Structural and functional connectivity of the human brain in autism spectrum disorders and attention‐deficit/hyperactivity disorder: A rich club‐organization study

Attention‐deficit/hyperactive disorder (ADHD) and autism spectrum disorders (ASD) are two of the most common and vexing neurodevelopmental disorders among children. Although the two disorders share many behavioral and neuropsychological characteristics, most MRI studies examine only one of the disorders at a time. Using graph theory combined with structural and functional connectivity, we examined the large‐scale network organization among three groups of children: a group with ADHD (8–12 years, n = 20), a group with ASD (7–13 years, n = 16), and typically developing controls (TD) (8–12 years, n = 20). We apply the concept of the rich‐club organization, whereby central, highly connected hub regions are also highly connected to themselves. We examine the brain into two different network domains: (1) inside a rich‐club network phenomena and (2) outside a rich‐club network phenomena. The ASD and ADHD groups had markedly different patterns of rich club and non rich‐club connections in both functional and structural data. The ASD group exhibited higher connectivity in structural and functional networks but only inside the rich‐club networks. These findings were replicated using the autism brain imaging data exchange dataset with ASD (n = 85) and TD (n = 101). The ADHD group exhibited a lower generalized fractional anisotropy and functional connectivity inside the rich‐club networks, but a higher number of axonal fibers and correlation coefficient values outside the rich club. Despite some shared biological features and frequent comorbity, these data suggest ADHD and ASD exhibit distinct large‐scale connectivity patterns in middle childhood. Hum Brain Mapp 35:6032–6048, 2014. © 2014 Wiley Periodicals, Inc.     

The role of the transfusion practitioner in the management of anaemia

Anaemia is a major public health issue, affecting 25% of the population worldwide, according to the World Health Organization. Iron deficiency is responsible for approximately half of all cases globally, with other causes including anaemia of chronic disease, other nutritional deficiencies, haemoglobinopathies, renal impairment, malignancy and bone marrow disease. In the elderly, where anaemia is even more common, the cause is frequently multifactorial. Patient blood management (PBM) is an evidenced‐based, integrated, multidisciplinary approach aimed to improve clinical outcomes by effectively managing anaemia and conserving the patient's own blood, thus reducing unnecessary exposure to transfusion. PBM has the patient as the central focus, with the aim being to improve their outcomes while including them in the process. The term transfusion practitioner (TP) includes those known as transfusion nurses, transfusion safety officers, haemovigilance officers or patient blood management (PBM) co‐ordinators. A key aspect of the role is driving and influencing clinical blood management activities such as PBM to help align practice to internationally recognized guidelines and standards. TP skills are a valuable asset to support patient groups and clinical settings to be targeted to achieve best outcomes. TPs know the organization and are well placed to help develop anaemia assessment and management concepts and processes, and provide education and support to promote and embed these practices. In this review, we outline the impacts of anaemia in the healthcare setting, along with different approaches to anaemia management (focussing on perioperative care), highlighting where the TP can support or lead activities.     

Relative prevalence and distribution of knee,hand and foot symptomatic osteoarthritis subtypes in an English population

In this brief report, we used data from a series of three related cohorts on pain and osteoarthritis (OA) of the knee, hand and foot, which were conducted in North Staffordshire, England. We used a common approach for sampling, data collection and coding, to estimate the relative prevalence of 10 different symptomatic radiographic OA subtypes in the knee, hand and foot and to compare their association with age, sex, socioeconomic position and body mass index. Overall, symptomatic hand OA was more common than knee or foot OA (22.4% vs 17.4% vs 16.5%), due mainly to the high prevalence of nodal interphalangeal joint OA among women. The first carpometacarpal joint OA was the most frequent subtype, with patellofemoral, tibiofemoral, (nodal) interphalangeal and midfoot OA also common. Of the risk factors examined, the greatest differences between subtypes appeared to be their associations with sex and obesity: sex differences were noticeably greater for all forms of hand OA except non‐nodal interphalangeal joint OA, while obesity appeared most strongly associated with forms of knee OA. The prevalence of all subtypes was higher among older ages, and among those with lower educational attainment.