RESUMO
This paper describes a process to define a comprehensive list of exemplars for seven core Diagnostic and Statistical Manual (DSM) diagnostic criteria for autism spectrum disorder (ASD), and report on interrater reliability in applying these exemplars to determine ASD case classification. Clinicians completed an iterative process to map specific exemplars from the CDC Autism and Developmental Disabilities Monitoring (ADDM) Network criteria for ASD surveillance, DSM-5 text, and diagnostic assessments to each of the core DSM-5 ASD criteria. Clinicians applied the diagnostic exemplars to child behavioral descriptions in existing evaluation records to establish initial reliability standards and then for blinded clinician review in one site (phase 1) and for two ADDM Network surveillance years (phase 2). Interrater reliability for each of the DSM-5 diagnostic categories and overall ASD classification was high (defined as very good .60-.79 to excellent ≥ .80 Kappa values) across sex, race/ethnicity, and cognitive levels for both phases. Classification of DSM-5 ASD by mapping specific exemplars from evaluation records by a diverse group of clinician raters is feasible and reliable. This framework provides confidence in the consistency of prevalence classifications of ASD and may be further applied to improve consistency of ASD diagnoses in clinical settings.
Assuntos
Transtorno do Espectro Autista , Manual Diagnóstico e Estatístico de Transtornos Mentais , Seleção de Pacientes , Criança , Humanos , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Vigilância da População , Prevalência , Reprodutibilidade dos TestesRESUMO
A limited life cycle assessment (LCA) was performed on a combined biological and chemical process for the production of adipic acid, which was compared to the traditional petrochemical process. The LCA comprises the biological conversion of the aromatic feedstocks benzoic acid, impure aromatics, toluene, or phenol from lignin to cis, cis-muconic acid, which is subsequently converted to adipic acid through hydrogenation. Apart from the impact of usage of petrochemical and biomass-based feedstocks, the environmental impact of the final concentration of cis, cis-muconic acid in the fermentation broth was studied using 1.85% and 4.26% cis, cis-muconic acid. The LCA focused on the cumulative energy demand (CED), cumulative exergy demand (CExD), and the CO(2) equivalent (CO(2) eq) emission, with CO(2) and N(2) O measured separately. The highest calculated reduction potential of CED and CExD were achieved using phenol, which reduced the CED by 29% and 57% with 1.85% and 4.26% cis, cis-muconic acid, respectively. A decrease in the CO(2) eq emission was especially achieved when the N(2) O emission in the combined biological and chemical process was restricted. At 4.26% cis, cis-muconic acid, the different carbon backbone feedstocks contributed to an optimized reduction of CO(2) eq emissions ranging from 14.0 to 17.4 ton CO(2) eq/ton adipic acid. The bulk of the bioprocessing energy intensity is attributed to the hydrogenation reactor, which has a high environmental impact and a direct relationship with the product concentration in the broth.
Assuntos
Adipatos/metabolismo , Ácido Benzoico/metabolismo , Biotecnologia/métodos , Caprolactama/análogos & derivados , Polímeros/metabolismo , Pseudomonas putida/metabolismo , Biomassa , Caprolactama/metabolismo , Meio Ambiente , Combustíveis FósseisRESUMO
The prevalence and characterization of premonitory symptoms have not been rigorously studied in children and adolescents. Using a questionnaire, we retrospectively studied the prevalence of 15 predefined premonitory symptoms in a clinic-based population. In 103 children and adolescents fulfilling the International Classification of Headache Disorders, 2nd edn criteria for paediatric migraine, at least one premonitory symptom was reported by 69 (67%). The most frequently reported premonitory symptoms were face changes, fatigue and irritability. The mean number of premonitory symptoms reported per subject was 1.8 (median 2.2). Age, migraine subtype (with or without aura) and mean attack frequency per month had no effect on the mean number of premonitory symptoms reported per subject. In conclusion, premonitory symptoms are frequently reported by children and adolescents with migraine. Face changes seem to be a premonitory symptom peculiar to paediatric migraine.
Assuntos
Transtornos de Enxaqueca/epidemiologia , Adolescente , Criança , Pré-Escolar , Fadiga/epidemiologia , Feminino , Humanos , Hiperacusia/epidemiologia , Hipercinese/epidemiologia , Masculino , Transtornos do Humor/epidemiologia , Náusea/epidemiologia , Cervicalgia/epidemiologia , Fotofobia/epidemiologia , Prevalência , Transtornos do Sono-Vigília/epidemiologia , Inquéritos e Questionários , BocejoRESUMO
Stevens-Johnson syndrome is an acute, self-limiting disease of the skin and mucous membranes. Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis are all part of a single spectrum illness. We report severe erythema multiform in 4 children aged from 6 to 15 years old. Erythema was mostly related to mycoplasma pneumoniae infection (3/4) and 1 case was attributed to drugs. Two children developed severe sequelae (obliterans bronchiolitis). No patient had recurrent disease. The early use of steroids is still debated, but in our experience it seems to benefit overall. A long term follow-up is necessary with the study of pulmonary function tests and chest X-rays ophtalmologic and dermatologic examination.
Assuntos
Síndrome de Stevens-Johnson/diagnóstico , Adolescente , Criança , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Masculino , Pneumonia por Mycoplasma/complicações , Radiografia Torácica , Síndrome de Stevens-Johnson/diagnóstico por imagemRESUMO
The reactivity and toxicity of metabolic intermediates that are generated by initial biotransformation reactions can be a major limiting factor for biodegradation of halogenated organic compounds. Recent work on the conversion of haloalkanes, chloroaromatics and chloroethenes indicates that microorganisms may become less sensitive to toxic effects either by using novel pathways that circumvent the generation of reactive intermediates or by producing modified enzymes that decrease the toxicity of such compounds.
Assuntos
Bactérias Anaeróbias/enzimologia , Halogênios/metabolismo , Microbiologia Industrial/métodos , Resíduos Industriais , Proteínas de Bactérias/metabolismo , Enzimas/metabolismo , Halogênios/químicaRESUMO
There is no ring test for quality assessment available in Europe for diagnostics and antimicrobial susceptibility testing of the fastidious, anaerobic bacteria of the genus Brachyspira. Therefore, an international ring test for Brachyspira spp. was performed once a year during 2002-2004. Two sets of coded samples were prepared and distributed on each occasion. One set comprised six swabs dipped in pig faeces spiked with Brachyspira spp. intended for diagnostics. The other set comprised two pure strains intended only for susceptibility testing. All methods used were in-house methods. The species used were Brachyspira hyodysenteriae, Brachyspira pilosicoli, Brachyspira innocens, Brachyspira murdochii and Brachyspira intermedia. In most cases, the correct Brachyspira spp. were detected. However, the results showed that Brachyspira spp. could be difficult to identify, especially if two Brachyspira spp. were mixed or if the concentration of Brachyspira in faeces was low. Additionally, some laboratories reported Brachyspira growth in control samples that were not seeded with any spirochaetes. The lowest detection level was 10(2) bacteria/ml faeces for both B. hyodysenteriae and B. pilosicoli. The susceptibility tests performed showed that disc diffusion was not recommendable for Brachyspira spp. Extended antimicrobial dilution series gave most congruent results. The diversity of the results highlights the importance of ring tests for a high quality of diagnostics and antimicrobial susceptibility tests for Brachyspira spp. This is the first ring test described for Brachyspira spp.
Assuntos
Antibacterianos/farmacologia , Spirochaetaceae/efeitos dos fármacos , Infecções por Spirochaetales/veterinária , Doenças dos Suínos/microbiologia , Animais , Técnicas de Tipagem Bacteriana , Europa (Continente) , Fezes/microbiologia , Testes de Sensibilidade Microbiana , Spirochaetaceae/isolamento & purificação , Infecções por Spirochaetales/diagnóstico , Infecções por Spirochaetales/microbiologia , Suínos , Doenças dos Suínos/diagnósticoRESUMO
BACKGROUND: In some patients with ventricular fibrillation (VF) there may be a better chance of successful defibrillation after a period of chest compression and ventilation before the defibrillation attempt. It is therefore important to know whether a defibrillation attempt will be successful. The predictive power of a model developed by 'genetic' programming (GP) to predict defibrillation success was studied. METHODS AND RESULTS: 203 defibrillations were administered in 47 patients with out-of-hospital cardiac arrest due to a cardiac cause. Maximal amplitude, a total energy of power spectral density, and the Hurst exponent of the VF electrocardiogram (ECG) signal were included in the model developed by GP. Positive and negative likelihood ratios of the model for testing data were 35.5 and 0.00, respectively. Using a model developed by GP on the complete database, 120 of the 124 unsuccessful defibrillations would have been avoided, whereas all of the 79 successful defibrillations would have been administered. CONCLUSION: The VF ECG contains information predictive of defibrillation success. The model developed by GP, including data from the time-domain, frequency-domain and nonlinear dynamics, could reduce the incidence of unsuccessful defibrillations.
Assuntos
Cardioversão Elétrica , Parada Cardíaca/terapia , Software , Fibrilação Ventricular/terapia , Idoso , Reanimação Cardiopulmonar/métodos , Eletrocardiografia , Feminino , Genética , Parada Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Prognóstico , Fibrilação Ventricular/complicaçõesRESUMO
We report on 2 cases associating retinal (RH) and cerebral hemorrhages (CH), which first suggested the diagnosis of shaken baby syndrome (SBS). After an etiologic search, the diagnosis was corrected: the first case was a late hemorrhagic disease of the newborn and the second case hemophilia A. RH is a major feature of SBS, although not pathognomonic. There is no specific RH of SBS but they usually affect the posterior retinal pole. Typically, RHs of SBS are present in both eyes, although unilateral RHs do not exclude the diagnosis of SBS. The relationship between RH and CH has been reported in SBS but also in other diseases. Thus, one must search for hemostasis abnormalities, even though the clinical presentation suggests SBS. Ignoring SBS as well as coming to the conclusion of SBS too quickly should be avoided. Diagnostic difficulties may be related to the number of physicians involved and their interpretation of the facts. These 2 cases underline the need for working as a team that includes hematologists able to interpret coagulation parameters.
Assuntos
Hemorragia Cerebral/etiologia , Hematoma Subdural/etiologia , Hemofilia A/complicações , Hemorragia Retiniana/etiologia , Síndrome do Bebê Sacudido/complicações , Sangramento por Deficiência de Vitamina K/complicações , Antifibrinolíticos/administração & dosagem , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/cirurgia , Coagulantes/administração & dosagem , Consanguinidade , Diagnóstico Diferencial , Fator VIII/administração & dosagem , Evolução Fatal , Hematoma Subdural/diagnóstico , Hematoma Subdural/cirurgia , Hemofilia A/diagnóstico , Hemofilia A/tratamento farmacológico , Humanos , Lactente , Recém-Nascido , Masculino , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/cirurgia , Fatores de Risco , Síndrome do Bebê Sacudido/diagnóstico , Vitamina K 1/administração & dosagem , Sangramento por Deficiência de Vitamina K/diagnóstico , Sangramento por Deficiência de Vitamina K/tratamento farmacológicoRESUMO
Pseudomonas putida KT2440-JD1 was derived from P. putida KT2440 after N-methyl-N'-nitro-N-nitrosoguanidine (NTG)-mutagenesis and exposure to 3-fluorobenzoate (3-FB). The mutant was no longer able to grow using benzoate as a sole carbon source, but co-metabolized benzoate to cis, cis-muconate during growth on glucose, which accumulated in the growth medium. The specific production rate (q(pm)) was 0.18±0.03 g cis, cis-muconate/(g(DCW) h) in continuous cultures, and increased to 1.4 g cis, cis-muconate/(g(DCW) h) during wash-out cultivation. Transcriptome analysis showed that the cat operon was not induced in P. putida KT2440-JD1 in the presence of 5mM benzoate, due to a point mutation in the highly conserved DNA binding domain of the transcriptional regulator (catR) of the cat operon. The ben operon was highly expressed in the presence of benzoate in the mutant and its parental strain. This operon contains PP_3166 (catA2), which was shown to be a second catechol 1,2-dioxygenase besides catA. P. putida KT2440-JD1 is the first cis, cis-muconate-accumulating mutant that was characterized at the genetic level. The specific production rate achieved is at least eight times higher than those reported for other cis, cis-muconate-producing strains.
Assuntos
Proteínas de Bactérias/genética , Proteínas de Ligação a DNA/genética , Regulação Bacteriana da Expressão Gênica , Pseudomonas putida , Ácido Sórbico/análogos & derivados , Fatores de Transcrição/genética , Benzoatos/metabolismo , Benzoatos/toxicidade , Biotecnologia/métodos , Mutação/efeitos dos fármacos , Óperon/genética , Pseudomonas putida/genética , Pseudomonas putida/metabolismo , Elementos Reguladores de Transcrição , Ácido Sórbico/metabolismo , Regulação para CimaRESUMO
NMR analysis of (13)C-labelling patterns showed that the Embden-Meyerhof (EM) pathway is the main route for glycolysis in the extreme thermophile Caldicellulosiruptor saccharolyticus. Glucose fermentation via the EM pathway to acetate results in a theoretical yield of 4 mol of hydrogen and 2 mol of acetate per mole of glucose. Previously, approximately 70% of the theoretical maximum hydrogen yield has been reached in batch fermentations. In this study, hydrogen and acetate yields have been determined at different dilution rates during continuous cultivation. The yields were dependent on the growth rate. The highest hydrogen yields of 82 to 90% of theoretical maximum (3.3 to 3.6 mol H(2) per mol glucose) were obtained at low growth rates when a relatively larger part of the consumed glucose is used for maintenance. The hydrogen productivity showed the opposite effect. Both the specific and the volumetric hydrogen production rates were highest at the higher growth rates, reaching values of respectively 30 mmol g(-1) h(-1) and 20 mmol l(-1) h(-1). An industrial process for biohydrogen production will require a bioreactor design, which enables an optimal mix of high productivity and high yield.
Assuntos
Bactérias Anaeróbias/metabolismo , Glicólise , Hidrogênio/metabolismo , Acetatos/química , Acetatos/metabolismo , Isótopos de Carbono , Fermentação , Glucose/metabolismo , Hidrogênio/química , Espectroscopia de Ressonância Magnética , TemperaturaAssuntos
Nutrição Enteral , Gastroscopia , Gastrostomia/métodos , Serviços de Assistência Domiciliar , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , MasculinoRESUMO
We have examined the electrophoretic pattern of mannose-labelled glycopeptides derived from liver, pancreas, heart, brain, lung and kidney. The various organs were removed from white Swiss mice of 4-5, 20 and 40 days of age as well as from adult animals. Our data demonstrated that each organ had a characteristic ratio of acidic to neutral glycopeptides and that this ratio, in some cases, was substantially modified as the animal grew, consistent with the hypothesis that these changes might play an important role in the development and physiological function of organs.
Assuntos
Glicopeptídeos/biossíntese , Envelhecimento , Animais , Encéfalo/crescimento & desenvolvimento , Coração/crescimento & desenvolvimento , Concentração de Íons de Hidrogênio , Rim/crescimento & desenvolvimento , Fígado/crescimento & desenvolvimento , Pulmão/crescimento & desenvolvimento , Manose , Camundongos , Pâncreas/crescimento & desenvolvimento , Técnica de Diluição de Radioisótopos , TrítioRESUMO
OBJECTIVES: The objectives of this study were (1) to show prediagnostic abnormalities in social and communicative behaviors on home videos of children who later received a diagnosis of one of the pervasive developmental disorders (PDD) and (2) to demonstrate that prediagnostic abnormalities in social and communicative behaviors for children with PDD not otherwise specified will be less prominent than those in children with autistic disorder but still distinguishable from those of typically developing peers. STUDY DESIGN: Parents of children with PDD each submitted home videos of social events that were made when their child was between the ages of 12 and 30 months, before diagnosis. Two independent observers, unaware of the subjects' diagnoses or purpose of the study, scored the rates of specific anomalies in social and communicative behavior. Two additional observers scored the percentage of time the children were engaged socially or with objects. Data from the experimental group were compared with those of 25 age-matched children with no developmental disabilities. RESULTS: Significant differences were found between the rates of social engagement and 8 of the 25 specific behaviors of the children in whom PDD was later diagnosed and those of the typical children. The children later given the diagnosis of PDD not otherwise specified had mean frequencies of some social interactions and communicative skills that fell between those of children later given the diagnosis of autistic disorder and those of children with typical development. CONCLUSION: In our sample children in whom PDD was later diagnosed could be differentiated from their typically developing peers on the basis of specific anomalies noted in their social and communicative behaviors, especially joint attention. In our sample children with PDD not otherwise specified could have been further differentiated on the basis of the rates of social interaction. Careful assessment of social interaction and communicative behaviors may help to identify children with PDD before the age of 30 months.
Assuntos
Transtornos Globais do Desenvolvimento Infantil/diagnóstico , Gravação de Videoteipe , Transtorno Autístico/diagnóstico , Transtornos Globais do Desenvolvimento Infantil/classificação , Pré-Escolar , Comunicação , Feminino , Humanos , Lactente , Masculino , Comportamento SocialRESUMO
This cross-cultural retrospective study investigates the problems parents experience when told that their child is physically and/or mentally disabled. The authors try to compare, where relevant, some of the responses of the parents from different ethnic groups. The parents of 40 randomly selected coloured, 26 white and 24 black pre-school children who were first seen at the Developmental Assessment Clinic at the Red Cross War Memorial Children's Hospital in Cape Town, South Africa between January 1989 and December 1990 were asked to participate in this study. The final sample comprised 65 children. Except for the Xhosa speaking parents, the majority of parents received the diagnosis in their own language (English or Afrikaans). Most Xhosa speaking parents denied having received an explanation of the diagnosis, or having had an opportunity to ask questions. Only a few black parents reported being asked as to their understanding of the diagnosis. White parents tended to deny the diagnosis of mental handicap more often than the other groups despite reporting that explanations were given. The majority of parents would have liked a written report after the first consultation. Despite these findings, most parents felt satisfied with the way the news were given to them, reported good progress in their children and some of them expected their children to go to a normal school. Use of a language other than the parent's tongue tends to have a negative influence on the communication between doctors and parents. A diagnosis of mild mental handicap, a 'perception' of good progress and an absence of visible signs of the disability contribute to parental denial of the reality of the child's developmental delay and its scholastic consequences. The process of 'breaking the news' can be facilitated by the introduction of a few simple measures as described in the recommendations.
Assuntos
Comparação Transcultural , Pessoas com Deficiência/psicologia , Pais/psicologia , Relações Médico-Paciente , Revelação da Verdade , Criança , Pré-Escolar , Comportamento do Consumidor , Feminino , Humanos , Lactente , Deficiência Intelectual/psicologia , Masculino , Estudos Retrospectivos , África do SulRESUMO
OBJECTIVE: This study determined the prevalence of autism for a defined community, Brick Township, New Jersey, using current diagnostic and epidemiologic methods. METHODS: The target population was children who were 3 to 10 years of age in 1998, who were residents of Brick Township at any point during that year, and who had an autism spectrum disorder. Autism spectrum disorder was defined as autistic disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS), and Asperger disorder. The study used 4 sources for active case finding: special education records, records from local clinicians providing diagnosis or treatment for developmental or behavioral disabilities, lists of children from community parent groups, and families who volunteered for participation in the study in response to media attention. The autism diagnosis was verified (or ruled out) for 71% of the children through clinical assessment. The assessment included medical and developmental history, physical and neurologic evaluation, assessment of intellectual and behavioral functioning, and administration of the Autism Diagnostic Observation Schedule-Generic. RESULTS: The prevalence of all autism spectrum disorders combined was 6.7 cases per 1000 children. The prevalence for children whose condition met full diagnostic criteria for autistic disorder was 4.0 cases per 1000 children, and the prevalence for PDD-NOS and Asperger disorder was 2.7 cases per 1000 children. Characteristics of children with autism in this study were similar to those in previous studies of autism. CONCLUSIONS: The prevalence of autism in Brick Township seems to be higher than that in other studies, particularly studies conducted in the United States, but within the range of a few recent studies in smaller populations that used more thorough case-finding methods.
Assuntos
Transtorno Autístico/epidemiologia , Antropometria , Transtorno Autístico/diagnóstico , Transtorno Autístico/fisiopatologia , Criança , Pré-Escolar , Feminino , Humanos , Inteligência , Masculino , New Jersey/epidemiologia , Prevalência , Índice de Gravidade de Doença , Distribuição por SexoRESUMO
Pseudomonas putida GS1 is able to convert limonene to perillic acid (up to 64 mM,(11 g/l) when the bacteria is cultivated in fed-batch culture with non-limiting amounts of glycerol. ammonium, and limonene. P. putida GS1 can use p-cymene as a single source of carbon and energy, and the enzymes that are responsible for the conversion of limonene to perillic acid belong to the degradation pathway of p-cymene. The p-cymene pathway of P putida GS1 is very similar, if not identical, to the cym pathway of P. putida F1. The latter strain, and a recombinant Escherichia coli strain that carried the genes of the cym pathway of P. putida Fl, also converted limonene to perillic acid. However, the final concentrations that were obtained in batch cultures with these two strains were lower than those obtained with P. putida GS1.