The affective value of faces in patients achieving long-term seizure freedom after temporal lobectomy

We investigated different aspects of facial expression evaluation in a homogeneous cohort of 42 seizure-free patients with 5 or more years of follow-up after temporal lobectomy (TL), with the aim of further characterizing the impairment in emotion and social cognition among patients. A group of healthy subjects matched for sex, age, and education served as controls. Four tasks of facial expression evaluation were used: (a) facial expression recognition, (b) rating of the intensity of facial expression, and (c) rating of valence (pleasantness) and (d) rating of arousal induced by facial expressions. Patients had a worse performance in the recognition task for all negative emotions, while no differences in intensity ratings were found. They also reported lower arousal ratings than controls for faces showing fear, anger, disgust, and neutral expressions, as well as lower valence ratings for all facial expressions except those showing happiness. Longer epilepsy duration before TL was negatively associated with ratings of arousal and intensity and positively associated with valence ratings for fearful facial expressions.This study showed that patients who become seizure-free after TL present long-term deficits in several aspects of facial expression evaluation. Longitudinal, prospective studies are needed to evaluate if social cognition improves or declines after TL.     

What difficulties are experienced by caregivers in relation to the sexuality of people with intellectual disabilities? A qualitative meta-synthesis

The aim of the meta-synthesis was to determine any difficulties experienced by caregivers relating to the sexuality of people with intellectual disabilities and how they address those difficulties. A qualitative meta-synthesis was used to integrate the findings from 17 papers about these topics. The synthesis produced five concepts: ‘Fear and Uncertainty’, ‘Impact of Perceptions of Sexuality’, ‘The Same and Different’, ‘Balancing the Roles of Protector and Facilitator’ and ‘Conditional Sexuality: Conditional Support’. The findings suggest key issues for caregivers in relation to addressing the sexual needs of people with intellectual disabilities and highlight the possible implications of caregivers own views on their practice. These issues are discussed and in conclusion the review offers explanations about what the difficulties for caregivers are and how they might be addressed, as well as recommendations for future research.     

Tissue engineering: A promising therapeutic approach to necrotizing enterocolitis

Tissue engineering is a promising potential candidate for treating intestinal failure resulting from necrotizing enterocolitis. This requires the acquisition, preparation and implantation of autologous organoid units. This may be affected by the complexities of periods of storage of viable donor tissue and delayed implantation. This chapter addresses the development, methodology, and application of tissue-engineered intestine in the experimental and clinical setting. Tissue engineering has the potential of avoiding the inherent toxicities of intestinal transplantation and prolonged immunosuppression.     

Evaluating the Keystones of Development - An Online Curriculum for Residents to Promote Positive Parenting in Primary Care

ObjectiveThis pilot outcome evaluation assesses the effectiveness of an online curriculum, the Keystones of Development, aimed at improving residents’ knowledge, attitudes, and reported behaviors around promoting positive parenting and childhood development in well-child visits.MethodsWe used an explanatory mixed-methods approach, including a single-arm pre-posttest of intervention effects on self-reported behavioral outcomes (discussing, modeling, and praising) and secondary outcomes (knowledge, perceived barriers, attitudes, and self-efficacy). Following this, a subset of residents participated in in-depth interviews to describe participant responses to the intervention.ResultsThe study was conducted at 8 pediatric residency programs across the United States with 67 pediatric residents (mean age = 29; 79% female; 57% PGY1). Within one month postintervention, there was a statistically significant increase in the behaviors that promote positive parenting: discussing (P < .01;d = 0.73) and modeling (P < .01;d = 0.61) but not praising (P = .05; d = 0.3). Significant changes in the secondary outcomes: knowledge (P < .01), perceived barriers, (P < .01), and retrospective self-efficacy (P < .01) were seen. Interviews revealed that integration of curriculum content into clinical practice was due to the relevance of the material to primary care and the modeling of how to apply in the clinical setting. Curriculum format, content, and clinical application helped participants weave recommendations into the well-child visit.ConclusionsIn this study, we demonstrated that the online curriculum, Keystones of Development, increased resident behaviors, knowledge, and self-efficacy, and decreased perceived barriers to promote parenting behaviors associated with improved child development outcomes in well-child visits. These findings were observed across participants demonstrating equal success regardless of demographic characteristics or study site.     

Phenomenology of OCD: Lessons from a large multicenter study and implications for ICD-11

This study aimed to investigate the phenomenology of obsessive–compulsive disorder (OCD), addressing specific questions about the nature of obsessions and compulsions, and to contribute to the World Health Organization's (WHO) revision of OCD diagnostic guidelines. Data from 1001 patients from the Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders were used. Patients were evaluated by trained clinicians using validated instruments, including the Dimensional Yale–Brown Obsessive–Compulsive Scale, the University of Sao Paulo Sensory Phenomena Scale, and the Brown Assessment of Beliefs Scale. The aims were to compare the types of sensory phenomena (SP, subjective experiences that precede or accompany compulsions) in OCD patients with and without tic disorders and to determine the frequency of mental compulsions, the co-occurrence of obsessions and compulsions, and the range of insight. SP were common in the whole sample, but patients with tic disorders were more likely to have physical sensations and urges only. Mental compulsions occurred in the majority of OCD patients. It was extremely rare for OCD patients to have obsessions without compulsions. A wide range of insight into OCD beliefs was observed, with a small subset presenting no insight. The data generated from this large sample will help practicing clinicians appreciate the full range of OCD symptoms and confirm prior studies in smaller samples the degree to which insight varies. These findings also support specific revisions to the WHO's diagnostic guidelines for OCD, such as describing sensory phenomena, mental compulsions and level of insight, so that the world-wide recognition of this disabling disorder is increased.     

Point-of-care lung ultrasound in children with non-cardiac respiratory distress or tachypnea

ObjectiveThe purpose of this study was to evaluate the feasibility and diagnostic benefit of point-of-care ultrasound (PoCLUS) in children with non-cardiac respiratory distress or tachypnea.MethodsIn this prospective observational study, children aged between 1 month and 18 years with respiratory distress, tachypnea, or both, at triage were included. Concordance and accuracy of the emergency department (ED) and ultrasound diagnoses, length of stay, and time elapsing until ED and ultrasound diagnoses were calculated.ResultsOne hundred forty-five patients were evaluated. The mean age of the children in the study was 67 ± 58 months. Seventy-nine patients (56%) were boys. Mean length of stay in the ED was 124.6 ± 76.5 min. Mean time to ultrasound diagnosis was 29.32 ± 15.71 min, compared to 46.75 ± 32.65 min for ED diagnosis, which was significantly longer (p < 0.001). Concordance between ultrasound and ED diagnoses was almost perfect for pneumonia, acute bronchiolitis, asthma and croup (0.8 < Ƙ < 1), and good for other non-pulmonary causes (0.6 < Ƙ < 0.8). Overall concordance for all diagnoses was also good (Ƙ = 0.76). Ultrasound diagnosis was more sensitive than ED diagnosis for pneumonia, acute bronchiolitis, and other non-pulmonary causes (81.4%–74.42%; 97.3%–86.49%; and 100%–95.83%, respectively). In addition, ultrasound diagnosis was more specific than ED diagnosis for pneumonia, acute bronchiolitis and other non-pulmonary causes (100%–97.35%; 99.07%–98.15%; and 93.39%–88.43%, respectively). However, ultrasound and ED diagnoses exhibited similar sensitivity and specificity values for asthma (97.22%–97.22%; and 99.08%–100%).ConclusionPoCLUS may constitute a beneficial and rational approach in the evaluation of children with increased work of breathing in the ED, and can also expedite the diagnostic process.