Following the children of depressed parents from childhood to adult life: A focus on mood and anxiety disorders

Background

Parental depression increases risk for anxiety and depression in offspring. The transition from adolescence to adulthood is a common risk period for onset of such disorders. However, relatively few studies have considered development of these disorders from childhood to adulthood including multiple assessments during this transition period.

Method

Offspring of depressed parents aged 9-17 years at baseline were followed prospectively for 13 years (n = 337). Average length of follow-up was 16 months between the first and second waves, 13 months between the second and third, and 8 years between the third and fourth. Current (3-month) psychopathology was assessed at each wave using diagnostic interviews. We derived estimates of 3-month prevalence, age at first diagnosis, course and comorbidity of disorders. Social functioning in adult life was assessed at the final wave and we assessed how prior and current disorder impacted adult functioning.

Results

A quarter of young people met criteria for a mood disorder and a third for anxiety disorder at least once. Mood and anxiety disorder prevalence increased from 4.5% and 15.8% respectively in childhood (9-11 years) to 22.3% and 20.9% respectively by age 23-28. Increased prevalence across the transition from adolescence to adulthood was particularly marked in males, while prevalence increased earlier in adolescence in females. Age at first diagnosis varied widely (mood disorder mean = 16.5 years (range 9-26); anxiety disorder mean = 14.5 years (range 9-28)). Over half (52%) reported functional impairment in early adulthood, 31% harmful alcohol use, and 10% self-harm or a suicide attempt. Both previous and current mood or anxiety disorder were associated with functional impairment in early adulthood.

Conclusions

There is a prolonged risk period for mood and anxiety disorders in this group, with prevalence peaking in early adulthood. This highlights the need for prolonged vigilance and effective targeted interventions in the offspring of depressed parents.

Validation of the Strengths and Difficulties Questionnaire (SDQ) emotional subscale in assessing depression and anxiety across development

Emotional disorders are common in childhood, and their prevalence sharply increases during adolescence. The Strengths and Difficulties Questionnaire (SDQ) is widely used for screening emotional and behavioural difficulties in children and young people, but little is known about the accuracy of the emotional subscale (SDQ-E) in detecting emotional disorders, and whether this changes over development. Such knowledge is important in determining whether symptom changes across age are due to developmental or measurement differences. This study assessed the validity of the SDQ-E and two individual items (low mood and general worry) in differentiating between cases and non-cases of Major Depressive Disorder (MDD), Generalised Anxiety Disorder (GAD), and other anxiety disorders across ages 7, 10, 13, 15, and 25 years in a UK population cohort. Analyses showed moderate accuracy of the subscale in discriminating cases of MDD (AUC = 0.67-0.85), and high accuracy for discriminating cases of GAD (AUC = 0.80-0.93) and any anxiety disorder (AUC = 0.74-0.83) compared to non-cases. The SDQ-E performed well across ages and sex, and generally performed better than the two individual items. Together our findings validate the SDQ-E as a screen for emotional disorders during childhood, adolescence, and early adulthood, and as a tool for longitudinal research on depression and anxiety disorders.

Digital technologies to support adolescents with depression and anxiety: review

Depression and anxiety are common in adolescents, but most affected will not get any formal help. Digital mental health technologies (i.e. resources and interventions to support and improve mental health) are a potential way to extend the reach and increase adolescents' access to therapies, at a relatively low cost. Many young people can access the internet and mobile technologies, including in low- and middle-income countries. There has been increased interest in integrating technologies in a range of settings, especially because of the effect of the COVID-19 pandemic on adolescent mental health, at a time when services are under pressure. This clinical review gives an overview of digital technologies to support the prevention and management of depression and anxiety in adolescence. The technologies are presented in relation to their technological approaches, underlying psychological or other theories, setting, development, evaluations to date and how they might be accessed. There is also a discussion of the potential benefits, challenges and future developments in this field.

Further development and feasibility randomised controlled trial of a digital programme for adolescent depression, MoodHwb: study protocol

INTRODUCTION

A digital programme, MoodHwb, was codesigned with young people experiencing or at high risk of depression, parents/carers and professionals, to provide support for young people with their mood and well-being. A preliminary evaluation study provided support for the programme theory and found that MoodHwb was acceptable to use. This study aims to refine the programme based on user feedback, and to assess the acceptability and feasibility of the updated version and study methods.

METHODS AND ANALYSIS

Initially, this study will refine MoodHwb with the involvement of young people, including in a pretrial acceptability phase. This will be followed by a multicentre feasibility randomised controlled trial comparing MoodHwb plus usual care with a digital information pack plus usual care. Up to 120 young people aged 13-19 years with symptoms of depression and their parents/carers will be recruited through schools, mental health services, youth services, charities and voluntary self-referral in Wales and Scotland. The primary outcomes are the feasibility and acceptability of the MoodHwb programme (including usage, design and content) and of trial methods (including recruitment and retention rates), assessed 2 months postrandomisation. Secondary outcomes include potential impact on domains including depression knowledge and stigma, help-seeking, well-being and depression and anxiety symptoms measured at 2 months postrandomisation.

ETHICS AND DISSEMINATION

The pretrial acceptability phase was approved by the Cardiff University School of Medicine Research Ethics Committee (REC) and the University of Glasgow College of Medicine, Veterinary and Life Sciences REC. The trial was approved by Wales NHS REC 3 (21/WA/0205), the Health Research Authority(HRA), Health and Care Research Wales (HCRW), university health board Research and Development (R&D) departments in Wales, and schools in Wales and Scotland. Findings will be disseminated in peer-reviewed open-access journals, at conferences and meetings, and online to academic, clinical, and educational audiences and the wider public.

TRIAL REGISTRATION NUMBER

ISRCTN12437531.

Developing and validating a prediction model of adolescent major depressive disorder in the offspring of depressed parents

BACKGROUND

Parental depression is common and is a major risk factor for depression in adolescents. Early identification of adolescents at elevated risk of developing major depressive disorder (MDD) in this group could improve early access to preventive interventions.

METHODS

Using longitudinal data from 337 adolescents at high familial risk of depression, we developed a risk prediction model for adolescent MDD. The model was externally validated in an independent cohort of 1,384 adolescents at high familial risk. We assessed predictors at baseline and MDD at follow-up (a median of 2-3 years later). We compared the risk prediction model to a simple comparison model based on screening for depressive symptoms. Decision curve analysis was used to identify which model-predicted risk score thresholds were associated with the greatest clinical benefit.

RESULTS

The MDD risk prediction model discriminated between those adolescents who did and did not develop MDD in the development (C-statistic = .783, IQR (interquartile range) = .779, .778) and the validation samples (C-statistic = .722, IQR = -.694, .741). Calibration in the validation sample was good to excellent (calibration intercept = .011, C-slope = .851). The MDD risk prediction model was superior to the simple comparison model where discrimination was no better than chance (C-statistic = .544, IQR = .536, .572). Decision curve analysis found that the highest clinical utility was at the lowest risk score thresholds (0.01-0.05).

CONCLUSIONS

The developed risk prediction model successfully discriminated adolescents who developed MDD from those who did not. In practice, this model could be further developed with user involvement into a tool to target individuals for low-intensity, selective preventive intervention.

Collecting genetic samples and linked mental health data from adolescents in schools: protocol coproduction and a mixed-methods pilot of feasibility and acceptability

OBJECTIVES

To coproduce a school-based protocol and examine acceptability and feasibility of collecting saliva samples for genetic studies from secondary/high school students for the purpose of mental health research.

DESIGN

Protocol coproduction and mixed-methods feasibility pilot.

SETTING

Secondary schools in Wales, UK.

PARTICIPANTS

Students aged 11-13 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

Coproduced research protocol including an interactive science workshop delivered in schools; school, parental and student recruitment rates; adherence to protocol and adverse events; ability to extract and genotype saliva samples; student enjoyment of the science workshop and qualitative analysis of teacher focus groups on acceptability and feasibility.

RESULTS

Five secondary schools participated in the coproduction phase, and three of these took part in the research study (eligible sample n=868 students). Four further schools were subsequently approached, but none participated. Parental opt-in consent was received from 98 parents (11.3% eligible sample), three parents (0.3%) actively refused and responses were not received for 767 (88.4%) parents. We obtained saliva samples plus consent for data linkage for 79 students. Only one sample was of insufficient quality to be genotyped. The science workshop received positive feedback from students. Feedback from teachers showed that undertaking research like this in schools is viewed as acceptable in principle, potentially feasible, but that there are important procedural barriers to be overcome. Key recommendations include establishing close working relationships between the research team and school classroom staff, together with improved methods for communicating with and engaging parents.

CONCLUSIONS

There are major challenges to undertaking large-scale genetic mental health research in secondary schools. Such research may be acceptable in principle, and in practice DNA collected from saliva in classrooms is of sufficient quality. However, key challenges that must be overcome include ensuring representative recruitment of schools and sufficient parental engagement where opt-in parental consent is required.

ADHD in adults with recurrent depression

BACKGROUND

Depression is highly heterogeneous in its clinical presentation. Those with attention deficit/hyperactivity disorder (ADHD) may be at risk of a more chronic and impairing depression compared to those with depression alone according to studies of young people. However, no studies to date have examined ADHD in recurrently depressed adults in mid-life.

METHOD

In a sample of women in mid-life (n=148) taken from a UK based prospective cohort of adults with a history of recurrent depression, we investigated the prevalence of ADHD and the association of ADHD with clinical features of depression.

RESULTS

12.8% of the recurrently depressed women had elevated ADHD symptoms and 3.4% met DSM-5 diagnostic criteria for ADHD. None of the women reported having a diagnosis of ADHD from a medical professional. ADHD symptoms were associated with earlier age of depression onset, higher depression associated impairment, a greater recurrence of depressive episodes and increased persistence of subthreshold depression symptoms over the study period, higher levels of irritability and increased risk of self-harm or suicide attempt. ADHD symptoms were associated with increased risk of hospitalisation and receiving non-first-line antidepressant medication.

LIMITATIONS

ADHD was measured using a questionnaire measure. We focussed on mothers in a longitudinal study of recurrent depression, so the findings may not apply to males or other groups.

CONCLUSIONS

Higher ADHD symptoms appear to index a worse clinical presentation for depression. Clinical implications include that in women with early onset, impairing and recurrent depression, the possibility of underlying ADHD masked by depression needs to be considered.

Validation of the short Mood and Feelings Questionnaire in young adulthood

Depression often onsets in adolescence and is associated with recurrence in adulthood. There is a need to identify and monitor depression symptoms across adolescence and into young adulthood. The short Mood and Feelings Questionnaire (sMFQ) is commonly used to measure depression symptoms in adolescence but has not been validated in young adulthood. This study aimed to (1) examine whether the sMFQ is valid in young adulthood, and (2) identify cut-points best capturing DSM-5 depression diagnosis at age 25 METHODS: The sample included participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) at age 25 (n = 4098). Receiver Operating Characteristic analyses examined how well the self-rated sMFQ discriminates between cases and non-cases of DSM-5 Major Depressive Disorder (MDD) classified using the self-rated Development and Well Being Assessment. Sensitivity and specificity values were used to identify cut-points on the sMFQ RESULTS: The sMFQ had high accuracy for discriminating MDD cases from non-cases at age 25. The commonly used cut-point in adolescence (≥12) performed well at this age, best balancing sensitivity and specificity. However, a lower cut-point (≥10) may be appropriate when favouring sensitivity over specificity e.g., in context of screening. Sensitivity analyses suggested similar results for males and females LIMITATIONS: ALSPAC is a longitudinal population cohort that suffers from non-random attrition CONCLUSIONS: The sMFQ is a valid measure of depression in young adults in the general population. It can be used to screen for and monitor depression across adolescence and early adulthood.

Investigating the validity of the Strengths and Difficulties Questionnaire to assess ADHD in young adulthood

Attention Deficit Hyperactivity Disorder (ADHD) symptoms typically onset early and persist into adulthood for many. Robust investigation of symptom continuity and discontinuity requires repeated assessments using the same measure, but research is lacking into whether measures used to assess ADHD symptoms in childhood are also valid in adulthood. The Strengths and Difficulties Questionnaire (SDQ) is widely used to assess ADHD symptoms in children, but little is known about its utility in adulthood. The aim of this study was to assess the validity of the SDQ hyperactivity/ADHD subscale to distinguish between cases and non-cases of DSM-5 ADHD at age 25 years in a UK population cohort (N = 4121). ADHD diagnosis was derived using the Barkley Adult ADHD Rating Scale-IV. Analyses suggested that the self-rated SDQ ADHD subscale had high validity in distinguishing ADHD cases/non-cases in young adulthood (area under the curve=0.90, 95% CI=0.87-0.93) and indicated a lower cut-point for identifying those who may have an ADHD diagnosis in this age group compared to that currently recommended for younger ages. Findings were similar for parent-reports. Our findings suggest that the SDQ is suitable for ADHD research across different developmental periods, which will aid the robust investigation of ADHD from childhood to young adulthood.

Practitioner review: Co-design of digital mental health technologies with children and young people

BACKGROUND

There is increasing interest in digital technologies to help improve children and young people's mental health, and the evidence for the effectiveness for these approaches is rising. However, there is concern regarding levels of user engagement, uptake and adherence. Key guidance regarding digital health interventions stress the importance of early user input in the development, evaluation and implementation of technologies to help ensure they are engaging, feasible, acceptable and potentially effective. Co-design is a process of active involvement of stakeholders, requiring a change from the traditional approaches to intervention development. However, there is a lack of literature to inform the co-design of digital technologies to help child and adolescent mental health.

METHODS

We reviewed the literature and practice in the co-design of digital mental health technologies with children and young people. We searched Medline, PsycInfo and Web of Science databases, guidelines, reviews and reference lists, contacted key authors for relevant studies, and extracted key themes on aspects of co-design relevant to practice. We supplemented this with case studies and methods reported by researchers working in the field.

RESULTS

We identified 25 original articles and 30 digital mental health technologies that were designed/developed with children and young people. The themes identified were as follows: principles of co-design (including potential stakeholders and stages of involvement), methods of involving and engaging the range of users, co-designing the prototype and the challenges of co-design.

CONCLUSIONS

Co-design involves all relevant stakeholders throughout the life and research cycle of the programme. This review helps to inform practitioners and researchers interested in the development of digital health technologies for children and young people. Future work in this field will need to consider the changing face of technology, methods of engaging with the diversity in the user group, and the evaluation of the co-design process and its impact on the technology.

A Digital Intervention for Adolescent Depression (MoodHwb): Mixed Methods Feasibility Evaluation

BACKGROUND

Treatment and prevention guidelines highlight the key role of health information and evidence-based psychosocial interventions for adolescent depression. Digital health technologies and psychoeducational interventions have been recommended to help engage young people and to provide accurate health information, enhance self-management skills, and promote social support. However, few digital psychoeducational interventions for adolescent depression have been robustly developed and evaluated in line with research guidance.

OBJECTIVE

We aimed to evaluate the feasibility, acceptability, and potential impact of a theory-informed, co-designed digital intervention program, MoodHwb.

METHODS

We used a mixed methods (quantitative and qualitative) approach to evaluate the program and the assessment process. Adolescents with or at elevated risk of depression and their parents and carers were recruited from mental health services, school counselors and nurses, and participants from a previous study. They completed a range of questionnaires before and after the program (related to the feasibility and acceptability of the program and evaluation process, and changes in mood, knowledge, attitudes, and behavior), and their Web usage was monitored. A subsample was also interviewed. A focus group was conducted with professionals from health, education, social, and youth services and charities. Interview and focus group transcripts were analyzed using thematic analysis with NVivo 10 (QSR International Pty Ltd).

RESULTS

A total of 44 young people and 31 parents or carers were recruited, of which 36 (82%) young people and 21 (68%) parents or carers completed follow-up questionnaires. In all, 19 young people and 12 parents or carers were interviewed. Overall, 13 professionals from a range of disciplines participated in the focus group. The key themes from the interviews and groups related to the design features, sections and content, and integration and context of the program in the young person's life. Overall, the participants found the intervention engaging, clear, user-friendly, and comprehensive, and stated that it could be integrated into existing services. Young people found the "Self help" section and "Mood monitor" particularly helpful. The findings provided initial support for the intervention program theory, for example, depression literacy improved after using the intervention (difference in mean literacy score: 1.7, 95% CI 0.8 to 2.6; P<.001 for young people; 1.3, 95% CI 0.4 to 2.2; P=.006 for parents and carers).

CONCLUSIONS

Findings from this early stage evaluation suggest that MoodHwb and the assessment process were feasible and acceptable, and that the intervention has the potential to be helpful for young people, families and carers as an early intervention program in health, education, social, and youth services and charities. A randomized controlled trial is needed to further evaluate the digital program.

Psychoeducational interventions in adolescent depression: A systematic review

BACKGROUND

Adolescent depression is common and leads to distress and impairment for individuals/families. Treatment/prevention guidelines stress the need for good information and evidence-based psychosocial interventions. There has been growing interest in psychoeducational interventions (PIs), which broadly deliver accurate information about health issues and self-management.

OBJECTIVE, METHODS

Systematic search of targeted PIs as part of prevention/management approaches for adolescent depression. Searches were undertaken independently in PubMed, PsycINFO, EMBASE, guidelines, reviews (including Cochrane), and reference lists. Key authors were contacted. No restrictions regarding publishing dates.

RESULTS

Fifteen studies were included: seven targeted adolescents with depression/depressive symptoms, eight targeted adolescents 'at risk' e.g. with a family history of depression. Most involved family/group programmes; others included individual, school-based and online approaches. PIs may affect understanding of depression, identification of symptoms, communication, engagement, and mental health outcomes.

CONCLUSION, PRACTICE IMPLICATIONS

PIs can have a role in preventing/managing adolescent depression, as a first-line or adjunctive approach. The limited number of studies, heterogeneity in formats and evaluation, and inconsistent approach to defining PI, make it difficult to compare programmes and measure overall effectiveness. Further work needs to establish an agreed definition of PI, develop/evaluate PIs in line with frameworks for complex interventions, and analyse their active components.

A Web-Based Psychoeducational Intervention for Adolescent Depression: Design and Development of MoodHwb

BACKGROUND

Depression is common in adolescence and leads to distress and impairment in individuals, families and carers. Treatment and prevention guidelines highlight the key role of information and evidence-based psychosocial interventions not only for individuals but also for their families and carers. Engaging young people in prevention and early intervention programs is a challenge, and early treatment and prevention of adolescent depression is a major public health concern. There has been growing interest in psychoeducational interventions to provide accurate information about health issues and to enhance and develop self-management skills. However, for adolescents with, or at high risk of depression, there is a lack of engaging Web-based psychoeducation programs that have been developed with user input and in line with research guidelines and targeted at both the individual and their family or carer. There are also few studies published on the process of development of Web-based psychoeducational interventions.

OBJECTIVE

The aim of this study was to describe the process underlying the design and development of MoodHwb (HwbHwyliau in Welsh): a Web-based psychoeducation multimedia program for young people with, or at high risk of, depression and their families, carers, friends, and professionals.

METHODS

The initial prototype was informed by (1) a systematic review of psychoeducational interventions for adolescent depression; (2) findings from semistructured interviews and focus groups conducted with adolescents (with depressive symptoms or at high risk), parents or carers, and professionals working with young people; and (3) workshops and discussions with a multimedia company and experts (in clinical, research, and multimedia work). Twelve interviews were completed (four each with young people, parents or carers, and professionals) and six focus groups (three with young people, one with parents and carers, one with professionals, and one with academics).

RESULTS

Key themes from the interviews and focus groups were: aims of the program, design and content issues, and integration and context of the program. The prototype was designed to be person-centered, multiplatform, engaging, interactive, and bilingual. It included mood-monitoring and goal-setting components and was available as a Web-based program and an app for mobile technologies.

CONCLUSIONS

MoodHwb is a Web-based psychoeducational intervention developed for young people with, or at high risk of, depression and their families and carers. It was developed with user input using qualitative methods as well as user-centered design and educational and psychological theory. Further research is needed to evaluate the effectiveness of the program in a randomized controlled trial. If found to be effective, it could be implemented in health, education, youth and social services, and charities, to not only help young people but also families, carers, friends, and professionals involved in their care.

Translation: From Bench to Brain – Using the visual arts and metaphors to engage and educate

This article examines multidisciplinary public engagement projects that bring together developments in psychiatric research and practice with visual art and its use of metaphor. The article focuses on the art exhibition Translation: From Bench to Brain , which was the basis for further collaborations, illustrating how the learning from the original event influenced subsequent projects. Combining art exhibitions with online documentation and resources, the projects explored not only medical and scientific themes, but also the wider social, cultural and ethical ramifications, specifically aspects of identity, risk and stigma. The activities demonstrate the value of a developmental approach to public engagement as a process, whereby projects build on previous activities and evolving multidisciplinary perspectives, networks and expertise.

Fludarabine with pharmacokinetically guided IV busulfan is superior to fixed-dose delivery in pretransplant conditioning of AML/MDS patients

We hypothesized that IV Busulfan (Bu) dosing could be safely intensified through pharmacokinetic (PK-) dose guidance to minimize the inter-patient variability in systemic exposure (SE) associated with body-sized dosing, and this should improve outcome of AML/MDS patients undergoing allogeneic stem cell transplantation (allo-HSCT). To test this hypothesis, we treated 218 patients (median age 50.7 years, male/female 50/50%) with fludarabine (Flu) 40 mg/m² once daily ×4, each dose followed by IV Bu, randomized to 130 mg/m² (N=107) or PK-guided to average daily SE, AUC of 6,000 µM-min (N=111), stratified for remission-status, and allo-grafting from HLA-matched donors. Toxicity and graft vs. host disease (GvHD) rates in the groups were similar; the risk of relapse or treatment-related mortality remained higher in the fixed-dose group throughout the 80-month observation period. Further, PK-guidance yielded safer disease-control, leading to improved overall and progression-free survival, most prominently in MDS-patients and in AML-patients not in remission at allo-HSCT. We conclude that AML/MDS patients receiving pretransplant conditioning treatment with our 4-day regimen may benefit significantly from PK-guided Bu-dosing. This could be considered an alternative to fixed dose delivery since it provides the benefit of precise dose delivery to a predetermined SE without increasing risk(s) of serious toxicity and/or GvHD.

Prevalence and correlates of psychotic experiences amongst children of depressed parents

Psychotic experiences in young people are substantially more common than psychotic disorders, and are associated with distress and functional impairment. Family history of depression as well as of schizophrenia increases risk for psychotic experiences, but the prevalence of such experiences and their clinical relevance in offspring of depressed parents is unknown. Our objectives were to explore i) the prevalence of psychotic experiences amongst offspring of parents with recurrent unipolar depression and ii) the relationship between psychotic experiences and other psychopathology. Data were drawn from the 'Early Prediction of Adolescent Depression' longitudinal study of high-risk offspring (aged 9-17 years at baseline) of 337 parents with recurrent depression. Three assessments were conducted over four years. Psychopathology was assessed using the Child and Adolescent Psychiatric Assessment. Seventy-eight percent of families (n=262) had complete data on psychotic experiences at each of the three time points. During the study, 8.4% (n=22; 95% CI 5.0%, 11.8%) of offspring reported psychotic experiences on at least one occasion, and these were associated with psychiatric disorder, specifically mood and disruptive disorders, and suicidal thoughts/behaviour. Psychotic experiences amongst offspring of depressed parents index a range of psychopathology. Further research is needed to examine their clinical significance and long-term consequences.

Gaining approvals for mental health research in the NHS

When embarking on mental health research it is often necessary to apply for approvals from one or more review bodies to ensure that the research is ethical and that the safety and well-being of participants are safeguarded. This can be complicated and time consuming, particularly to those unfamiliar with the process. In this article we describe the approvals commonly required for National Health Service-based research involving patients and endeavour to clearly explain what is involved at each stage. We then highlight some of the main considerations, including ethical aspects, which are particularly pertinent to conducting research in the field of mental health, and finish with general advice and considerations for future developments in the area.

Longitudinal symptom course in adults with recurrent depression: Impact on impairment and risk of psychopathology in offspring

BACKGROUND

Major depressive disorder (MDD) is common and is associated with an increased risk of psychopathology in offspring. However, depression shows considerable heterogeneity in its course over time. The aim of this study is to examine the relationship between parent depression symptom trajectories and (i) quality of life and social impairment and (ii) psychiatric disorder and depression symptoms in their offspring.

METHOD

Participants were from a longitudinal study of 337 parents with recurrent MDD and their adolescent offspring. Families were assessed on three occasions over four years. Parent depressive symptoms and current MDD diagnosis were assessed using the Schedules for Clinical Assessment in Neuropsychiatry. Adult quality of life and social impairment were derived from the EuroQol and current employment status. Psychiatric outcomes in offspring were assessed using the Child and Adolescent Psychiatric Assessment.

RESULTS

Using latent class growth analysis, three distinct classes of parental depression symptoms were identified (asymptomatic, mild, and chronic high). Parent depression classes were associated with their own quality of life and social impairment, and with psychiatric disorder and depression symptoms in their offspring.

LIMITATIONS

(i) We were unable to test associations with specific offspring disorders, (ii) we did not address the direction of effects underlying associations, and (iii) the sample consisted primarily of mothers and findings may not generalise to depressed fathers.

CONCLUSION

Longitudinal assessments of depressive symptoms in parents could help to identify families who are most in need of early intervention.

Bevacizumab/high-dose chemotherapy with autologous stem-cell transplant for poor-risk relapsed or refractory germ-cell tumors

BACKGROUND

High-dose chemotherapy (HDC) using sequential cycles of carboplatin/etoposide is curative for relapsed germ-cell tumors (GCT). However, outcomes of high-risk patients in advanced relapse remain poor. We previously developed a new HDC regimen combining infusional gemcitabine with docetaxel/melphalan/carboplatin (GemDMC), with preliminary high activity in refractory GCT. Given the high vascular endothelial growth factor expression in metastatic GCT and the synergy between bevacizumab and chemotherapy, we studied concurrent bevacizumab and sequential HDC using GemDMC and ifosfamide/carboplatin/etoposide (ICE) in patients with poor-risk relapsed or refractory disease.

PATIENTS AND METHODS

Eligibility criteria included intermediate/high-risk relapse (Beyer Model), serum creatinine ≤ 1.8 mg/dl and adequate pulmonary/cardiac/hepatic function. Patients received sequential HDC cycles with bevacizumab preceding GemDMC (cycle 1) and ICE (cycle 2). The trial was powered to distinguish a target 50% 2-year relapse-free survival (RFS) from an expected 25% 2-year RFS in this population.

RESULTS

We enrolled 43 male patients, median age 30 (20-49) years, with absolute refractory (N = 20), refractory (N = 17) or cisplatin-sensitive (N = 6) disease, after a median 3 (1-5) prior relapses. Disease status right before HDC was unresponsive (N = 24, progressive disease 22, stable disease 2), partial response with positive markers (PRm(+)) (N = 8), PRm(-) (N = 7) or complete response (N = 4). Main toxicities were mucositis and renal. Four patients (three with baseline marginal renal function) died from HDC-related complications. Tumor markers normalized in 85% patients. Resection of residual lesions (N = 13) showed necrosis (N = 4), mature teratoma (N = 2), necrosis/teratoma (N = 3) and viable tumor (N = 4). At median follow-up of 46 (9-84) months, the RFS and overall survival rates are 55.8% and 58.1%, respectively.

CONCLUSIONS

Sequential bevacizumab/GemDMC-bevacizumab/ICE shows encouraging outcomes in heavily pretreated and refractory GCT, exceeding the results expected in this difficult to treat population.

CLINICALTRIALSGOV

NCT00936936.

Reported child awareness of parental depression

Aims and method To determine rates of parent-reported child awareness of parental depression, examine characteristics of parents, children and families according to child awareness, and explore whether child awareness is associated with child psychopathology. Data were available from 271 families participating in the Early Prediction of Adolescent Depression (EPAD) study, a longitudinal study of offspring of parents with recurrent depression.

Results Seventy-three per cent of participating children were perceived as being aware of their parent’s depression. Older children, and children of parents who experienced more severe depression, were more likely to be aware. Awareness was not associated with child psychopathology.

Clinical implications Considering children in the context of parental depression is important. Child awareness may influence their access to early intervention and prevention programmes. Further research is needed to understand the impact of awareness on the child.

Optimal translational swimming of a sphere at low Reynolds number

Swimming velocity and rate of dissipation of a sphere with surface distortions are discussed on the basis of the Stokes equations of low-Reynolds-number hydrodynamics. At first the surface distortions are assumed to cause an irrotational axisymmetric flow pattern. The efficiency of swimming is optimized within this class of flows. Subsequently, more general axisymmetric polar flows with vorticity are considered. This leads to a considerably higher maximum efficiency. An additional measure of swimming performance is proposed based on the energy consumption for given amplitude of stroke.

Social discrimination in Japanese quail Coturnix japonica chicks genetically selected for low or high social reinstatement motivation

Japanese quail chicks of two lines genetically selected for low levels of social reinstatement behaviour (LSR) or high levels of social reinstatement behaviour (HSR) were housed in groups of three. The approach/avoidance tendencies of an individual chick from each group towards a familiar cagemate and a stranger from another group placed at opposite ends of a runway were measured at 7 days of age. Quail chicks of both genetic lines preferentially approached, spent longer near, and showed shorter mean distances from the cagemate than the stranger. Irrespective of stimulus type, the HSR quail generally showed shorter approach latencies, spent longer within 15 cm of the goal boxes, made more entries into these areas, and travelled further during the test than did their LSR counterparts. These findings demonstrated that Japanese quail chicks, of two genetic lines reared in small groups, successfully discriminated between familiar cagemates and strangers. They also suggest that there are no straightforward relationships between underlying social motivation and social preferences.

The Depression Impairment Scale for Parents (DISP): a new scale for the measurement of impairment in depressed parents

Children of depressed parents are at increased risk of developing mood disorders but mechanisms of intrafamilial transmission are currently unclear. One rarely investigated area is the impact of depression on a parent's everyday functioning. Currently there are no validated assessments of depression-specific parental impairment. The creation of such a measure would complement depression symptom counts, providing a more comprehensive account of the parent's depression. We therefore aimed to develop a valid and reliable measure of impairment specifically associated with parental depression. In a longitudinal study of parents with recurrent unipolar depression and their offspring, we collected data from 337 parents. These participants completed the Depression Impairment Scale for Parents (DISP), a questionnaire assessing depression-associated impairment in multiple domains of functioning. Factor analysis revealed that this measure consisted of two factors - impairment in routine tasks/activities and impairment in family functioning - that together accounted for 51.04% of variance. The scale evidenced good internal consistency (Cronbach's alpha=0.82). The DISP also displayed good construct and criterion validity as evidenced by significant associations with established measures of depression severity and global impairment. These results demonstrate that the DISP is a valid and reliable measure of depression-associated impairment in parents.

The effects of fasting duration on gastric emptying in man, an exploration of the role of the endocannabinoid system and inter-individual responsiveness

BACKGROUND

In animal studies, gut vagal afferent neurons express cannabinoid (CB1) receptors, whose expression is increased by fasting. We aimed to explore the possibility that similar effects might be relevant in man in controlling gastric emptying.

METHODS

Fourteen healthy volunteers underwent measurements of gastric emptying using the (13) C acetate breath test, after either a nutrient (skimmed milk) or non-nutrient (water) meal following both a 12 and 24 h fast. Further gastric emptying studies were performed with and without the CB1 receptor antagonist Rimonabant (20 mg or 80 mg). Because of the inter-individual variations observed, two subjects underwent additional studies with and without Rimonabant to determine intra-individual consistency. Gastric emptying was evaluated as cumulative C13 : C12 ratio values, measured at 5 min intervals for 30 min.

KEY RESULTS

In the group as a whole, fasting duration slowed gastric emptying for both the nutrient [120 ± 30 (mean ± SD) vs 101 ± 34, P < 0.05] and non-nutrient [226 ± 62 vs 177 ± 47, P < 0.05] meals, but there was no effect of Rimonabant. However, there was consistent inter individual variation; thus while 12 subjects showed a slowing, two (14%) exhibited accelerated gastric emptying for both the nutrient and the non-nutrient meal after 24 h fasting and in one of whom, Rimonabant consistently reversed the fasting effect on the non-nutrient meal.

CONCLUSIONS & INFERENCES

Extended fasting alters the gastric emptying of liquid meals but there are consistent differences between individuals. Where there is an accelerated response to fasting, Rimonabant appears to reverse the effect.

Trajectories of change in self-reported psychotic-like experiences in childhood and adolescence

BACKGROUND

Psychotic-like experiences (PLEs) during adolescence are not uncommon and potentially represent a clinical and public health concern. A greater understanding of their aetiology and patterns of change over time is needed. We aimed to describe trajectories of PLEs during adolescence, and examine their association with characteristics earlier during development.

METHOD

This was a cohort study of 7387 adolescents from the ALSPAC birth cohort who completed self-reported questionnaires about PLEs at 4 time points over a five-year period (ages 11.5-16.5years). Association between childhood characteristics and latent class membership was examined.

RESULTS

The proportion of children reporting PLEs declined with age. Individuals within decreasing (1.7%), intermittent (16.8%), and persistent (0.9%) PLEs trajectories were more likely to come from adverse backgrounds and have disturbed childhood development compared to the low PLE (80.6%) class. Persistent-class individuals scored highest on most measures though no measure clearly distinguished between persistent, intermittent and decreasing groups.

CONCLUSIONS

A number of early life characteristics and markers of childhood emotional and behavioural development are associated with trajectories of PLEs during adolescence. Despite the increase in cost and time required to collect data at repeated intervals, studies of trajectories are likely to have greater potential for predicting transition into clinical disorder at an earlier stage.

Pandemic H1N1 Influenza Infection and Vaccination in Humans Induces Cross-Protective Antibodies that Target the Hemagglutinin Stem

Most monoclonal antibodies (mAbs) generated from humans infected or vaccinated with the 2009 pandemic H1N1 (pdmH1N1) influenza virus targeted the hemagglutinin (HA) stem. These anti-HA stem mAbs mostly used IGHV1-69 and bound readily to epitopes on the conventional seasonal influenza and pdmH1N1 vaccines. The anti-HA stem mAbs neutralized pdmH1N1, seasonal influenza H1N1 and avian H5N1 influenza viruses by inhibiting HA-mediated fusion of membranes and protected against and treated heterologous lethal infections in mice with H5N1 influenza virus. This demonstrated that therapeutic mAbs could be generated a few months after the new virus emerged. Human immunization with the pdmH1N1 vaccine induced circulating antibodies that when passively transferred, protected mice from lethal, heterologous H5N1 influenza infections. We observed that the dominant heterosubtypic antibody response against the HA stem correlated with the relative absence of memory B cells against the HA head of pdmH1N1, thus enabling the rare heterosubtypic memory B cells induced by seasonal influenza and specific for conserved sites on the HA stem to compete for T-cell help. These results support the notion that broadly protective antibodies against influenza would be induced by successive vaccination with conventional influenza vaccines based on subtypes of HA in viruses not circulating in humans.

The association between early autistic traits and psychotic experiences in adolescence

BACKGROUND

There has been growing interest in the clinical and biological links between autistic spectrum disorder and psychotic disorders, and between symptoms of these disorders that exist below diagnostic thresholds. Whilst autism and schizophrenia are regarded as distinct disorders, recent studies support an overlap in the genetic architecture across these conditions. Although early neurodevelopmental impairment is associated with psychotic disorders in later life, evidence from longitudinal studies of the relationship between autistic traits and psychotic experiences is limited. Aims The aim of the study is to explore whether children with early autistic traits (social interaction and communication problems, and restricted, repetitive interests and behaviours) are more likely to present with psychotic experiences in early adolescence.

METHOD

Longitudinal study using the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. The mothers of 8232 children were asked about autistic traits in their children as part of the Development and Well-Being Assessment (DAWBA) at the age of 7. Of those, 6439 children completed a semi-structured clinical assessment for psychotic experiences at the age of 12.

RESULTS

Children whose mothers had concerns about autistic traits in early life, in particular with regard to speech development or 'rituals'/'habits', were more likely to develop psychotic experiences in early adolescence. The greater the number of early autistic traits a child had, the greater their risk of developing psychotic experiences. These associations were not confounded by IQ, family history of depression or schizophrenia, gender or socio-demographic characteristics.

CONCLUSIONS

Childhood autistic traits, and particularly speech problems and odd rituals or unusual habits, are associated with psychotic experiences in adolescence. This may be a result of a shared aetiology or because autistic traits may also be an early precursor of psychotic experiences.

THE MAINTENANCE OF A NORMAL PLASMA PROTEIN CONCENTRATION IN SPITE OF REPEATED PROTEIN LOSS BY BLEEDING

1. Experiments on five dogs are described consisting in the daily removal of blood plasma in amount from 25 to 100 cc. the red cells being returned to the circulation in Locke's solution. In no case was there a significant drop in plasma protein concentration. 2. A gravimetric method for the determination of total plasma protein is described. 3. A case is reported of cirrhosis of the liver in which over 10 gm. of protein daily was lost in the ascitic fluid during a period of 7 months without any lowering of plasma protein concentration. 4. The constancy of the plasma protein level and the adequacy of the mechanism of regeneration is pointed out.

[Not Available]

Introduction:

E-Learning methods such as webcasting are being used increasingly in healthcare education, including that of nurses and midwives. Webcasting means live synchronous broadcasting over the internet, where students participate simultaneously in text ‘chat room’ interactive discussions when logged on to a webpage where they can see and hear a presentation such as a PowerPoint lecture, a list of other participants, and access ‘chat rooms’.

Aims:

This paper reports student participation and satisfaction with the use of webcasting in a third year undergraduate nursing and midwifery research methods module in one higher education institution faculty of health and social work in the southwest of England, with students from distributed geographical locations.

Materials and Methods:

Students chose either webcasts or face-to-face lectures. Following each of the four webcasts, a web-based evaluation questionnaire was administered in a cross-sectional survey design.

Results:

Two thirds of students took part in webcasts and found them to be an acceptable teaching and learning strategy. Travel and cost savings were noted through not travelling to the main university campus, and these were statistically significantly correlated with students’ perception of gaining from the module and their overall satisfaction with webcasting. Across the four webcasts 5446 purposeful messages were posted indicating engagement with the material under study.

Conclusions and Recommendations:

Webcasting is an effective teaching and learning strategy which is popular with students, allows remote access to teaching and learning, and offers time and cost savings to students. Further research is required to investigate the educational potential of this new technology.

A critical review of fear tests used on cattle, pigs, sheep, poultry and horses

Fear is arguably the most commonly investigated emotion in domestic animals. In the current review we attempt to establish the level of repeatability and validity found for fear tests used on cattle, pigs, sheep and goats, poultry and horses. We focus the review on the three most common types of fear tests: the arena test (open field), the novel object test, and the restraint test. For some tests, e.g. tonic immobility in poultry, there is a good and broad literature on factors that affect the outcome of the test, the validity of the test and its age dependency. However, there are comparatively few of these well defined and validated tests and what is especially missing for most tests is information on the robustness, i.e., what aspects can be changed without affecting the validity of the tests. The relative absence of standardized tests hampers the development of applied ethology as a science.

Prognostic analysis of tumour angiogenesis, determined by microvessel density and expression of vascular endothelial growth factor, in high-risk primary breast cancer patients treated with high-dose chemotherapy

In contrast to early breast cancer, the prognostic effect of tumour angiogenesis in tumours with advanced axillary spread has been less studied. We retrospectively analysed the effect of microvessel density (MVD) and vascular endothelial growth factor (VEGF) by immunohistochemistry on the outcome of 215 patients treated uniformly within prospective trials of high-dose chemotherapy for 4-9 and >/=10 positive nodes, and followed for a median of 9 (range 3-13) years. Microvessel density was associated with epidermal growth factor receptor (EGFR) expression (P<0.001) and tumour size (P=0.001). Vascular endothelial growth factor overexpression (51% of patients) was associated with overexpression of EGFR (P=0.01) and HER2 (P<0.05), but not with MVD (P=0.3). High MVD was associated with worse relapse-free survival (74 vs 44%, P<0.001) and overall survival (76 vs 44%, P<0.001). Vascular endothelial growth factor overexpression had no effect on outcome. Multivariate analyses showed a prognostic effect of MVD independently of other known prognostic factors in this patient population. In conclusion, tumour angiogenesis, expressed as MVD, is a major independent prognostic factor in breast cancer patients with extensive axillary involvement.

Long-term comparison of rituximab treatment for refractory systemic lupus erythematosus and vasculitis: Remission, relapse, and re-treatment

OBJECTIVE

Current treatments for systemic lupus erythematosus (SLE) and vasculitis contribute to mortality and incapacity and are only partially effective; thus, newer therapies are clearly needed. Depletion of B cells has led to disease control in patients with autoimmune disorders. We sought to assess the long-term efficacy and safety of a B cell-depleting therapy in patients with SLE and patients with vasculitis.

METHODS

In a prospective study with a median followup of 24 months, 11 patients with active or refractory SLE and 11 patients with active or refractory antineutrophil cytoplasmic antibody-associated vasculitis (AAV) received a course of therapy with rituximab (an anti-CD20 monoclonal antibody) along with a single dose of intravenous cyclophosphamide.

RESULTS

Remission followed rapid B cell depletion, with response rates of 100% among the 11 patients with SLE (6 patients had a complete response, and 5 patients had a partial response) and 91% among the 11 patients with AAV (9 patients had a complete response, and 1 patient had partial remission). A renal response occurred in all 6 patients with lupus nephritis. Clinical improvement was accompanied by significant reductions in the daily dose of prednisolone. Relapse occurred in 64% of the patients with SLE and in 60% of those with AAV. B cell return preceded relapse in the majority of patients, and further treatment with rituximab proved effective. IgG and IgM levels were maintained in the normal range. The incidence of infective complications was low; however, infusion reactions were common, and human antichimeric antibodies developed in 5 of 14 patients.

CONCLUSION

B cell depletion offers the prospect of sustained disease remission and improved disease control combined with low toxicity in patients with active or refractory SLE or AAV. Relapse following treatment is common, but re-treatment is rapidly effective.

The primary amine metabolite of sibutramine stimulates lipolysis in adipocytes isolated from lean and obese mice and in isolated human adipocytes

Sibutramine is a satiety-inducing serotonin-noradrenaline reuptake inhibitor that acts predominantly via its primary and secondary metabolites. This study investigates the possibility that sibutramine and/or its metabolites could act directly on white adipose tissue to increase lipolysis. Adipocytes were isolated by a collagenase digestion procedure from homozygous lean (+/+) and obese-diabetic OB/OB mice, and from lean nondiabetic human subjects. The lipolytic activity of adipocyte preparations was measured by the determination of glycerol release over a 2-hour incubation period. The primary amine metabolite of sibutramine M2, caused a concentration-dependent stimulation of glycerol release by murine lean and obese adipocytes (maximum increase by 157+/-22 and 245+/-16%, respectively, p<0.05). Neither sibutramine nor its secondary amine metabolite M1 had any effect on lipolytic activity. Preliminary studies indicated that M2-induced lipolysis was mediated via a beta-adrenergic action. The non-selective beta-adrenoceptor antagonist propranolol (10 (-6) M) strongly inhibited M2-stimulated lipolysis in lean and obese murine adipocytes. M2 similarly increased lipolysis by isolated human omental and subcutaneous adipocytes (maximum increase by 194+/-33 and 136+/-4%, respectively, p<0.05) with EC50 values of 12 nM and 3 nM, respectively. These results indicate that the sibutramine metabolite M2 can act directly on murine and human adipose tissue to increase lipolysis via a pathway involving beta-adrenoceptors.

Solvation pressure in chloroform

Molecular dynamics (MD) simulations of chloroform vapor and liquid at normal temperature and pressure and liquid under hydrostatic pressure are presented, giving bond lengths and vibrational frequencies as functions of pressure. The change in bond lengths between vapor and liquid at normal temperature and pressure is consistent with a pressure equivalent to the cohesive energy density (CED) of the liquid, supporting the solvation pressure model which predicts that solvated molecules or nanoparticles experience a pressure equal to the CED of the liquid. Experimental data for certain Raman frequencies of chloroform in the vapor phase, in the liquid, and in the liquid under pressure are presented and compared to MD. Results for C-Cl vibrational modes are in general agreement with the solvation pressure model whereas frequencies associated with the C-H bond are not. The results demonstrate that masking interactions exist in the real liquid that can be reduced or eliminated in simplified simulations.

Effect of different forms of information produced for cancer patients on their use of the information, social support, and anxiety: randomised trial

OBJECTIVE

To explore the hypothesis that different methods of selecting and printing information for cancer patients could improve emotional support by affecting interaction with others, and so lead to improved psychological wellbeing.

DESIGN

Randomised trial with eight groups (three factors, 2x2x2). Data collected at recruitment and three month follow-up.

PARTICIPANTS

400 patients starting radiotherapy, of whom 325 with breast or prostate cancer and complete anxiety and depression data were included in the analysis.

INTERVENTIONS

Printed booklets: half had only general information from CancerBACUP about each patient's cancer and half had personalised information from the patient's medical record plus selected general information; half were composed of information chosen interactively by the patient and half were produced automatically with a larger volume of material; and half had additional advice on anxiety management and half did not.

MAIN OUTCOME MEASURES

Patients' views of the information, use of their booklets with others; change in reported social support; change in anxiety and depression.

RESULTS

The larger booklets produced automatically were more likely to be found useful and to tell patients something new and less likely to be seen as too limited than the booklets produced interactively, but they were also more likely to overwhelm some patients. Personalised booklets were more likely than general booklets to tell patients something new. There was no difference in patients' perceived understanding of their cancer by any of the intervention factors. Patients with personalised information were more likely to show their booklets to others and to think it helped in discussing their cancer or its treatment. There were no major differences in social support, anxiety, or depression by any intervention factors.

CONCLUSIONS

Patients were more likely to show personalised information to their confidants than general information. Further research is needed into the effects of sharing information on patients' social support and anxiety. Trial registration US Government Clinical Trials Database NCT00127465.

Is neighbourhood deprivation a risk factor for gestational diabetes mellitus?

AIMS

To assess the relationship between neighbourhood deprivation and the rate of gestational diabetes mellitus (GDM) using routinely collected data from a clinical information system, in Plymouth, UK.

METHODS

Between 1 January 1996 and 31 December 1997, 3933 women residing within the Plymouth Primary Care Trust (PCT) were screened for GDM using indices of neighbourhood deprivation and prevalence of GDM. Areas (n = 43) were classified according to the Townsend index, measuring material deprivation. Pregnant women with and without GDM were compared.

RESULTS

The prevalence of GDM was 1.7%[95%, confidence interval (CI) 1.20, 2.11]. The prevalence of GDM ranged from 1.05% (95% CI 0.60, 1.70) in the most deprived to 2.10% (95%, CI 1.34, 3.13), in the least deprived neighbourhood. Crude rates decreased by 50%[relative prevalence (RP) (95% CI) 0.50 (0.27, 0.94); P = 0.06] amongst those living in the most-deprived compared with those living in the least-deprived areas. Using a stepwise binary logistic regression model, older age at delivery significantly increased the risk of developing GDM. [RP (95%, CI) 1.09, (1.04, 1.13)]. Townsend deprivation score had no significant independent association with GDM when other covariates were considered.

CONCLUSION

These data suggest that the neighbourhood context in which women live has no impact on the risk of GDM. Diabet.

AML-loaded DC generate Th1-type cellular immune responses in vitro

BACKGROUND

The generation of AML-specific T-lymphocyte responses by leukemia-derived DC has been documented by multiple investigators and is being pursued clinically. An obstacle to widespread use of this strategy is that it has not been possible to generate leukemic DC from all patients, and an alternative approach is needed if the majority of leukemia patients are to receive therapeutic vaccination in conjunction with other treatment protocols.

METHODS

In the present study, we generated DC from CD14-selected monocytes isolated from healthy donor PBPC and loaded them with a total cell lysate from AML patient blasts.

RESULTS

Immature in vitro-derived DC exhibited robust phagocytic activity, and mature DC demonstrated high expression of CD80, CD83, CD86 and the chemokine receptor CCR7, important for DC migration to local lymph nodes. Mature, Ag-loaded DC were used as APC for leukemia-specific cytotoxic T-lymphocyte (CTL) induction and demonstrated cytotoxic activity against leukemic targets. CTL lysis was Ag-specific, with killing of both allogeneic leukemic blasts and autologous DC loaded with allogeneic AML lysate. HLA-matched controls were not lysed in our system.

DISCUSSION

These data support further research into the use of this strategy as an alternative approach to leukemia-derived DC vaccination.

Adrenocortical responses of Japanese quail to a routine weighing procedure and to tonic immobility induction

Tonic immobility (TI) is induced by brief manual restraint, and it is a commonly used test of fearfulness, particularly in poultry. However, in view of increasing ethical concerns about experimentation on living animals, there is a need to ensure that the tests used do not elicit unacceptable distress. In the United Kingdom, there is some debate as to whether TI should be classified as a regulated experimental procedure that requires a Home Office license to experiment on living animals under the Animals (Scientific Procedures) Act of 1986. The present study compared plasma corticosterone (PC) concentrations in undisturbed Japanese quail (controls) with those exposed to the induction of TI or those exposed to a routine weighing procedure. Circulating PC concentrations were higher following TI induction or weighing than in the controls, but the 2 treatments elicited similar adrenocortical responses. Further, the PC levels found here were lower than those reported elsewhere when quail were exposed to crating, transport, or mechanical immobilization stressors. We therefore concluded that the induction of TI might be best regarded as a mild stressor. Furthermore, studies using this technique can identify ways of alleviating fear and thereby improving well-being. Collectively, we believe that the use of TI is justified, and it does not require classification as a regulated procedure in the United Kingdom or elsewhere.

Rotational diffusion of colloidal particles near confining walls

We study the rotational diffusion of a spherical colloid confined in a narrow channel between parallel plane hard walls. The walls damp translational diffusion much more than rotational diffusion so that there is expected to be little translation-rotation coupling. Using a recent calculation of the nonisotropic rotational mobilities arising from the hydrodynamic interactions with the walls, we set up the rotational Smoluchowski equation for either a particle with a permanent dipole moment or a polarizable particle with axisymmetric polarizabilities subject to an external electric field. Using the Smoluchowski equation dynamics we calculate the time-correlation functions of orientation that are measured in depolarized light scattering for the cases of no external field, external field normal to the walls, and external field parallel to the walls. The decay of correlations is shown to be given by a weighted sum of decaying exponentials and can be characterized by an initial and a mean characteristic decay time. The weights and decay rates of each component and the characteristic decay times are studied numerically for a range of field strengths. The nonisotropic rotational mobilities make these decay times highly sensitive to the distance of the particle from the confining walls. This position dependence can be used as a method of measuring the rotational mobilities or, conversely, the rate of decay of correlations can be used as a probe of particle position between the confining walls.

Autologous transplantation followed closely by reduced-intensity allogeneic transplantation as consolidative immunotherapy in advanced lymphoma patients: a feasibility study

We report outcomes in advanced lymphoma patients (n = 32) who enrolled in a trial of prospectively planned combined autologous/reduced-intensity transplantation (RIT) (n = 25) or who received RIT shortly after prior autografting because of high relapse risk or progressive disease (n = 7). Nine patients on the autologous/RIT transplant protocol did not proceed to planned RIT because of patient choice (n = 4), disease progression (n = 3), toxicity (n = 1), or no adequate donor (n = 1). Among the 23 other patients, RIT was started a median of 59 days (range 31-123) after autologous transplant. Fifteen patients had related donors, five patients had unrelated donors, and three patients had cord blood donors. Among all patients completing RIT, the median overall survival time was 385 days (95% CI 272-792), and the median relapse-free survival time was 157 days (95% CI 119-385). At the time of reporting, six patients (26%) remain alive and three patients (13%) remain alive without relapse. The 100-day transplant-related mortality (TRM) was 9% among all patients and was 0% among matched sibling donors. Overall TRM was 43%. Tandem transplant is feasible in advanced lymphoma with low early TRM. However, practical challenges associated with the strategy were significant and high levels of late TRM due to graft-versus-host disease and infections suggest that modifications of the procedure will be needed to improve outcomes and patient retention.

Spherical particle in Poiseuille flow between planar walls

We study a spherical mesoparticle suspended in Newtonian fluid between plane-parallel walls with incident Poiseuille flow. Using a two-dimensional Fourier transform technique we obtain a symmetric analytic expression for the Green tensor for the Stokes equations describing the creeping flow in this geometry. From the matrix elements of the Green tensor with respect to a complete vector harmonic basis, we obtain the friction matrix for the sphere. The calculation of matrix elements of the Green tensor is done in large part analytically, reducing the evaluation of these elements to a one-dimensional numerical integration. The grand resistance and mobility matrices in Cartesian form are given in terms of 13 scalar friction and mobility functions which are expressed in terms of certain matrix elements calculated in the spherical basis. Numerical calculation of these functions is shown to converge well and to agree with earlier numerical calculations based on boundary collocation. For a channel width broad with respect to the particle radius, we show that an approximation defined by a superposition of single-wall functions is reasonably accurate, but that it has large errors for a narrow channel. In the two-wall geometry the friction and mobility functions describing translation-rotation coupling change sign as a function of position between the two walls. By Stokesian dynamics calculations for a polar particle subject to a torque arising from an external field, we show that the translation-rotation coupling induces sideways migration at right angles to the direction of fluid flow.

The management of orbital cysts associated with congenital microphthalmos and anophthalmos

AIMS

To study the management of the orbital cysts present in a group of patients with anophthalmos and microphthalmos.

METHODS

A retrospective study of 34 patients (40 orbits) treated for orbital cyst associated with microphthalmos and anophthalmos.

RESULTS

The two largest treatment groups comprised 17 orbits (42.5%) where the cyst was removed surgically and 17 orbits (42.5%) where the cyst was retained and conformers were used. The remaining cases comprised two orbits (5%) where the cyst was aspirated initially; two orbits (5%) with large cysts which will need to be excised after further orbital growth; one orbit (2.5%) in which a silicone expander was used initially, and one orbit (2.5%) in which a mildly microphthalmic eye had some vision and was monitored but required no surgery.

CONCLUSION

In this study 33 out of 34 patients had a good cosmetic result which illustrates that the orbital cyst in microphthalmos or anophthalmos performs a useful role in socket expansion and that the majority of patients with this condition can expect a good cosmetic outcome.

Nonmyeloablative allogeneic hematopoietic stem cell transplantation for congenital sideroblastic anemia

Congenital sideroblastic anemia (CSA) is a dyserythropoietic disorder that leads to transfusion dependency and subsequent iron overload. Nonmyeloablative allogeneic hematopoietic stem cell transplantation (NST) was performed for a patient with CSA, who had contraindications to conventional allografting. Conditioning was fludarabine, low-dose total body irradiation and antithymocyte globulin, followed by peripheral blood stem cell transplant. Cyclosporine and mycophenolate mofetil were used for graft-versus-host disease prophylaxis. Complete donor chimerism was observed day +131. Early after transplant, the patient became transfusion independent, allowing a regular phlebotomy program. On day +190, refractory lactic acidosis followed by fatal cardiovascular collapse developed, without evidence of infection. Data from this case demonstrates that NST may correct the erythropoietic defect of CSA.

Early T-maze behavior and broiler growth

In the laboratory and at a commercial farm in Argentina, chicks that showed a short latency to exit a T-maze (LEX) (HP, high performance) gained more weight than those with a longer LEX (LP, low performance). The present study re-examined this relationship and evaluated additional T-maze measures using broilers reared in quasi-intensive, environmentally controlled conditions. In the T-maze, a mirror strategically placed at the end of a corridor stimulates the test chick to leave the isolation chamber (start box) and to move toward its reflection. Having done so, it can then see other birds and thereby be further stimulated to completely exit the maze. However, when a test bird hesitates or stops at the mirror, its performance categorization may be confounded. Herein, the T-maze performance of 3-d-old broiler chicks was assessed using three different measurements: 1) the latency to exit the start box (LEB), 2) the latency to reach the mirror section of the maze (LRM), and 3) LEX. The fastest (top 25%) and slowest (bottom 25%) of the birds within a sex and within each of the three T-maze criteria were classified as HP and LP chicks, respectively. The relationships between these measures and body weight were examined in 4-, 42-, and 56-d-old males and females. Irrespective of the T-maze classification criteria used, HP and LP chicks had similar body weights at 4 d of age. However, chicks classified as HP according to LEB or LRM measures were heavier at 42 and 56 d of age than LP ones (P < 0.02 for all comparisons). These differences were apparent in both sexes. On the other hand, there were no detectable differences in body weight at the latter ages between chicks categorized as HP or LP according to their LEX scores. The present results indicate that 1) broiler chicks that exit the T-maze start box and reach the mirror quickly subsequently grow faster than their slower LP counterparts and 2) LEB and LRM are better predictors of growth than the LEX value used in previous studies.