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Objective: Blunt traumatic diaphragmatic injury (TDI) is typically associated with severe trauma and concomitant injuries. It is a diagnostic challenge in the setting of blunt trauma and can be easily overlooked especially in the acute phase often dominated by concurrent injuries. Methods: A retrospective review was conducted of patients with blunt‐TDI identified from a level 1 trauma registry. Variables associated with early versus delayed diagnosis as well as non‐survivor and survivor groups were collected to examine factors associated with delayed diagnosis. Results: A total of 155 patients were included (mean age 46 ± 20, 60.6% male). Diagnosis was made <24 h in 126 (81.3%), and >24 h in 29 (18.7%). Of the delayed diagnosis group, 14 (48%) were diagnosed >7 days. Overall, 27 (21.4%) patients had a diagnostic initial CXR and 64 (50.8%) had a diagnostic initial CT. Fifty‐eight (37.4%) patients were diagnosed intraoperatively. Of the delayed diagnosis group, 22 (75.9%) had no initial signs on CXR or CT, 15 (52%) of this group had persistent pleural‐effusions/elevated‐hemidiaphragm leading to further investigation and diagnosis. No significant difference in survival was observed between early and delayed diagnoses, no clinically significant injury patterns to predict delayed diagnoses were noted. Conclusion: The diagnosis of TDI is challenging. Without frank signs of herniation of abdominal contents on CXR or CT, the diagnosis is often not made on initial imaging. In patients with the evidence of blunt traumatic injury in the lower‐chest/upper‐abdomen, a high degree of clinical suspicion should be held and follow‐up CXRs/CTs arranged. [ABSTRACT FROM AUTHOR]

Following the 2008 recession, Ireland experienced unemployment rates as high as 15% (McGuinness, O’Connell and Kelly, 2014). Policy responses have been through the introduction of upskilling and reskilling through activation labour market policies (ALMPs) in the higher education sector (Department of Education and Skills, 2015). The evidence to date regarding the efficacy of such interventions (e.g., Springboard+) has been concerned with blunt measurements of progression rates, labour market entry, and earnings. The present study explored social capital and social well-being among a sample of 101 participants of Springboard+ programmes at one higher education provider in Dublin. The primary objective of the pilot study is to create and test a research method informed by well validated indicators to inform a larger national study.

Adults with autism experience significant impairments in social and non-social information processing for which few treatments have been developed. This study conducted an 18-month uncontrolled trial of Cognitive Enhancement Therapy (CET), a comprehensive cognitive rehabilitation intervention, in 14 verbal adults with autism spectrum disorder to investigate its feasibility, acceptability, and initial efficacy in treating these impairments. Results indicated that CET was satisfying to participants, with high treatment attendance and retention. Effects on cognitive deficits and social behavior were also large (d = 1.40-2.29) and statistically significant (all p <0.001). These findings suggest that CET is a feasible, acceptable, and potentially effective intervention for remediating the social and non-social cognitive impairments in verbal adults with autism.

Haemorrhagic shock after trauma is a leading cause of death worldwide, particularly in young individuals. Despite advances in trauma systems and resuscitation strategies, mortality from haemorrhagic shock has not declined over the previous two decades. A proportion of shocked trauma patients may experience a deficiency of cortisol relative to the severity of their injury. The benefit of exogenous steroid administration in patients suffering haemorrhagic shock as a result of injury is unclear. A systematic review of four databases (Ovid Medline, Ovid Embase, Cochrane, Scopus) was undertaken. Inclusion and exclusion criteria were pre-determined and two reviewers independently screened the articles with disagreements arbitrated by a third reviewer. The primary outcome variable was 28-day mortality. Quality of studies were assessed using the Cochrane-risk-of-bias (RoB 2) tool. Of the 2919 studies yielded by the search strategy, 1274 duplicates were removed and 1645 screened on title and abstract. After the full text of 33 studies were assessed, two articles were included. Both studies were over 30 years old with small numbers of participants and with primary outcomes not including mortality. Of the data available, no statistically significant difference in mortality was detected. Hospital length of stay, reversal of shock or adverse events were not reported. Both studies were at risk of bias. There are no high quality or recent studies in the English literature investigating the use of steroids for haemorrhagic shocked trauma patients. [ABSTRACT FROM AUTHOR]

Cognitive rehabilitation is an emerging set of potentially effective interventions for the treatment of autism spectrum disorder, yet the applicability of these approaches for "high functioning" adults who have normative levels of intelligence remains unexplored. This study examined the initial cognitive performance characteristics of 40 verbal adults with autism enrolled in a pilot trial of Cognitive Enhancement Therapy to investigate the need for cognitive rehabilitation in this population. Results revealed marked and broad deficits across neurocognitive and social-cognitive domains, despite above-average IQ. Areas of greatest impairment included processing speed, cognitive flexibility, and emotion perception and management. These findings indicate the need for comprehensive interventions designed to enhance cognition among verbal adults with autism who have intact intellectual functioning.

Killer-cell immunoglobulin-like receptors (KIRs) are a family of glycoproteins expressed primarily on natural killer cells that can regulate their function. Inhibitory KIRs recognize MHC class I molecules (KIR-ligands) as ligands. We have reported associations of KIRs and KIR-ligands for patients in two monoclonal antibody (mAb)-based trials: (1) A Children’s Oncology Group (COG) trial for children with high-risk neuroblastoma randomized to immunotherapy treatment with dinutuximab (anti-GD2 mAb) + GM-CSF + IL-2 + isotretinion or to treatment with isotretinoin alone and (2) An Eastern Cooperative Oncology Group (ECOG) trial for adults with low-tumor burden follicular lymphoma responding to an induction course of rituximab (anti-CD20 mAb) and randomized to treatment with maintenance rituximab or no-maintenance rituximab. In each trial, certain KIR/KIR-ligand genotypes were associated with clinical benefit for patients randomized to immunotherapy treatment (immunotherapy in COG; maintenance rituximab in ECOG) as compared to patients that did not receive the immunotherapy [isotretinoin alone (COG); no-maintenance (ECOG)]. Namely, patients with both KIR3DL1 and its HLA-Bw4 ligand (KIR3DL1+/HLA-Bw4+ genotype) had improved clinical outcomes if randomized to immunotherapy regimens, as compared to patients with the KIR3DL1+/HLA-Bw4+ genotype randomized to the non-immunotherapy regimen. Conversely, patients that did not have the KIR3DL1+/HLA-Bw4+ genotype showed no evidence of a difference in outcome if receiving the immunotherapy vs. no-immunotherapy. For each trial, HLA-Bw4 status was determined by assessing the genotypes of three separate isoforms of HLA-Bw4: (1) HLA-B-Bw4 with threonine at amino acid 80 (B-Bw4-T80); (2) HLA-B-Bw4 with isoleucine at amino acid 80 (HLA-B-Bw4-I80); and (3) HLA-A with a Bw4 epitope (HLA-A-Bw4). Here, we report on associations with clinical outcome for patients with KIR3DL1 and these separate isoforms of HLA-Bw4. Patients randomized to immunotherapy with KIR3DL1+/A-Bw4+ or with KIR3DL1+/B-Bw4-T80+ had better outcome vs. those randomized to no-immunotherapy, whereas for those with KIR3DL1+/B-Bw4-I80+ there was no evidence of a difference based on immunotherapy vs. no-immunotherapy. Additionally, we observed differences within treatment types (either within immunotherapy or no-immunotherapy) that were associated with the genotype status for the different KIR3DL1/HLA-Bw4-isoforms. These studies suggest that specific HLA-Bw4 isoforms may differentially influence response to these mAb-based immunotherapy, further confirming the involvement of KIR-bearing cells in tumor-reactive mAb-based cancer immunotherapy.

Objective: To examine the effects of psychosocial cognitive rehabilitation on employment outcomes in a randomized controlled trial for individuals with early course schizophrenia. Method: Early course schizophrenia outpatients (N = 58) were randomly assigned to cognitive enhancement therapy (CET) or an enriched supportive therapy (EST) control and treated for 2 years. Comprehensive data on cognition and employment were collected annually. Results: Individuals treated with CET were significantly more likely to be competitively employed, had greater earnings from employment, and were more satisfied with their employment status by the end of treatment compared to EST recipients. Mediator analyses revealed that improvements in both social and nonsocial cognition mediated CET effects on employment. Conclusion: CET can help facilitate employment in early schizophrenia by addressing the cognitive impairments that limit functioning in the disorder. Inclusion of cognitive rehabilitation in social work practice can support more optimal functional recovery from schizophrenia. (Contains 2 tables.)

The teacher education literature is replete with recommendations regarding the preparation of new teachers who are equipped to face the complexities and instructional demands of their first year of teaching. Recently, teacher education programs have begun to use online assessment products to provide evidence that their teacher candidates' can demonstrate competency with respect to established standards. While this process may initially be driven by the demands of accreditation requirements and/or institutional assessment needs, online systems can be configured to accommodate a host of relevant assignments and student performances across time to demonstrate student achievement and growth. This evidence can be aggregated and disaggregated to show the readiness of candidates to become first-year teachers in a variety of school settings. The purpose of this paper is to describe ways in which online products can be used to showcase teacher candidates' work that demonstrates what the experts claim sets apart graduates from exemplary programs from those less rigorous. This process will enable teacher education programs and their K-12 partners to prepare beginning teachers together and use the online assessment product to document preparation levels and identify strengths and possible areas for improvement in teacher preparation programs. (Contains 3 figures.)

This article provides an overview of the successful laptop implementation in the College of Education at the University of South Florida (USF). The pilot initiative began with one cohort of preservice teachers in 2003; since then, the program has expanded throughout the college. Through a chronological outline of the issues, formative evaluations, modifications, and expansion of the project as it progressed through the years, this article shares lessons learned related to the process and outcomes. For example, initial implementation decisions included issues such as whether participation should be voluntary or mandatory, which computer platforms would be supported, and how training and support would be provided. As the project expanded, questions related to ongoing maintenance, financial aid, and other issues were addressed.

Monte Carlo methods were used to examine techniques for constructing confidence intervals around multivariate effect sizes. Using interval inversion and bootstrapping methods, confidence intervals were constructed around the standard estimate of Mahalanobis distance (D[superscript 2]), two bias-adjusted estimates of D[superscript 2], and Huberty's "I." Interval coverage and width were examined across conditions by adjusting sample size, number of variables, population effect size, population distribution shape, and the covariance structure. The accuracy and precision of the intervals varied considerably across methods and conditions; however, the interval inversion approach appears to be promising for D[superscript 2], whereas the percentile bootstrap approach is recommended for the other effect size measures. The results imply that it is possible to obtain fairly accurate coverage estimates for multivariate effect sizes. However, interval width estimates tended to be large and uninformative, suggesting that future efforts might focus on investigating design factors that facilitate more precise estimates of multivariate effect sizes. (Contains 3 figures and 3 tables.)

The purpose of this study was to investigate the relationship between sample size and the quality of factor solutions obtained from exploratory factor analysis. This research expanded upon the range of conditions previously examined, employing a broad selection of criteria for the evaluation of the quality of sample factor solutions. Results showed that when communalities are high, sample size tended to have less influence on the quality of factor solutions than when communalities are low. Overdetermination of factors was also shown to improve the factor analysis solution. Finally, decisions about the quality of the factor solution depended upon which criteria were examined.

The purpose of this study was to investigate and compare the performance of a stepwise variable selection algorithm to traditional exploratory factor analysis. The Monte Carlo study included six factors in the design; the number of common factors; the number of variables explained by the common factors; the magnitude of factor loadings; the number of variables not explained by the common factors; the type of anomaly evidenced by the poorly explained variables; and sample size. The performance of the methods was evaluated in terms of selection and pattern accuracy, and bias and root mean squared error of the structure coefficients. Results indicate that the stepwise algorithm was generally ineffective at excluding anomalous variables from the factor model. The poor selection accuracy of the stepwise approach suggests that it should be avoided.

Developed and provided initial validation of scores from a survey designed to measure teachers' reported use of technology in their classrooms. Interprets results from a sample of 2000 teachers in terms of the ability of the instrument to measure the confluence of factors that are critical for study of technology use in classrooms. (SLD)

Individuals with schizophrenia who misuse substances are burdened with impairments in emotion regulation. Cognitive Enhancement Therapy (CET) may address these problems by enhancing prefrontal brain function. A small sample of outpatients with schizophrenia and alcohol and/or cannabis substance use problems participating in an 18-month randomized trial of CET (n = 10) or usual care (n = 4) completed post-treatment functional neuroimaging using an emotion regulation task. General linear models explored CET effects on brain activity in emotional neurocircuitry. Individuals treated with CET had significantly greater activation in broad regions of the prefrontal cortex, limbic and striatal systems implicated in emotion regulation compared to usual care. Differential activation favoring CET in prefrontal regions and the insula mediated behavioral improvements in emotional processing. Our data lend preliminary support of CET effects on neuroplasticity in fronto-limbic and striatal circuitries which mediate emotion regulation in people with schizophrenia and comorbid substance misuse problems.

We previously developed a method for determining MYCN gene amplification status using cell-free DNA fragments released from cancer cells into the blood of patients with neuroblastoma (NB). Here, we analyzed the relationship between MYCN amplification (MNA) status and neuroblastoma prognosis. We screened serum samples from 151 patients with NB for MNA, using real-time quantitative PCR, and compared the results with MYCN status determined using paired tumor samples. We additionally investigated whether MNA status correlates with patient survival. When a cut-off value of 5 was used, serum-based MNA analysis was found to show good sensitivity (86%) and very high specificity (95%). The sensitivities for stage 1 and 2 might be acceptable, even though it is not as good as for stage 3 and 4 (67% for stage 1 and 2, 92% for stage 3, and 87% for stage 4). MNA status correlated with overall survival in our cohort of 82 patients, with survival data available (p < 0.01). The hazard ratio of MNA status was 4.98 in patients diagnosed at less than 18 months of age (95% confidence interval, 1.00-24.78), and 1.41 (95% confidence interval, 0.63-3.14) for those diagnosed at 18 months of age or older. Serum-based MNA analysis is rapid and non-invasive compared with tumor-based MNA analysis, and has potential to predict tumor MNA status. There is still a room to improve the sensitivity of the test for tumors of stages 1 and 2, nonetheless this assay might help to determine therapeutic strategies prior to tumor biopsy, especially for patients with a life-threatening condition, as well as for patients of less than 18 months of age whose risk-grouping and treatment allocation depends on their MNA status.