Characterising illness stages and recovery trajectories of eating disorders in young people via remote measurement technology (STORY): a multi-centre prospective cohort study protocol.

BACKGROUND: Eating disorders (EDs) are serious, often chronic, conditions associated with pronounced morbidity, mortality, and dysfunction increasingly affecting young people worldwide. Illness progression, stages and recovery trajectories of EDs are still poorly characterised. The STORY study dynamically and longitudinally assesses young people with different EDs (restricting; bingeing/bulimic presentations) and illness durations (earlier; later stages) compared to healthy controls. Remote measurement technology (RMT) with active and passive sensing is used to advance understanding of the heterogeneity of earlier and more progressed clinical presentations and predictors of recovery or relapse. METHODS: STORY follows 720 young people aged 16-25 with EDs and 120 healthy controls for 12 months. Online self-report questionnaires regularly assess ED symptoms, psychiatric comorbidities, quality of life, and socioeconomic environment. Additional ongoing monitoring using multi-parametric RMT via smartphones and wearable smart rings ('Oura ring') unobtrusively measures individuals' daily behaviour and physiology (e.g., Bluetooth connections, sleep, autonomic arousal). A subgroup of participants completes additional in-person cognitive and neuroimaging assessments at study-baseline and after 12 months. DISCUSSION: By leveraging these large-scale longitudinal data from participants across ED diagnoses and illness durations, the STORY study seeks to elucidate potential biopsychosocial predictors of outcome, their interplay with developmental and socioemotional changes, and barriers and facilitators of recovery. STORY holds the promise of providing actionable findings that can be translated into clinical practice by informing the development of both early intervention and personalised treatment that is tailored to illness stage and individual circumstances, ultimately disrupting the long-term burden of EDs on individuals and their families.

The nature and frequency of relative clauses in the language children hear and the language children read: A developmental cross-corpus analysis of English complex grammar.

As written language contains more complex syntax than spoken language, exposure to written language provides opportunities for children to experience language input different from everyday speech. We investigated the distribution and nature of relative clauses in three large developmental corpora: one of child-directed speech (targeted at pre-schoolers) and two of text written for children - namely, picture books targeted at pre-schoolers for shared reading and children's own reading books. Relative clauses were more common in both types of book language. Within text, relative clause usage increased with intended age, and was more frequent in nonfiction than fiction. The types of relative clause structures in text co-occurred with specific lexical properties, such as noun animacy and pronoun use. Book language provides unique access to grammar not easily encountered in speech. This has implications for the distributional lexical-syntactic features and associated discourse functions that children experience and, from this, consequences for language development.

Observing maternal sensitivity in a South African township: an exploratory study into behavioral features using different measures.

There is evidence that sensitive responsiveness is manifested differently in varying cultural contexts. This exploratory study examines a sample of 50 South African mothers in the context of a socioeconomically deprived Township, and investigates differences between the Ainsworth sensitivity scale (that does not specify particular manifestations of sensitivity) and the Maternal Behavior Q-sort (MBQ) mini, that assesses a more specified array of behaviors. Results showed a significant but modest association between the two measures, and maternal education was related to the MBQ-mini but not the Ainsworth scores. This pattern of results appears to be due to the higher salience of social games and verbal teaching in the MBQ-mini than in the Ainsworth scale. Such behaviors are less common in South African parenting, where more physical forms of responsiveness seem more typical. A local "South African" sort was developed to capture culture-specific manifestations of sensitivity.

Comparing two measures of maternal sensitivity: goodness of fit with a South African cultural context.

Recent scholarly insights show that nonverbal and subtle forms of sensitive responsiveness are more applicable to describing and assessing non-Western parent-infant interactions than the more extraverted Western varieties of responsiveness. This paper examines whether the original Ainsworth scale (that does not specify particular manifestations of sensitivity) reveals different patterns of results in 50 South African mothers when compared to the Maternal Behavior Q-sort mini that assesses a more specified array of behaviors that may vary in their goodness of fit regarding the cultural context. The analysis reveals that there are key differences in the way the two measures operationalize maternal sensitivity, as seen in the incongruence of sensitivity ratings. The two measures are also shown to relate differently to maternal education and reflective functioning in this sample. The paper concludes that the Ainsworth sensitivity scale is better suited for use in the context of Alexandra Township, Johannesburg.

Fifteen minute consultation: A structured approach to the management of children and adolescents with medically unstable anorexia nervosa.

Assessing and managing children who are underweight is an integral part of paediatric practice. Young people with anorexia nervosa (AN) are mainly cared for in the community by specialist eating disorder services. However, increasing numbers require admission to paediatric wards with medical instability due to the complications of starvation. Despite recommendations published in the junior MARSIPAN report in 2012, many paediatricians still feel poorly equipped to care for these high-risk patients. This article aims to provide a safe and structured approach to the assessment and management of children and adolescents with medically unstable AN.

The Emotional Content of Children's Writing: A Data-Driven Approach.

Emotion is closely associated with language, but we know very little about how children express emotion in their own writing. We used a large-scale, cross-sectional, and data-driven approach to investigate emotional expression via writing in children of different ages, and whether it varies for boys and girls. We first used a lexicon-based bag-of-words approach to identify emotional content in a large corpus of stories (N>100,000) written by 7- to 13-year-old children. Generalized Additive Models were then used to model changes in sentiment across age and gender. Two other machine learning approaches (BERT and TextBlob) validated and extended these analyses, converging on the finding that positive sentiments in children's writing decrease with age. These findings echo reports from previous studies showing a decrease in mood and an increased use of negative emotion words with age. We also found that stories by girls contained more positive sentiments than stories by boys. Our study shows the utility of large-scale data-driven approaches to reveal the content and nature of children's writing. Future experimental work should build on these observations to understand the likely complex relationships between written language and emotion, and how these change over development.

The Effectiveness of Individualized Morphosyntactic Target Identification and Explicit Intervention Using the SHAPE CODING System for Children With Developmental Language Disorder and the Impact of Within-Session Dosage.

PURPOSE: We investigated the effectiveness of a highly individualized morphosyntactic intervention using the SHAPE CODING™ system delivered at different dosages. METHOD: Eight children with developmental language disorder aged 8;0-10;10 (years;months) received 10 hr of explicit individualized intervention for morphosyntax delivered in 30-min individual sessions once per week for 20 weeks. Following at least four baseline probe tests, two grammatical targets per session received explicit instruction until they reached criterion (90%), when the next target was introduced. To control for session length and teaching episode density, either both targets received 20 teaching episodes per session or one target received 10 teaching episodes and the other 30. Maintenance testing of completed targets was also carried out. RESULTS: Scores on probe tests post-intervention were significantly higher than during the baseline phase (d = 1.6) with no change during the baseline or maintenance phases. However, progress during the intervention phase was highly significant. One participant showed significantly faster progress with intervention, while one (with the lowest attention score) made little progress. When considering progress relative to cumulative intervention sessions, progress was faster with 30 teaching episodes per session and slower with 10. However, when cumulative teaching episodes were used as the predictor, all three within-session dosages showed very similar rates of progress, with the odds of a correct response increasing by 3.9% for each teaching episode. The targets that were achieved required an average of 40-60 teaching episodes. CONCLUSIONS: With the exception of one participant, the individualized intervention was highly effective and efficient. Thus, the individualized target identification process and intervention method merit further research in a larger group of children. The cumulative number of teaching episodes per target provided across sessions appeared to be key. Thus, clinicians should aim for high teaching episode rates, particularly if the number of sessions is constrained. Otherwise, intervention scheduling can be flexible. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25996168.

Ventilatory function in children with severe motor disorders using night-time postural equipment.

AIM: Night-time postural equipment (NTPE) can prevent hip subluxation in children with severe motor disorders (SMDs). However, it is unclear how it affects ventilatory function. The aims of the study were to determine how NTPE use affects ventilatory function and to compare night-to-night variability of ventilatory function in children with SMDs and typically developing healthy children. METHOD: Fifteen NTPE users (six males, nine females), aged 1 to 19 years (mean age 8y 7mo) alternated sleep condition between NTPE and sleeping unsupported for 14 nights. In all but two participants, gross motor function was classified as Gross Motor Function Classification System (GMFCS) level V; in the other two it was level IV. Oxyhaemoglobin saturation (SpO2 ) was monitored each night and transcutaneous CO2 (PtcCO2 ) for one night in each sleep condition. In 17 healthy children of similar age, home SpO2 only was monitored for seven nights. RESULTS: In 13 of 15 NTPE users and 12 of the 17 typically developing children, SpO2 monitoring was satisfactorily completed. Of the children with SMDs, two had mean SpO2 levels below the treatment threshold for supplemental oxygen, which was uniquely associated with use of NTPE in only one participant, and three had nocturnal hypoventilation, which was uniquely associated with NTPE use in only one case. Night-to-night SpO2 variability was higher in children with SMDs than in typically developing children. INTERPRETATION: NTPE may impair or enhance ventilatory function in a minority of children. Owing to night-to-night variability in SpO2 , at least three nights of monitoring are recommended to determine optimal positioning for effective ventilation before and after NTPE introduction.

Reflective supervision: The symbolic hands that hold.

Nonprofit organizations, providing psychotherapy services in community-based settings, are often faced with the tensions inherent in both ensuring quality services while limiting program costs. The same is true in private and public health care settings, where services regularly navigate cost reductions and budget cuts. At the Ububele Educational and Psychotherapy Trust, an nonprofit organization in South Africa, reflective supervision is seen as a critical component for effective, ethically sound, and culturally sensitive intervention despite competition for financial resources. This article will provide an overview of the organization's reflective supervision model, motivating for the need to prioritize reflective supervision for frontline staff. It also provides a case example, to demonstrate the value of reflective supervision for promoting practitioner reflexivity and preventing practitioner burnout in a highly traumatized environment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Finding the man amongst many: A developmental perspective on mechanisms of morphological decomposition.

Skilled reading is characterized by rapid recognition of morphologically complex words. Evidence suggests that adult readers segment complex words into their constituent morphemes during visual word recognition, and that this extends to items that have only a surface morphological structure (e.g., corner), a process termed 'morpho-orthographic segmentation'. It is not yet known how and when this mechanism is established over the course of reading development, although data from English-speaking children suggest that it may be a relatively late-acquired milestone. The purpose of this study was to examine for the first time the mechanisms driving morphological processing across late childhood and adolescence. A cross-sectional sample of 204 children and adolescents from South-East England, ranging in age from 9 to 18 years (M age = 13.74 years, SD = 2.68; 110 female), completed a visual masked prime lexical decision task using three sets of prime-target pairs: morphological (e.g., teacher - TEACH), pseudomorphological (sharing an apparent morphological relationship in the absence of a semantic relationship, e.g., corner - CORN), and form (sharing an orthographic relationship only, e.g., window - WIND). Linear mixed effects models revealed both morphological and pseudomorphological priming in the absence of form priming, with priming magnitude increasing in line with age, and stronger evidence of morpho-orthographic segmentation emerging in line with word reading efficiency. Our findings reveal advances in the reading system during adolescence which may reflect accumulated exposure to regularities in the writing system, facilitating rapid access to meaning from print.

From Uganda to Baltimore to Alexandra Township: How far can Ainsworth's theory stretch?

INTRODUCTION: After extensive observation of mother-infant dyads in two diverse contexts, Ainsworth developed the construct of maternal sensitivity to explain the nature of mother-infant interactions that lead to infant attachment security. She believed this construct to be universally applicable. Since Ainsworth's publications, her theory has been adapted and extended, particularly by theorists working in North American and Western European countries. These developments have been largely uninterrogated in relation to their universal cultural relevance, despite the fact that parenting practices differ greatly across cultural groups. Those who have begun to interrogate the cultural universality of current conceptualisation of maternal sensitivity highlight important areas of cultural disagreement. METHOD: This article provides a critical theoretical argument regarding the cultural universality of maternal sensitivity, extending comment to the cultural and contextual relevance of developments in its operationalisation. RESULTS: Particular aspects of current theoretical and operational use of the construct of maternal sensitivity that are potentially culturally specific (as opposed to culturally universal) are noted, namely the inclusion of positive affect, the centrality of parent-infant play, verbal responsiveness, the inclusion of learning in parent-infant interactions and the shift towards a more proactive (rather than reactive) role for the parent in parent-infant interactions. CONCLUSION: This article suggests that the evolution of the concept of maternal sensitivity has failed to account for cultural differences.

Morphological effects in visual word recognition: Children, adolescents, and adults.

The process by which morphologically complex words are recognized and stored is a matter of ongoing debate. A large body of evidence indicates that complex words are automatically decomposed during visual word recognition in adult readers. Research with developing readers is limited and findings are mixed. This study aimed to investigate morphological decomposition in visual word recognition using cross-sectional data. Participants (33 adults, 36 older adolescents [16 to 17 years], 37 younger adolescents [12 to 13 years], and 50 children [7 to 9 years]) completed a timed lexical-decision task comprising 120 items (60 nonwords and 60 real word fillers). Half the nonwords contained a real stem combined with a real suffix (pseudomorphemic nonwords, e.g., earist); the other half used the same stems combined with a nonmorphological ending (control nonwords, e.g., earilt). All age groups were less accurate in rejecting pseudomorphemic nonwords than control nonwords. Adults and older adolescents were also slower to reject pseudomorphemic nonwords compared with control nonwords, but this effect did not emerge for the younger age groups. These findings demonstrate that, like adults, children and adolescents are sensitive to morphological structure in online visual word processing, but that some important changes occur over the course of adolescence. (PsycINFO Database Record

The Effect of the Timing of Radiotherapy on Clinical and Patient-Reported Outcomes After Latissimus Dorsi Breast Reconstruction: A 10-Year Study.

BACKGROUND: Breast reconstruction (BR) is considered to be adversely affected by radiotherapy (RT), particularly when an implant is used. The aim of this study was to compare clinical and patient-reported outcomes after expander-assisted latissimus dorsi breast reconstruction depending on the timing of RT. METHODS: Patients undergoing BR over a 10-year period (follow-up mean, 56 [14-134] months) were divided into 3 groups. Group 1, RT after mastectomy and BR, Group 2, RT before mastectomy and BR, and Group 3, RT after mastectomy but before BR. The primary endpoints were early and late surgical interventions. Validated questionnaires were circulated to all study patients and matched controls. RESULTS: Three hundred thirteen patients underwent 389 BRs. One hundred eighteen patients received RT, of which 65 had undergone expander-assisted latissimus dorsi breast reconstruction. Both use and timing of RT influenced clinical outcomes. Overall, use of RT resulted in a 3-fold increase in complications (P = 0.003). Postreconstruction RT resulted in more than double the number of complications compared with prereconstruction RT (P = 0.008) and delaying BR until after mastectomy and RT reduced complications to levels observed in control patients (P = nonsignificant). Complications were halved in patients undergoing autologous LD reconstruction (P = 0.0001). Patient-reported outcomes were similar for emotional well-being, satisfaction, and shoulder symptoms, although a nonsignificant increase in chronic breast symptoms was reported by the RT group. CONCLUSION: The timing and type of LD reconstruction chosen by patients receiving RT has a significant impact on the risk of subsequent complications and unplanned interventions but has little impact on longer term patient well-being or satisfaction.

Structural requirements for the interaction of sheep insulin-like factor 3 with relaxin receptors in rat atria.

Relaxin is a peptide with various reproductive and nonreproductive functions. The site for the peptide-receptor interaction contains two arginines (Arg) and an isoleucine (Ile) or valine (Val) residue in the B-chain with a configuration of -Arg-X-X-X-Arg-X-X-Ile/Val-X-. The sheep insulin-like peptide 3 (INSL3), a structural homologue of relaxin, also contains the n, n+4 arginines in the B-chain but they are displaced towards the carboxyl terminus by four residues (-X-X-X-X-Arg-X-X-Val-Arg-). Human INSL3 increases the activity of human relaxin in mouse bioassays. Here, we investigated whether sheep synthetic INSL3 affects the relaxin activity in rat atria. INSL3 lacked relaxin-like agonist activity but blocked the activity of relaxin and competed for relaxin binding sites at high concentrations. We also synthesized analogues of INSL3, with amino acid substitutions in the arginine-binding region. Analogues A, D and E, which have the arginines in positions identical to relaxin, showed weak relaxin-like agonist activity. These results suggest that other sites in the relaxin molecule are involved in high-affinity peptide-receptor interaction for the production of the relaxin biological responses.

Relaxin-like bioactivity of ovine Insulin 3 (INSL3) analogues.

Relaxin is an insulin-like peptide consisting of two separate chains (A and B) joined by two inter- and one intrachain disulfide bonds. Binding to its receptor requires an Arg-X-X-X-Arg-X-X-Ile motif in the B-chain. A related member of the insulin superfamily, INSL3, has a tertiary structure that is predicted to be similar to relaxin. It also possesses an Arg-X-X-X-Arg motif within its B-chain, although this is displaced by four amino acids towards the C-terminus from the corresponding position within relaxin. We have previously shown that synthetic INSL3 itself does not display relaxin-like activity although analogue (Analogue A) with an introduced arginine residue in the B-chain giving it an Arg cassette in the exact relaxin position does possess weak activity. In order to identify further the structural features that impart relaxin function, solid phase peptide synthesis was used to prepare three additional analogues for bioassay. Each of these contained point substitutions within the arginine cassette. Analogue D contained the full human relaxin binding cassette, Analogue G consisted of the native INSL3 sequence containing an Arg to Ala substitution, and Analogue E was a further modification of Analogue A, with the same substitution. Each analogue was fully chemically characterized by a number of criteria. Detailed circular dichroism spectroscopy analyses showed that the changes caused little alteration of secondary structure and, hence, overall conformation. However, each analogue displayed only weak relaxin-like activity. These results indicate that while the arginine cassette is vital for relaxin-like activity, there are additional, as yet unidentified structural requirements for relaxin binding.

Human relaxin gene 3 (H3) and the equivalent mouse relaxin (M3) gene. Novel members of the relaxin peptide family.

We have identified a novel human relaxin gene, designated H3 relaxin, and an equivalent relaxin gene in the mouse from the Celera Genomics data base. Both genes encode a putative prohormone sequence incorporating the classic two-chain, three cysteine-bonded structure of the relaxin/insulin family and, importantly, contain the RXXXRXX(I/V) motif in the B-chain that is essential for relaxin receptor binding. A peptide derived from the likely proteolytic processing of the H3 relaxin prohormone sequence was synthesized and found to possess relaxin activity in bioassays utilizing the human monocytic cell line, THP-1, that expresses the relaxin receptor. The expression of this novel relaxin gene was studied in mouse tissues using RT-PCR, where transcripts were identified with a pattern of expression distinct from that of the previously characterized mouse relaxin. The highest levels of expression were found in the brain, whereas significant expression was also observed in the spleen, thymus, lung, and ovary. Northern blotting demonstrated an approximately 1.2-kb transcript present in mouse brain poly(A) RNA but not in other tissues. These data, together with the localization of transcripts in the pars ventromedialis of the dorsal tegmental nucleus of C57BLK6J mouse brain by in situ hybridization histochemistry, suggest a new role for relaxin in neuropeptide signaling processes. Together, these studies describe a third member of the human relaxin family and its equivalent in the mouse.