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Objectives: Research on developmental outcomes of preterm birth has traditionally focused on adverse effects. This study investigated the prevalence and correlates of resilience in 146 extremely preterm/extremely low birth weight (EPT/ELBW) children (gestational age <28 weeks and/or birth weight <1000 g) attending kindergarten and 111 term-born normal birth weight (NBW) controls. Methods: Adaptive competence (i.e., “resilience” in the EPT/ELBW group) was defined by scores within grade expectations on achievement tests and the absence of clinically elevated parent ratings of child behavior problems. The “adaptive” children who met these criteria were compared to the “maladaptive” children who did not on child and family characteristics. Additional analyses were conducted to assess the conjoint effects of group (ELBW vs. NBW) and family factors on adaptive competence. Results: A substantial minority of the EPT/ELBW group (45%) were competent compared to a majority of NBW controls (73%), odds ratio (95% confidence interval)=0.26 (0.15, 0.45), p<.001. Adaptive competence was associated with higher cognitive skills, more favorable ratings of behavior and learning not used to define adaptive competence, and more advantaged family environments in both groups, as well as with a lower rate of earlier neurodevelopmental impairment in the EPT/ELBW group. Higher socioeconomic status and more favorable proximal home environments were associated with competence independent of group, and group differences in competence persisted across the next two school years. Conclusions: The findings document resilience in kindergarten children with extreme prematurity and highlight the role of environmental factors as potential influences on outcome. (JINS, 2019, 25, 362–374)
In many countries, traditional medical planning for disasters developed largely in response to battlefield and multiple casualty incidents, generally involving corporal injuries. The mass evacuation of a metropolitan population in the aftermath of Hurricane Katrina evolved into life-and-death triage scenarios involving thousands of patients with nontraumatic illnesses and special medical needs. Although unprecedented in the United States, triage management needs for this disaster were similar to other large-scale public health emergencies, both natural and human-generated, that occurred globally in the past half-century. The need for alternative triage-management processes similar to the methodologies of other global mass public health emergencies is illustrated through the experience of disaster medical assistance teams in the first 3 days following Katrina's landfall. The immediate establishment of disaster-specific, consensus-based, public health emergency–related triage protocols—developed with ethical and legal expertise and a renewed focus on multidimensional, multifactorial matrix decision-making processes—is strongly recommended. (Disaster Med Public Health Preparedness. 2008;2(Suppl 1):S40–S44)
Our objectives were to examine cognitive outcomes for extremely preterm/extremely low birth weight (EPT/ELBW, gestational age <28 weeks and/or birth weight <1000 g) children in kindergarten and the associations of these outcomes with neonatal factors, early childhood neurodevelopmental impairment, and socioeconomic status (SES). The sample comprised a hospital-based 2001–2003 birth cohort of 148 EPT/ELBW children (mean birth weight 818 g; mean gestational age 26 weeks) and a comparison group of 111 term-born normal birth weight (NBW) classmate controls. Controlling for background factors, the EPT/ELBW group had pervasive deficits relative to the NBW group on a comprehensive test battery, with rates of cognitive deficits that were 3 to 6 times higher in the EPT/ELBW group. Deficits on a measure of response inhibition were found in 48% versus 10%, odds ratio (95% confidence interval) = 7.32 (3.32, 16.16), p < .001. Deficits on measures of executive function and motor and perceptual-motor abilities were found even when controlling for acquired verbal knowledge. Neonatal risk factors, early neurodevelopmental impairment, and lower SES were associated with higher rates of deficits within the EPT/ELBW group. The findings document both global and selective cognitive deficits in EPT/ELBW children at school entry and justify efforts at early identification and intervention. (JINS, 2011, 17, 1067–1079)
An evaluation of the reproductive endocrine status is an essential component in the investigation of all male partners with either an abnormal physical examination suggestive of a disorder in testosterone production and action, an abnormal semen examination, or evidence of impaired sexual function. Initial laboratory assessment of the hypothalamic- pituitary-testicular axis includes the measurement of circulating levels of LH, FSH, and testosterone. The differential diagnosis and treatment of endocrine- dependent male-factor infertility is based on the history, physical examination, and reproductive hormone levels. Hypogonadotropic hypogonadism, also referred to as secondary hypogonadism, can occur as the congenital condition idiopathic hypogonadotropic hypogonadism (IHH). Androgen receptor abnormalities are rarely amenable to hormone therapy. Testosterone replacement therapy available in the United States includes oral, intramuscular, transdermal, and buccal preparations. A number of non-FDA-approved drugs and supplements are marketed as alternative therapies for declining androgens and decreasing libido and potency in older men.
To investigate the effects of very low birth weight (VLBW, <1500
g) on the development of neuropsychological skills, we assessed 67
children with birth weight <750 g, 64 with birth weight
750–1499 g, and 67 term-born controls. Growth modeling of raw
scores from mean ages 7–14 years revealed persistent VLBW
sequelae. Even when adjusting for IQ, the <750 g group scored more
poorly than the term-born group on measures of language processing,
verbal list learning, and perceptual–motor and organizational
abilities. This group also made slower age-related progress than the
control group on tests of perceptual-motor and executive functions.
Environmental factors moderated group differences in change on other
cognitive measures. These results revealed further evidence for slower
skill development in both VLBW groups relative to controls, as well
as“catch-up” growth in the 750–1499 g group on some
measures. The findings suggest age-related changes in the cognitive
sequelae of VLBW that depend on the skill assessed, the degree of VLBW,
and environmental factors. (JINS, 2004, 10,
Little is known about the influence on child mental health symptoms of the timing of initial exposure to maternal major depression or whether the timing is associated with ‘pure’ or co-occurring internalising and externalising symptoms.
To address these issues, while also taking account of child gender and family socio-economic status.
In a prospective community-based study, 421 kindergarten teachers rated children's symptoms. Previous assessments of maternal major depression indicated whether children were first exposed during infancy, in the toddler/pre-school period, or never.
Exposure during infancy was associated with high internalising symptoms, especially when co-occurring with high externalising symptoms. Initial exposure in the toddler/pre-school years increased the risk of ‘pure’ externalising symptoms among girls.
The association of child mental health symptoms with the timing of initial exposure to maternal depression highlights the need for effective prevention and intervention strategies addressed to the developmental issues of each period.
The passage of the 1986 Amendments of the Education of All Handicapped Children's Act, P.L. 99-457, including the infant and toddler focus in Part H (now known as Part C) and the preschool focus in Part B, brought new challenges and opportunities to professionals and families alike. Within this legislation resides a philosophical framework emphasizing the family-centered, interdisciplinary, and collaborative nature of early childhood services. Although the legislation created new intervention opportunities for children and families, a major challenge facing the field is the preparation of an adequate supply of highly qualified personnel to deliver services to a diverse group of young children with disabilities and their families in a range of community settings.
Qualified early childhood personnel are those trained to work with infants, toddlers, and preschoolers with disabilities and their families as part of an interdisciplinary team (Bailey, 1996) in inclusive settings (Miller & Stayton, 1996) using a family-centered service delivery model (McCollum & Bailey, 1991). Federal law requires that all personnel, across disciplines, meet the highest entrylevel state standards and that states develop a Comprehensive System of Personnel Development (CSPD) to respond to the need for trained professionals from several disciplines. Training programs must assure that personnel not only meet state and federal requirements but also the professional standards of quality that are now accepted by the field as recommended practices (Bredecamp & Copple, 1997; McCollum & Maude, 1992; NAEYC, 1996; Odom & McLean, 1996).
our best poets have differed from other Nations (though not so happily) in usually mingling and interweaving Mirth and Sadness through the whole Course of their Plays, Ben. Johnson only excepted.
Sir Robert Howard, Four New Playes (1665)
This Oleo of a Play; this unnatural mixture of Comedy and Tragedy
John Dryden, An Essay of Dramatick Poesie (1668)
Sometime at the end of the seventeenth century, George Villiers, the second Duke of Buckingham, wrote a play which he called The Restauration: Or, Right will take Place. A Tragicomedy (February 1683). Since the beheading of the English monarch Charles I in 1649, the idea of “Restoration” had obsessed English playwrights – the theme permeates Restoration drama. Not coincidentally, Buckingham's title includes the designation “A Tragicomedy.” To an experienced reader of seventeenth-century drama, the plot of The Restauration sounds very familiar. A usurping king harasses a dispossessed prince, Philander, whose countrymen are waiting to take arms in his defense. A foreign prince has just arrived to marry the princess and thus becomes heir to the throne.
The Greek temples on the summit of the citadel at Mycenae were discovered and partially cleared by Ch. Tsountas in 1886, but the major excavation was undertaken in 1939 under the direction of A. J. B. Wace. The results of this season have never been fully studied. This article is based upon a new examination of the material evidence and the documents in the Mycenae archives of the British School at Athens. Previously unpublished architectural drawings, photographs, plans, and sections make it possible to assess the nature of the Archaic and Hellenistic temples at Mycenae. The evidence points to the establishment of the cult in the Geometric period, along with the construction of the northern terraces, followed by a significant reorganization of the temenos and the construction of the first stone temple in the early Archaic period. Preliminary analysis of the preserved architectural elements indicates a strong connection between the Archaic temple at Mycenae and the early temples at Corinth and Isthmia. The well-known stone reliefs from Mycenae, dated c. 630 BC, should also belong to this early structure. In the third century BC, when Mycenae had been resettled as an Argive kome, the temple was rebuilt, incorporating Archaic material in its foundations.
By Hisses th' Whiggs, and by their Claps the Tories.
Thomas Durfey, Sir Barnaby Whigg (1681)
John Crowne's two-part adaptation of Shakespeare's Henry VI trilogy uncovers the problem of being a “Tory” during the religious and political crisis of 1678–83. Scholars consider Crowne a political fence-sitter, like John Dryden, yet Crowne's The Misery of Civil-War. A Tragedy (1680) and Henry the Sixth, The First Part. With the Murder of Humphry Duke of Gloucester (1681) suggest that Crowne rather illustrates the fluidity of party identity, particularly the shifting attitudes toward succession. Perhaps genuinely ambivalent about religious and constitutional issues, Crowne appears to choose legitimacy, the Stuart right to the throne, in the first adaptation but equivocates about the advisability of a Catholic king in the second. In sharp contrast to other party literature, Crowne's adaptations portray both Whig and Tory sympathies. Crowne's indecisive drama thus encodes the faction-ridden ambivalence of 1678–83 even better than, for example, the blatantly Tory satire of Thomas Otway's more familiar Venice Preserv'd (1682).
In part, certainly, Crowne was consciously “trimming,” changing parties to follow political shifts, but he and his contemporaries were also struggling to balance political and religious agendas, muddling through to fundamental party tenets.
The tracer-to-infant deuterium dilution method for the measurement of milk intake was evaluated in twenty breast-fed and twenty formula-fed infants. The isotope method was compared with conventional direct-weighing techniques. Human milk intake was assessed by 5 d test-weighing. Intakes of formula, supplemental foods, and water were determined by pre- and post-weighing of feeding bottles. An oral dose of 200 mg 2H2O/kg body-weight was given to each infant, and urine was sampled daily for 14 d. 2H enrichment of the urine was measured by gas-isotope-ratio mass spectrometry. Milk intakes estimated from the deuterium dilution method were consistently higher than those from direct-weighing; the mean difference between methods was 106 (sd 47) g/d or 14% for the breast-fed group and 70 (sd 155) g/d or 8 % for the formula-fed group. Estimates of intake for some infants varied substantially between the two methods of measurement. When the estimated values of human milk intake were corrected for environmental water influx and insensible water loss during breast-feeding, the relative bias decreased to 5%. Correction of the estimated values of formula intake for environmental water influx decreased the relative bias to 1–2%. The acceptability of the deuterium dilution method to determine milk intake depends on the goals and the tolerance for error in group and individual intake estimates of a given study
1. Body fat, fat-free mass and total body water of ten lactating women were estimated from deuterium-dilution spaces and from skinfold thickness measurements. Deuterium-dilution spaces were calculated from the 6 h (equilibration) and zero-time (extrapolation) deuterium enrichments in saliva, urine, human milk and breath water vapour samples.
2. The deuterium spaces obtained by equilibration were statistically larger than those obtained by extrapolation. Isotope dilution spaces derived from deuterium enrichments in saliva, breath water vapour and human milk did not differ with the exception of the 6 h equilibration value of milk, which was greater than that estimated from saliva. Deuterium-dilution spaces estimated from urine were consistently smaller than those derived from the other biological fluids.
3. No significant differences in body fat, fat-free mass and total body water were observed between anthropometric measurements and deuterium-dilution methods, except for extrapolated values derived from deuterium enrichments in urine.
Britain now wear's the sock; the Theater's clean Transplanted hither, both in Place and Scene.
Martin Butler and Jonathan Dollimore have recently documented the importance of drama in English political life before 1642. Such scholarship, however, has stopped cold at the great divide of 1642. Except for Lois Potter in “‘True Tragicomedies’ of the Civil War and Interregnum,” no one has considered the relationship between politics and theater while the theaters were officially closed. Scholars have thereby missed a seminal question in understanding the discourse and complex political maneuvering enveloping the act of regicide in 1649. What is the relationship between the theatrical tradition and the execution of Charles I?
Even though historians frequently comment on the “tragic” nature of the execution of Charles I, thus far neither historian nor literary person has bothered to examine the immediate and popular reactions to the act of regicide. This is understandable. An odd mix of imaginative projection and verifiable fact enshrines the execution of Charles, and documentation is admittedly difficult. The available assortment of primary literature, however, indicates that many Englishmen responded to the execution as theater, more specifically, the dramatic genre of tragedy. A 1649 sermon (attributed to the Royalist Robert Brown) exemplifies both the tragic response to the act of regicide and the mid-century employment of the theatrical tradition: Brown describes the execution as “the first act of that tragicall woe which is to be presented upon the Theater of this Kingdome, likely to continue longer then the now living Spectators.”
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