The bidirectional relationship between sleep and physical activity following traumatic brain injury.

Sleep and physical activity are both modifiable behavioural factors that are associated with better health and are potentially related. Following traumatic brain injury, damage to the brain caused by an external force, sleep disturbances are common. Exploring bidirectional relationships between sleep and physical activity might provide insight into whether increasing physical activity could decrease these sleep disturbances.

Standardized reporting of appendicitis-related findings improves reliability of ultrasound in diagnosing appendicitis in children.

Purpose: Our objective was to increase ultrasound reliability for diagnosing appendicitis in an academic children's hospital emergency department (ED) through a multidisciplinary quality improvement initiative.

Methods: A retrospective review of ultrasound use in patients diagnosed with appendicitis in our ED from 1/1/2011 to 6/30/2014 established a baseline cohort. From 8/1/2014 to 7/31/2015 a diagnostic algorithm that prioritized ultrasound over CT was used in our ED, and a standardized template was implemented for the reporting of appendicitis-related ultrasound findings by our radiologists.

Economic Analysis of Diagnostic Imaging in Pediatric Patients With Suspected Appendicitis.

Objective: The use of computed tomography (CT) and ultrasound (US) in patients with acute abdominal pain has substantial variation across pediatric emergency departments (EDs). This study compares the cost of diagnosing and treating suspected appendicitis across a multicenter network of children's hospitals.

Methods: This study is a secondary analysis using deidentified data of a prospective, observational study of patients with suspected appendicitis at nine pediatric EDs.

The Effect of Early Knowledge of Respiratory Syncytial Virus Positivity on Medical Decision Making and Throughput Time Within the Pediatric Emergency Department.

Objective: The aim of this study was to evaluate whether early knowledge of respiratory syncytial virus (RSV) positivity by rapid triage-based testing protocol improved emergency department (ED) throughput time and decreased ED ancillary testing and antibiotic administration.

Methods: A retrospective cohort study was performed of ED patients aged 2 to 12 months, presenting November 1 to March 31 for the years 2008-2013. Included patients presented with fever and upper respiratory tract symptoms.

Time From Emergency Department Evaluation to Operation and Appendiceal Perforation.

Background And Objectives: In patients with appendicitis, the risk of perforation increases with time from onset of symptoms. We sought to determine if time from emergency department (ED) physician evaluation until operative intervention is independently associated with appendiceal perforation (AP) in children.

Methods: We conducted a planned secondary analysis of children aged 3 to 18 years with appendicitis enrolled in a prospective, multicenter, cross-sectional study of patients with abdominal pain (<96 hours).

A Clinical Score to Predict Appendicitis in Older Male Children.

Objective: To develop a clinical score to predict appendicitis among older, male children who present to the emergency department with suspected appendicitis.

Methods: Patients with suspected appendicitis were prospectively enrolled at 9 pediatric emergency departments. A total of 2625 patients enrolled; a subset of 961 male patients, age 8-18 were analyzed in this secondary analysis.

The Influence of Age on the Diagnostic Performance of White Blood Cell Count and Absolute Neutrophil Count in Suspected Pediatric Appendicitis.

Objective: White blood cell (WBC) count and absolute neutrophil count (ANC) are a standard part of the evaluation of suspected appendicitis. Specific threshold values are utilized in clinical pathways, but the discriminatory value of WBC count and ANC may vary by age. The objective of this study was to investigate whether the diagnostic value of WBC count and ANC varies across age groups and whether diagnostic thresholds should be age-adjusted.

Smartphones as assistive technology following traumatic brain injury: a preliminary study of what helps and what hinders.

Purpose: Smartphones have great potential as a convenient, multifunction tool to support cognition and independence following traumatic brain injury (TBI). However, there has been limited investigation of their helpful and less helpful aspects for people with TBI. We aimed to investigate patterns of smartphone use amongst individuals with TBI, identify potential barriers to use, and examine the relationships between smartphone use and daily functioning.

Computed Tomography Utilization for the Diagnosis of Acute Appendicitis in Children Decreases With a Diagnostic Algorithm.

Objective: The primary objective of this project was to decrease computed tomography (CT) utilization for the diagnosis of appendicitis in an academic children's hospital emergency department (ED) through a multidisciplinary quality improvement initiative.

Background: Appendicitis is the most common abdominal diagnosis leading to the hospitalization of children in the United States. However, the diagnosis of appendicitis in children can be difficult and many centers rely heavily upon CT scans.

Sleep and fatigue following traumatic brain injury.

This article reviews literature relating to sleep disturbance and fatigue after traumatic brain injury. It discusses the nature and prevalence of sleep disturbances associated with traumatic brain injury and the measures used to assess them. Potential causes are discussed, including damage to sleep-wake regulating centers, disruption of circadian timing of sleep, and secondary causes, such as pain, depression, and anxiety.

Randomized controlled trial of light therapy for fatigue following traumatic brain injury.

Background: Fatigue is a common, persistent complaint following traumatic brain injury (TBI). Effective treatment is not well established.

Objective: .

Demonstrating the effectiveness of less restrictive care pathways for the management of patients treated with clozapine.

Objective: The purpose of this study was to measure the effectiveness of two alternative care pathways for managing patients treated with clozapine.

Method: Medical records for 90 clozapine patients managed via three care pathways were audited for a 24 month period (30 per group). The three care pathways established to manage patients prescribed clozapine include: (1) remaining in public mental health service case management; (2) transitioning to general practitioner-mental health service shared care; or (3) transitioning to private psychiatry sole care.

Performance of ultrasound in the diagnosis of appendicitis in children in a multicenter cohort.

Objectives: The objectives were to assess the test characteristics of ultrasound (US) in diagnosing appendicitis in children and to evaluate site-related variations based on the frequency of its use. Additionally, the authors assessed the test characteristics of US when the appendix was clearly visualized.

Methods: This was a secondary analysis of a prospective, 10-center observational study.

Changes in sleep patterns following traumatic brain injury: a controlled study.

Background: Sleep changes are frequently reported following traumatic brain injury (TBI) and have an impact on rehabilitation and quality of life following injury. Potential causes include injury to brain regions associated with sleep regulation, as well as secondary factors, including depression, anxiety, and pain. Understanding the nature and causes of sleep changes following TBI represents a vital step in developing effective treatments.

Actigraphic assessment of sleep disturbances following traumatic brain injury.

The current study examined the use of actigraphy in measurement of sleep following traumatic brain injury (TBI). Twenty-one patients with TBI and self-reported sleep and/or fatigue problems and 21 non-injured controls were studied over seven days using actigraphy and sleep diary reports. Although strong associations between diary and actigraphic assessment of sleep duration were observed in both participant groups, agreement between these methods appeared to weaken in patients with TBI.

Sustained attention following traumatic brain injury: use of the Psychomotor Vigilance Task.

Objective: Deficits in sustained attention are common following traumatic brain injury (TBI), as a result of primary (i.e., neuropathology) and/or secondary factors (i.

Effects of a low glycemic load or a low-fat dietary intervention on body weight in obese Hispanic American children and adolescents: a randomized controlled trial.

Background: In Hispanic children and adolescents, the prevalence of obesity and insulin resistance is considerably greater than in non-Hispanic white children. A low-glycemic load diet (LGD) has been proposed as an effective dietary intervention for pediatric obesity, but to our knowledge, no published study has examined the effects of an LGD in obese Hispanic children.

Objective: We compared the effects of an LGD and a low-fat diet (LFD) on body composition and components of metabolic syndrome in obese Hispanic youth.

Use of computed tomography in the emergency department for the diagnosis of pediatric peritonsillar abscess.

Objective: The objective of this study was to review our pediatric emergency department's (ED's) utilization of computed tomography (CT) in the diagnosis of peritonsillar abscess (PTA) and treatment outcomes.

Methods: This study used case series with chart review.

Results: From January 2007 to January 2009, 148 patients were seen in our ED for possible PTA.

Validation and refinement of a prediction rule to identify children at low risk for acute appendicitis.

Objective: To validate and refine a clinical prediction rule to identify which children with acute abdominal pain are at low risk for appendicitis (Low-Risk Appendicitis Rule).

Design: Prospective, multicenter, cross-sectional study.

Setting: Ten pediatric emergency departments.

The effect of abdominal pain duration on the accuracy of diagnostic imaging for pediatric appendicitis.

Study Objective: Advanced imaging with computed tomography (CT) or ultrasonography is frequently used to evaluate for appendicitis. The duration of the abdominal pain may be related to the stage of disease and therefore the interpretability of radiologic studies. Here, we investigate the influence of the duration of pain on the diagnostic accuracy of advanced imaging in children being evaluated for acute appendicitis.

Interrater reliability of clinical findings in children with possible appendicitis.

Objective: Our objective was to determine the interrater reliability of clinical history and physical examination findings in children undergoing evaluation for possible appendicitis in a large, multicenter cohort.

Methods: We conducted a prospective, multicenter, cross-sectional study of children aged 3-18 years with possible appendicitis. Two clinicians independently evaluated patients and completed structured case report forms within 60 minutes of each other and without knowing the results of diagnostic imaging.

Case records of the Children's Mercy Hospital: A 12-year-old girl with a straddle injury.

Straddle injuries are common in children. At the end of this case presentation, you should be able to describe the approach to the evaluation and treatment of a straddle injury, list indications for gynecologic consultation and/or sedation, plan disposition, and discuss pitfalls to avoid in evaluating patients with straddle injuries.

Gay asylum seekers win right to stay in United Kingdom.

The Supreme Court has unanimously ruled that gay men facing persecution in their home countries have the right to asylum in the United Kingdom. This decision comes as a response to an appeal by two gay men who had their applications for asylum rejected on the basis that they could choose to keep their personal lives to themselves.

Michigan judge rules that HIV-positive man not a bioterrorist.

On 2 June 2010, the trial court in Macomb County, Michigan, dismissed charges against an HIV-positive man brought under the state's "bioterrorism" statute. David Allen was charged in November under a provision of the statute that prohibits the manufacture, delivery, possession, use or release of a harmful biological substance.