An investigation into the nature and content of spontaneous attributions and their relationship to feelings of self-efficacy and stress in parents of individuals with intellectual disabilities who exhibit self-injurious behaviour and research portfolio

OBJECTIVES: Although self injurious behaviour (SIB) is recognised as one of the most difficult management problems in people with intellectual disabilities (ID), the way that mothers attempt to make sense of the behaviour has been largely ignored. However, in parents of other groups of offspring, attributions and cognitions have been shown to predict maternal well-being and engagement in treatment. DESIGN: A mixed methods (quantitative & qualitative) design was employed. METHODS: Using Weiner's (1980) attributional model, 13 mothers were interviewed to examine the nature and content of their views about their offsprings' SIB, using semi-structured interviews and measures of parenting self-efficacy and stress. RESULTS: The findings suggested that mothers made a diverse and complex range of attributions that were consistent with attributional dimensions of locus of cause, stability and controllability. The nature of their attributions reflected their feelings of pessimism regarding the possibility of change and their often contradictory views about causes of SIB and consequent difficulties with interventions. CONCLUSIONS: Taking account of mothers' views will better enable professionals to provide adequate support to these families

Stimulation of the noradrenergic system enhances and blockade reduces memory for emotional material in man

Background. It is clearly established that emotional events tend to be remembered particularly vividly. The neurobiological substrates of this phenomenon are poorly understood. Recently, the noradrenergic system has been implicated in that beta blockade has been shown to reduce significantly the delayed recall of emotional material with matched neutral material being unaffected. Methods. In the present study, 36 healthy young adults were randomly allocated to receive either yohimbine, which stimulates central noradrenergic activity, metoprolol which blocks noradrenergic activity, or matched placebo. The three groups were well matched. All capsules were taken orally, prior to viewing a narrated 11 slide show described a boy being involved in an accident. Results. Yohimbine significantly elevated, and metoprolol reduced mean heart rate during the slide show relative to placebo, thus confirming the efficacy of the pharmacological manipulation. One week later, in a ‘surprise’ test, memory for the slide show was tested. As predicted, yohimbine-treated subjects recalled significantly more and metoprolol subjects fewer slides relative to placebo. This result was confirmed via analysis of multiple-choice recognition memory scores. Conclusions. We conclude that stimulation of the noradrenergic system results in the enhancement and blockade in a reduction of recall and recognition of emotional material in man

Evaluating the population impact of hepatitis C direct acting antiviral treatment as prevention for people who inject drugs (EPIToPe) – a natural experiment (protocol)

Hepatitis C virus (HCV) is the second largest contributor to liver disease in the UK, with injecting drug use as the main risk factor among the estimated 200 000 people currently infected. Despite effective prevention interventions, chronic HCV prevalence remains around 40% among people who inject drugs (PWID). New direct-acting antiviral (DAA) HCV therapies comine high cure rates (>90%) and short treatment duration (8 to 12 weeks). Theoretical mathematical modelling evidence suggests HCV treatment scale-up can prevent transmission and substantially reduce HCV prevalence/incidence among PWID. Our primary aim is to generate empirical evidence on the effectiveness of HCV ‘Treatment as Prevention’ (TasP) in PWID

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Chronicity of memory impairment in long-term out-of-hospital cardiac arrest survivors

As a result of out-of-hospital defibrillation initiatives, many cities have an increasing population of out-of-hospital cardiac arrest survivors. We previously identified that one third of these patients suffer memory problems in the months after resuscitation. The pattern of memory impairment (impaired recall memory and intact recognition memory) is suggestive of hippocampal damage. In this study we followed up ten subjects who had previously been found to have memory impairment after their cardiac arrest. To assess the chronicity of this memory impairment, we re-tested memory function approximately 3 years after the index events. These subjects were compared with age and sex matched control subjects with previous myocardial infarction and no cardiac arrest. Memory was assessed using the Rivermead Behavioural Memory test (RBMT). To further assess recall and recognition memory we used the Doors and People test (DPT), which is specifically designed to identify deficits in these functions. RBMT scores declined significantly in both groups compared with the original assessment 8 months after cardiac arrest, possibly an effect of ageing-control group: mean (S.D.) 22.2 (1.4)-18.4 (2.9); cardiac arrest group: 16.1 (2.7)-14.6 (4.4). The inter-group difference in RBMT score remained significant (P=0.001). DPT scores were poor in the cardiac arrest group (mean (S.D.) total 5.8 (2.8)), compared with the control group (10.8 (3.4)) who scored normally. Both recall and recognition memory were poor in the cardiac arrest group. We conclude that the memory deficits that we previously observed in cardiac arrest victims are persistent. Both recall and recognition memory are affected, implying that non-selective brain injury may be the mechanism