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Background: When compared to the general population, researchers have reported elevated rates of mental health issues in the pediatric epilepsy population. These issues have been found to be especially problematic around the time of transition from pediatric to adult care. This is significant because depression and/or anxiety have been found to be directly related to worsened seizure outcomes and quality of life. Despite this, no known Canadian pediatric epilepsy centers have integrated mental health assessment into mainstream practice. Methods: To explore the importance of mental health assessments, we looked at the prevalence rates of both depression and anxiety in 91 adolescents with epilepsy aged 14 to 18 (M=16.3, 51 males, 41 females) enrolled into an epilepsy transition clinic. Results: 58.3% of adolescents showed signs of depression (28.6% mild, 21.4% moderate, 6.0% moderately-severe, 2.4% severe), and 51.8% of adolescents showed signs of anxiety (31.8% mild, 10.6% moderate, 9.4% severe). Remarkably, 54.8% of patients presenting with moderate to severe depression and/or anxiety had not been previously identified Conclusions: These results suggest that in order to ensure the best possible outcomes for patients, mental health assessments should be integrated into the standard model of care for transition-aged adolescents with epilepsy.
Background: Growing evidence has that a suggested that mental health strongly influences quality of life (QoL) in adolescents with epilepsy. In addition, research has suggested that these mental health issues are associated with increased seizure burden and worsened health outcomes. Despite this, and the elevated rate of mental health issues in this population, seizure control tends to be the dominant or sole concern for treating physicians. Methods: In order to look at potential predictors of QoL in adolescents we looked at seizure related data, demographic variables, and comorbid conditions in 70 adolescents with epilepsy aged 14 to 18 (M= 16.3l; 37 males, 33 females) enrolled into an epilepsy transition clinic. Results: Regression analysis found that mental health remained a significant and independent predictor of QoL even when other significant seizure related variables were accounted for (t(58)= -3.44, p= .001). Furthermore, when looking at the individual subscales of patient QoL (e.g., memory, social support, stigma), mental health was consistently found to be the strongest correlate. Conclusions: These results demonstrate that in order to ensure the best outcomes for transition-aged adolescents with epilepsy, it is important to not only manage and treat seizures, but also to assess and treat mental health issues.
The transition from adolescent to adult mental health services (AMHS) is associated with disengagement, poor continuity of care and patient dissatisfaction. The aim of this retrospective and descriptive study was to describe the ‘care pathways’ in an independent mental health service when adolescents reach age 18 and to investigate the level of engagement of those who transitioned to independent AMHS.
This is a retrospective, naturalistic and descriptive study in design. All patients discharged from the St Patrick’s Adolescent Mental Health Service aged 17 years and 6 months and older, during a 3-year period between January 2014 and December 2016, were included. Electronic records were used to collect socio-demographic and clinical details and to determine engagement rates in adolescents who transferred to independent adult services.
A total of 180 patients aged over 17 years and 6 months were discharged from the adolescent service. Of these, 45.6% were discharged to their GP, 28.9% to public mental health services and 25.6% to independent mental health services. The majority who transitioned to independent AMHS went to a Young Adult Service, which had high engagement rates at 3 and 12 months post-transition.
In this independent mental health service, less than half of adolescents who reach the transition age are referred onto AMHS. Engagement rates were found to be high among those referred on to a specialised young adult service.
Migrant youths endure many challenges. Such challenges can be stressful and lead to psychological difficulties. We investigated the relationship between migration, psychopathology and stressful events in children and adolescents. We hypothesised that migrant youths would show higher levels of psychopathology and more stressful life events than non-migrant youths.
Using the Child cohort (Cohort ‘98) of the ‘Growing up in Ireland’ study we investigated psychopathology, as measured by the Strengths and Difficulties questionnaire (SDQ) at age 9 and 13 and stressful life events in migrant and non-migrant youths.
There was no significant difference between the proportion of migrant and non-migrant youths reporting psychopathology in childhood (p>0.05) or adolescence (p>0.05). Analysis of the SDQ subscales revealed that a significantly greater proportion of migrant youths had hyperactivity problems in childhood (p = 0.04) but a greater proportion of non-migrant youths had emotional problems in early adolescence (p = 0.04). We found that migrant youths experienced significantly more stressful life events than their non-migrant counterparts (p<0.01), however, once ‘Moving house/country‘ was removed as a stressor, there was no difference between the groups (p>0.27).
Contrary to our hypothesis, we observed that there were few differences between migrant and non-migrant youths in the levels of psychopathology. Migrant youths experienced a greater number of stressful life events, however, this was attributable to stressors relating to moving. An increased understanding of the factors promoting resilience, as demonstrated by the migrant youths, could aid health professionals and policy makers to effectively tailor interventions for mental health promotion.
Child maltreatment is a significant public health issue in the United States. Yet, fewer than half of pediatricians discuss behavioral, developmental, or parenting issues with parents.
This paper describes the testing of bundles of tools and processes, part of a larger intervention, Practicing Safety, targeted at changing physician and staff behavior to identify families at risk for child maltreatment, provide anticipatory guidance, refer to community resources, and follow-up and track at-risk families. The intervention was implemented with 14 pediatric primary care practices throughout the United States; the study was completed in 2011.
A within-subjects repeated measures pre-post follow-up design was used to evaluate the intervention. Baseline and repeated measurements of pediatric practices’ processes were collected using qualitative and quantitative methods. In total, 14 core improvement teams from across the country tested three bundles of tools (maternal, infant, toddler) within a quality improvement framework over seven months.
Quantitative results showed statistically significant adoption of tools and processes and enhancement of practice behaviors and office environmental supports. The increase in tool use was immediate and was sustained for six months after implementation. Qualitative data provided insight as to how meaningful the intervention was to the core improvement teams, especially with more complicated behaviors (eg, engaging social workers or community agencies for referrals). Barriers included lack of community resources. Findings showed unanticipated outcomes such as helping practices to become medical homes.
Lessons learned included that practices appreciate and can adopt brief interventions that have meaningful and useful tools and process to enhance psychosocial care for children 0–3 and that do not place a burden on pediatric practice. An innovative, quality improvement strategy, intuitive to pediatricians, with a brief intervention may help prevent child maltreatment.
In recent years there has been an increasing interest in the issue of farm animal welfare. This interest stems from a belief that many modern livestock production systems do not allow animals to perform a natural range of behaviour, leading to a possible decline in welfare. One method of determining the value of natural behaviours is to perform preference tests. In dairy cows, choices relating to various treatments, including feeding, shouting, electric shock, hitting (Pajor et al., 2003) and being milked (Prescott et al., 1998) have been assessed using Y-maze methodology. This is a process that involves training animals to anticipate receiving a treatment if they enter one arm of the Y and an alternative treatment if they enter the other. We used preference tests as a tool to determine how dairy cows perceive aspects of their feeding environment, with specific emphasis on understanding what difficulties low ranking animals face at the feed-face. We hypothesised that subordinate cows would trade-off proximity to a dominant individual at the feed-face with access to food of a high quality.
Parallel processing is being used to improve the catalog of earth orbiting satellites and for problems associated with the catalog. Initial efforts centered around using SIMD parallel processors to perform debris conjunction analysis and satellite dynamics studies. More recently, the availability of cheap supercomputing processors and parallel processing software such as PVM have enabled the reutilization of existing astrodynamics software in distributed parallel processing environments. Computations once taking many days with traditional mainframes are now being performed in only a few hours. Efforts underway for the US Naval Space Command include conjunction prediction, uncorrelated target processing and a new space object catalog based on orbit determination and prediction with special perturbations methods.
To compare mental health (MH) outcomes of and service use by children born under 1500 g in Ireland with a matched control group.
Using a retrospective cohort design, semi-structured and standardised MH assessments were conducted with parents, teachers and youth.
A total of 64 of 127 surviving children from a very low birth weight (VLBW) cohort from a National Maternity Hospital participated at a mean age of 11.6 years (s.d. 1.0), along with 51 matched controls. More VLBW children received clinical or borderline scores when rated by parents [χ2 (1, n=114)=7.3, p=0.007] or youths [χ2 (1, n=114)=4.83, p=0.028], but not by teachers [χ2 (1, n=114)=1.243, p=0.463]. There was no increase in the use of MH services. A main effect of birth weight remained on the parent Strengths and Difficulties Questionnaire [F (1, 88)=5.07, p<0.05) after controlling for intelligence quotient (IQ) and socio-economic status (SES), but only on hyperactivity in males. SES, rather than IQ or birth weight, predicted identification of problems by teachers [F (1, 82)=6.99, p=0.01).
Teachers miss MH difficulties and are influenced more by SES than by IQ or birth weight. This has implications for MH service access. Initial perinatal investment needs to be matched with ongoing surveillance and psychoeducation to ensure that disorders are recognised early and offered appropriate interventions.
The link between childhood obesity and both television viewing and television advertising have previously been examined. We sought to investigate the frequency and type of food and beverage placements in children-specific television broadcasts and, in particular, differences between programme genres.
Content of five weekdays of children-specific television broadcasting on both UK (BBC) and Irish (RTE) television channels was summarized. Food and beverage placements were coded based on type of product, product placement, product use and characters involved. A comparison was made between different programme genres: animated, cartoon, child-specific, film, quiz, tween and young persons’ programming.
A total of 1155 (BBC=450; RTE=705) cues were recorded giving a cue every 4·2 min, an average of 12·3 s/cue. The genre with most cues recorded was cartoon programming (30·8 %). For the majority of genres, cues related to sweet snacks (range 1·8–23·3 %) and sweets/candy (range 3·6–25·8 %) featured highly. Fast-food (18·0 %) and sugar-sweetened beverage (42·3 %) cues were observed in a high proportion of tween programming. Celebratory/social motivation factors (range 10–40 %) were most common across all genres while there were low proportions of cues based on reward, punishment or health-related motivating factors.
The study provides evidence for the prominence of energy-dense/nutrient-poor foods and beverages in children’s programming. Of particular interest is the high prevalence of fast-food and sugar-sweetened beverage cues associated with tween programming. These results further emphasize the need for programme makers to provide a healthier image of foods and beverages in children’s television.
The excavation of a large circular dished earthwork near Carnforth,
North Lancashire, in 1982, has revealed a substantial Bronze Age funerary
monument. The earliest structure was a sub-rectangular enclosure of
limestone boulders dated to c. 1740–1640 BC cal. and
associated with parts of two poorly preserved inhumation burials lying on
the previously cleared ground surface. Both burials were accompanied by
typologically early metalwork. The central inhumation was associated with
a flat axe and dagger, suggesting an individual of high status as well as
providing an important link between the early stages of development of
both bronze types. The subsequent overlying cairn of smaller stones
included eleven fairly discrete concentrations of inhumed bone, and seven
of cremated bone and pottery. All this material was extremely
fragmentary, and was probably derived from later re-use of the
Excavations were undertaken in advance of construction work at Newbury Sewage Treatment Works on the outskirts of Thatcham in Berkshire, close to the sites of previous excavations undertaken by Wymer and by Peake and Crawford. Worked flint of Mesolithic date was recovered from a sandy layer overlying river gravel in two distinct concentrations suggesting two distinct episodes. Use wear analysis of the flint suggests that the sites were used as home bases at which a wide range of activities took place, with an emphasis on the processing of plant foods. A 14C date of 9100±80 BP was obtained from a sample of hazel-nut shells from within one of the concentrations. Analysis of the soil and sedimentary sequence as well as the pollen indicates constantly changing localised environments in the early Holocene in the Thatcham area, with sporadic occupation by Mesolithic communities on the drier areas at the edge of the floodplain.
Engineered remediation technologies such as denitrifying bioreactors target single contaminants along a nutrient transfer continuum. However, mixed contaminant discharges to a water body are more common from agricultural systems. Indeed, evidence presented herein indicates that pollution swapping within denitrifying bioreactor systems adds to such deleterious discharges. The present paper proposes a more holistic approach to contaminant remediation on farms, moving from the use of ‘denitrifying bioreactors’ to the concept of a ‘permeable reactive interceptor’ (PRI). Besides management changes, a PRI should contain additional remediation cells for specific contaminants in the form of solutes, particles or gases. Balance equations and case studies representing different geographic areas are presented and used to create weighting factors. Results showed that national legislation with respect to water and gaseous emissions will inform the eventual PRI design. As it will be expensive to monitor a system continuously in a holistic manner, it is suggested that developments in the field of molecular microbial ecology are essential to provide further insight in terms of element dynamics and the environmental controls on biotransformation and retention processes within PRIs. In turn, microbial and molecular fingerprinting could be used as an in-situ cost-effective tool to assess nutrient and gas balances during the operational phases of a PRI.
To conduct a study looking at the prevalence and nature of Internet and mobile phone use in young people, focusing particularly on cyberbullying and its potential effects on young people's mental health.
Three secondary schools in an area of North Dublin were randomly selected, which included one all boys school, one all girls school and one co-educational school. Written information about the study was given to each school principal and to parents/carers of all first and second year students. First and second year students in each school from whom consent had been received were asked to complete two questionnaires, which included a questionnaire on cyberbullying and a self-report version of the Strengths and Difficulties Questionnaire (SDQ). A total of 130 students completed the study.
A total of 24 (18.46%) pupils were cyberbullied. Of these, 13 (65% of those cyberbullied) pupils who were cyberbullied said that it had a negative effect on their mood, and 9 (45% of those cyberbullied) said that cyberbullying had a negative effect on their overall mental health. A statistically significant higher proportion of pupils who were cyberbullied scored in the Abnormal/Borderline range of the SDQ, compared with those who were not cyberbullied.
This is the first study in Ireland, which looks at the potential mental health difficulties associated with cyberbullying. It is hoped that the information from this study will help to increase awareness of the effects of cyberbullying and help look at ways of managing cyberbullying.
Cardiac disease is the main cause of death in men and women in México and the U.S.A. When heart muscle suffers an injury, i.e. cardiac infarction, the tissue dies and is replaced by a fibrotic scar that does not allow for normal organ function. To alleviate scar tissue, the objective of this work was to investigate and synthesize polyurethane ureas from polycaprolactone diol, methylene bis(4-cyclohexilisocyanate), and butanediamine with different hard segment contents, characterize them, and prove their biocompatibility by seeding SCA-1+/CD45- cardiac progenitor cells obtained from mice cardiospheres. Ultimately, this work aims to explore how polyurethane urea elastomers can aid in therapeutic cardiac tissue regeneration.
Field, petrographic and geochemical evidence from the K-feldspar megacrystic Kameruka pluton, Lachlan Fold Belt, southeastern Australia, suggests that complex, multicomponent, mafic microgranular enclaves (MME) are produced by two-stage hybridisation processes. Stage 1 mixing occurs in composite dykes below the pluton, as mafic and silicic melts ascend through shared conduits. Pillows formed in these conduits are homogeneous, fine-to medium-grained stage 1 MME, which typically range from basaltic to granitic compositions that plot as a sublinear array on Harker diagrams. Stage 2 hybridisation occurs in the magma chamber when the composite dykes mix with the resident magma as synplutonic dykes. The stage 2 hybrids also form linear chemical arrays and range from basaltic to granodioritic compositions, the latter resembling the more mafic phases of the pluton. Stage 2 MME are distinguished from stage 1 types by the presence of K-feldspar xenocrysts and a more heterogeneous nature: they commonly contain stage 1 enclaves. Subsequent disaggregation and dispersal of stage 2 hybrid synplutonic dykes within the magma chamber produces a diverse array of multi-component MME.
Field evidence for conduit mixing is consistent with published analogue experimental studies, which show that hybrid thermo-mechanical boundary layers (TMBL) develop between mafic and silicic liquids in conduits. A mechanical mixing model is developed, suggesting that the TMBL expands and interacts with the adjacent contrasting melts during flow, producing an increasing compositional range of hybrids with time that are mafic in the axial zone, grading to felsic in the peripheral zones in the conduit. Declining flow rates in the dyke and cooling of the TMBL zones produce a pillowing sequence progressing from mafic to felsic, which explains the general observation of more MME in more silicic hosts.
The property of granitic magmas to undergo transient brittle failure in seismic regimes allows analogies with fractured solids to be drawn. The fracture network in granitic magmas consists of through-going ‘backbone’ mafic and silicic ± composite dykes, and smaller ‘dangling’ granitic dykes locally generated in the magma chamber. Stage 1 hybrids form in composite backbone dykes and stage 2 hybrids form where they intersect dangling dykes in the magma chamber. With subsequent shear stress recovery, the host magma chamber reverts to a visco-plastic material capable of flow, resulting in disaggregation and dispersal of these complex, hybrid synplutonic dykes, and a vast array of double and multicomponent enclaves potentially develop in the pluton.