The impact of the "Attachment and Biobehavioural Catch-Up" program on attachment related parent behavior-A systematic review.

"Attachment and Biobehavioural Catch-Up" (ABC) is a 10 session home visiting program, grounded in attachment theory. It aims to improve child emotion regulation, attachment and behavioral outcomes through changing caregivers' attachment related behaviors. There is increasing evidence with respect to the effectiveness of ABC in producing positive child outcomes, but the intervention's direct effect on parent outcomes remains unclear. This review examined the association of ABC with attachment related parent outcomes. The PubMed, EMBASE, PyschINFO and SCOPUS databases were searched for relevant studies in August 2021, and again in April 2022. The eligibility criteria for included studies were (1) infants aged 0-27 months at time of the ABC intervention, (2) "at risk" parents, (3) controlled trials published in peer-reviewed journals and (4) utilized a measure of attachment related parent outcomes. Eleven eligible studies were included. The findings showed ABC had a significant small to medium effect on a variety of attachment related parent outcomes among parents presenting with multiple psychosocial risk factors. "Sensitivity" was measured most frequently, with small to medium main effect sizes recorded at follow-up, compared to controls. Implications for the clinical effectiveness of the ABC program in community settings are discussed. Future research should clarify who ABC is most effective for and how it compares to similar interventions.

"El Alcance de Afectividad y Biocounducta" (ABC) es un programa de visita a casa en 10 sesiones, fundamentado en la teoría de la afectividad. Su meta es mejorar en el niño los resultados de la regulación de la emoción, de afectividad y de comportamiento por medio de cambiar el comportamiento relacionado con la afectividad de quien presta el cuidado. La evidencia con respecto a la eficacia de ABC para producir resultados positivos en el niño va en aumento, pero el efecto directo de la intervención sobre el resultado en el progenitor aún no está claro. Esta revisión examinó la asociación entre ABC y los resultados en el progenitor relacionados con la afectividad. Se investigaron los bancos de datos PubMed, EMBASE, PyschINFO y SCOPUS en agosto de 2021 en busca de estudios relevantes, lo cual se hizo otra vez en abril de 2022. Los criterios para elegir los estudios que se incluirían fueron (1) infantes de edad entre 0 y 27 meses al momento de la intervención ABC, (2) progenitores "bajo riesgo," (3) ensayos controlados publicados en revistas de aceptación profesional rigurosa y (4) la utilización de una medida de afectividad relacionada con los resultados en el progenitor. Se incluyeron once estudios que reunían los criterios. Lo que encontramos mostró que ABC tenía un efecto entre significativamente pequeño y medio en cuanto a una variedad de afectividad relacionada con los resultados en el progenitor entre progenitores que presentaban múltiples factores de riesgo sicosociales. La "sensibilidad" fue medida con mayor frecuencia, con anotación de la dimensión de los efectos de pequeños a medianos al momento del seguimiento, en comparación con el grupo de control. Se discuten las implicaciones para la eficacia clínica de ABC en la comunidad. La investigación futura debe aclarar para quién es ABC más eficaz y cómo se compara con intervenciones similares.

"L'attachement et le rattrapage bio-comportemental" (Attachment and Biobehavioural Catch-Up, soit ABC) est un programme de visite à domicile de 10 sessions, basé sur la théorie de l'attachement. Il a pour but d'améliorer la régulation de l'émotion de l'enfant, l'attachement et les résultats de comportement en changeant les comportements liés à l'attachement de la personne prenant soin du bébé. On a de plus en plus de données pour ce qui concerne l'efficacité de l'ABC à donner des résultats positifs pour l'enfant, mais l'effet direct de l'intervention sur le résultat parental n'est pas très clair. Ce compte-rendu a examiné le lien de l'ABC avec les résultats d'attachement liés au parent. Les bases de données PubMed, EMBASE, PyschINFO et SCOPUS ont fait l'objet d'une recherche pour des études pertinentes à ce sujet en août 2021 et à nouveau en avril 2022. Les critères d'éligibilité pour les études inclues ont été (1) bébés âgés de 0-27 mois au moment de l'intervention ABC, (2) parents "à risque", (3) essais contrôlés publiés dans des publications à comité de lecture et (4) ayant utilisé une mesure d'attachement liée aux résultats du parent. Onze études éligibles ont été inclues. Les résultats ont montré que l'ABC avait un effet relativement petit à moyen sur plusieurs résultats du parent liés à l'attachement chez les parents présentant plusieurs risques psychosociaux. La "sensibilité" a été mesurée le plus fréquemment, avec des tailles d'effet de petit à moyen enregistrées au suivi, comparés aux contrôles. Les implications pour l'efficacité clinique de l'ABC dans un contexte de communauté sont discutées. Les recherches futures devraient clarifier pour qui l'ABC est le plus efficace et comment on peut le comparer à des interventions similaires.

Rasch Analysis of the Independent Mobility Questionnaire.

PURPOSE: The Independent Mobility Questionnaire (IMQ) assesses participants' perceived ability for independent mobility. However, it has not been validated in a severely visually impaired population. The aim of this study was to explore the IMQ's psychometric properties in participants with severe visual impairment. METHODS: This was a cross-sectional study of 40 participants with retinitis pigmentosa (better eye visual acuity <20/200 and/or visual field <10%). The key psychometric properties of the IMQ were examined using Rasch analysis, including precision, targeting, and item fit. Construct validity was assessed by testing the correlation between the IMQ and the Mobility and Independence subscale of the Impact of Vision Impairment questionnaire (Pearson correlation coefficient, r). Criterion validity was also assessed. RESULTS: The IMQ had excellent precision (Person Separation Index, 3.01) with the capacity to distinguish at least four strata of participant ability, and item difficulty was well targeted to participant ability (difference between mean person and item measures, -0.21). Items 34, 35, 21, and 14 displayed misfit (infit MnSq >1.4); however, given our sample size restrictions, these items were not removed from the analysis. The IMQ had good construct validity (moderate correlation with the Impact of Vision Impairment Mobility subscale, r = 0.595, p < 0.05) but did not demonstrate criterion validity. CONCLUSIONS: The psychometric properties of the IMQ were promising. Our findings are useful for researchers evaluating the effectiveness of novel treatment technologies on mobility in a severely visually impaired population from the participant's perspective. However, further validation studies in larger samples are required to confirm our results.

Developing a Very Low Vision Orientation and Mobility Test Battery (O&M-VLV).

PURPOSE: This study aimed to determine the feasibility of an assessment of vision-related orientation and mobility (O&M) tasks in persons with severe vision loss. These tasks may be used for future low vision rehabilitation clinical assessments or as outcome measures in vision restoration trials. METHODS: Forty legally blind persons (mean visual acuity logMAR 2.3, or hand movements) with advanced retinitis pigmentosa participated in the Orientation & Mobility-Very Low Vision (O&M-VLV) subtests from the Low Vision Assessment of Daily Activities (LoVADA) protocol. Four categories of tasks were evaluated: route travel in three indoor hospital environments, a room orientation task (the "cafe"), a visual exploration task (the "gallery"), and a modified version of the Timed Up and Go (TUG) test, which assesses re-orientation and route travel. Spatial cognition was assessed using the Stuart Tactile Maps test. Visual acuity and visual fields were measured. RESULTS: A generalized linear regression model showed that a number of measures in the O&M-VLV tasks were related to residual visual function. The percentage of preferred walking speed without an aid on three travel routes was associated with visual field (p < 0.01 for all routes) whereas the number of contacts with obstacles during route travel was associated with acuity (p = 0.001). TUG-LV task time was associated with acuity (p = 0.003), as was the cafe time and distance traveled (p = 0.006 and p < 0.001, respectively). The gallery score was the only measure that was significantly associated with both residual acuity and fields (p < 0.001 and p = 0.001, respectively). CONCLUSIONS: The O&M-VLV was designed to capture key elements of O&M performance in persons with severe vision loss, which is a population not often studied previously. Performance on these tasks was associated with both binocular visual acuity and visual field. This new protocol includes assessments of orientation, which may be of benefit in vision restoration clinical trials.

Multidisciplinary rehabilitation following botulinum toxin and other focal intramuscular treatment for post-stroke spasticity.

BACKGROUND: Spasticity may affect stroke survivors by contributing to activity limitations, caregiver burden, pain and reduced quality of life (QoL). Spasticity management guidelines recommend multidisciplinary (MD) rehabilitation programmes following botulinum toxin (BoNT) treatment for post-stroke spasticity. However, the evidence base for the effectiveness of MD rehabilitation is unclear. OBJECTIVES: To assess the effectiveness of MD rehabilitation, following BoNT and other focal intramuscular treatments such as phenol, in improving activity limitations and other outcomes in adults and children with post-stroke spasticity. To explore what settings, types and intensities of rehabilitation programmes are effective. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (February 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 12), MEDLINE (1948 to December 2011), EMBASE (1980 to January 2012), CINAHL (1982 to January 2012), AMED (1985 to January 2012), LILACS (1982 to September 2012), PEDro, REHABDATA and OpenGrey (September 2012). In an effort to identify further published, unpublished and ongoing trials we searched trials registries and reference lists, handsearched journals and contacted authors. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared MD rehabilitation (delivered by two or more disciplines in conjunction with medical input) following BoNT and other focal intramuscular treatments for post-stroke spasticity with placebo, routinely available local services, or lower levels of intervention; or studies that compared MD rehabilitation in different settings, of different types, or at different levels of intensity. We excluded RCTs that assessed the effectiveness of unidisciplinary therapy (for example physiotherapy only) or a single modality (for example stretching, casting, electrical stimulation or splinting only). The primary outcomes were validated measures of activity level (active and passive function) according to the World Health Organization's International Classification of Functioning, Disability and Health. Secondary outcomes included measures of symptoms, impairments, participation, QoL, impact on caregivers and adverse events. DATA COLLECTION AND ANALYSIS: We independently selected the trials, extracted data, and assessed methodological quality using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Due to the limited number of included studies, with clinical, methodological and statistical heterogeneity, quantitative meta-analysis was not possible. Therefore, GRADE provided qualitative synthesis of 'best evidence'. MAIN RESULTS: We included three RCTs involving 91 participants. All three studies scored 'low quality' on the methodological quality assessment, implying high risk of bias. All studies investigated various types and intensities of outpatient rehabilitation programmes following BoNT for upper limb spasticity in adults with chronic stroke. Rehabilitation programmes included: modified constraint-induced movement therapy (mCIMT) compared with a neurodevelopmental therapy programme; task practice therapy with cyclic functional electrical stimulation (FES) compared with task practice therapy only; and occupational, manual therapy with dynamic elbow extension splinting compared with occupational therapy only. There was 'low quality' evidence for mCIMT improving upper limb motor function and spasticity in chronic stroke survivors with residual voluntary upper limb activity, up to six months, and 'very low quality' evidence for dynamic elbow splinting and occupational therapy reducing elbow range of movement at 14 weeks. Task practice therapy with cyclic FES did not improve upper limb function more than task practice therapy alone, only at 12 weeks. No studies addressed interventions in children and those with lower limb spasticity, or after other focal intramuscular treatments for spasticity. AUTHORS' CONCLUSIONS: At best there was 'low level' evidence for the effectiveness of outpatient MD rehabilitation in improving active function and impairments following BoNT for upper limb spasticity in adults with chronic stroke. No trials explored the effect of MD rehabilitation on 'passive function' (caring for the affected limb), caregiver burden, or the individual's priority goals for treatment. The optimal types (modalities, therapy approaches, settings) and intensities of therapy for improving activity (active and passive function) in adults and children with post-stroke spasticity, in the short and longer term, are unclear. Further research is required to build evidence in this area.

Process-relevant concentrations of the leachable bDtBPP impact negatively on CHO cell production characteristics.

The biopharmaceutical industry has invested considerably in the implementation of single-use disposable bioreactors in place of or in addition to their stainless steel-counterparts. This new wave of construction materials for disposable bioprocess containers encompass a plethora of uncharacterized secondary compounds that, when in contact with the culture media, can leach, contaminating the bioprocess. One such cytotoxic leachable already receiving attention is bis(2,4-di-tert-butylphenyl)-phosphate (bDtBPP), a breakdown product of the secondary antioxidant Irgafos 168 in polyethylene-film based bags. This compound has been demonstrated to inhibit cell growth at concentrations ranging from 0.12 to 0.73 mg/L across an array of cell lines. Here we demonstrate that a further two CHO cell lines exhibit sensitivity to bDtBPP exposure at concentrations lower than that previously reported (0.035-0.1 mg/L). Furthermore, these inhibitory concentrations reflect bDtBPP levels found to leach early into the bioprocess, exposing reactor inoculums to serious risk. Quantitative label-free LC-MS/MS revealed that irrespective of cell line or concentration of bDtBPP, 8 proteins were found to be commonly differentially expressed in response to exposure to the compound highlighting biological processes related to cellular stress. Although the glycoprofile of the recombinant antibody remains primarily unchanged, we demonstrate that this compound when spiked at meaningful concentrations 72 h into culture considerably reduces the maximum cell density achieved. Studies like this reinforce the requirement for the complete characterization of all potential leachable compounds from disposable materials to assess their risk not only to the patient but also to the production pipeline itself. © 2016 American Institute of Chemical Engineers Biotechnol. Prog., 32:1547-1558, 2016.

Developing an instrumental activities of daily living tool as part of the low vision assessment of daily activities protocol.

PURPOSE: To determine the validity, reliability, and measurement characteristics using factor and Rasch analysis of the Very Low Vision Instrumental Activities of Daily Living (IADL-VLV) in persons with severe vision loss. METHODS: From an initial pool of 296 tasks, 25 were shortlisted after conducting a Delphi survey with persons designated legally blind. Using further input from occupational therapy and low-vision professionals, 11 activities were chosen to be pilot tested. Forty legally blind participants (better eye visual acuity < 20/200) underwent clinical assessments and functional tests as well as the 53 IADL tasks related to the 11 activities. The task pool was refined and condensed using factor and Rasch analysis. RESULTS: Based on iterative principal component analyses, tasks were grouped together into the following domains: reading signs/information access, signature placement, clothes sorting, shelf search, gesture recognition, clock reading, and table search. A final selection of 23 tasks yielded satisfactory measurement characteristics, differentiated between at least four different levels of IADL performance (person separation of 3.8), and had adequate task difficulty for the tested sample (person mean -0.61). In multivariate analyses, only visual acuity (VA) and percent of remaining visual field (VF) were associated with IADL performance. CONCLUSIONS: Using a large item pool, participant, and expert input, as well as factor and Rasch analysis, we designed a valid and reliable assessment to measure vision-related IADL performance in persons with severe vision loss. This assessment tool can be used in clinical sight restoration trials.