Clinicians assessing children with autism are sometimes faced with a dilemma, especially if there is a definite or suspected history of abuse or neglect: is this autism or attachment disorder? This is important because the attachment disorders (reactive attachment disorder and disinhibited social engagement disorder) are thought to be caused by abuse or neglect, whereas autism is not. We discuss the Coventry Grid, a clinical tool aiming to aid differentiation between autism and attachment disorders. We examine the small body of empirical studies focusing on this differential diagnosis and find that the Coventry Grid can be regarded as an evidence-based tool. We also discuss preliminary findings regarding a relatively unstructured observational method involving two assessors who engage the child in jokes and playful social dilemmas, which might help clinicians elicit the information required to complete the Coventry Grid.

This prospective cohort study was conducted in eighteen Canadian hospitals with the aim of examining factors associated with nutritional decline in medical and surgical patients. Nutritional decline was defined based on subjective global assessment (SGA) performed at admission and discharge. Data were collected on demographics, medical information, food intake and patients’ satisfaction with nutrition care and meals during hospitalisation; 424 long-stay (≥7 d) patients were included; 38 % of them had surgery; 51 % were malnourished at admission (SGA B or C); 37 % had in-hospital changes in SGA; 19·6 % deteriorated (14·6 % from SGA A to B/C and 5 % from SGA B to C); 17·4 % improved (10·6 % from SGA B to A, 6·8 % from SGA C to B/A); and 63·0 % patients were stable (34·4 % were SGA A, 21·3 % SGA B, 7·3 % SGA C). One SGA C patient had weight loss ≥5 %, likely due to fluid loss and was designated as stable. A subset of 364 patients with admission SGA A and B was included in the multiple logistic regression models to determine factors associated with nutritional decline. After controlling for SGA at admission and the presence of a surgical procedure, lower admission BMI, cancer, two or more diagnostic categories, new in-hospital infection, reduced food intake, dissatisfaction with food quality and illness affecting food intake were factors significantly associated with nutritional decline in medical patients. For surgical patients, only male sex was associated with nutritional decline. Factors associated with nutritional decline are different in medical and surgical patients. Identifying these factors may assist nutritional care.

Deux études ont examiné la relation entre l'environnement physique et ses conséquences sur l'état des résidents de centre d'accueil pour personnes âgées. La première, une étude longitudinale, a établi qu'une vue plus naturelle avec des fenêtres extérieures était associée à des conséquences négatives, alors qu'un emplacement en contact avec les autres donnait des résultats positifs, en ce qui concerne les résidents nouvellement admis. Ces résultats qui entrent en contradiction avec ceux d'une précédente recherche laissent entendre que l'« emplacement social » est important au cours de la première période d'adaptation à la vie en centre d'accueil. Cependant, une étude sur dossiers, portant sur d'anciens résidents du même centre d'accueil, a établi que l'« emplacement social » était associé à des séjours plus courts, juste avant un décès ou un transfert pour des soins hospitaliers. L'« emplacement social » apparaît alors comme un facteur positif au cours de la période initiale d'adaptation, mais comme un élément négatif à plus long terme.

Sentence intelligibility as a function of reverberation time and the presence or absence of a pause was measured in three age groups by means of the Kent State Speech Discrimination Test. Young, middle aged, and old subjects listened to sentences recorded with approximately zero, one or three seconds reverberation time and with half containing a meaningful pause. In a second study, a different group of participants listened to an undistorted recording of the test to provide some information on the standardization of the Kent State Speech Discrimination Test across age groups. All subjects, who were prescreened for audiological normal hearing, were tested for recognition of one key word in each sentence immediately following presentation. Reverberation of three seconds reduced intelligibility for all groups. Age differences which occurred at the longest reverberation time disappeared when a pause was inserted. However, only pauses before a key word were effective. Unmasking of reverberation was suggested as a possible factor in the pause position effect. Practical applications of results are also discussed.

Electroencephalogram (EEG) alpha power has been demonstrated to be inversely related to mental activity and has subsequently been used as an indirect measure of brain activation. The thalamus has been proposed as an important site for modulation of rhythmic alpha activity. Studies in animals have suggested that cortical alpha rhythms are correlated with alpha rhythms in the thalamus. However, little empirical evidence exists for this relation in humans. In the current study, resting EEG and a fluorodeoxyglucose positron emission tomography scan were measured during the same experimental session. Over a 30-min period, average EEG alpha power across 28 electrodes from 27 participants was robustly inversely correlated with glucose metabolic activity in the thalamus. These data provide the first evidence for a relation between alpha EEG power and thalamic activity in humans.