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Background: More than 90% of pediatric patients presenting to emergency departments (EDs) in the United States are evaluated and treated in community-based EDs. Recent evidence suggests that mortality outcomes may be worse for critically ill pediatric patients treated at community EDs. The disparate mortality outcomes may be due to inconsistency in pediatric-specific education provided to emergency medicine (EM) trainees during residency training. There are few studies surveying recently graduated EM physicians assessing perceived gaps in the pediatric emergency medicine (PEM) education they received during residency., Methods: This was a prospective, survey-based, descriptive cohort study of EM residency graduates from 10 institutions across the United States who were <5 years out from residency training. Deidentified surveys were distributed via email., Results: A total of 222 responses were obtained from 570 eligible participants (39.1%). Non-ED pediatric rotations during residency training included pediatric intensive care (60%), pediatric anesthesia (32.4%), neonatal intensive care unit (26.1%), and pediatric wards (17.1%). A large percentage (42.8%) of respondents felt uncomfortable managing neonates and performing tube thoracostomy on pediatric patients (56.3%). The EM graduate's satisfaction with pediatric simulation-based training during residency was positively associated with comfort caring for neonates and infants ( p  < 0.0070 and p  < 0.0002) and performing endotracheal intubation ( p  < 0.0027), lumbar puncture ( p  < 0.0004), and Pediatric Advanced Life Support resuscitation ( p  < 0.0001)., Conclusions/discussion: This survey-based cohort study found considerable variation in pediatric-specific experiences during EM residency training and in perceived comfort managing pediatric patients. In general, participants were more comfortable managing older children. This study suggests that the greatest perceived knowledge gaps in PEM were neonatal medicine/resuscitation and pediatric cardiac arrest. Future research will continue to address larger cohorts, representative of the PEM education provided to EM physicians in the United States to promote future educational initiatives., Competing Interests: The authors declare no conflicts of interest., (© 2023 Society for Academic Emergency Medicine.)

Objective: While COVID-19 vaccination prevents severe infections, poor immunogenicity in immunocompromised people threatens vaccine effectiveness. We analysed the clinical characteristics of patients with rheumatic disease who developed breakthrough COVID-19 after vaccination against SARS-CoV-2., Methods: We included people partially or fully vaccinated against SARS-CoV-2 who developed COVID-19 between 5 January and 30 September 2021 and were reported to the Global Rheumatology Alliance registry. Breakthrough infections were defined as occurring ≥14 days after completion of the vaccination series, specifically 14 days after the second dose in a two-dose series or 14 days after a single-dose vaccine. We analysed patients' demographic and clinical characteristics and COVID-19 symptoms and outcomes., Results: SARS-CoV-2 infection was reported in 197 partially or fully vaccinated people with rheumatic disease (mean age 54 years, 77% female, 56% white). The majority (n=140/197, 71%) received messenger RNA vaccines. Among the fully vaccinated (n=87), infection occurred a mean of 112 (±60) days after the second vaccine dose. Among those fully vaccinated and hospitalised (n=22, age range 36-83 years), nine had used B cell-depleting therapy (BCDT), with six as monotherapy, at the time of vaccination. Three were on mycophenolate. The majority (n=14/22, 64%) were not taking systemic glucocorticoids. Eight patients had pre-existing lung disease and five patients died., Conclusion: More than half of fully vaccinated individuals with breakthrough infections requiring hospitalisation were on BCDT or mycophenolate. Further risk mitigation strategies are likely needed to protect this selected high-risk population., Competing Interests: Competing interests: KLH reports she has received non-personal speaker’s fees from AbbVie and grant income from BMS, UCB and Pfizer, all unrelated to this manuscript; KLH is supported by the NIHR Manchester Biomedical Research Centre. LG reports personal consultant fees from AbbVie, Amgen, BMS, Biogen, Celgene, Gilead, Janssen, Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis and UCB, and grants from Amgen, Lilly, Janssen, Pfizer, Sandoz, Sanofi and Galapagos, all unrelated to this manuscript. AS reports research grants from a consortium of 14 companies (among them AbbVie, BMS, Celltrion, Fresenius Kabi, Gilead/Galapagos, Lilly, Mylan/Viatris, Hexal, MSD, Pfizer, Roche, Samsung, Sanofi-Aventis and UCB) supporting the German RABBIT register and personal fees from lectures for AbbVie, MSD, Roche, BMS, Lilly and Pfizer, all unrelated to this manuscript. LC has not received fees or personal grants from any laboratory, but her institute works by contract for laboratories among other institutions, such as AbbVie Spain, Eisai, Gebro Pharma, Merck Sharp & Dohme España, Novartis Farmaceutica, Pfizer, Roche Farma, Sanofi-Aventis, Astellas Pharma, Actelion Pharmaceuticals España, Grünenthal and UCB Pharma. EF-M reports personal consultant fees from Boehringer Ingelheim Portugal and that LPCDR received support for specific activities: grants from AbbVie, Novartis, Janssen-Cilag, Lilly Portugal, Sanofi, Grünenthal, MSD, Celgene, Medac, Pharmakern and GAfPA; grants and non-financial support from Pfizer; and non-financial support from Grünenthal, outside the submitted work. IB reports personal consultant fees from AbbVie, Novartis, Pfizer and Janssen, all unrelated to this manuscript. JZ reports speaker fees from AbbVie, Novartis and Janssen/Johnson & Johnson, all unrelated to this manuscript. GR-C reports personal consultant fees from Eli Lilly and Novartis, all unrelated to this manuscript. JS is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant numbers: R01 AR077607, P30 AR070253 and P30 AR072577), and the R Bruce and Joan M Mickey Research Scholar Fund. JS has received research support from Amgen and Bristol Myers Squibb and performed consultancy for Bristol Myers Squibb, Gilead, Inova, Janssen and Optum, unrelated to this work. LW receives speaker’s bureau fees from Aurinia Pharma, unrelated to this manuscript. SB reports no competing interests related to this work. He reports non-branded consulting fees for AbbVie, Horizon and Novartis (all <$10 000). MGM has no competing interests related to this work. She serves as a patient consultant for BMS, BI JNJ and Aurinia (all <$10 000). RG reports no competing interests related to this work. Outside of this work she reports personal and/or speaking fees from AbbVie, Janssen, Novartis, Pfizer and Cornerstones and travel assistance from Pfizer (all <$10 000). JH reports no competing interests related to this work. He is supported by grants from the Rheumatology Research Foundation and has salary support from the Childhood Arthritis and Rheumatology Research Alliance. He has performed consulting for Novartis, Sobi and Biogen, all unrelated to this work (<$10 000). ESi reports non-financial support from Canadian Arthritis Patient Alliance, outside the submitted work. PS reports personal fees from the American College of Rheumatology/Wiley Publishing, outside the submitted work. ZW reports grant support from Bristol Myers Squibb and Principia/Sanofi and performed consultancy for Viela Bio and MedPace, outside the submitted work. His work is supported by grants from the National Institutes of Health. PMM has received consulting/speaker’s fees from AbbVie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this study. PMM is supported by the National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC). PCR reports no competing interests related to this work. Outside of this work PCR reports personal fees from AbbVie, Atom Bioscience, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, Kukdong, Novartis, UCB, Roche and Pfizer; meeting attendance support from BMS, Pfizer and UCB; and grant funding from Janssen, Novartis, Pfizer and UCB Pharma (all <$10 000). JY reports no competing interests related to this work. Her work is supported by grants from the National Institutes of Health (K24 AR074534 and P30 AR070155). Outside of this work, she has received research grants or performed consulting for Gilead, BMS Foundation, Pfizer, Aurinia and AstraZeneca., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Abdominal vascular emergencies are an uncommon entity in emergency medicine, but when they present, they are often catastrophic. These time-sensitive and life-threatening diagnoses are often hidden in nonspecific complaints such as nausea, vomiting, or flank pain, so the emergency physician must remain diligent and consider these in the differential diagnoses. The following is an overview of the more common of these abdominal vascular emergencies, in the hope that they help the Emergency Physician avoid the misdiagnosis and subsequent vascular catastrophe that would follow., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Ticks are among the most significant human-biting ectoparasites and they play a major role in transmission of many pathogenic agents to humans. In the present study, three species of Hyalomma ticks, Hyalomma aegyptium, H. marginatum and H. excavatum, were examined for the presence of zoonotic bacteria, both male and female ticks alike. Examination of microbial diversity with tag-encoded pyrosequencing indicates that H. marginatum and H. excavatum were more diversity rich than H. aegyptium. Although numerous pathogenic and non-pathogenic bacterial genera were detected, including Acidovorax, Bacillus, Bacteroides, Bdellovibrio, Clostridium, Curvibacter, Escherichia, Flavobacterium, Limnohabitans, Paenibacillus, Ralstonia, Sarcina, Sediminibacterium, Segetibacter Stenotrophomonas and Variovorax, the predominant zoonotic bacteria represented in these ticks were genera Borrelia, Francisella, and Rickettsia. To the authors' knowledge, this work represents the first detection of Yersinia enterocolitica in the tick H. excavatum, raising questions regarding the vector competency of this tick, as well as associations of different disease representations perhaps through previously unforeseen routes of pathogen introduction. Likewise, similar questions are related to the presence of Legionella pneumophila in one H. excavatum sample.

This study investigates infants' transition from nonverbal to verbal communication using evidence from regression patterns. As an example of regressions, prelinguistic infants learning American Sign Language (ASL) use pointing gestures to communicate. At the onset of single signs, however, these gestures disappear. Petitto (1987) attributed the regression to the children's discovery that pointing has two functions, namely, deixis and linguistic pronouns. The 1:2 relation (1 form, 2 functions) violates the simple 1:1 pattern that infants are believed to expect. This kind of conflict, Petitto argued, explains the regression. Based on the additional observation that the regression coincided with the boundary between prelinguistic and linguistic communication, Petitto concluded that the prelinguistic and linguistic periods are autonomous. The purpose of the present study was to evaluate the 1:1 model and to determine whether it explains a previously reported regression of intonation in English. Background research showed that gestures and intonation have different forms but the same pragmatic meanings, a 2:1 form-function pattern that plausibly precipitates the regression. The hypothesis of the study was that gestures and intonation are closely related. Moreover, because gestures and intonation change in the opposite direction, the negative correlation between them indicates a robust inverse relationship. To test this prediction, speech samples of 29 infants (8 to 16 months) were analyzed acoustically and compared to parent-report data on several verbal and gestural scales. In support of the hypothesis, gestures alone were inversely correlated with intonation. In addition, the regression model explains nonlinearities stemming from different form-function configurations. However, the results failed to support the claim that regressions linked to early words or signs reflect autonomy. The discussion ends with a focus on the special role of intonation in children's transition from "prelinguistic" communication to language.

Thermal expansion, electrical resistivity, magnetization, and specific heat measurements were performed on URu 2-x Fe x Si 2 single crystals for various values of Fe concentration x in both the hidden-order (HO) and large-moment antiferromagnetic (LMAFM) regions of the phase diagram. Our results show that the paramagnetic (PM) to HO and LMAFM phase transitions are manifested differently in the thermal expansion coefficient. The uniaxial pressure derivatives of the HO/LMAFM transition temperature T 0 change dramatically when crossing from the HO to the LMAFM phase. The energy gap also changes consistently when crossing the phase boundary. In addition, for Fe concentrations at x c ≈ 0.1, we observe two features in the thermal expansion upon cooling, one that appears to be associated with the transition from the PM to the HO phase and another one at lower temperature that may be due to the transition from the HO to the LMAFM phase., Competing Interests: The authors declare no conflict of interest.

While elderly patients account for only 10-12% of all trauma victims, they consume 25% of trauma-related health care resources, with higher rates of mortality and complication. Presently described is the case of an elderly patient who presented to the emergency department (ED) following mild thoracic trauma, with previous history of gastric pull-up surgery. The patient had consulted another facility 48 hours earlier and was prescribed analgesia and x-ray follow-up for a mechanical fall and pain in the lower rib cage. At arrival, the patient complained of increasing dyspnea and pain at the right hemithorax. X-ray showed right hemithorax effusion, and contrast computed tomography (CT) demonstrated a large amount of contrast filling the pleural space and a relatively small point of gastric pull-up rupture in the stomach. The patient was referred to the cardiothoracic unit, but was unresponsive upon arrival and died. The aim of the present report was to raise the index of clinical suspicion of traumatic rupture of the gastric pull-up following traumatic chest injury, and to affirm that contrast CT should be the gold standard for diagnosis.

The principal aim of this study was to evaluate pre-schoolers' expressive intonation in light of current debates about the underlying nature of language impairment (LI). Children with LI typically have deficits in grammar, a component of language that is phonologically represented on the segmental level. The hypothesis is that children with LI do not have deficits of this type when grammar is conveyed by intonation, a pitch-based component of language that is phonologically represented on the suprasegmental level. This study focused on the richly diversified suprasegmental patterns of sentences in which the speaker produces a series of items in a list. To address the hypothesis, list intonation in the speech of 4-year-olds with and without LI was acoustically analysed. Lists produced by children with LI were comparable to those produced by children with normal language development (NL). The results do not support the claim that LI stems from a poor understanding of grammatical principles. Rather, LI reflects an underlying impairment of segmental information processing. The discussion focuses on two characteristics of pitch contours which may account for the resilience of intonation in children with LI. Namely, steady state versus transient signals and universal symbol meanings versus arbitrary relationships between form and function.

This article describes the development of intonation in 12 cochlear implant (CI) recipients. In a previously reported study of the first year of CI use, children who were implanted late (after 24 months) acquired intonation more rapidly than the younger participants. The older children's advantage is plausibly owing to their greater maturity. However, children who were implanted early (before 25 months) did not have an advantage over the still younger control group of infants with normal hearing (NH), suggesting that the advantage requires a critical age of about 30 months. The younger CI-users reached this age in the second year of CI use. The results confirmed our expectation that even the younger CI recipients would acquire intonation more rapidly than infants with NH who had the same amount of robust hearing experience. Clinical implications are discussed in relation to the question of early versus late implantation.

Retrospective review of charts of 180 consecutive patients with frontal sinus fractures managed by plastic surgeons at the University of Kentucky between 1987 and 2007 was performed with institutional review board approval. Twenty-six charts did not meet the criteria. The remaining 154 records provided 1-to-20-year follow-up. The study included 34 patients who underwent cranialization and 120 patients who did not. A low-complication rate of 6% after cranialization is ascribed by the authors to meticulous sinus mucosal debridement; thorough obliteration of the frontal sinus outflow tract (with sterile gelatin sponge pledgets and bone chips from the outer cortex of the temporoparietal skull); and avoidance of avascular barriers, such as abdominal fat. As high-resolution computerized tomography with parasaggital views was introduced, an increasing ability to preoperatively define the extent of injury of the medial and lateral sinus floor was observed. The authors conclude selective use of cranialization is indicated.

Routine urine cultures were performed in cats with chronic kidney disease (CKD) to assess the overall prevalence and clinical signs associated with a positive urine culture (PUC). An occult urinary tract infection (UTI) was defined as a PUC not associated with clinical signs of lower urinary tract disease or pyelonephritis. Multivariate logistic and Cox proportional hazard regression models were used to evaluate the risk factors for an occult UTI and its relationship with survival. There were 31 PUCs from 25 cats. Eighty-seven percent of PUCs had active urine sediments. The most common infectious agent was Escherichia coli and most bacteria were sensitive to amoxicillin-clavulanate. Eighteen of 25 cats had occult UTIs. Among cats with occult UTI, increasing age in female cats was significantly associated with PUC; no significant association between occult UTI and survival was found and serum creatinine was predictive of survival in the short term (200 days) only. In conclusion, among cats with CKD, those with occult UTI were more likely to be older and female, but there was no association with severity of azotaemia. The presence of an occult UTI, when treated, did not influence survival.

Theories and measures of women's aggression in intimate relationships are only beginning to be developed. This study provides a first step in conceptualizing the measurement of women's aggression by examining how well three widely used measures (i.e., the Revised Conflict Tactics Scales (CTS), the Sexual Experiences Survey [SES], and the Psychological Maltreatment of Women Inventory [PMWI]) perform in assessing women's perpetration of and victimization by aggression in their intimate relationships with men. These constructs were examined in a diverse sample of 412 African American, Latina, and White women who had all recently used physical aggression against a male intimate partner. The factor structures and psychometric properties of perpetration and victimization models using these measures were compared. Results indicate that the factor structure of women's perpetration differs from that of women's victimization in theoretically meaningful ways. In the victimization model, all factors performed well in contributing to the measurement of the latent victimization construct. In contrast, the perpetration model performed well in assessing women's physical and psychological aggression but performed poorly in assessing women's sexual aggression, coercive control, and jealous monitoring. Findings suggest that the power and control model of intimate partner violence (IPV) may apply well to women's victimization but not as well to their perpetration of violence.

This article describes the longitudinal development of intonation in 18 deaf children who received cochlear implants (CIs) before the age of 3 years and 12 infants with typical development (TD) who served as controls. At the time their implants were activated, the children with CIs ranged in age from 9 to 36 months. Cross-group comparisons were made when the children had equivalent amounts of robust hearing experience but different chronological ages. This article reports the results for the 6-month period ending 9 months after activation of the child's device for children with CIs, and the 6-month period ending at 12 months of age for TD infants. The findings were compared with a model of early intonation development in children with normal hearing. The results indicated that all groups progressed through one or more of the stages predicted by the normative model. At the end of the study period, however, children who had received a CI later than 24 months reached a more mature stage of intonation development than younger CI recipients. Moreover, the older CI group reached the same stage of development as the TD infants who had 3 additional months of language listening experience. The findings suggest that the developmental advantage which older children had previously demonstrated shortly after activation of their CIs is maintained throughout most or all of the first year of CI use.

Purpose: This study examined the effect of Parkinson's disease (PD) on the intonational marking of final and nonfinal syntactic boundaries and investigated whether the effect of PD on intonation was sex specific., Method: Eight women and 8 men with PD and 16 age- and sex-matched control participants read a passage at comfortable pitch, rate, and loudness. Nuclear tones from final and nonfinal syntactic boundaries in clauses and lists were extracted. Measures of fundamental frequency (F0) were made on each tone contour., Results: Individuals with PD demonstrated impaired differentiation of syntactic boundary finality/nonfinality with contour direction. They produced a lower proportion of falling contours in final boundaries and a higher proportion of falling contours in nonfinal boundaries than did control participants. Although not mediated by syntax, the effect of PD on F0 standard deviation (F0 SD) and pitch range in semitones (PRST) was sex specific. Women with PD produced greater F0 SD and PRST than did men with PD and women without PD. Men with PD produced lower PRST than did men without PD., Conclusions: Impaired intonational marking of syntactic boundaries likely contributes to dysprosody and reduced communicative effectiveness in PD. The effect of PD on intonation was sex specific. The results are not fully explained by PD-related motor execution impairments.

Background: Decubitus ulcers, also known as bedsores or pressure ulcers, affect millions of hospitalized patients each year. The microflora of chronic wounds such as ulcers most commonly exist in the biofilm phenotype and have been known to significantly impair normal healing trajectories., Methods: Bacterial tag-encoded FLX amplicon pyrosequencing (bTEFAP), a universal bacterial identification method, was used to identify bacterial populations in 49 decubitus ulcers. Diversity estimators were utilized and wound community compositions analyzed in relation to metadata such as Age, race, gender, and comorbidities., Results: Decubitus ulcers are shown to be polymicrobial in nature with no single bacterium exclusively colonizing the wounds. The microbial community among such ulcers is highly variable. While there are between 3 and 10 primary populations in each wound there can be hundreds of different species present many of which are in trace amounts. There is no clearly significant differences in the microbial ecology of decubitus ulcer in relation to metadata except when considering diabetes. The microbial populations and composition in the decubitus ulcers of diabetics may be significantly different from the communities in non-diabetics., Conclusions: Based upon the continued elucidation of chronic wound bioburdens as polymicrobial infections, it is recommended that, in addition to traditional biofilm-based wound care strategies, an antimicrobial/antibiofilm treatment program can be tailored to each patient's respective wound microflora.

Point-of-care (POC) meters that determine whole blood triglyceride (TG) concentrations are used in human medicine to monitor both fasting and post-prandial TG concentrations. The aim of this study was to evaluate their performance for determining feline TG concentrations. A total of 116 venous blood samples were collected from 55 cats. TG concentrations were measured in whole blood using two meters: the Accutrend glucose cholesterol triglyceride (GCT) (GCT: Roche Diagnostics) and PTS CardioChek (PTS - Polymer Technology Systems), and results compared to those determined by a National Association of Testing Authorities (NATA) accredited veterinary laboratory. The GCT was not suitable for use in cats with normal TG concentrations (<0.9 mmol/l), as it overestimated almost 80% of the values; however, this device performed better with TG concentrations between 0.9 and 2.0 mmol/l. The PTS meter performed well in cats with normal TG concentrations, correctly classifying 90% of values as 'normal', and fairly well with TG concentrations <2.0 mmol/l. The PTS meter could be used to determine whether cats have normal fasting TG concentrations or predict mild elevations in serum TG, whereas the GCT meter can only be used to predict cats with elevated TG concentrations. Although both meters have limitations in determining some TG concentrations, the PTS in particular, could be used as a screening tool to distinguish normal cats to those with hypertriglyceridaemia., (Copyright 2010 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.)

A prevention trial tested the efficacy of INSIGHTS into Children's Temperament as compared to a Read Aloud attention control condition in reducing student disruptive behavior and enhancing student competence and teacher classroom management. Participants included 116 first and second grade students, their parents, and their 42 teachers in six inner city schools. Teachers completed the Sutter-Eyberg Student Behavior Inventory (SESBI) and the Teacher's Rating Scale of Child's Actual Competence and Social Acceptance (TRS) at baseline and again upon completion of the intervention. Boys participating in INSIGHTS, compared with those in the Read Aloud program, showed a significant decline in attentional difficulties and overt aggression toward others. Teachers in INSIGHTS, compared to those in the attention control condition, reported significantly fewer problems managing the emotional-oppositional behavior, attentional difficulties, and covert disruptive behavior of their male students. They also perceived the boys as significantly more cognitively and physically competent.

Objective: To evaluate agreement between 2 portable triglyceride meters and a veterinary laboratory for measurement of blood triglyceride concentrations in dogs and evaluate effects of Hct and blood volume analyzed., Sample Population: 97 blood samples collected from 60 dogs., Procedures: Triglyceride concentrations were measured in blood by use of 2 meters and compared with serum triglyceride concentrations determined by a veterinary laboratory. Within- and between-day precision, accuracy, and effects of blood volume and Hct were analyzed., Results: Accuracy of both meters varied with triglyceride concentration, although both accurately delineated dogs with triglyceride concentrations < 180 mg/dL versus > or = 180 mg/dL. One meter had results with excellent overall correlation with results of the standard laboratory method, with a concordance correlation coefficient of 0.94 and mean difference of 20.3 mg/dL. The other meter had a good overall concordance correlation coefficient of 0.86 with a higher absolute mean difference of -27.7 mg/dL. Results were only affected by blood volume; triglyceride concentrations determined via both meters were significantly lower when 7 microL of EDTA-anticoagulated blood was used, compared with larger volumes., Conclusions and Clinical Relevance: 1 meter had greater accuracy in the range of 140 to 400 mg/dL and was therefore well suited to detect hypertriglyceridemia. The other meter was accurate with triglyceride values < 140 mg/dL and yielded results similar to those of the veterinary laboratory in the range of 140 to 400 mg/dL, therefore being suitable for determination of triglyceride concentrations in nonfed dogs and dogs with mildly high concentrations.

This study is among the first attempts to address a frequently articulated, yet unsubstantiated claim that sample inclusion criteria based on women's physical aggression or victimization will yield different distributions of severity and type of partner violence and injury. Independent samples of African American women participated in separate studies based on either inclusion criterion of women's physical aggression or victimization. Between-groups comparisons showed that samples did not differ in physical, sexual, or psychological aggression; physical, sexual, or psychological victimization; inflicted or sustained injury. Therefore, inclusion criterion based on physical aggression or victimization did not yield unique samples of "aggressors" and "victims."

This study examines motives for intimate partner violence (IPV) among a community sample of 412 women who used IPV against male partners. A "Motives and Reasons for IPV scale" is proposed, and exploratory factor analyses identified five factors: expression of negative emotions, self-defense, control, jealousy, and tough guise. To our knowledge, the study is the first to investigate the relationship between women's motives for IPV and their perpetration of physical, psychological, and sexual aggression, as well as coercive control, toward partners. Hierarchical regression analyses revealed participants' aggression was driven by complex, multiple motives. All five motives were related to a greater frequency of perpetrating IPV. Treatment programs focusing on women's IPV perpetration should address both defensive and proactive motives.

This study examined whether relationships among women's aggression, their victimization, and substance use problems were moderated by race/ethnicity. Four hundred and twelve community women (150 African Americans, 150 Latinas, and 112 Whites) who recently were aggressive against a male partner completed a 2-hour computer-assisted interview. ANOVA and path analysis revealed that (a) for all women, victimization and aggression were strongly related; (b) race/ethnicity moderated the relationships between victimization and alcohol and drug use problems; and (c) no groups evidenced a relationship between alcohol or drug use problems and aggression. Findings suggest that it is essential to develop culturally relevant, gender-specific interventions to reduce both women's aggression and victimization, as well as related negative behaviors such as alcohol and drug use.

This study describes the development of emerging intonation in six children who had received a cochlear implant (CI) before the age of three years. At the time their implant was activated, the children ranged in age from 11 to 37 months. Spontaneous longitudinal speech samples were recorded from 30-minute sessions in which the child interacted with his or her mother. Data were collected 2 months before activation of each child's CI and at monthly intervals after activation for 6 months. The findings were compared to the typical pattern of early intonation development in children with normal hearing (NH). The results suggested that young CI recipients progress through stages similar to those observed in children with NH. However, the intonation development of children with a CI reflects a marked interaction between chronological age at implantation and amount of CI experience. That is, after 2 months of CI-assisted hearing experience, the older children demonstrated a later stage of intonation development than younger children. These preliminary results support the idea that children acquire some foundations or prerequisites of intonation production through maturation, as measured by chronological age, even without robust auditory experience.

This study examined relationships between mother-child interactions and children's behaviors in 119 urban African American mothers and their 6 - 7 year old children. Interactions during a cooking task and a follow-up child clean-up task were videotaped. Principal components analyses of behaviors during the cooking task yielded two factors in mothers (Sensitivity and Control), and three in children (Task Involvement, Responsiveness, and Communicative). Children's negativity during a clean up task was coded and mothers were interviewed about their children's problem behaviors. Parenting sensitivity was associated with positive child behaviors and parenting control was associated with negative child behaviors. Maternal education was associated with greater maternal sensitivity and less control. Child gender predicted their task involvement, responsiveness, communicativeness, negativity during clean-up, and behavior problems; maternal control and sensitivity mediated some of these relations. Findings underscore heterogeneity of African American parenting and factors that promote positive parenting and children's behavioral adjustment in early childhood.

Primary lipid disorders causing fasting triglyceridaemia have been documented infrequently in Burmese cats. Due to the known increased risk of diabetes mellitus and sporadic reports of lipid aqueous in this breed, the aim of this study was to determine whether healthy Burmese cats displayed a more pronounced pre- or post-prandial triglyceridaemia compared to other cats. Serum triglyceride (TG) concentrations were determined at baseline and variably at 2, 4 and 6h after ingestion of a high-fat meal (ie, an oral fat tolerance test) in a representative sample of Burmese and non-Burmese cats. The median 4 and 6h serum TG concentrations were significantly higher in Burmese cats (4h - 2.8mmol/l; 6h - 8.2mmol/l) than in other pedigree and domestic crossbred cats (4h - 1.5mmol/l; 6h - 1.0mmol/l). The non-Burmese group had post-prandial TG concentrations ranging from 0.6 to 3.9mmol/l. Seven Burmese cats had post-prandial TG concentrations between 6.6 and 19.0mmol/l, five had concentrations between 4.2 and 4.7mmol/l, while the remaining 15 had post-prandial concentrations between 0.5 and 2.8mmol/l. None of these Burmese cats had fasting triglyceridaemia. Most Burmese cats with a 4 h TG > 6.0 mmol/l had elevated fasting very low density lipoprotein (VLDL) concentrations. This study demonstrates that a proportion of Burmese cats in Australia have delayed TG clearance compared to other cats. The potential repercussions of this observation with reference to lipid aqueous, pancreatitis and diabetes mellitus in Burmese cats are discussed.

Objective: To compare serum triglyceride concentrations obtained after food had been withheld (i.e., fasting concentrations) in dogs with epilepsy that had been treated long term (> or = 3 months) with phenobarbital or with phenobarbital and potassium bromide with concentrations in healthy control dogs., Design: Cross-sectional study., Animals: 57 epileptic dogs that had been treated with phenobarbital (n=28) or with phenobarbital and bromide (29) and 57 healthy, untreated control dogs matched on the basis of age, breed, sex, neuter status, and body condition score., Procedures: Blood samples were collected after food had been withheld for at least 12 hours, and serum biochemical and lipid concentrations were determined. Oral fat tolerance tests were performed in 15 control dogs and 9 dogs with epilepsy treated with phenobarbital alone., Results: 19 of the 57 (33%) epileptic dogs had fasting serum triglyceride concentrations greater than the upper reference limit. Nine (16%) dogs had a history of pancreatitis, and 5 of the 9 had high fasting serum triglyceride concentrations at the time of the study. A significant relationship was found between body condition score and fasting serum triglyceride concentration in all dogs, but serum triglyceride concentration was not significantly associated with phenobarbital dosage or serum phenobarbital concentration., Conclusions and Clinical Relevance: Results suggested that dogs treated long term with phenobarbital or with phenobarbital and bromide may develop hypertriglyceridemia. Fasting serum triglyceride concentration should be periodically monitored in dogs treated with phenobarbital because hypertriglyceridemia is a risk factor for pancreatitis.

In order to address the issue of spring constant calibration in viscous fluids such as water, a new method is presented that allows for the experimental calibration of bimaterial cantilever spring constants. This method is based on modeling rectangular cantilever beam bending as a function of changing temperature. The temperature change is accomplished by heating water as it flows around the cantilever beams in an enclosed compartment. The optical static method of detection is used to measure the deflection of cantilever at the free end. Experimentally determined results are compared to Sader's method and to the Thermotune method most commonly used in cantilever calibrations. Results indicate that the new bimaterial thermal expansion method is accurate within 15%-20% of the actual cantilever spring constant, which is comparable to other nondestructive calibration techniques.

Cantilevers are useful as sensor devices with high sensitivity and have shown great promise for dense, multianalyte arrays. One of the difficulties has been the fabrication of multianalyte arrays that are capable of the simultaneous detection of a wide range of chemical and biological species. Functionalization procedures for one class of analytes are often incompatible with other classes and cross contamination is a significant concern when ink-jet deposition processes are used. In this study, we used surface micromachined cantilevers designed and fabricated using Sandia National Laboratories SUMMiT V MEMS process. The cantilevers are fabricated with a base that can be detached from the parent substrate after functionalization and mounted into a daughter array. We have utilized an IBM-fabricated 8-cantilever array chip as our daughter substrate due to its compatibility with a Scentris 8-cantilever readout system. Our initial work demonstrates that this is a feasible procedure for decoupling functionalization from array assembly.

The removal behavior of self-assembled monolayers (SAMs) of thiol molecules on a gold substrate by an NH(4)OH-H(2)O(2)-H(2)O solution was studied using attenuated total reflectance infrared spectroscopy (ATR-IR) and atomic force microscopy (AFM). Furthermore, the impact of the concentration of NH(4)OH and H(2)O(2) in the solution and reaction temperature on the SAM removal rate and efficiency was explored. The SAM removal rate and efficiency were significantly influenced by the concentration of NH(4)OH rather than H(2)O(2). The solution containing the 2 : 1 molar ratio of NH(4)OH : H(2)O(2) among three different solutions showed the highest removal rate and efficiency in the removal of 11-mercapto-1-undecanol. The increase in the reaction temperature resulted in the enhancement on the SAM removal rate, but it led to the fast delamination of the gold layer. These results may be useful in the regeneration of sensor surfaces relying on gold/thiol chemistry.

This article provides a review of research literature on women who use violence with intimate partners. The central purpose is to inform service providers in the military and civilian communities who work with domestically violent women. The major points of this review are as follows: (a) women's violence usually occurs in the context of violence against them by their male partners; (b) in general, women and men perpetrate equivalent levels of physical and psychological aggression, but evidence suggests that men perpetrate sexual abuse, coercive control, and stalking more frequently than women and that women also are much more frequently injured during domestic violence incidents; (c) women and men are equally likely to initiate physical violence in relationships involving less serious "situational couple violence," and in relationships in which serious and very violent "intimate terrorism" occurs, men are much more likely to be perpetrators and women victims; (d) women's physical violence is more likely than men's violence to be motivated by self-defense and fear, whereas men's physical violence is more likely than women's to be driven by control motives; (e) studies of couples in mutually violent relationships find more negative effects for women than for men; and (f) because of the many differences in behaviors and motivations between women's and men's violence, interventions based on male models of partner violence are likely not effective for many women.

An optical static method of detection is used to interpret surface stress induced bending related to cantilevers coated on one side with poly(vinyl alcohol), poly(vinyl butyral-co-vinyl alcohol-co-vinyl acetate), and poly(vinyl chloride-co-vinyl acetate-co-2-hydroxypropyl acrylate), or respectively, PVA, PVB, and PVC, and exposed to various solvent vapors. Results indicate that the adsorption and surface interactions of the different solvent vapors that cause polymer swelling and shrinking lead to rearrangements, which have been shown to change the elastic properties of the polymer film, and subsequently, the spring constant of the polymer coated cantilever. Static deflection measurements allow the direction of cantilever bending to be determined, which adds a new dimension of usefulness for surface functionalized cantilevers as transducers in the development of novel microelectromechanical systems (MEMS).

Previous studies have suggested that intonation development in infants and toddlers reflects an interaction between physiological and linguistic influences. The immediate background research for this study, however, was based on vocalizations that were only one syllable in length. By extending the analysis to polysyllabic utterances, the present study evaluated a broader range of physiological constraints on intonation production than the maximally simple context of monosyllabic utterances had permitted. The width and direction of pitch change across one- and two-syllable nuclear tones were acoustically analyzed in utterances produced by 60 children between the ages of 0;6 and 1;11. The results showed that the children controlled the characteristic intonation pattern of English monosyllables by the age of 1;6-1;8. However, even the youngest groups of children produced relatively robust and adult-like intonation contours when the tone-bearing string was polysyllabic, suggesting that the trochaic or dactylic foot is the natural 'unmarked' unit of tone production. The asymmetrical results for one- versus two-syllable tones support the conclusion that width of pitch change largely reflects physiological universals in children's earliest vocalizations and language-specific learning after the age of 1;6. Implications of the findings are also discussed in relation to the Trochaic Template Hypothesis. It is concluded that a bias for trochaic rhythms that some children demonstrate could be based, in part, on the child's sensitivity to physiological constraints on the velocity and range of intonational pitch change.

Individuals with severe mental illness (SMI) are at risk for HIV/AIDS. Despite the availability of supportive community programs for those with SMI, there have been no published evaluations of community-level HIV prevention trials among this population. A pilot intervention trial was conducted to determine the feasibility of such an intervention in supportive housing programs (SHPs). A multi-component community-level trial was implemented in two SHPs with a total of 28 residents. Participants completed assessments at three time points: prior to the intervention (baseline), following skills training (post-assessment), and following the 4-month community intervention (follow- up). Results demonstrated significant improvements in psychosocial risk factors at both post- and follow-up assessments, with indications of sexual behavior change at follow-up. The community-level intervention appeared to reduce the risk of HIV among persons with SMI living in SHPs, and supports the importance of conducting larger scale intervention trials.

Reports have appeared in the popular press in recent years concluding that women are just as violent as men. These reports stem from acontextual survey studies comparing prevalence rates of women's and men's physical violence. The authors contend that the above conclusion is simplistic and misleading, and that a theoretical framework that embeds women's violence in the context in which it occurs is sorely needed. This article proposes a model that includes women's violence in the context of their victimization by male partners, motivations for violent behavior and how they cope with relationship problems, experiences of childhood trauma, and outcomes of depression, anxiety, posttraumatic stress disorder, and substance use. The model is then examined within the context of gender, race, and class. The cultural context of domestic violence for African American and Latina women is reviewed. This literature reinforces the need to place women's violence in a broader sociocultural context.

Transmission infrared spectroscopy was applied to investigate properties of the perfluorosulfonated polymer Nafion. Measurements were made on thin films formed by casting the polymer from solution onto ZnSe windows. Effects of water vapor permeation were studied. A complex band structure between 1350 and 1100 cm(-1) was analyzed qualitatively by fitting the region to Gaussian functions. Features associated with vibrational modes of -CF(2) and -SO(3)(-) groups were identified and observed to be sensitive to film hydration. The intensities of bands for the -SO(3)(-) modes increased with film hydration, while bands assignable to -CF(2) modes decreased. The results were applied to interpret infrared difference spectra of Nafion and shed light on the complicated features that appear. Vibrational bands for water were also examined. In partially hydrated films, the stretching mode of the free -OH group for interfacial water present in pores and channels of the polymer and bands for hydrated proton clusters were detected.

This article examines the relationship of coping and problem drinking to men's abusive behavior towards female partners. While previous research has demonstrated a consistent association between problem drinking and male abuse of intimate partners, virtually no studies have assessed the role of coping in relation to men's violence. Furthermore, multivariate studies have not examined how these factors operate together to increase risk for abusive behavior. An ethnically diverse sample of 147 men in a court-mandated program for domestic violence offenders completed questionnaires at the first session. Path modeling was conducted to test the extent to which coping and problem drinking predicted both physical and psychological abuse. In addition, the relationships of problem drinking and physical abuse to injury of the men's female partners were examined. Results indicated that both the use of avoidance and problem-solving coping to deal with relationship problems were related indirectly to abusive behavior through problem drinking. Greater use of avoidance coping strategies was more likely among problem drinkers. By contrast, men who used higher levels of problem-solving coping were less likely to be problem drinkers. Avoidance, but not problem-solving coping also was directly and positively related to physical and psychological abuse. Men identified as problem drinkers were more likely to use both physical and psychological abuse. Finally, greater use of physical violence was strongly related to higher levels of injury among female partners, and served to mediate the relationship between problem drinking and injury. Results are discussed in terms of their contribution to the identification of risk and protective factors for men's violent behavior toward intimate female partners and implications for developing intervention strategies.

The purpose of this study was to describe the pattern in which English-speaking children acquire intonation. A second goal was to account for emerging intonation from a theoretical perspective. Six groups of 10 children each between the ages of 6 and 23 months participated in individual play sessions with their mothers and an experimenter. Pitch contours were acoustically analyzed in monosyllabic utterances produced by each child. The observed nonlinear shape of intonation development suggested a linguistically based pattern of regression and reorganization. However, the precocious expression of intonation in the youngest infants also pointed to the role of physiological universals and emotional experience. It is concluded that children's early intonation reflects biological, affective, and linguistic influences.

As a population, persons with serious mental illness (SMI) have an elevated risk for HIV infection. However, relatively little is known about how the risk of HIV has affected their lives, how persons with SMI evaluate their HIV risk, and what preventive measures they undertake. Furthermore, relatively little is known about community-based HIV prevention for persons with SMI as most interventions have been restricted to clinical settings. This report presents findings on the HIV-related experiences of persons with SMI living in supportive housing programs, one possible setting for implementing community-based HIV prevention with this population. The qualitative investigation interviewed 41 men and women living in five supportive housing programs. In-depth, qualitative interviews elicited discussion of research participants' (a) experiences with HIV, (b) knowledge about HIV and HIV prevention, (c) assessments of their own risk, (d) descriptions of how they apply their prevention knowledge, and (e) reports of barriers for HIV prevention. Research participants describe social networks that have substantial contact with persons affected by HIV. However, contrary to some expectations of persons with SMI, research participants report using HIV prevention knowledge in negotiating their risk of contracting HIV. The implications of these findings are discussed in terms of their relevance for implementing community-based HIV prevention for persons with SMI.

A prevention trial was conducted to evaluate a temperament-based intervention (INSIGHTS into Children's Temperament) as compared to a Read Aloud attention control condition in reducing behavior problems among inner city children. The participants were 148 inner-city first and second grade children, their parents, and their 46 teachers who were from six schools in a Northeastern city. Parents were interviewed on the Parent Daily Report at baseline and every two weeks until the completion of the intervention phase to assess the extent of child problem behaviors in the home. The parents also were interviewed at baseline with the Disruptive Module of the Diagnostic Interview for Children and completed the Brief Symptom Index to assess parental depression.A repeated measures multivariate analysis of covariance with parental depression as a covariate was conducted to examine the children's behavior over the course of the intervention. In order to test the impact of INSIGHTS for the overall sample and to determine whether the intervention was differentially effective for children diagnosed with a disruptive disorder versus those who did not receive a diagnosis, two and three-way interactions were examined and found to be significant. The INSIGHTS intervention was more effective than Read Aloud in reducing children's problem behaviors at home across both the diagnosed and non-diagnosed groups, but demonstrated a significantly greater efficacy among children who were at diagnostic levels compared to those who were within normal levels. Editors' Strategic Implications: The authors describe the promising practice of instructing parents and teachers on how to adapt their behavior management strategies to fit each child's temperament. Replication with a longitudinal follow-up will be necessary to determine whether program effects persist.

The present study examines the role of anger and victimization in women's use of aggression in heterosexual intimate relationships. The sample was composed of 108 women, primarily African American, urban, and poor, who had used violence against a partner in the previous 6 months. Path modeling was used to examine the interrelationships among anger, women's aggressive behavior, victimization, childhood abuse experiences, and symptoms of posttraumatic stress and depression. Results revealed that almost all of the women experienced violence from their partners. Greater frequency of victimization from partners and experiences of childhood abuse increased the likelihood that women would use aggression against their partners. Victimization from partners and childhood abuse also increased the likelihood that women would experience symptoms of posttraumatic stress and depression. Women with more symptoms of posttraumatic stress were also more likely to express anger outwardly towards others. Expressing anger outwardly toward others, in turn, predicted an increased likelihood of using aggression against partners.

This study examines the roles of physical and emotional abuse and resource utilization, relationship efficacy, and childhood abuse on relationship status (together or separated) in a sample of 69 low-income, nonsheltered battered women. Separate path models were conducted for physical and psychological abuse. Increased physical abuse was related to separated status, increased resource utilization, and decreased efficacy. The effect of physical abuse on status was mediated by resource utilization and efficacy, whereas the effect of psychological abuse on status was partially mediated only by utilization. Increased childhood abuse was associated with together status. Baseline psychological but not physical abuse predicted a longer term separated status thereby suggesting that the effects of psychological abuse may be enduring.

This study examined patterns of substance use throughout adolescence. A cluster analytic approach was used to identify subgroups of adolescents on the basis of their levels of substance use from early through late adolescence (Grades 6 through 11). Six distinct clusters of substance users emerged-2 groups representing relatively stable patterns of substance use from early through late adolescence (ie., nonusers and alcohol experimenters), and 4 groups of users showing escalating patterns of substance use (i.e., low escalators, early starters, late starters, and high escalators). The study provides a comprehensive view of adolescent substance use by examining the progression of use from early to late adolescence, demonstrates the usefulness of studying patterns of use across multiple substances, and underscores the importance of building classification schemes based on repeated measurements of substance use to reflect changes over time. Implications of the findings for future research and for identifying high-risk subgroups of adolescents for purposes of intervention based on timing and pattern of escalation are discussed.