A 46-year-old male experienced progressive neurocognitive decline, weight loss, intermittent headaches, and weakness over 6 months. Magnetic resonance imaging of the brain revealed hydrocephalus and ...the spinal cord imaging showed diffuse leptomeningeal enhancement with prominent nerve root involvement. Intradural biopsy of lumbar arachnoid tissue found mixed inflammatory infiltrate consisting predominantly of histiocytes, S100 and CD68 positivity, and lymphocytophagocytosis (emperipolesis) consistent with extranodal Rosai-Dorfman disease. Rosai-Dorfman disease, a non-Langerhans cell histocytic disorder, can mimic the appearance of neurosarcoidosis and leptomeningeal carcinomatosis and should remain on the differential of a patient presenting with diffuse leptomeningeal enhancement, a common occurrence on a neurohospitalist service.
We present a new and innovative near-infrared multi-band ultraprecise spectroimager (NIMBUS) for SOFIA. This design is capable of characterizing a large sample of extrasolar planet atmospheres by ...measuring elemental and molecular abundances during primary transit and occultation. This wide-field spectroimager would also provide new insights into Trans-Neptunian Objects (TNO), Solar System occultations, brown dwarf atmospheres, carbon chemistry in globular clusters, chemical gradients in nearby galaxies, and galaxy photometric redshifts. NIMBUS would be the premier ultraprecise spectroimager by taking advantage of the SOFIA observatory and state of the art infrared technologies. This optical design splits the beam into eight separate spectral bandpasses, centered around key molecular bands from 1 to 4 microns. Each spectral channel has a wide field of view for simultaneous observations of a reference star that can decorrelate time-variable atmospheric and optical assembly effects, allowing the instrument to achieve ultraprecise calibration for imaging and photometry for a wide variety of astrophysical sources. NIMBUS produces the same data products as a low-resolution integral field spectrograph over a large spectral bandpass, but this design obviates many of the problems that preclude high-precision measurements with traditional slit and integral field spectrographs. This instrument concept is currently not funded for development.
A diagnostic difficulty in neuropathology practice is distinguishing reactive from neoplastic astrocyte populations. This is particularly true in small biopsy samples that lack evidence of increased ...cellularity or mitotic activity, microvascular proliferation, or necrosis. We performed the current study to validate the previously reported finding that in the central nervous system, the expression of WT1 is limited to neoplastic astrocytes. We retrospectively studied WT1 protein expression by immunohistochemistry (IHC) in 100 formalin‐fixed, paraffin‐embedded brain tissue samples consisting of 3 normal control tissues, 44 cases of reactive gliosis, 49 gliomas and 4 lesions suspicious for glioma. In normal human cortex, WT1 staining was restricted to vascular endothelium. Most cases of reactive gliosis (82%) showed at least focal WT1 positivity, and analysis of specimens with electrode monitoring lesions showed an inverse relationship between WT1 expression intensity and the number of days from electrode placement to tissue resection. All glioma samples (100%) and all cases suspicious for glioma (100%) showed at least focal WT1 positivity. Our results likely differ from those in the prior report because of differences in tissue fixation and IHC methodology. Thus, our findings indicate that WT1 expression alone is not a reliable feature to distinguish reactive from neoplastic astrocytes.
Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous disease with no proven pharmacologic therapies. Cardiac amyloidosis shares common features of HFpEF, however endomyocardial ...biopsy data are only available on limited subsets of HFpEF patients. To our knowledge, this is the first study to comprehensively characterize biopsy data for patients referred for HFpEF evaluation.
We included patients referred to the Johns Hopkins HFpEF Clinic who underwent right heart catheterization and endomyocardial biopsy. HFpEF diagnosis was based on signs and symptoms of HF, LVEF ≥50%, and at least 2 of the following: 1) structural heart disease by echocardiogram, 2) invasive hemodynamics with elevated pulmonary capillary wedge pressure, or 3) NT-proBNP >100 pg/mL. We excluded patients with severe valvular heart disease, known infiltrative or restrictive cardiomyopathy, or constrictive pericarditis. We evaluated clinical characteristics, hemodynamics, echocardiography, and histology. Cardiac amyloidosis was diagnosed on Congo red stain if greater than mild deposition was present. Data were analyzed using median tests or Fisher's exact tests.
Of 108 HFpEF patients, cardiac amyloidosis was diagnosed in 15 patients (14%). Non-amyloid HFpEF patients had high incidence of myocyte hypertrophy and fibrosis on endomyocardial biopsy (Figure). HFpEF-Amyloid were older (74y v. 65y, p<0.01), predominantly male (60% v. 40%, p=0.09), with less hypertension (60% v. 98%, p<0.001), diabetes (27% v. 58%, p<0.05), and a lower BMI (29.4 kg/m2 v. 37.6 kg/m2, p<0.01), compared to non-amyloid HFpEF. HFpEF-Amyloid had higher NT-proBNP (3245 pg/mL v. 339 pg/mL, p<0.01), troponin-I (0.09 ng/mL v. 0.0 ng/mL, p<0.001), LV mass index (126.1 g/m2 v. 90.9 g/m2, p<0.05) and greater septal wall thickness (1.3 cm v. 1.1 cm, p=0.01), however lower cardiac output (4.13 L/min v. 5.74 L/min, p<0.01), compared to non-amyloid HFpEF.
Endomyocardial biopsy diagnosed cardiac amyloidosis in 14% of HFpEF patients not suspected to have amyloidosis, with markedly different characteristics between the subgroups. These findings have important diagnostic and therapeutic implications given recent advances in therapies for cardiac amyloidosis.
•Parents’ social network size can predict the number of autism services they access.•English speakers may be accessing more autism services than non-English speakers.•Linguistic minorities in areas ...with few resources need additional support.•Future studies could target expanding social network to improve service engagement.
Numerous studies have shown that racial/ethnic minority and under-resourced families face barriers that delay timely access to autism services. These barriers include lack of resources and information about autism, financial hardship, mistrust in the service system, cultural and language mismatch, and other factors that have yet to be identified.
The current study aimed to examine additional caregiver and system-level factors that could be associated with early service access using a diverse sample from four study sites (Los Angeles, CA; Philadelphia, PA; Sacramento, CA; and Rochester, NY). Partnering with community agencies that serve traditionally underrepresented groups, the research team recruited 118 caregivers of young children with autism who were low-income, English, Spanish or Korean speaking and had not accessed autism-specific services.
Regression analyses revealed that the total number of services accessed were associated with caregiver social network size (p = 0.011) but not by race, autism knowledge and caregiver agency. Among families receiving at least one non-autism specific service, a marginally significant interaction effect of site and primary language on total services received was observed (p = 0.06).
Findings suggest that caregivers’ social network connections are crucial in early service access, and future interventions could target increasing social networks to improve families’ service engagement. More attention for non-English speaking families, especially those living in areas with few supports in their native languages, is needed.
We sought to assess the association between parental depressive symptoms and school attendance and emergency department (ED) use among children with and without chronic health conditions. Secondary ...analysis of the 1997–2004 National Health Interview Survey, a nationally representative survey. Parental depressive symptoms were measured by three questions assessing sadness, hopelessness, or worthlessness in the past month. Children with and without asthma or attention-deficit/hyperactivity disorder (ADHD) were identified, and their school attendance and ED visits were reported by adult household respondents. Children with information on parental depressive symptoms, health conditions, and services use were eligible. We incorporated weights available in the survey for each eligible child to reflect the complex sampling design. 104,930 eligible children were identified. The point prevalence of parental depressive symptoms was low (1.8 %, 95 % CI 1.7–2.0), but greater among children with asthma (2.7 %, 95 % CI 2.4–3.0) and ADHD (3.8 %, 95 % CI 3.2–4.4) than among other children (1.6 %, 95 % CI 1.5–1.7). After adjustment for potential confounders, children whose parents reported depressive symptoms most or all of the time were more likely to report an ED visit (adjusted incident rate ratio IRR 1.18, 95 % CI 1.06–1.32) or school absence (adjusted IRR 1.36, 95 % CI 1.14–1.63) than children whose parents did not. The effect of parental depressive symptoms was not modified by child health conditions. Parental depressive symptoms were adversely associated with school attendance and ED use in children. These results suggest the importance of measuring depressive symptoms among adult caregivers of children.
Objectives To report the preliminary data of voice and quality‐of‐life improvement after micronized AlloDerm injection laryngoplasty in patients with unilateral vocal cord paralysis.
Study Design A ...prospective study was conducted in patients with unilateral vocal cord paralysis who underwent injection laryngoplasty with micronized AlloDerm.
Methods Preoperative and postoperative patient evaluation consisted of videostrobolaryngoscopy, computer voice analysis, airflow, and voice handicap index (VHI) assessment. All injections were conducted with the patient under general anesthesia using the Storz injector system and a 22‐gauge spinal needle.
Results Fourteen patients received injection with an average amount of 0.641 mL. Twelve patients were available for evaluation. Initial results at 4 weeks (n = 12) showed significant increase in habitual phonation time from 3.84 to 6.72 seconds (P <.01) and a decrease in airflow from 0.616 to 0.295 L/s (P <.01). The VHI rating improved from 62.8 to 37.5 (P <.01). Jitter and shimmer also improved significantly (P <.05). Stroboscopic findings showed complete closure of glottic gap in 10 patients with excellent return of mucosal wave on the injected side. The mucosal wave return after injection was rapid with little evidence of tissue reaction. Postoperative follow‐up at 3 months (n = 8) demonstrated slight resorption of the material, but sustained excellent voice was noted in 87.5%. Minimal morbidity and tissue reaction were noted.
Conclusions Micronized AlloDerm appears to be a safe new material that is suitable for injection laryngoplasty. Long‐term results are pending.
Objective: The act of moving, tailoring, and sustaining evidence-based practices (EBP) into real world settings has proven formidable. Schools of social work are responsible for preparing students to ...deliver EBP interventions while trying to engender the practice of routinely using evidence for decision making. Given the difficulty of accomplishing these objectives and cognizant that field education is the heart of the experiential component of graduate social work curricula, we developed FIELD as an educational intervention for dyads of field instructors and their students. FIELD is a multiphase didactic and experiential intervention driven by the interests of field instructors. This article presents findings from a pilot randomized controlled trial that examined the effectiveness of FIELD using motivational interviewing as the focal EBP. Methods: A convenience sample of 40 dyads (composed of a field instructor and a field student) was randomly assigned to experimental (n = 38) or control conditions (n = 42). Data collected at baseline and 1- and 3-month post intervention included 2 measures to examine attitudes toward both the EBP process of decision making as well as toward the use of designated EBPs. Results: Both groups were equal at baseline. At the 2 follow-up time points, experimental dyads had significantly higher scores on the attitude measures. Conclusion: FIELD holds promise as an EBP implementation strategy that capitalizes on the important role of field instruction in social work education by bridging classroom and field curricula while imparting competencies to both future and current generations of social workers.
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