Distinguishing and Managing Acute-Onset Complex Tic-like Behaviors in Adolescence

Consistent with international reports,1 this group of Tourette syndrome (TS) experts has noticed a recent increase in adolescents presenting with tic-like symptoms that show a markedly atypical onset and course. These sudden-onset motor movements and vocalizations are often associated with significant impairment and disability, resulting in emergency department visits and hospitalizations for some affected youths.

Psychometric properties of the diabetes skills checklist for adolescents with type 1 diabetes and their parents

OBJECTIVE

Among adolescents with type 1 diabetes, research has found that their perception of their diabetes management is an important predictor of actual diabetes management. There is a need for measures that assess adolescents' perception of their ability to independently complete daily diabetes self-care tasks. The current study examined the psychometric properties of the Diabetes Skills Checklist Teen-Report (DSC-T) and DSC Parent of Teen-Report (DSC-PT), which assess perceived independence in diabetes self-care skills.

RESEARCH DESIGN AND METHODS

Data were from 1450 adolescents aged 12 to 18 years and their parents who participated in the Diabetes Camp Matters Study. Families completed the DSC as well as other questionnaires online assessing demographic and diabetes-related information, diabetes strengths, and diabetes-specific emotional distress.

RESULTS

Exploratory factor analysis revealed a 14-item DSC-T and 12-item DSC-PT, both with excellent internal consistency and concurrent validity. Both the DSC-T and DSC-PT were found to be positively correlated with diabetes strengths and negatively correlated with HbA1c, and the DSC-PT was significantly correlated with parent-reported diabetes distress. Adolescents who used insulin pumps and continuous glucose monitoring reported higher perceived independence in diabetes self-care skills compared to adolescents who used insulin pens/syringes or blood glucose meters. No differences were found based on demographic characteristics.

CONCLUSIONS

The DSC-T and DSC-PT have strong potential to be used during diabetes clinic visits to spark discussion regarding adolescents' self-care, which would allow for a more successful transfer of diabetes care from parent to adolescent, and eventually, the transition from pediatric to adult healthcare.

Psychosocial Aspects of Diabetes Technology Use: The Child and Family Perspective

This article offers a systematic review of the literature on psychosocial aspects of technology use in children and adolescents with type 1 diabetes and their families, searching for relevant articles published the past 5 years. Topics included continuous subcutaneous insulin infusion, continuous glucose monitoring, predictive low-glucose suspend, and artificial pancreas systems. The review indicates there are positive and negative psychosocial aspects to diabetes technology use among youth and their families. Although consistent findings were revealed, contradictions exist. Discussed are recommendations for future research and implications for how health care providers can collaborate with families to discuss and manage diabetes technology.

Seasonal accumulation of persistent organic pollutants on a high altitude glacier in the Eastern Alps

The seasonal accumulations of perfluorinated substances (PFAS), polybrominated diphenyl ethers (PBDE) and polycyclic aromatic hydrocarbons (PAH) were measured in a 10 m shallow firn core from a high altitude glacier at Mt. Ortles (Italy, 3830 m above sea level) in South Tyrol in the Italian Eastern Alps. The most abundant persistent organic pollutants of each group were perfluorobutanoic acid (PFBA), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA) (for PFASs); BDE 47, BDE 99, BDE 209 (for PBDEs) and phenanthrene (PHE), fluoranthene (FLA) and pyrene (PYR) (for PAHs). All compounds show different extents of seasonality, with higher accumulation during summer time compared to winter. This seasonal difference mainly reflects meteorological conditions with a low and stable atmospheric boundary layer in winter and strong convective activity in summer, transformation processes during the transport of chemicals and/or post-depositional alterations. Change in the composition of the water-soluble PFCAs demonstrates the influence of meltwater percolation through the firn layers.

Annually resolved ice core records of tropical climate variability over the past ~1800 years

Ice cores from low latitudes can provide a wealth of unique information about past climate in the tropics, but they are difficult to recover and few exist. Here, we report annually resolved ice core records from the Quelccaya ice cap (5670 meters above sea level) in Peru that extend back ~1800 years and provide a high-resolution record of climate variability there. Oxygen isotopic ratios (δ(18)O) are linked to sea surface temperatures in the tropical eastern Pacific, whereas concentrations of ammonium and nitrate document the dominant role played by the migration of the Intertropical Convergence Zone in the region of the tropical Andes. Quelccaya continues to retreat and thin. Radiocarbon dates on wetland plants exposed along its retreating margins indicate that it has not been smaller for at least six millennia.

Late glacial stage and holocene tropical ice core records from huascaran, peru

Two ice cores from the col of Huascarán in the north-central Andes of Peru contain a paleoclimatic history extending well into the Wisconsinan (Würm) Glacial Stage and include evidence of the Younger Dryas cool phase. Glacial stage conditions at high elevations in the tropics appear to have been as much as 8 degrees to 12 degrees C cooler than today, the atmosphere contained about 200 times as much dust, and the Amazon Basin forest cover may have been much less extensive. Differences in both the oxygen isotope ratio zeta(18)O (8 per mil) and the deuterium excess (4.5 per mil) from the Late Glacial Stage to the Holocene are comparable with polar ice core records. These data imply that the tropical Atlantic was possibly 5 degrees to 6 degrees C cooler during the Late Glacial Stage, that the climate was warmest from 8400 to 5200 years before present, and that it cooled gradually, culminating with the Little Ice Age (200 to 500 years before present). A strong warming has dominated the last two centuries.

The little ice age as recorded in the stratigraphy of the tropical quelccaya ice cap

The analyses of two ice cores from a southern tropical ice cap provide a record of climatic conditions over 1000 years for a region where other proxy records are nearly absent. Annual variations in visible dust layers, oxygen isotopes, microparticle concentrations, conductivity, and identification of the historical (A.D. 1600) Huaynaputina ash permit accurate dating and time-scale verification. The fact that the Little Ice Age (about A.D. 1500 to 1900) stands out as a significant climatic event in the oxygen isotope and electrical conductivity records confirms the worldwide character of this event.

A 1500-year record of tropical precipitation in ice cores from the quelccaya ice cap, peru

Two ice cores, covering 1500 years of climatic information, from the summit (5670 meters) of the tropical Quelccaya ice cap, in the Andes of southern Peru, provide information on general environmental conditions including droughts, volcanic activity, moisture sources, temperature, and glacier net balance. The net balance record reconstructed from these cores reflects major precipitation trends for the southern Andes of Peru. These records indicate extended dry periods between 1720 and 1860, 1250 and 1310, and 570 and 610; wet conditions prevailed between 1500 and 1720. Establishing a tropical precipitation record may help explain climatic fluctuations since the tropical evaporation-precipitation cycle is a principal mechanism driving the atmospheric circulation.

El nino-southern oscillation events recorded in the stratigraphy of the tropical quelccaya ice cap, peru

Snow accumulation measured during 1982-1983 on the Quelccaya ice cap, Peru, was 70 percent of the average from 1975 through 1983. Inspection of 19 years (1964 through 1983) of accumulation measured near the summit of Quelccaya reveals a substantial decrease ( approximately 30 percent) in association with the last five El Niño-Southern Oscillation (ENSO) occurrences in the equatorial Pacific. The ENSO phenomenon is now recognized as a global event arising from large-scale interactions between the ocean and the atmosphere. Understanding this extreme event, with the goal of prediction, requires a record of past occurrences. The Quelccaya ice cap, which contains 1500 years of annually accumulated ice layers, may provide a long and detailed record of the most extreme ENSO events.

Clear goals, solid evidence, integrated systems, realistic roles

To maximize the effectiveness of home care in improving or maintaining the health of Canadians, home-care programs must have clear goals, be founded firmly on evidence of effectiveness, form part of an integrated healthcare system and be grounded in constitutional and political reality. Goals should be client-centred and distinguish between curative, supportive and preventive care. Curative and supportive home care can be cost-effective if substitution for more costly institutional services can be achieved, but the cost-effectiveness of preventive home care and comprehensive care for the elderly has not been clearly demonstrated. Integrated delivery systems are a prerequisite for effective substitution of care at home for institutional care. Federal financing dedicated to a home-care program is unnecessary and is a political and constitutional non-starter. Federal leadership for a national home-care approach would be welcome. Canada Health Act protection for access to medically necessary home care is attractive, but such protection for pharmaceuticals is a higher need. Federal support for research and demonstration of new models of care is valuable.

Isolation of bacteria and 16S rDNAs from Lake Vostok accretion ice

Lake Vostok, the largest subglacial lake in Antarctica, is separated from the surface by approximately 4 km of glacial ice. It has been isolated from direct surface input for at least 420 000 years, and the possibility of a novel environment and ecosystem therefore exists. Lake Vostok water has not been sampled, but an ice core has been recovered that extends into the ice accreted below glacial ice by freezing of Lake Vostok water. Here, we report the recovery of bacterial isolates belonging to the Brachybacteria, Methylobacterium, Paenibacillus and Sphingomonas lineages from a sample of melt water from this accretion ice that originated 3593 m below the surface. We have also amplified small-subunit ribosomal RNA-encoding DNA molecules (16S rDNAs) directly from this melt water that originated from alpha- and beta-proteobacteria, low- and high-G+C Gram-positive bacteria and a member of the Cytophaga/Flavobacterium/Bacteroides lineage.

A high-resolution millennial record of the south asian monsoon from himalayan ice cores

A high-resolution ice core record from Dasuopu, Tibet, reveals that this site is sensitive to fluctuations in the intensity of the South Asian Monsoon. Reductions in monsoonal intensity are recorded by dust and chloride concentrations. The deeper, older sections of the Dasuopu cores suggest many other periods of drought in this region, but none have been of greater intensity than the greatest recorded drought, during 1790 to 1796 A.D. of the last millennium. The 20th century increase in anthropogenic activity in India and Nepal, upwind from this site, is recorded by a doubling of chloride concentrations and a fourfold increase in dust. Like other ice cores from the Tibetan Plateau, Dasuopu suggests a large-scale, plateau-wide 20th-century warming trend that appears to be amplified at higher elevations.

A 25,000-year tropical climate history from bolivian ice cores

Ice cores that were recovered from the summit of Sajama mountain in Bolivia provide carbon-14-dated tropical records and extend to the Late Glacial Stage (LGS). Oxygen isotopic ratios of the ice decreased 5.4 per mil between the early Holocene and the Last Glacial Maximum, which is consistent with values from other ice cores. The abrupt onset and termination of a Younger Dryas-type event suggest atmospheric processes as the probable drivers. Regional accumulation increased during the LGS, during deglaciation, and over the past 3000 years, which is concurrent with higher water levels in regional paleolakes. Unlike polar cores, Sajama glacial ice contains eight times less dust than the Holocene ice, which reflects wetter conditions and extensive snow cover.

Holocene—Late Pleistocene Climatic Ice Core Records from Qinghai-Tibetan Plateau

Three ice cores to bedrock from the Dunde ice cap on the north-central Qinghai-Tibetan Plateau of China provide a detailed record of Holocene and Wisconsin-Würm late glacial stage (LGS) climate changes in the subtropics. The records reveal that LGS conditions were apparently colder, wetter, and dustier than Holocene conditions. The LGS part of the cores is characterized by more negative delta(18)O ratios, increased dust content, decreased soluble aerosol concentrations, and reduced ice crystal sizes than the Holocene part. These changes occurred rapidly approximately 10,000 years ago. In addition, the last 60 years were apparently one of the warmest periods in the entire record, equalling levels of the Holocene maximum between 6000 and 8000 years ago.

Microparticle Concentration Variations Linked with Climatic Change: Evidence from Polar Ice Cores

The microparticle concentrations in three deep ice cores reveal a substantial increase in the concentration of insoluble particles in the global atmosphere during the latter part of the last major glaciation. The ratio of the average particle concentration in the late glacial strata to that in the Holocene strata is 6/1 for the core from Dome C, Antarctica, 3/1 for the core from Byrd Station, Antarctica, and 12/1 for the core from Camp Century, Greenland. Whether this temporal correlation between increased atmospheric particle load and the lower surface temperatures is directly causal is unknown; however, the variations in these two parameters must be satisfactorily resolved in any successful hypothesis that addresses the causes of climatic change.

Climatic Ice Core Records from the Tropical Quelccaya Ice Cap

The Quelccaya Ice Cap in the easternmost glaciated mountain chain of the Peruvian Andes has been studied in four recentfield seasons. Ice cores to a depth of 15 meters have been retrieved at the summit dome (elevation, 5650 meters) and two other locations and used for microparticle, isotope, and beta radioactivity measurements. A concurrent study of the present climate and the heat and mass budgets is being made to permit a paleoclimatic interpretation of deep core records. The results indicate the need for a revision of the isotope "thermometry" for application in the tropics. However, the seasonality of the beta radioactivity, microparticle content, and isotope ratios offers the prospect of a mass balance chronology. This is important in that precipitation is believed to be a more indicative paleoclimatic parameter than temperature in the tropics.