Autism spectrum disorder (ASD).
2020.
The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance program that provides estimates of the prevalence of ASD among ...children aged 8 years. In 2020, there were 11 ADDM Network sites across the United States (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin). To ascertain ASD among children aged 8 years, ADDM Network staff review and abstract developmental evaluations and records from community medical and educational service providers. A child met the case definition if their record documented 1) an ASD diagnostic statement in an evaluation, 2) a classification of ASD in special education, or 3) an ASD International Classification of Diseases (ICD) code.
For 2020, across all 11 ADDM sites, ASD prevalence per 1,000 children aged 8 years ranged from 23.1 in Maryland to 44.9 in California. The overall ASD prevalence was 27.6 per 1,000 (one in 36) children aged 8 years and was 3.8 times as prevalent among boys as among girls (43.0 versus 11.4). Overall, ASD prevalence was lower among non-Hispanic White children (24.3) and children of two or more races (22.9) than among non-Hispanic Black or African American (Black), Hispanic, and non-Hispanic Asian or Pacific Islander (A/PI) children (29.3, 31.6, and 33.4 respectively). ASD prevalence among non-Hispanic American Indian or Alaska Native (AI/AN) children (26.5) was similar to that of other racial and ethnic groups. ASD prevalence was associated with lower household income at three sites, with no association at the other sites.Across sites, the ASD prevalence per 1,000 children aged 8 years based exclusively on documented ASD diagnostic statements was 20.6 (range = 17.1 in Wisconsin to 35.4 in California). Of the 6,245 children who met the ASD case definition, 74.7% had a documented diagnostic statement of ASD, 65.2% had a documented ASD special education classification, 71.6% had a documented ASD ICD code, and 37.4% had all three types of ASD indicators. The median age of earliest known ASD diagnosis was 49 months and ranged from 36 months in California to 59 months in Minnesota.Among the 4,165 (66.7%) children with ASD with information on cognitive ability, 37.9% were classified as having an intellectual disability. Intellectual disability was present among 50.8% of Black, 41.5% of A/PI, 37.8% of two or more races, 34.9% of Hispanic, 34.8% of AI/AN, and 31.8% of White children with ASD. Overall, children with intellectual disability had earlier median ages of ASD diagnosis (43 months) than those without intellectual disability (53 months).
For 2020, one in 36 children aged 8 years (approximately 4% of boys and 1% of girls) was estimated to have ASD. These estimates are higher than previous ADDM Network estimates during 2000-2018. For the first time among children aged 8 years, the prevalence of ASD was lower among White children than among other racial and ethnic groups, reversing the direction of racial and ethnic differences in ASD prevalence observed in the past. Black children with ASD were still more likely than White children with ASD to have a co-occurring intellectual disability.
The continued increase among children identified with ASD, particularly among non-White children and girls, highlights the need for enhanced infrastructure to provide equitable diagnostic, treatment, and support services for all children with ASD. Similar to previous reporting periods, findings varied considerably across network sites, indicating the need for additional research to understand the nature of such differences and potentially apply successful identification strategies across states.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Background
Autopsy-based radio-pathomic maps of glioma pathology have shown substantial promise inidentifying areas of non-enhancing tumor presence, which may be able to differentiate subsets of ...patients that respond favorably to treatments such as bevacizumab that have shown mixed efficacy evidence. We tested the hypthesis that phenotypes of non-enhancing tumor fronts can distinguish between glioblastoma patients that will respond favorably to bevacizumab and will visually capture treatment response.
Methods
T1, T1C, FLAIR, and ADC images were used to generate radio-pathomic maps of tumor characteristics for 79 pre-treatment patients with a primary GBM or high-grade IDH1-mutant astrocytoma for this study. Novel phenotyping (hypercellular, hypocellular, hybrid, or well-circumscribed front) of the non-enhancing tumor front was performed on each case. Kaplan Meier analyses were then used to assess differences in survival and bevacizumab efficacy between phenotypes. Phenotype compartment segmentations generated longitudinally for a subset of 26 patients over the course of bevacizumab treatment, where a mixed effect model was used to detect longitudinal changes.
Results
Well-Circumscribed patients showed significant/trending increases in survival compared to Hypercellular Front (HR = 2.0,
p
= 0.05), Hypocellular Front (HR = 2.02,
p
= 0.03), and Hybrid Front tumors (HR = 1.75,
p
= 0.09). Only patients with hypocellular or hybrid fronts showed significant survival benefits from bevacizumab treatment (HR = 2.35,
p
= 0.02; and HR = 2.45,
p
= 0.03, respectively). Hypocellular volumes decreased by an average 50.52 mm
3
per day of bevacizumab treatment (
p
= 0.002).
Conclusion
Patients with a hypocellular tumor front identified by radio-pathomic maps showed improved treatment efficacy when treated with bevacizumab, and reducing hypocellular volumes over the course of treatment may indicate treatment response.
Abstract Introduction Accurate and readily available documentation of burn fluid resuscitation is essential for decision-making by the multidisciplinary team during the first 24 to 48 hours of care. ...Fluid resuscitation documentation in the electronic medical record (EMR) is ideal. However, due to the limitations of the EMR, bedside nurses must navigate to various tabs to document fluids, view orders, document events, review labs, and notify providers. To decrease burden of care and improve the accessibility of accurate fluid resuscitation information, our multidisciplinary team embarked on a journey to create a new format in the EMR for fluid resuscitation with our information technology (IT) department. Methods In April 2022, the burn team initiated discussions to build a new and streamlined process for documentation of fluid resuscitation. The goal was to decrease the amount of navigation in the EMR during fluid resuscitation by the bedside nurse and improve the accessibility of meaningful hourly documentation for the multidisciplinary team. During monthly meetings, a multidisciplinary team of nurses, a pharmacist, educators, and IT professionals collaborated on each component needed to capture the desired detailed documentation of each fluid resuscitation. Results The new format for fluid resuscitation documentation in the EMR is constructed as a navigator flowsheet and initiated in September 2023. The bedside nurse performs all documentation on this one flowsheet. Information from the Lund-Browder calculates initial fluid resuscitation rates and goal hourly urine output. Once the bedside nurse initiates the fluid resuscitation, navigating to any additional flowsheets or tabs in the EMR is unnecessary. Certain information also pulls in automatically from devices, such as vitals, bladder pressure, and urine output. Documentation of hourly fluids infused, vital signs, urinary output, fluids changes, bedside procedures performed, provider notification, nursing notes, and consulting team interventions are all performed in the narrator. The bedside nurse can also access all orders, labs, and notes without navigating elsewhere in the EMR. Real-time documentation using the narrator allows multidisciplinary team access without disrupting the patient’s nursing care. The post-resuscitation report provides hour-by-hour documentation for debriefing and reviewing each fluid resuscitation. Conclusions The development of this new tool has afforded bedside nurses more time spent caring for the patient rather than navigating the EMR. Providers no longer go to the patient room to retrieve information to help guide fluid resuscitation and disrupt patient care. The post-resuscitation report provides an accurate account of the fluid resuscitation period for debriefing and review. Applicability of Research to Practice Our process can be shared with other burn centers hoping to replicate this process.
Urinary tract infections (UTIs) represent a major burden across the population, although key facets of their pathophysiology and host interaction remain unclear. Escherichia coli epitomizes these ...obstacles: this gram-negative bacterial species is the most prevalent agent of UTIs worldwide and can also colonize the urogenital tract in a phenomenon known as asymptomatic bacteriuria (ASB). Unfortunately, at the level of the individual E. coli strains, the relationship between UTI and ASB is poorly defined, confounding our understanding of microbial pathogenesis and strategies for clinical management. Unlike diarrheagenic pathotypes of E. coli, the definition of uropathogenic E. coli (UPEC) remains phenomenologic, without conserved phenotypes and known genetic determinants that rigorously distinguish UTI- and ASB-associated strains. This article provides a cross-disciplinary review of the current issues from interrelated mechanistic and diagnostic perspectives and describes new opportunities by which clinical resources can be leveraged to overcome molecular challenges. Specifically, we present our work harnessing a large collection of patient-derived isolates to identify features that do (and do not) distinguish UTI- from ASB-associated E. coli strains. Analyses of biofilm formation, previously reported to be higher in ASB strains, revealed extensive phenotypic heterogeneity that did not correlate with symptomatology. However, metabolomic experiments revealed distinct signatures between ASB and cystitis isolates, including in the purine pathway (previously shown to be critical for intracellular survival during acute infection). Together, these studies demonstrate how large-scale, wild-type approaches can help dissect the physiology of colonization versus infection, suggesting that the molecular definition of UPEC may rest at the level of global bacterial metabolism.
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•Clinical diagnosis of UTI relies on symptoms in cases of pertinent bacterial burden.•No empiric tools reliably distinguish strains of E. coli in cases of ASB versus UTI.•Phenotypic assays cannot predict the disease-state of urinary E. coli isolates.•Global metabolomic analyses reveal signatures of ASB-associated E. coli strains.
Oncology social workers are increasingly finding themselves diagnosed with or caring for a loved one with cancer. Self-disclosure may be useful for building a therapeutic alliance. Yet, ...practice-informed guidelines for psychosocial oncology providers do not exist.
Twenty-three psychosocial oncology providers diagnosed with and/or providing care to someone with cancer completed semi-structured interviews eliciting attitudes and utilization regarding self-disclosure.
Interviews were digitally recorded and transcribed verbatim. Using grounded theory's constant comparative method, researchers conducted open and theoretical coding.
Participants expressed consensus in defining, and reported a range of evolving practices regarding, self-disclosure. Recommendations for responsible self-disclosure included self-awareness, ongoing assessment, supervision, and enhanced educational programming.
Therapeutic tools must evolve as core features of psychosocial oncology care. A flexible and context-specific framework for clinician self-disclosure related to personal experiences with cancer can guide oncology social work practice.
Cystic fibrosis (CF) is a common life-shortening genetic disease and is associated with poor psychosocial and quality of life outcomes. The objective of this study was to describe the experiences and ...perspectives of children and adolescents with CF to direct care toward areas that patients regard as important.
MEDLINE, Embase, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature were searched from inception to April 2013. We used thematic synthesis to analyze the findings.
Forty-three articles involving 729 participants aged from 4 to 21 years across 10 countries were included. We identified 6 themes: gaining resilience (accelerated maturity and taking responsibility, acceptance of prognosis, regaining control, redefining normality, social support), lifestyle restriction (limited independence, social isolation, falling behind, physical incapacity), resentment of chronic treatment (disempowerment in health management, unrelenting and exhausting therapy, inescapable illness), temporal limitations (taking risks, setting achievable goals, valuing time), emotional vulnerability (being a burden, heightened self-consciousness, financial strain, losing ground, overwhelmed by transition), and transplant expectations and uncertainty (confirmation of disease severity, consequential timeliness, hope and optimism).
Adolescents and children with CF report a sense of vulnerability, loss of independence and opportunities, isolation, and disempowerment. This reinforces the importance of the current model of multidisciplinary patient-centered care that promotes shared decision-making, control and self-efficacy in treatment management, educational and vocational opportunities, and physical and social functioning, which can lead to optimal treatment, health, and quality of life outcomes.
Polyurethane-based polymers and their eventual degradation products pervade modern society. One common method for determining whether a microorganism or protein can degrade this class of polymer is ...to qualitatively assess its ability to “clear” a polyester-polyurethane colloid branded Impranil®DLN (Impranil), whose formulation is proprietary. However, its colloidal state has ultimately made Impranil a precarious choice for determining if an organism or enzyme can degrade polyurethanes. In this work, the chemical hydrolysis products from Impranil using 0.1 M HCl or 0.1 M NaOH were identified and compared to the concentration of hydrolysis products formed using three commercial enzymes by proton nuclear magnetic spectroscopy (1H NMR) and Fourier-transform infrared spectroscopy (FT-IR). The differences in the integrated signal intensities from key 1H NMR signals were used to calculate the amount of Impranil that was hydrolyzed. These data were then correlated with the change in optical density of colloid containing reaction mixtures (termed as “clearing”). The enzymes (a Pseudomonas fluorescens recombinant esterase, Pseudomonas sp. lipase, and Bacillus sp. protease) showed significant esterase activities and partially-cleared, completely-cleared, or aggregated Impranil, respectively. However, only the Pseudomonas sp. lipase significantly degraded Impranil based on NMR and IR data. This study illustrates how Impranil can be used to quantitatively assess biodegradation rather than just be a qualitative “clearing” indicator of biodegradation.
Cellular heterogeneity in the human brain obscures the identification of robust cellular regulatory networks, which is necessary to understand the function of non-coding elements and the impact of ...non-coding genetic variation. Here we integrate genome-wide chromosome conformation data from purified neurons and glia with transcriptomic and enhancer profiles, to characterize the gene regulatory landscape of two major cell classes in the human brain. We then leverage cell-type-specific regulatory landscapes to gain insight into the cellular etiology of several brain disorders. We find that Alzheimer's disease (AD)-associated epigenetic dysregulation is linked to neurons and oligodendrocytes, whereas genetic risk factors for AD highlighted microglia, suggesting that different cell types may contribute to disease risk, via different mechanisms. Moreover, integration of glutamatergic and GABAergic regulatory maps with genetic risk factors for schizophrenia (SCZ) and bipolar disorder (BD) identifies shared (parvalbumin-expressing interneurons) and distinct cellular etiologies (upper layer neurons for BD, and deeper layer projection neurons for SCZ). Collectively, these findings shed new light on cell-type-specific gene regulatory networks in brain disorders.
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