Theraplay for Attachment-Related Challenging Behaviour: A Case Series Approach

Childhood challenging behaviours is a common reason for referrals to child and adolescent mental health services. Challenging behaviours have been linked to various implications, including later mental health difficulties, risk-taking behaviours, and increased costs to society. Several risk factors are associated with challenging behaviours, including attachment insecurities. First line intervention for childhood challenging behaviours is Parent Training Programmes (PTP). PTP’s have a well-established and rigorous evidence-base demonstrating good effectiveness. Nonetheless, there are several limitations to PTPs including difficulties with engagement and attrition, alongside PTP’s locating the ‘problem’ within the parent. PTP’s are largely underpinned by behavioural and social learning theory and reportedly lack consideration into the parent-child relationship and attachment. Theraplay is an attachment and play-based therapeutic approach implemented in many services across the world despite there only being a limited evidence base. However, it has been found to be a promising approach for various presenting difficulties including challenging behaviours. Theraplay is hypothesised to create change in children’s internal working models by strengthening the overarching parent-child interactions based on four core concepts: Structure, Engagement, Challenge, and Nurture. Change is facilitated through sessions with the child, parent, and therapist using games based on the four concepts. Despite Theraplay’s world-wide use, the evidence-base is scarce and is lacking in design rigour. An increase in both the quantity and quality of research into Theraplay’s effectiveness, alongside if (and how) Theraplay works seems appropriate. The current study could be deemed a valuable contribution to the evidence base of an under-studied approach. The current study implemented a multiple case series design to investigate the effectiveness of Theraplay on challenging behaviour and parent-child attachment. The case series design allowed investigation into Theraplay’s key processes of change; a) Theraplay’s four core constructs, and b) child attachment. Three families participated in baseline, intervention, and follow-up phases. A mixed method approach of data collection and multiple forms of analyses was implemented. In light of COVID-19, the Theraplay interventions for two families were adapted and ended abruptly in line with service and governmental restrictions. Results found no evidence of Theraplay being effective at reducing childhood challenging behaviour and enhancing parent-child attachment. Gradual, yet positive, increases in Theraplay-based interactions and mechanisms of change were observed. However, the change in mechanisms had no effect on challenging behaviour or attachment. Findings may have been influenced by the measures used and the limited number of sessions implemented. Further research is warranted into Theraplay’s effectiveness. In particular, the use of a ‘gold standard’ attachment measure alongside intervention is recommended, with more understanding into the parental role as the potential mechanism of change within sessions required

A 1-acetamido derivative of 6-epi-valienamine: an inhibitor of a diverse group of β-N-acetylglucosaminidases

The synthesis of an analogue of 6-epi-valienamine bearing an acetamido group and its characterisation as an inhibitor of β-N-acetylglucosaminidases are described. The compound is a good inhibitor of both human O-GlcNAcase and human β-hexosaminidase, as well as two bacterial β-N-acetylglucosaminidases. A 3-D structure of the complex of Bacteroides thetaiotaomicron BtGH84 with the inhibitor shows the unsaturated ring is surprisingly distorted away from its favoured solution phase conformation and reveals potential for improved inhibitor potency

Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis

Introduction Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies. Methods We screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale. Results We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women. Pregnant women with SARS-CoV-2 infection—as compared with uninfected pregnant women—were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12). Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias. Conclusions This analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol

A conserved fungal glycosyltransferase facilitates pathogenesis of plants by enabling hyphal growth on solid surfaces

Article Authors Metrics Comments Related Content Abstract Author summary Introduction Results and discussion Conclusions Methods Supporting information Acknowledgments References Reader Comments (0) Media Coverage (0) Figures Abstract Pathogenic fungi must extend filamentous hyphae across solid surfaces to cause diseases of plants. However, the full inventory of genes which support this is incomplete and many may be currently concealed due to their essentiality for the hyphal growth form. During a random T-DNA mutagenesis screen performed on the pleomorphic wheat (Triticum aestivum) pathogen Zymoseptoria tritici, we acquired a mutant unable to extend hyphae specifically when on solid surfaces. In contrast “yeast-like” growth, and all other growth forms, were unaffected. The inability to extend surface hyphae resulted in a complete loss of virulence on plants. The affected gene encoded a predicted type 2 glycosyltransferase (ZtGT2). Analysis of >800 genomes from taxonomically diverse fungi highlighted a generally widespread, but discontinuous, distribution of ZtGT2 orthologues, and a complete absence of any similar proteins in non-filamentous ascomycete yeasts. Deletion mutants of the ZtGT2 orthologue in the taxonomically un-related fungus Fusarium graminearum were also severely impaired in hyphal growth and non-pathogenic on wheat ears. ZtGT2 expression increased during filamentous growth and electron microscopy on deletion mutants (ΔZtGT2) suggested the protein functions to maintain the outermost surface of the fungal cell wall. Despite this, adhesion to leaf surfaces was unaffected in ΔZtGT2 mutants and global RNAseq-based gene expression profiling highlighted that surface-sensing and protein secretion was also largely unaffected. However, ΔZtGT2 mutants constitutively overexpressed several transmembrane and secreted proteins, including an important LysM-domain chitin-binding virulence effector, Zt3LysM. ZtGT2 likely functions in the synthesis of a currently unknown, potentially minor but widespread, extracellular or outer cell wall polysaccharide which plays a key role in facilitating many interactions between plants and fungi by enabling hyphal growth on solid matrices

Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis.

INTRODUCTION Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies. METHODS We screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale. RESULTS We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.Pregnant women with SARS-CoV-2 infection-as compared with uninfected pregnant women-were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12).Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias. CONCLUSIONS This analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol

Turner syndrome and sexual differentiation of the brain: implications for understanding male-biased neurodevelopmental disorders

Turner syndrome (TS) is one of the most common sex chromosome abnormalities. Affected individuals often show a unique pattern of cognitive strengths and weaknesses and are at increased risk for a number of other neurodevelopmental conditions, many of which are more common in typical males than typical females (e.g., autism and attention-deficit hyperactivity disorder). This phenotype may reflect gonadal steroid deficiency, haploinsufficiency of X chromosome genes, failure to express parentally imprinted genes, and the uncovering of X chromosome mutations. Understanding the contribution of these different mechanisms to outcome has the potential to improve clinical care for individuals with TS and to better our understanding of the differential vulnerability to and expression of neurodevelopmental disorders in males and females. In this paper, we review what is currently known about cognition and brain development in individuals with TS, discuss underlying mechanisms and their relevance to understanding male-biased neurodevelopmental conditions, and suggest directions for future research

The effectiveness of Theraplay for children under 12 – a systematic literature review

Background Theraplay is a relationship‐focused model of treatment based on attachment theory involving both adult and child. The study aims to review the quality of Theraplay research and Theraplay’s effectiveness for children aged 12 years and under with a range of presenting difficulties, to inform future practice and identify areas for further research. Methods A systematic literature search was conducted using PsycINFO, CINAHL, MEDLINE and Web of Science. Quantitative studies using Theraplay only as a treatment for children aged 12 years and under with any presenting difficulty were identified. Additional manual searching was conducted, including eligible studies’ reference lists. Critical appraisal tools were used to provide a narrative synthesis of Theraplay’s effectiveness and research quality. Results Only six eligible articles were identified, meaning there was a lack of rigorous evidence eligible to offer conclusions into Theraplay’s effectiveness. The review highlighted the small evidence base, mixed quality research methodology and high levels of heterogeneity in how Theraplay is practiced and evaluated. Of the eligible studies, Theraplay was found promising in its effectiveness when used with internalising and externalising difficulties, dual diagnoses and developmental disabilities. Conclusions Theraplay is regularly practiced across the world; however, the evidence base of rigorous research to inform Theraplay’s effectiveness and mechanisms of change is lacking. Firm conclusions could not be offered, although Theraplay was shown to be promising intervention for some presentations. Further research into Theraplay’s effectiveness and key mechanisms of change are recommended to enhance the quality and depth of Theraplay literature

Pre-charge detention of terrorist suspects and the right to liberty and security

This thesis assesses the UK Terrorism Act 2000’s stop and search and pre-charge detention powers against liberty and security rights. It proposes that criminalizing ‘terrorism’, and legitimacy of counter-terrorism laws, depends on moral and legal norms defining legitimate sovereign power. External norms of territorial sovereignty and non-intervention define and legitimize external defensive actions by the state to protect nation state security. Individual liberty and security rights, specifically pursuant to article 9, ICCPR and article 5 ECHR, have a special moral and legal status externally, but are not universally determinative of sovereign legitimacy. The thesis argues that these external norms accommodate contrasting paradigms of internal legitimacy, the ‘security state’ and the ‘liberal state’. Conceptually, sovereign legitimacy in the former is grounded on heteronymous collective or ideological values, grounding fundamental obligations legitimizing ‘balancing’ of individual liberty and security against security of those ultimate norms. The ‘balancing metaphor’ and exceptionalist theories are conceptually located within the security state paradigm. Conversely, political and individual autonomy (liberty and security of the person) circumscribe legitimacy of liberal state action, grounding fundamental obligations to prevent and punish harms, and to refrain from violating individual autonomy unless justified by those obligations. Liberal rule of law standards, including due process rights, are legitimized by the instrumental role of law as the primary source of justification in the liberal state. Evaluating the policy justifications, enactment, and scope of the TA provisions against those norms, the thesis concludes they contradict liberal norms, violate international norms and individual legal rights to liberty and security, and undermine the rule of law and due process rights. The pre-emptive counter-terrorism policy, balancing national security against individual liberty, and degradation of due process rights, belies a security state approach

Safeguards in collective actions

There is a consensus in Europe that collective action mechanisms need to include correct safeguards in order to prevent abuse. This policy brief gives an overview of the main types of safeguards that are found in collective judicial procedures. It draws on extensive research into class action and collective redress laws across the world. Four consequences need to be understood in forming policy on collective actions:many safeguards involve economic aspects of litigation that are changing at national level. it appears to be almost impossible to select a set of safeguards that will guarantee that only meritorious cases will be brought and no abuse will occur. there is as yet insufficient empirical evidence to conclude that safeguards have worked in Europe in preventing abuse. there is a classic ‘catch-22’ situation - if safeguards are put in place that give adequate protection against abuse, the collective litigation procedure will itself not work in providing widespread access to justice. Accordingly, the alternative regulatory, negotiated, or alternative dispute resolution (ADR) solutions appear far more attractive as means of delivering collective redress