Fetal extraperitoneal rectal perforation: A case report

Fetal extraperitoneal rectal perforation is a very rare condition, but prompt diagnosis and appropriate treatment produce overall good outcome. Its etiology and pathophysiology are poorly understood. Only 16 cases have been reported worldwide. We report another case of fetal extraperitoneal rectal perforation managed by us.Keywords: extraperitoneal, fetal, rectal perforation Department of Pediatric Surgery, Choithram Hospital & Research Centre, Indore, Madhya Pradesh,  Indi

A study on enhancement techniques for electrocardiogram signals

Electrocardiogram (ECG) is a noninvasive technique that is used as a diagnostic tool for cardiovascular diseases. During the acquisition and transmission of ECG signals, different noises get embedded with it such as channel noise, muscle artifacts, electrode motion and baseline wander. In this project two techniques for ECG enhancement is proposed. The first method is based on Empirical Mode Decomposition and second method is based on time-frequency domain filtering using S-Transform. The performance of both techniques is compared with commonly used Wavelet Transform (WT) ECG enhancement technique. In EMD based ECG enhancement technique, the noisy ECG signal is initially decomposed into a set of Intrinsic Mode Functions (IMFs). In this method, the IMFs which are dominated by noise are automatically determined using Spectral Flatness (SF) measure and then filtered using butterworth filters to remove noise. This method gives good performance with high SNR and lower RMSE for channel noise. However, the method fails to provide signal enhancement for other types of noises. In S-Transform based enhancement technique, noisy ECG signal is represented in time-frequency domain using S-Transform. Next, masking and filtering technique is applied to remove unwanted noise components from time-frequency domain. This method gives good performance with high SNR and lower RMSE for different noises that are more probable to get embedded with ECG signal during its acquisition and transmission

Viewing Preschool Disruptive Behavior Disorders and ADHD Through A Developmental Lens: What We Know & What We Need to Know

There is now little doubt that DSM-IV behavior disorders are present and identifiable during the preschool years (1,2). With only minor modifications to DSM-IV Disruptive Behavior Disorders (DBDs) and attention-deficit/hyperactivity disorder (ADHD) nosology, multiple, independent studies have shown similar prevalence rates and correlates as in older children (1). In the preschool age range, these disorders also have modest stability (3-6). It is clear that the behaviors that comprise DBDs and ADHD (e.g., noncompliance, rule-breaking, aggression, destruction of property, hyperactivity, inattention, and impulsivity) impair children’s functioning and that caregivers of young children often experience considerable difficulty in managing those who exhibit high levels of these behaviors. Increasingly, preschoolers are being referred to mental health clinics for DBDS and ADHD (7), with escalating rates of pharmacological treatments (8). Thus, the “real world” consequences of behavior disorders are substantial for young children and their families and often mark the onset of long-term developmental maladaptation that marks psychopathology (9). Concerted effort to characterize the clinical manifestations of these disorders in early childhood more precisely will maximize our ability to intervene effectively in the lives of young children affected with DBDs and ADHD and, ultimately to reduce their long-term health burden. The increasing consensus that these syndromes exist in young children also comes with growing concern that these disorders may be developmentally misspecified, particularly for young children who are not at the extremes (10). In this paper, we review the extant empirical evidence through a “developmental lens,” with an eye to analyzing how the absence of a developmental approach may hinder accurate identification. Further, we show how integrating evidence from developmental science provides useful guideposts for generating and testing a developmentally-specified nosology. Together with the plethora of work on preschool psychopathology over the past decade, this provides a strong foundation for charting a course for the next generation of more refined efforts in early childhood

Multiple Family Groups to reduce child disruptive behavior difficulties: Moderating effects of child welfare status on child outcomes

Children who remain at home with their permanent caregivers following a child welfare (CW) involvement (e.g., investigation, out-of-home placement) manifest high rates of behavioral difficulties, which is a risk factor for further maltreatment and out-of-home placement if not treated effectively. A recently tested Multiple Family Group (MFG) service delivery model to treat youth Disruptive Behavior Disorders (DBDs) has demonstrated effectiveness in improving child behavior difficulties among hard-to-engage, socioeconomically disadvantaged families by addressing parenting skills, parent-child relationships, family communication and organization, social support, and stress. This exploratory study examines whether child behavioral outcomes for MFG differ for families with self-reported lifetime involvement in CW services compared to other families, as families with CW involvement struggle with additional stressors that can diminish treatment success. Youth (aged 7–11) and their families were assigned to MFG or services as usual (SAU) using a block comparison design. Caregivers reported on child behavior, social skills, and functional impairment. Mixed effects regression modeled multilevel outcomes across 4 assessment points (i.e., baseline, mid-test, post-test, 6 month follow-up). Among CW-involved families, MFG participants reported significantly reduced child oppositional defiant disorder symptoms at 6-month follow-up compared with SAU participants. No other differences were found in the effect of MFG treatment between CW and non-CW involved families. Findings suggest that MFG may be as effective in reducing child behavior difficulties for both CW and non-CW involved families. As a short-term, engaging, and efficient intervention, MFG may be a particularly salient service offering for families involved in the CW system

Engagement in Behavioral Parent Training: Review of the Literature and Implications for Practice

Engagement in behavioral parent training (BPT), including enrollment, attrition, attendance, within-session engagement, and homework completion, has long been a critical issue in the literature. Several estimates of various aspects of engagement have been suggested in the literature, but a systematic review of the available literature has never been accomplished. This review examines engagement data across 262 studies of BPT. Recruitment attrition, program attrition, attendance, and within-session engagement are examined across studies, with particular emphasis on the impact that SES, study purpose (efficacy vs. effectiveness), treatment format (individual vs. group), and age of child may have on those rates. Results of this review suggest that the significant amount of attrition occurs prior to enrollment in BPT, with at least 25 % of those identified as appropriate for BPT not enrolling in such programs. An additional 26 % begin, but drop out before completing treatment. Still the combined dropout rate of at least 51 % leaves at best half of identified parents completing treatment. While SES status had a small effect on attrition, other variables were not found to meaningfully impact engagement. Information on within-session engagement (homework and ratings of participation) was not often reported in studies. Key issues in this literature (e.g., varying definitions of engagement, limited attention to reporting key aspects of engagement) are discussed, and recommendations are made to further improve this important area of research and clinical practice

Pilot Randomized Trial of a Family Management Efficacy Intervention for Caregivers of African American Adolescents with Disruptive Behaviors

Background Caregivers of adolescents diagnosed with Oppositional Defiant Disorder and/or Conduct Disorder (ODD/CD) experience unique challenges when interacting with child service systems involved in their adolescents’ care. Absent from the literature are interventions to improve these interactions, which in the long term may improve adolescent behavioral health outcomes. Objective To examine feasibility/acceptability of Family Management Efficacy (FAME) intervention content, structure, delivery, and appropriateness of selected measures for caregivers of African American adolescents with ODD/CD. Secondary aim was to explore changes in FAME caregivers’ interaction self-efficacy, stress, quality of life, and family functioning scores relative to caregivers receiving treatment as usual (TAU). Method A pilot two-group randomized trial was conducted with caregivers of African American adolescents (ages 12–18 years) diagnosed with ODD/CD receiving FAME (n = 11) or TAU (n = 9). Feasibility outcomes of enrollment/attrition, measurement completion, session attendance, and homework completion were assessed using tracking logs and field notes, and acceptability through caregiver satisfaction scores and interviews. Preliminary outcomes were assessed at baseline, post- and 2-months post intervention. Results FAME was highly acceptable and met a priori thresholds for feasibility in enrollment (56%), attrition (35%), caregiver attendance (55%), and homework completion (50%), with lower than anticipated kin attendance (42%) and measurement completion (55%). Preliminary outcomes suggest FAME may benefit caregivers in areas of family communication, cohesion, and quality of life, but lacked observed benefit for self-efficacy and problem solving indicating need for refinement. Conclusion Results inform changes to FAME content, measurement, and delivery schedule in preparation for a fully powered randomized controlled trial

Effect of paddy straw plus nonforage fiber sources based complete rations with different levels of neutral detergent fiber on hemato-biochemical and mineral profile of lactating dairy cows

Aim: This study was conducted to assess the effect of feeding paddy straw plus nonforage fiber sources based complete rations with different levels of neutral detergent fiber (NDF) on hemato-biochemical and mineral parameters of lactating dairy cows. Materials and Methods: The study was conducted for 6 months in 18 lactating dairy cows, divided into three groups of six each, by feeding them on paddy straw plus nonforage fiber sources based complete rations containing different levels of NDF, in two phases of 3 months (90 days) each, being the early and mid lactation phases, respectively. Three isonitrogenous and isocaloric complete rations, T1, T2 and T3 with 25%, 30% and 35% NDF, respectively, were fed to the experimental animals. Blood samples were collected at the beginning and the end of each of the two phases to estimate the different hematological, plasma protein, and mineral parameters to know the overall health status of the animals and standard methods were followed to analyze the samples. Results: There was no significant difference (p>0.05) in various hematological parameters such as hemoglobin, glucose, and blood urea nitrogen (BUN) in blood; plasma protein parameters such as total protein, albumin, globulin and albumin: globulin ratio and mineral parameters such as plasma calcium and phosphorus levels at the beginning and end of Phase I (1st day and 90th day) and Phase II (91st day and 180th day) as well as between the three dietary treatments, with all the values being in the normal range for lactating dairy cows. Even though nonsignificant (p>0.05), the BUN values of animals fed on ration T1, both at the beginning and end of Phase I, were higher than that of animals fed on rations T2 and T3 because the diet T1 with lowest NDF and the highest soluble carbohydrate content underwent rapid fermentation in the rumen, produced more energy, which was utilized by the rumen microbes to degrade the protein in the feed to ammonia, the excess ammonia being transported to the liver and excreted through the blood resulting in a higher BUN content. Conclusion: Feeding of paddy straw plus nonforage fiber sources based complete rations with different levels of NDF had no effect on hemato-biochemical and mineral profile as well as overall health status of lactating dairy cows. However, the higher, BUN values found in cows fed on diet T1 with 25% NDF as compared to those fed on T2 and T3 with 30% and 35% NDF, respectively, indicate more wastage of protein in T1 as compared to T2 and T3, in early lactation

Asthma and mental health among youth in high-risk service settings

Abstract Objective: To investigate the prevalence of asthma and mental health problems among representative samples of youth in high-risk service settings and the community, and to examine the relationship between asthma and mental health in these groups. Methods: Data were drawn from the Alternative Service Use Patterns of Youth with Serious Emotional Disturbance Study (SED) (n ¼ 1181), a combined representative, cross-sectional sample of youth in various clinical settings and the community. Multiple logistic regression analyses were used to examine the association between asthma and mental disorders. Demographic characteristics were investigated as potential confounders. Results: Asthma was common among 15.2% of youth in service settings and 18.8% of youth in the community. The prevalence of mental disorders was extremely high among youth with and without asthma in all service settings, and asthma was associated with increased prevalence of mental disorders among youth in the community, but not among youth in service settings. The relationship between asthma and internalizing disorders among youth in the community does not appear entirely attributable to confounding by demographics. Conclusions: Findings are consistent with and extend previous data by showing that both asthma and mental disorders are disproportionately common among youth in high-risk service settings. Almost half of youth with asthma in service settings meet diagnostic criteria for a mental disorder. Clinicians and policy makers who are responsible for the health care of youth in these high-risk groups should be aware that asthma is common, and that the prevalence of internalizing disorders are especially common among those with asthma