Fluvoxamine for the treatment of anxiety disorders in children and adolescents.
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Adolescent↗
Biomedical subjects
E Isaacs
Publications and source records attributed to E Isaacs.
Nutrition and mental development.
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Animals↗
Randomized trial of nutrient-enriched formula versus standard formula for postdischarge preterm infants.
OBJECTIVES: Preterm infants are frequently discharged from the hospital growth retarded and show reduced growth throughout childhood. In a large efficacy and safety trial, we tested the hypothesis that nutritional intervention in the first 9 months postterm would reverse postdischarge growth deficits and improve neurodevelopment without adverse safety outcomes. PARTICIPANTS AND INTERVENTION: Two hundred eighty-four infants (mean gestation: 30.9 weeks) were studied; 229 were randomly assigned a protein, energy, mineral, and micronutrient-enriched postdischarge formula (PDF; N = 113) or standard term formula (TF; N = 116) from discharge (mean 36.5 weeks' postmenstrual age). A reference group (N = 65) was breastfed until at least 6 weeks' postterm. Outcome measures. Anthropometry was performed at 6 weeks and 3, 6, 9, and 18 months. Development was measured at 9 months (Knobloch, Passamanick, and Sherrard's developmental screening inventory) and 18 months (Bayley Scales of Infant Development II; primary outcome) postterm. RESULTS: At 9 months, compared with the TF group, those fed PDF were heavier (difference 370 g; 95% confidence interval [CI]: 84-660) and longer (difference 1.1 cm; 95% CI: 0.3-1.9); the difference in length persisted at 18 months (difference 0.82 cm; 95% CI: -0.04-1.7). There was no effect on head circumference. The effect of diet was greatest in males; at 9 months length deficit with TF was 1.5cm (95% CI: 0.3-2.7), and this remained at 18 months (1.5cm [95% CI: 0.3-2.7]). There was no significant difference in developmental scores at 9 or 18 months, although PDF infants had a 2.8 (-1.3-6.8) point advantage in Bayley motor score scales. At 6 weeks' postterm, exclusively breastfed infants were already 513 g (95% CI: 310-715) lighter and 1.6cm (95% CI: 0.8-2.3) shorter than the PDF group, and they remained smaller up to 9 months' postterm. CONCLUSIONS: 1) Improving postdischarge nutrition in the first 9 months may "reset" subsequent growth-at least until 18 months for body length. We intend to follow-up the children at older ages. The observed efficacy of PDF was not associated with adverse safety outcomes. 2) We cannot reject the hypothesis that postdischarge nutrition benefits motor development and this requires additional study. 3) Our data raise the possibility that breastfed postdischarge preterm infants may require nutritional supplementation, currently under investigation.
Anthropometry↗
Ability of laypersons to estimate short time intervals in cardiac arrest.
STUDY OBJECTIVE: Estimates of time intervals by bystanders are considered critical in cardiac arrest, and are often used in other disorders such as stroke and myocardial infarction. Because they have never been previously studied, we sought to determine their accuracy. METHODS: This study was performed by prospective collection of bystander estimates (made at the time of the arrest) of the time from calling 911 to the arrival of urban fire department first responders, and comparison with actual measured response interval from computerized records, in all out-of-hospital cardiac arrests from January 1996 through June 1998. RESULTS: The fire department responded to 1,015 patients in cardiac arrest during the study period. First responders arrived before advanced life support providers to 831 patients, who thus met study entry criteria. Bystander estimates were obtained in 497 of these 831 patients, who did not differ in key characteristics from those lacking estimates. The bystander's average estimated fire department response interval was 5.6 minutes (95% confidence interval [CI] 5.2 to 5.9 minutes) and the actual measured interval to the patient's side from computer records was 6.1 minutes (95% CI 5.9 to 6.4 minutes). However, the median error of the bystander estimate (1.3 minutes) was 32% of the median of the actual measured on-scene interval, and there was no correlation between the bystander estimates and the measured interval in individual cases (R </=0.14), regardless of which intervals were examined. Seventy-five percent of the bystander estimates erred by 20% or more. When bystanders estimated a response interval as excessively long, they were almost invariably wrong, but they also usually failed to identify intervals that actually were long. CONCLUSION: Although many diagnostic and research conclusions are based on interval estimates from laypersons, we found no correlation between estimates and actual measured intervals in cardiac arrest. Current methodology may not be developed well enough to provide reliable data for research or quality assurance, and other clinical time estimates by patients and bystanders may be equally unreliable.
Aged↗
Outcome after ischaemic stroke in childhood.
A parental questionnaire was used to investigate the outcome for children who had had ischaemic stroke, who were seen at Great Ormond Street Hospital, London between 1990 and 1996. The results of functional assessments carried out by a physiotherapist and an occupational therapist, and of quantitative evaluations carried out by a neuropsychologist were used for validation where possible. The relationship between clinical and radiological factors and outcome were examined. The children were aged between 3 months and 15 years at the time of stroke (median age 5 years) and the period of follow-up ranged from 3 months to 13 years (median duration 3 years). Of the 90 children for whom data were obtained, 13 (14%) had no residual impairments. Outcome was good in 37 children (40%) and poor in 53 (60%) (defined according to whether impairments interfered with daily life). Agreement, as measured by Cohen's kappa, was good or very good between the parents' responses and the qualitative measures provided by the medical professionals and the therapists, but only fair to moderate for the quantitative measures provided by the neuropsychologists. This may reflect different parental perceptions of the physical and cognitive aspects of outcome. Younger age at time of the stroke was the only significant predictor of adverse outcome.
Adolescent↗
Staff views on orthopaedic patients' accommodation.
Alternative accommodation to traditional wards may be suitable for some orthopaedic patients. Doctors and nurses in this study had different views about patient accommodation. Little reference to patient choice was made by either doctors or nurses. Further research is needed on different staff groups regarding factors influencing discharge decision-making.
Attitude of Health Personnel↗
An evaluation of WHA resolution 45.5: health human resource implications.
The World Health Assembly approved resolution WHA45.5 in 1992. This paper reports the findings of an evaluation of the implementation of this resolution using a survey technique. A total of 150 WHO Member States responded, for a 79% response rate. Findings suggest that the greatest strides worldwide have been made in education. While the data show that progress has been made at the country level, far more action is needed to strengthen nursing and midwifery if these cost-effective resources are to play a decisive role in improving the extent and quality of services, especially as delivered to people in the greatest need.
Cross-Sectional Studies↗
Language dysfunction in children with Rolandic epilepsy.
Rolandic epilepsy is regarded as the classic example of benign focal epilepsy. However, neuropsychological deficits have been noted in affected children. As Rolandic discharges are mainly distributed over the centrotemporal region, specific interference with language function might be suspected. Therefore, we conducted a standardized neuropsychological assessment in children with Rolandic epilepsy which covered all important aspects of language processing. We measured intelligence Quotient, verbal memory, auditory discrimination, vocabulary, grammar and literacy in 20 children with an active Rolandic focus. Information about performance at school was obtained from teachers by means of a questionnaire. Patients with Rolandic epilepsy failed five of the twelve standardized language tests significantly more often than the normative population and consequently showed impairment of the following functions: reading, spelling, auditory verbal learning, auditory discrimination with background noise and expressive grammar. Thirteen of the 20 children showed language dysfunction with difficulties in two or more of the twelve standardized language tests. In eight of these 13 children the Full Scale Intelligence Quotient was within average range, indicating a specific language deficit. Language dysfunction was closely associated with learning difficulties at school. This study documents a consistent pattern of language dysfunction in children with Rolandic epilepsy which suggests interictal dysfunction of perisylvian language areas.
Adolescent↗
Onset of speech after left hemispherectomy in a nine-year-old boy.
Case Alex, with Sturge-Weber Syndrome affecting the left hemisphere, failed to develop speech throughout early boyhood, and his comprehension of single words and simple commands remained stagnant at an age equivalent of 3-4 years. But then, following left hemidecortication at age 8.5 years and withdrawal of anticonvulsants when he was more than 9 years old, Alex suddenly began to acquire speech and language. He also showed an unusual degree of residual motor capacity on his right side. Alex's remarkable progress in learning speech and language, and the development of his other cognitive abilities, were measured periodically from the age of 9 to 15 years. His most recent scores on tests of receptive and expressive language place him at an age equivalent of 8-10 years. Comparison with the level of function attained in these domains by nine other left hemispherectomized patients with early onset of disease and comparable IQ (range, 40-68) but with early development of speech and language, suggests that, surprisingly, Alex has suffered no permanent disadvantage from his protracted period of mutism and severely limited comprehension. Although the findings in Alex, as in other left-hemispherectomized patients, indicate define limits to the cognitive and linguistic capacity of the isolated right hemisphere, Alex's achievements appear to challenge the widely held view that early childhood is a particularly critical period for acquisition of speech and language or any of their selective aspects, including phonology, grammar, prosody and semantics. It is concluded that clearly articulated, well structured, and appropriate language can be acquired for the first time as late as age 9 years with the right hemisphere alone.
Adolescent↗
Variable presentation of cerebrovascular disease in monovular twins.
We describe twin girls with bilateral cerebrovascular disease. In one child, a diagnosis of moyamoya disease was made after presentation in infancy with an acute hemiparesis; her asymptomatic sibling was found to have significant bilateral cerebrovascular disease after neuropsychological evaluation and assessment with transcranial Doppler ultrasound. Both subjects showed a discrepancy between verbal and performance IQ and deficits on a test of frontal-lobe function suggesting that these domains should be targeted in cognitive assessment. Family members of subjects with moyamoya are at risk of cerebrovascular disease. Clinical symptoms do not reliably predict disease and those at risk should be offered screening with non-invasive vascular imaging.
Cerebral Angiography↗
Effects of hemispheric side of injury, age at injury, and presence of seizure disorder on functional ear and hand asymmetries in hemiplegic children.
Dichotic listening, manual functions, and IQ were measured in a large group of hemiplegic children with unilateral hemispheric damage. In the children without a history of seizure disorder, only manual functions were impaired, but in those with such a history (and hence a regime of anticonvulsant medication), all measures were affected. Some children with congenital left hemisphere lesions (with and without siezure disorder) showed a left ear advantage for dichotic digits as well as greater impairment in right hand function than those who showed the usual right ear advantage. The latter result suggests that the hemipheric damage in the subgroup with altered ear asymmetry was greater than in the others and extensive enough to encroach on language areas, shifting language representation to the right.
Adolescent↗
Do not resuscitate, but do not forget comfort.
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Home Care Services↗
Agnosia, alexia and a remarkable form of amnesia in an adolescent boy.
Childhood cases of global anterograde amnesia, visual agnosia or alexia without agraphia, either alone or in any combination, are extremely rare. Here we report the case of a male adolescent, Neil (a pseudonym), who consequent to a pineal tumour began to exhibit all three disorders in the presence of normal verbal intelligence. The most surprising aspect of Neil's case, however, is his ability to retrieve postmorbid memories through the act of writing without being able to provide any oral account of the content of his written reports. His memory retrieval thus has some of the character of 'automatic writing'. This evidence pointing to Neil's possession of a dissociated form of episodic memory presents a new challenge to our understanding of the organization of memory and of the cerebral systems underlying it.
Adolescent↗
A review of cognitive outcome after unilateral lesions sustained during childhood.
Views on human brain organization early in development have swung back and forth between the extreme notions of complete equipotentiality and adult-like specialization. Recent research on the cognitive effects of early brain damage supports an intermediate position and suggests that many claims on the older literature must be re-examined in the light of new evidence that cognitive impairments are sometimes attributable to previously ignored factors, such as a history of seizures, time since injury, and unsuspected lesions that are now detectable with neuroimaging techniques.
Adolescent↗
Splitting of resonant Raman x-ray peaks near the MIV and MV edges of uranium.
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Journal Article↗
Graphical access to medical expert systems: IV. Experiments to determine the role of spoken input.
The goal of our research is to design improved interfaces for medical expert systems. Previously, the use of graphical techniques was explored to improve the acceptance by clinicians of the user interface. Now that devices that accept spoken input are available, we wish to design interfaces that take advantage of this potentially more natural modality for interaction. To understand how clinicians might want to speak to a medical decision-support system, we carried out an experiment that simulated the availability of a spoken interface to the ONCOCIN medical expert system. ONCOCIN provides therapy advice for patients on complex cancer therapy protocols based on a description of the patient's current medical status and laboratory-test values. In the experiment, we had oncologists present a clinical case while observing the ONCOCIN flowsheet display. A project member listened to the presentation and filled in values for the flowsheet, as well as introducing purposeful misunderstandings of the input. The results suggest that each individual developed a stereotypical grammar for communicating with the program. Our experience with the purposeful miscommunications suggests particular ways to tailor requests for repetition based on the part of the utterance that was not understood.
Decision Making, Computer-Assisted↗
Development of intelligence and memory in children with hemiplegic cerebral palsy. The deleterious consequences of early seizures.
Although substantial data exist regarding the consequences of early lateralized cerebral lesions on intelligence and language ability, little is known about the development of other cognitive functions after such lesions. We examined the development of both verbal and nonverbal memory in 82 hemiplegic children, grouped according to hemispheric side of injury and presence or absence of seizure disorder. The control group consisted of 41 age-matched normal children, most of them siblings of the patients. Measures were obtained of intelligence and of immediate and delayed recall for prose passages, word paired associates and geometric designs. Electrophysiological and neuroradiological measures were available for a majority of the patients. The scores of the hemiplegic children on the IQ and memory tests did not exhibit the pattern seen in brain-damaged adults, in that the children's deficits showed no relation to hemispheric side of damage. Indeed, early cerebral damage to either hemisphere, even if extensive, resulted in relatively few and mild deficits if the damage was unaccompanied by seizure activity. By contrast, early lateralized lesions that were accompanied by a seizure disorder resulted in both a high incidence and degree of deficit that was unrelated to lesion side.
Cerebral Palsy↗
The role of the gross spectral shape as a perceptual cue to place articulation in initial stop consonants.
This series of studies explored the extent to which the gross shape of the onset spectrum is used by the listener for the identification of place of articulation in initial stop consonants. Synthetic stimuli were generated with onset frequencies appropriate to the syllables [ba bi du da di du] and with the gross shape of the onset spectrum manipulated to be appropriate for either alveolar consonants or labial consonants. Stimuli were presented for identification and discrimination. In addition, adaptation effects of stimuli containing appropriate frequency and shape and incompatible frequency and shape were explored on a place-of-articulation onset continuum. Although identification performance was determined by onset frequency rather than gross shape of the spectrum, presentation of stimuli in which shape was inconsistent with frequency reduced identification performance. Further, subjects could discriminate stimuli which varied only in spectral shape. Finally, significantly less adaptation was found for a [da] onset with a labial spectrum shape than [da] onset with an alveolar spectrum shape. These results suggest that although the invariant properties residing in the gross shape of the onset spectrum may serve as a classificatory framework for the phonetic dimensions of natural language, they may not provide the primary perceptual attributes for place of articulation in ongoing speech processing.
Humans↗