Impact of "early intervention" parent workshops on outcomes for caregivers of children with neurodisabilities: a mixed-methods study.

PURPOSE: This study explored the feasibility, impact and parent experiences of ENVISAGE (ENabling VISions And Growing Expectations)-Families, a parent-researcher co-designed and co-led program for parents/caregivers raising children with early-onset neurodisabilities. METHODS: Parents/caregivers of a child with a neurodisability aged ≤6 years, recruited in Australia and Canada, participated in five weekly online workshops with other parents. Self-report measures were collected at baseline, immediately after, and 3 months post-ENVISAGE-Families; interviews were done following program completion. Quantitative data were analyzed with generalized estimating equations and qualitative data using interpretive description methodology. RESULTS: Sixty-five parents (86% mothers) were recruited and 60 (92%) completed the program. Strong evidence was found of effects on family empowerment and parent confidence (all p ≤ 0.05 after the program and maintained at 3-month follow-up). The ENVISAGE-Families program was relevant to parents' needs for: information, connection, support, wellbeing, and preparing for the future. Participants experienced opportunities to reflect on and/or validate their perspectives of disability and development, and how these perspectives related to themselves, their children and family, and their service providers. CONCLUSIONS: ENVISAGE was feasible and acceptable for parent/caregivers. The program inspired parents to think, feel and do things differently with their child, family and the people who work with them.Implications for rehabilitationENVISAGE (ENabling VISions And Growing Expectations)-Families is a co-designed, validated parent/researcher "early intervention and orientation" program for caregivers raising a child with neurodevelopmental disabilities (NDDs).ENVISAGE-Families empowered parents' strengths-based approaches to their child, family, disability, and parenting.ENVISAGE-Families increased caregivers' confidence in parenting children with NDD's and provided them tools to support connection, collaboration, and wellbeing.Raising children with NDD can have a profound impact on caregivers, who can benefit from strengths-based, future focused supports early in their parenting experience.

The Acceptance and Use of the e-Health Instrument 'The Personal Health Check' in Four Dutch Municipalities: Lessons Learned.

This pilot study assessed the acceptance and use of the e-Health instrument "the Personal Health Check" (PHC) among clients and professionals in primary care settings. By filling in the online PHC instrument, participants were provided insights into their health and lifestyle. When results revealed an increased health risk, participants were advised to undertake additional lab tests measuring blood pressure and haemaglobin levels. Based on the online questionnaire and optional lab tests, participants then received a report that included individually-tailored feedback from the e-Health application about personal health risks and suggestions for health interventions. The PHC was implemented in 2016 in four Dutch municipalities that determined which neighbourhood(s) the PHC targeted and how participants were invited. The Unified Theory of Acceptance and Use of Technology was used as a theoretical framework to address our research questions. Methods used to assess acceptance were: PHC instrument data, data from additional questionnaires completed by PHC participants, focus groups with PHC participants and professionals in primary care, and telephone interviews with non-responders to the invitation to participate in the online PHC. Of the 21,735 invited, 12% participated. Our results showed that participants and professionals in this pilot were predominantly positive about the PHC. Participants reported that they made an effort to apply the PHC lifestyle advice they received. Almost all had the knowledge and resources needed to use the PHC online instrument. Invitations from general practitioners almost doubled participation relative to invitations from the sponsoring municipalities. The overall low response rate, however, suggests that the PHC is unsuitable as a foundation on which to develop local public health policy.

Mapping the landscape of cataract surgery teaching assessment in Canadian residency programs.

OBJECTIVE: The Royal College of Physicians and Surgeons of Canada has mandated a shift in post-graduate residency education in Canada towards a competency-based model. Within this context, it is unclear how resident's competence in cataract surgery is currently being assessed for both formative and summative purposes. Therefore, we conducted a national survey to evaluate the current landscape of cataract surgery teaching in Canadian Ophthalmology programs. METHODS: The opportunity to participate in an online survey was extended to all Canadian ophthalmology program directors and residents. Between July and September 2017, data was collected on demographics (name of program, levels of training), current framework of assessment, and any other contexts for cataract surgery assessments being used (e.g., wetlabs or surgical simulators). RESULTS: We had a total of 32 responses including 7 program directors (22%), 14 senior residents (44%), and 10 junior residents (34%). The assessments used varied greatly; none of the residency programs used a published assessment tool for assessing skill in cataract surgery. The majority of programs (9 of 11; 82%) used locally-designed assessments and two programs (18%) did not use any standardized forms or tools. All schools were using a wet lab to augment surgical teaching and simulators were being used by 5 of 11 programs (45%). CONCLUSION: There are a variety of approaches being used to assess competence in cataract surgery. Many programs share some similarities, and a framework for designing assessment is suggested to guide future efforts at competency-based training and assessment.

Use of Diffusion-Weighted Imaging and 18F-Fluorodeoxyglucose Positron Emission Tomography Combined With Computed Tomography in the Response Assessment for (Chemo)radiotherapy in Head and Neck Squamous Cell Carcinoma.

AIMS: Our purpose was to assess the diagnostic accuracy and prognostic value of diffusion-weighted imaging (DWI) and 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (18F-FDG-PET/CT) carried out 3-6 months after (chemo)radiotherapy in head and neck squamous cell carcinoma. MATERIALS AND METHODS: For this retrospective cohort study we included 82 patients with advanced-stage head and neck squamous cell carcinoma treated between 2012 and 2015. Primary tumours and lymph nodes were assessed separately. DWI was analysed qualitatively and quantitatively. 18F-FDG-PET/CT was evaluated using the Hopkins criteria. Dichotomous qualitative analysis was carried out for both modalities. Cox regression analysis was used for univariate analysis of recurrence-free survival (RFS). Significant univariate parameters were included in multivariate analysis. RESULTS: In 12 patients, locoregional recurrence occurred. With all imaging strategies, either single-modality or multi-modality, a high negative predictive value (NPV) was achieved (94.3-100%). In response evaluation of the primary site, the preferred strategy is 18F-FDG-PET/CT only, which resulted in a sensitivity of 85.7%, specificity of 86.5%, positive predictive value (PPV) of 37.5% and NPV of 98.5%. For response evaluation of the neck, the best results were obtained with a sequential approach only including the second modality in positive reads of the first modality. It did not matter which modality was assessed first. This strategy for lymph node assessment resulted in a sensitivity, specificity, PPV and NPV of 83.3%, 95.6%, 62.5%, and 98.5%, respectively. After correction for received treatment and human papillomavirus status, primary tumour (P = 0.009) or lymph node (P < 0.001) Hopkins score ≥4 on 18F-FDG-PET/CT remained significant predictors of RFS. CONCLUSION: For response evaluation of the primary tumour 18F-FDG-PET/CT only is the preferred strategy, whereas for the neck a sequential approach including both DWI and 18F-FDG-PET/CT resulted in the best diagnostic accuracy for follow-up after (chemo)radiotherapy. Qualitative analysis of 18F-FDG-PET/CT is a stronger predictor of RFS than DWI analysis.

Limitations in ionization-induced compression of femtosecond laser pulses due to spatio-temporal couplings.

It was recently proposed that ionization-induced self-compression could be used as an effective method to further compress femtosecond laser pulses propagating freely in a gas jet [He et al., Phys. Rev. Lett. 113, 263904 2014]. Here, we address the question of the homogeneity of the self-compression process and show experimentally that homogeneous self-compression down to 12fs can be obtained by finding the appropriate focusing geometry for the laser pulse. Simulations are used to reproduce the experimental results and give insight into the self-compression process and its limitations. Simulations suggest that the ionization process induces spatio-temporal couplings which lengthen the pulse duration at focus, possibly making this method ineffective for increasing the laser peak intensity.

Lower verbal intelligence is associated with diabetic complications and slower walking speed in people with Type 2 diabetes: the Maastricht Study.

AIMS: To determine the association of verbal intelligence, a core constituent of health literacy, with diabetic complications and walking speed in people with Type 2 diabetes. METHODS: This study was performed in 228 people with Type 2 diabetes participating in the Maastricht Study, a population-based cohort study. We examined the cross-sectional associations of score on the vocabulary test of the Groningen Intelligence Test with: 1) determinants of diabetic complications (HbA1c , blood pressure and lipid level); 2) diabetic complications: chronic kidney disease, neuropathic pain, self-reported history of cardiovascular disease and carotid intima-media thickness; and 3) walking speed. Analyses were performed using linear regression and adjusted in separate models for potential confounders and mediators. Significant age- and sex-adjusted associations were additionally adjusted for educational level in a separate model. RESULTS: After full adjustment, lower verbal intelligence was associated with the presence of neuropathic pain [odds ratio (OR) 1.18, 95% CI 1.02;1.36], cardiovascular disease (OR 1.14, 95% CI 1.01;1.30), and slower walking speed (regression coefficient -0.011 m/s, 95% CI -0.021; -0.002 m/s). These associations were largely explained by education. Verbal intelligence was not associated with blood pressure, glycaemic control, lipid control, chronic kidney disease or carotid intima-media thickness. CONCLUSIONS: Lower verbal intelligence was associated with the presence of some diabetic complications and with a slower walking speed, a measure of physical functioning. Educational level largely explained these associations. This implies that clinicians should be aware of the educational level of people with diabetes and should provide information at a level of complexity tailored to the patient.

Organizational strategy use in children aged 5-7: standardization and validity of the Rey Complex Figure Organizational Strategy Score (RCF-OSS).

This study investigated psychometric properties (standardization and validity) of the Rey Complex Figure Organizational Strategy Score (RCF-OSS) in a sample of 217 healthy children aged 5-7 years. Our results showed that RCF-OSS performance changes significantly between 5 and 7 years of age. While most 5-year-olds used a local approach when copying the Rey-Osterrieth Complex Figure (ROCF), 7-year-olds increasingly adopted a global approach. RCF-OSS performance correlated significantly, but moderately with measures of ROCF accuracy, executive functioning (fluency, working memory, reasoning), and non-executive functioning (visual-motor integration, visual attention, processing speed, numeracy). These findings seem to indicate that RCF-OSS performance reflects a range of cognitive skills at 5 to 7 years of age, including aspects of executive and non-executive functioning.

High repetition rate plasma mirror device for attosecond science.

This report describes an active solid target positioning device for driving plasma mirrors with high repetition rate ultra-high intensity lasers. The position of the solid target surface with respect to the laser focus is optically monitored and mechanically controlled on the nm scale to ensure reproducible interaction conditions for each shot at arbitrary repetition rate. We demonstrate the target capabilities by driving high-order harmonic generation from plasma mirrors produced on glass targets with a near-relativistic intensity few-cycle pulse laser system operating at 1 kHz. During experiments, residual target surface motion can be actively stabilized down to 47 nm (root mean square), which ensures sub-300-as relative temporal stability of the plasma mirror as a secondary source of coherent attosecond extreme ultraviolet radiation in pump-probe experiments.

Grism compressor for carrier-envelope phase-stable millijoule-energy chirped pulse amplifier lasers featuring bulk material stretcher.

We demonstrate compression of amplified carrier-envelope phase (CEP)-stable laser pulses using paired transmission gratings and high-index prisms, or grisms, with chromatic dispersion matching that of a bulk material pulse stretcher. Grisms enable the use of larger bulk stretching factors and thereby higher energy pulses with lower B-integral in a compact amplifier design suitable for long-term CEP control.

Brunel-dominated proton acceleration with a few-cycle laser pulse.

Experimental measurements of backward accelerated protons are presented. The beam is produced when an ultrashort (5 fs) laser pulse, delivered by a kHz laser system, with a high temporal contrast (10(8)), interacts with a thick solid target. Under these conditions, proton cutoff energy dependence with laser parameters, such as pulse energy, polarization (from p to s), and pulse duration (from 5 to 500 fs), is studied. Theoretical model and two-dimensional particle-in-cell simulations, in good agreement with a large set of experimental results, indicate that proton acceleration is directly driven by Brunel electrons, in contrast to conventional target normal sheath acceleration that relies on electron thermal pressure.

Nonlinear optical transformation of the polarization state of circularly polarized light with holographic-cut cubic crystals.

Nonlinear modification of circularly polarized light propagating in holographic-cut cubic crystals is theoretically predicted and experimentally observed. To the best of our knowledge this is the first demonstration of nonlinear modification of circularly polarized light with cubic crystals.

Efficient cross polarized wave generation for compact, energy-scalable, ultrashort laser sources.

The generation of high contrast and ultrashort laser pulses via a compact and energy-scalable cross polarized wave filter is presented. The setup incorporates a waveguide spatial filter into a single crystal XPW configuration, enabling high energy and high intensity transmission, efficient contrast enhancement and pulse shortening at the multi-mJ level. Excellent XPW conversion of up to 33% (global efficiency: 20%, intensity transmission: 40%) led to an output energy of 650 µJ for an input of 3.3 mJ. Additionally, efficient conversion under specific input phase conditions, allowed pulse shortening from 25 fs to 9.6 fs, indicating the prospective application of this setup as a high energy, ultrabroad laser source.

Pharmacokinetics of an orally administered methylcellulose formulation of gallium maltolate in neonatal foals.

Gallium is a trivalent semi-metal with anti-microbial effects because of its incorporation into crucial iron-dependent reproductive enzyme systems. Gallium maltolate (GaM) provides significant gallium bioavailability to people and mice following oral administration and to neonatal foals following intragastric administration. To study the prophylactic and therapeutic effects of GaM against Rhodococcus equi pneumonia in foals, we developed a methylcellulose formulation of GaM (GaM-MCF) for oral administration to neonatal foals. Normal neonatal foals were studied. Six foals received 20 mg/kg and another six foals received 40 mg/kg of GaM-MCF orally. Serial serum samples were collected and serum gallium concentrations were determined using inductively coupled plasma mass spectroscopy. Gallium was rapidly absorbed (T(max) of 4 h), and a mean C(max) of 0.90 or 1.8 microg/mL was achieved in foals receiving 20 or 40 mg/kg respectively. Marked variability existed in C(max) among foals: only half of the foals receiving 20 mg/kg attained serum concentrations of >0.7 microg/mL, a level suggested to be therapeutic against R. equi by previous studies. Mean elimination half-life was 32.8 or 32.4 h for foals receiving 20 or 40 mg/kg respectively. The results of this study suggest that at least 30 mg/kg orally every 24 h should be considered in future pharmacodynamic and efficacy studies.

Closed-loop carrier-envelope phase stabilization with an acousto-optic programmable dispersive filter.

We demonstrate arbitrary carrier-envelope (CE) phase control of femtosecond laser pulses by an acousto-optic programmable dispersive filter (AOPDF), with an accuracy better than pi/100 at a repetition rate of 1 kHz. We also demonstrate, for the first time to the best of our knowledge, 15 Hz closed-loop CE phase stabilization using an AOPDF inside a 1 kHz chirped pulse amplifier to correct for slow CE phase drifts.

Fabrication of high-aspect ratio Si pillars for atom probe 'lift-out' and field ionization tips.

A process for fabricating high-aspect ratio ( approximately 1:20), micron-sized Si [001] pillars using mechanical and chemical size reduction is presented. A dicing saw was used for mechanically patterning an array of square pillars with side lengths of >20mum. These pillars were then reduced in size using an aqueous NaOH and KOH solution heated to 100 degrees C. The chemical etch reduces the pillar size within the time range amenable for focus ion beam milling and/or attachment for atom probe 'lift-out' specimens. The pillars can be formed with either a flat top surface or into <100nm tip points for direct field ionization.

Preservation of the carrier envelope phase during cross-polarized wave generation.

The preservation of carrier envelope phase (CEP) during Cross-Polarized Wave Generation (XPWG) is demonstrated through two independent experiments based on the spatially and spectrally resolved interference fringes formed by the XPW beam and its fundamental. In a first measurement, we found that the vertical fringe position on the spatial detector was maintained over many consecutive laser shots, implying practically no change in relative CEP between the XPW and the fundamental. In a second experiment, we measured the change in relative CEP between the XPW and fundamental beam by systematically varying the amount of material dispersion inside the XPW arm of the interferometer. The recorded rate of relative phase change was in excellent agreement with the theoretical value.

Broadband attosecond pulse shaping.

We use semiconductor (Si) and metallic (Al, Zr) transmission filters to shape, in amplitude and phase, high-order harmonics generated from the interaction of an intense titanium sapphire laser field with a pulsed neon gas target. Depending on the properties of the filter, the emitted attosecond pulses can be optimized in bandwidth and/or pulse length. We demonstrate the generation of attosecond pulses centered at energies from 50 to 80 eV, with bandwidths as large as 45 eV and with pulse durations compressed to 130 as.

Intense self-compressed, self-phase-stabilized few-cycle pulses at 2 microm from an optical filament.

We report the compression of intense, carrier-envelope phase stable mid-IR pulses down to few-cycle duration using an optical filament. A filament in xenon gas is formed by using self-phase stabilized 330 microJ 55 fs pulses at 2 microm produced via difference-frequency generation in a Ti:sapphire-pumped optical parametric amplifier. The ultrabroadband 2 microm carrier-wavelength output is self-compressed below 3 optical cycles and has a 270 microJ pulse energy. The self-locked phase offset of the 2 microm difference-frequency field is preserved after filamentation. This is to our knowledge the first experimental realization of pulse compression in optical filaments at mid-IR wavelengths (lambda>0.8 microm).