The Modified-Classroom Observation Schedule to Measure Intentional Communication (M-COSMIC): Evaluation of reliability and validity

The Modified – Classroom Observation Schedule to Measure Intentional Communication (M-COSMIC) was developed as an ecologically valid measure of social-communication behaviour, delineating forms, functions, and intended partners of children’s spontaneous communication acts. Forty one children with autism spectrum disorder (ASD) aged 48 to 73 months were filmed within small-group settings at school. Communication behaviours during a five-minute teacher-led activity and a 10-minute free play session were coded from video-tape. Inter-rater reliability was high. Many M-COSMIC codes were significantly associated as predicted with Social and Communication domain scores on the Autism Diagnostic Observation Schedule (ADOS) and with scores on standardised language assessments. Agreement was more variable, however, at the level of individual M-COSMIC codes and ADOS items. Higher rates of responding, compliance behaviours and following pointing gestures and gaze occurred during the more structured teacher-led activity, compared to the free play. Results demonstrate preliminary construct validity of the M-COSMIC, showing its potential to describe and evaluate spontaneous social-communication skills in young children with ASD for research and applied purposes

Case Studies in Asia Regarding Indigenous Women, Development, and Access to Justice

Case studies were conducted in the five countries—Cambodia, Lao PDR, Malaysia, Philippines and Thailand—on issues that Indigenous women in Asia are facing with respect to development projects: access to justice; and the promotion, protection and respect of their rights both as women and as Indigenous Peoples. Development projects in this context refer to both State and corporate projects that are intended to support national development, i.e., economic growth or national priorities like the establishment of protected areas. These projects include mining, economic land concessions, national parks and plantations. The case studies look at the national legal and policy framework on women’s rights and Indigenous Peoples’ rights as it relates to the situation of Indigenous women in the respective countries. A community profile is provided for each case to establish the context. Information is shared on the development project and the violations of the rights of Indigenous women that the project causes. Analysis is also provided on obstacles that Indigenous women face for accessing justice related to the development project. In the conclusion, Indigenous women propose recommendations to address these obstacles to access to justice

Three-Year Sustained Clinical Efficacy of Drug-Coated Balloon Angioplasty in a Real-World Femoropopliteal Cohort

Purpose:To report the 36-month outcomes from the prospective, multicenter, single-arm IN.PACT Global Study (ClinicalTrials.govidentifier NCT01609296) evaluating the performance of the IN.PACT Admiral drug-coated balloon (DCB) in real-world patients with femoropopliteal occlusive disease.Materials and Methods:The IN.PACT Global Study was conducted at 64 international sites and enrolled 1535 patients with complex lesions, which included bilateral disease, multiple lesions, de novo in-stent restenosis, long lesions, and chronic total occlusions. The predefined full clinical cohort included 1406 patients (mean age 68.6 years; 67.8% men) with claudication or rest pain treated with the study DCB. Mean lesion length was 12.09 +/- 9.54 cm; 18.0% had in-stent restenosis, 35.5% were totally occluded, and 68.7% were calcified. Freedom from clinically-driven target lesion revascularization (CD-TLR) was evaluated through 36 months. The safety composite endpoint was freedom from device- and procedure-related death through 30 days and freedom from major target limb amputation and clinically-driven target vessel revascularization within 36 months. All safety and revascularization events were reviewed by an independent clinical events committee.Results:The Kaplan-Meier estimate of freedom from CD-TLR through 36 months was 76.9%. The composite safety endpoint was achieved in 75.6% of patients. The 36-month all-cause mortality rate was 11.6%, and the major target limb amputation rate was 1.0%. The Kaplan-Meier estimate of freedom from CD-TLR through 36 months was significantly lower in patients with chronic limb-threatening ischemia (CLTI) compared with claudicants (67.6% vs 78.0%; p=0.003). Lesions affecting both the superficial femoral artery (SFA) and popliteal artery had lower Kaplan-Meier freedom from CD-TLR through 36 months (69.2%) than either isolated SFA (79.7%) or popliteal artery lesions (76.5%; log- rank pPeer reviewe

Heterogeneity of postpartum depression: a latent class analysis

Background—Maternal depression in the postpartum period confers substantial morbidity and mortality, but the definition of postpartum depression remains controversial. We investigated the heterogeneity of symptoms with the aim of identifying clinical subtypes of postpartum depression. Methods—Data were aggregated from the international perinatal psychiatry consortium Postpartum Depression: Action Towards Causes and Treatment, which represents 19 institutions in seven countries. 17 912 unique subject records with phenotypic data were submitted. We applied latent class analyses in a two-tiered approach to assess the validity of empirically defined subtypes of postpartum depression. Tier one assessed heterogeneity in women with complete data on the Edinburgh postnatal depression scale (EPDS) and tier two in those with postpartum depression case status. Findings—6556 individuals were assessed in tier one and 4245 in tier two. A final model with three latent classes was optimum for both tiers. The most striking characteristics associated with postpartum depression were severity, timing of onset, comorbid anxiety, and suicidal ideation. Women in class 1 had the least severe symptoms (mean EPDS score 10·5), followed by those in class 2 (mean EPDS score 14·8) and those in class 3 (mean EPDS score 20·1). The most severe symptoms of postpartum depression were significantly associated with poor mood (mean EPDS score 20·1), increased anxiety, onset of symptoms during pregnancy, obstetric complications, and suicidal ideation. In class 2, most women (62%) reported symptom onset within 4 weeks postpartum and had more pregnancy complications than in other two classes (69% vs 67% in class 1 and 29% in class 3). Interpretation—PPD seems to have several distinct phenotypes. Further assessment of PPD heterogeneity to identify more precise phenotypes will be important for future biological and genetic investigations

Economic evaluation of a pharmacogenetic dosing algorithm for coumarin anticoagulants in The Netherlands

AIM: To investigate the cost-effectiveness of a pharmacogenetic dosing algorithm versus a clinical dosing algorithm for coumarin anticoagulants in The Netherlands. MATERIALS & METHODS: A decision-analytic Markov model was used to analyze the cost-effectiveness of pharmacogenetic dosing of phenprocoumon and acenocoumarol versus clinical dosing. RESULTS: Pharmacogenetic dosing increased costs by €33 and quality-adjusted life-years (QALYs) by 0.001. The incremental cost-effectiveness ratios were €28,349 and €24,427 per QALY gained for phenprocoumon and acenocoumarol, respectively. At a willingness-to-pay threshold of €20,000 per QALY, the pharmacogenetic dosing algorithm was not likely to be cost effective compared with the clinical dosing algorithm. CONCLUSION: Pharmacogenetic dosing improves health only slightly when compared with clinical dosing. However, availability of low-cost genotyping would make it a cost-effective option

The rise of britain's super-indies: Policy-making in the age of the global media market

This article analyses Britain’s remarkable performance in the European television industry. In the space of a few years the UK has risen to become the world’s leading exporter of TV formats and the world’s second exporter, behind the Unites States, of finished TV programmes. The first section compares and contrasts British TV exports data with that of France, before examining the emergence of London as Europe’s media hub. The second part argues that this significant progress is essentially due to deft policy making. In 2003, the British government operated a strategic shift in favour of content producers and created a new intellectual property regime. This regime has enabled producers to keep hold of their rights and become asset-owning businesses, eventually giving rise to a new breed of production companies: the super-indies. This paper shows how these super-indies have acquired the scale to compete in an international TV market and drive today’s British TV exports. Contrasting again Britain’s performance in the European TV trade with France, this article also analyses historical influences and claims it is Britain’s imperial past that helps her performance in the European TV marketplace. In addition to the globalization of the English language and the cultural affinities this nurtures, the trading heritage of the British Empire has facilitated Britain’s political elite’s understanding of the role that trade and the market can play in the creative industries, and enabled them to frame a broadcasting policy that is adapted to the global age