Fine Motor Skills in Children With Prenatal Alcohol Exposure or Fetal Alcohol Spectrum Disorder

Objective: Prenatal alcohol exposure (PAE) can cause fetal alcohol spectrum disorders (FASD)and associated neurodevelopmental impairments. It is uncertain which types of fine motor skills are most likely to be affected after PAE or which assessment tools are most appropriate to use in FASD diagnostic assessments. This systematic review examined which types of fine motor skills are impaired in children with PAE or FASD; which fine motor assessments are appropriate for FASD diagnosis; and whether fine motor impairments are evident at both “low” and “high” PAE levels. Methods: A systematic review of relevant databases was undertaken using key terms. Relevant studies were extracted using a standardized form, and methodological quality was rated using a critical appraisal tool. Results: Twenty-four studies met inclusion criteria. Complex fine motor skills, such as visual-motor integration, were more frequently impaired than basic fine motor skills, such as grip strength. Assessment tools that specifically assessed fine motor skills more consistently identified impairments than those which assessed fine motor skills as part of a generalized neurodevelopmental assessment. Fine motor impairments were associated with “moderate” to “high” PAE levels. Few studies reported fine motor skills of children with “low” PAE levels, so the effect of lower PAE levels on fine motor skills remains uncertain. Conclusions: Comprehensive assessment of a range of fine motor skills in children with PAE is important to ensure an accurate FASD diagnosis and develop appropriate therapeutic interventions for children with PAE-related fine motor impairments

Turning to God in the Face of Ostracism: Effects of Social Exclusion on Religiousness

The present research proposes that individuals who are socially excluded can turn to religion to cope with the experience. Empirical studies conducted to test this hypothesis consistently found that socially excluded persons reported (a) significantly higher levels of religious affiliation (Studies 1, 2, and 4) and (b) stronger intentions to engage in religious behaviors (Study 2) than comparable, nonexcluded individuals. Direct support for the stress-buffering function of religiousness was also found, with a religious prime reducing the aggression-eliciting effects of consequent social rejection (Study 5). These effects were observed in both Christian and Muslim samples, revealing that turning to religion can be a powerful coping response when dealing with social rejection. Theoretical and practical implications of these findings are discussed

Environmental influences on the stable carbon isotopic composition of Devonian and Early Carboniferous land plants

Systematic analysis of the stable carbon isotopic composition of fossil land plants (δ13Cp) has the potential to offer new insights regarding paleoclimate variation and plant-environment interactions in early terrestrial ecosystems. δ13Cp was measured for 190 fossil plant specimens belonging to 10 genera of Early to Late Devonian age (Archaeopteris, Drepanophycus, Haskinsia, Leclercqia, Pertica, Psilophyton, Rhacophyton, Sawdonia, Tetraxylopteris, and Wattieza) and 2 genera of Early Carboniferous age (Genselia and Rhodeopteridium) collected from sites located mainly in the Appalachian Basin (22–30°S paleolatitude). For the full carbon-isotopic dataset (n = 309), δ13Cp ranges from −20.3‰ to −30.5‰ with a mean of −25.5‰, similar to values for modern C3 land plants. In addition to a secular trend, δ13Cp exhibits both intra- and intergeneric variation. Intrageneric variation is expressed as a small (mean 0.45‰) 13C-enrichment of leaves and spines relative to stems that may reflect differential compound-specific compositions. Intergeneric variation is expressed as a much larger (to ~5‰) spread in the mean δ13Cp values of coeval plant genera that was probably controlled by taxon-specific habitat preferences and local environmental humidity. Among Early Devonian taxa, Sawdonia yielded the most 13C-depleted values (−27.1 ± 1.7‰), reflecting lower water-use efficiency that was probably related to growth in wetter habitats, and Leclercqia, Haskinsia, and Psilophyton yielded the most 13C-enriched values (−23.0 ± 1.6‰, −22.3 ± 1.3‰, and −24.8 ± 1.6‰, respectively), reflecting higher water-use efficiency probably related to growth in drier habitats

Environmental influences on the stable carbon isotopic composition of Devonian and Early Carboniferous land plants

Systematic analysis of the stable carbon isotopic composition of fossil land plants (δ13Cp) has the potential to offer new insights regarding paleoclimate variation and plant-environment interactions in early terrestrial ecosystems. δ13Cp was measured for 190 fossil plant specimens belonging to 10 genera of Early to Late Devonian age (Archaeopteris, Drepanophycus, Haskinsia, Leclercqia, Pertica, Psilophyton, Rhacophyton, Sawdonia, Tetraxylopteris, and Wattieza) and 2 genera of Early Carboniferous age (Genselia and Rhodeopteridium) collected from sites located mainly in the Appalachian Basin (22–30°S paleolatitude). For the full carbon-isotopic dataset (n=309), δ13Cp ranges from −20.3‰ to −30.5‰ with a mean of −25.5‰, similar to values for modern C3 land plants. In addition to a secular trend, δ13Cp exhibits both intra- and intergeneric variation. Intrageneric variation is expressed as a small (mean 0.45‰) 13C-enrichment of leaves and spines relative to stems that may reflect differential compound-specific compositions. Intergeneric variation is expressed as a much larger (to ~5‰) spread in the mean δ13Cp values of coeval plant genera that was probably controlled by taxon-specific habitat preferences and local environmental humidity. Among Early Devonian taxa, Sawdonia yielded the most 13C-depleted values (−27.1 ± 1.7‰), reflecting lower water-use efficiency that was probably related to growth in wetter habitats, and Leclercqia, Haskinsia, and Psilophyton yielded the most 13C-enriched values (−23.0 ± 1.6‰, −22.3 ± 1.3‰, and −24.8 ± 1.6‰, respectively), reflecting higher water-use efficiency probably related to growth in drier habitats

Graphomotor skills in children with prenatal alcohol exposure and fetal alcohol spectrum disorder: A population-based study in remote Australia

Background/aim: Few studies have examined graphomotor skills in children with prenatal alcohol exposure (PAE) or fetal alcohol spectrum disorder (FASD). Methods: Graphomotor skills were assessed in 108 predominantly Australian Aboriginal children aged 7.5-9.6 years in remote Western Australia using clinical observations (pencil grasp; writing pressure) and standardised assessment tools (the Evaluation Tool of Children's Handwriting; and the Miller Function and Participation Scales - The Draw-a-Kid Game). Skills were compared between children (i) without PAE, (ii) PAE but not FASD and (iii) FASD. Results: Most children used a transitional pencil grasp and exerted heavy handwriting pressure (83.3% and 30.6% of the cohort). The percentage of letters (M = 62.9%) and words (M = 73.3%) written legibly was low. Children with FASD were more likely than children without PAE to use a cross-thumb grasp (P = 0.027), apply heavy writing pressure (P = 0.036), be unable to write a sentence (P = 0.041) and show poorer word legibility (P = 0.041). There were no significant differences between groups for drawing outcomes, although some children with FASD drew pictures that appeared delayed for their age. There were no significant differences between children without PAE and those with PAE but who were not diagnosed with FASD. Conclusions: Overall, graphomotor skills were poor in this cohort, but children with FASD performed significantly worse than children without PAE. Findings suggest the need for improved occupational therapy services for children in remote regions and evaluation of graphomotor skills in children with PAE. © 2016 Occupational Therapy Australia

Limitations of the MELD score in predicting mortality or need for removal from waiting list in patients awaiting liver transplantation

<p>Abstract</p> <p>Background</p> <p>Decompensated cirrhosis is associated with a poor prognosis and liver transplantation provides the only curative treatment option with excellent long-term results. The relative shortage of organ donors renders the allocation algorithms of organs essential. The optimal strategy based on scoring systems and/or waiting time is still under debate.</p> <p>Methods</p> <p>Data sets of 268 consecutive patients listed for single-organ liver transplantation for nonfulminant liver disease between 2003 and 2005 were included into the study. The Model for End-Stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP) scores of all patients at the time of listing were used for calculation. The predictive ability not only for mortality on the waiting list but also for the need for withdrawal from the waiting list was calculated for both scores. The Mann-Whitney-U Test was used for the univariate analysis and the AUC-Model for discrimination of the scores.</p> <p>Results</p> <p>In the univariate analysis comparing patients who are still on the waiting list and patients who died or were removed from the waiting list due to poor conditions, the serum albumin, bilirubin INR, and CTP and MELD scores as well as the presence of ascites and encephalopathy were significantly different between the groups (p < 0.05), whereas serum creatinine and urea showed no difference.</p> <p>Comparing the predictive abilities of CTP and MELD scores, the best discrimination between patients still alive on the waiting list and patients who died on or were removed from the waiting list was achieved at a CTP score of ≥9 and a MELD score of ≥14.4. The sensitivity and specificity to identify mortality or severe deterioration for CTP was 69.0% and 70.5%, respectively; for MELD, it was 62.1% and 72.7%, respectively. This result was supported by the AUC analysis showing a strong trend for superiority of CTP over MELD scores (AUROC 0.73 and 0.68, resp.; p = 0.091).</p> <p>Conclusion</p> <p>The long term prediction of mortality or removal from waiting list in patients awaiting liver transplantation might be better assessed by the CTP score than the MELD score. This might have implications for the development of new improved scoring systems.</p

Organic Reference Materials for Hydrogen, Carbon, and Nitrogen Stable Isotope-Ratio Measurements: Caffeines, n-Alkanes, Fatty Acid Methyl Esters, Glycines, L-Valines, Polyethylenes, and Oils

An international project developed, quality-tested, and determined isotope−δ values of 19 new organic reference materials (RMs) for hydrogen, carbon, and nitrogen stable isotope-ratio measurements, in addition to analyzing pre-existing RMs NBS 22 (oil), IAEA-CH-7 (polyethylene foil), and IAEA-600 (caffeine). These new RMs enable users to normalize measurements of samples to isotope−δ scales. The RMs span a range of δ^2H_(VSMOW-SLAP) values from −210.8 to +397.0 mUr or ‰, for δ^(13)C_(VPDB-LSVEC) from −40.81 to +0.49 mUr and for δ^(15)N_(Air) from −5.21 to +61.53 mUr. Many of the new RMs are amenable to gas and liquid chromatography. The RMs include triads of isotopically contrasting caffeines, C_(16) n-alkanes, n-C_(20)-fatty acid methyl esters (FAMEs), glycines, and L-valines, together with polyethylene powder and string, one n-C_(17)-FAME, a vacuum oil (NBS 22a) to replace NBS 22 oil, and a ^2H-enriched vacuum oil. A total of 11 laboratories from 7 countries used multiple analytical approaches and instrumentation for 2-point isotopic normalization against international primary measurement standards. The use of reference waters in silver tubes allowed direct normalization of δ2H values of organic materials against isotopic reference waters following the principle of identical treatment. Bayesian statistical analysis yielded the mean values reported here. New RMs are numbered from USGS61 through USGS78, in addition to NBS 22a. Because of exchangeable hydrogen, amino acid RMs currently are recommended only for carbon- and nitrogen-isotope measurements. Some amino acids contain ^(13)C and carbon-bound organic ^2H-enrichments at different molecular sites to provide RMs for potential site-specific isotopic analysis in future studies

Preoperative short-course radiotherapy versus combined radiochemotherapy in locally advanced rectal cancer: a multi-centre prospectively randomised study of the Berlin Cancer Society

BACKGROUND: The additional use of radiotherapy has changed the treatment of locally advanced rectal cancer (LARC) dramatically. But a major achievement has been the development of total mesorectal excision (TME) as a surgical standard and the recognition that the surgeon is the predominant prognostic factor. The benefit of preoperative hypofractionated radiotherapy (SCRT; five fractions each of 5 Gy), initially established by the Swedish Rectal Cancer Trial, has been demonstrated in conjunction with TME by the Dutch Colorectal Cancer Group. The concept of combined neoadjuvant radiochemotherapy (conventional radiation of about 50 Gy with chemotherapy) has not been compared over surgery alone with TME. However, the German Rectal Cancer Study Group recently demonstrated that preoperative radiochemotherapy (RCT) was better than postoperative radiochemotherapy in terms of local control. METHODS: Patients with histological proven rectal cancer staged T2N+ or T3 are randomized to receive either SCRT (25 Gy in five fractions of 5 Gy) plus TME-surgery within 5 days or RCT (50.4 Gy in 28 fractions of 1.8 Gy, continuous infusion 5-fluorouracil) plus TME-surgery 4-6 weeks later. All patients receive adjuvant chemotherapy (12 weeks continuous infusional 5-FU) and are followed up for 5 years. TME-quality is independently documented by the surgeon and the pathologist. Hypothesis of the study is that RCT is superior to SCRT in terms of local recurrence after five years. Secondary endpoints are overall survival, disease-free survival, complete resection rate (R0 resection), rate of sphincter saving resection, acute and late toxicity (radiation related side effects), and quality of life (including long term bowel function). DISCUSSION: Similar long-term survival, local control and late morbidity have been reported for both concepts of preoperative therapy in non-comparative studies. In addition to other ongoing (and recently published) comparative trials we include a larger number of patients for adequate power, apply quality-controlled TME and try to avoid the adjuvant treatment bias by mandatory adjuvant chemotherapy in both groups. Further more, stratification of the initially planned surgical procedure and sphincter-preservation will generate valid evidence whether RCT will allow a less aggressive (sphincter saving) surgical approach