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Youth sports participation has grown steadily over the years and so have injuries. The National Youth Sports Foundation for Safety reports dental injuries as the most common type of face and mouth injury kids experience in sports related accidents.
A new report issued by dental experts at the University of Alabama at Birmingham, says that mouthguards should be included in safety gear for all contact sports.
Sports-related dental injuries send more than 600,000 people to the emergency room every year, the U.S. Centers for Disease Control and Prevention reports.
Most of these injuries involve the front teeth, but the tongue and cheeks can also be hurt while playing sports, the UAB team said.
The best way to protect the mouth and teeth during sports is to wear a mouthguard, says Dr. Ken Tilashalski, associate dean for academic affairs at the UAB School of Dentistry. Mouthguards have been shown to reduce the risk of sports-related dental injury by 60 times, he said.
"Wearing a mouthguard reduces the chances of tooth fractures, tooth dislocations and soft tissue cuts," Tilashalski said in a university news release. "The guards also protect against jaw fractures and concussions by absorbing the energy of a traumatic blow to the chin."
The American Dental Association (ADA) recommends wearing custom mouthguards for the following sports: acrobats, basketball, boxing, field hockey, football, gymnastics, handball, ice hockey, lacrosse, martial arts, racquetball, roller hockey, rugby, shot putting, skateboarding, skiing, skydiving, soccer, squash, surfing, volleyball, water polo, weightlifting, and wrestling. Other experts include baseball and softball infielders on that list. They further recommend the mouthguard to be worn during all practices and competition.
There are basically three types of mouthguards to choose from:
· Stock: These are preformed and ready to wear, but they may not fit well inside the mouth.
· Boil and bite: These may be customized and molded to the mouth by softening in boiling water before biting down.
· Custom-made: A dentist tailor-makes these mouthguards to fit an individual's mouth. These mouthguards provide the best fit and the highest level of protection.
"For my kids, I have chosen to use custom mouthguards as they fit and feel better, do not interfere with speech, and are essentially invisible," Tilashalski said. "Mouthguards need to be replaced as they wear down, and athletes in the tooth-forming years will have to have these replaced more often as the mouth grows and the teeth change."
These mouthguards vary in price and comfort, yet all provide some protection. According to the ADA, the most effective mouthguard should be comfortable, resistant to tearing, and resilient. A mouthguard should fit properly, be durable, easily cleaned, and not restrict speech or breathing.
After each use, rinse your mouthguard and store it in a hard container to prevent the buildup of germs, Tilashalski said. Players should also avoid chewing on their mouthguard to extend its life.
It is important to remember damaged teeth do not grow back. Protect your child's teeth by making sure he or she wears a mouthguard during practice, competition or just out having fun in a sport where falls are common such as biking, skating and skateboarding.
Story sources: Mary Elizabeth Dallas, https://consumer.healthday.com/dental-and-oral-information-9/misc-dental-problem-news-174/mouthguards-key-defense-against-sports-related-injuries-716284.html
A new multicenter study says that lithium, a drug typically given only to adults, is safe and effective for children and adolescents who have bipolar disorder.
The study, led by a researcher at the Johns Hopkins Children's Center and published Oct. 12 in Pediatrics, affirms what clinicians who prescribe this drug have observed for years and suggests that doctors can now more confidently add lithium to the available treatments for this vulnerable population -- at least in the short term, the authors say.
Lithium is one of the oldest drugs for bipolar disorder, a chronic brain condition marked by spontaneous, seesawing bouts of abnormally high moods and depression. The drug's ability to stabilize mood extremes has been well established in adults.
The researchers point out that historically, children and women of childbearing age have generally been excluded from many clinical trials out of an abundance of caution. Some believe that while the intentions may have been good, being excluded in clinical studies may actually harm this population- leaving them without access to more effective treatments.
"Lithium is the grandfather of all treatments for bipolar disorder, but it has never been rigorously studied in children," says Robert Findling, M.D., M.B.A., a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and director of child and adolescent psychiatry at the Johns Hopkins Children's Center.
Findling initiated the work while director of child and adolescent psychiatry at Case Western Reserve University School of Medicine.
Though medications used to treat schizophrenia and other psychoses are prescribed to treat bipolar disorder in children, Findling says, those drugs have been linked to substantial weight gain, a considerable medical and social drawback for young people that causes many to stop taking them.
Results from the study showed that the patients on lithium experienced far more significant improvement in their symptoms over eight weeks compared with those on the placebo. Some 47 percent of those on lithium scored in the range of "very much improved" or "much improved" on the Clinical Global Impressions Scale, a rating system commonly used to assess the efficacy of treatments in patients with mental disorders, compared to 21 percent of those on the placebo.
Unlike antipsychotic agents, such as risperidone or olanzapine, lithium treatment was not associated with significant weight gain, and none of the patients experienced serious side effects due to the lithium treatment.
Findling says the findings provide a scientific and reliable confirmation of lithium's efficacy and safety for children in the short term, offering evidence that doctors can use when deciding what medication to prescribe their pediatric patients with bipolar disorder. Further analyses are currently in progress to examine the long-term implications of lithium use, he adds. Areas of particular focus include evaluation of any potential side effects, such as weight gain, reduced kidney function or diminished thyroid function -- all important considerations, as those with bipolar disorder may need a lifetime of medication and behavioral therapies.
Bipolar disorder affects approximately 1 percent of teens and is the leading cause of disability in adolescence.
Source: Adapted Media Release, http://www.medicalnewstoday.com/releases/300847.php
When your child is sick, chances are you have a difficult time getting him or her to swallow their prescription pills. It's a problem parents and caregivers have in common- getting a child's medication into their body. Liquids typically come in several flavors, which can be helpful, but pills are another matter.
Some pills are tiny and smooth – making the job easier. But others can be large powdery and oddly shaped. To make things worse, they may need to be taken throughout the day. So, what's a parent to do?
The results of a small study may be just what the doctor ordered. Researchers have found that a flavored spray, called Pill Glide, may make pill taking a lot more flavorful -- and maybe even enjoyable.
"There was a significant decrease in the difficulty of taking medicine with these sprays," said Dr. Catherine Tuleu, a pharmaceuticals researcher at University College London, who conducted the research with colleagues at Great Ormond Street Hospital in the UK. "The kids liked to be in charge and to change the flavor."
What is Pill Glide? It's a spray that is squirted into the mouth to lubricate and add flavor to tablets and capsules to make them easier to swallow. It's available in five flavors: strawberry, peach, grape, bubble gum and orange, with strawberry coming through as the favorite in the trial. Its ingredients include artificial flavors and sweeteners. This spray was used in the trial study with results published in the journal Pediatrics.
Tuleu and her team tried it among 25 children ages 6 to 17 that were receiving long-term therapies for HIV or organ transplants and who were transitioning from liquid medication to solids or were known to struggle with swallowing pills.
Keeping diaries, the study participants used a six-point scale to note the levels of difficulty they experienced when taking their regular tablets for two weeks and then using the Pill Glide sprays for one week. The final analysis was conducted on 10 children who had kept complete diary entries.
The flavored sprays were found to decrease the level of difficulty by a score of 0.93, almost one full level on the scale used by the team.
"The swallowing of medicine in the form of pills often poses a real challenge for a good many children, making this study of definite interest," said Dr. Laura Jana, a pediatrician and director of innovation at the University of Nebraska Medical Center College of Public Health, who was not involved in the research. "Something as seemingly simple as improving the taste and ease of swallowing a pill can have a significant impact on the proper and effective use of medicines."
The trial was very small and limited especially when you look at the number of participants, their health issues and the age group. But it may still be a process worth considering.
Tuleu acknowledges these limitations, and in addition to trying Pill Glide among larger groups, she wants to test its benefits in children who are less familiar with taking pills and who start out on solid pills, rather than transitioning from liquids.
"It would be interesting to try it with more naïve patients," she said. "If swallowing is not the challenge anymore, giving medication could be a lot easier."
Will this product make it easier for all kids to take a pill? Probably not. But this new approach may help some kids get past their difficulty with swallowing larger, more uncomfortable pills. It's worth a try!
Story source: Meera Senthilingam, http://www.cnn.com/2016/11/01/health/kids-swallowing-pills-spray/
Summer is a time when lots of family create life-long memories. Vacations offer a chance for everyone to get away from the daily grind and explore someplace new. Some families choose to spend the summer closer to home with a "staycation." You can still relax, have fun and spend time together without the added expense of travel.
One experience a family doesn't want to have is when someone is injured or worse or falls ill during the summer break. To help make summer is a little safer remember these common sense safety tips.
Water Safety: Probably the number one danger to children in the summer is drowning.
· Make sure your child learns how to swim.
· Never leave your child unattended around water. We know it sounds strict, but there is no room for compromise on this one. Babies can drown in as little as one inch of water.
· Drowning is silent. Always watch your child when they are in a pool, lake, ocean or pond.
· Have a flotation device nearby to toss into the water for a child to grab if they are tired or in danger.
· If you cannot swim, make sure that there is an adult who can swim with you when your children are in the water.
· Put the cell phone away, forget about all the other things you have to do and give young children 100 percent of your attention when they are near or around water.
· Keep pool areas fenced and locked when no one is in the pool.
· Empty all tubs, buckets, containers and wading pools immediately after use. Store them upside down and out of children's reach.
· Keep toilet lids closed and use toilet seat locks to prevent drowning. It's also a good idea to keep doors to bathrooms and laundry rooms closed.
· Parents have a million things to do, but learning CPR should be on the top of the list. It will give you tremendous peace of mind – and the more peace of mind you have as a parent, the better.
Hot Cars: Another danger for small children is hot cars. When a child dies or is injured in a hot car, it's one of the most preventable tragedies. Parents and caregivers can forget they have a small child in the back seat of a car, or they can leave them in the car not realizing how fast the temperature will rise in a very short time. Occasionally, a child will enter a parked car and accidently lock themselves in.
· Always look before you lock your car.
• Always check the back seats of your vehicle before your lock it and walk away.
• Keep a stuffed animal or other memento in your child's car seat when it's empty, and move it to the front seat as a visual reminder when your child is in the back seat. Put something you'll need in the back seat- like a briefcase or purse.
• If someone else is driving your child, or your daily routine has been altered, always check to make sure your child has arrived safely.
• Never leave a child unattended in a car. Opening windows will not prevent heatstroke. Heatstroke can happen on cloudy days and when the temperature outside is below 70 degrees.
• If your traveling with several children, do a head count – see each child- before locking or leaving the car.
• If your child is missing, check your car first thing.
If you see an unattended child alone in a car, take action!. Don't wait more than a couple of minutes for the driver to return. If you see a child is unresponsive or in distress; call 911. Get the child out of the car then spray the him or her with cool water (not an ice bath). If the child is responsive, stay with them until help arrives. Send someone else to find the driver.
Food Safety: Who doesn't love a good picnic or grilled meal? However, food borne illnesses are not something you'll enjoy.
• Keep cold foods cold.
• Don't keep any foods at room temperature longer than 2 hours -- or 1 hour if it's warmer than 90 degrees.
• Don't reuse platters that have held raw meat until you wash them thoroughly.
• Keep your grill away from buildings and branches.
• Don't let grease build up.
• Never leave your grill unattended.
• Keep kids and pets away.
• Does yours use propane? Test for leaks before the season starts. If you ever smell gas while you're cooking, get away from the grill and call the fire department.
Bug Bites: Summer brings bugs, ticks, bees, mosquitoes, fire ants, chiggers, spiders and other pests.
Mosquitoes are more than a bother. They can spread West Nile virus. Most people who get the virus have no symptoms at all. But very serious and sometimes fatal illness can happen in less than 1% of those infected.
The only way to avoid West Nile is to avoid mosquito bites. Wear mosquito repellent and, if weather permits, long pants and long sleeves outside from dusk to dawn.
At home, get rid of standing water in birdbaths, buckets, and tire swings. They're breeding grounds for mosquitos.
A bite from a tick is not usually a big deal, but the wrong type of tick can cause real problems. Ticks can cause diseases such as Lyme disease and Rocky Mountain spotted fever, a bacterial infection that occurs mostly in the South Atlantic region in the U.S. If the family is trekking in wooded areas. Make sure that everyone is:
• Wearing light-colored long pants, so it's easier to spot ticks.
• Tucks their pants into socks or high-top boots or tape them to boots.
• Wearing a hat and long-sleeved shirt, tucked in.
• Sprays or rubs insect repellent on the tops of boots, exposed area of socks, and pants openings (inside cuffs, waistband, and fly).
• Using insect repellant with DEET on your exposed skin. For children, choose a repellent with no more than 10% to 30% concentration of DEET. If your pets go outside, check them regularly for ticks so they don't bring them in the house.
Fire ants have a painful bite and some children are allergic to them. Check your yard for fire ant mounds and if you find any, have them removed professionally.
If you've ever had chigger bites, you know how miserable they are. Keep your grass cut short and use bug repellent. Shoes and socks also offer some protection.
During bug season, a good repellent is going to be your best bet to protect your child and yourself from many of these pesky critters.
Shark Attacks: If you're headed to the ocean, sunburn is more likely to be a problem for your child than a shark bite, however, this year is quickly on the way to setting a record for shark attacks. Here are some ways to lessen the risks.
• Avoid being in the water at twilight, when sharks are most active.
• Don't go in the water if you're bleeding.
• Don't wear shiny jewelry when you swim. It could look like fish scales to a shark.
• Know that sharks are sometimes near the shore. Sandbars can trap them close to the beach at low tide.
• Skip swimming after heavy rains, which may move some freshwater fish, including sharks, into areas they would not otherwise frequent.
Sunburn: Summertime can mean sunburn time as well. Not only are they painful; but sunburns can do more damage to the skin long after it has healed. Children are more prone to sunburn because of their delicate skin.
Try to keep your child out of the sun when the peak ultraviolet rays occur (between 10 A.M. and 4 P.M.).
In addition, follow these guidelines:
• Always use a sunscreen to block the damaging ultraviolet rays. Choose a sunscreen made for children with a sun protection factor (SPF) of at least 15. (Check the label.) Apply the protection 15 to 30 minutes before going out. Keep in mind that no sunscreens are truly waterproof, and thus they need to be reapplied every one and a half to two hours, particularly if your child spends a lot of time in the water. Consult the instructions on the bottle.
• Dress your child in lightweight cotton clothing with long sleeves and long pants.
• Use a beach umbrella or similar object to keep her in the shade as much as possible.
• Have her wear a hat with a wide brim.
• Babies under six months of age should be kept out of direct sunlight. If adequate clothing and shade are not available, sunscreen may be used on small areas of the body, such as the face and the backs of the hands.
Heat Exhaustion: Too much heat can make you or your child very sick. Take special care with children and the elderly, because their bodies don't cool as well. Kids are particularly at risk for heat cramps when they aren't drinking enough fluids.
Although painful, heat cramps on their own aren't serious. Cramps can be the first sign of more serious heat illness, so they should be treated right away to help avoid any problems.
Don't let your child play outside during the hottest part of the day. Make sure they have plenty of fluids and a cool place to rest. If you suspect your child is suffering from heat exhaustion, call 911. Symptoms can include:
• Increased thirst
• Weakness
• Fainting
• Muscle cramps
• Nausea and/or vomiting
• Irritability
• Headache
• Increase sweating
• Cool, clammy skin
• Elevation of body temperature, but less than 104°F (40°C)
Protect Your Feet!
One minute you're strolling barefoot. The next, you're in pain. Puncture wounds happen more often in summer, when bare feet meet nails, glass, toothpicks, and seashells.
The biggest problem is infection. Heat, swelling, and drainage are signs that need quick medical attention. You may also need to update your tetanus shot.
These are just a few tips to help prevent some serious summertime injuries. Sometimes the problems are just an annoyance, other times they can be fatal. Summer is about fun and family time together. Just use common sense and follow these simple rules for a safer summer.
Sources: http://www.webmd.com/a-to-z-guides/ss/slideshow-summer-health-hazards?print=true
Have you ever had a hard time understanding someone speak in a noisy restaurant? Imagine if you were trying to learn a new language. That's just what toddlers are trying to do, learn a language. According to a new study, toddlers learn new words quicker when their environment has less background noise.
"Modern homes are filled with noisy distractions such as TV, radio and people talking that could affect how children learn words at early ages," said study leader Brianna McMillan.
"Our study suggests that adults should be aware of the amount of background speech in the environment when they're interacting with young children," said McMillan, a doctoral student in psychology at the University of Wisconsin at Madison.
Researchers from the university assessed the ability of 106 children, aged 22 to 30 months, to learn new words. They found they were more successful when their surroundings were quiet than when there was background noise.
However, researchers noted that providing the children with additional language cues helped them overcome the detrimental effects of a noisy location.
"Hearing new words in fluent speech without a lot of background noise before trying to learn what objects the new words corresponded to, may help very young children master new vocabulary," said study co-author Jenny Saffran, a professor of psychology.
Sometimes, you simply can't avoid a noisy environment- especially if there are other children around. Saffron says there is a way to overcome that.
"… When the environment is noisy, drawing young children's attention to the sounds of the new word may help them compensate," she added.
Story source: Robert Preidt, https://consumer.healthday.com/kids-health-information-23/child-development-news-124/noisy-homes-slow-toddler-s-vocabulary-713013.html
Has your child ever been labelled "penicillin allergic"? Interestingly, up to 10% of people (of all ages) report having a penicillin allergy, but only about 1% are truly allergic. I see this often in my own practice, especially when seeing a new patient and inquiring about drug allergies, and the parent replies, " she is penicillin allergic, and developed a rash when she was younger". In many if not most of those cases the child is not allergic to penicillin.
Penicillins are a class of antibiotics known as beta-lactams and include not only penicillin but amoxicillin, augmentin, oxacillin and nafcillin, just to name a few. If you are incorrectly identified as penicillin allergic, when your doctor needs to prescribe an antibiotic they may resort to another class of antibiotic, which are not only more expensive but often may cause more side effects.
Penicillins are the antibiotic of choice and the first line treatment for many pediatric bacterial illnesses including otitis ( ear infections ), strep throat, and sinus infections. They are not only effective, but they are typically inexpensive and have few side effects….which includes allergic reactions.
Penicillin allergy is an immune - mediated reaction which usually causes hives ( raised rash ), face or throat swelling, difficulty breathing and in some cases life threatening anaphylaxis. Intolerance to penicillin is different than being allergic, and in this case symptoms are more likely nausea, diarrhea, headache or dizziness, which may make you uncomfortable but are not immune mediated.
In pediatrics, many children present with a viral illness that includes several days of fever and upper respiratory symptoms, and are then also found to have an ear infection. They are given a prescription for amoxicillin and several days later develop a rash. Many viral infections in children also cause a rash, which is typically red, flat and covers the trunk, face and extremities and does not cause any other symptoms which are seen with a true penicillin allergy. This rash is benign, but unfortunately many young children will be seen at an urgent care or even an ER due to the rash. The parents are told that their child is penicillin allergic and the antibiotic is changed…and the label "pen allergic" sticks….for many years or even life. I even saw this rash occur in one of my own sons while on an antibiotic. He is NOT allergic!
The good news is that most children are truly not penicillin allergic, and if possible I try to see all of my patients who report a rash while they are on an antibiotic. At times this is not possible, and now with the advent of "smart phones" I have parents send me a picture of the child and the rash. This often helps in determining if the rash truly appears allergic and to identify if there are other symptoms. Back to the "get a good history".
If I see an older patient who has had a rash on amoxil when they were little and had no other adverse effects (get a good history), I will sometimes try using a penicillin again, as most people also "outrgrow" their sensitivity after about 10 years. If it is my patient and I have seen the rash I tell the parents that this is not a "pen allergy" and I will use penicillins again. Some patients will report a "pen-allergy" but say I can take "augmentin" which is penicillin derivative, so that makes it easy to know they are not allergic. If I am unsure if a child has had a true penicillin allergy I will refer them to a pediatric allergist for skin testing. Skin testing is not painful and is an important method for documenting a true allergy.
While sipping on a coffee-laced Frappuccino, I'm reading about a current study on caffeine and kids. It made me think about my own dependence on caffeine and when it started. For as long as I can remember, my parents would drink several cups of coffee in the morning before going to work, and even as late as right before they retired for the night. I suspect my mother had a cup while I was busy being born.
I can't remember exactly when I joined the family coffee drinking ritual, but I know I was pretty young. Fall and winter demanded hot steaming cups of coffee and iced coffee helped cool the torturous Texas summers. Spring was a combination of both. Sometimes I think that by now, there's probably coffee bean residue percolating in my blood stream.
I kind of wish that I'd never started drinking coffee, because it's the caffeine I really crave- not necessarily the taste of the brew. When I've tried to quit, my body and mind rebels with headaches and bad attitudes. Which brings me back to the study on kids and caffeine.
Researchers from the U.S. Centers for Disease Control and Prevention (CDC) found that children and teens are now getting less caffeine from soda, but more from caffeine-heavy energy drinks and coffee.
"You might expect that caffeine intake decreased, since so much of the caffeine kids drink comes from soda," said the study's lead author, Amy Branum, a statistician at the CDC's National Center for Health Statistics. "But what we saw is that these decreases in soda were offset by increases in coffee and energy drinks."
Not too long ago, energy drinks were just a fad, something that was more likely to give you the shakes than boost your energy level. That was before they were tweaked and bottled or canned in fruity flavors, sugary beverages and clever advertising. Once kids (and adults) got a taste of the "new and improved" tasty stimulates, the caffeinated beverages began to become a part of every day life – at least Monday through Friday when school and work beckoned.
"In a very short time, they have gone from basically contributing nothing to 6 percent of total caffeine intake," Branum said.
"Energy drinks have more caffeine than soda,. That's their claim to fame," she said. "That's what they're marketed for."
So, what effect does excessive caffeine intake have on our kids? Scientists are not sure yet. There are concerns and a lot of questions about the possible adverse consequences for kids who are still developing. Caffeine addiction, obesity from sugar heavy beverages, high blood pressure, rapid heart beats and anxiety are some of the side –effects researchers are exploring.
Using data from the 1999 to 2010 National Health and Nutrition Examination Survey, Branum's team estimated that 73 percent of American children consume some level of caffeine each day.
Although much of their caffeine still comes from soda, the proportion has decreased from 62 percent to 38 percent. At the same time, the amount of caffeine kids get from coffee rose from 10 percent in 2000 to 24 percent in 2010, the researchers found.
The American Academy of Pediatrics (AAP) states that energy drinks are never appropriate for children or adolescents and in general, caffeine-containing beverages, including soda, should be avoided. The AAP suggests that children should drink water or moderate amounts of juice instead.
The genie is probably out of the preverbal bottle as far as some adolescents and college-aged kids are concerned. Although, if they are more aware of the possible health risks associated with excessive caffeinated beverages, they may decide to look at healthier energy producing sources such as exercise, meditation and more rest.
Where parents can have the most influence is with their younger children. Refraining from purchasing caffeinated products (there's even "energy" gum) and keeping them out of the home is a good first step.
And by all means, avoid introducing your kids to coffee at a young age. It might seem kind of cute, but twenty years down the road, they may wish you hadn't slid that first cup of java their way.
The report was published in the February edition of the online journal Pediatrics.
Sources: Steven Reinberg, http://www.webmd.com/parenting/news/20140210/energy-drinks-coffee-increasing-sources-of-caffeine-for-kids-cdc-says
From rural America to the suburbs, you can count on the sound of children and their new ATV buzzing up and down the street on Christmas morning. All-terrain vehicles are a popular gift during the holidays, and more often than not, you'll see children with a safety helmet on to reduce the risk of head trauma – should they have an accident.
What parents may not know is that these vehicles also pose a high risk for severe chest injuries, according to a new study.
"I believe that many parents are unaware of how serious ATV-related injuries can be," said the study's author, Dr. Kelly Hagedorn, a radiology resident at McGovern Medical School at the University of Texas Health Science Center at Houston.
"Some parents view ATVs as being more similar to bicycles. However, many of the injury patterns are more similar to those sustained in motor vehicle collisions," Hagedorn explained.
ATVs are motorized recreational vehicles with three or four tires, designed for off-road use. Because they can weigh 300 to 400 pounds and travel at speeds of up to 75 miles an hour, ATVs can often be involved in serious accidents, including crashes, rollovers and ejections, the researchers said.
The good news is that ATV-related injuries have declined since 2007. As public safety awareness about ATVs increases, more parents are making sure that helmets, protective clothing and personal oversight safeguard their children.
However, nearly 25,000 children under the age of 16 were treated for ATV-related injuries in hospital emergency rooms nationwide in 2014, according to the U.S. Consumer Product Safety Commission (CPSC).
Researchers suspect that one of the reasons children's ATV-related chest injuries are becoming more severe and frequent is that the newer vehicles are larger and weigh more than their predecessors.
"As ATVs have gotten bigger and heavier, riders have a harder time separating from the vehicle in a crash," said Gerene Denning. She's director of emergency medicine research at the University of Iowa Carver College of Medicine.
"The increasing size and weight of ATVs leads to more cases of the vehicle striking the rider. There is also a growing trend of riders being pinned by the vehicle, which can lead to compression asphyxia [a condition where the body doesn't get enough oxygen]," said Denning, who wasn't involved in this study.
The new study included records from 455 patients, 18 years old and younger. All had chest imaging at a trauma center in Houston after ATV-related incidents. The accidents occurred between 1992 and 2013. Of those admitted, 102 (22%) suffered a chest injury.
The researchers said that 40% of patients with chest injuries were treated in an intensive care unit (ICU), compared to 22% of patients without chest injuries. On average, patients with chest injuries were 13 years old.
The most common chest injury (61%) was pulmonary contusion, or bruising of the lung. About 45% of patients had a collapsed lung and 34% had rib fractures. Eight deaths occurred among the 102 patients who had chest trauma, the study found.
The study authors found that the biggest cause of chest injury was rollover (43%), followed by collision with landscape (2 %) and falls (16%).
In 41 cases, the injured child had been driving the ATV. In 33 cases, he or she had been riding along as a passenger. In the remaining 28 cases, it wasn't known whether the injured child was the driver or passenger.
While many parents are being more vigilant about ATV safety, some still believe bigger is better and are still allowing their children to operate adult-size vehicles.
"This increases both the risk of crashing and the severity of vehicle-related trauma," Denning said. "A group called Concerned Families for ATV Safety have story after story of children killed in ATV crashes. A common thread through those stories is a parent saying they didn't know how dangerous these vehicles were for their children."
ATV laws are not consistent nationwide. In many states, children younger than 16 can drive ATVs designed for adults, according to the CPSC. The American Academy of Pediatrics (AAP) recommends that children under that age be prohibited from riding ATVs.
Hagedorn is scheduled to present the study results at the annual meeting of the Radiological Society of North America, in Chicago. Findings presented at meetings are generally viewed as preliminary until they've been published in a peer-reviewed journal.
Concerned Families for ATV Safety, mentioned above, offers educational resources, news and ATV safety tips for parents. It also shares family stories of children injured or killed in an ATV accident. Their website is: http://www.cfatvsafety.org
Story source: Don Rauf, https://consumer.healthday.com/kids-health-information-23/child-safety-news-587/atv-accidents-can-cause-serious-chest-injuries-in-children-717207.html
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- Thanks $5000 #HFFTGALA sponsor @EarthfreshFarms! Amazing partnership making certain #nostudentgoeshungry and the wo… https://t.co/CkdvCCo5Umabout 1 hour ago
- Attending #HFFTGALA 2017? Awesome raffle items including 4 tkts to Faith Hill/Tim McGraw Soul2Soul at ACC, June 23r… https://t.co/Ves4PmKCk315 hours ago
- Looking forward to having @mohawkraceway prepare delicious breakfast items at #HFFTGALA 2017! Tkts available:… https://t.co/pI64kjyqO216 hours ago
62% of all Halton students have access to a Student Nutrition Program
Students in the 2013-14 school year
It costs just $1 to feed 2 students breakfast each day.

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they call me every day, but hang up after a few seconds of me answeringreply to this comment
Constant calls...no voicemail...totally spammy
This number has rung me several times during the day in the last week or so, as I am unable to answer my mobile at work, I have not spoken to the caller but on looking up the number I'm pleased that I haven't.
Keeps calling with no answer. Who are these people?
TPS ignorer / no msg - blocked
This number Calls me constantly - I answered and told them not to bother me and since then they call about four times a day and hang up as soon as I answer - it ought to be illegal - bloody nuisance
Pain in the butt, I answer and no one is there
Calls received once a week but hang up upon me answering.
The call was disconnected as soon as it was answered.
Hung up immediately
Every time I answer they hang up!
Keep calling me for past 3-4 weeks. When I answered the phone hangs up.Leesa replied 2017-03-27 13:01:13This no calls continually and hangs up when I answer. Very frustrating.
To stop 100% of these calls please visit www.callblocking.co.uk/register.html .
This number rings me daily, but when I answer the call is immediately disconnected.
Call every day 2 times despite being told on one occasion I have had no accident. Now they phone and it's silence for 8 seconds then they hang up.
This caller claimed I'd had an accident and asked if I'd been compensated.
Fishing for my details over an alleged road accident. Fraud. Scam. Avoid.
If this phone number keeps calling you, the answer should be yes
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"Very fun and easy to drive. A great car for those without young kids."
We bought this car as a second vehicle for my wife to drive in early to work. Fell in love with how it drives and ended up driving it more than our first car. Lots of heads turned out way whenever we drove it around town. I love how the seats hug you and it eliminated my wife's carsick feelings on curves. I would recommend this car for to anyone!
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David Shrigley, Antony Gormley and Bob and Roberta Smith to take part in Folkestone Triennial
Folkestone Triennial, the annual ambitious art exhibition has announced the artists participating in its fourth edition, titled Double Edge.
The artists participating in the 2017 exhibition include Rigo 23, Sol Calero, Michael Craig-Martin, Antony Gormley, Alex Hartley, Lubaina Himid, David Shrigley, Bob and Roberta Smith, among many more. Each of the artists involved will work on site-specific pieces in response "to the physical and conceptual context of Folkestone," says the exhibition.
The title of this year's exhibition Double Edge, "keys ambiguity first of all, and has two principal meanings following from that" says the exhibition's curator Lewis Biggs. "The first is anxiety: the edge of the world, the edge of the future and the unknown. The second is the notion of balance released through the artist's imagination when one tips over the edge and looks back on the known with a renewed perspective."
Folkestone Triennial will take place 2 September – 5 November 2017.
- Brooklyn-based Jyan Ku's naive pastel works are oddly charming
- Jules de Balincourt's vivid paintings of public spaces play with reality
- Harry Israelson photographs a renaissance fair in sunny California
- Pentagram's Domenic Lippa designs the inaugural issue of YES & NO Magazine
- Introducing graphic designer Moonsick Gang
- "Non-league football is our punk rock" – Alex Brown's work for Eastbourne Town FC
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- Photographer Sophie Mayanne's new personal project celebrates imperfection (NSFW)
- Animator Saiman Chow's trippy idents for Adult Swim's Rick and Morty
- The daily grind: Louis Quail's photographs of fascinatingly mundane offices
- "Before I was a graphic designer I had nearly no idea what one was": meet Austin Redman
- Matthew Raw: the east London artist making clay great again


text:
OXNARD, Calif. (AP) – A middle-school science teacher fired after students learned she had appeared in pornographic movies had hoped not just to get her job back, but to set a precedent for people looking to escape an embarrassing personal history.
A three-judge commission put a decisive stop to both, saying firmly and unanimously that Stacie Halas should not be in the classroom.
"We were hoping we could show you could overcome your past," Halas lawyer Richard Schwab said Tuesday. "I think she's representative of a lot of people who may have a past that may not involve anything illegal or anything that hurts anybody."
Judge Julie Cabos-Owen said such a past matters in an age when technology makes porn easy to access and hard to bury.
"Although her pornography career has concluded, the ongoing availability of her pornographic materials on the Internet will continue to impede her from being an effective teacher and respected colleague," Cabos-Owen said in the 46-page decision issued Friday by the Commission on Professional Competence.
Halas, 32, was continually deceitful about her nine-month career in porn before she went to work at the school, the judges said.
Schwab said Halas "was being honest and forthright, but was embarrassed and humiliated by her past experience in the adult industry."
Halas was fired in April from her job as a science teacher at Haydock Intermediate School in Oxnard after online videos of her in porn were discovered by students and teachers.
Student claims that the teacher was moonlighting as a porn star were initially dismissed after school officials said they couldn't find any images of her on the Internet _ but they were using the school's computers, which don't allow access to porn.
Teachers then showed administrators downloads of Halas' sex videos from their smartphones.
In hearings, former assistant principal Wayne Saddler testified that at the start of a sex video, Halas talked about being a teacher and he felt her effectiveness in the classroom had been compromised.
After rumors of her performance surfaced, profanity was etched on Halas' classroom window, a teacher testified.
Schwab has said Halas did not star in pornographic movies while teaching in any district. He said she took parts only during an eight-month period from 2005 to 2006 because of financial problems after her boyfriend abandoned her.
District superintendent Jeff Chancer applauded the commission's ruling.
Halas' decision to "engage in pornography was incompatible with her responsibilities as a role model for students," Chancer said in a statement.
(Copyright 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.)
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A pilot controlled trial of insulin-like growth factor-1 in children with Phelan-McDermid syndrome
- Alexander Kolevzon1, 2, 3, 4, 5, 10Email author,
- Lauren Bush1, 4, 10,
- A Ting Wang1, 2, 4, 6, 10,
- Danielle Halpern1, 4, 10,
- Yitzchak Frank1, 4, 5, 7, 10,
- David Grodberg1, 4, 10,
- Robert Rapaport5, 9, 10,
- Teresa Tavassoli1, 4, 10,
- William Chaplin11,
- Latha Soorya12 and
- Joseph D Buxbaum1, 2, 3, 4, 6, 8, 10
© Kolevzon et al.; licensee BioMed Central. 2014
Received: 25 June 2014
Accepted: 20 November 2014
Published: 12 December 2014
Autism spectrum disorder (ASD) is now understood to have multiple genetic risk genes and one example is SHANK3. SHANK3 deletions and mutations disrupt synaptic function and result in Phelan-McDermid syndrome (PMS), which causes a monogenic form of ASD with a frequency of at least 0.5% of ASD cases. Recent evidence from preclinical studies with mouse and human neuronal models of SHANK3 deficiency suggest that insulin-like growth factor-1 (IGF-1) can reverse synaptic plasticity and motor learning deficits. The objective of this study was to pilot IGF-1 treatment in children with PMS to evaluate safety, tolerability, and efficacy for core deficits of ASD, including social impairment and restricted and repetitive behaviors.
Nine children with PMS aged 5 to 15 were enrolled in a placebo-controlled, double-blind, crossover design study, with 3 months of treatment with IGF-1 and 3 months of placebo in random order, separated by a 4-week wash-out period.
Compared to the placebo phase, the IGF-1 phase was associated with significant improvement in both social impairment and restrictive behaviors, as measured by the Aberrant Behavior Checklist and the Repetitive Behavior Scale, respectively. IGF-1 was found to be well tolerated and there were no serious adverse events in any participants.
This study establishes the feasibility of IGF-1 treatment in PMS and contributes pilot data from the first controlled treatment trial in the syndrome. Results also provide proof of concept to advance knowledge about developing targeted treatments for additional causes of ASD associated with impaired synaptic development and function.
Autism spectrum disorder (ASD) is currently a diagnosis established by behavioral criteria but its etiology resides in complex genetics, and many distinct genetic risk genes have been identified as causal. One such example is the SHANK3 gene located on the terminal end of chromosome 22q where loss of one copy (haploinsufficiency) of SHANK3 causes a monogenic form of ASD with a frequency of at least 0.5% of ASD cases[1–4]. The SHANK3 gene codes for a protein that plays a critical role in synaptic function by scaffolding the postsynaptic density of glutamatergic synapses[5] and its loss is sufficient to cause Phelan-McDermid syndrome (PMS)[6, 7]. PMS is characterized by significant intellectual disability (ID), severely delayed or absent language, and ASD. Affected individuals also suffer from a heterogeneous array of dysmorphic and medical features, including increased risk of seizures, recurring infections, hypotonia, renal disease, and gastroesophageal reflux[8–17]. While PMS accounts for a relatively small proportion of ASD cases, the SHANK3 pathway is relevant to many forms of ASD because different genetic causes of ASD converge on several common pathways, including SHANK3[18, 19].
Using Shank3-deficient mice, deficits in synaptic function and plasticity have been shown using electrophysiological measures[20]. Behaviorally, Shank3- deficient mice display motor deficits, less social sniffing and reduced ultrasonic vocalizations as compared to wildtype controls[20, 21]. Insulin-like growth factor-1 (IGF-1) has been studied in this mouse, as well as in human neuronal models of PMS, and was found to reverse synaptic and behavioral deficits[21]. Importantly, IGF-1 is also effective in reversing phenotypic changes in human neuronal models of Rett syndrome[22], providing additional evidence that this pathway may be a target in diverse forms of ASD. These data are promising and provide preclinical evidence that IGF-1 may produce disease-modifying effects in subjects with PMS or Rett syndrome. Recent evidence also provides preliminary support of efficacy with IGF-1 in children with Rett syndrome[23].
IGF-1 is a commercially available compound that crosses the blood-brain barrier (BBB) and has beneficial effects on synaptic development by promoting neuronal cell survival, synaptic maturation, and synaptic plasticity[23, 24]. IGF-1 enters the brain from the circulation where it is released mainly by the liver upon growth hormone stimulation. Blood-borne IGF-1 is found in the central nervous system (CNS) where it promotes brain vessel growth[25], neurogenesis, and synaptogenesis[26]. The mechanisms that trigger IGF-1 entry through the BBB are proposed to occur by diffusible messengers released in areas of neuronal activity which lead to cleavage of IGF binding protein-3 (IGFBP-3) to increase free IGF-1 and allow passage of circulating IGF-1 into the CNS[27]. The recent IGF-1 study in Rett syndrome examined its pharmacokinetic profile in human subjects and found that IGF-1 reached the CNS compartment as demonstrated by significantly increased cerebrospinal fluid levels after treatment[23]. However, the precise mechanisms by which IGF-1 exerts its effects on the CNS remains an active area of study.
IGF-1 is currently approved by the Food and Drug Administration (FDA) for the treatment of short stature due to primary IGF-1 deficiency (Laron's Dwarfism). There have been no controlled treatment trials in PMS to date and this study was designed to evaluate the safety, tolerability, and efficacy of IGF-1 versus placebo in children with PMS targeting core domains of ASD. Specifically, social deficits and repetitive behaviors were measured using the Aberrant Behavior Checklist-Social Withdrawal (ABC-SW) subscale as the primary outcome measure[28] and the Repetitive Behavior Scale-Revised (RBS-R) as a secondary outcome[29].
All subjects were recruited under an Institutional Review Board (IRB) approved protocol as part of ongoing studies in PMS at the Seaver Autism Center for Research and Treatment at the Icahn School of Medicine at Mount Sinai and parents/guardians provided informed consent. Treatment followed a randomized, placebo-controlled, crossover format with 12 weeks in each treatment arm (IGF-1 and placebo), separated by a 4-week wash-out phase (ClinicalTrials.gov Identifier: NCT01525901). This was a pilot study in a rare disorder, PMS, and sample size and analyses were defined a priori. Multiple outcome measures are being collected as part of a larger ongoing clinical trial with IGF-1 in PMS but pilot data from the safety measures, and main primary and second outcomes have been analyzed to date and are presented herein.
Inclusion criteria
This pilot recruited 9 children between 5 and 15 years-old with PMS and confirmed to have SHANK3 deletions or mutations based on chromosomal microarray or high-throughput or targeted sequencing. All subjects were on stable medication regimens for at least 3 months prior to enrollment.
Exclusion criteria
Cases were excluded if any of the following were applicable: 1) closed epiphyses; 2) active or suspected neoplasia; 3) intracranial hypertension; 4) hepatic insufficiency; 5) renal insufficiency; 6) cardiomegaly/valvulopathy; 7) allergy to IGF-1; 8) patients with comorbid conditions deemed too medically compromised to participate.
Drug administration
IGF-1 (Increlex; Ipsen Biopharmaceuticals, Inc) is an aqueous solution for injection containing human insulin-like growth factor-1 (rhIGF-1) produced by recombinant DNA technology. Placebo consisted of saline prepared in identical bottles by the research pharmacy at Mount Sinai. We received an Investigational New Drug exemption from the Food and Drug Administration (#113031) to conduct this trial in children with PMS. Based on the package insert for Increlex, dose titration was initiated at 0.04 mg/kg twice daily by subcutaneous injection, and increased, as tolerated, every week by 0.04 mg/kg per dose to a maximum of 0.12 mg/kg twice daily. This titration was justified based on our preclinical data, which indicated that 0.24 mg/kg/day is effective in reversing electrophysiological deficits whereas 0.12 mg/kg/day was not as effective[21]. We aimed to reach the therapeutic dose as quickly as is safe and tolerated in order to allow maximum time for clinical improvement. Doses could be decreased according to tolerability by 0.04 mg/kg per dose. Medication was administered twice daily with meals, and preprandial glucose monitoring was performed by parents prior to each injection throughout the treatment period. Parents were carefully trained in finger stick monitoring, symptoms of hypoglycemia, and medication administration.
Outcome measures
Efficacy measurements were taken at baseline of each treatment phase, and at weeks 4, 8, and 12 of each treatment phase. The ABC is a rating scale used to monitor an array of behavioral features, including social withdrawal (i.e., Lethargy subscale). The ABC-SW subscale was chosen a priori as the primary outcome measure because it is well validated in both ID and ASD patients and is currently accepted as an appropriate outcome measure within the field of pediatric psychopharmacology research. In addition, preliminary data suggest that the ABC accurately reflects ASD-related deficits in PMS. Repetitive behavior was measured using the RBS-R, which has also been previously validated as a measurement tool in ID and ASD populations. Safety, tolerability, and adverse events (AEs) were measured throughout the trial during monitoring visits and phone calls using an adapted semi-structured interview, the Safety and Monitoring Uniform Report Form (SMURF) every 2 weeks, and extensive clinical and laboratory assessments every 4 weeks. AEs were documented with respect to severity, duration, management, relationship to study drug, and outcome.
Data analysis
This trial used a randomized crossover design; thus, order (phase) of assessment is nested (repeated) within treatment and treatment is nested within subjects. Given the small sample size, we considered several analytic strategies and selected a fully within-subject, repeated-measures design. To conform to intent-to-treat principles, we used mixed effects regression models so that participants missing observations would be included in the analysis (full information maximum likelihood estimation). Treatment was dummy coded as 0 = placebo and 1 = control and time coded naturally as weeks (0, 4, 8, and 12). In this analysis, the primary focus was time by treatment interaction, which estimates the differential change in the two treatments on the outcome measures. Because of the small sample size, we used a variance components intercept only model for the random effect variation. We then added 'phase' as another repeated factor to examine the effect of order through a three-way interaction analysis.
Baseline demographic characteristics
Chronological age (months)
Estimated mental age equivalent (months)
Vineland adaptive behavior scale composite standard score
Adverse events
Adverse events
Decreased appetite
Periobital/facial swelling
Sleep Disturbance
Increased appetite
Mood changes/irritability
Increased thirst
Increased phlegm
Teeth grinding
Hand flapping
Increased bowel movements
Increased chewing/biting
Decreased visual acuity
Lethargy/decreased energy
Cooler body temperature/sweating
Runny nose/congestion
Gait changes/fell
Stomach virus
Increased urine frequency
Increased energy
Increased thirst
Erythema/swollen eyes
Nose swelling
Warmer body temperature
Hair loss
Increased aggression
However, participants assigned to IGF-1 at phase 1 had a higher baseline ABC-SW value at phase 1 than the placebo participants. Given the small sample size, this disparity is not surprising despite randomization. To account for this disparity we controlled for phase 1 ABC-SW baseline values and the time x treatment interaction remained significant (N = 9; t = −2.151; P = 0.036). Analyses were performed on the other ABC subscales and results were not statistically significant (Irritability: t = −0.839, P = 0.405; Motor Stereotypies: t = −0.240, P = 0.811; Hyperactivity: t = −0.954, P = 0.344; Inappropriate Speech: t = 0.008, P = 0.994).
Results from the RBS-R Total score were not significant (N = 9, t = −0.791; P = 0.432). However, analyses were performed on the RBS-R subscales and significant improvement was found on the Restricted Behavior subscale (N = 9; t = −2.077; P = 0.042). Again, when 'phase' (order) was added as a third variable, the three-way interaction was not significant indicating that the significant time x group interaction is not a function of treatment order. Participants also had a higher baseline RBS-R Restrictive Behavior scores at phase 1 than the placebo participants, but after adding the baseline values of the RBS-R Restricted Behavior subscale to the model, the interaction remains significant and is largely unchanged (t = −2.107; P = 0.040). Results from the other RBS-R subscales were not statistically significant (Stereotyped Behavior: t = −0.269, P = 0.789; Self-Injurious Behavior: t = −1.896, P = 0.063; Compulsive Behavior: t = 0.888, P = 0.378; Ritualistic Behavior: t = −0.192, P = 0.848; Sameness: t = 0.005, P = 0.996).
This is the first controlled treatment trial in PMS and establishes safety and preliminary evidence of benefit of IGF-1 on core symptoms of ASD. Although PMS is now recognized to be a relatively common cause of ASD, a review of the literature revealed only two published reports of medication treatment trials, one case series with intranasal insulin[36] and one case study with risperidone[37], both open label and with reported improvement. In the intranasal insulin study, 6 children received up to 12 months of treatment with improvement based on sum of scores from a parental questionnaire in most domains, including cognitive, speech and language, and motor skills[36]. Insulin was hypothesized in these cases to improve neuronal function by increasing CNS glucose uptake and enhancing synaptic plasticity via glutamatergic receptors. Results from the case study with risperidone were similarly optimistic but equally uncontrolled: an 18-year-old girl with PMS was treated with risperidone 0.5 mg twice daily with significant improvement on the Clinical Global Impression Scale (CGI;[38]) in anxiety, aggression, and insomnia after 1 month that was sustained after 6 months. The hypothesized mechanism of action of risperidone in SHANK3 deficiency was to promote N-methyl-D-aspartate (NMDA) transmission via dopamine 2 receptor blockade. However, studies in Shank3 deficient mice indicate that reduced basal neurotransmission at glutamatergic synapses may be α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor mediated[20].
To date, few pharmacological treatments in ASD have been developed based on neurobiological strategies. Most trials have employed etiologically heterogeneous samples and targeted associated symptoms. More recently, genetic discovery and model systems have led to important opportunities for developing novel, potentially disease-modifying therapeutics. This study is based on preclinical evidence showing that IGF-1 reversed deficits in mouse and neuronal models of SHANK3 deficiency. The results now provide preliminary evidence of efficacy with IGF-1 in a clinical sample of children with PMS. Recent examples of a similar approach to treatment development are the large-scale clinical trials currently underway in fragile X syndrome (FXS), Rett syndrome, and tuberous sclerosis, all known causes of ASD. The SHANK3/glutamate signaling pathway is highly relevant to various forms of ASD[18, 19] and the link between deficits in synapse function and ASD suggest that treatment with IGF-1 may have implications for ASD caused by disruptions in common underlying pathways. Importantly, the first evidence of the efficacy of IGF-1 in an ASD-related syndrome has already emerged in Rett syndrome[23].
Despite the promise of these findings, several weaknesses must be acknowledged. For example, the small sample challenges our ability to generalize results to a broader population of children with PMS. The resulting decrease in statistical power did not compromise the significance of our findings but it is possible that the effect size may not be upheld in a larger sample. In addition, we showed that when patients received IGF-1 they were significantly more likely to report AEs and this may have introduced bias and contributed to the caregivers' anticipation of benefit. Such challenges are inherent to using caregiver reports as outcome measures. Further, while patients were more likely to report AEs while on IGF-1, the nature of AEs was similar between treatment groups. Lastly, crossover trial designs carry risks of treatment order effects. We provided a 4-week wash-out period to minimize this risk and evaluated the differential effect of treatment over time in the context of order to show that there was no significant effect of treatment order. We chose to use this design because PMS is a rare disease without available treatments and wanted to ensure that all participants were afforded the opportunity to receive active medication; the cost of IGF-1 prohibited an open label extension trial.
Results from this study are novel and of broad interest for a number of important reasons. First, PMS, while considered a rare disorder, is now known to be a more common, and highly penetrant cause of ASD[39]. As such, there is significant interest in the SHANK3 gene as genetic discovery and functional analysis of model systems continue to aid in our understanding of the neurobiology of ASD. Second, this is a translational clinical trial based on prior work in mice that demonstrates IGF-1 to reverse electrophysiological and motor learning deficits[21]. Third, an independent group has demonstrated a reversal of synaptic deficits with IGF-1 in neurons derived from induced pluripotent stem cells of patients with PMS[21]. Fourth, there is now additional independent clinical evidence of the efficacy of IGF-1 in Rett syndrome to generate interest in this compound. Finally, we have shown benefits with IGF-1 on core symptoms of ASD, suggesting a potentially disease-modifying effect. Of course, these positive findings must be interpreted with caution given the small sample size. With its limitations, the present study nevertheless contributes the first evidence of the safety and efficacy of IGF-1 in PMS from the first controlled treatment trial in the field. Results from this pilot are intended to facilitate larger studies that will more definitively inform efficacy.
Aberrant Behavior Checklist
Autism Diagnostic Interview-Revised
Autism Diagnostic Observation Schedule-Generic
adverse event
α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid
autism spectrum disorder
blood-brain barrier
Clinical Global Impression Scale
central nervous system
Diagnostic and Statistical Manual for Mental Disorders
Food and Drug Administration
intellectual disability
fragile X syndrome
insulin-like growth factor-1
IGF binding protein-3
Institutional Review Board
Phelan-McDermid syndrome
- rhIGF-1:
recombinant human insulin-like growth factor-1
Repetitive Behavior Scale-Revised
serious adverse event
Safety and Monitoring Uniform Report Form.
This work was supported by grants from the Beatrice and Samuel A Seaver Foundation and the National Institutes of Health (NIMH grant R34 MH100276-01 to AK). We would like to thank the Phelan-McDermid Syndrome Foundation for their support disseminating information about the trial - more information about PMS can be found through the Foundation athttp://www.22q13.org or the Seaver Autism Center athttp://www.shank3gene.org. We would also like to express our gratitude to the many families that work closely with us to better understand neurodevelopmental disability and a special thanks to the nine children and families who participated in this trial.
Authors' Affiliations
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best bagels in town hands down! these are real deal bagels and excellent coffee with free refills....friendly staff! must try!
Their bagels are good and this is a must breakfast destination for people in the area. These bagels are pretty darn close to NYC bagels, that is all that needs to be said.
We always stock up on bagels,when vacationing in Jupiter. Very good. Also loved the tuna salad that we tried this past time. Their coffee choices look great and my husband enjoyed his cup. I'm a Starbucks loyalist, so I just go for the food! They also offer delicious breakfast and lunch sandwiches.
Stopped there for breakfast, not bad but is higher priced than Einstein Bagel right down the street. Service is good and menu appears reasonable .
to me making a great bagel is an art...There are only 2 bagel places in Florida. The Sage in Lauderdale and Brooklyn Bagel ( a few spots)
My favorite is poppy seed bagel with smoked salmon...ALSO their coffee is terrific!
Ordered two Brownsville breakfast sandwiches. They did not disappoint! Very popular spot. Love the open kitchen to watch them making bagels.
We enjoyed our Taylor Ham, Egg & Cheese on Everything Bagels.
Lots of sandwich choices....hot and cold coffee choices....quick, friendly service.
We would definitely go back.
Its impossible to find true bagels outside of the NY metro area. (I heard from a baker friend of mine that open and since closed a bakery in Tequesta, that the FL water is just too full of minerals to bake with.)
I once even had bagels sent from Zabars years ago..a costly idea.
But this is as good/close as...
lines outside waiting to go in, order and seat. We ordered bagels to go and cream cheeses. Also a couple of bagels to go with a generous serving of cream cheese. totally delicious.
We like this place's bagels better than any others in this area, but I'm disappointed in the lack of variety of flavors. Back home in Albany, NY (where we live during the summer months), every bagel shop has blueberry bagels, cheddar cheese bagels, spinach bagels, cinnamon sugar bagels, and even chocolate chip bagels sometimes, in addition to the flavors I've...
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I hope you all take a moment to remember those who served and take advantage of our opportunity of freedom and exercise it in a positive way today and the rest of the year.
Happy Memorial Day from Guitar Ted Productions!
My ride started a little earlier and a little further away. AM sunrise over the High Trestle Trail Every year I've done the Renegade...


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Inland Empire Collie Club
April 14, 2017
Breed Judge: Alane Gomez
Roughs: 8-8 (2-2 (0-1)
Smooths: 4-8 (3-5) 1 smooth brace
Jr. Show: 6
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Rough Best of Variety: GCH Bayside Dreamgirl (Vet/B)
Rough Best of Winners: Milas Moxie La De Da (B)
Rough Best of Opposite Sex to Best of Variety: CH Markos-N-Rimba's Thank God It's Friday RE (D)
Rough Select Dog: CH Aurealis Zandria's Winning Colors
Rough Select Bitch: GCH Colebrae Krystal Blue Persuasion
Rough Winners Dog: Monarch Clarion Promise Me The Night (Open)
Rough Reserve Winners Dog: Belfair Cynclair I love A Rainy Nite (Open)
Rough Winners Bitch: Milas Moxie La De Da (Open)
Rough Reserve Winners Bitch: Moxie In Good Company (12-18)
Smooth Best of Variety: CH Zandria's Burn'N It Down (D)
Smooth Best of Winners: Aurealis Star Gaze (D)
Smooth Best of Opposite Sex to Best of Variety: GCH Encore's Zandria 'N Tercan's Magic In The Sky RN CGC (B)
Smooth Select Dog: GCH Encore Belfair's Bold Ruler RN PT CGC
Smooth Select Bitch: GCH Sinkona's Sumerhill Dancer
Smooth Winners Dog: Aurealis Star Gaze (12-18)
Smooth Reserve Winners Dog: Glenelg's Brief Encounter Of Shadaglen (Amateur-O-H)
Smooth Winners Bitch: Glenelg's Blu Victory Of Shadaglen (BBE)
Smooth Reserve Winners Bitch: Encore's Spectacular Bid (BBE)
Best Junior: not reported
Best in Sweepstakes: Caublestone Tales Of Snovalley
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April 21, 2017
TENNESSEE – Ceilidh Collies of Nashville, Tennessee offers 2 smooth male collies for sale. Show prospects. Grandsons of GrChP Ceilidh's Deep River Haute Couture. Send inquiries to firstname.lastname@example.com
April 20, 2017
ONTARIO, CANADA – Moonshadows Niagara Falls, ON CDA is pleased to announce a litter of 8 Smooth pups born Mar. 1/17. US CH.Tir Nan' Og Shock Rock and CDA CH Lochstarr Moonshadows Lady. Home raised. Send inquiries to Sandy at
1-905-382-6627 and moonshadowspage@
April 18, 2017
NORTH CAROLINA – Sunway and Magnolia Collies have three male puppies available. Show, performance, companion by Countryview Rocket Man x Ch Spiritwind Reflection (Scout Daughter), two tri roughs and one sable smooth. Send all inquiries to: Perausdesign
April 11, 2017
OHIO – Crooked River Collies has two adult sable and white females available for pet homes. Both are spayed and house trained. Please contact Kathy at: scarletpancho
March 24, 2017
OHIO – Fasganon Collies has rough and tri smooth male puppies born 1/31/2017 by CH Fasganon's Peacemaker out of CH Fasganon's Love Lives On Curtacy of StoneyAcre for sale. Call 330-225-5389 or email: firstname.lastname@example.com
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