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Multiple sclerosis in children is characterized by more frequent relapses than in adult patients. Diagnosing and treating youth with multiple sclerosis present a number of challenges including differentiating organic relapses from functional symptoms. However, there is no literature describing coexistence of functionality in pediatric multiple sclerosis. Here, we report 2 cases in which inconsistency between clinical history, physical examination, imaging, and atypical disease progression led to suspicion of functional relapses. The purpose of this study is to raise awareness of functional relapses, as prompt recognition can prevent overtreatment and iatrogenic risks in children and adolescents with multiple sclerosis. Underlying psychiatric issues also need to be addressed.

Este trabalho tem como objetivo apresentar a elaboração de um jogo sério para o ensino de programação orientada a objetos (POO), denominado POOGame. O desenvolvimento do jogo foi baseado em jogos de RPG, de forma que o jogador controla um personagem e a partir de batalhas é possível invocar criaturas e controlar suas açõees utilizando comandos baseado na linguagem JAVA. O jogo foi elaborado e avaliado no contexto da disciplina de Introdução ao Desenvolvimento de Jogos de um curso de Engenharia de Software, seguindo uma metodologia para o desenvolvimento de jogos. Os resultados da avaliação do POOGame indicaram evidências de que o jogo contribui para o aprendizado de POO.

The term psychosis is generally used to describe the abnormal behaviors of children and adolescents with grossly impaired reality testing. This article discusses evaluation of psychotic symptoms in students and psychosocial school interventions for students with psychosis, including the roles of teachers and school administrators. Psychoeducation provided by clinicians and school staff to enhance coping and cognitive strategies is described.

Adolescent substance use is a major public health problem that concerns parents, schools, clinicians, and policy makers. The authors review school-based prevention programs, school drug policies, clinical signs and symptoms of substance impairment, recommendations for referral and engaging adolescents who are using substances, and treatment interventions for adolescent substance use disorders.

Rhenium and Os concentrations and Os isotopic compositions were determined for a suite of previously characterized samples from a traverse across the Platreef at the Sandsloot–Mogolakwena mine of the Northern Limb of the Bushveld complex. The samples comprise five pyroxenites and five “parapyroxenites,” contact rocks representing variable mixtures of calc–silicate country rocks and magmatic rocks. The isotopic data from the pyroxenites define a Re–Os regression line with an age (2011 ± 51 Ma) that agrees within uncertainty with the accepted age for the Bushveld complex, whereas the parapyroxenite data scatter about this trend. The initial 187Os/188Os ratios of the pyroxenites (0.1820–0.1848) are similar to, but slightly more radiogenic than, previously published values for the Merensky Reef. Our preferred interpretation is that this section of the Platreef formed from a well mixed, crustally contaminated magma, genetically related to that which gave rise to the Merensky Reef. The Platreef parental magma may also have experienced minor additional contamination by wall rock interaction during emplacement.

Background: Suture button fixation of syndesmotic injury is growing in popularity, as it has been shown to provide adequate stability in a more cost-effective manner than screw fixation while allowing more physiologic distal tibiofibular joint motion. However, the optimal repair technique and implant orientation have yet to be determined. Purpose/Hypothesis: The purpose of this study was to biomechanically compare 3 suture button construct configurations/orientations for syndesmosis fixation: single, parallel, and divergent. The authors hypothesized that all 3 methods would provide adequate stabilization but that the divergent technique would be the most stable. Study Design: Controlled laboratory study. Methods: The fixation strengths of 3 stabilization techniques with suture button devices were compared with 10 cadaveric legs each (N = 30). Ankle motion under cyclic loading was measured in multiple planes: first in the intact state, then following simulated syndesmosis injury, and then following fixation with 1 of 3 randomly assigned constructs—1 suture button, 2 suture buttons in parallel, and 2 divergent suture buttons. Finally, axial loading with external rotation was applied to failure. Results: All syndesmotic fixation methods provided stability to the torn state. There was no statistically significant difference among the 3 fixation techniques in biomechanical stability. Failure most commonly occurred through fibular fracture at supraphysiologic loads. Conclusion: Suture button implant fixation for syndesmotic injury appears to provide stability to the torn syndesmosis, and the configuration of the fixation does not appear to affect the strength or security of the stabilization. Clinical Relevance: This study provides further insight into the biomechanics and optimal configuration of suture button fixation of the torn syndesmosis. Based on these results, the addition of a second suture button may not significantly contribute to immediate postoperative stability.

To combat the rise in internet-based crime, computer security warnings must be optimized to improve user compliance. Past research has shown various methods for improving warning efficiency but little research has examined the effectiveness of these methods on computer-based warnings. At present, a subset of the data from a proposed factorial design has been collected from seventy participants who encountered one of two computerized warnings: a control warning similar to these that are currently in use or an experimental warning that contained a number of physical and content improvements. The techniques used to improve the design of the experimental warning included color, borders, symbols, improved message clarity, the addition of a warning source and warning personalization. Compliance rates and reaction time responses were collected for each of the two warnings. Preliminary results indicated that the warning improvement increased compliance, though not at a statistically significant level. Potential directions for computer security software design, user training, and future research are discussed.

Embodiments are provided to create a virtual application or suite of virtual applications. In an embodiment, a system is configured to create a virtual package which includes information that can be used in a hosted virtual application environment. The system can provide bits of a virtual package based in part on user demand for an application or certain application functionality. In one embodiment, a system includes a sequencer component which can create a virtual package which includes information associated with setup-time and run-time changes made to a computing device. The sequencer component can use a number of extensible markup language (XML) files to create the virtual package. Other embodiments are available.

The use of industrial and agricultural waste substitutions for Portland cement has greatly contributed to sustainable development practices. The increase in cement demand will be met by the use of supplementary cementing materials, in order to minimize the clinker consumption. In this study, the effects of silica extracted from rice husk (SRH) as a partial replacement of cement in concretes with low water/binder are reported. The properties investigated include compressive strength, splitting tensile strength, water absorption by immersion, water absorption by capillarity and resistance to chloride ion penetration. The research indicates that SRH is an effective mineral addition for designing durable concrete presenting an optimal performance when the replacement ratio of Portland cement is around 10%El uso de desechos industriales y agrícolas como segmento en la producción de cemento Portland ha contribuido de manera importante en la práctica de desarrollo sustentable. El aumento en la demanda de cemento coincide con el uso de materiales aglomerantes suplementarios para minimizar el consumo de clinker. En este estudio, se informan los efectos de la sustitución parcial de cemento Portland por sílice extraído de la cascara de arroz (SRH) en hormigones con baja relación agua/materiales cementicios. Las propiedades investigadas incluyen resistencia a la compresión, resistencia a la tracción, absorción de agua por inmersión, absorción de agua por capilaridad y resistencia a la penetración de iones de cloruro. La investigación indica que SRH es una adición mineral eficaz para el diseño de hormigones durables que presenta una actuación óptima cuando la proporción del reemplazo de cemento de Portland está alrededor de 10%

Synthetic speech is a technology that can be utilized to convey information and aid people in their tasks. Older adults in particular are a population that may be able to benefit from synthetic speech, and they are a population that has been investigated in a limited capacity. The current researchers intended to elucidate lingering conflicts in previous research on the intelligibility and recall of word and stories in synthetic speech for older and younger adults and how that compared to similar conditions in natural speech. Twenty-four older and 24 younger adults completed intelligibility and recall tasks with word lists and stories. Results indicated that older adults had a more difficult time with all speech, natural speech was easier to understand and remember than synthetic speech, and stories were easier to recall than words. Results also indicated that older adults had a more difficult time understanding synthetic words as compared to natural words than younger adults. In addition, older adults improved differentially with the recall of stories as opposed to words when compared to the younger adult group. Potential directions for synthetic speech software design and future research are discussed.

Tujuan dilakukannya penelitian ini adalah untuk mengetahui bagaimana Undang-Undang Nomor 11 Tahun 2012 mengatur tentang Sistem Peradilan Pidana Anak dan bagaimana pertanggungjawaban pidana anak dalam sistem peradilan pidana anak di Indonesia. Denagn menggunakan metode penelitian yuridis normative, maka dapat disimpulkan: 1. Bahwa dengan adanya Sistem Peradilan Pidana Anak yang menginginkan adanya kemajuan secara praktis dalam rangka perlindungan sebaik-baiknya kepada anak yang dipandang sebagai aset berharga suatu bangsa dan negara di masa mendatang yang harus dijaga dan dilindungi hak-haknya. Perlindungan hukum bagi anak dapat diartikan sebagai upaya perlindungan hukum terhadap berbagai kebebasan dan hak asasi anak serta berbagai kepentingan yang berhubungan dengan kesejahteraan anak.2. Bahwa pertanggungjawaban pidana anak di bawah umur yang berkonflik dengan hukum adalah sesuai dengan ketentuan yang sudah diatur dalam KUHP dan Undang-Undang No. 11 Tahun 2012 tentang Sistem Peradilan Pidana Anak. Anak yang melakukan tindak pidana tetap dapat dimintakan pertanggungjawabannya, ancaman pidana bagi anak yang melakukan suatu perbuatan yang melawan hukum ditentukan oleh Kitab Undang-undang Hukum Pidana, dimana penjatuhan pidananya ditentukan setengah dari maksimal ancaman pidana dari orang dewasa, sedangkan penjatuhan pidana seumur hidup dan pidana mati tidak diberlakukan terhadap anak. Kata kunci: Anak, Peradilan Pidana

The origin of supernumerary (B) chromosomes is still a de- bated topic, with intra- and interspecific origins being the most plausible options. In the bee Partamona helleri, a se- quence-characterized amplified region (SCAR) marker being specific to B chromosomes suggested the possibility of inter- specific origin. Here, we search for this marker in 3 close rela- tive species and perform DNA sequence comparison be- tween species. The SCAR sequence does not show homolo- gy with other sequences in the databases, but does contain an open reading frame with sequence homology with a re- verse transcriptase. Dot-blot hybridization using the SCAR marker as a probe confirmed that it is present in B-carrying, but not B-lacking larvae of P. helleri, and indicated its pres- ence in adult individuals of P. cupira and P. criptica. Addition- ally, PCR amplification of the SCAR marker was successful on genomic DNA obtained from P. helleri and P. rustica larvae carrying B chromosomes, and on genomic DNA obtained from adult individuals of P. cupira, P. criptica and P. rustica. Finally, a comparison of the DNA sequence of the SCAR markers amplified from these 4 species showed very few nu- cleotide differences between the species. The complete as- sociation between B chromosome and SCAR presence and the scarce divergence observed for this DNA sequence be- tween the 4 species analyzed suggest the possibility that this B chromosome has recently been transferred between spe- cies through several episodes of interspecific hybridization.

Objective: Urinary tract infection diagnosis by urine culture can be time- and labor- consuming. In the National Kidney and Transplant Institute, up to 75% of urine culture samples sent to the laboratory yield no growth or insignificant growth. A rapid and reliable screening method to rule out bacterial UTI could reduce culture workload, turnaround time of negative results and also unnecessary antibiotic prescription. Sysmex UF-1000i is urine flow cytometry analyzer which is capable of quantifying urine particles including bacteria and leukocytes. We evaluated the UF-1000i performance for ruling out UTIs and its bacterial scattergram feature to estimate the causative bacterial group, using standard urine culture results as reference method. Methods: 293 urine samples were analyzed using Sysmex UF-1000i analyzer and compared with urine culture results. Bacterial cluster distribution in the bacterial scattergram of positive cultures was also analyzed for causative bacterial class estimation. Results: Out of 293 urine samples, 104 (35.5%) samples had bacterial growth of more than 103 CFU/ml on culture and most common organism isolated was Escherichia coli (28.8%). The optimum bacterial cut off value of 55/μl and/or leukocytes cut-off value of 27/μl were observed using ROC analysis to rule out UTI. The bacterial scattergram analysis showed 82.7% concordance with the results of the urine culture, with only 5.8% discordant results, and 11.5% had results showing non-specific or wide distribution patterns near the 30° angle. Conclusions: Urine samples can be routinely screened for UTI using the Sysmex UF-1000i, and this can improve the overall turnaround time of negative results and reduce laboratory culture workload

Joe is a 12-year-old boy living in a Boston suburb with his mother, the younger of his two brothers (the older being a half-brother), his mother’s boyfriend, and the boyfriend’s son. He has been in treatment at a Boston hospital since the age of 6 years, receiving both medications and therapy for bipolar disorder and separation anxiety disorder. He has been tried on different medications and has experienced significant side effects (namely, weight gain and other metabolic problems). In July 2005, between fifth and six grades, he was transferred to his current psychiatrist, FTM (a PGY-4 resident), for psychotherapy and medication management. At the time of this report (spring 2006), Joe is a sixthgrade student who has been in some form of psychiatric treatment since the age of 3 years. His mother reports that he was doing well until that time, when his younger brother was born. Joe was first referred for psychiatric treatment when his mother found him “jumping on the head of his younger newborn brother.” The patient was referred for play therapy at a community mental health center, where he received therapy for a couple of years. After starting in kindergarten, he began to have outbursts at school and was re

Computer users are faced with seemingly minor security decisions on a daily basis. While much is known about decision-making in general, less is known about decision-making in the context of computer security. In the current experiment, 56 relatively knowledgeable computer users completed a decision-making task that included 24 scenarios which varied in terms of decision domain (computer vs. non-computer), risk (high vs. low), and gain-to-loss ratio (high gains/low losses, equal gains/losses, low gains/high losses). Results indicated that there was no difference between computer and non-computer decisions when risk and gain-to-loss ratio were held constant. However, these decision factors did interact to differentially influence decisions within each of these domains. Perception of risk greatly impacted computer decisions whereas the gain-to-loss ratio seemed to have a larger influence on the non-computer decisions. Potential directions for computer security software design, user training, and future research are discussed.

OBJECTIVE. Recently, a US Food and Drug Administration advisory committee raised concerns about cardiovascular risks and sudden death in children and adolescents with attention-deficit/hyperactivity disorder who are receiving stimulants. METHODS. We comment on the risk of sudden death in children/adolescents taking stimulants compared with population rates, biological plausibility, and known cardiovascular effects of stimulants to determine specific risk. RESULTS. There does not seem to be higher risk of sudden death in stimulant-treated individuals compared with the general population. Although there is evidence of biological plausibility, the known effects of the stimulants on cardiovascular electrophysiology and vital signs seem to be benign. CONCLUSIONS. There does not seem to be compelling findings of a medication-specific risk necessitating changes in our stimulant treatment of children and adolescents with attention-deficit/hyperactivity disorder. The use of existing guidelines on the use of stimulants (and psychotropic agents) may identify children, adolescents, and adults who are vulnerable to sudden death.

CASE: Tessa is a 7-year-old girl with odd behaviors, worsening over the preceding year. She spends a significant amount of time alone in her room, talking to “Richard.” Her father observed that Tessa is “in her own world.” In school, she often glares at the teacher and refuses to work. She is alone at recess without any real friends. Her father reports that she eats little and only after he tastes the food. She is increasingly cruel to both real and toy animals. She tied a string around her cat's neck and swung it around, saying she wanted to punish it. She was heard to say to her stuffed cat, “Die, b … .; die.” Richard told her to do this and other “bad” things. CASE: Tessa has not had chronic health problems or developmental concerns. During the first 18 months of life, her height was between the 5th and 10th percentiles; it declined to below the 3rd percentile over the past 2 years. Weight has been consistently between the 3rd and 5th percentiles. Tessa's parents both have been diagnosed with schizophrenia. There are at least 7 first- and second-degree relatives with the same diagnosis. CASE: Both parents cared for Tessa for 4 years with a lot of support. Then, her father left the home, but he was in contact with her while managing his own illness. When the mother's illness and compliance worsened, Tessa was removed for neglect at 5 ½ years old. Two foster homes preceded Dad's award of sole custody 13 months ago. Mother's weekly visitations are quite upsetting to Tessa. CASE: Tessa is a verbal, solemn, small, well-dressed girl with no physical abnormalities. She talks with advanced vocabulary and syntax, with normal prosody and good conversational skills. She says Richard is a bad boy who gets her into trouble at school. She equivocates when asked if he is real or imagined or if others can see him. She says that she misses her mother.

Although Major Depressive Disorder (MDD) in children and adolescents is acommon and serious illness, associated with increased risk for suicide, weighingthe benefits and risks of treatment with antidepressant medications remainschallenging. Our best estimates are that between 5%Ð10% of children will sufferfrom depression before they reach adulthoo d; worse, almost one in 5 teenagersthink about suicide, and approximately one in 11 make a suicide attempt duringtheir adolescence. Data supporting the use of antidepressant medications in pe-diatric populations is conflicting, with many positive clinical observations, yetwith limited evidence of efficacy of antidepressants for the treatment of depres-sion in the pediatric population in clinical trials. Therefore, primum non nocereassumes even greater importance. Use of antidepressants in juveniles withoutrecognition of risks associated with their use, and without developmentally sen -sitive monitoring, could contribute to adverse outcomes. Y etoverstating the riskof antidepressants could result in overly conservative medication use, poten -tially leaving a devastating illness under or untreated. Indeed, prescribing of an -tidepressants has decreased since alarm emerged about a possible link betweenthe SSRIs and suicidality (see McNamera ,2006), with concerns emerging aboutthe suicide rate going back up in young people as detection and treatmentdecrease.The US Food and Drug Administration (FD A) andAntidepressant T rials in Children and AdolescentsDue to insufficient clinical trials demonstrating safety and efficacy ,m ost psycho -active agents lack FDA approval for use in pediatric patients. FDA indicationsoccur only when pharmaceutical companies elect to undertake studies in chil -dren, and then to submit an application for a pediatric indication. Patients oftenmistakenly believe that all medications are evaluated by the FDA to determinetheir safety and efficacy in children. Pharmaceutical companies have historicallypursued trials in the much larger adult market (ages 18Ð65), w h ere in form edcon sen tan d exposure to lon gterm risksorsequelae islessproblem atic.S o ch ild

This article reviews data on the safety, tolerability, and efficacy of the extended-delivery stimulant preparations and atomoxetine, including nine methylphenidate formulations, five amphetamine formulations, and one norepinephrine reuptake inhibitor, now indicated for treatment of attention-deficit hyperactivity disorder (ADHD). Six of the nine methylphenidate formulations, three of the five compounds, and the norepinephrine reuptake inhibitor are long-acting, potentially once-daily agents. Data on treatment of common adverse events are described, and data on investigational treatments of ADHD are reviewed.

Few studies exist on pharmacological interventions for adolescents with substance use disorders (SUD). To this end, we evaluated the response of bupropion hydrochloride sustained release (SR) in SUD adolescents with comorbid psychopathology (both attention-deficit/ hyperactivity disorder (ADHD) and a mood disorder).Fourteen adolescent outpatients were treated naturalistically and followed openly for 6 months. Adolescents were rated using the Drug Use Screening Inventory--Revised (DUSI-R), ADHD Symptom Checklist, and the Hamilton Rating Scale for Depression (HAM-D). Clinical Global Impression (CGI) Scale scores were obtained for Substance Abuse, ADHD, Anxiety, and Depression. The ratings were completed at baseline, at month 3, and at the 6-month endpoint. Bupropion SR was initiated at 100 mg once-daily and titrated naturalistically to a maximum dose of 400 mg/day.Of the 14 subjects followed, 13 subjects completed 6 months of treatment. At the 6- month endpoint compared to baseline, treatment with bupropion was associated with clinical and significant reductions in DUSI scores (-39%; p0.05), ADHD symptom checklist (-43%; p0.001), HAM-D (-76%; por = 0.001); and reductions in the CGIs for ADHD (por = 0.001), depression (por = 0.001), and substance abuse (p0.05). The mean daily dose of bupropion SR was 315 mg (in divided doses). No significant adverse events were noted during the follow-up period.These naturalistic data suggest that bupropion is well tolerated and may be an effective medication for the treatment of substance abusing adolescents with comorbid mood disorders and ADHD.

Depression occurs in children and adolescents, although it may appear differently in younger patients. Research suggests juvenile depression may respond to psychotherapy and to pharmacologic agents, and that antidepressants remain a valuable treatment for juveniles with depression. Diagnostic considerations in juveniles with mood symptoms are discussed. A brief overview is provided of the evidence supporting psychotherapy for juveniles with depression. Controlled antidepressant trials in juveniles with depression provide some support for the use of some selective serotonin reuptake inhibitors and little support for atypical antidepressants, tricyclic antidepressants, or monoamine oxidase inhibitors. Evidence from suicide rates over time, autopsy findings among juvenile suicides, and impacts of antidepressant prescribing trends are related to the current controversy over suicidality and antidepressant use in juvenile patients. Based on this evidence, practical guidelines for treatment of juvenile depression are provided.