Between 1960 and 1991, 156 episodes of central nervous system (CNS) bleeding were documented in 106 patients from a total population of 1,410 hemophiliacs (7.5%). Ninety-one hemophilia A patients presented 131 bleeding episodes; 15 hemophilia B patients had 25 episodes. 32% of these episodes took place in patients less than 5 years of age. 46 % were age 10 or less, and 72% were age 20 or less. The mean age was 14.8 years in hemophilia A and 9 years in hemophilia B patients. A significant increase in the mean age of hemophilia A patients has been observed over the last 10 years; this may be related to HIV infection. A history of recent trauma was documented in 39.7% of the episodes. Spontaneous CNS bleeding was predominant in severe hemophilia (85.2%). One hundred and fifty-four CNS bleeding episodes were intracranial and 2 intraspinal. Of the intracranial episodes, 37.7% were subarach-noid, 29.8 subdural, and 22.7% intracerebral. Factor VIII or IX inhibitors were present in 11.3% of the patients; this figure is slightly lower than that observed in our total hemophilic population. Over 50% of the patients had psychoneurological sequelae; the most frequent were seizure disorders and motor impairment. The overall mortality rate was 29.2%. The mortality was more closely related to the CNS bleeding site than to the severity of hemophilia. Treatment should be based on prompt and prolonged replacement therapy to ensure hemostatic levels of antihemophilia factors.

BACKGROUND: Glyphosate (GLY) is the most heavily used herbicide in the world. Despite nearly ubiquitous exposure, few studies have examined prenatal GLY exposure and potentially adverse pregnancy outcomes. Preterm birth (PTB) is a risk factor for neonatal mortality and adverse health effects in childhood. OBJECTIVES: We examined prenatal exposure to GLY and a highly persistent environmental degradate of GLY, aminomethylphosphonic acid (AMPA), and odds of PTB in a nested case-control study within the ongoing Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) pregnancy cohort in northern Puerto Rico. METHODS: GLY and AMPA in urine samples collected at 18 ± 2 (Visit 1) and 26 ± 2 (Visit 3) wk gestation (53 cases/194 randomly selected controls) were measured using gas chromatography tandem mass spectrometry. Multivariable logistic regression was used to estimate associations with PTB (delivery <37 wk completed gestation). RESULTS: Detection rates in controls were 77.4% and 77.5% for GLY and 52.8% and 47.7% for AMPA, and geometric means (geometric standard deviations) were 0.44 (2.50) and 0.41 ð2:56Þ lg=L for GLY and 0.25 (3.06) and 0.20 ð2:87Þ lg=L for AMPA, for Visits 1 and 3, respectively. PTB was significantly associated with specific gravity-corrected urinary GLY and AMPA at Visit 3, whereas associations with levels at Visit 1 and the Visits 1-3 average were largely null or inconsistent. Adjusted odds ratios (ORs) for an interquartile range increase in exposure at Visit 3 were 1.35 (95% CI: 0.99, 1.83) and 1.67 (95% CI: 1.26, 2.20) for GLY and AMPA, respectively. ORs for Visit 1 and the visit average were closer to the null. DISCUSSION: Urine GLY and AMPA levels in samples collected near the 26th week of pregnancy were associated with increased odds of PTB in this modestly sized nested case-control study. Given the widespread use of GLY, multiple potential sources of AMPA, and AMPA's persistence in the environment, as well as the potential for long-term adverse health effects in preterm infants, further investigation in other populations is warranted.

Locked-in syndrome (LIS) is a rare diagnosis in which patients present with quadriplegia, lower cranial nerve paralysis, and mutism. It is clinically difficult to differentiate from other similarly presenting diagnoses with no standard approach for assessing such poorly responsive patients. The purpose of this case is to highlight the clinical differential diagnosis process and outcomes of a patient with LIS during acute inpatient rehabilitation. A 32-year-old female was admitted following traumatic brain injury. She presented with quadriplegia and mutism but was awake and aroused based on eye gaze communication. The rehabilitation team was able to diagnose incomplete LIS based on knowledge of neuroanatomy and clinical reasoning. Establishing this diagnosis allowed for an individualized treatment plan that focused on communication, coping, family training, and discharge planning. The patient was ultimately able to discharge home with a single caregiver, improving her quality of life. Continued evidence highlights the benefits of intensive comprehensive therapy for those with acquired brain injury such as LIS, but access is still limited for those with a seemingly poor prognosis. Access to a multidisciplinary, specialized team provides opportunity for continued assessment and individualized treatment as the patient attains more medical stability, improving long-term management.

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The United Automobile Workers uses worker-trainers to deliver health and safety education training to its members. The union has experimented with worker-trainers participating in program evaluation. Worker-trainers participated in the design and conduct of a telephone survey of training impact, and of an on-site survey of trainee perceptions of a large-scale program. Worker evaluators were able to analyze data and give a highly successful presentation of results to trainees at the large-scale program. The incorporation of workers as evaluators is a key step toward the goal of worker empowerment. The involvement of program participants in their program's evaluation can enhance the quality and usefulness of work-site health and safety programs in general.

Background The long-term impact of the United Automobile Workers' (UAW) Industrial Emergency Response Training on health and safety conditions and practices in plants is described. Two strategies are combined in this 24-hour training: the use of peer (worker) trainers and a participant-centered approach, the Small Group Activity Method (SGAM). Methods Impact was assessed through a telephone survey of 67 trainees conducted on average 16.8 months post-training. Results 74% of trainees reported using at least one of the provided written training materials after training. Of those reporting an accident in their facility after training, 88% said it was handled differently because of training. Trainees report that peertrainers are more knowledgeable and communicate better than do other types of trainers. Trainees also reported that SGAM made training more applicable to their workplace. 98.5% of trainees like the methods utilized. Conclusions Worker-trainers and SGAM are effective training methods enhancing the long-term impact of union-based workplace health and safety training programs.

Blood biochemical and hematology analyses are helpful indicators of the physiologic health of animals, particularly when making conservation and management decisions for threatened species. In this study, we 1) established blood biochemical reference intervals for two populations of threatened, free-ranging ornate box turtles ( Terrapene ornata) in northern Illinois during their active season and 2) examined the effects of individual carapace temperature ( T) on blood biochemical variables by using a Bayesian hierarchical framework. Individual blood variables differed throughout the active season (May-September 2015), but there were few distinct patterns in concentrations over time. When controlling for individual variability, blood biochemical variables potassium, sodium, chloride, ionized calcium, hematocrit (percentage of packed cell volume), and osmolality showed no effect of T (i.e., slope estimates for these variables were not credibly different from zero) and had little individual variation. Glucose and urea nitrogen were found to have slopes credibly different from zero, with glucose having an estimated positive slope and urea nitrogen having an estimated negative slope, suggesting different relationships in response to T when controlling for individual variability. These physiologic blood data will serve as important baseline reference values for the clinical evaluation of wild ornate box turtles presented for veterinary care or for comparison to other studies of wild populations. Further, this study highlights the importance of considering individual-level effects (e.g., T) on physiologic health variables.