High-quality manipulable fiber-microsphere for super-resolution microscopy.

Despite the gain in resolution brought by microsphere (MS)-assisted microscopy, it has always faced several limitations, such as a limited field of view, surface defects, low contrast, and lack of manipulability. This Letter presents a new type of MS created at the tip of an optical fiber, which we call a fiber microsphere (fMS). The fMS is made from a single-mode or coreless fiber, molten and stretched, ensuring high homogeneity and a sphere diameter smaller than the fiber itself. In addition, the connection between the fMS and the fiber makes scanning the sample a simple task, offering a solution to the difficulties of handling. The fabrication procedure of the fMS and the optical system used in the study are detailed. Our measurements show a clear superiority of the fMS over the soda-lime MS in resolving power and imaging performance.

The Efficacy of Psychosocial Interventions in Minimising the Harm Caused to Affected Others of Problem Gambling: A Systematic Review and Meta-Analysis.

Problem gambling not only impacts gamblers but also protrudes onto several affected others who experience adverse impacts, including financial, health, relationships, and psychological problems. The aims of this systematic review were twofold; to identify the psychosocial interventions to minimise the harm caused to affected others of problem gambling and to assess their efficacy. This study was conducted as outlined in the research protocol PROSPERO (CRD42021239138). Database searches were conducted in CENTRAL, MEDLINE, Social Science Database, CINHAL Complete, Academic Search Ultimate and PsycINFO. Randomised controlled trials of psychosocial interventions that aimed to minimise the harm caused to affected others of problem gambling written in English were eligible for inclusion. Risk of bias for included studies was assessed using the Cochrane ROB 2.0 tool. The identified interventions focused on two approaches to supporting affected others: interventions involving both the problem gambler and affected others, and interventions involving affected others only. As the interventions and outcome measures used were sufficiently similar, a meta-analysis was conducted. The quantitative synthesis revealed that generally, treatment groups were unable to show greater benefits over control groups. The goal for future interventions aimed at affected others of problem gambling should focus primarily on the wellbeing of affected others. The standardisation of outcome measures and data collection time points for better comparison of future research is needed.

Wide-field parallel mapping of local spectral and topographic information with white light interference microscopy.

Fourier analysis of interferograms captured in white light interference microscopy is proposed for performing simultaneous local spectral and topographic measurements at high spatial resolution over a large field of view. The technique provides a wealth of key information on local sample properties. We describe the processing and calibration steps involved to produce reflectivity maps of spatially extended samples. This enables precise and fast identification between different materials at a local scale of 1 µm. We also show that the recovered spectral information can be further used for improving topography measurements, particularly in the case of samples combining dielectric and conducting materials in which the complex refractive index can result in nanometric height errors.

Systematic, multiparametric analysis of Mycobacterium tuberculosis intracellular infection offers insight into coordinated virulence.

A key to the pathogenic success of Mycobacterium tuberculosis (Mtb), the causative agent of tuberculosis, is the capacity to survive within host macrophages. Although several factors required for this survival have been identified, a comprehensive knowledge of such factors and how they work together to manipulate the host environment to benefit bacterial survival are not well understood. To systematically identify Mtb factors required for intracellular growth, we screened an arrayed, non-redundant Mtb transposon mutant library by high-content imaging to characterize the mutant-macrophage interaction. Based on a combination of imaging features, we identified mutants impaired for intracellular survival. We then characterized the phenotype of infection with each mutant by profiling the induced macrophage cytokine response. Taking a systems-level approach to understanding the biology of identified mutants, we performed a multiparametric analysis combining pathogen and host phenotypes to predict functional relationships between mutants based on clustering. Strikingly, mutants defective in two well-known virulence factors, the ESX-1 protein secretion system and the virulence lipid phthiocerol dimycocerosate (PDIM), clustered together. Building upon the shared phenotype of loss of the macrophage type I interferon (IFN) response to infection, we found that PDIM production and export are required for coordinated secretion of ESX-1-substrates, for phagosomal permeabilization, and for downstream induction of the type I IFN response. Multiparametric clustering also identified two novel genes that are required for PDIM production and induction of the type I IFN response. Thus, multiparametric analysis combining host and pathogen infection phenotypes can be used to identify novel functional relationships between genes that play a role in infection.

Illumination conditions in microsphere-assisted microscopy.

White-light microsphere-assisted microscopy is a full-field and label-free imaging promising technique making it possible to achieve a subdiffraction lateral resolution. However, performance of this technique depends not only on the geometrical parameters but also on the illumination conditions of the optical system. In the present work, experimental measurements and computer simulations have been performed in air in order to determine the influence of the two diaphragm apertures of the Köhler arrangement and the spectral width of the light source on both the depth-of-focus of the microsphere and the optimization of the imaging contrast. Furthermore, the super-resolution phenomenon is demonstrated and the cumulated optical aberrations are shown through the measurement of the optical transfer function for the different arrangements of the illumination part.

A phase II multicenter study of the anti-CD19 antibody drug conjugate coltuximab ravtansine (SAR3419) in patients with relapsed or refractory diffuse large B-cell lymphoma previously treated with rituximab-based immunotherapy.

This phase II, single-arm, multicenter study examined the efficacy and safety of coltuximab ravtansine (an anti-CD19 antibody drug conjugate) in 61 patients with histologically documented (de novo or transformed) relapsed or refractory diffuse large B-cell lymphoma who had previously received rituximab-containing immuno-chemotherapy. Patients had received a median of 2.0 (range 0-9) prior treatment regimens for diffuse large B-cell lymphoma and almost half (45.9%) had bulky disease (≥1 lesion >5 cm) at trial entry. Patients received coltuximab ravtansine (55 mg/m2) in 4 weekly and 4 biweekly administrations until disease progression or unacceptable toxicity. Forty-one patients were eligible for inclusion in the per protocol population. Overall response rate (International Working Group criteria) in the per protocol population, the primary end point, was 18/41 [43.9%; 90% confidence interval (CI:) 30.6-57.9%]. Median duration of response, progression-free survival, and overall survival (all treated patients) were 4.7 (range 0.0-8.8) months, 4.4 (90%CI: 3.02-5.78) months, and 9.2 (90%CI: 6.57-12.09) months, respectively. Common non-hematologic adverse events included asthenia/fatigue (30%), nausea (23%), and diarrhea (20%). Grade 3-4 adverse events were reported in 23 patients (38%), the most frequent being hepatotoxicity (3%) and abdominal pain (3%). Eye disorders occurred in 15 patients (25%); all were grade 1-2 and none required a dose modification. Coltuximab ravtansine monotherapy was well tolerated and resulted in moderate clinical responses in pre-treated patients with relapsed/refractory diffuse large B-cell lymphoma. (Registered at: clinicaltrials.gov identifier: 01472887).

Research Review: Cognitive bias modification of interpretations in youth and its effect on anxiety: a meta-analysis.

BACKGROUND: Emerging evidence suggests that cognitive bias modification of interpretations (CBM-I) is effective in altering interpretation biases and reducing anxiety in adults. Less is known about the impact of CBM-I in young people, but some recent findings, including a meta-analysis of combined cognitive bias modification of interpretation and attention techniques, have cast doubt on its clinical utility. Given the current debate, this meta-analysis sought to establish the independent effects of CBM-I on interpretations biases and anxiety in youth. METHODS: Studies were identified through a systematic literature search of PsycINFO, Ovid MEDLINE, PsycARTICLES, Web of Science and EMBASE between January 1992 and March 2017. Eligible studies aimed to target interpretation biases; did not combine CBM-I with another intervention; included a control condition; randomly allocated participants to conditions; assessed interpretation bias and/or anxiety as an outcome; included individuals up to age 18; and did not present previously reported data. Reference lists of included articles were checked for further eligible studies, and authors were contacted for unpublished data. RESULTS: We identified 26 studies meeting eligibility criteria that included in the meta-analysis. CBM-I had moderate effects on negative and positive interpretations (g = -0.70 and g = -0.52, respectively) and a small but significant effect on anxiety assessed after training (g = -0.17) and after a stressor (g = -0.34). No significant moderators were identified. CONCLUSIONS: In contrast to previous meta-analytic findings, our results indicate that CBM-I has potential but weak anxiolytic effects in youth. Our findings suggest that it may be premature to disregard the potential value of CBM-I research and further research in this field is warranted.

Self-Harm, Suicidal Behaviours, and Cyberbullying in Children and Young People: Systematic Review.

BACKGROUND: Given the concerns about bullying via electronic communication in children and young people and its possible contribution to self-harm, we have reviewed the evidence for associations between cyberbullying involvement and self-harm or suicidal behaviors (such as suicidal ideation, suicide plans, and suicide attempts) in children and young people. OBJECTIVE: The aim of this study was to systematically review the current evidence examining the association between cyberbullying involvement as victim or perpetrator and self-harm and suicidal behaviors in children and young people (younger than 25 years), and where possible, to meta-analyze data on the associations. METHODS: An electronic literature search was conducted for all studies published between January 1, 1996, and February 3, 2017, across sources, including MEDLINE, Cochrane, and PsycINFO. Articles were included if the study examined any association between cyberbullying involvement and self-harm or suicidal behaviors and reported empirical data in a sample aged under 25 years. Quality of included papers was assessed and data were extracted. Meta-analyses of data were conducted. RESULTS: A total of 33 eligible articles from 26 independent studies were included, covering a population of 156,384 children and young people. A total of 25 articles (20 independent studies, n=115,056) identified associations (negative influences) between cybervictimization and self-harm or suicidal behaviors or between perpetrating cyberbullying and suicidal behaviors. Three additional studies, in which the cyberbullying, self-harm, or suicidal behaviors measures had been combined with other measures (such as traditional bullying and mental health problems), also showed negative influences (n=44,526). A total of 5 studies showed no significant associations (n=5646). Meta-analyses, producing odds ratios (ORs) as a summary measure of effect size (eg, ratio of the odds of cyber victims who have experienced SH vs nonvictims who have experienced SH), showed that, compared with nonvictims, those who have experienced cybervictimization were OR 2.35 (95% CI 1.65-3.34) times as likely to self-harm, OR 2.10 (95% CI 1.73-2.55) times as likely to exhibit suicidal behaviors, OR 2.57 (95% CI 1.69-3.90) times more likely to attempt suicide, and OR 2.15 (95% CI 1.70-2.71) times more likely to have suicidal thoughts. Cyberbullying perpetrators were OR 1.21 (95% CI 1.02-1.44) times more likely to exhibit suicidal behaviors and OR 1.23 (95% CI 1.10-1.37) times more likely to experience suicidal ideation than nonperpetrators. CONCLUSIONS: Victims of cyberbullying are at a greater risk than nonvictims of both self-harm and suicidal behaviors. To a lesser extent, perpetrators of cyberbullying are at risk of suicidal behaviors and suicidal ideation when compared with nonperpetrators. Policy makers and schools should prioritize the inclusion of cyberbullying involvement in programs to prevent traditional bullying. Type of cyberbullying involvement, frequency, and gender should be assessed in future studies.

Long-term outcomes, secondary malignancies and stem cell collection following bendamustine in patients with previously treated non-Hodgkin lymphoma.

Despite the long history of bendamustine as treatment for indolent non-Hodgkin lymphoma, long-term efficacy and toxicity data are minimal. We reviewed long-term data from three clinical trials to characterize the toxicity and efficacy of patients receiving bendamustine. Data were available for 149 subjects at 21 sites. The median age was 60 years at the start of bendamustine (range 39-84), and patients had received a median of 3 prior therapies. The histologies included grades 1-2 follicular lymphoma (FL; n = 73), grade 3 FL (n = 23), small lymphocytic lymphoma (n = 20), marginal zone lymphoma (n = 15), mantle cell lymphoma (n = 9), transformed lymphomas (n = 5), lymphoplasmacytic lymphoma (n = 2) and not reported (n = 2). The median event-free survival was 14·1 months. Nine of 12 attempted stem cell collections were successful. With a median follow-up of 8·9 years, 23 patients developed 25 cancers, including 8 patients with myelodysplastic syndrome/acute myeloid leukaemia. These data provide important information regarding the long-term toxicity of bendamustine in previously treated patients. A small but meaningful number of patients achieved durable remissions following bendamustine. These rigorously collected, patient-level, long-term follow-up data provide reassurance that bendamustine or bendamustine plus rituximab is associated with efficacy and safety for patients with relapsed or refractory indolent non-Hodgkin lymphoma.

Depth-resolved local reflectance spectra measurements in full-field optical coherence tomography.

Full-field optical coherence tomography (FF-OCT) is a widely used technique for applications such as biological imaging, optical metrology, and materials characterization, providing structural and spectral information. By spectral analysis of the backscattered light, the technique of spectroscopic-OCT enables the differentiation of structures having different spectral properties, but not the determination of their reflectance spectrum. For surface measurements, this can be achieved by applying a Fourier transform to the interferometric signals and using an accurate calibration of the optical system. An extension of this method is reported for local spectroscopic characterization of transparent samples and in particular for the determination of depth-resolved reflectance spectra of buried interfaces. The correct functioning of the method is demonstrated by comparing the results with those obtained using a program based on electromagnetic matrix methods for stratified media. Experimental measurements of spatial resolutions are provided to demonstrate the smallest structures that can be characterized.

Microsphere-assisted phase-shifting profilometry.

In the present work, we have investigated the combination of a superresolution microsphere-assisted 2D imaging technique with low-coherence phase-shifting interference microscopy. The imaging performance of this technique is studied by numerical simulation in terms of the magnification and the lateral resolution as a function of the geometrical and optical parameters. The results of simulations are compared with the experimental measurements of reference gratings using a Linnik interference configuration. Additional measurements are also shown on nanostructures. An improvement by a factor of 4.7 in the lateral resolution is demonstrated in air, thus giving a more isotropic nanometric resolution for full-field surface profilometry in the far field.

A qualitative understanding of the effects of reusable sanitary pads and puberty education: implications for future research and practice.

BACKGROUND: The management of menstruation has come to the fore as a barrier to girls' education attainment in low income contexts. Interventions have been proposed and piloted, but the emerging nature of the field means limited evidence is available to understand their pathways of effect. METHODS: This study describes and compares schoolgirls' experiences of menstruation in rural Uganda at the conclusion of a controlled trial of puberty education and sanitary pad provision to elucidate pathways of effect in the interventions. Semi-structured interviews were undertaken with schoolgirls who participated in the Menstruation and the Cycle of Poverty trial concurrent with the final set of quantitative surveys. A framework approach and cross-case analysis were employed to describe and compare the experiences of 27 menstruating girls across the four intervention conditions; education (n = 8), reusable sanitary pads (n = 8), education with reusable sanitary pads (n = 6), and control (n = 5). RESULTS: Themes included: menstrual hygiene, soiling, irritation and infection, physical experience, knowledge of menstruation, psychological, social and cultural factors, and support from others. Those receiving reusable pads experienced improvements in comfort and reliability. This translated into reduced fears around garment soiling and related school absenteeism. Other menstrual hygiene challenges of washing, drying and privacy remained prominent. Puberty education improved girls' confidence to discuss menstruation and prompted additional support from teachers and peers. CONCLUSIONS: Findings have important implications for the development and evaluation of future interventions. Results suggest the provision of menstrual absorbents addresses one core barrier to menstrual health, but that interventions addressing broader needs such as privacy may improve effectiveness. Puberty education sessions should increase attention to body awareness and include strategies to address a wider range of practical menstrual challenges, including pain management. Interviews revealed possibilities for improving quantitative surveys in future research. TRIAL REGISTRATION: Pan-African Clinical Trials Registry PACTR201503001044408.

High-dynamic-range microscope imaging based on exposure bracketing in full-field optical coherence tomography.

By applying the proposed high-dynamic-range (HDR) technique based on exposure bracketing, we demonstrate a meaningful reduction in the spatial noise in image frames acquired with a CCD camera so as to improve the fringe contrast in full-field optical coherence tomography (FF-OCT). This new signal processing method thus allows improved probing within transparent or semitransparent samples. The proposed method is demonstrated on 3 µm thick transparent polymer films of Mylar, which, due to their transparency, produce low contrast fringe patterns in white-light interference microscopy. High-resolution tomographic analysis is performed using the technique. After performing appropriate signal processing, resulting XZ sections are observed. Submicrometer-sized defects can be lost in the noise that is present in the CCD images. With the proposed method, we show that by increasing the signal-to-noise ratio of the images, submicrometer-sized defect structures can thus be detected.

Transporting Evidence-Based Parenting Programs for Child Problem Behavior (Age 3-10) Between Countries: Systematic Review and Meta-Analysis.

There has been rapid global dissemination of parenting interventions, yet little is known about their effectiveness when transported to countries different from where they originated, or about factors influencing success. This is the first systematic attempt to address this issue, focusing on interventions for reducing child behavior problems. Stage 1 identified evidence-based parenting interventions showing robust effects in systematic reviews; Stage 2 identified trials of these interventions in a new country. Systematic review/meta-analysis of transported programs was followed by subgroup analyses by trial- and country-level cultural, resource, and policy factors. We found 17 transported trials of 4 interventions, originating in United States or Australia, tested in 10 countries in 5 regions, (n = 1,558 children). Effects on child behavior were substantial (SMD -.71) in the (14) randomized trials, but nonsignificant in the (3) nonrandomized trials. Subgroup analyses of randomized trials found no association between effect size and participant or intervention factors (e.g., program brand, staffing). Interventions transported to "western" countries showed comparable effects to trials in origin countries; however, effects were stronger when interventions were transported to culturally more distant regions. Effects were higher in countries with survival-focused family/childrearing values than those ranked more individualistic. There were no differences in effects by country-level policy or resource factors. Contrary to common belief, parenting interventions appear to be at least as effective when transported to countries that are more different culturally, and in service provision, than those in which they were developed. Extensive adaptation did not appear necessary for successful transportation.

Schoolgirls' experience and appraisal of menstrual absorbents in rural Uganda: a cross-sectional evaluation of reusable sanitary pads.

BACKGROUND: Governments, multinational organisations, and charities have commenced the distribution of sanitary products to address current deficits in girls' menstrual management. The few effectiveness studies conducted have focused on health and education outcomes but have failed to provide quantitative assessment of girls' preferences, experiences of absorbents, and comfort. Objectives of the study were, first, to quantitatively describe girls' experiences with, and ratings of reliability and acceptability of different menstrual absorbents. Second, to compare ratings of freely-provided reusable pads (AFRIpads) to other existing methods of menstrual management. Finally, to assess differences in self-reported freedom of activity during menses according to menstrual absorbent. METHODS: Cross-sectional, secondary analysis of data from the final survey of a controlled trial of reusable sanitary padand puberty education provision was undertaken. Participants were 205 menstruating schoolgirls from eight schools in rural Uganda. 72 girls who reported using the intervention-provided reusable pads were compared to those using existing improvised methods (predominately new or old cloth). RESULTS: Schoolgirls using reusable pads provided significantly higher ratings of perceived absorbent reliability across activities, less difficulties changing absorbents, and less disgust with cleaning absorbents. There were no significant differences in reports of outside garment soiling (OR 1.00 95%CI 0.51-1.99), or odour (0.84 95%CI 0.40-1.74) during the last menstrual period. When girls were asked if menstruation caused them to miss daily activities there were no differences between those using reusable pads and those using other existing methods. However, when asked about activities avoided during menstruation, those using reusable pads participated less in physical sports, working in the field, fetching water, and cooking. CONCLUSIONS: Reusable pads were rated favourably. This translated into some benefits for self-reported involvement in daily activities, although reports of actual soiling and missing activities due to menstruation did not differ. More research is needed comparing the impact of menstrual absorbents on girls' daily activities, and validating outcome measures for menstrual management research.

The Effect of Interchange Rotation Period and Number on Australian Football Running Performance.

Montgomery, PG, and Wisbey, B. The effect of interchange rotation period and number on Australian Football running performance. J Strength Cond Res 30(7): 1890-1897, 2016-To determine the effect of on-field rotation periods and total number of game rotations on Australian Football running performance, elite Australian Football players (n = 21, mean ± SD; 23.2 ± 1.7 years; 183.5 ± 3.7 cm; 83.2 ± 4.5 kg) had Global Positioning System game data from 22 rounds divided into a total of 692 on-field playing periods. These periods were allocated into time blocks of 2:00-minute increments, with the log transformed percentage differences in running performance (m·min) between blocks analyzed by effect size and meaningful differences. A total of 7,730 game rotation and associated average m·min combinations collected over 3 Australian Football seasons were also assessed by effect size and meaningful differences. Running capacity decreases after 5:00 minutes by ∼3% for each 2:00 minutes of on-field time up to 9:00 minutes, with variable responses between positions up to 6.7% for nomadic players. For each rotation less than 6 per game, clear small-to-moderate decreases up to 3.6% in running capacity occurred per rotation. To maintain a high level of running capacity, shorter on-field periods are more effective in Australian Football; however, players and coaches should be aware that with interchange restriction, slightly longer on-field periods achieve similar results.

Emerging role of IL-16 in cytokine-mediated regulation of multiple sclerosis.

Cytokines are pleiotropic soluble mediators of cellular functions. Cytokines are critical in immune pathogenesis of human diseases, including autoimmune CD4(+) T cell mediated chronic inflammatory, demyelinating and neurodegenerative diseases of the central nervous system (CNS), multiple sclerosis (MS). In MS and its experimental model, experimental autoimmune encephalomyelitis (EAE), chronic persistence and/or reoccurrence of inflammation in the CNS causes chronic progressive or relapsing disease, accompanied with demyelination and damage to axons and oligodendrocytes, which ultimately leads to paralysis and disability. As opposed to other cytokines, whose effects are not limited to the CD4(+) T cell subset, IL-16 exerts its biological properties by exclusive binding and signaling through CD4 receptor. IL-16 selectively regulates migration of all CD4 expressing T cells regardless of their activation state, which is of critical importance for immune modulation and potential therapy of MS. Other major biological properties of IL-16 essential for the function of CD4(+) T cells include regulation of: T cell activation, CD25 expression, MHC class II expression, dendritic cell (DC)-T cell cooperation, B cell-T cell and T cell-T cell cooperation, inflammatory cytokine production and modulation of chemokine regulated T cell chemo-attraction. In this article we outline immune pathogenesis of the disease necessary to understand significance of cytokines and IL-16 in MS regulation. We revisit cytokine regulation with emphasis on involvement of IL-16 mechanisms, implicated in MS progression and important for development of new therapies. We emphasize the significance of similar IL-16 mechanisms for other chronic inflammatory CNS diseases.

Organisational interventions for improving wellbeing and reducing work-related stress in teachers.

BACKGROUND: The teaching profession is an occupation with a high prevalence of work-related stress. This may lead to sustained physical and mental health problems in teachers. It can also negatively affect the health, wellbeing and educational attainment of children, and impose a financial burden on the public budget in terms of teacher turnover and sickness absence. Most evaluated interventions for the wellbeing of teachers are directed at the individual level, and so do not tackle the causes of stress in the workplace. Organisational-level interventions are a potential avenue in this regard. OBJECTIVES: To evaluate the effectiveness of organisational interventions for improving wellbeing and reducing work-related stress in teachers. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, ASSIA, AEI, BEI, BiblioMap, DARE, DER, ERIC, IBSS, SSCI, Sociological Abstracts, a number of specialist occupational health databases, and a number of trial registers and grey literature sources from the inception of each database until January 2015. SELECTION CRITERIA: Randomised controlled trials (RCTs), cluster-RCTs, and controlled before-and-after studies of organisational-level interventions for the wellbeing of teachers. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: Four studies met the inclusion criteria. They were three cluster-randomised controlled trials and one with a stepped-wedge design.Changing task characteristicsOne study with 961 teachers in eight schools compared a task-based organisational change intervention along with stress management training to no intervention. It found a small reduction at 12 months in 10 out of 14 of the subscales in the Occupational Stress Inventory, with a mean difference (MD) varying from -3.84 to 0.13, and a small increase in the Work Ability Index (MD 2.27; 95% confidence interval (CI) 1.64 to 2.90; 708 participants, low-quality evidence).Changing organisational characteristicsTwo studies compared teacher training combined with school-wide coaching support to no intervention. One study with 59 teachers in 43 schools found no significant effects on job-related anxiety (MD -0.25 95% CI -0.61 to 0.11, very low-quality evidence) or depression (MD -0.26 95% CI -0.57 to 0.05, very low-quality evidence) after 24 months. The other study with 77 teachers in 18 schools found no significant effects on the Maslach Burnout Inventory subscales (e.g. emotional exhaustion subscale: MD -0.05 95% CI -0.52 to 0.42, low-quality evidence) or the Teacher Perceived Emotional Ability subscales (e.g. regulating emotions subscale: MD 0.11 95% CI -0.11 to 0.33, low-quality evidence) after six months.Multi-component interventionOne study with 1102 teachers in 34 schools compared a multi-component intervention containing performance bonus, job promotion opportunities and mentoring support to a matched-comparison group consisting of 300 schools. It found moderately higher teacher retention rates (MD 11.50 95% CI 3.25 to 19.75 at 36 months follow-up, very low-quality evidence). However, the authors reported results only from one cohort out of four (eight schools), demonstrating a high risk of reporting bias. AUTHORS' CONCLUSIONS: We found low-quality evidence that organisational interventions lead to improvements in teacher wellbeing and retention rates. We need further evaluation of the effects of organisational interventions for teacher wellbeing. These studies should follow a complex-interventions framework, use a cluster-randomised design and have large sample sizes.

Dementia, walking outdoors and getting lost: incidence, risk factors and consequences from dementia-related police missing-person reports.

OBJECTIVES: To estimate incidence, identify consequences and potential risk factors for harm in people with dementia who got lost in one UK policing region. METHODS: In a retrospective observational study, data were extracted from missing-person records over a four-year period in one UK policing region (population of 2.1 million). RESULTS: Two hundred and eighty-one incidents of getting lost were identified. Incidence of getting lost was estimated at 0.5% of the regional dementia population. Fifty-nine percent of reports came from domestic settings, 29% from care homes/hospitals, and 12% on excursions from home. Five percent (n = 15) sustained significant harm, including two deaths. Average age was 78 years (SD 8.3). Harm was associated with older age (mean difference 6.16 years, CI 1.86 to 10.46, p = 0.005, t = 2.82), length of time missing (Mdn time 2.48 hours; IQR 0.97 to 9.45, p = 0.02), and season (9% winter, 2% summer, p = 0.006). The length of time missing increased with delays in reporting to police (r = 0.15, p = 0.018), getting lost at night (Mdn time 1.70 hours, IQR 0.52-3.32, p = 0.028), driving themselves (Mdn time 2.45 hours, IQR 0.42-2.00, p = 0.001), and using public transport (Mdn 1.78 hours, IQR 1.07-3.92, p = 0.001). CONCLUSION: Incidence in this study suggests getting lost is a low-frequency event for people with dementia but for a small minority, the risks are considerable. Exploratory analyses suggest individual and environmental factors increase the risk of harm. Suitable methods need to be developed to replicate these findings in larger prospective samples. A focus on the predictors of harm may aid development of assessment protocols to ensure intervention is proportionate.

Fatty acids and sleep in UK children: subjective and pilot objective sleep results from the DOLAB study--a randomized controlled trial.

Sleep problems in children are associated with poor health, behavioural and cognitive problems, as are deficiencies of long-chain omega-3 fatty acids such as docosahexaenoic acid. Theory and some evidence support a role for these fatty acids in sleep regulation, but this issue has received little formal investigation. We examined associations between blood fatty acid concentrations (from fingerstick blood samples) and subjective sleep (using an age-standardized parent questionnaire) in a large epidemiological sample of healthy children aged 7-9 years (n = 395) from mainstream UK schools. In a randomized controlled trial, we then explored whether 16-week supplementation (600 mg day(-1) ) with algal docosahexaenoic acid versus placebo might improve sleep in a subset of those children (n = 362) who were underperforming in reading. In a randomly selected subsample (n = 43), sleep was also assessed objectively via actigraphy. In 40% of the epidemiological sample, Child Sleep Habits Questionnaire scores indicated clinical-level sleep problems. Furthermore, poorer total sleep disturbance scores were associated weakly but significantly with lower blood docosahexaenoic acid (std coeff. -0.105*) and a lower docosahexaenoic acid : arachidonic acid ratio (std coeff. -0.119**). The treatment trial showed no significant effects on subjective sleep measures. However, in the small actigraphy subsample, docosahexaenoic acid supplementation led on average to seven fewer wake episodes and 58 min more sleep per night. Cautiously, we conclude that higher blood levels of docosahexaenoic acid may relate to better child sleep, as rated by parents. Exploratory pilot objective evidence from actigraphy suggests that docosahexaenoic acid supplementation may improve children's sleep, but further investigations are needed.