Exploring State Level Factors Associated with Short-Stays in Child Welfare: The Role of Systemic Risk and Surveillance

Growing attention has been directed toward children who are placed in out-of-home care by child welfare authorities for less than 30 days, deemed "short-stayers". This exploratory study uses multiple national child welfare and population data sources to identify macro level factors associated with short-stays. Two-level logistic regression modeling was conducted to explore how state-level factors were associated with risk of short-stays. Factors associated with lower odds of short-stays included living in a state with a centralized child welfare reporting structure and with greater food insecurity. Factors associated with greater odds included living in a state with a higher percentage of the state's population enrolled in the Supplemental Nutrition Assistance Program and states with more police per capita. Multiple state level factors were associated short-stay risk, which suggests broader systemic factors contribute to these brief removals. Findings suggest greater surveillance by police and social services increases risk of short-stays, which likely have implications for child welfare policy and practice.

'You just really have to assert yourself:' social work, nursing, and rehabilitation counseling student experiences of providing integrated behavioral health services before and after the immediate start of COVID-19

BACKGROUND

Educators who train healthcare students to provide behavioral health services in primary care settings frequently encounter challenges as they work to ensure that students acquire the knowledge and skills to effectively function on interprofessional practice teams. This has become increasingly important during COVID-19, as interprofessional collaborative practice is needed more than ever to address the interrelated health, mental health, and social structural issues linked to the pandemic.

METHODS

We used qualitative focus groups to understand the experiences of 6 interprofessional teams (comprised of graduate social work, nursing, and rehabilitation counseling students; n = 19) providing behavioral health services in primary care settings before and after the immediate start of COVID-19. To triangulate data and enrich findings, one focus group with students' faculty supervisors was also conducted; n = 5). Data were analyzed using thematic analysis.

RESULTS

Four themes highlighted student participants' need to assert themselves at the beginning of their educational experience, to communicate and learn from one another to develop positive team dynamics, to contend with role confusion and missed opportunities for collaboration, and to manage the emotional impact of COVID-19 on learning.

CONCLUSION

Findings indicate that educators should work with clinical faculty and agency supervisors to orient students to ensure they have role clarity within the agency. Graduate students providing behavioral health services should also learn to work collaboratively within their scopes of practice to serve patients virtually, especially in preparation for public health emergencies.

Victimization and Resilience Among Sexual and Gender Minority Homeless Youth Engaging in Survival Sex

This study examined how a diverse group of sexual and gender minority (SGM) homeless youth described and understood their victimization experiences occurring before they were homeless and those occurring after they were homeless and engaging in survival sex. In addition, the study explored how these youths manifested resilience when living on the street. The sample consisted of 283 racially/ethnically diverse youth between the ages of 15 and 26 years (M = 19.6, SD = 1.28) living in a large U.S. city. Participants identified their gender as male (47%), female (36%), transgender (15%), or queer and other (3%) and their sexual orientation as bisexual (37%), gay (23%), lesbian (15%), heterosexual (13%), or queer and other (13%). Thirty-seven percent identified as Black, 30% as multiracial, 22% as Latino/a, 5% as White, and 5% as another race. Content and thematic analyses were used to conduct a secondary analysis of qualitative data. Four themes were identified: unsafe and unsupported at home; barriers to housing and employment stability; ongoing victimization and lack of protection; and unexpected opportunities for resilience. Findings demonstrated that participants experienced victimization related not only to their SGM identities but also to chaotic home environments. Once homeless and engaging in survival sex, youth experienced barriers to securing employment and housing as well as victimization by police and clients. These experiences frequently involved prejudice related to their intersecting identities. Despite encountering numerous challenges, participants described surviving on the streets by living openly and forming relationships with other youth. Implications for practice and policy are discussed.

Implementation Fidelity in the Replication of Tuning in to Teens (TINT) Adapted for Adoptive Parents and Guardians in the US

Purpose: Clear explication of the conditions necessary to reproduce results is imperative in the development of evidence-based interventions.Methods: This study used a fidelity framework to guide the exploration of implementation fidelity in a study of the Tuning in to Teens (TINT) intervention in New Jersey. TINT is an evidence-based prevention program - previously tested with parents of pre-adolescents to reduce emotionally dismissive parenting - that was adapted for use with adoptive and guardianship families.Results: The review of intervention design adaptation and protocols; intervention training; and monitoring of intervention delivery revealed extensive efforts by an adoption clinician, the purveyor of the program, and an implementation team to support the implementation efforts. Results of the monitoring of intervention receipt indicate that the intervention was implemented with high fidelity.Discussion: Future intervention research should consider assessing the effects of implementation efforts on outcomes to improve replication under real-world conditions. Regardless, this exploration of fidelity has implications for public and private organizations seeking to implement an evidence-based intervention. The framework developed by Gearing and Colleagues and the TIDieR checklist could provide useful guidance when planning for and reporting on implementation fidelity in the furtherance of developing and disseminating evidence-based interventions.

Learning to endure: A qualitative examination of the protective factors of homeless transgender and gender expansive youth engaged in survival sex

Background: Transgender and gender expansive (TGE) youth face a number of adversities that are associated with deleterious consequences, including mental health problems, substance misuse, suicide, and homelessness. However, there is evidence that TGE youth still demonstrate resilience under extraordinary conditions. Aims: Therefore, this study examined how TGE youth who are homeless and engaging in survival sex describe and understand the protective factors present in their lives. Methods: In-depth qualitative interviews were conducted with 57 TGE youth living in a large U.S. city. Participants were 17-26 years old (M = 19.88, SD = 1.55), and identified as transgender woman (53%), transgender man (16%), and other (32%; gender-queer, gender-fluid, androgynous, or non-binary). Youth identified as Black (40%), multiracial (35%), Latinx (16%), White (5%), and as another race (3%). Researchers conducted a secondary analysis of qualitative data using thematic analysis. Results: We identified three themes to capture youth's understanding of their protective factors: relying on oneself and others to avoid violence, accessing gender-affirming health and mental health care, and proactively maintaining sexual health. Participants described strategies for mitigating risk of harm while attempting to meet their basic needs. Additionally, they discussed the importance of having gender-affirming health and mental health services. Participants also expressed keen awareness of their sexual health risks and making calculated, often proactive decisions about their sexual health. Conclusion: The protective factors described by TGE youth reflect the unique ways in which hyper-marginalized youth must navigate their own survival and well-being, and align with literature suggesting resilience is not mutually exclusive from risk. By focusing on TGE youth, this research privileges the experiences of individuals historically underrepresented in research and encourages future research to incorporate these perspectives into policies and programs.

Abstract WP389: Improving Systems of Care With Stroke Severity Adjusted EMS Triaging and Bypass Criteria Protocols to a Comprehensive Stroke Center

A validated pre-hospital assessment tool to detect severe strokes including intracranial hemorrhages and large vessel occlusions along with protocols for bypassing to comprehensive stroke centers remains an ongoing debate.

The long term goals align with the emphasis of developing formalized stroke severity adjusted EMS triaging and bypass protocols to recognize both large vessel ischemic and intracerebral hemorrhagic stroke patients early in the pre-hospital setting with the utilization of a recognized, validated assessment tool, formal bypass criteria protocols, and formalized training for emergency medical service personnel. These goals align with the topic of careful selection of patients who meet strict criteria for bypassing acute stroke ready and primary stroke centers throughout the Southeastern New Jersey region which includes one acute ready hospital and two primary stroke centers to the closest Comprehensive Stroke Center in Atlantic City, New Jersey. The first specific aim is to analyze the EMS field diagnostic accuracy completed by both AtlantiCare EMS ACLS providers and Mid Atlantic Medevac EMS personnel. A therapeutic bypass yield will be analyzed in order to determine the effectiveness of the formalized training to conduct effective stroke severity EMS triaging assessments and a formal bypass protocol to the Comprehensive Stroke Center in Atlantic City, New Jersey. Sensitivity results of the near-infrared (NIR) technology device as a pre-scanning tool for hemorrhages prior to CT scan and operator error will be analyzed. Final diagnosis, CT results, and the need for comprehensive services will serve as the sole factor for the therapeutic bypass yield analysis.

The second aim is to analyze the percentage of bypassed patients to the Comprehensive Stroke Center that undergo comprehensive interventions or medical services.

Policy/Protocol Design (refer to images)

IRB Information : FWA#00011915 and RP# 15-039ex IRB

The marital and family functioning of adults with ADHD and their spouses

Little is known about the family relationships of adults with Attention-Deficit/Hyperactivity Disorder (ADHD). Thus, the marital adjustment and family functioning of 33 married adults with ADHD and their spouses was compared to 26 non-ADHD control participants and their spouses. Results revealed that married adults with ADHD reported poorer overall marital adjustment on the Dyadic Adjustment Scale (DAS; Spanier, 1989) and more family dysfunction on the Family Assessment Device (FAD; Eptein, Baldwin, & Bishop, 1983) than control adults. The spouses of adults with ADHD did not differ from control spouses in reports of overall marital adjustment and family dysfunction. A greater proportion of their marital adjustment scores, however, fell within the maladjusted range. The ADHD adults' perceptions of the health of their marriages and families were more negative than their spouses' perceptions. The way in which spouses of ADHD adults compensated for their partners' difficulties were explored through clinical interviews. The findings in this study underscore the need for assessments and treatments to address marital and family functioning of adults with ADHD.

Multiple complex developmental disorder: the "multiple and complex" evolution of the "childhood borderline syndrome" construct

OBJECTIVES

To provide an overview of the history, evolution, and nosology of the diagnostic constructs for "borderline syndrome of childhood," also known as "multiple complex developmental disorder."

METHOD

The authors synthesized information found via electronic searches of databases (MEDLINE, PsycINFO, Current Contents, Humanities Abstracts, and Social Sciences Abstracts) and bibliographic directed searches.

RESULTS

Although early publications (prior to 1980) were either highly anecdotal or lacking in scientific rigor, they were nonetheless noted for their historic value and influence on research trends. The recent publications (1990s) were characterized by more rigorous methodology and greater generalizability. Current classifications, proposals for diagnostic criteria, epidemiological data, and nosological suggestions were summarized.

CONCLUSION

The literature supports the creation of a new diagnostic label to describe a population of children whose symptoms are currently subsumed under the labels "borderline" or "multiple complex developmental disorder." A full characterization of the syndrome, including its evolution, would require prospective studies and may differ from the known evolution for personality disorders and/or pervasive developmental disorders. The authors propose a process by which a new nomenclature is derived.

Inpatient treatment of severe disruptive behaviour disorders with risperidone and milieu therapy

OBJECTIVES

To evaluate the therapeutic impact of adding risperidone to milieu therapy of latency-aged inpatients with severe disruptive disorders.

METHODS

The charts of 90 latency-aged patients consecutively admitted to a psychiatry ward were reviewed retrospectively. Fifteen of these patients received risperidone treatment, were nonpsychotic, and did not suffer from pervasive developmental disorder (12 male, 3 female; mean age 9.99 years, SD 1.76). Their scores on the Children's Global Assessment Scale (CGAS) were compared at admission, before risperidone treatment, and at discharge.

RESULTS

All subjects were diagnosed with a disruptive behavioural disorder. Ten (66.67%) had additional learning difficulties, and 13 (86.7%) had pathological personality traits. The characteristics of the sample suggested borderline pathology or multiple complex developmental disorder. Following a mean of 38 days after admission (SD 22.3), the patients received risperidone for a mean of 46 days (SD 28.2) before being discharged. The mean maintenance dose of risperidone was 1.27 mg daily (SD 0.36). Mean CGAS scores increased from admission (21.9, SD 7.0) to before risperidone treatment (26.8, SD 7.6, P < 0.0001) and to discharge (50.3, SD 5.3, P < 0.0001). Only 2 patients had documented side effects.

CONCLUSIONS

Low-dose risperidone used adjunctively to milieu therapy led to statistically and clinically significant additional improvement in the functioning of hospitalized latency-aged children with severe behavioural disorders. Low-dose risperidone is a safe and effective adjunct to milieu therapy for treating this population in inpatient settings. Prospective randomized controlled trials are needed to confirm these findings.

Characterization of the heparan sulfate and chondroitin sulfate assembly sites in CD44

Isoforms of CD44 are differentially modified by the glycosaminoglycans (GAGs) chondroitin sulfate (CS), heparan sulfate (HS), and keratan sulfate. GAG assembly occurs at serines followed by glycines (SG), but not all SG are utilized. Seven SG motifs are distributed in five CD44 exons, and in this paper we identify the HS and CS assembly sites that are utilized in CD44. Not all the CD44 SG sites are modified. The SGSG motif in CD44 exon V3 is the only HS assembly site; this site is also modified with CS. HS and CS attachment at that site was eliminated by mutation of the serines in the V3 motif to alanine (AGAG). Exon E5 is the only other CD44 exon that supports GAG assembly and is modified with CS. Using a number of recombinant CD44 protein fragments we show herein that the eight amino acids located downstream of the SGSG site in V3 are responsible for the specific addition of HS to this site. If the eight amino acids located downstream from the first SG site in CD44 exon E5 are exchanged with those located downstream of the SGSG site in exon V3, the SG site in E5 becomes modified with HS and CS. Likewise if the eight amino acids found downstream from the first SG in E5 are placed downstream from the SGSG in V3, this site is modified with CS but not HS. We also show that these sequences cannot direct the modification of CD44 with HS from a distance. Constructs containing CD44 exon V3 in which the SGSG motif was mutated to AGAG were not modified with HS even though they contained other SG motifs. Thus, a number of sequence and structural requirements that dictate GAG synthesis on CD44 have been identified.

Generation of artificial proteoglycans containing glycosaminoglycan-modified CD44. Demonstration of the interaction between rantes and chondroitin sulfate

All CD44 isoforms are modified with chondroitin sulfate (CS), while only those containing variably spliced exon V3 are modified with both CS and heparan sulfate (HS). The CS is added to a serine-glycine (SG) site in CD44 exon E5, while HS and CS are added to the SGSG site in exon V3. Site-directed mutagenesis and other molecular biology techniques were used to determine the minimal motifs responsible for the addition of CS and HS to CD44 (see accompanying paper (Greenfield, B., Wang, W.-C., Marquardt, H., Piepkorn, M., Wolff, E. A., Aruffo, A., and Bennett, K. L. (1999) J. Biol. Chem. 274, 2511-2517)). We have used this information to generate artificial proteoglycans containing the extracellular domain of the cell adhesion protein lymphocyte function-associated antigen-3 (LFA-3) (CD58) and CD44 motifs modified with CS or a combination of CS and HS. Analysis of the CD44-modified LFA-3 protein showed that it retains the ability to engage and trigger the function of its natural ligand CD2, resulting in T cell activation. In addition, the glycosaminoglycan-modified artificial proteoglycan is capable of binding the chemokine RANTES (regulated upon activation, normally T cell expressed and secreted) and delivering it to human T cells, resulting in enhanced T cell activation. These data demonstrate that artificial proteoglycans can be engineered with functional domains that have enhanced activity by codelivering glycosaminoglycan-binding molecules. The artificial proteoglycans were also used as a model system to explore the glycosaminoglycan binding properties of basic-fibroblast growth factor and the chemokine RANTES. While basic-fibroblast growth factor was shown to bind HS alone, this model revealed that RANTES binds not only HS, as has been demonstrated in the past, but also CS. Thus, artificial proteoglycans can be used for studying the glycosaminoglycan binding patterns of growth factors and chemokines and provide a means to manipulate the levels, types, and activity of glycosaminoglycan-binding proteins in vitro and in vivo.

Function of the nasal muscles in normal subjects assessed by dynamic MRI and EMG: its relevance to rhinoplasty surgery

The external nose is generally considered to have a relatively static shape. Movement of the nose and the potential for change of external shape and the internal airway have been assessed by (1) cadaver dissection and (2) dynamic studies during a standardized series of facial expressions in 13 subjects; video recording of the movement of skin markers, electromyography, and moving magnetic resonance images. A standard description of muscle anatomy is presented. The dynamic investigations indicated the following. Video analysis showed the components of muscle action: dilatation, constriction of the nostril, depression of the tip, vertical contraction in the bridge, and elevation of the alar, in different expressions. Electromyography confirmed muscle actions during expression and phonation. Magnetic resonance imaging demonstrated large changes in the external shape of the nose and nasal aperture due to muscle actions. Muscle function should be given greater consideration in aesthetic and cleft rhinoplasty.

Identification of CD44 residues important for hyaluronan binding and delineation of the binding site

CD44 is a widely distributed cell surface protein that plays a role in cell adhesion and migration. As a proteoglycan, CD44 is also implicated in growth factor and chemokine binding and presentation. The extracellular region of CD44 is variably spliced, giving rise to multiple CD44 isoforms. All isoforms contain an amino-terminal domain, which is homologous to cartilage link proteins. The cartilage link protein-like domain of CD44 is important for hyaluronan binding. The structure of the link protein domain of TSG-6 has been determined by NMR. Based on this structure, a molecular model of the link-homologous region of CD44 was constructed. This model was used to select residues for site-specific mutagenesis in an effort to identify residues important for ligand binding and to outline the hyaluronan binding site. Twenty-four point mutants were generated and characterized, and eight residues were identified as critical for binding or to support the interaction. In the model, these residues form a coherent surface the location of which approximately corresponds to the carbohydrate binding sites in two functionally unrelated calcium-dependent lectins, mannose-binding protein and E-selectin (CD62E).

Deleted in colorectal carcinoma (DCC) binds heparin via its fifth fibronectin type III domain

DCC (deleted in colorectal carcinoma) is a broadly expressed cell-surface receptor. Netrin-1 was recently identified as a DCC ligand in brain, but the possibility of other DCC ligands was suggested by the finding that an anti-DCC antibody (clone AF5) neutralized netrin-1-dependent commissural axon outgrowth without blocking DCC/netrin-1 interactions. Here we have searched for alternative cell-surface DCC ligands. A DCC-Ig fusion protein bound to neural and epithelial derived cell lines, indicating that these lines express ligand(s) for DCC. The cell-surface binding activity was mediated by the loop between beta-strands F and G of the fifth fibronectin type III repeat FNIII-D5. The loop included the sequence KNRR, which resembles heparin-binding motifs in other proteins. Heparinase and heparitinase treatment of cells reduced binding of DCC-Ig, suggesting that heparan sulfate proteoglycans are cell-surface DCC ligand(s). This was further supported by heparin blocking experiments and by binding of DCC-Ig to immobilized heparan sulfate. The interaction between DCC-Ig and heparan sulfate/heparin, both on the surface of cells and immobilized on plastic, was blocked by the same anti-DCC antibody that blocks netrin-1-dependent commissural axon outgrowth. Taken together, these findings suggest that the DCC-Ig/heparin interaction may contribute to the biological activity of DCC.

Juvenile onset bipolar disorder

This article reviews juvenile onset bipolar disorder with regard to history, diagnosis, comorbidity, differential diagnosis, prevalence, etiology, treatment, and outcome. Specifically, it deals with past and current diagnostic criteria for juvenile onset bipolar disorder, the controversy around its comorbidity with attention deficit hyperactivity disorder (ADHD), and how to differentiate it from ADHD, conduct disorder, drug and alcohol abuse, and schizophrenia, Genetic and neuroimaging studies investigating the possible etiology of this condition are also described. Treatment, both pharmacological (eg, lithium, neuroleptics, anticonvulsants, benzodiazepines, antidepressants) and psychosocial (eg, psychoeducation of child and family, school intervention, family, group and/or individual therapy) are outlined. Finally, long-term outcome and factors which may influence outcome are addressed.

Regulation of CD44 binding to hyaluronan by glycosylation of variably spliced exons

The hyaluronan (HA)-binding function (lectin function) of the leukocyte homing receptor, CD44, is tightly regulated. Herein we address possible mechanisms that regulate CD44 isoform-specific HA binding. Binding studies with melanoma transfectants expressing CD44H, CD44E, or with soluble immunoglobulin fusions of CD44H and CD44E (CD44H-Rg, CD44E-Rg) showed that although both CD44 isoforms can bind HA, CD44H binds HA more efficiently than CD44E. Using CD44-Rg fusion proteins we show that the variably spliced exons in CD44E, V8-V10, specifically reduce the lectin function of CD44, while replacement of V8-V10 by an ICAM-1 immunoglobulin domain restores binding to a level comparable to that of CD44H. Conversely, CD44 bound HA very weakly when exons V8-V10 were replaced with a CD34 mucin domain, which is heavily modified by O-linked glycans. Production of CD44E-Rg or incubation of CD44E-expressing transfectants in the presence of an O-linked glycosylation inhibitor restored HA binding to CD44H-Rg and to cell surface CD44H levels, respectively. We conclude that differential splicing provides a regulatory mechanism for CD44 lectin function and that this effect is due in part to O-linked carbohydrate moieties which are added to the Ser/Thr rich regions encoded by the variably spliced CD44 exons. Alternative splicing resulting in changes in protein glycosylation provide a novel mechanism for the regulation of lectin activity.

Short-term efficacy of interventions by a youth crisis team

OBJECTIVE

To determine the impact of an outpatient psychiatric Emergency Room Follow-up Team (ERFUT) on the hospitalization rate of youth in crisis (mostly suicidal adolescents).

METHOD

The rate of psychiatric admissions of youth to a general pediatric hospital during a year prior to the ERFUT creation was compared to that same rate after the team's creation. The proportion of patients returning to the Emergency Room (ER) 2 or more times was also compared for those same years. Deaths were identified at 3-year follow-up for the experimental group.

RESULTS

A 16% reduction in the hospitalization rate followed the team's creation, without an increase in the proportion of patients returning to the ER. Also, none of the experimental group subjects had died at 3-year follow-up.

CONCLUSION

There is a subpopulation of previously hospitalized suicidal adolescents who can be effectively cared for as outpatients when treated rapidly and intensively.

Posture in patients with shoulder overuse injuries and healthy individuals

Assessment of posture is an integral component of patient evaluation with shoulder overuse injuries. However, the professional literature contains relatively few studies that have assessed the relationship between posture, function, and injury. The purpose of this study was to determine the relationship and differences in postural variables within and between subjects with overuse injuries to the shoulder of healthy subjects. Thirty patient subjects and 30 healthy subjects matched for age and gender were recruited. Scapular protraction and rotation, forward head position, midthoracic curvature, and passive humeral elevation in the plane of the scapula were measured randomly in standing. All measurement techniques were standardized and validated. Intrarater and interrater reliability for all clinical measures were established before data collection. Forward head position was significantly greater (p < .001) in the patient group than the healthy group; humeral elevation was significantly greater (p < .001) in the healthy group than in the patient group and in the uninvolved shoulders (p < .01) than the involved shoulders within the patient group. Scapular protraction, rotation, midthoracic curvature, and scapular symmetry were not significantly different between groups. Scapula protraction and rotation were significantly related (p < .05) in the patient group. No other postural variables were related. Conclusions regarding the influence of posture to shoulder injury are inconclusive based on several confounding variables that may have affected the outcome.

Association of the eosinophilia-myalgia syndrome with the ingestion of tryptophan

We report on a series of three patients with an unusual syndrome of eosinophilia and myalgia associated with the oral ingestion of tryptophan that was recognized in New Mexico in October 1989. All three patients, who were women 37 to 44 years of age, had severe muscle pain, muscle weakness, mouth ulcers, and striking eosinophilia (more than 8 X 10(9) cells per liter). Other manifestations included fever, abdominal pain, dyspnea, skin rash, and elevated serum concentrations of aminotransferase and aldolase. The women had been taking tryptophan in doses of 1.2 to 2.4 g a day for three weeks to 2 1/2 years. The discontinuation of tryptophan and the initiation of glucocorticoid treatment resulted in improvement, but all three women were still symptomatic three to five months later. Tests for trichinosis and other parasites and for allergic and connective-tissues disorders were negative, and serum immunoglobulin concentrations and erythrocyte sedimentation rates were normal. A muscle biopsy in one patient and biopsies of the vagina, liver, and other abdominal organs in another revealed eosinophilic infiltration, as well as the extracellular deposition of eosinophil-granule major basic protein. All three patients had elevated serum and urinary levels of this protein and eosinophil-derived neurotoxin, indicative of eosinophil degranulation. The syndrome of eosinophilia and myalgia in association with the ingestion of tryptophan that was seen in these three patients is a newly recognized adverse effect of tryptophan ingestion. Our identification of this association in these patients led to the discovery of an epidemic of what is now called the eosinophilia-myalgia syndrome.

The influence of cephalostatic ear rods on the positions of the head and neck during postural recordings

This study examined the effect of cephalostatic ear rods on the positions of the head and neck. The method error was assessed for postural recordings of the head and neck position made with and without ear rods. A photographic angle was correlated with the postural angles on x-ray film. The material compared 33 dental students who were recorded with ear rods in and with ear rods out. Subjects were chosen randomly to repeat the postural recordings. The differences between the mean for each postural variable were subjected to comparative analysis, using Student's t test for paired samples. A significant difference (p less than or equal to 0.05) was found between the means of the inclination of the cervical spine to the true horizontal and the means of the photographic angle. The mean values for the remaining postural variables showed an insignificant but consistent pattern of axial extension of the cervical spine. Cephalostatic ear rods may alter head and neck position during postural recordings. The method error made for recording total head and neck position with ear rods was higher than without ear rods. The difference in the photographic angle was found to have a moderate positive correlation with the difference in the cervical inclination and the total head and neck position. These data suggest that lateral cephalostatics without ear rods may be used to record total head and neck position and the photographic technique may be used as a quick, inexpensive method for the clinician to determine head and neck positional changes before and after treatment.

Two subgroups of hyperactives as adults: correlations of outcome

This prospective study explored the association of continuing symptoms of the hyperactive syndrome with adult outcome. A fifteen year follow-up compared 61 hyperactive subjects and 41 matched controls. Outcome measures examined included continuing symptoms of the hyperactive syndrome, antisocial behaviour, substance use, and emotional difficulties. Two subgroups of the hyperactive population were identified. Those hyperactive subjects with moderate or severe continuing symptoms were characterized by significant emotional difficulties, alcohol use, and antisocial behaviour. By contrast, hyperactive subjects with none or only mild continuing symptoms at follow-up did not have other difficulties in psychosocial functioning, and were, in addition, similar to the control group in many respects. The importance of continuing symptoms in determining the adult outcome of children with a diagnosis of ADDH is discussed. Accordingly, the need for comprehensive early, and ongoing interventions is emphasized.

A rural child psychiatry day treatment centre: systemic perspective

The author presents the complexities of directing a DTC (Day Treatment Center) in a rural setting. These complexities are explored from the perspective of system's theory. The various systems contained within the DTC are in dynamic equilibrium with each other as well as with various community groups. Changes in any one system have significant impact on the groups the system impinges on. As an example, the DTC had not functioned well for a period of time prior to the author's arrival. During that period the staff communicated poorly among themselves, resulting in conflicts between the teaching and non-teaching staff. When these conflicts were resolved the well-established incompatibilities and stresses within the system of the non-teaching staff surfaced. In the process of this conflict resolution the DTC was reorganized. New groups were established to access children at primary and secondary levels of medical prevention. Rapport with other systems in the community improved. Consequently, with better communication between groups of staff and with the community, the treatment of the children could be more effective.

Acceleration of tetrazolium reduction by bacteria

Conditions were assessed which would permit more rapid recognition of bacterial growth than has been previously reported using tetrazolium salts. Microtitration trays were used. 2-(p-Iodophenyl)-3(p-nitrophenyl)-5-phenyltetrazolium chloride is rapidly reduced by respiring cells in tissue homogenates but is more toxic than other tetrazoliums when added to growing bacterial cultures. Phenazine methosulfate (PMS), an intermediate electron carrier, potentiates tetrazolium reduction. Growth was readily detected by the addition of these compounds after 3 to 4 h of incubation in Schaedler broth. The final concentration prior to addition to tray wells was 1.0 mg/ml for 2-(p-iodophenyl)-3(p-nitrophenyl)-5-phenyltetrazolium chloride and 0.06 mg/ml for PMS. Addition of 0.5 to 0.8 g of agar per liter of broth enhanced subsequent tetrazolium reduction.