Do focused interests support word learning? A study with autistic and nonautistic children.

Although focused interests are often associated with a diagnosis of autism, they are common in nonautistic individuals as well. Previous studies have explored how these interests impact cognitive, social, and language development. While some research has suggested that strong interests can detract from learning (particularly for autistic children), newer research has indicated that they can be advantageous. In this pre-registered study, we asked whether focused interests support word learning in 44 autistic children and a vocabulary-matched sample of 44 nonautistic children (mean ages 58 and 34 months respectively). In a word-learning task administered over Zoom, children were exposed to an action labeled by a novel word. The action was either depicted by their focused interest or by a neutral image; stimuli were personalized for each child. At test, they were asked to identify the referent of the novel word, and their eye gaze was evaluated as a measure of learning. The preregistered analyses revealed an effect of focused interests, and post-hoc analyses clarified that autistic children learned the novel word in both the focused interest and neutral conditions, while nonautistic children only showed evidence of learning in the neutral condition. These results suggest that focused interests are not disruptive for vocabulary learning in autism, and thus they could be utilized in programming that supports early language learning in this population.

Normal table of embryonic development in the four-toed salamander, Hemidactylium scutatum.

We present a complete staging table of normal development for the lungless salamander, Hemidactylium scutatum (Caudata: Plethodontidae). Terrestrial egg clutches from naturally ovipositing females were collected and maintained at 15 °C in the laboratory. Observations, photographs, and time-lapse movies of embryos were taken throughout the 45-day embryonic period. The complete normal table of development for H. scutatum is divided into 28 stages and extends previous analyses of H. scutatum embryonic development (Bishop, 1920; Humphrey, 1928). Early embryonic stage classifications through neurulation reflect criteria described for Xenopus laevis, Ambystoma maculatum and other salamanders. Later embryonic stage assignments are based on unique features of H. scutatum embryos. Additionally, we provide morphological analysis of gastrulation and neurulation, as well as details on external aspects of eye, gill, limb, pigmentation, and tail development to support future research related to phylogeny, comparative embryology, and molecular mechanisms of development.

Implementation of proven interventions in general medical inpatients: development and evaluation of a new quality indicator for drug therapy.

BACKGROUND: Among adult general medical inpatients, there are numerous interventions whose benefits outweigh their risks. However, there are no published reports describing the overall use of such proven interventions in this population. OBJECTIVES: To determine implementation rates of a broad range of interventions while accounting for valid reasons for non-use, predictors of implementation and feasibility of generating new indices to describe quality of care. METHODS: Based on a review of current practice guidelines and clinical trials related to five common conditions, implementation rates of 17 interventions were assessed retrospectively. Subjects were a complete sample of 150 adults with target medical conditions discharged from general medical units at an urban community hospital. RESULTS: The Ideal Intervention Index (3I), which described the proportion of ideal intervention opportunities that were implemented, was 0.74 (95% CI 0.70 to 0.78). The Justified Non-Use Index (JNUI), which described the proportion of all the interventions not implemented that were justified by a valid reason for non-use, was 0.49 (95% CI 0.41 to 0.55). Smoking cessation therapy in high-risk patients had the lowest indices (3I 0.30, 95% CI 0.00 to 0.60; JNUI 0.00), and aspirin for secondary stroke prevention had the highest (3I 1.0; JNUI 1.0). CONCLUSIONS: Overall, proven interventions are underused among the patients studied, and the reasons for non-use are frequently not readily discernible. There is potential for improvement, but research is required to further investigate reasons for non-use. It is feasible to measure implementation rates of proven interventions as an indicator of quality of care using the indices developed.

Delaware's medicolegal investigation of death. Part 2.

Part 1 of this series began in 1194, when the coroner system was formally established in England with the original interest in death to protect the financial interest of the crown. This coroner system was brought to the United States during the early 1600s where the first recorded autopsy was performed in Massachusetts in 1647. Significant changes were made to improve upon the coroner system. In 1877, the first medical examiner system was established in the state of Massachusetts, requiring that the coroner be supplanted by a physician known as a medical examiner. Using the system established in Massachusetts as a model, New York City developed an improved medical examiner system in 1915. The improvements made by New York City, under the leadership of men such as Drs. Charles Norris and Alex Gettler, essentially laid down the foundation for medical examiner systems and forensic toxicology throughout the country. Part 2 of this series begins in Maryland. Maryland soon followed in New York City's footsteps and in 1939 developed the first statewide medical examiner system in the U.S. Influenced by systems such as Maryland's and New York City's, Delaware established a medical examiner system in 1955 to work alongside of the pre-existing coroner system. It was not until about a decade later, in 1964, that the system became successful under the leadership of Dr. Ali Z. Hameli. In 1970, after 15 years of uphill battles with supporters of the antiquated coroner system, it was abolished, resulting in a statewide medical examiner system. Today, Delaware's medical examiner system has one of the best medicolegal investigative facilities in the country, complete with its own forensic sciences laboratory under the jurisdiction of a Chief Medical Examiner. Delaware's Office of Chief Medical Examiner will try to continue its tradition to serve as a model for other states and possibly other countries to follow.

Delaware's medicolegal investigation of death. Part 1.

In 1194, the coroner system was formally established in England with the original interest in death to protect the financial interest of the crown. This coroner system was brought to the United States during the early 1600s where the first recorded autopsy was performed in Massachusetts in 1647. Significant changes were made to improve upon the coroner system. In 1877, the first medical examiner system was established in the state of Massachusetts requiring that the coroner be supplanted by a physician known as a medical examiner. Using the system established in Massachusetts as a model, New York City developed an improved medical examiner system in 1915. The improvements made by New York City, under the leadership of men such as Drs. Charles Norris and Alex Gettler, essentially laid down the foundation for medical examiner systems and forensic toxicology throughout the country. Part II of this series will begin in Maryland. Maryland soon followed in New York City's footsteps and in 1939 developed the first statewide medical examiner system in the U.S. Influenced by systems such as Maryland's and New York City's, Delaware established a medical examiner system in 1955 to work alongside of the pre-existing coroner system. It was not until about a decade later in 1964 that the system became successful under the leadership of Dr. All Z. Hamell. In 1970, after 15 years of uphill battles with supporters of the antiquated coroner system, it was abolished, resulting in a statewide medical examiner system. Today, Delaware's medical examiner system has one of the best medicolegal investigative facilities in the country, complete with its own forensic sciences laboratory under the jurisdiction of a Chief Medical Examiner. Delaware's Office of Chief Medical Examiner will try to continue its tradition to serve as a model for other states and possibly other countries to follow.

Thrombus Precursor Protein and the measurement of thrombosis in patients with acute chest pain syndrome.

BACKGROUND: The major limitation of current diagnostic methods for the rapid diagnosis of an acute myocardial infarction (AMI) involves the measurement of the effects of ischemic or necrotic processes on myocardial function rather than the detection of the precipitating thrombotic event. The utility of an assay was investigated for thrombus precursor protein (TpP) in the diagnosis of 115 patients with symptoms consistent with myocardial ischemia or infarction of less than six hours in duration. Samples from patients were drawn at 0, 1, 2, 4, 8, 16, and 24 hours post presentation, and creatine kinase, CK-MB, myoglobin, troponin I, and TpP concentrations were determined. Significantly abnormal concentrations of TpP were observed in 15 of 17 patients presenting with an AMI within 6 hours of the onset of symptoms (p < 0.00001), 2 of 8 patients presenting with an AMI after 6 hours from the onset of symptoms (p = 0.0077), 22 of 35 patients with unstable angina (p = 0.00035), 15 of 30 patients with angina (p = 0.00024), 3 of 5 patients with atrial fibrillation (P = 0.00005), 6 of 9 patients with congestive heart failure (p = 0.00002), and 6 of 11 patients with non-cardiac chest pain (p = 0.00139). Non-cardiac chest pain patients with gastroenteritis, esophageal spasm, duodenal ulcer, cocaine overdose, and pericarditis presented with abnormal plasma concentrations of thrombus precursor protein. Peak concentrations of TpP in patients with AMI preceded those of the other markers by two to four hours.

An immunoassay for anti-neuronal antibodies associated with involuntary repetitive movement disorders.

Tourette's syndrome (TS) is a complex neurobehavioral disorder emerging in childhood and is characterized by motor and vocal tics of at least one year in duration. In a portion of patients with TS, environmental (non-genetic) factors may either have an etiologic role or act to modulate the phenotype. One possible environmental factor may be antibodies to central nervous system cells, as sera from several children diagnosed with either TS or Sydenham's chorea contained anti-neuronal antibodies. Using enriched membrane preparations isolated from HTB-10 neuroblastoma cells, a sensitive and specific assay was developed for the determination of human anti-neuronal antibodies associated with involuntary repetitive movement disorders. This assay exhibited between-run and within-run precision of 11.3 percent and 5.9 percent, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of this assay for the diagnosis of TS and TS or chorea are 79.1 percent, 61.2 percent, 61.6 percent, 78.8 percent, and 71.1 percent, 60.9 percent, 68.6 percent, and 63.6 percent, respectively. In addition, there was a significant difference (p < 0.0001) between the mean optical density in the patients with TS and children determined to be clinically "normal".

Comparative sensitivities and specificities of the mass measurements of CK-MB2, CK-MB, and myoglobin for diagnosing acute myocardial infarction.

We evaluated the clinical utility of the mass measurement of the tissue isoform of creatine kinase MB isoenzyme (CK-MB2) in the diagnosis of an acute myocardial infarction (AMI) by determining its sensitivity, specificity, and predictive value relative to those of CK-MB mass and myoglobin. Samples were obtained at 0, 4, 8, and 16 h postpresentation from 100 patients (41% with AMI). The order of sensitivity for the sample proportions taken at 0-2 h from the onset of symptoms was myoglobin > CK-MB2 > CK-MB. At all other time points, the sensitivity of CK-MB2 either equaled or surpassed that of both CK-MB and myoglobin, although the 95% confidence intervals for the population proportions each of these markers overlapped. Of the 41 AMI patients, 31 (76%) exhibited concurrent abnormal increases of CK-MB and %CK-MB2; the other 10 (24%; 8 non-Q wave, 2 Q wave) exhibited abnormal values for %CK-MB2 before their CK-MB exceeded the upper limit of normal. The specificity of myoglobin was statistically lower than that for either CK-MB2 or CK-MB at all time points.