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The purpose of this study was to identify 1) the proportion of patients discharged from the emergency department (ED) with a diagnosis of concussion and return within 14 days, and 2) the characteristics that prompt a return.
A health records review was conducted on adult patients with a discharge diagnosis of a concussion who accessed care through Hamilton Health Sciences EDs and Urgent Care Centre in 2016. Subsequent data were collected from those who returned to the ED within 14 days. Clinical characteristics of returners were compared to those of non-returners.
Of the 389 patients included in the study, 38 (10%) returned within 14 days. Patients who sustained a concussion in a sport-related context or were referred to a specialized clinic were less likely to return (p = 0.03). Those who suffered an assault-related concussion were more likely to return (p = 0.01). Of those who did return, 42% received a CT scan with normal results, and 42% were given new discharge instructions.
Approximately 10% of patients diagnosed with a concussion in a Canadian hospital setting returned to the ED within 14 days of their index visit. Our study suggests the opportunity to reduce this burden to both the healthcare system and the patient through careful discharge instructions outlining anticipated symptoms following a concussion (specifically, headache) or referral to a concussion clinic.
School-based interventions and policies encourage youths to include and consume fruits and vegetables at lunchtime via school lunches, but limited research has examined how these behaviours compare when youths have home-packed lunches. The objective of the present study was to compare fruit and vegetable contents and consumption among students having school or home-packed lunches over the school week.
Participants were observed over five consecutive days at school lunchtime. Trained analysts estimated students’ lunchtime fruit and vegetable contents and consumption using digital imaging. Mixed models examined associations between fruit and vegetable dietary behaviours and lunch source (school v. home-packed), controlling for student gender, grade and school.
Three elementary schools in northern California, USA.
Fourth-, fifth- and sixth-grade students (nchildren 315; nobservations 1421).
Students were significantly less likely to have and to consume fruits and vegetables (all P<0·05) when having home-packed lunches, compared with when having school lunches. Among those who did have or did consume these foods, having a home-packed lunch was associated with consuming significantly less fruit (P<0·05) but no differences for other dietary outcomes.
The study adds to a growing body of literature indicating shortfalls in fruit and vegetable contents and consumption associated with having a home-packed lunch, relative to having a school lunch. Findings suggest that school-based interventions, particularly when targeting home-packed lunches, should focus on whether or not these foods are included and consumed, with less emphasis on quantities.
In this paper we explore differences in prosodic rhythm between two English speech communities in rural Southern Alberta, Canada: speakers of Blackfoot First Nation descent and those of settler descent. Using the Variability Index (VI), we show that there are statistically significant differences between English speakers of settler descent and those of Blackfoot descent, where those of Blackfoot descent have a higher VI, that is, they are further along the stress-timing continuum than those of settler descent. We hypothesize that these differences are due to language transfer effects stemming from the community's original Blackfoot phonology which were present in their L2 English when the community norm shifted primarily to English, and that the historical, social, and geographical isolation of Blackfoot people in Southern Alberta has contributed to the development of a new local Blackfoot English norm.
The extensive heterogeneity both between and within the medulloblastoma (MB) subgroups underscores a critical need for variant-specific biomarkers and therapeutic strategies. We previously identified a role for the CD271/p75 neurotrophin receptor (p75NTR) in regulating stem/progenitor cells in the SHH MB subgroup. Here, we demonstrate the utility of CD271 as a novel diagnostic and prognostic marker for SHH MB using immunohistochemical analysis as well as transcriptome data across 763 primary tumors. Characterization of CD271+ and CD271- cells by RNA sequencing revealed that these two subpopulations are molecularly distinct, co-existing cellular subsets both in vitro and in vivo. MAPK/ERK signaling is upregulated in the CD271+ population and inhibiting this pathway reduced CD271 levels, stem/progenitor cell proliferation and cell survival as well as cell migration in vitro. Importantly, the MEK inhibitor selumetinib extends survival and reduces CD271 levels in vivo. Our study demonstrates the clinical utility of CD271 as both a diagnostic and prognostic tool for SHH MB tumors and reveals a novel role for MEK inhibitors in targeting CD271+ SHH MB cells.
Jennifer Fraser, Registered Nurse and Associate Professor in Nursing at the University of Sydney.,
Lindsay Smith, Lecturer in the School of Health Sciences at the University of Tasmania. He developed the Australian Family Strengths Nursing Assessment (AFSNA).,
Julia Taylor, Registered Nurse and Clinical Lecturer at the University of Tasmania.
• Be introduced to the concept of determinants of child and adolescent mental health
• Gain an understanding of mental disorders and mental health problems experienced in childhood and adolescence
• Become familiar with the importance of positive relationships, experiences and environments to developing adaptive responses to stress and change in children and young people
• Understand that mental disorder in childhood is a dimensional phenomenon
• Learn nursing skills that help promote good mental health and enhance resilience in children and young people
The focus of this chapter is the role of the nurse in optimising child and youth mental health. An overview of mental disorders experienced during childhood and adolescence is followed by a discussion of mental health promotion for children and young people. In this edition, we have included a section on eating disorders. Although the lifetime prevalence of these disorders is very low, they are common, and nurses play an important role in the care of those affected children and young people admitted to hospital for treatment. The importance of working closely with the parents and families of children and young people disabled by mental illness and the services available to them is emphasised throughout the chapter.
The Australian Institute of Health and Welfare (AIHW) published the first national survey of child and adolescent mental health and wellbeing in Australia in 1998. The second survey was published in 2015 (Lawrence et al., 2015); it includes data on the use of mental health services by children, young people and their families. This national survey of mental health and wellbeing provides valuable information on the prevalence of child and youth mental disorders in Australia. The AIHW also publishes a list of services that exist for people living with a mental disorder and makes recommendations for services that are needed. The latest survey indicates that while the prevalence of mental health disorders for children and young people remained stable between 1998 and 2015, there was a significant increase in the use of mental health services for 4–17-year-old Australians.
Although childhood hyperactivity and conduct problems are associated with difficulties in adulthood, little is known about later service use or public expenditure costs in the UK.
To describe the use of services and calculate recent (past 6 months) and early adulthood (since the age of 18 years) public expenditure costs incurred by young adults who had hyperactivity and/or conduct problems during childhood.
A 20-year follow-up of a community sample of 6- to 7-year old boys (n = 83) with hyperactivity only, conduct problems only, mixed hyperactivity and conduct problems, and no behaviour problems (control). Information was obtained about service use; recent (past 6 months), and early adulthood (since age 18 years) public expenditure costs were calculated.
High levels of childhood conduct problems were associated with a two- to threefold increase in early adulthood costs, mainly driven by criminal justice contacts. Although the mixed problems group had the highest recent costs in terms of receipt of benefits and health and social care, they had the lowest criminal justice costs.
High levels of early childhood conduct problems are particularly associated with increased health, social care and criminal justice costs in adulthood.
The neural organization of cognitive processes, particularly hemispheric lateralization, changes throughout childhood and adolescence. Differences in the neural basis of relational memory between children and adults are not well characterized. In this study we used magnetoencephalography to observe the lateralization differences of hippocampal activation in children and adults during performance of a relational memory task, transverse patterning (TP). The TP task was paired with an elemental control task, which does not depend upon the hippocampus. We contrasted two hypotheses; the compensation hypothesis would suggest that more bilateral activation in children would lead to better TP performance, whereas the maturation hypothesis would predict that a more adult-like right-lateralized pattern of hippocampal activation would lead to better performance. Mean-centered partial least squares analysis was used to determine unique patterns of brain activation specific to each task per group, while diminishing activation that is consistent across tasks. Our findings support the maturation hypothesis that a more adult-like pattern of increased right hippocampal lateralization in children leads to superior performance on the TP task. We also found dynamic changes of lateralization throughout the time course for all three groups, suggesting that caution is needed when interpreting conclusions about brain lateralization. (JINS, 2013, 19, 1–11)
To examine associations among diet quality and dairy group membership, membership duration and non-member status for women and school-aged children in rural Kenya.
A cross-sectional survey, using chain referral sampling, was conducted and diet quality indices and prevalence of inadequate intake (PII) were estimated using the ‘estimated average requirement’ cut-off point method from single 24 h recalls, using a Kenyan nutrient database. PII was compared among members and non-members and among membership-duration groups.
Women and children of dairy group members (n 88), across membership-duration groups (1–3, 4–6, 7–9 and 10+ years), and non-members (n 23) living among members.
Small farms in central Kenya.
Members had higher energy, percentage of energy from animal-source foods and dietary diversity. Member women and children had lower PII for respectively seven and three of eleven micronutrients. Reduced PII for milk-source micronutrients was associated with membership duration for women. Many member women (38 %) had inadequate vitamin A intake and 39 % of member children had inadequate Zn intake. Members’ PII was also high (>45 %) for Fe, Ca and vitamin B12. A higher prevalence of being overweight among member women compared with non-member women suggested nutrition transition effects of higher farm productivity.
Dairy group membership was positively associated with adequate quantity and quality of diets for women and children. Long-term membership was insufficient to address micronutrient deficiencies. Understanding and addressing barriers to better diet quality and strategies to mitigate negative nutrition transition effects are needed to optimize nutritional outcomes of dairy group membership.
Conjugated linoleic acid (CLA) present in dairy and ruminant fat has beneficial effects on metabolic syndrome characteristics in humans and some rodent models. Production practices to increase the milk content of CLA are also substantially elevating trans-11-vaccenic acid (VA). Questions are being raised whether VA has the same beneficial actions as CLA or has adverse biological effects similar to industrially produced trans-fatty acids. The present study examined the effects of dietary supplementation of either 0 or 1·5 % (w/w) VA for 8 weeks on lipidaemia, glycaemia, blood pressure, hepatic steatosis, adipocyte size and molecular markers of inflammation and insulin signalling in fa/fa Zucker rats. Dietary supplementation of VA did not alter feed intake, weight gain, blood pressure or organ:body weight (BW) ratios, except the epididymal fat:BW ratio which was lower in the VA group compared with the control group. The total liver lipid concentration as an indicator of hepatic steatosis was not different between the groups. Likewise, there were no changes in fasting lipidaemia, glycaemia or oral glucose tolerance. Although there were no physiological differences observed between the groups, animals supplemented with VA had smaller adipocytes (approximately 7 % smaller than the controls). The VA group also had higher adipophilin and IL-10 protein levels in epididymal adipose tissue (1·7- and 1·4-fold higher than the controls, respectively); however, there were no changes observed in critical nodes of insulin signalling. The present study provides evidence that supplementation with VA, a naturally produced trans-fat, has some positive effects on adipose tissue and did not exacerbate obesity-mediated metabolic abnormalities.
To assess the nutritional quality of lunchtime food consumption among elementary-school children on Prince Edward Island according to the source of food consumed (home v. school).
Students completed a lunchtime food record during an in-class survey. Dietary adequacy was assessed by comparing median micronutrient intakes with one-third of the Estimated Average Requirement; median macronutrient intakes were compared with the Acceptable Macronutrient Distribution Ranges. The Wilcoxon signed rank test was used to assess differences in nutrient intakes according to source of food consumed.
Elementary schools in Prince Edward Island, Canada.
Grade 5 and 6 students (n 1980).
Foods purchased at school were higher in nutrient density for ten micronutrients (Ca, Mg, K, Zn, vitamin A, vitamin D, riboflavin, niacin, vitamin B6 and vitamin B12) compared with packed lunch foods from home, which were higher in three micronutrients (Fe, vitamin C and folate). School lunches provided sufficient protein but were higher in sugar and fat than home lunches. Foods brought from home were higher in carbohydrates, fibre and Na than foods purchased at school.
The overall nutritional quality of lunches was poor, regardless of source. A significant proportion of foods consumed by the students came from home sources; these were lower nutritional quality and were higher in Na than foods offered at school. Findings suggest that improving the dietary habits of school-aged children will require a collaborative effort from multiple stakeholders, including parents.
In this paper, we describe a novel approach to computational modeling and understanding of social and cultural phenomena in multi-party dialogues. We developed a two-tier approach in which we first detect and classify certain sociolinguistic behaviors, including topic control, disagreement, and involvement, that serve as first-order models from which presence the higher level social roles, such as leadership, may be inferred.
Brunilde Gril, National Cancer Institute, United States,
Russell Szmulewitz, The University of Chicago, Committee on Cancer Biology and Pritzker School of Medicine, United States,
Joshua Collins, National Cancer Institute, United States,
Jennifer Taylor, The University of Chicago, Committee on Cancer Biology and Pritzker School of Medicine, United States,
Carrie Rinker-Schaeffer, The University of Chicago, Committee on Cancer Biology and Pritzker School of Medicine, United States,
Patricia Steeg, National Cancer Institute, United States,
Jean-Claude Marshall, National Cancer Institute, United States
In the 1970s and 1980s, clever scientific insight and innovation rapidly advanced our understanding of the molecular mechanisms of cancer biology. The discoveries of oncogenes and tumor suppressors, and the elucidation of their functions, greatly aided in studies aimed at a molecular understanding of the etiology of primary tumors. Despite this, cancer biologists had little understanding of the molecular aspects of metastasis. Considering the devastating consequences, scientists were anxious for a breakthrough. The first clue would come from the study of tumor suppressors.
Tumor suppressor genes were identified when it was discovered that their loss of function was critical to tumorigenesis. Prior to their discovery, researchers were of the mindset that the oncogenic phenotype was always dominant. In other words, a mutation need happen on only a single allele for a normal cell to be transformed into a tumor cell. However, not all disease incidence data seemed to fit neatly into this hypothesis. By studying retinoblastoma case histories, a “two-hit” hypothesis emerged, predicting that for at least some cancers, two mutations must occur (one on each allele) to successfully transform a cell . Indeed, the retinoblastoma gene, or Rb, would become known as the first described tumor suppressor. We now know that the “two hits” need not come in the form of distinct somatic mutations but may be the result of any combination of germinal and/or somatic mutations, mitotic recombinations, gene conversions, and functional inactivation of genes owing to promoter hypermethylation.
Data assessing the effect of altitude on Fontan haemodynamics are limited to experimental models and case reports. Both suggest a detrimental impact. This study describes exercise performance in patients with Fontan circulation and matched controls at a low altitude versus at sea level. We sought to assess the impact of increasing altitude on functional capacity in patients with Fontan palliation.
A retrospective review of 22 patients at low altitude (1602 metres) and 119 patients at sea level with Fontan circulation, as well as age-, gender-, and altitude-matched controls, underwent maximal cardiopulmonary exercise testing. Linear regression models were created to determine the influence of altitude on differences in exercise variables between Fontan patients and their matched controls.
Peak oxygen consumption was 28.4 millilitres per kilogram per minute (72% predicted) for the sea-level cohort and 24.2 millilitres per kilogram per minute (63% predicted) for the moderate altitude cohort. The matched case–control differences for patients at moderate altitude were greater for peak oxygen consumption (−29% against −13%, p = 0.04), anaerobic threshold (−36% against −5%, p = 0.001), and oxygen pulse (−35% against −18%, p = 0.007) when compared with patients living at sea level. When compared to institution-matched controls, the same parameters fell by 3%, 8.9%, and 4.2%, respectively, for each increase of 1000 feet in residential altitude (p = 0.03, p = 0.001, and p = 0.05, respectively).
Patients with Fontan circulation at a higher altitude have impairment in aerobic capacity when compared with patients at sea level. Reduction in exercise capacity is associated with a reduction in stroke volume, likely related to increased pulmonary vascular resistance.