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Lymphopenia is a known adverse effect in patients with relapsing multiple sclerosis (RMS) treated with fumaric acids. We present a case series of four patients diagnosed with RMS with prolonged lymphocyte stability on dimethyl fumarate for over 1 year who developed significant lymphopenia after transitioning to diroximel fumarate. This case series highlights the need for further research to elucidate the risk of lymphopenia in patients switching between fumaric acids. [ABSTRACT FROM AUTHOR]

Objective: The Review of health services for children, young people and families within the NSW Health system identified that novel models of care were needed to improve access to clinical management for people with ADHD. The present study aimed to evaluate GPs' knowledge of and attitudes towards ADHD and the challenges and opportunities for a more substantial role for GPs in ADHD management. Method: An online survey of Australian GPs was conducted, with recruitment via email invitation. Results: Out of 230 respondents, 213 surveys could be analysed. Of these, 97% believed ADHD was a genuine condition, with 90% identifying inattention as a primary symptom. Most (92%) had seen and diagnosed ADHD within the past year. Prevalent concerns included inadequate access to specialist assessment and treatment; 77% felt that GPs should have a more substantial role in ADHD management. Barriers included lack of time, knowledge and experience. Conclusions: There was willingness amongst respondents take on a greater role in managing individuals with ADHD. However, a need for further training and education was highlighted. The Australian Evidence-Based Clinical Practice Guideline for ADHD may resolve an identified need for clinical guidance. [ABSTRACT FROM AUTHOR]

Objective: The objective of this article was to provide an overview of the development and recommendations from the Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder (ADHD). The guideline aims to promote accurate and timely identification and diagnosis, and optimal and consistent treatment of ADHD. Methods: Development integrated the best available evidence with multidisciplinary clinical expertise and the preferences of those with lived experience, underpinned by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. The 23 guideline development group members included psychiatrists, paediatricians, general practitioners, psychologists, speech pathologists, occupational therapists, educators, Indigenous psychologists, and people with a lived experience; with two independent chairs and a methodologist. Where appropriate, evidence reviews from the National Institute for Health and Care Excellence (NICE) 2018 'Attention Deficit Hyperactivity Disorder: Diagnosis and Management' guideline were updated. Fifty prioritised clinical questions were addressed in 14 systematic reviews (new and updated from NICE 2018) and 28 narrative reviews. Results: The 113 clinical recommendations apply to young children (5 years and under), children, adolescents and adults. They provide guidance for clinicians on identification, screening, diagnosis, multimodal treatment and support, including pharmacological and non-pharmacological interventions. The guideline and supporting information are available online: https://adhdguideline.aadpa.com.au/ Conclusions: The guideline was approved by the National Health and Medical Research Council (NHMRC) of Australia and relevant medical and allied health professional associations. It is anticipated that successful implementation and uptake of the guideline by organisations, health care providers and other professionals will increase delivery of evidence-based treatment and improve health outcomes for the more than 800,000 Australians with ADHD. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of long-term anti-CD20 B-cell-depleting treatment on regulatory T cell immune subsets that are subnormal in untreated MS patients. Methods: 30 clinically stable MS patients, before and over 38 months of ocrelizumab treatment, were compared to 13 healthy controls, 29 therapy-naïve MS, 9 interferon-β-treated MS, 3 rituximab-treated MS, and 3 rituximab-treated patients with other autoimmune inflammatory diseases. CD8, CD28, CD4, and FOXP3 expression in peripheral blood mononuclear cells was quantitated with flow cytometry. Results: CD8+ CD28− regulatory cells rose from one-third of healthy control levels before ocrelizumab treatment (2.68% vs 7.98%), normalized by 12 months (13.5%), and rose to 2.4-fold above healthy controls after 18 months of ocrelizumab therapy (19.0%). CD4+ FOXP3+ regulatory cells were lower in MS than in healthy controls (7.98%) and showed slight long-term decreases with ocrelizumab. CD8+ CD28− and CD4+ FOXP3+ regulatory T cell percentages in IFN-β-treated MS patients were between those of untreated MS and healthy controls. Interpretation: Long-term treatment with ocrelizumab markedly enriches CD8+ CD28− regulatory T cells and corrects the low levels seen in MS before treatment, while slightly decreasing CD4+ FOXP3+ regulatory T cells. Homeostatic enrichment of regulatory CD8 T cells provides a mechanism, in addition to B cell depletion, for the benefits of anti-CD20 treatment in MS. [ABSTRACT FROM AUTHOR]

Currently, there are no direct and reliable methods to measure the body fat content of women during pregnancy. Estimates of fat accretion can significantly affect calculations of energy requirements. We report here the first direct measurement of determining the body fat content of two women during pregnancy using the Fourier transform near-infrared spectroscopy (FT-NIR) method. Fourier transform near-infrared spectroscopy was shown to provide comparable results to dual-energy X-ray absorptiometry and magnetic resonance imaging. These latter methods, even though very reliable to measure body fat levels, cannot be used to measure the body fat of women during pregnancy because of health concerns, while FT-NIR poses no health risk. The FT-NIR results showed the percent body fat remained relatively constant throughout pregnancy, but fat mass and fat free mass increased. Fat mass followed an S curve with a maximum increase between 15 to 25 weeks of gestation that was only detected by repeated measurements using the FT-NIR technique. These results demonstrate the value of the FT-NIR method to directly measure the fat content of pregnant women in minutes instead of relying on indirect calculations or taking measurements before and after pregnancy to track gestational fat mass accretion. [ABSTRACT FROM AUTHOR]

Background. For therapeutics directed to the injured spinal cord, a change in neurological impairment has been proposed as a relevant acute clinical study end point. However, changes in neurological function, even if statistically significant, may not be associated with a functional impact, such as a meaningful improvement in items within the self-care subscore of the Spinal Cord Independence Measure (SCIM). Objective. The authors examined the functional significance associated with spontaneously recovering upper-extremity motor function after sensorimotor-complete cervical spinal cord injury (SCI). Methods. Using the European Multi-center Study about Spinal Cord Injury (EMSCI) data set, a retrospective analysis was undertaken of individuals with cervical sensorimotor-complete SCI (initial motor level, C4-C7). Specifically, changes in upper-extremity motor score (UEMS), motor level, and SCIM (total and self-care subscore) were assessed between approximately 1 and 48 weeks after injury (n = 74). Results. The initial motor level did not significantly influence the total UEMS recovered or number of motor levels recovered. SCIM self-care subscore recovery was significantly greater for those individuals regaining 2 motor levels compared with those recovering only 1 or no motor levels. However, the recovery in the SCIM self-care subscore was not significantly different between individuals recovering only 1 motor level and those individuals who showed no motor-level improvement. Conclusions. A 2 motor-level improvement indicates a clinically meaningful change and might be considered a primary outcome in acute and subacute interventional trials enrolling individuals with cervical sensorimotor-complete SCI. [ABSTRACT FROM PUBLISHER]

Background. Dermatomal somatosensory evoked potentials (dSSEPs) not only provide a neurophysiological readout comparable with conventional SSEPs but also provide an opportunity to track changes in sensory function corresponding to individual dermatomes (ie, a single spinal segment) above, at, and below the level of spinal cord injury (SCI). Objectives. This study aimed to determine the reliability and responsiveness of dSSEPs and electrical perception thresholds (EPTs) to monitor changes in sensory function after cervical SCI. Methods. Initial and follow-up dSSEPs and EPTs were recorded from cervical dermatomes (C4-C8) of patients with traumatic tetraplegia (C3-C8; ASIA Impairment Scale A-D) during recovery after SCI (n = 18). Results. Follow-up examination of 74 initial dSSEPs unaffected by SCI (n = 18) revealed no significant change in latency (Δ = 0.0 ± 1.4 ms; P = .9) or EPT sensitivity (Δ = 0.1 ± 0.8 mA; P = .3). In 41 dSSEPs initially delayed after SCI (n = 14), latencies significantly decreased on follow-up examination (Δ = -3.1 ± 2.9 ms; P < .01) without a corresponding increase in sensitivity of the EPT (Δ = 0.2 ± 3.4 mA; P = .7). dSSEPs that were not measurable initially were subsequently recorded in 11 dermatomes (n = 5) on follow-up examination. This conversion of abolished-to-recordable dSSEPs was often preceded by the perception of an initial EPT and associated with a concomitant recovery of EPT at follow-up. Conclusion. dSSEPs and EPT can be reliably recorded to monitor changes in sensory function for each individual spinal segment after cervical SCI. dSSEPs may be potentially useful to monitor the safety of a therapeutic drug or cell transplant in early-phase (I/II) clinical trials as well as document the potential efficacy of interventions where the standard neurological assessment might not detect subtle therapeutic effects. [ABSTRACT FROM AUTHOR]

The criminal justice system is often viewed as a revolving door for drug-dependent offenders due to its failure to recognize the association between addiction and offending, and repeated incarceration of drug-dependent offenders has contributed to prison overcrowding. The authors evaluated the effectiveness of Pennsylvania's drug and alcohol treatment-based intermediate punishment, Restrictive Intermediate Punishments (RIP/D&A), at reducing the risk of rearrest. Rearrest was compared at 12, 24, and 36 months postrelease. Offenders who successfully completed treatment had a lower risk of rearrest than traditionally sentenced offenders in general and county jail and probation offenders specifically. However, offenders sentenced to RIP/D&A who did not successfully complete treatment were more at risk for rearrest than traditionally sentenced offenders in general. Also, offenders sentenced to state incarceration had a lower risk of rearrest than RIP/D&A participants, regardless of program completion. [ABSTRACT FROM AUTHOR]

Background: Despite a lack of evidence for their effectiveness, functional knee braces are commonly prescribed to patients after anterior cruciate ligament (ACL) reconstruction. Purpose: This trial was conducted to compare postoperative outcomes in patients using an ACL functional knee brace and patients using a neoprene knee sleeve. Hypothesis: Patients using a brace will have superior outcomes than those using a sleeve. Study Design: Randomized controlled clinical trial; Level of evidence, 1. Methods: One hundred fifty patients were randomized to receive a brace (n = 76) or neoprene sleeve (n = 74) at their 6-week postoperative visit after primary ACL reconstruction with hamstring autograft. Patients were assessed preoperatively, then 6 weeks and 6, 12, and 24 months postoperatively. Outcome measures included disease-specific quality of life (Anterior Cruciate Ligament-Quality of Life [ACL-QOL] Questionnaire), anterior tibial translation (KT-1000 arthrometer side-to-side difference), the single-limb forward hop test (limb symmetry index), and Tegner Activity Scale. Outcomes at 1 and 2 years were compared after adjusting for baseline scores. Subjective ratings of how patients felt while using the brace/sleeve were also collected for descriptive purposes using a questionnaire. Four a priori directional subgroup hypotheses were evaluated using tests for interactions. Results: There were no significant differences between brace (n = 62) and sleeve (n = 65) groups for any of the outcomes at 1- and 2-year follow-ups. Adjusted mean differences at 2 years were as follows: -0.94 (95% confidence interval [Cl], -7.52 to 5.64) for the ACL-QOL Questionnaire, -0.10 mm (95% Cl, -0.99 to 0.81) for KT-1000 arthrometer side-to-side difference, -0.87% (95% Cl, -8.89 to 7.12) for hop limb symmetry index, and -0.05 (95% CI, -0.72 to 0.62) for the Tegner Activity Scale. Subjective ratings of confidence in the knee provided by the brace/sleeve were higher for the brace group than the sleeve group. Subgroup findings were minimal. Adverse events were few and similar between groups. Conclusions: A functional knee brace does not result in superior outcomes compared with a neoprene sleeve after ACL reconstruction. Current evidence does not support the recommendation of using an ACL functional knee brace after ACL reconstruction. [ABSTRACT FROM AUTHOR]

In Pennsylvania, the imposition of mandatory minimum sentences presents an important opportunity to examine relatively "pure" prosecutorial discretion over sentencing outcomes. The authors present a multilevel analysis of the prosecutorial decision to apply a mandatory minimum among mandatory-eligible offenders sentenced for drug crimes or as repeat, "three-strikes" offenders. They find that prosecutors' decisions to apply the mandatory minimum are significantly affected by the type and characteristics of offenses and guideline sentence recommendations, prior record, mode of conviction, and gender. They also find that Hispanic males are more likely to receive mandatory minimums and that Black-White differences in mandatory application increase with county percentage Black. The authors frame and interpret their analysis and findings in light of the uncertainty reduction theory of prosecutorial discretion, the view of courts as communities, and an integrative focal concerns perspective on criminal justice decision-making. [ABSTRACT FROM AUTHOR]

The primary goal of this study was to examine the relationship between parental psychopathology (specifically, alcohol dependence and depression) and adolescent psychopathology, by the gender of the adolescent and the gender of the parent. The sample included 426 13- to 17-year-old adolescents and their parents. All participants were administered the SemiStructured Assessment for the Genetics of Alcoholism to obtain clinical psychiatric diagnoses. Paternal psychopathology (depression and alcohol dependence) significantly predicted adolescent alcohol dependence, whereas maternal psychopathology did not. Maternal alcohol dependence did not predict any of the adolescent psychiatric diagnoses. In contrast, both paternal depression and maternal depression significantly predicted adolescent conduct disorder and depression. In addition, maternal depression significantly predicted adolescent anxiety. No significant interactions between parental psychopathology and adolescent gender were observed. Nevertheless, results from this study underscore the importance of considering the gender of the parent when examining the relationship between parental psychopathology and psychopathology in the offspring. [ABSTRACT FROM AUTHOR]

Examines the reliability of a derived strength measurement and also how variability between test sessions affects the utility of this variable for judging an individual's muscular effort. Physiological and psychological characteristics of maximal muscle performance; Variability of strength scores observed during repeated maximal efforts.

Provides information on a study that compares the effect of neoprene sleeve on knee joint position sense during a sitting open kinetic chain test and a supine closed kinetic chain test. Materials and methods of the study; Definition of open kinetic chain exercise; Study results.

Compares knee flexor and extensor strength measurements of operated and non-operated knees following anterior cruciate ligament reconstruction. Use of semitendinosus tendon and ligament augmentation device during concentric and eccentric muscle actions; Surgical technique and postoperative rehabilitation; Strength assessments; Anterior displacement; Activity levels.

Reports on an assessment of Pennsylvania's commission-developed sentencing guidelines. Responsibility of the Pennsylvania Commission on Sentencing; Width of guideline ranges; Purpose of sentencing; Impact of the guidelines on sentences imposed in Pennsylvania.

The article presents a discussion on the images of sociology and sociologist in Anglo-American fictions. Sociologists are generally aware of their negative images projected through popular fictions. One commonly encountered characteristic of fictional sociologists is their fondness for employing indecipherable, semi-professional jargon, even in social discourse. Although sociologists in fiction frequently exhibit unconventional and extremist patterns of personal behavior, their success in solving practical problems of imagery can scarcely be ignored. The overriding impression of sociology one gains through fiction is that anything can be studied under its aegis. Some fictional sociologists seem to revel in the bizzare. The aggressiveness which fictional sociologists exhibit in their professional and occupational roles is often transmuted, in their personal lives, into unconventional, oftentimes extreme forms of behavior. Many are obsessed with sex.

Reports on a comparative assessment of determinate sentencing in four states in the United States. Description of the judicial model in Maine; Sentencing structure in California; Details on the sentencing provisions of the Indiana code.

Since the introduction of supported employment in the Developmental Disabilities Act of 1984 and the Rehabilitation Act Amendments of 1986, there has been continued development and refinement of best practices in employment services and supports. Progress includes creative outcomes for individuals with significant support needs including customized jobs and self-employment, community rehabilitation providers that have shifted emphasis to integrated employment, and states that have made a substantial investment in Employment First policy and strategy. Despite these achievements, the promise of integrated employment remains elusive for the majority of individuals with intellectual and developmental disabilities. The number of individuals supported in integrated employment by state agencies has remained stagnant for the past 15 years, participation in nonwork services has grown rapidly, and individual employment supports have not been implemented with fidelity. This article presents preliminary findings from activities completed by the Rehabilitation Research and Training Center on Advancing Employment for Individuals with Intellectual and Developmental Disabilities and discusses a framework for organizing state and federal investments in research, practice, and systems change. [ABSTRACT FROM AUTHOR]

Laser-induced fluorescence (LIF) and intrinsic fluorescence spectroscopy (IFS) have been used experimentally for diagnosing coronary atherosclerosis. In this study, we demonstrated the diagnostic superiority of IFS at 342-nm excitation (IFS342) versus LIF (LIF342) and described a protocol for head-to-head comparison of old (LIF) versus new (IFS) generations of similar diagnostic methods, labeled as “generational comparison model”. IFS342and LIF342were modeled with basis spectra of media, fibrous caps, and superficial foam cells and of their correspondent chemicals (elastin, collagen, and lipoproteins). The average accuracy and receiver operating characteristic area under the curve of IFS342in single-, double-, and triple-parameter diagnostic algorithm iterations, geared toward identifying 84 atherosclerotic specimens from a group of 117 coronary segments, was 90% ± 1% and 0.87 ± 0.025, superior to LIF342(84% ± 3% and 0.84 ± 0.016; P= 0.0002 and 0.02, respectively) in a generational comparison model. [ABSTRACT FROM AUTHOR]

Sensation seeking is a heritable personality trait that has been reliably linked to behavioral disorders. The dopamine system has been hypothesized to contribute to variations in sensation seeking between different individuals, and both experimental and observational studies in humans and nonhuman animals provide evidence for the involvement of the dopamine system in sensation-seeking behavior. In this study, we took a candidate-system approach to genetic association analysis of sensation-seeking behavior. We analyzed single-nucleotide polymorphisms (SNPs) from a number of dopaminergic genes. Using 273 SNPs from eight dopamine genes in a sample of 635 unrelated individuals, we examined the aggregate effect of SNPs that were significantly associated with sensation-seeking behavior. Multiple SNPs in four dopamine genes accounted for significant variance in sensation-seeking behavior between individuals. These results suggest that multiple SNPs, aggregated within genes that are relevant to a specific neurobiological system, form a genetic-risk score that may explain a significant proportion of observed variance in human traits such as sensation-seeking behavior. [ABSTRACT FROM PUBLISHER]