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Research has identified that male and female perpetrators are viewed differently. The aim of the study was therefore to (a) explore attitudes towards and perceptions of females who sexually offend against children, and (b) compare these attitudes and perceptions between a sample of students and professionals. Ten students, who had not previously studied theories of sexual offending or the management of child sexual offenders, and ten professionals, who work with females in a therapeutic capacity, took part in the study. Semi-structured interviews were conducted, transcribed and analysed using Thematic Analysis. Three themes were identified, namely the “facilitating role of women in society”, “why women offend”, and “what should happen to women who offend”. There was a tendency to minimise sexual offending by females. Across the two samples, there were similarities in terms of perceptions around why women offend, and differences in terms of attitudes around what should happen to women who offend.

Cardiac arrest (CA) is a common reason for admission to the cardiac intensive care unit (CICU), though the relative burden of morbidity, mortality, and resource use between admissions with in-hospital (IH) and out-of-hospital (OH) CA is unknown. We compared characteristics, care patterns, and outcomes of admissions to contemporary CICUs after IHCA or OHCA.The Critical Care Cardiology Trials Network is a multicenter network of tertiary CICUs in the US and Canada. Participating centers contributed data from consecutive admissions during 2-month annual snapshots from 2017 to 2021. We analyzed characteristics and outcomes of admissions by IHCA vs OHCA.We analyzed 2,075 admissions across 29 centers (50.3% IHCA, 49.7% OHCA). Admissions with IHCA were older (median 66 vs 62 years), more commonly had coronary disease (38.3% vs 29.7%), atrial fibrillation (26.7% vs 15.6%), and heart failure (36.3% vs 22.1%), and were less commonly comatose on CICU arrival (34.2% vs 71.7%), p0.001 for all. IHCA admissions had lower lactate (median 4.3 vs 5.9) but greater utilization of invasive hemodynamics (34.3% vs 23.6%), mechanical circulatory support (28.4% vs 16.8%), and renal replacement therapy (15.5% vs 9.4%); p0.001 for all. Comatose IHCA patients underwent targeted temperature management less frequently than OHCA patients (63.3% vs 84.9%, p0.001). IHCA admissions had lower unadjusted CICU (30.8% vs 39.0%, p0.001) and in-hospital mortality (36.1% vs 44.1%, p0.001).Despite a greater burden of comorbidities, CICU admissions after IHCA have lower lactate, greater invasive therapy utilization, and lower crude mortality than admissions after OHCA.

To investigate whether delayed timing of physician rounds improves patient satisfaction for postpartum women.Women were randomized to early (5-7 AM) or delayed (8-10 AM) physician rounding. Women with stillbirth, high-risk pregnancy, or complications precluding delayed rounding were excluded. At discharge, women completed a modified Hospital Consumer Assessment of Healthcare Providers and Systems survey. The primary outcome was rating of the hospital. Secondary outcomes included patient assessment of patient-physician communication, various hospital experiences, and timing of maternal and neonatal discharge. We estimated that 74 women were needed to detect a 20% difference in rating of the hospital (0-10 score) between groups (assumption P=.05, power 90%). Given limited information on primary outcome, an a priori plan was in place to conduct the study for 2 months.One hundred fifty-two women were randomized (n=76 early rounding; n=76 delayed rounding). More women had a cesarean delivery in the early compared with the delayed rounding group (47.4% compared with 22.4%). Median rating of the hospital was higher in the delayed as compared with the early rounding group (9.0 [7.0-9.0] compared with 7.0 [6.0-8.0]; P.01). Median scores regarding physician communication and perception of hospital experiences were higher in the delayed compared with the early group (8.0 [7.0-9.0] compared with 6.0 [5.0-7.0]; P.001). Adjustment for delivery mode did not alter results (P.01). No differences in timing of maternal (P=.47) or neonatal hospital discharge (P=.35) were observed.Postpartum women receiving delayed physician rounding were more satisfied with their hospital experience and patient-physician communication without prolonging maternal or neonatal discharge.ClinicalTrials.gov, https://clinicaltrials.gov, NCT02432573.

Insomnia in children is complex and frequently multifactorial. This review discusses the major categories of insomnia as well as common causes. The consequences of insomnia, including issues with mood, behavior, and cognition, are discussed. Sleep disorders are much more prevalent in certain pediatric populations, such as children with autism spectrum disorders. The evaluation of insomnia in children includes a focused history and examination and occasionally actigraphy or polysomnography. Behavioral and pharmacological therapies are discussed, as are future directions for research and clinical practice.

The aim of the literature review presented here was to identify goals and offense-supportive cognitions that act as motivational factors in the sexual offending against children committed by females. A scoping search revealed that there was currently no review in this area. A systematic search of empirical research that examined motivations in female child sexual offenders (FCSOs) was initiated based upon an inclusion and exclusion criteria. Identified studies were screened and reference lists were hand searched. A quality assessment tool reviewed the strengths and weaknesses of the final 13 articles. A data extraction form established for the current review enabled the extraction of standardized information. The review identified support for many motivational factors in FCSOs, which have previously been referred to in the literature. The review has categorized these into motivations and offense-supportive cognitions. There was strong support for the following motivations and goals: offending under coercion of an abusive co-offender, offending to meet one's own needs and offending to feel power and control over another. The strongest offense-supportive cognitions were entitlement and uncontrollability. There was an apparent overlap between the two categories, with some offense-supportive cognitions and functions amalgamating to facilitate females to engage in offending behavior. Limitations of the present literature and suggestions for future research are discussed.

Background: Episodic ataxia type 2 (OMIM 108500) is an autosomal dominant channelopathy characterized by paroxysms of ataxia, vertigo, nausea, and other neurologic symptoms. More than 50 mutations of the CACNA1A gene have been discovered in families with episodic ataxia type 2, although 30%–50% of all patients with typical episodic ataxia type 2 phenotype have no detectable mutation of the CACNA1A gene. Case: A 46-year-old Caucasian man, with a long history of bouts of imbalance, vertigo, and nausea, presented to our hospital with 2 weeks of ataxia and headache. Subsequent evaluation revealed a novel mutation in the CACNA1A gene: c.1364 G > A Arg455Gln. Acetazolamide was initiated with symptomatic improvement. Conclusion: This case report expands the list of known CACNA1A mutations associated with episodic ataxia type 2.

Epilepsy is a chronic disorder that adversely affects social, vocational, and psychological functioning. Despite the variety and complexity of the negative clinical associations with epilepsy, depression is remarkable in prevalence and related adverse effects on health status. An estimated 30-50% of persons with refractory epilepsy have major depression, and depression has a stronger correlation than seizure rate with quality of life. Suicide is one of the leading causes of death in epilepsy. Available data indicate that depression may result from underlying brain dysfunction rather than social and vocational disability. Most patients with depression are not screened systematically for the diagnosis, and are subsequently not treated. Although the density of serotonin receptors is greatest in limbic brain regions commonly involved in human epilepsy, such as the mesial temporal and prefrontal areas, no prior randomized controlled trials have evaluated the efficacy of serotonin reuptake inhibitors for depression in epilepsy.

Recent work on public goods contributions has examined the relationship between gender and free-riding behavior in studies using laboratory public goods. This research furthers this line of inquiry by examining gender as a possible explanation of hypothetical bias, which occurs in valuation studies using real world public goods. Results show that gender differences exist in hypothetical valuation exercises, but not in real valuation exercises. Further, the results show that hypothetical bias is almost three times larger for males than for females, an important result for researchers investigating the source of, and solutions for, hypothetical bias.

Encephalitis is a significant cause of morbidity and mortality, yet a causative factor is identified in

Background Fatigue is experienced by most patients with multiple sclerosis (MS) and often is profoundly debilitating. No large-scale studies to our knowledge have examined circadian rhythm abnormalities in MS patients or the relationship of fatigue to circadian rhythms. Objective To determine if patients with MS and fatigue have sleep disturbances or circadian rhythm abnormalities associated with fatigue. Design Case-control study. Setting Washington University School of Medicine, St Louis, Mo. Patients Fifteen patients with MS and fatigue were compared with 15 patients with MS without fatigue and 15 age- and sex-matched, healthy controls. Main Outcome Measures Sleep disturbances and circadian rhythm abnormalities were quantitated by actigraphy, fatigue by the Fatigue Descriptive Scale, and excessive sleepiness by the Epworth Sleepiness scale (ESS). Results Of the 15 fatigued patients with MS, 2 had delayed sleep phase, 10 had disrupted sleep, and 3 had normal sleep. One of the 15 nonfatigued MS patients had irregular sleep cycles, 2 others had disrupted sleep, and 12 had normal sleep. All 15 of the healthy controls had normal sleep. Nine patients with MS and fatigue scored 10 or higher on the ESS, suggesting excessive daytime sleepiness. Only 2 patients with MS without fatigue scored higher than 10 on the ESS. None of the healthy controls were fatigued, and 14 were not excessively sleepy. A relationship was found between fatigue and abnormal sleep cycles or disrupted sleep (Fisher exact test, P = .003). There was also a relationship between subjective excessive daytime sleepiness and fatigue in MS patients ( P = .02). Conclusion There is a significant correlation between fatigue in MS patients and disrupted sleep or abnormal sleep cycles.

A 71-year-old woman with a 3-year history of excessive daytime sleepiness and an increased need for sleep did not feel restored upon awakening and had daytime fatigue despite a full night's sleep. She was evaluated with polysomnography (PSG). She significantly underestimated her sleep latency and awake time after sleep onset. The following morning, she stated that she had slept all night, when in fact she had extremely poor sleep efficiency and prolonged sleep latency. Another PSG and a two-week long actigraphy confirmed her misperception. Therefore, she perceived physiologic wakefulness, by PSG and actiraphy criteria, as subjective sleep, in direct contrast to ‘conventional’ sleep state misperception, in which patients usually present with a complaint of insomnia but have normal sleep quality and duration by PSG criteria. This patient may have a previously undescribed variation of sleep state misperception that the authors have tentatively named ‘reverse’ sleep state misperception.

Levetiracetam reduces spike-wave density and duration during continuous EEG monitoring in patients with idiopathic generalized epilepsy.