Bimanual strategies for object retrieval in infants and young children.

Age differences in goal-directed bimanual coordination were studied in typically developing infants aged 9-29 months, compared to a group of children aged 4-6 years and a group of adults, using an object retrieval task. This task required one hand to open and hold the lid of a transparent box, while the second hand retrieved a small toy from inside the box. Well-coordinated retrieval strategies with differentiated use of the two hands were not established in the majority of infants until 18 months of age. Temporal analysis of the hand actions revealed that, unlike adults who perform the task with close synchronization of the hands at the start, the infants performed the task sequentially and did not activate the second hand until the first hand had started to lift the lid. The children's hand preferences for the two-hand actions also contrasted with those of adults. In children aged 27-29 months and 4-6 years, there was a preference for using the right-hand to lift the lid while in right-handed adults, the reverse pattern was observed. The results suggest that although bimanual coordination starts to develop in the second year of life, the adult pattern of performance on this task is not observed before 6 years of age. It is likely that further maturation of the brain networks involved in bimanual coordination, and in particular functional interhemispheric transfer via the corpus callosum, is required before automatization of bimanual hand actions is achieved.

Haematological malignancy: are patients appropriately referred for specialist palliative and hospice care? A systematic review and meta-analysis of published data.

Haematological malignancies are complex diseases, affecting the entire age spectrum, and having marked differences in presentation, treatment, progression and outcome. Patients have a significant symptom burden and despite treatment improvements for some sub-types, many patients die from their disease. We carried out a systematic review and meta-analysis to examine the proportion of patients with haematological malignancies that received any form of specialist palliative or hospice care. Twenty-four studies were identified, nine of which were suitable for inclusion in the meta-analysis. Our review showed that patients with haematological malignancies were far less likely to receive care from specialist palliative or hospice services compared to other cancers (Risk Ratio 0.46, [95% confidence intervals 0.42-0.50]). There are several possible explanations for this finding, including: ongoing management by the haematology team and consequent strong bonds between staff and patients; uncertain transitions to a palliative approach to care; and sudden transitions, leaving little time for palliative input. Further research is needed to explore: transitions to palliative care; potential unmet patient needs; where patients want to be cared for and die; existing practices in the delivery of palliative and end-of-life care; and barriers to specialist palliative care and hospice referral and how these might be overcome.