Placental Localization and Perinatal Outcome

This retrospective case-control study was designed to investigate the relationship between placental localization and intrauterine growth restriction (IUGR). Pregnant women with an anatomic survey from January 1, 2000, to December 31, 2005, and delivery of the pregnancy at Yale-New Haven Hospital (YNHH) were identified using clinical and billing records. Multiple gestation, fetal anomaly, and incomplete medical information were reasons for exclusion. Cases (N=69) were consecutive pregnancies with evidence of IUGR (estimated fetal weight \u3c10th percentile for gestational\u3eage) at last follow-up ultrasound. Randomly selected controls (N=258) from the same time period had no evidence of IUGR. Maternal, ultrasound, delivery, and perinatal data were collected by retrospective medical record review, and IUGR cases and non-IUGR controls were compared using the Students t-test, Wilcoxon test, Chi-square analysis, Fishers exact test, and ANOVA. Placental location was determined from the anatomic survey record (obtained at 18.4 ± 1.2 weeks gestation in the IUGR group and 18.2 ± 1.0 weeks gestation in the control group; P=0.18). Multivariate logistic regression with adjustment for confounders was used to investigate the association between IUGR and placental localization. Consistent with known predictors of IUGR, the IUGR group had a higher proportion of black women (36.4% vs. 19.8%, P=0.03), chronic hypertension (26.0% vs. 3.5%, P\u3c0.001), and hypertensive disorders of pregnancy (36.2% vs. 5.0%, P\u3c0.001). Mean birth weights of IUGR and non-IUGR pregnancies differed by 2 kilograms (3244 ± 625 grams vs. 1277 ± 637 grams, P\u3c0.001). IUGR infants were more likely to receive antenatal steroids, deliver preterm, deliver by cesarean section, and be admitted to neonatal intensive care. In both IUGR and non-IUGR pregnancies, the placenta was most commonly anterior or posterior. Unilateral placentas were three times more common in the IUGR group than in the non-IUGR group (17.4% vs. 5.0%, P=0.01). IUGR pregnancies were over four times as likely as control subjects to have unilaterally-located placentas compared to anterior placentas (OR 4.8, 95% confidence interval, 1.9-11.7). Adjusting for ethnicity, chronic hypertension, and hypertensive disorders of pregnancy did not affect this finding (OR 4.6, 95% confidence interval 1.6-13.5). In conclusion, we compared a group of 69 IUGR pregnancies to 258 non-IUGR controls and found intrauterine growth restriction to be associated with unilateral placentation

Gluten-free diet intervention reduces thiamine intake in two weeks, increases glycaemic response and body weight in four weeks, with no long term nutritional deficiencies

This research investigated the effects of gluten free diet (GFD) on nutritional intake, glycaemic and insulin response. In a cross-sectional study, participants who consumed gluten-containing diet (GCD; n=11) and GFD (n=11) completed a food diary, blood glucose and insulin measurements. In a pre-post intervention study (n= 11), glycaemic and insulin responses were tested before and after four weeks of a GFD. Food intake was recorded before and after two weeks. No significant differences in nutrient intake, glycaemic or insulin responses were found in the cross-sectional study. In the intervention study, there was a significant reduction in body weight (p=0.007) and body mass index (BMI) (p=0.004) after four weeks and lower thiamine intake (p=0.021) after two weeks of GFD. Glycaemic response was significantly higher (p<0.05) following GFD with no differences in insulin response. These differences were not evident if GFD was followed for a longer period, possibly due to improved food choices

Culture-independent detection of nontuberculous mycobacteria in clinical respiratory samples

Culture-based detection of nontuberculous Mycobacteria (NTM) in respiratory samples is time consuming and can be subject to overgrowth by nonmycobacterial bacteria. We describe a single-reaction TaqMan quantitative PCR assay for the direct detection of NTM species in clinical samples that is specific, sensitive, and robust

Social rearing environment influences dog behavioral development

Early life experiences are known to influence behavior later in life. In dogs, environmental influences of early home rearing could be exploited to improve the chances of developing adult behavior most suited to the adult environment. For working dog organizations, such as Guide Dogs, suitable adult behavior is important to ensure that dogs can fulfill their role as guides for people with visual impairment. Here, we test the hypothesis that dogs' home rearing environment will influence behavioral development. To investigate this hypothesis, carers of potential guide dogs (puppy walkers) completed a questionnaire, termed the Puppy Walker Questionnaire (PWQ), about the dog's behavior at 5, 8, and 12 months of age. An additional 11 questions were answered about the home environment at the last assessment. Because no questionnaire existed which measured behavior most relevant to Guide Dogs, questions from an existing questionnaire (Canine Behaviour and Research Questionnaire) were combined with additional questions. Thus, a subsidiary aim of the study was to test the reliability of the PWQ for measuring behavioral development of potential guide dogs. The PWQ, scored on a 100-mm visual analogue scale, grouped into 5 new scales: trainability, distractibility, general anxiety, body sensitivity, and stair anxiety, with 4 Canine Behaviour and Research Questionnaire scales: excitability, separation-related behavior, attachment and attention seeking, and energy level. For each reliable scale, multivariate linear regression identified significant predictors from the home environmental questions. The results suggest that home rearing environment is indeed important for behavioral development: 9 of 11 environmental variables were significant predictors of behavioral scores. Those environmental variables that appeared most important were social in nature. Dogs were scored as higher in energy level, excitability, and distractibility if they had been raised in a home with children, lower on energy level and distractibility the more experience of puppy walking their carer had, and lower on separation-related behavior the more they had been able to play with other dogs. These findings have implications for matching between dogs' early and later home environments. Follow-up of dogs in this study could help to elucidate effects on guiding suitability and matching between dog and guide dog owner

Test-retest reliability and predictive validity of a juvenile guide dog behavior test

The ability to measure stable and consistent behavioral traits in dogs would facilitate selection and assessment of working dogs, such as guide dogs. Ideally, these measures should predict suitability for the working role from a young age. This study assessed test-retest reliability of a juvenile guide dog behavior test and predictive validity using qualification or withdrawal from guide dog training. Ninety-three guide dog puppies (52 female; 41 male) were tested at 5 (mean 4.78; ±0.73 SD) and 8 (mean 7.98; ±0.78 SD) months of age. The dogs were exposed to a sequence of 11 stimuli designed to assess the dogs’ reactions to meeting a stranger, obedience commands, body sensitivity, scavenging, and “animal” and human distractions. The behavior of dogs was digitally recorded and analyzed using an ethogram incorporating both frequency of behavior and specific reactions to stimuli. Test-retest reliability indicated interindividual consistency in many of the behavioral measures such as jumping, barking, and “low” greeting posture, as defined in our ethogram. Behavior measures that did not show interindividual consistency between tests included obedience responses, lip licking, body shaking, and scratching. Binary logistic regression models revealed 7 behavioral measures at 5 months and 5 measures at 8 months that were significantly associated with qualification or withdrawal. Uncorrelated measures and principal component scores of correlated measures were combined in a logistic regression model that showed great potential for predicting the probability of a dog qualifying or being withdrawn from guide dog training

Experiences of Receiving a Diagnosis of Autism Spectrum Disorder: A Survey of Adults in the United Kingdom

A total of 128 adults with high-functioning autism spectrum disorders were surveyed concerning the process they went through to obtain their diagnosis and the subsequent support they received. Results suggested that routes to diagnosis were quite heterogeneous and overall levels of satisfaction with the diagnostic process were mixed; 40 % of respondents were ‘very/quite’ dissatisfied, whilst 47 % were ‘very/quite’ satisfied. The extent of delays, number of professionals seen, quality of information given at diagnosis and levels of post-diagnostic support predicted overall satisfaction with the diagnostic process. Important areas and suggestions for improvement were noted for all stages of the diagnostic pathway. Respondents also displayed above average levels of depressed mood and anxiety, with greater support being requested in this area

An evidence-based decision assistance model for predicting training outcome in juvenile guide dogs

Working dog organisations, such as Guide Dogs, need to regularly assess the behaviour of the dogs they train. In this study we developed a questionnaire-style behaviour assessment completed by training supervisors of juvenile guide dogs aged 5, 8 and 12 months old (n = 1,401), and evaluated aspects of its reliability and validity. Specifically, internal reliability, temporal consistency, construct validity, predictive criterion validity (comparing against later training outcome) and concurrent criterion validity (comparing against a standardised behaviour test) were evaluated. Thirty-nine questions were sourced either from previously published literature or created to meet requirements identified via Guide Dogs staff surveys and staff feedback. Internal reliability analyses revealed seven reliable and interpretable trait scales named according to the questions within them as: Adaptability; Body Sensitivity; Distractibility; Excitability; General Anxiety; Trainability and Stair Anxiety. Intra-individual temporal consistency of the scale scores between 5±8, 8±12 and 5±12 months was high. All scales excepting Body Sensitivity showed some degree of concurrent criterion validity. Predictive criterion validity was supported for all seven scales, since associations were found with training outcome, at at-least one age. Thresholds of z-scores on the scales were identified that were able to distinguish later training outcome by identifying 8.4% of all dogs withdrawn for behaviour and 8.5% of all qualified dogs, with 84% and 85% specificity. The questionnaire assessment was reliable and could detect traits that are consistent within individuals over time, despite juvenile dogs undergoing development during the study period. By applying thresholds to scores produced from the questionnaire this assessment could prove to be a highly valuable decision-making tool for Guide Dogs. This is the first questionnaire-style assessment of juvenile dogs that has shown value in predicting the training outcome of individual working dogs

Outcomes following SARS-CoV-2 infection in patients with primary and secondary immunodeficiency in the UK

In March 2020, the United Kingdom Primary Immunodeficiency Network (UKPIN) established a registry of cases to collate the outcomes of individuals with PID and SID following SARS-CoV-2 infection and treatment. A total of 310 cases of SARS-CoV-2 infection in individuals with PID or SID have now been reported in the UK. The overall mortality within the cohort was 17.7% (n = 55/310). Individuals with CVID demonstrated an infection fatality rate (IFR) of 18.3% (n = 17/93), individuals with PID receiving IgRT had an IFR of 16.3% (n = 26/159) and individuals with SID, an IFR of 27.2% (n = 25/92). Individuals with PID and SID had higher inpatient mortality and died at a younger age than the general population. Increasing age, low pre-SARS-CoV-2 infection lymphocyte count and the presence of common co-morbidities increased the risk of mortality in PID. Access to specific COVID-19 treatments in this cohort was limited: only 22.9% (n = 33/144) of patients admitted to the hospital received dexamethasone, remdesivir, an anti-SARS-CoV-2 antibody-based therapeutic (e.g. REGN-COV2 or convalescent plasma) or tocilizumab as a monotherapy or in combination. Dexamethasone, remdesivir, and anti-SARS-CoV-2 antibody-based therapeutics appeared efficacious in PID and SID. Compared to the general population, individuals with PID or SID are at high risk of mortality following SARS-CoV-2 infection. Increasing age, low baseline lymphocyte count, and the presence of co-morbidities are additional risk factors for poor outcome in this cohort

Verbal, visual, and intermediary support for child witnesses with autism during investigative interviews

Three promising investigative interview interventions were assessed in 270 children (age 6-11 years): 71 with autism spectrum disorder (ASD) and 199 who were typically developing (TD). Children received ‘Verbal Labels’, ‘Sketch Reinstatement of Context’ or ‘Registered Intermediary’ interviews designed to improve interview performance without decreasing accuracy. Children with ASD showed no increases in the number of correct details recalled for any of the three interview types (compared to a Best-Practice police interview), whereas TD children showed significant improvements in the Registered Intermediary and Verbal Labels interviews. Findings suggested that children with ASD can perform as well as TD children in certain types of investigative interviews, but some expected benefits (e.g., of Registered Intermediaries) were not apparent in this study