Gaze Aversion During Children's Transient Knowledge and Learning

Looking away from an interlocutor’s face during demanding cognitive activity can help adults and children answer challenging mental arithmetic and verbal-reasoning questions (Glenberg, Schroeder, & Robertson, 1998; Phelps, Doherty-Sneddon, & Warnock, 2006). While such “gaze aversion” (GA) is used far less by 5-year old school children, its use increases dramatically during the first years of primary education, reaching adult levels by 8-years of age (Doherty-Sneddon, Bruce, Bonner, Longbotham, & Doyle, 2002). Furthermore GA increases with increasing mental demands, with high levels signalling that an individual finds material being discussed challenging but remains engaged with it (Doherty-Sneddon et al., 2002; Doherty-Sneddon & Phelps, 2006). In the current study we investigate whether patterns of gaze and gaze aversion during children’s explanations can predict when they are in states of transient knowledge (Karmiloff-Smith 1992; Goldin-Meadow, Kim, & Singer, 1999). In Study 1, fifty-nine 6-year-olds took part and completed a “Time Task” along with periodic teaching intervention to improve their comprehension of telling the time. Some children improved immediately, whereas others did so more gradually. The gradual improvers showed the highest levels of GA, particularly when they were at an intermediate level of performance. In Study 2, thirty-three 6-year-old children completed a balance beam task (Pine & Messer, 2000). Children who improved the representational level of their explanations (Karmiloff-Smith, 1992) of this task with training used more GA than those who did not. Practical implications for teaching and for recognizing transient knowledge states are discussed

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

Children’s identification of unfamiliar voices on both target-present and target-absent lineups

A robust finding from the eyewitness literature is that children are as accurate as adults on target-present lineups from the age of five years, whereas they continue to make an erroneous false positive identification from a target-absent lineup up until around fourteen years of age (Pozzulo & Lindsay, 1998). The current study explores whether the same pattern occurs when voices are used instead of faces. A total of 334 participants from six age groups (6-7-year-olds, 8-9-year-olds, 10-11-year-olds, 12-13-year-olds, 14-15-year-olds and adults) listened to a 30 second audio clip of an unfamiliar voice and were then presented with either a six person target-present or target-absent voice lineup. Overall, participants were more accurate with target-present than target-absent lineups. Moreover, performance on target-present lineups showed adult-like levels of attainment by 8-9 years of age. In contrast, performance on target-absent lineups was extremely poor, with all age groups tending to make a false identification. Confidence was higher when participants made correct rather than incorrect decisions for both types of lineup and this did not change with increasing age. Given these results, both child and adult earwitness evidence needs to be treated with considerable caution

Les indices visuels de la communication chez l’enfant

In this article we discuss our work on visual cues (such as hand gestures and eye gaze) in children's communication. We describe evidence showing the facilitatory role of such cues as well as their cognitive impact. While face-to-face signals are often beneficial to communication, they carry a cognitive load which children and adults avoid under certain conditions, by averting their gaze. Indeed under certain circumstances there is a measurable and observable cognitive cost associated with looking at faces. So when thinking, especially about cognitively demanding material, we often avert our gaze from the face of our interlocutor or other potentially distracting aspects of the visual environment (Glenberg, Schroeder, & Robertson, 1998; Doherty-Sneddon, Bruce, Bonner, Longbotham, & Doyle, 2002; Phelps, Doherty-Sneddon & Warnock, 2006). Reasons why we might look away from faces in particular are that they are 'capturing', hard to ignore and physiologically arousing (e.g., Langton & Bruce, 2000; Beattie 1981). Gaze aversion (GA) develops over the early primary school years; and young typically developing children can be trained to use gaze aversion to optimise their problem solving performance. In our most recent work we have begun applying our gaze aversion paradigm with atypical populations for example: children on the autistic spectrum; children with ADHD; and young people with Williams syndrome. Gaze aversion promises to provide new and important insights into the cognitive and social functioning of atypically developing children. We conclude that gaze aversion is often an adaptive response to cognitive load and indicative of internal processing effort

Long-term efficacy and safety of a treatment strategy for HIV infection using protease inhibitor monotherapy: 8-year routine clinical care follow-up from a randomised, controlled, open-label pragmatic trial (PIVOT)Research in context

Summary: Background: Treatment-simplification strategies are important tools for patient-centred management. We evaluated long-term outcomes from a PI monotherapy switch strategy. Methods: Eligible participants attending 43 UK treatment centres had a viral load (VL) below 50 copies/ml for at least 24 weeks on combination ART. Participants were randomised to maintain ongoing triple therapy (OT) or switch to a strategy of physician-selected PI monotherapy (PI-mono) with prompt return to combination therapy if VL rebounded. The primary outcome, previously reported, was loss of future drug options after 3 years, defined as new intermediate/high level resistance to at least one drug to which the participant's virus was considered sensitive at trial entry. Here we report resistance and disease outcomes after further extended follow-up in routine care. The study was registered as ISRCTN04857074. Findings: We randomised 587 participants to OT (291) or PI-mono (296) between Nov 4, 2008, and July 28, 2010 and followed them for a median of more than 8 years (100 months) until 2018. At the end of this follow-up time, one or more future drug options had been lost in 7 participants in the OT group and 6 in the PI-mono group; estimated cumulative risk by 8 years of 2.7% and 2.1% respectively (difference −0.6%, 95% CI −3.2% to 2.0%). Only one PI-mono participant developed resistance to the protease inhibitor they were taking (atazanavir). Serious clinical events (death, serious AIDS, and serious non-AIDS) were infrequent; reported in a total of 12 (4.1%) participants in the OT group and 23 (7.8%) in the PI-mono group (P = 0.08) over the entire follow-up period. Interpretation: A strategy of PI monotherapy, with regular VL monitoring and prompt reintroduction of combination treatment following rebound, preserved future treatment options. Findings confirm the high genetic barrier to resistance of the PI drug class that makes them well suited for creative, patient-centred, treatment-simplification approaches. The possibility of a small excess risk of serious clinical events with the PI monotherapy strategy cannot be excluded. Funding: The National Institute for Health Research Health Technology Assessment programme

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally