Children affected by differences/disorders of sex development (DSDs) and their families are vulnerable to significant risks across developmental stages that threaten quality of life and psychosocial ...functioning. Accordingly, both experts in DSD treatment and patient advocacy groups have endorsed the incorporation of psychosocial care into interdisciplinary management of DSD conditions.
This study assessed psychosocial needs and received services reported by parents of children with DSD treated at two large US academic medical centers. Specifically, differences in parents' perceptions of psychosocial service needs were compared between those who received or did not receive interdisciplinary care that included psychology/social work professionals.
In a cross-sectional study, sixty-four parents of children with DSD aged 0–19 years attending two major academic centers with interdisciplinary teams completed a questionnaire about their receipt and perception of 12 individual psychosocial services throughout their child's DSD treatment.
Receipt of individual psychosocial services ranged from 27 to 81%. Most commonly, parents reported having a psychosocial provider explain medical terms and answer questions after talking with a doctor (81%), assist with words and terms to describe the condition and treatment (69%), and help navigate the hospital system (63%). Families positively endorsed psychosocial services, with 91–100% of services received rated as helpful. Parents of children who received care as part of an interdisciplinary team were significantly more likely to receive psychosocial services than those treated by single providers (e.g., urologists). Specific gaps in psychosocial care were noted in regard to access to mental health providers familiar with DSD, fertility counseling, and support with community advocacy (e.g., arranging for accommodations at the school or advocating on patient's behalf with the insurance company). Among families who had not received them, services most desired were assistance with words and terms to describe condition or treatment; explanation of medical terms and answering questions after meeting with a doctor; connection to resources such as books, pamphlets, websites, and support groups; and a central care coordinator for the medical team.
Families value psychosocial services but are far less likely to receive services if they are not seen in an interdisciplinary clinic visit that includes a psychosocial provider. Families desire but often lack mental health, advocacy, and fertility-related support. This study highlights the need for sustained psychosocial follow-up across development, even in the absence of pressing medical concerns, to provide support and anticipatory guidance as needs and issues evolve.Extended Summary TablePsychosocial services received by DSD interdisciplinary clinic visit (yes/no).Extended Summary TablePsychosocial service receivedInterdisciplinary DSD clinic visitp-valueYesNon%n%Emotional support for the family at diagnosis2463.2415.40.0002Strategies for talking with others about diagnosis2257.9623.10.006Ways to help the family talk with the child about diagnosis2668.4623.10.0004Central contact person or care coordinator2155.3726.90.03Emotional support as the child aged2668.4416.0<0.0001Patient and family advocacy to the community (e.g., school, insurance company)1539.527.70.005Connection to resources (e.g., books, support groups)2668.4726.90.001Mental health services with a provider who is knowledgeable about the condition2257.927.7<0.0001Individual to talk with the child about fertility1539.527.70.005DSD, difference or disorder of sex development.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
In this study the regulation of the murine double minute-2 (
mdm-2) gene was examined in NIH 3T3-L1 preadipocytes. The 3T3-L1 cell line, under proper conditions, has the capacity to differentiate ...from fibroblasts into adipocytes 15. A recent report demonstrated that
mdm-2 overexpression could block myogenesis 12. While examining the regulation of the
mdm-2 gene during adipogenesis, it was discovered that 3T3-L1 cells possess a 36-fold elevation of
mdm-2 mRNA relative to A31 cells, another immortalized Balb/c 3T3 fibroblast cell line that lacks the capacity to differentiate. Based on Southern blot analysis, the increase in
mdm-2 mRNA was the result of a
mdm-2 gene amplification. The level of Mdm-2 protein in undifferentiated 3T3-L1 cells was elevated relative to A31 fibroblasts and resulted from translation of mRNA transcripts initiating from the p53-independent P1 promoter. We also examined how
mdm-2 and p53 levels changed as undifferentiated fibroblasts converted to adipocytes. While
mdm-2 mRNA levels remained elevated, p53 mRNA, protein, and DNA-binding activity decreased. These results suggest that adipogenesis is unaffected by elevated Mdm-2 levels and that the overexpression of
mdm-2 mRNA is predominantly p53 independent.
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IJS, IMTLJ, KILJ, KISLJ, NUK, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Manufacturing planning and control (MPC) systems have existed since the earliest days of the industrial revolution. Perhaps more than any other single factor, information technology has changed the ...basis of production economics by automating many clerical tasks and greatly improving manufacturing accuracy, reliability, and predictability. This paper seeks to explore in more detail the most recent stages of MPC evolution, MRP-II with MES, and ERP with MES. In today's global manufacturing environment, it is necessary to continue integrating advanced information technologies with existing MPC capabilities to maintain and improve MPC system effectiveness. A stage model is proposed as a useful way of organizing and defining thoughts concerning the nature and content of manufacturing planning and control systems.
We performed a qualitative and quantitative assessment of contact lens performance at 1 and 6 months among 24 patients enrolled in the Piggyback Bifocal Contact Lens Study.
We fit 24 presbyopic ...patients with the Piggyback Bifocal Contact Lens System (i.e., a plano soft lens with a 9.4 mm cutout portion on which a bifocal RGP lens rides or "piggybacks"). Patients were evaluated prior to inclusion in the study and then at one month and six months after obtaining their lenses. Evaluations included slit lamp examination, evaluation of visual acuity at near and distance, and subjective rating of the patients' comfort.
At one month, 61% of patients had Snellen acuities of 20/30 or better, 79% had near acuities of J2 or better, and 60% rated their comfort as good or very good. At six months, 100% of patients had Snellen acuities of 20/30 or better, 90% had near acuities of J2 or better, and 86% of patients rated their comfort as good or better. Twelve patients did not complete the study due to their decision to drop the study.
The Piggyback Bifocal Contact Lens System is a well-tolerated, satisfactory means of optical correction for the motivated presbyope.
Residential video services Sutherland, J.; Litteral, L.
IEEE communications magazine,
07/1992, Volume:
30, Issue:
7
Magazine Article
A local exchange telephone company's (LEC's) investigation and development of new residential video services and the technologies and market needs that are making such services possible are ...discussed. Several potential LEC residential video services are described, and the technology necessary to implement such services is discussed, including network access and transport, switching, network management, and customer premises equipment (CPE). The LEC's experiences with residential video technology and service trials are presented along with new service implementation plans.< >
