Motivational context determines the impact of aversive outcomes on mental effort allocation.

It is well known that people will exert effort on a task if sufficiently motivated, but how they distribute these efforts across different strategies (e.g., efficiency vs.

Pityriasis rosea after administration of Pfizer-BioNTech COVID-19 vaccine.

Pityriasis rosea (PR) is an acute papulosquamous cutaneous disorder that classically presents with a herald patch rapidly followed by a widespread rash along skin cleavage lines. Although the exact pathogenesis of PR is unknown, current evidence suggests that an inflammatory reaction due to a viral trigger may lead to the cutaneous manifestations. COVID-19 has been reported as one such viral trigger for PR.

Pseudoglandular-type melanoma: a rare melanoma variant.

We describe a 64-year-old man with a primary nodular melanoma showing unusual histologic features. It consisted entirely of markedly atypical melanocytes arranged in a well-structured glandular pattern. These atypical melanocytes were positive for S-100.

Incontinentia pigmenti (Bloch-Sulzberger syndrome): a systemic disorder.

Incontinentia pigmenti (IP) is a rare inherited multisystem disorder characterized by a distinctive swirling pattern of the skin; defects of teeth, hair, and nails; and ophthalmic, central nervous system, and musculoskeletal abnormalities. It progresses through several well-defined stages. IP is transmitted as a dominant X-linked trait with variable expressivity, but many--if not most--cases are sporadic.

Keratoacanthoma-like squamous cell carcinoma within the fibroepithelial polyp.

Acrochordons (skin tags) are often considered clinically insignificant cutaneous redundancies that should be removed and destroyed with no histopathologic analysis performed. One rarely finds another neoplasm within an acrochordon. We describe a patient with an acrochordon that contained a squamous cell carcinoma that had features resembling a keratoacanthoma.

Blaschkoid eccrine spiradenomas.

We report a case of multiple eccrine spiradenomas that arose in adulthood along a patient's arm and continued to the midline of the patient's chest across multiple dermatomes. This is one of a handful of such cases, which have been reported as linear, nevoid, or zosteriform eccrine spiradenomas. We believe this distribution is best described as Blaschkoid rather than zosteriform or linear because these lesions follow the lines of Blaschko rather than those of a single dermatome.

Role of US-guided fine-needle aspiration with on-site cytopathologic evaluation in management of nonpalpable breast lesions.

Rationale And Objectives: The purpose of this study was to evaluate the accuracy of ultrasound (US)-guided fine-needle aspiration (FNA), with radiographic follow-up or surgical excision, in conjunction with on-site cytopathologic support in the management of nonpalpable breast lesions.

Materials And Methods: The findings of 266 consecutive mammographically or sonographically identified, nonpalpable lesions (228 patients) that underwent US-guided FNA were examined retrospectively. Clustered microcalcifications did not undergo biopsy with this method.

Effective management of difficult surgical defects using tissue-engineered skin.

Background: Graftskin, a bilayered living skin construct, is an effective therapeutic option in the management of chronic venous ulcerations and simple acute surgical excisions. However, it is not routinely used in the management of complicated surgical wound defects.

Objective: To determine the effectiveness of graftskin as a therapeutic modality in difficult surgical defects.

Otoacoustic emissions as a screening test for hearing impairment in children recovering from acute bacterial meningitis.

Objectives: To study the efficacy of otoacoustic emissions (OAEs) as a screening test for hearing impairment in children with acute bacterial meningitis. Hearing tests were performed before discharge from the hospital in an attempt to improve coverage and avoid delays in the diagnosis of postmeningitic hearing loss.

Methods: Children with bacterial meningitis were recruited from 21 centers.

Ototoxicity resulting from intracochlear perfusion of Streptococcus pneumoniae in the guinea pig is modified by cefotaxime or amoxycillin pretreatment.

Acute changes in the electrophysiology and ultrastructure of the organ of Corti were studied after microperfusion of c. 5 x 10(6) CFU of serotype 2 Streptococcus pneumoniae D39 or Escherichia coli K-12 directly into the scala tympani of guinea pigs. Hearing loss was assessed by recording the auditory nerve compound action potential response to a 10 kHz tone pip.

Chickenpox in childhood. A review prepared for the UK Advisory Group on Chickenpox on behalf of the British Society for the Study of Infection.

Chickenpox in childhood is a milder condition than in older patients, but serious and even fatal complications may occur. These occur especially in immunosuppressed individuals, but can also be seen in normal children. The commonest of these is secondary bacterial infection with staphylococci or streptococci.

Otitis media: pathogenesis and medical sequelae.

Eustachian tube abnormalities are a primary determinant of otitis media. Other determinants include viral infections and local and systemic immune deficiencies, which predispose to superimposed bacterial disease. Local infection induces inflammation, which can be exacerbated by the presence of antibiotics.

Imported infections in east Birmingham children.

This 15-month prospective study of admissions to a children's ward found imported infections in 58 children (1.3% of admissions), aged between two months and 15 years. Most had visited the Indian subcontinent 14 (1-341) days earlier.

Acute otitis media and otitis media with effusion in children with bacterial meningitis.

Acute otitis media and otitis media with effusion (OME) have often been observed in children with bacterial meningitis. OME has also been proposed as the mechanism of reversible hearing loss after meningitis. In this controlled study, children with acute bacterial meningitis were studied using auditory brainstem responses (ABR), otoacoustic emissions, tympanometry and otoscopy.

A role for pneumolysin but not neuraminidase in the hearing loss and cochlear damage induced by experimental pneumococcal meningitis in guinea pigs.

We investigated the roles of pneumolysin and neuraminidase in the pathogenesis of deafness and cochlear damage during experimental pneumococcal meningitis. Anesthetized guinea pigs were inoculated intracranially with 7.5 log10 CFU of either (i) wild-type Streptococcus pneumoniae D39 (n = 8), (ii) PLN-A, a defined isogenic derivative of D39 deficient in pneumolysin (n = 5), or (iii) deltaNA1, a new derivative of D39 deficient in neuraminidase constructed by insertion-duplication mutagenesis of the nanA gene (n = 5).

Diagnosis of primary human herpesvirus 6 and 7 infections in febrile infants by polymerase chain reaction.

Primary human herpesvirus 6 (HHV-6) and 7 (HHV-7) infections were identified in febrile children by qualitative and quantitative polymerase chain reaction (PCR) assays. Diagnosis was based on the differential detection of viral DNA in peripheral blood mononuclear cells (PBMC), but not in saliva. Six of 41 febrile infants, but none of seven non-febrile controls, were identified with primary infections (three HHV-6, three HHV-7).

Possible involvement of nitric oxide in the sensorineural hearing loss of bacterial meningitis.

Microperfusion of scala tympani with the NO donors, sodium nitroprusside (SNP) and S-nitroso-N-acetylpenicillamine (SNAP), produced marked depression of the compound action potential (CAP) and cochlear microphonic (CM) together with severe and widespread morphological damage to hair cells and supporting cells in the organ of Corti. In addition, direct perfusion of N-methyl-D-aspartate (NMDA) into scala tympani, which probably induces excess stimulation of NMDA receptors within the cochlea and which is known to lead to the release of NO, was found to elicit similar electrophysiological and structural lesions in the cochlea. Pre-perfusion of scala tympani with L-methyl arginine (L-MA), which inhibits the release of NO, or superoxide dismutase (SOD), an O2-scavenger, conferred marked protection upon the cochlea from the lesions caused by NO donors.

Future indications for macrolides.

The antimicrobial spectrum of azithromycin and clarithromycin suggests a number of further uses for these newer macrolides. Favorable clinical and bacteriologic responses have been reported with both antibiotics in children with community-acquired pneumonia. Response rates were high for overall patient populations and for subgroups with infection caused by Mycoplasma pneumoniae and Chlamydia pneumoniae.

Macrolides in the management of streptococcal pharyngitis/tonsillitis.

The most frequent bacterial cause of pharyngitis/tonsillitis, a common infection in children, is group A beta-hemolytic streptococci. Prevention of acute rheumatic fever is the principal goal of treatment, although antibiotic therapy may also relieve the signs and symptoms of infection, shorten the infective period and prevent suppurative complications. Penicillin is the drug of choice.

Laboratory, clinic and community: the logistics of liaison.

Background: Infectious diseases are the cause of much morbidity and mortality in children. In the industrialized world the majority of childhood infections are treated by primary care physicians; nevertheless a high degree of professional liaison is needed among the various specialists concerned with pediatric infectious disease.

Objective: To review the contributions of the various medical practitioners to the management of pediatric infections and the ways in which communication between them can be improved.

Hearing loss during bacterial meningitis.

Objective: To determine the natural history and pathogenesis of hearing loss in children with acute bacterial meningitis.

Design: Multicentre prospective study.

Setting: 21 hospitals in the south and west of England and South Wales.