Tuning into the real effect of smartphone use on parenting: A multiverse analysis

Background Concerns have been raised regarding the potential negative impacts of parents' smartphone use on the parent-child relationship. A scoping literature review indicated inconsistent effects, arguably attributable to different conceptualizations of parent phone use and conflation of phone use with technological interference. Methods Based on a sample of n = 3, 659 parents collected in partnership with a national public broadcaster, we conducted a multiverse analysis. We explored 84 different analytic choices to address whether associations were weak versus robust, and provide clearer direction for measurement, theory, and practice. Effects were assessed in relation to p values, effect sizes, and AIC; we further conducted a meta‐analytic sensitivity check. Results Direct associations between smartphone use and parenting were relatively weak and mixed. Instead, the relation between use and parenting depended on level of technological interference. This pattern was particularly robust for family displacement. At low levels of displacing time with family using technology, more smartphone use was associated with better (not worse) parenting. Conclusions Our results indicate fragility in findings of risks for parental smartphone use on parenting; there were few concerns in this regard. Rather, at low levels of technological interference, more phone use was associated with higher parenting quality. Scholars should avoid generalized narratives of family risk and seek to uncover real effects of smartphone use on family outcomes across diverse households and contexts

Nasal Bone Fractures and the Use of Radiographic Imaging: An Otolaryngologist Perspective

Objective To determine radiologic preferences of practicing otolaryngologists regarding isolated nasal bone fractures. Study design An 8-question survey on isolated nasal bone fractures was designed. Setting Surveys were sent to all otolaryngology residency program directors for distribution among residents and faculty. Additional surveys were distributed to private practice otolaryngology groups. Results 140 physicians responded to the survey. 57% of the respondents were practicing otolaryngologists (75% with 10+ years of experience), while 43% of respondents were residents-in-training. 56% of respondents treated 1–5 nasal bone fractures per month. 80% of all respondents reported imaging being performed prior to consultation. If imaging was obtained before consultation, plain films and computed tomography (CT) maxillofacial/sinus scans were the most frequent modalities. 33% of residents and 70% of practicing otolaryngologists report imaging as ‘rarely’ or ‘never’ helpful in guiding management. 42% of residents and 20% of practicing otolaryngologists report asking for imaging when it wasn't already obtained. Decreased use of radiography was associated with greater years in practice and higher frequency of fractures treated. Conclusions and relevance Otolaryngologists seldom request imaging to evaluate and treat isolated nasal bone fractures. When ordered, imaging is utilized more often among residents-in-training and non-otolaryngology consulting physicians. This study highlights an opportunity to educate primary care and emergency room providers as well as otolaryngology residents on the value of comprehensive physical exam over radiographic imaging in the work-up of isolated nasal fractures. In addition, widespread adoption of a “no x-ray policy” in this setting may result in better resource utilization

Pennsylvania Folklife Vol. 19, No. 1

• The Moravian Settlements of Pennsylvania in 1757: The Nicholas Garrison Views • The San Rocco Festival at Aliquippa, Pennsylvania: A Transplanted Tradition • Amish Genealogy: A Progress Report • Pulpit Humor in Central Pennsylvania • The Pre-Metric Foot and its Use in Pennsylvania German Architecture • Mennonite Contacts Across the Atlantic: The Van der Smissen Letter of 1838 • Bread, Baking, and the Bakeoven: Folk-Cultural Questionnaire No. 13https://digitalcommons.ursinus.edu/pafolklifemag/1037/thumbnail.jp

A CAM- and starch-deficient mutant of the facultative CAM species Mesembryanthemum crystallinum reconciles sink demands by repartitioning carbon during acclimation to salinity

In the halophytic species Mesembryanthemum crystallinum, the induction of crassulacean acid metabolism (CAM) by salinity requires a substantial investment of resources in storage carbohydrates to provide substrate for nocturnal CO2 uptake. Acclimation to salinity also requires the synthesis and accumulation of cyclitols as compatible solutes, maintenance of root respiration, and nitrate assimilation. This study assessed the hierarchy and coordination of sinks for carbohydrate in leaves and roots during acclimation to salinity in M. crystallinum. By comparing wild type and a CAM-/starch-deficient mutant of this species, it was sought to determine if other metabolic sinks could compensate for a curtailment in CAM and enable acclimation to salinity. Under salinity, CAM deficiency reduced 24 h photosynthetic carbon gain by >50%. Cyclitols were accumulated to comparable levels in leaves and roots of both the wild type and mutant, but represented only 5% of 24 h carbon balance. Dark respiration of leaves and roots was a stronger sink for carbohydrate in the mutant compared with the wild type and implied higher maintenance costs for the metabolic processes underpinning acclimation to salinity when CAM was curtailed. CAM required the nocturnal mobilization of >70% of primary carbohydrate in the wild type and >85% of carbohydrate in the mutant. The substantial allocation of carbohydrate to CAM limited the export of sugars to roots, and the root:shoot ratio declined under salinity. The data suggest a key role for the vacuole in regulating the supply and demand for carbohydrate over the day/night cycle in the starch-/CAM-deficient mutant

O efeito do treino da visão periférica na correlação entre chutes para o gol e tentos realizados no futsal

O objetivo do estudo foi determinar o efeito do treino da visão periférica na correlação entre chutes para o gol e tentos realizados no futsal. A amostra foi composta por dez meninos com 10,4±2,31 anos que foram divididos entre grupo experimental (GE) e grupo controle (GC). Esses jovens realizaram 25 sessões, o GE praticou o treino da visão periférica (TVP), enquanto que o GC realizou 15 sessões do treino tradicional e se exercitou em 10 sessões do TVP. O TVP ensina o futebolista a atuar na partida com ênfase na visão espacial através do treino técnico, treino situacional, treino tático e no jogo. O campeonato em dupla foi filmado pela câmera Sony Handycam Vision CCD-TRV 12 e posteriormente foram quantificados os chutes e gols das respectivas zonas da quadra por scout. Os resultados apresentaram um r insignificante (p>0,05) por zona do campo do GE e do GC. Todas as zonas da quadra foram significantes (p≤0,05) para o GC (r = - 0,97) e insignificante (p>0,05) para o GC. Concluindo, nesta pesquisa foi evidenciado que o mais importante é a precisão do chute que resulta em gol e não a alta quantidade desse fundamento no jogo

Renal Artery Stenosis and Obstructive Uropathy: To Resect or to Stent?

INTRODUCTION: Atherosclerotic renal artery stenosis causes hypertension that is resistant to medical management and may eventually lead to loss of kidney function. The treatment options for uncontrolled hypertension include best medical therapy (BMT), renal artery stenting (RAS), or surgical intervention; however, the optimal modality remains uncertain. This is the case of a patient with renal artery stenosis complicated by concurrent obstructive uropathy. CASE DESCRIPTION: Our patient is a 66-year-old male with a long-standing history of hypertension uncontrolled with BMT (beta blocker, angiotensin II receptor blocker (ARB) and a thiazide diuretic) and progressive renal insufficiency which was presumed to be due to prostatic obstructive uropathy. Despite undergoing a transurethral prostatectomy, his renal function continued to decline. A pelvic magnetic resonance angiogram (MRA) was performed which showed bilateral renal artery stenosis with the left being worse than the right. Computed tomography angiogram (CTA) was then performed which confirmed significant bilateral renal artery stenosis of 80 percent and 60 percent of the left and right renal artery respectively. The patient then underwent balloon angioplasty followed by stenting of both vessels without complication. Post-stenting angiography showed less than 30 percent stenosis of either vessel. During hospitalization, he had some improvement in his blood pressure, and his renal function was improved from baseline. One month follow up showed no significant change in blood pressure from initial visit prior to stenting. DISCUSSION: In healthy subjects, reduced renal perfusion lowers the glomerular filtration rate (GFR), causing a response by the renin-angiotensin-aldosterone system (RAAS) which leads to a compensatory increase in blood pressure. Although the GFR is reduced, renal parenchyma is able to adapt to reduced blood flow if perfusion pressure is reduced by 40 percent. There are a number of ways to manage renal artery stenosis, including RAS versus BMT. Currently, the effects of stenting are controversial and not fully understood. Multiple randomized trails have shown confounding results. Some trails have shown benefit in RAS, while others have demonstrated increase adverse outcomes due to renal reperfusion. In this case, we decided to to proceed with RAS given the significant stenosis on imaging, the patient's clinical presentation of worsening renal function despite BMT, and having ruled out other causes of progressive renal failure. The decision to intervene in these patients is usually determined on a case-by-case basis after discussion between surgeon, nephrologist and patient and after educating the patient on the risks and benefits.N

An Interesting Case Highlighting Management of Pelvic Congestion Syndrome

INTRODUCTION: The development of valvular incompetence and/or obstruction in the pelvic and gonadal veins causing disabling symptoms comprises Pelvic Congestion Syndrome (PCS). It is a less known pathologic condition commonly occurring in women of child bearing age, and diagnosis can be challenging due to a variety of clinical presentations. Nutcracker syndrome (NCS) is a potential cause of PCS and involves compression of the left renal vein between the superior mesenteric artery and the aorta. We report one such case of a woman who presented with chronic pelvic pain. CASE DESCRIPTION: Our patient is a 31-year-old woman evaluated in our clinic with 6 years of unbearable back and suprapubic pain associated with dyspareunia and dysuria. She underwent evaluation by her gynecologist, and a transvaginal ultrasound demonstrated vaginal varicosities. Computed tomography angiogram (CTA) showed dilated left ovarian vein contiguous with left greater than right pelvic varicosities. We then performed a diagnostic venogram that demonstrated left pelvic venous plexus consistent with pelvic varicosities in the left ovarian vein and NCS anatomy. We decided to treat the PCS first. The patient underwent foam sclerotherapy of the pelvic venous plexus using 3cc of foam sclerosing agent (polidocanol) followed by coil embolization of the left ovarian vein. Post embolization venogram demonstrated radiographically successful treatment with no flow in the ovarian vein and preserved flow in the left renal vein. DISCUSSION: Chronic pelvic pain due to pelvic congestion is often associated with a constellation of symptoms including pelvic pain, dyspareunia, dysmenorrhea, and dysuria causing negative cognitive, behavioral, sexual and emotional consequences. There are three types of chronic pelvic pain, categorized by etiology. Type I is secondary to valvular incompetence of pelvic or ovarian veins, Type II is secondary to obstruction of outflow, and Type III is due to local compression. Venography is the gold standard for diagnosis. Treatment is directed at providing symptomatic relief with medical therapy, and treating the underlying cause by either endovascular (sclerotherapy and embolization, left renal venous stent placement) or open surgical techniques (including gonadal vein transposition, left renal vein transposition, or saphenous vein bypass).N