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Abstract Background The purpose of this literature review was to examine the existing patient-reported outcome measurement literature to understand the empirical evidence supporting response scale selection in pain measurement for the adult population. Methods The search strategy involved a comprehensive, structured, literature review with multiple search objectives and search terms. Results The searched yielded 6918 abstracts which were reviewed against study criteria for eligibility across the adult pain objective. The review included 42 review articles, consensus guidelines, expert opinion pieces, and primary research articles providing insights into optimal response scale selection for pain assessment in the adult population. Based on the extensive and varied literature on pain assessments, the adult pain studies typically use simple response scales with single-item measures of pain—a numeric rating scale, visual analog scale, or verbal rating scale. Across 42 review articles, consensus guidelines, expert opinion pieces, and primary research articles, the NRS response scale was most often recommended in these guidance documents. When reviewing the empirical basis for these recommendations, we found that the NRS had slightly superior measurement properties (e.g., reliability, validity, responsiveness) across a wide variety of contexts of use as compared to other response scales. Conclusions Both empirical studies and review articles provide evidence that the 11-point NRS is likely the optimal response scale to evaluate pain among adult patients without cognitive impairment.

To address lesbian, gay, bisexual, transgender, queer, asexual, intersex et al. (LGBTQAI+) health policy, we must consider the historical context of the population in the United States. Within the last twenty years, the legal system codified basic safety and fundamental rights for LGBTQAI+ citizens. The legal system makes change slower than most other systems in order to preserve the rule of law from the tidal waves of popular opinion, and law often follows and codifies established policy. In the United States, there is great discrepancy in social attitudes towards this community that the creation of anti-discrimination laws beget new policies across all areas of social systems (Harrison & Michelson, 2017). Consequently, new anti-discrimination laws prescribe the conscientious and meticulous undoing of systemic bias in all of our social services, from housing to health care.

There is evidence that life on Earth originated in cold saline waters around scorching hydrothermal vents, and that similar conditions might exist or have existed on Mars, Europa, Ganymede, Enceladus, and other worlds. Could potentially habitable complex brines with extremely low freezing temperatures exist in the shallow subsurface of these frigid worlds? Earth, Mars, and carbonaceous chondrites have similar bulk elemental abundances, but while the Earth is depleted in the most volatile elements, the Icy Worlds of the outer solar system are expected to be rich in them. The cooling of ionic solutions containing substances that likely exist in the Icy Worlds could form complex brines with the lowest eutectic temperature possible for the compounds available in them. Indeed, here, we show observational and theoretical evidence that even elements present in trace amounts in nature are concentrated by freeze–thaw cycles, and therefore contribute significantly to the formation of brine reservoirs that remain liquid throughout the year in some of the coldest places on Earth. This is interesting because the eutectic temperature of water–ammonia solutions can be as low as ~160 K, and significant fractions of the mass of the Icy Worlds are estimated to be water substance and ammonia. Thus, briny solutions with eutectic temperature of at least ~160 K could have formed where, historically, temperature have oscillated above and below ~160 K. We conclude that complex brines must exist in the shallow subsurface of Mars and the Icy Worlds, and that liquid saline water should be present where ice has existed, the temperature is above ~160 K, and evaporation and sublimation have been inhibited.

Abstract Background Caveolae are membrane invaginations measuring 50–100 nm. These organelles, composed of caveolin and cavin proteins, are important for cellular signaling and survival. Caveolae play incompletely defined roles in human kidneys. Induction of caveolin-1/CAV1 in diseased tubules has been described previously, but the responsible mechanism remains to be defined. Methods Healthy and atrophying human kidneys were stained for caveolar proteins, (caveolin 1–3 and cavin 1–4) and examined by electron microscopy. Induction of caveolar proteins was studied in isolated proximal tubules and primary renal epithelial cells. These cells were challenged with hypoxia or H2O2. Primary tubular cells were also subjected to viral overexpression of megakaryoblastic leukemia 1 (MKL1) and MKL1 inhibition by the MKL1 inhibitor CCG-1423. Putative coregulators of MKL1 activity were investigated by Western blotting for suppressor of cancer cell invasion (SCAI) and filamin A (FLNA). Finally, correlative bioinformatic studies of mRNA expression of caveolar proteins and MKL1 were performed. Results In healthy kidneys, caveolar proteins were expressed by the parietal epithelial cells (PECs) of Bowman’s capsule, endothelial cells and vascular smooth muscle. Electron microscopy confirmed caveolae in the PECs. No expression was seen in proximal tubules. In contrast, caveolar proteins were expressed in proximal tubules undergoing atrophy. Caveolar proteins were also induced in cultures of primary epithelial tubular cells. Expression was not enhanced by hypoxia or free radical stress (H2O2), but proved sensitive to inhibition of MKL1. Viral overexpression of MKL1 induced caveolin-1/CAV1, caveolin-2/CAV2 and SDPR/CAVIN2. In kidney tissue, the mRNA level of MKL1 correlated with the mRNA levels for caveolin-1/CAV1, caveolin-2/CAV2 and the archetypal MKL1 target tenascin C (TNC), as did the MKL1 coactivator FLNA. Costaining for TNC as readout for MKL1 activity demonstrated overlap with caveolin-1/CAV1 expression in PECs as well as in atrophic segments of proximal tubules. Conclusions Our findings support the view that MKL1 contributes to the expression of caveolar proteins in healthy kidneys and orchestrates the induction of tubular caveolar proteins in renal injury.

Comprehensive transcriptome studies of cancers often rely on corresponding normal tissue samples to serve as a transcriptional reference. In this study, we performed in-depth analyses of normal kidney tissue transcriptomes from the TCGA and demonstrate that the histological variability in cellularity, inherent in the kidney architecture, lead to considerable transcriptional differences between samples. This should be considered when comparing expression profiles of normal and cancerous kidney tissues. We exploited these differences to define renal-cell-specific gene signatures and used these as a framework to analyze renal cell carcinoma (RCC) ontogeny. Chromophobe RCCs express FOXI1-driven genes that define collecting duct intercalated cells, whereas HNF-regulated genes, specific for proximal tubule cells, are an integral part of clear cell and papillary RCC transcriptomes. These networks may be used as a framework for understanding the interplay between genomic changes in RCC subtypes and the lineage-defining regulatory machinery of their non-neoplastic counterparts.

ObjectivesWorking with men/boys, in addition to women/girls, through gender-transformative programming that challenges gender inequalities is recognised as important for improving sexual and reproductive health and rights (SRHR) for all. The aim of this paper was to generate an interactive evidence and gap map (EGM) of the total review evidence on interventions engaging men/boys across the full range of WHO SRHR outcomes and report a systematic review of the quantity, quality and effect of gender-transformative interventions with men/boys to improve SRHR for all.MethodsFor this EGM and systematic review, academic and non-academic databases (CINAHL, Medline, PsycINFO, Social Science Citation Index-expanded, Cochrane Library, Campbell Collaboration, Embase, Global Health Library and Scopus) were searched using terms related to SRHR, males/masculinities, systematic reviews and trials (January 2007–July 2018) with no language restrictions for review articles of SRHR interventions engaging men/boys. Data were extracted from included reviews, and AMSTAR2 was used to assess quality. Outcomes were based on WHO reproductive health strategy.ResultsFrom the 3658 non-duplicate records screened, the total systematic reviews of interventions engaging men/boys in SRHR was mapped through an EGM (n=462 reviews) showing that such interventions were relatively evenly spread across low-income (24.5%), middle-income (37.8%) and high-income countries (37.8%). The proportion of reviews that included gender-transformative interventions engaging men/boys was low (8.4%, 39/462), the majority was in relation to violence against women/girls (n=18/39, 46.2%) and conducted in lower and middle-income countries (n=25/39, 64%). Reviews of gender-transformative interventions were generally low/critically low quality (n=34/39, 97.1%), and findings inconclusive (n=23/39, 59%), but 38.5% (n=15/39) found positive results.ConclusionResearch and programming must be strengthened in engagement of men/boys; it should be intentional in promoting a gender-transformative approach, explicit in the intervention logic models, with more robust experimental designs and measures, and supported with qualitative evaluations.

Though they recently received legal legitimacy, the LGBTQAI+ community faces discrimination through deeply entrenched heterosexist social systems, which amplify inequities for women and gender minorities. Social workers must advocate for expansive policy interventions to promote economic andhealth equity for female-identi ed members of the LGBTQAI+ community.Practical policy interventions for the promotion of health equity include provider training programs, anti-discrimination protections, the collection of comprehensive demographic data, and youth education curricula.

Enhanced recovery after surgery (ERAS) aims to improve perioperative care, hasten recovery to the normal physiological state and shorten length of stay (LoS). There is evidence that ERAS programmes following elective caesarean section (ELCS) confer benefit through faster return to physiological state and reduced LoS for mother and baby. Baseline audit of ELCS in 2013 revealed a mean LoS of 3 days. We piloted an ERAS discharge pathway promoting day 2 discharge, which rose from 5.0% to 40.2%. 19.2% of women went home on day 1. Many women fed back that they would prefer day 1 discharge. We hypothesised that a day 1 discharge pathway for low-risk women could benefit both women and services at our maternity unit. From October 2015, we developed a ‘fast-track pathway’ (FTP) using a Plan-Do-Study-Act approach. Between October 2015 and April 2016, we prospectively audited clinical outcomes, LoS and maternal satisfaction from all women placed on the FTP. We held regular multidisciplinary team meetings to allow contemporaneous analysis. Satisfaction was analysed by Likert scale at postoperative surveys. Women were identified in antenatal clinic after meeting predefined low-risk criteria. 27.3% of women (n=131/479) delivering by ELCS entered the FTP. 76.2% of women on the FTP were discharged on day 1. Mean LoS fell to 1.31 days. 94.2% of women who established breast feeding at day 1 were still breast feeding at 7 days. Overall satisfaction at day 7 was 4.71 on a 5-point Likert scale. 73.1% of women reported good pain control. Additional financial savings are estimated at £99 886 annually. There were no related cases of readmission. Day 1 discharge after ELCS is safe and acceptable in carefully selected, low-risk women and has high satisfaction. There may be resultant financial savings and improved flow through a maternity unit with no detected adverse effect on breast feeding, maternal morbidity or postnatal readmissions.

Malaria remains a significant health problem in many tropical and sub-tropical regions. The development of vaccines against the clinically active blood-stage of infection needs to consider variability and polymorphism in target antigens, and an adjuvant system able to induce broad spectrum immunity comprising both antibodies and helper T cells. Moreover, recent studies have shown some conventional pro-inflammatory adjuvants can also promote expansion of immunosuppressive regulatory T cells (Treg) and myeloid derived suppressor cells (MDSC), both of which could negatively impact malaria disease progression. Herein, we explore the ability of a model nanoparticle delivery system (polystyrene nanoparticles; PSNPs), previously proven to not induce conventional inflammation, Treg or MDSC, to induce immunity to MSP4/5 from Plasmodium yoelii, a member of the MSP4 and MSP5 family of proteins which are highly conserved across diverse malaria species including P. falciparum. The results show PSNPs-MSP4/5 conjugates are highly immunogenic, inducing immune responses comprising both T helper 1 (Th1) and Th2 cellular immunity, and a spectrum of antibody subclasses including IgG1, IgG2a, and IgG2b. Benchmarked against Alum and Complete Freund's Adjuvant (CFA), the immune responses that were induced were of comparable or higher magnitude, for both T cell frequencies by ELISpot and antibody responses in terms of ELISA end titer. Importantly, immunization with PSNPs-MSP4/5 induced partial protection against malaria blood-stage infection (50–80%) shown to be mechanistically dependent on interferon gamma (IFN-γ) production. These results expand the scope of adjuvants considered for malaria blood-stage vaccine development to those that do not use conventional adjuvant pathways and emphasizes the critical role of cellular immunity and specifically IFN-γ producing cells in providing moderate protection against blood-stage malaria comparable to Freunds adjuvant.

Introduction Chronic salicylate toxicity is an uncommon, potentially life-threatening poisoning that requires high clinical suspicion in order to make the diagnosis. We created a simulation case that challenges learners to analyze case information, construct a differential diagnosis of an elevated anion gap metabolic acidosis with respiratory alkalosis, and initiate treatment for this toxicity. Methods The simulation case was designed for emergency medicine residents and pediatric emergency medicine fellows. The activity began with a brief overview of the monitors, equipment, and simulation experience. For interns, a team of two learners comanaged the case; for senior learners, the case was managed solo. The learners had 15 minutes to complete a focused history and physical exam, request and interpret labs and studies, and initiate specific treatments. The simulation was followed by a 15-minute facilitated debrief session that included an overview of key learning points and learner performance based on an evaluation checklist. Results Residents completed a postparticipation questionnaire consisting of six questions rated on a 5-point Likert scale. Overall, residents reported a high degree of satisfaction with the simulation experience. The case and debrief were effective in meeting the educational objectives and proved to be an effective modality to fill this educational gap. Discussion This simulation exercise was effective in showing residents the uncommon presentation of chronic salicylate toxicity. Learners reported increased confidence in recognizing and managing this ingestion. The simulation experience closed an identified education gap and provided an experiential learning opportunity that accomplished the targeted learning objectives.

Objective: This study investigated the delivery of paediatric (0-17 years) government dental services in New South Wales (NSW), Australia through public dental clinics and the commissioned payments models of Fee-for-Service and Capped-Fee. Method: De-identified patient data from government provided dental care and the commissioned services was sourced from NSW Oral Health Data Warehouse for evaluation and interpretation using descriptive analysis during the period 1 January 2012 to 31 December 2013. Result: The breakdown of dental care provided the associated cost analysis for the study’s cohort that resulted in both years, more than 50 percent dental services offered to paediatric patients were preventive care in all payment systems. The most common preventive items offered were fluoride treatment, dietary advice, oral health education and fissure sealants. Conclusion: There was little difference in the mix of dental care provided between study years and age groups through the three payment systems in NSW. The difference between the government services and those provided via the Fee-for-Service and Capitation payment systems was negligible. This has important implications for the delivery of dental care to public dental care, particularly when patients may not live close to a public dental clinic and also with the interest nationally in giving patients greater choice.

Objective: Clostridium tertium is considered an uncommon pathogen in humans, but is a cause of bacteremia in patients with underlying hematological malignancies and neutropenia. A case series highlighting 10 years of experience with C. tertium as a cause of bacteremia in this population is presented; the cases were seen at a National Cancer Institute designated cancer center. Methods: Institutional review board approval was obtained prior to the start of the study. All cases of C. tertium bacteremia seen at H. Lee Moffitt Cancer Center and Research Institute from 2005 to 2015 were reviewed. The study population was identified by positive blood cultures obtained from the microbiology laboratory over the same time period. Results: Seven patients were found to have had C. tertium bacteremia. These patients had a temperature of >38.3 °C at the time of diagnosis and severe neutropenia. All patients had a history of hematological malignancy, five having acute myeloid leukemia and two having myelodysplastic syndrome. All of the patients’ blood cultures cleared within ≤3 days of antibiotic therapy. Conclusions: The unusual susceptibility pattern of C. tertium, with resistance to beta-lactams and clindamycin, likely explains its presence in immunosuppressed patients. Vancomycin remains the drug of choice. The pathogen continues to have a low virulence and a low mortality when treated appropriately.

Purpose: Current practices applied to mouse pharmacokinetic (PK) studies often use large numbers of animals with sporadic or composite sampling that inadequately describe PK profiles. The purpose of this work was to evaluate and optimize blood microsampling techniques coupled with dried blood spot (DBS) and LC-MS/MS analysis to generate reliable PK data in mice. In addition, the feasibility of cross-over designs was assessed and recommendations are presented. Methods: The work describes a comprehensive evaluation of five blood microsampling techniques (tail clip, tail vein with needle hub, submandibular, retro-orbital, and saphenous bleeding) in CD-1 mice. The feasibility of blood sampling was evaluated based on animal observations, ease of bleeding, and ability to collect serial samples. Methotrexate, gemfibrozil and glipizide were used as test compounds and were dosed either orally or intravenously, followed by DBS collection and LC-MS/MS analysis to compare PK with various bleeding methods. Results: Submandibular and retro-orbital methods that required non-serial blood collections did not allow for inter-animal variability assessments and resulted in poorly described absorption and distribution kinetics. The submandibular and tail vein with needle-hub methods were the least favorable from a technical feasibility perspective. Serial bleeding was possible with cannulated animals or saphenous bleeding in non-cannulated animals. Conclusions: Of the methods that allowed serial sampling, the saphenous method when executed as described in this report, was most practical, reproducible and provided for assessment of inter-animal variability. It enabled the collection of complete exposure profiles from a single mouse and the conduct of an intravenous/oral cross-over study design. This methodology can be used routinely, it promotes the 3Rs principles by achieving reductions in the number of animals used, decreased restraints and animal stress, and improved the quality of data obtained in mouse PK studies. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page

Background: Child maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems. Objectives: To synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment. Study design: For effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views. Participants: Children and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months. Interventions: Any psychosocial intervention provided in any setting aiming to address the consequences of maltreatment. Main outcome measures: Psychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability. Methods: Young Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible. Results: We identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive–behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) –0.44 (95% CI –4.43 to –1.53)], depression [mean difference –2.83 (95% CI –4.53 to –1.13)] and anxiety [SMD –0.23 (95% CI –0.03 to –0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist–child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself. Conclusions: It is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions. Limitations: Studies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses. Future work: Studies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes. Study registration: This study is registered as PROSPERO CRD42013003889. Funding: The National Institute for Health Research Health Technology Assessment programme.

This mixed methods study examines whether the rural/urban distribution of credit union/caisse populaire branches differs significantly from the general urban/rural demographic pattern in Canada. It also explores whether their distribution is different from that of banks, looking at the cases of Québec and Atlantic Canada. The study finds a rural tilt among financial cooperatives in Canada, and seven key informants present their views on the results. Their responses are categorized in two main themes: why financial cooperatives are overrepresented in rural and small town areas, and why they are under-represented in urban ones. A discussion follows, and directions for further study are provided. / Cette étude utilisant des méthodes combinées examine si la distribution des succursales de coopératives d’épargne et de crédit / caisses populaires en milieu rural et urbain diffère de façon importante de la tendance démographique générale des milieux urbains et ruraux au Canada. Elle aborde aussi la question de savoir si leur distribution est différente de celle des banques en observant le cas du Québec et du Canada atlantique. L’étude révèle une tendance rurale chez les coopératives financières du Canada, et sept répondants clés donnent leur opinion sur les résultats. Les réponses des intervenants sont divisées en deux thèmes principaux : pourquoi les coopératives sont surreprésentées dans les milieux ruraux et les petites villes et pourquoi elles sont sous-représentées dans les milieux urbains. Un débat s’ensuit, et des lignes directrices sont fournies aux fins d’une étude plus approfondie.

Diabetic foot ulcers (DFU) are a major health problem associated with diabetes mellitus. Impaired nitric oxide (NO) production has been shown to be a major contributor to the dysregulation of healing in DFU. The level of impairment is not known primarily due to challenges with measuring NO. Herein, we report the actual level of NO produced by human dermal fibroblasts cultured under normal and high glucose conditions. Fibroblasts produce the extracellular matrix, which facilitate the migration of keratinocytes to close wounds. The results show that NO production was significantly higher in normal glucose compared to high glucose conditions. The real-time NO detected was compared to the nitrite present in the culture media and there was a direct correlation between real-time NO and nitrite in normal glucose conditions. However, real-time NO detection and nitrite measurement did not correlate under high glucose conditions. The inducible nitric oxide synthase (iNOS) enzyme responsible for NO production was upregulated in normal and high glucose conditions and the proliferation rate of fibroblasts was not statistically different in all the treatment groups. Relying only on nitrite to assess NO production is not an accurate determinant of the NO present in the wound bed in pathological states such as diabetes mellitus.

Background: The needs of children with autism spectrum disorder (ASD) are complex and this is reflected in the number and diversity of outcomes assessed and measurement tools used to collect evidence about children’s progress. Relevant outcomes include improvement in core ASD impairments, such as communication, social awareness, sensory sensitivities and repetitiveness; skills such as social functioning and play; participation outcomes such as social inclusion; and parent and family impact. Objectives: To examine the measurement properties of tools used to measure progress and outcomes in children with ASD up to the age of 6 years. To identify outcome areas regarded as important by people with ASD and parents. Methods: The MeASURe (Measurement in Autism Spectrum disorder Under Review) research collaboration included ASD experts and review methodologists. We undertook systematic review of tools used in ASD early intervention and observational studies from 1992 to 2013; systematic review, using the COSMIN checklist (Consensus-based Standards for the selection of health Measurement Instruments) of papers addressing the measurement properties of identified tools in children with ASD; and synthesis of evidence and gaps. The review design and process was informed throughout by consultation with stakeholders including parents, young people with ASD, clinicians and researchers. Results: The conceptual framework developed for the review was drawn from the International Classification of Functioning, Disability and Health, including the domains ‘Impairments’, ‘Activity Level Indicators’, ‘Participation’, and ‘Family Measures’. In review 1, 10,154 papers were sifted – 3091 by full text – and data extracted from 184; in total, 131 tools were identified, excluding observational coding, study-specific measures and those not in English. In review 2, 2665 papers were sifted and data concerning measurement properties of 57 (43%) tools were extracted from 128 papers. Evidence for the measurement properties of the reviewed tools was combined with information about their accessibility and presentation. Twelve tools were identified as having the strongest supporting evidence, the majority measuring autism characteristics and problem behaviour. The patchy evidence and limited scope of outcomes measured mean these tools do not constitute a ‘recommended battery’ for use. In particular, there is little evidence that the identified tools would be good at detecting change in intervention studies. The obvious gaps in available outcome measurement include well-being and participation outcomes for children, and family quality-of-life outcomes, domains particularly valued by our informants (young people with ASD and parents). Conclusions: This is the first systematic review of the quality and appropriateness of tools designed to monitor progress and outcomes of young children with ASD. Although it was not possible to recommend fully robust tools at this stage, the review consolidates what is known about the field and will act as a benchmark for future developments. With input from parents and other stakeholders, recommendations are made about priority targets for research. Future work: Priorities include development of a tool to measure child quality of life in ASD, and validation of a potential primary outcome tool for trials of early social communication intervention. Study registration: This study is registered as PROSPERO CRD42012002223. Funding: The National Institute for Health Research Health Technology Assessment programme.

BACKGROUND:Behaviour problems are common in young children with autism spectrum disorder (ASD). There are many different tools used to measure behavior problems but little is known about their validity for the population. OBJECTIVES:To evaluate the measurement properties of behaviour problems tools used in evaluation of intervention or observational research studies with children with ASD up to the age of six years. METHODS:Behaviour measurement tools were identified as part of a larger, two stage, systematic review. First, sixteen major electronic databases, as well as grey literature and research registers were searched, and tools used listed and categorized. Second, using methodological filters, we searched for articles examining the measurement properties of the tools in use with young children with ASD in ERIC, MEDLINE, EMBASE, CINAHL, and PsycINFO. The quality of these papers was then evaluated using the COSMIN checklist. RESULTS:We identified twelve tools which had been used to measure behaviour problems in young children with ASD, and fifteen studies which investigated the measurement properties of six of these tools. There was no evidence available for the remaining six tools. Two questionnaires were found to be the most robust in their measurement properties, the Child Behavior Checklist and the Home Situations Questionnaire-Pervasive Developmental Disorders version. CONCLUSIONS:We found patchy evidence on reliability and validity, for only a few of the tools used to measure behaviour problems in young children with ASD. More systematic research is required on measurement properties of tools for use in this population, in particular to establish responsiveness to change which is essential in measurement of outcomes of intervention. PROSPERO REGISTRATION NUMBER:CRD42012002223.

Abstract Acute iron overdose is an uncommon but life-threatening ingestion that requires basic knowledge of clinical effects to evaluate and manage. This case requires residents to critically think about numerous tests and interventions to manage the case, including required laboratory studies, utility of radiographic studies, decontamination efforts, and antidote administration. Secondary to unfamiliarity with this ingestion, this case offers residents an opportunity to test their knowledge base and critically self-assess their approach to patient care for this ingestion. Included in the resource is the patient information (laboratory, EKG, and radiographic imaging) as well as a PowerPoint presentation.

ABSTRACT This mixed methods study examines whether the rural/urban distribution of credit union/caisse populaire branches differs significantly from the general urban/rural demographic pattern in Canada. It also explores whether their distribution is different from that of banks, looking at the cases of Québec and Atlantic Canada. The study finds a rural tilt among financial cooperatives in Canada, and seven key informants present their views on the results. Their responses are categorized in two main themes: why financial cooperatives are overrepresented in rural and small town areas, and why they are under-represented in urban ones. A discussion follows, and directions for further study are provided. RÉSUMÉ Cette étude utilisant des méthodes combinées examine si la distribution des succursales de coopératives d’épargne et de crédit / caisses populaires en milieu rural et urbain diffère de façon importante de la tendance démographique générale des milieux urbains et ruraux au Canada. Elle aborde aussi la question de savoir si leur distribution est différente de celle des banques en observant le cas du Québec et du Canada atlantique. L’étude révèle une tendance rurale chez les coopératives financières du Canada, et sept répondants clés donnent leur opinion sur les résultats. Les réponses des intervenants sont divisées en deux thèmes principaux : pourquoi les coopératives sont surreprésentées dans les milieux ruraux et les petites villes et pourquoi elles sont sous-représentées dans les milieux urbains. Un débat s’ensuit, et des lignes directrices sont fournies aux fins d’une étude plus approfondie.

Abstract This educational resource provides the information and materials for a high-fidelity simulation case suitable for resident physicians in emergency medicine. This case is currently in use at Wake Forest University in North Carolina and Wright State University in Ohio for emergency medicine residents completing educational time in emergency department simulation programs. This case has been used for the past 3 years and has recently been edited and expanded to its existing form. The resource contains a high-fidelity patient simulation case involving a patient presenting with fatigue and weakness. Evaluation in the emergency department demonstrates bradycardia and worsening hemodynamic status from beta-adrenergic antagonist toxicity. Appropriate treatment with glucagon and vasopressors will allow stabilization of the patient. Debriefing materials are provided to illustrate and stimulate discussion of the important concepts for diagnosing and treating patients with beta-blocker toxicity. This case is currently in use for emergency medicine residents completing required educational time in an emergency medicine simulation program. This scenario has been presented for small groups of three to four participants, and has been field-tested approximately eight times over the past 3 years. All participants have been PGY1, PGY2, and PGY3 emergency medicine residents.

Objectives: We piloted a monitoring mechanism to document police encounters around programs targeting people who inject drugs (PWID), and assessed their demographic predictors at 2 Baltimore, Maryland, needle exchange program (NEP) sites., Methods: In a brief survey, 308 clients quantified, characterized, and sited recent police encounters. Multivariate linear regression determined encounter predictors, and we used geocoordinate maps to illustrate clusters., Results: Within the past 6 months, clients reported a median of 3 stops near NEP sites (interquartile range [IQR] = 0-7.5) and a median of 1 arrest in any location (IQR = 0-2). Three respondents reported police referral to the NEP. Being younger (P = .009), being male (P = .033), and making frequent NEP visits (P = .02) were associated with reported police stops. Among clients reporting arrest or citation for syringe possession, Whites were significantly less likely than non-Whites to report being en route to or from an NEP (P < .001). Reported encounters were clustered around NEPs., Conclusions: Systematic surveillance of structural determinants of health for PWID proved feasible when integrated into service activities. Improved monitoring is critical to informing interventions to align policing with public health, especially among groups subject to disproportionate levels of drug law enforcement.