Contributions of preschool behavioral self-regulation and social skills to growth in different domains of early math knowledge

The current study explored the relative contribution of individual differences in children's behavioral self-regulation and social skills (often referred to as learning-related skills) in the fall of preschool to children's rate of growth in different domains of early math knowledge through the spring of kindergarten. Participants were 684 children (Mage = 57.6 months, SD = 3.8, at Time 1 [fall of preschool]; 48% female; 43% Black, 32% White, 13% Latine, 11% multiracial, and 1% Asian). All children were from families with low incomes and lived in the midwestern United States. The math domains of informal numeracy, formal numeracy, and math language were assessed at four time points: fall and spring of preschool and fall and spring of kindergarten. Contrary to expectations, we did not find that either learning-related skill positively predicted rate of growth in math knowledge or observe differential relations by math domain. Rather, the relative contribution of behavioral self-regulation and social skills in the fall of preschool to rate of growth in math knowledge followed similar patterns across all math domains: an early advantage for children with higher initial social skills that stayed consistent over time (i.e., a nonsignificant slope effect) and an early advantage for children with higher initial behavioral self-regulation that diminished over time (i.e., a negative slope effect).

A metascience investigation of inclusive, open, and reproducible science practices in research posters at the 2021 SRCD biennial meeting

Over the past decade, there has been a growing appreciation of metascience issues in psychological science. Using data collected from 2615 posters presented at the 2021 biennial meeting of the Society for Research in Child Development, this article examines the use of transparent research practices to increase rigor and reproducibility as well as generalizability through greater inclusivity of diverse samples. Research presented through poster presentations was heavily skewed toward quantitative studies featuring American researchers using Western hemisphere samples. Sharing of data/materials, preregistrations, and replications were uncommon. During a time when governments are increasingly requiring more open practices and access, this research provides an important baseline by which developmental science can benchmark progress toward the goals of greater inclusivity and openness.

International comparisons of the home mathematics environment and relations with children's mathematical achievement

BACKGROUND

Home mathematics environment (HME) research has focused on parent-child interactions surrounding numerical activities as measured by the frequency of engaging in such activities. However, HME survey questions have been developed from limited perspectives (e.g., Early Childhood Research Quarterly, 27, 2012, 231; Journal of Social Issues, 64, 2008, 95; Early childhood mathematics education research: Learning trajectories for young children, Routledge, New York, 2009), by researchers from a small subset of countries (15; Psychological Bulletin, 147, 2020, 565), which may skew our interpretations.

AIMS AND SAMPLE

This study broadened international representation by leveraging secondary data from the 2019 TIMSS to examine the variation of the frequency and reliability of the HME scale and its relation to children's mathematical achievement. Across 54 countries, 231,138 parents and children (Mage  = 10.22 years; 51% male) participated in the larger study.

METHODS

Parents completed a retrospective home environment survey and children were assessed on mathematics skills. Basic frequency descriptive statistics, Cronbach's alpha reliability coefficients, and Pearson's r correlation coefficients were used to assess variability across countries.

RESULTS

Findings suggested that families in certain countries engaged in home mathematics activities more frequently than families in other countries; however, the HME scale demonstrated acceptable internal consistency across families in all countries (M α = .79; range = [.73, .89]). Further, the average relation between HME and mathematical achievement was r = .15 with a range between r = .02 to r = .41.

CONCLUSION

Our results indicate substantial variation across countries in the HME-mathematical achievement association. These findings underscore the importance of international representation in advancing research on the diversity of a child's home environment.

Systemic administration of budesonide in pegylated liposomes for improved efficacy in chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a chronic inflammatory condition affecting the nasal and paranasal sinuses of approximately 11.5% of the United States adult population. Oral corticosteroids are effective in controlling sinonasal inflammation in CRS, but the associated adverse effects limit their clinical use. Topical budesonide has demonstrated clinical efficacy in patients with CRS. Herein, we investigated the systemic delivery of liposomes tethered with poly(ethylene glycol) (PEG) and loaded with budesonide in a murine model of CRS. PEGylated liposomes encapsulated with budesonide phosphate (L-BudP) were administered via tail vein injection, and the feasibility of L-BudP to reduce sinonasal inflammation was compared to that of free budesonide phosphate (F-BudP) and topical budesonide phosphate (T-BudP) treatment over a 14-day study period. Compared to a single injection of F-BudP and repeat T-BudP administration, a single injection of L-BudP demonstrated increased and prolonged efficacy, resulting in the significant improvement of sinonasal tissue histopathological scores (p < 0.05) with decreased immune cell infiltration (p < 0.05). Toxicities associated with L-BudP and T-BudP treatment, assessed via body and organ weight, as well as peripheral blood liver enzyme and differential white blood cell analyses, were transient and comparable. These data suggest that systemic liposomal budesonide treatment results in improved efficacy over topical treatment.

The role of executive function in shaping the longitudinal stability of math achievement during early elementary grades

There is substantial rank-order stability in children's mathematical skills throughout development. Research has shown that children who enter school with relatively low math skills are unlikely to catch up to peers who begin kindergarten with more developed math skills. Emerging evidence suggests that children's executive function skills might play an important role in shaping the rate and stability of mathematical skill development during early development. Therefore in the present study, we used data from the Early Childhood Longitudinal Study-Kindergarten Cohort 2010-11-a prospective sample of over 18,000 children in the United States-to examine executive function as an antecedent to characteristics of growth in math skills and to test whether executive function moderates the longitudinal stability of math achievement from kindergarten through second grade. Latent growth curve models reveal that executive function is related to not only the level of math skills at school entry but also to the rate of growth in early elementary years. Moreover, we found that executive function moderated the stability of math achievement from kindergarten to second grade, suggesting that early executive function skills can serve as a compensatory mechanism for children who enter school with lower levels of mathematical skills. These findings might have important implications for narrowing gaps in math achievement during early elementary school.

Working memory development from early childhood to adolescence using two nationally representative samples

We leveraged nationally representative data from the Panel study of Income Dynamics-Child Development Supplement (N = 3,562) and the Early Childhood Longitudinal study (N = 18,174), to chart the development of working memory, indexed via verbal forward and backward digit span task performance, from 3 to 19 years of age. Results revealed nonlinear growth patterns for forward and backward digit span tasks, with the most rapid growth occurring during childhood followed by a brief accelerated period of growth during early adolescence. We also found similar developmental trajectories on digit span task performance for males and females across the U.S. population. Together, this study highlights the relative importance of the childhood period for working memory development and provides researchers with a reference against which to compare the developmental changes of working memory in individual studies. From a practical perspective, clinicians and educators can also use this information to understand important periods of working memory growth using national developmental trends. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

POS0939 BIMEKIZUMAB IN PATIENTS WITH ACTIVE NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS: 24-WEEK EFFICACY & SAFETY FROM BE MOBILE 1, A PHASE 3, MULTICENTRE, RANDOMISED, PLACEBO‑CONTROLLED STUDY

Background

Bimekizumab (BKZ) is a monoclonal IgG1 antibody that selectively inhibits IL-17F in addition to IL-17A. BKZ has shown rapid and sustained efficacy and was well tolerated up to 156 weeks (wks) in a phase 2b study in patients (pts) with active ankylosing spondylitis.1,2

Objectives

To assess efficacy and safety of BKZ vs placebo (PBO) in pts with active non-radiographic axial spondyloarthritis (nr-axSpA) up to Wk 24 in the ongoing pivotal phase 3 study, BE MOBILE 1.

Methods

BE MOBILE 1 (NCT03928704) comprises a 16-wk double-blind, PBO-controlled period and 36-wk maintenance period. Pts were aged ≥18 yrs, had BASDAI ≥4 and spinal pain ≥4 at BL, and sacroiliitis on MRI and/or elevated CRP at screening. Pts were randomised 1:1, BKZ 160 mg Q4W:PBO. From Wk 16, all pts received BKZ 160 mg Q4W. Primary and secondary efficacy endpoints were assessed at Wk 16.

Results

Of 254 randomised pts (BKZ: 128; PBO: 126), 244 (96.1%) completed Wk 16, 240 (94.5%) Wk 24. BL characteristics were comparable between groups: mean age 39.4 yrs, symptom duration 9.0 yrs; 54.3% pts male, 77.6% HLA-B27+, 10.6% TNFi-experienced. At Wk 16, the primary (ASAS40: 47.7% BKZ vs 21.4% PBO; p<0.001) and all ranked secondary endpoints were met (Table 1). Responses were rapid with BKZ, including in PBO pts who switched to BKZ at Wk 16, and increased to Wk 24 (Figure 1; Table 1). Substantial reductions of hs-CRP by Wk 2 and MRI SIJ inflammation by Wk 16 were achieved with BKZ vs PBO (Table 1). At Wk 24, >50% of pts initially randomised to BKZ had achieved ASDAS <2.1 (Figure 1).

Table 1.

Efficacy at Wks 16 and 24

BLWk 16Wk 24PBO N=126BKZ 160 mg Q4W N=128PBO N=126BKZ 160 mg Q4W N=128p valuePBO→BKZ 160 mg Q4W N=126BKZ 160 mg Q4W N=128Ranked endpoints in hierarchical orderASAS40* [NRI] n (%)--27 (21.4)61 (47.7)<0.00159 (46.8)67 (52.3)BASDAI CfB† [MI] mean (SE)6.7 (0.1)6.9 (0.1)–1.5 (0.2)–3.1 (0.2)<0.001–3.2 (0.2)–3.4 (0.2)ASAS20† [NRI] n (%)--48 (38.1)88 (68.8)<0.00187 (69.0)96 (75.0)ASAS PR† [NRI] n (%)--9 (7.1)33 (25.8)<0.00135 (27.8)37 (28.9)ASDAS-MI† [NRI] n (%)--9 (7.1)35 (27.3)<0.00137 (29.4)41 (32.0)ASAS 5/6† [NRI] n (%)--21 (16.7)49 (38.3)<0.00151 (40.5)57 (44.5)BASFI CfB† [MI] mean (SE)5.3 (0.2)5.5 (0.2)–1.0 (0.2)–2.5 (0.2)<0.001–2.3 (0.2)–2.8 (0.2)Nocturnal spinal pain CfB† [MI] mean (SE)6.7 (0.2)6.9 (0.2)–1.7 (0.2)–3.6 (0.3)<0.001–3.5 (0.2)–4.0 (0.3)ASQoL CfB† [MI] mean (SE)9.4 (0.4)9.5 (0.4)–2.5 (0.4)–5.2 (0.4)<0.001–4.8 (0.4)–5.7 (0.4)SF-36 PCS CfB† [MI] mean (SE)33.6 (0.8)33.3 (0.7)5.5 (0.7)9.5 (0.7)<0.00110.1 (0.8)10.6 (0.8)Other endpointsdEnthesitis-free state†a [NRI] n (%)--22 (23.9)b48 (51.1)c-40 (43.5)b45 (47.9)cASAS40 in TNFi-experienced [NRI] n (%)--2 (11.8)e6 (60.0)f---ASDAS-CRP CfB [MI] mean (SE)3.7 (0.1)3.8 (0.1)–0.6 (0.1)–1.5 (0.1)-–1.5 (0.1)–1.6 (0.1)hs-CRP, mg/L [MI] geometric mean (median)5.0 (6.5)4.6 (6.1)3.8 (4.1)2.0 (1.8)-2.3 (2.6)1.9 (1.8)MRI spine Berlin CfBg [OC] mean (SD)1.9 (3.2)h1.6 (2.9)i–0.1 (1.7)j–0.7 (2.2)k---SPARCC MRI SIJ score CfBg [OC] mean (SD)10.5 (13.8)l8.5 (10.3)m–1.5 (9.2)n–6.3 (10.0)o---

Randomised set. *Primary endpoint; †Secondary endpoint; aMASES=0 in pts with BL MASES >0; bn=92; cn=94; dNominal p values not shown; en=17; fn=10; gIn pts in MRI sub-study; hn=65; in=75; jn=58; kn=73; ln=68; mn=79; nn=60; on=77.

Over 16 wks, 80/128 (62.5%) pts had ≥1 TEAE on BKZ vs 71/126 (56.3%) on PBO; most frequent were nasopharyngitis (BKZ: 9.4%; PBO: 4.8%), upper respiratory tract infection (BKZ: 7.0%; PBO: 7.1%) and oral candidiasis (BKZ: 3.1%; PBO: 0%). No systemic candidiasis was observed. Up to 16 wks, incidence of SAEs was low (BKZ: 0.0%; PBO: 0.8%); no MACE or deaths were reported; 0 IBD cases occurred in pts on BKZ vs 1 (0.8%) in a pt on PBO.

Conclusion

Dual inhibition of IL-17A and IL-17F with BKZ in pts with active nr-axSpA resulted in rapid, clinically relevant improvements in efficacy outcomes vs PBO. No new safety signals were observed.1,2

References

[1]van der Heijde D. Ann Rheum Dis 2020;79:595–604;

[2]Gensler L. Arthritis Rheumatol 2021;73(suppl 10):0491.

Acknowledgements

This study was funded by UCB Pharma. Editorial services were provided by Costello Medical.

Disclosure of Interests

Atul Deodhar Speakers bureau: Janssen, Novartis, and Pfizer, Consultant of: AbbVie, Amgen, Aurinia, BMS, Celgene, Eli Lilly, GSK, Janssen, MoonLake, Novartis, Pfizer, and UCB Pharma, Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, and UCB Pharma, Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, and UCB Pharma, Employee of: Imaging Rheumatology BV (Director), Lianne S. Gensler Consultant of: AbbVie, Eli Lilly, GSK, Janssen, Novartis, Pfizer, and UCB Pharma, Grant/research support from: Novartis, Pfizer and UCB Pharma, Huji Xu: None declared, Karl Gaffney Speakers bureau: AbbVie, Eli Lilly, Novartis, UCB Pharma, Consultant of: AbbVie, Eli Lilly, Novartis, and UCB Pharma, Grant/research support from: AbbVie, Gilead, Eli Lilly, Novartis, and UCB Pharma, Hiroaki Dobashi Speakers bureau: BMS, Chugai, Eli Lilly, GSK, MSD, Novartis, Pfizer, UCB Pharma, Walter P Maksymowych Consultant of: AbbVie, Boehringer-Ingelheim, Celgene, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer and UCB Pharma, Grant/research support from: AbbVie, Janssen, Novartis and Pfizer, Employee of: Chief Medical Officer for CARE Arthritis, Martin Rudwaleit Speakers bureau: AbbVie, BMS, Boehringer Ingelheim, Chugai, Eli Lilly, Janssen, Novartis, Pfizer, and UCB Pharma, Paid instructor for: Janssen, Novartis, and UCB Pharma, Consultant of: AbbVie, Novartis, and UCB Pharma, Marina Magrey Consultant of: AbbVie, Eli Lilly, Novartis, Pfizer and UCB Pharma, Grant/research support from: AbbVie and UCB Pharma, Dirk Elewaut Speakers bureau: AbbVie, Eli Lilly, Galapagos, Novartis and UCB Pharma, Consultant of: AbbVie, Eli Lilly, Galapagos, Novartis and UCB Pharma, Marga Oortgiesen Employee of: Employee of UCB Pharma, Carmen Fleurinck Employee of: Employee of UCB Pharma, Alicia Ellis Employee of: Employee of UCB Pharma, Thomas Vaux Employee of: Employee of UCB Pharma, julie smith Employee of: Employee of UCB Pharma, Xenofon Baraliakos Speakers bureau: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB Pharma, Paid instructor for: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB Pharma

It matters how you start: Early numeracy mastery predicts high school math course-taking and college attendance

Using data from the Applied Problems subtest of the Woodcock-Johnson Tests of Achievement (Woodcock & Johnson, 1989/1990, Woodcock-Johnson psycho-educational battery-revised. Allen, TX: DLM Teaching Resources) administered to 1,364 children from the National Institute of Child Health and Human Development (NICHD) Study of Early Childcare and Youth Development (SECCYD), this study measures children's mastery of three numeric competencies (counting, concrete representational arithmetic and abstract arithmetic operations) at 54 months of age. We find that, even after controlling for key demographic characteristics, the numeric competency that children master prior to school entry relates to important educational transitions in secondary and post-secondary education. Those children who showed low numeric competency prior to school entry enrolled in lower math track classes in high school and were less likely to enrol in college. Important numeracy competency differences at age 54 months related to socioeconomic inequalities were also found. These findings suggest that important indicators of long-term schooling success (i.e., advanced math courses, college enrollment) are evident prior to schooling based on the levels of numeracy mastery.

Conceptualizing the factor structure of parents' math anxiety and associations with children's mathematics skills

There is a growing literature examining the association between parents' math anxiety and children's mathematics skills. Previous research has considered parents' math anxiety as a unidimensional construct that primarily focused on parents' experiences doing mathematics themselves. However, this research did not account for parents' experiences when doing mathematics with their children. Thus, there were two goals of the present study: (1) to identify the structure of parents' math anxiety when considering context-dependent situations, and (2) to determine whether parental math anxiety was related to children's early numeracy skills. We conducted a series of confirmatory factor analyses using a sample of 155 preschool children (M_age  = 4.20 years, SD = 0.71; 51% female). The best fitting model of parents' math anxiety was a bifactor model, suggesting that parents' math anxiety was best conceptualized as a multidimensional construct. However, structural equation models showed parent math anxiety was not a significant predictor of children's numeracy performance. These findings provide a foundation for understanding parents' math anxiety as multidimensional and raise questions about potential mechanisms that may explain prior work finding mixed relations between math anxiety and children's numeracy performance.

Developmental cascades and educational attainment

Developmental cascades describe how systems of development interact and influence one another to shape human development across the lifespan. Despite its popularity, developmental cascades are commonly used to understand the developmental course of psychopathology, typically in the context of risk and resilience. Whether this framework can be useful for studying children's educational outcomes remains underexplored. Therefore, in this chapter, we provide an overview of how developmental cascades can be used to study children's academic development, with a particular focus on the biological, cognitive, and contextual pathways to educational attainment. We also provide a summary of contemporary statistical methods and highlight existing data sets that can be used to test developmental cascade models of educational attainment from birth through adulthood. We conclude the chapter by discussing the challenges of this research and explore important future directions of using developmental cascades to understand educational attainment.

Next Directions in Measurement of the Home Mathematics Environment: An International and Interdisciplinary Perspective

This article synthesizes findings from an international virtual conference, funded by the National Science Foundation (NSF), focused on the home mathematics environment (HME). In light of inconsistencies and gaps in research investigating relations between the HME and children's outcomes, the purpose of the conference was to discuss actionable steps and considerations for future work. The conference was composed of international researchers with a wide range of expertise and backgrounds. Presentations and discussions during the conference centered broadly on the need to better operationalize and measure the HME as a construct - focusing on issues related to child, family, and community factors, country and cultural factors, and the cognitive and affective characteristics of caregivers and children. Results of the conference and a subsequent writing workshop include a synthesis of core questions and key considerations for the field of research on the HME. Findings highlight the need for the field at large to use multi-method measurement approaches to capture nuances in the HME, and to do so with increased international and interdisciplinary collaboration, open science practices, and communication among scholars.

Collocated burn and fracture injuries in major trauma: a 10 year experience

INTRODUCTION

Collocated burn and fracture injuries, defined as a burn overlying the site of a fracture, represent a serious subset of major burns and trauma. The literature pertaining to these rare injuries is inconclusive. Recent studies cast doubt on the safety of operative fixation in this population. No study to date has examined outcomes of collocated burn and fracture injuries compared with control. The aim of this study was to compare characteristics, injury patterns and complication rates in major burns and fracture patients with a collocated injury to those without.

METHODS

A retrospective chart review of all consecutive patients with dermal burns and major fractures were undertaken between January 2005 and December 2015 at a tertiary referral trauma hospital. Outcomes assessed included demographics, injury characteristics and complications, including infection. Orthopaedic infection was defined as orthopaedic surgical site infection or osteomyelitis.

RESULTS

Of the 40 patients identified, 21 subjects sustained collocated injuries. Patients with collocated injuries demonstrated a trend towards higher injury severity, higher percentage of total body surface area affected, longer length of stay and greater overall and orthopaedic complication rate. Significant predictors of orthopaedic infection were related to injury severity rather than collocation or operative management.

CONCLUSION

There are differences in the characteristics and complication rates between collocated and non-collocated burn and fracture injuries. Collocated injuries tend to result from greater energy mechanisms, undergo longer inpatient stays and demonstrate increased morbidity. Injury severity appears to be the most important factor in determining postoperative orthopaedic infection. These characteristics must be considered when managing these rare but significant injuries.

An overview of issues in infant and developmental research for the creation of robust and replicable science

In the last few years, the field of psychology has been challenged with a crisis in the rigor and reproducibility of the science. The focus of these issues has primarily been in social, cognitive, and cognitive neuroscience psychology, however, the area of developmental research is not immune to these issues. This paper provides an overview of the "replication crisis" and the choices made by researchers that are often not noted in methods, thus making the replication of studies more difficult. In this review we discuss issues of researcher flexibility in the data design and selection of sample size, collection, and analysis stages of research. In each of these areas we address examples of bias and how developmental researchers can address these issues in their own research.

86-GBaud subcarrier multiplexed 16QAM signal generation using an electrical 90 degree hybrid and IQ mixers

We experimentally demonstrate an aggregate 86-GBaud (over three sub-bands and one polarization) signal generation based on subcarrier multiplexing technique using IQ mixers, an electrical 90 degree hybrid, and diplexers. The electrical hybrid allows transmitter-side digital signal processing to be simplified to pulse shaping and digital pre-emphasis. We verified the configuration by testing the performance of an 86-GBaud Nyquist-shaped 16 quadrature amplitude modulation signal with differential bit encoding. The implementation penalty assuming 7% hard-decision forward error correction is reduced to 2 dB by utilizing a 31-tap decision-directed least mean square based multiple-input multiple-output equalizer for sideband crosstalk mitigation.

First report of Comamonas kerstersii causing urinary tract infection

The association of Comamonas kerstersii with peritonitis resulting from perforated appendix and its isolation from a psoas abscess and pelvic peritonitis have previously been described by us. We present the first case of C. kerstersii urinary tract infection, broadening the spectrum of infections caused by this species.

All bereaved parents are entitled to good care after stillbirth: a mixed-methods multicentre study (INSIGHT)

OBJECTIVE

To understand challenges in care after stillbirth and provide tailored solutions.

DESIGN

Multi-centre case study.

SETTING

Three maternity hospitals.

POPULATION

Parents with a stillborn baby, maternity staff.

METHODS

Thematic analysis of parent interviews and staff focus groups and service provision investigation.

OUTCOMES

1 Themes; 2 Triangulation matrix; 3 Recommendations.

RESULTS

Twenty-one women, 14 partners, and 22 staff participated. Service Provision: Care for parents after stillbirth varies excessively; there are misconceptions; post-mortem does not delay follow-up.

PRESENTATION

Women 'do not feel right' before stillbirth; their management is haphazard and should be standardised.

DIAGNOSIS

Stillbirth is an emergency for parents but not always for staff; communication can seem cold; well-designed bereavement space is critical. Birth: Staff shift priorities to mother and future, but for parents their baby is still a baby; parents are not comfortable with staff recommending vaginal birth as the norm; there are several reasons why parents ask for a caesarean; better care involves clear communication, normal behaviour, and discussion of coping strategies. Post-mortem: Parents are influenced by discussions with staff. Staff should 'sow seeds', clarify its respectful nature, delineate its purpose, and explain the timescale.

FOLLOW-UP

It is not standardised; parents wish to see their multi-professional team.

CONCLUSIONS

There is unacceptable variation in care after stillbirth, and insensitive interactions between staff and bereaved parents. Understanding parents' needs, including why they ask for caesarean birth, will facilitate joint decision-making. Every bereaved parent is entitled to good, respectful care.

TWEETABLE ABSTRACT

Care too varied & interactions often insensitive after stillbirth; national pathway & training urgently needed PLAIN LANGUAGE SUMMARY: Why and how was the study carried out? Previous studies have shown that improving care after stillbirth is important for families. We investigated the opinions of bereaved parents and maternity staff to find ways to improve care. At three hospitals in 2013, all women who experienced a stillbirth were invited to an interview along with their partners. Thirty-five parents of 21 babies agreed to participate. Twenty-two obstetricians and midwives took part in focus group discussions. What were the main findings? Care was often not as good as it should and could be. Communication with parents was not always as sensitive as they would have liked because staff did not have appropriate training. Some women reported they did not 'feel right' before going to hospital. Once they arrived, there was no standard approach to how care was given. Sometimes there were long delays before the death of the baby was confirmed and action was taken. After it had been confirmed that the baby had died, staff focussed on the mothers' needs, but the parents' priorities were still with their baby. There were several reasons why parents asked for a caesarean birth that staff had not considered. Staff influenced parents' decisions about post-mortem examinations. Parents found it helpful when staff explained the respectful nature and purpose of the examination. After discharge from hospital, there was no consistent plan for how follow-up care would be given. Parents would have liked more information about their next hospital appointment. What are the limitations of the work? The parents interviewed depended on their memories of the details of the care, which happened some time ago. In staff group discussions, junior doctors may not have spoken openly because there were senior doctors present. Further research is necessary to understand and improve care globally. What is the implication for parents? Every bereaved parent is entitled to the best possible care after stillbirth, but some do not get good care. Parents and staff made suggestions that can help to develop processes for how care is given after stillbirth. These suggestions can also inform staff training, so that every single parent is treated respectfully and participates in decision making.

Neuroinflammation and the generation of neuropathic pain

Inflammation is the process by which an organism responds to tissue injury involving both immune cell recruitment and mediator release. Diverse causes of neuropathic pain are associated with excessive inflammation in both the peripheral and central nervous system which may contribute to the initiation and maintenance of persistent pain. Chemical mediators, such as cytokines, chemokines, and lipid mediators, released during an inflammatory response have the undesired effect of sensitizing and stimulating nociceptors, their central synaptic targets or both. These changes can promote long-term maladaptive plasticity resulting in persistent neuropathic pain. This review aims to provide an overview of inflammatory mechanisms at differing levels of the sensory neuroaxis with a focus on neuropathic pain. We will compare and contrast neuropathic pain states such as traumatic nerve injury which is associated with a vigorous inflammatory response and chemotherapy induced pain in which the inflammatory response is much more modest. Targeting excessive inflammation in neuropathic pain provides potential therapeutic opportunities and we will discuss some of the opportunities but also the clinical challenges in such an approach.

Contamination and current practice in decontamination pof nebulisers in ventilated patients

To examine the incidence of contamination and current practice of decontamination of nebulisers after use within a ventilator circuit, in public- and private sector intensive care units (ICUs) in Johannesburg; to assess the presence of and adherence to a decontamination protocol in these ICUs and to identify which practices were associated with lower or no bacterial growth. Methods: A cross-sectional study design was used which included a semi-structured interview with the ICU manager and an audit of current nebuliser practice. Nebulisers that were identified in the interview were swabbed and streaked on blood agar plates (BAPs). BAPs were incubated and assessed for bacterial colonisation, number of colony forming units (CFUs) and number of different species of CFUs present. Results: Two hundred and sixty-nine ICU beds were surveyed over a two-month period resulting in 45 nebulisers used within a ventilator circuit that could be tested. The majority (93%) were single-use jet nebulisers, all were being re-used and 52% presented with contamination. None of the ICUs had a nebuliser decontamination protocol in place. Contaminated nebulisers that were stored in a sterile drape had significantly higher concentrations of bacterial growth (p=0.03). Conclusion: The rate of colonisation of re-used jet nebulisers is high. Nebuliser decontamination protocols are urgently needed.

Defining the endoscopic appearances of tylosis using conventional and narrow-band imaging: a case series

Tylosis is an autosomal dominant skin disorder strongly associated with esophageal squamous cell cancer. We present a single-operator experience of utilizing conventional endoscopy and narrow-band imaging with magnification to characterize esophageal appearances in tylosis. Nineteen consecutive patients with tylosis attending for surveillance endoscopy were studied. White-light imaging (WLI) and narrow-band imaging (NBI) were undertaken, with magnification being performed as necessary. On WLI, we classified 12 patients as having mild change, 5 moderate change, and 2 severe change. WLI can define changes to the esophageal mucosa of variable hyperkeratosis and identify more significant focal abnormalities. NBI enhances these mucosal changes, and NBI with magnification can demonstrate intrapapillary capillary loop changes compatible with dysplasia, prompting consideration of surgery. This report is the first to characterize the endoscopic appearances in tylosis.