Attachment representations in mothers of young children with developmental delay: Relations with concurrent and later maternal depression

Despite the importance of early parent-child attachment and maternal depression to child development and the vulnerability of children with developmental delay, maternal attachment representations and their relation to depression have not been studied in this population. In this study, I examined attachment representations (i.e., internal working models) in 47 mothers of 4- to 8-year-old children with developmental delay and explored the relation between these attachment representations and maternal depression assessed concurrently and again one and two years later. The Working Model of the Child Interview (WMCI) was used to classify representations as balanced (i.e., secure) or non-balanced (i.e., disengaged or distorted) and the Center for Epidemiological Studies Depression (CES-D) Scale was used to assess maternal depression. Because both insecure attachment and maternal depression are associated with negative outcomes, the findings highlight the need for prevention and intervention strategies aimed at fostering secure attachment and alleviating depression

Characterization of the anti-leukemia stem cell activity of chaetocin

Chronic myelogenous leukemia is a myeloproliferative hematopoietic stem cell disease resulting from a reciprocal translocation that gives rise to BCR-ABL, a constitutively active tyrosine kinase. Imatinib and other tyrosine kinase inhibitors are currently standard therapy; however, point mutations often lead to drug resistance and disease relapse often occurs due to the persistence of quiescent leukemia stem cells that are shielded by stromal factors within the bone marrow microenvironment. In an effort to develop new therapies capable of eradicating these elusive cells, a novel approach has been proposed in which the biochemical properties of cancer cells are targeted. It has been established that one such property is oxidative stress due to the increased production of reactive oxygen species, which makes cancer cells especially dependent on their antioxidant systems to maintain redox homeostasis. Recent studies demonstrate that chaetocin, a mycotoxin produced by Chaetomium species fungi, possesses potent and specific antimyeloma activity due in part to its ability to inhibit thioredoxin reductase-1, a central oxidative stress remediation enzyme. In this study, the effectiveness of chaetocin against leukemia stem cells has been investigated using in vitro and in vivo murine chronic myelogenous leukemia models. Our results indicate that: chaetocin and imatinib function synergistically in decreasing cell viability, inducing apoptosis, and inhibiting the colony formation of chronic myelogenous leukemia cells in vitro; that chaetocin in combination with imatinib reduces leukemia stem cell frequency in vivo; that chaetocin increases intracellular reactive oxygen species levels; and that chaetocin does not disrupt the proliferation and differentiation of normal murine hematopoietic stem cells. Surprisingly, our results also show that while bone marrow stromal factors inhibit the activity of imatinib, they potentiate the activity of chaetocin, indicating that chaetocin could potentially be used to target leukemia stem cells within the bone marrow niche

Do exercisers maximize their pleasure by default? Using prompts to enhance the affective experience of exercise

Researchers and practitioners are increasingly recognizing the importance of maximizing pleasure during exercise in order to promote exercise behavior. Self-selected intensity exercise can increase pleasure during exercise, but it is not yet known whether participants maximize pleasure during self-selected intensity exercise by default. We hypothesized that prompting participants to maximize pleasure and enjoyment would result in more positive affective valence during (H1) and after (H2) exercise, greater remembered pleasure following exercise (H3), and greater enjoyment of exercise (H4). In this within-subjects experiment, 39 inactive adults completed two 10-min stationary cycling sessions at a self-selected intensity. During the experimental condition, participants were reminded (five times during the 10-min session) to maximize pleasure and enjoyment, and that they could change the intensity if they wanted. Affective valence, heart rate, and ratings of perceived exertion were measured every two minutes during exercise. Affective valence, enjoyment, and remembered pleasure were measured after each exercise session. The control condition was identical, except no prompts were provided. Each hypothesis was supported (p < .05). Prompting participants to maximize their pleasure and enjoyment resulted in increased pleasure as the exercise session progressed. After receiving prompts, participants also reported more positive post-exercise affective valence and rated the session as more pleasant and enjoyable. These results suggest that participants do not maximize pleasure and enjoyment by default (i.e., in the absence of reminders to do so). Researchers can build on these results to determine the mechanisms and whether prompting exercisers to maximize pleasure and enjoyment can promote exercise behavior

Multiple health behaviours among mothers and partners in England : clustering, social patterning and intra-couple concordance

Research on multiple health behaviours is increasing but little is known about parental behaviours and how they covary. Our study investigates cigarette smoking, alcohol intake, fruit and vegetable (F&V) consumption and physical activity among mothers and co-resident partners in England. Using the UK Household Longitudinal Study, we examined (i) clustering of health behaviours using observed-expected ratios and latent class analysis (ii) socio-demographic correlates of the derived latent classes and (iii) intra-couple concordance of individual health behaviours and their latent classes. We identified five latent classes for mothers and partners: Never smoked drinkers (28% of mothers; 29% of partners), Abstainers (25%; 17%), Drinkers and ex-smokers (19%; 26%), Unhealthy low frequency drinkers (18%; 16%) and Unhealthiest behaviour group (11%; 12%). These had distinctive social profiles. Never smoked drinkers were more likely than those in other groups to be white and socially advantaged: married, older, and with higher educational qualifications and incomes. Abstainers were non-smokers who never or occasionally drank, and were disproportionately drawn from ethnic minority groups and middle/lower income families. Drinkers and ex-smokers were the most physically active group and were more likely to be socially advantaged. Unhealthy low frequency drinkers were more likely to be disadvantaged and have a limiting long-standing illness. The Unhealthiest behaviour group had the highest proportion of smokers, heavy smokers and binge drinkers and the lowest F&V intake and physical activity levels. They were largely white and socially disadvantaged: younger, non-married and with lower educational levels. Mothers and their partners typically shared the same risk behaviours, and 44 per cent of partners and mothers belonged to the same latent class. Our findings point to the potential for a broadening of research and policy perspectives, from separate behaviours to combinations of behaviours, and from individuals to the domestic units and communities of which they are part

Prognostically controlled comparison of dialysis and renal transplantation

Prognostically controlled comparison of dialysis and renal transplantation. Because the comparison of survival in patients with renal failure treated by dialysis and transplantation may be biased by pretreatment prognostic differences in the patients who receive these two therapies, we quantified the pretreatment prognosis of all 430 dialysis and transplant patients who began therapy for end-stage renal disease at two hospitals from 1970 to 1980. Five pretreatment factors had a statistically significant adverse effect on survival: age, duration of diabetes, left ventricular failure, myocardial infarction, and other serious comorbid illness. Dialysis patients had a worse pretreatment prognosis than transplant patients did. When we controlled for these pretreatment differences, the actuarial 5-year patient survivals were 80% for dialysis (D), 79% for cadaver transplantation (CT), and 91% for living donor transplantation (LDT), (P = 0.9 for CT vs. D, and P = 0.05 for LDT vs. D). This similarity in survival with dialysis and cadaver transplantation was quite different from the results obtained when pretreatment prognosis was not controlled; the uncontrolled 5-year patient survivals were 43% for D, 77% for CT, and 89% for LDT (P < 0.001 for CT vs. D, and P < 0.001 for LDT vs. D). Our data suggest that the major factor determining differences in survival with dialysis and renal transplantation is not the relative efficacy of the two treatments but the pretreatment prognostic status of the patients chosen to receive them.Une comparaison contrôlée de façon pronostique entre la dialyse et la transplantation rénale. Puisque la comparaison de la survie des malades en insuffisance rénale traités par dialyse ou par transplantation peut être biaisée par des différences pronostiques pré-thérapeutiques entre les malades qui reçoivent ces deux traitements, nous avons quantifié le pronostic pré-thérapeutique de l'ensemble des 430 malades dialysés et transplantés qui ont commencé le traitement de leur insuffisance rénale dans deux hôpitaux de 1970 à 1980. Cinq facteurs préthérapeutiques possédaient un effet adverse statistiquement significatif sur la survie: l'âge, la durée du diabète, une insuffisance ventriculaire gauche, un infarctus du myocarde, et une autre maladie sérieuse associée. Les dialysés avaient un pronostic pré-thérapeutique plus mauvais que les transplantés. Lorsque nous avons contrôlé ces différences pré-thérapeutiques, la survie actuarielle à 5 ans des malades était de 80% pour la dialyse (D), 79% pour la transplantation cadavérique (CT), et 91% pour la transplantation avec donneur vivant (LDT) (P = 0,9 pour CT contre D, et P = 0,05 pour LDT contre D). Cette similitude de survie en dialyse ou après transplantation cadavérique était très différente des résultats obtenus lorsque le pronostic pré-thérapeutique n'était pas contrôlé; les survies non contrôlées à 5 ans des malades étaient de 43% pour D, 77% pour CT, et 89% pour LDT (P < 0,001 pour CT contre D, et P < 0,001 pour LDT contre D). Nos données suggèrent que le facteur principal déterminant les différences de survie en dialyse ou après transplantation rénale n'est pas l'efficacité relative des deux traitements, mais l'état pronostique pré-thérapeutique des malades choisis pour les recevoir

Naturalising Semiramide in 1842: Adaptation, Spectacle and English Prima Donnas

This thesis examines how Rossini’s Semiramide was adapted by T.H. Reynoldson for Covent Garden in 1842, where it was mounted for the first time in the English language, in a spectacular production. Semiramide was performed by Adelaide Kemble, a compelling actress who overturned what had been the dominant interpretation of the role, Giuditta Pasta’s, creating a new one that was vulnerable and womanly. Mary Shaw as Arsace had a refined simplicity and gave meaning to recitative in a way that was unknown in England. With their high standard, Kemble and Shaw were seen as English singers who could compete as equals with the fashionable foreign singers at Her Majesty’s Theatre. The transfer of Semiramide to Covent Garden resulted in an entanglement of English, Italian and other cultural values and operatic practices. The main purpose of this study is, through a close reading of newspapers, memoirs, letters and other contemporary documents, as well as existing iconography, to examine how the opera was ‘naturalised’ for Covent Garden; and to test how well Werner and Zimmermann’s model of histoire croisée and Homi Bhabha’s theories about ambivalence can be applied to this revival of Rossini’s opera. In so doing, it analyses the norms, prejudices and preoccupations of the interpretative communities of the adapters, singers and critics. I argue that the adaptation and spectacle tilted the opera towards the populist genres of melodrama and pantomime. I also propose that Kemble and Shaw’s performances represented a fusion of English and Italian singing. On a larger scale, this study shines a light on the values and performance practices in London theatres at the time and adds to the body of literature about operatic adaptations and staging, as well as prima donna cultur

The PROCESS study: a protocol to evaluate the implementation, mechanisms of effect and context of an intervention to enhance public health centres in Tororo, Uganda.

BACKGROUND: Despite significant investments into health improvement programmes in Uganda, health indicators and access to healthcare remain poor across the country. The PRIME trial aims to evaluate the impact of a complex intervention delivered in public health centres on health outcomes of children and management of malaria in rural Uganda. The intervention consists of four components: Health Centre Management; Fever Case Management; Patient- Centered Services; and support for supplies of malaria diagnostics and antimalarial drugs. METHODS: The PROCESS study will use mixed methods to evaluate the processes, mechanisms of change, and context of the PRIME intervention by addressing five objectives. First, to develop a comprehensive logic model of the intervention, articulating the project's hypothesised pathways to trial outcomes. Second, to evaluate the implementation of the intervention, including health worker training, health centre management tools, and the supply of artemether-lumefantrine (AL) and rapid diagnostic tests (RDTs) for malaria. Third, to understand mechanisms of change of the intervention components, including testing hypotheses and interpreting realities of the intervention, including resistance, in context. Fourth, to develop a contextual record over time of factors that may have affected implementation of the intervention, mechanisms of change, and trial outcomes, including factors at population, health centre and district levels. Fifth, to capture broader expected and unexpected impacts of the intervention and trial activities among community members, health centre workers, and private providers. Methods will include intervention logic mapping, questionnaires, recorded consultations, in-depth interviews, focus group discussions, and contextual data documentation. DISCUSSION: The findings of this PROCESS study will be interpreted alongside the PRIME trial results. This will enable a greater ability to generalise the findings of the main trial. The investigators will attempt to assess which methods are most informative in such evaluations of complex interventions in low-resource settings. TRIAL REGISTRATION: Clinicaltrials.gov, NCT01024426

'A smile is most important.' Why chains are not currently the answer to quality concerns in the Indian retail pharmacy sector.

Chain pharmacies are expanding in many low and middle-income countries (LMICs). Historically practices of independent pharmacies in these settings have been poor, and there is a need to understand how these new organisational arrangements are affecting the functioning of pharmacies, and the implications for public health. Drawing on economics literature, we develop a set of hypotheses as to how chains could address the quality failures that typify LMIC retail pharmacy markets, and explore these hypotheses using a set of 38 in-depth interviews, conducted in Bengaluru, India between 2014 and 2015. We look specifically at how being organised in a chain affects several key behaviours: employment of qualified staff; the ability of government authorities to focus regulation on central management structures; the propensity for firms to self-regulate; and the impact of the potentially lower-powered incentives faced by chain employees compared to independent owners. In practice, few differences were identified between chain and independent organisations in these areas. Not all chains were operating with a qualified pharmacist (akin to independent shops). Drug control authorities did not take advantage of the existing chain architecture to enforce regulation. Chains did heavily self-regulate but their focus was on customer service, rather than aspects of quality relevant to health outcomes. Additionally, widespread bribery in the sector was a barrier to effective drug control. Finally, the incentives faced by chain employees were not low-powered due to rewarding sales targets and pressure to increase sales. We observed that chains exerted strong influence over their staff but the potential to exploit this to improve quality of care is not currently being realised. A shift in focus from customer satisfaction to outcomes of public health concern is unlikely without either financial incentives or strengthened external regulation

Safety of service users with severe mental illness receiving inpatient care on medical and surgical wards: A systematic review

This review aimed to synthesize the evidence on the likelihood of harm and mortality on medical and surgical inpatient wards for people with severe mental illness (SMI). From 937 results identified through database searching, and a further 10 papers identified through citation searching and hand searching, 11 papers met the criteria for inclusion in the final review. This review did not find strong evidence for higher in‐hospital mortality in people with SMI. There was evidence that adverse events are higher in people with SMI. A higher likelihood of emergency instead of planned care, and poorer access to treatment were identified as potential contributing factors to these adverse events. In addition, service users with SMI were more likely to have a longer length of stay, associated with a higher cost of care. The severity of the mental illness increased the likelihood of harm or death, and people with schizophrenia were more likely than people with other mental illnesses to experience these adverse outcomes. There is evidence that people with SMI are provided with lower‐quality health care, whereas higher‐quality, better‐planned care is required to overcome the inequalities in access faced by this vulnerable population