Only connect: addressing the emotional needs of Scotland's children and young people

A report on the SNAP (Scottish Needs Assessment Programme) Child and Adolescent Mental Health Phase Two survey. It describes a survey of a wide range of professionals working with children and young people in Scotland, and deals with professional perspectives on emotional, behavioural and psychological problems. Conclusions and recommendations are presented

To add or not to add a new treatment arm to a multiarm study: A decision-theoretic framework.

Multiarm clinical trials, which compare several experimental treatments against control, are frequently recommended due to their efficiency gain. In practise, all potential treatments may not be ready to be tested in a phase II/III trial at the same time. It has become appealing to allow new treatment arms to be added into on-going clinical trials using a "platform" trial approach. To the best of our knowledge, many aspects of when to add arms to an existing trial have not been explored in the literature. Most works on adding arm(s) assume that a new arm is opened whenever a new treatment becomes available. This strategy may prolong the overall duration of a study or cause reduction in marginal power for each hypothesis if the adaptation is not well accommodated. Within a two-stage trial setting, we propose a decision-theoretic framework to investigate when to add or not to add a new treatment arm based on the observed stage one treatment responses. To account for different prospect of multiarm studies, we define utility in two different ways; one for a trial that aims to maximise the number of rejected hypotheses; the other for a trial that would declare a success when at least one hypothesis is rejected from the study. Our framework shows that it is not always optimal to add a new treatment arm to an existing trial. We illustrate a case study by considering a completed trial on knee osteoarthritis

Classroom based cognitive behavioural therapy in reducing symptoms of depression in high risk adolescents: Pragmatic cluster randomised controlled trial

Copyright © 2012 by the BMJ Publishing Group Ltd. This articles was first published in: BMJ, 2012, Vol. 345, Issue 7878Objective To compare the effectiveness of classroom based cognitive behavioural therapy with attention control and usual school provision for adolescents at high risk of depression. Design Three arm parallel cluster randomised controlled trial. Setting Eight UK secondary schools. Participants Adolescents (n=5030) aged 12-16 years in school year groups 8-11. Year groups were randomly assigned on a 1:1:1 ratio to cognitive behavioural therapy, attention control, or usual school provision. Allocation was balanced by school, year, number of students and classes, frequency of lessons, and timetabling. Participants were not blinded to treatment allocation. Interventions Cognitive behavioural therapy, attention control, and usual school provision provided in classes to all eligible participants. Main outcome measures Outcomes were collected by self completed questionnaire administered by researchers. The primary outcome was symptoms of depression assessed at 12 months by the short mood and feelings questionnaire among those identified at baseline as being at high risk of depression. Secondary outcomes included negative thinking, self worth, and anxiety. Analyses were undertaken on an intention to treat basis and accounted for the clustered nature of the design. Results 1064 (21.2%) adolescents were identified at high risk of depression: 392 in the classroom based cognitive behavioural therapy arm, 374 in the attention control arm, and 298 in the usual school provision arm. At 12 months adjusted mean scores on the short mood and feelings questionnaire did not differ for cognitive behavioural therapy versus attention control (−0.63, 95% confidence interval −1.85 to 0.58, P=0.41) or for cognitive behavioural therapy versus usual school provision (0.97, −0.20 to 2.15, P=0.12). Conclusion In adolescents with depressive symptoms, outcomes were similar for attention control, usual school provision, and cognitive behavioural therapy. Classroom based cognitive behavioural therapy programmes may result in increased self awareness and reporting of depressive symptoms but should not be undertaken without further evaluation and research. Trial registration Current Controlled Trials ISRCTN19083628

Parent and child agreement for acute stress disorder, post-traumatic stress disorder and other psychopathology in a prospective study of children and adolescents exposed to single-event trauma

Examining parent-child agreement for Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) in children and adolescents is essential for informing the assessment of trauma-exposed children, yet no studies have examined this relationship using appropriate statistical techniques. Parent-child agreement for these disorders was examined by structured interview in a prospective study of assault and motor vehicle accident (MVA) child survivors, assessed at 2-4 weeks and 6 months post-trauma. Children were significantly more likely to meet criteria for ASD, as well as other ASD and PTSD symptom clusters, based on their own report than on their parent's report. Parent-child agreement for ASD was poor (Cohen's κ = -.04), but fair for PTSD (Cohen's κ = .21). Agreement ranged widely for other emotional disorders (Cohen's κ = -.07-.64), with generalised anxiety disorder found to have superior parent-child agreement (when assessed by phi coefficients) relative to ASD and PTSD. The findings support the need to directly interview children and adolescents, particularly for the early screening of posttraumatic stress, and suggest that other anxiety disorders may have a clearer presentation post-trauma

Entire functions with Julia sets of positive measure

Let f be a transcendental entire function for which the set of critical and asymptotic values is bounded. The Denjoy-Carleman-Ahlfors theorem implies that if the set of all z for which |f(z)|>R has N components for some R>0, then the order of f is at least N/2. More precisely, we have log log M(r,f) > (N/2) log r - O(1), where M(r,f) denotes the maximum modulus of f. We show that if f does not grow much faster than this, then the escaping set and the Julia set of f have positive Lebesgue measure. However, as soon as the order of f exceeds N/2, this need not be true. The proof requires a sharpened form of an estimate of Tsuji related to the Denjoy-Carleman-Ahlfors theorem.Comment: 17 page

Three-Dimensional Human iPSC-Derived Artificial Skeletal Muscles Model Muscular Dystrophies and Enable Multilineage Tissue Engineering

Summary: Generating human skeletal muscle models is instrumental for investigating muscle pathology and therapy. Here, we report the generation of three-dimensional (3D) artificial skeletal muscle tissue from human pluripotent stem cells, including induced pluripotent stem cells (iPSCs) from patients with Duchenne, limb-girdle, and congenital muscular dystrophies. 3D skeletal myogenic differentiation of pluripotent cells was induced within hydrogels under tension to provide myofiber alignment. Artificial muscles recapitulated characteristics of human skeletal muscle tissue and could be implanted into immunodeficient mice. Pathological cellular hallmarks of incurable forms of severe muscular dystrophy could be modeled with high fidelity using this 3D platform. Finally, we show generation of fully human iPSC-derived, complex, multilineage muscle models containing key isogenic cellular constituents of skeletal muscle, including vascular endothelial cells, pericytes, and motor neurons. These results lay the foundation for a human skeletal muscle organoid-like platform for disease modeling, regenerative medicine, and therapy development. : Maffioletti et al. generate human 3D artificial skeletal muscles from healthy donors and patient-specific pluripotent stem cells. These human artificial muscles accurately model severe genetic muscle diseases. They can be engineered to include other cell types present in skeletal muscle, such as vascular cells and motor neurons. Keywords: skeletal muscle, pluripotent stem cells, iPS cells, myogenic differentiation, tissue engineering, disease modeling, muscular dystrophy, organoid

Cassini observations of ion and electron beams at Saturn and their relationship to infrared auroral arcs

We present Cassini Visual and Infrared Mapping Spectrometer observations of infrared auroral emissions from the noon sector of Saturn's ionosphere revealing multiple intense auroral arcs separated by dark regions poleward of the main oval. The arcs are interpreted as the ionospheric signatures of bursts of reconnection occurring at the dayside magnetopause. The auroral arcs were associated with upward field-aligned currents, the magnetic signatures of which were detected by Cassini at high planetary latitudes. Magnetic field and particle observations in the adjacent downward current regions showed upward bursts of 100–360 keV light ions in addition to energetic (hundreds of keV) electrons, which may have been scattered from upward accelerated beams carrying the downward currents. Broadband, upward propagating whistler waves were detected simultaneously with the ion beams. The acceleration of the light ions from low altitudes is attributed to wave-particle interactions in the downward current regions. Energetic (600 keV) oxygen ions were also detected, suggesting the presence of ambient oxygen at altitudes within the acceleration region. These simultaneous in situ and remote observations reveal the highly energetic magnetospheric dynamics driving some of Saturn's unusual auroral features. This is the first in situ identification of transient reconnection events at regions magnetically conjugate to Saturn's magnetopause

The initiation and development of metamorphic foliation in the Otago Schist, Part 2: evidence from quartz grain-shape data

Shape, size and orientation measurements of quartz grains sampled along two transects that cross zones of increasing metamorphic grade in the Otago Schist, New Zealand, reveal the role of quartz in the progressive development of metamorphic foliation. Sedimentary compaction and diagenesis contributed little to the formation of a shape-preferred orientation (SPO) within the analysed samples. Metamorphic foliation was initiated at sub-greenschist facies conditions as part of a composite S1-bedding structure parallel to the axial planes of tight to isoclinal F1 folds. An important component of this foliation is a pronounced quartz SPO that formed dominantly by the effect of dissolution?precipitation creep on detrital grains in association with F1 strain. With increasing grade, the following trends are evident from the SPO data: (i) a progressive increase in the aspect ratio of grains in sections parallel to lineation, and the development of blade-shaped grains; (ii) the early development of a strong shape preferred orientation so that blade lengths define the linear aspect of the foliation (lineation) and the intermediate axes of the blades define a partial girdle about the lineation; (iii) a slight thinning and reduction in volume of grains in the one transect; and (iv) an actual increase in thickness and volume in the survivor grains of the second transect. The highest-grade samples, within the chlorite zone of the greenschist facies, record segregation into quartz- and mica-rich layers. This segregation resulted largely from F2 crenulation and marks a key change in the distribution, deformation and SPO of the quartz grains. The contribution of quartz SPO to defining the foliation lessens as the previously discrete and aligned detrital quartz grains are replaced by aggregates and layers of dynamically recrystallized quartz grains of reduced aspect ratio and reduced alignment. Pressure solution now affects the margins of quartz-rich layers rather than individual grains. In higher-grade samples, therefore, the rock structure is characterized increasingly by segregation layering parallel to a foliation defined predominantly by mica SPO

X-rays from Saturn: A study with XMM-Newton and Chandra over the years 2002-05

We present the results of the two most recent (2005) XMM-Newton observations of Saturn together with the re-analysis of an earlier (2002) observation from the XMM-Newton archive and of three Chandra observations in 2003 and 2004. While the XMM-Newton telescope resolution does not enable us to resolve spatially the contributions of the planet's disk and rings to the X-ray flux, we can estimate their strengths and their evolution over the years from spectral analysis, and compare them with those observed with Chandra. The spectrum of the X-ray emission is well fitted by an optically thin coronal model with an average temperature of 0.5 keV. The addition of a fluorescent oxygen emission line at ~0.53 keV improves the fits significantly. In accordance with earlier reports, we interpret the coronal component as emission from the planetary disk, produced by the scattering of solar X-rays in Saturn's upper atmosphere, and the line as originating from the Saturnian rings. The strength of the disk X-ray emission is seen to decrease over the period 2002 - 2005, following the decay of solar activity towards the current minimum in the solar cycle. By comparing the relative fluxes of the disk X-ray emission and the oxygen line, we suggest that the line strength does not vary over the years in the same fashion as the disk flux. We consider possible alternatives for the origin of the line. The connection between solar activity and the strength of Saturn's disk X-ray emission is investigated and compared with that of Jupiter. We also discuss the apparent lack of X-ray aurorae on Saturn and conclude that they are likely to lie below the sensitivity threshold of current Earth-bound observatories. A similar comparison for Uranus and Neptune leads to the same disappointing conclusion.Comment: 10 pages, 5 figures; to be published in 'Astronomy and Astrophysics