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This study was aimed to evaluate the yearly incidence of pediatric narcolepsy prior to and following the 2009 H1N1 pandemic and to evaluate seasonal patterns of narcolepsy onset and associations with H1N1 influenza infection in the United States. This was a multicenter retrospective study with prospective follow-up. Participants were recruited from members of the Pediatric Working Group of the Sleep Research Network including 22 sites across the United States. The main outcomes were monthly and yearly incident cases of childhood narcolepsy in the United States, and its relationship to historical H1N1 influenza data. A total of 950 participants were included in the analysis; 487 participants were male (51.3%). The mean age at onset of excessive daytime sleepiness (EDS) was 9.6 ± 3.9 years. Significant trend changes in pediatric narcolepsy incidence based on EDS onset (p

Introduction An American Academy of Sleep Medicine (AASM) task force identified a need for a valid, reliable, patient-reported outcome measure (PROM) to monitor obstructive sleep apnea (OSA) in adults in clinical practice. Ideally, the PROM should be easy and quick to complete ( Methods Development of the OSA-Q included interviews with patients with OSA (n=14) to identify important concepts to them, conceptual model and draft questionnaire formulation, and cognitive interviews (n=14) to assess content validity and guide revisions to wording, item comprehension and redundancies, recall period, and response options. Usability of the electronic version of the OSA-Q was then assessed in patients with OSA. Finally, acceptability and utility of the OSA-Q in clinical practice was evaluated by surveying clinicians in ten geographically-dispersed US sleep clinics. Results Patient interviews were used to construct a conceptual model for the draft OSA-Q which served as a basis for generating 44 items about daytime/night-time symptoms and OSA impacts. Cognitive interviews identified poorly worded, ambiguous, and redundant items to inform revisions, resulting in a revised draft OSA-Q (3 domains, 28 items). Subsequently, clinicians (n=13) administered the draft OSA-Q to five patients each, obtained patients’ feedback on the OSA-Q, and completed a survey regarding its comprehensiveness, format/content, utility, and acceptability in clinical practice. These clinicians endorsed the OSA-Q for ease of use, language simplicity, convenience of electronic platform, and speed of completion (3-5 min). They also indicated that the OSA-Q would be useful in clinical practice and enhance patient communications (69% and 77%, respectively). The OSA-Q was revised and finalized for psychometric testing, based on clinician comments. Conclusion A new AASM-supported PROM to monitor OSA in clinical practice has been developed, including the patients’ perspective according to FDA guidance. This OSA-Q shows content validity and is positively perceived by clinicians. Psychometric testing of the OSA-Q is underway to establish its measurement properties and demonstrate its validity, reliability, and sensitivity to change in patients with OSA. Support (If Any) This work was funded by the American Academy of Sleep Medicine.

Background The reported incidence of brachial plexus birth injury (BPBI) is 0.87 to 2.2 per 1,000 live births. The psychological functioning, including self-concept and emotional-behavioral functioning, of children with BPBI has only been examined to a limited extent. Objective The purpose of this study was to describe the self-concept and emotional-behavioral functioning in children with BPBI from both the child's and parent's perspective. Methods Thirty-one children with BPBI, mean age 11 years 1 month, completed the Draw A Person: Screening Procedure for Emotional Disturbance (DAP:SPED) and Piers Harris Children's Self-Concept Scale (PHCSCS). The parents answered questions from the Behavior Assessment System for Children, Parent Rating Scales (BASC-2 PRS). Results The scores from the DAP:SPED drawings showed further evaluation was not strongly indicated in the majority of the children. The PHCSCS Total score demonstrated that the children had a strongly positive self-concept. The parental responses to the BASC-2 PRS indicated that few children were at risk or in the clinically significant range for the four composite scores and all of the component clinical or adaptive scales. Gender comparison revealed females exhibited greater anxiety than males. Conclusion Both children and parents reported a positive psychological well-being for the majority of the children. Parents had greater concerns about their child's social-emotional functioning, particularly anxiety. An interdisciplinary approach (occupational therapy evaluation, clinical observation, and parental interview) is necessary to determine the need for mental health referral.

OBJECTIVES: To report on the longitudinal cognitive functioning of older women receiving adjuvant chemotherapy for breast cancer. DESIGN: Neuropsychological and functional status testing were performed before chemotherapy and 6 months after chemotherapy. SETTING: Cancer center. PARTICIPANTS: Thirty-one patients aged 65 and older with Stage I to III breast cancer. Of the 31 patients enrolled, three refused posttesting, and 28 were evaluable. MEASUREMENTS: The following domains of cognitive function were examined: attention; verbal memory; visual memory; and verbal, spatial, psychomotor, and executive functions. RESULTS: Participants had a mean age of 71 (range 65–84): 39% Stage I, 50% Stage II, and 11% Stage III. The number of scores 2 standard deviations (SDs) below the norm were calculated for each patient before and 6 months after chemotherapy; 14 (50%) had no change, 11 (39%) worsened, and three (11%) improved (P=.05). Seven patients (25%) experienced a decline in cognitive function, defined as a 1-SD decline from pre- to posttesting in two or more neuropsychological domains. Exploratory analyses revealed no significant difference between functional status, comorbidity, and depression scale scores and change in overall quality-of-life scores before and after chemotherapy. CONCLUSION: In this cohort of older women receiving adjuvant chemotherapy, a subset experienced a decline in cognitive function from before chemotherapy to 6 months after chemotherapy. Further prospective study is needed to confirm these observations and to identify the subgroup at special risk.

Always honing the theatrical tools with which to chart unknown emotional territory, Shepard in A Lie of the Mind more radically than before creates a new stage language, returning to the battered, objectified, and silenced female subject a voice of her own. It is a highly physical language, yet one that aims at dissolving the splits between mind and matter, as well as between conflicting and mutually exclusive genders, in an approach towards a concept of love not based on power and submission. This new form is borne by the mockery of men and by their treatment as women. The ensuing redefinition of male consciousness towards a recognition and incorporation of the feminine offers the promise for a shared redemption of the male and female characters alike.

The primary purpose of this study was to investigate the reliability and validity of the Southern California Ordinal Scales of Development (SCOSD). The SCOSD is a criterion-referenced test that assesses six domains of development and was designed for use with children with disabilities. Results found that the SCOSD alpha internal consistency coefficients ranged from .94 to .98; percent agreement between raters ranged from 85% to 100%; and interrater correlations ranged from .96 to .99. Strong intercorrelations were found between the SCOSD and standardized domain-specific instruments (.65 to .92), providing evidence of concurrent validity. The secondary purpose was to investigate patterns of development across domains of the children's functioning. As expected, results revealed a hierarchy of skill development, with the children showing relatively less development in gross-motor skills and practical abilities.

Data are presented herein that support a phase boundary or quasi-phase-boundary delineating in Y 1 Ba 2 Cu 3 O 7- δ and in Bi 2 Sr 2 Ca 2 Cu 3 )O 10 ceramic materials a transition from a vortex solid lattice to a line-flux disordered state that has been referred to as representing flux lattice melting to a flux liquid, but herein is interpreted not in terms of a liquid but in the form of a less-mobile ‘polymer’-like or entangled chain species. These data are derived from electrical resistance ( r ) versus applied magnetic field ( H ) measurements at various isotherms ( T ) corresponding to the zero resistance state of yttrium-barium-cuprate, and the mixed state foot regime of bismuth-strontium-calcium-cuprate. We interpret significant slope changes in r versus B at constant T in these materials to be indicative of the H-T conditions for a second-order or weakly first-order phase transition delineating the disordering of a flux lattice vortex solid. We believe that this technique is in ways more direct and at least as accurate as the conventional mechanical oscillator and vibrating magnetometer method to study the flux state. Additional very-low-field studies in Gd 1 Ba 2 (Fe 0.02 Cu 0.98 ) 3 O 7- δ , from 1 to 1000 mT, yield indication for what appears to be a magnetic transition at ca. 77 K at 575 mT, and possibly a second transition at 912 mT (also at ca . 77 K). These data points correspond well with the extrapolated low-field experimental magnetic phase transition boundary curve described at higher field herein (and by others using the mechanical technique), and also correspond well to theoretically predicted work regarding transition involving the vortex state.

Sam Shepard is, of course, a conundrum. He is undoubtedly one of the most intuitive practitioners of what Cocteau called "poetry of the theatre," creating a personal, concrete, physical language of the stage to be apprehended sensually. This encoder of American signs onstage is also an actor's playwright, among the most subtle and sympathetic chroniclers of characters' emotional states since O'Neill. Yet although he occasionally still produces a new play, most recently States of Shock in 1991, Sam Shepard now works primarily in prose and films. He has just completed filming Silent Tongues, a "truly different Western" about an 1870s Indian Medicine Show, which he both scripted and directed.

The languages of the Romance family are descended from Latin, but what kind of Latin? Just as Modern English exists in many varieties and registers, so also Latin came to be a socially complex language, extending over a vast territory and serving the needs of diverse speech communities. Among the educated, a codified literary Latin existed, enshrined in the classics and in treatises on grammar. But Latin also lived on as an evolving spoken language among the far-flung populations of the Roman Empire. The basic vocabulary of the Romance languages bears the imprint of a casual, spoken style of Latin, always open to change. In conservative social contexts, in the domain of religion and high culture, the frozen classical language remained an influential presence in the minds of the literate few, and became in later centuries a source of new layers of vocabulary. Syllables and word stress in Latin In this overview of the sound changes leading from Latin to the major Romance languages, we begin with the stressed vowels. Since the first requisite is knowing how to identify the stressed vowel, this lesson explains vowel quantity, syllable weight, and the rule that assigns stress in Latin. Why word stress matters Stress position in a Latin word ( etymon ) has a crucial effect on its Romance outcomes ( reflexes ).

Ti Alkire and Carol Rosen trace the changes that led from colloquial Latin to five major Romance languages, those which ultimately became national or transnational languages: Spanish, French, Italian, Portuguese, and Romanian. Trends in spoken Latin altered or dismantled older categories in phonology and morphology, while the regional varieties of speech, evolving under diverse influences, formed new grammatical patterns, each creating its own internal regularities. Documentary sources for spoken Latin show the beginnings of this process, which comes to full fruition in the medieval emergence of written Romance languages. This book newly distills the facts into an appealing program of study, including exercises, and makes the difficult issues clear, taking well motivated and sometimes innovative stands. It provides not only an essential guide for those new to the topic, but also a reliable compendium for the specialist.

Although in fact a brothel is more likely to resemble a nondescript rooming house than an ornate pleasure dome, popular literature favors fancy rather than reality. And the brothel, an institution of tabooed sexuality, is an especially inviting premise, promising to substantiate forbidden dreams. So in fiction, heroes have been regularly seduced into submission and then metamorphosed into creatures of degenerate lust by vile temptresses (who occasionally sport hearts of gold). The Circean nighttown episode of Ulysses may be seen as the apotheosis of this fictive standard, for in Joyce's novel the brothel suggests a modem sexual mythology.

To evaluate the level of evidence regarding the safety and efficacy of nonprescription therapies used for insomnia.Members of the American Academy of Sleep Medicine's Clinical Practice Review Committee.A search of the World Wide Web was conducted using the terms insomnia, herbal remedies, and alternative treatments to develop a list of therapies. Therapies in this review include passionflower, valerian, Jamaican dogwood, hops, California poppy, chamomile, lemon balm, St. John's wort, kava kava, wild lettuce, scullcap, Patrinia root, first-generation histamine-1-receptor antagonists, alcohol, calcium, vitamin A, nicotinamide, magnesium, vitamin B12, I-tryptophan, 5-hydroxytryptophan, dietary changes, Natrum muriaticum, and Yoku-kan-san-ka-chimpi-hange. A search of the PubMed database was conducted in October 2002 using MeSH terms insomnia and each product listed in this paper, including only articles published in English between 1980 and 2002. Additional relevant articles from reference lists were also reviewed. Given the paucity of pediatric publications, this age group was excluded from this review.Although randomized, placebo-controlled studies were available for a few compounds, rigorous scientific data supporting a beneficial effect were not found for the majority of herbal supplements, dietary changes, and other nutritional supplements popularly used for treating insomnia symptoms. Nevertheless, such treatments are described as alternative remedies for insomnia. Studies are limited by small numbers of participants and, in some instances, inadequate design, lack of statistical analysis, and sparse use of objective measurements. Sparse or no scientific data were found to support the efficacy of most products as hypnotics, including chamomile and St. John's wort. There is preliminary but conflicting evidence suggesting Valerian officinalis L. and first-generation histamine-1-receptor antagonists have efficacy as mild hypnotics over short-term use. There are significant potential risks associated with the use of Jamaican dogwood, kava kava, alcohol, and I-tryptophan. Physicians may find this information useful in counseling their patients.

To formulate a rational approach to the pharmacologic treatment of pediatric insomnia, and to develop clinical guidelines regarding indications, target populations, and parameters for the use of these medications, especially by community-based pediatricians.A multidisciplinary task force developed under the auspices of the American Academy of Sleep Medicine, which included experts in pediatric sleep medicine, psychiatry, pharmacology, neurology, and general pediatrics.Review of existing data regarding current use of over-the-counter and prescription medications for pediatric insomnia in the primary care practice setting, and of empirical data on the pharmacology, safety, efficacy, and tolerability of medications commonly used for the treatment of pediatric insomnia.Group consensus definition of pediatric insomnia and clinical guidelines; working group recommendations regarding special populations and future directions.Use of medications for pediatric insomnia should be diagnostically driven, and should be implemented in conjunction with empirically-based behavioral treatment strategies and adequate sleep hygiene. Specific target populations include children with neurodevelopmental disorders, pervasive developmental disorders, chronic medical conditions, and psychiatric disorders. Additional research, including clinical trials, is critically needed to provide an evidence-based approach to the use of these medications in clinical practice.

To report on the longitudinal cognitive functioning of older women receiving adjuvant chemotherapy for breast cancer.Neuropsychological and functional status testing were performed before chemotherapy and 6 months after chemotherapy.Cancer center.Thirty-one patients aged 65 and older with Stage I to III breast cancer. Of the 31 patients enrolled, three refused post-testing, and 28 were evaluable.The following domains of cognitive function were examined: attention; verbal memory; visual memory; and verbal, spatial, psychomotor, and executive functions.Participants had a mean age of 71 (range 65-84): 39% Stage I, 50% Stage II, and 11% Stage III. The number of scores 2 standard deviations (SDs) below the norm were calculated for each patient before and 6 months after chemotherapy; 14 (50%) had no change, 11 (39%) worsened, and three (11%) improved (P=.05). Seven patients (25%) experienced a decline in cognitive function, defined as a 1-SD decline from pre- to post-testing in two or more neuropsychological domains. Exploratory analyses revealed no significant difference between functional status, comorbidity, and depression scale scores and change in overall quality-of-life scores before and after chemotherapy.In this cohort of older women receiving adjuvant chemotherapy, a subset experienced a decline in cognitive function from before chemotherapy to 6 months after chemotherapy. Further prospective study is needed to confirm these observations and to identify the subgroup at special risk.

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common sleep disorder in adults that is increasingly recognized in children, affecting 1 to 3% of children. Children experience a spectrum of severity related to the degree of upper airway obstruction, the duration of the disease, and the presence or absence of hypoxemic episodes. Failure to diagnose and treat OSAHS can result in serious, but generally reversible consequences for the child including impaired growth, neurocognitive and behavioral dysfunction, and cardiorespiratory failure. Even mild OSAHS appears linked to reversible health consequences. Adenotonsillar hypertrophy is the major predisposing factor for OSAHS in childhood. However, enlarged tonsils and adenoids can be a normal finding in young children and are not diagnostic for OSAHS. The identification of children with OSAHS is often difficult because affected children may have no signs or symptoms when awake. Furthermore, clinical assessment cannot reliably distinguish between simple snoring and OSAHS. Adenotonsillectomy is the most common therapy for OSAHS in children, but surprisingly, only a small percentage of children undergo any diagnostic testing prior to surgery. Thus, the challenge is to develop new diagnostic strategies that effectively screen, identify, and treat children most likely to benefit from specific treatment.

Berman S, Miller AC, Rosen C, Bicchieri S. Assessment training and team functioning for treating children with disabilities. Arch Phys Med Rehabil 2000;81:628-33. Objective: To investigate differences in team functioning before and after assessment training. Design: Before-after trial. Setting: Outpatient rehabilitation and education program in a university medical center-based rehabilitation institute. Participants: A population-based sample of 19 rehabilitation and education specialists. Intervention: Baseline measures were taken during four meetings using the multidisciplinary team approach. Training in a global measure of child development ensued and staff administered the test to children in their care. Test results were then used during four transdisciplinary team meetings. Outcome Measures: Behavioral ratings of team participation (Transdisciplinary Team Rating Scale), self-report instruments of team development (Team Assessment Questionnaire), treatment planning and goal development (Staff Perception Questionnaire). Results: Results of t tests confirmed two of three hypotheses. There was more team member participation during transdisciplinary meetings than during multidisciplinary meetings ( p =.003) and staff members' perceptions of the efficacy of treatment planning and implementation of goals significantly favored the transdisciplinary model ( p p =.254). Conclusion: This study provides evidence for the value of training in an assessment tool that requires the use of a common, functional language that is comprehensible to all staff members and promotes a transdisciplinary approach to team work. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Objective: To investigate differences in team functioning between the multidisciplinary and transdisciplinary models when treating children with disabilities. Design: A crossover trial. Setting: An outpatient educational and rehabilitation program in a rehabilitation institute based at a university medical center. Participants: A population-based sample of 19 rehabilitation specialists and educators. Intervention: Participants attended four team meetings using the multidisciplinary approach and then attended four team meetings using the transdisciplinary approach. Outcome Measures: Behavioral ratings of team participation (Transdisciplinary Team Rating Scale) and self-report instruments of team development (Team Assessment Questionnaire) and treatment planning and goal development (Staff Perception Questionnaire). Results: Results of t tests confirmed the hypothesis that there was more team member participation during transdisciplinary meetings than during multidisciplinary meetings ( p = .027). There were no differences in levels of team development ( p = .329); however, staff members favored the transdisciplinary model for treatment planning and goal development ( p Conclusion: This study provides evidence of the effectiveness of the transdisciplinary model. Further research is now needed to investigate outcome variables such as rate of success in attaining treatment goals when using this model.

8204 Background: Data suggests a possible impact of adjuvant (adj) CRx for BC on cognitive function but an effect in pts ≥ age 65 has not been previously reported. Methods: 31 pts ≥ age 65 with sta...

Application du modele autosegmental a l'etude morphosyntaxique du tiwa du sud. Etude des trois types d'accord grammatical dans cette langue