Supine sleep positioning in preterm and term infants after hospital discharge from 2000 to 2011.

OBJECTIVE: Supine sleep positioning (SSP) has been shown to reduce the risk of sudden infant death syndrome (SIDS) and preterm infants are at higher risk for SIDS. Population-based estimates of SSP are lacking for the preterm population. The objectives of this study are: (1) compare the prevalence of SSP after hospital discharge for preterm and term infants in the United States; and (2) assess racial/ethnic disparities in SSP for preterm and term infants. STUDY DESIGN: We analyzed the 2000 to 2011 data from the Pregnancy Risk Assessment Monitoring System of Centers for Disease Control and Prevention from 35 states. We measured prevalence of SSP by preterm and term gestational age (GA) categories. We calculated adjusted prevalence ratios (APR) to evaluate the likelihood of SSP for each GA category compared with term infants and the likelihood of SSP for non-Hispanic black (NHB) and Hispanic infants compared with non-Hispanic white (NHW) infants. RESULTS: Prevalence of SSP varied by GA: ⩽27, 59.7%; 28 0/7 to 33 6/7, 63.7%; 34 0/7 to 36 6/7 (late preterm), 63.6%; and 37 0/7 to 42 6/7 (term) weeks, 66.8% (P<0.001). In the adjusted analyses, late preterm infants were slightly less likely to be placed in SSP compared with term infants (APR: 0.96, confidence interval: 0.95 to 0.98). There were racial/ethnic disparities in SSP for all GA categories when NHB and Hispanic infants were compared with NHW infants. CONCLUSIONS: All infants had suboptimal adherence to SSP indicating a continued need to better engage families about SSP. Parents of late preterm infants and families of NHB and Hispanic infants will also require greater attention given their decreased likelihood of SSP.

Disruptive mood dysregulation disorder at the age of 6 years and clinical and functional outcomes 3 years later.

BACKGROUND: Little is known about the predictive validity of disruptive mood dysregulation disorder (DMDD). This longitudinal, community-based study examined associations of DMDD at the age of 6 years with psychiatric disorders, functional impairment, peer functioning and service use at the age of 9 years. METHOD: A total of 473 children were assessed at the ages of 6 and 9 years. Child psychopathology and functional impairment were assessed at the age of 6 years with the Preschool Age Psychiatric Assessment with parents and at the age of 9 years with the Kiddie-Schedule of Affective Disorders and Schizophrenia (K-SADS) with parents and children. At the age of 9 years, mothers, fathers and youth completed the Child Depression Inventory (CDI) and the Screen for Child Anxiety Related Disorders, and teachers and K-SADS interviewers completed measures of peer functioning. Significant demographic covariates were included in all models. RESULTS: DMDD at the age of 6 years predicted a current diagnosis of DMDD at the age of 9 years. DMDD at the age of 6 years also predicted current and lifetime depressive disorder and attention-deficit/hyperactivity disorder (ADHD) at the age of 9 years, after controlling for all age 6 years psychiatric disorders. In addition, DMDD predicted depressive, ADHD and disruptive behavior disorder symptoms on the K-SADS, and maternal and paternal reports of depressive symptoms on the CDI, after controlling for the corresponding symptom scale at the age of 6 years. Last, DMDD at the age of 6 years predicted greater functional impairment, peer problems and educational support service use at the age of 9 years, after controlling for all psychiatric disorders at the age of 6 years. CONCLUSIONS: Children with DMDD are at high risk for impaired functioning across childhood, and this risk is not accounted for by co-morbid conditions.

Predictors of caregiver satisfaction with visiting nurse home visits after NICU discharge.

OBJECTIVE: High-risk infants are commonly referred to Visiting Nurse Association (VNA) agencies for post-hospitalization services after discharge from the neonatal intensive care unit (NICU). Little is known about the effectiveness and perceived benefits of routine VNA services for these infants. The objective of this study was to identify factors predictive of family satisfaction with VNA services after NICU discharge. STUDY DESIGN: This is an observational study using data collected from routine quality assurance phone calls to families after NICU discharge. The setting is a single NICU at a large, urban academic medical center in Boston, MA, USA. We included all hospitalized infants discharged from the NICU from 1 January 2008 to 31 July 2014. Predictors included markers of infant biological and social risk and a survey measure of parent and nurse perceptions of parents' preparedness at discharge. The outcome was parent response to the question, 'Did you find the VNA visit helpful?' at 2 weeks post discharge. RESULTS: Bivariate analyses showed perceived helpfulness of VNA visits associated with low maternal parity, lower 1-min Apgar score, lower birth weight and gestational age, diagnosis of respiratory distress syndrome and intraventricular hemorrhage and low discharge readiness scores. Only low maternal parity (odds ratio (OR) 1.82, 95% confidence interval (CI) 1.35, 2.46) and birth <35 weeks' gestation (OR 1.45, 95% CI 1.15, 1.83) were significant predictors in multivariable analysis. CONCLUSIONS: Low maternal parity and gestational age <35 weeks predicted parent satisfaction with VNA services. Referral for VNA services is common after NICU discharge. There are currently no guidelines indicating which infants and families stand to benefit most from such services. Our findings may help in developing and streamlining processes for post-hospitalization VNA service referrals for high-risk infants.

Complexation of Cm(III) with the recombinant N-lobe of human serum transferrin studied by time-resolved laser fluorescence spectroscopy (TRLFS).

The complexation of Cm(III) with the recombinant N-lobe of human serum transferrin (hTf/2N) is investigated in the pH range from 4.0 to 11.0 using TRLFS. At pH ≥ 7.4 a Cm(III) hTf/2N species is formed with Cm(III) bound at the Fe(III) binding site. The results are compared with Cm(III) transferrin interaction at the C-lobe and indicate the similarity of the coordination environment of the C- and N-terminal binding sites with four amino acid residues of the protein, two H2O molecules and three additional ligands (e.g. synergistic anions such as carbonate) in the first coordination sphere. Measurements at c(carbonate)tot = 0.23 mM (ambient carbonate concentration) and c(carbonate)tot = 25 mM (physiological carbonate concentration) show that an increase of the total carbonate concentration suppresses the formation of the Cm(III) hTf/2N species significantly. Additionally, the three Cm(III) carbonate species Cm(CO3)(+), Cm(CO3)2(-) and Cm(CO3)3(3-) are formed successively with increasing pH. In general, carbonate complexation is a competing reaction for both Cm(III) complexation with transferrin and hTf/2N but the effect is significantly higher for the half molecule. At c(carbonate)tot = 0.23 mM the complexation of Cm(III) with transferrin and hTf/2N starts at pH ≥ 7.4. At physiological carbonate concentration the Cm(III) transferrin species II forms at pH ≥ 7.0 whereas the Cm(III) hTf/2N species is not formed until pH > 10.0. Hence, our results reveal significant differences in the complexation behavior of the C-terminal site of transferrin and the recombinant N-lobe (hTf/2N) towards trivalent actinides.

Early Levallois technology and the Lower to Middle Paleolithic transition in the Southern Caucasus.

The Lower to Middle Paleolithic transition (~400,000 to 200,000 years ago) is marked by technical, behavioral, and anatomical changes among hominin populations throughout Africa and Eurasia. The replacement of bifacial stone tools, such as handaxes, by tools made on flakes detached from Levallois cores documents the most important conceptual shift in stone tool production strategies since the advent of bifacial technology more than one million years earlier and has been argued to result from the expansion of archaic Homo sapiens out of Africa. Our data from Nor Geghi 1, Armenia, record the earliest synchronic use of bifacial and Levallois technology outside Africa and are consistent with the hypothesis that this transition occurred independently within geographically dispersed, technologically precocious hominin populations with a shared technological ancestry.

DSM-5 disruptive mood dysregulation disorder: correlates and predictors in young children.

BACKGROUND: Despite the inclusion of disruptive mood dysregulation disorder (DMDD) in DSM-5, little empirical data exist on the disorder. We estimated rates, co-morbidity, correlates and early childhood predictors of DMDD in a community sample of 6-year-olds. METHOD: DMDD was assessed in 6-year-old children (n = 462) using a parent-reported structured clinical interview. Age 6 years correlates and age 3 years predictors were drawn from six domains: demographics; child psychopathology, functioning, and temperament; parental psychopathology; and the psychosocial environment. RESULTS: The 3-month prevalence rate for DMDD was 8.2% (n = 38). DMDD occurred with an emotional or behavioral disorder in 60.5% of these children. At age 6 years, concurrent bivariate analyses revealed associations between DMDD and depression, oppositional defiant disorder, the Child Behavior Checklist - Dysregulation Profile, functional impairment, poorer peer functioning, child temperament (higher surgency and negative emotional intensity and lower effortful control), and lower parental support and marital satisfaction. The age 3 years predictors of DMDD at age 6 years included child attention deficit hyperactivity disorder, oppositional defiant disorder, the Child Behavior Checklist - Dysregulation Profile, poorer peer functioning, child temperament (higher child surgency and negative emotional intensity and lower effortful control), parental lifetime substance use disorder and higher parental hostility. CONCLUSIONS: A number of children met DSM-5 criteria for DMDD, and the diagnosis was associated with numerous concurrent and predictive indicators of emotional and behavioral dysregulation and poor functioning.

Neonatal intensive care unit discharge preparation, family readiness and infant outcomes: connecting the dots.

Neonatal intensive care unit (NICU) discharge readiness is defined as the masterful attainment of technical skills and knowledge, emotional comfort, and confidence with infant care by the primary caregivers at the time of discharge. NICU discharge preparation is the process of facilitating comfort and confidence as well as the acquisition of knowledge and skills to successfully make the transition from the NICU to home. In this paper, we first review the literature about discharge readiness as it relates to the NICU population. Understanding that discharge readiness is achieved, in part, through successful discharge preparation, we then outline an approach to NICU discharge preparation.

Are families prepared for discharge from the NICU?

OBJECTIVE: (1) Quantify and compare the family's and the nurse's perception regarding the family's discharge preparedness. (2) Determine which elements contribute to a family's discharge preparedness. STUDY DESIGN: We studied the families of all the infants discharged from a neonatal intensive care unit after a minimum of a 2-week admission. The families rated their overall discharge preparedness with a 9-point Likert scale on the day of discharge. Independently, the discharging nurse evaluated the family's discharge preparedness. Families were considered discharge 'prepared' if they rated themselves and the nurse rated their technical and emotional preparedness as >or=7 on the Likert scale. RESULT: We had 867 (58%) family-nurse pairs who completed the survey. Most families (87%) were prepared for discharge as assessed by the concordant questionnaire (Likert scores of >or=7 by the parent and the nurse). In multivariate analysis, confidence in their child's health and maturity (odds ratios, OR=2.5 95% confidence interval, CI (1.2, 5.3)), their readiness for their infants to come home (OR=2.9 95% CI (1.0, 8.3)), and selecting a pediatrician (OR=4.2 95% CI (1.6, 11.0)) were statistically significant. CONCLUSION: Assistance with pediatrician selection and home preparation may improve the percentage of families prepared for discharge.

Computerized color-vision test based upon postreceptoral channel sensitivities.

An automated, computerized color-vision test was designed to diagnose congenital red-green color-vision defects. The observer viewed a yellow appearing CRT screen. The principle was to measure increment thresholds for three different chromaticities, the background yellow, a red, and a green chromaticity. Spatial and temporal parameters were chosen to favor parvocellular pathway mediation of thresholds. Thresholds for the three test stimuli were estimated by four-alternative forced-choice (4AFC), randomly interleaved staircases. Four 1.5-deg, 4.2 cd/m2 square pedestals were arranged as a 2 x 2 matrix around the center of the display with 15-minute separations. A trial incremented all four squares by 1.0 cd/m2 for 133 ms. One randomly chosen square included an extra increment of a test chromaticity. The observer identified the different appearing square using the cursor. Administration time was approximately 5 minutes. Normal trichromats showed clear Sloan notch as defined by log (deltaY/deltaR), whereas red-green color defectives generally showed little or no Sloan notch, indicating that their thresholds were mediated by their luminance system, not by the chromatic system. Data from 107 normal trichromats showed a mean Sloan notch of 0.654 (SD = 0.123). Among 16 color-vision defectives tested (2 protanopes, 1 protanomal, 6 deuteranopes, & 7 deuteranomals), the Sloan notch was between -0.062 and 0.353 for deutans and was < -0.10 for protans. A sufficient number of color-defective observers have not yet been tested to determine whether the test can reliably discriminate between protans and deutans. Nevertheless, the current data show that the test can work as a quick diagnostic procedure (functional trichromatism or dichromatism) of red-green color-vision defect.

The effects of air flow and stem flexure on the mechanical and hydraulic properties of the stems of sunflowers Helianthus annuus L.

Many studies have shown that wind affects plant development, causing them to develop shorter and usually stronger stems. Many of these effects have been shown to be due to a response to mechanical flexing of the stem which is known as thigmomorphogenesis. However, it is not known how wind affects the hydraulic properties of stems, nor have the effects of air flow past leaves been examined in isolation from mechanical flexing. This study, therefore, used a factorial experiment to distinguish between the effects of stem flexing and air flow, and examined the morphology, hydraulics and mechanics of developing sunflowers Helianthus annuus. It was found that flexure and air flow had opposite effects on several aspects of development; air flow increased plant height and length-specific stem hydraulic conductivity, k(h), and reduced stem rigidity and strength, while flexing did the reverse. There was also a clear trade-off between hydraulic and mechanical capability: as one increased the other decreased. A plant's response to wind must, therefore, be a complex response to at least two different stimuli and this might help explain why it varies with species and environment.

Pulse and steady-pedestal contrast discrimination: effect of spatial parameters.

The goal of this study was to establish the spatial summation properties associated with inferred PC- and MC-pathway mediated psychophysical contrast discrimination. Previous work has established two paradigms that reveal characteristic signatures of these pathways. In the pulse paradigm, a four-square array was pulsed briefly, on a constant background. In the steady-pedestal paradigm, the stimulus array was presented continuously as a steady-pedestal within a constant surround. In both paradigms, one square differed from the others, giving the observer a forced choice spatial discrimination task. Area summation functions derived for the pulse paradigm decreased with area, with a slope of -0.25 on a log-log axis. Area summation functions derived for the steady-pedestal paradigm decreased as a power function of area, approaching an asymptote above one square degree. The latter are consistent with the classical data of threshold spatial summation.

The role of spatial frequency in color induction.

Color induction was measured for test and inducing chromaticities presented in spatial square-wave alternation, with spatial frequencies of 0.7, 4.0, 6.0 and 9.0 cpd. Observers matched the test chromaticities to a rectangular matching field using haploscopic presentation. Data were collected and analyzed within the framework of a cone chromaticity space, allowing analysis of spatial frequency effects on post-receptoral spectral opponent pathways. Assimilation, a shift of chromaticity toward the inducing chromaticity, was found at the highest spatial frequency (9.0 cpd). Contrast, a shift of chromaticity away from the inducing chromaticity, occurred at the lowest spatial frequency (0.7 cpd). The spatial frequency at the transition point from assimilation to contrast was near 4 cpd, independent of the cone axis. Assimilation was unaffected by the presence of a neutral surround and could be described by a spread light model. Contrast was reduced in the presence of a neutral surround. The data suggested that retinal contrast signals are important determinants in the perception of chromatic contrast.

The consequences of opponent rectification: the effect of surround size and luminance on color appearance.

Smith and Pokorny (Vision Res. 36 (1996) 3087.) described conditions under which chromatic contrast induction can reveal a hiatus, a region of chromaticity space which appears neither reddish nor greenish when presented in a chromatic equiluminant surround. The current study investigated the effect of varying the size and the luminance of the inducing surround. The color appearance of test stimuli in chromatic surrounds was assessed by asymmetric color matching to a comparison display. Equiluminant (12 cd/m(2)), 1 degrees square stimuli were generated on a CRT display and presented haploscopically. Ten test fields varied in their L-cone excitation along a constant S-cone line. The chromatic surrounds were of either high (red) or low (green) L-cone excitation on a constant S-cone line. In Experiment 1, surrounds were 1.1 degrees, 1.5 degrees, 2.0 degrees, or 3.0 degrees square (surround widths of 3', 15', 30', 1 degrees ). In Experiment 2, the test and comparison surrounds were at higher (16.7 cd/m(2)) or lower (8.3 cd/m(2)) retinal illuminance than the test field. Contrast induction reached an asymptote for surround widths of 30' or larger. The amount of induction decreased for the surround widths of 15' and 3'. The hiatus was present for the larger surrounds and decreased as surround size decreased. The use of a higher or lower surround luminance did not affect the magnitude of induction or the size of the hiatus.

Contrast discrimination deficits in retinitis pigmentosa are greater for stimuli that favor the magnocellular pathway.

Luminance contrast discrimination was measured in 14 patients with retinitis pigmentosa (RP) and 14 control observers with normal vision, using steady-pedestal and pulsed-pedestal paradigms [Pokorny, J., & Smith, V. C. (1997). Psychophysical signatures associated with magnocellular and parvocellular pathway contrast gain. Journal of the Optical Society of America A, 14, 2477-2486] to bias performance toward the magnocellular (MC) or parvocellular (PC) pathway, respectively. The aim was to determine the relative effects of retinal degeneration on MC- and PC-pathway function in RP. For five of the RP patients, contrast discrimination thresholds were within normal limits for both the steady-pedestal and pulsed-pedestal paradigms. The other nine RP patients showed threshold elevations for the steady-pedestal paradigm (presumed magnocellular mediation), whereas their thresholds for the pulsed-pedestal paradigm (presumed parvocellular mediation) were within normal limits for all but the two patients who had the most extreme threshold elevations using the steady-pedestal paradigm. A control experiment on four of the RP patients, using a greater number of pedestal contrasts, verified that the patients' thresholds for the pulsed-pedestal paradigm showed the pattern expected for contrast discrimination mediated by the PC pathway. The higher threshold elevations for the steady-pedestal paradigm than for the pulsed-pedestal paradigm indicate that the retinal degeneration that occurs in RP predominantly disrupts contrast discrimination under stimulus conditions that favor the MC pathway.

Primate horizontal cell dynamics: an analysis of sensitivity regulation in the outer retina.

The human cone visual system maintains sensitivity over a broad range of illumination, from below 1 troland to 1,000,000 trolands. While the cone photoreceptors themselves are an important locus for sensitivity regulation-or light adaptation-the degree to which they contribute in primates remains unclear. To determine the range of sensitivity regulation in the outer retina, the temporal dynamics, neural gain control, and response range compression were measured in second-order neurons, the H1 horizontal cells, of the macaque retina. Situated at the first synapse in the retina, H1 cells receive input from a large population of cones. Lee et al. have previously shown that sensitivity regulation in H1 cells is both cone type-specific and spatially restricted. The sensitivity regulation seen in H1 cells at moderate illuminances thus takes place before the summation of cone signals in these cells, and the data establish the H1 cell as a convenient locus for analyzing cone signals. In the present study, cone-driven responses of primate H1 cells to temporally modulated sine-wave stimuli and to increment pulses were measured at steady levels of 1-1,000 trolands. The H1 cell gave a modulated response to sine-wave stimuli and hyperpolarized to increment pulses with overshoots at stimulus onset and offset. The temporal amplitude sensitivity function was primarily low-pass in shape, with a small degree of low-frequency roll off and a resonance shoulder near 40 Hz. A model incorporating a cascade of first-order filters together with an underdamped second-order filter could describe both temporal sinusoidal and pulse hyperpolarizations. Amplitude sensitivity was estimated from both pulse and sine-wave data as a function of the steady adaptation level. Sensitivity at low light levels (1 troland) showed a slowing in temporal dynamics, indicating time-dependent sensitivity regulation. Sensitivity was reduced at light levels above approximately 10 trolands, reflecting both response range compression and neural gain control. Thus the outer retina is a major locus for sensitivity regulation in primates.

Brightness induction from rods.

Rod modulation of an annular surround can produce brightness contrast in a test field centered at 100 from the fovea. In our research, stimuli originated from a colorimeter that provided 4 primaries in both the circular test and the annular surround fields, and allowed independent modulation of the rods and each of the short (S)-, middle (M)-, and long (L)-wavelength-sensitive cone types. The chromaticity was set so fields had the same appearance as the equal energy spectrum. At 1 photopic troland (td), rod-induced modulation in the test field could be cancelled by either a rod- or a cone-nulling modulation added to the test field. The best cone nulling of rod induction showed residual flicker. Nulling was more effective, though still imperfect, with a cone-nulling stimulus of higher S-cone modulation contrast. Rod induction with square-wave, on-pulse, and off-pulse temporal profiles was closely similar. At higher light levels, 10 and 100 td, rod contrast could not be nulled by rod or cone modulation. The failure to achieve nulls may have been caused by either or both of the following hypotheses: (1) there is a mismatch between the rod and cone temporal waveforms; (2) there is strong rod input to the magnocellular pathway, but negligible rod input to the parvocellular pathway, as shown by single-unit electrophysiological data.

Rod-cone interactions assessed in inferred magnocellular and parvocellular postreceptoral pathways.

Interactions between receptor-isolating rod and long (L)- or middle (M)-wavelength-sensitive cone modulations at 2 Hz and 10 Hz were analyzed in terms of underlying inferred magnocellular (MC) and parvocellular (PC) postreceptoral pathways. Stimuli originated from a colorimeter with 4 primaries in both the center and surround fields. The first experiment employed a phase paradigm in which the thresholds for mixed rod and cone modulations were measured as a function of relative phase. The amplitudes of the rod and cone modulations, equated in threshold units, were varied in tandem. In the second experiment, thresholds for mixed rod and cone modulations were measured as a function of the ratio of the rod and cone modulation amplitudes for 2 fixed phase offsets. Both experiments yielded similar interpretations of rod and L- (or M-) cone interactions. At 1 and 10 troland (td), rod and L- (or M-) cone interactions varied depending on the postreceptoral pathways underlying the detection. When cone thresholds were mediated by the inferred MC pathway, rod and cone thresholds showed almost linear summation. When cone thresholds were mediated by the inferred PC pathway, rod and cone thresholds showed probability summation. Assuming that signals within the same pathway follow linear summation, and signals traveling in different pathways follow probability summation, we concluded that the rod thresholds were mediated by the inferred MC pathway for both the 2-Hz and 10-Hz conditions.

The innervation of the human antro-pyloric region: organization and composition.

Although the composition of the gastric innervation has been determined in animal models, relatively little known about the innervation of the human antro-pyloric region. We used immunocytochemical techniques to establish the localization and co-expression of neuropeptides and nitric oxide in the human antrum and upper duodenum. Our results demonstrate the existence of a clearly defined submucosal plexus in the antral region that is absent in rats and guinea pigs. The abundant innervation of the lamina propria contains 3 major nerve populations: VIP- and NOS-, SP- and CGRP-, and GRP-immunoreactive. For the first time, NOS-containing nerve fibers were observed throughout the length of the antral glands. Within the antrum somatostatin was confined to endocrine cells, however, at the pyloric sphincter both enteric plexi contained immunoreactive neurons and nerve fibres. Within the pyloric sphincter CGRP- and SP-immunoreactive fibres were significantly increased, correlating with the presence of large ganglia in the submucosal plexus. In conclusion, the organization and composition of the innervation of human antro-pylorus differed substantially from that reported in other mammals. The presence of an abundant mucosal innervation paralled by a well-defined submucosal plexus indicates that the functional regulation of the gastric-pyloric region will be distinct from that of smaller animal models.

Unilocular retroperitoneal cyst of mesothelial origin presenting as a renal mass.

We report the first 2 cases, to our knowledge, of retroperitoneal cysts with features of mesothelial differentiation that clinically mimic renal masses. The first lesion occurred in a 71-year-old man who presented with flank pain. Ultrasound and magnetic resonance imaging studies showed a unilocular cystic structure arising from the upper pole of the left kidney. The second lesion was in a 44-year-old woman who presented with left flank pain. Imaging studies revealed an 8-cm hemorrhagic cyst at the lower pole of the left kidney. Histologic examination of the nephrectomy specimens in each case revealed a unilocular cyst with intracystic and pericystic hemorrhage. In each case, the cyst was lined by a single layer of cells with ample eosinophilic cytoplasm and benign nuclear features without mucinous or müllerian differentiation. Histochemical staining showed Alcian blue positivity on the cell surface, which was sensitive to hyaluronidase digestion. Intracytoplasmic mucin, however, was not detected. Immunostaining showed that the cyst lining cells were positive for keratin, vimentin, HBME-1, WT1, and thrombomodulin but negative for carcinoembryonic antigen, B72.3, Leu-M1, and BerEP4. The first case was positive for calretinin, whereas the second was negative. These findings support the mesothelial nature of the cysts.