The role of well-child visits in detecting developmental delay in preschool children

Background: Early detection of developmental delay (DD) in preschool children is crucial for counselling parents, initiating diagnostic work-up, and starting early intervention (EI). Methods: We conducted a register study of all preschool children referred for EI in the Canton of Zurich, Switzerland, in 2017 (N = 1,785) and used an online survey among primary care physicians (PCPs, N = 271) to evaluate the care service of DD children. Results: PCPs accounted for 79.5% of all referrals by physicians and had correctly referred over 90% of the children in need of EI at an average age of 39.3 months (SD 8.9). In the survey, which represents 59.2% of all pediatricians and 11.3% of all general practitioners in the Canton, PCPs reported performing a mean of 13.5 (range 0-50, SD 10.7) well-child visits per week to preschool children and estimated well-child visits to be the most frequent type of consultation (66.7%) for the identification of DD. Parents' hesitancy in accepting further evaluation or support were reported by 88.7%. Conclusions: Most preschool children with DD are identified in well-child visits. These visits represent an ideal opportunity for early detection of developmental impairment and initiation of EI. Carefully addressing parents' reservations could reduce the rate of refusal, thus improving early support for children with DD

Observations of the low-mode internal tide and its interaction with mesoscale flow south of the Azores

Understanding the temporal variability of internal tides plays a crucial role in identifying sources and sinks of energy in the ocean. Using a 10-month-long time series from moored instruments inside a tidal beam south of the Azores, the magnitude and the underlying causes of temporal variability in the first two modes of the internal tide energy flux was studied. We analyzed changes of the direction and coherence of the energy flux, its modal structure, and the impact of two eddies. Semidiurnal energy fluxes were further compared with estimates from a 1/10° ocean global circulation model, as well as with fluxes derived from satellite altimetry. All energy fluxes correlate reasonably well in direction, deviations from its fixed phase relation to astronomical forcing, and modal composition while model and satellite underestimate the total energy flux. A pronounced damping of the in situ fluxes coincides with the passing of two eddies. In the presence of a surface-intensified eddy, the coherent part of the energy flux in the first two modes is lowered by more than 40, a subsurface eddy coincides with a decrease of the energy flux mainly in the second mode. These observations support the hypothesis that eddy interactions increase the incoherent part of the energy flux and transfer energy from low modes into higher modes, which can lead to increased local dissipation. It remains an open question how much of the energy converted from lower to higher modes results in local dissipation, a crucial part in creating energetically consistent ocean-climate models. © 2020. The Authors

Recent changes in the Labrador Sea Water within the Deep Western Boundary Current southeast of Cape Cod

Author Posting. © The Author(s), 2011. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Deep Sea Research Part I: Oceanographic Research Papers 58 (2011): 1019-1030, doi:10.1016/j.dsr.2011.07.006.Water properties measured by the central mooring in the Line W mooring array southeast of Cape Cod document a large character shift during the period of November 2001 to April 2008. The observed temperature, salinity and planetary potential vorticity (PPV) anomalies manifest changes in the formation region of the water masses present at Station W, specifically upper Labrador Sea Water (uLSW), deep Labrador Sea Water (dLSW) and Overflow Water (OW). During the observation period, the minimum in the PPV anomaly field relative to the record mean PPV profile migrated from 1500m, where it was originally found, to 700m. Temporal changes in the vertical distribution of temperature and salinity were correlated with the PPV changes. This suggests a dLSW-dominated first half of the record, versus an uLSW-dominated second half. The structure of these anomalies is consistent with observations within the Labrador Sea, and their transit time to Line W agrees well with tracer-derived times for signals spreading along the western boundary. In that context, the observed water properties at Line W in the early 2000s reflected the intense deep convection in the Labrador Sea in the mid 1990s, with less intense convection subsequently affecting lighter isopycnals. The observed velocity field is dominated by high-frequency (periods of days to months) fluctuations, however, a fraction of the velocity variability is correlated with changes in water mass properties, and indicate a gradual acceleration of the southwestward flow, with a corresponding increase in Deep Western Boundary Current transport.Financial support for the early observations (2001-2004) was provided by the G. Unger Vetlesen Foundation. Observations collected as part of the Line Wprogram (2004-2008) were funded by the U.S. National Science Foundation (grants number OCE-0241354 and OCE-0726720) as well as funding from WHOI’s Ocean and Climate Change Institute

Mental health challenges and digital platform opportunities in patients and families affected by pediatric neuromuscular diseases - experiences from Switzerland

Receiving the diagnosis of a severe disease may present a traumatic event for patients and their families. To cope with the related challenges, digital interventions can be combined with traditional psychological support to help meet respective needs. We aimed to 1) discuss the most common consequences and challenges for resilience in Neuro Muscular Disease patients and family members and 2) elicit practical needs, concerns, and opportunities for digital platform use. We draw from findings of a transdisciplinary workshop and conference with participants ranging from the fields of clinical practice to patient representatives. Reported consequences of the severe diseases were related to psychosocial challenges, living in the nexus between physical development and disease progression, social exclusion, care-related challenges, structural and financial challenges, and non-inclusive urban design. Practical needs and concerns regarding digital platform use included social and professional support through these platforms, credibility and trust in online information, and concerns about privacy and informed consent. Furthermore, the need for safe, reliable, and expert-guided information on digital platforms and psychosocial and relationship-based digital interventions was expressed. There is a need to focus on a family-centered approach in digital health and social care and a further need in researching the suitability of digital platforms to promote resilience in the affected population. Our results can also inform city councils regarding investments in inclusive urban design allowing for disability affected groups to enjoy a better quality of life

Mental health challenges and digital platform opportunities in patients and families affected by pediatric neuromuscular diseases : experiences from Switzerland

Receiving the diagnosis of a severe disease may present a traumatic event for patients and their families. To cope with the related challenges, digital interventions can be combined with traditional psychological support to help meet respective needs. We aimed to 1) discuss the most common consequences and challenges for resilience in Neuro Muscular Disease patients and family members and 2) elicit practical needs, concerns, and opportunities for digital platform use. We draw from findings of a transdisciplinary workshop and conference with participants ranging from the fields of clinical practice to patient representatives. Reported consequences of the severe diseases were related to psychosocial challenges, living in the nexus between physical development and disease progression, social exclusion, care-related challenges, structural and financial challenges, and non-inclusive urban design. Practical needs and concerns regarding digital platform use included social and professional support through these platforms, credibility and trust in online information, and concerns about privacy and informed consent. Furthermore, the need for safe, reliable, and expert-guided information on digital platforms and psychosocial and relationship-based digital interventions was expressed. There is a need to focus on a family-centered approach in digital health and social care and a further need in researching the suitability of digital platforms to promote resilience in the affected population. Our results can also inform city councils regarding investments in inclusive urban design allowing for disability affected groups to enjoy a better quality of life

The Impact of Generic Data Structures: Decoding the Role of Lists in the Linux Kernel

International audienceThe increasing adoption of the Linux kernel has been sustained by a large and constant maintenance effort, performed by a wide and heterogeneous base of contributors. One important problem that maintainers face in any code base is the rapid understanding of complex data structures. The Linux kernel is written in the C language, which enables the definition of arbitrarily uninformative datatypes, via the use of casts and pointer arithmetic, of which doubly linked lists are a prominent example. In this paper, we explore the advantages and disadvantages of such lists, for expressivity, for code understanding, and for code reliability. Based on our observations, we have developed a toolset that includes inference of descriptive list types and a tool for list visualization. Our tools identify more than 10,000 list fields and variables in recent Linux kernel releases and succeeds in typing 90%. We show how these tools could have been used to detect previously fixed bugs and identify 6 new ones

Comparative Proteomic Analysis of the PhoP Regulon in Salmonella enterica Serovar Typhi Versus Typhimurium

Background: S. Typhi, a human-restricted Salmonella enterica serovar, causes a systemic intracellular infection in humans (typhoid fever). In comparison, S. Typhimurium causes gastroenteritis in humans, but causes a systemic typhoidal illness in mice. The PhoP regulon is a well studied two component (PhoP/Q) coordinately regulated network of genes whose expression is required for intracellular survival of S. enterica. Methodology/Principal Findings: Using high performance liquid chromatography mass spectrometry (HPLC-MS/MS), we examined the protein expression profiles of three sequenced S. enterica strains: S. Typhimurium LT2, S. Typhi CT18, and S. Typhi Ty2 in PhoP-inducing and non-inducing conditions in vitro and compared these results to profiles of $phoP^−/Q^−$ mutants derived from S. Typhimurium LT2 and S. Typhi Ty2. Our analysis identified 53 proteins in S. Typhimurium LT2 and 56 proteins in S. Typhi that were regulated in a PhoP-dependent manner. As expected, many proteins identified in S. Typhi demonstrated concordant differential expression with a homologous protein in S. Typhimurium. However, three proteins (HlyE, STY1499, and CdtB) had no homolog in S. Typhimurium. HlyE is a pore-forming toxin. STY1499 encodes a stably expressed protein of unknown function transcribed in the same operon as HlyE. CdtB is a cytolethal distending toxin associated with DNA damage, cell cycle arrest, and cellular distension. Gene expression studies confirmed up-regulation of mRNA of HlyE, STY1499, and CdtB in S. Typhi in PhoP-inducing conditions. Conclusions/Significance: This study is the first protein expression study of the PhoP virulence associated regulon using strains of Salmonella mutant in PhoP, has identified three Typhi-unique proteins (CdtB, HlyE and STY1499) that are not present in the genome of the wide host-range Typhimurium, and includes the first protein expression profiling of a live attenuated bacterial vaccine studied in humans (Ty800)