Psychological problems in children with hemiplegia: a European multicentre survey

Objective: To describe the prevalence and determinants of psychological problems in European children with hemiplegia. Design: Cross-sectional survey. Setting: Home visits in nine European regions by research associates who administered standard questionnaires to parents. Patients: 279 children with hemiplegia aged 8–12 years were recruited from population-based case registers. Outcome measure: Strengths and Difficulties Questionnaire comprising emotion, conduct, hyperactivity, peer problems and prosocial domains. An “impact score” (IS) measures the social and psychological impact of the child’s difficulties. Results: Children with hemiplegia had higher mean scores on the total difficulties score (TDS) compared with a normative sample (p<0.001). 48% and 57% of children, respectively, had borderline–abnormal TDS and IS. Significant, independent associations were observed between intellectual impairment and an increased risk for hyperactivity (odds ratio; OR 8.4, 95% CI 3.4 to 20.8), peer problems (OR 3.1, 95% CI 1.7 to 5.5), psychological and social impact (OR 3.0, 95% CI 1.6 to 5.6) when children with an intellectual quotient (IQ) <50 were compared with those with an IQ >70. Boys had an increased risk for conduct (OR 2.1, 95% CI 1.2 to 3.7) and hyperactivity disorders (OR 2.5, 95% CI 1.4 to 4.6). Poor self-esteem was associated with an increased risk for peer problems (OR 5.8, 95% CI 2.5 to 13.4) and poor prosocial skills (OR 7.5, 95% CI 2.4 to 23.2) compared with those with high self-esteem. Other determinants of psychological adjustment were impaired communication, severe pain and living with a single parent. Conclusions: Many of the psychological problems identified are amenable to treatment. Special attention should be given to those at highest risk of developing psychological difficulties.

Posting Incognito ... Males with Eating Problems: Online Emotional Expression and Support

Qualitative research in the area of eating disorders (eds) has predominantly focused on females,whilst the experiences of males’ remains poorly understood. due to the secretive nature of eating problems/eds it can be difficult to explore the experiences of males with these problems; however, online support groups/message boards, which are common and popular, provide a non-invasive
forum for researchers to conduct research. This study analyzed naturally occurring discussions on an internet message board dedicated to males and eating problems using content analysis. Two major overarching themes of emotional expression (sharing feelings of disturbed eating attitudes and emotions; being secretive) and support (informational and emotional) were identified. The message board provided a vital support system for this group, suggesting that online message boards may be an important avenue for health professionals to provide information, support, and advice.

Reconstructing ethical conduct within financial firms

This chapter explores whether ethical cultures can be created within a financial market context. Ongoing regulatory and legal actions, and press coverage of these, suggest that a definition of ethical problems in terms of ‘rogue traders’ and ‘bad apples’ would be inadequate, since entire business areas have been resorting to collusive illegal behaviour. The concept of ‘bad barrels’ seems to capture the situation rather better: the culture of firms fails to discourage transgression and indeed supports it. Unpacking the links between regulatory objectives and the cultural settings of firms and their employees, this chapter questions the chances of success of measures such as enhanced controls on individuals and restructured reward mechanisms. Financial firms typically have very flat, nodal structures, within which traders conceptualise themselves as an elite, in contrast to back office staff and also in contrast to managers. Traders’ functions and their occupational mobility mean that their linkages and attachments may be much stronger with others outside ‘their’ firm than their firm and those within it. Performance, camaraderie and their linkages are important in all work situations, yet all the more so for traders in financial markets. Thus, whether regulators and senior management combine to send a clear and consistent message to traders – or whether the logic of the financial marketplace leads some firms to continue send conflicting or ambivalent messages to them – misconduct is likely to continue to be a tough nut to crack.

Applying Jackson’s methodological ideal-types: problems of differentiation and classification

In The Conduct of Inquiry in International Relations, Patrick Jackson situates methodologies in International Relations in relation to their underlying philosophical assumptions. One of his aims is to map International Relations debates in a way that ‘capture[s] current controversies’ (p. 40). This ambition is overstated: whilst Jackson’s typology is useful as a clarificatory tool, (re)classifying existing scholarship in International Relations is more problematic. One problem with Jackson’s approach is that he tends to run together the philosophical assumptions which decisively differentiate his methodologies (by stipulating a distinctive warrant for knowledge claims) and the explanatory strategies that are employed to generate such knowledge claims, suggesting that the latter are entailed by the former. In fact, the explanatory strategies which Jackson associates with each methodology reflect conventional practice in International Relations just as much as they reflect philosophical assumptions. This makes it more difficult to identify each methodology at work than Jackson implies. I illustrate this point through a critical analysis of Jackson’s controversial reclassification of Waltz as an analyticist, showing that whilst Jackson’s typology helps to expose inconsistencies in Waltz’s approach, it does not fully support the proposed reclassification. The conventional aspect of methodologies in International Relations also raises questions about the limits of Jackson’s ‘engaged pluralism’.

Emotional and behavioural problems in children with language impairments and children with autism spectrum disorders

Background: Although it is well-established that children with language impairment (LI) and children with autism spectrum disorders (ASD) both show elevated levels of emotional and behavioural problems, the level and types of difficulties across the two groups have not previously been directly compared. Aims: To compare levels of emotional and behavioural problems in children with LI and children with ASD recruited from the same mainstream schools. Methods & Procedures: We measured teacher-reported emotional and behavioural problems using the Strengths and Difficulties Questionnaire (SDQ) in a sample of 5-to-13-year old children with LI (N=62) and children with ASD (N=42) attending mainstream school but with identified special educational needs. Outcomes & Results: Both groups showed similarly elevated levels of emotional, conduct and hyperactivity problems. The only differences between the LI and ASD groups were on subscales assessing peer problems (which were higher in the ASD group) and prosocial behaviours (which were higher in the LI group). Overall, there were few associations between emotional and behavioural problems and child characteristics, reflecting the pervasive nature of these difficulties in children with LI and children with ASD, although levels of problems were higher in children with ASD with lower language ability. However, in the ASD group only, a measure of family social economic status was associated with language ability and attenuated the association between language ability and emotional and behavioural problems. Conclusions & Implications: Children with LI and children with ASD in mainstream school show similarly elevated levels of emotional and behavioural problems, which require monitoring and may benefit from intervention. Further work is required to identify the child, family and situational factors that place children with LI and children with ASD at risk of emotional and behavioural problems, and whether these differ between the two groups. This work can then guide the application of evidence-based interventions to these children.

Parenting style as a moderator of the effect of temperament on adolescent externalising and internatlising behaviour problems

The direct and interactive effects of temperament and parenting were examined in the prediction of early adolescent externalising behaviour problems (conduct disorder and hyperactivity), internalising problems (depression and anxiety), and substance use, using data on 1,402 13- and 14-year-olds. Significant direct effects were found for four temperament factors (negative reactivity, task persistence, activity, and approach), and four parenting factors (warmth, power assertion, physical punishment, and monitoring). For those high in persistence, low in negative reactivity, or low in activity, problem outcomes were generally very rare, regardless of parenting. Prevalence of behaviour problems was generally elevated among those low in persistence, high in negative reactivity, or high in activity, even in cases where parenting was high in positive qualities such as warmth and monitoring. Prevalence of certain behaviour problems was substantially elevated when low persistence, high negative reactivity, or high activity occurred in combination with lower parental warmth or lower monitoring. The results suggest that parenting can play an important moderating role in the relationship of particular temperament characteristics to behavioural problems. [Author abstract]

Development of guidelines for workplace prevention of mental health problems : a Delphi consensus study with Australian professionals and employees

The purpose of the research was to conduct a Delphi expert consensus study (with employer, health professional and employee experts) to develop guidelines for the workplace prevention of mental health problems. A systematic review of websites, books, pamphlets and journal articles was conducted; a 363-item survey developed; and 314 strategies were endorsed as essential or important by at least 80% of all three panels. The endorsed strategies provided information on: creating a positive work environment; reducing job strain; rewarding employee efforts; workplace fairness; provision of supports; supportive change management; provision of training; provision of mental health education; and employee responsibilities.

Parent and family factors associated with service use by young people with mental health problems: a systematic review

AIM: To conduct a systematic review of parent and family factors associated with service use for young people with mental health problems, to inform early intervention efforts aimed at increasing service use by young people. METHODS: A systematic search of academic databases was performed. Articles were included in the review if they had: a sample of young people aged between 5 and 18 years; service use as the outcome measure; one or more parental or family variables as a predictor; and a comparison group of non-service using young people with mental health problems. In order to focus on factors additional to need, the mental health symptoms of the young person also had to be controlled for. Stouffer's method of combining P-values was used to draw conclusions as to whether or not associations between variables were reliable. RESULTS: Twenty-eight articles were identified investigating 15 parental or family factors, 7 of which were found to be associated with service use for a young person with mental health needs: parental burden, parent problem perception, parent perception of need, parent psychopathology, single-parent household, change in family structure and being from the dominant ethnic group for the United States specifically. Factors not found to be related to service use were: family history of service use, parent-child relationship quality, family functioning, number of children, parent education level, parent employment status, household income and non-urban location of residence. CONCLUSIONS: A number of family-related factors were identified that can inform effective interventions aimed at early intervention for mental health problems. Areas requiring further research were also identified.

Better conduct of clinical trials: the control group in critical care trials

OBJECTIVE: To review trial design issues related to control groups. DESIGN: Review of the literature with specific reference to critical care trials. MAIN RESULTS AND CONCLUSIONS: Performing randomized controlled trials in the critical care setting presents specific problems: studies include patients with rapidly lethal conditions, the majority of intensive care patients suffer from syndromes rather than from well-definable diseases, the severity of such syndromes cannot be precisely assessed, and the treatment consists of interacting therapies. Interactions between physiology, pathophysiology, and therapies are at best marginally understood and may have a major impact on study design and interpretation of results. Selection of the right control group is crucial for the interpretation and clinical implementation of results. Studies comparing new interventions with current ones or different levels of current treatments have the problem of the necessity of defining "usual care." Usual care controls without any constraints typically include substantial heterogeneity. Constraints in the usual therapy may help to reduce some variation. Inclusion of unrestricted usual care groups may help to enhance safety. Practice misalignment is a novel problem in which patients receive a treatment that is the direct opposite of usual care, and occurs when fixed-dose interventions are used in situations where care is normally titrated. Practice misalignment should be considered in the design and interpretation of studies on titrated therapies.

Refinement of experimental design and conduct in laboratory animal research.

The scientific literature of laboratory animal research is replete with papers reporting poor reproducibility of results as well as failure to translate results to clinical trials in humans. This may stem in part from poor experimental design and conduct of animal experiments. Despite widespread recognition of these problems and implementation of guidelines to attenuate them, a review of the literature suggests that experimental design and conduct of laboratory animal research are still in need of refinement. This paper will review and discuss possible sources of biases, highlight advantages and limitations of strategies proposed to alleviate them, and provide a conceptual framework for improving the reproducibility of laboratory animal research.

Experimental and statistical investigation of canonical problems in sloshing

En hidrodinámica, el fenómeno de Sloshing se puede definir como el movimiento de la superficie libre de un fluido dentro de un contenedor sometido a fuerzas y perturbaciones externas. El fluido en cuestión experimenta violentos movimientos con importantes deformaciones de su superficie libre. La dinámica del fluido puede llegar a generar cargas hidrodinámicas considerables las cuales pueden afectar la integridad estructural y/o comprometer la estabilidad del vehículo que transporta dicho contenedor. El fenómeno de Sloshing ha sido extensivamente investigado matemática, numérica y experimentalmente, siendo el enfoque experimental el más usado debido a la complejidad del problema, para el cual los modelos matemáticos y de simulación son aun incapaces de predecir con suficiente rapidez y precisión las cargas debidas a dicho fenómeno. El flujo generado por el Sloshing usualmente se caracteriza por la presencia de un fluido multifase (gas-liquido) y turbulencia. Reducir al máximo posible la complejidad del fenómeno de Sloshing sin perder la esencia del problema es el principal reto de esta tesis doctoral, donde un trabajo experimental enfocado en casos canónicos de Sloshing es presentado y documentado con el objetivo de aumentar la comprensión de dicho fenómeno y por tanto intentar proveer información valiosa para validaciones de códigos numéricos. El fenómeno de Sloshing juega un papel importante en la industria del transporte marítimo de gas licuado (LNG). El mercado de LNG en los últimos años ha reportado un crecimiento hasta tres veces mayor al de los mercados de petróleo y gas convencionales. Ingenieros en laboratorios de investigación e ingenieros adscritos a la industria del LNG trabajan continuamente buscando soluciones económicas y seguras para contener, transferir y transportar grandes volúmenes de LNG. Los buques transportadores de LNG (LNGC) han pasado de ser unos pocos buques con capacidad de 75000 m3 hace unos treinta años, a una amplia flota con una capacidad de 140000 m3 actualmente. En creciente número, hoy día se construyen buques con capacidades que oscilan entre 175000 m3 y 250000 m3. Recientemente un nuevo concepto de buque LNG ha salido al mercado y se le conoce como FLNG. Un FLNG es un buque de gran valor añadido que solventa los problemas de extracción, licuefacción y almacenamiento del LNG, ya que cuenta con equipos de extracción y licuefacción a bordo, eliminando por tanto las tareas de transvase de las estaciones de licuefacción en tierra hacia los buques LNGC. EL LNG por tanto puede ser transferido directamente desde el FLNG hacia los buques LNGC en mar abierto. Niveles de llenado intermedios en combinación con oleaje durante las operaciones de trasvase inducen movimientos en los buques que generan por tanto el fenómeno de Sloshing dentro de los tanques de los FLNG y los LNGC. El trabajo de esta tesis doctoral lidia con algunos de los problemas del Sloshing desde un punto de vista experimental y estadístico, para ello una serie de tareas, descritas a continuación, se han llevado a cabo : 1. Un dispositivo experimental de Sloshing ha sido configurado. Dicho dispositivo ha permitido ensayar secciones rectangulares de tanques LNGC a escala con movimientos angulares de un grado de libertad. El dispositivo experimental ha sido instrumentado para realizar mediciones de movimiento, presiones, vibraciones y temperatura, así como la grabación de imágenes y videos. 2. Los impactos de olas generadas dentro de una sección rectangular de un LNGC sujeto a movimientos regulares forzados han sido estudiados mediante la caracterización del fenómeno desde un punto de vista estadístico enfocado en la repetitividad y la ergodicidad del problema. 3. El estudio de los impactos provocados por movimientos regulares ha sido extendido a un escenario más realístico mediante el uso de movimientos irregulares forzados. 4. El acoplamiento del Sloshing generado por el fluido en movimiento dentro del tanque LNGC y la disipación de la energía mecánica de un sistema no forzado de un grado de libertad (movimiento angular) sujeto a una excitación externa ha sido investigado. 5. En la última sección de esta tesis doctoral, la interacción entre el Sloshing generado dentro en una sección rectangular de un tanque LNGC sujeto a una excitación regular y un cuerpo elástico solidario al tanque ha sido estudiado. Dicho estudio corresponde a un problema de interacción fluido-estructura. Abstract In hydrodynamics, we refer to sloshing as the motion of liquids in containers subjected to external forces with large free-surface deformations. The liquid motion dynamics can generate loads which may affect the structural integrity of the container and the stability of the vehicle that carries such container. The prediction of these dynamic loads is a major challenge for engineers around the world working on the design of both the container and the vehicle. The sloshing phenomenon has been extensively investigated mathematically, numerically and experimentally. The latter has been the most fruitful so far, due to the complexity of the problem, for which the numerical and mathematical models are still incapable of accurately predicting the sloshing loads. The sloshing flows are usually characterised by the presence of multiphase interaction and turbulence. Reducing as much as possible the complexity of the sloshing problem without losing its essence is the main challenge of this phd thesis, where experimental work on selected canonical cases are presented and documented in order to better understand the phenomenon and to serve, in some cases, as an useful information for numerical validations. Liquid sloshing plays a key roll in the liquified natural gas (LNG) maritime transportation. The LNG market growth is more than three times the rated growth of the oil and traditional gas markets. Engineers working in research laboratories and companies are continuously looking for efficient and safe ways for containing, transferring and transporting the liquified gas. LNG carrying vessels (LNGC) have evolved from a few 75000 m3 vessels thirty years ago to a huge fleet of ships with a capacity of 140000 m3 nowadays and increasing number of 175000 m3 and 250000 m3 units. The concept of FLNG (Floating Liquified Natural Gas) has appeared recently. A FLNG unit is a high value-added vessel which can solve the problems of production, treatment, liquefaction and storage of the LNG because the vessel is equipped with a extraction and liquefaction facility. The LNG is transferred from the FLNG to the LNGC in open sea. The combination of partial fillings and wave induced motions may generate sloshing flows inside both the LNGC and the FLNG tanks. This work has dealt with sloshing problems from a experimental and statistical point of view. A series of tasks have been carried out: 1. A sloshing rig has been set up. It allows for testing tanks with one degree of freedom angular motion. The rig has been instrumented to measure motions, pressure and conduct video and image recording. 2. Regular motion impacts inside a rectangular section LNGC tank model have been studied, with forced motion tests, in order to characterise the phenomenon from a statistical point of view by assessing the repeatability and practical ergodicity of the problem. 3. The regular motion analysis has been extended to an irregular motion framework in order to reproduce more realistic scenarios. 4. The coupled motion of a single degree of freedom angular motion system excited by an external moment and affected by the fluid moment and the mechanical energy dissipation induced by sloshing inside the tank has been investigated. 5. The last task of the thesis has been to conduct an experimental investigation focused on the strong interaction between a sloshing flow in a rectangular section of a LNGC tank subjected to regular excitation and an elastic body clamped to the tank. It is thus a fluid structure interaction problem.

Impact study on driving by special populations, final report. Volume I - conduct of the project and state of the art.

National Highway Traffic Safety Administration, Washington, D.C.

'Tween you an' I; some little problems of life.

pt. I. Concerning men.--pt. II. Concerning women.

Ethical and professional conduct of medical students: review of current assessment measures and controversies

As medical education increasingly acknowledges the importance of the ethical and professional conduct of practitioners, and moves towards more formal assessment of these issues, it is important to consider the evidence base which exists in this area. This article discusses literature about the health needs and problems experienced by medical practitioners as a background to a review of the current efforts in medical education to promote ethical conduct and develop mechanisms for the detection and remediation of problems.