The Good Behaviour Game intervention to improve behavioural and other outcomes for children aged 7–8 years: a cluster RCT

BackgroundUniversal, school-based behaviour management interventions can produce meaningful improvements in children’s behaviour and other outcomes. However, the UK evidence base for these remains limited.ObjectiveThe objective of this trial was to investigate the impact, value for money and longer-term outcomes of the Good Behaviour Game. Study hypotheses centred on immediate impact (hypothesis 1); subgroup effects (at-risk boys, hypothesis 2); implementation effects (dosage, hypothesis 3); maintenance/sleeper effects (12- and 24-month post-intervention follow-ups, hypothesis 4); the temporal association between mental health and academic attainment (hypothesis 5); and the health economic impact of the Good Behaviour Game (hypothesis 6).DesignThis was a two-group, parallel, cluster-randomised controlled trial. Primary schools (n = 77) were randomly assigned to implement the Good Behaviour Game for 2 years or continue their usual practice, after which there was a 2-year follow-up period.SettingThe trial was set in primary schools across 23 local authorities in England.ParticipantsParticipants were children (n = 3084) aged 7–8 years attending participating schools.InterventionThe Good Behaviour Game is a universal behaviour management intervention. Its core components are classroom rules, team membership, monitoring behaviour and positive reinforcement. It is played alongside a normal classroom activity for a set time, during which children work in teams to win the game to access the agreed rewards. The Good Behaviour Game is a manualised intervention delivered by teachers who receive initial training and ongoing coaching.Main outcome measuresThe measures were conduct problems (primary outcome; teacher-rated Strengths and Difficulties Questionnaire scores); emotional symptoms (teacher-rated Strengths and Difficulties Questionnaire scores); psychological well-being, peer and social support, bullying (i.e. social acceptance) and school environment (self-report Kidscreen survey results); and school absence and exclusion from school (measured using National Pupil Database records). Measures of academic attainment (reading, standardised tests), disruptive behaviour, concentration problems and prosocial behaviour (Teacher Observation of Child Adaptation Checklist scores) were also collected during the 2-year follow-up period.ResultsThere was no evidence that the Good Behaviour Game improved any outcomes (hypothesis 1). The only significant subgroup moderator effect identified was contrary to expectations: at-risk boys in Good Behaviour Game schools reported higher rates of bullying (hypothesis 2). The moderating effect of the amount of time spent playing the Good Behaviour Game was unclear; in the context of both moderate (≥ 1030 minutes over 2 years) and high (≥ 1348 minutes over 2 years) intervention compliance, there were significant reductions in children’s psychological well-being, but also significant reductions in their school absence (hypothesis 3). The only medium-term intervention effect was for peer and social support at 24 months, but this was in a negative direction (hypothesis 4). After disaggregating within- and between-individual effects, we found no temporal within-individual associations between children’s mental health and their academic attainment (hypothesis 5). Last, our cost–consequences analysis indicated that the Good Behaviour Game does not provide value for money (hypothesis 6).LimitationsLimitations included the post-test-only design for several secondary outcomes; suboptimal implementation dosage (mitigated by complier-average causal effect estimation); and moderate child-level attrition (18.5% for the primary outcome analysis), particularly in the post-trial follow-up period (mitigated by the use of full information maximum likelihood procedures).Future workQuestions remain regarding programme differentiation (e.g. how distinct is the Good Behaviour Game from existing behaviour management practices, and does this makes a difference in terms of its impact?) and if the Good Behaviour Game is impactful when combined with a complementary preventative intervention (as has been the case in several earlier trials).ConclusionThe Good Behaviour Game cannot be recommended based on the findings reported here

Review of Positron Emission Tomography at Royal Prince Alfred Hospital, CHERE Project Report No 18

This report is a review of the clinical uses, impacts on clinical management, clinical outcome and resource use of Positron Emission Tomography (PET) at Royal Prince Alfred Hospital (RPAH).Positron emission tomography

Comparison of Fas(Apo-1/CD95)- and perforin-mediated cytotoxicity in primary T lymphocytes

Cytolytic T lymphocytes kill target cells by two independent cytolytic mechanisms. One pathway depends on the polarized secretion of granule-stored proteins including perform and granzymes, causing target cell death through membrane and DNA damage. The second cytolytic effector system relies on the interaction of the Fas ligand (FasL) on the effector cell with its receptor (Fas) on the target cell, leading to apoptotic cell death. Using mixed lymphocyte culture (MLC)-derived primary T lymphocytes of perforin-knockout and gld (with non-functional FasL) mice, the molecular basis of the two killing mechanisms was compared. The activity of both pathways was dependent on extracellular Ca2+. Incubation of MLC-stimulated primary T cells with protein synthesis inhibitors prior to TCR triggering impaired FasL cell surface expression and abolished cytolytic activity, although the cells exhibited an intracellular pool of FasL. The perforin-dependent mechanism induced cell death more rapidly, although both pathways ultimately showed similar killing efficiencies. Both pathways induced comparable levels of DNA degradation, but Fas-induced membrane damage was less pronounced. We conclude that upon TCR triggering FasL may be recruited in part from pre-existing intracellular stores. However, efficient induction of target cell death still depends on the continuous biosynthesis of FasL molecule

Estimating the cost impact of dressing choice in the context of a mass burns casualty event

SUMMARY. Mass casualty burn events (MCBs) require intense and complex management. Silver-infused longer use dressingsmight help optimise management of burns in an MCB setting. We developed a model estimating the impact of dressing choice inthe context of an MCB. The model was developed in Excel in collaboration with experienced emergency response clinicians. Themodel compares use of silver-infused dressings with use of traditional dressings in patients with partial thickness burns covering30% of their body. Costs were estimated from a UK perspective as a proxy for a funded emergency response team and limitedto cost of dressings, bandages, padding, analgesia and staff time. Expected patient costs and resource use were summarised overan acute 2-week intervention period and extrapolated to estimate possible time savings in a hypothetical MCB. Per patient costswere estimated at £2,002 (silver) and £1,124 (traditional) (a daily additional spend of £63). Per patient staff time was estimatedat 864 minutes (silver) and 1,200 minutes (traditional) (a daily time saving of 24 minutes). Multiplying up to a possible MCBpopulation of 20 could result in a saving equivalent to 9 staff shifts over the 2-week intervention period. The model was sensitiveto type of silver dressing, frequency of dressing change and staff costs. We found increased costs through use of silver dressingsbut time savings that might help optimise burns management in an MCB. Exploring the balance between costs and staff timemight help future MCB response preparation.Keywords: mass casualty incident, burns, silver dressing, SSD, cost mode

Caracterización geomecánica del macizo rocoso presente en el bloque 5 del sinclinal la Jagua, La Jagua de Ibirico - Cesar

En este trabajo se analizaran las propiedades físicas, mecánicas y el comportamiento hidráulico del macizo rocoso presente en el sinclinal la jagua, siendo este asimétrico con un buzamiento de 5°-25° en su flanco oriental haciéndose mayor hacia el flanco occidental, alcanzando ángulos de hasta 53°. En esta estructura aflora el miembro medio de la formación los cuervos que contiene los mantos de carbón que son extraídos por la mina La Jagua. Las minas a cielo abierto son propensas a sufrir procesos geodinámicas como derrumbes, que pueden ser provocados ya sean por saturación, fallas geológicas o por la alteración de la matriz rocosa.Declaración: EL AUTOR-ESTUDIANTE, manifiesta que la obra objeto de la presente autorización es original y la realizó sin violar o usurpar derechos de autor de terceros, por lo tanto, la obra es de su exclusiva autoría y tiene la titularidad sobre la misma. PARÁGRAFO: en caso de presentarse cualquier reclamación o acción por parte de un tercero en cuanto a los derechos de autor sobre la obra en cuestión, EL ESTUDIANTE-AUTOR, asumirá toda la responsabilidad, y saldrá en defensa de los derechos aquí autorizados; para todos los efectos la Fundación Universitaria del Área Andina actúa como un tercero de buena fe

T-cell intracellular antigens in health and disease

T-cell intracellular antigen 1 (TIA1) and TIA1-related/like protein (TIAR/TIAL1) are 2 proteins discovered in 1991 as components of cytotoxic T lymphocyte granules. They act in the nucleus as regulators of transcription and pre-mRNA splicing. In the cytoplasm, TIA1 and TIAR regulate and/or modulate the location, stability and/or translation of mRNAs. As knowledge of the different genes regulated by these proteins and the cellular/biological programs in which they are involved increases, it is evident that these antigens are key players in human physiology and pathology. This review will discuss the latest developments in the field, with physiopathological relevance, that point to novel roles for these regulators in the molecular and cell biology of higher eukaryotes.Ministry Economic Affairs and Competitiveness through FEDER funds (BFU2008–00354, BFU2011–29653 and BFU2014–57735-R). The CBMSO receives an institutional grant from Fundación Ramón Areces.Peer Reviewe

Comparison of Fas(Apo-1/CD95)- and perforin-mediated cytotoxicity in primary T lymphocytes

Cytolytic T lymphocytes kill target cells by two independent cytolytic mechanisms. One pathway depends on the polarized secretion of granule-stored proteins including perforin and granzymes, causing target cell death through membrane and DNA damage. The second cytolytic effector system relies on the interaction of the Fas ligand (Fasl) on the effector cell with its receptor (Fas) on the target cell, leading to apoptotic cell death. Using mixed lymphocyte culture (MLC)-derived primary T lymphocytes of perforin-knockout and gld (with non-functional FasL) mice, the molecular basis of the two killing mechanisms was compared. The activity of both pathways was dependent on extracellular Ca2+. Incubation of MLC-stimulated primary T cells with protein synthesis inhibitors prior to TCR triggering impaired FasL cell surface expression and abolished cytolytic activity, although the cells exhibited an intracellular pool of FasL. The perforin-dependent mechanism induced cell death more rapidly, although both pathways ultimately showed similar killing efficiencies. Both pathways induced comparable levels of DNA degradation, but Fas-induced membrane damage was less pronounced. We conclude that upon TCR triggering FasL may be recruited in part from pre-existing intracellular stores. However, efficient induction of target cell death still depends on the continuous biosynthesis of FasL molecules

Cost effectiveness analysis of school based Mantoux screening for TB in Central Sydney, CHERE Discussion Paper No 37

A cost effectiveness analysis of differing school based TB infection screening regimes was conducted for 1996 populations of Year 1 and Year 8 students who attended schools in the areas of Central Sydney Area Health Service and South Western Sydney Area Health Service. The costs of screening would be partially offset by savings in future costs of treating adult cases of TB disease. Screening the high risk group of Year 8 students was found to be the most cost effective screening option. The cost per case prevented and the cost per death prevented were comparable with other health programs which are judged to be ?value for money?. Screening Year 1 students was found to be not as effective nor as cost effective. Universal screening would prevent more cases of adult TB disease than targeted screening but at a relatively high cost per case.TB, cost effectiveness, school based screening