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Aim: To assess revision rates and postoperative mortality in patients undergoing hip arthroplasty (HA) for inflammatory arthritis compared to hip osteoarthritis (OA). Methods: The analysis was conducted among cases of HA that were recorded in the National Joint Registry for England and Wales (NJR) between April 2003 and December 2012 and linked to Office for National Statistics mortality records. Procedures were identified where the indication for surgery was listed as seropositive rheumatoid arthritis (RA), ankylosing spondylitis (AS), other inflammatory arthritis (otherIA), or OA. 5-year revision risk and 90-day postoperative mortality according to indication were compared using Cox regression models adjusted for age, sex, American Society of Anaesthesiologists (ASA) grade, year of operation, implant type, and surgical approach. Results: The cohort included 1457 HA procedures conducted for RA, 615 for AS, 1000 for otherIA, and 183,108 for OA. When compared with OA, there was no increased revision risk for any form of inflammatory arthritis (adjusted HRs: RA: 0.93 (0.64–1.35); AS: 1.14 (0.73–1.79); otherIA: 1.08 (0.73–1.59)). Postoperative 90-day mortality was increased for RA when compared with OA (adjusted HR: 2.86 (1.68–4.88)), but not for AS (adjusted HR: 1.56 (0.59–4.18)) or otherIA (adjusted HR: 0.64 (0.16–2.55)). Conclusions: The revision risk in HA performed for all types of inflammatory arthritis is similar to that for HA performed for OA. The 3-fold increased risk of 90-day mortality in patients with RA compared with OA highlights the need for active management of associated comorbidities in RA patients during the perioperative period.

US military policy has come under fire by critics who charge that it does not do enough to prevent sexual harassment and sexual assault, to support and protect victims, and to hold perpetrators acc...

This report provides recommendations for how the Air Force's survey system for monitoring abuse and misconduct in Basic Military Training can best be adapted for use in technical training and flying training environments. The report also provides background on the training environments, revisions to tailor the survey content for these environments, survey pretest results, strategies to promote participation, and recommendations for future use.

The authors evaluate the impact of the U.S. Department of Defense's My Career Advancement Account (MyCAA) Scholarship program, which provides tuition assistance to military spouses for education and training in portable career fields, on the retention of military personnel. Using a propensity-score matching analysis comparing MyCAA households to households of nonusers, they find consistent and sustained evidence for its impact on retention.

The Department of Defense works to prevent and address child abuse or neglect (CAN) and domestic abuse (DA) through the Family Advocacy Program and other services. RAND conducted a study to review resources available to military-affiliated victims and perpetrators of CAN and DA, barriers to utilization, challenges faced by military providers working to prevent and respond to CAN and DA; and to provide recommendations to improve services.

The aim of this study was to determine outcomes and survivorship of the Triathlon knee replacement up to 5 years post-operation. A cohort of 266 patients receiving a Triathlon knee replacement were assessed before surgery and at 3 months, 1 year, 2 years, 3 years and 5 years post-operation. Assessments included patient-reported outcome measures, American Knee Society Score, complications and survivorship. The largest improvements in pain, function, stiffness and knee-related quality of life occurred in the first 3 months post-operation. Further smaller improvements were reported between 3 and 12 months post-operation, and then a plateauing of outcomes was observed up to 5 years. A high percentage of patients (86%) were satisfied with their outcome at 5 years. Survivorship with revision as the endpoint was 96.6% (95% CI 93.2-98.1%) at 5 years post-operation. In conclusion, this study observed good mid-term patient outcomes and survivorship of the Triathlon knee replacement.

My Career Advancement Account Scholarships are intended to help military spouses with education and employment. The percentage of eligible spouses working declined over time, but users were more likely than nonusers to be working two years later.

The aim of this study was to refine the population prevalence estimate of Tourette Syndrome (TS) in children and to investigate potential sources of heterogeneity in previously published studies. A systematic review was conducted and all qualifying published studies of TS prevalence were examined. Extracted data were subjected to a random-effects meta-analysis weighted by sample size; meta-regressions were performed to examine covariates that have previously been proposed as potential sources of heterogeneity. Twenty-six articles met study inclusion criteria. Studies derived from clinically referred cases had prevalence estimates that were significantly lower than those derived from population-based samples (P = 0.004). Among the 21 population-based prevalence studies, the pooled TS population prevalence estimate was 0.52% (95% confidence interval CI: 0.32-0.85). In univariable meta-regression analysis, study sample size (P = 0.002) and study date (P = 0.03) were significant predictors of TS prevalence. In the final multivariable model including sample size, study date, age, and diagnostic criteria, only sample size (P < 0.001) and diagnostic criteria (omnibus P = 0.003; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision [DSM-IV-TR]: P = 0.005) were independently associated with variation in TS population prevalence across studies. This study refines the population prevalence estimate of TS in children to be 0.3% to 0.9%. Study sample size, which is likely a proxy for case assessment method, and the use of DSM-IV-TR diagnostic criteria are the major sources of heterogeneity across studies. The true TS population prevalence rate is likely at the higher end of these estimates, given the methodological limitations of most studies. Further studies in large, well-characterized samples will be helpful to determine the burden of disease in the general population.

Current extended military engagements in foreign nations have taken their toll on U.S. service members and their families. As a result, the services have made renewed commitments to support the needs of these families of military personnel. Quality-of-life and family programs across the services continue to grow. But no service has applied neighborhood theory and methods to better understand these military issues. Installations, and the communities where they are located, vary in terms of the quality of life they provide inhabitants. Similarly, the families who live in these communities and who are assigned to these installations vary in terms of their needs. A one-size-fits-all approach to base resource allocation and the provision of services may not be the most effective in fostering health and well-being among service members and their families. Thus, the services may want to use this approach as part of their efforts to identify gaps in support to service members and families so that they can make the necessary adjustments and better compensate where communities are lacking. This article explores the applicability of neighborhood theory and social indicators research to understanding the quality of life in and around military bases. It also highlights gaps in neighborhood study methodology that need to be addressed in future research. Finally, it outlines how a more in-depth neighborhood analysis of military installations could be conducted.

This final overarching study in a series documents research and recommendations RAND offered to the Air Force to help strengthen the development of a new office responsible for monitoring and promoting resilience among Air Force Airmen, civilian employees, and Air Force families. Efforts to boost resilience have become an important military response to suicide and other markers of distress and poor health. The study reviews the concepts and measures of resilience, resilience factors, hardiness and flourishing. It describes how resilience and the military's Total Force Fitness concepts are related. The study brings together highlights from the eight companion studies on each Total Force Fitness domain and characterizes types of Air Force data that could be used to track resilience.

This article reviews the scientific literature on the epidemiology, prevention, and treatment of problematic Internet use (PIU) with the goal of informing Air Force policies aimed at mitigating PIU's negative impact on operations and the mental health of Airmen. The study is motivated by a recent RAND study estimating that 6 percent of Airmen have PIU. Individuals with PIU, similar to people with substance addictions, suffer from excessive and compulsive online activities, symptoms of tolerance and withdrawal, and functional impairment. PIU is also strongly associated with other mental health problems including major depression. However, at present there is no single accepted definition of PIU, and no up-to-date estimates of the prevalence of PIU in the general U.S. population are available. A range of prevention and treatment approaches have been developed, but none has been rigorously tested in clinical trials. Prevention programs rely on workplace Internet policies and strategies to help individuals self-regulate their Internet use. Treatment approaches that have proven feasible and acceptable to patients with PIU include adaptations of cognitive-behavioral therapy, an evidence-based treatment for depression and anxiety, to the specific symptoms of PIU. Based on our findings, we recommend: (1) increasing awareness of PIU among organizational leadership and mental health professionals, (2) incorporating content related to PIU into existing trainings related to mental health, (3) providing support for self-regulation of Internet use on the job by incorporating PIU management principles into Internet use policies, and (4) continuing monitoring of the emerging scientific literature on PIU.

Retrospective recall about children's symptoms is used to establish early developmental patterns in clinical practice and is also utilised in child psychopathology research. Some studies have indicated that the accuracy of retrospective recall is influenced by life events. Our hypothesis was that an intervention: speech and language therapy, would adversely affect the accuracy of parent recall of early concerns about their child's speech and language development. Mothers (n = 5,390) reported on their child's speech development (child male to female ratio = 50:50) when their children were aged 18 or 30 months, and also reported on these early concerns retrospectively, 10 years later, when their children were 13 years old. Overall reliability of retrospective recall was good, 86 % of respondents accurately recalling their earlier concerns. As hypothesised, however, the speech and language intervention was strongly associated with inaccurate retrospective recall about concerns in the early years (Relative Risk Ratio = 19.03; 95 % CI:14.78-24.48). Attendance at speech therapy was associated with increased recall of concerns that were not reported at the time. The study suggests caution is required when interpreting retrospective reports of abnormal child development as recall may be influenced by intervening events.

Written and verbal languages are neurobehavioral traits vital to the development of communication skills. Unfortunately, disorders involving these traits-specifically reading disability (RD) and language impairment (LI)-are common and prevent affected individuals from developing adequate communication skills, leaving them at risk for adverse academic, socioeconomic and psychiatric outcomes. Both RD and LI are complex traits that frequently co-occur, leading us to hypothesize that these disorders share genetic etiologies. To test this, we performed a genome-wide association study on individuals affected with both RD and LI in the Avon Longitudinal Study of Parents and Children. The strongest associations were seen with markers in ZNF385D (OR = 1.81, P = 5.45 × 10(-7) ) and COL4A2 (OR = 1.71, P = 7.59 × 10(-7) ). Markers within NDST4 showed the strongest associations with LI individually (OR = 1.827, P = 1.40 × 10(-7) ). We replicated association of ZNF385D using receptive vocabulary measures in the Pediatric Imaging Neurocognitive Genetics study (P = 0.00245). We then used diffusion tensor imaging fiber tract volume data on 16 fiber tracts to examine the implications of replicated markers. ZNF385D was a predictor of overall fiber tract volumes in both hemispheres, as well as global brain volume. Here, we present evidence for ZNF385D as a candidate gene for RD and LI. The implication of transcription factor ZNF385D in RD and LI underscores the importance of transcriptional regulation in the development of higher order neurocognitive traits. Further study is necessary to discern target genes of ZNF385D and how it functions within neural development of fluent language.

As part of a large-scale study of children's development, 7390 children were assessed on a range of speech tasks. These were used to identify three groups of children with speech errors within the sample: persistent speech disorder (PSD); speech errors but below the threshold for classification as persistent speech disorder (non-PSD); and common clinical distortions only (CCD). These three groups were compared on demographic factors, performance on IQ, non-word repetition, and diadochokinetic tests. Findings showed that the PSD group and the non-PSD group were most similar for gender, socio-economic status, IQ, and non-word repetition. In the diadochokinetic tasks, the PSD group and the CCD groups were more similar. Implications for these findings in terms of clinical practice are discussed.

Background: Several susceptibility genes have been proposed for dyslexia (reading disability; RD) and specific language impairment (SLI). RD and SLI show comorbidity, but it is unclear whether a common genetic component is shared. Methods: We have investigated whether candidate genes for RD and SLI affect specific cognitive traits or have broad effect on cognition. We have analyzed common risk variants within RD (MRPL19/C2ORF3, KIAA0319, and DCDC2) and language impairment (CMIP and ATP2C2) candidate loci in the Avon Longitudinal Study of Parents and Children cohort (n = 3725), representing children born in southwest England in the early 1990s. Results: We detected associations between reading skills and KIAA0319, DCDC2, and CMIP. We show that DCDC2 is specifically associated with RD, whereas variants in CMIP and KIAA0319 are associated with reading skills across the ability range. The strongest associations were restricted to single-word reading and spelling measures, suggesting that these genes do not extend their effect to other reading and language-related skills. Inclusion of individuals with comorbidity tends to strengthen these associations. Our data do not support MRPL19/C2ORF3 as a locus involved in reading abilities nor CMIP/ATP2C2 as genes regulating language skills. Conclusions: We provide further support for the role of KIAA0319 and DCDC2 in contributing to reading abilities and novel evidence that the language-disorder candidate gene CMIP is also implicated in reading processes. Additionally, we present novel data to evaluate the prevalence and comorbidity of RD and SLI, and we recommend not excluding individuals with comorbid RD and SLI when designing genetic association studies for RD. © 2011 Society of Biological Psychiatry.

Background: The low level of response (LR) to alcohol is one of several genetically influenced characteristics that increase the risk for heavy drinking and alcohol problems. Efforts to understand how LR operates through additional life influences have been carried out primarily in modest-sized U.S.-based samples with limited statistical power, raising questions about generalizability and about the importance of components with smaller effects. This study evaluates a full LR-based model of risk in a large sample of adolescents from the United Kingdom. Methods: Cross-sectional structural equation models were used for the approximate first half of the age 17 subjects assessed by the Avon Longitudinal Study of Parents and Children, generating data on 1,905 adolescents (mean age 17.8 years, 44.2% boys). LR was measured with the Self-Rating of the Effects of Alcohol Questionnaire, outcomes were based on drinking quantities and problems, and standardized questionnaires were used to evaluate peer substance use, alcohol expectancies, and using alcohol to cope with stress. Results: In this young and large U.K. sample, a low LR related to more adverse alcohol outcomes both directly and through partial mediation by all 3 additional key variables (peer substance use, expectancies, and coping). The models were similar in boys and girls. Conclusions: These results confirm key elements of the hypothesized LR-based model in a large U.K. sample, supporting some generalizability beyond U.S. groups. They also indicate that with enough statistical power, multiple elements contribute to how LR relates to alcohol outcomes and reinforce the applicability of the model to both genders. Language: en

U.S. policy banning openly gay and lesbian personnel from serving in its military rests on the belief that heterosexual discomfort with lesbian and gay service members in an integrated environment would degrade unit cohesion and readiness. To inform this policy, data from a 2006 survey of Iraq and Afghanistan war veterans are analyzed in this study. Views of these war veterans are consistent with prior surveys of military personnel showing declining support for the policy: from about 75 percent in 1993 to 40 percent in this survey. Among the demographic and military experience variables analyzed, comfort level with lesbian and gay people was the strongest correlate of attitudes toward the ban. War veterans indicated that the strongest argument against the ban is that sexual orientation is unrelated to job performance and that the strongest argument in favor of the ban is a projected negative impact on unit cohesion. However, analyses of these war veterans’ ratings of unit cohesion and readiness revealed that knowing a gay or lesbian unit member is not uniquely associated with cohesion or readiness; instead, the quality of leaders, the quality of equipment, and the quality of training are the critical factors associated with unit cohesion and readiness.

Objective The proportion of schoolchildren with mild social communicative deficits far exceeds the number diagnosed with an autistic spectrum disorder (ASD). We aimed to ascertain both the population distribution of such deficits and their association with functional adaptation and cognitive ability in middle childhood. Method The parent-report Social and Communication Disorders Checklist was administered to participants ( n = 8,094) in the Avon Longitudinal Study of Parents and Children. We correlated impairment severity with independent clinical diagnoses of ASD, cognitive abilities, and teacher-rated maladaptive behavior. Results Social and Communication Disorders Checklist scores were continuously distributed in the general population; boys had mean scores 30% higher than girls. Social communicative deficits were associated with functional impairment at school, especially in domains of hyperactivity and conduct disorders. A sex-by-verbal IQ interaction effect occurred: verbal IQ was protective against social communication impairments across the range of abilities in female subjects only. In male subjects, this protective effect did not exist for those with above-average verbal IQ. Conclusions Social communicative deficits are of prognostic significance, in terms of behavioral adjustment at school, for boys and girls. Their high general population prevalence emphasizes the importance of measuring such traits among clinically referred children who do not meet diagnostic ASD criteria. Above-average verbal IQ seems to confer protection against social communication impairments in female subjects but not in male subjects.

Background Low education has an impact on life expectancy and level of cognition, but little is known on its effect on life expectancy with cognitive impairment. Methods The Medical Research Council Cognitive Function and Ageing Study (MRC CFAS) collected population-based longitudinal data on people aged 65 years and older including measures of education and cognitive impairment, using the Mini-Mental State Examination (MMSE), for five geographically diverse areas around England and Wales interviewed between 1991 and 2003. Transitions between health states were calculated using Markov chain methods. Life expectancy in different states of cognitive function as measured by MMSE were further explored for different education groups. The effect of fixed and educationally based cut points for cognitive impairment are investigated. Results Life expectancy spent with cognitive impairment is fairly constant with increasing age at around 1.4 years in men and 2.5 years in women, though this reflects a large increase in the proportion of life spent with cognitive impairment. The differences seen between education groups for the proportion of total life with cognitive impairment (men 13% and women 22% of life lived for low education vs men 7% and women 12% in high education group) disappear when education-adjusted cut points are used (10% in men and 17% in women at age 65 for all education groups). Conclusions The results show that there is a substantial amount of life expectancy with cognitive impairment in both men and women. The impairment burden is just as great for those with high education as the lowest educated group.

This prospective longitudinal population study observed the speech of 741 children at the ages of 2, 5 and 8 years. At the age of 8, 132 children were categorized as speech impaired. There was stro...

Background Reading disability (RD) and language impairment (LI) are heritable learning disabilities that obstruct acquisition and use of written and spoken language, respectively. We previously reported that two risk haplotypes, each in strong linkage disequilibrium (LD) with an allele of READ1, a polymorphic compound short tandem repeat within intron 2 of risk gene DCDC2 , are associated with RD and LI. Additionally, we showed a non-additive genetic interaction between READ1 and KIAHap, a previously reported risk haplotype in risk gene KIAA0319 , and that READ1 binds the transcriptional regulator ETV6. Objective To examine the hypothesis that READ1 is a transcriptional regulator of KIAA0319 . Methods We characterised associations between READ1 alleles and RD and LI in a large European cohort, and also assessed interactions between READ1 and KIAHap and their effect on performance on measures of reading, language and IQ. We also used family-based data to characterise the genetic interaction, and chromatin conformation capture (3C) to investigate the possibility of a physical interaction between READ1 and KIAHap. Results and conclusions READ1 and KIAHap show interdependence—READ1 risk alleles synergise with KIAHap, whereas READ1 protective alleles act epistatically to negate the effects of KIAHap. The family data suggest that these variants interact in trans genetically, while the 3C results show that a region of DCDC2 containing READ1 interacts physically with the region upstream of KIAA0319 . These data support a model in which READ1 regulates KIAA0319 expression through KIAHap and in which the additive effects of READ1 and KIAHap alleles are responsible for the trans genetic interaction.

The authors compare recent users and nonusers of My Career Advancement Account (MyCAA), a scholarship program for eligible military spouses pursuing associate's degrees, occupational certificates, or licenses in portable career fields. Through survey data, they investigate program use and nonuse and educational and employment experiences, preferences, and barriers. They conclude with recommendations for the Department of Defense.

Purpose The purpose of this study was to determine prevalence and predictors of persistent speech sound disorder (SSD) in children aged 8 years after disregarding children presenting solely with common clinical distortions (i.e., residual errors). Method Data from the Avon Longitudinal Study of Parents and Children (Boyd et al., 2012) were used. Children were classified as having persistent SSD on the basis of percentage of consonants correct measures from connected speech samples. Multivariable logistic regression analyses were performed to identify predictors. Results The estimated prevalence of persistent SSD was 3.6%. Children with persistent SSD were more likely to be boys and from families who were not homeowners. Early childhood predictors identified as important were weak sucking at 4 weeks, not often combining words at 24 months, limited use of word morphology at 38 months, and being unintelligible to strangers at age 38 months. School-age predictors identified as important were maternal report of difficulty pronouncing certain sounds and hearing impairment at age 7 years, tympanostomy tube insertion at any age up to 8 years, and a history of suspected coordination problems. The contribution of these findings to our understanding of risk factors for persistent SSD and the nature of the condition is considered. Conclusion Variables identified as predictive of persistent SSD suggest that factors across motor, cognitive, and linguistic processes may place a child at risk.

Objectives Previously, in the Avon Longitudinal Study of Parents and Children (ALSPAC), we have shown different sex-specific birth anthropometric measurements contingent upon whether or not prenatal smoking was undertaken by paternal grandmother (PGM±), maternal grandmother (MGM±), and the study mother (M±). The findings raised the question as to whether there were long-term associations on the growth of the study children over time. Methods Measures of weight, height, body mass index, waist circumference, lean mass, and fat mass of children in the ALSPAC study from 7 to 17 years of age were used. We compared growth in four categories at each age: PGM+M− with PGM−M−; MGM+M− with MGM−M−; PGM+M+ with PGM−M+; MGM+M+ with MGM−M+; and adjusted for housing tenure, maternal education, parity, and paternal smoking at the start of the study pregnancy. Results We found that if the PGM had, but the study mother had not, smoked in pregnancy, the girls were taller and both genders had greater bone and lean mass. However, if the MGM had smoked prenatally but the mother had not (MGM+M−), the boys became heavier than expected with increasing age—an association that was particularly due to lean rather than fat mass, reflected in increased strength and fitness. When both the maternal grandmother and the mother had smoked (MGM+M+) girls had reduced height, weight, and fat/lean/bone mass when compared with girls born to smoking mothers whose own mothers had not smoked (MGM−M+). Conclusions This study indicates that smoking in humans can have sex-specific transgenerational effects. Am. J. Hum. Biol. 26:731–739, 2014. © 2014 The Authors American Journal of Human Biology Published by Wiley Periodicals, Inc.

The yeast INO2 gene encodes a transcriptional activator. Inositol and choline repress transcription of the INO2 gene, and its target genes. That is, INO2 transcription is auto-regulated. This observation prompted two separate investigations to determine if regulation of INO2 is required for regulation of its target genes. One study, using northern blot hybridization, showed that constitutive INO2 transcription did not affect regulation of the INO1 gene, while another study revealed that it severely dampened regulation of an INO1-lacZ gene. By repeating both assays from a single yeast strain we demonstrate that this disparity is due to the different reporter systems.

Tourette syndrome and chronic tic disorder are heritable but aetiologically complex. Although environment plays a role in their development, existing studies of non-genetic risk factors are inconsistent.To examine the association between pre- and perinatal exposures and Tourette syndrome/chronic tic disorder in the Avon Longitudinal Study of Parents and Children (ALSPAC) prospective longitudinal pre-birth cohort.Relationships between exposures and Tourette syndrome/chronic tic disorder were examined in 6090 children using logistic regression.Maternal alcohol and cannabis use, inadequate maternal weight gain and parity were associated with Tourette syndrome or Tourette syndrome/chronic tic disorder. Other previously reported exposures, including birth weight and prenatal maternal smoking, were not associated with Tourette syndrome/chronic tic disorder.This study supports previously reported relationships between Tourette syndrome/chronic tic disorder and prenatal alcohol exposure, and identifies additional previously unexplored potential prenatal risk factors.

Although soldiers and relief workers traditionally have engaged in conflicting missions—killing versus saving lives—recent peacekeeping operations have required the two groups to work together on humanitarian efforts. Interviews with aid workers in Bosnia and in Haiti reveal that this traditionally antimilitary population has come to support military interventions in their regions. They have developed a cooperative relationship with the military despite lingering doubts and persistent cultural differences. This recent shift in attitudes demonstrates that the concept of task cohesion, developed from studies of small-group dynamics, can be applied at the organizational level. Organizations that share a common goal and that depend on one another to reach that goal can develop a cooperative relationship and yet retain distinct organizational memberships and cultures.

Although claiming to represent the views of military women on the combat exclusion policy, feminist activists actually represent only a minority of Army women. Most women soldiers do support opening the combat arms to women, however only on a volunteer basis and with physical qualifications for those jobs. Most Army women are not interested in serving in the combat arms, and roughly half do not believe they would be capable of doing so. A gap exists, then, between activists who deny differences between men and women and seek to bring women's policy in line with men, and women soldiers who support greater opportunities for women but who do not perceive most women as equally qualified for the combat arms as men. Furthering the gap between these activists and much of their constituency, the feminist framing of the debate has neither been tailored to fit the specific nature of the military as an organization (one which does not value individualist perspectives) nor the particular circumstances of the lives of military women (particularly enlisted and/or minority women).

Military personnel presumably resist missions that diverge from their primary goal of fighting and winning wars. Little attention has been paid to reasons why they might accept or even benefit from peacekeeping service. Interviews and surveys with U.S. Army personnel deployed to Operation Able Sentry in Macedonia reveal mixed feelings. Many soldiers find that even a relatively quiet operation such as this can offer training benefits for combat units. Although some combat skills deteriorate in noncombat deployments, many troops believe that readiness can be regained quickly. Those who approved of the mission are characterized in contrast to those who disapproved on items including who should serve in these operations, acceptance of a non-American UN commander, how the mission affects their careers, and belief in the principle of limiting use of force to self-defense.

Aim Only a few studies have examined the relationship between Tourette syndrome or chronic tic disorder and socio-economic status (SES). Existing studies are primarily cross-sectional, arise from specialty clinics, and use single measures of SES. In this study we examine this relationship in a longitudinal, population-based sample. Method Data are from 7152 children born during 1991 and 1992 in the county of Avon, UK, from the Avon Longitudinal Study of Parents and Children, who were followed up to age 13. After exclusions for intellectual disability* and autism, 6768 participants (3351 males [49.5%]) and 3417 females [50.5%]) remained. Parental SES was assessed using multiple measures during pregnancy and at 33 months of age. Presence of Tourette syndrome or chronic tics was determined from repeated maternal questionnaires up to when the child was 13 years of age. Results Multiple SES measures were associated with an approximately twofold increased risk of Tourette syndrome and chronic tics. A postnatal composite factor score (lowest vs highest tertile odds ratio 2.09, 95% confidence interval 1.38–3.47) provided the best fit to the data. Interpretations As is seen in several childhood conditions, such as cerebral palsy and autism, lower SES is a risk factor for Tourette syndrome/chronic tics. Potential explanations include differential exposure to environmental risk factors or parental psychopathology as a measure of an increased genetic risk leading to decreased parental SES.

The aim of this study was to refine the population prevalence estimate of Tourette Syndrome (TS) in children and to investigate potential sources of heterogeneity in previously published studies. A systematic review was conducted and all qualifying published studies of TS prevalence were examined. Extracted data were subjected to a random-effects meta-analysis weighted by sample size; meta-regressions were performed to examine covariates that have previously been proposed as potential sources of heterogeneity. Twenty-six articles met study inclusion criteria. Studies derived from clinically referred cases had prevalence estimates that were significantly lower than those derived from population-based samples (P = 0.004). Among the 21 population-based prevalence studies, the pooled TS population prevalence estimate was 0.52% (95% confidence interval CI: 0.32-0.85). In univariable meta-regression analysis, study sample size (P = 0.002) and study date (P = 0.03) were significant predictors of TS prevalence. In the final multivariable model including sample size, study date, age, and diagnostic criteria, only sample size (P0.001) and diagnostic criteria (omnibus P = 0.003; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision [DSM-IV-TR]: P = 0.005) were independently associated with variation in TS population prevalence across studies. This study refines the population prevalence estimate of TS in children to be 0.3% to 0.9%. Study sample size, which is likely a proxy for case assessment method, and the use of DSM-IV-TR diagnostic criteria are the major sources of heterogeneity across studies. The true TS population prevalence rate is likely at the higher end of these estimates, given the methodological limitations of most studies. Further studies in large, well-characterized samples will be helpful to determine the burden of disease in the general population.

BACKGROUND:There are animal data that indicate that prenatal environmental exposures have sex-specific effects on subsequent generations. In humans, an increase in birthweight has been reported if the maternal grandmother had smoked in the pregnancy giving rise to the mother. Here we assess whether prenatal exposure of either parent to cigarette smoke has a sex-specific effect on the grandchild's birth measurements. METHODS:Information from 12707 maternal and 9677 paternal grandmothers of children in the Avon Longitudinal Study of Parents and Children (ALSPAC) concerned whether they had smoked while expecting the study parent. Study children were weighed and measured at birth. Analyses to test effects of grandmaternal prenatal smoking used multiple regression allowing for several potential confounders; analyses were restricted to births to non-smoking study mothers. FINDINGS:After adjustment, the average birthweight, birth length and bmi measurements of the grandsons (but not granddaughters) were greater if the maternal grandmother smoked prenatally: birthweight = +61 [95% CI +30, +92] g; birth length = +0.19 [95% CI +0.02, +0.35] cm; BMI = +1.6 [95% CI +0.6, +2.6] g/m(2). Similar effects were seen in births to primiparae and multiparae. Additional allowance for maternal birthweight resulted in an average increase in boys to +100 g [95% CI +61, +140] g. There were no fetal growth differences if the paternal grandmother had smoked prenatally. CONCLUSIONS:The evidence from this study suggests that when the mother does not smoke in pregnancy the maternal grandmother's smoking habit in pregnancy has a positive association with her grandson's fetal growth.

A group of ice‐cored frost mounds formed during the winter of 1995–1996 near Barrow, Alaska in a drained thaw‐lake basin. Over 20 mounds, ranging from 5 to 20 m across, were observed in mid‐August ...

Operation Restore Hope was a confusing mission for American soldiers. Trained aswarriors, they were thrust into a humanitarian mission. Expecting to distribute food tograteful Somalis, they were attacked instead by the locals and were limited to security and guard duty. Soldiers' attitudes evolved through three stages: high expectations, disillusionment, and reconsideration. In the last stage, soldiers adopted one of two frameworks to cope with the ambiguity of the mission: warrior versus humanitarian. The former was more strongly associated with whites, men, and combat soldiers, who constructed negative stereotypes of Somalis and favored returning violence with violence. Blacks, women, and support soldiers tended to reject victim-blaming arguments seemingly imported from the United States. They maintained a humanitarian position, seeking explanations for Somali actions and distinguishing between clan warriors and needy refugees. Our data come from field observations, interviews, and surveys of Army troops who served in Somalia.

Speech disorder that continues into middle childhood is rarely studied compared with speech disorder in the early years. Speech production in single words, connected speech and nonword repetition was assessed for 7390 eight-year-old children within the Avon Longitudinal Study of Parents and Children (ALSPAC). The majority ( n = 6399) had typical speech and 50 of these children served as controls. The remainder were categorised as using common clinical distortions only (CCD, n = 582) or speech difficulties (SDiff, n = 409). The samples from the CCD children were not analysed further. Speech samples from the SDiff and the control children were transcribed and analysed in terms of percentage consonants correct, error type and syllable structure. Findings were compared with those from children in the Shriberg et al. (1997) lifespan database ( n = 25). The 8-year-old children from ALSPAC in the SDiff and control groups achieved similar speech accuracy scores to the 8-year-old children in the lifespan database. The SDiff group had consistently lower scores than the ALSPAC control group, with the following measures most clearly differentiating the groups: single word task (percentage of substitutions and distortions), connected speech task (percentage of vowels correct (PVC), percentage of omission of singletons and entire clusters, and stress pattern matches), nonword repetition task (PVC, percentage of entire clusters omitted, percentage of distortions, and percentage of stress pattern matches). Connected speech and nonword samples provide useful supplementary data for identifying older children with atypical speech. Learning outcomes: The reader will recognize the methods used to identify speech characteristics in a large scale population study. They will describe how measures of speech accuracy in connected speech compare with the Shriberg et al. (1997) lifespan database. The reader will also recall information on how typically and atypically developing children differ on a range of measures across different types of speech sample.

The low level of response (LR) to alcohol is one of several genetically influenced characteristics that increase the risk for heavy drinking and alcohol problems. Efforts to understand how LR operates through additional life influences have been carried out primarily in modest-sized U.S.-based samples with limited statistical power, raising questions about generalizability and about the importance of components with smaller effects. This study evaluates a full LR-based model of risk in a large sample of adolescents from the United Kingdom.Cross-sectional structural equation models were used for the approximate first half of the age 17 subjects assessed by the Avon Longitudinal Study of Parents and Children, generating data on 1,905 adolescents (mean age 17.8 years, 44.2% boys). LR was measured with the Self-Rating of the Effects of Alcohol Questionnaire, outcomes were based on drinking quantities and problems, and standardized questionnaires were used to evaluate peer substance use, alcohol expectancies, and using alcohol to cope with stress.In this young and large U.K. sample, a low LR related to more adverse alcohol outcomes both directly and through partial mediation by all 3 additional key variables (peer substance use, expectancies, and coping). The models were similar in boys and girls.These results confirm key elements of the hypothesized LR-based model in a large U.K. sample, supporting some generalizability beyond U.S. groups. They also indicate that with enough statistical power, multiple elements contribute to how LR relates to alcohol outcomes and reinforce the applicability of the model to both genders.

Describes a new survey design framework that is centered on what service members and their families believe are their greatest needs.

Purpose To examine the association between autistic spectrum disorder (ASD) and seasons of conception and birth in a UK birth cohort: Avon Longitudinal Study of Parents and Children (ALSPAC). Methods Seasons of conception and birth were compared in children with and without ASD with season grouped as follows: spring (March-May); summer (June-August); autumn (September-November) and winter (December-February). Results A total of 86 children with ASD were identified in the ALSPAC cohort giving a prevalence of ASD of 61.9 per 10,000. There was some evidence for an excess of children with ASD being conceived during the summer months with a rate per 1,000 conceptions of 9.5 in summer compared to 5.1, 4.6, 5.7 in spring, autumn and winter, respectively. A doubling of the odds was suggested for summer compared to autumn (Odds ratio 2.08 [1.18, 3.70]). In agreement with previous research, there was a corresponding peak in spring births. Conclusion Conception during the summer months was associated with an over-representation of children with ASD in this UK birth cohort. There was also an association between ASD and spring births. Further investigation of seasonal influences on the aetiology of autism is required to identify possible factors in the environment, and their mechanisms and timings.

The aim of this study was to assess the prevalence of heartworm in domestic dogs in Madera and Fresno Counties, California, dependent on habitat and other host and environmental factors. Dogs were screened for presence of heartworm antigen using the PetChek® ELISA on blood samples (N = 519) collected at seven sites during April-July 2009. Eighteen dogs were heartworm antigen positive. Pearson Chi-square analyses were conducted testing the presence of heartworm antigen against the following independent variables: elevation range, percentage of time spent outdoors during the day, percentage of time spent outdoors during the night, pet coat length, weight class, prevention status, and sex. Dogs that spent at least 50% of their time outdoors during the day were significantly more likely to have heartworm that those who spent less time outside (N = 519, df = 1, p = 0.031). Overall prevalence (3.47%) was lower than expected, with Madera County having 3.8% positive samples and Fresno County 3.5%; this prevalence is lower than in many previous studies. The effect of time spent outdoors on heartworm prevalence was similar to previous studies. The impact of elevation on infection, though not significant, requires further investigation, as does the prevalence and viability of larval stages in mosquitoes.

Background. Insulin-like growth factor I (IGF-I) is a hormone that mediates the effects of growth hormone and plays a critical role in somatic growth regulation and organ development. It is hypothesized that it also plays a key role in human brain development. Previous studies have investigated the association of low IGF-I levels attributable to growth hormone receptor deficiency with intelligence but produced mixed results. We are aware of no studies that investigated the association of IGF-I levels with IQ in population samples of normal children.Objectives. To investigate the association of circulating levels of IGF-I and its principle binding protein, IGF-binding protein-3 (IGFBP-3), in childhood with subsequent measures of IQ.Methods. The cohort study was based on data for 547 white singleton boys and girls, members of the Avon Longitudinal Study of Parents and Children, with IGF-I and IGFBP-3 measurements (obtained at a mean age of 8.0 years) and IQ measured with the Wechsler Intelligence Scale for Children (at a mean age of 8.7 years). We also investigated associations with measures of speech and language based on the Wechsler Objective Reading Dimensions test (measured at an age of 7.5 years) and the Wechsler Objective Language Dimensions test (listening comprehension subtest only, measured at an age of 8.7 years). For some children (n = 407), IGF-I (but not IGFBP-3) levels had been measured at ∼5 years of age in a previous study. Linear regression models were used to investigate associations of the IGF-I system with the measures of cognitive function.Results. Three hundred one boys and 246 girls were included in the sample. IGF-I levels (mean ± SD) were 142.6 ± 53.9 ng/mL for boys and 154.4 ± 51.6 ng/mL for girls. IQ scores (mean ± SD) were 106.05 ± 16.6 and 105.27 ± 15.6 for boys and girls, respectively. IGF-I levels were associated positively with intelligence. For every 100 ng/mL increase in IGF-I, IQ increased by 3.18 points (95% confidence interval [CI]: 0.52 to 5.84 points). These positive associations were seen in relation to the verbal component (coefficient: 4.27; 95% CI: 1.62 to 6.92), rather than the performance component (coefficient: 1.06; 95% CI: −1.67 to 3.78), of IQ. There was no evidence that associations with overall IQ differed between boys and girls. In a data set with complete information on confounders (n = 484), controlling for birth weight (adjusted for gestation), breastfeeding, and BMI slightly strengthened the associations of IGF-I levels with IQ. Additionally controlling for maternal education and IGFBP-3 levels attenuated the associations (change in IQ for every 100 ng/mL increase in IGF-I levels: 2.51 points; 95% CI: −0.42 to 5.44 points). The weakening of associations in models controlling for markers of parental socioeconomic position and education could reflect shared influences of parental IGF levels on parents' own educational attainment and their offspring's IGF-I levels. In unadjusted models examining associations of Wechsler Objective Reading Dimensions and Wechsler Objective Language Dimensions test scores with IGF-I levels, there was no strong evidence that performance on either of these tests was associated with circulating IGF-I levels, although positive associations were seen with both measures. Associations between IGF-I levels measured at age 5 and Wechsler Intelligence Scale for Children scores (n = 407) were similar to those for IGF-I levels measured at age 7 to 8. For every 100 ng/mL increase in IGF-I levels at 5 years of age, IQ increased by 2.3 points (95% CI: −0.21 to 4.89 points).Conclusions. This study provides some preliminary evidence that IGF-I is associated with brain development in childhood. Additional longitudinal research is required to clarify the role of IGF-I in neurodevelopment. Because IGF-I levels are modifiable through diet and other environmental exposures, this may be one pathway through which the childhood environment may influence neurodevelopment.