Diagnostic Performance of Ultrafast Brain MRI for Evaluation of Abusive Head Trauma.

BACKGROUND AND PURPOSE: MR imaging with sedation is commonly used to detect intracranial traumatic pathology in the pediatric population. Our purpose was to compare nonsedated ultrafast MR imaging, noncontrast head CT, and standard MR imaging for the detection of intracranial trauma in patients with potential abusive head trauma. MATERIALS AND METHODS: A prospective study was performed in 24 pediatric patients who were evaluated for potential abusive head trauma. All patients received noncontrast head CT, ultrafast brain MR imaging without sedation, and standard MR imaging with general anesthesia or an immobilizer, sequentially. Two pediatric neuroradiologists independently reviewed each technique blinded to other modalities for intracranial trauma. We performed interreader agreement and consensus interpretation for standard MR imaging as the criterion standard. Diagnostic accuracy was calculated for ultrafast MR imaging, noncontrast head CT, and combined ultrafast MR imaging and noncontrast head CT. RESULTS: Interreader agreement was moderate for ultrafast MR imaging (κ = 0.42), substantial for noncontrast head CT (κ = 0.63), and nearly perfect for standard MR imaging (κ = 0.86). Forty-two percent of patients had discrepancies between ultrafast MR imaging and standard MR imaging, which included detection of subarachnoid hemorrhage and subdural hemorrhage. Sensitivity, specificity, and positive and negative predictive values were obtained for any traumatic pathology for each examination: ultrafast MR imaging (50%, 100%, 100%, 31%), noncontrast head CT (25%, 100%, 100%, 21%), and a combination of ultrafast MR imaging and noncontrast head CT (60%, 100%, 100%, 33%). Ultrafast MR imaging was more sensitive than noncontrast head CT for the detection of intraparenchymal hemorrhage (P = .03), and the combination of ultrafast MR imaging and noncontrast head CT was more sensitive than noncontrast head CT alone for intracranial trauma (P = .02). CONCLUSIONS: In abusive head trauma, ultrafast MR imaging, even combined with noncontrast head CT, demonstrated low sensitivity compared with standard MR imaging for intracranial traumatic pathology, which may limit its utility in this patient population.

Utility of a precursor-to-product ratio in the evaluation of presumptive positives in newborn screening of congenital adrenal hyperplasia.

OBJECTIVE: Screening for congenital adrenal hyperplasia (CAH) caused by 21-α-hydroxylase deficiency is challenging because factors such as prematurity and stress increase intermediate steroid metabolite levels in newborn infants. The objective of this study was to explore the use of the 17-α-hydroxyprogesterone (17-OHP)/11-deoxycortisol ratio as an adjunct measure in the follow-up evaluation of infants with presumptive positive newborn screens for CAH to distinguish between infants with no disorder and those with CAH. STUDY DESIGN: This was a retrospective cohort study of infants with presumptive positive newborn screens for CAH. The precursor-to-product ratio of 17-OHP/11-deoxycortisol was compared between infants with no disorder (n=47) and infants with CAH (n=5). RESULTS: The CAH infants had higher 17-OHP/11-deoxycortisol ratios than infants with no disorder: 26 (18 to 58) and 1.05 (0.69 to 1.46), respectively (P<0.05). Among infants with no disorder, higher levels of serum 17-OHP did not reflect higher ratios, indicating sufficient enzyme activity. CONCLUSION: The results suggest that a low 17-OHP/11-deoxycortisol ratio represents 21-α-hydroxylase sufficiency among presumptive positives in newborn screening of CAH.

High oleic/stearic fatty-acid desaturation index in cord plasma from infants of mothers with gestational diabetes.

OBJECTIVE: Enhanced fatty-acid desaturation by stearoyl-CoA desaturase enzyme-1 (SCD1) is associated with obesity. This study determined desaturation in the cord plasma of newborns of mothers with and without gestational diabetes (GDM). STUDY DESIGN: Newborns of mothers with GDM (n=21) and without (control, n=22) were recruited. Cord plasma fatty-acid desaturation indices (palmitoleic/palmitic, oleic/stearic ratios) were compared, and correlated with anthropometrics and biochemical measures. A subset of very low-density lipoprotein (VLDL) desaturation indices were determined to approximate the liver SCD1 activity. RESULT: The total oleic/stearic index was higher in GDM, despite adjustment for cord glucose concentrations. Among GDM and controls, the oleic/stearic index correlated with cord glucose concentrations (rs=0.36, P=0.02). Both palmitoleic/palmitic and oleic/stearic indices correlated with waist circumference (r=0.47, P=0.001; r=0.37, P=0.01). The VLDL oleic/stearic index was higher in GDM. CONCLUSION: The elevated total oleic/stearic index suggests increased lipogenesis in GDM newborns. Factors in addition to glucose supply may influence fetal SCD1 activity.

Bio-monitoring for uranium using stream-side terrestrial plants and macrophytes.

This study evaluated the abilities of various plant species to act as bio-monitors for environmental uranium (U) contamination. Vegetation and soil samples were collected from a U processing facility. The water-way fed from facility storm and processing effluents was the focal sample site as it represented a primary U transport mechanism. Soils and sediments from areas exposed to contamination possessed U concentrations that averaged 630 mg U kg(-1). Aquatic mosses proved to be exceptional accumulators of U with dry weight (dw) concentrations measuring as high as 12,500 mg U kg(-1) (approximately 1% of the dw mass was attributable to U). The macrophytes (Phragmites communis, Scripus fontinalis and Sagittaria latifolia) were also effective accumulators of U. In general, plant roots possessed higher concentrations of U than associated upper portions of plants. For terrestrial plants, the roots of Impatiens capensis had the highest observed levels of U accumulation (1030 mg kg(-1)), followed by the roots of Cyperus esculentus and Solidago speciosa. The concentration ratio (CR) characterized dry weight (dw) vegetative U levels relative to that in associated dw soil. The plant species that accumulated U at levels in excess of that found in the soil were: P. communis root (CR, 17.4), I. capensis root (CR, 3.1) and S. fontinalis whole plant (CR, 1.4). Seven of the highest ten CR values were found in the roots. Correlations with concentrations of other metals with U were performed, which revealed that U concentrations in the plant were strongly correlated with nickel (Ni) concentrations (correlation: 0.992; r-squared: 0.984). Uranium in plant tissue was also strongly correlated with strontium (Sr) (correlation: 0.948; r-squared: 0.899). Strontium is chemically and physically similar to calcium (Ca) and magnesium (Mg), which were also positively-correlated with U. The correlation with U and these plant nutrient minerals, including iron (Fe), suggests that active uptake mechanisms may influence plant U accumulation.

Self-reported sleep durations of college students: normative data for 1978-79, 1988-89, and 2000-01.

In 2000-2001 academic year the frequency distribution of hours slept per night was not significantly different from distributions of 1978-79 and 1988-89.

"You are hereby commanded to appear": pediatrician subpoena and court appearance in child maltreatment.

OBJECTIVE: To determine the frequency of court appearance by pediatricians evaluating child abuse and neglect cases and to identify case characteristics associated with actual court appearance or case adjournment. DESIGN: Retrospective review of subpoenas received between 1995 and 1999 for child maltreatment cases personally evaluated by 2 pediatricians during the years 1995 to 1998. Information was collected regarding patient age, gender, race/ethnicity, type of suspected maltreatment, date of evaluation, date of subpoena, type of court hearing, whether the pediatrician actually testified in court, and legal outcomes. Case characteristics were compared between pediatricians and were used to predict physician appearance and case continuance or adjournment in logistic regression models. RESULTS: Four hundred forty-five subpoenas concerning 260 patients were received. Although significant differences were noted between the pediatricians in type of abuse, no differences were found in patient age, gender, ethnicity or legal outcomes. The pediatricians received subpoenas in <15% of child maltreatment cases, and <5% of children seen resulted in the physician being required to actually appear in court. No case characteristics significantly predicted court appearance or case continuance or adjournment. CONCLUSIONS: Although pediatricians are sometimes subpoenaed to appear in court to explain the medical evaluation and the needs of the child in cases of child abuse and neglect, most court cases were continued, adjourned, or settled before physician testimony. Most subpoenas did not result in the pediatrician going to court, and it is unclear which child factors may predict court involvement. Pediatricians can take steps to minimize (but not eliminate) the potential dissatisfaction and inconvenience associated with receiving and responding to subpoenas in child maltreatment cases.

The changing sleep habits of university students: an update.

Using data collected from 9,543 university undergraduates, we noted that over three decades, the median hours of sleep reported by these students has decreased by more than one hour.

Striking changes in the sleep satisfaction of university students over the last two decades.

Over two decades, our data document a substantial linear increase in the percentage of university students who self-reported dissatisfaction with their sleep, i.e., 24% in 1978, 53% in 1988, and 71% in 2000.

Stamina in adults: is attachment style a factor?

The study was designed to extend inquiry on adult attachment style to include the variable of personal stamina. The data were derived from an anonymous survey administered to 163 college students (82 women and 81 men) in introductory psychology classes. Attachment style was measured by the Close Relationship Questionnaire, based on a four-category scheme suggested by Bartholomew. Stamina was evaluated with a self-report scale developed by R. A. Hicks. The pattern of statistically significant differences (p < .001) in the relative frequency with which respondents self-identified with descriptions of each of the four attachment styles on the questionnaire diverged somewhat from those reported previously. Respondents who identified themselves as most accurately described by the questionnaire's alternative defined as characterizing secure attachment had significantly higher stamina scores than did those who self-endorsed the fearful or preoccupied alternatives in that categorical measure. No other pairwise comparisons of stamina scores were statistically significant. The results provide preliminary support for the hypothesis that secure attachment is more facilitative of personal stamina than are insecure styles. Methodological limits on inferences and corresponding alternative interpretations, the potential effectiveness of defensive suppression of the attachment system in dismissing-avoidant adults, and directions for research are discussed.

Consistency of hand use and frequency of colds among college students.

The self reported annual frequencies of colds were assessed for two groups of 37 students each who were either consistent or inconsistent in the use of their hands. These data indicated that the inconsistent hand use group reported significantly more colds than their consistent hand use peers.

Consistency of hand use and sleep problems.

In this study, we measured the relationship between the consistency of hand use and three symptoms of insomnia, i.e., delayed sleep onset, frequent awakenings during sleep, and trouble returning to sleep after an awakening. For each of these insomnia-related symptoms, university students who were classified as inconsistent in the use of their hands (n = 30) were significantly more likely to report problems than their consistent hand-use peers (n = 30). These data were discussed both in relation to the literature on handedness classification and sleep problems and the emerging literature on consistency of hand use and health-related problems.

Nightmare distress and stress-related health problems.

Responses of 289 university students to Belicki's Nightmare Distress Questionnaire and the Stress-related Health Problems Scale were used to test the hypothesis that persons who score high on nightmare distress are more likely to report psychological problems. Since relative to the Low Nightmare Distress group, the High Nightmare Distress group scored significantly higher on all seven of the sets of symptoms that are measured by the Stress-related Health Problems Scale, this hypothesis was supported.

Ethnicity, Sleep Hygiene Knowledge, and Sleep Hygiene Practices.

We tested the mean differences in scores on Sleep Hygiene Knowledge and on Sleep Hygiene Practices among four ethnic groups of university students (N = 963). We computed significant main effects for ethnicity for both of these variables. Primarily the results reflect that the Euro-American students scored significantly higher on both scales than each of the other three groups.

Consistency of hand use and frequent falls.

We examined relationships between consistency of hand use and falling in groups of right-handed university undergraduates who were either consistent (n = 45) or inconsistent (n = 32) in the use of their hands. A scoring procedure developed for the Briggs-Nebes Handedness Scale permitted us to classify individuals as consistent or inconsistent in the use of their hands. The inconsistent group was 2.81 times more likely to have experienced frequent falls during the last 12-mo. period and was 1.64 times more likely to rate themselves higher on proneness to falling. These data suggest that inconsistent hand use may be a sign of a developmental inconsistency in motor coordination.

Boundaries and handedness.

The responses of 116 university students were used to assess a possible relation between scores on Hartmann's Boundary Questionnaire and the Briggs-Nebes Handedness Scale. Consistent with our prediction, the mean handedness score of the students with thin boundaries was significantly skewed in the direction of mixed-handedness.

Consistency of hand use, exercise, and sports-related injuries.

In this study, we examined the relationships between the consistency of hand use, exercise, and sports-related injuries as an indirect test of the hypothesis that the consistency of hand use is a reflection of general motor coordination. As we predicted, the consistent hand-use group (n = 23) exercised more, were more likely to follow a regular exercise schedule, and reported having experienced more sports-related accidents than their inconsistent hand-use peers (n = 23).

Time perspective and sleep problems.

In this study of 137 university students, we examined the relationships among the five dimensions of the Zimbardo Time Perspective Inventory and three scales that measure aspects of sleep problems. All of the Zimbardo Inventory dimensions correlated significantly with each of the sleep problem-related scales. These data suggest that concern about time, regardless of the specific nature of individuals' time perspective, and certain sleep problems are significantly related.

Ethnicity, sleep duration, and sleep satisfaction.

Analysis of responses of 1100 students from four ethnic groups to questions about the quantity and quality of their sleep indicated that ethnicity was modestly but significantly related.

Ethnicity and bruxism.

Distributions of students of four ethnic groups were statistically significantly different. 106 African-American students reported the lowest incidence of self-reported bruxism (9.4%), 452 Asian students the highest incidence (24.6%); 312 Euro-American and 225 Hispanic students' incidence was intermediate.