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Introduction: Patients with spontaneous intracranial hemorrhage (sICH) have high mortality and morbidity, which are associated with blood pressure variability. Additionally, blood pressure variability is associated with acute kidney injury (AKI) in critically ill patients, but its association with sICH patients in emergency departments (ED) is unclear. Our study investigated the association between blood pressure variability in the ED and the risk of developing AKI during sICH patients’ hospital stay. Methods: We retrospectively analyzed patients with sICH, including those with subarachnoid and intraparenchymal hemorrhage, who were admitted from any ED and who received an external ventricular drain at our academic center. Patients were identified by the International Classification of Diseases, Ninth Revision (ICD-9). Outcomes were the development of AKI, mortality, and being discharged home. We performed multivariable logistic regressions to measure the association of clinical factors and interventions with outcomes. Results: We analyzed the records of 259 patients: 71 (27%) patients developed AKI, and 59 (23%) patients died. Mean age (± standard deviation [SD]) was 58 (14) years, and 150 (58%) were female. Patients with AKI had significantly higher blood pressure variability than patients without AKI. Each millimeter of mercury increment in one component of blood pressure variability, SD in systolic blood pressure (SBP SD), was significantly associated with 2% increased likelihood of developing AKI (odds ratio [OR] 1.02, 95% confidence interval [CI], 1.005–1.03, p = 0.007). Initiating nicardipine infusion in the ED (OR 0.35, 95% CI, 0.15–0.77, p = 0.01) was associated with lower odds of in-hospital mortality. No ED interventions or blood pressure variability components were associated with patients’ likelihood to be discharged home. Conclusion: Our study suggests that greater SBP SD during patients’ ED stay is associated with higher likelihood of AKI, while starting nicardipine infusion is associated with lower odds of in-hospital mortality. Further studies about interventions and outcomes of patients with sICH in the ED are needed to confirm our observations.

Abstract Background Interleukin-1 receptor 1 (IL-1R1) inhibition is a potential strategy for treating patients with chronic obstructive pulmonary disease (COPD). MEDI8968, a fully human monoclonal antibody, binds selectively to IL-1R1, inhibiting activation by IL-1α and IL-1β. We studied the efficacy and safety/tolerability of MEDI8968 in adults with symptomatic, moderate-to-very severe COPD. Methods This was a phase II, randomised, double-blind, placebo-controlled, multicentre, parallel-group study. Subjects aged 45–75 years and receiving standard maintenance therapy with ≥2 exacerbations in the past year were randomised 1:1 to receive placebo or MEDI8968 300 mg (600 mg intravenous loading dose) subcutaneously every 4 weeks, for 52 weeks. The primary endpoint was the moderate/severe acute exacerbations of COPD (AECOPD) rate (week 56 post-randomisation). Secondary endpoints were severe AECOPD rate and St George’s Respiratory Questionnaire-COPD (SGRQ-C) score (week 56 post-randomisation). Results Of subjects randomised to placebo (n = 164) and MEDI8968 (n = 160), 79.3% and 75.0%, respectively, completed the study. There were neither statistically significant differences between treatment groups in moderate/severe AECOPD rate ([90% confidence interval]: 0.78 [0.63, 0.96], placebo; 0.71 [0.57, 0.90], MEDI8968), nor in severe AECOPD rate or SGRQ-C scores. Post-hoc analysis of subject subgroups (by baseline neutrophil count or tertiles of circulating neutrophil counts) did not alter the study outcome. The incidence of treatment-emergent adverse events (TEAEs) with placebo and MEDI8968 treatment was similar. The most common TEAE was worsening of COPD. Conclusions In this phase II study, MEDI8968 did not produce statistically significant improvements in AECOPD rate, lung function or quality of life. Trial registration ClinicalTrials.gov, NCT01448850 , date of registration: 06 October 2011.

Behaviors characterized as restricted and repetitive (RRBs) in autism manifest in diverse ways, from motor mannerisms to intense interests, and are diagnostically defined as interfering with functioning. A variety of early autism interventions target RRBs as preoccupying young autistic children to the detriment of exploration and learning opportunities. In an exploratory study, we developed a novel stimulating play situation including objects of potential interest to autistic children, then investigated repetitive behaviors and object explorations in 49 autistic and 43 age-matched typical young children (20-69 months). Autistic children displayed significantly increased overall frequency and duration of repetitive behaviors, as well as increased specific repetitive behaviors. However, groups did not significantly differ in frequency and duration of overall object explorations, in number of different objects explored, or in explorations of specific objects. Exploratory analyses found similar or greater exploration of literacy-related objects in autistic compared to typical children. Correlations between repetitive behaviors and object explorations (their frequency and duration) revealed positive, not negative, associations in both groups. Our findings, from a novel situation incorporating potential autistic interests, suggest that RRBs do not necessarily displace exploration and its possibilities for learning in autism.

Can autistic people see the forest for the trees? Ongoing uncertainty about the integrity and role of global processing in autism gives special importance to the question of how autistic individuals group local stimulus attributes into meaningful spatial patterns. We investigated visual grouping in autism by measuring sensitivity to mirror symmetry, a highly-salient perceptual image attribute preceding object recognition. Autistic and non-autistic individuals were asked to detect mirror symmetry oriented along vertical, oblique, and horizontal axes. Both groups performed best when the axis was vertical, but across all randomly-presented axis orientations, autistics were significantly more sensitive to symmetry than non-autistics. We suggest that under some circumstances, autistic individuals can take advantage of parallel access to local and global information. In other words, autistics may sometimes see the forest and the trees, and may therefore extract from noisy environments genuine regularities which elude non-autistic observers.

A distinctively uneven profile of intelligence is a feature of the autistic spectrum. Within the spectrum, Asperger individuals differ from autistics in their early speech development and in being less likely to be characterized by visuospatial peaks. While different specific strengths characterize different autistic spectrum subgroups, all such peaks of ability have been interpreted as deficits: isolated, aberrant, and irreconcilable with real human intelligence. This view has recently been challenged by findings of autistic strengths in performance on Raven's Progressive Matrices (RPM), an important marker of general and fluid intelligence. We investigated whether these findings extend to Asperger syndrome, an autistic spectrum subgroup characterized by verbal peaks of ability, and whether the cognitive mechanisms underlying autistic and Asperger RPM performance differ. Thirty-two Asperger adults displayed a significant advantage on RPM over Wechsler Full-Scale and Performance scores relative to their typical controls, while in 25 Asperger children an RPM advantage was found over Wechsler Performance scores only. As previously found with autistics, Asperger children and adults achieved RPM scores at a level reflecting their Wechsler peaks of ability. Therefore, strengths in RPM performance span the autistic spectrum and imply a common mechanism advantageously applied to different facets of cognition. Autistic spectrum intelligence is atypical, but also genuine, general, and underestimated.

ContextRed fox (Vulpes vulpes) predation has an impact on populations of many species throughout its range worldwide, and as such, the red fox is the target of control programs. AimsWe investigated the potential for participatory landscape management to reduce the impact of fox predation on a major prey species, lambs.MethodsThe present study monitored fox-management programs already operating across 4.5million hectares of regional New South Wales to compare the impact of varying (frequency and spatial coverage) control effort on lamb survival.Key resultsThe frequency and timing of fox control was correlated with lamb survival. Lamb survival was higher in areas where fox baiting was carried out twice a year, in autumn and late winter/spring. Spatial coverage of the control program was also positively correlated with lamb survival. Properties that had near neighbours (up to 2.5km away) participating in group fox-control programs had higher survival of lambs than properties that did not.ConclusionsThese results support the development of a high level of group participation in fox-control programs that considers both spatial extent and frequency of baiting programs. They also support a movement away from the reactionary, short-term practice of baiting small areas to protect vulnerable prey.ImplicationsCoordinated group-baiting programs are likely to deliver improved lamb survival and should be promoted in areas where ongoing control programs for foxes are necessary. [ABSTRACT FROM AUTHOR]

Abstract Purpose  To investigate the dispersion mechanism(s) of ternary dry powder inhaler (DPI) formulations by comparison of the interparticulate adhesions and in vitro performance of a number of carrier–drug–fines combinations. Materials and Methods  The relative levels of adhesion and cohesion between a lactose carrier and a number of drugs and fine excipients were quantified using the cohesion–adhesion balance (CAB) approach to atomic force microscopy. The in vitro performance of formulations produced using these materials was quantified and the particle size distribution of the aerosol clouds produced from these formulations determined by laser diffraction. Results  Comparison between CAB ratios and formulation performance suggested that the improvement in performance brought about by the addition of fines to which the drug was more adhesive than cohesive might have been due to the formation of agglomerates of drug and fines particles. This was supported by aerosol cloud particle size data. The mechanism(s) underlying the improved performance of ternary formulations where the drug was more cohesive than adhesive to the fines was unclear. Conclusions  The performance of ternary DPI formulations might be increased by the preferential formation of drug–fines agglomerates, which might be subject to greater deagglomeration forces during aerosolisation than smaller agglomerates, thus producing better formulation performance. [ABSTRACT FROM AUTHOR]

Autistic adults display enhanced and locally oriented low-level perception of static visual information, but diminished perception of some types of movement. The identification of potential precursors, such as atypical perceptual processing, among very young children would be an initial step toward understanding the development of these phenomena. The purpose of this study was to provide an initial measure and interpretation of atypical visual exploratory behaviors toward inanimate objects (AVEBIOs) among young children with autism. A coding system for AVEBIOs was constructed from a corpus of 40 semistandardized assessments of autistic children. The most frequent atypical visual behavior among 15 children aged 33–73 months was lateral glance that was mostly oriented toward moving stimuli and was detected reliably by the experimenters (intraclass correlation > .90). This behavior was more common among autistic than typically developing children of similar verbal mental age and chronological age. As lateral vision is associated with the filtering of high spatial frequency (detail perception) information and the facilitation of high temporal frequencies (movement perception), its high prevalence among very young autistic children may reflect early attempts to regulate and/or optimize both excessive amounts of local information and diminished perception of movement. These findings are initial evidence for the need to consider the neural bases and development of atypical behaviors and their implications for intervention strategies. [ABSTRACT FROM AUTHOR]