From 100-year-old women’s motoring masks to contemporary PPE: A socio-political study of persistent problems and inventive possibilities

Amid the Covid-19 pandemic, personal protective equipment (PPE) became central to daily news. Face masks may have been critical, but they were clearly not equally designed or distributed, compelling many women health workers to make their own. These issues are neither new nor specific to health-oriented fields. We offer insights from another case of individuals taking PPE into their own hands. We analyse patents for women’s motoring face masks invented in America, Canada, England, and France (1900 -1925). Our findings suggest that women invented and wore face masks not only to drive safely, but to position themselves as legitimate motorists and as citizens with equal rights to technology, public space, and resources at the turn of last century. We propose that a study of historic motoring face masks might offer insights into persistent problems and inventive possibilities relating to contemporary PPE

Testing a Web-Based Interactive Comic Tool to Decrease Obesity Risk Among Minority Preadolescents: Protocol for a Pilot Randomized Control Trial

Background: Childhood obesity is a public health crisis, particularly in low-income, minority populations in the United States. Innovative and technology-enhanced interventions may be an engaging approach to reach at-risk youth and their parents to improve dietary behaviors and feeding practices. However, such tools are limited, especially ones that are theory-based; co-developed with user-centered approaches; tailored to low-income, minority preadolescents; and include parent-focused content. Objective: The objectives of this study include assessing the feasibility and acceptability and exploring the potential impact of the Intervention INC (Interactive Nutrition Comics for urban, minority preadolescents) Web-based tool, which is focused on decreasing childhood obesity risk in black/African American and Latino children aged 9 to 12 years. Methods: Intervention INC is underpinned by the narrative transportation theory, social cognitive theory, and health belief model, and it was co-developed by children and parents from the intended population. The child component consists of a 6-chapter interactive nutrition comic optimized for use on tablet devices, a goal-setting and self-assessment feature, and weekly text/email messages and reminders. The parental component consists of 6 Web-based newsletters, access to the child comic, and weekly text/email messages and reminders. The tool was evaluated using a pilot, single-blind, 2-group randomized controlled study design. Child-parent dyads were randomized to either the experimental or comparison group and assigned to a targeted behavior (increase fruit/vegetable or water intake) based on initial screening questions. Data were collected at 4 time points: baseline (T1), intervention midpoint (T2), intervention endpoint (T3), and 3 months postintervention (T4). Primary measures comprise usage, usability, and feasibility of the Web-based tool. Secondary measures comprise dietary knowledge, preferences, and intake and anthropometric measures (for child) and feeding practices and home food environment (for parent). Results: Study enrollment was completed in November 2017. A total of 89 child-parent dyads were randomized to either the experimental (n=44) or comparison (n=45) group. Data analysis is currently being conducted. Conclusions: This study aims to implement and assess an innovative approach to deliver health messages and resources to at-risk minority preadolescents and their parents. If found to be acceptable, engaging, feasible, and a potential approach to improve dietary behaviors, a full-fledged randomized controlled trial will be conducted to assess its efficacy and potential impact. Trial Registration: ClinicalTrials.gov NCT03165474; https://clinicaltrials.gov/ct2/show/NCT03165474 (Archived by WebCiteat http://www.webcitation.org/73122IjgP) International Registered Report Identifier (IRRID): RR1-10.2196/1068

Machine Learning Solution to Organ-At-Risk Segmentation for Radiation Treatment Planning

In the treatment of cancer using ionizing radiation, it is important to design a treatment plan such that dose to normal, healthy organs is sufficiently low. Today, segmentation requires a trained human to carefully outline, or segment, organs on each slice of a treatment planning computed tomography (CT) scan but it is laborious, time-consuming, and contains intra- and inter-rater variability. Currently, existing clinical automation technology relies on atlas-based automation, which has limited segmentation accuracy. Thus the auto-segmentations require post process editing by an expert. In this paper, we propose a machine learning solution that shortens the segmentation time of organs-at-risk (OARs) in the thoracic cavity. The overall system will include preprocessing, model processing, and postprocessing steps to make the system easily integratable into the radiotherapy planning process. For our model, we chose to use a 3D deep convolutional neural network with a U-net based architecture because this machine learning strategy takes into account local spatial relationships, will restore the original image resolution and has been utilized in image segmentation, especially in medical image analysis. Training and testing were done with a 60 patient dataset of thoracic CT scans from the AAPM 2017 Grand Challenge. To assess and improve our system we calculated accuracy metrics (Dice similarity coefficient (DSC), mean surface distance (MSD)) and compared our model’s segmentation performance to that of an expert and the top two performing machine learning methods of the challenge. We explored using preprocessing steps such as cropping and image enhancement to improve the model segmentation accuracy. Our final model was able to segment the lungs as accurately as a dosimetrist and the heart and spinal cord within acceptable DSC ranges. All DSC values of the OARs from our method were as accurate as other machine learning methods. The DSC for the esophagus was below tolerable error for radiotherapy planning, but our mean surface distance was superior to other auto-segmentation methods. We were successful in significantly reducing manual segmentation time by developing a machine learning system. Though our approach still necessitates a single preparatory step of manually cropping anatomical regions to isolate segmentation volume, a general hospital technician could complete this task which removes the need of an expert for one time-consuming step of radiotherapy planning. Implementation of our methods to provide radiotherapy in lower-middle income countries brings us closer to accessibility of treatment for a wider population

Memantine for autism spectrum disorder

Background Autism spectrum disorder (ASD; also known as autism) is a developmental disability that begins in childhood and is typically seen in around 1% to 2% of children. It is characterised by social communication difficulties and repetitive and restricted behaviours and routines that can have a negative impact on a child's quality of life, achievement at school, and social interactions with others. It has been hypothesised that memantine, which is traditionally used to treat dementia, may be effective in reducing the core symptoms of autism as well as some co‐occurring symptoms such as hyperactivity and language difficulties. If memantine is being used to treat the core symptoms of autism, it is important to review the evidence of its effectiveness. Objectives To assess the effects of memantine on the core symptoms of autism, including, but not limited to, social communication and stereotypical behaviours. Search methods We searched CENTRAL, MEDLINE, Embase, nine other databases and three trials registers up to February 2022. We also checked reference lists of key studies and checked with experts in the field for any additional papers. We searched for retractions of the included studies in MEDLINE, Embase, and the Retraction Watch Database. No retractions or corrections were found. Selection criteria We included randomised controlled trials (RCTs) of any dose of memantine compared with placebo in autistic people. We also included RCTs in which only one group received memantine, but both groups received the same additional therapy (e.g. a behaviour intervention). Data collection and analysis We used standard Cochrane methods. Our primary outcomes were core autism symptoms and adverse effects. Secondary outcomes were language, intelligence, memory, adaptive behaviour, hyperactivity, and irritability. We used GRADE to assess certainty of evidence. Main results We included three RCTs (two double‐blind and one single‐blind) with 204 participants that examined the short‐term effect (immediately postintervention) of memantine in autistic people. Two studies took place in the USA and the other in Iran. All three studies focused on children and adolescents, with a mean age of 9.40 (standard deviation (SD) 2.26) years. Most participants were male (range across studies 73% to 87%). The diagnosis of ASD was based on the Diagnostic and Statistical Manual of Mental Disorders (4th edition; 4th edition, text revision; or 5th edition). To confirm the diagnosis, one study used the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview‐Revised (ADI‐R); one used ADOS, ADI‐R or the Autism Diagnostic Interview Screener; and one used the Gilliam Autism Rating Scale. Dosage of memantine was based on the child's weight and ranged from 3 mg to 15 mg per day. Comparisons Two studies examined memantine compared with placebo; in the other study, both groups had a behavioural intervention while only one group was given memantine. Risk of bias All studies were rated at high risk of bias overall, as they were at high or unclear risk of bias across all but four domains in one study, and all but two domains in the other two studies. One study was funded by Forest Laboratories, LLC, (Jersey City, New Jersey), Allergan. The study sponsor was involved in the study design, data collection (via contracted clinical investigator sites), analysis and interpretation of data, and the decision to present these results. The other two studies reported no financial support or sponsorship; though in one of the two, the study medication was an in‐kind contribution from Forest Pharmaceuticals. Primary outcomes There was no clear evidence of a difference between memantine and placebo with respect to severity of core symptoms of autism, although we are very uncertain about the evidence. The standardised mean difference in autism symptoms score in the intervention group versus the control group was –0.74 standard deviations (95% confidence interval (CI) −2.07 to 0.58; 2 studies, 181 participants; very low‐certainty evidence; medium effect size); lower scores indicate less severe autistic symptoms. Two studies (144 participants) recorded adverse effects that the authors deemed related to the study and found there may be no difference between memantine and placebo (odds ratio (OR) 0.64, 95% CI 0.17 to 2.39; low‐certainty evidence). Secondary outcomes There may be no difference between memantine and placebo on language (2 studies, 144 participants; low‐certainty evidence); memory or adaptive behaviour (1 study, 23 participants; both low‐certainty evidence); or hyperactivity or irritability (1 study, 121 participants; both low‐certainty evidence). Authors' conclusions It is unclear whether memantine is an effective treatment for autistic children. None of the three included trials reported on the effectiveness of memantine in adults. Further studies using rigorous designs, larger samples, longer follow‐up and clinically meaningful outcome measures that are important to autistic people and their families will strengthen our knowledge of the effects of memantine in autism

Evaluating the effectiveness of key components of zones of regulation™ curriculum training on teachers' self-efficacy at managing self-regulation needs in autistic pupils

There has been a rise in autistic pupils in the mainstream classroom. Teachers have often reported frustration caused by a lack of training on managing autistic pupils' presentations. The aim of this study was to investigate the effect of an online training programme comprising the main paradigms and resources of the Zones of Regulation™ curriculum on teachers' sense of self-efficacy when managing autistic pupils' self-regulation needs in the mainstream primary school classroom. Purposive sampling was used to identify primary 5, 6 and 7 teachers with at least one autistic pupil with self-regulation needs in their current class. An occupational therapist with post-graduate qualifications in autism and sensory processing provided a 2.5-hour online training session on the Zones of Regulation™ curriculum for participants. The Teachers' Sense of Efficacy Scale (TSES) was completed pre- and post-training and at two-month follow-up. The Usage Rating Profile-Intervention Revised was completed post-training and a survey exploring participants' experience of implementing the Zones of Regulation™ curriculum with their autistic pupils was completed at two-month follow-up. Findings showed that online training in the use of the Zones of Regulation™ curriculum significantly improved TSES scores for teachers (p < 0.001). The curriculum was also shown to be an acceptable, understandable and feasible intervention for primary school teachers in the mainstream classroom. This study suggests that education authorities should consider providing training opportunities on the Zones of Regulation™ curriculum to support teachers in the mainstream classroom. It also demonstrates the important role occupational therapists, with post-graduate qualifications in autism and sensory processing, have in capacity building within education

Memantine for autism spectrum disorder

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of memantine on the core features of ASD, including, but not limited to, social functioning, communication skills and stereotypical behaviours

Is language ability associated with behaviors of concern in autism? A systematic review

This review systematically synthesized evidence on the association between structural language ability and behaviors of concern (BoC) in autism. Four databases were searched for studies that included >10 autistic participants, measures of structural language (content and/or form of language) and BoC, and an analysis of their association. BoCs included self-injurious behavior (SIB), aggression, tantrums, and externalizing behavior. Methodological quality of studies were assessed using the Newcastle Ottawa Scale. Forty-five publications (n = 11,961) were included. Forty studies were cross-sectional and five were prospective cohort studies. Over 70% of the studies investigating expressive language and SIB (n = 10), aggression (n = 5), tantrums (n = 3), and externalizing behavior (n = 17) reported an inverse association, where lower expressive language ability was associated with increased BoC. Eleven out of sixteen studies of combined expressive and receptive language reported an inverse relationship with SIB or aggression. All outcomes were rated as moderate to very low certainty of evidence. This review highlights evidence showing an inverse association between expressive or combined language ability and SIB, and externalizing behavior in autism. However, further high-quality studies that use standardized, consistent measures of language and behavior and investigate longitudinal associations are needed. Early detection and support for reduced structural language difficulties have substantial potential to assist in reducing BoC

Treating Obesity in Latino Children: A Systematic Review of Current Interventions

Childhood obesity remains a significant public health issue in the U.S. and globally. Rates are disproportionately higher in Latinos than other ethnic groups. This review provides a qualitative synthesis of the current evidence for childhood obesity treatment interventions among Latino children. A systematic search was performed in PubMed, Web of Science and Google Scholar for articles published from September 2010 to December 2015. Randomized controlled trials treating childhood overweight/obesity in Latino children ages 5-19 focused on diet and/or physical activity (PA) behaviors were included. Of the records initially identified (n=1,592), 11 studies met the inclusionary criteria. The majority included a family-based component (n=8; 73%). Nearly half (n=5) focused on children ages 5-12, with three specifically developed for the pre-adolescence stage (ages 8-12). Nine studies acknowledged cultural tailoring, most frequently by seeking input from their intended population and utilizing bilingual delivery staff. Improvements in anthropometric measures (e.g. body mass index (BMI) z-score) were observed in 55% of the studies (n=6). Many interventions with a combined focus of diet and PA, in the form of nutrition education in a group setting and in-person activity/exercise sessions and incorporated a parent/family component reported positive anthropometric results. Three (27%) studies included a follow-up period, all of which observed a sustained decrease in BMI over time. Overall, family-based interventions focusing on both diet and PA demonstrated promising results. However, additional research incorporating a follow-up period is warranted to assess sustainability of these outcomes. Additionally, more interventions could be developed specifically for the critical developmental stage of pre-adolescence

Overall prognosis of preschool autism spectrum disorder diagnoses

Background Autism spectrum disorder is a neurodevelopmental disorder characterised by social communication difficulties, restricted interests and repetitive behaviours. The clinical pathway for children with a diagnosis of autism spectrum disorder is varied, and current research suggests some children may not continue to meet diagnostic criteria over time. Objectives The primary objective of this review was to synthesise the available evidence on the proportion of preschool children who have a diagnosis of autism spectrum disorder at baseline (diagnosed before six years of age) who continue to meet diagnostic criteria at follow‐up one or more years later (up to 19 years of age). Search methods We searched MEDLINE, Embase, PsycINFO, and eight other databases in October 2017 and ran top‐up searches up to July 2021. We also searched reference lists of relevant systematic reviews. Selection criteria Two review authors independently assessed prospective and retrospective follow‐up studies that used the same measure and process within studies to diagnose autism spectrum disorder at baseline and follow‐up. Studies were required to have at least one year of follow‐up and contain at least 10 participants. Participants were all aged less than six years at baseline assessment and followed up before 19 years of age. Data collection and analysis We extracted data on study characteristics and the proportion of children diagnosed with autism spectrum disorder at baseline and follow‐up. We also collected information on change in scores on measures that assess the dimensions of autism spectrum disorder (i.e. social communication and restricted interests and repetitive behaviours). Two review authors independently extracted data on study characteristics and assessed risk of bias using a modified quality in prognosis studies (QUIPS) tool. We conducted a random‐effects meta‐analysis or narrative synthesis, depending on the type of data available. We also conducted prognostic factor analyses to explore factors that may predict diagnostic outcome. Main results In total, 49 studies met our inclusion criteria and 42 of these (11,740 participants) had data that could be extracted. Of the 42 studies, 25 (60%) were conducted in North America, 13 (31%) were conducted in Europe and the UK, and four (10%) in Asia. Most (52%) studies were published before 2014. The mean age of the participants was 3.19 years (range 1.13 to 5.0 years) at baseline and 6.12 years (range 3.0 to 12.14 years) at follow‐up. The mean length of follow‐up was 2.86 years (range 1.0 to 12.41 years). The majority of the children were boys (81%), and just over half (60%) of the studies primarily included participants with intellectual disability (intelligence quotient < 70). The mean sample size was 272 (range 10 to 8564). Sixty‐nine per cent of studies used one diagnostic assessment tool, 24% used two tools and 7% used three or more tools. Diagnosis was decided by a multidisciplinary team in 41% of studies. No data were available for the outcomes of social communication and restricted and repetitive behaviours and interests. Of the 42 studies with available data, we were able to synthesise data from 34 studies (69% of all included studies; n = 11,129) in a meta‐analysis. In summary, 92% (95% confidence interval 89% to 95%) of participants continued to meet diagnostic criteria for autism spectrum disorder from baseline to follow‐up one or more years later; however, the quality of the evidence was judged as low due to study limitations and inconsistency. The majority of the included studies (95%) were rated at high risk of bias. We were unable to explore the outcomes of change in social communication and restricted and repetitive behaviour and interests between baseline and follow‐up as none of the included studies provided separate domain scores at baseline and follow‐up. Details on conflict of interest were reported in 24 studies. Funding support was reported by 30 studies, 12 studies omitted details on funding sources and two studies reported no funding support. Declared funding sources were categorised as government, university or non‐government organisation or charity groups. We considered it unlikely funding sources would have significantly influenced the outcomes, given the nature of prognosis studies. Authors' conclusions Overall, we found that nine out of 10 children who were diagnosed with autism spectrum disorder before six years of age continued to meet diagnostic criteria for autism spectrum disorder a year or more later, however the evidence was uncertain. Confidence in the evidence was rated low using GRADE, due to heterogeneity and risk of bias, and there were few studies that included children diagnosed using a current classification system, such as the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5) or the eleventh revision of the International Classification of Diseases (ICD‐11). Future studies that are well‐designed, prospective and specifically assess prognosis of autism spectrum disorder diagnoses are needed. These studies should also include contemporary diagnostic assessment methods across a broad range of participants and investigate a range of relevant prognostic factors

Home learning environments and children’s language and literacy skills: a meta-analytic review of studies conducted in low- and middle-income countries

A robust finding from research in high-income countries is that children living in resource-poor homes are vulnerable to difficulties with language and literacy but less is known about this association in low- and middle-income (LMI) countries. We present a meta-analysis of 6,678 correlations from studies in 43 LMI countries. Overall, the results indicate a small but significant association (r = .08) between home language and literacy environment and children’s language and literacy skills. After examining a range of moderators, adult literacy practices and books at home had a significantly larger association with children’s language and literacy skills than did home tutoring. Studies using customized measures demonstrated a more marked association between home attributes and children’s outcomes (r = .14) than studies using a common measure across multiple sites (r = .06). Published studies showed significantly larger associations than unpublished studies, and countries with greater income inequality showed a larger association than relatively egalitarian societies. We conclude that the small overall association should not be taken as support for the absence of, or a vanishingly small relationship between the home learning environment and children’s language and literacy skills in LMI countries. Rather, an important factor in detecting this relationship is that assessments must better reflect the nature of homes in different cultures to capture true variation in the population. Such contextually situated measurement would lead to an inclusive conceptualization of home learning environments and can better inform intervention programs to enhance children’s educational success, a critical target for many LMI countries