The design of a performance-based assessment tool to evaluate the emotional intelligence of children in middle childhood

no abstract availableTeacher EducationM.Ed. (Specialisation in Guidance and Counselling

Evaluation of endometrial thickness by transvaginal ultrasound and baseline risk factors as a predictor for endometrial abnormalities in postmenopausal women

Introduction/Purpose: To evaluate the endometrial thickness (ET) as a predictor of endometrial abnormalities in postmenopausal women and whether consideration of baseline risk factors increases diagnostic accuracy. Methods: This is a retrospective observational study of postmenopausal women presenting with bleeding or thickened endometrium (≥4 mm) on ultrasound, between 2003 and 2012. Risk factors for endometrial abnormality were analysed using logistic regression. Of 301 women, 220 were symptomatic and 81 were asymptomatic. The median ET was 6 mm (IQR 4–9) for symptomatic women and 9 mm (IQR 6–12) for asymptomatic women. Results: Abnormal pathology was found in 35 symptomatic (15.9%) and 6 asymptomatic women (7.4%). For each 1 mm increase in ET, the odds of an abnormal diagnosis increased by 16.3% (95% CI 9.6–23.5) for symptomatic and 19.9% (95% CI 3.1–39.3) for asymptomatic women. The Youden's index method identified an ET threshold of ≥7.1mm for symptomatic and ≥14.5mm for asymptomatic women. In symptomatic women the sensitivity was 88.6% (95% CI 72.3–96.3) and specificity 69.2% (95% CI 61.9–75.6), while in asymptomatic women the sensitivity was 50.0% (95% CI 13.9–86.1) and specificity was 89.3% (95% CI 79.5–95.0). The addition of age in the symptomatic women model reduced the sensitivity (82.9% (95% CI 65.7–92.8)) but increased the specificity (72.4% (95% CI 65.3–78.6)). Conclusion: ET is a significant predictor of abnormality. In the absence of risk factors, our study suggests that invasive procedures may be withheld until the ET is ≥7.1 mm with bleeding and ≥14.5 mm in asymptomatic women with no bleeding

A robust automated technique for operational calibration of ceilometers using the integrated backscatter from totally attenuating liquid clouds

A simple and robust method for calibrating ceilometers has been tested in an operational environment demonstrating that the calibrations are stable to better than ± 5 % over a period of a year. The method relies on using the integrated backscatter (B) from liquid clouds that totally extinguish the ceilometer signal; B is inversely proportional to the lidar ratio (S) of the backscatter to the extinction for cloud droplets. The calibration technique involves scaling the observed backscatter so that B matches the predicted value for S of 18.8 ± 0.8 sr for cloud droplets, at ceilometer wavelengths. For accurate calibration, care must be taken to exclude any profiles having targets with different values of S, such as drizzle drops and aerosol particles, profiles that do not totally extinguish the ceilometer signal, profiles with low cloud bases that saturate the receiver, and any profiles where the window transmission or the lidar pulse energy is low. A range dependent multiple scattering correction that depends on the ceilometer optics should be applied to the profile. A simple correction for water vapour attenuation for ceilometers operating at around 910 nm wavelength is applied to the signal using the vapour profiles from a forecast analysis. For a generic ceilometer in the UK the 90-day running mean of the calibration coefficient over a period of 20 months is constant to within 3 % with no detectable annual cycle, thus confirming the validity of the humidity and multiple scattering correction. For Gibraltar, where cloud cover is less prevalent than in the UK, the 90-day running mean calibration coefficient was constant to within 4 %. The more sensitive ceilometer model operating at 1064 nm is unaffected by water vapour attenuation but is more prone to saturation in liquid clouds. We show that reliable calibration is still possible, provided the clouds used are above a certain altitude. The threshold is instrument dependent but is typically around 2 km. We also identify a characteristic signature of saturation, and remove any profiles with this signature. Despite the more restricted sample of cloud profiles, a robust calibration is readily achieved, and, in the UK, the running mean 90-day calibration coefficients varied by about 4 % over a period of one year. The consistency of profiles observed by nine pairs of co-located ceilometers in the UK Met Office network operating at around 910 nm and 1064 nm provided independent validation of the calibration technique. EUMETNET is currently networking 700 European ceilometers so they can provide ceilometer profiles in near real time to European weather forecast centres and has adopted the cloud calibration technique described in this paper for ceilometers with a wavelength of around 910 nm

Differential impact of two risk communications on antipsychotic prescribing to people with dementia in Scotland: segmented regression time series analysis 2001-2011

The two risk communications were associated with reductions in antipsychotic use, in ways which were compatible with marked differences in their content and dissemination. Further research is needed to ensure that the content and dissemination of regulatory risk communications is optimal, and to track their impact on intended and unintended outcomes. Although rates are falling, antipsychotic prescribing in dementia in Scotland remains unacceptably hig

Evaluation of forward-modelled attenuated backscatter using an urban ceilometer network in London under clear-sky conditions

Numerical weather prediction (NWP) of urban aerosols is increasingly sophisticated and accurate. In the absence of large particles (e.g. rain, cloud droplets), information on atmospheric aerosols can be obtained from single wavelength automatic lidars and ceilometers (ALC) that measure profiles of attenuated backscatter (βo). To assess the suitability of ALC profile observations for forecast evaluation and data assimilation, a forward operator is required to convert model variables into the measured quantity. Here, an aerosol forward operator (aerFO) is developed and tested with Met Office NWP data (UKV 1.5 km) to obtain synthetic attenuated backscatter profiles (βm). aerFO requires as input the profiles of bulk aerosol mass mixing ratio and relative humidity to compute βm, plus air temperature and pressure to calculate the effect of water vapour absorption. Bulk aerosol characteristics (e.g. mean radius and number concentration) are used to estimate optical properties. ALC profile observations in London are used to assess βm. A wavelength-dependent extinction enhancement factor accounts for the change in optical properties due to aerosol swelling. Sensitivity studies show the aerFO unattenuated backscatter is very sensitive to the aerosol mass and relative humidity above ~60-80 %. The extinction efficiency is sensitive to the choice of aerosol constituents and to ALC wavelength.Given aerosol is a tracer for boundary layer dynamics, application of the aerFO has proven very useful to evaluate the performance of urban surface parameterisation schemes and their ability to drive growth of the mixing layer. Implications of changing the urban surface scheme within the UKV is explored using two spring cases. For the original scheme, morning βm is too high probably because of delayed vertical mixing. The new scheme reduced this persistence of high morning βm, demonstrating the importance of surface heating processes. Analysis of profiles at five sites on 12 clear-sky days shows a positive, statistically significant relation between the differences of modelled and measured near-surface attenuated backscatter [βm - βo] and near-surface aerosol mass. This suggests errors in near-surface attenuated backscatter can be attributed to errors in the amount of aerosol estimated by the NWP scheme. Correlation increases when cases of high relative humidity in the NWP model are excluded. Given the impact on aerosol optical properties demonstrated, results suggest the use of a fixed, bulk aerosol for urban areas in the UKV should be revisited and the lidar ratio should be constrained. As quality of the observed attenuated backscatter is demonstrated to be critical for performing model evaluation, careful sensor operation and data processing is vital to avoid false conclusions to be drawn about model performance

Estimation of the blood pressure response with exercise stress testing

Background: The blood pressure response to exercise has been described as a significant increase in systolic BP (sBP) with a smaller change in diastolic BP (dBP). This has been documented in small numbers, in healthy young men or in ethnic populations. This study examines these changes in low to intermediate risk of myocardial ischaemia in men and women over a wide age range. Methods: Consecutive patients having stress echocardiography were analysed. Ischaemic tests were excluded. Manual BP was estimated before and during standard Bruce protocol treadmill testing. Patient age, sex, body mass index (BMI), and resting and peak exercise BP were recorded. Results: 3200 patients (mean age 58 ± 12 years) were included with 1123 (35%) females, and 2077 males, age range 18 to 93 years. Systolic BP increased from 125 ± 17 mmHg to 176 ± 23 mmHg. The change in sBP (ΔsBP) was 51 mmHg (95% CI 51,52). The ΔdBP was 1 mmHg (95% CI 1, 1), from 77 to 78 mmHg, p < 0.001). The upper limit of normal peak exercise sBP (determined by the 90th percentile) was 210 mmHg in males and 200 mmHg in females. The upper limit of normal ΔsBP was 80 mmHg in males and 70 mmHg in females. The lower limit of normal ΔsBP was 30 mmHg in males and 20 mmHg in females. Conclusions: In this large cohort, sBP increased significantly with exercise. Males had on average higher values than females. Similar changes were seen with the ΔsBP. The upper limit of normal for peak exercise sBP and ΔsBP are reported by age and gender

An Intron 7 Polymorphism in APP Affects the Age of Onset of Dementia in Down Syndrome

People with Down syndrome (DS) develop Alzheimer's disease (AD) with an early age of onset. A tetranucleotide repeat, attt5−8, in intron 7 of the amyloid precursor protein has been associated with the age of onset of AD in DS in a preliminary study. The authors examine the impact of this polymorphism in a larger cohort of individuals with DS. Adults with DS were genotyped for attt5−8 and APOE. The results were analysed with respect to the age of onset of dementia. The presence of three copies of the six-repeat allele resulted in onset of dementia seven years earlier than in the presence of other genotypes. Further study is essential to elucidate the mechanism by which this polymorphism functions, with an exciting opportunity to identify novel treatment targets relevant for people with DS and AD

Minocycline 200 mg or 400 mg versus placebo for mild Alzheimer's disease: the MADE Phase II, three-arm RCT

Background: Minocycline is an anti-inflammatory drug and protects against the toxic effects of β-amyloid in vitro and in animal models of Alzheimer’s disease. To the best of our knowledge, no randomised placebo-controlled clinical trials in patients with Alzheimer’s disease looking at the efficacy and tolerability of minocycline have been carried out. Objectives: The trial investigated whether or not minocycline was superior to placebo in slowing down the rate of decline in cognitive and functional ability over 2 years. The safety and tolerability of minocycline were also assessed. Design: A Phase II, three-arm, randomised, double-blind, multicentre trial with a semifactorial design. Participants continued on trial treatment for up to 24 months. Setting: Patients were identified from memory services, both within the 32 participating NHS trusts and within the network of memory services supported by the Dementias and Neurodegenerative Diseases Research Network (also known as DeNDRoN). Participants: Patients with standardised Mini Mental State Examination scores of > 23 points and with Alzheimer’s disease assessed by the National Institute on Aging–Alzheimer’s Association’s criteria were identified from memory services. Intervention: Patients with mild Alzheimer’s disease were randomly allocated 1 : 1 : 1 to receive one of three treatments: arm 1 – 400 mg per day of minocycline; arm 2 – 200 mg per day of minocycline; or arm 3 – placebo. Patients continued treatment for 24 months. Participants, investigators and outcome assessors were blind to treatment allocation. Main outcome measures: Primary outcome measures were decline in standardised Mini Mental State Examination and Bristol Activities of Daily Living Scale scores of combined minocycline treatment arms versus placebo, as analysed by intention-to-treat repeated measures regression. Results: Between 23 May 2014 and 14 April 2016, 554 participants were randomised. Of the 544 eligible participants, the mean age was 74.3 years and the average standardised Mini Mental State Examination score was 26.4 points. A total of 252 serious adverse events were reported, with the most common categories being neuropsychiatric and cardiocirculatory. Significantly fewer participants completed treatment with 400 mg of minocycline [29% (53/184)] than 200 mg [62% (112/181)] or placebo [64% (114/179)] (p < 0.0001), mainly because of gastrointestinal symptoms (p = 0.0008), dermatological side effects (p = 0.02) and dizziness (p = 0.01). Assessment rates were also lower in the 400-mg treatment arm: 68% (119 of 174 expected) for standardised Mini Mental State Examination scores at 24 months, compared with 82% (144/176) for the 200-mg treatment arm and 84% (140/167) for the placebo arm. Decline in standardised Mini Mental State Examination scores over the 24-month study period in the combined minocycline arms was similar to that in the placebo arm (4.1- vs. 4.3-point reduction; p = 0.9), as was the decline in the 400- and 200-mg treatment arms (3.3 vs. 4.7 points; p = 0.08). Likewise, worsening of Bristol Activities of Daily Living Scale scores over 24 months was similar in all trial arms (5.7, 6.6 and 6.2 points in the 400-mg treatment arm, 200-mg treatment arm and placebo arm, respectively; a p-value of 0.57 for minocycline vs. placebo and a p-value of 0.77 for 400 vs. 200 mg of minocycline). Results were similar in different patient subgroups and in sensitivity analyses adjusting for missing data. Limitations: Potential limitations of the study include that biomarkers were not used to confirm the diagnosis of Alzheimer’s disease, as these and apolipoprotein E (APOE) genotyping are not routinely available within the NHS. Compliance was also worse than expected and differential follow-up rates were observed, with fewer assessments obtained for the 400-mg treatment arm than for the 200-mg treatment and placebo arms. Conclusions: Minocycline does not delay the progress of cognitive or functional impairment in people with mild Alzheimer’s disease over a 2-year period. Minocycline at a dose of 400 mg is poorly tolerated in this population. Future work: The Minocycline in mild Alzheimer’s DiseasE (MADE) study provides a framework for a streamlined trial design that can be usefully applied to test other disease-modifying therapies

Factors that Influence Enrollment in Syringe Services Programs in Rural Areas: A Qualitative Study among Program Clients in Appalachian Kentucky

BACKGROUND: Enrolling sufficient number of people who inject drugs (PWID) into syringe services programs (SSP) is important to curtail outbreaks of drug-related harms. Still, little is known about barriers and facilitators to SSP enrollment in rural areas with no history of such programs. This study\u27s purpose was to develop a grounded theory of the role of the risk environment and individual characteristics of PWID in shaping SSP enrollment in rural Kentucky. METHODS: We conducted one-on-one semi-structured interviews with 41 clients of 5 SSPs that were established in rural counties in Appalachian Kentucky in 2017-2018. Interviews covered PWID needs, the process of becoming aware of SSPs, and barriers and facilitators to SSP enrollment. Applying constructivist grounded theory methods and guided by the Intersectional Risk Environment Framework (IREF), we applied open, axial and selective coding to develop the grounded theory. RESULTS: Stigma, a feature of IREF\u27s meso-level social domain, is the main factor hampering SSP enrollment. PWID hesitated to visit SSPs because of internalized stigma and because of anticipated stigma from police, friends, family and healthcare providers. Fear of stigma was often mitigated or amplified by a constellation of meso-level environmental factors related to healthcare (e.g., SSPs) and social (PWID networks) domains and by PWID\u27s individual characteristics. SSPs mitigated stigma as a barrier to enrollment by providing low threshold services in a friendly atmosphere, and by offering their clients program IDs to protect them from paraphernalia charges. SSP clients spread positive information about the program within PWID networks and helped their hesitant peers to enroll by accompanying them to SSPs. Individual characteristics, including child custody, employment or high social status, made certain PWID more susceptible to drug-related stigma and hence more likely to delay SSP enrollment. CONCLUSIONS: Features of the social and healthcare environments operating at the meso-level, as well as PWID\u27s individual characteristics, appear to enhance or mitigate the effect of stigma as a barrier to SSP enrollment. SSPs opening in locations with high stigma against PWID need to ensure low threshold and friendly services, protect their clients from police and mobilize PWID networks to promote enrollment