Beyond money: Risk preferences across both economic and non-economic contexts predict financial decisions.

Important decisions about risk occur in wide-ranging contexts, from investing to healthcare. While an underlying, domain-general risk attitude has been identified across contexts, it remains unclear what role it plays in shaping behavior relative to more domain-specific risk attitudes. Clarifying the relationship between domain-general and domain-specific risk attitudes would inform decision-making theories and the construction of decision aids. The present research assessed the relative contribution of domain-general and domain-specific risk attitudes to financial risk taking. We examined risk attitudes across different decision domains, as revealed through a well-validated measure, the Domain-Specific Risk-Taking Scale (DOSPERT). Confirmatory factor analysis indicated that a domain-general risk attitude shaped responses across multiple domains, and structural equation modeling showed that this domain-general risk attitude predicted observed behavioral risk premiums in a financial decision-making task better than domain-specific financial risk attitudes. Thus, assessments of risk attitudes that include both economic and non-economic domains improve predictions of financial risk taking due to the enhanced insight they provide into underlying, domain-general risk preferences.

Neural Mechanisms of Reward Prediction Error in Autism Spectrum Disorder.

Few studies have explored neural mechanisms of reward learning in ASD despite evidence of behavioral impairments of predictive abilities in ASD. To investigate the neural correlates of reward prediction errors in ASD, 16 adults with ASD and 14 typically developing controls performed a prediction error task during fMRI scanning. Results revealed greater activation in the ASD group in the left paracingulate gyrus during signed prediction errors and the left insula and right frontal pole during thresholded unsigned prediction errors. Findings support atypical neural processing of reward prediction errors in ASD in frontostriatal regions critical for prediction coding and reward learning. Results provide a neural basis for impairments in reward learning that may contribute to traits common in ASD (e.g., intolerance of unpredictability).

Placenta praevia, placental abruption and amphetamine use in pregnancy: a case study.

UNLABELLED: Pregnant women who misuse alcohol or substances often develop obstetric conditions that further complicate their pregnancy. This case study reflects on the maternity care provided for a woman who continued to use amphetamines during her pregnancy; and who was diagnosed with placenta praevia and subsequently suffered a placental abruption. Alcohol and substance misuse in pregnancy is currently escalating, increasing the risk in maternal and neonatal morbidity and mortality. Midwives must be confident in the advice and care they provide in order to reduce the risks caused by substance misuse, and be able to support this with evidence-based care. PURPOSE: The purpose of this case study is to discuss the obstetric condition involved with placenta praevia with the occurrence of a placental abruption in a woman who uses amphetamines during pregnancy; and the midwifery and obstetric care involved. INTEREST/RELEVANCE/CONGRUENCY: It will highlight the importance of evidence-based care in high risk obstetrics. CONTENT: (1) Case summary; (2) discussion; (3) risk factors; screening, diagnosis and management; foetal and neonatal monitoring; postnatal management, and trauma informed care. CONCLUSION: It was shown with planning, understanding, communication, and vigilance, the care of an amphetamine using pregnant woman with a diagnosis of placenta praevia and abruption can be successfully accomplished. The management of the woman discussed in this case study was within the recommendations currently available in the literature.

Low- and high-testosterone individuals exhibit decreased aversion to economic risk.

Testosterone is positively associated with risk-taking behavior in social domains (e.g., crime, physical aggression). However, the scant research linking testosterone to economic risk preferences presents inconsistent findings. We examined the relationship between endogenous testosterone and individuals' economic preferences (i.e., risk preference, ambiguity preference, and loss aversion) in a large sample (N = 298) of men and women. We found that endogenous testosterone levels have a significant U-shaped association with individuals' risk and ambiguity preferences, but not loss aversion. Specifically, individuals with low or high levels of testosterone (more than 1.5 SD from the mean for their gender) were risk and ambiguity neutral, whereas individuals with intermediate levels of testosterone were risk and ambiguity averse. This relationship was highly similar in men and women. In contrast to received wisdom regarding testosterone and risk, the present data provide the first robust evidence for a nonlinear association between economic preferences and levels of endogenous testosterone.

Evaluation of nucleic acid amplification methods for the detection of hog cholera virus.

A blind panel was tested in a diagnostic evaluation of a reverse transcription (RT) polymerase chain reaction (PCR) method for detecting hog cholera virus (HCV) from pig tissues. The capability of the RT-PCR test to discriminate between HCV and related pestiviruses, bovine viral diarrhea virus (BVDV), and those viruses causing similar diseases in swine, including African swine fever virus (ASFV) and pseudorabies virus (PRV), was also considered. Nucleic acid extraction involved either kit-based or conventional phenol:chloroform:isoamyl alcohol methods. A single-round PCR assay, using primers that hybridize to the conserved p120 nonstructural gene region, was 82.5% sensitive (n = 17) and 100% specific (n = 18) in the detection of the presence of HCV RNA. However, the sensitivity was increased to 100% following a second PCR test. In all, 4 HCV, 7 BVDV, 2 ASFV, and 1 PRV isolates were studied. Novel nucleic acid sequences were generated for 9 HCV strains. Analysis of a portion of the p120 region using these methods was suitable for HCV isolate characterization.

Medicolegal issues in pediatric neurosurgical practice.

The medical profession has an increasing interface with the profession of law and in no specialty is this more apparent than in pediatric neurosurgery. The areas of interface include the neurosurgeon as a defendant, as an expert witness, and as an ethicist. The role of a neurosurgical defendant may be eased if he/she is aware of the legal principles involved in malpractice litigation. This article discusses the doctrine of 'standard of care' as it applies presently in malpractice cases. The accepted defenses to a claim of breach of standard of care are outlined. The history of the principle of 'informed consent' is discussed briefly, as well as its present application. The position of the mature minor and emancipated minor in the process of informed consent is described. Finally, a few recommendations for avoidance of malpractice are suggested.

Reversal sign on CT: effect of anoxic/ischemic cerebral injury in children.

A retrospective study was performed to determine the clinical and pathologic features, etiology, and outcome of children with the reversal sign. The reversal sign, a striking CT finding, probably represents a diffuse, anoxic/ischemic cerebral injury. CT features of the reversal sign are diffusely decreased density of cerebral cortical gray and white matter with a decreased or lost gray/white matter interface, or reversal of the gray/white matter densities and relatively increased density of the thalami, brainstem, and cerebellum. Twenty children with the reversal sign were retrospectively analyzed. We divided the patients into three groups: (1) acute reversal, (2) intermediate group, and (3) chronic reversal. There were nine cases of trauma (seven of child abuse); nine hypoxia/anoxia incidents (birth asphyxia, drowning, status epilepticus); one bacterial meningitis; and one degenerative encephalitis. All acute- and intermediate-group patients had respiratory problems requiring ventilator support and intensive care. In five of seven patients who died, autopsy findings were consistent with anoxic/ischemic encephalopathy. Surviving patients have profound neurologic deficits with severe developmental delay. The CT reversal sign carries a poor prognosis and indicates irreversible brain damage.

Reversal sign on CT: effect of anoxic/ischemic cerebral injury in children.

A retrospective study was performed to determine the clinical and pathologic features, etiology, and outcome of children with the reversal sign. The reversal sign, a striking CT finding, probably represents a diffuse, anoxic/ischemic cerebral injury. CT features of the reversal sign are diffusely decreased density of cerebral cortical gray and white matter with a decreased or lost gray/white matter interface, or reversal of the gray/white matter densities and relatively increased density of the thalami, brainstem, and cerebellum. Twenty children with the reversal sign were retrospectively analyzed. We divided the patients into three groups: (1) acute reversal, (2) intermediate group, and (3) chronic reversal. There were nine cases of trauma (seven of child abuse); nine hypoxia/anoxia incidents (birth asphyxia, drowning, status epilepticus); one bacterial meningitis; and one degenerative encephalitis. All acute- and intermediate-group patients had respiratory problems requiring ventilator support and intensive care. In five of seven patients who died, autopsy findings were consistent with anoxic/ischemic encephalopathy. Surviving patients have profound neurologic deficits with severe developmental delay. The CT reversal sign carries a poor prognosis and indicates irreversible brain damage.

Radiographic characteristics of skull fractures resulting from child abuse.

Radiographic characteristics of skull fractures in 39 cases of documented child abuse were compared with skull fractures in 95 cases of accidental injury to determine if differential features could be identified. All children were less than 2 years old. Emergency room and hospital records for these patients were also reviewed. The results of this study show that clinical features did not provide any clues as to whether the children had been injured by abuse or by accident. However, it was found that multiple fractures, bilateral fractures, and fractures crossing sutures occurred significantly more often in abuse cases than in accidental injury. When such fractures are present, abuse should be suspected.

Treatment of infections of cerebrospinal fluid shunts.

There is no unanimity at present concerning the best method of treatment of cerebrospinal fluid shunt-related infections. The most frequently used method includes removal of the shunt followed by antibiotic therapy and later replacement of the shunt. The experience at the University of Cincinnati during the past 15 years indicates that many shunt infections can be effectively treated without shunt removal. This report summarizes experiences with 11 consecutive ventriculoperitoneal shunt infections. These were treated by externalization of the peritoneal catheter followed by intraventricular and systemic antimicrobial therapy and by later replacement of the peritoneal catheter. The advantages of this method include the avoidance of two major operative procedures and the elimination of a period in which the intracranial pressure is not controlled. The need for externalization of the peritoneal catheter relates to the occurrence of localized peritoneal infection and pseudocyst formation, which prevents cure of the infection in many instances if the catheter is left in place. After follow-up periods of four months to five years, 10 of the 11 patients have apparently been cured of their infection.

Slit-ventricle syndrome: review of 15 cases.

The slit-ventricle syndrome (SVS) has been the subject of diverse opinions and recommendations during the past 2 decades. In an effort to define the clinical features of SVS and to make recommendations concerning management we have reviewed 15 cases treated by a fairly uniform technique during the past 5 years. The syndrome consists of: (1) intermittent, but self-limiting episodes resembling shunt malfunction, usually lasting a few days, (2) nonfilling of the pumping device after compression, and (3) a slit-like ventricular system on CT scan. In all but 2 patients the initial shunt was performed in infancy. The mean interval from the initial shunt to treatment of SVS was 6 years. The age range at onset of SVS varied from 2 to 17 years with a mean of 7 years. All patients in this series were relieved of symptoms by placement of an antisiphon device and, in most patients, upgrading the valve resistance. Analysis of this series has led to the following conclusions: (1) SVS is a characteristic clinical entity, usually distinguishable from persistent shunt malfunction and from low-pressure headache, (2) the pathogenesis is intermittent obstruction of the ventricular catheter, (3) there is no good evidence that changes of brain compliance or La Place principles apply, and (4) placement of antisiphon device and upgrading valve resistance are effective treatments.

Management of spina bifida and associated anomalies.

Myelomeningocele and its accompanying deformities are among the most complex and frequent of the malformations to which the developing nervous system is subject. a multidisciplinary approach to management of the patient with myelomeningocele is essential, and with aggressive and continuous care, the results may be extremely gratifying.

Acute responses to experimental blunt head trauma: topography of white matter edema.

The location of edema and territory of extravasation of serum protein were examined in the white matter of cats with different forms of intracranial pathology following an impact-acceleration injury to the head. Edema was tested with an organic density gradient and Evans blue dye was used as a marker for breakdown of the blood-brain barrier. Animals with tissue hemorrhage (contusions) involving both cerebral cortex and white matter had a substantial, progressive accumulation of Evans blue-stained edema near tissue hemorrhage during the 6 h following trauma. In addition, this category of cats had a widespread, mild edema at 15 min after injury that was usually unaccompanied by Evans blue stain. Cats with cortical contusions had rather mild edema neighboring tissue hemorrhage; animals with subarachnoid hemorrhage in the absence of cerebral contusions had neither measurable edema nor (usually) visible Evans blue staining. We conclude that: acute traumatic cerebral edema varies considerably in presence, magnitude and territory with different forms of intracranial pathology; and mechanically induced edema can occur that is independent of spread of fluid from areas of tissue hemorrhage.

Cerebrospinal fluid pseudocysts: sonographic appearance and clinical management.

Eight patients with 10 intraperitoneal cerebrospinal fluid pseudocysts occurring as a complication of ventriculoperitoneal (VP) shunt procedure were reviewed to determine the sonographic characteristics as well as the etiologic basis for the pseudocysts. An additional 10 patients with VP shunts, being routinely evaluated for genitourinary tract abnormality, were reviewed to determine the sonographic characteristics and the amount of fluid present in the abdomen with a normally functioning VP shunt in place. We found that a small amount or no peritoneal fluid is found in the patient with a normally functioning VP shunt. Larger, localized, simple or loculated fluid collections are abnormal and compatible with pseudocyst formation. Debris was identified in the majority of the fluid collections. We believe that ultrasonography is the method of choice in evaluation of complications of the distal end of the VP shunt. Our series suggests that infection is the principle cause for pseudocyst development despite the frequent absence of systemic signs of infection. Appropriate treatment involves removal of the peritoneal catheter and treatment of the infection. The catheter may later be replaced intraperitoneally.

Benign extra-axial collections of infancy.

The clinical histories, physical examinations and results of head computed tomography and head ultrasound scans were reviewed in a group of 15 infants who had macrocrania, excessive extra-axial fluid and normal development. Diagnostic evaluations demonstrated mild ventriculomegaly and extra-axial fluid collections. No treatment was undertaken. All infants continued to exhibit normal development during a period of extended follow-up. In this select group of infants exhibiting these findings, treatment appears to be unnecessary and the prognosis for continued normal development is excellent.

Nonsurgical cure of brain abscess in a neonate.

A 7-day-old girl was found to have meningitis due to Staphylococcus aureus and a left parietal brain abscess. Six weeks treatment with intravenous methicillin resulted in resolution of her right hemiparesis and brain abscess. This is one of the youngest patients successfully treated by medical therapy alone. The case suggests that in carefully selected, closely monitored infants, medical therapy alone can be successful.

Tuberous sclerosis: diagnostic and surgical considerations.

Twenty-six patients with tuberous sclerosis have been reviewed from the standpoints of CT diagnosis and surgical indications. It was concluded that a diagnosis can be made on the basis of subependymal calcification but not on the basis of cortical calcifications or low density lesions alone. Enhancing lesions, especially at the foramen of Munro, must be considered to be tumors and should be excised if there are symptoms of obstruction. The transcallosal approach is preferred. Asymptomatic enhancing lesions may be followed by periodic scans; if no enhancing lesions are present routine follow-up scans do not appear to be useful.