The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis.

BACKGROUND: Child maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems. OBJECTIVES: To synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment. STUDY DESIGN: For effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views. PARTICIPANTS: Children and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months. INTERVENTIONS: Any psychosocial intervention provided in any setting aiming to address the consequences of maltreatment. MAIN OUTCOME MEASURES: Psychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability. METHODS: Young Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible. RESULTS: We identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive-behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) -0.44 (95% CI -4.43 to -1.53)], depression [mean difference -2.83 (95% CI -4.53 to -1.13)] and anxiety [SMD -0.23 (95% CI -0.03 to -0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist-child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself. CONCLUSIONS: It is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions. LIMITATIONS: Studies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses. FUTURE WORK: Studies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes. STUDY REGISTRATION: This study is registered as PROSPERO CRD42013003889. FUNDING: The National Institute for Health Research Health Technology Assessment programme

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations

The function and therapeutic targeting of anaplastic lymphoma kinase (ALK) in non-small cell lung cancer (NSCLC)

Abstract Lung cancer is the leading cause of death by cancer in North America. A decade ago, genomic rearrangements in the anaplastic lymphoma kinase (ALK) receptor tyrosine kinase were identified in a subset of non-small cell lung carcinoma (NSCLC) patients. Soon after, crizotinib, a small molecule ATP-competitive ALK inhibitor was proven to be more effective than chemotherapy in ALK-positive NSCLC patients. Crizotinib and two other ATP-competitive ALK inhibitors, ceritinib and alectinib, are approved for use as a first-line therapy in these patients, where ALK rearrangement is currently diagnosed by immunohistochemistry and in situ hybridization. The clinical success of these three ALK inhibitors has led to the development of next-generation ALK inhibitors with even greater potency and selectivity. However, patients inevitably develop resistance to ALK inhibitors leading to tumor relapse that commonly manifests in the form of brain metastasis. Several new approaches aim to overcome the various mechanisms of resistance that develop in ALK-positive NSCLC including the knowledge-based alternate and successive use of different ALK inhibitors, as well as combined therapies targeting ALK plus alternative signaling pathways. Key issues to resolve for the optimal implementation of established and emerging treatment modalities for ALK-rearranged NSCLC therapy include the high cost of the targeted inhibitors and the potential of exacerbated toxicities with combination therapies

Snow flies self-amputate freezing limbs to sustain behavior at sub-zero temperatures

<p><span>All living things are profoundly affected by temperature. In spite of the thermodynamic constraints on biology, some animals have evolved to live and move in extremely cold environments. Here, we investigate behavioral mechanisms of cold tolerance in the snow fly (<em>Chionea</em> spp.), a flightless crane fly that is active throughout the winter in boreal and alpine environments of the northern hemisphere. Using thermal imaging, we show that adult snow flies maintain the ability to walk down to an average body temperature of -7 °C. At this supercooling limit, ice crystallization occurs within the snow fly's hemolymph and rapidly spreads throughout the body, resulting in death. However, we discovered that snow flies frequently survive freezing by rapidly amputating legs before ice crystallization can spread to their vital organs. Self-amputation of freezing limbs is a last-ditch tactic to prolong survival in frigid conditions that few animals can endure. Understanding the extreme physiology and behavior of snow insects is important at this moment when the alpine ecosystems they inhabit are rapidly changing due to anthropogenic climate change.</span></p><p>Microsoft Excel is required to open data files. </p><p>Funding provided by: Kinship Conservation Fellows<br>Crossref Funder Registry ID: https://ror.org/05pt1d114<br>Award Number: </p><p>Funding provided by: Esther A. & Joseph Klingenstein Fund<br>Crossref Funder Registry ID: https://ror.org/01q222b25<br>Award Number: </p><p>Funding provided by: Pew Charitable Trusts<br>Crossref Funder Registry ID: https://ror.org/02xhk2825<br>Award Number: </p><p>Funding provided by: McKnight Foundation<br>Crossref Funder Registry ID: https://ror.org/003ghvj67<br>Award Number: </p><p>Funding provided by: Alfred P. Sloan Foundation<br>Crossref Funder Registry ID: https://ror.org/052csg198<br>Award Number: </p><p>Funding provided by: New York Stem Cell Foundation<br>Crossref Funder Registry ID: https://ror.org/03n2a3p06<br>Award Number: </p><p>Funding provided by: University of Washington<br>Crossref Funder Registry ID: https://ror.org/00cvxb145<br>Award Number: </p><p>This dataset was collected using the FLIR T860 thermal camera and the FLIR ResearchIR program to record body temperatures and behavior of snow flies and other crane flies during experimental trials.</p&gt

How optometrists record corneal staining

Free to read at publisher\ud \ud Purpose: The aim of this study was to determine current approaches adopted by optometrists\ud to the recording of corneal staining following fluorescein instillation.\ud Methods: An anonymous ‘record-keeping task’ was sent to all 756 practitioners who are\ud members of the Queensland Division of Optometrists Association Australia. This task\ud comprised a form on which appeared a colour photograph depicting contact lens\ud solution-induced corneal staining. Next to the photograph was an empty box, in which\ud practitioners were asked to record their observations. Practitioners were also asked to\ud indicate the level of severity of the condition at which treatment would be instigated.\ud Results: Completed task forms were returned by 228 optometrists, representing a 30 per\ud cent response rate. Ninety-two per cent of respondents offered a diagnosis. The most\ud commonly used descriptive terms were ‘superficial punctate keratitis’ (36 per cent of\ud respondents) and ‘punctate staining’ (29 per cent). The level of severity and location of\ud corneal staining were noted by 69 and 68 per cent of respondents, respectively. A\ud numerical grade was assigned by 44 per cent of respondents. Only three per cent\ud nominated the grading scale used. The standard deviation of assigned grades was � 0.6.\ud The condition was sketched by 35 per cent of respondents and two per cent stated that\ud they would take a photograph of the eye. Ten per cent noted the eye in which the\ud condition was being observed. Opinions of the level of severity at which treatment for\ud corneal staining should be instigated varied considerably between practitioners, ranging\ud from ‘any sign of corneal staining’ to ‘grade 4 staining’.\ud Conclusion: Although most practitioners made a sensible note of the condition and\ud properly recorded the location of corneal staining, serious deficiencies were evident\ud regarding other aspects of record-keeping. Ongoing programs of professional optometric\ud education should reinforce good practice in relation to clinical record-keeping

(Re)visions of Sex : A Companion to the Third Biennial of International Photo-based art

This anthology, presented on the occasion of the third Fotofeis biennal, contains eighteen texts (in styles ranging from poetic, critical, theoritical and fictional) which address the festival's central theme: sex. Subjects such as pornography, voyeurism, homosexuality, erotica, fetishism and desire are considered whitin the contexts of ethics, aesthetics, semiotics, psychoanalysis and digital culture. Brief biographical notes on authors. 52 bibl.ref