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To compare the nature and prevalence of use of procedures employed to treat and manage challenging behaviours across two approaches to providing community-based supported accommodation for people with intellectual disabilities (ID) and severe challenging behaviour: noncongregate settings where the minority of residents have challenging behaviour, and congregate settings where the majority of residents have challenging behaviour. Community-based supported accommodation for people with ID and challenging behaviour. Main outcome measures the nature and prevalence of use of procedures employed to treat and manage challenging behaviours, observed and reported severity of challenging behaviours. Both types of settings were associated with low prevalence of use of behavioural technologies for the reduction of challenging behaviour (less than 15% of participants). In contrast, high proportions of participant received antipsychotic medication in both noncongregate (56%) and congregate (80%) settings. Congregate settings were associated with the increased use of physical restraint as a reactive management strategy, with over half of participants being in receipt of physical restraint by two or more members of staff. Changes in reported and observed challenging behaviour over a 10-month period were slight. The use of evidence-based behavioural technologies for the reduction of challenging behaviour may have led to better outcomes.

We report on the preparation of Ga/Al nanoalloys embedded glass-ceramic by heat treatment as well as femtosecond laser irradiation. The Ga/Al nanoalloys embedded glass-ceramic exhibits intense extinction in the visible region, as well as superior optical nonlinearities. The third-order nonlinear optical properties of the glass-ceramics were investigated by employing Z-scan technique. The maximum nonlinear extinction coefficient β and nonlinear refraction γ value reached 1.14 × 10−11 m/W and 2.01 × 10−17 m2/W, respectively. Three-dimensional Ga/Al nanoalloys embedded structures were also achieved in glass by scanning the focused femtosecond laser beam. These results may find applications for the fabrication of ultrafast optical switches and diffractive optical elements. [ABSTRACT FROM AUTHOR]

The article presents information on the Pressure Ulcer Programme of Research (PURPOSE) for the pressure ulcer patients (PU) in Great Britain. It is mentioned that the program has been started by more than 40 National Health Services (NHS) of the country for the early identification of the PU patients and capturing health related quality of life (HRQoL) in clinical trials. It further mentions the programme's two themes including risk assessment and patient reported outcomes.

The article examines some qualitative data from the second phase semi-structured interviews conducted with 92 adult social care practitioners from 23 local authority social service departments in Great Britain. Protection rights and confusion about the type of information that could be shared legally between agencies were the barrier identified. According to most respondents, greater involvement and empowerment of service users in the adult protection process is one way of enhancing the system .

Background: Photon counting detector (PCD) CT benefits from reduced noise compared with conventional energy-integrating detector (EID) CT, which should translate to improved image quality and reduced radiation exposure for pediatric patients undergoing chest CT with IV contrast., Objective: To determine the differences in radiation exposure and image quality of PCD CT and EID CT in pediatric chest CT with intravenous (IV) contrast., Materials and Methods: In this institutional review board-approved retrospective observational study, 20 scan pairs (20 PCD CT; 20 EID CT) for children who underwent chest CT with IV contrast on both a PCD CT (Siemens NAEOTOM Alpha) and an EID CT (Siemens SOMATOM Definition Edge or Force) within 12 months were reviewed independently by three pediatric radiologists for three subjective quality features on 5-point Likert scales: overall quality, small structure delineation, and motion artifact. Objective measures of image quality (image noise, signal-to-noise ratio, and contrast-to-noise ratio) were assessed by a single radiologist in several locations in the chest through region of interest measurement of Hounsfield units (HU) and standard deviation. Patient-related and radiation exposure parameters were collected for each scan and summarized with median and interquartile range (IQR). The Wilcoxon rank-sum test was utilized to compare groups. A P < 0.05 indicated statistical significance. Inter-observer agreement of subjective image quality metrics was analyzed using weighted kappa., Results: Age (14.2 years vs 13.8 years, P= 0.15), height (P= 0.13), weight (P= 0.21), and BMI (P = 0.24) did not significantly differ between groups. There were 10 male and 3 female patients. Compared to EID CT, PCD CT showed lower radiation exposure parameters including volumetric CT dose index, 1.7 mGy (IQR 1.1-2.4 mGy) vs 3.8 mGy (IQR 2.0-4.7 mGy) (P< 0.01), and size-specific dose estimate, 2.6 mGy (IQR 1.8-3.1 mGy) vs 5.0 mGy (IQR 3.3-6.2 mGy) (P< 0.01). Objective image quality of lung parenchyma was improved on the PCD CT scanner, including image noise 119.5 HU (IQR 95.4-135.7 HU) vs 143.1 HU (IQR 125.4-169.8 HU) (P < 0.01), signal-to-noise ratio (SNR) -6.1 (IQR -8.4 to -4.8) vs -4.9 (IQR -5.6 to -3.8) (P= 0.01), and contrast-to-noise ratio -63.9 (-84.1 to -57.5) vs -60.5 (-76.3 to -52.5) (P = 0.01). Motion artifact was improved on the PCD CT scanner (P< 0.01). No significant differences in overall image quality or small structure delineation were identified (P= 0.06 and P= 0.31)., Conclusion: PCD CT pediatric chest CT had significantly reduced radiation exposure, improved image quality, and reduced motion artifact compared with EID CT., Competing Interests: Declarations. Competing interests: Single author received speaker honorarium from Siemens Healthineers. This author, Dr Bari Dane, helped create the data collection instrument and prepare the manuscript. She was not otherwise involved in data collection, data handling or data analysis., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To assess the MRI features of growth plate injury at the base of the coracoid process., Materials and Methods: Subjects were identified through retrospective search of our department imaging database and teaching files and the teaching files of two outside academic institutions. The coracoid base growth plate was examined with attention to widening, irregularity, abnormal signal intensity of the growth plate, and the presence of adjacent soft tissue edema. The apposing coracoid and scapular bony surfaces were examined for signal intensity and morphology., Results: Shoulder MRIs in eight patients with coracoid base growth plate disturbances were retrospectively reviewed (7 males, 1 female, mean age 15 years). Growth plate injury manifested as widening, irregularity and increased signal, apposing bony marrow edema and hypertrophy, and surrounding soft tissue edema. Five subjects were athletes (football, archery, basketball, swimming, rugby), two had a history of neuromuscular disorders, and one subject presented after a fall. Clinical indications included: rule out labral tear (n = 3), rule out rotator cuff tear or fracture after fall (n = 1), nonspecific pain (n = 1), shoulder subluxation, rule out glenoid pathology (n = 1, patient with underlying neuromuscular disorder), muscular dystrophy with shoulder pain (n = 1), and impingement (n = 1). Coracoid growth plate injury was not suspected clinically in any of the patients., Conclusion: Awareness of the imaging appearance of coracoid base growth plate injury can aid in a more accurate diagnosis of shoulder MRI studies in young pediatric athletes. While uncommon, coracoid growth plate injury should be considered when assessing children with shoulder symptomatology.

Background: More people than ever receive care and support from health and social care services. Initiatives to integrate the work of health and social care staff have increased rapidly across the UK but relatively little has been done to chart and improve their impact on service users. Our aim was to develop a framework for gathering and using service user feedback to improve integrated health and social care in one locality in the North of England., Methods: We used published literature and interviews with health and social care managers to determine the expected service user experiences of local community-based integrated teams and the ways in which team members were expected to work together. We used the results to devise qualitative data collection and analysis tools for gathering and analyzing service user feedback. We used developmental evaluation and service improvement methodologies to devise a procedure for developing service improvement plans., Findings: We identified six expected service user experiences of integrated care and 15 activities that health and social care teams were expected to undertake. We used these to develop logic models and tools for collecting and analysing service user experiences. These include a narrative interview schedule, a plan for analyzing data, and a method for synthesizing the results into a composite 'story'. We devised a structured service improvement procedure which involves teams of health and social care staff listening to a composite service user story, identifying how their actions as a team may have contributed to the story and developing a service improvement plan., Conclusions: This framework aims to put service user experiences at the heart of efforts to improve integration. It has been developed in collaboration with National Health Service (NHS) and Social Care managers. We expect it to be useful for evaluating and improving integrated care initiatives elsewhere.

Background: Rapid and accurate diagnosis of appendicitis, particularly with respect to the presence or absence of perforation, is essential in guiding appropriate management. Although many studies have explored sonographic findings associated with acute appendicitis, few investigations discuss specific signs that can reliably differentiate perforated appendicitis from acute appendicitis prior to abscess formation., Objective: The purpose of our study was to identify sonographic findings that improve the specificity of US in the diagnosis of perforated appendicitis. Our assessment of hepatic periportal echogenicity, detailed analysis of intraperitoneal fluid, and formulation of select constellations of sonographic findings expands upon the literature addressing this important diagnostic challenge., Materials and Methods: We retrospectively reviewed 116 abdominal US examinations for evaluation of abdominal pain in children ages 2 to 18 years from January 2008 to September 2011 at a university hospital pediatric radiology department. The study group consisted of surgical and pathology proven acute appendicitis (n = 51) and perforated appendicitis (n = 22) US exams. US exams without a sonographic diagnosis of appendicitis (n = 43) confirmed by follow-up verbal communication were included in the study population as the control group. After de-identification, the US exams were independently reviewed on a PACS workstation by four pediatric radiologists blinded to diagnosis and all clinical information. We recorded the presence of normal or abnormal appendix, appendicolith, appendiceal wall vascularity, thick-walled bowel, dilated bowel, right lower quadrant (RLQ) echogenic fat, increased hepatic periportal echogenicity, bladder debris and abscess or loculated fluid. We also recorded the characteristics of intraperitoneal fluid, indicating the relative quantity (number of abdominal regions) and quality of the fluid (simple fluid or complex fluid). We used logistic regression for correlated data to evaluate the association of diagnosis with the presence versus absence of each US finding. We conducted multivariable analysis to identify constellations of sonographic findings that were predictive of perforated appendicitis., Results: The individual US findings of abscess/loculated fluid, appendicolith, dilated bowel and increased hepatic periportal echogenicity were significantly associated with perforated appendicitis when compared with acute appendicitis (P < 0.01). The sonographic observation of increased hepatic periportal echogenicity demonstrated a statistically significant association with perforated appendicitis compared with acute appendicitis (P < 0.01). The presence of complex fluid yielded a specificity of 87.7% for perforated appendicitis compared with the acute appendicitis group. The US findings of ≥2 regions or ≥3 regions with fluid had specificity of 87.3% and 99.0%, respectively, for perforated appendicitis compared with the acute appendicitis group. Select combinations of sonographic findings yielded high specificity in the diagnosis of perforated appendicitis compared with acute appendicitis. These constellations yielded higher specificity than that of each individual finding in isolation. The constellation of dilated bowel, RLQ echogenic fat, and complex fluid had the highest specificity (99.5%) for perforated appendicitis (P < 0.01)., Conclusion: Our study demonstrates that identification of select constellations of findings using abdominal sonography, in addition to focused US examination of the right lower quadrant, can improve sonographic diagnosis of perforated appendicitis in the pediatric population.

Objectives: This study focuses on the ways in which the organisational context can influence the development of severe pressure ulcers. Severe pressure ulcers are important indicators of failures in the organisation and delivery of treatment and care. We have a good understanding of patients' risk factors, but a poor understanding of the role played by the organisational context in their development., Setting: The study was undertaken in six sites in Yorkshire, England. The settings were sampled in order to maximise diversity, and included patients' own homes, acute hospital medical and surgical wards, a community hospital and a nursing home during a period of respite care., Participants: Data were collected about eight individuals who developed severe pressure ulcers, using a retrospective case study design. The data sources included interviews with individuals with severe pressure ulcers, and with staff who had treated and cared for them, and clinical notes., Results: 4 accounts indicated that specific actions by clinicians contributed to the development of severe pressure ulcers. Seven of the 8 accounts indicated that they developed in organisational contexts where (1) clinicians failed to listen and respond to the patients' or carers' observations about their risks or the quality of their treatment and care, (2) clinicians failed to recognise and respond to clear signs that a patient had a pressure ulcer or was at risk of developing one and (3) services were not effectively coordinated., Conclusions: Patient accounts could only be partially explained in terms of specific events or sequences of events. The findings support the conclusion that there was general acceptance of suboptimal clinical practices in 7 of the 8 contexts where patients developed severe pressure ulcers.

Background: Shielding of the gonads is a dose-saving strategy in pediatric radiography and its use is the law in New York and the majority of other states. However, routine use of gonadal shields is controversial because of concerns that important diagnostic information can be obscured., Objective: The purpose of this study was to assess the frequency and spatial distribution of key findings on portable neonatal abdominal radiographs., Materials and Methods: We reviewed the 2,544 portable neonatal intensive care unit anteroposterior abdominal radiographs performed in 2010 at a university medical center, of which 962 were inadequately shielded. These 962 radiographs were reviewed by pairs of pediatric radiologists for the presence of findings in different regions, including bowel abnormalities, pneumatosis, free air, inguinal hernias, osseous abnormalities, and catheter/tube tips., Results: The fewest pertinent findings were present below the level of the sacrosciatic notches (n = 181, 18.8%). Of the 853 abnormalities below the level of the iliac crests in our cohort, six were isolated to these regions, whereas others had concomitant abnormalities more superiorly. Of 35 radiographs with pneumatosis or suspected pneumatosis in the pelvis, 33 had pneumatosis in more superior regions. Suspected free air was never isolated to the pelvis. Osseous abnormalities were only present in the pelvis below the sacrosciatic notch, and 37.5% of lower extremity catheters terminated below the level of the sacrosciatic notches., Conclusion: Pertinent findings on neonatal intensive care unit abdominal radiographs are rarely isolated to the pelvic regions.

Struma ovarii is rare ovarian tumor that is characterized by the presence of at least 50% thyroid tissue on histologic examination. This usually benign neoplasm is predominantly found in women between the ages of 40 and 60 years and infrequently in the pediatric age group. In the foregoing report, we present an unusual case of a large struma ovarii in a 16-year-old adolescent girl with abdominal pain and increasing abdominal girth. Removal of the mass was achieved via a laparoscopic approach. We conclude that the diagnosis of struma ovarii should be considered in adolescent girls presenting with large cystic ovarian masses and that a laparoscopic approach to management is the treatment of choice.

Background: The arterial vascularity of the hip has been investigated in normal infants using duplex Doppler sonography. This study addressed the differences in hip vascularity in infants with respect to gender and acetabular morphology., Objective: To determine whether there is a relationship between the resistive index of the vessels of the femoral chondroepiphysis and the alpha angle in normal infant hips and in those with developmental dysplasia of the hip., Materials and Methods: We studied 76 hips (38 patients) with gray-scale and power Doppler US. The patients were referred because of a possible abnormal clinical hip examination or had risk factors for developmental dysplasia of the hip. The infants ranged in age from 1 day to 6 weeks. There were 13 boys and 25 girls. Gray-scale images were initially performed in the coronal and transverse planes to evaluate acetabular morphology, alpha angle and position of the femoral chondroepiphysis relative to the acetabulum. The hips were then examined with power Doppler US, in both sagittal and transverse planes, to identify arterial vessels within the femoral epiphysis. Resistive indices were then recorded from the spectral analysis in each vessel identified. Each examination was performed by one of five pediatric radiologists. Mixed model regression was used to assess the relationship between resistive index and alpha angle, age and gender., Results: Of the 76 hips, 34 had an alpha angle of 60 degrees or greater and were classified as normal, 26 had an alpha angle between 50 degrees and 59 degrees and were classified as immature, and 13 had an alpha angle of less than 50 degrees and were either subluxed or dislocated at the time of examination. At least two vessels were documented in each femoral epiphysis except in three hips, in which no vessels could be documented because of technical factors. There was a statistically significant linear relationship between the alpha angle and resistive index, such that the resistive index tended to rise with increasing alpha angle (P=0.0022). In addition, female infants had a significantly higher average resistive index than the average resistive index in male infants with the same alpha angle (P=0.0005)., Conclusion: There is a direct linear relationship between alpha angle and resistive index in the infant hip. Female infants have a higher average resistive index than male infants. We believe that these results might serve as a model for predicting an infant hip at risk of ischemia. In addition, the fact that lower resistive indices of the femoral epiphysis are associated with acetabular dysplasia might help explain the documented low incidence of avascular necrosis in untreated hip dysplasia.

Background: A number of authors have described, with disparate results, the prevalence of people with intellectual disability and their characteristics, in a range of offender cohorts defined by service use. These have included high security, a range of criminal justice services and community services. There is a need for research comparing cohorts of offenders with intellectual disabilities across different settings. AIM AND HYPOTHESIS: To conduct such a comparison and test the hypothesis that severity of characteristics measured will be highest in highest levels of residential security., Method: A clinical-record-based comparison a offenders with intellectual disability in high security (n = 73), medium/low security (n = 70), and a community service (n = 69)., Results: Groups were similar in age and tested IQ levels. Early psychiatric service contact had been more likely in the lower security groups. In line with the hypothesis, more complex presentations, in particular comorbid personality disorder, was more likely in the highest security group. Both fatal and non-fatal interpersonal violence convictions were significantly related to group, with more in the high security group sustaining a conviction both at the index offence and prior to that. Over 50% of all groups had at least one conviction for a sexual offence. A regression model accounting for 78% of the variance was made up largely of disposal variables (Mental Health Act status and probation) and indications of antisocial traits (criminal damage, lifetime conviction for murder and ICD-10 personality disorder classification)., Conclusions and Implications for Practice: The authors show that context of sampling affects most relationships between intellectual disability (ID) and offending when the methods for measuring ID are held constant. The results also present several questions on the relationship between risk, services available in an area and referral to higher security.

We present an infant with macrocrania, who initially demonstrated prominent extra-axial fluid collections on sonography of the brain, compatible with benign infantile hydrocephalus (BIH). Because of increasing macrocrania, a follow-up sonogram of the brain was performed; it revealed progressive enlargement of the extra-axial spaces, which now had echogenic debris. Color Doppler US showed bridging veins traversing these extra-axial spaces, so it was initially thought that these spaces were subarachnoid in nature (positive cortical vein sign). However, an arachnoid membrane was identified superior to the cortex, and there was compression of true cortical vessels beneath this dural membrane. An MRI of the brain showed the extra-axial spaces to represent bilateral subdural hematomas. The pathogenesis of spontaneous development of the subdural hematomas, in the setting of BIH, is discussed. We also emphasize that visualizing traversing bridging veins through extra-axial spaces does not necessarily imply that these spaces are subarachnoid in origin.

Metanephric adenoma (MA) is a renal tumor that is rarely found in children. We present a case of MA that was incidentally discovered in an 8-year-old child on computed tomography. We also review the literature regarding this lesion in the pediatric population. There are certain imaging features of MA that may suggest the diagnosis preoperatively. Metanephric adenoma is often hyperechoic on sonography, hyperdense on noncontrast computed tomography scans, and of low signal intensity on T1- and T2-weighted magnetic resonance images. Nephron sparring surgery has been performed in several cases. However, the distinction of MA from other metanephric lesions as well as from Wilms' tumor and papillary renal cell carcinoma may not be readily apparent at the time of surgery.

A longitudinal matched-groups design was used to examine the quality and costs of community-based residential supports to people with mental retardation and challenging behavior. Two forms of provision were investigated: noncongregate settings, where the minority of residents had challenging behavior, and congregate settings, where the majority of residents had challenging behavior. Data were collected for 25 people in each setting. We collected information through interviewing service personnel in each type of setting on the costs of service provision, the nature of support provided, and the quality of life of residents. We also conducted observations in each setting. Results suggest that noncongregate residential supports may be more cost effective than congregate residential supports.

Hepatic hematomas in newborn infants are not frequently detected clinically, but are often found at perinatal autopsies. These hematomas of the liver are usually subcapsular in location. A variety of etiologies for such hematomas has been implicated, such as trauma, sepsis, and coagulopathies. We present a neonate who presented with jaundice and abdominal distention. Initial imaging studies revealed a large intraparenchymal lesion of the liver, which was at first thought to be suspicious for neoplasm; however, MRI showed the lesion to be hemorrhagic and follow-up sonographic studies showed total resolution of this lesion, compatible with hematoma. The intraparenchymal location and the idiopathic nature of this lesion distinguish this case from others previously reported.

Purpose: To determine the accuracy of a focused computed tomographic (CT) technique with oral and intravenous contrast materials for the diagnosis of appendicitis., Materials and Methods: Ninety-three abdominal-pelvic contrast material-enhanced CT scans obtained during 6 years in 54 girls and 39 boys (age range, 1-18 years) with right lower quadrant pain were retrospectively reviewed. The detected abnormal findings were recorded as being in the region above the upper pole of the right kidney, between the upper pole of the right kidney and the lower pole of the right kidney (RLP), or below the iliac crest. Sensitivity, specificity, and positive and negative predictive values were calculated. chi(2) analysis was performed to determine whether there were significant differences among patient groups according to region of detected disease., Results: Fifty-five scans were abnormal: 38 showed appendicitis; and 17, other diseases. No scans, except two that showed pneumonia, had key findings above the RLP. Nineteen scans showed key findings between the RLP and the iliac crest. Thirty-three scans had diagnostic findings only below the iliac crest. The sensitivity (97%), specificity (93%), positive predictive value (90%), and negative predictive value (98%) of interpretation with all images for the diagnosis of appendicitis were the same as those of interpretation with only the focused images., Conclusion: CT performed to diagnose appendicitis can be limited to the region below the RLP.

Objective: Dilatation of the small bowel is a common finding on plain abdominal radiographs. In such cases, it is often difficult to determine if the cause of the dilatation is small-bowel obstruction, paralytic ileus, or another intraabdominal disorder. Accordingly, we studied the efficacy of CT in making this distinction., Materials and Methods: The medical records of 75 patients with small-bowel dilatation seen on CT scans (more than three segments > 2.5 cm in diameter) were reviewed. The patients were divided into three groups (obstruction [27 patients], other surgical diagnosis [16 patients], and no surgery [32 patients]) on the basis of clinical course, findings at surgery, or both. CT scans were retrospectively evaluated by two gastrointestinal radiologists who did not know the results of the chart review. They evaluated the images with regard to the following specific criteria for obstruction: presence/continuity of duodenal, small-bowel, and colonic dilatation; presence of air-fluid levels; amount of intestinal fluid; presence of prestenotic dilatation; presence of transition zone; and cause of obstruction. In addition, each radiologist gave an overall impression regarding the presence or absence of obstruction (criteria not specified to the observers) and its site, or other cause of bowel dilatation. The CT interpretations of each of the radiologists were compared with the patients' subsequent clinical course., Results: Observer A was correct in 89%, 88%, and 72% of cases in the obstruction, other surgical diagnosis, and no surgery groups, respectively. Observer B was correct in 78%, 81%, and 69% of cases in the obstruction, other surgical diagnosis, and no surgery groups, respectively. Observer agreement regarding the proposed criteria for obstruction ranged from 65% to 91%. For both observers, only the presence of continuous small-bowel dilatation, prestenotic dilatation, and a transition zone correlated significantly with the presence of small-bowel obstruction., Conclusion: CT can be a useful test for evaluating small-bowel dilatation and can aid both the diagnosis of small-bowel obstruction and its differentiation from other conditions resulting in small-bowel dilatation.

Plasma membranes from bovine adrenal zona fasciculata cells were incorporated into lipid bilayers, and the activity of individual calcium channels was monitored under voltage clamp conditions. Using barium as the permeant ion, two distinct channels with conductances of approximately 8 and 20 picoSiemens (pS) were characterized. The 20 pS conductance corresponds to conductances found in L-type calcium channels. This channel displayed voltage dependency and a sensitivity to BayK 8644. Addition of ACTH (10 nM) to the bilayer preparations promoted an increased open time for the 20-pS channel. These data confirm the presence of dihydropyridine-sensitive calcium channels in bovine adrenocortical cells and support a potential role for these channels as a site of modulation by ACTH.