Meaningful inclusion of people living with HIV as a model for workplace policies: Key findings from the project PEER study

BACKGROUND

As a large number of people live with HIV, it is worthwhile to examine the integration of this group in the workplace.

OBJECTIVE

To investigate how the operationalization of GIPA/MEPA supports workplace policies and practices for PLHIV. The study aims to explore what is being offered to support PLHIV in community-based agencies and what can be done to enhance the offerings.

METHODS

For this community-based research, 2 bilingual online surveys were sent to 150 Canadian organizations that work closely with PLHIV or offer support to them. One of the surveys was for Executive Directors of these organizations while the other was sent to peers; i.e. PLHIV whose job is to offer services to PLHIV. Questions in the surveys varied between open-ended, binary, and Likert.

RESULTS

GIPA/MEPA are implemented in most organizations and Executive Directors affirmed that PLHIV and their impacts on the workplace are valued. There is a consensus among Executive Directors that formal support is provided but most respondents argued that this support is not specific for PLHIV. More than half of respondents were either unaware or uncertain about the existence of informal support. Peer-employees claimed that one of the challenges of disclosing HIV to receive peer support is that they may face stigma.

CONCLUSION

The application of GIPA/MEPA results in positive outcomes in the workplace. The study emphasizes the need to facilitate access to informal support.

An investigation into academic career pathways across Radiography education centres internationally

INTRODUCTION

Robust academic pathways are critical to support of radiography faculty within third level education. As the profession of Radiography grows its' research activity, it is important that academic opportunities meet the needs of the profession. The purpose of this research was to investigate current academic career pathways across radiography education centres internationally.

METHODS

An online survey was developed and administered to radiography academics and clinical/academic staff members internationally. The survey questions (n = 28) include demographic data; teaching and research requirements; academic promotion criteria; identification of the challenges and benefits of being an academic, including equality, diversity and inclusion (EDI) matters.

RESULTS

A total of 175 responses were obtained (6 continents and 39 countries), with a variety of experience levels amongst academics that primarily held permanent work contracts. Regarding the highest qualifications held, 31.4% (n = 55) had a Doctorate and 45.7% (n = 80) a Master's degree, and most respondents were employed as academic lecturers (40.6%; n = 71), with 17.7% (n = 31) employed at professorial level. The minimum time requirement to achieve a permanent contract was variable, ranging from no delay (5.7%; n = 10) to more than 10 years (12.6%; n = 22). Doctorate qualification is currently not necessary in order to career progression for 126 (72%) respondents, while 52% (n = 91) provided specific research requirements. 106 (60.6%) respondents indicated that their institution has EDI policy.

CONCLUSION

This study has captured details related to academic pathways across international radiography education centres. Whilst some heterogeneity exists, there are numerous differences impacting standardised academic career opportunities for Radiography academics. These may challenge academic career opportunities and discourage those interested in an academic career.

IMPLICATIONS FOR PRACTICE

The profile and educational background of these academics has been highlighted as well as the perceived barriers and advantages of a career in academic.

The cost of anticipating stigma: a longitudinal examination of HIV stigma and health

Levels of HIV stigma remain high, however there is a limited understanding around how different types of stigma interact to impact health. This study uses data from two time points to examine how enacted and internalized stigma lead to worse health through anticipated stigma as a mediator. We recruited 341 participants in Ontario, Canada to complete the HIV Stigma Index survey at baseline (t₁) from September 2018 to August 2019 and follow up (t₂) approximately two years later. Mediation models were created with enacted and internalized stigma at t₁ as the antecedents, anticipated stigma at t₂ as the mediator, and physical health, mental health, and overall health at t₂ as the outcomes. Only the model with internalized stigma (t₁) as the antecedent had anticipated stigma (t₂) as a significant mediator contributing to both decreased mental and overall health. This highlights the need to address internalized stigma and the potential for anticipated stigma interventions to be effective at improving the health and wellbeing of people living with HIV.

Evaluation of optimised 3D turbo spin echo and gradient echo MR pulse sequences of the knee at 3T and 1.5T

INTRODUCTION

To investigate the impact of parameter optimisation for novel three-dimensional 3D sequences at 1.5T and 3T on resultant image quality.

METHODS

Following institutional review board approval and acquisition of informed consent, MR phantom and knee joint imaging on healthy volunteers (n = 16) was performed with 1.5 and 3T MRI scanners, respectively incorporating 8- and 15-channel phased array knee radiofrequency coils. The MR phantom and healthy volunteers were prospectively scanned over a six-week period. Acquired sequences included standard two-dimensional (2D) turbo spin echo (TSE) and novel three-dimensional (3D) TSE PDW (SPACE) both with and without fat-suppression, and T2∗W gradient echo (TrueFISP) sequences. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured for knee anatomical structures. Two musculoskeletal radiologists evaluated anatomical structure visualisation and image quality. Quantitative and qualitative findings were investigated for differences using Friedman tests. Inter- and intra-observer agreements were determined with κ statistics.

RESULTS

Phantom and healthy volunteer images revealed higher SNR for sequences acquired at 3T (p-value <0.05). Generally, the qualitative findings ranked images acquired at 3T higher than corresponding images acquired at 1.5T (p < 0.05). 3D image data sets demonstrated less sensitivity to partial volume averaging artefact (PVA) compared to 2D sequences. Inter- and intra-observer agreements for evaluation across all sequences ranged from 0.61 to 0.79 and 0.71 to 0.92, respectively.

CONCLUSION

Both 2D and 3D images demonstrated higher image quality at 3T than at 1.5T. Optimised 3D sequences performed better than the standard 2D PDW TSE sequence for contrast resolution between cartilage and joint fluid, with reduced PVA artefact.

IMPLICATIONS FOR PRACTICE

With rapid advances in MRI scanner technology, including hardware and software, the optimisation of 3D MR pulse sequences to reduce scan time while maintaining image quality, will improve diagnostic accuracy and patient management in musculoskeletal MRI.

Permanent brain arrest as the sole criterion of death in systemic circulatory arrest

Historically, there has been a tendency to think that there are two types of death: circulatory and neurological. Holding onto this tendency is making it harder to navigate emerging resuscitative technologies, such as extracorporeal membrane oxygenation and the recent well-publicised experiment that demonstrated the possibility of restoring cellular function to some brain neurons 4 h after normothermic circulatory arrest (decapitation) in pigs. Attempts have been made to respond to these difficulties by proposing a unified brain-based criterion for human death, which we call 'permanent brain arrest'. The clinical characteristics of permanent brain arrest are the permanent loss of capacity for consciousness and permanent loss of all brainstem functions, including the capacity to breathe. These losses could arise from a primary brain injury or as a result of systemic circulatory arrest. We argue that permanent brain arrest is the true and sole criterion for the death of human beings and show that this is already implicit in the circulatory-respiratory criterion itself. We argue that accepting the concept of permanent cessation of brain function in patients with systemic permanent circulatory arrest will help us better navigate the medical advances and new technologies of the future whilst continuing to provide sound medical criteria for the determination of death.

Evaluation of unenhanced axial T1W and T2W liver MR images acquired from institutions within the Republic of Ireland and the Kingdom of Saudi Arabia

INTRODUCTION

This multi-site study evaluated two breath-hold sequences commonly utilised for liver MRI; non-enhanced T1W-3D-FS-GRE-TRA and T2W-2D-FSE-TRA sequences, using physical measurements of SNR and CNR, and observer perceptions' (Visual Grading Analysis: VGA).

METHODS

Liver MR image datasets (n = 168) from nine hospitals in the Kingdom of Saudi Arabia (KSA) and 11 hospitals in the Republic of Ireland were evaluated. Images were categorised into two groups per sequence, defined by slice thickness (T2W-2D-FSE, ≤5 mm vs ≥ 6 mm and T1W-3D-GRE-FS, ≤3 mm vs 4 mm). Images were evaluated using visual grading analysis VGA and physical measurements: SNR/CNR. Account was taken of varying patient sizes based on AP/transverse diameter measurements.

RESULTS

Physical image quality measurements (SNR/CNR) returned no significant findings across Irish and KSA hospitals, for both sequences, despite variations in acquisition parameters. Statistically significant differences were found for some scoring criteria based on the observers' perceptions including spleen parenchyma, and spatial resolution for the non-enhanced T1W-3D-FS-GRE-TRA images, with a preference for images acquired using thin slices (≤3 mm). In addition, statistically significant difference was found for the scoring criteria motion artefact for the axial T2W-2D-FSE-TRA images, with a preference for images acquired using thick slices (≥5 mm). Negligible correlation was noted between SNR/CNR and measured abdominal AP/transverse diameters.

CONCLUSION

Whilst variations in sequences rendered no statistical differences in SNR/CNR findings, significant differences in observer image criteria scores was noted. The importance of both physical measurements and observers' perceptions evaluation methods for quality assessment of MR images was demonstrated and optimisation of liver sequence parameters is warranted.

A study to explore opinions and attitudes of Saudi Arabian MR professionals on the current status of routine MR scanner quality assurance testing in the Kingdom of Saudi Arabia

INTRODUCTION

Internationally it is recommended that quality assurance (QA) testing of MR systems is the responsibility of MR professionals to ensure efficient scanner performance. This study aims to explore the opinions and attitudes of MR professionals in the Kingdom of Saudi Arabia (KSA) regarding the current status of routine QA testing within MRI departments.

METHODS

A qualitative approach was adopted, with MR professionals working in public, semi-public and private hospitals in the KSA invited to participate in this interview-based study. A total of 52 individual semi-structured interviews were conducted with purposive sampling of MR radiographers and medical physicists based at 19 major centres across the three main geographical regions in the KSA. Data went through duration of coding following qualitative data analysis framework based on Miles and Huberman's philosophical underpinnings.

RESULTS

The findings demonstrated that 89.5% (n = 17) of the MRI departments surveyed rely on the service provided by the equipment vendor in order to ensure ongoing MR scanner performance. Overall, the level of MR radiographer participation in weekly MR scanner QA testing was low (13.3%, n = 3). Lack of legal requirement, professional organisation and knowledge were highlighted as the principal factors limiting radiographer involvement in the weekly MR QA in the KSA.

CONCLUSION

The results of this study support the establishment of a legal requirement and national policy in order to encourage radiographers in the KSA to take an active role in MRI QA testing to enable suboptimal MR scanner performance to be identified before it becomes clinically evident.

Implementation of a mentored professional development programme in laboratory leadership and management in the Middle East and North Africa

Laboratories need leaders who can effectively utilize the laboratories' resources, maximize the laboratories'capacity to detect disease, and advocate for laboratories in a fluctuating health care environment. To address this need, the University of Washington, USA, created the Certificate Program in Laboratory Leadership and Management in partnership with WHO Regional Office for the Eastern Mediterranean, and implemented it with 17 participants and 11 mentors from clinical and public health laboratories in 10 countries (Egypt, Iraq, Jordan, Lebanon, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, and Yemen) in 2014. Designed to teach leadership and management skills to laboratory supervisors, the programme enabled participants to improve laboratory testing quality and operations. The programme was successful overall, with 80% of participants completing it and making impactful changes in their laboratories. This success is encouraging and could serve as a model to further strengthen laboratory capacity in the Region.

An investigation of Saudi Arabian MR radiographers' knowledge and confidence in relation to MR image-quality-related errors

OBJECTIVE

To investigate MR radiographers' current knowledge base and confidence level in relation to quality-related errors within MR images.

METHOD

Thirty-five MR radiographers within 16 MRI departments in the Kingdom of Saudi Arabia (KSA) independently reviewed a prepared set of 25 MR images, naming the error, specifying the error-correction strategy, scoring how confident they were in recognising this error and suggesting a correction strategy by using a scale of 1-100. The datasets were obtained from MRI departments in the KSA to represent the range of images which depicted excellent, acceptable and poor image quality.

RESULTS

The findings demonstrated a low level of radiographer knowledge in identifying the type of quality errors and when suggesting an appropriate strategy to rectify those errors. The findings show that only (n = 7) 20% of the radiographers could correctly name what the quality errors were in 70% of the dataset, and none of the radiographers correctly specified the error-correction strategy in more than 68% of the MR datasets. The confidence level of radiography participants in their ability to state the type of image quality errors was significantly different (p < 0.001) for who work in different hospital types.

CONCLUSION

The findings of this study suggest there is a need to establish a national association for MR radiographers to monitor training and the development of postgraduate MRI education in Saudi Arabia to improve the current status of the MR radiographers' knowledge and direct high quality service delivery.

Change in Driving Performance following Arthroscopic Shoulder Surgery

The current study aimed to measure perioperative changes in driving performance following arthroscopic shoulder surgery using a validated driving simulator.21 patients who underwent arthroscopic surgery for rotator cuff or labral pathology were tested on a driving simulator preoperatively, and 6 and 12 weeks postoperatively. An additional 21 subjects were tested to establish driving data in a control cohort. The number of collisions, centerline crossings, and off-road excursions were recorded for each trial. VAS and SPADI scores were obtained at each visit.The mean number of collisions in the study group significantly increased from 2.05 preoperatively to 3.75 at 6 weeks (p<0.001), and significantly decreased to 1.95 at 12 weeks (p<0.001). Centerline crossings and off-road excursions did not significantly change from preoperative through 12 weeks, although centerline crossings were statistically different from the controls at each time point (p<0.001). Surgery on the dominant driving arm resulted in greater collisions at 6 weeks than surgery on the non-dominant driving arm (p<0.001).Preliminary data shows that driving performance is impaired for at least 6 weeks postoperatively, with a return to normal driving by 12 weeks. Driving is more profoundly affected in conditions that require avoiding a collision and when the dominant driving arm is involved.

Rheumatoid arthritis: a novel radiographic projection for hand assessment

Rheumatoid arthritis (RA) is the most common form of inflammatory disease, affecting 1-2% of the population. Posteroanterior (PA) and Brewerton projections are well established in radiographic practice for scoring and monitoring RA, but there is little evidence to demonstrate the diagnostic efficacy of these techniques. This work, by varying the positioning of a cadaveric hand, investigates whether an alternative radiographic projection could yield greater diagnostic information than the traditional techniques. Phase I of the study evaluated moving the hand 15 degrees from the anteroposterior position and then in 5 degrees increments in four directions: medial rotation, lateral rotation, flexion of the wrist and extension of the wrist. Phase II of the study took the optimum projections from Phase I and further manipulated these positions in a direction at right angles to the original position. Images were scored based on joint space visualisation in 29 joints. Results demonstrated that significantly higher diagnostic efficacy was evident with 15 degrees lateral rotation of the hand or 15 degrees flexion at the wrist compared to the Brewerton projection. Either projection is recommended, but on the basis of patient comfort, the latter of these novel positions, now known as the UCD projection, was chosen as the optimum procedure to replace the Brewerton projection. The value of using cadavers for the establishment of optimum radiographic procedures is highlighted.

Proposed preliminary diagnostic reference levels for three common interventional cardiology procedures in Ireland

This study has gathered data across Ireland to determine the range of radiation doses received during interventional cardiology (IC) investigations. Radiation doses for three common types of IC examinations where investigated: coronary angiography (CA), percutaneous coronary intervention (PCI) and pacemaker insertions (PPI). A total of 22 cardiac imaging suites participated in the study. Radiation dose was monitored for 1804 adult patients using dose area product (DAP) meters. Individual patient DAP values ranged from 136-23,101 cGy cm2, 475-41,038 cGy cm2 and 45-17,192 cGy cm2 for CA, PCI and PPI respectively, with third quartile values of 4654 cGy cm2, 10,650 cGy cm2 and 1686 cGy cm2. The importance of optimising radiation dose, while not compromising diagnostic efficacy is clear. Although setting reference levels for these complex procedures has some difficulties, it is important that some guideline values are available as a benchmark to guide the operators during these potentially high dose procedures. The third quartile values as described by this paper may offer such guidance.

Food portion weights in primary and secondary school lunches in England

BACKGROUND

National Nutritional Standards for school lunches were reintroduced in 2001, and included guidance on portion sizes for primary schools. For the first time since 1997, nationally representative data on school food portion sizes in England have been collected using direct assessment rather than reported portion sizes.

METHODS

Food portions were weighed directly in foods served in nationally representative samples of primary and secondary school meals. Results were grouped by food or food group.

RESULTS

The number of portions weighed was 7975 in primary schools and 3354 in secondary schools. Individual portion weights were grouped by food or food group to yield mean, median, SD and inter-quartile range. For a given food or food group, the number of portions weighed varied from 5 to 210 portions in primary schools and between 5 and 194 portions in secondary schools.

CONCLUSIONS

The results provide a good representation of typical portion weights for different foods and food groups in primary and secondary schools in England. Portion size is one factor that determines nutrient intake. New standards for school lunches are both nutrient and food-based. Guidance on portion weights will help to ensure that pupils consume the correct balance of foods to obtain the recommended nutrient intake. The present findings complement and extend existing guidance on portion sizes for pupils in schools in England and Scotland.

Reduction of the posterior pelvic ring by non-invasive stabilisation: a report of two cases

We demonstrate radiological evidence that an external pelvic splint is effective at reducing open book pelvic fractures. Its use in the pre-hospital and emergency department settings should be encouraged in the initial management and resuscitation of patients with pelvic fractures.

Integrations of the hepatitis B virus (HBV) and human papillomavirus (HPV) into the human telomerase reverse transcriptase (hTERT) gene in liver and cervical cancers

Chronic infections with the hepatitis B virus (HBV) and high-risk human papillomaviruses (HPVs) are important risk factors for hepatocellular carcinoma (HCC) and cervical cancer (CC), respectively. HBV and HPV are DNA viruses that almost invariably integrate into the host genome in invasive tumors. The viral integration sites occur throughout the genome, leading to the presumption that there are no preferred sites of integration. A number of viral integrations have been shown to occur within the vicinity of important cancer-related genes. In studies of HBV-induced HCC and HPV-induced CC, we have identified two HBV and three HPV integrations into the human telomerase reverse transcriptase (hTERT) gene. Detailed characterization of the integrations revealed that four integrations occurred within the hTERT promoter and upstream region and the fifth integration occurred in intron 3 of the hTERT gene. None of the integrations altered the hTERT coding sequence and all resulted in juxtaposition of viral enhancers near hTERT, with potential activation of hTERT expression. Our work supports the hypothesis that the sites of oncogenic viral integration are nonrandom and that genes at the sites of viral integration may play important roles in carcinogenesis.

A randomised controlled trial of enhanced key-worker liaison psychiatry in general practice

BACKGROUND

Despite much interest in the development of liaison psychiatry in general practice there is no clear evidence that any form of intervention is effective. We carried out a pilot randomised controlled trial, the first we believe into this type of care, of one such model; enhanced liaison with individual patients by key workers, in general practices in Paddington and North Kensington in London.

METHODS

All patients referred from primary to secondary psychiatric care from four general practices over a 10-month period, and still in contact with services, were eligible to be included in the study. The practices were allocated in a constrained randomised procedure to either normal care or enhanced key-worker liaison. The latter involved encouraging individual key workers to adopt improved communication between primary and secondary care. Baseline assessments of symptomatology and social functioning were made before randomisation and after 6 months by an independent researcher.

RESULTS

Of the 84 eligible patients, 43 were seen at baseline and 34 re-assessed after 6 months. There was no difference between the clinical outcomes in the two groups but self-rated social function was significantly improved in the enhanced liaison service compared with standard care (adjusted P = 0.05). Costs were similar but somewhat more expensive for enhanced liaison. Less than half (42 %) of all key workers in the enhanced liaison arm felt they had involved the primary health care team more in the care of their patient, with 21 % of these altering their practice markedly during the study.

CONCLUSIONS

It is concluded that without additional resources enhanced key-worker liaison for psychiatry in primary and secondary care has limited benefits although this does not necessarily apply to other forms of liaison practice.

Hypotension, autonomic failure, and cardiac hypertrophy in transgenic mice overexpressing the alpha 1B-adrenergic receptor

alpha(1)-Adrenergic receptors (alpha(1A), alpha(1B), and alpha(1D)) are regulators of systemic arterial blood pressure and blood flow. Whereas vasoconstrictory action of the alpha(1A) and alpha(1D) subtypes is thought to be mainly responsible for this activity, the role of the alpha(1B)-adrenergic receptor (alpha(1B)AR) in this process is controversial. We have generated transgenic mice that overexpress either wild type or constitutively active alpha(1B)ARs. Transgenic expression was under the control of the isogenic promoter, thus assuring appropriate developmental and tissue-specific expression. Cardiovascular phenotypes displayed by transgenic mice included myocardial hypertrophy and hypotension. Indicative of cardiac hypertrophy, transgenic mice displayed an increased heart to body weight ratio, which was confirmed by the echocardiographic finding of an increased thickness of the interventricular septum and posterior wall. Functional deficits included an increased isovolumetric relaxation time, a decreased heart rate, and cardiac output. Transgenic mice were hypotensive and exhibited a decreased pressor response. Vasoconstrictory regulation by alpha(1B)AR was absent as shown by the lack of phenylephrine-induced contractile differences between ex vivo mesenteric artery preparations. Plasma epinephrine, norepinephrine, and cortisol levels were also reduced in transgenic mice, suggesting a loss of sympathetic nerve activity. Reduced catecholamine levels together with basal hypotension, bradycardia, reproductive problems, and weight loss suggest autonomic failure, a phenotype that is consistent with the multiple system atrophy-like neurodegeneration that has been reported previously in these mice. These results also suggest that this receptor subtype is not involved in the classic vasoconstrictory action of alpha(1)ARs that is important in systemic regulation of blood pressure.

A randomized controlled trial of community-oriented and hospital-oriented care for discharged psychiatric patients: influence of personality disorder on police contacts

An important forensic psychiatric measure, contacts with police, was compared in a randomized, controlled trial of 155 patients with severe mental illness with a previous admission within the past two years. The patients, who also had their personality status addressed formally before randomization, were allocated to community multidisciplinary teams or to hospital-based care programs after discharge from in-patient care and were followed up for one year. A total of 138 patients (89%) had at least one post-baseline assessment and of these patients, 16 (12%) had at least one police contact in the year of the study, most of which were emergency assessments. The data showed significantly greater numbers of police contacts in patients with increasing severity of personality disturbance. Patients with such disturbance were six times more likely to have police contacts than those with no personality disorder. There were significantly more contacts in patients with borderline and antisocial (dissocial) personality disorder allocated to community-oriented care compared with hospital-oriented care. These findings have important implications for risk assessment in severe mental illness.

Mediating factors in the grieving process of the suddenly bereaved

This article explores the role of the staff of accident and emergency (A&E) departments in managing events surrounding sudden death. Key aspects, such as the way in which initial contact with relatives is made, reception and resuscitation procedures, viewing of the deceased, and the bureaucratic elements of these events, are discussed in terms of the impact that they may have on the subsequent adjustment of the bereaved to the sudden death of their relative. The management of death may be problematic, particularly if it involves children or if the body of the dead person is mutilated. This article suggests ways to support health professionals in facilitating the processes of grieving, and raises awareness of the potential influence the experiences in the A&E department at the time of bereavement may have on the grieving process.

Survival in medically treated patients with homozygous beta-thalassemia

BACKGROUND

The prognosis of patients with homozygous beta-thalassemia (thalassemia major) has been improved by transfusion and iron-chelation therapy. We analyzed outcome and prognostic factors among patients receiving transfusions and chelation therapy who had reached the age at which iron-induced cardiac disease, the most common cause of death, usually occurs.

METHODS

Using the duration of life without the need for either inotropic or antiarrhythmic drugs as a measure of survival without cardiac disease, we studied 97 patients born before 1976 who were treated with regular transfusions and chelation therapy. We used Cox proportional-hazards analysis to assess the effect of prognostic factors and life-table analysis to estimate freedom from cardiac disease over time.

RESULTS

Of the 97 patients, 59 (61 percent) had no cardiac disease; 36 (37 percent) had cardiac disease, and 18 of them had died. Univariate analysis demonstrated that factors affecting cardiac disease-free survival were age at the start of chelation therapy (P < 0.001), the natural log of the serum ferritin concentration before chelation therapy began (P = 0.01), the mean ferritin concentration (P < 0.001), and the proportion of ferritin measurements exceeding 2500 ng per milliliter (P < 0.001). With stepwise Cox modeling, only the proportion of ferritin measurements exceeding 2500 ng per milliliter affected cardiac disease-free survival (P < 0.001). Patients in whom less than 33 percent of the serum ferritin values exceeded 2500 ng per milliliter had estimated rates of survival without cardiac disease of 100 percent after 10 years of chelation therapy and 91 percent after 15 years.

CONCLUSIONS

The prognosis for survival without cardiac disease is excellent for patients with thalassemia major who receive regular transfusions and whose serum ferritin concentrations remain below 2500 ng per milliliter with chelation therapy.

Patterns of neuropsychological function in a low-birthweight population

An investigative analysis was carried out of the neuromotor and cognitive findings in a population-based study of low-birthweight infants (< 1750g) at 4 1/2 years of age to try to improve the understanding of the neuropathological basis of their deficits. Cluster analysis identified groups of children whose performance in the cognitive subscales of the British Ability Scales followed similar patterns, and also differentiated between children in neuromotor competence. Cluster membership correlated highly with language attainment, ability to copy shapes, behaviour as reported by parents and parents' and examiners' perception of attention span. Children in poorer-performing clusters were more likely to be born to mothers who had had a previous perinatal death, and were also more likely to have experienced septicaemia during the neonatal period. These findings are discussed in the light of evidence from the neuropathological and physiological literature.