Birth cohort-specific consideration in an Emergency Department Hepatitis C Testing Programme: A description of age-related characteristics and outcomes

The emergency department (ED) has increasingly become an important public health partner in non-targeted hepatitis C virus (HCV) testing and referral to care efforts. HCV has traditionally been an infection associated with the Baby Boomer generation; however, recent exacerbation of the opioid epidemic has resulted in a growing number of younger cohorts, namely Millennials, also impacted by HCV. Examination of this age-related demographic shift, including subsequent linkage success and linkage barriers, from the perspective of an ED-based testing and linkage programme may have implications for future population and health systems interventions. A retrospective descriptive chart review was performed, inclusive of data from August 2015 through December 2020. We compared the quantity of positive HCV screening antibody (Ab) and confirmatory (RNA) tests and further considered linkage rates and correlative demographics (e.g. gender, race). Patient barriers to HCV care linkage (e.g. substance misuse, lack of health insurance, homelessness) were also evaluated. The data set was disaggregated by birth cohort to include Silent Generation (SG) (1928-45), Baby Boomer (BB) (1946-64), Generation X (Gen X) (1965-80), Millennial (1981-96) and Generation Z (1997-2012). Descriptive statistics and chi-square analysis were performed. Overall, 83,817 patients were tested for HCV (50.6% of eligible); 6187 (7.4%) were HCV Ab positive, and 2665 were HCV RNA positive (3.2%). RNA-positive individuals were more likely to be white (70.4%) and male (67.7%); generational distribution was similar (BB 33.3%, Gen X 32.0% and Millennials 32.7%). Amongst Ab-positive patients, white (45.5%), male (47.2%) and Millennial (49.7%) individuals were most likely to be RNA-positive. Overall, 28.1% of the RNA-positive cohort successfully linked to care; linkage to care rates were significantly higher in older generations (38.1% in BB vs. 17.8% in Millennials) (p < .00001). Over 90% were identified as having at least one linkage to care barrier. Younger generations (Gen X and Millennials) were disproportionately impacted by linkage barriers, including incarceration, lack of health insurance, history of mental health and substance use disorders, as well as history of or active injection drug use (IDU) (p < .00001). Older generations (SG and BB) were more likely to be impacted by competing medical comorbidities (p < .00001). The ED population represents a particularly vulnerable, at-risk cohort with a high prevalence of HCV and linkage to care barriers. While past HCV-specific recommendations and interventions have focused on Baby Boomers, this data suggests that younger generations, including Gen X and Millennials, are increasingly affected by HCV and face disparate social risk and social need factors which impede definitive care linkage and treatment.

Emergency department-based interventions affecting social determinants of health in the United States: A scoping review

BACKGROUND

Social determinants of health (SDoH) have significant implications for health outcomes in the United States. Emergency departments (EDs) function as the safety nets of the American health care system, caring for many vulnerable populations. ED-based interventions to assess social risk and mitigate social needs have been reported in the literature. However, the breadth and scope of these interventions have not been evaluated. As the field of social emergency medicine (SEM) expands, a mapping and categorization of previous interventions may help shape future research. We sought to identify, summarize, and characterize ED-based interventions aimed at mitigating negative SDoH.

METHODS

We conducted a scoping review to identify and characterize peer-reviewed research articles that report ED-based interventions to address or impact SDoH in the United States. We designed and conducted a search in Medline, CINAHL, and Cochrane CENTRAL databases. Abstracts and, subsequently, full articles were reviewed independently by two reviewers to identify potentially relevant articles. Included articles were categorized by type of intervention and primary SDoH domain. Reported outcomes were also categorized by type and efficacy.

RESULTS

A total of 10,856 abstracts were identified and reviewed, and 596 potentially relevant studies were identified. Full article review identified 135 articles for inclusion. These articles were further subdivided into three intervention types: a) provider educational intervention (18%), b) disease modification with SDoH focus (26%), and c) direct SDoH intervention (60%), with 4% including two "types." Articles were subsequently further grouped into seven SDoH domains: 1) access to care (33%), 2) discrimination/group disparities (7%), 3) exposure to violence/crime (34%), 4) food insecurity (2%), 5) housing issues/homelessness (3%), 6) language/literacy/health literacy (12%), 7) socioeconomic disparities/poverty (10%). The majority of articles reported that the intervention studied was effective for the primary outcome identified (78%).

CONCLUSION

Emergency department-based interventions that address seven different SDoH domains have been reported in the peer-reviewed literature over the past 30 years, utilizing a variety of approaches including provider education and direct and indirect focus on social risk and need. Characterization and understanding of previous interventions may help identify opportunities for future interventions as well as guide a SEM research agenda.

Ultrasound-guided transurethral urinary bladder biopsy using an endoscopic biopsy forceps in dogs: 27 cases (2016-2019)

OBJECTIVES

To describe an ultrasound-guided transurethral bladder biopsy technique using endoscopic forceps and its results in dogs of different sizes with different lesion locations.

MATERIALS AND METHODS

Medical records of dogs that underwent ultrasound-guided transurethral bladder biopsy with endoscopic forceps were retrospectively reviewed. Patient signalment, lesion location, use of urinary catheter as a guide, outcome of the procedure and histopathology results were retrieved.

RESULTS

Twenty-seven dogs underwent this procedure. Biopsy samples were successfully obtained in 23 dogs. Insertion of the endoscopic forceps without a urinary catheter allowed the procedure to be performed in patients with a small urethral diameter without complication. The procedure was unsuccessful in dogs with a urethral diameter smaller than the outer diameter of the biopsy forceps (i.e. 1.8 mm), either due to small patient size or obstructive urethral lesion. All biopsy samples allowed histopathological diagnosis. No complications were reported after the procedure.

CLINICAL SIGNIFICANCE

This non-invasive biopsy technique should be considered in patients with bladder lesions in which histopathological diagnosis is needed, especially when endoscopic examination is not feasible. By use of the Doppler mode, biopsy retrieval was safe also when the lesion ​was highly vascularised.

The European carbon cycle response to heat and drought as seen from atmospheric CO2 data for 1999-2018

In 2018, central and northern parts of Europe experienced heat and drought conditions over many months from spring to autumn, strongly affecting both natural ecosystems and crops. Besides their impact on nature and society, events like this can be used to study the impact of climate variations on the terrestrial carbon cycle, which is an important determinant of the future climate trajectory. Here, variations in the regional net ecosystem exchange (NEE) of CO₂ between terrestrial ecosystems and the atmosphere were quantified from measurements of atmospheric CO₂ mole fractions. Over Europe, several observational records have been maintained since at least 1999, giving us the opportunity to assess the 2018 anomaly in the context of at least two decades of variations, including the strong climate anomaly in 2003. In addition to an atmospheric inversion with temporally explicitly estimated anomalies, we use an inversion based on empirical statistical relations between anomalies in the local NEE and anomalies in local climate conditions. For our analysis period 1999–2018, we find that higher-than-usual NEE in hot and dry summers may tend to arise in Central Europe from enhanced ecosystem respiration due to the elevated temperatures, and in Southern Europe from reduced photosynthesis due to the reduced water availability. Despite concerns in the literature, the level of agreement between regression-based NEE anomalies and temporally explicitly estimated anomalies indicates that the atmospheric CO₂ measurements from the relatively dense European station network do provide information about the year-to-year variations of Europe’s carbon sources and sinks, at least in summer.

This article is part of the theme issue ‘Impacts of the 2018 severe drought and heatwave in Europe: from site to continental scale’.

History of El Niño impacts on the global carbon cycle 1957-2017: a quantification from atmospheric CO2 data

Interannual variations in the large-scale net ecosystem exchange (NEE) of CO₂ between the terrestrial biosphere and the atmosphere were estimated for 1957-2017 from sustained measurements of atmospheric CO₂ mixing ratios. As the observations are sparse in the early decades, available records were combined into a 'quasi-homogeneous' dataset based on similarity in their signals, to minimize spurious variations from beginning or ending data records. During El Niño events, CO₂ is anomalously released from the tropical band, and a few months later also in the northern extratropical band. This behaviour can approximately be represented by a linear relationship of the NEE anomalies and local air temperature anomalies, with sensitivity coefficients depending on geographical location and season. The apparent climate sensitivity of global total NEE against variations in pan-tropically averaged annual air temperature slowly changed over time during the 1957-2017 period, first increasing (though less strongly than in previous studies) but then decreasing again. However, only part of this change can be attributed to actual changes in local physiological or ecosystem processes, the rest probably arising from shifts in the geographical area of dominating temperature variations.This article is part of a discussion meeting issue 'The impact of the 2015/2016 El Niño on the terrestrial tropical carbon cycle: patterns, mechanisms and implications'.

Warming effects on the urban hydrology in cold climate regions

While approximately 338 million people in the Northern hemisphere live in regions that are regularly snow covered in winter, there is little hydro-climatologic knowledge in the cities impacted by snow. Using observations and modelling we have evaluated the energy and water exchanges of four cities that are exposed to wintertime snow. We show that the presence of snow critically changes the impact that city design has on the local-scale hydrology and climate. After snow melt, the cities return to being strongly controlled by the proportion of built and vegetated surfaces. However in winter, the presence of snow masks the influence of the built and vegetated fractions. We show how inter-year variability of wintertime temperature can modify this effect of snow. With increasing temperatures, these cities could be pushed towards very different partitioning between runoff and evapotranspiration. We derive the dependency of wintertime runoff on this warming effect in combination with the effect of urban densification.

New Insights into the Neural Differentiation Potential of Canine Adipose Tissue-Derived Mesenchymal Stem Cells

Adipose tissue-derived stem cells (ASCs) can be obtained from different adipose tissue sources within the body. It is an abundant cell pool, easily accessible, suitable for cultivation and expansion in vitro and preparation for therapeutic approaches. Amongst these therapeutic approaches are tissue engineering and nervous system disorders such as spinal cord injuries. For such treatment, ASCs have to be reliably differentiated in to the neuronal direction. Therefore, we investigated the neural differentiation potential of ASCs using protocols with neurogenic inductors such as valproic acid and forskolin, while dog brain tissue served as control. Morphological changes could already be noticed 1 h after neuronal induction. Gene expression analysis revealed that the neuronal markers nestin and βIII-tubulin as well as MAP2 were expressed after induction of neuronal differentiation. Additionally, the expression of the neurotrophic factors NGF, BDNF and GDNF was determined. Some of the neuronal markers and neurotrophic factors were already expressed in undifferentiated cells. Our findings point out that ASCs can reliably be differentiated into the neuronal lineage; therefore, these cells are a suitable cell source for cell transplantation in disorders of the central nervous system. Follow-up studies would show the clinical benefit of these cells after transplantation.

Prevalence, location and concurrent diseases of ultrasonographic cyst-like lesions of abdominal lymph nodes in dogs

Lymph nodal cyst-like lesions are occasionally identified during abdominal ultrasound in dogs. However, a study evaluating their prevalence and clinical significance is lacking. The aim of this observational cross-sectional study was to evaluate prevalence, most common location and concurrent diseases of cyst-like lymph nodes detected during abdominal ultrasound. Affected lymph nodes, patient signalment and concurrent diseases of dogs with cyst-like lymph nodal lesions having undergone abdominal ultrasound over a one-year period were recorded. Twenty-three affected lymph nodes were observed in 17/553 dogs (prevalence=3 per cent). The most commonly affected was the lumbar lymphocenter (7/23), followed by the coeliac (6/23), the cranial mesenteric (5/23) and the iliosacral (5/23). Twenty-three concurrent diseases were diagnosed in 17 dogs, among which 16/23 were non-neoplastic (70 per cent). The most common concurrent disease was renal insufficiency (8/23), followed by neoplasia (7/23), gastroenteropathy (3/23), benign prostatic disease (2/23), pancreatitis (1/23), peritonitis (1/23) and neurological disease (1/23). No statistical correlation existed between cyst-like lymph nodal lesion and a specific neoplastic or non-neoplastic disease. In conclusion, in the present study, cyst-like lymph nodal lesions have a low prevalence, involve different lymphocenters and were found in dogs affected by different diseases, including both non-neoplastic and neoplastic aetiologies.

Canine Hyperplastic Intraepidermal Pustular and Suprabasal Acantholytic Dermatosis with Features of Human Pemphigus Vegetans

Pemphigus vegetans is a rare autoimmune blistering acantholytic dermatosis of humans that combines unusually hyperplastic and verrucous pustular skin lesions and mucosal erosions. We report herein the clinical, histopathologic, and immunologic findings in a dog whose lesions resembled, but were not identical to, those of human pemphigus vegetans. A 4-year-old male Greater Swiss Mountain Dog presented with multifocal cutaneous verrucous and crusted papules and pustules, as well as skin and mucosal erosions and ulcers. Microscopic lesions consisted of exophytic papillated epidermal hyperplasia, superficial and deep intraepidermal acantholytic neutrophilic and eosinophilic pustules, and suprabasal epidermal clefts leaving rounded basal keratinocytes at the bottom of the vesicles. Direct and indirect immunofluorescence revealed antikeratinocyte IgG autoantibodies. Immunoprecipitation immunoblotting and immunoabsorption experiments with recombinant canine desmogleins confirmed that autoantibodies recognized desmoglein-1. In this dog, clinical and histopathologic features resembled those of human pemphigus vegetans, while circulating autoantibodies against canine desmoglein-1 were solely identified. This antigen target is different from that of the human disease in which antidesmoglein-3 autoantibodies are detected most commonly.

Children with autism respond differently to spontaneous, elicited and deferred imitation

BACKGROUND

Imitation, a key vehicle for both cognitive and social development, is often regarded as more difficult for children with autism spectrum disorders (ASD) than for children with Down syndrome (DS) or typically developing (TD) children. The current study investigates similarities and differences in observed elicited, spontaneous and deferred imitation using both actions with objects and gestures as imitation tasks in these groups.

METHODS

Imitation among 19 children with autism was compared with 20 children with DS and 23 TD children matched for mental and language age.

RESULTS

Elicited imitation resulted in significantly lower scores for the ASD group compared with the other two groups, an effect mainly carried by a low level of gesture imitation among ASD children. We observed no differences among the groups for spontaneous imitation. However, children with ASD or DS displayed less deferred imitation than the TD group. Proneness to imitate also differed among groups: only 10 (53%) of the children with autism responded in the elicited imitation condition compared with all children with DS and almost all TD children (87%).

CONCLUSIONS

These findings add to our understanding of the kind of imitation difficulties children with ASD might have. They also point to the necessity of not equating various imitation measures because these may capture different processes and be differently motivating for children with autism.

Ultrasonographic and histopathological findings of gastric adenocarcinoma in a uremic cat

Gastric carcinoma is very rare in cats. In this case report, a gastric adenocarcinoma in a chronically uremic cat is described. The cat presented with vomiting, dysorexia and weight loss. The ultrasound examination demonstrated an ultrasonographic pseudolayering effect on the gastric wall, which is suggested as a specific sign of adenocarcinoma. On histopathology, this adenocarcinoma was organized, and a continuous intralymphatic infiltration line was visible underneath the muscularis mucosae, which might explain the pseudolayering effect.

Imitation in autism. A preliminary research note

Previous studies have claimed that children with autism are poor imitators and a lack of imitative capacity has been included by some investigators as one early sign of autism. Presented here are results from a pilot study focusing on observed imitation after presenting 15 tasks to five children with autism (mental age 25-51 months). Imitation tasks involving simple object manipulation, vocal responses, facial and manual gestures, and object substitution were presented to each child. The performance of the children with autism is compared with (1) three normal 4-year-old children (for all 15 tasks), and (2) observations from 28 healthy 1-year-olds (for 10 of the tasks used). The findings indicate that the autistic group displayed the highest level of imitation on object manipulation and vocal tasks while object substitution, facial, and motor imitation acts seemed to be difficult for children with autism. However, the small number of children included as well as the individual variation observed among the autistic subjects precludes any definite conclusions from these pilot observations. It is hypothesized that imitation in children with autism has to be studied separately for different domains and probably also for different subgroups within the autistic population.

P01-295-Communication impairments in children with attention deficit hyperactivity disorder

Introduction

Communication disorders are often described in children with Attention Deficit Hyperactivity Disorder (AD/HD), but language related problems are neither among the cardinal features nor required to fulfil diagnostic criteria of AD/HD.

Objective

To investigate communication impairments in a group of children with AD/HD compared to a group of Typically Developing (TD) children.

Methods

Fifty-six Norwegian children aged 6–15 years participated. The AD/HD group consisted of 28 children and was matched on age and gender with a TD group. The parents completed a Norwegian translation of the Children's Communication Checklist Second Edition (CCC-2).

Results

In the AD/HD group communication impairment was identified in 23 out of 28 children (82.1%) compared to only one child in the TD group (3.6%). The two groups differed significantly on 9 out of 10 subscales of the CCC-2, as well as on the GCC (MANOVA, p ≤ .001).

Conclusions

Children with AD/HD are likely to exhibit communication problems relative to typically developing children. The two groups differed on 9 out of 10 subscales on the CCC-2. These results add to the growing body of research showing that communication disorders are frequent among children with AD/HD. They underline the importance of routine screening of communication to be performed as part of the assessment procedure in children with AD/HD.

Outbreak of betanodavirus infection in tilapia, Oreochromis niloticus (L.), in fresh water

A betanodavirus associated with a massive mortality was isolated from larvae of tilapia, Oreochromis niloticus, maintained in fresh water at 30 degrees C. Histopathology revealed vacuolation of the nervous system, suggesting an infection by a betanodavirus. The virus was identified by indirect fluorescent antibody test in the SSN1 cell line and further characterized by sequencing of a PCR product. Sequencing of the T4 region of the coat protein gene indicated a phylogenetic clustering of this isolate within the red-spotted grouper nervous necrosis virus type. However, the tilapia isolate formed a unique branch distinct from other betanodavirus isolates. The disease was experimentally reproduced by bath infection of young tilapia at 30 degrees C. The reservoir of virus at the origin of the outbreak remains unidentified. To our knowledge, this is the first report of natural nodavirus infection in tilapia reared in fresh water.

Clinical, Histologic, and Immunohistochemical Analyses of Feline Squamous Cell Carcinoma In Situ

Actinic keratosis (AK) and Bowenoid in situ carcinoma (BISC) are two distinct forms of in situ squamous cell carcinoma in felines. They usually occur on different locations and present with specific clinical and histologic features. However, in some cases, these diseases cannot be distinguished either clinically or histopathologically. The aim of the present study was to determine the accuracy of diagnosis based on clinical or histologic criteria alone, and whether immunohistochemistry for papillomavirus or p53 can improve the accuracy of diagnosis. A series of in situ squamous cell carcinoma cases ( n = 45) were selected according to their location and initial histologic classification and subsequently classified as AK ( n = 22) or BISC ( n = 23) according to the clinical criteria and were reevaluated histologically by 2 dermatopathologists. All BISC cases and most of the AK cases ( n = 15) were confirmed histologically. In 7 cases clinically classified as AK, this diagnosis was not unanimously confirmed histologically because of the presence of overlapping features. P53 immunoreactivity was observed in 11/14 (79%) confirmed AK cases and in 4/22 (18%) BISC cases, while papillomavirus antigen was not detected in any confirmed AK case but was detected in 11/23 (48%) BISC cases. It was concluded that BISC can usually be reliably diagnosed histologically. The histologic diagnosis of lesions clinically suggestive of AK might sometimes be difficult. Results of immunohistochemistry for p53 and papillomavirus antigen were supportive for a role of sun exposure and papillomavirus in the pathogenesis of AK and BISC, respectively.

Diffusion Tensor Imaging (DTI) und seine entwicklungspsychiatrische Bedeutung

Diffusion tensor MR imaging (DTI) can provide in vivo unique information on integrity of white matter structures (anisotropy) and connectivity (fiber tracking) in the human brain. This is made possible by means of non-invasive MR-based technique. The purpose of this article is to review the method and the current applications of diffusion tensor MR imaging. Studies of the past decade featuring relevant neuropsychiatric disorders as well as disorders in child psychiatry are reviewed. Furthermore, this report offers a summary of DTI-studies in children and adolescents showing alterations in brain or CNS structures including neurological, traumatological and oncological investigations. In particular, it focuses on the importance of this method with respect to exploration of normal and pathological brain development.

Psychological follow-up study of 5-year-old ICSI children

BACKGROUND

The developmental outcomes of children born after ICSI are still a matter of concern. The purpose of the present study was to investigate psychological outcomes for 5-year-old children born after ICSI and compare these with outcomes for children born after spontaneous conception (SC).

METHODS

Three hundred singleton children born after ICSI in Belgium, Sweden and the USA were matched by maternal age, child age and gender. Outcome measures included the Wechsler Preschool and Primary scales of intelligence (WPPSI-R), Peabody Developmental Motor Scales, Parenting Stress Index and Child Behaviour Checklist.

RESULTS

Regarding cognitive development, no significant differences were found on WPPSI-R verbal and performance scales between ICSI and SC children. However, some differences were noted on subtests of the Performance Scale. ICSI children more often obtained a score below 1 SD of the mean on the subtests: Object Assembly, Block Design and Mazes (all P<0.05). Significant differences by site (i.e. Belgium, Sweden and New York) were found on subtests related to parenting stress, child behaviour problems and motor development (all P<0.05). These findings can probably be explained by variables other than conception mode, such as cultural differences and selection bias.

CONCLUSIONS

Although the finding that a higher proportion of ICSI children obtained scores below the cut-off on some of the visual-spatial subscales of the WPPSI-R warrants further investigation, ICSI does not appear to affect the psychological well-being or cognitive development at age 5.

Resolution of chylothorax after resection of rib chondroma in a dog

A six-year-old, male dobermann was presented with a history of dyspnoea and bouts of coughing. Radiography and computed tomography of the thorax showed pleural effusion and a well-circumscribed, calcified mass of 10 cm in diameter, appearing to originate from the left first rib. Thoracocentesis revealed that the pleural fluid was chylous in nature. An incisional biopsy was performed, which gave a histological diagnosis of chondroma. Resolution of the chylothorax after en-bloc surgical removal of the tumour suggested that the rib tumour was the initiating cause of the chylothorax. Seventeen months later, rib neoplasia recurred without pleural effusion, and was removed successfully. To the authors' knowledge, rib chondroma, which is an unusual tumour in dogs, has not been previously documented as a cause of chylothorax.

Recent patterns and mechanisms of carbon exchange by terrestrial ecosystems

Knowledge of carbon exchange between the atmosphere, land and the oceans is important, given that the terrestrial and marine environments are currently absorbing about half of the carbon dioxide that is emitted by fossil-fuel combustion. This carbon uptake is therefore limiting the extent of atmospheric and climatic change, but its long-term nature remains uncertain. Here we provide an overview of the current state of knowledge of global and regional patterns of carbon exchange by terrestrial ecosystems. Atmospheric carbon dioxide and oxygen data confirm that the terrestrial biosphere was largely neutral with respect to net carbon exchange during the 1980s, but became a net carbon sink in the 1990s. This recent sink can be largely attributed to northern extratropical areas, and is roughly split between North America and Eurasia. Tropical land areas, however, were approximately in balance with respect to carbon exchange, implying a carbon sink that offset emissions due to tropical deforestation. The evolution of the terrestrial carbon sink is largely the result of changes in land use over time, such as regrowth on abandoned agricultural land and fire prevention, in addition to responses to environmental changes, such as longer growing seasons, and fertilization by carbon dioxide and nitrogen. Nevertheless, there remain considerable uncertainties as to the magnitude of the sink in different regions and the contribution of different processes.

Interaction patterns between children and their teachers when using a specific multimedia and communication strategy: observations from children with autism and mixed intellectual disabilities

This study reports on observed interaction patterns between 20 children with autism and mixed intellectual disabilities (mean chronological age = 11:4 years; language age = 4:7 years) and their nine teachers working with a specially developed multimedia program aiming to increase literacy skills. An increase in verbal expression was found over time for the total group. Children with autism also showed increased enjoyment and willingness to seek help from their teachers. Teachers for both diagnostic groups reduced their instructions on how to handle the computer during the program but the decrease was greater in the teachers for children with autism. When the total group of children was subdivided according to language age (high versus low), it appears that those with a low language age showed an increase in verbal expressiveness from start to end of training. Those with a high language age showed increased enjoyment. It is concluded that more detailed studies of the interaction patterns between teachers and children are needed, and these should be related to children's language level as well as to diagnostic group.

Climate change. Managing forests after Kyoto

The Kyoto protocol aims to reduce carbon emissions into the atmosphere. Part of the strategy is the active management of terrestrial carbon sinks, principally through afforestation and reforestation. In their Perspective, Schulze et al. argue that the preservation of old-growth forests may have a larger positive effect on the carbon cycle than promotion of regrowth.

High mortality rate associated with bovine respiratory syncytial virus (BRSV) infection in Belgian white blue calves previously vaccinated with an inactivated BRSV vaccine

In a group of 60 Belgian White Blue calves less than 8 months old still housed in barns, a bovine respiratory syncytial virus (BRSV) outbreak was revealed on the basis of a direct diagnosis (immunofluorescence and virus isolation) performed on the lungs of dead animals, and the kinetics of BRSV neutralizing antibodies. Clinical signs, macroscopical and microscopical pulmonary lesions were also compatible with a BRSV infection. This outbreak is peculiar because the 35 oldest calves (204 +/- 29 days old) had been vaccinated 3-4 months before with an inactivated BRSV vaccine and 30% of these animals had died of respiratory distress. While they experienced a mild respiratory symptomatology, no death was recorded among the 25 youngest calves (69 +/- 29 days old) which had been left unvaccinated. Another peculiarity was found at the histological level where a massive infiltration of eosinophils was demonstrated in the pulmonary tissues of the dead animals. Together these data parallel the dramatic story described 30 years ago in children previously vaccinated with a formalin-inactivated human RSV (HRSV) vaccine upon a natural HRSV challenge. This illustrates that an immunopathological phenomenon also takes place after BRSV vaccination in cattle.

Imitation in eight young infants with Down's syndrome

Imitation of tongue protrusion and mouth opening was studied in eight infants with Down's syndrome. Five of the children were observed at approximately 1 mo, seven around 3 mo, and seven at 4 mo. The only significant group result revealed imitation of tongue protrusion at 1 mo. In addition, a descriptive analysis of each child's response pattern during the presentation period showed that all five children observed at 1 mo imitated tongue protrusion and that four of them also seemed to imitate mouth opening. The result for the 3-mo observation was some-what inconsistent. All but one of the infants increased their response rates of both tongue protrusion and mouth opening when mouth opening was modeled. At 4 mo imitation seems to disappear. Overall, the findings are in agreement with what is known from typically developing children.

N-terminal protease of pestiviruses: identification of putative catalytic residues by site-directed mutagenesis

Pestiviruses are the only members of the Flaviviridae that encode a nonstructural protease at the N terminus of their polyproteins. This N-terminal protease (Npro) cleaves itself off of the nascent polyprotein autocatalytically and thereby generates the N terminus of the adjacent viral capsid protein C. In previous reports, sequence similarities between Npro and the catalytic residues of papain-like cysteine proteases were put forward. To test this hypothesis, substitutions of cysteine and histidine residues within Npro were carried out by site-directed mutagenesis. Translation of the mutagenized Npro-C proteins in cell-free lysates confirmed that only the predicted Cys69 was an essential amino acid for proteolysis, not His130. Further essential residues were identified with His49 and Glu22. While it remains speculative whether Glu22-His49-Cys69 actually build a catalytic triad, these results invalidate the assumption that Npro is a papain-like cysteine protease.

Early dynamics of acute extradural and subdural hematomas

In a retrospective study volumes of 42 extradural and 102 subdural traumatic hematomas were evaluated. Results were related with the time interval between injury and initial CT scan, outcome, coma grade and subject age. Mean volumes were found to increase with time after the injury. In the first hour volumes of 8 intracranial hematomas were hardly space consuming, while they became clearly space consuming in the second and in later hours after the injury. It was therefore concluded that it should not take longer than one hour until a CT scan be performed when an intracranial post-traumatic hematoma is suspected in the comatose patient.

Increasing reading and communication skills in children with autism through an interactive multimedia computer program

This paper reports on the effect of using an interactive and child-initiated microcomputer program (Alpha) when teaching three groups of children (N = 30) reading and communications skills: (a) 11 children with autism (M chronological age, CA = 9:4 years), (b) 9 children with mixed handicaps (M CA = 13:1), and (c) 10 normal preschool children (M CA = 6:4 years). Their mental age varied from 5:8 years to 6:9 years and all children received computer instruction supplementary to their regular reading and writing activities. Tests of reading and phonological development were carried out at the onset of the training (Start), at the end (Post 1), and at a follow-up evaluation (Post 2). In addition, video observations of the childrens' verbal and nonverbal communication were added at Start and Post 1. The children with autism increased both their word reading and their phonological awareness through the use of the Alpha program. Clearly significant gains were observed during the intervention, but none during the follow-up period. A similar but weaker pattern is observed for the children with mixed handicaps. In contrast, the normal preschool children increased their scores regardless of the program. Analyses of the children's classroom behavior indicate that the intervention succeeded in stimulating verbal expressions among the children with autism and mixed handicap. A significant increase in enjoyment was also noted for the children with autism. It is concluded that the intervention with a motivating multimedia program might stimulate reading and communication in children with various developmental disabilities, but that such interventions must be individually based and include both detailed planning and monitoring from teachers, and parents, as well as from clinicians in charge.

Influence of tyrosine residues Y705 and Y807 on the transforming potency of the v-fms oncogene product of feline sarcoma virus

Cell transformation is characterized by overt changes in growth control and cell morphology. To study the role of tyrosine residues Y705 and Y807 of v-Fms of the McDonough strain of feline sarcoma virus in cell transformation we replaced them individually with phenylalanine residues. Cells expressing the mutant genes showed mitogenic properties similar to wild-type v-Fms transformed cells. However, the morphology of cells expressing the Y807F mutant remained the same as nontransformed cells. Four phosphoproteins of 190, 120, 55 and 50 kDa were detected in cells expressing the wild-type but were absent in cells expressing the mutant Y807F-v-fms gene.