Protocol for a systematic review: Interventions for anxiety in school-aged children with autism spectrum disorder (ASD): a mixed methods systematic review

This review aims to synthesise evidence about interventions to reduce anxiety symptoms in school-aged children with autism spectrum disorder (ASD). While clinical studies will not be excluded per se, this review seeks to move beyond interventions that are relevant only for clinical practice and care in clinical settings and prioritise studies that draw out implications for school-aged children that will help their functioning in real-world settings such as school and the home. To achieve this aim, the review will employ a mixed-methods systematic review which can accommodate the anticipated diverse types of available studies. These studies are likely to use quantitative methods such as quasi-experimental, mixed-methods randomised control trial approaches as well as qualitative methods such as action-research and case-study designs. This publication outlines the methodology which will be used in the systematic review and covers the criteria for inclusion and exclusion of studies in the review, the search strategy to be used for identification of relevant studies, the bibliographic databases and other sources used for searching, the data collection process including the selection process and data synthesis and analysis, and the timeframe for this project

I know your face but can’t remember your name:Age-related differences in the FNAME-12NL

OBJECTIVE: The Face-Name Associative Memory test (FNAME) has recently received attention as a test for early diagnosis of Alzheimer’s disease. So far, however, there has been no systematic investigation of the effects of aging. Here, we aimed to assess the extent to which the FNAME performance is modulated by normal ageing. METHOD: In a first step, we adapted the FNAME material to the Dutch population. In a second step, younger (n = 29) and older adults (n = 29) were compared on recall and recognition performance. RESULTS: Significant age effects on name recall were observed after the first exposure of new face-name pairs: younger adults remembered eight, whereas older adults remembered a mean of four out of twelve names. Although both age groups increased the number of recalled names with repeated face-name exposure, older adults did not catch up with the performance of the younger adults, and the age-effects remained stable. Despite of that, both age groups maintained their performance after a 30-min delay. Considering recognition, no age differences were demonstrated, and both age groups succeeded in the recognition of previously shown faces and names when presented along with distractors. CONCLUSIONS: This study presents for the first time the results of different age groups regarding cross-modal associative memory performance on the FNAME. The recall age effects support the hypothesis of age-related differences in associative memory. To use the FNAME as an early cognitive biomarker, further subscales are suggested to increase sensitivity and specificity in the clinical context

Modeling payback from research into the efficacy of left-ventricular assist devices as destination therapy

Objectives: Ongoing developments in design have improved the outlook for left-ventricular assist device (LVAD) implantation as a therapy in end-stage heart failure. Nevertheless, early cost-effectiveness assessments, based on first-generation devices, have not been encouraging. Against this background, we set out (i) to examine the survival benefit that LVADs would need to generate before they could be deemed cost-effective; (ii) to provide insight into the likelihood that this benefit will be achieved; and (iii) from the perspective of a healthcare provider, to assess the value of discovering the actual size of this benefit by means of a Bayesian value of information analysis. Methods: Cost-effectiveness assessments are made from the perspective of the healthcare provider, using current UK norms for the value of a quality-adjusted life-year (QALY). The treatment model is grounded in published analyses of the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial of first-generation LVADs, translated into a UK cost setting. The prospects for patient survival with second-generation devices is assessed using Bayesian prior distributions, elicited from a group of leading clinicians in the field. Results: Using established thresholds, cost-effectiveness probabilities under these priors are found to be low (.2 percent) for devices costing as much as £60,000. Sensitivity of the conclusions to both device cost and QALY valuation is examined. Conclusions: In the event that the price of the device in use would reduce to £40,000, the value of the survival information can readily justify investment in further trials

Diagnosing Autism Spectrum Disorder in community settings using the development and well-being assessment: validation in a UK population-based twin sample

Background: Increasing numbers of people are being referred for assessment for autism spectrum disorder (ASD). The NICE (UK) and the American Academy of Pediatrics recommend gathering a developmental history using a tool that operationalises ICD/DSM criteria. However the best-established diagnostic interview instruments are time-consuming, costly and rarely used outside national specialist centres. What is needed is a brief, cost-effective measure validated in community settings. We tested the Development and Well-Being Assessment (DAWBA) for diagnosing ASD in a sample of children/adolescents representative of those presenting in community mental health settings. Methods: A general population sample of twins (TEDS) was screened and 276 adolescents were selected as at low (CAST score<12; n=164) or high risk for ASD (CAST score≥15 and/or parent reported that ASD suspected/previously diagnosed; n=112). Parents completed the ASD module of the DAWBA interview by telephone or online. Families were visited at home: the ADI-R and ADOS were completed to allow a best-estimate diagnosis of ASD to be made. Results: DAWBA ASD symptom scores correlated highly with ADI-R algorithm scores (rho=.82, p<.001). Good sensitivity (0.88) and specificity (0.85) were achieved using DAWBA computerised algorithms. Clinician review of responses to DAWBA questions minimally changed sensitivity (0.86) and specificity (0.87). Positive (0.82-0.95) and negative (0.90) predictive values were high. Eighty-six percent of children were correctly classified. Performance was improved by using it in conjunction with the ADOS. Conclusions: The DAWBA is a brief structured interview that showed good sensitivity and specificity in this general population sample. It requires little training, is easy to administer (online or by interview), and diagnosis is aided by an algorithm. It holds promise as a tool for assisting with assessment in community settings and may help services implement the recommendations made by NICE and the American Academy of Pediatrics regarding diagnosis of young people on the autism spectru

The Power Laws of Violence against Women: Rescaling Research and Policies

BACKGROUND: Violence against Women -despite its perpetuation over centuries and its omnipresence at all social levels- entered into social consciousness and the general agenda of Social Sciences only recently, mainly thanks to feminist research, campaigns, and general social awareness. The present article analyzes in a secondary analysis of German prevalence data on Violence against Women, whether the frequency and severity of Violence against Women can be described with power laws. PRINCIPAL FINDINGS: Although the investigated distributions all resemble power-law distributions, a rigorous statistical analysis accepts this hypothesis at a significance level of 0.1 only for 1 of 5 cases of the tested frequency distributions and with some restrictions for the severity of physical violence. Lowering the significance level to 0.01 leads to the acceptance of the power-law hypothesis in 2 of the 5 tested frequency distributions and as well for the severity of domestic violence. The rejections might be mainly due to the noise in the data, with biases caused by self-reporting, errors through rounding, desirability response bias, and selection bias. CONCLUSION: Future victimological surveys should be designed explicitly to avoid these deficiencies in the data to be able to clearly answer the question whether Violence against Women follows a power-law pattern. This finding would not only have statistical implications for the processing and presentation of the data, but also groundbreaking consequences on the general understanding of Violence against Women and policy modeling, as the skewed nature of the underlying distributions makes evident that Violence against Women is a highly disparate and unequal social problem. This opens new questions for interdisciplinary research, regarding the interplay between environmental, experimental, and social factors on victimization

‘Wellness’ lifts us above the Food Chaos’: a narrative exploration of the experiences and conceptualisations of Orthorexia Nervosa through online social media forums

The increasing prevalence of eating disorders has motivated a burgeoning of research from narrative methods to illuminate the cultural and social aspects of disordered eating habits. A seemingly new eating disorder, Orthorexia Nervosa, has gained visibility through the internet sphere and popular media, though scholarly attention has been scarce. This study develops qualitative understandings of the fixation with ‘clean eating’ through narrative inquiry by employing an internet ethnographic approach. Data were analysed using a thematic narrative analysis, focusing on parallels and divergences across narratives presented online. This article presents 30 male and female voices, illustrating how these individuals understand their eating habits through narratives of pursuit, resistance and recovery, which are largely motivated by the desire for physical, emotional and social change. Crucially, this study illuminates a range of cultural elements enabling eating disorders in response to the transmission of cultural values online set within the broader context and processes of reflexive-modernisation

Engineered neural tissue for peripheral nerve repair

A new combination of tissue engineering techniques provides a simple and effective method for building aligned cellular biomaterials. Self-alignment of Schwann cells within a tethered type-1 collagen matrix, followed by removal of interstitial fluid produces a stable tissue-like biomaterial that recreates the aligned cellular and extracellular matrix architecture associated with nerve grafts. Sheets of this engineered neural tissue supported and directed neuronal growth in a co-culture model, and initial in vivo tests showed that a device containing rods of rolled-up sheets could support neuronal growth during rat sciatic nerve repair (5 mm gap). Further testing of this device for repair of a critical-sized 15 mm gap showed that, at 8 weeks, engineered neural tissue had supported robust neuronal regeneration across the gap. This is, therefore, a useful new approach for generating anisotropic engineered tissues, and it can be used with Schwann cells to fabricate artificial neural tissue for peripheral nerve repair

Survival Analysis of Patients with Heart Failure: Implications of Time-Varying Regression Effects in Modeling Mortality

Background: Several models have been designed to predict survival of patients with heart failure. These, while available and widely used for both stratifying and deciding upon different treatment options on the individual level, have several limitations. Specifically, some clinical variables that may influence prognosis may have an influence that change over time. Statistical models that include such characteristic may help in evaluating prognosis. The aim of the present study was to analyze and quantify the impact of modeling heart failure survival allowing for covariates with time-varying effects known to be independent predictors of overall mortality in this clinical setting. Methodology: Survival data from an inception cohort of five hundred patients diagnosed with heart failure functional class III and IV between 2002 and 2004 and followed-up to 2006 were analyzed by using the proportional hazards Cox model and variations of the Cox's model and also of the Aalen's additive model. Principal Findings: One-hundred and eighty eight (188) patients died during follow-up. For patients under study, age, serum sodium, hemoglobin, serum creatinine, and left ventricular ejection fraction were significantly associated with mortality. Evidence of time-varying effect was suggested for the last three. Both high hemoglobin and high LV ejection fraction were associated with a reduced risk of dying with a stronger initial effect. High creatinine, associated with an increased risk of dying, also presented an initial stronger effect. The impact of age and sodium were constant over time. Conclusions: The current study points to the importance of evaluating covariates with time-varying effects in heart failure models. The analysis performed suggests that variations of Cox and Aalen models constitute a valuable tool for identifying these variables. The implementation of covariates with time-varying effects into heart failure prognostication models may reduce bias and increase the specificity of such models.CNPq Brazilian Foundation for Scientific and Technological DevelopmentCNPq - Brazilian Foundation for Scientific and Technological Development [150653/2008-5

Host-Derived Smooth Muscle Cells Accumulate in Cardiac Allografts: Role of Inflammation and Monocyte Chemoattractant Protein 1

Transplant arteriosclerosis is characterized by inflammation and intimal thickening caused by accumulation of smooth muscle cells (SMCs) both from donor and recipient. We assessed the relationship between clinical factors and the presence of host-derived SMCs in 124 myocardial biopsies from 26 consecutive patients who received hearts from opposite-sex donors. Clinical and demographic information was obtained from the patients' medical records. Host-derived SMCs accounted for 3.35±2.3% of cells in arterioles (range, 0.08–12.51%). As shown by linear regression analysis, an increased number of SMCs was associated with rejection grade (mean, 1.41±1.03, p = 0.034) and the number of leukocytes (19.1±12.7 per 20 high-power fields, p = 0.01). The accumulation of host-derived SMCs was associated with an increased number of leukocytes in the allografts. In vitro, monocyte chemoattractant protein 1 (MCP-1) released from leukocytes was crucial for SMC migration. After heart allotransplantion, mice treated with MCP-1-specific antibodies had significantly fewer host-derived SMCs in the grafts than mice treated with isotypic antibody controls. We conclude that the number of host-derived SMCs in human cardiac allografts is associated with the rejection grade and that MCP-1 may play pivotal role in recruiting host-derived SMCs into cardiac allografts