Does screening or routine enquiry for adverse childhood experiences (ACEs) meet criteria for a screening programme? A rapid evidence summary.

BACKGROUND: Adverse childhood experiences (ACEs) are traumatic events in childhood that can have impacts throughout life. It has been suggested that ACEs should be 'screened' for, or routinely enquired about, in childhood or adulthood. The aim of this work is to review evidence for this against the United Kingdom National Screening Committee (UKNSC) programme criteria. METHODS: A rapid review of evidence on ACEs screening was conducted using the approach of the UKNSC. RESULTS: Good quality evidence was identified from meta-analyses for associations between ACEs and a wide range of adverse outcomes. There was no consistent evidence on the most suitable screening tool, setting of administration, and time or frequency of use. Routine enquiry among adults was feasible and acceptable to service users and professionals in various settings. A wide range of potentially effective interventions was identified. Limited evidence was available on the potential for screening or routine enquiry to reduce morbidity and mortality or possible harms of screening. CONCLUSIONS: Based on the application of available evidence to UKNSC screening criteria, there is currently insufficient evidence to recommend the implementation of a screening programme for ACEs. Further research is needed to determine whether routine enquiry can improve morbidity, mortality, health and wellbeing.

MAGNETOCALORIC RESPONSE OF NON-STOICHIOMETRIC Ni2MnGa ALLOYS AND THE INFLUENCE OF CRYSTALLOGRAPHIC TEXTURE.

Currently, there is significant interest in magnetocaloric materials for solid state refrigeration. In this work, polycrystalline Heusler alloys belonging to the Ni2+xMn1-xGa family, with x between 0.08 and 0.24, were evaluated for the purpose of finding composition(s) with an enhanced magnetocaloric effect (MCE) close to room temperature. Differential scanning calorimetry (DSC) was successfully used to screen alloy composition for simultaneous magnetic and structural phase transformations; this coupling needed for a giant MCE. The alloy with x = 0.16 showed an excellent match of transformation temperatures and exhibited the highest magnetic entropy change, ΔSM, in the as-annealed state. Furthermore, the MCE increased by up to 84 % with a 2 Tesla (T) field change when the samples were thermally cycled through the martensite to austenite transformation temperature while held under a constant mechanical load. The highest ΔSM measured for our x = 0.16 alloy for a 2 T magnetic field change was -18 J/kg-K. Texture measurements suggest that preferential orientation of martensite variants contributed to the enhanced MCE in the stress-assisted thermally cycled state.

Magmatic and crustal differentiation history of granitic rocks from Hf-O isotopes in zircon.

Granitic plutonism is the principal agent of crustal differentiation, but linking granite emplacement to crust formation requires knowledge of the magmatic evolution, which is notoriously difficult to reconstruct from bulk rock compositions. We unlocked the plutonic archive through hafnium (Hf) and oxygen (O) isotope analysis of zoned zircon crystals from the classic hornblende-bearing (I-type) granites of eastern Australia. This granite type forms by the reworking of sedimentary materials by mantle-like magmas instead of by remelting ancient metamorphosed igneous rocks as widely believed. I-type magmatism thus drives the coupled growth and differentiation of continental crust.

Episodic growth of the Gondwana supercontinent from hafnium and oxygen isotopes in zircon.

It is thought that continental crust existed as early as 150 million years after planetary accretion, but assessing the rates and processes of subsequent crustal growth requires linking the apparently contradictory information from the igneous and sedimentary rock records. For example, the striking global peaks in juvenile igneous activity 2.7, 1.9 and 1.2 Gyr ago imply rapid crustal generation in response to the emplacement of mantle 'super-plumes', rather than by the continuous process of subduction. Yet uncertainties persist over whether these age peaks are artefacts of selective preservation, and over how to reconcile episodic crust formation with the smooth crustal evolution curves inferred from neodymium isotope variations of sedimentary rocks. Detrital zircons encapsulate a more representative record of igneous events than the exposed geology and their hafnium isotope ratios reflect the time since the source of the parental magmas separated from the mantle. These 'model' ages are only meaningful if the host magma lacked a mixed or sedimentary source component, but the latter can be diagnosed by oxygen isotopes, which are strongly fractionated by rock-hydrosphere interactions. Here we report the first study that integrates hafnium and oxygen isotopes, all measured in situ on the same, precisely dated detrital zircon grains. The data reveal that crust generation in part of Gondwana was limited to major pulses at 1.9 and 3.3 Gyr ago, and that the zircons crystallized during repeated reworking of crust formed at these times. The implication is that the mechanisms of crust formation differed from those of crustal differentiation in ancient orogenic belts.

A review of annual growth screening in Aboriginal schoolchildren in Australia.

OBJECTIVES: To determine if growth screening in school-age Aboriginal children detects new, treatable growth problems. METHODOLOGY: A retrospective review of health centre records of children identified as stunted or wasted from school screening from 11 remote Aboriginal communities in the Top End of the Northern Territory. The age of onset of growth faltering, the occurrence of new growth problems in school-age children and initiation of treatment in response to the school screening results were determined. RESULTS: Weight faltering had occurred in all children by 18 months. The average age of onset of weight faltering was 6.6 months (range 3.5-12 months) for stunted children and 8.9 months (range 7.5-18 months) for wasted children. Height faltering in stunted children commenced in all children with documented height measurements by 3 years. Staff did not report any new interventions for poor growth as a result of screening school-age children in 1993 although many children had previously been assessed by the local doctor or visiting paediatrician and were being monitored. CONCLUSIONS: All children that were found to be stunted or wasted were already known to have poor growth prior to school entry. A change in focus is needed from repeatedly weighing and measuring school-age children to developing community- based interventions to improve the nutritional status of all children. Annual measurement of weight and height beyond 5 years of age is not recommended unless it is used to help evaluate interventions aimed at improving nutritional status and educational achievement.

Estimating the prevalence of Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, and human papillomavirus infection in indigenous women in northern Australia.

OBJECTIVE: To estimate more accurately the age specific prevalence of Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, and human papillomavirus infection (HPV) in indigenous women living in urban, rural, and remote areas of the "Top End" of the Northern Territory (NT). DESIGN: Analysis of data obtained from two community based studies using self administered tampon specimens tested by polymerase chain reaction for sexually transmitted disease (STD). Data pertaining to the notifiable STDs (N gonorrhoeae and C trachomatis) were obtained from the NT health department. PATIENTS: 1090 indigenous women (age range 12-73 years) were enrolled when they attended local community health centres, family planning clinics, and STD clinics. The majority attended clinics in their home community in the course of "well women's checks" which encourage women to undergo screening for a variety of general medical conditions. RESULTS: The overall prevalence of T vaginalis, C trachomatis, N gonorrhoeae, and HPV was 0.25 (95% CI: 0.22-0.28), 0.11 (0.09-0.13), 0.17 (0.15-0.19), and 0.42 (0.37-0.48) respectively. Of the women found to be infected (excluding HPV), 25.5% had two or more of the above organisms detected. There was a statistically significant increase in the age specific prevalence of T vaginalis but a significant decrease with age for C trachomatis and HPV infection. There was no statistically significant change for N gonorrhoeae with age. CONCLUSIONS: STDs are hyperendemic in this population of indigenous women and the notification data significantly underestimate their prevalence. Distinct patterns of age specific prevalence were demonstrated, highlighting the need to tailor control strategies to specific epidemiological features.

Comparison of tampon and urine as self-administered methods of specimen collection in the detection of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis in women.

Self-administered sampling techniques for the detection of sexually transmitted diseases (STDs) are particularly useful due to their ease of collection and better patient compliance. Urine specimens, and recently tampons, have been described as methods of specimen collection for the detection of some STDs in women. In this study, 660 women had both first-void urine (FVU) and tampon specimens analysed by polymerase chain reaction (PCR) for the detection of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis. Overall 6.5%, 10.1% and 17.9% of urine samples were positive whereas 7%, 21.2% and 22% of tampon specimens were positive for C. trachomatis, N. gonorrhoeae and T. vaginalis respectively. Tampon-collected specimens tested by PCR were more sensitive than urine specimens for the detection of N. gonorrhoeae and T. vaginalis (P < 0.001) and equally sensitive for the detection of C. trachomatis (P=0.45).

The tampon test for trichomoniasis: a comparison between conventional methods and a polymerase chain reaction for Trichomonas vaginalis in women.

OBJECTIVES: Trichomonas vaginalis is the most common STD worldwide and the infection has been linked with an increased risk of HIV transmission. We present a detailed comparison between conventional collection and testing methods and the polymerase chain reaction (PCR) tampon test for T vaginalis. METHODS: Women were tested for the presence of T vaginalis by PCR analysis of a tampon specimen and by conventional methods which included one or more of the following: culture and microscopy from a high vaginal swab (HVS) or endocervical swab (ECS), and microscopy of a Papanicolaou (Pap) smear. RESULTS: T vaginalis was detected in 51/590 (8.6%) conventional tests and 93/590 (15.8%) tampon specimens. Retesting of all tampon PCR positive specimens confirmed 89/93 (95.7%) tests. Using the tampon PCR as the reference, the sensitivities of the different conventional sampling and testing methods for the detection of T vaginalis were 8.3% (5/60) for ECS microscopy or culture, 31% (13/42) for HVS microscopy or culture, 52.8% (19/36) for HVS directly inoculated into Trichomonas medium and 59.4% (38/64) for Pap smear. CONCLUSIONS: No conventional test in the remote setting has comparable sensitivity to PCR. The Pap smear is the next most sensitive, but requires a speculum examination. The use of PCR will allow inclusion of T vaginalis into STD screening programmes in both developed (lower prevalence) and developing (higher prevalence) countries.

Using self-administered tampons to diagnose STDs.

The new nucleic acid amplification techniques (e.g., LCR and PCR) have allowed the introduction of non- and minimally-invasive techniques for the detection of sexually transmitted diseases (STDs). In this article, we describe one of these-the self-administrated tampon method-which we have used to detect the presence of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and human papillomavirus in women.