Problematisation and regulation: bodies, risk, and recovery within the context of Neonatal Abstinence Syndrome

Background Neonatal Abstinence Syndrome (NAS) is an anticipated effect of maternal drug use during pregnancy. Yet it remains a contested area of policy and practice. In this paper, we contribute to ongoing debates about the way NAS is understood and responded to, through different treatment regimes, or logics of care. Our analysis examines the role of risk and recovery discourses, and the way in which the bodies of women and babies are conceptualised within these. Methods Qualitative interviews with 16 parents (9 mothers, 7 fathers) and four focus groups with 27 health and social care professionals based in Scotland. All the mothers were prescribed opioid replacement therapy and parents were interviewed after their baby was born. Data collection explored understandings about the causes and consequences of NAS and experiences of preparing for, and caring for, a baby with NAS. Data were analysed using a narrative and discursive approach. Results Parent and professional accounts simultaneously upheld and subverted logics of care which govern maternal drug use and the assessment and care of mother and baby. Despite acknowledging the unpredictability of NAS symptoms and the inability of the women who are opioid-dependent to prevent NAS, logics of care centred on ‘proving’ risk and recovery. Strategies appealed to the need for caution, intervening and control, and obscured alternative logics of care that focus on improving support for mother-infant dyads and the family as a whole. Conclusion Differing notions of risk and recovery that govern maternal drug use, child welfare and family life both compel and trouble all logics of care. The contentious nature of NAS reflects wider socio-political and moral agendas that ultimately have little to do with meeting the needs of mothers and babies. Fundamental changes in the principles, quality and delivery of care could improve outcomes for families affected by NAS

Arbitration and Managed Care: Will Consumers Suffer if the Two are Combined?

Published in cooperation with the American Bar Association Section of Dispute Resolutio

Smoothing group-based trajectory models through B-splines

Purpose This paper investigates the use of B-spline smoothers as an alternative to polynomials in time when estimating trajectory shape in group-based trajectory models. The use of polynomials in these models can cause undesirable curve shapes, such as uplifts at the end of the trajectory, which may not be present in the data. Moreover, polynomial curves are global, meaning that a data point at one end of the trajectory can affect the shape of the curve at the end. Methods We use the UK Offenders Index 1963 birth cohort to investigate the use of B-splines. The models are fitted using Latent Gold, and two information criteria (BIC and ICL-BIC are used to estimate the number of knots of the B-spline, as well as the number of groups. A small simulation study is also presented. Results A three-group solution was chosen. It is shown that B-splines can provide a better fit to the observed data than cubic polynomials. The offending trajectory groups correspond to the classic groups of adolescent-limited, low-rate chronic and high-rate chronic which were proposed by Moffitt. However ,the shapes of the two chronic trajectory curves are more consistent with the life-course persistent nature of chronic offending than the traditional cubic polynomial curves. The simulation shows improved performance of the B-spline over cubic polynomials. Conclusions The use of B-splines is recommended when fitting group-based trajectory models. Some software products need further development to include such facilities, and we encourage this development

The PAAFID project:exploring the perspectives of autism in adult females among intellectual disability healthcare professionals

Purpose: The purpose of this paper is to explore the perspectives of healthcare professionals on autism in adult females with intellectual disability (ID), including regarding the gender ratio of autism, the clinical manifestation of autism in females, and the recognition, screening and diagnosis of autism. Design/methodology/approach: The questionnaire was developed following a review of the relevant literature and distributed to professionals within three healthcare trusts as well as members of two clinical research groups. The questionnaire was completed by 80 ID healthcare professionals. Data were aggregated and analysed using Microsoft Excel. Findings: ID healthcare professionals had a lack of recognition of the smaller gender ratio of autism in patients with ID as compared to those without ID. Most respondents reported believing that autism manifests differently in females; with women demonstrating a greater ability to mask their symptoms. A considerable proportion of participants reported feeling less confident in recognising, screening and diagnosing autism in female patients, with many endorsing a wish for additional training in this area. Practical implications: These findings suggest that ID healthcare professionals are keen to improve their skills in providing services for women with autism. Training programmes at all levels should incorporate the specific needs of women with ASD, and individual professionals and services should actively seek to address these training needs in order to promote best practice and better outcomes for women with autism. Originality/value: This is the first published questionnaire exploring the perspectives of healthcare professionals regarding autism in adult females with ID

The early Neolithic of Iraqi Kurdistan: current research at Bestansur, Shahrizor Plain

Human communities made the transition from hunter-foraging to more sedentary agriculture at multiple locations across southwest Asia through the Early Neolithic (ca. 10,000-7000 BC). Societies explored strategies involving increasing management and development of plants, animals, materials, technologies and ideologies specific to each region whilst sharing some common attributes. Current research in the eastern Fertile Crescent is contributing new insights into the Early Neolithic transition and the critical role that this region played. The Central Zagros Archaeological Project (CZAP) is investigating this transition in Iraqi Kurdistan, including at the earliest Neolithic settlement so far excavated in the region. In this article, we focus on results from ongoing excavations at the Early Neolithic site of Bestansur on the Shahrizor Plain (Sulaimaniyah province), in order to address key themes in the Neolithic transition