A work in progress: William Bateson's vibratory theory of repetition of parts.

In 1891 Cambridge biologist William Bateson (1861-1926) announced his idea that the symmetrical segmentation in living organisms resulted from energy peaks of some vibratory force acting on tissues during morphogenesis. He also demonstrated topographically how folding a radially symmetric organism could produce another with bilateral symmetry. Bateson attended many lectures at the Cambridge Philosophical Society and viewed mechanical models prepared by eminent physicists that illustrated how vibrations affected materials. In his subsequent research, Bateson utilized analogies and metaphors based upon his observations of nature to build a thought model on the effects of vibrations on living tissue, because he realized that the chemistry and biology of his day lacked technologies to perform actual experiments on the subject. He concluded the production of organic segmentation was both a chemical and mechanical phenomenon. By the time of his death Bateson had incorporated new ideas about embryonic organizer regions to suggest a center from which a rhythmic force emanated and then produced the observed repetitive segmentation as a common feature in living organisms.

The Tyranny of Distance: The Treatment and Prevention of Diphtheria in Middle Canada, 1894-1920.

Before 1900, diphtheria was a deadly infection in Canadian children. Clinical trials in Europe demonstrated that "antitoxin" decreased mortality of the disease. Canadian physicians first utilized the new medication in 1894 and found it most efficacious when administered early in the illness. Two factors hindered the widespread application of the new medication. Imported antitoxin was expensive, and physicians frequently purchased it themselves rather than let their patients expire. In 1916, Connaught Laboratories in Toronto began domestic production of antitoxin, and provincial governments eventually provided access to the life-saving medication for all citizens. The vast distances between families and physicians in rural districts also made it impossible to access the antitoxin before sick children were beyond hope. During the 1920s, a public health program began to actually prevent diphtheria. Ten years of experience in many regions demonstrated the efficacy of immunization as mortality from diphtheria declined to almost zero.

Cambridge geneticists and the chromosome theory of inheritance: William Bateson, Leonard Doncaster and Reginald Punnett 1879-1940.

Early in the 20th century Bateson, Doncaster and Punnett formed a cooperative collective to share research findings on the chromosome theory of heredity (CTH). They cross-bred plants and animals to correlate behaviour of chromosomes and heredity of individual traits. Doncaster was the most enthusiastic proponent of the new theory and worked for years to convince Bateson and Punnett on its relevance to their own research. The two younger biologists collaborated with Bateson, the preeminent geneticist in England. As their own reputations developed, their research findings allied with the consensus on the importance of the CTH by the broader scientific community. After Doncaster's tragic death in 1920, major objections to the theory had been resolved; Bateson and Punnett then utilized the CTH to construct chromosome maps detailing locations of specific genes on particular chromosomes in several different species. The marriage of heredity and cytology enhanced confidence that the theory was an accurate mechanism to explain inheritance in both plants and animals.

Counting human chromosomes before 1960: preconceptions, perceptions and predilections.

In 1956 the biomedical world was surprised to hear a report that human cells each contained forty six chromosomes, rather than the forty eight count that had been documented since the 1920s. Application of available techniques to culture human cells in vitro, halt their division at metaphase, and disperse chromosomes in an optical plane permitted perception of visual images not seen before. Researchers continued to obtain the preconceived forty eight counts until reeducation with these novel epistemic 'chromosomes' convinced them that they could confidently report forty six chromosomes per cell. Within only a few years, and virtually without dissent, the social community of human cytogeneticists agreed upon a shared visual culture of human chromosome count and morphology. The initial forty six count proved not to be an anomaly. A new comparison of historical and ethnomethodological studies has suggested a better understanding of how applied technologies coupled with altered human perceptions established a new science. Human cytogenetics then collaborated with medical genetics to correlate changes in the new human karyotype with disorders of clinical significance.

Infant domestic adoption: outcomes at mid-life.

BACKGROUND: Adoption studies can cast light on environmental influences on development, but heterogeneity in preplacement experiences often complicates interpretation of findings. METHODS: We studied infant-adopted samples drawn from the 1958 and 1970 British birth cohorts and examined mental health, well-being, physical health and externalizing outcomes at mid-life. Outcomes for adopted cohort members were compared with those of (a) individuals raised in two biological parent families ('general population' comparisons) and (b) birth comparison groups of other nonadopted children from similar circumstances at birth. RESULTS: In both cohorts, to-be-adopted children shared early characteristics in common with birth comparison children, but were placed in more socially advantaged adoptive homes. Followed to mid-life, there were few group differences on indicators of physical health or psychological well-being. Levels of psychological distress were comparable in the adopted and general population samples in both cohorts, and more favourable than in the birth comparison groups among women in the 1958 cohort; more beneficial childhood family circumstances contributed to these differences. Rates of adult externalizing outcomes were comparable in the adopted and birth comparison groups in both cohorts, and higher than in the general population samples; indicators of maternal and prenatal exposures contributed to these differences. CONCLUSIONS: Rearing in adoptive homes may provide protective effects in relation to internalizing problems but may not be as protective in relation to externalizing outcomes.

"Whatever Works": Innovations in the Treatment of Hemophilia in the United States 1783-1950.

Treatment of the bleeding disorder hemophilia in the nineteenth century was empirical, based on clinical experience. Medications, transfusions of human or animal blood, and injections of blood sera were utilized in an attempt to halt life-threatening hemorrhages. After 1900, the application of clinical laboratory science facilitated the utilization of anti-coagulated blood and donor blood compatibility tests for safer emergency transfusions. But repeated transfusions produced blood incompatibility that limited future utilization. Investigation of hormones and snake venom as coagulants appeared hopeful during the 1930s, but plasma globulin research during World War II resulted in the isolation of antihemophilic factors that promptly reduced hemorrhage. Their application to bleeding episodes resulted in a more normal life for hemophiliacs after 1950.

Is Early Experience Destiny? Review of Research on Long-Term Outcomes following International Adoption with Special Reference to the British Chinese Adoption Study.

The pathway from adverse early experience to adulthood for internationally adopted children is complex in identifying key influences, impacts, and outcomes. This review arose from the authors' involvement in the British Chinese Adoption Study, a recent outcomes study that explored the links between early orphanage care, adoptive experiences, and midadulthood. It differs from previous reviews in focusing on a greater length of time since adoption. Both quantitative and qualitative studies were included to allow for examination of a fuller range of adult-related outcomes rather than mental health scores alone. The sampling, methods, and results of reviewed articles are summarised and a critical commentary is provided. Despite methodological differences and identified strengths and weaknesses, conclusions are drawn on the basis of the evidence available. Special attention is paid to the interpretation of negative outcomes. Findings identify areas that should be explored further in order to gain a fuller understanding of midlife outcomes of people who experienced a poor start in life followed by international adoption. Such studies help in refining lifespan developmental theories.

[The outcomes of Adoption in the Case of the "British Chinese Adoption Study"]. / Die Auswirkungen von Adoption am Beispiel der "British Chinese Adoption Study.

Practitioners can over-estimate the incidence of problems in adopted children and adults because they do not see those who make good psychological and social adjustments. Research into adoption outcomes can be hard to interpret without information about differing pre-adoption histories. Examples are given of research into three types of adoption: domestic infant adoption, adoptions from public care of maltreated children and international adoption of ex-orphanage children. Although negative outcomes are indisputably evident for some, recovery from adversity is more common than many would predict. It is important to recognize that subsequent nurturing in consistent and stimulating environments can build a platform for effective adaptations to challenges in the future. However, a proper understanding of the consequences of adoption has been limited by the fact that follow-up studies have rarely extended beyond adolescence and early adulthood. The British Chinese Adoption Study is a 50 year follow-up of orphanage girls internationally adopted into the United Kingdom, and is given as an example of good outcomes despite early years of adversity. Scores on mental health assessments were equivalent to the non-adopted, age-matched comparison group of UK women. Most of the women were rated as "good functioning" and educational achievements were many times higher than the comparison women. Life-long adverse effects are not inevitable following early adversity. Improved circumstances can promote recovery and good adult adjustment. Practice and research implications are discussed.

The British Chinese Adoption Study: orphanage care, adoption and mid-life outcomes.

BACKGROUND: While studies of ex-orphanage care show adverse effects on development, the longer-term impact on mid-life psychosocial functioning and physical health has not been established. METHODS: Orphanage records provided baseline data on a sample of 100 Hong Kong Chinese girls who were subsequently adopted into the UK. A mid-life follow-up using standardised questionnaires and face-to-face interviews assessed current circumstances, life satisfaction and mental and physical health outcomes. Comparisons were made with age-matched UK-born adopted and nonadopted women. RESULTS: Half the group spent between 1 and 2 years in orphanages, average age at adoptive placement was 23 months and 72% participated in the follow-up. Despite this poor early start, mid-life outcomes were commensurate with the comparison groups in terms of mental and physical health measures. Serious psychiatric and social difficulties were largely absent. Although the timing and extent of exposure to orphanage care did not influence outcome, participants' reports of poorer quality adoptive family experience and a negative view of their adoption were significantly associated with poorer mental health outcomes (difference in means = 0.76, 95% CI 1.33-0.19, p = .01; difference in means = 1.2, 95% CI 0.68-1.73, p = .01, respectively). CONCLUSIONS: Moderately depriving orphanage care did not predict enduring adverse consequences in mid-life but subsequent poor adoption experience was associated with outcome.

Leopold: the "bleeder prince" and public knowledge about hemophilia in Victorian Britain.

Hemophilia is a rare bleeding disorder inherited by males born of unaffected female carriers of the trait. British physicians became knowledgeable about this hereditary disease early in the nineteenth century as they investigated families transmitting the character through several generations. Prince Leopold (b. 1853), the fourth son of Queen Victoria, experienced recurrent bleeding episodes and was diagnosed with hemophilia during childhood. His hemorrhagic attacks were first described in the medical journals during 1868, and subsequently in the London and provincial newspapers. The royal family carefully managed news about health matters, and many newspapers reported widespread public sympathy for the travails of the queen and her children. But the republican press argued that the disaffected working classes resented the hyperbole connecting the health of royal individuals with the political future of the entire nation. Public discussion of hemophilia transformed it from a rare medical phenomenon to a matter of national news. Practicing physicians, the royal family, and the general public all came to understand the clinical features and the hereditary nature of the problem. Members of the royal family subsequently utilized this information to guide the marriages of their own children to prevent the spread of this dreaded bleeding disorder.

Enhancing Adoptive Parenting: A Cost-Effectiveness Analysis.

BACKGROUND: Children adopted from care often exhibit behavioural difficulties. There is however limited cost-effectiveness evidence regarding different interventions to address this. This paper reports a cost-effectiveness analysis of parenting programmes for these children. METHOD: Adoptive parents of children aged between 3 and 8 years participated in home-based, manualised, parenting programmes delivered by trained family social workers. The adopters were randomly allocated to one of two interventions (n = 19) or to a 'services as usual' control group (n = 18). Baseline, immediate post-intervention and 6-month follow-ups were assessed by questionnaires and adopter interviews. Economic costs were calculated. RESULTS: At 6-month follow-up, a significant difference (p < .007) was found for 'satisfaction with parenting' in favour of the intervention group. No significant differences were found on child measures between the combined intervention groups and control group, adjusting for baseline scores. The mean costs for the combined intervention group were £1528 higher than for the control group at the post-intervention point, which was statistically significant (95% CI, £67 to £2782). However, over the entire follow-up period the difference (£1652) was not statistically significant (-£1709 to £4268). The cost-effectiveness analysis showed that costs of £731 would be incurred to achieve a point improvement in satisfaction with parenting compared to routine care by the end of treatment, whilst the figure was £337 for a point improvement by the 6-month follow-up. CONCLUSIONS: Findings suggest that a home-based parenting programme for adopters caring for difficult children in the first 18 months of placement may be cost-effective in enhancing satisfaction with parenting, but not in reducing child behavioural problems, compared with 'services-as-usual'.

The adoption of children from public care: a prospective study of outcome in adolescence.

OBJECTIVE: To discover the outcomes for children placed late for adoption (between 5 and 11 years old) from public care and to establish which factors predict poorer outcome. METHOD: Data were collected prospectively (1993-2003) from a representative sample of domestic U.K. adoptive placements (N = 108) at the start of placement, at 1 year, and 6 years later. Most of the children entered care because of abuse and neglect. Outcome was assessed by the disruption rate, by a twofold classification of the character of continuing placements, and by an assessment of psychological well-being. RESULTS: At the adolescent follow-up, 23% of placements had disrupted, 49% were continuing positively, and 28% were continuing but with substantial ongoing difficulties. Four factors contributed independently to a higher risk of disruption: older age at placement (odds ratio = 1.07), having been singled out from siblings and rejected (5.87), time in care (1.04), and a high level of behavioral problems (1.25). Two factors predicted differences in continuing placements. CONCLUSIONS: Late adoption can be successful in that half the children made good progress, but the extent of disruptions and difficulties in continuing placements gives rise to concern. Knowledge of predictors will help in devising planning pre- and postplacement support services.

Enhancing Adoptive Parenting: Devising Promising Interventions.

After describing the common problems of children placed for adoption from local authority care and the views and concerns of adopters as recipients of services, the article describes two contrasting interventions designed to enhance new adopters' parenting skills and understanding. Aspects covered are the empirical and theoretical justifications for the interventions, the process of manualisation and the plan to evaluate the effectiveness of the interventions in a randomised controlled trial.

Cost-Effectiveness of Individual versus Group Psychotherapy for Sexually Abused Girls.

BACKGROUND: Children who have been sexually abused may suffer from emotional and behavioural difficulties. Recent research found that individual and group psychotherapy have similar outcomes. In this study we compare the costs and cost-effectiveness of the two therapies and support for carers. METHODS: Subjects were recruited to two clinics in London and randomly allocated to the two treatments. The different components of each intervention were identified and costed. RESULTS: Total mean costs of individual therapy were found to be £1246 greater than for group therapy. Costs as they would apply in routine practice were relatively unchanged. Group therapy was thus more cost-effective than individual therapy. DISCUSSION: Carefully considering the impact of different therapies could allow more treatment to be offered from available staff resources and budgets. However, this is a single small study and further work is required to strengthen the evidence-base before change in practice is readily undertaken.

Quality Protects: A Commentary on the Government's Agenda and the Evidence Base.

Quality Protects was introduced in 1998 as the government's main initiative to improve children's social services. This review considers the aims, origins and intended effects of the policy. While applauding the attempt to improve services, attention is drawn to four areas on which progress will depend: better performance indicators; the extent and quality of research based evidence; the expansion of professional social work training and user feedback and involvement. The first of the Quality Protects objectives on promoting secure attachment is highlighted and the evidence for the current emphasis on adoption is considered. The article concludes that the extent of progress that is being made to help children and families in difficulty will need to be assessed by systematic research as well as by routine service performance indicators.