Physician attitude, awareness, and knowledge regarding guidelines for transcranial Doppler screening in sickle cell disease.

ObjectiveWe explored factors that may influence physician adherence to transcranial Doppler (TCD) screening guidelines among children with sickle cell disease.MethodsPediatric hematologists, neurologists, and primary care physicians (n = 706) responded to a mailed survey in May 2012 exploring factors hypothesized to influence physician adherence to TCD screening guidelines: physician (internal) barriers and physician-perceived external barriers. Responses were compared by specialty using chi-square tests.ResultsAmong 276 physicians (44%), 141 currently treated children with sickle cell disease; 72% recommend screening. Most primary care physicians (66%) did not feel well informed regarding TCD guidelines, in contrast to neurologists (25%) and hematologists (6%, P < .0001). Proportion of correct answers on knowledge questions was low (13%-35%). Distance to a vascular laboratory and low patient adherence were external barriers to receipt of TCD screening.ConclusionsAdditional research regarding physicians' lack of self-efficacy and knowledge of recommendations could help clarify their role in recommendation of TCD screening

Missed Opportunities for Transcranial Doppler Screening Among Children With Sickle Cell Disease.

Transcranial Doppler (TCD) screening rates remain low among children with sickle cell disease (SCD). We assessed TCD screening rates and missed opportunities for TCD screening. Children 2 to 16 years old with SCD enrolled in Michigan Medicaid for ≥1 year (2007-2011) were identified through newborn screening. Receipt of TCD screening and presence of a missed opportunity (≥1 SCD-related outpatient visit, no TCD screening) were identified through administrative claims. Potential correlates of missed opportunities included SCD-related health services, comorbidities, and demographics. Logistic regression with generalized estimating equations modeled associations between a missed opportunity and correlates. Overall, 353 children contributed 1066 person-years. TCD screening was low yearly (10%-32%); missed opportunities occurred in 73% of the person-years. Increasing age (odds ratio [OR] = 1.11; confidence interval CI = 1.07, 1.15), previous TCD screening (OR = 0.26; CI = 0.16, 0.41), and 4 to 5 (OR = 0.48; CI = 0.26, 0.87) or ≥6 outpatient visits (OR = 0.26; CI = 0.14, 0.49) were associated with a missed opportunity. Reduction of missed opportunities is a potential strategy to increase TCD screening rates

Development and validation of a measure of maladaptive social-evaluative beliefs characteristic of social anxiety disorder in youth: the Report of Youth Social Cognitions (RYSC)

Recent research has started to examine the applicability of influential adult models of the maintenance of social anxiety disorder (SAD) to youth. This research is limited by the lack of psychometrically validated measures of underlying constructs that are developmentally appropriate for youth. One key construct in adult models of SAD is maladaptive social-evaluative beliefs. The current study aimed to develop and validate a measure of these beliefs in youth, known as the Report of Youth Social Cognitions (RYSC). The RYSC was developed with a clinical sample of youth with anxiety disorders (N = 180) and cross-validated in a community sample of youth (N = 305). In the clinical sample, the RYSC exhibited a three-factor structure (Negative Evaluation, Revealing Self, and Positive Impression factors), good internal consistency, and construct validity. In the community sample, the three-factor structure and the internal consistency of the RYSC were replicated, but the test of construct validity showed that the RYSC had similarly strong associations with social anxiety and depressed affect. The RYSC had good test-retest reliability overall, although the Revealing Self subscale showed lower temporal stability which improved when only older participants were considered (age ≥ 9 years). The RYSC in general was also shown to discriminate between youth with and without SAD although the Revealing Self subscale again performed suboptimally but improved when only older participants were considered. These findings provide psychometric support for the RYSC and justifies its use with youth in research and clinical settings requiring the assessment of maladaptive social-evaluative beliefs

Smart sensors to detect movements of cobbles and large woody debris dams. Insights from lab experiments.

An increase in population pressure and severe storms under climate change have greatly impacted landslide and flood hazards globally. At the same time, recent advances in Wireless Sensor Network (WSN) and Internet of Things (IoT) technologies, microelectronics and machine learning offer new opportunities to effectively monitor stability of boulder and woody debris on landslides and in flood-prone rivers. In this framework, smart sensors embedded in elements within the landslide body and the river catchment can be potentially used for monitoring purposes and for developing early warning systems. This is because they are small, light-weight, and able to collect different environmental data with low battery consumption and communicate to a server through a wireless connection. However, their reliability still needs to be evaluated. As data from field sites could be fragmented, laboratory experiments are essential to validate sensor data and see their potential in a controlled environment. In the present study, dedicated laboratory experiments were designed to assess the ability of a tag equipped with an accelerometer, a gyroscope, and a magnetometer to detect movements in two different settings. In the first experimental campaign, the tag was installed inside a cobble of 10.0 cm diameter within a borehole of 4.0 cm diameter. The experiments consisted in letting the cobble fall on an experimental table composed of an inclined plane of 1.5 m, followed by a horizontal one of 2.0 m. The inclined plane can be tilted at different angles (18˚- 55˚) and different types of movement have been generated by letting the cobble roll, bounce, or slide. Sliding was generated by embedding the cobble within a layer of sand. The position of the cobble travelling down the slope was derived from camera videos by a tracking algorithm developed within the study. In the second experimental campaign, a simplified analogue model of a woody debris dam was built from a single hollowed dowel with a length of 40 cm and a diameter of 3.8 cm. The sensor tag is installed in the woody dowel within a 2.5 cm longitudinal borehole. Two metal rigs are mounted at both sides of the woody dowel to allow different modes of movement. Specifically, the woody dowel is allowed to move either horizontally or vertically within a range of 20-30 mm, whereas it is always free to complete full rotations. The woody dowel is mounted on a frame within a 20 m long and 0.6 m wide flume. In these two experimental settings, combining data from the accelerometer, gyroscope and magnetometer it was possible to detect movements and differentiate between different type of motions both in a woody dowel and in the cobble under different initial conditions. Data were analysed to understand which type of information could be retrieved. This gives important insights for the assessment of the feasibility and effectiveness of the use of smart sensors in the detection of movements in woody logs within dams and boulders embedded in landslides, thus providing indications for the development of early warning systems using this innovative technology

Constraining the contribution of the Antarctic Ice Sheet to Last Interglacial sea-level

Polar temperatures during the Last Interglacial [LIG; ~129 to 116 thousand years (ka)] were warmer than today, making this time period an important testing ground to better understand how ice sheets respond to warming. However, it remains debated how much and when the Antarctic and Greenland ice sheets changed during this period. Here, we present a combination of new and existing absolutely dated LIG sea-level observations from Britain, France, and Denmark. Because of glacial isostatic adjustment (GIA), the LIG Greenland ice melt contribution to sea-level change in this region is small, which allows us to constrain Antarctic ice change. We find that the Antarctic contribution to LIG global mean sea level peaked early in the interglacial (before 126 ka), with a maximum contribution of 5.7 m (50th percentile, 3.6 to 8.7 m central 68% probability) before declining. Our results support an asynchronous melt history over the LIG, with an early Antarctic contribution followed by later Greenland Ice Sheet mass loss

The sugar content of children’s and lunchbox beverages sold in the UK before and after the soft drink industry levy

Background: Childhood obesity is associated with an increased intake of sugary soft drinks and juice drinks. The aims of this study were (1) to report the sugar and energy content in commercial fruit juice (FJ), juice drinks (JD) and smoothies (S) specifically targeted at children in the UK, (2) to identify beverages liable for the Soft Drinks Industry Levy (SDIL) and (3) to compare the amount of sugar in these beverages before and after the levy. Methods: The beverages were retrieved using the online shopping tool my Supermarket, websites of nine major supermarket in the UK and manufacturers webpages. Comparisons of sugar content were taken before and after the introduction of the SDIL. Results: 131 FJJDS fulfilled the inclusion criteria. The mean sugar content of all the beverages was 6.3g±4.5/100mL. There was large variation in the sugar content from 0.1g/100mL to 15.2g/100mL, with smoothies found to contain the most sugar (11.55±1.62 g/mL). The beverages were reanalysed in September 2018 to determine their eligibility for the SDIL. Of the 131 products only 7 JD were eligible for the levy. Four of these beverages had reformulated their ingredients since the initial analysis resulting in a sugar content of <5g/100mL. Conclusions: The majority of the beverages targeted at children and children’s lunch boxes were not eligible for the SDIL. This study suggests the necessity to adapt the SDIL to include all FJJDS aimed at children as the total sugar content of these beverages are still above the recommended quantities for this age group