Search

Increasing scientific and regulatory concern regarding environmental concentrations of bisphenol A (BPA) increases the need to understand the sources and sinks of this chemical. We developed a coupled flow network/fugacity-based fate and transport model to assess the contribution of different emissions sources to the concentration of BPA in surface water in Germany. The model utilizes BPA loadings and sinks, BPA physicochemical properties, a water flow network, environmental characteristics, and fugacity equations. The model considers industrial emissions, leaching from BPA-containing articles, wastewater treatment and bypass events, and emissions from landfills. The model also considers different scenarios that account for changes in the usage profile of BPA. Model predictions compare favorably to measured surface water concentrations, with the modeled concentrations generally falling within the range of measured values. Model scenarios that consider reductions in BPA usage due to government-mandated restrictions and voluntary reductions in usage predict falling BPA concentrations that are consistent with the most recent monitoring data. Model predictions of the contributions from different usage scenarios and wastewater treatment methods can be used to assess the efficacy of different restrictions and waste handling strategies to support efforts to evaluate the costs and benefits associated with actions aimed at reducing BPA levels in the environment. This feature of the model is of particular importance, given current efforts to update the regulations regarding BPA usage in the EU. The model indicates that as the current restriction on BPA in thermal paper works through the paper recycling process, BPA concentrations will continue to decrease. Other actions, such as upgrades to the stormwater and wastewater infrastructure to minimize the frequency of storm-related bypasses, are predicted to provide more meaningful reductions than additional restrictions on usage. Integr Environ Assess Manag 2024;20:226-238. © 2023 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC)., (© 2023 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).)

Bisphenol A (BPA) enters the environment through various industrial and consumer-related pathways. Industrial sources include BPA manufacturing and secondary industrial uses such as the manufacturing of polymers and other substances based on or containing BPA. However, secondary sources and emissions to the environment, such as those related to the consumer use of articles containing BPA, may be more important than industrial emissions. Although readily biodegradable, BPA is widely distributed in various environmental compartments and living organisms. It is still not well understood which specific sources and pathways are responsible for releasing BPA into the environment. Therefore, we developed FlowEQ, a coupled flow network and fugacity-based fate and transport model for the assessment of BPA in surface water. The work is divided into two parts. In Part I, inputs needed to support the modeling and model validation were collected. Bisphenol A was measured at 23 wastewater treatment plants (WWTPs) and 21 landfills in Germany. In addition, the BPA content of 132 consumer articles from 27 article classes was analyzed. Bisphenol A concentrations in WWTPs ranged from 0.33 to 910 µg L -1 in influents and from less than 0.01 to 0.65 µg L -1 in effluents, resulting in removal efficiencies of 13%-100%. Average BPA concentrations in landfill leachate ranged from less than 0.01 to approximately 1400 µg L -1 . Bisphenol A concentrations measured in consumer articles varied significantly by type, ranging from less than 0.5 µg kg -1 in printing inks up to 1 691 700 µg kg -1 in articles made from recycled polyvinyl chloride (PVC). These concentrations were combined with information on use, leaching, and contact with water to develop estimates of loadings. Together with the results of the FlowEQ modeling presented in Part II, this assessment improves our understanding of the sources and emission pathways of BPA in surface water. The model considers various sources of BPA and can estimate future surface water concentrations of BPA based on changes in use. Integr Environ Assess Manag 2024;20:211-225. © 2023 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC)., (© 2023 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).)

Central vascular access is frequently required for preterm infants. Confirmation of positioning of central line is typically on chest and abdominal radiographs; POCUS is a relatively novel diagnostic method. Misdiagnosis is the main concern limiting use of this modality. The aim of this study is to validate our standard protocol accuracy in locating the central catheter position by correlating catheter position as determined by POCUS with radiographs. Premature babies < or equal to 30 weeks gestation who had peripheral central lines or surgical lines were enrolled. Confirmation of line position by radiographs was compared to images obtained through a specific US protocol technique. The operator of US exam was blinded to the radiograph findings. All images were reviewed by two radiologists who were blinded to the radiograph findings. 35 central line placements were assessed. 22 lines were inserted in the UL, and 13 were inserted in the LL with a total of 91 ultrasound scans and radiographs. The position of the line was interpreted as normal in 79/91 scans with interpreter reliability of [Formula: see text]=0.778 (p < 0.001), sensitivity of 0.83 and specificity of 0.96, and positive predictive value of 0.77 and negative predictive value of 0.97. There was no significant difference between the ultrasound interpretation and the radiograph interpretation of UL and LL.  Conclusion: The protocol of POCUS that we propose is a reliable tool for assessing the central line positions in preterm infants. What is Known: • POCUS is a reliable tool assessing the central line positions in preterm infants. What is New: • The protocol of POCUS that we propose is a reliable tool for assessing the central line positions in preterm infants., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Most mental pathologies are diagnosed on the sole basis of the symptoms reported by patients, such as "I'm feeling low." The thrust of this paper is the proposal to reconceptualize mental disorders as dysfunctions of brain subsystems. This shift from symptom to organ would bring psychiatry in line with the rest of medicine, and is analogous to the change in status of venereal infections from skin pathologies, such as chancres, to bacterial infections. The proposal in question is part of the reconceptualization of mental processes as brain processes, in line with the materialist conception of the mind as neural. A practical advantage of this conceptual change is that it suggests approaching mental disorders as brain dysfunctions treatable by biological and chemical means, in addition to social measures, such as accommodating mental patients in ordinary hospitals rather than in isolated "madhouses" at the mercy of amateurs or even charlatans. An additional advantage of the "embodiment" of mental diseases is that it suggests reframing some new research projects, such as explaining why the common cold causes mental fogginess, why hypertension can cause irritability, and why nicotine dependence can be even stronger than cocaine addiction. In other words, the present proposal is to complete the so-called "mapping of the mind onto the brain" by including the abnormal mental processes, which used to be treated by shamans at a time when the mind was conceived of as an immaterial entity detachable from the body., (© 2017 The Institute of Psychology, Chinese Academy of Sciences and John Wiley & Sons Australia, Ltd.)

Competing Interests: The authors report no conflicts of interest.

Extramedullary leukemia in pediatric acute myeloid leukemia can manifest as a myeloid sarcoma (MS), also known as granulocytic sarcoma or chloroma, in a variety of sites, or as leukemic blasts in the cerebrospinal fluid. Isolated MS of the central nervous system is rare. We report a case of acute myeloid leukemia with central nervous system-MS presenting as a posterior fossa mass mimicking a primary intracranial tumor., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Methane (CH4), an important greenhouse gas that affects radiation balance and consequently the earth's climate, still has uncertainties in its sinks and sources. The world's oceans are considered to be a source of CH4 to the atmosphere, although the biogeochemical processes involved in its formation are not fully understood. Several recent studies provided strong evidence of CH4 production in oxic marine and freshwaters but its source is still a topic of debate. Studies of CH4 dynamics in surface waters of oceans and large lakes have concluded that pelagic CH4 supersaturation cannot be sustained either by lateral inputs from littoral or benthic inputs alone. However, frequently regional and temporal oversaturation of surface waters occurs. This comprises the observation of a CH4 oversaturating state within the surface mixed layer, sometimes also termed the "oceanic methane paradox". In this study we considered marine algae as a possible direct source of CH4. Therefore, the coccolithophore Emiliania huxleyi was grown under controlled laboratory conditions and supplemented with two 13C-labelled carbon substrates, namely bicarbonate and a position-specific 13C-labelled methionine (R-S-13CH3). The CH4 production was 0.7 µg POC g-1 d-1, or 30 ng g-1 POC h-1. After supplementation of the cultures with the 13C labelled substrate, the isotope label was observed in headspace-CH4. Moreover, the absence of methanogenic archaea within the algal culture and the oxic conditions during CH4 formation suggest that marine algae such as Emiliania huxleyi contribute to the observed spatial and temporal restricted CH4 oversaturation in ocean surface waters. [ABSTRACT FROM AUTHOR]

The leitmotif of Mario Bunge's work was that the philosophy of science should be informed by a comprehensive scientific philosophy, and vice versa; with both firmly rooted in realism and materialism. Now Bunge left such a big oeuvre, comprising more than 70 books and hundreds of articles, that it is impossible to review it in its entirety. In addition to biographical remarks, this obituary will therefore restrict itself to some select issues of his philosophy: his scientific metaphysics, his philosophy of physics, his concept of mechanismic explanation, his philosophy of social science and technology, and his approach to the demarcation problem. The final section will explore why Bunge, despite the extent and depth of his work, has not achieved a more prominent status in the philosophical community. [ABSTRACT FROM AUTHOR]

This letter, published in Clinical Neuroradiology, discusses a case of an 8-year-old girl with Noonan syndrome (NS) who presented with episodes of headache. Magnetic resonance imaging (MRI) revealed three lesions in the cerebellum that showed changes in size and signal intensity over time. These findings are consistent with focal areas of signal intensity (FASI), which have been previously observed in patients with neurofibromatosis type 1 (NF1). The letter highlights the occurrence of FASI in NS patients and provides further evidence of their evolution and change over time. [Extracted from the article]

Objective: The objective of our study was to characterize and update the radiologic patterns of pediatric pulmonary blastomycosis, and correlate the radiologic patterns with patient age., Materials and Methods: Patients 0-18 years old with pulmonary blastomycosis who underwent chest imaging from 2005 to 2016 were included in this study. The following data were collected: age, sex, clinical information, and imaging findings including presence of extrapulmonary involvement and scarring on follow-up examinations. Concordance between radiography and CT was analyzed., Results: Thirty-six patients (28 boys and eight girls) ranging in age from 3 months to 17 years (mean, 10.5 years) were identified. Consolidation was found in 94.4% of patients and was unilateral in 76.5% of cases and bilateral in 23.5%. Upper (70.6%) and middle (47.1%) lobes were more frequently involved. Air bronchograms were identified in 76.5% of patients with consolidations, masslike consolidation was found in 55.9%, cavitation in 38.2%, and bubbly pattern (i.e., multiple small cavities) in 32.4%. In all patients younger than 5 years, consolidations involved multiple lobes. In 67.6% of patients, consolidations were associated with the following additional pulmonary or pleural abnormalities: pulmonary nodules (50% of patients), diffuse patchy opacification (26.5%), reticulonodular pattern (41.2%), atelectasis (5.9%), pleural effusion (20.6%), and hilar lymphadenopathy (23.5%). Pulmonary scarring was found in 70.4% of patients. Five patients had extrapulmonary involvement. The concordance between radiography and CT was excellent for location and extension of consolidation and diagnosis of cavitation, bubbly pattern, and nodules., Conclusion: The most common pattern of lung involvement from pulmonary blastomycosis in our series was a combination of consolidations with bilateral lung nodules and reticulonodular opacification.

Professional phagocytic cells such as macrophages are a central part of innate immune defence. They ingest microorganisms into membrane-bound compartments (phagosomes), which acidify and eventually fuse with lysosomes, exposing their contents to a microbicidal environment. Gram-positive Rhodococcus equi can cause pneumonia in young foals and in immunocompromised humans. The possession of a virulence plasmid allows them to subvert host defence mechanisms and to multiply in macrophages. Here, we show that the plasmid-encoded and secreted virulence-associated protein A (VapA) participates in exclusion of the proton-pumping vacuolar-ATPase complex from phagosomes and causes membrane permeabilisation, thus contributing to a pH-neutral phagosome lumen. Using fluorescence and electron microscopy, we show that VapA is also transferred from phagosomes to lysosomes where it permeabilises the limiting membranes for small ions such as protons. This permeabilisation process is different from that of known membrane pore formers as revealed by experiments with artificial lipid bilayers. We demonstrate that, at 24 hr of infection, virulent R. equi is contained in a vacuole, which is enriched in lysosome material, yet possesses a pH of 7.2 whereas phagosomes containing a vapA deletion mutant have a pH of 5.8 and those with virulence plasmid-less sister strains have a pH of 5.2. Experimentally neutralising the macrophage endocytic system allows avirulent R. equi to multiply. This observation is mirrored in the fact that virulent and avirulent R. equi multiply well in extracts of purified lysosomes at pH 7.2 but not at pH 5.1. Together these data indicate that the major function of VapA is to generate a pH-neutral and hence growth-promoting intracellular niche. VapA represents a new type of Gram-positive virulence factor by trafficking from one subcellular compartment to another, affecting membrane permeability, excluding proton-pumping ATPase, and consequently disarming host defences., (© 2018 John Wiley & Sons Ltd.)

Background: Many children with neurofibromatosis type 1 (NF1) have focal abnormal signal intensities (FASI) on brain MRI, whose full clinical impact and natural history have not been studied systematically. Our aims are to describe the clinical and neuroradiological features in children with NF1 and cerebellar FASI, and report on the natural history of FASI that display atypical features such as enhancement and mass effect., Method: A retrospective review of the hospital charts and brain MRIs was performed on children from Manitoba diagnosed between 1999 and 2008 with NF1, who also had cerebellar FASI on MRI., Results: Fifty patients (mean age: 16.1y, minimum-maximum: 6.4 - 30y, 27 M) were identified. Mean duration of follow up was 10.1y. Developmental delay, learning disabilities, tumors, and visual signs occurred commonly. Cerebellar signs were not reported. Mean age of the patients at baseline MRI was 7.8 (SD: 4.5) years. FASI occurred in several brain locations and were rarely confined to the cerebellum. FASI displayed mass effect and enhancement infrequently but were associated with malignancy only once. The number of FASI at baseline MRI was significantly less in patients with attention deficient hyperactivity disorder and more if a first degree relative had NF1 or if they had decreased visual acuity., Discussion: Patients with NF1 and cerebellar FASI do not have motor or consistent non-motor (e.g. developmental delay or learning disabilities) cerebellar features. The number of FASI may correlate with some clinical features. FASI may display enhancement and mass effect but they rarely become malignant., Competing Interests: Ethical approval for the study was given by the Research Ethics Board of the University of Manitoba.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Background: Focal abnormal signal intensities (FASI) on brain MRI occur commonly in patients with neurofibromatosis type 1 (NF1). The natural history of cerebellar FASI and their correlation with clinical features have not been studied comprehensively. Our aims are to describe the natural history of cerebellar FASI on repeat MRI scans and correlate the findings with the clinical features in children with NF1 and cerebellar FASI., Method: A retrospective review of 226 brain MRI scans and hospital charts was performed in 50 patients with cerebellar FASI, who were diagnosed with NF1 during their childhood between 1999 and 2008., Results: Mean age at the end of the study period was 16.1 years. There were 27 males. Mean duration of clinical follow up was 10.1 years. Mean duration between the first and the last MRI was 6.6 years ( n  = 36, SD: 2.8 years). FASI were rarely confined to the cerebellum. The number of FASI was highest in early childhood and decreased significantly on subsequent MRI scans in most brain regions with the exception of the cerebrum, where a fewer number of patients with a smaller number of FASI were seen. Four patterns of change in FASI size over time were determined, none correlated with the clinical features., Conclusions: In patients with NF1, the natural history of FASI including their number, age at onset, rate of size changes, and resolution if any, varies by brain region. FASI patterns of change over time showed no clinical correlate., Competing Interests: Ethical approval for the study was given by the Research Ethics Board of the University of Manitoba.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

In the environment of Alpine glacier forefields, bacteria represent the functional link between initial soil development and secondary colonization. An important question is whether soil bacteria are adapted to the poor nutrient availability in this environment and whether selection processes significantly limit their local expansion along the gradients of chemical and biological factors. To address these questions, we used a two-dimensional sampling strategy at our study site, the Damma glacier forefield, Switzerland, to characterize the soil environment by selected biogeochemical parameters. Our results revealed two contrasting sites that differed in time since deglaciation (‘young’ and ‘old’ soil, ≤ 13 years and > 53 years of ice-free conditions) and vegetation cover (threefold increase), but also showed significant differences in soil properties thought to be relevant for the successional development of glacier forefield soils, such as pH (0.5-fold decrease), ammonium (0.5-fold decrease) concentration, and the content of total organic carbon (10-fold increase). Isolated strains, affiliated to the genus Pseudomonas, according to their 16S rDNA profile, were tested experimentally for local adaptation by a reciprocal transfer experiment. The bacteria from both young and old soils showed a significant interaction with their local environment; the direction of the interaction, however, did not follow the expected pattern of local adaptation. The significant genoype-with-environment interaction indicates a limited local expansion of soil bacteria in the Damma glacier forefield over the range of only 110 m. The lack of local adaptation could be explained by environmental constraints such as exclusion of competition, different migration behaviour of bacteria from young and old soil, or the ability of early colonizing bacteria to survive under the glacier ice. [ABSTRACT FROM AUTHOR]

The rationale for implantation of autologous human Schwann cells (SCs) in persons with subacute spinal cord injury (SCI) is based on evidence that transplanted SCs are neuroprotective, support local axonal plasticity, and are capable of myelinating axons. A Phase I clinical trial was conducted to evaluate the safety of autologous human SC transplantation into the injury epicenter of six subjects with subacute SCI. The trial was an open-label, unblinded, non-randomized, non-placebo controlled study with a dose escalation design and standard medical rehabilitation. Participants were paraplegics with neurologically complete, trauma-induced spinal lesions. Autologous SCs were cultured in vitro from a sural nerve harvested from each participant and injected into the epicenter of the spinal lesion. Outcome measures for safety were protocol compliance, feasibility, adverse events, stability of neurological level, absence of detectable mass lesion, and the emergence of clinically significant neuropathic pain or muscle spasticity no greater than expected for a natural course cohort. One year post-transplantation, there were no surgical, medical, or neurological complications to indicate that the timing or procedure for the cell transplantation was unsafe. There were no adverse events or serious adverse events related to the cell therapy. There was no evidence of additional spinal cord damage, mass lesion, or syrinx formation. We conclude that it is feasible to identify eligible candidates, appropriately obtain informed consent, perform a peripheral nerve harvest to obtain SCs within 5-30 days of injury, and perform an intra-spinal transplantation of highly purified autologous SCs within 4-7 weeks of injury.

Introduction: Owing to the shared embryonic origin, defects in development of optic nerves are often seen in conjunction with defects affecting the surrounding brain and pituitary gland. Optic nerve hypoplasia (ONH) and septo-optic dysplasia (SOD) represent a clinical spectrum associated with visual, pituitary and severe central nervous system structural abnormalities (SODplus). Based on changing clinical patterns, our primary objective was to examine trends in annual incidence of ONH/SOD and geographical clustering in Manitoba., Methods: This was a retrospective 1996 to 2015 chart review with extraction of anthropometric measures, radiologic findings, parental characteristics, endocrinopathies and neurologic symptoms from all involved in care. Postal codes were used to assign map co-ordinates and identify relevant census-based deprivation indices., Results: Ninety-three children were identified in our catchment area; Poisson regression confirmed a striking 1.11-fold annual increase (95% confidence interval 1.07 to 1.16) or ~800% over two decades. The annual incidence (averaged 2010 to 2014 chart data) reached 53.3 per 100,000, affecting 1 in 1875 live births. Most (~55%) had SODplus. Common presenting features were hypoglycemia, nystagmus, seizures and developmental delay; 40% had hormone deficiencies; 80% had reduced visual acuity, typically bilateral. Many were premature with young, primiparous mothers. Unhealthy maternal lifestyles and severe material deprivation were noted. There was disproportionate clustering in individuals from Northern Manitoba at three times the average provincial rate., Conclusion: We noted a dramatic rise in the annual incidence of ONH/SOD, which was strongly associated with poverty and northern communities. The pattern was consistent with environmental or nutritional etiologies. Many children were severely affected with increased morbidity and health care burdens.

Mario Bunge was born in Argentina in the final year of the First World War. He learnt atomic physics and quantum mechanics from an Austrian refugee who had been a student of Heisenberg. Additionally he taught himself modern philosophy in an environment that was a philosophical backwater. He was the first South American philosopher of science to be trained in science. His publications in physics, philosophy, psychology, sociology and the foundations of biology, are staggering in number, and include a massive 8-volume Treatise on Philosophy. The unifying thread of his scholarship is the constant and vigorous advancement of the Enlightenment Project, and criticism of cultural and academic movements that deny or devalue the core planks of the project: namely its naturalism, the search for truth, the universality of science, rationality, and respect for individuals. At a time when specialisation is widely decried, and its deleterious effects on science, philosophy of science, educational research and science teaching are recognised – it is salutary to see the fruits of one person's pursuit of the `Big' scientific and philosophical picture. [ABSTRACT FROM AUTHOR]

The transplantation of rodent Schwann cells (SCs) provides anatomical and functional restitution in a variety of spinal cord injury (SCI) models, supporting the recent translation of SCs to phase 1 clinical trials for human SCI. Whereas human (Hu)SCs have been examined experimentally in a complete SCI transection paradigm, to date the reported behavior of SCs when transplanted after a clinically relevant contusive SCI has been restricted to the use of rodent SCs. Here, in a xenotransplant, contusive SCI paradigm, the survival, biodistribution, proliferation and tumorgenicity as well as host responses to HuSCs, cultured according to a protocol analogous to that developed for clinical application, were investigated. HuSCs persisted within the contused nude rat spinal cord through 6 months after transplantation (longest time examined), exhibited low cell proliferation, displayed no evidence of tumorigenicity and showed a restricted biodistribution to the lesion. Neuropathological examination of the CNS revealed no adverse effects of HuSCs. Animals exhibiting higher numbers of surviving HuSCs within the lesion showed greater volumes of preserved white matter and host rat SC and astrocyte ingress as well as axon ingrowth and myelination. These results demonstrate the safety of HuSCs when employed in a clinically relevant experimental SCI paradigm. Further, signs of a potentially positive influence of HuSC transplants on host tissue pathology were observed. These findings show that HuSCs exhibit a favorable toxicity profile for up to 6 months after transplantation into the contused rat spinal cord, an important outcome for FDA consideration of their use in human clinical trials., (© 2017 Wiley Periodicals, Inc.)

Objectives: To summarize the clinical characteristics and outcomes of pediatric sports-related concussion (SRC) patients who were evaluated and managed at a multidisciplinary pediatric concussion program and examine the healthcare resources and personnel required to meet the needs of this patient population., Methods: We conducted a retrospective review of all pediatric SRC patients referred to the Pan Am Concussion Program from September 1st, 2013 to May 25th, 2015. Initial assessments and diagnoses were carried out by a single neurosurgeon. Return-to-Play decision-making was carried out by the multidisciplinary team., Results: 604 patients, including 423 pediatric SRC patients were evaluated at the Pan Am Concussion Program during the study period. The mean age of study patients was 14.30 years (SD: 2.32, range 7-19 years); 252 (59.57%) were males. Hockey (182; 43.03%) and soccer (60; 14.18%) were the most commonly played sports at the time of injury. Overall, 294 (69.50%) of SRC patients met the clinical criteria for concussion recovery, while 75 (17.73%) were lost to follow-up, and 53 (12.53%) remained in active treatment at the end of the study period. The median duration of symptoms among the 261 acute SRC patients with complete follow-up was 23 days (IQR: 15, 36). Overall, 25.30% of pediatric SRC patients underwent at least one diagnostic imaging test and 32.62% received referral to another member of our multidisciplinary clinical team., Conclusion: Comprehensive care of pediatric SRC patients requires access to appropriate diagnostic resources and the multidisciplinary collaboration of experts with national and provincially-recognized training in TBI.

Background: Chronic ataxia, greater than two months in duration, is encountered relatively commonly in clinical pediatric neurology practise and presents with diagnostic challenges. It is caused by multiple and diverse disorders. Our aims were to describe the neuroimaging features and the value of repeat neuroimaging in pediatric chronic ataxia to ascertain their contribution to the diagnosis and management., Materials and Methods: A retrospective charts and neuroimaging reports review was undertaken in 177 children with chronic ataxia. Neuroimaging in 130 of 177 patients was also reviewed., Results: Nineteen patients had head computed tomography only, 103 brain magnetic resonance imaging only, and 55 had both. Abnormalities in the cerebellum or other brain regions were associated with ataxia. Neuroimaging was helpful in 73 patients with 30 disorders: It was diagnostic in 9 disorders, narrowed down the diagnostic possibilities in 14 disorders, and revealed important but non-diagnostic abnormalities, e.g. cerebellar atrophy in 7 disorders. Having a normal magnetic resonance imaging scan was mostly seen in genetic diseases or in the early course of ataxia telangiectasia. Repeat neuroimaging, performed in 108 patients, was generally helpful in monitoring disease evolution and in making a diagnosis. Neuroimaging was not directly helpful in 36 patients with 10 disorders or by definition the 55 patients with unknown disease etiology., Conclusions: Normal or abnormal neuroimaging findings and repeat neuroimaging are very valuable in the diagnosis and management of disorders associated with pediatric chronic ataxia.

OBJECT A neuroimaging assessment tool to visualize global and regional impairments in cerebral blood flow (CBF) and cerebrovascular responsiveness in individual patients with concussion remains elusive. Here the authors summarize the safety, feasibility, and results of brain CO2 stress testing in adolescents with postconcussion syndrome (PCS) and healthy controls. METHODS This study was approved by the Biomedical Research Ethics Board at the University of Manitoba. Fifteen adolescents with PCS and 17 healthy control subjects underwent anatomical MRI, pseudo-continuous arterial spin labeling MRI, and brain stress testing using controlled CO2 challenge and blood oxygen level-dependent (BOLD) MRI. Post hoc processing was performed using statistical parametric mapping to determine voxel-by-voxel regional resting CBF and cerebrovascular responsiveness of the brain to the CO2 stimulus (increase in BOLD signal) or the inverse (decrease in BOLD signal). Receiver operating characteristic (ROC) curves were generated to compare voxel counts categorized by control (0) or PCS (1). RESULTS Studies were well tolerated without any serious adverse events. Anatomical MRI was normal in all study participants. No differences in CO2 stimuli were seen between the 2 participant groups. No group differences in global mean CBF were detected between PCS patients and healthy controls. Patient-specific differences in mean regional CBF and CO2 BOLD responsiveness were observed in all PCS patients. The ROC curve analysis for brain regions manifesting a voxel response greater than and less than the control atlas (that is, abnormal voxel counts) produced an area under the curve of 0.87 (p < 0.0001) and 0.80 (p = 0.0003), respectively, consistent with a clinically useful predictive model. CONCLUSIONS Adolescent PCS is associated with patient-specific abnormalities in regional mean CBF and BOLD cerebrovascular responsiveness that occur in the setting of normal global resting CBF. Future prospective studies are warranted to examine the utility of brain MRI CO2 stress testing in the longitudinal assessment of acute sports-related concussion and PCS.

OBJECTIVE: To survey quality criteria for evidence-based patient information (EBPI) and to compile the evidence for the identified criteria. METHODS: Databases PubMed, Cochrane Library, PsycINFO, PSYNDEX and Education Research Information Center (ERIC) were searched to update the pool of criteria for EBPI. A subsequent search aimed to identify evidence for each criterion. Only studies on health issues with cognitive outcome measures were included. Evidence for each criterion is presented using descriptive methods. RESULTS: 3 systematic reviews, 24 randomized-controlled studies and 1 non-systematic review were included. Presentation of numerical data, verbal presentation of risks and diagrams, graphics and charts are based on good evidence. Content of information and meta-information, loss- and gain-framing and patient-oriented outcome measures are based on ethical guidelines. There is a lack of studies on quality of evidence, pictures and drawings, patient narratives, cultural aspects, layout, language and development process. CONCLUSION: The results of this review allow specification of EBPI and may help to advance the discourse among related disciplines. Research gaps are highlighted. PRACTICE IMPLICATIONS: Findings outline the type and extent of content of EBPI, guide the presentation of information and describe the development process. [ABSTRACT FROM AUTHOR]

Background: To reduce their decisional uncertainty, health policy decision-makers rely more often on experts or their intuition than on evidence-based knowledge, especially in times of urgency. However, this practice is unacceptable from an evidence-based medicine (EbM) perspective. Therefore, in fast-changing and complex situations, we need an approach that delivers recommendations that serve decision-makers' needs for urgent, sound and uncertainty-reducing decisions based on the principles of EbM., Aims: The aim of this paper is to propose an approach that serves this need by enriching EbM with theory., Materials and Methods: We call this the EbM+theory approach, which integrates empirical and theoretical evidence in a context-sensitive way to reduce intervention and implementation uncertainty., Results: Within this framework, we propose two distinct roadmaps to decrease intervention and implementation uncertainty: one for simple and the other for complex interventions. As part of the roadmap, we present a three-step approach: applying theory (step 1), conducting mechanistic studies (EbM+; step 2) and conducting experiments (EbM; step 3)., Discussion: This paper is a plea for integrating empirical and theoretical knowledge by combining EbM, EbM+ and theoretical knowledge in a common procedural framework that allows flexibility even in dynamic times. A further aim is to stimulate a discussion on using theories in health sciences, health policy, and implementation., Conclusion: The main implications are that scientists and health politicians - the two main target groups of this paper-should receive more training in theoretical thinking; moreover, regulatory agencies like NICE may think about the usefulness of integrating elements of the EbM+theory approach into their considerations., (© 2023 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.)