A Direct Comparison of Three Screening Methods for Autism Spectrum Disorder in a High-Likelihood Sibling Population.

Targeted screening of children at increased likelihood of autism is recommended. However, autism screening tools are usually validated for use mainly in low-likelihood populations. This study compared the accuracy of the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F), the ASDetect app, and the Social Attention and Communication Surveillance, Revised (SACS-R). Siblings of autistic children underwent autism screening at 12, 18 and 30 months old. At each visit, caregivers completed the M-CHAT-R/F and ASDetect while trained nurses tested the siblings using the SACS-R. At 36 to 48 months, the siblings underwent an Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) assessment. 189 siblings were screened, 141 completed the study, and 32 were confirmed to have autism. Although not validated for use at 12 months, the M-CHAT-R/F had the best sensitivity among the three tools for this age group, suggesting that early signs are already apparent to caregivers. The M-CHAT-R/F had overall better sensitivity (0.72-0.83) across all age groups, but with overall lower specificity (0.55-0.77). The SACS-R and ASDetect had better positive predictive values at 18 and 30 months (0.60-0.68), while the M-CHAT-R/F was 0.43-0.48. Negative predictive values were generally high across all three tools across all age groups (0.78-0.93). Targeted screening of children at high likelihood of autism yielded a detection rate of 22.7% and should therefore be implemented routinely to facilitate early detection and intervention. The performance of autism screening tools should be examined in higher-likelihood populations for targeted screening of these children.

[Effects of integrated disease management program on the outcome of patients with heart failure].

OBJECTIVE: To investigate the feasibility and efficacy on the outcome of patients with heart failure of integrated disease management program with heart failure clinic, patient education and telephone follow-up. METHODS: A total of 145 hospitalized patients with chronic heart failure and LVEF ≤ 45% or patients with LVEF > 45% and NT-proBNP > 1500 ng/L were divided into conventional group (n = 71) and interventional group (n = 74). Patients were followed for 10 to 12 months. RESULTS: Baseline clinical characteristics, LVEF and dose of evidence-based medicine were similar between the 2 groups. During follow-up, the NYHA functional class was higher in conventional group than interventional group (3.2 ± 0.5 vs 1.4 ± 0.5, P < 0.05), and the LVEF deteriorated in the conventional group and improved from 34% to 40%in the interventional group. The proportions of self-monitoring of weight, blood pressure and pulse rate in the interventional group were significantly higher than those of conventional group (P < 0.05). Among patients with systolic heart failure, 40% patients in the interventional group and 11% patients in the conventional group achieved the target doses of ß-blockers (P < 0.05). Cardiovascular event rate of conventional group and interventional group is 91.5% and 27.0% respectively (P < 0.05). CONCLUSION: Integrated disease management program with heart failure clinic, patient education and telephone follow-up can improve patient compliance to heart failure treatment, improve cardiac function and reduce cardiovascular event rate.

[Provenance difference in stable carbon isotope discrimination of Schima superba].

The difference in leaf stable carbon isotope discrimination (delta) of 18 representative Schima superba provenances was investigated based on three provenance trails located at Jian' ou of Fujian Province and Chun' an and Qingyuan of Zhejiang Province, and the geographic variation pattern and the effects of trial site and provenances growth rate were studied. Significant differences in leaf delta were observed among the provenaces, and the differences in leaf delta value between the highest and lowest provenances reached 6.9%, 3.0%, and 3.7% in 3 experimental sites, respectively. A classic latitudinal clinical variation pattern was found, because there were significant correlations between the leaf delta value and the latitude of seed sources in all the 3 sites while no significant correlations were observed between the leaf delta value and the longitude of the seed sources. The southern provenances showed higher leaf delta value than the northern provenances, indicating that the water use efficiency (WUE) was lower in southern provenances. The leaf delta value of different provenances was demonstrated to be greatly affected by the environment of trial sites. The leaf delta value increased significantly with the improvement of site environment and with the increase of annual rainfall. Significant positive correlations were observed between the leaf delta value and the growth traits including tree height, DBH, total number of lateral branches, and length of the strongest lateral branch, which indicated that the provenances with higher growth rate and denser crown had larger leaf delta value. Two and four superior provenances with high growth rate and low leaf delta value (or high WUE) were selected for Jian' ou of Fujian and Chun' an of Zhejiang, respectively.