Lumbar spine and total-body dual-energy X-ray absorptiometry in children with severe neurological impairment and intellectual disability: a pilot study of artefacts and disrupting factors

Background Children with severe neurological impairment and intellectual disability (ID) are susceptible for developing low bone mineral density (BMD) and fractures. BMD is generally measured with dual-energy X-ray absorptiometry (DXA). Objective To describe the occurrence of factors that may influence the feasibility of DXA and the accuracy of DXA outcome in children with severe neurological impairment and ID. Materials and methods Based on literature and expert opinion, a list of disrupting factors was developed. Occurrence of these factors was assessed in 27 children who underwent DXA measurement. Results Disrupting factors that occurred most frequently were movement during measurement (82%), aberrant body composition (67%), small length for age (56%) and scoliosis (37%). The number of disrupting factors per child was mean 5.3 (range 1-8). No correlation was found between DXA outcomes and the number of disrupting factors. Conclusion Factors that may negatively influence the accuracy of DXA outcome are frequently present in children with severe neurological impairment and ID. No systematic deviation of DXA outcome in coherence with the amount of disrupting factors was found, but physicians should be aware of the possible influence of disrupting factors on the accuracy of DXA

Undergraduate medical research: the student perspective

Background: Research training is essential in a modern undergraduate medical curriculum. Our evaluation aimed to (a) gauge students’ awareness of research activities, (b) compare students’ perceptions of their transferable and research-specific skills competencies, (c) determine students’ motivation for research and (d) obtain students’ personal views on doing research. Methods: Undergraduate medical students (N=317) completed a research skills questionnaire developed by the Centre for Excellence in Teaching and Learning in Applied Undergraduate Research Skills (CETL-AURS) at Reading University. The questionnaire assessed students’ transferable skills, research-specific skills (e.g., study design, data collection and data analysis), research experience and attitude and motivation towards doing research. Results: The majority of students are motivated to pursue research. Graduate entrants and male students appear to be the most confident regarding their research skills competencies. Although all students recognise the role of research in medical practice, many are unaware of the medical research activities or successes within their university. Of those who report no interest in a career incorporating research, a common perception was that researchers are isolated from patients and clinical practice. Discussion: Students have a narrow definition of research and what it entails. An explanation for why research competence does not align more closely with research motivation is derived from students’ lack of understanding of the concept of translational research, as well as a lack of awareness of the research activity being undertaken by their teachers and mentors. We plan to address this with specific research awareness initiatives

Detecting One-Hundred-Year Environmental Changes in Western China Using Seven-Year Repeat Photography

Due to its diverse, wondrous plants and unique topography, Western China has drawn great attention from explorers and naturalists from the Western World. Among them, Ernest Henry Wilson (1876 –1930), known as ‘Chinese’ Wilson, travelled to Western China five times from 1899 to 1918. He took more than 1,000 photos during his travels. These valuable photos illustrated the natural and social environment of Western China a century ago. Since 1997, we had collected E.H. Wilson's old pictures, and then since 2004, along the expedition route of E.H. Wilson, we took 7 years to repeat photographing 250 of these old pictures. Comparing Wilson's photos with ours, we found an obvious warming trend over the 100 years, not only in specific areas but throughout the entire Western China. Such warming trend manifested in phenology changes, community shifts and melting snow in alpine mountains. In this study, we also noted remarkable vegetation changes. Out of 62 picture pairs were related to vegetation change, 39 indicated vegetation has changed to the better condition, 17 for degraded vegetation and six for no obvious change. Also in these photos at a century interval, we found not only rapid urbanization in Western China, but also the disappearance of traditional cultures. Through such comparisons, we should not only be amazed about the significant environmental changes through time in Western China, but also consider its implications for protecting environment while meeting the economic development beyond such changes

Reading the Landscape in Antler, North Dakota: Repeat Photography in an Atrophying Northern Plains Town

This study presents repeat photography as an effective method to construct a narrative of change for a cultural landscape. The technique of repeat photography is the process of revisiting the vantage point of a historic photograph and capturing a contemporary image. This chapter focuses on the town of Antler, North Dakota, which has lost more than 85% of its population in the last 50 years (the 2016 estimated population was 25). Repeat photography with eleven historic photographs in Antler began to uncover a story of abandonment and change over the last century. It is this telling of a story through photography that situates our chapter in a book regarding language. In addition to exploring some of the region’s precursors to population decline, previous scholarship using repeat photography is presented along with a methodological framework for anyone interested in conducting similar studies elsewhere

Utility of sedation for young children undergoing dimercaptosuccinic acid renal scans

BACKGROUND: No studies have examined whether use of sedation during a Tc-99m dimercaptosuccinic acid (DMSA) renal scan reduces patient discomfort. OBJECTIVE: To compare discomfort level during a DMSA scan to the discomfort level during other frequently performed uroradiologic tests, and to determine whether use of sedation during a DMSA scan modifies the level of discomfort. MATERIALS AND METHODS: We examined the discomfort level in 798 children enrolled in the Randomized Intervention for children with Vesicoureteral Reflux (RIVUR) and Careful Urinary Tract Infection Evaluation (CUTIE) studies by asking parents to rate their child's discomfort level with each procedure on a scale from 0 to 10. We compared discomfort during the DMSA scan and the DMSA image quality between centers in which sedation was used >90% of the time (sedation centers), centers in which sedation was used <10% of the time (non-sedation centers), and centers in which sedation was used on a case-by-case basis (selective centers). RESULTS: Mean discomfort level was highest for voiding cystourethrogram (6.4), followed by DMSA (4.0), followed by ultrasound (2.4; P<0.0001). Mean discomfort level during the DMSA scan was significantly higher at non-sedation centers than at selective centers (P<0.001). No difference was apparent in discomfort level during the DMSA scan between sedation centers and selective centers (P=0.12), or between the sedation centers and non-sedation centers (P=0.80). There were no differences in the proportion with uninterpretable DMSA scans according to sedation use. CONCLUSION: Selective use of sedation in children 12–36 months of age can reduce the discomfort level experienced during a DMSA scan

Pain in cognitively impaired children: a focus for general pediatricians

Pain in children with cognitive impairment and cerebral palsy is a particularly relevant issue due to its high prevalence and impact on quality of life. We review available evidence about prevalence of pain, causes and specific treatment, recognition and use of specific pain scales, physiology, and consequences of pain in this subset of patients. Conclusions: Pain is very common and is a critical determinant of quality of life in children with cognitive impairment and cerebral palsy. The diseases and associated complications that frequently expose these patients to pain can be treated and pain prevented. For patients with communication difficulties, appropriate, effective, validated tools are available and should be used to diagnose pain in itself, to >choose analgesic treatment and to determine effectiveness of these therapies. The level of awareness of pediatricians towards this issue seems to be quite low