Cystic Multiglandular Maternal Hyperparathyroidism Diagnosed by Neonatal Hypocalcemic Seizures

A 7-day-old male infant born to a healthy 33-year-old female at 37 weeks of gestation was brought to the local emergency department (ED) with sudden-onset tonic-clonic seizures. Laboratory testing revealed extreme hypocalcemia (ionized calcium of 3.2 mg/dl) and undetectable parathyroid hormone (PTH/ml). Concomitant evaluation of the mother revealed both elevated ionized calcium (5.9 mg/dl) and PTH (116 pg/ml). The mother underwent preoperative ultrasound localization and sestamibi scan, followed promptly by parathyroidectomy. Given the cystic appearance and presence of multiglandular disease, evaluation for familial cystic parathyroid adenomatosis (hyperparathyroidism-jaw bone-tumor syndrome) and MEN 1 were undertaken. The infant was stabilized and discharged home. He returned to the ED with seizures at 1 month of age. After increasing calcium supplementation appropriately, he was monitored with weekly office visits. This represents a unique case of undiagnosed maternal primary hyperparathyroidism manifesting with intrauterine parathyroid suppression and hypocalcemic seizures in the newborn

Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial

BackgroundAnterior cruciate ligament (ACL) rupture is a common debilitating injury that can cause instability of the knee. We aimed to investigate the best management strategy between reconstructive surgery and non-surgical treatment for patients with a non-acute ACL injury and persistent symptoms of instability.MethodsWe did a pragmatic, multicentre, superiority, randomised controlled trial in 29 secondary care National Health Service orthopaedic units in the UK. Patients with symptomatic knee problems (instability) consistent with an ACL injury were eligible. We excluded patients with meniscal pathology with characteristics that indicate immediate surgery. Patients were randomly assigned (1:1) by computer to either surgery (reconstruction) or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment), stratified by site and baseline Knee Injury and Osteoarthritis Outcome Score—4 domain version (KOOS4). This management design represented normal practice. The primary outcome was KOOS4 at 18 months after randomisation. The principal analyses were intention-to-treat based, with KOOS4 results analysed using linear regression. This trial is registered with ISRCTN, ISRCTN10110685, and ClinicalTrials.gov, NCT02980367.FindingsBetween Feb 1, 2017, and April 12, 2020, we recruited 316 patients. 156 (49%) participants were randomly assigned to the surgical reconstruction group and 160 (51%) to the rehabilitation group. Mean KOOS4 at 18 months was 73·0 (SD 18·3) in the surgical group and 64·6 (21·6) in the rehabilitation group. The adjusted mean difference was 7·9 (95% CI 2·5–13·2; p=0·0053) in favour of surgical management. 65 (41%) of 160 patients allocated to rehabilitation underwent subsequent surgery according to protocol within 18 months. 43 (28%) of 156 patients allocated to surgery did not receive their allocated treatment. We found no differences between groups in the proportion of intervention-related complications.InterpretationSurgical reconstruction as a management strategy for patients with non-acute ACL injury with persistent symptoms of instability was clinically superior and more cost-effective in comparison with rehabilitation management

Understanding the role of referential processing in sentence complexity

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Brain and Cognitive Sciences, 2001.Includes bibliographical references (p. 123-128).Language comprehension requires syntactic, semantic and pragmatic processing. The work presented in this thesis clarifies the role that the resource demands of syntactic and referential processing play in sentence complexity. Results are interpreted within the framework of the Dependency Locality Theory (Gibson, 1998), which provides a hypothesis about how computational resources constrain the process of sentence comprehension. These new results support and further develop the DLT's discourse-based distance metric for computing locality. The experiments presented here were designed to investigate the referential processing load imposed by relating noun phrase (NP) anaphors to their antecedents and to discover the ramifications of increased referential processing load on behavioral measures of language comprehension. Four questionnaire experiments tested the intuitive complexity of doubly nested sentences containing NPs that were differently referentially accessible. These experiments demonstrated that sentences with structural dependencies crossing less accessible referents are judged more difficult than sentences with structural dependencies crossing more accessible referents. They also showed that referential accessibility manipulations had a negligible effect on intuitive complexity in positions that did not interrupt long distance structural dependencies.(cont.) Five self-paced word-by-word reading experiments elucidated the time course of the complexity ramifications of increased referential processing. Each of these experiments showed that when less accessible referents interrupted long distance structural dependencies, reading times slowed more at the completion of the structural dependency than at the referent itself. From the results of these experiments it is argued that performing referential processing during an incomplete structural dependency makes accessing the representation of the beginning of the dependency more difficult at the dependency's completion. This finding is important to the development of the DLT, expanding it to take both referential and syntactic processing into account when predicting complexity effects. This work also provides new evidence about the relative processing loads incurred by multiple referential processes, new evidence concerning the mechanisms underlying referent accessibility and new evidence about the allocation of resources to different subprocesses of the human language comprehension system.by Tessa Cartwright Warren.Ph.D

Secondary school students' understanding of the socio-emotional nature of the New Zealand Key Competencies

In its 2007 curriculum, New Zealand introduced Key Competencies (KCs) that are intended to ensure students’ future participation in the economy, communities, and also to introduce metacognitive and socio-emotional dimensions to learning. The KCs also have important implications for contributing to students’ wellbeing and resilience. However, they are open to interpretation and have been conceptualised, implemented, and taught in different ways. This research explored students’ views of the KCs. Twelve students from five secondary schools were interviewed to explore their understanding and value of the KCs and their ideas for teaching them. Thematic analysis was used to analyse the data. Results show that participants value the KCs and interpreted them in a variety of ways, though they often failed to discuss the interconnection between the KCs or identify socio-emotional aspects of the KCs. Implications for teaching the KCs in school are discussed

Secondary school students' understanding of the socio-emotional nature of the New Zealand Key Competencies

In its 2007 curriculum, New Zealand introduced Key Competencies (KCs) that are intended to ensure students’ future participation in the economy, communities, and also to introduce metacognitive and socio-emotional dimensions to learning. The KCs also have important implications for contributing to students’ wellbeing and resilience. However, they are open to interpretation and have been conceptualised, implemented, and taught in different ways. This research explored students’ views of the KCs. Twelve students from five secondary schools were interviewed to explore their understanding and value of the KCs and their ideas for teaching them. Thematic analysis was used to analyse the data. Results show that participants value the KCs and interpreted them in a variety of ways, though they often failed to discuss the interconnection between the KCs or identify socio-emotional aspects of the KCs. Implications for teaching the KCs in school are discussed

Women’s Leadership and COVID-19 Pandemic: Navigating Crises through the Application of Connective Leadership

International and national crises often highlight behavioral patterns in the labor market that illustrate women’s courage and adaptability in challenging times. The COVID-19 pandemic and resulting changes in the workplace due to social distancing, remote work, and tele-communications protocols showcased women’s power of authenticity and accessibility (interpersonal and personalized experiences) to engage with their constituents effectively. The catalyzed this research was our desire to underscore the importance of studying the impact of COVID-19 on women leaders. The COVID-19 pandemic brought to light specific challenges and disparities women faced in the workplace. It has been asserted that women leaders substantially benefit businesses and organizations and we wanted to test this out through the practices of our research participants. Decades of research reveal that women leaders enhance productivity, foster collaboration, inspire dedication, and promote fairness in the workplace. This article introduces the feminist Connective Leadership Model (CL) an integrative leadership model and one informed by early feminist theory for understanding women’s leadership during the COVID-19 pandemic. A mixed-method study of select US women leaders before and during the COVID-19 pandemic revealed the CL model and its efficacy for adaptive, inclusive leadership in various contexts. First, this article highlights the impact of the COVID-19 pandemic on women’s leadership and behavioral response to the crisis through the lens of the CL model. Second, this article delves into challenges the women leaders faced, including adaptive challenges, isolation, team management, increased caregiving responsibilities, and gender-related disparities. Third, this article reframes women’s voices articulated through a crisis management leadership framework coupled with an understanding and application of the behaviors defined through complexity theory which are aligned with the CL model. Finally, the article discusses the four ‘As’ of crisis leadership: authenticity, alignment, awareness, and adaptability. The application of the CL model provides an effective framework for determining the most appropriate leadership behaviors within the complex challenges of a crisis; it enables the leader to focus on personal, employee, and organizational well-being

Distribution and Performance of the Nonnative Seagrass Zostera japonica across a Tidal Height Gradient on Shaw Island, Washington.

v. ill. 23 cm.QuarterlyIn the Northeast Pacific the nonnative seagrass Zostera japonica frequently exists at the same sites as the native seagrass Zostera marina. Although at some sites their vertical distributions overlap, at most sites in the Pacific Northwest there is a distinctive unvegetated zone between them. The objective of this study was to better understand why a gap between the lower limit of Z. japonica and the upper limit of Z. marina exists. To address this issue we carried out transplant experiments, conducted in situ monitoring of existing Z. japonica patches, and collected sediment samples at South Beach on Shaw Island, Washington, during the spring and summer of 2006. Transplant and in situ monitoring data indicate that survival and performance of Z. japonica are reduced lower in the intertidal zone. In addition, Z. japonica patches tended to be smaller and more spaced out at lower tidal heights. Although we found no Z. japonica seeds within or outside extant Z. japonica patches, high transplant mortality indicates that Z. japonica dispersal limitation is an unlikely cause of the unvegetated gap zone. Our field observations further suggest that herbivory, bioturbation, and epiphytes are unlikely causes of the gap pattern at our study site. Instead, we hypothesize that light limitation prevents Z. japonica from occurring lower in the intertidal. A review of published vertical distribution data for both Zostera species indicates that the lower limit of Z. japonica is relatively invariant among sites. In contrast, the upper limit of Z. marina is highly variable, ranging by more than 4 m within some subregions in Washington State. Consequently we hypothesize that intersite variability in the vertical distribution of Z. marina is the primary driver of spatial variability in the presence of the unvegetated gap

Improving Health Care Transition and Longitudinal Care for Adolescents and Young Adults with Hydrocephalus: Report from the Hydrocephalus Association Transition Summit

The health care needs of children with hydrocephalus continue beyond childhood and adolescence; however, pediatric hospitals and pediatric neurosurgeons are often unable to provide them care after they become adults. Each year in the US, an estimated 5000–6000 adolescents and young adults (collectively, youth) with hydrocephalus must move to the adult health care system, a process known as health care transition (HCT), for which many are not prepared. Many discover that they cannot find neurosurgeons to care for them. A significant gap in health care services exists for young adults with hydrocephalus. To address these issues, the Hydrocephalus Association convened a Transition Summit in Seattle, Washington, February 17–18, 2017. The Hydrocephalus Association surveyed youth and families in focus groups to identify common concerns with HCT that were used to identify topics for the summit. Seven plenary sessions consisted of formal presentations. Four breakout groups identified key priorities and recommended actions regarding HCT models and practices, to prepare and engage patients, educate health care professionals, and address payment issues. The breakout group results were discussed by all participants to generate consensus recommendations. Barriers to effective HCT included difficulty finding adult neurosurgeons to accept young adults with hydrocephalus into their practices; unfamiliarity of neurologists, primary care providers, and other health care professionals with the principles of care for patients with hydrocephalus; insufficient infrastructure and processes to provide effective HCT for youth, and longitudinal care for adults with hydrocephalus; and inadequate compensation for health care services. Best practices were identified, including the National Center for Health Care Transition Improvement’s “Six Core Elements of Health Care Transition 2.0”; development of hydrocephalus-specific transition programs or incorporation of hydrocephalus into existing general HCT programs; and development of specialty centers for longitudinal care of adults with hydrocephalus. The lack of formal HCT and longitudinal care for young adults with hydrocephalus is a significant health care services problem in the US and Canada that professional societies in neurosurgery and neurology must address. Consensus recommendations of the Hydrocephalus Association Transition Summit address 1) actions by hospitals, health systems, and practices to meet local community needs to improve processes and infrastructure for HCT services and longitudinal care; and 2) actions by professional societies in adult and pediatric neurosurgery and neurology to meet national needs to improve processes and infrastructure for HCT services; to improve training in medical and surgical management of hydrocephalus and in HCT and longitudinal care; and to demonstrate the outcomes and effectiveness of HCT and longitudinal care by promoting research funding