Early parental physical punishment and emotional and behavioural outcomes in preschool children

OBJECTIVE

To determine whether there is an association between being smacked by your main caregiver in the first two years and emotional and behavioural problems at age four.

DESIGN

Secondary analysis of data from the Growing Up in Scotland Prospective Study (GUS).

SETTING

Scotland, UK.

PARTICIPANTS

GUS birth cohort children, whose main caregiver had no concerns about their behaviour at 22 months.

EXPOSURE

Ever smacked by main caregiver in first 22 months, as measured by caregiver self-report at 22 months.

MAIN OUTCOME

Emotional and behavioural problems as measured by parental assessment and the Strengths and Difficulties Questionnaire (SDQ) at 46 months.

RESULTS

Preschool children exposed to main caregiver smacking in the first two years were twice as likely to have emotional and behavioural problems as measured by parental assessment [odds ratio (OR) 2.5, 95% confidence interval (CI) 1.9-3.2; absolute risk reduction (ARR) 17.8%, 95% CI 12.1-23.5] and SDQ (OR 2.5, 95% CI 1.7-3.7; ARR 7.5%, 95% CI 3.7-11.5), as children never smacked by their main caregiver. The association remained significant after adjusting for child age and sex, caregiver age, sex, ethnicity, educational attainment and mental health status, sibling number, structural family transitions and socioeconomic status (adj. OR 2.4, 95% CI 1.8-3.2 for parental assessment and adj. OR 2.2, 95% CI 1.4-3.5 for SDQ).

CONCLUSIONS

Parental use of physical punishment in the first two years may be a modifiable risk factor for emotional and behavioural difficulties in preschool children.

Multidimensional Treatment Foster Care for Adolescents in English care: randomised trial and observational cohort evaluation

BACKGROUND

Children in care often have poor outcomes. There is a lack of evaluative research into intervention options.

AIMS

To examine the efficacy of Multidimensional Treatment Foster Care for Adolescents (MTFC-A) compared with usual care for young people at risk in foster care in England.

METHOD

A two-arm single (assessor) blinded randomised controlled trial (RCT) embedded within an observational quasi-experimental case-control study involving 219 young people aged 11-16 years (trial registration: ISRCTN 68038570). The primary outcome was the Child Global Assessment Scale (CGAS). Secondary outcomes were ratings of educational attendance, achievement and rate of offending.

RESULTS

The MTFC-A group showed a non-significant improvement in CGAS outcome in both the randomised cohort (n = 34, adjusted mean difference 1.3, 95% CI -7.1 to 9.7, P = 0.75) and in the trimmed observational cohort (n = 185, adjusted mean difference 0.95, 95% CI -2.38 to 4.29, P = 0.57). No significant effects were seen in secondary outcomes. There was a possible differential effect of the intervention according to antisocial behaviour.

CONCLUSIONS

There was no evidence that the use of MTFC-A resulted in better outcomes than usual care. The intervention may be more beneficial for young people with antisocial behaviour but less beneficial than usual treatment for those without.

Maternal mortality, birth with a health professional and distance to obstetric care in Indonesia and Bangladesh

OBJECTIVE

To examine the relationship between distance to a health facility, consulting a health professional and maternal mortality.

METHODS

Retrospective cohort study in Matlab, Bangladesh (1987-2005), to collect data on all pregnancies, births and deaths. In Java, Indonesia (2004-2005), an informant-based approach identified maternal deaths and a population-based survey sampled women who survived birth. Logistic regression was used to examine the influence of distance to a health facility and uptake of a health professional on odds of dying.

RESULTS

Maternal mortality was 320 per 100 000 births (95% CI: 290, 353) in Indonesia and 318 per 100 000 (95% CI: 272, 369) in Bangladesh. Women who lived further from health centres in both countries were less likely to have their births attended by health professionals than those who lived closer. For women who were assisted by a health professional, the odds of dying increased with increasing distance from a health centre [odds ratio per km; Indonesia: 1.07 (95% CI: 1.02-1.11), Bangladesh: 1.47 (95% CI: 1.22-1.78)]. There was no evidence for an association between distance to a health centre and maternal death for women who were not assisted by a health professional.

CONCLUSIONS

Even in settings where health services are relatively close to women's homes, distance to a health facility affects maternal mortality for women giving birth with a health professional. Women may only seek professional care in an emergency and may be unable to reach timely care when living far away from a health centre.

Descriptive characteristics and rehabilitation outcomes in active duty military personnel and veterans with disorders of consciousness with combat- and noncombat-related brain injury

OBJECTIVE

To report the injury and demographic characteristics, medical course, and rehabilitation outcome for a consecutive series of veterans and active duty military personnel with combat- and noncombat-related brain injury and disorder of consciousness (DOC) at the time of rehabilitation admission.

DESIGN

Retrospective study.

SETTING

Rehabilitation center.

PARTICIPANTS

From January 2004 to October 2009, persons (N=1654) were admitted to the Polytrauma Rehabilitation System of Care. This study focused on the N=122 persons admitted with a DOC. Participants with a DOC were primarily men (96%), on active duty (82%), ≥12 years of education, and a median age of 25. Brain injury etiologies included mixed blast trauma (24%), penetrating (8%), other trauma (56%), and nontrauma (13%). Median initial Glasgow Coma Scale score was 3, and rehabilitation admission Glasgow Coma Scale score was 8. Individuals were admitted for acute neurorehabilitation approximately 51 days postinjury with a median rehabilitation length of stay of 132 days.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Recovery of consciousness and the FIM instrument.

RESULTS

Most participants emerged to regain consciousness during neurorehabilitation (64%). Average gains ± SD on the FIM cognitive and motor subscales were 19 ± 25 and 7 ± 8, respectively. Common medical complications included spasticity (70%), dysautonomia (34%), seizure occurrence (30%), and intracranial infection (22%). Differential outcomes were observed across etiologies, particularly for those with blast-related brain injury etiology.

CONCLUSIONS

Despite complex comorbidities, optimistic outcomes were observed. Individuals with severe head injury because of blast-related etiologies have different outcomes and comorbidities observed. Health-services research with a focus on prevention of comorbidities is needed to inform optimal models of care, particularly for combat injured soldiers with blast-related injuries.

Phylogenetic and phylogeographic analysis of the genus Orestias (Teleostei: Cyprinodontidae) in the southern Chilean Altiplano: the relevance of ancient and recent divergence processes in speciation

This study presents phylogenetic molecular data of the Chilean species of Orestias to propose an allopatric divergence hypothesis and phylogeographic evidence that suggests the relevance of abiotic factors in promoting population divergence in this complex. The results reveal that diversification is still ongoing, e.g. in the Ascotán salt pan, where populations of Orestias ascotanensis restricted to individual freshwater springs exhibit strong genetic differentiation, reflecting putative independent evolutionary units. Diversification of Orestias in the southern Altiplano may be linked to historical vicariant events and contemporary variation in water level; these processes may have affected the populations from the Plio-Pleistocene until the present.

Formation and stability of impurity "snakes" in tokamak plasmas

New observations of the formation and dynamics of long-lived impurity-induced helical "snake" modes in tokamak plasmas have recently been carried out on Alcator C-Mod. The snakes form as an asymmetry in the impurity ion density that undergoes a seamless transition from a small helically displaced density to a large crescent-shaped helical structure inside q<1, with a regularly sawtoothing core. The observations show that the conditions for the formation and persistence of a snake cannot be explained by plasma pressure alone. Instead, many features arise naturally from nonlinear interactions in a 3D MHD model that separately evolves the plasma density and temperature.

Droplet-based microfluidics

Droplet-based microfluidics or digital microfluidics is a subclass of microfluidic devices, wherein droplets are generated using active or passive methods. The active method for generation of droplets involves the use of an external factor such as an electric field for droplet generation. Two techniques that fall in this category are dielectrophoresis (DEP) and electrowetting on dielectric (EWOD). In passive methods, the droplet generation depends on the geometry and dimensions of the device. T-junction and flow focusing methods are examples of passive methods used for generation of droplets. In this chapter the methods used for droplet generation, mixing of contents of droplets, and the manipulation of droplets are described in brief. A review of the applications of digital microfluidics with emphasis on the last decade is presented.

Streptavidin binding bifunctional aptamers and their interaction with low molecular weight ligands

This paper describes the measurement of the binding affinities of two bifunctional RNA aptamers to their respective ligands. The aptamers comprise either a theophylline or malachite green binding sequence fused to a streptavidin binding sequence. These bifunctional aptamers are shown to bind simultaneously to both the small ligand and to streptavidin whether in free solution or on gold surfaces. Binding isotherms for both interactions were measured by different physiochemical techniques: surface plasmon resonance, fluorescence spectroscopy and dynamic light scattering. Both qualitatively and quantitatively there is little difference in binding affinities between the bifunctional aptamers and their monofunctional components. The respective K(d) values for streptavidin binding in the monofunctional aptamer and in the theophylline bifunctional aptamer were 12 nM and 65 nM, respectively whilst the K(d) values for theophylline binding in the monofunctional aptamer and the streptavidin bifunctional aptamer were 300 nM and 120 nM. These results are consistent with treating each aptamer sequence as a module that can be combined with others without significant loss of function. This allows for the use of streptavidin based immobilization strategies without either the cost of biotinylated dNTPs or the variable yields associated with the chemical biotinylation of RNA.

Measuring the effects of alexithymia on perception of emotional vocalizations in autistic spectrum disorder and typical development

BACKGROUND

The results from recent studies suggest that alexithymia, a disorder characterized by impairments in understanding personal experiences of emotion, is frequently co-morbid with autism spectrum disorder (ASD). However, the extent that alexithymia is associated with primary deficits in recognizing external emotional cues, characteristic in ASD, has yet to be determined.

METHOD

Twenty high-functioning adults with ASD and 20 age- and intelligence-matched typical controls categorized vocal and verbal expressions of emotion and completed an alexithymia assessment.

RESULTS

Emotion recognition scores in the ASD group were significantly poorer than in the control group and performance was influenced by the severity of alexithymia and the psycho-acoustic complexity of the presented stimuli. For controls, the effect of complexity was significantly smaller than for the ASD group, although the association between total emotion recognition scores and alexithymia was still strong.

CONCLUSIONS

Higher levels of alexithymia in the ASD group accounted for some, but not all, of the group difference in emotion recognition ability. However, alexithymia was insufficient to explain the different sensitivities of the two groups to the effects of psycho-acoustic complexity on performance. The results showing strong associations between emotion recognition and alexithymia scores in controls suggest a potential explanation for variability in emotion recognition in non-clinical populations.

A new scheme for stigmatic x-ray imaging with large magnification

This paper describes a new x-ray scheme for stigmatic imaging. The scheme consists of one convex spherically bent crystal and one concave spherically bent crystal. The radii of curvature and Bragg reflecting lattice planes of the two crystals are properly matched to eliminate the astigmatism, so that the conditions for stigmatic imaging are met for a particular wavelength. The magnification is adjustable and solely a function of the two Bragg angles or angles of incidence. Although the choice of Bragg angles is constrained by the availability of crystals, this is not a severe limitation for the imaging of plasmas, since a particular wavelength can be selected from the bremsstrahlung continuum. The working principle of this imaging scheme has been verified with visible light. Further tests with x rays are planned for the near future.

The Aarhus statement: improving design and reporting of studies on early cancer diagnosis

Early diagnosis is a key factor in improving the outcomes of cancer patients. A greater understanding of the pre-diagnostic patient pathways is vital yet, at present, research in this field lacks consistent definitions and methods. As a consequence much early diagnosis research is difficult to interpret. A consensus group was formed with the aim of producing guidance and a checklist for early cancer-diagnosis researchers. A consensus conference approach combined with nominal group techniques was used. The work was supported by a systematic review of early diagnosis literature, focussing on existing instruments used to measure time points and intervals in early cancer-diagnosis research. A series of recommendations for definitions and methodological approaches is presented. This is complemented by a checklist that early diagnosis researchers can use when designing and conducting studies in this field. The Aarhus checklist is a resource for early cancer-diagnosis research that should promote greater precision and transparency in both definitions and methods. Further work will examine whether the checklist can be readily adopted by researchers, and feedback on the guidance will be used in future updates.

Information needs across the colorectal cancer care continuum: scoping the literature

Because cancer care requires a multifaceted approach, providing useful and timely information to people with colorectal cancer may be fragmented and inconsistent. Our interest was in examining what has and has not captured the attention of researchers speaking to the information needs of people with colorectal cancer. We followed Arksey and O'Malley's framework for the methodology of scoping review. Focusing solely on colorectal cancer, we analysed 239 articles to get a picture of which information needs and sources of information, as well as the timing of providing information, were attended to. Treatment-related information received the most mentions (26%). Healthcare professionals (49%) were mentioned as the most likely source of information. Among articles focused on one stage of the care continuum, post-treatment (survivorship) received the most attention (16%). Only 27% of the articles consulted people with colorectal cancer and few attended to diet/nutrition and bowel management. This study examined the numerical representation of issues to which researchers attend, not the quality of the mentions. We ponder, however, on the relationship between the in/frequency of mentions and the actual information needs of people with colorectal cancer as well as the availability, sources and timing of information.

High-precision soft x-ray polarimeter at Diamond Light Source

The development and performance of a high-precision polarimeter for the polarization analysis in the soft x-ray region is presented. This versatile, high-vacuum compatible instrument is supported on a hexapod to simplify the alignment with a resolution less than 5 μrad, and can be moved with its own independent control system easily between different beamlines and synchrotron facilities. The polarimeter can also be used for the characterization of reflection and transmission properties of optical elements. A W/B(4)C multilayer phase retarder was used to characterize the polarization state up to 1200 eV. A fast and accurate alignment procedure was developed, and complete polarization analysis of the APPLE II undulator at 712 eV has been performed.