Homelessness in pregnancy

OBJECTIVES

To evaluate the association, if any, of homelessness or refuge accommodation on delivery and short term perinatal outcomes in an Irish tertiary maternity hospital.

METHODS

A retrospective cohort study of 133 singleton pregnancies in women reporting to be homeless or living in refuge at their booking antenatal appointment between 2013 and 2022. Analysis compared sociodemographic characteristics and perinatal outcomes in this cohort to a reference population of 76,858 women with stable living arrangements.

RESULTS

Women in the homeless/refuge population were statistically more likely to be single (75.2 % vs 39.5 %, p < 0.001), have an unplanned pregnancy (73.7 % vs 27.2 %, p < 0.001), report a history of psychiatric illness (42.9 % vs 22.4 %, p < 0.001), domestic violence (18.8 % vs 0.9 %, p < 0.001) alcohol consumption in pregnancy (3.0 % vs 0.8 %, p < 0.001) or smoking in pregnancy (41.3 % vs 9.7 %, p < 0.001). They were significantly more likely to have a preterm birth (adjusted OR 1.71 (1.01-2.87) p = 0.04). They also had a significantly lower median birth weight compared to the reference population (birthweight 3270 g vs 3420 g, p < 0.001).

CONCLUSION

Women in the homeless and refuge population are more likely to experience poorer perinatal outcomes compared to women with stable living arrangements.

Associations between executive function and attention abilities and language and social communication skills in young autistic children

LAY ABSTRACT

Executive functioning describes a set of cognitive processes that affect thinking and behavior. Past research has shown that autistic individuals often have delays in the acquisition of executive function abilities. Our study explored how differences in executive function and attention abilities relate to social abilities and communication/language in 180 young autistic children. Data were gathered via caregiver report (questionnaires/interviews) and an assessment of vocabulary skills. The ability to sustain attention to a dynamic video was measured via eye tracking. We found that children with higher levels of executive function skills demonstrated lower levels of social pragmatic problems, a measure of having difficulties in social contexts. Furthermore, children who were able to sustain their attention longer to the video displayed higher levels of expressive language. Our results emphasize the importance of executive function and attention skills across multiple areas of functioning in autistic children, in particular those that involve language and social communication.

Response to treatment and outcomes of infantile spasms in Down syndrome

AIM

To estimate the prevalence, and evaluate presentation, treatment response, treatment side effects, and long-term seizure outcomes in all known cases of children with Down syndrome and infantile spasms on the island of Ireland.

METHOD

This was a 10-year retrospective multicentre review of clinical records and investigations, focusing on treatment response, side effects, and long-term outcomes.

RESULTS

The prevalence of infantile spasms in Down syndrome was 3.0% during the study period. Fifty-four infants were identified with median age of spasm onset at 201 days (interquartile range [IQR] 156-242). Spasm cessation was achieved in 88% (n=46) at a median of 110 days (IQR 5-66). The most common first-line medications were prednisolone (n=20, 37%), vigabatrin (n=18, 33.3%), and sodium valproate (n=9, 16.7%). At follow-up (median age 23.7mo; IQR 13.4-40.6), 25% had ongoing seizures and 85% had developmental concerns. Treatment within 60 days did not correlate with spasm cessation. Seventeen children (31%) experienced medication side effects, with vigabatrin accounting for 52%.

INTERPRETATION

Prednisolone is an effective and well-tolerated medication for treating infantile spasms in Down syndrome. Despite the high percentage of spasm cessation, developmental concerns and ongoing seizures were common.

Prevalence of Impaired Orthostasis after Concussion Injury

Objective

To determine the prevalence of orthostatic hypotension (OHypo) and hypertension (OHTN), respectively after a concussion in collegiate athletes.

Background

Orthostasis causes a gravity-dependent redistribution of blood volume to the lower extremities. The baroreflex coordinates the cardiovascular autonomic nervous system to mitigate aberrant changes in systolic blood pressure (SBP). In autonomic dysfunction (AD), impaired accommodation may lead to a clinically significant? SBP decreases (OHypo: SBP fall = 20 mm Hg) or paradoxical increases (OHTN: SBP rise = 20 mm Hg) within 3 minutes of assuming the standing (STND) posture. Concussion injuries may induce a transient state of AD. A clinical approach to surveil this state has yet to be defined.

Design/Methods

A prospective study was performed in 36 concussed (gender: 23 female, 13 male; age: 20 ± 1 years; height: 1.75 ± 0.12 meters; weight: 73 ± 14 kilograms) and 20 non-concussed athletes (gender: 12 female, 8 male; age: 21 ± 2 years; height: 1.74 ± 0.15 meters; weight: 72 ± 18 kilograms). Continuous beat-to-beat SBP was collected for 10-minutes in a resting supine position (SUP) and then for 3-minutes in the STND position within 48 hours (48H) of concussion. The average SBP was computed from the difference between SUP and the final 15 seconds of STND. SBP were then categorized: Normal (NR: SBP -15 to +15 mm Hg); Borderline OHypo (BordOHypo: SBP −16 to −19 mm Hg) and OHTN (BordOHTN: SBP +16 to +19 mm Hg); OHypo; and, OHTN.

Results

In concussed athletes, the SBP prevalence rates were 42% NR, 31% OHypo, 11% OHTN, 11% BordOHTN, and 6% BordOHypo compared to 90% NR, 5% OHypo and 5% OHTN in the non-concussed athletes. ?2 test revealed a significant difference in this distribution (p = 0.012).

Conclusions

Within 48H of concussion injury, a combined 42% of injured athletes had an abnormal SBP response to orthostasis and a further 6% had borderline responses that warrant re-evaluation. The incidence rates for each circumstance exceeded the control group.

An Assessment of Digital Media-related Admissions in Psychiatrically Hospitalized Adolescents

Background:

Prevalent adolescent digital media use has brought clinical attention to its potential associated risks. While excessive digital media use has been connected to adolescent difficulties with mood and impulsivity, no study has examined digital media’s role in precipitating adolescent psychiatric admissions.

Objective:

Our study aims were to identify and characterize digital media-related admissions in a sample of psychiatrically hospitalized adolescents, and to recognize unique patterns of digital media use within this sample. We hypothesized that adolescents with digital mediarelated admissions would endorse higher amounts of digital media use and problematic online behaviors.

Methods:

We administered a cross-sectional survey of psychiatrically hospitalized adolescents between 2012 and 2016. Admissions were considered related to digital media use either by adolescent report or documentation in the medical record. Unadjusted comparisons were used to examine relationships between digital media-related psychiatric admissions, online behaviors and suicide-related risk factors.

Results:

68 of 218 participants (31.2%) had digital media-related admissions. The most frequent cause of digital media-related admission was cyberbullying (31.9%). Teens with digital- media related admissions were significantly more likely to sext, use social media, and be cyberbullied; these adolescents were also at increased risk of suicide planning and hopelessness.

Conclusion:

Efforts should be made by mental health clinicians to identify and address online relational conflict, as well as to screen for cyberbullying and sexting. Clinicians should consider that adolescents with digital media-related presentations may be at elevated risk of self-harm, with higher rates of suicide planning and hopelessness compared to hospitalized peers with admissions unrelated to digital media.

Problematic Internet Use and Associated High-Risk Behavior in an Adolescent Clinical Sample: Results from a Survey of Psychiatrically Hospitalized Youth

Problematic Internet use (PIU) is a growing clinical concern to clinicians working in adolescent mental health, with significant potential comorbidities like depression and substance use. No prior study has examined associations between PIU, high-risk behavior, and psychiatric diagnoses specifically in psychiatrically hospitalized adolescents. Here, we analyzed how PIU severity correlated with preadmission Internet habits, psychiatric symptoms, and high-risk behavior in this unique population. We hypothesized that as the severity of PIU increased, so would endorsement of mood symptoms, engagement in risky behaviors, and chances of having comorbid mood and aggression-related diagnoses. We performed a cross-sectional survey on an adolescent psychiatric inpatient unit in an urban community hospital in Massachusetts. Participants were 12-20 years old (n = 205), 62.0 percent female, and of diverse racial/ethnic backgrounds. Relationships between PIU, high-risk symptoms, diagnoses, and behaviors were performed both using chi-square tests and determining Pearson correlation coefficients. Two hundred five adolescents participated in the study. PIU severity was associated with being female (p < 0.005), sexting (p < 0.05), cyberbullying (p < 0.005), and increased suicidality within the last year (p < 0.05). Adolescents with aggressive and developmental disorders, but not depressive disorders, also had significantly higher PIU scores (p ≤ 0.05). In our sample of psychiatrically hospitalized adolescents, PIU severity was significantly associated with both serious psychiatric symptoms and high-risk behaviors, including those related to suicide. Our findings may improve safety assessments in this vulnerable adolescent population by identifying comorbid risks associated with problematic digital media use.

Next generation of the self-consistent and environment-dependent Hamiltonian: Applications to various boron allotropes from zero- to three-dimensional structures

An upgrade of the previous self-consistent and environment-dependent linear combination of atomic orbitals Hamiltonian (referred as SCED-LCAO) has been developed. This improved version of the semi-empirical SCED-LCAO Hamiltonian, in addition to the inclusion of self-consistent determination of charge redistribution, multi-center interactions, and modeling of electron-electron correlation, has taken into account the effect excited on the orbitals due to the atomic aggregation. This important upgrade has been subjected to a stringent test, the construction of the SCED-LCAO Hamiltonian for boron. It was shown that the Hamiltonian for boron has successfully characterized the electron deficiency of boron and captured the complex chemical bonding in various boron allotropes, including the planar and quasi-planar, the convex, the ring, the icosahedral, and the fullerene-like clusters, the two-dimensional monolayer sheets, and the bulk alpha boron, demonstrating its transferability, robustness, reliability, and predictive power. The molecular dynamics simulation scheme based on the Hamiltonian has been applied to explore the existence and the energetics of ∼230 compact boron clusters BN with N in the range from ∼100 to 768, including the random, the rhombohedral, and the spherical icosahedral structures. It was found that, energetically, clusters containing whole icosahedral B12 units are more stable for boron clusters of larger size (N > 200). The ease with which the simulations both at 0 K and finite temperatures were completed is a demonstration of the efficiency of the SCED-LCAO Hamiltonian.

A non-stationary model for simulating the dynamics of ocular aberrations

The time-evolution of ocular aberrations has been the subject of many studies, but so far there has been little discussion involving the modelling of the underlying temporal statistics. This paper presents a non-stationary modelling approach based on a coloured-noise generator, which can be applied to ocular aberration dynamics. The model parameters are computed from measured ocular aberration data. A custom-built aberrometer based on a Shack-Hartmann sensor was used for measurement. We present simulations based on our modelling approach, and validate them through comparison to real data. This work could be useful in areas such as the testing of ophthalmic devices and the development of improved algorithms for laser refractive surgery.

Temporal dynamics and statistical characteristics of the microfluctuations of accommodation: dependence on the mean accommodative effort

Microfluctuations of accommodation have been the subject of many studies. New technological developments now permit us to study the dynamics of the microfluctuations with unprecedented resolution and accuracy. We aim to characterise their temporal statistics for different levels of accommodative effort, using a custom-built aberrometer. We conducted 46 s long measurements on the dominant eye of 9 young, healthy subjects. The ocular wavefront was sampled every 250 microm across the 3.9 mm measured pupil, at a frame rate of 173 Hz. This enabled us to obtain high resolution estimates of the Power Spectral Density (PSD). Results show that the shape of the estimated PSD for a 4 D effort is distinct from the shape for the two extrema of the accommodation range. The autocorrelation function of the increments of the accommodation signal is also affected by the level of effort, regardless of the refractive error of the subject.

The DBA/2J strain and prepulse inhibition of startle: a model system to test antipsychotics?

RATIONALE

Prepulse inhibition (PPI) of the startle response in mice is increasingly used as a paradigm of sensory gating with potential predictive and construct validity towards schizophrenia.

OBJECTIVES

Establishment of a mouse PPI paradigm in which typical and atypical antipsychotic drugs directly improve a low performance PPI.

METHODS

Three strains of mice--C57Bl/6J, 129S6/SvEvTac and DBA/2J--were tested in a startle paradigm with three prepulse intensities, 2, 4 and 8 dB above background.

RESULTS

Under these conditions, risperidone (0, 0.25, 0.5 and 1 mg/kg i.p.) and clozapine (0, 1, 3 and 9 mg/kg i.p.) improved PPI in all three strains, with order of effect in DBA/2J > 129S6SvEvTac > C57Bl/6J. The DBA/2J strain showed larger PPI-enhancing effects, without disturbing the basal startle response. Two alpha7 nicotinic receptor agonists, GTS-21 (1-10 mg/kg i.p.) and AR-R17779 (1-10 mg/kg i.p.) were inactive in the PPI procedure in DBA/2J mice.

CONCLUSIONS

DBA/2J mice were very sensitive to the antipsychotic-like effects of atypical (clozapine) and typical (risperidone) antipsychotics, and this strain is proposed as a model to directly measure sensory gating properties of drugs. Alpha7 Nicotinergic receptor agonists were ineffective in this PPI paradigm.

Emedastine ophthalmic solution 0.05% versus levocabastine ophthalmic suspension 0.05% in the treatment of allergic conjunctivitis using the conjunctival allergen challenge model

PURPOSE

To compare a new ocular antihistamine, emedastine difumarate (Emadine Ophthalmic Solution 0.05%; Alcon Laboratories, Fort Worth, Texas), with the marketed ocular antihistamine, levocabastine hydrochloride (Livostin Ophthalmic Suspension 0.05%; CIBA Vision, Atlanta, Georgia), in the treatment of allergic conjunctivitis after conjunctival allergen challenge.

METHODS

We performed a prospective, double-masked, randomized, contralateral eye study comparing emedastine 0.05% in one eye with levocabastine 0. 05% or emedastine vehicle (placebo) in the contralateral eye. Efficacy was determined 10 minutes and 2 hours after administration of study medications. Ocular itching and redness scores were recorded 3, 5, and 10 minutes after conjunctival allergen challenge.

RESULTS

A total of 97 subjects with a history of allergic conjunctivitis and a positive response to a diagnostic test were evaluable for safety analysis, and 91 subjects were evaluable for the efficacy analysis. Emadastine 0.05% was statistically significantly more effective than levocabastine 0.05% in reducing ocular itching after conjunctival allergen challenge in both the 10-minute and the 2-hour challenge (P <.05). Emedastine 0.05% and levocabastine 0.05% were statistically equivalent in reducing conjunctival redness after conjunctival allergen challenge, although emedastine tended to be more efficacious than levocabastine at every observation time point.

CONCLUSIONS

After conjunctival allergen challenge, emadastine 0.05% is significantly more effective than levocabastine 0.05% in reducing ocular itching associated with allergic conjunctivitis. The two compounds are equivalent in controlling the conjunctival redness associated with allergic conjunctivitis.

Contingent and non-contingent auditory cueing in Parkinson's disease

Parkinson's disease (PD) patients and their normal controls performed two experiments involving a sequential movement task, depressing a series of buttons at choice points along a response board. Visual or auditory cues were presented prior to each move according to various contingencies. PD, a disorder characterised by degeneration of the basal ganglia (BG), typically manifests with poor execution of motor sequences. We found that external cueing facilitated motor sequencing in PD patients. In particular, auditory cues which occurred late in the movement cycle maximally facilitated switching between subcomponents of a sequence. Based on physiological findings reported in the primate literature [Brotchie et al., Brain 114, 1685-1702, 1978; Schultz and Romo, Exp. Brain Res. 1, 363-384, 1992], it is suggested that external cues enhance performance by replacing defective, internally generated cues (discharges) of the BG. This has implications for the use of physical training strategies in the treatment of PD.