Mothers and fathers in the criminal justice system and children's child protective services involvement.

BACKGROUND: Parental criminal justice system (CJS) involvement is a marker for child protective services (CPS) involvement. OBJECTIVE: To document how parental criminal case processing affects children's CPS involvement. PARTICIPANTS AND SETTING: Participants included mothers and fathers with a serious criminal charge (mothers = 78,882; fathers = 165,070) and without any criminal charge (mothers = 962,963; fathers = 743,604) between 2008-2012. Statewide North Carolina records on court proceedings, births, CPS assessments/investigations, and foster care placements were used. METHODS: The observational unit was an individual's first charge date of a year. Outcomes were CPS assessment/investigation and foster care entry within six months and alternatively three years following the charge. Key explanatory variables were whether the charges resulted in prosecution, conviction following prosecution, and an active sentence conditional on conviction. An instrumental variables approach was used. RESULTS: Parents charged with a criminal offense had higher rates of having a CPS assessment/investigation during the three years preceding the charge than parents who were not charged. Among mothers who were convicted, CPS assessment/investigation increased 8.1 percent (95 % CI: 2.2, 13.9) and 9.5 percent (95 % CI: 1.3, 17.6) 6 months and 3 years following the charge. An active sentence increased CPS assessment/investigations by 21.6 percent (95 % CI: 6.4, 36.7) within 6 months. For fathers, active sentence increased foster care placement by 1.6 percent (95 % CI: 0.24, 2.9) within 6 months of the criminal charge. CONCLUSIONS: Changing parental incarceration rates would change CPS caseloads substantially. The criminal justice and CPS systems work with overlapping populations, data and services sharing should be considered a high priority.

Flexibility in MOFs: do scalar and group-theoretical counting rules work?

We investigate the ability of counting rules drafted from engineering to predict the flexibility or rigidity of bar-and-joint or body-and-joint assemblies representing metal organic frameworks. We show that while scalar counting rules are not reliable, group-theoretical approaches are able to disentangle mechanisms from states of self-stress and to predict the existence of flexible mechanisms. We give several detailed examples of such calculations, highlighting the fact that behind an abstract exterior they are in fact easy to apply and similar to the method used to obtain molecular vibrations. We also correct a slight misinterpretation of the rigidity of IRMOF-1.

A systematic typology for negative Poisson's ratio materials and the prediction of complete auxeticity in pure silica zeolite JST.

Single crystals can commonly have negative Poisson's ratio in a few directions; however more generalised auxeticity is rarer. We propose a typology to distinguish auxetic materials. We characterise numerous single crystals and demonstrate that partial auxeticity occurs for around 37%. We find average auxeticity to be limited to α-cristobalite and no example of complete auxeticity. We simulate two hundreds pure silica zeolites with empirical potentials and quantum chemistry methods, and for the first time identify complete auxeticity in a zeolite network, JST.

Mental incapacity in hospitalised patients undergoing percutaneous endoscopic gastrostomy insertion.

BACKGROUND & AIMS: Decisions to insert percutaneous endoscopic gastrostomy (PEG) tubes may be difficult because patients have serious underlying disease, and the procedure has associated risks. Patients may also lack mental capacity to consent to PEG insertion. This study aimed to prospectively determine the prevalence of mental incapacity in hospitalised patients undergoing PEG insertion. METHODS: Mental capacity was assessed using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) in 72 consecutive inpatients referred for PEG insertion. Cognitive function was measured using the Mini-Mental State Examination (MMSE). Sixty eight inpatients and 69 outpatients having diagnostic upper gastrointestinal (UGI) endoscopy were similarly studied. RESULTS: Thirty nine of the PEG patients had suffered stroke, and none had a primary diagnosis of dementia. Seventy four % (53/72) of inpatients referred for PEG, 22% (15/68) of inpatients having UGI endoscopy, and 3% (2/69) of outpatients having UGI endoscopy, lacked mental capacity, p < 0.001. MMSE scores were normal in just 18% of inpatients having PEG, in 72% of inpatients having UGI endoscopy, and in 91% of outpatients having UGI endoscopy, p < 0.001. CONCLUSION: Amongst inpatients undergoing PEG insertion there is a high prevalence (three-quarters patients) of mental incapacity to consent to this important intervention. Decisions have to be made on behalf of most inpatients referred for PEG insertion.

What is the use of biopsy and antibodies in coeliac disease diagnosis?

The advent of highly sensitive and specific serological markers has led to some protagonists proposing that coeliac disease can be diagnosed without the need for a biopsy. However, this is an area of controversy. Lack of consensus about diagnostic degrees of histological change, paucity of symptoms, antibody-negative disease and immunodeficiency can make diagnosis difficult even with a biopsy. Conversely, an argument can be put forward for a 'no biopsy' approach based on the large number of patients with typical symptoms and positive serology who experience a diagnostic delay. In addition, endoscopy is not without discomfort. This article discusses the use of antibodies and duodenal biopsy within this context. Finally, we propose a pragmatic diagnostic algorithm for clinicians to use when investigating patients for coeliac disease.

A prospective study into the aetiology of lymphocytic duodenosis.

BACKGROUND: Lymphocytic duodenosis is defined by normal villous architecture and intraepithelial lymphocytes (IELs) >25 per 100 enterocytes. Such patients should not be diagnosed with coeliac disease, solely by histology, as previous retrospective studies have suggested other associations with lymphocytic duodenosis. AIM: To study prospectively the aetiology of lymphocytic duodenosis. METHODS: One hundred patients with lymphocytic duodenosis were investigated rigorously for coeliac disease and other known associations for lymphocytic duodenosis by initial investigations of coeliac serology, and exclusion of infection. Of 34 with no explanation for lymphocytic duodenosis, 29 underwent repeat duodenal biopsies following a gluten challenge. RESULTS: Coeliac disease was present in 16% of patients with lymphocytic duodenosis. In the absence of a positive coeliac diagnosis, lymphocytic duodenosis was most commonly associated with drugs (21%), infection (19%), immune dysregulation (4%), inflammatory bowel disease (2%), microscopic colitis (2%), sarcoidosis (1%) and IgA deficiency (1%). Of 34 with no known associations, 18 had symptoms of irritable bowel syndrome (IBS), and in 29 patients investigated with repeat duodenal biopsies, the IEL count returned to normal in 22. CONCLUSIONS: In 66% of cases of lymphocytic duodenosis, a known association can be found by further investigations; importantly, 16% will have coeliac disease. In those with no apparent cause, there may be an association with IBS and the IEL count becomes normal on repeat biopsy in 76%.

Changing patterns of coeliac serology requests.

BACKGROUND: Accurate serological tests have revolutionized the diagnosis of coeliac disease. AIM: To quantify the volume of coeliac serology requests at a district hospital over a decade, identify their origin, assess positivity rates and subsequent duodenal biopsy and histological confirmation rates. METHODS: Details of patients in whom coeliac serology was requested from 1997 to 2006 were obtained from laboratory databases. The origins of request were categorized into gastroenterology, general practice, paediatrics and other specialities. Duplicate requests were excluded. RESULTS: A total of 9976 serological tests were requested. Testing increased from 302 in 1997, to 1826 in 2006. In all, 66% of requests were in females. Tests in children accounted for 14-25% of each year's total. General practitioner requests increased from 3.3% in 1997 to 52% in 2006. The proportion of positive serological results fell from 5.7% in 1997 to 2.6% in 2006. Duodenal biopsies were performed in approximately 85% of seropositive patients in earlier years and approximately 75% of seropositive patients in later years. Most nonbiopsied seropositive patients had serology requested by general practitioners. Biopsies confirmed coeliac disease in 91% of seropositive patients. CONCLUSION: Increasingly, coeliac serological testing is requested by general practitioners. Twice as many females are tested. Increasing test numbers but diminishing positivity rates suggest testing is requested at lower symptom thresholds. Positive serological results are often not confirmed histologically.

Deformation mechanisms leading to auxetic behaviour in the α-cristobalite and α-quartz structures of both silica and germania.

Analytical expressions have been developed in which the elastic behaviour of the α-quartz and α-cristobalite molecular tetrahedral frameworks of both silica and germania are modelled by rotation, or dilation or concurrent rotation and dilation of the tetrahedra. Rotation and dilation of the tetrahedra both produce negative Poisson's ratios (auxetic behaviour), whereas both positive and negative values are possible when these mechanisms act concurrently. Concurrent rotation and dilation of the tetrahedra reproduces with remarkable accuracy both the positive and negative ν(31) Poisson's ratios observed for silica α-quartz and α-cristobalite, respectively, when loaded in the x(3) direction. A parametric fit of the concurrent model to the germania α-quartz experimental ν(31) Poisson's ratio is used to predict ν(31) for germania α-cristobalite, for which no experimental value exists. This is predicted to be +0.007. Strain-dependent ν(31) trends, due to concurrent rotation and dilation in the silica structures, are in broad agreement with those predicted from pair-potential calculations, although significant differences do occur in the absolute values. With the model of concurrent dilation and rotation of the tetrahedra we predict that an alternative uniaxial stress (σ(3))-induced phase exists for both silica, α-quartz and α-cristobalite, and germania, α-cristobalite, having geometries in reasonable agreement with ß-quartz and idealized ß-cristobalite, respectively.

Transforming growth factor-beta enables NFATc1 expression during osteoclastogenesis.

Osteoclastogenesis is dependent on distinct stimuli that prime and activate osteoclast differentiation. One cytokine needed to prime monocytes for osteoclastogenesis is TGF-beta, which enables and augments RANKL and TNF-alpha-induced osteoclast differentiation. However, the precise time-period during which this occurs and the molecular mechanism mediating this action are unknown. We report here TGF-beta prime monocytes for osteoclast formation within 24h by regulating expression of NFATc1, a key osteoclastic transcription factor. TGF-beta directly induces cytoplasmic NFATc1 expression within 24h, but is unable to stimulate NFATc1 nuclear translocation. Furthermore, RANKL-induced NFATc1 expression is dependent on the presence of TGF-beta during the early stages of osteoclastogenesis. Similarly, TNF-alpha activates osteoclastogenesis by stimulating translocation of TGF-beta-induced NFATc1. In light of these findings, it is apparent that osteoclast formation is dependent on coordinated interactions between TGF-beta and RANKL/TNF-alpha that regulate the expression and intracellular distribution of NFATc1 during early stages of osteoclast differentiation.

The distribution of ganglion cells in the equine retina and its relationship to skull morphology.

It has recently been reported that a strong correlation exists between the distribution of retinal ganglion cells and nose length in the domestic dog. To determine if this phenomenon occurs in another domestic species with diverse skull morphology, the current study examined the distribution of retinal ganglion cells in 30 horses from a variety of breeds. There was a significant variation in the density of ganglion cells found across the retinae. Breed was a significant predictor for ganglion cell density within the visual streak. A strong positive correlation exists between the density of ganglion cells in the visual streak and nasal length. Significant variation was also seen in the area centralis but did not correlate with any of the recorded skull measurements. The findings of this study provide us with further understanding of the equine visual system and the level of variation that exists between individuals of the same species.

Conformation of the equine skull: a morphometric study.

There is a lack of an established method for quantifying equine skull morphology. This study proposes a method that is valid for use on both live and deceased horses. A total of nine head measurements (skull length, cranial length, nasal length, ratio of cranial:nasal length, cranial width, zygomatic width, mandibular depth, nasal profile area, cranial profile area) and six indices (skull index, cranial index, nasal index, mandibular index, nasal profile index, cranial profile index) were recorded from 30 horses from a variety of breeds whilst the soft tissues of the head were intact. A line was drawn level with the palpable notches caudal to the caudal lacrimal process of each orbit to estimate the suture line of the nasal and frontal bones and distinguish between the neurocranium and splanchnocranium. There were positive correlations between many of the head measurements. This method also illustrated significant differences in the skull morphology of three breeds (Arabians, thoroughbreds and standardbreds).

Approaches to the structural modelling of insect wings.

Insect wings lack internal muscles, and the orderly, necessary deformations which they undergo in flight and folding are in part remotely controlled, in part encoded in their structure. This factor is crucial in understanding their complex, extremely varied morphology. Models have proved particularly useful in clarifying the facilitation and control of wing deformation. Their development has followed a logical sequence from conceptual models through physical and simple analytical to numerical models. All have value provided their limitations are realized and constant comparisons made with the properties and mechanical behaviour of real wings. Numerical modelling by the finite element method is by far the most time-consuming approach, but has real potential in analysing the adaptive significance of structural details and interpreting evolutionary trends. Published examples are used to review the strengths and weaknesses of each category of model, and a summary is given of new work using finite element modelling to investigate the vibration properties and response to impact of hawkmoth wings.

The hind wing of the desert locust (Schistocerca gregaria Forskål). I. Functional morphology and mode of operation.

Detailed morphological investigation, mechanical testing and high-speed cinematography and stroboscopic examination of desert locusts, Schistocerca gregaria, in flight show that their hind wings are adapted to deform cyclically and automatically through the wing stroke and that the deformations are subtly dependent on the wings' structure: their shape, venation and vein design and the local properties of the membrane. The insects predominantly fly fast forwards, generating most force on the downstroke, and the hind wings generate extra lift by peeling apart at the beginning of the downstroke and by developing a cambered section during the stroke's translation phase through the 'umbrella effect' - an automatic consequence of the active extension of the wings' expanded posterior fan. Bending experiments indicate that most of the hind wing is more rigid to forces from below than from above and demonstrate that the membrane acts as a stressed skin to stiffen the structure.

The hind wing of the desert locust (Schistocerca gregaria Forskål). II. Mechanical properties and functioning of the membrane.

As part of an investigation of the functional mechanics of the hind wing of the desert locust Schistocerca gregaria, the Young's modulus of the membrane was measured using a newly developed universal materials test machine capable of testing very small specimens of cuticle, down to 1 mm gauge length. Strain was measured optically. Specimens were cut from various locations around the wing and tested under controlled temperature and humidity. The modulus of the membrane was typically between 1 and 5 GPa, but both this and the membrane thickness varied around the wing, with the remigium and the anal fan showing markedly different properties. The membrane was tested for chitin using two methods: a gas pyrolysis/mass spectrometry assay, and a gold-labelled immunoassay specific to chitin. None was detected, and the membrane may consist of epicuticle alone. The wings were examined for evidence of crystalline material using standard polarising microscopy and an advanced technique that distinguishes between three components of the polarised image. Birefringence was detected in the membrane of the anterior part of the wing, but vanished when the membrane was separated from the surrounding veins, suggesting that it was due to pre-stress rather than to ultrastructure. The implications are discussed.

The hind wing of the desert locust (Schistocerca gregaria Forskål). III. A finite element analysis of a deployable structure.

Finite element analysis is used to model the automatic cambering of the locust hind wing during promotion: the umbrella effect. It was found that the model required a high degree of sophistication before replicating the deformations found in vivo. The model has been validated using experimental data and the deformations recorded both in vivo and ex vivo. It predicts that even slight modifications to the geometrical description used can lead to significant changes in the deformations observed in the anal fan. The model agrees with experimental data and produces deformations very close to those seen in free-flying locusts. The validated model may be used to investigate the varying geometries found in orthopteran anal fans and the stresses found throughout the wing when loaded.

Postpericardiotomy syndrome following temporary and permanent transvenous pacing.

The postpericardiotomy syndrome may occur as a complication of temporary and permanent pacing. Physicians involved in procedures which may be complicated by this condition therefore need to be aware of its diagnosis and management.

Surgery for oesophageal carcinoma in the elderly.

OBJECTIVE: There has been a gradual increase in the number of elderly patients referred for oesophageal surgery. The aim of this study is to review our experience with oesophageal cancer surgery in the elderly. METHODS: Between January 1974 and December 1996, 591 patients (408 males, 183 females; mean age 66 years) underwent an oesophageal resection for carcinoma. 221 were aged greater than 70 years of age (group A) and 370 less than 70 (group B). RESULTS: Total in hospital mortality was 8.8% (52/591). This has decreased to less than 5% over the last decade. There was no significant difference in perioperative morbidity or mortality between the groups (P = 0.11). When deaths from unrelated medical conditions were excluded, there was no significant difference in survival between the different age groups (P = 0.96). CONCLUSION: Oesophageal surgery can be performed in a selected elderly population with a low operative morbidity and mortality. The survival benefit of resection is the same in the elderly as for younger patients.

Envoplakin, a possible candidate gene for focal NEPPK/esophageal cancer (TOC): the integration of genetic and physical maps of the TOC region on 17q25.

Focal nonepidermolytic palmoplantar keratoderma (NEPPK), or tylosis, is an autosomal, dominantly inherited disorder of the skin that manifests as focal thickening of the palmar and plantar surfaces. In three families studied, the skin disorder cosegregates with esophageal cancer and oral lesions. New haplotype analysis, presented here, places the tylosis esophageal cancer (TOC) locus between D17S1839 and D17S785. Envoplakin (EVPL) is a protein component of desmosomes and the cornified envelope that is expressed in epidermal and esophageal keratinocytes and has been localized to the TOC region. Mutation analysis of EVPL in the three affected families failed to show tylosis-specific mutations, and haplotype analysis of three intragenic sequence polymorphisms of the EVPL gene placed it proximal to D17S1839. Confirmation of the exclusion of EVPL as the TOC gene by location was obtained by integration of the genetic and physical mapping data using radiation hybrid, YAC, BAC, and PAC clones. This new physical map will allow further identification of candidate genes underlying NEPPK associated with esophageal cancer, which may also be implicated in the development of sporadic squamous cell esophageal carcinoma and Barrett's adenocarcinoma.

The tylosis esophageal cancer (TOC) locus: more than just a familial cancer gene.

Tylosis (focal non-epidermolytic palmoplantar keratoderma; NEPPK) is associated with esophageal cancer in three families, two of which contain six or seven generations. The causative locus, the tylosis esophageal cancer (TOC) gene, has been localized to a small region on chromosome 17q25. Recent loss of heterozygosity (LOH) studies have indicated a role for the TOC gene in sporadic squamous cell esophageal cancer and Barrett's adenocarcinoma. We have now integrated genetic and physical mapping data from the TOC region, based on microsatellite markers and radiation hybrid, yeast (YAC), bacterial (BAC) and P1 artificial chromosomal (PAC) clones, and formed a partial minimal contig of one non-chimeric YAC (330 kb) and one PAC. Twenty-three candidate genes, including envoplakin (EVPL), were mapped against this contig, but only one was shown to be located within the minimal region. This physical map will allow further characterization of the region and identification of a gene implicated in both familial and sporadic squamous cell esophageal carcinoma and Barrett's adenocarcinoma.