Markers of Discourse Structure in Child-Directed Speech

Although the language we encounter is typically embedded in rich discourse contexts, existing models of sentence processing focus largely on phenomena that occur sentence internally. Here we analyze a video corpus of child-caregiver interactions with the aim of characterizing how discourse structure is reflected in child-directed speech and in children’s and caregivers ’ behavior. We use topic continuity as a measure of discourse structure, examining how caregivers introduce and discuss objects across sentences. We develop a variant on a Hidden Markov Model to identify coherent discourses, taking into account speakers ’ intended referent and the time delays between utterances. Using the discourses found by this model, we analyze how the lexical, syntactic, and social properties of caregiver-child interaction change over the course of a sequence of topically-related utterances. Our findings suggest that cues used to signal topicality in adult discourse are also available in child-directed speech and that children’s responses reflect joint attention in communication

Changing Midwifery: Working Conditions and the Quality of Care

Maternity units have been expected to achieve, within constrained resources, significant improvements in the quality and continuity of care as required by government policy. While significant advances have been made, these have been achieved by drawing upon the professionalism and vocational commitment of midwives, and at the expense of their working conditions and sense of wellbeing. While this approach has, in the short term, served the purpose of increasing midwifery output within existing resource constraints, the quality of care has suffered. The increasing problems of recruitment, retention, and falling morale within the profession suggest that it is not sustainable. In the longer term, if the improvements in care achieved thus far are to be sustained, there is a need to reform midwives' working conditions and working environment. This is not to imply that the answer to the ongoing dilemmas facing the maternity services lies solely in improvements in the pay levels or pay structure for midwives. The solution is also dependent on the extent to which midwives are afforded the enhanced status and autonomy recognised as necessary for the improvement of maternity services. Furthermore, strong representation of midwives, alongside improvements in management structures and systems of communication in NHS trusts, are necessary if midwives are to be enabled to participate in decision-making and thereby effectively contribute to improvements in the quality of care.

Unambiguous Deterrence: Ambiguity Attitudes in the Juvenile Justice System and the Case for a Right to Counsel During Intake Proceedings

According to the traditional rational choice theory of criminal behavior, people choose to commit crimes in a rational manner.\u27 They weigh the costs and benefits and make informed decisions to maximize their utility. Under this framework, the state can deter crime through two main avenues: increasing the probability of detection and increasing the punishment if caught, both of which increase the total cost of committing a crime. Recently, however, behavioral insights have begun to cast doubt on traditional rationality assumptions. Lab experiments and empirical studies using real-world data have shown that people exhibit bounded rationality. For example, individuals have limited cognitive capacities and use heuristics-mental shortcuts-to simplify complex decisions. A clear understanding about when and how these behavioral biases come into play can open up a new range of policy tools and help inform a more accurate model of criminal decisionmaking and deterrenc

Effects of Seat and Axle Position on Pain, Pathology, and Independence in Pediatric Manual Wheelchair Users with Spinal Cord Injury

Manual wheelchair (MWC) users with spinal cord injury (SCI) rely heavily on their upperextremities to complete daily occupations. Due to repetitive shoulder use during wheelchair mobility and propulsion, MWC users are at greater risk of shoulder pain and shoulder pathology, and thus decreased independence, and lower quality of life. The relative fit of the wheelchair and its parameters are critical and can further impact the user’s propulsion biomechanics. Parameters such as seat angle and axle position may put the user in detrimental shoulder positions for longer periods of time, impacting health outcomes even more. Although the effects of wheelchair setup on health outcomes have been explored in adult populations, little is known about the impact on pediatric MWC users, which is unfortunate because these children will live with the secondary medical conditions of an SCI longer than their adult counterparts. Limited research also exists on the wheelchair parameters currently being used by pediatric MWC users with SCI, and there are very few recommendations for wheelchair setup and fit specific to the pediatric population. This study aims to explore the seat and axle positions that are currently being used by pediatric MWC users with SCI, to identify the presence of shoulder pain and pathology in this population, and to determine if the relative fit of the pediatric wheelchair is related to pain, pathology, or independence scores in children with SCI. A total of 9 pediatric MWC users with SCI, ages 6-21, participated in this study. Three-dimension (3D) kinematics data were collected using 14-camera Vicon (Oxford Metric Group, Oxford, UK) Vantage and TS motion analysis systems. Shoulder pathologies were identified using diagnostic and quantitative ultrasound. Pain and independence outcomes were analyzed using the Wheelchair Users Shoulder Pain Index (WUSPI) and the Spinal Cord Independence Measure (SCIM). The mean seat angle used by the group was 5.16 degrees of elevation. Of the 9 participants, 7 used rearward axle positions in relation to their shoulders, while 2 used the adult recommended, forward axle position. Similarly, 4 of the participants followed the adult guideline to have an elbow flexion angle between 100-120 degrees, while 5 of the participants had their axles positioned non-optimally in the vertical direction according to adult guidelines. Shoulder pathologies were identified in 44% of the participants, and the average occupation ratio (percentage of the subacromial space occupied by the supraspinatus tendon) for the supraspinatus tendon was 69.62%. The average WUSPI score for the group was a 3.40 out of 150, and 4 of the 9 participants reported experiencing some level of shoulder pain on the assessment. The average SCIM score for all participants was a 67.13 out of 100, with age and time since injury strongly and significantly correlating with independence scores. After analyzing the data, a strong negative correlation between seat angle and occupation ratio was found. There was also a moderate correlation between the use of a non-optimal elbow angle and a higher WUSPI score. Finally, there was a strong positive correlation between seat angle and SCIM independence scores. Only weak correlations were found between horizontal axle positioning and the various outcomes, unlike the adult population. Results of this study will help to inform clinical decision-making when prescribing wheelchairs to children with SCI and when making wheelchair setup recommendations to pediatric MWC users and their families

Authors' response:clinical evaluation of the MPS 9000 macular pigment screener

As a research group with no commercial interest in any macular pigment optical density (MPOD) measurement devices or nutritional supplements, we feel that we were well-placed to carry out an independent clinical assessment of the reliability of the MPS 9000 (Tinsley Precision Instruments, Redhill, Surrey, UK). Our study was prompted by the fact that we could not find any reported coefficient of repeatability value within the literature, and none was provided by the manufacturer.1 We had planned to use this instrument in our own research studies investigating the impact of nutritional supplementation on MPOD. For this purpose, we needed

Apparent motion photometry:evaluation and reliability of a novel method for the measurement of macular pigment

Background/aims Macular pigment is thought to protect the macula against exposure to light and oxidative stress, both of which may play a role in the development of age-related macular degeneration. The aim was to clinically evaluate a novel cathode-ray-tube-based method for measurement of macular pigment optical density (MPOD) known as apparent motion photometry (AMP). Methods The authors took repeat readings of MPOD centrally (0°) and at 3° eccentricity for 76 healthy subjects (mean (±SD) 26.5±13.2 years, range 18–74 years). Results The overall mean MPOD for the cohort was 0.50±0.24 at 0°, and 0.28±0.20 at 3° eccentricity; these values were significantly different (t=-8.905, p<0.001). The coefficients of repeatability were 0.60 and 0.48 for the 0 and 3° measurements respectively. Conclusions The data suggest that when the same operator is taking repeated 0° AMP MPOD readings over time, only changes of more than 0.60 units can be classed as clinically significant. In other words, AMP is not suitable for monitoring changes in MPOD over time, as increases of this magnitude would not be expected, even in response to dietary modification or nutritional supplementation

Dietary analysis and patterns of nutritional supplement use in normal and age-related macular disease affected subjects: a prospective cross-sectional study

BACKGROUND: Poor diet is thought to be a risk factor for many diseases, including age-related macular disease (ARMD), which is the leading cause of blind registration in those aged over 60 years in the developed world. The aims of this study were 1) to evaluate the dietary food intake of three subject groups: participants under the age of 50 years without ARMD (U50), participants over the age of 50 years without ARMD (O50), and participants with ARMD (AMD), and 2) to obtain information on nutritional supplement usage. METHODS: A prospective cross-sectional study designed in a clinical practice setting. Seventy-four participants were divided into three groups: U50; 20 participants aged < 50 years, from 21 to 40 (mean ± SD, 37.7 ± 10.1 years), O50; 27 participants aged > 50 years, from 52 to 77 (62.7 ± 6.8 years), and ARMD; 27 participants aged > 50 years with ARMD, from 55 to 79 (66.0 ± 5.8 years). Participants were issued with a three-day food diary, and were also asked to provide details of any daily nutritional supplements. The diaries were analysed using FoodBase 2000 software. Data were input by one investigator and statistically analysed using Microsoft Excel for Microsoft Windows XP software, employing unpaired t-tests. RESULTS: Group O50 consumed significantly more vitamin C (t = 3.049, p = 0.005) and significantly more fibre (t = 2.107, p = 0.041) than group U50. Group ARMD consumed significantly more protein (t = 3.487, p = 0.001) and zinc (t = 2.252, p = 0.029) than group O50. The ARMD group consumed the highest percentage of specific ocular health supplements and the U50 group consumed the most multivitamins. CONCLUSIONS: We did not detect a deficiency of any specific nutrient in the diets of those with ARMD compared with age- and gender-matched controls. ARMD patients may be aware of research into use of nutritional supplementation to prevent progression of their condition

Possible contraindications and adverse reactions associated with the use of ocular nutritional supplements

The role of oxidation in the development of age-related eye disease has prompted interest in the use of nutritional supplementation for prevention of onset and progression. Our aim is to highlight possible contraindications and adverse reactions of isolated or high dose ocular nutritional supplements. Web of Science and PubMed database searches were carried out, followed by a manual search of the bibliographies of retrieved articles. Vitamin A should be avoided in women who may become pregnant, in those with liver disease, and in people who drink heavily. Relationships have been found between vitamin A and reduced bone mineral density, and beta-carotene and increased risk of lung cancer in smoking males. Vitamin E and Ginkgo biloba have anticoagulant and anti-platelet effects respectively, and high doses are contraindicated in those being treated for vascular disorders. Those patients with contraindications or who are considered at risk of adverse reactions should be advised to seek specialist dietary advice via their medical practitioner. © 2005 The College of Optometrists

Histone acetyltransferases:challenges in targeting bi-substrate enzymes

Histone acetyltransferases (HATs) are epigenetic enzymes that install acetyl groups onto lysine residues of cellular proteins such as histones, transcription factors, nuclear receptors, and enzymes. HATs have been shown to play a role in diseases ranging from cancer and inflammatory diseases to neurological disorders, both through acetylations of histone proteins and non-histone proteins. Several HAT inhibitors, like bi-substrate inhibitors, natural product derivatives, small molecules, and protein-protein interaction inhibitors, have been developed. Despite their potential, a large gap remains between the biological activity of inhibitors in in vitro studies and their potential use as therapeutic agents. To bridge this gap, new potent HAT inhibitors with improved properties need to be developed. However, several challenges have been encountered in the investigation of HATs and HAT inhibitors that hinder the development of new HAT inhibitors. HATs have been shown to function in complexes consisting of many proteins. These complexes play a role in the activity and target specificity of HATs, which limits the translation of in vitro to in vivo experiments. The current HAT inhibitors suffer from undesired properties like anti-oxidant activity, reactivity, instability, low potency, or lack of selectivity between HAT subtypes and other enzymes. A characteristic feature of HATs is that they are bi-substrate enzymes that catalyze reactions between two substrates: the cofactor acetyl coenzyme A (Ac-CoA) and a lysine-containing substrate. This has important-but frequently overlooked-consequences for the determination of the inhibitory potency of small molecule HAT inhibitors and the reproducibility of enzyme inhibition experiments. We envision that a careful characterization of molecular aspects of HATs and HAT inhibitors, such as the HAT catalytic mechanism and the enzyme kinetics of small molecule HAT inhibitors, will greatly improve the development of potent and selective HAT inhibitors and provide validated starting points for further development towards therapeutic agents.</p

Age-related macular degeneration and nutritional supplementation:a review of randomised controlled trials

Age-related macular degeneration (AMD) is the leading cause of severe vision loss in the developed world. The lack of effective treatment modalities, coupled with evidence supporting an oxidative pathogenesis, has increased interest in the potential preventative role of nutritional supplementation. This article reviews seven randomised controlled trials (RCTs) that have investigated the role of nutritional supplementation in AMD. Three of these trials reported a positive effect of nutritional supplementation on AMD; the Age-related eye study (AREDS), the Lutein Antioxidant Supplementation Trial (LAST), and the oral zinc trial by Newsome et al. (1988). However, the oral zinc trial by Newsome et al. (1988) was unlikely to detect any difference between treatments smaller than 72%, and the AREDS results were based on a subgroup of their study population. Lutein was considered for the AREDS formulation, but was not commercially available at that time. The findings of the LAST support a possible therapeutic role of lutein in AMD. © 2004 The College of Optometrists