"Work through it on your own": parent-centered emotion socialization beliefs and parenting stress.

Parent-centered emotion socialization beliefs that children should manage their emotions on their own without parent support may seem convenient for parents but may actually relate to greater parenting stress if this approach is incompatible with children's developmental needs. We explored relations between mothers' and fathers' parent-centered autonomy beliefs about children's emotions and their parenting stress, controlling for child behavior problems and parent education. We also examined whether these associations varied depending on child age. Participants included 142 mothers and 60 paired fathers with a 5- to 8-year-old child who completed survey measures on parenting and child behavior. The sample was primarily White (59%) or Hispanic (20%) and low (44%) to middle income (47%). Path analyses revealed significant actor effects, such that mothers and fathers who endorsed more parent-centered emotion socialization beliefs reported greater parenting stress. Partner effects showed that mothers also reported greater parenting stress when their partners endorsed more parent-centered emotion socialization beliefs. Child age did not moderate these associations. Findings are discussed in terms of developmentally appropriate parenting expectations, gender roles for family emotion work, and practical implications.

Evaluation of sputum cultures in children with spinal Muscular atrophy.

BACKGROUND: Spinal Muscular Atrophy (SMA) is a severe neuromuscular disorder. Despite increased survival due to novel therapies, morbidity from respiratory complications still persists. We aim to describe these patients' sputum cultures as an expression of chronic infectious airway disease. METHODS: Retrospective review of medical records of all children with SMA followed at the multidisciplinary respiratory neuromuscular clinic at Schneider Childrens' Medical Center of Israel over a 16-year period. Sputum cultures were obtained during routine visits or pulmonary exacerbations. RESULTS: Sixty-one SMA patients, aged 1 month to 21 years, were included in this cohort. Of these, sputum cultures were collected from 41 patients. Overall, 288 sputum cultures were obtained, and 98 (34%) were negative for bacterial growth. For the first culture taken from each patient, 12 out of 41 (29%) were sterile. The most common bacteria were pseudomonas aeruginosa (PSA) (38%) and staphylococcus aureus (19.6%). PSA was found in SMA type I patients more frequently than in type II patients (15/26 = 58% vs 4/13 = 31%, p < 0.001). PSA infection was positively associated with noninvasive ventilation, recurrent atelectasis, recurrent pneumonias, swallowing difficulties, but no significant association was found with cough assist machine usage. The incidence of positive cultures did not differ between those treated with Onasemnogene abeparvovec or Nusinersen compared to those without treatment, but the age of first PSA isolation was slightly older with Nusinersen treatment (p = 0.01). CONCLUSIONS: Airway bacterial colonization is common in SMA type I patients and is not decreased by Onasemnogene abeparvovec or Nusinersen treatment.

Pulmonary function tests for evaluating the severity of Duchenne muscular dystrophy disease.

AIM: In Duchenne muscular dystrophy (DMD), lung disease contributes significantly to morbidity and mortality. This study aimed to assess the usefulness of various pulmonary function tests in evaluating DMD severity. METHODS: This retrospective study analysed lung function tests of patients with DMD-treated in the multidisciplinary respiratory neuromuscular clinic at Schneiders' Children Medical Center of Israel. Data were analysed according to age, ambulatory status and glucocorticoid treatment. RESULTS: Among 90 patients with DMD, 40/63 (63.5%) ambulatory patients and 22/27 (81.5%) nonambulatory patients successfully performed spirometry. Significant annual declines were demonstrated among nonambulatory patients, in percentile predicted forced vital capacity (3.8%) and in total lung capacity (5.5%) per year. The decline correlated with age and loss of ambulation but not with steroid treatment. Peak cough flow values were randomly distributed and did not correlate with age, ambulation or treatment. In nonambulatory patients, transcutaneous carbon dioxide measurement correlated significantly with age (r = 0.55, p = 0.02). CONCLUSION: Forced vital capacity, total lung capacity and transcutaneous carbon dioxide correlated with the clinical severity of disease in children with DMD. These measures may be useful in follow-up and clinical trials. A comparable correlation was not found for peak cough flow.

Impact on neonatal morbidities after a change in policy to administer antenatal corticosteroids to mothers at risk for late preterm delivery.

OBJECTIVES: Antenatal corticosteroids (ACS) administered to mothers at risk for preterm delivery before 34 weeks has been standard care to improve neonatal outcomes. After introducing a new obstetric policy based on updated recommendations advising the administration of ACS to pregnant women at risk for late preterm (LPT) delivery (34-36 6/7 weeks), we set out to determine the short-term clinical impact on those LPT neonates. METHODS: Retrospective chart review of LPT neonates delivered at NYU Langone Medical Center both one year before and after the policy went into place. We excluded subjects born to mothers with pre-gestational diabetes, multiple gestations, and those with congenital/genetic abnormalities. We also excluded subjects whose mothers already received ACS previously in pregnancy. Subjects were divided into pre-policy and post-policy groups. Neonatal and maternal data were compared for both groups. RESULTS: 388 subjects; 180 in the pre-policy and 208 in the post-policy group. This policy change resulted in a significant increase in ACS administration to mothers who delivered LPT neonates (67.3 vs. 20.6%, p<0.001). In turn, there was a significant reduction in LPT neonatal intensive care unit (NICU) admissions (44.2 vs. 54.4%, p=0.04) and need for respiratory support (27.9 vs. 42.8%, p<0.01). However, we also found an increased incidence of hypoglycemia (49.5 vs. 28.3%, p<0.001). CONCLUSIONS: This LPT ACS policy appears effective in reducing the need for LPT NICU level care overall. However, clinicians must be attentive to monitor for adverse effects like hypoglycemia, and there remains a need for better understanding of potential long-term impacts.

Effectiveness of a "Suppression Bundle" to improve HIV virologic suppression in an outpatient infectious disease clinic: a pilot implementation study.

Despite effectiveness and accessibility of combined anti-retroviral therapy (cART), only 85% of people living with HIV (PLHIV) in the United States are virologically suppressed. Improving suppression is complex. Our objective was to consider unique factors in PLHIV with non-suppressed viral loads in clinic and improve the percentage of suppressed patients by implementing a "Suppression Bundle" consisting of three to five bundled interventions with the goal of improved suppression. Prior to the study, there were 567 HIV-positive patients receiving care in clinic. Of those, 89 had a measurable viral load (>40 copies/mL). In this pilot pre-post implementation, we focused on the 89 non-suppressed patients to (1) determine feasibility of implementing bundles and (2) increase the number of patients with suppressed viral loads pre- to post-intervention. Of non-suppressed patients, 65 were active in care immediately pre-intervention and participated in the pilot. At the completion of the 9-month intervention, 46 had viral loads <40 copies/mL, demonstrating substantial improvement with 70.1% of the previously non-suppressed patients achieving suppression. By considering unique patient factors, an individualized Suppression Bundle is acceptable, feasible, and may increase virally suppressed patients in an outpatient clinic. Next steps include determining whether suppression bundles can be implemented in differing practices.

COVID-19 in advanced Duchenne/Becker muscular dystrophy patients.

Duchenne muscular dystrophy (DMD) is the most common childhood muscular dystrophy. As a result of progressive muscle weakness, pulmonary function decreases during the second decade of life and lung disease contributes significantly to morbidity and mortality in these patients. Corticosteroids are the current standard of care for patients with DMD, despite known adverse effects such as obesity and immunosuppression. Over the past year (2020), the novel coronavirus (COVID-19/SARS-CoV2) outbreak has caused a global pandemic. Restrictive lung disease due to low lung volumes, chronic immunosuppressive treatment with corticosteroids, and obesity are potential risk factors that may contribute to a more severe course of the disease. Out of 116 Duchenne/Becker muscular dystrophy patients treated in our tertiary neuromuscular center, six patients with DMD and one with advanced Becker muscular dystrophy were found to be positive for COVID-19 infection. Two of the DMD patients were admitted for hospitalization, of whom one was dependent on daily nocturnal non-invasive ventilation. All patients recovered without complications despite obesity, steroid treatment and severe restrictive lung disease.

Genetics, not the uterine environment, drive the formation of trophoblast inclusions: Insights from a twin study.

INTRODUCTION: Trophoblast inclusions (TIs) are associated with aneuploidy and pregnancy loss and have thus been considered to be a marker of genetic abnormality. However, to date, no study has specifically explored whether TIs are a manifestation of fetal genetics or, rather, the result of the intrauterine environment. The goal of this study was to compare the frequency of TIs in the placentas of monozygotic (MZ) and dizygotic (DZ) twin pairs in order to determine whether the formation of TIs is genetically driven or not. METHODS: We performed a retrospective case series of placentas from 48 twin pairs. The placentas were grouped based on zygosity: MZ, DZ, or unknown (UZ). The average number of total TIs per slide was calculated for each twin individual and the mean absolute difference in the total TIs per slide between the twin pairs was calculated for each zygosity group and compared. RESULTS: The mean difference in the total TIs per slide for DZ twins was significantly greater than the mean difference in the total TIs per slide for MZ twins (p = 0.003). The mean difference in the total TIs per slide for the UZ group was also significantly greater than the mean difference in total TIs per slide between MZ twin pairs (p = 0.028). DISCUSSION: Our finding that MZ twins were significantly more concordant than DZ twins for the average number of TIs per slide supports the conclusion that TIs are intrinsic to the genetics of the fetus, not the uterine environment.

Prenatal and perinatal metabolic risk factors for autism: a review and integration of findings from population-based studies.

PURPOSE OF REVIEW: Given the ongoing rise in prevalence of autism spectrum disorder (ASD) and the challenges in developing and administering interventions to significantly alleviate ASD symptoms, there is an urgent need to identify modifiable risk factors for ASD. The goal of this review is to systematically evaluate the current evidence for an association between conditions related to maternal metabolic syndrome and risk for ASD in offspring focusing on methodically rigorous studies. RECENT FINDINGS: In recent years, multiple studies explored the association between various conditions related to maternal metabolic syndrome (obesity, hypertension, or diabetes prior to, or with onset during pregnancy) and ASD risk in the offspring. SUMMARY: Examining large, sufficiently powered, population-based epidemiological studies that explored the association between maternal metabolic syndrome and ASD, we found consistent evidence for an association between maternal preeclampsia and risk for ASD. Other conditions that are part of maternal metabolic syndrome, including maternal obesity, gestational weight gain, diabetes and gestational diabetes, should be studied further with careful attention paid to potential synergistic effects between different metabolic conditions. These findings highlight the need for rigorous, large, population-based epidemiological studies of potentially modifiable ASD risk factors that could inform public health interventions.

A 15-Year-Old With Tetralogy of Fallot With Pulmonic Atresia, Multiple Aorticopulmonary Collateral Arteries and Bilateral Peripheral Pulmonary Stenosis.

Tetralogy of Fallot (TOF) is a congenital disorder comprised of four heart defects. It is considered a critical condition that requires surgical repair. TOF may be complicated by pulmonary valve atresia (PA) and the development of major aorticopulmonary collateral arteries (MAPCA). A 15-year-old girl from Jimma, Ethiopia, was admitted to the pediatric cardiology unit through the "Save a Child's Heart" organization. She was diagnosed at the age of four years with TOF but had not yet received treatment for the condition. Echocardiography prompted a diagnosis of TOF with PA and MAPCA. It is recommended that TOF be treated shortly after birth, thus observing this condition in 15-year-old highlights the complications that may accompany delayed repair. This report details the course of diagnosis and treatment for this patient.

Doctors are seen as Godlike: Moral typecasting in medicine.

OBJECTIVE: Doctors are generally thought of as very intelligent and capable. This perception has upsides-doctors are afforded respect and esteem-but it may also have downsides, such as neglecting the mental and physical health of physicians. Two studies examine how Americans "typecast" doctors as Godlike "thinkers" who help others, rather than as vulnerable "feelers" who might themselves need help. METHOD AND RESULTS: Study 1 examines how a representative sample of Americans (N = 681) view the mental capacities of doctors compared to other targets (including patients, other workers, and God). Result show that people see physicians as highly capable of the thinking-related capacities of thinking, remembering, self-control, and planning (equal to that of God), but less capable of the feeling-related capacities of experiencing fear, pain, embarrassment, and hunger. Study 2 (N = 451) examines whether physician typecasting impacts other domains. People believe that, relative to the average working professional, physicians are better able to ignore physical and mental health issues, and physician job performance is less impacted by bodily and emotional limitations. DISCUSSION: We discuss implications for medical practice, especially the growing epidemic of physician burnout.

Haptoglobin therapy has differential effects depending on severity of canine septic shock and cell-free hemoglobin level.

BACKGROUND: During sepsis, higher plasma cell-free hemoglobin (CFH) levels portend worse outcomes. In sepsis models, plasma proteins that bind CFH improve survival. In our canine antibiotic-treated Staphylococcus aureus pneumonia model, with and without red blood cell (RBC) exchange transfusion, commercial human haptoglobin (Hp) concentrates bound and compartmentalized CFH intravascularly, increased CFH clearance, and lowered iron levels, improving shock, lung injury, and survival. We now investigate in our model how very high CFH levels and treatment time affect Hp's beneficial effects. MATERIALS AND METHODS: Two separate canine pneumonia sepsis Hp studies were undertaken: one with exchange transfusion of RBCs after prolonged storage to raise CFH to very high levels and another with rapidly lethal sepsis alone to shorten time to treat. All animals received continuous standard intensive care unit supportive care for 96 hours. RESULTS: Older RBCs markedly elevated plasma CFH levels and, when combined with Hp therapy, created supraphysiologic CFH-Hp complexes that did not increase CFH or iron clearance or improve lung injury and survival. In a rapidly lethal bacterial challenge model without RBC transfusion, Hp binding did not increase clearance of complexes or iron or show benefits seen previously in the less lethal model. DISCUSSION: High-level CFH-Hp complexes may impair clearance mechanisms and eliminate Hp's beneficial effect during sepsis. Rapidly lethal sepsis narrows the therapeutic window for CFH and iron clearance, also decreasing Hp's beneficial effects. In designing clinical trials, dosing and kinetics may be critical factors if Hp infusion is used to treat sepsis.

Disquiet in the consulting room: everything/nothing that is said here is confidential.

Writing from experiences in the consulting room in private practice in Australia, the author refers to the layered complexity of a conflict of ethical duty which has legal and social implications. The paper explores how the ethics that are congruent with creating a safe vas bene claustrum can be diametrically opposed to the social and legal structures and processes on which we all rely. It is suggested that within the vas, analysts and analysands engage in a shared process of emotionally connected, layered, symbolic thinking. Subpoenas directed at analysts are seeking concrete evidence that will stand up in court. The paper argues that this is a category error based on ignorance and misconceptions of what analytic work entails. The intrusion of a subpoena into the vas has the potential to cause havoc in the mental health and the lives of already vulnerable, possibly traumatized and isolated individuals. It can undermine a fundamental human right and undermine the profession of psychotherapy as a whole. The paper proposes that analysts have an ethical obligation to protect the work contained within the vas from these category errors and to educate other professionals as to why we cannot provide the kind of evidence that the courts require.

Ecrivant à partir d'expériences de sa pratique avec sa patientèle privée, en Australie, l'auteur souligne la complexité s'étageant sur plusieurs niveaux d'un conflit concernant un devoir éthique qui a des implications légales et sociales. L'article étudie comment l'éthique congruente avec la création d'un bon vas bene claustrum peut être diamétralement opposée aux structures et processus légaux et sociaux sur lesquels nous nous appuyons tous. Il est suggéré qu'à l'intérieur du vas, les analystes et les analysants sont impliqués dans un processus partagé de pensée symbolique, à plusieurs niveaux, et reliée aux émotions. Les assignations adressées à des analystes demandent des preuves concrètes qui tiendraient lors d'un procès. L'article argumente qu'il s'agit là d'une erreur de catégorie provenant de l'ignorance et de l'incompréhension sur ce que le travail analytique implique. L'intrusion d'une assignation dans le vas risque potentiellement de faire des ravages dans la santé psychique et la vie de personnes déjà vulnérables, et peut-être traumatisées ou isolées. Cela peut porter atteinte à un droit humain fondamental et saper la profession de psychothérapie dans son ensemble. L'article suggère que les analystes ont une obligation éthique de protéger le travail contenu dans le vas de ces erreurs de catégorie et d'éduquer les autres professions sur la question de pourquoi nous ne pouvons pas fournir la sorte de preuve dont les tribunaux ont besoin.

A partir de experiencias en su práctica privada en Australia, la autora hace referencia a los distintos niveles de complejidad de un conflicto de deber ético que tiene implicancias sociales y legales. El trabajo explora como la ética congruente con la noción de crear un vas bene claustrum seguro puede ser diametralmente opuesta a las estructuras sociales y legales y a los procesos sobre los cuales todos nos apoyamos. Se sugiere que al interior del vas, analistas y analizandos se comprometen en un proceso compartido de pensamientos simbólico, emocionalmente conectado. Las citaciones dirigidas a analistas buscan evidencia concreta que se sostendrá en la corte. El presente trabajo argumenta que este es un error de categoría basado en la ignorancia y la incomprensión de lo que implica el trabajo analítico. La intrusión de una citación dentro del vas tiene el potencial de hacer estragos en la salud mental y en las vidas de individuos ya vulnerables, y posiblemente aislados y traumatizados. Puede debilitar un derecho humano fundamental y la profesión de psicoterapia en su totalidad. El artículo propone que analistas tienen una obligación ética de proteger el trabajo contenido al interior del vas de estos errores categóricos, así como de educar a otros profesionales respecto a porqué no es posible proveer esta clase de evidencia que la corte requiere.

Development of home cage social behaviors in BALB/cJ vs. C57BL/6J mice.

BALB/cJ and C57BL/6J inbred mouse strains have been proposed as useful models of low and high levels of sociability (tendency to seek social interaction), respectively, based primarily on behaviors of ∼30-day-old mice in the Social Approach Test (SAT). In the SAT, approach and sniffing behaviors of a test mouse toward an unfamiliar stimulus mouse are measured in a novel environment. However, it is unclear whether such results generalize to a familiar environment with a familiar social partner, such as with a littermate in a home cage environment. We hypothesized that C57BL/6J mice would show higher levels of social behaviors than BALB/cJ mice in the home cage environment, particularly at 30 days-of-age. We measured active and passive social behaviors in home cages by pairs of BALB/cJ or C57BL/6J littermates at ages 30, 41, and 69 days. The strains did not differ robustly in their active social behaviors. C57BL/6J mice were more passively social than BALB/cJ mice at 30 days, and C57BL/6J levels of passive social behaviors declined to BALB/cJ levels by 69 days. The differences in passive social behaviors at 30 days-of-age were primarily attributable to differences in huddling. These results indicate that different test conditions (SAT conditions vs. home cage conditions) elicit strain differences in distinct types of behaviors (approach/sniffing vs. huddling behaviors, respectively). Assessment of the more naturalistic social interactions in the familiar home cage environment with a familiar littermate will provide a useful component of a comprehensive assessment of social behaviors in mouse models relevant to autism.