Listening to the autistic voice: Mental health priorities to guide research and practice in autism from a stakeholder-driven project.

LAY ABSTRACT: Autistic adults commonly experience mental health conditions. However, research rarely involves autistic adults in deciding priorities for research on mental healthcare approaches that might work for them. The purpose of this article is to describe a stakeholder-driven project that involved autistic adults in co-leading and designing research about priorities to address mental health needs. Through a large online survey, two large meetings, and three face-to-face focus group discussions involving over 350 stakeholders, we identified five priorities for mental health research desired by autistic adults. These priorities and preferred outcomes should be used to guide research and practice for autistic adults.

Provision of abortion and other reproductive health services among former Midwest Access Project trainees.

OBJECTIVE: The Midwest Access Project (MAP) offers opt-in training to students, residents and practicing clinicians in reproductive health care including abortion. We surveyed MAP alumni to identify current practice characteristics and assess predictors of reproductive health service provision. STUDY DESIGN: We sent an online survey to alumni of MAP's Individual Clinical Training program, 2007-2015 (n=127). The primary outcome was current provision of any abortion service. Secondary outcomes included providing specific abortion services and other reproductive services. RESULTS: We received responses from 61% of eligible MAP alumni (n=77 out of 127). The majority reported a specialty of Family Medicine (68%) and current location in the Midwest (52%). Among current residents, fellows or clinicians practicing in a field whose scope includes abortion (n=56), 50% provide abortion. Most (84%) provide outpatient miscarriage management, and nearly all (≥96%) provide pregnancy options counseling and full scope contraception. Respondents who received the most advanced training in medication abortion as part of their MAP training were more likely to report providing abortion in their current practice than those who did not (63% vs. 32%, p=.027), as were those who completed more than one MAP rotation compared to those who completed one rotation (100% vs. 44%, p=.009). CONCLUSIONS: Half of MAP's alumni provide some abortion care. Nearly all provide comprehensive counseling and contraceptive services. IMPLICATIONS: Opt-in training is a promising strategy to develop providers of comprehensive reproductive health care.

Sex and gender differences in autism spectrum disorder: summarizing evidence gaps and identifying emerging areas of priority.

One of the most consistent findings in autism spectrum disorder (ASD) research is a higher rate of ASD diagnosis in males than females. Despite this, remarkably little research has focused on the reasons for this disparity. Better understanding of this sex difference could lead to major advancements in the prevention or treatment of ASD in both males and females. In October of 2014, Autism Speaks and the Autism Science Foundation co-organized a meeting that brought together almost 60 clinicians, researchers, parents, and self-identified autistic individuals. Discussion at the meeting is summarized here with recommendations on directions of future research endeavors.

Acute adrenal failure following anticoagulation with dabigatran after hip replacement and thrombolysis for massive pulmonary embolism.

A 75-year-old woman presented 9 days post-total hip replacement with sudden onset of shortness of breath and fever. She had been discharged taking dabigatran. The patient was treated for sepsis with antibiotics and fluids. However, she deteriorated and was transferred to the intensive care unit. Following a 10 s asystolic episode the patient was thrombolysed with alteplase for presumed massive pulmonary embolism. Initially, her blood pressure and oxygen saturation improved. However, over the next few days, she remained persistently hypotensive. A CT scan of her chest, abdomen and pelvis demonstrated bilateral adrenal haemorrhages. A short synacthen test confirmed acute adrenal failure.

The DIEA branching pattern and its relationship to perforators: the importance of preoperative computed tomographic angiography for DIEA perforator flaps.

BACKGROUND: Abdominal donor-site flaps based on the deep inferior epigastric artery (DIEA) are the most common flaps used in autologous breast reconstruction. With significant variation in the vascular anatomy of the DIEA, preoperative imaging is desirable. Computed tomographic angiography, recently described for this purpose, uniquely demonstrates the branching pattern of the DIEA. The authors sought to correlate the DIEA branching pattern to the location and course of perforators as a preoperative planning tool for perforator flaps. METHODS: Forty-five cadaveric hemi-abdominal walls were used for contrast injection of the DIEA with subsequent radiographic imaging. The branching pattern on radiography was thus correlated to the location and intramuscular course of perforators, from the main DIEA trunk to the point of the penetrating rectus sheath. RESULTS: The DIEA branching pattern correlated closely with the course of perforators. A bifurcating (type II) branching pattern demonstrated a reduced transverse distance traversed by each perforator, whereas a trifurcating (type III) branching pattern demonstrated significantly greater transverse distances (p = 0.0002). Type I vessels were intermediate. Vessel branching type, however, displayed no significant correlation with the number of perforators (p = 0.56). CONCLUSIONS: The distances traversed by perforators were significantly reduced with a bifurcating branching pattern of the DIEA, particularly those originating from the lateral branch, and were greatest with a trifurcating branching pattern. Increased transverse distances correlate with greater rectus muscle sacrificed during perforator flap surgery. As computed tomographic angiography is the optimal modality for demonstrating this pattern preoperatively, the authors suggest its use for preoperative assessment in transverse rectus abdominis musculocutaneous and DIEA perforator flaps.