Criminology

Mandatory, fast, and fair: Case outcomes and procedural justice in a family drug court Abstract Objectives Problem-solving courts are traditionally voluntary in nature to promote procedural justice and to advance therapeutic jurisprudence. The Family Treatment Drug Court (FTDC) in Lancaster County, Nebraska is a mandatory dependency court for families with allegations of child abuse or neglect related to substance use. We conducted a program evaluation examining parents' case outcomes and perceptions of procedural justice to examine whether a mandatory problem-solving court could replicate the positive outcomes of problem-solving courts. Methods We employed a quasi-experimental design that compared FTDC parents to traditional dependency court parents (control parents). We examined court records to gather court orders, compliance with court orders, case outcomes, and important case dates. We also conducted 263 surveys (FTDC = 232; control = 31) to understand parents' perceptions of procedural justice in the court process. Results Overall, FTDC parents were more compliant with some court orders than control parents. Although FTDC and control parents did not have significantly different case outcomes, FTDC parents' cases closed significantly faster than control parents' cases. FTDC parents also had higher perceptions of procedural justice than control parents. Mediation analyses indicated that FTDC parents believed the court process was more fair and therefore participated more consistently in court-ordered services and therefore reunified more often than control parents. Conclusions Mandatory problem-solving courts can serve parents through the same mechanisms as voluntary problem-solving courts. More research is necessary to examine which specific elements of problem-solving courts, aside from the voluntary nature, are essential to maintain their effectiveness.

The co-offender as counterfactual: a quasi-experimental within-partnership approach to the examination of the relationship between race and arrest Abstract Objectives Estimate the relationship between race and arrest within co-offending partnerships using a quasi-experimental framework. More specifically, this study argues that when two offenders commit an offense together (i.e., co-offend), the characteristics of the offense and victim are the same and can be removed as possible confounding variables. In this way, co-offenders can serve as counterfactual observations to one another, allowing for quasi-experimental analysis of the effects of race on arrest likelihood. Methods The current study restructures data from the National Incident-Based Reporting System (NIBRS) into a multi-level format wherein level-1 information on offender demographics and arrest are nested within a level-2 file containing information on co-offending partnerships, offense characteristics, and victim characteristics. By restricting the data to co-offending partnerships and examining within-partnership differences in arrest, the analysis examines racial differences in arrest given that two offenders commit the same offense together against the exact same victim. Results While a traditional logistic regression approach suggests that black offenders are less likely than white offenders to be arrested (OR = 0.749), the quasi-experimental analysis examining within-partnership differences suggests the opposite: black offenders are more likely than their white co-offending partners to be arrested for an offense (OR = 1.031). Conclusions These results have two implications. First, traditional regression analyses of the relationship between race and arrest may be subject to significant selection and omitted variable bias. Second, there is potential racial disparity in co-offender arrest: black co-offenders are more likely than their white partners to be arrested for the same violent offense.

Addressing the "black box" of focused deterrence: an examination of the mechanisms of change in Chicago's Project Safe Neighborhoods Abstract Objectives Chicago's Project Safe Neighborhoods focused deterrence program is an effective crime reduction policy. However, similar to other focused deterrence programs, prior evaluations have not empirically established the mechanisms of change believed to underlie the program. The purpose of this paper was to address this gap by examining the influence of offender notification meetings—a key component of the program—on three mechanisms: perceptions of risks associated with future offending, perceptions of police legitimacy, and adherence to community norms. Methods Over a 1-year period, parolees attending the notification meetings were randomly assigned to complete surveys assessing each of the mechanisms immediately before the meeting (control) or immediately after (treatment). Results Parolees in the treatment condition had higher perceptions of risk and police legitimacy compared to those in the control condition. Additionally, they were more likely to judge police as procedurally fair. The groups did not differ with respect to adherence to community norms. Within both groups, perception of risk was positively associated with motivation to stay out of prison. Police legitimacy was also positively associated with motivation for the treatment group, while community norm adherence was positively associated with motivation for those in the control condition. Conclusions This study indicates that the offender notification meetings are working as intended with respect to the underlying mechanisms of change embedded in Chicago's Project Safe Neighborhoods.

Framing innocence: an experimental test of the effects of wrongful convictions on public opinion Abstract Objectives Discourse about criminal justice in the USA increasingly revolves around wrongful convictions. Research has documented the emergence of the "innocence frame," but relatively little is known about its effects on public opinion. We utilize framing theory to examine how various presentations of wrongful conviction information affect attitudes toward the justice system and highlight the consequences of the innocence movement for public opinion. Methods We implement two survey experiments to test the effects of innocence information for criminal justice attitudes. In the first experiment, we test the impact of wrongful conviction numbers relative to a control group for death penalty support. In the second experiment, we analyze the effects—both separately and jointly—of exoneration numbers and a wrongful conviction narrative relative to a control group for attitudes toward the death penalty and police reform, trust in the justice system, and personal concern. Results We demonstrate that the presentation of factual numbers of exonerations reduces support for capital punishment and erodes trust in the justice system, but fails to garner support for police reforms or increase personal concern about wrongful convictions. However, a narrative about an individual wrongful conviction predictably has more pronounced effects on death penalty attitudes and increases personal concern and support for police reform, but has little effect on trust in the justice system more broadly. Conclusions Wrongful convictions are consequential for public opinion, but the effects are contingent on how the information is framed and the attitudinal outcome of interest. Our findings have implications for criminal justice attitudes and policy, the innocence movement, and framing theory.

Testing filter term performance in PsycINFO to identify evidence syntheses in crime reduction, using the relative recall method Abstract Objectives To test filter term performance against an original search strategy to identify evidence syntheses with a crime reduction outcome in the PsycINFO database, with a view to maximising efficiency and/or effectiveness in the search phase of a systematic review. Methods A search strategy was developed to identify evidence syntheses with crime reduction outcomes. A 'quasi-gold standard' set of 255 relevant studies that were indexed in the PsycINFO database was derived from this initial work and was used to test various filter terms available in the database using the relative recall method. Precision and sensitivity statistics were generated for each search strategy. Results Seven search strategies were tested using three clusters of index terms, on (1) method filter terms, (2) topic filter terms and (3) method and topic filter terms. These were applied as filters for the original search strategy and, to facilitate comparison, against all records in PsycINFO. The most sensitive filter scored 74.1%, the most precise scored 44.1% and the best compromise between sensitivity and precision scored 53.7% sensitivity and 16.3% precision. Conclusions Filter term performance in PsycINFO can be used to inform search strategies used within criminology and allied fields for systematic reviews. The variety of filter terms tested here, in the absence and presence of a keyword search, caters for researchers with different information requirements. Using an evidence-based approach to systematic searching can yield considerable resource savings in conducting a systematic review.

Using citizen notification to interrupt near-repeat residential burglary patterns: the micro-level near-repeat experiment Abstract Objectives Test the efficacy of swift resident notification for preventing subsequent burglaries within near-repeat high-risk zones (NR-HRZ). Methods The experiment was conducted in Baltimore County, Maryland and Redlands, California. As residential burglaries came to the attention of the police, a trickle randomization process was used to assign each micro-level NR-HRZ (measured 800 ft, 244 m from the burglary location) and associated buffer (400 ft, 122 m) to treatment or control. Treatment was performed by uniform agency volunteers and consisted of swift notification to residents in the area of increased risk of burglary victimization. Treatment and control zones were compared for differences in the mean count of residential burglary using independent samples t tests. Two surveys were administered to gauge the impact of the program: one targeted residents and one targeted at the treatment providers. Results There was limited evidence that the treatment reduced follow-on burglaries. The effectiveness of the intervention varied depending on the post-intervention time period being considered. The results of the community survey suggested that: (1) the most frequent crime prevention actions taken by residents were relatively low-cost and low-effort and (2) notification did not increase resident fear of burglary. The treatment provider survey found that the program was effective at increasing the level of engagement between volunteers and the agency and had positive impacts on community perception. Conclusions This research demonstrated that law enforcement volunteers can be used to undertake programs that have positive impacts on police-community relations. Limitations included low near-repeat counts, delays in discovering/reporting burglary, and staffing constraints.

Eyes wide open: exploring men's and women's self-reported and physiological reactions to threat and crime Abstract Objectives In response to calls for physiological measurement of people's fear of crime, we explored how men and women responded to self-report and physiological measures as they viewed threatening and/or crime-related images. Method We used a gender (men vs. women) × threat (high vs. low) × crime (high vs. low) mixed-factorial design. Participants (N = 40) viewed two blocks of 40 images from the Crime and Threat Image Set (CaTIS). In one block, participants rated their pleasantness and arousal (self-report) as they viewed the images. In the second block, we recorded participants' eye blinks and galvanic skin response (GSR; physiological) as they viewed the images. Participants also completed two traditional fear of crime measures. Results On the traditional fear of crime measures, women reported significantly more fear of crime than men. When viewing images, there was a gender dynamic for self-reports of pleasantness: women reported feeling more unpleasant when viewing high-threat images than did men. Ratings of arousal, eye blink rates and GSR did not significantly differ between men and women, but GSR and arousal ratings did significantly differ across image categories. Conclusions We found gender differences between traditional fear of crime measures and self-reports of pleasantness, but no statistically significant differences in men's and women's physiological reactions. We propose that this is not a function of impression management, but that men and women may be interpreting their physiological responses in line with gender-socialised scripts.

The Crime and Threat Image Set (CaTIS): a validated stimulus set to experimentally explore fear of crime Abstract Objectives Fear of crime may develop in response to crime specifically (the narrow pathway) or may be a projection of broader threats (the broad pathway). New approaches are needed to examine how crime and threat, independently and in combination, influence people's fear. To address this need, we created, evaluated, and validated an image set that varied across the dimensions of threat and crime. Method We used a 2 (Threat: high vs. low) × 2 (Crime: high vs. low) within-subjects factorial design. In three studies, participants (N = 24, 29, and 176, respectively) gave threat, crime, and fear ratings towards images. Participants also completed two traditional fear of crime measures and a measure of anxiety. Two evaluation studies explored the suitability of 178 images to produce a final set of 80 images (20 in each of the four categories). We validated this final set of 80 images in a third study. Results The validated Crime and Threat Image Set (CaTIS) contains 78 images across four categories: threat-and-crime (high-crime, high-threat), threat-only (low-crime, high-threat), crime-only (high-crime, low-threat), and neutral (low-crime, low-threat). There were significant main effects of threat and crime, and an interaction between Threat × Crime, on participants' fear ratings. Participants' own ratings of threat—but not crime—had a strong relationship with their fear ratings. Conclusions Threat had a stronger influence on participants' fear ratings than crime. Thus, what is typically referred to as fear of crime may reflect broader fear. Further research with the CaTIS could explore the expression of this fear.

The mobilization of computerized crime mapping: a randomized controlled trial Abstract Objectives To develop and evaluate the effectiveness of a decentralized, smartphone-based crime mapping and analysis tool designed for law enforcement officers working in a patrol capacity. Methods A mixed-methods, block randomized controlled trial was conducted. Baseline and exit surveys were conducted to evaluate device usage, application usage, knowledge of crime clusters, and data sources that individuals perceived to be most useful in identifying crime clusters. Focus groups were used to explore contextual factors associated with app usage. Results The results of this research suggest that patrol officers did not value the functionality offered by mobile crime mapping capabilities. Despite broad popularity of agency-provided smartphones, users saw little value in the custom app developed for those devices. Users reported that they were already aware of where crime was occurring and that the mobile platform did not provide useful additional details. Focus group members described some backfire effects of the evaluation methodology. Conclusions The results of this randomized experiment demonstrate that smartphone-based crime mapping technology was poorly adopted because it was not perceived as useful. These results suggest that decentralizing crime mapping to this degree may have limited utility for end users. However, advances in smartphone technology since this research was conducted may provide future opportunities for development.

Full disclosure: experimental analysis of female online dating on parole Abstract Objectives Research has considered the effect of convictions on employment and housing outcomes, but there are limited studies exploring how criminal justice contact affects the initiation of relationships. This study uses an experimental design to explore how people react to criminal stigma in the context of online dating. Methods Female online dating profiles were created using pre-rated, open access photographs of women that varied in race (Black, White, Latino). These three profiles comprised the control condition. The experimental condition consisted of the same exact three profiles with one exception: a brief mention of their being on parole in written profile bios. The three profiles attempted to match with 6000 online daters each in the control and experimental conditions across 18 online dating platforms (N = 36,000). Results Findings indicate that the Black and Latina profiles matched significantly less frequently when disclosing parole. In the parole disclosure condition, White female profiles received significantly more matches than Black and Latino profiles, and White females disclosing parole matched at a higher rate than White females not disclosing parole. Conclusions The stigma of a criminal record is damaging for Blacks and Latinas who disclose parole in online dating bios, but for White females, disclosure of parole does not hinder and may even help their online dating match success. The stigma of being minority appears to compound criminal stigma in online dating. This has crucial implications for the relationships of formerly incarcerated because prosocial romantic relationships reduce recidivism.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Skeletal Radiology

Test Yourself: Question: "Painless right leg swelling"

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Skeletal Radiology: The Year in Review 2018

Selective rickets from localized advanced maturation—a case report Abstract An unusual cause of rickets is illustrated by a patient with infantile multisystem inflammatory disease who, by age 2 years and 4 months, developed striking radiographic and clinical rickets restricted to those joints involved by the inflammatory process. The locally increased vascularity from his inflammation led to increased maturation at those sites so rapid as to override the usual enchondral calcification, thus causing a rickets pattern. Other sites, such as the proximal humeri, lacking any inflammation, showed no increased maturation rate and did not manifest local rickets. Rapid local bone maturation may cause localized rickets.

Osteoma-like melorheostosis: a rare type of skeletal dysplasia depicted on FDG PET/CT Abstract Melorheostosis, also known as Leri's disease, is a rare benign form of mesodermal mixed sclerosing bone dysplasia. We report the unusual case of a 14-year-old boy with melorheostosis in the lower extremity that went undiagnosed due to concurrent Ewing sarcoma in the opposite limb, confounding the findings for metastatic disease. The diagnosis was made on FDG PET/CT when the patient presented for post Ewing sarcoma treatment follow-up. The different types of melorheostosis as well as the challenge of diagnosing this rare entity are discussed in this report.

Test yourself: question: "painless right leg swelling"

Primary infectious costochondritis due to Prevotella nigrescens in an immunocompetent patient: clinical and imaging findings Abstract Infection of costal cartilage is a rare observation. We report the case of a 43-year-old male patient without relevant history who presented with a progressive painful swelling of the left chest wall since 4 months. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated an abscess within the left ninth costal cartilage with surrounding reactive changes. A CT-guided biopsy was performed and the culture of the sample revealed the presence of Prevotella nigrescens. Musculoskeletal infections by Prevotella are rarely described in the literature, Prevotella oralis and Prevotella bivia being the most frequently observed pathogens. These infections usually originate from a hematogenous spread after thoracic surgery or dental procedure. In our patient, conservative treatment was chosen. A clinical improvement was noted after 1-month antibiotherapy, confirmed by short-term and 6-month imaging follow-up showing the complete disappearance of all previously observed abnormalities.

Shear-wave elastography of the ulnar collateral ligament of the elbow in healthy volunteers: a pilot study Abstract Objective To estimate the intra-observer repeatability of shear wave elastography in the UCL of the elbow, and to compare shear wave velocities between dominant and non-dominant arms. Materials and methods Twenty elbows in ten healthy volunteers were evaluated [five males, five females; mean age, 31.8 ± 10.3 years]. Shear wave velocity was measured on three separate days during the span of 1 week utilizing a linear 18-MHz transducer. Elastograms were obtained until ten ROIs were drawn, not drawing more than two ROIs on any elastogram. Elastograms were considered diagnostic if any portion of the UCL was colored in and free of boundary artifacts. Median velocity and interquartile range were recorded. A result was considered reliable if the IQR/median ratio of the ten measurements was < 0.3. Results IQR/median was < 0.3 in 88% of sessions, although in 28% of sessions fewer than 60% of elastograms were diagnostic. The ICC was 0.05 (95% CI; − 0.18–0.36; poor). Repeatability coefficient (95% limits of agreement) was 1.95 m/s (95% CI; 1.61–2.37 m/s). Mean velocity in dominant arms was 5.14 ± 0.53 m/s and 5.24 ± 0.39 m/s in non-dominant (p = 0.558). Conclusions Mean shear wave velocity was similar between dominant and non-dominant arms. Although repeatability was poor as assessed by ICC, the repeatability coefficient may be a more useful indicator of clinical utility once shear wave velocities in diseased ligaments are explored. Future studies should therefore evaluate velocities in diseased ligaments and develop techniques to improve elastogram quality.

Optimizing radiation dose parameters in MDCT arthrography of the shoulder: illustration of basic concepts in a cadaveric study Abstract Objective To determine in a cadaveric study the lowest achievable radiation dose and optimal tube potential generating diagnostic image quality in multidetector computed tomography (MDCT) arthrography of the shoulder. Materials and methods Six shoulders from three human cadavers were scanned using a 256-MDCT system after intra-articular injection of diluted iodinated contrast material. Using six decreasing radiation dose levels (CTDIvol: 20, 15, 10, 8, 6, and 4 mGy) and for each dose level, four decreasing tube potentials (140, 120, 100, and 80 kVp), image noise and contrast-to-noise ratio (CNR) were measured. Two independent and blinded observers assessed the overall diagnostic image quality, subjective amount of noise, and severity of artifacts according to a four-point scale. Influence of those MDCT data acquisition parameters on objective and subjective image quality was analyzed using the Kruskal–Wallis and Wilcoxon signed-rank tests, and pairwise comparisons were performed. Results Multidetector CT protocols with radiation doses of 15 mGy or higher, combined with tube potentials of 100 kVp or higher, were equivalent in CNR to the reference 20 mGy–140 kVp protocol (all p ≥ 0.054). Above a CTDIvol of 10 mGy and a tube potential of 120 kVp, all protocols generated diagnostic image quality and subjective noise equivalent to the 20 mGy–140 kVp protocol (all p ≥ 0.22). Conclusions Diagnostic image quality in MDCT arthrography of the shoulder can be obtained with a radiation dose of 10 mGy at an optimal tube potential of 120 kVp, corresponding to a reduction of up to 50% compared with standard-dose protocols, and as high as 500% compared with reported protocols in the literature.

Volume of hip synovitis detected on contrast-enhanced magnetic resonance imaging is associated with disease severity after collapse in osteonecrosis of the femoral head Abstract Objective To evaluate the relationship between the volume of hip synovitis detected on contrast-enhanced magnetic resonance imaging (MRI) and the disease stage of osteonecrosis of the femoral head (ONFH). Materials and methods Sixty-three consecutive hips in 40 ONFH patients were reviewed using contrast-enhanced MRI. Ten unaffected hips in 10 patients with unilateral ONFH were used as controls. Based on the Japanese Investigation Committee system, these hips were classified according to stage and type. The volume and location of hip synovitis were semi-quantitatively measured on contrast-enhanced MRI. Clinicoradiological factors were statistically analyzed to determine the relationship with the volume of hip synovitis. Results The mean synovial volume was significantly larger in ONFH hips (8,020 ± 6,900 mm3) than in controls (910 ± 1,320 mm3; p = 0.001). The area of synovitis in the anterior portion of the hip joint was double (mean: 2.17 ± 1.77) that in the posterior portion. The volume of synovitis was small in pre-collapse-stage hips (stage 1: 680 ± 690 mm3, stage 2: 1,460 ± 1,200 mm3), but significantly larger in post-collapse-stage hips (stage 3A: 7,820 ± 4,490 mm3, stage 3B: 13,850 ± 7,110 mm3; p < 0.001). Multiple regression analysis showed that disease stage was the only factor related to hip synovitis. Conclusions Our study suggests that hip synovitis in ONFH might occur after femoral head collapse and worsen with collapse progression, mainly in the anterior portion.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Brain

Is schizotypic maternal personality linked to sensory gating abilities during infancy? Abstract Schizotypy is a personality dimension within the general population elevated among schizophrenia-spectrum patients and their first-degree relatives. Sensory gating is the pre-attentional habituation of responses distinguishing between important and irrelevant information. This is measured by event-related potentials, which have been found to display abnormalities in schizophrenic disorders. The current study investigated whether 6-month-old infants of mothers with schizotypic traits display sensory gating abnormalities. The paired-tone paradigm: two identical auditory tones (stimulus 1 and stimulus 2) played 500 ms apart, was used to probe the selective activation of the brain during 15-minutes of sleep. Their mothers completed the Oxford and Liverpool Inventory of Feelings and Experiences-Short Form as an index of schizotypy dimensionality, categorized into: infants of control, and infants of schizotypic, mothers. The findings revealed that although the infants' P50 components displayed significant differences between stimulus 1 and stimulus 2 in the paired-tone paradigm, there was no clear difference between infants of schizotypic and infants of control mothers. In contrast, all mothers displayed significant differences between stimulus 1 and stimulus 2, as observed in the infants, but also significant differences between their sensory gating ability correlated with schizotypy dimensionality. These findings are consistent with sensory processes, such as sensory gating, evidencing impairment in schizophrenia-spectrum disorders. The present research supports the idea that first-degree relatives of individuals who identify on this spectrum, within the sub-clinical category, do not display the same deficit at 6 postnatal months of age.

Referent control of anticipatory grip force during reaching in stroke: an experimental and modeling study Abstract To evaluate normal and impaired control of anticipatory grip force (GF) modulation, we compared GF production during horizontal arm movements in healthy and post-stroke subjects, and, based on a physiologically feasible dynamic model, determined referent control variables underlying the GF–arm motion coordination in each group. 63% of 13 healthy and 48% of 13 stroke subjects produced low sustained initial force (< 10 N) and increased GF prior to arm movement. Movement-related GF increases were higher during fast compared to self-paced arm extension movements only in the healthy group. Differences in the patterns of anticipatory GF increases before the arm movement onset between groups occurred during fast extension arm movement only. In the stroke group, longer delays between the onset of GF change and elbow motion were related to clinical upper limb deficits. Simulations showed that GFs could emerge from the difference between the actual and the referent hand aperture (Ra) specified by the CNS. Similarly, arm movement could result from changes in the referent elbow position (Re) and could be affected by the co-activation (C) command. A subgroup of stroke subjects, who increased GF before arm movement, could specify different patterns of the referent variables while reproducing the healthy typical pattern of GF–arm coordination. Stroke subjects, who increased GF after arm movement onset, also used different referent strategies than controls. Thus, altered anticipatory GF behavior in stroke subjects may be explained by deficits in referent control.

Control strategies for rapid, visually guided adjustments of the foot during continuous walking Abstract When walking over stable, complex terrain, visual information about an upcoming foothold is primarily utilized during the preceding step to organize a nearly ballistic forward movement of the body. However, it is often necessary to respond to changes in the position of an intended foothold that occur around step initiation. Although humans are capable of rapidly adjusting foot trajectory mid-swing in response to a perturbation of target position, such movements may disrupt the efficiency and stability of the gait cycle. In the present study, we consider whether walkers sometimes adopt alternative strategies for responding to perturbations that interfere less with ongoing forward locomotion. Subjects walked along a path of irregularly spaced stepping targets projected onto the ground, while their movements were recorded by a full-body motion-capture system. On a subset of trials, the location of one target was perturbed in either a medial–lateral or anterior–posterior direction. We found that subjects were best able to respond to perturbations that occurred during the latter half of the preceding step and that responses to perturbations that occurred during a step were less successful than previously reported in studies using a single-step paradigm. We also found that, when possible, subjects adjusted the ballistic movement of their center of mass in response to perturbations. We conclude that, during continuous walking, strategies for responding to perturbations that rely on reach-like movements of the foot may be less effective than previously assumed. For perturbations that are detected around step initiation, walkers prefer to adapt by tailoring the global, pendular mechanics of the body.

Effect of coadministration of the GABA B agonist baclofen and the 5-HT 2C agonist Ro60-0175 on the expression of amphetamine-induced locomotor sensitization Abstract GABAB and 5-HT2C agonists are effective in attenuating the behavioral effects of psychostimulants. However, they induce adverse side effects when used in high doses. The previous evidence has suggested that the 5HT2C receptor activation effect could be produced by an increased release of GABA in the ventral tegmental area (VTA) and the consequent activation of GABAergic receptors. Therefore, the objective of this study was to evaluate the effects of joint administration of an intermediate dose of the GABAB agonist baclofen (3.0 mg/kg) with different doses of the 5HT2C agonist Ro60-0175 (0.3, 1.0, and 3.0 mg/kg) on the locomotor sensitization expression induced by the repeated administration of amphetamine (1.0 mg/kg). Our results showed an attenuation of the expression of sensitization in a dose-dependent manner with both agonists. In both cases, we observed a complete blockade at the highest dose. In addition, the intermediate dose of baclofen increased the effects of the three doses of Ro60-0175. These results support the role of the joint action of GABAB and 5-HT2C receptors in the effects of psychostimulants. However, it remains to be explored whether the observed effect can be attributed to receptors located in the VTA or the nucleus accumbens.

Divergent effects of conditioned pain modulation on subjective pain and nociceptive-related brain activity Abstract Background and objectives Pain is a complex experience involving both nociceptive and affective–cognitive mechanisms. The present study evaluated whether modulation of pain perception, employing a conditioned pain modulation (CPM) paradigm, is paralleled by changes in contact heat-evoked potentials (CHEPs), a brain response to nociceptive stimuli. Methods Participants were 25 healthy, pain-free, college students (12 males, 13 females, mean age 19.24 ± 0.97 years). Twenty computer-controlled heat stimuli were delivered to the non-dominant forearm and CHEPs were recorded at Cz using a 32-channel EEG system. After each stimulus, participants rated the intensity of the heat pain using the 0–100 numerical rating scale. The latency and amplitude of N2, P2 components as well as single-sweep spectral analysis of individual CHEPs were measured offline. For CPM, participants had to submerge their dominant foot into a neutral (32 °C) or noxious (0 °C) water bath. CHEPs and heat pain ratings were recorded in 3 different conditions: without CPM, after neutral CPM (32 °C) and after noxious CPM (0 °C). Results The noxious CPM induced a facilitatory pain response (p = 0.001) with an increase in heat pain following noxious CPM compared to neutral CPM (p = 0.001) and no CPM (p = 0.001). Changes in CHEPs did not differ between conditions when measured as N2–P2 peak-to-peak amplitude (p = 0.33) but the CPM significantly suppressed the CHEPs-related delta power (p = 0.03). Changes in heat pain in the noxious CPM were predicted by trait catastrophizing variables (p = 0.04). Conclusion The current study revealed that pain facilitatory CPM is related to suppression of CHEPs delta power which could be related to dissociation between brain responses to noxious heat and pain perception.

How does environmental knowledge allow us to come back home? Abstract Herein, we investigate how the three types of mental spatial representation (landmark, route and survey) are reorganized to perform wayfinding and homing behaviour. We also investigate the contribution of visuo-spatial working memory in reaching and in vista space in performing the retracing of the path. For this purpose, we asked 68 healthy college students to learn and come back along an unknown path in a real environment and to perform two different forward and backward working memory tasks, one in the reaching space (Corsi Block-Tapping Test) and the other in a vista space (Walking Corsi Test). The results show that participants performed better when travelling the route forward (which corresponds to the originally learned direction) than when travelling the route backward (return path) and that working memory in vista space is crucial for both wayfinding and homing behaviour, while the working memory for reaching space contributes only to homing behaviour. Although homing behaviour is an early mechanism in navigation shared among many species, it represents a very complex behaviour that requires both topographic and visuo-spatial memory as well as the first two levels of environmental knowledge.

Transcranial alternating current stimulation over the prefrontal cortex enhances episodic memory recognition Abstract It remains unknown whether transcranial alternating current stimulation (tACS) affects episodic memory and the effect of gamma oscillations delivered to the left prefrontal cortex (PFC) on long-term memory retention has not been fully investigated. We examined whether tACS over the left PFC enhances recognition of episodic memory. The study enrolled 36 healthy young adult volunteers. The participants were randomly assigned to either a tACS group [n = 18; 14 females; mean age ± standard deviation (SD): 21.2 ± 0.4 years] or a sham-control group [n = 18; 14 females; mean age ± SD: 21.2 ± 0.4 years]. Participants received either tACS or sham stimulation both during the learning task that was conducted on day 1 and during a recognition task on day 2. The recognition task was also conducted on days 1 and 7, and response accuracy was measured at all three time points (days 1, 2, and 7). Patients in the tACS group were better able to retain long-term memory than those in the sham-control group. These findings suggest that tACS over the left PFC enhances recognition of episodic memory in healthy young adults.

Neuromechanical control of leg length and orientation in children and adults during single-leg hopping Abstract Adult-like fine control of cyclical motor patterns found in locomotion develops into adolescence. Single-leg hopping in place is one such motor pattern where children have demonstrated a reduced capacity to control horizontal motion and match metronome cues. These developmental differences might arise from immature inter-segment coordination strategies and variability regulation. Therefore, the purpose of this study was to use an uncontrolled manifold (UCM) analysis to evaluate the control of segment angle variance (i.e., local variables) to stabilize leg length and leg orientation (i.e., task variables) in the sagittal plane between young adults and children aged 5–11 years old while hopping at different frequencies. The UCM space and its orthogonal space were constructed and segment angle variance was partitioned into these two spaces. Increased variance in the UCM space represents the stabilization of a task variable, while increased variance in its orthogonal space indicates a greater deviation of a task variable from its mean value. Our results indicated that children have developed an adult-like inter-segment coordination strategy of stabilizing leg length at mid-stance and leg orientation during flight. However, children might have an underdeveloped capacity to modulate leg length at take-off from cycle-to-cycle. Moreover, when increasing hopping frequency, children showed limited capacity to selectively increase leg-length stabilization. When decreasing hopping frequency, children illustrated an increased stabilization of leg orientation over the entire stance phase. Mid-stance leg-length stabilization might emerge with the motor skill; however, other inter-segment coordination strategies might continue to develop beyond 11-years of age.

Remote muscle contraction enhances spinal reflexes in multiple lower-limb muscles elicited by transcutaneous spinal cord stimulation Abstract Transcutaneous spinal cord stimulation (tSCS) is a useful technique for the clinical assessment of neurological disorders. However, the characteristics of the spinal cord circuits activated by tSCS are not yet fully understood. In this study, we examined whether remote muscle contraction enhances the spinal reflexes evoked by tSCS in multiple lower-limb muscles. Eight healthy men participated in the current experiment, which required them to grip a dynamometer as fast as possible after the presentation of an auditory cue. Spinal reflexes were evoked in multiple lower-limb muscles with different time intervals (50–400 ms) after the auditory signals. The amplitudes of the spinal reflexes in all the recorded leg muscles significantly increased at 50–250 ms after remote muscle activation onset. This suggests that remote muscle contraction simultaneously facilitates the spinal reflexes in multiple lower-limb muscles. In addition, eight healthy men performed five different tasks (i.e., rest, hand grip, pinch grip, elbow flexion, and shoulder flexion). Compared to control values recorded just before each task, the spinal reflexes evoked at 250 ms after the auditory signals were significantly enhanced by the above tasks except for the rest task. This indicates that such facilitatory effects are also induced by remote muscle contractions in different upper-limb areas. The present results demonstrate the existence of a neural interaction between remote upper-limb muscles and spinal reflex circuits activated by tSCS in multiple lower-limb muscles. The combination of tSCS and remote muscle contraction may be useful for the neurological examination of spinal cord circuits.

Force asymmetry deteriorates complementary force production during joint action Abstract The present study aimed to determine the effects of force asymmetry on interpersonal force production. This study consisted of an individual task executed by one participant at a time in a pair, and three joint tasks executed by two participants simultaneously under conditions of 1:1, 1:0.75, and 1:0.5. Two individuals produced discrete forces at the same time so that the sum of forces they produced was the target force in the joint task. Under the 1:1 condition, the target force was the sum of the maximum voluntary contraction (MVC) produced by the index finger of each participant × 0.1 (10% MVC). Under the 1:0.75 condition, the investigators manipulated the force produced by only one of the pair, for example, B, but not A. The feedback was also scaled as a result. The target force was the MVC of participant A + the MVC of participant B × 0.75 × 0.1. Similarly, the target force under the 1:0.5 condition was the MVC of participant A + the MVC of participant B × 0.5 × 0.1. The present study found that forces produced by pairs were negatively correlated and the correlation value was higher under the 1:1 condition than the 1:0.75 and 1:0.5 conditions. The absolute error was smaller under the 1:1 condition than the 1:0.5 condition. Complementary force production was attenuated and the error increased as differences between forces produced by two participants increased. Thus, asymmetry of forces produced by pairs deteriorated complementary force production and interpersonal performance.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Nuclear Medicine and Molecular Imaging

Endorsement of International Consensus Radiochemistry Nomenclature Guidelines

Treatment of brain metastases of castration-resistant prostate cancer with 225 Ac-PSMA-617

Retroperitoneal fibrosis in on-going anti-PD-1 immunotherapy detected with [ 18 F]-FDG PET/CT

Correction to: 18 F-DOPA PET/CT in brain tumors: impact on multidisciplinary brain tumor board decisions Jérôme Barriere was inadvertently missing in the original version of this article. He has participated to the study design, protocol writing and inclusion of a significant number of patients.

Reply to the letter

Small-voxel reconstructions significantly influence SUVs in PET imaging

Transfer of yttrium-90 to breast milk during radiosynoviorthesis of the knee joint Dear Sir, Radiosynoviorthesis (RSO) (or radiation synovectomy), which involves intra-articular injection of small radioactive particles, is a well-established therapy in arthritis to treat villonodular synovitis, rheumatoid arthritis and related indications [1, 2, 3, 4]. RSO should only be used when all methods of conservative therapy have failed [5]. Various radioisotopes have been used for RSO, including gold-198, yttrium-90, erbium-169, rhenium-186 and phosphorus-32, but the silicate colloid of yttrium-90 (90Y) is currently preferred [6]. 90Y is a pure beta emitter with a mean/maximum tissue penetration depth of 3.6/11 mm, minimizing the radiation absorbed dose to the non-target tissue. It has a mean half-life of 2.7 days. After direct injection into the articular cavity, the 90Y colloid particles are phagocytized by macrophages and other inflammatory cells [7]. However, the lymphatic circulation may result in leakage of radionuclides to the locoregional lymph nodes and,...

Andrei Iagaru, Thomas Hope, Patrick Veit-Haibach (Eds): PET/MRI in Oncology. Current Clinical Applications

Breaking an unhelpful circle, where innovation and regularia delay clinical practice for patient benefit

EANM Focus 1: one small step for two men, one giant leap for a specialty

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Child and Adolescent Social Work

Prevalence of Substance Use, Housing Instability, and Self-Perceived Preparation for Independence Among Current and Former Foster Youth Abstract This study assesses prevalence of substance use, and the impact of housing instability. and independence preparation on substance use in two samples: youth currently in-care and former foster youth. Both samples were from a mid-Atlantic state with youth currently in-care residing in rural jurisdictions and former foster youth residing in the state's largest urban jurisdiction. A cross-sectional design utilizing paper and web-based surveys was used to collect data. Findings indicate youth in-care are consuming substances that are on average with national prevalence statistics. However, former foster youth are consuming substances at alarmingly high rates well above the national prevalence. A high rate of housing instability after leaving child welfare was reported for former foster youth. In addition, greater preparation for independence among former foster youth was associated with less substance usage. Implications for social work practice, independence preparation, and life skills classes are presented.

Association of School Engagement, Academic Difficulties and School Avoidance with Psychological Difficulties Among Adolescents Admitted to a Psychiatric Inpatient Unit Abstract Mental illness is a pressing public health concern, particularly when the onset is during childhood or adolescence. Many youth admitted to hospital-based psychiatric care experience school-related difficulties. The purpose of this report was to explore the associations of academic difficulties, school avoidance and school engagement to total psychological difficulties and emotional problems. Youth completed surveys that included standardized measures of school-related factors and the Strengths and Difficulties Questionnaire while in hospital. Psychiatrists provided the primary diagnosis and diagnosis most responsible for the current admission. In total, 161 patients participated in this study (mean age 15 years, SD 1.4; 75% female). All three school-related variables were significantly associated with emotional problems; however, only school avoidance and academic difficulties were associated with total difficulties. School-related concerns were significantly associated with the severity of mental health symptoms. Patients may benefit from attention to school-related difficulties before discharge from psychiatric care that continues beyond school reintegration.

Examining Parental Alienation Treatments: Problems of Principles and Practices Abstract When children of high-conflict divorced parents prefer one parent and resist or refuse visitation with the other parent, some authors have spoken of this situation as parental alienation (PA). PA refers to cases of avoidance of a parent in which the preferred parent is alleged to have manipulated the child's thinking and created antagonism toward the non-preferred parent, and in which neither abuse nor neglect has been substantiated. Advocates of the PA concept have offered treatment methods that entail court-ordered separation of the child from the preferred parent, followed by intensive treatment and aftercare through specialized counseling, with separation and treatment sometimes lasting years. This paper examines the published evidence and other material related to the safety and effectiveness of PA treatments, and concludes that the treatments have not been shown to be effective, but are in fact potentially harmful. Suggestions are made for research approaches that could help to explain avoidance of a parent and that could yield effective treatment for such avoidance.

My Path Towards Living on My Own: Voices of Youth Leaving Dutch Secure Residential Care Abstract Youth departing from secure youth care are often not well prepared for living on their own. This study aims to provide more insight into youth's perspectives on what they need to improve their chances for successful return to and participation in Dutch society. The study is a first necessary step on a journey to develop a tool for these youth to evaluate the development of autonomy and participation. We chose for a participatory research methodology. Youth participated as co-researchers in all steps of the research. Sixteen adolescents aged 15–20 years participated in open in-depth interviews using an autobiographical life story method. They were treated as partners and future owners of the tool to be developed. The interviews were transcribed and analysed. Realizing trustworthy social bonds appeared essential for developing autonomy. Youth started to move when they were socially connected and had found out what they value. Then they started "to do their thing" and "to find their own path", which was their language for experiencing autonomy. An interesting new finding was the importance of rest for youth to enable them to develop self-insight and to find their own path. The findings imply that staff in secure residential care should invite youth to develop their own ideas about their life and future, stimulate exploration and reflection, and a dialogue with people around them. Opportunity for acting, trying and doing is also needed, so that youth can discover in practice what works for them.

Foster Care Alumni and Higher Education: A Descriptive Study of Post-secondary Achievements of Foster Youth in Texas Abstract In 1993, Texas became one of the first states to adopt a post-secondary tuition and fee waiver for foster youth. In the present study, we examine the post-secondary achievements of a cohort of foster youth in Texas. Youth formerly in care were followed from age 18 to 24. Academic data reveal that only 1.5% of the youth received a bachelor's degree and 2% received an associate's degree or certificate, despite the state tuition and fee waiver. While we cannot assess causality, our descriptive data indicate potential waiver benefits in terms of post-secondary enrollment, retention, and graduation rates. However, results reveal that a significant percentage of emancipated youth who enroll in college (all waiver eligible), do not utilize the waiver (46%). In addition, the graduation rate for waiver recipients, while higher than non-recipients, is low. Study findings suggest that waivers may be a viable strategy for promoting higher education among foster youth. However, to substantively improve post-secondary outcomes for foster youth, tuition legislation must be supplemented with initiatives specifically designed to promote waiver utilization as well as college retention and graduation.

Needs of Newcomer Youth Abstract The journey following migration for adolescent youth can consist of psychosocial and sociocultural difficulties with acculturating and integrating into the new host society. The family unit, however, has been identified to be a source of strength and wellbeing for youth during the integration process. This study explores factors that are suggested to make the home environment more supportive after migration. Newcomer youth between 15 and 18 years of age within a medium-sized Canadian city, living in Canada for no more than 2 years were interviewed in a group setting. Mixed methods were utilized and collected data was analyzed using concept mapping. Participants stated wanting more positive feedback from and increased communication with parents, in addition to having a home that is more open and welcoming to friends. The needs of youth can be sourced in the effects of the migrant journey and acculturation process. By improving the degrees of understanding, warmth, communication and cultural integration in the home, youth and their families can develop a greater sense of cohesion which can assist with supporting their migrant experience. Implications for practitioners working with newcomer youth and their families are provided, in addition to research and policy-related implications.

Sense and Sensibilities: Schoolboys Talk about Sex in the Private Conversational Space Abstract This article focuses on the narratives of 18 adolescent boys as they engaged with issues of sex, sexuality and peer relations in their daily lives. The ethnographic research was conducted in two public secondary schools in a working-class community within KwaZulu-Natal, South Africa. Participants were boys aged between 16 and 19 years, who self-identified as either Black African or Indian. Theories of positioning are employed in this paper to delve into the complexity and intricacies of boys enacting their masculinities and sexual identities within a one-to-one interview space with one of the researchers. Identity performance in this private space is read in relation to public positions (in the company of peers), exposing the malleable nature of positioning and its subjective use in different spaces. Findings suggest that boys' struggle with the concept and social practice of 'masculinity', and that while they may not want to be seen as aspiring to certain ideals regarding male sexuality, these values remain a standard against which to evaluate self and other. In the individual interviews, authenticity as a heterosexual man is negotiated through various rhetorical strategies, namely a tendency to self-position as mature and sensible. It is argued that positionality is a useful conceptual tool for highlighting diversities in the performance of masculinities, and that intervention strategies need to pay attention to how spaces are constructed and nurtured for boys to engage with the ideological dilemmas in their identity development.

Adolescent–Parent Communication Among Youth Who Have and Have Not Experienced Dating Violence Abstract The current study examines the impact of adolescent–parent communication, which can play a significant role in alleviating risk behaviors, especially adolescent dating violence (ADV). Adolescents (N = 55; 28 males and 27 females), majority of whom were Latinos, were recruited from social service agencies serving youth and families. Adolescents completed a paper survey on the Parent–Adolescent Communication (comprised of open and problematic subscales) and Revised Conflict Tactics scales. T-tests and ANOVAs were conducted revealing that youth with ADV experience reported lower overall communication levels with their parents and increased problematic communication, especially with their mothers than adolescents with no ADV experience. No significant difference emerged by age or gender but Latino youth who experience ADV had lower levels of problematic communication with both parents. Teens, whose mothers were receiving domestic violence-related services, versus who were not receiving services, reported more overall communication with their mothers. Implications for educators, practitioners, and research are provided.

They Don't Listen: A Qualitative Interpretive Meta-synthesis of Children's Sexual Abuse Abstract Although the literature is copious with studies using qualitative methodology to retrospectively explore issues related to child sexual abuse (CSA) from the adult's perspective, there is a dearth of qualitative literature regarding the child's perception of sexual abuse. The purpose of this qualitative interpretive meta-synthesis (QIMS) is to inform practice and research to understand how children make sense of sexual abuse, the factors that influence their disclosure experiences, and coping methods used after disclosure. The QIMS included studies from various disciplines, including psychology, sociology, social work and medicine, to understand the experiences of childhood victims of sexual abuse. Three themes and five subthemes emerged: (1) phases of CSA: (a) initial onset of symptoms, (b) maladaptive coping, and (c) paralyzing fear; (2) types of disclosure: (a) healthy disclosure and healing and (b) destructive disclosure, and; (3) traumatizing "helping" process for CSA victims. In an effort to reduce negative outcomes associated with CSA, it is imperative to explore one's perception of sexual abuse while still a child to inform prevention and intervention efforts of their specific understanding of the experience.

Validation of the Abbreviated Socio-Political Control Scale for Youth (SPCS-Y) Among Urban Girls of Color Abstract This study tested and validated the factor structure of the abbreviated Sociopolitical Control Scale for Youth (SPCS-Y) among a sample of urban girls of color. Participants include (N = 830) urban girls of color from a northeastern United States community. Confirmatory Factor analyses (CFA) were conducted using AMOS Structural Equation Modeling Software. Cluster groups were created using Latent Class Cluster Analysis (LCA) and tested using Multivariate analysis of covariance (MANCOVA) with conceptually related variables. CFA results supported the two-factor structure of the abbreviated SPCS-Y among the sample. Following the creation of cluster groups, MANCOVA analyses revealed significant heterogeneity among cluster groups of participants on neighborhood sense of community, social support, ethnic identity, and lower levels of drug use. Findings support the factor structure of the SPCS-Y and its use to measure empowerment among girls of color. Results contribute significantly to the field of social work and encourages the importance of promoting strengths-based approaches among girls of color. Implications for social work practice with girls of color are conveyed in light of the need for reliable measurement tools for practitioners.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Critical Care Medicine

Perioperative Assessment of Cerebral Oxygen Metabolism in Infants With Functionally Univentricular Hearts Undergoing the Bidirectional Cavopulmonary Connection Objectives: The transition from single-ventricle lesions with surgically placed systemic-to-pulmonary artery shunt to the circulation following a bidirectional cavopulmonary connection results in higher pressure in the superior vena cava when compared with the preceding circulation. The aim of this study was to evaluate the impact of this transition on the perioperative cerebral oxygen metabolism. Design: Prospective observational cohort study. Setting: Pediatric critical care unit of a tertiary referral center. Patients: Sixteen infants after bidirectional cavopulmonary connection. Intervention: Cardiac surgery (bidirectional cavopulmonary connection). Measurements and Main Results: We measured regional cerebral oxygen saturation, amount of hemoglobin, blood flow velocity, and microperfusion immediately before, 12–24 hours, and 36–48 hours following bidirectional cavopulmonary connection. Based on these measurements, we calculated cerebral fractional tissue oxygen extraction and approximated cerebral metabolic rate of oxygen. Mean pressure in the superior vena cava increased significantly (8 vs 17 mm Hg; p < 0.001) following bidirectional cavopulmonary connection. Mean cerebral oxygen saturation increased from 49.0% (27.4–61.0) to 56.9% (39.5–64.0) (p = 0.008), whereas mean cerebral blood flow velocity decreased from 80.0 arbitrary units (61.9–93.0) to 67.3 arbitrary units (59.0–83.3) (p < 0.001). No change was found in the cerebral amount of hemoglobin and in the cerebral microperfusion. Mean cerebral fractional tissue oxygen extraction (0.48 [0.17–0.63] vs 0.30 [0.19–0.56]; p = 0.006) and approximated cerebral metabolic rate of oxygen (5.82 arbitrary units [2.70–8.78] vs 2.27 arbitrary units [1.19–7.35]; p < 0.001) decreased significantly. Conclusions: Establishment of bidirectional cavopulmonary connection is associated with postoperative improvement in cerebral oxygen metabolism. Cerebral amount of hemoglobin did not increase, although creation of the bidirectional cavopulmonary connection results in significant elevation in superior vena cava pressure. Improvement in cerebral oxygen metabolism was due to lower cerebral blood flow velocity and stable microperfusion, which may indicate intact cerebral autoregulation. Drs. Neunhoeffer and Michel are co-first authors and contributed equally to this work. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http:/journals.lww.com/pccmjournal). Supported, in part, by grants from the foundation Stiftung KinderHerz. The authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: felix.neunhoeffer@med.uni-tuebingen.de ©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

Decision-Making Around Positive Tracheal Aspirate Cultures: The Role of Neutrophil Semiquantification in Antibiotic Prescribing Objectives: Ventilator-associated infections are a major contributor to antibiotic use in the PICU. Quantitative or semiquantitative assessment of neutrophils (microscopic purulence) is routinely reported in positive cultures from tracheal aspirates. The role of microscopic purulence in guiding antibiotic therapy or its association with symptoms of ventilator-associated infections is less described in children. We examine microscopic purulence as an independent predictor of antibiotic use for positive tracheal aspirate cultures in the PICU. Design: Retrospective cohort study. Setting: Tertiary care pediatric hospital. Patients: Children admitted to the PICU, neuro-PICU, or cardiac PICU with a positive tracheal aspirate culture from January 1, 2016, to December 31, 2016. Interventions: None. Measurements and Main Results: Positive tracheal aspirate cultures were reviewed. The outcome variable was antibiotic treatment that targeted the positive tracheal aspirate culture. The predictor variable was microscopic purulence, defined as moderate or many neutrophils on Gram stain report. Competing predictors included demographics, comorbidities, vital signs changes, respiratory support, and laboratory values. Of 361 positive cultures in the cohort, 81 (22%) were treated with antibiotics. Positive cultures with microscopic purulence were targeted for therapy more frequently (30% vs 11%). Microscopic purulence was the strongest predictor for antibiotic therapy (odds ratio, 3.3; 95% CI, 1.6–6.8) compared with fever (odds ratio, 2.0; 95% CI, 1.0–4.1) or increased respiratory support (odds ratio, 2.3; 95% CI, 1.2–4.3). There was no significant variation in symptomatology between microscopic purulence reported as moderate or many versus other (e.g., fever –24% vs 22%, increased respiratory support –36% vs 28%). Microscopic purulence was less prevalent with longer ventilator durations at the time of sampling. Conclusions: Microscopic purulence was an independent predictor of antibiotic therapy for positive tracheal aspirate cultures in our PICUs. However, microscopic purulence was not associated with clinical symptomatology. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/pccmjournal). Dr. Saiman's institution received grant funding form Merck, and she received funding from TEVA and AB Comm. The remaining authors have disclosed that they do not have any potential conflicts of interest. This work was performed at Morgan Stanley Children's Hospital, New York Presbyterian-Columbia University Irving Medical Center. For information regarding this article, E-mail: sirisha.yalamanchi@rutgers.edu ©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

Impact of Age of Packed RBC Transfusion on Oxygenation in Patients Receiving Extracorporeal Membrane Oxygenation Objective: To determine the effect of age of packed RBCs on tissue oxygenation in children receiving extracorporeal membrane oxygenation support. Design: A retrospective study was done between March 2013 and August 2015. The following biomarkers were examined 6 hours before and 6 hours after the conclusion of a transfusion: serum and circuit hematocrits, serum and circuit venous saturations, serum lactate levels (mg/dL), and cerebral saturation via near-infrared spectroscopy. Biomarkers were examined with respect to time relative to transfusion using four discrete categories (< 3, –3 to 0, 0–3, and > 3 hr). The association between age of blood transfusion and change in biomarkers was accessed analyzing time relative to transfusion as described above. In addition, the age of blood transfusion was analyzed similarly, using four discrete categories (0–7, 7–14, 14–21, and > 21 d). Setting: Twenty-four bed mixed pediatric medical and cardiac ICU at a tertiary care center. Subjects: Zero- to 18-year-old patients of required extracorporeal membrane oxygenation support. Interventions: None. Measurements and Main Results: Circuit venous saturation demonstrated an increase of 2.5% (p < 0.001) in first 3 hours posttransfusion. This was followed by a 1.4% decrease after the initial 3 hours posttransfusion. Serum venous saturation showed no statistically significant change with relation to transfusions. Neither lactate levels nor near-infrared spectroscopy demonstrated any observed statistical change with relation to transfusion. With regards to the relationship between the age of RBC transfusion and tissue oxygenation biomarkers, none of the biomarkers exhibited a consistent interaction. Conclusions: Our study demonstrates that the age of packed RBC transfusion does not affect the degree tissue oxygenation in children receiving extracorporeal membrane oxygenation support, as measured by mixed venous oxygen saturation, lactate, and near-infrared spectroscopy. In addition, packed RBC transfusion, in general, did not produce any meaningful change in these markers of tissue oxygenation. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/pccmjournal). Dr. Chang received funding from Ortho Clinical Diagnostics. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: sdatta.ucla@gmail.com ©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

Antithrombin Population Pharmacokinetics in Pediatric Ventricular Assist Device Patients Objectives: Describe the pharmacokinetics of antithrombin in pediatric patients undergoing ventricular assist device therapy and provide dosing recommendations for antithrombin in this population. Design: A retrospective population pharmacokinetic study was designed. Setting: Large tertiary care children's hospital Subject inclusion criteria consisted of less than 19 years old. Patients: Subjects less than 19 years old undergoing therapy with a HeartWare ventricular assist device (HeartWare, Framingham, MA) or Berlin EXCOR ventricular assist device (Berlin GmbH, Berlin, Germany), who received a dose of antithrombin with a postdose antithrombin activity level from January 1, 2011, to June 30, 2017. Interventions: Population pharmacokinetic analysis and simulation using NONMEM v.7.4 (Icon, PLC, Dublin, Ireland). Measurements and Main Results: A total of 41 patients met study criteria (median age, 5.8 years [interquartile range, 1.6–9.9 yr]), and 53.7% underwent therapy with the pulsatile Berlin EXCOR pediatric ventricular assist device (Berlin Heart GmbH, Berlin, Germany). All patients received unfractionated heparin continuous infusion at a mean ± SD dose of 29 ± 14 U/kg/hr. A total of 181 antithrombin doses (44.1 ± 24.6 U/kg/dose) were included, and baseline antithrombin activity levels were 77 ± 12 U/dL. Antithrombin activity levels were drawn a median 19.9 hours (interquartile range, 8.8–41.6 hr) after antithrombin dose. A one-compartment proportional error model best fit the data, with allometric scaling of fat-free mass providing a better model fit than actual body weight. Unfractionated heparin and baseline antithrombin were identified as significant covariates. A 50 U/kg dose of antithrombin had a simulated half-life 13.2 ± 6.6 hours. Conclusions: Antithrombin should be dosed on fat-free mass in pediatric ventricular assist device patients. Unfractionated heparin dose and baseline antithrombin activity level should be considered when dosing antithrombin in pediatric ventricular assist device patients. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http:/journals.lww.com/pccmjournal). Dr. Moffett disclosed off-label product use of antithrombin in pediatric ventricular assist device patients. Dr. Teruya received funding from STAGO (reagent company for coagulation, Advisory committee), Evaheart, and Octapharma. Dr. Adachi serves as consultant and proctor for Berlin Heart and Medtronic and consultant for Sony-Olympus Medical Solutions. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: bsmoffet@texaschildrens.org ©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

Cardiopulmonary Resuscitation in the Pediatric Cardiac Catheterization Laboratory: A Report From the American Heart Association's Get With the Guidelines-Resuscitation Registry Objectives: Hospitalized children with underlying heart disease are at high risk for cardiac arrest, particularly when they undergo invasive catheterization procedures for diagnostic and therapeutic interventions. Outcomes for children experiencing cardiac arrest in the cardiac catheterization laboratory remain under-reported with few studies reporting survival beyond the catheterization laboratory. We aim to describe survival outcomes after cardiac arrest in the cardiac catheterization laboratory while identifying risk factors associated with hospital mortality after these events. Design: Retrospective observational study of data from a multicenter cardiac arrest registry from November 2005 to November 2016. Cardiac arrest in the cardiac catheterization laboratory was defined as the need for chest compressions greater than or equal to 1 minute in the cardiac catheterization laboratory. Primary outcome was survival to discharge. Variables analyzed using generalized estimating equations for association with survival included age, illness category (surgical cardiac, medical cardiac), preexisting conditions, pharmacologic interventions, and event duration. Setting: American Heart Association's Get With the Guidelines-Resuscitation registry of in-hospital cardiac arrest. Patients: Consecutive patients less than 18 years old experiencing an index (i.e., first) cardiac arrest event reported to the Get With the Guidelines-Resuscitation. Interventions: None. Measurements and Main Results: A total of 203 patients met definition of index cardiac arrest in the cardiac catheterization laboratory composed primarily of surgical and medical cardiac patients (54% and 41%, respectively). Children less than 1 year old comprised the majority of patients, 58% (117/203). Overall survival to hospital discharge was 69% (141/203). No differences in survival were observed between surgical and medical cardiac patients (p = 0.15). The majority of deaths (69%, 43/62) occurred in patients less than 1 year old. Bradycardia (with pulse) followed by pulseless electrical activity/asystole were the most common first documented rhythms observed (50% and 27%, respectively). Preexisting metabolic/electrolyte abnormalities (p = 0.02), need for vasoactive infusions (p = 0.03) prior to arrest, and use of calcium products (p = 0.005) were found to be significantly associated with lower rates of survival to discharge on multivariable regression. Conclusions: The majority of children experiencing cardiac arrest in the cardiac catheterization laboratory in this large multicenter registry analysis survived to hospital discharge, with no observable difference in outcomes between surgical and medical cardiac patients. Future investigations that focus on stratifying medical complexity in addition to procedural characteristics at the time of catheterization are needed to better identify risks for mortality after cardiac arrest in the cardiac catheterization laboratory. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/pccmjournal). Supported, in part, by grant from the Texas Children's Hospital departmental funds were used for this study. The scientific advisory board of the American Heart Association (AHA) provided review and approval of the article, and the Executive Database Steering Committee of the AHA provided additional peer review of the article before submission. Part of the content of this article was presented in poster abstract format at the American Heart Association's Scientific Sessions, November 12, 2017, Anaheim, CA. The authors have disclosed that they do not have any potential conflicts of interest. Address requests for reprints to: Javier J. Lasa, MD, FAAP, Department of Pediatrics, Divisions of Critical Care Medicine and Cardiology, Texas Children's Hospital/Baylor College of Medicine, MC: E1420, 6651 Main Street, Houston, TX 77030. E-mail: jjlasa@texaschildrens.org ©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

Superiority of Dynamic Needle Tip Positioning for Ultrasound-Guided Peripheral Venous Catheterization in Patients Younger Than 2 Years Old: A Randomized Controlled Trial Objectives: This study evaluated whether the dynamic needle tip positioning technique increased the success rate of ultrasound-guided peripheral venous catheterization in pediatric patients with a small-diameter vein compared with the static ultrasound-guided technique. Design: Randomized controlled study. Setting: Single institution, Osaka Women's and Children's Hospital. Patients: The study population included 60 pediatric patients less than 2 years old who required peripheral venous catheterization in the PICU. Interventions: Patients were randomly divided into the dynamic needle tip positioning (n = 30) or static group (n = 30). Each group received ultrasound-guided peripheral venous catheterization with or without dynamic needle tip positioning, respectively. The Fisher exact test, Kaplan-Meier curve plots, log-rank tests, and Mann-Whitney U test were used in the statistical analysis. Measurements and Main Results: The first-attempt success rate was higher in the dynamic needle tip positioning group than in the static group (86.7% vs 60%; p = 0.039; relative risk = 1.44; 95% CI, 1.05–2.0). The overall success rate within 10 minutes was higher in the dynamic needle tip positioning group than in the static group (90% vs 63.3%; p = 0.03; relative risk = 1.42; 95% CI, 1.06–1.91). Significantly fewer attempts were made in the dynamic needle tip positioning group than in the static group (median [interquartile range, range] = 1 [1–1, 1–2] vs 1 [1–2, 1–3]; p = 0.013]). The median (interquartile range) catheterization times were 51.5 seconds (43–63 s) and 71.5 seconds (45–600 s) in the dynamic needle tip positioning and static groups, respectively (p = 0.01). Conclusions: Dynamic needle tip positioning increased the first-attempt and overall success rates of ultrasound-guided peripheral venous catheterization in pediatric patients less than 2 years old. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/pccmjournal). The authors have disclosed that they do not have any potential conflicts of interest. This work was performed at Osaka Women's and Children's Hospital. For information regarding this article, E-mail: t-k-s-t@koto.kpu-m.ac.jp ©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

Trauma Bay Disposition of Infants and Young Children With Mild Traumatic Brain Injury and Positive Head Imaging Objectives: To describe the disposition of infants and young children with isolated mild traumatic brain injury and neuroimaging findings evaluated at a level 1 pediatric trauma center, and identify factors associated with their need for ICU admission. Design: Retrospective cohort. Setting: Single center. Patients: Children less than or equal to 4 years old with mild traumatic brain injury (Glasgow Coma Scale 13–15) and neuroimaging findings evaluated between January 1, 2013, and December 31, 2015. Polytrauma victims and patients requiring intubation or vasoactive infusions preadmission were excluded. Interventions: None. Measurements and Main Results: Two-hundred ten children (median age/weight/Glasgow Coma Scale: 6 mo/7.5 kg/15) met inclusion criteria. Most neuroimaging showed skull fractures with extra-axial hemorrhage/no midline shift (30%), nondisplaced skull fractures (28%), and intracranial hemorrhage without fractures/midline shift (19%). Trauma bay disposition included ICU (48%), ward (38%), intermediate care unit and home (7% each). Overall, 1% required intubation, 4.3% seizure management, and 4.3% neurosurgical procedures; 15% were diagnosed with nonaccidental trauma. None of the ward/intermediate care unit patients were transferred to ICU. Median ICU/hospital length of stay was 2 days. Most patients (99%) were discharged home without neurologic deficits. The ICU subgroup included all patients with midline shift, 62% patients with intracranial hemorrhage, and 20% patients with skull fractures. Across these imaging subtypes, the only clinical predictor of ICU admission was trauma bay Glasgow Coma Scale less than 15 (p = 0.018 for intracranial hemorrhage; p < 0.001 for skull fractures). A minority of ICU patients (18/100) required neurocritical care and/or neurosurgical interventions; risk factors included neurologic deficit, loss of consciousness/seizures, and extra-axial hemorrhage (especially epidural hematoma). Conclusions: Nearly half of our cohort was briefly monitored in the ICU (with disposition mostly explained by trauma bay imaging, rather than clinical findings); however, less than 10% required ICU-specific interventions. Although ICU could be used for close neuromonitoring to prevent further neurologic injury, additional research should explore if less conservative approaches may preserve patient safety while optimizing healthcare resource utilization. Drs. Noje and Jackson had equal contributions to this article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http:/journals.lww.com/pccmjournal). The authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: cnicule1@jhmi.edu ©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

Short- and Long-Term Outcomes of Extremely Preterm Infants in Japan According to Outborn/Inborn Birth Status Objectives: Outborn (born outside tertiary centers) infants, especially extremely preterm infants, are at an increased risk of mortality and morbidity in comparison to inborn (born in tertiary centers) infants. Extremely preterm infants require not only skilled neonatal healthcare providers but also highly specialized equipment and environment surroundings. Maternal transport at an appropriate timing must be done to avoid the delivery of extremely preterm infants in a facility without the necessary capabilities. Cases of unexpected deliveries at birth centers or level I maternity hospitals need to be attended emergently. We compared the differences in short- and long-term outcomes between outborn and inborn infants to improve our regional perinatal system. Design: Retrospective cohort study. Setting: Neonatal Research Network of Japan database. Patients: Extremely preterm infants (gestational age between 22 + 0 and 27 + 6 wk) in the Neonatal Research Network of Japan database between 2003 and 2011. Interventions: None. Measurements and Main Results: A total of 12,164 extremely preterm infants, who were divided into outborn (n = 785, 6.5%) and inborn (n = 11,379, 93.5%) groups, were analyzed. Significant differences were observed in demographic and clinical factors between the two groups. Outborn infants had higher short-term odds of severe intraventricular hemorrhage (adjusted odds ratio, 1.49; 95% CI, 1.11–2.00; p < 0.01), necrotizing enterocolitis (adjusted odds ratio, 1.49; 95% CI, 1.11–2.00; p < 0.01), and focal intestinal perforation (adjusted odds ratio, 1.58; 95% CI, 1.09–2.30; p = 0.02). There were no significant differences in long-term outcomes between the two groups, except in the rate of cognitive impairment (adjusted odds ratio, 1.49; 95% CI, 1.01–2.20; p = 0.04). Conclusions: The frequency of severe intraventricular hemorrhage, necrotizing enterocolitis or focal intestinal perforation, and cognitive impairment was significantly higher in outborn infants. Thus, outborn/inborn birth status may play a role in short- and long-term outcomes of extremely preterm infants. However, more data and evaluation of improvement in the current perinatal environment are needed. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. The authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: yoshihitosasaki@hotmail.co.jp ©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

Healthcare Provider Perceptions of Cardiopulmonary Resuscitation Quality During Simulation Training Objectives: To assess the relationship between quantitative and perceived cardiopulmonary resuscitation performance when healthcare providers have access to and familiarity with audiovisual feedback devices. Design: Prospective observational study. Setting: In situ simulation events throughout a pediatric quaternary care center where the use of continuous audiovisual feedback devices during cardiopulmonary resuscitation is standard. Subjects: Healthcare providers who serve as first responders to in-hospital cardiopulmonary arrest. Interventions: High-fidelity simulation of resuscitation with continuous audiovisual feedback. Measurements and Main Results: Objective data was collected using accelerometer-based measurements from a cardiopulmonary resuscitation defibrillator/monitor. After the simulation event but before any debriefing, participants completed self-evaluation forms to assess whether they believed the cardiopulmonary resuscitation performed met the American Heart Association guidelines for chest compression rate, chest compression depth, chest compression fraction, chest compression in target, and duration of preshock pause and postshock pause. An association coefficient (kappa) was calculated to determine degree of agreement between perceived performance and the quantitative performance data that was collected from the CPR defibrillator/monitor. Data from 27 mock codes and 236 participants was analyzed. Average cardiopulmonary resuscitation performance was chest compression rate 106 ± 10 compressions per minute; chest compression depth 2.05 ± 0.6 in; chest compression fraction 74% ± 10%; chest compression in target 22% ± 21%; preshock pause 8.6 ± 7.2 seconds; and postshock pause 6.4 ± 8.9 seconds. When all healthcare providers were analyzed, the association coefficient (κ) for chest compression rate (κ = 0.078), chest compression depth (κ = 0.092), chest compression fraction (κ = 0.004), preshock pause (κ = 0.321), and postshock pause (κ = 0.40) was low, with no variable achieving moderate agreement (κ > 0.4). Conclusions: Cardiopulmonary resuscitation performance during mock codes does not meet the American Heart Association's quality recommendations. Healthcare providers have poor insight into the quality of cardiopulmonary resuscitation during mock codes despite access to and familiarity with continuous audiovisual feedback. This work was performed at the Lucile Packard Children's Hospital Stanford. Supported, in part, by grant from the Laerdal Foundation and from the Jackson Vaughan Critical Care Research Fund. Dr. Su's institution received funding from Laerdal Foundation for Acute Medicine and Jackson Vaughan Critical Care Research Fund. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: lindsey.troy@hsc.utah.edu ©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

Telemedicine for Interfacility Nurse Handoffs Objective: To compare nurse preparedness and quality of patient handoff during interfacility transfers from a pretransfer emergency department to a PICU when conducted over telemedicine versus telephone. Design: Cross-sectional nurse survey linked with patient electronic medical record data using multivariable, multilevel analysis. Setting: Tertiary PICU within an academic children's hospital. Participants: PICU nurses who received a patient handoff between October 2017 and July 2018. Interventions: None. Main Results and Measurements: Among 239 eligible transfers, 106 surveys were completed by 55 nurses (44% survey response rate). Telemedicine was used for 30 handoffs (28%), and telephone was used for 76 handoffs (72%). Patients were comparable with respect to age, sex, race, primary spoken language, and insurance, but handoffs conducted over telemedicine involved patients with higher illness severity as measured by the Pediatric Risk of Mortality III score (4.4 vs 1.9; p = 0.05). After adjusting for Pediatric Risk of Mortality III score, survey recall time, and residual clustering by nurse, receiving nurses reported higher preparedness (measured on a five-point adjectival scale) following telemedicine handoffs compared with telephone handoffs (3.4 vs 3.1; p = 0.02). There were no statistically significant differences in both bivariable and multivariable analyses of handoff quality as measured by the Handoff Clinical Evaluation Exercise. Handoffs using telemedicine were associated with increased number of Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver components (3.3 vs 2.8; p = 0.04), but this difference was not significant in the adjusted analysis (3.1 vs 2.9; p = 0.55). Conclusions: Telemedicine is feasible for nurse-to-nurse handoffs of critically ill patients between pretransfer and receiving facilities and may be associated with increased perceived and objective nurse preparedness upon patient arrival. Additional research is needed to demonstrate that telemedicine during nurse handoffs improves communication, decreases preventable adverse events, and impacts family and provider satisfaction. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/pccmjournal). The telemedicine infrastructure for this study was developed with funds from grant number G01RH27872 from the Health Resources and Services Administration (HRSA), Federal Office of Rural Health Policy, Office for the Advancement of Telehealth and from grant number H3AMC24073 from HRSA, Maternal and Child Health Bureau, Emergency Medical Services for Children Program, and State Partnership Regionalization of Care. Ms. Lieng's institution received funding from National Center for Advancing Translational Sciences (NCATS) and National Institutes of Health (NIH)—grant number UL1 TR001860 and linked award TL1 TR001861 and KL2 TR001859. Ms. Lieng and Dr. Rosenthal received support for article research from the NIH. Dr. Rosenthal's institution received funding from NCATS and NIH—grant number UL1 TR001860 and linked award KL2 TR001859. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: mlieng@ucdavis.edu ©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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