Professional practices, training, and funding mechanisms: A survey of pediatric primary care psychologists

The integration of mental health services in primary care settings has expanded rapidly in recent years with psychologists being at the forefront of efforts to promote healthy behaviors, reduce disease, and care for behavioral, emotional, and developmental needs to promote overall health and well-being for children and families (Asarnow, Kolko, Miranda,&Kazak, 2017; Stancin& Perrin, 2014). While there are many psychologists working in pediatric primary care (PPC), little is known about the specific activities that these psychologists engage in, the training they receive, or funding mechanisms that support their work. This study sought to address this gap in the literature through a survey of psychologists working in PPC. An anonymous online survey was disseminated to members of professional organizations and listservs who were identified as having interest in PPC. Psychologists (N-65) currently practicing in PPC completed the survey by reporting on clinical roles and practices, professional training, practice settings, and funding supports in PPC settings. Results indicate that psychologists assume a number of roles in PPC including providing individual and family therapy, conducting screenings for child mental health concerns, and providing consultation to medical colleagues. Many psychologists also provide supervision and offer educational opportunities for those in related fields, such as medicine and social work. Engagement in research activities was identified as a secondary activity. It was reported that a number of clinical activities were not billed for on a regular basis. Additional areas of research will be discussed along with implications for clinical services in PPC.. © 2017 American Psychological Association

Hitzschlag mit Alpha-Koma: Ein Fallbericht

Zusammenfassung: Wir berichten über einen 41-jährigen komatösen Patienten, der einen schwer verlaufenden Hitzschlag mit einer Körperkerntemperatur von 41,5°C erlitt. Der klinische Verlauf wurde kompliziert durch eine akute systemische inflammatorische Reaktion und Multiorganversagen. Das EEG zeigte ein prognostisch ungünstiges Alpha-Koma ohne Reaktivität auf externe Stimuli. Der Patient erlangte das Bewusstsein wieder und wurde nach 16Tagen aus der intensivmedizinischen Behandlung entlassen. Im weiteren Verlauf entwickelte sich eine zerebrale Toxoplasmose, die mit einer Kombinationstherapie aus Sulfadiazin und Pyrimethamin behandelt wurde. Nach 65Tagen erfolgte eine Verlegung in eine Neurorehabilitationsklinik mit einem moderaten neurologischen Defizi

Statistical analysis of the primary outcome in acute stroke trials

Common outcome scales in acute stroke trials are ordered categorical or pseudocontinuous in structure but most have been analyzed as binary measures. The use of fixed dichotomous analysis of ordered categorical outcomes after stroke (such as the modified Rankin Scale) is rarely the most statistically efficient approach and usually requires a larger sample size to demonstrate efficacy than other approaches. Preferred statistical approaches include sliding dichotomous, ordinal, or continuous analyses. Because there is no best approach that will work for all acute stroke trials, it is vital that studies are designed with a full understanding of the type of patients to be enrolled (in particular their case mix, which will be critically dependent on their age and severity), the potential mechanism by which the intervention works (ie, will it tend to move all patients somewhat, or some patients a lot, and is a common hazard present), a realistic assessment of the likely effect size, and therefore the necessary sample size, and an understanding of what the intervention will cost if implemented in clinical practice. If these approaches are followed, then the risk of missing useful treatment effects for acute stroke will diminish

Contemporary outcome measures in acute stroke research: choice of primary outcome measure

BACKGROUND AND PURPOSE: The diversity of available outcome measures for acute stroke trials is challenging and implies that the scales may be imperfect. To assist researchers planning trials and to aid interpretation, this article reviews and makes recommendations on the available choices of scales. The aim is to identify an approach that will be universally accepted and that should be included in most acute trials, without seeking to restrict options for special circumstances. METHODS: The article considers outcome measures that have been widely used or are currently advised. It examines desirable properties for outcome measures such as validity, relevance, responsiveness, statistical properties, availability of training, cultural and language issues, resistance to comorbidity, as well as potential weaknesses. Tracking and agreement among outcomes are covered. RESULTS: Typical ranges of scores for the common scales are described, along with their statistical properties, which in turn influence optimal analytic techniques. The timing of recovery on scores and usual practice in trial design are considered. CONCLUSIONS: The preferred outcome measure for acute trials is the modified Rankin Scale, assessed at 3 months after stroke onset or later. The interview should be conducted by a certified rater and should involve both the patient and any relevant caregiver. Incremental benefits at any level of the modified Rankin Scale may be acceptable. The modified Rankin Scale is imperfect but should be retained in its present form for comparability with existing treatment comparisons. No second measure should be required, but correlations with supporting scales may be used to confirm consistency in direction of effects on other measures

Wide variation and rising utilization of stroke magnetic resonance imaging: Data from 11 States

Objective: Neuroimaging is an essential component of the acute stroke evaluation. Magnetic resonance imaging (MRI) is more accurate than computed tomography (CT) for the diagnosis of stroke, but is more costly and time‐consuming. We sought to describe changes in MRI utilization from 1999 to 2008. Methods: We performed a serial cross‐sectional study with time trends of neuroimaging in patients with a primary International Classification of Diseases, 9th Edition, Clinical Modification discharge diagnosis of stroke admitted through the emergency department in the State Inpatient Databases from 10 states. MRI utilization was measured by Healthcare Cost and Utilization Project criteria. Data were included for states from 1999 to 2008 where MRI utilization could be identified. Results: A total of 624,842 patients were hospitalized for stroke in the period of interest. MRI utilization increased in all states. Overall, MRI absolute utilization increased 38%, and relative utilization increased 235% (28% of strokes in 1999 to 66% in 2008). Over the same interval, CT utilization changed little (92% in 1999 to 95% in 2008). MRI use varied widely by state. In 2008, MRI utilization ranged from a low of 55% of strokes in Oregon to a high of 79% in Arizona. Diagnostic imaging was the fastest growing component of total hospital costs (213% increase from 1999 to 2007). Interpretation: MRI utilization during stroke hospitalization increased substantially, with wide geographic variation. Rather than replacing CT, MRI is supplementing it. Consequently, neuroimaging has been the fastest growing component of hospitalization cost in stroke. Recent neuroimaging practices in stroke are not standardized and may represent an opportunity to improve the efficiency of stroke care. Ann Neurol 2012;71:179–185Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90061/1/22698_ftp.pd

Diabetic Cardiovascular Disease Induced by Oxidative Stress.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among patients with diabetes mellitus (DM). DM can lead to multiple cardiovascular complications, including coronary artery disease (CAD), cardiac hypertrophy, and heart failure (HF). HF represents one of the most common causes of death in patients with DM and results from DM-induced CAD and diabetic cardiomyopathy. Oxidative stress is closely associated with the pathogenesis of DM and results from overproduction of reactive oxygen species (ROS). ROS overproduction is associated with hyperglycemia and metabolic disorders, such as impaired antioxidant function in conjunction with impaired antioxidant activity. Long-term exposure to oxidative stress in DM induces chronic inflammation and fibrosis in a range of tissues, leading to formation and progression of disease states in these tissues. Indeed, markers for oxidative stress are overexpressed in patients with DM, suggesting that increased ROS may be primarily responsible for the development of diabetic complications. Therefore, an understanding of the pathophysiological mechanisms mediated by oxidative stress is crucial to the prevention and treatment of diabetes-induced CVD. The current review focuses on the relationship between diabetes-induced CVD and oxidative stress, while highlighting the latest insights into this relationship from findings on diabetic heart and vascular disease

Cytogenetic features of human trophoblast cell lines SWAN-71 and 3A-subE

Immortalization of primary cells with telomerase is thought to maintain normal phenotypic properties and avoid chromosomal abnormalities and other cancer-associated changes that occur following simian virus 40 tumor antigen (SV40 Tag) induced immortalization. However, we report that the human telomerase reverse transcriptase (hTERT)-immortalized SWAN-71 trophoblast cell line has a near pentaploid 103∼119,XXXX[cp20] karyotype. Additionally, DNA typing analysis indicated that SWAN-71 cells have acquired microsatellite instability. In comparison, the post-crisis SV40-transformed trophoblast cell line 3A-subE was hypertriploid 69∼81,XX[cp20]. Both cell lines contained multiple specific clonal rearrangements. These findings emphasize the need to monitor for genetic instability in hTERT-immortalized cells

Deficits in trabecular bone microarchitecture in young women with Type 1 diabetes mellitus

Context: The pathophysiological mechanism of increased fractures in young adults with Type 1 Diabetes Mellitus (T1DM) is unclear. Objective: Case:control study of trabecular bone microarchitecture and vertebral marrow adiposity in young women with T1DM. Patients and Settings: 30 women with T1DM with a median (range) age of 22.0yrs (16.9, 36.1) attending one outpatient clinic with a median age at diagnosis of 9.7yrs (0.46, 14.8) were compared to 28 age-matched healthy women who acted as controls. Methods and Main Outcome Measures: Measurements included MRI-based assessment of proximal tibial bone volume/total volume (appBV/TV), trabecular separation (appTb.Sp), vertebral bone marrow adiposity (BMA) and abdominal adipose tissue and biochemical markers of GH/IGF-1 axis (IGF-1, IGFBP3, ALS) and bone turnover. Results: Median appBV/TV in cases and controls was 0.3 (0.22, 0.37) and 0.33 (0.26, 0.4), respectively (p = 0.018) and median appTb.Sp in T1DM was 2.59 (2.24, 3.38) and 2.32 (2.03, 2.97), respectively (p = 0.012). The median appBV/TV was 0.28 (0.22, 0.33) in those cases with retinopathy (n,15) compared to 0.33 (0.25, 0.37) in those without retinopathy (p = 0.02). Although median visceral adipose tissue in cases was higher than in controls at 5,733mm3 (2030, 11,144) and 3,460mm3 (1,808, 6,832), respectively (p = 0.012), there was no difference in median BMA which was 31.1% (9.9, 59.9) and 26.3% (8.5, 49.8) in cases and controls, respectively (p = 0.2). Serum IGF-1 and ALS were also lower in cases and the latter showed an inverse association to appTbSp (r = -0.30, p = 0.04). Conclusion: Detailed MRI studies in young women with childhood-onset T1DM have shown clear deficits in trabecular microarchitecture of the tibia. Underlying pathophysiological mechanisms may include a microvasculopathy

40 Gbit/s silicon-organic hybrid (SOH) phase modulator

A 40 Gbit/s electro-optic modulator is demonstrated. The modulator is based on a slotted silicon waveguide filled with an organic material. The silicon organic hybrid (SOH) approach allows combining highly nonlinear electro-optic organic materials with CMOS-compatible silicon photonics technology