Recommendations from a European Roundtable Meeting on Best Practice Healthy Infant Skin Care

Background European roundtable meeting recommendations on bathing and cleansing of infants were published in 2009; a second meeting was held to update and expand these recommendations in light of new evidence and the continued need to address uncertainty surrounding this aspect of routine care. Methods The previous roundtable recommendations concerning infant cleansing, bathing, and use of liquid cleansers were critically reviewed and updated and the quality of evidence was evaluated using the Grading of Recommendation Assessment, Development and Evaluation system. New recommendations were developed to provide guidance on diaper care and the use of emollients. A series of recommendations was formulated to characterize the attributes of ideal liquid cleansers, wipes, and emollients. Results Newborn bathing can be performed without harming the infant, provided basic safety procedures are followed. Water alone or appropriately designed liquid cleansers can be used during bathing without impairing the skin maturation process. The diaper area should be kept clean and dry; from birth, the diaper area may be gently cleansed with cotton balls/squares and water or by using appropriately designed wipes. Appropriately formulated emollients can be used to maintain and enhance skin barrier function. Appropriately formulated baby oils can be applied for physiologic (transitory) skin dryness and in small quantities to the bath. Baby products that are left on should be formulated to buffer and maintain babies’ skin surface at approximately pH 5.5, and the formulations and their constituent ingredients should have undergone an extensive program of safety testing. Formulations should be effectively preserved; products containing harsh surfactants, such as sodium lauryl sulfate, should be avoided. Conclusion Health care professionals can use these recommendations as the basis of their advice to parents

Clinical psychologists’ use of reflection and reflective practice within clinical work

Previous research regarding reflective practice has considered the training and development of reflective skills; little attention has been paid to how these are used by clinicians in practice. This study aims to understand how clinical psychologists experience reflection and reflective practice in their day-to-day clinical role. Six practicing clinical psychologists in Singapore were interviewed regarding their experiences. The interviews were analysed using Interpretative Phenomenological Analysis. Participants experienced reflection and reflective practice in many ways. Reflection helped the participants understand themselves better and how they personally impacted their work. Reflection helped in understanding and engaging with clients; it was particularly important for the development of the therapeutic relationship, and when cases felt ‘stuck’. Finally, reflection helped participants understand their professional role as clinicians, and maintain professional and ethical standards. Whilst participants valued reflection and could describe the mechanisms they used to reflect, they struggled to define reflective practice and their own process of reflection. In conclusion, participants were able to describe how using reflection and reflective practice within their clinical work benefited them and their clients. Further investigation into this area is required, particularly focusing on the challenging issue of developing a clearer definition of reflective practice

Histone gene replacement reveals a post-transcriptional role for H3K36 in maintaining metazoan transcriptome fidelity

Histone H3 lysine 36 methylation (H3K36me) is thought to participate in a host of co-transcriptional regulatory events. To study the function of this residue independent from the enzymes that modify it, we used a ‘histone replacement’ system in Drosophila to generate a non-modifiable H3K36 lysine-to-arginine (H3K36R) mutant. We observed global dysregulation of mRNA levels in H3K36R animals that correlates with the incidence of H3K36me3. Similar to previous studies, we found that mutation of H3K36 also resulted in H4 hyperacetylation. However, neither cryptic transcription initiation, nor alternative pre-mRNA splicing, contributed to the observed changes in expression, in contrast with previously reported roles for H3K36me. Interestingly, knockdown of the RNA surveillance nuclease, Xrn1, and members of the CCR4-Not deadenylase complex, restored mRNA levels for a class of downregulated, H3K36me3-rich genes. We propose a post-transcriptional role for modification of replication-dependent H3K36 in the control of metazoan gene expression

A randomised controlled trial comparing standard or intensive management of reduced fetal movements after 36 weeks gestation-a feasibility study

BACKGROUND: Women presenting with reduced fetal movements (RFM) in the third trimester are at increased risk of stillbirth or fetal growth restriction. These outcomes after RFM are related to smaller fetal size on ultrasound scan, oligohydramnios and lower human placental lactogen (hPL) in maternal serum. We performed this study to address whether a randomised controlled trial (RCT) of the management of RFM was feasible with regard to: i) maternal recruitment and retention ii) patient acceptability, iii) adherence to protocol. Additionally, we aimed to confirm the prevalence of poor perinatal outcomes defined as: stillbirth, birthweight <10(th) centile, umbilical arterial pH <7.1 or unexpected admission to the neonatal intensive care unit. METHODS: Women with RFM ≥36 weeks gestation were invited to participate in a RCT comparing standard management (ultrasound scan if indicated, induction of labour (IOL) based on consultant decision) with intensive management (ultrasound scan, maternal serum hPL, IOL if either result was abnormal). Anxiety was assessed by state-trait anxiety index (STAI) before and after investigations for RFM. Rates of protocol compliance and IOL for RFM were calculated. Participant views were assessed by questionnaires. RESULTS: 137 women were approached, 120 (88%) participated, 60 in each group, 2 women in the standard group did not complete the study. 20% of participants had a poor perinatal outcome. All women in the intensive group had ultrasound assessment of fetal size and liquor volume vs. 97% in the standard group. 50% of the intensive group had IOL for abnormal scan or low hPL after RFM vs. 26% of controls (p < 0.01). STAI reduced for all women after investigations, but this reduction was greater in the standard group (p = 0.02). Participants had positive views about their involvement in the study. CONCLUSION: An RCT of management of RFM is feasible with a low rate of attrition. Investigations decrease maternal anxiety. Participants in the intensive group were more likely to have IOL for RFM. Further work is required to determine the likely level of intervention in the standard care arm in multiple centres, to develop additional placental biomarkers and to confirm that the composite outcome is valid. TRIAL REGISTRATION: ISRCTN0794430

IL-2 Regulates Expression of C-MAF in Human CD4 T Cells

Blockade of IL-2R with humanized anti-CD25 Abs, such as daclizumab, inhibits Th2 responses in human T cells. Recent murine studies have shown that IL-2 also plays a significant role in regulating Th2 cell differentiation by activated STAT5. To explore the role of activated STAT5 in the Th2 differentiation of primary human T cells, we studied the mechanisms underlying IL-2 regulation of C-MAF expression. Chromatin immunoprecipitation studies revealed that IL-2 induced STAT5 binding to specific sites in the C-MAF promoter. These sites corresponded to regions enriched for markers of chromatin architectural features in both resting CD4 and differentiated Th2 cells. Unlike IL-6, IL-2 induced C-MAF expression in CD4 T cells with or without prior TCR stimulation. TCR-induced C-MAF expression was significantly inhibited by treatment with daclizumab or a JAK3 inhibitor, R333. Furthermore, IL-2 and IL-6 synergistically induced C-MAF expression in TCR-activated T cells, suggesting functional cooperation between these cytokines. Finally, both TCR-induced early IL4 mRNA expression and IL-4 cytokine expression in differentiated Th2 cells were significantly inhibited by IL-2R blockade. Thus, our findings demonstrate the importance of IL-2 in Th2 differentiation in human T cells and support the notion that IL-2R–directed therapies may have utility in the treatment of allergic disorders

Digital sculpting for historical representation: Neville tomb case study

Despite digital 3-D polygon modelling applications providing a common and powerful tool-set for archaeological, architectural and historical visualisation over recent years, the relatively recent developments in high-resolution sculpting software allow for the possibility to create digital outcomes with a degree of surface fidelity not previously obtainable from the more widely used poly-modelling software packages. Such digital sculpting applications are more commonly applied within the video games and TV/motion picture industries, the intention of this paper is to show how such tools and methodologies together with existing scanned data and some historical knowledge can remediate and re-imagine lost sculptural form. The intended research will focus on an examination and partial re-construction of the tomb of Sir John Neville, 3rd Baron Raby located at Durham Cathedral, County Durham UK

Inhomogeneous magnetization in dipolar ferromagnetic liquids

At high densities fluids of strongly dipolar spherical particles exhibit spontaneous long-ranged orientational order. Typically, due to demagnetization effects induced by the long range of the dipolar interactions, the magnetization structure is spatially inhomogeneous and depends on the shape of the sample. We determine this structure for a cubic sample by the free minimization of an appropriate microscopic density functional using simulated annealing. We find a vortex structure resembling four domains separated by four domain walls whose thickness increases proportional to the system size L. There are indications that for large L the whole configuration scales with the system size. Near the axis of the mainly planar vortex structure the direction of the magnetization escapes into the third dimension or, at higher temperatures, the absolute value of the magnetization is strongly reduced. Thus the orientational order is characterized by two point defects at the top and the bottom of the sample, respectively. The equilibrium structure in an external field and the transition to a homogeneous magnetization for strong fields are analyzed, too.Comment: 17 postscript figures included, submitted to Phys. Rev.