A Prospective Study of the Concordance of DSM-IV and DSM-5 Diagnostic Criteria for Autism Spectrum Disorder

The transition from DSM-IV to DSM-5 criteria for autism spectrum disorder (ASD) sparked considerable concern about the potential implications of these changes. This study was designed to address limitations of prior studies by prospectively examining the concordance of DSM-IV and final DSM-5 criteria on a consecutive sample of 439 children referred for autism diagnostic evaluations. Concordance and discordance were assessed using a consistent diagnostic battery. DSM-5 criteria demonstrated excellent overall specificity and good sensitivity relative to DSM-IV criteria. Sensitivity and specificity were strongest for children meeting DSM-IV criteria for autistic disorder, but poor for those meeting criteria for Asperger’s disorder and pervasive developmental disorder. Higher IQ, older age, female sex, and less pronounced ASD symptoms were associated with greater discordance.     

Sensory perception and motoric reactivity in Schizophrenic patients

Explored the effect of non-signal and signal stimuli conditions upon skin conductance (SC) and finger pulse amplitude (FPA) of 8 schizophrenic patients and 6 normal controls. Both groups were assessed on a reaction time (RT) task that consisted of visual, auditory and tactile stimuli. Schizophrenics were significantly slower in the perception and reaction to visual, auditory and tactile stimuli than the normal volunteers. The autonomic reactivity of schizophrenics and normals was nonsignificant during the relaxation and non-signal stimuli conditions. However, when schizophrenics were asked to respond to signal stimuli or when an interfering stimulus was introduced, an autonomic imbalance was observed. The concept of directional fractionation provides the theoretical framework for the discussion of the autonomic results.     

The clinically unrecognized colorectal cancer in a patient autopsy sample

An evaluation of 27,543 postmortem records revealed that 29 percent of colon carcinomas and 16.9 per cent of rectum carcinomas had not been identified until postmortem investigation (186 cases). The rate of false diagnosis have decreased from 1954 by 12.5 per cent for colon carcinoma and by 20.8 per cent for rectum carcinoma. They still amounted to 27.7 per cent for patients above 65 years of age and to 11.5 per cent for younger patients. They were 31.6 per cent for carcinoma of the right colon half and 20.6 per cent for left-side colon carcinoma. On admission to hospital, tumour stages III and IV were recorded form 52.7 per cent of all patients hospitalized for colon carcinoma and from 30.8 per cent of those with rectum carcinoma. Sixty-four patients died within 72 hours form hospitalization and another 27 within one week.     

Self-certification in lay midwives'' organizations: A vehicle for professional autonomy

The recent resurgence of lay midwifery in the United States has been intimately connected with the establishment of grassroots organizations which address women's health issues and make the reappearance of the lay midwife a different kind of phenomenon than was the case earlier in this century. This paper describes the organizational structure of 32 lay midwives' organizations and compares them to a model of alternative women's health groups as well as more traditional health professional organizations. Are lay midwives' groups the beginnings of new professional organizations which eventually will become part of the dominant system or do they model themselves more closely after alternative women's health groups? Voluntary self-certification in five lay midwives' groups is described in detail as a means of determining how a group handles the question of integration with or separation from the existing medical care system. Certification plays a critical role in promoting acceptance and credibility of midwifery practice and is seen increasingly as a mechanism to preempt regulation by another body.     

Spatial attentional shifts: implications for the role of polysensory mechanisms

Simple reaction times to lateralized visual (Experiment 1) or auditory (Experiment 2) targets were studied in normal subjects. The targets were preceded by a visual or auditory cue located on the same (valid cue), or opposite (invalid cue) side as the subsequent target, or on both sides (neutral cue), with one of four cue target intervals. The validity of visual and auditory cues influenced the speed of response to the visual target but not to the auditory target. It is hypothesized that cross-modal cueing of spatial position works only with modalities for which a movement (e.g. saccade) leads to improved sensory analysis.     

Effect of Direction and Rate of Change of Calcium on Parathyroid Hormone Secretion in Uraemia

We have studied the control of amino-terminal parathyroid hormone(PTH) secretion in haemodialysis patients in response to slowor fast calcium infusion and during acute hypocalcaemia. Innine patients, fast calcium infusion (0.4 mmol/kg bodyweightper hour) for 15 min increased ionised calcium and reduced PTH,with an initial t of 12.8 min. After the infusion had ceased,calcium decreased steadily, and PTH increased, mean PTH reachingbaseline values when calcium was still significantly greaterthan pre-infusion values. During slow calcium infusion for 2.5h (0.1 mmol/kg bodyweight per hour), parathyroid suppressionwas evident at 15 min, when the calcium increment was only 0.03mM. After 60 min, PTH did not decrease further despite progressivehypercalcaemia. Hypocalcaemic haemodialysis led to rapid increasesin PTH. After 15 min, the mean calcium decrement was 0.09 mM(P<0.01) and the mean PTH increment was 283 pg/ml (P<0.01).The parathyroid response was maximal at 30 min, and did notincrease subsequently, despite progressive hypocalcaemia fora further 90 min. During recovery from hypocalcaemia, PTH reducedand, despite comparable hypocalcaemia, PTH during periods ofincreasing calcium was always lower at a given calcium concentrationthan while calcium was decreasing. This influence of the directionof change of calcium was not seen during hypocalcaemia. Theresults showed that even in advanced renal disease, the parathyroidglands are highly responsive to small initial increments (0.03mM) and decrements (0.09 mM) in blood calcium, though less soto further perturbation of blood calcium. During hypocalcaemia,the parathyroid glands respond to both the absolute value ofblood calcium and also to the direction of change of calcium.     

Changes in sensory inattention, directional motor neglect and "release" of the fixation reflex following a unilateral frontal lesion: a case report

We recorded eye movements to and away from visual stimuli from a patient with left-sided neglect following a right frontal infarct in order to determine (a) whether and to what extent his neglect was due to sensory inattention and directional motor neglect and (b) whether he had difficulty suppressing inappropriate eye movements to visual stimuli ("release" of visual grasp) as his sensory inattention declined. In the first testing session, conducted 5 days following his stroke, he often failed to move his eyes when a stimulus on the left required a rightward eye movement, but he consistently moved his eyes to a stimulus on the right. Thus, he showed contralateral but not ipsilateral sensory inattention. Initially, he also was impaired in making leftward eye movements when right stimuli were presented. Thus, he also showed a directional motor neglect. In subsequent tests, his left-sided sensory inattention as defined above decreased, and was no longer present three weeks following his stroke, nor in a follow-up test conducted almost 6 months following this stroke. In contrast, his directional motor neglect, as defined above, was still present in the follow-up test. As his left-sided sensory inattention declined, his tendency to move his eyes incorrectly to stimuli on the left side (the side contralateral to his lesion) when these stimuli required eye movements to the right became stronger ("release" of visual grasp); he continued to show this strong tendency in the test conducted almost 6 months following his stroke.     

Technical aspects of a successful transvascular retrieval of an acutely dislodged WaveCrest® left atrial appendage occluder

Percutaneous left atrial appendage (LAA) closure is an alternative therapy in patients with atrial fibrillation who are not suitable for anticoagulation. However, device embolization is one of the notable complications which inevitably requires catheter or surgical retrieval. In addition to previously reported Watchman® or AMULET® occluder embolization, here we report the first case of a WaveCrest® occluder dislodgement which was successfully removed by transcatheter technique. Instead of using the well‐known snaring technique, we used a “wiring and ballooning technique” for retrieval. Considering its specific architecture without having hooks or feet where suitable for grasping, this technique is an option for retrieving WaveCrest® devices.     

Modelling the complexity of pandemic-related lifestyle quality change and mental health: an analysis of a nationally representative UK general population sample

Purpose

The COVID-19 pandemic has affected the way many individuals go about their daily lives. This study attempted to model the complexity of change in lifestyle quality as a result of the COVID-19 pandemic and its context within the UK adult population.

Methods

Data from the COVID-19 Psychological Research Consortium Study (Wave 3, July 2020; N = 1166) were utilised. A measure of COVID-19-related lifestyle change captured how individuals’ lifestyle quality had been altered as a consequence of the pandemic. Exploratory factor analysis and latent profile analysis were used to identify distinct lifestyle quality change subgroups, while multinomial logistic regression analysis was employed to describe class membership.

Results

Five lifestyle dimensions, reflecting partner relationships, health, family and friend relations, personal and social activities, and work life, were identified by the EFA, and seven classes characterised by distinct patterns of change across these dimensions emerged from the LPA: (1) better overall (3.3%), (2) worse except partner relations (6.0%), (3) worse overall (2.5%), (4) better relationships (9.5%), (5) better except partner relations (4.3%), (6) no different (67.9%), and (7) worse partner relations only (6.5%). Predictor variables differentiated membership of classes. Notably, classes 3 and 7 were associated with poorer mental health (COVID-19 related PTSD and suicidal ideation).

Conclusions

Four months into the pandemic, most individuals’ lifestyle quality remained largely unaffected by the crisis. Concerningly however, a substantial minority (15%) experienced worsened lifestyles compared to before the pandemic. In particular, a pronounced deterioration in partner relations seemed to constitute the more severe pandemic-related lifestyle change.

     

Does ultrasound training boost Year 1 medical student competence and confidence when learning abdominal examination?

OBJECTIVES: Learning to perform physical examination of the abdomen is a challenge for medical students. Medical educators need to find engaging, effective tools to help students acquire competence and confidence in abdominal examination techniques. This study evaluates the added value of ultrasound training when Year 1 medical students learn abdominal examination. METHODS: The study used a randomised trial with a wait-list control condition. Year 1 medical students were randomised into 2 groups: those who were given immediate ultrasound training, and those for whom ultrasound training was delayed while they received standard instruction on abdominal examination. Standardised patients (SPs) used a clinical skills assessment (CSA) checklist to assess student abdominal examination competence on 2 occasions - CSA-1 and CSA-2 - separated by 8 weeks. Students also estimated SP liver size for comparison with gold-standard ultrasound measurements. Students completed skills confidence surveys. RESULTS: Proficiency in abdominal examination technique acquired from traditional instruction boosted with ultrasound training showed no advantage at CSA-1. However, at CSA-2 the delayed ultrasound training group showed significant improvement. Students uniformly underestimated SP liver sizes and the estimates were not affected by ultrasound training. Student confidence in both groups improved from baseline to CSA-1 and CSA-2. CONCLUSIONS: Ultrasound training as an adjunct to traditional means of teaching abdominal examination improves students' physical examination technique after students have acquired skills with basic examination manoeuvres.