Pharmacological and non-pharmacological interventions for non-respiratory sleep disturbance in children with neurodisabilities : a systematic review

BACKGROUND: There is uncertainty about the most appropriate ways to manage non-respiratory sleep disturbances in children with neurodisabilities (NDs). OBJECTIVE: To assess the clinical effectiveness and safety of NHS-relevant pharmacological and non-pharmacological interventions to manage sleep disturbance in children and young people with NDs, who have non-respiratory sleep disturbance. DATA SOURCES: Sixteen databases, including The Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE, were searched up to February 2017, and grey literature searches and hand-searches were conducted. REVIEW METHODS: For pharmacological interventions, only randomised controlled trials (RCTs) were included. For non-pharmacological interventions, RCTs, non-randomised controlled studies and before-and-after studies were included. Data were extracted and quality assessed by two researchers. Meta-analysis and narrative synthesis were undertaken. Data on parents' and children's experiences of receiving a sleep disturbance intervention were collated into themes and reported narratively. RESULTS: Thirty-nine studies were included. Sample sizes ranged from 5 to 244 participants. Thirteen RCTs evaluated oral melatonin. Twenty-six studies (12 RCTs and 14 before-and-after studies) evaluated non-pharmacological interventions, including comprehensive parent-directed tailored (n = 9) and non-tailored (n = 8) interventions, non-comprehensive parent-directed interventions (n = 2) and other non-pharmacological interventions (n = 7). All but one study were reported as having a high or unclear risk of bias, and studies were generally poorly reported. There was a statistically significant increase in diary-reported total sleep time (TST), which was the most commonly reported outcome for melatonin compared with placebo [pooled mean difference 29.6 minutes, 95% confidence interval (CI) 6.9 to 52.4 minutes; p = 0.01]; however, statistical heterogeneity was extremely high (97%). For the single melatonin study that was rated as having a low risk of bias, the mean increase in TST was 13.2 minutes and the lower CI included the possibility of reduced sleep time (95% CI -13.3 to 39.7 minutes). There was mixed evidence about the clinical effectiveness of the non-pharmacological interventions. Sixteen studies included interventions that investigated the feasibility, acceptability and/or parent or clinician views of sleep disturbance interventions. The majority of these studies reported the 'family experience' of non-pharmacological interventions. LIMITATIONS: Planned subgroup analysis was possible in only a small number of melatonin trials. CONCLUSIONS: There is some evidence of benefit for melatonin compared with placebo, but the degree of benefit is uncertain. There are various types of non-pharmacological interventions for managing sleep disturbance; however, clinical and methodological heterogeneity, few RCTs, a lack of standardised outcome measures and risk of bias means that it is not possible to draw conclusions with regard to their effectiveness. Future work should include the development of a core outcome, further evaluation of the clinical effectiveness and cost-effectiveness of pharmacological and non-pharmacological interventions and research exploring the prevention of, and methods for identifying, sleep disturbance. Research mapping current practices and exploring families' understanding of sleep disturbance and their experiences of obtaining help may facilitate service provision development. STUDY REGISTRATION: This study is registered as PROSPERO CRD42016034067. FUNDING: The National Institute for Health Research Health Technology Assessment programme

The enigma of German operational theory: the evolution of military thought in Germany, 1919-1938

From the end of the Second World War historians have sought to answer one of its most intriguing questions: to what - and to whom - did the Wehrmacht owe its shocking initial operational successes? What was the nature of German strategic and operational perceptions, and were they new — or even, as some researchers have suggested, 'revolutionary'? Was German post-1918 military culture conducive to a thorough investigation of past mistakes, a re-evaluation of traditional notions, and the pursuit of new ideas? In reality the Reichswehr officer corps jealously defended its inherited conceptual boundaries, retreated ever-deeper into a one-dimensional self-perception and strategic outlook, and offered conceptually ossified solutions to the Republic's pressing security problems. German officers, convinced that their doctrine and military world-view were flawless, never challenged the axioms and values that had brought army and nation to catastrophe in 1918: extreme warfare, culminating in the most destructive and eventually self-destructive actions; extremes of risk-taking; the endless pursuit of annihilational battles that dictated the reduction of strategy to meticulous operational and tactical planning; the trust in 'spiritual superiority' to overcome enemy advantages in material and manpower; ruthlessness; and an exaggerated drive for action at all costs. Idiosyncratic operational planning that was at times completely detached from strategic reality completed the picture of a military organisation unable to renew itself. No comprehensive analysis has yet convincingly explained this astonishing continuity, or linked it to the allegedly innovative operational theory and doctrine that evolved in the second half of the 1930s. The concept of military and organisational culture can however provide the necessary theoretical foundations for understanding both that continuity and the doctrinal shape that it assumed in the imminence of the Second World War. It can explain - as this thesis demonstrates - the disastrous and seemingly inexplicable wrong-headedness of a group of otherwise highly intelligent men

The compleat infidel

The Compleat Infidel is a study in discursive psychology (Edwards and Potter, 1992: Potter and Wetherell, 1987). Its topic is defensive practice in the discourse of marital and para-marital infidelity. The objectives were threefold: to document and explicate the discursive terrain: to demonstrate an application of the principles of discursive psychology; to develop a critique of selected areas of social science generally and social psychology in particular. A database of more than 230 samples of discourse drawn from heterogeneous sources including newspaper reports, works of popular psychology and original research interviews was amassed and subjected to discourse analysis according to the methods described by Edwards, Potter and Wetherell. The findings are that in contemporary, Anglo-American discourse five discrete types of construction are routinely produced to defend infidels and infidelity: (1) non-events; (2) isolated episodes; (3) special categories of self; (4) specific reasons: (5) generic rationales. The variability within and between these constructions reflects their orientation to differing aspects of the interactional context and their different functions therein. Relevant aspects of context include: interviews and other question-and-answer sessions; silent, anonymous and sympathetic recipients, tabloid and broadsheet news; contexts of argument and debate. The range of defensive functions being performed includes: (1) exoneration, (2) appeal to mitigating circumstances: (3) appeal to diminished capacity or diminishe d responsibility; (4) defence of provocation: (5) justification. The conclusions are that social scientific investigations of infidelity, adultery, cheating, extramarital sex and similar phenomena must acknowledge that discourse is action orientated if a complete and coherent analysis is to be achieved. This conclusion is shown to be relevant to endeavours in sociology, evolutionary psychology, social cognition, the psychology of individual differences, psychopathology and applications of psychology in public health surveys and couples therapy, as well as studies of discourse that are informed by feminist and other varieties of social cons tructionism. The contribution of The Compleat Infidel to the accounts literature and to action orientated approaches to discourse such as discursive psychology is discussed and directions for further research are recommended

An Experimental Study of the Influence of Social Background and Political Opinion on Literary Preferences

A survey of some relevant researches showed that aesthetic appreciation has generally Been studied either in terms of individual psychology or in relation to a standard determined by so-called 'art experts'&dot; Neither of these approaches gave due consideration to the social aspect of aesthetic experience. It was concluded that in order to explore this aspect, the problem of literary preferences could profitably be studied in a social psychological context. The hypothesis which the present investigation proposed to test was that literary appreciation and preference, though highly individual in their nature, are influenced by two important social factors, namely, social background and political opinion, both being related to social values and attitudes&dot; An experiment was devised for this purpose, consisting of sixteen poems (most of which were selected by four groups of people, two with contrasting social backgrounds and the other two with contrasting political outlooks), a preference scale on which the poems were to be rated, and a questionnaire regarding the raters' social background and political opinion&dot; The raters were also to give their comments on each poem. Ratings and comments were obtained from a total number of 212 subjects, out of whom 164 completed the political opinion tests included in the questionnaire&dot; The subjects were classified into three social groups according to the types of their occupations and each group was again divided into political sub-groups on the basis of the subjects' political affiliations. Analysis of variance was applied to the ratings of the sixteen poems taken together as well as separately in order to see if the three social groups differed significantly in their preferences. To study the relation between political opinion and literary preferences, correlation coefficients between political opinion scores and the ratings of each poem were calculated and their statistical significance determined&dot; The mean ratings of different social groups and political sub-groups for the sixteen poems were compared and contrasted and were represented graphically&dot; To Interpret the differences among social groups as well as political sub-groups within them, a qualitative analysis of the comments was made with special reference to the social attitudes and literary values of the subjects in different groups on the one hand, and the theme and the style of each poem on the other. The results of the experiment suggest that social background and political opinion, which involve certain attitudes and values on the part of the subjects, influence their preferences for certain types of poems, mainly in relation to the ideas, attitudes and sentiments expressed in them.<p

Elizabeth Madox Roberts: Her Symbolism and Philosophic Perspective

Thesis (Ph.D)--Boston UniversityThe work of Elizabeth Madox Roberts, Kentucky novelist and poet (1881-1941), presents a problem in valuation. Her early novels, particularly The Time of Man (1926) and The Great Meadow (1930), received critical acclaim and popular success. Yet today Miss Roberts' novels are virtually neglected or given scant recognition as "regionalist." Examination shows that "regionalism" in the 1920's and 1930's was primarily a sociological phenomenon; the term "literary regionalist" proves to have little objective critical meaning, operating rather as a vaguely pejorative label . Accordingly, I examine Miss Roberts' work in terms of three questions: What does she try to accomplish? How well does she succeed? Is the achievement worthwhile? By studying her published works and her extensive private writings, it is possible to extract her philosophic and aeathetic perspectives . The intellectual profile which emerges is that of a philosophical idealist whose basis of faith is in an active perceiving imagining mind; her definition of reality is highly subjective , organic and dynamic. The primal unit ia the self-contained experiential individual, striving to grow in accordance with the principles of organic harmony - - that is to say, self-urged to become true, beautiful, and good by the natural accretions of experience. Further, this isolated individual can transcend himself, merging into something beyond himself through love, friendship, communal groupings, and aesthetic and religious experiences. In these flashes of transcendent "belongingess," individuality is not lost, but, paradoxically, greatly intensified. Happiness consists then in the most extensive creation of design on the chaos of sensation. [TRUNCATED

Literature, dogma and education : a study of Matthew Arnold's later criticism and its educational implications for today

The main object of the thesis is to explore the concepts 'literature' and 'dogma' in relation to education. It considers the place of literature in the educational curriculum and examines its relationship with religion, moral education and science.\ud The point of departure for the study is Matthew Arnold's Literature and Dogma (1873) which, in conjunction with related writings, is considered first within the cultural and educational climate of its own age, and then evaluated for its relevance and educational implications for the present day. Matthew Arnold, a distinguished social critic, professor of poetry and Inspector of Education, wrote Literature and Dogma at a time of considerable social and intellectual upheaval; and the pattern of social change bro ught about by accelerating technology over the past century, with its increasing clash of cultures and diverse dogmatic and ideological systems has given new significance to Arnold's thought. In particular, his ideas on moral, scientific and religious education have implications for the modern curriculum and for the place of literature within it, which the research endeavours to bring into focus and develop. \ud In a shrinking and increasingly complex world1where there is evidence of an increasing need for education to provide young people with both a sense of security and a flexible capacity to cope with unexampled change, Arnold's own upbringing is shown to be of some educational interest. \ud The conclusion reached is that, while it is impossible to prove the moral. efficacy of literature, there seems to be some justification for believing that imaginative literature, appropriately taught, has an increasingly significant role to play as a means of ordering emotions, conveying values, enhancing our capacity for empathy and communicating insights, as religious certainties and moral dogmas come under challenge from alternative competing dogmas and agencies for change. \u

The Retention and Processing of Communications Data for Law Enforcement: A Challenge for Privacy

Law enforcement agencies are dominant end users of information communication technologies. These technologies are not necessarily created for pursuing criminal justice objectives. They are mechanisms that are built, administered, and maintained by private actors for their own purposes and later incorporated into law enforcement processes. They serve an effective role in the investigation, detection, and prosecution of crime, particularly through their collection and processing of relevant data. For the purposes of this thesis, the data at issue concerns the who, where, when, and how of a communication. Broadly classed as 'communications data' this information is readily and consistently available due to technological developments which result in blanket collection and retention, enable easier access, and create opportunities to derive greater meaning from the information through data analysis. The thesis examines the challenges of reconciling privacy with the use of this data in policing by conducting a critical analysis of 'how, and to what extent, do the current legal and policy frameworks governing the retention of, access to, and analysis of communications data by law enforcement, constitute a violation of privacy which requires substantive changes to the legal regime?'. Employing the approach of Thomas P. Hughes for examining socio-technical systems, the thesis argues that technology and privacy are co-constructed. This is evidenced though the evolution of the technology and the relevant legal and policy factors which contributed to the information communication system's development and acceptance as a policing tool. Three key areas, namely data retention, access to data, and data analysis are used to explore how communications data intersects with law enforcement objectives. Each element of the system is critiqued to assess significant changes in actors and roles, information types, and transmission principles. Utilising Helen Nissenbaum's theory of contextual integrity, it is argued that changes in each of the three key areas represent a prima facie violation of informational norms. Where a violation of these norms is identified, it is then evaluated against the perceived benefits of the technology to determine the impact on privacy. The impact on privacy is weighed against the existing legal safeguards in the investigatory powers mechanisms. Examining the privacy interest in a contextual manner allows for the specifics of the technology system to be incorporated into the assessment of the privacy violations. The thesis concludes that it is insufficient to apply traditional interpretations of privacy to technologies which have fundamentally altered social expectations through the scale/scope of data, the deconstruction of traditional boundaries, the limitation of ephemerality, and changes in technologically mediated presence. Applying a legal framework which does not acknowledge this impact fails to guarantee fundamental privacy rights. A number of recommendations are advanced for reform of the investigatory powers mechanisms to ensure privacy is protected when communications data is utilised by law enforcement

Cognitive complexity revisited

Cognitive Complexity is an important and obtrusive phenomenon over a wide range of situations, and is worthy of study in its own right. Although the term "Cognitive Complexity" occurs in an informal way in the psychological literature, there is no general agreement about what it means or connotes. A new approach was needed in order to re-conceptualise cognitive complexity. This re-conceptualisation originated in the unobtrusive observation of cognitive complexity in a relatively free, uncontrolled and naturalistic environment. From this came the formulation of an appropriate and explicit methodology, which encouraged subjects to display cognitive complexity in an unhurried way in a private interview situation by talking about topics in the news and personal issues. Initial experimental techniques (including an impressionistic analysis, pen pictures and a content analysis), led on to the development of the main analysis which identified types of cognitive complexity and their constituents in the interview transcripts. The types of cognitive complexity identified were true (divided into outstanding and pedestrian), disjunctive, borderline, no cognitive complexity and secondhand cognitive complexity. The main constituents of true cognitive complexity (outstanding) were systemic and penetrating thinking, independence of thought and truth-seeking. Pedestrian cognitive complexity was characterised by analogical and investigative reasoning, clarity and incisiveness. The importance of this re-conceptualisation of cognitive complexity is that it has resulted in the development of a new methodology which facilitates the display by subjects of more than one type of cognitive complexity. This methodology which identifies the types of cognitive complexity can be applied in real-life situations in which people are facing complex decisions

Literature and history in the age of ideas: essays on the French Enlightenment presented to George R. Havens

(print) xix, 414 p. ; 24 cmGEORGES MAY Foreword ix -- Preface xvii -- HUGH M . DAVIDSON Fontenelle, Perrault, and the Realignment of the Arts 3 -- J. H. BRUMFITT Historical Pyrrhonism and Enlightenment Historiography in France 15 -- CHARLES G. S. WILLIAMS The Diamond of Courtoisie and the Dragonnades of 1681: Valincour's Vie de François de Lorraine 31 -- ALESSANDRO S. CRISAFULLI The Journal des Sçavans and the Lettres Persanes 59 -- HARCOURT BROWN From London to Lapland: Maupertuis, Johann Bernoulli I, and La Terre applatie, 1728-1738 69 -- IRA O. WADE Notes on the Making of a Philosophe: Cuenz and Bouhier 97 -- JEAN SAREIL Sur les Mémoires de Voltaire 125 -- JEANNE R. MONTY Voltaire's Debt to the Encyclopédie in the Opinion en Alphabet 153 -- ROBERT D. COTTRELL Ulcerated Hearts: Love in Voltaire's La Mort de César 169 -- VIRGIL W. TOPAZIO A Réévaluation of Rousseau's Political Doctrine 179 -- JAMES F. HAMILTON Literature and the "Natural Man" in Rousseau's Emile 195 -- RICHARD A. BROOKS Rousseau's Antifeminism in the Lettre à d'Alembert and Emile 209 -- OTIS FELLOWS Diderot's Supplément as Pendant for La Religieuse 229 -- DOUGLAS BONNEVILLE Diderot's Artist: Puppet and Poet 245 -- GEORGES MAY Une certaine Madame Madin 255 -- DIANA GUIRAGOSSIAN Subterfuges et stratagèmes, ou les romanciers malgré eux 273 -- EDWARD P. SHAW Censorship and Subterfuge in Eighteenth-Century France 287 -- THEODORE BESTERMAN Bibliographie Notes on the Beaumarchais-Goezman Lawsuit 311 -- ARNOLD AGES Lamartine and the Philosophes 321 -- GITA MAY Stendhal and the Age of Ideas 343 -- PAUL M. SPURLIN Readership in the American Enlightenment 359 -- DOROTHY M. MCGHEE Encyclopedism and Its Conscience: Evolution and Revolution 377 -- A Bibliography of the Writings of George R. Havens 387 -- Notes on the Contributors 401 -- Index 40