive series with associated dosimetry and resolution data.

INTRODUCTION: Endovascular coiling of intracranial aneurysms carries a risk of complications. Early detection and management of complications can improve clinical outcomes. AngioCT is a new imaging technology enabling CT-like images to be generated on a flat-panel digital subtraction angiography system, which can provide immediate "on angio table" identification and thorough assessment of such complications. We prospectively audited its utility during aneurysm coiling in patients following subarachnoid haemorrhage (SAH). METHODS: A prospective series of 44 patients with SAH undergoing endovascular coiling with AngioCT was audited for image quality and the influence of the AngioCT on patient management. In a parallel experimental study, radiation doses were measured and image quality parameters on standard phantoms were established. RESULTS: In all patients, AngioCT provided adequate diagnostic information. In 40.9% of patients, AngioCT was a substantial or major factor in determining the management immediately after coiling. Using a 10-s high-dose acquisition technique, acceptable image quality could be obtained rapidly with a radiation dose just over half that for a conventional CT scan of the head (35 mGy versus approximately 60 mGy). No patient in this series required conventional CT to clarify the AngioCT appearance. CONCLUSION: AngioCT has many applications in the neurointerventional setting. In particular during coiling, AngioCT provides a rapid way to clarify concerns or identify complications and in some cases was the major factor influencing further patient management immediately after coiling. AngioCT images were judged of adequate quality to be clinically useful in all patients in this series.

Top tips for effective teaching and learning.

UNLABELLED: If we wish to improve the quality of care provided to our patients it is essential that we all, as healthcare professionals, develop and update our knowledge and skills throughout our careers. To make our teaching and learning more effective and relevant, I have derived 10 tips to assist both the learner and teacher in making learning and teaching as effective as possible. These will be valuable to learners and, in particular, to the increasing numbers of dental surgeons who teach, both in a formal and informal role. CLINICAL RELEVANCE: For continuing professional development to be beneficial, the teaching and learning must be relevant and effective.

Decomposition and plant-available nitrogen in biosolids: laboratory studies, field studies, and computer simulation.

This research combines laboratory and field studies with computer simulation to characterize the amount of plant-available nitrogen (PAN) released when municipal biosolids are land-applied to agronomic crops. In the laboratory studies, biosolids were incubated in or on soil from the land application sites. Mean biosolids total C, organic N, and C to N ratio were 292 g kg(-1), 41.7 g kg(-1), and 7.5, respectively. Based on CO2 evolution at 25 degrees C and optimum soil moisture, 27 of the 37 biosolids-soil combinations had two decomposition phases. The mean rapid and slow fraction rate constants were 0.021 and 0.0015 d(-1), respectively, and the rapid fraction contained 23% of the total C assuming sequential decomposition. Where only one decomposition phase existed, the mean first order rate constant was 0.0046 d(-1). The mean rate constant for biosolids stored in lagoons for an extended time was 0.00097 d(-1). The only treatment process that was related to biosolids treatment was stabilization by storage in a lagoon. Biosolids addition rates (dry basis) ranged from 1.3 to 33.8 Mg ha(-1) with a mean value of 10.6 Mg ha(-1). A relationship between fertilizer N rate and crop response was used to estimate observed PAN at each site. Mean observed PAN during the growing season was 18.9 kg N Mg(-1) or 37% of the biosolids total N. Observed PAN was linearly related to biosolids total N. Predicted PAN using the computer model Decomposition, actual growing-season weather, actual analytical data, and laboratory decomposition kinetics compared well with observed PAN. The mean computer model prediction of growing-season PAN was 19.2 kg N Mg(-1) and the slope of the regression between predicted and observed PAN was not significantly different from unity. Predicted PAN obtained using mean decomposition kinetics was related to predicted PAN using actual decomposition kinetics suggesting that mean rate constants, actual weather, and actual analytical data could be used in estimation of PAN. There was a linear relationship between predicted N mineralization for the growing season and for the first year. For this study, the mean values for the growing season and year were 27 and 37% of the organic N, respectively.

Colorectal cancers in Jamaica: a review (1958-1967)

Two conditions seem necessary for better results in the treatemnt of colorectal cancer in Jamaica: dissemination to the public information about the early signs and symptoms of cancer, and a greater alertness by the medical profession in the interpretation of the patient's gastointestinal complaints. (Summary)

Spontaneous rupture of the distal large bowel

Six new cases of spontaneous rupture of the normal distal large bowel are described and 19 cases from the literature are reviewed, bringing the total of the recorded cases to 25. The aetiology of these cases is discussed. The ruptures occur in the region of the pelvi-rectal junction, in the sigmoid loop, and in the upper rectum. The tear is considered to be mechanical in origin and to be due to a sudden rise in intraluminar pressure which results from sudden obstruction during active peristalsis. Rupture may occur quite spontaneously but is more likely to occur in the presence of constipation and during def‘cation. The diagnosis, treatment, and mortality are also discussed. (Summary)

Massive gastro-duodenal haemorrhage

The etiology and management of massive gastro-duodenal haemorrage is discussed, on the basis of findings in 225 cases. (AU)

Acute intussusception in childhood

Twenty eight cases of acute intussusception in childhood are described. A total mortality of 14 percent and a post-operative mortality of 12 percent indicates the need for earlier diagnosis and improvements in surgical management. In only 9 cases was there a classical clinical picture and in 8 of these, the tumour remained in the right half of the colon with normal peritoneal fixation. Misleading a typical symptoms commonly occurred when the tumour had reached the left half of the colon and rectum and in all of these the right half of the colon was llax and pendulous. These cases had a variable incidence of pain, pyrexia, vomiting, diarrhoea and of blood in the stools, making it important to differentiate intussusception from infective gastro-enteritis in infancy and to recognise that intussusception may be a complication or a sequel of infective gastro-enteritis. Surgical reduction and methods of resection are discussed. The importance of careful pre-operative resuscitation and of post-operative care is stressed and a plea, based on results elsewhere, is made for the co-operation of paediatrician, surgeon, radiologist and anaesthetist in the management of these cases (AU)

The use of gastric cytology in the early diagnosis of carcinoma of the stomach

Hitherto the diagnosis of gastric carcinoma has been made by the clinician with the assistance of the gastrocopist and radiologist. The results remain dissappointing for not more than 50 percent of the cases are operable when first seen and of these only about 10 percent survive post-operatively for five years or more. An earlier diagnosis is required if results are to be improved. Exfoliative gastric cytology is a new diagnostic procedure which in the hands of the trained pathologist can reveal the presence of malignant cells in gastric washings in over 90 percent of gastric cancers. Experience has shown that cells are shed from even the smallest carcinoma in situ and that by cytology it is possible to detect a growth before there is any radiological or positive gastroscopic evidence of it. Gastric resections in these cases furnish material for the study of these early lesions and the surgeon may reasonably hope that his results will be vastly improved. The associations of such lesions with chronic atrophic gastritis suggests that this is a malignant condition (AU)