The relationship between Infantile Postural Asymmetry and unsettled behavior in babies: a quantitative observational study

A thesis submitted to the University of Bedfordshire in partial fulfilment of the requirements for the degree of Professional DoctorateBackground: Unsettled infant behaviour is a common problem of infancy without known aetiology or effective management, and it is costly in both social and economic terms. Some osteopaths propose that musculoskeletal dysfunction contributes to unsettled infant behaviour, yet reported improvement following osteopathic treatment is anecdotal. A primary issue is the absence of a measurement tool to test musculoskeletal dysfunction in infants. Aims and Objectives: This research aimed to investigate: the reliability and validity of the infantile postural asymmetry (IPA) measurement scale; whether there was a relationship between IPA and unsettled infant behaviour as measured by the Revised Infant Behavior Questionnaire – short form (IBQ-Rs); and whether any relationship between IPA and unsettled infant behaviour was mediated by, or confounded with, the demographic variables of age, sex, birth weight and weight gain in twelve- to sixteen-week-old infants. Methods: Fifty-eight infants aged twelve- to sixteen-weeks-old were recruited through public health clinics, and their behaviour was assessed using the parent-report IBQ-Rs. Infantile asymmetry was measured using observer ratings of spontaneous movements in the IPA scale. A quantitative cross-sectional observational design was used to investigate the relationship between IPA and unsettled behaviour. Results: An association between unsettled behaviour and musculoskeletal dysfunction was not found in twelve- to sixteen-week-old infants using the IPA measurement scale. Ratings for the trunk convexity parameter of the IPA scale were unreliable and excluded from statistical analysis. A significant difference between high and low cervical rotation deficit groups for Surgency was detected in female babies and needs further examination. Some subsets of the IBQ-Rs were unstable when measuring behaviour in twelve- to sixteen-week-old infants. Future research targeting infants younger than twelve-weeks-old, and presenting with unsettled behaviour, is indicated. Conclusion: A causal relationship between unsettled infant behaviour and musculoskeletal dysfunction is still unproven. The literature suggests benefits associated with a consistent approach to providing parents with information, support and advice on normal behaviour patterns and optimal handling of infants. Non-specific effects cannot be ruled out in reported improvements following osteopathic treatment. Management strategies require early implementation and a multidisciplinary approach. The absence of common terminology in infant behaviour problems is an obstacle in cross-professional communication. A role for osteopathy may be in developing a shared language to facilitate management and research, and to examine the importance of positioning and handling practices on infant asymmetry and the relationship with the musculoskeletal system

Papers on anthropology VI

Eelkäija: Tartu Ülikooli toimetised. Antropoloogia-alaseid töid, ISSN 0207-4575http://www.ester.ee/record=b1339521*es

Priorities for hydrocephalus research: report from a National Institutes of Health-sponsored workshop

Journal ArticleObject. Treatment for hydrocephalus has not advanced appreciably since the advent of cerebrospinal fluid (CSF) shunts more than 50 years ago. Many questions remain that clinical and basic research could address, which in turn could improve therapeutic options. To clarify the main issues facing hydrocephalus research and to identify critical advances necessary to improve outcomes for patients with hydrocephalus, the National Institutes of Health (NIH) sponsored a workshop titled "Hydrocephalus: Myths, New Facts, and Clear Directions." The purpose of this paper is to report on the recommendations that resulted from that workshop. Methods. The workshop convened from September 29 to October 1, 2005, in Bethesda, Maryland. Among the 150 attendees was an international group of participants, including experts in pediatric and adult hydrocephalus as well as scientists working in related fields, neurosurgeons, laboratory-based neuroscientists, neurologists, patient advocates, individuals with hydrocephalus, parents, and NIH program and intramural staff. Plenary and breakout sessions covered injury and recovery mechanisms, modeling, biomechanics, diagnosis, current treatment and outcomes, complications, quality of life, future treatments, medical devices, development of research networks and information sharing, and education and career development. Results. The conclusions were as follows: 1) current methods of diagnosis, treatment, and outcomes monitoring need improvement; 2) frequent complications, poor rate of shunt survival, and poor quality of life for patients lead to unsatisfactory outcomes; 3) investigators and caregivers need additional methods to monitor neurocognitive function and control of CSF variables such as pressure, flow, or pulsatility; 4) research warrants novel interdisciplinary approaches; 5) understanding of the pathophysiological and recovery mechanisms of neuronal function in hydrocephalus is poor, warranting further investigation; and 6) both basic and clinical aspects warrant expanded and innovative training programs. Conclusions. The research priorities of this workshop provide critical guidance for future research in hydrocephalus, which should result in advances in knowledge, and ultimately in the treatment for this important disorder and improved outcomes in patients of all ages

Evolutionary hypotheses for human childhood

The origins of human childhood have fascinated scholars from many disciplines. Some researchers argue that childhood, and many other human characteristics, evolved by heterochrony, an evolutionary process that alters the timing of growth stages from ancestors to their descendants. Other scholars argue against heterochrony, but so far have not offered a well-developed alternative hypothesis. This essay presents such an alternative. Childhood is defined as a unique developmental stage of humans. Childhood is the period following infancy, when the youngster is weaned from nursing but still depends on older people for feeding and protection. The biological constraints of childhood, which include an immature dentition, a small digestive system, and a calorie-demanding brain that is both relatively large and growing rapidly, necessitate the care and feeding that older individuals must provide. Evidence is presented that childhood evolved as a new stage hominid life history, first appearing, perhaps, during the time of Homo habilis. The value of childhood is often ascribed to learning many aspects of human culture. It is certainly true that childhood provides “extra” time for brain development and learning. However, the initial selective value of childhood may be more closely related to parental strategies to increase reproductive success. Childhood allows a woman to give birth to new offspring and provide care for existing dependent young. Understanding the nature of childhood helps to explain why humans have lengthy development and low fertility, but greater reproductive success than any other species. Yrbk Phys Anthropol 40:63–89, 1997. © 1997 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/37682/1/3_ftp.pd

The Role of Transcranial Doppler Sonography in the Management of Pediatric Hydrocephalus

In the pathophysiology of pediatric hydrocephalus, a significant role is played by the negative influence of cerebral circulation with the emergence of cerebral hypoperfusion. Transcranial Doppler sonography is a noninvasive method that can be used for indirect measurement of intracranial pressure and decrease of intracranial compliance by assessment of changes of cerebral circulation. The goal of this work was to assess the cerebral circulation and intracranial dynamics in pediatric hydrocephalus. The work is also focused on evaluation of impact of various intracranial factors on Doppler parameters of cerebral circulation, especially in neonates with hydrocephalus. The ambition of this work is to improve indication and timing of drainage procedure in children with hydrocephalus by application of the scientific results and clinical experience

Treatment of brain cancer and ischaemic stroke utilising High Intensity Focus Ultrasound (HIFU) guide with MRI

In this thesis high intensity focused ultrasound (HIFU) is utilized for cancer treatment (thermal mode) and treatment of ischaemic stroke (mechanical mode). These two applications were investigated in vitro and in vivo models. MRI was utilized to monitor the lesions created by HIFU either in thermal or cavitation mode in freshly excised lamb brain tissue in vitro, and in rabbit brain in vivo. Additionally, MRI was used to monitor lesions deep in tissue for both in vitro and in vivo exposures. All three MRI sequences used (T1-W FSE, T2-W FSE and FLAIR) were able to detect lesions. Both thermal and bubbly lesions were best monitored using T1-W FSE with excellent contrast, proving the potential of HIFU to treat reliably tumours in the brain. A HIFU system was also used to assist thrombolysis in cooperation with a thrombolytic drug such as recombinant tissue plasminogen activator (rt-PA) in vitro and in vivo. It was shown that higher intensity results to higher volume of dissolved clot, but there is a limit of the intensity to be used in order to avoid heating of the clot and the surrounding tissue. The goal in this study was to achieve temperature elevation not exceeding 1ºC (called safe temperature). It was found that the larger the beam area the larger the dissolved clot volume. Also, the lower the frequency, the larger the volume of the dissolved clot. The results reported herein point to the use of frequency around 0.5 MHz and pulsing to optimize thrombolysis and skull penetration and at the same time avoiding unwanted heating. Finally, an Acrylonitrile Butadiene Styrene (ABS) phantom skull model was developed in order to evaluate the propagation of ultrasound using a single element transducer. The skull model was appropriately designed so that it has the same attenuation as a human skull. It was demonstrated that using a frequency of 0.5 MHz versus 1 MHz, ultrasound propagation through the phantom skull was higher. Therefore, higher frequency has poor skull penetration and a small beam size at the focus, while low frequencies have better skull penetration but with the risk of reaching the unpredictable effect of cavitation. The developed system has proven to successfully create large lesions in the brain and at the same time, these lesions are successfully monitored with excellent contrast using MRI (T1-W FSE) enabling the accurate determination of the margins of these lesions. The results reported in this study point to the use of frequency around 0.5 MHz and pulsing to optimize thrombolysis and skull penetration and at the same time avoiding unwanted heating. For treating tumours located deep in the brain and for dissolving thrombus causing an acute ischaemic stroke, further extensive clinical studies will be needed before this technology is applied to humans

Assessing the cognitive, behavioural and psychosocial profile of children with Russell Silver Syndrome

The main objective of this research was to create a better understanding of the long term cognitive, behavioural and psychosocial consequences for children with Russell Silver Syndrome (RSS), a syndrome characterised by being born Small for Gestational Age (SGA) and having short stature and phenotypical facial features. A systematic review revealed a trend for SGA children is increasing cognitive difficulties with increasing age, possibly due to spatial difficulties. A comparison of the cognitive abilities of an RSS group and an age matched control group revealed a cognitive disadvantage in RSS children, particularly spatial difficulties. RSS children were also found to have more behavioural problems than control children, particularly symptoms of ADHD. An investigation revealed an increased incidence of Autistic Spectrum Disorder (ASD) in RSS than would be expected in the general population, though those with ASD symptoms were not found to form a distinct group of children with RSS. An investigation self esteem in RSS revealed that although they were physically smaller and perceived this, this was not impacting on their overall self esteem. In turn it was revealed that others were not viewing the physical symptoms of RSS as guiding their expectations. Overall the findings from this research were positive and have real life application. It was important that weaknesses, such as was found for spatial ability and hyperactivity and inattention are recognised. What this research was not able to conclude conclusively was why these patterns of behaviour were observed and this offers future directions for the research

What Hope Lies Buried Here: Differential Mortality and Mortuary Treatment of Adolescents in Dubuque's Third Street Cemetery

Appendix C is available at https://doi.org/10.24378/exe.2763 and Appendix D is available at https://doi.org/10.24378/exe.2764Excavations at the Catholic Third Street Cemetery in Dubuque, Iowa (2007-2011), uncovered 939 unmarked graves dating to the period between 1833 and 1880. Skeletal analysis identified 43 individuals whose age estimate ranges overlapped with osteological (12 to 20 years) and social (13 to 19 years) adolescence, as defined for this cultural context. The current research design focused on mortality patterns and mortuary preparations of these individuals and highlights differences between teenagers and the rest of the cemetery population. This interdisciplinary project utilised data from osteological analyses and archival research to explore health and mortality among adolescent non-survivors. Palaeopathological observations reflecting early life health insults (linear enamel hypoplasias, cribra orbitalia, porotic hyperostosis) and later illness (labyrinthine endocranial lesions, periosteal new bone formation, tubercular lesions) were studied to explore the potential vulnerability of adolescents with frailty acquired through earlier health stresses. Perimortem trauma and local death records were examined to determine the proportion of teenage mortality due to external causes such as accidents, homicide, and suicide. The lack of perimortem trauma observed in the Third Street adolescent sample was explained to some extent by the number of teenagers who perished from, but were unmarked by, a single accidental cause – drowning. The investigation of mortuary treatment examined combinations of burial attributes – including coffin hardware, burial clothing, religious objects, and nonreligious grave goods – and demonstrated how age-related patterns reflect an increase in socially acceptable sentimentality and changing views of the afterlife, with preferential treatment afforded to some adolescents. Comparative pathological marker and burial attribute data were gathered from publications on nine additional nineteenth-century burial populations, and death records from a tenth were consulted. Despite issues with inconsistent data collection procedures for parts of the comparative sample, results tentatively support the observations from Third Street. The proportion of adolescents with both early-life stress markers and later pathological manifestations is higher than that of other age classes, suggesting that survival of health insults in infancy or early childhood left teenagers more susceptible to fatal disease, particularly when their immune systems were vulnerable due to competing pubertal energy investments. Observed regional differences in skeletal marker rates suggest that this “double signal” may be more pronounced in populations with a high prevalence of TB. Perimortem trauma levels are equal to those of adults, though greater evidence of violence in the South and Southwest reflects the unstable social conditions in those areas. Regional, as well as temporal, trends were also identified in adolescent funerary preparations. Mid-nineteenth-century adolescents received preferential treatment, though general increases in mortuary elaboration overshadow this distinction in some later cemetery populations. Parental grief at the loss of near-adult offspring was expressed in the tendency to employ the metaphor of death as a journey when preparing adolescents for the grave, instead of the metaphor of sleep applied to younger children. Meanwhile, in frontier areas, independently living teenagers were often interred without familial involvement in the equivalent of paupers’ graves

Tongue Movements in Feeding and Speech

The position of the tongue relative to the upper and lower jaws is regulated in part by the position of the hyoid bone, which, with the anterior and posterior suprahyoid muscles, controls the angulation and length of the floor of the mouth on which the tongue body \u27rides\u27. The instantaneous shape of the tongue is controlled by the \u27extrinsic muscles \u27 acting in concert with the \u27intrinsic \u27 muscles. Recent anatomical research in non-human mammals has shown that the intrinsic muscles can best be regarded as a \u27laminated segmental system \u27 with tightly packed layers of the \u27transverse\u27, \u27longitudinal\u27, and \u27vertical\u27 muscle fibers. Each segment receives separate innervation from branches of the hypoglosssal nerve. These new anatomical findings are contributing to the development of functional models of the tongue, many based on increasingly refined finite element modeling techniques. They also begin to explain the observed behavior of the jaw-hyoid-tongue complex, or the hyomandibular \u27kinetic chain\u27, in feeding and consecutive speech. Similarly, major efforts, involving many imaging techniques (cinefluorography, ultrasound, electro-palatography, NMRI, and others), have examined the spatial and temporal relationships of the tongue surface in sound production. The feeding literature shows localized tongue-surface change as the process progresses. The speech literature shows extensive change in tongue shape between classes of vowels and consonants. Although there is a fundamental dichotomy between the referential framework and the methodological approach to studies of the orofacial complex in feeding and speech, it is clear that many of the shapes adopted by the tongue in speaking are seen in feeding. It is suggested that the range of shapes used in feeding is the matrix for both behaviors

PRELIMINARY FINDINGS OF A POTENZIATED PIEZOSURGERGICAL DEVICE AT THE RABBIT SKULL

The number of available ultrasonic osteotomes has remarkably increased. In vitro and in vivo studies have revealed differences between conventional osteotomes, such as rotating or sawing devices, and ultrasound-supported osteotomes (Piezosurgery®) regarding the micromorphology and roughness values of osteotomized bone surfaces. Objective: the present study compares the micro-morphologies and roughness values of osteotomized bone surfaces after the application of rotating and sawing devices, Piezosurgery Medical® and Piezosurgery Medical New Generation Powerful Handpiece. Methods: Fresh, standard-sized bony samples were taken from a rabbit skull using the following osteotomes: rotating and sawing devices, Piezosurgery Medical® and a Piezosurgery Medical New Generation Powerful Handpiece. The required duration of time for each osteotomy was recorded. Micromorphologies and roughness values to characterize the bone surfaces following the different osteotomy methods were described. The prepared surfaces were examined via light microscopy, environmental surface electron microscopy (ESEM), transmission electron microscopy (TEM), confocal laser scanning microscopy (CLSM) and atomic force microscopy. The selective cutting of mineralized tissues while preserving adjacent soft tissue (dura mater and nervous tissue) was studied. Bone necrosis of the osteotomy sites and the vitality of the osteocytes near the sectional plane were investigated, as well as the proportion of apoptosis or cell degeneration. Results and Conclusions: The potential positive effects on bone healing and reossification associated with different devices were evaluated and the comparative analysis among the different devices used was performed, in order to determine the best osteotomes to be employed during cranio-facial surgery