Treatment of Sleep Problems in Young Children: A Case Series Report of a Cognitive-Behavioral Play Intervention

Sleep problems and bedtime resistance are common in young children. Treatment is critical because sleep problems typically persist, and insufficient sleep is related to worse outcomes. Current behavioral treatments do not work directly with the child to reduce anxiety and distress at bedtime. Cognitive-behavioral play therapy is a treatment approach designed to teach coping skills to young children by combining cognitive-behavioral therapy with pretend play, a developmentally-appropriate intervention mode. The current case series examined the effectiveness of adding a brief cognitive-behavioral play intervention (CBPI) to parent behavior management for young children with sleep difficulties. Four children (4-6 years) received three 20-30 minute individual sessions during which the child played out stories with an advanced graduate student therapist (first author, K.F.) about a child coping with sleep problems. Each child’s parent also received a 30-minute sleep information session. Three parents returned questionnaires post-treatment. As expected, all three parents reported improvements in their child’s sleep habits, sleep anxiety, and general fears. All three parents also reported a high level of satisfaction with the treatment. These preliminary results suggest that the CBPI may be effective for decreasing anxiety and child distress when added to behavioral treatment, thus increasing the breadth of treatment approaches available for young children with sleep problems. These results are promising, although a randomized study is needed to further refine the intervention and establish the efficacy of a CBPI for treatment of sleep problems in young children

MASH Test Nos. 3-11 and 3-10 on a Non-Proprietary Cable Median Barrier

The Midwest States Pooled Fund has been developing a new non-proprietary cable median barrier. This system incorporates four evenly spaced cables, Midwest Weak Posts spaced at 8 to 16 ft (2.4 to 4.9 m) intervals, and a bolted, tabbed bracket to attach the cables to each post. Full-scale crash testing was needed to evaluate the barrier’s safety performance. According to the Manual for Assessing Safety Hardware (MASH) updated/proposed testing matrix for cable barriers installed within a 6H:1V or median ditch, a series of eight full-scale tests are required to evaluate the safety performance of a system. A ninth test is required to establish the working width for systems with variable post spacing. Three full-scale crash tests were performed. Test no. MWP-4 was conducted according to MASH test no. 3-11 and utilized a 2270P pickup truck impacting the barrier on level terrain. The vehicle was contained by the barrier, and the test was deemed acceptable. Test no. MWP-6 was conducted according to MASH test no. 3-10 and utilized a 1100C passenger car impacting the barrier on level terrain. The vehicle was contained and redirected by the system. However, the system posts penetrated the occupant compartment through tearing and rupture of the vehicle floor board, and the test was deemed unacceptable. Test no. MWP-7 was also conducted with a 1100C vehicle according to MASH test no. 3-10. Alterations were made to the system posts. Although the vehicle was contained by the system, occupant compartment penetration by line posts was again observed. Test no. MWP-7 was deemed unacceptable

MASH Test Nos. 3-11 and 3-10 on a Non-Proprietary Cable Median Barrier

The Midwest States Pooled Fund has been developing a new non-proprietary cable median barrier. This system incorporates four evenly spaced cables, Midwest Weak Posts spaced at 8 to 16 ft (2.4 to 4.9 m) intervals, and a bolted, tabbed bracket to attach the cables to each post. Full-scale crash testing was needed to evaluate the barrier’s safety performance. According to the Manual for Assessing Safety Hardware (MASH) updated/proposed testing matrix for cable barriers installed within a 6H:1V or median ditch, a series of eight full-scale tests are required to evaluate the safety performance of a system. A ninth test is required to establish the working width for systems with variable post spacing. Three full-scale crash tests were performed. Test no. MWP-4 was conducted according to MASH test no. 3-11 and utilized a 2270P pickup truck impacting the barrier on level terrain. The vehicle was contained by the barrier, and the test was deemed acceptable. Test no. MWP-6 was conducted according to MASH test no. 3-10 and utilized a 1100C passenger car impacting the barrier on level terrain. The vehicle was contained and redirected by the system. However, the system posts penetrated the occupant compartment through tearing and rupture of the vehicle floor board, and the test was deemed unacceptable. Test no. MWP-7 was also conducted with a 1100C vehicle according to MASH test no. 3-10. Alterations were made to the system posts. Although the vehicle was contained by the system, occupant compartment penetration by line posts was again observed. Test no. MWP-7 was deemed unacceptable

Search for anisotropic gravitational-wave backgrounds using data from Advanced LIGO and Advanced Virgo\u27s first three observing runs

We report results from searches for anisotropic stochastic gravitational-wave backgrounds using data from the first three observing runs of the Advanced LIGO and Advanced Virgo detectors. For the first time, we include Virgo data in our analysis and run our search with a new efficient pipeline called PyStoch on data folded over one sidereal day. We use gravitational-wave radiometry (broadband and narrow band) to produce sky maps of stochastic gravitational-wave backgrounds and to search for gravitational waves from point sources. A spherical harmonic decomposition method is employed to look for gravitationalwave emission from spatially-extended sources. Neither technique found evidence of gravitational-wave signals. Hence we derive 95% confidence-level upper limit sky maps on the gravitational-wave energy flux from broadband point sources, ranging from F-a,F-Theta \u3c (0.013-7.6) x 10(-8) erg cm(-2) s(-1) Hz(-1), and on the (normalized) gravitational-wave energy density spectrum from extended sources, ranging from Omega(a,Theta) \u3c (0.57-9.3) x 10(-9) sr(-1), depending on direction (Theta) and spectral index (alpha). These limits improve upon previous limits by factors of 2.9-3.5. We also set 95% confidence level upper limits on the frequencydependent strain amplitudes of quasimonochromatic gravitational waves coming from three interesting targets, Scorpius X-1, SN 1987A and the Galactic Center, with best upper limits range from h(0) \u3c (1.7-2.1) x 10(-25), a factor of \u3e= 2.0 improvement compared to previous stochastic radiometer searches

Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Overall Survival Among Women With Invasive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 (Alliance) Randomized Clinical Trial

The results of the American College of Surgeons Oncology Group Z0011 (ACOSOG Z0011) trial were first reported in 2005 with a median follow-up of 6.3 years. Longer follow-up was necessary because the majority of the patients had estrogen receptor–positive tumors that may recur later in the disease course (the ACOSOG is now part of the Alliance for Clinical Trials in Oncology)

Viral Endomyocardial Infection Is an Independent Predictor and Potentially Treatable Risk Factor for Graft Loss and Coronary Vasculopathy in Pediatric Cardiac Transplant Recipients

ObjectivesThis study sought to evaluate the outcome and prevalence of viral endomyocardial infection after cardiac transplantation.BackgroundViral myocardial infection causes heart failure, but its role after cardiac transplantation is unclear. We hypothesized that viral infection of the cardiac allograft reduces graft survival.MethodsBetween June 1999 and November 2004, 94 pediatric cardiac transplant patients were screened for the presence of viral genome in serial endomyocardial biopsies (EMBs) using polymerase chain reaction (PCR) assays. Graft loss, advanced transplant coronary artery disease (TCAD), and acute rejection (AR) were compared in the PCR-positive (n = 37) and PCR-negative (n = 57) groups, using time-dependent Kaplan-Meier and Cox regression analyses. From November 2002 to November 2004, intravenous immunoglobulin therapy (IVIG) was administered to patients with PCR-positive EMBs. The outcomes of the IVIG-treated, PCR-positive patients (n = 20) were compared with IVIG-untreated, PCR-positive patients (n = 17).ResultsViral genomes were detected in EMBs from 37 (39%) patients; parvovirus B19, adenovirus, and Epstein-Barr virus (EBV) were the most common. The PCR-positive group (n = 37, 25% graft loss at 2.4 years) had decreased graft survival (p < 0.001) compared with the PCR-negative group (n = 57, 25% graft loss at 8.7 years) and developed advanced TCAD prematurely (p = 0.001). The number of AR episodes was similar in both groups. On multivariate analysis, presence of viral genome was an independent risk factor for graft loss (relative risk: 4.2, p = 0.015). The time to advanced TCAD after becoming PCR-positive was longer in the IVIG-treated patients (p = 0.03) with a trend toward improved graft survival (p = 0.06).ConclusionsViral endomyocardial infection is an independent predictor of graft loss in pediatric cardiac transplant recipients. This effect appears to be mediated through premature development of advanced TCAD. IVIG therapy in this subgroup may improve survival and merits further investigation

Search for Gravitational Waves Associated with Gamma-Ray Bursts Detected by Fermi and Swift during the LIGO–Virgo Run O3a

We search for gravitational-wave transients associated with gamma-ray bursts (GRBs) detected by the Fermi and Swift satellites during the first part of the third observing run of Advanced LIGO and Advanced Virgo (2019 April 1 15:00 UTC–2019 October 1 15:00 UTC). A total of 105 GRBs were analyzed using a search for generic gravitational-wave transients; 32 GRBs were analyzed with a search that specifically targets neutron star binary mergers as short GRB progenitors. We find no significant evidence for gravitational-wave signals associated with the GRBs that we followed up, nor for a population of unidentified subthreshold signals. We consider several source types and signal morphologies, and report for these lower bounds on the distance to each GRB

Circulating microRNAs Reveal Time Course of Organ Injury in a Porcine Model of Acetaminophen-Induced Acute Liver Failure

Acute liver failure is a rare but catastrophic condition which can progress rapidly to multi-organ failure. Studies investigating the onset of individual organ injury such as the liver, kidneys and brain during the evolution of acute liver failure, are lacking. MicroRNAs are short, non-coding strands of RNA that are released into the circulation following tissue injury. In this study, we have characterised the release of both global microRNA and specific microRNA species into the plasma using a porcine model of acetaminophen-induced acute liver failure. Pigs were induced to acute liver failure with oral acetaminophen over 19h±2h and death occurred 13h±3h thereafter. Global microRNA concentrations increased 4h prior to acute liver failure in plasma (P<0.0001) but not in isolated exosomes, and were associated with increasing plasma levels of the damage-associated molecular pattern molecule, genomic DNA (P<0.0001). MiR122 increased around the time of onset of acute liver failure (P<0.0001) and was associated with increasing international normalised ratio (P<0.0001). MiR192 increased 8h after acute liver failure (P<0.0001) and was associated with increasing creatinine (P<0.0001). The increase in miR124-1 occurred concurrent with the pre-terminal increase in intracranial pressure (P<0.0001) and was associated with decreasing cerebral perfusion pressure (P<0.002)