Changes in parental sleep from pregnancy to postpartum: A meta-analytic review of actigraphy studies.

Sleep changes in new parents are widely observed but there is no extant meta-analysis of changes to sleep parameters in this group. We completed a meta-analysis of changes in actigraphy-measured parent sleep between pregnancy and the end of the first year of a child's life. A search of six databases was completed. Following review using predetermined inclusion and exclusion criteria, 16 papers were left for review. Data were extracted, analysed and each paper was reviewed for methodological quality. Where possible, subgroup analysis was completed based on time since birth and location of the study, and meta-regression of parent age. Parents' total sleep time and sleep efficiency were shown to decrease following the birth of a child, with wake after sleep onset increasing. This change was most notably observed in the first four weeks after birth. Up to 16 weeks post-birth, differences were still apparent, but sleep parameters were beginning to return to pre-birth levels. New parents experience a significant change in multiple sleep parameters following the birth of a child. Future data collection, using best practice actigraphy measurement, reporting a broader range of variables and including fathers, as well as mothers, is warranted.

Are knowledge- and belief-reasoning automatic, and is this the right question?

Phillips et al. conclude that current evidence supports knowledge-, but not belief-reasoning as being automatic. We suggest four reasons why this is an oversimplified answer to a question that might not have a clear-cut answer: (1) knowledge and beliefs can be incompletely equated to perceptual states, (2) sensitivity to mental states does not necessitate representation, (3) automaticity is not a single categorical feature, and (4) how we represent others' minds is dependent on social context.

Exploring the Processes Involved in Seeking Help from a General Practitioner for Young People Who Have Been at Risk of Suicide.

General practitioners (GPs) play a key role in the early identification and management of suicide risk in young people. However, little is known about the processes involved in how, when and why a young person decides to seek help from their GP. Eight young people, aged 17-23, took part in semi-structured interviews exploring their experiences of help seeking when feeling suicidal. Data were analysed using framework analysis. The analysis identified three main themes and seven subthemes. The main themes explored were: understanding when to seek help from a GP, barriers and facilitating factors at the GP consultation, and help seeking as a non-linear and dynamic process. The processes involved in how, when and why young people seek help from a GP when feeling suicidal were found to be dynamic and to fluctuate over time. Help seeking was initially related to how young people were able to understand and articulate their distress, the availability of informal support networks, and their perception of the GP as a source of help. During a GP consultation, help seeking was influenced by how safe and supported the young people felt. Perceived GP training, communication and validation of young people's concerns were important factors to help facilitate this process. Subsequent help seeking was influenced by prior experience of GP consultations and the availability of alternative support.

Sleep duration and sleep quality in people with and without intellectual disability: A meta-analysis.

This study provides the first meta-analysis of the purported differences in sleep time and sleep quality between people with and without intellectual disabilities. Twenty-one papers were identified that compared sleep time and/or sleep quality in people with and without intellectual disabilities. The meta-analysis of sleep time revealed that people with an intellectual disability slept for 18 min less, on average, than people without an intellectual disability. This significant difference was limited to those studies that tested groups of people with an identified genetic syndrome or developmental disorder. The analysis of sleep quality also concluded that people with intellectual disabilities experienced poorer sleep: In 93% of comparisons between groups, sleep was found to be of poorer quality in the group of people with intellectual disabilities. There were no differences found between studies that measured sleep objectively and those that used diary or questionnaire measures. Notably, most samples were drawn from populations of people with specified genetic syndromes or developmental disorders, rather than intellectual disability of heterogeneous origin. Similarly, most studies investigated sleep in children, although there was no evidence that the differences between the groups reduced during adulthood. Most studies used highly-regarded objective measures of sleep, such as polysomnography or actigraphy, although methodological flaws were evident in the identification of samples and the measurement of intellectual disability.

A Second Look at Automatic Theory of Mind: Reconsidering Kovács, Téglás, and Endress (2010).

In recent work, Kovács, Téglás, and Endress (2010) argued that human adults automatically represented other agents' beliefs even when those beliefs were completely irrelevant to the task being performed. In a series of 13 experiments, we replicated these previous findings but demonstrated that the effects found arose from artifacts in the experimental paradigm. In particular, the critical findings demonstrating automatic belief computation were driven by inconsistencies in the timing of an attention check, and thus do not provide evidence for automatic theory of mind in adults.

Direct and indirect measures of Level-2 perspective-taking in children and adults.

Studies with infants show divergence between performance on theory of mind tasks depending on whether direct or indirect measures are used. It has been suggested that direct measures assess a flexible but cognitively demanding ability to reason about the minds of others, whereas indirect measures assess distinct processes which afford more efficient but less flexible theory of mind abilities (Apperly & Butterfill, 2009). This leads to the prediction that performance on indirect measures should be subject to signature limits. The current study tested whether the Level-1/Level-2 distinction might constitute one such limit. The study adapted a task that has shown evidence of Level-1 perspective-taking on both direct and indirect measures (Samson, Apperly, Braithwaite, Andrews, & Bodley-Scott, 2010). The aim was to test Level-2 perspective-taking in a sample of 6- to 11-year-olds (N = 80) and adults (N = 20). Participants were able to make Level-2 judgements on the direct measure. In contrast with the findings from Level-1 perspective-taking, there was no evidence of automatic processing of Level-2 perspectives on the indirect measure. This finding is consistent with the view that theory of mind abilities assessed by indirect measures are subject to signature limits. The Level-1/Level-2 distinction, suitably refined, marks one way in which efficient but inflexible theory of mind abilities are limited.

A multi-centre analysis of the impact of updated risk stratification on follow-up of gastric gastro-intestinal stromal tumours in the post-imatinib era.

BACKGROUND: Previously Gastro-Intestinal Stromal Tumours (GISTs) have been risk stratified histologically according to their size and mitotic index. However, gastric GISTs have a lower likelihood of recurrence and so the Miettinen criteria are now used to risk stratify patients. Records were reviewed from multiple centres to determine if these changes altered patients' clinical care and also to determine the survival of patients following the introduction of imatinib therapy. METHODS: Prospective databases of GISTs undergoing surgical resection and those reviewed by the regional sarcoma MDT were cross-referenced and added to by searching a variety of clinical and pathology coding datasets, to identify patients diagnosed between January 2000 and March 2010. Patients undergoing resection for localised disease were re-scored using Miettinen criteria and Kaplan-Meier analysis was used to determine survival outcomes. RESULTS: The search identified 203 patients; including 132 gastric GISTs, 89 of which had resections of untreated localised disease. These were reassessed, of which approximately one third were scored as intermediate risk. Following reclassification, 26 of 29 of intermediate risk cases moved to low risk groups, representing 27.7% of all those remaining in follow-up at the time of audit. Median survival was not reached after a median follow-up of 3.85 years and 4-year survival was estimated at 72%. CONCLUSIONS: Clinicians involved in the follow-up of gastric GISTs should reassess the pathology of all intermediate and high risk patients in order to decrease patient exposure to stressful interventions, as well as hospital workload, and expenditure on unnecessary observation.

Egocentrism and automatic perspective taking in children and adults.

Children (aged 6-10) and adults (total N = 136) completed a novel visual perspective-taking task that allowed quantitative comparisons across age groups. All age groups found it harder to judge the other person's perspective when it differed from their own. This egocentric interference did not decrease with age, even though, overall, performance improved. In addition, it was more difficult to judge one's own perspective when it differed from that of the other person, suggesting that the other's perspective was processed even though it interfered with self-perspective judgments. In a logically equivalent, nonsocial task, the same degree of interference was not observed. These findings are discussed in relation to recent findings suggesting precocious theory-of-mind abilities in infancy.

Sometimes losing your self in space: children's and adults' spontaneous use of multiple spatial reference frames.

Two experiments tested 6- to 11-year-old children's and college students' use of different frames of reference when making judgments about descriptions of social and nonsocial scenes. In Experiment 1, when social and nonsocial scenes were mixed, both children and students (N = 144) showed spontaneous sensitivity to the intrinsic and the relative frame of reference for both social and nonsocial scenes. All groups over 7 years old showed a stronger effect of the intrinsic frame of reference for social stimuli. This is the first evidence of sensitivity to more than 1 frame of reference in individual judgments made by children. Experiment 2 tested a further sample of 6- to 11-year-old children and students (N = 185) with social and nonsocial scenes in separate blocks. In this study, participants were no longer sensitive to the relative frame of reference--an effect we characterize as "losing your self in space," as this frame is generated by one's own position in the world. Children showed this effect only when the stimuli were social, suggesting that spontaneous use of intrinsic frames of spatial reference may develop out of sensitivity to the perspectives of agents.

The neural and cognitive time course of theory of mind.

Neuroimaging and neuropsychological studies implicate both frontal and temporoparietal cortices when humans reason about the mental states of others. Here, we report an event-related potentials study of the time course of one such "theory of mind" ability: visual perspective taking. The findings suggest that posterior cortex, perhaps the temporoparietal cortex, calculates and represents the perspective of self versus other, and then, later, the right frontal cortex resolves conflict between perspectives during response selection.

Epithelioid haemangioendothelioma of the anterior skull base: what is the optimal treatment?

We report an unusual malignant tumour affecting an unusual site. Epithelioid haemangioendothelioma was formerly considered a tumour of intermediate malignancy but has been reclassified as fully malignant. It is important to be aware of this clinical entity as the best hope of cure is timely radical resection. There is a paucity of evidence concerning the efficacy of alternative treatments because the tumour is very rare.

Is aortography in lower limb ischaemia still abused?

A study in 1980 revealed that 38% of aortograms performed in a series had been referred for inappropriate reasons and only 49% had been clearly indicated. Recommendations were made to reduce the number of inappropriate investigations. An audit has been carried out of the aortography referrals made in this unit recently. This has shown that, despite changes in the management of peripheral vascular disease in the intervening years, by following the recommendations made in the previous paper, the number of inappropriate aortograms has been reduced to a minimum. The recommendations are endorsed.

Successful resection of a massive hepatic artery aneurysm.

Hepatic artery (HA) aneurysms are seen infrequently, but many eventually rupture, often with a fatal outcome. With modern diagnostic technology, aneurysms can be identified at an earlier stage, providing the opportunity for intervention. This review outlines the case of a patient with a massive, leaking hepatic artery aneurysm and discusses the aetiology and management of these lesions.

Meckel's diverticulum-rare complications and review of the literature.

Meckel's diverticulum is the most common congenital anomaly of the gastro-intestinal tract. It arises as a result of incomplete dissolution of the vitello-intestinal duct. Approximately 4% of patients with Meckel's diverticula develop complications, most commonly obstruction, gastro-intestinal bleeding and inflammation. We describe three unusual presentations of Meckel's diverticulum-perforation due to ingested foreign body, a smooth muscle neoplasm simulating an ovarian tumour, and a Littre's hernia.

A comparison of laparoscopic and open inguinal hernia repair in servicemen.

In a prospective comparison of 70 servicemen undergoing inguinal hernia repair by either the Shouldice method or by laparoscopy, it was found that the laparoscopic operation took longer (mean 52.6 minutes compared to 28.4) and required a postoperative hospital stay as long as that following open operation. However the postoperative analgesia requirement was significantly less, and the patients undergoing laparoscopic herniorraphy were able to regain full fitness and to return to work earlier than those having a Shouldice repair. Despite the higher costs of the laparoscopic operation we believe that the earlier return to work makes this technique cost-effective.

The Guinea Pig Club.

The "Guinea Pig Club" was formed in 1941 by a group of airmen who had sustained grievous injuries--mostly serious burns of the hands and face--and been treated by a team of plastic surgeons led by a remarkable New Zealander, Archibald McIndoe, at the Queen Victoria Hospital at East Grinstead in England. The most senior "Guinea Pig" was Tom Gleave, a fighter pilot who had been shot down during the Battle of Britain, and who carried out his duties as "Chief Guinea Pig" until his death in June 1993. This paper describes Tom Gleave's arrival at the Queen Victoria Hospital, and the formation and development of The Guinea Pig Club.

Helicopter ambulances in critical care.

The origins of aeromedical transport lie in the ferrying of wounded soldiers to hospital. This paper outlines the history of aeromedical evacuation and examines American military and civil experience.